Hauntington Disease Free Essays

Huntington disease Name Institute Huntington Disease Introduction Shortage of information about Huntington disease (HD) and its non-clinical management inveigled me into a quest for journal articles about this comparatively rare illness. Having pored over scores of Journal of Clinical Nursing Issues, I stumbled across the article entitled â€Å"Exploring supportive care for individuals affected by Huntington disease and their family caregivers in a community setting†. It immediately arrested my attention, as it touched upon the possible implications of HD for the affected persons, their family members (including those, who could inherit the illness genetically) and caregivers. We will write a custom essay sample on Hauntington Disease or any similar topic only for you Order Now This article is a collaborative work of the three authors from the University of Plymouth, namely Beverley Soltysiak, Penny Gardiner and Heather Skirton. It was published first on 10 July, 2008. Summary of the article According to McDonald (2003), Huntington disease, formerly known as Huntington’s chorea, is a chronic neurodegenerative condition caused by a genetic mutation in the Huntingtin gene, situated on chromosome 4†. The article traverses implications and supportive care approaches to the individuals, who suffer from Huntington disease. Authors argue that different approaches should be applied to various age categories of the affected. The difference in symptoms may be subtle at first glance, but younger individuals, affected by the long-term conditions, find facilities for their senior counterparts unsuitable. Important role in this regard belongs to the psychological aspects of the disease. People struck by HD tend to lead sedentary and recluse life. Huntington disease affects badly humans’ perception and cognition, renders their speech unintelligible, and makes them helpless to some extent in general. The far-reaching implications include unsteady gait and severe depressions, which sometimes result in strangers mistaking persons with HD for inebriates or drug abusers. It takes protracted periods of time and frenzied efforts of caregivers to jolt people ffected by Huntington disease out of the so-called â€Å"public alienation†. Authors argue that Huntington disease is debilitating in terms of its impact on the person’s physical condition, but they conclude that it is devouring person’s psychological strength even more eagerly. Sporadic outdoors activities lead to the development of the trait of standoffishness, which, in its turn, hinders the process of treatm ent. This illness is incurable, while affected people usually live no more than 30 years after the emergence of the first symptoms. However, multifarious therapies and techniques aimed at helping patients to cope with the disease are employed (physiotherapy, occupational therapy, speech therapy). A multidisciplinary approach is utilized to make sure that complex care needs are met. Research focuses in part on interviewing the afflicted people in order to understand better how to help them to deal with the problems they face every day (anxiety disorders, animosity, petulance, apathy, and obsession). Depending on their willingness to cooperate, separate persons were interviewed individually or in groups. It was found that participants with cognitive deficits or/and psychic disorders did not feel comfortable to communicate with impaired colleagues in groups, and consequently opted for individual interview or shunned it at all. The same specialists facilitated both group and individual interviews. â€Å"Data analysis was undertaken using inductive coding technique† (Miles Huberman, 1994). Interviewers point out that it was a daunting task for them to conduct the research, because cognitive problems of people with Huntington disease barred interviewers from following their train of thought. The heed was paid to the participants’ standpoint on the following themes: 1) Deciding whether to have genetic test; 2) Being given the lethal diagnosis; 3) Disclosure of information about the participant’s being diagnosed with HD; 4) Entering into serious relationship and having a child; 5) Making decisions about how to let children know of the genetic mutation; 6) Observing a family member suffer and wither from HD. Following the diagnosis of one individual, other family members are haunted by or preoccupied with the fear of having genetic mutation. Some people prefer being oblivious to this possibility, while others, prompted by the desire to obtain confidence in future, eagerly agree to undergo a genetic test. In any event, propitious outcome of a genetic test has not proved to be a precondition for sunny disposition. It failed to provide them with a necessary degree of certainty, as those, who turned out to be healthy, started to monitor themselves vigilantly for the possible appearance of symptoms. Evaluation This article provides a comprehensive study of the implications of HD and the means to address the challenges that these implications entail. The main emphasis is placed on those with HD; though, a good amount of attention is also paid to their family members, who are prone to inherit the genetic mutation, and caregivers. Bearing in mind brevity of this research and overall paucity of research into non-clinical management of HD, it would not be wise to grumble about certain details that authors failed to examine. However, I see it fit to note that more approaches of incorporating the afflicted people into the social milieu should have been developed, or at least, more thorough analysis of those listed should have been provided. In terms of interest, I would give this article eight points out of ten. On the plus side, it is laced with excerpts from the interviews, which enable the readers to take a closer look at the problem. Moreover, authors managed to construe the material without abusing the buzzwords. This makes the article flow easily and renders it readable to a broad audience. Given the scarcity of knowledge about this area of health assessment, there are no slightest doubts that further research into this area should be carried out. Many gaps still are due to be filled. Some of the possible directions of research were mentioned above. The information highlighted in this article would be of an utmost importance to the family members of people with HD and those, who take care of these people. Hospital staff could also defer to some advice put forward by Soltysiak et al. This article constitutes a precious groundwork for the researchers, who are interested in this particular area. Conclusion People affected by Huntington disease have to address a series of challenges in everyday life. It should be noted that neither these very people, nor their relatives, lead ordinary life after a family member has een diagnosed with HD. Huntington disease seriously undermines person’s physical and psychological well-being, with psychological effects having far greater scopes. Reluctance of the affected persons to engage in social activities exacerbated by their distorted vision of the world hampers the process of treatment. There is no efficient treatment at all; though, a number of therapies were developed to extenuate the implications. The problem is that at the same time as people with HD need outdoors activities to muster stamina, they also need to muster stamina to go outdoors. By and large, individuals prone to HD feel frustrated at the lack of information about HD held by health professors. References MacDonald, M. E. , Gines, S. , Gusella, J. F. Wheeler, V. C. (2003). Huntington’s disease. Neuromolecular Medicine, 4. Miles, M. , Huberman, A. (1994). Qualitative data analysis – an expanded sourcebook. (2nded. ). Thousand Oaks, CA: Sage Publications. Soltysiak, B. , Gardiner, P. , Skirton, H. (2008). Exploring supportive care for individuals affected by Huntington disease and their family caregivers in a community setting. Journal of Clinical Nursing, 17, 7b, 226-234. How to cite Hauntington Disease, Essay examples

Fall Prevention Among Older People in Hospital Settings

Question: Discuss about the Report of Fall Prevention Among Older People in Hospital Settings. Answer: Introduction Falls have been a common cause of morbidity and mortality in people of all ages. However, their risk increases with age. Hospitalization further increases the risk of falls due to the unacquainted environment, ailments, and treatments. It has been found that nearly 30% of the falls cause injury. These cause unrest to the patients, clinicians, and the health care system as a single fall may built up the fear of falling and initiate a downhill trend of reduced mobility. This leads to further loss of function and increased risk of falls. It also increases the hospital costs and length of stay. In severe cases, there may be a risk of institutionalization of the patient and legitimate complaint with following lawsuit against the hospital. Thus, clinical governance and practice improvement in relation to fall prevention among older people in hospital settings is extremely essential. The following summary table gives and overview of the published literature in this field followed by its critical appraisal. Summary table Sl.no. Author/s, year, Country Aims Sample/setting Design/methods Main findings Strengths and limitations of the study Article 1 Cameron et al., 2012, Australia To evaluate the effectiveness of interventions designed for reducing falls by older people in care facilities and hospitals. The Cochrane database 2012;MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles were searched. 43 trials (30,373 participants) in care facilities and 17 (29,972 participants) in hospitals were studied. Review of randomized controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals. For exercise interventions the results were inconsistent. Vitamin D supplementation decreased the rate of falls but not the risk of falling. Multifactorial interventions in care facilities and hospitals suggested a decrease in the rate of falls and risk of falling. Additional physiotherapy did not significantly reduce rate of falls but achieved a significant reduction in risk of falling. Carpet flooring significantly increased the rate of falls compared with vinyl flooring and potentially increased the risk of falling. Training and education of nurses and patients significantly decreased the risk of falling. Strengths: Two review authors independently assessed the risk of bias and extracted data. A rate ratio was used to compare the rate of falls between intervention and control groups. Risk ratio (RR) was used to assess the risk of falling in each group. Results were pooled where appropriate. Limitations: No conclusive results obtained. More trials are needed to confirm the effectiveness of multifactorial interventions in acute and subacute hospital settings. Article 2 Haines TP et al. 2011 Australia To identify single intervention strategies that prevent falls across a mixture of hospital wards Participants were older adults admitted to acute and sub-acute wards of the Princess Alexandra Hospital, Brisbane, Australia, and the acute and sub-acute wards of Swan Districts Hospital, Perth, Australia. 3-group randomized control trial. There were two intervention groups and one control group. One intervention group was given complete patient education by providing written, video-based materials and 1- to-1 follow-up with a health professional trained to provide this program at the patients bedside. The second intervention group was provided with materials only. The rate of falls was significantly lower among participants with intact cognitive function and allocated to the complete program group compared with the rate among similar participants allocated to the control and materials-only groups, and the proportion of these patients who became fallers was lower in the complete program group than in the control group. Strengths: Appropriate randomization and blinding. Limitations: Patients who were too ill to provide informed consent or those who had previously participated in the trial were excluded. Article 3 Dykes PC et al. 2010 US To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients) Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates The number of patients with falls differed between control (n = 87) and intervention (n = 67) units. Site-adjusted fall rates were significantly higher in control units than in intervention units. The FPTK was found to be particularly effective with patients aged 65 years or older. No significant effect was noted in fall-related injuries. Strengths: This is the first fall prevention clinical trial that provides evidence for using a specific HIT intervention to reduce falls in short-stay hospitals Limitations: It was conducted in 4 hospitals within a single health care system. The intervention was not blinded and the reporting of falls was biased. The FPTK was not effective with younger patients. The sample size was small. Article 4 Gates et al. 2008 England To evaluate the effectiveness of multifactorial assessment and intervention programs to prevent falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of included studies, and previous reviews. Systematic review of randomised and quasi randomised controlled trials, and meta-analysis. Eligible studies were randomised or quasi-randomised trials (n=19) that evaluated interventions to prevent falls that were based in emergency departments, primary care, or the community that assessed multiple risk factors for falling and provided or arranged for treatments to address these risk factors. No clear overall effect was found on the number of fallers during follow-up in 18 studies. Only one study gave accurate data on the number of falls per person year of follow-up. Evidence that multifactorial fall prevention programmes in primary care, community, or emergency care settings are effective in reducing the number of fallers or fall related injuries is limited. Strengths: NA Limitations: No studies reported quantitative data on health related quality of life or physical activity. Data was insufficient to assess fall and injury rates. The overall quality of the evidence was not high. Most of the trials were small and many had methodological drawbacks leaving them open to bias due to either insecure allocation concealment, lack of blinding of outcome assessment, high losses to follow-up, and poor reporting. Article 5 Cumming et al. 2008 Australia To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay. 24 elderly care wards in 12 hospitals in Sydney, Australia. 3999 patients, mean age 79 years, with a median hospital stay of seven days. Cluster randomised trial. A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards. They provided a targeted multifactorial intervention that included a risk assessment of falls, staff and patient education, drug review, modification of bedside and ward environments, an exercise programme, and alarms for selected patients. Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics. In all, 381 falls occurred during the study. No difference was found in fall rates during follow up between intervention and control wards. A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay. Strengths: Large sample size, which resulted in fairly narrow confidence intervals. Limitations: Relatively short average length of stay (7 days). data were not collected blind to intervention status. Some falls prevention activities were already occurring in control (and intervention) wards before the start of the study. Critical appraisal of literature Critical appraisal of literature helps us to assess the reliability of the sample, methods and design used for the study. It is used to analyze the relevance and results of published papers so that we can decide if the information is believable and useful. Various tools have been developed for the critical appraisal of published literature. One commonly used one is the Critical Appraisal Skills Programme (CASP) tools and checklist (Anon, n.d.). Article 1 and 4 are review articles taking data from previous studies. So, for these systematic reviews tool by CASP may be used (Anon, n.d.). Article1was unable to address the focused question the need for more trials was ascertained as no conclusions were drawn from the existing trials. In article 4 also the aim could not be achieved as no clear overall effect was found in the studies chosen. Article 2, 3, 5 are randomized control trials. So, for these randomized control trial tool by CASP may be used (Anon, n.d.). Article 2 was able to reach conclusions pertaining to its aim as the study methodology was planned and appropriate randomization and blinding. Article 3 also justified the aim of the study though it was having some limitations. Lack of blinding however ascertains biasness in the results. Article 5 did not aim correctly for reaching any definitive conclusion as they aimed at the follow up (7 days) of patients with a short length of stay and there was no blinding. Findings Article 1 states that exercise interventions, physiotherapy, carpet flooring did not produce ay consistent results. However, vitamin D supplementation, multifactorial interventions, training and education of nurses and patients significantly affected the rate of falls and risk of falling. Article 2 added to the knowledge by stating that the rate of falls decreases significantly when the complete program (including written, video-based materials and 1- to-1 follow-up with a health professional) as compared with the rate among similar participants when only materials were used. Article 3 adds the role of FPTK in patients aged 65 years or older. No significant effect was noted in fall-related injuries. Article 4 reviewed that no clear overall effect was found on the number of fallers during follow-up. Limited evidence was found in relation to multifactorial fall prevention programs were found to be effective in primary care, community, or emergency care settings in reducing the number o f fallers or fall related injuries. Article 5 also gave no conclusive results for multifactorial interventions applied in the hospitals to prevent falls. Thus, the overall findings indicate that though multifactorial approaches for prevention of falls in hospitals have been studied but due to their limitations they have not been able to give any conclusive results. So, further research, and training and education of nurses about this aspect of nursing is needed. References Anon, CASP checklist for randomized control trials. Available at: https://media.wix.com/ugd/dded87_40b9ff0bf53840478331915a8ed8b2fb.pdf [Accessed July 30, 2016a]. Anon, CASP checklist for systematic reviews. Available at: https://media.wix.com/ugd/dded87_a02ff2e3445f4952992d5a96ca562576.pdf [Accessed July 30, 2016b]. Anon, Critical Appraisal Skills Programme (CASP). Critical Appraisal Skills Programme (CASP). Available at: https://www.casp-uk.net/ [Accessed July 30, 2016c]. Cameron, I.D. et al., 2012. Interventions for preventing falls in older people in care facilities and hospitals. The Cochrane Database of Systematic Reviews, 12, p.CD005465. Cumming, R.G. et al., 2008. Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. BMJ, 336(7647), pp.758760. Dykes PC et al., 2010. Fall prevention in acute care hospitals: A randomized trial. JAMA, 304(17), pp.19121918. Gates, S. et al., 2008. Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. BMJ, 336(7636), pp.130133. Haines TP et al., 2011. Patient education to prevent falls among older hospital inpatients: A randomized controlled trial. Archives of Internal Medicine, 171(6), pp.516524.

The Advantages to the Well-Being of Society free essay sample

This paper provides an in-depth look at the caste system in a Hindu society. This paper examines the classification, or caste, system that exists in Hindu societies and the purposes. The author discusses the Brahmins, who are priests and scholars; the Kshatrias, warriors and rulers; the Vaishyas, who pursue commerce and trades; and the Shudras, serfs who serve and support the three higher groups. From the Paper: The Western idea of knowledge and wisdom almost always, it seems, has a material purpose, to master physical problems in physical ways. The Hindu idea is to master what is physical to be liberated from physical concern altogether. Thus it seems true that in general all cultures, human development can be described as the process from childhood to youth to adulthood to old age. It also seems true that all cultures can be said to desire wisdom and knowledge. But the real importance of the whole process is judged by each culture?s priorities, which are not the same in Hinduism, in Buddhism, and in the West. We will write a custom essay sample on The Advantages to the Well-Being of Society or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page

Nora and Helmer Essay Example

Nora and Helmer Essay The relationship between Helmer and Nora strikes modern readers as intolerable.   Helmer assumes a position of superiority in the marriage which takes for granted his wife’s role as decorative accompaniment to the man of action and achievement.   At the end of the play Nora declares that she is not just a wife and mother. â€Å"I believe that before all else I am a human being, just as you are† (77).   Until the events of the play Nora has accepted her role as flighty, unserious, trivial, â€Å"charming† consort, though Ibsen shows from very early on that this is not the whole truth about her.   Her actions have been motivated largely by a desire to protect her husband from the consequences of his own arrogant folly.   It is a moment of great irony when Helmer says â€Å"I’ve forgiven you† (73), since her actions have been entirely self-sacrificing, and designed to save him, physically and mentally.   In her enlightened state she finds i t impossible to forgive him. Helmer’s attitudes are partly characteristic of his time, but it is clear that he has personal weaknesses that make his behavior more infuriating.   He calls Nora his â€Å"little lark† (3), â€Å"my little squirrel† (4) and other such patronizing endearments.   He also sees her as considerably less than a mature adult in her handling of the world.   She is â€Å"my little spendthrift† and â€Å"my little featherbrain† (4).   Money â€Å"just slips through your fingers† (6), though he is of course unaware of why she needs money.   His fussy attitude to debt, which he declares as a sort of gospel law to her, is the cause of the whole Krogstad crisis.   She can never tell him where the money came from – the money that saved his life – because â€Å"it would hurt his self-respect–wound his pride†¦ Our whole marriage would be wrecked by it† (16).   His pompous arrogance and priggishness force Nora to spin an elaborate fabric of concealment, and lead eventually to her realization of the truth.   Similarly his declaration that â€Å"Almost all cases of early delinquency can be traced to dishonest mothers† (32) terrifies her, but also reveals the central contempt he has for women generally, and therefore, though he would not admit it, for Nora herself.   Her only device to influence him seems to be her acceptance of the demeaning role he has designed for her.   If he will agree to reinstate Krogstad â€Å"Your squirrel would skip about and play all sorts of pretty tricks† (40).   He will not do it because he fears people would laugh at him for being influenced by his wife.   He is â€Å"entirely unimpeachable† (41) in contrast to her father, and anyway, Krogstad would address him by his Christian name, at which Nora’s mask comes off inadvertently and she says â€Å"But–it’s all so petty† (41), a disastrous thing to say to so egocentric a man. We will write a custom essay sample on Nora and Helmer specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Nora and Helmer specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Nora and Helmer specifically for you FOR ONLY $16.38 $13.9/page Hire Writer His behavior in Act 3 reveals all the truth of his deepest assumptions about her and their relationship.   When she tells him he is always right she is â€Å"my sweet, sensible little lark† (65).   His conception of their marriage is that she is a property: â€Å"Why shouldn’t I look at my own dearest treasure? – at all this loveliness that is mine† (65).   His passion for his â€Å"young bride† (66) is misplaced, as he disregards her mood.   How can she not want him at the moment, â€Å"Aren’t I your husband –?† (66)?   All the assumptions of power are in his words, and a disregard for her human individuality.   His romantic dream of saving her from danger seems stupid in the circumstances, and leads to his horrific change of tone when he reads Krogstad’s letter.   Now she is â€Å"a hypocrite, a liar† (71).   She has inherited her father’s lack of principle.   He urges her, with supreme i rony, to â€Å"stop all this play-acting† (71).   She will no longer be allowed to bring up the children, though the pretence of normal married life will be maintained for the sake of appearances.   Then his response to the second letter is sickening:   â€Å"Nora, I’m saved! I’m saved!† (72), his thoughts concentrated, as they always have been in fact, entirely on himself.   Then he can go back to the role of protecting knight, he thinks. â€Å"There’s something very endearing about a woman’s helplessness† (73).   But by now Nora has seen the truth, and the cataclysmic but liberating end is in sight. Nora has accepted her position without serious question until this final crisis, again as a result of social convention.   The marriage relationship has required her to be a child, and that is what she has done.   She never rebels at Helmer’s patronizing descriptions of her, choosing to see them only as affectionate, and indeed living her life in an immature fashion.   She is always laughing gaily, childishly eating macaroons and sweets in secret: â€Å"(Wags a threatening finger at her): Has my little sweet-tooth been breaking rules today?† (7). She is happy to let him think that her desire for money is a result of her irresponsibility.   â€Å"Oh! How lovely it all is† (8), she cries of her life in general.   With Mrs Linde she is terribly insensitive in the way children are.   She tells this aging, childless widow that â€Å"I want you to tell me all about yourself† but immediately goes on to burst out naively that with Helmer’s new j ob, â€Å"I’m so happy and excited! Won’t it be wonderful to have lots and lots of money, and nothing to worry about† (10).   But when Mrs Linde says â€Å"You’re just a child, Nora† (13), it begins to become clear that there is far more to her.   The money was borrowed to save Helmer’s life, and indeed all the ramifications of her actions stem from the necessity to prevent him from knowing how she got the money, to protect his foolish male arrogance, in fact.   Money can be raised by a wife in this patriarchal world â€Å"if a wife has a good head on her shoulders† (15), and this is exactly what she has.   Now we can see why she asks him for money, though she does not disturb his conception of her as irresponsible.   Her whole life is play-acting, but the role she plays is the one designed for her by him, and by the society for which he speaks, and so deeply ingrained that she is largely unaware of it herself. The rebellion is not yet here though.   She plays happily with the children, characteristically taking on the role of a child herself.   Everything will be all right because â€Å"after all – I only did it for love’s sake† (30) and to please Torvald.   She takes his warning about the corrupting effect of the mother seriously and plans to leave her children, seeing herself alone as guilty.   She continues to play the â€Å"squirrel†, only once laughing at his pettiness, where surely her genuine intelligence comes to the surface.   She will sacrifice herself, even, to save Helmer’s â€Å"honor†, and dances for him, desperately clinging to the myth that â€Å"we’re having such fun† (56).   Mrs Linde urges her to â€Å"tell your husband everything† (63), but Nora knows him well enough to realize that this is not an available option.   Her hope is that â€Å"the wonderful thing† (57) will happen, that Helm er will indeed act as the all-wise protector he has always claimed to be, but even as she says this she is calculating how many hours she has left to live.   She is always too intelligent to believe her own fantasies. Only she can understand Rank’s tragic plight, and her â€Å"Sleep well, Doctor Rank† (69) is moving and compassionate.   Then comes the crisis of the letter and all her buried intelligence comes to the surface and her life is transformed from fantasy to reality.   She is quiet through all his attacks and then â€Å"forgiveness† because â€Å"I think I’m beginning to understand for the first time† (71).   They have never had â€Å"a serious talk† (75) before, and his failure to understand what she means is a measure of the gap between them.   With calm fluency she tells him the complete, unflinching truth as it now appears to her intelligence.   â€Å"You never loved me.   You just thought it was fun to be in love with me† (75).   Movement from her father’s house to her husband’s was simply replacing one nursery with another.   She was never happy, â€Å"only merry† (76), a quite different thing.   Now she must start her education in the world.   He can make nothing of her words, perhaps because they challenge so radically everything he assumes to be true, and he is the most conventional of men, who married, it now emerges, the most original of women. He says she is ill, but in fact â€Å"I’ve never felt so sure – so clear headed – as I do tonight† (78).   She cannot spend the night in a strange man’s house, and the heavy front door slams behind her. It is hardly surprising that A Doll’s House caused a commotion when first performed in 1880.   It still has a power to shock as well as to move audiences.   The view of marriage it contains undoubtedly helped to change the world, and the profound understanding of Nora’s experience provoked thought and reflection in all who saw it.   It is one of the documents of the modern world.

Reality vs. Illusion essays

Reality vs. Illusion essays In Tennessee Williams play A Streetcar Named Desire, a major theme that is present is the desire to escape. In the play, Williams clearly tends to favor the real world of Stanley and Stella Kowalski, than the imaginary world of the unfortunate Blanche Dubois. He demonstrates that when the two worlds intersect, reality will smash the artificial world of illusion. The first evidence that proves Williams alliance with reality, is Blanches life before New Orleans, in Laurel. Blanche had fell in love and married a boy whom she thought of as perfect in every way. Unfortunately for her he is a homosexual. This intrusion of reality breaks up her dream image of her husband, and she tells him how he disgusts her. He then commits suicide, and Blanche forever blames herself. These unpleasant realities that have invaded her life make her find refuge in promiscuous relationships with all kinds of men. She still believes that she is a refined and respectable woman, but in reality she is nothing but a tramp that is forced to leave Laurel. Another instance where the two worlds conflict is the night of the poker game. When Stanley gets drunk and beats Stella, Blanche is extremely upset and disgusted. His actions convince her that she must leave with Stella. She concocts a ridiculous plan to run away with Shep Huntleigh, an acquaintance she had seen long ago. Stella being more realistic, knows that this plan has no merit. She knows that Stanley is crude and violent at times but she knows how to cope. Besides, she is about to have a baby and cannot raise a child without a father. Stella decides to stay with Stanley, and seems to forget about the event as if it never happened. Stella has chosen Stanley over Blanche, and in the process choosing reality over illusion. The two defining incidents in the play clearly show that Tennessee Williams favors the world of reality. The moments before Stanley rapes Blanche is the first tim ...

Lowest cost leader (part 3) Essay Example | Topics and Well Written Essays - 250 words

Lowest cost leader (part 3) - Essay Example This can be a difficult strategy to prosecute in todays fast-paced marketplace for many products. Thoughts? Comment/Discuss in 250 words? I do not completely agree with the argument that low cost leadership cannot be practiced in todays fast-paced marketplace. It is still possible in today’s world to be cost efficient and some companies are live examples in front of us. For example, Wal-Mart has successfully refined its supply chain which is adding values in the lowest cost possible in a consistent manner, hence driving the completion away. Another example is that of Mc Donalds who has been able to keep the prices of its products low through hiring cheap inexperienced labor and making it efficient. Ikea is sourcing its raw materials from other countries at lower costs, hence gaining a competitive advantage and Southwest airlines remained competitive for very long by reducing the fringe benefits being offered to the customers and reducing the resting time for their planes. Lost leadership is all about how a company refines its whole value chain and does something at a lower cost in a distinctive manner which can not be acquired by a competitor (Scilly 2015). However, it is also true that internet has improved operational effectiveness for almost all firms and that it has increased the chances of being copied rapidly hence increasing rivalry and competition. So it has become difficult for firms to stay competitive for very long and the dynamics for competition are changing quite rapidly. Therefore it has become crucial more than ever to have a distinctive strategic positioning and a unique value proposition which can be achieved with a combination of cost leadership and differentiation (Thomas 2015). The companies have proved to be cost efficient throughout human history and my take is that whatever the circumstances, there will always be winners while at the same time there will be losers too. It is all about how vigilant we are in

The Highly Appreciated Powerful Performance of American History X Essay

The Highly Appreciated Powerful Performance of American History X - Essay Example Maslin’s response to the violence depicted which he observes Derek commits â€Å"with horrifying gusto†. His take suggests the raw virility of Derek’s character is such that milks a certain kind of violent furiously and heats things up simply by viewing Derek in a sexual tryst right before the violence initiates. However, the focus of the film overflows with the ‘tacitly homoerotic violent energy’ of the skinhead bullies. Roger, on the other hand, focuses on the hostile tribalism being an epidemic angle of the movie. He denotes the rapidly spreading race hatred of the skinheads being largely due to the stringent culture of the local ethnic group. Cinematography, another key element of American History X, plays a vital role in its effective execution and hence formulates the basis of divergent critic responses. Mccarthy views Kaye’s registration of scenes from the movie as tremendously powerful, with a ‘certain fierce beauty’. The cinematography that is so artfully executed focuses on dramatic action as well as illustrates a ‘potent visceral effect’. According to Mccarthy it also rarely strays or overstates the case that the director is trying to present. Maslin, although believes that the storyline was oversimplified in the way it was reduced to a mere outline, seen in the way there is no detailed emphasis on the transformation that Derek undergoes in prison. That being said it is directed with an impressive combination of ‘handsome photo-realism’, as well as ‘visceral punch’, which effectively complements the fiery acting to make its impact felt.