Member of the wedding notes Essay

Stuck between being to young for adolescence and to old to be a child, the protagonist Frankie Addams, has the desire to be the child and the adult. Within herself she’s confused and lost, her body is to big, yet her mind is broken. Through the journey of Carson McCullers novel The Member of the Wedding, Frankie clenches on to the ridiculous idea of belonging to the wedding and even going off with the honeymooners after. This concept developed by her, is what she believes is a way in which she can develop a sense of belonging. Although this idea preposterous and highly immature it highlights that Frankie wants an adult dream at her young age. Her confused desires between child and adulthood are depicted again, when she almost experiences her first sexual encounter with a solider. Although being inquisitive and interested in what would go on between the two of them and although Frankie enjoyed being treated like an adult, it was all to much for her to handle and she fled from the solider. It is difficult to posses a sense of belonging when we are unsure of our own identity. Why? In having a sense of belonging, one must always have a clear understanding of their identity. This is because the groups we attach ourselves with throughout the journey of life resemble features of our own personality. So when one lacks the knowledge of their own self, in finding somewhere or something to belong to which suites and allows them to be comfortable, it is almost impossible. Evidence Through Carson McCullers novel The Member of the Wedding (1946 ) the confused protagonist Frankie Addams reflects how her own frail understanding of her identity impacts and makes it difficult for Frankie to develop a sense of belonging. This â€Å" unjoined â€Å" from society feeling that the protagonist feels is partly formed from different experiences she endures. From growing too old for sharing a bed with her father to being rejected from the club house for being â€Å" too young â€Å". Frankie’s self perception of her physical aspect also adds to this unsettled identity, as she is entering the stages of puberty and feels as if she is a â€Å" freak â€Å" due to her tall height. With both her experiences and her appearance shattering her identity in to an unsettled state, Frankie finds it difficult to belong to something more then the people she lives with. Leaving the protagonist to clench on to the ridiculous idea of being a member of her brothers wedding. Although this concept that Frankie desires so much, of belonging to a wedding, is preposterous it proves how much of an impact having a weak identity can play it finding a sense of belonging.

Haiti Earthquake Essay

Haiti is situated in Hispaniola in the Caribbean. Hispaniola, which consists of two countries Dominican Republic and Haiti itself. Haiti is the poorest country in the Western Hemisphere and it is the 145th poorest country the world. 80% of its 9.7 million people live below the poverty line. The Haitian earthquake occurred on the 12th January 2010; it left the country in devastation. The Social impacts of this earthquake left people homeless, the Haitian homes were not earthquake resistant as this was the biggest earthquake that Hispaniola has had so they did not prepare for it , the last earthquake occurred in Dominican Republic. The quake didn’t only leave the country either dead or injured it also brought back cholera a disease that the country hadn’t seen for a century this was because of the wrecked water treatment systems and crowded conditions it had spread quickly. Food shortage was also a side effect to the Haitian earthquake as staple crops like maize, plantains and bananas had been affected by the earthquakes mainly by the dust or being squashed, which means Haiti had to rely even more on increasingly expensive food imports that they couldn’t afford as country. Injuries and deaths was a big impact as the population went down .The death total tolls topped 200,000 a number of bodies were found under buildings and injuries were caused, fire fighters tried to retrieve many of these people, some survived but some sadly lost their lives. Another side effect after the devastation of Haiti was more crime as 3000 prisoners escaped. After the earthquake, orphans were also formed as parents of young children died and children were left homeless, parentless school less as the construction of the school wasn’t earthquake resistant each and every school in Haiti was destroyed. Life expectancy also went lower to 62 years and 7 months only. No residents couldn’t be aided without clean drinking water and dead bodies rotting in the hot sun the risk of life threatening diseases were expected. Economic Impacts was to do with government, the cost to rebuild and how Haiti was 145th poorest country in the world so they had no money to rebuild. Death tolls topped 200,000 and reliable industries and  structures were destroyed, leaving the nation in a tough situation. Haiti had never been known as a wealthy country. The homes of people were destroyed and job places were destroyed, so nobody could work, so no money could be made in the country therefore there was no income for the residents to rely on to rebuild the nation. Haiti had no chance to rebuild the country with their income in 2010. It is been no different three years later in 2014. In 2009 Haiti’s GDP stood at $11.9 billion compared to $11.6 billion in 2008. The population in Haiti increases by 2% of the total population of 10 million every single year. This made the country less rich because they didn’t have enough income for such large number people for the government to rebuild homes, more schools etc. Shops and businesses were destroyed. Looting had to take place. Damage to transport and communication links made trade became very difficult. Environmental impacts were outcomes of the earthquake to the environment. Farmers areas had been destroyed no crops could be grown due the dust and the destruction of the country. Air was also a victim to this disaster as it was polluted by the dust of the buildings and that collapsed and water was affected as chemicals and spillages from collapsed buildings oil had leaked out of damaged storage facilities into water which made it poisoned. The Earthquake reduced Haiti’s forest cover from 60% per cent to less than 2 per cent today. Today the population in Haiti has increased to 10.32million people. To avoid any further destruction to the country in future they should consider making their homes earthquake resistant and the country less populated to avoid a poor country. The number of people living in camps decreased from 1.5 million to 145,403 today, allowing over one million people to return home. More than 11,000 families have now been relocated, allowing the closure of 50 temporary camps. UNDP has been a major help to Haiti to help rebuild their small nation.UNDP is a charity that helps affected countries like Haiti. Key words Definitions. Earthquakes: Sudden release of energy through the earth’s crust in the form of waves. Tension builds up within the crust as convectional forces in the mantle try to move the plates above but are prevented from doing so by friction between plates. When friction is overcome, an earthquake occurs.  Social Impacts: Social impact is the effect of an activity on the social fabric of the community and well-being of individuals and families Convectional: Transfer of heat in a gas or liquid by upward movement of the hotter, less dense portion. Cholera: Cholera is an infection of the intestines. People get it from drinking water or eating food that’s contaminated with a type of bacteria called Vibrio cholera. Food Imports: Food imported from other countries Life expectancy: How long you are expected to live for Economic Impacts: Impacts that have affected the country’s money GDP: Gross Domestic Product. Population: All the inhabitants of a particular place Incomes: Money received. Looting: Stealing from unguarded homes or businesses Environmental Impacts: Impacts to do with Environment affecting the Landscape UNDP: United Nation Development Programme is a charity. Convectional: Final way that heat is transferred from one place to another is convection

Starting From Scratch Or Buying An Existing Business

Starting From Scratch Or Buying An Existing Business If you're about to have a business, you'll think about how to get it, by staring a new one or buying an existing one. Anna Bryant bought an existing salon when she had the chance instead of starting her own.The reasons for that are because she had no business experience or skills but she believes that she have the capabilities to run this salon, also she's an entrepreneur for the first time and this will save her the time of the stating period plus the effort of building the business name and make it stand in ground, it also have customers and taff and already been running for years so she can start making sales from the first day.Before buying the business there are some steps to be taken, studies, plans and more, like knowing the first owner decided to sell the business and if there are major problems within the business and figuring out how to solve them. Appraising the business is a must too because she wouldn't want to pay mor e for the business. She should get help and ask experts about all the details as she also need to sit plans about how she'll run the business and about the changes needed to be made and ake expectations to be reached. Also evaluating the risks and see how to avoid them.After finding the reasons and applying the required steps before buying, Anna Bryant is now able to make her decision. Successful Entrepreneur Effectiveness A Successful entrepreneur have special characteristics, passion, willingness to take risks, Positive attitude, Confidence, respect, and trust are all needed in the entrepreneur character. Commitment, leading skills, team building and flexibility also makes a good entrepreneur. knowledge in markets and how to run businesses and ow to communicate with others, all these characteristics build a Successful entrepreneur.Having no previous experience as an entrepreneur doesn't mean that the business won't be successful. Anna's first business succeeded because she had a l ot of a successful entrepreneur characteristics, the first was her love to the business and her passion about fashion. Courage, Wisdom, and excitement all were in her heart, and the desire to take the business to the next level all made her a great entrepreneur. Anna didn't have an experience but she was determined to gain it by consulting and getting help from others. She sat goals and put plans, she had a vision and this is one of the entrepreneur characteristics. ne of the challenges that face any business is financial management, high expenses, low sales and insignificant protlts, these problems and more which were facing Anna's business can be solved by using analysis techniques and take the right action based on the analysis process. Anna was able to improve the business finance by hiring a professional team and using their help, also by working on herself and gaining knowledge about the business market and learning some marketing techniques,. By studying the businesses' hance s, opportunities, strengths and weaknesses she was able to manage it Just right.After that she started to make changes in the business and make it more effective and attractive, by offering new services and new fashionable designs that are desirable which brought her new customers, Anna didn't wait until she make the salon exactly as she wants, she stared to work and make profits right away plus working in making the needed improvements, taking an advantage of all the available opportunities of the existing business made in easier for her to manage all the financial matters and this made her a great entrepreneur.My references Nitish. (2011). Main Reasons to Buy an Existing Business. Available: http:// accessed 29th April 2013. From E-library Slavec, Alenka-Prodan, Igor. (2012). The influence of entrepreneur's characteristics on small manufacturing firm debt financing. East European Management Studies. 17 (2), 22-23-24. The Advantages Of Franchising Owning and running a franchise ins tead of starting a business is an action taken by a lot of business people, John is one of them.Franchising have advantages which makes it a better option, as for John, a franchise have a lot benefits to offer like having big known brand to stand by you and support you for different aspects like the product knowledge, training development and sales. It was way easier that staring his own business. A franchise makes profits quickly, and it have a proven business format and it's supported by the Franchisors. It have lower risks and worries and a help is available when needed from the Franchisors who have powerful motivation.From my point of view franchising have five main advantages, Branding, it offers a strategic identity which impact on the market, big businesses spend millions on their branding and ranchisee gets the advantage of that, and the Franchisors are mostly well known for customers. Advertising, advertising takes a lot of the business expenses and a business can't survive without expensive and effective advertising. Name Recognition, which makes people guarantee the quality of the products and a known name gives them that.Reputation, which enable the Franchisee to enjoy protectiveness against lawsuits or accidents or any issues with the employees. Support, running a business needs training, and by have a Franchise you'll get all the train you need, they want you to be successtul because your success is ll possible ways. A Successful Franchise Business their success so they'll support you in Acquiring a franchise is a successful business to run, as it's cleared by the advantages of franchising. t have the benefit of having an access to the franchiser established system which have been running for a long time, franchisers spend a lot of time to modifying their system to the best it can be and hand it over to the franchisees, the system includes information about the products or services and all the details of the market methods, plus they make researc h to determine the best ocation for the franchise and some of them also manage the building and the renting matters which leave less worries for the franchisees.Another thing is, franchisees are not alone, the are supported by the franchisers who really want them to success, they train them to operate the business effectively , this is a very important reason why franchising can be a successful business. Moreover, franchisees' customers have a full awareness of the business and its products so they can trust without even trying it, means that loyal customer exists with any effort.John made it in his business and he became very successful because he had the experience of running a franchise before, he picked a good company with sound model to franchise and he started with full energy and high confidence. He received different trainings in different parts of the company, and used what he have learnt effectively and ran the business properly, he succeeded perfectly and became one of th e best too.Here are a study which clears the success of franchising: franchises success rate is 90% comparing to only 15% of business staring from scratch, meaning hat a franchisees will surely succeed as long as they follow the franchisors the instructions and use the support system effectively. My references: Don Daszkowski. Higher Likelihood of Success with a Franchise Business . Available: http://franchises. about. com/od/buyingafranchise/a/franchise-success. htm. Last accessed 1st may 2013. From the E-library: Abell-Mark1. (2010). The franchising advantage. Managing Intellectual Property. 9 (1-2), 16-17-18.GOING FOR A BUISNESS Starting a business is never easy whether it was a franchising, entrepreneurial enture or an independent small business. If I'm about to start my own business I wouldn't go for franchising, not because it won't be successful or because it's hard, it's Just that I'd rather to come up with new idea and add something to the world rather that applying the ide a of someone else, franchising may be profitable and better option tor those who are seeking tor cash and high incomes but I'm one ot those who cares more about changing the world and putting my fingerprint on it.Becoming an entrepreneur of an existing business is a good idea which will save a lot f preparing time in the starting period, still the existing business may not apply my own perspectives which means I'll have to do a lot of changes and this may cost me more that what I'll may pay if I started it myself, That's why my best option is to start from the ground. My new small business is about handmade stuff trade, not going to say it's growing fast but I follow the saying: think big and start small.My band is LA FEMME TOM and it's a one-person business so far, it's growing slowly but it's giving me all I need at the moment, plus it's helping me to spread the awareness of the mportance and the value of the handmade stuff which is one of the business aims, it is about selling my handmade stuff, giving courses on how to make them and supporting those who have a talent in this field.I sell my stuff online and in some places, I don't have my own shop yet but soon I'll do as it's planed for. The business approach is to grow and have many branches, it's in a progress development and aiming to have partners and hire working hands to take the production to the next level. Basically the business activities are about girls hobbies to fell the spear time with useful and beneficial things.

Critical Thinking Application Paper Essay Example | Topics and Well Written Essays - 750 words

Critical Thinking Application Paper - Essay Example Kirby and Goodpaster (2007) averred that thinking is â€Å"the activity of the brain that can potentially be communicated† (6). The role of expressing thoughts through communication, either through verbal or nonverbal means, is crucial in either speaking or writing. In this regard, the essay aims to proffer issues pertinent to describe critical thinking by using various sources. The discourse would likewise provide an example from personal experience in applying critical thinking to a work related decision, and the importance and benefits of critical thinking in the decision-making processes. Definitions of Critical Thinking The study conducted by Paton (2006) initially presented diverse definitions of critical thinking, to wit: â€Å"reasonable reflective thinking that is focused on deciding what to believe or do† â€Å"Ennis (1987) â€Å"purposeful, self regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, and contextual considerations upon which that judgment is based. . .† (Facione 1990). ... etting, various opportunities for decision making require the application of critical thinking skills to ensure that judgments are made only after all alternative courses of actions have been exhausted. One envisions being a manager of an organization’s human resources division whose main responsibilities encompass the functions of acquisition, development and maintenance of human resources. Through all tasks require exemplary qualifications and competencies to exude leadership skills, one of the most challenging decisions are to retrench employees as a way of saving the organization. The critical thinking process that needs to be exercised in this scenario is the identification of employees to be retrenched based on factors such as performance, length of stay in the organization, leadership potentials, and demographic background. Further, senior management would expect a benefit versus cost analysis of possibly retaining a number, retrenching all identified personnel, or even closing or liquidating the assets of the organization at the extreme level. Through different analytical approaches (cost – benefit, employee performance appraisal results, financial conditions of performance) one is given the tools to use and apply to outline the courses of action, the advantages and disadvantages of each alternative, and the overall effect would be gauged in terms of costs, image, corporate responsibility and adherence to ethical standards. A manager whose critical thinking skills are not effectively and sufficiently honed to use analytical tools could make abrupt and harsh judgments and recommendations that could compromise the image and future survival of the organization. Wrong actions taken regarding firing employees, for example, could expose the organization to legal

Poor employee motivation and compensation at Walmart Stores Inc Research Paper

Poor employee motivation and compensation at Walmart Stores Inc - Research Paper Example Formerly Wal-Mart Stores Incorporation, the multinational was rebranded Walmart Stores, Incorporation since 2008. The organization is an American multinational corporation in the retail industry, owning and managing thousands of large discount department outlets in form of stores and warehouses. Currently, the corporation occupies the third position globally in the private sector. Walmart is also the biggest private organization employing more than two million workers across the world. The organization occupies the first position within the retail industry in the world. The organization is owned by Walton family, who control 48 percent of the shares. Additionally, Walmart is apparently one of the most profitable corporations in the world. Barely a decade after being founded by Sam Walton in 1962, Walmart was incorporated in late 1969 and later traded publicly at the New York Stock Exchange. With its headquarters situated in Bentonville, Arkansas, the multinational is also the biggest retailer of grocery in America. Three years ago, the corporation generated more than half of its income from grocery sales in the United States market. The Corporation also owns and manages the Sam's Club warehouses situated in North America; the store falls within Walmart’s retail business. Walmart boasts more than 8,500 outlets in 15 countries.These branches are, however, existing under different names. The organization operates under the popular Walmart name in the native United States and Canadian market, and also in Latin American states. such as Puerto Rico, Brazil, and Argentina (Agren, Ogier, & Bamrud, 2011). The organization serves Mexicans under Walmex name, Britons as

Stanley Park Essay Example | Topics and Well Written Essays - 1500 words

Stanley Park - Essay Example   Large sections of the park were densely forested in the late 1800s and covered by half million trees that mainly occupied stand that was seventy-six meters, which is many centuries old. Numerous trees were lost and others were planted subsequent to the major windstorms that happened past one hundred years in the year 2006. An important effort was concentrated in the building of the near century-old Vancouver Seawall that mainly attracts numerous residents and corresponding visitors to the Stanley Park. Stanley Park also possesses features forest trails, Vancouver Aquarium, lakes, beaches, and children’s play locations.   The land where Stanley Park is situated was leased by the Vancouver’s City Council in the year 1886. The year 1908 federal government converted the lease of the Stanley Parkland by ninety-nine year. It was possess a lease that was continuously renewable by the park board in regard to the restitution. The park was officially opened in the year 1888 and named after Lord Stanley. Lord Stanley dedicated it to the utilization and enjoyment of the populace of all races, creeds and customs thus being named Stanley Park.   The building of the Lost Lagoon and the corresponding causeway of the Stanley Park took place amidst the year 1913 to corresponding 1916.The lake was built within a shallow section of the Coal Harbour and was named the Lost Lagoon because of its disappearance during low tide.   Moreover, the lake and corresponding causeway into the Stanley Park was designed by Thomas Mawson.  Ã‚  

Writing about Literature Essay Example | Topics and Well Written Essays - 250 words

Writing about Literature - Essay Example It allows exploration of diverse innate capabilities of an individual such as to sympathize, investigate, laugh, learn/absorb and wonder (Clugston, 2010). It lets a person reflect on the importance of life’s common human experiences by highlighting common place practices and recognizing shared human interests and emotions. It helps in linking feeling to thinking and safeguarding a vision of the ideal, thus, enabling a connection between intellect and imagination (Clugston, 2010). It restores the past and serves as compendium of history since writers usually incorporate the traditions, norms, societal conditions and complexities of their society in their writings (Clugston, 2010). This helps future generations to realize the kind of situations that existed. For instance, war time literature informs modern-day readers about the negativities of war and this is why wars are avoided now. Most importantly, it simulates human imagination, since writers can easily let readers see things clearly by using a variety of visual elements such as factual descriptions, exquisite details, expressions and word pics. This course will develop the skills of understanding human nature and emotions, addressing the innate urge to seek ideals and recognizing the most effective way of sharing personal experiences and impressions with the world. It can develop the skill of making a fair and worthy comparison between the real and imaginative world. It will encourage the ability of using critically important elements like metaphor, simile and use of persona in order to formulate an effective piece of literature (Clugston, 2010). Literature writers aim to help the reader create an intentional imaginative connection with the writer’s world, which can only be achieved through these elements. It will help in differentiating between the writing styles of various literary geniuses. Lastly, it will help in exploring the indispensable but

How Did the Wright Brothers Pull-Off Their First Flight Research Paper

How Did the Wright Brothers Pull-Off Their First Flight - Research Paper Example Wings plus an aerodynamic body structure resulted in birds being able to ride the wind in a way that man could only imagine. That is until that fateful day when the Wright Brothers took flight in their technology changing invention, the airplane. These days, we all take our ability to take flight for granted. That is why we tend to overlook the fact that our ability to take flight is not as easy at we believe it to be. The Wright Brothers actually had to overcome quite a few obstacles in order to help man achieve his dream of taking to the skies in flight. This paper serves to look into the difficulties that existed during the time when the Wright Brothers were trying to get their dreams off the ground and into the air. Collectively known as the Wright Brothers, Orville and Wilbur Wright were actually inventors who are best known for being aviation pioneers. Inventors that they were, they had always been intrigued by the thought of flight and the history of man's quest to take to the skies. Little did they know that they would be the imagineers of an invention so out of this world for their era that their names would be forever etched in the history books. But their quest to build their first airplane, a flimsy looking, jurassic type of aircraft and actually get it to take flight was beset with problems that had the brothers wondering if they were not actually crazy for having undertaken such a gargantuan project with very little financial backing to help out. It was their belief that gliding itself and learning to master gliding controls were the key factors in creating flight. A reliable steering method was required in order to create a flyable machine since most people who had tried to take flight prior to their successful attempt ended up in deaths or serious physical injuries. Their observations of previous flight attempts led them to study and understand the importance of wing warping when it came to maneuvering the plane. They needed the plane to bank fr om side to side and tilt forward and back on its wings in order to pick up wind and speed to keep the glider up in the air. (Rosenberg, Jennifer â€Å"The Wright Brothers Make the First Flight†) Once they had solved the problem of wing warping, they next needed to find an engine that had enough horse power to push the plane from the ground and up into the air. However, no car company had the ability to deliver such a type of engine to them. So the Wright Brothers set about assembling one to their specific project specifications instead. (â€Å"The Wright Brothers -- First Flight, 1903†). After testing out their Wing Warping theory on kites, the brothers assembled their first glider in the 1900's and began testing various models with various enhancements to see which of their concepts would actually represent the reality that they sought. They performed most of their experiments on the beach at the legendary Kitty Hawk. Most of their experiments during this era turned o ut to be dismal failures because they tried to incorporate the theories of the earlier fliers into their own concepts. Thus rendering all their attempts unsuccessful. However, in 1902, the brothers did a wind tunnel experiment in Dayton, Ohio where the scale model of the glider performed as they expected using their new information and calculations. This accomplishment signified that they had finally conquered the problems relating to flight control. (Rosenberg, Jennifer â€Å"The Wright Brothers Make the First Flight†) Needless to say the brothers were ecstatic and looking forward to trying out the full model of their glider in Kitty Hawk based upon the information that they gathered in the wind tunnel. They invited a number of press people to witness their first flight but only a small town journal managed

Scientific paper about reconstructing 3D models of buildings Essay

Scientific paper about reconstructing 3D models of buildings - Essay Example First, most of it is unorganized, uncalibrated, have uncontrolled illumination, image quality and resolution and is widely variable. In essence, coming up with a computer vision technique that can work with most of these images has proved to be a challenge for most researchers. Now how can researchers work with this huge resource; this paper proposes solution such as Image Based Rendering algorithm and Structure from Motion. While a few other researchers such as Brown and Lowe (Lowe 395) have used Structure from Motion to tackle the above problems, the technique used in this paper has several modifications. Structure from Motion is effective in 3D visualization and scene modeling and can operate on hundreds of images obtained from keyword queries (photo tourism). Through photo tourism, it is possible to reconstruct many world sites. In effect, an algorithm that can work effectively on internet photos can enable vital applications such as 3D visualization, communication/media sharing, and localization. Two recent breakthroughs in the field of computer vision namely Structure from Motion and Feature Matching will be the backbone of this paper. Through these techniques, it is possible to reconstruct buildings in 3D to offer virtual and interactive tours for internet users. You can also evaluate the current state of a building and identify degradation and areas that may require renovation or reconstruction. Further, we can come up with creations or display of any building of interest as long as we have its image. Sparse geometry and camera reconstruction The browsing and visualization components of this system requires exact information in regards to the orientation, relative location and inherent parameters like focal lengths for each photo in a collection and sparse three dimension scene geometry. The system also requires a geo-referenced coordinate frame. For the most part, this information can be obtained through electronic components and Global Positioning Sys tem gadgets over the internet. Image files in EXIF tags often have this data though the vast majority of these sources are mostly inaccurate. As such, this system will compute this data via computer vision techniques. First, we will detect feature points in every image after which the system will equate feature points between pairs of images. Finally, the system will run an iterative Structure from Motion procedure to retrieve the camera parameters. Since Structure from Motion procedure will only produce estimates and our system requires absolute values, the system will run iterative procedure to acquire better estimates. How this whole procedure unfolds is detailed below. Detecting feature points will be done using SIFT keypoint detector (Lowe 411). This technique has better invariance to image alteration. The next step is matching keypoint descriptors using the approximate bordering neighbors. For instance, if we want to match two images I and J, first we will create a kd-tree obt ained from element descriptors in J. Next, for each element in I we will locate an adjacent neighbor in J using the kd-tree. For effectiveness, we can use ANN’s priority search algorithm. This technique limits each query to visit a maximum of two hundred bins in the kd-tree. Alternatively, we can use a technique described by Lowe (Lowe 95). In the technique, for each

How the ideal Renaissance space continued to be used or was radically Essay

How the ideal Renaissance space continued to be used or was radically challenged in the following centuries - Essay Example Filippo Brunelleschi and Leon Battista Alberti later used linear perspective. Significance of expressions, postures and proportion increased. This approach of understanding and learning in art was said to be the 'humanist' approach. Humanism emphasized on the right of a man to reason out his beliefs and thereby, made it important for him to be an individual who realized his potential. There was a visible return to the state of naturalism. Such changes mainly took place in some parts of Europe, especially, Flanders and Italy. (Early renaissance art, 2008) The fall of Constantinople in 1453 also indirectly contributed to such changes in Italian architecture, literature and paintings. This event led to the migration of scholars to Rome. These scholars were interested in learning of their new environment, which led to their research about arts and art techniques prevalent there. They needed the intellectual knowledge, akin to ancient times. Filippo Brunelleschi made use of mathematical coordinates system rather than irrational forms and measurements. Leon Battista Alberti added to this approach, a method of using a wider social and urbane context, laying emphasis on walls rather than points in his buildings. (Early Renaissance Architecture, 2008) Next came the concept of Neo-Platonism. ... According to him, the beauty exists when all parts are in harmony, such that nothing can be added to or taken from it, without spoiling the whole. One of the famous Aristotelians was Leonardo da Vinci. High Renaissance generally started with the painting of The Last Supper by Leonardo da Vinci. Painting had a sort of decisive period in its style. This period was when there was a mass convergence of talent in the same area. The characteristics of the High Renaissance paintings were clearly seen in those of the Three Big Names of this period - Leonardo, Michelangelo, and Raphael. Although these geniuses deserve their fame every bit given, there were also many others with staggering talents. (Finearttouch, 2008) During this period, the Humanism concept was replaced by Mannerism. The importance given to perspective, balances and proportions earlier was then given to depicting expressions in art. Pontormo showed the troubled expressions clearly and another citation can be El Greco showing the intensities of emotions. This was definitely maturity over the serene faces and gestures of Piero della Francesca and the calm Virgins of Raphael. The pleasant mood in Giorgione and young Titian also reflect the above idea. In The Last Supper, Leonardo recreated the earlier traditional theme in a new style. Christ remained a nucleus of serenity while the others showed animated expressions and wonder about who was the traitor among them. This marked the start of Mannerism in paintings. The ever famous Mona Lisa also shows the ingenuity of this artist - the meaning of her mysterious smile still being unknown to us. Leonardo was the creator of what was known as the atmospheric perspective.

Night Essay Example for Free

Night Essay Elie Wiesel’s Night is a novel about himself and his family and their time in Auschwitz. This book describes the most gruesome event in human history, the Holocaust. It also describes the psychological effect that the Holocaust had on the young people and adults who survived the horrible event. In the interview with Bob Costas Elie describes some of the aspects of Judaism. The main setting of this book is in Auschwitz, a concentration camp in the Holocaust and is from Elie’s point of view. This book has a sad tone to it and this book has many different conflicts. First off, Elie Wiesel’s novel Night is Elie describing his time in the biggest concentration camp in the Holocaust, Auschwitz. The purpose of writing this novel in my opinion was to inform people of what actually happened in these concentration camps on a first-hand account. Secondly, many historical and psychological events were present in the book. An example of this is the descriptions of Auschwitz by Elie Wiesel. Elie also describes the crematories and gas chambers that were used to exterminate the Jewish people in Europe. Some psychological aspects of the Holocaust are that many kids knew that their parents were dead and had to go on with their lives. Also, During Elie’s interview with Bob Costas, he describes how his community was mainly Jewish and how the shops in the town were closed on Saturday and on Saturday and on the Sabbath people changed and became sacred. Lastly, the novel Night has two main settings. It takes place in a small town in Transylvania called Sighet. Also it takes place in Auschwitz, the largest concentration camp in the Holocaust. This book is told from the point of view of Elie. The tone of this book is a distraught tone. There were many conflicts in Night there was Man vs. Man with Jews against the Nazi regime. There was Man vs. self when the Jews had to tell themselves that they would make it through the Holocaust and survive. Lastly there was Man vs. nature when the Jews were running around in the night for 40+ miles. In conclusion, I really enjoyed reading Night because it gave me a better understanding of the Holocaust and what it felt like to be in a concentration camp. Night is an interpretation of the Holocaust from the perspective of a young boy named Elie Wiesel. The Holocaust is a tragedy not only of Jews but of all mankind because it deals with the question of human freedom and equality. It touches people ‘s souls because it is not just a narration about the Holocaust and its victims it is the author ‘s real memories with all the emotions and feelings . It is hard to refer this book to the memoir genre because the truth in it is combined with the invention it is a literary work not a documentary one. Nevertheless, we can see that under the main character, Eliezer, is hidden the author himself. After the occupation of Hungary by the Nazis , Eliezer and his father are separated from the mother and sisters and their terrible journey to the concentration camp of Auschwitz starts . They are exhausted , hungry and practically cannot move but it is only the beginning . One of the most terrible Eliezer ‘s memories is the picture of the hanging of fellow prisoners in the middle of the camp . Another terrible episode is a dreadful , slow death of a young boy , who was accused in collaborating with the Nazis ‘ enemies . Elie asks â€Å"Where is God ? Where is He? † This shows how the Holocaust affected Elie’s faith in God. http://essaytree. com/english-literature/criticism-over-night-by-elie-wiesel/ Elie Wiesel was born in the small town of Sighet in Transylvania, where people of different languages and religions have lived side by side for centuries, sometimes peacefully, sometimes in bitter conflict. The region was long claimed by both Hungary and Romania. In the 20th century, it changed hands repeatedly, a hostage to the fortunes of war. Elie Wiesel grew up in the close-knit Jewish community of Sighet. While the family spoke Yiddish at home, they read newspapers and conducted their grocery business in German, Hungarian or Romanian as the occasion demanded. Ukrainian, Russian and other languages were also widely spoken in the town. Elie began religious studies in classical Hebrew almost as soon as he could speak. The young boys life centered entirely on his religious studies. He loved the mystical tradition and folk tales of the Hassidic sect of Judaism, to which his mothers family belonged. His father, though religious, encouraged the boy to study the modern Hebrew language and concentrate on his secular studies. The first years of World War II left Sighet relatively untouched. Although the village changed hands from Romania to Hungary, the Wiesel family believed they were safe from the persecutions suffered by Jews in Germany and Poland. The secure world of Wiesels childhood ended abruptly with the arrival of the Nazis in Sighet in 1944. The Jewish inhabitants of the village were deported en masse to concentration camps in Poland. The 15-year-old boy was separated from his mother and sister immediately on arrival in Auschwitz. He never saw them again. He managed to remain with his father for the next year as they were worked almost to death, starved, beaten, and shuttled from camp to camp on foot, or in open cattle cars, in driving snow, without food, proper shoes, or clothing. In the last months of the war, Wiesels father succumbed to dysentery, starvation, exhaustion and exposure.

Unemployment in the Recent Recession Essay Example for Free

Unemployment in the Recent Recession Essay The United States of America is currently suffering from an economic recession as the country’s economy is taking a steep decline. In line with this recession, the unemployment rate has also risen to the highest level it reached within twenty-six years. In addition, Americans have been cutting their expenses and are living below their means. Furthermore, their expenses are expected to go higher without knowing when it would stop. The recession indeed caused a major set back on the United States wealth, cutting the net worth of every household in the States. The unemployment rate hit 8. 1% as the United States lost more than four million jobs since the recession began; a quarter of million jobs lost coming from the areas of construction and manufacturing. In addition, people with part-time jobs who are looking for full time jobs bubbled to 14. 8% of the total number of employed workers. In this light, economists have predicted that if the decline of the U. S economy continues, the unemployment rate in the country will reach 10%. And if the economy continues to worsen, the lowest employment rate in the history of the United States will be reached (Evans). After the surge in unemployment, many Americans have cut down their expenses. Even though some still have decent and stable jobs, they still feel the need of to save their money. They curtail their spending by going to discount stores. In line with cutting down their expenses, most Americans opt to settle on their old stuff which are still usable, rather than buying new ones. Moreover, parents encourage their children to spend little and save their money. In addition, people who used to dream of studying in private colleges are now looking for state colleges (Dougherty). Consumer purchase is indeed an important indicator of an economy’s progress since it is occupies a great part in the country’s Gross Domestic Product or GDP. As such, a decline in the consumer purchase largely affects the GDP in general. Consequently, a lower GDP would also mean that the country also has lower revenue (Dougherty). Aside from lower revenues, the thrifty lifestyle that most Americans are now keeping is also said to have negative effects on employment. The cut on spending by Americans who have, as economists say, buying power, depletes the consumer demand. As a result, companies will decrease their production before the prices go down because of oversupply. In line with this, more employees had to be laid off from their work. Thus, every healthy consumer who does not buy what he or she should buy is making his or her contributions on the increasing unemployment rate and on the economic recession (Evans). However, consumers who still have jobs should not be blamed if they have opted to cut down their spending. They too, are being plagued by the current economic recession; and as such, they are also dealing with their own problems. Most of them are concerned with the shrinking value of their retirement funds and other investments. In addition, most of them are also afraid to lose their jobs. As such, they tend to save more for their future (Dougherty). Furthermore, the rise in unemployment and curtailing of expenses by Americans tend to lower the wealth of the United States. Accordingly, the wealth of every American household has lessened; as such, most Americans are expected to lose money everyday rather than earn. In addition, mortgages and credit-card debts have already reached the total of 13 trillion dollars. In line with this, the equity of house owners already fell to 43%; which means that the value of houses has declined to 43% of the original price because of mortgages and loans (Kalita). With these situations at hand, the government should be held responsible in creating a probable solution to recover from the recession. Indeed, government officials have been working overtime to restore the country’s economy progress. As such, the government has released billions of dollars to fund American companies that were greatly affected by the recession. This act from the government has helped to save 3. 5 million of jobs for the American employees. Also, a part of this fund will be used to finance government programs that will help Americans to get back to their normal life again. This stimulus fund, as Summers said in his address to the Brookings Institution, will be used for the purpose of recovery and expansion. Unfortunately, the government does not know when the recession will be over. Furthermore, Summers said that they spend large amounts of money everyday on the financial system to get the economy back to its feet again (Barkley and Pulizzi). However, even as the American economy positively reacts and flourishes again, Americans will not immediately feel its effects on the employment sector. This is due to the fact that the employment sector is an avenue of the economy that is slow to react in response to economic growth. It means that even if the economic situation of the United States improved, the employment rate is likely to move up little by little every month. Thus, the government would have to create more jobs to ensure that there is a large scale increase in jobs. They have to work on livelihood programs to help unemployed people to cope with the ongoing recession (Evans). The government is perceived to do all it can to attend to the needs of the American people and to surpass the current financial crisis. As such, they have released funds in order to support companies that are in need of help and also generated plans to further help the people. In addition, they have constantly encouraged the American people to help in building the blocks to stop the ongoing crisis. The government pronounced that healthy consumers should not be afraid in spending more to increase consumer demand and help the economy to move in the right direction. If the consumer purchases increase, the government revenue will also increase, thus pulling the economy up (Barkley and Pulizzi). As unemployment rate continuously increases, the U. S government may take longer to provide probable solution to the economy. However, the President of the United States and the government has shown that they are optimistic that the economy will recover. They believe that the programs that they are executing and planning will help the economy to become stronger and move towards recovery. And consequently, the problems of unemployment will be eradicated, thus helping Americans to live a better life. Works Cited Barkley, Tom, and Henry Pulizzi. 14 March 2009. â€Å"Summers: Timing of Turnaround Is Unclear. † Wall Street Journal. 20 March, 2009 http://online. wsj. com/article/SB123695590029320001.html. Dougherty, Conor. 7 March, 2009. â€Å"Those Who Are Still Working Spend Less, Deepening Gloom. † Wall Street Journal. 20 March, 2009 http://online. wsj. com/article/SB123638518267558311. html? mod=relevancy. Evans, Kelly. 8 March, 2009. †Jobless Rate Tops 8%, Highest in 26 Years†. Wall Street Journal. 20 March, 2009 http://online. wsj. com/article/SB123634566437552601. html. Kalita, S. Mitra. 13 March, 2009. â€Å"Americans See 18% of Wealth Vanish. † Wall Street Journal. 20 March, 2009 http://online. wsj. com/article/SB123687371369308675. html.

Case Summary On The Effects Of Unstable Angina Nursing Essay

Case Summary On The Effects Of Unstable Angina Nursing Essay Mr AR is a 41 years old male. His calculated BMI was 20.9kg/m2. His presenting complaint was chest pain which has lasted for three days before being admitted into the hospital. His chest pain was of pressing type, it occurred even at rest and lasted for 5-10 minutes each time. It was relieved slightly by rest and it was always accompanied by numbness on his left hand. He had shortness of breath, orthopnea, headache and low effort tolerance. He complained of abdominal discomfort also. He had stopped taking all his medications for the past three days. He had a pacemaker fixed 16 years ago for his atrial fibrillation (AF), but the pacemaker stopped functioning 3 years ago. Due to financial constraint, he did not go for a new pacemaker replacement. He underwent an angiogram last year and was found that he has 2 blocked vessels. He has a history of hypertension too. Before being admitted into the hospital, he has been taking frusemide 40mg twice daily, hydrochlorothiazide 25mg once daily, perindopril 8mg once a day and amlodipine 10mg once a day for his hypertension. For his AF, he has been taking warfarin 5mg once daily and digoxin 125microgram once daily. In addition, he took simvastatin 40mg at night for the prevention of cardiovascular events. Mr AR was found to have poor compliance. He always missed the dose, took the medications at the wrong time and was unsure the reason behind taking all his medications. He was first admitted to the acute and emergency department. ECG was carried out and there was no ST-elevation. His blood pressure was found to be high, 172/126mmHg. No troponin test was done on Mr AR, the only available test results on cardiac enzymes were that of creatine kinase (CK), aspartate amino transferase (AST) and lactate dehydrogenase (LDH). All three were not elevated. Hence, he was diagnosed with unstable angina, gastritis and hypertensive urgency. He was given nifedipine 10mg, aspirin 300mg, Sublingual GTN and plavix 300mg in the acute and emergency department. His management plans were to monitor his vital signs every hourly for two hours followed by every two hourly and to carry out dextrostix test three times daily. He was given 60mg enoxaparin subcutaneously immediately and twice daily thereafter, intravenous ranitidine 50mg three times daily, sublingual glyceryl trinitrate (GTN) one tablet when required and IV frusemide 20mg twice daily. He was restricted to fliud intake of 800mL per day and started on fliud input and output monitoring. He will also be started on low salt diet for the management of his hypertension. On day 2, he no longer complained of chest pain. His potassium level was found to be slightly lower than normal range (3.3mmol/L). His BP was still high throughout the day, fluctuating at around 150/120mmHg. He was started on tablet clopidogrel 75mg once daily. On day 3, IV frusemide was changed to oral frusemide. On day 4 his blood pressure has already dropped to around 120/90 mmHg. He was planned for discharge and enoxaparin was to be stopped on that day. Disease overview and pharmacological basis of drug therapy Mr AR was diagnosed with 3 diseases. Only unstable angina will be discussed. Unstable angina (UA) is categorized under acute coronary syndrome (ACS) which is very common in the UK. According to the hospital episode statistic year 2002-2003, there were 83842 cases of UA in England and 4421 cases in Wales.1 UA happened when there is insufficient myocardial oxygen supply to meet the oxygen demand of the heart. The reduction in the oxygen supply is due to the disruption of artherosclerotic plaque, causing the formation of intracoronary thrombus and hence narrowing of artery. Abnormal vasospasm of the coronary arteries or coronary dissection may also lead to UA. UA is closely related to non-ST elevated myocardial infarction (NSTEMI) as they have the same pathogenesis and both are presented as chest pain. The only difference between them is that in NSTEMI, there is a rise in the cardiac biomarkers such as cardiac troponin or the MB isoenzyme of creatine phospokinase (CK-MB), which indicate s myocardial injury. In UA, the ischemia is not severe enough to cause damage to the myocardial cells and thus releasing these biomarkers in detectible amount. For the diagnosis of unstable, the patients history of anginal symptoms should be obtained. Physical examination like cardiac examination and vital signs monitoring may also be done. Patient with ongoing chest discomfort should have a 12-lead ECG performed within 10 minutes of onset to check if there is any ST-elevation or depression. If there is no ST elevation, STEMI will be ruled out and the level of serum cardiac biomarkers will be used to determine if the patient has UA or NSTEMI. Troponin I or T are normally the biomarker chosen for detecting myocardial cell death as it is detectable in the serum 3-6 hours after a myocardial infarction and remained raised for 14 days. If the serum troponin level is less than 0.01 Ã‚ ­g/L, then the patient will be diagnosed to have unstable angina. CK-MB may also be used when troponin test is not available. In Mr AR case, the results on the cardiac enzymes available, namely AST, CK and LDH are all non specific cardiac biomarkers as those enzy mes can also be elevated in skeletal muscle injury or liver disease. The treatment of UA can be divided into emergency treatment and secondary prevention treatment.2,3 Patients must rest in bed and ECG monitoring should be continued during the early phase of hospital stay. Sublingual glyceryl trinitrate (GTN) tablet or spray should be given for the relief of angina symptoms. GTN is a fast acting coronary vasodilators. Dilatation of veins going to the heart reduces ventricular volume and preload, while dilatation of systemic conductive arteries together with the decrease in ventricular volume causes a reduction in afterload. These effects will all reduce the myocardial oxygen demand.4 GTN also found to dilate collateral vessels, thus the areas of ischemia will receive a higher blood flow. If the chest pain is not relieved by GTN, intravenous morphine sulphate can be given to ensure patient comfort. Patient with ongoing chest pain or high risk patients should be given inravenous beta-blockers followed by oral route if there is no contraindication. Inter mediate or low risk patients can be given oral beta-blockers. If beta-blocker is contraindicated such as the in presence of uncontrolled heart failure, or the chest pain is not relieved by GTN and beta-blocker, nondihydropyridine calcium channel blocker can be given. Antiplatelet therapy should be given immediately by giving aspirin 300mg initially, followed by 75mg once daily for long term secondary prevention. In addition, clopidogrel 300mg should be given initially and 75mg daily thereafter for 3 months. Aspirin works by inhibiting the cyclooxygenase (COX) 1 enzyme on the platelet, thus preventing the production of thromboxane which stimulates platelet aggregation.5 Clopidogrel is an antiplatelet which acts by inhibiting adenosine diphosphate (ADP) from binding to its receptor, hence blocking the activation of ADP-mediated glycoprotein GPIIb/IIIa complex, a step involved in aggregation of platelets.6 Unfractionated heparin (UH) or low molecular weight heparin (LMWH) is an important antithrombotic agent in the management of UA. LMWH is normally preferred over UH as it can be given subcutaneously and no coagulation monitoring is needed. LMWH like enoxaparin should be given for 2-8 days. Heparin binds to antithrombin and the complex formed deacti vates a series of enzymes involved in the coagulation process. Thus thrombus formation will be inhibited.7 Patients with high risk of MI or death should also be given glycoprotein IIb/IIIa antagonist such as eptifibatide, tirofiban or abciximab. For the secondary prevention treatment, in addition to aspirin and clopidogrel, beta-blockers should be continued indefinitely. Statins can be started regardless of the patients cholesterol level for the preventing cardiovascular events. Statins are 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, which act by inhibiting the biosynthesis of cholesterol.8 Angiotensin converting enzyme (ACE) inhibitors are useful in patients with UA also. They work by inhibiting the production of angiotensin II which is a potent vasoconstrictor and reducing the breakdown of bradykinin which is a potent vasodilator.9 Evidence for the treatment of the conditions When the patient was admitted to the acute and emergency department, he was given clopidogrel 300mg, aspirin 300mg immediately and was then continued with long term treatment of 75mg of clopidogrel. The use of clopidogrel for the long term treatment of unstable angina was supported by two large trials. First, the CAPRIE trial which compare the beneficial effect of clopidogrel versus aspirin in patients at high risk of ischaemic event.10 In this trial, patients were either given 75mg clopidogrel once daily or 325mg of aspirin once daily. The clopidogrel group has a marginally lower risk of ischaemic stroke, myocardial infarction, or vascular death (5.32%) compared to the aspirin group (5.83%). The side effects reported were similar in both groups, indicating that clopidogrel has a comparable safety profile to that of aspirin. The second trial is the CURE Trial which investigate the beneficial effect of adding clopidogrel to aspirin therapy in patients with non-ST elevation acute coronary syndrome.11 In this trial, 12,562 patients were given either 300 mg clopidogrel innitially, then 75 mg once daily or placebo plus aspirin for 3 months to a year. It was found that there was a lower rate of death from cardiovascular causes, nonfatal MI or stroke in the clopidogrel group. However, the risk of major bleeding was significantly higher in clopidogrel group. Hence, it can be concluded that long term clopidogrel should be used in patients with acute coronary syndrome in addition to aspirin. In addition, according to a meta-analysis done by the Antithrombotic Trialists Collaboration, long term treatment of aspirin in the range of 75-150mg was found to be beneficial in patients with acute coronary syndrome. In cases where antithrombotic effect is needed immediately such as during acute attack of MI or UA, aspirin at a dose of 300mg should be given.12 In Mr AR case, only 300mg of aspirin was given in the acute and emergency department, no long term treatment of aspirin was given. This might be due to his newly diagnosed gastritis. NSAIDs were found to cause or worsen gastritis.13 According to the AHA/ACC guideline, clopidogrel will be the alternative for patients intolerant to aspirin due to gastrointestinal problems. According to a study done by Harker LA et al. where the tolerability and side effects of aspirin and clopidogrel were compared using the results from the CAPRIE trial, it was found that the group of patients receiving clopidogrel has a lower percentage of gas trointestinal side effects, with a rate 27.1% compared to 29.8% in those taking aspirin (p < 0.001).14 This finding support the reason behind clopidogrel being the only antiplatelet given to Mr AR. However, The difference in the incidence of side effects between the two treatment group was small and higher rate of occurrence of gastrointestinal problem in aspirin group might be due to the high dose of aspirin used (325mg). The policy of the ACC/AHA guideline of using clopidogrel instead of aspirin in patient with a history of GI complication was also refuted by Chan and colleagues.15 In this study, 320 patients who had recovered from aspirin-induced upper GI bleeding were given either 75 mg of clopidogrel daily or 80 mg of aspirin daily together 20mg of proton-pump inhibitor esomeprazole twice daily. When the patients were followed up after one year, it was found that patients in the aspirin group has a lower rate of recurrent upper GI bleeding compared to those receiving clopidogrel plus esomeprazole (8.6% versus 0.7%, P=0.001). No protective effect was conferred by esomeprazole in aspirin-induced lower GI bleeding. Hence, low dose aspirin is still deemed appropriate in Mr ARs case if given with a proton pump inhibitor or H2-antagonist like ranitidine. On day 1 Mr AR was given 60mg of enoxaparin immediately and twice daily thereafter. A comparison between the efficacy of UH and LMWH was carried out in the ESSENCE trial.16 In this trial, patients were allocated either subcutaneous enoxaparin plus placebo bolus and infusion or bolus and infusion unfractionated heparin plus placebo subcutaneous injection. In addition, they were all given oral aspirin. It was found that the enoxaparin group has a lower rate of recurrent angina, MI or death and also the need of revascularization process. Hence it was concluded that enoxaparin is more advantageous than UH, as there is little protein binding, longer plasma half life and more resistant to neutralisation by platelet factor IV as compared to UH. The dose given to Mr AR is justified according to a trial where the dose of enoxaparin was adjusted according to the weight of the patients. 17 It was found that giving 1mg/kg of enoxaparin to patients with UA or non-Q wave MI resulted in a lower ris k of major bleeding compared to giving a dose of 1.25mg/kg (6.5% versus 1.9%). Mr ARs weight was 59kg, thus a dose of 60mg is appropriate and evidence based. Sublingual GTN was given to Mr AR for the relief of his chest pain. According to the British Medical Journal evidence centre, no good evidence was found on the angina. There is one randomized placebo controlled study done by Karlberg et al. where they compared the effectiveness of intravenous GTN versus placebo in reducing ischaemic attack in unstable angina.18 In this trial, they found that patients given GTN have a fewer new onset of chest pain compared to placebo group. No trial was done to investigate the effectiveness of sublingual GTN in preventing ischaemic attack. However, according to a methodological study done by G Nyberg to determine the time of onset of sublingual GTN, it was found there was a significant reduction in the intensity of exercise induced chest pain and an improvement in the ST-depression when 0.5mg of GTN was given sublingually at the onset of chest pain.19 Hence, there is a consensus that sublingual GTN can be used for symptomatic control of unstable angin a. Mr ARs previous medications were continued during the hospital stay. Among those medications, perindopril, an ace-inhibitor, is also proved to be beneficial in the prevention of MI. There are two well known studies done on the effect of ace-inhibitors in preventing cardiovascular event in patients with cardiovascular disease, namely the HOPE trial and the EUROPA trial.20,21 In the HOPE trial, ramipril was chosen as the treatment drug. As for the EUROPA trial, perindopril was chosen to investigate if there is any beneficial effect in preventing MI, cardiac arrest or mortality in patients with stable coronary disease. It was found out that in the group of patients receiving perindopril, there was a 20% relative risk reduction in the primary end point as compared to the placebo group. Hence, it was concluded that perindopril should be given to all patients with coronary heart disease, including Mr AR who has unstable angina. In addition, Mr AR was continued with 40mg simvastatin once daily at night. According to a trial on simvastatin, it was found that giving simvastatin to high risk patients lowers their cholesterol level and reduces the incidence of cardiovascular events.22 In this trial, 20536 adults in the UK with high risk of getting cardiovascular event were given simavastatin 40mg daily or placebo. It was found that the simvastatin group has a lower percentage of all cause of death (12.9%) and major vascular event (19.8%) compared to the placebo group (14.7% and 25.2% respectively). There was a difference of about 1.0mmol/L in the LDL cholesterol level between the two groups after treatment regardless of the initial cholesterol level. This indicates that there is a reduction in the LDL cholesterol level in the simvastatin group which is independent on the initial cholesterol level. For patient given simvastatin, the risk reduction of the first major vascular event is similar no matter the patient s were taking ace inhibitors, aspirin, beta blockers or antihypertensive drugs or not. This shows that simvastatin provides additional benefits when added to the existing treatment with these drugs. Thus, it can be concluded that simvastatin will be beneficial to Mr AR who was taking ace inhibitor and antihypertensive drugs concurrently. Mr Ar was newly diagnosed with gastritis and was commenced on IV ranitidine. In a double blind clinical study, patients diagnosed with gastritis were given 300mg ranitidine daily for 4 weeks or placebo only.23 It was found that patients from the ranitidine group improved significantly faster than the placebo group and 80% of the patients had their symptoms completely resolved. Only 45% of the patients from placebo group achieved improvement in their symptoms while the remaining showed no change in their gastritis. Hence, it was concluded that ranitidine is an effective treatment option for gastritis. However, this trial only involved 52 patients and this small sample size renders the finding from trial inconclusive. In another trial where the effectiveness of ranitidine and sucrafate was compared, it was found out that both have a similar activity in relieving the symptoms of gastritis.24 77.6% of the patients receiving sucralfate and 79.4% from the ranitidine group had their symptom s completely resolved at the end of the study period (8 weeks). However, ranitidine was found to act faster in relieving pain compared to sucralfate. Hence, it can be concluded that the management of Mr ARs gastritis with ranitidine is justified. Mr AR was given nifedipine 10mg for the treatment of his hypertensive urgency. Even though nifedipine was found to be effective in reducing blood pressure within 20 minutes, this fast release, short-acting calcium channel blocker are not recommended in this case as Mr AR did not receive any beta-blocker before. According to the results obtained from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT), monotherapy with nifedipine in patients with unstable angina naà ¯ve to beta blockers was associated with a higher risk of recurrence ischaemic attack or MI.25 The event rate ratio compared to placebo for beta blocker naà ¯ve, nifedipine only group was 1.15. As for the group receiving both nifedipine and metoprolol, the ratio was lower (0.80). Patients who were already receiving beta blockers and were added with nifedipine also showed lower rate ratio (0.68). Hence, it was concluded that nifedipine was only beneficial in patients who were treated with beta blocker at the sa me time. Moreover, it was found from the Trent study that nifedipine does not show any beneficial effect in patients with MI.26 In this trial, the death rate for patients receiving nifedipine 10mg four times daily and placebo was similar. When the number of death and MI were compared among patients taking beta blocker and not taking beta blocker among admission, it was found that the latter group has a higher rate of death and MI. This result is comparable to those from the HINT trial. Hence, the use of nifedipine in treating Mr ARs hypertensive urgency is not justified, other drug should be chosen. Conclusion The immediate treatment of UA with high dose of antiplatelet agent aspirin and clopidogrel together with the antithrombotic agent LMWH are justified as they help preventing the progression of UA to MI. Sublingual GTN on the other hand helps relieving his chest pain. As for his previous perindopril and simvastatin that were continued, these help in preventing recurrent angina also. Choosing clopidogrel for the long term prevention treatment of UA due to the presence of gastritis might not be the best option for Mr AR. Once his gastritis has resolved, life-long aspirin at the dose of 75mg should be added in with oral ranitidine 300mg twice daily prescribed as prophylaxis against NSAID induced gastritis. However, the use of nifedipine in the management of his hypertensive urgency is not justified. Instead, he should be given labetalol, atenolol or clonidine which were found to be better alternatives to nifedipine in treating hypertensive urgency.27 PATIENT MEDICATION PROFILE Patient details Name: AG Consultant: General Practitioner: Address: Gender: Male Weight: 59kg Height: 168cm Community pharmacist: Age: 41 Known sensitivities: NKDA Social history: Non-smoker, No alcohol abuse. Patient hospital stay Reason for admission Admission date: Chest pain. Discharge date: Relevant medical history Relevant drug history Date Problem description Medication Comments 1994 Pacemaker fixed Warfarin 5mg OD Atrial fibrillation 2007 Pacemaker not functioning, did not go for replacement due to financial constraint T digoxin 125mcg OD Atrial fibrillation 2007 Angiogram, 2 blocked vessels T frusemide 40mg BD Hypertension Hypertension Perindropil (coversylƒ’) 8mg OD Hypertension T amlodipine 10mg OD Hypertension Hydrochlorthiazide 25mg OD Hypertension T simvastatin 40mg ON Prevention of cardiovascular event Prescribed medication Route of administration Start Stop Nifedipine (adalat) 10mg PO Day 1 Aspirin 300mg PO Day 1 Day 1 Clopidogrel (plavixƒ’) 300mg PO Day 1 Day 1 Clopidogrel (plavixƒ’) 75mg OD PO Day 2 Enoxaparin (Clexaneƒ’) 60mg stat, BD subcutaneous Day 1 GTN 1 tablet PRN sublingual Day 1 Simvastatin 40mg ON PO Day 1 Amlodipine 10mg OD PO Day 1 Hydrochlorothiazide 25mg OD PO Day 1 Warfarin 5mg OD PO Day 1 Furosemide (Lasix) 40mg stat, BD IV Day 1 Day 3 Furosemide 40mg BD PO Day 3 Perindopril (Coversylƒ’) 8mg OD PO Day 1 Ranitidine (zantac) 50mg tds IV Day 1 Digoxin 125mcg OD PO Day 1 Clinical/ Laboratory Tests Date Results Potasium (3.5-5.0 mmol/L) Day 2 3.3 BP Day 2 150/118 Day 3 134/100 Day 4 122/86 Pharmaceutical Care Plan Care Issue Action Actual output/ Desired output Long term treatment with aspirin. Patient should be given 75mg of aspirin for the secondary prevention of UA. Patient has gastritis. He should be started on long term treatment of aspirin once his gastritis has resolved and ranitidine should be prescribed as prophylaxis against NSAIDs induced GI complications. Long term treatment with beta blockers. Beta blocker should be given to the patient as the secondary prevention treatment. Patient should be started on labetalol 100mg twice daily and titrate up to 200mg twice daily. Inappropriate use of nifedipine for the management of hypertensive urgency. Nifedipine should be substituted with labetalol 200-300mg every 3-4 hours when required. Not taken. Interaction between digoxin and diuretics when hypokalaemia occur. Potasium level should be monitored. Inform the patient on signs and symptoms of digoxin toxicity. Patients potassium level was lower than the normal range on day 2. He should be given potassium sparing diuretics or potassium supplement if the potassium level keeps going down. Monitoring should be continued. High risk of bleeding due to warfarin, aspirin, clopidogrel and enoxaparin. Bleeding tendency should be monitored. Patient should be told to inform the GP if there is any unusual bleeding like blood in the stool. Patients INR and prothrombin time were within the normal range. Monitoring was continued. Changing of IV ranitidine to oral ranitidine. Patient should be switched to oral ranitidine150mg twice daily after being discharged. Not taken. GTN for relief of angina symptoms. Patient should be prescribed GTN spray or sublingual tablet for the relief of chest pain shoul the patient has another angina attack. GTN sublingual tablet was prescribed as discharge medication. Poor patient compliance Patient should be informed on the reason behind taking his medication, the importance of compliance. Compliance aid should be given. Patient was counselled on the importance of compliance. Side effects of simvastatin -muscular side effects -liver disease Patient should be advised to report immediately any unexplained muscle pain, weakness nor tenderness. Regular LFT monitoring should be done. No monitoring of cholesterol level. Cholesterol level should be monitored suring the hospital stay so that the dosage of simvastatin can be adjusted accordingly. Cholesterol level should be maintained below 5.2mmol/L. Patient education on healthy lifestyle. Patient should be told on the importance of low salt diet for his HT and encouraged to exercise more. Patient was counselled on the importance of healthy lifestyle before being discharged.

The Death of my Father Essay -- Autobiography Essay, Personal Narrative

Everyone has milestone days in his/her life that change the direction of his/her life for better or worse. Let me tell you one of my experiences that I will never forget from when I was 12 years old. It was Friday night, I took a shower, and one of my aunts came into the bathroom and told me that my dad was sick but he was going to be ok. She told me that so I did not worry. I finished taking a bath, and I immediately went to my daddy’s house to see what was going on. My dad was throwing-up blood, and he could not breath very well. One of my aunts cried and prayed at the same time. I felt worried because she only does that when something bad is going to happen. More people were trying to help my dad until the doctor came. Everybody cried, and I was confused because I thought it was just a stomachache. I asked one of my older brothers if my dad was going to be ok, but he did not answer my question and push me away. My body shock to see him dying, and I took his hand and told him not to give up. The only thing that I heard from him was, â€Å"Daughters go to auntie...

Serial Killers :: Papers

In the last three decades the USA has been troubled by an approaching problem, the serial killer. A serial killer is a person who kills a number of people, usually considered over five, with a cooling off period between each murder, usually one murder at one given time). Two murders at one time occasionally happen and these murders may go on for a period of months or years until the killer is caught. Throughout the last three decades the US serial killer rate has risen 94% and it is estimated that by the next millennium it will claim an average of 11 lives a day. Serial Murder is an epidemic; there are at least 35 serial killers active in the USA today who claim one third of the annual murder rate. The USA has 6% of the world's population yet it has three quarters of all serial killers. Not only are serial killers appearing in more numbers in the US but also all over the world countries are terrorized by serial killers, which are appearing in more numbers year and year after. KILLER TRAIT: A serial killer is a typical white male, 20-30, and most of them are usually in the USA. Their main motives are sex (even though the act of sex may or may not take place), power, manipulation, domination and control. The sex motive is usually rape for an organized killer and sadism for a disorganized killer. They act in a series of 5 or more murders with a cooling off period between each murder. Serial killers can go on for months and years before they are usually caught. The victim is usually the same for every killer - prostitute, hitchhiker etc. Their victims may also have the same or similar attributes in gender, age, race, general look, residence etc. Serial killers also stick by their modus operandi very closely and may change it with experience. Most murders occur by strangulation, suffocation, stabbing etc. Serial killers act by a sex-murder fantasy based with their control, they usually live in this dream world in their teens until they act it out for real when they get into the adult stage. As each murder occurs a serial killer may be disappointed by his murder fantasy and may act it out again to achieve it to there own satisfaction. CHARACTERISTICS OF A SERIAL KILLER: 1. Killings are separate ('serial'), occurring with greater or less frequency, often escalating over a period of time, sometimes years, and will continue until the killer is taken into custody, dies, or is himself/herself killed.

Christianity in The Grapes Of Wrath :: John Steinbeck

The novel The Grapes of Wrath by John Steinbeck has many themes, but one theme the story is centralized around is the role of Christianity. The role of Christianity in The Grapes of Wrath is what allows the people to keep going during the times of the Great Depression. Without religion, the families in the novel would have simply given up all faith and hope. Like many events in the novel, many characters in Steinbeck's novel The Grapes of Wrath symbolize the theme of Christianity. The most obvious character would be that of Jim Casy. Jim Casy was previously a preacher, but he gave up preaching because he felt he had sinned. He travels with the Joad family on their journey to California, and although he insists that he has given up his counseling past, he continues to act as a preacher for the Joad family. Although the other characters in the novel symbolizing religious acts are not main characters, they do play an important role in the thread of the theme. An example of such a character would be the woman that shows up when Grandma is dying. The woman, who Ma refers to as a "Jehovite" is dressed all in black, the skin on her face sagging, and she has loose lips that hang over her teeth. She expresses to Ma and Rose of Sharon that they should pray for Grandma, and that they should have faith to move on. Steinbeck introduces this woman to the readers to symbolize death and the ability to move on in peace. Events such as the strange woman appearing before Grandma's death and Jim Casy's preaching reinforce the purpose of religion for the migrating poor in the novel of The Grapes of Wrath. Religion allows the migrating poor to continue their journey to a "better" life. Throughout the novel the people, such as the Joad family, encounter many hardships. Several other families who have already been to California, in search of the same "paradise" the Joad's are in search of, found exactly the opposite. The Joad's are advised of this problem, but because of their hope and faith that they will find the work they need, they continue on. Without religion, the migrating poor would not be able to keep on their way. Religion and Christianity do more helping than hindering for the migrating families.

Politically Correct Language Essay

Politically correct language is language that avoids offending or ostracizing particular groups of people – the word â€Å"homosexual† is the politically correct version of the word â€Å"faggot†. While politically correct language prevents conflict, and improves individuals and communities, it also has limitations. Sometimes it can disrupt the meaning and impact of the message we are trying to portray. Because of this, it is important to find an extent of political correctness that still enables freedom of speech. While people can define us by the language we use, the language we use also defines us. Being politically correct can make us better people. The way the receiver of our message construes our message determines whether it is politically correct. What is considered politically correct varies from person to person; while one Asian might find the term â€Å"chink† humorous, another might find it degrading. As a result, being politically correct requires assessing how the receiver of our message differs from ourselves, and how we can remain tactful despite these differences. This forces us to accept that people have varying beliefs; sometime sit even forces us to refine our own. Similarly, while we can define a community by the language the people within that community use, the language the people within a community use defines the relationships within that community. Being politically correct can improve the community we live in by creating an atmosphere where everyone is comfortable with sharing their ideas, without feeling restrained by the fear of being penalized for thinking differently. This enables us to productively debate diverse viewpoints, and broaden our own. It ensures that the future generation will learn how to be tolerant from a very young age, which is essential for the development of society. While being politically correct seems ideal, it also has limitations. Take the news. People trust the news to objectively impart what is happening in the world. One might debate that this gives them the responsibility to be politically correct, lest they create conflict or further segregate the world. However, being politically correct can disrupt the meaning of their message. The term â€Å"undocumented immigrants† could give people the impression that it is a slight mishap that the country forgot to document these immigrants, or that these immigrants were unaware that they had to be documented. On the other hand, the term â€Å"illegal aliens† makes it clear that these individuals are doing something illicit. It pressures them to do, and gives them no excuse not to do, what is right – get a citizenship, or leave. Being politically correct can also alleviate the impact of the news. If a child molester is on the loose, it is the responsibility of the news to warn society about it. Stating that a child has been â€Å"molested and terminated† instead of â€Å"raped and beaten to death† lessens the urgency parents will feel to be wary of their child’s whereabouts. While the latter is politically incorrect – it creates disturbingly vivid imagery – it is more effective in keeping the citizens safe. Nevertheless, the news should refrain from unnecessarily using politically incorrect language. They should use the world â€Å"black† instead of â€Å"nigger† because they are so interchangeable. If possible, the news reporter shouldn’t even label the people he is reporting about. This would conceal any irrelevant prejudices (which might inadvertently skew a viewer’s understanding,) that the reporter may have. It would also prevent the creation of unnecessary conflict and further segregation of the world. In conclusion, politically correct language – language that avoids offending or ostracizing particular groups of people – can improve individuals and communities. More importantly, it prevents the expression of prejudices that separate the world. On the other hand, political correctness also has limitations: it can disrupt the meaning and impact of our message. Because of this, it is important to find an extent of political correctness that does not disrupt the meaning or impact of our messages. Otherwise, we would no longer have freedom of speech, which is imperative to the progression of society.

Running Away

That night, she peered at me with eyes that was hanging out of her sockets and then said quietly that i could stay at her house. We strolled along the windey road waiting to see any of our other friends from school we saw a few but no one we wanted to hang around with; i was cold and so was Sarah we decided to go home we walked for miles †¦ well it seemed like miles my legs were aching and my back was killing i had shooting pains right from the top all the way to the bottom! We got to Sarah's house and to our amazment Sarah's mum wasn't in we decided to make a comfy spot for us to sit while her mum came home †¦ it was like we had been sat there for hours in the background we could hear the church bells ringing we listened carefully to hear each chime we counted the chimes; something didn't add up right both of us counted 10 chimes we starred at each other for at least 30 seconds we were amaized †¦ Sarah said in a quiet voice † where's my mum im getting scared?† I thought to my self i know the feeling †¦we sat there a while longer to see if she turned up when we could hear a rumbling noise from the drain pipe †¦ it was like someone was in the house †¦Sarah knew there couldnt have been anyone in the house because when she tried the door earlier it wouldnt open! I was so scared We sat there a little longer; I couldn't feel my feet and the end of my fingers were numb. I couldn't believe how long we had been out for. â€Å"Do you have any sweets, my blood sugar is going down† I searched my pockets and my bag I had nothing † I haven't got anything im sorry† I whispered in a shivery voice. Sarah had diabetes and couldn't go for very long with out food, I looked at Sarah she appeared tired and gloomy I thought she might be upset with me â€Å"Sarah† I said quietly â€Å"are you upset with me† she didn't answer I turned around and asked her again Sarah had passed out. NOW I WAS FRIGHTENED. I was alone; I rummaged through my bag and found one sweet. A deep red aniseed ball, I looked at Sarah. I knew she needed it more than me, so I sat her up against the wall and placed the aniseed ball on her tongue. Nothing happened†¦after a few seconds her eyes started to flutter â€Å"mum† Sarah called out, â€Å"Sarah its me, im here, are you ok?† she mumbled a few words I couldn't make out what she was trying to say. I asked her to repeat the what she said â€Å"the foot mat in front of the garage, there is a key for the front door† I ran to the garage lifted the mat and there was a key I picked it up and scrambled back. We stood up slowly put the key in the door and turned it, we walked in slowly. Sarah looked into the living room and started screaming†¦ I turned not knowing what I was going to see and Sarah's mum was slumped in the chair alone. She had passed away†¦

A Game of Thrones Chapter Sixty-seven

Sansa In the tower room at the heart of Maegor's Holdfast, Sansa gave herself to the darkness. She drew the curtains around her bed, slept, woke weeping, and slept again. When she could not sleep she lay under her blankets shivering with grief. Servants came and went, bringing meals, but the sight of food was more than she could bear. The dishes piled up on the table beneath her window, untouched and spoiling, until the servants took them away again. Sometimes her sleep was leaden and dreamless, and she woke from it more tired than when she had closed her eyes. Yet those were the best times, for when she dreamed, she dreamed of Father. Waking or sleeping, she saw him, saw the gold cloaks fling him down, saw Ser Ilyn striding forward, unsheathing Ice from the scabbard on his back, saw the moment . . . the moment when . . . she had wanted to look away, she had wanted to, her legs had gone out from under her and she had fallen to her knees, yet somehow she could not turn her head, and all the people were screaming and shouting, and her prince had smiled at her, he'd smiled and she'd felt safe, but only for a heartbeat, until he said those words, and her father's legs . . . that was what she remembered, his legs, the way they'd jerked when Ser Ilyn . . . when the sword . . . Perhaps I will die too, she told herself, and the thought did not seem so terrible to her. If she flung herself from the window, she could put an end to her suffering, and in the years to come the singers would write songs of her grief. Her body would lie on the stones below, broken and innocent, shaming all those who had betrayed her. Sansa went so far as to cross the bedchamber and throw open the shutters . . . but then her courage left her, and she ran back to her bed, sobbing. The serving girls tried to talk to her when they brought her meals, but she never answered them. Once Grand Maester Pycelle came with a box of flasks and bottles, to ask if she was ill. He felt her brow, made her undress, and touched her all over while her bedmaid held her down. When he left he gave her a potion of honeywater and herbs and told her to drink a swallow every night. She drank it all right then and went back to sleep. She dreamt of footsteps on the tower stair, an ominous scraping of leather on stone as a man climbed slowly toward her bedchamber, step by step. All she could do was huddle behind her door and listen, trembling, as he came closer and closer. It was Ser Ilyn Payne, she knew, coming for her with Ice in his hand, coming to take her head. There was no place to run, no place to hide, no way to bar the door. Finally the footsteps stopped and she knew he was just outside, standing there silent with his dead eyes and his long pocked face. That was when she realized she was naked. She crouched down, trying to cover herself with her hands, as her door began to swing open, creaking, the point of the greatsword poking through . . . She woke murmuring, â€Å"Please, please, I'll be good, I'll be good, please don't,† but there was no one to hear. When they finally came for her in truth, Sansa never heard their footsteps. It was Joffrey who opened her door, not Ser Ilyn but the boy who had been her prince. She was in bed, curled up tight, her curtains drawn, and she could not have said if it was noon or midnight. The first thing she heard was the slam of the door. Then her bed hangings were yanked back, and she threw up a hand against the sudden light and saw them standing over her. â€Å"You will attend me in court this afternoon,† Joffrey said. â€Å"See that you bathe and dress as befits my betrothed.† Sandor Clegane stood at his shoulder in a plain brown doublet and green mantle, his burned face hideous in the morning light. Behind them were two knights of the Kingsguard in long white satin cloaks. Sansa drew her blanket up to her chin to cover herself. â€Å"No,† she whimpered, â€Å"please . . . leave me be.† â€Å"If you won't rise and dress yourself, my Hound will do it for you,† Joffrey said. â€Å"I beg of you, my prince . . . â€Å" â€Å"I'm king now. Dog, get her out of bed.† Sandor Clegane scooped her up around the waist and lifted her off the featherbed as she struggled feebly. Her blanket fell to the floor. Underneath she had only a thin bedgown to cover her nakedness. â€Å"Do as you're bid, child,† Clegane said. â€Å"Dress.† He pushed her toward her wardrobe, almost gently. Sansa backed away from them. â€Å"I did as the queen asked, I wrote the letters, I wrote what she told me. You promised you'd be merciful. Please, let me go home. I won't do any treason, I'll be good, I swear it, I don't have traitor's blood, I don't. I only want to go home.† Remembering her courtesies, she lowered her head. â€Å"As it please you,† she finished weakly. â€Å"It does not please me,† Joffrey said. â€Å"Mother says I'm still to marry you, so you'll stay here, and you'll obey.† â€Å"I don't want to marry you,† Sansa wailed. â€Å"You chopped off my father's head!† â€Å"He was a traitor. I never promised to spare him, only that I'd be merciful, and I was. If he hadn't been your father, I would have had him torn or flayed, but I gave him a clean death.† Sansa stared at him, seeing him for the first time. He was wearing a padded crimson doublet patterned with lions and a cloth-of-gold cape with a high collar that framed his face. She wondered how she could ever have thought him handsome. His lips were as soft and red as the worms you found after a rain, and his eyes were vain and cruel. â€Å"I hate you,† she whispered. King Joffrey's face hardened. â€Å"My mother tells me that it isn't fitting that a king should strike his wife. Ser Meryn.† The knight was on her before she could think, yanking back her hand as she tried to shield her face and backhanding her across the ear with a gloved fist. Sansa did not remember failing, yet the next she knew she was sprawled on one knee amongst the rushes. Her head was ringing. Ser Meryn Trant stood over her, with blood on the knuckles of his white silk glove. â€Å"Will you obey now, or shall I have him chastise you again?† Sansa's ear felt numb. She touched it, and her fingertips came away wet and red. â€Å"I . . . as . . . as you command, my lord.† â€Å"Your Grace,† Joffrey corrected her. â€Å"I shall look for you in court.† He turned and left. Ser Meryn and Ser Arys followed him out, but Sandor Clegane lingered long enough to yank her roughly to her feet. â€Å"Save yourself some pain, girl, and give him what he wants.† â€Å"What . . . what does he want? Please, tell me.† â€Å"He wants you to smile and smell sweet and be his lady love,† the Hound rasped. â€Å"He wants to hear you recite all your pretty little words the way the septa taught you. He wants you to love him . . . and fear him.† After he was gone, Sansa sank back onto the rushes, staring at the wall until two of her bedmaids crept timidly into the chamber. â€Å"I will need hot water for my bath, please,† she told them, â€Å"and perfume, and some powder to hide this bruise.† The right side of her face was swollen and beginning to ache, but she knew Joffrey would want her to be beautiful. The hot water made her think of Winterfell, and she took strength from that. She had not washed since the day her father died, and she was startled at how filthy the water became. Her maids sluiced the blood off her face, scrubbed the dirt from her back, washed her hair and brushed it out until it sprang back in thick auburn curls. Sansa did not speak to them, except to give them commands; they were Lannister servants, not her own, and she did not trust them. When the time came to dress, she chose the green silk gown that she had worn to the tourney. She recalled how gallant Joff had been to her that night at the feast. Perhaps it would make him remember as well, and treat her more gently. She drank a glass of buttermilk and nibbled at some sweet biscuits as she waited, to settle her stomach. It was midday when Ser Meryn returned. He had donned his white armor; a shirt of enameled scales chased with gold, a tall helm with a golden sunburst crest, greaves and gorget and gauntlet and boots of gleaming plate, a heavy wool cloak clasped with a golden lion. His visor had been removed from his helm, to better show his dour face; pouchy bags under his eyes, a wide sour mouth, rusty hair spotted with grey. â€Å"My lady,† he said, bowing, as if he had not beaten her bloody only three hours past. â€Å"His Grace has instructed me to escort you to the throne room.† â€Å"Did he instruct you to hit me if I refused to come?† â€Å"Are you refusing to come, my lady?† The look he gave her was without expression. He did not so much as glance at the bruise he had left her. He did not hate her, Sansa realized; neither did he love her. He felt nothing for her at all. She was only a . . . a thing to him. â€Å"No,† she said, rising. She wanted to rage, to hurt him as he'd hurt her, to warn him that when she was queen she would have him exiled if he ever dared strike her again . . . but she remembered what the Hound had told her, so all she said was, â€Å"I shall do whatever His Grace commands.† â€Å"As I do,† he replied. â€Å"Yes . . . but you are no true knight, Ser Meryn.† Sandor Clegane would have laughed at that, Sansa knew. Other men might have cursed her, warned her to keep silent, even begged for her forgiveness. Ser Meryn Trant did none of these. Ser Meryn Trant simply did not care. The balcony was deserted save for Sansa. She stood with her head bowed, fighting to hold back her tears, while below Joffrey sat on his Iron Throne and dispensed what it pleased him to call justice. Nine cases out of ten seemed to bore him; those he allowed his council to handle, squirming restlessly while Lord Baelish, Grand Maester Pycelle, or Queen Cersei resolved the matter. When he did choose to make a ruling, though, not even his queen mother could sway him. A thief was brought before him and he had Ser Ilyn chop his hand off, right there in court. Two knights came to him with a dispute about some land, and he decreed that they should duel for it on the morrow. â€Å"To the death,† he added. A woman fell to her knees to plead for the head of a man executed as a traitor. She had loved him, she said, and she wanted to see him decently buried. â€Å"If you loved a traitor, you must be a traitor too,† Joffrey said. Two gold cloaks dragged her off to the dungeons. Frog-faced Lord Slynt sat at the end of the council table wearing a black velvet doublet and a shiny cloth-of-gold cape, nodding with approval every time the king pronounced a sentence. Sansa stared hard at his ugly face, remembering how he had thrown down her father for Ser Ilyn to behead, wishing she could hurt him, wishing that some hero would throw him down and cut off his head. But a voice inside her whispered, There are no heroes, and she remembered what Lord Petyr had said to her, here in this very hall. â€Å"Life is not a song, sweetling,† he'd told her. â€Å"You may learn that one day to your sorrow.† In life, the monsters win, she told herself, and now it was the Hound's voice she heard, a cold rasp, metal on stone. â€Å"Save yourself some pain, girl, and give him what he wants.† The last case was a plump tavern singer, accused of making a song that ridiculed the late King Robert. Joff commanded them to fetch his woodharp and ordered him to perform the song for the court. The singer wept and swore he would never sing that song again, but the king insisted. It was sort of a funny song, all about Robert fighting with a pig. The pig was the boar who'd killed him, Sansa knew, but in some verses it almost sounded as if he were singing about the queen. When the song was done, Joffrey announced that he'd decided to be merciful. The singer could keep either his fingers or his tongue. He would have a day to make his choice. Janos Slynt nodded. That was the final business of the afternoon, Sansa saw with relief, but her ordeal was not yet done. When the herald's voice dismissed the court, she fled the balcony, only to find Joffrey waiting for her at the base of the curving stairs. The Hound was with him, and Ser Meryn as well. The young king examined her critically, top to bottom. â€Å"You look much better than you did.† â€Å"Thank you, Your Grace,† Sansa said. Hollow words, but they made him nod and smile. â€Å"Walk with me,† Joffrey commanded, offering her his arm. She had no choice but to take it. The touch of his hand would have thrilled her once; now it made her flesh crawl. â€Å"My name day will be here soon,† Joffrey said as they slipped out the rear of the throne room. â€Å"There will be a great feast, and gifts. What are you going to give me?† â€Å"I . . . I had not thought, my lord.† â€Å"Your Grace,† he said sharply. â€Å"You truly are a stupid girl, aren't you? My mother says so.† â€Å"She does?† After all that had happened, his words should have lost their power to hurt her, yet somehow they had not. The queen had always been so kind to her. â€Å"Oh, yes. She worries about our children, whether they'll be stupid like you, but I told her not to trouble herself.† The king gestured, and Ser Meryn opened a door for them. â€Å"Thank you, Your Grace,† she murmured. The Hound was right, she thought, I am only a little bird, repeating the words they taught me. The sun had fallen below the western wall, and the stones of the Red Keep glowed dark as blood. â€Å"I'll get you with child as soon as you're able,† Joffrey said as he escorted her across the practice yard. â€Å"If the first one is stupid, I'll chop off your head and find a smarter wife. When do you think you'll be able to have children?† Sansa could not look at him, he shamed her so. â€Å"Septa Mordane says most . . . most highborn girls have their flowering at twelve or thirteen.† Joffrey nodded. â€Å"This way.† He led her into the gatehouse, to the base of the steps that led up to the battlements. Sansa jerked back away from him, trembling. Suddenly she knew where they were going. â€Å"No,† she said, her voice a frightened gasp. â€Å"Please, no, don't make me, I beg you . . . â€Å" Joffrey pressed his lips together. â€Å"I want to show you what happens to traitors.† Sansa shook her head wildly. â€Å"I won't. I won't.† â€Å"I can have Ser Meryn drag you up,† he said. â€Å"You won't like that. You had better do what I say.† Joffrey reached for her, and Sansa cringed away from him, backing into the Hound. â€Å"Do it, girl,† Sandor Clegane told her, pushing her back toward the king. His mouth twitched on the burned side of his face and Sansa could almost hear the rest of it. He'll have you up there no matter what, so give him what he wants. She forced herself to take King Joffrey's hand. The climb was something out of a nightmare; every step was a struggle, as if she were pulling her feet out of ankle-deep mud, and there were more steps than she would have believed, a thousand thousand steps, and horror waiting on the ramparts. From the high battlements of the gatehouse, the whole world spread out below them. Sansa could see the Great Sept of Baelor on Visenya's hill, where her father had died. At the other end of the Street of the Sisters stood the fire-blackened ruins of the Dragonpit. To the west, the swollen red sun was half-hidden behind the Gate of the Gods. The salt sea was at her back, and to the south was the fish market and the docks and the swirling torrent of the Blackwater Rush. And to the north . . . She turned that way, and saw only the city, streets and alleys and hills and bottoms and more streets and more alleys and the stone of distant walls. Yet she knew that beyond them was open country, farms and fields and forests, and beyond that, north and north and north again, stood Winterfell. â€Å"What are you looking at?† Joffrey said. â€Å"This is what I wanted you to see, right here.† A thick stone parapet protected the outer edge of the rampart, reaching as high as Sansa's chin, with crenellations cut into it every five feet for archers. The heads were mounted between the crenels, along the top of the wall, impaled on iron spikes so they faced out over the city. Sansa had noted them the moment she'd stepped out onto the wallwalk, but the river and the bustling streets and the setting sun were ever so much prettier. He can make me look at the heads, she told herself, but he can't make me see them. â€Å"This one is your father,† he said. â€Å"This one here. Dog, turn it around so she can see him.† Sandor Clegane took the head by the hair and turned it. The severed head had been dipped in tar to preserve it longer. Sansa looked at it calmly, not seeing it at all. It did not really look like Lord Eddard, she thought; it did not even look real. â€Å"How long do I have to look?† Joffrey seemed disappointed. â€Å"Do you want to see the rest?† There was a long row of them. â€Å"If it please Your Grace.† Joffrey marched her down the wallwalk, past a dozen more heads and two empty spikes. â€Å"I'm saving those for my uncle Stannis and my uncle Renly,† he explained. The other heads had been dead and mounted much longer than her father. Despite the tar, most were long past being recognizable. The king pointed to one and said, â€Å"That's your septa there,† but Sansa could not even have told that it was a woman. The jaw had rotted off her face, and birds had eaten one ear and most of a cheek. Sansa had wondered what had happened to Septa Mordane, although she supposed she had known all along. â€Å"Why did you kill her?† she asked. â€Å"She was godsworn . . . â€Å" â€Å"She was a traitor.† Joffrey looked pouty; somehow she was upsetting him. â€Å"You haven't said what you mean to give me for my name day. Maybe I should give you something instead, would you like that?† â€Å"If it please you, my lord,† Sansa said. When he smiled, she knew he was mocking her. â€Å"Your brother is a traitor too, you know.† He turned Septa Mordane's head back around. â€Å"I remember your brother from Winterfell. My dog called him the lord of the wooden sword. Didn't you, dog?† â€Å"Did I?† the Hound replied. â€Å"I don't recall.† Joffrey gave a petulant shrug. â€Å"Your brother defeated my uncle Jaime. My mother says it was treachery and deceit. She wept when she heard. Women are all weak, even her, though she pretends she isn't. She says we need to stay in King's Landing in case my other uncles attack, but I don't care. After my name day feast, I'm going to raise a host and kill your brother myself. That's what I'll give you, Lady Sansa. Your brother's head.† A kind of madness took over her then, and she heard herself say, â€Å"Maybe my brother will give me your head.† Joffrey scowled. â€Å"You must never mock me like that. A true wife does not mock her lord. Ser Meryn, teach her.† This time the knight grasped her beneath the jaw and held her head still as he struck her. He hit her twice, left to right, and harder, right to left. Her lip split and blood ran down her chin, to mingle with the salt of her tears. â€Å"You shouldn't be crying all the time,† Joffrey told her. â€Å"You're more pretty when you smile and laugh.† Sansa made herself smile, afraid that he would have Ser Meryn hit her again if she did not, but it was no good, the king still shook his head. â€Å"Wipe off the blood, you're all messy.† The outer parapet came up to her chin, but along the inner edge of the walk was nothing, nothing but a long plunge to the bailey seventy or eighty feet below. All it would take was a shove, she told herself. He was standing right there, right there, smirking at her with those fat wormlips. You could do it, she told herself. You could. Do it right now. It wouldn't even matter if she went over with him. It wouldn't matter at all. â€Å"Here, girl.† Sandor Clegane knelt before her, between her and Joffrey. With a delicacy surprising in such a big man, he dabbed at the blood welling from her broken lip. The moment was gone. Sansa lowered her eyes. â€Å"Thank you,† she said when he was done. She was a good girl, and always remembered her courtesies.