The Life of the Buddha Essay Example for Free

The Life of the Buddha Essay Question 1- Select, describe and explain the events in the life of Siddhartha Gautama, which illustrate his religious development There are generally many events in the life of Siddhartha Gautama, which illustrate his religious development, but personally, I have planned to look at specific events very carefully. It can be said that the events contained specifically within the past lives of Siddhartha Guatama illustrate his religious development. There are, most evidently, the Jataka tales of the Pali Canon, which are supposedly stories of his actual rebirths. First of all, there is a most fundamental event, which occurs at around 100,000,000 aeons ago, where Dipuncena makes the crucial Bodhissatva vow to devote a life for the help of others. Now, after this, we see many stories of compassionate actions done by the 547 reincarnations of Dipuncena in the form of animal, god, and man. For example, one is the courageous story of Prince Vessantra, who gives up everything that he owns, even his wife and children out of compassion. The fact that he did this, giving everything and not expecting anything in return, portrays Dana, which is the idea of charity, and is a fundamental quality that is essential to be on the way to the Bodhissatva Path. There is also the story of the young prince, who slits his own throat in order for a starving tigress with seven hungry cubs, might live by eating his own flesh1. In terms of religious development, this is clearly showing the Bodhisattva Concept as it is displaying extreme compassion, or Karuna. A clear favourite, is of the loving, and righteous monkey king, and how he, by bridging himself, saved his fellow monkeys, but died while being bridged. This shows the Bodhisattva Concept again as he died to save his fellow monkeys and therefore delayed his enlightenment to help others. He developed the religious virtue of patience (Kshanti) as an ascetic in a previous life where he felt no hatred, only pity, for the evil king who cut his body into pieces, bit by bit. These stories all exemplify how the Bodhisattva developed all the qualities and characteristics of someone on the Bodhissatva path (according to Mahayana), and also, it shows the Bodhissatva concept, as his own enlightenment is delayed purely for the sake of others enlightenment, but on the other hand, he religiously develops himself to bring his spirit and mind even closer to attaining the ultimate enlightenment, and fulfilment of his vow. The most obvious and clear event, which shows his religious development, is the four sights. Here, upon leaving the palace with a charioteer, he sees an old man, a sick man, a dead man, and a holy man. Certainly in the first three, he realises that everyone grows old, everyone may face disease and everyone has to die. This is actually very moving for Siddhartha Gautama, as it increases his religious, and therefore Buddhist development, but more importantly, his awareness of life. However, a deeper analysis of his situation concludes that this impact of shock was even more penetrating, as his father had shielded Siddhartha from the natures of suffering. These sights he sees at the age of 29 while riding with his charioteer set him thinking about the issues now central to Buddhism (key to religious development) which lead him to realise that there is no release from suffering. After this critical and indeed, pivotal moment, Siddhartha could now no longer enjoy any of the luxuries which had been set out for him, as he was conscious of the fact that none of these could save him from age, disease, or even death. However, he finally sees the fourth sight, the holy man, i.e a person truly devoted to spirituality. Now, this consequently leads him to decide that he too, can go and seek after the unborn, unageing, unailing, deathless, sorrowless, undefiled supreme surceases of bondage, nibbana2. So, he decided that he too would leave home to seek a cure for the worlds suffering3. He had felt so uneasy about human suffering that he thought by becoming an ascetic; he would understand and comprehend everything there is. Therefore it can be said that these sights led him straight onto the path of religious development, and especially on the road to understanding Dukkha (all life is suffering). One of the most evident parts of Siddhartha Gautamas religious development, was when he was enlightened. After receiving an alms bowl, Siddhartha Gautama left the hardship, and arduousness of the ascetic life. Upon doing this however, he left himself with no friends from his past, but nevertheless, was strongly assured by what he was doing, since he had evidently found the middle way (the reality between luxury and poverty). Hence this was because he had discovered neither had given him real satisfaction.4 Now, in spite of this departure, Siddhatha was determined to reach enlightenment, in such a way, that he sat under a Bodhi tree (pipal tree) determined to sit until he had reached divine reality and knowledge. As he sat in a meditative state, Mara tried to cast him away with his temptations, however they were futile and seemed to reflect of Siddhartha, since he had such a strong concentration and determination to fulfil his aim. Mara even tried to deny him the right to be enlightened, but yet again, Siddhartha called upon the Earth goddess as witness, and eventually, upon realisation that Siddhatha would not be beaten, Mara backed down. Then the real enlightenment took place, in the form of the four watches. The first watch began with Siddhartha recalling past lives with unbelievable detail and understanding. The second watch took place with Siddhartha watching people and animals passing into and out of existence, and crucially at this point realising constant change. The third watch was the realisation that all suffering is caused by a constant continual cycle of craving, and realised the way to overcome suffering. Finally, he was enlightened and blessed with Nibbana and showered with supreme knowledge and understanding, beyond belief. This represents his huge step into the known, and into the aspects of life in which we do not understand. This was all the result of determination, and specifically effort to fulfil the Bodhisattva vow, and was the final hurdle of the Bodhisattva Path, and after enlightenment, the BUDDHA could now teach, and help others more supremely than ever before. After a life of purity and sincerity of teaching, the life of Siddhartha Gautama, had come to an end. His death marked the end of religious development for him. He died at Kushinara at the age of 80 from food poisoning, and his last, and severely crucial, words, were , remember, all things are subject to decay, so be mindful and vigilant in working out your own salvation 5. Here he sends out his message, that all things are subject to change, even him. He died in an obscure place which shows his humility and desire for people to listen to his message rather to make a fuss about his person.6 The main point though, is that the Buddha didnt want to increase fame, or celebrity status, he only wanted people to care for him for what he did. He subtly died while in the jhana of meditation, and this critically shows the extreme emphasis on the fact that he was not a god, but a man, and even he would eventually die. His death, is extremely significant, and specifically illustrates his religious development, as it represents him entering parinibbana, and enlightenment beyond death. So, hence, consequently, an escape of Samsara (cycle of rebirth) occurs, and he has obtained total bliss. As a religious teacher, here he had reiterated and emphasised one of his most important teachings, and died in the highest form of concentration and meditation there is. Overall, at this point, religiously, he had reached the highest place and thus, the peak of his religious development. 1 Denise Cush: Buddhism (1994) pp 25 2 Denise Cush: Buddhism (1994) pp 20 3 S. Clark M. Thompson: Buddhism: a New Approach London, Hodder and Stoughton 1996, p10 4 S. Clark M. Thompson: Buddhism: a New Approach London, Hodder and Stoughton 1996, p11 5 Denise Cush: Buddhism (1994) pp 25 6 Denise Cush: Buddhism London, Hodder and Stoughton 1995, page 23

Seven Steps In The Benchmarking Process Business Essay

Seven Steps In The Benchmarking Process Business Essay Benchmarking  is the process of comparing ones business processes and  performance metrics  to industry bests or  best practices from other industries. Dimensions typically measured are quality, time and cost. In the process of benchmarking, management identifies the best firms in their industry, or in another industry where similar processes exist, and compare the results and processes of those studied (the targets) to ones own results and processes. In this way, they learn how well the targets perform and, more importantly, the business processes that explain why these firms are successful. Benchmarking is used to measure performance using a specific  indicator  (cost per unit of measure, productivity per unit of measure, cycle time of x per unit of measure or defects per unit of measure) resulting in a metric of performance that is then compared to others. Also referred to as best practice benchmarking or process benchmarking, this process is used in management and particularly strategic management, in which organizations evaluate various aspects of their processes in relation to best practice companies processes, usually within a peer group defined for the purposes of comparison. This then allows organizations to develop plans on how to make improvements or adapt specific best practices, usually with the aim of increasing some aspect of performance. Benchmarking may be a one-off event, but is often treated as a continuous process in which organizations continually seek to improve their practices. BASICS OF BENCHMARKING Indian organizations are becoming world class both in terms of size and performance. Therefore, there is a greater need to become superior in performance consistently. Quality is becoming the hallmark for both products and services. Indian and multinational organizations are increasingly becoming quality conscious and try to deliver high quality products and services to customers. Quality delivery which was the property of General Electric, Ford, General motors, Xerox and ATT had become the buzzword in many corporate circles in India as well. From Software major Infosys to Automobile giant Mahindra are adopting best in class technologies, borrows and adopt best ideas, incubate and implement them as part of their corporate strategy. As individuals do swot analysis, companies have to do swot analysis for their competitive advantage and for long term survival. The external competitive pressure on the system had made its absolutely necessary to benchmark with similar organizations or organizations of different breed. However, benchmarking cannot cure all diseases of the company. Why the companies benchmark? Instead of being inward looking companies, large corporations are more outward looking nowadays. Liberalization and globalization had made the industries very competitive. Equally the transfer and adoption of technologies are more easier nowadays. The other advantage of benchmarking is the lowest cost associated with the process. The companies do not invest sizeable investments in research and development and there is no threat of any sunk cost. The process or practice or technology are readily available and easily be plagiarized. A company that decides to undertake a bench-marking initiative should consider the following questions: When? Why? Who? What? and How? WHEN Benchmarking can be used at any time, but is usually performed in response to needs that arise within a company. According to C.J. McNair and Kathleen H.J. Leibfried in their book  Benchmarking: A Tool for Continuous Improvement,  some potential triggers for the benchmarking process include: quality programs cost reduction/budget process operations improvement efforts management change new operations/new ventures rethinking existing strategies competitive assaults/crises WHY This is the most important question in managements decision to begin the benchmarking process. McNair and Leibfried suggest several reasons why companies may embark upon benchmarking: to signal managements willingness to pursue a philosophy that embraces change in a proactive rather than reactive manner; to establish meaningful goals and performance measures that reflect an external/customer focus, foster quantum leap thinking, and focus on high-payoff opportunities; to create early awareness of competitive disadvantage; and to promote teamwork that is based on competitive need and is driven by concrete data analysis, not intuition or gut feeling. WHO Companies may decide to benchmark internally, against competitors, against industry performance, or against the best of the best. Internal benchmarking is the analysis of existing practice within various departments or divisions of the organization, looking for best performance as well as identifying baseline activities and drivers. Competitive benchmarking looks at a companys direct competitors and evaluates how the company is doing in comparison. Knowing the strengths and weaknesses of the competition is not only important in plotting a successful strategy, but it can also help prioritize areas of improvement as specific customer expectations are identified. Industry benchmarking is more trend-based and has a much broader scope. It can help establish performance baselines. The best-in-class form of benchmarking examines multiple industries in search of new, innovative practices. It not only provides a broad scope, but also it provides the best opportunities over that range. WHAT Benchmarking can focus on roles, processes, or strategic issues. It can be used to establish the function or mission of an organization. It can also be used to examine existing practices while looking at the organization as a whole to identify practices that support major processes or critical objectives. When focusing on specific processes or activities, the depth of the analysis is a key issue. The analysis can take the form of vertical or horizontal benchmarking. Vertical benchmarking is where the focus is placed on specific departments or functions, while horizontal bench-marking is where the focus is placed on a specific process or activity. Concerning strategic issues, the objective is to identify factors that are of greatest importance to competitive advantage, to define measures of excellence that capture these issues, and to isolate companies that appear to be top performers in these areas. HOW Benchmarking uses different sources of information, including published material, trade meetings, and conversations with industry experts, consultants, customers, and marketing representatives. The emergence of Internet technology has facilitated the bench-marking process. The Internet offers access to a number of databases-like Power-MARQ from the nonprofit American Productivity and Quality Center-containing performance indicators for thousands of different companies. The Internet also enables companies to conduct electronic surveys to collect bench-marking data. How a company benchmarks may depend on available resources, deadlines, and the number of alternative sources of information. ADVANTAGES OF BENCHMARKING Lowering Labor Costs One advantage of benchmarking may be lower labor costs. For example, a small manufacturing company may study how a top competitor uses robots for several basic plant functions. These robots may help the competitor save a significant amount of money on labor costs. Company managers may obtain information on these robotics systems through the competitors website or online articles. They may also identify the company that sold the competitor the robots. Subsequently, the company using benchmarking may call the robot manufacturer to help set up its own system. Improving Product Quality Companies may also use benchmarking to improve product quality. Engineers sometimes purchase leading competitors products. They may then take them apart, study them and determine how the competitors products outlast or outperform others in the industry. Chemical engineers may study food or cleaning products in a similar manner. They can then compare various elements contained in competitive products to their own product line. Subsequently, improvements can be made to product quality. Increasing Sales and Profits A company that uses benchmarking to improve its functions, operations, products and services may enjoy increases in sales and profits. Customers are likely to notice these improvements. The benchmarking company may also promote is improvements through company brochures, its sales reps, magazine and television ads. These efforts are likely to increase sales, especially among core customers. Companies that operate more efficiently due to benchmarking can drastically lower their expenses. These savings can be lead to greater profits. Considerations Some organizations use internal benchmarking to improve performance in different departments. Department managers may study and emulate the best practices of one particular department. These changes may spark improvements among all departments. Internal benchmarking has its limitations, however. The companys top department may not be functioning as efficiently as others in the industry. This means the other departments were not truly benchmarking against the best departments out there. PROCESS OF BENCHMARKING When it comes to Competitive Intelligence, there are a few simple tools that can provide for sophisticated comparisons of business functions between organizations that can help firms benchmark the constituent processes of the company with direct or indirect competitors, allowing a company to gain the upper hand in a marketplace. But, what is the process for setting the metrics, methodologies, milestones and comparisons which might be used to measure the success of a CI/benchmarking function, or the success of a Strategic Planning department as a whole? Benchmarking is best used and described as a framework for strategic planning in that, once elements of study are identified, metrics can be applied to the key success factors (KSFs) of the industry or marketplace and these measures or benchmarks are then used to develop future quality and market initiatives for the firm to enhance its overall competitive position. It is generally considered that there are seven steps to this process, as explained below. However, this analysis of intra- and sometimes inter-industry competitors can form the foundation for future competitor analysis when the emphasis is placed upon the goals and financial capabilities of the competitor. Seven Steps in the Benchmarking Process: 1. Determine which functional areas within your operation are to be benchmarked those that will benefit most from the benchmarking process, based upon the cost, importance and potential of changes following the study. 2. Identify the key factors and variables with which to measure those functions usually in the general form of financial resources and product strategy. 3. Select the best-in-class companies for each area to be benchmarked those companies that perform each function at the lowest cost, with the highest degree of customer satisfaction, etc. Best-in-class companies can be your direct competitors (foreign or domestic), or even companies from a different industry (parallel competitors with replacement or substitute products or services; latent competitors which might backwards- or forwards-integrate into your market; or, out-of-industry firms with whom you do not compete, but which have best-in-class areas to be studied such as FedEx or Wal-Mart in logistics). 4. Measure the performance of the best-in-class companies for each benchmark being considered from sources such as the SEC, companies themselves, articles in the press or trade journals, analysts in the market, credit reports, clients and vendors, trade associations, the government or from interviews with other organizations willing to share their prior research or swap it with you. 5. Measure your own performance for each variable and begin comparing the results in an apples-to-apples format to determine the gap between your firm and the best-in-class examples. Always feel free to estimate results, as exact measures are usually disproportionately difficult to obtain and often do not significantly add value to the study. 6. Specify those programs and actions to meet and surpass the competition based on a plan developed to enhance those areas that show potential for compliment. The firm can choose from a few different approaches from simply trying harder, to emulating the best-in-class, changing the rules of the industry or leapfrogging the competition with innovation or technology from outside the industry. 7. Implement these programs by setting specific improvement targets and deadlines, and by developing a monitoring process to review and update the analysis over time. This will also form the basis for monitoring, revision and recalibration of measurements in future benchmarking studies. DIFFERENT MEASURES OF BENCHMARKING One of benchmarkings cardinal questions is that of what to measure. That depends on the nature of the business. The point is that you cannot chase 50 benchmarks at the same time. One macro benchmark is required which then might be broken down into a series of supporting micro measures. Although it is fine to circulate such a measure, the most worthwhile aspect of the benchmarking process can be the opportunity for people in an organisation to see at first hand how other organisations go about their business. It is the process itself which is valuable; the voyage that is more educational than the reaching of the destination. Nevertheless, measurable performance falls into the three broad areas: à ¢Ã¢â€š ¬Ã‚ ¢ time; à ¢Ã¢â€š ¬Ã‚ ¢ cost; and à ¢Ã¢â€š ¬Ã‚ ¢ quality. Time measures should incorporate the process from start to finish. For example, from when a customer places an order to the time of receipt of goods and payment, thereby accounting for total lead time, product development time and productive time. Cost measures are the traditional basis of comparison between firms and, because of this, we are often most comfortable with these measures. Two which can be useful in benchmarking are total process cost per unit of output and return on assets. Quality measures should capture the errors, defects and waste attributable to processes. Some measures which should be used in achieving this include process variability, defects, process yields, customer perceived quality, cost of quality and quality improvement efforts. TYPES OF BENCHMARKING There are a number of different types of benchmarking, as summarised below: Type Description Most Appropriate for the Following Purposes Strategic Benchmarking Where businesses need to improve overall performance by examining the long-term strategies and general approaches that have enabled high-performers to succeed. It involves considering high level aspects such as core competencies, developing new products and services and improving capabilities for dealing with changes in the external environment. Changes resulting from this type of benchmarking may be difficult to implement and take a long time to materialise Re-aligning business strategies that have become inappropriate Performance or Competitive Benchmarking Businesses consider their position in relation to performance characteristics of  key products and services. Benchmarking partners are drawn from the same sector. This type of analysis is often undertaken through trade associations or third parties to protect confidentiality. Assessing relative level of performance in key areas or activities in comparison with others in the same sector and finding ways of closing gaps in performance Process Benchmarking Focuses on improving specific  critical processes and operations. Benchmarking partners are sought from best practice organisations that perform similar work or deliver similar services. Process benchmarking invariably involves producing process maps to facilitate comparison and analysis. This type of benchmarking often results in short term benefits. Achieving improvements in key processes to obtain quick benefits Functional Benchmarking Businesses look to benchmark with partners drawn from different business sectors or areas of activity to find ways of improving similar functions or work processes. This sort of benchmarking can lead to innovation and dramatic improvements. Improving activities or services for which counterparts do not exist. Internal Benchmarking Involves benchmarking businesses or operations from within the same organisation (e.g. business units in different countries). The main advantages of internal benchmarking are that access to sensitive data and information is easier; standardised data is often readily available; and, usually less time and resources are needed. There may be fewer barriers to implementation as practices may be relatively easy to transfer across the same organisation. However, real innovation may be lacking and best in class performance is more likely to be found through external benchmarking. Several business units within the same organisation exemplify good practice and management want to spread this expertise quickly, throughout the organisation External Benchmarking Involves analysing outside organisations that are known to be best in class. External benchmarking provides opportunities of learning from those who are at the leading edge. This type of benchmarking can take up significant time and resource to ensure the comparability of data and information, the credibility of the findings and the development of sound recommendations. Where examples of good practices can be found in other organisations and there is a lack of good practices within internal business units International Benchmarking Best practitioners are identified and analysed elsewhere in the world, perhaps because there are too few benchmarking partners within the same country to produce valid results. Globalisation and advances in information technology are increasing opportunities for international projects. However, these can take more time and resources to set up and implement and the results may need careful analysis due to national differences Where the aim is to achieve world class status or simply because there are insufficientnational businesses against which to benchmark. SUCCESSFUL BENCHMARKING There are several keys to successful benchmarking. Management commitment is one that companies frequently name. Since management from top to bottom is responsible for the continued operation and evaluation of the company, it is imperative that management be committed as a team to using and implementing benchmarking strategies. A strong network of personal contacts as well as having an open mind to ideas is other keys. In order to implement benchmarking at all stages, there must be a well-trained team of people in order for the process to work accurately and efficiently. Based on the information gathered by a well-trained team, there must also be an effort toward continuous improvement. Other keys include a benchmarking process that has historical success, sufficient time and staff, and complete understanding of the processes to be benchmarked. In almost any type of program that a company researches or intends to implement, there must be goals and objectives set for that specific program. Benchmarking is no different. Successful companies determine goals and objectives, focus on them, keep them simple, and follow through on them. As in any program, it is always imperative to gather accurate and consistent information. The data should be understood and able to be defined as well as measured. The data must be able to be interpreted in order to make comparisons with other organizations. Lastly, keys to successful benchmarking include a thorough follow-through process and assistance from consultants with experience in designing and establishing such programs.

Scarlet Letter :: essays research papers

"Life is like a box of chocolates. You never know what you're going to get," suggests Tom Hanks in the motion picture "Forrest Gump". He utilizes this metaphor to align a box of chocolates as a symbol for life. Symbolism serves as a useful tool to convey a message or point subtly so that the concept lingers in the mind of the reader, who then establishes a relation in his or her mind with that object and the message. Hawthorne uses symbolism in The Scarlet Letter extensively to express the underlying truths about the stifling nature of Puritan society and the dispositions of the characters in the novel. Such elements as nature, color, and light; the scarlet letter itself; as well as the scaffold, where the three pinnacles of the plot occur, operate on a firm foundation of symbolism. Nature, color and light are used as symbols throughout the novel to illustrate several areas of the story (Waggoner 154). The prison door, for example, was described as being composed of â€Å"oak and iron† and its coloring â€Å"sad† and â€Å"gray†, symbolizing the rigidity of the Puritan society against sinners (Waggoner 154). The rosebush situated outside of the prison door is like a â€Å"moral blossom† growing amongst the bitter weeds of society, in the â€Å"most unlikely of places† (Hawthorne). The placement of the rosebush in such a dank, improbable position as outside of a place housing sinners (the prison), imparts the fact that such an element of beauty and innocence is nevertheless able to be born out of a station with such an ill aura. Pearl is symbolic of the rosebush in that she was spawned from the same evil air of sin (Waggoner 156). However, her purity is just as real as that which comes from a origin of virtue (Waggoner 156). She is often associated with roses (Waggoner 156). For example, in the governor’s she cries and pleas that she must have one (Waggoner 156). In addition, her very name is an indication of the symbol she conveys (Waggoner 157). Like a pearl comes from the mangled, impure exterior of the oyster, Pearl comes from the equally impure and squalid exterior of the sin her parents willingly committed (Waggoner 157). Another nature related symbol comes in the forest. The forest itself holds its own variety of symbolism. â€Å"Freedom† is one expression of the forest. There is no reason for Hester and Dimmesdale to be secretive among the trees where no one can witness their union (Matthiessen 299).

Self-reliance Essay -- essays research papers

1. The essay that I elected to read and analyze was "Self-Reliance" by Ralph Waldo Emerson. 2. The Transcendental Movement held a strong opinion that one should have complete faith in oneself. Emerson, being an avid transcendentalist, believed in this philosophy. He supported this concept that we should rely on our own intuition and beliefs. "Trust thyself: every heart vibrates to that iron string." Emerson, along with the Transcendental Movement, believed in the vitality of self-reliance. One must have confidence and belief in oneself. "†¦the only right is what is after my constitution; the only wrong what is against it." Once one has reliance upon oneself, he can generate his own set of ideals and morals, not just the ideals bestowed upon him by society. In obeying these principles of life, he has created a constitution of his own. This constitution is the guiding light of his life; it leads the way to truth and ultimate liberation and provides the right path to follow. This idea brings about the transcendental concept of the belief in the worth of the individual. The individual, in transcendental philosophy, has the power to accomplish anything and everything. Social organization and friendship offer a small satisfaction of companionship and structure in life, but one will ultimately succeed based upon his own skills and conviction. In doing so, he will lose interest in the society and concentrate on more individual dependency as he strives to gain ultimate truth in life. "What I must do is all that concerns me, not what the people think." Once one considers less the social ramifications of his actions and considers more the personal consequences, he will become more apt to discover what he is looking for; in the transcendentalists’ case, it was the meaning of life. 3. a). "To be great is to be misunderstood." This statement was used by Emerson to explain the lagging growth of the conception of ideas and thought of his generation. Original and novel ideas were and still are scorned by those who believe that the best method for learning is repetition and memorization. When one comes up with a groundbreaking idea, it is generally disregarded because so-called "experts" do not agree with it. This is because soci... ...ing is uncomfortable, we should leave. Conformity with society has disabled this aspect of human nature, and I feel that it is something that needs to be addressed. 4. We should not conform to the preconceived laws of society. When we dislike something, we should not hesitate to be different and oppose. Believe in the power of the individual, and learn to depend on yourself, in order to achieve greatness. 5. In reading this essay, I saw many viewpoints on life that I have never seen before. They are opinions that are different from what is normal, and they are sometimes abrupt and shocking. Some of the opinions are opinions that I can relate with; others were completely out of the ballpark. I was surprised, and a little excited to read many of the philosophies that Emerson held to be the great truths of this world. Emerson had many ideas that can benefit the world today; they can help societies evolve into better places for people to live. They also provide a call for humans to evolve from conforming automatons to individuals who do and say what they feel. These thought that Emerson conveyed moved me and made me realize how precious our free will and judgement are.

Supernatural in Shakespeares Macbeth - The Naturally Supernatural :: GCSE Coursework Macbeth Essays

The Supernatural in Macbeth Writers often use supernatural to add suspense and interest to their work. The Witches and ghosts create a sense of horror as well as foreshadow what will happen next. Ghosts and apparitions really took over MacBeth’s emotions and fears. For example in the opening scene witches are used   to create an atmosphere of horror and suspense. Later in the scene   the ghost of Banquo appears at the dinner table and drives Macbeth mad. His wife try's to calm him but she can't and Macbeth has the people at the table getting awfully suspicious. Again we see it when Macbeth saw the dagger, he is seeing things due to guilt. The witches foresaw what happened through the play by telling Macbeth his future as well as Banquo. Ghosts made the audience feel scared the sky black and the wind misty. Witches in the play did prophecise to Macbeth that he would be king. Macbeth knowing this information became curious, knowing that Duncan was king he wondered how he would acheive the position. So he did indeed kill Duncan under the guidance of the three witches. The witches in this play in terms of ghosts are concerned,   we see they are not human or half ways normal when baquo quotes to Macbeth that are not human like as well as   irregular in some sort and very unattractive. This leaves a feeling of darkness for example the sky is black and the grass is gray instead of green the branches on the tress are short and rotting. The witches were Macbeth’s fortune tellers but they lead him a bad life In the end. Ghosts and apparitions not only drove Macbeth to his grave but also gave him up. When he kills Duncan there is a sense of real guilt. We see him going crazy   and feeling extreme guilt when immediately after he kills him he sais to his wife what a sorry sight and she tells him to stop worrying about Duncan and to get on with his life. She also tells him to stop being a coward, and that killing was the only option. In actuality it is not because a murder will never stay secret. Ghosts were a big factor in this play but guilt plays a part as well, a much bigger part. Guilt led to the witnessing   of ghosts. For example when Macbeth hosts   the dinner he witnesses baquo’s ghost this has an   affect of pity for Macbeth as far as the audience is concerned, Macbeth himself from guilt is going crazy.

Unilateral Neglect After Stroke Health And Social Care Essay

Behavioral Inattention Test is a common standardised measuring for one-sided disregard and has been widely used as the chief results in many neglect surveies. A systematic reappraisal was conducted in the undermentioned database from January 1997 to June 2012: PubMed/Medline ( 1965+ via EbscoHost ) , PsyhcINFO ( 1806+ ) , Science Direct, CINAHL ( Cumulative Index to Nursing and Allied Health Literature, 1982+ ) , Cochrane Collaboration ‘s registry of tests and PEDro ( Physiotherapy Evidence Database ) .The reappraisal included articles of randomized controlled tests about neglect schemes among stroke patients that addressed Behavioral Inattention Test as primary results in the intercessions. Meta-analysis was done.ConsequencesTwelve RCTs were identified in our reappraisal harmonizing the inclusion and exclusion standards. The qualities of the surveies were good with average Physiotherapy Evidence Database ( PEDro ) mark of 6.08 A ± 0.81. Different intercessions have been stud ied in RCTs ; Prism Adaptation ( PA ) appeared to be the most common, with 5 out of 12. The meta-analysis showed that for immediate effects of neglect intercessions, the BIT conventional subtests has a statistically important average consequence size of 0.76 ( 95 % CI, 0.28-1.23 ; p=0.002 ) whereas the BIT Behavorial subtest showed no statistically important average consequence size of 0.37 ( 95 % CI, -0.19-0.91 ; p=0.17 ) , and the BIT ( Total ) showed a modest statistically important average consequence size of 0.55 ( 95 % CI, 0.16-0.94 ; p=0.006 ) . However, the meta-analysis showed that there was no statistically important average consequence size on durable effects for all BIT results. Among all intercessions, Prism Adaptation ( PA ) appears to be more effectual when compared to others based on the BIT results after pooled analysis.DecisionPrism Adaptation ( PA ) appeared to be the most common and effectual scheme among rehabilitation intercessions on one-sided disregard and rT MS possibly is a promising attack for intervention of one-sided disregard. Rehabilitation intercessions have positive immediate effects on one-sided disregard as measured by the BIT conventional subtest than that on the behavioral subtest. As shown by the short durable effects, effects of rehabilitation intercessions are frequently transeunt and frequently can non be generalized across clip to daily working. All surveies faced the same failing of lower power with smaller samples and restriction in sightlessness design. More strict surveies should be done before coming to a steadfast decision.KeywordsSystematic reappraisal, Stroke, Unilateral Neglect, Rehabilitation, Treatment, Behavioural Inattention Test1. IntroductionUnilateral disregard ( ULN ) is a heterogenous perceptual upset that follows intellectual hemispherical lesion [ 1 ] , particularly after right hemisphere stroke. The most typically characteristic of disregard is failure to describe or react the stimulation presented from the contralateral infinite, including stimulation from the ocular, somatosensory, audile and kinesthesia stimulation even comprehending their ain organic structure parts [ 2 ] . The reported incidence varies from 10 % to 82 % following right-hemisphere shot and from 15 % to 65 % following left-hemisphere shot [ 3 ] . Capable choice standards, lesion site, the nature and timing of the appraisal and deficiency of understanding on appraisal methods are all responsible for the variableness in the reported rate of happening of one-sided disregard after shot [ 1, 4 ] . As disregard involved upset in directing attending, stand foring infinite and commanding motion, it became an obstruction for recovery from shot. Neglect has a important negative impact associated with functional recovery at place discharge [ 5, 6 ] . Recently more research workers have put attempts on researching the underlying mechanism and the curative methods about the enormous challenge. Different intervention attacks and assessment battery have been developed to measure and rectify disregard. Recent literature shows that interventions for one-sided neglect autumn under two types of behavioural attacks. They are either enrolling the hemiplegic side or limbs to cut down a spacial penchant over the ipsilesional infinite, or bettering consciousness of the contralesional infinite to advance patients ‘ attending [ 7, 8 ] , Up to now, more than 18 methods were put into pattern in these Fieldss [ 9 ] . Surveies based on these attacks have reported changing consequences based on a big figure of outcome steps. Despite the reported quality is moderate for RCTs in neglect rehabilitation [ 7 ] , some attacks appear to be more promising. There were besides remarks that the effects of these new interventions are frequently task-specific or transeunt and frequently can non be generalized to daily working [ 8, 10, 11 ] . It is difficult to state which attack is the optimum rec ommendation for clinical pattern due to deficient grounds [ 9 ] . In add-on, professional healers seldom use these scientifically proved interventions [ 12 ] . The appraisal of ULN in the clinical scene has normally involved in â€Å" pencil-and-paper † undertakings, including line bisection, cancellation undertakings, copying, and pulling [ 13 ] , many RCTs used some of the undertakings as results. The Behavioural Inattention Test ( BIT ) is a criterion-referenced trial for one-sided disregard or ocular inattention in patients enduring from shot or encephalon hurts [ 14 ] . The trial is divided into two classs: the conventional and the behavioural subtests. This survey used the conventional subtest, which is made up of 6 points: line crossing, missive cancellation, star cancellation, figure and form copying, line bisection, and representational drawing. A cancellation subscore was calculated by adding the first 3 cancellation undertakings together and pulling subscore by adding the staying 3 undertakings. This reappraisal aimed to consistently reexamine the updated grounds from RCTs on the effectivity of rehabilitation intercessions for one-sided disregard as measured by the Behavioral Inattention Test ( BIT ) or its conventional ( BIT-C ) and behavioural subtests ( BIT-B ) .2. Methods2.1. DatabaseWe searched the undermentioned electronic databases: PubMed/Medline ( 1965+ via EbscoHost ) , PsyhcINFO ( 1806+ ) , Science Direct, CINAHL ( Cumulative Index to Nursing and Allied Health Literature, 1982+ ) , and Cochrane Collaboration ‘s registry of tests. We besides hand-searched the bibliography of all surveies ordered in full text. Date of publication was restricted between January 1997 and June 2012.2.2. Search schemesWe used the undermentioned footings for seeking databases ( Cerebrovascular accident OR shot ) AND ( Neglect OR visuospatial disregard OR ocular disregard OR one-sided disregard OR hemisphere neglect OR visuo-spatial disregard ) .We included merely RCTs for grownups with age ( 19 old ages + ) published from: 19970101-20120630, restricted to English linguistic communication.2.3. Inclusion and exclusion standardsInclusion standardsWe included: ( 1 ) all RCTs aimed at place the effectivity of any type of rehabilitation intercession to rectify disregard in grownup shot patients as diagnosed with one-sided disregard by clinical scrutiny and/or classical neuropsychological trials ; ( 2 ) Given our intent, we merely considered the surveies which addressed the Behavioral Inattention Test ( BIT ) [ 15 ] as the primary results. The BIT included the conventional subtest ( BIT-C ) and/or the behavioural subtest ( BIT-B ) every bit good as the entire mark of BIT ( BIT ( Total ) ) or both.Exclusion standards:( 1 ) Observational survey, and instance study every bit good as cross-over design surveies ; ( 2 ) Full text is non available ; ( 3 ) with sample size less than 5 in each group ; and ( 4 ) every bit rated as 4 or less out of 10 by the Physiotherapy Evid ence Database ( PEDro ) .2.5. Quality appraisalThe 2 referees ( Nicole, Y.Y.H and Kenneth, F.N.K ) appraised all documents harmonizing to the Physiotherapy Evidence Database ( PEDro ) graduated table. It was developed specifically for measuring the quality of surveies aimed at comparing the effectivity of rehabilitation intercessions [ 16, 17 ] which has been proved to be a valid step of the methodological quality of clinical tests. It was valid to sum PEDro scale point tonss to obtain a entire mark that can be treated as interval degree measuring and subjected to parametric statistical analysis [ 18, 19 ] . There are 11 points in the PEDro graduated table: The first standards point eligibility is non scored which was used as a constituent of external cogency, the other 10 points obtained a entire mark from 10 ( RCT that satisfies all points ) to 0 ( RCT that does non fulfill anyone ) . The PEDro graduated table classify surveies as of high or low qualities based on a cut-off mark a t 6 out of 10. High quality means articles that obtain a mark equal to or higher than 6 and low quality surveies score less than 6.2.4. Data extraction and analysisEach included survey was carefully assessed for inclusion standards, and the necessary information and features of each included survey was ab initio summarized and extracted by the first writer ( first referee ) and was listed on a tabular array. The abstract every bit good as these sum-ups was independently checked and confirmed by a 2nd referee who is the 2nd writer of the manuscript. In instance of dissensions between the referees, the sentiment of the 3rd referee was sought. We calculate Cohen ‘s vitamin D on single consequence sizes for included surveies and compare the comparative effectivity. Meta-analysis one the overall intervention effectivity will be done with Review Manager 5.0. Standardized average difference ( SMD ) was taken as the consequence size and its 95 % assurance interval was computed. Test of heterogeneousness was used to measure the possible heterogeneousness across surveies. If heterogeneousness existed, random-effect theoretical account was used. Otherwise, the fixed-effect theoretical account was used alternatively. The sensitiveness analysis was besides used to measure the impact of the overall intervention effectivity by excepting one test one time at a clip.3. ConsequencesFigure 1 shows the choice procedure. The hunts chiefly yielded 201 commendations from 1997 to 2012. After taking extras, 153 commendations were obtained. Based on the rubric and abstract of the articles, 32 potentially relevant articles were obtained. An d they were so carefully evaluated by the referees. We identified 25 clinical tests [ 20-44 ] which entered the eventually assessment. Reasons for the exclusion of the other 7 articles were: ( 1 ) they were merely reviews or mechanical surveies, instance studies or other clinical survey design such as multiple-baseline design, cross-over design, ( 2 ) absence of a control group, and ( 3 ) the sample is less than 5 in each group. Finally, 12 articles were included in our reappraisal [ 21, 22, 25-27, 30, 32, 35, 36, 39, 40, 44 ] and other articles were excluded as the BIT was non used as the primary outcome step.Fig 1: Overview of literature hunt and choice procedureThe overall quality of the 12 RCTs is just to good ( Table 1 ) . The average sum mark was 6.08 A ± 0.81, with a scope from 5 to 9. 4 of them ( 33.3 % ) were identified with just quality when cut-off line was set at 6 out of 10 based on the PEDro graduated table.Table 1: PEDro tonss of included surveiesItemsSurveiesEligib ility 1: Random allotment 2: Concealed allotment 3: Baseline comparison 4: Blind topics 5: Blind healers 6: Blind assessors 7: Adequate followup 8: Intention-to-treat analysis 9: Between-group comparings 10: Point estimations variablenessMarkQualityNysa et Al. 2008 yes 1 0 1 1 0 0 1 0 1 1 6/10 Good Serino et Al. 2009 yes 0 0 1 1 0 0 1 0 1 1 5/10 Carnival Turton et Al. 2010 yes 1 1 0 0 0 1 1 0 1 1 6/10 Good Mizuno et Al. 2011 yes 1 1 1 1 0 1 1 0 1 1 8/10 Good Ladavas et Al. 2011 yes 1 0 1 1 0 1 0 0 1 1 6/10 Good Robertson et Al. 2002 yes 1 0 1 0 0 1 1 0 1 1 6/10 Good Luukkainen-Markkulaa et Al. 2009 yes 1 1 1 0 0 0 1 0 0 1 5/10 Carnival Fong et Al. 2007 yes 1 0 1 0 0 1 1 0 1 1 6/10 Good Tsang et Al. 2006 yes 1 1 1 0 0 1 0 0 1 1 6/10 Good Harvey et Al. 2003 yes 1 0 1 1 0 0 1 0 1 0 5/10 Carnival Koch et Al. 2012 yes 1 1 1 1 1 1 1 0 1 1 9/10 Good Ferreira et Al. 2011 NO 1 0 1 0 0 0 1 0 1 1 5/10 CarnivalFeatures of the included surveiesDescriptions of the 12 articles included in the reappraisal are listed in Table 2. Two surveies [ 40, 44 ] used double-blinded design and others largely were single-blinded tests.Table 2: Features of included surveiesSurveiesMethodsInterventionsBIT based ConsequencesTypeStudy designControlGroupstopics( N )shot continuanceTreatmentgovernmentDurationImmediateLong-runNysa et Al. 2008 Dad single-blind RCT Placebo ( impersonal goggles ) n=16 PA gp=10 CT gp=6 a†°Ã‚ ¤ 4 tungsten Wore brace of goggles fitted with wide-field point-to-point prismatic lenses shifted their ocular field 10A °/0A °rightward and make some fast pointing motions 30min/session four-day-in-row Sessionss 4d BIT-Ci-i?†° BIT-Bi-i?†° follow-upi1m Serino et Al. 2009 Dad single-blind Pseud-RCT Placebo ( impersonal goggles ) ni20 PA gp=10 CT gp=10 a†°?1 m have oning prismatic lenses, which shifted their ocular field 10A °/0A °rightward and indicating motions 30 min/session 10 day-to-day Sessionss within 2 hebdomad 2w BITi+i?†° BITi+i?†° follow-upi1m Turton et Al. 2010 Dad single-blind RCT Placebo ( level field glass ) ni36 PA gp=17 i1 drop-outi?†° CT gp=19 i1 drop-outi?†° a†°?20 vitamin D wore 10 diopters, 6 grade prisms utilizing index finger to touch a bold vertical line on screen one time a twenty-four hours, each working twenty-four hours 2w BITi-i?†° BITi-i?†° follow-upi8w Mizuno et Al. 2011 Dad double-masked RCT Placebo ( impersonal spectacless ) ni38 PA gp=18 CT gp=20 a†°Ã‚ ¤ 3m wore prism spectacless shifted ocular field 12A ° to right and repeat pointing undertakings 20 min/session command, 5 yearss / hebdomad 2w BIT-Ci-i?†° BIT-Bi-i?†° BIT-Ci-i?†° BIT-Bi-i?†° follow up until discharge Ladavas et Al. 2011 Dad single-blind Pseud-RCT Placebo ( impersonal spectacless ) ni30 TPA gp=10 CPA gp=10 CT gp=10 a†°?2m Wore wide-field prismatic lenses bring oning a 10a- ¦ displacement ocular field to right and repeat pointing undertakings 30 min/session one per twenty-four hours, 10 Sessionss 2w TPAi?s BIT-Bi+i?†° BIT-Ci+i?†° CPAi?s BIT-Ci-i?†° BIT-Bi-i?†° No followup Robertson et Al. 2002 LA single-blind RCT silent person device n=40 LA+PT=19 i2 drop-outi?†° PT=21 i2 drop-outi?†° Lanthanum: 152.8A ±142.4 Platinum: 152.1 A ±117.9 utilizing a semi-automatic device for limb activation combined with perceptual preparation 45 min/ session one time a hebdomad 12 Sessionss 12w BIT-Bi-i?†° BIT-Bi-i?†° follow-upi18-24m Luukkainen-Markkulaa et Al. 2009 LA single-blind RCT traditional ocular scanning preparation ni12 LA gp=6 CT gp=6 a†°Ã‚ ¤6 m arm activation trainingiDetermined by the single manus and arm motor position assessed by WMFTi?†° Entire 48 hours of therapy 3w BIT-Ci+i?†° BIT-Ci+i?†° Follow-upi6m Fong et Al. 2007 TR TR+EP single-blind RCT conventional OT ni54 TR gp=19 TR+EP gp=20 CT gp=15 a†°Ã‚ ¤8 tungsten Trunk rotary motion was performed in three different places: supine lying on a pedestal, unsupported sitting on a pedestal, and standing in a standing frame 1 hour/session 5 times /week 30d BIT-Bi-i?†° BIT-Ci-i?†° BIT i-i?†° BIT-Bi-i?†° BIT-Ci-i?†° BIT i-i?†° Follow-up= 60d Tsang et Al. 2009 EP single-blind RCT conventional OT ni34 EP gp=17 CT gp=17 EP: 21.5A ±21.67 Connecticut: 22.18 A ± 15.87 underwent occupational therapy with particular spectacless barricading the right half ocular field 30min ADL +30min NDT for UL/day 4w BIT-Ci+i?†° No followup Harvey et Al. 2003 VF RCT Same activities Without feedback ni14 VF gp=7 CT gp=7 5-25 m experimenter-administered pattern of rod raising with justice centre grids for proprioceptive and ocular feedback 1h/d with 3di?†º so 10 yearss of homebased intercession 3d/2w BIT-Ci+i?†° BIT-Bi-i?†° BIT-Ci+i?†° BIT-Bi-i?†° follow-upi1m Koch et Al. 2012 Terbium double-blind RCT fake spiral angled 90A ° ni18 TBS gp=9 CT gp=9 a†°?1 m ( 43A ±16d ) 3-pulse explosions at 50 Hz repeated every 200 millisecond for 40 s i80 % AMT over the left PPC 2 essions/di15min intervalli?†º 5 d/week 2w BIT-Bi+i?†° BIT-Ci+i?†° BIT i+i?†° BIT-Bi+i?†° BIT-Ci+i?†° BIT i+i?†° follow-upi1m Ferreira et Al. 2011 Military policeman VST single-blind RCT Conventional PT without any intervention for disregard ni15 MP gp=5 VST gp=5 CT gp=5 a†°? 3 m Volt: The protocol included 4 undertakings: 2 directed to the extrapersonal infinite and 2 turn toing peripersonal disregard ; Military policeman: included 4 undertakings: 2 undertakings of motor imagination and 2 of ocular imagination. 1h/session Twice per hebdomad 5w VST: BIT-Ci+i?†° Military policeman: BIT-C ( – ) VST: BIT-Ci+i?†° Military policeman: BIT-Ci-i?†°follow-upi2m Abbreviations: PA=prism version ; LA=limb activation ; TR= bole rotary motion ; EP=eye patching ; VF=Visuomotor feedback ; TBS=Theta-burst stimulation ; MP=mental pattern ; VST= ocular scanning preparation ; BIT= Behavioral Inattention Test ; BIT-C= BIT conventional subtest ; BIT-B= BIT behavioural subtests ; OT=occupational therapy ; PT=physiotherapyParticipantsThis reappraisal encompassed 277 topics with one-sided disregard. All of them were grownups with right encephalon harm due to stroke ; most of the topics had a diagnosing of first individual right hemisphere stroke. The continuance from the shot oncoming covered from acute stage ( a†°Ã‚ ¤4w ) to chronic stage ( a†°?6m ) , but most surveies were conducted in the subacute and chronic stage after shot. All surveies used similar inclusion and exclusion standards including age, diagnosing of shot ( the lesion location based on CT or MRI ) , right-handed, presence of one-sided disregard identified by either a clinical scrutiny or a standard disregard appraisal battery, and free of any other confusing neurological shortages or rational damages.InterventionsAmong the 12 surveies included, five [ 27, 32, 39, 40 ] implemented the effectivity of prism version ( PA ) . There were differences in the PA process, one survey [ 27 ] used insistent PA for a short period, and another survey used different feedback schemes in PA ( Terminal prism version, TPA and Concurrent prism version, CPA ) .During TPA, merely the concluding portion of the indicating motion is seeable and prism version relies most strongly on a strategic recalibration of visuomotor eye-hand co-ordinates. In contrast, for CPA the 2nd half of the indicating motion is seeable, and therefore version chiefly consists of a realignment of proprioceptive co-ordinates [ 39 ] . All the five surveies used the same control methods with impersonal goggles. There were two [ 21, 30 ] articles applied limb activation, other articles used different intercessions: visuomotor feedback, practical world, insistent transcranial magnetic stimulation ( Theta-burst stimulation ) . Compared to a old reappraisal [ 45 ] , there was no new i ntercession reported in this reappraisal in the clip period except the uninterrupted Theta-burst stimulation ( cTBS ) . We included a RCT utilizing rTMS with high quality for the first clip. All surveies investigated individual intervention, except one RCT survey [ 26 ] investigated the effectivity of combinations of two different therapeutics ( trunk rotary motion and eye-patching ) . Duration of intervention period ranged from 3-day [ 29 ] to 5-week [ 38 ] , but for half of the surveies the intervention frequence was 30 min per session, 5 Sessionss per hebdomad, and 2 hebdomads for a entire 10 Sessionss. All intervention were conducted in infirmaries except one [ 22 ] survey involved self-administered home-based pattern for two hebdomads.Outcome measuringIn all surveies the results included functional activities and badness of disregard. The functional results included the Functional Independence Measure, the Barthel Index, upper limb motor maps ( the Wolf Motor Function Test and the Modified Motor Assessment Scale ) every bit good as the Stroke Impairment Assessment Set. Apart from the BIT, the result for neglect badness included the Catherine Bergego Scale ( CBS ) , the Bell Cancellation Test, reading and computerized ocular hunt undertakings, and paper-and-pencil disregard trials. There were three surveies [ 32, 35, 36 ] utilizing BIT entire tonss, three surveies [ 27, 39, 40 ] utilizing both the BIT-C and the BIT-B individually as results, two surveies [ 26, 44 ] utilizing both the BIT entire, the BIT-C and the BIT-B as results. Merely one survey [ 21 ] utilizing the BIT-B entirely as the result.Effectss of rehabilitation intercession1. The optimum intercession for disregard Cohen ‘s vitamin D on single consequence sizes was calculated as the difference between the pre- and posttest agencies for the individual intervention group, divided by the SD of the pretest scores. There were more than one paper about PA, so we pooled the consequence size of PA prior to relative comparing on all consequence sizes. The consequences showed that for immediate effects, PA was the highest one when measured by BIT-C and BIT-B, while CBT was the highest in BIT entire graduated table ; all attacks showed low consequence size in the durable effects ( Table 3a & A ; 3b ) .Table 3a: Immediate consequence size of each attackResultsSurveyApproachEffect sizeBIT-C Ladavas et Al ( 1 ) . 2011 Ladavas et Al. ( 2 ) 2011 Mizuno et Al. 2011 Dad 1.31 [ -0.26, 2.88 ] ( pooled ) Ferreira et Al. 2011 VST 1.16 [ -0.24, 2.56 ] Harvey et Al. 2003 VF 1.15 [ -0.25, 2.55 ] Tsang et Al. 2009 EP 0.71 [ 0.02, 1.41 ] Fong et Al ( 1 ) . 2007 TR 0.50 [ -0.19, 1.19 ] Luukkainen-Markkula 2009 LA 0.27 [ -0.87, 1.41 ] Fong et Al ( 2 ) .2007 TR+EP 0.19 [ -0.48, 0.86 ] BIT-B Ladavas et Al ( 1 ) . 2011 Mizuno et Al. 2011 Dad 0.86 [ -0.45, 2.18 ] ( pooled ) Fong et Al ( 1 ) . 2007 TR 0.16 [ -0.52, 0.84 ] Fong et Al ( 2 ) .2007 TR+EP 0.15 [ -0.52, 0.82 ] Robertson et Al. 2002 LA -0.08 [ -0.70, 0.54 ] BIT ( Total ) Koch et Al. 2012 Terbium 1.46 [ 0.39, 2.53 ] Serino et Al. 2009 Turton et Al. 2010 Dad 0.55 [ 0.16, 0.94 ] ( pooled ) Fong et Al ( 1 ) . 2007 TR 0.40 [ -0.28, 1.09 ] Fong et Al ( 2 ) .2007 TR+EP 0.18 [ -0.49, 0.85 ]Table 3b: durable consequence size of each attackItems Survey Approach Effect size BIT-C Mizuno et Al. 2011 Nysa et Al. 2008 Dad 0.52 [ -0.07, 1.11 ] ( pooled ) Luukkainen-Markkula 2009 LA 0.38 [ -0.76, 1.53 ] Fong et Al ( 1 ) . 2007 TR 0.26 [ -0.52, 1.03 ] Fong et Al ( 2 ) .2007 TR+EP 0.25 [ -0.47, 0.97 ] BIT-B Fong et Al ( 1 ) . 2007 TR 0.26 [ -0.51, 1.03 ] Fong et Al ( 2 ) .2007 TR+EP 0.22 [ -0.50, 0.94 ] Mizuno et Al. 2011 Nysa et Al. 2008 Dad 0.03 [ -0.55, 0.60 ] ( pooled ) Robertson et Al. 2002 LA -0.23 [ -0.85, 0.40 ] BIT ( Total ) Fong et Al ( 1 ) . 2007 TR 0.27 [ -0.50, 1.05 ] Fong et Al ( 2 ) .2007 TR+EP 0.24 [ -0.48, 0.96 ] Koch et Al. 2012 Terbium 1.97 [ 0.79, 3.14 ] Serino et Al. 2009 Turton et Al. 2010 Dad -0.06 [ -0.57, 0.44 ] ( pooled )2. Effectss of rehabilitation intercession versus any control on BIT stepsIn order to see the overall effectivity of rehabilitation intercessions on disregard, we applied a meta-analysis on all BIT consequences refer to standardised average difference ( SMD ) and 95 % assurance intervals ( CI ) utilizing random-effects theoretical accounts. The comparing consequences of both immediate and durable effects based on BIT were summarized in Table 4 and inside informations of single intercessions are presented in wood secret plan ( fig 2a & A ; 2b ) .Table 4 Effectss of rehabilitation intercession versus any control on BIT stepsResult or Subgroup Surveies Participants Statistical Method Effect Estimate 1.1 immediate effects 13 547 Std. Mean Difference ( IV, Random, 95 % CI ) 0.57 [ 0.29, 0.84 ] A A 1.1.1 BIT-C 9 209 Std. Mean Difference ( IV, Random, 95 % CI ) 0.76 [ 0.28, 1.23 ] A A 1.1.2 BIT-B 6 183 Std. Mean Difference ( IV, Random, 95 % CI ) 0.37 [ -0.16, 0.91 ] A A 1.1.3 BIT ( Total ) 5 155 Std. Mean Difference ( IV, Random, 95 % CI ) 0.55 [ 0.16, 0.94 ] 1.2 durable effects 9 400 Std. Mean Difference ( IV, Random, 95 % CI ) 0.21 [ 0.01, 0.41 ] A A 1.2.1 BIT-C 5 117 Std. Mean Difference ( IV, Random, 95 % CI ) 0.37 [ 0.00, 0.74 ] A A 1.2.2 BIT-B 5 145 Std. Mean Difference ( IV, Random, 95 % CI ) 0.04 [ -0.29, 0.37 ] A 1.2.3 BIT ( Total ) 5 138 Std. Mean Difference ( IV, Random, 95 % CI ) 0.36 [ -0.21, 0.92 ]Fig 2a Rehabilitation intercession versus any control, result: immediate effectsFigure 2b rehabilitation versus any control, result: durable effectsImmediate consequence of rehabilitation intercession Fig.2a showed the forest secret plan of the immediate effects of the included surveies. The meta-analysis showed that there was important heterogeneousness across the surveies, the random consequence theoretical account was chosen. The BIT-C had a statistically important average consequence size of 0.76 ( 95 % CI, 0.28-1.23 ; p=0.002 ) . The BIT-B showed no statistically important average consequence size of 0.37 ( 95 % CI, -0.19-0.91 ; p=0.17 ) , and the BIT ( Total ) showed a statistically important average consequence size of 0.55 ( 95 % CI, 0.16-0.94 ; p=0.006 ) . The sensitiveness of each test on the average consequence size was besides assessed by excepting one test one time at a clip. The overall consequence was the same even when any one of the tests was eliminated. Durable consequence of rehabilitation intercession Fig.2b showed the forest secret plan of the durable effects of the included surveies. The meta-analysis showed that there was no statistically important on all results of the BIT-C, BIT-B, and BIT ( Total ) .The impact of each test on the average consequence size was besides evaluated by excepting one test at a clip. The consequence was still non-significant ( p & gt ; 0.05 ) even when one of the tests was eliminated. Pooled consequence of PA on disregard Since there was more than one survey on the consequence of PA, we pooled the consequence size of each result ( Table 5 ) . No statistically important consequences were found both immediate and durable effects in all results with important heterogeneousness.Table 5: PA intercession on DisregardResult or Subgroup Surveies Participants Statistical Method Effect Estimate 2.1 immediate effects 5 216 Std. Mean Difference ( IV, Random, 95 % CI ) 0.89 [ 0.27, 1.51 ] A A 2.1.1 BIT-C 3 74 Std. Mean Difference ( IV, Random, 95 % CI ) 1.31 [ -0.26, 2.88 ] A A 2.1.2 BIT-B 3 74 Std. Mean Difference ( IV, Random, 95 % CI ) 0.86 [ -0.45, 2.18 ] A A 2.1.3 BIT ( Total ) 2 68 Std. Mean Difference ( IV, Random, 95 % CI ) 0.59 [ -0.02, 1.19 ] 2.2 durable effects 4 125 Std. Mean Difference ( IV, Random, 95 % CI ) 0.15 [ -0.20, 0.51 ] A A 2.2.1 BIT-C 2 47 Std. Mean Difference ( IV, Random, 95 % CI ) 0.52 [ -0.07, 1.11 ] A A 2.2.2 BIT-B 1 16 Std. Mean Difference ( IV, Random, 95 % CI ) -0.04 [ -1.06, 0.97 ] A A 2.2.3 BIT ( Total ) 2 62 Std. Mean Difference ( IV, Random, 95 % CI ) -0.06 [ -0.57, 0.44 ]4. DiscussionOur systematic reappraisal indicates that there is modest grounds back uping prism version and oculus patching to cut down one-sided disregard in patients with shot, as shown by the BIT-C both in immediate and durable effects. Other surveies proved positive effects with usage of ocular scanning preparation [ 36 ] , visuomotor feedback [ 22 ] , and TBS [ 46 ] . Since Koch et al [ 44 ] , Merely reported the entire mark of BIT and entire tonss of BIT-C and the BIT-B was non available, it is impossible to pull the decision that rTMS was better than prism version in bettering the public presentation of undertakings from the BIT-C and BIT-B for neglect patients. Harmonizing to this reappraisal, the PA seems slope to had the highest consequence size in immediate effects, but the 95 % assurance interval of consequence size crossed over nothing point, so it is no statistically important when it come to the decision. prism version, a bottom-up intercession affecting sensory-motor malleability, was foremost described by Rossetti et al [ 46 ] based on the phenomenon of visuo-motor version. And has been widely used as a paradigm to show visuomotor short-run malleability [ 47 ] .the process consists of have oning an optical prisms and a series of insistent perceptual-motor indicating motions. The possible nervous mechanism underlying the curative consequence is that prism version reduces left spacial disregard by easing the enlisting of integral encephalon countries responsible for commanding normal visuospatial end product by ways of short-run sensori-motor malleability. This technique have produced some betterment in a broad scope of disregard sym ptoms particularly the ocular 1s [ 48-50 ] . However, some opposite consequences were reported [ 51, 52 ] , The inconsistent consequences likely due to the incomparability of intervention setup, continuance of the intervention, differences in the undertakings used to measure prism version effects and the post-stroke continuance. Similar to PA, oculus patching is another underside up compensational intercession for disregard. In our reappraisal, Tang [ 25 ] reported that the 4 hebdomads application of right hemi-visual field patching demonstrated a important consequence with consequence size of 0.71. This technique concentrates the patients ‘ attending on the contralesional infinite by barricading the ipsilesional ocular field, which lessens the disinhibition to the pointing mechanism of the ipsilesional side ensuing from interhemispheric instability. But more good quality RCTs is needed for measuring the existent impact on disregard. The theta-burst stimulation ( TBS ) is a sort of insistent transcranial magnetic stimulation ( rTMS ) which showed comparatively high consequence size as measured by the BIT entire tonss in our reappraisal. Transcranial magnetic stimulation ( TMS ) has become a popular method to excite the human encephalon, Insistent stimulation ( rTMS ) has particularly gained involvement for its curative potency to modify cortical irritability [ 53 ] , which throw visible radiations on the usage of the inter-hemispheric competition theoretical account in explicating the recovery after neglect upset in shot patients [ 54-57 ] . Harmonizing to these surveies, the insistent Transcranial Magnetic Stimulation ( rTMS ) induced and repaired the interhemispheric instability ( a neglect-like behaviour ) in the left or right posterior parietal cerebral mantle in healthy worlds. Based on these findings, some surveies were conducted to research whether this attack may be utile in advancing clinical recovery fr om disregard and the consequence is assuring [ 57-60 ] . Compared to traditional standard cognitive intercession, rTMS can speed up clinical recovery and more effectual in bettering standard trials. And it seemed that the severely patients at baseline benefited more from the intercession. However, the different result measurings and clinical test methodological restriction made it impossible to pull any decision based on robust grounds. This reappraisal can non reply inquiry refering the best beginning clip for neglect rehabilitation intercession, because that most participants of the included surveies were recruited in either the subacute or chronic stages. Merely few surveies implemented rehabilitation to pretermit within one month after stroke [ 26, 27 ] . As most of the self-generated recovery after shot was happened in the first month [ 61 ] , in order to avoid the confounding of self-generated recovery, farther research is necessary to find the effects of an earlier rehabilitation against natural recovery of one-sided disregard after shot. Neglect is the best individual forecaster of long-run functional damage and hapless result in the early phase [ 62, 63 ] , and recent surveies on the mechanism of neglect emphasized more on the secondary alterations of remote web related to attending [ 64 ] . A survey [ 65 ] based on neuroimaging showed that at two hebdomads after shot, the usually functional connectivity be tween left and right dorsal parietal cerebral mantle was disrupted and the grade of dislocation correlated with the badness of left spacial disregard. So it is sensible that patients should get down neglect intercession every bit shortly as possible in the acute phase in order to avoid erudite no-use occurred over the neglect side by increasing multisensory inputs or stimulation to the ipslateral encephalon parts and decelerate down the secondary alteration in the encephalon relation to pretermit. For farther research, we recommend earlier intercession and adequate follow up to maximise the benefit and proctor persist consequence of disregard rehabilitation and functional results. Our reappraisal indicates that the BIT conventional subtests and the BIT entire mark may be used to mensurate the immediate effects on one-sided disregard as the entire average consequence size on immediate effects was 0.76 and 0.57 severally, which can be consider as clinically important [ 66 ] . The BIT behavioural subtests should non be used entirely as an result as we could non establish any satisfactory consequence in the BIT-B as the consequence size is excessively little ( average immediate consequence size=0.37, average durable consequence size=0.04 ) to make any statistical important consequences. Restrictions of the reappraisal The reappraisal exists some restrictions. The quality of the included surveies limits the determination of this reappraisal. Although there was an betterment in the coverage quality as the average sum mark in this reappraisal was 6.08 A ± 0.81 ( ranged from 5 to 9 ) as rated by the PEDro, which is higher than that of the antecedently reported mark 4.56 A ± 1.54 with a scope from 2 to 7, obtained from the overall RCTs in another reappraisal of neglect rehabilitation [ 7 ] . The intention-to-treat analysis is non satisfied by any of the surveies. The sightlessness design is still the most failing of these RCTs. The heterogeneousness of surveies included meant this meta-analysis is less powerful and could non place a conclusive optimum intervention approach.in add-on ; extended hunt may acquire more surveies to beef up the decision.DecisionPrism Adaptation ( PA ) appeared to be the most common and effectual scheme among rehabilitation intercessions on one-sided disregard and rTMS po ssibly is a promising attack for intervention of one-sided disregard. Rehabilitation intercessions have positive immediate effects on one-sided disregard as measured by the BIT conventional subtest than that on the behavioral subtest. As shown by the short durable effects, effects of rehabilitation intercessions are frequently transeunt and frequently can non be generalized across clip to daily working. All surveies faced the same failing of lower power with smaller samples and restriction in sightlessness design. More strict surveies should be done before coming to a steadfast decision.

Loneliness †theme within Steinbecks ‘Of Mice and Men’ Essay

Loneliness is the theme ‘Of Mice and Men’ by John Steinbeck. He describes loneliness, and secluded lives of men who work on the ranch. George and Lennie who together share a dream, their partnership of farming their own land. Mutually they partake in a relationship so rare, travelling so many miles together building independence upon one another. Lennie’s loving puppy-like character has its advantages and disadvantages. His natural simplicity is also considered as naivety, which in many cases leads to disaster. For instance he reverts to fighting when he can’t get his way ‘Crashing back through the bush.’ This proves his childish qualities and immaturity. As with George who adopts a father figure role is by far more realistic, sensible and reliable. He’s independent suggesting that ‘I could get along so easy and so nice if I didn’t have you no my tail†¦live easy and get a girl.’ Alone the two would not survive the cruel ways of the world but together as where one lacks the other gains building a strong companionship. We discover further information about the lonely lives of specific characters living on the ranch from chapter two onwards. Steinbeck at the beginning of chapter two sets the scene. He illustrates the deserted spread of land of which, Lennie and George come across ‘the ranch.’ They encounter an unfamiliar face by the name of Swamper, a crippled old man who introduced them to the bunkhouse and discussed Whitey a former worker. Whitey was a blacksmith, was strangely hygienic and kept himself to himself. He had the tendency to dress-up even when he wasn’t going anywhere ‘put on a necktie even’ as the swamper described. He had recently quit as he had an issue with all food. This I feel shows a life of very small meaning. I can’t imagine anyone who is completely fulfilled to pick at food for the reason of just because? ‘Gimme my time.’ This I think is Steinbeck showing some evidence of loneliness. A man could be so desolate that he would look to find any excuse to make a fuss, to be noticed. He seemed to create the excitement in which he lacked so desperately, dressing up on any occasion possible a reason to wake up each morning! A character in the story that experiences loneliness is the swamper also known as Candy. A friendly and elderly man, who has worked at the ranch for many years. He stays at the bunkhouse with a dog as a companion. Candy and his dog are inseparable. Candy depends on the loyal hound, and they have shared many happy times together. Later on in the story, Candy’s dog is forced to be put down for the reason that the rest of the workers disagree for the nasty and decayed mutt to be kept alive. The workers constantly complained of the redolence of the dog However, Candy and his dog were literally attached by the hip and the stench had become unnoticeable and became part of Candy he ‘had been around him so much †¦ I never notice how he stinks.’ This I think explains part of Candy’s loneliness that without his dog there is a great emptiness within him. George and Lennie soon befriended Candy after the death of the dog, proposing a chance to go into business together. This seems like the opportunity of a lifetime to Candy, his hope for companionship and a secure job to rely on. His destiny to find fulfilment in many respects has come true and will do any thing in his own power to make sure it’s not taken away from him. Another character that is lonely is Curlys Wife an attractive woman with full rouged lips and wide spaced eyes, heavily made-up. Fingernails painted red, hair hung in little rolled clusters. She was known to be flirtatious with a bitchy personality, a terrible reputation. Curlys Wife had seen life as a disappointment failing in her life’s goals ‘coulda been in the movies’ said so frequently and her bitterness towards anyone who was happier or more successful than herself. She is found picking on those less fortunate than her as when she made the remark ‘They left all the weak ones here,’ clearly it obvious that the comment was meant to be offensive. A reason for all this cruel behaviour may be loneliness Curlys Wife has no friends and a husband that ignores her. He never seems to be around ‘Any you boys seen Curly?’ He’s usually in a hoar house or out with the guys. Although, extremely over protective of her. The ranch workers had little respect for Curlys Wife by speaking of her as something of Curlys, no importance she often feels that she is never wanted. Curlys Wife discovers Lennie’s desire of her in which she takes of advantage of. For once there is someone with an interest of her ‘I get lonely†¦ I never get to talk to nobody.’ When Curlys wife hides behind the make or makes rude remarks it could be because she’s insecure within herself, lacking confidence so when she puts people down it makes her feel better. The character that experiences the most loneliness is Crooks also known as the Nigger. He is crippled from a damaged spine resulting in an odd shape figure (hunch back). He is described to have ‘eyes deep in his head †¦ his lean face was lined with deep black wrinkles, and thin pain-tightened lips which were lighter than his face.’ Crooks lives alone as around the time the story was set to be in there were race issues causing discrimination, which was unfortunate for Crooks. Over the years of working in such a secluded environment Crooks seemed to have become bitter and nasty warning people away ‘Don’t come where you’re not wanted’. Crooks seemed to talk to no one other than Slim ‘a real skinner he looks out for his team.’ Crooks respected Slim, as he was the only one who would treat him as if he were a human being. You learn about Crooks when Lennie approaches him in his bunk. At first he is completely against the idea and tries to worry Lennie with the thought that George maybe hurt or unable to come back ‘Spose he gets killed, or hurt so much, he can’t come home.’ This was poof of Crook’s evil way of thinking leaving Lennie’s mind running crazy but he shortly reassures him saying he will come back, no need to worry. We discover later that Crooks lived a happy childhood playing with the white kids from next door. He also had close relationships with his brothers. It was later on in life that the harsh world ended up him living such a lonely life. He is self-conscious, believing no one to ever like him so when he meets Lennie and discovers he actually takes interest in him, he is shocked and even suggest to help in the assistance of the business between George, Candy and Lennie when he over here the discussion between the three.