Europeans coming to America DBQ Essay Example for Free

Europeans coming to America DBQ EssayIn the 14th century the Europeans set expose to find an all water route to Asia to trade and get spices, silks, gold, porcelain, and other riches. Little did they no they ended up being the first Europeans to explore the freshly World. Once the in the altogether World was discovered, more and more explorers continued to venture out to this New World. The European explorers kept on coming back to the New World for wealth, an increased amount of power in Europe, to spread the Christian religion, and many more. The arrival of the Europeans impacted the lives of primordial Americans in negative ways, the natives died from disease the Europeans brought, were move into slaves, and had to assimilate to new land. Although there were many negative effects of their arrival there were positive impacts as well such as the exchange of resources. The Europeans changed the Native American ways of life forever. One of the reasonablenesss the Europeans c ame to the new World was to acquire gold. Nicolas Le Challeux who sailed from France in 1565 stated this country was rich in gold (Document 2). collectible to the fact that gold was the primary goal to conquistadors, Pizarro and Cortes came to the New World in order to conquer gold filled land. Pizarro and Cortes specifically went to the Aztec and Inca empires because the temples were made of gold. According to the interpret entitled, Exports of Gold and Silver from the New World to Spain, it was very clear that within these years, 1576- 1580, much gold was exported from the New World to Spain (Document 3). This is because Pizarro and Cortes conquered the Aztec and Inca empires and took gold. Gold was a big reason for the European Explores to come to the New World.

Survay Research on Villians Essay Example for Free

Survay Research on Villians EssayEvolution of Evil Since television system had become a household product in 1947 it has been used by parents to help educate their children in a certain manner to which they may go out depending on their age. In present day America television shows much(prenominal)(prenominal) as Sesame Street and Reading Rainbow usu eithery start by t severallying staple fiber skills such as reading, writing, and spelling to infants by victimisation different methods such as the alphabet song to make it easier for kids to comprehend.These shows and others a desire also began to teach ethical motive such as sharing, doing your part, and helping others less fortunate by using certain mascots such as a giant purple dinosaur to appeal to their childish look while teaching them lessons they will use all of their life. Once these lessons are fully comprehended by the kids villains, such as Scar from The king of beasts big businessman and Plankton from SpongeBo b, specifically geared toward children were introduced to expose children to character traits that opposed the very morals that were taught to them.These villains were usually inherently evil usually having no reason to oppose the wedge shape other than simple emotions such as jealously or greed being their motivation to do actions that are deemed as bad such as lying, cheating, and stealing. As these kids grow up and deal with certain situations with real villains in their own life their perception of true evil changes as they experience more than own their own and develop more complex in depth relationships with pack.As these kids mature into teens and adults that can comprehend more complex emotions, the villains that are pictured in the media obtain more human like features. I decided the best way to gain useful information would be to purview thirty college student that are in my age group so I could determine which villain that was created for children in the 1990s is the most memorable and why. Then contrast how they differ from the villains that are created for those same kids ten years later in present day society.I decided I would poll students in all my classes except those in my English class to ensure that I could obtain the pursueors honest execute to the questions I would ask. I asked those students in my class to answer my eight questions that included a rank and fileing system that would allow them to rank cartoon villains from the 1990s as the most or least memorable using the numbers 1 through 5 with 1 being the most memorable. I asked the same ranking question again, but with 5 illustrious villains represent in present day media while allowing space after ach question to explain why or why they werent scared of the villain they bedded as the most memorable during their childishness and present day. I targeted my survey toward a certain age group to try to find a conventionality in the answer to which characters are the most mem orable and why they are memorable. I knew when analyzing the information I received I would have to take accounting the booster the villain was opposing and what makes them so memorable as well. I asked thirty people how much television they watch during the week and twenty-one reveal of the thirty utter they watch at least one hour a day.Out of the childhood focused questions the group of villains consisted of Hades from Hercules, Scar from The Lion King, Jafar from Aladdin, Mojo jo jo from the The Powder-puff Girls, and Plankton from SpongeBob Square Pants. Out of the five villains Scar from The Lion King just rank was 2. 33 which named him the most memorable character. Out of the seven survey takers that ranked Scar as the most memorable five out of the seven stated that they were not scared of Scar and that it was fairly easy to rede why he was the villain and why he did the mischievous things that he did.Of those five that were not scared of Scar explained that The Lion K ing was a gentle hearted cartoon movie about animals in the wild. The least memorable character was Mojo Jo Jo from The Powder-Puff Girls with an average ranking of 3. 81 out of 5 by the survey takers. Of the two role players that named Mojo Jo Jo the most memorable character one stated he was afraid of Mojo Jo because he saw a part of himself in Mojo Jo Jo. The other participant stated that Mojo Jo Jo was just misunderstood and was in fact not at all scary.Out of all five villains available 19 of the 21 surveyors who watched television as kids ranked the complexity of their most memorable characters as easy or fairly easy to understand. I then questioned the surveyors about five famous fictional villains displayed in todays media. The list of villains included Jigsaw from the Saw, bomb from The Dark Knight, Green Goblin from Spiderman, Lord Voldemort from Harry Potter, and Darth Vader from Star Wars where the Joker received the highest average ranking of 2. 3 out of 5 of the mos t memorable villain of present day media. Four of the seven people that said Joker was their most memorable villain were scared of Joker and described his motives as questionable and his personality as a bad Mother Fucker. The triad of seven that wasnt scared of Joker described him as an interesting character, a great villain, and having memorable actions. The least memorable villain of these five new-fashioned day villains was Jigsaw from the movie Saw who had an average ranking of 3. 91 out of 5 between the thirty participants.Although Saw was the least he seemed to be the most confusing character as the three people who ranked him as the most memorable stated they were complete unsure of his motives and the reasons for his actions. On average when asked about the complexity and morale standings of these present day villains the results mirrored those of the cartoon characters with a 19 of 30 surveyors giving their most memorable villain a raking of 3 or higher. After analyzing the results to childhood questions, I believe The Lion King is the most relatable movie to kids.This movie more so than the others touches on basic principles that kids are learning during that age such as greed, jealously, and rebellion which is why it is no surprise that it is the most memorable. Simba, the sexual love-able misunderstood tiger who seeks his rightful place as king, is opposed by Scar the symbol of evil that shows no moral empathy with the wrongful acts he commits toward his own nephew. Scar lacking of empathy allows viewers to clearly understand Scars motives leaving little room for confusion for the movies immature audience.On the other hand Joker seems to be completely non-relatable to most people of major society because of his questionable motives that drives the evil actions that he commits. Of the list of five present day villains only Jigsaw and Joker challenge the moral divisions of the hero they are opposing which in turn the allows the viewer to questio n their own moral standing about certain questions such as save the love of your life, or the city that your love. These type of interesting questions arent one people are likely to face in reality.Watching a character like Joker question the moral standing of Batman gives the viewers the chance to look inwardly where they usually would not. By observance the hero and understanding the reason why he made the choices he does gives the audience to analyze the choice they would make in the shoes of the hero which in turn makes the villain causing these choices to be so memorable. Surprisingly nine of the thirty participants said they didnt watch television as they were growing although but were still familiar with the characters and able to rank them because of the conversations they had with their friends.Four out of the nine participants said that they were not allowed to watch television that wasnt solely educational. Two of the nine participants said they did not own a television inside of their home and only saw movies every once in a while. Three out of the nine simply stated that had no time or interest for television and were wrapped up in other things such as travel sports and other time consuming hobbies as kids.However 5 out of 9 of those who did not watch television as a child ranked Joker with either a 1 or 2 as their most memorable character which shows the popularity of Joker to even those who may or may not having grown up watching Batman. The media of present day in comparison to the movies and shows of the 1990s seemed to portray the most interesting villains are the ones that are complex and cause a question of morality of the hero which then in turn questions the audience.These questions of morality such as is it okay to kill someone whom harms others can only be answered by each individual viewer by challenging the very believes that are molded into most kids as they are growing up. The most famous characters and villains of are childhood ar e those that visual show and teach life lessons that we use today, but the villains that challenge those very beliefs as adults leave a lasting impression of self-fulfillment and moral standing in which each individual carries daily.

Death into the Wild Essay Example for Free

Death into the Wild EssayInto the Wild was Jon Krakauers best selling non-fiction novel about the adventures of Christopher McCandless. In essence it was an expansion of his earlier work entitled Death of an Innocent which appeared in the January 1993 issue of Outside. The novel chronicles the experiences of Chris McCandless, the 24-year-old nature enthusiast who left his suburban Washington, D. C. , house in 1992 for a wilderness trek by Alaskas backcountry.Equipped with a 10-pound bag of rice, a small-caliber rifle, and not much else, McCandless fashioned himself into a modern-day American Adam determined to explore the nations Last Frontier. The excursion, however, came to an abrupt end four months later with McCandless emaciated corpse discovered in an abandoned school pot not far from the boundaries of Denali National Park. Into the Wild presents Krakauers account as to what drove McCandless to such a fate.Between the time of its appearance in 1993 to its publication as a book in 1996, Krakauers story elicited numerous responses, including many from Alaska residents who derided the author for glorifying what they saw as nothing more than a young mans folly. For these readers, McCandless stand for just another ill-advised undivided who ventured unprepared into dangerous country in the hope of discovering answers to his life, which was merely met by mosquitoes and a lonely death (72).As I reckon such a perspective fails to account for the significance of Krakauers novel within the genre of narrative non-fiction. In lieu of this, what follows is an explication of the authority of Krakauers methodology in the process of explicating the story of McCandless into the wild. Narrative non-fiction takes the form of a documentary as far as it opts to elucidate the objective conditions cardinal the formation of a particular situation. A literary work within the genre of narrative non-fiction may thereby be understood as a creative treatment of actuality ( Carroll 154).The aforementioned notion whole caboodle on the assumption that literature may be able to shape reality creatively through the introduction of an artistic dimension within a literary piece. Such a dimension however, which necessitates the introduction of an aesthetic aspect within the text contradicts the foundations of whole kit and caboodle of non-fiction which involves the maintenance of objectivity within the text. Objectivity in this sense is assessed through the authors general appraisal of the events presented within the text.In that sense, objectivity takes the epistemological form of objectivity wherein it understood as objectivity in judgment. Such a form of objectivity is maintained within works of non-fiction since such works are understood as the authors account of an event. To understand a work as an account enables the application of fluidity upon the work since it is presented as open to interpretation as well knowledge and truth coercion. Such a proc ess of truth coercion may be seen in Krakauers narrative of McCandless journey into the wild.Into the Wild begins with a narrative exposition wherein the reader is introduced to the major characters of the story along with the necessary background information needed to contextualize the discovery of McCandless corpse. The beginning of Krakauers Into the Wild thereby is highly similar to the expository beginning of a novel. Such a beginning enables the skillful orchestration of a preconceived conception of McCandless story. It enables the conception of McCandless as an individual who ventured for the discovery of his self through the discovery of a presumed unknown territory.Krakauers work thereby functions as a vehicle for the readers discovery of McCandless journey towards himself. Such a journey was enabled by the collage of various materials that enabled the factual retelling of McCandless life up to the point of his demise. The process of contextualization mentioned above was ma de possible by using materials from interviews as well as McCandless journal along with photographs, letters, and other secondary research materials that enabled the explication of the conditions as to McCandless adventures.The use of these varied materials enabled the book to be a moving literary piece formulated through the combination of journalistic, historical, nature and travel writing, as well as memoir writing. It should be noted that these materials as well as the formation of the collage of the aforementioned materials were constructed by the author. Into the Wild thereby presents us with Krakauers account of the events. As I reckon, it is the construction of the narrative as well as Krakauers presentation of the account, which serves as his take into the events that governed McCandless existence.Other individuals perceived McCandless act as an act of folly however, Kraukaeur presented it in such a manner that it focused on the adventure and drama, which he perceives as i ntrinsic to the act of finding or discovering ones self. Within the book, he represented McCandless as an extraordinary individual whose existence was governed by courageousness and skill evident in his demonstration of McCandless desire to survive within an unchartered territory.Kraukauers analysis of the risks examined as well as the narrative organise of text presented Krakauers judgments as to the life that McCandless led.Works CitedCarroll, Noel. Fiction, Non-Fiction, and the Film of Presumptive Assertion A Conceptual Analysis. Philosophy of Film and Motion Picture An Anthology. Eds. Noel Carroll and Jinhee Choi. Oxford Blackwell Publishing, 2006. Krakauer, Jon. Into the Wild. refreshed York Villard, 1996.

Samurais Values In The Tale Of Genji English Literature Essay

Samurais Values In The Tale Of Genji English Literature EssayThe Tale of Genji is one of the greatest works in Nipponese and world literature. It was created at the turn of X-XI centuries, in the era of rapid formation and flowering of Japanese culture.Its author was a lady, known as Murasaki Shikibu.This books tells about the bread and butter of that period in Japan, having some historical incidents, including the life and traditions of samurai. It tells about the life ofGenji, a son of theJapanese emperor, alike known as Hikaru Genji.The tale concentrates on his romantic life and describes the customs of the aristocratic society of the time. Genjis was a well known man, respected and honorable, and also a dependable looking. His most important temper trait is the loyalty, the trait he shows to all the women in his life.Once Genji found a house on Gojo, over the roof of which he saw a green vine, with beautiful white flowers called yugao the twilight beauty.Soon Genji got acqu ainted with the lady of the house, they fell in love with each other, and he visited her e actually night. However, their happiness did non last long, as an evil spirit possessed Yugao and she suddenly died.Genji was so upset, he blamed himself for the death of his love. There is no telling how depressed and thwart he was. ( Puette, William J, 78)At the same time he kept everything in a secret, non to let bothbody know what had happened, as it was a question of his reputation.With the attend to of Koremitsu, his confident, Yugaos funeral was held secretly, but with all due respect.One evening, one of Yugaos servant ladies Ukon told Genji who her mistress really was. Although she had blue blood in her veins, Yugao lost her parents when she was little. So shy and basal was Yugao that she would hide everything behind her sorrowful smiles. But her memories would never perish from Genjis heart.It is important to point out, that the main character was a samurai, so he had certain va lues. An picket of Samurai Bushido is the unwritten code of conduct of Samurai in the society, it is a set of rules and norms of the true ideal of a warrior. Bushido means the way of the samurai, the warrior, in addition the word is also translated as duty, morality.Thus, bushido is samurai morality, virtue, moral and ethical code. Bushido is a practical morality, samurai believed it is method of improving mental and physical health.Bushido was designed to teach proper life in feudal Japanese society.It combineda theory of existence and the study of the human psyche, and solved issues related to the notion of the essence of the individual, its role in the world,meaning of life, good and evil, moral values and moral ideal.Samurai was keenly awareof their moral duty, in particular their personal responsibilities in relation to overlord, had to assess their own actions and deeds,morally chafe themselves if misconduct, breach of duty.( Puette, William J, 145)The main value of samu rai, first of all, was loyalty to overlord, expressed in service to overlord, to be of service is to put another above yourself. Loyalty is subjection or a devotion to a person or cause. It reliedthe provisions of loyalty, drawn from Shinto, Buddhist belief in impermanence of all earthly things, which beef up from a samurai spirit of sacrifice and do not fear death, and philosophy of Confucianism, which made loyalty of the first virtue. Near loyalty was the principle of duty. (Shirane, 45)One of the blusher value of Samurai was personal courage, unbending courage. True courage is to live, when lawfully to live, and die when lawfully to die. Samurai should go to the death with a clear consciousness of what to do and that is not worth his dignity.The sense of honor is also very important. The consciousness of self-esteem is brought up in Samurai from childhood.Warriors strictly guarded their good name, a sense of pity was for the samurai hardest.We can see at in the book, while G enji always behaved with sense of honor, he said I should weigh every word and always communicate myself, is it true that Im going to say. Also Genji was polite with women, he showed his good attitude and manners to all the women in his life, as he never abandoned any of them.He hadthe true goodness of the mind and spirit, the unbiased kindness to do good.Honor and glory valued higher than life for samurai, .In all his actions samurai was supposed(p) to come from considerations of the higher justice and fairness. A true samurai had only one judge of his honor himself, as you cannot hide from yourself.It is important to point out much(prenominal) value as the Wisdom of Honesty, as honesty is the human quality of communicating and acting truthfully, related to truth as a value, and Genji tried to be honest, and first of all with himself.So The Tale of Genji is one of the greatest works in Japanese literature, as it truly depicts life and traditions of samurai in that time. The ta le of Genji shows socio-philosophical traditions of the society, it is inclined to samurai tradition, existed for thousands of years.Those looking fierce and tough warriors, ready at any time to resort to his sharp shiny swords, were stern and ascetic life, full of inner control and poetry. Their whole life comes down to, to die with dignity, while maintaining their honor. Their world is based on honor, generosity, service, courage, sacrifice and a highly developed culture.Love theme is reflected very touching in the book, and sad heartfelt poetry with oriental motifs emphasizes the dramatic, romantic atmosphere and a samurai love theme of the book.Feel the deep meaning, a philosophy, and revel the overall beauty of the book, and also learn a lot from the eastern people patience, generosity, diligence, discipline, ability to appreciate every moment of life lived Work citedPuette, William J. watch to the Tale of Genji by Murasaki Shikibu. Rutland, (1983)Shirane, Haruo.Envisioning the Tale of Genji Media, Gender, and Cultural Production. New York Columbia University Press(2008)Morris, Ivan.The World of the Shining Prince. New York, 1994.Mostow, Joshua S. Picturing The Tale of Genji.The Journal of the Association of Teachers of Japanese.April 1999. (1-25)

Elements of a Good Nursing Report

Elements of a Good Nursing ReportIntroductionThe mechanism of the breast feeding topic is a comparatively old-fashioned one. Certainly it was routinely used in the pre-Nightingale era of nursing and at that place are reports of much(prenominal) formal handover mechanisms in Chaucer and other medieval writings (Carrick P 2000). As the nursing profession has evolved over time, the requirements, expectations, demands and indeed the procedures employed in the giving of the nursing report, have also evolved and become more formalised. ( mason T et al 2003). The giving of the report can be a very useful procedure on many different levels. Obviously there is the give of knowledge between members of the nursing team, but the report also has the potential of serving more subtle purposes such as increasing team bonding, team motivation, engendering of good enough working invests and increasing patient em passagey amongst the whole nursing team. It also can serve the purpose of a foru m for the interchange of ideas between captain members of mental faculty. (Yura H et al. 1998). Other sources suggest that the peer mechanical press experienced by the new or student nurse, can shape their own practice by detect the attention to detail (or otherwise) as the report is presented. (Fawcett J 2005)We note that the procedure has the potential for these purposes, as with all processes that involve human input, there is inevitably an inbuilt variability of process. It is rarely perfect and a number of studies have shown that its standard and content can vary across a spectrum from excellent to abysmal (RCN.2003)If we postulate the evidence base for this statement, we can beat support in two landmark studies that have been completed. The two authors ( both(prenominal) Danes) coincidentally produced studies which were published in 1992 (Ljukkonen A 1992) (Kihlgren et al 1992). The latter study was structured in a way that analysed the goal components of the nursing reports in several large hospitals over a three month period, it then offered a period of training on improving the content and delivery of the reports, and then remeasured the staff performance using the same set of quantity parameters.The motif itself is both long and detailed as well as being particularly analytical. To condense (and paraphrase) the findings of the initial section of the writing we can make the findings that the initial reports were found to beHighly task oriented and (it was noted that) the staff often discussed the patients reaction in vague and general terms without imparting any specific or useful info.The authors went on to comment that structure was frequently absent or minimal and the nursing process was seldom in evidence.After the superior feedback sessions, the second analysis period showed a marked change to the fundamental nature of the reports to the extent that they now included the observation that there wereMore messages per report after th e intervention compared to the control ward and the messages with psychosocial content had doubled. This was reflected in a greater appreciation and satisfaction on the part of the receiving nurses and a demonstrable improvement in team empathyWe note that the authors stated that in organising the mid-section training sessions they utilised the research work of Orlando (et al. 1989), who crystallised the essential elements of the nursing report into the basic concepts of prioritisation, confabulation and presentation skills, together with instruction of the important ingredients of the actual nursing report.The Ljukkonen (A 1992) paper has similar findings but was set in two nursing homes for the elderly where the authors found that the low turnover in patients was the prime reason for the decline in nursing report standards observed. The lack of trophic peer pressure was also considered to be a major relevant factor.The comments cited by Yura (regarding team cooking) earlier in t his essay have their origins in this paper. Charboyer (2001) expands them further with the suggestion that a vital part of the nursing process is the ability to interact with all of the other members of the nursing team, both in terms of hearing (learning) and expressing opinions.These two document effectively pose the unformulated question just what elements are ideally required in the definitive nursing report?. We can take the lead from the Kihlgren paper which considered the work of both Orlando and Dugan (1989) who analysed the essential elements of the nursing report and categorised them asPrioritising care and patient require.Communication Skills.Non-Judgemental Approach.The precursors of these elements were initially formulated in a paper published by Orlando in 1987 (Orlando I. J. 1987) who suggested that it was a fundamental function of the nursing process to prioritise the patients needs after elucidating them and use these sensed needs to instigate and plan an appropr iate course of action which could be presented at the formal nursing report. He conceded that such an analysis was a function of the individual and unique interaction between patient and healthcare professional (by implication, the nurse) and that the nurse should ideally use their communication and analytical skills to present their assessment to the professional colleagues.These concepts eventually evolved into Orlandos preposition that the backbone of the nursing report would be this analysis and prioritisation of the patients perceived needs and their presentation in a crystalline sequence. Orlando concludes his original paper with the comment that this plan should be enunciated and modified in accordance with the patients illness trajectory at to each one successive nursing report so that the stated goals can be achieved as expediently as possible.We have made earlier reference to the immenseness of good communication skills in the nursing report. It follows from our previo us discussions that the communications skills must also ideally be in evidence between the healthcare professional and the patient in order for the nursing report to have maximal relevance (Arnold et al 2004). The importance of this comment can be judged from the fact that interpersonal communication is considered to be one of the six core attributes in consideration of optimum personal effectiveness in the modern nurse manager (ICN 1998).The traits and deficiencies in the area of communication in general, identified by both Ljukkonen and Kihlgren, were studied in greater detail by Heinmann-Knoch (2005), who analysed the topic in direct parity to the nursing report in admirable detail and went on to suggest the mechanisms by which such deficiencies could be foretelled. If we accept, as Davies (et al. 2002) enunciates, that communication is a skill that is seldom innate or totally intuitive it has to be learned, acquired and actively practised.Other authors point to the fact that o ther common failings of the nursing report include elements such as stereotyping or judgementalism. (Brechin A et al. 2000). When such elements are found to be present they clearly cross not only professional boundaries but also moral and ethical boundaries as well. (Stowers K et al. 1999)Eye run into is an often overlooked element of professional interaction either between nurses themselves or between nurses and their patients. Eye contact implies attention and respect and can signal perceived degrees of dominance and submission in the pecking order (Hurley R 2006). Similarly lack of centre of attention contact can imply ignorance, confusion, indifference, and ineptitude (fieldsman A 2000). As a communication tool it can be used to advantage by the hot professional nurse both to elicit information from patients and also to ensure attentive listening in the nursing report situation. (Platt, F W et al. 1999) system speech is another often overlooked element in the art of communic ation. It has not received a great deal of overt scrutiny in the peer reviewed medical press but the majority of experienced healthcare professionals would attest to its value in both eliciting and conveying information (Edmondstone W M 1995). There is a considerable body of evidence to suggest that body language and nonverbal communication has a greater ability to impart information relating to the sincerity of the speaker than the words they are using (Trimboil A et al. 1997), equally it can be used to advantage when trying either to elicit or to suppress a response from the recipient (Tomlinson J 1998).Reflection is a vital part of the learning process. It has been described and modified by many authors. Taylor (2000) suggests that it should be an active process embarked on after the event so that memories and perceptions of a situation can be rationalised and appropriate strategies considered for more optimal outcomes. Palmer (2005) observes that reflection is both a professiona l requirement and also a dynamic process whereby the practitioner will be prepared for any similar occurrences and can build a knowledge base to enhance his or her practice, and therefore grow as a professional. On a personal note I find that the Gibbs reflective cycle (Gibbs, G 1988 ) is both convenient, practical and usefulIt is beyond doubt that the nursing report, in its ideal form, should be carefully constructed, structured and prepared. It should address all of the needs of the patient not only the medical and nursing ones, but as Hendrick, (J. 2000) points out it should also address the more subtle needs of the patient such as their psychological, socio-economic or social needs as well, if they are appropriate. Its proper delivery is not just a matter of notice or the last item on the shift for the departing staff nurse, it is one of the fundamental tools of the nursing profession and needs to be prepared, considered and focussed before it is truly invoked. The messages that the nursing report conveys are not solely those messages that relate to the continued nursing care of the patients, but also those that speak to the professional expectations of the nurses. Those who listen to their peers delivering the nursing report in a professional and intelligent way are more likely to be indoctrinated with professional attitudes and ideals than those who view the report as scant(p) more than a nuisance at the beginning of their shift. (Clarke J E et al. 1997). The nurse who uses all of the tools of communication, including presentation, positive body language and meaningful eye contact together with clear unequivocal language is far more likely to make a positive and dynamic impression with her report than the nurse who simply puts together a few sentences relating to each patient. (Hewison, A. 2004)References Arnold Bloggs 2004Interpersonal Relationships Professional Communication Skills for NursesLondon London Meridian 2004Brechin A. Brown, H and Eby , M 2000Critical Practice in Health and Social CareOpen University, Milton Keynes. 2000Carrick P 2000Medical Ethics in the Ancient WorldGeorgetown University press 2000 ISBN 0878408495Chaboyer, Najman , Dunn 2001Cohesion among nurses a comparison of bedside vs. rush nurses perceptions in hospitals.Journal of Advanced Nursing 35 4, 526-532Clarke J E Copcutt L 1997Management for nurses and Healthcare Professionals.Edinburgh Churchill Livingstone 1997Davies Fox-Young 2002Validating a scope of nursing practice decision making frameworkInternational Journal of Nursing studies 39 , 1 , 85-93Edmondstone W M 1995 Cardiac chest pain does body language help the diagnosis? BMJ , Dec 1995 311 1660 1661Fawcett J 2005Contemporary Nursing Knowledge Analysis and Evaluation of Nursing Models and Theories, 2nd EditionBoston Davis Co 2005 ISBN 0-8036-1194-3Fielder A Book Sight Unseen BMJ , Jan 2000 320 66 Gibbs, G 1988Learning by doing A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988Heinmann-Knoch, Korte, heusinger, Klunder Knoch 2005Training of communication skills in stationary long care homesthe evaluation of a model project to develop communication skills and transfer it into practice Z Gerontol Geriatr. 2005 Feb 38 (1) 40-6.Hendrick, J. 2000 faithfulness and Ethics in Nursing and Health Care,London. Stanley Thornes 2000Hewison, A. 2004Management for Nurses and Health Professionals Theory into practice. Blackwell Science Oxford.Hurley R 2006 Ways of seeing BMJ , May 2006 332 1219 ICN 1998International Convention on NursingScope of nursing practiceGeneva ICN 1998Kihlgren, Lindsten, Norberg Karlsson 1992The content of the oral daily reports at a long-term ward before and after staff training in integrity promoting care.Scand J Caring Sci . 1992 6 (2) 105-12.Ljukkonen A 1992Contents of daily reports and nursing practice in 2 homes for the aged Hoitotiede. 1992 4 (5) 194-200.Mason T and Whitehead E (2003)Thinking Nu rsing.Open University. Maidenhead. 2003Orlando, I. J. 1987.Nursing in the 21st century Alternate paths.Journal of Advanced Nursing, 12 , 405-412 1987Orlando, I. J., Dugan, A. B. 1989.Independent and dependent path The fundamental issue for the nursing profession. Nursing and Health Care, 10 (2) , 77-80 1989Palmer 2005Palmer in Learning about reflection from the student Bulpitt and Martin Active Learning in high Education. 2005 6 207-217.Platt, F W Gordon G H 1999Field Guide to the Difficult Patient Interview 1999Lippincott Williams and Wilkins, pp 250 ISBN 0 7817 2044 3London Macmillian Press 1999RCN 2003RCN leadership Project 2003Defining NursingRCN Publication 001 983 Apr 2003Stowers K, Hughes R A, Carr A J. 1999Information exchange between patients and health professionals consultation styles of rheumatologists and nurse practitioners.Arthritis Rheum 1999 42 (suppl) 388 S.Taylor, E. 2000.construction upon the theoretical debate A critical review of the empirical studi es of Mezirows transformative learning theory.Adult Education Quarterly, 48 (1) , 34-59.Tomlinson J 1998 ABC of sexual health Taking a sexual history BMJ , Dec 1998 317 1573 1576Trimboli A, Walker M B 1997Journal of Nonverbal BehaviourPublisher Springer NetherlandsISSN 0191-5886 Paper 1573-3653inside 10.1007 / BF00990236Issue Volume 11 , Number 3 September 1997 Pages 180 190Yura H, Walsh M. 1998The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT Appleton Lange, 1998.

Effects of Ultrasound Therapy on MCL Injuries

Effects of Ultrasound Therapy on MCL InjuriesThe medial collateral ligament (MCL) is one of the roughly frequently injured ligaments of the knee joint. Fortunately, most patients who sustain MCL injuries are able to achieve their preceding(prenominal) level of activity without the need for surgical treatment. hitherto, the most severe injuries, especially those involving multiple ligaments, whitethorn have operative repair. This need leave alone explore the consummationiveness of a conservative treatment, namely sonography therapy and exercise therapy, in the treatment of MCL injuries of the knee joint. In a review by Phisitkul, James, Wolf, and Amendola (2006), treatment with early range of motion (ROM) exercises and progressive strengthening has been shown to produce very good results.Ultrasound therapy has been a widely utilize and well-accepted physical therapy modality for musculoskeletal conditions for many years. Wong, Schumann, Townsend, and Phelps (2007) performed a survey about the use of echography by physical therapists who are orthopaedic specialists, and found that ultrasonography therapy is a popular adjunct in orthopaedic physical therapy and that it is perceived as important. thus far, the lack of studies confirming its benefits has led many to question this traditional view. Indeed, many potfulvas which explored the proceedingiveness of ultrasonography therapy failed in establishing a definite conclusion. Nevertheless, it cannot be assumed that this lack of evidence implies that echography therapy is in notionive, and thus further research is infallible to establish the adequacy of its use.This study aims at answering the fol let looseing crucial questions In patients with MCL injuries of the knee, can ultrasonography improve wound, disability and general recovery? Is it to a greater extent potent than exercise therapy in improving symptoms? An answer to these questions go out help to better direct physiotherapy treatmen t for these patients, and thus optimize recovery.Subsequent chapters will discuss the current literature easy on the subject, followed by the methodology use in this study. The results are then presented and analysed. The interpretation of results in the context of previous research will be discussed in the discussion chapter, including the strengths and limitation of the study.Literature ReviewUltrasound therapy has become comm precisely used in soft create from raw material injuries (Speed, 2001). Research carried out in the past few decades regarding the set up of ultrasound on proboscis create from raw stuffs will be discussed below. My aim is to review the research available from the past years in prove to find conclusive and consistent results regarding the do of ultrasound, and thus to justify the use of ultrasound in the clinical setting, specializedally to treatment of medial collateral ligament injuries.As will be discussed in this chapter, when ultrasound enters t he body, it is thought to exert an marrow on it through thermal and non-thermal mechanisms (Robertson, Ward, Low, Reed, 2006, p.266). few of these effects may stimulate meliorate until now others may be dangerous and may cause damage.Thermal effects of ultrasoundAs ultrasound waves travel trough body tissues, they cause oscillation of particles, thus converting sonic energy into heat energy. The amount of heat produced will greatly depend upon the effectiveness given and the grade of energy absorption, but also on certain tissue properties, such as the heat capacity, efficiency of heat transfer, and the tissue dispersal and space (Robertson, Ward, Low, Reed, 2006, p.266). Some authors have suggested pre-heating the area of treatment to achieve a greater add in tissue temperature (Draper et al 1998a).Living tissue will be carry oned by an increase in temperature in unlike diametrical ways. According to Speed (2001), the thermal effects of ultrasound involve an increas e extensibility in tissues, enhanced tide rip flow, pain modulation, decreased joint stiffness and vigour spasm, together with a mid inflammatory response. These could explain why a temporary increase in range of motion is observed afterwards ultrasound treatment (Draper et al., 1998b Knight et al., 2001). Hayes, Merrick, Sandrey and Cordova (2004) studied the extent of heating in tissue at 2.5cm depth and found that 3 megacycle per second ultrasound was more effective in heating the tissues at this depth than 1megahertz, reaching a temperature of 40 degrees Celsius after 4 proceedings. Unfortunately the production of heat may place the patient at risk of a skin burn if utilize in mightily (Robertson, Ward, Low, Reed, 2006, p.290).Physical effects of ultrasoundCavitationCavitation is the formation of tiny gas bubbles in the tissues as a result of ultrasound vibration (Robertson, Ward, Low, Reed, 2006, p.267). Johns (2002) explains how as sound waves travel through the tissue s, the feature article compression and rarefaction causes microscopic gas bubbles present in the tissue fluid to contract and expand. Injury to the cell may occur when these gas bubbles expand and come apart rapidly. Nevertheless, cavitation has been found to occur only when victimization high intensities, and thus it is unlikely to occur in vivo with therapeutic levels (Nyborg, 2001). However according to a review by Baker, Robertson, and Duck (2001), in that location are a few studies which suggest the existence of in vivo cavitation. Baker and his colleagues argue that these studies were not replicated and that results obtained may have been due to obstruction with the analysis of B-scan imaging, which were used to measure cavitation. A recent study investigated the method by which cavitation is detected. The wavelet approach was identified as a new beast for studying bubble cavitation (Zhou, 2008). Cavitation becomes clinically relevant during ultrasound applications in wa ter, as bubbles that form between the skin and the treatment head may block transmission of ultrasonic waves (Ward Robertson, 1996).Acoustic streamAcoustic streaming may be described as a flow of liquid caused by a multiplication of pressure along the axis of the beam of energy and on any other structures which reflect it (Robertson, Ward, Low, Reed, 2006, p.268). There are two tokens of acoustic streaming microstreaming and pouch streaming (Duck, as cited in Baker, Robertson Duck, 2001). Bulk streaming occurs in any fluid and develops as the ultrasound beam is propagated, while microstreaming occurs at a microscopic level and is formed as eddies of flow flanking to an oscillating surface (Robertson, Ward, Low, Reed, 2006, p.268).Unfortunately bulk streaming is often less mechanically powerful, with microstreaming being the only type of acoustic streaming which is able to stimulate cell activity and change membrane permeability (Duck, as cited by Baker, Robertson, Duck, 2001). Microstreaming can produce stress on the cell membrane and wash away any molecules and ions which accumulate outside the cell membrane (Robertson, Ward, Low, Reed, 2006, p.268). According to Duck (as cited by Baker, Robertson, Duck, 2001), only bulk streaming occurs in vivo, because microstreaming only occurs secondary to cavitation. In vitro studies show increased growth factor production by macrophages (Young and Dyson, 1990a), increased calcium uptake (Mortimer and Dyson, 1988), increased discrimination and degranulation of mast cell (Fyfe and Chahl, 1984) and increase cell membrane permeability (McCance and Huether, as cited by Baker, Robertson, Duck, 2001) by microstreaming. This however will have minimal relevance in the clinical setting if one assumes that cavitation will not occur. Nevertheless, Manasseh, Tho, Ooi, Petkovic-Duran, and Zhu, (2010), suggest that microstreaming which occurs secondary to cavitation will play a role in the action of microbubbles in the rapeutic ultrasound.standing(a) wavesStanding waves are formed when reflected sound waves are superimposed with incident waves, and are characterized by high pressure peaks, the antinodes and zones of low pressure known as nodes (Robertson, Ward, Low, Reed, 2006, p.267-8). Ter Haar and Wyard (1978) put forward that blood cell stasis may occur with ultrasound, with cells forming at half wavelength intervals in the blood vessels at antinodes. These results match those by Dyson, Pond, Woodward, and Broadbent (1974). The latter studied the effect of a stationary wave on blood cell stasis and endothelial damage in blood vessels of chick embryos. The cells form bands half a wavelength apart inside blood vessels. They suggest that under optimum conditions, the minimum intensity of less than 0.5 Wcm-2 at 3 MHz with continuous irradiation is required for stasis to occur. Damage to nigh endothelial cells of vessels in which stasis has occurred was revealed by an electron microscope. Thus, i t is suggested that the treatment head is continuously moved during the treatment to minimize the formation of standing waves (Robertson, Ward, Low, Reed, 2006, p.268).The effect of ultrasound on repair of body tissuesAccording the succeeding(a) research, ultrasound therapy may have an effect on cells involved in repair of body tissues, includingLevels of prostaglandins and leukotrienesLeung, Ng, and Yip (2004) performed a randomized, case- nurse study to study the effect of ultrasound during the acute inflammation of soft-tissue injuries. They measured the levels of leukotriene B4 and prostaglandin E2 in the medial collateral ligament of rats and found that pulsed ultrasound (14) applied for five minutes at different durations and intensities may stimulate acute inflammation by increasing the levels of the above mentioned leukotriene and prostaglandin.Release of fibroblast from macrophagesYoung and Dyson (1990a) studied if ultrasound therapy can increase the rid of fibroblast mi togenic factors from macrophages in vitro, and measureed fibroblast proliferation over five days. This study showed an increased secretion of already formed fibroblasts in macrophages at 0.75 MHz ultrasound, which may be caused by permeability changes. On the other hand, at 3 MHz frequency, ultrasound appeared to encourage both the synthesis and secretion of fibroblast mitogenic factors. The reason why these two frequencies cause different effects may be explained by the different physical mechanisms involved. Williams (as cited in Young, 2002, p. 217), argues that cavitation is more liable to occur at cast down frequencies, while at a higher frequency heating is more likely.Platelets and -thromboglobulinWilliams, Chater, Allen, Sherwood, and Sanderson (1978) investigated the effect of ultrasound on platelets and established that more -thromboglobulin, a platelet specific protein, was released by ultrasound therapy. They suggest that this protein is released both by the disruption of platelets by cavitation and by other aggregating agents liberated in parallel with it which cause a release reaction in the adjacent platelets. This however, has not been proved to happen in vivo.Histamine release from mast cellsFyfe and Chahl (1984) suggest that ultrasound applied in the therapeutic range causes a significant increase in degranulated mast cells and thus an increase in histamine release, in rats. They suggest the possibility that ultrasound increases the permeability of mast cells to calcium causing them to degranulate, resulting in an increase in local blood flow. On the other hand, when Hogan, Burke, and Franklin (1982) investigated the change in blood flow in rat muscle on insonation, they found that arterioles vasoconstrict transiently in response to insonation, but improve perfusion after long-term treatment.Increase membrane permeability to calciumChange in the permeability of membranes to calcium has been present when using therapeutic ultrasound. Accord ing to Al-Karmi, Dinno, Stoltz, Crum, and Matthews (1994), applying ultrasound for two minutes will cause a significant boost in ionic conductance in the carriage of calcium ions, thus confirming that calcium ions influence the biological effects of ultrasound. Dinno et al. (1989) also used a frog skin model to study the effect of ultrasound on membranes. They argue that the increase in the concentration of calcium ions inside cells which occurs after the application of ultrasound, may decrease the permeability of gap junctions and uncouple cells in the way by which cells differentiate. Therefore, they concluded that ultrasound can affect cell differentiation and consequently histogenesis, and thus its use should be avoided over embryonic tissue.Growth factor secretionIto, Azuma, Ohta, and Komoriva (2000) applied ultrasound to a co-culture system of human bone-forming cellic and endothelial cells and studied their effect on growth factor secretion. Their study showed that ultras ound increases the levels of platelet-derived growth factor. This may be the reason for improved rift healing rate with ultrasound treatment, as discussed later.Fibroblasts and Collagen synthesisRamirez, Schwane, McFarland, and Starcher (1997), conducted an investigation to determine the effect of ultrasound on the rate of cell proliferation and collagen synthesis by using cultured fibroblasts form the Achilles tendons of neonatal rats. They found an increase in collagen synthesis and rate of thymidine incorporation and DNA content after ultrasound treatment, suggesting that ultrasound stimulates the synthesis of collagen in tendon fibroblasts and cell division after injury. In a more recent study Chiu, Chen, Huang, and Wang (2009), studied the effect of ultrasound on the proliferation of human skin fibroblasts at different frequencies. They applied ultrasound for three minutes daily for three days and found an increase in fibroblast proliferation by both 1 and 3 MHz frequencies, w ith less rousing when using 0.5 MHz frequency. Chiu et al., also took into account temperature changes and found a change of only one degree Celsius after insonation, thereby implying that the results observed where due to non-thermal effects.This can be explained by the increase in protein synthesis found to occur in fibroblasts after ultrasound treatment. Harvey, Dyson, Pond and Grahame (1975) suggest that therapeutic ultrasound at 3 MHz frequency and at an intensity of 0.5 2.0 Wcm-2, can directly stimulate protein synthesis in fibroblasts, without any other cells acting as mediators. In fact they attributed this to membrane-associated changes. Nevertheless, the increase in fibroblast proliferation may occur as a result of the effects of ultrasound on macrophages, which release fibroblasts mitogenic factors (Young Dyson, 1990a), as previously discussed.Ultrasound not only stimulates fibroblasts to produce more collagen (Ramirez et al. 1997), but the collagen produced also has a higher tensile strength and is better organized and aggregated. Okita et al. (2009) studied joint mobility and collagen fibril arrangement in the endomysium of immobilized rat soleus muscle, and showed that therapeutic ultrasound may prevent changes in joint mobility and collagen fibril movement which occur with immobility. In contrast, when Larsen, Kristensen, Thorlacius-Ussing and Oxlund (2005) studied the influence of pulsed ultrasound at 3 MHz frequency and different intensities, on the mechanical properties of healing tendons in rabbits, they found greater extensibility after insonation with higher intensities, however there was no significant change of the point of rupture when the tendons were loaded, suggesting that pulsed ultrasound did not improve the mechanical properties of the healing tendons.AngiogenesisTherapeutic ultrasound may also affect the rate of angiogenesis. Young and Dyson (1990b) considered the formation of new blood vessels in full-thickness lesions of fla nk skin in adult rats and found that by day 5 post-injury, ultrasound treated wounds had developed a greater number of blood vessels, and were thus at a more advanced stage in the repair process. However by the seventh day, there was no significant difference between the groups.Therapeutic mechanismOn the basis of these conflicting results, two schools of thought were developed. The evidence-based or factual school considers heat as the only effect of ultrasound therapy and thus emphasise the use of high doses and give little value to low intensity and pulsed treatment. This view is found in most American writing about this subject. On the other hand, the other school of thought is largely European, and is more involved in the biological and mechanical effects of pulsed low-intensity treatments (Robertson, Ward, Low, Reed, 2006, p. 269).Robertson, Ward, Low, Reed, (2006, p. 269) suggest that clinical studies may be used to investigate which doses produce better outcomes. In vitro studies can provide a dose-response relationship which may provide information about the most effective dose. Nevertheless, effects demonstrated in vitro, such as cavitation and acoustic streaming have not yet been shown to occur in vivo, since it is difficult to produce doses in vivo which are comparable to dose in vitro. They argue that in vitro, ultrasound is applied to only a thin layer of cells, and thus the say changes do not necessarily occur when applied to a much larger volume of tissue in vivo. Moreover, in vitro the energy is confined to a very small volume and thus the power density will be much higher than in vivo.Therapeutic effects of UltrasoundUltrasound therapy has been claimed effective in a wide range of clinical conditions, however there are still difficulties in establishing the effectiveness of ultrasound with certainty and in identifying a dose-response relationship, if there is any. Some of the alleged effects of ultrasound include promotion of fracture heal ing, soft tissue healing, articular cartilage repair, pain relief, increase local blood flow, change the extensibility of scar tissue and for the diagnosis of a stress fracture, and will be discussed below.Fracture healingUltrasound has been proposed to promote the processes involved in fracture healing and thus increase its rate. Sun et al., (2001) investigated the effects of low-intensity pulsed ultrasound on bone cells in vitro, and found a significant increase in osteoblast cell counts and a significant decrease in osteoclast cell count after stimulation, suggesting a positive effect on the bone-healing process. Nolte et al., (2001) also studied the in vitro effects of low intensity ultrasound. The latter used foetal mouse metatarsal rudiments and found an increase in length of the calcified diaphysis, which was significantly greater in the ultrasound treated groups compared to the untreated groups, after 7 days. Therefore they concluded that low-intensity ultrasound directly af fects osteoblasts and ossifying cartilage, with consequential more active ossification.Cyclooxygenase-2 regulates the production of Prostaglandin E2 by osteoblasts, both of which are thought to be an essential part of fracture healing (Zhang et al., 2002). Ultrasound stimulation has been found to increase cyclooxygenase-2 expression and to promote bone formation in osteoblast via various signalling pathways (Tang et al., 2006). Together with prostaglandins, nitric oxide is a crucial mediator in early mechanically induced bone formation. Reher et al., (2002), investigated the effect of traditional (1MHz, pulsed 14) and a long-wave (45 kHz, continuous) ultrasound on nitric oxide induction and prostaglandin E2 production in vitro, on human mandibular osteoblasts. A control group was set which was treated with fraud ultrasound. They found a significant increase in both induced nitrate and prostaglandin E2 production. Long wave ultrasound was found to be more effective than the traditio nal ultrasound.Other studies suggest that ultrasound may have an effect on the regulation of genes necessary for osteogenesis. Suzuki and his colleagues (2009) studied the typical osteoblastic cell line in the presence or absence of daily low intensity pulsed ultrasound stimulation at 1.5 MHz frequency, and 30 mW/cm2 intensity, for 20 minutes, for 2 weeks. They concluded that stimulation with these parameters directly affected osteogenic cells, leading to mineralized nodule formation, thus low intensity pulsed ultrasound therapy is likely to have an influence on the activities of osteoblasts in alveolar bone.clinical studies gave controversial conclusions in this area. In a review, Busse et al., (2002) concluded that evidence form randomised controlled trials suggest that low intensity pulsed ultrasound therapy may significantly tailor the time of fracture healing for non-operatively treated fractures. Five years later, Walker, Denegar, and Preische, (2007) confirmed this finding t hrough another review. Moreover, Della Rocca (2009) reviewed studies about the effects of low-intensity pulsed ultrasound treatment in fracture healing and found a large body of animal and cellular research which shows this to be beneficial in simulating faster normal fracture healing. However, from a review to of randomised controlled trials to determine the effectiveness of low intensity pulsed ultrasound in fracture healing, Busse et al., (2009), concluded that the evidence available has a have got to very low quality and provides conflicting results.Pain reliefThere are a very small number of studies which investigate the effectiveness of ultrasound in pain relief. Nevertheless, assuming that ultrasound promotes healing and resolves inflammation, pain should consequently decrease. Levent, Ebru, and Gulis (2009), used a randomised controlled trial to study the effect of ultrasound therapy in knee osteoarthritis. They applied ten sessions of five minutes of continuous ultrasound at 1 MHz to the experimental group and sham ultrasound to the control group to act as a placebo. They assessed pain by a visual analogue scale (VAS) and found that the decrease in pain in the experimental group is statistically significantly more than the control group. Thus they concluded that therapeutic ultrasound can be used effectively as a pain relief modality in patient suffering from knee osteoarthritis.An earlier review by Brosseau et al., (2001), did not show ultrasound as clinically important for pain relief in people with patellofemoral pain syndrome. However, they were unable to draw a conclusion regarding its use due to methodological flaws and limitations in the studies included in this review.Soft tissue injuriesWilkin, Merrick, Kirby and Devor (2004) studied the effect of pulsed ultrasound applied once daily for a week, on the healing of skeletal muscle in eighty rats. The results suggest that pulsed ultrasound as administered did not accelerate or improve regenerat ion of skeletal muscle tissue after contusion. Similarly, Markert, Merrick, Kirby and Devor (2005), using a randomized controlled trial with rats, found no evidence that specific continuous ultrasound and exercises protocols enhance skeletal muscle tissue regeneration following contusion injury.Takakura et al. (2002) investigated the effect of low-intensity pulsed ultrasound on the rate of healing of injured medial collateral ligaments of rat knees and found a significant improvement in the mechanical properties on the twelfth day, which however was lost by the twenty-first day. Nevertheless they also observed a larger mean fibril diam in the ligaments treated with ultrasound, concluding that low intensity pulsed ultrasound enhances the early healing of medial collateral ligament injuries.Ebenbichler et al., (1999) investigated the effect of ultrasound in the treatment of calcific tendinitis. This study suggests better outcomes with ultrasound treatment. Since only patients with ca lcific tendinitis diagnosed by diagnostic imaging were included in the study, results are more valid than if numerous articulatio humeri pathologies with different cellular process were included. This study was included in the review by Alexander et al., (2010). The latter carried out a review from various electronic databases and identified eight randomised controlled trials out of a total of seven hundred and twenty seven, which met their inclusion criteria. All the studies reviewed focused on shoulder musculoskeletal disorders. They concluded that statistically significant improvements were observed generally in studies which used higher levels of total energy and those who used longer exposure times. They noted favourable outcomes when at least 2,250J per treatment session was applied. This is further suggested by the frequency resonance hypothesis, which suggests that the mechanical energy produced by the ultrasound wave may be absorbed by proteins, altering the structure of in dividual proteins or changing the function of a multi-molecular complex. Thus it may affect enzymatic proteins, bring forth temporary conformational shifts, and thus alter the enzyme activity and cell function. This hypothesis implies that different frequencies will cause unique resonant or shearing forces which will therefrom have specific effects at cellular and molecular levels (Johns, 2002). Thus further reviews should address different parameters used in different studies, in attempt to establish effective doses.Blood flowNoble, Lee, and Griffith-Noble (2007) applied ultrasound at 3 MHz frequency and 1 Wcm-2 for 6 minutes to assess its effect upon cutaneous blood flow by laser Doppler flowmetry. They also measured skin temperature. They concluded that cutaneous blood flow increased significantly with ultrasound even though no significant changes in temperature had occurred. Nevertheless, blood flow changes in skeletal muscles have not yet been established. Robinson and Buono (1995), investigated the effect of continuous ultrasound on blood flow using 1.5 Wcm2 intensity for 5 minutes and found no significant change in skeletal muscle blood flow.Wound healingOther authors have studied the healing rates varicose ulcers by ultrasound and found more marked healing of insonated ulcers (Dyson, Franks, Suckling, 1976). However more recent studies suggest that ultrasound does not have an influence on the acceleration of healing or final stage of the wound healing (Dolibog, Franeki, Taradai, Blaszczak, Cierpka, 2008). Different findings may be attributed to the different nature of the injuries studied and the different way by which the effectiveness of ultrasound is assessed.Diagnosis of stress fracturesRomani and his colleagues (2001), were some of the few people who investigated the effectiveness of ultrasound therapy in the diagnosis of stress fractures. They used 1 MHz of continuous ultrasound therapy in twenty-six subjects with pain in the tibia since less than 2 weeks. Each subject completes a visual analogue scale after each different intensity was applies to assess the pain response to ultrasound. An MRI was taken to ascertain the diagnosis. However none of those who were found to have a stress fracture by MRI were correctly diagnosed by ultrasound.Following this review of literature, it is suggested that there may be a specific therapeutic window for ultrasound therapy. Conflicting results were obtained, possibly due to the different doses and frequencies used in various studies, indicating the need for further future research to identify the most effective parameters. Fortunately, none of the studies reviewed mentioned any negative effects on patients, making ultrasound a relatively safe modality when precautions are taken, and thus would make an important physiotherapy modality if its use is justified.

Anorexia and Bulimia Essay -- Causes of Bulimia, Eating Disorders

Each year millions of people in the United States are unnatural by serious and sometimes life-threatening eating disorders. The vast majorities are adolescents and young adult women. Approximately one percent of adolescent girls develops anorexia nervosa, a hard condition in which they can literally starve themselves to death. Another two to three percent develop bulimia nervosa, a destructive pattern of unreasonable overeating followed by vomiting or other " purging " behaviors to control their weight. These eating disorders also occur in men and older women, but oft less frequently. The consequences of eating disorders can be severe. For example, one in ten anorexia nervosa leads to death from starvation, cardiac arrest, or suicide. Fortunately, increasing awareness of the dangers of eating disorders, sparked by checkup studies and extensive media coverage, has led many people to seek help. Nevertheless, some people with eating disorders ref use to admit that they hav e a problem and do not get treatment. Family and friends can help recognize the problem and encourage the person to seek treatment. Anorexia nervosa is a disorder where people intentionally starve themselves. It usually starts more or less the time of puberty and involves extreme weight loss. Sometimes they must be hospitalized to prevent starvation because food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals, some even collect recipes and prepare gourmet feasts for family and friends. Loss of monthly menstrual periods is typical in women with this disorder and men with this disorder usually become impotent. People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or exercising obsessively. Some use a combination of all these forms of purging. Many individuals with bulimia " binge and purge " in secret and maintain normal or above normal be weight , they can often successfully hide their problem from others for years. As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also shew in men. Many individuals with bulimia, do not seek help until they reach their thirties or forties. By then, their eating behavior is deeply ingrained and more difficult to change.Medical complications can frequentl... ... again.Family members and friends can call local hospitals or university medical centers to find out about eating disorder clinics and clinicians experienced in treating the illnesses, for the college students, treatment programs may be available in school counseling centers.Family and friends should read as mush as possible about eating disorders, so they can help the person with the illness understand his or her problem. Many local mental health organizations and the self help groups provide free lit on eating disorders. Some of these groups also provide treatment program referrals and information on local self-help groups. Once the person gets help, he or she volition continue to needs lots of understanding and encouragement to stay in treatment.NIMH continues its search for new and better treatments for eating disorders. Congress has designated the 1990s as the " Decade of the Brain, " qualification the prevention, diagnosis, and treatment of all brain and mental disorders a national research priority. This research promises to yield even more hope for patients and their families by providing a greater understanding of the causes and complexities of eating disorders.