A historical approach to The Guest Essay Example | Topics and Well Written Essays - 1250 words

A historical approach to The Guest - Essay Example The story’s rich historical derivation makes it ideal for an examination through the lenses of historical criticism, as such, one can examine the occurrences themes and stylistic and the impacts of the larger historical backdrop both within and without the text. Concisely, the story revolves around three major characters are Daru, Baducci the gendarme and the Arab prisoner. Daru is a schoolteacher stationed in the desert school where the gendarme brings the Arab who has been accused of murder. Daru receives them hospitably and makes them tea in the schoolroom; he unties the prisoner’s hands and makes both of the as comfortable as he could with his limited facilities. That he takes off the ropes binding the prisoner, connotes the shame felt by colonialist for treating their subjects as if they were less than human (Just 904). Daru is told that the French suspect an uprising, he should deliver the prisoner to the town so that the gendarme can return and prepare in case it materializes the schoolteacher however turns down the task of delivering the prisoner. Balducci tells him it is an orderfrom the authorities but Daru insists that he will not comply; he does not stop him from leaving the prisoner there and even signs a document to att est to the fact. Daru accommodates the prisoner for the night, the next morning, despite his insistence that he would not take him to the authorities; he leads him in the direction of the town. Halfway there, he stops at a crossroads and tells him he can choose to deliver himself to the police or he can escape. He gives the prisoner food and money and leaves him to make up his mind. He heads back to the school where ironically, someone has written on the board that he would pay for the delivering â€Å"their brother†. Here, Camus uses dramatic irony to bring out the absurdity of the situation in which Daru finds himself because had Author of the threat known

Literature Review On Plantar Fasciitis Health And Social Care Essay

Literature Review On Plantar Fasciitis Health And Social Care Essay Well I would like to describe the prevalence and research about the topic in brief in this part as it is important to know why this topic has become an issue now and why do we need to make research on it. Plantar fasciitis is found to be the common foot complaint. It has been estimated that it affects approximately one in ten people at some time in their life (Crawford, Atkins, Edwards, 2003). However, it can occur at any age. It is twice as common in women as men and it is also common in athletes (NHS Clinical knowledge, 2009). The most common cause is infracalcaneal pain of plantar fasciitis and accounts for 11% to 15% of all foot complaints that require professional treatment (Buchbinder, 2004). A recent survey done by Riddle and Schappert in (2004) estimated that there are approximately one million patient visits per year to office-based physians and hospital departments in the United States by patients diagnosed as having plantar fasciitis. It occurs in approximately 10% of people who run regularly. Incidence of this condition peaks between the ages of 40 and 60 years (Buchbinder, 2004; Wearing , Smeathers , Urry et al., 2006). It is a bilateral complaint in about one third of pa tients (Buchbinder, 2004 ). Podiatric physicians, rheumatologists, general practitioners, physiotherapists and orthopaedic surgeons are the main healthcare providers involved in the treatment of plantar fasciitis (Riddle Schappert, 2004; Crawford and Thomson, 2003; Atkins et al., 1999). As I have been working as a musculoskeletal physiotherapist this topic quite influences me as most of the patient which i have been looking suffer from this injury. So in this systematic review i would be discussing about effectiveness of low-dye taping technique in plantar fasciitis. Plantar fasciitis is not gender specific and affects approximately 2 million of the American population per year (Irving , Cook and Menz, 2006). This disorder is expected to have many factors in origin such as obesity, excessive periods of weightbearing activity and decreased ankle range of motion commonly suggested to be involved (Riddle, Pulisic, Pidcoe, Johnson 2003). A wide diversity of treatment strategies have be en developed. Up to 90% of patients treated conservatively (eg taping and ultrasound), they experienced resolutions of symptoms (Thomas et al., 2001; Gill, 1997). There limited support of evidence showing specific treatment strategies for plantar fasciitis (Crawford and Thomson, 2003; Gill, 1997; McPoil et al., 2008). Atkins et al. (1999) identified 28 different conservative treatments and eight different surgical treatments, which confirms the vagueness of this condition. Foot orthoses are a common treatment for plantar heel pain, however due to the manufacturing process, they often require a time of a few weeks between the initial consultation and issuing the devices (Kosmahl, 1987; Lynch et al., 1998; Martin et al., 2001; Scherer, 1991). As such, short-term treatments such as supportive taping are used to improve symptoms during this temporary period (Martin JE, Hosch, Goforth, Murff, Lynch, Odom 2001) the low-Dye (Dye 1939) taping technique being one of the most frequently used . Foot taping, such as low-dye taping, alters the mechanical function of the foot, decreasing stress on the plantar fascia and subsequently producing symptom relief (Saxelby, Betts, Bygrave 1997). Low-Dye taping by Dye in (1939) is a common conservative treatment for plantar fasciitis. Most research (Ator et al., 1991; Childs et al., 1996; Del et al., 2004; Harradine, Jarrett, 2001; Holmes, Wilcox, Fletcher, 2002; Keenan, Tanner, 2001; Moss, Gorton, Deters, 1993; Russo, Chipchase, 2001; Scranton, Pedangana, Whitesal, 1982; Vicenzino et al., 1997; Whitaker, Augustus, Ishi, 2003) to date has examined the mechanical effects of the tape on the lower limb. One of the study done by Saxelby et al. in 1997 has evaluated the symptom relief offered by low-dye taping, but it had small numbers of participants and did not include a control group. But consequently there is need for larger studies that use a control group for comparison so we need to carry out this study. Those tapings which extended up the leg were known as High-Dye, while those in the foot were named Low-Dye. It has been used in the management of an array of foot pathologies, especially plantar fasciitis, and its effectiveness has been discussed by several workers (Newell1977, Miller 1977, Subotnick 1975, Van Pelt 1989). Taping as an intervention or as part of an intervention for the treatment of plantar fasciitis has been used for at least 70 years (Dye 1939). A systematic review assessing the efficacy of low-dye treatment strategy has not been found. Therefore, it was considered relevant to conduct the review. The discussion about the basic information regarding the topic in detail and why it is an issue now will be discussed in the following chapter. Well the basic aim of this review is asking whether low-dye taping is effective in the management of plantar fasciitis or not? The purpose of this study is to give low-dye taping treatment to people suffering from plantar fasciitis with respect to pain relief, gait improvement, impact on lifestyle and overall rate of success. The systematic review helps to identify the papers which relate to the question asked by the review and in turn will help to answer the review question. A organised SR protocol should be developed to carry the review in a easy way. The systematic review should be carried out in an organised manner as follows: Background: Intially i would like to discuss about plantar fascia, its situation and what structures it covers and how it causes injury. According to Haung 1993, the plantar fascia is the major arrangement that supports and maintains the arched position of the foot. This aponeurosis acts as a bowstring to grip up the longitudinal arch. It covers the major part of the foot. The planter fascia is a fat, fibrous group of connective tissue. Its starting point is the medial plantar tubercle of the calcaneum. It extends along the length of the sole of the foot like a fan, being attached at its other end to the bottom of each of the toes. It is a tough, flexible structure that has a number of significant functions during running and walking. It stabilizes the metatarsal joints during impact with the ground. It behaves as a shock absorber for the whole leg. It forms the longitudinal arch of the foot and helps to raise the arch to get ready for the take-off phase of the gait cycle. The plantar fascia helps to preserve the complex arch system of the foot and plays role in ones equilibrium and the various phases of gait. The pla ntar fascia consists of a multilayered fibrous aponeurosis (Kwong, Kay, Voner, White, 1988) that starts from the medial tubercle of the calcaneus .The plantar fascia is made of three major bands, the lateral, central, and medial. The central band is the strongest and thickest. The medial and lateral bands cover the undersurface of the abductor hallucis and abductor digiti minimi muscles, respectively. The fibers of the central band separate into 5 slips near the level of the metatarsal heads and then attach to the proximal phalanx via the plantar plate of each metatarsophalangeal joint (Schepsis, Leach, Gorzyca, 1991). Figure 1 Now we will discuss about plantar fasciitis. Here are some acceptable definitions of plantar fasciitis cited by experts which would be helpful in this study. Injury of this tissue, called as a plantar fasciitis, is very difficult to resolve. Plantar fasciitis is a localized inflammatory condition of the plantar aponeurosis of the foot and is reported to be the most common cause of inferior heel pain (Schepsis, Leach, Gorzyca, 1991). Plantar fasciitis represents the fourth most common injury to the lower limb and represent 8 10% of all presenting injuries to sports clinics. It can be caused by many factors. Plantar fasciitis develops when repetitive weight-bearing stress irritates and inflames the tough connective tissues along the base of the foot. It is difficult to treat. Rehabilitation can be long and frustrating process. The use of preventing exercise and early acknowledgment of danger signals are considerable in the avoidance of this injury. Plantar fasciitis refers to an inflammation of the plantar fascia. The inflammation in the tissue results in some type of injury to the plantar fascia. Typically plantar fasciitis ults from rep eated trauma to the tissue where it attaches to the calcaneus. According to souza, plantar fasciitis presents as a sharp heel pain that radiates next to the bottom of inside of the foot. In short the definition varies from person to person and it mainly depends upon the cause. The pain is found to be terrible when getting out of bed in the morning. Plantar fasciitis is a aching condition of the subcalcaneal aspect of the foot resulting from soreness or contracture of the deep fascia of the sole with or without calcaneal spur. Plantar fasciitis has been used synonymously with the following terms: Painful heel syndrome Subcalcaneal bursitis Subcalcaneal pain Runners heel Medial arch sprain According to Baxter, Plantar fasciitis can take place in runners or other athletes who repetitively land on the foot. Plantar fasciitis is an overuse damage whose occurrence accounts for 10% of all running injuries (Am J Sports Med 1991). Another vulnerable group is middle-aged people who use up much time on their feet. More infrequently, the fascia becomes irritated after a single traumatic episode, such as landing incorrectly after a jump or running a long hill. The massive majority of people will respond to conservative care and not require surgery. Appropriate treatment is necessary, however, to permit continuous participation in sports and daily activities, and to stay away from chronic damage. Risk factors: Plantar fasciitis is particularly prevalent in runners and people who are overweight (Hill and Cutting, 1989), however, it is also prevalent in people with systemic, inflammatory arthritis (Davis and Blair, 1950; Hassani et al., 2002; Furey, 1975; Gerster, 1980). Despite plantar fasciitis being a relatively common disorder, little is known about its etiology and pathogenesis (Wearing et al., 2006). Most anecdotally (Singh et al., 1997; Irving, Cook and Menz, 2006; Rome, 1997), intrinsic and extrinsic risk factors for plantar fasciitis have been reported. Participants in sports that engage some degree of running and jumping, e.g. basketball, tennis, step-aerobics, dancing may be at risk. Non-athletic people who spend much time on their feet. It may emerge in someone who suddenly becomes more active after a time of relative inactivity. Running on hard ground aggravates the risk, as does an increase in hill training. Worn out trainers boost risk as they lose their shock absorption prope rties. Obesity increases risk. There is increase in stress placed through the fascia. Other mechanical risk factors include flat feet (pes planus) and having a high arch (pes cavus). Studies done by (Riddle et al., 2003; Irving et al., 2007) identified that reduced talocrural dorsiflexion, high body mass index, pronated foot posture, and prolonged work related weightbearing are independent risk factors of plantar fasciitis. The most widely reported clinical sign of plantar fasciitis as said by Wearing et al., (2006) is pain localised to the medial tubercle of the calcaneus. Characteristically, the pain is exacerbated after periods of nonweightbearing. The pain decreases after few minutes of initial weightbearing but returns and get worst when time on feet increases (Singh et al., 1997; Thomas et al., 2001; Schepsis, Leach and Gorzyca, 1991). Various interventions used for plantar fasciitis: In general, plantar fasciitis is a self-limiting condition. Unfortunately, the period until resolution is frequently six to 18 months, which can direct to frustration for patients and physicians. Rest was cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best (Wolgin, Cook, Mauldin, Graham 1994). It is equally important to correct the troubles that place individuals at risk for plantar fasciitis, such as increased amount of weight-bearing activity, increased intensity of movement, hard walking/running surfaces and worn shoes. Early recognition and treatment usually direct to a shorter course of treatment as well as improved probability of success with conservative treatment measures (Martin, Irrgang, Conti 1998, Reid 1992). Various treatment strategies, including orthoses (Kwong et al. 1988, Gross et al. 1984, Goulet et al. 2002, Lynch et al. 1988), stretching (Probe et al. 1999, Powell et al. 1998, DiGiovanni et al. 2003, Chandler et al. 1993, Barry et al. 2002), taping (Lynch et al. 1988, Scranton et al. 1982), extracorporeal shock wave therapy (Boddeker et al. 2001, Buchbinder et al. 2002), laser therapy (Basford et al. 1998) and drug therapy in the appearance of systemic medication (Probe et al. 1999), percutaneous injection (Cunnane et al. 1996, Kamel et al. 2000, Kane et al. 1998) and topical application (Gudeman et al. 1997, Japour et al. 1999) have been investigated and have revealed variable clinical benefit. In the recovery phase of rehabilitation, the objective is to decrease stress on the plantar fascia (J M.). Orthotic shoe inserts are thought to give stress relief and hold the plantar fascia, but a review of several studies found them to be unconvincing and contradictory due to methodology, small study size, or lack of long-term follow-up. There are many conservative treatments which can give better relief such as: Icing: Ice massage for over 15 minutes for three times a day can give better results and decrease the inflammation. Stretching Heel lifts Supportive shoes Weight loss Taping Orthotics: Devices such as rubber heel cups, elastic heel inserts can provide relief for plantar fasciitis. Night splints: Splints can provide relieve from plantar fasciitis, but it usually takes more than 12 weeks. Taping: The purpose of taping the foot is to change the mechanical load toward the fascial enthesis. Several studies done by Lange, Chipchase, Evans, (2004); Vicenzino et al., 2005; Radford et al., 2006) have reported that antipronation tape change the longitudinal arch height and decrease pressure in the heel which are clinically relevant in patients with plantar fasciitis. Taping can be done in many methods but i am more interested in low-dye taping as it is widely used and so i will be discussing about that technique in detail. LOW-DYE TAPING: Low-dye taping is an orthopaedic/sports adhesive strapping technique first described by Dye (1939) and later modified by a number of authors (Boergers, 2000; Del et al., 2004; Lange, Chipchase, Evans, 2004; Russo, Chipchase, 2001). Low-Dye taping is designed to off-load the plantar fascia. It is a short term treatment and its off-loading effects vary from patient to patient. However, as a general rule leave the tape on for a maximum of 3 days, but some might find it needs to be replaced more frequently in order remain effective. If at anytime the tape is uncomfortable, irritates, causes itching or pins and needles it should be removed immediately. The taping aims to limit foot pronation and is used in the short-term to reduce the symptoms of disorders thought to be related to excessive foot pronation which includes plantar fasciitis, tibialis posterior dysfunction, and patellofemoral syndrome (Schulthies, Draper, 1995; Whitesel, Newell, 1980). The taping required is a 1 inch zinc oxide (rigid strapping), most chemist should stock it. Another place to access it is from www.simplyfeet.co.uk, look under strapping and for Leukoplast (2.5cm), its costs approximately  £2.70p per roll (which should last for 3-4 applications) How to apply the taping 1. The first taping is applied down the outer and inner border of the foot, repeat 3-4 times. Apply enough tension to avoid the tape wrinkling, it needs to be no tighter. 2. The second taping is applied across the underside of the foot-starting level with the ankle, apply the tape across the foot from the outside to the inside. Over lap the each strap slightly and keep going until just before reaching the ball of the foot. 3. The final taping is a securing tape-apply a piece of tape across the midfoot, at about where the second taping ends, apply across the top of the foot, but do not encircle the whole foot, as this will be too tight. 4. Initially the tape will feel slightly tight, but this should ease, if it feels uncomfortable at all-remove immediately. Effects of Low-Dye taping: Offers support for the medial longitudinal arch and reduces pronation (inward rolling of the foot). Can be used for any condition affected by excessive pronation Plantar fasciitis, Tibialis Posterior Tendonopathy/Dysfunction, Sinus tarsi syndrome. Limitation of taping: One restriction of long term taping is that there is danger for skin breakdown. So therefore it may be considered only as a short term management option. Literature review: For writing the literature review, the following databases and books were searched. There was a detailed search on internet which gave a lot of information about plantar fasciitis. Some information was gathered from books and journals as well. Some of the journals were available online while rest of them had to be purchased from library. Some of the books were available online as well. The following databases had been searched for writing this literature review: Medline AMED CINAHL ClinPSYC EMBASE PsycINFO PEDRO. The following information was gathered from all the sources taking account of the review question. The proximal insertional disorder of the plantar fascia is best known as plantar fasciitis and as per Lemont, Ammirati and Usen in (2003), histopathologic research has found no signs of inflammation but has reported degenerative changes in the plantar fascia. The prevalence of plantar fasciitis has not been studied (Riddle Scappert 2004), but it is estimated that it affects 10 percent of the general population at some time during life (Demaio et al., 1993). PF is considered a self-limiting condition, however, the typical resolution time is anywhere from 6-18 months, sometimes longer (Young, Rutherford, Niedfeldt 2001) which can lead to frustration on both that is the physician and patient. Most experts agree that early recognition and treatment of PF leads to a shorter course of treatment and greater probability of success with conservative therapies (Singh, Angel, Bcntk, Trevino 1997). Of the many treatment options available for PF, one of the most effective is also the most fundamental rest and avoidance of aggravating activity provides significant relief. One study cited rest as the treatment that worked best for 25percent of PF patients (Wolgin, Cook, Graham, Mauldin, 1994). Martin et al. 2001 compared custom orthoses, over-the-counter arch supports, and tension night splints in the management of plantar fasciitis. Lynch et al. compared anti-inflammatory therapy, accommodative therapy and mechanical therapy in the management of pla ntar fasciitis. There are several conservative treatments that are employed to manage this condition. Scientists at the University of Bridgeport Chiropractic College in Calgary, Alberta, conducted an comprehensive review of the literature from 1980 to March 2005 on the management of plantar fasciitis. They concluded that due to numerous methodological flaws, none of the 15 randomised controlled trials showed finally which conservative treatment modality was best for plantar fasciitis (JCCA, 2006). Contrast baths, in which the application of cold and heat to a wounded area is alternated, are widely believed to reduce oedema (tissue swelling) and relieve uneasiness following an injury (Sullivan and Anderson 2000). A hunt of the scientific literature on this topic using Medline uncovered just two articles in this area, and one of the articles was unreliable in nature, with no rigorous, controlled testing of the efficacy of contrast baths. The other journal article listed research carri ed out at the University of North Carolina in which 30 subjects with post-acute sprained ankles were assigned to either a cold (n = 10), heat (n = 10), or contrast-bath (n = 10) treatment group (Comparison of Three Treatment Procedures for Minimizing Ankle Sprain Swelling, Physical Therapy, Vol 68 (7), pp1072-1076, 1988). Volumetric measurements of the subjects ankles were completed in a specially constructed tank, prior to and after treatment. An increase in the measure of oedema was actually observed with all three treatments, but cold application was connected with the least measure of swelling; contrast baths were no better than the direct application of heat when it came to controlling swelling. This study is somewhat faulty, since there were no control individuals with whom the persons utilizing a variety of treatments could be compared. Nonetheless, the research suggests that there is nothing particularly beneficial about contrast baths (especially when compared with the appl ication of nothing but cold) in the management of sprained ankles or oedema in common. Interestingly enough, there also does not show to be a single study in the scientific literature involving contrast baths with quicker recovery from injury or with a considerable decrease in pain associated with an injury. Compression is thought to be valuable in this phase through taping of the foot (Anderson 2000). Scherer and the Biomechanics Graduate Research Group in 1998 performed a prospective study in which they treated 73 patients with 118 painful heels with taping, nonsteriodal anti-inflammatory drugs, injections, and rigid orthoses (98% received these orthoses). The study showed that, within 6 weeks, approximately 84% of the patients had at least 80% relief of symptoms. This study also identified a subgroup of 43 heels (27patients) that received only mechanical therapy with taping or orthoses. Of this group, 90% had more than 80% relief of symptoms. The author concluded that mechanical control of midtarsal joint was the most successful treatment modality for plantar fasciitis. In an attempt to measure the effects of Low-Dye taping on the foot, eight patients (nine feet) with plantar fasciitis were studied using the pedobarograph to investigate changes in gait patterns. In addition, patients completed a questionnaire to assess symptom improvement. Significant changes between the untaped and taped foot were found in respect of pressure levels, areas under the pressure time curves and temporal parameters. The questionnaire revealed subjective improvements in symptoms in eight out of the nine feet studied (Saxelby, Betts and Bygrave 2004). The results from this nonrandomised trial indicate that this technique may be helpful for pain associated with plantar fasciitis. This article reveals that taping technique can improve gait to some extent. The best method to avoid plantar fasciitis is to minimise your risk factors. Follow the guidelines outlined above for selecting suitable and well-constructed shoes. Progress training schedules properly and works in new environments gradually. Keep your calf muscles physically powerful. Although plantar fasciitis is a prevalent problem, little scientific evidence exists concerning the most appropriate intervention (Crawford, Atkins, Edwards 2002 ). In the book by Rose Macdonald (2009), named Pocketbook of Taping Techniques By Rose Macdonald, Functional taping is now acknowledged as a skill which is essential for those concerned in the treatment and rehabilitation of sports injuries and many other conditions such as muscle imbalances, unstable joints and neural control. It incorporates all the basic techniques essential to the practice of good taping but also includes chapters on new evidence-based procedures written by experts from around the world. To assist in the development of these techniques, this pocketbook demonstrates many new methods which may be used as indicated or customized to suit the clinical situation. The Key Features in the book are Structured by body region with highly-illustrated descriptions of significant taping techniques Covers all aspects of functional taping New techniques to modify muscle activity and proprioception based on scientific evidence. Handy, portable size for simple reference in the field. Well there are few papers (Saxelby et al., 1997; Radford et al., 2006; Osborne and Allison, 2006; Landorf et al., 2005) published in the journals which say that low-dye taping has been effective in the management of plantar fasciitis. We will discuss about the papers in detail in the later part of the review. A systematic review conducted by Radford et al., in (2006) of randomised controlled trials examined the result of low-dye taping on biomechanical variables. According to Kogler et al. (1999), the supportive tape reduces the symptoms of plantar heel pain by reducing strain in the plantar fascia during standing and ambulation. A study conducted by Nolan and Kennedy in 2009 aimed to determine the special effects of Low-Dye taping on peak plantar pressure immediately post-application and found that Low-Dye tapes initially reduced lateral forefoot peak plantar pressure after a 10-minute walk. However, the tape continued to have an effect on the medial forefoot after 20 minutes of exercise. Chapter 2: Now we will be discussing about the systematic review methodology in this chapter The basis for a systematic review: According to Altmann (1999), Systematic reviews, in healthcare, have been described as providing objective overviews of all the evidence currently available on a particular topic of interest. Such overviews cover clinical trials in order to establish where effects of healthcare are consistent and where they may vary. This is achieved through the use of explicit, systematic methods aimed at limiting systematic error (bias) and reducing the chance of effect (Higgins and Green 2006). So systematic review are useful to decide which treatment in health care is more effective. Methodology: Systematic literature reviews are a method of making sense of large bodies of information, and a means of contributing to the answers to questions about what works and what does not- and many other types of question too (Petticrew and Roberts 2006). They are a method of mapping out areas of uncertainty, and identifying where little or no relevant research has been done, but where new studies are needed. Systematic reviews are literature reviews that remain closely to a set of scientific methods that explicitly aim to limit systematic error (bias), mainly by attempting to identify, appraise and synthesize all relevant studies in order to answer a particular question. Definition of systematic review: A review that strives to comprehensive identify, appraise, and synthesize all the significant studies on a specified topic. Systematic reviews are often used to test just a single hypothesis, or a series of related hypotheses (Petticrew and Roberts 2006). Systematic reviews provide information about the effectiveness of interventions by identifying, appraising, and summarising the results of otherwise unmanageable quantities of research (Light and Pillemer 1984, Mulrow 1994). A review of the evidence on a obviously formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to remove and analyse data from the studies that are incorporated in the review. Statistical methods (meta-analysis) may or may not be used. Systematic reviews are defined, according to the Cochrane collaboration, as scientific literature reviews aimed at answering clearly formulated questions by use of systematic and explicit methods for identifying, selecting, and critically appraising relevant research, and for collecting and analysing data from the literature included in the review (The Cochrane collaboration. During a systematic review, meta-analysis may be used as a statistical tool for analysing and summarising the results of the included studies (Green and Higgins 2005). In order to fulfil this function, a systematic review should: (i) present a synthesis of the acquired knowledge regarding one particular clinical question derived from all relevant studies that are identifiable at one point in time, (ii) identify the level of internal validity and the subsequent potential systematic error risk associated with the acquired knowledge and (iii) provide recommendations for improving any identified shortcoming related to internal validity, for further research. Owing to continued further research, systematic reviews should also provide continued updates of their synthesis. Why do a systematic review? A rationale: Single studies can usefully be seen as similar to single respondents in a survey. The results from one respondent may say something, and sometimes something very important, but one might well get the opposite answer from the next respondent. It is more likely that one will learn more by examining data from other respondents, by looking at the range of answers and examining why those answers vary, and by attempting to summarize them (Petticrew and Roberts 2006). Literature reviews are also, in essence surveys, and it is worth remembering that they share very similar biases with other forms of social surveys. History of systematic review: From the 1930s onwards, and possibly even before, the specific term systematic review was being used to refer to literature reviews (Petticrew and Roberts 2006). In short, contrary to what is commonly supposed, neither the term systematic review nor the general approach of systematic literature reviewing is particularly new, nor particularly biomedical. Many systematic reviews involve a statistical pooling of the findings of the primary studies. This approach, meta-analysis, probably derives in its current form from Glass and Smiths work, which began in the late 1970s (Glass and Smith 1978). Systematic Review Process: Scoping review: A scoping review involves a search of the literature to determine what sorts of studies addressing the systematic review question have been carried out, where they are published, in which databases they have been indexed, what sorts of outcomes they have assessed, and in which populations (Petticrew and Roberts 2006). It may include restricted searches across a limited number of key databases, limited to a certain time period, and perhaps restricted by language. This can help cost a review for the purpose of drawing up a funding proposal, and can help with estimating how long it is likely to take, and what mix of skills might be needed to carry it out. From the below systematic review on effectiveness of low dye taping in the management of plantar fasciitis we can see that one relevant study has been found which involves effectiveness of taping in the management of plantar fasciitis but that differs from the current systematic review as it did not involve low dye taping which is the key factor of the undergoing review and this review is based on only effectiveness of low dye taping and not taping in broader context. Chapter 3: Role of the protocol: The protocol will specifies the plan which the review will follow to identify, appraise and collate evidence (Cook, Sackett and Spitzer 1995). The first milestone of any review is the development and approval of the protocol before proceeding

Arcady: His Voyage Towards Individualism Essay -- essays research pape

In the novel Fathers and Sons by Ivan Turgenev, Arcady plays a major role both in his own life and the lives of others. Arcady, despite the shield he surrounds himself with, is not a true Nihilist like his friend Bazarov through his thoughts and actions we see his change. To begin, Arcady shows signs of Romanticism Early on in the novel despite the announcement of his Nihilist beliefs. For example, Bazarov and Arcady were walking one afternoon in the garden and overheard Nicholas playing his cello. "At that instant the lingering notes of a 'cello were wafted towards them from the house . . . and, like honey, the melody flowed through the air" (49). Like a true Nihilist, Bazarov immediately denounced the act of playing music as a purely romantic institution. "Good Lord! At forty-four, a pater familias, in the province of X, playing the 'cello! Bazarov continued to laugh: but, on this occasion, Arcady, though he venerated his mentor, did not even smile" (50). By this we see that although Arcady looks up to Bazarov, he truly does not uphold the Nihilist beliefs as strongly or as strictly. His acceptance of his father's cello playing shows that Arcady, unlike Bazarov. does not find music a purely romantic institution, but an enjoyable way to be merry. Also this incident shows us that Arcady does not like when others poke fun at his family. Here, he obviously does not think his father's cello playing is a laughing matter.Secondly, Nihilist ideas included...

Anorexia, bulimia and related eating disorders treatment Essay

Anorexia and Bulimia Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In the United States, millions of people are affected by severe eating disorders which are sometimes life-threatening. Bulimia nervosa and Anorexia nervosa are the most common destructive eating disorders. Over 90% of those individuals who are affected with these eating disorders are youthful women. About 1% of the young girls develop anorexia nervosa, which is a risky condition where those girls can starve themselves literary to death while another 2% or 3% of youthful women get bulimia nervosa, which is also a vicious pattern of extreme overheating which is usually followed by vomiting among other â€Å"purging† behaviors. Anorexia and Bulimia have gotten to epidemic proportions. For instance, a new study conducted by NEDA (National Eating Disorders Association) revealed that 50% of girls have noteworthy eating disorders during their teens. Anorexia and bulimia obviously are severe disorders that require and necessitate serious at tention. Nevertheless, many individuals are not knowledgeable regarding the disorders; therefore do not distinguish warning signs most of the times until when it is too late. Anorexia and bulimia are destructive eating disorders which can have adverse effects on human beings if not well treated (Buckroyd & Rother, 2008).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Anorexia nervosa refers to a disorder in which individuals starve themselves intentionally. The disorder, which usually begins in young individuals around the puberty stage, involves excessive weight loss. Different from normal dieting, which ends after the desired weight is attained, in anorexia weight loss and dieting persists until the sufferer is below normal limit for height and age. Numerous anorectics appear to be emaciated however are certain that they are suffering from overweight. The most frightening aspects of this disorder is that individuals suffering from anorexia continue perceiving that they are suffering from overweight even when they become bone-thin. In this regard these individuals get scared of gaining extra weight due to the unknown reasons. Bulimics also have this fear (Retrieved March 17, 2004, from http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As eating disorders usually develop in adolescence stage, they can blight social and physical development and numerous sufferers are unable to achieve their academic potential. A mood which is depressed is a frequent feature, partially because of these unfavorable effects and also due to the distressing nature of key warning signs of these disorders. Adverse physical effects of dieting, purging behaviors and weight loss are critical and usually prove to be fatal. In fact, anorexia has the highest rate of mortality of any adolescence psychiatrist disorder (Espejo, 2012).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Approximately 40% of anorexics start developing the bulimia disorder later. Bulimia nervosa differs a bit from the anorexia since individuals suffering from bulimia don’t shun eating. Instead, people with bulimia usually consume huge food amounts over short period of time after which they get rid of the eaten food quickly through taking diuretics or laxatives or vomiting. Bulimia is 2 or 3 times more prevalent compared to anorexia and is also more common in females compared to males. Nevertheless bulimia has an effect slightly on older age group, frequently women who are in their early to mid-twenties who were overweight during their childhood. Since many bulimics â€Å"binge and purge† in top secret and maintain body weight which normal or above normal, they can habitually hide their disorder successfully from other individuals for many years. The bulimics challenging eating pattern is an uncontrollable and compulsive one th at results to chemical imbalances in their bodies. These imbalances lead to depression, clouded thinking and lethargy (Retrieved March 17, 2004, from http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf ).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Both bulimia and anorexia when severe can lead to colon damage, constipation, muscle spasms, irregular or loss of menstruation, seizures, urinary tract infections, kidney dysfunction, chronic indigestion and strain on most of the organs of the body. The bulimia vomiting practices can result to a ruptured stomach, swollen salivary glands, erosion of dental enamel and also chronic sore gullet and throat. The anorexia malnutrition also has its own effects which include; growth of hair all over the body which is down-like, severe cold sensitivity and inability to concentrate and think rationally. Both bulimia and anorexia have severe physical effects which are reversible if dealt with during the early stages. Nevertheless the diseases are deadly and it is imprudent to disregard the warning signs and delay the treatment. In a case where the disorders are unattended, they can take away quality of life of an individual or even life altogether (Re trieved March 17, 2004, from http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf ).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Eating disorders consist of a variety of syndromes including social, psychological and physical features. Even as the acute physical impediments of these disorders might arouse immense concern in health care staff and family members, bulimia nervosa and anorexia nervosa are often chronic conditions having considerable long –term social and physical sequelae, from which recovery turn out to be complex. Long-term disabilities comprise negative effects on fertility, parenting, relationships and employment. The impact of an individual’s eating disorder on family life and home is usually significant and family members might carry a great burden over a long time. Frequently family members are at a loss to be acquainted with how to assist and offer support to a relative who is affected (Retrieved March 17, 2004, from http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Various different ideas exist concerning the causes of anorexia and bulimia disorders and it is essential to recognize that not all these ideas apply to all the sufferers. Royal college of psychiatrists records on its website the potential causes of bulimia and anorexia; they include control, depression, puberty, social pressures, upsetting events and family. Social pressures for individuals to be thin are usually brought on by newspapers, magazines and television that are filled with pictures of men and women who are slim and attractive. Many individuals have a notion that they must look in accordance with the way the media enlightens them they look. Some individuals develop eating disorders since they perceive to be out of control in various aspects of their weight and life and what they consume is something which they can be able to control (Garner & Garfinkel, 1997).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The latest increases in prevalence and incidents of eating disorders can be accredited to both improved method of diagnosis and increase in number of cases. On the other hand, even with better eating disorder identification, numerous bulimics and anorectics do not look for assistance. Bulimia and anorexia are diseases that are often very quiet since they are not concerns that individuals like discussing openly. Receiving quality care during the early stages of the disorders is the predicator of an excellent outcome in bulimia and anorexia (Retrieved March 17, 2004, from http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf ).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Bulimia nervosa and anorexia nervosa are multidimensional and multifaceted; thus many experts have a perception that referral for professional assessment and assistance is necessary for people showing signs of eating disorders. According to college of Royal psychiatrists illustrates that recognizing that an individual is suffering from an eating disorder and also getting the treatment is challenging. Individuals suffering from anorexia have extreme and alarming weight loss but such sufferers will never admit that they have a problem. On the other hand, individuals suffering from bulimia usually feel ashamed and guilty of their behavior and may go on to greater extents with an aim of hiding it. Due to these reasons, all individuals should be knowledgeable regarding the warning signs of these disorders so as to distinguish them and reduce their existence (Friedman & Skancke, 2009).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In a case where it is recognized that a certain individual is a sufferer of either bulimia or anorexia or both, treatment is crucial. There are various different options when it comes to treatment which includes education, family therapy, possibly hospitalization, Cognitive Behavioral Therapy, psychotherapy, drug therapy and reality imaging. During therapy treatments, therapists assist the sufferers work to alter the unclear and inflexible thinking patterns relating to eating disorders. Mental health professionals’ efforts necessitate to be combined together with those of the other health professionals to get the most excellent treatment. Nutritionists give an advice on eating and diet regimes while physicians treat the medical complications (Lawton, 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In conclusion, scientists have discovered that combination of medication and psychotherapy is also very effectual. There are no specific drugs approved for anorexia and bulimia, however numerous, including a number of antidepressants, are being examined for this use. Bulimics and anorectics can be perceived as dieting junkies and an effective treatment might be a drug which is regularly prescribed to the addicts (Espejo, 2012). A Detroit scientist examined Naltrexone, the drug which is given to do away with the heroin habit, in those women having bulimia and anorexia and established the drug to be productive. With the drug, the weight of the anorectics stabilized and bulimics essentially decreased their purges and binges. Effective treatment can save life of an individual with an eating disorder. Teachers, friends, relatives, physicians and relatives all play a great role in assisting the ill individual start and continue with a treatment program. References Buckroyd, J., & Rother, S. (2008). Psychological responses to eating disorders and obesity recent and innovative work. Chichester, England: John Wiley & Sons. Eating Disorders. (n.d.). Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. Retrieved March 17, 2004, from http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf Espejo, R. (2012). Eating disorders. Detroit: Greenhaven Press. Friedman, L. S., & Skancke, J. (2009). Eating disorders. Farmington Hills, MI: Greenhaven Press/Gale Cengage Learning. Garner, D. M., & Garfinkel, P. E. (1997). Handbook of treatment for eating disorders (2nd ed.). New York: Guilford Press. Lawton, S. A. (2005). Eating disorders information for teens: health tips about anorexia, bulimia, binge eating, and other eating disorders including information on the causes, prevention, and treatment of eating disorders, and such other issues as maintaining healthy eating a. Detroit, MI: Omnigraphics. Source document

Importance of Law to Different People Essay

Various schools of law define law from different angles and this is done by mainly looking at the purpose that is to be achieved. The meaning of law maybe different to a lawyer, a law enforcement agency, a law breaker and even a business man. If defined simply then law is a system, a set of rules and guidelines that are enforced/implemented through a set of different government institutions. It helps to shape politics, economics, and most importantly, society by serving as a mediator of relations between people and different groups (Various, 2011). They are considered to be the basic of behavior, and at the same time, orders established by the Government of a country. These guidelines are applicable to anyone and everyone, with the expectations that are followed rather than broken, without any discrimination. Law is the command of the sovereign. It imposes a duty and is supported by a sanction, which will be looked at further in this writing. Law is made of three elements: command, duty and sanction. To implement and enforce law and provide services to the public, a government’s bureaucracy, the military and police are vital. With all these organs of the state are creatures created and bound by law, an independent legal profession and vibrant civil society inform and support their progress (Various, 2011). Law is a fair means of keeping everyone equal in the eyes of the state, and rid out crimes which are the cancer of society. Law is a generic term which is further divided into categories so no walks of life isn’t out of the reach of the law enforcers. Law is not a man made phenomena as we can see law in effect in nature too. It is something that keeps things in balance. Some might argue that law isn’t required, but man in its nature is inclined to sway from the right code of conduct. Law doesn’t enforce something un-natural but kosher ways of doing things. The need of Law is fundamental, it sets up guidelines for appropriate behavior that has been perfected over time and based on moral beliefs. And also Law is a divine quality given to man to controls mans sinful nature for centuries. When can see the importance of Law in man life by the example of Adam and Eve, they had guidelines they had to follow, no matter how limited it was, and when they were broken they were punished for it. This shows that the need of Law or guidelines is something as natural to mankind as breathing. Law has a different meaning to a lawyer, a law enforcement agency, a law breaker and a businessman. A lawyer assists others in understanding the rule of law and provides his help to those who want to enforce the law for a particular purpose. The objective of a law enforcement agency is to promote law and ensure that it is being followed in an organized manner. A law breaker is not try to understand the rule of law and just wants to disrupt the society by breaking it. A business man has to follow the law in his day to day dealings and to a business man, law is mainly a set of rules and regulations that have to be followed in order to carry out the business. The objective of this paper is to highlight how various individuals perceive law and the meaning that law has to them. Law is there to serve different purposes and law can only be easily defined if this purpose is apparent. The aim of this paper is to show what perception different individuals have of law. It is very important to know the differences in perception of various segments regarding law to be able to understand how it would be defined by them. This would help us analyze and interpret the way they look at law and might help us in forming a mutual definition of law. It is necessary to shed light upon what law means to different segments in order to create a linkage among the common elements exist so it becomes easier for us to understand the actual meaning of law. Methodology The topic that has been covered in this paper can have a legal as well as a social impact. It can have a social impact because it highlights the different meanings that law can have to different individuals in the society which can assist the members of the society to understand how various individuals perceive law. Law is importance to all the individual but the degree of importance surely varies. The paper sheds light on the importance that different individuals attach to law hence having a society wide impact. The paper can have a legal impact because it shows us how the various segments of the legal system including the lawyers and law enforcement agencies perceive law and how essential law is to them. This can help us interpret their reaction towards various aspects and also help us understand how different segments within the legal system might work. What does law mean to a lawyer? Law has a great deal of significance to a lawyer. Law is needed to resolve these disputes and lawyers use these laws a valid ground for resolving such disputes, as exemplified by the famous story of the Judgment of Solomon. It was thought even from classical times that law performed a very important function – that of encouraging and helping people to do the right thing. For example, Aristotle (384 BC – 322 BC) argued that people needed the discipline of law to habituate them into doing the right thing, from which standpoint they could then appreciate why doing the right thing was the right thing to do and lawyers set examples for others through use of laws. Up until the 20th century, this view of law was accepted by law makers, with the result that the legal system contained a large number of ‘morals laws’ – that is, laws that were designed purely and simply to stop people acting immorally, according to the lights of Christian teaching on what counted as immoral behavior. For the lawyer law is formulated to improve the system of legal representation, ensure that lawyers conduct their business in accordance with the law, standardize lawyers’ behavior, protect the legitimate rights and interests of litigants, safeguard the correct enforcement of laws and bring into full play the positive role of lawyers in establishing a socialist legal system. Lawyer refers to personnel who have obtained a business license for setting up a lawyer’s practice in accordance with the law and who are providing legal services for the public. When setting up a practice, lawyers must abide by the Constitution and the law, and must scrupulously observe professional ethics and discipline. Lawyers who set up in practice must use facts as a basis and the law as criteria. Lawyers who set up in practice must accept supervision by the state, the public and litigants. Lawyers who set up in practice in accordance the law are protected by the law.