Talking about love Essay Example For Students

Talking about love Essay Talking about love. What is love? It may seem like a stupid question, but on second examination, it doesn’t seem quite so stupid. After all, love is a feeling. How can we really describe what a feeling is or means? The meaning of any feeling can differ greatly between individuals, and the meaning of love is no different. In â€Å"What We Talk About When We Talk About Love,† Raymond Carver weaves a tale of two couples examining what love is. While Carver doesn’t reveal any great truths about what love is, he does make a statement about the nature of true love. Carver makes the point that modern, on-again, off-again relationships have little to do with love. True love is about needing someone so badly that it’s unbearable to think of life without that person. There is a fine line between true love and obsession; the former being one of the most wonderful feelings that humans can experience, and the latter many times ending in tragedy. Carver makes these points in the story thro ugh his use of subplot, imagery, and symbolism. We will write a custom essay on Talking about love specifically for you for only $16.38 $13.9/page Order now The most obvious technique Carver uses in â€Å"What We Talk About When We Talk About Love† to make his point is through the subplots in the story. The subplots revolve around the two main couples in the story, and another couple that is introduced by one of the characters near the end of the story. The first couple, Mel and Terri, had been in very bad relationships before meeting one another. They have been together for five years, and married for four. Mel’s marriage to his ex-wife Marjorie apparently ended on a very bad note. Carver states near the end of â€Å"What We Talk About When We Talk About Love,† â€Å"’She’s allergic to bees,’ Mel said. ‘If I’m not praying she’ll get married again, I’m praying she’ll get herself stung to death by a swarm of fucking bees† (444). Clearly whatever love Mel once felt for his ex-wife has evaporated. Terri also suffered through a bad relationship at the hands of an abusive man named Ed. Terri and Mel argue over Terri’s belief that Ed really did love her, though not in a way that was healthy to her or to Ed. After Terri and Ed separated, Ed made threats against Terri and Mel, and finally committed suicide. The second couple, Nick and Laura, had both been previously married to other people. Carver doesn’t state the circumstances surrounding their subsequent divorces, and only states that they met at work and started a relationship that led to marriage. Carver describes Nick and Laura as â€Å"still on the Honeymoon† (439). They are still at the point in their relationship where they are very affectionate toward one another, which contrasts with Mel and Terri’s somewhat grating remarks to each other. In â€Å"Carver’s Couples Talk About Love,† Fred Moramarco describes the relationship between Nick and Laura as a â€Å"relationship of what we might call ‘lite intimacy’.† Referring t o Carver’s description of Laura as being â€Å"easy to be with† (439), Moramarco states, â€Å"This is the ideal contemporary relationship—between a man and a woman who are friends as well as lovers, and the operative word here is ‘easy.’ We all seek easy relationships, but the real world keeps intruding.† Carver seems to describe both couples as being together more because of convenience, rather than any strong need or desire to be with each other. Moramarco refers to this situation as â€Å"Serial, transient love.† During the course of the conversation, Mel introduces the third couple later in the story, by telling Nick and Laura a story about them. Moramarco describes the way in which they are compared with the other two couples: â€Å"Both Mel and Terri on the one hand, and Nick and Laura on the other—as well as Mel and Marjorie and Terri and Ed—are contrasted with yet another couple referred to in the story, an elde rly couple in their mid-seventies who have been in an auto accident. Significantly, their camper was slammed by a teenage drunk driver who was killed in the accident. The old couple survived, but ‘just barely.’ Carver intends the couple to represent our traditional conception of love—lifetime monogamy—a love that lasts ‘until death do us part.’ What troubles Mel about the love between this old couple is that the husband is upset not so much because he and his wife are badly injured, but because his face is bandaged so severely he cannot move his head and look at his wife.†Moramarco goes on to explain this sort of dependent love is closer to the love that Ed had for Terri than any of the other couples described in Carver’s story. Carver uses the subplots of the different couples to contrast against each other, and show that obsession and â€Å"true love† actually are much closer than many people may think. He also uses the s ubplots to provide some detail into the viewpoints that the different couples come from, in respect to the issue of love. The fact that Nick and Laura have much less to say may have to do with their comparative inexperience, at least as far as the length of their relationship. And, as Carver states, â€Å"†¦Mel McGinnis was talking. Mel McGinnis is a cardiologist, and sometimes that gives him the right.† Another technique that Carver uses in â€Å"What We Talk About When We Talk About Love,† is imagery. Carver’s use of imagery is somewhat subtle, but is used effectively to represent certain ideas in the story. The first use of imagery is that of light in the story. At the beginning of the story, Carver states that, â€Å"Sunlight filled the kitchen from the big window behind the sink† (437). He later describes the light in various stages; â€Å"The afternoon sun was like a presence in this room, the spacious light of ease and generosity† (440) , â€Å"The sunshine inside the room was different now, changing, getting thinner† (443), and â€Å"The light was draining out of the room, going back through the window where it had come from† (443). The light in the story is representative of the cycle of life, and directly relates to some of the symbolism that Carver uses in the story. Carver also uses imagery when describing the characters in various stages of intoxication. He states, â€Å"Mel poured himself another drink. He looked at the label closely as if studying a long row of numbers. Then he slowly put the bottle down on the table and slowly reached for the tonic water† (442-443). He goes on to say that â€Å"Laura was having a hard time lighting her cigarette† (443), and, â€Å"He crossed one leg over the other. It seemed to take him a long time to do it† (444). Carver is using the intoxication of the characters to again describe a life cycle. With the imagery of the light and the into xication, he shows a cycle of a bright and coherent time that increasingly winds down, as if fading away. He uses words such as â€Å"slowly† many times, to illustrate how things tend to move at a slower pace later in life. This again relates to the symbolism elsewhere in the story. In an interesting turn, Carver uses alcohol itself as both imagery and symbolism in the story. As imagery, the alcohol, and the characters increasing consumption of it, is a statement about the unease that we have speaking about love and matters of the heart. It seems that the more the characters drink, the easier time they have baring their souls, and sharing their feelings. At the same time though, the thoughts and feelings they share become more and more disjointed and abstract in direct relation to the amount of alcohol that is consumed. For instance, later in the story, Mel starts talking of chefs and vassals, and the conversation seems to wander away from the topic of what love is. He also b ecomes more crude uses more profanity while he gets drunker. Carver states, â€Å"’Vassals, vessels,’ Mel said, ‘what the fuck’s the difference? You know what I meant anyway. All right,’ Mel said, ‘So I’m not educated. I learned my stuff. I’m a heart surgeon, sure, but I’m just a mechanic. I go in and fuck around and I fix things. Shit.’ Mel said.†Carver’s use of symbolism is what really ties the story together. He uses three main symbols that sort of bring the theme of â€Å"What We Talk About When We Talk About Love† to the surface. Alcohol is a major symbol in this story, even though it also serves as a form of imagery. Alcohol in the story is used to symbolize the sort of love that has become pervasive in our society. In effect, it can be fun for a while, but in the end it leaves us unfilled, and feeling like we’ve been run over by a truck. This is in direct contrast to Carver’ s use of food as a symbol in the story. In â€Å"Carver’s Couples Talk About Love,† Moramarco states, â€Å"Drinking is often contrasted with eating. Food is almost always presented as both nourishing and nurturing. Eating is a communal activity, †¦while alcohol is a kind of empty substitute for it that neither nourishes nor nurtures but distorts and confuses.† He goes on, â€Å"All of the characters are hungry for love, but love as we too often experience it in the contemporary world is a shallow substitute for the real thing. Being hungry for love is one thing, but doing something about that hunger is another.† Carver uses the imagery of waning light and growing intoxication as a metaphor for our journey through life. During this journey, too many of us settle for love that is unfulfilling (alcohol), instead of waiting to find a truer form of love (food). Finally, Carver uses the gin bottle itself as a symbol that represents the way we pass around the term â€Å"love† in the modern world, without ever really stopping to examine what it means. The point where Mel stopped and â€Å"looked at the label closely as if studying a long row of numbers† (443), illustrates his effort to understand, but he has become so drunk with alcohol (false love), that he fails to really grasp what he is looking at. .ua2496b82b61dc18b76c3ce91b360a64d , .ua2496b82b61dc18b76c3ce91b360a64d .postImageUrl , .ua2496b82b61dc18b76c3ce91b360a64d .centered-text-area { min-height: 80px; position: relative; } .ua2496b82b61dc18b76c3ce91b360a64d , .ua2496b82b61dc18b76c3ce91b360a64d:hover , .ua2496b82b61dc18b76c3ce91b360a64d:visited , .ua2496b82b61dc18b76c3ce91b360a64d:active { border:0!important; } .ua2496b82b61dc18b76c3ce91b360a64d .clearfix:after { content: ""; display: table; clear: both; } .ua2496b82b61dc18b76c3ce91b360a64d { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ua2496b82b61dc18b76c3ce91b360a64d:active , .ua2496b82b61dc18b76c3ce91b360a64d:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ua2496b82b61dc18b76c3ce91b360a64d .centered-text-area { width: 100%; position: relative ; } .ua2496b82b61dc18b76c3ce91b360a64d .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ua2496b82b61dc18b76c3ce91b360a64d .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ua2496b82b61dc18b76c3ce91b360a64d .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ua2496b82b61dc18b76c3ce91b360a64d:hover .ctaButton { background-color: #34495E!important; } .ua2496b82b61dc18b76c3ce91b360a64d .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ua2496b82b61dc18b76c3ce91b360a64d .ua2496b82b61dc18b76c3ce91b360a64d-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ua2496b82b61dc18b76c3ce91b360a64d:after { content: ""; display: block; clear: both; } READ: Of Mice And Men EssayIn â€Å"What We Talk About When We Talk About Love,† Raymond Carver examines the question of what love really is, and shows us that love in modern society as a throwaway commodity, is one of the greatest fallacies of our time. He attempts to get us to examine the question for ourselves, so that perhaps the concept of true love won’t be lost or forgotten by the time our children’s children head out to find love. He shows us that true love is about more than lust and comfort. It is about need, desire, longing, and intimacy of the sort that many of us don’t ever know. Perhaps by asking ourselves the question â€Å"What do we talk about when we talk about love?† we may discover that the â€Å"love† that many of us settle for isn’t the love we really want. In order to be true to ourselves we need to stop drinking from the â€Å"bottle† of Moramarco’s â€Å"Serial, transient love,† and start looking for something a little more nourishing. For without nourishment, we as people, and as a society, can’t grow, and will fade away as surely as the setting sun that Carver so eloquently describes. Works CitedCarver, Raymond. â€Å"What We Talk About When We Talk About Love.† Literature And The Writing Process. Ed. Elizabeth McMahon, Susan X Day, and Robert Funk. New Jersey: Prentice, 1999. 437-444Moramarco, Fred. â€Å"Carver’s Couples Talk About Love.† The Raymond Carver Web Site. Ed. Tom Luce. Sept. 1997. Whitman College. 26 Aug. 1999

1000 Posts, And A Favor To Ask

1000 Posts, And A Favor To Ask 1000 Posts, And A Favor To Ask 1000 Posts, And A Favor To Ask By Daniel Scocco Last week I was browsing through the control panel of our blog and I noticed a curious fact: we are already over 1000 published posts! To be precise, this one is post number 1011. I was pleasantly surprised to find that out. The main challenge of any blog or website is to persist over the long term, as the first year is probably the hardest. We managed to do that, and the blog is going quite well. We receive around 250,000 unique visitors every month. On top of that there are over 30,000 subscribers who receive our posts via email or RSS. If you are one of those visitors or subscribers, thank you! I also wanted to ask a favor. If you like our tips and think that other people could benefit from them, we would love if you could recommend the blog. If you have a blog or website of your own, for instance, you could write about Daily Writing Tips there. If you have a Twitter or Facebook account, you could share our link there. You could even recommend us verbally to friends and relatives. We would really appreciate it, and this kind of support keeps us motivated to improve the blog and provide as much value as possible through our posts. We have some good things planned for 2010, so stay tuned! Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the General category, check our popular posts, or choose a related post below:50 Handy Expressions About HandsDawned vs. Donned1,462 Basic Plot Types

Phases of Capitalism - Mercantile, Classical and Keynesian

Phases of Capitalism - Mercantile, Classical and Keynesian Most people today are familiar with the term capitalism and what it means. But did you know that it has existed for over 700 years? Capitalism today is a much different economic system than it was when it debuted in Europe in the 14th century. In fact, the system of capitalism has gone through three distinct epochs, beginning with mercantile, moving on to classical (or competitive), and then evolving into Keynesianism or state capitalism in the 20th century before it would morph once more into the global capitalism we know today. The Beginning: Mercantile Capitalism, 14th-18th centuries According to Giovanni Arrighi, an Italian sociologist, capitalism first emerged in its mercantile form during the 14th century. It was a system of trade developed by Italian traders who wished to increase their profits by evading local markets. This new system of trade was limited until growing European powers started to profit from long-distance trade, as they began the process of colonial expansion. For this reason, American sociologist William I. Robinson dates the beginning of mercantile capitalism at Columbus’s arrival in the Americas in 1492. Either way, at this time, capitalism was a system of trading goods outside of one’s immediate local market in order to increase profit for the traders. It was the rise of the â€Å"middle man.† It was also the creation of the seeds of the corporation- the joint stock companies used to broker the trade in goods, like the British East India Company. Some of the first stock exchanges and banks were created during this per iod as well, in order to manage this new system of trade. As time passed and European powers like the Dutch, French, and Spanish rose to prominence, the mercantile period was marked by their seizure of the control of trade in goods, people (as slaves), and resources previously controlled by others. They also, through colonization projects, shifted production of crops to colonized lands and profited off of enslaved and wage-slave labor. The Atlantic Triangle Trade, which moved goods and people between Africa, the Americas, and Europe, thrived during this period. It is an exemplar of mercantile capitalism in action. This first epoch of capitalism was disrupted by those whose ability to accumulate wealth was limited by the tight grasp of the ruling monarchies and aristocracies. The American, French, and  Haitian Revolutions  altered systems of trade, and the Industrial Revolution significantly altered the means and relations of production. Together, these changes ushered in a new epoch of capitalism. The Second Epoch: Classical (or Competitive) Capitalism, 19th century Classical capitalism is the form we are probably thinking of when we think about what capitalism is and how it operates. It was during this epoch that Karl Marx studied and critiqued the system, which is part of what makes this version stick in our minds. Following the political and technological revolutions mentioned above, a massive reorganization of society took place. The bourgeoisie class, owners of the means of production, rose to power within newly formed nation-states and a vast class of workers left rural lives to staff the factories that were now producing goods in a mechanized way. This epoch of capitalism was characterized by free market ideology, which holds that the market should be left to sort itself out without intervention from governments. It was also characterized by new machine technologies used to produce goods, and the creation of distinct roles played by workers within a compartmentalized division of labor. The British dominated this epoch with the  expansion of their colonial empire, which brought raw materials from its colonies around the world into its factories in the UK at low cost. For example, sociologist John Talbot, who has studied the coffee trade throughout time, notes that British capitalists invested their accumulated wealth in developing cultivation, extraction, and transportation infrastructure throughout Latin America, which fostered a huge increase in flows of raw materials to British factories. Much of the labor used in these processes in Latin America during this time was coerced, enslaved, or paid very low wages, notably in Brazil, where slavery was not abolished until 1888. During this period, unrest among the working classes in the U.S., in the UK, and throughout colonized lands was common, due to low wages and poor working conditions. Upton Sinclair infamously depicted these conditions in his novel, The Jungle. The U.S. labor movement took shape during this epoch of capitalism. Philanthropy also emerged during this time, as a way for those made wealthy by capitalism to redistribute wealth to those who were exploited by the system. The Third Epoch: Keynesian or New Deal Capitalism As the 20th century dawned, the U.S.  and nation states within Western Europe were firmly established as sovereign states with distinct economies bounded by their national borders. The second epoch of capitalism, what we call â€Å"classical† or â€Å"competitive,† was ruled by free-market ideology and the belief that competition between firms and nations was best for all, and was the right way for the economy to operate. However,  following the stock market crash of 1929, free-market ideology and its core principles were abandoned by heads of state, CEOs, and leaders in banking and finance. A new era of state intervention in the economy was born, which characterized the third epoch of capitalism. The goals of state intervention were to protect national industries from overseas competition, and to foster the growth of national corporations through state investment in social welfare programs and infrastructure. This new approach to managing the economy was known as â€Å"Keynesianism,† and based on the theory of British economist  John Maynard Keynes, published in 1936. Keynes argued that the economy was suffering from inadequate demand for goods, and that the only way to remedy that was to stabilize the populace so that they could consume. The forms of state intervention taken by the U.S. through legislation and program creation during this period were known collectively as the â€Å"New Deal,† and included, among many others, social welfare programs like Social Security, regulatory bodies like the United States Housing Authority and Farm Security Administration, legislation like the Fair Labor Standards Act of 1938 (which put a legal cap on weekly work hours  and set a minimum wage), and lending bodies like Fannie Mae that subsidized home mortgages. The New Deal also created jobs for unemployed individuals and put stagnant production facilities to work with federal progr ams like the  Works Progress Administration.   The New Deal included regulation of financial institutions, the most notable of which was the  Glass-Steagall Act of 1933, and increased rates of taxes on very wealthy individuals, and on corporate profits. The Keynesian model adopted in the U.S., combined with the production boom created by World War II, fostered a period of economic growth and accumulation for U.S. corporations that set the U.S. on course to be the global economic power during this epoch of capitalism. This rise to power was fueled by technological innovations, like radio, and later, television, that allowed for mass mediated advertising to create demand for consumer goods. Advertisers began selling a lifestyle that could be achieved through consumption of goods, which marks an important turning point in the history of capitalism:  the emergence of consumerism, or consumption as a way of life. The U.S. economic boom of capitalism’s third epoch faltered in the 1970s for several complex reasons, which we won’t elaborate here. The plan hatched in response to this economic recession  by U.S. political leaders, and heads of corporation and finance, was a neoliberal plan premised on undoing much of the regulation and social welfare programs created in the previous decades. This plan and its enactment created the conditions for the globalization of capitalism, and led into the fourth and current epoch of capitalism.

What is CPD and how is this relevant to the PG student Essay

What is CPD and how is this relevant to the PG student - Essay Example The paper tells that from a business discipline perspective, Boud & Hager define CPD as ‘a variety of learning undertakings through which business professionals uphold and progress throughout their profession to guarantee that they maintain their ability to trade effectively, safely, and legally within their developing scope of practice’. In short, CPD is the process through which professionals continue to learn and develop continuously in their careers to keep their knowledge and skills up to date and are able to trade effectively, safely, and legally. Organizational modality mostly involves the entire organization. Through team CPD, HR managers can ensure that workers complete their CPD hours. There are numerous advantages to implementing CPD as a team. However, there are disadvantages to CPD as well. In organizational CPD practices, there is a massive emphasis on flexibility of provisions and a strong need for transparency and justification in making a judgment on pro vision and performance. From the perspective of an individual professional, the question that needs to be addressed is: what subjects CPD should address. The literature suggests: 1) circumstance and context, 2) knowledge, 3) practices and skills, 4) human factors, 5) Professional values and identities, 6) decision-making, 7) approaches to identifying learning needs, 8) performance and realization. CPD is a process meant to help professionals manage their individual development on an ongoing basis. It is mainly purposed to help professionals, reflect and review what they learn. It is not a tick-box manuscript documenting individual preliminary training. It goes beyond that. Training and development are often used interchangeably, although there is a distinction.

Presentation Critiques Essay Example | Topics and Well Written Essays - 500 words

Presentation Critiques - Essay Example The presentation also included real life examples of people who had been highly successful as civilized engineers. The listeners were expected to be effective in having an ethical approach in all the future engineering tasks. The information as delivered by the presenter would be beneficial in different engineering. The approach of the presentation was generic so as to be beneficial for the diverse nature of the audience. The presentation was carefully planned and delivered in a proper scientific manner. The information delivered was precise, properly arranged and was specific to the context. The slides had a good flow and continuity giving it a good narrative style. Catchy slide backgrounds and attractive color settings gave the audience a good visual effect. The selection of the font and other settings could add more authenticity to the whole presentation. Through the slide styles, the presenter ensured to be serious in areas required and to be jovial wherever required. The presenter also did well with the fluency in flow of information. The language chosen by the presenter to connect between two slides made the presentation quite attractive. The prime element of attraction in the narration of the presenter was that it could give an exact idea to the audience on what to expect in the slides which followed. However, the presenter lacked the skill to communicate to the crowd through the body language . There was hardly any eye contact with the audience. This made the presentation totally non interactive. However the use of proper animations and graphics in the slides negated this lacking and made the audience concentrate right from the beginning till the end of the presentation. A number of tables were included in the slides which explained the factual quite efficiently. The bulleted captions gave precise direction to the audience. These elements along with the diagrams made the slides interesting and thus could get the full attention of

Essay --

Over the years, much has been written about the two novels, both positive and negative. For example, Ben Clarke of the University of North Carolina has written extensively about Orwell, and asserts that although mainly acclaimed for his non-fiction works, Orwell’s fiction writing had significant value, and was generally under-rated (Clarke). Orwell’s only novel to receive critical acclaim was Nineteen Eighty-four. Even this novel, when studied, is considered for its historical significance rather than its literary contribution (Clarke). Clarke also suggests that Orwell’s female characters reflect Orwell’s views of masculinity and femininity. Though he recognizes the limited choices that women had in society, he shows showed little originality in their portrayal (Clarke). Certainly Julia, in Nineteen Eighty-Four is portrayed as a woman engaging in sexual relationships with Party members more out of boredom than from any real disagreement with the poli tics of the Party. She depicted as being accepting of the status quo, and follows Winston’s lead in his rebellious activities. This is similar to the way that women in Orwell’s time period were viewed, as passive but supportive components in society. The restrictive bounds on society trigger rebellion by the major characters in both novels. By restricting the knowledge and information available, the governments in both novels maintain tight control on their citizens. In Nineteen Eighty-four, the public is manipulated by propaganda to believe what the Party wants it to believe. There are laws against even thinking of anything that creates individuality or harms the Party in any way, labelled by Orwell as â€Å"thoughtcrime†. â€Å"Thoughtcrime was not a thing that could be concea... ..., Winston’s search for the truth drives him to rebel in small ways initially. Driven to create something that will not be re-written at the whim of the Party, he writes in an illicitly obtained diary to a nameless future reader from â€Å"a time when truth exists and what is done cannot be undone† (Orwell 28). His next step on the path to rebellion is to begin a forbidden sexual relationship with a woman he works with. He has longed for a relationship where he is free to love without the purpose of procreation. Even more important to him, however, is that his actions undermine the Party. When Julia, his girlfriend, tells him that he has done this "Hundreds of times -well, scores of times†, Winston is not upset; instead, he is thrilled because that means there were many others who are â€Å"corrupt to the bones† and were also rebelling against the Party (Orwell 112). Essay -- Over the years, much has been written about the two novels, both positive and negative. For example, Ben Clarke of the University of North Carolina has written extensively about Orwell, and asserts that although mainly acclaimed for his non-fiction works, Orwell’s fiction writing had significant value, and was generally under-rated (Clarke). Orwell’s only novel to receive critical acclaim was Nineteen Eighty-four. Even this novel, when studied, is considered for its historical significance rather than its literary contribution (Clarke). Clarke also suggests that Orwell’s female characters reflect Orwell’s views of masculinity and femininity. Though he recognizes the limited choices that women had in society, he shows showed little originality in their portrayal (Clarke). Certainly Julia, in Nineteen Eighty-Four is portrayed as a woman engaging in sexual relationships with Party members more out of boredom than from any real disagreement with the poli tics of the Party. She depicted as being accepting of the status quo, and follows Winston’s lead in his rebellious activities. This is similar to the way that women in Orwell’s time period were viewed, as passive but supportive components in society. The restrictive bounds on society trigger rebellion by the major characters in both novels. By restricting the knowledge and information available, the governments in both novels maintain tight control on their citizens. In Nineteen Eighty-four, the public is manipulated by propaganda to believe what the Party wants it to believe. There are laws against even thinking of anything that creates individuality or harms the Party in any way, labelled by Orwell as â€Å"thoughtcrime†. â€Å"Thoughtcrime was not a thing that could be concea... ..., Winston’s search for the truth drives him to rebel in small ways initially. Driven to create something that will not be re-written at the whim of the Party, he writes in an illicitly obtained diary to a nameless future reader from â€Å"a time when truth exists and what is done cannot be undone† (Orwell 28). His next step on the path to rebellion is to begin a forbidden sexual relationship with a woman he works with. He has longed for a relationship where he is free to love without the purpose of procreation. Even more important to him, however, is that his actions undermine the Party. When Julia, his girlfriend, tells him that he has done this "Hundreds of times -well, scores of times†, Winston is not upset; instead, he is thrilled because that means there were many others who are â€Å"corrupt to the bones† and were also rebelling against the Party (Orwell 112).

Long term conditions Essay

Long-term conditions also known as chronic diseases or non-communicable diseases have been defined by the World Health Organization (WHO, 2005, p.35) as conditions that have origins at young ages take decades to be fully established, with their long duration, requiring a long term and systematic approach to treatment. Plans to transform care for patients with long-term conditions are based on continuing to maintain focus on early intervention and prevention; supporting integrated services shall help the patients and the public have a clear set of rights and patients in turn shall help the health care by undertaking the necessary steps, to take good care of their own health: promoting a preventative, people- centred, and productive care to be delivered (Great Britain. Department of Health, 2009). Director General of WHO expressed that, â€Å"the lives of far too many people in the world are being blighted and cut short by chronic diseases, this is a  very serious situation, both for public health and for the societies and economies affected† (WHO, 2005, p. VII), which has raised a need for long term conditions to be managed differently. Goodwin et al (2010, p.61) report that it was recognised, if patients with long-term conditions were managed effectively in the community, they would remain relatively stable and enjoy a quality of life free from frequent crises or observed increases in hospital visits. Chronic diseases have placed a heavy burden on the health care with demand for services and cost for treatment; the economic cost levels incurred; directly by the health care and indirectly by the individuals has also increased, and also increased use of hospital resources, raising need to manage the differently (Canada. Department of Health and Community Services, 201 1, p.7). They are time-consuming and some do not require the expertise and skill of a physician, but rather, may be managed by other members of the health care team (Canada. Ontario Medical Association, 2009, p.1). Chronic conditions have an effect on workplaces as regards productivity losses, where modifications have to be made by employers who attain workers with long-term conditions; so there is a need to manage them differently (Canada. Department of health and Community Services, 2011, p.7). Great Britain. Department of Health (2012) published a policy to support the management of long term conditions: improving quality of life for patients with long term conditions. Majority of the health care systems of middle-income countries, including Malaysia, are organised around models of healthcare developed in western countries, such systems are clearly at odds when dealing with long-term and continuing illness that require collaboration across health care sectors and where patient behaviour change forms the primary focus (Yasin et al, 2012, p.3). Malaysia is now implementing the Innovative Care for Chronic Conditions Model (ICCC), for it was developed, recognizing the challenges of the under-resourced and non-integrated health systems in low-and-middle income countries; but still holds focus on encouraging behaviour change at an individual level through improving self-management (Yasin et al, 2012, p.4). Managing long-term conditions requires key principles to be applied for  health care to remain focused with the plans to transform care; the Department of Health, Social Services and Public Safety (Great Britain. Department of Health, Social Services and Public Safety, 2012, p.13) identifies six key principles that may be used as guidelines for managing long-term conditions and these include: working in partnership with the patients and their carers, supporting self-management, avail appropriate and timely evidence-based information to service-users and their carers, promote personalised aid for patients to manage their medicines, recognising carers as partners in planning and delivery of services, services should be patient-centred, and flexible and integrated services across all sectors. In this assignment, a scenario of a patient diagnosed with Rheumatoid Arthritis three months ago, is going to be discuss, regarding examination findings outlined in the pro-forma; her name is Marjory 32 years old, married and a mother of two, works as a secretary. It is her first physiotherapy session, and she is receiving active treatment, and shall be introduced to self-management guidelines that are to help her manage her condition at home. Rheumatoid arthritis (RA) is an inflammatory, autoimmune disease that causes pain, joint stiffness especially in the morning, and loss of function; it can occur at any age but is more common in persons over the age of 30 years and affects women more often than men (Australia. The Department of Health and Ageing, 2009, p.1). RA is a systematic disease that affects the whole body; joint pain and swelling manifest, leading to structural deformities and disability, causing a reduction in joint movement and muscle use; this happens because the immune system attacks the synovium first, with which the synovial membrane becomes thick and inflamed, resulting in unwanted tissue growth, but the most affected joints are particularly those of the wrists, hands and feet (Australia. The Department of Health and Ageing, 2009, p.3-4). Goal-setting process is required when managing RA patients: a formal process where a physiotherapist together with the patient formulates the rehabilitation goals which need to be specific, measurable, achievable, realistic/relevant and timed, i.e. meeting the criteria for â€Å"SMART† principle (Meesters et al, 2013, p.1). Physiotherapy management of RA uses a comprehensive approach which consists of a combination of education, exercise and pain relief agents, with the emphasis varying depending on clinical needs identified, so the physiotherapist and patient discuss coming to an agreement in regards to setting goals (The National Collaborating Centre for Chronic Condition (NCCCC), 2009, p.77). Physiotherapy aims to reduce pain and stiffness, prevent deformity and maximise function, independence and quality of life, which Marjory equally needs (NCCCC, 2009, p. 77). Kavuncu and Evcik (2004, p.1) assert that successful management involves educating patients and informing them about the planned treatment modalities that are going to be used and their effects to the patient’s identified problems. It was identified that Marjory had residual swelling around her hands, but no heat on palpation and the range of motion (ROM) had also reduced; paraffin wax therapy and hand exercises are the interventions chosen. Kacunvu and Evcik (2004, p.2) recommend using heat therapy before exercise for maximum benefit and applications are recommended for 10–20 minutes once or twice a day. Paraffin wax therapy has a short term symptomatic relief of pain and stiffness at the hands; the use of moist heat is intended to increase blood flow to the area, reduce pain and improve ROM (Welch et al, 2011, p.2). Recent evidence shows positive results for paraffin wax baths combined with hand exercises for arthritic hands on objective measures of ROM, pinch function, grip strength, pain on non-resisted motion, stiffness compared to control after four consecutive weeks of treatment (Welch et al, 2011, p.2). Despite paraffin wax therapy having benefits, its heat effects may increase inflammation, thus increasing swelling of the synovial membrane, so both joint and skin temperature elevate following superficial heating, which is a disadvantage to using heat therapy as an intervention, because RA patients often have unstable vascular reactions following exposure to heat (Hayes, pg.255, 2006). Another identified problem on Marjory was the swelling on the knees with heat on palpation, cold therapy is preferred for active joints where intra-articular heat increase is undesired; the physiological effects of  cold therapy include an abrupt drop in skin temperature, and a slow decline in temperatures within the muscles and joints: the recommended application time is 20 minutes to decrease synovial blood flow in patients with arthritis (Demoulin and Vanderthommen, 2011, p.117). Cold therapy is advocated to be applied intermittently rather than continuous, for the optimal parameters; each session should last 25 to 30 minutes, which is the time thought to be needed to substantially decrease temperature, blood flow, and metabolism (Demoulin and Vanderthommen, 2011, p.118). After cold therapy application, then TENS will be applied on Marjory’s knees, for it decreases pain and inflammation, and also reduces stiffness; its physiological effect of stimulation of the large sensory fibres prevents impulses from the smaller pain fibres from being transmitted in the ascending tracks in the spinal cord; decreased inflammation and joint volume will give an analgesic effect (Hayes, 2006, p.257). The burst-mode is recommended for it has both the high (70–100 Hz), and low (3–4 bursts per second) frequency modes; the advantage of burst-mode TENS is the greater comfort of the current, recommended treatment time is 30 minutes, only once per day for several weeks (Hayes, 2006, p. 257). The disadvantage of TENS, is the discomfort that arises from skin irritation through the electrode couplant from the electricity, and a study reported that an RA patient developed paresthesias which increased pain following heat and TENS, these effects were delayed, so RA patients should be monitored closely (Hayes, 2006, p. 257). In early disease of RA, patient education is a foundation of all rehabilitation interventions; however, using cognitive behavioural approach delivered at the appropriate time which is after active treatment, in order to promote long-term adherence to management strategies rather than an education-only approach (Luqmani et al, 2006, p.5). Research suggests that changing of illness perceptions and the use of coping strategies have a significant influence on psychological well- being, health-seeking behaviours, adherence and treatment outcome on rheumatoid arthritis patients (Dures and Hewlett, 2012, p.553). Rehabilitation is targets managing the consequences of disease, so there are other strategies that are to be applied for long-term remission for everyone with RA (Hammond A, pg.135, 2004); for which Marjory shall be empowered to manage her condition. Self-management training does plays a role with patient knowledge gain, aiming to give patients the strategies and tools necessary to make daily decisions to cope with the disease; patients’ involvement in the management of their care helps to improve self-confidence, desirable behaviour and improved functional status (Vliet Vlieland, 2007, p.1400). Self-efficacy is a component that may influence Marjory to have a positive change towards her health behaviour, become motivated to succeed and have perseverance once she has decided on a plan of action; and she gain the ability to recover from setbacks, and the likelihood of maintaining the change over time (Dures and Hewlett, 2012, p.553) Joint Protection and energy conservation strategies through resting and using splinting, compressive gloves, assistive devices, and adaptive equipment have beneficial effects in managing RA symptoms and deformities, which help to stabilise Marjory’s symptoms; splints may be used to give desired position at rest and functional positioning to the involved active joints; indirectly diminishing pain and inflammation, preventing development of deformities, preventing joint stress, supporting joints, and reducing joint stiffness (Kanvucu and Evcik, 2004, p.4). Compression gloves give a gentle compression which is an advantage on controlling joint swelling leading to decrease of pain (Kanvucu and Evcik, 2004, p.4). Exercise therapy has physiological advantages of improving cardiovascular health, increasing muscular hypertrophy and increasing bone mineral density; also as a therapy, it enhances physical function and psychosocial advantages of the patients (Law et al, 2012, p. 332). Despite the positive reports about exercise, there are barriers to this management approach: psychosocial aspects cause barriers, concerns relating to joint health and limitations in exercise prescription, musculoskeletal pain and fatigue (Law et al, 2012, p. 334). Pain Management strategies are needed because pain is the main cause for the lack of activity and losses of functional ability in RA patients, successful rehabilitation cannot be achieved if the patient is in pain, so the control of the disease with classic therapeutic forms to control the pain and to improve the activities is needed (Giavasopoulos.E.K., 2008, p.65). Thermotherapies should be recommended for Marjory to use at home; even if hot and cold stimuli, in inflammatory arthritis do not alter the articular inflammation, but improve the secondary answer in the pain and the behaviour (Giavasopoulos.E.K. pg.66, 2008). Pain in the soles is common presentation among RA patients, recommendations on using insoles from high density polypropylene, that are to produce satisfactory treatment of the pain (Giavasopoulos.E.K., 2008, p.67). Work rehabilitation strategies are needed; Hammond (2004, p.143) points out key strategies to maintain people in work and these include: rapid communication with employers, job modification, re-organizing work schedules; short periods of rest should be allowed because rest decreases the inflammation and the pain and promotes the physiologic place of articulation. Good evidence indicates that introducing a simple work problem-screening tool assists early identification of work problems, and early work assessment reduces work problems, maintain people in work and results in high levels of satisfaction from workers with RA (Hammond, 2004, p.143). This assignment has justified the purpose of promoting the plans to transform care for patients with long term conditions, particularly RA for this case, by showing how the policy of improving quality of care for people with long term should be implemented in the healthcare system. The key principle priorities that were applied to Marjory, were: provision of patient education, facilitation of self-management, delivery of patient-centred care, giving evidence-based interventions and improvising early proactive intervention: these principles display patient involvement to improve the quality of care with the aim of producing good management outcomes and preventing secondary complications on the patient, so as to  improve the patient’s quality of life despite her having rheumatoid arthritis. APPENDIX 1 Proposed Management Approach Pro-forma Student Number: w12035846Scenario Number: #1 Current problems identified in order of priority: †¢Pain, swelling and stiffness at the knees †¢Stiffness in her hands – MCP and PIP joints †¢Slight swelling at the hands †¢Reduced ROM †¢Reduced grip strength Short Term Goals: †¢Reduce pain †¢Reduce swelling †¢Reduce stiffness †¢Increase grip strength †¢Increase range of motion in reference to the extension lack at the knees †¢Increase muscle strength of quadriceps †¢Counsel patient to correct emotional status Long Term Goals: †¢To stabilize symptoms †¢To improve quality of life Does the patient require any active treatment at the moment? If so, what? If not, why? †¢Yes, in reference the swelling and stiffness around the hands †¢Active treatments: Paraffin wax therapy combined with hand exercises, Ice therapy for the knees, TENS, and Patient Education What strategies do you think it would be appropriate for you to use in assisting the patient to self-manage their condition at this stage? †¢Joint protection (energy conservation, assistive devices, splints) strategies, †¢Pain management strategies heat therapy †¢Therapeutic Exercise †¢Work rehabilitation strategies †¢Hydrotherapy †¢Gait Training †¢ Evaluation and monitoring strategies using outcome measures How do you think your role will change / evolve in the long-term management of his patient? Physiotherapy plays as a role in rehabilitating Rheumatoid Arthritis (RA) with the goal to optimize function in patients. As a physiotherapist, role playing is recognised through providing patient education with reliable and appropriate information, and availing evidence based treatment programmes to the patient; by identifying factors that will positively or negatively affect maintenance of the management of RA condition. Also encourage the patient to have a positive mind set towards exercise prescriptions and physical activity tasks. Another role is to improve patients’ perception towards the management approach of RA. REFERENCES Australia. The Department of Health and Ageing (2009) A picture of rheumatoid arthritis in Australia. Canberra: Australian Institute of Health and Welfare (9) (pp.1,3,4) [Online]. Available at: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459857 (Accessed: 14 May 2014) Canada. Ontario Medical Association (2009) Policy on Chronic Disease Management, Ontario: Health Policy Department [Online] Available at: https://www.oma.org/Resources/Documents/2009ChronicDiseaseManagement.pdf (Accessed: 7 May 2014) Canada. Department of Health and Community Services (2011) Improving Health Together: a policy framework for Chronic Disease Prevention and Management in Newfoundland Labrador. Newfoundland Labrador: The Department of Health and Community Services. (p.7) [Online] Available at: http://www.health.gov.nl.ca/health/chronicdisease/Improving_Health_Together.pdf (Accessed: 14 May 2014) Demoulin, C and Vanderthommen, M. (2011) ‘Cryotherapy in rheumatic diseases’, Joint Bo ne Spine, 79, pp. 117-118. ScienceDirect [Online] Available at: (Accessed: 20 May 2014) Dures, E. and Hewlett, S. (2012) ‘Cognitive–behavioural approaches to self-management in rheumatic disease’, Perspectives, 8(10), p.553. [Online] Available at: (Accessed: 27 May 2014) Giavasopoulos, E.K. (2008) ‘Rehabilitation in Patients with Rheumatoid Arthrits’, Health Science Journal, 2 (2), pp.