Carmilla the Lover and Monster Essay

The story of Carmilla is one that shows the complexity that mankind is capable of. This story shows how loving and caring mankind can be and how monstrous we can become without knowing how or why we became so monstrous. Carmilla meets the criteria to be called a lover and monster. Love is a virtue representing human kindness compassion and/or affection. Out of love Carmilla slowly drains the life out of Laura so she can turn her into a lifelong companion. But to die as lovers may–to die together, so that they may live together. Girls are caterpillars while they live in the world, to be finally butterflies when the summer comes; but in the meantime there are grubs and larvae, don’t you see–each with their peculiar propensities, necessities and structure. So says Monsieur Buffon, in his big book, in the next room. † Sometimes it was as if warm lips kissed me, and longer and longer and more lovingly as they reached my throat, but there the caress fixed itself. My heart beat faster, my breathing rose and fell rapidly and full drawn; a sobbing, that rose into a sense of strangulation, supervened, and turned into a dreadful convulsion, in which my senses left me and I became unconscious. This shows that Carmilla despite being a vampire has retained the human ability to love. She wishes to have friends and the only way to accomplish this task is to turn humans into vampires. She also has the characteristics that many would call monstrous. As a vampire, Carmilla needed blood to sustain her existence. As humans hunt for sustenance so did Carmilla, she obtained sustenance where ever she could without disrupting her relationship with Laura. As we sat thus one afternoon under the trees a funeral passed us by. It was that of a pretty young girl, whom I had often seen, the daughter of one of the rangers of the forest. The poor man was walking behind the coffin of his darling; she was his only child, and he looked quite heartbroken . â€Å"I hope there is no plague or fever coming; all this looks very like it,† I continued. The swineherd’s young wife died only a week ago, and she thought something seized her by the throat as she lay in her bed, and nearly strangled her. Papa says such horrible fancies do accompany some forms of fever. She was quite well the day before. She sank afterwards, and died before a week†. If Carmilla was just a monster she would have killed everyone in the area just to continue her existence and then moved on to another area to find sustenance. That is not the case here in this shows that certain things are not always as they seem. Carmilla believes her existence is better than that of the human and in many ways she is correct. She does not know illness of any sort and because of her longevity. She has been a vampire for over 100 years. â€Å"She ? I don’t trouble my head about peasants. I don’t know who she is,† answered Carmilla, with a flash from her fine eyes. â€Å"The house of Karnstein,† he said, â€Å"has been long extinct: a hundred years at least. My dear wife was maternally descended from the Karnsteins. But the name and title have long ceased to exist. The castle is a ruin; the very village is deserted; it is fifty years since the smoke of a chimney was seen there; not a roof left†. Carmilla in a twisted way shows the good and evil that has existed in our world for many millennia. She has the ability to love but for her to love long-term she must kill the object of her affection. As twisted as many would perceive this is a fair reflection upon mankind over the generations. Mankind has been doing strange things to find and hold on to what they believed they love for as long as we have been in existence. The existence of vampires such as in the text Camilla is imaginary but the actions of vampires are mirrored in many aspects by the actions of man!

Amazon Case study

Question 1In what ways does Bezos’s decision to develop and deliver the Kindle and Kindle Fire show systematic and intuitive thinking?I think that Bezo’s decision to develop and to deliver the Kindle show systematic and intuitive thinking through competitive strategy to assure the success of the company. Competitive strategy refers to a strategy that is designed to create value for customers by providing lower prices or unique features not offered by rival organizations. This is proven based on Amazon’s quarterly filing ending March 31,2010 when their net sales had increased to 45% in the electronics category. Jeff Bezo, CEO of Amazon.com says â€Å" as we continue to offer increased selection, lower prices and additional product lines within our electronics and other general merchandise category, we expect to see the relative mix of sales from this category increase!†Another reason would be seeing an opportunity only Amazon.com can give long form reading to be digitalized. They have analyzed their strengths and capacities that helped them develop a new innovation in the market. From there, they were able to produce a refined product called Kindle that has the ability to review and remember more what a person reads follow people of interest and allows one to see their Public notes and manage his books, highlights, and notes.Question 2How do you describe the competitive risk in Amazon’s environment as Wal-Mart, Barnes and Noble, and other retailers strengthen their online offerings?Having the most of the services that Amazon provides myself it is my go to place for every time I am trying to make a purchase. In my opinion, since Amazon has established a great amount of customers and being the one of the most organized and friendly online place where you can purchase practically anything, it will be hard for other competitors to achieve such results. Also the greatest benefit to some people is not paying taxes on the products tha t they purchase which is currently being disused by the Government to have amazon costumers to pay a tax.Question 3Amazon is continuously looking for new markets to exploit. As CEO Bezos addresses the strategic opportunity of delivering streaming video, he calls on you for advice. Amazon’s presence and technology are already established in this market. But what decision error and traps might cause him to make the wrong decisions regarding Amazon’s future moves, and why? What can he do to best avoid these mistakes?Question 4What are the latest initiatives coming out of Amazon? How do they stack up in relation to actual or potential competition? How has the decision to produce the Fire turned out? Is Bezos making the right decisions as he guides the firm through today’s many business challenges?Latest initiatives that are coming out, is Prime membership.The benefits include:FREE Two-Day Shipping on eligible items. Note: If the item you're ordering is out of stock or unavailable to ship, we'll get it to you two days after it's back in stock. Remember to check the cut-off time shown on the detail page. Items are delivered every day but Sunday, and orders over $1300 may require a signature.FREE Standard Shipping on eligible items. FREE No-Rush Delivery (typical delivery one week after placing an order). Note: You may receive promotional credit for selecting No-Rush Shipping. Credit will be automatically applied to your Amazon.com account once the first package from a No-Rush Shipping-eligible order ships. You'll receive an e-mail as soon as the credit is available. You may select No-Rush Shipping as many times as it's offered to you, but you won't be eligible for the credit if you cancel your No-Rush Shipping order or return items from it.Shipping Upgrades to expedite delivery. Free Prime Instant Video access for paid or free trial members in the U.S. and Puerto Rico. Note: Instant Video isn't available to customers receiving free Amazon Prime shipping benefits through Amazon Student, Amazon Mom, or as guests of another membership.Kindle Owners' Lending Library access to members in the U.S. For more information, go to Kindle Owners' Lending Library. Note: Customers in a paid membership, free trial or receiving a free month of Prime benefits with a Kindle Fire activation are eligible. The Kindle device must be associated with the Prime account that's eligible for the benefit.Early access for members in the U.S. to download a new book for free every month from the Kindle First picks. For more information, go to Kindle First.An estimated 200 million fire tablets have been shipped worldwide since 2009 and another 1 billion are predicted to ship over the next five years. Market intelligence firm ABI Research estimates that 22% of the U.S. tablet users spend $50 or more per month and 9% spend $100 or more – much higher than the spending levels observed for smartphone users. The growing popularity of Amazon’s Kindl e Fire range could mean that a major share of this spending will be re-directed to Amazon’s online storefronts. Since Kindle devices are optimized to run on Amazon’s services, we expect them to drive greater adoption of Amazon’s services. We believe that the content business comprising eBooks and movie/music streaming will be the biggest gainer from the trend.In my opinion he is defiantly making the right moves especially in todays business world.

Categorisation in Long-Term Memory Essay Example for Free

Categorisation in Long-Term Memory Essay The method used was a field experiment as it took part in a classroom. This method was chosen because the independent variable can be manipulated to find the effect on the dependent variable, which can draw conclusions about cause and effect. Doing this allows reasonable control of extraneous variables and where the experimenter has a significant amount of control. An independent groups design was most appropriate because it prevents order effects and demand characteristics to a certain extent. There will be two groups, a control group who will be shown a random list of words and an experiment group who will receive a categorised list. This enables me to compare the number of words each group can recall and therefore claim the cause and effect. Independent variable Whether participants are presented with an organised list of words or not. Dependant variable Memory as measured by the number of words the participant recall from the list of words. Participants It was an opportunity sample of International school students from 13 to 14 years old. 10 participants were allocated into each condition randomly (condition 1: control group who received a random list of words, condition 2: experiment group with an organised list of categorised words). Each condition had 5 females and 5 males. Anyone that was available was asked if they would take part in the experiment. None of the participants dropped out and only 2 students refused to take part, because they were not ‘free’ at that moment. This sampling method was chosen because it was quick and convenient. By using independent designs, some extraneous variables were controlled. Order effects were prevented since different participants were allocated in different conditions. Having clear and concise standardised instructions reduced confusion. The procedures were standardised to reduce any experimenter effects. The room was kept in a constant temperature to reduce it from possibly affecting participant’s memory. Students were ranged from 13-14 years old. Other noise from outside the room may have distorted the results and therefore all windows and doors were closed so that as little noise as possible was allowed into the room. The group of participants who received the organised lists of words recalled more words than the participants with the randomly categorised list. It was distinctive from the graph that people given categorised words recalled more words than people who received a random list. The results support my hypothesis of better recall from students if words were categorised. The relationship between the independent and dependant variable was if the words were categorised, the higher the recall. Discussion Validity Validity is if the measuring apparatus measures what it’s meant to measure. By looking at the number of words remembered, it’s an indicator of memory as it is clear that the more words you recall the more words were remembered, this is called face validity and its purpose is to see if the experiment is testing what it’s supposed to measure. I chose 3 categories of words to use in my experiment and I think that they were the correct categories to use as they were all only 1 syllable and are generally used in everyday life. This is related to construct validity which is whether the method can be used to support the variable that is being measured. (If the experiment was replicated, we would see similar results) I think that I chose the words that best measure organisation and that my test was valid. Ecological validity is if the experiment measures a naturally occurring behaviour. This was a field experiment which has good ecological validity but it’s not usual for someone to be taken into a room and to participate in a test on a daily life setting. The participants were aware they were taking part in a psychology experiment so the results could have been affected by demand characteristics. Suggestions for improving validity Participants were aware they were talking part in a psychology experiment which could have created demand characteristics and possible experimenter bias. To obtain a higher ecological validity I could have applied my study to school/everyday life. For example, asking participants to recall a list of ingredients that they had used to bake a cake. This could prevent demand characteristics and experimenter bias as participants might not be aware this that it is a psychology experiment and could possibly make my results more valid. Doing this however, would make it harder to control any extraneous variables and the study would be more difficult to replicate and standardise. Reliability Reliability is whether the measuring method can measure consistently. If the experiment was repeated, similar results would appear. I have increased reliability using the same words in both lists. Two different lists of words decreases reliability as some words are easier to remember than others. Therefore using the same words will reduce this effect. In the list of organised words it was obvious that the experiment was testing memory which led to demand characteristics. The experiment were standardised which meant it’s easy to replicate. However, because participants were already told that they were taking part in a psychology experiment on memory, they knew what the experiment was about and could try harder to perform better on the test (demand characteristics). Improving reliability If I were to choose a different sampling method results would be much more representative, because my sample was an opportunity sample with only people who were ‘free’ at that moment. I could have chosen a random sample to increase reliability since there are different levels of cognitive abilities in students and not only people who were ‘free’. This method could be done by picking 10 males and females randomly (picking out names from hat) from each year group. This means a total of 70 subjects would be used instead of just 20 and doing this would give me more reliable results and a much more representative sample of school students. Also, to reduce demand characteristics the purpose of the experiment shouldn’t have been told to the participants until after the experiment, which is called debriefing. Implications of study Bousfield found that we have semantic organisation in our long-term memory. Bower et al found that organising words into a categorised hierarchy would help to improve recall. In this study I found that participants recalled more words when the words on this list were organised. This means that the findings of my experiment support both Bower’s and Bousfield’s findings. This implies that there is in fact a short and long-term memory and that there is some kind of semantic organisation of the information in the long-term memory which can improve people’s re-call. Generalisation of findings Target population is the age and group of people an experimenter plans to generalise their findings on. In my experiment the target population was Island School students between the ages 13-14 years old. This was hard to generalise due to the sampling method. The method was biased because only students who were available and around at that time were asked to participate. This could be improved if a larger sample of students were used and not only people who were ‘free’ to participate. My experiment only involved 20 people, which was too little to generalise a school of 1500 students. It was hard to generalise beyond the target population, as there are individual differences, psychological differences and cultural differences between much of the population. In addition my sample was too small to generalise beyond target population. Applications of everyday life It was found that an organised list of categorized words would be more efficient to remember than a randomly placed list of words. This can be applied to everyday life, for example when teachers teach children they have to teach in a systematical order so it is easier to recall the majority of information. As for a high school there is a syllabus which is organized by categorising the same type of information together. This is the most efficient way for remembering information and recalling it for exams. Categorisation in Long-Term Memory. (2017, Sep 17).

Raw Food Diet Essay Example | Topics and Well Written Essays - 1000 words

Raw Food Diet - Essay Example The 20th century brought huge industrial and economic development to the world, and since its second half, a system of industrial nutrition has been cultivated widely in economically developed countries. As growing urban population needs large food supplies, the crops are often canned, refined and frozen. Such processing methods lead to elimination of useful vitamins and trace nutrients, let alone the fact that many companies add â€Å"undesirable† and not quite useful ingredients for better preservation of the product. Furthermore, lack of balance in diet led to development of obesity and numerous diseases caused by it. Thus, in 1960’s – 1970’s numerous healthy eating movements emerged, including raw foodism. Yet, it should be mentioned that the key principles of raw food eating were developed in the 19th century by the Presbyterian Sylvester Graham who described advantages of eating fresh food and drinking fresh water in prevention of cholera (Graham, 18 49). First raw food restaurant in America opened in 1917 in California was named Euthropheon and didn’t only serve clients, but also carried out informative activity. A very remarkable contribution to raw foodism development was made by Ann Wigmore who studied effects of eating raw food on ill people. Wigmore and Viktor Kulvinskas began treating â€Å"incurable† diseases and thus proved usefulness of raw products for health. Still, raw food like sprouts, salads and wheatgrass juice is very health-friendly, but it isn’t the most delicious option.

Find two articles that are influential in the field of Organizational Essay

Find two articles that are influential in the field of Organizational Development - Essay Example In brief, organization development remains the dominant approach to organizational change. Organization development involves changing of the operations of the company to ensure suitability. The past, present and future trends indicate that organizational development still remains the key factor in the enactment of organizational change. Burnes and Cooke argue that the future of organization development is bright owing to the success witnessed in the process. The article is valuable in the evaluation of success and failures of organization development. Since its inception, organization development has been used to change operations within organizations with selected success being achieved. The article evaluates the past [present and future of organization development. Several issues are highlighted which are vital. Change is inevitable in any organization due to changes in the market economy and production. To understand the problem Burnes and Cooke addresses the past, present and future of organization development in the article thus developing a better understanding of organization development. According to Ron Cacioppe, organization development requires the support of the leadership structure to be successful. Organizational change is viewed by employees as a process of laying off workers leading to resistance when organization development is mentioned. The situation can be different if leadership and management encourage employees to participate in the change. The participation cannot be achieved without creativity and team building. Cacioppe addresses issues of leadership in organization development. Leadership development is vital during organizational restructuring. Modern management practices such as vision statement and balance score cards can be realigned to integrate the new operational models. The role of leadership is to develop a spirit at individual and team level to ensure

Lswee9 Essay Example | Topics and Well Written Essays - 1000 words

Lswee9 - Essay Example Nothing speaks for itself’ (Thorpe and Holt, 2008: p. 184). It can be anticipated that any researcher will have preconceived ideas about the area of study. This preconception will be founded upon the knowledge gained before actually commencing the research when interacting with others concerned. In my case, I am part of the company. The preconceptions held are going, in some way, going to have an influence both upon the way the research is conducted and could perhaps influence the results obtained. This occurs because it is the researcher who interprets the data, whether this be from his observations, the text of interviews, or from documents obtained from participants. When the researcher reflects upon the preconceptions he might have towards the subject of study and the participants involved, he must also reflect upon how his own characteristics will have an effect upon the data he collected. Hertz (1997: p. 8) stated that reflexivity allows the researcher to realise where he is in relation to the research undertaken , and so is able to minimise the effect he, and his personal ideas and knowledge has upon the research undertaken. When undertaking qualitative research it can be difficult for the researcher to operate in a detached way as they are required to interact personally with the respondents. Reflexive research is able to take this involvement of the researcher into account (Thorpe and Holt, 2008: p. 184). The writers are able to discuss this topic within reflexivity which is where methodological, discussing the proximity of the researchers to the matter under discussion. It is shown that the researcher need to be aware of this closeness and so be aware of the need to be professional and keep their distance so that the process of data collection and its outcomes is influenced in the most minimal way possible and not compromised. Johnson and Duberly (2000: p. 191) discuss

Women, marriage, and shame in the nineteenth century France Term Paper

Women, marriage, and shame in the nineteenth century France - Term Paper Example Flaubert relates the marriage and the shame Emma had to endure with the other ordinary women of France and the way French trends were followed by them. Emma, in the beginning of novel, is presented as a beautiful, sharp and happy girl but, after marriage is referred to as a troubled, unhappy and unsatisfied house wife and mother, while at the end of the novel, she portraits herself as a tragic heroine and kills herself. Emma Bovary (Madame Bovary): Madame Bovary, was the young and beautiful wife of a doctor named â€Å"Charles†. She lived in the world of imaginations and fantasy. For Emma, life was nothing but a bundle of excitements. She was not only beautiful, but was also very intelligent and sharp. But, unfortunately, she could not develop her mind as a cautious adult woman. She could not utilize her intelligence and be well-aware of the world and her surroundings. The world in which Emma would live was far more different from the actual world. Emma had a very extremely ro mantic view and imagination of the world. She strongly believed in romance and excitement related to romance. This opinion of her about a beautiful and romantic world differed from the real world. As Emma was in a habit of reading romantic books and novels, this habit drove her even more towards the heights of passion for romance. She grew even more desperate to experience it. After she met Charles, she felt that she was having a great compatibility with him as both of them enjoyed each other’s company. They would spend a lot of time meeting each other which would please not only Emma but also Charles. Soon with the consent of Emma’s father, they got married. But, unexpectedly Emma started getting bored after marriage and started losing interest in her husband. Therefore, Emma’s opinion about marriage and her excitement about romance in the married life perished away. She became quite disillusioned, dull and miserable about her married life as her husband Charle s was very good but a bit dull and boring and was not able to come up with the expectations of his wife, rather the imaginations of his wife. This dissatisfaction with her married life led Emma to two marital affairs. This was because she was trying to seek for more romantic pleasure and wanted to make her life risky and excited. Emma, after marriage, soon gave birth to a daughter who was named â€Å"Berthe†. This could prove to be a change and a reason to get excited fir Emma but even motherhood seemed boring to her and was again disappointed with her life Women in the 19th century France: Women in 19th century France, were quite different and far more responsible and loyal than the way Emma was described I the novel. They not only had to look after their home but also earn for their family. They would work in different fields performing different jobs in order to act as a helping hand for their husband. They would usually work outside their homes without their children, hus band and other members of the family being neglected. Working outside the home would make them face uncountable and unimaginable sorts of challenges which they would face readily and bravely and then would take good care of their family as well. Some women would work indoors as well, such as maids, laundry women, tailors etc. This would not only keep them safe from the challenges of the outer world but also provide them with the income to help their family. But, these kinds of indoor jobs were not always helpful and enough for their family, therefore, majority of them had to go out to

Greenhouse Gases and Climate Change Article Example | Topics and Well Written Essays - 750 words

Greenhouse Gases and Climate Change - Article Example Oil-burning automobiles and other forms of transportation vehicles are the primary source of air pollution, creating about 60% of the CO2 in the air (California Air Resources Board).   In addition to CO2, these vehicles also emit carbon monoxides (CO), hydrocarbons (HC) and nitrogen oxides (NOx), all of which contribute to global warming (Energy Information Administration).   All of these chemicals function as filters that trap the heat energy from the sun within the planet's atmosphere and cause the earth's temperature to rise on a global scale. But it isn't just the air that is affected by greenhouse gases causing climate change - the oceans are affected as well, contributing to changes in our weather patterns. The ocean acts as a natural filter for CO2 and other naturally-occurring atmospheric gases. Unfortunately, the naturally occurring levels have long been outweighed by human activity, overwhelming the natural system's balance and ability to process.   The oceans, which have been the earth’s natural filter, are now being forced to continually absorb higher concentrations of greenhouse gases than they naturally can handle (Miller).   As the water warms with the rising air temperatures and with its own collection of greenhouse gases, it becomes less capable of absorbing greenhouse gases, leaving them in even higher quantities in the air.   These warmer waters also have the effect of helping the ice caps melt, leading to rising water levels and warmer seas.   Additionally, increased air and water temperatures will increase.... All of these chemicals function as filters that trap the heat energy from the sun within the planet's atmosphere and cause the earth's temperature to rise on a global scale. But it isn't just the air that is affected by greenhouse gases causing climate change - the oceans are affected as well, contributing to changes in our weather patterns. The ocean acts as a natural filter for CO2 and other naturally-occurring atmospheric gases. Unfortunately, the naturally occurring levels have long been outweighed by human activity, overwhelming the natural system's balance and ability to process. The oceans, which have been the earth’s natural filter, are now being forced to continually absorb higher concentrations of greenhouse gases than they naturally can handle (Miller). As the water warms with the rising air temperatures and with its own collection of greenhouse gases, it becomes less capable of absorbing greenhouse gases, leaving them in even higher quantities in the air. These war mer waters also have the effect of helping the ice caps melt, leading to rising water levels and warmer seas. Additionally, increased air and water temperatures will increase the atmospheric water vapor through evaporation. This means the resulting precipitation will be proportionately higher and in different places than it has been in recorded history. Cloud compositions will change which will further amplify the greenhouse effect (Miller). This also leads to greater numbers of violent hurricanes and tropical storms. While rising sea levels may not seem all that bad, the effects of more powerful tidal forces and encroaching water can be devastating. â€Å"The tide comes and goes like clockwork, but if we continue to watch and

Introduction to Africana Studies Assignment Essay

Introduction to Africana Studies Assignment - Essay Example This could be done through delayed menstrual cycle, breaking tools, feigning illness, slowing down work or breaking tools. This was the common recourse when slave owners provided meager rations, punished too severely or increased workloads (Winant 85). The effectiveness of this method was due to the fact that in as much as it angered the slave masters, there was little they could do to stop them without risking prolonged breaks in production. The second form of resistance is showing defiance. This could involve publicly defying the master by failing to plead for mercy when beaten. A slave would disobey an order or fight back to prevent a beating. Defiance carried the risk of inviting more severe punishment. The third and most desperate form of resistance involves making oneself incapable of working. This could be achieved through self-mutilation. Some slaves would murder their slave masters and mistresses. Others would commit suicide by drowning themselves in rivers or jumping out of windows. The fourth form of resistance is running away. Groups of slaves would came together to plan escapes. They would run away and hide out in swamps and the forest often attacking plantations to save other slaves. Individual slaves would also run away to the North. Most escape attempts were unsuccessful. The American civil war was caused by a complex set of economic, social, political and psychological differences. In the course of the American Revolution and the making of the constitution, differences between northerners and southerners were overtaken by their mutual interest in building a new nation. However, once this was done, those differences started growing with the south seeking to separate from the Union. It took the leaders of a national stature to hold the Union together. The deaths of Daniel Webster and Henry Clay in 1852 left a vacuum that was replaced by sectional spokesmen who were unwilling to compromise. In the 19th century, the South was

Wegener's Granulomatosis Research Paper Example | Topics and Well Written Essays - 2250 words

Wegener's Granulomatosis - Research Paper Example Wegener’s granulomatis has no known cause and although it affects people at any age, it usually affects the young or adults at their middle age. Fatigue, loss of weight, fever, shortness of breath, bloody sputum, joint pain, and inflammation in the sinuses are the common symptoms of Wegener’s granulomatosis. Several literatures are reviewed in this paper. Among patients with Wegener granulomatosis, narrowing of the lumen with some evidence of vasculitis resulted from thickened or fibrotic laryngeal wall. In some cases, granulation tissue replaces the mucosal lining of the larynx. Hence, laryngoscopy must be carefully performed to avoid bleeding from granulomas and dislodgement of ulcerations tissue among patients whom suspected diagnosis of Wegener granulomatosis is noted. Wegener’s granulomatosis is a fatal disease when it is not diagnosed and treated properly since it presents in various forms and deceives as manifestations of other diseases. Annotated Bibliogr aphy 1. Tanna, et al., (2011) Otolaryngologic Manifestations of Wegener Granulomatosis (WG) This article discusses that it is common to have otolaryngologic manifestation among patients with Wegener granulomatosis, and usually presents as nasal, sinus, ear, or tracheal manifestations in about 70 percent. The symptoms of otolaryngologic manifestations are oftentimes misdiagnosed as infectious or allergic in etiology and generally precede the pulmonary or renal involvement. On the other hand, up to 80 percent of nose and paranasal sinuses are involved in WG and in its early stage, are often misdiagnosed as chronic rhinitis or sinusitis. Mucosal edema with obstruction, rhinorrhea, ulceration, crusting, and epistaxis are common nasal signs and symptoms observed in WG. It is mentioned in this article that necrotizing granulomatous inflammation of upper and lower airways, small arteries and veins systemic vasculitis, and focal granulomatous are known as the classical triad of full  œ blown granulomatosis. However, it is noted that it does necessarily involve all three areas and organ systems. Hence, both could be limited and systemic variations may include in the head and neck alone; head and neck and pulmonary; and head, neck, pulmonary and renal, which can be indolent or rapid in its clinical course. Its constitutional signs and symptoms, which are common but dominate rarely the clinical picture, include fever, loss of weight, and fatigue. 2. Goritsas, C., Paissios, N., Trigidou, R., and Delladetsima, J. (2010). Hepatic Involvement in Wegener’s Granulomatosis: A Case Report. This paper talks about the hepatic involvement in a patient diagnosed to have Wegener’s Granulomatosis. This is a case report of a 58 year old man, Caucasian Greek presenting with dry cough, fever, bilateral alveolar infiltrates, and acute hepatitis. The patient was diagnosed with Wegener’s granulomatosis after a lung biopsy, and its diagnosis was supported by anti-p roteinase-3 anti-neutrophil cytoplasmic antibodies present. Liver biopsy indicated a â€Å"presence of mild non-specific lobular hepatitis and periodic acid-Schiff positive Lafora-like inclusions in a large number of his liver cells.† Patient had remissions of chest x-ray findings and liver function test after being treated with prednisone and cyclophosphamide. The authors of this paper concluded that there is an etiological link between hepatitis and

Knowledge, Attitude and Breast Cancer Screening Practices in Ghana Essay Example for Free

Knowledge, Attitude and Breast Cancer Screening Practices in Ghana Essay INTRODUCTION   Ã‚   Breast cancer in its simplest definition is the cancer of breast tissue. It is the most common nonskin cancer that affects women in the United States and the highest fatality rates of cancer deaths among women in low-resource countries (Anderson et al 2006). Severity of breast cancer differs based on its level of tissue invasion. Ductal carcinoma in situ is the most common noninvasive breast cancer while infiltrating or invasive ductal carcinoma is the most common breast cancer that accounts for about 80% of invasive breast cancer. Breast lumps presentation is the commonest form of presentation regardless of the breast cancer type (ACS 2005). Epidemiologic factors are attributed to dietary and environmental risk factors, although association of diet and breast cancer had varied results. Environmental risk factors involve the exposure to several toxic elements which accounts for the increased incidence of breast cancer in Western countries. Alcohol intake is also considered to effect in the increase of the number of cases in the US population. Age is also considered as cancer risk factor and can be attributed to hormonal change. Genetic variation and ethnicity are not out of scope for the investigation of breast cancer risk factors (Barton 2005). Diagnosis and Pathology of Breast Cancer: In 2002, Breast Health Global Initiative (BHGI) together with panel of breast cancer experts and patient advocates develop a consensus of recommendations for the diagnosis of breast cancer in limited-resource countries (Shyyan 2006). Histopathologic diagnosis included fine-needle aspiration biopsy which was recognized as the least expensive, core needle biopsy and surgical biopsy and had a consensus of choosing the method based on the availability of tools and expertise. They gave emphasis on the correlation of histopathology, clinical and imaging findings. They agreed on the need of histopathologic diagnosis before breast cancer treatment. In 2005, BHGI panel recommended an additional strategy of breast cancer management. They stratify diagnostic procedure and histopathology methods into – â€Å"basic, limited, enhanced, and maximal—from lowest to highest resources†. Basic level includes medical history of the patient, clinical breast examination, tissue diagnosis and medical record keeping. Limited level includes the increasing resources that enable diagnostic imaging utilization such as ultrasound with or without mammography, tests that can evaluate metastasis, use of image-guided sampling and hormone receptor sampling. Enhanced level includes diagnostic mammography, bone scanning and an onsite cytologist. Maximal level includes mass screening mammography (Shyyan 2006). Treatment of Breast Cancer: Treatment includes surgery, radiotherapy or chemotherapy or combinations of these three treatment modalities. According to American Cancer Society (2005), treatment can be local or systemic. Local treatment of the tumor is done without affecting the rest of the body. Surgery and radiation are examples of this treatment. On the other hand, systemic treatment which includes chemotherapy, hormone therapy and immunotherapy, is given into the bloodstream or by mouth to reach the cancer cells that may have spread the beyond the breast.    Radiotherapy is a treatment of breast cancer with high-energy rays to help shrink the cancer cells. It can be given outside of the body (external radiation) or can be placed directly into the tumor as radioactive materials (ACS 2005). It may be given external to the body.   Radiotherapy requires safe and effective application requiring appropriate facilities, staff and equipment. Radiotherapy should be applied without delay, should be accessible to all but without prolongation of the overall treatment time exposure. It is part of an integral part of breast-conserving treatment. It is required in almost all women with the breast cancer, and therefore should be available (Bese 2006).   Ã‚  Chemotherapy is the use of anticancer drugs that are administered through injection in the vein or taken orally as a pill. It may be given before breast cancer surgery to reduce the size of the tumor or may be given after the surgery to reduce the chance of   recurrence (ACS 2005). This treatment is done in cycle the most common of which is 3-6 months. Most common side effects of these drugs usually stop   once the treatment is over such as in hair falling. Some of   drugs used as chemotherapy     are tamoxifen, cyclophosphamide, methotrexate, 5-fluorouracil doxorubicin, epirubicin, taxane and aromatase . These are usually prescribed in combination, and treatment is done with adjuvant therapy such as radiotherapy and pre- and post operation ( Eniu 2006).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Surgical management in breast cancer is very common. This is done to remove as much as the cancer as possible and to find out whether the cancer has spread to the lymph nodes under the arm. Surgery can also restore the appearance of the breast and relieve the symptoms of advanced cancer. ACS (2005) released some of the common surgical procedures in breast cancer. These are lumpectomy, partial or segmental mastectomy, simple or total mastectomy, modified radical mastectomy and radical mastectomy. RESULTS    Breast cancer patients in Ghana. The present study which included women with mean age population of 48 years   revealed an almost consistent perception with regards to breast cancer.  Ã‚   They were aware that breast cancer is highly increasing in their place but not informed of the cause of disease. All of the responders were not aware of family breast cancer history except one. Information about breast cancer was acquired through television and radio programs. Only after   consultation with doctors due to lumps or   pains in their breast and some due to liquid coming out of their breast, that they were informed that they have breast cancer. Most of them underwent breast tissue exam for confirmation of the disease. Afterwards, they were advised to undergo surgery with medical treatment. The responders were ignorant of the breast cancer screening and prevention. In fact, out of 10 responders, only 2 (20%) of them were aware of breast self examination and clinical breast examination and admitted that they occasionally practice BSE. None of the responders knew about mammogram except for one (10%) of them who has heard of it but never had tried one. The feeling towards the knowledge of acquiring the disease was also the same; the feeling of being a burden in the family was common. They were afraid to face the reality but have realized that they have to fight the disease through the encouragement and support of family members and   help of medical professionals. The sample population was aware of the herbalist and faith healers but they did not submit themselves into that kind of treatment because herbalist have not   proven cure for breast cancer.   The most common complaint of the responders was the high cost of therapies, hospitalization and doctor fees. The treatment cost ranged to    ¢250,000- ¢24 million except to one of them who received a free treatment for being enrolled to a clinical trial. Sentiments of the participants were the same. Delay of treatment was attributed to their distant place from the health clinics; some facilities like x-ray were not available in the clinics and   high cost of treatment. These people asked for the betterment of breast cancer management through education dissemination to the community by health care providers and a help from the government to provide financial support to those who cannot afford to submit themselves for treatment. Patients in breast cancer clinic. In this part of the study, women with mean age of 42 years who were in breast cancer clinic were included. Most common medical complaint was lump and pain in the breast while others submit themselves for screening because they have just heard it from the radio/TV.   The study revealed that women who were attending the clinic were not actually informed of the cause breast cancer but aware of its increasing rate of mortality. Misconception about the cause of breast cancer such as exposure to coins was not common but did not exclude the form of trauma due to manipulation of the breast. Others correlate breast cancer with smoking and taking alcoholic beverages. They were not aware of their family history of breast cancer.   Information regarding breast cancer was acquired through television and radio programs and others were through their friends and family members. Most of the respondents believed that early detection and prompt treatment of the disease can prevent the unfavorable outcome of breast cancer such as removal of their breast or the worst would be cancer death. Only one out of   10 participants (10%) actually practice breast self examination (BSE). Most of them were informed of BSE but not actually practicing it. They were also aware of healers and herbalist but they did not believe that they can cure breast cancer but did not disagree of the possibility that herbalist and healers could treat other diseases or illnesses like hypertension. The participants suggested that it would be better if the government would provide or establish more health care clinics for breast cancer screening and provide free screening programs especially to those who cannot afford to   pay for high cost of treatment of the disease and for an open-easy access to all especially to those in rural areas. One of the participants suggested   that doctors should study further about the treatment of breast cancer instead of resorting to breast surgery. Healers involved in breast cancer management. Many of the population of Ghana are still patronizing healers and herbalist as a resort   of treatment. Two healers from Ghana were interviewed regarding their management of breast cancer. The healers have been into this practice for about 20-50 years. According to them, breast cancer is very common in Ghana and they are aware of the increasing incidence of   the disease. They described breast cancer as an â€Å"obosam† disease and the other was a supernatural disease. Healers believed that their ability to cure   the disease inherited from their forefathers who taught them how to prepare herbs and provide them with dwarfs. They believed that doctors have no right treatment towards breast cancer because according to them they just remove the breasts of women   and subsequently die. According to the healers they do not promote breast   examinations to their patients because these are useless and cannot stop women from getting the disease. Despite the big machines available in the hospitals, women with breast cancer still die, according to them. Healers charge their patients with as much as  ¢200,000- ¢1( £15-60) million depending on the patients’ condition. The healers admitted that there were cases of recurrence of the disease due to lost to follow up and missed spiritual sessions. Healers do not refer patients to hospitals rather, they encourage hospital doctors to refer their patients to healers because they are more capable of treating breast cancer. Breast cancer consultants.   Medical health professionals play a significant role in the awareness of breast cancer. They have the power to influence their patients toward right management of the disease. In the present study, surgeon/breast cancer consultants were interviewed. Consultants as expected were aware of the increasing incidence of breast cancer but they cannot give an exact figure due to absence of cancer registry in the place however they were able to attend to 200-300 new cases of breast cancer annually with age range starting from 20 years and above. They revealed that women in Ghana associate breast cancer to death because after undergoing breast caner surgery they usually die. People in Ghana link medical intervention and death which made the women in this place afraid of   the disease and lead them to negative attitude towards the disease. Consultants believed that there were several misconceptions about the disease. They were also aware that healers and herbalist delay the   presentation of patients to   hospital which accounted for the late stage of diagnosis. National Screening Program would benefit the people in Ghana for early detection of breast cancer and prompt treatment, however, they did not deny the fact it would be difficult to establish such program due to lack of funds by the government at present time. Consultants were aware of the limited resources of the needed for the implementation of the program. They believe that it is much easier and feasible to educate the women on simple screening methods such as regular breast self examination and encourage practitioners to take advantage of examining the breasts of their patients. There are also NGOs who are engaged in some activities like providing health care assistance. Consultants revealed that they receive referrals from district regions and from private practitioners. All patients with breast cancer are candidates for surgery. There are just some procedures that lead to untoward incident which cause the people to blame the doctors. According to consultants, one big problem that they encounter is the delay of the result of tissue exam from the pathologists which sometimes lead them to acquire the high cost of private laboratory. According to consultants the 5-year survival rate in Ghan is 25% which is disappointing. According to radiology consultant, patients present themselves to treatment once they are already in advanced stage, most at stage 3 and 4. They revealed the common factors that influence the delay of treatment among Ghana women. Most of the patients were scared of the procedure of   breast cancer treatment like in breast surgery which have many social and marriage implications. The high cost of the procedure hinders the patient to go to the doctors. Consultants revealed that surgical procedure may cost    ¢2-3million   ( £ 150-200), radiotherapy is about    ¢3-4 million (  £ 200-300) and chemotherapy is around  ¢6 million ( £400). Although surgical treatment cost is covered in National Health Insurance, the cost of radiotherapy and chemotherapy are excluded. Mammography which is an effective tool in breast cancer screening costs  ¢400,000 ( £30) in private health institution and around  ¢250,000 ( £20). DISCUSSION WITH REVIEW OF RELATED LITERATURES   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The present study aimed to increase the awareness of the women in Ghana to breast cancer and the benefits that can be gained from breast cancer screening. The knowledge, attitude, behavior and practices of the women regarding early detection of breast cancer were analyzed. The ultimate aim of the study was to reduce the mortality rate of   breast cancer.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The study revealed that there were still misconceptions about breast cancer despite the information gathered from televisions and radio programs. Attendance of Ghanaian women in breast clinic did not mean that they were informed of the nature of their disease. Only few of them were also aware of preventive procedure in detecting breast cancer. Local healers and spiritualists also delayed the presentation of the patients to the hospital which contributed to the late diagnosis of the disease. Difference in the disease management of health professionals can be attributed to the location of practice and availability of resources. Several factors   thought to affect the breast cancer screening program were the poor education of the Ghanaian towards prevention awareness against breast cancer; lack of initiative of the people to spread the knowledge of   breast cancer screening such as simple breast self examination and clinical breast examination; the inaccessibility of the of primary health care and the organizers; the unavailability of the appropriate screening tools like x-ray and mammography in the community and its high cost   and the lack of support from the government.   The following   review of related literatures will help in the understanding of breast cancer and breast cancer screening. Because of the continuous increasing prevalence of breast cancer and high cost of treatment, breast cancer screening remains the most cost effective way of cancer management (Parkin and Fernandez 2006).   Most of the world faces resource constraints that hinder the capacity to improve early detection, prompt diagnosis and sufficient treatment of the breast cancer. Every country finds its way to develop evidenced based, economically feasible and culturally appropriate guidelines that can be utilized by countries of limited health care resources to improve breast cancer outcomes (Anderson 2006). Adaptive strategies should be applied to ease the growing burden of breast cancer. In 2005, according to Smith and his colleagues (2006), the Breast Health Global Initiative (BHGI) held its second summit in Bethesda, MD with the intention of reaffirming the principle of requiring all women of all resource levels to support in seeking health care and assuring the access to affordable and appropriate diagnostic tests and treatment intervention against breast cancer. They recommended breast health awareness to all women including the basic resources. They enhanced the basic facilities for effective training of relevant staff in clinical breast examination (CBE) or breast self examination and even the feasibility of mammography. MRI: Magnetic resonance imaging is one of the breast cancer screening procedures. It has been increasingly used as tool for early diagnosis of breast cancer. This screening tool has shown to detect cancers even they are small and potentially proven to be more curable than mammography alone. However, MRI is more costly than mammography and can lead to unnecessary breast biopsies, thus causing anxiety and discomfort to patient. On the other hand, a research study about the cost-effectiveness of breast MRI screening by cancer risk where they included the cancer detection ability of MRI, characteristics of women with dense breast tissue and women with high inherited breast cancer risk, revealed mortality reduction and cost effectiveness of breast MRI screening added to mammography in BRCA1 and BRCA2 mutation carriers (Kurian 2006).    The hallmark of morality and morbidity of breast cancer can be attributed to the late presentation of the patients at an advanced stage of breast cancer. It is when there is no or little benefit that can be derived from any treatment modality. In a study conducted by Okobia and colleagues (2006), the knowledge, attitude and practice of community dwellers of Nigeria towards breast cancer were analyzed. They recruited urban-dwelling women with conducted an interviewer-administered questionnaires to elicit sociodemographic information regarding knowledge, attitude and practice towards breast cancer. It was found out that the participants had poor knowledge of breast cancer. Only 214 out of 1000 participants knew that breast cancer is presented initially with breast lumps. Breast cancer examination practices were low. Only 432 participants were able carry out breast self examination while only 91 participants had clinical breast examination. This study revealed that participants with higher level of education were significantly more knowledgeable about breast cancer. Ethnicity or race-related culture and beliefs are factors that affect the increase in prevalence of breast cancer mortality. Paterniti (2006) investigated how ethnically diverse women who are eligible for tamoxifen prophylaxis because of their breast cancer risk decide about tamoxifen use for risk reduction. Prior to the study, there was discussion of the benefits and risks of tamoxifen as prophylaxis. The study which included African-American, White, and Latina women, of 61–78 years, revealed that fear of breast cancer was not prominent and they were not inclined to take tamoxifen as preventive therapy after receiving the information. Participants showed limited unwillingness to take the medication with potential adverse effects. This study revealed that women felt that they had other options other than taking the risk of tamoxifen to reduce their risk of breast cancer, including early detection, diet, faith and other alternative therapies.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Graham (2002) conducted a research about   the relationship between beliefs and practice of breast self examination (BSE in a black women population of 20-49 years of age. It was found out that health beliefs were much stronger in determining BSE performance for a given individual than were demographic characteristics. Breast self examination was related to increased perceived seriousness of breast cancer, benefit of the procedure and health motivation and was noted to have inverse relationship with perceived barriers. A related study was reported by Mitchell and colleagues (2002), about the effects of religious beliefs with other variables on breast cancer screening and the intended presentation of self-discovered breast lump. This study included women aging 40 years and above and were interviewed in their homes. Most of the interviewees believed that doctors cure breast cancer with God’s intervention which was labeled as â€Å"religious intervention with treatment†. This dimension was found out to be correlated with self-reported mammography but no clinical breast examination or intention to delay presentation of self-discovered breast lump. Minority of them believed treatment of breast cancer was unnecessary because only God could cure the disease which was labeled as â€Å"religious intervention in place of treatment†, and was significantly more common among African-American women who   are less educated and older. This was correlated with the strong intention of delaying the presentation of self-discovered breast lump. It was concluded that   religious intervention in place of treatment contributes significantly the delay presentation of breast cancer among African-American that contribute largely to the advanced-stage cancer diagnosis. The cause of breast cancer is still unclear. Adjei (2006) who grew up in Ghan and had some work about breast cancer. In his letter, he revealed his sentiments about the genetic differences in breast cancer. He had been aware of the incidence of breast cancer in Ghana since 1974 to 1999. He noted that the peak incidence of breast cancer in Ghana is in younger women with age range of 40-45 years while in United States and Caucasians, the peak incidence is in older age groups. Adjei (2006) pointed out that women of different places and environments, with different diets have similar epidemiology of breast cancer. In an argument which revealed number of breast cancer in African-Americans but rare in native African has been used to suggest that ethnicity is one factor of acquiring the disease, however, according to Adjei (2006), this information is leading because cancer has not been well-studied in Africa. Researchers are still finding their ways to fully disclose the correlation of genetic signature in breast tumors that are presently noted   to be a powerful predictor of cancer spread and cancer death. In a limited study conducted by Kolata (2002), she included few patients who are relatively. As she stated in her report, scientists said that the activity of a collection of 70 genes appear to predict cancer mortality   better than traditional measures like tumor size, cancer stage or lymph node spread to the axilla of women. She revealed in her study that 5.5% of women with good genetic signature died within the next decade while 45% of women are those of with bad genetic signatures. Adherence to the treatment regimen of breast cancer plays a big role in the improvement of disease outcome. There are no much literature about the factors associated to the behavior that influence the patient to delay or cause an incomplete adherence to the recommended follow up in patients with breast cancer. In a study conducted by Kaplan (2006), race/ethnicity, country of birth, financial issues fear of pain and difficulty of communicating with the healthcare providers are the barriers to seek follow up consultation Breast Cancer Screening: There was decline in breast cancer mortality rate of 0.9% in African American women while 2.1% was the decline in breast cancer mortality rate in non-Hispanic White women (Stewart et al 2004 as stated by Settersten , Dopp, and Tjoe, (2005).    On the contrary, De Koning (2000), questioned in his study the cost effectiveness of breast cancer screening. His idea came out when he analyzed his expectations of the reduction of breast cancer mortality after breast cancer screening. He stated in his study that the Dutch program of 2-yearly screening for women aged 50-70 would produce a 16% reduction in the total population. As stated in his research paper, the actual benefit that can be achieved from breast cancer screening programs is overstated. According to him breast cancer screening need to be carefully balanced against the burden to women and health care system. De Koning (2000) stated that â€Å"effects of breast cancer screening program depend on many factors such as epidemiology of the disease, the health care system, costs of health care, quality of the screening program and the attendance rate†. Groot, M. T. et al (2006) estimated the costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America and Asia. They developed a mathematical simulation model of breast cancer using the different stages of cancer, its distribution and case fatality rates in the absence and presence of treatment as predictors of survival. The study resulted to a conclusion that untreated patients were the most sensitive to case fatality rates. This study suggest that treating breast cancer at stage 1 and introduction of an extensive breast cancer program are the most cost effective breast cancer interventions.   Ã‚   This study is supported by the research done by Aylin and colleagues (2005). They recruited women at the mammography clinic to evaluate the knowledge about breast cancer and mammography as breast cancer screening procedure. The striking result of this study is that most of the participants (95.3% of the total participants) were aware that women should have mammography screening periodically. They were informed of the fact that breast cancer screening such as mammography could help in the early detection of breast cancer. However, less than 50% of them admitted that they had never had mammography screening. Majority of the respondents (71.1%) were practicing breast self-examination. Another related study was conducted by Dundar and colleagues (2006), since breast cancer is the second leading cause of cancer deaths in Turkey , they determined the t the knowledge and attitudes of women in a rural area in western Turkey about breast self examination and mammography. They recruited women with age ranging from 20-64 years. Although majority of the participants have heard or read about breast cancer only 56.1% of them had sufficient knowledge about breast cancer and some admitted that they acquired the information from their health care professionals. Those with information of beast cancer were also those who practice breast self examination. This study revealed that health care professionals play a big role in information dissemination about breast cancer. Table 1. Recommendations for routine mammographic screening in North American women aged 40 years or older who are at average risk for breast cancer* Group (date of recommendations) Frequency of screening (yr) Included ages (yr) 40-49 50-69 70 Government-sponsored and private groups US Preventive Services Task Force (2002)** 1-2 Yes Yes Yes*** Canadian Task Force on Preventive Health Care (1998, 1999, 2001) 1-2 No Yes No National Institutes of Health consensus conference (1997) No+ American Cancer Society (1997) 1 Yes Yes Yes National Cancer Institute (2002) 1-2 Yes Yes Yes Medical societies American College of Obstetricians and Gynecologists (2000) 1-2 if aged 40-49 yr 1 if aged 50 yr Yes Yes Yes American Medical Association (1999) 1 Yes Yes Yes American College of Radiology (1998) 1 Yes Yes Yes American College of Preventive Medicine (1996) 1-2 No|| Yes Yes American Academy of Family Physicians (2001) 1-2 No+|| Yes No American Geriatrics Society (1999) 1-2 Yes*** Advocacy groups National Breast Cancer Coalition (2000) No + No National Alliance of Breast Cancer Organizations (2002) 1 Yes Yes Yes Susan B. Komen Foundation (2002) 1 Yes Yes Yes The above table   was taken from the study conducted by Barton (2005) There are several ways presented and studied for breast cancer screening. Its concern is to reduce the prevalence of cancer mortality and to improve the quality of life as a result of early detection, however, there are still people that are not aware of breast cancer screening In response to increase the worldwide awareness of breast cancer, breast cancer advocacy movement has been analyzing the common experiences of women with breast cancer around the world especially those with limited resources. They found out that although there are language barriers, sentiments were consistent across cultures; cancer survivors have the same experiences and fears. The beliefs and taboos about breast cancer hinder the awareness programs and treatment. There are also limited resources for public education and awareness. Difficulty in understanding and translating the concept of the disease into English also hinders them in the public awareness of breast cancer (Errico and Rowden 2006). In accordance with this, sociological review of the barriers experienced by the women from different traditional cultures is essential not just to understand patterns of late breast cancer diagnosis but also the importance of interventions and programs. This is necessary for them to understand the preventive health care, specifically in breast cancer. This is because many are still ignorant of the breast cancer. According to Remennick (2006), health care providers and policymakers should try to understand and influence women especially those who are cancer risk to be aware of the disease to detect and treat breast cancer early. There are many structural barriers that hinder women especially those living in rural areas. Socioeconomic factors include poor health insurance, distance to medical facilities and inability to take time off work. Organizational barriers include difficulty in navigating complex health care systems and interacting with medical staff. Psychological and sociocultural barriers are poor health motivation, denial of personal risk, fatalism mistrust of cancer treatments and fear of becoming a burden on the family members. Still in other cultural behavior, especially in Muslims, women are strongly controlled by men and therefore may prohibit women in breast cancer screening. Remennick (2006) includes in his study the different approaches that lower the mentioned barriers, including implementation of uplifting the educational programs that would enlighten people regarding cancer myths and fallacies. He suggests that health care professional must outreach to their co ethnics. Primary health care providers play a critical role in   determining the compliance with treatment and preventive practices through direct recommendations to their patients. Family physicians and general internists showed that 70% of women who received a provider referral completed a screening mammography within one year versus only 18% of self-referred women (Grady   et al 1997 as stated by Santora 2003). However, Over 90% of rural women report that a doctors recommendation to have breast cancer screening is important† (Sparks et al 1996 as stated by Santora 2003). It should be noted that clinician compliance is contributed by several factors such as relation with provider, guideline of the treatment, patient’s behavior and environmental factors. Several studies have been conducted to report the   differences of health services in rural, urban and suburban areas with regards to their   health care services in the family practice clinics. It has been pointed out that lower utilization has been a significant factor. Those rural health practitioners have less access to health care services.   In a study done by   Pol and his colleagues (2001), suggested that rural health services do not lag for patients with access after revealing that 9 out of 16 services examined were as high or higher in rural areas. Another   study to examine the variations in breast cancer screening among primary care clinicians by geographic location of   clinical practice was done by Santora (2003). Physicians, nurse practitioners and physician assistants were included in the study and were classified into urban, rural and suburban categories based upon practice location. The study revealed that although there was no significant difference in the practice location, there was evident variation in the practice of   breast screening. It was reported that urban and suburban health practitioners were less compliant with the use of breast cancer guidelines as compared to clinicians in rural areas.   Primary care clinicians, including physicians, nurse practitioners and physician’s assistants lack a consistent. This study revealed   that geographical location is not the main factor of inconsistent medical approach to breast cancer screening. Although the difference in the approaches to the procedure is uncertain in this study. A related study about General Practitioners’ (GP’s) knowledge, beliefs and attitudes toward breast screening, and their association with practice based-organizations of breast cancer screening, was conducted by Bekker, Morrisona and Marteau (1999). This study revealed that women’s attendance for breast cancer screening may be increased due to raising GP’s perceptions of the   threat of breast cancer. 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S. and Gupta, R. 2003, â€Å"Predictors of Screening for Breast and Colorectal Cancer among Middle-aged Women†, Family Medicine Journal, vol 35 no 5, pp. 349-354 †Weight Gain a Big Factor in Postmenopausal Breast Cancer†, 2006, Journal of the American Medical Association, Available at http://www.aphroditewomenshealth.com/news/20060612001144_health_news.shtml Yip, C. H. et al, 2006, â€Å"BREAST HEALTH GLOBAL INITIATIVE: Breast Cancer in Limited-Resource Countries: Health Care Systems and Public Policy†, The Breast Journal, vol 12 no. 1, pp. S54–S69.

Ethics Essay Example for Free

Ethics Essay In comparing the similarities and differences in ethical theories, the goals of each theory and the morals and values that can be observed in the process. While the following ethical theories appear similar on the surface virtue theory, utilitarianism, and deontological ethical will be discussed and their differences will be defined. Virtue Theory relates to the pursuit of excellence in everything you do. As one commercial put it, â€Å"Be all that you can be† (U. S. Army 1981). One must have the idea that if they want to maximize their greatest potential, they must work hard to produce it. To the Utilitarian this may appear selfish, but self-discipline and self-determination is key to achieving the goal. Oxford dictionary describes utilitarianism as one who practices the doctrine that produces the greatest happiness of the greatest number. For example, a busy mother gives great sacrifice of putting her needs aside to take care of her three children who are home sick with the flu. At this moment, the mother, who is also sick with a temperature of 102 F, is not practicing virtue theory because; the mother has currently put her needs aside. The mother is practicing patience and compassion to assure that her children get the care that they need. Boylan (page 171) describes Deontological ethics as a moral theory that emphasizes one’s duty to do a particular action just because it is right and not through any other sort of calculations. An example of this would include presenting an inventory sheet to authorities proving that fraudulent activity has occurred buy a company that has been charging customers extra for supplies. The distinct difference of these theories suggests that virtual theory focuses attention toward creating greatness within one’s self. Utilitarianism focuses attention by creating greatness toward the masses. Deontological ethics relates to doing what is right whether it be for one’s self or for the masses with the understanding that happiness is not the goal but a moral responsibility is. A personal experience explaining the relationship between virtue, values, and moral concepts includes a deontological experience that I had several years ago. One Friday afternoon I walked into a bank to cash a check in the amount of $527. 28. The teller cashed my check, but I did not bother to double check the money until I got home. After checking and double-checking the money that evening, I came to the realization that I had 627. 28 cash in my envelope. The teller accidently gave me an additional $100 dollar bill. I could not go back to the bank to address the problem because the bank had closed for the day. I could not with good conscious keep the money because my family has instilled strong morals and values of honesty, integrity, and dignity within me. The money must be returned for it is the morally right thing to do. Saturday morning I drove back to the bank and asked for the manager and explained what had happened. I handed over the entire envelope as it was presented to me and I explained that two very crisp one hundred dollar bills were so tightly stuck together that it appeared as one bill. The manager surprised at what had transpired the day before, thanked me for my honesty and determination to see that the money was returned. I told the manager that I appreciate her kind words but it was truly the right thing to do. Though comparing the similarities and differences with these moral standards, ethical theories along with morals and values can be observed in the process. While it is clear that these theories may appear similar in nature the following ethical theories, virtue theory, utilitarianism, and deontological ethical will be discussed and their differences will be defined.

Indian Jurisprudence Gender Sensitivity In CRPC Law Essay

Indian Jurisprudence Gender Sensitivity In CRPC Law Essay The basic tenet of criminal jurisprudence is that crime is not genetic, that is, one is not born a criminal. As no iron curtain is drawn between constitution and the accused, an under trial or a convict, his basic human rights cannot be put to jeopardy for an accused or a convict by the mere reason of accusation or conviction, is not denuded from his fundamental rights guaranteed in the constitution  [1]  . The distinction between gender and sex is often ignored by those who claim to be the sentinels of gender justice. While once in a while one hears voices against the injustice towards women, our justice system often turns a blind eye to the brutality with which all criminals are treated. It is true that the purpose of a punishment is deterrent and punitive in nature and the offender deserves a hard handed treatment as a retribution for his action, this cannot justify the acts which border brutality. Police, which is the first instrument in the process of ensuring criminal justice, often fails to justify its actions of dishonoring gender dignity of other genders when they interact with them in the society and particularly when they investigate crimes in which they are the suspects, dà ©tinues or the accused.  [2]  Men, women, transsexuals, all fall in the grind of this insensitivity perpetrated in the hands of those in charge of safeguarding the fundamental rights of convicts and other participants( victim, witness etc) in a criminal trial. The fact however remains that while substantive law fails to acknowledge the thin line of distinction between gender and sex and transsexuals and male criminals continue to be treated inconsiderately, our procedural laws, furthered by judicial activism; do provide some sense of sensitivity towards women. Spurred by judicial pronouncements, Code of Criminal Procedure (hereinafter CrPC or the Act) has been amended time to time to introduce elements of sensitivity towards women. This paper is an attempt to trace the gender-sensitive provisions of CrPC, supported by judicial pronouncements, restricting the scope of gender to women. The discussion runs in three parts: part I dealing with provisions when women are offenders, part II when they are victims of criminal offenses and part III when they are witnesses in a criminal trial. The last part will be followed by a conclusion with an analysis whether these laws provide adequate protection to women and whether the available procedure are being implemented in reality or are merely a letter of law. The CrPC amendments of 2005 and 2008 have been taken as the backdrop of the discussions in this paper. As it is not possible to cover all sections reflecting sensitivity towards women in the prescribed word-limit, the author has narrowed down the scope of discussion to the most important provisions under each part. Part II and subsequently III discuss in detail the special provisions for women in rape cases and other atrocities of women-trafficking, domestic violence and dowry deaths and sexual harassment at work have been excluded from the discussion. Part I Accused Arrest The Indian criminal jurisprudence has been sensitive to the fact that women, being physically weaker, are often mistreated by police while arrest and consequently, provisions preventing any physical or sexual assault while arresting them find place in CrPC. Section 46 of the code enlists the details of how arrests have to be made by the police  [3]  . Parliament, through the 2005 Amendment Act to CrPC introduced in section 46, sub clause 4 to ensure that women offenders are not mistreated while being arrested by the police officers. It read:Save in exceptional circumstances, no woman shall be arrested after sunset and before sunrise and where such exceptional circumstances exist, the woman police officer shall, by making a written report, obtain the prior permission of the Judicial Magistrate of the first class within whose local jurisdiction the offense is committed or the arrest is to be made. The history of this provision can be traced back to the report submitted by the National Human Rights Commission in 1997. The report examined the complaints of human rights violation through abuse of powers of arrest and detention given to the police. According to this report, the NHRC requested that all Indian state governments translate th ese guidelines into their respective regional language and make them available to all Police Officers and in all Police Stations.  [4]   The report includes the following guideline pertaining to the arrest of women, As far as is practicable women police officers should be associated where the person or persons being arrested are women. The arrest of women between sunset and sunrise should be avoided  [5]  . The incorporation of this provision in CRPC was spurred by the case law produced by the Courts in response to the demand for protecting women. In Christian Community Welfare Council of India and another v Government of Maharashtra another  [6]  ,the High Court of Bombay made it mandatory for the presence of a woman officer for arresting a woman. The Supreme Court however reversed the judgment  [7]  , accounting for the situations when arresting a woman is crucial but logistical impediments make the presence of a woman officer difficult. The 2005 amendment act was a closer embodiment of the Supreme Court decision as it gave the police some leeway to arrest females even in absence of lady officers. 2008 Amendment to CrPC saw further sensitizing of arrest procedures with regards to women when a proviso to clause 1 of section 46 was added to ensure that the clause 1 is not misused to offend women who are arrested. As interpreted by Courts, un-amended section 46(1) implied that arrest being a restraint of the liberty of a person, it can be effected by actually contacting or touching the body of such person or by his submission to the custody of the person making the arrest as a mere oral declaration to arrest without actual contact or submission does not amount to arrest.  [8]   The proviso states that Provided that where a woman is to be arrested, unless the circumstances indicate to the contrary, her submission to custody on an oral intimation of arrest shall be presumed and, unless the circumstances otherwise require or unless the police officer is a female, the police officer shall not touch the person of the woman for making her arrest. The proviso permits the physical arrest of a woman by a female officer or unless the circumstances make it an indispensible necessity for the police office to make use of physical force to restrain and arrest her. Even then, the use of force should be reasonable and not more than required to prevent the offenders escape.  [9]   search Section 47  [10]  places restrictions on police while searching for the offender in a place occupied by a pardanasheen woman, in which case she will be adequately notified by the police before search giving her time to remove herself from the sight before the police commences with the search. Clause 3  [11]  of section 51 as well as clause 3  [12]  of section 100 makes it mandatory that the search of a female is conducted only by a lady to ensure that her dignity is not violated in any form.  [13]   Section 53(2)  [14]  and 54  [15]  , that allows for the medical examination of the accused make it mandatory for the police to ensure that female arrestees are examined only by registered female doctor or under her close supervision. bail CrPC empowers every arrestee with the right to be released on bail when arrested for a bailable offence. It is the duty of the police officer to inform him of his right to be released on bail  [16]  . Women however are given the privilege of a bail even in circumstances When a female is arrested for a non-bailable offence, even if the offence is very serious (punishable by death penalty even), the court can release her on bail as provided in section 437(1) of CrPC  [17]  . For instance where a young woman of two infant children was accused of murder along with her husband and her husband was incarcerated for the crime as an under trial, the accused in such facts and circumstances of case would be entitled to be released on bail as per the provisions of this section  [18]  . This provision is not to be taken violative of article 14 of the Constitution as it discriminated between male and female offenders because article 14 had to be read subject to article 15(3) of the Con stitution under which the State Is empowered to make special provisions for women and children. Detention Even though CrPC is silent on the issue of separate provisions for detention of women offenders, Supreme Court in Sheela Barse case  [19]  held that female suspects must be kept in a separate lock-up in the police station. They should not be kept where male suspects are detained. Various states have, by orders made it mandatory that all female prisoners have to be imprisoned in a separate building or in separate part of the same building which is completely separate from the male prisoners.  [20]   In R.D. Upadhyay vs. State of AP.  [21]  , gender specific issues of women have been dealt with by the Supreme Court in detail and minimum standards laid for the care of the mother and the child. In pursuance of this, women inmates are allowed to keep their children up to six years of age. Pregnant women in prisons have to be given proper pre-natal and post-natal care  [22]  . Section 416  [23]  provides the provision of postponement of capital sentence awarded to a women if she is carrying a child. The High Court is also empowered by this section to commute the sentence of death penalty to that of life imprisonment. The purpose behind this provision is to ensure that the unborn child is not penalized for the crimes committed by the mother. Part II Victim Colonial law treated women as chattels: fragments of property of their male messiahs. It took two centuries to liberate the country, and another half to liberate the thoughts. In 1970, India witnessed a rape trial that mocked the very fundamentals of our constitution: equality and justice were stifled as Supreme Court refused to penalize a police personal charged of raping a tribal minor girl, in police custody, on grounds of the girls questionable sexual conduct in past. This was the infamous Mathura rape trial  [24]  . Efforts of women activists and judicial intervening finally paid off and the last decade saw attempts to ensure there werent any Mathuras with the promulgation of the 1983 amendment. In 1983, the government passed the Criminal Law Amendment Act, which created a rebuttal presumption in cases related to custodial rape  [25]  . Custodial rape, gang rape, rape of pregnant women and minor women were recognized as rape offenses by introduction of sections 376A to 376D in the IPC. The government also made amendments stipulating that the penalty for custodial rape should not be less than seven years imprisonment; and it provided for in camera proceedings  [26]  and made the disclosure of the victims identity a punishable offence.  [27]  Publication of proceedings in a rape trial could be possible only with prior permission of the Court. This clause however was amended by the 2008 amendment to facilitate the dissemination of information regarding the atrocities on women and their rights through media. Therefore, the 2008 amendment allows the publication of proceedings in a rape trial provided confidentiality of name and address of the parties is maintained  [28]  . Women rights activist claim that despite the 1983 amendment which did bring some procedural improvement in the state of women in rape trials, not much was reflected in reality. These amendments were not enough to stem the rise in the number of cases of sexual violence against women  [29]  . One crucial defect in the law was the definition of rape under Section 375 of the Indian Penal Code (IPC), which took into account only penile-vaginal penetration. Other physical and mental injuries were left to be dealt with under Sections 354 and 509 of the IPC as `outraging the modesty of a woman.  [30]   In 1996, the substantive redundancy of these laws was exposed in the Gurmeet Singh case  [31]  where the trial court acquitted the rapists disbelieving the version of the prosecutrix( despite section 114A of Evidence Act that allows the assumption of truth in the statement of the victim in rape trials and placing of the burden of proof on the accused) and delay in lodging the FIR, . The Supreme Court, however was emphatic to the cause and laid down certain guidelines to be followed in case of rape trials  [32]  : Delay in lodging FIR is not material if properly explained. Testimony of the prosecutrix in cases of sexual harassment in cases of sexual assault is vital and unless there are compelling reasons which necessitate looking for corroboration of her statement, the Court should find no difficulty in convicting the ccused on prosecutrix testimony alone. Trial of sexual offences should be in camera and invariably by a lady judge wherever available. Court must restrain making observations that probably the prosecutrix is a girl of loose moral character. Court is under an obligation to see that prosecutrix is not unnecessarily harassed and humiliated in cross examination in case of rape trial. In the case of Dildar Singh v. State of Punjab  [33]  , it has been held by Honble Apex Court that delay in lodging of the first information report cannot be used as ritualistic formula for doubting the prosecution case and discarding the same on the ground of delay in lodging the first information report. Some of these guidelines were translated into law by subsequent amendments to Indian Criminal Law. Later, vide the 2003 amendment to Indian Evidence Act, a proviso was added to section 146 which allowed for cross examination. It made it impermissible to question the prosecutrix in a rape trial regarding her past sexual conduct and history.  [34]   With the 2005 amendment to CrPC, section 53A  [35]  was added to incorporate provisions for medical examination of the rape accused to provide evidence. As for the examination of the rape victim, she cannot be medically examined without her consent, as stated in 164A  [36]  of CrPC. In case she is unable to express her consent, a person competent to consent on her behalf will do so. Also, the medical examination of both the accused and the victim has to be conducted within 24 hours of receiving the information of the offense. Notified on 31 December 2009 was the latest amendment in CrPC in an attempt to sensitize the criminal laws towards protection of women further. Many provisions were introduced to minimize the harassment faced by victims during the process of investigation and trial in a rape case. The amendment act introduces a proviso in section 157  [37]  stating that the statement of the victim in a rape case has to be recorded , as far as feasible, by a lady officer, in a place she feels comfortable in: preferably her house and in presence of her parents, guardians, near relatives or a social worker. This was primarily done to avoid the humiliation the victim has to suffer in revisiting the details of the horrifying incident in front of police men and others in a police station. Besides this, the act allowed audio-video electronic means to record statement under 161 and 164 of CrPC to facilitate victims who are not in the physical or psychological state to be present in person before the magistrate for a statement. The amendment act adds to section 327, the provision of a lady judge trying a rape case as far as possible so as to bring a compassionate thought to the proceedings. One of the major contributions of the 2008 amendment act is the introduction of section 357 A  [38]  in CrPC providing for the provision for compensation to victims for injuries suffered. Though this provision is not women-specific, it can prove to be a major instrument for justice by providing the rape victims adequate compensation for the physical and emotional torture they were subjected to. Compensation for rape was recognized by the Supreme Court for the first time in the Chandrima Das case  [39]  where the court held that the relief can be granted to the victim for two reasons- firstly, on the ground of domestic jurisprudence based on the Constitutional provisions( as her fundamental right to life and dignity is violated in a crime of this heinous a nature); and secondly, on the ground of Human Rights Jurisprudence based on the Universal Declaration of Human Rights, 1948 which has international recognition as the Moral Code of Conduct- adopted by the General Assembly of the United Nations. Activists hope that 357A will not merely be a procedural puppet in the hands of the state government and be actually utilized in facilitating some compensations to the unfortunate victims of rape and sexual violence. The amendment also has provision of right to appeal for victims. Currently, the right to appeal lies with the state which directly fights the case with the accused. Under the proposed change, the victim can independently hire a lawyer and go in for an appeal in addition to what the state does  [40]  . Part III Witness Police is authorized by section 160  [41]  of CrPC to summon a witness during investigation in case. This power however is limited by the proviso to sub-section 1 that restricts the police from summoning a male below fifteen years of age or a woman other than the place of his or her residence. A woman accused or a witness should not be summoned or required to attend at any police station under section 160 but they must be enquired only by women police or in presence of woman police at the place where they reside.  [42]  It was considered by the Supreme Court , in the Nandani Satpathy  [43]  case, to be a matter of public policy to keep minor children and women away from police company except as much as possible till the time community confidence and consciousness will regard the police force as entitled to better trust and soften the stigmatizing provisions now writ across the code.  [44]   In the landmark case of Sakshi v Union of India  [45]  , the Supreme Court realized and acknowledged the pain and trauma a woman goes through when she is asked to reiterate the soul-scathing instance of rape and prescribed guidelines for treatment of victims and witnesses in a rape trial. The court accounted for the fact that the mere sight of the accused may induce an element of extreme fear in the mind of the victim or the witnesses and can put them in a state of shock, making it difficult to give a true testimony  [46]  . Therefore, a screen or some such arrangement can be made where the victim or witness do not have to undergo the trauma of seeing the body or face of the accused. In State of Maharashtra and P.C.Singh v Dr. Praful Desai  [47]  , the Supreme Court explicitly recognized video conferencing as a means of recording evidence in a rape trial to facilitate the victim-witness to answer questions without fear or embarrassment. The latest amendment to CrPC seems to be a manifestation of this guideline by the Court as it adds to section 275  [48]  , a proviso allowing audio-video electronic means to witness in presence of advocate of the accused so as to facilitate their testimony if they feel uncomfortable facing the accused and others in the court room. Conclusion Though amendments over the last two decades have introduced some element of sensitivity in our criminal laws, skeptics have their reservations regarding the same. The way women have been treated in criminal justice system in the past makes it difficult to place faith in it. For instance, the 2008 amendment act introducing the provision of women judges hearing rape cases is being frowned upon by some women rights activists and is being seen as a means of ghettoizing  [49]  female judges, confining them only to women related matters. There seems some legitimacy in this accusation as if providing male judges was the problem to be solved, why is one ignoring the male defense lawyers projecting scathing questions to the victim. Moreover, since there are lesser number of female judges in the country, waiting for the appointment of one in a rape trial will delay the justice further by weeks. Despite the gender-sensitive provisions like women officers arresting female offender, the system fails to account for practical impediments like the skewed ratio of male and female officers  [50]  . A gender-sensitive, rather than a gender-biased system seems a more wholesome solution to the approach as law as without the backing and support of law-enforcement authorities, the laws made are hollow words, which go unnoticed. Gender sensitivity, not gender, is the watchword, for patriarchy is endemic to the system, not a trait of males alone  [51]  .  Thus, what is needed today is not merely simulated sensitivity in procedural law, rather its reflection in reality to ensure that no woman is wronged in the hands of those claiming to dispense justice.