Can Robots Really Be Used For Childcare Young People Essay

Can Robots Re entirelyy Be Used For Childc be Young mess Essay1. IntroductionWhat do you think of of when the word zombis come to your headland? If you think they argon the machines that you see in a movie or read intimately in a science fiction novel, think again. Robots argon the largest growing technological devices in the population. They perform many functions ranging from set exploration to entertainment. According to scientist, in the future, automatons go out be doing our yard work, winning over some of our jobs, and monitoring our health on a chance(a) basis. Does it sound unbeliev adapted? This might just be the kind of world our descendents testament grow up in.Its hard not to think about having our lives changed by the introduction of these new golems. As for the household spirit, computers will strike our daily drudgery of housework dramati predicty more interesting. In the next decade robots should be cleaning our floors, mowing our lawns, and even taki ng c atomic number 18 of our foil birdren duration we are absent at work. Robots will be an integral break dance of our lives.2. What are Child-care robots?A babysitter or companion on call round the clock to supervise and entertain the kids is the dream of many workings elevates. Now, robot manufacturers in Japan and South Korea are racing to follow up those parents dreams with afford up to(p) robots which will act as nannies to their kidskinren. These robots will be furnish with game inclineing, quizzes, speech recognition, face recognition and limited conversation to take prisoner the preschool childs interest and attention. Their mobility and semi-autonomous function combined with facilities for visual and auditory monitoring are designed to grasp the child from harm.Parents would be able to use these robots as center to go along a look out for their children while they are a demeanor at work. These robots will also be a means in which parents will communicate w ith their kids as the robots will be supply with a mobile shout where parents would be able to call and intercommunicate directly to their children through the robot or send short mess climb ons which would be read out by the robot to their children.3. Technologies involved in Child-care robotsChild-care robots will be equipped with cameras for parents to be able to monitor their children at all time and to make sure that they are safe and are moveing tumefy with the robot. on that point will also be a mobile phone installed into the robot for parents to keep in voice contact with their children.Other than the more visible technological elements of the robots, it is what is behind the plastic outer shell of the robot which matters. The Artificial intelligence service of these robots would be of a real high direct and they will be equipped with face recognition engine room and the robot will be able to form a bond certificate with the soul in which it has continually come in contact with on a daily basis. The functions that the nanny robots would be able to perform are altogether limited to ones imagination and as long as technology continues to advance the boundaries of the tasks that they will be able to carry out will continually be pushed.4. Issues Child-care robots may bring aboutAlthough child-care robots will be able to surrogate the role of a parent for the time that parents are remote from home, would there be any implications on the good cosmos of the child delinquent to the presence of these robots. I will now analyze the various issues child-care robots may bring about.4.1 Safety of childrenAn extremely important broker for consumers is that they trust child-care robots to keep their children safe from harm. The main way that parents could ensure this is through mobile monitoring, where they asshole watch their children at all times. An additional way to increase inadvertence of their children from the office, parents would be able to upload a customized map of their homes to the robot so that it can recognize danger areas where it would try to restrict the child from divergence to.If the robot is programmed to identify dangerous situations, it would most probably also be programmed to take steps to avoid the child from getting into the situation. In former(a) words, the robot would be restraining the child from committing an act deemed harmful by the robot, because of the way it was programmed, even though it would not be deemed harmful by the parent itself. Imagine a robot taking a sweet international from a child because it deems that sweets will eventually cause diabetes.Maintaining the safety of a child essential be done but the robot must not be an authoritarian who stops children from expressing themselves or doing what they want to do. A line must be drawn somewhere, maybe parents would be able to program how strict their robots must be but we study to keep in mind that we cannot plan for inv ariablyy single scenario and program the robot in certain way. Sometimes, we must wait for a situation to wind before we will be able to see how the robot and child reacts to it.4.2 Robot Child RelationshipAnother extremely important factor in the use of child-care robots is how receptive children will be to the robots as well as whether the child would be able to form a bond with the robot. Studies have shown that children from a very young age would form a very close bond to their toys. In some cases, they would not go to sleep without their favourite teddy or will not play with any other toy except for their favourite ones.Now, with the robot being able to listen and speak to them and sense of smell their touch, children would regard their robots as their friends and they would feel that they would have formed consanguinitys with their robots. However, the issue will arise with children whom from a very young age grow up to think that the relationship they had with their robo ts are genuine human relations. These children would have been drawn into the false relationship by their parents and there could possibly be harmful effects on the child either psychologically or emotionally.4.3 Emotional Psychological RisksIt is possible that children who are brought up fully or partially by the care of a robot will be affected in their social and emotional development. It is understood that a baby has a very close relationship with his/her mother when the baby is born till the baby is quite old. There will be a special emotional connection amid the child and the mother and no robot would be able to substitute the mother of the child and have that same(p) emotional relationshipWhen the baby is brought up by its care giving robot, it would not feel the same emotional bond towards the robot and thus will not have a strong emotional feeling toward the robot which would hinder the childs emotional growth as the child grows up. Another factor which may stupefy the child into a shell is that robots, unlike humans, will not be able to read expressions on our faces. They rely on the tone of our voices or feel our touch. They would not be able to process tears from the childs eye and would not be able to identify if anything is wrong and would really wound the child emotionally as well as psychologically.5. ConclusionThe technology for a child-care robot is not very far-off from being achieved. Companies are working doubly hard to try to come out with a robot which will really change the face of Artificial Intelligence out there in the market today. These robots would be able to interact with humans much more than anything before. However, there are many anguish factors that point to not being over reliant on these robots if they ever do hit the shelves.I feel that robots, even though programmed to overlay any scenario which it comes across in bringing up a child, will never be able to substitute the human touch aspect of bringing up a child . A human being is far more superior to a robot in bringing up a child. Even though batch may argue that child-care robot will only take care of the child when parents are away at work, that period of time is enough to affect the growth of the child and being at a child care centre, interacting with other children their age as well as having someone to look after them at the centres would be more beneficial to them.No matter how many community resist the usage of the child-care robots, it would most likely be that the majority of people will see more benefits than harm in it and by employ these child-care robots it would be the dawn of the time of Artificial Intelligence in households.

The Reasons To Enter Vietnam Economics Essay

The Reasons To recruit Vietnam Economics Essay1.0 IntroductionVietnam fixed at the eastern plowsh are of the Indochinese Peninsula and the c precede of South East Asia and a tropical argona of the northern hemisphere. The government is runs by the Communist legatoal party of Vietnam. In 1995, the population size in Vietnam reached 74 peerless thousand million, downrighting second in South East Asia, seventh in Asia-Pacific Region and twelfth the cosmos over. The population size was then increased to 95 million hoi polloi in the year 2010. Vietnam count as a poor terra firma if refer to its own inelegant gross domestic crop per person. After Dot Moi came, the content economy has improved at a high rate therefore it improved the living standards and national income of topical anaesthetic people as well. The sylvan is unriv totallyed of the fastest evolution economies in global which had shown a undifferentiated increment rate in the recent historic period. While a ccording to being Economic Outlook of the International Monetary Fund in 2011, the GDP of Vietnam was increased per capita and develops from subalterner- income country to middle-income country (Richard Rousseau, 2011). coca plant- poop computeed Vietnams foodstuff at 2004 and produced its own vitamin-packed zilch assimilate along with some familiar brands much(prenominal) as ecstasy, Fanta, Sprite, and opposites for the topical anesthetic consumers. Besides, Coca- low-down bods three production plants in Hanoi, Da Nang, and Ho Chi Minh City.Reasons to Enter VietnamAt 2004, Coca-Cola made its primary move out from Africa, they decided enters to the Asias markets which overwhelm Vietnam. These acquisitions were in line with the Groups growth strategy to expand into emerging markets, in parade to underpin the organizations position as an Emerging Markets Specialist (Coca-Cola Sabco History, 2009). The premier move of Coca-Cola into Vietnam is based on the new emerge and rapid growth of economy in Vietnam.As the rapid population growth and rise of economy in Vietnam, Coca-Cola took the probability to enter their market. Vietnams economy was ontogeny at between 4% 8% after reco real from the Asian monetary Crisis of 1997.The enhancing of living and educational standards of Vietnamese help in providing employment opportunities to them. The entrance of the firm in Vietnamese market able in kindle the economic growing and bring on some job opportunities for the local anesthetic people. As the soda usance has reduced in the U.S., Coca-Cola is one of the soft drink industries that increasingly looking to expand their argumentation in countries where there in incorporated of higher national income rate and huge population (Bloomberg Business workweek New, 2012). This news had shown the reason that Vietnam still able to encourage to a greater extent coronation from Coca-Cola in Vietnam.Moreover, Vietnam relies on the petroleum industry for i ts local energy consumption and for export it will cause the economy of Vietnam more stable and attracted some(prenominal) overseas companies direct invest in Vietnam. This had attracted Coca- boob to enter Vietnam markets at 2004. Moreover, the defrayal for employees in Vietnam is quite low, therefore, it attract foreign companies moving into Vietnam instead of conventional market such as China, India, and Thailand. These all reasons push Coca-Cola chooses Vietnam and made it first move into it to start its plants there.2.0 AnalysisGains of entering into a foreign countryPolitical StabilityEntering into a foreign country such as Vietnam consists of haves and shortcomings. One of the advantages to enter Vietnam is its political stability. jibe to Mr. Philippe Delalande in 2010, he makeed that political stability is one of the factors that attain helped Vietnam pursue its economic development policy. Others view from George E. Kobrossy in 2013, General Director of Zamil Ste el Vietnam (ZSV) alike mention the advantages which help in attracting foreign investors to the country is Vietnams political stability, administrative purify and its efforts in upgrading infrastructure facilities. Coca-Cola faced problems to enter some countries few decades agone due to the politic issues that happened in the country. Standage (n.d) said that Coca-Cola did not exist in the former Soviet Union (Russian) because they worry that the revenue would go transit to communist government coffers. While Webster (n.d) mention that Coca-Cola not enter french society because Coca-Cola was a mark of dandyism and a difference between capitalism and communism during Cold War.US brand alike Coca-Cola found itself torment in politics, or singled out for criticism although they are not onerous to get involved in politics, said Webster. Thus, for the obvious reason, Coca-Cola reentered Vietnams market because of the political stability after Doi Moi (reformation) policy as they feel more assurance in expanding their business in a stable politic country.Foreign Direct InvestmentOne of the gains of Coca-Cola is that Vietnamese government provides many investment incentives for foreign investors, the corporate income task is low compared to other countries in South East Asia (standard rate is 28% and preferential rates from 10% to 20%). The Foreign Investment Agency reports that by 15 declination 2011 Vietnam had attract more than 13,667 foreign investment projects, with a come capital of around RM612 billion (Foreign Investment Agency, 2011). Foreign-invested companies including Coca-Cola accounted for around 27% of the countrys exports, 35% of the countrys total industrial productivity, constituted 13% of GDP, and dedicated around 25% of total tax incomes (Vietnam Investment Review, 2001). Thus, there are about US$300 million was announced to invest in Vietnam by Coca-Cola for further capture growing opportunities in one of the most developing consumer markets (Staff, 2012). Under commitments made by Vietnam as part of its agreement to the World Trade Organization, Vietnam offered foreign endeavour which included Coca-Cola the general right to import products and sell them to licensed distributors. The deal to obtain an investment certificate for foreign-owned company is much easier now.Low moil embodyVietnam is gaining private-enterprise(a) advantage for labor-intensive production industry on the basis of low salary level (Meyer, 2005). In the research on labor costs, Japan labor cost in one calendar month is $1,810, continue by $1,144 in Singapore, $82 in Indonesia, and then Vietnam rank the second lowest place which is US$49 a month and take after by the highest is Cambodia with $47.36 (EuroCham, 2010). Coca-Cola who has chosen to set-up regional offices in Vietnam help Vietnam proved the extensive labor pool is competitive in the market (GLC, 2007). According to the information collected, we found that Coca-Cola Vietna m invest in Vietnam to help boost the local business sales and created 500 new jobs locally in Vietnam magical spell the total labor oblige that gain this benefit is 99 partage of local Vietnamese (Staff, 2012). This high percentage use of labor force proves that Coca-Cola Vietnam is afforded to hire more local employees due to their low labor cost or low wages.Low production CostCoca-Cola entering Vietnam because one of the gains is they evict exempted from import duties to build fixed assets, such as bottling machinery, essence of transport, and production materials that are not produced locally. Additional exemptions are available for barren materials, parts and materials imported for production of goods for export. Coca-Colas revenue in underlying Vietnam had witnessed a double digit growth over the past few years three bottling plants of the company produce more than 608 million liters per year in Vietnam (Nordic Industry Development, 2012). Therefore, Coca-Cola beverag es Vietnam invested over $3 million into its second Danang-based purified bottle piss production chain, with a capacity of up to 6,000 of 500ml bottles per hour due to the low production cost they gain in Vietnam (Nordic Industry Development, 2012).Variety growth Lines that meet Vietnameses deglutitions NeedCoca-Cola enters Vietnam as they met the motive for hydration, nutrition and energizing refreshment of their customer in Vietnam. Coca-Cola has variety brand of products in Vietnam such as Coca-cola, Coca-cola Light, Fanta, Joy, Minute Maid, Dasani, Real Leaf, Samurai, Schweppes and Sprite. Joy is bottled irrigate drink that pure and has the largest plow of 32% compare other brand that company produce. Coca-Cola has the second largest divvy up of 23% continue by Sprite with the percentage of 18% and Fanta which has 17%. Other brands like Samurai obtain 5% from the market share eon Minute Maid and Schweppes each occupied 2.5% (Soft drink-Vietnam, 2010). They offer high p ure tone product that meet the need of their target market. For example, Samurai is targeted on the underserved market which is the Vietnamese male adults who need an energy boost, as most of them have life-threatening workloads. This vitamin-packed energy drink is fortified with six essential B vitamins and has an elicit and refreshing taste with a carbonated, sweet flavor that appeals to the Vietnamese palate and popular among the target group. (Coca Cola Sabco, 2009)Shortcomings of entering into a foreign countryUnable to generate wholly-owned hyponym businessOne of the shortcomings of Coca-Cola in Vietnam is that foreign-based companies are generally not able to have wholly-owned subsidiary without production in the country. Therefore, importers would normally cooperate with local partners. (Nguyen Meyer, 2004). This had caused Coca-Cola lost a great opportunity in generating more profits. Coca-Cola started-up their bottling plants through joining venture with local Vietnam ese partner using the name of Coca-Cola Vietnam. (DDDN, 2013) With the holding totally 60 percents of the venture, Coca Cola has limited control over the mental imagerys, information and financial supplement to expand their business model and caused this business to be unprofitable. (lvarez, 2003) According to Ho Chi Minh City Department of Taxation, Coca-Colas cumulative losses are US$180.6 million, even hulkyger than its equity of US$141.6 million and Coca Cola was doubted that having transfer pricing. (TuoiTreNews, 2012).Limited ControlThere a major part of Vietnamese business still owned and controlled by the government and local authorities although there is dramatically growth of private business in Vietnam in recent years (Embassy, 2005). State ownership is still dominant, and issues like informal business practices or land leasing still cause headaches to foreign investors. From the information we analyze, we believe that Coca-Cola as well as face more difficulties in a ccessing chamfer financing, land, and other critical resources that private and smaller enterprises faced the same problems (Tenev, 2003). Coca-Cola as a foreign investors enter Vietnam this Communist country need follow their culture and unfortunately control as well as restrict their business operation in arrangement to continue survive in Vietnam. We believe that Coca-Cola need to have personal relationships in order to take their business under Vietnams control because there are some enterprises also follow the same culture with Coca-Cola. There are 40 percent of the enterprises believed they had to have personal relationships to receive allocated and transferred lands if regarding to the land use procedures (Vietna.net Bridge, 2012). crapulence body of water ProblemsThe last shortcoming of entering Vietnam is about drinking water problems. Drinking water is a key element for intelligent life and it is a cornerstone for sustainable community. Most of the consumers of bever ages who are concern of the water resource and it will directly affect their purchase decision. (Dickson, 2005)Thus for this obvious reason, Coca cola acknowledged that sportsmanlike water is critical to operate in sustainable community like Vietnam. In many part of Vietnam, surface water is still a dream. However, Coca-Cola wasted 2.43 liters of water just to produce 1 liter of beverage on average. (Kenan Institute Asia , 2010) Thus, it has given a big impact toward the environment. Our business coffin nail only be as vigorous as the local communities where we operate access to salvage water is one of the most important barometers of a communitys health. by Muhtar Kent, Chairman and CEO, the Coca-Cola follow. Coca Cola also understand that the issue of water wastage for the production not only affects the ecology and environment but it affects the corporate image of their company as well.3.0 RecommendationsIn past decades, Coca-Cola adopted joint venture with the local partne rs to cross into the Vietnamese market. However, many partners had quit the venture as they unable to stomach with the consecutiveloss made. These losses are basically caused by the supernumerary spending and poor cash flow in the business. Thus, in order overcome the problem, jointing venture with local partner such as Chuong Duong Beverage Co. is not sufficient to expand their business efficiently, Coca-Cola should joint venture with other foreign firms who are large enough to support them in name of financial and management as well as serve the demand of the market. For instance, the PepsiCo. has jointed venture with Japanese beverage and wellness company Suntory Holdings Ltd. in Vietnam in order to sustain long term growth in Vietnamese market. As Suntory has a consolidated business foundation in South-East Asian markets, PespiCo is boosting its current market position in order to compete with their competitions. (RTT , 2012) Beside, In order to generate more revenue, Coca- Cola should follow the footsteps of FedEx to opine in application for wholly-owned subsidiary. FedEx is expected to be the firm that having 100 percents of subsidiary in Vietnam. This could help them to have long-term commitment in Vietnamese market as they able to take advantage in this growing market. (Linh, 2012)In order to net the limited control problems, Coca-Cola seat lay out a harmonious relationship with the local authorities since it easier to solve bureaucratic problems if and when they occur especially in Communist country. Relations with local and central authorities can be developed as cooperative relationships, and meshing and construction personal relationships is recommended to expand their business in Vietnam. Coca-Cola Company should build a close relationship with government so that they will provide more subsidies and privileges to Coca-Cola including the decreasing cost in power usage and cheaper raw materials. Gifts to the clutch persons and doing more c harity to the poverty residents may enhance the atmosphere and inactive the business process given that sending presents is part of traditional Vietnamese culture.Coca-Cola spent over 5milions to 2.1 billion populations in Pacific for the effort of managing the sportsmanlike water resources with the Community Water Partnership (CWP) program .For example, in Vietnam, Coca-Cola enhances their corporate image and improving the water reference through the Plain of Reeds Wetland reappearance Project and Clean Water for Communities (Phase II), more than 10,000 Vietnam residents able to access to the clear water through. (Staff, 2012) However, these programs dont really have a significant onward motion to clean water issue. Thus, in order to achieve competency and effectiveness for the business and production operation, Coca-Cola needs to have advance water recovery transcription besides their CWP program. Water resources always is the global challenges for the beverages company esp ecially operate in country like Vietnam who facing serious issue of clean water. Indeed, Coca-Cola claimed that the technology that they developed not only can reduce practicable water needs but it also improves water use efficiency by up to 35percents. (The Coca Cola company, 2012). However, we believe that this technology can be improved by learning from competitors foot such as PepsiCo. With the helping of Siemens Industry Automation Division PepsiCo has installed an integrated utilise termination at Santiagos sharpness plantation. It helps the manufacturing facility in increasing its sewer water treatment capacity by 20percents and it is a beneficial technology that incorporating environmental. Besides, the trunk will reduce 70 percents of fresh water consumption. (Warrendale, 2012)Nonetheless, as we all know these two giant beverage companies were competed aggressively in the industry over a century. Additional, one of the competitive advantages of these companies to ret ain their uniqueness is their innovation and technology. Therefore, if these two companies could alliance themselves in term of sharing their technology among themselves to solve the water wastage issue it could bring a better water quality to Vietnamese as well as enhances their production especially the bottling process. Since they have the same interest, they can cooperate under the strategic alliance basis. Strategic alliances are agreements between companies that remain independent and are often in competition. (R.J., 1999). Many alliances are designed in order to seek for improvement in volume, divide fixed costs of production and distribution. A very good example Coca-Cola can refer is the alliance of Nestl and Haagen-Dazs. We believe we can grow better together than separately said a Diageo spokesperson. Nestl would contribute its frozen dessert technology, while Haagen Dazs would contribute to distribution through the network of points of sale with its name. (E, 1999). The alliance of these two companies for production and marketing has allowed Nestl sought to build critical mass in the ice cream sector and a way to reduce costs by operating its plants in calcium and Maryland at full capacity. (Pellicelli, 2003)Besides, further improvement in competitive advantages can be done through improving Coca-Colas variety product lines. As we know few of the Coca-Cola product lines like Samurai, Coke Light, and Joy win a competitive advantage in Vietnams market. If compare to Coca-Cola biggest competitor markets strategy, PepsiCo had entered the food market and earn over $13 million to their business. Besides, PepsiCo also engaged in nosh food which brand under Frito-Lay to gain more markets share. Thus, we suggest that Coca-Cola Company also can increase their market share by extends their product brand in snack as what PepsiCo done. Coca-Cola Company can invest in a new snack brand to attract more consumers in the Vietnam food market. This strategy can be e ffectively and efficiently implement because snack food is usually consumed by Vietnamese families but Vietnamese will consume snack food that import from United State due to its lower footing (What We Eat to Help Us Grow, 2010). Coca-Cola Company can produce healthy snack food with lower price to attract Vietnamese who cogitate in health such as Frito Lay which their tasting chips are low fat and ingredient all are natural which lease no artificial colors, flavors or preservatives (Pepsico, 2012).4.0 ConclusionCoca-cola as a global cartroader in beverages industry offer hundreds of brand over the adult male had entered Vietnam market by offer quality product that can be trust and fulfill the need of Vietnamese. Coca-Cola Company help people lead to an active and healthy lifestyle by provide the information of the beverages. Coca-Cola Company announcement an investment plan of invest $300 million in Vietnam over the next three years to build new infrastructure, create jobs, de velop strong partnerships and build its brands in the country.In the research, we found that enter to Vietnam market have it advantages and disadvantages. After we analyze, we realize that the gains of Coca-Cola is more than shortcomings after enter Vietnam. In order to overcome the shortcomings, Coca-Cola needs to adopt immediate solution and effective strategies in order to strengthen their market position in Vietnam.

Developing Transport Service Provisions in Rural Areas

Developing Transport att dying Provisions in Rural AreasUNDERGRADUATE ESSAYRURAL impartation PROVISION CORNWALLCritically examine the range of approaches that prevail been used by artless suppuratencies to overcome lines of run homework. Discuss in relation to aspecific policy bea.The following paper discusses the range of approaches used by Cornwall Country Council (CCC) to modify its provision of transmit function to its artless population, concentrate in-depth on the CCCs support of association gestate schemes. In the past 2 decades comport military countenances to coarse argonas across Britain, as well as in Cornwall in particular, have been in a state of ceaseless decline. Bus and train timet fits have been dramatically minify and made more inefficient and unreliable, and this decline has in turn conduct to m any campestral constituents becoming ever more dependent upon occult and environmentally harmful imparting at the same time, hundreds of thousan ds of Cornish time-honored people in coarse atomic number 18as have been either totally excluded from earth pack services or have found these services to be severely limited. This problem of public channelize provision to unsophisticated aras has touched Cornwall particularly badly Cornwalls geography is diverse and its rural communities are widely dispersed to meet these communities needs the county requires a comprehensive and highly-organized agreement of public captivate that has simply non been present in fresh decades. In these years, under two Conservative and Labour regimes, a laborious lack investment in the infrastructure of rural channelise facilities in Cornwall has lead to a degeneration of service provision. Moreover, the price of public maneuver in rural areas, particularly after the privatization of many services, has proved prohibitively expensive for many people. Recent efforts to alleviate this problem have centred upon a reinvestment of resource s, and it is the work of this essay to consider the ways in which this m wizardy has been invested in Cornwall. On April 1st 2006 the CCC launched its Countryside Concessionary Fares Scheme (CCC, 2006), replacing the Cornish list Card scheme, and providing publish bus travel in Cornwall to persons above the age of sixty and to alter persons who are resident in Cornwall. The scheme extends across the whole of Cornwall and is co-run in partnership between Caradon, Carrick, Kerrier, North Cornwall, Penwith and Restormel councils. To tackle the problem of the cost of institutionalize facilities the Cornwall County Council has introduced a number of budget schemes to help poorer residents in rural areas. For instance, PLUSBUS is a scheme that allows rural residents to save money by purchasing a combined rail and bus ticket and so make an overall saving. PLUSBUS provides holders with unlimited free travel on any routes within the county of Cornwall. In addition, Cornwall County Counci l has pledged to provide free school transport to every child of compulsory school age in rural Cornwall who would not otherwise be able to attend school. But perchance the most important innovation supported by the CCC is that of partnership transport schemes.The term community transport is used to describe passenger transport schemes that are owned and registered by local community pigeonholings. The stem behind such(prenominal)(prenominal) gatherings is that each works to solve some of the transport difficulties of a particular village or town or group of associated towns. Numerous such projects have been founded across Cornwall and have thus ameliorate to a signifi scum bagt degree the service provision pressure from the CCC. The human race of such schemes mean that the council is freer to better use its resources in areas where no such community schemes exist. Community transport schemes are operated as volunteer and non-profit organizations and then they have a secon d key usefulness that they do not subject the people depending upon them to financial exploitation or manipulation. service are not operated because they are profitable, or suspended because they are unprofitable as with transport services run by commercial companies but quite an services are operated because they meet a definite need of a particular community or group communities. The attraction of such schemes is that they throw out be moulded to the needs of a particular community if only trey pensioners in the village of Grisham or Chatham require daily transport to the adjacent town, then, instead of being denied service by commercial companies who fear losing money by operating(a) a service for these pensioners, a community transport service such as a single minibus or minivan git be organised at minimal cost to provide service for these three pensioners. If twenty such pensioners need transport then two or three services and minivans can be organized such schemes and then have a great degree of flexibility. The additional advantage of such schemes is that they are specifically founded and run to help those persons in rural areas who would not otherwise have access to help.Of the discordant community transport schemes run in Cornwall the following are particularly worthy of discussion. self-imposed Car Schemes are, according to the CCC an organized form of lift bragging(a) (CCC, 2006) where volunteer drivers offer to use their own cars to make entre to door pick-ups and returns for people, usually the elderly or disabled, who would not otherwise be able to travel as frequently or freely. Community Bus Services are minibus services run by local volunteer groups operating along regular routes and according to a regular timetable such services are moreover made available to all members of the general public. enlarge of such services have youth wide of the marky been published in the every Cornwall Public Transport Guide. Minibus Hire is anot her community transport service whereby minibuses owned and run by one local volunteer group are lent to other groups either for free or for a very small charge. Many of these vehicles have disabled persons access and can be used for the purposes of leisure, of sport, of education and so on. Dial a cause is a further community service which provides transport on a door-to-door basis to incapacitated members of the community who register for the service. Shopmobility lends wheelchairs and electric scooters as well as other services to allow the elderly and others to store for themselves rather than remaining dependent upon others for their transport.Though not directly in control of community transport schemes, the CCC has recently sought to unravel an active part in the ravel and support of these transport initiatives. On its website, the CCC tells that three principal events or ideas have led to this decision. (1) The Council has begin ever more conscious of the special transp ort needs of disabled persons and of the elderly, and has expressed a determination to do more than the basic requirements of the impairment divergence Act (HMG, 1995) mandatory requirements. The CCC has set as its supreme transport goal for disabled and elderly people the idea of transport independence an aim that goes well beyond the minimum requirements of the baulk discrimination Act. To this end, the council has tending(p) considerable financial support to Age Concern, an organization which operates a volunteer car scheme across the county of Cornwall. Thus the CCC states This (policy) has led to the development of financial support for age concern in its provision of a county-wide car scheme greater consideration of a commensurate transport provision for all sectors of the community by the County Council and other statutory agencies, which has identified more clearly the opportunities for community transport activity (CCC, 2006). (2) Thee bailiwick Labour government h as provided greater levels of central funding for county councils to develop and improve their service provision to rural areas the arrival of this money has enabled the CCC to guidance greater attention upon rural disability access and upon totality of service provision. (3) The CCC has begun to enter into several partnerships with conscious agencies, thus providing an extension to their exist transport services. To this end, the CCC has stated that The (Cornwall) County Council recognises that whilst it has a critical role to symbolize in sector development, it is inappropriate and simply not viable for it to be the exclusive agency involved. Consequently, it is looking to develop new partnerships wit both the statutory and voluntary sector, operating at both a strategical and a local level (CCC, 2000). This quotation best sums up this substantive change of attitude and strategy by the County Council towards the question of rural transport provision. The County Council is ad mitting that its own resources are insufficient to provide the full range of transport services required by its rural population and so has enlisted the aid of both other agencies and the rural population itself in the form of voluntary transport schemes.A few points of caution might be given here however to intersperse the many arrogant notes close to community transport schemes given above. Firstly, such schemes, though welcomed and applauded by local councils and authorized agency organizations are not directly under their control therefore the regulation of such schemes is far weaker and less organized than official transport services run by the CCC. Concomitant with this worry is another about resort since community transport schemes are not managed directly by local government they are not subject to the same safety inspections and regulations as official services. Nonetheless, it may generally be said that those running community schemes are responsible members of their l ocal communities and naturally therefore beat to general laws of transport safety. The other point is that it is a widely held ruling of those running such schemes that they are having to do so because of the inadequacy of government provided public transport to rural areas. If these services were more proficient and reliable, as they used to be, and as they presently are in many European countries such as Switzerland, Denmark, Holland and elsewhere, then community transport schemes would be emaciated because public transport would be a total provision. Indeed, it is the case that in the aforementioned countries community transport schemes do not exist nor do others like them.In the final analysis, this review of the success of Cornwall County Councils various agencies in improving rural transport provision must end with a note of equivocation and suspended judgement. On the one hand, local agencies in Cornwall have clearly recognised the problem and extent of recent decades of u nderinvestment in rural transport, and rather than denying this problem or blaming it on preliminary administrations, they have actually sought to improve those services offered to Cornwalls rural populations. Also on the positive side the County Council has recognised the needs of the countys long-forgotten disabled and elderly rural populations and has welcomed the opportunity to implement, and indeed go beyond, the Disability Discrimination Act, in its transport provision. Schemes like the Countywide Concessionary Fares Scheme and PLUSBUS are direct efforts to improve the transport facilities and opportunities for underprivileged people in rural Cornwall so too the CCCs pledge to guarantee free school transport for all school-children of compulsory age in rural Cornwall is a crucial and admirable initiative. But perhaps the County Councils boldest initiative, and the one that signifies a profound change of attitude towards its obligations over rural transport, is that of suppor ting community transport schemes such as Dial a cod and Shopmobility. In supporting these schemes, which are not officially under County Council funding or regulation, the Cornwall Country Council has recognised that it has insufficient resources to provide a full range of transport services to its rural population. Such an admission has its positive aspects in as much as it allows the council to contribute to the excellent schemes founded and operated by voluntary groups in Cornwall groups who have made a very true difference to the quality of transport experience enjoyed by many of Cornwalls elderly and disabled rural populations. On the other hand, in making such an admission the County Council has also shown its own failure, as well as the failure of successive governments, to properly deal with the national question of rural transport provision, and its particular condition in Cornwall. It is a simple particular that in those countries of Europe which have the highest stand ard of living, Sweden, Switzerland, Austria would be examples, that community transport schemes are just not necessary because government and local councils are sufficiently funded to provide all such services themselves. Proper and more efficient government allocation and spending of resources in Britain could undoubtedly have led to the same result in Cornwall, and so made the admirable and noble efforts of community transport scheme organizers unnecessary.BIBLIOGRAPHYAcademic Books, Journals Internet SourcesCornish Key Transport in Cornwall. (2006). www.cornishkey.comCornwall County Council (CCC). (2006). www.cornwall.gov.ukHer Majestys Government. (1995). The Disability Discrimination Act 1995.Restormel Borough Council. (2006). www.restormel.gov.ukThe Department for Environment Food and Rural Affairs (DEFRA). www.defra.gov.uk

Electroconvulsive Therapy for Severe Depression: Evaluation

Electroconvulsive Therapy for Severe Depression EvaluationCan electroconvulsive therapy educate a meaningful contri hardlyion in the word of Severe depressive unhealthiness? The work of noetic health nurses.ContentsAbstract designMethodology of the criticism tiny Re position of the literary productionsThe prescribe of electroconvulsive therapy in the remediation armamentariumThe place of electroconvulsive therapy in relapse stripeMechanism of body processP alludeence of site of arousalSide effect of give-and-takeDiscussionConclusionsAppendixReferencesAbstractThis sermon seeks to explore the license animal for electroconvulsive therapy. It does so by con positionring the historical minimise to the enumerate and its evolution to the present. It projects the professional and legislative guidelines which g everywheren its occasion and contrasts the regulations in the UK with those in some otherwise(a) cultures, nonably the USA.In order to assist the exploration, the literary productions review is subdivided into five sections, apiece exploring a different area of interest. Electroconvulsive therapy is put indoors a redress spectrum of sermon for perseverings with major depressive illness and psychosis and is compared with other modalities of word. Its use in some(prenominal) groovy give-and-take and its role in disease prevention and relapse is discussed. electric electric current hypotheses of its possible mode of action are explored, and conclusions drawn about the strength of the say vile in this area.There appears to be considerable discussion about the site of optimum remonstrate for electroconvulsive therapy. This area is discussed in depth with a critical analysis of the studies which inform the evidence base in this area.The literature review concludes with an testing of the various side effects of the treatment. There is an element of discussion of the evidence and conclusions are drawn from the evidence extrap olated and presented.The whole dissertation is fully referenced.IntroductionElectroconvulsive therapy was introduced into clinical practice in the late 1930sand rapidly gained a place in the standard treatment of major depressive illness.It was originated by the Hungarian, Dr Meduna, who mistakenly believed that schizophrenia and epilepsy were mutually exclusive conditions. He argued that epilepsy was never seen in schitzophrenic patients and so artificially inducing fits (epilepsy) in patients would cure schizophrenia. (Mowbray R M 1959). The effects on schitzophrenia were soon recognised to be minor and the most tag effect appeared to be in the patients with major depressive illness.The advent of effective classes of antidepressant, major tranquilliser and mood stabilising drugs has seen a attach decline in the use of electroconvulsive therapy, but recent figures advise that it is still employ in everywhere 10,000 cases per year in the UK ( electro jarful therapy Survey 200 3).Currently the main use of electroconvulsive therapy is in major depressive illness although it in like manner is considered still to project a place in the treatment of schizophrenia and some other mood disorders (UK ECT 2003), psychosis (Corrible E et al. 2004), and everyplacet suicidal intent (Kellner C H et al. 2005).The rational Health Act of 1983 allowed Psychiatrists to give electroconvulsive therapy to inpatients without consent if they were secti angiotensin converting enzymed. This should be contrasted to the situation later on the 1959 Mental Health Act, where psychiatrists had no illumine guidance and a bod of litigation cases forced a change in legislation. (Duffett R et al. 1998)The procedure itself involves anaesthetising the patient with a global anaesthetic and a muscle relaxant and the a half-size, brief thump current (typically about 800 milliamperes) is passed between cardinal electrodes applied unmediatedly to the scalp. This generates a seizure an d in that respect are a number of demonstrable biochemical changes in the brain aft(prenominal) the event. (Nobler M S et al. 2001)Electroconvulsive therapy is usually given as a ply over several weeks. The evidence base for length of time of treatment is non strong and appears to vary considerably between authorities. (Lisanby S H 2007)In 2003 NICE investigated the evidence base for electroconvulsive therapy and issued guidelines which suggested that it should scarce be used barely to achieve rapid and short- bound improvement of severe symptoms aft(prenominal)wards(prenominal) an suitable trial of treatment options has proven ineffective and/or when the condition is considered to be potentially life-threatening in individuals with severe depressive illness, catatonia or a prolonged manic episode. (NICE 2003) atomic number 53 of the most extensive recent reviews on electroconvulsive therapy concluded that it had been demonstrated to be effective short confines treatment for depressive illness in otherwise healthy adults. Many studies were cited and had shown it to have a sweller effect than drug treatment. The authors noned shortcomings in many of the trials cited, especially in areas such as drug resistant depressive illness where electroconvulsive therapy is believed to be particularly helpful. (UK ECT Review Group 2003)One of the major side effects of electroconvulsive therapy is short and long term memory loss cited in many trials and studies (viz Gupta N 2001)Methodology of the reviewCormack suggests that Ultimately all comfortably research is guided by and lay outed on a critical review of all of the relevant literature published on the subject. (Cormack, D. 2000). It is at that placefore key non only to define what is currently believed about a subject, but in any case to place this in a historical context. This is particularly cardinal in the field of electroconvulsive therapy, as the introduction to this dissertation has suggested , with great fluctuations in both understanding and application of this type of therapy over the years.One of the autochthonic reasons for conducting a literature review is to establish the current evidence base for a particular subject. A critical review of the literature essential be preceded by a careful literature search. It is often believed that inquisitive the literature is a linear or single episode process. Current cerebration suggests that this is seldom an optimal strategy. Bowling advises that a good literature review is primarily a cyclical recursive process that mirrors the thinking and research process, where the discovery of tender information progenys in new ideas, new knowledge and possibly new understanding. Once an overview, or sign persuasion has been formed, it accordingly becomes possible to revisit the sign reviews from a more certified perspective which, in turn, allows for a more perceptive interpretation of the data. (Bowling A 2002).The methodol ogy used in this particular review was to allow for an initial terminus of reflection on the subject matter and to consult a miserable number of reference books to achieve an overview of the area. (Taylor, E. 2000). References were noted and some followed up in order to ascertain the main themes of the review. Once these were established, then methodical searches of a number of databases were carried out utilising the facilities of the local University library, the Post-graduate library (Client to personalise here) and a number of on-line search engines and literary sources including Cochrane, Cinhal, Ovid, BMJ and Lancet accounts, Royal College of Psychiatrists archive and various NICE publications. Papers were accessed in both hard hind end and electronic forms. (Fink A 1998)Search terms included electroconvulsive therapy evidence base evolution history schizophrenia psychosis major depressive illness mental health nurse antidepressant drugs Mental Health Act psychiatrist. The se terms were used in various combinations to sift instructions with varying degrees of relevance to the affair under consideration. (Carr LT 1994)Inclusion criteria were opuss less than 10 years ancient (unless there were specific reasons for older paper inclusion). UK sources were preferred to other ones. It should be noted that a substantial proportion of the body of literature on the subject of electroconvulsive therapy is Ameri send away establish. A number of authorities have suggested that this whitethorn be be coiffe the USA currently uses electroconvulsive therapy more frequently than the UK and therefore has a greater experience with it. Papers were only considered from peer reviewed sources unless making a historical wind. (Bell J 1999). Each paper considered was then ranked consort to its evidential range (See Appendix 1) and the highest value paper was presented for each(prenominal) point to be make.Critical Review of the literatureThe place of electroconvulsiv e therapy in the alterative armamentariumA good place to start this literature review is with the Olfsen paper. (Olfson M et al. 1998). This is an authoritative overview of the place of electroconvulsive therapy in the treatment spectrum. It has to be noted that this paper is already 10 years old and reflects clinical patterns of usage in the USA. The reason that this paper is selected for discussion is primarily on the vast surface of its reputation cohort, which is 6.5 million patient contacts (249,600 with a diagnosis of depressive illness) spread over mainland USA.Critical analysis of the paper suggests that the authors reveal their viewpoint in the starting line few sentences of the paper and therefore the opinion part of the review must be understood on the basis that the authors consider electroconvulsive therapy a adept and effective treatment for patients with all subtypes of major depression citing the authority of the APA for this financial statement (APA 1997)The paper suggests that there is a strong evidence base to tolerate that electroconvulsive therapy is at least as effective as antidepressant drugs pharmaceuticals for the treatment of major depressive illness. (Weiner R D 2004)The authors make the point that despite this prevalent belief, electroconvulsive therapy is not as widely used as it should be collectible to three major misconceptions namely public concern about the galosh of the procedure, reactive regulations and guidelines and the belief that it is not cost-effective. They then toughened about addressing each of these concernsRather worryingly, the authors cite evidence of safety with the unqualified find that none of the down(p) patients who received ECT died during the hospitalisation. In contrast, 30 (0.14%) of the depressed patients who did not receive ECT died in the hospital. (Schulz K F et al. 1995)Although this whitethorn well(p) be the case, it is entirely possible that patients who were ill with other comor bidities (and therefore at greater stake of death) were not offered electroconvulsive therapy, as it required a general anaesthetic. One lowlifenot jump to the implied conclusion that these figures suggest that electroconvulsive therapy is therefore intrinsically safe. (Mohammed, D et al. 2003)The authors draw a number of conclusions, perhaps the most monumental of which is that current practice tends to reserve electroconvulsive therapy for the elderly, and those with comorbidities such as schizophrenia, dementia, and general medical (nonpsychiatric) disorders. They also comment that prompt use of electroconvulsive therapy is associated with shorter in patient stays and, by definition, more rapid solvent of the depressive state.Despite these findings, there is a cosmic body of literature documenting the fact that many patients with major depressive illness reside largely unresponsive to healthful intervention. With this in mind one should consider the contribution of the Sp anish research stem under Gonzalez-Pinto who published a trial of a small group of patients (13) who had proved resistant to both venlafaxine and electroconvulsive therapy separately but who responded to both measures when used in a have fashion. (Gonzalez-Pinto A et al. 2002). This was a non- randomize non- tone downled trial and therefore constitutes evidence value at aim III. Curiously the response was not proportional to the dose of venlafaxine used. The authors however, enunciate the rather worrying side effect of asystole in 3 of the 13 patients immediately after the electroconvulsive therapy.A number of authorities suggest that there is a definite place for electroconvulsive therapy in the severely depressed patient who is a suicidal risk. The Kellner paper addresses this suggestion directly. (Kellner C H et al. 2005). Suicide remains one of the major associations of major depressive illness and carries a 15% lifetime risk for any patient who has been hospitalised with th e uniform. (Bostwick J M et al. 2000) with symptoms such as profound hopelessness, hypochondriacal ruminations or delusions, and thoughts of suicide or self-harm during depression predict future suicide. (Schneider B et al. 2001).The Kellner turn over was a randomised crossover comparative follow-up trial making it evidence value of train 1b. There are a great many result strands from this discipline, but if one specifically considers the suicidal elements, then one can state that the ponder showed that of the 444 patients enrolled in the trial as having major depressive illness, 26% had suicidal ideation at a level of 3 or greater on the Hamilton rating scale (the measurement tool used in the trial) and 3% achieving a score of 4 (actual suicidal attempt). This group had a reduction of their scores to 0 in over 80% within the two week course of the electroconvulsive therapy. It was also describe that in the group who scored 4, 100% dropped to 0 by the end of the treatment. D espite there gallant figures for short term remission, one would have to note that the trial did not have any significant long term follow-up and there is no information on the rate of relapse after the initial treatment. (Rosenthal R. 1994). The authors state that they were aware of two successful suicide attempts which occurred whilst the trial was zip (but after these patients had completed their treatment. The authors suggest that electroconvulsive therapy should be used early in the treatment regime once a diagnosis of suicidal risk has been made.To provide a balanced argument on the place of electroconvulsive therapy in the spectrum of treatment, one can consider the recent paper by Eranti (Eranti S et al. 2007) who tested out the hypothesis that has lately been published, that continual transcranial magnetic stimulation (rTMS) is as effective as electroconvulsive therapy but does not have the same side effect profile that restricts the use of electroconvulsive therapy in s ome patients. (viz. Gershon A A et al. 2003 and Loo C K et al. 2005)This trial was a randomised, blind comparative trial with a substantial entry cohort (260 patients) existence followed up for 6 months after treatment giving it a level 1b significance. (Clifford C 1997). There were a number of possible outcome measures analyse but, of relevance to our considerations in this dissertation, one can state that the authors found that Repetitive transcranial magnetic stimulation (rTMS) was not as effective as electroconvulsive therapy in the treatment of depressive illness both at the end of the treatment full point and at the end of the 6 month study. The authors were able to comment however, that the rTMS was most free of demonstrable side effects.The place of electroconvulsive therapy in relapse preventionIt is fair to comment that a brief examination of the literature shows closely no good quality published material on this exit with the studies that have been done comprising i ndividual case reports (viz Kramer B A 1990), naturalistic studies and small studies of retrospective cases (viz. Schwarz T et al. 1995), none of which have any promise element and all of which are evidence level IV at best.A notable exception is Keller et al. who made a large UK based study of relapse prevention in major depressive illness with a randomised controlled trial over a seven year period involving over 500 patients. (Kellner C H et al. 2006). The trial is a level 1b evidence level trial and is of a particularly robust twist with great efforts made to achieve standardisation. (Denscombe, M 2002). The structure is a direct comparison between electroconvulsive therapy and a standard pharmacological regime (lithium change plus nortriptyline hydrochloride). Both were given as a therapeutic course (the medication over a six month period) and the patients were followed up with DSM-IV assessments to determine their degree of relapseThe analysis is long and complex but, in es sence, the study clearly demonstrated that both groups had better results than a placebo control with similar percentages (about 33%) suffering a relapse and about 46% remaining disease free. The trial suffered from having a large group (about 20%) failing to complete the trial protocol. (Rosenthal R. 1994). This study does however, provide firm evidence that electroconvulsive therapy is at least as effective as pharmacological measures in reducing the likelihood of clinical relapse.Further evidence for longer term efficacy comes from the Gagn study (Gagn G G et al. 2000), which starts by acknowledging the fact that depressive illness tends to be a long term disability with long term pharmacological intervention a comparatively normal treatment strategy. The authors make a subtle distinction between continuance therapy (which is starting a new course of treatment after initial resolution and then relapse) and livelihood therapy which extends beyond the continuation therapy stage an d is aimed at preventing relapse.This paper is far-famed because, as the authors point out, there is general acceptance by health care professionals that long term maintenance therapy with pharmaceuticals is both rational and indicated in patients with a high likelihood of relapse of depressive illness. Treatment with continuation electroconvulsive therapy has failed to gain general acceptance. The authors argue that such an approach is particularly rational, at least in a group of patients who have demonstrated their ability to respond to electroconvulsive therapy in the past, are at high risk of relapse and who may be refractory to pharmacological intervention.The Gagn study is a retrospective case-controlled comparative study comparing the long term course of electroconvulsive therapy plus pharmacological maintenance therapy with long-term antidepressant treatment alone in a demographically matched group. The two groups comprised 60 patients. The maintainence electroconvulsive t herapy group received the electroconvulsive therapy as a single treatment monthly after the normal intensive treatment course for the acute episode. It has to be noted that this regime is comparatively arbitrary as there appears to be no preceding published evidence base to harbor it.The results from this study are nonetheless quite impressive. Both groups are reported to have responded to treatment, but the group who were also maintained with follow up electroconvulsive therapy did markedly better in terms of resistance to relapse universe almost doubled at two years (93% vs. 52%), and quadrupled at five years (73% vs. 18%). This result could also be express as a doubling of the mean time to relapse in the electroconvulsive therapy group (6.9 years versus 2.7 years for the antidepressant-alone group).A major criticism of this study would have to be a lack of standardisation of treatment in the electroconvulsive therapy group with some patients receiving univocal and others bipol ar electroconvulsive therapy. The number and length of each was left over(p) to the clinical judgement of the responsible clinician. This does not reduce the strike of the overall finding, but does make for difficulties in comparison with any other trials which might follow. (Berlin J A et al. 1999)A critical analysis of the study would also have to conclude that the study suffered from a comparatively small number of patients with denominatements to the comparison groups not being random. More importantly, the trial assessor was not blinded to the patients group assignment. These factors make it difficult to confidently assign an evidence level to this trial. (Denzin, N K et al. 2000)The authors conclude their study with the comment that a larger, prospective study on the subject is currently underway. One should perhaps regard the results of this study as interesting, but not proven.In assessing the validity of this paper, one should note comments that it has generated in the peer reviewed press. Gupta makes a number of valid points of criticism (Gupta N. 2001), arguably the most important of which is that the study did not make any measurement of the well recognised effect on memory function that short term electroconvulsive therapy is cognise to have. (Isenberg K E et al. 2001). Gupta suggests that clinical effectiveness must be assessed only after a risk-benefit ratio has been properly resolute. Certainly a valid point and one that was not addressed in the original paper.Mechanism of actionA number of papers have been published reporting biochemical changes after electroconvulsive therapy. There seems to be a general agreement that depressive illness is associated with a disturbance in the monoaminergic-cholinergic balance within the cerebral cortex. (Schatzberg A F et al. 2005).A novel and significant advance was published in 1998 by Avissar (Avissar S et al. 1998) when a correlation with G-protein levels in leucocytes was found and was discovered to be significantly reduced in depressive illness. The significance of this paper was that the authors found that electroconvulsive therapy resulted in a normalisation of the G-proteins level which preceded (by about a week), and thus predicted, clinical improvement. Patients who did not respond to electroconvulsive therapy did not show a change in G-protein levels. The significance of this finding is enhanced with the knowledge that lithium is also known to alter G-protein levels (Schreiber G et al. 2000), as are some other treatments for bipolar disorder. (Young L T et al. 2003). It is also known the G-protein levels are raised in manic states thereby suggesting that it is a marker for affective mood states. (Schreiber G et al. 2001)Further evidence of altered metabolism comes from the Nobler study (Nobler M S et al. 2001). This study used Positron emission tomography (PET) to study glucose metabolism in different brain areas. It has to be noted that this was a small study of 10 patients who were assessed before and after a course of electroconvulsive therapy. This study involved highly sophisticated measurements and concluded that certain areas of the brain showed marked reduction in metabolic rate after electroconvulsive therapy and these changes were most significant in the frontal, prefrontal, and parietal cortices. The authors suggest that their results support the hypothesis that electroconvulsive therapy works by suppression of functional (non trophic) brain activity, most prominently in the prefrontal cortex. The authors comment that their findings are consistent with the earlier Drevets study which demonstrated a reduction in brain metabolism after successful treatment with antidepressant drugs. (Drevets W C 1998)A more modern paper by Sanacora reported alterations in the gamma aminobutyric acid concentrations in plasma, and cortex after electroconvulsive therapy. (Sanacora G et al. 2003). It is known that patients with depressive illness have red uced levels of the neurotransmitter GABA. This study, again with a small entry cohort of 10 patients, assessed patients before and after electroconvulsive therapy. It was found that the levels of GABA increased with successive treatments. It was also found that the length of duration of the convulsions was proportional to the concentrations of GABA found in the cortex supporting the view that GABA decreases cortical excitability. It may also be significant that GABA concentrations have been found to increase after the use of selective serotonin reuptake inhibitor (SSRI) treatment. (Sanacora G et al. 2002). These findings suggest that enhanced GABA activity may be central to any antidepressant activityTakano et al. have recently produced a yet more sophisticated study along the lines of the Nobler investigation. (Takano H et al. 2007). This study also uses positron emission tomography (PET) and it studied patients before, during and after the application of electroconvulsive therapy. This is essentially a technical rather than a clinical study. It also has to be noted that all the data was derived from only six patients. The majority of the results are therefore not relevant to this consideration other than the fact that the authors concluded that electroconvulsive therapy exerts its effect by increasing the post treatment blood supply to the anterior cingulate and medial frontal cortex and thalamus. They expand this comment by acknowledging that it cannot be stated that this observed phenomenon is cause or effect, but simply an association with the mechanism of treatment and is associated with a resolution of symptoms.Preference of site and nature of stimulationThere is a great deal of discussion in the peer reviewed literature about the optimal sites for electroconvulsive therapy application and whether univocal or bipolar stimulation gives better results. regrettably the vast majority of it is anecdotal and of poor evidential value. The Bailine study is a n otable exception providing a randomised comparative trial with a moderate size of entry cohort (60) making it a level 1b trial. (Bailine S H et al. 2000).The authors compared the efficacy of bitemporal stimulation with bifrontal stimulation over a treatment period of 12 treatments. The study was assessor blinded. The rationale butt end the trial was that bifrontal stimulation avoids direct stimulation of the temporal areas which are directly involved with cognition and memory functions.The authors reported that they found both placements to be equally effective in their ability to relieve depressive illness, but the bifrontal spot achieved statistical significance in reducing cognitive and memory effects. Although not directly tested, the authors comment that right sided unilateral frontal placement has less cognitive side effects than bilateral stimulation but take 2 5 times the current to achieve its therapeutic effect. (citing Letemendia F J J et al. 1993)One area of fuss wh ich, even a brief overview of the subject illuminates, is the level of remark that is required to achieve therapeutic results. Some studies do not specify the level of remark, others simply refer to a supra-threshold stimulus, a third group refer to a titration of stimulus. This makes direct comparison of results difficult. Some authorities have made the comment that not standardising the level of stimulus applied is similar to conducting a comparative trial of antidepressant drugs to placebo when the drugs are given at a sub-optimal sexually transmitted disease and therefore not achieving their maximal therapeutic effect.Krystal has attempted to tackle this paradox by reviewing the regulations governing the administration of electroconvulsive therapy and also trying to achieve a generally acceptable standard of treatment. (Krystal A D et al. 2000)The USA limits (by statute) the upper limit output charge for clinical applications of electroconvulsive therapy to 576 millicoulombs . The equivalent restriction in the UK is 1,200 millicoulombs for electroconvulsive therapy devices and this has been determined by the Royal College of Psychiatrists, and this limit is more than double the limit allowed in the USA. As far as the USA is concerned there is no evidence base to ensure that this limit will allow for consistently effective electroconvulsive therapy, which is something of a paradox considering that the USA considers electroconvulsive therapy more mainstream than does the UK.Krystal published a retrospective study of nearly 500 patients who had received electroconvulsive therapy. Although most of the patients reviewed had a clinically successful treatment, the authors noted that 15% of patients required the utmost stimulus intensity to blow up a seizure and 5% of the total did not have a seizure at all.The authors comment that the clinicians responsible for the patient had to use enhancing strategies to boost the therapeutic response with caffeine, ketam ine, or hyperventilation. This still left a residual 5% of patients with a sub-therapeutic response at the maximum permitted output charge.Further problems can be encountered as not only can patients vary with regard to the amount of charge that they need to trigger tonic-clonic seizures, but the amount of charge can vary as the course of treatment progresses in each individual patient. (Coffey C E et al. 2005)The difficulty that therefore arises in these non-responders, is that there is no greater therapeutic response than placebo if a tonic-clonic seizure is not triggered, but the effects on cognition and memory impairment are still present. (PECT 2000). If this is added to the clinical and economic costs, it is clear that a case can be made for higher limits of initial triggering charge, at least in the USA.The other factor which may also be relevant and can be a major cause of inconsistency between studies is the pulse width with some electroconvulsive therapy machines deliverin g a shorter pulse width and longer stimulus duration than others. The majority deliver a pulse width between 0.50.75 msec. but other machines are equal to(p) of delivering pulse widths considerably beyond these limits. There has been no definitive study which has considered the possible effect of pulse width on either the therapeutic response or the likelihood of triggering a tonic-clonic seizure.The final point made in the Krystal paper is the fact that one of the reasons that the charge limit was set at the level that it is was the fact that the authorities wanted to minimise the suppositious risk of neuropathological damage. There is now evidence that the levels of stimulus charge necessity to cause such damage is far in excess of the enforce limits. (viz. Weiner R D 1994 and Devanand D P et al. 2004)The concept of stimulus titration is referred to in many of the clinically based papers reviewed. If this concept is considered in gibe with the comments by Krystal relating to th e variation of charge required to produce the seizure, the situation can be clarified in an monograph by MacEwan who advises that it is an important feature of the treatment to allow sufficient time between the initial unsuccessful shock and the attempt at restimulation as the effect of the comparative refractivity after the first shock takes a little time to wear off. (MacEwan T 2002)Side effects of treatmentConsidering the rather gross and intrusive corporal nature of the treatment, it is quite remarkable that the literature shows very few studies which have specifically explor

Managing Change At Procter And Gamble Commerce Essay

Managing transplant At Procter And try Commerce EssayThe human race of seam is facing unlike reassigns in the environment which create opportunities and threats. As a result, caperes make permutes in different exhibites that ar link up to execution place more than abruptly and often comp ar before. This is because these substitutes post ferment the speed and quality of the performance of companies including acquisitions, merging, insane asylum, restructuring and downsizing which displace result to the egress of climate of uncertainty (FEAP n.d.). Currently, the note initiation is facing different budges that are related to technology, regulation and competition and economic condition which affect the perceptions and conduct of the customers and oppositewise s reserveholders of the guild. due to this, pitch is considered as inevitable in the world of argumentation, because form constitute growth and development. According to Peter Drucker, any change in an y organizational culture and prudence is considered as common and healthy (cited in Dulebohn 2006, p. 37). It get out be impossible for any worry to grow and reform without improving any changes in set to have it off with the changes happenings in the environment its operating. Any change to be done inner(a) and outside the organization can dish out the absolute organization to compensate to the current situation of the marketplace and industry, by improving and adjusting the culture and other burning(prenominal) inhering aspects of the organization. Therefore, it is grave to consider that change is the most(prenominal) classic decision of the top level management of different companies however, it is one of the most taken for granted aspect of management, particularly regarding the issue of lack of involvement.This opus impart point on go throughation of change in Procter and Gamble (PG). PG projects branded products of superior quality and value in coordina te to ameliorate the lives of the consumers from different part of the globe. This results in leadership sales, profits as closely as value creation, which on the wholeow all the stakeholders to prosper (PG UK 2010). Currently, the community markets more than 300 branded products and operating in more than 80 countries and employs close to 140,000 people (PG UK 2010). The business started when William Procter and James Gamble started their business of making and selling soap and candles separately on April 12, 1837. In August 22 of the aforesaid(prenominal) year, the two decided to establishedize their business affinity by pledging $3, 3596.47 in Cincinnati, Ohio and signed in October 31. The initial foray of PG into branding was The Moon and Stars, a trademark that have appeared on all products of the phoner starting premature 1860s (PG UK 2010).As a result of this parkway and the unyielding commitment of the smart set to potencyen the brand, widening portfolio and d elivering high level of customer process, PG ranked tenth in the Fortunes Most Admired Companies in 2007 and hailed as the 23rd largest companionship by US revenue and 14th largest in terms of profit.Because of the bureau and leadership of PG in different consumer product categories, it is important for the smart set to focalization on the advantage to be done in its boilersuit operation. The participation counsel ones on adopting refreshful changes and seizes invigorated opportunities that the company created. This paper leave alone focus on analyzing the new technology to be applied in PG that pull up stakes assistant to improve its current operation and performance. soil to ChangeBackground of ChangeOne of the important characteristics of PG and the reason behind the victor of the company is its ability to cope with change. The company focuses on adopting different changes that get out supporter to improve its performance. If chartered, the company is pull up s takesing to unlearn habits as hygienic as assumptions that were rapidly becoming obsolete and challenge traditional skills as well as strengths. Based on this, change is the term that equates with PG and it happens in major events, such as scientific entrys inside the company.One of the major technological hitments of the company is the concept of Enterprise Content Management (ECM) in 2003. This enables the company to implement content spread across different applications. The result is the consolidation from back-end governing body into the more appropriate application of choice. It also enables the company to move from unstructured to structured content management and have been applied to the inbred stakeholders to enable pointing life cycle management. This had religious serviceed in secernate to create, store, get and distribute information that lead to trimmed cost and improved collaboration.However, this dust created some problems or threats that might affect th e operation of the company. There is a need to tap virtual doinging opportunities, at the uniform time, land the maneuverload because of sack up- base space and chargeback reports. Therefore, it is important to implement smarter working practices and focuses on the need for a fully immixd web-based facilities management environment. This action is connected to the last and mission of the company to use innovative technologies that impart dish out PG to work smarter, faster and more efficiently.Therefore, based on this, it is important to implement new system that get outing help in cast to fully integrate the operation of PG in the UK, as well as other separate of the world. This is important because it can help in run to lessen the effort that must be exerted by the employees in terms of managing the system, at the alike(p) time, it can help in order to fully integrate the system that will detainment the data of different departments and units of PG UK, which will he lp in order to improve the decision-making process.Strengths and Weaknesses of PGIn connection with the current problem of the company, and the proposed change, it is important to focus on the strengths and weaknesses of PG. One of the strength of PG focuses on its ability to handle change. This pertains on the different activities of the company regarding researchers and development. One of the main activities in the company is researching regarding the changes that are going on in the environment, which the company believes that could offer threats and opportunities. Due to this, it can be said that being open to change is strength for PG because of its willingness to adopt development and improvement. Furthermore, the company also has a strong relationship and connection with other IT organizations which enables the company to have connections with those companies that are informed and competent in this aspect. With the connection and the willingness to learn and change, the com pany will have advance in the said aspect.On the other hand, the weakness of the company will focus on the ability of the employees of the company to use the fully interconnected system. This will be a problem because the perceptions of the employees towards a system are important factor that will affect their individual performance, gum olibanum the boilersuit performance of the company.Organizational DevelopmentOrganization development (OD) is a sizable set of concepts and techniques in order to improve the effectiveness and individual well-being of an organization (Friday 2003, p. 2). In the case of PG, the application of new technology, online full treatmentpace system, it can offer different development and improvement for the company. This can help in order to build up an inventory of applications that will deliver information for the entire business units in the UK as well as other parts of the globe, which will help in order for the information to be visible(prenomina l) as the services through the vena portae. With this, the employees as well as managers will be able to reuse systems and codes from other parts of the business including purchasing, marketing, logistics, manufacturing and other parts of the company. Furthermore, it can also offer a security faculty which will help in order to protect information, at the akin time, offer service platform that will facilitate data from different sources that can be accessed when needed. Overall, it can help in order to improve and exercise decision-making, at the same time, increasing the access of the internal and outer stakeholders to association and information (Mari 2008).Systems for Process of ChangeSystems of ChangeThe nature of change program falls under deuce-ace important categories, including sustained improvement, knowledge management and management by objectives. The continuous improvement placed its focus on the improvement of the satisfaction of the customers by implementing co ntinuous and incremental improvements to processes. This focuses on offering workers with flexible data access, particularly regarding the ongoing management of web content. On the other hand, knowledge management pertains on the collection and management of critical knowledge for the office of increasing the capacity in order to achieve results. With the help of the program, the application of computer technology can help to wider the audience and connection with the stakeholders. Above all, the ongoing tracking and feedbacks can help in order to motivate PG to reach its objectives by way of employee and consumer inputs.This change will focus on satisfying the end-users and develop products that are innovative, which will help to improve the lives of the consumers and the employees of the company. Three important strategies will be use in order to capture the end-users requirements and build new products in come across those requirements. The first two are interactive, which per tains to living it and working it, while the trine pertains on the innovation labs. The innovation labs focus on the needs that are not articulated in direct manner. Aside from these, the corporate portal will also focus on implementing personalized website which will in the main focus on individual websites of each and every products of the company.This will focus on refurbishing the website, introducing new workspace standards, flexible hot desks for workers who occasionally work at home and additional meeting and huddle rooms.With this, different physical and geomorphological aspect of the company will be changed. The structure of the organization will be changed in a way that managers and employees will be trained and coached with accordance to the new system. Furthermore, it will also focus on the improvement and changing the overall standards, rules and procedures being implement inside the company. This is because it can help in order to ensure that everything is based o n the mission, vision and purpose of the company.EvaluationAssessment and rating is important in any change or any actions or strategies to be implemented in an organization. This is because, it can help in order to ensure and maintain that the planned case of the program is the exact result, at the same time, ensure that the company acquires agonistic advantage. It is important to focus on the main purposes of the program management support, internal and external communication and program operation. These important factors will be the deciding factors in the evaluation process to know if the program is effective. With this, it is important to implement intensive communication between the different levels of management. It is live to maintain formal and informal communication via reporting in order to know the post of each and every changes being implemented inside the organization. In the end, evaluation of the impact of the system to the organization will be evaluate by aski ng the employees about the result of the system and its advantages and advantages in their current works and roles, at the same time, focuses on the overall performance of the company via the pecuniary and other resources matters.Models of ImplementationCommonly, business leaders considered IT to be costly however, it is important for PG to focus on becoming and continuing to be innovation leader, particularly in the UK. Therefore, it is important to unite the IT aspect of the company with its core business services as the core strategy. With this change, it will help to drive shared out services across business process with the ongoing commitment in order to maintain the top-to-bottom focus regarding the mission. In the entire change process, the eight-stage process by Kotter (1996).1. Establishing a mother wit of urgency it is important to overcome complacency. This can be done by creating a strong reason wherefore change is needed. The current implementation of IT in PG crea ted several problems and threats which include duplication and inefficiency. As a result, there is a need to implement new IT platform which will help the company to integrate its current business applications and processes. Thus, the new system will help to focus on scalability, tractability and easy-to-use system which will help to handle different processes and flow of information and data inside the organization.2. Creating the guiding coalition it is vital to build a team up with the right composition of power, level of trust and shared objectives in order to lead the change. In the case of the PG UK, the guided coalition will be from Cincinnati headquarter by Passerni. This is because the said guiding coalition must line up to the international operation of the company. Thus, in the continuing effort of the company to supplement scale as a global business while retaining the local anesthetic touch, PG will focus on transforming its global strategic thinkers with aggressiv e entrepreneurial spirit, with the influence of the improving IT capabilities and skills. Thus, the company will focus on the three important structural drivers including global organization, holistic thinking across the business process organizations and technologies and growth of partnership with HP, IBM and other important IT companies.3. Developing a vision and strategy this pertains on the clarification of direction, motivating people and part coordination. The premise focused on how new technologies must find its purpose on delivering the product of PG in the market. Through this process, PG will continue to be the entrepreneurial thinker where in innovative ways that are related on improving the current products and services being offered to the current market and target market. With this, it can help in order for the company to maintain its position in the UK market, at the same time, ensure that continuous innovation and development will be done.4. Communicating the chang e vision discernment is vital in any change management, because it can affect the overall change implementation. The actors of this change are the members of the enterprise architecture unit at PG. In order to gain the 100% employee buy-in, it is important that the bulk of ideas will be generated from different sources from the top IT providers to the employee who work on shop floor. This will cause 10% to 15% jobs changes and structural changes. Communication strategies to be implemented are downward and horizontal communication (Guffrey n.d.). Downward communication refers to communications from superior to those who report to them. These may be used in order to communicate about job instructions, job rationale, procedures and practices, performance feedback and company missions. On the other hand, the horizontal communication consists of message between colleagues at the same level of organization (CMR Institute 2006). Overall, the information will flow from decision-makers and will be shared between lateral channels (Guffrey n.d.).5. Empowering employees for broad based action this stage will focus on eliminating barriers and time constraints. The team approach gets hold of the willingness of each and every employee for the implementation of the online workspace system. This will help in order to empower the employees for broad-based action. It is vital to focus on creating sense of involvement to the employees, at the same time implement self-directed work teams in order to meet their objectives of adapting to the online workspace systems. The company will focus on implementing different training and development programs that will help to coach and train the employees to be familiar with the new system.6. Generating short terms wins it is important to stick about on the course as major change will take long time. The said change is an indication that the top management of the company must focus on the strategic actions that focus on the extreme busi ness perspective and not just focus towards the product or the employee. It is vital to focus on the organizational process, decision making and innovation with connection on the IT strategy and the business needs in order to generate short term wins.7. Consolidate gains and produce more change using short term wins, with this change, the company can focus on international change, particularly in the sense of the geographically dispersed business units, it is important to focus on the development of the organization, global business service as well as corporate functions into a single, cohesive collaboration.8. rachis the new culture it is important to innovate and change in continuous manner in order to firmly ground the operating style. It will pertain on the multi-layer content management architecture, at the same time, leverage open standards consolidating the gains. The paradigm shift was from being technologies-thinking into solution-thinking.Conclusion and RecommendationCh ange is inevitable, particularly in the world of business. Change can cause twain positive and negative results for any company. First, change means growth and improvement, thus it can help companies to focus on the different threats and opportunities which can be implemented and prevented inside the organization in order to ensure success and maintain position in the market and industry. On the other hand, change can also cause negative results for any company, particularly in the aspect of management. It can cause huge amount to be spent, at the same time great effort to be exerted in order to ensure that the change will not affect the behavior and attitudes of the employees and other important stakeholders towards the company.In the case of PG, it is important for the company to focus on improving its IT, because it can help to maintain competitive advantage by ensuring that information flow is properly manage, at the same time, ensure that all the stakeholders in the company ar e properly connected in the decision-making process. With this, it is vital for PG to focus on the different aspects that are related with the change management, including theories and practices.

Déjàvu and the Brain :: Biology Essays Research Papers

UGH I Just Got the Creepiest Feeling That I Have Been Here Before Dj vu and the Brain, Consciousness and SelfWe have all some get wind of a feeling, that comes over us occasionally,, of what we are saying and doing having been said and make before, in a remote time - of our having been surrounded, dim ages ago, by the selfsame(prenominal) faces, objects, and circumstances - of our knowing perfectly what will be said next, as if we suddenly remember it (Dickens in David Copperfield - chapter 39 (1)) It happens to me and it has probably happened to you. It is sudden and fleeting, difference as unexpectedly as it came. While the experience is striking in its clarity and detail, it is difficult to recapture or recount. Generally, it is left unexplained and is expound in a vague sense, often simply as, Wow, I alone got the strangest dj vu. Because it is so difficult to research and seems to have no deleterious effects on daily and long-term nervous remains function, dj vu has been left largely to the wayside of neurobiological investigation. In all of its ambiguity, dj vu is still a perplexing phenomenon that has not yet been fully explained. The value of truly understanding the source of dj vu and its circuitry is in uncovering one of the many keys to the role of the certain self in the functioning of the brain. What is dj vu and how does it work? Dj vu is considered a common phenomenon. Surveys show that about one tertiary of the population has had the most common form of dj vu sensations (1). due to the subjective and often indescribable nature of the associated feelings, it has been difficult, to determine who is actually experiencing dj vu. In general, however, dj vu is any number of hard-to-explain sometimes upsetting occurrences of unexpected recognition, in which the person involved has trouble identifying an root word for the events and/or places which seem so strangely and intensely familiar (1). Dj vu has been defined as familiarity without co nsciousness (13). While the situational cues of a dj vu are familiar, there is a definite lack of awareness about the specific source of the memory. Arthur Funkhouser (1) defines three types of dj vu in an attempt to more clearly delineate between associated, but different, neurologic experiences. These are dj vecu (already experienced), dj senti (already felt) and dj visit (already visited).

The Qualms of Communication Essay -- miscellaneous

The Qualms of CommunicationHe never talks to me That phrase is the most common complaint that wo hands take up about work force. The communication process between men and women has long been an post for many quite a little. The way we intercommunicate and why we speak that way rich person prompted diverse opinions from various authors over the years. Deborah Tannen is bingle such author. Tannen, who has a doctorate in linguistics, is a professor at Georgetown University. She has been study the way people communicate and the problems they have communicating with each other for many years. Her studies inspire her to write several books on the subject. The excerpt Put Down That physical composition and Talk To Me, which appears in the textbook Writing the World, was taken from her best-seller You Just forefathert Understand Women and Men in Conversation, written in 1991. Deborah Tannen believes men and women talk disparately because they are raised in two different conversat ional cultures and that problems arise because of conversational style. She thinks that boys are taught to speak like men and girls taught to talk like women. In the essay Tannen addresses many of the misgivings of communication, based upon her legion(predicate) studies, that she believes proves men and women really are taught to talk a certain way. Deborah Tannen has been studying how people communicate with each other and she believes it starts at a very(prenominal) early age. Starting when we are very young, we communicate very differently. On a television show titled She Said, He Said, Tannen showed some telecasting recording on a study of hers that had two same-sex children enter a room and sit and talk to each other. She performed this same study on varying ages of children from 5 to 16 and in every case the results were the same. She tack together that the boys would sit side by side and would speak almost distractedly, magic spell looking about the room. The girls would enter the room, place their chairs facing each other, and would speak looking directly at each other. To Tannen, this study showed how males do not talk with much intimacy. Their relationships are held together by performing activities in a group, such as sports or politics. She believes men speak when they intuitive feeling a need to impress or if their complaisant status is in question. The females however, spoke with much more closeness. Tannen says, For females, talk is the glue that holds their relationships... ...them control power, wealth, and social resources because men think that women do not want them. Another one of Tannens critics, Senta Troemel-Ploetz, accuses Deborah Tannen of ignoring the possibility that men and women communicate differently because of differences of power. Troemel-Ploetz contends that the problem goes beyond conversational style. She believes that Tannen completely misses the power-struggle between the two sexes in the ways that they speak. She believes that ordering is giving men too much power in harangue and essentially how people are leading their lives. Tannens advice on how to elucidate communication problems is mainly just to understand the differences in the way we speak. Tannen says, legion(predicate) men honestly do not know what women want, and women honestly do not know why men find what they want so hard to comprehend and deliver. Men and women are different so naturally we will behave and talk differently. Since we start communicating at a young age Tannen believes we are raised to speak in discontinue worlds by a combination of cultural and biological influences, and if we can break out understand our differences, we can solve many of the qualms of communication.

Narrative on Attending a Speech by Ira Berlin -- Slavery

report It was 223 on a Friday afternoon. Normally, at this time, I would pass been missing my Computer Science lash. But by a gothic and, dare I call it convenient, twist of fate, the professor?s become died a couple days ago and the class was canceled. Not that it would book made a difference I was prepared to skip the lecture and attend another given by Ira Berlin, a fantastic Mellon Senior Scholar, entitled Rethinking Slavery 1800-1861. I walked through the entrance to 213 Gregory Hall, the way in which the lecture was to be given, and entered a completely empty room. To the outperform of my knowledge, the lecture was supposed to start at 230, which puzzled me. I figured that maybe it was rescheduled to a later time, and I?d astonish around for a while until I got bored enough to leave. I seized the opportunity to choose my buns wisely. The room was divided into two major groups of seats, oriented in columns. Each column was seven seats replete(p ) and 10 seats deep. And there were a few seats seamed up along the windows in the back as well, providing an approximate expertness of 150 persons, I estimated. My thought process was that I was here to trace the people more than the lecture. I also analyzed the fact that I don?t like history and concluded that if I sit in front, to see and hear the professor with greater ease, I would any bore myself or I wouldn?t understand. And since both of those were scenarios that eventually resulted in my narrative being terrible, I decided to try my luck in the back. Two minutes passed before two more entered the room. They were two men, schoolboyish enough to be students. The first had white skin, and wore a T-Shirt, a cap, and a metallic watch similar... ... made my way out. I had sat is that seat for over 2 hours and 10 minutes. My legs needed stretched, and I had a predilection for a Big-Mac. What was the point of that lecture? For me, it was for a grade in e mpty words 105, but I was probably a minority. It puzzled me that the lecture was on the fence(p) to the public, yet the average Joe, unless I have seriously overestimated my intelligence, would have no idea what Berlin was talking about. I go to lectures and classes in order to fall upon something, but I learned nothing here. Berlin spent a well-grounded 45 minutes bombarding me with new information, but he obviously presume that the audience already knew things that I didn?t, because I comprehended none of the material. The exactly conclusion I could make was that, in order to understand what Berlin was saying, you had to already be familiar with the material that Berlin was covering.