10 Analytical Essay Topics on Othello

10 Analytical Essay Topics on Othello Welcome to the first of our three guides on writing an analytical essay on Othello,   composed by the famous playwright, actor and poet William Shakespeare. Everyone knows Shakespeare as the greatest English writer of all time, and one of the world’s most prominent dramatists. But understanding Shakespeare’s plays can be quite a daunting task. However, you don’t have to worry since you’ve hit the jackpot! Shakespeare is known to be a playwright, who was always more influenced by the real-world rather than by abstract imaginations. The majority of his plays were based on tales, short stories and real events. Othello was no exception. This play was strongly influenced by Cinthio’s short-story â€Å"Un Capitano Moro.† In fact, all the characters had prototypes and were mentioned solely by their ranks and titles in the initial Italian version. Desdemona was the only hero whose name Shakespeare borrowed directly from Cinthio. Othello is the main character of this play. At the same time, if you have read this play not knowing its title you would suspect it is called â€Å"Iago†, because this secondary character surpasses Othello both in terms of dialogues and overall significance in the plot. Iago, the main villain of the story, had pronounced some of the most memorable lines in the history of drama, can still be heard in the everyday language of playwrights. He is also considered to be the most verbose character of the play. Othello was a pioneer play in shining a spotlight on the subject of interracial marriage as a mainstream entertainment of that time. In this matter, Shakespeare was ahead of his time, because the dilemma of interracial marriages has not been discussed for 350 years since then. â€Å"Guess Who’s Coming to Dinner† play and movie was the first mass piece of art dedicated to the same topic in the modern history. Othello is a very complex, and subtly nuanced play. It describes the story of Othello, a valiant army general, his wife Desdemona, and his ensign (second lieutenant), Iago. Since Iago doesn’t get promoted to the rank of a lieutenant, which he desperately wanted, he plots a deceit that makes   Othello accept the idea of his wife, Desdemona,   being unfaithful to him.Due to the personal tragedy, Othello becomes desperate to escape from the pressure of this nightmare. These sufferings blind him and make him kill the love of his life. When he finds out that he was tricked into believing gossips about his wife having an affair, he commits suicide out of regret, shame and moral pain. Such ending has very strong allusions to the â€Å"Oedipus Rex† by Sophocles. Iago gets executed in the end of the play, which is remarkable for Shakespeare, who never pursued the idea of the immediate punishment for evil. Shakespeare was inspired by Cinthios Un Capitano Moro, and most of the story, along with some plot twists based on it. However, we find that there are some characters, such as Roderigo, not existing in Cinthios Un Capitano Moro. Othello became so popular and famous in the 1900s. Its first film version was made in 1909. The originally titled film, Othello was directed by Ugo Falena. It was filmed in Venice, which made â€Å"Othello,† the first Shakespeare play filmed in its actual location. Amazing sights, strong group of actors and Ugo Falena’s impeccable taste brought the film to the top of numerous charts and Shakespeare once again got his well-earned recognition. Othello was interpreted and turned into movies more than 20 times by relentless Hollywood. These include Stuart Burges 1965 and Oliver Parkers 1995 classic adaptations, as well as Tim Blake Nelsons eccentric â€Å"O† filmed in 2001. Othello, the tragic hero in the play of William Shakespeares Othello, comes from the name of an ancient Roman emperor, Otho, which means â€Å"wealth†. At the same time you shouldn’t take it for granted as it is only a speculation that’s been made by historians. Honesty is one of the words that is intensely repeated throughout the play, at least 52 times to be exact. It may be due to the fact that the whole play is about ‘honesty’ and how Desdemona was very faithful to her husband, while Othello suspected otherwise, because Iago’s cunning plan. Othello was first performed in Whitehall Palace 1604. According to the history of Othello’s premier, the play is said to be performed on the Halloween  day, November the 1st. The adaptation of the play, however, wasn’t adapted during the Restoration Period – whereas, most of Shakespeare’s plays were adapted in that era. These facts will surely come in handy when you’re about to write an analytical essay on the play. We’ve also included seven references from where we’ve gathered these facts. This will save a lot of your time as you can use these links to find more information on a specific topic. It will allow you to concentrate more on actually writing the essay. But before you start writing, we urge you to read our second guide, 20 Othello essay topics, first – where you’ll find relevant topics on Othello, along with a sample essay helpful in   avoiding   any confusion when composing your paper. Of course, we have also included a final guide on how to write a killer analytical essay on Othello, which is a must-read. In this guide, you’ll explore how to write and compose a sublime and exemplary paper on Othello. References: Bullough, G. (1973). Narrative and Dramatic Sources of Shakespeares: Major tragedies. Hamlet, Othello, King Lear, Macbeth. Volume VII (Vol. 7). Columbia University Press. Veldhuijzen, D. G. J. (2016). Feminism and Feminisms: An Analysis of Paula Vogel and Toni Morrison’s Feminist Play Appropriations of Othello (Bachelors thesis). Simmons, A. M. (2016). Supporting Critical Literacy in High School English by Using Systemic Functional Linguistics to Analyze Fantasy, Canonical, and Non Fiction Texts. Critical Inquiry in Language Studies, 13(3), 183-209. Smith, I. (2016). We are Othello: Speaking of race in early modern studies. Shakespeare Quarterly, 67(1), 104-124. Stella, C. (2016). Italian Studies: Cinquecento (1500–1599). The Years Work in Modern Language Studies, 76, 276-283. Dwivedi, A. V. (2016). Othello: Language and writing [Book Review]. Australasian Drama Studies, (68), 195. Mondal, S. Race, Ideology and Theatre: A Classroom Reading of Othello.

Japanese War Crimes

Japanese War Crimes Introduction Japanese war crimes were committed during the reign of Emperor Hirobito. The paper will give a detailed analysis of the crimes that were committed such as mass killing, forced labor, lootings, use of biological and chemical weapons, cannibalism, sexual slavery, torture and enslavement. This will hence help in giving limelight to the main effects of the crimes.Advertising We will write a custom research paper sample on Japanese War Crimes specifically for you for only $16.05 $11/page Learn More To fully understand the crimes committed, the discourse will also analyze the Japanese and international law and some of the agreements that Japan signed in relation to the crimes that were later committed. As a means to an end, it will give a brief recommendation on the whole subject of war crime and the way forward for Japan. Discussion War crimes are the violations of war customs or laws (Trahan,7-13). This includes crimes that are committed against the enemies who can either be opponents or civilians. Though Japan has offered numerous apologies in regard to the suffering it caused, most people still assert that Japan still has not been humble enough to offer a genuine apology (Kristof, 37-49). Others in support of Kristof allege that the Japan government is not humble as it has until now not accepted the legal duty to compensate the people who were affected during the atrocities. Most women’s and Human’s rights organizations agree that Japan should have a legal and moral role to fully compensate the victims. However, Maga (9-31) disagrees with Kristof asserting that the nation has chosen to reject any form of reconciliation. It is the aim of this discourse to give a detailed analysis on the causes of war crimes in Japan in relation to crimes committed such as mass killing, enslavement, and forced labor among others.. It will also give limelight to obvious effects and discuss related laws and trials. Finally, it will give a recommendation. The Japanese Law in relation to War Crimes Japan promised to abide by the terms of Geneva Convention of 1929. Most of the crimes that were committed such as mass killing, lootings, slavery, forced labor, sexual slavery, torture among others did fall in the category of Japanese as well as the international law. For instance most of the crimes by the personnel in the period of the Second World War directly violated the military law. Moreover, the empire ended up breaking agreements that had been signed by Japan such as use of biological or chemical weapons as well as protecting the prisoners. The Japanese government fully accepted the terms that were set in 1945 by Potsdam declaration meaning they were not supposed to engage in the heinous activities that they later engaged in.Advertising Looking for research paper on asian? Let's see if we can help you! Get your first paper with 15% OFF Learn More Overview of Japanese War crimes and cau ses The military forces were responsible for the war crimes in Japan (Christopher and Eitzen.412-417). Other forces such as Japanese army, the navy, imperial, emperor Hirohito among others were responsible for the war crimes ( Nelson443-467). These people have been cited to have been directly or indirectly involved in the killings and the crimes that were committed against innocent civilians and war prisoners. They were responsible for the killing of millions as even some of the Japanese soldiers admitted to committing the crimes is (Maga 17-35). They conducted numerous abuses against the prisoners and the civilians in East Asia as well as the pacific region (Nelson, 443-467). Since 1950s, most of the government officials in Japan have offered unaccountable apologies for the war crimes though others still deny of having knowledge on the happenings of this period as the killings and lootings at Nanjing by the Japanese soldiers. In comparison to other forms of aggression during the Se cond World War in other nations, Japan is the only country that used biological and chemical weapons. As stated earlier, the paper will give a detailed analysis on the crimes that were committed which were against the law. Use of biochemical weapons and effects Japan started researching on both the chemical and biological weapons in 1920s (Guillemin 545-549). One of the most influential persons who was responsible for these weapons and the later effects was Shiro Ishii ( Kleinman, 23-47). He did his research on innocent victims with the protection of the local police among other influential agencies. He later constructed a biological weapon research center which was later completed in the year 1939. Every year hundreds of his prisoners were exposed to numerous known diseases such as yellow fever and anthrax (Kleinman, 23-47) Ishii even used these prisoners for various hyperthermia and gangrene experiments (Guillemin 545-549). This was a period where most prisoners were even coerced to having intercourse with people who had venereal diseases. The main victims of all these heinous acts and experiments were ordinary criminals, mentally challenged people, political prisoners, the homeless, the poor among others. Most of the prisoners who were used for the experiment were of Chinese origin as well as Americans, Europeans and Koreans.Advertising We will write a custom research paper sample on Japanese War Crimes specifically for you for only $16.05 $11/page Learn More There is no definite data on the people who were killed during the experiments but it is estimated that over twelve thousand people were sacrificed in the name of research (Greenleaf, 275-411). Over 250, 000 people were killed during the field tests as well as in the period of the post war epidemic outbreak which is directly related to biological and chemical weapons that were used (Greenleaf, 275-411). Though Ishii was an influential researcher for both biological and chemica l weapons, he did not commit these crimes alone, but he was helped by various veterinarians, researchers, doctors, among other medical experts (Kleinman, 23-47). All this happened during the reign of Emperor Hirohito in which other units which was like those of Ishii were constructed between 1931 and 1945. From the beginning of 1945, the Japan government denied having any knowledge on the activities of the chemical and biological weapons and its impact on people. They also in their interrogations on the issue tended to reduce the impact that these weapons had. In 1996 the spokesman for foreign affairs lied and defended the Japanese government asserting that the government did not have documents to prove without doubt that they used Chinese people for research.( Edwards, 317-336). That was an outright lie and Drifte ( 47-71) agrees that the Japanese government was obviously aware of the documents that confirmed the vast activities of the allied units and Unit 731. The Japanese govern ment was aware that during this period the highest authority including the Royal Family was fully responsible for these crimes. Since then, for unknown reasons, the Japanese government has refused to acknowledge on the existence of these crimes and those in authority today have continued to deny of having knowledge on such activities. It is to be understood that Japanese War Crimes were not just committed by the ethnic personnel. However, people in pacific and Asian countries teamed up with the Japanese military after coercion and threats. Others collaborated due to economic hardships, imperialist influence, aversion, among other adverse reasons. The result of the war crimes is quite vast and is nothing less than horrific. The war criminals due to the immunity given by the U.S were free to resume to their careers as if nothing happened. Various professions were dominated by high ranking Japanese researchers and medical personnel for a long time. These murderers even rose to high pos ts and became prominent government officials and presidents of various institutions and were credited for being outstanding researchers in the scientific world.Advertising Looking for research paper on asian? Let's see if we can help you! Get your first paper with 15% OFF Learn More Research shows that most of the graduates of various units dominated the Ministry of Health. Additionally, criminals such as Kitano Masaji and Naito Ryoichi developed influential pharmaceutical companies for instance the Green Cross Company (Hornblum, 1437). Having criminals occupy public and private companies had its own consequence. It led to the Green Cross Scandal in which approximately 1500 Japanese were given unsterilized blood which had HIV virus The war crimes have led to numerous lawsuits which are still pending. The War crimes have led numerous charges to people who were liable against various crimes against peace. Some of these charges were introduced in Tokyo trials so as to prosecute class A, Class B and class C criminals. Class B criminals were prosecuted on the merit of being found guilty of the war crimes as per the Japanese and international law. Class C were the people who were guilty of crimes related During the period of 2nd Sino Japanese War, there was use of ga s weapons for example such as tear gas was used in 1937 though from 1938, the Japanese Army started using other chemical weapons such as nausea, chlorine, phosgene gas among other toxic gases. For instance, the emperor permitted the use of such toxic gases on various occasions during the Wuhan war of 1930 despite the agreement signed in relation to use of Noxious Gases in Warfare and Hague conventions(Maga, 18). Furthermore, during the Yichang battle of 1941, the Japanese army launched around one thousand toxic yellow and red gas shells which led to immense adverse effect on over 1,600 Chinese soldiers (Maga, 17-35). Enslavement in relation to war crimes There has been immense controversy on the role of Japan during the Second World War. This has been in relation to the numerous deaths of prisoners of war who were all under Japanese rule. During this period, the Japanese government during its criminal activities killed over 30 million people in which 25 million were Chinese (Futamur a, 59-114). Japan is known to have enslaved millions of people. People were exploited and worked as casual laborers and forced prostitutes. Additionally, forced labor caused several deaths. Over 100, 000 civilians ended up dying during the Siam Railway construction (Fatamura, 59-114). Fatumura in regard to the Tokyo Tribunal’s findings, asserts that the death rates from the Asian nations in which Japan was fully accountable was approximately 27.1% whereas the Chinese death rates were higher than that of the Asians which were directed by Emperor Hirohito( 59-114). Enslavement led to war crimes as it was against the Japanese and international law. Mass killings in relation to war crimes Japanese government was also guilty of mass killings as between the year 1937 and 1945; the military killed over 10 million people (Fatamura, 59-114). This was a result of poor military strategy and immoral national culture. The most famous incident happened in 1937 to 1938; Nanking Massacre, wh ere the Japanese military and army killed over 300, 000 prisoners and civilians (Maga, 17-35). This was against the law and hence led to war crimes. Torture as a cause of war crimes The Japanese forces employed vast usage of torture mechanisms in an effort to promptly gather intelligence. The tortured prisoners could be later executed which went undetected and unquestioned. The prisoners were bullied and murdered so as to cover evidence. This was crime against humanity. Cannibalism as a cause of war crime Another issue under crimes were cannibalism in which most Tokyo tribunals cases indicates that the personnel in Pacific and Asia who were from Japanese origin committed heinous acts of cannibalism against the prisoners. It was so tragic that the Japanese personnel started selecting prisoners daily where every day a prisoner would be killed and later eaten by the army. Liutenant Yoshio Tachibana among other personnel was convicted of cannibalism in 1946 (Maga, 17). Sexual slavery Th e other form of crime was sexual slavery among women where women were recruited by deceptive means, then abducted and finally forced to sexual slavery. This was against the law hence causing war crimes. Trials in relation to war crimes After the war, various people were categorized in the class A, B and C war criminals where around 984 people were condemned to death. Approximately 920 people were executed, 2, 944 people received prison terms, 475 people got a life sentence, 1, 018 got acquitted and around 279 people were neither brought to trial nor sentenced (Maga, 17-31). Emperor Hirohito and other members of the Royal Family who were implicated in the war were exonerated from the criminal prosecutions. Most of the historians have been cited criticizing this decision of the court to exonerate these high ranking officials of the Royal family arguing that they were directly involved in the war crimes. Recommendations It goes without saying that there comes a time when it is not nece ssary anymore to understand why Japan cannot genuinely apologize for its acts, why the Japanese soldiers committed such barbaric acts and even why the emperor was exonerated from the war crimes. The question is, does it matter anymore to count on the innocent victims who were killed during Nanjing Massacre, how many Chinese and Americans were tortured and killed or even how many times the Japanese used biochemical weapons in China which resulted to deaths? It is time that Japanese government acknowledged its war crimes if at all they want to maintain peace in the international sphere and even play a meaningful role in the United Nations (Li,.8-12). For Japan to gain trust of other nations, it ought to settle its legal and moral obligations. Japan should take responsibility for the war crimes, apologize to the victims who were involved in the atrocities and pay the appropriate reparations to all the victims. Conclusion It is apparent that Japanese War crimes had immense effect. The p aper has extensively discussed the Japanese War crimes focusing on the crimes committed, its effects and finally given a recommendation. Christopher, George., Eitzen, Edward. â€Å"Biological warfare†. JAMA, 278.5 (1997): 412-417. Drifte, Reinhard. Japan’s security relations with China since 1909. From balancing to bandwagoning. New York: Routledge, 2002. Print Edwards, Jason. â€Å"Community focused apologia in international affairs. Japanese prime minister Tomiichi Murayama’s apology†. Howard journal of communication, 16.4 (2005): 317-336. Futamura, Madoka. War crimes tribunals and transitional justice. The Tokyo trial and the Nuremburg legacy. New York: Routledge, 2000. Print Greenleaf, Peter. Japan’s secret weapon. Washington: Current publishing, 1944 Guillemin, Jeanne. â€Å"Scientists and the history of biological weapons†. Science and society, 7 (2006): 545-549 Hornblum, Allen. â€Å"They were cheap and available: prisoners as resea rch subjects in 20th century’. Education and debate, 315(1997): 1437 Kristof, Nicholas. â€Å"The problem of memory†. JSOR, Foreign affairs, 77.6 (Nov 1998): 37-49 Kleinman, Arthur. Japan’s wartime medical atrocities. Comparative inquiries in science, history and ethics. New York: Taylor and Francis, 2010. Print Li, Peter. Japanese War Crimes: The search for justice. New York: Transaction publishers, 2003. Print Maga, Timothy. Judgment at Tokyo: The Japanese War crimes Trials. CA: University press of Kenturcky, 2001. Print Nelson, John. â€Å"Social memory as ritual practice: commemorating spirits of the military dead at Yasukuni Shinto Shrine†. Journal of Asian Studies, 62.2 (2003): 443-467 Trahan, Jennifer. Genocide, war crimes, and crimes against humanity. A topical digest of the case law of the international criminal tribunal for the former Yugoslavia. New York: Human Rights watch, 2006. Print

Spiritual Beliefs as a Factor in the Performance of Nursing Staff Research Paper

Spiritual Beliefs as a Factor in the Performance of Nursing Staff - Research Paper Example These questions are significant to nursing practice; in order to meet the demands of the population and increase both patient chances of survival and patient satisfaction the role of spiritualism as a factor considered motivational has been studied to evaluate its efficiency. Following a literature review nursing practices have been identified which contribute to better patient outcomes and advanced education has been noted to increase the ability of the nurse to provide spiritual care. Those nurse’s with more experience and those working at a higher grade have a greater understanding of spirituality (Noble, & Jones, 2010). The value of communication with non-verbal cues is necessary and spiritual care must be guided by the patients themselves. Communication has been identified as a strong factor in the ability to deliver appropriate spiritual care in Milligan, 2004; McSherry, 2006; and Ross, 2006 by Noble and Jones. A lack of time is also considered a barrier to providing spi ritual care and the need for better education and training would be welcome by many. Spirituality among nurse’s is related positively to education levels and those having a Master’s degree. It is also related to 11-19 years clinical experience and having received spiritual education and training (Wu, & Lin, 2011). In Lind, Sendelbach, & Steen, (2011) nurses were described as feeling unprepared and unable to meet the spiritual needs of patients. Patient satisfaction surveys in a Minnesota cardiovascular progressive care unit determined that meeting the spiritual needs of patients in the unit was an area that needed improvement. The unit first analyzed the 2001 Joint Commission of 2001Press Ganey national inpatient data which indicated that there is a high value placed on emotional and spiritual care while patient’s are hospitalized. Second, there is a very strong correlation between meeting a patient’s emotional and spiritual needs to their overall satisfa ction and third, this is area in most hospitals that provides opportunity for a significant improvement. Spiritual distress has been named as an appropriate nursing diagnosis by The North American Nursing Diagnosis Association and it is a recommendation of the American Association of Colleges of Nursing that spiritual care is included in all education programs. Despite this fact education and training seems to be lacking to many nurses. Only a small number of nurses feel that they are able to meet the spiritual and emotional needs of patients. The unit began offering a two hour voluntary education program to the nurses with time paid and which 37 or 70% of the nurses attended over the period of a year. The instructor who taught the class was from a local faith affiliated University and the hospital Chaplain participated in each training class. This education program included concepts such as defining spirituality, what spiritual care is, what prevents spiritual care, when to call th e Chaplain and nursing interventions for spiritual care. Sessions were based on literature and staff surveys. The unit implemented a new survey, the HOPE survey, in order to provide spiritual assessment. The survey was taken from a teaching tool that was developed for Physicians. Likert type survey scores which measured patient satisfaction with spiritual and emotional care went up from 65% and 62% to 74% and 71% the two months following implementation of the training program. Pastoral care consultancies were increased from 16 to 27 per month and spiritual care plans were increased from 1 to 4 per month. The success of this program in the

What do you think comprises reality Term Paper Example | Topics and Well Written Essays - 1000 words

What do you think comprises reality - Term Paper Example We do not have a direct perception of substances in minds, but only a representation of them. What we know is not what is inherent to the substances, but only the secondary and primary qualities. Thus, according to Locke, the substances are bodies, which are material, and souls, which are immaterial. Then there is God. He explains the existence of God, not from inherent ideas, but from sense-experience. Their basic substance is assumed from the perception of physical qualities, since qualities must have a solid basis. Likewise, a spiritual soul is formed from the observation of mental operations. We perceive bodies through sensation and have a lucid and instant idea of our soul by reflection. The outside world is independent of the mind. The presence of real objects is what causes real sensations in us (Tully 53). Locke further says there are interactions between the body and mind, both of which are real beings, resulting in the actions of our bodies and minds. The changes experience d by the soul are as a result of its being acted on by outside bodies. On Locke’s third substance, God, he provides that we shape an idea of God by expanding or taking to infinity the rules and objects of our sensations and reflections. What we experience are existence, extension, knowledge and power. Taking them to infinity is our idea of God (Tully 67). Descartes described a substance as a particular thing. He argues that there are material or physical substances and thinking substances, the mind. The substances have characteristics called modes. Modes of physical substances include their location in time, space, shape and volume. The mode of thinking substances includes ideas, judgments and desires of the subject. Every substance has an essential property. The essential property of a material substance is occupying space and time. The essential property of a thinking substance is thinking. Therefore, having ideas, believing or desiring are ways of thinking, and having a sh ape and volume are ways of occupying space and time. Descartes further divides material substances into finite and infinite. Examples of finite materials are human bodies, plants and earth. Likewise, human minds are finite thinking substances. Adding a third substance, he says God is an infinite substance. Therefore, according to Descartes, there are three types of substances; modes, finite substances, and infinite substance. Descartes views reality as relative and divides them into formal and objective reality. Formal is the kind of reality something possesses by merit of the type of thing it is. Infinite substances, finite substances, and modes possess formal reality in varying degrees. Modes have the least formal reality, followed by finite substances then infinite substance in ascending order. The amount of formal reality contained in something is determined by its dependence on another for its existence. The higher the dependence something has on another for existence, the less the formal reality it contains. Modes depend on finite substances, and in turn finite substances depend on infinite substances for existence (Tully 41). For example, the shape of a ball would not exist without a ball, but a ball could exist without that shape. On objective reality, Descartes contributes that first it is only possessed by representation. This means that it is possessed by things that stand for other things. Basically, these are ideas. Examples of representations

In Asthmatic Children under the age of 5yrs is spacer inhaler more Essay - 1

In Asthmatic Children under the age of 5yrs is spacer inhaler more beneficial than a nebulizer - Essay Example Asthma prevalence is increasing with corresponding increase in incidences of emergency department admissions. Pollution as well as changes in lifestyle has contributed significantly in increasing the prevalence of asthma (Dhuper et al, 2011). Certain demographic factors such as poor socioeconomic status, are also contributing to higher numbers of asthma prevalence among certain ethnic populations such as African American and Hispanic populations (Dhuper et al, 2011). Among children, asthma is found to be 10 to 15% prevalent and a major cause of admissions to the emergency departments with high morbidity and mortality rates (Kovesi et al, 2010). Management of younger children remains a challenge as there are lot of constraints on the test results. Children show less cooperation, are more anxious and are not in the development stage to understand instructions or abide by them (Kovesi et al, 2010). The similar reasons are the cause of difficulty in diagnosis of the condition. While wheezing is a very common phenomena present in children, not all wheezing can be categorized as asthma. This is because wheezing pattern of breathing is quite similar to noisy breathing, which is caused by nasal secretions in children which they haven’t learnt to swallow (Kovesi et al, 2010). Children also show different asthma presentations as compared to adults (Kovesi et al, 2010). Therefore, the diagnosis of asthma is based mainly on symptoms and treatment responses than testing methods such as pulmonary function tests. Bronchodilator therapy remains a mainstay in the management of asthma conditions in children. The bronchodilator therapy can be carried out either orally or through inhalation. Inhalation therapy is now the preferred method of treatment of asthma symptoms due to lesser systemic effects as compared to oral therapy. Inhalation therapy is also speedier in remission of asthma

Investigation Of Kinetic And Kinematic Parameters Physical Education Essay

Investigation Of Kinetic And Kinematic Parameters Physical Education Essay This study reviewing the biomechanical effects of the orthosis on human gait pattern and a specific type of ankle foot orthosis (AFO) with rocker bottom was used for the pilot study. Walking gait cycle background theory and related terms definition is explained as the introduction. A complete review on AFO functionality and efficacy on gait correction via laboratory testing is done. The review is mainly expressed from biomechanics approach with the use of kinematics and kinetic knowledge. From the reviewed process, it is no doubt to clarify that AFO enable to prevent and correct pathological gait for better improvement. Motion analysis technique using camera based system to conduct laboratory experiment on human gait is studied too. A sequence of procedures is design for further study, which consist of subject acquirement, rocker AFO fabrication, customization, laboratory experiment testing using Vicon motion analysis system, data collection and analyse. Besides, pilot studys results are included in result and discussion. A healthy woman was used as the subject in the pilot study who undergo 2 types of walking, which are walked barefoot and with AFO condition. As conclusion, the review provides evidence that the influence of AFO in altering human walking gait is significant and further study is necessary to be proceeded for better describe AFO functionality. Acknowledgement The first thank goes to Prof. Dr. Ir. Wan Abu Bakar Wan Abas, my supervisor for this graduation project. His willingness and patient in teaching and guide me either to accomplish the tasks or when I facing problems during the time, were indeed appreciated. My grateful thank goes to Dr Noor Azuan Abu Osman with his enthusiasm of sharing valuable knowledge and all kind of challenges gave by him, were definitely brought me chances to work as an professional biomedical engineer. I express much gratitude to Miss Arezoo Eshraghi too, for her guidance and assistance brought to the smoothness of my thesis study. Nevertheless, I would like to thank for all the hard work done by my faculty, especially to the Coordinator for the Graduation Project, Dr.Belinda Murphy, assistant for the project Miss Khairunnisa Hasikin and all the stuff of Biomedical Engineering Department. Table of Contents List of Figures List of Tables List of Symbols and Abbreviations AFO Ankle Foot Orthosis IC Initial contact LR Loading Response MST Mid Stance TST Terminal Stance TO Toe Off ISW Initial Swing MSW Mid Swing TSW Terminal Swing DF Dorsiflexion PF Plantarflexion KF Knee Flexion KE Knee Extension HF Hip Flexion HE Hip Extension PTB Patellar Tendon Bearing ToA Types of AFO CGC Control Group Condition Introduction Human locomotion defined as movement from one place to another and a numbers of ways could be done to achieve it, walking, use of a bicycle, wheelchair are examples of locomotion (Smidt, 1990). In this study, walking gait is the targeted locomotion. Walking is a cyclic movement interlaced between left and right foot with at least one foot being contact with the ground at all times in a certain periodic pattern (Ounpuu, 1995). A systemic analysis and parameter is required to evaluate walking gait effectively and biomechanics knowledge has been introduced to solve for this. It is a brand new term developed around the year of 1970s which integrating engineering mechanics knowledge into biological system. Biomechanics is actually applied in gait analysis by the ancient scientists few centuries ago (Martin, 1999). Biomechanics study on the gait analysis has been started since the year of 1680 by Aristotle on the gait of animals and in the year of 1890, Christian Wilhelm Braune an anatomist and Otto Fischer were started investigating human gait from biomechanics aspects (Martin, 1999). Scientists enthusiasm toward human gait analysis never shelved, it continue evolutes until today. At present, biomechanics investigation in gait analysis is able to provide profusion information for clinical practitioner to assess patient locomotion effectively. For instances, a pathology gait pattern by patient can be visualized by measuring biomechanical parameters, step length, length, joint angles, forces and etcetera. To evaluate how well the treatment improves patient ambulatory level, biomechanics knowledge applied too. Main interest of this study is not only focus on human walking gait, but also to investigate the manner orthotics alters its users gait pattern from biomechanics aspect. Orthosis is a medical appliance major used in orthopedics field for the purpose to support, alter, and align injured body segments involve in body movement (Edelstein Bruckner, 2001). In this study, the ankle foot orthosis (AFO) with additional rocker sole is chose as the orthosis in this study. Figure 1.1(a) shown a solid AFO and (b) rocker bottom. Figure 1. Solid AFO Rocker AFO is a kind of treatment apply to diabetic patient who has plantar foot ulceration risk and with ankle joint mobility difficulty. From statistical analysis from University Malaya Medical Centre Diabetic Foot Clinics, plantar foot wound treatments on diabetic patient possess the highest number of among other kind of treatment and also footwear is the highest treatment modality among others in 2008 and 2009. This statement has support and encourages the necessity to carry out this study as number of diabetic patient is increase gradually every year. AFO is worn on lower extremity and around foot to support and correct ankle position. Patient having diabetes, experienced bones segment fracture, cerebral palsy, spinal cord injury, tendon dysfunction and limb disorder patient who ankle failed to support their body weight while walking are commonly suggested by orthotist to use an AFO to improve gait routine and to minimise further injury risk (Edelstein Bruckner, 2001). Besides that, rocker sole is a creature use to reduce pressure on the forefoot and use to transmit pressure from high pressure to low pressure area meanwhile off loading the pressure exerted to risky area (Albright Woodhull-Smith, 2009). To be relative to orthosis definition, an AFO with rocker sole should not bring more burdens to patient in increase energy demand or cause any long term side effects. Consequently, investigating AFO biomechanical performance in aiding and influencing wearer locomotion therefore becomes an important study. Three dimensional (3D) gait analysis systems are laboratory equipment involve the use of reflective markers that placed on subjects interest body segments as the landmarks (Davis, Deluca, Ounpuu, 2000). It has been use widely in clinical gait analysis services and research. The video camera based system employ 2 to 7 infrared cameras allocated on the measurement volume to record subject motion or markers trajectories in precise as shown in Figure 1.2 (a) (b). The entire system applies stereophotogrammetric techniques to produce each markers 3D coordinates from the two dimensional (2D) images capture by each of the camera (Davis, et al., 2000). This 3D system digitized subject movement in real time into frames depending on sampling rate set. The frame to frame analysis provides better motion visualization and subsequently from the 3D images generated it makes the possibility to compute a more complete description towards the dynamic gait in terms of biomechanical parameters. Kinemat ic, kinetic, and temporal parameters or some other dynamic gait variables are able to be obtained from this system. During the entire study, Vicon Nexus 1.4 motion analysis system is employ to record and examine subjects walking gait pattern. Kinematic and kinetic parameters are extracting to further illustrate rocker AFO effects on its user gait pattern. Figure 1.2(c) presented a monkey hooping frame image capture using 3D motion analysis systems. http://rehablab.creighton.edu/share/sharedfiles/UserFiles/image/Camera1.jpghttp://www.med.nyu.edu/rehabengineering/images/vicon8cameras.jpg (b) (c) Figure 1. (a) Infrared Camera (b) Overview of Motion Analysis Laboratory (c) Frame Images Capture from Infrared Camera 1.1 Theory Walking gait Normal one complete gait cycle consists of stance phase and swing phase in a proportion of 60% and 40%, respectively. A normal adult will spent approximately 60% of total gait duration for heel strike to toe off (stance phase) and 40% for initial swing to terminal swing (swing phase). Stance phase is the event when foot touch on ground and body passes over the top of it whereas swing phase is when the same foot moves forwards in the air. Figure 1. Stance and Swing Phase Propotion. Stance phase is defined from initial contact, loading response, mid stance and terminal stance (toe off). Swing phase is defined from the instance toe off, initial swing, mid swing and terminal swing (Ounpuu, 1995). Figure 1.4 illustrates the phases of the gait cycle shown with the corresponding position for sagittal plane motion. http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=physmedrehabpart=A8414blobname=ch6f6-2.jpg Figure 1. Gait cycle phases (Carson, M.D. 1995) Stance phase Initial contact(IC) (0% of the gait cycle), it occur when foot contact to ground. Loading response (LR) (0-10% of the gait cycle), during this stage, shock absorption occurred with stability remain and body more forwarded. This is the first double support happened. Mid stance (MST) (10%-30% of the gait cycle), the first single leg support instance, purpose of this phase is to advance body over the stance phase limb while stability is maintained. Terminal stance (TST) (30%-50% of gait cycle), or sometimes called toe off(TF) single support ended when the sound limb contact with floor and in this phase, body still being advanced through the stance foot through the forward fall of the trunk. Toe off (TO) (60% of the gait cycle), when foots toes are about to leave floor. Swing Phase Initial Swing (ISW) (60%-73% of the gait cycle), second single support phase and begins when the foot leaves the ground until it passes opposite the stance limb. Mid swing (MSW) (73%-87%), continue advance the swing limb while providing clearance of stance foot. Terminal swing (TSW) (87%-100%), swing leg already in preparation for the next stance phase. In order for a person to walk normally, the locomotor system must fulfill four requirements. Firstly, stability of foot is essential to ensure each foot capable to withstand body weight with no collapsing. Secondly, during single leg support in stance phase, balance shall sustain for that particular period. Thirdly, swinging leg must be able to move in a sequence reaching the position where it can take over the supporting leg. Lastly, locomotor system must provided substantial power to induce limb movements and to advance the body (Whittle, 1993). Pathological gait produce abnormal walking patterns when it fails to obey any of the four requirements stated above. It can be indentified obviously by visual or using appropriate clinical gait analysis method. This abnormal gait maybe performed unintended by the subject due to the weakness, spasticity or deformity occurred onto them. Besides, sometimes the abnormal gait is also consequences of the compensatory motion by some other problem. Any abnormal gait should be corrected using an orthotics or braces in order to minimize overload harms on muscles, joints and bones. Kinematic and kinetics of human gait The terms kinematic and kinetics are branches of biomechanics, which are commonly employed in gait assessment. Kinematic describing a body movement without considering its causes for example forces and torque. Camera is a example of kinematic equipment which only used to observe limbs movement without but without providing information of force involved (Whittle, 1993). Meanwhile, kinetic is more in explaining the body motion with it causes like mass and forces exert onto the system. Moment, force, mass, and acceleration are the examples which usually utilize the kinetic of the systems. Example of kinematic equipment in gait analysis is force plate, which measure force exerted by foot but without the position and angle of the leg segment (Whittle, 1993). Kinematic of human gait: Angle Pelvis, hip, knee and ankle angle are the common kinematic parameters used in gait analysis. Each anatomical angle can be observed from sagittal, coronal and transverse plane. During normal gait, most of the motion occurred in sagittal plane meanwhile coronal and transverse plane have greater motion in pathological gait(Ounpuu, 1995). Table 1.1 is a summary on the each segment movement with respect to gait cycles phases. Table 1. Summary of the Major components of gait with respect to the phase of the gait cycle. Phase Joint Movement Ankle Knee IC Neutral Position Fully KE LR PF KF MST DF KE TST DF KE TF PF KF ISW Peak PF then DF rapidly KF rapidly to peak MSW Peak DF Start with peak KF and KE rapidly TSW PF KE PlantarFlexion(PF), DorsiFlexion(DF), Knee Flexion(KF), Knee Extension(KE), Hip Flexion(HF) and Hip Extension (HE) Kinetics of human gait: Ground reaction forces When a person is walking, forces will apply toward ground on each step taken. According to Newtons Third Law, a force will generate that is equal magnitude but in the opposite direction to the force applied by the foot, and it is called ground reaction forces. The vertical component of ground reaction forces is raise from heel strike and shot 112% of body weight during 25% of gait. At the mean time, the opposite leg propels the centre of gravity upward and thus vertical force descends to around 80% of body weight. At the instance of heel off, centre of gravity start to move downward therefore vertical forces raise again to around 115% of body weight at almost 80% of stance phase. Vertical forces descend greatly right after the peak vertical forces as the foot is propel to swing phase. Figure 1.5 shown the overview of vertical forces exert on the stance leg. Figure 1. Ground reaction forces Literature Review Types of AFO AFO is categorized into many types depending on its functionality, design approach and usages. AFOs are generally classified into five main branches: rigid AFOs, hinged AFOs, Patellar Tendon Bearing (PTB) AFOs, posterior leaf spring AFOs and ground reaction AFOs. Each AFOs functionality will be discussed in detail later. Table 2. Summary on Types of AFO and description (Edelstein Bruckner, 2001) Types of AFO Features Solid AFOSolid ankle-foot orthosis (AFO), Plastazote-lined (Photo courtesy of Hersco Orthotic Labs.) Trimmed anterior to malleoli surrounds ankle. Restrict ankle motion without allows any plantarflexion. During loading response, maintain a rigid foot and ankle alignment Hinged AFOhttp://www.appliedbiomechanics.com/Home/Home/Hinged_AFO.gif Add mechanical joint around ankle to permit motion. Degrees of motion are determined by the joint design. Allow dorsiflexion and plantar flexion without restriction. PTB AFOhttp://www.capstoneorthopedic.com/Orthoservicespages/afo/afo_clip_image018.png Cast until patella area as to transfer weight from plantar foot to patella tendon Responsible for off loading effect. Posterior Leaf Spring AFOhttp://www.neuromuscular-orthotics.com.au/images/PLS%20AFO.jpg Trimmed posterior to malleoli, allow plastic to recoil Function as a spring during swing phase off loaded, allow plantar flexion. Ankle motion is permitted by deformation and recoil of the plastic strip. Gait analysis method Reliability of the result obtained from motion analysis is mainly relay on the markers placement (Ferrari, et al., 2008; A. Leardini Benedetti, 1999). Therefore, marker positioning is depending strongly to the objective of the research or study. The inconsistency of marker placement is generally a crucial factor contribute to the data variation because each marker represent different body landmark respectively too. A full body marker set is often applying to investigate whole body posture and gait. A total of 60 markers with 22 on each leg, 5 on pelvis and 11 on trunk are consider as a complete marker set. It has been applied to evaluate treatment gait pattern correction or diseases caused pathological gait for example cerebral palsy and diabetic patient (Radtka, Skinner, Elise Johanson, 2005; Sawacha, et al., 2009). Only lower limb markers set were use more often in gait motion analysis (Abel Juhl, 1998; Fatone, Gard, Malas, 2009; Alberto Leardini, et al., 2007; Yokoyama Sashik a, 2005). There also few study make their focus on gait assessment on AFO user which only applied reflective marker on lower limb as anatomic landmarks for the whole experiment (Abel Juhl, 1998; Fatone, et al., 2009). When come across with gait analysis, researchers putting more interest on the lower limbs kinetic and kinematic parameters rather than upper limb because the locomotion trajectories occurred mainly in leg segments. In analyzing treatment effect for a particular illness or disease, control group or control variable present to serve a better comparison to the tested result. While evaluating the relation of orthosis treatment and gait assessment caused by it, subject under barefoot condition sometimes appeared as the control variable (Abel Juhl, 1998; Lam, Leong, Li, Hu, Lu, 2005; Romkes Brunner, 2002). However, in some cases, barefoot control does not provide a comparable opportunity and it is not practical as in real life subjects usually walk with foot wear. Besides, as of experimental approach, it has shown that subjects walking with footwear is more relative to evaluate AFO efficacy with contrast to barefoot ((Radtka, et al., 2005)Churchill et al., 2003; Radtka et al., 2005). Two reviewed articles obtained result with subject walking while wore footwear alone (Bleyenheuft Hanson, 2010; Fatone, et al., 2009). There is one of the article used able bodied subject with footwear alone to acqui re control variables (Fatone et al., 2009). Either way of choosing control group is proportion to the research behavior and objectives. Therefore, appropriate consideration should be taken while designing a research methodology. Gait analysis parameters In general, AFO is use as prevention of foot deformity, limit joint movement, position and provide stability. The effect of AFO in serving all these functionality is been studied via various method from simple to more sophisticated gait analysis technique. Majority of the reviewed papers adopted video-camera based system to collect and record data. (Abel Juhl, 1998; Fatone, et al., 2009; Lam, et al., 2005; Radtka, et al., 2005; Romkes Brunner, 2002; Yokoyama Sashika, 2005). Kinematic and temperal parameters are the two common results obtained from ambulation analysis. Temperal parameter Cadance Cadence, defined as number of steps taken in a given period and its unit is steps over minute. In gait analysis, cadence becomes a popular parameter to evaluate AFO efficacy. Researches which have examined subjects gait with dynamic AFO and without dynamic AFO proved that cadence is one variable altered by the manipulation on AFO (Lam, et al., 2004; Romkes et al., 2001; Bleyenheuft et al., 2007). Lam and Romkes studies have shown a decrease of cadence while subject walked with dynamic AFO compare to walk with barefoot. However, in Bleyenheuft study, changes of cadence value are less significant compare to others. In hinged AFO, two papers reported a increase on cadence compare to barefoot ( Romkes et al., 2001; Tyson et al., 1998) and one shown decrease effect (Radtka et al., 2004). Four reviewed papers tested subjects walked with solid AFO reported decrease of cadence compare to without solid AFO (Abel et al., 1998; Radtka et al., 2004; Lam et al., 2004; Bleyenheuft et al., 2007). C adence in a new design AFO which use oil damper resistance to restrict ankle movement also reported a decrease phenomenon on subjects walking gait with against barefoot trials. Dynamic AFO reported to have higher cadence compare to solid AFO in Lam, 2004 and Bleyenheuft, 2007 studies. Meanwhile, between hinged AFO and dynamic AFO, hinged types AFO having higher cadence value ( Romkes et al., 2001). By reviewing this, an instance conclusion can be making that hinged AFO provide a high cadence. Resultant cadence variation is likely due to the design of types of the AFO. Manipulate ankle movement degree certainly influence entire locomotion trajectories, consequently cadence are involved. Velocity Velocity is a resultant product of stride length time cadence. Any changes of these two variables may vary walking velocity. Solid AFO, dynamic AFO, and hinged AFO were all result higher velocities and stride length compare to the condition without AFO on tested walking trials (Abel et al., 1998; Lam et al., 2004; Radtka et al., 2004; Bleyenheuft et al., 2007; Romkes et al., 2001; Fatone et al., 2009). However, a less significant increase observed while analyzes hinged AFO and solid AFO toward barefoot condition in Fatone, 2009 and Lam, 2004 researches, respectively. From these two cases, a common observation found between them is the insignificant of stride lengths alterations. Kinematic of Gait Analysis DF at IC (Stance Phase) Currently, AFO are design to restrict exceed ankle PF, simultaneously improve pre-positioning of the foot during IC f gait cycle. However, DF ability of AFO is strictly relying on the design and trimming pattern of particular AFO (Yokoyama et al., 2005). All types of AFO being study in this section have shown reasonable increase of DF angle compare to barefoot or without AFO condition (Abel et al., 1998; Lam et al., 2004; Radtka et al., 2004; Bleyenheuft et al., 2007; Romkes et al., 2001; Fatone et al., 2009; Yokoyama et al., 2005). This outcome is consistent with the basic functionality and characteristic of AFOs. For hinged and dynamic types, both allows free ankle DF during stance and meanwhile limit PF (Romkes et al., 2001). From review, subjects wore dynamic AFO have noticeable better DF than solid AFO and barefoot (Lam et al., 2004; Bleyenheuft et al, 2007). KF during IC (Stance phase) Knee fully extends just before heel contact and this is named as stance phase flexion. Patient walked with dynamic AFO showed significant increased in KF during initial stance compare to barefoot and there was less significant compared to solid type AFO (Lam et al., 2004; Bleyenheuft et al., 2007). Nevertheless, a slightly decreased on KF during initial contact is observed too. Both dynamic and hinged AFO shown little attenuate of KF angle compare to barefoot in Romkes, 2001 studies. In Radtka, 2005 research, the abnormal KF during barefoot walking remained although subject walk with hinged and solid AFO and this is consistent with Rethlefsen, 1999 findings. PF during TST (stance Phase) At the instance stance foot leave ground and preparing for swinging, plantar foot is flex as to push off body forwarded. Hinged AFO have impressed decreasing of PF during terminal stance if compare to walked with barefoot ( Radtka et al., 2005; Romkes et al., 2001). In Romkes, 2001 study, it revealed that hinged AFO has better push off effect compare to dynamic AFO according to their flexing ability. Besides that, in Radtka 2005s study, researchers concluded hinged AFO has better rocker effect as to proceed swing phase compared to solid AFO. DF during MSW (Swing Phase) DF is necessary to prevent foot drop as to provide toe clearance for patient to have better gait performance. In all the reviewed papers, DF were all increased during MSW (Abel et al., 1998; Lam et al., 2004; Radtka et al., 2004; Bleyenheuft et al., 2007; Romkes et al., 2001; Fatone et al., 2009; Yokoyama et al., 2005). Table 2. Summary on Variables Comparison of Types of AFO (ToA) with respect to Control Group Condition (CGC) Author, Year ToA CGC Variables comparison on ToA with respect to CGC Cadence Velocity DF at IC KF at IC PF at TST Abel et al., 1998 Fixed AFO Barefoot Decrease Increase Increase Increase Blenyenheuft et al., 2007 Dynamic AFO Shoe only Not significant Increase Increase Increase prefabricated AFO Shoe only Decrease Increase Increase Decrease Fatone et al., 2009 Hinged AFO Shoe only Not significant Not significant Increase Increase Lam et al., 2004 Solid AFO Barefoot Decrease Not significant Increase Increase Decrease Dynamic AFO Barefoot Decrease Increase Increase Increase Decrease Radtka et al., 2004 Solid AFO Barefoot Decrease Increase Increase Decrease Hinged AFO Barefoot Decrease Increase Increase Not significant Decrease Romkes et al., 2001 Dynamic AFO Barefoot Decrease Increase Increase Decrease Decrease Hinged AFO Barefoot Increase Increase Increase Decrease Decrease Tyson, 1998 Hinged AFO Barefoot Increase Increase Increase Yokoyama et al., 2005 Oil damper resistance AFO Shoe only Increase Increase Increase Increase Decrease Kinetic of human gait: Ground reaction forces and Peak pressure High peak plantar pressure (PPP) on foot is significant in contributing ulceration and callus formation on diabetic patient (Caselli, 2002; Veyes, Murray, Buoulton, 1992). If PPP occurred on the same area for a repeated period it might associated with callus or skin break down on that particular area (Boulton AJ, 1993). Incidence of skin breakdown in the forefoot chance is higher compare to in rear foot (Mueller, Zou, Lott, 2005). It has been prove in few studies that metatarsal head is the most frequent areas having skin injury problem rather than at heel in diabetic patient (Caselli, 2002; Sinacore, 1996). By using rocker sole in diabetic subjects, reviewed papers shown a significant PPP reduction over the high pressure area especially over forefoot and rear foot area (Albright Woodhull-Smith, 2009; Brown Wertsch, 2004; Schaff Cavanagh, 1990). Rocker sole is designed in a way that to redistribute plantar pressure from a conventional pressure distribution to a newly designed pressure map(Brown Wertsch, 2004). Aims and Objectives Examine orthosis efficacy in walking gait is the foremost objective in this study. AFO is prescribing enable to make better alignment of foot on patient with pathological gait. A rocker bottom is claimed to serve better plantar pressure distribution and as treatment to avoid further foot deformity. Basic approach in this study is to investigate the effectiveness of rocker AFO in prevent and utilize better ambulation pattern on diabetic patient from abnormal walking mechanism. Joint mobility caused by rocker AFO believed serve a better gait pattern and harmless to the connected leg segment. Rocker effect on the AFO is tending to reduce ground reaction forces to AFO user foot. Biomechanics and engineering knowledge is applied for better description. To test this hypothesis the following key objectives were undertaken: To study and enhance better gait mechanism knowledge from engineering and medical approach. To quantify and compare joint mobility with and without rocker AFO using lower limb component motion range analysis. To observe the relationship between the rocker bottom to kinetic changing on patient gait. Methodology Introduction Method to conduct this study is structured into few stages from recruiting subjects to conclude the study objectives. In order to keep align with this study objectives, each procedure taken has to be design carefully to reduce the possibility of data confusion and the occurrence of technical errors. Mostly, methodology to investigate orthosis efficacy usually being categorized into subject acquirement, subject assessment, AFO fabrication, AFO customize process, gait analysis laboratory testing, data acquisition and data analyzing ( Fatone et al., 2009). Subject acquirement In this study, AFO with rocker bottom is fixed to be the interest orthosis to investigate for the entire process. From literature, an AFO rocker sole mostly applied for the purpose of offloading on diabetic patient, thus the targeted subject is diabetic patient who possess potential to occur ulceration at plantar foot (Zimmy et al., 2004; Albright et al., 2009). 5 patients with diabetic peripheral neuropathy are recruiting as the subjects. Subject should be free from any other physical abnormality, surgery or injury on the lower limb extremities. To be prior to their participation, informed concern was acquired from all the subjects. Equipment: AFO Fabrication Only unilateral study will be carry out which means rocker AFO will be only fabricate for either leg depends on the foot condition. Each participant will be customizing a rocker AFO which is unique with their ulceration area and foot sizes. Participants are evaluated barefoot and going through anthropometrical measurement on the affected leg by the orthotists. The AFO are custom molded by polypropylene and with a suggested 4.8 mm thick (Lam eta al., 2005). Neutral position of the AFO will be 90Â ° at foot shank ankle. Foot length of the AFO will extended distally under the toes end and trimmed along the mediolateral border of the foot. Upper part of the AFO will trimmed on posterior until about 2.5cm below fibula. Rocker sole apex has to be position according to subject pressure distribution. Usually subject affected areas are location with metatarsal and forefoot area. A consistent rocker sole design is purposed with the apex fall behind of the fifth metatarsal with an angle of 15à ‚ °. Figure 3.1 shown the rocker AFO suggested: Figure 3. Rocker AFO After rocker AFO finishing, subject request to test the fitness of the AFO. If the custom made rocker AFO raises any comfort ability issue, adjustment being done to fix it. Gait analysis laboratory testi

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Evaluation of Estella from Great Expectations. Evaluation of Estella "The lady whom I had never seen before, lifted up her eyes and looked archly at me, and then I saw that the eyes were Estella's eyes." From this passage, I believe it is safe to infer that Pip notices a great change in Estella's appearance and the way she carries herself, once she comes back from finishing school, but is there really that much of a change in the rest of her? Although she may change her methods, she's still unemotional, she still takes orders from Miss Havisham, and she still leads Pip on. Speaking of leading Pip on, Estella leads Pip on. When Pip is at Miss Havisham's for the second time, Estella acts as if she likes Pip and does something very unlike herself. "There was a bright flush upon her face... she stepped back into the passage and beckoned me. 'Come here! You may kiss me if you like! I kissed her cheek as she turned it to me. I think I would have gone through a great deal to kiss her cheek. But, I felt that the kiss was given to the coarse common boy as a piece of money might have been, and that was worth nothing." (Page 93, paragraphs 2-4) As you can see Estella is definitely leading Pip on. Estella also leads Pip on in the second half of the book. She goes with Pip to balls and other parties. She also goes down to Miss Havisham's with him, but these things have no meaning.] As I just mentioned Pip and Estella go down to Miss Havisham's together. This is because; although she is grown-up Estella is still controlled by Miss H. What I'm saying is that Miss H makes them go (well not so much Pip; he just comes along for the ride). She also controls Estella in other ways. She makes her write notes ho... ...the book, but I've got more proof from the second half. At this part Pip tries to compliment Estella and she laughs right in his face. "'I live quite pleasantly there; at least-'It appeared to me that I was losing a chance. 'At least?' repeated Estella. 'As pleasantly as I could anywhere away from you.' 'You silly boy,' said Estella, quite composedly, 'how can you talk such nonsense?'" (Page 226, paragraphs 8-11) Hey, I don't know about anyone else, but I think that was pretty mean (although it wasn't the same kind of meanness that was in the first part). That's exactly what my paper's on. I think I've just proved that Estella is the same person throughout the whole book, but the kind of person she is changes (whether she's leading Pip on, being controlled by Miss Havisham, or being her mean ol' self). If I have then my mission was successful. Evaluation of Estella from Great Expectations Essay -- Great Expectatio Evaluation of Estella from Great Expectations. Evaluation of Estella "The lady whom I had never seen before, lifted up her eyes and looked archly at me, and then I saw that the eyes were Estella's eyes." From this passage, I believe it is safe to infer that Pip notices a great change in Estella's appearance and the way she carries herself, once she comes back from finishing school, but is there really that much of a change in the rest of her? Although she may change her methods, she's still unemotional, she still takes orders from Miss Havisham, and she still leads Pip on. Speaking of leading Pip on, Estella leads Pip on. When Pip is at Miss Havisham's for the second time, Estella acts as if she likes Pip and does something very unlike herself. "There was a bright flush upon her face... she stepped back into the passage and beckoned me. 'Come here! You may kiss me if you like! I kissed her cheek as she turned it to me. I think I would have gone through a great deal to kiss her cheek. But, I felt that the kiss was given to the coarse common boy as a piece of money might have been, and that was worth nothing." (Page 93, paragraphs 2-4) As you can see Estella is definitely leading Pip on. Estella also leads Pip on in the second half of the book. She goes with Pip to balls and other parties. She also goes down to Miss Havisham's with him, but these things have no meaning.] As I just mentioned Pip and Estella go down to Miss Havisham's together. This is because; although she is grown-up Estella is still controlled by Miss H. What I'm saying is that Miss H makes them go (well not so much Pip; he just comes along for the ride). She also controls Estella in other ways. She makes her write notes ho... ...the book, but I've got more proof from the second half. At this part Pip tries to compliment Estella and she laughs right in his face. "'I live quite pleasantly there; at least-'It appeared to me that I was losing a chance. 'At least?' repeated Estella. 'As pleasantly as I could anywhere away from you.' 'You silly boy,' said Estella, quite composedly, 'how can you talk such nonsense?'" 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Recently my family bought a new home, and while it was as much money as most homes are ( we are paying $167,100 for a three bedroom one bath) it was the most expensive thing we have ever bought. Buying a new home in any economy will always be an expensive endeavor. In this current economy it is a buyers market but there are still many things a buyer and seller must consider when buying or selling a home. The strength of the economy for a buyer can affect the benefits of the home ownership because it would determine the future market value of the home. It will also determine the market price that has to be paid at the time of purchase as well as determining the interest rate of how much that needs to be repaid. The removal of the tax deductibles of the payments increases the after-tax cost, and when taxes come due on the house at the end of the year there is no added incentives for owning a home. This will lead to the decrease in buying of new homes and the drastic fall of prices for sellers. There are many other things that can affect whether a person can afford to buy a home, but government spending and taxes are the biggest incentive as to what a family can afford and what benefits they can receive when buying. With an increase to taxes there is less money to spend and save for buying a new home, and the location of the home will effect how much I need to pay in property taxes.

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Listening to children and valuing their opinion It is important for children to feel they can express their feelings and opinions, sometimes children may need help in doing this. If they feel they cant express them they may become frustrated and show unwanted behavior. This is why its important to listen to what the children want to do, the reason why they are showing unwanted behavior and ideas is because these are all ways of helping children to develop confidence. 3. Providing a challenging and stimulating environment Children and young people enjoy having fun and learning provided that the environment is a stimulating one. With this in mind we have to think about what type of equipment, resources and layout is on offer. Children may have the same toys at home so it is worth having a wide variety to choose from and rotate them to provide the children with a challenge. 4. Planning experiences well Boredom is often a key factor in unwanted behavior Children and young people will often find things to do that may not always be desirable to entertain themselves if nothing is in place to keep them busy or the ctivities that are in place are too easy or of no interest to the child. Planning experiences are linked to understanding childrens development and also the individual needs and interests of the child. 5. Giving children choices It is important to give children choices, this allows them to learn about having some responsibility. As it can be very frustrating being a child as you dont have much control over where you go and who you may see. Given children choices also means that they will be less frustrated which may prevent unwanted behaviour. The choices given need to be appropriate for the age and stage of development of the child and must also be genuine. For example saying to a child do you want to go outside if there isnt any choice. 6. Meeting the individual needs of a child For children to show positive behavior, their basic needs need to be met. These need include, food, love attention, stimulation and sufficient sleep. There is a link between childrens behaviour, language skills and their stage of development. 7. Being inclusive Each child is unique and some may need more attention then others at some point, they may need extra support or reminding more often. As every child is an individual and each child should feel valued and cared for in each practice, the heart of every practice should be inclusive. When settings show an inclusive practice children tend to show positive behaviour. 8. Acting as role models Children can pick up on adults behaviour and this is one way where they can learn positive behaviour and also unwanted behaviour such as swearing this is why any adult working with children must act as a good role model and show positive behaviour at all times such as kindness, taking turns and gentleness. 9 Setting clear boundaries for children. Each child needs boundaries. They wont know them straight away and will take a while to fully understand what is expected of them. This is why it is important for adults to set fair boundaries that are appropriate for the childs age and explain to the child why they are in place e. g we walk not run to prevent accidents. 10. Reinforcing positive behavior All children need encouragement. Praise, encouragement and rewards are great ways of showing positive behaviour. For this to be most effective, it is important that children understand why praise is given. And that the praise is given when the child has done something right like sharing. 11. Encourage children to resolve conflict When children get to a certain age they begin to play cooperatively which means by the age of about four alot of children start to resolve conflict on their own. As adults we still need to show children how to do this in a positive way. As children grow older adults need to step back and see if children can resolve conflicts on their own. It is also important to give praise when this is done, if the children are still finding it difficult, it may be useful to act as a guide rather then tell them exactly what to do. 12. Looking for reasons for inappropriate behavior If children are happy they will generally show positive behaviour unless they are tired, poorly or hungry. When children start showing unwanted behaviour it is important to figure out why they are behaving in that way. This may mean talking to parents along with observing the child closely. Event recordings can be useful when monitoring a childs behaviour as you can usually tell how long a child has been showing a certain type of behaviour and also when and why. 13. Following your behavior policy All settings that follow the EYFS should have a behavior policy in place. This policy should set out how a setting intends to manage unwanted behavior, it should also show that practitioners encourage positive behavior. 14. Following plans for individual behavior Some children may need additional support to learn positive behavior. for example if they have a learning difficulty. To support these children a plan should be drawn up and show what strategies the adult needs for certain situations. The parents should be involved in then plans so there is consistency.

ET Essay Example | Topics and Well Written Essays - 1500 words

ET - Essay Example In this scenario, the link between BA and strategy is coordinated. Here the BA function is purely reactive and there is no feedback procedure from BA to strategy. Method competencies help a business analyst to keep the tool kit in order. He or she should be able to deliver multiple information in same data and should be able to visualize the information as the user. Answer. A data warehouse provides an organization with data which is consistent, integrated and valid. It ensures the collection of data from its source. Data warehouse retains the desired key features and provides data for creating reports. Answer. A company can collect source data either by collecting primary data or secondary data. The data collected for the first time is called the primary data. A primary data when further used becomes secondary data. A secondary data is collected from already collected data.The data sources for a company can be classified as: 1.Data generating source system- A data generating source system specifies which systems which create data for the first time and which don’t. Some examples of data generating source systems are billing systems, Reminder systems, Debt collection systems, CRM systems, and Product and consumption information. 2. Source system -When a data generated for the first time is saved, it becomes the source system for data warehouse. Data in the warehouse comes from primary sources and is saved on the basis of organizations rules and requirements. Based on the data warehouse information a large number of analysis and business processes are carried. 1. Establishment of information wheel- In order to provide the right information to the right people at the right time, data is condensed into information and knowledge. This is called information wheel. An information wheel summarizes the knowledge and information. 2. Creating Synergies between Information Wheels- The BICC must maintain the information wheels. The BICC

Movie osama Essay Example | Topics and Well Written Essays - 500 words

Movie osama - Essay Example My mother and I are left with little to no options. My mother, feeling like there is no other option, has had the idea to dress me as a boy in order for me to seek employment. She has opted to call me ‘Osama’ and we both are desperately concerned that the Taliban will discover my true identity if we are not very careful. I must embark on a journey to find employment as a boy in order for my mother and I to have enough money to survive. I am only 12 and it is hard for me to understand the stringency and rules being placed on the society in which I live, especially when they create such a difficult environment for women and girls. Every moment of every day must be planned out in advance if one is female, in order to make sure that there is a male to provide accompaniment. If a woman does happen to venture out on her won, the Taliban will surely punish her. These patriarchal rules make being female not only next to impossible, but almost ike one is living under a curse. It is as though women are such lesser beings that they must cover their faces and bodies to hide every part of themselves from view. I dream of living in a place where the patriarchy of the Taliban does not dictate every move of one’s life and where women are not only free to experience sunlight on their skin, but are also able to leave their homes without a man. I long for this burden of making ends meet to be lifted from my mother as well as from me. It is so difficult to survive under circumstances where one needs to work alone but tot hen not be permitted to do so is painfully difficult. I do not like the culture in which I live and am accustomed. I want to leave this place but feel trapped as though I will be stuck here all of my days. I do not feel that thi culture offers me any type of future as a female. I watch my mother and can see how years of thi type of oppression have weighed her down and made her who she is today. I dislike