Squad Training Management

Squad Training Management PE †¢ 1. You are a member of Special Troop Battalion, 3d BCT, 10th Mountain Division. Your battalion will deploy to Iraq within six months. The battalion commander approved your unit’s METL. The METL identifies critical tasks for each platoon and now it is time for squad leaders to select tasks to train that support the platoon’s critical tasks. 2. The platoon’s critical tasks are as follows: a. Conduct unit operations. Subject Area 22: Unit Operations 071-326-5503 Issue a Warning Order 071-326-5502 Issue a Fragmentary Order 551-88N-3043 Prepare for Unit Move 71-326-3013 Conduct a Tactical Road March 551-88N-3042 Plan a Unit Move b. Guard detained prisoners of war. Subject Area 24: Enemy Personnel 4250. Supervise the Processing of Detainees at the Point of Capture 191-377-4252 Supervise the Escort of Detainees 181-105-2002 Conduct Combat Operations According to the Law of War 191-377-4254 Search a Detainee 191-377-4256 Guard Detaine es c. Treat casualties. Subject Area 2: First Aid 081-831-1058 Supervise Casualty Treatment and Evacuation 081-831-1001 Evaluate a Casualty 081-831-1007 Perform First Aid for Burns 81-831-1011 Establish a Saline Lock 081-831-1046 Transport a Casualty d. Perform in a Chemical, Biological, Radiological, and Nuclear (CBRN) environment. Subject Area 3: Chemical, Biological, Radiological and Nuclear 031-503-1023 Protect Yourself from Chemical, Biological, and Nuclear (CBRN) Injury/Contamination when Changing Mission-Oriented Protective Posture (MOPP) Gear 031-503-1015 Protect yourself from CBRN injury or contamination with MOPP gear 031-503-1018 React to Nuclear hazard/attack 031-503-1024 Replace your canister on your M-40 series protective mask e.Implement combat survival techniques in area of operation. Subject Area 4: Survive (Combat Techniques) 071-410-0012 Conduct Occupation of an Assembly Area 071-000-0006 React to man-to-man combat 071-326-0501 Move as a member of a fire team 071- 410-0002 React to direct fire while mounted 071-326-3002 React to indirect fire while mounted 3. Use the class reference material to select the appropriate tasks for your squad to train that support the platoon’s critical tasks. Record your answers (title and task number) in the comment box. The references for this training can be found in STP 21-24-SMCT

Xcom/285 Business Writing Portfolio

Business Writing Portfolio Mea Greenidge September 26, 2010 XCOM/285 Essentials of Managerial Communication Axia College The writing skills and techniques learned in my Essentials of Managerial Communication class can and will benefit me in my future classes as well as in my career in many ways. A few of the skills learned are including, but not limited to the appropriate ways of communicating depending on the audience, e-mail and business letter writing etiquette and also the importance of unbiased speaking in the workplace.It is important to have been taught these skills as I now know that there are many changes that need to be made to my future business plan and even in my current work day. I can use the skills that I was taught to give efficient business lectures and presentations. The class also taught me the importance of appropriate introductions and closing. Within this lesson I learned that every presentation should be altered based on the type of audience to whom it will be presented to as a presenter can easily lose his or her audience if the presentation is not created specifically for that audience.Another lesson in the Essentials of Managerial Communication class discussed the proper ways to begin business writing. It is important to have business writing mapped out and clearly thought out before one even begins writing. A writing map or outline can be used as a guide for a writer so that he or she may effectively include all the necessary information needed within the writing.In my future endeavors as a wife, mother, daughter, student, employee and future business woman, I will take the skills learned from this communications class and apply them in any way possible as these skills are skills that will only push me further down the road to success within my business. [pic] NOTICE OF CHANGE IN BUSINESS HOURS Effective SEPTEMBER 1, 2010 In an effort to preserve fuel and energy and due to the slowing economy, Effective September 1, 2010, Dress for A ll will be changing its store hours to Monday-Saturday opening at 10am and closing at 9pm. MemorandumTo:ALL COMPANY EMPLOYEES CC:ALL MANAGERS From:PUBLIC RELATIONS MANAGER Date:9/26/2010 Re:NOTICE OF CHANGE OF BUSINESS HOURS Effective September 1, 2010, Dress for All will be changing its store hours to Monday-Saturday opening at 10am and closing at 9pm. As a result of this change all employee work hours will be changing as well. In the coming weeks full time employees’ work schedule will be converted to a four day work week/ ten hour work day. For all part time employees, schedules will be converted to a 1, 2, or 3 day work week depending on the average number of hours worked.There will NOT be a change in compensation at this time. Thank you all for your continued hark work and cooperation regarding this matter. If you have any questions or concerns, feel free to contact your immediate supervisor. Regards, Mea Greenidge Public Relations Manager Confidential E-MAIL To: STORE M ANAGERS CC:OWNERS From:PUBLIC RELATIONS MANAGER Date:9/26/2010 Re:NOTICE OF CHANGE IN BUSINESS HOURS Managers, As you all may be aware the cost of gas has been rising immensely and in an effort to lower operations cost, Dress For All will be changing its store hours.The new store hours will be Monday-Saturday opening at 10am and closing at 9pm. As a result of the change in the business hours, there will also be a change in employee work hours. In the coming weeks full time employees work schedule will be converted to a four day work week/ ten hour work day. For all part time employees, schedule will be converted to a 1,2, or 3 day work week depending on the average number of hours worked. The change may be difficult to adjust to for some of the employees, so it will be your jobs as managers to assist and work with them as much as possible during the transition.The employees will be notified of the change within the next week and will be directed to their immediate supervisors with a ny questions or concerns that they may have. If you have any questions or concerns, please contact me at any time. Regards, Mea Greenidge Public Relations Manager Many companies have implemented the benefit of tuition reimbursement. Tuition reimbursement benefits both the employer and the employee. Our company has approved a budget plan for the expansion of tuition reimbursement for those employees seeking a bachelor’s degree in business and communication.In most cases, companies begin determining whether or not to implement tuition assistance and/or tuition reimbursement during the developmental stages of the company’s benefit package. Other companies wait for the success of the company to begin rolling, and then decide to provide additional benefits for its employees. Offering tuition assistance to employees seeking a bachelor’s degree in business and communication, will qualify employees for new internal professional opportunities. Having employees with bache lor’s degree in business and communications will also benefit the company both financially and socially.Business Communications degree programs teach students important skills they'll need to work in the communications-dependent world of business. Students come out of Business Communications programs ready to write, speak in public, schmooze with clients and do everything else it takes to work as communications managers, public relations specialists, technical writers and more. â€Å"People who complete a business communication program are qualified for a wide range of careers and work in a multitude of industries; a wide variety of industries require the skills and expertise gained in business communication degree program.People working in this field are responsible for constructing, disseminating and evaluating different types of communications, including press releases, e-mails, television commercials, print ads, business reports, conferences and websites. † (Babcoc k, 2009) Companies with internal business and communication degree recipients are able to complete tasks internally and for a fraction of the normal cost, which another company would have to seek an external company to perform the job. This will prove its self tremendously in the marketing department.Many companies are at times forced to seek additional resources when trying to market their company and/or products. Implementing the addition of tuition reimbursement to our employee benefits, will lessor the number of times we have to call outside sources, and provide us with more internal resources for marketing and public relations. According to the University of Phoenix, â€Å"The Bachelor of Science in Business with a concentration in Communications promotes the knowledge and skills needed for effective communication within the business environment. Giving employees the option to higher their education to completing their bachelor’s degree in business and communication not only builds additional rapport between the employee and employer, but it also gives the employer the opportunity to create new positions based on the capabilities of the current employees. In addition to the perks, rewards and benefits received from the current position, having a bachelor’s degree in business and communication will boost ones earnings potential tremendously, which will ultimately boost the earning potential of the company in which they are employed. The monetary value of a college degree is hard to dispute. According to the U. S. Census Bureau, adults aged 18 and older holding a bachelor's degree earned an average of $51,544 in 2004, compared with an average of $28,645 earned by those with a high school diploma–or about 73% more. Multiplied over the course of a lifetime, that could translate into a difference in income of hundreds of thousands of dollars. † (Value of a College Degree) Take public relations specialist for example, â€Å"Median a nnual earnings for public relations specialists were $43,830 in 2004.Communications professionals involved in advertising and related services had salaries of $50,450 in the same year. † Therefore, the earning potential of individuals seeking a bachelor’s degree in business and communications will increase immensely following the completion of the program. Not only will the employees who take advantage of the newly implemented benefit of tuition reimbursement see an increase in their earning potential, they will also see an increase of different positions within a business that they now qualify for.The of the different careers people with a bachelor’s degree in business and communications include but are not limited to, a Public Relations Specialists, Technical Writers, and Communications Managers. â€Å"Graduates of Business Communications bachelor's degree programs generally have better employment opportunities than students who graduate from associate program s. † (Education-Portal) Competition within the field of business communications is particularly high at the entry-level, and the number of qualified applicants usually exceeds the number of job openings available.Employments for a business communication degree regiments is expected to grow faster than average to 2014, as the demand for professional and it's skilled candidates grows with the competitive business industry. As previously stated, having internal employees with the capabilities of the above mentioned job titles will benefit the company in multiple ways including being able to complete different task without being required to hire an outside company or individual. In most cases, businesses are able to tilize individuals with a degree in Business and Communications, to Draft press releases, contact people in the media, prepare speeches, conduct presentations, make film presentations, slideshows, and compile media kits. Putting together reports, articles, and news sto ries are also among the many things that can be done. When our company expands or employee benefits, adding tuition reimbursement for those seeking a Bachelor’s Degree in Business and Communications will ultimately only provide positive benefits for our company and its employees.With the skills and training learned in the Business and Communications program, our employees will be able to boost our marketing and public relations department as well as our technical support and information systems department. In addition, with the conflict management and strong writing skills learned employees will also be able to assist in the employee relations department if needed. Adding tuition reimbursement for those seeking a Bachelor’s degree in business and communications will ultimately be another step forward in our company’s journey to success. References Babcock, Pamela. 2009. Always More to Learn. † HRMagazine 54, no. 9: 51. MasterFILE Premier, EBSCOhost (access ed September 14, 2010). Education-Portal. com  © copyright 2003-2010 Education-Portal. com. All other trademarks and Copyrights are the property of their respective owners. All rights reserved. â€Å"Tuition Reimbursement and More. † Connection: The Journal of the New England Board of Higher Education 19, no. 1 (Summer2004 2004): 21. Professional Development Collection, EBSCOhost (accessed September 14, 2010). â€Å"Value of a College Degree. † Facts On File: Issues & Controversies, EBSCOhost (accessed September 26, 2010).

Duccio Madonna and Child

This is the first time I do the museum paper, that’s made me have a lot of mixing feeling, wondering, excited, curious†¦ Then, I went to the internet to make some research in art works at Metropolitan Museum. Actually, I’m interested in painting for one reason is I love drawing. I made about eleven oil paintings in my whole life. My life inspired me to put my emotion into the painting, sometime it was sad, sometime it was exciting.The value of all the painting is not just only about the drawing skill, but also the deep meaning idea the artist want to put inside the painting and the personality the artist want to present in this painting. I tried to figure out what is the best painting to write about. One Europe painting was be amazed me is the â€Å"Madonna and Child†, by Duccio di Buoninsegna, acquired by the Metropolitan Museum of Art for $45 million, the most expensive purchase ever by the museum. I saw it online and I was so curious and wondering why thi s painting cost so expensive.Then I decided to go to the museum to expand my knowledge about this painting for real. In 1963, when the â€Å"Mona Lisa† came to the Met for a month, more than a million people stood in long lines; but when I went to look at the Duccio, I was the only person in the room. To be sure, 13 and 14 century Italian paintings lack the popular of works by Leonardo or van Gogh, but I think more people will be curious about something that cost so much more what the Met had spent on any previous acquisition. To see this painting for real was so amazing!It’s beautiful, the colors were so unique, shinning and I keep wondering how it can be maintained till nowadays. I came home and felt so hunger to research about this painting. That painting made me surprised every seconds. The â€Å"Madonna and child† by Duccio was purchased in 2004, made in tempura and gold on wood painting was made from 1295-1300. Remarkably, it has the original frame with a technique which would later become popular in Renaissance paintings. The little picture which it just measures eleven inches high by just over eight inches wide has not attracted people that would make it difficult to see.But for real, the painting has a powerful existence with the meaning deep inside. The Virgin holds the Christ child in her left arm and looks beyond him with sad tenderness, while Jesus touching His mother’s veil, and the Virgin’s distant expression. Why Mary was so sad? Perhaps, the sadness in knowing that her only beget son will someday die for the sins of mankind. The subject about biblical was painted by Duccio in a very unique manner for his time. The artist rejected the flat expression of earthly and heavenly beings that was the style of Byzantine art.We are at the beginning of what we think of as Western art; elements of the Byzantine style still linger—in the gold background, the Virgin’s boneless and elongated fingers, and the c hild’s unchildlike features – but the colors of their clothing are so miraculously maintained, and the sense of human intercommunication is so convincing, that the two figures seem to exist in a real space, and in real time. However, The rigid line of Mary's shoulder and her long nose out of Byzantine art. It testifies to a Jesus as a human child, capable of fancy, rebellion, and love.It also testifies to a prematurely independent Jesus, able to sit up straight and to offer a regal blessing. Gold testifies further to the icon's value, its function, and its subject matter. Imagine, in fact, the gold represent to a god. Right away, the work signals at its closeness to the viewer, but also its larger-than-life subject. In this way, it brings the divine into the lives of its beholders. Duccio di Buoninsegna was born in Siena, Tuscany in about 1256. He was one of the most influential artists of his time along with that other great master from Tuscany, Cimabue.He spent almos t his entire working life in Siena. Despite not having a great deal of information about his personal life, we do know that he fathered at least seven children and that he died in 1318 or 1319. Duccio achieves the same end in a different way: he creates not just an image, but also an object. Over time, images became more and more powerful. Artists used the illusion of real life to break through walls. The more real art became, the more it became larger than life. It took Modernism's rediscovery of the art object to return painting to earth. Duccio anticipated the puzzle of the imaginary.That aim helps account for his impulse toward the decorative. It drives the unexpected delicacy of his image. He has a softer, more personal range of color than one expects from a conservative icon, as in the robe on the infant Jesus. Duccio's combination of the familiar, the divine, and the decorative extends to the image, too. When is the painting not just only the painting but also the signature o f something else. The â€Å"Madonna and child† was the last known Duccio still in private hands inspired me so much. But I keep asking myself why just only the lack of people know about the real value of this painting?

Controversy Analysis Essay---- internet virtual life against the real Essay

Controversy Analysis ---- internet virtual life against the real - Essay Example The controversy on whether the internet impact is exactly positive or negative in family lives is still on debate, and no clear answer has come up yet. This paper will analyze the various viewpoints and positions held about families’ real life and internet virtues. Introduction Technology emerged weirdly back in 1884, in Washington, when telegrams were produced to assist in sending messages from one location to the other (Giovanni 3). Later on, in 1969 in California Los Angeles, the first attempt to send messages through the computer was invented when a professor and one of his students set up a phone line connection between two computers. One computer was located at the University of California Los Angeles, and the other one at Stanford Research Institute. These two individuals were experimenting whether a computer could send a message from one computer to the other. Their intention was to send a command line with the word ‘login’, but the computer managed to sen d the command ‘lo’ and crashed immediately. That is how ‘Hallo’ became communication trend to date. After the incident, another experimental computer network cropped up approximately in 1970, with an intention to connect four American University Research centers. From then on, more experiments arose, and the systems evolved gradually to what is today’s internet (Giovanni 5). Currently, the internet is being is the most favorite trend of communicating used by billions of people worldwide, for different activities. Analysis Information and communication technologies (ICT) are tremendously contributing to economic growth, relieving workloads in work places, simplifying education and improving people’s daily leisure. Originally, this ICT as a sector was marked by criticism and unending debates of how and when it should be used. This was as a result of the negative effects that was attributed to ICT especially tot eh growing generation. For instanc e, children in the most developed countries in the world spend most of their time working and playing with computers of different forms. In the UK for instance, most homes have access to computers and the rate is rapidly growing (Voogt & Gerald 358). Statistics show that approximately eight million households had access to computers by the end of 2000. However, such statistics seem to cultivate much on technology accessibility rather than the influence that these devices bring about. This is because understanding technology is not how many people has access to it, or how much people uses the internet but the controversial factors that emerges after using the internet. To begin with, it is essential to bring back the pictures of the family lives before the internet took the center stage. Most families in the past strictly followed the rule of traditional virtues where family bonding was the most crucial factor to consider. For instance, such families’ weekends were exceptional because families spent their time together at home or went outdoors together. Meals were shared together, and most of the time would be spent together watching TV or doing outdoor activities like shopping. Things have changed in the present days. Families no longer share light moments together. In essence, the internet has become the best companion for many people thus family bondage has been weakened. In contrary, today’

Desserts Research Paper Example | Topics and Well Written Essays - 2500 words

Desserts - Research Paper Example This is a statling statisctics given that many of us may never have come across deserts in our life time. Yet one fifth of the earth is such a huge chunk of earth. This therefore makes deserts even more intersting to study. A desert can be defined as an area of land which is very dry because it receives very little amounts of rainfall and other forms of precipitation such as mist, snow and fog. The National Geographic estimates that any place receiving less than 10 inches of rain (approximately 25 centimeters) annually is considered to be a desert. These are very low amounts of rainfall and there is no guessing that life can be harsh in such a place. Yet as we will see later, deserts are rich in plant and animal life. Another characteristic of deserts is that they experience very high levels of evaporation from the earth’s surface and transpiration from plants. This is because of the very high levels of temperatures found in these places, mostly due to direct sunlight hitting the ground. The reason for this is that due to low levels of precipitation, there is very little clouds to reflect back the sun rays, therefore much of the sun rays actually reach the earth’s surface. The temperature levels are so high that the National Geographic estimates that in North Africa’s Sahara desert, temperatures reaches 50 degrees Celsius during the day. It is important to note that not all deserts of the world experiences very high temperatures. Indeed, we have cold deserts of the world. In these deserts, very low temperatures hinder most of the life forms and therefore the ground is largely bare and barren, just like in other deserts. Examples of cold deserts of the world are the Gobi desert in Asia and the desert found in the continent of Antarctica. From the above description, it is possible to understand why deserts are vast areas with low vegetation cover and bare soil. Principally, conditions are so harsh that normal life is almost impossible. To thrive

Behavior in Higher Mammals Essay Example | Topics and Well Written Essays - 2500 words

Behavior in Higher Mammals - Essay Example They achieved a balance between molecular work, on the one hand, and anatomical and paleontological2 work on the other hand making them the higher amongst the all mammals found. Scientists say placental mammals are the most prominent mammals in the world today. Realizing the biggest category of the mammals we need to understand the ways in which we could observe them. Various precautions have to be taken before beginning with this activity. Some the things that have to be studied are It would be easy to observe domestic mammals in the beginning if you are not equipped with complete biological exploring4 kit. If you have a large team and resources you can go out and observe them in open settings else placental mammals can be started with to begin the study. Some of the placental mammals include rats, squirrels, rabbits, elephants, horses, lions, tigers, pandas, pigs, sheep, dolphins, whales, as well as humans and other primates. So we can begin our study by choosing the mammals we can have control over like rats, squirrel, pig, sheep, dolphins because they might be too friendly about your observation activity. So being precautious friendly mammal has to be chosen before you become expert with the technique of observing mammals. (According to Frost, PWS and the Gulf of Alaska (GOA)) Some o... Various precautions have to be taken before beginning with this activity. Some the things that have to be studied are We need to study the eating habits of the mammal. Realization of its food chain and biome3 is most necessary. Categorization into domestic and free mammal has to be realized. If one chooses to observe a mammal in a natural and semi natural surroundings one has to get knowledge about their foot marks their smell and things which attract them. Gulati Peeyush 2007 Keen observations have to be made depending upon the environment we have chosen to make observations. It would be easy to observe domestic mammals in the beginning if you are not equipped with complete biological exploring4 kit. If you have a large team and resources you can go out and observe them in open settings else placental mammals can be started with to begin the study. Some of the placental mammals include rats, squirrels, rabbits, elephants, horses, lions, tigers, pandas, pigs, sheep, dolphins, whales, as well as humans and other primates. So we can begin our study by choosing the mammals we can have control over like rats, squirrel, pig, sheep, dolphins because they might be too friendly about your observation activity. So being precautious friendly mammal has to be chosen before you become expert with the technique of observing mammals. (According to Frost, PWS and the Gulf of Alaska (GOA)) Some of the richest marine mammal fauna in the world: 21 species are currently known to live in these waters, of these 21, four species - the harbor seal, the killer whale, the sea otter, and the stellar sea lion - would likely be the easiest and most useful to monitor. So if you are technologically

Financial Management (Currency Risk Management) Essay

Financial Management (Currency Risk Management) - Essay Example Suppose a U.S tourist flies from New York to London then to Paris then to Munich and finally back to New York. When he arrived at London’s Heathrow Airport, he goes to the bank to check the foreign currency listing. The rate he observed for US dollar is $1; this means that $1 will cost him â‚ ¬ 0.6814. Assume that he changed $2000 for â‚ ¬1362.8 and enjoys a week vacation in London, spending â‚ ¬500 while there are saving â‚ ¬862.8. At the end of the week, he travelled to Dover to catch the Hovercraft to Calais on the coast of France and realizes that he needs to exchange his â‚ ¬862.8 remaining Euro for Swiss francs. However what he sees on the board is the direct quotation between Euro and dollar and indirect quotation between franc and dollars. The exchange rate between any two currencies is called the cross rate. Cross rates are actually calculated on the basis of various currencies relative to the USD$. For example the cross rate between Euro and French fra nc is computed as follows:Therefore for every Euro he would receive 0.009923 Swiss franc and arrives at Czech Koruna, he again needs to determines a cross rate. This time between Swiss franc and Czech Koruna to find the cross rate he must divide the two dollar basis rate.First, we assume that our traveller had to calculate the entire cross rates. For retail transactions it is customary to display the cross rate directly instead of a series of dollar rate. Second, we assume that exchange rate remain constant over time. Actually exchange rates vary every day, often dramatically.

German Photomontage in 1920s and 1930s Essay Example | Topics and Well Written Essays - 2500 words

German Photomontage in 1920s and 1930s - Essay Example Hoch was raised in a conventional, middle-class, small-town family. She moved to Berlin during World War I to study art and work for a women's magazine. It was during these years that she became a member f Berlin Dada. She showed her works regularly with the Dada group but did not establish an international reputation as an artist until after the Dada movement had fallen apart. Cut With The Kitchen Knife includes more than 150 illustrations f works Hoch created during 1918-1933, the Weimar years. Hoch assembled her montages by selecting photographs f women from illustrated print sources and juxtaposing them with fragments f scenes from Weimar and German colonial society. Readers will be intrigued by the surprising even shocking compositions which combine the pleasure f viewing mass media images with critical, even destructive feelings about the subject matter. Maud Lavin offers both interpretation and critical analysis f these montages. (Freud 1955, 145-72) Unless you're very knowledgeable, German art in the twentieth century has been done by men, and German women in the twentieth century have been reduced to the equation Woman=Nature, to child-like whores or to old whores, or the scary, brittle, maneating New German Woman. Masks. What a delight to discover the work f Hannah Hoch (1889-1978). The Walker Art Center has mounted an exhibition f her photomontages which will travel from there to the Museum f Modern Art and to the Los Angeles County Museum f Art. The Photo-montages f Hannah Hoch is the catalogue for the exhibition. "Photomontage" (associated with the German word montieren, to assemble or to fit,) was used by the Berlin Dadaists to describe their piecing together f photographic and typographic sources, usually cut from the printed mass media. The Dadaists enjoyed the mechanica--and proletarian--connotations f the term and used it to distinguish their work from Cubist collage. Although Hannah Hoch worked in other media--useful black and white reproductions f her drawings and oil paintings accompany the text--all her work contained the elements she perfected in the photomontages she made for nearly sixty years. (Burgin 1982, 177-216) The obligatory scholarly essays describing Hoch's life and work are inoffensive and useful But the colour plates are glorious. One hundred and nine reproductions are accompanied by a brief bit f text commenting on a play f words in the tide f a work or providing an historical detail or biographical sketch f a ballerina or industrialist or describing how the original mass media sources were manipulated by the artist. This detail, small colour reproductions f the original sources, conveys the creativity f the curators f this catalogue. Showing how a reproduction f drapery from an advertisement was cut, fumed on its side, and conjoled into becoming waves on the surface f water is magic. Somehow words, the right words, said about a work f art make the work f art visible. Magic. The Photomontages, naturally, conveys the same old sad story f the boys refusing to acknowledge that a girl had played in

Social Contract Theory of John Locke Essay Example | Topics and Well Written Essays - 750 words

Social Contract Theory of John Locke - Essay Example It works in a way so that no one can deny that a rule is unjust because the rules are made when all members of the society agree to them. John Locke, one of the greatest eighteenth century theorists, also put forward the idea of natural rights and property, which formed the basis for his social contract theory. However, this is opposed to the central idea of egalitarianism – all people have an equal right and claim on the resources of the society. The social contract theory negates this concept and relies solely on individual rights rather than communal rights. Also, some perceive this negatively and argue that Locke’s studies tend to be more conservative in nature compared to other theorists of the social contract theory and included only the males and the educated and propertied class of the society (Cohen, 1986). Pollock (2006) explains that the Lockean ‘contract’ is one where individuals give up the freedom to aggress against others in return for their own safety. The government or any law-enforcing authority rests upon the principles of quid pro quo which means that we give the government the power to protect us, in full recognition of the fact that this power may be used against us. However, this ‘contract’ with the government comes with a set of principles. Locke rejects the notion of an unconditional duty of obedience: ‘For him the legitimacy of political authority depends upon the end for which it was instituted, namely, the preservation of the natural rights to life, liberty, and estate. If these rights are infringed, the trust between the community and the magistrate (government) is canceled, and the people have a right to appeal to heaven (revolution) to establish a new legislative body.’ (Gray, 1999). Therefore, Lockean version of the social c ontract theory allows the members of the society to initiate a revolution if the social contract’s

As I Lay Dying (book) Essay Example for Free

As I Lay Dying (book) Essay The character Addie Bundren is portrayed in many ways throughout the novel As I Lay Dying. The whole story revolves around the fact that Addie is dead and her wish to be buried near her blood relatives rather than her own family. The impression the reader gets of Addie is developed through many different characters’ views and descriptions of Addie. One character that helps us understand Addie’s personality a little more is Cora Tull. Cora Tull, Vernon Tull’s wife, expresses Addie’s voice and personality through her memories of Addie. Cora stood with Addie during her final hours. Cora disapproves of Addie’s behavior and lack of religion. Cora dislikes the fact that Addie’s love for Jewel is greater than her love of God. Another character that helps us understand Addie is Minister Whitfield. Addie had an affair with the minister and had a baby. This affair shows how Addie sees marital love and motherhood as empty concepts and are just there to fill empty voids. Addie doesn’t have an affair with the minister solely on lust, but she does it for self-gratification and self-expression also. Vardaman, the youngest of the Bundren children, compares his mother’s death to a fish he recently caught and cleaned. Vardaman compares his mother to a fish because the fish and his mother have both died. The fish and his mother have changed because of death. Both Addie and the fish no longer have essence, which could be interpreted as an existentialist view. In a chapter where Addie seemingly speaks from the dead, Addie’s personality is truly shown. We learn that Addie is a pessimistic and unfulfilled woman, who marries her ignorant husband Anse. She admits to only caring for two of her children and the rest she calls or labels as â€Å"Anse’s children†, who were born out of an obligation. Addie’s personality is put together by the views, comparisons, and descriptions of her youngest son Vardaman, her neighbor Cora Tull, The affair she had with Minister Whitfield, and her own personal voice. Through these views, we could conclude/interpret that Addie was a strong-willed and intelligent woman who dislikes the obligations put on women during that time period. Cora Tull shows her as some who lacks religion. The affair with the minister shows that she is a woman who needed gratification. Her youngest son shows how she is a mother who was completely lost in death and no longer has essence. Her own voice shows that she is a person who feels like women are obligated to fit into the roles of being a mother and a wife.

Its The Beauty Pageants Media Essay

Its The Beauty Pageants Media Essay By definition, the beauty pageant is a competition in which young women are judged by physical appearance alone. As the old saying goes, beauty is in the eye of the beholder. Beauty, as determined by a panel of judges (the beholders), means that someone who is considered attractive to one person may not necessarily appeal to another, and it allows judges to set the standard of what is beautiful or not. If this was a perfect world, maybe everyone would follow the wise words of this old saying and admit that evaluating beauty is only a matter of personal taste and contemporary standards and trends. However, society often turns every aspect of a persons life into a competition. The beauty pageant is perhaps one competition society could do without. Beauty pageants are an unnecessary entertainment of society because they set unrealistic beauty standards for an audience of easily influenced young women, they encourage judging a persons worth based on appearance only, rather than on a persons character, and they objectify young women. In the world of beauty pageants, there is only one kind of beauty. This one kind of beauty is Barbie: tall, long-legged, tiny waist, straight white teeth, long thick hair. These beauty pageants can be misleading and harmful, not only to women without this body type, but to society as a whole. The standard that beauty pageants strive for is not an all-encompassing idea of beauty, but one that is shallow and looks only at a womans physical appearance. Beauty pageant organizers have striven for years to ensure that contestants have an opportunity to show their skills before they are crowned a beauty queen, but the reality is that a woman not fitting the physical standards of beauty competition would nev er be considered to enter a competition. Beauty pageants promote the idea that looks are superior to a persons abilities, feelings and heart. These young women are judged only on the basis of physical appearance. The talent component of competition just does not have much weight simply because an ugly person (a person who does not have a body fitting with the accepted standards of the time) could never win a competition, and often would not compete at all. Judging young women primarily on their looks takes important character developments out of focus because other qualities, such as intelligence, are not seen as part of ideal femininity and therefore not as things to which women should aspire. Miss USA 2002 went to a tall, blonde Texas woman who won the crowd when she stated that education was important and that you can tell if someone has an education by looking at them (Cornforth, 1). Perhaps her intent was to promote the value of education, but the statement instead implied that important character traits and intelligence can be summed up by a glance. (Dont judge a book by its cover, to use another familiar saying.) Young women are judged mainly on their physical appearance, while their personal qualities and talents are not judged. Beauty pageants include quizzes in which the contestants show their intelligence by answering questions that are really just demonstrations of adhering to the social norms of the time. These questions are always very simple, broad questions involving current issues such as health care, gay marriage, and abortion. The contestants are discouraged from answering in a way that demonstrates their own personal opinions; if a girl is on a stage being evaluated by a panel of liberal judges in front of a liberal audience, she would never speak against gay marriage or abortion, but would give the answer that would most likely please the crowd. In this way, she is only learning to give the popular answer and not analyze what her own beliefs are, and then learn to defend those beliefs. Beauty pageants are misleading to young women. Very few women are born with a body that fits the current standard of beauty. A majority of young women dont have a body which adheres to the current social standard of the time. These young women tend to be viewed as plain but they can clean up and look beautiful but they cannot stand the pressure. After watching beauty pageants, plain young women often lower their self esteem (these young women dont do this on purpose) and some young women then try to make themselves look more attractive. Besides, for beauty pageants winners, their success often gives them the need to do after ward is to keep up and improve their physical beauty (physical body), and as a result many no longer live up to further education or other ways of professional development. Beauty pageants strongly promote the negative aspect that young women are seen as objects of sexual interest. These contests fail to challenge harmful political attitudes to young women. They do nothing to aid the liberation of young women. By promoting looks as the most important feminine quality, they harm young womens liberation in general. On the 17th of February the Campus National Organization for Women protested the Miss MAO Beauty Pageant (Gats, 1). They handed out four-hundred protest flyers which stated their disgust with Florida Blue Key and the University of Florida for holding a sexist pageant where women must be checked out in swimsuits and parade themselves in skin-tight evening gowns in order to be awarded scholarship money. (Gats, 1) In this way, beauty pageants encourage young women to see and promote themselves as an object (like a car) to be judged by men. Beauty pageants hurt young women by treating them as objects held up to a strict standard of beauty, a standa rd that is painful, time consuming, and expensive for young women to try to achieve. Beauty pageants can be misleading by having young women lower their personal standards of sexuality. At what age is it appropriate for a young woman to be called sexy? Young women have a huge role model role in a little girl. Little girls look up to these young women because they are beautiful, if these young women are wearing immodest clothes to be sexy, then these little girls will want to do the same. These little girls should not be worried about trying to be sexy, they should enjoy a healthy childhood as girls who are developing talents and interests and whose worth is evaluated by their poise, intelligence, hard work, kindness, and grace. Beauty pageants are well promoted by the media with television and images, which influence young womens opinions on appearance. The participants of these pageants are poor role models for these young women as they set a standard for an almost unhealthy body weight, unrealistic breast size, and flawless complexion standards. Only a small minority of women can realistically achieve this ideal female body. The media pressures all young women to conform which can encourage unhealthy dieting and eating disorders, tanning, cosmetic surgery, and simply to keep working to achieve unrealistic, temporary goals that often have irreversible damages. An article, titled Thoughts about Miss Teen USA, out of a local American magazine was written by a young women teen in 2005, who had just watched Miss Teen on NBC. Her wrap up of the beauty pageant was; White teeth. White teeth. Prom-style dress. Blonde. White teeth. Blonde. Chandelier earrings. Tan. Blonde. Tan. Strapless gown. followed by, Thats al l you need to know (Callow, 1). The statement made by this young women teen is not one that is from a minority. She is one of thousands that view this as the norm for a woman of beauty. It is not healthy or realistic for a young woman to think there is one type of beauty or one type of accepted body. It is harmful and could lead to both physical and emotional damage. The media has so many affects of young women; they wish to be as perfect as the beauty queen on television, magazines, and internet. These young women will do anything it takes to become the next beauty queen, even it causes them to go on diets or get plastic surgery. In a high percentage of Hollywood films, even those in which the young woman should be portrayed as a strong willed, independent heroine, usually feature young women being played off as sex objects. Though there is nothing wrong with a woman being classified as sexy, it should not be the main focus. One made of uniqueness, intelligence and charm is what should be promoted. Movies such as Lara Croft: Tomb Raider and Charlies Angels send the same message to young woman that beauty pageants do, which is that only one kind of body is acceptable. This is harmful to a majority of young women as beauty pageants are encouraging men to treat them as an object rather than young women with opinions and uniqueness. Joel Yager, M.D. writes: Every society has a way of torturing its women, whether by binding their feet or by sticking them into whalebone corsets. What contemporary American culture has come up with is designer jeans. (94). With media pressuring young women to be thin and a millions of dollars spent towards dieting, higher rates of eating disorders in the population are growing (Gats, 2). Many beauty pageant contestants suffer from some form of eating disorder. Anorexia (starvation to loose weight) and bulimia (binge eating) are the two main eating disorders. Young women who suffer from anorexia have the fear of being fat so severe that they starve themselves to weight loss, often leading to death (Gats, 2). Even when anorexic young women are thin, they think of themselves too fat. A low self esteem causes them to fear even taking a small amount of food. Bulimia is binge eating that following a pattern such as, eating compulsively and then throwing it up. After a binge young women eats, they try to control themselves by throwing up their food through vomiting. Young women have extreme habits of both eating and exercising. Ideally, beauty pageants should be healthy role models, but this is not the case. To be beautiful in the world means that a young woman never feels decent about herself, she is always putting herself down. If a woman does not see her body as acceptable, she will often be driven to change it, and these changes are often drastic. Plastic surgery can be used to alter any body part: the breasts, lips, thighs, and stomach are among the most popular. Plastic surgery can be especially harmful to adolescents. When a young women have plastic surgery done at such a early age, the risk for diseases such as breast cancer are extremely high. Many young women are striving to look their best, and they feel that plastic surgery is the only way to go. They do not stop to think about the long-term consequences of the surgery. They want instant results, meaning that they will often pay thousands of dollars to alter bodies that had nothing wrong them in the first place. The promotion of this single standard of physical beauty is harmful to women everywhere because it discourages girls to love the body they are born with. The simple and realistic truth is that there are some physical aspects of a persons body that are impossible to change, and promoting the tall, slim, supermodel figure as being the only accepted body type excludes different styles. Every year more than one million people are diagnosed with skin cancer in the United States. Despite this fact, hundreds of thousands of people routinely visit tanning salons (Cornforth, 1). Tanning beds generally give off 93% to 99% UVA radiation (Cornforth, 1). This is three times the UVA radiation given off by the sun! Over time, the effects of too much UVA exposure can lead to many different problems such as eye damage, immune system changes, wrinkles and premature aging of the skin, and skin cancers. The most common cancer is malignant melanoma, it is the deadliest form and its degree is flat out rising in young women under 40 (Cornforth, 1). Beauty pageants are an unnecessary element in society because they set unrealistic beauty standards for an audience. There are beauty pageants out there which attempt to create a judgment of well-balanced young women. These sorts of competitions are trying to promote the intelligence mixed with beauty side, which should be heavily commended. However, beauty pageants in which beauty is emphasized as a solitary basis for winning are dangerous and harmful to society. Young women are fragile, as they try to find a place for themselves in this world. When someone sees the pain of a young women struggling with eating disorders, hears a young women beg to convince her parents to allow her to get plastic surgery because they cant stand a certain part of their body, it can be concluded that beauty pageants do a great disservice to the winners, the losers, and all children. Personal hope would be that an organization such as to find a better way to lift up the spirit of our young women. WORK CITED: Gats, Thomas. Are Beauty Pageants Harmful?. October 27, 2008 >. Cornforth, Tracee. Are Indoor Tanning Booths Safe?. September 09, 2009 . Callow, Clare. How Beauty Contests Harmful. Septemeber 10, 2009: 2004.

Glucose Tolerance Tests Accuracy In Diagnosing Diabetes

Glucose Tolerance Tests Accuracy In Diagnosing Diabetes According to the World Health Organization (WHO), more than 220 million people worldwide have diabetes. An estimated 1.1 million people died from diabetes in 2005, and almost half of diabetic deaths occurred in people under the age of 70 years of age. WHO projects that the number of diabetic deaths will increase to 366 million by the year 2030 (8). Diabetes Mellitus Type 2 is a prevalent disorder that causes one to have high blood sugar, or hyperglycemia. This hyperglycemia can be the result from one or a combination of 1) decrease production of insulin from beta cells of the pancreas; 2) increase sugar production from the liver; 3) decrease sugar uptake by cells secondary to insulin receptors. Symptoms of DMII are excess urination, excess thirst, dizziness, blurred vision, sweating, and fatigue. Patients presenting with these symptoms should be screened by a finger stick, where a blood sample is taken from a quick prick of the finger, to be tested for hyperglycemia. Normal blood sugar should range from 70-100mg. If one has a fasting sugar of >126mg or an after eating sugar level > 200mg, then an oral glucose tolerance test (OGTT) should be performed. During an OGTT, a patient consumes a 150-200g carbohydrate diet for three days and fasts from midnight prior to test date. The morning of test, the patient consumes 75g sugar mixe d with 300ml of water within a 5 minute period. The patients blood sugar level is be measured at baseline, and then again at 120 minutes. A diagnosis of DMII is made if the baseline level is >126 mg and the 120 minute level is >200mg. These guidelines are set by the American Diabetic Association (ADA) and the World Health Organization (WHO) (1,8). Another option for obtaining a blood sugar level is measuring the percent of glycosylated red blood cells, or the percent of sugar attached to a RBC. RBCs live for approximately 90 days in the human body. By measuring this percentile one can observe the patients blood sugar level over the previous 3 months and not just at the moment an OGTT is performed. Today, HbA1c is a main tool for following metabolic control in persons with diabetes(5). A HbA1c > 6.0 percent should permit a diagnosis of DMII, but is not at this time a definite diagnostic tool. Diabetes can cause complications of multiple organ systems. WHO defines consequences of diabetes as follows: Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke). Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation. Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment. Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure. Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes (8). Previous studies have showed that better control of plasma glucose levels reduced the risk of developing long-term complications pertaining to diabetes (4). A higher HbA1c correlates well with the likelihood of developing chronic complications such as the ones listed above. This study is designed to explore if a HbA1c be used to diagnose diabetes. Observations suggest that a reliable measure of chronic glycemic levels such as HbA1c, which captures the degree of glucose exposure over time and which is related more intimately to the risk of complications than single or episodic measures of glucose levels, may serve as a better biochemical marker of diabetes and should be considered a diagnostic tool (2). As for the current gold standard for diagnosing diabetes, the oral glucose tolerance test (OGTT) has its limitations (2). These include high interindividual variability, low reproducibility compared to FPG, poor compliance with the conditions needed to perform the test correctly, and is cumbersome and time-consuming for medical staff and patients (4). Due to these factors one may ask, Is a HbA1c or an OGTT more accurate at diagnosing new onset diabetes mellitus type 2 in a patient presenting with hyperglycemia? By exploring this question and answering it from an evidence-based approach, the answer may help clinicians advance to an easier and less time consuming way to diagnose diabetes mellitus type II. CLINICAL CASE A 57 year old African American male presented to the outpatient office with symptoms of dizziness, blurred vision, polydipsia, and polyuria. He has a significant history of hypertension and hyperlipidemia. The patient was unclear when his symptoms started. Upon evaluation in the office, the patient was noted to have a marked glucose elevation of 420. An in-house HbA1c was also noted at 13.0. Upon further questioning, the patient has not been taking any medications for diabetes, and is currently taking Lisinopril and Zocor for his other medical conditions. Due to the presenting symptoms and lab results, the patient was admitted to the hospital for hyperosmolar nonketotic hyperglycemic state. METHODS A PubMed search was performed by using the Clinical queries and Diagnosis filters. The terms A1c AND diagnosis AND diabetes and glycosylated hemoglobin AND diagnosis AND diabetes were used to search the site for relating articles. With these search terms, a total of 176 hits revealed articles pertaining to the requested information. Articles that met all inclusion criteria for the research were evaluated and assigned a type/level of evidence. In order to be included in this evidence-based study, articles had to meet the following inclusion criteria: Articles must be cohort studies. Studies must not be > 6 years old. Articles must have participants with impaired glucose levels or symptoms of impaired glucose. Studies must include evidence of OGTT or FPG and HbA1c. Studies must have a significant number of participants to produce a significant result (n > 375). Any articles that did not specifically relate to diagnosing DMII with a HbA1c were excluded. Articles that were not cohort studies, were older than six years, did not have participants with impaired glucose, or did not have a significant amount of participants were excluded. Certain articles that appeared in the PubMed search were strictly review articles. These papers were reviewed, and if applicable, may be used to provided supporting factors about pathophysiology/ epidemiology of diabetes type II and its diagnostic criteria. Articles that met all inclusion criteria were evaluated and assigned a level of evidence using the Oxford Centre for Evidence-based Medicine Levels of Evidence worksheet. RESULTS Study #1: Diagnosing Type 2 Diabetes Mellitus: in Primary Care, Fasting Plasma Glucose and Glycosylated Hemoglobin Do the Job Study Design: This study was performed at the Raval Sud Primary Care Center in Barcelona, Spain and was begun in 1992. The purpose of this study was to determine the validity of glycosylated hemoglobin values as a method to diagnose type 2 diabetes mellitus in a population at risk seen in primary care. Four hundred fifty four subjects were selected to participate in the study. The population served by the Raval Sud Center is characterized by it low evonomic level, high rate of immigration, and high rate of morbidity and mortality for certain diseases and disorders. Inclusion criteria for eligible participants had at least on e of the risk factors for developing DMII described in the ADA guidelines. These included family history of DMII, personal history of carbohydrate intolerance or gestational diabletes, prolonged use of a drug able to raise glucose levels, obesity with a body mass index > 30, hypertension, HDL-cholesterol levels 250 mg/dL. Persons who did not wish to take part in the study were excluded. For the purpose of this particular study, data was recorded from the time the patient was included in the Raval Sud Care Center. The study then used a cross-sectional analytical design to validate a diagnostic test. (4) Study Conduct: Subjects were interviewed and variables were recorded for each participant. These included sociodemographic characteristics such as age and sex, clinical characteristics such as BMI and blood pressure, and laboratory values including fasting plasma glucose in a venous blood sample, oral glucose tolerance test after a 75g glucose overload, and a HbA1c measured by high pressure liquid chromatography. To standardize the results for the HbA1c, the absolute values were recalculated in terms of the number of standard deviations above the mean. FPG and OGTT values were based on the WHO criteria as having normal, impaired, or DMII glucose levels. (4) Study Results: The distribution of demographic characteristics and laboratory findings are shown in Table 1. The study found that plasma glucose levels were significantly lower in normal subjects than in subjects with abnormal glucose levels (IFG or OGTT) and even lower in subjects with abnormal glucose levels than in patients with diabetes (P 5.94% (mean, +3SD), the diagnosis of DMII is reliable and accurate in 93% of the cases. Table 4 shows the diagnostic validity of a combined strategy of FPG and HbA1c values: patients were considered to have DMII when FPG > 125 mg/dL, or when FPG >110 mg/dL and HbA1c was greater than the cutoff value. Maximal efficacy (93% GV) was found for HbA1c > 5.94% (x +3SD), with a sensitivity of 92.2% and a specificity of 95.1%. (4) Study Critique: It has been confirmed that the relationship between circulating glucose values and the onset of chronic complications exists. Thus, it is logical for the diagnosis of DMII to be based on glucose values. One of the main problems in this particular study was to define and establish a cutoff point for this continuous quantitative variable. This study analyzed different cutoff points for the whole sample of patients at risk for DMII. When HbA1c values > 5.51% (x +2SD), were used for the cutoff point for diagnosis of DMII, the sensitivity (76%) and specificity (85%) were acceptable. However, when a higher cutoff point was used, specificity increased, but only at the expense of reduced sensitivity. Due to this situation, the study designed a strategy for diagnosis based on the FPG values and the validity of HbA1c. (4) Level of Evidence: 1c Study #2: Comparison of A1c and Fasting Glucose Criteria to Diagnose Diabetes Among U.S. Adults Study Design: This study included participants from the 1999-2006 National Health and Nutrition Examination Survey. Participants included 6,890 adults (>20 years of age), without a self-reported history of diabetes. The subjects attended a morning examination, fasted for > 9 hours at the time of their blood collection, and had valid plasma glucose and HbA1c values taken. Participants were categorized into one of the four groups by presence or absence of fasting plasma glucose > 126 mg/dL and HbA1c > 6.5%. The distribution of the population into these groupings was determined and the K statistic value was calculated. Also, the distribution of U.S. adults by fasting glucose and different HbA1c cutoff points (6.0-6.7%) were calculated. The objective for this study was to compare A1c and fasting glucose for the diagnosis of diabetes among U.S. adults. (6) Study Conduct: Data was collected through questionnaires (demographics, medical history), a physical examination (blood pressure, BMI, and waist circumference), and blood collection (lipids, plasma glucose, HbA1c). The plasma glucose was measured by using a modified hexokinase enzymatic method and the HbA1c using a high-performance liquid chromatography. (6) Study Results: This study concludes that an HbA1c of > 6.5%, along with a FPG >125 mg/dL demonstrates reasonable agreement for diagnosing diabetes. 1.8% of the participants were classified as having diabetes with a HbA1c > 6.5% and a fasting glucose >126 mg/dL. Among participants with a HbA1c 125 mg/dL, 45% had an A1c value > 6.0% but less than 6.5%. According to A1c guidelines, this value poses an elevated risk for diabetes. Table A1 shows a distribution of adults by fasting glucose and different HbA1c cutoff points. From this table, the lower the HbA1c cutoff points results in higher sensitivity and lower specificity. (6) Study Critique: In this study, certain participants had discordant results such as a HbA1c > 6.5% and a fasting glucose of Study #3: A1c and Diabetes Diagnosis: The Rancho Bernardo Study Study Design: The Rancho Bernardo Study included 2, 107 participants without known DMII, who had an OGTT and a HbA1c between 1984 and 1987. This cross-sectional study of community dwelling adults was provided written informed consent and laboratory data was performed. (3) Study Conduct: HbA1c was measured with high performance liquid chromatography using an automated analyzer. Ophthalmologic evaluation was also performed on the subjects. This was done by using nonmydriatic retinal photography. Sensitivity and specificity of HbA1c cutoff points for DMII were calculated, along with K coefficients which were used to test for agreement between A1c values and diabetes status. The objective for this study was to examine the sensitivity and specificity of HbA1c as a diagnostic test for DMII in older adults. (3) Study Results: For this study the HbA1c cutoff value was 6.5%. This value had a sensitivity of 44% and a specificity of 79%. A lower A1c cutoff point of 6.15% yielded the highest sensitivity at 63% but a lower specificity at 60%. If one were to use this cutoff value, it would miss one-third of those with DMII by the American Diabetes Association guidelines. It would also misclassify one-third of those without DMII. Using the HbA1c value of 6.5% as the cutoff point, the agreement with DMII diagnosis was low (K coefficient was 0.119). In order to compare A1c and ADA criteria with DMII complications, the study looked at participants with some degree of retinopathy. Of the participants who had retinopathy, 40% had and A1c > 6.5% and none had DMII by ADA criteria. This study concluded that the limited sensitivity of the A1c value cutoff may result in missed or delayed diagnosis of DMII, whereas the use of current OGTT criteria will fail to identify a high proportion of individuals with hi gh A1c values, which correlate with long term complications of DMII. (3) Study Critique: This study was performed on a much older population than the other studies examined in this paper. It has its benefits and disadvantages for surveying a population in which there mean age was 69.4. The advantage is that the U.S. elderly population has the greatest current burden and is expected to have the greatest increase in the prevalence of DMII. On the other hand, the disadvantage to having such an older subject population is that it limited the HbA1c cutoff values to that particular population. In a previous critique of an article one of the concerns was the fact that there are different aspects of glucose metabolism. It would have been supportive if the article addressed the age of their participants and compared them with the study results. (3) Level of Evidence: 1c Study #4: Diagnostic value of glycated haemoglobin (HbA1c) for the early detection of diabetes in high-risk subjects Study Design: This study was performed by collecting data from the Bundang CHA General Hospital database. A total of 392 subjects who had an abnormal random plasma glucose, a history of gestational diabetes mellitus, a macrosomic baby, or a severe obesity were selected to participate in the study. Exclusion criteria included a previous history of diabetes of other endocrinopathies, pregnancy, abnormal liver or renal function tests, a history of major surgery, severe illness, blood transfusion within the previous 6 months, and weight loss > 3kg during the past three months. After an overnight fasting, blood samples were drawn from all participating subjects to include FPG and HbA1c values. (7) Study Conduct: Glucose concentrations were measured using the glucose oxidase method on a autoanalyzer. The HbA1c values were measured by the high-performance liquid chromatography method. All statistical analysis was performed and the best predictive cutoff values for FPG and A1c for detecting patients with new diabetes were identified using the optimal sensitivity/specificity values determined by the receiver operating characteristic curve. (7) Study Results: Figure 1 shows the ROC plot representing the sensitivity and specificity for the HbA1c and the FPG in detecting undiagnosed DMII. From this study, the optimal cutoff value for HbA1c was 6.1% and for FPG was 6.1 mmol/l. The sensitivity/specificity for the HbA1c cutoff value was 81.8% and 84.9% respectively. Table 1 shows the results from the combination of using FPG and HbA1c. This study demonstrated that HbA1c was very useful to screen for diabetes in high-risk patients and the combined use of HbA1c and FPG made up for the lack of sensitivity in FPG alone. (7) Study Critique: This studys subjects were only Korean, therefore making the population very ethnically limited. It would have been beneficial to have seen the population more diverse and to notice the change in results. Also, the study stated that an OGTT was performed, yet a confirmation status of repeat testing was not recorded. This would have been beneficial to have in order to compare results to the FPG and HbA1c values obtained for cutoff for diagnosing DMII. (7) Level of Evidence: 1c DISCUSSION The purpose if this study was to assess if a HbA1c was sufficient enough to make a unknown diagnosis of diabetes mellitus type 2. From these studies one can gather that a HbA1c is adequate for making a new diagnosis for DMII. The following chart compares the specificity and sensitivity of each HbA1c from each study critiqued in this study. Also, each study uses a different HbA1c cutoff that they gathered from their cohort or cross-sectional study which is also included in the chart below. Study Sensitivity Specificity HbA1c used for Diagnosis Diagnosing Type 2 Diabetes Mellitus: in Primary Care, Fasting Plasma Glucose and Glycosylated Hemoglobin Do the Job 63.3% 93.4% 5.94% Comparison of A1c and Fasting Glucose Criteria to Diagnose Diabetes Among U.S. Adults 72.5% 96.5% > 6.0% A1c and Diabetes Diagnosis: The Rancho Bernardo Study 44% 79% 6.5% Diagnostic value of glycated haemoglobin (HbA1c) for the early detection of diabetes in high-risk subjects 81.8% 84.9% 6.1% Study #1 discussed the option of performing a combination of HbA1c and a FPG test. This exhibited to be most the most poignant result with a specificity/sensitivity of 92.2 and 95.1, respectively. In study #2, it also agreed that a HbA1c and a FPG level provided the most assured diagnosis for DMII. However, this study had the most discordant results and was probably due to the fact of its subject population. It stated that the results may have been due to the fact that assessment of different aspects of glucose metabolism was present (6). Study #3 was performed on a much older population, and focused on the importance of following HbA1c levels to help prevent long term complications of DMII. However, it also stated that a HbA1c would also have a higher sensitivity and specificity if it were performed along with a FPG test. Finally, study #4 agreed on the fact that a HbA1c was very sufficient for screening for DMII, and that it provided much support for diagnosing DMII along with a FP G. CONCLUSION This study provided that a HbA1c of approximately 6.0% is a great support to help making the diagnosis of DMII along with a FPG > 125. Some studies have suggested that a HbA1c of this value is suggestive of a diagnosis, however, the studies above advocate that FPG levels should also be obtained to solidify the actually diagnosis of DMII. However, in a recent publication from the JAAP, it states thatan A1c value of 6.5% higher as diagnostic. This value appears to be the level at which a person is at risk for developing the complications of diabetes. A diagnosis should be confirmed with a repeat A1c test, unless clinical symptoms and a glucose level higher than 200 mg/dL are present (5). From this statement one can confer that the patient described above in the clinical case portion of this paper, does indeed warrant the diagnosis of DMII on the basis of a HbA1c of 13.0%, the presence of clinical symptoms, and the glucose elevation of 420 mg/dL.

Aldous Huxleys Brave New World Essay -- essays research papers

In the "Brave New World" of 632 A. F. (After Ford), universal human happiness has been achieved. (Well, almost.) Control of reproduction, genetic engineering, conditioning--especially via repetitive messages delivered during sleep--and a perfect pleasure drug called "Soma" are the cornerstones of the new society. Reproduction has been removed from the womb and placed on the conveyor belt, where reproductive workers tinker with the embryos to produce various grades of human beings, ranging from the super-intelligent Alpha Pluses down to the shorter and dumber semi-moron Epsilons. The story takes place in England where the new society lives. Due to a gigantic biological attack almost all of the world is destroyed except for england and parts of the U.S. In â€Å"Brave New World† civilization is controlled by conditioning and hatchery. Everyone is brought into civilization through a test tube, "the operation undergone voluntarily for the good of society." The D.H.C. (the Director of Hatcheries and Conditioning) decides which of the five castes in society the test tube babies will belong to. At a young age, the babies are conditioned to think and act certain ways depending on which caste they will belong to. The beginning chapters describe this brave new world as the D.H.C (Director of hatcheries and conditioning.) gives a group of children a tour of the facility. The reader meets Lenina Crowne who had been dating Henry Foster for some time, and ...

Free College Admissions Essays: I Hated My Father :: College Admissions Essays

I Hated My Father I hated my father for a long time. I resemble him completely, and everyone says I am a copy of him in appearance. And some people even said that 30 years after, I would be what he was completely in everything. But I really disliked to be told so, and I felt it was an insult to me. My father was an object of detestation for me; to be his son was my curse. I didn't regard him as my father and despised him very much, so I sought ways of revenge on him. I decided that after I graduate from university and I can earn my own living, I would abandon him. "For now, I will act a meek son, but it won't last forever. He should live his lonely old age," I thought. There were many reasons why I hated my father. He was quick-tempered, selfish, and he easily beat and kicked me, because he wanted to have his own way in everything. Though I had not been such a bad child, I was often scolded and knocked about by him since I was a small child, so I was afraid of him, and I really had contempt for him. There was one more reason why I hated my father; it was my name "Taro", given me by my father "Taro" is a very simple name. Anyone naming a child could think of this name in one second. Of course, this simple name was made fun of by my friends. I really hated it, and I wondered whether my father had really thought my name over seriously. I asked him the reasons for naming me this, but he answered only "Taro is simple, manful, and easy to remember." I even wondered if perhaps my father thought of me as a dog. I seldom felt his love for me. Last year, I entered Fukui Medical School, and started to live alone. My despising of my father had not changed at all, so I was very happy to live alone, because I didn't have to meet him except during my vacation! Of course, I seldom went home though it is possible to go there in only one hour by car. But since I have lived by myself, my impression of my father has gradually changed. My mother often said my father wanted to meet me and he talked about me very often.

Black House Chapter Twenty-nine

29 â€Å"YOU GUYS READY?† Dale asks. â€Å"Aw, man, I don't know,† Doc says. This isn't the fifth time he's said it, maybe not even the fifteenth. He's pale, almost hyperventilating. The four of them are in a Winnebago kind of a rolling green room that has been set up on the edge of La Follette Park. Nearby is the podium on which they'll stand (always assuming Doc can keep his legs under him) and deliver their carefully crafted answers. On the slope running down to the broad river are gathered nearly four hundred newspeople, plus camera crews from six American networks and God knows how many foreign stations. The gentlemen of the press aren't in the world's best mood, because the prime space in front of the podium has been reserved for a representative sampling (drawn by lottery) of French Landing's residents. This was Dale's one ironclad demand for the press conference. The idea for the press conference itself came from Jack Sawyer. â€Å"Mellow out, Doc,† Beezer says. He looks bigger than ever in his gray linen slacks and open-collared white shirt almost like a bear in a tuxedo. He has even made an effort to comb his acres of hair. â€Å"And if you really think you're going to do one of the Three P's piss, puke, or pass out stay here.† â€Å"Nah,† Doc says miserably. â€Å"In for a penny, in for a fuckin' pound. If we're gonna give it a try, let's give it a try.† Dale, resplendent in his dress uniform, looks at Jack. The latter is if anything more resplendent in his gray summerweight suit and dark blue silk tie. A matching blue handkerchief pokes from the breast pocket of his coat. â€Å"You sure this is the right thing?† Jack is completely sure. It's not a matter of refusing to allow Sarah Gilbertson's Color Posse to steal the limelight; it's a matter of making certain that his old friend is in an unassailable position. He can do this by telling a very simple story, which the three other men will back up. Ty will do the same, Jack is confident. The story is this: Jack's other old friend, the late Henry Leyden, figured out the Fisherman's identity from the 911 tape. This tape was supplied by Dale, his nephew. The Fisherman killed Henry, but not before the heroic Mr. Leyden had mortally wounded him and passed his name to the police. ( Jack's other interest in this press conference, understood perfectly and supported completely by Dale, is to make sure Henry gets the credit he deserves.) An examination of French Landing property records and plats uncovered the fact that Charles Burnside owned a house on Highway 35, not far out of town. Dale deputized Jack and two widebodies who just happened to be in th e vicinity (that would be Messrs. Amberson and St. Pierre), and they went on out there. â€Å"From that point on,† Jack told his friends repeatedly in the days leading up to the press conference, â€Å"it's vital that you remember the three little words that lead to most acquittals in criminal trials. And what are those words?† † ? ®I can't remember,' † Dale said. Jack nodded. â€Å"Right. If you don't have a story to remember, the bastards can never trip you up. There was something in the air inside that place â€Å" â€Å"No lie,† Beezer rumbled, and grimaced. † and it messed us up. What we do remember is this:Ty Marshall was in the backyard, handcuffed to the clothesline whirligig.† Before Beezer St. Pierre and Jack Sawyer slipped through the police barricades and vaporized Black House with plastic explosive, one reporter got out there and took numerous pictures. We know which reporter it was, of course; Wendell Green has finally realized his dreams of fame and fortune. â€Å"And Burnside was dead at his feet,† Beezer said. â€Å"Right. With the key to the handcuffs in his pocket. Dale, you found that and released the boy. There were a few other kids in the backyard, but as to how many â€Å" â€Å"We don't remember,† Doc said. â€Å"As to their sexes â€Å" â€Å"A few boys, a few girls,† Dale said. â€Å"We don't remember exactly how many of each.† â€Å"And as for Ty, how he was taken, what happened to him â€Å" â€Å"He said he didn't remember,† Dale said, smiling. â€Å"We left. We think we called to the other kids â€Å" â€Å"But don't exactly remember † the Beez chips in. â€Å"Right, and in any case they seemed safe enough where they were for the time being. It was when we were putting Ty into the cruiser that we saw them all streaming out.† â€Å"And called the Wisconsin State Police for backup,† Dale said. â€Å"I do remember that.† â€Å"Of course you do,† Jack said benevolently. â€Å"But we have no idea how that darn place got blasted all to hell, and we don't know who did it.† â€Å"Some people,† Jack said, â€Å"are all too eager to take justice into their own hands.† â€Å"Lucky they didn't blow their heads clean off,† said Dale. â€Å"All right,† Jack tells them now. They're standing at the door. Doc has produced half a joint, and four quick, deep tokes have calmed him visibly. â€Å"Just remember why we're doing this. The message is that we were there first, we found Ty, we saw only a few other children, we deemed their situation secure due to the death of Charles Burnside, also known as Carl Bierstone, the South Side Monster, and the Fisherman. The message is that Dale behaved properly that we all did and he then handed the investigation off to the FBI and WSP, who are now holding the baby. Babies, I guess in this case. The message is that French Landing is okay again. Last but far from least, the message is that Henry Leyden's the real star. The heroic blind man who I.D.'d Charles Burnside and broke the Fisherman case, mortally wounding the monster and losing his own life in the process.† â€Å"Amen,† Dale says. â€Å"Sweet old Uncle Henry.† Beyond the door of the Winnebago, he can hear the surflike rumble of hundreds of people. Maybe even a thousand. He thinks, This is what rock acts hear before they hit the stage. A lump suddenly rises in his throat and he does his best to gulp it back down. He reckons that if he keeps thinking of Uncle Henry he will be okay. â€Å"Anything else,† Jack says, â€Å"questions that get too specific â€Å" â€Å"We can't remember,† Beezer says. â€Å"Because the air was bad,† Doc agrees. â€Å"Smelled like ether or chloro or something like that.† Jack surveys them, nods, smiles. This will be a happy occasion, on the whole, he thinks. A love feast. Certainly the idea that he might be dying in a few minutes has not occurred to him. â€Å"Okay,† he says, â€Å"let's go out there and do it. We're politicians this afternoon, politicians at a press conference, and it's the politicians who stay on message who get elected.† He opens the RV's door. The rumble of the crowd deepens in anticipation. They cross to the jury-rigged platform this way: Beezer, Dale, Jack, and the good Doctor. They move in a warm white nova glare of exploding flashbulbs and 10-k TV lights. Jack has no idea why they need such things the day is bright and warm, a Coulee Country charmer but it seems they do. That they always do. Voices cry, â€Å"Over here!† repeatedly. There are also thrown questions, which they ignore. When it comes time to answer questions they will as best they can but for now they are simply stunned by the crowd. The noise begins with the two hundred or so French Landing residents sitting on folding chairs in a roped-off area directly in front of the podium. They rise to their feet, some clapping, others waving clenched fists in the air like winning boxers. The press picks it up from them, and as our four friends mount the steps to the podium, the roar becomes a thunder. We are with them, up on the platform with them, and God, we see so many faces we know looking up at us. There's Morris Rosen, who slipped Henry the Dirtysperm CD on our first day in town. Behind him is a contingent from the now defunct Maxton Elder Care: the lovely Alice Weathers is surrounded by Elmer Jesperson, Ada Meyerhoff (in a wheelchair), Flora Flostad, and the Boettcher brothers, Hermie and Tom Tom. Tansy Freneau, looking a bit spaced out but no longer outright insane, is standing next to Lester Moon, who has his arm around her. Arnold â€Å"Flashlight† Hrabowski, Tom Lund, Bobby Dulac, and the other members of Dale's department are up on their feet, dancing around and cheering crazily. Look, over there that's Enid Purvis, the neighbor who called Fred at work on the day Judy finally high-sided it. There's Rebecca Vilas, looking almost nunnish in a high-collared dress (but cry no tears for her, Argentina; Becky has stashed away quite a nice bundle, thank you very much). Butch Yerxa is with her. At the back of the crowd, lurking shamefully but unable to stay away from the triumph of their friends, are William Strassner and Hubert Cantinaro, better known to us as Kaiser Bill and Sonny. Look there! Herb Roeper, who cuts Jack's hair, standing beside Buck Evitz, who delivers his mail. So many others we know, and to whom we must say good-bye under less than happy circumstances. In the front row, Wendell Green is hopping around like a hen on a hot griddle (God knows how he got into the roped-off area, being from La Riviere instead of French Landing, but he's there), taking pictures. Twice he bum ps into Elvena Morton, Henry's housekeeper. The third time he does it, she bats him a damned good one on top of the head. Wendell hardly seems to notice. His head has taken worse shots during the course of the Fisherman investigation. And off to one side, we see someone else we may or may not recognize. An elderly, dark-skinned gentleman wearing shades. He looks a little bit like an old blues singer. He also looks a little bit like a movie actor named Woody Strode. The applause thunders and thunders. Folks cheer. Hats are thrown in the air and sail on the summer breeze. Their welcome becomes a kind of miracle in itself, an affirmation, perhaps even an acceptance of the children, who are widely supposed to have been held in some bizarre sexual bondage linked to the Internet. (Isn't all that weird stuff somehow linked to the Internet?) And of course they applaud because the nightmare is over. The boogeyman died in his own backyard, died at the foot of a prosaic, now vaporized aluminum clothes whirligig, and they are safe again. Oh how the cheers ring in these few last moments of Jack Sawyer's life on planet Earth! Birds are startled up from the bank of the river and go squawking and veering into the sky, seeking quieter environs. On the river itself, a freighter responds to the cheers or perhaps joins in by blasting its air horn over and over. Other boats get the idea and add to the cacophony. Without thinking about what he's doing, Jack takes Doc's right hand in his left, Dale's left hand in his right. Dale takes Beezer's hand, and the Sawyer Gang raises their arms together, facing the crowd. Which, of course, goes nuts. If not for what is going to happen next, it would be the picture of the decade, perhaps of the century. They stand there in triumph, living symbols of victory with their linked hands in the sky, the crowd cheering, the videocams rolling, the Nikons flashing, and that is when the woman in the third row begins to make her move. This is someone else we know, but it takes us a second or two to recognize her, because she has had nothing at all to do with the case we have been following. She's just been . . . sort of lurking around. The two hundred seats up front have been awarded by random drawing from the French Landing voter rolls, the lucky lottery winners notified by Debbi Anderson, Pam Stevens, and Dit Jesperson. This woman was No. 199. Several people shrink from her as she passes them, although in their happy frenzy they are hardly aware of doing it; this pale woman with clumps of straw-colored hair sticking to her cheeks smells of sweat and sleeplessnes s and vodka. She's got a little purse. The little purse is open. She's reaching into it. And we who have lived through the second half of the twentieth century and have through the miracle of TV witnessed a dozen assassinations and near assassinations know exactly what she is reaching for. We want to scream a warning to the four men standing with their linked hands raised to the sky, but all we can do is watch. Only the black man with the sunglasses sees what's happening. He turns and starts to move, aware that she has probably beaten him, that he is probably going to be too late. No, Speedy Parker thinks. It can't end like this, it can't. â€Å"Jack, get down!† he shouts, but no one hears him over the clapping, the cheering, the wild hurrahs. The crowd seems to block him on purpose, surging back and forth in front of him no matter which way he moves. For a moment Wendell Green, still bobbing around like a man in the throes of an epileptic seizure, is in the assassin's path. Then she heaves him aside with the strength of a madwoman. Why not? She is a madwoman. â€Å"Folks † Dale's got his mouth practically on the microphone, and the P.A. horns mounted to the nearby trees whine with feedback. He's still holding up Jack's hand on his left and Beezer's on his right. There's a small, dazed smile on his face. â€Å"Thank you, folks, we sure do appreciate the support, but if you could just quiet down . . .† That's when Jack sees her. It's been a long time, years, but he recognizes her at once. He should; she spat in his face one day as he left the Los Angeles courthouse. Spat at him and called him a railroading bastard. She's lost fifty pounds since then, Jack thinks. Maybe more. Then he sees the hand in the purse, and even before it comes back out, he knows what's happening here. The worst is that he can do nothing about it. Doc and Dale have his hands in a death grip. He drags in a deep breath and shouts as he has been taught to do in just such a situation as this â€Å"Gun!† and Dale Gilbertson nods as if to say, Yes it is, it is fun. Behind her, pushing through the clapping, cheering crowd, he sees Speedy Parker, but unless Speedy's got a particularly good magic trick up his sleeve He doesn't. Speedy Parker, known in the Territories as Parkus, is just fighting his way into the aisle when the woman standing below the platform brings out her gun. It's an ugly little thing, a bulldog .32 with its handle wrapped in black kitchen tape, and Jack has just half a second to think that maybe it will blow up in her hand. â€Å"Gun!† Jack shouts again, and it's Doc Amberson who hears him and sees the snarling woman crouched just below them. â€Å"Ohfuck,† Doc says. â€Å"Wanda, no!† Jack cries. Doc has let go of his left hand (Dale has still got his right one hoisted high in the summer air) and Jack holds it out to her like a traffic cop. Wanda Kinderling's first bullet goes right through the palm, mushrooms slightly, begins to tumble, and punches into the hollow of Jack's left shoulder. Wanda speaks to him. There's too much noise for Jack to hear her, but he knows what she's saying, just the same: Here you go, you railroading son of a bitch Thorny says hello. She empties the remaining five bullets into Jack Sawyer's chest and throat. No one hears the insignificant popping sounds made by Wanda's bulldog .32, not over all that clapping and cheering, but Wendell Green has got his camera tilted up, and when the detective jerks backward, our favorite reporter's finger punches the Nikon's shutter-release button in simple reflex. It snaps off eight shots. The third is the picture, the one that will eventually become as well known as the photo of the Marines raising the flag on Iwo Jima and that of Lee Harvey Oswald clutching his belly in the parking garage of the Dallas police station. In Wendell's photo, Jack Sawyer looks calmly down toward the shooter (who is just a blur at the very bottom of the frame). The expression on his face might be one of forgiveness. Daylight is clearly visible through the hole in the palm of his outstretched hand. Droplets of blood, as red as rubies, hang frozen in the air beside his throat, which has been torn open. The cheering and the applause stop as if amputated. There is a moment of awful, uncomprehending silence. Jack Sawyer, shot twice in the lungs and once in the heart, as well as in the hand and the throat, stands where he is, gazing at the hole below his spread fingers and above his wrist. Wanda Kinderling peers up at him with her dingy teeth bared. Speedy Parker is looking at Jack with an expression of naked horror that his wraparound sunglasses cannot conceal. To his left, up on one of four media towers surrounding the platform, a young cameraman faints and falls to the ground. Then, suddenly, the freeze-frame that Wendell has captured without even knowing it bursts open and everything is in motion. Wanda Kinderling screams â€Å"See you in hell, Hollywood† several people will later verify this and then puts the muzzle of her .32 to her temple. Her look of vicious satisfaction gives way to a more typical one of dazed incomprehension when the twitch of her finger produces nothing but a dry click. The bulldog .32 is empty. A moment later she is pretty much obliterated broken neck, broken left shoulder, four broken ribs as Doc stage-dives onto her and drives her to the ground. His left shoe strikes the side of Wendell Green's head, but this time Wendell sustains no more than a bloody ear. Well, he was due to catch a break, wasn't he? On the platform, Jack Sawyer looks unbelievingly at Dale, tries to speak, and cannot. He staggers, remains upright a moment longer, then collapses. Dale's face has gone from bemused delight to utter shock and dismay in a heartbeat. He seizes the microphone and screams, â€Å"HE'S SHOT! WE NEED A DOCTOR!† The P.A. horns shriek with more feedback. No doctor comes forward. Many in the crowd panic and begin to run. The panic spreads. Beezer is down on one knee, turning Jack over. Jack looks up at him, still trying to speak. Blood pours from the corners of his mouth. â€Å"Ah fuck, it's bad, Dale, it's really bad,† Beezer cries, and then he is knocked sprawling. One wouldn't expect that the scrawny old black man who's vaulted up onto the stage could knock around a bruiser like Beezer, but this is no ordinary old man. As we well know. There is a thin but perfectly visible envelope of white light surrounding him. Beezer sees it. His eyes widen. The crowd, meanwhile, flees to the four points of the compass. Panic infects some of the ladies and gentlemen of the press, as well. Not Wen-dell Green; he holds his ground like a hero, snapping pictures until his Nikon is as empty as Wanda Kinderling's gun. He snaps the black man as he stands with Jack Sawyer in his arms; snaps Dale Gilbertson putting a hand on the black man's shoulder; snaps the black man turning and speaking to Dale. When Wendell later asks French Landing's chief of police what the old fellow said, Dale tells him he doesn't remember besides, in all that pandemonium, he could hardly make it out, anyway. All bullshit, of course, but we may be sure that if Jack Sawyer had heard Dale's response, he would have been proud. When in doubt, tell 'em you can't remember. Wendell's last picture shows Dale and Beezer watching with identical dazed expressions as the old fellow mounts the steps to the Winnebago with Jack Sawyer still in his arms. Wendell has no idea how such an old party can carry such a big man Sawyer is six-two and must go a hundred and ninety at least but he supposes it's the same sort of deal that allows a distraught mother to lift up the car or truck beneath which her kid is pinned. And it doesn't matter. It's small beans compared to what happens next. Because when a group of men led by Dale, Beez, and Doc burst into the Winnebago (Wendell is at the rear of this group), they find nothing but a single overturned chair and several splashes of Jack Sawyer's blood in the kitchenette where Jack gave his little gang their final instructions. The trail of blood leads toward the rear, where there's a foldout bed and a toilet cubicle. And there the drops and splashes simply stop. Jack and the old man who carried him in here have vanished. Doc and Beezer are babbling, almost in hysterics. They bounce between questions of where Jack might have gone to distraught recollections of the final few moments on the platform before the shooting started. They can't seem to let that go, and Dale has an idea it will be quite a while before he can let go of it himself. He realizes now that Jack saw the woman coming, that he was trying to get his hand free of Dale's so he could respond. Dale thinks it may be time to quite the chief's job after all, find some other line of work. Not right now, though. Right now he wants to get Beezer and Doc away from the Color Posse, get them calmed down. He has something to tell them that may help with that. Tom Lund and Bobby Dulac join him, and the three of them escort Beez and Doc away from the Winnebago, where Special Agent Redding and WSP Detective Black are already establishing a CIP (crime investigation perimeter). Once they're behind the platform, Dale looks into the stunned faces of the two burly bikers. â€Å"Listen to me,† Dale says. â€Å"I should have stepped in front of him,† Doc says. â€Å"I saw her coming, why didn't I step in front â€Å" â€Å"Shut up and listen!† Doc shuts up. Tom and Bobby are also listening, their eyes wide. â€Å"That black man said something to me.† â€Å"What?† Beezer asks. â€Å"He said, ? ®Let me take him there may still be a chance.' â€Å" Doc, who has treated his share of gunshot wounds, gives a forlorn little chuckle. â€Å"And you believed him?† â€Å"Not then, not exactly,† Dale says. â€Å"But when we went in there and the place was empty â€Å" â€Å"No back door, either,† Beezer adds. Doc's skepticism has faded a little. â€Å"You really think . . . ?† â€Å"I do,† Dale Gilbertson says, and wipes his eyes. â€Å"I have to hope. And you guys have to help me.† â€Å"All right,† Beezer says. â€Å"Then we will.† And we think that here we must leave them for good, standing under a blue summer sky close to the Father of Waters, standing beside a platform with blood on the boards. Soon life will catch them up again and pull them back into its furious current, but for a few moments they are together, joined in hope for our mutual friend. Let us leave them so, shall we? Let us leave them hoping. ONCE UPON A TIME IN THE TERRITORIES . . . ONCE UPON A TIME (as all the best old stories used to begin when we all lived in the forest and nobody lived anywhere else), a scarred Captain of the Outer Guards named Farren led a frightened little boy named Jack Sawyer through the Queen's Pavilion. That small boy did not see the Queen's court, however; no, he was taken through a maze of corridors behind the scenes, secret and seldom-visited places where spiders spun in the high corners and the warm drafts were heavy with the smells of cooking from the kitchen. Finally, Farren placed his hands in the boy's armpits and lifted him up. There's a panel in front of you now, he whispered do you remember? I think you were there. I think we both were, although we were younger then, weren't we? Slide it to the left. Jack did as he was bidden, and found himself peeking into the Queen's chamber; the room in which almost everyone expected her to die . . . just as Jack expected his mother to die in her room at the Alhambra Inn and Gardens in New Hampshire. It was a bright, airy room filled with bustling nurses who had assumed a busy and purposeful manner because they had no real idea of how to help their patient. The boy looked through the peephole into this room, at a woman he at first thought was his own mother somehow magically transported to this place, and we looked with him, none of us guessing that years later, grown to a man, Jack Sawyer would be lying in the same bed where he first saw his mother's Twinner. Parkus, who has brought him from French Landing to the Inner Baronies, now stands at the panel through which Jack, hoisted by Captain Farren, once looked. Beside him is Sophie of Canna, now known in the Territories as both the Young Queen and Sophie the Good. There are no nurses in the sleeping chamber today; Jack lies silent beneath a slowly turning fan. Where he is not wrapped in bandages, his skin is pale. His closed eyelids are hazed with a delicate purple bruise-blush. The rise and fall of the fine linen sheet drawn up to his chin can hardly be seen . . . but it's there. He breathes. For now, at least, he lives. Speaking quietly, Sophie says, â€Å"If he'd never touched the Talisman â€Å" â€Å"If he'd never touched the Talisman, actually held it in his arms, he would have been dead there on that platform before I could even get close to him,† Parkus says. â€Å"But of course, if not for the Talisman, he never would have been there in the first place.† â€Å"What chance has he?† She looks at him. Somewhere, in another world, Judy Marshall has already begun to subside back into her ordinary suburban life. There will be no such life for her Twinner, however hard times have come again in this part of the universe and her eyes gleam with an imperious, regal light. â€Å"Tell me the truth, sir; I would not have a lie.† â€Å"Nor would I give you one, my lady,† he tells her. â€Å"I believe that, thanks to the residual protection of the Talisman, he will recover. You'll be sitting next to him one morning or evening and his eyes will open. Not today, and probably not this week, but soon.† â€Å"And as for returning to his world? The world of his friends?† Parkus has brought her to this place because the spirit of the boy Jack was still lingers, ghostly and child-sweet. He was here before the road of trials opened ahead of him, and in some ways hardened him. He was here with his innocence still intact. What has surprised him about Jack as a grown man and touched him in a way Parkus never expected to be touched again is how much of that innocence still remained in the man the boy has become. That too is the Talisman's doing, of course. â€Å"Parkus? Your mind wanders.† â€Å"Not far, my lady; not far. You ask if he may return to his world after being mortally wounded three, perhaps even four times after being heart-pierced, in fact. I brought him here because all the magic that has touched and changed his life is stronger here; for good or ill, the Territories have been Jack Sawyer's wellspring since he was a child. And it worked. He lives. But he will wake different. He'll be like . . .† Parkus pauses, thinking hard. Sophie waits quietly beside him. Distantly, from the kitchen, comes the bellow of a cook lacing into one of the ‘prentices. â€Å"There are animals that live in the sea, breathing with gills,† Parkus says at last. â€Å"And over time's long course, some of them develop lungs. Such creatures can live both under the water and on the land. Yes?† â€Å"So I was taught as a girl,† Sophie agrees patiently. â€Å"But some of these latter creatures lose their gills and can live only on the land. Jack Sawyer is that sort of creature now, I think. You or I could dive into the water and swim beneath the surface for a little while, and he may be able to go back and visit his own world for short periods . . . in time, of course. But if either you or I were to try living beneath the water â€Å" â€Å"We'd drown.† â€Å"Indeed we would. And if Jack were to try living in his own world again, returning to his little house in Norway Valley, for instance, his wounds would return in a space of days or weeks. Perhaps in different forms his death certificate might specify heart failure, for instance but it would be Wanda Kinderling's bullet that killed him, all the same. Wanda Kinderling's heart shot.† Parkus bares his teeth. â€Å"Hateful woman! I believe the abbalah was aware of her no more than I was, but look at the damage she's caused!† Sophie ignores this. She is looking at the silent, sleeping man in the other room. â€Å"Condemned to live in such a pleasant land as this . . .† She turns to him. â€Å"It is a pleasant land, isn't it, sirrah? Still a pleasant land, in spite of all?† Parkus smiles and bows. Around his neck, a shark's tooth swings at the end of a fine gold necklace. â€Å"Indeed it is.† She nods briskly. â€Å"So living here might not be so terrible.† He says nothing. After a moment or two, her assumed briskness departs, and her shoulders sag. â€Å"I'd hate it,† she says in a small voice. â€Å"To be barred from my own world except for occasional brief visits . . . paroles . . . to have to leave at the first cough or twinge in my chest . . . I'd hate it.† Parkus shrugs. â€Å"He'll have to accept what is. Like it or not, his gills are gone. He's a creature of the Territories now. And God the Carpenter knows there's work for him over here. The business of the Tower is moving toward its climax. I believe Jack Sawyer may have a part to play in that, although I can't say for sure. In any case, when he heals, he won't want for work. He's a coppiceman, and there's always work for such.† She looks through the slit in the wall, her lovely face troubled. â€Å"You must help him, dear,† Parkus says. â€Å"I love him,† she says, speaking very low. â€Å"And he loves you. But what's coming will be difficult.† â€Å"Why must that be, Parkus? Why must life always demand so much and give so little?† He draws her into his arms and she goes willingly, her face pressed against his chest. In the dark behind the chamber in which Jack Sawyer sleeps, Parkus answers her question with a single word: Ka. Epilogue SHE SITS BY his bed on the first night of Full-Earth Moon, ten days after her conversation with Parkus in the secret passageway. Outside the pavilion, she can hear children singing â€Å"The Green Corn A-Dayo.† On her lap is a scrap of embroidery. It is summer, still summer, and the air is sweet with summer's mystery. And in this billowing room where his mother's Twinner once lay, Jack Sawyer opens his eyes. Sophie lays aside her embroidery, leans forward, and puts her lips soft against the shell of his ear. â€Å"Welcome back,† she says. â€Å"My heart, my life, and my love: welcome back.† April 14, 2001