Knowledge, Attitude and Breast Cancer Screening Practices in Ghana Essay

INTRODUCTION   Ã‚   Breast cancer in its simplest definition is the cancer of breast tissue. It is the most common nonskin cancer that affects women in the United States and the highest fatality rates of cancer deaths among women in low-resource countries (Anderson et al 2006). Severity of breast cancer differs based on its level of tissue invasion. Ductal carcinoma in situ is the most common noninvasive breast cancer while infiltrating or invasive ductal carcinoma is the most common breast cancer that accounts for about 80% of invasive breast cancer. Breast lumps presentation is the commonest form of presentation regardless of the breast cancer type (ACS 2005). Epidemiologic factors are attributed to dietary and environmental risk factors, although association of diet and breast cancer had varied results. Environmental risk factors involve the exposure to several toxic elements which accounts for the increased incidence of breast cancer in Western countries. Alcohol intake is also considered to effect in the increase of the number of cases in the US population. Age is also considered as cancer risk factor and can be attributed to hormonal change. Genetic variation and ethnicity are not out of scope for the investigation of breast cancer risk factors (Barton 2005). Diagnosis and Pathology of Breast Cancer: In 2002, Breast Health Global Initiative (BHGI) together with panel of breast cancer experts and patient advocates develop a consensus of recommendations for the diagnosis of breast cancer in limited-resource countries (Shyyan 2006). Histopathologic diagnosis included fine-needle aspiration biopsy which was recognized as the least expensive, core needle biopsy and surgical biopsy and had a consensus of choosing the method based on the availability of tools and expertise. They gave emphasis on the correlation of histopathology, clinical and imaging findings. They agreed on the need of histopathologic diagnosis before breast cancer treatment. In 2005, BHGI panel recommended an additional strategy of breast cancer management. They stratify diagnostic procedure and histopathology methods into – â€Å"basic, limited, enhanced, and maximal—from lowest to highest resources†. Basic level includes medical history of the patient, clinical breast examination, tissue diagnosis and medical record keeping. Limited level includes the increasing resources that enable diagnostic imaging utilization such as ultrasound with or without mammography, tests that can evaluate metastasis, use of image-guided sampling and hormone receptor sampling. Enhanced level includes diagnostic mammography, bone scanning and an onsite cytologist. Maximal level includes mass screening mammography (Shyyan 2006). Treatment of Breast Cancer: Treatment includes surgery, radiotherapy or chemotherapy or combinations of these three treatment modalities. According to American Cancer Society (2005), treatment can be local or systemic. Local treatment of the tumor is done without affecting the rest of the body. Surgery and radiation are examples of this treatment. On the other hand, systemic treatment which includes chemotherapy, hormone therapy and immunotherapy, is given into the bloodstream or by mouth to reach the cancer cells that may have spread the beyond the breast.    Radiotherapy is a treatment of breast cancer with high-energy rays to help shrink the cancer cells. It can be given outside of the body (external radiation) or can be placed directly into the tumor as radioactive materials (ACS 2005). It may be given external to the body.   Radiotherapy requires safe and effective application requiring appropriate facilities, staff and equipment. Radiotherapy should be applied without delay, should be accessible to all but without prolongation of the overall treatment time exposure. It is part of an integral part of breast-conserving treatment. It is required in almost all women with the breast cancer, and therefore should be available (Bese 2006).   Ã‚  Chemotherapy is the use of anticancer drugs that are administered through injection in the vein or taken orally as a pill. It may be given before breast cancer surgery to reduce the size of the tumor or may be given after the surgery to reduce the chance of   recurrence (ACS 2005). This treatment is done in cycle the most common of which is 3-6 months. Most common side effects of these drugs usually stop   once the treatment is over such as in hair falling. Some of   drugs used as chemotherapy     are tamoxifen, cyclophosphamide, methotrexate, 5-fluorouracil doxorubicin, epirubicin, taxane and aromatase . These are usually prescribed in combination, and treatment is done with adjuvant therapy such as radiotherapy and pre- and post operation ( Eniu 2006).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Surgical management in breast cancer is very common. This is done to remove as much as the cancer as possible and to find out whether the cancer has spread to the lymph nodes under the arm. Surgery can also restore the appearance of the breast and relieve the symptoms of advanced cancer. ACS (2005) released some of the common surgical procedures in breast cancer. These are lumpectomy, partial or segmental mastectomy, simple or total mastectomy, modified radical mastectomy and radical mastectomy. RESULTS    Breast cancer patients in Ghana. The present study which included women with mean age population of 48 years   revealed an almost consistent perception with regards to breast cancer.  Ã‚   They were aware that breast cancer is highly increasing in their place but not informed of the cause of disease. All of the responders were not aware of family breast cancer history except one. Information about breast cancer was acquired through television and radio programs. Only after   consultation with doctors due to lumps or   pains in their breast and some due to liquid coming out of their breast, that they were informed that they have breast cancer. Most of them underwent breast tissue exam for confirmation of the disease. Afterwards, they were advised to undergo surgery with medical treatment. The responders were ignorant of the breast cancer screening and prevention. In fact, out of 10 responders, only 2 (20%) of them were aware of breast self examination and clinical breast examination and admitted that they occasionally practice BSE. None of the responders knew about mammogram except for one (10%) of them who has heard of it but never had tried one. The feeling towards the knowledge of acquiring the disease was also the same; the feeling of being a burden in the family was common. They were afraid to face the reality but have realized that they have to fight the disease through the encouragement and support of family members and   help of medical professionals. The sample population was aware of the herbalist and faith healers but they did not submit themselves into that kind of treatment because herbalist have not   proven cure for breast cancer.   The most common complaint of the responders was the high cost of therapies, hospitalization and doctor fees. The treatment cost ranged to    ¢250,000- ¢24 million except to one of them who received a free treatment for being enrolled to a clinical trial. Sentiments of the participants were the same. Delay of treatment was attributed to their distant place from the health clinics; some facilities like x-ray were not available in the clinics and   high cost of treatment. These people asked for the betterment of breast cancer management through education dissemination to the community by health care providers and a help from the government to provide financial support to those who cannot afford to submit themselves for treatment. Patients in breast cancer clinic. In this part of the study, women with mean age of 42 years who were in breast cancer clinic were included. Most common medical complaint was lump and pain in the breast while others submit themselves for screening because they have just heard it from the radio/TV.   The study revealed that women who were attending the clinic were not actually informed of the cause breast cancer but aware of its increasing rate of mortality. Misconception about the cause of breast cancer such as exposure to coins was not common but did not exclude the form of trauma due to manipulation of the breast. Others correlate breast cancer with smoking and taking alcoholic beverages. They were not aware of their family history of breast cancer.   Information regarding breast cancer was acquired through television and radio programs and others were through their friends and family members. Most of the respondents believed that early detection and prompt treatment of the disease can prevent the unfavorable outcome of breast cancer such as removal of their breast or the worst would be cancer death. Only one out of   10 participants (10%) actually practice breast self examination (BSE). Most of them were informed of BSE but not actually practicing it. They were also aware of healers and herbalist but they did not believe that they can cure breast cancer but did not disagree of the possibility that herbalist and healers could treat other diseases or illnesses like hypertension. The participants suggested that it would be better if the government would provide or establish more health care clinics for breast cancer screening and provide free screening programs especially to those who cannot afford to   pay for high cost of treatment of the disease and for an open-easy access to all especially to those in rural areas. One of the participants suggested   that doctors should study further about the treatment of breast cancer instead of resorting to breast surgery. Healers involved in breast cancer management. Many of the population of Ghana are still patronizing healers and herbalist as a resort   of treatment. Two healers from Ghana were interviewed regarding their management of breast cancer. The healers have been into this practice for about 20-50 years. According to them, breast cancer is very common in Ghana and they are aware of the increasing incidence of   the disease. They described breast cancer as an â€Å"obosam† disease and the other was a supernatural disease. Healers believed that their ability to cure   the disease inherited from their forefathers who taught them how to prepare herbs and provide them with dwarfs. They believed that doctors have no right treatment towards breast cancer because according to them they just remove the breasts of women   and subsequently die. According to the healers they do not promote breast   examinations to their patients because these are useless and cannot stop women from getting the disease. Despite the big machines available in the hospitals, women with breast cancer still die, according to them. Healers charge their patients with as much as  ¢200,000- ¢1( £15-60) million depending on the patients’ condition. The healers admitted that there were cases of recurrence of the disease due to lost to follow up and missed spiritual sessions. Healers do not refer patients to hospitals rather, they encourage hospital doctors to refer their patients to healers because they are more capable of treating breast cancer. Breast cancer consultants.   Medical health professionals play a significant role in the awareness of breast cancer. They have the power to influence their patients toward right management of the disease. In the present study, surgeon/breast cancer consultants were interviewed. Consultants as expected were aware of the increasing incidence of breast cancer but they cannot give an exact figure due to absence of cancer registry in the place however they were able to attend to 200-300 new cases of breast cancer annually with age range starting from 20 years and above. They revealed that women in Ghana associate breast cancer to death because after undergoing breast caner surgery they usually die. People in Ghana link medical intervention and death which made the women in this place afraid of   the disease and lead them to negative attitude towards the disease. Consultants believed that there were several misconceptions about the disease. They were also aware that healers and herbalist delay the   presentation of patients to   hospital which accounted for the late stage of diagnosis. National Screening Program would benefit the people in Ghana for early detection of breast cancer and prompt treatment, however, they did not deny the fact it would be difficult to establish such program due to lack of funds by the government at present time. Consultants were aware of the limited resources of the needed for the implementation of the program. They believe that it is much easier and feasible to educate the women on simple screening methods such as regular breast self examination and encourage practitioners to take advantage of examining the breasts of their patients. There are also NGOs who are engaged in some activities like providing health care assistance. Consultants revealed that they receive referrals from district regions and from private practitioners. All patients with breast cancer are candidates for surgery. There are just some procedures that lead to untoward incident which cause the people to blame the doctors. According to consultants, one big problem that they encounter is the delay of the result of tissue exam from the pathologists which sometimes lead them to acquire the high cost of private laboratory. According to consultants the 5-year survival rate in Ghan is 25% which is disappointing. According to radiology consultant, patients present themselves to treatment once they are already in advanced stage, most at stage 3 and 4. They revealed the common factors that influence the delay of treatment among Ghana women. Most of the patients were scared of the procedure of   breast cancer treatment like in breast surgery which have many social and marriage implications. The high cost of the procedure hinders the patient to go to the doctors. Consultants revealed that surgical procedure may cost    ¢2-3million   ( £ 150-200), radiotherapy is about    ¢3-4 million (  £ 200-300) and chemotherapy is around  ¢6 million ( £400). Although surgical treatment cost is covered in National Health Insurance, the cost of radiotherapy and chemotherapy are excluded. Mammography which is an effective tool in breast cancer screening costs  ¢400,000 ( £30) in private health institution and around  ¢250,000 ( £20). DISCUSSION WITH REVIEW OF RELATED LITERATURES   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The present study aimed to increase the awareness of the women in Ghana to breast cancer and the benefits that can be gained from breast cancer screening. The knowledge, attitude, behavior and practices of the women regarding early detection of breast cancer were analyzed. The ultimate aim of the study was to reduce the mortality rate of   breast cancer.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The study revealed that there were still misconceptions about breast cancer despite the information gathered from televisions and radio programs. Attendance of Ghanaian women in breast clinic did not mean that they were informed of the nature of their disease. Only few of them were also aware of preventive procedure in detecting breast cancer. Local healers and spiritualists also delayed the presentation of the patients to the hospital which contributed to the late diagnosis of the disease. Difference in the disease management of health professionals can be attributed to the location of practice and availability of resources. Several factors   thought to affect the breast cancer screening program were the poor education of the Ghanaian towards prevention awareness against breast cancer; lack of initiative of the people to spread the knowledge of   breast cancer screening such as simple breast self examination and clinical breast examination; the inaccessibility of the of primary health care and the organizers; the unavailability of the appropriate screening tools like x-ray and mammography in the community and its high cost   and the lack of support from the government.   The following   review of related literatures will help in the understanding of breast cancer and breast cancer screening. Because of the continuous increasing prevalence of breast cancer and high cost of treatment, breast cancer screening remains the most cost effective way of cancer management (Parkin and Fernandez 2006).   Most of the world faces resource constraints that hinder the capacity to improve early detection, prompt diagnosis and sufficient treatment of the breast cancer. Every country finds its way to develop evidenced based, economically feasible and culturally appropriate guidelines that can be utilized by countries of limited health care resources to improve breast cancer outcomes (Anderson 2006). Adaptive strategies should be applied to ease the growing burden of breast cancer. In 2005, according to Smith and his colleagues (2006), the Breast Health Global Initiative (BHGI) held its second summit in Bethesda, MD with the intention of reaffirming the principle of requiring all women of all resource levels to support in seeking health care and assuring the access to affordable and appropriate diagnostic tests and treatment intervention against breast cancer. They recommended breast health awareness to all women including the basic resources. They enhanced the basic facilities for effective training of relevant staff in clinical breast examination (CBE) or breast self examination and even the feasibility of mammography. MRI: Magnetic resonance imaging is one of the breast cancer screening procedures. It has been increasingly used as tool for early diagnosis of breast cancer. This screening tool has shown to detect cancers even they are small and potentially proven to be more curable than mammography alone. However, MRI is more costly than mammography and can lead to unnecessary breast biopsies, thus causing anxiety and discomfort to patient. On the other hand, a research study about the cost-effectiveness of breast MRI screening by cancer risk where they included the cancer detection ability of MRI, characteristics of women with dense breast tissue and women with high inherited breast cancer risk, revealed mortality reduction and cost effectiveness of breast MRI screening added to mammography in BRCA1 and BRCA2 mutation carriers (Kurian 2006).    The hallmark of morality and morbidity of breast cancer can be attributed to the late presentation of the patients at an advanced stage of breast cancer. It is when there is no or little benefit that can be derived from any treatment modality. In a study conducted by Okobia and colleagues (2006), the knowledge, attitude and practice of community dwellers of Nigeria towards breast cancer were analyzed. They recruited urban-dwelling women with conducted an interviewer-administered questionnaires to elicit sociodemographic information regarding knowledge, attitude and practice towards breast cancer. It was found out that the participants had poor knowledge of breast cancer. Only 214 out of 1000 participants knew that breast cancer is presented initially with breast lumps. Breast cancer examination practices were low. Only 432 participants were able carry out breast self examination while only 91 participants had clinical breast examination. This study revealed that participants with higher level of education were significantly more knowledgeable about breast cancer. Ethnicity or race-related culture and beliefs are factors that affect the increase in prevalence of breast cancer mortality. Paterniti (2006) investigated how ethnically diverse women who are eligible for tamoxifen prophylaxis because of their breast cancer risk decide about tamoxifen use for risk reduction. Prior to the study, there was discussion of the benefits and risks of tamoxifen as prophylaxis. The study which included African-American, White, and Latina women, of 61–78 years, revealed that fear of breast cancer was not prominent and they were not inclined to take tamoxifen as preventive therapy after receiving the information. Participants showed limited unwillingness to take the medication with potential adverse effects. This study revealed that women felt that they had other options other than taking the risk of tamoxifen to reduce their risk of breast cancer, including early detection, diet, faith and other alternative therapies.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Graham (2002) conducted a research about   the relationship between beliefs and practice of breast self examination (BSE in a black women population of 20-49 years of age. It was found out that health beliefs were much stronger in determining BSE performance for a given individual than were demographic characteristics. Breast self examination was related to increased perceived seriousness of breast cancer, benefit of the procedure and health motivation and was noted to have inverse relationship with perceived barriers. A related study was reported by Mitchell and colleagues (2002), about the effects of religious beliefs with other variables on breast cancer screening and the intended presentation of self-discovered breast lump. This study included women aging 40 years and above and were interviewed in their homes. Most of the interviewees believed that doctors cure breast cancer with God’s intervention which was labeled as â€Å"religious intervention with treatment†. This dimension was found out to be correlated with self-reported mammography but no clinical breast examination or intention to delay presentation of self-discovered breast lump. Minority of them believed treatment of breast cancer was unnecessary because only God could cure the disease which was labeled as â€Å"religious intervention in place of treatment†, and was significantly more common among African-American women who   are less educated and older. This was correlated with the strong intention of delaying the presentation of self-discovered breast lump. It was concluded that   religious intervention in place of treatment contributes significantly the delay presentation of breast cancer among African-American that contribute largely to the advanced-stage cancer diagnosis. The cause of breast cancer is still unclear. Adjei (2006) who grew up in Ghan and had some work about breast cancer. In his letter, he revealed his sentiments about the genetic differences in breast cancer. He had been aware of the incidence of breast cancer in Ghana since 1974 to 1999. He noted that the peak incidence of breast cancer in Ghana is in younger women with age range of 40-45 years while in United States and Caucasians, the peak incidence is in older age groups. Adjei (2006) pointed out that women of different places and environments, with different diets have similar epidemiology of breast cancer. In an argument which revealed number of breast cancer in African-Americans but rare in native African has been used to suggest that ethnicity is one factor of acquiring the disease, however, according to Adjei (2006), this information is leading because cancer has not been well-studied in Africa. Researchers are still finding their ways to fully disclose the correlation of genetic signature in breast tumors that are presently noted   to be a powerful predictor of cancer spread and cancer death. In a limited study conducted by Kolata (2002), she included few patients who are relatively. As she stated in her report, scientists said that the activity of a collection of 70 genes appear to predict cancer mortality   better than traditional measures like tumor size, cancer stage or lymph node spread to the axilla of women. She revealed in her study that 5.5% of women with good genetic signature died within the next decade while 45% of women are those of with bad genetic signatures. Adherence to the treatment regimen of breast cancer plays a big role in the improvement of disease outcome. There are no much literature about the factors associated to the behavior that influence the patient to delay or cause an incomplete adherence to the recommended follow up in patients with breast cancer. In a study conducted by Kaplan (2006), race/ethnicity, country of birth, financial issues fear of pain and difficulty of communicating with the healthcare providers are the barriers to seek follow up consultation Breast Cancer Screening: There was decline in breast cancer mortality rate of 0.9% in African American women while 2.1% was the decline in breast cancer mortality rate in non-Hispanic White women (Stewart et al 2004 as stated by Settersten , Dopp, and Tjoe, (2005).    On the contrary, De Koning (2000), questioned in his study the cost effectiveness of breast cancer screening. His idea came out when he analyzed his expectations of the reduction of breast cancer mortality after breast cancer screening. He stated in his study that the Dutch program of 2-yearly screening for women aged 50-70 would produce a 16% reduction in the total population. As stated in his research paper, the actual benefit that can be achieved from breast cancer screening programs is overstated. According to him breast cancer screening need to be carefully balanced against the burden to women and health care system. De Koning (2000) stated that â€Å"effects of breast cancer screening program depend on many factors such as epidemiology of the disease, the health care system, costs of health care, quality of the screening program and the attendance rate†. Groot, M. T. et al (2006) estimated the costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America and Asia. They developed a mathematical simulation model of breast cancer using the different stages of cancer, its distribution and case fatality rates in the absence and presence of treatment as predictors of survival. The study resulted to a conclusion that untreated patients were the most sensitive to case fatality rates. This study suggest that treating breast cancer at stage 1 and introduction of an extensive breast cancer program are the most cost effective breast cancer interventions.   Ã‚   This study is supported by the research done by Aylin and colleagues (2005). They recruited women at the mammography clinic to evaluate the knowledge about breast cancer and mammography as breast cancer screening procedure. The striking result of this study is that most of the participants (95.3% of the total participants) were aware that women should have mammography screening periodically. They were informed of the fact that breast cancer screening such as mammography could help in the early detection of breast cancer. However, less than 50% of them admitted that they had never had mammography screening. Majority of the respondents (71.1%) were practicing breast self-examination. Another related study was conducted by Dundar and colleagues (2006), since breast cancer is the second leading cause of cancer deaths in Turkey , they determined the t the knowledge and attitudes of women in a rural area in western Turkey about breast self examination and mammography. They recruited women with age ranging from 20-64 years. Although majority of the participants have heard or read about breast cancer only 56.1% of them had sufficient knowledge about breast cancer and some admitted that they acquired the information from their health care professionals. Those with information of beast cancer were also those who practice breast self examination. This study revealed that health care professionals play a big role in information dissemination about breast cancer. Table 1. Recommendations for routine mammographic screening in North American women aged 40 years or older who are at average risk for breast cancer* Group (date of recommendations) Frequency of screening (yr) Included ages (yr)       40-49 50-69 >70 Government-sponsored and private groups US Preventive Services Task Force (2002)** 1-2 Yes Yes Yes*** Canadian Task Force on Preventive Health Care (1998, 1999, 2001) 1-2 No Yes No National Institutes of Health consensus conference (1997)    No+ — — American Cancer Society (1997) 1 Yes Yes Yes National Cancer Institute (2002) 1-2 Yes Yes Yes Medical societies American College of Obstetricians and Gynecologists (2000) 1-2 if aged 40-49 yr 1 if aged >50 yr Yes Yes Yes American Medical Association (1999) 1 Yes Yes Yes American College of Radiology (1998) 1 Yes Yes Yes American College of Preventive Medicine (1996) 1-2 No|| Yes Yes American Academy of Family Physicians (2001) 1-2 No+|| Yes No American Geriatrics Society (1999) 1-2 — — Yes*** Advocacy groups National Breast Cancer Coalition (2000)    No –+ No National Alliance of Breast Cancer Organizations (2002) 1 Yes Yes Yes Susan B. Komen Foundation (2002) 1 Yes Yes Yes The above table   was taken from the study conducted by Barton (2005) There are several ways presented and studied for breast cancer screening. Its concern is to reduce the prevalence of cancer mortality and to improve the quality of life as a result of early detection, however, there are still people that are not aware of breast cancer screening In response to increase the worldwide awareness of breast cancer, breast cancer advocacy movement has been analyzing the common experiences of women with breast cancer around the world especially those with limited resources. They found out that although there are language barriers, sentiments were consistent across cultures; cancer survivors have the same experiences and fears. The beliefs and taboos about breast cancer hinder the awareness programs and treatment. There are also limited resources for public education and awareness. Difficulty in understanding and translating the concept of the disease into English also hinders them in the public awareness of breast cancer (Errico and Rowden 2006). In accordance with this, sociological review of the barriers experienced by the women from different traditional cultures is essential not just to understand patterns of late breast cancer diagnosis but also the importance of interventions and programs. This is necessary for them to understand the preventive health care, specifically in breast cancer. This is because many are still ignorant of the breast cancer. According to Remennick (2006), health care providers and policymakers should try to understand and influence women especially those who are cancer risk to be aware of the disease to detect and treat breast cancer early. There are many structural barriers that hinder women especially those living in rural areas. Socioeconomic factors include poor health insurance, distance to medical facilities and inability to take time off work. Organizational barriers include difficulty in navigating complex health care systems and interacting with medical staff. Psychological and sociocultural barriers are poor health motivation, denial of personal risk, fatalism mistrust of cancer treatments and fear of becoming a burden on the family members. Still in other cultural behavior, especially in Muslims, women are strongly controlled by men and therefore may prohibit women in breast cancer screening. Remennick (2006) includes in his study the different approaches that lower the mentioned barriers, including implementation of uplifting the educational programs that would enlighten people regarding cancer myths and fallacies. He suggests that health care professional must outreach to their co ethnics. Primary health care providers play a critical role in   determining the compliance with treatment and preventive practices through direct recommendations to their patients. Family physicians and general internists showed that 70% of women who received a provider referral completed a screening mammography within one year versus only 18% of self-referred women (Grady   et al 1997 as stated by Santora 2003). However, Over 90% of rural women report that a doctor’s recommendation to have breast cancer screening is â€Å"important† (Sparks et al 1996 as stated by Santora 2003). It should be noted that clinician compliance is contributed by several factors such as relation with provider, guideline of the treatment, patient’s behavior and environmental factors. Several studies have been conducted to report the   differences of health services in rural, urban and suburban areas with regards to their   health care services in the family practice clinics. It has been pointed out that lower utilization has been a significant factor. Those rural health practitioners have less access to health care services.   In a study done by   Pol and his colleagues (2001), suggested that rural health services do not lag for patients with access after revealing that 9 out of 16 services examined were as high or higher in rural areas. Another   study to examine the variations in breast cancer screening among primary care clinicians by geographic location of   clinical practice was done by Santora (2003). Physicians, nurse practitioners and physician assistants were included in the study and were classified into urban, rural and suburban categories based upon practice location. The study revealed that although there was no significant difference in the practice location, there was evident variation in the practice of   breast screening. It was reported that urban and suburban health practitioners were less compliant with the use of breast cancer guidelines as compared to clinicians in rural areas.   Primary care clinicians, including physicians, nurse practitioners and physician’s assistants lack a consistent. This study revealed   that geographical location is not the main factor of inconsistent medical approach to breast cancer screening. Although the difference in the approaches to the procedure is uncertain in this study. A related study about General Practitioners’ (GP’s) knowledge, beliefs and attitudes toward breast screening, and their association with practice based-organizations of breast cancer screening, was conducted by Bekker, Morrisona and Marteau (1999). This study revealed that women’s attendance for breast cancer screening may be increased due to raising GP’s perceptions of the   threat of breast cancer. 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Kolata, G. 2002, â€Å"Breast Cancer: Genes Are Tied to Death Rates†, SusanLoveMD.org, Available at http://www.susanlovemd.com/community/flashes/in-the-news/news021219.htm Kurian, A., 2006, â€Å"Cost-effectiveness of Breast MRI Screening by Cancer Risk†, Available at http://www.cbcrp.org/research/PageGrant.asp?grant_id=4018 Mitchell, J. et al. 2002, â€Å"Religious Beliefs and Breast Cancer Screening†, Journal of Women’s Health, vol 11 no 10, pp.   907-915 Okobia et al, 2006, â€Å"Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross- Sectional study†, World Journal of Surgical Oncology, vol 4 no 11, Available at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1397833 Parkin, M. D. and Fernandez, L. M., 2006, â€Å"ORIGINAL ARTICLE: GLOBAL EPIDEMIOLOGIC METHODS Use of Statistics to Assess the Global Burden of Breast Cancer†, The Breast Journal, vol 12 no. 1, pp. S70–S80. Paterniti, A. D. 2006, â€Å"â€Å"I’m Going To Die of Something Anyway†: Women’s Perceptions of Tamoxifen for Breast Cancer Risk Reduction†, Ethnicity & Disease, vol. 15 no. 3, pp. 365–372, Available at http://apt.allenpress.com/aptonline/?request=get-abstract&issn=1049-510X&volume=015&issue=03&page=0365. Pol, L. G. et al, 2001, â€Å"Rural, urban and suburban comparisons of preventive services in family practice clinics†, Journal of Rural Health, vol 17 no 2, pp 114-121. Reichenbach, L., 2002, â€Å"The Politics of Priority Setting for Reproductive Health: Breast and Cervical Cancer in Ghana†, Reproductive Health Matters, vol 10 no 20, pp. 47-58. Remennick, L. 2006, â€Å"ORIGINAL ARTICLE: SOCIOCULTURAL BARRIERS TO CARE The Challenge of Early Breast Cancer Detection among Immigrant and Minority Women in Multicultural Societies†, The Breast Journal, vol 12 no 1, pp. S103–S110. Rimer, B. R. 1995, Adherence to Cancer Screening, Available at https://www.moffitt.usf.edu/pubs/ccj/v2n6/article4.html Santora, L M. 2003, â€Å"Breast cancer screening beliefs by practice location†, BMC Public Health, vol 3 no 9, Available at http://www.biomedcentral.com/1471-2458/3/9. Settersten, L., Dopp, A. and Tjoe, J., 2005, â€Å"Breast cancer epidemiology: Myths and science†, Available at http://www.son.wisc.edu/ce/programs/asynch/bccd/1-introduction.htm. Shyyan, R. et al, 2006, â€Å"BREAST HEALTH GLOBAL INITIATIVE: Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology†. The Breast Journal, vol 12 no.1, pp. S27–S37. Smith, R. A. et al, 2006, â€Å"BREAST HEALTH GLOBAL INITIATIVE: Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care†, The Breast Journal, vol 12 no.1, pp. S16–S26. Wallace, L. S. and Gupta, R. 2003, â€Å"Predictors of Screening for Breast and Colorectal Cancer among Middle-aged Women†, Family Medicine Journal, vol 35 no 5, pp. 349-354 †Weight Gain a Big Factor in Postmenopausal Breast Cancer†, 2006, Journal of the American Medical Association, Available at http://www.aphroditewomenshealth.com/news/20060612001144_health_news.shtml Yip, C. H. et al, 2006, â€Å"BREAST HEALTH GLOBAL INITIATIVE: Breast Cancer in Limited-Resource Countries: Health Care Systems and Public Policy†, The Breast Journal, vol 12 no. 1, pp. S54–S69.

Managing Time And People Commerce Essay

Planning is indispensable in making a new venture. This undertaking remains chiefly on the enterpriser get downing the concern. A good enterpriser demands to hold a assortment of accomplishments in order to be successful. SimVenture which is a concern simulation game, is a good manner of rehearsing these accomplishments. Indeed, learning entrepreneurial and concern accomplishments is one of the chief intents of SimVenture, by leting the users to make and run their ain practical company. SimVenture besides gives the chance to larn how to do efficient determinations in all the different sectors of a concern including selling, human resources, operations, finance, and more. As a concern disposal pupil and possibly future enterpriser, it is cardinal to understand how to successfully run a company and to pattern and trade with diverse accomplishments. I have learned many lessons by utilizing that simulation and many of these will decidedly be utile in my future life and heighten my cognition and personal development. Three of the chief that I have learned are how to pull off clip and people, how to develop a concern theoretical account, and how to research and analyse the market.Pull offing clip and peopleFirst, managing clip and people has been a important lesson that I have learned utilizing SimVenture. An enterpriser ‘s most of import and most hard occupation is to pull off these two constituents. The first constituent of the concern that has to be good managed is people. Get downing a concern is non merely a one individual trade, in the reverse, good developed and directed squads are behind most of the most successful concern start-up. Indeed, developing strong entrepreneurial squads are cardinal to a good functioning venture. It is the enterpriser ‘s undertaking to happen persons that can offer cognition, experience, accomplishments, and, therefore, add up a to the societal capital of their company. Furthermore, one time the good 1s are chosen, employees have to be motivated, leaded, inspired, and encouraged in order to be efficient and to increase their committedness to the company. With SimVenture, I have learned that this procedure is important for a concern, because taking inefficient or unsuitable employees can increase unusually its costs. Besides, the simulation taught me that non merely taking the best campaigner is of import, but particularly giving them the o ccupation place in harmony with what they are the best in. The 2nd constituent of the venture that has to be greatly managed is clip. Effectiveness, productiveness, and efficiency, are facets that can be overly increased if clip is managed right. Particularly during the concern start-up procedure, at every measure of it, clip should be spent on elements that are truly relevant for the creative activity of the company. SimVenture clearly showed that clip can truly be an issue in a company as clip direction was one on the chief jobs that my squad and I had while utilizing the simulation. Sometimes employees were passing clip idle, and some other times, they were non able to complete their undertaking due to miss of clip. In the hereafter, I will cognize that clip is the constituent of a concern that is likely the most indispensable to be good managed in order to be successful.Developing a concern theoretical accountSecond, making a concern theoretical account has been an indispensable lesson that I have learned with SimVenture. Constructing a concern theoretical account can be a really long and hard procedure, because it is a complex, precise, and specific undertaking. However, it is indispensable for a new venture to develop an effectual 1 because it is the bosom of a company. â€Å" Management author Joan Magretta defined a concern theoretical account as â€Å" the narrative that explains how an endeavor plant † † ( Casadesus-Masanell and RicartAA , 2011 ) . Bing portion of a concern scheme, a concern theoretical account is used to stand for nucleus facets of a venture. A concern theoretical account can be separated in five chief characteristics. The first subdivision is understanding the clients and their purchase determination. A client in a purchase determination procedure will go through through some phases before purchasing a merchandise or service. He will research information, seek value, measure alternate, and assess value before doing any determination. Using the simulation, I learned that understanding the clients that are in the mark market can greatly profit the company in doing merchandises in harmony with their demands. Besides, through SimVenture, I realized that clients are the wheels of the concern and that it is aboriginal to do determinations in relation to them. The 2nd characteristic of a concern theoretical account is the value proposition, or the benefits that clients gain. It is really of import for a company to understand and be cognizant of what their clients derive and profit from their merchandises or services. Developing a value proposition relies on analyzing qualitative and quantitative facets and happening a manner to be different from rivals by cognizing who they are and what they do. The value proposition is used to pull clients and guarantee the company ‘s fiscal good health. The 3rd portion of a concern theoretical account is the architecture of the concern. That characteristic describes the construction and the administration of the company. It besides defines how the venture creates and distributes its merchandises and services. The concern architecture discusses whether there is a market or non for what the company is selling, by analyzing the external environment such as geographics. All these different constituents are put together to make value for the clients. Using SimVenture, it was a challenge to do efficient determinations because all the characteristics of the concern and the mark market were to be taken in history. The 4th subdivision is the gross theoretical account of the concern. Its end is for the company to happen a profitable manner to present great value to their clients and fulfilling their demands. In other words, by making better than its rivals, the venture has to pull off its costs and disbursals in order to increase its return on investings. Pricing is besides an of import facet of that phase, so the monetary value should be fixed so that it is high plenty to do net income but non excessively high for the gross revenues to diminish. Furthermore, the company has to make up one's mind which gross mechanism will be adopted and how the benefits will be delivered to their clients. SimVenture taught me that it is indispensable to hold a great cognition of our costs and disbursals in order to repair the monetary value of the merchandise at a profitable degree. The 5th characteristic of the concern theoretical account is the strategic way. The strategic way is how the organisation scheme will be achieve and which actions will be in topographic point to make so. It demonstrate the place that the venture is be aftering to take over its rivals in a long term position. It is besides a projection of where the concern wants to be in a certain sum of old ages. Using SimVenture, I have learned that the strategic program of the concern is ever to be kept in head if you want the long term aims to be achieved. In the simulation, I would hold made different determinations than my squad. In my sentiment, we were believing excessively much about the present month and non plenty of the hereafter of the venture.Researching and analyzing the marketThird, researching and analyzing the market has been a important lesson that I have learned with SimVenture. The market analysis is indispensable to be done at the get downing point of every new venture. It allows the enterpriser to cognize more about the planetary environment of its concern. The market analysis is highly of import because it â€Å" helps specify the nature of the concern and the balance of the program. [ †¦ ] Similarly, the more a start-up understands the demands of its mark market, the more it can fit its merchandise attributes to those demands † ( Barringer, 2009 ) . Indeed, the venture will hold to section the market and choose a mark market. The â€Å" market cleavage is the procedure of spliting a market into distinguishable subsets ( or sections ) that behave in the same manner or have similar demands † ( Barringer, 2009 ) . As the market cleavage was already done in SimVenture, nil was learned from that subdivision. Before choosing a mark market, the company should research and analyze the size and the tendencies of the different market sections. This is critical because a good choice will let the concern to be successful in footings of net income and gross revenues growing. With SimVenture, I have learned that choosing the best market section is one of the most of import things, because if you do n't do a good choice, maintaining a financially healthy company can be debatable in the hereafter. I had trouble choosing the appropriate mark market for the concern. Therefore, what I have learned from that for the hereafter is that a deeper research and analysis of the market and of the sections should be done in order to do the best determination possible.DecisionTo conclude, through SimVenture, I have learned many of import lessons including managing clip and people, making a concern theoretical account, and researching and analyzing the market. The simulation made me cognizant that a concern can c onfront many troubles and that the enterpriser needs the cognition and the ability to do the best determination harmonizing to any state of affairss that can happen. Runing my ain concern for a few hebdomads has decidedly helped me in my personal development, because I would now experience more confident and experient if, in the hereafter, I would make up one's mind to get down my ain company.

Micheal Moore “Sicko”

I have heard of Mr.. Michael Moore doing controversial films on events In America, such as â€Å"Fahrenheit 9/11†. After â€Å"Fahrenheit 9/11† I had not follow Mr.. Michael Moore. Since the movie â€Å"Kickoff' that Professor Irene Cola showed during class on Friday, February 28th, 2014 1 check to see what else Mr.. Moore was doing. It seems Mr.. Michael Moore has been very busy as more than a filmmaker but as an activist with the type of films he makes. The film â€Å"Clock† Is what I would call one of his activist film documentaries.This film was about the Health care In the united states and In Canada. The film to some point was used to put shame on the Insurance Health Care Industry in the united States. Mr.. Moore did this by showing his on film how the Insurance Health Care Industry in America has cause the death of people, financial hardship due to insurance or medical high cost. Mr.. Moore went as far as interviewing some Doctors as well as people who w orked for insurance companies that know from inside experiences the truth of the matter.The matter being, how people in America insurance claims or insurance policies are rejected by Insurance companies Just to save a buck. This is an outrage. Now to compare Mr.. Moore travel across the border to Canada; Mr.. Moore found out while in Canada that Health care was totally free. I had heard in the past from a Canadian the Health Care was free but, never thought much about it. Now after seeing how the Canadians do not have to pay for health care at all. I think that the United States should get on the same page as Canada. In conclusion I do believe that Mr.. Moore movie may have had an effect onBeamer being past in this country. I believe this because it became a world issue when the movie was viewed all over the world. It seems that this is what has to happen sometime to get the wheels in motion. Although Beamer Is not as benefiting as the health care in Canada it Is a start. All Americ ans will Just have to Walt for the next Health Care Insurance Reform. Michael Moore â€Å"Kicks† By guesthouse I have heard of Mr.. Michael Moore doing controversial films on events in America, Since the movie â€Å"Kicks† that Professor Irene Cola showed during class on Friday,Michael Moore has been very busy as more than a filmmaker but as an activist with The film â€Å"Kicks† is what I would call one of his activist film documentaries. This film was about the Health care in the United States and in Canada. The film to some point was used to put shame on the Insurance Health Care Industry in the United States. Happen sometime to get the wheels in motion. Although Beamer is not as benefiting as the health care in Canada it is a start. All Americans will Just have to wait for the next Health Care Insurance Reform.

Ethical and Moral Philosophies Research Paper Example | Topics and Well Written Essays - 750 words

Ethical and Moral Philosophies - Research Paper Example There are moral philosophies that come in handy when business decisions are made by business people to ensure it falls within the realms of their morals and achieve business goals (Forsyth, 1992). These include teleology, egoism, utilitarianism, relativist, virtue ethics, and justice but this study will elaborate on idealism and relativism. One of the moral philosophies applied in business decision-making include idealism where a decision-maker considers the welfare of others in choosing the decision to make. Highly idealistic individual’s belief in the presence of measures to avoid harming others and will not decide to chose a lesser evil between two evils that will negatively affect other people. Lowly idealistic people belief in the assumption that little harm may be necessary for good to be produced, hence if their decision will harm less people they would chose it among two harmful evils (Forsyth, 1992). Relativism is the other example of moral philosophy applied in business decision-making where a decision maker uses their selves or the people around them as a basis for defining ethical standards (Ferrell et al., 2013). High relativist individuals make a decision depending on the individuals and that the nature of the situation and circumstances are weighed more than ethical principles. Low relativist individuals base their decisions on ensuring they are consistent with moral principles, norms, and practices. Moral philosophies influence behavior and decision-making because when a person takes on a given moral philosophy either consciously or unconsciously, the moral philosophy becomes his/her guiding principle. The person carries out the moral philosophy relentlessly through each obstacle in his way. He/she will strategize and make ways through which the given moral philosophy will be beneficial to them as an

Assignment Example | Topics and Well Written Essays - 1250 words - 32

Assignment Example With this concern, the assignment intends to establish certain methods by which Chile has been able to perform unilateral trade liberations successfully to the full elimination of quantitative restrictions and exchange controls. Trade liberalization of Chile could be classified under five stages of development process. Generally, unilateral trade liberalization technique involves the risk sharing mechanism. By deducting the interest of domestic political affairs, the unilateral trade relaxation may get blocked. The unilateral tariff cutback by a certain degree gets rid of this incompetence, but at certain situations, the factor concerning trade liberalization becomes more effective in the nation (Edwards and Lederman, 1998). Trade liberalization is duly considered to be one of the significant topics from the preceding two decades as a form of economic policy for the developing countries. It is worth mentioning in this regard that public-private partnership has played a pivotal role in framing the emerging economy for Chile. The reduction of tariff towards the import of goods aided the private enterprises of the nation to grow extensively. In the past, executing free trade agreement has always been a subject of conflict for the agricultural sector. Agricultural product has been the issue of dynamic export arena accounting for fifteen percent of total exports. The main contrast appears from the traditional inward thoughts of the people (Saez, 2005). The first stage ranged from the period of 1974-1978 and thus categorized by the reduction and the simplification of trade barriers. The second stage could be identified from 1978-1982, which reflected the picture of variation of its stabilization program. The third phase may be stated as the reversal stage that ranged from 1983-1985. It was the phase where Chile confronted severe

Children of heaven Movie Review Example | Topics and Well Written Essays - 1250 words

Children of heaven - Movie Review Example As a result, Ali and Zahra decide to share Ali’s converse; Zahra’s wears it to school for her morning class and races back to Ali, so he can wear them to his afternoon class. The pair bicker and clash like any other siblings, but yet stick together and help each other in solving their predicament. I. Family ties and Social Network The shoes are symbolic of the family’s poverty which slowly unravels and emboldens the many challenges on a daily basis throughout the course of the movie. Due to this reason, the children do not get their parents involved in the matter, which would have only added to their financial troubles. The only way they can coordinate is by exchanging notes and taking advantage of their parents’ illiteracy. Ali’s concern for his sister and family’s financial condition highlights the significance of family values in the Iranian society. Despite their young age and innocence, Ali realizes the magnitude of his irresponsibility and therefore tries his best to make up to his sister and faces all sorts of mishaps. The film not only focuses on family values and importance, but also depicts a strong sense of trust shared by all members of the community. The people are considerate and greatly concerned for the wellbeing of everyone else. When Zahra and Ali finally discover that her pink shoes were actually picked up by the blind trash scavenger, who gave them to his young daughter; they actually give up their entire plan of retrieving those shoes. The aforementioned aspect clearly portrays that the siblings are endowed with the same kind of consideration for others as their community members. They can relate to the other girl’s situation which then causes them to continue with their previous arrangement. Community spirit is an integral theme of the movie, which is clearly deeply instilled within the young children, who despite their own financial hardships are capable of empathizing with the other girl a s well. The consideration within the community is further evident when Ali’s teacher tries to save Ali from getting in trouble with the principal when he fails to reach school on time. The community spirit and filial piety is truly heartwarming especially with Ali, who begins to accompany his father to the suburbs, where he helps him talk to the rich residents of the area to help him get work. It is shown that Ali fully understands his responsibility as a son and assists his father as much as he can. Ali understands that his father works hard to get his children educated and it is the fulfillment of these filial duties that end up becoming a crucial turning point in the plot of the movie. (Ebert, 2011) II. The divide between the rich and the poor As poverty is a recurring theme in the movie, it further juxtaposes the lifestyle of the rich and poor to demonstrate the ever-increasing schism in the society. While the main object of conflict is the missing pair of shoes, which is an object usually taken for granted for the privileged ones but in Ali’s household, they are a valuable possession. Besides the plot, the filmmakers have made use of great cinematography that has played an exceptional role in portraying rural life. The scene where Ali and his father are actually riding towards the suburbs, the camera shifts from the medieval streets and dirt roads, to the high rises and beautiful bungalows situated in Northern Tehran. There

CONTRACT LAW Essay Example | Topics and Well Written Essays - 1500 words

CONTRACT LAW - Essay Example This is the basic definition and understanding of how a deal is formed. Following are the characteristics of deal: 1. Agreement between parties 2. Agreement for consideration of goods or services 3. Should be in a written format 4. Should have an offer and an acceptance to the same offer 5. Deal should be sufficient in nature 6. There should be damages if the deal does not take place As mentioned above, a deal starts with an offer made by one party, then the same offer has to be accepted in the language it was made by the other party.1 The characteristic of an offer consists of a consideration on both sides to the parties. Without consideration like money, service a deal/contract cannot e formed between the two parties. It is paramount that each and every deal consist of a consideration to do something or to not do something in return of the favor by the other party. Once the parties form the deal, the next step is to get it down in a written format so that the same can be challenged , and argued in a court of law. An oral deal does not stand any status or character in the court of law. Part 2 This part of the paper is divided into three questions. The first question is as follows: Advice Jay on his position: Jay had been given the power to run the business and saw an advert for a sale of Bankrupt stock in the warehouse. He decided to place an order for 500 Singing Santas from the warehouse and promised them that he will be at 7 to pick them up. However, when he arrived the stock has been sold to someone else. Applying the principles of contract law, at the outset, Jay saw an advert which was an invitation to offer and not an offer it totality. Following is the definition of invitation to offer: â€Å"invitation to treat – that is, an invitation for other people to submit offers. Some everyday situations, which we might think, are offers are in fact invitations to treat: Goods displayed in a shop window or on a shelf. When a book is placed in a shop wind ow priced at ?7.99, the bookshop owner has made an invitation to treat.† Understanding from the above definition, the advert in the warehouse was a merely invitation to offer and not an offer. Once Jay placed an order of 500 Singing Santas, he offered his willingness to purchase the bankrupt stock, and not vice versa. This means that the offer was made by Jay and not by the warehouse owners. The next step in this contractual relation is the acceptance of the offer. The warehouse owners were made an offer by Jay, and it was upto them to accept it or withdraw. As obvious from the facts, they withdrew the offer by selling the bankrupt stock to someone else. Therefore, there is no legal defense in this case for Jay. There is no breach of contract as there was no contract formed in the first place. b) After leaving, Jay bought a handful of flashing fairy lights and put it up on sale. When he put it on sale he had written a disclaimer saying that goods will not be refunded until and unless there is a defect with the object of purchase. There were three customers who were not happy with the purchase, and this part of the essay shall deal with each and every customer. Elena is the first distraught customer, who claims that the lights do not flash. This is a genuine defect with the goods and this falls within the ambit of the disclaimer written down by Jay. Therefore, Jay should refund Elena immediately. In the second case, Henry

Music, Performance and Authenticity in Films Essay

Music, Performance and Authenticity in Films - Essay Example In addition, rock film performance has been encrypted from Quadrophenia, the album of the group The Who, to the film bearing the same name as the album. This transformation of recorded audio music pieces into films did not bring any disparaging change in the rock culture; rather, it boosted and made rock performance more livelier and entertaining, attracting more and more enthusiasts. Initially, rock artists recorded music without the inclusion of videos and other display features that would make it more appealing. While rock music performance concentrates on the rock culture promotion through recording the audio pieces, the film performance is greatly involved in the use of visuals to promote the same culture. This paper will critically compare and contrast the differences and similarities in the music, the authenticity, and self-conscious film performances of Pink Floyd and The Who. Pink Floyd – The wall The film Pink Floyd-The Wall was adapted from the album The Wall. The w riter of the film utilized the music lyrics to convey different themes as represented in the original songs. Some of these include the theme of isolation, cruelty, insanity, fascism, and hard mentality as fashioned by the wall. Notably, throughout the film, there is an expression of a sad and brutal mood of the music as depicted by the author’s feelings in his school day poems. ... While music metaphorically illustrates this social alienation, the film projects the character into the real emotional situation (Kaarki 2002, p. 184). There is an illustration of severe emotional suffering that revolves in the abyss of loss and isolation resulting from fatherless childhood (due to his father death in the British war) and the domineering, overprotective, and phobia-filled love of his mother. As noted, Pink built a mental wall that could allow him to live a life free of the emotional troubles caused by the failing education system which concentrated on producing societal compliant sycophants, by police brutality, estranged marriage, and uncontrollable drug abuse (Pink Floyd 1982). Remarkably, not only does the film performance demonstrate the ability of the writer to describe the moods of the song but also evokes the emotions of the film viewers. Through the evaluation of the harmony of the film performance, viewers are able to observe the relevance of the musical per formance which develops and maintains the psychological wall built by Pink to run away from his pains. Significantly, the film performance brings out a better understanding of the music themes with an illustrative depiction of the continuous piling of problems as one runs away from their effects rather than finding solutions. In the film, the author excellently matches the themes present in the music with the film performance, giving insightful, enigmatic, and arresting images. Factually, critics have been of the view that the lifestyle as described in the song perfectly suits the film performance with its spectacular ability to conjure captivating and memorable images that elicit lingering and

Would the decriminalization of marijuana have a net positive or Research Paper

Would the decriminalization of marijuana have a net positive or negative impact on Canadian society - Research Paper Example Nevertheless, its use in the medical community is being supported because apparently its benefits to patients would far outweigh its risks. Its use in Canada is considered a crime and harsh penalties are imposed among violators. Suggestions for its decriminalization are currently being discussed. This paper shall now discuss whether or not the decriminalization of marijuana would have a net positive or negative impact on Canadian society. It shall also discuss who would benefit and who would lose from its decriminalization. This paper is being undertaken in order to establish a clear and comprehensive understanding of marijuana, its implications for use, and its overall impact on society. Discussion Under the 1923 Opium and Drug Act, marijuana was classified as an illegal drug and those violating the provisions of the act were liable to face criminal penalties (Khoo). In 1997, marijuana was covered by the Controlled Drugs and Substances Act, and this law is the main legislation which some interest groups are seeking to amend. They cite how the Ontario Court of Appeal was able to decide in favor of the possession of 30 grams of marijuana – mostly for medicinal purposes (Khoo). The court argued that banning marijuana would be tantamount to violating the Canadian Charter of Rights and Freedoms. Canada is considered the first nation to apply the regulated medicinal use of marijuana; however, the Marijuana Medical Access Regulations did not adequately consider the issue of recreational use (Khoo). In 2003, a new ruling by the Ontario court decided that the possession of small amounts of marijuana was not anymore valid; the courts noted how hundreds of thousands of young Canadians were engaged in recreational marijuana use and that no firm legal provisions on the use of the drug have been set forth by the legislators (Khoo). The Ontario Court of Appeals then passed new rulings in order to make it easier for patients to avail of the drug for medicinal purposes. To this day, this issue has yet to be settled in Canada (Khoo). And this issue involves relevant players including the patients who need marijuana for medicinal purposes, the recreational drug users, the doctors who prescribe the substance for their patients, the legislators who have the burden of deciding on passing (or not passing) the law to decriminalize marijuana, police officers and law enforcement authorities who are enforcing the law, and the international community. These individuals and social groups are all stakeholders in the resolution of the issue on the decriminalization of marijuana. For those who use the drug for medicinal purposes, they believe that decriminalizing marijuana use would largely be beneficial to them because they would be able to benefit from the medical benefits of the substance – effects which they would not be able to experience from any drug or any other intervention. Decriminalizing marijuana use can be beneficial for the following purpos es: to stimulate appetite of HIV/AIDS patients and to relieve cachexia of cancer patients; to relieve and reduce nausea and vomiting induced by chemotherapy among cancer patients; to reduce the intraocular pressure for glaucoma patients; to provide analgesic effect for cancer patients; and to relieve the spasticity and nocturnal spasms caused by neurologic and movement disorders (Yambura, pp. 2-4). For these reasons, patients positively impacted by marijuana use would stand to gain from the decriminalization of marijuana. The main issue being taken with the decriminaliza

The Relationship Between Health, Healing, and Religion Term Paper

The Relationship Between Health, Healing, and Religion - Term Paper Example Different religions utilize different ideas about the healing. Some utilize the spiritual activities while some utilize the scientific approach and give medicines to heal a sick person. The medicine might come from the plant source or might be a modern medicine. The modern scientific community has taking interest in all the healing techniques that are utilized from the religious point of view and some of the religious activities considering the health and healing got importance due to the positivism towards the society and religion. In general, illness is the phase of a body or mind where it is unable to work in its capacity or body or mind is unable to perform that it has the capacity of. However, different religions views illness differently. In the Voodoo religion, the believers have believed that an illness is caused due to the evil or bad sprits or sometimes sprits of the family members. Voodoo has concepts that â€Å"lwa† are the sprits that make an interaction with the people and are able to cause bad thing to the people. In the Kung religion, illness is caused by the dead Kung, the dead ancestor of a person or sometimes gods penetrate the illness into the person (Kingsley 41). In this way, in this religion it is very important to cure and heal the sick to try best to make the person healthy. Shaman has also the similar conditions that consider illness a spiritual deal of the person. In the shamanism, people believe that there is an invisible world around us and invisible creatures are present around us that are sprits. The sprits are able to put illness in a person. Yoga involves the practices that are capable of making the disease away from the practitioner. The practitioners have the faith that certain forces that block the life can cause illness. How is it best addressed? In different religions the illness is expressed in different forms and sometimes it referred to as the spiritual illness. In the religion ‘Kung’ people give spec ial important to the sick because they believe that if the person dies of illness (Kingsley 42), he will spread the illness or give it to the other person. In the Voodoo, illness is paid a significant attention and 60% of the activity in the religion is to heal the person. In the similar way the yoga also addresses the illness in a proper manner and to remove it from the person’s body and soul special attention is required. Yoga is all about the methods that increase the blood flow in the body, increase the brain function and make the body flexible and healthy. The practices utilized in the yoga can help maintain the blood pressure and reduce the cholesterol that helps maintain the health of the heart and the lungs. What kind of healer is needed? In almost all the religion, some of the persons of the society work significantly to preach and heal the persons like the priests, which make give their lives to the religion to protect and preach the religion and make people underst and what their religion is. In the similar way, in all the religion people consider then sacred and they are the person who work to heal the persons. In Voodoo, the priesthood presents both is man and women and these persons heal the ill persons with some rituals, herbal medicines and now a day the scientific medicines. Houngan is the word for the male priest and Mambo is the name of the female priest. Similarly, a healer is required in the Kung to make the illness away from the people and he can be able to fight with the gods to pull the illness away from the person, in this way, a healer should be strong both mentally and physical. In the similar way, in Curandero’s healing mechanism, saints play the role of the healer. In

Atmospheric Conditions Compared to Indoor Air Pollution Essay Example for Free

Atmospheric Conditions Compared to Indoor Air Pollution Essay There are many different air pollution problems that exist today. Ozone depletion, climate change conditions, volcanic eruptions, acid rains, and motor vehicle exhaust to name a few. One particular problem that is wide spread is â€Å"acid rain†. Acid rain is an effect caused by natural as well as man-made pollution, with a mixture of wet and dry deposited materials in our atmosphere containing nitric and sulfuric acids higher than normal amounts. Increase of these chemical compounds is caused from exhaust from burning of fossil fuels such as automobiles, electric power generation as well as volcanic eruptions and activity and natural plant decay. www. epa. gov). Nitrogen oxides and sulfur dioxides are emitted from power generation and other sources where acid rain is created when these gases react with other components of the atmosphere, water, oxygen, and other acid compounds resulting in creation of sulfuric acid and nitric acid. Prevailing winds cause these particulates to spread out over long distances over wide spread regions. These acid rains are of environmental and quality of living concerns. Water vapors from acid rain can enter into the homes through open windows, poor insulation around doors and windows, ventilation systems and vent pipes that can affect air quality of the home as well as outside environments. Some of the environmental effects of acid rain can cause paint to peel, steal corrosion of bridges and structures, erosion of stone buildings and statues affecting the quality of air and life in residential and commercial areas. (http://en. wikipedia. org). Ground water supply sources can become contaminated and affects everything the water is used for. Acid rain can have harmful effects on animals, aquatic life, plants and their ecosystems. The effects are greater lakes, streams, wetlands and aquatic environments. Acid rain causes waters to become acidic and absorb aluminum deposits from runoff from the soils around them. The combination of this and the results of the chemical reaction make the water toxic to shell fish, crayfish and other aquatic species. Even though some species tolerate acidic waters, interconnected ecosystems that impact certain species will eventually impact others along the food chain. The damaging effects of acid rain on plant life are quite dramatic. Damage to forests in higher elevations is more apparent than lower lying regions. The acid content is at a higher level and leaches the soil nutrients and releasing aluminum making it harder for trees and plant life to absorb water. In lower lying areas the effects of acid rain, environmental stressors, and poor soil quality on plant life and trees cause them to become weaker where they cannot tolerate temperatures too cold or too hot, resist infestation of insects and susceptible to disease, and inhibit the ability to reproduce. Some areas the soil is better equipped to neutralize the acids in a â€Å"buffering capacity† that varies from region to region. (www. environment. nationalgeographic). By curbing the use of fossil fuel burning will decrease the forming of acid rains and conservation efforts of individuals. Not only is acid rain damaging to the outside environment, but also on inside air quality of the home. Physical contact of acid rain from rain droplets or swimming in acidic recreational waterways has little effect on human health. However, the pollutants that cause acid rain are associated with increasing the risks of health problems including respiratory and other illnesses. These pollutants infiltrate into indoor living spaces and cause many respiratory illnesses, breathing disorders including asthma and can even cause death. By improving ventilation systems and air purification techniques of the home, using better insulation and installing energy efficient windows and doors will greatly improve air quality of the home and diminish the risk factors from outside air pollution. http://greenliving. nationlageographic. com). Laws, such as the Clean Air Act has improved greatly the air quality. The EPA, through monitoring, and imposing strict guidelines on release of toxins in fossil fuel burning industries. The EPA has reported that from 1980 and 2009, the national average of sulfur dioxide content in the air has decreased by 76 percent, and the amount of nitrogen dioxide decreased by 48 percent. Congress has also created the Acid Rain Program Title IV of the 1990 Clean Air Act Amendment. Some of the EPA’s initiatives are the SO2 Reductions and Allowances Trading under the Acid Rain Program involves Phase 1, which imposed tightened annual emission limits of higher emitting plants by installing pollution control devices. Allowance trading systems contributes the low-cost rules of exchange minimizing government intrusions and allowance trading to prepare for a viable compliance tool in reduction of SO2. (www. epa. gov). Another asset implemented by the EPA and Congress in the Clean Air Act Amendment is the reduction of NOx beginning in 1995 through 2000 as a two phase program concerning coal-fired electric electricity utility boilers. Phase 1 covered Group 1 Boilers and Phase 2 covered Group 1 and 2 boilers. Group 1 boilers are tangentially dry bottom fired boilers which has a tendency to give off higher NOx concentrations than Group 2 wet bottom wall fired boilers. Although the NOx reduction program incorporates many of the same characteristics as the SO2 program, it does not include allowance trading or caps the NOx emissions. www. epa. gov). The EPA also requires participants of programs to install, monitor and report data so tracking of the progress can be compiled on quarterly, semi-annually, and yearly bases. Monitoring devices known as CEMS (Continuous Emissions Monitoring System) are required to be installed and maintained by the participants. In the event that data is not compiled or not reported during a reporting period, the applicants will be considered non-compliant and the units deemed out of control for that period and fines incurred to the applicants. (www. epa. gov). The EPA requires any new or upgraded boilers or generating plants to install pollution control devices to capture, or remove sulfur before burning the fuel, and stack collectors for NOx particulates. There are several types of pollution control devices in use, and, depending on the fuels burned, amount of fuel burned, boiler types, amount of electricity produced and type of â€Å"stacks† used for venting on which device will meet the appropriate application. With the aide of the EPA and other government and private pollution control departments involved our air quality has improved greatly in the past few decades. With contributions of these departments and each individual persons working together to improve air quality of our open spaces and within businesses and homes will bring us that much closer to improving our world air quality for the new generation growing now, and even better for future generations. Keeping due diligence in our efforts ensures the planets recovery not only in air pollution, not only, but also our environment as a whole improving quality of life for all organisms large and small.

The House of Mango Street by Sandra Cisneros Essay Example for Free

The House of Mango Street by Sandra Cisneros Essay The House of Mango Street is a story written in vignettes, which shows how a girl grows up and how she is maturing. In this story there are some vignettes that specify when she is growing up and that show some of steps that take part as people grow up. The House of Mango Street is a coming of age story where Esperanza, the protagonist, is growing up as the story progresses. Esperanza is a girl that has is sort of poor but not completely. They have moved from place to place until they settled at a house in Mango Street when she was eight years old. There she starts to grow up and becoming more mature. In a vignette called hips she discovers she starts growing hips. Then she with her sister and friend start telling each other why women grow hips. This shows that Esperanza is starting to become a woman. This is because she is starting to grow hips and that is an important change and sign that a girl is indeed growing up. In addition, she is now aware that she is becoming a woman and is starting to develop. This shows that because she starts telling his two sisters and her friend about her growing hips. This is because she is interested and exited about the fact that she now starts to have hips. Furthermore, they start to discuss and argue about why women have hips. This shows that they as girls are growing up, but the things they argue about still show that they are not so mature but start maturing. This is because they still have childish beliefs about why they grow hips. Hips tells us how Esperanza is growing up and they start the maturing process. Esperanza as we know is a sort of poor person and she has no money to buy too many things. There is a vignette called chanclas were she starts to feel ashamed of her shoes that were old and ruined. This shows that she is starting to be aware of how she looks and if she looks fine or bad. This is because as she starts to mature and grow up she starts to develop more vanity. In addition, she starts to notice that boys are looking at her and that makes her try to be as beautiful as she can possibly be. This shows that as she matures, and as she starts to notice boys and vice versa she feels the urge of being attractive to them and to grab their attention. This is because she knows that to get married or to attract boys she has to be  beautiful enough for the boys. Furthermore, as the vignette develops it says that she in the urge of trying to look good, and starts to hide her shoes under her dress. This shows that she is aware that people are looking at her and makes her feel uneasy about her shoes. This is because she sees a boy looking at her from the other side and it sets her shame wild trying to hide the shoes. This vignette shows us how she starts to feel ashamed of her things and how much she cares about her appearance. The House of Mango Street is a story written in vignettes, which shows how a girl grows up and how she is maturing. The story shows us how Esperanza, the protagonist, changes from a girl to a woman. For me the story was a little confusing because of me being a boy and the story about a girl. For the conclusion the story was a coming of age story that tells us the side that we dont know about people like Esperanza and how they grow up.

How does early childhood attachment affect child development

How does early childhood attachment affect child development 2- Describe three important contributions Freud made to the field of human development. How does early childhood attachment affect child development? Describe the relationship between temperament and best fit parenting. Freud suggested that the development occurs through a series of psychosexual stages: Oral stage (first 18 months of life): Infants main source of interaction occurs through the mouth. Infant receives pleasure from oral stimulation through sucking. The infant also builds a sense of trust and comfort through this oral stimulation. Anal stage (ages 1.5 to 3.5): Childs pleasure centers around anus and elimination. Phallic stage (ages 3 to 6): Child discovers the differences between males and females. Childs pleasure centers on genitals. Child begins to identify the same-sex parent. Latency stage (ages 6 to puberty): Child enters the school and has other interests like hobbies and friends. Sexual energy is directed into other areas such as social and academic areas. Genital stage (from puberty onward): Individual has sexual interest in the opposite sex. Freud believed in the importance of the unconscious mind and childhood experiences. He divided the mind into two parts: Conscious mind: includes all the things we are aware of. Unconscious mind: includes feelings, ideas, and memories that we are not aware of. Most of the unconscious contents are undesirable, such as feelings of pain and fear. Freud suggested that the unconscious mind continues to influence our behavior, even though we are unaware of these influences. According to Freud, the human personality is composed of the following three elements: Id: the only element of personality that is present from birth. This component of personality is totally unconscious. The id is the source of all psychic energy, making it the primary component of personality. Ego: is the component of personality that deals with reality. The ego develops from early childhood experiences. The ego operates in both the conscious and unconscious mind. The ego functions to fulfill the Ids desires in the appropriate time and place. Superego: is the component of personality that senses the right and wrong. The superego offer rules for making judgments and functions to improve our behavior, it inhibits all unacceptable desires of the id and exert effort to make the ego act idealistically rather than realistically. Attachment is an emotional bond between infant and caregiver. Attachment is to seek contact to another person, to feel safe when that person is there and to feel uneasy when that person is missing. The important aspects of attachment are trust and comfort, in contrast feeding is not an important aspect. Children develop different styles of attachment based on interactions with their caregivers. Four attachment styles have been recognized in children: Secure child: walks around freely when the mother is present, engages with strangers, will be disturbed when the mother leaves, and happy to see the mother return. The caregiver of a secure child is sensitive to the childs needs. Insecure-resistant child: resists closeness, dont explore or engage with strangers even when the mother is there. When the mother leaves, the child is extremely upset. When the mother returns, the child will push away if the mother offers comfort. The caregiver of an insecure-resistant child is not always available to the child. Insecure-avoidant child: pay no attention to the mother, showing little emotion when the mother leaves or returns. The child will not explore much. Strangers are treated in the same way as the mother. The caregiver of an insecure-avoidant child is rejecting. Insecure- disorganized child: shows insecurity by being disorganized and frightened. With new experiences the child may be afraid and confused. The caregiver of an insecure- disorganized child usually abuses the child. As a conclusion for improving the childs development, caregivers should be sensitive and always available to meet the childs needs. Temperament is an individuals behavioral manner and the way he reacts to emotions. Temperament influences the babys initial response to his environment. The ways in which the family responds to a baby are inclined by that babys temperament. The three basic styles of temperament according to Thomas and Chess (1977; 1991) are: Easy babies (40 %). Positive temper, happy, launches regular routines in infancy, adaptable to new experiences, and curious, Slow-to-warm-up babies (15 %). Inactive to the environment, has low adaptation and withdraw from new situations. Difficult babies (10%). negative temper, fearful of strangers, slow to accept new situations, easily displeased and launches irregular routines in infancy. It is the mix between parent and child that concern. This mix is known as Goodness of fit which refers to the balance between a childs temperament and the environmental stress the child must deal with. The interaction between parents and the child will certainly affect the childs development. The following table shows the different parenting styles: Parent style description Authoritarian (very strict) Extremely controllable, stress obedience, refuses discussions. Authoritative (moderate) Allow children to learn from their own mistakes, firm, kind, allow discussion, and give confidence to their children. Permissive (kind) Exert little control, dont set rules and dont demand high levels of behavior. Uninvolved Demand very little and react minimally. Parents have to consider the childs temperament and respond correctly to it, in order to improve the childs behavior. Parents should imply the following to achieve the best fit parenting: Be sensitive to the childs characteristics. Be flexible in responding to the childs characteristics. Avoid labeling the child negatively. Allow discussions, and listen to the childs point of view. Encourage the child to find solutions to problems. Respect the childs opinion but also be firm in your decisions. Set your expectations and limits to help the child develop self control. There are differences among children, dont compare children and respect the strong points of each child.

Live Flesh by Pedro Almodovar: Scene Analysis :: essays research papers

Pedro Almodovar’s 1997 film Live Flesh (Carne Tremula), is rich in both visual and story elements, making in the perfect candidate for a scene analysis. Upon writing this paper, however, this was almost to my disadvantage. I watched it through and whittled it down to about five scenes I considered analyzing. This self-challenge is a testament to not only this film, but Almodovar’s whole body of work; he has created so many thoughtful, intricate, and all together entertaining films in his career, I had to somehow forgive myself for just choosing one short scene out of only one of his movies for analysis. So, without further ado, here is an analysis of a scene from Live Flesh. The scene I chose to analyze is the one in which David (Javier Bardem) returns home from a basketball game, only to find out his wife, Elena (Francesca Neri) has slept with another man. It occurs at roughly an hour and 17 minutes into the film, and is relatively short, but extremely powerful. The opening shot to the scene of Elena returning home from her tryst early in the morning. She enters the shower and begins to smell her naked body, seemingly bringing back memories from the previous night. Every time she inhales, she lets out an orgasmic sigh, which makes it clear to the audience exactly what she is recalling. With each sigh it seems that she not only had an amazing sexual experience, but that she also doesn’t regret it at all. This is until her last deep breathe. After this, she pauses for a beat, and in this moment, a look of full realization about the events of the past night washes over her face. This moment is fleeting, however, because right when she turns the shower on, she closes her eyes, as if she is recalling not only the scents of the night before, but even the sights and sounds. As soon as she stops moving and cracks a smile, the shot quickly changes to David’s cab pulling up. The cab symbolizes David’s dependence, in that all he can do is sit in the back and tell the driver where to go, showing that his disability has forced him to become dependent on so many different people. The fact that David’s cab was shown right as Elena began to smile shows that David’s dependence is preventing Elena from truly being happy, which I’m sure is a struggle in any relationship involving a handicapped person.

Lack of Male Intimacy :: Feminism Feminist Women Criticism

The Lack of Male Intimacy As I sit in the auditorium of the school I attend, I listen to the speaker of the day make his fatal mistake. He has done well up until now, relating to us only facts and ideas. Now, he has suffered from a lapse in judgment, and seems to have forgotten his surroundings - an all male audience. He has the audacity to display genuine, vulnerable emotion. I wait for the response I know he will get. The sound fills my ears. The all male audience brings forth a sarcastic and mocking chorus of "awwwwwww." One could not imagine the same event transpiring in an all female group. It is pretty much commonly accepted that men do not show emotion. It is pretty much commonly accepted among men that men should not show emotion. The group in the auditorium had bought into this stereotype. Most of them were probably not accustomed to seeing men display their emotions, and it made them nervous and uncomfortable. So, they reacted with the two most common defenses used when one is uncomfortable in the face of something one does not understand: criticism and humor. In "Locker Room Talk," Stephen Dunn notes that the danger of a man having sex is the possibility of "admitting he felt something...". So, Dunn believes that many males see the display of emotions as something along the same lines as an admission of guilt. Something they would try to avoid in most situations. I agree. I think it is pretty clear that men, as a rule, have trouble sharing their emotions. So, the real questions are, "why do m en have this problem," and "can things change, and how?" While there are probably a few reasons for this condition, and the answer cannot be given with absolute certainty, I think the answer can be found by looking back through time. This abstinence from intimacy is probably as old as the family structure. When humans began to settle down as families, responsibilities were assigned in the way that the family could survive the most efficiently. The children would have to be taken care of, and food would have to be provided. It made sense for one person to handle one of the two major tasks. It was logical for the mother to attend to the children, because she had carried each of them for nine months, and was required to breastfeed them.

The Nyphs Reply Poetry Interpretation Essay -- essays research papers

Poetry Analyzation Essay   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  What Is Love Worth?   Ã‚  Ã‚  Ã‚  Ã‚  A typical situation, in these modern times is the picture of a man and woman living together without marriage. Even more common than this is a man claiming his love and life for a woman then moving on after he becomes bored with her. This idea between man and woman hasn’t changed over the years. In â€Å"The Passionate Shepherd to His Love†, by Christopher Marlowe and â€Å"The Nymphs Reply to the Shepherd† by Sir Walter Raleigh, shows this battles. The question is if the love is real or superficial, and also if it’s everlasting true love.   Ã‚  Ã‚  Ã‚  Ã‚  The idea that love or infatuation is so strong that it can take man’s emotion and lust to blind him and tool him into believing it’s love is a terrifying thought. Marlowe begins a plea with the Lady, by promising to â€Å"all pleasures prove†. His first proposal only offers experiences that can be shown or felt by either lust, or lies. Figuring he can use his honey-sweet talk, to win her over, then never be held accountable for his promises. The shepherd next moves to complimenting her beauty and by speaking of â€Å"coral clasps and amber studs†, which of course can’t compare to her. Speaking only of gifts that are beautiful alludes to his fascination with her own beauty. Material gifts that can only be used and remembered in the p...

How does Miller present ideas about settling for half in the play? Essay

One of the strongest messages that Miller presents about ‘settling for half’ is that there is a need to settle for half between Sicilian morals and the US Law system. At the beginning of the play, the chorus figure, Alfieri, states how ‘we settle for half and we like it’, and this ‘settling for half’ is again repeated at the end of the play. It is likely that Alfieri is a figure of authorial intrusion, and so these views about ‘settling for half’ are likely to be Miller’s own. Because Alfieri is a ‘lawyer’, he is naturally a symbol of the US Law system. He is described to be ‘in his fifties, turning gray’. This is possibly used by Miller to suggest that the US Law system is 50 years out of date, and the fact that he is ‘turning gray’ could be symbolic of how the US Law System is becoming increasingly out of date. Furthermore, the illustration of ‘gray’ hair could be a blend between the ‘black and white’ US Law system, and so, through this, it is likely that Miller is trying to convey his own thoughts of the workings of the US Law System. However, Miller also criticises the Sicilian moral code, by portraying Marco’s downfall. Initially, the audience are told that Marco arrives to earn money to provide for his family. However, his belief in Italian Morals, and the belief that ‘all the law is not in a book’ results in him killing Eddie, and therefore, having no choice but to be deported back to Italy. He even states that ‘in my country he would be dead now’, and this is used to highlight the severity and ruthlessness that the Italian Morals can operate with. Through the fact that neither men get what they want through the US Law system, and Alfieri states that ‘there is nothing you can do’ and that ‘the hearing is just a formality, but also that the reliance on Italian morals leads to the downfall of both men, it is possible that Miller is trying to showcase the need to settle for half between the US Law system and the Italian moral code. Furthermore, Miller portrays messages about settling for half through the portrayal of Beatrice, and especially suggests ideas about the need to settle for half between the roles of a loyal housewife and a strong female personality. From the outset of the play, Beatrice is portrayed as a loyal, somewhat stereotypical 1950s housewife. She is seen to ‘start into the kitchen’, and state that ‘I was gonna wash the walls’, showing how she is responsible for housekeeping, but she is also portrayed as independent in the way that she is seen to do these things without any prompting or command. However, she is also portrayed as someone who is not afraid to challenge Eddie. Throughout the poem, she is seen to say phrases such as ‘She’s no baby no more’ and ‘When am I gonna be a wife again’. The fact that she questions somewhat masculine responsibilities such as Eddie’s sexuality and the future of the children is somewhat unstereotypical of a 1950s housewife, and so, this would be somewhat shocking or surprising to the audience. In fact, at the end of the play, Beatrice’s ‘final thrust is to turn toward him instead of running away’, which shows that she is the only one in the play to challenge Eddie’s questionable behaviour, in a play full of ‘turning away’ and ‘covering the eyes’, and this leads to Beatrice assuming a sort of ‘heroine’ role in the play, and in fact, Beatrice’s actions are those which bring about Eddie’s catharsis – characteristic of a Greek Tragedy-style play. This causes Eddie to realise his love for Beatrice, and while he dies, he calls ‘Oh, B, My B’, which is indicative of the rebirth of Eddie’s affection for Beatrice. However, this unstereotypical yet powerful behaviour leads to Beatrice becoming quite a tragic character in the play, with Eddie dying in her arms, and so, Miller is possibly trying to suggest that there is a need to settle for half between the roles of an independent powerful figure and a loyal housewife. In addition, Miller presents the need to settle for half through the presentation of Eddie. Initially, we can see that Eddie’s love for Catherine may not be purely platonic, as he greatly enjoys the event of Catherine showing off her new dress to him, and states that he thinks it’s ‘beautiful’. It is down to the actor whether this phrase is mutter subconsciously or not, but it is evident that Eddie’s emotions and feelings for Catherine are possibly overflowing and he cannot keep them in. However, when Rodolpho enters the scene and essentially takes Catherine away from him, Eddie is unable to ‘settle for half’, and his fatal flaw, which is his desire for total control, causes him to inform on the immigrants, which eventually leads to his own demise. The fact that he is unable to settle for half in a familial loving relationship with Catherine, and still allow Catherine herself to be in a loving relationship with Rodolpho is essentially the deciding factor in Eddie’s death, and the actions of Rodolpho, as well as this inability to ‘settle for half’ is what essentially accelerates Eddie’s tragic demise and his catharsis. Perhaps, through this, Miller is trying to suggest that an inability to settle for half will only in our demise.