Antidepressant Drugs: Types, Effects and Developments

Antidepressant Drugs: Types, Effects and Developments Introduction: Depression is one of the parts of mental disorder which is affecting millions of people worldwide. [6] The logical analytical approach used in clinical and forensic toxicology for the identification of one or more Antidepressant Drugs as a cause of intoxication is largely based on both simple and fast screening methods which cover their extraction and identification including detection of their possible metabolites is been tried to reviewed. Antidepressant: Types Functions Antidepressant drugs cover many varieties of drugs having different modes of actions like [16] etc. Adverse effects Antidepressants are supposed to increase the risk of suicidal thinking and behavior in children accompanying other disorders like depressive and psychiatric disorders. [17] [18] [19] The European Medicines Agency showed warning on the use of Antidepressants which might be increased the risk of suicidal behavior in children and adolescents. [31] TCAs and MAOIs can produce similar kind of side effects like Tachycardia, blurred vision, urinary retention, cardiovascular effects , hypotension, respiratory depression, coma etc. [4] Thus, these drugs may be responsible for the fatality and intoxication and can produce severe effects. Also their growing rate all over the world may show threatening effects which is the matter of global concern. Thus, its increasing prescription rate and adverse effects resulting in a growing interest for determination methods in the Clinical and Forensic field. Biological Samples use for the Screening of Antidepressant Drugs Biological samples are the basic requirement of Forensic and Clinical Toxicology as it solve several related questions which make basis of judgement, consultation and expertise for the above two fields. The matrices generally encountered for analysis are urine [34], hair, nails, vitrous humour etc. The most important biosample used for analytical purposes is Blood. It is a liquid connective tissue of the body composed of different kinds of blood cells suspended in a fluid called plasma. Blood (plasma, serum) is one of the best choices for quantitative and qualitative measurements of drugs of interest because pharmacological or toxicological effects correlate more effectively with their concentrations in blood. [42] Another important biological sample is Urine which is a widely used specimen employed for screening, identification and testing of unknown drugs, forms in high amount, readily available, easy to collect and contains much useful information about the major metabolic functions of the body. [43] Taking Forensic concept in postmortem cases if the positive finding of drug occurs in urine shows that the detected substance or its parent compound might be present in the body some time before death [48] A next alternative to the blood and urine specimen found is Oral fluid for their applications in therapeutic and toxicological drug monitoring [54] When analytical studies get concern with long duration of exposure to the detection window Hair could be as a best biological matrix for the identification and analysis of drugs. It is supposed that drugs or chemicals enter in to hair by passive diffusion from blood capillaries into growing cells and the mechanisms of substance incorporation, analytical methods, result interpretation and practical applications of hair analysis has been well reviewed showing practical utility of hair analysis. [62] Except from all the above given matrices one very precise and rarely encountered biological sample is Vitreous Humor. Its a fluid found between the lens and retina of the eye proved to be the best choice for analytical examinations as it is relatively well isolated and protected from putrefaction. Two different fatality cases were reported where the extraction of drugs is done from Vitreous humor. One case has been reported of citalopram fatality where the extraction of drug is done from Vitreous humor yeilding concentration of citalopram (SSRI) less than 0.04mg/L and in second case venlafaxine fatality is reported where postmortem analysis revealed the concentrations of Fluoxetine (SSRI) and its metabolite Norfluoxetine as 5.2 mg/l and 2.2mg/l respectively. [64] Other than these specimens, body tissues like liver [71], cerebrospinal fluid etc. canalso encounter for toxic and therapeutic drug monitoring biological matrices. Techniques for Sample Preparation Several methods have been published for the determination of one or more antidepressants in biological fluids for therapeutic monitoring or for toxicological purposes. For making biological samples suitable for analytical purposes some treatments should be given to overcome the matrix effects such that the other materials should not interfere with the analytical separation that is the extractability of the analytes in the sample inturn the results of the analysis. [96] These kinds of techniques are rapidly gaining acceptance in bioanalytical applications to reduce both time and labor required to produce bioanalytical results. Thus we can say that these methods give a high selectivity and sensitivity over a wide dynamic range and contribute in formulating very fine detection techniques. Some Commonly Prescribed New Generation Antidepressant Drugs and their Metabolites Several new antidepressants that inhibit the Serotonin (SERT) and Norepinephrine transporters (NET) have been consistently use for therapeutic purposes. [108] are showing below. Sertraline is an effective and highly utilized SSRIs group of drug and â€Å"its principle metabolite is desmethylsertraline.† [41] Another SSRIs group of Antidepressant drug, Fluoxetine has been used worldwide in the therapy of major depression. (3) â€Å"It is primarily metabolized via N-demethylation by the [117] Citalopram is a selective and potent serotonin reuptake inhibitor. [78] Another very important group of Antidepressant drug is SNRIs which includes drugs like Venlafaxine which inhibits serotonin, noradrenaline, and to a lesser extent dopamine reuptake. [39] In the majority of published analytical methods for determination of Antidepressant drugs, gas chromatography and high-performance liquid chromatography, in combination to different kinds of colums operating under different separation conditions, mobile phases and detectors has been used. These were tried to review in the table given below. With high-performance liquid chromatography the analysis is done by using different kinds of detectors like Fluorescence detector, UV detector, Mass detectors etc. For ex. a high-performance liquid chromatographic method is described for the determination of serotonin and norepinephrine reuptake inhibitor (SNRI) in human plasma where Fluorescence detector was used. [140] A survey of most recent multiresidue analytical methods developed for the determination of different kinds of Antidepressant drugs in different types of biological test matrices with their specific cleanup procedures including the choice of mobile phase, stationary phase, detector system and validation data is summarized in the tabular form below. TABLE Abbreviations:APCI atmospheric pressure chemical ionisation, ESI eletrospray ionisation, LLE liquid-liquid extraction, LOD limitation of detection, LOQ limit of quantification, SIM single ion monitoring, SPE solid-phase extraction, SRM selected reaction monitoring , ESI electron spray ionization, UV ultraviolet, FD fluorescence detector, LC_TMS liquid chromatography tandom mass spectrometry, LC_MS, GC_MS gas chromatography mass spectrometry, RP-HPLC reverse phase high performance liquid chromatography. Thus, this table is framed for the comparative study of the major analytical approaches used in the detection and identification of Antidepressant Drugs and their metabolites in different biological matrices in order to develop the new methods with the aim to increase the sample throughput and to improve the quality of analytical methods. Thus, analytical methods for the detection of ADs and their metabolites in biological matrices are of interest in the field of forensic toxicology which involves the analysis of drugs and poisons in biological specimens and interpretation of the results to be applied in a court of law. Several analytical methods have been developed for analysis of these antidepressants in biological matrices. These methods provide a good precision and accuracy over the entire analytical range and allowing the development of very rapid and efficient analytical methods by using newer kind of analytical techniques. Conclusion: As the subject of Antidepressants toxicity is evolving, newer methods for their analysis are also evolving. However, some classes of Antidepressants drugs are less toxic and well tolerated but can lead to Toxic or Fatal Drug interaction. The research in this field is very active and results in a large number of papers published every year. Therefore they may be encountered in many Clinical and Forensic cases. Therefore, this review is mainly aimed to target latest analytical and instrumental methods used for detection and characterization of Antidepressant drugs and their metabolites in biological test matrices in turn focus on their toxic as well as therapeutic aspects which would be definitely prove to be helpful in future research and still there is lots of work required in this area as its prescription rate and toxicity is evolving day by day all over the world and by using non-destructive and sophisticated newer instrumental techniques we can also built a new strategy of examina tion and investigation for the drugs of interest. However, in this study, a decision about whether a studys findings are positive or negative cannot always be based strictly on the primary outcome measure. Future trials should also consider, using different kinds of detecting techniques and methods which would allow for easier comparison and interpretation of results across studies as the subject is of global concern and despite the success of such methods there is a continuing need for sustained innovations. Thus, future work in this area will definitely prove to be a promising from both clinical as well as from forensic prospect.

Frankfurt Schools Contribution To Popular Culture Cultural Studies Essay

Frankfurt Schools Contribution To Popular Culture Cultural Studies Essay The idea that culture is mass produced came from two German academics named Theodore Adorno and Max Horkheimer. These two intellectuals, who would later begin a cultural enquiry, were members of The Frankfurt School. This institute was established in 1923 and consisted of many other German left-winged intellectuals. It was very much interested in the ideas of Karl Marx and Sigmund Freud and therefore endeavoured to study the emergence of capitalist societies through the exploration of Marxism and psychoanalysis. This is what The Frankfurt School referred to as critical theory. The Frankfurt School, Adorno and Horkheimer in particular, were interested in studying popular culture and the mass production of cultural artefacts which they later referred to as the culture industry. In order to explore The Frankfurt Schools contribution to our understanding of popular culture, firstly we need to ask; what is culture? The word culture suggests a particular way of life, whether of a people, a period or a group. (Storey, 2006.1) It can also refer to the works and practices of intellectual and especially artistic activities. (Storey, 2006.1) The word cultivate was used to refer to the cultivation of land but now it can refer to the cultivation of the mind. Culture plays an important part in how human societies communicate with each other and how the new technological developments which contribute to this create a new type of culture known as popular culture. An obvious starting point in any attempt to define popular culture is to say that popular culture is simply culture which is widely favoured or well liked by many people. (Storey, 2006.4) Popular culture is centred on consumerism and is dominated by money; there is no part of popular culture that one doesnt have to pay for. Popular culture produces products known as commodities which have a use value and an exchange value. A commodity is only a commodity if it can be replaced by something else. Commodity fetishism was an idea that came out of popular culture. Capitalist organisations fetishize commodities and invest them with power that they do not really have. They discourage us from asking where the things we consume actually come from. These companies do not want us to think about this process. The idea that capitalist companies are manipulating the thoughts of the masses about what they consume and the great power that they have leads us to the term mass culture. In a mass culture, industrialised society there are no longer the same traditional values. The idea of an organic community no longer exists. The individual is left more and more to his or her own devices, has fewer and fewer communities or institutions in which to find identity or values by which to live, and has less and less idea of the morally appropriate ways to live.(Strinati, 2004.6) The Frankfurt School argue that the culture industry is killing the desire that might let us imagine a better world. They have an ideal notion of what human beings are capable of. The institute believes that we could never create a better world as long as we are part of this commodity culture. Adorno stated that the culture industry does not give the mass any responsibility for the culture that they are consuming, yet the masses are unaware of this which explains their passivity in accepting it. Although the culture industry undeniably speculates on the conscious and unconscious state of the millions towards which it is directed, the masses are not primary but secondary. . . The customer is not king, as the culture industry would have us believe, not its subject but its object. (Strinati, 2004.55) This point further emphasises the power that the culture industry has on the masses. With living in a culturally industrialised society comes conformity. Conformity replaces the consciousness of the masses according to The Frankfurt School. They believed that the masses are dependent on the culture industry and that the masses themselves are no longer producing culture. Through researching the works of The Frankfurt School, we can understand that the masses are oblivious to the mass controlled culture in which they live due to the face that everything is pseudo-individualised. Products that were being produced by the culture industry were all standardised. This meant that they all had certain characteristics that made them significantly similar. The Frankfurt School, Theodore Adorno in particular, realised that the industry knew that standardised products would sell and therefore they needed to be given a supposed uniqueness to provoke the masses to continue buying them. This was referred to as pseudo-individualism. The Frankfurt School stated that the culture industry created false needs in the pursuit of profit while ignoring the true needs of humans. According to The Frankfurt School the cultural industry and mass culture, . . . shapes the tastes and preferences of the masses, thereby moulding their consciousness by instilling the desire for false needs. (Strinati, 2004.55) They point out that the capitalist industries bring in a lot of profit through what they called waste production. They generated products that, in the opinion of The Frankfurt School, the masses did not need. Masses become so enthralled in the culture industry that their consciousness is overridden. The masses become too interested in the falsehoods that the industry has created and tend to forget about satisfying their true human needs. The school argues that it is due to all of this that the culture industry maintains its stability. With regards to true and false needs, Theodore Adorno once wrote, The indistinguishability of true and false needs is an essential part of the present phase one day it will be readily apparent that men do not need the trash provided them by the culture industry. (Adorno, Theodore W, The Culture Industry revisited at http://books.google.co.uk.p.156 accessed on 27/10/10) Another point that The Frankfurt School has highlighted to us in order to contribute to our understanding of popular culture is that a lot of culture is very homogeneous. They believed that all aspects of popular culture were generic and predictable. They could not fathom the fact that the masses were accepting this constant reproduction of the same thing. They believed that people should want something more; something different and challenging. The culture industry followed a formula. The reason for the formulaic structure of the industry and the way in which its products were produces was because it was successful. This particular formula and method of mass producing standardised products generated profit. When referring to this great power that the culture industry has, Adorno says, Today anyone who is incapable of talking in the prescribed fashion, that is of effortlessly reproducing the formulas, conventions and judgements of mass culture as if they were his own, is threatened in his very existence, suspected of being an idiot or an intellectual. (Adorno, 1991. 79) Critics of The Frankfurt School say that they do not appreciate just how diverse and hybrid popular culture is. They also say that The Frankfurt School invest too much power in the culture industry and that they consider capitalism as being more stable than it actually is. Critics believe that the culture industry has a lot more potential than The Frankfurt School gives it credit for. The term culture has been described by Richard Williams as, One of the two or three most complicated words in the English language. (Storey, 2006.1) Although some agree with this statement, The Frankfurt School has contributed greatly to our understanding of popular culture by highlighting how culture has become commercialised in the pursuit of profit. It points out to us that in a culturally industrialised society, no one thinks for themselves and that they consume this culture because it has been imposed onto them. The authenticity and traditional aspects of culture are no longer present and we can now come to the realisation that we will always live in a culture that is controlled by capitalism and consumerism. Everything that is presented to us, including the false needs that the industry provides is all in the interests of capital and profit. Our ability to understand how the culture industry works is aided greatly by the work of The Frankfurt School. References Storey, John (2006) Cultural Theory and Popular Culture: An Introduction Strinati, Dominic (2004) An Introduction to Theories of Popular Culture (Second Edition) Adorno, Theodore W (1991) The Culture Industry

Schindlers List :: essays research papers

Schindler’s List   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"I knew the people who worked for me. When you know people, you have to behave towards them like human beings.† This was a quote from Oskar Schindler. However, throughout the movie, it didn’t quite seem like he felt that way the entire time.   Ã‚  Ã‚  Ã‚  Ã‚  The movie began in 1939, and Schindler was very into alcohol, womanizing, and making money. He bought a Jewish factory in Krakow called Deutsche Email Fabrik. In order get the resources necessary; he talked to his key contact throughout the entire movie, a Jewish accountant by the name of Itzhak Stern. Stern informed him that Jewish labor was cheaper than Polish Labor. Schindler, of course being interested in having a higher profit, went and hired the Jews, thus beginning his relationship with them. The produced pots, pans, basins, and other items as such, and then later on, munitions.   Ã‚  Ã‚  Ã‚  Ã‚   At certain points in the movie, it was hard to tell that he was changing. At certain moments, it seemed like he was, but then the next second, he would turn around and act the same as he always did. Such as when Stern brought in the one-armed Jew to thank him for giving him a job, and while he was there, he seemed happy to be able to be helping this man, but as soon as the man left, he turned around to Stern and said, â€Å"Don’t ever do that to me again. That man has one arm, he is of no use.†   Ã‚  Ã‚  Ã‚  Ã‚  There were many other moments in the movie though when you could tell that he was changing, such as when he was convincing that Nazi soldier friend of his’ slave/mistress that he actually does care about her and then kisses her on the forehead and tells her that everything will be okay. He eventually then buys her from him to save her. Another scene was the girl in the red coat.   Ã‚  Ã‚  Ã‚  Ã‚  Once the â€Å"liquidation† of the ghetto occurred in 1941, and they took all of his workers, I think that was when you could see him change the most, because he then spent millions of dollars of his own money to get them back, in order to save them from being killed at Auschwitz. And then when they couldn’t produce the munitions correctly, he bought them himself to be sent to the German army so they couldn’t shut down the factory.

Carl Orffs Philosophies In Music Education :: essays research papers

While Carl Orff is a very seminal composer of the 20th century, his greatest success and influence has been in the field of Music Education. Born on July 10th in Munich, Germany in 1895, Orff refused to speak about his past almost as if he were ashamed of it. What we do know, however, is that Orff came from a Bavarian family who was very active in the German military. His father's regiment band would often play through some of the young Orff's first attempts at composing. Although Orff was adamant about the secrecy of his past, Moser's Musik Lexicon says that he studied in the Munich Academy of Music until 1914. Orff then served in the military in the first world war. After the war, he held various positions in the Mannheim and Darmstadt opera houses then returned home to Munich to further study music. In 1925, and for the rest of his life, Orff was the head of a department and co-founder of the Guenther School for gymnastics, music, and dance in Munich where he worked with musical beginners. This is where he developed his Music Education theories. In 1937, Orff's Carmina Burana premiered in Frankfurt, Germany. Needless to say, it was a great success. With the success of Carmina Burana, Orff orphaned all of his previous works except for Catulli Carmina and the En trata which were rewritten to be acceptable by Orff. One of Orff's most admired composers was Monteverdi. In fact, much of Orff's work was based on ancient material. Orff said: I am often asked why I nearly always select old material, fairy tales and legends for my stage works. I do not look upon them as old, but rather as valid material. The time element disappears, and only the spiritual power remains. My entire interest is in the expression of spiritual realities. I write for the theater in order to convey a spiritual attitude.1 What Orff is trying to say here is that he does not use "old" material, but material that is good enough to be used again. If one eliminates the fact that this material was written many years ago, then there is nothing to stop that material from being any less legitimate in recent times. Orff's work in Music Education has been astounding. In the early 1920's, Orff worked with Mary Wigman. Wigman was a pupil of Emile Jaques-Dalcroze, another very influential name in Music Education. In fact, Orff's approach to music is very similar to Dalcroze's, but Orff focuses on education through percussion instruments. In 1924, Orff joined Dorthee Guenther and together

Mini Dialectic Journal

This old lore I had forgotten; else I was not here. In the first scene, we see Teiresias brought in front of Oedipus to talk about the prophecy. He knows the true identity of the King, but feels like it is a burden for him to know it at all. He knows that it wouldn’t profit him to know the truth about Oedipus and the prophecy. He regrets being there, and wished that if he could have just forgotten it, then he won’t have to be in that place. As a prophet, Teiresias felt compelled to tell the truth though he knows that it won’t benefit him. He got dragged in the situation that’s why it’s really is burdensome for him. Ode 1 – CHORUS: Sore perplexed am I by the words of the master seer. Are they true, are they false? I know not and bridle my tongue for fear, Fluttered with vague surmise; nor present nor future is clear. Quarrel of ancient date or in days still near know I none Twixt the Labdacidan house and our ruler, Polybus' son. Proof is there none: how then can I challenge our King's good name, How in a blood-feud join for an untracked deed of shame? In this part, the chorus is somewhat doubting Teiresias and is siding with Oedipus. They’re saying that what the old prophet’s words were confusing, and because of this ambiguity, there is a hint of doubt in the prophecy. They dare not challenge the integrity of the good King Oedipus, as there is not much proof in what the prophet is saying. Because of this, none of them really knows what lies ahead in the future. Scene 2 – CREON: Were not his wits and vision all astray, when upon me he fixed this monstrous charge? When Oedipus and Teiresias argued, it unfolded to the King that someone would dethrone him, and it was Creon. Creon, brazened, stood up to question his King’s assumptions. He reasoned out that the prophet may be out of his mind when he said such things to Oedipus, which he shouldn’t believe much of what he says. Ode 2 – CHORUS: My lot be still to lead   The life of innocence and fly Irreverence in word or deed,   To follow still those laws ordained on high Whose birthplace is the bright ethereal sky No mortal birth they own, Olympus their progenitor alone: Ne'er shall they slumber in oblivion cold, The god in them is strong and grows not old. Still, Oedipus is devoid of the truth. He consults the gods, yet none of them seems to hear his woes and prayers. As a King who knows nothing about himself, he feels fear, anger and pity for himself. All he wanted to know was who his true parents are, but how will he now about it, if there’s know hope left for him to find the truth. Scene 3 – JOCASTA: My greetings to thee, stranger; thy fair words Deserve a like response. But tell me why Thou comest—what thy need or what thy news. Jocasta receives a visitor, who came to tell them that Polybus, Oedipus’ father has died. She thought that because of this, Oedipus was freed of the prophecy, only to find out that Polybus was really not the King’s father. Jocasta thought it was great news at first, only to find out that it would be a nail in the coffin for them. The visitor finally confirmed that Polybus and Merope were not Oedipus’ real parents. Ode 3 – CHORUS: Child, who bare thee, nymph or goddess? sure thy sure was more than man, Haply the hill-roamer Pan. Of did Loxias beget thee, for he haunts the upland wold; Or Cyllene's lord, or Bacchus, dweller on the hilltops cold? Did some Heliconian Oread give him thee, a new-born joy? Nymphs with whom he love to toy? At this part, the chorus questions that the real parents of Kind Oedipus, as the King himself doesn’t know anything about it. All that has unfolded to him that moment was realizations that he grew up knowing nothing about his own self, and as the truths became known, slowly he understands that there is a possibility that the prophecy about him has already been fulfilled. Scene 4 – OEDIPUS: Ah me! Ah me! All brought to pass, all true! O light, may I behold thee nevermore! I stand a wretch, in birth, in wedlock cursed, A parricide, incestuously, triply cursed! This part is the bitter realization that it was really him who’s mentioned in the prophecy, as confirmed by the shepherd. He killed his own father, and married his own mother Jocasta. He wasn’t able to bear all the bitter realizations in the end, despite all his greatness as a king. He was still a human being, weak at heart. Ode 4 – CHORUS: O heavy hand of fate! Who now more desolate, Whose tale more sad than thine, whose lot more dire? This is the summary of emotions felt in the story. Oedipus feels nothing but sadness, as his life has been full of lies. As he discovers the truth about himself, he learns that the prophecy has been true. He is the murderer of his father and had an incestuous relationship with his mother. Nothing could be worst that what he experienced. Exodos – OEDIPUS: Dark, dark! The horror of darkness, like a shroud, Wraps me and bears me on through mist and cloud. Ah me, ah me! What spasms athwart me shoot, What pangs of agonizing memory? After knowing the truth bout his life, Oedipus blinded himself, and has exiled himself away from the city. The haunting memory of his past would always be with him, that’s why he could not bear live in the light. Works Cited: â€Å"Sophocles' Oedipus the King†.   2000. April 1 2008. . Segal, Charles. Oedipus Tyrannus: Tragic Heroism and the Limits of Knowledge. 2nd ed. New York: Oxford University Publishing, 2001. SparkNotes. â€Å"Oedipus Plays†.   2006. April 1 2008. . —. â€Å"Oedipus the King†.   2006. April 1 2008. .   

English essay on Of Mice and Men Essay

Steinbeck uses an example of symbolism in the form of Candy’s dog. Re-read pages 70-76, what qualities/ values does this dog represent? Which human characteristics could be represented by these qualities/ values? Candy is the oldest man on the ranch. As he is the oldest, he has more things to worry about than the others. He has only one hand and a women’s name, and through Steinbeck’s writing, we know why this is, because he has lost his masculinity and pride. He also has a pet extremely old pet dog, which he loves and everyone loathes, as they think it is useless and suffering, Candy thinks otherwise and doesn’t want it shot. Candy’s dog, which doesn’t have a name and is incredibly old in the story, represents the fact that things that are unimportant are unknown to other people. This represents Candy as an old undervalued character that is slowly loosing value like his dog. It establishes that if you’re an old animal, then you’re in trouble. This is why Candy is so reluctant to have his dog shot because he knows what its like to be old and unwanted, but because he and his dog share the same qualities, he feels like they are close friends that rely on each other. In the book, he says ‘I’m so used to him,’ he said softly. ‘I had him as a pup.’ This shows the closeness between the two. Candy can’t bear to imagine loosing something he has been so close to for most of his life on the ranch. And has he and the dog don’t have anyone but themselves, Candy feels that he will be completely alone after the dog dies. Because Candy doesn’t want the dog to die before him, he wants to savour what he has got left. Candy and the dog are both living on borrowed time, which means as soon as the boss finds out Candy is too old to work, he’ll throw him, and Candy won’t have anywhere to go. When Candy’s dog does get shot he feels instant regret. This is because he felt he should have shot the dog, and not Carlson. Candy feels that by not doing this, he has betrayed his dog and let him down. If anyone is supposed to take responsibility over anyone, it should be their best or closest friend. He wasn’t there to comfort the dog too, he feels guilt and is let down by his actions. Some one else that is in the same position as Candy and his dog are Lennie and George. George being the strongest to the two is very protective over Lennie. He makes a point of always telling what to do, but for his own good. People at the ranch criticize George on his choice of friendship, but this is because no one else seems to have a close companionship except them and Candy and his dog. They are jealous they don’t have the privilege to have someone to rely on. George and Lennie really do count on each other, as they are planning to get some money together and buy and farm so they can grow their own food and have animals. At the end of the book, when George kills Curley’s wife, he runs away just like George told him to and hides. When George finally finds him, he knows Lennie is going to be killed by an angry mob, so he takes the matter into his own hands. He speaks to Lennie about how they’re going to live, and about rabbits, as Lennie loves them so. This way he can kill Lennie without a sore consciousness and with Lennie truly happy. The only other couple in the story are Curley and his wife, who has no name in the book. This shows that women weren’t the same status like men, and also like Candy’s dog, she doesn’t really have any value to anyone’s life in the book, so she dies along with Lennie and the dog. Though she and Curley didn’t have a good relationship, he obviously cared for her, and went crazy when she was killed. Because it was Lennie who killed her, Curley felt like it was his responsibility to kill Lennie. Curley new what his wife’s nature was like, flirtatious and open. This would make the reader think that Curley was maybe jealous that it wasn’t him that killed her, but Lennie, who is seen as the ‘village idiot’. In this novel, I think Steinbeck was trying to tell us that if you have companionship throughout the toughest times of your life, don’t count on it, because one day the other person will let you down. He also wanted to show that whoever you take companionship with; you will have to take responsibility of their death. He wanted to show the readers that in a tough time, you can’t have someone to reply on all the time you have to be independent and strong.

Rural Public Health Analysis Health And Social Care Essay

Current State of the ProblemBackground: The population of rural Texas is about 3,060,392 which is about 8 % of the entire Texas population ( 25,145,561 ) . Harmonizing to the US nose count Bureau about 70.4 per centum of province ‘s population is white, 11.8 per centum is Afro-american, 3.8 per centum is Asiatic, and 37.6 per centum is Hispanic ( 2010 ) . There are about 4044 infirmaries in Texas and merely a mere 149 of them are located in rural countries ( 3 ) . Although the rural communities of Texas have 499 exigency medical bureaus and 303 accredited suppliers and 193 first respondent organisations but still about 21 counties are deprived of accredited exigency medical service organisation in their countries and merely 32 % ( 161 ) infirmaries are located in rural counties ( 10 ) . The rural countries are confronting a possible ruin with regard to exigency services. This public wellness issue is originating as a consequence of scarceness of exigency medical trained staff, unequal fiscal resources, outdated medical equipment usage and supply, geographic barriers, communicating spreads. The comparative hazard for decease from motor vehicle clang in rural countries is 15 times higher than urban countries, adjusted for gender, age and type of clang and 40 per centum higher hurt related deceases in rural countries than urban countries ( 6 ) . These statistics reflect the grade of demand of quality exigency attention services in rural countries. Physician Recruitment and Retention Problem: The 2001 study by the Texas State Board of Medical Examiners stated there are a sum of 196 rural Texas counties out of which 24 counties had no doctors, 22 had two doctors and 19 of them had merely one doctor. A study showed that the urban countries have 11 times higher figure of physician when compared to rural countries ( Texas State Board of Medical Examiners, 2003 ) . In rural Emergency Department, there are a greater figure of primary attention doctors on contract or impermanent doctors than exigency medical specialty trained doctors functioning merely a little community. Rural countries are confronting jobs such as most of Emergency medical managers are non trained in exigency medical specialty which worsens the state of affairs besides lead to staffing job. This is chiefly happening as a consequence of deficiency of fiscal resources and specialised doctors choosing to acquire employed in urban countries than rural communities. Other Problem is medical malpractice liability insurances in rural countries of Texas particularly in Rio Grande Grade Valley and the South Texas ( 4 ) . Trained Staff deficit: Rural Emergency services have deficit of EMS professionals and about one tierce of rural exigency medical forces voluntary. About 57 to 90 per centum voluntaries are first respondents in rural countries ( 4 ) . These voluntaries may non be available round the clock and are non to the full trained to manage complex instances. This forms a major challenge for EMS because most of them are non medical professionals ( 10 ) . If we compare counties on footing of advanced life support capableness so merely 5 counties have that installation and 22 counties have basic support organisations and 45 out of 131 counties have first respondent organisations ( 10 ) . It is difficult to supply exigency attention services for low volume population with unequal fiscal resources, deficiency of trained staff and basic medical equipment. Some EMS organisations still use manual defibrillators and are non equipped with all diagnostic machinery. Harmonizing to DHHS, Texas has 3106 lice nsed land ambulances out of the lone 22 % are for rural countries ( 10 ) .Geographic barriers:One of the most of import property that effects entree to wellness attention in rural countries is the big distance between abodes and services. The ability to transverse these distances becomes imperative in obtaining wellness attention. Most of the rural occupants refrain from seeking medical services because of the clip and money they have to pass in acquiring treated for a peculiar disease. Language Barrier: In South Texas peculiarly at U.S-Mexico cad part, linguistic communication barrier is another job faced by rural EMS. More than 20 percent population in rural Texas is bilingual and Spanish speech production population ( 10 ) . Resources Allocation Problem: Reason for less exigency medical professional are low wages, longer displacements, and geographic unavailability. The rural communities largely rely on the basic exigency service suppliers and voluntary first respondents. EMS is dearly-won in rural countries compare to urban countries because they cover larger country. They largely get low net income so hold to trust on unpaid staff. Since most of the first respondents work voluntary so they can non afford long distance travel for exigency. Trauma-Related Injuries and Deaths: Harmonizing to the Texas Department of Health ‘s Bureau of Emergency Management, in Texas about day-to-day 30 people die because of trauma-related hurts. Trauma is one of the taking cause of deceases among age groups 1 to 44yrs. 11,898 people died from hurt in Texas and in that 68.8 per centum were unwilled deceases ( 4 ) ( 2002 ) . From surveies, if terrible injured patient receive intervention from injury centre will hold better opportunity of endurance ( 2 ) . The above statistics reflect that injury are one of the major causes of deceases which call for immediate attending peculiarly in rural countries.Golden Hour and Response Time:‘Golden Hour ‘ is the term used for the first hr after incident happens. A patient receiving intervention within this first hr of incident has greater opportunities of endurance. A victim ‘s life would be jeopardized if the waiting clip is increased for more than 30 proceedingss. The rural cou ntries have mean response clip 18 proceedingss and for urban countries it is 8 proceedingss lesser than rural country ( 5 ) . A five twelvemonth survey in Arkansas rural county, 72 per centum deceases occur at scene because of delayed intervention. Response clip for urban country is 7 min. and for rural country its 13.6 proceedingss and so transit clip is 17.2 min and for urban its 8 proceedingss ( 11 ) . Most of deceases from injury in rural countries occur even before hospitalization. Harmonizing to Bureau of Emergency Management at Texas Department of Health, the preventable decease rate in rural countries is about 85 % higher in rural countries as compared to their urban opposite numbers. Harmonizing to Vermont and New York metropolis survey, the paediatric injury decease instances is twice in rural countries compared to urban countries ( 11 ) . The information of Texas Department of Health Bureau of Epidemiology ( Texas DSHS ) shows that rural countries have a response clip up to 2 hours and 16 proceedingss and conveyance clip to infirmary was 2 hours and 12 proceedingss. 157 of 254 counties of Texas have response clip of about 10 proceedingss and for 151 counties transport clip is greater than 20 proceedingss ( 2002 ) ( 10 ) . A study conducted by the National Highway Transportation Administration showed a important difference of 98 % in the response clip for exigency services between rural and urban countries ( 15 ) . This has been illustrated in the figure belowThe graph clearly indicates the trouble in accessing transit services and waiting clip in the rural infirmaries.Medicare and Medicaid:Other job is uninsured population ; about 25 per centum of Texas Population was uninsured in 2002 ( 4 ) . A bulk of rural occupants are financially weak and are less likely to hold insurance coverage than urban occupants. This suggests that the rural population will confront greater resource restraints in accessing attention. Rural occupants tend to hold lower incomes, and are normally freelance as husbandmans. Besides the concern houses in rural countries are smaller in size and the insurance benefits provided by the employers are less likely to cover the standard wellness attention services. Hence, it is more like ly that we can happen greater uninsured or underinsured population in these countries and when it comes to accessing medical services they have to pass a immense sum compared to urban population. Rural populations have more ageing population so they require more immediate and effectual exigency services. In 2001, Texas was top ranked for unsalaried attention to gross patient gross ( 4 ) .Equipment and installation Problems:From 2002 Texas Department of Health reported 61 Texas counties have no infirmaries, 105 had one infirmary and 26 counties had two infirmaries ( 4 ) . In 2002 Texas Hospital Association conducted Emergency Care Issues Survey and found that 72 % of rural installations had issues reassigning the patients and directing ambulances because of deficiency of beds. Harmonizing to Texas Department of Health, there are 131 trauma centres have basic Level IV installations in Texas State. Level IV injury is basic exigency service, normally they lack in equipment and trained staff. Most of accidents occur on rural roads because of high velocity, inefficient usage of place belts, intoxicant ingestion. The hold in reassigning the patients to infirmaries leads to complicat ions like pneumonia, sepsis and multi-organ failure. Since the rural exigency medical services have deficit of trained staff most of the rural exigency services are working over their capacity therefore endangering the quality of services.Review of Current Policies Affecting the SubjectFederal Policies:The Emergency Medical Treatment and Active Labor Act was approved by U.S in 1986. This act ensures that the entree to exigency medical attention would non be dependent on individual ‘s economic ability ( 4 ) . With the execution of this Act many uninsured and underserved population got entree to exigency medical services. National Highway Safety Administration created the EMS to diminish traffic related deceases ( Mead, 1998 ) . The Highway Safety Act 4 was passed in the twelvemonth 1996 which resulted in the formation of EMS and in 1967 EMS began officially. After constitution of EMS, there was a important decrease in the mortality rate from injury related deceases. The rural countries are less dumbly populated and at long distance from the degree I and II injury installations. So Balance Budget Act ( BBA ) in 1997 modified the compensation policies by adding Medicare ambulance fee agenda and besides started Medicare Rural Hospital Flexibility Program to back up little infirmaries in rural communities to exchange into Critical Access Hospitals ( CAH ) ( 12 ) . CAH helped to beef up the EMS in rural countries. This was the attempt to better the quality, entree to exigency medical services to better rural wellness system. The Federal Office of Rural Health Policy ( FORHP ) Grant plan provides the resources to prolong the betterments to rural EMS systems ( 12 ) . National Association of State EMS Officials ( NASEMSO ) and National Organization of State Offices of Rural Health ( NOSORH ) formed Joint Committee on Rural Emergency Care in 2009 ( 13 ) . This commission serves to implement the policies to supply seasonably, low-cost and high quality exigency medical services in rural countries. Healthy people ( HP ) act 2010 was an enterprise which was developed to better the quality of wellness attention services and entree to exigency medical services in rural countries ( 11 ) . Texas is portion of federal plan for enlisting and keeping of medical professionals in Texas rural countries ( 4 ) . With all federal attempts there is range to better the EMS in rural Texas. But still increased attempts are needed to better the quality of EMS in rural countries. Other plans which are working to better the exigency attention services in rural countries are The Rural Health Care Services Outreach Grant Program, The Rural Health Network Development Grant Program, The Rural Health Network Development Planning Grant Program, The Small Rural Hospital Improvement Program, Grants for Policy-Oriented Rural Health Services Research, The Rural Health Research Grant Program, Public Access Defibrillation Demonstration Projects Grant Program, The Rural Emergency Medical Service Training and Equipment Assistance Program, The Rural Health Best Practices and Community Development Cooperative Agreement Program etc. ( 4 )State Policies:The 77th Legislature passed House Bill 7 in 2001 and formed Office of Rural Community Affairs. It provided funding for many plans to better entree to rural wellness attention. It provides fundss to plans like Critical Access Hospital Board Training Reimbursement, Critical Access Hospital Designation, Critical Access Hospital Feasibility Study Grant, Critical Access Hospital Feasibility Study Grant, Access to Emergency Dev ices Grants, Capital Improvement Loan Fund, Small Rural Hospital Improvement Program, Rural Communities Healthcare Investment Loan Reimbursement Program, Rural Physician Relief Program, Medically Underserved Community, Rural Recruitment and Retention Initiative, Outstanding Rural Scholar Recognition Program and Texas Health Service Corps Program. The 78th Texas legislative assembly passed an act in November 2002 to cover with jobs like unequal support issues, inaccessibility of EMS system and deficit of doctor ( 4 ) . There is no entirely federal and province plan for injury services. Both the federal and province authoritiess are working in a synchronism to supply grants for injury attention, EMS suppliers and first respondents to better and prolong the quality of EMS services in the rural countries. In 2003, new history for EMS was created in 78th Texas Legislature. A $ 100 mulct was imposed for poisoning related offenses and the money was deposited in this history ( 4 ) . Fifty per centum of that money is allocated for local Emergency Medical Services, no more than twenty per centum is for Rural Assistance Clinics for 22 TSAs, 27 per centum is for unsalaried injury attention installations and three per centum is for administrative cost for Bureau of Emergency Management ( 4 ) . State resources are non equal to for enlistin g and keeping of wellness attention professionals, better exigency medical equipment and keep the quality of EMS in rural countries of Texas. Most of federal and province rural wellness policies and plans rely on nose count Bureau information and bounds set by the OMB, ERS, agency, and HRSA for country of appellation such as urban and rural, metro and non tube or frontier ( 4 ) . The agency of Health Professional National Center for Health Workforce Analysis of Health Resources and Services Administration has criterions to sort certain geographic countries and population groups into a wellness professional deficit country ( HPSA ) or medically underserved country or Population ( MUA/MUP ) . Harmonizing to this study, Texas has 100 HPSA in non tube or frontier parts and in those 60 seven counties, 20 nine are population groups and three comprehensive wellness centres and one Rural Health Clinic ( 4 ) . As per the Bureau of Emergency Management has administered presently 131 as Level IV ( basic ) injury installations, 36 as Level III ( general ) injury installations, 9 as Level II ( major ) injury installations, and 12 installations designated, as degree I ( comprehensive ) injury installations, . In 1997 Senate Bill 102 approved the regular session, 75th Texas Legislature and provided the EMS/Trauma attention system impermanent fund. Permanent resources provided by 76th Texas Legislature for EMS, with the money from the baccy judicial proceeding colony ( 4 ) .Federal and State Programs:Plans like Statewide Rural Health Care System provided by Texas Department of Insurance to rural population aids in supplying insurance coverage for exigency attention. The School-based Health Centers plan is offered by Texas Department of Health for rural country where there is a lack of medical professionals. Besides Rural Emergency Medical Services Scholarship Incentive plan is provided by the Center for Rural Health Initiatives for rural countries holding a population of less than 50,000 which are non designated as metropolitan statistical country and they besides have community scholarship plan for nonmetropolitan Texas rural countries. The Office of Rural Community Affairs have Rural Health Facility Capital Improvement plan is for 150,000 populated rural countries and other plans like Outstanding Rural Scholar Recognition and loan Program for Rural Health Care, Rural Physician Recruitment Program and Rural Physician Relief Program. The Bureau of Emergency Management has Temporary Exemptions for Rural EMS which covers 50,000 or less populated rural countries. ( 4 )