Prohibition and Marijuana: History Does Repeat

Decriminalization or to not decriminalize. That is the big question. Will the decriminalization of marijuana be the next revolution of America? Marijuana prohibition has been in effect since 1937, with trends that closely resemble those of alcohol prohibition-meaning an increase in crime, distrust, and dissension. If the goal of marijuana prohibition is to stop Americans from using it, then it has failed, just like the other prohibition failed to make America a â€Å"dry† country. It is important to go back and look at the factors leading to marijuana prohibition-especially the stages of exaggeration, silence, and the imposition of severe penalties-before looking at the effects of prohibition during the last half-century. Let me first point out that I am an advocate of marijuana, and will not argue that marijuana is not harmless. Research shows that marijuana damages short term memory, distorts perceptions, impairs judgment and complex motor skills, alters heart rates, and has the potential to trigger severe anxiety, paranoia, and lethargy (www. ndsn. com). Yet I also feel its effects are in many ways less harmful than those of alcohol and tobacco-for instance, alcohol's potential to cause cirrhosis and tobacco's links to lung cancer and heart disease. Both are considered carcinogenic. In addition, alcohol is cited as a factor in half of this country's highway fatalities, half of all arrests made for any criminal charge-including homicides-and one-fourth of all suicides. In 1972 the National Commission on Marihuana and Drug Abuse estimated the social costs of America's alcohol habit to be $15 billion a year (www. ndsn. com); it has steadily increased since then. When comparing tobacco, alcohol, and marijuana, there is strong evidence that marijuana has the least addictive power (www. peretto. com). However, this does not hide the fact that all three can have a strong impact on an individual. As with all drugs, they are capable of disrupting home life, affecting job performance, and causing withdrawal from society. In my opinion, all drugs share this power on equal terms because of the emotional problems of the people who use them; no single drug has more potential for harm than any other in terms of social impacts. While hemp has been grown in America since 1611 (Grinspoon, 1971, p. 1), the practice of smoking marijuana did not become widespread until the 1920's-a period of strong drug intolerance during the â€Å"great social experiment† of alcohol prohibition. Marijuana use was highest among people who also used opiates, primarily recent immigrants. In the 1930's, the common belief that immigrants were inhumane and violent included a strong belief that marijuana was part of the cause. Since it was associated with opiates, marijuana was quickly defined as a narcotic (Thies, C. F. , 1993 p. 71), and by 1931 all but two states had passed anti-marijuana legislation. The final two did so by 1937, the same year the federal government created the Marijuana Tax Act . For which no tax stamps were ever issued. Not once during this period of prohibitive legislation was any research conducted on marijuana and it's effects, nevertheless it was almost universally assumed that marijuana was a narcotic, caused psychological dependence, provoked violent crime, and led to insanity. The first of three strategies used to fight marijuana was silence. It was believed that if youth didn't hear about marijuana, they wouldn't become curious and experiment with it. Therefore, in the 1930's discussion about marijuana was forbidden in all public schools, and from 1934 to 1956 the Motion Picture Association of America banned all films showing the use of narcotics (www. legalize. com). The strategy did not work as well as hoped, so anti-marijuana groups adopted the next strategy: exaggeration. The goal was to scare potential marijuana users. Even such respected periodicals as the American Journal of Medicine went along with this strategy, publishing such warnings as: â€Å"Marijuana users will suddenly turn with murderous violence upon whoever is nearest to them. They will run amuck with a knife, axe, gun, or anything else that is close at hand, and will kill or maim without reason†. F. T. Merrill of the Opium Research Committee wrote: â€Å"While numerous crimes [have been] traced to its abuse, its peculiar virulent effect, leading sometimes to insanity, makes its use dangerous to the individuals and to society in general . . . [it] leads to uncontrollable irritability and violent rages, which in most forms cause assault and murder† (Grinspoon, 1971, p. 17). During my research I found a medical handbook written in 1970 that continued to report these myths as fact, going so far as to imply that the words â€Å"hashish† and â€Å"assassin†Ã¢â‚¬â€œwhich do have a common root in terms of word history–have a cause and effect relationship. In the same manual the word â€Å"amuck† was associated to a characteristic of the drug; according to its author, the word, which means â€Å"to kill,† â€Å"was the word the natives of Malay would shriek as they dashed down the street, maddened by hashish, in a murderous frenzy† (Williams, 1970, p. 140). From the official California police officers' guide of the same period came this warning: â€Å"Marijuana is the immediate and direct cause of the crime committed . . . the user is very often dangerous to handle or control, has no fear, feels no pain, and may commit crimes of violence. Penalties for marijuana use fluctuated with popular belief regarding its level of danger. If people believed the effects were particularly bad, the penalties were stiff, but during some decades public attitudes were more lenient, therefore penalties were reduced. Drug use declined, fear increased, and so did penalties throughout the 1950s. One of the first federal mandatory prison sentences was established at that time: 10 years minimum for marijuana possession, and a mandatory death sentence for selling marijuana to a minor (Theis, C. F. ,1993 p. 46). During the 1960s and 70s, penalties declined as use increased, with eleven states decriminalizing possession for personal use (Thies and Register, 1993, p. 389). Then, in the 1980s, drug use declined and penalties rose. The â€Å"three strike† program was established, under which a mandatory life sentence without parole must be given for third-time offenders. Judges no longer have the power to use their own discretion in sentencing, but are required to base their punishment on the â€Å"most serious readily provable charge†, including a mandatory death sentence for anyone found guilty of managing a major marijuana plantation of 60,000 plants. It appears that the current attitude toward marijuana prohibition is based on the belief that relaxed policies lead to greater use. Statistics argue otherwise: nationwide, marijuana use in 1984 was measured at 26. 3%, and in the eleven states that decriminalized marijuana, it was 27. 3%. In 1988 the percentages were 15. and 16. 1, respectively. In those eleven states, decriminalization meant that individuals were no longer arrested for simple possession. In ten of those states there is a $0-100 fine for possession-the result of a threat by the federal government to withhold highway money for states that did not have minimum punishment standards (Thies and Register, 1993, p. 387). Going outside the country for another example of how legalization does not lead to greater use, Holland has witnessed a 40% decrease in marijuana use since the Dutch government legalized it in 1976 (Grinspoon, L. 1971, p. 4). During the same time period, marijuana use has decreased in the United States, so it cannot be definitively argued that either stronger penalties or decriminalization is better at affecting the number of people who use marijuana. It seems clear that social policy, and not legal policy, had the greater effect in Holland. Accusations of marijuana's addictive powers are also under attack from well-designed research studies. During the Nixon administration (1972), the federal government reviewed existing studies and concluded that marijuana did not possess physically addictive traits. The great majority of articles published in medical journals since that time have agreed. For example, Dr. Jack Henningfield of the Addiction Research Center (part of the National Institute on Drug Abuse) and Dr. Neal Benowits of the University of California ranked heroin, cocaine, nicotine, alcohol, caffeine, and marijuana in terms of their power to induce psychological dependence. Nicotine was first, marijuana last. Marijuana also ranked last in terms of producing a physical tolerance to the drug, and was deemed least likely to produce signs of withdrawal upon quitting (Theis, C. F, 1993, p. 92). It seems as though the primary result of the three-pronged attack using strict penalties, silence, and exaggeration has been increased ignorance. Regardless of research findings refuting long-held claims about marijuana addiction since 1972, the old arguments of the 1930s continue to be used when establishing new soft drug laws. People's tendency to hold onto their initial beliefs means that most of their knowledge on the topic of marijuana is based on what their parents taught them. While it is the responsibility of all parents to teach their children values, this is not an acceptable basis for creating law. If the purpose of prohibition is to eliminate the use of a substance, then marijuana is certainly another example of how prohibition fails. In 1979, 68. 2% of all 18-25 year olds had tried marijuana at least once, and 35% said that they were regular users (U. S. Substance Abuse and Mental Health Services Administration, 1991). While those respective numbers have decreased to 50% and 13%, its clear that marijuana is still readily available and used by a large number of Americans. Two other detrimental effects of marijuana prohibition are the large amounts of money spent on enforcement and prosecution, and prison overcrowding. The percentage of the American population living in prison has increased from . 061 in 1880 to . 1 in 1920 to . 35 in 1995, with an associated tripling of real tax dollars required to house inmates. Today, 62% of all inmates are in prison for drug offenses-the result of a 1,100% increase in drug arrests between 1980 and 1992, even though marijuana use dropped from 35% to 13% during the same period. The increase in violent offenders incarcerated during that time was only 50%. Of felons convicted of crimes related to marijuana possession, production and trafficking during this period, 58% had no prior arrest history, 91% were not identified as organizers, leaders, managers or supervisors of drug-oriented organizations, and 92% did not own or possess a gun. In other words, the large majority of these felons should not be viewed as individuals endangering our society. I believe the main point of these statistics is that an enormous amount of money is spent each year on incarcerating non-violent and otherwise law-abiding citizens. Not including the money spent on prison management and construction, the federal Drug Enforcement Agency (DEA) now spends $1. 3 billion a year â€Å"fighting† marijuana. Overall, federal anti-marijuana efforts have cost taxpayers $30 billion. The result: $2 billion worth of cannabis being seized and destroyed, 4 million people being arrested, and 250-thousand individuals being jailed for more than one year–but no basic change in usage patterns from the 1970†³s (www. bergen. com). Is it worth it? Mark Young is a victim of a US District Attorney's overzealous efforts to enforce federal marijuana laws. Young, a resident of Illinois, went on a fishing trip in Florida with some old friends, bringing along some marijuana for everyone to enjoy privately. His Florida friends asked Young to introduce them to the grower, which he did, then was cut out of the deal from that point onward. He was later arrested and charged with conspiracy to manufacture marijuana. He had two strikes against him-minor possession charges that were twenty years old-so he faced a life sentence with no possibility of parole, even though he did not benefit at all from the transaction. The District Attorney offered Young a reduced charge if he testified against his friends and others whom he had no prior knowledge of. He refused, and the DA won his case without having to inform the jury about Young's two-strike status. The judge had no choice but to pass down a sentence of life without parole. In a prison interview, Young was quoted as saying, â€Å"They've only proved I'm capable of smoking a joint, or of introducing a guy to another guy who needs some pounds. That's the most they've proved me capable of. What they [the prosecutors] are doing, they're destroying these families and passing out life sentences, taking people's lives, putting children on the street-I mean horrendous acts. I don't know of anyone that would do anything that malicious for a salary† (Williams J. B. , 1970, p. 46). It is my opinion that the state has no right to interfere with anyone's private conduct, especially under the guise of protecting anyone from our own folly. The government is free to educate people as much as it wishes on the effects of using marijuana, education being the best way to alter behavior. However, it must not dictate what behavior an individual can or cannot practice in private. This opinion is the same one given in the 1972 report published by the National Commission on Marihuana and Drug Abuse; in their summary, the authors of that report argued that private production and consumption of marijuana should be made legal (National Commission on Marihuana and Drug Abuse, 1972, p. 152). They also recommended continued efforts to arrest anyone involved in trafficking or in the commercial production of marijuana. The report was accepted by the President, Speaker of the House, and President of the Senate, and the argument was later given support by President Jimmy Carter (Theis, C. F. , 1993, p. 45). However, political pressure prevented him from making concerted effort to reform marijuana laws. The original motivation for marijuana prohibition was based on a lack of knowledge. Nevertheless, the hate and fear resulting from initial attitudes still echo in current arguments against marijuana. Despite research to the contrary, a significant number of people refuse to have their beliefs challenged. And so billions of tax dollars continue to be spent on enforcement and prosecution, while use patterns remain the same-a return on an investment that no private business would ever tolerate. And it is important to remember that statistics describe many casual marijuana users such as M. Y. , and families that are affected by overly strict laws. Prohibition was established due to a misunderstanding, has not achieved its goal, and goes against an American philosophical approach. I believe it is time to reconsider its consequences.

Drivers Ed

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Description of human emotions Personal Statement

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Class Dialogue Assignment Example | Topics and Well Written Essays - 250 words - 7

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Learning and Development - Essay Example The primary concern of the business is the human resource pool and as a store manager, Douglas Forbes should confront the business concerns and provide solutions. Problems of poor human resource pool of Fair Price Stores can be linked to the process of selection and hiring of its employees. If proper screening has been undertaken for the recruitment process, the human resource pool of the company should not have been a problem. To address the issue of poor level of supervisory skills, everything should start in the process where employees are being selected. The people are the most important asset of the business and effective human resource management can help establish an important strategic tool and sustainable competitive advantage for the company. As Douglas Forbes, I will be tackling the issues in a systematic manner. A human resource management process should deal with the problem of incompetency. Activities should be laid out for staffing the organization and sustaining high employee performance. Human resource planning should be given priority for a manager to ensure that the right number and kinds of people are in the right places at the right time that is capable of effectively and efficiently perform assigned tasks. It is evident that the current human resource inventory of the company lacks the essential qualities to help the business succeed. As a manager, a clear delineation of jobs should be done to help the employees understand their functions. The job description for each employee should be discussed to them for them to know the requirements of the job assigned to them, how it is done and the reason why it is done. It will guide the employee on their performance of their jobs. A job specification should be stated during the hiring process to provide information on the minimum qualifications that a person must possess to perform a given job

Personal Statement for MSc Finance application Essay

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Sweatshops Essay Example | Topics and Well Written Essays - 1000 words

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Module Four Assignment Essay Example | Topics and Well Written Essays - 500 words

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Essay question Example | Topics and Well Written Essays - 500 words - 6

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Ernest Hemingway Legend Essay Example for Free

Ernest Hemingway Legend Essay Ernest Hemingway is the ideal of an American legend, rugged, no-nonsense, with personal adventures rivaled only by those in his groundbreaking fiction.   His sparse newspaper style created a literary furor and his success came early and grew until the day he died.   In addition to his canonical novels, Hemingway was also adept at short fiction, including one only six-words long.   Besides, his male bravado, he also managed to capture the alienating effects of modern life in his fiction.   The modern themes of abortion, feminism, and alienation are expressed simply and eloquently in â€Å"Hills Like White Elephants. † In the short story â€Å"Hills Like White Elephants,† Hemingway explores modern alienation in a tense discussion between a couple waiting for a train.   Two Americans in Spain, the man is trying to pressure the woman into some operation, though it is never revealed what this operation is.   Throughout the tense, yet sparse conversation, the man insists she have the operation, yet the woman resists.   It becomes increasingly clear that the operation they discuss may be an abortion, and the tension between the two symbolizes something uniquely modern.   Though abortions have been performed for centuries, it remained taboo until the twentieth century. Hemingway, though never specifically citing abortion as the subject in the story, displays the alienating effect it has on relationships and couples:   â€Å"‘It’s really an awfully simple operation, Jig,’ the man said. ‘It’s not really an operation at all.’   The girl looked at the ground the table legs rested on. ‘I know you wouldnt mind it, Jig. It’s really not anything. It’s just to let the air in’† (Hemingway).   The man refuses to completely acknowledge the significance of the situation, perhaps suggesting either his refusal or dismissal of Jig’s role as a woman worthy of making her own decision. According to critic Paul Lankin, â€Å"as the man persists in opposing the continuance of Jig’s maternity, he grossly oversimplifies the issue, even to the point of self-contradiction, calling abortion first ‘an awfully simple operation’ and then ‘not really an operation at all’† (234).   His dismissive attitude speaks of a former socially acceptable condescension by men towards women during a time when women were often treated as second class citizens.   This frank discussion between the man and the woman seems only possible in modern literature and seems unimaginable during Victorian times. The tension between the man and the girl is palpable in the short story.   Though they are travelers, imbibing alcohol and waiting for the train to their next destination, the conversation is filled with underlying themes of male dominance and female perseverance.   The man continuously belittles the girl’s feelings towards the pregnancy, and his argument includes many attempts at downplaying the importance.   The man persistently tries to convince her, even though he seems to feign sincerity in much of his words: â€Å"‘Well,’ the man said, ‘if you don’t want to you don’t have to.   I wouldn’t have you do it if you didn’t want to.   But I know it’s perfectly simple’† (Hemingway).    The girl does her best to contend with the man, believing that if she listens to him the relationship will be back to normal.   She hides her worry with levity, including her comment about the hills looking like white elephants.   It becomes apparent that more than fear over the procedure, the girl is coming to the realization that her relationship with the man is not what she thought it was: â€Å"the girl clings to a dream of family and togetherness until the last minute, and finally decides to give it all up as the requisite price of staying with the man-not knowing, as the reader does, from the many hints provided by Hemingway, that the man is likely to leave her, even if she goes through with the abortion† (Hashmi 3). Her final declaration that she is fine is the affirmation that a man cannot dictate her womanhood and her life decisions.   In the end, she becomes the one with the strength and wisdom, understanding that the relationship is forever changed.   The newfound disconnect between the man and the girl will be permanent after this episode, exemplifying the theme of alienation brought by many modern decisions. Though the man believes that the only way to preserve the comfortable relationship is to maintain the status quo, even if it means aborting their baby, the woman disagrees.   The American tries to make himself sound perfectly reasonable and rational, but as the dialogue continues, it becomes clear that he is both selfish and hypocritical (â€Å"Overview: Hills Like White Elephants†). The couple’s disagreement, about something as monumental as creating human life, is a clear sign that they have little that bonds them other than their superficiality.   The girl even comments in the beginning of the story how, â€Å"That’s all we do, isnt it look at things and try new drinks?’† The man responds, â€Å"I guess so† (Hemingway).   Later, when the man claims that everything will be the same after the abortion and the baby is the only thing that made them unhappy, it seems like a statement lacking all truth. The very fact that keeping or aborting a baby is a choice, is a uniquely modern issue.   The reality of having to even consider it completely destroys their carefree lifestyle as travelers in Europe, and underlines their existences as solitary beings alienated from each other.   Ironically, the man claims that he only wants her and no one else, but his statements seem insincere. The girl realizes their alienation from each other and the happiness they once knew with the â€Å"claim that Europe ‘isn’t ours anymore,’ which expresses her knowledge that such an innocent return to a secularized American-in-Europe experience of time is impossible† (Grant 3).   Europe is not theirs to share, seemingly as if enjoyment is also no longer theirs to share.   The complexity of their modern dilemma illustrates the true distance between them. Hemingway’s story is one that could only be written during modern times.   Though not many years removed from the Victorian Age, the themes of abortion, feminine independence, and modern alienation have continued to echo throughout the literature of modernity.   While short and devoid of lengthy descriptions, the dialogue and significant themes give â€Å"Hills Like White Elephants† a lasting power that only continues to grow as time goes by. Works Cited: Grant, David. â€Å"Hemingways ‘Hills Like White Elephants’ and the tradition of the American in Europe.† Studies in Short Fiction. Summer, 1998. 25 July 2008. http://findarticles.com/p/articles/mi_m2455/is_3_35/ai_83585388/pg_3. Hashmi, Nilofer. â€Å"‘Hills Like White Elephants’: The Jilting Of Jig.† The Hemingway Review.   Fall 2003. 25 July 2008. http://findarticles.com/p/articles/mi_qa3786/is_200310/ai_n9334110/pg_3. Hemingway, Ernest. â€Å"Hills Like White Elephants.† The Heath Anthology of American Literature.   Lauter, Paul.   3rd Ed.   Boston: Houghton Mifflin, 1998. â€Å"Hills Like White Elephants.† Short Stories for Students, Vol. 6. The Gale Group, 1999. Lankin, Paul. â€Å"Hemingway’s Hills Like White Elephants.† The Explicator. Summer 2005; v63.

Music Essays- Rave Culture Music

Music Essays- Rave Culture Music Rave Culture Music Since its emergence in the late 1980s, the subculture referred to as â€Å"rave† has become a significant global youth phenomenon. Postmodern scholars tend to treat the rave subculture as one of disappearance and pleasure. The â€Å"armchair† approach of postmodernists is inherently flawed because it fails to acknowledge the meaningful spiritual experiences of those attending raves. Scott R. Hutson’s â€Å"The Rave: Spiritual Healing in Modern Western Subcultures†introduces an opposing theory that raving is a spiritual practice wherein the symbolic processes embedded in culture create appropriate frameworks for healing. Gilbert Rouget’s conceptualization of trance and how it is managed in the ritual context provide the analytical foundations for this spiritual practice. This paper will analyze the role of the DJ as a leader of a possession trance ritual who â€Å"aided by key symbols, guides the ravers on an ecstatic journey to paradise- a pre-soci al state of non-differentiation and communitas† (Hutson 1999:54). Raves have increasingly become the focus of books, movies, and media coverage, and the culture has been the undercurrent behind some of the latest music and fashion trends. Described by Merchant and McDonald as â€Å"the most vibrant, popular and visible cultural expression of young people† (Merchant and McDonald 1994:16), rave culture has had such an enormous impact on the mainstream youth and popular culture that it is now often considered part of the mainstream. The electronic and rhythmically repetitive nature of the music, the long hours of dancing, the semi-legal secret location, and the ingestion of psychoactive substances, differentiate raves from other youth parties. When combined, these features are specifically designed to promote feelings of connectedness, spirituality, and a state of â€Å"ecstasy† among contemporary youth. At the heart of these proceedings one encounters the individual responsible for the success or failure of the event: the Disc-Jockey or DJ. Using equipment to manipulate the rhythm, sound, and lighting, the DJ guides individuals through a psychological journey of what some have described as healing, identity transformation, and spiritual growth. Get help with your essay from our expert essay writers A small body of recent publications on raves reflects the growing recognition that the rave scene provides a spiritual outlet for many contemporary youth. The DJ’s position within this culture as a spiritual leader and guide has also been noted. What is uncertain, however, is the specific nature of this role. Poschardt contends that the DJ’s tendency toward â€Å"laconic autism† has made him a difficult object of study that has â€Å"remained untouched by academic study† (Poschardt 1995:17). Similarly, Fikentscher observes that â€Å"his gradual rise in the hierarchy of the music industry has not been accompanied by a corresponding growth in academic literature† (Fikentscher 2000:33). Although similarities have been noted between the function of the DJ in the rave culture, and that of the shaman in traditional cultures, a precise and in-depth academic analysis of the DJ’s work is lacking. It is often assumed that what ravers experience during raves is â€Å"ecstasy,† but a definition or thorough investigation of this state of consciousness is lacking. Similarly, references to â€Å"trance† or hypnotic states are also presented as fact but explanations and interpretations of these states and how they are elicited are usually glossed over. Some authors appear to be completely baffled by the altered states of consciousness (ASC’s) encountered at raves, their position clearly illustrates a poor understanding of ASC phenomena. One author explains that â€Å"ravers move in a hypnotic delirium which has been described as a ‘trance dance.’ It is as if some sort of spell has been cast over them causing the throng to lose themselves in their own thoughts while the pounding of the music remains starkly unobtrusive† (MacDonald et al. 1998:243). Postmodern scholars seem to avoid the subject of ASC’s altogether, while acknowledging the ineffable quality of the experience as grounds for its exclusion from academic inquiry. Additionally, the DJ’s expertise and the symbiotic relationship he develops with the dancers has also been neglected, perhaps due to the embodied, performative, and intuitive elements under which these processes are informed. In an attempt to explain this neglect, Gerard states that â€Å"while the dance music press, insider accounts and testimonials from DJs and dancers suggested a fertile ground for investigation, scholars tended to avoid the dialectical possibilities inherent in performance analyses or phenomenologically inspired investigations by simply treating such interactions as somehow ineffable† (Gerard 2004:170). Another embodied element so central to raving is body movement, that is the dance experience, and as Malbon remarks â€Å"I note the reticence and/or inability of both clubbers and academics to discuss dancing† (Malbon 1999:71). It is probable that this reticence is partially rooted in the limitations of an â€Å"armchair† approach. It is obvious that many scholars of rave and club culture have never physically participated in the contexts they are writing about. This armchair methodology is addressed by Gerard and Sidnell who call for an approach that is instead framed in the â€Å"immediate:† Rather than attempting to extricate symbolic meanings or covert subcultural agendas, future studies of contemporary dance music would be best served from the dance floor and not the armchair. If as a number of authors have suggested, these music and dance spaces can be likened to ritual events, we should approach them as such-not by serving enactment from text, as Bruce Kapferer has cautioned, but by framing analysis in the immediate and locally organized contexts of performance (Gerard and Sidnell 2000:36). This paper is an investigation the precise function of the DJ within the rave culture. This involves an investigation of the DJ’s training, of his techniques of the mechanisms involved in inducing altered states of consciousness (ASC’s) in the rave context, of the experience of the participants with these states, and of the relationship between the DJ and rave participants. Much of the DJ’s elevated status and recent success has to do with the artistic license and technological innovations in music production that afford today’s DJs with seemingly limitless opportunities for creative development. This forces the DJ into a role as a paradoxical artist, a meta-musician whose performance is based on prerecorded music. The profession thus questions the traditional notion of live performance and as Poschardt states, â€Å"questions the traditional concept of the artist, blows it apart and re-establishes it in overhauled form† (Poschardt 1995:15-16). An emblematic figure of the postmodern era, the DJ has been likened to a writer, an editor, and even a weaver of mosaics and tapestries. This is largely due to the techniques of mixing, remixing, and sampling, procedures that make each performance spontaneous, unique, unexpected, and thus â€Å"live† as opposed to prerecorded. Combining two records is referred to as mixing, remixing in volves altering and therefore reinterpreting and existing song, and sampling consists of inserting any sound, musical passage, or rhythm into an existing track at any desired point. This is where the creative element and metaphor of the DJ as writer is relevant: I love the idea of continuous sampling: like remixing everything as you go so writing is like that. Just like you’re probably going to do edits, cuts and splice when you’re editing this tape, I mean you do that with language, even when you’re speaking, you’re always picking and choosing what words you’re using, the way you’re going to describe something so everything is a mix. I’m mainly a writer, DJ’ing to me†¦ every DJ is a writer, you’re using the urban landscape as your book, as your novel, as your text, so everything is writing (‘DJ Spooky’ in Reiss 1999). The ability to create new sounds and sample virtually anything also emphasizes the freedom of the artist. While there are â€Å"DJ schools,† information resources on the internet, and technical manuals available to those entering the DJ profession, most DJs are self-taught and the process of learning and refining skills for oneself seems to be the ultimate rite of passage into the trade. For the most part, DJs seem to frown upon professional schools that offer courses in DJ’ing, feeling that these schools are no more than the product of a recent fad. Most seemed to agree that experience and intuition are the greatest tools for learning available to an amateur, and these cannot be acquired in an academic institution. The notion of being self taught still allows DJs to be influenced by others or to have their careers assisted along the way. Fikentscher characterizes DJ’ing as an oral tradition where knowledge is passed down to new artists from the DJs that come before them (Fikentscher 2000:44). Like raves, DJs on the rise develop a following through word of mouth and the circulation of their music. At clubs and raves, the local and unknown DJs are given the opportunity to spin in the peripheral rooms while the headliner DJs spin in the main room. Through this kind of exposure, a DJ can develop a following and eventually graduate to the central room which houses the best lighting and sound equipment. DJs have also been known to collaborate with other musicians in producing records, and even tour with other DJs thus picking up techniques along the way. A DJ must have an extensive knowledge of music tracks and remember such details as the rhythm, the vocals, and key structure, so that the current song will be complementary to the track that it is being combined or sampled with. Just as many ravers note an alteration in the way they perceive Techno music through continued participation in the subculture, DJs also identified a change in their musical perception that is oriented toward the more technical aspects of the music. Evidence for this kind of neural entertainment is supported by the finding that the analytic left brain tends to dominate musical processing in trained musicians, whereas for the untrained it is the right hemisphere that dominates (Wilkinson 2000:1). While there has been considerable discussion surrounding MDMA or Ecstasy use as a prerequisite for fully understanding and appreciating electronic music, in contrast to the majority of rave-goers who advocate drug use to â€Å"get into† the music, all of the DJs interviewed in a study by Dr. Melanie L. Takahashi disagreed with this view. Although a majority had tried MDMA or other dance related drugs, the sentiment that the music combined with the skill of the DJ in its own right were enough to elicit an ASC appeared to dominate. The DJ’s adeptness for musical perception and producing musical triggers for trance states could explain the incongruity between DJs’ and participants’ views concerning drug use. All subjects interviewed performed their sets without taking drugs, the reason given being that these substances would negatively affect the concentration required to perform a live show. Instrumentalists of possession rituals are reported to not ingest psychoactives or enter into trance during performances for similar reasons. According to Rouget, â€Å"to do so would be incompatible with their function, which is to provide for hours on end and sometimes on several consecutive days, music whose execution must continuously adapt itself to the circumstances† (Rouget 1985:103-104). Rouget argues that these musicians must therefore be external to the cult, such that they are not vulnerable to the music, or they must be experienced adepts who are able to withstand the effects of the music (Rouget 1985:104). As the DJ is given the power to introduce the participants to an experience, it becomes increasingly important for the DJ to sustain the integrity of that experience. In Gerard’s 2004 article â€Å"Selecting Ritual: DJs, Dancers and Liminality in Underground Dance Music,† Gerard describes the importance of flow by framing the dance experience, and the process of mixing, as conduits for â€Å"liminality† as defined by Victor Turner (Turner 2003:176). The DJ employs what Gerard coins as â€Å"techniques of liminality† which create periods of uncertainty for the dancers following the resolution. When the flow is interrupted by poor mixing â€Å"the flash of spontaneous communitas is potentially threatened; dancers are often drawn out of their ecstatic state; they return to an increased awareness of both setting and self, and sometimes abandon the dance floor† (Gerard 2004: 176). In order to avoid losing experiential integrity, DJs function in a manner similar to instrumentalists in possession rituals by developing an intimate and symbiotic relationship with the dancers. The dancers’ ability to achieve an â€Å"ecstatic† state is dependent on the DJ’s stage presence, his proficiency in intuitively â€Å"reading† and responding to the crowd, and his ability to form a temporary bond with the dancers. Without these skills, the techniques of trance induction on their own right are generally inadequate for eliciting what participants call an â€Å"ecstatic† state. In ceremonial possession, the notion of performance is a central element to the ritual. Instrumentalists perform for an audience, and irrespective of an individual’s familiarity with the music, the trance state is only induced within the ritual context in the presence of others. Furthermore, additional aspects of raves that are paired with the music (i.e. lighting, psychoactives) are generally absent at home even though they play an important role in trance induction. Also absent outside of the rave context is the interpersonal relationship between the DJ and the participants. Similarly on the subject of possession rituals, Rouget emphasizes the importance of the connection between the instrumentalists and the dancers, stating â€Å"in order to induce trance in a particular person the priests and musicians establish a special relationship with him, make him an object of their ‘solicitude,’ address themselves to him in an exclusive way, and become at the same time very attentive to what he himself is feeling† (Rouget 1985:112). At raves, participants recognize that a DJ must be selfless in order to establish this special bond. Although most DJs have a general idea of the style of music and the songs that they will play, it is accepted that flexibility is more important, and this is particularly relevant for touring DJs who must also adapt to regional differences in music taste: I know the records that are good to start the evening, but I don’t prepare my set in advance. I watch and I react. I try to adapt. Every city is influenced by the people who initially created the scene. You have to adapt and still be true to yourself. In Germany, I play techno. In Belgium and Switzerland, it’s more funky tech house. In Spain, it’s predominantly techno, except in Barcelona and Ibiza where it’s house (‘Jack de Marseille’ in Huegli 2002:69). The active role of the crowd in shaping the mood and atmosphere of the party also favors a more spontaneous approach. It is believed that DJs who prioritize the tastes of the crowd over their own, are humble DJs and that this quality is a precondition to a â€Å"people’s DJ† (Brewster and Broughton 1999:11-12). Cues indicating a DJ’s humbleness that were remarked upon, are gestures suggesting appreciation and gratitude toward the crowd such as bowing, clapping, eye-contact, and smiling. These gestures also play an important role in breaking the artist/spectator barrier and this strengthens, and reifies the connection between the DJ and the dancers. Breaking the barrier between the artist and participant is another reason why DJ booths are centrally located at raves. It is important that the DJ see the dancers so that he can respond to them, and it is equally important for the participants to be in close physical proximity to the DJ, so that his personality and presence are able to come through: I don’t feel like I have to hide and say, â€Å"No one should see me when I DJ. It’s all about the music.† Bullshit! People always need someone they can connect to and they can identify with. I always felt that I could bring the music across in a more convincing way by using my personality. Because I give people an honest feeling. The most important thing is to see people standing happily on the dance floor in the end (Sven Vath in Huegli 2002:18). All of these factors are conducive to breaking the barrier between the DJ and the dancers. The communication that occurs between the two is much more than music, lyrics, and the dance movements, or what Rouget refers to as the â€Å"level of the code† (Rouget 1985:113). In reference to possession rituals, communication is established â€Å"at the personal level, the emotional level of direct person-to-person relationships† (Rouget 1985:113). The active role of the dancers also reinforces the dismantling of the barrier between the performer and audience, and this is where the concept of the feedback loop between the DJ and participants is relevant. As DJ Spooky puts it, â€Å"the DJ/audience relationship is like a symbiosis you know, it’s like a biological structure you know, I mean it’s like you are sending out information and pulses that the crowd in a way then sends back to you, and like you’re like a focal point of the energy of these gathered people† (Reiss 1999). There is also an emotional element involved in this symbiotic relationship which targets the DJ with responsibility for the emotions of the crowd of dancers. The DJ’s emotional state can be transmitted to the crowd through his music and consequently impacts the condition of the dancers. A DJ’s seeming lack of enthusiasm, his failure to make eye-contact, smile, or dance are indicators suggesting that he isn’t having a good time, and this has consequences on the crowd. While the crowd is sensitive to these nonverbal indicators of the DJ’s affective state, the DJ’s mental state can influence his choice of music, and this too will impact the experience of the dancers. While electronic music has been accused by some of being repetitive, bland, and even minimal, there is a strong correlation between the genres of Techno music and affect. For example, Terrorcore, Industrial Hardcore, Jungle, and Drum n’ Bass, are noted for bringing out aggressive and negative emotional states in some individuals. Bold, militant rhythmic patterns, sounds of machinery, people screaming, and vocals with coarse language, are the kinds of sounds attributed to some of these music styles. It is generally felt that the people who are looking to experience negativ e and aggressive states seek out these types of events. In contrast, Trance, House, and Happy Hardcore, are generally characterized by warm melodic styles and positive lyrics that are noted for engendering such feelings as love, a sense of well-being, connectedness, and spirituality among participants. Depending on his mood, the DJ can choose tracks with vocals and melodies that accentuate positive themes, or tracks with sounds and lyrics that concentrate on the darker aspects of life. This is why a participant’s sense of trust in the DJ is so important. It becomes evident that there is a shared feeling of uncertainty arising from the inability to pinpoint the DJ’s intentions: I realized that the DJ had POWER over me. I was basically prostituting for the DJ: I was a slave to what he had (the promise of the climax) and he was flexing his power and tweaking with me to see how much I could stretch myself out for it. It really scared me†¦ I think some DJs definitely hold the power of a cult in their turntables and in their speakers, and it’s really not something that I want to get down on my knees for. Just a thought, I’m not bagging here. I still think rave is one of the best things the 20th century has to offer, but I think that if left unchecked, it could turn on us (cited in Takahashi and Olaveson 2003:86). At raves, the trance state is very much dependent on the individual’s willingness to let go and trust the DJ in allowing him to guide the nature of his or her experience. One DJ regards the dancers as having a responsibility to meet him half way, â€Å"As long as they are open for a while and let themselves go, they have the opportunity to feel things the way I intended them to† (Heiko Laux, in Huegli 2002). Here again, the similarities between possession rituals and raves are apparent. Rouget characterizes the relation of the possessee to the musicians as â€Å"the submission of the former to the latter† (Rouget 1985:112). The following description of the ndop ceremony highlights many of these striking resemblances including the instrumentalist’s ability to observe and respond to the dancers’ movements, and the bond established between the two: In fact, a close interpersonal relationship develops at this point between drummer and possessee. The drummer takes charge of her, so to speak. Keeping very close to her, never leaving her side, concentrating on her slightest movements, incessantly observing her behavior in order to: speed up the tempo, or, on the contrary, relax it; select the necessary types of beat; and adjust the intensity of the stroke. Communicating the rhythm of the dance to her, he holds the possessed woman in his sway and leads her into the ever more violent whirlwind of his music. But if he is able to lead her in this way, and finally guide her where he wishes, it is because he has been able to establish a close understanding with her. It is because he can follow her that he is able to dominate her and impose his will upon her. He is the master of the game, but within a dialogue. He speaks music and she replies dance (Rouget 1985:112). The theme of submission is also apparent in possession ceremonies in relation to the spirit beings that possess cult members. In the case of Haitian Vodou, for example, Bourguignon highlights extreme passivity as one of the prerequisites for trance induction: However, one aspect of submission-dominance seems of importance in relation to possession trance: in person, as we have seen, is said to be â€Å"mounted† by the spirit, to be his â€Å"horse.† The personality of the individual, one of his souls called â€Å"gros bon ange,† is displaced and the body is taken over by the spirit. In other words, there is total subjection to the spirit and total submission to him (or her). The spirit, as a powerful superhuman entity, can do as he pleases, both with the horse he has mounted and with other human beings present. We thus have an expression of extreme passivity in this interpretation of possession trance (Bourguignon 1976:40). At raves, references to the power of music in directing the body are reminiscent of possession’s horse and rider metaphor. According to Sylvan, these accounts of submitting to the music â€Å"suggest a trance state very similar to possession, in which music becomes the rider and the body becomes the horse, but without reference to any specific possessing spirit† (Sylvan 2002:129). In the rave locale, the DJ is equally influenced by the emotions of the crowd, where participant feedback is transmitted at the visceral level. While it is not unusual for participants to demonstrate their admiration for a DJ by whistling or chanting his name, for the most part, crowd feedback is nonverbal. Occurring as sets of coordinated body techniques that all ravers seem to intuitively know and all DJs can follow, these moves are acquired at the corporal level and most ravers seem to be unconscious or unaware of these movements. The responses to the DJ are well coordinated from an observer’s point of view. Fikentscher calls the sum of individual dancing bodies the â€Å"collective performance† wherein the bodies of the dancers can potentially unite to form â€Å"one musical instrument† (Fikentscher 2000:58-59). As McCall suggests, this process is mediated by dancers’ observation of subconscious cues. These cues create a system where â€Å"people are helping each other dance without knowing it, feeding off the collective anticipation for that moment of synergy where it feels like utter madness: cheers, claps, whistles, hands in the air. Suddenly everyone is dancing in unison† (McCall 2001:93). When the dancers are in sync with one another, the boundaries between individuals seem to vanish as the crowd appears to function as one organism (McCall 2001:95). This process of synchronization also encompasses the entry into a collective psychic space. In Music and Trance: A Theory of the Relations Between Music and Possession, Rouget emphasizes that rituals of possession are embedded within rich cultural traditions wherein trance is a learned and culturally patterned process. In these traditions, the musical motifs, instruments, and dance steps are localized to specific gods and myths, and thus the music operates as â€Å"the principal means of socializing trance† (Rouget 1985:323). Rouget argues that it is the possessee’s ability to identify emotionally with the music and dancing as signifiers of cultural knowledge, that enables him to enter the trance state. This is where electronic music departs from possession music. Although raves are emotionally charged events, the music and dance movements are not rooted in a specific cultural tradition other than rave. Nevertheless, there is an inherent power in the music to evoke extraordinary states of consciousness and this is where the universal agents involved in trigger ing trance are paramount. DJs have not only utilized these mechanisms to induce trance among participants, but the available technology in sound and music production has given artists the means to refine these practices into a science of precision. To a certain extent, these technological advancements compensate for the lack of cultural signifiers, as DJs have access to a range of equipment that is clearly absent in ceremonial possession. Electronic music producers are creating works that are intended to elicit specific states in the brain, and advancements in sound and visual effects at raves create the optimal listening environment for these tracks. Even though the sophisticated scripted process of initiation as observed in ceremonial possession is lacking at raves, these features when combined with the DJ’s proficiency in track selection and crowd interaction, and the learning on the part of participants in recognizing and responding to the DJ’s cues, account for the ASC’s that people are reporting at raves. Many DJs as well as experienced rave participants have developed their senses in such a way that they perceive Techno music differently than those who have never been exposed to it. This shift in musical perception is a learned by-product of repeatedly exposing the auditory system to new stimuli, and this transition is a key part of the scripted process as well as a prerequisite to ASC induction. For DJs and their fans, listening entertainment is only a small part of the electronic music scene. Specifically, the tones, frequencies and beats of electronic music are designed by producers and further refined by DJs to target the body in precise ways. Electronic music is intended to be physically experienced and this is evinced by the fact that many veterans of the rave scene describe the music as having a three-dimensional vibrational quality that transcends the traditional way music is perceived. The body-centered quality of the music is deeply intrinsic to electronic music culture and this is the common thread that links the numerous classifications of rave music. Computer technology has provided the DJ with the power to totally control the means of perception at raves. Whereas â€Å"the tonalities and structures of traditional music are limited by the parameters of the instruments on which they are played† electronic music â€Å"sets tonality loose releasing creativity from the discipline-and exclusivity-of musicianship† (Hemment 1997:29). As Gauthier remarks, â€Å"Techno becomes a presence that cannot be ignored-more, it is a shock whose intensity is only matched by the body’s urge to give in to it, an aggression made positive through the festive context† (Gauthier 2004:75). The dominance of the music is also supported by the high volume of the music. According to Fikentscher, this ensures the authority of the DJ as the music establishes â€Å"absolute priority over other acoustic phenomena: conversation, handclapping, foot stomping, yelling, whistling† (Fikentscher 2003:85). Some electronic musicians are even experimenting with sounds that go beyond the human auditory range. Fritz argues that sounds that vibrate through the body without being heard â€Å"may be partly responsible for the powerful emotional response people have when listening to rave music† (Fritz 1999:78). While the majority of DJs are not necessarily versed in the scientific literature on trance states, or use scientific language to describe what they do, there is an underlying intuitive knowledge of what works with the crowd at raves. Rouget observes that an interruption in the music’s flow is used cross-culturally to induce trance. Such catalysts as the acceleration of tempo, the crescendo in volume, the use of polyrhythm, rhythmic changes such as syncopation, and even a brief cessation of the music, are techniques that interrupt the music’s flow, triggering trance (Rouget 1985:80-84). Rouget notes that most possession ceremonies begin slowly, gradually intensifying throughout the evening with the onset of possession being the climax of the event (ibid 1985:80-84). The methods implemented by instrumentalists in interrupting the music’s flow function to intensify the sound and atmosphere of possession rituals. With electronic music, the idea of tension and releas e is a built-in characteristic of all classifications of rave music. Thus while Trance, Jungle, and House may differ with regard to tempo, meter, instrumentation, and use of lyrics, the same techniques of building tension are employed by DJs in all three genres. As Reynolds notes â€Å"rave music has always been structured around the delay of climax† and the anticipation of a â€Å"plateau of bliss that can be neither exceeded nor released† (Reynolds 1994:56). This paper examined the role of the electronic music DJ, and how DJ’ing has evolved into an art-from as well as a science. Technology has played a pivotal role in shaping the development of rave culture. At its core, the music that binds this global culture together is created, exchanged, performed, and experienced through computer-mediated technology. According to Wilson, â€Å"a reverence to and celebration of technology, and an implicit and explicit belief in ‘progress through technology,’† is one of the underlying doctrines of rave culture (Wilson 2003:386). As Gauthier remarks in reference to rave culture, â€Å"technology is synonymous with possibility, and stands as a prerequisite for creation, gathering and effervescence† (Gauthier 2004:71). Raves would be crippled without technology and this reinforces Reynolds’ point that rave music is not about â€Å"what the music ‘means’ but how it works† (Reynolds 1998:9). The DJ is the expert in knowing how electronic music works. His expansive knowledge of repertoire, aptitude for musical memory, technical prowess at the turntable, charismatic presence on stage, and ability to interact with, read, and manipulate the crowd, have awarded him the power to take his dancers on what participants have described as an â€Å"ecstatic† journey.

Peripheral Neuropathy among Patients Living with Diabetes

Peripheral Neuropathy among Patients Living with Diabetes Update on Foot Care: Identifying Early signs of Peripheral Neuropathy among  Patients Living with Diabetes Mellitus Bernice S. Samuel DNP  and  Susan J. Appel, PhD, APRN-BC, CCRN, FAHA Introduction Among those individuals living with diabetes, peripheral neuropathy (PNP) is a major contributor in the development of foot ulcers.1 Even though there has been a decline in recent limb amputations due to advanced management of foot ulcers, 7% of those affected with type 2 diabetes (T2D) will still develop foot ulcers.2 Diabetes-related foot ulcers not only cause further physical disability, they also reduce the quality of life and increase the risks of lower extremity amputations. 3 The CDC 4 reports that 65,700 non-traumatic lower-limb amputations were performed among people living with diabetes. While diabetes is a major cause of complications such as vasculopathies and PNP, foot ulcers are the most easily prevented complications. 5 Therefore, practitioners must be fully apprised of tools and methods used to identify early PNP and prevent foot ulcers. Practitioners should also focus on actively educating the patient and family regarding PNP. Most practitioners are familiar with the Semmes-Weinstein Monofilament testing (SWMT) as the gold standard used in primary care to assess for PNP. Mayfield and Sugarman reported the use of the SWMT as a useful tool in the primary care office for practitioners to assess patients for PNP, but indicated it is not without limitations. 6 Further interventions are needed when there is a loss of sensation detected, such as proper footwear and patient education, to prevent trauma and foot ulcers. 6 Research has shown that practitioners can continue to assess patients with diabetes using the monofilament testing as long as PNP is not present. Once PNP is noted, additional assessment and management techniques are warranted. A yearly thorough foot exam by a podiatrist has been recommended by the American Diabetes Association for those living with diabetes. 7 In addition, persons with diabetes and one or more risk factors need frequent assessments of their feet during routine office visits. 5 Patients with known risk factors for foot ulcers (e.g., poor vision, previous foot ulcers or amputation, monofilament insensitivity, and fungal infections of skin or nails) deserve special attention. 8 When practitioners have available clinical information that can help to predict the development of diabetes- related foot ulcers, patients will have better outcomes. 8 These predictors were found to be helpful in accurately targeting clients at high risks of contracting foot ulcers for preventative interventions. The use of proper footwear such as diabetes specialized shoes with proper diabetes foot insoles has been found to be a protective intervention. Pathophysiology of Foot Ulcers Diabetes related foot lesions occur as a result of two or more risk factors: PNP and peripheral arterial disease (PAD). 9 Diabetes-related PNP is a leading contributor to foot lesions. 10 The presence of PAD increases the risk for foot infections and ulcers among people living with diabetes. 11 Foot lesions are less likely to heal due to vascular insufficiency. 12 Research shows that there are three factors that leads to foot ulcers and infections: foot deformities, PNP, and minor trauma. 13 It is important to understand that the longer an individual lives with elevated blood glucose, the more likely he or she will develop PNP. 2 Long term hyperglycemia can affect the skin and delay wound healing if minor cuts or sores occur on the foot. 14 PNP According to Benbow, 14 PNP can be classified as sensory, autonomic or motor. In sensory system PNP, an individual with diabetes has no feeling of sensation on his or her feet, does not feel hot or cold temperature, and does not feel cuts or trauma to his or her feet. 14 When PNP affects the autonomic system an individual will experience a decrease in sweat, resulting in cracked or fissured skin, dilated dorsal veins and an increase in temperature of their feet. 14 When the motor system is affected by PNP, the patient will be at risk for developing foot deformities such as Charcot foot. 14 Commonly, these patients report symptoms of aches and pains with tingling in their feet when PNP is present. 13 Foot Deformities According to Abad Safdar, 13 foot deformities are the second causative factor that leads to foot ulcers among people living with diabetes. People affected by neuropathy have decreased sensation in their feet, and are more prone to foot deformities. 13 These foot deformities affect the muscles and bones of the foot leading to bony protrusions that put the individual at increased risk for ulceration especially when PNP is present. 13 The correlation of PNP and foot deformities was examined by Soyupek, Ceceli, Suslu, Yorgancioglu, 15 utilizing x-rays. Their study showed that the patients with PNP commonly also have foot deformities such as pes planus, pes cavus, tendon calcifications and osteoporosis. 15 Patients living with type 1 diabetes are particularly at risk for developing Charcot neuropathy that causes destruction of the bones of the foot. 16The resultant bone thinning causes the bones to be fragile and leads to foot deformities. 16 Foot Trauma Abad Safar 13 identify foot trauma as the third factor that can lead to foot ulcers. Foot ulceration occurs when there is breaking of the skin, which leads to impaired healing of the lesion. 12 People affected by PNP have sensory loss of their feet and are unable to identify foot pain, trauma, calluses or injury to their feet. 13 Wearing ill-fitting shoes, calluses, onychomycosis, and foot infections that are not treated are all causes of foot trauma leading to ulceration. Once ulceration occurs due to trauma, the wound becomes infected. Testing Tuning Fork and Neurothesiometer A study by Kà ¤stenbauer, Sauseng, Brath, Abrahamian, Irsigler 17 investigated the effectiveness of the Rydel-Seiffer tuning fork in helping with the detection of diabetes-related neuropathy and compared its ability with that of the electronic neurothesiometer. In this study a 128-Hz tuning fork and a neurothesiometer were used at the bedside. 17 The results of the study showed that vibration perception threshold (VPT) was normal in 1917 individuals and abnormal in about 105 individuals when the tuning fork was used. 17 The participants who had abnormal results were older and also had elevated A1c results. The researchers used the neurothesiometer and the results showed that VPT was 2.5 times higher among patients who had an abnormal tuning fork test. 17 The researchers concluded that the tuning fork had a higher sensitivity and a better predictive value in diagnosing PNP at the bedside. 17 The tuning fork is a reliable instrument in helping to detect PNP in the outpatient setting. It is an appropriate clinical tool that practitioners can utilize either at the bedside or in primary care. Neurometer A double-blinded study by Nather and et al. 18 showed that there were other testing methods that were superior in comparison to the SWMT in detecting PNP. One useful tool was neurometer testing. The neurometer measures readings from rapid current perception threshold (R-CPT) which is derived from the lowest strength of stimulus that the patient could perceive. 18 Three different rates of current signals at levels measuring between 0 and 10 mA were applied by the neurometer to the big toe and ankle. 18 Neurometer testing was found to be highly sensitive as compared to the SWMT. Sensory neuropathy was detected with better accuracy when using the neurometer testing at the big toe and ankle sites in comparison to the SWMT. 18 Studies show that the neurometer is an effective tool that practitioners can use to detect PNP. Temperature guided avoidance therapy Research shows that the best intervention in the prevention of foot ulcers was foot temperature guided avoidance therapy (TGAT). 19 A study by Lavery et al. 20 sought to evaluate the effectiveness of infrared temperature monitoring among individuals at a high risk for diabetes related ulceration and amputations. Patients were placed in a usual therapy group or an enhanced therapy group. 20 The enhanced therapy group had additional tasks such as such as the use of a handheld infrared skin thermometer to measure the temperatures on the bottom of their feet twice a day. 20Participants contacted a nurse if they noted a difference in temperature >4 °F between the left and right foot. 20 The results of the study showed that the enhanced therapy group had notably fewer diabetes related foot complications. 20 The TGAT is an effective method in the detection of PNP where practitioners can assist patients in identifying sensory loss so that foot ulcers and complications can be prevented. Scales for Neuropathy Symptoms The Diabetes Neuropathy Symptom (DNS) score is a valuable tool that can be used to screen for and identify PNP. 21 The scoring is based upon symptoms such as ataxic walking, neuropathic pain, paraesthesia, and/or numbness. The DNS criteria are scored with 1 point each and there is a total of 4 points that can be given. 21 Presence of PNP is present with a score of 1, or more. 21 Similarly, the Diabetic Neuropathy Examination (DNE) is another valuable scoring system that helps to identify PNP. This scoring system consists of a total of eight items: two of the items describe the person’s muscle strength; one item addresses reflexes of the tendon and the other five items address sensation. 21 There is a total of 16 points that can be scored with this system. Any score above 3 points is considered to be abnormal and is PNP. 21 Treatment Educating patients Educational interventions are an important tool in reducing foot ulcers. A randomized controlled trial by Gershater and et al. 22 was designed to investigate the effectiveness of patients learning in groups versus learning on their own with information that is provided to them. The authors sought to understand what types of learning would decrease the incidence of foot ulcers. The study results showed that about 42% of the patients got foot ulcers. 22 Some of the reasons for ulcer development were: stress- related plantar ulcer and trauma. 22 The study showed that education in group sessions among patients who are at increased risk for foot ulcers did not have an effect on whether they would develop ulcers of the foot. 22 It was concluded that sessions conducted within a group educational method may be suitable for patients who have a low risk of getting foot ulcers. The authors of the study suggests that it is important to educate practitioners involved in the patient’s medic al care and also their caregivers regarding improved foot care such as footwear and signs of foot problems. Implications for Practice The conclusive results show the best methods to identify PNP and to prevent foot ulcers was the TGAT, the neurothesiometer and the tuning fork. The TGAT method shows that patients can complete this task at home and alert their practitioner about the results. The TGAT is valuable in showing the results of further neuropathy or damage if patients have a prior history of insensitivity to the SWMT. The SWMT is valuable for practitioners to use in the office setting as this is an inexpensive test. The SWMT is not valid once neuropathy is diagnosed. The practitioner should consider the use of the TGAT at this point and teach the patient how to use an infrared sensitive skin thermometer. The patient should be advised to keep a log book and if the temperature on the designated site is >4 °F, he or she will need to reduce the number of steps taken in the following days and contact their practitioner. The tuning fork was also validated as being highly sensitive in diagnosing PNP and is a goo d test for practitioners to use at the bedside. Certain clinical information about the patient is valuable in predicting future foot ulcers. These predictors were high A1c levels, poor vision, prior history of foot ulcer and/or amputation, monofilament insensitivity, tinea pedis and onychomycosis. The practitioner needs to be aware of these predictors and educate the patient about foot care. Practitioners need to increase monitoring of the patient’s foot at every office visit when these predictors are identified. Education is an important criterion in managing PNP. Patients need to be educated about PNP, foot ulcers, proper fitting shoes and the signs of foot infections. This review of the evidence- based literature revealed that basic SWMT is useful in predicting neuropathy but is not useful in preventing ulcers once neuropathy is diagnosed. There is a common misconception among practitioners that SWMT can be used even when neuropathy is diagnosed. The re-education of practitioners is important with the introduction of new testing methods such as TGAT once neuropathy is already diagnosed. This best practice will help to prevent ulcers among persons affected by diabetes and therefore improve the quality of their life. References Meaney, B. (2012). Diabetic foot care: Prevention is better than cure. Journal Of Renal Care, 3890-98. doi:http://dx.doi.org/10.1111/j.1755-6686.2012.00276.x Eddy, J., Price, T. (2009). Diabetic foot care: Tips and tools to streamline your approach. Journal Of Family Practice, 58(12), 646-653 Dorresteijn, J., Kriegsman, D., Valk, D. (2011). Complex interventions for preventing diabetic foot ulceration. The Cochrane Library. Retrieved from http://www.thecochranelibrary.com Centers for Disease Control and Prevention (2012). Diabetes data and trend. Retrieved from: http://www.cdc.gov/diabetes/statistics/prev/national/figraceethsex.htm Broersma, A. (2004). Preventing amputations in patients with Diabetes and Chronic kidney disease. Nephrology Nursing Journal, 31(1), 53-64. Mayfield, J. A., Sugarman, J. R. (2000). The use of the Semmes-Weinstein Monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. Journal Of Family Practice, 49(11), S17-S29. American Diabetes Association. (2013). Standards of Medical Care in Diabetes. Diabetes care. Retrieved from http://care.diabetesjournals.org/content/36/Supplement_1/S11.full Boyko, E.J., Ahroni , J.H., Cohen, V., Nelson, K.M., Heagerty, P.J. (2006). Prediction of diabetic foot ulcer occurrence using commonly available clinical information: The Seattle Diabetic Foot Study. Diabetes Care, 29(6):1202-7. Retrieved from: http://care.diabetesjournals.org/content/29/6/1202.full.pdf+html Bakker, K., Apelqvist, J., . Schaper, N. C. (2012). Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes/metabolism Research and Reviews, 28, 225-231. doi:10.1002/dmrr.2253 Bakker, K., Apelqvist, J., . Schaper, N. C. (2012). Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes/metabolism Research and Reviews, 28, 225-231. doi:10.1002/dmrr.2253 Jarrett, L. (2013). Prevention and management of neuropathic diabetic foot ulcers. Nursing Standard, 28(7), 55-65. Nagoba, B., Gandhi, R., Wadher, B., Rao, A., Hartalkar, A., Selkar, S. (2010). A simple and effective approach for the treatment of diabetic foot ulcers with different Wagner grades. International Wound Journal, 7(3), 153-158. doi:http://dx.doi.org/10.1111/j.1742- 481X.2010.00666.x Abad, C., . Safdar, N. (2012). From Ulcer to Infection: An Update on Clinical Practice and Adjunctive Treatments of Diabetic Foot Ulcers. Curr Infect Dis Re, 14:540–550. DOI 10.1007/s11908-012-0283-3 Benbow, M. (2012). Diabetic foot ulcers. Journal Of Community Nursing, 26(5), 16 Soyupek, F., Ceceli, E., Suslu, F., Yorgancioglu, R. (2007). Neurologic and radiologic abnormalities of the foot in diabetic patients. Journal Of Back Musculoskeletal Rehabilitation, 20(2/3), 55-60 Holt, P. (2013). Assessment and management of patients with diabetic foot ulcers. Nursing Standard, 27(27), 49-55 Kà ¤stenbauer, T., Sauseng, S., Brath, H., Abrahamian, H., Irsigler, K. (2004). The value of the Rydel-Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer. Diabetic Medicine, 21(6), 563-567. Nather, A., Keng, W., Aziz, Z., Ong, C., McFeng, B., Lin. C. (2011). Assessment of sensory neuropathy in patients with diabetic foot problems. Diabetic Foot Ankle.2(10). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/22396819 19. Arad, Y., Fonseca, V., Peters, A., Vinik, A.( 2011). Beyond the monofilament for the insensate diabetic foot: a systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes. Diabetes Care, 34(4):1041-6. doi: 10.2337/dc10-1666. Lavery, L., Higgins, K., Lanctot, D., Constantinides, G., Zamorano, R., Armstrong, D., Kyriacos, A., Agrawal, M. (2004). Home Monitoring of Foot Skin Temperatures to Prevent Ulceration. Diabetes Care, 27 (11):2642-2647. Meijer, J.W., Bosma, E., Lefrandt, J., Links, T., Smit, A., Stewart, R., Van Der Hoeven, J. (2003). Clinical Diagnosis of Diabetic Polyneuropathy With the Diabetic Neuropathy Symptom and Diabetic Neuropathy Examination Scores Diabetes Care, 26(3), 697-701. Retrieved from: http://care.diabetesjournals.org/ Gershater, M., Pilhammar, E., Apelqvist, J., Alm-Roijer, C,. (2011). Patient education for the prevention of diabetic foot ulcers. European Diabetes Nursing, 8(3), 102-107b. Retrieved from: http://dx.doi.org/10.1002/edn.189

Loneliness Essay -- Journalistic Essays

To be lonely is an easy thing, being alone is another matter entirely. To understand this, first one must understand the difference between loneliness and being alone. To be alone means that your are not in the company of anyone else. You are one. But loneliness can happen anytime, anywhere. You can be lonely in a crowd, lonely with friends, lonely with family. You can even be lonely while with loved ones. For feeling lonely, is in essence a feeling of being alone. As thought you were one and you feel as though you will always be that way. Loneliness can be one of the most destructive feelings humans are capable of feeling. For loneliness can lead to depression, suicide, and even to raging out and hurting friends and/or strangers. The second major problem with loneliness is that it can be a very difficult feeling to lose, especially if it has already progressed into depression. There are, of course, drug therapies, but unless the problems are hormonal or chemical in nature, they will not serve the purpose of treating the longer term problem. The proper treatment of ...

The Life and Mind of Jerry Garcia in Conjunction with Howard Gardners Model of Creativity :: Howard Gardner Jerry Garcia Paperes

The Life and Mind of Jerry Garcia in Conjunction with Howard Gardner's Model of Creativity "We always though of the Grateful Dead as being the engine that was driving the spaceship that we were traveling on."-Ken Babbs, a former Merry Prankster "Daddy is sleeping. Don't touch the guitars." -Heather Garcia In his Creating Minds, Howard Gardner states the purpose of his book as an examination of the "...often peculiar intellectual capacities, personality configurations, social arrangements, and creative agendas, struggles, and accomplishments" (6). In this paper I will examine the life and creativity of John Jerome Garcia from the framework and theories provided by Gardner, from the perspective of aptness in the musical intelligence. One of the most significant events of Jerry Garcia's childhood occurred when he was four and brother Clifford, "Tiff," was eight. "We'd been given a chore to do...he'd hold the wood and I'd chop it...he was [messing] around and I was just constantly chopping." Jerry lost about half of his right ring finger. This was the first of many losses Jerry experienced that would affect his life and musical style. The Early Years Born in San Francisco, Jerry Garcia was the son of a registered nurse and an immigrant big bandleader. When Garcia's band broke up, he went into the bar business. It was right after the Depression. "It was a job he had to take to survive. Back then, you had to take any damn thing." Continuing the pattern of loss, Garcia drowned when Jerry was five. It is notable that he grew up with a single parent, an environment that characterizes many of today's children's formative experiences. When his father died, his decided to continue the bar business. As a result of this, what was left of the Garcia family moved around the San Francisco area quite frequently during the childrens' formative years. All the family members the children knew lived within a five-block radius. This enabled them to have an even bigger run of the city, as they would often ride the train around town to visit relatives. Prodigiousness One of the issues in Gardner's model is the child prodigy. We see this reflected best in Picasso, less so in Einstein. Jerry was quite the opposite. His musical career was characterized by very, very hard work. As former wife Sara recalled, "He'd be in a bad mood if he couldn't practice for several hours a day" (32). "He'd get into an absolute funk if he couldn't get something absolutely right" (47).

The Style of Milan Kundera :: Biography Biographies Essays

The Style of Milan Kundera ex is ten tial ism - A philosophy that emphasizes the uniqueness and isolation of the individual experience in a hostile or indifferent universe, regards human existence as unexplainable, and stresses freedom of choice and responsibility for the consequences of one's acts. This word has been used when describing Milan Kundera’s style of writing. The term existentialism came from Jean Paul Sartre, a French philosopher. Existentialism emphasizes individual existence, freedom and choice. The philosophy focuses on the existence of man. Sartre believed that to be a true existentialist one must accept that there is no God therefore man is alone with only himself to rely on for all decisions. This gives man total freedom of choice. However with this total freedom comes the responsibility of knowing one must choose wisely. Kundera applies this philosophy to his characters in â€Å"The Unbearable Lightness of Being†. He shows us how the four lovers choices affect their lives. Will the characters choose lightness or weight? After seven years of living with the ‘heaviness† of Tereza, Tomas thinks he will enjoy â€Å"the sweet lightness of being† (Kundera P 30) when she leaves him. However, he soon realizes that the lightness of her absence is swiftly replaced by the heaviness of her absence. Franz on the other hand leaves his wife for Sabina, but when Sabina rejects him and his wife will not take him back Franz finds that he enjoys the lightness of his life. Tomas wished to be free but found it was not what he wanted at all. Franz who wished to be tied reveled in his freedom. â€Å"At last he ceased to be a little boy; for the first time in his life he was on his own.† (Kundera p120) Sabina did not want to be Mari-Claude. She did not want to share a marriage bed with Franz, but when she left him her lightness was not joy, it was emptiness. â€Å" What fell to her lot was not the burden [heaviness] but the unbearable lightness of being.† (Kundera P 122) When Tereza has sex with the engineer she thought it would help her understand how Tomas could sleep with many women in lightness without the burden of love. Tereza thinks, â€Å"How she [Tereza] wished she could learn lightness!†(Kundera P143) Instead she thought if the engineer â€Å"addressed her soul† she would have fallen in love with him at that instant.