The Road Not Taken - An Analysis Essays - The Road Not Taken

The Road Not Taken - an analysis Title: The Road Not Taken - an analysis "Do not follow where the path may lead... Go instead where there is no path and leave a trail." -Robert Frost Everyone is a traveler, choosing the roads to follow on the map of their continuous journey, life. There is never a straight path that leaves one with but a sole direction in which to head. Regardless of the original message that Robert Frost had intended to convey, his poem, "The Road Not Taken", has left its readers with many different interpretations. It is one's past, present and the attitude with which he looks upon his future that determines the shade of the light that he will see the poem in. In any case however, this poem clearly demonstrates Frost's belief that it is the road that one chooses that makes him the man who he is. "And sorry I could not travel both..." It is always difficult to make a decision because it is impossible not to wonder about the opportunity cost, what will be missed out on. There is a strong sense of regret before the choice is even made and it lies in the knowledge that in one lifetime, it is impossible to travel down every path. In an attempt to make a decision, the traveler "looks down one as far as I could". The road that will be chosen leads to the unknown, as does any choice in life. As much he may strain his eyes to see as far the road stretches, eventually it surpasses his vision and he can never see where it is going to lead. It is the way that he chooses here that sets him off on his journey and decides where he is going. "Then took the other, just as fair, and having perhaps the better claim." What made it have the better claim is that "it was grassy and wanted wear." It was something that was obviously not for everyone because it seemed that the majority of people took the other path therefore he calls it "the road less travelled by". The fact that the traveler took this path over the more popular, secure one indicates the type of personality he has, one that does not want to necessarily follow the crowd but do more of what has never been done, what is new and different. "And both that morning equally lay in leaves no step had trodden black." The leaves had covered the ground and since the time they had fallen no one had yet to pass by on this road. Perhaps Frost does this because each time a person comes to the point where they have to make a choice, it is new to them, somewhere they have never been and they tend to feel as though no one else had ever been there either. "I kept the first for another day!" The desire to travel down both paths is expressed and is not unusual, but "knowing how way leads on to way", the speaker of this poem realizes that the decision is not just a temporary one and he "doubted if I should ever come back." This is his common sense speaking and acknowledging that what he chooses now will affect every other choice he makes afterward. Once you have performed an act or spoken a word that crystalizes who you are, there is no turning back, it cannot be undone. Once again at the end of the poem the regret hangs over the traveler like a heavy cloud about to burst. He realizes that at the end of his life, "somewhere ages and ages hence", he will have regrets about having never gone back and traveling down the roads he did not take. Yet he remains proud of his decision and he recognizes that it was this path that he chose that made him turn out the way and he did and live his life the way in which he lived. "I took the road less trvaeled by and that had made all the difference." To this man, what was most important, what really made the difference, is that he did what he

Dnde enviar la solicitud para la greencard por matrimonio

Dnde enviar la solicitud para la greencard por matrimonio   Los ciudadanos americanos y los residentes permanentes pueden solicitar la tarjeta de residencia   por matrimonio para sus esposos enviando la aplicacià ³n  al USCIS. Estas son las reglas. La solicitud al Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s)  se hace mediante la planilla I-130. Debe acompaà ±arse de otros documentos y del pago de la cuota correspondiente. A la hora de enviar los papeles pueden darse las siguientes posibilidades: El solicitante est en Estados Unidos y su marido o mujer estn en otro pas Es el caso en el que un ciudadano americano o residente permanente legal est en Estados Unidos y su cà ³nyuge se encuentra en otro paà ­s. El lugar al que hay que enviar la documentacià ³n depende del estado o territorio en el que vive el solicitante. Asà ­: Si reside en: Alaska, Arizona, California, Colorado,Dakota del Norte, Dakota del Sur,  Florida, Hawaii, Idaho, Kansas, Montana, Nebraska, Nevada, Nuevo Mà ©xico, Oklahoma, Oregà ³n, Texas, Utah, Washington o Wyoming o en los territorios de Samoa, Puerto Rico, Guam o las Islas Marianas,  la documentacià ³n que se envà ­a por correo ordinario del servicio de Correos pà ºblico ha de dirigirse a: USCISATTN: I-130PO Box 21700Phoenix, AZ 85036 Pero si se envà ­a por Express Mail o utilizando un servicio privado de mensajerà ­a tipo UPS o Fedex, entonces el sobre con la documentacià ³n ha de enviarse a: USCISAttn: I-1301820 E. Skyharbor Circle SSuite 100Phoenix, AZ 85034 Si el solicitante reside en: Alabama, Arkansas, Carolina del Norte, Carolina del Sur, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kentucky, Luisiana, Maine, Maryland, Massachusetts, Michigan, Minesota, Misisipi, Misuri, Nuevo Hampshire, Nueva Jersey, Nueva York, Ohio, Pensilvania, Rhode Island, Vermont, Virginia, Virginia Occidental, Wisconsin y Washington D.C., entonces los envà ­os realizados por correo ordinario del Servicio de Correos Pà ºblico (US Postal Service o USPS) han de dirigirse a: USCISP.O. Box 804625Chicago, IL 60680-4107 Sin embargo, si se prefiere utilizar un Express Mail o un servicio de mensajerà ­a privado, la direccià ³n a la que se envà ­a es: USCISAttn: I-130131 South Dearborn-3rd  FloorChicago, IL 60603-551 En los casos en que ambos cnyuges estn en este momento residiendo en el extranjero Puede suceder que el solicitante està © viviendo temporalmente en otro paà ­s pero desea regresar a Estados Unidos. Por esta razà ³n solicita la tarjeta de residencia para su cà ³nyuge. Son pocos los casos en los que se da esta circunstancia pero sà ­ que son posibles. La direccià ³n a la que enviar la documentacià ³n es la seà ±alada en el supuesto anterior cuando se envà ­a a las oficinas (lockbox) de Chicago,  IL. Recordar enviar a una u otra direccià ³n en Chicago dependiendo del servicio de envà ­o que se utilice. Adems, si el solicitante vive en un paà ­s donde el USCIS tiene una oficina internacional, puede enviarse la documentacià ³n allà ­. Es lo que se conoce como una presentacià ³n de solicitud directamente en una oficina consular (DCF, por sus siglas en inglà ©s por Direct Consular Filing).  Estas son las posibilidades con sus direcciones para envà ­o de correo y servicio de mensajerà ­a en paà ­ses en los que se habla espaà ±ol: CubaEl SalvadorGuatemalaMà ©xico DFMà ©xico, Ciudad JurezMà ©xico, MonterreyPerà ºRepà ºblica Dominicana El USCIS mantiene un pgina con las direcciones de correo de cada una de esas oficinas. Cuando el solicitante y el cnyugeresiden en Estados Unidos Si  adems de la solicitud de la tarjeta de residencia para su cà ³nyuge aplica por un ajuste de estatus para à ©ste mediante la planilla I-485. En estos casos, si se emplea correo ordinario del Servicio de Correos la direccià ³n de envà ­o es: USCISP.O. Box 805887Chicago, IL 60680-4120 Si se prefiere utilizar Express Mail o un servicio de mensajerà ­a privado (courier service) entonces enviar la documentacià ³n a: USCISFBAS131 South Dearborn-3rd  FloorChicago, IL 60603-5517 Es muy importante estar seguros de que se puede ajustar el estatus. Ya que si no se puede, la consecuencia es que el cà ³nyuge extranjero debe salir de Estados Unidos y completar el proceso para la green card mediante un procedimiento consultar. Y en el momento de salir de los Estados Unidos comienza a aplicar el castigo o penalidad de los 3 y 10 aà ±os si se ha estado en el paà ­s como ilegal. No pueden ajustar su estatus dentro de Estados Unidos los cà ³nyuges de residentes permanentes que estn en situacià ³n de ilegalidad. En el caso de esposos de ciudadanos el caso es distinto. Sà ³lo est prohibido que ajusten estatus los que ingresaron al paà ­s cruzando ilegalmente la frontera. Por lo tanto, consultar con un abogado para ver cules son las opciones en el caso de estancia ilegal por parte del cà ³nyuge extranjero. A tener en cuenta Si la documentacià ³n se envà ­a al lugar equivocado se va a producir un retraso en la tramitacià ³n de la solicitud. Para asegurarse de tener siempre la direccià ³n correcta se puede verificar si ha habido cambios en la pgina web del uscis o llamando al  1-800-375-5283. Adems, las peticiones de una tarjeta de residencia para el cà ³nyuge pueden ser hechas en base tanto a matrimonios heterosexuales como homosexuales. Y es que las bodas entre gays y lesbianas producen los mismos beneficios migratorios que las que se celebran entre un hombre y una mujer. Finalmente, tener en cuenta que la green card puede ser negada por ms de 40 causas. Algunas son temporales y el problema desaparece con el paso del tiempo. En otras ocasiones es posible solicitar un perdà ³n y en algunos casos simplemente es imposible. Es decir, casarse con un ciudadano o un residente no siempre quiere decir que se obtiene la green card. Este es un artà ­culo informativo. No es asesorà ­a legal.

Circular Reasoning Definition and Examples

Circular Reasoning Definition and Examples In informal logic, circular reasoning  is an argument that commits the logical fallacy of assuming what it is attempting to prove. Fallacies closely related to circular reasoning include  begging the question  and petitio principii. The fallacy of the petitio principii, says Madsen Pirie, lies in its dependence on the unestablished conclusion. Its conclusion is used, albeit often in a disguised form, in the premises which support it (How to Win Every Argument: The Use and Abuse of Logic, 2015). Examples and Observations The circular argument uses its own conclusion as one of its stated or unstated premises. Instead of offering proof, it simply asserts the conclusion in another form, thereby inviting the listener to accept it as settled when, in fact, it has not been settled. Because the premise is no different from and therefore as questionable as its conclusion, a circular argument violates the criterion of acceptability. (T. Edward Damer, Attacking Faulty Reasoning. Wadsworth, 2001)Circular argument: A sentence or argument that restates rather than proves. Thus, it goes in a circle: President Reagan was a great communicator because he had the knack of talking effectively to the people. The terms in the beginning of the sentence (great communicator) and the end of the sentence (talking effectively) are interchangeable. (Stephen Reid, The Prentice Hall Guide for College Writers, 5th ed., 2000) Mental Illness and Violent Crimes The assumption that people with mental health issues are violent is deeply entrenched (cleaver-wielding lunatic costumes,  anyone?). It often leads to circular reasoning. How often have you heard people claim that committing a violent crime is proof of mental illness? Only a mentally ill person would kill someone, so anyone who kills someone is automatically mentally ill. Leaving aside the  vast majority of homicides  which aren’t committed by people with mental problems, this isn’t evidence based. (Dean Burnett, Stop Blaming Mental Illness for Violent Crimes. The Guardian [UK], June 21, 2016) Circular Reasoning  in Politics Senator Kent Conrad of North Dakota offers a perfectly circular argument: we cant have the public option, because if we do, health care reform wont get the votes of senators like him. In a 60-vote environment, he says . . ., youve got to attract some Republicans as well as holding virtually all the Democrats together, and that, I dont believe, is possible with a pure public option. (Paul Krugman, Health Care Showdown. The New York Times, June 22, 2009)Ralph Nader and Pat Buchanan are banging at the doors, and the political establishment, consisting of both politicians and the media, seems determined not to let them in on the grounds that they have no public support. This is a circular argument; one of the reasons they have so little support is that they are generally ignored by the press and will most likely be barred from the presidential debates, which require a base support of 15 percent of the electorate. (Lars-Erik Nelson, Party Going. The New York Review of Books, August  10, 2000) Going in Circles Circular reasoning can be used fallaciously . . . in arguments which require the use of premises that can be shown to be better established than the conclusion to be proved. The requirement here is one of evidential priority . . ..  Arguing in a circle  becomes a fallacy of petitio  principii or begging the question where an attempt is made to evade the burden of proving one of the premises of  an argument by basing it on the prior acceptance of the conclusion to be proved. . . . So the fallacy of begging the question is a systematic tactic to evade fulfillment of a legitimate burden of proof . . . by the proponent of an argument in dialogue by using a circular structure of argument to block the further progress of dialogue, and, in particular, to undermine the capability of the respondent, to whom the argument was directed, to ask legitimate critical questions in reply. (Douglas N. Walton, Circular Reasoning.  A Companion to Epistemology, 2nd ed., edited  by  Jonathan Dancy et al. Wiley-Blackwell, 2010)

Management Essay Example | Topics and Well Written Essays - 2500 words - 26

Management - Essay Example This theory is also based on another theory known as cognitive evaluation theory according to which a person loses interest in his work because of the external factors such as increase in pay etc. This can be explained in other words as the decrease in the motivation of a person to work gradually decreases as the number of incentives being provided to him increase because people get the perception that the work they are doing is forced and compulsory and hence, the person loses interest in doing the same work because then he feels that it is his duty. Another theory, the goal setting theory explains the importance of setting goals and how it improves the performance of an individual. This theory also proves that when a person is told about what goals to achieve and when to achieve it, he automatically works on the task in order to reach his goal. Similarly, if a person is appreciated for his works, his performance eventually increases to a great extent. But a big factor regarding thi s theory is the acceptance of the set goal. And harder goals gave better performances as compared to easier goals. The third theory, known as self efficacy theory or social learning theory is based upon the thinking of an individual whereby he thinks that he has the ability to achieve certain goals or tasks. Hence, if a person is less efficacious he is more prone to give up easily, whereas someone who is highly efficacious will try his best to accomplish the task. The most widely accepted theory is known as expectance theory in which a person seems to think that if he performs better he will be rewarded for it and hence his performance is greatly affected due to this thinking. The manager told that motivating employees was one of the most important parts of any organization and special attention is given to make sure that the employees are motivated to the best level possible. The leader appreciated each and every employee individually

Social Psychology Essay Example | Topics and Well Written Essays - 3000 words - 1

Social Psychology - Essay Example Social psychology is a â€Å" scientific study of the effects of social and cognitive processes on the way individuals perceive, influence and relate to others† (Smith & Mackie, 2000, p. 3). Different psychologists have tried to explain the impact of society on human being. However, Floyd Allport believed that society does not influence the thinking of human being. Floyd Allport said that , â€Å"the individual in the crowd behaves just as he would behave alone, only more so†, as according to him, human being’s behavior in the society is a result of his own thinking, feelings, perception and nature and not the result of society’s influence on him (Allport & Wozniak, 1994, p.295). What Allport suggests is that all the aspects of human behavior and human nature like self identity, attitude, prejudice, discrimination, performance, self image etc. are results of his own thinking and what he makes out of that thinking. His own thinking pattern and the perception of the social behavior makes him to form a picture of the society. Hence, the aspects of behavior pattern which we think are shaped by the society are in fact shaped by man’s own thinking and feelings. According to Allport (1954), discrimination is the extension of behavior and it makes person use behavioral elements like harsh words, exclusion, avoidance and also physical attack (Lott & Maluso, 1995, p.4). Hence, it can be said that the behavior pattern of prejudice and the discrimination that man practices against people belonging to certain race, class or skin color is not a result of social influence but is a result of his own belief and thinking. The question is, even if

Neural Control Of Respiration Health And Social Care Essay

Neural Control Of Respiration Health And Social Care Essay Breathing is a complex behaviour which is governed by a variety of regulatory mechanism under the control of large part of central nervous system Breathing exercise improves lung volume and lung capacities and the term geriatrics comes from the Greek geron meaning old man and iatros meaning healer. However Geriatrics differs from gerontology, which is the study of the aging process itself. The by some as Medical Gerontology In geriatric age group decrease in thoracic mobility also results in decreased vital capacity, this decline in pulmonary function can negatively impact on older individuals ability to exercise Neurophysiological facilitation and diaphragmatic breathing exercise given to thorax give attachment to the respiratory muscles. Some of age related changes are: increase in rigidity of trachea and bronchi, decrease in elasticity of bronchial walls, decrease in cilia Age related changes in respiratory muscles show increase in contraction and relaxation time and alteration in diaphragm position and efficiency Changes in respiratory and pulmonary performance occur gradually allowing the elderly to continue to breathe effortlessly in the absence of pathological status. when the elderly are confronted with a little exersion or stress however, dysnea and other symptoms usually appear The prominent effect of age related changes on the respiratory system is reduced efficiency in ventilation and gas exchange. The respiratory system includes nose, pharynx, larynx, trachea, bronchi, bronchioles, alveolar duct and alveoli [Ebersole and Hess 1998] NOSE Nose is readily visible appendage, which with age elongates downward and it has been suggested that this age related changes may account for the mouth breathing that occurs while the elder sleep and thus the lack of saliva production [Saxon And Etten 1994] TRACHEA Stiffening of the larynx and tracheal cartilage occurs as a result of calcification. The cilia that line the trachea and help to push up mucus, debris and dust into the pharynx makes it less effective, cilia decrease in number with decrease in respiratory epithelium and increase in bronchial mucus gland hypertrophy [Shumman 1995] CHEST WALL AND LUNGS According to Tockman[1995] when a person reaches 55, his or her respiratory muscles start to weaken. Chest wall compliance began to decrease and there is loss of elastic recoil as a result of ventilation and gas exchangs are affected. OXYGEN EXCHANGE The aged blood oxygen level is approximately 75mmhg, whereas blood oxygen level of younger adult ranges from 90mmhg to 95 mmhg RESPIRATORY PROBLEMS According to Tockmann airway problems experienced later in life are due to repeated inflammatory injuries, disruption of inflammatory mediators and humeral protection and tissue repair. The thorax or chest wall become less complain with age, meaning it gets stiffer because of calcification of the chondral cartilage or kypho scoliosis. This results in the chest wall becoming fixed in slight expanded position from which there is restriction in its ability to expand outward further or to contract inward. During normal breathing rib cage expansion accounts for about 40% in adult but only 30% in elderly (Rossi et al., 1996). The muscles of thoracic cage are the only skeletal muscles that must contract on a regular basis throughout the life span (Rossi et al., 1996). The strength of an old adults diaphragm is noted to about 28% less than the young adult (Enright, 1999). Whether cross linkage or changes in location and orientation of the individual elastic fibers within the lung (De martinis and timiras, 2003, culver and butler, 1985. Sparrow and Weiss, 1988). The alveolar ducts to become enlarged and the alveoli to fallen this results in more over staying within the alveolar duct rather than within the alveoli where oxygen exchange is more efficient (Demartins and Timiras, 2003). Elderly people are at an increased risk for lung infection and the body has many ways to protect against lung infection with aging, these defenses may weaken. The cough reflex may not trigger readily and the cough may be less forceful the hair like protection that line the airway cilia, are less able to move mucus up and out of the airway. 1.1 AIM AND NEED OF STUDY There are many biological researches done on neural control of respiration hence there is need of clinical implication to assist the integrity of such biological research It is needed to evaluate effectiveness of neuro physiological facilitation of respiration which can be evaluated by chest expansion It is needed to evaluate effectiveness of diaphragmatic breathing exercise which can be evaluated by chest expansion 1.2 STATEMENT OF THE STUDY This a study on the effect of neurophysiological facilitation and diaphragmatic breathing exercise in improving chest expansion of geriatric population 1.3 HYPOTHESIS Null hypothesis There is no significant effect of neurophysiological facilitation technique compared with diaphramtic breathing technique in improving chest expansion, peak expiratory flow rate, and inspiratory capacity. Alternative hypothesis There is significant effect of neurophysiological facilitation technique compared with diaphramtic breathing technique in improving chest expansion, peak expiratory flow rate, and inspiratory capacity. 1.4 OPERATIONAL DEFINITION 1. Diaphragmatic breathing exercise A breathing exercise that emphasizes the contraction and release of the diaphragm muscle to fully inflate the lung, there by engaging the muscle of the back and abdomen [by Marguerite Agle october29,2008] 2. Neurophysiological facilitation Neurophysiological facilitation of respiration is the use of selective external proprioceptive and tactile stimuli that produce reflexive movement response in the ventilator apparatus to assist respiration 3. Chest expansion Chest wall expansion was defined as a circumferential measurement of chest wall where recorded in centimeter using rectractable tape 4. Peak expiratory flow rate Peak flowmeter measures the patients maximum speed of expiration or expiratory flow rate 5. Inspiratory capacity The volume of gas that can be taken into the lungs in a full inhalation, starting from the resting inspiratory position; equal to the tidal volume plus the inspiratory reserve volume. REVIEW OF LITERATURE Joy Varghese[2009] the effectiveness of the neurophysiological facilitation of respiration technique with chest physiotherapy technique in respiratory care of people with intellectual disability The PNF technique was found to be the main contributors to improvement in spo2 for subject with myotonic dystrophy [dr. Jennifer article published on online 29th march 2006,volume-7,issue-4 page 228-238] Inter costal stretch alter breathing pattern and respiratory muscle activity in conscious adult [volume 88, issue 2, February 2002, page 89-97. T. Pakree. FCerny and b.Bishop Jennifer and Ammani [2001] the proprioceptive and tactile stimuli selected produce remarkable consistent reflexive response in ventilator muscles Tucker et al [1999] suggest that there is an increase in chest wall movement and increase in lung volume Miller et al [1997] have considered the many neural structures that can potentially modifies the final output of the ventilatory muscles Duron and rose [1997] afferent input that activates the dorsal intercostal muscle is consistent where every intercostal space the dorsal part of external [inspiration] and the dorsal part of internal [expiration] intercostal muscles are antagonistic during quite breathing Destroyer [1997] inspiratory force of the diaphragm is also related to its opposition to the rib cage. Frazier et al 1997, Hilaire and Monteau 1997 afferent information from the lower intercostals and the abdominal muscles may facilitate phrenic motar neuron by a spinal reflex . emerging evidence suggest that phrenic afferent are more involve in respiratory regulation during stress breathing Richer et al [1997] efferent axons from the medullary neurons project to the inspiratory neurons in the spinal cord Frozer et al [1997] states that respiratory drive is regulated by information from sensory receptor within the airways ,lungs and respiratory muscles as well as central and peripheral chemoreceptor Hilare et al [1997] emerging evidence suggested that phrenic nerve are more involve in respiratory regulation during stress breathing James E zachazewski [1996] PNF techniques are used to place specific demand promoting or hastening the response of tissue through the use of stimulation of proprioceptor Carolyn kisner [1996] has given the result that the diaphragmatic breathing exercise is improving ventilation and chest expansion Scand j.t [1995] states that any exercise given to diaphragm, moblises chest wall and improves ventilation Vibekk[1991] pilot studies have shown improvement in lung function in subject with cystic fibrosis using these techniques Green and morhan [1985] breathing control in normal tidal breathing using lower chest with relaxation of upper chest and shoulder .diaphragm work to improve the work of inspiratory muscles Hamberg and lindahi [1981] have shown improvement in chest wall pain due thorasic spine disorder followed by these techniques Menkes and traysman [1977] breathing is regulated by a multiple of reflex, negative feedback circuit and feed forward mechanism Bethene [1975 and 1976] neurophysiological facilitation of respiration is the use of selective external proprioceptive and tactile stimuli that produce reflexive movement response in ventilator apparatus to assist respiration .the response they elicit appear to alter the rate and depth of breathing Sumi[1973] studies tactile and pressure receptor in the cat and reported thorasic cutaneous fields for both inspiratory and expiratory motar neurons he proposed the local cutaneous stimulus of the thorasic would then tend to reflexively produce an inspiratory position of rib cage Franstin [1970] experiment with decerebrate in cat have demonstrated that there is increase muscle tone also involves the intercostals muscles providing the respiratory muscle also obeys brain stem mechanism Voss [1967] tactile cules on PNF are mainly provided by therapist manual contact which facilitate movement through or promote relaxation, manual contact must applied to agonist to facilitate maximal response Eklud et al [1964] demonstrated reflex effect on intercostal motar activity in response to stimulation of artery from overlying skin 3. RESEARCH DESIGN AND METHODOLOGY 3.1 Research design The research design of this study is experimental, comparative in nature 3.2 Settings The study was conducted in RVS hospital 3.3 Criteria for selection 3.4 Inclusion criteria Geriatric Population Only Males Age Above 60 -70Years 3.5 Exclusion criteria subject with recent rib fracture patient with coronary disease patient with recent surgery patient with systemic illness 3.6 Sample population 30 subject and 15 in each group 3.7 Method of sampling Random sampling technique 3.8 VARIABLE USED IN THE STUDY Independent variable Diaphragmatic breathing exercise Neurophysiological facilitation Dependent variable Chest expansion Peak expiratory flow rate Inspiratory capacity 3.9 METHODOLOGY 30 subject are selected and divided into two groups The procedure was explained to subject Group A- treated with diaphragmatic breathing exercise Group B- treated with neurophysiological facilitation technique Hence both the group are treated and after 10 days chest expansion measured along with peak expiratory flow rate and inspiratory capacity TECHINIQUES DIAPHRAGMATIC BREATHING EXERCISE Prepare the patient in relaxed and comfortable position in which gravity assist the diaphragm such as semi reclining position If your examination reveals that the patient initiate the breathing pattern with the accessory muscles of respiration. Start instruct by teaching the patient how to relax those muscles[shoulder rool or Shoulder shrugle coupled with relaxation place your hand on the rectus abdominal muscle just below the anterior costal margin ask the patient to breathe slowly and deeply through the nose. Have the patient keep the shoulder relaxed and upper chest quite allowing the abdomen to rise slightly then tell the patient to relax and exhale slowly through the mouth. Have the patient practice this 3or 4 times and then rest. Do not allow the patient to hyperventilate If the patient is having difficulty in using the diaphragm during inspiration have the patient inhale several times in succession through nose by using sniffing action this action used to facilitate diaphragm NEURO PHYSIOLOGICAL FACILITATION TECHINIQUE 1. Inter costal stretch Intercostal stretch is provided by applying pressure to upper border of rib in a direction that will widen the space above it pressure should be applied in downward direction not inward, stretch is maintained as the patient continues to breathe in his usual manner, as the stretch is maintained, a gradual increase in inspiratory movement in and around area being stretched occur. When performing over an area of instability as in presence of paradoxical movement of upper rib cage or over decrease mobility. This procedure is effective in restoring normal breathing pattern where epigastric excursion can be observed and increase in area being stretched. This represents reflexive activation of diaphragm by intercostal afferent that innervate its margin. 2. Vertebral pressure Position of patient: Supine lying Procedure: A firm pressure is applied directly over the vertebrae of upper and lower thoracic cage activates dorsal intercostal muscles, pressure should be appl;ied with open hand and must be firm enough to provide some stretch. i) Vertebral pressure high Manual pressure to upper thoracic vertebrae T2 T5 Response obtain was increase in epigastric excursion. Deep breathing ii) Vertebral pressure low Pressure over lower thoracic vertebrae T7- T 10 Response obtain was increase in respiratory movement of apical thorax. 3. Anterior stretch lifting posterior basal area Position of patient: Supine lying Procedure: Placing t he hands under ribs and lifting gently upward. The lift is maintained and provides a maintained stretch and pressure posteriorly and anterior stretch. Response obtain as a result the lift is sustained and stretch is maintained and increase in movement of ribs in lateral and posterior direction can be seen and felt, increase in epigastric movement and expansion of posterior basal. Maintained manual pressure From contact of open hands is maintained over an area in which expansion is desired gradual increase in excursion of ribs under contact will be felt. This is useful procedure to obtain expansion in any situation where pain is present for instance when there is chest tubes or cardiac surgery which may have required splinting of sternum. Manual contact over the posterior chest wall is also useful and comfortable for person with chronic obstructive pulmonary disease. 5. Perioral pressure Perioral stimulation is provided by applying firm maintained pressure to the patient top lip being carefully not to occlude the nasal passage (the use of surgical gloves to avoid contamination) the response to this stimuli is brief for 5 seconds a period of apnea followed by increase in epigastric excursion. Pressure is maintained for the length of time the therapist wishes the patient to breath in active pattern. As the stimuli is maintained the epigastric excursion may increase so that movement is transmitted to the upper chest and the patient appears to deep breathing. 6. Co contraction of the abdomen Pressure is applied simultaneously over the patents lower lateral ribs and over the ilium in direction right angle to the patient. Moderate force is applied and maintained roods believe that this procedure increase tone in abdominal muscles and activates diaphragm. The response obtain are depression of umbilicus, as the pressure is maintained increase abdominal tone is seen and palpated, in the presence of retained secretion abdominal contraction may produce coughing (as ventilation increase cough can occur in any procedure), in obese abdominal co-contraction has frequently result in decrease abdominal girth. PROCEDURE METHODS OBSERVATION 1.PERIORAL PRESSURE 2.[1]VERTEBRAL PRESSURE HIGH 2[2].VERTEBRAL PRESSURE LOW 3.ANTERIOR STRETCH LIFTING POSTERIOR BASAL AREA 4.CO-CONTRACTION OF ABDOMEN 5.INTERCOSTAL STRETCH 6. MAINTAINED MANUAL PRESSURE Pressure is applied to the patients toplip by the therapist fingers and maintained Manual pressure to thoracic vertebrae in region of T2-T5 Manual pressure to thoracic veretebrae In region of T7-T10 Patient supine Hands under lower ribs lifting upward Pressure laterally over ribs and pelvis Alternate right and left side Stretch on expiratory phase maintained Moderate pressure of open hands Increase epigastric excursion, Deep breathing, Mouth closure, Swallowing, Increase epigastric, exursion Deep breathing, Increased respiratory Movement of apical thorax Expansion of posterior basal area Increasing epigastric movement, increase muscle contraction, decrease girth in obese Increase movement of area being stretched Gradual increase of area under contact 3.10 MEASURING TOOL Inch tape Peak flow meter Incentive spirometer CHEST EXPANSION Chest expansion measured with a measuring tape in 3 levels 1. Axillary 2. Nipple 3. Xiphisternum The measurement is taken at full inspiration and at full expiration The measurement at expiration-the measurement at inspiration gives the amount of chest expansion. PEAK FLOW METER A peak flow meter measures the patient maximum speed of expiration or expiratory flow rate PROCEDURE Make sure the peak flow meter reads zero Stand up right The mouth piece should be cleaned with antiseptic in each use Form a tight seal with the lips around the mouth piece Take a deep breath Blow as hard and as fast as the person can until all the air is gone from the lungs If the patient cough or make mistake, just repeat. In between each attempt, make sure the peal flow meter reads zero Take some deep breath between peak flow attempts if the person feels dizzy. Stop the testing and sit down for few minutes before continuing. Do not put the tongue inside the hole do not cover the hole and the back of the peak flow meter when holding it. Record the readings shown in peak flow meter. INCENTIVE SPIROMETER PROCEDURE 1. Hold the incentive Spiro meter upright 2. Breath out normally, close your lips tightly around the mouth piece and inhale slowly through your mouth. This slow deep breath will raise the ball in clear chamber of the Spiro meter 3. Continue to breath in, trying it raise the ball as high as you can. Read the volume that you have achieved by raise in ball 4. When you feel like you cannot breathe in any longer, take your breath for3to 5 seconds then breathe out slowly 5. After you have taken 10 deep breaths on your incentive Spiro meter, it is important to cough to try to remove secretion that build up in your lungs 6. Incase of surgery splint your incision with pillow or blanket. 7. Measure the level of raise in ball during breath. 4. DATA ANALYSIS AND INTERPREATION The data collected was subjected to pairedt test individually for group A and group B using formulas. Formula 1 d = à ¢Ã‹â€ Ã¢â‚¬Ëœ d/n Where, d = difference between pre test and post test values d = is the mean value of d n = is the number of subjects à ¢Ã‹â€ Ã¢â‚¬Ëœ (d-d)2 (n -1) Æ’-Formula 2: Standard deviation SD = Formula 3: Standard Error (S.E) = SD Æ’-n t calculated value = d S.E Formula 4: t cal = d S.E Where, t cal is the t calculated value INDEPENDENTt TEST Æ’- Formula 1: S= (n1-1)s12 + (n2-1) s22 n1+n2 -2 Where, s is the standard deviation n1 is the number of subject in group A n2- is the number of subject in group B s1 is the standard deviation of group A s2 is the standard deviation of group B Æ’- Formula2 S.E = S 1/n12 + 1/n22 Where, s is the standard deviation S.E. is the standard error Formula 3 X1 X2 t cal = S.E Where, X1 is the average of difference in values between pretest and post test X2 is the average of difference in values between pretest and post test Paired T test [comparison of pretest and posttest mean] Pairedt test 1. Chest expansion TABLE 1 Axillary level Subject Chest expansion Group A Group B Pretest mean 1.13 1.46 Posttest mean 2.6 2.73 S.D 0.5168 0.4582 In group A the mean chest expansion for (axillary level), pre test value was 1.1 and post test value was 2.6 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 10.491 which is greater than t value and in group B the mean chest expansion for (axillary level), pre test value was 1.46 and post test value was 2.73 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 10.650 statistically significant TABLE II Nipple level Subject Chest expansion Group A Group B Pretest mean 1.93 2.00 Posttest mean 3.06 3.33 S.D 0.4423 0.4884 In group A the mean chest expansion for (Nipple level), pre test value was 1.93 and post test value was 3.06 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 9.894 which is greater than t value and in group B the mean chest expansion for (Nipple level), pre test value was 2.00 and post test value was 3.33 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 10.546, statistically significant TABLE III Xiphisternal level Subject Chest expansion Group A Group B Pre test mean 2.46 2.53 Post test mean 3.46 3.93 S.D 1.2489 0.5731 In group A the mean chest expansion for (Xiphisternal level), pre test value was 2.46 and post test value was 3.46 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 3.7213 which is greater than t value and in group B the mean chest expansion for (Xiphisternal level), pre test value was 2.53 and post test value was 3.93 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 9.4611, statistically significance 2. Peak expiratory flow rate TABLE 1V Subject Peak expiratory flow rate Group A Group B Pre test mean 130.33 113 Post test mean 148 122 S.D 4.5512 7.7451 In group A the mean peak expiratory flow rate pre test value was 130.33 and post test value was 148 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 14.467which is greater than t value and in group B the mean peak expiratory flow rate pre test value was 113 and post test value was 122 for 14 degree of freedom at 0.05 level of significance, the t table value is 11.001 and t calculated value is 9.4611, statistically significant 3. Inspiratory capacity TABLE V Subject Inspiratory capacity Group A Group B Pre test mean 1.2 1.26 Post test mean 2.6 2.86 S.D 0.5731 0.5209 In group A the mean inspiratory capacity pre test value was 1.2 and post test value was 2.6 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 9.4611 which is greater than t value and in group B the mean inspiratory capacity pre test value was 1.26 and post test value was 2.86 for 14 degree of freedom at 0.05 level of significance, the t table value is 2.145 and t calculated value is 11.375, statistically significant GRAPH- I GROUP A (Chest Expansion: Axillary, Nipple, Xiphisterinal level) GRAPH-II GROUP B (Chest Expansion: Axillary, Nipple, Xiphisterinal level) GRAPH-III GROUP -A (Peak Expiratory Flow Rate) GRAPH-IV GROUP -B (Peak Expiratory Flow Rate) GRAPH-V GROUP -A (inspiratory capacity) GRAPH-VI GROUP -B (inspiratory capacity) Independent t test Chest expansion (axillary level) TABLE VI Subject Neurophysiological facilitation VS diaphragmatic breathing exercise Group A Group B Post test mean 2.6 2.73 Independent t test 0.7865 The independentt test value for chest expansion (axillary level) is 0.78650 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group. 2. Chest expansion (Nipple level) TABLE VII Subject Neurophysiological facilitation VS diaphragmatic breathing exercise Group A Group B Post test mean 3.06 3.33 Independent t test 1.1751 The independentt test value for chest expansion (Nipple level) is 1.1757 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group. 3. Chest expansion (Xiphisternal level) TABLE VIII Subject Neurophysiological facilitation VS diaphragmatic breathing exercise Group A Group B Post test mean 3.46 3.93 Independent t test 0.5641 The independentt test value for chest expansion (Xiphisternal level) is 0.5641 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group. 4. Peak expiratory flow rate TABLE IX Subject Neurophysiological facilitation VS diaphragmatic breathing exercise Group A Group B Post test mean 148 122 Independent t test 0.0555 The independent t test value for peak expiratory flow rate is 0.0555 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group. 4. Inspiratory capacity TABLE X Subject Neurophysiological facilitation VS diaphragmatic breathing exercise Group A Group B Post test mean 2.6 2.86 Independent t test 0.6509 The independent t test value for inspiratory capacity is 0.6509 respectively for 28 degree of freedom at 0.05 level of significance and critical table value is 2.048 there fore there is no significant difference in both the group. Independentt test GRAPH-VII Chest expansion (axillary level) GRAPH- VIII Chest expansion (Nipple level) GRAPH- IX Chest expansion (Xiphisternal level) GRAPH-X Peak expiratory flow rate GRAPH-XI Inspiratory capacity INTERPRETATION OF DATA Calculated value of pairedt test for group A [chest expansion] Axillary level- T= 10.491 Nipple level T= 9.894 Xiphisternal level- T= 3.7213 Calculated value of paired T test for group B [chest expansion] Axillary level- T= 10.650 Nipple level- T= 10.546 Xiphisternal level- T= 9.4611 Calculated value of paired T test for group A [peak expiratory flow rate] T= 14.467 Calculated value of paired T test for group B [peak expiratory flow rate] T= 11.001 Calculated value of paired T test for group A [inspiratory capacity] T= 9.4611 Calculated value of paired T test for group B [inspiratory capacity] T = 11.375 Calculated T value is greater than T table value Calculated value of independent T test for chest expansion Axillary level- T= 0.7865 Nipple level- T = 1.1757 Xiphisternal level- T= 0.5641 2. Calculated value of independent T test for inspiratory capacity

Environmental Stressors Essay

The objective of the authors was to identify the psychosocial and environmental factors which young people who receive special education are associated with. The authors conducted a research in Public schools located in Minnesota with the aim of testing the psychosocial and environmental factors between people who have attended special education and those who have not. The total number of adolescents who participated in the research was 121848. The findings revealed that the adolescents who had attended special education experienced higher levels of psychosocial and environmental problems compared to adolescents who had not. This paper aims at analyzing the article â€Å"Environmental stressors and emotional status of adolescents who have been in special eduction classes† by Iris Wagman and Michael Resnick. Introduction. There has been an increase in the number of young people who receive special education, in recent days. This has been attributed to the increase in cases of physical and mental health disability. In the article being analyzed, the authors begin by giving statistics on the number of children who receive special education. They put this figure at ten percent of all children aged between six and seventeen, with another 750000 children being at risk of developing similar disabilities. According to Borowsky and Resnick (1998), bbetween 1976 and 1994, the number of adolescents who receive special education has risen from 3. 7 million to 5. 4 million. Funding for this education has also increased to $2. 32 billion from $373 million in a similar period. The high number of children who suffer from these disorders necessitates the need to improve the welfare of disabled people. Literature review. The authors intend to investigate the difference in psychosocial and environmental factors experienced by adolescents who attend special schools in comparison to those who do not. As has been stated, this was necessitated by the large number of children who experience developmental disability. The increase in the number of students who attend special schools followed the passage of the Handicapped Children Act in 1975, which empowered the disabled children to access appropriate and free education. However, there is limited information on the outcome of special education on these students. This is due to the reason that most surveys that have been carried out in the past have ignored them. Most researches which have been carried out have focused on the welfare of young adults who have received special education. These studies have proved that most of them acquire employment after finishing high school and other training programs. Further studies of children with learning disorders have revealed that there is an association between child neglect and abuse, and learning impairment. However, the extent to which psychosocial and environmental factors which young people who receive special education experience has not been conclusively researched. This is the major reason why the researchers carried out the research on the subject. Methods and procedures. In obtaining the data, all public schools in Minnesota participated, with the exception of one school. A questionnaire was given to 131000 students in public schools in grade six, nine and twelve. About 3% of the surveys had questionable accuracy and were thus excluded. According to Borowsky and Resnick (1998), the questionnaire had a completion time of about an hour, and was designed at the reading level of fifth graders. The questionnaire was given with parental consent, and the students were also allowed to ignore any questions they did not wish to answer. This is commendable, since flexibility enabled the students to be comfortable with the questionnaire. This survey is carried out after every three years, which is consistent and enables results to be comparable. However, the authors do not describe the weaknesses of the use of questionnaires as a source of data collection. According to Kothari (2005), qquestionnaires have many disadvantages and some of them include the fact that the questions are standardized, which presents the risk of misinterpretation by the respondent. Questionnaires do not also present the possibility of probing responses, which limits the extent to which a researcher can get an insight on the opinion of the participant. Another limitation of a questionnaire is that some people only present socially desirable behavior when answering them, which may limit the accuracy of questionnaires. Finally, open ended questions can generate long responses, and this may present difficulties in processing the data. These weaknesses should have been disclosed to people who will rely on this information for decision making. Results and data analysis. The results revealed that 14. 9% of female and 20. 8% of males had attended special education classes. The students who had attended these special classes had higher chances of performing poorly in academics, as compared to the students who had not attended these classes. Boys who had attended special education classes were four times more likely to have difficulties in reading, compared to those who had not attended these classes. On the other hand, girls who had attended special education classes were six times more likely to have difficulties in reading, compared to those who had not attended these classes. Boys who had attended special education classes were three times more likely to have below average grades, compared to those who had not attended these classes. On the other hand, girls who had attended special education classes were also three times more likely to have below average grades, compared to those who had not attended these classes. The students who attended special education classes reported higher instances of not living with their adoptive or biological parents. In the case for boys, 43. 9% of special education students and 31. 8% of children who did not attend special classes reported not living with their adoptive or biological parents respectively. On the other hand, in the case for girls, 42. 4% special education students and 30. 2% of children who did not attend special classes reported not living with their adoptive or biological parents respectively. In terms of family violence, more than one and a half times as many boys and girls who had attended special education school, experienced family violence, compared to those who did not attend these schools. However of the students who experienced abuse, girls outnumbered boys by three times. The levels of emotional status varied between sixth, ninth and twelve graders. These findings reveal that the students who attend special schools experience higher proportions of non traditional and single parent households, compared to those who did not attend these schools. The findings also revealed that the students who attend special schools experience higher proportions of having family members with drug or alcohol problems. They suffered from poor emotional health and sexual abuse. However, female students suffered more than their male peers regarding sexual abuse. These findings are consisted with others which have been done in the past, which reveal that children of parents who either abuse alcohol or experience family violence, are likely to perform poorly as compared to those of families which do not experience these problems. The findings are particularly useful for groups which advocate for the rights of children or disabled people, since they expose the problems which such children experience. Summary and conclusion The authors have presented the research in an internationally acceptable format, though there have been a few weaknesses. The only weakness in the presentation of the paper is the lack of a clear hypotheses statement. Other weaknesses include the fact that the authors did not reveal the weaknesses of the use of questionnaire. The authors did not also give the weaknesses of the use of secondary sources of data when gathering information. They used academic journals to gather information, yet they did not mention the weaknesses of using them in research. Some weaknesses include the fact that there is no possibility of verifying the information gathered. Another weakness is that if the original journal was biased and the authors rely on it for writing the research, then it is likely that the research will also be biased (Kumar, 2005). These weaknesses should have been mentioned since they are useful for people who will use the research to make decisions. However the research has been comprehensively covered. The use of academic journals reduces the chances of bias since they are written by scholars. The references represent a diversity of sources, a fact which makes the research more comprehensive and valid. This research can be used as a basis for future research. For instance, a future research can be carried out with the aim of finding out the causes of disparity between the levels of girls and boys attending special schools, who have been sexually abused. References Kothari, C. R. (2005). Research Methodology: Techniques & Methods. New York: New Age Publishers. Kumar, R. (2005). Research Methodology: A Step-by-step Guide for Beginners. New York: SAGE. Borowsky, I. W. , Resnick, M. D. (1998). Environmental Stressors and Emotional Status of Adolescents Who Have Been in Special Education Classes. Archpediatrics adolesc Med Journal. Retriev