Music Intervention as Anxiety and Stress Relief

Music Intervention as Anxiety and Stress Relief Evelyn Neville Music Intervention as Anxiety and Stress Relief during Minor Medical Procedures Introduction This concept analysis will address the anxiety and stress relief effect of music on patients during routine medical procedures. Music can have a calming effect on patients which can greatly reduce the anxiety and stress the patients may be feeling while enduring procedures such as blood draws or IV insertions (Mok Wong, 2003). The anxiety felt by many patients can provide many obstacles throughout the appointment such as the inability to listen effectively due to the inability to focus (Baldwin, 2016), a negative impact on seeking out further medical treatments in the future (Detz, Lopez Sarkar, 2013), and a general increase in muscle tightness, heart rate, blood pressure and respirations (Bandelow, Boerner ,Kasper, Linden, Wittchen Mà ¶ller, 2013). The alleviation of some of this anxiety and stress may have a powerful impact that could contribute to a patients overall health and continue to build a strong foundation for the relationship between the patient and their health care provider. It is significant that the concept of using music for anxiety relief is studied further as this could provide a new involvement for patients in their own healthcare. It could also provide cost effective ways for the healthcare providers to ensure patients are comfortable, are relaxed and walk away feeling better about their relationship with their health care provider. Music is a universal language that we can all relate to and we should use it to our advantage in the medical field. Music has been successfully used to reduce anxiety in dental procedures (Lahmann et al., 2008), the use of music may be a simple and inexpensive way for hospitals, clinics or doctors offices to make the patients experience better and less stressful. It has been found that music may even be have sufficient anxiety and pain relief in postoperative settings that it may be used as a substitute for adverse effect causing opioid medications (Allred, Byers Sole, 2008). Therefore it is significant that health care professionals should attempt to use the benefits of this non-pharmacologic intervention while treating their patients. The specific use of personally chosen music will ensure that the patient feels they have control over the situation and are involved in their own care (Erlang, Nielsen, Hansen Finderup, 2015). Assumptions The underlying assumptions of this concept analysis include that inherently people like music and it can aid in anxiety reduction as shown by lowered blood pressure, heart rate and respiratory rates (Bandelow, Boerner, Kasper, Linden, Wittchen Mà ¶ller 2013). It has also been used in therapy and other medical practices such as dentistry to assist patients in coping with stress, pain and anxiety (Lahmann et al., 2008). Even though everyone copes differently with stress, it can be assumed that many people use music to reduce stress for physiological, cognitive and emotional processes (Thoma, La Marca, Bà ¶nnimann, Finkel, Ehlert Nater, 2013) Preview In the following section of this concept analysis the reader will be presented with a review of literature reviews that describe the concept in different disciplines. Using the Walker and Avant (2005) method, the concept analysis will include a discussion of the concept and its attributes, antecedents and consequences. Lastly, Empirical referents will also be discussed. Literature Review The literature review for this concept analysis was done with materials found on the following databases: Cumulative Index of Nursing and Allied Health (CINAHL), DePaul Library Book Circulation, UptoDate and Google Scholar. The databases were searched between 1990 and 2017, focusing on articles published after 2000. The CINAHL database produced 1 result for nursing theory music, 11,857 results for music, 333 for music anxiety, 1,531 results for generalized anxiety disorder, 61 results for previous pain experience, and 52 results for music procedure. UptoDate was searched for generalized anxiety disorder with an undisclosed amount of total results. Google Scholar produced 908,000 results for music therapy, 46,200 results for music calming, 597,000 results for music preference, 102,000 results for music therapy anxiety reduction, 1,100,000 results for trust anxiety, 268,000 results for nursing theory music, 1,890,000 results for nurse patient relationship, 976,000 results for patient n urse communication long term, 1,990,000 results for music psychology, 749,000 results for music anxiety and 70,400 results by searching music social bonding. Two additional sources were used, 2 books about music found in the DePaul University Library Book Circulation database when searching for music medicine and music philosophy. Music Therapy According to Oxford dictionary music can be defined as vocal or instrumental sounds (or both) combined in such a way as to produce beauty of form, harmony, and expression of emotion (Oxford Dictionary, n.d.). As music is an abstract form of art, it is able to relate the composers and musicians feelings and intention through direct imitation, approximate imitation and symbolization (Cooke, 2001). With this ability to convey emotion and feelings, music is able to stimulate a heightened emotional response from its creators and listeners (Sloboda, 1991), creating a framework for therapists to create an enriched environment through the use of music. Within music therapy the terms music and music therapy have been used interchangeably, this was especially common practice at that time when the profession was not yet established (Horden, 2000). Music in and of itself is defined as the use of music and/or musical elements (sound, rhythm, melody, and harmony) within the music therapy discipline. To describe music therapy the World Federation of Music Therapy goes one step further and defines it as a process designed to facilitate and promote communication, relationships, learning, mobilization, expression, organization and other relevant therapeutic objectives, in order to meet physical, emotional, mental, social and cognitive needs. (Horden, 2000). Music therapy has been used for anxiety reduction in the past including in a study about the effects of music therapy on patients anxiety while undergoing a flexible sigmoidoscopy. The results of this study confirmed that patients who listened to self-selected music tapes during the procedure had significantly decreased scores for State-trait anxiety inventory, heart rates and mean arterial pressures compared to the control group. Within this study it was concluded that music is an effective anxiolitic adjunct for the flexible sigmoidoscopy procedure (Palakanis, DeNobile, Sweeney, Blankenship, 1994). Psychology Music psychology is a branch of psychology that focuses on the production, creation and perception of music. Within music psychology, music is defined as patterned action in time which appears communicative, complex, generative and representational (Hallam, Cross Thaut, 2009). Music psychology can be applied to individual preferences, arguably due to personality, and the way music is perceived. Studies exploring influence of personality on musical preferences such as the study performed by Stephen J. Dollinger in 1993 have shown that overall personality does have an influence on the types of music individuals prefer. Dollinger, for example, showed that the personality trait openness had a positive correlation to enjoyment of a variety of different kinds of music (Dollinger, 1993). Anxiety has been linked to experiencing additional stressors in childhood, an environmental factor, according to Wiedemann (2013). He points out that personality traits are another factor that can predispose people to experiencing anxiety and how strongly they experience it. Age can also be a factor in the expression of anxiety, with adolescents having a higher incidence rate of anxiety overall (Wiedemann, 2013). Lastly, Wiedeman discusses that anxiety when due to a life event is adaptive, however once the perceived danger passes and the anxious state lasts, this may be due to a pathologic type of anxiety. These anxiety causing events may also cause the patient to experience lasting bouts of anxiety in the future during similar traumatic events (Wiedemann, 2013). Biology Within biology, music can have a neurobiological role. There music is regarded in biological terms as originating in the brain, so that most explanations concentrate on the ways in which brains process information (Freeman, 1998).   As explained by Freeman in his study, music is defined by deeply personal experiences of individuals which are made unique by the separation of information within the brain as it learns more and goes through epistemological solipsism or isolation of uniqueness of knowledge (Freeman, 1998). As sounds pass through the inner ear, along excited sensory neurons into the primary auditory cortex, musical experience is still a neurobiological experience deprived of emotion. However, as explained by Freeman: as the information is processed through neighboring cortical areas concerned with speech and song the information is passed between the newer brain and older part of the forebrain and can generate memories evoked by listening to music, and arouse the em otional states that have become associated with now familiar songs through previous experiences (Freeman 1998). As this information is continuing to pass through the brain, a sense of social bonding is felt by the subject through the perception, creation and sharing of music and dance (Freeman 1998). This social bonding leads to trust, and is related to a social aspect as well as a release of neurochemicals. It is therefore a plausible assumption that music can create neurobiological stimuli that create an environment of bonding and trust building. This can be an important aspect of a patient-nurse/healthcare professional relationship. Lastly, genetics is another factor when discussing anxiety in patients. In recent studies it has been shown that genetics explained about half of the variance when it comes to the predisposition of anxiety in familial cases (Wiedemann, 2013). Concept Maturity This concept has gained some traction within the last few years, especially in other disciplines besides nursing. Dentistry has used music to assist patients during dental exams and procedures for several years and more studies have been done recently in using music to assist in stress and anxiety relief. Generally the concept has been researched in specific instances such as children in the ED receiving IVs or patients receiving a flexible sigmoidoscopy. A longer term study within the nursing discipline needs to be performed to ensure a complete concept analysis can be done. Analysis Defining attributes The defining characteristics that are repeated in the literature include anxiety, music and a positive effect on decreased heart rate. Anxiety encompasses a general feeling of worry and concern about future events which may have an uncertain ending. This can be very well translated to patients worry and fears about medical procedures that may cause them pain and discomfort as well as feeling a lack of knowledge and control over the situation. It has been confirmed that anxiety can manifest itself in things such as increased heart rate, feeling of tightness, and muscle tension (Bandelow, Boerner ,Kasper, Linden, Wittchen Mà ¶ller 2013). The effect of music on heart rate as a relaxation technique has been studied in a clinical setting. It has been proven that a patients preferred music can have a positive effect on lowering the heart rate post procedure (Vaajoki, Kankkunen, Pietilà ¤ Vehvilà ¤inen-Julkunen, 2011). The heart rate is defined as a clinical value measured as a full heart contraction for the duration of a full minute. The ability to lower heart rate allows us to empirically measure the effects of music on the patients during and after their procedures. The patient will have sole control over their choice of music in this concept. Giving the patient the ability to control the type of music has also shown to provide patients with a sense of choice and involvement in the procedure (Erlang, Nielsen, Hansen Finderup, 2015). The musical choices of the patients will be songs played by instruments that are kept in a key with harmonies and rhythm. The patient has full control over the genre of music which may include rock, classical, pop and acoustic. Antecedents Most adult patients will have previously experienced a blood draw and therefore will know what to expect. This knowledge may range from a feeling of impending doom and anxiety over the pain and discomfort they may experience. Though blood draws may not always be painful, previous experiences influence a patients expectations and can translate into higher anxiety and stress when the previous experience was negative (Reicherts, Gerdes, Pauli Wieser, 2016). The travel to the medical facility and the identification of music to be played are also antecedents to the impending procedure. Consequences Consequences of the attempt to relieve anxiety during a blood draw can include a positive experience due to relieved anxiety as well as improved rapport with the nurse or other health care professional which will result in return of the patient for future screenings and preventative care (Detz, Lopez, Sarkar, 2013) . This in turn will result in the patient seeking out healthier long term behavior as well as a decrease in emergency service use (Weiss Blustein, 1996). Additionally, the patient may feel more relaxed and not tense up as much making the nurses job to perform the blood draw much easier. As illustrated in a study by Hartling, Newton, Liang, Jou, Hewson, Klassen and Curtis (2013) a significant amount of health care providers reported that it was easier to perform IV placement on children admitted into the Emergency Department who listened to music than those who were not listening to music. It was also noted that the health care providers were happier with the placement whe n patients were listening to music than if they were not (Hartling et al., 2013) The opposite experience may also occur, creating a negative consequence. The patient may not have found the music they wanted to listen to and may have not experienced anxiety relief during the blood draw. If the nurse was unsuccessful in performing the blood draw by having to start over, puncturing or fishing for the vein resulting in pain, the patient may reflect on this being a bad experience and will not want to return and may even feel the relationship with the nurse has been damaged which may result in the patient not seeking out medical care in the future. Empirical Referents The attribute of anxiety can be measured through a number of Anxiety scales such as the Generalized Anxiety Disorder seven-item scale (GAD-7) or The Hospital Anxiety and Depression Scale (HADS) (Baldwin, 2016). These measurements can be done before and after the procedure, as well as across a population of patients who did listen to music as well as those that did not. A similar comparison between heart rate, blood pressure and respiration rate should be done for everyone involved in the study. A general Patient Satisfaction Survey may also be done for all patients to get an overall sense of the experience and to ask specifics on the patient-nurse relationship after the procedure. A study that may be emulated can include the study performed by Hartling et al. (2013) which looked at pediatric patients response to having music played while having an IV placed in an Emergency Department setting. Within the study an Observational Scale of Behavioral Distress-Revised was used to measure behavioral distress, as well as child-reported pain, heart rate and parent and health care provider satisfaction, ease of performing procedure and parental anxiety were measured. This takes into account a variety of different types of data (qualitative vs. quantitative) while measuring success from more than 1 angle. Nursing Application The following two cases will outline how anxiety can lead to a positive and negative experience while experiencing a blood draw. The model case will show a positive experience of how music is able to reduce anxiety while the contrary case will portray a case in which anxiety is high for the patient. Model Case Jane Doe is coming in for a routine physical with the instruction of fasting as she will have blood drawn for a routine blood panel. Jane has an established rapport with the doctors office she is attending including the nurse who will be performing the blood draw today. Since Jane has had good experiences with this nurse before she is feeling calm prior to her appointment; she knows what to expect. When the nurse arrives she explains that they have added a new feature of having music played while the blood is being drawn. She is given a tablet with a music app where Jane is able to choose what music she would like to listen to. This gives Jane a sense of control and involvement in the situation and feels she can relax while the nurse is drawing her blood. As Jane relaxes the nurse is able to easily insert the needle and draw the blood quickly on her first attempt. Janes ability to relax her muscles and lowered anxiety ensured that she would not flinch and potentially disrupt the bloo d drawing process. After the appointment Jane leaves happy with the interaction with the nurse and feels the music helped in keeping her anxiety at bay in a natural way reinforcing her positive view of this doctors office. Contrary Case Jane Doe is coming in for a routine physical with the instruction of fasting as she will have blood drawn for a routine blood panel. Jane has never been to this doctors office before and is feeling some anxiety about this new environment. As the nurse gets ready to perform the blood draw, Janes anxiety intensifies as she recalls previous needle sticks. She feels as though she has no control over the situation and is starting to tense up as the nurse begins prepping her arm. The nurse is unable to accurately place the needle into the vein and has to start over. Jane is now feeling more anxious than ever as the first attempt was very painful and now the nurse will attempt to reinsert the needle again. After the appointment, Jane leaves the office not being confident in the ability of the nurse nor her desire to want to continue making appointments with this doctors office. Discussion and Conclusion The purpose of this concept analysis was to analyze the effects of music on patient anxiety during blood draws.   Through the lens of music therapy, psychology and biology it is concluded that music may act as a cost effective and non pharmacological solution to anxiety reduction while also improving patient-nurse relationships and encouraging patients to further seek medical intervention and preventative care in the future. Musical intervention may even encourage patients to seek a more long-term relationship with their nurse or other Healthcare provider which will ensure better health outcomes in their lifetimes. A practical application of this concept would be a very real possibility at the Japanese American Service Committee. Here, older adults are provided with a place to go while their families are at work to provide a stimulating environment as well as ensuring they are safe. Most of the clients suffer from some type of age related difficulties in performing activities of daily living effectively and on their own. Some may have dementia while others are no longer able to ambulate safely on their own without an assistive ambulation device. Though JASC does have a nurse on staff, they do not have a need to perform blood draws, though the use of music may come in handy while giving vaccines or administering other types of injection medications. Often clients become anxious towards the end of the day as they worry they will not make it home or that their families have forgotten them. The use of music may be a simple and cost effective way for JASC to engage the clients while reducing their worry. The care takers may also teach the clients about the use of music during stressful medical procedures as many of the clients do see their doctors quite often. The education may also be given to the clients families who may be able to put the concept into use and therefore assist in making these doctors visits less stressful for everyone. Implications for further research include a more comprehensive study across all ages, genders, settings, socioeconomic and insurance status, various procedures and patients who are predisposed to anxiety disorders. There are many factors that can influence a patients anxiety level and it is important to distinguish between musics effectives versus a persons inability to effectively deal with anxiety. References   Ã‚   Allred, K. D., Byers, J. F., Sole, M. L. (2010). The Effect of Music on Postoperative Pain and Anxiety. Pain Management Nursing, 11(1), 15-25. doi:10.1016/j.pmn.2008.12.002 Baldwin, D. (2016). Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. In M.B. Stein R. Hermann (Eds.). UptoDate. Available from https://www-uptodate-com.ezproxy.depaul.edu/contents/generalized-anxiety-disorder-in-adults-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis?source=search_resultsearch=generalized%20anxiety%20disorder%20diagnosisselectedTitle=1~128 Bandelow, B., Boerner, J. R., Kasper, S., Linden, M., Wittchen, H. U., Moeller, H. J. (2013). The diagnosis and treatment of generalized anxiety disorder. Deutsches Aerzteblatt International, 110(17), 300-309. doi:10.3238/arztebl.2013.0300 Cooke, D. (2001). The language of music. London: Oxford University Press. Detz, A., Là ³pez, A., Sarkar, U. (2013). Long-Term Doctor-Patient Relationships: Patient Perspective From Online Reviews. Journal of Medical Internet Research, 15(7). doi:10.2196/jmir.2552 Dollinger, S. J. (1993). Research Note: Personality and Music Preference: Extraversion and Excitement Seeking or Openness to Experience? Psychology of Music, 21(1), 73-77. doi:10.1177/030573569302100105 Erlang, A. S., Nielsen, I. H., Hansen, H. O., Finderup, J. (2015). Patients Experiences Of Involvement In Choice Of Dialysis Mode. Journal of Renal Care, 41(4), 260-267. doi:10.1111/jorc.12141 Freeman, W. J. (1998). A neurobiological role of music on social bonding. In N. Wallin, B. Merkur, S. Brown   (Eds.), The Origins of Music. Cambridge MA: MIT Press. Hallam, S., Cross, I., Thaut, M. (2016). The Oxford handbook of music psychology. Oxford: Oxford University Press. Hartling, L., Newton, A. S., Liang, Y., Jou, H., Hewson, K., Klassen, T. P., Curtis, S. (2013). Music to Reduce Pain and Distress in the Pediatric Emergency Department. JAMA Pediatrics, 167(9), 826. doi:10.1001/jamapediatrics.2013.200 Horden, P. (2014). Music as medicine: the history of music therapy since antiquity. Aldershot: Ashgate. Lahmann, C., Schoen, R., Henningsen, P., Ronel, J., Muehlbacher, M., Loew, T., . . . Doering, S. (2008). Brief Relaxation Versus Music Distraction in the Treatment of Dental Anxiety. The Journal of the American Dental Association, 139(3), 317-324. doi:10.14219/jada.archive.2008.0161 Mok, E., Wong, K. (n.d.). Effects of Music on Patient Anxiety. Aorn Journal, 77(2), 396-410. http://dx.doi.org/10.1016/S0001-2092(06)61207-6 Palakanis, K. C., Denobile, J. W., Sweeney, B. W., Blankenship, C. L. (1994). Effect of music therapy on state anxiety in patients undergoing flexible sigmoidoscopy. Diseases of the Colon Rectum, 37(5), 478-481. doi:10.1007/bf02076195 Reicherts, P., Gerdes, A. B., Pauli, P., Wieser, M. J. (2016). Psychological Placebo and Nocebo Effects on Pain Rely on Expectation and Previous Experience. The Journal of Pain, 17(2), 203-214. doi:10.1016/j.jpain.2015.10.010 Sloboda, J. A. (1991). Music Structure and Emotional Response: Some Empirical Findings. Psychology of Music, 19(2), 110-120. doi:10.1177/0305735691192002 Thoma, M. V., Marca, R. L., Brà ¶nnimann, R., Finkel, L., Ehlert, U., Nater, U. M. (2013). The Effect of Music on the Human Stress Response. PLoS ONE, 8(8). doi:10.1371/journal.pone.0070156 Vaajoki, A., Kankkunen, P., Pietilà ¤, A., Vehvilà ¤inen-Julkunen, K. (2011). Music as a nursing intervention: Effects of music listening on blood pressure, heart rate, and respiratory rate in abdominal surgery patients. Nursing Health Sciences, 13(4), 412-418. doi:10.1111/j.1442-2018.2011.00633.x Weiss, L. J., Blustein, J. (1996). Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans. 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The Physicists Essay -- Essays Papers

The Physicists The Physicists is a satiric play written by the Swiss author Friedrich DÃ ¼rrenmatt about three physicists who are living in the private sanatorium " Les Cerisiers " headed by the last living member of an old regional aristocratic family, Miss Dr. h.c. Dr. med. Mathilde Von Zahnd. The first one thinks he is Sir Isaac Newton, but he is in reality Herbert Georg Beutler, the second one thinks he is Albert Einstein and his real name is Ernst Heinrich Ernesti. The third physicist, Johann Wilhelm MÃ ¶bius is different, he has got no second identity but he is in this sanatorium because King Solomon speaks to him. We enter the play when many men are in the saloon. It is the place of a tragedy as Mr Ernesti has strangled a nurse. Mr. Beutler has also killed a nurse a couple of months ago. The inspector is slightly annoyed because he has to visit Les Cerisiers the second time during a short period of time and because he can’t speak to or take away the murderer . He is also expressing the wish of the public prosecutor that the sanatorium has to be taken over by male nurses because of the two murders by the two physicists. During the course of the play the personal and physical change is perceptible. Both the main characters and the environment are changing. For an example in act two, Herbert Georg Beutler alias Sir Isaac Newton turns out to be a long lost world famous physicist Alex Jasper Kilton who discovered the "Theory of Equivalents" also Albert Einstein alias...

Four Poems by Derek Mahon Essay

Four Poems by Derek Mahon INTRODUCTION Derek Mahon belongs to the same generation of Northern Ireland poets as Seamus Heaney. But, whereas many of Heaney’s poems are rooted firmly in the rural landscape of Ulster where he grew up, Mahon’s poems reflect his childhood spent in Belfast. His familiar places were the streets of the city, the Harland and Wolff shipyard where his g-andfather and father worked, and the flax-spinning factory where his mother worked. Later on, Mahon would come to study at Trinity College Dublin and from there he spread his wings to travel and work in many different places, from France, Canada and America, to London and Kinsale in Co. Cork. , †¢Ã¢â‚¬ DAY TRIP TO DONEGAL† Tie shift, in both meaning and feeling, that :sxes place between the first and final lines of ~ s poem makes it memorable. The title :=e~s ordinary: Day Trip to Donegal suggests :- :~ :od days out at the seaside or even a school trip with classmates and teachers. ~–~ opening stanza is conversational in tone. I :– ,al at his seaside destination, the poet s n familiar surroundings. There were to be seen† and â€Å"as ever† the hills â€Å"a deeper green/Than anywhere in the : : – seems at this point that we are r: – r :: share a pleasant day at the seaside in Donegal with the poet. However, just as we . – rev. ~†~ comfortable with this expectation, -:::†¢Ã¢â‚¬ ¢Ã¢â‚¬ ¢ appears. We are disturbed by the 2. Deration in the final line and the image : ^reduces: â€Å"†¦ the grave/Grey of the sea Me grwnmer in that enclave. † – – : — : _s -â€Å"rial line of the opening stanza , a similar scenario in stanza two. The poet watches the fishing-boats arriving back at the pier with their catch. This familiar scene is often described in attractive terms by songwriters and painters. But here Mahon startles us in the second line by describing the catch as â€Å"A writhing glimmer offish†. The word â€Å"writhing† is very vivid. The fish are seen as suffering and this notion becomes more intense in the concluding lines of the stanza where he sees them â€Å"flopping about the deck/In attitudes of agony and heartbreak†. A story is told about Mahon as an only child who spent a lot of time alone. His imagination had free rein and in the bicycle shed in the garden at home the Mahons also kept coal. Apparently the boy Derek Mahon suffered guilt when he went to the shed to get his bicycle. He felt pity for the coal which was, to him, imprisoned in that dark, cold, shed. His compassion was evident even then; he felt sorry for the coal! In Day Trip to Donegal we see that the poet’s day is changed by the sight of the caught fish. He feels compassion for them in their dying moments. In stanza three the return journey to Belfast is described. This poem is poised between two worlds — the seaside one in rural Donegal and the urban one in Belfast. Have you noticed how Mahon chooses to describe his arrival back in Belfast? â€Å"We changed down into suburbs/Sunk in a sleep no gale-force wind disturbs. † There is a suggestion here of a â€Å"tamer† world than the wild gale-beaten one of Donegal. The phrase â€Å"changed down† refers to the gear-change of the car, but it also shows how the poet is struck by the difference between the rural and the urban worlds he has experienced on that particular day. The sleeping suburbs seem slow and quiet after the drama of the Donegal landscape. Exam ; Career Guide 241 I t/2 _i O Z LU LU h-U LU U Nightmare Stanza four picks up again on the disturbing imagery of stanza two. There is an intense feeling of terror here as the poet recalls his dream after his day out at the seaside. In his nightmare, the sea is seen as a powerful force of destruction. We can be chilled by his description of the sea performing its â€Å"immeasurable erosions† — â€Å"Spilling into the skull. † The combination of words here is powerful: â€Å"immeasurable erosions† and the alliteration of â€Å"spilling† and â€Å"skull†. The choice of the word â€Å"erosion† is worth noting here. It suggests eating away at something — the action of the sea on the coastline over many years. Why does the poet draw a parallel between himself and the eroding coastline, at the mercy of the infinite onslaught of the sea? Could this be an oblique reference to the political circumstances in which he lived in Northern Ireland? We remember that Donegal was described in stanza one as a â€Å"green enclave†. He has travelled there from Belfast — another political entity to which he returns after his day across the border. In the nightmare he is the helpless victim at the mercy of the relentless sea. It mutters â€Å"its threat† — the poet does not enjoy a peaceful sleep after his day-trip to Donegal. Instead he has a kind of nightmare, a surreal vision which is frightening and sinister. The nightmarish journey continues into the final stanza. Now the sea has become a metaphor for the poet’s own view of his life. He is alone and drifting, has not taken enough caution to prevent this danger and feels surrounded on all sides by the â€Å"vindictive wind and rain†, i. . , the malevolent forces that control his life and which cannot be placated. The poem ends on a note of hopelessness and despair. There is no promise of rescue. His predicament recalls that of the fish described in stanza two — â€Å"flopping about the deck/In attitudes of agony and heartbreak†. †¢ â€Å"ECCLESIASTES† The title of this poem situates it immediately in the context of relig ion — Ecclesiastes being the title of a book in the Old Testament, used frequently by preachers in their sermons. The context of the poem is the Ulster of the religious preachers and the churchmen which Mahon knew very well, being an Ulster Protestant by birth. The opening three lines of the poem are full of feeling. We notice the repetition of God and the rhythm created by â€Å"purist† and â€Å"puritan†, and â€Å"wiles and smiles†. Mahon is imagining himself as a member of the preaching classes and he tries in this poer-look closely at his identity as an Ulster Protestant. There is self-mockery in h s _s= of the phrase â€Å"purist little puritan†. The preacher is narrow minded (little) and rigid his attitudes — a â€Å"purist† puritan would be 3 extreme version of an ordinary puritan *^ would have been very strict in religious :. -†¢Ã¢â‚¬â„¢ moral matters. There is mockery and contempt as he describes the preache’ (Ecclesiastes) as â€Å"God-chosen† and â€Å"God-fearing†. He sees himself as occupying tr-e high moral ground while at the same t~-= basing his morality on fear rather than genuine conviction. The world inhabited by the Ecclesiastes (preachers) is a grim one. The images in ine 4 and 5 convey this most powerfully. The choice of the word â€Å"dank† (meaning da-x sr damp and cold) for the churches and the â€Å"tied up swings† on Sundays paint a joyless picture. Sunday was a particularly gloorny ~ in Protestant Ulster as it was strictly designated for prayer and church-going. Pleasure of any kind was frowned on. Marc then contrasts this life-denying way of lrvr>f with the real life of the world — – â€Å"the heat i the world†. He mentions how such a rigic code of behaviour allows those Churchmer to avoid the humanising interaction with women and the â€Å"bright eyes of children†. He continues with this train of thought in lines to 16. His tone is very critical. He sees tr-e preacher as using his public morality tc 2*c the real challenges of life — the call on eac of us â€Å"to understand and forgive†. The red bandana and stick and the ban? c referred to represent the antithesis of the preacher’s life. The red is a lively contrast n the â€Å"dork doors† mentioned before and the bandana and stick would be used on journe to brighter, livelier places than the dark r of Antrim which are washed by the cole â€Å"January rains†. This dark, cold place is the natural habitat of the preacher. He is following in the tradition of his forebears — â€Å"the heaped graves of your fathers†. Here he can â€Å"close one eye and be king†. This is an allusion to Erasmus, who once said: â€Å"In the country of the blind the one-eyed man is King†. Is this a reference to the closed mm and the bigotry of Mahon’s Ulster? The preacher can lord it over the ordinary peoc whose â€Å"heavy washing flaps† in the housing estates. They are credulous. But Mahon’s preacher has nothing to offer them. The ft imagery of the poem is filled with contemp 42 Exam ; Career Guide cts the preacher â€Å"stiff with rhetoric† forth to the captive audience yet lothing whatever to offer them — ng nothing under the sun†. eamus Heaney writes about Ulster :es in the memory of The Forge, in scape of Bogland, The Harvest Bow and Mahon, on the other hand, has a vision of Ulster — and he shares >n with us in Ecclesiastes. It is a place ;tants and Puritans and Preachers. He :dges that this is part of his own oo, and we find that he has a very ew of the narrow, life-denying f the culture which formed him. IT SHOULD BE† m, the mindset of another type of explored. This time it is that of the jrderer — who kills another man ie sees as a just cause. When ;ntions the Moon in the Yellow ire reminded of the Irish Civil War. :hat name was written by Denis ;et in 1927. Its story is of a man e who tried to blow up a generator ydroelectric station which was and was a symbol of the progress Irish Free State. Blake was shot by ;gt;f the Free State called Lanigan. The = officer of the Free State is the ir in this poem, as he justifies his nd even takes pride in it. : of Murder titeous tone is struck at the

Summary Of On Being An Atheist - 1341 Words

For many years theists and atheists have argued with one another over the existence of a creator, or God. H.J. McCloskey published his thoughts on the matter in a journal article in 1968 titled â€Å"On Being an Atheist†. In his article McCloskey aims to discredit cosmological and teleological arguments for a creator and he uses the existence of evil in the world as evidence that a divine creator cannot exist. McCloskey routinely refers to the cosmological and teleological arguments as believers’ â€Å"proof† of God’s existence; however, this is not an accurate statement. (McCloskey, 1968) Foreman points out in his presentation; we cannot provide certain proof of many things and just because something cannot be proven does not mean that it is not a justified belief. Rather than seeking proof of God’s existence we should find the best explanation for things. Regularly the field of science and the legal system gather multiple points that support an argument to arrive at the best explanation. (Foreman, Approaching the Question of God s Existence, 2014) In his writing, McCloskey states that the general basis of the cosmological argument, â€Å"the existence of God from the existence of the cosmos†¦Ã¢â‚¬  Theists argue however that the contingency of all things in the universe support the cosmological argument; more simply stated there is no obvious answer as to why there is anything at all, therefore, something must have created it. (Evans Manis) Additionally McCloskey claims that theShow MoreRelatedApologetics Application Paper Part 2 Submission Form Jeremy Story861 Words   |  4 Pagesthe criterian for worldview evaluation. 2. Complete Outline of Final Paper: I. Introduction II. Summary of the Atheistic Naturalism Worldview A. Belief about ultimate reality is that everything that can be seen came from matter. 1. 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The Comparison Of MKL and Malcolm X - Free Essay Example

Sample details Pages: 6 Words: 1664 Downloads: 6 Date added: 2019/03/26 Category History Essay Level High school Tags: Malcolm X Essay Martin Luther King Essay Did you like this example? While MLKs letter tends to white conservatives and Malcolm Xs discourse tends to members of the African American people group, they each are attempting to discover to upgrade the lives of African Americans by utilizing inciting disfavor in their gathering of people. Dr. Ruler bodes well disgrace about not satisfying both their otherworldly and moral commitments to the development. Don’t waste time! Our writers will create an original "The Comparison Of MKL and Malcolm X" essay for you Create order By summoning the scriptural principles of Christianity and Judaism, the talk of the letter makes the gathering of people involvement as despite the fact that they are neglecting to live in understanding to their confidence. He starts to do this in the second passage of the letter. There, Dr. Ruler interfaces himself with Christianity through uncovering that he is the leader of the SCLC and associated with the Alabama Christian Movement for Human Rights. Such associations are vital on the grounds that they remind his peruser that he shares their confidence. He looks at his situation to the Apostle Paul, taking note of Like Paul, I should constantly answer to the Macedonian call for help (King 1). He additionally makes a similarity of his predicament to that of Jesus. While tending to allegations that he is a fanatic, he asks Was not any more Jesus a radical in affection? (King 4). With these two analogies, Dr. Lord adjusts the Civil Rights Movement to the abuse of Jesus and the wants of St. Paul. For a non-common crowd, such an arrangement would make them question any reservations that they have about the development. In this manner, it is verifiable that individuals who cant help contradicting Dr. Lords objectives and systems are not abiding as indicated by their confidence. MLKs references to religious researchers and his verbalization of his error in the religious system are used to induce disrespect. Dr. Lord references St. Thomas Aquinas and Martin Burber intentionally. Since these researchers may now not be as ordinary for the reliably Christian or Jew, Dr. Ruler uses them to demonstrate his information of confounded non standard precepts, thusly setting himself in an unrivaled position. These references further pressure the misleading quality of approaching individuals who are searching for fundamental social freedoms to delay. At whatever point arranged researchers share his dispute that injustice of any kind is a moral floundering, by then his gathering of spectators may request their viewpoint of the Social Liberties Development and feel humiliated about their powerlessness to encourage the improvement. Perhaps the most huge logical gadget that is proposed to reason disfavor is his disposition of dissatisfaction in the white focus portrayal orga nize. He gives the remaining two pages of the letter to clearing up his disappointment. To be in a circumstance to out and out disappointment prescribes that he and his feelings are morally overwhelming. Thusly, his appearance of disappointment is a kind of decry that burdens that any activity towards his ability is at present not in staying aware of significant precept and need to cause disfavor. Dr. Ruler makes use of standard illustrative equipment that make his target advertise feel disapproval moreover. For example, he counters ensures that he is damaging laws by using helping his social event to remember individuals that Hitlers lead was once genuine, anyway degenerate. The evaluation to Hitler is high bore as a result of the truth only twenty years after the finish of WWII, Americans consider Hitler to be the end event of insidiousness. Along these lines, the planned intrigue gathering would be frightened to be in any way to considered to him. The Hitler connection makes the gathering of spectators feel disgrace that they are more connected with what is legal offense than in what is morally right. Finally, the discussion affects disfavor without ability to stay up to the rules of our nation. Dr. Ruler references Americas setting up dads. He illuminates that We [African Americans] will win our chance in light of the fact that the blessed heritage of our state and the eve rlasting will of God are embodied in our resonating solicitations (5). This is gigantic due to the truth it helps the social event to remember individuals that a need to frustrate African Americans and the name for African Americans to take transport of unfaltering freedom is opposite to the models whereupon this kingdom used to be built up, as authentically as reverse to the Judeo-Christian custom. By evaluating their political commitment and their reluctance to shield themselves rationally and mentally, Malcolm X, similar to Martin Luther King, disgraces his intended interest group with the end goal to rouse them to enhance their lives. By examining their political duty and their hesitance to watch themselves judiciously and rationally, Malcolm X, like Martin Luther King, disfavors his planned intrigue aggregate with the true objective to energize them to improve their lives. From the get-go in his talk, Malcolm X makes his African American target gathering of on lookers experienc e humiliated about their outwardly disabled complicity in their very own unique maltreatment through Americas political system. He pronounces that the Democrats have gotten the organization sewed up, and youre [African Americans] the individual who sewed it up structure them. Likewise, what have they given you for it? Four years in office, and a couple of moments back getting around to some social uniformity order (X 27). Here, he is attempting to look good inept about their assistance for law based government authorities like John F. Kennedy and Lyndon Johnson. Malcolm Xs proposal is that the democrats earned African American votes by methods for control and rejected the needs and needs of that hoard once picked. He needs African Americans to experience humiliated about being used as pawns. He besides condemns the Johnson association. He fights that Johnson is in cahoots with his buddy Richard Russell, a staunch foe to social freedoms control (X 27). He furthermore battles that the y are strolling a con preoccupation and playing with African American voters (X 27). The words cahoots and con redirection are the two articulations related with offense (Malcolm X 27). Along these lines, he sets these administrators as wrongdoers, and he gives his proposed intrigue assemble a job as silly individuals who inadvertently supportive resource guilty parties. Likewise, the likelihood that the African American voters is being performed besides exhibits a nonappearance of multifaceted nature and guilelessness in that social occasion. These are each quality for which, he recommends, they be humiliated. Be that as it may, Minister Malcolm scorns standard social uniformity activists, making them feel humiliated about what he sees as their misled undertakings to search for social balance through the political system. He calls African Americans who have been related with the standard Social freedoms Development tissue heads (X 31). This term is tremendous in light of the way that it was a severe term used to depict African Americans who were obliging to white master and willing to recognize a below average position. He anticipates that this attack will make normal rights pioneers, some of whom were accessible when he gave this talk, and moreover the customary people who admire them feel that the present social freedoms inspiration isnt dynamic enough. He ponders these social occasions to frail people who recognize fair conditions; he needs them to feel humiliated about their weakness. Malcolm X in like manner declares that we dont intend to let them [mainstream social freedoms leaders] pussyfoot and delay and exchange off any more (31). Essentially, he accuses the pioneers for putting off or blocking progress. Like the control that Martin Luther Ruler states when he disfavors white preservationists and church pioneers, Malcolm Xs ask for that he is more strong and along these lines more grounded exhibits his power and additionally underscores what he sees as the disgracefulness of their gradualist position. He continues with his usage of non-genuine request by asking How may you thank a man for giving you whats starting at now yours? How by then would you have the capacity to express profound gratitude to him for giving you simply bit of whats currently yours? You havent made progress, if whats being given to you, you should have starting at now (X 31). By rehashing the dilemma of the social equity fight in its minimum complex edge, he makes the social freedoms arrange have all the earmarks of being disgracefully ludicrous and silly. Malcolm X disgraces individuals who are hesitant to address the physical and mental dangers caused by prejudice. He clarifies The ticket or the slug. In case youre reluctant to utilize an articulation like that, you ought to get out of the nation, you ought to get back in the cotton fix, you ought to get back in the rear way (X 28). He makes the gathering of people feel embarrassed about their reluctance to forfeit everything to the battle against racial persecution if important. He adjusts such reluctance to the cotton fix, which is intended to conjure pictures of subjugation, as one of the souths essential harvests was at one time cotton and exhausting farming ventures, for example, sharecropping and cultivate working that were noticeable in the principal half of the twentieth century. Accordingly, to go back to the cotton fix would be backward. Malcolm X keeps on utilizing disgrace as a logical gadget once more when he notes If you [African Americans] dont take this sort of stand , your little kids will grow up and take a gander at you and think disgrace' (34). Guardians need to be good examples for their youngsters. He is demanding that inability to remain against persecution will lessen the more youthful ages regard for the more seasoned one. This makes his group of onlookers feel embarrassed about inaction and frightful that inaction will distance them from their kids. Like, MLKs declaration that all good and energetic natives ought to be embarrassed about disregarding metro and religious regulations, Malcolm X declares that African Americans who neglect to defend their unavoidable rights ought to be embarrassed about themselves as guardians and smart individuals. Therefore, the two pioneers utilize disgrace as an amazing logical gadget

Book Report in the Life of Laetitia - 2015 Words

Book Report On â€Å"In the Life of Laetitia† Merle Hodge ‘In the life of Laetitia’, published in 1994 by Farrar Straus Giroux of New York; Paperback, Aerial Fiction, 244 pages. The Novel was written by Merle Hodge a Trinidadian novelist and critic, she’s a lecturer at the University of the West Indies, she’s also the Author of the 1970 novel ‘Crick Crack, Monkey’, which is a classic of West Indian literature. The story is about an adolescent girl (Laetitia) who begins on a life changing journey, after successfully passing the common entrance exams that enables her to attend the government secondary school in La Puerta. It was a dream come true, as no other member of her family had an opportunity to obtain a secondary education. It bring to†¦show more content†¦Harvesting what he didn’t plant, no hard work done on his path. I ask myself the question if Lacy was a boy would he have treated her in such manner. He believed a son is more of an asset and importance instead of a daughter. That goes to show the gender prejudice within the book and also in the cultural beliefs in Trinidad. In the Caribbean we were face with issues of gender and gender inequality in the past. A woman had to know her place and boundaries in society and the home. In those days a woman was expected to be limited to what she must do and active part in decision making, in most cases limited to the day to day running of the house and taking care of the children. The boys were not trained or taught to take part such skills leaving all the work to the girls, while the boys run wild. Doing so will only continue the cycle as boys in turn will be men and that’s how customs were pass down through generations. Various part of the novel express such issues, on page 84 when Mr. Cephas came home from work and met his son at the sink washing wares, he blow up in anger and rage at his wife Ms. Velma for having his own washing wears and accusing her of turning his son into a ‘damn cunumunu’. He even went as far instructing him to curse his mother. That speaks volume as how Laceyâ€℠¢s father saw women and their rolls. Ms. Velma was like a living dead practically invisible to her husband. Never once in the novel there was anythingShow MoreRelatedCentra software 502009 PDF ENG Essay7368 Words   |  30 Pagescustomers. I say use telesales to make the first sale into a Global 2000 firm, and then use field sales to sell to other ________________________________________________________________________________________________________________ Research Associate Laetitia Pouliquen and Professor John Deighton prepared this case. HBS cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective managementRead MoreEnglish Source Doc.7581 Words   |  31 PagesTwins, I, 100). Finally Herminia Barton, the heroine of the 1895 best seller, The Woman Who Did, like Hardy s Sue Bridehead, argues for free love because marriage itself is still an assertion of man s supremacy over woman. It ties her to him for life; it ignores her individuality. Herminia continues, If I love a man at all, I must love him on terms of perfect freedom. I can t bind myself down to live with him to my shame one day longer than I love him; or to love him at all if I find him unworthyRead MoreStandardization Adaptation15058 Words   |  61 Pagesstandardization and adaptation Purpose: Compare two strategies, standardization and adaptation, to show how companies manage cultural differences. Method: Our research method is a descriptive one. Then, we collect data from secondary sources such as the books, articles, journals and studies. Then, we judge essential to gather primary data to answer our purpose. In this way, we do one qualitative personal interview with the international marketing director of Agatha and one email interview with its communication

Harmonization and Financial Statement Comparability †Free Samples

Question: Discuss about the Harmonization and Financial Statement Comparability. Answer: Introduction: From the relevant evaluation it could be identified that Peru has operations in Argentina, Brazil, Chilli, and Mexico, which allows the organisation to target high paying clients. Operations of the organisation are adequately conducted in international borders, which could help in increasing its value. The overall net income of the organisation mainly went from $225 million to negative $765 million. However, relevant investments that was conducted by the organisation on its operations which amounted to $1.5 billion. However, the operations of the organisation were not providing adequate results which allowed Entel to quote a price of $397 million and $415 million. After the valuation of the case study it could be identified by Peru has been conducting operations in different countries which tends to increase the risk involved in operations of the organisation. The evaluation of the market directly indicated a correlation and Country risk premium that needs to be addressed by the organisation. Furthermore due to globalisation has relevantly market comprising in different countries has mainly become huge market. Therefore, it could be understood that all the markets are interlinked as organisations listed it one market also invests in different markets to generate higher return. Hence, DAnconia mainly needs to focus in Global market and understand the relevant risk that would affect Peru stock market. Adequate standard deviation is mainly used to identify Perus stock returns and bond yields. The relevant estimation of country risk premium could be affected from the overall capital market, as any kind of negative impact food increase volatility and raise risk from investment. Loughran and McDonald (2016) mentioned that use of adequate valuation directly help in deriving the relevant risk involved in investments. Particulars Value Stock returns relative Peru Peru / US Stock returns relative Peru 0.09 / 0.047 Stock returns relative Peru 1.93 30 year bond yield relative Peru Peru bond / US bond 30 year bond yield relative Peru 0.009 / 0.007 30 year bond yield relative Peru 1.34 From the relevant evaluation of the above table stock returns of Peru can be identified, 30 year bond yield Peru. Moreover, the stock returns are mainly calculated at 1.93, while the 30 year bond yields are detected at 1.34. The overall values could mainly be used in the calculation for deriving the overall country risk premium. Kothari, Mizik and Roychowdhury (2015) argued that without adequate valuation of beta and other relevant valuation actual country risk premium could not be detected. Depicting Nextel Perus estimated asset beta and what is its estimated required return on assets, while considering the estimates of cost of capital, long-range growth rate and free cash flow: Relevant calculation of the required return is also conducted, which comprises with the country risk premium to detect the modified CAPM formula. The required rate of return formula directly comprises from the valuation of country risk premium. Moreover, the required rate of return also detects and uses risk free rate, and beta of the organisation. Hence, the relevant risk factor in emerging markets is different, where adequate Lambda is used to separately identify different types of risk. The Beta calculation may be calculated with the help relevant data, where beta of Peru can be identified with adequate formula, which directly indicates that the beta of the company is at 0.62. The overall results of Beta would be used in different formulas to detect the relevant risk involved an investment. In this context, Hoskin, Fizzell and Cherry (2014) stated that use of relevant investment option could eventually help in generating higher revenue from investment and detection of Beta could allow investors you identify a risk factors of the stock. Particulars Value US risk free rate 3.08% Peru risk free rate 5.05% US MRP 5% US cost of capital 6.56% Peru Cost of capital 8.60% With the help of the above table adequate us cost of capital is mainly calculated, where does period of US, beta, US MRP and country MRP is mainly used to detect overall cost of capital of US. Furthermore, the relevant formula is also used arrived Peru cost of capital, which is identified in the above team. Furthermore derivation of the cost of capital would eventually help in identifying relevant actual value of the organisation. This detection could also help in deriving required return that is needed by Peru. This derivation helps in identifying the overall value of the firm in future. Warren, Reeve and Duchac (2013) mentioned that detection of the required return mainly allows the investor to compare the actual return provided by the company. Particulars Value Growth US 3.00% Growth Peru 5.90% FCF0 11,731 FCF1 16,659 Unlevered Value 616,992 StDev Peru 9% StDev US 4.66% Rel StDev Peru 193.13% StDev debt Peru 27.35% Country MRP 0.65% With the help of adequate growth rate and growth value the overall forms actual value is being calculated. Show the map the calculation directly the text that the overall form values at $616.992 million, which is relatively undervalued. Therefore, the current valuation the organisation relatively undervalued, which might in turn help in detecting the overall growth rate FCF value. Reference and Bibliography: Amiraslani, H., Iatridis, G.E. and Pope, P.F., 2013.Accounting for Asset Impairment: A Test for IFRS Compliance Across Europe: a Research Report by the Centre for Financial Analysis and Reporting Research, Cass Business School. Cass Business School. Gigler, F., Kanodia, C., Sapra, H. and Venugopalan, R., 2014. How Frequent Financial Reporting Can Cause Managerial Short?Termism: An Analysis of the Costs and Benefits of Increasing Reporting Frequency.Journal of Accounting Research,52(2), pp.357-387. Hoskin, R.E., Fizzell, M.R. and Cherry, D.C., 2014.Financial Accounting: a user perspective. Wiley Global Education. Kothari, S.P., Mizik, N. and Roychowdhury, S., 2015. Managing for the moment: The role of earnings management via real activities versus accruals in SEO valuation.The Accounting Review,91(2), pp.559-586. Loughran, T. and McDonald, B., 2016. Textual analysis in accounting and finance: A survey.Journal of Accounting Research,54(4), pp.1187-1230. Sullivan, S.D., Mauskopf, J.A., Augustovski, F., Caro, J.J., Lee, K.M., Minchin, M., Orlewska, E., Penna, P., Barrios, J.M.R. and Shau, W.Y., 2014. Budget impact analysisprinciples of good practice: report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force.Value in health,17(1), pp.5-14. Vogel, H.L., 2014.Entertainment industry economics: A guide for financial analysis. Cambridge University Press. Wang, C., 2014. Accounting standards harmonization and financial statement comparability: Evidence from transnational information transfer.Journal of Accounting Research,52(4), pp.955-992. Warren, C.S., Reeve, J.M. and Duchac, J., 2013.Financial managerial accounting. Cengage Learning. Zeff, S.A., 2016.Forging accounting principles in five countries: A history and an analysis of trends. Routledge.