Night World : The Chosen Chapter 11

The U-Haul whirred across smooth resonant pavement and Rashel tried to guess where they were. She had been drawing a map in her mind, trying to imagine each turn they made, each change of the road underneath them. Ivan sat slouched, blocking the back doors of the truck. His eyes were small and mean, and they flickered over the girls constantly. In his right hand he held a taser, a hand-held electrical stun gun, and Rashel knew he was dying to use it. But the cargo was being very docile. Daphne was beside Rashel, leaning against her very slightly for comfort, her dark blue eyes fixed vacantly on the far wall. They were shackled together: although both Lily and Ivan had been checking Daphne constantly for signs of waking up, they were dearly taking no chances. On the opposite side of the truck were the two other girls. One was Juanita, her wavy bronze hair tangled from two days of lying on it, her bee-stung lips parted, her gaze empty. The second girl was a towhead, with flyaway hair and Bambi eyes staring blankly. Ivan called her Missy. She was about twelve. Rashel allowed herself to daydream about things to do to Ivan. Then she focused. The van was stopping. Ivan jumped up, and a minute later he was opening the back doors. Then he and Lily were unshackling the girls and herding them out, telling them to hurry. Rashel breathed deeply, grateful for the fresh open air. Salty air. Keeping her gaze aimless and glassy, she looked around. It was twilight and they were on a Charlestown dock. â€Å"Keep moving,† Ivan said, a hand on her shoulder. Ahead, Rashel saw a sleek thirty-foot power cruiser bobbing gently in a slip. A figure with dark hair was on the deck, doing something with lines. Quinn. He barely glanced up as Ivan and Lily hustled the girls onto the boat, and he didn't help steady Missy when she almost lost her balance jumping from the dock. His mood had changed again, Rashel realized. He seemed withdrawn, turned inward, brooding. â€Å"Move!† Ivan shoved her, and for an instant, Quinn's attention shifted. He stared at Ivan with eyes like black death, endless and fathomless. He didn't say a word. Ivan's hand dropped from Rashers back. Lily led them down a short flight of steps to a cramped but neat little cabin and gestured them to an L-shaped couch behind a dinette table. â€Å"Here. Sit down. You two here. You two there.† Rashel slipped into her seat and stared vacantly across at the sink in the tiny galley. â€Å"You all stay here,† Lily said. â€Å"Don't move. Stay.† She would have made a great slave overseer, Rashel thought. Or dog trainer. When Lily had disappeared up the stairs and the door above had banged shut, Rashel and Daphne simultaneously let out their breath. â€Å"You doing okay?† Rashel whispered. â€Å"Yeah. A little shaky. Where d'you think we're going?† Rashel just shook her head. Nobody knew where the vampire enclaves were. An idea was beginning to form in her mind, though. There must be a reason they were traveling by boat-it would have been safer and easier to keep the prisoners in the U-Haul. Unless they were going to a place you couldn't get to by U-Haul. An island. Why shouldn't some of the enclaves be on islands? There were hundreds of them off the eastern coast. It was a very unsettling thought. On an island they would be completely isolated. Nowhere to escape to if things got bad. No possible hope of help from outside. Rashel was beginning to regret that she'd brought Daphne into this. And she had the ominous feeling that when they got to their destination, she was going to regret it even more. The boat sliced cleanly through the water, heading into darkness. Behind Quinn was the skyline of Boston, the city lights showing where the ocean ended and the land began. But ahead there was no horizon, no difference between sky and sea. There was only formless, endless void. The inky blackness was dotted with an occasional solitary winking light-herring boats. They only seemed to make the vastness of empty water more lonely. Quinn ignored Lily and Ivan. He was not in a good mood. He let the cold air soak into him, permeating his body, mixing with the cold he felt inside. He imagined himself freezing solid-a rather pleasant thought. Just get to the enclave, he thought emptily. Get it over with. This last batch of girls had upset him. He didn't know why, and he didn't want to think about it. They were vermin. All of them. Even the dark-haired one who was so lovely that it was almost too bad she was certifiably insane. The little blond one was crazy, too. The one who, having had the luck to fall out of the frying pan once, had come right back, coated herself with butter and breadcrumbs, and jumped in again. Idiot. Someone like that deserved†¦ Quinn's thought broke off. Somewhere deep inside him was a little voice saying that no one, however idiotic, deserved what was going to happen to those girls. You're the idiot. Just get them to the enclave and then you can forget all this. The enclave†¦ it was Hunter Redfern who had first thought of enclaves on islands. Because of Dove, he'd said. â€Å"We need a place where the Redferns can live safely, without looking over their shoulders for humans with stakes. An island would do.† Quinn hadn't objected to the classification of himself as a Redfern-although he had no intention of marrying Garnet or Lily. Instead he said, practically, â€Å"Fishermen visit those islands all the time. Humans are settling them. We'd have company soon.† â€Å"There are spells to guard places humans shouldn't go. I know a witch who'll do it, to protect lily and Garnet.† â€Å"Why?† Hunter had grinned. â€Å"Because she's their mother.† And Quinn had said nothing. Later he'd met Maeve Harman, the witch who had mingled her blood with the lamia. She didn't seem to like Hunter much, and she kept their youngest daughter, Roseclear, who was being raised as a witch, away from him. But she did the spell. And they'd all moved to the island, where Garnet finally gave up on Quinn and married a boy from a nice lamia family. Her children were allowed to carry on the Redfern name. And as time went on, other enclaves had sprung up†¦. But none quite like the one Quinn was heading for now. He shifted on his seat in the cockpit. Ahead, there was a horizon again. A luminous silver moon was rising above the pond-still dark water. It shone like an enchantment, as if to guide Quinn's way. Scrrrunch. Rashel winced as the boat docked. Somebody wasn't being careful. But they'd arrived, and it could only be an island. They'd been heading east for over two hours. Daphne lifted her head weakly. â€Å"I don't care if they eat us the minute we get off, as long as I get to feel solid ground again.† â€Å"This practically is solid ground,† Rashel whispered. â€Å"It's been dead calm the whole way.† â€Å"Tell that to my stomach.† Daphne moaned, and Rashel poked her. Someone was coming down the stairs. It was Lily. Ivan waited above with the taser. They herded the girls off the boat and up onto a little dock. Rashel did her vacant-eyed staring around again, blessing the moonlight that allowed her to see. It wasn't much of a dock. One wharf with a gas pump and a shack. There were three other powerboats in slips. And that was all. Rashel couldn't see any sign of life. The boats rode like ghost ships on the water. There was silence except for the slap of the waves. Private island, Rashel thought. Something about the place made the hair on the back of her neck rise. With Lily in front and Ivan in back, the group was herded to a hiking trail that wound up a cliff. It's just an island, Rashel told herself. You should be dancing with joy. This is the enclave you wanted to get to. There's nothing†¦ uncanny†¦ about this place. And then, as they reached the top of the cliff, she saw the rocks. Big rocks. Monoliths that reminded her eerily of Stonehenge. It looked as if a giant had scattered them around. And there were houses built among them, perched on the lonely cliff, looking down on the vast dark sea. They all seemed deserted, and somehow they reminded Rashel of gargoyles, hunched and waiting. Lily was headed for the very last house on the sandy unpaved road. It was one of those huge â€Å"summer cottages† that was really a mansion. A massive white frame house, two and a half stories high, with elaborate ornamentation. Shock coursed through Rashel. A frame house. Wood. This place wasn't built by vampires. The lamia built out of brick or fieldstone, not out of the wood that was lethal to them. They must have bought this island from humans. Rashel was tingling from head to toe. This is definitely not a normal enclave. Where are all the people? Where's the town? What are we doing here? â€Å"Move, move.† Lily marched them around the back of the house and inside. And at last, Rashel heard the sounds of other life. Voices from somewhere inside the house. But she didn't get to see who the voices belonged to. Lily was taking them into a big old-fashioned kitchen, past a pantry with empty shelves. At the end of the pantry was a heavy wooden door, and on a stool by the door was a boy about Rashel's age. He had bushy brown hair and was wearing cowboy boots. He was reading a comic book. â€Å"Hey, Rudi,† Lily said crisply. â€Å"How're our guests?† â€Å"Quiet as little lambs.† Rudi's voice was laconic, but he stood up respectfully as Lily went by. His eyes flickered over Rashel and the other girls. Werewolf. Rashel's instincts were screaming it. And the name†¦ werewolves often had names like Lovell or Felan that meant wolf in their native language. Rudi meant â€Å"famous wolf† in Hungarian. Best guards in the world, Rashel thought grimly. Going to be hard to get past him. Rudi was opening the door. With Lily prodding her from behind, Rashel walked down a narrow, extremely steep staircase. At the base of the stairway was another heavy door. Rudi unlocked it and led the way. Rashel stepped into the cellar. What she saw was something she'd never seen before. A large low-ceilinged room. Dimly lit. With two rows of twelve iron beds along opposite walls. There was a girl in each bed. Teenage girls. All ages, all sizes, but every one beautiful in her own unique way. It looked like a hospital ward or a prison. As Rashel walked between the rows, she had to fight to keep her face blank. These girls were chained to the beds, and awake†¦ and scared. Frightened eyes looked at Rashel from every cot, then darted toward the werewolf. Rudi grinned at them, waving and nodding to either side. The girls shrank away. Only a few seemed brave enough to say anything. â€Å"Please†¦Ã¢â‚¬  â€Å"How long do we have to stay here?† â€Å"I want to go home!† The last two beds in each row were empty. Rashel was put into one. Daphne looked both sick and frightened as the shackles dosed over her ankles, but she went on gamely staring straight ahead. â€Å"Sleep tight, girlies,† Rudi said. â€Å"Tomorrow's a big day.† And then he and Lily and Ivan walked out. The heavy wooden door slammed behind them, echoing in the stone-walled cellar. Rashel sat up in one motion. Daphne twisted her head. â€Å"Is it safe to talk?† she whispered. â€Å"I think so,† Rashel said in a normal voice. She was staring with narrowed eyes down the rows of beds. Some of the girls were looking at them, some were crying. Some had their eyes shut. Daphne burst out with the force of a breaking dam, â€Å"What are they going to do to us?† â€Å"I don't know,† Rashel said. Her voice was hard and flat, her movements disciplined and precise, as she slid the knife out of her boot. â€Å"But I'm going to find out.† â€Å"What, you're gonna saw through the chains?† â€Å"No.† From a guard on the side of the sheath, Rashel pulled a thin strip of metal. She bared her teeth slightly in a smile. â€Å"I'm going to pick the lock.† â€Å"Oh. Okay. Great. But then what? I mean, what's happening here? What kind of place is this? I was expecting some kind of-of Roman slave auction or something, with, like, everybody dressed in togas and vampires waving and bidding-â€Å" â€Å"You may still see something like that,† Rashel said. â€Å"I agree, it's weird. This is not a normal enclave. I don't know, maybe it's some kind of holding center, and they're going to take us someplace else to sell us†¦.† â€Å"Actually, I'm afraid not,† a quiet voice to her left said. Rashel turned. The girl in the bed beside her was sitting up. She had flaming red hair, wistful eyes, and a diffident manner. â€Å"I'm Fayth,† she said. â€Å"Shelly,† Rashel said briefly. She didn't trust anyone here yet. â€Å"That's Daphne. What do you mean, you're afraid not?† â€Å"They're not taking us somewhere else to sell us.† Fayth looked almost apologetic. â€Å"Well, I'd like to know what they're going to do with us here,† Rashel said. She sprung one lock on the shackles and jabbed the lockpick into the other. â€Å"Twenty-four girls on an island with one inhabited house? It's insane.† â€Å"It's a bloodfeast.† Rashel's hand on the lockpick went still. She looked over at Fayth and said very softly, â€Å"What?† â€Å"They're having a bloodfeast. On the spring equinox, I think. Starting tomorrow night at midnight.† Daphne was reaching across the gap for Rashel. â€Å"What, what? What's a bloodfeast? Tell me.† â€Å"It's†¦Ã¢â‚¬  Rashel dragged her attention from Fayth. â€Å"It's a feast for vampires. A big celebration, a banquet. Three courses, you know.† She looked around the room. â€Å"Three girls. And there are twenty-four of us†¦.† â€Å"Enough for eight vampires,† Fayth said quietly, looking apologetic. â€Å"So you're saying that they take a little blood from each of three girls.† Daphne was leaning anxiously toward Rashel. â€Å"That's what you're saying, right? Right? A little sip here, a little sip there-† She broke off as Rashel and Fayth both looked at her. â€Å"You're not saying that.† â€Å"Daphne, I'm sorry I got you into this.† Rashel took a breath and opened the second lock on her shackles, avoiding Daphne's eyes. â€Å"The idea of a bloodfeast is that you drink the blood of three people in one day. All their blood. You drain them.† Daphne opened her mouth, shut it, then at last said pathetically, â€Å"And you don't burst?† Rashel smiled bleakly in spite of herself. â€Å"It's supposed to be the ultimate high or something. You get the power of their blood, the power of their lifeforce, all at once.† She looked at Fayth. â€Å"But it's been illegal for a long time.† Fayth nodded. â€Å"So's slavery. I think somebody wants it to make a comeback.† â€Å"Any idea who?† â€Å"All I know is that somebody very rich has invited seven of the most powerful made vampires here for the feast. Whoever he is, he really wants to show them a good time.† â€Å"To make an alliance,† Rashel said slowly. â€Å"Maybe.† â€Å"The made vampires ganging up against the lamia.† â€Å"Possibly.† â€Å"And the spring equinox†¦ they're celebrating the anniversary of the first made vampire. The day Maya bit Thierry.† â€Å"Definitely.† â€Å"Just wait a minute,† Daphne said. â€Å"Just everybody press pause, okay? How come you know about all this stuff?† She was staring at Fayth. â€Å"Made vampires, this vampires, that vampires, Maya†¦ I never heard of any of these people.† â€Å"Maya was the first of the lamia,† Rashel said rapidly, glancing back at her. â€Å"She's the ancestress of all the vampires who can grow up and have children-the family vampires. The made vampires are different. They're humans who get made into vampires by being bitten. They can't grow any older or have kids.† â€Å"And Thierry was the first human to get made into a vampire,† Fayth said. â€Å"Maya bit him on the spring equinox†¦ thousands of years ago.† Rashel was watching Fayth closely. â€Å"So now maybe you'll answer her question,† she said. â€Å"How do you know all this? No humans know about Night World history-except vampire hunters and damned Daybreakers.† Fayth winced, and then Rashel understood why she seemed so apologetic. â€Å"I'm a damned Daybreaker.† â€Å"Oh, God.† â€Å"What's a Daybreaker?† Daphne prompted, poking Rashel. â€Å"Circle Daybreak is a group of witches who're trying to get humans and Night People to†¦ I don't know, all dance around and drink Coke together,† Rashel said, nonplussed. She was confused and revolted-this girl had seemed so normal, so sensible. â€Å"To live in harmony, actually,† Fayth said to Daphne. â€Å"To stop hating and killing each other.† Daphne wrinkled her nose. â€Å"You're a witch?† â€Å"No. I'm human. But I have friends who're witches. I have friends who're vampires. I know lamia and humans who're soulmates-â€Å" â€Å"Don't be disgusting!† Rashel almost shouted it. It took her a moment to get hold of herself. Then, breathing carefully, she said, â€Å"Look, just watch it, Daybreaker. I need your information, so I'm willing to work with you-temporarily. But watch the language or I'll leave you here when I get the rest of us out. Then you can live in harmony with eight vampires on your own.† Despite her effort at control, her voice was shaking. Somehow Fayth's words seemed to keep echoing in her mind, as if they had some strange arid terrible importance. The word soulmates itself seemed to ricochet around inside her. And Fayth was acting oddly, too. Instead of getting mad, she just looked at Rashel long and steadily. Then she said softly, â€Å"I see†¦Ã¢â‚¬  Rashel didn't like the way she said it. She turned toward Daphne, who was saying eagerly, â€Å"So we're going to get out of here? Like a prison break?† â€Å"Of course. And we'll have to do it fast.† Rashel narrowed her eyes, trying to think. â€Å"I assumed we'd have more time†¦ and there's that werewolf to get past. And then once we do get out, we're on an island. That's bad. We can't live long out in the wild-it's too cold and they'd track us. But there has to be a way†¦.† She glanced at Fayth. â€Å"I don't suppose there's any chance of other Daybreakers showing up to help.† Fayth shook her head. â€Å"They don't know I'm here. We'd heard that something was going on in a Boston club, that somebody was gathering girls for a bloodfeast. I came to check it out-and got nabbed before I made my first report.† â€Å"So we're on our own. That's all right.† Rashel's mind was in gear now, humming with ideas. â€Å"Okay, first, we'll have to see what these girls can do-which of them can help us-â€Å" Fayth and Daphne were listening intently, when Rashel was interrupted by the last thing she expected to hear in a place like this. The sound of somebody shouting her name. â€Å"Rashel! Rashel the vampire hunter! Rashel the Cat!†

Edwin Arlington Robinson

â€Å"One of the most prolific major American poets of the twentieth century, Edwin Arlington Robinson is, ironically, best remembered for only a handful of short poems,† stated Robert Gilbert in the Concise Dictionary of American Literary Biography. Fellow writer Amy Lowell declared in the New York Times Book Review, â€Å"Edwin Arlington Robinson is poetry. I can think of no other living writer who has so consistently dedicated his life to his work.† Robinson is considered unique among American poets of his time for his devotion to his art; he published virtually nothing during his long career except poetry. The expense of Robinson’s single-mindedness,† Gilbert explained, â€Å"was virtually everything else in life for which people strive, but it eventually won for him both fortune and fame, as well as a firm position in literary history as America’s first important poet of the twentieth century. † Robinson seemed destined for a career in business or the sciences. He was the third son of a wealthy New England merchant, a man who had little use for the fine arts. He was, however, encouraged in his poetic pursuits by a neighbor and wrote copiously, experimenting with verse translations from Greek and Latin poets. In 1891 Edward Robinson provided the funds to send his son to Harvard partly because the aspiring writer required medical treatment that could best be performed in Boston. There Robinson published some poems in local newspapers and magazines and, as he later explained in a biographical piece published in Colophon, collected a pile of rejection slips â€Å"that must have been one of the largest and most comprehensive in literary history. † Finally he decided to publish his poems himself, and contracted with Riverside, a vanity press, to produce The Torrent and The Night Before, named after the first and last poems in the collection. In the poems of The Torrent and The Night Before, Robinson experimented with elaborate poetic forms and explored themes that would characterize much of his work—†themes of personal failure, artistic endeavor, materialism, and the inevitability of change,† according to Gilbert. He also established a style recognizably his own: an adherence to traditional forms at a time when most poets were experimenting with the genre (â€Å"All his life Robinson strenuously objected to free verse,† Gilbert remarked, â€Å"replying once when asked if he wrote it, ‘No, I write badly enough as it is. †), and laconic, everyday speech. Robinson mailed copies of The Torrent and The Night Before out â€Å"to editors of journals and to writers who he thought might be sympathetic to his work,† said Gilbert. Read also  How Powerful Do You Find Atticus Finch’s Closing Speech? The response was generally favorable, although perhaps the most significant review came from Harry Thurston Peck, who commented unfavorably in the Bookman on Robinson’s bleak outlook and sense of humor. Peck found Robinson’s tone too grim for his tastes, saying that â€Å"the world is not beautiful to [Robinson], but a prison-house. â€Å"I am sorry that I have painted myself in such lugubrious colours,† Robinson wrote in the next issue of the Bookman, responding to this criticism. â€Å"The world is not a prison house, but a kind of spiritual kindergarten, where millions of bewildered infants are trying to spell God with the wrong blocks. † Encouraged by the largely positive critical reaction, Robinson quickly produced a second manuscript, The Children of the Night, which was also published by a vanity press, a friend providing the necessary funds. Unfortunately, reviewers largely ignored it; Gilbert suggests that they were put off by the vanity imprint. In 1902, two friends persuaded the publisher Houghton Mifflin to publish Captain Craig, another book of Robinson’s verse, by promising to subsidize part of the publishing costs. Captain Craigwas neither a popular nor a critical success, and for several years Robinson neglected poetry, drifting from job to job in New York City and the Northeast. He took to drinking heavily, and for a time it seemed that he would, as Gilbert put it, fall â€Å"into permanent dissolution, as both his brothers had done. † â€Å"His whimsical ‘Miniver Cheevy,’† Gilbert continued, â€Å"the poem about the malcontent modern who yearned for the past glories of the chivalric age and who finally ‘coughed, and called it fate/and kept on drinking,’ is presumably a comic self-portrait. † Robinson’s luck changed in 1904, when Kermit Roosevelt brought The Children of the Night to the attention of his father, President Theodore Roosevelt. Roosevelt not only persuaded Random House to republish the book, but also reviewed it himself for the Outlook (â€Å"I am not sure I understand ‘Luke Havergal,’† he said, â€Å"but I am entirely sure that I like it†), and obtained a sinecure for its author at the New York Customs House—a post Robinson held until 1909. The two thousand dollar annual stipend that went with the post provided Robinson with financial security. In 1910, he repaid his debt to Roosevelt in The Town down the River, a collection of poems dedicated to the former president. Perhaps the best known of Robinson’s poems are those now called the Tilbury Town cycle, named after the small town â€Å"that provides the setting for many of his poems and explicitly links him and his poetry with small-town New England, the repressive, utilitarian social climate customarily designated as the Puritan ethic,† explained W. R. Robinson in Edwin Arlington Robinson: A Poetry of the Act. These poems also expound some of Robinson’s most characteristic themes: â€Å"his curiosity,† as Gerald DeWitt Sanders and his fellow editors put it in Chief Modern Poets of Britain and America, â€Å"about what lies behind the social mask of character, and †¦ is dark hints about sexuality, loyalty, and man’s terrible will to defeat himself. † Tilbury Town is first mentioned in â€Å"John Evereldown,† a ballad collected in The Torrent and The Night Before. John Evereldown, out late at night, is called back to the house by his wife, who is wondering why he wants to walk the long cold miles into town. He responds, â€Å"God knows if I pray to be done with it all/But God’s no friend of John Evereldown. /So the clouds may come and the rain may fall,/the shadows may creep and the dead men crawl,—/But I follow the women wherever they call,/And that’s why I’m going to Tilbury Town. Tilbury Town reappears at intervals throughout Robinson’s work. The title poem in Captain Craig concerns an old resident of the town whose life, believed wasted by his neighbors, proves to have been of value. The Children of the Night contains the story of Richard Cory, â€Å"a gentleman from sole to crown,/Clean favored, and imperially slim,† who â€Å"one calm summer night,/Went home and put a bullet through his head,† and Tilbury Town itself is personified in the lines â€Å"In fine, we thought that he was everything/ To make us wish that we were in his place. The Man against the Sky—according to Gilbert, Robinson’s â€Å"most important single volume,† and probably his most critically acclaimed—includes the story of the man â€Å"Flammonde,† one of the poet’s most anthologized Tilbury verses. Despite the fact that much of Robinson’s verse dealt with failed lives, several critics see his work as life-affirming. May Sinclair, writing an early review of Captain Craig for the Fortnightly Review, said of the Captain, â€Å"He, ragged, old, and starved, challenges his friends to have courage and to rejoice in the sun. Amy Lowell, in her Tendencies in Modern American Poetry, stated, â€Å"I have spoken of Mr. Robinson’s ‘unconscious cynicism. ’ It is unconscious because he never dwells upon it as such, never delights in it, nor wraps it comfortably about him. It is hardly more than the reverse of the shield of pain, and in his later work, it gives place to a great, pitying tenderness. ‘Success through Failure,’ that is the motto on the other side of his banner of ‘Courage. † And Robert Frost, in his introduction to Robinson’s King Jasper, declared, â€Å"His theme was unhappiness itself, but his skill was as happy as it was playful. There is that comforting thought for those who suffered to see him suffer. † Many Tilbury Town verses were among the poems Robinson included in his Pulitzer Prize-winning Collected Poems of 1922—the first Pulitzer ever awarded for poetry. He won his second poetry Pulitzer in 1924, this time for The Man W ho Died Twice, the story of a street musician whose one musical masterpiece is lost when he collapses after a night of debauchery. Gilbert attributed the poem’s success to its â€Å"combination of down-to-earth diction, classical allusion, and understated humor. † In 1927, Robinson again won a Pulitzer for his long narrative poem Tristram, one in a series of poems based on Arthurian legends. Tristram proved to be Robinson’s only true popular success—it was that rarity of twentieth-century literature, a best-selling book-length poem—and it received critical acclaim as well. â€Å"It may be said not only that ‘Tristram’ is the finest of Mr. Robinson’s narrative poems,† wrote Lloyd Morris in the Nation, â€Å"but that it is among he very few fine modern narrative poems in English. † Early in 1935, Robinson fell ill with cancer. He stayed hospitalized until his death, correcting galley proofs of his last poem, King Jasper only hours before slipping into a final coma. â€Å"Magazines and newspapers throughout the country took elaborate notice of Robinson’s death,† declared Gilbert, â€Å"reminding their readers that he had been considered America’s foremost poet for nearly twenty years and praising his industry, integrity, and devotion to his art. â€Å"It may come to the notice of our posterity (and then again it may not),† wrote Robert Frost in his introduction to King Jasper, â€Å"that this, our age, ran wild in the quest of new ways to be new†¦. Robinson stayed content with the old-fashioned ways to be new. † â€Å"Robinson has gone to his place in American literature and left his human place among us vacant,† Frost concluded. â€Å"We mourn, but with the qualification that, after all, his life was a revel in the felicities of language. †

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Christian muslim relation - Essay Example My prayers have really improved after I gained an understanding of the Surah that declares Tawheed, Du’a, and the practical aspect of the Muslim conduct. The entire Surah stresses the importance of making supplication for all. When I read the Surah I learn that Allah has anger towards those that reject the truth since they go astray due to their ignorance. I believe the knowledge of the tafsir will enable one to know the consequences for sins while Muslim faithful can ask to guide them to a straight path. The words You alone we worship and from you alone we seek help give me comfort during salah and the rest of the day since Allah helps me out in my difficult situations. I have learned that Allah has chosen this Surah as the second pillar of Islam since it opens some of the greatest miracles. The Surah summarizes the purpose of life as I worship Allah since he is always merciful. May Allah always keep my feet on Siraat al-Mustaqeem, Inshallah. Ayah 76 of the Surah state that, â€Å"And when Jews met the Muslims they assert, we believe†, but they met in privacy they cite, â€Å"Shall we tell the Muslims what Allah has revealed to us Jews concerning the characteristics and the description of Prophet Muhammad (Peace be upon him), Muslims argue concerning the writing of the Torah before the Lord. Have the Jews got no understanding? This ayah Allah informs us concerning the children of Israel, the nation where Jews and Christians originated. Allah charged this nation with the duty of carrying his message to humanity. Allah did this and showed the nation many signs and miracles to convince them that he is a rational person while they became unreceptive to the truth and hardened their hearts. The nation failed to accept the message from Allah since the Message was the Truth and they did not submit to it. The nation had immense love of the worldly pleasures and love of themselves as they rejected the Message since they ha rdened their hearts.

Politic Essay Example | Topics and Well Written Essays - 500 words

Politic - Essay Example According to the article written by Samuel Kernel and Gary Jacobson published in the Logic of American Politics, the judiciary system of America is arguably the weakest of the three branches the American Constitution. 2006. This will be the very essence that this essay intends to advance, the nature, function and power of the American Judicial System. A very sensational case that highlights the inherent and acquired power of the judicial system is the William Marbury versus James Madison case, which was a controversial issue regarding the interpretation of the exercise and purpose of the powers of the judicial branch. This is a case that triggered the cause for a judiciary efficiency review, followed by a series of eye opening conclusions as to the conflict created between the political faction of the Jeffersonians and the Republicans. In a gist, this case began at the time of transition of government from George Washington to James Adam, where in the night before Washinton's term ends, her attempted to fill in the vacancies by signing several appointments among which includes that of William Marbury. This Signed commissions were said to have been delivered that same night however, it did not reach the office nor residence of the plaintiff Marbury.

Drunk Drivers Should Have Their License Revoked Essay

Drunk Drivers Should Have Their License Revoked - Essay Example Most of the drivers who cause accidents because of driving under the influence of alcohol do not get the punishments that they deserve. In most cases, they have their licenses suspended for a few weeks and have to pay a fin. In some cases, they do not even get their licenses suspended. This means that they are legally allowed to go out and drive again. This increases the chance that they will repeat the drunken driving offense. It is interesting to note that most of those who cause accidents while driving drunk have previously committed the offense. The only way to ensure that people who have been found to be driving under the influence do not repeat the offense is revoke their licenses permanently. The permanent revocation of the license is punishments that will make people avoid committing the offense, as they do not want to lose their licenses. Driving while under the influence of alcohol is a choice that the driver makes, and it is a choice that puts him and other people at the risk of injury or of death. As such, it is necessary to harsh penalties to be imposed on those found to be guilty of the offense. The harsh consequences of the action should not have to wait until a person has committed the offense repeatedly. A penalty as strict as the revocation of a license is enough to make people avoid committing the offense. It therefore acts as a deterrent measure (Ross and Gonzales 380). ... The permanent revocation of the license is punishments that will make people avoid committing the offense, as they do not want to lose their licenses. Driving while under the influence of alcohol is a choice that the driver makes, and it is a choice that puts him and other people at the risk of injury or of death. As such, it is necessary to harsh penalties to be imposed on those found to be guilty of the offense. The harsh consequences of the action should not have to wait until a person has committed the offense repeatedly. A penalty as strict as the revocation of a license is enough to make people avoid committing the offense. It therefore acts as a deterrent measure (Ross and Gonzales 380). Another reason as to why people found to be driving while having alcohol levels that exceed the legal limits should have their licenses revoked is that suspension of licenses has not been found to work. The temporary suspension of licenses does not achieve the intended purpose as most drivers find it too lenient and are therefore likely to repeat the offense. The permanent revocation of the license is a stricter penalty and will deter people from drunk driving. If one is allowed to have their license after driving under the influence of alcohol, it is likely that they will cause an accident that may lead to the loss of life. Some people argue that permanent revocation of a license will not work as people may still drive even without the license. It is also argued that despite the strict penalties for drunken driving people still drink and drive. This assertion is however incorrect as it has been seen that penalties for drunken driving are

First Fundamental Theorem of Welfare Economics Essay

First Fundamental Theorem of Welfare Economics - Essay Example The third condition for competitive equilibrium is that the allocation maximizes the profit of each firm at the given price system. A simple proof of the theorem is shown in the following notation. Proof of the first fundamental theorem of welfare economics Let [(x0i), (y0j), (Ð ¤)] be a competitive equilibrium, and under the condition of non-satiation, for each: i, ui(x) = ui (x0i)†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ eqn. 1 implies Ð ¤ (x) ? Ð ¤ (x0i). Instead, if we denote this as: ui(x) = ui (x0i), and Ð ¤ (x) ui(x)= ui (x0i), 1, 2, †¦Ã¢â‚¬ ¦ Since Ð ¤ is continuous, this condition implies that, for a big n, Ð ¤ (xn) ui (x0i), implies that Ð ¤ (xn)>Ð ¤ (x0i). Therefore, the contradiction implies that eqn. 1 is true. Using this contradiction, we can suppose that the initial allocation [(x0i), (y0j), (Ð ¤)] is not Pareto optimal, which implies that there is another allocation of resources [(x’i), (y’j)] such that ui(x’i) > ui (x0i). this condition holds for all i with strict inequality for some i. Employing the second condition in the definition of competitive equilibrium, gives that for some instances of i, ui(x’i) > ui (x0i) gives the implication that Ð ¤ (x’i)> Ð ¤ (x0i). From eqn. 1 and the linearity of Ð ¤, it can be seen that k?i, where ui(x’k) > uk (x0k), ?k Ð ¤(x’k) k Ð ¤(x0i). For l?k, where ul(x’l)> ul(x0l), ?l Ð ¤(x)> ?l Ð ¤(x0i). Finding the sum of the equations across all i; , which contradicts the third condition of competitive equilibrium. 2. The theorem proved above is mathematically true; however, some drawbacks are associated with it, for example, when public goods and externalities are introduced. This is because the theorem assumes that in the economy, there are no public goods or externalities (Jehle and Reny, 2001). This means that the theorem will not hold in an exchange economy where an individual’s utility depends on another individual’s consumption as well a s the original individual’s consumption. Also, the theorem does not hold if the production possibility set of one firm in an exchange economy depends on the production set of another firm in the same economy. The presence of externalities and public good sin the market will cause market failure iof they are not corrected, since there are no markets for these goods. 3. The above proposition can be proved by the following example, where externalities and public goods are introduced into an economy. In this case, an externality is used to mean the situation where the actions of an individual or firm affects the actions of another individual or firm other than through the effect on prices (Jehle and Reny, 2001). For example, one production firm could be increasing the costs of production for another firm by the production of smoke, which forces the other firm to increase costs. One factory could be producing electronic gadgets, a process which requires the emission of smoke. The factory could be located upwind, meaning that the smoke emitted harm another

Pope John Paul II, A man for others Essay Example | Topics and Well Written Essays - 1500 words

Pope John Paul II, A man for others - Essay Example In the later part of his pontificate, he spoke against war, communism, dictatorship, materialism, abortion, contraception, relativism and unrestrained capitalism. John Paul II was Pope during a period in which the Catholic Church's influence declined in developed countries but expanded in the Third World countries. During his reign, the pope traveled extensively, visiting over 100 countries, more than any of his predecessors. He remains one of the most-traveled world leaders in history. He was fluent in numerous languages. He canonized a great number of people. In 1992, he was diagnosed with Parkinson's disease. On April 2, 2005 at 9:37 p.m. local time, Pope John Paul II died in the Papal Apartments. Millions of people came to Rome to pay their respects for his funeral. This paper researches how he was a man for others and how he developed himself through his childhood and adulthood days. Childhood days: St.John Paul II was born as Karol Jozef Wojtyla in Wadowice, a town of 8,000 Catholics and 2,000 Jews 35 miles southwest of Krakow in 1920, the second son of Karol Wojtyla Sr., a retired army officer and tailor, and Emilia Kaczorowska Wojtyla, a schoolteacher of Lithuanian descent. The Wojtylas were strict Catholics, but did not share the anti-Semitic views of many Poles..His playmate Kluger had once remarked about the pope as "The people in the Vatican do not know Jews, and previous popes did not know Jews but this pope is a friend of the Jewish people because he knows Jewish people." In fact, Wojtyla became the first pope to visit a synagogue and the first to visit the memorial at Auschwitz to victims of the Holocaust. In ending the Catholic-Jewish estrangement, he called Jews "our elder brothers." John Paul II was very athletic in his youth days: he played soccer as a goal keeper, took daring swims in the flooded Skawa River and enjoyed skiing, hiking, mountain climbing and kayaking. He was also an excellent student. Adversities: His infant sister died before he was born. In 1929 his mother died of heart and kidney problems. When he was 12, his 26 year old brother died of scarlet fever. He himself had two near-misses with mortality in his youth. He was hit once by a streetcar and again by a truck in 1944 while he was a college student. He had been beset by physical difficulties including a dislocated shoulder, a broken thigh that led to femur-replacement surgery, the removal of a precancerous tumor from his colon Passions and occupations: Wojtyla's passions in those early years were poetry, religion and the theater. After graduating from secondary school in 1938, he and his father moved to Krakow where he enrolled at Jagiellonian University to study literature and philosophy. He also joined an experimental theater group and participated in poetry readings and literary discussion groups. He was an intense and gifted actor, and a fine singer. After the Germans invaded Poland, he escaped deportation and imprisonment in late 1940 by taking a job as a stone cutter in a quarry. His father was very much interested in making him a priest before he died but died with his interest unfulfilled. After his father's death he began studying at an underground seminary in Krakow and registered for theology courses at the university. He continued his studies,

See the instructions Essay Example | Topics and Well Written Essays - 250 words

See the instructions - Essay Example By being persuasive, Mr. Berkowitz stated that one can be able to lead others, and even influence others’ perceptions and beliefs. Therefore, when one is communicating persuasively, especially in the workplace, success is always within reach: being persuasive makes one earn the trusts and the confidence of their employers, their co-workers, and even with the industry leaders where they are practicing their respective professions. In addition to persuasion, Mr. Berkowitz also emphasized that being hard working, as well as and displaying a highest level of professionalism is essential for one to succeed, especially if that person wants to set up his or her own company on the future. By being hard working and professional, one will gain the confidence and trusts of the industry, and most importantly the consumers, believing that this particular company would be able to deliver the best services to their clients and business partners alike, a trait that is vital to the success of a start-up

Game Theory Research Paper Example | Topics and Well Written Essays - 1250 words

Game Theory - Research Paper Example Game theory is mainly applied in areas such as psychology, logic, biology, economics, and political science. This is a report on game theory with particular focus given to its applications, benefits and limitations, and other aspects. Game Theory Game theory or alternatively interactive decision theory is based on the fundamental concept of zero-sum games, where gains of an individual are exactly to the net losses of other participants. The game theory can be applicable to a range of behavioral relations. According to the game theory, a game must specify four essential elements such as players of the game, information and actions (which are available for decision making), and payoffs for each outcome (Game Theory). The two main branches of game theory include cooperative and non-cooperative game theory. When the non-cooperative games are illustrated in the extensive and normal forms, characteristic function form is used to present most cooperative games. According to Fudenberg and Ti role, in the extensive form, games are played using trees (see figure 1) and each node (vertex) indicates a player’s point of choice. Each player is clearly specified with a number represented by the vertex (67). The player’s possible action is indicated by the lines out of the vertex whereas the payoffs are presented at the bottom of the tree. The extensive form can be regarded as â€Å"a multi-player generalizations of a decision tree† (Fudenberg and Tirole 67). This is illustrated in the figure 1. Figure 1 The figure is taken from Ross, Don, "Game Theory",  The Stanford Encyclopedia of Philosophy  (Winter 2012 Edition), In contrast to the extensive form, a matrix indicating players, strategies and payoffs are used to represent the normal form or strategic form. As Jian et al point out, in general any function which is associated with a payoff for each player with all combination of actions can be used to represent the normal form. When the normal form is used to define a game, it is assumed that each player acts without actually knowing the actions of others. If the players are aware of the action of other players, the game is usually illustrated using the extensive form. The origin of the characteristic function form is found in the book written by John von Neumann and Oskar Morgenstern. The authors guessed that when a union C emerges, it functions against the fraction (N/C) as if a normal game is played by two individuals. Here, the balanced payoff of C is identified as the basic function. Examples of Game Theory One of the most commonly cited examples of game theory is the prisoner’s dilemma. Suppose that two brokers, Robinson and Thomas, have been accused of fraudulent trading activities and arrested. Both of them are being questioned separately and hence they do not know what the other is going to say. Robinson and Thomas want to minimize the term of imprisonment and there are four different situations. 1. If Robinson pl eads that he is not guilty of the crime accused and Thomas confesses, Robinson will be jailed for a maximum term of five years and Thomas will be sentenced for a minimum of one year imprisonment. 2. If nobody confesses, then both of them will be jailed for a minimum of two years. 3. If both pleads that they are guilty of the crime accused and tries to implicate their partner, then both of the

Human Form versus Nature Essay Example | Topics and Well Written Essays - 2000 words

Human Form versus Nature - Essay Example The Romans were influenced by these thoughts and also sought to portray man as a superior being. Here the emphasis is on man’s power as opposed to the lesser importance of people as seen in Eastern art where nature has a much more dominant role. The sculptures of Michalangelo are famous for the way the human body is treated. With his excellent skill at carving the marble his work stands as some of the greatest ever created in this style. In China, the philosophical principles of Daoism and Confucianism play a big role in the way of life and the way of thinking is a guide to live by. One of the facets of Daoism is the relationship of nature in relation to its various elements and to man. Man is taught to follow the principles of nature. Nature in art is illustrated as the central element in a great many pieces. Nature as a dominant theme has lasted more than a thousand years. By the late Tang Dynasty, landscape painting had evolved to depict man as seeking an escape from everyday life to commune with nature in all its beauty. The influence of China spread to Japan, as did the philosophy of Buddhism. In Japanese art people are often portrayed as a small part of the vast landscape. They are only a part of the world and the powerful forces of nature are seen as great in comparison. Hokusai’s 36 Views of Mount Fuji beautifully illustrate this theme. â€Å"A hint to solving our current questions of what nature is, how it should be faced and how to coexist with it should be hidden within these art pieces that have viewed nature.† (Sakagami 1) References 1. Nature in Japanese Art after the Experience of the Earthquake, Keiko Sakagami, Web. 10 Nov. 2011. http://www.yomiuri.co.jp/adv/wol/dy/reviews/110422.htm Writing Assignment: The Afterlife Across Cultures The afterlife has long been a theme in art. From Ancient Egypt, Greece, Africa and other Far Eastern cultures the attitudes and beliefs about a supernatural transformation that takes place after a person dies has inspired many objects to be placed with them at the time of their death. In Ancient Egypt people were buried with objects that they might have used in their life on earth. This practice stems from the belief that the person will be living in another realm after their death in a similar fashion. They therefore will need the things they had with them in their former life. Depending on the place in society and economic class the t hings they will need vary. A member of the royal family may have statues of soldiers and musical instruments buried with them while a farmer might have animals and tools and pottery with them. These things relate to their lifestyle as it was. The idea of immortality was also ceremonial zed in the elaborate coffins the dead were buried in. The Egyptians believed that these complex burial rituals help to ensure the person would arrive safely in the afterlife. The coffins themselves were decorated with symbolic images that were believed to guarantee this passage into the next life. Many of these artifacts have been uncovered in tombs of the dead and survive in museums today. In Ancient Greece they believed that the spirit of a person left the body at the time of death and went to a place known as Hades. In the Underworld all of the dead resided. In honor of the deceased elaborate preparations of the body were made and large stone structures marking the grave sites were built. Sculpture s and other objects also decorated the graves. In addition to the actual site of burial, vases were decorated with scenes commemorating the person’s life in homage to them. The immortality of a person lay in their

Evidence based practice Essay Example for Free

Evidence based practice Essay American Academy of Pediatrics and the American Academy of Family Physicians. [Clinical practice guideline:]. (2004). Source Of EvidenceThis evidence meets the criteria for a filtered source. It was sourced online from the Official Journal of the American Academy of Pediatrics and Family Physicians. Specialists from multi medical disciplines assembled to create an integrative systematic study and review of the current evidence- based literature available for the treatment and management of Acute Otitis Media (AOM). The conclusions and findings were utilized to devise guidelines and a practice protocol that recommended early diagnosis and makes recommendations for the management of AOM in children aged between 2 months and 12 years old. Quantitative data such as randomized, controlled trials and comparative cohort studies were to ensure quality of the evidence. The guideline was reviewed by a number of professional peer groups prior to introduction and publication. Appropriate For Nursing Practice The evidence in the article is applicable and appropriate for nursing practice. The guideline clearly defined the care and best practice treatment options for children with AOM and also the situations when the guideline is not appropriate, like children with a reoccurrence with in 30 days. The recommendations act as a template to guide clinician’s treatment options using evidence based standardized protocol, which can be shared with anxious patients to give validity to help understand their child’s diagnosis and treatment. Source of Evidence Classification This articles source is classified as evidence-based guidelines and research. Specialist and peer recognized experts jointly convened and defined the subject for the study and developed a theoretical framework to review the literature and developed a guideline for standardizing the diagnosis, treatment and management of pediatric AOM using research based knowledge. Block, S. L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media Source Of EvidenceThe source of this article is classified as unfiltered and was retrieved from a medical database -PubMed. The article published in The Pediatric Infectious disease Journal offers a synopsis of the research of the author on  identifying the common the bacterial pathogens isolated as the causative agents in children presenting with AOM. The author also discussed traditional treatment with antibiotics and the problem of microbial resistance and the availability of newer antibiotics as treatment options. Appropriate For Nursing PracticeThe evidence in this article is a ppropriate for nursing practice, as it raises awareness of increased incidence of microbial resistance to the traditional first line management and treatment of children with AOM and offers treatment options with newer more effective antibiotics. Source of Evidence ClassificationThis article is classified as a research evidence summary. The author collected quantitative data related to the incidence of the pathogens that most commonly caused AOM infectious in children and the microbe demonstrating increasing resistance. The article made recommendations for treatment of AOM based on the findings and made recommendations such as increase antibiotic doing for certain bacterial strains of AOM. Kelley, P. E. , Friedman, N. , Johnson, C. (2007). Ear, nose, and throat. In W. W. Hay, M. J.Levin, J. M. Sondheimer, R. R. Deterding, Current pediatric diagnosis and treatment. Source Of EvidenceThis source is classified as general information. It was sourced from the Ear Nose and Throat chapter of the textbook â€Å"Current Pediatric Diagnosis and Treatment†, which discusses the general presentation, signs, symptoms and course of AOM infections. It also details the management, treatment and prognosis. Appropriate For Nursing Prac ticeThis source has relevance to nursing practice as it clearly gives an overview of AOM in pediatric setting. Although given in medical model format, nurses need to have knowledge of the pathogens, symptomology, treatment and course of the infection to be able to formulate nursing care plans and actions. They need to have an awareness of the most current treatments to be able to advocate for their patients. Source of Evidence ClassificationThe source of this evidence is classified as â€Å"none of these. There is no primary research, literature review, experimental studies or clinical trials. The authors are experts in the field of Ear Nose and Throat specialty and provided an accepted general overview of the care and management of AOM as appropriate in 2007. McCracken, G. H. (1998). Treatment of Acute Otitis Media in an Era of Increasing Microbial Resistance. Source Of Evidence This article can be classified as an unfiltered source. The article was sourced from the medical database, PubMed and published in Pediatric Infectious Disease Journal, a professional peer reviewed journal. The researcher conducts a search of the data base and screens and evaluates primary research related to the topic. The article discussed the common pathogens that cause AOM and distinguished between simple and complicated presentations and made recommendations for differential diagnosis and antibiotic treatment options. Appropriate For Nursing PracticeThis article is appropriate to nursing practice, as provides a very good overview AOM in particular related to the history and incidence of the problem and the difficulty for providers in diagnosis and the pressure to prescribe antibiotics. Treatment recommendations are made and rationales for when antibiotics is not the first line of treatment in view of rising rates of microbial resistance Source of Evidence ClassificationThis source of evidence is classified as an evidence summary, the author reviews the research on AOM pre 1997 and evaluates the data to make a recommendations and provides a guideline for AOM treatment and diagnosis. The author cites multiple sources and references. Parent Interviews: Source Of EvidenceThis source of evidence is unfiltered, general information gathered from parents with children with AOM. It is retrospective, anecdotal accounts of signs, symptoms and course of the illness that they observed and related to the nurses. It can’t be quantified or validated but is useful to gain insight into the experience and perceptions of parents coping with a sick child Appropriate For Nursing PracticeThis data while appropriate information for nurses to gather, does not meet the criteria for research. There is no framework or theoretical model that was designed and followed and no uniformity of information collected. Interviewing the parents can give some insight into activity of the child and the onset of the symptomology that could lead to observing some commonalities and then research could be instituted. Interviews are also appropriate clinically as parents can offer insight in to coping or lack of coping skills with their sick child and can lead to parent education on care of the child with AOM. Source of Evidence ClassificationThe source of this evidence is classified as â€Å"none of these. Parental interviews can’t be classified as evidence and is not a legitimate source; It does not meet the criteria to be called evidence or research. The parents’ responses are personal and anecdotal and are not objective and the interviews were conducted informally with no structure framework for data collection. B1. Watchful Waiting: Acute Otitis Media, (AOM) an ear infection commonly diagnosed in children and by age three, 50% to 70% of children will have had at least one incidence of the infection. In the year 2000 sixteen million visits to doctor’s office with thirteen million prescriptions at indirect cost of $1. 02 billion were attributed to AOM. (Diagnosis and management of acute otitis media, 2004) The rise in resistant strains of bacteria has made the medical and nursing profession search for answers on the appropriate use and dispensing of antibiotics. For many years family practitioners and pediatricians have spoken about parental pressure to prescribe antibiotics for self-limiting viral illnesses. Many doctors, who refused, could be frustrated by colleagues who bowed to the pressure to prescribe. (Marcy, 1999) It was recognized that there was a need for research and guidelines to develop a standardized approach. Evidence was needed to formulate what was best practice that would deliver rational evidence based care in a cost effective reasonable manner. In response to these concerns, the American Academy of Pediatrics and the American Academy of Family Physicians convened a panel of experts to review the research and data available and to analyze and summarize the facts and statistics to create a guideline for the management, diagnosis and treatment of AOM in children from 2 months to 12 years. The data collected indicated that an observation protocol was needed if the use of unnecessary antibiotic therapy was to be curbed. Results from controlled clinical trials that were done with placebo control groups validated the data collected over a 30 year time span. They found that in 75% of cases, the condition resolved without prescribing antibiotics, within seven days. They also recognized in certain incidents that observation and symptomatic management of fever and pain was not appropriate and treatment should be immediate, and an exclusion criterion was included in the guideline. These included children who represented with AOM that was obviously severe and there were certain clinical signs that lead to a certainty or severity of the diagnosis or if there was a reoccurrence within 30 days of initial consultation. The guideline was not designed to supplant the clinical judgment of the practitioner but to support it and provide validated evidence to corroborate the observation protocol, AKA ‘Watchful Waiting’ It gives practitioners rational for treating uncomplicated AOM and preventing the masking of other symptoms more serious conditions by unnecessary antibiotics. In addition doctors have validated information to share with parents to reassure them that the illness will resolve without antibiotics and educate them on symptomatic management of their children symptoms. C. Application of Findings: There are many reasons why healthcare organizations are motivated to introduce new practices procedures or guidelines some of these reason include to achieve certification, like Magnet status or become compliant with health regulation. Sometimes changes are for cost savings are to improve market share of certain health consumers. Nurses look to research to improve patient care or the effectiveness of practice. Most hospitals and organizations use certain change management models like Six Sigma or DMAIC to introduce new policies, procedures and practices. Clinical practice councils or shared governance councils identify issues and staff has the opportunity to bring forward practices identified that could be improved. Some people find change difficult and are offer resistance and put up barriers. How a process or suggestion is framed and managed is vital to success if the change is to be achieved and sustained. In the case of a multidisciplinary group in a clinic, having research based evidence to support getting group support for the introduction of the guideline is fundamental. Getting physician buy in and agreement would be an important element. Barriers at clinic level have been recognized by other change adopters including â€Å"a lack agreement about the care process changes desired and little engagement of physicians† (Horscikoski, 2006). The efficacy and the credibility of the sources such as the of the research by American Academy of Pediatrics and the American Academy of Family Physicians lends standing to the proposal for adoption of the guideline. Once the nurse leadership had reviewed the research and the team approves the findings as best practice, the next step is to have the other disciplines review and approve and provide input in to translation of research guideline into a workable clinic protocol that has the support of all stakeholders. A plan, a time line and education are formulated prior to implementation of the guidelines and follow up and data is gathered post implementation to monitor success. D. Ethical Issues: Ethical considerations in healthcare research have been sensitive subject in the research community for many years. Unfortunately wise and ethical choices have not always been exercised. Few can be unaware of the case of the Tuskegee syphilis study (1932–1972), a study by the United States Public health Service, that knowingly did not treat a group of poor African American men for syphilis. When this was discovered it led to the founding of The Office for Human Research Protections (OHRP) under the provisions of the 1974, the National Research Act. (NRA) Its role is to deals with ethical oversight of human clinical trials and studies in conjunction with the National Institute of Health. (Wikipedia, 2014) Unfortunately even today ethical concerns continue to be of concern. Recently the OHRP found that â€Å"23 academic institutions authorized a research project that failed to meet the most basic ethical standards :†(NYT Editorial Board, 2013). The NRA mandated that research participants must give informed consent. They must be told of any risks and benefits. If there is a control group they need to know that they may not receive the investigational treatment. They must be aware that they have the right to leave the study at any time. Their privacy and health information must protected at all times. To meet NRA ethical requirements, the study should be to benefit patients and the knowledge should not be available by other means. Unnecessary mental or physical suffering is not permitted; it should do no harm, and be for a laudable purpose.D1. Ethical Issues in Vulnerable populations: Ethics in research is always of special concern but it is heightened when the target participants are unable to speak for themselves or give consent. In these vulnerable populations like the children, the mentally ill, the intellectually disabled or developmentally delayed the risk of abuse and the desire to protect is equally strong. Other grou ps that are considered vulnerable are the poor, the illiterate, non-English speakers and prisoners which sometimes are discounted as vulnerable. Special considerations are needed when these populations are the subject of research studies. As these populations can’t not give consent for themselves another entity or person consents on their behalf be it parent, guardian, institution or state. It raises moral questions about the motivation of those who have the power to consent for others to be in experimental trials and other forms of research. For this reason the Food and Drug Administration (FDA) and the Department of Health and Human Services (HHS) have developed special safeguards for children. The parents must give informed consent and the child must give age appropriate assent. Confidentially is another complicated issue, the Health Information and Portability and Accountability Act Privacy Rule instituted in 2003 states that records from research studies are confidential and release to subjects need be done if the conditions are justified. Parents have the right to receive information and reports on all their child’s records but often do not know about the 2003 laws provision. In addition, when a child reaches 12, State and Federal law limits parental access to certain medical information, which can cause conflict, discomfort and conflict of interest. Institutional review boards, to which research proposals must be submitted prior to the approval of any study, holds researchers to higher standards regarding the necessity and benefits of studies on the more vulnerable groups in society. They must ensure that risks to subjects are minimized and rational in relation to expected benefits and that the choice of participants is impartial.

Thought Experiment Essay Example for Free

Thought Experiment Essay The fear of death is natural for all human beings regardless of race or culture and perhaps the only thing that separates the fear among different cultures are the vast array of concepts and views pertaining to it. After the concept of a higher being, death is perhaps the second most philosophically debated topic and rightly so, because as the text supplied to us said â€Å"we can and must postulate, as reasonably as possible, what our end has in store for us. †   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Historically speaking, the fear of death itself has been a hotly debated topic and has even been used for ulterior motives such as the case of the Catholic Church and their concept of plenary indulgence. In more recent times the fear of death has even been used as an incentive, fundamentalist Muslims have turned the fear into something that should be welcomed and coupled with the promise of seventy-seven virgins in the afterlife, has itself been used to persuade impressionable people into wearing vest bombs.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Fear is indeed a great motivator and yes, few things can compete with the fear of death but I beg to differ about it and I’ll even go so far as to say that not only should you not fear death but you should in all sense of the word, welcome that fear and turn it into something positive.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Following the arguments from the texts given to us, the first thing we should consider is the question of whether it is rational to fear death. Of course, death being unable to exist at the same time and place as you can therefore not harm you and should not be feared. The fear of death is irrational in all respects according to this argument and rightly so. Unfortunately, there are such things as irrational fears and I suspect that the fear of death has enough magnitude to trump rationality –at least most of the time.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It is a given fact that we do indeed fear death regardless of whether it is rational or irrational to do so. In that regard, what other choices are there? Death being a fact of life means that we can do nothing else about it but to simply accept it. We can of course at this point minimize the fear of death by proving that it is not death itself that should be feared but rather a life unlived.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The â€Å"badness† of death can actually depend on what would have happened to a person if that person’s death had not taken place. Suppose then that some very old and unhappy person dies and considering that further life would inevitably only lead to more pain for this person, then dying is not so bad for him (Feldman 140). Some may even see death for this person as a blessing and arguably, this is where one should start looking as death as more than something to fear but as something that could be a motivation.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Death should not be feared, it should be seen as a reminder that a person may have a greater purpose in his life and should do all he can to strive for it. It is a reminder that regardless of whether there is an afterlife or not, this life matters and one does not have a lot of time to MAKE it matter. Yes, the fear of death is irrational, but more than that, is it not more irrational to make nothing of death and simply accept it?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   At this point it seems that I arrived at a different conclusion than the author of the given text. It just seems to me that the author is so focused on death as an end rather than as an opportunity. Yes, death is an end but is it not also an opportunity to be reminded that there are things you could achieve and people you can touch before that end ultimately comes?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   At the end of the day, I do concede that we have no doubt proven the irrationality of death but I also argue that not only have we proven that but we may have also given a solution regarding it. By considering the rationality of death, I’m was hard pressed not to consider the rationality of life itself and now I’ll have to conclude that the only solution to the fear of death is simply acceptance and doing what you can to make sure that when the proverbial clock ends, you will be able to look the reaper in the eye and say that you have no regrets. Works Cited Feldman, Fred. Confrontations with the Reaper. New York: Oxford University Press, 1994.

Evaluating Mental Health Policy Health And Social Care Essay

Evaluating Mental Health Policy Health And Social Care Essay Mental ill health during early motherhood, or perinatal mental illness, is a serious public health issue with potentially serious consequences for womens life-long mental health and the health and wellbeing of their children and families (Hayes, et al, 2001). Although difficult to estimate, there are also economic and social costs associated with the cognitive and behavioural impact of postnatal depression. As of 2008, the national economic burden of this condition to public services is estimated at  £35.7 million per annum. The mean estimated cost for maternal care in the community for those with postnatal depression is 55% higher than for those without (Petrou et al, 2002). It can also herald the onset of long-term mental health problems for the mother and is associated with increased risk of maternal suicide (Oates, 2003). Postnatal depression has also been linked with depression in fathers and with high rates of family breakdown (Ballard, 1994). There is also evidence that chil dren born to depressed mothers do less well educationally, experience higher levels of behavioural problems and are more likely to develop psychological problems in later life (Oates, 2002). Social support is a flexible concept so broad that its meaning can easily be assumed, or bent to different purposes, rather than overtly attended to. This produces problems in researching social support since the underlying assumptions or theoretical frameworks of the work are not always clear. Postnatal depression has been associated with a lack of social support (Bebbington, 1998). The risk of PND has been found to increase when the level of social support is low or absent (Morse et al 2000; Pederson 1999). Beck (1992) states that social support not only provides practical help, but can aid the mother emotionally by hindering the common experience of rumination. There are three common forms of postnatal illnesses: the baby blues, postnatal (or postpartum) depression and puerperal psychosis, each of which differs in its prevalence, clinical presentation, and management. Postnatal depression is the most common complication of childbearing (Wisner, et al 2002), affecting 10-15% of women (Cooper et al, 2008). According to the National Institute for Clinical Evidence (NICE, 2007) postnatal depression (hereafter also known as PND) has been defined as non-psychotic depression occurring during the first 3 months following the birth of a baby. The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) defines the perinatal period as commencing at 22 completed weeks (154 days) of gestation and ending seven completed days after birth (WHO, 1992). In the fourth edition of the Diagnostic Statistical Manual (DSM-IV), the American Psychiatric Association makes no mention of perinatal mental illness a lthough postnatal depression is included, but only if the mother is diagnosed within four weeks of the birth (American Psychiatric Organisation, 1994). The interest and motivation for exploring the topic of postnatal depression is due to professional experience of working in this field. This dissertation seeks to explore the variety of approaches for treating PND, focussing on the role of social support. Current national policy and frameworks will be examined, together with current practice of interventions. Evaluating Mental Health Policy There have been many discussions about whether depression during the early postnatal period is either quantitatively or qualitatively different from depression at other times (Stoppard, 2000) and has been the focus of much policy and research since the 1960s (Brockington, 1998). In 2004, the National Institute for Clinical Evidence (NICE) asked the National Collaborating Centre for Mental Health (NCCMH) to develop a clinical guideline on the treatment and management of mental health problems in the antenatal and postnatal period (NCCMH, 2004). Before this, the Department of Health published a 10 year agenda for improving mental health care in England, known as the National Service Framework for Mental Health (NSF, 1999) which set priorities for the way that services were to be provided. The NSF proposed protocols to be implemented for the management of postnatal depression, anxiety disorders and those needing referral to psychological therapies. The NSF recognised the role of Health Visitors with training who could use routine contact with new mothers to identify PND and treat its milder forms. Furthermore, the NSF related to actions to reduce suicides, by ensuring that staff would be competent to assess the risk of suicide among individuals at greatest risk. This standard was relevant to Health Visitors, as maternal suicide was cited as the largest cause of maternal death in the first postnatal year. Subsequent policy statements and guidance have since been supplemented to the framework, including the National Institute of Clinical Evidence (NICE, 2007) guidelines for antenatal and postnatal mental health (NICE-CG45, 2007). The NICE guidance identifies the need for emotional and social support for new mothers, whilst the National Service Framework aims to deliver a high quality standardized service. In 2007, the in-depth guidance was published where the standards for postnatal mental health needs were summarized as: All professionals involved in the care of women immediately following childbirth need to be able to distinguish normal emotional and psychological changes from significant mental health problems, and to refer women for support according to their needs All professionals directly involved in the care of each woman who has been identified as at risk of a recurrence of a severe mental illness following the birth, including the family, are familiar with her relapse signs Each woman who has been identified as at risk of a recurrence of a severe mental illness has a written plan of agreed multi-disciplinary interventions and actions to be taken The Department of Health issued guidance in 2009, called the Healthy Child Programme: pregnancy and the first five years of life and is an update to the National Service Framework for Children, Young People and Maternity Services (2004). The programme emphasises the NICE guidelines, including the need for the woman to be asked sensitive and appropriate questions to help identify depression. Additionally, the programme states the need for parent-infant groups, baby massage, listening visits, cognitive behavioural therapy and interpersonal therapy. In February 2011, the Government published its new Mental Health strategy No Health without Mental Health which acknowledges that mental health is a public health issue that needs co-operation from many different agencies, including education, social care, housing, employment and welfare. According to NICE (2007), various psychosocial and psychological treatments are recommended for the management of depression in the postnatal period: Social support can be defined in terms of sources of support (e.g. spouse, friends and relatives, support groups), or in terms of the type of support received, (e.g. informational support, emotional support, practical support). Non-directive counselling an empathic and non-judgemental approach, listening rather than directing but offering non-verbal encouragement. This approach is usually offered by health visitors. Self-help strategies: Guided self help Computerized cognitive behavioural therapy (C-CBT) Exercise Brief psychological treatment Structured psychological treatment: Cognitive behavioural therapy Interpersonal therapy NICE guidelines clearly state that PND services are subject to local variation due to locally existing services. To ensure the effective provision of high quality clinical services, it is essential that there is a clear referral and management protocol for services with a well defined pathway. Furthermore, NICE guidance states that services should develop clinical networks to improve access for women to specialist perinatal mental health services. In a report published in March 2011 by the Patients Association, it was found that 64% of Primary Care Trusts (PCTs) do not have a specific strategy in place when commissioning services specific to PND. World Class Commissioning (www.icn.csip.org.uk) clearly states that PCTs should have services that accurately reflect the needs of the local population. The report also shows that 44% of PCTs are failing to implement the NICE guidance due to not being part of a clinical network or not having a lead clinician for perinatal mental health. Is there a problem? What is it? Why does it need to be solved? What is your hypothesis (hunch)? Who will benefit from your investigation? In what sense will they benefit? In what sense will my contribution add to what is already known? How in general terms are you going to solve the problem, e.g., collect data, analyse data? By what methods? E.g., a case study approach. What are the constraints or limitations of the study? Methodology ( The title of this dissertation is postnatal depression and the role of social support from a feminist perspective. A systematic literature review was conducted The search methods used for the literature review were as follows: Databases searched included: MEDLINE, CINAHL, DAWSONERA, PsychLit, EBCOHOST, CENTRAL and DARE. Published books as listed in the References. Published articles in hard copy journals. Key terms were: postnatal depression, postpartum depression, isolation, social support, stigma, mental illness The searches were designed to be as inclusive as possible The searches were limited to articles between 1985 and 2011. An additional google search was conducted Overall, a total of ( ) abstracts were identified by the literature searches, over ( ) papers were assessed resulting in the final reference list of ( ) papers. Methodological limitations Ethical limitations The overall aim of this study is to understand postnatal depression and the objectives are as follows: Explore the different sources of social support for new mothers in the year following childbirth To evaluate the effectiveness of different models To examine the evidence of efficacy of social support To consider the findings in relation to policy and practice interventions and guidance of perinatal mental health Theoretical Perspective Brewer (2000) states that theory is a set of interrelated abstract propositions about human affairs and the social world. While much of the research on postnatal depression has been subjective, it may provide a political and ideological commitment to supporting the development of health services specifically targeted at womens health needs. Such a political process is consistent with the drive of feminist concerns that the health care system has failed to distinguish the particular needs of women (Najman, et al, 2000). This dissertation will attempt to look at the role of social support role from a feminist perspective. According to Busfield (1996), feminism is a philosophy suggesting that women have been systematically disadvantaged. Durrheim (1999) argues that feminist theorists aim to change this by investigating the situations and understanding the experiences of women in society and in doing so, provide a better world for women. Feminist research is opposed to patriarchal societies, which attempt to understand the world in order to control and exploit its resources. Feminists also describe the male point of view as objective, logical, task-orientated and instrumental. It reflects a male emphasis on individual competition, on dominating and controlling the environment (Neuman, 1997). Further, by examining postnatal depression through a feminist lens, the mechanism of social structure that contributes to the pressure to find motherhood a perfect, happy time can be addressed. Postnatal depression has been reported and studied since 1858 (Richards, 1990). In the nineteenth century, psychiatric disorders due to pregnancy and childbirth were common enough to account for 10% of all asylum admissions (Marland, 2003). Allen (1986) states that writer Chesler (1972) assumes that psychiatry sees women as madder than men and is perhaps rooted in the historical context of womens psycho-pathology being linked with femininity (Showalter, 1987). Taylor (1996), suggests that the dominant discourse surrounding postnatal depression overlooks the social construction of gender order and conventional gendered power dynamics. Furthermore, she stresses that the media play a role in blaming mothers, questioning appropriate behaviour and the choice of self-identity outside of motherhood. The structure of families in modern society creates problems of isolation and alienation (Taylor, 1996) as we move away from the traditional nuclear family unit and loss of close extended family ties. Over the past decade, self-help, recovery, and support groups that draw upon the discourse of feminism have gained increasing importance as sources of emotional support and settings in which women seek to redefine the female self. Models of mental illness Postnatal depression is conceptualized as a disease or illness and research efforts have been devoted to describing, predicting, preventing, and treating it (Cox Holden, 1994). Researchers have also endeavoured to uncover the underlying factors associated or correlated with postnatal depression, including biological variables such as hormones, other biochemicals, genetic factors; psychological characteristics such as personality traits, self-esteem, previous psychiatric history, family history, attitudes towards children, deficiencies in self-control, attribution style, social skills; a range of social variables, for example an unplanned pregnancy, method of feeding the baby, type of delivery, obstetric complications, infant temperament, previous experience with babies, marital relationship, social support, stressful life events, employment status, and socio-demographic characteristics such as social class, age, education, income, parity (OHara Zekoski, 1988). Mental illness can be difficult for people to understand or empathise with. Similarly, even mental health professionals can have difficulties in understanding what is going on for the patient, as there is no one diagnostic test that can be performed on the brain in an attempt to provide a simple answer or treatment. The effects of mental illness are made apparent in actions, feelings and thoughts, and therefore a model or group of linked theories is used to explain the cause and predict the best source of treatment. Doctors helping people with mental illness have models to guide them in both diagnosis and treatment. Most models of mental illnesses will nowadays acknowledge a combination of biological, psychological and social factors. Different models will, however, vary in which factors they rate as the most important. When advising a patient, a doctor tries to look at which interventions are likely to work best for that particular patient, taking into account the patients symptom s and circumstances. Models are the basis of every scientific belief. The medical model and behavioural model of psychiatric illness differ in their assumptions about the nature of the illness and the appropriate treatment (ref), however many practicing psychiatrists use features from both in the bio-psycho-social model (ref). Psychological models such as the learning theory, personal construct theory and psychoanalytic theory differ in the time-scale over which they try to produce explanations of behaviour. A biological model of mental illness is based on the presumption that the illness has a physical cause and therefore requires a physical treatment. This model suggests that mental illness is caused by chemicals, genetics or hormonal imbalances and such, a biological intervention or treatment would be drugs to reverse the chemical imbalance. A psychological model says that disruption or dysfunction in psychological processes lead to mental illness. Furthermore, personal experiences, social and environmental factors are important contributors to psychological distress. Taking anti-depressant medication would not be treating the cause of the problems; therefore treatment would be in the form of therapy such as psychoanalysis and cognitive behaviour therapy. There are two social models of mental illness: the labelling theory states that behaviours disliked by society are labelled as symptoms of a psychiatric illness. Labelling a person as having a disease, particularly mental illness is to become that illness, for instance shes mental and it is therefore easy to understand the concept of blame and stigma surrounding mental illness. Society believes that we can and should be able to control our psyche and emotions and thus the descent into mental crisis should be avoidable and controllable. Labelling, therefore, questions the very existence of mental illness and helps to maintain the imbalance of power between men and women (Taylor, 1996). Labelling a gendered illness provides society with a more palatable acceptance of the disease and its options for treatment. Szasz (1962) examined the concepts of stigma in mental illness and criticised the ways in which psychiatry made assumptions about those labelled as mentally ill. Another theory is that social situations can lead to a mental illness. For instance poverty leads to situations that a person cannot control, which can lead the person to develop anxiety. Some researchers suggest that the availability of medical care and expectations of quality of life following the birth of a baby (Thurtle, 1995) lead to postnatal depression. Feminist sociologists have looked at the impact of social factors on womens mental illness from three different perspectives: societal causes, medical causes and the mother herself (Taylor, 1996). A typical feminist approach would be to question whether a historically patriarchal tradition, namely medicine, can realistically address the experiences and needs of women. Medical perspectives consider that womens unhappiness and discontent is framed in psychiatric terms and are therefore treated accordingly. The medical model has been the dominant theoretical perspective of postnatal depression and according to a feminist perspective this disempowers womens individual experiences. While feminist researchers have criticized the medical model for the way it blames individual mothers for their difficulties, mothers themselves feel that the medical label and status, and the hormonal explanation, have the opposite effect of releasing them from blame and responsibility because the depression is something which is happening to them, their bodies and is therefore beyond their control. It is reassuring for some to know that they were not going mad but experiencing a medically recognized problem, shared by other mothers, and for which they were neither responsible nor to blame. Oakley (ref) suggests that pregnancy and childbirth are constituted as a disease by the medical profession. In an article written for the British Journal of General Practice, Richards (ref) questioned whether giving the diagnosis of postnatal depression to tired, overwhelmed women, simply allows them to claim sickness benefit. Considerable effort has been put into research into the causes of postnatal depression from a biological or hormonal reason; however Richards (1990) believes that no consistent relationship has been found. Dalton (1989) claims that there are endocrinology reasons for depression after childbirth, and that this could be treated by diet or hormonal treatment. However Oakley (1980) criticizes this view from a feminist perspective, believing this emphasizes women as reproducers. Despite Daltons (1989) opinion that postnatal depression is caused by hormones, she does believe that social and psychological support could benefit the mother. Kitzinger (2006) believes that many women are wrongly labelled as suffering from postnatal depression because they are unhappy after the birth, when in fact their distress is the result of a medically managed but traumatic birth. Kitzinger (2006) argues that the failure of the maternity services to give humane care can be ignored when the focus is placed on the mothers performance during childbirth. There are many theoretical perspectives that seek to explain the notion of postnatal depression and this dissertation will be focussing on the feminist perspective in a later chapter. Chapter 2 Postnatal Depression The postnatal period is well known as an increased time of risk for the development of serious mood disorders. Many women feel exhausted, not just from the physical efforts from giving birth, but the emotional effects of adjusting to their new role as a mother. Although this dissertation is concentrating on postnatal depression, there are two other important conditions that can be diagnosed after the birth, which will be briefly mentioned as follows; Baby blues Baby blues is the term used to describe temporary feelings of tearfulness and lack of concentration either immediately following the birth or within a few days, sometimes coinciding with the mothers milk coming in. These feelings may come as a shock to the mother, as she may have expected to feel joy and elation. This condition is very common in up to 80% of new mothers, so is considered as normal, but generally passes after about ten days. There is no treatment for the baby blues, however practical and emotional support in these first few days would be helpful. Puerperal psychosis Puerperal psychosis is a terrifying and rare complication following the birth affecting between one in 500 and one in 1000 mothers. The symptoms are hallucinations and delusions and often the mother believes that the baby is evil, she hears voices and can be confused. The word psychosis is simply a medical term, which means, according to the dictionary: any severe mental disorder in which contact with reality is lost or highly distorted The common treatment is anti-psychotic medication; however the mother may have to be admitted to a psychiatric unit for observation. Symptoms of PND The onset of postnatal depression can be gradual and difficult to distinguish either from the normal emotional sensitivity of recent childbirth, or because the mother is hesitant to disclose her true feelings. Many women feel that they may not need support or that they can manage on their own, whereas others may think there is a stigma attached to admitting feeling depressed. Some of the identifying symptoms of postnatal depression can be physical, however the majority are emotional and affect the everyday life of the mother. In order for a diagnosis to be made, at least five of the following symptoms have to be present for at least two continuous weeks; Feeling unable to cope, loss of confidence, feeling inadequate Panic attacks, excessive anxiety and obsessions about the baby, routines and cleaning Negative thoughts, irrational thoughts, depressed mood Feeling little/no love for the child, delayed/no bonding with the baby Not enjoying motherhood and wondering what is wrong with them because of it No interest or pleasure in anything, boredom, things seeming pointless Suicidal thoughts Constantly needing reassurance Fear that if they asked for help their baby would be taken away Feeling a burden to family and friends Everything seeming negative, unable to remember positive times/things Things getting out of proportion, being thrown by even small things Tiredness, lethargy Loss of appetite, weight loss Loss of interest in sex, loss of libido Risk factors There is considerable discussion surrounding the cause of postnatal depression (Richards, 1990). In a report written by OHara and Zekosi (1996), their findings led to the conclusion that PND reflects the coincidental occurrence of the puerperium and depression, rather than reflecting a causal relation between childbearing and depression. However, Kumar et al, (1984) found that childbearing in itself has a damaging effect on the mental health of women. Martin et al (2001) conducted a comparison of women in a psychiatric mother and baby unit and concluded that puerperal depression has a distinct biological aetiology. This conflicts with Richards (1990) conclusion that there is no link. According to Harlow (2003), any mother can be affected by postnatal depression, with no relation to age, social class, cultural background or educational status. However, research studies have consistently shown that the following risk factors are strong predictors of PND: Poor quality social support An unstable or unsupportive relationship Depression or anxiety in pregnancy Previous history of sexual abuse Recent stressful life events Labour/birth trauma In addition to many factors on the mothers side, there may be a relation between the behaviour of the infant that has an effect on maternal depression. In a study of 188 first time mothers, neonatal irritability and poor motor function was found to predict postnatal depression (Murray et al. 1996). There are few studies on the role of infant factors in the aetiology of postnatal depression, but it is possible that the babies react to parental mood and depression and vice versa. Prevalence According to Cox (1993) the incidence of women developing postnatal depression in the UK is between 10-12%. However, a study conducted in 2002, found that 27% of mothers aged between 15-44 years of age were found to be suffering from postnatal depression, of which half of them had contacted their GP within 4 months of the birth (Kaye, 2002). The rate of prevalence has varied due to different criteria (e.g, general practitioners or psychiatrists diagnosis, self-report questionnaire, clinical interview), different study designs and different time intervals (from few days up to several years) used. OHara (1987) suggested that the symptoms of postnatal depression can be relieved and diminished within one to six months, but sometimes depression can become chronic. Thus, it should be acknowledged that without effective treatment postnatal depressive symptoms may continue for as long as one to two years. The sixth report of the confidential enquiries into maternal deaths in the UK, Why Mothers Die, reported suicide as the most common cause of maternal death for women in the first year after childbirth. According to the Confidential Enquiries Report for Mothers and Child Health (Lewis, 2004) the number of suicides by women during the perinatal period has declined from 29 in 1997-1999 to 21 known suicides in 2000-2002. Depression can lead to more deaths from suicide each year than there are deaths from road accidents. According to Gregoire et al (1996), if postnatal depression is left untreated, 25% of women will continue to suffer one year after delivery and one in twenty-one women will still have postnatal depression two years later (Lumley et al, 2003). The statistics also show that women with untreated PND are at least 300 times more likely to suffer again in subsequent pregnancies (Hamilton et al, 1992). Detection There are a number of rating scales used to measure and detect postnatal depression. In many countries, health visitors screen for PND using the Edinburgh Postnatal Depression Scale (EPDS), which is a 10-item self-reporting screening instrument to aid the detection of post-natal depression (Cox et al. 1987; Murray and Carothers 1990; Warner et al. 1996; Wickberg and Hwang 1996b). This is designed to assess the mother at 6-8 weeks after the birth by the Health Visitor at home (appendix). A threshold score of 12 has been used as an indication that correctly identifies at least 80% of mothers with major depression (Cox et al. 1987; Harris et al. 1989; Murray and Carothers 1990). The NICE guidelines recommend the use of the Whooley questions (appendix) as a simple screening method to detect postnatal depression. This screening technique is used by health visitors at the initial contact and offers the opportunity to screen without a formal assessment. However, the EPDS and Whooley questions are not diagnostic tools in their self, and should always be used in conjunction with a clinical evaluation if necessary. Consequences of postnatal depression Different mechanisms have been proposed to explain the effect of postnatal depression to childs psychopathology (Murray and Cooper 1997). Whiffen (1989) suggests that infant temperament and behaviour is related to postnatal depression, both as a consequence and a cause of it. Mothers with chronic depression have infants with more behavioural problems such as sleeping and eating problems and temper tantrums (Campbell et al. 1997), and severity of depressive symptoms associates with compromised cognitive and attachment security (Lyons-Ruth et al. 1986). A second effect might be the maternal interactional and parenting style, secondary to maternal depression. Mothers with postnatal depression may be emotionally unavailable for their infants and they may withdraw from interaction situations. In addition, they may respond in an inappropriate or unpredicted or even unreceptive manner to their child. Paternal postnatal depression is rarely reported or studied, but estimated rates of paternal depression have varied from 4 to 13% (Ballard et al. 1994, Areias et al. 1996) in the early postpartum period. Treatment and Prevention If postnatal depression is left untreated, it can persist for many months with adverse consequences for mothers, children and families (Josefsson et al, 2001). There is the possibility of short and long-term consequences for the babys cognitive, social and emotional development. Depressed mothers make more negative and fewer positive responses to their babies and the infants learn a style of interaction that transfers to their subsequent interactions with other people (Field, et al 1988). Longer term adverse influences have been demonstrated on childrens language development, IQ and social development (Coghill et al . 1986; Sharp et al . 1995; Murray et al. 1996; 1999). Typically, mothers with postnatal depression go through silent suffering. Effective treatments are available, but help is often not actively sought. Small and his group (1994) found out that only one third of depressed mothers sought professional help. However, these mothers often advised other depressed mothers to find someone to talk to. However, the evidence for the effectiveness of interventions to prevent postnatal depression is conflicting. Stuart, et al, (2003) suggested that early intervention, even in the antenatal period is an effective way of tackling postnatal depression. Midwives counselling, given support and explanations about the childbirth prior to labour provided a better postnatal mental health of the mothers (Lavender and Walkinshaw 1998). The statistical power of existing studies is, however, very limited (Lawrie 2000). The provision