How Does Tom Buchanan Represent 1920s Society in the Great Gatsby free essay sample

Fitzgerald has done this, as he does not like men whose lives mirror Toms. Tom is a violent man, who is completely in control of the women in his life. He shows how disrespectful some men were to women. For example, he breaks his mistress Myrtles nose. In the Great Gatsby Tom is represented as a muscular â€Å"brute† of a man with a short temper and little morals, these characteristics are shown throughout the book through his actions, the first being his complete lack of morals as he has an affair with another man’s wife, Myrtle, and even lies to her, saying that Daisy is a â€Å"catholic† and she does not â€Å"believe in divorce†. This anti-moralistic attitude that Tom employs is directly representative of 1920’s society, as not only was this a time when there was increased sexual independence (especially within women) but it was also a time when morals were dropped and the society as a whole became much more careless. We will write a custom essay sample on How Does Tom Buchanan Represent 1920s Society in the Great Gatsby? or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The anti-moralistic arrogance was enthused by the criminal underworld which in many ways was fuelled by the prohibition of alcohol. Tom’s short temper is also shown throughout the book and is particularly prevalent when he strikes myrtle when he is drunk, â€Å"making a short, deft movement, Tom Buchanan broke her nose with his open hand† this misogynistic part of his personality again creates links between him and the 1920’s society, as, women were becoming less and less respected as they became more independent this idea is encouraged by Tom as he treats women like second class citizens, even his wife whom he cheats on for the entire length of the book. However Tom is not completely representative of the entire 1920’s society, despite the luxuries that a massive amount of people had in this era, as shown in the book through most of the characters. However, there were people in the 1920’s who experienced severe poverty and this is shown in some parts of the book especially through George Wilson as he struggles to survive whilst others such as Tom and Gatsby live a life of luxury with money they will never spend. Tom’s treatment of George in many ways has direct links to the treatment of the poor by the rich in the 1920’s as they exploited them through their desperation, employing them into the underworld to perform dangerous jobs for little money. In the same way Tom treats George poorly through his reluctance to give him a car for him to sell and the enormous factor that he has an affair with his wife. Toms affair with Myrtle Wilson emphasizes both moral blindness and the refusal to condemn wrongdoings. Tom willingly admits his affair, yet Daisy has come to ignore it, at least outwardly. Tom thinks that Daisy will understand his affairs, believing Once and a while I go off on a spree and make a fool of myself, but I always come back, and in my heart I love her all the time. The fact that Daisy refuses to condemn Toms actions adds to Fitzgeralds portrayal of societys view on sin during the 1920s. Because society during the 1920s doesnt hold marriage in the position that perhaps their parents and grandparent did, they tolerate sins such as infidelity and lust, this acceptance of many of these sins was also a great factor in the rise of underworld criminality. In conclusion Tom does not necessarily represent the entire 1920’s society, however he does represent a lot of their values, such as carelessness, immorality and the large amount of money that he possessed.

Think Your New ACT Writing Score Is Wrong Recent Issues, Explained

Think Your New ACT Writing Score Is Wrong Recent Issues, Explained SAT / ACT Prep Online Guides and Tips If you took the ACT with Writing in September, October, or December of 2015, you may have been taken by surprise by the change in the essay prompt (compared to previous ACT Writing tests). And when you got your scores back...well, you may have been even more confused. While the change in the ACT essay format was announced ahead of time, the full explanation of how the Writing scores would be normalized was not made clear until after the first administration of the new ACT Writing test. Because of this, ACT, Inc. faceda bit of controversy about the scoring of the new Writing test.Now they've returned to a 12-point scoring scale, with a more transparent calculation system. Read on to learn what all this means for you. feature image credit: Shock and Awe by Pascal. Public domain. Some Quick Background Information Saturday, September 12, 2015 was the first worldwide administration of the new ACT Writing Test. The changes to the essay included a completely different assignment, a different scoring system (essay scores range from 1-36 instead of 2-12), and a different amount of time for the essay (40 minutes instead of 30). These parameters were made publicly available beforehand (although they were not perhaps publicized as widely as they could have been), so while some students didn’t realize the test was changing, that part wasn't entirely ACT, Inc.'s fault. Deadline Drama Many students applying early decision or early action to schools had thought that taking the September ACT would leave plenty of time for their scores to be ready before those November 1st Early Decision or Early Action deadlines. After all, in the past, multiple choice scores had been released by a couple of weeks after the test date, and Writing scores by a couple of weeks after that. Even though ACT, Inc. gave its standard caution that scores could take as much as 8 weeks, most students expected (reasonably) that their scores would be in and sent to colleges well before the ED/EA deadlines. It rapidly became apparent, however, that scoring the Writing tests was taking longer than usual, presumably because of the new scoring for the new Writing test. On October 14th (about one month after the September 12th test date), one student complained: "My writing score isn't up yet, even though I got my multiple choice scores 2 weeks ago. This is so frustrating." Six days later, students and parents alike were starting to get nervous. As one parent wrote, "...apparently most people who took the September 12th test have still not received their complete scores, which is putting some ED applications in jeopardy. (I have a niece in this situation.)" The concern students were feeling about not having their Writing scores back rapidly snowballed when it was realized that, if you take the ACT with Writing, ACT, Inc. won't send out your score report at all until your essay has been graded. This meant that if your essay wasn’t graded before the end of October (or before October 15th, in the case of some ED/EA deadlines), whatever school(s) you were applying to wouldn’t even get to see your multiple choice scores on English, Math, Reading, and Science for the September ACT. Soon, the frenzy about the delay in Writing scores spread beyond (mainly student-populated) forums to online news sites. As Examiner.com reported: So far, ACT has refused to support students affected by the absence of Writing scores by sending colleges official score reports minus the Writing score for those needing these results for early consideration. No reason has been provided, only an indication that it’s not the policy of ACT to send partial results. This policy made many students and parents less than happy with ACT, Inc. â€Å"Still no writing score. As many of you, cannot get scores out without writing. We reached out to some colleges to let them know that an updated score would be coming. Very disappointing, as ACT released the MC choice later than expected (states on their website "most" score are released within 2 weeks.... So of course they did not release the MC scores timely, and then once again, falsely state that the writing score would be available 14 days after MC scores are released again, did not occur. So, same story as you all and then of course those who still have not even received your MC scores my heart goes out to you... Bottom line - ACT needs to revise their processes, it's just not working well or fairly.† (source: College Confidential) Most likely as a result of the outcry from students and parents, ACT, Inc. reached out to schools in October to notify them of the issue with the delay in score release. Inside Higher Ed reported that ACT, Inc. had sent an email to the National Association of College Admission Counseling urging colleges to allow screenshots of multiple-choice scores from the September ACT as a stopgap measure. While many students were unhappy with the score delay, however, it was clear that ACT, Inc. was still within the timeframe it had set out for itself for grading the essays. As another College Confidential poster wrote: "There is no "fiasco". When we signed up for the Sept. test, the website very clearly stated what bluebayou posted above. This means that some people will not have their complete score report until after Nov. 1, since 8 weeks after Sept. 12 is clearly after Nov. 1. D has received all of her scores, including writing, as of last week. But we went in knowing that they might be late enough that she'd miss an EA date or two. I don't know why it's shocking to people that ACT is releasing scores exactly as the website says it will." Because of the scoring issues in September, when students asked if the December ACT with Writing scores would be available by January, I advised that the answer was probably NO. The Plot Thickens So...some students thought they’d be able to squeeze in one more ACT before early decision/early action deadlines, but it turns out they were wrong. So what? Well, the ACT Writing scoring saga doesn’t stop there. When students finally did get their scores back, confusion still abounded over how exactly these scores were reached. Students who were used to getting in the 30s on all the other sections of the ACT found that they were getting essay scores in the low 20s on the Writing section. One student posted on Reddit: â€Å"I was really disappointed that I got a 20 on writing but 32 composite.. I pretty much can't send this score anymore.† For students who didn’t know there was a new prompt, or who have difficulty writing under pressure, low Writing scores weren't all that surprising. But some students soon realized that there seemed to be a disconnect between their writing subscores and their overall essay scores. As another confused student put it: â€Å"I received a 9 on all subscores for Writing, but my score came out to a 24. Is this correct on ACT's part, or is there a scoring error† It seemed that the Writing scores on, for instance, the September 2015 ACT were equated differently from how ACT, Inc. had announced they'd be scored. For instance, one commenter on our blog received 11/12 on all four subscores but a 31/36 for her ACT Writing score, whereas the Preparing for the ACT 2015-2016 PDF indicated that 11/12 on all four subscores should result in a 34/36 Writing score. Another student on a different site noted this same issue, writing: â€Å"†¦what's also weird is that the curve for the writing section changes for each administration. So, 11/11/11/11 may be a 31 on one test (like the September one) and a 34 on a different test (the 2015-2016 Official Practice Test). It seems odd that there isn't a uniform curve for the writing section. How is one prompt harder than another prompt?† Was ACT, Inc. changing how the Writing test was scored from test to test? If so, it hadn't made that fact clear beforehand. Still other students saw a precipitous drop in their essay scores from one administration of the new Writing test to the next. One angry student wrote: â€Å"I literally just got my Dec 12th test back, and my composite is a whopping 35, but my writing score is 09. This is extremely peculiar, because the last two times I took the test, my writing scores were 34 and 35, respectively, and if anything, I only IMPROVED during my most recent attempt. Clearly my writing booklet has been mixed up with someone else's, because this is not only an inaccurate measure of my abilities, but a clear CLERICAL error.† What Happened? Why the huge issues with scoring for ACT Writing? Why were normally 32+ composite scoring students getting single-digit scores on the ACT Writing? I believe that there were a couple of reasons that things went so wrong. 1. Grading Error Every time the ACT is administered, a few tests are graded incorrectly. Whether the wrong score report gets sent out, or the scanner read a â€Å"7† instead of a â€Å"27,† or you didn't fill in your multiple choice answers darkly enough†¦these things happen. The fraction of students who are affected by these errors is so small that it’s normally not an issue. In addition, any scoring errors on the previous ACT Writing test might not have been as noticeable, since there were smaller gaps between the score points. It was conceivable that you could go from a 11/12 on a good day to a 6/12 on a not-so-great day. However, the September and December ACT administrations were critical for early and regular admissions deadlines, which made students hyper-conscious of any unusual blips in their scores. Add that to the change in scoring method, and there were just more people complaining about oddly low scores than usual. 2. Norming Error ACT, Inc. did finally release a concordance chart for the new ACT writing test in late September. This chart explains how the current system of ACT Writing scoring and the old system are linked. Basically, ACT, Inc. ran a special score concordance study where the same group of students took both essay tests. The scores for the new ACT Writing were then normalized so that the same numbers of students got scores at each new score point as they would have on the old essay (although it wasn’t necessarily the same students in each percentile). Normalizing scores like this is a little tricky because, just like when comparing the SAT and ACT, the scores aren’t on the same scale, so some extra math is required to equate the scores. Here is a copy of the chart the ACT has released comparing the previous out-of-12 Writing scores to the current out-of-36 Writing scores: Former ACT Writing Score Concordant Current ACT Writing Score 2 1 3 7 4 10 5 12 6 16 7 19 8 23 9 30 10 32 11 34 12 36 (source: ACT.org) As you can see, there are some pretty large leaps in the concordant scores, particularly between what used to be an 8/12 (both graders giving the essay 4/6) and a 9/12 (one grader giving the essay 4/6 and one giving it 5/6). Now, when you look at the ACT’s percentile ranking for the new Writing test, it’s clear that a 23/36 on the Writing still places you in the 83rd percentile, which is not too shabby. Score Writing Percentile 36 99 35 99 34 99 33 99 32 99 31 98 30 98 29 97 28 95 27 95 26 93 25 90 24 88 23 83 But as one concerned parent pointed out: â€Å"My DD also got a 35 composite and a 23 on writing. This sounds really low, but actually correlates to the 83rd percentile. But a 23 on the other sections correlate to percentiles in the 60s. So when colleges see a 23, will they also see the 83rd percentile, or will they assume it's much worse than it is?† And as ACT, Inc. itself admitted in a January 2016 report, "A casual observer may assume that a student who received a score of 32 on ACT English, ACT Composite, and ACT writing demonstrated consistent performance, but that would be incorrect." To explain why, we need to look at the percentile ranks for all the sections, side by side. I've combined the most recent information ACT, Inc. has released for the Writing scores and for composite and section scores in the below chart: Score (/36) Composite Percentile English Percentile Math Percentile Reading Percentile Science Percentile Writing Percentile 36 99 99 99 99 99 99 35 99 99 99 99 99 99 34 99 98 99 98 99 99 33 99 97 98 97 98 99 32 98 95 97 95 97 99 31 96 93 96 92 96 98 30 95 92 95 89 95 98 29 92 90 93 86 94 97 28 90 88 91 84 92 95 27 87 85 88 81 90 95 26 83 82 84 78 87 93 25 79 79 78 75 83 90 24 74 74 73 71 77 88 23 68 69 67 66 70 83 For a refresher what percentiles rankings mean, read our guide to percentiles and score ranking on the ACT. As you can see, there is a pretty big discrepancy between a 23 on the Writing (which places you at or above 83 percent of all test takers) and a 23 on any of the other sections (which only places you at or above 66-70 percent of all test takers). Here's a graph that illustrates this contrast even further: (source: ACT.org) That jagged purple line to the left, lagging behind all the other section scores? That's the Writing scores for the September and October 2015 ACT. Because of this discrepancy, ACT, Inc. warns against comparing scores on the Writing test directy to scores on the other sections of the ACT. Quoted verbatim: "However, the new writing test combines the four domain scores, which are also reported to students, into an overall summary score on the 1–36 scale, making comparisons with other scores much more tempting. Perhaps too tempting!" What’s particularly weird is ACT, Inc.'s explanation of this scoring difference. In the same article in which the graph appears, the writers stated that it made sense that there was more variation in writing scores because it was just one question. True enough, but the rest of their explanation left me baffled: "Therefore, the writing test does have significantly greater variation than other scores because it is a single task, evaluated by raters using a 6-point interval scale, while other ACT tests are comprised of 40 to 75 questions." One of the big changes with the new ACT essay is that the essay graders aren’t giving essays a holistic score any more - two graders are giving each essay four domain scores out of six, for total domain scores out of twelve. Which means that the essay is really evaluated out of a 48 point raw score - not entirely dissimilar to the rest of the sections. So where does the score out of 36 come from? How is it being equated from the sum of the domain scores (which would be out of 48)? Well, according to ACT, Inc.: "The new writing scale score (1–36) is a nonlinear transformation of the sum of the two 1–to–6 rater scores on four domain scores (8–48)." But while ACT, Inc. released a preliminary chart for how this would work for the Preparing for the ACT 2015-2016 practice test, it appears, as I noted earlier, that the equating may be changing from test to test. Alas, it does not appear that a copy of the equating chart is sent out with the score report, so students have no way of knowing how the score out of 36 was arrived at. Without transparency about the process, it’s understandable why some students are confused and upset. Lifeless Face #038, by Nottsexminer, used under CC BY-SA 2.0/Cropped and resized from original. This hinge is just as upset as you. If not more so! Look at that face. UPDATE: More Changes to ACT Writing Ahead Just one year after ACT, Inc. completely overhauled the ACT Writing test, the scoring for the test is changing yet again. As of September 2016, the ACT Writing Test will no longer be scored on a scale of 1-36. Instead, students will receive a Writing score on a scale of 2-12 that is the average of all four of their domain scores (Ideas Analysis, Development Support, Organization, and Language Use), which are also each scored on a scale of 2-12. In addition, there are some "minor changes" to the wording of the prompt that removed the necessity of discussing all three perspectives in your essay. Here's a look at what the ACT essay task looked like up through June 2016: Write a unified, coherent essay in which you evaluate multiple perspectives on the conflict between public health and individual freedom. In your essay, be sure to: analyze and evaluate the perspectives given state and develop your own perspective on the issue explain the relationship between your perspective and those given Your perspective may be in full agreement with any of the others, in partial agreement, or wholly different. Whatever the case, support your ideas with logical reasoning and detailed, persuasive examples. And here's what it'll look like from September 2016 onwards. I've bolded the relevant change below. Write a unified, coherent essay about the conflict between public health and individual freedom. In your essay, be sure to: clearly state your own perspective on the issue and analyze the relationship between your perspective and at least one other perspective develop and support your ideas with reasoning and examples organize your ideas clearly and logically communicate your ideas effectively in standard written English Your perspective may be in full agreement with any of those given, in partial agreement, or completely different. ACT, Inc. announced the changes to the Writing test would go into effect September 2016 as part of ACT, Inc.’s effort to â€Å"reduce confusion among users.† As stated in both the official press release and in the FAQs about the Writing section, the reason for the scoring change was due to the larger differences between the scoring of the Writing test and the English, Math, Reading, and Science subject scores. "Students assumed that the scores on the 1-36 scale meant the same thing from one subject test to another. We recognize that this is a logical assumption, but it is not a correct assumption" (source: ACT Writing FAQs). The formal announcement of the changes to the ACT Writing test scoring occurred June 28, 2016; however, these changes didn’t come entirely out of nowhere. We at PrepScholar first noticed something odd when reading through the newly-released â€Å"Preparing for the ACT 2016-2017† PDF in mid-June 2016. Here's what it says on page 8, under the discussion of the ACT Writing Test: You will receive a total of five scores for this test: a single subject-level writing score reported on a scale of 2–12, and four domain scores based on an analytic scoring rubric. The four domain scores are: Ideas and Analysis, Development and Support, Organization, and Language Use and Conventions. Note: The subject score is the rounded average of the four domain scores. On page 62, further information was given on how to calculate your ACT Writing score for the practice test included in the PDF: So other than Step 2 (which on the real ACT will involve adding the two essay graders' scores on each rubric area together, rather than just multiplying each area score by two), this domain-score-averaging process is how the ACT Writing test will be scored starting September 2016. What Does This Mean For You? At this point, many colleges are aware of the issues ACT, Inc. had with the score release of the new ACT Writing. As Boston College states on its admissions website, "ACT has notified us that delivery of scores this year will be delayed due to their implementation of an enhanced design to the Writing portion of the test.† Plus, by now most college application deadlines for Fall 2016 have passed, so whether or not the scores were released in time is kind of a moot point. But what if you're applying to colleges next year, or are still worried about a low Writing score? What can you do about it? Option 1: Order Hand-Scoring Some students have resorted to ordering hand-scoring for their essays to see if it affects their scores (since ACT will only send colleges the new score if it is higher). In the case of at least one student, this was a success – the re-score took a Writing score of 22 (80th percentile) up to a 28 (95th percentile). Because hand-scoring for the essay is so expensive ($50.00), it might only be worth doing if you believe that you really did receive someone else’s scores in error (i.e. if your Writing score is 6 points different from what you expected), or if the subscores don’t seem to correlate to your writing score out of 36 (e.g. subscores of all 10s, writing score of 11/36). Unfortunately, this means that some students will be at a disadvantage, because fee waivers do not apply to hand-scoring. You do get refunded the fee if a scoring error is found, but the initial investment of $50 may still be something that economically disadvantaged students don’t want to risk (if there is no score difference). Option 2: Re-take ACT Writing in September 2016 In other cases, it might be worth taking the September or October ACTs in order to get an essay score on the more-familiar (to admissions officers) 12 point scale. I would strongly urge against depending on either of these test dates if you're applying early decision or early action for most schools, given the score reporting delays that were rampant last year. If you're applying regular decision, though, taking the September or October ACT Writing test could have a positive affect on your application, since a lower Writing score won't look quite as discrepant against the rest of your ACT scores. Now that ACT Writing is scored out of 12, rather than also being out of 36, schools will be less likely to compare your Writing score directly to your ACT English, Math, Reading, Science, and composite scores, and give a sideeye to any huge discrepancies. Option 3: Wait It Out For many students, however, the lower-than-expected writing scores are just a byproduct of the way the new ACT Writing section is normed. Take heart, though – many schools already view standardized test essays with a skeptical eye. As the National Council of Teachers of English has noted, â€Å"With respect to writing ability, the ACT's figures indicate at best that students who do well on the test can perform the writing tasks required on the test.† It's unlikely that the ACT's updated September 2016 scoring system is going to do anything to dispel this skeptical attitude. With the SAT essay becoming optional as of March 2016, it’s likely that fewer and fewer schools will care about the Writing section at all. And if you’re really worried about a low ACT Writing score, make sure to blow admissions officers away with a great personal statement to showcase your real writing skills. What Should You Do Now? If you want to retake the ACT to increase your Writing score, you'll need to make sure you completely understand the new prompts, what the rubric looks like, and how scoring works. Definitely make sure to check out our articles on how to get a perfect score on the ACT essay and how to write an ACT essay, step by step. Are you within three months of the date you took the ACT and want to get your essay re-scored? You're in luck! Find out all about how hand-scoring works here. Curious about what the difference is between test information release and hand scoring? Get the details on what TIR is and why you might want to order it in this article. Want to improve your ACT score by 4 points? Check out our best-in-class online ACT prep program. We guarantee your money back if you don't improve your ACT score by 4 points or more. Our program is entirely online, and it customizes what you study to your strengths and weaknesses.Along with more detailed lessons, you'll get your ACT essays hand-graded by a master instructor who will give you customized feedback on how you can improve. We'll also give you a step-by-step program to follow so you'll never be confused about what to study next. Check out our 5-day free trial:

The Unification of Information Security Program Management and Project Article

The Unification of Information Security Program Management and Project Management - Article Example However, converging the two managements has drawbacks as well. More often than not, drawbacks weigh more than success on the first stages of the implementation. In light of the mentioned union, his paper will discuss the risks brought about by the new technology, the tasks to be dealt with in developing the Enterprise Information Security Program, and the adherence to executing risk management. The life of any organization or enterprise moving to build up a gateway lies in making goals into reality, and maintaining a successful position in the industry. Dealing with new things may bring more thoughts to ponder. The unification of Information Security Program Management and Project Management comes with new security threats/risks that must be addressed accordingly. "Unfortunately, in the context of security, requirements and specifications are most often overlooked. This may in turn account for the estimated 92% of security vulnerabilities NIST3 recently attributed to applications."1 Organizations wanting to advance with Information Security Program are susceptible to the possible hazards for the Project Management in setting up new systems to adhere with the goals of both managements. A partner of Hurwitz and Associates, Fran Howarth, wrote an article about "The Convergence of Physical and IT Security." Howarth stated that "IT systems are increasingly being attacked-and not in the way they used to be, by hackers concerned most with gaining the respect of their peers for their exploits, but by criminals intent on financial gain."2 H owarth further explained that: the heightened security threats that we face today-especially given the high levels of international terrorism that we face-affect huge parts of our lives. In recent years, public buildings, hotels, embassies and transport links have all been targeted by terrorists. And huge parts of our critical national infrastructures, including power, water and food supply, transport links and facilities, government and commercial facilities remain vulnerable, not just to terrorist attacks, but also to theft, sabotage and environmental disasters.3An executive summary of a research entitled "Making Security an Integral Part of the Management" from Computer Electronics Inc. reveals that "security should be an important element of project management, to ensure that the security implications of these changes are addressed."4 A skilled and knowledgeable project manager must be aware of the security requirements in managing projects. In addition, A Guideline to the Project & Program Management Standard produced by the International Association of Project and Program Management for the benefit of the project managers who need "to attain project success according to schedule, cost, quality, and to customer expectations."5 IAPPM sees a greater need in developing new techniques as organizations compete to be more accessible in providing solutions, products and services.6 IAPPM describes project management as "the centralized management by an individual to plan, organize, control and deploy key milestones, deliverables and resources from conception through retirement, according to customer goals. Often project managers are skilled to use specific templates and techniques to manage through the preferred project life-cycle."7 For example, a

Green Computing Research Project Part 2 Case Study

Green Computing Research Project Part 2 - Case Study Example The company will need a well functioning network that will enable the two IT analysts to maintain and implement the system by consulting Christian at the code company. This will need them to interact and work together by testing the codes of the application and ensuring that the application will be running without any problem. Compatibility will also be needed by using the required printing software that will be installed in the computers when the customers need to scan their checks. By analyzing the best printing machines the company needs to contact DevAn Consultants for them pick out the best machines needed for the project. This will be done while looking for the best market of the printing machines and considering the kind of applications that will be used in the system. The scanning project will enable the customers in the company to have an easy time to communicate with the company by sending their information and checks to the company by scanning their documents. This has been a request that has been made by many of the customers in order for them to avoid insecurity and save time. As stated early, the customers will be scanning their checks and documents then send them to the company by filling in their personal information that will be protected by the company’s security. Each customer is required to send the information from anywhere provided he or she accesses the internet. For a customer to be able to use the service, he or she will first fill in the required information for the transaction to be successful. Before the scanning starts the company must ensure that there is a network for the customers to access the company’s website. This will also be accompanied by the security the company is to provide to the customers. This includes installation of maintenance software and the security protection system in the company’s system. Example is the anti virus which will protect the company site from any malware

Bertrand Russells criticism of direct realism Essay

Bertrand Russells criticism of direct realism - Essay Example To begin with, it may be important to highlight several important aspects of the view which was developed by Bertrand Russell. Thus, he questions whether there is some kind of knowledge that everyone would agree on. He concludes that the knowledge about the objects that exist in reality can be such knowledge as two people who walk into the same room would see in the similar manner. However, that is exactly the kind of approach that he wants to criticism, suggesting that the knowledge that he was of the ordinary objects (he particularly focuses on the example of the table) is, in fact, relative. Russell points out that the perception of a physical object is largely conditioned by the state of the observer; for example the color of the table will change based on the angle of view. The same can be said about texture shape and so on. Keeping in mind that all these states exist simultaneously, he argues that it is not logical to talk about the â€Å"real† color or shape of the tabl e.The philosopher in question then moves to the issue of norm in terms of determining properties of the object. Having established that the color can be bright (under direct sunlight), moderate (under artificial light) and invisible (if perceived in the darkness), Russell notes that most people would agree that the â€Å"real† color is the one found in the second case. However, in his view this leads to â€Å"favoritism† that can hardly be justified since it is grounded on such vague assumptions as â€Å"normal spectator †¦ an ordinary point of view †¦ usual conditions of light†.

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay Carpal tunnel syndrome is a most common compression neuropathy of the upper extremity. It is caused by compression of median nerve in the carpal tunnel. Women are more commonly affected than men. It is commonly seen in age group between 30 and 60 years. Carpal tunnel syndrome usually occurs due to excessive use of the hands and occupational exposure to repeated trauma. Average cross sectional area of the carpal tunnel is 1.7 cm2 with the wrist in neutral position. Passive flexion and extension of the wrist has been increased the carpal tunnel pressure. Wrist extension increases carpal tunnel pressure more than the wrist flexion. Any space occupying mass or swelling of the structures in the tunnel also causes pressure on the median nerve. Mostly, the cause of carpal tunnel syndrome is unknown. Any condition which causes pressure on median nerve at the wrist will result in carpal tunnel syndrome. Obesity, pregnancy, hypothyroidism, arthritis, diabetes and trauma are the common conditions that lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing which result in tendon inflammation can also cause carpal tunnel symptoms. Carpal tunnel syndrome due to repetitive activities has referred to one of the repetitive stress injuries. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation. Prolonged flexion or extension of the wrists under the patients head or pillow during sleep is believed to contribute to the prevalence of nocturnal symptoms. Usually patient complaints pain, numbness and tingling sensation in the hand and fingers. Symptoms worsening at night typically awakening the patient or occurring on bunching up the hand for tasks such as writing. Carpal tunnel syndrome is the most common cause of acroparaesthesiae often pain and paraesthesiae may be the only symptoms for many months or years. The syndrome is essentially a sensory one; the loss or impairment of superficial sensation affects the thumb, index and middle fingers and may be or may not split the ring finger. There may be wasting and weakness of the thenar muscles. Weakness and atrophy of the abductor pollicis brevis and other muscles supplied by median nerve occur in only the most advanced cases of compression. Degrees of carpal tunnel syndrome are classified as dynamic, mild, moderate and severe. The pathophysiology of carpal tunnel syndrome is typically demyelination. Secondary axon loss may present in more severe cases. With 20 to 30 mm hg compression, the initial insult is a reduction in epineural blood flow. With wrist extension, intracarpal pressures routinely measure atleast 33 mm hg and often upto 110 mm hg in patients with carpal tunnel syndrome. Edema in the epineurium and endoneurium is caused by continued or increased pressure. Carpal tunnel syndrome diagnosed by detailed history collection, phalen maneuver, percussion test, two point discrimination test, vibrometry, monofilament test, distal sensory latency and conduction velocity, distal motor latency conduction, upper limb tension tests. X-ray is taken to check for arthritis and fracture. If there is a suspected medical condition that is associated with carpal tunnel syndrome, laboratory tests may be done. This condition could be mistaken for a brachial neuritis due to cervical intervertebral disc prolapse at C5 C7 level. Nerve conduction tests on the median nerve help to localize the lesion in the tunnel. Both conservative and surgical management options are available in order to reduce pressure over median nerve. The current conservative treatments include non steroidal anti inflammatory drugs, sometimes rest, local injection of corticosteroids, activity modification, ultrasound therapy, carpal bone mobilization, magnetic therapy, night and/or daytime wrist splint positioned at 0 to 15 degrees of extension, nerve and tendon gliding exercises. Anyone of the measures alone or in combination can be effective in treating early carpal tunnel syndrome. Tendon gliding exercises are performed to lubricate and increase gliding of the flexor pollicis longus, flexor digitorum superficialis and flexor digitorum profundus tendons. They are best performed with the hand elevated to concurrently control local edema. Median nerve gliding exercises and the upper limb tension test with median nerve bias can be used as treatment techniques. Modality treatment can also control symptoms and enhance the therapeutic exercise program. Exercise intervention for carpal tunnel syndrome focuses on mobility and strengthening without producing an exacerbation. Stretches for the extrinsic and intrinsic muscles are prescribed for several times each day. If working, a patient should perform them before work. They should be performed slowly and gently; the patient feel only a gentle stretching sensation. In workplace, modification of the job site or complete ergonomic redesign is typically the most helpful approach. In addition yoga, chiropractics, laser treatment have been advocated. Surgery is indicated in advanced cases with objective sensory loss and /or weakness or atrophy of the abductor pollicis brevis. In severe cases surgical division of the transverse carpal ligament relieves the condition. Surgical management includes open carpal tunnel release and endoscopic release. It aims to decompress nerve, to improve excursion and to prevent flexor damage. Splinting is the most popular method of conservative management of carpal tunnel syndrome. Splints are recommended by the American Academy of Neurology for the Carpal tunnel syndrome with light and moderate pathology. Immobilization of the wrist joint in a neutral position with splint will increase the carpal tunnel volume and minimize the median nerve pressure. Wrist Splinting in a neutral position will help reduce and may even completely relieve Carpal tunnel syndrome (Slater RR et al 1999). Ultrasound therapy is more useful in the management of Carpal tunnel syndrome. It has the potential to accelerate normal resolution of inflammation. Ultrasound therapy elicit anti inflammatory and tissue stimulating effects. Ultrasound therapy accelerates the healing process in damaged tissues. Pulsed Ultrasound therapy with the intensity of 1.0 w/cm2, 1:4 for fifteen minutes per session has significantly improved subjective symptoms in patients with carpal tunnel syndrome (Ebenbichler GR et al). Nerve and tendon gliding exercises are used in conservative treatment of carpal tunnel syndrome to decrease adhesions and to regulate venous return in nerve bundles (Rozmaryn et al). Nerve and tendon gliding exercises may maximize the relative movement of the median nerve within the Carpal tunnel and the excursion of flexor tendon relative to one another (Rempel D, Manojlovic R et al). Wrist splint along with nerve and tendon gliding exercises showed significant improvement in reducing symptoms in Carpal tunnel syndrome. (Akalin et al) NEED FOR THE STUDY: Ultra sound therapy, splints, nerve and tendon gliding exercises are significantly effective in reducing symptoms in the treatment of Carpal tunnel syndrome. Combination of various treatments is also useful in reducing symptoms in Carpal tunnel syndrome. Ultrasound therapy helps to increase healing process in damaged tissue. This study aimed to find out the effect of Ultrasound therapy in reducing pain in patients with Carpal tunnel syndrome. STATEMENT OF THE PROBLEM Effect of Ultrasound Therapy in reducing pain in patients with Carpal tunnel syndrome. KEY WORDS: Carpal tunnel syndrome Ultrasound therapy Splint Exercises Pain Visual analogue scale (VAS) AIM: To find out the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome. OBJECTIVE: To study the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome. HYPOTHESIS: 1.6.1. NULL HYPOTHESIS There is no significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is no significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is no significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. 1.6.2. ALTERNATE HYPOTHESIS There is significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. II.REVIEW OF LITERATURE CARPAL TUNNEL SYNDROME DAVID A FULLER, MD, et al (2010) Stated that carpal tunnel syndrome is the most common entrapment neuropathy. The syndrome is characterised by pain, paraesthesia, and weakness in the median nerve distribution of the hand. The etiology of carpal tunnel syndrome is multifactorial which is contributed by various degrees of local and systemic factors. Symptoms of carpal tunnel syndrome are due to ischemia and impaired axonal transport of the median nerve which results from median nerve compression at the wrist. (Lunborg G, Dahlin LB 1992). Elevated pressure inside the carpal tunnel leads to compression. HARVEY SIMON, MD et al, (2009) Stated that carpal tunnel syndrome is considered as an inflammatory disorder caused by medical conditions, physical injury or repetitive stress. JEFFREY G NORVELL, MD et al (2009) Stated that carpal tunnel syndrome (CTS) is caused predominantly by median nerve compression at the wrist because of hypertrophy or oedema of the flexor synovium. Pain is thought to be secondary to nerve ischemia rather than direct physical damage of the nerve. S.BRENT BROTZMAN, MD (2003) Explained that degree of the carpal tunnel syndrome as dynamic, mild moderate and severe. In mild cases, patients has intermittent symptoms, decreased light touch, positive digital compression test and positive tinel sign or phalen test may or may not be present. In moderate cases, patients have frequent symptoms, decreased vibratory sense, muscle weakness, positive tinel sign, phalen test and digital compression test. GERRITSEN AA, DE KROM MC, STRUIJS MA, ET AL (2002) Stated that carpal tunnel syndrome (CTS) is caused by median nerve compression at the wrist and is considered to be the more common entrapment neuropathy. Symptoms of carpal tunnel syndrome include pain, numbness or tingling sensation, paraesthesia, involving the fingers innervated by the median nerve. (Bakhtiary AH, Rashidy Pour AR et al 2004) GELBERMAN RH, HERGENROEDER PT, HARGENS AR, RYDEVIK B, LUNDBORG G, BAGGE U (1981) Fracture callus, osteophytes, anomalous muscle bodies, tumours, hypertrophic synovium, and infection as well as gout and other inflammatory conditions can produce increased pressure within the carpal tunnel. Extremes of wrist flexion and extension also elevate pressure within the carpal tunnel. Intraneural blood flow is affected by compression on nerve. Venular blood flow in a nerve is reduced by pressure as low as twenty to thirty mm Hg. At level of thirty mm Hg, axonal transport is impaired. At forty mm Hg, neurophysiologic changes manifested as sensory and motor dysfunctions are present. Any further increase in pressure will produce sensory and motor block. At level of sixty to eighty mm Hg, complete cessation of intraneural blood flow is seen. In one study, the carpal tunnel pressure in patients with carpal tunnel syndrome averaged thirty two mm Hg, compared with only about two mm Hg in control subjects. RH GELBERMAN, AR HARGENS, GN LUNDBORG, PT HERGENROEDER et al, (1981) Measured intra carpal canal pressures with the wick catheter in 15 patients with carpal tunnel syndrome and in 12 control subjects. The average pressure in the carpal tunnel was raised significantly in the patients with carpal tunnel syndrome. When the wrist was in neutral position, the mean pressure was 32 millimeters of mercury. With ninety degrees of wrist flexion the pressure raised to 94 millimeters of mercury. While with ninety degrees of wrist extension the average pressure was 110 millimeters of mercury. The pressure of carpal canal in the control subjects with the neutral position of wrist was 2.5 millimeters of mercury; with wrist flexion the carpal canal pressure rise to 31 millimeters of mercury, and with wrist extension it increased to 30 millimeters of mercury.  ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­GEORGE S. PHALEN M.D, et al (1966) Stated that diagnosed Carpal tunnel syndrome has been made in 654 hands of 439 patients during the last seventeen years. The typical patient with this syndrome is a middle-aged housewife with numbness and tingling in the thumb and index, long, and ring fingers, which is worse at night and worse after excessive activity of the hands. The sensory disturbances both objective and subjective must be directly related to the sensory distribution of the median nerve distal to the wrist but pain may be referred proximal to the wrist as high as the shoulder. There is usually a positive tinel sign over the median nerve at the wrist, and the wrist flexion test is also usually positive. About half of the patients also have some degree of thenar atrophy. In clinical practice, Carpal tunnel syndrome is the most commonly seen entrapment mononeuropathy which is caused by median nerve compression at the wrist (PHALEN 1966, GELBERMAN et al 1998). Usually patients show one or more symptoms of hand weakness, pain, numbness or tingling in the hand, especially in the thumb, index and middle fingers (SIMOVIC and WEINBERG 2000). Symptoms are worst during night time and often wakeup the patient. WILLIAM C. SHIEL JR., MD.FACP, FACR, et al Stated that the cause of the carpal tunnel syndrome is unknown. Any condition which causes pressure on the median nerve at the wrist will result in carpal tunnel syndrome. Common conditions such as obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma can lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing result in tendon inflammation can also cause Carpal tunnel symptoms. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation. MEDIAN NERVE LUNDBORG G, DAHLIN LB, et al (1996) Stated that throughout the extremity movement, mobility of the peripheral nerve changes and longitudinal movement of the median nerve mostly occur in the carpal tunnel. In Carpal tunnel syndrome, this physiologic mobility of the median nerve disappears. REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994) Stated that during the exercise there may be redistribution of the point of maximal compression on the median nerve. This milking effect would promote venous return from the median nerve, thus decreasing the pressure inside the perineurium. NAKAMICHI AND S. TACHIBANA et al Conducted a study the motion of median nerve in patients with carpal tunnel syndrome and normal subjects. Median nerve motion was assessed by axial ultrasonographic imaging the mid carpal tunnel. They concluded that wrist of patients with Carpal tunnel syndrome showed less sliding which indicates that physiological motion of the nerve is restricted. This decrease in nerve mobility may be of significance in the pathophysiology of carpal tunnel syndrome. ULTRASOUND THERAPY BAKHTIARY AH, RASHIDY-POUR A et al (2004) Conducted a study to compare the effect of Ultrasound and laser therapy in patients with mild to moderate idiopathic carpal tunnel syndrome. By electromyography findings, 90 hands in 50 consecutive patients with carpal tunnel syndrome were confirmed and allocated randomly in two groups. One group received low level laser therapy and the other group received ultrasound therapy. Ultrasound treatment (pulsed 1:4, 1.0 W/cm2, 1 MHz, 15 min/session) and low level laser therapy (infrared laser, 830nm, 9 Joules, at five points) were given to the carpal tunnel for fifteen daily treatment sessions. Ultrasound group showed more significant improvement than low level laser therapy group in motor latency, motor action potential amplitude, finger pinch strength, and pain reduction. Effects were also sustained in the follow-up period. They concluded that ultrasound therapy was more effective than laser therapy in the management of carpal tunnel syndrome. EBENBICHLER GR, RESCH KL et al (1998) Studied the efficacy of Ultrasound therapy in patients with mild to moderate idiopathic Carpal tunnel syndrome. Ultrasound with parameters 1MHZ, 1.0 W/cm2 pulsed mode 1:4, 15 minutes per session was applied over the carpal tunnel and compared with Sham Ultrasound. Actively treated ultrasound group showed significant improvement than sham treated wrists in both subjective symptoms and electroneurographic variables. To confirm the usefulness of ultrasound therapy for Carpal tunnel syndrome, more studies are needed. Additional randomized trials comparing conservative therapies for Carpal tunnel syndrome would be useful in selecting appropriate treatments for individual patients. EL HAG M, COGHLAN K, CHRISMAS P et al (1985) Stated that Ultrasound could elicit anti-inflammatory and tissue-stimulating effects as already shown in clinical trials and experimentally (Byl et al 1992, Young and Dyson 1990). In this way, Ultrasound has the potential to accelerate normal resolution of inflammation (Dyson 1989). The results of these studies confirm that Ultrasound may accelerate the healing process in damaged tissues. In mild to moderate carpal tunnel syndrome patients, these mechanisms may explain their findings including pain relief, increased grip and pinch strength, and changed electrophysiological parameters toward normal values better than Laser therapy. WRIST SPLINT Wrist splints help to keep the wrist straight and reduce pressure on the compressed nerve. Doctor may recommend the patients to wear wrist splints either at night, or both day and night, although patient may find that they get in the way when they are doing their daily activities. Some research indicates that ultrasound treatment may help to reduce the symptoms of carpal tunnel syndrome. (BUPAS health information team 2010) BRININGER TL, ROGERS JC et al (2007) Fabricated customized neutral splint and nerve and tendon gliding exercises is more effective than wrist cock up splint and nerve and tendon gliding exercises in reducing symptoms and improving functional status in the treatment of Carpal tunnel syndrome. GERRITSEN AA, DE KROM MC, STRUIJS MA, et al (2002) Immobilization of the wrist joint in a neutral position with a splint will maximizes carpal tunnel volume and minimize the pressure acting on median nerve. AKALIN E, EL O, SENOCAK O, et al (2002) Compared the effect of wrist splint alone to wrist splint with nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome. In their study, both groups showed significant improvement in clinical parameters, functional status scale and symptom severity scale. They also reported significant improvement only in pinch strength in the group with wrist splint in combination with exercises compared with the wrist splint group. MANENTE G, TORRIERI F, et al (2001) Stated that wearing a specially designed wrist splint at night time for four weeks was more effective than no treatment in reducing the symptoms of Carpal tunnel syndrome. SLATER RR, et al (1999) Stated that splinting the wrist in a neutral position will help to reduce and may even completely relieve carpal tunnel syndrome symptoms. SAILER SM, et al (1996) Stated that the optimal splinting regimen depends on the patients symptoms and preferences. To prevent prolonged wrist flexion or extension, night splint use is recommended. BURKE DT, STEWRT GW, CAMBER A, et Al (1994) Stated that carpal tunnel syndrome is the commonest compression neuropathy in the upper limb. Several studies have demonstrated the effect of wrist splint in reducing the symptoms of carpal tunnel syndrome. But the chosen angle of immobilization has varied in the management of carpal tunnel syndrome. Wick catheter measurements of carpal tunnel pressures suggest that the neural position has less pressure and, therefore, greater potential to provide relief from symptoms. KRUGER VL, KRAFT GH, et al (1991) Stated that wrist splint at a neutral angle helps to decrease repetitive flexion and rotation, thereby relieving mild soft tissue swelling or tenosynovitis. Splinting is most effective when it is applied within three months of the onset of symptoms. NERVE AND TENDON GLIDING EXERCISES BAYSAL O, ERTEMK, YOLOGLUS, ALTAY Z, KAYHANA et al (2006) Stated that combination of ultrasound therapy, splinting and exercises is a preferable and an efficacious treatment for patients with carpal tunnel syndrome. ROZMARYN LM, et al (1998) Used nerve and tendon gliding exercises in conservative treatment models to decrease adhesions developed in the carpal tunnel and regulate venous return in the nerve bundles. They reviewed more than 200 hands under consideration for carpal tunnel decompression. Altogether 71% of the patients who were not offered gliding exercises went forward to surgery; only 43% of the gliding exercise group was felt to require surgery. SERADGE et al (1995) Stated that intermittent active wrist and finger flexion-extension exercises reduce the pressure in the carpal tunnel. SZABO et al (1994) Showed that the relationship between median nerve and flexor tendon excursion was consistently linear. They suggested active finger motion of the median nerve and flexor tendons in the vicinity of the wrist to prevent adhesion formation even if the wrist is immobilized. REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994) Stated that the median nerve movement is increased by nerve and tendon gliding exercises in the carpal tunnel and the flexor tendons excursion is increased in relative to one another. TOTTEN AND HUNTER, et al (1991) Proposed a series of exercises enhancing the gliding of the median nerve and tendon at the carpal tunnel for management of postoperative Carpal tunnel syndrome. They also suggested these exercises for non-operative Carpal tunnel syndrome. LAMINA PINAR, SAIT ADA AND NEVIN GUNGOR ET AL Stated that nerve and tendon gliding exercises included in conservative therapy approaches showed more rapid pain reduction and greater functional improvement in grip strength. HANNAH RICE MYERS, et al Stated that carpal tunnel exercises reduce the tension on the tendons in the tunnel and strengthen the weakened muscles of wrist and forearms. Even though nerve and tendon gliding exercises are effective when used alone, they have a greater effect when used along with other intervention such as splint. For people who are involving jobs with keeping their hands in a fixed position throughout the day such as typing secretaries, these exercises may help to prevent carpal tunnel syndrome from developing. VISUAL ANALOGUE SCALE POLLY E. BIJUR PHD, WENDY SILVER MA, E. JOHN GALLAGHER MD et al (2008) Conducted to study to assess the reliability of the visual analogue scale (VAS) for acute pain measurement as assessed by the intraclass correlation coefficients (ICC) appears to be high. The results showed that the Visual analogue scale (VAS) is sufficiently reliable to be used to assess acute pain. PAUL S. MYLES, MBBS, MPH, MD, FFARCSI, et al (1999) Stated Visual analog scale (VAS) is a tool widely used to measure pain. A patient is asked to indicate his/her perceived pain intensity (most commonly) along a 100 mm horizontal line, and this rating is then measured from the left edge (VAS score). The visual analogue scale score correlates well with acute pain. JOYCE, et al Suggested that visual analogue scale and another scales have been compared in terms of sensitivity, distribution of responses and preferences. Results of these studies appear equal. The visual analogue scale has been described as superior in one study because it was more sensitivity than any other scale. III. METHODOLOGY 3.1 STUDY DESIGN: Pretest and Posttest Experimental group study design. 3.2 STUDY SETTING: The study was conducted at Department of Physiotherapy, K.G.Hospital, Coimbatore. 3.3 STUDY DURATION: 3 weeks for each individual subject and the total duration was one year. 3.4 STUDY POPULATION: Patients with Carpal tunnel syndrome referred to the Department of physiotherapy, K.G.Hospital, Coimbatore. 3.5 STUDY SAMPLE: All patients with carpal tunnel syndrome who referred to Department of Physiotherapy, K.G. Hospital were selected. Among all patients, 20 patients who satisfied inclusive and exclusive criteria were selected and assigned into two groups, 10 of each by using Purposive Sampling method. 3.6 CRITERIA FOR SELECTION: INCLUSIVE CRITERIA: Age group above 30 years. Both sexes. Patients with mild to moderate unilateral carpal tunnel syndrome. Patients with Positive Tinel sign, Phalens test and Digital compression test. EXCLUSIVE CRITERIA: Patients with severe carpal tunnel syndrome Patients having thenar atrophy or denervation on electromyographic findings Patients with a neuropathy other than carpal tunnel syndrome in the past year Patient with history of steroid injection in carpal tunnel in the past 3 months Patients had a prior carpal tunnel release Cervical disc prolapse Degenerative changes of cervical spine Acute upper limb fractures Wrist and fingers stiffness Recent hand surgeries Deqeurains disease Pregnancy Acute Infections of Wrist and Hand 3.7 Variables: Dependent variable Pain. Independent variable Visual analogue scale. 3.8 Orientation of subjects: Before treatment all the patients were explained about the study and procedure to be applied and were asked to inform if they feel any discomfort during the course of the treatment. All the willing patients were asked to sign the consent form before the treatment. 3.9 OUTCOME MEASURES: Pain. 3.10 OPERATIONAL TOOLS: Visual analogue scale 3.11 STUDY PROCEDURE: 20 Patients with carpal tunnel syndrome were selected for this study after due consideration of inclusive and exclusive criteria. 20 patients were divided into 2 groups of 10 each. Group A: 10 patients received ultrasound therapy, splint and exercises. Ultrasound therapy with parameters of 1 MHz pulsed mode, 1:4, 1 w/cm2 is given 15 minutes per day, five times per week. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day. The total treatment duration is 3 weeks. Group B: 10 patients received only Splint and Exercises. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day. The total treatment duration is 3 weeks. 3.12 STATISTICAL TOOLS: Statistical analysis was done using Student t-test. Paired t test Where, n = Total number of subjects SD = Standard deviation d = Difference between initial and final value = Mean difference between initial and final value. (ii) Unpairedt test: To compare the pre test, post test values of both groups independentt test is used. Where, n1 = Number of subjects in Group A. n2 = Number of subjects in Group B. = Mean of Group A = Mean of Group B s1 = Standard deviation of Group A. s2 = Standard deviation of Group B. S = Combined standard deviation IV.DATA ANALYSIS AND INTERPRETATION TABLE-1 VISUAL ANALOGUE SCALE FOR PAIN GROUP A PAIREDt TEST Mean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group A who underwent Ultrasound therapy, Splint, Nerve and Tendon gliding exercises. S. NO VAS Improvement t value Mean Mean difference Standard deviation 1. Pre test 5.60 3.90 0.70 39.0 2. Post test 1.70 0.67 FIGURE-1 GRAPHICAL REPRESENTATION OF MEAN VISUAL ANALOGUE SCALE FOR GROUP A TABLE-2 VISUAL ANALOGUE SCALE FOR PAIN FOR GROUP B PAIREDt TEST Mean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group B who underwent to Splint, Nerve and Tendon gliding exercises. S. NO VAS Improvement t value Mean Mean difference Standard deviation 1. Pre test 5.40 3.0 0.70 20.12 2. Post test 2.40 0.52 FIGURE-2 GRAPHICAL REPRESENTATION OF MEAN VISUAL ANALOGUE SCALE FOR GROUP B TABLE-3 VISUAL ANALOGUE SCALE FOR PAIN PRETEST VALUES OF GROUP A VERSUS GROUP B UNPAIREDt TEST Mean, mean difference, standard deviation and unpairedt test of pre test v

Life :: essays research papers

Life; A Work In Progress The average person has a grand total of 2 billion seconds to live out their existance. For those of us lucky enough to live out this time in relative health, or to exceed it, shouldn't we be trying for something more? It ends, people. Life ends. There is coming a time when your heart stops beating and you lie dead and cold on the floor somewhere--and that is it. No redo's, no timeouts, no second chances. Only the bittersweet what-ifs that you will have plagued yourself with for the remaining moments of life. 2 billion seconds doesn't seem nearly as long as my life feels, and I am still a kid. And yet we waste time bickering over the television, fighting over the computer, and resenting each-other over petty quarrels. A saying comes to mind when you consider how sad people can be; when you honestly consider that they would throw their time away on such things. It is a classic case of not being able to see the forest, through all the trees. When infact, those trees that you are so desperately trying to see around are the forest. You are trying to get past that next tree and then, then the forest will be in plain site. Only, it isn't there, and one more tree is in the way. First the tree of graduation is in your way and soon the tree of college jumps behind it. The tree of mediocre jobs blocks your view for years as you try and see around it it. The tree of midlife, or of retirement get in your way as you try and see the trees of contentment, happiness and fulfillment that affirm that 'yes, you have made a difference', and that when your two billionth second chimes to a close, and your eyes glaze over, you will not have been forgotten. That is all we want, people. That is it. One simple goal that will push every American until they die. That one goal of having meaning. Trying to hold on to the fact that, "if I make a difference in someone else's life, then mine will have mattered." So the question is, if making a difference to someone else's life is so important, and they are trying for the same goal you are, then why isn't making a difference in your own life just as important.