Combating Female Genital Mutation In Sudan Essays -

Combating Female Genital Mutation In Sudan Combating Genital Mutilation in Sudan In the country of Sudan, in Northern Africa, there is a procedure that is tradition and is performed on most women called female genital mutilation, or FGM, which used to be known as female circumcision. It has been a normal practice for generations, but is now the subject for international controversy on the morality and safety of this procedure. It is now known that 82 percent of Sudanese woman have an extreme form of genital mutilation done on them, normally at a young age. This form of mutilation is called the Pharaonic form and includes the total removal of the clitoris and labia, and stitching together of the vulva, leaving only a small hole for urination and menstrual cycle. This is normally done without any type of anaesthetic or professional medical care. There is also a more moderate form of mutilation, called Sunni, where only the covering of the clitoris is removed. This practice started and became tradition in foreign countries in or der to ensure that women practice chaste behavior, and to suppress female sexuality. It has also been attributed to religious beliefs of monogamy although most religions do not support this type of practice. In today's society it has become more of a traditional and social norm, and has less to do with religious beliefs. This problem is not only in Sudan; it is practiced in the majority of the continent of Africa as well as other countries. In other cultures, such as Australian aborigines, genital mutilation is a part of the rite of passage into maturation, and is done on both men and women (Bodley, p. 58). FGM has often been referred to as female circumcision and compared to male circumcision. However, such comparison is often misleading. Both practices include the removal of well- functioning parts of the genitalia and are quite unnecessary. However, FGM is far more drastic and damaging than male circumcision because it is extremely dangerous and painful. It is believed that two t hirds of these procedures are done by untrained birth attendants, who have little knowledge of health. They are often unconcerned with hygiene, and many use instruments that are not cleaned or disinfected properly. Instruments such as razor blades, scissors, kitchen knives, and pieces of glass are commonly used. These instruments are frequently used on several girls in succession and are rarely cleaned, causing the transmission of a variety of viruses such as the HIV virus, and other infections. There are many side effects of this procedure including trauma, stress or shock from the extreme pain; and bleeding, hemorrhaging and infections that can be fatal from improperly cleaned instruments. There can also be painful and difficult sexual relations and obstructed childbirth. The effects of this one procedure can last a lifetime, both physically and pyschologically. Today, 85 to 114 million girls and women in more than 30 countries have been subjected to some form of genital mutilatio n. It was declared illegal in Sudan in 1941, although that did little to stop this age-old tradition. To this day, about 90% of women are still being subjected to the mutilation, especially if it is a family tradition. In various cultures there are many justifications for these practices. Many older women feel that if they have an uncircumcised daughter, she will not be able to find a husband and will become a social outcast. Family honor, cleanliness, protection against spells, insurance of virginity and faithfulness to the husband, or simply terrorizing women out of sex are sometimes used as excuses for the practice of FGM. Examples similar to this are found in other cultures, such as the Maasai, an African cattle peoples tribe. A clitoridectomy is performed on adolescent girls in this tribe as part of their rite of passage, and signifies that they are ready for marriage. This practice is openly accepted by these women as another ritual and a normal precondition of marriage (Bodle y, p. 121). The efforts to stop procedures of this kind are mounting though, especially with the help of women ages 16 to 30 who realize the dangers of this practice. These women can help to save their daughters and many other

Gerry Mulligan essays

Gerry Mulligan essays Gerry Mulligan was known for his outstanding writing skills along with his talent as a baritone saxophonist. Mulligans skills were developed at an early age, when he was seventeen he wrote for Jonny Warringtons radio band. Even before settling on the baritone sax, he played the piano and other various reed instruments. He also wrote arrangements for influential musicians such as Claude Thornhill and Stan Kenton (Down Beat 1). Mulligan became known for his work as an arranger, writer, and soloist on the Miles Davis Album The Birth of Cool. Some of Mulligans Compositions included on this album are Godchild and Jeru (Klinkowitz 233). His influential involvement with this album helped to launch his career. After his success he then moved to Los Angeles where Mulligan, along with trumpeter Chet Baker, formed the first piano-less quartet (Down Beat1) This was unheard of at the time, and was definitely a shock to the jazz community (Williams 29). The event that attributed to this unusual quartet happened at a gig one night when the piano player, Jimmy Rawles didnt show up. Due to the fact that the group was forced to play without him, Mulligan came to the realization that he could carry the band without the use of a piano. That night they cut three numbers and convinced a club owner that if he stored the piano elsewhere, it would create more space for people to sit. This in turn would increase the numbers of the audience, and therefore increase the profit. The owner, liking the idea, hired the quartet. This led to the start of the popularity of the piano-less After some time Chet Baker was replaced with trombonist Bob Brookmeyer (Excite 1). Brookmeyer had a happier more lively feeling that was in great contrast to the former quartet in which Baker as the trombonist. Their new sound worked for the group and the popularity grew. During the 1950s, ...

Business law assignment Essay Example | Topics and Well Written Essays - 1000 words

Business law assignment - Essay Example Additionally, the tax rates and reliefs are more favourable. Nevertheless, there are numerous administrative requirements in order to commence trading and companies are subject to strict financial reporting requirements, which can be cumbersome. Another option would be to set up a partnership, which can open up other business opportunities. The Partnership Act 1890 (the Act) regulates partnerships at common law. Unlike sole traders, partners share the business and control, decision making and profit and losses. All partners are jointly and severally liable for debts and â€Å"owe duty of good faith to each other5†. Section 28 of the Act further imposes a statutory duty to account and Law v Law6 determined that the impact of section 29 of the Act was to prohibit secret profits. The Act governs liability of partners and their legal obligations and provides that each partner is equally liable for the business regardless of their share of the ownership. Additionally, depending on the number of partners, partners can terminate and dissolve the partnership at any point resulting in automatic dissolution7. Therefore the main disadvantage of this trading medium is exposure to potential liability for acts of other partners under section 10. The other alternative would be to set up a limited liability partnership (LLP) under The Limited Liability Partnerships Act 2000 (LLPA). The LLP has certain similarities to limited companies and section 1(2) of the LLPA states that an LLP is a separate corporate entity with legal personality separate to its members. Accordingly, the distinct advantage compared to a general partnership is that an LLP can hold land and other assets in its own name, enter intro contracts with its own name and goes further in protecting partners from wrongful acts of other partners8. Moreover, in contrast to a limited liability company, as an LLP does not have any share

Client brief Essay Example | Topics and Well Written Essays - 2750 words

Client brief - Essay Example Byron Kakulas. The organization works for the children suffering from such ailments through fundraising activities, gaining of sponsorships and through donations. Total amount of fund raised during 2011 was estimated to rise by $200 Million in comparison to the 2010 period. The major contributors to the organization’s charitable fund comprised of 28 industries pertaining to resources and 49 industries pertaining to property and lease holdings. 1 Internal and External Environment Analysis of the Organization Internal Environment TOWS Matrix for the Concern The TOWS Matrix for Muscular Dystrophy Western Australia can be framed as follows reflecting the threats, weaknesses, opportunities and strengths of the concern. ... oreover another threat faced by the firm is possessing small number of offices that in turn make it hard for the company to manage the different volunteers allocated to different regions. 2 Weaknesses-Threats Lack of proper office infrastructure limits the ability of the firm to enhance its research objectives. Again owing to the lack of effective volunteers operating in large numbers the organization fails to deliver the best possible service to the ailing community. Weaknesses- Opportunities Though opportunities exist in terms of financing and community support from the firm’s external climate the company suffers from its incapability in forming strategic alliances with other health based organizations. Inability of the company to open proper offices in ailment prone zones makes it difficult for the company to render effective services in spite of finances and communal support.3 Strength- Opportunities The organization tends to render a larger growth opportunity for the peop le in the form of volunteers to grow with the company which presently operates based on a permanent team member of five people. Moreover the opportunities available from the external environment in the form of financial and communal support help the firm to grow and develop its human resources through training and developmental functions. External Environment Public The Muscular Dystrophy Western Australia organization focuses on gaining a large amount of public support owing to its community sharing and support programs aimed at enhancing the relationships with the parents of the ailing children. Through such community network the organization tends to forward potential advice and support. Moreover the organization supports the people suffering from career problems through holding of workshops

Evaluation of Professional Development Plan (Reflective paper) Essay

Evaluation of Professional Development Plan (Reflective paper) - Essay Example Established what made the communication process with patients difficult. 6th day I made a self-assessment to evaluate if I knew the different methods of communication and if I applied these to my patient. Established that I knew only few skills and methods in communication 7th day Established the different gaps of communication in my communication patterns Established the gaps I had in patient communication 8th day Reviewed information from books and journals on how other methods of communication can apply to health care scenarios Established how new skills in communication apply to efficient communication in health care 9th day Write down these methods and how each method can be carried out Wrote down how I can enhance my skills in communication 10th day Apply such methods in communicating with the patient Used new communication skills in communicating with patients 11th day Made a self-evaluation on the gaps seen in the communication with the patient while applying such new methods of communication: Established rapport with patients: use their names, make casual conversations, initiate introductions Established my weaknesses while applying new communication skills 12th day Made adjustments and changes in the application of such new methods of communication based on feedback from the patient and other health professionals Implemented changes in communicating with patients based on patient feedback. Reflection In applying the action plan above, I was able to discover that there are different communication skills which are needed to ensure efficient communication. First and foremost, I discovered that in effectively communicating with the patient, a two-way flow of ideas is a very effective means of communicating (McConnell, 1993). In this regard, I cannot be the one who keeps talking or the patient cannot also be the one who is talking. I found that in applying a two-way process of communication, I was able to gain much information from the patient (McConnell, 1993). I also found out that as a nurse, it is best for me to be the one to initiate introduction with the patient. I started off conversations by introducing myself to the patients with a handshake and a smile. This immediately made the patients relax and feel at ease (Young, 2009). Starting off the conversation with small talk also helped ease the communication process (Fernandez, 2010). After shaking hands with the patients, I made a casual remark about the weather. Most of the time, they easily responded to that; they also made negative or positive remarks about the weather. One time, I walked into a patient’s room while the patient was watching a basketball game on TV and we then started talking about the game and our favorite teams.

Peripheral Neuropathy among Patients Living with Diabetes

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

Literary Devices Used In Macbeth Essay -- essays research papers

Literary Devices used in Macbeth Imagine how dull a Shakespearean play would be without the ingenious literary devices and techniques that contribute so much to the fulfillment of its reader or viewer. Macbeth, by William Shakespeare, is a tragedy that combines fact and legend to tell the story of an eleventh century king. Shakespeare uses numerous types of literary techniques to make this tragic play more appealing. Three literary devices that Shakespeare uses to make Macbeth more interesting and effective are irony, symbolism, and imagery.   Ã‚  Ã‚  Ã‚  Ã‚  One technique that Shakespeare uses is irony. Verbal irony is when a character says one thing but means the opposite. When a reader understands the irony of what a character is saying, then he can truly understand the nature and intentions of the character. An example of verbal irony is when Macbeth says to Banquo, "Tonight we hold a solemn supper, sir,/ And I’ll request your presence" (Macbeth 3.1.13-14). The reader soon discovers that Banquo never makes it to the banquet because he is brutally murdered by order of Macbeth. Shakespeare also uses situation irony. This occurs when the results of an action or event are different than what is expected. An example of situation irony occurs when Macduff talks to Malcolm and discusses the tragedies that are taking place in Scotland. Without knowing that his own family has been slain Macduff says, " Each new morn/ New widows howl, new orphans cry, new sorrows/ Strike heaven on the fac...