Oral Reading Essay Example for Free

Oral Reading Essay Reading is a complex activity. It sends our brains into a frenzy of electrical impulses that zig and zag through matter in ways we still do not totally understand. It organizes sights and sounds in designs that ultimately connect us to the broad vistas of lifes many landscapes. Reading gives us the opportunity to appreciate those landscapes in all their variety. It is remarkable that, whatever approach, method, or ideology is used to teach reading, most students become proficient at it. For many students, successful reading is assimilated into their experience quickly and with seeming smoothness. For perhaps as many as 20% of students however, reading is not an automatic skill. Patterns of understanding have to be systematically instilled so that the reading has the opportunity to crack the alphabetic code. More and more, what we have learned is that connecting these alphabetic symbols to specific sounds in order to create meaningful words. There is considerable longitudinal research to support that we should employ literacy skills every time we read. Without this connection between the basic unit of sound and the alphabetic symbol, reading does not occur for any of us. Accurate identification of children who experience delays in attaining critical early literacy skills is needed to prevent reading problems. Studies have demonstrated that reading problems become increasingly more resistant to intervention and treatment after the 3rd grade. This study will focus on early core literacy skills. These needed core skills for young children are phonological awareness (ability to identify and manipulate sounds), alphabet knowledge (awareness of individual letters and letter names), and grapheme–phoneme correspondence (ability to identify correspondence between letters and sounds). Children’s abilities across these four core skills serve as important predictors of subsequent reading achievement. A screening instrument that does not comprehensively examine all core skills may be ineffective for identifying children who display limitations in a particular area of early literacy. However, failing to identify young children exhibiting delays in early literacy acquisition or lacking core literacy skills is a risky venture and this is a challenge that we will face in this study. Historical Background Name: Alyza Zofia Z. RenonAge: 5 Sex: FemaleDate of birth: March 10, 2006 Identification: Alyza is a normal, outgoing 5 year-old kindergarten girl. Since her mother is a pre-elementary teacher, she teaches her everything when they are at home. She enjoys dancing and playing games. She loves to listen about science-related topics whenever possible. She is talkative and loves to answer questions. She can only read alphabet and one or two syllable words with pictures. Affective Factors Alyzass motivational level apparently varies with the topic. According to her mother, if the topic is interesting to her like books with colorful pictures, she is highly motivated. However, if the topic does not appeal to her, she keeps silent or finds something to play with. Physical Factors Alyza has a very good eyesight, in terms of auditory acuity, Alyza showed no indications of difficulties. Alyza didnt show any other physical limitation; she appears to be physically healthy. This means, there are no obvious health-related reasons for her reading difficulties. Objectives: This research will aim to determine or identify student who is at risk or not at risk for reading problems. This study will also seek to answer the following questions: 1. How do the 3 literacy skills affect the reading of the child? 2. How does the students background affect her reading ability? 3. What are the strengths and weaknesses of the child in reading? Significance of the study The researchers hope that the study will be beneficial to the following: To the student, who will learn and improve her reading skills. Likewise, to the teachers of kindergarten, for they will focus more on the three literacy skills. Furthermore, to the researchers, to understand the factors that affect the poor reading ability of the child. Lastly, to the school administration, this study will provide basis to improve their curriculum and to focus more on literacy skills in pre-elementary department. Scope and Delimitation of the study This study will be conducted to determine the literacy skills of a kindergarten child. It will deal on how the child identify and manipulate sounds, her awareness of letter names and ability to identify correspondence between letters and sounds. It will discuss the certain measures, steps and ways on how to develop the literacy skills of the child in reading but it does not deal on the ways on how to pronounce the words correctly nor steps on how to syllabicate the words properly. The respondent of the study will be limited to kindergarten student only. Research Paradigm Chapter 2 Review of related literature Local According to Unicef Philippines, there are only 63% of the children who enroll in school complete primary school, this means that the quality of education remains poor in many areas of the country. A childs literacy skills are important to their success in school and work. Children who learn to read from an early age are generally more successful in academic areas. (Unicef Philippines) There were a research in 2008 conducted by by Bananal, a faculty member of arts and letters in U. S. T on how to measure the reading ability of grades 1 and 2 students. She stated that there were 3 levels in reading: Independent reading level pupil can read with ease without the help or guidance of a teacher. The student can also read with rhythm, with a conversational tone and can interpret punctuation correctly. Instructional reading level pupil can profit from instruction. Frustrated reading level pupils show symptoms or behavior of withdrawing from reading situation and commit multiple type of error in informal reading. Reading levels of children Grade 1 Frustrated reader 64. 41% Instructional reader 20. 17% Independent reader 15. 42% Grade 2 Frustrated reader 49. 98% Instructional reader 31. 40% Independent reader 19. 07% The result showed that there many students who encountered difficulties in oral reading. This means that children did not master the three literacy skills when they were in the primary level. The use of accurate, valid, reliable screening tools several times throughout the early years can help in the identification of those in need of monitoring further intervention or remediation. Information obtained from early reading screenings is likely to lead to positive changes in childrens reading trajectories because prevention strategies and interventions provided have a better chances of success when started sooner rather than later (Bananal, 2008). Foreign The negative effects of reading problems are well documented (Harris Sipay, 1990). There is evidence that reading disability is associated with social, economic, and psychological problems. There is little evidence, however, that efforts to correct reading problems through remedial reading programs or through special education placement have been very successful (Allington McGill-Franzen, 1989; Hiebert Taylor, 1994; Johnston Allington, 1991; Karweit, Slavain, Wasik, 1992-93; Kennedy, Birman, Demaline, 1986; Rowan Guthrie, 1989). Instead, there is evidence to suggest that children who encounter difficulty in learning to read fall further and further behind their achieving peers (Stanovich, 1986). Traditional approaches to dealing with reading problems, such as tracking and grade retention, do not help; indeed, they often appear to be detrimental to eventual student achievement (Shepard Smith, 1989; McGill-Franzen Allington, 1993). In contrast, a growing body of evidence suggests that reading problems are preventable for the vast majority of students who encounter difficulty in learning to read, if these students receive extra support in the form of an early intervention program (Goldenberg, 1994; Hiebert Taylor, 1994; Reynolds, 1991). In this paper, the term early intervention refers to early school intervention programs that are designed to prevent problems in literacy from developing rather than trying to correct a problem after it is established. For the most part, such programs have been used in first and second grades. Several of these programs have proven very effective when compared to conventional compensatory reading programs. For example, Hiebert, Colt, Catto, and Gury (1992) report that while 77 percent of the students in their early intervention project were reading at a primer level at the end of first grade, only 18 percent of a comparison group who participated in a traditional Title I program achieved that level of reading proficiency. While almost half (47 percent) of the students in the conventional Title I program remained nonreaders at the end of first grade, only 7 percent of the early intervention students were nonreaders. Thus, a growing body of evidence suggests that almost all reading problems are preventable. A review of the research literature indicates that there are at least five early reading intervention programs that have documented effectiveness. This paper will only very briefly describe the individual programs and then will concentrate on the factors that seem characteristic of all or at least most of these successful intervention programs. Two of the five programs, Success for All (Madden, Slavin, Karweit, Dolan, Wasik, 1991; Slavin, Madden, Karweit, Livermon, Dolan, 1990; Slavin, Madden, Karweit, Dolan, Wasik, 1992), and the Winston-Salem Project (Cunningham, Hall, Defee, 1991; Hall, Prevatte, Cunningham, 1993), involve comprehensive reorganization of the entire classroom routine; all students in the grades in which the program is implemented are affected. In the Winston-Salem Project all first and second grade reading/language arts instruction was reorganized around four major, thirty-minute blocks of activities: teacher-directed group reading activities, word learning activities, writing, and self-selected reading. In addition, in the school that served a very high proportion of at-risk students, an additional 45-minute block of time for very small-group instruction was included. During this small-group instruction time, students had additional opportunities to practice reading, writing, and word learning activities. Though it has now been implemented in more than 85 schools, Success for All was first implemented in schools in major metropolitan areas that served, almost exclusively, children from low socioeconomic backgrounds who had few experiences with literacy. Major features of this schoolwide program included heterogeneous grouping for most of the day, cross-grade grouping according to reading level for 90 minutes of smaller group (15 to 20 students) reading instruction, and one-to-one tutoring for those students  who needed extra support. The Boulder Program (Hiebert, Colt, Catto, Gury, 1992) and Reading Recovery (Clay, 1985; Clay, 1993; Clay, 1993a; Pinnell, 1989; Pinnell, Fried, Eustice, 1990) are add-on, pull-out programs; they are added to whatever approach to language arts instruction is being used in a school. The Reading Recovery Program, which originated in New Zealand, has been widely implemented in the United States and in several other countries as well. It is exclusively a first grade, one-to-one tutoring program. Reading Recovery is also recognized for the extensiveness of its teacher training program, which is conducted over the course of a year with fully certified teachers. The Boulder Program operated exclusively with the resources of a Title I program. The program worked originally with a pupil-teacher ratio of six students for each teacher. Through the use of carefully trained, supervised paraprofessionals who worked closely with certified, trained teachers, the ratio was reduced to three students for each teacher. Instruction was daily for twenty minutes. The Early Intervention in Reading Program (EIR) (Taylor, Frye, Short, Shearer, 1992; Taylor, Strait, Medo, 1994) takes yet another approach. Regular first and second grade classroom teachers work for an extra twenty minutes with the five or six students who are encountering the greatest amount of difficulty in learning to read. Provision is also made for these students to practice their reading for an additional five or ten minutes each day by reading individually or in pairs to the teacher, a teachers aide, a volunteer, etc. All five programs clearly acknowledge that the small-group or individual early intervention instruction that students receive is an addition to, not a substitute for, the instruction they receive as part of the regular classroom program. In the case of two of the programs (Success for All and the Winston-Salem Project), regular classroom reading instruction has been redesigned to ensure that appropriate instructional routines and materials are used. However, even when early intervention instruction is added to an effective existing reading program, there is also the anticipation that the sound practices that are part of the early intervention program will become infused into regular classroom instruction if they are not already part of it. For example, Reading Recovery teachers almost always spend part of their day as regular classroom teachers, reading consultants, language arts coordinators, etc. ; through these roles they attempt to introduce  instructional principles and practices that are part of Reading Recovery into the ongoing regular classroom. All of the programs reflect a model of reading as an active, meaningful, constructive process. Before-reading activities are used to build or activate relevant background knowledge, concepts, and vocabulary. Students are taught to monitor their reading to ensure that what they are reading makes sense. They are taught strategies for correcting word recognition errors that detract from meaning, and they are given opportunities for reacting and responding to selections they have read. The texts they are asked to read are read for enjoyment and for information. Other activities are developed within a framework of reading for meaning. Because reading for meaning is the constant point of reference and because students in these programs need substantial help in building word identification skills, the amount of time spent in discussing selections and in teacher questioning about the selection is kept to a minimum.

English Transformation Practice Essay Essay Example for Free

English Transformation Practice Essay Essay Composers often use different methods to portray similar ideas to their audience. How have the two texts you have studied reflect the same ideas in different ways?  Shakespeares Taming of the Shrew and Jill Junges 10 Things I Hate about You are examples of where composers have used different methods to portray similar ideas to their audience. This essay will compare the three common themes the texts share, including marriage and dating, deception and disguise and the role and hierarchy of women in society. By comparing the dramatic and film techniques used in each of these respective texts, the common themes are expressed in their individual ways which ultimately are able to engage their audiences. Traditionally, economics and financial gain have been the more important aspect in relationships, especially marriage, as opposed to love. The marriage and dating customs of society have remained relatively similar overtime. In Taming of the Shrew, the audience is given an exclusive view into what marriage meant to society and individuals of the Elizabethan period. William Shakespeare conveyed how marriage as a financial gain was specifically applied to peoples during his era in Taming of the Shrew, where in Act 1 Scene 2, Petruchio and his servant Grumio visit Hortensios house. Petruchio boldly announces his quest to wed a rich wife. I come to wive it wealthily in Padua, if wealthily then happily in Padua. Such a blunt statement clearly shows Petruchios gold digger of a personality and his values when it comes to marriage, most likely influenced by the society he lives in. When Hortensio refers Petruchio to Katherina as part of a devious scheme for Bianca, the dramatic irony only further enhances how when it comes to women, men of Petruchios standard prioritize marriage as a financial transaction first, then their own feelings or even the feelings of the intended and that the view of the female is not taken into account. In this way, Shakespeare is able to demonstrate the value of marriage and by comparing this to 10 Things I Hate about you, it is evident that the same values still apply. The modern day teenage filmic text is still able to portray marriage and dating mostly as a profitable process through a different setting. When Joey asked Patrick to take out Kat, again, for his own warped benefit, including the punchline that if Patrick were to make Kat his own problem, a generous compensation would be rewarded, Patrick immediately becomes interested. youre going to pay me to take out some chick? How much?. This question highlights Patricks cleverly concealed interest in this deal because it ultimately involves money. Throughout this scene, Joey is seen mostly cast in sunlight, which suggests an almost innocent like motive to his request, where as Patrick is seemingly more of the selfish, sullen and nasty party in his business deal, because it is all for money, and he is completely disregarding or holding no respect for what Kats opinion and emotions might be on this matter if she heard of it. Jill Junge also makes effective use of medium shots, where the surly facial expressions of Patrick and arrogant body language of Joey and Patrick can be observed in more detail during their conversation. It also shows the reactions and emotions of them both whilst finalizing their business deal. The camera works and techniques of Jill Junge in this scene evidently express the monetary benefits of marriage and dating throughout time, from Shakespeares time well into the modern day. Deception and disguise in the two set texts involves harmlessly deceiving one, or multitudes of people by impersonating someone, or good at something theyre in actual fact not, the result of which is gaining something in personal value. Shakespeare expresses his interpretation of deception and disguise through Act I Scene II where upon arrival in Padua Lucentio and Tranio swap identities with each other as part of the plan to capture Biancas heart. Tranio assures when I am alone, why then I am Tranio, but in all places else, your master Lucentio. Master and servant are well disguised as someone theyre not, and the chess pieces are set. Furthermore, Baptista, Bianca, Petruchio and the others of the story are deceived by the role swapping of Lucentio and Tranio. Again, the use of dramatic irony further increases the masquerade atmosphere developing in this scene, thus supporting the theme of deception and disguise, for masquerades often involve not knowing the identity of anyone as their face is so effectively shielded with masks. Shakespeare cleverly inserts the concept of deception and disguise within his play that it becomes an important and crucial element to the plot, and when compared back to 10 Things I Hate about You, deception and disguise is another important and crucial element to the plot.

Health Essays Treatment OCD Disorder

Health Essays Treatment OCD Disorder Treatment OCD Disorder Introduction My research intention is to compose a literature review aimed at finding the best existing method for the treatment of Obsessive-Compulsive disorder (OCD). OCD is an anxiety disorder characterized by intrusive and distressing thoughts, urges and images as well as repetitive behaviours aimed at decreasing the discomfort caused by these obsessive thoughts. So in order to achieve my research intention I will be comparing and analysing a wide assortment of current and previous literature to distinguish the most favourable treatment method, where advantages outweigh all disadvantages. The key features of OCD as already discussed, include obsessional doubt, the need to feel in control, and risk aversion, and these features have significant impact on the successful application of both pharmacological and behavioural treatments. Treatment History of Obsessive-compulsive disorder Until the 1960’s OCD was considered a refractory psychiatric condition, neither psychotherapy nor a variety of pharmacological treatments had proven successful with the symptoms, however since around 1975, much progress has been made in improving the effectiveness of these treatments. Prior to 1980, OCD was unresponsive to psychotherapy, anxiolytic drugs, and anti-psychotic drugs and had a poor record of success. Today although treatment of this disorder remains challenging, the effectiveness of both behavioural and pharmacological therapies has been significantly improved. Treatments There are many methods available for the treatment of obsessive-compulsive disorder (OCD) arguably the most popular of these being administration of antidepressants, either taken singularly or a combination of 2. Also Psychotherapy strategies including both behavioural and cognitive treatments where it is common (and often claimed to achieve better results) for the two to be combined, this is known as Cognitive Behavioural Therapy (CBT). I will then go on to investigate Combination treatments. This being the combination of antidepressants and a CBT treatment to see if a combination of the two is more successful than using either alone. Alternative strategies are available for OCD sufferers and although these are not as successful as some of the already discussed, they are worth mentioning as they can provide relief to patients, also when added to another more established treatment better results may be achieved. I will also be touching on psychosurgery (also known as neurosurgery), and Electro Convulsive therapy, which although are only used in the most extreme cases, are still worth mentioning as, when used, have shown significant efficacy in the treatment of OCD. Pharmacotherapy, the uses of antidepressants for the treatment of Obsessive-compulsive disorder. Currently in the UK only 5 drugs are licensed for the treatment of OCD, They include the Tricyclic antidepressant (TCA) Clomipramine and the Selective Serotonin reuptake inhibiting (SSRI) antidepressants Fluoxetine, Sertraline, Paroxetine, and Fluvoxamine which can be collectively labelled as STI’s, these STI’s represent the cornerstone of Pharmacological treatment in patients with OCD. A good reason for using antidepressants in OCD treatment is that very often there will be underlying depressive disorder. There is a substantial amount of evidence derived from a large number of placebo-controlled clinical trials, to indicate that drugs, which preferentially block the re-uptake of Serotonin, are effective in ameliorating the symptoms of OCD. The evidence in favour of other antidepressants without potent serotonergic properties is poor. Clomipramine was the first agent to receive food and drug administration (FDA) approval for the treatment of OCD, and was also the first medication to demonstrate consistent efficacy in the treatment of patients with OCD (Clomipramine collaborative study group) it has been the most extensively studied medication for the treatment of OCD. Studies in OCD treatment that have compared two antidepressants have been very small and yet an apparent superiority of Clomipramine emerges. In a small three-way study by Thoren et al (94), which compared Clomipramine with Nontriptyline and Placebo, found there was significant effect for Clomipramine but Nontriptyline appeared no different from Placebo. However a significant difference between active treatments is not normally expected unless very large numbers are included in studies. Clomipramine which affects both 5-HT and non adrenalin may be more effective than SSRI’s although does have more side effects which is the biggest disincentive, these include constipation, dry mouth, tremor and weight gain, however these side effects can be used to advantage in patients who cannot deal with the agitation of the SSRI’s During trials, drop out rates due to side effects from Clomipramine are consistently higher than for the SSRI’s. (Pata et al 90) Although there are only rare reports of less efficacy, the issue of how long to maintain treatment before a trial off medication has not been well explored. The only data that exists in this area comes from 3 rather small-blinded discontinuation studies. All were done with Clomipramine. (Pato, Zohar, Kadouch, Zohar Murphy 1988) in each case, the majority of the patients upwards of 90% had their symptoms return within 4-7 weeks of discontinuing medication. The efficacy of SSRI’s versus those of the TCA’s, for these indications is unstudied, further research is required fully to assess the place of the SSRI’s in the treatment and understanding of OCD. Fluvoxamine has been shown to be significantly better than Placebo and equal in efficacy to Tricyclic’s such as Clomipramine however Fluvoxamine compared to Clomipramine is found to have fewer side effects and is a first line agent in the treatment of OCD. More than 50% of patients with OCD are significantly improved after a trial with Fluvoxamine, however not all patients benefit from this treatment- In a single-blind study of Fluvoxamine 6 of 10 in patients with severe OCD were ‘responders’ on the basis of a clinical rating of ‘much’ or very ‘much’ improved. The most commonly reported side effects for Fluvoxamine are daytime drowsiness, nausea, insomnia, and headache. However these seem to be common side effects of all the SSRI’s. The effects of Fluoxetine in OCD have been studied in a number of single blind and open trials, and the results indicate that Fluoxetine is effective in reducing the symptoms of OCD; these results also appear to be dependent of the drugs antidepressant effect. (Liebowitz et al 1990, Riddle et al 1990) While these studies suggest that drugs with Serotonin re-uptake blocking properties are effective in OCD, they do not bear on which of these drugs may be more effective or better tolerated. Although no such comparative trials have been published, Jenike and associates (1990) indirectly compared Fluoxetine with Clomipramine in OCD symptoms in a recent meta-analysis. The data came from two separate open studies of each compound in OCD, and the special statistical techniques used suggested that Clomipramine had a slightly superior therapeutic effect. Fluoxetine however was considerably bettered tolerated. Fewer data is available on Fluoxetine, ideally more research is needed to better understand its place in OCD treatment. Paroxetine efficacy reports back to Wheaden et al (1993) however a more recent study (Zohar et al 1996) reported that in a 12 week acute trail comparing patients on Paroxetine, Clomipramine and Placebo, only 16% of Paroxetine patients had drug related adverse experiences, compared to 28% on Clomipramine, and although generally well tolerated, there have been some reports of severe withdrawal symptoms, even when done gradually. This however may be related to the fact Paroxetine is a newer FDA approved agent for OCD, and there have not been as many published findings of its efficacy compared to other agents available. Sertraline has generally shown significant improvement in OCD symptoms when compared to placebo (Greist et al 95), and although Sertraline does have the smallest effect size, with regard to side effects it is well tolerated. However unlike Fluoxetine, Fluvoxamine and Paroxetine there are no head to head trials comparing it to other antiobsessionals. Some advantages of the SSRI’s are that they have fewer clinically meaningful interactions, for example, they do not potentiate the effects of alcohol, or other sedatives- (Cooper et al 1989), however as not all of the SSRI’s have been tested with all drugs generalisations are difficult. One meaningful global measure of how well medications are tolerated is the number of patients who have dropped out of double-blind trials because of adverse effects. Most double blind studies of SSRI’s have had more dropouts among patients treated with tricyclic antidepressants such as Clomipramine. Within the SSRI’s the highest dropout rate was associated with Fluvoxamine and the lowest with Paroxetine. While the number of dropouts provides useful information, this variable is also important for the examination of specific side effects. When considering a combination of 2 types of drugs there is rarely any rationale for prescribing together more than one drug from the same general class. Fatalities have been reported following the combination of Clomipramine and Tranylcypromine. Other combinations can lead to adverse effects. TCA’s and SSRI’s have been tried together but there is a high risk of adverse interactions. If the two-antidepressant classes were to be co prescribed the safest choice would appear to be Citalopram, or low dose Sertraline that have little or no effect on the metabolism of TCA. (Taylor 95) ‘Triple therapy’ has also been tried, one example being Clomipramine, Tryptophan and Lithium. When considering Pharmacotherapy treatment failure, comparative dropout rates rather than number of intensity of side effects, may be a good indirect measure of the tolerability of the medication, the results in this regard have been mixed but very interesting. In comparative studies between Fluvoxamine and Clomipramine (Freeman et al 1994, Koran et al 1996) dropout rates were virtually identical with both medications around 15%. However in the meta-analysis conducted by Greist et al 1995 they note that analysis of the pooled multicenter studies revealed the lowest rates of dropout in the Clomipramine group at 12%, followed by Fluvoxamine at 24%. There are some data on the characteristics of patients who are more resistant to treatment or poor treatment responders, but more work is needed in this area. For example, many OCD patients have shown poor response to Pharmacotherapy in some studies. (Jenike 93, Riccardi et al 92), and more recently (Black, Manahan, Clancy, Baker, and Gabel 97) Psychotherapy in the treatment of Obsessive-Compulsive disorders a Cognitive-Behavioural approach. Research has shown that psychological and social treatment can produce definite and measurable benefits (Kingdon et al 1994). Cognitive behavioural therapy leads to marked improvement in the large majority of clients with OCD who complete the treatment, and has been estimated that between 80/90% of patients will respond to CBT (Abramowitz 97) In Meyers (1966) treatment plan hospital staff actually stopped the patients from performing rituals-this treatment procedure was labelled ‘exposure and response prevention’ (EX/RP). However this kind of intervention is no longer typical or recommended. Actual physical prevention is too coercive to be acceptable-and reliance upon this technique may limit generalizability to non-therapy situations in which staff are non-present to prevent rituals. Although exposure reduces obsessional distress it is not so effective in reducing compulsions. Exposure and response prevention (EX/RP) is the psychological treatment of choice for OCD. Although other interventions (Cognitive approaches) have received some attention in the literature EX/RP has received by far the strongest empirical support for treating. Despite documented efficacy of EX/RP treatment 25% of individuals with OCD decline to accept this form of CBT. Efforts to understand the factors influencing acceptability of exposure treatment are indicated so that more clients may profit from this powerful remedy. Separate effects of exposure and response prevention for OCD have been examined, treatment that combined both exposure and response prevention was found to be more effective. (Foa, Steketee, Grayson, Turner, Latimer 1984) With non-ritualisers, exposure did not prove particularly effective. Emmelkamp Kwee (1977) noted only 1 of 3 patients showing improvement after 5 one-hour sessions. Although exposure reduces obsessional distress it is not as effective as reducing compulsions. It is generally held that patients with obsessions alone, rather than obsessions and compulsions are more difficult to treat using conventional behavioural procedures. However recent research is inconsistent with this view as patients in 2 studies evidenced some improvement in compulsive behaviour with this technique. (Marks, Crowe, Young Dewhurst 69) CBT has been found to be more helpful than drugs for individuals who complete it. About 75% of clients who complete CBT do well both immediately after treatment and in the long run, showing lasting improvement of about 65% fewer symptoms on average-also no side effects. Drugs, mainly antidepressants in this condition, are easy to administer and are more rapidly effective than the main forms of behaviour therapy, response prevention and gradual exposure. However unlike drug treatment, once behaviour therapy has been used and shown to be effective, relapse is much less likely to occur even after treatment is withdrawn completely. A number of other exposure-orientated procedures, such as paradoxical intention, imaginal flooding, satiation, and aversion relief have been found relatively unsuccessful with OCD. Procedures aimed at blocking or punishing obsessions and compulsions such as though stopping, aversion therapy, and covert sensitisation have also been relatively unsuccessful with OCD. (Emmelkamp Kwee 1977, Kenny, Mowbray Lalani 1978) Conversely Victor Meyer treated clients with OCD with prolonged exposure to situations of objects that evoked obsessional distress and prevention of rituals-the treatment was very successful in 10 of its 15 cases. (Meyer 1966, Meyer Levy 1973, Meyer, Levy Schnurer 1974) Another downfall that the literature indicates is that OCD patients who have additional psychological problems are less likely to respond favourably to CBT, these include depression, anxiety or poor judgement, and unfortunately these often coexist with OCD symptoms. Combination treatments, Antidepressants CBT in Obsessive-Compulsive disorder. As already discussed, effective treatments for OCD consist mainly of Cognitive behavioural therapy and antidepressants. In order to maximise the effects of treatment, antidepressants and CBT are frequently combined in clinical practice, despite the fact that scientific support for this is surprisingly thin. Preliminary findings of a controlled, double blind, multicenter comparison of Clomipramine, exposure therapy and their combination indicate that exposure therapy have stronger effects than Clomipramine-both procedures combined are equivalent to exposure therapy alone. (Foa et al 93) Also Combination of EX/RP was not enhanced by the addition of cognitive therapy (Emmelkamp Beens 1991). However findings by Van Oppen et al (95) show that cognitive approaches compared to EX/RP indicated that cognitive therapy alone was as effective as exposure therapy. A recent meta-analysis (Van Balkom et al 94) showed that CBT was superior to antidepressants on self-ratings, also compared with CBT; antidepressants have a higher dropout rate and higher relapse rate after stopping treatment. Thus when given alone CBT is more effective than antidepressants. However meta-analysis have shortcomings, firstly since studies are combined, there is always a mixture of the specific study details such as the way in which treatments were implemented, also studies differ in length, therapist involvement, and strictness of ritual control, leaving many reasons to believe that the results of meta-analysis are not conclusive. Conversely one large multicenter study carried out by the national institute of mental health compared 2 forms of psychotherapy with antidepressant drug treatment, all treatments were approximately equally effective over the period of study when mildly ill people were assessed, however, with more severely ill patients, drug treatment was clearly superior to psychotherapy. (Elkin et al 1989) Third line treatments-Electro compulsive therapy and Psychosurgery for Obsessive-compulsive disorder. If psychosocial and pharmacological treatments do not work, third-line treatment includes Psychosurgery and electro convulsive therapy (ECT). Although rarely used electro convulsive therapy (ECT) has been shown to be of benefit in some who failed to respond adequately to Pharmacological or Psychotherapy interventions (Strober et al 98). In many cases there will be temporary amnesia post treatment and mild headache but otherwise ECT is free from side effects. This makes it distinct from the anti-depressants, and it is for this reason that ECT is still used. Studies using ECT however lack any control data that allow a conclusion to be reached about its efficacy. Psychosurgery like ECT has aroused a great deal of controversy. Results suggest that 25-30% of the patients who previously were unresponsive to medication and behavioural treatments are significantly improved after psychosurgery, although should always be considered as a last resort, studies suggest that complications are relatively rare and that neuropsychological and personality functioning is not adversely effected by psychosurgery Some Conclusions. In sum, there are 2 very good treatments for OCD. CBT seems to produce more improvement than medication, and improvements are more lasting after treatment is stopped. Medication however does take less time and effort in the short run than CBT but may have to be continued indefinitely. Medication is not emotionally challenging but you must tolerate side effects, EX/RP requires determination and is emotionally challenging. With regards to treatment failure Foa et al (1983) argue that it is only when investigation is carried out of the differences between those who succeed and those who fail, that light can be thrown on the mechanisms involved in the treatment and more effective treatment strategies be developed, as it is evident that new and more effective pharmacological and psychotherapy strategies are needed for the treatment-refractory OCD patient.

Foreshadowing in Kate Chopins The Storm Essay -- Chopin Storm Essays

Foreshadowing in The Storm Effectively using foreshadowing in a piece of literature enhances the reader's curiosity. One clear example of such usage is seen in Kate Chopin's writing. Her use of foreshadowing in the short story "The Storm" adds an element of intrigue, holding the reader's interest throughout. In this story a father and son, Bobinôt and Bibi, are forced to remain in the store where they were shopping, waiting for an approaching storm to pass. Meanwhile, the wife and mother, Calixta, remaining at home, receives an unexpected visit from a former lover of hers, Alcée. The two lovers ultimately consummate their relationship. Alcée then departs once the storm subsides, at which time the father and son return home. No repercussions of the extramarital affair take place within the story. Perhaps the clearest examples of foreshadowing in "The Storm" are the made when Chopin introduces the storm, writes that Calixta and Alcée had never been alone together since her marriage, calls attention to Calixta unbuttoning her garment because of the heat, mentions the distance separating Calixta from her husband and son and describes Calixta's physical appearance. These areas of foreshadowing maintain the reader's interest in the story and prepare the readers for the turn of events. The first such signal given to the reader is found in the opening paragraph of the story. The atmosphere and the approaching storm are described and contrasted. The opening atmosphere's tranquility is apparent because "[t]he leaves were so still that even Bibi thought it was going to rain" (665). This stillness prior to the storm ... ...anate seed. Her white neck and a glimpse of her full, firm bosom disturbed him powerfully" (667). This passion leads to physical touching, congering up past passionate feelings towards one another, ultimately leading to their intercourse. As seen in "The Storm," Chopin makes good use of foreshadowing throughout the short story. Had Chopin omitted her foreshadowing, the story would have lost much of its believability. It also would create an irrational storyline in which the extramarital affair occurs without any explanation or rationale. This would more than likely cause the reader to discount the story as unrealistic. Therefore, it is crucial that one notices the vital role foreshadowing plays in literature. Chopin did an excellent job in convincingly describing the turn of events in "The Storm" by using foreshadowing to do so.

Tender Is the Night Parallels Fitzgerald’s Life Essay -- Tender Is the

Tender Is the Night Parallels Fitzgerald’s Life Away! Away! for I will fly to thee, Not charioted by Bacchus and his pards, But on the viewless wings of Poesy Though the dull brain perplexes and retards: Already with thee! Tender is the night†¦ -From â€Å"Ode to a Nightingale† by John Keats Charles Scribner III in his introduction to the work remarks that â€Å"the title evokes the transient, bittersweet, and ultimately tragic nature of Fitzgerald’s ‘Romance’ (as he had originally subtitled the book)† (Fitzgerald ix). Tender Is the Night parallels Fitzgerald’s own struggles with his mentally ill Zelda, and the characters are carefully constructed from his interactions with the social elite of artists, composers and Hollywood personas on the French Riviera and Rome, among other settings. From the fall of 1925 to the spring of 1934, Fitzgerald revised his fourth novel seventeen times before it was published—he was still revising it when he died in 1940. Over those years he continually promised Perkins the novel, but had to delay due to his incessant creative manipulation and extenuating personal circumstances. When he began work on the novel in 1925, he was battling debt and a severe drinking problem. His idea for his fourth novel centered around matricide and a movie director named Francis Mularky. In this version, the protagonist Mularky befriends an expatriate group and then mentally falls apart, subsequently killing his mother. The inspiration for this character, according to Bruccoli, came from two of Fitzgerald’s friends: Theodore Chanler, a composer that shared in the over-indulgent expatriate life with F. Scott and the couples, the Murphys and the MacLeishes, and then abruptly dec... ...ultiple sanitariums and found himself attracted to a young actress, Lois Moran. The novel is a chronicle of the unraveling of a character that eerily foreshadows Gatsby’s own unraveling from a drinking problem, an ailing wife and fading professional success. Works Cited: Bruccoli, Matthew J. â€Å"A Brief Life of Fitzgerald.† F. Scott Fitzgerald: A Life in Letters, ed. Bruccoli with assistance of Judith Baughman. New York: Scribner’s, 1994. Online: http://www.sc.edu/fitzgerald/biography.html Bruccoli, Matthew J. The Composition of Tender Is the Night. Pittsburgh: University of Pittsburgh, 1963. Fitzgerald, F. Scott. Tender Is the Night. New York: Scribner, 1933. 1982 ed. Stern, Milton R. Tender Is the Night: The Broken Universe. New York: Twayne, 1994. Other Sources: â€Å"Books and Works.† Tender Is the Night Parallels Fitzgerald’s Life Essay -- Tender Is the Tender Is the Night Parallels Fitzgerald’s Life Away! Away! for I will fly to thee, Not charioted by Bacchus and his pards, But on the viewless wings of Poesy Though the dull brain perplexes and retards: Already with thee! Tender is the night†¦ -From â€Å"Ode to a Nightingale† by John Keats Charles Scribner III in his introduction to the work remarks that â€Å"the title evokes the transient, bittersweet, and ultimately tragic nature of Fitzgerald’s ‘Romance’ (as he had originally subtitled the book)† (Fitzgerald ix). Tender Is the Night parallels Fitzgerald’s own struggles with his mentally ill Zelda, and the characters are carefully constructed from his interactions with the social elite of artists, composers and Hollywood personas on the French Riviera and Rome, among other settings. From the fall of 1925 to the spring of 1934, Fitzgerald revised his fourth novel seventeen times before it was published—he was still revising it when he died in 1940. Over those years he continually promised Perkins the novel, but had to delay due to his incessant creative manipulation and extenuating personal circumstances. When he began work on the novel in 1925, he was battling debt and a severe drinking problem. His idea for his fourth novel centered around matricide and a movie director named Francis Mularky. In this version, the protagonist Mularky befriends an expatriate group and then mentally falls apart, subsequently killing his mother. The inspiration for this character, according to Bruccoli, came from two of Fitzgerald’s friends: Theodore Chanler, a composer that shared in the over-indulgent expatriate life with F. Scott and the couples, the Murphys and the MacLeishes, and then abruptly dec... ...ultiple sanitariums and found himself attracted to a young actress, Lois Moran. The novel is a chronicle of the unraveling of a character that eerily foreshadows Gatsby’s own unraveling from a drinking problem, an ailing wife and fading professional success. Works Cited: Bruccoli, Matthew J. â€Å"A Brief Life of Fitzgerald.† F. Scott Fitzgerald: A Life in Letters, ed. Bruccoli with assistance of Judith Baughman. New York: Scribner’s, 1994. Online: http://www.sc.edu/fitzgerald/biography.html Bruccoli, Matthew J. The Composition of Tender Is the Night. Pittsburgh: University of Pittsburgh, 1963. Fitzgerald, F. Scott. Tender Is the Night. New York: Scribner, 1933. 1982 ed. Stern, Milton R. Tender Is the Night: The Broken Universe. New York: Twayne, 1994. Other Sources: â€Å"Books and Works.†

The Rivers Of France :: Geography France Rivers Water Essays

The Rivers of France The Rhà ´ne system The Rhà ´ne is the great river of the southeast. Rising in the Alps, it passes through Lake Geneva (French: Lac Là ©man) to enter France, which has 324 miles of its total length of 505 miles. At Lyon it receives its major tributary, the Saà ´ne. In eastern France the direction of the main rivers is predominantly north-south through the Alpine furrow. The regime of the Rhà ´ne is complex. Near Lyon the Rhà ´ne and its important Isà ¨re and Drà ´me tributaries, draining from the Alps, have a marked late spring-early summer peak caused by the melting of snow and ice. While this peak is generally characteristic of the river as a whole, it is considerably modified by the contribution of the Saà ´ne, of the Durance, and of some tributaries in the Mediterranean south as a result of the fall-winter rainfall peak. Thus the powerful Rhà ´ne has a remarkably ample flow in all seasons. The course of the river and the local water tables has been much modified by a series of dams to gener ate power and to permit navigation to Lyon. The Rhà ´ne also supplies cooling water to a series of atomic power stations. West of the Rhà ´ne, the Bas Rhà ´ne-Languedoc canal, constructed after World War II to provide irrigation, has proved to be an essential element in the remarkable urban and industrial development of Languedoc. East of the Rhà ´ne the Canal de Provence taps the unpolluted waters of a Rhà ´ne tributary, the Durance, supplying Aix-en-Provence, Marseille, Toulon, and the coast of Provence with drinking water and providing impetus for urban expansion. At its delta, beginning about 25 miles from the Mediterranean, the Rhà ´ne and its channels deposit significant amounts of alluvium to form the Camargue region. The Rhine system The Rhine forms the eastern boundary of France for some 118 miles. In this section its course is dominated by the melting of snow and ice from Alpine headstreams, giving it a pronounced late spring-summer peak and often generally low water in autumn. The Ill, which joins the Rhine at Strasbourg, drains southern Alsace. The Rhine valley has been considerably modified by the construction on the French side of the lateral Grand Canal d'Alsace, for power generation and navigation. The eastern Paris Basin is drained by two tributaries, the Moselle, (partly canalized), and the Meuse; the former reaches the Rhine by way of Luxembourg and Germany, and the latter, as the Maas (Dutch), reaches the Rhine delta at the North Sea by way of Belgium and The Netherlands.

Because of postmodernist changes in economic conditions

The current business environment is characterized by a considerable level of competitive rivalry and therefore businesses have to constantly reengineer their internal processes in order to build and maintain a competitive advantage. In this respect, a business organization has three strategies at its disposal: differentiation, cost-minimization and focus (cited in Dess, 2007).Because of postmodernist changes in economic conditions, businesses have been globalizing their operations in order to implement the strategy of cost minimization. This is because in some countries lower labor costs reduce the cost of operations. This enables businesses to build a competitive advantage.However given the high state of competitive rivalry in the current business environment, achieving sustainability is the critical success factor. Strategies of differentiation, cost minimization and focus cannot meet this objective of achieving sustainability. In order to meet this objective, the top management ha s to build the right organizational culture.Organizations structures must adapt constantly to the changes taking place in the external environment. As a result, the process of managing change becomes a critical success factor in the organizational context. When it comes to managing change involving an IT project, the strategic alignment process becomes relevant.This alignment takes place between IT strategy, business strategy, organizational issues and information systems issues. Managing change is a difficult process because alignment with strategic focus must be maintained. Otherwise the value of managing change will have been lost.In this regard, the critical consideration is to minimize the level of employee resistance. Most change management projects fail because of employee resistance. However the management can avoid this problem by involving the employees in the process from the beginning. In this respect, building an organizational culture based on ownership, responsibility and accountability is the critical success factor.This enables the management to enhance employee motivation.According to Hammer & Champy 1994, the process of reengineering internal business processes is best facilitated through implementing the balanced scorecard methodology. This methodology becomes particularly relevant in the context of David Harvey’s account of post-modernity. According to David Harvey’s account of post-modernity, the process of international business has facilitated the high speed of labor mobility.This means that working conditions cannot be monitored sufficiently. This is because businesses are reengineering their internal business processes in terms of globalizing their operations. The balanced scorecard methodology views the organization from four perspectives: financial, customer, learning and growth, and internal business processes.The advantage in managing change under the framework of the balanced scorecard is that this process emphasize s the interconnectedness between different process chains. This facilitates the development of the project management team.Because the different process chains are interconnected, managing change means that more than one department will be affected. This enhances the complexities of managing change. However the management must maintain the continuous improvement program as a result of post-modernity as described by David Harvey.This is because the rising level of competitive rivalry forces businesses to seek new segments of the market in order to maximize shareholder wealth. This leads to the process of globalization. Normally this would increase the cost of production since the supply chain must be managed on an international basis.However in the context of post-modernity as described by David Harvey, the management in an international business can conduct the process of global segmentation in order to standardize operations across political boundaries. This facilitates the impleme ntation of the strategy of cost minimization.This confirms the need for business process reengineering as described by Hammer & Champy, 1994. As a result of this framework for strategy formulation, the competitive advantage becomes sustainable.One of the critical considerations when it comes to globalization is the need for delegation of authority. This is because consumer tastes and preferences vary across political boundaries. As a result, businesses have to vary their strategies in order to target the local market effectively. However the international business environment is characterized by a fast pace of change and therefore, local business units must be given the autonomy to formulate their own strategies.However these strategies must be in alignment with the corporate strategic focus. For this reason, delegation of authority must be supported by an efficient and effective world-wide communications structure. However in the business environment characterized by post-modernity , businesses have to reengineer their internal operations in order to meet the demands of consumerism.This standardizes demand patterns to some extent and as a result reduces the cost of operations. This also leads to the development of a sustainable competitive advantage.