How the works selected relate to life as we know it

In the play â€Å"Macbeth† by William Shakespeare, it is questionable whether Macbeth was destined by destiny or by an imperfection in his character. It could be contended that Macbeth was bound both by destiny and by an imperfection in his character. On one hand, the job of the witches impact could be viewed as a significant outer power that abused Macbeth’s character blemishes. Notwithstanding, then again, Macbeth’s goal-oriented nature and voracity for power was the defect in his character that eventually prompted his destruction. The degree to which Macbeths destruction is controlled by destiny or a blemish in his character will be talked about. It could be contended that it was destiny that lead Macbeth to his fate. The job of his opportunity meeting with the witches was instrumental in impacting Macbeth’s dynamic. On a scary night, Macbeth was told three predictions by the witches, â€Å"_All hail, Macbeth! Hail to thee, Thane of Glamis! All hail, Macbeth, hail to thee, Thane of Cawdor! All hail, Macbeth, thou shalt be the best hereafter.†_ Macbeth didn't scrutinize the precision of the predictions, which he accepted were predetermined in light of the fact that in Elizabethan occasions, it was accepted that witches could see into the future, slaughter their foes and make themselves imperceptible. Everybody accepted that the witches could see the future, and this drove Macbeth to executing Duncan once he had tuned in to the prescience that he would become King of Scotland. Macbeth thought, _†If chance will make them lord, why, chance may crown me without my stir.†_ An understanding of this statement as indicated by Macbeth could be, if destiny needed him to be the best, maybe destiny would simply get it going and he wouldn’t need to do anything. Subsequently, Macbeth was lead to destiny through the predictions of the witches, however by attempting to ace destiny, his aspiring nature and ravenousness for power was the imperfection in his character that eventually prompted his destruction. Macbeth isn't destined by destiny, however by a defect in his character. This defect can be seen as the manner in which he let his desire dominate and cloud his ethical quality. At his first taste of intensity, his desire dominates and he is longing for additional. Since Duncan is as of now King, the main route for Macbeth to satisfy hisâ desire is to slaughter him. Macbeth concedes that he needs to slaughter Duncan and eventually his own desire drives him to choose to murder the King. _†I have no spike to prick the sides of my aim, however just vaulting aspiration, which o’erleaps itself and falls on the other.†_ This is demonstrating that Macbeth was set up to slaughter any individual who was in danger to subvert his seat on Scotland’s seat. Macbeth obscured his decision making ability and yielded his ethics to accomplish his objective, to become lord. Macbeth put his own longing before the benefit of his nation and at long last it is decimated by his des ire. In this manner, Macbeth’s desire and voracity for power was not brought about by destiny, yet by a blemish in his character that he is capable because of his degenerate activities. Macbeth’s desire went to all lengths to get sort of Scotland, that in spite of the impacts, Macbeth was as yet answerable for his own activities. The witches revealed to Macbeth his three predictions; they don't constrained anything, basically introduced realities that affected Macbeth to act. Macbeth deciphered the words and activities to make the predictions work out. The witches gave Macbeth a phony feeling that all is well with the world and it is his heartbreaking defects that brought him upon his ruin. After Macbeth was told the predictions, he said to himself _†My thought, whose murder yet is nevertheless fantastical, Shakes so my single condition of man that function.Is smother’d in construe, and nothing is. Yet, what is not.†_ The witches’ forecast stirs inside Macbeth a lethal aspiration that was there from the start. Woman Macbeth is the main thrust that urges Macbeth to defeat his feeling of blame and make a move on the predictions. Woman Macbeth controlled Macbeth into murder by saying _†When you durst do it, at that point you were a man†_ A translation of this statement as per Lady Macbeth could be, he was even more a man when he set out to submit the homicide, and perceives that his desire to submit the homicide and guarantee the seat are appealing and masculine to her. Woman Macbeth was a gigantic impact to Macbeths debasements, for example she says, † A little water frees us from this deed.† Meaning she is truly disavowing with murder. Despite the fact that Lady Macbeth was a colossal impact, Macbeth was the person who held the blade. As an outcome of Macbeth’s activities, it was his aspiration and ravenousness for power that at last prompted his destruction. Indeed, even in light of outside powers, for example, controls of Lady Macbeth and predictions of the witches, Macbeth chose his own destiny through his activities. His ethical quality was feeble and he was conceited. Thusly, Macbeth aspiration and ravenousness for power was the defect in his character that at last prompted his ruin.

Expository Essay on Exercise and Obesity Essay Example for Free

Interpretive Essay on Exercise and Obesity Essay Some state that a diminished measure of rest time can be related with the expansion of muscle versus fat. A sleeping disorder or rest apnea or even RLS (anxious rest condition) are only three out of a wide range of types genuine rest that can likewise in certainty lead to a wide range of expanded hazard a few other interminable medical issues. Numerous examinations have clarified the unexpected motivation of these rest issue and the connections its offers on corpulence, these are significant connections in mulling over the connection between rest issue weight. Physical wellness and great dietary patterns are significant prognostic apparatuses in heftiness and constant ailment; there are a few investigations that have inspected the resemblance between corpulence, rest issue, and exercise. It likewise clarifies how unique rest issue may affect the physical wellness routine reactions and how amazingly overweight may affect ways of life of the patients as to rest issue will likewise be checked on. (Hargens, 2013) (Nature Science of rest. 2013 Vol 5 p,27-35. 9p. The clarification to these issues incorporate better comprehension of the clinical network, However, it does in any case stay brainless about these sickness procedures of work out and rest down and out patients. Generally specialists suggest prescriptions with symptoms that incorporate a sleeping disorder and weight gain as opposed to giving out data to their patients that help them to show signs of improvement way of life improvement. This regularly involves remarkable specialists with extraordinary administration, for example, drug with no negative symptoms. [ (hargens, 2013) ] Numerous investigations have built up the connection between rest insufficiency and both corpulence and even the ailment called diabetes. By getting a decent work out may improve rest penniless patients and their day by day works, moreover to putting on weight and digestion work. Weight has been a principle part in the association with SC and DC in ladies, and DC in men. (Grandner) April 24 2013 The goals to these issues contain better comprehension of the wellbeing network, However, it does in any case keeps on being thick about these affliction procedure of corpulence. exercise and rest desperate patients.

Role and Training of a Clinical Psychologist

Role and Training of a Clinical Psychologist Basics Print The Role and Training of a Clinical Psychologist By Owen Kelly, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on January 08, 2018 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on October 13, 2019 Rafal Rodzoch / Getty Images More in Psychology Basics Psychotherapy Student Resources History and Biographies Theories Phobias Emotions Sleep and Dreaming A clinical psychologist is a mental health professional with highly specialized training in the diagnosis and psychological treatment of mental, behavioral and emotional illnesses, including obsessive-compulsive disorder (OCD). What a Clinical Psychologist Does Clinical psychologists do not prescribe medications to treat mental illness. Rather, they use psychological techniques, such as cognitive-behavioral therapy (CBT) and psychoanalytic therapy. Clinical psychologists must usually complete a Ph.D. in clinical psychology before being able to see patients and utilize these techniques. However, in some states and provinces, a Master’s degree is sufficient. In most states and provinces, the professional activities of clinical psychologists are regulated by a licensing board and/or professional college. In addition to delivery of psychotherapy, psychologists may undertake a variety of activities, including psychological testing, research, and teaching. ABCP Basic Competencies The American Board of Clinical Psychology (ABCP) examination makes certain that board certification for clinical psychologists includes basic competencies in order to be able to practice, teach, or conduct research. These competencies include: Making and maintaining effective relationships with others, including clients, fellow practitioners, and the public. The clinical psychologist must also be fair, respectful, a clear communicator, and able to handle potentially difficult situations with understanding and diplomacy.Sensitivity to individual and cultural diversity and understanding how these factors affect who we are and how we think.An awareness of ethical and legal principles and employs them effectively.A professional attitude, values, and behaviors that are apparent in interactions with others.A continual practice of self-evaluation and always striving to improve treatment methods.An understanding of different scientific disciplines that relate to psychology and how they may impact treatment.Skill in collaborating with others from different disciplines and organizations, employing respect, appreciation, and communication.Keeping up with the latest research and identifying how it can improve clinical practice. Specific Skills Clinical psychologists have a whole host of specific skills that they employ in their work, including: Consulting with a variety of other behavioral and health professionals and organizations about violence, suicide, and severe mental distress.Understanding the broad expanse of mental health issues and how they may occur at any age.Assessing personality and standardized psychological test scores in order to be more effective in treating patients.Having extensive knowledge of mental illness and how to diagnose and treat it.Being able to perform research and collect data to enhance the understanding of clinical psychology. The Difference Between a Psychologist and a Psychiatrist The biggest difference between a psychologist and a psychiatrist is that a psychiatrist is a medical doctor (MD) with a medical degree who can prescribe medications. A psychologist typically cannot. While psychologists also have a doctorate, it is not a medical doctorate. Psychiatrists go through a year of medical internship followed by three years of residency in treating and diagnosing mental illnesses. Psychologists usually do one to two years of internship after completing their degrees. Psychiatrist Medical Doctor (MD) Can prescribe medications May provide talk therapy Can diagnose psychological illness Board certification through the American Board of Psychiatry and Neurology Clinical Psychologist Masters degree or Ph.D. Cannot prescribe medications (with some exceptions) May diagnose psychological illness May conduct talk therapies Board certification through American Board of Clinical Psychology Differences Between Psychologists and a Psychiatrists Should You See a Psychologist or a Psychiatrist? One major difference between the two approaches is that while a psychologist will typically look at your behavior, a psychiatrist is more likely to look first at the biological factors behind your mental health problems. Whether you pick a psychologist or a psychiatrist may depend on several factors. Some psychiatrists only prescribe medication and do not do psychotherapy, so you may choose to see both a psychiatrist and a psychologist to get both medication and therapy. Many psychiatrists do both, however.

Ralont Marketing Plan - 7298 Words

Marketing Plan: Ralont Pill Bottle by Pills R’ US Keller Graduate School of Management MM522: Marketing Management Bojlur Rahman Alex Garcia Donald Weston Taiwo Adenuga Executive Summary The Ralont Pill Bottle is dedicated to producing newly redesigned pharmaceutical medicine bottles that offer an â€Å"at a glance† view of â€Å"what medicine† belongs to â€Å"what person† in a medicine cabinet. This redesign came about after careful years of market research against the conventional â€Å"brown bottle† used for 90% of all medicine dispensed. We believe that our â€Å"color coordinated† bottles for Male Adults, Female Adults, Male Children and Female Children are exactly what the public has been asking for, thereby meeting market demand as well†¦show more content†¦Many of these individuals are all living longer thanks to advances in medical science as well as healthier living, and progression of preventative and combative medications. During any segment of television advertisements you can see a commercial for â€Å"ONE-A-DAY† the supplemental source for your daily vitamins and minerals for healthy living. That comm ercial will be followed by an advertisement for â€Å"VIAGRA† also to be taken once a day for men with erectile dysfunction which would be approximately 30 million men in the US. Finally you’ll see an advertisement for any one brand of the daily birth control pill being used by approximately 100 million women in the US. Given this above commercial break, we can see that there can be at least 3 or 4 types of daily pills in one household to be consumed on a daily basis, and especially, in a household mixed with Viagra, Aspirin, and Yasmin, you don’t want to take the wrong pill or the wrong dosage. This brings us to the Ralont Pill Bottle, where we say â€Å"Right Bottle, Right Person, Right Dosage†. As we go onto describe the bottle itself, we here at Pills R’ US have designed this product to offer the end-user a convenient, easy to recognize pill storage system that is advanced in its safety precautions and can prevent dosage errors in our daily pre ventative and combative medical needs. The team here at Ralont believes that the product will launch itself into the epicenter of prescription medication delivery; such that we can

The Lottery, By Shirley Jackson And An Adaptation Of ``...

â€Å"The Lottery† by Shirley Jackson and an adaptation of â€Å"The Metamorphosis† by Peter Kuper are valuable short stories that are worth a close evaluation of. A comparison and contrast of the theme alienation in both stories would lead to a more thorough understanding of the messages behind the texts. The purpose of this essay is to answer the question on â€Å"what insights do we gain into the course theme of alienation when we read both â€Å"The Lottery† and â€Å"The Metamorphosis† side by side?† Gregor Samsa in â€Å"The Metamorphosis† by Peter Kuper and the townspeople in â€Å"The Lottery† by Shirley Jackson are similar in that they both reveal a passive approach to alienation that ultimately leads to the growing of alienation; the alienation is different for Gregor and the townspeople in terms of how active they participate within their community determine their likelihood of being marginalized. Gregor’s minimal exp ression of his feelings towards his family alienates and marginalizes Gregor from his family. The townspeople’s active participation in the lottery, however, contributes to the severity of alienation within the town. These two stories attempt to tell us that alienation and the failure to take initiative to resist oppression are interconnected. This essay will compare Gregor Samsa and the townspeople’s passivity and also explore how taking on an active and inactive role in their story’s context would foster different types of alienation. In â€Å"The Metamorphosis† by Peter Kuper, Gregor

American History Study Guide Ch. 15-18 Free Essays

Chapter 15 Elizabeth Cady Stanton: One of the most prominent leaders of the 19th century and leading figure of the early woman’s body; social activist/abolitionist Opposed the 14th and 15th amendment because it did nothing to enfranchise women Leader of the National Suffrage Association Crop-lien/Sharecropping: Growing of cotton and pledge a part of the crop as collateral Sharecropping: initially arose as a compromise between blacks’ desire for land and planters’ demand for labor discipline System allowed each black family to rent a part of a plantation with the crop divided between worker and owner at the end of the year Guaranteed the planters a stable resident labor force Black Codes: Laws passed by the new southern governments that attempted to regulate the lives of the former slaves Granted blacks certain rights: legalized marriage, ownership of property, and limited access to courts Denied them rights to testify against whites, serve on juries or in state militias, or to vote Declared that those who failed to sign yearly labor contracts could be arrested and hired out to white landowners Thaddeus Stevens: Radical who represented Pennsylvania in the House of Representatives Wanted to confiscate the land of disloyal planters and divide it among former slaves and northern migrants to the South; plan proved to be too radical Hiram Revels: Mississippi representative for the U. S. Senate during Reconstruction Served as chaplain in the wartime Union army and became the first black senator in American history Enforcement Acts of 1870-1871: Outlawed terrorist societies and allowed the president to use the army against them Continued the expansion of national authority during Reconstruction. We will write a custom essay sample on American History Study Guide Ch. 15-18 or any similar topic only for you Order Now Defined crimes that aimed to deprive citizens of the civil and political rights as federal offenses rather than violations of state law Klan eventually went out of existence U. S. v Cruikshank overthrew the Enforcement Acts U. S. v Cruikshank: Ruled that the due process and equal protection clauses applied only to state action and not to actions of individuals Case that gutted the Enforcement Acts by throwing out convictions of some of those responsible for the Colfax Massacre of 1873 Election of 1876/Bargain of 1877: Republican nominee: Rutherford B. Hayes Democratic nominee: Samuel J. Tilden Election so close that whoever captured SC, FL, or LA would win Bargain: Congress appointed a 15-member electoral commission Members decided Hayes carried the disputed southern states, and therefore, won Reconstruction Act of 1867: Temporarily divided the South into 5 military districts and called for the creation of new state governments, with black men given the right to vote Passed by Congress over Johnson’s veto Chapter 16 Railroad Strike of 1877: ka Great Railroad Strike: first national labor walkout When workers protested a pay cut that paralyzed rail traffic, militia units tried to force them back to work The strike revealed a strong sense of solidarity among workers and close ties b/w the Republican party and the new class of industrialists Aftermath: government constructed armories to ensure troops would be in hand in the event of labor difficulties Henry George, Progress and Poverty: Influen tial writer on social issues during the Gilded Age He identified the monopolization of land as the cause of social inequality Progress and Poverty: offered a critique of the expansion of poverty amid material abundance Book proposing more optimistic remedies for the unequal distribution of health His solution: â€Å"single tax†which would replace other taxes with a levy on increases in the value of real estate; it would be so high that it would prevent speculation in both urban and rural land George rejected the traditional equation of liberty with ownership of land; saw government as a â€Å"repressive power† Sherman Ant-Trust Act: Banned combinations and practices that restrained free trade; impossible to enforce Helped to establish the precedent that the national government could regulate the economy to promoted the public good Lochner v New York/Liberty of Contract Ideal: Supreme court voided a state law establishing ten hours per day or sixty per week as the maximum hours for bakers Battle at Wounded Knee: Soldiers opened fire on Ghost Dancers encamped near Wounded Knee Creek, killing b/w 150 and 200 Indians Marked the end of four centuries of armed conflict b/w the continent’s native population and European settlers and their descendants Andrew Carnegie: Established a â€Å"vertically integrated† steel company – one that controlled every phase of the business from raw materials to transportation, manufacturing, and distribution. Dominated steel industry Knights of Labor: First group to try to organize unskilled workers as skilled, women alongside men, and blacks as well as whites Wanted to end the use of public and private police forces and court injunctions against strikes and labor organizations Thomas A. Edison: Era’s greatest inventor; Invented the phonograph, light bulb, motion picture, and a system for generating and distributing electric power Opened first electric generating station U. S. Steel Company: Founded in 1901; maintained labor policies held by Andrew Carnegie – lower wages and opposition to unionization Chapter 17 Omaha Platform, 1892: Party program adopted at the formative convention of the Populist Party Represents the merger of the agrarian concerns of the Farmers’ Alliance with the free-currency monetarism of the Greenback Party while explicitly endorsing the goals of the largely urban Knights of Labor. Tom Watson: Georgia’s leading Populist who worked the hardest to forge a black-white alliance Made vicious speeches whipping up prejudice against blacks, Jews, and Catholics Kansas Exodus: Some blacks sought a way out through emigration from the South 40, 000 to 60, 000 African Americans migrated to Kansas seeking political equality, freedom from violence, access to education, and economic opportunity Exodus derived from biblical account of Jews escaping slavery in Egypt Ida B. Wells: Nation’s leading antilynching crusader; insisted that given the conditions of southern blacks, the US had no right to call itself the â€Å"land of the free† â€Å"New Immigrants†: 3. 5 million newcomers seeking jobs in the industrial centers of the North and Midwest Described by native-born Americans as members of distinct â€Å"races†, whose lower level of civilization explained everything from their willingness to work for substandard wages to their supposed inborn tendency toward criminal behavior â€Å"Business Unionism†: Women’s Christian Temperance Union: Largest female organization; comprehensive program of economic and political reform including the right to vote â€Å"must abandon the idea that weakness and dependence were their nature and join assertively in movements to change society† Frances Willard: President Election of 1896: Republicans met the silverite challenge insisting that gold was the only â€Å"honest† currency Republican nominee: William McKinley Sometimes called the first modern presidential campaign because of the amount of money spent Democrats and Populists supported: William Jennings Bryan McKinley was the winner Platt Amendment: Drafted by Senator Platt of Connecticut Authorized the US to intervene militarily whenever it saw fit; US also acquired a permanent lease on naval stations in Cuba Had to be approved before Cuba could recognize their independence Chapter 18 Muckraking: The use of journalistic skills to expose the underside of American life; Theodore Roosevelt came up with the term New Immigration: Began around 1890 and reached its peak during the Progressive Era People came from southern and eastern Europe; 13 million came to the US, the majority from Italy, Russia, and the Austro-Hungarian empire Fordism: Concentration on standardizing output and lowering prices Moving assembly line: car frames brought to workers on a continuously moving conveyor belt Fordism: economic system based on mass production and mass consumption Lawrence, Mass. , strike of 1912: When the state legislature enacted a 54 hour workweek, employers reduced the weekly take home pay of those who had been laboring longer hours Workers spontaneously went on strike and called IWW for assistance Children strikers left the city, and city officials ordered that no more children could leave Lawrence Samuel â€Å"Golden Rule†Jones: Gilded Age mayors who pioneered urban Progressivism Instituted 8 hour day and paid vacations at his factory that produced oil drilling equipment Founded night schools and free kindergartens, built new parks, and supported right of workers to unionize Jane Addams: Era’s most prominent female reformer Believed woman’s life should be governed by the â€Å"family claim† – the obligation to devote herself to parents, husband, and children Founder of the Hull House in 1889 – settlement house devoted to improving the lives of the immigrant poor John Muir: Organized the Sierra Club to help preserve forests from uncontrolled logging by timber companies and other intrusions of civilization Federal Trade Commission: Second expansion of national power in 1914 Established to investigate and prohibit â€Å"unfair†business activities such as price-fixing and monopolistic practices Welcomed by many business leaders as a means of restoring order to the economic marketplace and warding off more radical measure for curbing corporate power How to cite American History Study Guide Ch. 15-18, Essay examples

Purpose Of Life Essay Example For Students

Purpose Of Life Essay Outline1 Purpose of life essay example 12 Purpose of life essay example 23 Purpose of life essay example 34 Purpose of life essay example 4 Purpose of life essay example 1 We can say about some people that he or she is purposeful; he or she will certainly achieve his goal. But how does it happen that some people have a goal, while others live more like a meaningless existence? The purpose of life  and the destiny of man is a philosophical question, and this question  is a difficult one. Many great sages were looking for answers to it, and each had his view of this question. Lets try and figure out what is the role of the goal in human life, and what are the main goals and values. The main goal of human life: what is it? First, lets see what the goal is. At its core is a desire or motive. The goal may be conscious or unconscious. For example, the desire to travel to distant countries is a goal fully realized. However, at the moment of danger, we can instinctively strive to do something to avoid this danger. Such a goal is unconscious. Speaking about the purpose of life, we will mean the first option, that is, only those motives that we are aware of. The main purposes of life  are an aggregate, which in the end should lead to the realization of the main goal. In other words, any of our goals are small sub-goals. Purpose of life essay example 2 To find the purpose of life, there is a special algorithm: Remember any of your current goal, which you are pursuing at the moment of your life and is considered extremely important. Find the motive that â€Å"gave birth† to this current goal. The answer to the question is why this goal you have appeared. If you could find the motive that precedes the birth of this goal, then, again go to point 2 and in the same way, check the motive itself. If your motive has no sub-goal, then it is the main goal in your life. We are actually the worst kind of all animals. We kill for joy, we kill each other in the name of God. We hate, we envy, we etc etc ..Anyway that is another story. Now that we are at the same level with all other animals I can start to explain the purpose of life .There are three phases in the life of any living species. First survival, second have children and third taking care of the children until they can take care of themselves. Then the children can do the same as their parents did. That is the whole purpose of life CONSERVATION OF THE SPECIES. And the process goes on and on.

Road traffic accidents in Kerala Essay Essay Example

Road traffic accidents in Kerala Essay Essay Traffic accidents are a major cause of decease and hurts universe broad. but while they are worsening in many parts of the developed universe. human deaths are still on the rise in many developing states including India. In our province more than half of the route accident victims are in the age group of 20 to 55. the key pay gaining and child raising age group. The loss of the chief staff of life victor and caput of family due to decease or disablement can be ruinous. taking to take down life criterions and poorness. The chief causes of the increasing decease rates in the Road Accidents are:†¢Not cognizing or non following right driving wonts.†¢Increasing figure of New coevals vehicles particularly Two Wheelers.†¢Aggressive driving behaviour of Heavy vehicle drivers particularly Private Buses A ; Tipper Lorries.†¢Drivers kiping while driving particularly of Heavy vehicles A ; light motor vehicles after midnight due to tire and other grounds.†¢Over hurrying.†¢Bad status of Roads and absence of different lanes.†¢Driver /Rider’s ignorance of Road conditions. Road marks and the Environmental factors.†¢Driver /Rider’s ignorance or misdemeanor of Traffic Rules.†¢Drunken Driving/Driving without place belt.†¢Driving without Helmet. We will write a custom essay sample on Road traffic accidents in Kerala Essay specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Road traffic accidents in Kerala Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Road traffic accidents in Kerala Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer All route users should retrieve that route is to be shared amongst all. Requirements of different route users may differ harmonizing to fortunes and observation of traffic regulations and consideration for the fellow users can cut down congestions. traffic jams and accidents. All route users must guarantee that they †¢Obey traffic regulations at all times†¢Obey all traffic signals and route sings†¢Give penchant to exigency vehicles and other fast traveling vehicles wherever conditions allow.†¢Mandatory usage signals who turning. halting. over taking decelerating down and parking†¢Park merely in designated countries.†¢Give due consideration to walkers at all times†¢Keep within permitted velocity bounds at all times.

How to Write a Good Research Paper on a History of the Middle East

How to Write a Good Research Paper on a History of the Middle East This is our last guide that covers tips and the pattern that you should follow when writing a research paper. Going through this guide will help you grasp the strategies and the right approach to write an impressive research paper. Let us have a recap. The very first guide, 10 facts for a research paper on the history of the Middle East, dealt with explaining the core events related to the Middle Eastern history. You can pick one fact and expand on it by selecting a topic from our second guide, 20 History of the Middle East Research Paper Topics. And now here we are in our last guide It contains all the techniques you should be looking forward to implementing in your research paper: Writing a Good Research Paper A good research paper depends on its structure. Presentation matters a lot, more than you think. Presentation The presentation lays out the setting and a general outline of the paper. It draws a brief picture of the paper. It might prove to be a smart thought to compose the presentation at the end after you have completed the exploration of your topic and figured out adequate information related to your topic. Introduction and Hypothesis Start with an introduction highlighting why you chose this topic and how you’re going to cover it. Next, lay out the possible structure that helps the reader to outline his or her perspective about the topic. Here you tell readers what you are going to test basically. For example, if you’re studying the role of Islam in the Middle Eastern history, your hypothesis can be: Islam impacts Middle Eastern politics. Research Research is very important no matter what your topic is. The research will help you open the door to grasp more ideas, methodologies, and strategies involved in writing a good research paper. You may also use your own methods of research such as getting questionnaires filled etc. Findings Here you will mention what youve learned using your research and present your ideas to the readers. Conclusion This section sums up your research paper. A summary is what is needed here. Conver all your research, ideas, thoughts and information and conclude them here, in the last. Write down points of interest in the hypothesis on the topic given to you. Final Verdict The mission of this guide was to give a general idea as for how to write a good research paper on the history of the Middle East. It contains essential techniques to compose, arrange and organize a well-presented research paper that looks professional. We also penned down various tips and tricks that focused on how to conduct research on a specific topic and how to accumulate information via references from viable sources. In the end, don’t forget to proofread your assignment and correct any minor mistakes that happen to be there.

LOGICAL DATA MODELLING AND SQL Coursework Example | Topics and Well Written Essays - 1750 words - 1

LOGICAL DATA MODELLING AND SQL - Coursework Example In this case study of the SOUNMISSION Company, we have been given the conceptual diagram and we are required to form the logical Entity Relationship Diagram (ERD) based on the conceptual diagram. The logical data model is developed without considering the database tools to be used for creation and implementation of the database. The logical ER data model facilitates to identify and specify additional data entities include but not limited to the Transactional and Operational data entities. Moreover, the logical ER data model contains more information related to the relationships, primary and foreign keys, as compared to the conceptual data model. In the ER logical models the attributes of the entities are defined, refined and categorized in diverse attribute types include: the derived attributes, composite attributes, multi-valued attributes, null and simple attributes. Furthermore, relationships are established in the logical ER data model. There are three (3) major types of the relationships include: one-one (1 to 1), one-many (1 to many) and many to many relationship. The relationships are based on the primary key and foreign key. The base table contains the primary key that makes a relationship with the other data type contains the foreign key. Usually, this type of relationship is said to be ‘one- to-many’ relationship. However, the same relationship can be changed by implementing constraint of uniqueness to the attribute / foreign key to restrict the duplicate values. This implies that the established relationship is one to one because both the data entities contain the non-duplicate value (Tao, n.d). The document presents the conversion of the conceptual data model into the logical data model for the company named SOUNDMISSION. Moreover, the document can be considered as the base document for the development of the database for the company. In the beginning, it is required to identify the

Information System Project Management Research Paper

Information System Project Management - Research Paper Example Week 10 Week 11 Testing Testing Testing Week 12 Week 13 Coding Week 14 Week 15 Testing Coding Week 16 Testing Testing Week 17 Coding Coding Coding Week 18 Testing Testing Testing Week 19 Week 20 Write a memo to Tom Jones explaining if john can or cannot meet Tom's goal of five Months. Inter office Memo From: Project Manager To: Accounts Manager I am attaching the project schedule with this IOM. Please go through it. Here I want to inform you that according to this project schedule we can complete this project in given time of five months. To complete this project within the time limit, we need your support and co-operation time to time. John Price Project Manager How Should John ensure that the project is completed on time as determine by the network Is there any way the time for the project can be shortened Using this project schedule john can easily ensure that project can be completed on time. For completing the project on time from networks point of view, John need to focus on the work done by networking department. Because in the project schedule only the network manager has a longer lead time to complete this project. Network manager is taking 13 weeks for completing its work. Any delay in networking work may cause delay of the project. To avoid delay in networking John has to ensure that each & every activity scheduled in project should complete on time. If there are some problem in completing an activity, then early decision are to be made to rectify the problem. John should make a grid on a paper and keep this paper on his table every time. After completing of activity John can tick on the grid and can have a overview on the complete project. Yes, the project time...Network manager is taking 13 weeks for completing its work. Any delay in networking work may cause delay of the project. To avoid delay in networking John has to ensure that each & every activity scheduled in project should complete on time. If there are some problem in completing an activity, then early decision are to be made to rectify the problem. John should make a grid on a paper and keep this paper on his table every time. After completing of activity John can tick on the grid and can have a overview on the complete project. Yes, the project time can shortened if the design the network changes can be completed in one week instead of two weeks, if the cabling can be completed in one week instead of two weeks, if the quotation open can be completed in 4 weeks instead of five weeks. So over all three weeks can be free if we shorten only three activities. So if we keep concentrate on each an every activity then only the project can be complete early. Raw Material: There should be some procedure of quality control to check the incoming material. If the incoming material is of good quality then obliviously the final product will be made of good quality. There may procedure to test the incoming material in quality control department. Machines: The maintenance of machine should be on time, so that they will not malfunction during the project work.

Experiences of Adult Offspring Making Care Decisions

Experiences of Adult Offspring Making Care Decisions In normal aging, decline in mental skills is modest with no consequential decrease in ability to care for oneself. Normally, older adults are able to maintain activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting, and instrumental activities of daily living (IADLs), which include shopping, cooking, housekeeping, laundry, and handling money (Schaie, 1989). Nevertheless, one in 10 persons over 65 and nearly half of those over 85 have Alzheimers disease, a form of dementia (The Alzheimers Association, 1999) and, thus, have problems with IADLs, ADLs or both, and need assistance with care decisions. Often these decisions are left to adult offspring who are ill prepared to cope with role changes and parent-caring responsibilities (Archbold, 1980; Brody, Johnsen, Fulcomer Lang, 1983; Brody, Kleban, Johnsen, Hoffman Schoonover, 1987; Cantor 1883; Stoller, 1982). What is the experience of these adult children as they negotiate their way through the their own internal voices, their family of origin and the healthcare system? Have we been asking the right questions when we assume that all is reduced to family obligation and responsibility? This project was designed to elicit and understand the experience of those adult offspring who are making care decisions for a mentally impaired parent. Chapter I includes background and significance of the project, the philosophical framework in which the project question is poised, the project question, and definition of terms. Background and Significance of the Project Although almost half (47%) of persons 85 and older will have mental impairment (Schaie, 1989), many elderly do not make plans for dealing with possible changes in mental status. As elderly â€Å"age in place†, it is frequently left to family members to decide about care and living arrangements. For most family members these care decisions about the care of elderly parent are difficult at best (Pfeiffer, 1995), and the number of people involved in making these decisions will increase as life expectancy increases and the population of the United States continues to age. Life expectancy is the average number of years people born in a given year are expected to live based on a set of age-specific death rates. At the beginning of the 20th century, life expectancy at birth was 47.3 years. Today, at the beginning of the 21st century, the average life expectancy has increased dramatically at birth to nearly 77 years. In addition, life expectancy for every age group has also increased during the past century. â€Å"Based on todays age-specific death rates, individuals aged 65 years can be expected to live an average of 18 more years, for a total of 83 years. Those aged 75 years can be expected to live an average of 11 more years, for a total of 86 years† (http://www.health.gov/healthypeople/Document/HTML/Volume1/goal.htm, August 14, 2000). Persons older than 65 now comprise 12.7% of the population of the United States (Statistical Abstract of the United States, 1999, http://www.census.gov/statab/www/states/md.txt, August 14, 2000). By the year 2020, 20% of the population will be older than 65 years (US Bureau of the Census, 1996). The largest percentage of growth is in elders 85 and over, a group at high risk for mental disorders such as Alzheimers disease. Almost 19 million Americans report they have a family member with Alzheimers, and 37 million know someone with the disease (The Alzheimers Association, 1999). Since 7 out of 10 people with Alzheimers live at home, lost productivity of caregivers is estimated to cost American businesses $26 billion a year plus $7 billion annually related to costs for health and long-term care (The Alzheimers Association, 1999). Other estimates put the cost of informal caregiving at $18 billion. In a project of 7, 443 of elders seventy and over taken from a national representative sur vey, the cost of informal care for mild dementia at $3,630 per person with double the cost for moderate dementia relatives and almost five times the cost for severe dementia (Langa, Chernew, Kabeto, Herzog, Ofstedal, Willis, Wallace, Much, Straus Fendrick, 2001). It is not surprising that the public is starting to ask for help with this complex issue. Previous research sought to identify predictors of placement decisions by family caregivers with dementia (Colerick George, 1986) when care options were few and rational mental models of decision making were thought to be superior to the human mind. At the turn of the 21st century, however, the healthcare environment offers multiple models of care for mentally impaired patients (Abraham, Onega, Chalifoux Maies, 1994). Decision making needs to be informed by the context of continuity of care, which now ranges from home and home-like environments to part time respite or adult day care to long term care services in nursing homes. Indeed, â€Å"patients and families are often surprised if not shocked about the actual services they may receive from various community-based or institutionalized services† (Abraham, Onega, Chalifoux Maies, 1994, p.165). In addition to the increasing complexity of choices, rational mental models of decision-making are in question and giving way to a more naturalistic project of how real world decisions are being made (Sloan, 1996). Rational standards, in which it is assumed people merely choose among options, do not take into consideration most contextual factors that impact on decision-making in real-world situations (Beach Lipshitz, 1993; Cohen, 1993). There is a stark contrast between the assumptions of rational decision-making and naturalistic decision-making. In the naturalistic decision making paradigm, problems are seen as ill structured rather than artificial and well structured. Solutions to these problems are made in uncertain, dynamic environments rather than static, simulated situations. Goals are shifting, ill defined or competing rather than clear and stable. There are action/feedback loops to decision-making process not one-shot decisions. Time stress is a factor and stakes are high i nstead of the presumed luxury of leisurely deliberation and absence of true consequences for the decision-maker (Orasanu Connolly, 1993; Zsambok, 1997). Research on the experience of making care decisions for mentally impaired parents needs to take into account the way decisions are made in the real world and the numerous opportunities for care assistance that are available today. The majority of middle aged, and even young-old Americans, will be faced with making decisions about care for a mentally impaired parent at a time in life when they are dealing with their own transitional issues, as well as those of the generations before and after them. Given the resulting emotional and financial cost, it would be wise to develop health policy about mentally impaired elder citizens and their offspring based on an understanding of the experience of making decisions about the care of a mentally impaired parent. Understanding what these care decisions mean to the increasing number of persons who must make care decisions for mentally impaired parents would lay the foundation for addressing issues in getting adequate assistance for these famili es. It would also help to provide a framework for policy decisions about the fragmented care system for the mentally impaired elderly, and decrease the cost to society in lost productivity. Clearly, the experience of making these decisions needs to be reexamined. Since the definition of naturalistic decision-making is â€Å"the way people use their experience to make decisions in the field setting† (Zsambok, 1997), it is incumbent upon the researcher to go into the field. Qualitative methodologies, which involve fieldwork can help build knowledge of the enormously complex and profound issue of making care decisions for mentally impaired family members. CHAPTER III METHODS Methods Design of the project Personal Reflections Part of the process in analyzing data during a qualitative project is the use of field notes. I have to admit that the process of recording field notes after each visit was a tiresome one for me. I choose to incorporate my thoughts and feelings about the phenomenon at hand, the relationships with my respondents, and the data, in the form of tape recorded field notes immediately after each visit, which were later transcribed. I have never considered myself disciplined enough to be a consistent and in-depth journaler but do consider myself a very reflective person. I guess what happens to me is once I start to put down thoughts and feelings into a very personal form, I dont know when or if I can stop. I also wanted to keep some of my personal issues private and did not initially understand who might be reading these notes. In addition, the interviews were so intense and so moving that I thought I would never forget one word, one thought, one emotion, or one observation that I had experienced before, during and after the encounter with each respondent. Well I guess it easy to imagine that, indeed, I have forgotten some of my reactions. I have been impressed and surprised by how valuable reading my field notes were during this project. When I was growing up, I was exposed to several close relatives who either had dementia or a type of mental illness where they were experienced delusions. My own grandfather experienced delusions and hallucinations when I was about 11 and was hospitalized in a mental institution for some time. I do remember some of his erratic behavior, he stayed right next door to our house, which enabled us to visit him anytime, so I had experienced being around a relative with mental conditions. I was surprised to learn that many of the respondents who had taken a mentally impaired parent into their home stated that they did not feel particularly close or even liked their parent while growing up or in subsequent adulthood. On the other hand, many family that their parents had had hard times during their lifetimes and wanted to make this part of their lives easier. Indeed, many family the parent had become part of the nuclear family and took them everywhere with them. I couldnt help but wonder, how ever, that the parents dementia might make things somewhat easier for these adult children regarding painful memories. One of the difficulties I encountered during this project was role change. I was the listener, the interpreter, and the one becoming vicariously part of their experiences. It was hard not to intrude and offer some input and advice when I family it was being solicited or challenge assumptions when needed. I was surprised and shocked about how deeply this affected me. Another challenge was the feelings I had to deal with after each interview. It was difficult sort out at first what my feelings were versus what I had ‘empathized during the interview and hadnt let go of. After many interviews I family tired, very tired and fatigued, sometimes depressed, sometimes overwhelmed and some times angry. On the other hand, some interviews energized me and where I had gone to the interview very tired after a busy day at work, I drove home feeling great until my real fatigue actually caught up with me. One helpful strategy was to have one of my committee members review some of my field notes. I learned from that feedback to pay attention to my feelings and use them to inform myself about how that particular respondent interacted with the world. Although there were many personal issues that came up during interviews which held personal meanings for me and from which I had to distance my own reactions from the respondents, there were also professional issues which got to me. When the ‘system, be it healthcare, political or whatever let these informants down, I took it personally. It made me very angry that in our very rich, very evolved society we do not offer supports and safety nets for those who are dealing with such difficult and challenging isse4s such as making care decisions for a mentally impaired parent. I am hoping my anger will drive me to work on legislative issues and to continue research in this area. CHAPTER IV RESULTS The five themes and nineteen categories (see Table 1) presented in this chapter emerged from sixty-seven codes rendered from the raw data. Raw data consisted of nineteen transcripts from interviews with twenty-two adult offspring who self-identified as primary decision-makers for mentally impaired parents. Findings collapsed into five main themes: Level of Contact ; Interpersonal Conflict; Personal Sharing; Providng Assistance; and Giving Gratitude. These themes suggest that, indeed, adult offspring in this project did go through a reiterative decision-making process when making care decisions for a mentally impaired parent. At various times during the course of numerous decision-making processes, adult offspring struggled to find that Level of Contact internally, as reality set in that parents were no longer able to make effective and safe care decisions. There was the need to Interpersonal Conflicty as they contemplate where they, as adult children, fit into this picture and what r esponsibilities they will accept while negotiating with other siblings. Other phases of the decision-making process involve: Personal Sharing as they stepped up to the plate and made and implemented decisions; inevitably having to alter course as circumstances and levels of energy changed (Providng Assistance); and Self Sufficiency where they reinforced their decisions by being thankful that their situation (or perception of their situation) was more tolerable than others in similar circumstances. Nineteen sub-themes or categories flowed from the five themes. Level of Contact consisted of Defining Condition, Safety Concerns, and Role-Reversion. Interpersonal Conflict involved a Conscious Choice, Strained Family Relationships, Sharing the Load and Sole Responsibility. A Thread of Memory on the part of the parent sustains adult offspring in the Personal Sharing stage of the decision-making process. In this stage, the adult offspring would be Guessing Needs of the parent, Getting Information, looking at Finances, and Expressing Goals. Caregiver Wear and Tear, Time Constraints, and Problems with Care triggered a Providng Assistance phase. Adult offspring would respond to these stressors by Dealing with It and Becoming Assertive with the parent. Finally adult offspring would use mental coping strategies to confirm their decisions and the accompanying hardships by Comparing with Others and turning to Spirituality (Self Sufficiency). Theme I. Level of Contact Category 1. Defining Condition All but three of the interviews contained a category of Defining Condition of the parent. Adult offspring went through a process where they had to let go of their past preconceptions of parents capabilities and put their own words to the startling fact that the parent needed help with care decision making. Sometimes this became much clearer after the parent was in the household a number of years. One respondent who had taken his mother in before the onset of dementia was able to describe her condition after several years of living with her. She used to get on the bus and run around and all that stuff. When she took that fall she developed this what I call this old persons syndrome. She became so deathly afraid of falling again that her movements became choppier and choppier and tighter and tighter and the tighter they got the more prone she was to kind of losing her balance a little bit and then she would get scared more. She has physically gone down hill a lot since then. Mentally, well mentally shes gone down a lot too. Dementia, as I understand, is about a ten-year disease and she is probably three to four years into it. She probably had some symptoms of dementia four years ago, but it has gotten significantly worse since then. I think it has been four years. Although this respondent was able to clearly acknowledge symptoms of dementia, he still had difficulty accurately defining which symptoms were pertinent to the dementia and to the type of dementia involved. I said well my mother doesnt have Alzheimers, my mother has dementia. She said oh it is the same thing. I said well no its not, it is a significantly different thing. Alzheimers is a variation of dementia, dementia is a much broader category. If my mother has Alzheimers it wouldnt be safe to leave her alone because Alzheimers, as I understand it, is a spatial disorientation to where they can feel they are not where they need to be and they need to go where they want to go. Now they may be right there, but they dont feel it and so they go. My mother doesnt have Alzheimers. She plants, she is right where she wants to be and she knows it. But she does have dementia, that mental sense of connection to what just happened. And the gal said well we treat them both the same. Well how can you do that, they are both two separate issues and for one you should do this and for the other you should do that. Its frustrating. This adult son as he was trying to define the condition to himself, limited his conception to physical components of Alzheimers however inaccurately. How he defined his mothers condition to himself influenced what decisions he made and implemented in the Personal Sharing stage. Indeed, he had recently undergone an investigation by the Department of Aging (from which he was cleared of all charges) for leaving his mother alone and for cleanliness issues. Another respondent described how she was able to put words to the deteriorating condition of her mother. This respondent was a registered nurse with her masters degree and chose to define the condition through objective tests and outside opinions. No, she was not. She was totally independent and totally well until about the age of 82. So, that is getting to be close to five years now, she is 86. Then she began to get lost driving and not to be able to do what you and I would do if we were lost to stop and find out where we were, draw a map and follow it home, she couldnt do it anymore. At that point I took her toI had a wonderful physician who was a geriatric specialist and she got us in touch with some psychological testing services and we went through a battery of those and came up with the fact that what she should for her level of functioning prior to that date, she was losing an awful lot of executive ability. You probably know better than I exactly what that encompassed. So that is the point at which somebody had said to me she truly has some dementia developing, it is not just normal forgetfulness, it is dementia. Then I began to intervene with things like finances and make sure that she got to doctors. You know, just gradually taking on more and more responsibility. Note how this daughter accurately describes and defines her mothers condition, relying on her own observations and objective tests, a method of assessment which she probably is familiar with through her professional nursing career. Once the diagnosis was established, she got on with Personal Sharing phase by examining finances and making and keeping doctors appointments. This was an only child, born of parents who were also only children of which only the mother was living. These circumstances necessitated that the daughter did not have the luxury of dealing with siblings and determining her place in all of these decisions for her mentally impaired mother. Another adult daughter defined her mothers condition by the things she was still able to observe and how she functioned. Yeah. She is so observant. On the way home from [the daycare facility] the other day she said you know I am just intrigued by the cloud formations. She said I look up and I see all these configurations in the cloud. Coming down 29 she said have you ever thought about the laying of asphalt on that road, that is such a steep hill. How did they lay all that asphalt without it trickling down hill? So I mean shes not out of it. And every Sunday morning I dont know what triggers it she wakes up at six oclock and says is it time to go to mass. The other mornings of the week she will say what day is today. But somehow Sunday she knows it is Sunday. She will say now what time is it. Be sure to fast long enough to go to communion. She is a big help to me with her hands. She folds all the laundry. She cleans up all the plates and Sunday afternoon she took the fern and gave it a haircut all afternoon, it took quite a while to do it. She cuts up the salad, she makes fruit salads, she will wash ve getables, she will wash beans, anything she can do with her hands. Focusing on the positive might impact on this respondents ability to acknowledge continuous regression and might negatively influence the Personal Sharing phase when the inevitable physical decline begins and nursing home care must be considered. I mean if the time comes when she can no longer go to the Center or she is so feeble I would then have to make the choices to whether I was going to have somebody come in during the day to care for her and then I would be the caregiver until I got home from school until the next morning or put her in assisted living. I doubt that she will ever need nursing care, although one never knows. I mean nursing home care. She would be more likely to go into an assisted living. And as to where I would take her I dont know. Two other respondents defined their mothers and mothers-in-law mental impairment by attributing it to being taken advantage of by a preacher. Respondent: I truly believe that the religious aspect of this deteriorating her rather than helped her. Ive had extensive kinds of confrontations on her about she and God. This man always prayed with her and just a week ago did she say I believe in God. I think this man was her avenue and had her believing she was an avenue to God. Wife: And shes been in church all of her life and taught Sunday school. Respondent: I think it was a brainwash. I think this lady right now could still be playing the piano and doing everything she wanted to do if she hadnt of gotten too involved with him. Interviewer: So you think some of her thinking difficulties have to do with being involved with the church. Respondent: I know so. Three years, two years or more before this happened she always raised money for the preacher. She was the league chairman. She was going to give him this appreciation and I told her I was not taking her back there for her to take a bunch of money a thousand dollars or so out of the bank to give to some preacher. She said if you dont take me Ill catch the bus. It took her fourteen hours to go to West Virginia. It almost killed her. They continued talking about their journey to define in their own words what was happening to their parent despite what others were telling them. Wife: Then the people told us that she had gotten to the point where she was not bathing, had weird stuff on her hands, dirty, nasty stinking and he was steadily draining her and the neighbors and the church people had been telling us this and of course we didnt believe it not as strong a woman as momma was. But, they said she was even begging in the church for money for him and she would call us here and people kept sending bank statements to them that checks were bouncing. And he found out because he asked about a savings account and she said what savings account and we know that his father left her plenty of money. She doesnt have a dime except for money that she gets Respondent: And we have a beautiful house like this in West Virginia and we have borrowed on it. We go there and live four weeks out of the year. Two months out of the year we are there, we just came back. But, yeah I really think that this man really deteriorated her mind. Any time something would go wrong for himI hadnt paid attention to it. She would tell Wife that she called the preacher and he prayed with her and things were okay. I think that can happen to an old person and its called brainwash. Brainwash is a strange thing. The respondents kept coming back to the fact that their mother was taken advantage of by a preacher but incorrectly attribute this as a cause of her mental impairment rather than a consequence of it. On the other hand, they were able to seek out a doctors opinion and had some understanding of dementia. And I started questioning him about her and he said why dont I just get the chart and discuss it with you. I said because I am going to be taking her away from here and she can not get over here to see you properly. She has to pay somebody for everything that they do. So, he started out with dementia and I said what is dementia. I said is that Alzheimers what is it. He said a form of it. He said she will do well for a good while and I cant tell you how long, but he said she will start deteriorating and this will take over and it will appear to be almost like Alzheimers. He said she always has some deficiencies here in the spine at the base and that is going to be crippling and she would be wheelchair bound. He said other than that there was some enlargement of the heart which is normal for this age, 95 or 96. That is how we found out. There was always no problem everything is all right. Because we never went to see her business because she took care of everything. But when we found i t out that is when we made the decision. She had always said she would come and live in her room at the right time and the room was fixed, it was all ready Of course she has been unhappy many, many times in the beginning when we brought her here. She always wanted to send money back to the preachers wife, which she used to always buy her clothes all the time and making commitment always for that group. I guess people like who they like. I think they took advantage of her, I know so. This man was also an only child and it is evident that he moved into the Personal Sharing phase with the support of his wife while short-circuiting the Interpersonal Conflict stage due to his clear place in the family and no siblings with whom to negotiate. Category 2. Safety Concerns As adult children moved through the Level of Contact phase, they inevitably encountered issues about the safety of the parents behavior. They were often still unsure about whether these safety concerns were real since many times at the beginning of the course of the mental impairment, they were being told of these behaviors by others and not directly observing them for themselves. Thus presented quite a dilemma. The adult offspring were still struggling with defining the parents condition and not believing that the parent they knew could no longer be counted on to behave in an appropriate and safe manner. Looking back on being told of his mothers erratic behavior about finances and being drained of her life savings by a local preacher, one adult son remarked: Well it really was at a point that something I should have addressed ten years ago when I was told by distance relatives and friends and classmates there in the town that he was doing this. I just came to grips to where I just didnt believe it and you all told me and I didnt do anything about it. You all were right. I should have called this guy on the carpet way back. Hey man what are you doing. As I tell Wife Im not sure that would have been right either because then it is hearsay. This respondent was much more comfortable intervening in the situation once he had concrete evidence of the unsafe manner in which his mother was handling her finances and ability to live on her income. What happens is I have fact. I have the canceled checks. I know things that hes done. I have people that have seen him take her to the stores where she can cash checks and wait on the money, all of that. Safety Concerns whether they were about finances, getting lost in familiar surroundings, leaving appliances on such as stoves, falling or being unable to perform routine activities of daily living particularly eating regularly were effective at helping the adult offspring to move through the Level of Contact phase only when they were real to the adult son or daughter. The implications of seeing a formerly competent parent falter at taking care of themselves in an appropriate and safe manner seemed to be almost impossible until unsafe behaviors were personally observed. One adult daughter put it this way: Um, so it went on like that and then, what really brought it to a head was one morning I knew she needed milk. She could get her cereal but for some reason that was the thin that she really wanted so thats what she did, um, and I thought, well Ill drop the milk by and shell have milk for her cereal and then Ill come by at lunchtime and see, you know, see whats going on. So ordinarily, my mother slept very well and slept a little bit later in the morning, so I thought, well, you know, I let myself in and put the milk in the refrigerator and then thought, well, Ill just take a little peek, maybe shes awake, and I went around the corner and my mother, yeah she was awake but she was also on the floor surrounded by her covers, didnt know how shed gotten there, didnt know who she was, didnt know who I was at first, but she was so upset and you know, didnt have any idea how long shed been there, so I got her back up on the bed. She didnt hurt anything, cause the bed was low and she just sor t of slipped off of it. I think she used to take a medication. Sometimes it would make her a little sleepy, you know and she used to get up in the middle of the night to go to the bathroom and I think that maybe when she went back she may have missed the bed for some reason. I dont know how she did it, but she was OK, so I called my husband, I called my job and I called the doctorfrom then on it just seemed that things just went very quickly Another adult daughter talked about the time she realized that it was no longer safe for her mother to live alone. What happened one day, my mother stayed with them, they had a house and what happened was my mom she went to the dentist and they gave her some anesthesia and I think it just made her more confused and she was lost, we couldnt find her. She had left the house about ten oclock that morning and everybody was wondering where is mother, where is mother and we couldnt find her. So I think around like ten oclock or something like that we called the police and eventually we found her. She was over in the old neighborhood where she used to live prior to staying with them. So, I just took her at my house and I kept her like six months because I Experiences of Adult Offspring Making Care Decisions Experiences of Adult Offspring Making Care Decisions In normal aging, decline in mental skills is modest with no consequential decrease in ability to care for oneself. Normally, older adults are able to maintain activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting, and instrumental activities of daily living (IADLs), which include shopping, cooking, housekeeping, laundry, and handling money (Schaie, 1989). Nevertheless, one in 10 persons over 65 and nearly half of those over 85 have Alzheimers disease, a form of dementia (The Alzheimers Association, 1999) and, thus, have problems with IADLs, ADLs or both, and need assistance with care decisions. Often these decisions are left to adult offspring who are ill prepared to cope with role changes and parent-caring responsibilities (Archbold, 1980; Brody, Johnsen, Fulcomer Lang, 1983; Brody, Kleban, Johnsen, Hoffman Schoonover, 1987; Cantor 1883; Stoller, 1982). What is the experience of these adult children as they negotiate their way through the their own internal voices, their family of origin and the healthcare system? Have we been asking the right questions when we assume that all is reduced to family obligation and responsibility? This project was designed to elicit and understand the experience of those adult offspring who are making care decisions for a mentally impaired parent. Chapter I includes background and significance of the project, the philosophical framework in which the project question is poised, the project question, and definition of terms. Background and Significance of the Project Although almost half (47%) of persons 85 and older will have mental impairment (Schaie, 1989), many elderly do not make plans for dealing with possible changes in mental status. As elderly â€Å"age in place†, it is frequently left to family members to decide about care and living arrangements. For most family members these care decisions about the care of elderly parent are difficult at best (Pfeiffer, 1995), and the number of people involved in making these decisions will increase as life expectancy increases and the population of the United States continues to age. Life expectancy is the average number of years people born in a given year are expected to live based on a set of age-specific death rates. At the beginning of the 20th century, life expectancy at birth was 47.3 years. Today, at the beginning of the 21st century, the average life expectancy has increased dramatically at birth to nearly 77 years. In addition, life expectancy for every age group has also increased during the past century. â€Å"Based on todays age-specific death rates, individuals aged 65 years can be expected to live an average of 18 more years, for a total of 83 years. Those aged 75 years can be expected to live an average of 11 more years, for a total of 86 years† (http://www.health.gov/healthypeople/Document/HTML/Volume1/goal.htm, August 14, 2000). Persons older than 65 now comprise 12.7% of the population of the United States (Statistical Abstract of the United States, 1999, http://www.census.gov/statab/www/states/md.txt, August 14, 2000). By the year 2020, 20% of the population will be older than 65 years (US Bureau of the Census, 1996). The largest percentage of growth is in elders 85 and over, a group at high risk for mental disorders such as Alzheimers disease. Almost 19 million Americans report they have a family member with Alzheimers, and 37 million know someone with the disease (The Alzheimers Association, 1999). Since 7 out of 10 people with Alzheimers live at home, lost productivity of caregivers is estimated to cost American businesses $26 billion a year plus $7 billion annually related to costs for health and long-term care (The Alzheimers Association, 1999). Other estimates put the cost of informal caregiving at $18 billion. In a project of 7, 443 of elders seventy and over taken from a national representative sur vey, the cost of informal care for mild dementia at $3,630 per person with double the cost for moderate dementia relatives and almost five times the cost for severe dementia (Langa, Chernew, Kabeto, Herzog, Ofstedal, Willis, Wallace, Much, Straus Fendrick, 2001). It is not surprising that the public is starting to ask for help with this complex issue. Previous research sought to identify predictors of placement decisions by family caregivers with dementia (Colerick George, 1986) when care options were few and rational mental models of decision making were thought to be superior to the human mind. At the turn of the 21st century, however, the healthcare environment offers multiple models of care for mentally impaired patients (Abraham, Onega, Chalifoux Maies, 1994). Decision making needs to be informed by the context of continuity of care, which now ranges from home and home-like environments to part time respite or adult day care to long term care services in nursing homes. Indeed, â€Å"patients and families are often surprised if not shocked about the actual services they may receive from various community-based or institutionalized services† (Abraham, Onega, Chalifoux Maies, 1994, p.165). In addition to the increasing complexity of choices, rational mental models of decision-making are in question and giving way to a more naturalistic project of how real world decisions are being made (Sloan, 1996). Rational standards, in which it is assumed people merely choose among options, do not take into consideration most contextual factors that impact on decision-making in real-world situations (Beach Lipshitz, 1993; Cohen, 1993). There is a stark contrast between the assumptions of rational decision-making and naturalistic decision-making. In the naturalistic decision making paradigm, problems are seen as ill structured rather than artificial and well structured. Solutions to these problems are made in uncertain, dynamic environments rather than static, simulated situations. Goals are shifting, ill defined or competing rather than clear and stable. There are action/feedback loops to decision-making process not one-shot decisions. Time stress is a factor and stakes are high i nstead of the presumed luxury of leisurely deliberation and absence of true consequences for the decision-maker (Orasanu Connolly, 1993; Zsambok, 1997). Research on the experience of making care decisions for mentally impaired parents needs to take into account the way decisions are made in the real world and the numerous opportunities for care assistance that are available today. The majority of middle aged, and even young-old Americans, will be faced with making decisions about care for a mentally impaired parent at a time in life when they are dealing with their own transitional issues, as well as those of the generations before and after them. Given the resulting emotional and financial cost, it would be wise to develop health policy about mentally impaired elder citizens and their offspring based on an understanding of the experience of making decisions about the care of a mentally impaired parent. Understanding what these care decisions mean to the increasing number of persons who must make care decisions for mentally impaired parents would lay the foundation for addressing issues in getting adequate assistance for these famili es. It would also help to provide a framework for policy decisions about the fragmented care system for the mentally impaired elderly, and decrease the cost to society in lost productivity. Clearly, the experience of making these decisions needs to be reexamined. Since the definition of naturalistic decision-making is â€Å"the way people use their experience to make decisions in the field setting† (Zsambok, 1997), it is incumbent upon the researcher to go into the field. Qualitative methodologies, which involve fieldwork can help build knowledge of the enormously complex and profound issue of making care decisions for mentally impaired family members. CHAPTER III METHODS Methods Design of the project Personal Reflections Part of the process in analyzing data during a qualitative project is the use of field notes. I have to admit that the process of recording field notes after each visit was a tiresome one for me. I choose to incorporate my thoughts and feelings about the phenomenon at hand, the relationships with my respondents, and the data, in the form of tape recorded field notes immediately after each visit, which were later transcribed. I have never considered myself disciplined enough to be a consistent and in-depth journaler but do consider myself a very reflective person. I guess what happens to me is once I start to put down thoughts and feelings into a very personal form, I dont know when or if I can stop. I also wanted to keep some of my personal issues private and did not initially understand who might be reading these notes. In addition, the interviews were so intense and so moving that I thought I would never forget one word, one thought, one emotion, or one observation that I had experienced before, during and after the encounter with each respondent. Well I guess it easy to imagine that, indeed, I have forgotten some of my reactions. I have been impressed and surprised by how valuable reading my field notes were during this project. When I was growing up, I was exposed to several close relatives who either had dementia or a type of mental illness where they were experienced delusions. My own grandfather experienced delusions and hallucinations when I was about 11 and was hospitalized in a mental institution for some time. I do remember some of his erratic behavior, he stayed right next door to our house, which enabled us to visit him anytime, so I had experienced being around a relative with mental conditions. I was surprised to learn that many of the respondents who had taken a mentally impaired parent into their home stated that they did not feel particularly close or even liked their parent while growing up or in subsequent adulthood. On the other hand, many family that their parents had had hard times during their lifetimes and wanted to make this part of their lives easier. Indeed, many family the parent had become part of the nuclear family and took them everywhere with them. I couldnt help but wonder, how ever, that the parents dementia might make things somewhat easier for these adult children regarding painful memories. One of the difficulties I encountered during this project was role change. I was the listener, the interpreter, and the one becoming vicariously part of their experiences. It was hard not to intrude and offer some input and advice when I family it was being solicited or challenge assumptions when needed. I was surprised and shocked about how deeply this affected me. Another challenge was the feelings I had to deal with after each interview. It was difficult sort out at first what my feelings were versus what I had ‘empathized during the interview and hadnt let go of. After many interviews I family tired, very tired and fatigued, sometimes depressed, sometimes overwhelmed and some times angry. On the other hand, some interviews energized me and where I had gone to the interview very tired after a busy day at work, I drove home feeling great until my real fatigue actually caught up with me. One helpful strategy was to have one of my committee members review some of my field notes. I learned from that feedback to pay attention to my feelings and use them to inform myself about how that particular respondent interacted with the world. Although there were many personal issues that came up during interviews which held personal meanings for me and from which I had to distance my own reactions from the respondents, there were also professional issues which got to me. When the ‘system, be it healthcare, political or whatever let these informants down, I took it personally. It made me very angry that in our very rich, very evolved society we do not offer supports and safety nets for those who are dealing with such difficult and challenging isse4s such as making care decisions for a mentally impaired parent. I am hoping my anger will drive me to work on legislative issues and to continue research in this area. CHAPTER IV RESULTS The five themes and nineteen categories (see Table 1) presented in this chapter emerged from sixty-seven codes rendered from the raw data. Raw data consisted of nineteen transcripts from interviews with twenty-two adult offspring who self-identified as primary decision-makers for mentally impaired parents. Findings collapsed into five main themes: Level of Contact ; Interpersonal Conflict; Personal Sharing; Providng Assistance; and Giving Gratitude. These themes suggest that, indeed, adult offspring in this project did go through a reiterative decision-making process when making care decisions for a mentally impaired parent. At various times during the course of numerous decision-making processes, adult offspring struggled to find that Level of Contact internally, as reality set in that parents were no longer able to make effective and safe care decisions. There was the need to Interpersonal Conflicty as they contemplate where they, as adult children, fit into this picture and what r esponsibilities they will accept while negotiating with other siblings. Other phases of the decision-making process involve: Personal Sharing as they stepped up to the plate and made and implemented decisions; inevitably having to alter course as circumstances and levels of energy changed (Providng Assistance); and Self Sufficiency where they reinforced their decisions by being thankful that their situation (or perception of their situation) was more tolerable than others in similar circumstances. Nineteen sub-themes or categories flowed from the five themes. Level of Contact consisted of Defining Condition, Safety Concerns, and Role-Reversion. Interpersonal Conflict involved a Conscious Choice, Strained Family Relationships, Sharing the Load and Sole Responsibility. A Thread of Memory on the part of the parent sustains adult offspring in the Personal Sharing stage of the decision-making process. In this stage, the adult offspring would be Guessing Needs of the parent, Getting Information, looking at Finances, and Expressing Goals. Caregiver Wear and Tear, Time Constraints, and Problems with Care triggered a Providng Assistance phase. Adult offspring would respond to these stressors by Dealing with It and Becoming Assertive with the parent. Finally adult offspring would use mental coping strategies to confirm their decisions and the accompanying hardships by Comparing with Others and turning to Spirituality (Self Sufficiency). Theme I. Level of Contact Category 1. Defining Condition All but three of the interviews contained a category of Defining Condition of the parent. Adult offspring went through a process where they had to let go of their past preconceptions of parents capabilities and put their own words to the startling fact that the parent needed help with care decision making. Sometimes this became much clearer after the parent was in the household a number of years. One respondent who had taken his mother in before the onset of dementia was able to describe her condition after several years of living with her. She used to get on the bus and run around and all that stuff. When she took that fall she developed this what I call this old persons syndrome. She became so deathly afraid of falling again that her movements became choppier and choppier and tighter and tighter and the tighter they got the more prone she was to kind of losing her balance a little bit and then she would get scared more. She has physically gone down hill a lot since then. Mentally, well mentally shes gone down a lot too. Dementia, as I understand, is about a ten-year disease and she is probably three to four years into it. She probably had some symptoms of dementia four years ago, but it has gotten significantly worse since then. I think it has been four years. Although this respondent was able to clearly acknowledge symptoms of dementia, he still had difficulty accurately defining which symptoms were pertinent to the dementia and to the type of dementia involved. I said well my mother doesnt have Alzheimers, my mother has dementia. She said oh it is the same thing. I said well no its not, it is a significantly different thing. Alzheimers is a variation of dementia, dementia is a much broader category. If my mother has Alzheimers it wouldnt be safe to leave her alone because Alzheimers, as I understand it, is a spatial disorientation to where they can feel they are not where they need to be and they need to go where they want to go. Now they may be right there, but they dont feel it and so they go. My mother doesnt have Alzheimers. She plants, she is right where she wants to be and she knows it. But she does have dementia, that mental sense of connection to what just happened. And the gal said well we treat them both the same. Well how can you do that, they are both two separate issues and for one you should do this and for the other you should do that. Its frustrating. This adult son as he was trying to define the condition to himself, limited his conception to physical components of Alzheimers however inaccurately. How he defined his mothers condition to himself influenced what decisions he made and implemented in the Personal Sharing stage. Indeed, he had recently undergone an investigation by the Department of Aging (from which he was cleared of all charges) for leaving his mother alone and for cleanliness issues. Another respondent described how she was able to put words to the deteriorating condition of her mother. This respondent was a registered nurse with her masters degree and chose to define the condition through objective tests and outside opinions. No, she was not. She was totally independent and totally well until about the age of 82. So, that is getting to be close to five years now, she is 86. Then she began to get lost driving and not to be able to do what you and I would do if we were lost to stop and find out where we were, draw a map and follow it home, she couldnt do it anymore. At that point I took her toI had a wonderful physician who was a geriatric specialist and she got us in touch with some psychological testing services and we went through a battery of those and came up with the fact that what she should for her level of functioning prior to that date, she was losing an awful lot of executive ability. You probably know better than I exactly what that encompassed. So that is the point at which somebody had said to me she truly has some dementia developing, it is not just normal forgetfulness, it is dementia. Then I began to intervene with things like finances and make sure that she got to doctors. You know, just gradually taking on more and more responsibility. Note how this daughter accurately describes and defines her mothers condition, relying on her own observations and objective tests, a method of assessment which she probably is familiar with through her professional nursing career. Once the diagnosis was established, she got on with Personal Sharing phase by examining finances and making and keeping doctors appointments. This was an only child, born of parents who were also only children of which only the mother was living. These circumstances necessitated that the daughter did not have the luxury of dealing with siblings and determining her place in all of these decisions for her mentally impaired mother. Another adult daughter defined her mothers condition by the things she was still able to observe and how she functioned. Yeah. She is so observant. On the way home from [the daycare facility] the other day she said you know I am just intrigued by the cloud formations. She said I look up and I see all these configurations in the cloud. Coming down 29 she said have you ever thought about the laying of asphalt on that road, that is such a steep hill. How did they lay all that asphalt without it trickling down hill? So I mean shes not out of it. And every Sunday morning I dont know what triggers it she wakes up at six oclock and says is it time to go to mass. The other mornings of the week she will say what day is today. But somehow Sunday she knows it is Sunday. She will say now what time is it. Be sure to fast long enough to go to communion. She is a big help to me with her hands. She folds all the laundry. She cleans up all the plates and Sunday afternoon she took the fern and gave it a haircut all afternoon, it took quite a while to do it. She cuts up the salad, she makes fruit salads, she will wash ve getables, she will wash beans, anything she can do with her hands. Focusing on the positive might impact on this respondents ability to acknowledge continuous regression and might negatively influence the Personal Sharing phase when the inevitable physical decline begins and nursing home care must be considered. I mean if the time comes when she can no longer go to the Center or she is so feeble I would then have to make the choices to whether I was going to have somebody come in during the day to care for her and then I would be the caregiver until I got home from school until the next morning or put her in assisted living. I doubt that she will ever need nursing care, although one never knows. I mean nursing home care. She would be more likely to go into an assisted living. And as to where I would take her I dont know. Two other respondents defined their mothers and mothers-in-law mental impairment by attributing it to being taken advantage of by a preacher. Respondent: I truly believe that the religious aspect of this deteriorating her rather than helped her. Ive had extensive kinds of confrontations on her about she and God. This man always prayed with her and just a week ago did she say I believe in God. I think this man was her avenue and had her believing she was an avenue to God. Wife: And shes been in church all of her life and taught Sunday school. Respondent: I think it was a brainwash. I think this lady right now could still be playing the piano and doing everything she wanted to do if she hadnt of gotten too involved with him. Interviewer: So you think some of her thinking difficulties have to do with being involved with the church. Respondent: I know so. Three years, two years or more before this happened she always raised money for the preacher. She was the league chairman. She was going to give him this appreciation and I told her I was not taking her back there for her to take a bunch of money a thousand dollars or so out of the bank to give to some preacher. She said if you dont take me Ill catch the bus. It took her fourteen hours to go to West Virginia. It almost killed her. They continued talking about their journey to define in their own words what was happening to their parent despite what others were telling them. Wife: Then the people told us that she had gotten to the point where she was not bathing, had weird stuff on her hands, dirty, nasty stinking and he was steadily draining her and the neighbors and the church people had been telling us this and of course we didnt believe it not as strong a woman as momma was. But, they said she was even begging in the church for money for him and she would call us here and people kept sending bank statements to them that checks were bouncing. And he found out because he asked about a savings account and she said what savings account and we know that his father left her plenty of money. She doesnt have a dime except for money that she gets Respondent: And we have a beautiful house like this in West Virginia and we have borrowed on it. We go there and live four weeks out of the year. Two months out of the year we are there, we just came back. But, yeah I really think that this man really deteriorated her mind. Any time something would go wrong for himI hadnt paid attention to it. She would tell Wife that she called the preacher and he prayed with her and things were okay. I think that can happen to an old person and its called brainwash. Brainwash is a strange thing. The respondents kept coming back to the fact that their mother was taken advantage of by a preacher but incorrectly attribute this as a cause of her mental impairment rather than a consequence of it. On the other hand, they were able to seek out a doctors opinion and had some understanding of dementia. And I started questioning him about her and he said why dont I just get the chart and discuss it with you. I said because I am going to be taking her away from here and she can not get over here to see you properly. She has to pay somebody for everything that they do. So, he started out with dementia and I said what is dementia. I said is that Alzheimers what is it. He said a form of it. He said she will do well for a good while and I cant tell you how long, but he said she will start deteriorating and this will take over and it will appear to be almost like Alzheimers. He said she always has some deficiencies here in the spine at the base and that is going to be crippling and she would be wheelchair bound. He said other than that there was some enlargement of the heart which is normal for this age, 95 or 96. That is how we found out. There was always no problem everything is all right. Because we never went to see her business because she took care of everything. But when we found i t out that is when we made the decision. She had always said she would come and live in her room at the right time and the room was fixed, it was all ready Of course she has been unhappy many, many times in the beginning when we brought her here. She always wanted to send money back to the preachers wife, which she used to always buy her clothes all the time and making commitment always for that group. I guess people like who they like. I think they took advantage of her, I know so. This man was also an only child and it is evident that he moved into the Personal Sharing phase with the support of his wife while short-circuiting the Interpersonal Conflict stage due to his clear place in the family and no siblings with whom to negotiate. Category 2. Safety Concerns As adult children moved through the Level of Contact phase, they inevitably encountered issues about the safety of the parents behavior. They were often still unsure about whether these safety concerns were real since many times at the beginning of the course of the mental impairment, they were being told of these behaviors by others and not directly observing them for themselves. Thus presented quite a dilemma. The adult offspring were still struggling with defining the parents condition and not believing that the parent they knew could no longer be counted on to behave in an appropriate and safe manner. Looking back on being told of his mothers erratic behavior about finances and being drained of her life savings by a local preacher, one adult son remarked: Well it really was at a point that something I should have addressed ten years ago when I was told by distance relatives and friends and classmates there in the town that he was doing this. I just came to grips to where I just didnt believe it and you all told me and I didnt do anything about it. You all were right. I should have called this guy on the carpet way back. Hey man what are you doing. As I tell Wife Im not sure that would have been right either because then it is hearsay. This respondent was much more comfortable intervening in the situation once he had concrete evidence of the unsafe manner in which his mother was handling her finances and ability to live on her income. What happens is I have fact. I have the canceled checks. I know things that hes done. I have people that have seen him take her to the stores where she can cash checks and wait on the money, all of that. Safety Concerns whether they were about finances, getting lost in familiar surroundings, leaving appliances on such as stoves, falling or being unable to perform routine activities of daily living particularly eating regularly were effective at helping the adult offspring to move through the Level of Contact phase only when they were real to the adult son or daughter. The implications of seeing a formerly competent parent falter at taking care of themselves in an appropriate and safe manner seemed to be almost impossible until unsafe behaviors were personally observed. One adult daughter put it this way: Um, so it went on like that and then, what really brought it to a head was one morning I knew she needed milk. She could get her cereal but for some reason that was the thin that she really wanted so thats what she did, um, and I thought, well Ill drop the milk by and shell have milk for her cereal and then Ill come by at lunchtime and see, you know, see whats going on. So ordinarily, my mother slept very well and slept a little bit later in the morning, so I thought, well, you know, I let myself in and put the milk in the refrigerator and then thought, well, Ill just take a little peek, maybe shes awake, and I went around the corner and my mother, yeah she was awake but she was also on the floor surrounded by her covers, didnt know how shed gotten there, didnt know who she was, didnt know who I was at first, but she was so upset and you know, didnt have any idea how long shed been there, so I got her back up on the bed. She didnt hurt anything, cause the bed was low and she just sor t of slipped off of it. I think she used to take a medication. Sometimes it would make her a little sleepy, you know and she used to get up in the middle of the night to go to the bathroom and I think that maybe when she went back she may have missed the bed for some reason. I dont know how she did it, but she was OK, so I called my husband, I called my job and I called the doctorfrom then on it just seemed that things just went very quickly Another adult daughter talked about the time she realized that it was no longer safe for her mother to live alone. What happened one day, my mother stayed with them, they had a house and what happened was my mom she went to the dentist and they gave her some anesthesia and I think it just made her more confused and she was lost, we couldnt find her. She had left the house about ten oclock that morning and everybody was wondering where is mother, where is mother and we couldnt find her. So I think around like ten oclock or something like that we called the police and eventually we found her. She was over in the old neighborhood where she used to live prior to staying with them. So, I just took her at my house and I kept her like six months because I