Cognitive Behavioural Therapy for Psychosis

Cognitive Behavioural Therapy for Psychosis A literature review in chronological order from past 5 years Introduction The blanket term Psychotherapy covers a multifaceted pluralistic enterprise in which a range of therapies is required to meet a patient’s various needs (Holmes J 2002). The National Service Framework cites cognitive behaviour therapy as being the psychotherapeutic method of choice for conditions that include â€Å"depression, eating disorders, panic disorder, obsessive-compulsive disorder, and deliberate self harm.† (Rouse et al. 2001) Literature review The first article we shall consider is a letter to the editor of the BMJ by Van Meer (R 2003). It is comparatively unusual since it is a clinician referring to clinical matters which are both intuitive and experience based. The author refers to the fact that many psychiatrists and related healthcare professionals actually avoid talking about the content of psychotic symptoms. The generally accepted rationale being that these are diagnostically of no significance and therefore therapeutically irrelevant. Van Meer contrasts this view with the basic concepts of cognitive behaviour therapy. He suggests that in his experience, the patient actually often will want to talk about issues that are central to their experience and are distressed when they are kept out of the conversation. He suggests that this is one of the reasons why cognitive behaviour therapy is popular with psychotic patients is that they have the opportunity to discuss with sympathetic professionals the significance of the ir experiences and this is capable of giving them a mechanism of dealing with what may be otherwise unexplainable to them. This publication is selected because of its counterintuitive thrust to support cognitive behaviour therapy against the â€Å"mainstream† of current clinical psychiatric practice and is written by an experienced practising clinician. This area of consideration is given a further twist with a different insight from Moorhead (S 2003). He agrees that psychiatric professionals tend to try to avoid engagement with psychotic patients on the subject of their psychosis and â€Å"thereby unwittingly add to the prejudice that blights the lives of people who live with psychosis† . He points, very succinctly, to the fact (and cites Brabban A et al. 2000) that the central tenet of cognitive behaviour therapy is that the therapist should endeavour to show a clear linkage between â€Å"personal experience, core beliefs (schemas), and emergence of psychotic symptoms†. The significance of this publication is that it is unusual insofar as it outlines the benefit of cognitive behaviour therapy for the staff as much as the benefit for the patient, by suggesting that staff trained in the techniques of cognitive behaviour therapy are able to empathise on a much deeper level with the patient and this, in itself, has a â €Å"remarkable remoralising effect of developing a meaningful understanding of the psychotic phenomenon with a patient†. This point is echoed in the discussion of the Craig paper. The Craig paper (Craig T K J et al. 2004) is a carefully constructed, but badly reported, randomised controlled trail of the current efficacy of specialised care modalities for cases of early psychosis. (Vickers, A. J et al. 2001). It is presented here as a case study in critical analysis. The interventions were delivered in two groups. The entry cohort was allocated to a standard care group (the control) or the intervention group (specialised care group). Both sets of treatment were delivered by the community mental health teams. The outcomes for both groups were rates of relapse or readmission to hospital. (Friedman GD. 1994) We present this paper to illustrate a common problem with this type of trial. On first appreciation, it demonstrates the fact that the intervention group did better than the control group. The difficulty in critical analysis comes in trying to decide which of the treatment modalities actually produced this beneficial effect. (Mohammed, D et al. 2003) The entry cohort was quite impressive for a study of this type with 319 presenting with psychotic illness over an 18 month period and 144 of these meeting the inclusion criteria. 94% of these were remained in the trial over the 18 months of follow up. We note that, although the programme of interventions did include cognitive behaviour therapy, it also included other treatment options such as low dose atypical antipsychotic regimens, cognitive behaviour therapy based on manualised protocols, and family counselling and vocational strategies based on established protocols (Jackson H et al. 1998). From the point of view of our considerations here, on the one hand the results appeared to be good insofar as the study showed that the intervention group had fewer readmissions to hospital in the study period and also they had fewer psychotic relapses (although this was of low statistical significance). On the other hand the paper tells us that all patients had medication and the ultimate choice of treatment pathway was decided by the intervention clinician, so although cognitive behaviour therapy was used, we have no absolute idea of its effectiveness from this trial. (Green J et al. 1998). All we can say with confidence is that, as part of a total package, cognitive behaviour therapy appeared to have helped to contribute to a beneficial outcome for a significant number of psychotic patients. A completely analytical and minimalist approach to this particular trial could suggest that it is indeed possible that cognitive behaviour therapy is actually ineffective per se. other than it served to keep the patient in closer contact with the clinicians. (Piantadosi S. 1997) In this respect this is an instance of a trial which is seemingly supportive but does not contribute greatly to the evidence base On first sight this particular view might be considered pedantic, but it is echoed by Yates (DH 2005) in a letter in the BMJ, where he specifically takes up this very point. He points to the fact that there is very little description of the regimes of cognitive behaviour therapy and the degree that it’s impact can be isolated from the overall effect. He also refers to the fact that a breakdown of the various therapies offered and the degree that each was helpful would have improved the paper tremendously. We have to agree. We will next consider a high profile paper by Morrison (A P et al. 2004) which has been widely cited. This paper took the pioneering work of Yung (et al. 1996) who identified a high risk group of patients who would develop psychosis and studied the effect of cognitive behaviour therapy on the prevention of the development of the clinical state. Morrison et al. identified the fact that other studies (McGorry, P. D et al. 2002) had demonstrated that it was possible to reduce the incidence of psychosis development with a multifaceted approach, like that of Craig, which included elements of cognitive behaviour therapy. Morrison however, elected to carry out a study that used cognitive behaviour therapy as a single strand approach in this high risk population. (Leaverton P E. 1995) The results from this study convincingly demonstrated that cognitive behaviour therapy alone â€Å"significantly reduced the likelihood of making progression to psychosis as defined on the Positive and Negative Syndrome Scale over 12 months.† (Kay, S. R et al. 1987) The authors were also able to demonstrate that cognitive behaviour therapy also reduced the likelihood of a patient being prescribes antipsychotic medication. Other criteria of analysis demonstrated that cognitive behaviour therapy â€Å"significantly improved the positive symptoms of psychosis â€Å" in the target population. This is an important study as it is one of the first to provide a reasonably secure evidence base that cognitive behaviour therapy works in the psychotic patient. It also shows that it works in the high risk group and has the possibility of a prophylactic effect by minimising the likelihood of psychotic relapse. A critical analysis would observe that the intervention cohort was comparatively small and a disproportionately small number were entered in the control group (37 and 23 respectively). High risk psychotic patients are comparatively rare and therefore one has to appreciate the practical difficulties involved in accumulating a sufficiently large sample to study. (Grimes D A et al. 2002), The last publication that we shall consider is that by Trower (P et al. 2004). It was published at the same time as the Morrison paper and is notable for the fact that, like the Morrison paper it recognises the shortfalls of the previous multi-modality studies and isolates cognitive behaviour therapy in its analysis. It also specifically targets a notoriously treatment-resistant group of psychotics, those who suffer from command hallucinations. (Haddock, G et al. 1999) This was a single blind randomised trial with 38 patients. The trial was complex in structure but, in essence, it was able to show, with convincing statistical significance that cognitive behaviour therapy interventions alone was able to reduce the patient’s compliance rate with the psychotic commands. The authors noted that this reduction in compliance was associated with a reduction in levels of both anxiety and depression. In conclusion we would like to commend the book by Eisenman (R 2004) â€Å"The Case Study Guide to Cognitive Behaviour Therapy of Psychosis† as a particularly authoritative and clinically useful overview. It cites a number of clinical case studies and analyses them in depth. It supports the view that cognitive behaviour therapy, by attempting to confront the patient’s distorted thinking and allowing them to appreciate their thoughts in a more rational and realistic way, can have beneficial results and it places cognitive behaviour therapy in a clinical context amongst the other, generally accepted modes of psychotherapy. It is not a peer reviewed publication so we shall not consider it further than that. References Brabban A, Turkington D. 2000  The search for meaning: detecting congruence between life-events, underlying schema and psychotic symptoms. Formulation-driven and schema focussed CBT for a neuroleptic-resistant schizophrenic patient with a delusional memory. In: Morrison T, ed.  A casebook of cognitive therapy for psychosis.  Brighton : Psychology Press, 2000. Craig T K L, Philippa Garety, Paddy Power, Nikola Rahaman, Susannah Colbert, Miriam Fornells-Ambrojo, and Graham Dunn 2004 The Lambeth Early Onset (LEO) Team : randomised controlled trial of the effectiveness of specialised care for early psychosis BMJ, Nov 2004 ; 329 : 1067 ; Eisenman R 2004 The Case Study Guide to Cognitive Behaviour Therapy of Psychosis Am J Psychiatry, Jul 2004 ; 161 : 1318. Friedman G D. 1994  Primer of Epidemiology. 4th ed.  New York : Mc-Graw-Hill, 1994. Green J, Britten N. 1998  Qualitative research and evidence based medicine.  BMJ 1998 ; 316 : 1230-1233 Grimes D A, Schulz K F.2002  Cohort studies: marching towards outcomes.  Lancet 2002 ; 359 : 341-5 Haddock, G., McCarron, J., Tarrier, N., et al (1999)  Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS).  Psychological Medicine, 39, 879 –889. Holmes J 2002  All you need is cognitive behaviour therapy?  BMJ, Feb 2002 ; 324 : 288 294 ; Jackson H, McGorry P, Edwards J, Hulbert C, Henry L, Francey S, et al. 1998 Cognitively orientated psychotherapy for early psychosis (COPE).  Br J Psychiatry 1998 ; 172 (Suppl 33) : 93-100.  Kay, S. R. Opler, L. A. (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 507 -518. Leaverton PE. 1995  A Review of Biostatistics. 5th ed.  Boston: Little, Brown, 1995 McGorry, P. D., Yung, A. R., Phillips, L. J., et al (2002)  Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis first-episode in a clinical sample with subthreshold symptoms.  Archives of General Psychiatry, 59, 921 -928. Mohammed, D Braunholtz, and T P Hofer 2003 The measurement of active errors: methodological issues Qual. Saf. Health Care, Dec 2003 ; 12: 8 12. Moorhead S 2003  Cognitive behaviour therapy can help end alienation of psychosis  BMJ 2003 ; 326 : 549 Morrison A P , Paul French, Lara Walford, Shà ´n W. Lewis, Aoiffe Kilcommons, Joanne Green, Sophie Parker, and Richard P. Bentall 2004 Cognitive therapy for the prevention of psychosis in people at ultra-high risk: Randomised controlled trial Br. J. Psychiatry, Oct 2004 ; 185 : 291 297. Piantadosi S. 1997  Clinical Trials: A Methodologic Perspective.  New York: John Wiley, 1997.   Rouse, Jolley, and Read 2001 National service frameworks BMJ, Dec 2001 ; 323 : 1429. Rower P, MAX BIRCHWOOD, ALAN MEADEN, SARAH BYRNE, ANGELA NELSON, and KERRY ROSS 2004 Cognitive therapy for command hallucinations: randomised controlled trial Br. J. Psychiatry, Apr 2004; 184: 312 320. van Meer R 2003  To listen or not to listen  BMJ 2003 ; 326 : 549 Vickers, A. J. Altman, D. G. (2001)  Analysing controlled trials with baseline and follow up measurements.  BMJ, 323, 1123–1124 Yates D H 2005 Specialised care for early psychosis: More detail is needed BMJ, Jan 2005 ; 330 : 197 Yung, A., McGorry, P. D., McFarlane, C. A., et al (1996)  Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283 -303. 5.5.06 PDG Word count 2,313

Art History Slide Notes

Venus of Willendorf from Willendorf, Austria 28,000 – 25,000 BCE Limestone Naturhistorisches Museum, Vienna Paleolithic – representation of a woman – female anatomy is exaggerated – serves as a fertility image – no facial features, just hair/hat – freestanding sculpture Statuettes of 2 worshipers from the Square Temple at Eshnunna (Tell Asmar), Iraq 2700 BCE (early dynastic/Sumerian) Soft gypsum and inlaid with shell + black limestone Iraq Museum, Baghdad – represent mortals praying – tiny beakers were used in religious rites men wear belts + fringed skirts + have beard + shoulder-length hair – women wear long robes – heads tilt upwards with large open eyes – not proportionate, eyes=too big and hands=too small Bull-headed lyre from tomb789 (King’s Grave), Royal Cemetery, Ur (Tell Muqayyar), Iraq 2600 BCE Bull’s head = gold leaf over a wooden core Hair, beard = lapis lazuli University of Pennsyl vania Museum of Archaeology and Anthropology, Philadelphia – sound panel depicts a hero grasping animals that look human, serving at a banquet + playing music Spotted horse+ negative handprint rom Pech Merle, France 22,000 BCE (Paleolithic) Wall painting (cave) – negative hand imprints – horse in profile Hall of the Bulls from Lascaux, France 15,000 – 13,000 BCE (Paleolithic) – coloured and non-coloured silhouettes Wall painting of horses, rhinos, aurochs from Chauvet Cave, Vallon-Pont-d’Arc, France 30,000 – 28,000 BCE – oldest cave paintings – advanced features (overlapping animal horns) Bird Headed Man with Bison from Lascaux, France 15,000 – 13,000 BCE Paleolithic – depicts a possible hunting scene – early example of a narrative Victory Stele of Naram-Sin from Susa, Iran 2254 – 2218 BCE (Akkadian empire) Pink sandstone Louvre, Paris – king defeats his enemies; one has spear through throat, one begs for mercy, one thrown off cliff – 3 stars=3 gods – hierarchy of scale is used to emphasize king’s absolute power and influence; he is the focal point b/c he wears horned crown (signifies divinity) + larger + leads army (who look at him for guidance) up the mountain + in profile – diagonal tiers, relief sculpture – narrative Stele of Hammurabi from Susa, Iran 1780 BCE (Babylonian) Basalt Louvre, Paris – top = relief of Hammurabi with sun-god, Shamash – Hammurabi salutes Shamash, hand up and is able to rule as he is given permission from Shamash – one of the first examples employing foreshortening (representation at an angle) e. g. Shamash’s beard = series of diagonal lines Palette of King Narmer (back) from Hierakonpolis, Egypt 3000 – 2920 BCE (Predynastic) Slate Egyptian Museum, Cairo – relief carving – utilitarian object; carried eye makeup which was also used to protect eyes from sun – circle stands for union of Upper + Lower Egypt King of Narmer = detailed, largest, calve muscles, directional lines lead up to him, wears a crown, has a beard, has an aggressive pose, holds a baton, has a bull’s tail, wears decorated kilt Horus – King’s protector/falcon – organized into registers very flat, linear Palette of King Narmer (front) – 2 heads of a cow (top) with woman’s face = identified as goddess – hieroglyphic represent Narmer’s name – narrative art King Narmer combined Upper + Lower Egypt Khafre enthroned (Statue of Khafre) from Gizeh, Egypt 520 – 2494 BCE (4th Dynasty) Old Kingdom Diorite – hardest stone to sculpt Egyptian Museum, Cairo – idealistic portrait – carved for the pharaoh’s valley temple and for the king to reside in, in case the mummy disintegrates – king sits firmly/rigidly upright on throne (fused); bare-chested, detailed kilt, feet placed firmly on the ground, right hand fisted, false beard atta ched, royal linen nemes headdress with the uraeus cobra of kingship on the front, looking strong and young (regardless of age), calm, head tilted slightly upwards – might have held omething important in his hand—a symbol that shows Khafre=king – throne’s legs show intertwined lotus and papyrus plants (which happen to be symbolic of the united Egypt) – falcon sits on the back of his head with its wings around for protection. falcon=Horus – perfectly symmetrical, flawless, well-developed, muscular body to show that he was a divine ruler – statue’s function was to make sure it lasted for eternity, so no breakable parts Menkaure and Khamerernebty from Gizeh, Egypt 2490 – 2472 BCE (4th Dynasty) Graywacke Museum of Fine Arts, Boston double-portrait, high-relief sculpture, contained sculpture – she holds onto him, signifies that they are married – carved for Menkaure’s valley temple – Menkaure is rig idly frontal, his arms lie straight and close to his well-built body, has clenched fists, even with left foot forward body stays rigid, physique is idealistic, short beard – Khamerernebty’s right arm encircles the king’s waist, left hand rests on his left arm, clothing is light to show female form – both look out into space, not at each other – function – to show the timeless nature of the stone statue that was also designed to provide an eternal substitute home Nefertiti bust by Thutmose from Amarna, Egypt 1353 – 1335 BCE (18th Dynasty) New Kingdom Painted limestone Agyptisches Museum, Berlin – Nefertiti (Akhenaton’s wife) has expression of entranced musing + sensitivity + delicacy – work, unfinished b/c of missing left pupil – long curved neck balance long crown, broken right ear – portrayed as elegant beauty, symmetrical – found in Thutmose’s workshop – purpose? Thutmose’s model Akhenaton, Nefertiti, 3 daughters from Amarna, Egypt 1353 – 1335 BCE (18th Dynasty) New Kingdom Limestone Agyptisches Museum, Berlin – sunken relief – intimate family portrait = new, never been done before undulating curves replace rigid lines – figures possess prominent bellies (characteristic of Amarna period) – family bask in life-giving rays of the Sun (Aton, the sun disk) – mood = informal, anecdotal – Akhenaton lifts 1 daughter to kiss, one sits one Nefertiti’s lap who gestures toward father, youngest one reaches to touch pendant on mother’s crown – flowing scarves suggest wind Innermost coffin of Tutankhamen, from his tomb from Thebes, Egypt 1323 BCE (18th Dynasty) New Kingdom Gold with inlay of enamel + semiprecious stone Egyptian Museum, Cairo – tomb contained sculpture, furniture, jewelry – mummy within the innermost of 3 coffins dressed in official regalia, nemes headdress, fake beard – effects of mask and tomb treasures express power, pride, wealth – innermost coffin – gold, portrays pharaoh as Osiris (god of underworld/afterlife) Egyptians – enjoyed life – loved to eat + drink – loved and embraced life – believed afterlife = important – evolved and made their gods (sun gods) – left behind artworks to show that the kings were to exist eternally in the afterlife – majority = farmers – had intimate relati onships with Gods – preserved bodies – made solid tombs that preserved materials – wore jewellery to look good, loved precious stones would never have bothered to live in Egypt if it weren’t for the Nile – believed that they would have a straight narrow path like the Nile – believed that people have spirit – Middle kingdom disintegrated, Egyptians were invaded by the Hyksos (shepherd kings) with chariots + horses, but were later overthrown by Ahmose – Ahmose = 1st king of the 18th Dynasty (first to call Pharaoh), ushered in the New Kingdom, in which borders were extended and new capital, Thebes (in Upper Egypt)became a luxurious metropolis with palaces, tombs, temples – have ceremonial meal/feast/banquet at the deceased tomb 1/year – purpose? Commune with deadFacts about Egypt – houses = mud brick and were made to not last – Nile river (longest river on Earth) floods 1 a year – desert = sand, dry – no rainfall for decades – rich mud = good for growing plants – ultimate god – Re = is the Sun, creates dry land, – – creates life by ejaculating/spitting, creates gods of dryness/wetness – only wealthy people could afford mummification between the Old and Middle kingdom, Egypt was in a state of civil unrest – rock-cut tombs were characteristic and became popular during the middle kingdom, even replaced the mastaba as standard Egyptian tomb – temples were built to honour pharaohs, gods – long narrow passageways = characteristic of Egyptian temples (eg, Hatshepsut + Amen-Re) – successful hunting = metaphor for triumphing over death + disorder, which ensured a happy existence in the afterlife – King Tut – died at 18 â₠¬â€œ NEW KINGDOM – temple of Hatshepsut, Ramses, Amen-Re Old kingdom = pyramids Middle kingdom = rock-cut tombs New kingdom = temples Predynastic Period Early Dynastic Period Old Kingdom (3,4 dynasty) Middle Kingdom (11-14) New Kingdom (18,19)Old stone age (Paleolithic period) Sumerian (3500-2340 BCE) Akkadian (2340-2180 BCE) Babylonian (2125-1750 BCE) Mastaba – an Egyptian tomb made of brick/stone that is rectangular in shape with sloping sides, featuring a chapel with a false door. Some included a serdab – a small room that housed a statue of the deceased elonging to take into next world – portrait sculpture â€Å"he who keeps alive† Slide exam – Title, Artist, Date, Period, Medium. Be able to analyze style + significance, be able to compare MINOANS No big statues, no ideas that there were kings, built palaces on slopes, bull-leaping ceremonies, typical to have columns with cut stone bottoms, artists painted on wet plaster (fresco) which has the advantage of a picture staying on the wall, Minoans adored nature , 2 key elements Minoan art – line and color. Unlike the Egyptians who painted in fresco secco (dry fresco), Minoans painted on a white lime plaster and used a true (wet) fresco. Volcanic eruption on Thera (Cyclades), 4. 12 big eyes, holds snake, skirt has folds, snakes didn't come from Crete, came from Asia Minor. Unlike Egypt, no temples/monumental statues of gods, kings, or monsters have been found in Minoan Crete, Minoan sculptures usually small in size, Proto geometric Geometric Oritentalizing Archaic Early classical High clausal Late classical Hellenistic

Barrick Gold and the Mine at the Top of the World

Barrick Gold and the Mine at the Top of the World Introduction The purpose of this case analysis is to identify the main communication problem that the world's largest gold mining company, Barrick Gold, is facing in the midst of their major Pascua-Lama developmental project. The following paper discusses the causes of the communication problem and resulting symptoms, along with the key stakeholders that are affected and their concerning issue. Finally, this paper will provide a solution using all the steps of the communication model on how Barrick Gold can deal with all the key stakeholder groups.Main Body Barrick Gold's main communication problem has been formed by Barrick saying one thing, then doing something else; this inevitably caused a lack of trust between its stakeholders and the company. The problem has created hidden agendas and guarded communication, thereby slowing decision making and productivity. For example, Argentina passed a law that protected their glaciers and per mafrost, â€Å"which looked as if it might prevent the Argentinian part of the project from going forward. † (Barrick Gold case, pp. 11).The cause of the problem stems from Barrick Gold not keeping their promise. They proposed to transport the most affected glaciers farther away from the mining site, but did not live up to that promise. The symptoms of the problem include the farmer's unhappiness with the company and the mayor for supporting the mining project. Another symptom is the fact that the Argentinian national legislatures passed the law protecting the glaciers. This desperate move shows that Argentina has a lack of trust that the company will follow through on their promise to deal with the melting glaciers.The 5 main stakeholders include the Chile and Argentina governments, the local farmers, residents of the valley, and the shareholders of Barrick Gold. Each of these stakeholders have separate issues they are concerned with. The Chile government is concerned with w aste the mine is dumping into the river that runs through the Huasco Valley of Chile, specifically cyanide. The Argentina governments concern is based on the fact that the royalties they receive from the mine are ? of the totalGDP of their poor San Juan province; once the mining is finished this will regress back to zero and devastate the economy. The local farmers are concerned with the explosions that cause dust to settle on the glaciers and accelerate its melting; the effects are devastating to the whole surrounding ecosystem. The resident's of the valley share the same concern as the Argentinian government, that once the mining ceases their income will revert to zero. Finally, the shareholders of Barrick Gold are concerned with the idea of huge opposition and lack of productivity that ensued because of it.In dealing with the afore mentioned stakeholder groups, Barrick Gold can use all the steps of the communication model, including: sender, encode, channel, receiver, and feedbac k. First off, the Chilean government: Barrick Gold (sender) needs to think of a method that allows cyanide to be removed from the river (encode), and this idea needs to be presented face-to-face (channel) to the Chilean government (receiver); once the idea is received, Barrick Gold needs to allow for feedback (positive or negative) from this stakeholder.Secondly, the local farmers: Barrick Gold (sender) is responsible for devising a plan for decelerating the melting of the glaciers (encode) and portraying this plan, either in a proposal or in a meeting (channel), to the local farmers (receiver); the farmers need to provide their response of how the government is doing (feedback). ConclusionIn conclusion, Barrick Gold has a communication problem that could potentially destroy its whole project. How the company deals with its stakeholders is very important to its future success in Chile and Argentina. To mend the problem it is of the company's best interest to follow the communication model and make all attempts to repair the damage already done by not keeping their promise.

Artifical Womb - Free Essay Example

Sample details Pages: 3 Words: 884 Downloads: 10 Date added: 2017/09/25 Category Advertising Essay Type Argumentative essay Tags: Children Essay Did you like this example? Imagine, the next time you want to have a child there might not be a need for a mother, at least her womb. Science is coming up with a way to eliminate the need for a mothers’ womb or a sergeant mother, in what they are calling â€Å"the new fashioned way†: growing the embryo in an artificial womb. Doctors are developing artificial wombs in which embryos can grow outside woman’s body. The work has been hailed as a breakthrough in treating the childless. Scientists have created prototypes made out of cells extracted from women’s bodies. Embryos successfully attached themselves to the walls of these laboratory wombs and began to grow. However, experiments had to be terminated after a few days to comply with in-vitro fertilization (IVF) regulations. â€Å"We hope to create complete artificial wombs using these techniques in a few years,† said Dr Hung-Ching Liu of Cornell University’s Centre for Reproductive Medicine and Infertility. à ¢â‚¬Å"Women with damaged uteruses and wombs will be able to have babies for the first time. † The pace of progress in the field has startled experts. Artificial wombs could end many women’s childbirth problems – but they also raise major ethical headaches, which will be debated at a major international conference. There are going to be real problems,’ said organizer Dr Scott Gelfand, of Oklahoma State University, where these conferences are to be held. Dr. Gelfand goes on to say, â€Å"Some feminists even say artificial wombs mean men could eliminate women from the planet and still perpetuate our species. That’s a bit alarmist. Nevertheless, this subject clearly raises strong feelings. † Liu’s work entails removing cells from the endometrium, the lining of the womb. â€Å"We have learnt how to grow these cells in the laboratory using hormones and growth factors,’ she said. After this, Liu and her fellow researchers grew laye rs of these cells on scaffolds of biodegradable material, which had been modeled into shapes imitating the inside of the uterus. The cells grew into tissue and the scaffold dissolved. Then nutrients and hormones such as estrogen were added to the tissue. â€Å"Finally, we took embryos left over from IVF programmes and put these into our laboratory engineered tissue. The embryos attached themselves to the walls of our prototype wombs and began to settle there. †(Dr. Liu, 2008) The experiments were cut short after six days. However, Liu now plans to continue with this research and allow embryos to grow in the artificial wombs for 14 days, the maximum permitted by IVF legislation. â€Å"We will then see if the embryos put down roots and veins into our artificial wombs’ walls, and see if their cells differentiate into primitive organs and develop a primitive placenta. †(Dr. Liu, 2008) The pressing aim of this work is to help women whose damaged wombs stop them fr om conceiving. An artificial womb would be made from their own endometrium cells, an embryo placed inside it, and allowed to settle and grow before the whole package is placed back in her body. The new womb would be made of the woman’s own cells, so there would be no danger of organ rejection,† (Dr. Liu 2008) Yet, her research is presently limited by IVF legislation. â€Å"The next stage will involve experiments with mice or dogs. If that works, we shall ask to take our work beyond the 14-day limit now imposed on such research. † (Dr. Liu, 2008) Yoshinori Kuwabara, at Juntendo University in Tokyo is trying out a different method. His team has detached fetuses from goats and placed them in clear plastic tanks filled with amniotic fluid stabilized at body temperature. In this way, Kuwabara has kept goat fetuses alive and growing for up to 10 days by connecting their umbilical cords to machines that pump in nutrients and dispose of waste. While Liu’s work is intended at helping those having difficulty conceiving, Kuwabara’s is intended to help women who suffer miscarriages or very premature births. In this way Liu is extending the time an embryo can exist in a laboratory before being placed in a woman’s body; Kuwabara is trying to give a fetus a safe home if delivered too early from its natural womb. Significantly, both believe artificial wombs capable of supporting a child for nine months will become reality in a few years. â€Å"Essentially research is moving towards the same goal but from opposite directions,† UK fertility expert Dr Simon Fishel, of Park Hospital, Nottingham, said. â€Å"Getting them to meet in the middle will not be easy, however. There are so many critical stages of pregnancy, and so many factors to get right. Nevertheless, this work is very exciting. † Dr. Gelfand has pointed out that this is cause of concern of some serious ethical issues: â€Å"For a start, there is the issue o f abortion. A woman is usually allowed to have one on the grounds she wants to get rid of something alien inside her own body. At present, this means killing the fetus. But if artificial wombs are developed, the fetus could be placed in one, and the woman told she has to look after it once it has developed into a child. † I don’t know about you, but me, I think science is turning into it’s own worst enemy! Resources Harvard. Edu/artificialwomb, fall 2008 Nwotruth. com- September, 2008 Don’t waste time! Our writers will create an original "Artifical Womb" essay for you Create order

Descriptive Essay - Original Writing - 1699 Words

Hurrying over to the creek with a can of corn, my father’s friend, Steve, my dad, and myself all had a tiny pole in our hands. Every time one of us dunked our corn-on-a-hook, a creek chub would snap snap snap at it, and we’d have another piece of bait for the real fishing journey. After we snagged enough creek chubs, we headed to the Illinois river. The three of us drove for what seemed to be forever, but finally made it. As we pulled into the parking space, my dad and I went through our mental checklist. â€Å"Go ahead and slip your life-jacket on.† â€Å"Yeah, don’t forget that!† â€Å"Uh...wasn’t it in the back of the truck, Dad?† I had scavenged all over the truck, but it was nowhere to be seen. â€Å"Oh NO! We left it in the boat, I think. Because†¦show more content†¦Steve finally jammed the boat plug into place after fifteen minutes, and we were set. We sat for hours on end, with no bites, just sitting in the dark snacking on food, when, out of the blue, there was a little tugging at the end of my pole. I knew what was coming, and at five years old I was surprisingly patient. I waited and waited until my pole totally bent over, signaling the perfect time to set the hook. However, nothing ever really took off with the bait, but just nibbled around the hook, where I couldn’t get it. I finally gave up, and put fresh bait on the hook. My father, his friend Steve, and I hurried over to a nearby creek with a can of corn and a tiny pole in our hands. Every time one of us dunked our corn-on-a-hook, a creek chub would snap snap snap at it, and we’d have another piece of bait for the real fishing journey. After we snagged enough creek chubs, we headed to the Illinois river. The three of us drove for what seemed to be forever, but finally made it. As we pulled into the parking space, my dad and I went through our mental checklist. â€Å"Go ahead and slip your life-jacket on.† â€Å"Yea, don’t forget that!† â€Å"Uh...wasn’t it in the back of the truck, Dad?† I had scavenged all over the truck, but it was nowhere to be seen. â€Å"Oh NO! We left it in the boat, I think. Because we had to move it to fit the cooler inside the truck, and it must have flown away while we were driving!†Show MoreRelatedDescriptive Essay - Original Writing1110 Words   |  5 PagesI don’t know how I got to where I am, but I’m here now, and I have to win if I want to live. I am in a game, and in order to live, I have to escape. That’s the thing, though: I don’t know how to escape. I was running for my life around this old house that looked like it came straight out of a horror movie. I doubled over and held my head in pain as I saw the static, which meant it was coming. I was being chased by what looked like a person but in no way acted like one. Just as it was about to appearRead MoreDescriptive Essay - Original Wri ting1102 Words   |  5 PagesIt is on days like this when we stop to think about our life. Small drops of rain begin to dapple the cobblestone pavement as people whip out their umbrellas for cover. I continue sauntering down the busy street, relishing the feeling of a light shower. Moving with the mass of pedestrians, I stop at a crosswalk where I wait for the stoplight to turn green. A flower shop employee across the street scurries to bring in the numerous bouquets and close the doors as rain starts rolling down the displayRead MoreDescriptive Essay - Original Writing914 Words   |  4 PagesDreamy I thought. Standing on the corner is a young guy with a smile. I see him here almost every day, so I linger for a while. He tells me his name, and I tell him mine. I m Ester, what s your name? I enquired. My names David .,He replied. We end up talking for a while and I asked him if he had ever left this city. He tells me of all these stories of the places where he s been, the di stant lakes and mountains, and in valleys oh so green. I can see it in his eyes, he really has beenRead MoreDescriptive Essay - Original Writing974 Words   |  4 Pages I was used to moving round, having a mother who liked to travel more than making roots was something I had gotten used to. Still, I had never gotten used to the loneliness of an empty house when she was out exploring, or the feeling of leaving behind someone who could have meant something to me. Our most recent move was Oregon. It was pretty, and I didn’t mind it, but it was much different than Florida. Not only was it opposite sides of the country, it felt as if it were opposite worlds. InRead MoreDescriptive Essay - Original Writing1012 Words   |  5 Pageshave plenty of time in the next month to think about my feeling in regards to Kendrick. I needed to finish up the article and get it off to my editor. I should be able to get it done by tonight and send an email in the morning. I was thinking of writing my next article about the sea life around the Scottish coast. Since our salmon dinner last evening I thought I would do a piece about the commercial salmon farming that began in Scotland in 1969. In 2002 over 145,000 metric tons of farmed AtlanticRead MoreDescriptive Essay - Original Writing1561 Words   |  7 PagesThere’s something I need to say and what follows may not be something that you’d expect, it won’t be heartening or uplifting. If you remember today, I told you about going somewhere I wanted to go to†¦ I’m not sure if you believed and accepted what I now confess as untrue; it is partly. I needed to pull away emo tionally†¦ from you. You must have had fathomed that some degree of formality had seeped between us. Born of habit, formulaic greetings had become a routine. You presume that I’m a close friendRead MoreDescriptive Essay - Original Writing1387 Words   |  6 PagesI was wearing a beautiful blue dress with sapphire gems all around the chest area as I entered the ball with Ciel and Sebastian. I took a good look around here, the hallway was lined with gold. There was a servant ready to escort us to the ball room. Hello, come this way. He said, walking forward. Wow, this place is so fancy! I exclaimed, looking around. It s fake gold. Ciel bluntly replied, bringing my hopes down. I sighed. Ciel sounded like he wasn t in a very good mood. Ciel, lightenRead MoreDescriptive Essay - Original Writing1287 Words   |  6 Pages In the morning, Caireann woke me up. She stood above my bed, shaking my shoulder. I opened my eyes, looking at her. Then I looked across the room to her empty bed. Andy s empty bed sat in the corner. I swallowed, climbing out of bed. Sleep well? Caireann asked me, starting out the door. Yeah, I said, going over to our small dresser. I had the bottom two drawers. Andy had the middle two, and Caireann had the top. I pulled open the drawers, pulling on a colorful tank top and a grayRead MoreDescriptive Essay - Original Writing1345 Words   |  6 PagesLater that night, I was behind the wheel of my G-Wagon with Melissa in the passenger seat. She didn’t feel like driving since she was on the road all day and I understood so I didn’t mind when she asked me to. I had been tight-lipped. She kept eyeballing me as if she detected that something was bothering me but I just kept singing to my India Arie as if I was carefree. â€Å"So are you going to tell me what’s going on or no† Melissa said disrupting my own personal concert. I stopped singing and tookRead MoreDescriptive Essay - Original Writing1085 Words   |  5 PagesI WAS SITTING IN a taxi, wondering if I had overdressed for the evening, when I looked out the window and saw Mom rooting through a Dumpster. It was just after dark. A blustery March wind whipped the steam coming out of the manholes, and people hurried along the sidewalks with their collars turned up. I was stuck in traffic two blocks from the party where I was heading. Mom stood fifteen feet away. She had tied rags around her shoulders to keep out the spring chill and was picking through the trash

Investigating Staff And Children s Perceptions Of...

This research project will investigate staff and children’s perceptions of inclusion of children with special educational needs (SEN) across year three. It will consider whether the inclusive methods used by staff are effective, with reference to psychological theories, relevant legislation and recent research. The project will take place at a three form entry junior school where I am a teaching assistant. It will involve a range of school staff and pupils from Year Three. The enquiry will be based around perceptions gained through a range of interviews, questionnaires and observations. Therefore permission from the parents of the children involved will be required and informed consent given due to their age. Similarly, consent will be required from all adult participants involved. The effectiveness of inclusion will be measured by the extent to which participants feel children with SEN are included within the classroom setting. The researcher will take observations from a series of lessons, which will also be recorded. Another teaching assistant will then observe the recordings and give feedback to provide another viewpoint, or rather ‘investigator triangulation’, consequently reducing researcher bias (Thomas, 2013, p.146). This area of research is of particular interest to the researcher, firstly because inclusion is widely recognised by the National Curriculum. It highlights ‘A wide range of pupils have special educational needs’ and consequently, ‘Lessons should beShow MoreRelatedMadison Metropolitan School District18559 Words   |  75 Pagesnew strategies to render the values expressed in their practice more consistent with the educational values they espouse; record their work in a form which is readily available to and understandable by other teachers; and thus develop a shared theory of teaching by researching practice. - John Elliott What is Action Research? | Five Phases of Action Research | Starting Points | Data Collection: The 5 W s and an H | Writing Prompts for Classroom Action Researchers | Ideas for Your Final Write-upRead MoreHistory and Rolls of Law Enforcement in America10094 Words   |  41 Pagesresponses will incorporate knowledge of policing trends and issues gained throughout the course. Followed by a reaction summary. To understand today, you often have to look at yesterday. To grasp the challenges that contemporary policing faces, we need to explore a brief history of law enforcement in the Untied States. It is a story of a countries continuing struggle with law enforcement within a democracy. On the one hand we all want a professional police, with highly trained officers who willRead MoreEssay Paper84499 Words   |  338 Pagesin the glossary are applicable only to uniformed personnel. AR 690–600 contains similar terms that are applicable to Department of Defense civilians. Proponent and exception authority. The proponent of this regulation is the Deputy Chief of Staff, G–1. The proponent has the authority to approve exceptions or waivers to this regulation that are consistent with controlling law and regulations. The proponent may delegate this approval authority, in writing, to a division chief within the proponentRead More2006 Arroyo Case Study31910 Words   |  128 PagesMeasurement, Analysis, and Review of Organizational Performance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Information and Knowledge Management †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 17 Category 5—Human Resource Focus 5.1 5.2 5.3 Work Systems†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Staff Learning and Motivation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Staff Well-Being and Satisfaction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 19 21 24 Category 6—Process Management 6.1 6.2 Health Care Processes †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Support Processes and Operational Planning †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 25 29 Read More2006 Arroyo Case Study31910 Words   |  128 Pages4.1 4.2 Measurement, Analysis, and Review of Organizational Performance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Information and Knowledge Management †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 17 Category 5—Human Resource Focus 5.1 5.2 5.3 Work Systems†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Staff Learning and Motivation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Staff Well-Being and Satisfaction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 19 21 24 Category 6—Process Management 6.1 6.2 Health Care Processes †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Support Processes and Operational Planning †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 25 29 Category 7—ResultsRead MoreAdvancing Effective Communicationcommunication, Cultural Competence, and Patient- and Family-Centered Care Quality Safety Equity53293 Words   |  214 PagesAdvancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care A Roadmap for Hospitals Quality Safety Equity A Roadmap for Hospitals Project Staff Amy Wilson-Stronks, M.P.P., Project Director, Health Disparities, Division of Quality Measurement and Research, The Joint Commission. Paul Schyve, M.D., Senior Vice President, The Joint Commission Christina L. 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If successful, the individual then makes use of the information found and may either fully or partially satisfy the perceived need - or, indeed, fail to satisfy the need and have to reiterate the search process. The model also showsRead MoreOverview of Hrm93778 Words   |  376 Pages most of these elements will affect you at some point in your career. Either you will be working with some organizations or having people working for you, in both cases you will be dealing with people. To be understandable and lively means that we need to communicate you. We start every chapter with learning objectives. The most important thing you will get out of this course are the basic skills required to succeed in today’s environment which are, you must be able to communicate, think creativelyRead MoreLibrary Management204752 Words   |  820 PagesCongress Subject Headings: Principles and Application, Fourth Edition Lois Mai Chan Developing Library and Information Center Collections, Fifth Edition G. Edward Evans and Margaret Zarnosky Saponaro Metadata and Its Impact on Libraries Sheila S. Intner, Susan S. Lazinger, and Jean Weihs Organizing Audiovisual and Electronic Resources for Access: A Cataloging Guide, Second Edition Ingrid Hsieh-Yee Introduction to Cataloging and Classification, Tenth Edition Arlene G. Taylor LIbRaRy and InfoRMaTIon

UW-Whitewater College Essay free essay sample

I come home from work to hear my dad throwing up. It was from food poisoning, he said. Good thing I didn’t eat that pizza last night. Then, my dad’s phone rings. I have two options: either hit ignore or answer the phone and say what I hear at least one hundred times a day—â€Å"Milwaukee Coach and Carriage.† The first time I answered the phone I shook, thinking, what if I screw up the reservation? What if I don’t get the credit card right? What if I don’t send them to the right hotel? Then the customer asks, â€Å"Do you have any openings for tonight?† â€Å"Sorry, we are booked for tonight,† I say. Thinking, that was easy, another person calls. I answer: â€Å"Milwaukee Coach and Carriage.† This customer says, â€Å"Do you have any openings for next Monday? And I have the Groupon.† Great. Now I have to worry about getting their Groupon number too. We will write a custom essay sample on UW-Whitewater College Essay or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page â€Å"Sure, what time did you have in mind?† I ask. â€Å"Do you have a five or six o’clock open?† â€Å"Yes, I have a 5 o’clock at the Pfister or the Intercontinental,† I say. â€Å"I’ll take the five o’clock at the Pfister for an hour ride.† â€Å"Alright, then I just need the number on your Groupon and there is a two dollar and fifty cent tax that we have to collect and we take Mastercard, Visa, or Discover,† I say. Confirming information, I say, â€Å"You are all set. Have a great day.† By the end of the day, I had taken fifteen reservations, some complicated and some simple. Yet I had successfully sent all of the customers to the right hotel and informed the drivers about the rides I added to their schedule. I even dealt with an issue at a wedding. All of this tested my patience, and my ability to learn and problem solve quickly. In the end, I had a different perspective on how stressful my dad’s life is and also the knowledge that if I ever come home to my dad throwing up again, I can answer the phone and take control of Milwaukee Coach and Carriage.