Quality of Life in Turkish Ankylosing Spondylitis Patients

Quality of Life in Turkish Ankylosing Spondylitis Patients Introduction Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease characterized by spinal inflammation, usually in the form of sacroiliitis and spondylitis which may lead to syndesmophyte formation and ankylosis in the further course of the disease [1]. AS most commonly begins in the second and third decade of life as persistent inflammatory back pain that can already be associated with significant loss of function, work disability and impaired quality of life early in the disease [2-4]. In studies conducted previously, risk factors affecting the functional status and quality of life in patients with AS have been evaluated. Age, duration of symptoms, pain severity, stiffness, peripheral arthritis, total hip arthroplasty, smoking habit of patient, having history of more physically demanding jobs and lower levels of education have been demonstrated as risk factors for functional limitations and quality of life in patients with AS [3-8]. In other rheumatic diseases, level of education has been found to be possibly associated as a risk factor [9-11]. In this study, we planned to determine the possible risk factors affecting functional situation and quality of life in Turkish patients with AS. Materials and Methods Eigthy nine Turkish AS patients diagnosed with AS according to the Modified 1984 New York Criteria who were admitted to the Rheumatology Outpatient Clinics of Akdeniz University and Adnan Menderes University were included in the study. This study was approved by the Research Eth ­ics Committee Yet, one patient, who did not want to participate, was excluded from the study. Thus, a total of 88 volunteer Turkish AS patients consisting of 24 females (27.3%) and 64 males (72.7%) with their age ranging from 21 to 81 were enrolled in the study. Demographic information of the patients was obtained, their heights and weights were measured and these values were recorded. Then body mass indices (BMIs) of the patients were calculated by dividing the body weight as kilograms by the square of height in meters. Levels of education of the patients were investigated and recorded (0: illiterate, 1: literate, 2: primary school graduate, 3: secondary school graduate, 4: high school graduate, 5: university graduate). Dates of diagnosis of the patients, drug(s) they used, their duration of morning stiffness (as minutes) were investigated and recorded. Patients with diagnosis of AS who were admitted to the Rheumatology Outpatient Clinics are routinely instructed with a home-based exercise program. Exercises recommended are as breathing and posture exercises, and range of motion/stretching exercises for all joints. Patients were inquired about the extent they do these recommended exercises, and they were rated as 0 (not doing the exercises) , 1 (doing irregularly or occasionally), 2 (doing regularly every day), and the results were recorded. Smoking habits of the patients were evaluated. Those who have smoked at least one cigarette a day for a period of longer than 6 months during their lifetime were included in the smoking group. Whether or not the individuals in this group were currently smoking and how many cigarettes a day and for how many years they have smoked were determined. â€Å"Packs/year† term was calculated by multiplying amount of cigarettes (as packs) smoked daily by smoking period (as years). Indices have been developed to measure the activation status, functional status, spinal mobility values and quality of life of patients with ankylosing spondylitis. Bath AS Disease Activity Index (BASDAI), developed for evaluating disease activity, consists of 6 visuel analog scale (VAS) measurements comprising of fatigue, spinal and peripheral joint pain, severity and morning stiffness [12]. Bath AS Functional Index (BASFI), developed for functional evaluation, was determined to have been superior regarding sensitivity to the change to the Dougados Functional Index (DFI) which was developed for the same purpose [13]. Bath AS metrology index (BASMI) was developed by evaluating 20 different clinical assessment methods and selecting 5 among them with the property of the highest validity, reliability, repeatability, and sensitivity to the change [14]. Developed to assess the quality of life of patients with AS, Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) has been demons trated to be a valid and reliable tool that can be used both in clinical practice and in scientific research [15]. To evaluate the functional status, disease activity, spinal mobility and quality of life of the patients, BASFI, BASDAI, BASMI and ASQoL scales were used respectively. All indices were assessed by the same physician. Turkish versions of BASFI, BASDAI and ASQoL were used. The reliability of the Turkish versions of BASFI, BASDAI, and ASQoL has been confirmed [16-19]. BASMI is a combined index comprising five assessments of spinal mobility in AS patients. The index include assessments of lateral lumbar flexion, tragus-to-wall distance, lumbar flexion, intermalleolar distance and cervical rotation [20]. These measurements have been found to be clinically practical and reliable in reflecting axial status [1]. In our study, measurements of tragus-to-wall distance, modified Schober, cervical rotations (mean of the sum of right and left rotations was taken), lumbar lateral flexion difference (mean of the sum of right and left lateral flexion differences was taken), intermalleolar distance were performed by the same physician on all patients to obtain BASMI score. Apart from these mobility assessments performed, occiput-to-wall distance, chin-to-sternum distance, chest expansion, thoracic Schober, lumbar Schober, hand-to-ground distance and intermalleolar distance were measured. As laboratory values of the patients, erythrocyte sedimentation rate (using Standard Westegren Method) and serum C-reactive protein (CRP) levels were measured. SPSS 14.0 (SPSS Inc., Il., USA) software package was used for data analysis. Results for continuous variables were presented as maximum, minimum and mean  ± standard deviation (SD). Descriptive statistical method was used to obtain these values. For the correlation analysis of the results, Pearson Correlation test was used. Multivariate regression models were constructed to evaluate associations between identified variables. A p value of

How women are presented in “The Great Gatsby” Essay

F. Scott Fitzgerald said of The Great Gatsby that it ‘contains no important woman character’. How are women presented in The Great Gatsby, and how can this be compared with the presentation of women in Cormac McCarthy’s No Country for Old Men? Initially, it appears that the women characters are seen as inferior and are significant only in the relationship to male characters. A distorted view could be shown as both texts are written by male narrators. F.Kerr said that Fitzgerald felt â€Å"women are so weak, really- emotionally unstable- and their nerves, when strained, break†¦ this is a man’s world.† This insinuates that neither ‘The Great Gatsby’ or ‘No Country for old men’ contain an important female character. In The Great Gatsby, Daisy’s life is defined entirely by her relationship with men. The line â€Å"Dinner with the Tom Buchanans,† enforces the unimportance of women characters because it suggests that Daisy’s identity is only as Tom’s wife, not as an individual in her own right, which fits with the Patriarchal society of the time. Fitzgerald uses Daisy, Jordan and Myrtle as props to reveal the male character’s personalities â€Å"tell em all Daisy’s changed her mind† shows Daisy’s main role within the novel is to be the object of Gatsby’s desire. The character of Daisy also realises how little control she has over her life when she says â€Å"the best thing a girl can be in the world is a beautiful little fool.† This confirms Fitzgerald’s statement of no important females because it simply implies women believed their roles in society weren’t important and had accepted the reality of living in the shadows of men. The noun ‘fool’ is a person who lacks judgement which reflects Daisy’s life as she is dictated by Tom and was easily persuaded to marry him. It indicates that Daisy is aware of her unimportance as a woman and corroborates Fitzgerald’s statement. Furthermore, the adjective ‘beautiful’ means looking pleasing at sight which was how Daisy first met her husband and triumphed in sustaining a rich, luxurious lifestyle. Similarly, In No Country for Old Men Carla Jean lives in the shadow of her controlling, assertive husband. Although Llewelyn doesn’t have money to control her, he possesses another kind of controlling factor to ensure that she feels insignificant. â€Å"What? Quit hollerin.† This  enforces Llewelyn’s dominant behaviour because his disrespectful response indicates he shows no regard towards her point of view. The verb â€Å"hollerin† is extremely commanding and domineering, implying Carla Jean had yelled at Llewelyn, which isn’t particularly reflective of her nature suggesting Llewelyn finds his wife irritating and sees her of no great importance. Fitzgerald enforces his statement of no female importance when he gives Jordan a name that isn’t gender specific as it could show he believes masculinity is a key aspect to obtaining importance. The descriptions of Jordan focus on her masculine characteristics, â€Å"she wore her evening dress, all her dresses, like sports clothes,† which suggests, through the use of a simile, she has to flaunt her boyish figure in order to remain independent and not become controlled by male characters. On the other hand, the novel was set in the aftermath of World War One, a time when women started to fulfil the job roles of males who found themselves fighting a war. This contradicts Fitzgerald’s statement â€Å"like a young cadet,† through use of a simile, Jordan could represent a modern changing woman of the 1920s. The noun ‘cadet’ means a young trainee in the police force or armed services which can stereotypically be seen as a masculine job. However, even though Jordan appears to be independent and obtains a certain level of importance, the men still seems to act apathetically towards her, thus confirming her irrelevance and insignificance. Similarly, in No Country for Old Men McCarthy displays Carla Jean being the victim of unimportance through Llewelyn and Chigurh constantly referring to her using the pronoun ‘she’ instead of her name. Although, when Chigurh is committing murder he doesn’t distinguish between the sexes he just kills equally, he still pays no respect to Carla Jean â€Å"it doesn’t make any difference where she is,† which enforces her unimportance because to Chigurh it is just another wasted bullet rather than the taking of someone’s life. Ryan P. Doom agrees with Fitzgerald’s: â€Å"the women in No Country for Old Men serve no purpose other than to offer support.† He believed they have little influence on the plot or the decisions made by the male characters. â€Å"You ain’t going have to come looking for me at all.† This supports Doom’s statement as it shows Llewelyn becoming more concerned about himself, rather than the urgency to save his wife. Therefore, the narcissistic Llewelyn helps portray woman as containing  no importance because he puts himself first, irrespective of what will happen to his wife. Myrtle is a character that represents the working class women of the 1920s and is someone who isn’t happy with what she has as she naively thinks Tom would leave Daisy and take her away from the Valley of Ashes. Therefore, she is a character who believes in the ideals of the ‘American Dream.’ Fitzgerald uses the oxymoron â€Å"soft, coarse voice,† to relate to her two contradictory lives as the â€Å"coarse† wife of Mr Wilson and the â€Å"soft† mistress of the upper-class Tom Buchanan. Additionally, although Myrtle believes she is Tom Buchanan’s mistress, she is essentially just involved in adultery and exposed to Patriarchal treatment because Tom has the power and control of the relationship and make the authoritative decisions as to when he wants to see her. When Myrtle begins to mock Daisy in front of Tom, â€Å"Daisy, Daisy, Daisy,† he becomes protective of his wife and let his anger overpower him by punching Myrtle. â€Å"Making short deft movement, Tom Buchanan broke her nose with his open hand.† This proves Myrtle’s unimportance because Tom is indifferent to her feelings and values her with little significance. Feminist critic Judith Fetterley would argue Myrtle is like the unattainable ‘American Dream’. Her objectification by Tom means she has no hope of actually achieving the Dream because the Valley of Ashes has left her with little opportunity to achieve more in life, thus confirming Fitzgerald’s statement of ‘no important women characters because he gives them a poor quality of life. On the other hand, Myrtle displays some power over her husband, â€Å"his wife’s man and not his own,† which helps contradict Fitzgerald’s statement as a higher authority and importance is being portrayed, however, her death overturns this and makes her insignificant. Similarly, in No Country for Old men, Carla Jean can be compared to Myrtle because they are both victims of lives they have no control over. Llewelyn explores female unimportance through a contemptuous tone â€Å"Well I got a good feeling, so that should even out,† suggesting he possesses no shame in the ignorance of his wife’s viewpoint and feels no disgrace in taking control. It is evident that both Myrtle and Carla Jean are powerless to control their deaths Myrtle’s erotic personality followed her right until death â€Å"her left  breast swinging loosely like a flap,† suggesting by the use of the simile ‘like a flap’ and because the focus was on her ‘left breast’, rather than any other body part, it was her sexuality that metaphorically killed her. The adjective ‘loosely’ helps confirm Fitzgerald’s statement as it could indicate how fragile and insignificant Myrtle is as a woman character. The physical mutilation or ‘rape’ as some critics argue shows her insignificance and weakness. It suggests Fitzgerald felt some disdain or misogynism towards women. Similarly, in No Country for Old Men Carla Jean watches powerlessly as Chigurh flips the coin that decides her fate â€Å"This is the best I can do. Call it.† The inability to influence the plot implies Carla Jean delivers no significant importance because she suffers with the fate that lies in the hands of a male character, which holds the direction her life is heading. Thus implying women are unimportance because they are powerless and given no authority. A feminist may argue that women characters in The Great Gatsby are victims to a distorted interpretation as it contains male narrators and male protagonists. Fitzgerald himself admitted it was â€Å"a man’s book† which perhaps gives a biased representation of women in ‘The Great Gatsby’ and supports the notion that it ‘contains no importance woman characters.’ Arguably, Nick is an unreliable narrator as the only events brought to attention are those he has witnessed, which could suggest he’s portraying a subjective view on the female characters. Also, his opinion of Jordan as â€Å"incurably dishonest† implies distain towards her and a disregard of her viewpoint. On the other hand, in No Country for Old Men Sheriff Bell perhaps gives a more faithful representation of female characters because he shows respect her wife Loretta Bell â€Å"she’s probably right. She generally is,† suggesting his admiration shows he gives women the acknowledgment they deserve. Arguably, when the book goes into third person, traditional ‘Western cowboy’ attitudes are exposed as women have very minor roles and barely any time to build up an important image. This could lead to a distorted view of women as they are not treated fairly and not given equal opportunity to gain the recognition and importance the male characters achieve. Overall, the impression is given that women serve less importance than men in both novels and are less influential towards the direction the plots take. Some parts within The Great Gatsby contradict Fitzgerald’s statement because it contains characters such as Jordan who help portray a modern, independent woman which allows her to obtain a certain amount of importance. However, in No Country for Old Men the plot is largely based around Llewelyn and Chigurh who are both very narcissistic which leaves little opportunity for characters such as Carla Jean to express any importance as she isn’t even valued by her husband. On the whole, it could be argued Fitzgerald’s statement is acceptable because both novels are very male dominant.

Admission Essay Final

Pursuing my dream career in Practical Nursing will bring to me a great sense of satisfaction.   I have always wanted to study nursing up to the highest education level possible for two reasons; one to use the education for life and secondly to live off the education.Education for me is just more than attaining good grades. Education for me is an opportunity to develop into a well-rounded person, fully equipped to face the world and serve my community and humanity and eventually make the world a better place for future generations to live in.The Lead School of Technology University has a unique culture which emphasizes on innovation, imagination and a culture of valuing of people. The Lead School of Technology University has a well-equipped library which meets the research needs of students, fully computerized and equipped with state of the art equipment. This is very ideal for nursing students and is very crucial for me as a nursing student.Throughout my life, I have always desired to study nursing from a reputable University hence my desire to join Lead School of Technology University which has unmatched standards in as far as nursing programs are concerned. My dream is to excel as a nursing student and graduate as a well-rounded nursing professional able to deal with the challenges that constantly emerge in the field.Without this hands-on experience, skills and knowledge, I cannot be able to make it, hence, my resolve to join Lead School of Technology University where I believe I will achieve my career and academic goals.   My dream to pursue nursing stems from an early age, partly from the encouragement from parents and secondly from my personal ambitions and career goals.My ambition is grounded in the realization that I am talented I love caring for people. I understand the importance of nurturing the talent and for me, the best way to do it is by studying nursing at the University level.For me, nursing is more than giving care; it is more than a path t o a promising career.   Nursing is a means to express oneself in one of the mot effective ways. Nursing leads to special way of communication in that it connects the nurse and the patient.Nursing is the best avenue to solve some of the social challenges the world is faced with, in regard to disease. Nursing can play a very positive role in conflict resolution in a world dominated by violence and selfishness.It is my conviction that, enrolling for a LPN course in this college will provide me with the necessary information-based skills to excel in achieving my career goals.   In this competitive world, it takes discipline, an understanding of relevant laws, a good understanding of ethical code of conduct and a couple of other skills to survive in the competitive nursing field.   My admission for a LPN program will therefore equip me with the above-mentioned skills and therefore make me a qualified professional.Conclusion  My interest in Lead School of Technology University is informed by the fact that, it will offer me with an empowering study environment. Lead School of Technology University has a sizeable number of students which means that, admission at the University requires high qualifications making it a center for excellence. I really look forward to getting admission to the Lead School of Technology University nursing program.BibliographyGordon, V (2005).   Career advising: An academic advisor’s guide. San Francisco CA: Jossey-Bass.

Essay about The Black Death in The Decameron by Boccaccio

The Black Death was an epidemic disease that was also known as the Bubonic Plague. It was one of the most tragic epidemics that has happened in the world. The Black Death hit England between the years of 1348-1350. This plague annihilated one third of its original population. Trading ships that came to England during this time were blamed for the spread of this disease. People believed that when trading ships left other countries that they would bring in infested rats that carried the disease. When the rats would come in contact with a person or bit a person is believed to be the reason on why the deadly virus spread so quickly. Also many thought that the plague was airborne; when they thought this was the cause of the spreading of the†¦show more content†¦However, after the Black Death the paintings then turned for the worse. Paintings turned dark and no one painted to show realism anymore they painted to show peoples fear of death. They also showed that no one lives a perf ect life and death is right around the corner. In the paintings, the people who were dressed elegantly were exchanged with skeletons with dilapidated clothing. â€Å"Paintings were overflowing with tortured souls, death, dying, fire and brimstone.† Before the Black Death the atmosphere of the paintings were very bright and optimistic. The happiness that filled the paintings before were replaced with images of Hell and Satan (The Effect the Black Death para. 3). The masks that doctors wore during this time period to save themselves from getting the disease when treating patients became an important visual art. In Behind the Mask: Plague Doctors they quoted: The nose [is] half a foot long, shaped like a beak, filled with perfume with only two holes, one on each side near the nostrils, but that can suffice to breathe and carry along with the air one breathes the impression of the [herbs] enclosed further along in the beak. Under the coat we wear boots made in Moroccan leather (goat leather) from the front of the breeches in smooth skin that are attached to said boots, and a short sleeved blouse in smooth skin, the bottom of which is tucked into the breeches. The hat and gloves are also made of the same skin†¦withShow MoreRelatedEurope and the Black Death Essay1541 Words   |  7 PagesEurope–almost one-third of the continent’s population,† by the 1350’s (Black Death). Now in today’s society scientists classify the unidentifiable disease as the bubonic plague, also referred to as the Black Death. During fourteenth century European-society, there was no logical medical knowledge; instead, people resor ted to supplementary explanations, such as God punishing misbehaving religious groups and sinners (Black Death). In this time period, oral tradition was still common among the illiterateRead MoreThe Impacts of Boccaccios Writing Style on the Tone of Decameron1609 Words   |  6 PagesBoccaccios Decameron is a masterpiece of early 14th century European literature; its bawdiness and its sheer wit are a wonderful, funny indicator of what life was like in 14th century Italy. However, the central framing device of the book itself - the Black Plague, which ravaged Europe around the time of the books setting and publication - plays a somber but vital role in this important work. The importance of the plague to the story is no less evident than in the introduction, which demonstratesRead MoreEuropes Response to the Black Death Essay1296 Words   |  6 Pageswell-known Black Death, which starting in 1347 took its toll on Western Europe. 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Boccaccio was most likely born in Florence or Certaldo and was the illegitimate son of a wealthy Florentine merchant, Bocacino di Chellino. As a youth he was trained to follow in his father s business but he eventually chose instead to study canon law and subsequently pursued the arts. It is a combination of Greek words for ten and day. According to Frankforter, the Decameron is a fictiveRead MoreThe Themes Of Death And Death1282 Words   |  6 PagesQuestion Paper The Meaning of Death The themes of life and death are used frequently throughout many ancient and modern stories, and specifically, thoughts on death and what it means differ from author to author, time period to time period, and circumstance to circumstance. Many works of ancient literature address the meaning of death directly; examples include the drama Medea by ancient Greek playwright Euripides in 431 BCE, and the Decameron by Italian Giovanni Boccaccio in around 1353. 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