Psychological Interventions in Patients with Cancer

Psychological Interventions in Patients with Cancer Introduction Patients with cancer may experience comorbid conditions such as anxiety and depression, and symptoms including fatigue, nausea and vomiting. Anxiety and depression are both very common and it has been estimated that 16–25% of newly diagnosed cancer patients experience either depression or depressed mood (DSM-IV criteria) (Sellick 1999). Studies in women with breast cancer have shown that up to 30% develop psychological morbidity (either anxiety or depressive disorder) within one year of diagnosis (Bleiker 2000; Maguire 2000). Cancer-related symptoms are also very common. As many as 70–80% of all cancer patients receiving chemotherapy experience nausea and vomiting (Lindley et al. 1989; Morrow 1992) and 78% of patients are estimated to be affected by fatigue (Ashbury et al. 1998), in particular those with advanced cancer and those receiving radiotherapy and chemotherapy treatment (Ahlberg et al. 2003; Jacobsen et al. 2007), where symptoms may persist even after treatment has finished (Servaes et al. 2002). The use of psychological interventions can be beneficial in the management of cancer-related conditions and symptoms and may result in improved quality of life and better long-term outcomes (Devine and Westlakes 1995). Psychological interventions may be classified into four groups (which also include broader psychosocial interventions) as described below (Fawzy et al.1995; Greer 2002; Edwards et al. 2004): Cognitive behavioural interventions involve the identification and correction of those thoughts, feelings and behaviours that may be involved in the development and/or maintenance of cancer-related symptoms or conditions (Jacobsen 1998). Individual psychotherapy interventions involve one-to-one interaction between patient and therapist, aimed at reducing feelings of distress and increasing the patient’s morale, self-esteem and ability to cope (Fawzy et al. 1995) Educational interventions provide patients with information about cancer, ways of coping with the disease and what resources are available to help them, with the aim of reducing commonly experienced feelings such as inadequacy, confusion, helplessness and loss of control (Fawzy et al. 1995). Group interventions may be either patient led or led by healthcare professionals and serve to provide social support for cancer patients (Leszcz and Goodwin 1998). One intervention within this category, supportive-expressive group therapy, involves building bonds, expressing emotions, improving the relationship between patient and healthcare professional and improving coping skills (Edwards et al. 2004). It is also important to consider the effectiveness of other interventions, such as the use of complementary therapies, which may be used alongside psychological interventions to achieve a greater improvement in cancer-related conditions and symptoms than those obtained using psychological interventions alone. This paper reports the process and findings of a literature review performed to identify and evaluate published literature on psychological interventions in patients with cancer, and other interventions that may also be effective in achieving improved psychological outcomes, together with a discussion of how the evidence gathered may guide informed decision-making on best clinical practice. Data sources and search strategy Electronic searches were performed on the Medline, CINAHL and PsychINFO databases for English language articles published between 1998 and 2008. Search terms included cancer AND intervention OR cancer AND therapy plus education OR patient education OR educational OR cognitive behavioural OR cognitive OR psychotherapy OR psychological OR supportive-expressive OR supportive OR group psychotherapy. For each trial, the quality of both the trial itself and the report in the published literature were assessed. Literature review Main results Well-designed, single or multicentre, randomised controlled trials involving large study samples were selected for inclusion, together with systematic reviews and meta-analyses. Only UK published literature was originally planned for inclusion; however, due to the limited number of high quality, well-designed studies identified, searches were performed again to identify suitable non-UK articles. Summary of studies selected Cognitive behavioural interventions One randomised controlled trial and one systematic review were identified from the UK-published articles found during the electronic searches. The randomised controlled study by Moynihan et al. investigated the use of adjuvant psychological therapy in 73 men with newly diagnosed, non-suicidal men with testicular cancer (Moynihan et al. 1998). This is a cognitive behavioural treatment programme designed specifically for patients with cancer. The therapist was a mental health nurse with experience of caring for testicular patients and who was trained in adjuvant psychological therapy techniques. Outcome measures included validated self-completed questionnaires such as the Hospital Anxiety and Depression Scale, the mental adjustment to cancer scale and the psychosocial adjustment to illness scale. The treatment group showed a minimal reduction in anxiety after 2 months and when adjustment for histology, stage of disease and type of treatment was made, the observed effect was not signifi cant. No between group differences in depression scores were observed after 2 months. After 1 year, control patients actually achieved better anxiety and depression scores than those in the treatment group. This study therefore concluded that there was no benefit from the use of adjuvant psychological therapy in men with testicular cancer. The systematic review performed by Richardson et al. evaluated the use of hypnosis for nausea and vomiting in patients with various types of cancer (Richardson et al. 2006). Study participants were children in 5 of the 6 randomised controlled studies selected. Meta-analyses demonstrated a large effect size of hypnosis compared with standard treatment, and this effect was at least as large as that achieved with cognitive-behavioural therapy. Limitations of this review were that the sample sizes of the studies included were small, and some of the studies were poorly described in the published literature. As the majority of the studies were conducted in children, further research is needed in adults to confirm these findings. A number of non-UK published studies evaluating the use of cognitive-behavioural training in patients with cancer were also identified. A randomised controlled study conducted by Korstjens et al. investigated the effects of physical plus cognitive-behavioural training compared with physical training alone on quality of life in 147 patients with various cancers who had completed treatment (Korstjens et al. 2008). Quality of life was measured using the RAND-36. After 12 weeks, there were no differences between groups in quality of life. It can therefore be concluded that adding cognitive-behavioural training had no added benefit on cancer survivors’ quality of life compared with physical training alone. Individual psychotherapeutic interventions Fenlon et al. conducted a randomised controlled trial to investigate the effect of relaxation training in reducing the incidence of hot flushes 150 women with primary breast cancer (Fenlon et al. 2008). Study participants in the treatment group received a single relaxation training session in conjunction with the use of practice tapes. Outcome measures included a patient diary and validated measures of anxiety and quality of life. After 1 month, the incidence and severity of hot flushes were significantly reduced (p Educational interventions A randomised controlled trial by Ream et al. evaluated an educational support intervention (i.e. investigator-designed information pack) for fatigue in 103 chemotherapy-naà ¯ve cancer patients. Additional psychological support was also provided by nurses. After 3 months, the intervention group reported significantly less fatigue, lower levels of anxiety, depression and distress, and better adaptive coping (all p Jones et al. carried out a randomised trial to investigate whether different types of educational information could increase interaction between the patient and others, thereby improving emotional support and psychological well-being (Jones et al. 2006). A total of 325 patients with breast or prostate cancer who were about to begin radiotherapy participated in the study. Patients were given either a general information booklet on cancer or else a booklet containing personalised information. Outcome measures included the use of Likert scales to score answers to questions on anxiety and depression (non-validated) and Helgeson’s social support questionnaire. Results showed no differences between groups in anxiety or depression scores but patients who received personalised information reported that they were more likely to show their booklet to others and believe it helped in discussions. These findings suggest that this type of intervention may have the potential to improve emoti onal well-being by increasing the levels of support patients receive from others. A systematic review conducted by Smith et al. evaluated the effectiveness of mindfulness-based stress reduction as supportive therapy (Smith et al. 2005). This is a highly-structured psycho-educational, skill-based therapy that combines mindfulness meditation with hatha yoga. Two randomised controlled and four uncontrolled trials were selected which used self-reported outcome measures for mood, stress, anxiety and quality of life. Study findings showed improvements in mood and sleep quality and reductions in stress in patients following the use of this intervention. However, the studies included in this review largely involved small sample sizes and may therefore be underpowered. Furthermore, the quality of the written study manuscripts was variable; for example, some contained limited descriptions of the randomisation process and a lack of methods on sampling and participant recruitment. While these results are encouraging and suggest that mindfulness-based stress reduction may be e ffective as a self-administered intervention for cancer patients, further research conducted through well-designed, randomised controlled trials is needed to confirm these preliminary findings. Group psychological interventions A non-UK published study was conducted to investigate the effectiveness of hospital psychosocial support groups on emotional distress and quality of life in 108 women with breast cancer (Schou et al. 2007). Outcome measures involved the use of the validated Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire. After 12 months, the prevalence of anxiety was significantly lower among group participants than in non-participants (19% vs 34%; p=0.04). These findings suggest that psychosocial support appears to have a long-term benefit on anxiety although the effects of this intervention on depression and quality of life were inconclusive in this study. Another non-UK published randomised controlled trial has been conducted to investigate the effect of supportive-expressive group therapy compared with educational materials on distress in 125 women with metastatic breast cancer (Classen et al. 2001). Participants were offered either one year of weekly group therapy plus educational materials or educational materials only. Outcome measures included the Profile of Mood States (POMS) to assess mood disturbance and Impact of Event Scale (IES) to assess change over time in trauma symptoms. Patients who received weekly therapy showed a significantly greater decline in traumatic stress symptoms than those in the control group but no between group differences in mood disturbance were observed. It can be concluded that supportive-expressive group therapy may offer some benefit in reducing distress in women with metastatic breast cancer. Complementary/alternative interventions Wilkinson et al. conducted a multicentre randomised controlled trial to investigate the effectiveness of aromatherapy massage in the management of anxiety and depression in 288 patients with cancer diagnosed with clinical anxiety and/or depression (Wilkinson et al. 2007). Patients were randomised to receive either a course of aromatherapy massage plus usual supportive care or supportive care only. Outcome measures included the validated State Subscale of the State Anxiety Inventory (SAI) and the Center for Epidemiological Studies Depression (CES-D) Scale. At 6 weeks post-randomisation, patients who received aromatherapy massage showed a significant improvement in clinical anxiety and/or depression compared with those receiving standard care only (p=0.001) but this effect was not sustained at 10 weeks post-randomisation (p=0.10) Patients receiving the aromatherapy intervention also recorded a greater improvement in self-reported anxiety at both 6 and 10 weeks than those in the control group (p=0.04). These results suggest that although aromatherapy massage may not confer long-term benefits to patients with cancer, short-term benefitsmmay be seen. Strengths and weaknesses of this literature review As previously stated, one of the major limitations of this review was that the original searches only included UK-published articles. As a lack of good quality published research was identified, further searches were conducted to identify suitable non-UK articles to include in the review. Although a number of studies were selected that recruited participants with various types of cancer, several studies involved patients with only breast cancer and only one study was conducted in men only. It may therefore be argued that the scope of this review was too narrow. One of the systematic reviews which were included (Richardson et al. 2007) involved small studies which were sometimes poorly designed or poorly written up. The findings of this systematic review should therefore be treated with caution until supported with data from randomised controlled trials. The strengths of this review are that well-designed randomised controlled trials were included, with sample sizes large enough for adequate power. The reports of these trials were generally good quality and comprehensively written with a logical flow. The aims and/or objectives were clearly stated, and descriptions of study design, participant recruitment and selection, and the randomisation process were included. Many of the outcome measures used were validated instruments, a description of all measures was included and appropriate statistical analyses were used to analyse the data. Implications for clinical practice Previous research and systematic reviews have reported conflicting findings on whether psychological interventions for patients with cancer are beneficial or not (Greer 2002; Edwards et al. 2004). The current review also presents conflicting data on the benefits of psychological interventions in cancer patients. Two of the studies selected presented evidence that cognitive behavioural interventions provide no added benefit to cancer patients. Interestingly, a systematic review concluded that hypnosis may be beneficial but many of the studies were conducted in children so whether these findings are also observed in adults requires further investigation. Individual psychotherapeutic interventions such as relaxation training may be beneficial for breast cancer patients in reducing distress although no improvement in anxiety or quality of life was observed. The effectiveness of these types of interventions in men and in patients with other types of cancer requires further research. Educational interventions and group psychological interventions produced the best outcomes of all the psychological interventions evaluated. In particular, the use of educational booklets and information packs, either used alone or in conjunction with psychological support, may result in improvements in psychological and emotional well-being in patients with cancer. Again, further research is needed to determine whether these types of interventions are beneficial in patients with all types of cancer. Psychosocial support groups and supportive-expressive group therapy have both been shown to be beneficial in women with breast cancer, particularly in reducing anxiety and distress. Further evidence is needed to demonstrate the effectiveness of these interventions in men. Complementary and/or alternative treatments such as aromatherapy may play a role as adjuvant therapies and can be beneficial in the short-term management of anxiety and depression in cancer patients. Conclusions This review has provided evidence that certain psychological interventions such as educational and group interventions may provide some benefit to cancer patients in the management of cancer-related conditions and symptoms including anxiety, depression, fatigue, nausea and vomiting. Both short- and long-term improvements in quality of life and emotional well-being may be achievable using these interventions but further research is needed to provide the evidence to guide best practice. Psychological and psychiatric support services are currently unable to meet demand from oncology services and the oncology nurse is ideally placed to play a key role in the provision of psychological care and support for cancer patients, either directly or as part of a multidisciplinary team. For example, educational interventions such as information leaflets can be developed and provided to patients by the oncology nurse, who would also able to lead group therapy sessions. It is essential that the nurse has sufficient knowledge of the most appropriate psychological intervention to use for patients and the skill and expertise to implement this effectively to ensure a successful outcome. Bibliography Ahlberg, K., Ekman, T., Gaston-Johannson, F., Mock, V. 2003, ’Assessment and management of cancer-related fatigue in adults’, Lancet, vol. 362, pp. 640–50. Ashbury, F.D., Findlay, H., Reynolds, B., McKerracher, K. A., ‘A Canadian survey of cancer patients’ experiences: are their needs being met? Journal of Pain and Symptom Management, vol. 16, no. 5, pp. 298–306. Bleiker, E. M., Pouwer, F., van der Ploeg, H. M., Leer, J. W., Ader, H. J. 2000, ‘Psychological distress 2 years after diagnosis of breast cancer: frequency and prediction’, Patient Education and Counselling, vol. 40, pp. 209–17. Classen, C., Butler, L. D., Koopman, C., Miller, E., DiMiceli, Giese-Davis, J., Fobair, P., Carlson, R. W., Kraemer, H. C., Spiegel, D. 2001, ‘Supportive-expressive group therapy and distress in patients with metastatic breast cancer’, Archives of General Psychiatry, vol. 58, pp. 494–501. Devine, E. C. Westlakes, S. K. 1995, ‘The effects of psychoeducational care provided to adults with cancer: met-analysis of 116 studies’, Oncology Nursing Forum, vol. 22, vol. 9, pp. 1369–81. Edwards, A. G. K., Hulbert-Williams, N., Neal, R. D. 2008, ‘Psychological interventions for women with metastatic breast cancer’, The Cochrane Library, issue 2, CD004253. Fawzy, F., Fawzy, N., Arndt, L., Pasnau, R. 1995, ‘Critical review of psychosocial interventions in cancer care’, Archives of General Psychiatry, vol. 52, pp. 691–9. Fenlon, D. R., Corner, J. L., Haviland, J. S. 2008, ‘A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer’, Journal of Pain and Symptom Management, vol. 35, no. 4, pp. 397–405. Greer, S. 2002, ‘Psychological intervention. The gap between research and practice’, Acta Oncol, vol. 41, no. 3, pp. 238–43. Jacobsen, P. Hann, D. 1998, Cognitive-behaviour interventions. In: Psycho-oncology, Holland, J. (ed), Oxford University Press, New York, pp. 717–29. Jacobsen, P. B., Donovan, K. A., Vadaparampil, S. T., Small, B. J. 2007, ‘Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue’, Health Psychology, vol. 26, no. 6, pp. 660–7. Jones, R. B., Pearson, J., Cawsey, A. J., Bental, D., Barrett, A., White, J., White, C. A., Gilmour, W. H. 2006, ‘Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial’, British Medical Journal, vol. 342, pp. 942–8. Korstjens, I., May, A. M., van Weert, E., Mesters, I., Tan, F., Ros, W. J., Hockstra-Weebers, J. E., van der Schrans, C. P., van den Borne, B, ‘Quality of life after self-management cancer rehabilitation: a randomized controlled trial comparing physical and cognitive-behavioural training versus physical training’, Psychosomatic Medicine, vol. 70, no. 4, pp. 422–9. Leszcz, M. Goodwin, P. 1998, ‘The rationale and foundations of group psychotherapy for women with metastatic breast cancer’, International Journal of Group Psychotherapy, vol. 48, no. 2, pp. 245–69. Maguire, P. 2000, ‘Psychological aspects. In: ABC of Breast Diseases, Dixon, M. (eds), BMJ Books, London, pp. 85–9. Moynihan, C., Bliss, J. M., Davidson, J., Burchell, L., Horwich, A. 1998, ‘Evaluation of adjuvant psychological therapy in patients with testicular cancer’, British Medical Journal, vol. 316, pp. 429–35. Ream, E., Richardson, A., Alexander-Dann, C. 2006, ‘Supportive intervention for fatigue in patients undergoing chemotherapy: a randomised controlled trial’, Journal of Pain Symptom Management, vol. 31, no. 2, pp. 148–61. Richardson, J., Smith, J. E., McCall, G., Richardson, A., Pilkington, K., Kirsch, I. 2007, ‘Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence’, European Journal of Cancer Care, vol. 16, no. 5, pp. 402–12. Schou, I., Ekeberg, O., Karesen, R., Sorensen, E. 2007, ‘Psychosocial intervention as a component of routine breast cancer care – who participates and does it help?’, Psycho-oncology, E-pub ahead of print. Sellick, S. Crooks, D. 1999, ‘Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development’, Psycho-oncology, vol, 8, pp. 315–33. Servaes, P., Verhagen, C., Bleijenberg, G. 2002, ‘Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions’, European Journal of Cancer, vol. 38, pp. 27–43. Smith, J. F., Richardson, J., Hoffman, C., Pilkington, K. 2005, ‘Mindfulness-based stress reduction as supportive therapy in cancer care: systematic review’, Journal of Advanced Nursing, vol. 52, no. 3, pp. 315–27. Wilkinson, S. M., Love, S. B., Westcombe, A. M., Gambles, M. A., Burgess, C. C., Cargill, A., Young, T., Maher, E. J., Ramirez, A. J. 2007, ‘Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter, randomized controlled trial’, Journal of Clinical Oncology, vol. 25, no. 5, pp. 532–9. Table 1. Summary of main UK published studies selected

Essay --

JFC is building a competitive advantage to go against some global competitors such as KFC, McDonald’s and Burger King. The secrets of its success from perspective of marketing are focusing on the Filipino market, building brand equity and offering variety and convenience. JFC builds very strong brand equity. The brand sign is the bee, which is really engraved to the minds and hearts of Filipinos. And also they are engaged in socio-civic programs to serve its communities. JFC puts major resources in the Filipino market to serve local style meals that cannot be found in competitors’ chains. They serve spaghetti, rice and burgers in Filipino style. JFC is offering a menu with a wide variety of meals. And JFC’s one-stop outlet will bring convenience to all customers. From perspective of operations, JFC is learning McDonald’s operating systems and trying to gain more control on costs, service and quality to be able to reduce production time and ensure quality and higher standard of cleanliness. From perspective of human Resource, JFC provides high-class services in its stores. JFC is only looking for service-oriented staff through high- standard processes of recruitment and selection. JFC offers higher compensation to increase staff loyalty and encourage better service performance. JFC also offers training programs to help staff to gain necessary skills and builds a better working environment to increase the standards of service. 2. Although the new brands have its own different identity; JFC can still leverage its resources and skills in management, recruitment, training, selection, marketing and logistics. And also they can use economies of scale to reduce cost of production. I think that there should not be dilution of the Jollib... ...e brand equity. JFC should bring the same IT system technology to ensure operation efficiency and understand consumer trends overseas. JFC should figure out what the local customers want, and build localized service standards. And also they should train local staff by using the same methods to train its best crew to ensure consistent high-level service. 5. I believe that JFC should concentrate on the Philippines market since this market is growing at the fastest rate and has 89 percent of all stores. And JFC should also focus on China market since China’s market and economy are developing very quickly, and both McDonald’s and KFC are operating very well in China. However, expanding in overseas should not be the main focus. It takes a lot of efforts, investments and costs, especially marketing cost to introduce this unfamiliar food culture to the local customers.

Social Costs To Those Entering Gender-Specific Sports :: Sociology Essays Research Papers

Social Costs To Those Entering Gender-Specific Sports not Their Own I was part of the wrestling team when I was in middle school and in high school. While in middle school, the wrestling coaches were supportive of me and the other four girls on the team. We were trained as if we were men and competed with other team members. One girl was even cut from the team for not keeping up with the training that was expected of all team members. The other coaches in the school were not as supportive. P.E. teachers that were once friendly to the five of us became aloof and discriminatory. Students – other athletes, some on the wrestling team – taunted us. We five women on the wrestling team found we were no longer accepted by teachers and friends. We were never told that this change in attitude towards us was directly caused by our participation in a man's sport, but wrestling seems to be the only reason five women of different race, religion, and social grouping would have undergone such an experience. My teammates and I were outcast by many of our peers and punished in our classes by some of our teachers for participating in a non-traditional sport for women. When I received a wrestling injury that ended my wrestling season, I was still outcast because I carried the stigma of being a wrestler. In high school, I did not try out for the wrestling team until my sophomore year because I was afraid of the social implications that joining the wrestling team had. When I did try out with a friend in our second year of high school, we were accepted onto the team automatically so that our school could compete on the female level. We were not supported by the coaches or any of our teammates and were forced to sit out during trials. Off of the wrestling mat, we did not face any social repercussions for wrestling. Then again, we were not wrestling. We were not trained, we were not expected to weigh in, we were not a part of the team. In both middle school and high school, the social benefit would have been acceptance of female wrestlers and propagation of competitive female wrestling. My friends and I failed in both situations and suffered socially in one way or another for our efforts as a group.

C++ :: essays research papers

1. For each question below indicate True (T) or False (F) a. The binomial distribution is a possible model for a continuous variable: F b. In any normal distribution 95% of the probability lies within two standard deviations of the mean: T c. For a Poisson(m=4) distribution the variance is 2: F d. For any exponential distribution, the mean is greater than the median: T e. The Poisson is a good approximation to binomial when n is large and p is small. T (2+2+2+2+2=10 points) 2. Given that the area under the standard normal curve, to the left of –2.3 is .0107, what is the area under the normal curve to the right of 2.3? (show work) DTDP ____0.0107____________ value (8 points) 3. Suppose you flip a fair coin 7 times, let X be the possible number of heads. Find the following probabilities (in each case show work below): (i) P(X = 0) =___(.5)7______________ (ii) P(X = 1) = __7*.5*.56_________ (value) (value) (iii) Probability of at least 2 heads: Prob. Statement: _P(X > 2)__ value __1-(.5)7-7*(.5)7___ (5+5+7+5=22 points) 4. You are the safety inspector at some parts manufacturing plant. Safety at the plant is a concern; it is known that on an average there are 5 accidents per week. Assuming that the number of accidents in any week follows a Poisson distribution with mean 5, what's the probability that in 2 weeks there will be only one accident? Let X be the number of accidents in 2 weeks. ______P(X=1)________________ __10*e-10__________ Prob. Statement value (show work: Hint: what's the distribution of X?) X~Poisson(mean=2*5=10) (8+7=15 points) 5. The scores on a test are normally distributed with a mean of 80 and a standard deviation of 5. The score distribution is shown in figure 1 below. Answer the following questions. Let X denote the variable score. (a) Refer to the blue shaded area in figure 1. This is the probability of: __P(X < 70)______________ (just write the probability statement). (b) Find the value of probability in part (a) (show work) _P(Z

Death of a Salesman & Brother Dear Comparison Essay

Throughout the constant journey of life you are often under pressure. There is pressure to satisfy, pressure you put on yourself and the pressure that other people put on you. Throughout the play Death of a Salesman by Arthur Miller and the short story â€Å"Brother Dear† by Bernice Friesen, the characters find themselves facing these pressures on a daily basis. Both plotlines show how people can experience these pressures, for all different reasons, during various times in their life. In Death of a Salesman, Biff, a son of the main character, Willy, is struggling with the pressure to impress his father and satisfy him. Willy is constantly complaining about Biff, saying he is a bum and is not good. One day Biff decides he is going to try to go into business, just like his father, hoping to make Willy happy. He speaks to his mother about this, â€Å"It’s just-you see, Mom, I don’t fit in business. Not that I won’t try. I’ll try, and I’ll make good† (Miller 60). Biff knows that he will not be successful in the business world and that it is not for him, but he is going to try it anyways just so his Dad will be proud of him. The pressure to satisfy his father is so big that Biff is willing to do something he does not want to do just to make him happy. Similarly, in â€Å"Brother Dear† Greg is also under the pressure to satisfy his father. Greg wants to be a member of Green Peace, plant trees, and save the planet, while his father expects him to go to University, like his older brother, and make something of himself. His younger sister Sharlene explains, â€Å"He’s in pre-law at university, but his marks are crap. I think he went into law just because Dennis did and Dad hasn’t stopped sheering† (Friesen 3). Just like Biff, Greg is doing something he is uninterested in just to make his Dad happy and proud. Schneider 2 Coming to the end of Death of a Salesman, Biff finally, after all of the hurt and stress, puts some pressure on himself to confront his father. â€Å"I stole myself out of every good job since high school! † â€Å"And whose fault is that? † â€Å"And I never got anywhere because you blew me so full of hot air I could never stand taking orders from anybody! That’s whose fault it is! † (Miller 131) All of Biff’s pressure makes him blow and tell his father the truth about why he has never been successful. Greg’s father in â€Å"Brother Dear† is constantly putting pressure on Greg to do good in school and make something of himself. However Greg does not want to do what his Dad wants, but what he wants. Eventually, after years of pressure, Greg applies pressure onto himself to tell his father his real plans. He tells his Dad how he got a job planting trees for the summer, so he no longer has to pay his rent anymore. When his father questions how he will make enough money for rent and tuition Greg responds saying, â€Å"I’m not going back to school† (Friesen 4). Just like Biff, Greg makes himself confess and tell his father the truth about his life. Throughout Death of a Salesman, Willy Loman has a huge amount of pressure on him from his family and those around him. He has pressure from his wife to get money to pay bills, pressure from his sons to â€Å"get himself together† and pressure from hid friends to do better. All of this pressure makes Willy act crazy. One day, while he was asking a friend for a loan he states, â€Å"Funny y’know? After all the highways, and the trains, and the appointments, and the years, you end up worth more dead than alive† (Miller 98). Willy is implying the he in under so much pressure, he often wishes he were dead so he could be relieved. Schneider 3 In â€Å"Brother Dear†, Sharlene, Greg’s younger sister, is also feeling the pressure in her family to get an education and be something. Like Greg, she has dreams of her own. â€Å"†¦next year’s grade twelve, then it’s escape to the University of Alberta†¦Like Dad wants. I have dreams of running off to Europe for a couple of years, being a nanny and learning a language or two†¦I’ll tell Dad I’ll do the university thing when I get back. He’ll probably explode anyways† (Friesen 2). Sharlene is torn between following her dreams or doing as Daddy wants. Overall, throughout life you often have pressure put on you. The characters in both Death of a Salesman and â€Å"Brother Dear† are all under the pressure to satisfy, the pressure of themselves and the pressure of others. Whether the pressure be to get a job, go to school or be something, they all experience pressures throughout their journey of life.

Is Christian Morality Today Too Lenient

According to the Cambridge Dictionary, Morality is a personal or social set of standards for good or bad behavior and character, or the quality of being right, honest or acceptable. It is characteristically the way you make decisions based on what you think is right or wrong. It is this same principle that today is affecting the Christian Population. Christians are being tormented with daunting questions such as: Am I doing the right thing? Should I do the right thing even though it may end up affecting me? How come nonbelievers get to have fun and I can’t? Just because I attend church and I am a Christian, does it mean that I have to do what the church says? on a daily basis. Christian morality hasn’t changed and should not ever change. It is a constant. The New Testament reminds us that Christian Morality is a contract with God and mankind. In fact, Leviticus 19 says that we should follow his commandments and be moral; not to steal, not to lie, not to commit adultery etc. if we plan to get to heaven. However, this warning seems to be considered a fraud due the amount of people who subscribe to these laws seem to diminish every day. This, therefore, gives reason to my opinion that Christian morality is having a tough time surviving due to its leniency. As compared to years past, the principle of Christian morality has been taken advantage of. People tend to make decisions now based on social pressures and what they feel will be accepted. They believe that because the entire world is doing something, they should too or else they would be considered an outcast. Therefore, they end up making their decisions in vacuums, without a solid base. In the past, the church, the society, parents and elders had an input in guiding and helping in the decision making process of its young people. In fact, Christian Morality can be considered too tolerant as compared to the adjective lenient. For example, many people watch things in movies and television that they shouldn't, sometimes hangout with the wrong people and think nothing of a hearing a dirty joke or something similar. They put worldly things before God- sports, entertainment, people, and their needs. A very common example in Belize is the willingness among teenagers to engage in sexual activity in spite of heir Christian moral values. Even though the Christian church has certain rules that its followers should follow, teenagers ignore them and turn on their good Christian morals. The same with the music; Christian music has meaning but because of wanting to attract youths, they use the rhythm of secular music. This cheap tactic works; however, youths are attracted to the sound of the music rather than the message. We live in a society of carnality, brutality and mortality since our motivation stems from our longing for â€Å"comfort†, â€Å"convenience† and â€Å"pleasure†. In order to achieve this, people who practice to be moral are attacked and made irrelevant. Those who defend past principles and try to practice their traditional Christian values are being put down and becoming an insignificant minority. Liberal institutions condemn the church for its Christian moral values and try to instill in our youths immorality and unethical values. I believe that the Christian Church need not change their morals but try to become stricter while still keeping their traditional values and hopefully a spark of hope will be lit.

Demand difference/ focus of a business Essay

Methods: cause, solution(s), ED ( Elasticity of Demand), challenges, effects. Cause The main cause would be origin, LUMOS is based in the UK, has an British founder and aims on the British public. However this does not mean that all the marketing they produce is reaching British people. Since the fund is all about helping children in poor European countries and not aimed to only help British people, they receive a high percentage contribution from other counties as well. Solution(s) More attention can be received by using J.K Rowling giving a message, I think LUMOS can use het in their advantage compared, especially to other non-profit organisation. The message will be received worldwide since her books are an universal best- seller and not just in England. Another solution to make the international public more appealed to contribution to LUMOS is by starting to focus on other languages as well, like a Dutch website with a euro system ( they use pounds ) this makes it more complicated for people who have a basic or lower level English. Money available should go to promotions in the Netherlands, LUMOS is very unheard of in the Netherlands. PED The demand in the Netherlands is less than in the UK because the advertisements and promotion is kept in the UK. The demand to donate to LUMOS is 70% less from Holland compared to the UK. Percentage change of price has been replace by percentage change in advertising. % advertising PEA= x 100 % in demand Advertising There is 100% in the U.K % A = 20% There is 80% in The Netherlands There are  £9.834.037,- donations made in the UK. There are  £3.947.394 donations made by Holland. The change 5.886.643 % =x100x 100 = 149% Original figure 3.947.394 % QD = 149 % 13.4 Challenges: Making LUMOS well known and accepted in the Netherlands by making promotion and other communication tools Dutch. Effects on the business: There will be more contributors both from Holland as well as other parts of the word (note world-wide message for J.K Rowling) Environment 1B Business: Mc Donalds Environment difference: Demand difference Counties: Netherlands – UK Methods: cause, solution(s), PED ( Price Elasticity of Demand), challenges, effects. Cause The cause of a demand fall in the U.K compared to the Netherlands is because of the *1 difference in target tastes in both counties and *2 because of the prices in pounds ( inflation) Solution(s) To cause *1 -Get to know the (target) audienc(es) better so they can adapt their products to the consumers tastes. – offer more options in the menu to choose from. To cause *2 – lower the prices by finding cheaper suppliers or lower them and make less profit calculating from the same amount of Demand, however this might be a very good idea. (See PED) PED ( Price Elasticity of Demand) The following formula can be used to measure exactly how responsive demand is to a given price change: ( ceterus paribus ) Ed = The price elasticity of demand Δ = ‘change in’ Qd = Quantity demanded P = Price A Prices from mc Donald’s fall 17.8% Demand rise with 23.4% B Prices from mc Donald’s fall 10% Demand rise with 3% ( nobody really notice) This means that Price and Demand are inversely related ( Ceterus Paribus) Calculation: A -17.8:23.3= -.763 -10:3:3= -3.4 = elastic, or A is the best option. Challenges. Disequilibrium: since Mc Donald’s sells consumables the products have to be sold quickly otherwise it would creating a surplus in stock. But if either the prices are lowered or the food adapted to a more university liked taste the position would be equilibrium which in turn would create a shortage or an equal position. So the challenge is to estimate the higher number of sales so they can calculate the right stock and amount to purchase at the supplier. Effects There will be more or an equal number of consumers at the Mc donald’s in the UK compared to Holland. Some things are going to have to be changed, like I mentioned the purchases in stock.