Write an essay on the impact of working long hours on the present Americans social isolation.

Use the June 23rd,2006, issue of the Washington Post,A3 article " Social Isolation Growing in US, Study says"

Is social Isolation incrasing because Americans spend too much time at work.'

If it helps you can read the following essay and come up with an original one which some how encompasses most of the ideas of the essay.

In the article Social Isolation Growing in U.S, Study Says, Shankar Vedantam, a Washington Post staff writer, points out that spending extended hours at work places is one of the causes for the increasing social isolation of Americans to date. Even though the regular working hours for an ordinary person is eight hours a day, this remains to be ideal for many who are striving to carry out their professional and family responsibilities torn between two or more jobs. These people are left neither with the time nor the energy, which they can invest in socializing with others.
According to the writer, this has made the term workaholic suit the life style of many Americans who spend much of their time in their jobs or performing job related activities at home. However, Vedantam has failed to make the demarcation on the level of impact this may have among the Americans themselves. In other words, the double fold impact situations like this may have on immigrants who might recently have acquired a citizenship status in United States seemed to be overlooked. When the citizens by birth could only get socially isolated, the recent transferees would also get alienated facing identity crisis for getting consumed by work.
Some people believe that Americans are involuntarily directed to a lifestyle which expects them to allot much of their time to carry out their professional tasks in order to meet their citizenship requirement which is to get the latest and the best out of everything. Of course, many are required to go out of their ways in order to meet these self-imposed necessities. Some people decide to invest their time in education, which would eventually equip them with the proficiency and financial capacity to meet their ends. Others are left with no option except to drag themselves in to two or more jobs in order to come up with the income that would enable them to catch up with the fast paced living situation of this country. Still others get consumed in their work even if they are financially secured to live up to the standards of the society since it is a lifestyle legacy they inherited from their parents.
For this reason, the significance of spending time to build meaningful relationship with others has diminished. As many of them would not have the time, which they would invest to socialize with others, their social ties will only be confined to their immediate family members. Their life would be devoid of true friends who would be with them in good or bad times. Since building friendship is the fruit of socialization that needs time and patience, most people nowadays lack confidants in their life.
However, some tried to quench this natural desire for real friends by surfing the internet and pouring their guts out to strangers. Others end up spilling their secrets to total strangers, which they run in to stores, bars, gyms, work places and etc. Some would even go to the extent of seeking advices from mere acquaintances they have in their daily chores. For instance I, working as a front desk representative in one of the hotels in Alexandria, had the chance of listening to very personal details of guests form different walks of life in their brief stays at the hotel.
Most of the guests are elderly people who have apparently worked round the clock in their youth so that they are left with the money and time which they would be able to spend their close family members and friends while in pension. Of course there are young and middle age guests who stays at the hotel from time to time, but I do not have much to say about them as they are always in a rush carrying their lap tops in one hand running back and forth between the business center and their respective rooms. Some of them skip breakfast as they have a pile of work they brought with them even if they were supposed to be on vacations. Their young ones would spend their time playing video games in their rooms or chatting on the internet with whoever they have on the other end of the computer.
Looking at the life style of these two generations, one can see that the young are following the footsteps of the old following the same path, sowing the same seed to reap the same fruit. The elders seemed to overpass the value of socializing and cultivated individualism, which they passed it to their children. And yet they are reaping the fruit of loneliness at old age as the only confidants they have saved for their old age does not pass beyond their spouses and immediate family members. They sometimes would have one or two confidants over the ages. These people had never prepared themselves for the fact that social contacts has a trend of decreasing after retirement or that it will keep on decreasing with the loss of their significant others to death.
Americans also seem to ignore the fact that their children, whom they have as their only confidants in life, could have the tendency of being caught in the turmoil of the fast paced American life that they might not have the time to share the vice and virtues of life with them. So when the time comes and when they need some one to confide with, all the money, skills or experience they accumulated over time would not help at all.
For some who managed to save some time out of their hectic life to keep in touch with their previous friends or once good neighbors, would certainly have some one whom they can turn in to their confidants circle when they have ample time in old ages. This might have taken them to employ every means they have like e-mails or text messaging or occasional phone conversations, whenever maintaining physical contact was impossible.
Nevertheless, attempting to build many acquaintances through the chartrooms on the internet or in other walks of life devoid of further personal commitment to some of these people, would not help to lay the foundation for true friendship. Since friendship requires committing ourselves for the benefits of few others in the end of acquaintances line. But one can never be a friend for many as he/she can never be there for everyone when the need arises.
Since all the aforementioned situations tends to be true for most Americans, those who acquired the citizenship recently would pay even more for spending more time to their work at the expense of socializing with others. Americans by citizen may get isolated in general, but those who have recently immigrated would also face alienation from the society they come from. As most of these transferee citizens are assimilated by the American culture, they find themselves in a constant conflict with the norms and regulations the culture that produced them.
Even though they were required to pull many strings in order to acquire the position they have as an American living an American way, their identity as a product of a society which bear them would be questioned constantly with every step they take on the ladder to be Americanized. As each step requires them to overpass and drop some norms out of their previous culture. Eventually they would end up cutting every single tie they have with their community. For instance, when these people decide to skip one or two social gatherings, or invitation for weddings or funerals, they would close their gate for further similar invitations. Since the rest of the community members residing in this country might have made sacrifices to be present on those occasions, so they would not have the patience and the time to spare for those who gave the American way of life priority over their original culture.
For example, those Ethiopians who made to this country earlier and are totally embraced Amercan way of life but some how managed to spend some time for the causes of the community are referred as Americanized citizens of Ethiopia. Where as others who seemed to be caught in the mayhem of this country are considered as if they have spent their time in a comma. This is because it would be too late for them to pull long lost strings in the community by the time they are done working their ways around the American system of things. So when situations seemed better and provide them with the financial stability, they would not have any one to turn to. By this time, members of the society would not have only alienated them denying their social identity, but also have already assigned them a name, Comma, to refer to the time they spent and the intense lifestyle they lead in America.
This would not have been a problem if these people were totally assimilated in the new culture. However finding a spot in the American society would be difficult one as people prefers to hang out with people having similar social and ethnic backgrounds. So finding confidants out of a society who nurtures individualism would remain to be a challenge. Even if America is known for being a land of diversity, citizens sometimes find it hard to expand their friendship zone to encompass those new additives to the diversity with fresh trace of accents.
A good example can be a life this Ethiopian girl whom I came to know up on coming to this country some five years ago. When I was first introduced to her she was in her late twenties and she already had worked on her masters in one the medical fields and had secured herself a good paying job. I asked her how she managed to be successful at that age. She merely smiled and told me that she had invested all her time and energy towards her education, and worked with any spare time she had to cover her expenditures. She told me that she never had time to socialize with other students and work met she had not that she didnt want it by only for she didnt have the time. Then she let me know that she is happy to hang out with me whenever it is suitable for me. I told her that I would more than happy to do that but never had the time to even keep in touch with her throughout e-mails and phones. Four years and six months later I met her again not in person but to put a flower on her coffin that was prepared to fly off back home. She had committed suicide.
The note she wrote prior to her tragic incident reads: I couldnt take it any more, I got tired of waiting for my cell phone to ring some time for two or three days. I have no one in my life. I went back home for a vacation but everything seemed changed. I felt like a stranger in my own home. I came back here again. I didnt even have anyone to pick me up at the airport. I had to hire a cab to my apartment. I am not blaming anyone for not spending his or her time with me; I know that everyone is busy as I once was. But I simply am tired if longing for some one to talk to and to laugh with. And yes she was an American by citizen and Ethiopian by birth.
To put it in a nutshell, it is time for Americans, who have got the citizenship by birth or through immigration, to wake up and evaluate if dragging themselves around the clock consumed in their work is worth the energy and the time they spend and above all their life. Even though there is nothing wrong getting addicted to work, it should not be done at the expense of the time we spend to socialize with others which is crucial in making true friends which we can lean on in good and bad times.

Directions:

PLEASE, summarize the selected article (including the address where the article can be found) in one 275words page. The article content summary in a page will serve as discussion. The summary will answer some or all of the following questions:
1. How does the issue (article) relate to gerontology?
2. What fields of study are involved? (multidisciplinary aspect)
3. How is demography involved?
4. How does it relate to theory?
5. What type of source is the article from?
6. Does the source impact the credibility of the article?
7. Whose issue is this? (Remember there can be more than one approach to this question.

If you have any question, please e-mail me. Thank you!!!!!





Aging and social isolation


JOHNSON, COLLEEN L. (Summer 1999)FAMILY LIFE OF OLDER BLACK MEN. In Journal of Aging Studies, 13, p145. Retrieved September 07, 2006, from Expanded Academic ASAP via Thomson Gale:
http://find.galegroup.com/itx/infomark.do?&contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=EAIM&docId=A55240799&source=gale&userGroupName=lom_accessmich&version=1.0

Full Text:COPYRIGHT 1999 JAI Press, Inc.

ABSTRACT: This report explores family structure and functioning among 58 men whose ages range from 65 to 96. In comparison to women in this study, men are no more likely to be isolated from their family. In fact, more men are married and live with others, and there are no significant differences in other indicators of family integration. There were no significant differences in the instrumental and expressive supports from members of the extended family. Those men who are married have a strong relationship with their wives. Most fathers have active relationships with their children but are closer to sons over daughters and proximal children over distant ones. Collateral relationships include strong bonds with siblings and siblings' children. Those with few family relationships have pieced-together networks of friends and kindred.

Recent studies of black families in later life shed few insights on men's family roles. In their extensive review of the research literature, Taylor and his colleagues (Taylor et al. 1990) concluded that studies of men's family life are exceedingly rare and one of the most conspicuous gaps in the literature. In the absence of adequate literature on the family life of older black men, this report draws upon already available data from two studies conducted in the San Francisco Bay Area that included 58 black men and 192 women 65 years and older. Three questions will be addressed. First, how do black men's family roles and their family integration differ from black women's? This question will be addressed by comparing men and women in these two samples. Second, how do men perceive and evaluate their family status and roles as husbands, fathers, and kin, and what are the qualities of these relationships? Third, conceptually how does the organization of the family affect the resources available to older male members? To address these questions, I will draw upon the open-ended discussions of the men in the studies in order to tap not only contacts and mutual aid but also qualities of their family relationships.

The findings on black men are organized around three constellations of the extended family. These include: those that emphasize lineal ties between generations, those that emphasize collateral relationships such as the sibling relationship, and a residual category that includes not only a few loners, but also those who have pieced together networks of kindred from various sources. By classifying the respondents' discussions about their families into these categories, it is possible to identify how one constellation may be emphasized over another and lead to different types of family relationships. For example, those who emphasize collateral ties through the solidarity of siblings usually have a larger kinship group than those emphasizing generational bonds to the exclusion of other kin (Johnson and Barer 1995).

BACKGROUND

Two contradictory views on black men's family life dominate the literature (Allen 1978; Wilson 1986). One set of assumptions traces black men's current family status to historical antecedents in slavery when marriage and fatherhood were not emphasized. In combination with later economic and employment barriers and discriminatory practices, high rates of marital instability left men more peripheral to female-centered households (Staples and Johnson 1993).

A second set of assumptions coming from in-depth studies of black extended families point to the strengths of black families that have facilitated survival under difficult circumstances (Aschenbrenner 1973, 1975, 1978; Hill 1971; Martin and Martin 1978; Shimkin et al. 1978; Stack 1974, 1996). Since relatives beyond the nuclear family are readily willing to respond to the needs of kin, this extended family type is particularly adaptive in urban areas. Flexible household structures permit the easy incorporation of kin, making the extended family a convenient facilitator of mobility for economic gains. These studies are in agreement that the black kinship system is bilateral but has a matrilateral focus. In other words, both maternal and paternal sides are recognized, but the maternal side is more central to family functioning.

Given the high interactions and cooperation among residentially clustered households, relatedness by blood often takes precedence over marital ties (Mitchell and Register 1984). Consequently, men may be active in matrifocal extended families either of their mother, sister, and their wife, and men are active in kinship roles as fathers, grandfathers, and uncles (Aschenbrenner 1973, 1975, 1978). Where not active with biological children, they may be devoted stepfathers and stepgrandfathers. Additionally, men's capacity to move in and out of several households has an advantage in making them more mobile in looking for work. They may be contributing to households of their mother, an ex-wife, and a girlfriend who is raising their children. In other words, they may have formed several families rather than being without families. In recent years, however, such extended-family households have declined in prevalence, so men may no longer have that advantage (Sudarkasa 1997).

A more recent and variant view comes from Scott and Black (1989), who view the family from a network perspective. They maintain that to understand how black families function, male and female networks must be considered as distinct entities. Each has created survival strategies through the formation of different types of social networks. Since economic deprivation has been a major impediment to forming conventional nuclear families, female networks are child-centered and household-focused, while males tend to live on the margins of female-headed households as they participate in street-corner-centered networks.

Most recent research findings on black families in later life come from national surveys, where gender is rarely singled out for special analyses. Nevertheless, the roles of men are undoubtedly affected by the symbolic and emotional importance assigned to women in black families. Historical references to the rural southern family stress the importance of the mother and grandmother (Frazier 1966). Where large extended families are found, they are as likely to be headed by women as by men (Martin and Martin 1978). Taylor et al. (1993a) found that three-quarters of their respondents identified a grandmother, not a grandfather, as their significant relationship. Since black women have been active economic contributors to the family since slavery, however, they may compete with men in the economic sphere to the extent that the marital bond is weakened (Staples and Johnson 1993). Gender differences in the provider and homemaker role are not rigid in the black family. An analysis of attitudes in a sample of blacks 55 years and older found that their gender attitudes mirrored those of the general population. But the divorced and unmarried, particularly the women in the survey, found the absence of a spouse was usually considered to their advantage in terms of their independence and freedom (Taylor et al. 1993b).

In addition to supportive extended family relationships, moreover, the importance of children to older blacks is repeatedly stressed (Chatters 1990; George 1988; Gibson 1982; Mutran 1985; Taylor 1985). Studies also find that families have a strong capacity to mobilize support from relatives beyond the nuclear family to meet the needs of older people as well as dependent children (Crosbie-Burnett and Lewis 1993). In fact, happiness or subjective well-being among blacks is strongly associated with closeness to the family over friends (Ellison 1990). Strong community ties are also prominent such as the family-like relationships formed through black churches (Gibson 1982; Johnson and Barer 1990; Perry and Johnson 1994; Taylor and Chatters 1986). Such effective mechanisms have been traced to the generalized, incorporative kinship system on plantations and later in the rural South.

Spitze and Miner (1992) report that older black men have less contact with their children than women do. Urban-rural differences may be important, however, for Kivett (1991) reports that the grandfather role in the rural South is more central to black men than white men. In gender comparisons of the oldest old, Perry and Johnson (1994) found that women have more expansive urban networks than men, because their networks are often augmented through the creation of fictive kin. In fact, in our two San Francisco studies, we found that older blacks were significantly more integrated into their family than their white counterparts (Johnson and Barer 1990). Racial differences were particularly prominent in comparisons of childless blacks and whites who were 85 years and older, with blacks having significantly more helpful relatives as substitutes for children (Johnson and Barer 1995).

In contrast to the emphasis upon kin solidarity, Burton and Dilworth-Anderson (1991) conclude that such conceptions of the black family as an all-embracing support network need to be reassessed to take contemporary cultural changes into account. They maintain that the contemporary black family is distinct from its predecessors. Not only is the family more vertical in its structure with more generations present, but it also has fewer members in each generation. It is also age-condensed with fewer years between each generation (Bengtson et al. 1990; George and Gold 1991). They also challenge the widely held assumptions about the high fertility of black women. With delayed childbearing or permanent childlessness, birth rates among black women have fallen by 50% since the 1940s. As a result, one increasingly finds truncated family structures consisting of those without lineal kin. In view of these changes, they suggest that the costs of family involvement today as well as its benefits need to be explored.

Because of the dearth of research specifically on older black men, these varied reports on black families leave important questions unanswered. This paper hopes to fill some of the gaps inductively by reporting on the men's descriptions of their family roles and relationships. Knowing more about their adaptation in later life can extend our knowledge of cultural and gender differences in family life. Since the literature suggests that the black family in later life usually meets the needs of older members more adequately than the average white family, these findings may also add to the growing body of empirical data on minority aging and the social support process.

THE STUDY

The findings reported here come from participants in two research studies. First, between 1987 and 1990, 32 black men and 96 women 65 years and older were part of a research project on the informal and formal supports of inner-city elderly. Respondents in this study were selected from patient rolls of the general medical clinics of two hospitals (Johnson and Barer 1990). Second, 26 men and 96 women come from a sample of 122 blacks 85 years and older drawn in 1991-1992 (Johnson 1995; Perry and Johnson 1994). They were selected from voting rolls in those neighborhoods with a high proportion of blacks. Since my purpose here is to map men's family roles, the women in these studies will be used only in an initial comparison to identify gender differences in family involvements.(1)

Data Collection

Because little information is available on older men's family roles, the methods here are inductive and aimed at generating hypotheses or propositions that can be the basis for further study. In both studies, a focused interview technique was used, and the same questions on family life were asked. This technique of combining forced-choice with open-ended questioning encourages respondents to speak freely about their family life. Other than specific questions that resulted in measures of social relationships, respondents ranged widely in their discussions of their families. Verbatim notes were recorded and transcribed later. These interviews lasted two to three hours and were held in the respondents' homes in one or two sittings.

In addition to demographic information, respondents were questioned by the open-ended techniques about each category of relationship (spouse, child, child-in-law, grandchild, sibling, and other relatives). They were asked general questions about their activities together, patterns of reciprocity, and the positive and negative aspects of family relationships. Then they were asked three questions about whom they turn to for expressive functions (when they are feeling down, when they want to have some fun, and whom they see on holidays) and five questions on instrumental functions (those who provide household help, transportation, meal preparation, shopping, and paying bills). Finally, they were also asked to identify those individuals they considered as members of their families.

Using these data, two social support variables were coded on 5-point scales. Instrumental components of relationships were derived from their discussion about practical assistance they did or did not receive from each category of relatives such as household help, money management, and transportation. Expressive components refer to the extent the relationship met needs for security and sociability. These were elicited through questions about shared activities, whether contacts were rewarding, whether they could share confidences or go to that person when troubled. A third variable, family contacts, is a measure of the total number of family members and kin with whom the respondent had weekly interactions.

To determine the qualitative dimensions of relationships, two members of the research staff examined each interview and recorded and coded all comments. Where needed, they also derived measures. These coders had a mean agreement rate of 81%. A content analysis was also conducted on the participants' open-ended discussions to identify the organizational emphasis of their family. Discussions about their families were extracted from the interviews, and the patterns were identified, summarized, and categorized by which types of relationships were emphasized. These categories of vertical, collateral, and kindred dominated networks are not mutually exclusive, however, for some maintained strong vertical and collateral emphases or strong generational relationships in addition to having pieced-together networks of kindred.

Comparison of Two Samples

T-tests and chi-squares identified significant differences between the men in the two samples. The only significant family variable was the finding that the oldest old men had fewer children, most likely because more of them had witnessed the deaths of children. The oldest old men did differ on two socioeconomic variables; they were more likely to report that their economic status was good, and more of them were home owners. The men in the out-patient study and the oldest old study did not differ in either mean education (6.0 years and 5.9 years, respectively) or in occupation level with most having had semiskilled or unskilled positions. In physical status, their situation was similar with 40% to 44% being disabled on four or more instrumental tasks of daily living.

GENDER COMPARISONS IN DEMOGRAPHIC INFORMATION AND FAMILY RELATIONSHIPS

To address the first research question, "Do men differ from women in their family functioning?", Table 1 makes comparison by gender in the structure and functioning of extended families. Significantly more men are currently married, and thus, more men live with others--55% of the men but only 30% of the women. It should also be noted that 32% of the men, but only 10% of the women live with a spouse either with or without the presence of a child. There are no significant gender differences in parent status or the numbers of children in proximity. A high proportion of parents, however, have at least one child in the area--69% of the men and 83% of the women.

TABLE 1
Comparisons of Male and Female Family Characteristics
(by Percentage)

Males Females
(n = 58) (n = 192)

Marital Status
Married 33 9
Widowed 21 53
Divorced 41 36
Never Married 5 2, p < .001
Household
Alone 45 70
Spouse 27 8
Spouse and Child 5 2
Child 14 11
Relative 9 9, p < .005
Parent Status
Childless 28 40
Children Present 72 60
Parents with
Child in Proximity 69 83
Child Away 31 17
Informal Supports
Instrumental from
Spouse 31 7
Child 38 51
Grandchild 23 29
Sibling 14 22
Relative 17 27
Expressive from
Spouse 31 7
Child 59 72
Grandchild 50 61
Sibling 45 55
Relative 51 51
Contacts (weekly or more)
Child 53 68
Sibling 16 19
Relative 36 43
Weekly Family Contacts
None 22 30
One Member 40 32
Two or More 38 38
Church Attendance
Frequent 35 67
Rarely or Never 65 33, p < .001

No significant gender differences are found in their relationships with members of their extended families. Men and women did not differ in the instrumental and expressive supports they received from children, grandchildren, siblings, and other relatives. Fifty-three percent of the fathers and 68% of the mothers have at least weekly contact with at least one child, while 16% of the men and 19% of the women have weekly or more contact with a sibling, and 36% and 43%, respectively have weekly contact with other collateral relatives such as nieces, nephews, and cousins. Consequently no gender differences are found in their lineal and collateral relationships. Also, only 22% of the men and 30% of the women have no weekly contact with a family member. One significant gender difference may affect the social relationships of men; they attend church less frequently than women. Since the church is an important base for forming fictive kin relationships, they may have fewer such relationships (Johnson and Barer 1990). Nevertheless, the absence of gender differences in family was unanticipated so possible explanations will be discussed in the conclusion.

MARITAL RELATIONSHIPS OF BLACK MEN

At the time of the interviews, 33% of the men were married, 21% were widowed, 41% were divorced, and only 5% never married. While the numbers are too small to report in tabular form, in their marital history, 20 of the 58 men had lived in a long-term marriage of whom 12 were still married. Almost twice as many had multiple marriages, a mean of 1.7 per married man, and the majority of the marriages had ended in divorce. Some marriages ended informally when the husband migrated from the South to California without his family. Despite histories of marital instability, relationships with women were important to these men. Thirteen of the men currently had close female companions whom they saw frequently, and 4 of these 13 men lived with them. Also 25% of the divorced men carried on friendly relationships with former wives.

Consequently, the male-female bond was likely to be central to most men at some point in their lives. Some men sustained relationships with women over the years through a succession of marriages or casual unions. Most men who were currently married were satisfied with their marriage, and we observed high levels of companionship and interdependence between spouses in long-term marriages. Most married men identified their wife as their most important relationship, a bond that took precedence over other relationships.

The men in long-term marriages of over 50 years had usually married in the South before migrating to California. These marriages seemed particularly rewarding. They were rated as "a number-one marriage" or "a happy marriage for all 55 years." Some couples beamed with pleasure as they recounted their courtship in the rural South. For example, one man spoke romantically of their meeting at a country store almost 70 years ago:

She was going out with a man who owned two cars and seven houses, and I had
nothing. But I'd be there waiting for her on her front porch when she got
back from dates. I got to know her mamma well, who decided I'd make the
better husband even if I was poor.

Another couple met at church in Louisiana. The first time he called on her, he brought along his preacher to vouch for him. Now, 66 years later, they are very affectionate, and both are constantly worried that something might happen to the other one.

VERTICAL GENERATIONAL BONDS

The emphasis upon the vertical bonds between generations is the most common configuration in these kinship systems for the 72% of the men who had children. The role of father is quite varied, most likely because of the varied marital histories. In some cases, respondents were vague about their paternity or their role as fathers, so the precise number of children was difficult to clarify. They also selectively redefined the conventional father-child relationships in four ways. First, there was a propensity to maintain relationships with only those children in the area. Some men ceased contact or had only rare contact with children who lived at a distance. In some cases, they had had no role in raising their distant children, having left them with their mother when they moved on to look for work. Thus, the proximity of children is an important determinant of the relationship.

Of the 42 men who are fathers, 69% have at least one child living nearby, and 53% are in contact with them at least weekly. In contrast, 45% have no contact with children who live outside the area, and another 14% have less than monthly contact. Consequently, most fathers with descendants in the area maintain a fairly active relationship with them, and they often report strong bonds of affection between themselves and selected children. Supports between generations are usually unilateral, however, with children aiding their fathers rather than the reverse. These fathers are proud of the esteem and respect they receive from their descendants. For example, Mr. R. reports: "I got three children, and my daughter has a million grandchildren. They all are mighty good to me. They don't leave me to myself."

Second, not only are generational bonds determined by geographic proximity but also by genealogical nearness. Closeness to children does not necessarily insure strong relationships with grandchildren and great grandchildren. In their discussions, these men did not usually single out qualities of a specific grandchild nor talk about their relationships with any of them. If they had many descendants, grandchildren and great grandchildren were often treated as a generic category with few being singled out by name or specific personal characteristics. The respondents would say: "There are too many to count," "I can't remember all their names," or "I hardly know them." This vagueness was also present when describing supports from grandchildren: "They see after me," or "They come around when I need them." One man typifies this situation. He lives with his son whom he considers his best friend, but he rarely sees his grandchildren. He knows little about them and is not particularly motivated to see more of them.

In only a few cases were these men distant with their children but close to grandchildren. Sometimes if a child was unable or unwilling to help out, selected grandchildren might come by each week to clean their house or shop for them. A few emotionally close bonds developed with a specific grandchild out of mutual needs as well as affection. For example, Mr. S. had been widowed for 15 years. He explained that his closeness to his grandchildren over his children developed, because they needed a place to live:

After my wife died, the grandkids started moving in. I haven't been alone
since then. That's all right with me. I like to have them around. I don't
see my children much though.

While most grandfathers avoid those grandchildren who have problems with substance abuse or with the law, a few in troubled families became surrogate parents. Mr. and Mrs. T. have three daughters, 15 grandchildren, and two great grandchildren. According to the T.s, most of their children are "heavy drinkers" and some of their grandchildren "live on the streets and are druggy." They had in their words "rescued" two grandchildren 15 years previously. Both still live with them and call them "Papa George and Mama Rose." The T.s rarely see their children, even though they live in the same neighborhood. It seems that the T.s have barricaded themselves along with their two grandchildren to avoid the problems of the rest of their extended family.

Third, father-son relationships are usually closer and more companionate than relationships between fathers and daughters. While conflict was rarely reported between fathers and sons, tensions between fathers and daughters were found even when they shared a household. The comments of two men typify this situation: "We live together but as strangers," or "We share the household, but we don't really live together." To further illustrate qualities of some father-daughter relationships, Mr. A.'s daughter and her teen-age son had moved in to help him after he had a stroke, and they stayed on after he regained his functioning. He continually referred to his daughter as antagonistic: "She always gives me snappy answers. She seems to carry a grudge." He wondered whether the source of her anger could be traced to some event in her childhood or some current issue. He thought that his daughter's anger might be due to jealousy about the attention he received from his female companion's daughter. Another man chose to live with his son over his daughter, because his son was more affectionate, while his daughter was "quick to take offense." Still another man lived with his daughter and her children, but most of his time was spent behind the locked door of his bedroom: "I don't like what I see going on around here," he explained.

Fourth, some fathers transferred their affection to stepchildren or the children of girlfriends. In fact, it was common in long-term marriages to blur the distinctions between step and biological descendants. If they had raised their stepchildren over much of their younger years, they considered themselves as their father: "My wife had three children, and I had three. Three died, so now we only have three left." Others switch their allegiances to stepchildren, because they have stronger bonds of affection with them than they have with their biological children.

COLLATERAL BONDS

Collateral bonds are those between members of the same generation such as siblings. Through their siblings, they are linked to other relationships such as nieces and nephews. Although 55% of the men have no surviving siblings, those with siblings in the area have frequent contact with them. Since many blacks came to California from the South in a chain-migration of siblings, they have lived near each other for many years. Some traced the close bond to their shared privations during their childhood. One man elaborated: "I had always lived near my sister. I was mostly raised by her, and we went through hard times together. When she came to California, oh how I missed her. I came to visit and never went back. I've been married five times, but my sister and her gang of kids have always been my real family."

Collateral bonds have at least four advantages in strengthening family resources. First, they can be mobilized in the absence of vertical relationships, or they can augment weak or unsupportive relationships with children and grandchildren. For instance, Mr. K., who is quite disabled, has five children in Mississippi whom he rarely sees. In their place, he has two types of collateral bonds. Most important is his sister, who calls every morning. If he needs something, she comes over, or she sends her children over to help him. Additionally, his ex-wife also calls daily, and she or her children from another marriage come when he needs help.

Second, collateral bonds are potentially expansive, in that they link together a wider network of kin than is found in lineal bonds between generations (Johnson and Barer 1995). Commonly sibling solidarity continues after the death of one of them, because they continue to maintain their relationship with a sibling's surviving spouse. That relationship is often similar to what they had with their sibling. A brother of a former girlfriend can also assume such importance. Even with children present, collateral bonds may supersede the parent-child bond. As Mr. L. explained his distance from his only child:

I didn't raise him, so I lost contact. I hear I have four grandchildren and
some great grandchildren, but I don't even know their names. The only one I
feel related to is my brother-in-law, who is my best friend. I used to go
out with his sister.

One man had been married three times and had three children from two of these marriages. He rarely sees them or his 12 grandchildren and 8 great grandchildren:

I left one wife and children in Louisiana and moved around a lot. After I
settled here, I never went back to get them. I married here and began a
family who still live here, but they don't come around. My brother and
sister are my family--we look after each other.

Third, relationships through collateral relatives may be less demanding or problematic than those with children and grandchildren. For example, fathers voiced a common complaint about their descendants' frequent requests for money, a complaint rarely heard about nieces and nephews. Siblings and cousins were even less likely to ask for money. Since men have fewer expectations or responsibilities for collateral relatives, these relationships are also less likely to cause as much worry as those with their children. As a counterpoint, consequently, collateral ties may provide a relief from potential tensions in relationships with children and grandchildren.

Fourth, creating fictive kin collaterally can also personalize relationships beyond the kinship group, thus enhancing family resources. Unlike black women, who have numerous links to the community through churches and senior centers, black men have fewer such connections. In fact, some are suspicious of relations outside their extended family and their friendship networks. Consequently relationships outside the extended family are either defined as like family members or defined as strangers who are objects of suspicion. For example, Mr. M. is widowed and childless. As he explained:

My nieces and nephews see after me. My landlady's children are like my
family, and that boy over there is my brother (pointing to a fellow
attendee at his senior center). I call him when I need a ride.

When asked about his friends, he replied: "I can't make a friend with too many. They take advantage of you." Others comment on the disadvantages of having too many friends: "They'll steal you blind."

PIECED-TOGETHER NETWORKS

Men's extended kin networks can have other configurations. Either because of personal preferences or no family was in the area, some men have attenuated networks with few relatives available to them. Others have kindred networks that incorporate real and potential relatives to meet their needs for sociability and support (Aschenbrenner 1973).

Attenuated Networks

Twenty-two percent of the men have no weekly contact with any family member, and another 40% have weekly contact with only one category of relative. Nevertheless, loners are rare in this study of black men, for only two men are truly isolated. One man had children but he reported: "I don't know where they are. I don't want to talk about it. I only have Jesus and maybe a cousin somewhere." Another has no children and no relatives either in the Bay Area or the South:

I was married, but I haven't seen her for years--I guess I'm divorced. I
only see people when I go to the senior center to listen to music.

Others with scant family resources have at least one significant relationship. For example, one man was terminally ill when he was interviewed, and he was no longer able to go to his dominoes club where most of his socializing had occurred. A son in Michigan, his only surviving family member, had come to visit a few months previously. After he left, his only ongoing relationship other than his hired help was a good friend.

Kindred Networks

Joyce Aschenbrenner (1973) makes a distinction between localized kin groups that live in proximity to each other and kindred, a network in which distinctions between biological, affinal and fictive kin are blurred. Among the men in this study, the boundaries around kindred are vaguely defined with blurred distinctions between kin, fictive kin, and good friends. The structure and functioning of the these kindred networks are quite varied. They may be based upon relationships at church. For example, Mr. A. had been in a good marriage for 20 years. Neither he nor his wife had children, but he reported:

A nephew in Oakland is the only real family I got, but we have lots of
children at our church. One goddaughter lives next door. Through
association, I got my wife's goddaughter. I make my family wherever I am.

Even with attentive children, some defined their family more broadly. Mr. B. was the center of much affection and support from his children, but he identified his "real" family as consisting of, "My church family, my brother, and my girlfriend."

Kindred networks may be expanded through a common-law wife's family. For 20 years, Mr. C. had been living with his female friend, and he helped her raise her son from infancy. Currently his household consists of his mate, her son, her son's girlfriend, and their new baby. He also is in frequent contact with his own three children in the area and his brother and his family. He proudly reported that all the grandchildren including his partner's son were working and doing well.

Others draw upon varied sources of kin. Mr. D., a retired merchant seaman, had been living with a lady friend and her mother for 10 years. It had been prearranged between him and her dying husband:

She takes good care of me, and I've got a sister in Seattle I see every few
years. Then I got another family, my garage group. Some of us men get
together every afternoon in my garage. We drink vodka and swap stories.

Some men blur distinctions not only between kin and friends, but also in distinctions between generations in the choice of a mate. Mr. E. had been divorced for eight years and was currently living with his daughter's friend. He feels he has had a most fortunate life. He had eleven uncles when growing up, none of whom had children:

It was like I had eleven fathers and eleven homes. I'm still blessed. I
have my girl friend. My kids are so attentive. My daughters are in and out
of here, always looking out for me. We like to listen to my CD collection.
They are very good kids. My stepson is pretty close too, and a friend's
wife is my play sister.

CONCLUSIONS

In recent years, voluminous research has reported on caregiving and social supports to older people. Since these reports often come from large-scale surveys, statistical models are used that control for race and gender. At this point, consequently, we know little about older black men's family life. My first objective has been to compare men and women in their level of family integration. The findings here clearly indicate that older men are no more likely than women to be isolated or marginal to family life. In fact, they are significantly more likely than women to be married and to live with others. In terms of their instrumental and expressive supports from members of their extended families, there are no significant gender differences, nor are differences found in the frequency of contacts with family members. Since men are less frequent church attendees, however, they may be less likely than women to have fictive kin formed through the church.

The absence of significant differences in men and women's family participation was unanticipated. The family literature offers no explanations, because gender issues among the older black population have not been studied extensively (Taylor et al. 1993b). It is possible that three factors may apply. First, Aschenbrenner (1973) concludes that black men in their younger years are not without family, because they are members of multiple households. Such flexibility was adaptive, for they needed to migrate to look for work and could be integrated into the households of relatives. Such a flexible view of kin is reflected in some of the commentary included here. Second, if black men were marginal to their family because they could not perform the economic role, such a situation is less likely in later life. With government entitlement programs available to both men and women, earlier economic disparities are lessened. Third, the fact that more men in this report are married and living with others inevitably links them to more family members, such as step relatives, in-laws, and grandchildren. Such a situation could also act as a leveller and offset women's usually higher family involvement.

The second objective was to present the male respondents' accounts of their roles as husbands, fathers, and kin. Most black men in this report are the beneficiaries of the strengths commonly noted of black extended families. Those who are married have strong relationships with their wife. In their vertical ties, those men with children in the area tend to have good relationships with them, although most have weaker bonds with children living in distant places. These men also appear to be closer and more companionate to sons rather than daughters. Since our data on this gender issue does not permit a ready explanation for the greater closeness to sons, and the scant literature on black men's family life sheds no insights, further research is indicated. Even if relationships with biological children are distant, they still may be effective father figures for stepchildren and stepgrandchildren or a girl friend's children. Nevertheless, strong bonds with children are not necessarily transferred to grandchildren.

Their kinship group is also extended through collateral bonds. Where sibling solidarity exists, relatives by blood such. as nieces, nephews, and cousins and their relatives by marriage potentially become an important part of men's families particularly for the childless. Since these bonds do not have the demands, expectations, and tensions sometimes built into generational bonds, they may be more rewarding. This analysis found few loners. Where men did not have strong lineal or collateral bonds, they mobilized support by drawing upon a network of kindred to create kin or quasi-kin relationships that met their needs for sociability and support. In other words, black men, like black women, benefit from the loose-knit flexible structure of the extended family and the blurred boundaries between family and friends. While kinship involvements were strong, however, we found few multifunctional, household-based extended families among either men or women.

Our third objective was to provide a conceptual framework to better understand the variations in black families that potentially affect their family's capacity to serve the needs of older members. First, vertical bonds between parent and child are usually the most important relationships, but that bond alone does not necessarily lead to an active kinship network. Second, the potential tensions and gaps in supports in generational bonds are not evident when collateral relationships are emphasized. Moreover, a collateral emphasis on siblings or other age peers usually provides a larger pool of kin. The fact that there were few loners among these men attests to a capacity to mobilize kin or kin-like relationships. Third, some men formed looseknit networks of kindred out of a constellation of distant kin and friends so as to have supportive relationships.

These findings point to the need to study black families from a kinship perspective, an approach that goes beyond intergenerational relationships to include collateral kin. In fact, researchers on the late life family would benefit by a closer examination of the ethnographic research on black kinship, for it provides a productive context to better understand the reports from recent large-scale surveys of black families. Although the findings reported here come from small, nonprobability samples, hopefully they may generate hypotheses that address the serious gap in the literature, that of the family life of older black men. Older black men are innovative in constructing rewarding networks to serve their needs and enhance their well-being. This analysis of family diversity among older people on the basis of ethnicity and gender also point to special features of minority group families that serve older people well.

ACKNOWLEDGMENTS: The research on which this report was based was funded by the National Institute on Aging (ROI AG06804 and R37 AG06559) and it has been supported by a MERIT Award from the National Institute on Aging, R37 AG06559.

NOTE

(1.) Migration patterns: Blacks began arriving in San Francisco in the 1850s, and for a time this city had the largest black population on the West Coast. Working predominantly in the service trades, their employment ended with the formation of exclusionary unions in 1889, after which many left the city (Daniels 1990). From then until the 1940s, the San Francisco Bay Area was noted for its low proportion of blacks in its population, .5% in 1900. Those few still in the city worked as servants for leading businessmen and professionals. In fact, Daniels (1990) reports that the largest concentration of blacks reported in the census before 1900 lived in the most expensive neighborhoods in the city. In our sample, we identified no one born in the Bay Area, and only two men migrated there before the 1940s. Most in the samples came from the proximal southern states, Louisiana, Mississippi, and Texas.

REFERENCES

Allen, W. R. 1978. "The Search for Applicable Theories of Black Family Life." Journal of Marriage and the Family 40: 117-129.

Aschenbrenner, J. 1973. "Extended Families among Black Americans." Journal of Comparative Family Studies 4: 257-268.

Aschenbrenner, J. 1975. Lifelines: Black Families in Chicago. New York: Holt, Rinehart, & Winston.

Aschenbrenner, J. 1978. "Continuities and Variations in Black Family Structure." Pp. 181-200 in The Extended Family in Black Society, edited by D. Shimkin, E. Shimkin, and D. Frate. Paris: Mouton.

Bengtson, V. L., C. Rosenthal, and L. M. Burton. 1990. "Families and Aging: Diversity & Heterogeneity." Pp. 263-287 in Handbook of Aging and Social Sciences, edited by R. H. Binstock and L. K. George. New York: Academic Press.

Burton, L. M. and P. Dilworth-Anderson. 1991. "The Intergenerational Family Roles of Aged Black Americans." Journal of Marriage and Family Review 16: 311-330.

Burton, L., J. Kaper, A. Shore, K. Cagney, T. Laveist, C. Cubbin, and P. German. 1995. "The Structure of Informal Care: Are There Differences by Race?" Journal of Gerontology 35: 744-752.

Chatters, L. M. 1990. "The Family Life Cycle of Older Black Adults." Journal of Health and Social Policy 1: 45-53.

Crosbie-Burnett, M. and E. A. Lewis. 1993. "Functioning to Address the Challenges of European-American Post-Divorce Families." Family Relations 42: 243-248.

Daniels, D. J. 1990. Pioneer Urbanites: A Social and Cultural History of Black San Francisco. Berkeley: University of California.

Dilworth-Anderson, P., L. M. Burton, and W. L. Turner. 1993. "The Importance of Values in the Study of Culturally Diverse Families." Family Relations 42: 238-242.

Ellison, C. G. 1990. "Family Ties, Friendship, and Well-Being Among Black Americans." Journal of Marriage and the Family 52: 298-310.

Frazier, E. F. 1966. The Negro Family in the United States. Chicago: University of Chicago.

Genevay, B. 1992. "Creating Families: Old People Alone." Generations 17: 61-64.

George, L. 1988. "Social Participation in Later Life: Black and White Differences." Pp. 99-128 in The Black Elderly: Research on Physical and Psychosocial Health, edited by J. S. Jackson. New York: Springer Publishing Co.

George, L. and D. T. Gold. 1991. "Life Course Perspectives on Intergenerational and Generational Connections." Pp. 67-88 in Families: Intergenerational and Generational Connections, edited by S. P. Pfeiffer and M. Sussman. New York: Haworth.

Gibson, R. C. 1982. "Blacks in Middle and Late Life: Resources and Coping." Annals of the American Academy of Political and Social Science 446: 79-90.

Hays, J. G., G. B. Fillenbaum, D. T. Gold, M. C. Shanley, and D. G. Blazer. 1995. "Black-White, and Urban-Rural Differences in Stability of Household Composition Among Elderly Persons." Journal of Gerontology 50: S301-S311.

Hill, R. B. 1971. The Strength of Black Families. New York: Emerson Hall.

Johnson, C. L. 1995. "Adaptation of Very Old Blacks." Journal of Aging Studies 9: 231-244.

Johnson, C. L. and B. M. Barer. 1990. "Families and Social Networks among Older Inner-City Blacks." The Gerontologist 30: 726-733.

Johnson, C. L. and B. M. Barer. 1995. "Childlessness and Kinship Organization: Comparisons of Very Old Black and White Oldest Old." Journal of Cross-Cultural Gerontology 10: 289-306.

Kivett, V. R. 1991. "Centrality of the Grandfather Role Among Older Rural Black and White Men." Journal of Gerontology: Social Sciences 46: S250-S258.

Martin, E. P. and J. M. Martin. 1978. The Black Extended Family. Chicago: University of Chicago Press.

Mitchell, J. and J. C. Register. 1984. "An Exploration of Family Interaction with the Elderly by Race, Socioeconomic Status, and Residence." The Gerontologist 24: 48-54.

Mutran, E. 1985. "Intergenerational Family Support among Blacks and Whites: Response to Culture or to Socioeconomic Differences." Journal of Gerontology 40: 382-389.

Perry, C. M. and C. L. Johnson. 1994. "Families and Social Networks Among African American Oldest Old." International Journal of Aging and Human Development 38: 41-50.

Scott, J. W. and A. Black. 1989. "Deep Structures of African American Family Life: Female and Male Networks." The Western Journal of Black History 13: 17-24.

Shimkin, D., E. Shimkin, and D. Frate. 1978. The Black Extended Family. Chicago: Aldine.

Spitze, G. and S. Miner. 1992. "Gender Differences in Adult Child Contact among Black Elderly Parents." The Gerontologist 32: 213-218.

Stack, C. 1974. All Our Kin: Strategies for Survival in a Black Community. New York: Harper and Row.

Stack, C. 1996. Call to Home: African Americans Reclaim the Rural South. New York: Basic Books.

Staples, R. and L. B. Johnson. 1993. Black Families at the Crossroads. San Francisco: Jossey-Bass.

Sudarkasa, N. 1997. "African Americans Families and Family Values." Pp. 9-40 in Black Families, edited by H. P. MacAdoo. Thousand Oaks, CA: Sage.

Taylor, R. J. 1985. "Receipt of Support from Family among Black Americans: Demographic and Familial Differences." Journal of Marriage and the Family 48: 67-77.

Taylor, R. J. and L. M. Chatters. 1986. "Church-Based Informal Support among Elderly Blacks." The Gerontologist 26: 637-642.

Taylor, R. J., L. M. Chatters, M. B. Tucker, and E. Lewis. 1990. "Developments in Research on Black Families: A Decade Review." Journal of Marriage and the Family 52: 993-1014.

Taylor, R. J., L. M. Chatters, and J. S. Jackson. 1993a. "A Profile of Familial Relationships among Three-Generation Black Families." Family Relations 42: 332-341.

Taylor, R. J., M. Keith, and M. B. Tucker. 1993b. "Gender, Marital and Familial and Friendship Roles." Pp. 48-68 in Aging in Black Families, edited by J. S. Jackson, L. M. Chatters, and R. J. Taylor. Newbury Park, CA: Sage.

Wilson, M. N. 1986. "The Black Extended Family: An Analytical Consideration." Developmental Psychology 22: 246-258.

COLLEEN L. JOHNSON University of California, San Francisco

(*) Direct correspondence to: Colleen L. Johnson, Medical Anthropology Program, University of California, 3333 California St. #485, San Francisco, CA 94143-0850.

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There are faxes for this order.

The paper itself is suppose to be structured around a specific theory. what i did wrong the first time was make it to broad, so it needs to be a specific theory that is based upon the factors that leads to juvenile delinquency. for example: Social Isolation theory *just made that up and the paper is suppose to structure around this theory revolving around this four areas that need to be boldy subheaded in the paper and just these four: underlying assumptions (what does the author of the theory say is the cause of crime? in other words why do people commit crimes or not?) *this should be one sentence. structure of theory (how does the theory work to explain behavior?)*this is the bulk of the crritique. strengths and weaknesses of theory(what makes the theory a viable explanation for behavior(strenghts) what are the shortcomings of theory in terms of explaining behavior? and lastly policy Implications (what policies can be developed from this theory to address behavior?

these are a list of theories that cannot be used: social disorganization theory, anomie theory, institutional anomie theory, general strain theory, theory of delinquent subcultures, theory of differential opportunity, focal concern theory, theory of delinquent gangs, theory of oppportunity, basically any theory that is talked about in our text book, and the name of my textbook in case you wanna take a look at it is Criminolgy (theories, patterns,and typologies) by siegel 10th edition..the theory just needs to be unique and very specific to the factors that leads to juvenile delinquency.

Times new roman 12 font, APA format and reference page, and 5 articles from referred journals or edited books

Topic
try to find a social identity theory relating to juvenile delinquency

The paper itself is suppose to be structured around a specific theory. what i did wrong the first time was make it to broad, so it needs to be a specific theory that is based upon the factors that leads to juvenile delinquency. for example: Social Isolation theory *just made that up and the paper is suppose to structure around this theory revolving around this four areas that need to be boldy subheaded in the paper and just these four: underlying assumptions (what does the author of the theory say is the cause of crime? in other words why do people commit crimes or not?) *this should be one sentence. structure of theory (how does the theory work to explain behavior?)*this is the bulk of the crritique. strengths and weaknesses of theory(what makes the theory a viable explanation for behavior(strenghts) what are the shortcomings of theory in terms of explaining behavior? and lastly policy Implications (what policies can be developed from this theory to address behavior?

these are a list of theories that cannot be used: social disorganization theory, anomie theory, institutional anomie theory, general strain theory, theory of delinquent subcultures, theory of differential opportunity, focal concern theory, theory of delinquent gangs, theory of oppportunity, basically any theory that is talked about in our text book, and the name of my textbook in case you wanna take a look at it is Criminolgy (theories, patterns,and typologies) by siegel 10th edition..the theory just needs to be unique and very specific to the factors that leads to juvenile delinquency.

Times new roman 12 font, APA format and reference page, and 5 articles from referred journals or edited books

SUBDOMAIN 724.2 - ADVANCED PATHOPHYSIOLOGY

Competency 724.2.4: Safety, Communication, and Placement for the Older Adult - The graduate identifies safety issues associated with the older adult?s living environment; facilitates communication with and assesses the care capacity of the older adult?s family; and determines appropriate discharge placement for the older adult after illness or surgery.

Objectives:
724.2.4-01: Discuss how social isolation can affect an older adult?s recovery from surgery or illness.
724.2.4-02: Identify safety issues when older adults return home from the hospital after a major illness or surgery.
724.2.4-03: Assess safety of an older adult?s living environment in a given scenario.
724.2.4-04: Determine appropriate discharge placement for an older adult based on a given physical/psychological status.
724.2.4-05: Explain how specified psychological factors can play a role in the recovery process.
724.2.4-06: Assess the adequacy of the family?s or caregiver?s knowledge of skills necessary to deliver care to an older adult in a given situation.
724.2.4-07: Collaborate with a given patient?s family to develop a plan of care for an older adult upon discharge from the hospital.

--------------------------------------------------------------------------------

Introduction:

Elderly patients have many needs that younger patients do not. Being discharged from the hospital after surgery can present additional issues beyond those associated with physical recovery. In this task, you will assume the role of a case management nurse who is responsible for determining the most appropriate discharge placement for an elderly patient named Mr. Trosack. The patient is to be discharged from the hospital after undergoing total hip replacement surgery.

Review the ?Elder Care Case Study? (attached below) for information on your patient. You will use this information to complete this task.

TASK:

Write an essay in which you analyze the case study information to complete the following:

A. Assessment of the Situation (suggested length of 2 pages)

1. Identify at least three healthcare issues that you, as the case manager, must address when working with an interdisciplinary team to determine the most appropriate discharge plan for Mr. Trosack.

a. Explain why these are important issues when planning for management of the elderly discharge patient.

2. Identify three to five members to make up an interdisciplinary team to determine the most appropriate discharge placement for Mr. Trosack.

a. Describe the role expected of each person on the team.

3. Analyze the issues from the safety assessment that could affect the determination of discharge placement.



Note: You may include any other safety issues you think might be a problem if this patient returns home upon discharge.



B. Discharge Plan of Care (suggested length of 2 pages)

1. Explain to the family what care Mr. Trosack needs and how he should be discharged based on the interview data and the safety assessment. Your explanation should include the following:

a. Discuss the ability of the family to adequately care for Mr. Trosack if he is discharged home.

b. Discuss how social isolation affects an older adult?s recovery from surgery or illness.

c. Discuss the ways psychological factors play a role in the recovery process.

2. Recommend a discharge placement for Mr. Trosack with supportive documentation.







C. When you use sources, include all in-text citations and references in APA format.





Note: Please save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files.


Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly.


724.2.4-01-07 Case Study
You have just accepted the assignment of Mr. Trosack?s case management. As such, you are
responsible for determining the most appropriate discharge placement and plan. From the
patient?s chart, you are able to ascertain the following information:

PATIENT CHART:
Mr. Henry Trosack is a 72-year-old, second-generation Polish American who, until
recently, has been in excellent health for all of his life. He reticently admits that prior to
this hospitalization he has not had a physical examination in over 10 years, is taking no
prescription medications, and has never had surgery in his life. In passing, he mentions
taking some ?vitamins? to ?help his energy? every day, but he is not sure what they are.
He wears glasses for reading and has hearing loss at 60% in his left ear.
Mr. Trosack manages a family-owned bakery along with his brother Karl, who is a
widower. Mr. Trosack?s wife of 40 years, Helena, died two years ago at the age of 70.
Mr. Trosack has lived in a two-bedroom apartment on the second floor in a three-story,
post?WWII apartment building in downtown Chicago since he married his wife, Helena.
Mr. Trosack has one married son, Peter, 44, a financial consultant. Peter and his 43-
year-old wife, Rita, both work an average of 60 hours a week and are trying to conceive
their first child. They live in a condominium in downtown Chicago close to the lake and
not far from the bakery. Although both were raised Catholic, neither chooses to practice
their religion at this time. This infuriates Henry, but he doesn?t talk about it. Contact
between Peter and his father is infrequent.
One month ago while taking out the trash, Mr. Trosack fell down the long flight of steps
leading to the ground floor of his apartment building, fracturing his right hip. His brother
called 911, and Henry was brought to the hospital where he underwent a right total hip
replacement (THR) within 24 hours of admission. After a successful and uneventful
surgery, Mr. Trosack has been in in-hospital rehabilitation for the past 2 weeks.
While in the hospital for the THR, it was determined that Mr. Trosack had hypertension.
Mr. Trosack was prescribed Lopressor 25 mg bid for an average B/P of 160/100. He was
also diagnosed with noninsulin-dependent diabetes for which he was prescribed
Glucophage 500 mg twice a day to control his condition. After diabetic teaching in the
hospital, he was able to perform his own blood sugar checks and was issued a
glucometer for home use. Being overweight at 5?7?and 210 lbs., Mr. Trosack was also
given dietary counseling to help him lose weight and to control his blood sugar. He was
prescribed Percocet for any residual postoperative pain that might surface.
Upon discharge, Mr. Trosack will use a walker as the only means of assisted mobility.
To determine the appropriate plan of care, you meet with the patient and then the family to
gain more information. With the patient and family?s permission, you conduct a safety
assessment of the patient?s apartment.

PATIENT INTERVIEW RESULTS:
Mr. Trosack is not happy about being what he calls ?disabled? and having to take the
?darn? medications. His apartment is on the second floor, and he is concerned that it will
be difficult and painful to climb the stairs. While this frustrates him, he is determined to
be able to help in the bakery. However, he admits that he cannot go down to the
basement where the supplies are stored. Mr. Trosack insists that he can take care of
himself and can take his own medications. He has lived alone for two years since his
wife died.

FAMILY INTERVIEW RESULTS:
The family insists that according to earlier family discussions Mr. Trosack was supposed
to return home with daily assistance from family members who would take turns running
the store while seeing to his needs. When asked, the son and his wife admitted that they
work a minimum of sixty-hour weeks and have had little time in the past to visit Mr.
Trosack. They hope to do better once he is home, but they know that right now there is
a lot of pressure from work.
When questioned, the family did not appear to understand the need for taking
medications at regular times. They do not believe that he really has diabetes since he
has always been so healthy. They believe a change of diet will probably be all that is
needed.
The family states that they do not know how Mr. Trosack obtains his groceries, but they
are sure there is a store nearby that will deliver. Mr. Trosack usually eats his meals in
the bakery so he does not keep much food in the apartment.
The family also believes that Mr. Trosack will follow directions and remain in the
apartment rather than going downstairs to the bakery. The family refuses any outside
nursing assistance since they know that Mr. Trosack will not want anyone ?fussing? over
him. However, they will try to visit as often as possible.
The family states that Mr. Trosack?s apartment is small and cluttered with WWII
memorabilia. They admit that it may be difficult to maneuver the walker around
furniture and his ?valuables.? However, they state that, ?Maybe this will finally get him
to get rid of all that junk.? The family states that Mr. Trosack is alert and well able to
care for himself. He has been living alone without difficulty for two years since his wife
died.

SAFETY ASSESSMENT:
? Apartment is small and cluttered with furniture and memorabilia.
? Bathroom is small and does not include any safety features.
? Kitchen is small but clean, and there is room to maneuver with the walker.
? Controls for the stove are in the front making it easy to reach.
? Access to the apartment is by two flights of stairs.
? There is no elevator.
? Trash must be taken down the two flights of stairs to the rear of the building.
? Groceries must be brought up the two flights of stairs.
? Bathroom medicine cabinet is filled with old prescriptions.
? Food in the refrigerator is expired.
? Multiple, small scatter rugs are present throughout the apartment, even on top of
other carpets.

Scenario: 72 years old male,wife died 2 years ago,second generation Polish American. No prior health problems, no medication,just vitamins for energy,not sure which,using glasses for reading,lost 60% of hearing in the left ear. Managing family bakery with his widowed brother.
Did not have medical examination for ten years.Has son, who is married, both son and wife work 60 hours a week, trying to have a child, contact with son infrequent.

Admitted to the hospital after fell down the long flight of stairs in his apartment building ,taking out trash. Underwent Right hip replacement.

While in the hospital diagnosed with hypertension, prescribed Lopressor 25mg BID, also diagnosed with non-insulin-dependent diabetes prescribed Glucophage 500 mg BID. After diabetic teaching able to check his own blood sugar,issued glucometer for home use. Overweight 5'7 210lb given dietary teaching to help him to loose weight and control blood sugar. Prescribed Percocet for residual pain. Upon discharge will use walker.

Patient interview:Not happy being "disabled" and take "darn" medications. His apartments on the second floor,concerned how he will climb the stairs. While this frustrates him,determine to be able to help in the bakery. Admits he can not go to the basement to get supplies, insist he can take care of himself. he lived alone for two years since his withe died.

Family interview: family insist that according to earlier family discussion patient was supposed to return home with daily assistance from family members who will take turns. When asked son and his wife admitted that they work 60 hours a week and have little time to visit, but hope to do better. when questioned family did not appear to understand the need to take medications at regular times,do not believe patient really has diabetes, think he just need to change diet, because he was so healthy all his life. promise to found store which delivers groceries,patient usually eats in the bakery do not keep much food in the apartment. family believe patient will stay in the apartment and will not go downstairs to the bakery. Family refuse any outside nursing help, stated patient wont like it.


Safety assessment: apartment small and cluttered with furniture and memorabilia. Bathroom small without any safety features.Kitchen small,clean, there is a room to maneuver walker. Controls for the stove on the front and easy to reach. No elevator, apartment on the second floor,two flights of stairs, trash outside in the ground floor. Bathroom medicine cabinet filled with old prescriptions, food in the refrigerator expired. Multiple, small scattered rugs throughout apartment, even on the top of other carpets.

Write an essay (4 pages) to analyze case study information.

I. Assessment of the Situation
a. Identify 3 or 4 healthcare issues, as a case manager, should address when working with interdisciplinary team to determine the most appropriate discharge plan for given patient.
b. explain why these issues important when planning for management of the elderly discharge patient.
c. Identify 5 members to make up interdisciplinary team to determine the most appropriate discharge placement for given patient.
d,Describe the role expected from each identify team member.
II.. Analyze the issues from the safety assessment that could affect determination of discharge placement.
III. Discharge plan
a.Explain to the family what care patient needs and how he should be discharged based on the interview data and safety assessment. explanations should include:
1.discuss the ability of the family to adequately care for the patient if he is discharge home
2.discuss how social isolation affects older adult's recovery from surgery or illness.
3.discuss the ways psychological factors play a role in the recovery process.
IV. Recommend a discharge placement for the given patient with supportive documentation.

Include all in-text sitations and references in APA format.

Need five pages of Chapter One of a dissertation done using the following problem statement and research questions. Please follow APA style and Walden University guidelines for chapter one that is also attached to this email. My new deadline for this is January 23, 2003. I anticipate that you will be able to complete this job by the deadline. Thanks. Email me at [email protected] if you have any questions. Please confirm receipt of this email request.

Topic: Male Teacher Retention in Early Childhood Programs: Why They Stay.

Problem statement:

There is a problem in male teacher retention in early childhood education. Male teachers represent fewer than five percent of all early childhood teachers in the United States (U.S. Department of Education, 1994). Despite national efforts to recruit, prepare, and retain qualified teachers, the percentage of male teachers in early childhood has been declining since the 1970s (Robinson, 1988; Nelson, 2002). The lack of men in early childhood education negatively impacts staff diversity, employment opportunities for men, and school success in young children. Some reasons why so few men remain in the field of early childhood education include suspicion, subtle discrimination, social isolation, pressure to move into administrative position away from children, and a double standard for behavior and performance (Sargent, 2001). Perhaps a descriptive case study that investigates why the five percent of men in early childhood education remain in the field would yield some solutions that would reverse the current trend.

Research Questions:

Why do the five percent of men in early childhood education remain in the field?

How do the views of men in early childhood by staff and administrators impact male teacher retention?

Additional sources in pdf file format will be supplied. Email [email protected] for additional sources.

The paper is about police subculture, for example police secrecy, solidarity,social isolation.Than describe their characteristics like argot,esoteric knowledge,cynicism,internal sanctions, solidarity,social isolation, and their perception of violence and psychological distance. Than briefly descibe the the Hawthorne experiments and their relevance to subcultures.Also, include a brief explanation of why knowledge and understanding of these concepts are important for police management.please use two sources, include one direct and one indirect quote from each source.please use the following book as one source, Edward A.Thibault, Lawrence M.Lynch and Bruce Mc Bride. Proactive Police Management, 5th or 6th edition. Upper Saddle River,NJ: Prentice Hall,2001.

Write an 8 page in-depth analysis paper (Graduate/Doctoral-level writing) identifying key elements of the case Moving to the Country and recommending possible actions/approaches based upon perspectives of development, learning motivation, and other relevant Educational Psychology areas. The paper should discuss the perspectives of the main character(s) in the case as well as your own perspectives about what issues or problems are of importance in the case. You should provide evidence from the case to support your analysis and discuss relevant Educational Psychology principles and theories. You should discuss what you think was done right or what helped the persons learning or development as well as what else might have been done to optimize learning or development. Your approaches and analysis should again be supported by concepts, research, principles, theories from Educational Psychology. Approaches or solutions should be clearly linked to the analysis of the events in the case.

Answer/address the following questions in your analysis of Franks case study. You do not need to address these in any particular orderyou may just blend/weave these throughout the paper:

1. Is Frank really lazy? What would motivational theorists have to say about frank, especially the attributions he makes regarding his successes and failures?

2. What do Franks parents and teachers see as the source of his motivational problems? What types of approaches have they tried with him? What else might they do to address Franks current failure to live up to his potential?

3. Do you agree with Franks mother that Frank might be depressed? Why or why not? What does research on depression in adolescence suggest might be indicative of depression in franks case?

4. What might you suggest to Franks teachers as a means to engage Frank (or any student new to the school) in more social and peer activities? What does research suggest are the risks of social isolation? What are the benefits of involvement in peer relationships?

5. Bronfenbrenner might contend the changes observed in Frank are the consequences of changes in the ecology of his world. Use Bronfenbrenners ecological theory to discuss how the changes in Franks microsystem and macrosystem were causing problems as well as how the timing of the move (just before early adolescence) might pose difficulties at the chronosystem.

6. Frank is likely in the early part of Eriksons Stage 5, Identity vs. Role Confusion. How would you characterize the way he is resolving this stage? How would Eriksons concept of Community of Life Cycles influence Franks resolution?

7. Based on information from the case and what you know about Kohlbergs theory of moral development, at what level of moral reasoning is Frank operating? Also, discuss what the social learning theorists say about moral development since they are the major alternative view. They point out that moral behavior is more situation-dependent not just a set stage.

* Make sure to discuss how the context or approaches described in the case helped and/or hindered learning and/or development. You also must include an in-depth discussion of possible approaches/solutions to unresolved problems in the case. How would you deal with his problem behaviors? Be specific.

In addition to the 7 above questions, you may discuss any other relevant Educational Psychology concepts or theories to analyze both the major issues/events in the case and the approaches/solutions suggested by you. I do not have a minimum or maximum number of resources that you must use, but 5 or so sources should suffice. I will e-mail essaytown the case study Moving to the Country. Due date: Sunday, October 14th





There are faxes for this order.

I need to research to my questions
What do cases of social isolation teach us about the importance of social experience to human beng.
I need a research to this question one page paper and work cited

NURSING CASE STUDY

Review the ?Elder Care Case Study? (ATTACHED) for information on your patient. You will use this information to complete this task.

Task:

Write an essay (suggested length of 4 pages) in which you analyze the case study information to complete the following:

A. Assessment of the Situation (suggested length of 2 pages)

1. Identify at least three healthcare issues that you, as the case manager, must address when working with an interdisciplinary team to determine the most appropriate discharge plan for Mr. Trosack.

a. Explain why these are important issues when planning for management of the elderly discharge patient.

2. Identify three to five members to make up an interdisciplinary team to determine the most appropriate discharge placement for Mr. Trosack.

a. Describe the role expected of each person on the team.

3. Analyze the issues from the safety assessment that could affect the determination of discharge placement.



Note: You may include any other safety issues you think might be a problem if this patient returns home upon discharge.



B. Discharge Plan of Care (suggested length of 2 pages)

1. Explain to the family what care Mr. Trosack needs and how he should be discharged based on the interview data and the safety assessment. Your explanation should include the following:

a. Discuss the ability of the family to adequately care for Mr. Trosack if he is discharged home.

b. Discuss how social isolation affects an older adult?s recovery from surgery or illness.

c. Discuss the ways psychological factors play a role in the recovery process.

2. Recommend a discharge placement for Mr. Trosack with supportive documentation.


C. If you use sources, include all in-text citations and references in APA format.

Please see fax of Freidman Family Assessment Model. Be concise and systematicl I need three peices of data in each catagorie. You do not need to include the genogram mentioned on the form faxed to you. If some of the needed infrmation is missing in the faxed information please improvise. The family assessment must identify family strenghts and try to attend to these in the implementation part of the nursing care plan. I would like to use the followint format for the nursing care plan part:

Caregiver Role Strain: Reports insufficient physical energy to perform caregiving activities on an ongoing basis. Caregiver voices aprehension about the care receiver''s care when the caregiver is ill or has age related declining health. In tervension: Assess causative factors-reluctance or inability to access help, insufficient lesur, social isolation, aging caregiver with health issues. Promote insight into situation- what is a typical day? Assist to identify activities for which assistance is desired- care receivers needs, potential for adequate extended care living for care receiver that allows caregiver to still interact in his life.Outcome criteria: caregiver will verbalize plan to decrease caregiver''s burden that will promote the best interests of all who are concerned as evidenced by 1) shares frustrations 2) identifies one source of support 3) identifies two changes that could be made that would improve daily life. The family will 1) relate and intent to listen without giving advice 2) convey empathy to caregiver regarding daily responsibilities of careing for chronically ill or dependant child.
There are faxes for this order.

A nursing care plan based on Jean Watson Nursing Theory using "Concept Mapping" for patients. The patient is a female, 96 year old women at Crosslands Rehabilitation Center.

Current Medical diagnosis: Dementia, Hypothyroidism, GERD, cataract eye problems, Iron defiency anemia.

Nursing Diagnosis: Distured sleep patterns, dementia, depression, social isolation.

Current Medications: Compazine 5 mg, (1/2 hour before meals) helps to not vomit.
Aleve 1 capsule twice a day for arthritis
Demadex 20 mg, 1/2 tablet daily (Diuretic)
Synthroid 75 mcg. daily (hypothyroid)
Namenda 10 mg daily (dementia)
Pepcid 20 mg, twice a day (Barretts esophagus)
Lexapro 10 mg, daily, depression

updated information and sources below!

Initial Handout for Formal Papers

1. Introduction: This document contains important information about the first three formal papers you are required to write in this classSummary Essay1, Summary Essay 2, and the Research Paper. In addition to basic instructions and requirements, this document also sets out due dates for these papers. Also included is a list of thirteen stories. You must select one story from that list to base all three papers on.

In other words, all three papers must be based on the same story. Each summary essay must be about a different article, but each article summarized must be about the same story.

You may not write about a story that is not on the list. If you base your papers on some story not on this list, the paper will be returned to you with a grade of zero.

2. Format: All of your papers and any drafts of papers must be computer or word processor generated in a Times New Roman .12 font. No handwritten drafts or papers will be accepted.

All papers must be prepared following the MLA guidelines. Failure to adhere to MLA guidelines will lower your grade.

3. Do your own work. You are guilty of plagiarism if you try to take credit for work done by someone else. For example, do not turn in a paper written or largely edited by someone else; do not use someone elses words or ideas without giving credit by using proper documentation, including, where appropriate, quotations marks. See LBH 629-38. If you are guilty of plagiarism, you may receive a failing grade for the course.

4. General note about articles and sections of a book: While the instructions and guidelines that follow use the term article and not book section, that restricted use of terms is for convenience and brevity. You may use books for secondary sources and may summarize sections of books in your summary essays as long as the book section that you summarize meets the applicable minimum page requirements and is of high quality.

5. Turning in Copies of Your Secondary Sources: You are required to turn in to me copies of all of your secondary sources. Your primary source for these papers will be the short story you write your research paper about. Your secondary sources will be the critical articles and book sections about the story that you find in or through the library and take information from to use in your research paper. See LBH 898 and 900 for general definitions of these terms. When you turn in a paper, you must also turn in at that time a good copy of any secondary source used in the paper and not already submitted to me in connection with an earlier paper.





Summary EssaysGuidelines for Preparing

Three key features of a summary essay are: (1) it is shorter than the source, (2) except for brief quotations, it repeats the ideas of the source in different phrases and sentences, and (3) it contains none (or almost none) of your own ideas, facts, or opinions.

The purpose of a summary essay is to convey to others an understanding of an article or book section you have read, without their having to read it. Hence, your summary essay functions as a substitute for the article you are summarizing. You must not misrepresent your source or mislead your audience. So you must represent your source accurately and comprehensively, with as little of your own interpretation as possible (Anytime you read and repeat a source, you are, to a limited extent, interpreting it; but writing a good summary essay requires that you minimize your interpretation and opinion as much as possible. For example, you should not add your own examples or explanations. Also avoid phrases, such as this excellent article, which express your opinion.)

Each summary essay must summarize one of the four to six critical articles that you plan to use as secondary sources in your Research Paper. You may not summarize the same article twice. Each of the articles that you summarize must be at least six pages long and meet all the requirements for secondary sources in the Research Paper. Summaries of articles that do not meet the requirements for secondary sources, including the minimum page length (six pages), will not be accepted for a grade but will simply be returned with a grade of zero.

Each of your summary essays must be between one-and-a-half to three pages long.

Remember; summarize the article. Do not summarize or retell the story the article is about. Assume your reader has read the story.

A helpful, basic discussion of summary writing can be found at LBH 140-42. More information can be found at http://www.users.drew.edu/~sjamieso/Summary.html, particularly in the sections on writing a summary essay. A link to that site is on our Course Homepage at My.Lamar.edu.

Your summary essays must be prepared using the MLA guidelines that apply to all formal papers submitted in this class. Each summary essay must also include a works cited page listing the article summarized and the story the article addresses. You must cite to the copy of the story found in the Kennedy reader.

For an example of a summary essay of this type written by another student, please see the sample summary essay I will give you entitled Ann Ronalds Roger Malvins Grandson.

Your Title: The title of your summary essay must include both the full name of the critic and the full title of his or her article that you are summarizing. See the title of the sample summary essay.

Your Introductory Paragraph: Your first paragraph, written as though your essay had no title, must include the full name of the critic and the full title of his or her article. Your introductory paragraph must also clearly identify the story the article is about (do this by stating the full title of the story and the full name of the author). See the sample summary essay, first paragraph.
The Research PaperBasic Instructions and Information

1. Basic Requirements: Your Research Paper must be about one of the short stories on the attached list of approved works. Your research paper mustin a thesis driven fashionsummarize, interpret, and analyze secondary sources related to the story you are writing about. This process is called synthesis. A good discussion of synthesis writing can be found at: http://users.drew.edu/~sjamieso/Synthesis.htm. See especially the sections on a Thesis-Driven Synthesis and on writing a Synthesis Essay. See also LBH 161-63 and 610-11.

Typically, in the Research Paper for this class, about 70 percent of the ideas and opinions about the story will come form your secondary sources. We will discuss at length in class how your original thoughts and opinions enter into this kind of paper.

The Research Paper must be three to five pages in length, not counting the works cited
page. Papers shorter than the minimum page requirement are usually lacking in
substance, quality, or both, and the grades they receive usually reflect that fact.

2. Draft of the Research Paper: You must submit a draft of your Research Paper. The draft must include a draft thesis statement, two supporting paragraphs, and a draft works cited page, all in MLA format. The draft will be graded as daily work and will count the same as three quizzes. See the attached list of dates for the date when this draft is due.

3. Secondary sources: In addition to your primary source (the short story), you must also draw on and properly document four to six high quality, clearly relevant secondary sources. Two of your secondary sources must be at least six pages in length. Two of the other secondary sources must be at least three pages long. None of your secondary sources may be from Magills or Gales. For more information about the kind of secondary sources that are acceptable, see the attached document entitled Requirements, Guidelines, and Suggestions for Reference Works Used in Your Research Paper and Summary Essays.

4. Your Research Paper will be evaluated on the substance of what you say, on your adherence to MLA guidelines, on the quality of your sources, on your understandin and use of your sourcesboth primary and secondary, and on your adherence to the rules of standard grammar. Clarity and precision, if lacking in a paper, detract from its substance.
Requirements, Guidelines, and Suggestions for Secondary Sources
Used in Your Research Paper

Books: The most reliable and useful books will generally be the ones you obtain from or through the Lamar Library. Books published by one of the university presses are typically among the most reliable. You can find books for your project through our Librarys online catalog accessible via the Librarys main web page.

Journal Articles and Required Number of Pages: The best way to locate high quality articles about your story is through the online MLA database. You can access this database through the Librarys main web page by using the Electronic Resources function.

The journal articles on your works cited page should come from journals indexed in the MLA International Bibliography and listed in the MLA Directory of Periodicals.

Two of the articles must be at least six pages in length. The other two must be at least three pages in length. This page number requirement also applies to articles (or chapters or sections) found in books (see discussion above) or obtained from electronic sources (see discussion below). Whether an article meets the required number of pages will be determined by the number of pages in the original article, not by the number of pages in an online html copy of the article.

Electronic Sources: Do not browse the Internet looking for secondary sources. Instead, use only the online, electronic sources that you can access directly through the Lamar Librarys Electronic Resources link to electronic indexes. Note that there may be special, additional information requirements when citing one of these electronic sources. Be sure you fulfill any such requirements.

PDF versus html Format: If you find an article online through the librarys electronic sources and if it is available in Full Text in PDF format (as opposed to html format), be sure to download the version of the article that is in PDF format, not the one in html format. The copy in PDF format will include the original page numbers, which will make it easier to properly cite the article in your paper.

Magills and Gales: Do not use articles from Magills or Gales for secondary sources in your research paper. Magills and Gales should be used only for preliminary research, to get an overview of the story or of the available criticism of that story. For your research paper, do not include on your works cited page any articles from either of these two sources. In addition, do not base either of you Summary Essays on anything you obtained directly from Magills or Gales. If you do so, the paper will be returned with a grade of zero.

Note: If my permission is obtained in advance, I may permit a student to use an article not obtained directly via the Lamar Librarys Electronic Resource portal to internet resources, but such an article will be in addition to the four articles otherwise required, not a substitute for one of them.



Some Thoughts on Selecting Articles (or Book Sections)

Remember that each of your two summary essays must be about a critical article (or book section) at least six pages long that you find in a journal (or book) through the Lamar Library.

Each article must be about the story you will write your Research Paper about. Articles do not have to be only about symbolism, or tone, or any one particular ideathey have to be about the story.

As to how to select a good article, that is part of the challenge of the assignment and how well you pick helps determine your grade. I suggest that initially you find fifteen to twenty articles that seem interesting to you because they say something important or helpful to you about the story. Avoid articles that you do not understand because of, for example, the heavy use of highly technical terms or jargon in the article. Find articles that help you understand or appreciate the story more than you did before you read the article. If you like the article because it helps you, you will be much more likely to be able to use it intelligently and enthusiastically in your papers.

If you want an above average grade (an A or a B) do not use only the full text articles you find online. Those are the easy ones to find and get copies of. As a result, they have been used over and over by students in prior classes. Hence, a paper written based only on such articles stands little chance of being fresh or original. There are many more articles in the stacks or available through interlibrary loan than are on line. Indeed, many of the best and most insightful articles are not available in full text online. Dont be lazy; seek out the best. Go to the library and pull some of the journals off the shelves and look for great articles for your paper. Start looking early, so if what seems like a great article or book is not in our library you can get it though the interlibrary loan process.

Then, from the articles you have identified as potential ones to use, pick the eight to ten best, being sure that they meet the page length requirements. If all goes well, some of these articles will serve as the required four to six secondary sources for your research paper.

Next, from this final group, write summary essays about any two that are at least six pages long.

Now, it is possible that you may, at first, think an article is great and write your summary essay about it. And then when it comes time to write the Research Paper, you may find that the article just does not fit in with the theme you want to write the paper about. Frankly, that doesn't happen very often, but if it does, then you just see me and explain the situation, we agree on a change in articles, and you switch to another article you have found and use it in the research paper.

I strongly suggest that for the first article you summarize, you should pick what seems like an interesting and helpful article that you understand and can confidently explain to someone else.

Good luck!



Quick ChecklistSummary Essay

The Critical Article or Book Section (see pages 2 and 4 of the Initial Handout for Formal Papers)

_____ It was obtained through the Lamar Library, either a hardcopy from the shelves, online through the EBSCOHOST portal, in PDF format, or via inter library loan.

_____ It is not from either Gales or Magills. Summaries of articles from either such database will not be accepted. They and summaries of articles that are too short will be returned with a zero grade.

_____ The Article or Book Section is about the story your research paper will be about and is six or more pages long.

Your Summary Essay (see page 2 of Initial Handout for Formal Papers)

Your Title

_____ Must include (1) the name of the critic and (2) the title of his or her article or book

_____ Must be capitalized correctly (LBH 491) and use quotation marks correctly (LBH 470-71 and 472-73)

Your Introductory Paragraph

_____ Must identify (1) the story and (2) its author (full name).

_____ Must identify (3) the critical article or book (your topic) and (4) its author.

_____ The thesis statement is not your main point, it is the main point of the article or book section.

_____ Paragraph does not contain any of you own opinions, facts, ideas, examples, or the like.

Your Other Paragraphs

_____ Each body paragraph has a topic sentence, about the article or book section, and everything in the paragraph supports the topic. Everything else is left out of the paragraph.

_____ Each idea, fact, or opinion from the article or book is properly documented in MLA fashion. None of your own opinions, facts, ideas, or the like is present.

_____ Tell the reader in less words than the original what the original says. You include major points and omit minor points from the original. Summary is the primary method used; quotations are short, limited, ntegrated, and properly punctuated.

_____ Include one or more key examples from the article or book, and only short, carefully selected and limited quotations for illustration. [Note: Quotations must be integratednot floating or dumped. See LBH 625 (2) and the handout on Integrating Quotations.]

_____ There is no concluding paragraph.

_____ Present tense is used. First person is not used, only third person. See LBH 744 (50c(2)).

Other ___________________________________________________________________




Scholars and critics lately have put to good use the companion pieces among Ernest Hemingway's short fiction. Susan Beegel has achieved insights into "The Undefeated" and "A Lack of Passion" from side-by-side analysis of these two antithetical companion stories. Robert Fleming, in "Dismantling the Code: Hemingway's 'A Man of the World,"' opens up the riches of that short story when he aligns it with "The Undefeated" and "Fifty Grand" by interpreting all three narratives as "structured around 'code heroes"'(6). By comparing "A Man of the World" with "The Battler," "The Killers," and "The Short Happy l if e of Francis Macomber," Fleming sees an initiation story, although he concludes that the protagonist of "A Man of the World," Blindy, is a parody of the "code hero" and, underneath "his stoic insistence on the sacredness of that [heroic! identity," a "hollow man" (9).[ 1] For Fleming, "A Man of the World" is an ironic code story.

Applying the same critical method, I offer a comparison between "A Man of the World" and its more famous counterpart, "A Clean, Well-Lighted Place." The close reader quickly discovers a large number of elements common to both stories. This is not to say that "A Man of the World" replicates the conscious and hidden symbols and actions of its renowned predecessor. There arc differences, most notably the memorably foregrounded nihilism in "A Clean, Well-Lighted Place," which as Fleming points out is not found in "A Man of the World," and the use of a first-person narrator (Tom) in the later story.

The reader should bear in mind that the stories were published nearly a quarter century apart: "A Clean, Well-Lighted Place" in 1933 and "A Man of the World" in 1957, the latter about four years before the author's suicide. But given the two stories' common themes, one must acknowledge the author's uniform and sustained attitude toward age. Hemingway's wisdom concerning age came early, and he seems to have kept that counsel all his life. In The Garden of Eden, David Bourne has the same recognition: 'He [David Bourne] must remember that. He had only a sorrow that had come from his own tiredness that had brought an understanding of age. Through being too young he had learned how it must be to be too old" ( 1-2).

Age is a central theme in both short stories, and it is the older characters, the old man and older waiter versus the younger waiter in "A Clean, Well-Lighted Place," and Frank the bartender and Blindy versus the young fellow/stranger in "A Man of the World," who carry the ideological burden. Tom the narrator stresses the generation gap throughout "A Man of the World": Blindy has been "on lots of roads" (CSS 493); Frank the bartender was a witness to Blindy's brawl with Willie Sawyer during the former's "fighting days," making him coeval with Blindy; the outsider who learns about Blindy's history is "the young fellow" during the first half of the story. In "A Clean Well-Lighted Place," opposing viewpoints due to differences in age and experience create dramatic conflict. Julian Smith calls "A Man of the World" a "technically perfect story" (10), and also notes that it takes its meaning from "the reactions inspired in others" (Willie Sawyer, Frank, Al Chaney, Tom, and the young fellow) by Blindy (10). Actually all of the older characters seek the young fellow's response in one way or another: Tom by denying that he knows anything about how Blindy lost his sight (494), Frank by setting the record straight, Blindy by justifying his name ("I earned that name" 495). Each older subject has a specific restless need to intiate youth.

Readers of Hemingway know well the brief plot of "A Clean, Well-Lighted Place." They may however need reminding of the abbreviated action in "A Man of the World," narrated by Tom and set in Wyoming. Blindy nightly cadges money from the patrons of saloon slot machines in The Flats, and then travels on foot or hitchhikes to Jessup, where he works that town's two saloons, The Pilot and The Index. On the night the story takes place, Tom asks Blindy why he looks frozen and Blindy explains that he had to walk part of the way to Jessup. Blindy refuses a drink from Al Chaney, and when a young fellow hits twice on the machines, Blindy begs a quarter from him each time. After serving the young fellow and Tom a drink, Frank the bartender tells the young stranger how years earlier Blindy lost both eyes in a brawl with Willie Sawyer, whose face Blindy mutilated in the same fight. Blindy overhears the narration and with pride adds a detail or two. He also notes that it was Willie Sawyer who put him out of the car on the way to Jessup, because Blindy placed his hands on Willie's face. After insisting that his name is now Blindy and not Blackie, he accepts from Frank a drink and an offer to sleep overnight in the back of The Pilot. The story is brief, but a detailed reading reveals that a lot happens in the span of four pages.

The consolation of light is crucial in both stories, most obviously in "A Clean, Well-Lighted Place" (CSS 290). "Well" is an important qualifier: the cafe is shadowed by leaves so as not to be "very bright" (291). In addition it is "clean and pleasant" (290). The bodega has a "shining steam pressure coffee machine" (291), but unlike the cafe is "very bright (291). Its excessive brightness and "unpolished" bar repel the older waiter (291). In "A Man of the World," approaching cars pick up Blindy in "their lights" (492) as he stops along the road between The Flats and Jessup, and his fight with Willie Sawyer took place in the lights from the doors of The Pilot and The Index (494). Blindy regrets not being able to "see sometimes" (495), but darkness does not undermine his ebullient persona. He puts a heroic face on his tragic life.
Annette Benert interprets the "Light" of "A Clean, Well-Lighted Place" as one of the "barriers . . . against Nothingness itself' (183). Steven K. Hoffman sees the light of the same story as a metaphor for "a special kind of vision, the clear-sightedness and absolute lack of illusion to look into the darkness and thereby come to grips with the nada which is everywhere" (176). One can argue that Blindy also has this "special kind of vision." He is well aware of the odds against him, of his lowly and disadvantaged position in a difficult society, of the incessant demands life puts on his wits and will-power, yet he never despairs. Toward the end of the story Tom describes a brief, passing gesture of Blindy's: "His hand reached out and found the glass and he raised it accurately to the three of us" (495). Blind though he is, Blindy performs his toast "accurately," as if he could see and did not live in darkness. The accurate toast becomes an implicit metaphor for the daily routines of Blindy's life. He is careful on the roads, drinks moderately, works the slot machines nightly, and is ever alert to the sounds from the machines. He lives as if he actually experiences light with little or no psychic or physical disorientation. His is a very limited life but one that is admirably functional. At times he rejoices with manic glee over his bits and pieces of good fortune.

As a frequently discussed symbol or as a special kind of vision (Hoffman 176), light opens to wide view "the dignity of movement" that is the surface of Blindy's daily life and, to a lesser degree, the hidden "seven-eighths" below. I should note that many still question the "dignity of movement" in the one-eighth above the surface of "A Man of the World" -- according to Paul Smith, "Carlos Baker dismissed both these stories [A Man of the World" and "Get a Seeing-Eyed Dog"] as trivial and there is always the off chance that he was right" (392).[ 2] Much of what is subtextual is arguable, conjectural, and enigmatic; as well as ultimately indistinguishable from the voice of Hemingway. But what is there must be formidable enough to sustain the resilience of Blindy's surface life.

Another signifier common to both short stories is concern over money, specifically in the context of age. The old man in "A Clean, Well-Lighted Place" has "plenty of money" (298), but Blindy must "work" the slot machines of the two towns (492). Both characters evince a middle-class fiscal conservatism, of the same sort George Cheatham, following Scott Donaldson, finds in Jake Barnes. Cheatham defines it this way: "Just exchanges [Jake's term in The Sun Also Rises l are also equitable exchanges, legal, correct, proper, exact, accurate, uniform exchanges" (29). Note how the old man accounts and pays for his drinks in "A Clean, Well-Iighted Place": "[He] slowly counted the saucers, took a leather coin purse from his pocket and paid for the drinks, leaving half a peseta tip" (290). The exchange is "proper, exact, accurate," even given the old man's inebriated condition.

Blindy may lack the wealth of the old man but he imbues his financial and social affairs with the same spirit of "just exchanges." Blindy has to scramble for quarters, but his transactions are always enacted with the assiduous sense of the honest business deal. Blindy gets his first quarter from the young fellow despite the latter's reluctance to give it to him. On the "pretty good" second jackpot Blindy politely accepts a single quarter; he raises no quarrel about a bigger jackpot entitling him to a bigger cut, and when the young fellow's luck turns, Blindy does not badger him with any undue pleas for money. Nor does Blindy follow the young fellow after he leaves the machines and returns to the bar; Blindy continues to stand by the machines "waiting for someone else to come in and make a play" (493). Blindy will "earn" his quarters. His diligence, his obsessive concern about justly earning his quarters, his name, and even his social worthiness, overshadows his physical ugliness, his lack of personal hygiene, and his formerly violent nature. The narrator again and again attests to the assiduity of Blindy's vocation: "it must have taken him quite a time" "to learn the sounds of all the different machines" (492). For a blind man to walk the often frozen road between The Flats and Jessup every night is a considerable feat--"He'd stop by the side of the road when he heard a car coming and their lights would pick him up and either they would stop and give him a ride or they wouldn't and would go on by on the icy road" (492). The narrator uses the word "worked" twice in the first paragraph of the story and in the second "threw his trade" to emphasize the economic propriety of Blindy's cadging in these difficult circumstances. Blindy also uses financial terms to describe the acquisition of his nickname: " [ 1 ] earned that name. You seen me earn it" (495).
The old man and Blindy live out their lives with the diminishment or loss of the male sexual drive. In "A Clean, Well-Lighted Place" the younger waiter boasts that he has "a wife waiting in bed" (289) and then scornfully avers that "A wife would be no good to him [the old man] now" (289). The compassionate older waiter counters: "You can't tell. He might be better with a wife" (289), a response abundant with meanings: a wife might be an antidote to the loneliness and depression the old man experiences, someone to care for him or someone for whom he could care, someone with whom perhaps to have conjugal relations. The older waiter's sympathy for the old man's conjugal deprivations finds a responsive chord in Hemingway's correspondence. In a letter written in 1954 to Bernard Berenson, Hemingway observed: "But B.B. there is nothing like Africa as there is nothing like youth and nothing like loving who you love or waking each day not knowing what the day will bring, but knowing it will bring something" (SL 838).

A reader might lose sight of the lost sexuality theme amid the sensational violence and repellent physical ugliness described in "A Man of the World." But despite all that has befallen Blindy since his memorable brawl with Willie Sawyer, and despite his current squalor, only once in the story does he evince sadness or discouragement and that by understatement. In "his high-pitched voice" (494) Blindy tells the young fellow that after blinding him Willie Sawyer "stomped me when I couldn't see" (494). He then discursively adds the judgment: "That was the bad part" (494). Blindy could reconcile himself to being blinded by Willie Sawyer; being castrated by him, however, is horrible and morally reprehensible, a wanton act of humiliation. The "youth . . . and loving" Hemingway described to Berenson is lost forever.
In the aftermath of these irreversible traumas Blindy has shown what Julian Smith calls "lifelong endurance under pressure" (9). His stoical acceptance of his dire fate inspires Smith to add: the "dignified, stigmata-bearing Blindy [is] . . . like Christ, a man of the world, a man of all the world" (12). Between Smith's effusive judgment and Howard L. Hannum's estimate of Blindy as "Hemingway's final, sardonic comment on the boxer-brawler" (342) lie the upbeat elements, amid preponderant squalor and ugliness, of Blindy's life: his speaking "without any rancor," his narrating "happily" how he touched Willie Sawyer's face earlier that night, and his raising his glass "accurately to the three of us" (495). His elan is the manic antipode to the sad though dignified life of the old man in "A Clean, Well-Lighted Place." Both characters, however, play out their biases as a response to losing the consolatory joys of human sexuality.

Another theme common to both stories is social isolation. The old man is a widower; the younger waiter calls him "lonely" (289), and the older waiter agrees. The older waiter, arguably the story's protagonist but certainly the "mentor," lives much like the old man, apparently also with no wife and with no niece. At the end he is to "go home to his room"; his profoundest "thinking" is shared with no one: he keeps his thoughts "to himself" (291). In "A Man of the World" the cars that pass Blindy on the road, Blindy's positioning himself "down at the far end of the machines" (494), his sleeping by himself in the back of The Pilot, and Tom's assertion that it "was always hard for me to look at him" (493) demonstrate the reality of Blindy's loneliness. Considering Blindy"s social isolation, "A Man of the World" is an ironic title; that Blindy tries to sustain this view of himself is a tribute to his lonely heroism. Isolation envelops other characters as well. Even though Blindy's life is tied to Willie Sawyer's in a perverse and unrelenting way, Blindy states the truth simply: Willie Sawyer is "Probably alone home by himself' (495). The "young fellow" becomes "the stranger" in the second half of the story, following the narrator's denial of having witnessed the brawl between Blindy and Willie Sawyer. That the older characters in the Hemingway canon must suffer in isolation seems to be a constant. David Bourne in The Garden of Eden sounds the knell: "That was all he took from the elephant except the beginning of the knowledge of loneliness" (16).
Three other themes cluster about loneliness, adding their dismaying significance to the view of age presented in both stories. Consider physical debility. That the body withers and loses its prowess and beauty is a commonplace but worrisome fact. The drama lies in the eventual allotment of debilities to each person and how he or she responds spiritually. In "A Clean, Well-Lighted Place" the old man counts "slowly" and walks "unsteadily" (290). He is deaf, "in despair" (288), and according to the younger waiter, "a nasty thing" (289). The older waiter argues against that judgment, observing, "He [the old man] drinks without spilling" (289), a thrust at the younger waiter having "poured on into the glass so that the brandy slopped over and ran down the stem into the top saucer of the pile" (289). The older waiter too has lost "youth" (290), "confidence" (291), sleep ("only insomnia" 290), and by implication joy. But his sadness yields compassion ("Each night I am reluctant to close up because there may be some one who needs the cafe" 290).

In "A Man of the World" physical debility is shockingly foregrounded in Willie Sawyer and Blindy. Sawyer's face has a hole big enough so that "the whole inside of his face . . . [could] catch cold" (495). And then there are Blindy's eyeless sockets covered with "small pus icicles" (493), his body which smells "plenty strong" (492), and his "high-pitched" voice (494). He is so physically repellent that it is "hard for [Tom I to look at him" (493). He looks "so awful" (493) that the young stranger "quit playing [the slots] and came over to the bar" (493). In both stories, the younger characters are unsympathetic to the infirmities inherent in age. A "nasty thing" says the younger waiter of the old man, and "Him fight'?" asks the young stranger of Blindy (494). Empathy for the aging subjects proceeds from their cohorts, the older waiter in "A Clean, Well-Lighted Place" and Prank the bartender in "A Man of the World."

Depression bordering on despair dogs the older characters in these stories. "The old man is "drunk every night" (289), is quite capable of becoming "too drunk," and has "tried to commit suicide" (288). Depression pervades the story linguistically and dramatically. The old man's drunkeness, despair, loneliness, and attempted suicide dominate the conversation between the waiters and gloom even infects their observations on the "girl and a soldier [who go] by in the street": "The guard will pick him up" (288). The younger waiter becomes a pitiless agent of despair, telling the unhearing old man to his face "You should have killed yourself last week" (289). The older waiter too bears a melancholic burden; lacking "Everything but work" (290), he fully comprehends that "a man was nothing too" (291). Only in the final paragraph does the pall of despair begin to lighten, with "sleep" and "daylight" finally becoming achievable ends.

In "A Man of the World," depression, both from trauma and shame, drives the self-imposed and unchanging social isolation of Willie Sawyer. Depression nags at Blindy's spirit also, though paradoxically acted out. He exhibits a hale and happy resilience even to strangers ('our night is my night" 493); a laudable prudence governs his bibulousness (he has "to be careful on the roads" 493). It is true that by cadging drinks, in addition to husbanding his meager store of coins, he guarantees that he never has to drink alone. Yet Tom, the narrator, clearly alludes to the dark underside of Blindy's nature. Blindy placed himself "at the far end of the machines," figuring "no one would come in if they saw him at the door" 494.) Even though he tries to get tauntingly "funny" with Willie Sawyer, Blindy states emphatically that they "have never made friends" (495). On two occasions he angrily tells Tom and Frank that "Blindy's the name," "just don't call me Blackie" (495). A sense of unworthiness' bitterness over the castrating injury, sadistic humor, and suppressed anger exact their depressive levy on Blindy's spirit. Only Frank's quick action defuses Blindy's anger and melancholic mood: "Have a drink, Blindy" (495), Frank says, offering alcohol-induced tranquility and safe sleep at the story's end.

In the Hemingway oeuvre, from In Our Time to "The Garden of Eden, the essential characteristic of all experience is threatened or actual violence. The old man in "A Clean, Well-Lighted Place" is an unsettling reminder that age is no protection against violence. Violence is the primary raw material of the critical industry surrounding the Hemingway canon. From Malcolm Cowley's, "In no other writer of our time can you find such a profusion of . . . morally wounded people who also devour themselves" (40-41) to Amberys R. Whittle's observation that many "of Hemingway's stories . . . are parables of. . . violent death" (287), the question is one of how the subject deals with violent, often lethal experience. "A Clean, Well-Lighted Place" and "A Man of the World" are no exceptions.

Consider "A Clean, Well-Lighted Place." The old man tries to commit suicide by hanging. The soldier for a night of passion risks arrest by the guard. The young waiter urges the deaf old man to commit suicide. Only accidental good fortune forestalls violence in the first half of the story: the niece prevents the old man from dying, the guard does not arrest the soldier, and the old man cannot hear the younger waiter's brutal taunt. In the second half of the story, only the ameliorating actions of the older waiter and the old man defuse two potentially violent incidents. The old man responds cooperatively to the younger waiter's "Finished"; and the older writer/mentor backs off his "insult" to the younger waiter by saying he was only trying "to make a joke" (290).

The violence in "A Man of the World," both past and present, is actual. Violence at its most sensational occurs in Frank's narrative and Blindy's coda about the fight between Blindy and Willie Sawyer. Based on those two paragraphs, Howard L. Hannum logically concludes that Blindy's story is "Hemingway's final, sardonic comment on the boxer-brawler," representing "the final stage of such violence" (342). The reader must stretch to find "dignity of movement" in the fight passages, and may incline either to share "Carlos Baker's estimate" (340) or to follow Paul Smith's lead and link up the story with "Mark Twain and the tradition of the tall tale" (393).

Putting aside the sensational "fight" passage, the reader will discover violence in other guises. Willie Sawyer puts Blindy out of his car to "be frozen up so bad" (493). Later Blindy confesses he started the altercation in the car by once again putting his hands on Willie Sawyer's face (495). Although their "fighting days" are long past, the urge to assault or humiliate each other is still present (495). Even if Blindy is just using his hands to "see" and remind himself of his past accomplishments, his action is abusive and malevolent, an assault on Willie's forlorn dignity.
Reprising the subtle, psychological, and diminishing violence in "A Man of the World" requires an extended dramatic example involving Blindy, Tom, and Frank. First, one should note that Paul Smith, following Julian Smith, is correct in ascertaining that the "drama [in 'A Man of the World'] rests in the reaction of the three others [Frank, Tom, the young fellow/strangerl at the bar" (393). Secondly, Julian Smith in his critical study has noted certain parallels with the New Testament:

Blindy, I am suggesting, is, like Christ, a man of the world .... But whereas Blindy has accepted his fate, Tom the narrator would turn away could he. Thrice he denies Blindy, once by claiming not to know his story, once by claiming he has not heard of the fight though he was there, once by calling him by his old name. Tom is a doubting Thomas unwilling to put his hands, metaphorically, into Blindy's wounds--unlike Blindy who can touch Willie's wounds (12).

This religious interpretation does not lack cogency, although it is arguable. However, the dramatic import of Tom's denial is evident. When the outsider asks Tom how Blindy lost "his sight," Tom belligerently replies, "I wouldn't know" (494). Immediately Tom, who up until then had identified the outsider seven times as "the young fellow," calls him "the stranger" and will do so twice more in the remainder of the narrative:
"I wouldn't know," I told him. ["In a fight," Frank told him.][ 3] "Him fight," the stranger said. He shook his head. "Yeah," Frank said. (494)
Tom, obviously unnerved, estranges himself from the young outsider. And he also grows testier with Frank's and Blindy's recapitulation of the brawl, a testiness exacerbated by Frank's deliberately curt retorts, "In a fight" and "Yeah," aimed at jogging Tom's memory and conscience. His testiness is also demonstrated when he angers Blindy by using his old name: "Give Blackie a drink," I [Tom] said to Frank. "Blindy's the name, Tom. I earned that name. You seen me earn it." (495).

Blindy goes on to explain to the stranger what he did to Willie Sawyer's face earlier that night, arousing the disapproval of Frank, who reproves the blind man by calling him Blackie: "'Blackie, you have one on the house,' Frank said." Blindy, of course, takes vehement exception once again to being called by his old name: "That's mighty good of you Frank [to offer me sleeping quarters!. Only just don't call me Blackie. I'm not Blackie any more. Blindy's my name." Frank, unlike Tom, wisely and compassionately corrects himself and adds a fillip: "Have a drink, Blindy" (495). Just as the older waiter in "A Clean, Well-Lighted Place" defuses a potentially violent altercation by making "a joke," Frank also becomes the peacemaker who facilitates the swing of the narrative from abhorrent violence to social amity and eventually to the tranquility of isolated but secure and consolatory sleep.

The stories share positive as well as negative themes. There is a merging of voices into a kind of spiritual bond. In "A Clean, Well-Lighted Place," the voices of the older waiter and the old man, who, as Carlos Baker notes, never speak a single word to each other, join to express a common ethos, by implication Hemingway's as well. In "A Man of the World" there is a similar bonding between Frank and Blindy. Tom is uneasy about Blindy's loquacious presence, but it's Frank the bartender who should want Blindy gone from The Pilot. Blindy is bad for business: he "had run . . . [the young fellow] out" from the slot machines (493), the patrons threaten to "go next door to The Index," "no one would come in if they saw him at the door" (494). And yet Frank tells the story of the fight, pacifies Blindy by using his correct name, and offers him a drink and a room for the night "in the back of the place" (495). Like the older waiter in "A Clean, Well-Lighted Place," one "of those who like to stay late at the cafe" (290), Frank signals his spiritual closeness to Blindy with various offers of comfort and security.

Blindy "reached out and found the glass and he raised it accurately" (495) and gratefully for the bartender's respect and compassion for him. As the "accurate" toast shows, Blindy never forgets his manners. Good manners, indeed dignity and self-esteem, found in such an unlikely subject, only reinforce the argument that the need to act with grace is universal and lifelong. In "A Clean, Well-Lighted Place" the old man and the older waiter certainly embody this virtue. The old man walks "unsteadily but with dignity" (290), he says "thank you" (289) to the insulting younger waiter who pours him a brandy, and he pays for all his drinks, "leaving half a peseta tip" (290). The older waiter too exercises good manners. Although the younger waiter does "not understand" (290), the older waiter never sinks to rude or provocative behavior, but responds with a well-mannered "Good night" (291). And even though the older waiter "disliked bars and bodegas," his final words in the story, addressed to the barman, naturally are: "No, thank you" (291) --laconic but polite.

Strange to tell, a politeness born of earned self-esteem is also Blindy's strong suit in public. He too says "thank you" each time to the young man who gives him a quarter from his jackpots. He stays "at the far end of the machines" (494) so as not to drive away any new patrons, and he is politely grateful to Frank for allowing him to stay the night ("That's mighty good of you" 495) and for offering him a drink, accepting with a "Yes, sir" (495) and a formal toast. As for the mentor/code hero of the story and his patience, wisdom, generosity, business savvy, and deference toward Blindy, especially in the matter of Blindy's correct name--all these I have already alluded to as elements of Frank's persona.
And so both short stories converge dramatically on these common themes: age, the consolation of light, a conservative viewpoint toward money, the loss or diminishment of sexuality, aloneness, the deprivation of physical powers and beauty, lurking depression and despair, violence (here eventually attenuated), the lifelong need for dignity and self-esteem, spiritual bonding among men, and the wisdom of age duly earned. In "A Clean, Well-Lighted Place" the abundance of naturalistic detail, some of it unpleasant, does not undercut the dignity of movement in the text and most readers come away "unusually stirred," as Sean O'Faolain once put it (112). A "dignity of movement" occurs, perhaps arguably, in "A Man of the World," especially if the reader perceives the overall movement toward amity and tranquility in the narrative and if he or she acknowledges that the tall-tale part of the story, the two paragraphs in which Frank and Blindy respectively recount the brawl, represents action that is prior, off-stage and verbally reprised to suit the occasion.

There is much in age that is a "nasty thing." But the older subjects in both these stories face it with exceptional dignity, some with more (the older waiter and Frank) and some with less (the old man and Blindy). The adversities that confront the latter, perhaps even the greater flaws in their characters (Blindy's sadistically violent nature and the old man's brooding aloofness) diminish their heroism. In the case of "A Man of the World," Blindy's durably happy and fun-loving disposition is a partial counterweight to the increased dross of violence that weighs down his heroism. It's a dicey trade-off that Hemingway made late in his career, making "A Man of the World" appear to be a "final, sardonic comment on the boxer-brawler" and clouding over the unexpected similarities between this story and "A Clean, Well-Lighted Place." Ironically, the less despairing of these two short stories comes just four years before that fateful 2 July 1961 date. The singular event of that day in American letters prevented Ernest Hemingway from experiencing the aspects of age he had creatively prefigured in these two short stories.

For the article below, please provide a review that includes the following;
1. Incidence rates (measurement issues, definitional issues, perceptions)
2. Causation (who is blamed is another way to look at this)
Prevention efforts (evidence of effectiveness ? for whom, under what conditions)
3. Intervention (what level - 1-1, group, policy; evidence of effectiveness ? see above; ramping up?)
4. School/college climate issues (if they apply)
Concept of victimization
5. What do we know regarding race, sex, age, SES

Direct and relational bullying among primary school
children and academic achievement
Sarah Woodsa,*, Dieter Wolkeb
a Department of Psychology, University of Hertfordshire, UK
bDepartment of Community Based Medicine, University of Bristol, ALSPAC, UK
Received 28 March 2003; received in revised form 30 July 2003; accepted 8 December 2003
Abstract
The association between bullying behaviour and academic achievement was investigated in 1016
children from primary schools (6?7-year-olds/year 2: 480; 8?9-year-olds/year 4: 536). Children
were individually interviewed about their bullying experiences using a standard interview. Key Stage
I National Curriculum results (assessed at the end of year 2) were collected from class teachers, and
parents completed a behaviour and health questionnaire. Results revealed no relationship between
direct bullying behaviour and decrements in academic achievement. Conversely, higher academic
achievement at year 2 predicted bullying others relationally (e.g. social exclusion at year 4).
Relational victimisation, Special Educational Needs (SEN), being a pupil from a rural school or
small classes and low socioeconomic status (SES) predicted low academic achievement for year 2
children. Findings discount the theory that underachievement and frustration at school leads to direct,
physical bullying behaviour.
D 2004 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.
Keywords: Bullying; Victimisation; Academic achievement; Special needs; Primary school students
According to Olweus (1993, 1999), victimisation refers to a student being exposed to
negative actions on the part of one or more other students? with the intention to hurt.
Bullying must be a repeated action and occur regularly over time (Olweus, 1999) and it
usually involves an imbalance in strength, either real or perceived (Craig, 1998;
Whitney & Smith, 1993). Bullying can be physical, verbal, or relational (Bjo?rkqvist,
0022-4405/$ - see front matter D 2004 Society for the Study of School Psychology. Published by Elsevier Ltd.
All rights reserved.
doi:10.1016/j.jsp.2003.12.002
* Corresponding author. Computer Science Department, University of Hertfordshire STRC, Hatfield
Campus, College Lane, Hatfield, Herts AL10 9AB, UK. Tel.: +44-1707-281-133; fax: +44-1707-285-073.
E-mail address: [email protected] (S. Woods).
Journal of School Psychology
42 (2004) 135?155
1994; Bjo?rkqvist, Lagerspetz, & Kaukianen, 1992), whereby relational victimisation is
defined as the purposeful damage and manipulation of peer relationships leading to
social exclusion (Crick & Grotpeter, 1995). The first two forms of victimisation have
sometimes been labelled as ??direct bullying?? as they include direct aggressive acts
such as hitting, kicking, pinching, taking belongings or money, pushing or shoving, or
direct verbal abuse (name calling, cruel teasing, taunting, threatening, etc.). In contrast,
relational or ??indirect?? bullying refers to social exclusion by spreading malicious
gossip or withdrawal of friendships (Wolke, Woods, Bloomfield, & Karstadt, 2000).
The prevalence of physical and verbal victimisation in primary schools has revealed
ranges from 8% to 46% and for bullying others between 3% and 23% across countries
worldwide (Smith et al., 1999; Wolke & Stanford, 1999; Wolke, Woods, Schulz, &
Stanford, 2001).
Initial research studies into the characteristics of bullying behaviour solely considered
those children who were ?pure? bullies or ?pure? victims. However, more recently, research
has revealed that a sizeable group of children cannot be simply classified as ?pure? bullies or
?pure? victims but both bully other children and are victimised at other times, and have been
termed bully/victims (Kumpulainen et al., 1998; Sutton & Smith, 1999; Wolke & Stanford,
1999; Wolke et al., 2000). Bully/victims have been found to be a distinct group of children
in terms of their behavioural characteristics (Schwartz, 2000) and are rated as being the least
popular by peers (Forero, McLellan, Rissel, & Bauman, 1999; Wolke & Stanford, 1999),
easily provoked, provoke others and are hot tempered (Schwartz, 2000). Furthermore,
bully/victims are characterised as having more behaviour problems with hyperactivity,
impulsivity, and conduct problems compared to ?pure? victims, ?pure? bullies, or neutral
children (Duncan, 1999; Kumpulainen et al., 1998; Wolke et al., 2000).
Less is known about the characteristics of those children involved in relational
bullying and an inconsistent profile emerges. Children who are relationally aggressive
have been found to be less liked by other children (Crick & Grotpeter, 1995, 1996)
and there is also evidence that relational aggression is related to maladjustment in
terms of depression, loneliness, anxiety, and social isolation (Bjo?rkqvist, 1994; Crick,
Casas, & Hyon-Chin, 1999). In contrast, other findings have revealed that those
children who are relational ?pure? bullies are physically healthy, enjoy going to
school, have few absenteeism?s from school, have few behaviour problems in terms
of hyperactivity and conduct problems, but are characterised by low prosocial
behaviour (Wolke et al., 2000; Wolke, Woods, Bloomfield, & Karstadt, 2001; Wolke,
Woods, Schulz, et al., 2001).
Bullying behaviour is a social, group process that is prevalent in the school environment
and there are well documented findings regarding the behavioural and health
consequences of bullying behaviour at school for both direct and relational bullying
profiles (Kumpulainen et al., 1998; Owens, Slee, & Shute, 2000; Williams, Chambers,
Logan, & Robinson, 1996; Wolke et al., 2000). However, there is a dearth of research that
has considered the association between bullying behaviour per se and academic achievement
among primary school children.
Olweus (1978, 1983) first speculated that aggressive behaviour of bullies towards
peers could be considered as a reaction to frustrations and failures at school. However,
data from a large sample of boys from Greater Stockholm provided no evidence to
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 136
suggest that aggressive behaviour was a consequence of poor grades at school. Rather, it
was found that both bullies and victims had lower than average marks than neutral
children (Olweus, 1978).
In a recent study, Schwartz, Farver, Chang, and Lee-Shin (2002) reported that children
who exhibited poor academic performance in school tended to emerge as frequent targets
of bullying. However, it was only a subset of victimised children, the aggressive victims
(or bully/victims) who were likely to be characterised by poor school performance
(Schwartz, 2000). What remains to be established by research studies is whether poor
academic achievement leads to bullying involvement or whether being bullied leads to
poorer school achievement, possibly mediated by less participation in school.
Research on peer rejection has also considered the relationship to academic
achievement and school adjustment. Peer rejection is predominantly assessed by standardised
scores that are comparable across classes and school, but does not take into
account individual bullying roles within classes. Ladd (1990) considered the academic
behaviour and school adjustment of children over the first year of school life and
reported that rejected children had less favourable school perceptions, significantly
higher levels of school avoidance and significantly lower school performance compared
to popular, average, and neglected children. In a similar vein, DeRosier, Kupersmidt, and
Patterson (1994) assessed three different cohorts of children over 4 consecutive years
and revealed that children who had experienced peer rejection displayed higher levels of
absenteeism, and that the youngest cohort of children who were more chronically
rejected, performed more poorly on academic tests compared to those children who had
never been rejected. However, it was concluded that there was no direct relationship
between peer rejection and later academic achievement, and instead an indirect pathway
was proposed. Further evidence for this contention was derived from a study by Buhs
and Ladd (2001) who found that the effects of peer rejection on children?s adjustment
were partially mediated through the processes of maltreatment and reduced classroom
participation.
Research studies to date have solely considered direct bullying and peer rejection,
and no consideration for the possible association between relational bullying status and
academic achievement is evident. The profile of relational ?pure? bullies remains
controversial, and academic achievement results for these individuals would shed light
on the overall characteristic profile for these children. For example, if relational ?pure
bullies are found to be characterised by outstanding academic achievement, this would
provide further support for the claim by Sutton, Smith, and Swettenham (1999) that
?pure? bullies or ring leaders are socially intelligent and have superior theory of mind
skills resulting in enhanced manipulation skills in peer group situations.
To further complicate the picture, academic achievement and school adjustment
have been employed interchangeably within research studies, which is potentially
problematic as both place different emphasis on aspects of children?s academic school
life. Academic achievement has been assessed by school records of composite
achievement test scores (DeRosier et al., 1994), Task Mastery subscale of the
California Preschool Social Competence Scale, (Ladd, 1990), verbal and quantitative
subtests of the Metropolitan Readiness Tests (Buhs & Ladd, 2001; Tremlow et al.,
2001), and categorical variables rated by teachers as ?this child is excellent?, ?this
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 137
child is a good student?, or ?this child has difficulties with school work? (Schwartz,
2000; Schwartz et al., 2002).
Furthermore, no studies have considered the sole importance of academic achievement
and school adjustment in relation to bullying behaviour, but have instead included these
factors as much smaller aspects of larger research studies. School adjustment variables
have included negative school attitudes, social adjustment at school, school avoidance,
child?teacher relationships, cooperative classroom participation, involvement in school
activities, and adaptation to the classroom environment (Blankemeyer, Flannery, &
Vazsonyi, 2002; Buhs & Ladd, 2001; Ladd & Burgess, 2001).
Measurements that assess academic ability by tests and teacher assessments in the
same way across different schools are needed in order to provide consistency. The
National Curriculum Standard Assessment Tasks (SATs) employed to assess children?s
academic achievement in the U.K., combine tests with teacher assessments. Despite
scepticism, reliability on the SATs tests have revealed high values (Hurry, 1999;
Reeves, Boyle, & Christie, 2001). One strength of SATs assessments is that they
sample a broad range of skills compared to other standardised tests. SATs tests also
enable researchers to identify subtle and relative changes such as a decline in standards
(Hurry, 1999).
In summary, the literature reveals a noticeable gap concerning the possible causal
pathways between bullying behaviour and academic performance and the direction of
influence, i.e. does being involved in direct or relational bullying behaviour as a bully,
victim, or bully/victim contribute to the prediction of academic achievement or alternatively,
does poor academic achievement predict involvement in bullying behaviour?
Furthermore, previous studies have often concentrated on small sample sizes, on preschool
or grade one children, failed to consider relational bullying, and solely focused on
peer rejection and sociometric status, rather than bullying behaviour per se.
The current study with primary school children from the U.K. had two major aims:
(1) to assess the relationship between direct and relational bullying behaviour, and SATs
tests results and teacher assessments; (2) consider variables that predict children?s SATs
results and teacher assessments and determine whether SATs results and teacher
assessment results contribute to the prediction of being involved in direct and/or
relational bullying.
Method
Population
Parents of children in 82 classes in 39 primary schools in Hertfordshire and North
London in the United Kingdom were approached. Five schools (eight classes) failed to
provide Key Stage Level I National Curriculum results (SATs) resulting in an 87.2% return
rate and a total of 74 classes from 34 primary schools. Table 1 illustrates the sample data
for age, gender, non-consent rates, Special Educational Needs (SEN), and children with
full data sets (bullying interview, SDQ behaviour questionnaire, health questionnaire, and
SATs results).
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 138
Procedure
The study received ethical permission from the University of Hertfordshire Ethical
Committee and all instruments and information was lodged with the Hertfordshire
Education Council. When the head teacher and class teachers consented to participate
in the study written information about the study and a non-consent form (parents were
asked to sign when they wanted their child not to take part) was passed to all parents via
the pupils in sealed envelopes. On prearranged dates all pupils were interviewed
individually in a private room in the school by one of four trained interviewers
(postgraduate psychologists). The school was asked to provide a copy of the Key Stage
1 National Curriculum and Teacher Assessment results for those children that had
participated in the bullying interview.
Instruments
Bullying interview
Children were interviewed individually in a quiet, private room within the school
using a standard structured interview that enquired about friendships and peer relationships
(previously described in detail, see Wolke et al., 2000; Wolke, Woods, Bloomfield,
et al., 2001; Wolke, Woods, Schulz, et al., 2001). The part of the interview that is
subject to this report was adapted from the Olweus (1993) Bullying Questionnaire. First,
children were asked whether they had experienced any of six behaviours in the last 6
months that had upset them: (1) having been called bad or nasty names, (2) having
belongings taken, (3) having lies told about them, (4) having nasty tricks played on
them, (5) having been threatened or blackmailed, (6) having been hit or beaten up. If the
child answered that s/he had experienced any of the six above behaviours, the child was
Table 1
Sample data
Variable/instrument Sample size (n)
Total available sample (bullying interview, SDQ N: 1639
behaviour questionnaire, health questionnaire) N: 722 (44.1%), year 2
N: 917 (55.9%), year 4
Total sample with complete data sets (SATs results,
bullying interview, SDQ behaviour questionnaire,
N: 1016 (62% of total
available sample)
health questionnaire) N: 480 (47.2%), year 2
N: 536 (52.8%), year 4
SATs return rate N: 34/39 schools (87.2%)
N: 74/82 classes
Age Overall: x: 7.52, S.D.: 1.02
year 2: x: 6.62 years, S.D.: 0.53
year 4: x 8.33 years, S.D.: 0.58
Gender Males: n: 498 (49%)
Females: n: 518 (51%)
SEN Yes: n: 44 (4.1%)
No: n: 972 (95.9%)
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 139
asked to give examples and describe how this happened. This was done to ascertain that
the behaviours experienced were carried out with intent by the perpetrator(s) to upset the
child rather than having occurred by accident or during play fighting, etc. Researchers
were also able to ensure that there was an imbalance of power between the perpetrator
and victim. Those children who had experienced one or more of these behaviours were
asked how frequently these incidents happened in the last 6 months (seldom: one to
three times during past 6 months, frequently: four times or more during past 6 months,
very frequently: at least once per week). To aid children?s reference to approximately 6-
month periods, anchors such as ??since last Christmas??, ??since the summer holidays??,
etc. were used. The six behaviours were then repeated and the child was asked whether
they have used these behaviours to upset other children and how often they had done
this over the last 6 months (never or seldom: one to three times during past 6 months,
frequently: four times or more during past 6 months, very frequently: at least once per
week).
Subsequently, children were asked four questions relating to relational bullying at
school: (1) other children saying that they did not want to play with them; (2) other
children saying that they would not be the child?s friend anymore; (3) other children telling
nasty stories that were not true about them; (4) Other children deliberately spoilt their
games. If the child responded that they had experienced any of the above behaviours, the
child was asked to supply a description with examples. This was carried out to ensure that
the behaviours had been deliberate, that there was a perceived imbalance of power, and
to ascertain that the perpetrator(s) were children that the child normally played with.
Children were then asked to express how frequently the incidents occurred in the last
6 months for each of the four questions.
Children?s frequency responses were subsequently coded according to three categories,
seldom, frequently, and very frequently (seldom: one to three times during the past 6
months, frequently: four times or more during the past 6 months, very frequently: at least
once per week).
The four types of relational bullying were then repeated to the child and they were
asked whether they had ever used any of the behaviours to upset other children over the
past 6 months (never or seldom: one to three times during the past 6 months, frequently:
four times or more during the past 6 months, very frequently: at least once per week).
At no time during the interview was the term ?bullying? used, i.e. only behavioural
(operational) descriptions were used.
According to the results of the interview and the frequency of bullying events reported,
children were classified using a standardised coding manuscript into the following groups
(Whitney & Smith, 1993; Wolke & Stanford, 1999; Wolke et al., 2000) for physical direct
bullying and relational bullying, separately: physical bullies [children who were involved
in physically bullying others frequently (at least four times during past 6 moths) or very
frequently (at least once every week) but are never or only rarely physically victimised],
physical victims (children who experienced any of the above described behaviours: being
called bad/nasty names, being threatened, having belongings stolen, having lies told about
them, being hit/beaten, having nasty tricks played on them, frequently or every week but
bully others rarely or never); physical bully/victims (children who both physically bully
others and become physical victims of the six described behaviours frequently or every
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 140
week), physical neutrals who neither physically bully others nor become physical victims
(never or rarely only).
For relational bullying the same classification system was employed to categorise
children as: relational bullies, relational victims, relational bully/victims, and relational
neutrals.
Each post-graduate psychologist received intensive training in a standard interviewing
and coding protocol which required them to carry out pilot supervised bullying
interviews and subsequently code them. Any inconsistencies or discrepancies were
individually discussed and rectified until there were no problems before the main study
commenced. The basis of determining whether behaviour constituted bullying and the
bullying classifications was made according to guidelines stipulated in the research
coding manual which as a result of a pilot study clearly outlined direct and relational
bullying behaviours. Researchers used standardised probing questions to determine the
frequency of bullying behaviours and researchers always asked the children to back up
statements by describing the behaviour they had made and to ensure consistency in
responses. Behaviours were recorded in standard datasheets and any difficulties in
decision making discussed in the coder group (consensus rating). Interviews were not
audio taped as this would have required a second consent form which was likely, from
previous experience to lead to higher and selective drop out (which ideally should be
avoided).
The bullying interview has shown high predictive validity for direct and relational
victimisation over 2?4 years (Wolke, Woods, & Samara, article in submission). Concurrent
validity is evident between bullying classification established from the bullying
interview (bully, victim, bully/victim, and neutral) and sociometric status (popular,
average, neglected, rejected, and controversial status) (Wolke & Stanford, 1999; Wolke,
Woods, Kropp, & Schulz, unpublished manuscript).
Behaviour questionnaire
The Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) was given to
parents to complete after children had been interviewed. The SDQ comprises of 25 SDQ
items falling into 5 scales of 5 items each: conduct problems, hyperactivity, emotional
symptoms, peer problems, and prosocial behaviour (Goodman, 1997). For each scale,
except for prosocial, higher scores indicate more problems. A total difficulties behaviour
score is computed by combining all scales except from the prosocial behaviour scale.
The current study reports on total difficulties behaviour scores only. The SDQ correlates
highly (>.80) with the Child Behaviour Checklist (CBCL) total score and discriminates
as well as the Rutter Behaviour Scales (Elander & Rutter, 1996) and the Achenbach
(1991) CBCL between children with clinical behaviour problems and no problem
behaviour children. Goodman (2001) reported high reliability and validity of the SDQ
regarding Cronbach a, cross-informant correlations, and retest stability over 4?6
months.
For categorical analysis, Goodman (1997) suggested the following bandings for the
total behaviour problems subscale: 0?80th percentile are normal, between 81 and 90th
percentile are borderline, and those >90th percentile are in the clinical range. All
children in the study were classified according to the Goodman bandings as either
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 141
having normal/borderline behaviour difficulties or behaviour difficulties within the
clinical range.
Health questionnaire
Parents of children also completed a health questionnaire (Wolke, Woods, Bloomfield,
et al., 2001) that comprised of two sections: (a) seven items about physical health
problems (PHP) over the previous 6 months rated on a seven-point scale (none to six or
more times) (headache, tummy ache, sore throat/ear ache, cold/cough, feeling sick,
breathing problems, skin problems); (b) seven items about emotional health problems
(EHP) (previously known as psychosomatic health problems) rated according to a fivepoint
scale (never to most days) (bed wetting, problems going to sleep, nightmares, woken
in the night, poor appetite, excessive appetite, worried about going to school). Two
variables were constructed to examine the total amount of physical and emotional health
problems that children experienced.
Key Stage 1 national curriculum assessments
The Key Stage 1 National Curriculum Assessment (SATs 1) (www.qca.org.uk;
www.dffes.gov.uk/ncat) for 7-year-olds (year 2) comprised of five tests: (1) The Writing
Task (levels 1?3), (2) Spelling Task, (3) The Reading Comprehension Task (level 2 and
level 3), (4) The Reading Task (levels 1 and 2), and (5) Mathematics Task. The Writing
Task examines children?s ability to plan and write a non-narrative piece of work in a
single session. The length, sentence structure, vocabulary, punctuation, spelling, and the
structure and organisation of the piece of work are assessed. The Spelling Task consists
of 30 words and assesses a range of letter combinations and regular and irregular
spelling patterns. The Reading Comprehension Task tests children?s literal comprehension
in terms of retrieving information from a preset text, ability to make simple
inferences, understanding of the text?s organisation, and the author?s use of language.
The Mathematics Test is split according to levels. Level 1 assesses children?s ability to
identify properties of 3D shapes, money, and working with larger numbers. Level 2?3
examines children?s knowledge of number, calculations in terms of addition and
subtraction, multiplication and division, problem solving, handling data, and shape,
space and measures. The tests are not based on a multiple choice format, but require the
child to write their answers on standard examination forms and demonstrate their
workings out for questions where appropriate.
Results from each of the tests are individually graded as follows: working towards
grade 1(W), grade 1, grade 2C, grade 2B, grade 2A, grade 3, and grade 4. Children
who received a ?W? may have special educational needs and were underachieving.
Grade 1 is below the national curriculum average, grade 2C is slightly below the level
that should be achieved in accordance with national curriculum average, grade 2B is in
line with the national curriculum average, and grade 2A is slightly above the national
curriculum average. Grades 3 and 4 are substantially above the national curriculum
average. The following categories were formed for the analysis of SATs test results
(TR): (1) working towards level 1 or below level 1, (2) low level 2 (2C), (3) average
level 2 (2B), (4) high level 2 (2A), (5) above level 2 (levels 3 and 4), (6 missing) did
not sit SATs tests.
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 142
Summative teacher assessment (TA) for Key Stage 1
Teacher assessments for children at Key Stage 1 are carried out at the end of a unit
or the school year in order to make judgements about pupils? performance in relation
to national set standards. TA initially occurs in the form of formative assessment
which happens throughout the year in the classroom and involves the teacher and
pupil in a process of continual reflection and review about progress, leading up to the
Summative TA at the end of the year. TAs are based on level descriptions and are
frequently assigned a numerical value. The following teacher assessments were
recorded: (1) an overall English assessment, (2) speaking and listening, (3) reading,
(4) writing, (5) spelling, (6) mathematics (included: using and applying mathematics,
number, shape, space, and measures), and (7) science (included: experimental and
investigative science, life processes and living things, materials and their properties,
physical processes).
The following grading system was used to assess each teacher assessment: grade 0
to grade 4. In addition, children were rated according to whether they did not sit the
tests due to behavioural problems and whether they were absent on the day of the
assessment. (labelled ??disapplication due to absenteeism??). Children who had missed
a substantial amount of the curriculum relevant to their year group were exempt from
sitting the SATs tests. Level 0 denotes a child who is working towards level one and
usually has special educational needs. Level 1 refers to a child who is working below
the national average. Level 2 represents the national curriculum average. Levels 3 and
4 are both above the national curriculum average. For quantification purposes derived
from guidelines from the QCA (www.qca.org.uk), the following categories were
formed for TA statistical analysis: (1) working towards level 1 (W) or below the
threshold (X), (2) level 1 or (L) (substantially below curriculum average), (3) below
threshold of 2 but reached level 1 (not quite reached curriculum average, e.g. 2C),
(4) level 2 (2B or 2A, curriculum average), (5) level 3 or 4 (above curriculum
average).
Although National Curriculum SATs TR and TA are universally employed as the
standardised measure of assessment in U.K. schools, there are few studies which have
considered their reliability and validity. Hurry (1999) reported that the actual tests that
make up part of the SATs levels (SATs TR) have face validity according to curriculum.
Reliability has been measured using internal consistency and Cronbach?s a?s of between
.77 and .87 have been reported (Cronbach, 1960).
Reeves et al. (2001) argue that the teacher assessment (SATs TA) is an essential part of
the National Curriculum assessment arrangements.
The results of end of year key stage teacher assessment are reported alongside the test
results. Both have equal status and provide complementary information about the
pupils? attainment. The tests provide a standard ?snapshot? of attainment at the end of
the key stage, while teacher assessment, carried out as part of teaching and learning in
the classroom, covers the full range and scope of the programmes of study, and take
account of evidence of achievement in a range of contexts, including that gained
through discussion and observation. (QCA, 1999, p. 7)
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 143
Rose (1999) stated that TAs are an under used source of information and better use
should be made of them, particularly in the test development phase. An important question
concerns the relationship between TR and TA. Teacher expectations and test results are not
completely independent of one another and teachers are able to consult TR to assist them
with TA. Reeves et al. (2001) explored the relationship between SATs TR and SATs TA for
Key Stage 2 results for over 6000 children. Comparison of SATs TR and TA for individual
pupils revealed a remarkably high level of consistency across years in all three subjects
(Math, English, and Science) ranging from 73% to 77%. Where a difference was found
between TR and TA this was nearly always just by one level (e.g. level 2 on English TA
and level 3 on English TR). Tymms (1996) reported exact agreement between TR and TA
for 74% of pupils and agreement within one level for 99.6% from a study involving over
7000 pupils from schools in Avon, U.K.
The result from the study by Reeves et al. (2001) and Tymms (1996) suggest that a
certain level of non-agreement is not only acceptable but desirable, otherwise one measure
becomes redundant. The SATs TR and TA appear to be complimentary assessment
measures, which usually concur but have variability to justify the application of both.
However, what remains unknown is how many teachers consult the SATs TR before
making their own TA.
Cronbach a (Cronbach, 1960) for the current sample revealed high internal consistency
for SATs TR and SATs TA (Math TR and Math TA: a=.77; English TR and English TA:
a=.92).
SEN
Information was recorded for those children who were deemed as having SEN.
Guidelines set out by the British Education Act (1996) to identify and assess SEN were
adhered to. There are 5 recommended stages for addressing the different levels of
children?s SEN. Stages 1?3 are school based, with support from specialists from outside
the school at Stage 3. Stage 4 involves the Local Education Authority (LEA), which
considers whether a multidisciplinary assessment of the child?s needs is necessary. Stage 5
involves the LEA issuing and monitoring a statement of SEN. Children at stages 2?5 were
considered as having SEN in the current sample, where the decision was made for a child
to receive extra support either from within the school or an outside party.
School variables
Data was collected from schools regarding social class distribution (records of free
school lunches were noted), school location in terms of urban (inhabitants of community>
50,000) or rural (inhabitants of community<50,000), and mean school and class size.
School absenteeism for each pupil was also recorded.
Statistical analyses
First, frequency analysis was carried out for the SATs TR and TA. As a result of this, it
was decided that spelling TA (N: 229), Reading Task (N: 960), and Spelling Test (N: 711)
should be dropped from the final analysis due to substantially reduced sample sizes. Factor
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 144
analysis (extraction method: principal component analysis with varimax rotation) was
computed to determine whether TR and TA constituted the same or different factors.
Differences in SATs results according to direct and relational bullying status for year 2 and
year 4 on standardised scores from the factor analysis were computed using one-way
ANOVA. Final data analysis was carried out only for children who had full data sets (N:
1016) (bullying interview, SATs TR and TA, SDQ behaviour questionnaire, and health
questionnaire).
Prospective analysis was carried out between bullying status assessed before sitting
SATs tests (year 2 children) using ANOVA with bullying status as the IV and the SATs
result as the DV. Furthermore, logistic regression analyses were computed to determine the
best combination of factors predicting SATs TR and SATs TA. For year 4 children, logistic
regressions were carried out with SATs results at year 2 as predictors for bullying status at
year 4 as the DV (Fig. 1).
Results
SATs TR and TA scales
Factor analysis (principal components analysis) with varimax rotation including nine
variables from the SATs results revealed two distinct factors, SATs TA and SATs TR,
respectively. Eigenvalues for the solution were 4.7 and 1.7 accounting for 70.7% of
the total variance. Factor I accounted for 51.7% of variance and Factor II 19% of
variance. All variables loaded onto the primary factors at .59 or greater (Table 2).
Factor I had six primary loadings (Table 2), and constituted all SATs TA items and
three variables loaded on the second factor (Table 2) identified as SATs TR items.
Fig 1. Sample characteristics for statistical analysis.
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 145
Standardised factor scores with a mean of 0 and S.D. of 1 were computed for SATs
TR and SATs TA.
SATs results and the relationship with bullying and victimisation behaviour for year 2 and
year 4 children
Table 3 illustrates the frequencies for direct and relational bullying classifications.
SATs TR
ANOVA analyses carried out on standardised factor scores for SATs TR revealed no
significant differences between bullying status (bully, bully/victim, victim, neutral) for
both direct [F(3,770)=0.33, p<.80] and relational bullying [ F(3,769)=0.52, p<.67] for
year 2 children (6?7-year-olds). In contrast, children in year 4 (8?9-year-olds) who were
involved in relational bullying had significantly higher SATs TR 2 years previously (in
year 2) than those children not involved in relational bullying, F(3,890)=4.25, p=.005.
A posteriori contrasts (Tukey-HSD test) indicated that those children in year 4 who
relationally bullied other children had significantly higher SATs TR previously in year 2
compared to relational victims and neutral children (relational bullies M=0.60 vs.
relational victims M=_0.12 and neutrals M=_0.05).
SATs TA results
ANOVA analyses carried out on standardised factor scores for SATs TA revealed no
significant differences between year 2 children and SATs TA for direct [ F(3,714)=0.15,
p=.93] and relational bullying status [F(3,713)=0.52, p=.67]. However, significant differ-
Table 2
Factor analysis of SATs Teacher Assessment (TA) items and SATs TR items (N: 1016)
Item Factor 1 Factor 2
English TA .93 .15
Speaking and listening TA .86 .10
Reading TA .86 .16
Writing TA .85 .17
Math TA .81 .11
Science TA .78 4.87(E_02)
Reading comprehension TR 8.44(E_02) .86
Writing task TR .12 .90
Math TR .12 .59
Table 3
Physical and relational bullying classifications
Bully Victim Bully/victim Neutral
Direct bullying (N: 1015) N: 35 (3.4%) N: 419 (41.3%) N: 111 (10.9%) N: 450 (44.3%)
Relational bullying (N: 1014) N: 11 (1.1%) N: 424 (41.8%) N: 60 (5.9%) N: 60 (5.9%)
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 146
ences were uncovered for SATs TA and relational bullying status for year 4 children
[F(3,782)=3.78, p=.01].
The a posteriori contrasts highlighted that year 4 children involved in relationally
bullying others had significantly higher SATs TA results 2 years earlier than those
children who were relationally victimised or not involved in any relational bullying
(neutral) (relational bullies M=0.63 vs. relational victims M=_0.08 and neutrals
M=_0.05).
Predictors of children?s SATs results
Logistic regression analyses were carried out to determine the best combination of
factors predicting the following dependent variables: (1) SATs TR in year 2 and (2)
SATs TA in year 2. The independent variables were categorised as follows for year 2
analyses predicting SATs TR and SATs TA: (a) whether the child was involved as a
relational victim (yes vs. no); (b) whether the child was involved as a relational bully
(yes vs. no); (c) whether the child was involved as a direct victim (yes vs. no); (d)
whether the child was involved as a direct bully (yes vs. no); (e) gender (boy vs. girl);
(f) behavioural problems (clinical vs. normal/borderline); (g) total number of emotional
health problems (no emotional health problems vs. at least one emotional health
problem); (h) total number of physical health problems (0?2 physical health problems
vs. 3?6 physical health problems); (i) school absenteeism (0?11 vs. 12?21 days); (j)
ethnic minority (native English vs. non English native); (k) school location (urban vs.
rural); (l) social class (SES) (lower vs. upper/middle); (m) class size (small vs. medium/
large); (n) school size (small vs. medium/large); (o) whether the child had a statement
of SEN (SEN vs. no SEN).
First a full model was built forcing, all independent variables into the prediction
function and then removing those variables (backward stepping), which did not make a
significant contribution to the model (no significant change in fit when removing
variables).
SATs TR
The final model for predicting SATs TR is shown in Table 4 [v2(507)=40.17,
df=6, p=.000]. Factors which had a significant impact on predicting SATs TR were
Table 4
Final logistic regression models for predicting SATs TR (Year 2) (Backward Stepwise Method) (N: 507)
Predictor B S.E. Wald df Significance Exp. (B) 95% C.I. for Exp. (B)
Lower Upper
SEN (yes) _1.74 0.51 11.86 1 .001 0.18 0.07 0.47
Relational victim (yes) 0.99 0.35 7.93 1 .005 2.71 1.35 5.40
School location (rural) 0.91 0.41 4.94 1 .026 2.49 1.11 5.56
Class size (small) _0.83 0.37 5.01 1 .025 0.44 0.21 0.90
SES (lower) _0.77 0.35 4.71 1 .030 0.46 0.23 0.93
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 147
in order of importance: SEN (odds ratio: 0.18, CI (95%): 0.65?0.47), relational
victimisation (odds ratio: 2.71, CI (95%): 1.35?5.42), school location (odds ratio:
2.49, CI (95%): 1.11?5.56), class size (odds ratio: 0.44, CI (95%): 0.21?0.90),
and social class (odds ratio: 0.46, CI (95%): 0.23?0.93). Children were more
likely to underachieve on SATs TR if they had SEN compared to no SEN, were
relationally victimised compared to not victimised, went to rural schools compared
to urban schools, were in small class sizes compared to medium/large class sizes,
and went to schools in lower social class areas compared to middle/upper class
areas.
SATs TA
The final model for predicting SATs TA was significant [v2(462)=26.43, df=3, p=.000].
Only one factor remained in the final model and had a significant impact in predicting
SATs TA, SEN (odds ratio: 0.19, CI (95%): 0.75?0.49). Children were more likely to be
low achievers on SATs TA if they had SEN compared to no SEN.
Predictors of children?s bullying status
Logistic regression analyses were carried out to determine the best combination of
factors predicting the following dependent variables in year 4: (1) direct bullying
involvement, (2) direct victimisation, (3) relational bullying involvement, (4) relational
victimisation.
The independent variables were the same as for the SATs results, but with the omission
of bullying status, and the inclusion of (a) achievement on SATs TR (average/high
achievement vs. low achievement), (b) achievement on SATs TA (average/high achievement
vs. low achievement).
Direct bullying
The final model for predicting direct bullying involvement in year 4 was significant
(v2(514)=21.67, df=2, p=.000]. Two factors had a significant impact in predicting
involvement in direct bullying: gender (odds ratio: 0.35, CI (95%): 0.21?0.57) and class
size (odds ratio: 0.56, CI (95%): 0.33?0.96). Those children involved in direct bullying
were more likely to be boys rather than girls, and from small class sizes compared to
medium or large class sizes.
Direct victimisation
The final model for predicting direct victimisation in year 4 was significant
[v2(514)=36.34, df=3, p=.000]. Three factors had a significant impact on predicting
direct victimisation: behaviour problems in the clinical range (odds ratio: 0.23, CI
(95%): 0.12?0.45, school location (odds ratio: 1.74, CI (95%): 1.20?2.52), and gender
(odds ratio: 0.62, CI (95%): 0.43?0.89). Direct victims were more likely to be
children who had behaviour problems within the clinical range compared to normal/
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 148
borderline, came from rural schools compared to urban schools, and were boys rather
than girls.
Relational bullying
A significant model was revealed for predicting involvement in relational bullying
[v2(514)=17.50, df=4, p=.002] (Table 5). Those factors that had a significant impact in
predicting involvement in relationally bullying others were in order of importance: high
achievement on SATs TR (odds ratio: 5.74, CI (95%): 0.77?42.72), gender (odds ratio:
0.42, CI (95%): 0.21?0.86), class size (odds ratio: 0.48, CI (95%): 0.23?0.99), and
emotional health problems (odds ratio: 0.50, CI (95%): 0.25?0.99). Children who were
involved in relationally bullying others were more likely to have average/above average
achievement compared to low achievement on SATs TR, be boys rather than girls, came
from schools with small class sizes as opposed to medium/large class sizes and had at least
one emotional health problem compared to no emotional health problems.
Relational victimisation
A significant final model for predicting involvement in relational victimisation in year 4
was revealed [v2(514)=23.44, df=4, p=.000]. Factors that had a significant impact in
predicting relational victimisation were in order of importance: school absenteeism (odds
ratio: 2.18, CI (95%): 1.12?4.25), behaviour problems (odds ratio: 0.52, CI (95%): 0.30?
0.93), school size (odds ratio: 0.60, CI (95%): 0.41?0.88), and school location (odds ratio:
1.48, CI (95%): 1.02?2.14). Children involved in relational victimisation were more likely
to have had fewer days (0?11) off school (compared to more days (12?21)), had
behaviour problems within the clinical range compared to the normal/borderline range,
came from small schools compared to medium/large sized schools, and went to a rural
school compared to an urban school.
Discussion
The present study investigated the association between direct and relational bullying
behaviour, and academic achievement among primary school children in the U.K.
Table 5
Final logistic regression models for predicting relational bullying (Backward Stepwise Method) (N: 514)
Predictor B S.E. Wald df Significance Exp. (B) 95% C.I. for Exp. (B)
Lower Upper
SATs TR
(average/above average)
1.75 1.02 2.91 1 .088 5.74 0.77 42.72
Gender (boys) _0.87 0.36 5.69 1 .017 0.42 0.21 0.86
Class size (small) _0.74 0.37 3.93 1 .048 0.48 0.23 0.99
Emotional health problems
(at least 1 problem)
_0.70 0.35 3.94 1 .047 0.50 0.25 0.99
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 149
Predictors of academic achievement and being involved in bullying behaviour were also
examined. The major findings of the present research study were:
1. There was a higher incidence of direct bullying behaviour among primary school
children compared to relational bullying.
2. No association between direct bullying and academic achievement was uncovered at
year 2. However, relational ?pure? bullies in year 4 had significantly higher SATs TR
and SATs TA at year 2 compared to victims and neutral children.
3. Important predictors of academic achievement for year 2 children were relational
victimisation, SEN, rural schools, small classes, and low socioeconomic status (SES).
4. Important predictors of involvement in bullying behaviour in year 4 were small classes,
behaviour problems, rural schools, being male, having average/above average
achievement, small schools, and emotional health problems.
The finding that primary school children were involved in more direct bullying than
relational bullying fits in with a developmental explanation of bullying behaviour.
Bjo?rkqvist (1994) proposed that young children lack essential verbal skills, which results
in aggressive behaviour being predominantly physical in nature. Once verbal skills and
more importantly complex social skills develop, children will demonstrate more
sophisticated styles of aggression such as relational aggression, usually in secondary
school.
This is the first study to report results concerning the relationship between direct and
relational bullying behaviour and academic achievement among primary school children
in the U.K. No significant associations were revealed for children in years 2 and 4 and
direct bullying status for ?pure? bullies, ?pure? victims, bully/victims, and neutral
children and academic achievement as assessed by SATs TR and SATs TA. In contrast,
children in year 4 who were involved as relational ?pure? bullies had had significantly
higher SATs TR and SATs TA results in year 2. Olweus (1993) argued that aggressive
direct bullies? behaviour could be explained as a reaction to frustration and failure at
school although future research studies were unable to confirm this claim (Tremblay et
al., 1992; Olweus, 1994). The current findings provide further substantiation that having
lower academic grades does not seem to be related to involvement in direct bullying
behaviour. No support was generated for the findings by Schwartz et al. (2002) where
children who exhibited poor academic performance in school tended to emerge as
frequent targets of bullying.
A number of explanations could account for the lack of association between direct
bullying and academic achievement. Direct victims and neutral children did not differ
from each other in terms of academic ability. One account previously proposed is that
children who are victims of bullying actually turn to school work and related activities
as an escape route from the problems they are experiencing with bullying behaviour
(Sharp, 1995) therefore increasing their academic capabilities and grades. Research
findings from work carried out on peer rejection and school adjustment could provide an
alternative explanation. Buhs and Ladd (2001) reported no direct pathway between peer
rejection and school adjustment including academic achievement and instead proposed a
model of mediation by other factors such as peer maltreatment and reduced classroom
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 150
participation. The current study did not consider levels of classroom participation or
cooperation and therefore no direct conclusions can be made. The school milieu and
ethos in the current study may have contributed to the lack of association between direct
bullying and academic achievement. Twemlow et al. (2001) carried out a highly
controlled intervention study based on zero tolerance for bullying. A significant increase
in academic performance and a reduction in disciplinary referrals was found in the
experimental school, but not in the control school. Schools in the current sample may
have had a similar ethos towards bullying behaviour.
The relationship uncovered between being a relational bully and obtaining significantly
higher academic achievement is new to the literature and proffers several
explanations. The current controversy regarding the individual characteristics of bullies
and whether they are ?cool? planners of their torment towards others, or are anxious,
depressed, insecure individuals with behaviour problems is one account for the current
findings. Support is generated for the theory proposed by Sutton and Smith (1999) and
Sutton et al. (1999) that bullies, in particular those children who use social manipulation,
are socially skilled and intelligent individuals who avoid being caught in the act of
bullying other children. Previous findings have also revealed that ?pure? relational bullies
enjoy going to school, have few days absent from school and are physically and
psychologically healthy (Wolke, Woods, Bloomfield, et al., 2001; Wolke, Woods,
Schulz, et al., 2001). The current findings add substance to the profile of ?pure?
relational bullies and their strong and successful demeanour in school environments.
Conversely, the findings do not support the assertion that bullies lack self-esteem, are
anxious and depressed individuals (Farrington, 1993, 1995; Salmon, James, & Smith,
1998, Salmon, James, Cassidy, & Javaloyes). The developmental concept that relational
bullying follows on from direct bullying is also supported by the present results in that it
was only year 4 children who were classified as relational ?pure? bullies that had
significantly higher academic results (Bjo?rkqvist, 1994). Children in year 4 (aged 8?9)
are more likely to have the developed social skills to use relational bullying as opposed
to younger children in year 2. It appears that children with high academic abilities have
the social skills available to employ relational manipulation.
Bullying role for both direct and relational bullying, with the exception of relational
victimisation, was not an important predictor for children?s academic achievement.
Children were nearly three times more likely to have under achieved on SATs TR if they
were relational victims. Relational victimisation could have more deleterious effects on the
child?s academic achievement in terms of firstly being more hurtful and long-term than
direct physical bullying and secondly, could be more classroom focused compared to
direct bullying, therefore distracting the child from concentrating on school tasks.
Interestingly, school absenteeism and health problems did not contribute to the prediction
of SATs TR or SATs TA.
Previous research has often discounted the association between bullying behaviour and
school factors such as school size, class size, school location, and SES. Results reported by
Wolke et al. (2001) found more bullying problems in small schools and classes in rural
locations compared to large urban schools. In a similar vein, the current study found that
small schools, small class sizes, rural locations and schools with lower SES significantly
contributed to the prediction of lower SATs TR. Indirect pathways between bullying
S. Woods, D. Wolke / Journal of School Psychology 42 (2004) 135?155 151
behaviour and school characteristics may be having an impact on SATs results. The nature
of these pathways is unknown resulting in the need for research studies to determine the
underlying factors that characterise these schools in terms of lower school attainment and
bullying problems.
A discussion of the limitations of the current study includes the reliance on individual
interviewers to classify children as being direct or relational bullies, victims, bully/victims,
or neutral. Ideally, reliability analyses based on tape recorded interviews should have been
conducted across researchers to ensure that direct and relational bullying classifications
were assigned consistently and reliably. However, this was not within the capability of the
study for several reasons. Firstly, due to the study taking place within a school setting,
teaching staff would not permit the same child to be interviewed about bullying
experiences on repeated occasions by different researchers. This was deemed unethical
and impractical due to time constraints. Secondly, the research team did consider and
approach schools about the possibility of videotaping and audio taping each interview to
permit reliability testing. Again, teachers had serious reservations about breaching children?s
confidence and viewed this practise as unethical. Furthermore, this required a second
consent form and thus likely increased selective dropout of pupils. It would be imprudent
to assume that the bullying interview methodology is entirely objective as bullying
behaviour due to its complex social nature and the fact that 6?9-year-olds took part is
bound to reveal some subjective issues. Nonetheless, the bullying interview is highly
structured and all researchers received a highly structured comprehensive training
schedule. A pilot study revealed 90% agreement across bullying classifications across
four interviewers. The procedural manual was adhered to throughout the study, which
contained concrete examples of the distinctions between what constitutes bullying
behaviour and what does not. Any problems were discussed and consensus coding
applied. Interviewer ratings are at least as valid and reliable as would be obtained by
questionnaire and the interview method has the advantage to not be influenced by reading
age. The age range of children chosen for the current study only allows conclusions about
the association between bullying behaviour and academic achievement in primary school.
Other studies may want to consider adolescent samples in addition to primary school aged
children. Furthermore, the predictive power of bullying behaviour for academic achievement
could only be carried out with children in year 2 and the time lag between bullying
and SATS assessment was less than 1 year. Future studies may consider prospective
investigation of the causal pathways over a longer period of time. Finally, despite the
application of national tests with hundred of thousands of children every year, there are
few studies on the validity and reliability of SATs TR and TA. However, the ecological
validity is high as national markings of schools? and supply of financial resources are
dependent on SATS results.
In sum, the current study provides empirical evidence that direct bullying behaviour is
not largely associated with decrements in academic achievement in primary school. No
support was generated for the theory that under achievement and frustration at school leads
to direct physical bullying behaviour in 6?9-year-olds. Conversely, it was ascertained that
relational bullies are often average or high achievers. Important factors contributing to the
prediction of SATs results were revealed including SEN, behaviour problems and school
characteristics such as school size, class size, and school location.

****The Directions for this paper***
Text: Drown, Junot Diaz
Topic: Immigration

Objective: The objective of the English 199 course is to analyze primary (novel) and secondary sources (articles) and write a research paper based on a THESIS that the students has developed.

Description:The text for the course will be the primary source for the paper. There is one assignment due (research paper) on August 11th without exception.

Assignment:
Write a 5-8-page research paper using Drown as a primary source with a minimum of 2 secondary sources to support your thesis. You will need to submit a draft of the paper for approval in order to pass the course. You need to use the MLA format to properly cite sources and include in text citations to meet the guidelines of research writing at the college level. Paper should be paginated and include a work cited page
In order to pass the course you will need to:
1. Submit a 5-8 page research paper based on the book Drown
2. Include secondary sources to support your point of view
3. Choose one of the questions below and write a documented paper supporting your thesis.
4. Provide a work cited page with all sources cited correctly in the MLA format

Consider one of following questions as the topic of you research paper. You will need to support your opinion with details from the readings and provide a thesis in the beginning of the paper.
1. Is America the land of the free? Does the American Dream exist? Do you believe that Diaz believes the American Dream applies for today?s immigrant?

2. Diaz writes in the first and last short story about a family who become divided because the father migrates to America. What are the ramifications to the nuclear family when integral family members (like mothers and fathers) chose to migrate to America and leave their children behind in their home country? Under what circumstances do people migrate? What are the living situations of the people in their country and in countries like Haiti or Mexico?

3. Do you agree with President Bush that we should put several millions dollars into border control at this moment? Do you agree with his tactics and approach to solving the immigration issue? If not, what would you do differently?


***Here is a link the professor told me to go to find some good sources on immigration***
http://www.immigration-usa.com/debate.html






*****all the information you need for this book******

"Drown" by Junot Diaz


About the Author

Remarkably, Junot Diaz is only the second Dominican-American to have published a book of fiction in English (Julia Alvarez was the first). He is primarily a writer of poetry and prose fiction but his work is largely autobiographical.

One of five children, Diaz was born in 1969 in Santo Domingo, Dominican Republic. Knowing no English, he moved with his family to New Jersey at age seven. He began writing at about thirteen in an effort to escape the pain of his parents' failing marriage, his family's poverty, and his older brother's newly diagnosed leukemia. He later graduated from Rutgers, the State University of New Jersey, where his professors praised his talent for writing poetry and prose and encouraged him to pursue a literary career. Toward this end, he went on to complete a master of fine arts degree at Cornell University.

Before gaining success as a writer, Diaz held various jobs, including dishwasher, pool table deliverer, steelworker, and editorial assistant. His first published works consisted mainly of poetry, but he soon branched out into short stories and essays, publishing stories in The New Yorker, the Paris Review, and Best American Stories before the age of thirty. Drown, a collection of short stories that draws on his youth in Santo Domingo and in New Jersey, was his first book. A 1999 recipient of a coveted Guggenheim Fellowship, Diaz has won many literary awards. In 1997 he won a Pushcart Prize, and the following year he won the Eugene McDermott Award. More recently, The New Yorker named him one of the Twenty Writers for the Twenty-first Century. Diaz teaches creative writing at Syracuse University.

Overview

Drown is an intensely raw and realistic collection of ten short stories. Although the stories share neither one common protagonist nor one common setting, each story involves a Dominican or Dominican American adolescent male's struggle to survive in the harsh and often violent world of poverty, drugs, and petty crime. Diaz's young protagonists, who live in rural areas of the Dominican Republic or in Dominican neighborhoods of suburban New Jersey, struggle to survive in the face of absent fathers, abject poverty, and tedious jobs.

Setting

Two settings dominate these stories: the rural Dominican Republic and suburban New Jersey..Both are tough, grim settings, awash in poverty and misery. The stories that contain the most Spanish words and phrases are set in the Dominican Republic.

The stories set in the United States contain less Spanish and more English slang terms, creating a sharp narrative contrast between the two environments.

Although both settings share a defining poverty, and almost all of the families in the stories are desperately poor, the families who live in the Dominican Republic are the poorest, often lacking basic necessities and suffering related health problems. The mother in "Aguantando" is periodically forced to send her children to live with relatives because she cannot afford to feed them. She tries to ease the pain of their situation by telling her children that things could be worse: "We were poor. The only way we could have been poorer was to have lived in the campo or to have been Haitian immigrants, and Mami regularly offered these to us as brutal consolation." Still, the family cannot afford meat or beans, living off of boiled yucca, boiled plantano (plantains), pieces of cheese, and shreds of bacalao (codfish). In "No Face," the younger brother suffers never-healing scabs on his scalp, probably due to malnutrition. Poverty is inescapable for these Dominicans, except possibly through emigration.

Moving to the United States, however, provides only minimal relief from poverty.

To the characters in the stories, impoverished suburban New Jersey is the United States, with its "break-apart buildings, the little strips of grass, the piles of garbage around the cans, and the dump, especially the dump," all of which typify the impoverished Dominican neighborhoods where the characters reside. To these young immigrants and children of immigrants, life in the States involves walking along the sides of gritty highways, breaking into abandoned apartments to live for short periods of time, selling illicit drugs to teens at gas stops and public pools, and urinating freely in public.

These characters are aware that there is another New Jersey, another United States, where wealthy Caucasians swim in sterilized swimming pools in their own backyards and hire recent immigrants to clean their rambling kitchens, but this world is so unattainable that it may as well not exist.

The narrator in "Edison, New Jersey" explains how last names, which serve as ethnic background identifiers, separate the two worlds of New Jersey: "Pruitt. Most of our customers have names like this, court case names: Wooley, Maynard, Gass, Binder, but the people from my town, our names, you see on convicts or coupled together on boxing cards."

Themes and Characters

The protagonists in Drown live midway between childhood and adulthood, as do the protagonists in all classic works of young adult literature. These boys and young men vary in age from nine through about twenty.

The younger protagonists are still clearly children, climbing trees and playing ball games, yet they witness and experience decidedly adult events, such as learning of their fathers' marital infidelities and engaging in basic sexual experimentation. The older protagonists face the reality of having to support themselves to survive from day to day, yet they often retreat into more childish behaviors, dreaming of unrealistic futures and methods of escaping from the responsibilities of impending adulthood.

The title of the collection can be seen as a reference to the drowning of the young protagonists' innocence as they leave the comforting protection of childhood and enter the harsh reality of adulthood.

On the surface, these main characters appear toughened and inured to emotional pain, yet they harbor deep emotional sensitivities. The protagonist in "Boyfriend" claims to be immune to Girlfriend's obvious emotional pain: "I guess I'd gotten numb to that sort of thing. I had heartleather like walruses got blubber." He wishes his heart were hardened, yet he maintains empathy even for a total stranger's pain, as he listens to Girlfriend's crying for days, following her movements as she wanders around her apartment, wishing he could talk to her. He is also suffering from his own broken heart, further destroying his attempt to be tough and unattached. Girlfriend herself wants to be emotionally impenetrable, cutting off her luxurious hair to appear tougher, but this action is merely a response to the lasting pain she feels from Boyfriend's callous rejection of her. No matter how the characters try to toughen themselves, they still feel the pain of their disappointing lives.

Most of the families represented in Drown are broken families with no fathers. Even though the fathers are absent, the familial culture Diaz presents is still mostly patriarchal. When they are on the scene, the fathers exercise almost total authority and children fear their father's violent temper, and when they are absent, having deserted their families for a variety of reasons, the fathers' influence on the families remains strong. The specters of their missing fathers hang forever in the back of the main characters' minds. Even in "Fiesta, 1980," the only story in the book in which the protagonist lives with his father, it is clear that the family is on the brink of demise. Papi spends increasing amounts of time with his mistress as his passive wife fears their impending separation. Both sons are aware of the situation, but they are powerless to stop their father from leaving.

It is the mothers in these stories who suffer the most from this patriarchal familial culture. In "Fiesta, 1980," Mami closes her eyes as her husband pulls their son to his feet by his ear, anticipating that her husband will beat the boy. She objects in no way because "being around Papi all her life had turned her into a major-league wuss.

Anytime Papi raised his voice her lip would start trembling, like some specialized tuning fork." Similarly, life has beaten down the mother in "Drown" to such an extent that she barely continues to exist, living more as an automaton than a thinking, feeling human. She has almost turned into a part of the apartment in which she subsists: "She's so quiet that most of the time I'm startled to find her in the apartment. I'll enter a room and she'll stir, detaching herself from the cracking plaster walls, from the stained cabinets... . She has discovered the secret to silence: pouring cafe without a splash, walking between rooms as if gliding on a cushion of felt, crying without a sound."

Women generally play secondary roles in the book and are rarely mentioned except as side characters. Exceptions include Aurora and the girlfriend in "Boyfriend," who can perhaps be seen as the protagonists of their stories. Unlike the men in the book, who suffer from chronic boredom, the ever-working mothers view idle time as but a fantasy as they struggle to support their families both on the job and at home, despite the poverty and violence that rule their lives.

Violence is central to these stories, and all of the characters experience it in a variety of forms. Together, these ten stories highlight the violence in which youth often engage. Older brothers pummel their younger brothers, and the street gangs torment unpopular outsiders. Older brothers spend a lot of time training their younger brothers, often through violence. In many ways, the role of the older brothers seems to be to prepare the younger brothers for the cruelty and disappointment of the adult world.

Older brothers not only physically beat their younger siblings but harass them in other ways as well. For example, in "Aguantando," Rafa flaunts a lighter in front of Yunior and promises to give it to him if he "shuts up."

When Yunior responds with a hopeful, "Yeah?" Rafa reneges on the offer: "See....

You already lost it." Rafa is preparing Yunior for the many disappointments he will face in his adult life.

Violence is also central to the many malefemale relationships in the book. Most of the fathers threaten and beat most of the mothers; most of the young boyfriends threaten and beat most of the young girlfriends. The male characters create much of the violence in the book, yet they are occasionally victims of violence as well. In "Negocios," Papi had "been robbed twice already, his ribs beaten until they were bruised." In his home, Papi laughs with delight in response to the violence he sees in Tom and Jerry cartoons. His world is violent, both at home and on the streets, and he finds violence both repugnant and appealing, depending on whether he is the victim, the perpetrator, or the observer.

Although the males initiate most of the violence in the stories, the females also instigate violence at times. For instance, Mami slaps Yunior in "Aguantando" and makes him kneel on sharp pebbles with his face to the wall as a form of punishment.

The title character in "Aurora" is probably the most violent female in the book when she fights back in response to her boyfriend's physical abuse. When he punches her chest until it turns black and blue, Aurora tries to jam a pen into his thigh. She also often leaves deep nail scratches on his body.

And even though they have had a fairly long-term romantic relationship, the homeless, penniless Aurora steals from her boyfriend's pockets as he sleeps. Despite their obviously unhealthy relationship, the two like to fool themselves into thinking that they are "normal folks. Like maybe everything was fine." But the violence and the mistrust that characterize their relationship presage an adult life of continued relational dysfunction. Even as they fool themselves into thinking they have a "normal" relationship, violence lurks in wait. Aurora tells the boyfriend that while she was in juvenile jail she created a fantasy future for the two of them, with kids, a big blue house, and even hobbies. A week later, though, the boyfriend explains, "she would be asking me again, begging actually, telling me all the good things we'd do and after a while I hit her and made the blood come out of her ear like a worm.".

170 Drown Indeed, many of the characters try to fool themselves in a like manner to escape their miserable conditions. In "Aguantando," Yunior avoids the obvious conclusion that his father has abandoned the family, thinking of him instead only rarely, and then in vague terms as a composite of other children's fathers and of other adults he knows: On the days I had to imagine him--not often, since Mami didn't much speak of him anymore--he was the soldier in the photo. He was a cloud of cigar smoke, the traces of which could still be found on the uniforms he'd left behind. He was pieces of my friends' fathers, of the domino players on the corner, pieces of Mami and Abuelo. I didn't know him at all. I didn't know that he'd abandoned us. That this waiting for him was all a sham.

He fools himself into believing that his father will return.

Similarly, Ysreal turns to fantasizing to escape his misfortunes. He imagines himself a superhero, fighting evil and avenging wrong. Even in the face of abject poverty, tragic misfortune, and brutal social isolation, Diaz portrays in Ysreal a child whose imagination and hope remain intact. Ironically, Ysreal, the character who faces the harshest circumstances of all of the characters in the book, is portrayed with the most optimism for life.

Boredom is another important theme that runs through these stories. The characters who have jobs find them dull and unsatisfying, and even the characters who work suffer from long hours of idle time (with the exception of the mothers). The main characters in "Edison, New Jersey" are so bored with their pool table delivery jobs that they pass the time guessing what towns will be included on their delivery route the next day. Wayne's state of boredom even extends to his private life, and he has a series of extramarital affairs to relieve the routine of his home life.

Similar to boredom is the theme of waiting. Many of the characters are waiting for events that will most likely never occur.

The young protagonists are often waiting for the fathers who abandoned them to come back, but the fathers rarely return.

The deserted mothers also are often waiting for the return of their husbands. Most wait for years, never to see their spouses again.

For the characters in the book, life is disappointing and unfulfilling, with little hope for the future.

Literary Qualities

The stories in Drown are fairly short, averaging between fifteen and twenty pages.

Only "Negocios" is much longer, at fiftyfour pages. Each story is a slice of life, more a presentation of setting, character, and mood than a plot-driven tale. Many of the stories have unclear resolutions.

As Diaz himself admits, much of his work is thinly veiled autobiography. His work is definitely fiction, however, and not to be seen as accurately portraying his own life. His life serves as literary inspiration, but he freely embellishes and changes characters, settings, and events to enhance his storytelling.

Diaz's greatest literary strength is his narrative style. He creates raw prose and uses spare language in an unadorned style similar to reportage. All but two of the stories are in the first-person voice. "No Face" is told in the third person. Its smoothly flowing, dreamlike narrative style sets it apart from the other stories and makes it a story that lends itself especially well to reading aloud: "He watches the sun burn the mists from the fields and despite the heat the beans are thick and green and flexible in the breeze.... He's tired and aching but he looks out over the valley, and the way the land curves away to hide itself reminds him of the way Lou hides his dominos when they play."

"How to Date a Browngirl, Blackgirl, Whitegirl, or Halfie" is told in the secondperson voice, which allows the narrator to address the reader directly and serves to heighten the humor in the story. For example, Diaz writes, "She'll say, I like Spanish guys, and even though you've never been to Spain, say, I like you. You'll sound smooth." The second-person narration turns this satire of racial tension into a comical dating guide.

The remaining eight stories are told in the first person. Diaz's first-person narrative is colloquial and casual. For example, in "Fiesta, 1980," the narrator comments, "If Papi had walked in and caught us lounging around in our underwear, he would have kicked our asses something serious.

He didn't say nothing to nobody, not even my moms." Diaz's rather unadorned firstperson style reads almost like sociological field notes that record events while reserving commentary and analysis.

However, even the first-person stories contain occasional bursts of poetic loveliness, such as this brief description in the brutal tale "Ysreal": "Rosebushes blazed around the yard like compass points, and the mango trees spread out deep blankets of shade where we could rest and play dominos." Diaz's spare use of language enables him to create a vividly realistic scene in just one or two sentences. He develops the setting for "Drown" in just two sentences: "The heat in the apartments was like something heavy that had come inside to die. Families arranged on their porches, the glow from their TVs washing blue against the brick."

Diaz's style also includes recurrent frank discussions of sexual activities, and sexual curiosity and sexual awakening are central to the stories. For example, twelve-year-old Rafa brags about his sexual experimentation in "Ysreal." Even more sexually blunt is a scene in "Fiesta, 1980" in which Papi has sex with his mistress while Yunior sits downstairs watching television. Diaz also includes frank portrayals of the young men's homosexual experimentation in the title story, experimentation that leads the protagonist to bitterly rue his behavior.

Profanity also characterizes Diaz's narrative style, adding rhythm and tone to descriptive passages, as in the use of "ass" in the following sentence: "Homeboy's got himself an Afro and his big head looks ridiculous on his skinny-ass neck." This generous use of profanity is part of Diaz's success in authentically replicating everyday speech patterns.

In addition to profanity, Spanish words and phrases also lend the narrative an authentic tone. When Diaz incorporates Spanish into the text, he does so without using italics or quotation marks to separate the Spanish from the English. Moreover, he rarely offers contextual definitions of the Spanish words he uses, and he never offers parenthetical or footnoted translations. As a result, his mixing of Spanish and English more closely resembles naturally occurring speech than does the mixed language prose of many other authors, who present foreign words and phrases so as to stand out visually from the English.

In some cases, readers unfamiliar with Spanish might have trouble understanding significant aspects of these stories, as in the title story "Drown," in which Diaz introduces the crucial term "pato" (homosexual) in the first paragraph of the story, writing simply, "He's a pato now but two years ago we were friends." The meaning of the word becomes contextually apparent only toward the end of the story. The meanings of other Spanish words never become clear from the text, as in the use of "finca" (farm) in the following passage: "On some days I spent entire afternoons in our trees, watching the barrio in motion and when Abuelo was around (and awake) he talked to me about the good old days, when a man could still make a living from his finca."

Also unusual is Diaz's frequent incorporation of snippets of dialogue into his narrative passages, which he does without separating the dialogue with quote marks or speaker tags, and without creating new paragraphs to indicate changing speakers.

For example, all within one paragraph he writes: Sometimes the customer has to jet to the store for cat food or a newspaper while we're in the middle of a job. I'm sure you'll be all right, they say. They never sound too sure. Of course, I say. Just show us where the silver's at. The customers ha-ha and we ha-ha and then they agonize over leaving, linger by the front door, trying to memorize everything they own, as if they don't know where to find us, who we work for.

The result is a raw tone that resembles the disjointed nature of actual human speech patterns.

Diaz also uses humor to temper the painful realities of poverty, drugs, crime, and violence in his characters' lives. In "Fiesta, 1980," for instance, the young protagonist vomits on every ride in his father's beloved new van. His constant carsickness is portrayed lightheartedly, mitigating the more unpleasant central plot, in which the boy's father is preparing to abandon his mother to live with his mistress. Nonetheless, the humor does not fully alleviate the wistful feeling of loss of innocence and childhood that permeates the book. Most of the characters are likely to spend the remainder of their lives discontented with their menial jobs, possibly turning to drugs or crime, in a never-ending circle of poverty, failed relationships, and discontent.

Social Sensitivity

Drown is a candid, blunt book. Just as Diaz does not shy away from presenting the seedy side of life in poverty, he does not scrub his stories clean of racial and cultural conflicts. For the most part, the author reserves comment on the settings and cultures that he portrays, but his characters occasionally express cultural biases. In "Fiesta, 1980," for instance, Mami dislikes all things American: "In her mind, American things--appliances, mouthwash, funnylooking upholstery--all seemed to have an intrinsic badness about them." On the contrary, Papi seems to favor American luxury items, a discord that foreshadows the marital friction between the two characters. Even when he profiles drug dealers and petty criminals, Diaz refrains from moralizing, attempting only to present his characters authentically.

Racial issues underlie all of the stories.

Most of the characters are Dominican; many also have black skin. Racial issues are treated the most overtly in "How to Date a Browngirl, Blackgirl, Whitegirl, or Halfie." Diaz treats discord between racial groups with humor in this story, directly confronting the racial tension that adolescents face in schools and other community environments and tying that tension to skin color. For example, the narrator asserts that visiting the girl's family will be especially strained, and racial issues will inevitably arise: "Dinner will be tense.... A halfie will tell you that her parents met in the Movement, will say, Back then people thought it a radical thing to do. It will sound like something her parents made her memorize."

Issues of cultural adjustment also underlie the stories, but they are usually secondary to the plots. Unlike many fiction works that depict the immigrant experience in the United States, Drown does not attempt to detail the process of cultural adjustment.

Drown 173 The characters are never shown struggling to learn English, nor do they struggle against the often bewildering American governmental bureaucracy. Nonetheless, they face considerable discrimination and hardship in the United States, and their immigrant status largely defines their characters.

"Negocios" deals the most directly with cultural conflict, as Papi struggles for years to survive in a foreign land. Away from home and in an unfamiliar country, Papi is forced to rely on a woman to survive. He marries Nilda for citizenship and for financial security, not for love or companionship. He resents this dependency on a woman, a dependency that clashes with his culture's patriarchal basis. In the end, he leaves Nilda and reunites his broken first family, escaping from a second family to which he never really seemed to belong.


You can start the Introduction with the following:

Introduction
Drown is an intensely raw and realistic collection of ten short stories. Although the stories share neither one common protagonist nor one common setting, each story involves a Dominican or Dominican American adolescent male's struggle to survive in the harsh and often violent world of poverty, drugs, and petty crime. Diaz's young protagonists, who live in rural areas of the Dominican Republic or in Dominican neighborhoods of suburban New Jersey, struggle to survive in the face of absent fathers, abject poverty, and tedious jobs.


I REALLY NEED A THESIS< INTRODUCTION< AND CONCLUSION.

Here is a statement I started to write and if you could put this in there that would be grate....

I do believe that the ?American Dream? still exists today. For example, my girlfriend?s father (Farouk) is a West Indian immigrant from Trinidad & Tabago. He got a ?VISA? to come over to the United States when he was 17 years old. He came over here with only 20 dollars in his pocket. When Farouk was in the States he transferred all of his high school credits, to a high school in the Boston area try get a High School diploma. They denied him thee diploma and told him,? in order for you to get you H.S. diploma you need to take a whole year of classes here or you can take these four books (which included trigonometry, physics, English writing, and U.S. history) home to study them for two weeks and take a five hour test in front of me using no notes. If you pass we will honor you and give you your H.S. diploma.? Farouk chose to take the books home to study for two weeks. When it was time for Farouk to take the test, He went in there and finished it in three hours. He passed with flying colors and got is diploma. After that he took night classes at Wentworth Institute of technology, in Electronic Engineering to get his associates degree. While he was taking night classes he managed to get in to realestate with no money and managed to buy a multifamily and two apartment complexes in Dorchester. When the market crashed in the 90?s he became broke and his wife and five kids were living of food stamps for a few years. He and his family held on tight for a bought five years and Farouk got a job with EMC with is associates degree. He has seven patens with the company, making a lot of money and is know living the American Dream!


***Here is a link the professor told me to go to find some good sources on immigration***
http://www.immigration-usa.com/debate.html If you could use two sources on this website that would be great and my other source would be my girlfriends father farouk.

There are faxes for this order.

Introduction:

Elderly patients have many needs that younger patients do not. Being discharged from the hospital after surgery can present additional issues beyond those associated with physical recovery. In this task, you will assume the role of a case management nurse who is responsible for determining the most appropriate discharge placement for an elderly patient named Mr. Trosack. The patient is to be discharged from the hospital after undergoing total hip replacement surgery.
Review the ?Elder Care Case Study? (attached below) for information on your patient. You will use this information to complete this task.

Task:

Write an essay (suggested length of 4 pages) in which you analyze the case study information to complete the following:

A. Assessment of the Situation (suggested length of 2 pages)
1. Identify at least three healthcare issues that you, as the case manager, must address when working with an interdisciplinary team to determine the most appropriate discharge plan for Mr. Trosack.
a. Explain why these are important issues when planning for management of the elderly discharge patient.
2. Identify three to five members to make up an interdisciplinary team to determine the most appropriate discharge placement for Mr. Trosack.
a. Describe the role expected of each person on the team.
3. Analyze the issues from the safety assessment that could affect the determination of discharge placement.
Note: You may include any other safety issues you think might be a problem if this patient returns home upon discharge.

B. Discharge Plan of Care (suggested length of 2 pages)
1. Explain to the family what care Mr. Trosack needs and how he should be discharged based on the interview data and the safety assessment. Your explanation should include the following:
a. Discuss the ability of the family to adequately care for Mr. Trosack if he is discharged home.
b. Discuss how social isolation affects an older adult?s recovery from surgery or illness.
c. Discuss the ways psychological factors play a role in the recovery process.

2. Recommend a discharge placement for Mr. Trosack with supportive documentation.

C. If you use sources, include all in-text citations and references in APA format.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly.

724.2.4-01-07 Case Study
You have just accepted the assignment of Mr. Trosack?s case management. As such, you are responsible for determining the most appropriate discharge placement and plan. From the patient?s chart, you are able to ascertain the following information:

PATIENT CHART:
Mr. Henry Trosack is a 72-year-old, second-generation Polish American who, until recently, has been in excellent health for all of his life. He reticently admits that prior to this hospitalization he has not had a physical examination in over 10 years, is taking no prescription medications, and has never had surgery in his life. In passing, he mentions taking some ?vitamins? to ?help his energy? every day, but he is not sure what they are. He wears glasses for reading and has hearing loss at 60% in his left ear.

Mr. Trosack manages a family-owned bakery along with his brother Karl, who is a widower. Mr. Trosack?s wife of 40 years, Helena, died two years ago at the age of 70. Mr. Trosack has lived in a two-bedroom apartment on the second floor in a three-story, post?WWII apartment building in downtown Chicago since he married his wife, Helena.

Mr. Trosack has one married son, Peter, 44, a financial consultant. Peter and his 43-year-old wife, Rita, both work an average of 60 hours a week and are trying to conceive their first child. They live in a condominium in downtown Chicago close to the lake and not far from the bakery. Although both were raised Catholic, neither chooses to practice their religion at this time. This infuriates Henry, but he doesn?t talk about it. Contact between Peter and his father is infrequent.

One month ago while taking out the trash, Mr. Trosack fell down the long flight of steps leading to the ground floor of his apartment building, fracturing his right hip. His brother called 911, and Henry was brought to the hospital where he underwent a right total hip replacement (THR) within 24 hours of admission. After a successful and uneventful surgery, Mr. Trosack has been in in-hospital rehabilitation for the past 2 weeks.

While in the hospital for the THR, it was determined that Mr. Trosack had hypertension. Mr. Trosack was prescribed Lopressor 25 mg bid for an average B/P of 160/100. He was also diagnosed with noninsulin-dependent diabetes for which he was prescribed Glucophage 500 mg twice a day to control his condition. After diabetic teaching in the hospital, he was able to perform his own blood sugar checks and was issued a glucometer for home use. Being overweight at 5?7?and 210 lbs., Mr. Trosack was also given dietary counseling to help him lose weight and to control his blood sugar. He was prescribed Percocet for any residual postoperative pain that might surface.

Upon discharge, Mr. Trosack will use a walker as the only means of assisted mobility. To determine the appropriate plan of care, you meet with the patient and then the family to gain more information. With the patient and family?s permission, you conduct a safety assessment of the patient?s apartment.

PATIENT INTERVIEW RESULTS:
Mr. Trosack is not happy about being what he calls ?disabled? and having to take the ?darn? medications. His apartment is on the second floor, and he is concerned that it will be difficult and painful to climb the stairs. While this frustrates him, he is determined to be able to help in the bakery. However, he admits that he cannot go down to the basement where the supplies are stored. Mr. Trosack insists that he can take care of himself and can take his own medications. He has lived alone for two years since his wife died.

FAMILY INTERVIEW RESULTS:
The family insists that according to earlier family discussions Mr. Trosack was supposed to return home with daily assistance from family members who would take turns running the store while seeing to his needs. When asked, the son and his wife admitted that they work a minimum of sixty-hour weeks and have had little time in the past to visit Mr Trosack. They hope to do better once he is home, but they know that right now there is a lot of pressure from work.

When questioned, the family did not appear to understand the need for taking medications at regular times. They do not believe that he really has diabetes since he has always been so healthy. They believe a change of diet will probably be all that is needed.

The family states that they do not know how Mr. Trosack obtains his groceries, but they are sure there is a store nearby that will deliver. Mr. Trosack usually eats his meals in the bakery so he does not keep much food in the apartment.

The family also believes that Mr. Trosack will follow directions and remain in the apartment rather than going downstairs to the bakery. The family refuses any outside nursing assistance since they know that Mr. Trosack will not want anyone ?fussing? over him. However, they will try to visit as often as possible.
The family states that Mr. Trosack?s apartment is small and cluttered with WWII memorabilia. They admit that it may be difficult to maneuver the walker around furniture and his ?valuables.? However, they state that, ?Maybe this will finally get him to get rid of all that junk.? The family states that Mr. Trosack is alert and well able to care for himself. He has been living alone without difficulty for two years since his wife died.

SAFETY ASSESSMENT:
??Apartment is small and cluttered with furniture and memorabilia.
??Bathroom is small and does not include any safety features.
??Kitchen is small but clean, and there is room to maneuver with the walker.
??Controls for the stove are in the front making it easy to reach.
??Access to the apartment is by two flights of stairs.
??There is no elevator.
??Trash must be taken down the two flights of stairs to the rear of the building.
??Groceries must be brought up the two flights of stairs.
??Bathroom medicine cabinet is filled with old prescriptions.
??Food in the refrigerator is expired.
??Multiple, small scatter rugs are present throughout the apartment, even on top of other carpets.

Read the following case studies about two very different people coping with their mental illness. In the first case, legal scholar Elyn Saks talks about her struggles with, and surprising triumphs over, her diagnosis of schizophrenia. In the second case study, Andy discusses his journey with high functioning autism, a developmental condition that experiences a similar stigma to many mental health disorders.
Case Assignment
Case Study 1
Saks, E. (2009). Diary of a High-Functioning Person with Schizophrenia. Scientific American. Accessed at http://www.scientificamerican.com/article/diary-of-a-high-function/ on August 23, 2016.
Case Study 2
Kirtland, A. Growing up undiagnosed Early signs of autism. The National Autistic Society. Accessed at http://www.autism.org.uk/about/adult-life/stories/growing-up-undiagnosed.aspxon August 23, 2016.
Write a 2- to 3-page paper addressing the following:
1. What symptoms of mental illness did each person display? What made each of these cases different? Contrast these conditions in the context of mental illness versus developmental disabilities.
2. Why does society tend to stigmatize mental illness? Is the stigma different for those with mental illness versus developmental disabilities?
3. What impact did being stigmatized have on their lives? Consider such things as reluctance to seek treatment, living a lie, social isolation and difficulty gaining an accurate diagnosis.
4. What personal qualities have helped each of them meet the challenge of their conditions? Discuss the role resilience has played in their recovery.
5. What strategies have helped them cope with their conditions?
6. What kinds of factors might contribute to changing public perceptions around mental illness?
Assignment Expectations
Organize this assignment using subtitles that summarize each question above. For example, to answer Question 1, use a descriptive subtitle like the following: Mental Illness versus Developmental Disabilities. Answer each question under the subtitle using complete sentences that relate back to the question. Use APA formatting to cite any sources used within the text of your essay. Also, be sure to include a reference section at the end of your assignment that lists the sources that you were required to read and any additional resources you used to research your answers.

The required readings for this Forum is Chapter 15, James Baldwin's short story Going to Meet the Man:

For Baldwin, Chapter 15:

Here are some guiding questions: what does the story tell about "race relations" in the American South? Who is Jesse? What is his occupation? What does the story tell about the effect of the civil rights movement on the class of white southerners Jesse represents? What is Baldwin's portrayal of the sexual underpinning of the system of caste relations between black and white that was upheld under the system of racial segregation that existed in the American south? What is the significance of the events on the last page of the story?


Form and requirements:
1) It must be at least 3 paragraphs long (it can be more, but not less)
2) Each paragraph must be at least 8 substantial sentences - full sentences, not sentence fragments.
3 There must be an empty, blank line between paragraphs.
4) You must check your spelling and grammar. Please use spellcheck, which means writing your essay in a word processing format and then posting it in Blackboard - an essay filled with spelling errors will not gain credit.
5) Your essay must contain DETAILED discussion, analysis and response to the reading in question. This means that I need to see at least two actual citations (more are even better) from the article - with page numbers from each citation (not from the same page). Actually citing a few words or a sentence from the article in quotes is REQUIRED as is the page number.
6) Writing a Viewpoint Essay for a particular reading must choose their citations from different pages. In other words, if you are writing on an author, you cannot use the same page numbers for your citations as those who have posted before you have done.


Example of a viewpoint essay: Use this as an example :


David S. Ludwig identifies four phases of the childhood obesity epidemic. He claims that the first phase began in the 1970s. The epidemic crosses cultural and economic classes as far as increase in average weight(s) overall. Ludwig asserts, ?'A?A"Today, about one in three children and adolescents is overweight and the proportions approaches one in two in certain minority groups?'A?. One in three is a huge number if we look at the American population of kids. (pg 2325) He points out that many of these kids remain and appear healthy for years, thus have no (apparent) influence on public health. Ludwig describes phase two is the phase he defines us being at presently. He states that this phase is distinguished by considerable weight related problems. Fatty liver related to being over weight, previously unrecognized in pediatric literature before 1980 has been reported as one in three- among the obese children population at the time of his article. He states, ?'A?A"The incidence of type 2 diabetes among adolescents, though still not high, has increased by a factor of ten in the past two decades and may now that of type 1 diabetes among African American and Hispanic adolescents?'A?. (pg 2325)

Phase three is defined as life threatening. Coronary heart disease, high risk for limb amputation, kidney failure requiring dialysis, and premature death are some of the consequences of childhood obesity at this juncture. He further points out, ?'A?A"Fatty liver will progress to hepatitis and cirrhosis, which may remain asymptomatic until irreversible organ damage has occurred?'A?. (pg 2325)Ludwig believes that stage four has irreversible possibilities and outcomes. Children that are obese as children will most likely be obese into and throughout adulthood. He asserts, ?'A?A"Carrying excessive weight in early in life may elicit irreversible biologic changes in hormonal pathways, fat cells, and the brain increase hunger and adversely affect metabolism?'A?. Ludwig goes as far as to say that a parent?'A?A?s obesity can affect the Body Mass Index (BMI) of their newborn. In short, he terms this phenomenon perinatal programming. (pg 2326)

According to Ludwig, if childhood obesity is not prevented- the following consequences are eminent. He found that obese children tend to isolate and introvert in their childhood and into adulthood. Furthermore, he found that they are prone to live in poverty and not to complete education beyond high school. This is apparently an outcome of high anxiety and depression. He and his colleagues predict, ?'A?A"Pediatric obesity may shorten life expectancy in the United States by 2-5 years by mid-century- and affect equal to that of all cancers combined?'A?. (pg 2325) This article on childhood has direct implications on our communities. Wherever we live and whatever our economic status, we are all related to and/or have people that we love, care about, and are close to. Ludwig?'A?A?s findings and reports can and will affect each and every one of us somehow. When he stated that he and his colleagues predict childhood obesity to equal the affect to that of all cancers combined, I had to do a double take. I have had two aunties in my immediate family and my grandmother battle with cancer. My grandmother actually died from stomach cancer partly because she didn?'A?A?t like hospitals and failed to report her condition. That is three people close to just me. For every ?'A?A"me?'A? there is a ?'A?A"you?'A?. Me and you makes a ?'A?A"we?'A?. We need to take heed of this article and others like it in order to live and share a full- healthy life for ourselves and with others.




Marian Diamond is an internationally known brain researcher who has been at UC Berkeley and she's been one of a number of people who've done groundbreaking research in the relationship between the brain, growth of the brain, or decline of the brain, and the kind of environment that organisms are in. Her work not only has implications for humans, but in fact I believe she did most of her work with rats. But as you'll see in her reading this concept of the enriched environment has implications for the relationship between the environment and brain enrichment or brain impoverishment. It is not only humans that this theory applies to.


She begins, I'm going to start with the introduction, Experience is the Best Sculptor, and she says that we "once viewed the child's brain as static and unchangeable" but we understand today it's a "dynamic organ that feeds on stimulation and experience." And what's different here about looking at the brain development is we actually look at the brain as an organ. We look and see that, in her language, "the flourishing of branched intertwined neural forests is what can be seen as the result of the proper relationship between the organism and environment at different stages of the life cycle."


She asks a number of questions on page three which are appropriate for you to look at and on the top of page three, "when it comes to the brain, experience does it." So this is not something that is merely an unfolding of genetic patterns. The genes make possible the growth and development of the brain but it is the environment and experience which channel it and which stimulate it, or do not stimulate it. She writes a little bit about this concept of the enriched environment. If you go to page five she says that one of her reasons for wanting to tell the enrichment story is how applicable it is to American education and American children. She says on page five, "the typical American child does not experience an enriched environment." I would like you to read her description in that paragraph and see if that corresponds to your own experience. And so we do not provide an enriched environment for most of our children. There are a few fortunate ones that do get it and maybe many fortunate ones do get it but perhaps even many more do not and so we hear about teen pregnancy, children living in poverty, delinquency, dropout rates, drug abuse, crim, failed teaching methods, the growth of prisons, and so on. And so this is her claim that, in fact, brain enrichment when we're talking about human development we needed a certain point to focus on what's known about the growth of the brain itself.


We move from the introduction to Chapter One (which is the only chapter I've reproduced in this book), "Trees That Grow So Fair: Neural Forests of the Mind." She talks about herself and her interesting childhood and the fact that she became very interested in the hypothalamus, described on page 11 what its function is. She then describes her own life, her marriage to a nuclear chemist, and her arrival at Cornell University, and talks about events in her own life and her interest, on page 12, in the work of Krech, Rosenzweig, and Bennett, and for the first time seeing the link between what was physically there in the animal's brain and its ability to learn. She went down to see them, shed moved to Berkeley by this time, and talked about the work of a man named Donald Head. Head had made observations of rats who had been free-ranging and played with his own children versus laboratory rats and found that the free-ranging rodents ran a much better maze than the locked-up rats. And so from Head's observation his Berkeley team decided to raise baby rats in two kinds of cages: a large enrichment cage (this is on page 13) filled with toys; and a small impoverishment cage. The important thing there is that actually, when these behavioral differences in the groups on the basis of being put in different environments became clear, she then did research that involved removing the brain of a deceased laboratory rat, and she says from both groups, carefully measuring the thickness of the cerebral cortex. The enriched rats had a thicker cerebral cortex than the impoverished rats. It was only 6% thicker but it was highly significant: 9 out of 9 cases showed this. She repeated the experiment and she says this is about 1963. Then in 1964 she was coauthor of a paper called "Effects of Enriched Environments on the Histology of the Cerebral Cortex. She then talks about giving a paper at the American Association of Anatomists in Washington, DC, and showing this evidence. At that time people were less receptive to women scientists than today and a man said, in a loud voice, "Young lady, that brain cannot change." This is a point of view that's still with us today even though it is contradicted by an enormous amount of experimental evidence. So then this idea of brain enhancement, brain enrichment, she talks about the fact that this really involved the shattering of some dogmas that perhaps many of you have heard about as well, that, you know, the brains can't get thicker, they're fixed, that we are loosing 100,000 brain cells every day, and the brain has an intelligence level fixed at birth and it can't change, except to go down after whatever age you pick (8, 10, 12, 14) and she points out that neurologists have measured the dwindling of brain cells in rats and humans over the typical lifespan. But she argues that her group's theory of enriched and impoverished environments could explain this by looking to the source of the experimental brains. Before 1964 she says, the researchers didn't pay much attention to where a brain came from. Researchers got (human) brains from coroners: indigents, alcoholics, and bedridden soldiers. Animal researchers housed mice, rats, and other lab animals in small sterile cages. So she says, "the neurologist's standard model was based on starving brains." And she says, "when researchers collect brain tissue from enriched research animals or from people who have lived healthy, mentally active lives, they do not find a thinning of the cortex or a relentless loss of neurons with age."


After this, the next section is called, "A Rodent's Brain Revealed." I would like you to look at that and to study that picture of the rat's brain on page 18.


I'm going to jump ahead to page 20 to, "The Heart of Enrichment, Nerve Cell Branching." I want you to look on page 21 at the diagram of a typical neuron, or nerve cell. Isn't it extraordinary that the egg and sperm which unite, two cells, contain the potentiality for cell differentiation for all of the thousands and thousands of different cell types that we find in an organism at different stages of its lifecycle development. One of these types is the neuron, of course, very critical, the cells that comprise the basis of the nervous system. The heart of enrichment, she says, is nerve cell branching. So take a look there: the cell body in the middle, the long thin axon going down with branches, and then at the top of the picture the dendrites, which, she describes them, the "luxuriantly branching dendrites, and its thorn-like spines that grow, change shape, or shrink." So look at the dendrites and notice the spines on the dendrites.


Down at the bottom of page 22 she says some interesting descriptions of the brain and I'd like you to pay attention to the bottom of page 22, "surface areas," and the fact that this concept of surface areas is necessary to understand how plant leaves collect solar energy and they are necessary to understand how our lungs absorb oxygen and liberate carbon dioxide or our small intestines liberate food. But nothing, she says, holds a candle to the human brain. So please do look at that concept of surface areas.


Holloway's work on page 23, the branching in part was causing the cortex to grow thicker. Diamond had speculated that the branching of dendrites might explain this additional 6% thickness of the enriched cerebral cortex. And she suggests the term "little trees" on page 23 and this is well worth reading.


Go to page 25, "Nubbins, Umbrellas, and Lollipop Trees." These are her colloquial terms for what can happen to the dendritic spines. But first it is necessary to understand the term "synapse." I would expect many of you had this in elementary biology courses but it is good to review it. When the electrical signal traveling down the axon reaches the button-like ending at the wire's terminus, a chemical message crosses the gap in the synapse and we get the neurotransmitters.


Turn to page 26. Again I'd like you to be familiar with the diagram there:

the sending nerve cell,

the axon

notice the little circle where the axon is adjacent to the dendritic spine and then the big circle that magnifies that

electrical input from the sending nerve cell

the release of neurotransmitters

the electrical output from the dendritic spine


As you read this right now, probably hundreds of thousands of such electrical inputs are simultaneously being transmitted along the neurons of your brain at every level from the peripheral nervous system, through the spinal cord, through the brain stem, the medulla, through all of the different structures such as the thalamus, hypothalamus (that regulate thirst, hunger, and so on), through the limbic system and its amygdala (that is primarily connected with feelings), and through all of the different parts of the cerebral cortex (which regulate fine movement, perception, thought, and so on). All of this, this is the mechanism through which this text plays, the neurotransmitter. You begin to understand then what Parkinson's disease is a disease where dopamine, one of the main transmitters, is not being produced and this leads to failure, in particular, of motor neurons. So it is very important to understand what this simple but correct model of neurons and how they interconnect.


On page 26 and 27, the Diamond group and other researchers found that bees' dendritic spines themselves grow, change shape, or shrink as an animal experiences the world. The work of James Connor is important, how social isolation could affect a rat's brain, especially in an elderly rat. Two groups of advanced-age rodents, some housed with their aged friends, others alone. When the animals died he found that spines resembled either three-dimensional lollipops wit the ball on the stalk like Tootsie-Pops or they were short squat nubbins with no stalk. And the older rats alone had a lot of these nubbin spines, so could there be various lollipop shapes depending on experience in a lonely deprived animal? Could the lollipop spines go unused and eventually collapse into gnarled old nubbins? This is her statement of what the primary mechanism is of either brain enrichment or brain impoverishment, that it has to do with changes that are produced in the dendritic spines which affect the process of neural communication and pathways in the brain. She then cites the work of Richard Coss on page 27. Bees that made one single flight out into the meadows were very different in what had happened to their dendritic spines than bees that had remained in the hive permanently. The Coss team found that a number of spine shapes, not just lollipops and nubbins, depending on the bees' level of stimulation from the outside world. I would like you to look at this. This is very important. Experience, even an hour or two of flying through the meadow, had a dramatic enlarging effect on a bee's dendritic spines. Coss found similar changes in the dendrites of socially enriched and deprived jewelfish. Another team found changes in young Myna birds, and so on. So this is really important.


On page 29 there is a marvelous quote from Richard Coss, who says, "an animal is only as smart as it needs to be." And Diamond goes on to add that a nurse bee inside the hive just apparently doesn't need to be as smart as the worker buzzing through the meadows and orchards. So, "just as the muscles are programmed to grow smaller and weaker with disuse, the dendritic trees and spines will shrivel and the cortex grow thinner with lack of mental activity," she tells us also on page 29. So the implications of this are clear, I believe, that we really need throughout the lifecycle to think about this question of the enrichment environment because it is the environment and our relationship with the environment which is the key overriding factor in determining what kinds of changes will or will not happen in our dendritic spines, which in turn affect neural pathways, which in turn affect every aspect of our human life experience from the maintenance of our intelligence, to our motor coordination, to our interest in life, to our interaction with others, and so on.


In page 30 under the heading "Rats Revisited," she gives on the next two pages quite a good summary of the work of the Diamond lab group at UC Berkeley. They studied enrichment and impoverishment with great intensity. They wanted to learn everything. So they split animals into three groups:

1) A standard intermediate condition with three rats in a small cage with no toys,

2) Impoverishment conditions with a solitary rat in a small cage without toys, and

3) An enrichment condition in which 12 rats inhabit a much larger cage with a rotating array of toys such as exercise wheels, platforms, and ladders.


She tells us on page 30 the findings are potentially valid for students in dormitories, prisoners in solitary confinement, senior citizens living together in comfort or in poverty, for children treated well or abused. And so with the three cage types they formulated the basic principles of brain enrichment and these are on page 31. I would like you to study these and think about them and use them as a basis perhaps for your viewpoints and responses. Remember also that the Wiki project, which I have asked you all to start thinking about during the past weekend this week, the Wiki project asks you in some way, whatever your chosen topic and problem formulation is, in relation to human development, asks you in some way to relate it to the concept of the enriched environment. So what she says on page 31, "the impact of a stimulating or boring environment is wide-spread throughout the regions involved in learning and remembering." How interesting, a stimulating environment or a boring environment. I ask myself, is this the limit of the different kinds of environments that one could have? I ask, for instance, what about the type of environment that prisoners at Abu Ghraib had where they were subjected to many forms of humiliation and torture? They were certainly being stimulated in many cases, it certainly wasn't boring, and so we could certainly have a broader discussion of environments. But stimulating or boring is probably a good place to begin. Neurons in other parts of the brain besides the cerebral cortex can also respond. I should tell you that there has been peer-reviewed work showing that actually new neurons can be generated in the adult phase of the lifecycle even though Diamond's model focuses primarily on the dendritic spines and this seems to be the key area. The paradigm shift has been so great in brain research, the older view that the brain with no more neurons growing after a very early age and development and then the death of 100,000 cells a day. You might hear this in the popular press. You might hear this by people with different kinds of theoretical or social axes to grind, but in fact even at the level of new neuron production it is clear now that, not only in humans but also in other organisms, entirely new neurons can be produced in the adult phase of the lifecycle. I'll try to put up an electron micrograph picture of one of these for you.


Enriching the environment of a pregnant female rat can result in newborn pups with a thicker cerebral cortex. Now that's interesting, isn't it? Nursing rat pups show the effects of enrichment on the brain and the impact of boredom in young and adolescent rats, a boring environment had a more powerful thinning effect on the cortex than an exciting environment had on cortex thickening. Now what are the implications of this for the kinds of education that we are giving our children? One of the mathematics teachers, a third grade math teacher with 22 years experience, complained about the kind of impoverished environment for teaching mathematics that is now mandated because of the dominance of the standardized testing and she said, in her words, "what we do now is drill and kill." In her school, pardon my small diversion here but some of you might want to talk about this in your viewpoints and responses, that in effect for these third graders school has become an experience where they are tested and the testing becomes much more important than the learning process to the despair of good teachers and to the confusion of new teachers who may begin to wonder what they got themselves into. In this third grade school not only do they have the week or more of standardized tests but they have trimester tests given three times a year, each one of which takes a week to prepare the students for the standardized tests. They have pre-testing and post-testing and they also have individual teachers' tests. So this is a situation, widespread in American education, where assessment has replaced learning. Assessment is the goal, learning becomes secondary. I wonder about the effect of the boredom that I would imagine that this is having for the students who have to adapt to something in these classrooms that is presenting itself to them as education. Of course, what about adolescence? I would be interested to have some of your views on this, speaking from your own experience.


And the last one, brain changes were found in young adult rats, middle-aged rats, and even in rats the equivalent of 90-year-old humans. Use it or lose it. The question remained, does a thicker cortex mean a smarter animal? The answer the Berkeley group says according to its data, "Yes!" And she gives examples of that.


That really sums up the essence of this argument that Diamond makes about brain enrichment. I would like you to read and study her article carefully. Think about this in relationship to the other parts of Unit One and Unit Two, the importance of birth bonding, the nature of attachment bonding, all of these kinds of questions. Now we have a third perspective on human development based on the concept of brain enrichment or brain impoverishment and that is really all that I will talk about today. Thank you.

The Crucible: 1692 and 1952
POINTS AND QUESTIONS TO CONSIDER
Arthur Miller has written a number of pieces on the significance of The Crucible as an allegory for the McCarthy era. Here are a few quotations taken from the readings for this Topic:
? "But as the anti-Communist crusade settled in, and showed signs of becoming the permanent derangement of the American psyche, a kind of mystery began to emerge from its melodramas and comedies. We were all behaving differently than we used to; we had drunk from the cup of suspicion of one another; people inevitably were afraid of too close an association with someone who might one day fall afoul of some committee. Even certain words vibrated perilously, words like organize, social, militant, movement, capitalism - it didn't do to be on too familiar terms with such language. We had entered a mysterious pall from which there seemed no exit." (Cup of Suspicion)
? "...what kept assaulting my brain now was not the hunt for witches itself; it was the paralysis that had led to more than 20 public hangings of very respectable farmers by their neighbors. There was something "wonderful" in this spectacle, a kind of perverse, malign poetry that had simply swamped the imaginations of these people. I thought I saw something like it around me in the early 50's. The truth is that the more I worked at this dilemma the less it had to do with Communists and McCarthy and the more it concerned something very fundamental in the human animal: the fear of the unknown, and particularly the dread of social isolation. What research showed me, and what I hoped the play would show the country and the world, was the continuity through time of human delusion, and the only safeguard, fragile though it may be, against it - namely, the law and the courageous few whose sacrifice illuminates delusion." (Cup of Suspicion).
? "It was as though the court had grown tired of thinking and had invited in the instincts: spectral evidence--that poisoned cloud of paranoid fantasy--made a kind of lunatic sense to them, as it did in plot-ridden 1952, when so often the question was not the acts of an accused but the thoughts and intentions in his alienated mind." (Why I Wrote The Crucible)
? "Few of us can easily surrender our belief that society must somehow make sense. The thought that the state has lost its mind and is punishing so many innocent people is intolerable. And so the evidence has to be internally denied." (Why I Wrote The Crucible)
? "For some, the play seems to be about the dilemma of relying on the testimony of small children accusing adults of sexual abuse, something I'd not have dreamed of forty years ago. For others, it may simply be a fascination with the outbreak of paranoia that suffuses the play--the blind panic that, in our age, often seems to sit at the dim edges of consciousness. ... But below its concerns with justice the play evokes a lethal brew of illicit sexuality, fear of the supernatural, and political manipulation, a combination not unfamiliar these days." (Why I Wrote The Crucible)
TOPIC FOR YOUR ESSAY
There is the obvious theme in The Crucible: the abuse of power and the corruption of those in power. The power of the church and its ministers moves the action, whose focus is the witchcraft trials. The civil authorities, bolstered by the church, use fear to control the people, and citizens use gossip and slander to defend themselves. There is a less obvious theme in the sexual spark that sets off the firestorm: John Proctor has abused his servant girl, Abigail, by committing adultery with her. She appears as a conniving outcast who exploits the growing hysteria to assert her power over Proctor. But she is a victim herself who compensates for her loss of innocence and respect by rousing the other children in a frenzied, adolescent game of sticking together to protect themselves at all costs - even the destruction of the community.
What moment in the play seems to you to describe or explain most powerfully the situation in 1952? Describe how the action or speeches of characters in this moment evoke the fear and hysteria of McCarthyism. Use material from the play to illustrate your points. Gather your observations and thoughts into an essay -
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You are required to write a personal reflective essay which in some way refers to Sogyal Rimpoche from the Tibetan Book of Living and Dying, and also refers to at least one of the other enrichment readings dealing with case studies of self-actualization.This essay might well be a summing up of what you have learned in the course in relation to a human life seen as a whole, in terms of the human life cycle.

Form and requirements:
1) It must be at least 4 paragraphs long (it can be more, but not less)

2) Each paragraph must be at least 8 substantial sentences - full sentences, not sentence fragments.

3 There must be an empty, blank line between paragraphs.

4) You must check your spelling and grammar. Please use spellcheck, which means writing your essay in a word processing format and then posting it in Blackboard - an essay filled with spelling errors will not gain credit.

5) Your essay must contain DETAILED discussion, analysis and response to the reading in question. This means that I need to see at least two actual citations (more are even better) from the article - with page numbers from each citation (not from the same page). Actually citing a few words or a sentence from the article in quotes is REQUIRED as is the page number.

6) Writing a Viewpoint Essay for a particular reading must choose their citations from different pages. In other words, if you are writing on an author, you cannot use the same page numbers for your citations as those who have posted before you have done.


Example of a viewpoint essay: Use this as an example :


David S. Ludwig identifies four phases of the childhood obesity epidemic. He claims that the first phase began in the 1970s. The epidemic crosses cultural and economic classes as far as increase in average weight(s) overall. Ludwig asserts, ?'''?'A??''?'A?A?'A?A"Today, about one in three children and adolescents is overweight and the proportions approaches one in two in certain minority groups?'''?'A??''?'A?A?'A??''A?'A?. One in three is a huge number if we look at the American population of kids. (pg 2325) He points out that many of these kids remain and appear healthy for years, thus have no (apparent) influence on public health. Ludwig describes phase two is the phase he defines us being at presently. He states that this phase is distinguished by considerable weight related problems. Fatty liver related to being over weight, previously unrecognized in pediatric literature before 1980 has been reported as one in three- among the obese children population at the time of his article. He states, ?'''?'A??''?'A?A?'A?A"The incidence of type 2 diabetes among adolescents, though still not high, has increased by a factor of ten in the past two decades and may now that of type 1 diabetes among African American and Hispanic adolescents?'''?'A??''?'A?A?'A??''A?'A?. (pg 2325)

Phase three is defined as life threatening. Coronary heart disease, high risk for limb amputation, kidney failure requiring dialysis, and premature death are some of the consequences of childhood obesity at this juncture. He further points out, ?'''?'A??''?'A?A?'A?A"Fatty liver will progress to hepatitis and cirrhosis, which may remain asymptomatic until irreversible organ damage has occurred?'''?'A??''?'A?A?'A??''A?'A?. (pg 2325)Ludwig believes that stage four has irreversible possibilities and outcomes. Children that are obese as children will most likely be obese into and throughout adulthood. He asserts, ?'''?'A??''?'A?A?'A?A"Carrying excessive weight in early in life may elicit irreversible biologic changes in hormonal pathways, fat cells, and the brain increase hunger and adversely affect metabolism?'''?'A??''?'A?A?'A??''A?'A?. Ludwig goes as far as to say that a parent?'''?'A??''?'A?A?'A??''?'A?A?'A?s obesity can affect the Body Mass Index (BMI) of their newborn. In short, he terms this phenomenon perinatal programming. (pg 2326)

According to Ludwig, if childhood obesity is not prevented- the following consequences are eminent. He found that obese children tend to isolate and introvert in their childhood and into adulthood. Furthermore, he found that they are prone to live in poverty and not to complete education beyond high school. This is apparently an outcome of high anxiety and depression. He and his colleagues predict, ?'''?'A??''?'A?A?'A?A"Pediatric obesity may shorten life expectancy in the United States by 2-5 years by mid-century- and affect equal to that of all cancers combined?'''?'A??''?'A?A?'A??''A?'A?. (pg 2325) This article on childhood has direct implications on our communities. Wherever we live and whatever our economic status, we are all related to and/or have people that we love, care about, and are close to. Ludwig?'''?'A??''?'A?A?'A??''?'A?A?'A?s findings and reports can and will affect each and every one of us somehow. When he stated that he and his colleagues predict childhood obesity to equal the affect to that of all cancers combined, I had to do a double take. I have had two aunties in my immediate family and my grandmother battle with cancer. My grandmother actually died from stomach cancer partly because she didn?'''?'A??''?'A?A?'A??''?'A?A?'A?t like hospitals and failed to report her condition. That is three people close to just me. For every ?'''?'A??''?'A?A?'A?A"me?'''?'A??''?'A?A?'A??''A?'A? there is a ?'''?'A??''?'A?A?'A?A"you?'''?'A??''?'A?A?'A??''A?'A?. Me and you makes a ?'''?'A??''?'A?A?'A?A"we?'''?'A??''?'A?A?'A??''A?'A?. We need to take heed of this article and others like it in order to live and share a full- healthy life for ourselves and with others.




Marian Diamond is an internationally known brain researcher who has been at UC Berkeley and she's been one of a number of people who've done groundbreaking research in the relationship between the brain, growth of the brain, or decline of the brain, and the kind of environment that organisms are in. Her work not only has implications for humans, but in fact I believe she did most of her work with rats. But as you'll see in her reading this concept of the enriched environment has implications for the relationship between the environment and brain enrichment or brain impoverishment. It is not only humans that this theory applies to.


She begins, I'm going to start with the introduction, Experience is the Best Sculptor, and she says that we "once viewed the child's brain as static and unchangeable" but we understand today it's a "dynamic organ that feeds on stimulation and experience." And what's different here about looking at the brain development is we actually look at the brain as an organ. We look and see that, in her language, "the flourishing of branched intertwined neural forests is what can be seen as the result of the proper relationship between the organism and environment at different stages of the life cycle."


She asks a number of questions on page three which are appropriate for you to look at and on the top of page three, "when it comes to the brain, experience does it." So this is not something that is merely an unfolding of genetic patterns. The genes make possible the growth and development of the brain but it is the enironment and experience which channel it and which stimulate it, or do not stimulate it. She writes a little bit about this concept of the enriched environment. If you go to page five she says that one of her reasons for wanting to tell the enrichment story is how applicable it is to American education and American children. She says on page five, "the typical American child does not experience an enriched environment." I would like you to read her description in that paragraph and see if that corresponds to your own experience. And so we do not provide an enriched environment for most of our children. There are a few fortunate ones that do get it and maybe many fortunate ones do get it but perhaps even many more do not and so we hear about teen pregnancy, children living in poverty, delinquency, dropout rates, drug abuse, crime, failed teaching methods, the growth of prisons, and so on. And so this is her claim that, in fact, brain enrichment when we're talking about human development we needed a certain point to focus on what's known about the growth of the brain itself.


We move from the introduction to Chapter One (which is the only chapter I've reproduced in this book), "Trees That Grow So Fair: Neural Forests of the Mind." She talks about herself and her interesting childhood and the fact that she became very interested in the hypothalamus, described on page 11 what its function is. She then describes her own life, her marriage to a nuclear chemist, and her arrival at Cornell University, and talks about events in her own life and her interest, on page 12, in the work of Krech, Rosenzweig, and Bennett, and for the first time seeing the link between what was physically there in the animal's brain and its ability to learn. She went down to see them, she?'A?A?d moved to Berkeley by this time, and talked about the work of a man named Donald Head. Head had made observations of rats who had been free-ranging and played with his own children versus laboratory rats and found that the free-ranging rodents ran a much better maze than the locked-up rats. And so from Head's observation his Berkeley team decided to raise baby rats in two kinds of cages: a large enrichment cage (this is on page 13) filled with toys; and a small impoverishment cage. The important thing there is that actually, when these behavioral differences in the groups on the basis of being put in different environments became clear, she then did research that involved removing the brain of a deceased laboratory rat, and she says from both groups, carefully measuring the thickness of the cerebral cortex. The enriched rats had a thicker cerebral cortex than the impoverished rats. It was only 6% thicker but it was highly significant: 9 out of 9 cases showed this. She repeated the experiment and she says this is about 1963. Then in 1964 she was coauthor of a paper called "Effects of Enriched Environments on the Histology of the Cerebral Cortex. She then talks about giving a paper at the American Association of Anatomists in Washington, DC, and showing this evidence. At that time people were less receptive to women scientists than today and a man said, in a loud voice, "Young lady, that brain cannot change." This is a point of view that's still with us today even though it is contradicted by an enormous amount of experimental evidence. So then this idea of brain enhancement, brain enrichment, she talks about the fact that this really involved the shattering of some dogmas that perhaps many of you have heard about as well, that, you know, the brains can't get thicker, they're fixed, that we are loosing 100,000 brain cells every day, and the brain has an intelligence level fixed at birth and it can't change, except to go down after whatever age you pick (8, 10, 12, 14) and she points out that neurologists have measured the dwindling of brain cells in rats and humans over the typical lifespan. But she argues that her group's theory of enriched and impoverished environments could explain this by looking to the source of the experimental brains. Before 1964 she says, the researchers didn't pay much attention to where a brain came from. Researchers got (human) brains from coroners: indigents, alcoholics, and bedridden soldiers. Animal researchers housed mice, rats, and other lab animals in small sterile cages. So she says, "the neurologist's standard model was based on starving brains." And she says, "when researchers collect brain tissue from enriched research animals or from people who have lived healthy, mentally active lives, they do not find a thinning of the cortex or a relentless loss of neurons with age."


After this, the next section is called, "A Rodent's Brain Revealed." I would like you to look at that and to study that picture of the rat's brain on page 18.


I'm going to jump ahead to page 20 to, "The Heart of Enrichment, Nerve Cell Branching." I want you to look on page 21 at the diagram of a typical neuron, or nerve cell. Isn't it extraordinary that the egg and sperm which unite, two cells, contain the potentiality for cell differentiation for all of the thousands and thousands of different cell types that we find in an organism at different stages of its lifecycle development. One of these types is the neuron, of course, very critical, the cells that comprise the basis of the nervous system. The heart of enrichment, she says, is nerve cell branching. So take a look there: the cell body in the middle, the long thin axon going down with branches, and then at the top of the picture the dendrites, which, she describes them, the "luxuriantly branching dendrites, and its thorn-like spines that grow, change shape, or shrink." So look at the dendrites and notice the spines on the dendrites.


Down at the bottom of page 22 she says some interesting descriptions of the brain and I'd like you to pay attention to the bottom of page 22, "surface areas," and the fact that this concept of surface areas is necessary to understand how plant leaves collect solar energy and they are necessary to understand how our lungs absorb oxygen and liberate carbon dioxide or our small intestines liberate food. But nothing, she says, holds a candle to the human brain. So please do look at that concept of surface areas.


Holloway's work on page 23, the branching in part was causing the cortex to grow thicker. Diamond had speculated that the branching of dendrites might explain this additional 6% thickness of the enriched cerebral cortex. And she suggests the term "little trees" on page 23 and this is well worth reading.


Go to page 25, "Nubbins, Umbrellas, and Lollipop Trees." These are her colloquial terms for what can happen to the dendritic spines. But first it is necessary to understand the term "synapse." I would expect many of you had this in elementary biology courses but it is good to review it. When the electrical signal traveling down the axon reaches the button-like ending at the wire's terminus, a chemical message crosses the gap in the synapse and we get the neurotransmitters.


Turn to page 26. Again I'd like you to be familiar with the diagram there:

?'A? the sending nerve cell,

?'A? the axon

?'A? notice the little circle where the axon is adjacent to the dendritic spine and then the big circle that magnifies that

?'A? electrical input from the sending nerve cell

?'A? the release of neurotransmitters

?'A? the electrical output from the dendritic spine


As you read this right now, probably hundreds of thousands of such electrical inputs are simultaneously being transmitted along the neurons of your brain at every level from the peripheral nervous system, through the spinal cord, through the brain stem, the medulla, through all of the different structures such as the thalamus, hypothalamus (that regulate thirst, hunger, and so on), through the limbic system and its amygdala (that is primarily connected with feelings), and through all of the different parts of the cerebral cotex (which regulate fine movement, perception, thought, and so on). All of this, this is the mechanism through which this text plays, the neurotransmitter. You begin to understand then what Parkinson's disease is a disease where dopamine, one of the main transmitters, is not being produced and this leads to failure, in particular, of motor neurons. So it is very important to understand what this simple but correct model of neurons and how they interconnect.


On page 26 and 27, the Diamond group and other researchers found that bees' dendritic spines themselves grow, change shape, or shrink as an animal experiences the world. The work of James Connor is important, how social isolation could affect a rat's brain, especially in an elderly rat. Two groups of advanced-age rodents, some housed with their aged friends, others alone. When the animals died he found that spines resembled either three-dimensional lollipops with the ball on the stalk like Tootsie-Pops or they were short squat nubbins with no stalk. And the older rats alone had a lot of these nubbin spines, so could there be various lollipop shapes depending on experience in a lonely deprived animal? Could the lollipop spines go unused and eventually collapse into gnarled old nubbins? This is her statement of what the primary mechanism is of either brain enrichment or brain impoverishment, that it has to do with changes that are produced in the dendritic spines which affect the process of neural communication and pathways in the brain. She then cites the work of Richard Coss on page 27. Bees that made one single flight out into the meadows were very different in what had happened to their dendritic spines than bees that had remained in the hive permanently. The Coss team found that a number of spine shapes, not just lollipops and nubbins, depending on the bees' level of stimulation from the outside world. I would like you to look at this. This is very important. Experience, even an hour or two of flying through the meadow, had a dramatic enlarging effect on a bee's dendritic spines. Coss found similar changes in the dendrites of socially enriched and deprived jewelfish. Another team found changes in young Myna birds, and so on. So this is really important.


On page 29 there is a marvelous quote from Richard Coss, who says, "an animal is only as smart as it needs to be." And Diamond goes on to add that a nurse bee inside the hive just apparently doesn't need to be as smart as the worker buzzing through the meadows and orchards. So, "just as the muscles are programmed to grow smaller and weaker with disuse, the dendritic trees and spines will shrivel and the cortex grow thinner with lack of mental activity," she tells us also on page 29. So the implications of this are clear, I believe, that we really need throughout the lifecycle to think about this question of the enrichment environment because it is the environment and our relationship with the environment which is the key overriding factor in determining what kinds of changes will or will not happen in our dendritic spines, which in turn affect neural pathways, which in turn affect every aspect of our human life experience from the maintenance of our intelligence, to our motor coordination, to our interest in life, to our interaction with others, and so on.


In page 30 under the heading "Rats Revisited," she gives on the next two pages quite a good summary of the work of the Diamond lab group at UC Berkeley. They studied enrichment and impoverishment with great intensity. They wanted to learn everything. So they split animals into three groups:

1) A standard intermediate condition with three rats in a small cage with no toys,

2) Impoverishment conditions with a solitary rat in a small cage without toys, and

3) An enrichment condition in which 12 rats inhabit a much larger cage with a rotating array of toys such as exercise wheels, platforms, and ladders.


She tells us on page 30 the findings are potentially valid for students in dormitories, prisoners in solitary confinement, senior citizens living together in comfort or in poverty, for children treated well or abused. And so with the three cage types they formulated the basic principles of brain enrichment and these are on page 31. I would like you to study these and think about them and use them as a basis perhaps for your viewpoints and responses. Remember also that the Wiki project, which I have asked you all to start thinking about during the past weekend this week, the Wiki project asks you in some way, whatever your chosen topic and problem formulation is, in relation to human development, asks you in some way to relate it to the concept of the enriched environment. So what she says on page 31, "the impact of a stimulating or boring environment is wide-spread throughout the regions involved in learning and remembering." How interesting, a stimulating environment or a boring environment. I ask myself, is this the limit of the different kinds of environments that one could have? I ask, for instance, what about the type of environment that prisoners at Abu Ghraib had where they were subjected to many forms of humiliation and torture? They were certainly being stimulated in many cases, it certainly wasn't boring, and so we could certainly have a broader discussion of environments. But stimulating or boring is probably a good place to begin. Neurons in other parts of the brain besides the cerebral cortex can also respond. I should tell you that there has been peer-reviewed work showing that actually new neurons can be generated in the adult phase of the lifecycle even though Diamond's model focuses primarily on the dendritic spines and this seems to be the key area. The paradigm shift has been so great in brain research, the older view that the brain with no more neurons growing after a very early age and development and then the death of 100,000 cells a day. You might hear this in the popular press. You might hear this by people with different kinds of theoretical or social axes to grind, but in fact even at the level of new neuron production it is clear now that, not only in humans but also in other organisms, entirely new neurons can be produced in the adult phase of the lifecycle. I'll try to put up an electron micrograph picture of one of these for you.


Enriching the environment of a pregnant female rat can result in newborn pups with a thicker cerebral cortex. Now that's interesting, isn't it? Nursing rat pups show the effects of enrichment on the brain and the impact of boredom in young and adolescent rats, a boring environment had a more powerful thinning effect on the cortex than an exciting environment had on cortex thickening. Now what are the implications of this for the kinds of education that we are giving our children? One of the mathematics teachers, a third grade math teacher with 22 years experience, complained about the kind of impoverished environment for teaching mathematics that is now mandated because of the dominance of the standardized testing and she said, in her words, "what we do now is drill and kill." In her school, pardon my small diversion here but some of you might want to talk about this in your viewpoints and responses, that in effect for these third graders school has become an experience where they are tested and the testing becomes much more important than the learning process to the despair of good teachers and to the confusion of new teachers who may begin to wonder what they got themselves into. In this third grade school not only do they have the week or more of standardized tests but they have trimester tests given three times a year, each one of which takes a week to prepare the students for the standardized tests. They have pre-testing and post-testing and they also have individual teachers' tests. So this is a situation, widespread in American education, where assessment has replaced learning. Assessment is the goal, learning becomes secondary. I wonder about the effect of the boredom that I would imagine that this is having for the students who have to adapt to something in these classrooms that is presenting itself to them as education. Of course, what about adolescence? I would be interested to have some of your views on this, speaking from your own experience.


And the last one, brain changes were found in young adult rats, middle-aged rats, and even in rats the equivalent of 90-year-old humans. Use it or lose it. The question remained, does a thicker cortex mean a smarter animal? The answer the Berkeley group says according to its data, "Yes!" And she gives examples of that.


That really sums up the essence of this argument that Diamond makes about brain enrichment. I would like you to read and study her article carefully. Think about this in relationship to the other parts of Unit One and Unit Two, the importance of birth bonding, the nature of attachment bonding, all of these kinds of questions. Now we have a third perspective on human development based on the concept of brain enrichment or brain impoverishment and that is really all that I will talk about today. Thank you.
There are faxes for this order.

The required reading for this Forum is Chapter 13, Marian Diamond, Introduction and Chapter 1 in her book Magic Trees of the Mind. What is the neurological basis of Diamond's concept of brain enrichment? What specific components of the brain and nervous system are involved - what is its cellular basis, in terms of the structure of the neuron itself? What is the relationship between brain enrichment and the organism fortunate enough to live in an enriched environment? What are some of the lines of evidence she cites in favor of this point of view? Is the concept of brain enrichment important only for infants and young children? What are some of its implications for our educational system? For family life?

For this forum, each student is asked to write a Viewpoint contribution that deals with Diamonds article, AND relates its themes to one of the enrichment readings in Chapter 14 (Linn, Healy, Kamii and DeVries on Children with Rollers, Borish on NCLB and public education). Or, you may relate Diamonds work on brain enrichment and the crucial nature of the enriched environment to any of the previous articles discussed in Units One or Two.

Form and requirements:
1) It must be at least 3 paragraphs long (it can be more, but not less)
2) Each paragraph must be at least 8 substantial sentences - full sentences, not sentence fragments.
3 There must be an empty, blank line between paragraphs.
4) You must check your spelling and grammar. Please use spellcheck, which means writing your essay in a word processing format and then posting it in Blackboard - an essay filled with spelling errors will not gain credit.
5) Your essay must contain DETAILED discussion, analysis and response to the reading in question. This means that I need to see at least two actual citations (more are even better) from the article - with page numbers from each citation (not from the same page). Actually citing a few words or a sentence from the article in quotes is REQUIRED as is the page number.
6) Writing a Viewpoint Essay for a particular reading must choose their citations from different pages. In other words, if you are writing on an author, you cannot use the same page numbers for your citations as those who have posted before you have done.


Example of a viewpoint essay: Use this as an example :


David S. Ludwig identifies four phases of the childhood obesity epidemic. He claims that the first phase began in the 1970s. The epidemic crosses cultural and economic classes as far as increase in average weight(s) overall. Ludwig asserts, A"Today, about one in three children and adolescents is overweight and the proportions approaches one in two in certain minority groups. One in three is a huge number if we look at the American population of kids. (pg 2325) He points out that many of these kids remain and appear healthy for years, thus have no (apparent) influence on public health. Ludwig describes phase two is the phase he defines us being at presently. He states that this phase is distinguished by considerable weight related problems. Fatty liver related to being over weight, previously unrecognized in pediatric literature before 1980 has been reported as one in three- among the obese children population at the time of his article. He states, A"The incidence of type 2 diabetes among adolescents, though still not high, has increased by a factor of ten in the past two decades and may now that of type 1 diabetes among African American and Hispanic adolescents. (pg 2325)

Phase three is defined as life threatening. Coronary heart disease, high risk for limb amputation, kidney failure requiring dialysis, and premature death are some of the consequences of childhood obesity at this juncture. He further points out, A"Fatty liver will progress to hepatitis and cirrhosis, which may remain asymptomatic until irreversible organ damage has occurred. (pg 2325)Ludwig believes that stage four has irreversible possibilities and outcomes. Children that are obese as children will most likely be obese into and throughout adulthood. He asserts, A"Carrying excessive weight in early in life may elicit irreversible biologic changes in hormonal pathways, fat cells, and the brain increase hunger and adversely affect metabolism. Ludwig goes as far as to say that a parents obesity can affect the Body Mass Index (BMI) of their newborn. In short, he terms this phenomenon perinatal programming. (pg 2326)

According to Ludwig, if childhood obesity is not prevented- the following consequences are eminent. He found that obese children tend to isolate and introvert in their childhood and into adulthood. Furthermore, he found that they are prone to live in poverty and not to complete education beyond high school. This is apparently an outcome of high anxiety and depression. He and his colleagues predict, A"Pediatric obesity may shorten life expectancy in the United States by 2-5 years by mid-century- and affect equal to that of all cancers combined. (pg 2325) This article on childhood has direct implications on our communities. Wherever we live and whatever our economic status, we are all related to and/or have people that we love, care about, and are close to. Ludwigs findings and reports can and will affect each and every one of us somehow. When he stated that he and his colleagues predict childhood obesity to equal the affect to that of all cancers combined, I had to do a double take. I have had two aunties in my immediate family and my grandmother battle with cancer. My grandmother actually died from stomach cancer partly because she didnt like hospitals and failed to report her condition. That is three people close to just me. For every A"me there is a A"you. Me and you makes a A"we. We need to take heed of this article and others like it in order to live and share a full- healthy life for ourselves and with others.




Marian Diamond is an internationally known brain researcher who has been at UC Berkeley and she's been one of a number of people who've done groundbreaking research in the relationship between the brain, growth of the brain, or decline of the brain, and the kind of environment that organisms are in. Her work not only has implications for humans, but in fact I believe she did most of her work with rats. But as you'll see in her reading this concept of the enriched environment has implications for the relationship between the environment and brain enrichment or brain impoverishment. It is not only humans that this theory applies to.


She begins, I'm going to start with the introduction, Experience is the Best Sculptor, and she says that we "once viewed the child's brain as static and unchangeable" but we understand today it's a "dynamic organ that feeds on stimulation and experience." And what's different here about looking at the brain development is we actually look at the brain as an organ. We look and see that, in her language, "the flourishing of branched intertwined neural forests is what can be seen as the result of the proper relationship between the organism and environment at different stages of the life cycle."


She asks a number of questions on page three which are appropriate for you to look at and on the top of page three, "when it comes to the brain, experience does it." So this is not something that is merely an unfolding of genetic patterns. The genes make possible the growth and development of the brain but it is the environment and experience which channel it and which stimulate it, or do not stimulate it. She writes a little bit about this concept of the enriched environment. If you go to page five she says that one of her reasons for wanting to tell the enrichment story is how applicable it is to American education and American children. She says on page five, "the typical American child does not experience an enriched environment." I would like you to read her description in that paragraph and see if that corresponds to your own experience. And so e do not provide an enriched environment for most of our children. There are a few fortunate ones that do get it and maybe many fortunate ones do get it but perhaps even many more do not and so we hear about teen pregnancy, children living in poverty, delinquency, dropout rates, drug abuse, crime, failed teaching methods, the growth of prisons, and so on. And so this is her claim that, in fact, brain enrichment when we're talking about human development we needed a certain point to focus on what's known about the growth of the brain itself.


We move from the introduction to Chapter One (which is the only chapter I've reproduced in this book), "Trees That Grow So Fair: Neural Forests of the Mind." She talks about herself and her interesting childhood and the fact that she became very interested in the hypothalamus, described on page 11 what its function is. She then describes her own life, her marriage to a nuclear chemist, and her arrival at Cornell University, and talks about events in her own life and her interest, on page 12, in the work of Krech, Rosenzweig, and Bennett, and for the first time seeing the link between what was physically there in the animal's brain and its ability to learn. She went down to see them, shed moved to Berkeley by this time, and talked about the work of a man named Donald Head. Head had made observations of rats who had been free-ranging and played with his own children versus laboratory rats and found that the free-ranging rodents ran a much better maze than the locked-up rats. And so from Head's observation his Berkeley team decided to raise baby rats in two kinds of cages: a large enrichment cage (this is on page 13) filled with toys; and a small impoverishment cage. The important thing there is that actually, when these behavioral differences in the groups on the basis of being put in different environments became clear, she then did research that involved removing the brain of a deceased laboratory rat, and she says from both groups, carefully measuring the thickness of the cerebral cortex. The enriched rats had a thicker cerebral cortex than the impoverished rats. It was only 6% thicker but it was highly significant: 9 out of 9 cases showed this. She repeated the experiment and she says this is about 1963. Then in 1964 she was coauthor of a paper called "Effects of Enriched Environments on the Histology of the Cerebral Cortex. She then talks about giving a paper at the American Association of Anatomists in Washington, DC, and showing this evidence. At that time people were less receptive to women scientists than today and a man said, in a loud voice, "Young lady, that brain cannot change." This is a point of view that's still with us today even though it is contradicted by an enormous amount of experimental evidence. So then this idea of brain enhancement, brain enrichment, she talks about the fact that this really involved the shattering of some dogmas that perhaps many of you have heard about as well, that, you know, the brains can't get thicker, they're fixed, that we are loosing 100,000 brain cells every day, and the brain has an intelligence level fixed at birth and it can't change, except to go down after whatever age you pick (8, 10, 12, 14) and she points out that neurologists have measured the dwindling of brain cells in rats and humans over the typical lifespan. But she argues that her group's theory of enriched and impoverished environments could explain this by looking to the source of the experimental brains. Before 1964 she says, the researchers didn't pay much attention to where a brain came from. Researchers got (human) brains from coroners: indigents, alcoholics, and bedridden soldiers. Animal researchers housed mice, rats, and other lab animals in small sterile cages. So she says, "the neurologist's standard model was based on starving brains." And she says, "when researchers collect brain tissue from enriched research animals or from people who have lived healthy, mentally active lives, they do not find a thinning of the cortex or a relentless loss of neurons with age."


After this, the next section is called, "A Rodent's Brain Revealed." I would like you to look at that and to study that picture of the rat's brain on page 18.


I'm going to jump ahead to page 20 to, "The Heart of Enrichment, Nerve Cell Branching." I want you to look on page 21 at the diagram of a typical neuron, or nerve cell. Isn't it extraordinary that the egg and sperm which unite, two cells, contain the potentiality for cell differentiation for all of the thousands and thousands of different cell types that we find in an organism at different stages of its lifecycle development. One of these types is the neuron, of course, very critical, the cells that comprise the basis of the nervous system. The heart of enrichment, she says, is nerve cell branching. So take a look there: the cell body in the middle, the long thin axon going down with branches, and then at the top of the picture the dendrites, which, she describes them, the "luxuriantly branching dendrites, and its thorn-like spines that grow, change shape, or shrink." So look at the dendrites and notice the spines on the dendrites.


Down at the bottom of page 22 she says some interesting descriptions of the brain and I'd like you to pay attention to the bottom of page 22, "surface areas," and the fact that this concept of surface areas is necessary to understand how plant leaves collect solar energy and they are necessary to understand how our lungs absorb oxygen and liberate carbon dioxide or our small intestines liberate food. But nothing, she says, holds a candle to the human brain. So please do look at that concept of surface areas.


Holloway's work on page 23, the branching in part was causing the cortex to grow thicker. Diamond had speculated that the branching of dendrites might explain this additional 6% thickness of the enriched cerebral cortex. And she suggests the term "little trees" on page 23 and this is well worth reading.


Go to page 25, "Nubbins, Umbrellas, and Lollipop Trees." These are her colloquial terms for what can happen to the dendritic spines. But first it is necessary to understand the term "synapse." I would expect many of you had this in elementary biology courses but it is good to review it. When the electrical signal traveling down the axon reaches the button-like ending at the wire's terminus, a chemical message crosses the gap in the synapse and we get the neurotransmitters.


Turn to page 26. Again I'd like you to be familiar with the diagram there:

the sending nerve cell,

the axon

notice the little circle where the axon is adjacent to the dendritic spine and then the big circle that magnifies that

electrical input from the sending nerve cell

the release of neurotransmitters

the electrical output from the dendritic spine


As you read this right now, probably hundreds of thousands of such electrical inputs are simultaneously being transmitted along the neurons of your brain at every level from the peripheral nervous system, through the spinal cord, through the brain stem, the medulla, through all of the different structures such as the thalamus, hypothalamus (that regulate thirst, hunger, and so on), through the limbic system and its amygdala (that is primarily connected with feelings), and through all of the different parts of the cerebral cortex (which regulate fine movement, perception, thought, and so on). All of this, this is the mechanism through which this text plays, the neurotransmitter. You begin to understand then what Parkinson's disease is a disease where dopamine, one of the main transmitters, is not being produced and this leads to failure, in particular, of motor neurons. So it is very important to understand what this simple but correct model of neurons and how they interconnect.


On page 26 and 27, the Diamond group and other researchers found that bees' dendritic spines themselves grow, change shape, or shrink as an animal experiences the world. The work of James Conor is important, how social isolation could affect a rat's brain, especially in an elderly rat. Two groups of advanced-age rodents, some housed with their aged friends, others alone. When the animals died he found that spines resembled either three-dimensional lollipops with the ball on the stalk like Tootsie-Pops or they were short squat nubbins with no stalk. And the older rats alone had a lot of these nubbin spines, so could there be various lollipop shapes depending on experience in a lonely deprived animal? Could the lollipop spines go unused and eventually collapse into gnarled old nubbins? This is her statement of what the primary mechanism is of either brain enrichment or brain impoverishment, that it has to do with changes that are produced in the dendritic spines which affect the process of neural communication and pathways in the brain. She then cites the work of Richard Coss on page 27. Bees that made one single flight out into the meadows were very different in what had happened to their dendritic spines than bees that had remained in the hive permanently. The Coss team found that a number of spine shapes, not just lollipops and nubbins, depending on the bees' level of stimulation from the outside world. I would like you to look at this. This is very important. Experience, even an hour or two of flying through the meadow, had a dramatic enlarging effect on a bee's dendritic spines. Coss found similar changes in the dendrites of socially enriched and deprived jewelfish. Another team found changes in young Myna birds, and so on. So this is really important.


On page 29 there is a marvelous quote from Richard Coss, who says, "an animal is only as smart as it needs to be." And Diamond goes on to add that a nurse bee inside the hive just apparently doesn't need to be as smart as the worker buzzing through the meadows and orchards. So, "just as the muscles are programmed to grow smaller and weaker with disuse, the dendritic trees and spines will shrivel and the cortex grow thinner with lack of mental activity," she tells us also on page 29. So the implications of this are clear, I believe, that we really need throughout the lifecycle to think about this question of the enrichment environment because it is the environment and our relationship with the environment which is the key overriding factor in determining what kinds of changes will or will not happen in our dendritic spines, which in turn affect neural pathways, which in turn affect every aspect of our human life experience from the maintenance of our intelligence, to our motor coordination, to our interest in life, to our interaction with others, and so on.


In page 30 under the heading "Rats Revisited," she gives on the next two pages quite a good summary of the work of the Diamond lab group at UC Berkeley. They studied enrichment and impoverishment with great intensity. They wanted to learn everything. So they split animals into three groups:

1) A standard intermediate condition with three rats in a small cage with no toys,

2) Impoverishment conditions with a solitary rat in a small cage without toys, and

3) An enrichment condition in which 12 rats inhabit a much larger cage with a rotating array of toys such as exercise wheels, platforms, and ladders.


She tells us on page 30 the findings are potentially valid for students in dormitories, prisoners in solitary confinement, senior citizens living together in comfort or in poverty, for children treated well or abused. And so with the three cage types they formulated the basic principles of brain enrichment and these are on page 31. I would like you to study these and think about them and use them as a basis perhaps for your viewpoints and responses. Remember also that the Wiki project, which I have asked you all to start thinking about during the past weekend this week, the Wiki project asks you in some way, whatever your chosen topic and problem formulation is, in relation to human development, asks you in some way to relate it to the concept of the enriched environment. So what she says on page 31, "the impact of a stimulating or boring environment is wide-spread throughout the regions involved in learning and remembering." How interesting, a stimulating environment or a boring environment. I ask myself, is this the limit of the different kinds of environments that one could have? I ask, for instance, what about the type of environment that prisoners at Abu Ghraib had where they were subjected to many forms of humiliation and torture? They were certainly being stimulated in many cases, it certainly wasn't boring, and so we could certainly have a broader discussion of environments. But stimulating or boring is probably a good place to begin. Neurons in other parts of the brain besides the cerebral cortex can also respond. I should tell you that there has been peer-reviewed work showing that actually new neurons can be generated in the adult phase of the lifecycle even though Diamond's model focuses primarily on the dendritic spines and this seems to be the key area. The paradigm shift has been so great in brain research, the older view that the brain with no more neurons growing after a very early age and development and then the death of 100,000 cells a day. You might hear this in the popular press. You might hear this by people with different kinds of theoretical or social axes to grind, but in fact even at the level of new neuron production it is clear now that, not only in humans but also in other organisms, entirely new neurons can be produced in the adult phase of the lifecycle. I'll try to put up an electron micrograph picture of one of these for you.


Enriching the environment of a pregnant female rat can result in newborn pups with a thicker cerebral cortex. Now that's interesting, isn't it? Nursing rat pups show the effects of enrichment on the brain and the impact of boredom in young and adolescent rats, a boring environment had a more powerful thinning effect on the cortex than an exciting environment had on cortex thickening. Now what are the implications of this for the kinds of education that we are giving our children? One of the mathematics teachers, a third grade math teacher with 22 years experience, complained about the kind of impoverished environment for teaching mathematics that is now mandated because of the dominance of the standardized testing and she said, in her words, "what we do now is drill and kill." In her school, pardon my small diversion here but some of you might want to talk about this in your viewpoints and responses, that in effect for these third graders school has become an experience where they are tested and the testing becomes much more important than the learning process to the despair of good teachers and to the confusion of new teachers who may begin to wonder what they got themselves into. In this third grade school not only do they have the week or more of standardized tests but they have trimester tests given three times a year, each one of which takes a week to prepare the students for the standardized tests. They have pre-testing and post-testing and they also have individual teachers' tests. So this is a situation, widespread in American education, where assessment has replaced learning. Assessment is the goal, learning becomes secondary. I wonder about the effect of the boredom that I would imagine that this is having for the students who have to adapt to something in these classrooms that is presenting itself to them as education. Of course, what about adolescence? I would be interested to have some of your views on this, speaking from your own experience.


And the last one, brain changes were found in young adult rats, middle-aged rats, and even in rats the equivalent of 90-year-old humans. Use it or lose it. The question remained, does a thicker cortex mean a smarter animal? The answer the Berkeley group says according to its data, "Yes!" And she gives examples of that.


That really sums up the essence of this argument that Diamond makes about brain enrichment. I would like you to read and study her article carefully. Think about this in relationship to the other parts of Unit One and Unit Two, the importance of birth bonding, the nature of attachment bonding, all of these kinds of questions. Now we have a third perspective on human development based on the concept of brain enrichment or brain impoverishment and that is really all that I will talk about today. Thank you.

I need a literature review on the topic above. I am including in the email the problem statement that I wrote, the introdutory paragraph for the literature review and the topics that I want you to conduct the literature review on. Please just focus on topics that I have stated. I have also included a reference page from my project for your information in case you wanted to use some of these sources.


Problem Statement

There is a problem in male teacher retention in early childhood education. Male teachers represent only 3% of all early childhood teachers in the United States (Center for the Child Care Workforce, 2002; Nelson 2002). Despite national efforts to recruit, prepare, and retain qualified teachers, the percentage of male teachers in early childhood has been declining since the 1970s (Robinson, 1988; Nelson, 2002). The lack of men in early childhood education negatively impacts staff diversity, employment opportunities for men, and school success in young children. Some reasons why so few men remain in the field of early childhood education include child abuse suspicion, subtle discrimination, social isolation, pressure to move into administrative positions away from children, and a double standard for behavior and performance (Sargent, 2001). A descriptive case study that investigates the reasons the 3% of men in early childhood education remain in the field would yield some solutions that could reverse the current trend.

Research Questions:

1. Why do the 3% of men in early childhood education remain in the field?

2. How do the views of men in early childhood by staff and administrators impact male teacher retention?

3. How do certain sociological perspectives impact male teacher retention in early childhood education?

CHAPTER TWO

LITERATURE REVIEW

The purpose of this chapter is to review research findings related to male teacher retention and attrition in early childhood programs. Major findings from teacher retention studies are also reviewed to provide a context for understanding the factors related to why certain male teachers have chosen to remain in a field dominated by women. In order to provide a theoretical framework for this descriptive case study, sociological perspective on gender, men working in non-traditional professions, and how social interactions in the workplace impact male teacher career decisions will are examined. Research findings are organized around three categories related to male teacher retention in early childhood education: (a) male teacher retention and in early childhood programs, (e.g., public schools, child care centers, Head Start programs), (b) perceptions of men in child care and non-traditional professions, and (c) sociological perspectives and male teacher retention (e.g., gender, sociology and the culture of schools, societal views of men in child care). Conceptual and methodological considerations related to teacher retention research are also considered as well as male involvement/fatherhood initiatives in education programs. A critical examination of the reasons why male teacher remain in this field is critical as programs look for ways to retain highly qualified teachers.

Teacher Retention and Attrition



Male Teacher Retention



Impact of Male Teachers in Early Childhood



Perceptions of Men in Early Care and Education



Men in Non-traditional Professions (Child Care, Teaching, Nursing, etc.)



Sociology and Culture of Early Childhood Program



Other Sociological Perspectives in Male Teacher Retention (Gender/Sex-Role Model)


Thanks for your assistance in writing this literature review.

Calvin Moore, Jr.


References for you information:


Acker, J. (1990). Hierarchies, jobs, bodies: A theory of gendered organizations. Gender & Society 4: 139-158.



Bredekamp, S. & C. Copple. (1998). Developmentally appropriate practices for early childhood programs. (Rev. ed). Washington, DC: National Association for the Education of Young Children.



Carrington, B. (2002). A quintessentially feminine domain? Student teachers? constructions of primary teaching as a career. Educational Studies 28(3): 287-303.



Center for Child Care Workforce & Human Services. (2002) Estimating the size and components of the U.S. child care workforce and caregiving population: Key findings from the child care workforce estimate (Preliminary report).Washington D.C.



Chilwinak, L. (1997). Higher education leadership. Washington, DC: George Washington University.



Colley, A. (2002). What can principals do about new teacher attrition? Principal 81(4): 22-24.



Creswell, J. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage Publications.



Cunningham, B. & Watson, L. (2002). Recruiting male teachers. Young Children 57(6): 10-15.



Davey, L. (1991). The application of case study evaluation. ERIC/TM Digest.



Elicker, J. (2002). More men in early childhood education? Why? Young Children 57(6): 50-54.



Encarta MSN Encyclopedia. (2002). Sociology.



Fredricks, J. (2001). Why teachers leave. The Education Digest 66(8): 46-48.



Gheradi, S. (1995). Gender, symbolism, and organizational cultures. New York: Sage.



Hancock, D. (1999). Encouraging teachers to remain in the profession: A model for stress reduction. The Education Forum 63(2): 166-172.



Hansot, E. & D. Tyack. (1988). Gender in America public schools: Thinking institutionally. Signs: Journal of Women in Culture and Society 13(4): 741-61.



Horn, W. (1998). Father facts, (3rd ed). Gaithersburg, MD: National Fatherhood Initiative.



Ingersoll, R. (2002). The teacher shortage: A case of wrong diagnosis and wrong prescription. National Association of Secondary School Principals Bulletin, 86(631): 1-12.



Ingersoll, R. (2001). Teacher turnover and teacher shortages: An organizational analysis. American Educational Research Journal 38(3): 499-534.



Kennedy, N. M. 1991. Policy issues in teacher education. Phi Delta Kappan, 72: 658-665.



Merriam, S. (1998). Case study research in education: A qualitative approach. San Francisco: Jossey-Bass.



Miles, M. & A. M. Huberman (1984). Qualitative data analysis: A sourcebook of new methods. Beverly Hills, CA: Sage.



Moore, C. (2000). The thinking book curriculum: For early childhood educators. Birmingham, AL: Esquire Production, Inc.



National Commission on Teaching and America''s Future. (1997). Doing what matters most: Investing in quality teaching. New York: Author.



Nelson, B. (2002). The importance of male teachers and why there ar so few: A survey of NAEYC members. Unpublished report.



Nelson, B. & B. Sheppard, eds. (1992). Men in child care and early education: A handbook for administrators and educators. Minneapolis, MN: Min in Child Care Project.



Neugebauer, R. 1994. Recruiting and training men in your center. Child Care Information Exchange, May: 8-11.



Newman, J. (1995). Gender and cultural change, in: C. Hzin & J. Newman (Eds) Gender, culture, and organizational change: Putting theory into practice. London: Routledge.



Owens, R. (1998). Organizational behavior in education (6th ed.). Needham Heights, CA: Allyn and Bacon.



Parsons, T. (1955). Family socializations and interaction process. Glencoe, IL: Free Press.



Pleck, J. (1981). The myth of masculinity. Cambridge, MA: MIT Press.



Robinson, B. (1988). Vanishing breed: Men in child care programs, Young Children, 43(6): 54-58.



Sanders, K. (2002). Men don?t care? Young Children 57(6): 44-48.



Sargent, P. (2002). Under the glass: Conversations with men in early childhood education. Young Children 57(6):22-30.



Sargent, P. 2001. Real men or real teachers: Contradictions in the lives of men elementary school teachers. Harriman, TN: Men''s Studies Press.



Schlechty, P.C., & V. S. Vance. (1983). Recruitment, selection, and retention: The shape of the teaching force. The Elementary School Journal, 83, 469-487.



Seifert, K. L. 1988. Men in early childhood education. In Professionalism in early childhood education, eds. B. Spodeck, O.N. Saracho, & D.L. Peters, 101-116. New York: Teachers College Press

.

Skelton, A. (1993). On becoming a male physical education teacher: The informal culture of students and the construction of hegemonic masculinity. Gender and Education 5(3): 289-304.



Stake, R. (1995). The art of case study research. Thousand Oaks, CA: Sage.



Sumsion, J. (2000). Rewards, risks, and tensions: Perceptions of males enrolled in an early childhood teacher education program. Asia-Pacific Journal of Teacher Education 28(1): 89-98.



Sweeney, J.C. (1987). Development and testing of a longitudinal model designed to examine the factors that influence the career paths of Iowa State University teacher education graduates. Doctoral dissertation, Iowa State University, 1987. (University Microfilms International No. 8716827)



Tellis, W. (1997). Introduction to case study. The Qualitative Report (On-line Serial) retrieved June 16, 2003 http://www.nova.edu/sssQR/QR3-2/tellis1.html



Texas Education Agency. (1994). Public education information management system data. Austin, TX: Texas Education Agency.



U. S. Department of Health and Human Services, Administration for Children, Youth, and Families. (1998). Head Start performance standards and other regulations. Washington, DC: Head Start Bureau.

Whitebrook, M., C. Howes, and D. Phillips. (1998). Who cares? Child care teachers and the quality of care in America: Final report, National Child Care Staffing Study. Washington, DC: Center for the Child Care Workforce.



Yin, R. (1984). Case study research: Design and methods (1st ed). Beverly Hills, CA: Sage Publishing.



Yin, R. (1994). Case study research: Design and methods (2nd ed). Beverly Hills, CA: Sage Publishing.



Webster?s American Family Dictionary. (1998). New York: Random House, Inc.

8 pages total for 2 case studies with reference pages.

2 scenarios included

Scenario 1: 4 pages with 1 reference page

Mrs. Elli Baker is a 73-year-old female who is transferred to the emergency room after collapsing in her backyard. Just prior to this, while talking to her friend on the phone, she seemed confused and beside herself. Upon arrival to the ER, she complains of some dyspnea with an increase in her respiratory rate and pulse. Her previous history includes diabetes and hypertension. She has recently started a new blood pressure medication: lisinopril. Her other medications include metformin and hydrochlorothiazide. The nurse is able to ask Mrs. Baker a few questions, but she then becomes unresponsive and has a more difficult time breathing.

Reflect on your analysis of the geriatric patient in multisystem failure by doing the following:

A. Explain key immediate assessments you should make that would help assess the patients homeostasis, oxygenation, and level of pain.

Note: Be sure to include physical observations and observations made through technology and in the laboratory.

B. Describe the technological tools you would utilize to assess and treat the patient.

1. Explain why you would utilize these specific tools.

2. Explain the benefits of the tools in determining the patients status.

C. Discuss how you prioritized data collection in the scenario

D. Compare how you would assess pain in a geriatric patient who is alert and conversant to a geriatric patient who is not alert.

E. Discuss how you would manage pain in a geriatric patient experiencing multisystem failure and showing signs of pain (e.g., moaning, restlessness, grimacing) who is not alert enough to respond to questions.


Note: Assume you have standing doctors orders to administer acetaminophen 500 mg by mouth or morphine 0.05 mg/kg IV or morphine 0.1mg/kg IM.


1. Discuss how you would know whether your choice of pain management was successful.

2. Discuss what you learned regarding assessment of the geriatric patient.


F. Identify the collaborative team members pertinent to the care of the geriatric patient in the scenario, including the emergency room nurses response to changes in the level of consciousness and increasing respiratory distress.


Scenario 24 pages with 1 reference page

Elderly patients have many needs that younger patients do not. Being discharged from the hospital after surgery can present additional issues beyond those associated with physical recovery. In this task, you will assume the role of a case management nurse who is responsible for determining the most appropriate discharge placement for an elderly patient named Mr. Trosack. The patient is to be discharged from the hospital after undergoing total hip replacement surgery.
Review the Elder Care Case Study (attached below) for information on your patient. You will use this information to complete this task.
Case Study



As a nurse in a high-risk obstetric clinic, you have just accepted the assignment of Mrs. Rita Trosacks case management. As such, you are responsible for determining how to best meet her needs for care upon the initial visit. From the patients chart you are able to ascertain the following information:



CHART



Rita Trosack, a 43-year-old Caucasian woman, has been married for six years to her husband, Peter, a 46-year-old Caucasian man who is a financial consultant. She was raised in a small town in the Midwest where her Irish grandparents settled in the early 1900s.



Rita went to college in Chicago, where she received a bachelors degree in finance, and has lived there ever since. Either her middle-class family, who still raise cattle on the family farm, visit her in Chicago, or she goes home for a visit at least once a year usually around the Thanksgiving holiday. After college, Rita was eager to move away from the farm, and she now enjoys the lifestyle in a big city.



Peter comes from Chicago. His family has lived there since his great grandparents emigrated from Poland just before World War I. His family still owns a bakery in the heart of the city where many members of Peters family work. His mother died two years ago, and his father still lives in their apartment located over the store.



Rita and Peter live in a condominium in downtown Chicago, close to the lake, and both work an average of 60 hours a week in the financial district. They were both raised as Catholics; however, neither chooses to practice the religion at this time.



After about two years of trying to conceive a child, Rita missed her menstrual period, began feeling nauseated, and started dry heaving every morning. Her breasts became tender, and she was experiencing fatigue so severe that she had to cut down her hours at the bank where she worked as an officer. She performed an early pregnancy test, which was positive. Since her last menstrual period (LMP) began on April 20, 2008, she calculated her due date as January 27, 2009.



Rita attended her first prenatal visit with Dr. Zimmerly in early June. He confirmed the estimated date of delivery (EDD) as late January 2009. Due to advanced maternal age, the chorionic villus sampling (CVS) was recommended to screen for fetal genetic defects. Rita scheduled the test for early July, began taking prenatal vitamins, and has stopped drinking her usual glass of wine with dinner. Both Peter and Rita gave up smoking over 20 years ago, so they are happy that this is not an issue for the unborn child. The physician also gave her basic information about nutrition and exercise, education regarding the normal signs and symptoms of pregnancy, proper seatbelt use, as well as warning signs that might signal problems to report to a physician. Since Rita is of normal weight for her height and has always been in good health, she is very happy about her pregnancy



In July, the result of the CVS indicated that the fetus is afflicted with Tay-Sachs disease. The couple was given a referral to a high-risk perinatal clinic by the physician.



You are assigned as Ritas case manager. You are to meet with the couple to gain more information.



FAMILY INTERVIEW RESULTS:



Rita and Peter are very distraught that their child has inherited Tay-Sachs disease. They do not understand how this could have happened. They vacillate between denial and acceptance of the situation. Rita blames herself for working so hard that it affected the baby. Peter is very angry and usually denies that anything will happen to the child and that the test is wrong. At this time, they refuse to consider the possibility of abortion because of religious and personal beliefs.



During the interview you determine the following family history:



Ritas parents:

Ritas mother is 70 years old, alive and well. Her father is 72 years old, alive and well. Her two sisters are alive and well. Her maternal grandparents are deceased??"they had three children (two girls and one boy, who are all alive and well). Her paternal grandparents are deceased??"they had two children (one son who died at an early age of unknown causes, and another son who is alive and well).



Peters parents:

Peters mother died at 68 years old from pancreatic cancer; his father is 72 years old, alive and well. His maternal grandparents are deceased??"they had four children (three girls and one boy, the rest who are alive and well). His paternal grandparents are deceased??"they had three children (one son who died at an early age of unknown causes, another son who is alive and well, and a daughter who died at an early age of unknown causes).



Write an essay (suggested length of 4 pages) in which you analyze the case study information to complete the following:

A. Assessment of the Situation (suggested length of 2 pages)

1. Identify at least three healthcare issues that you, as the case manager, must address when working with an interdisciplinary team to determine the most appropriate discharge plan for Mr. Trosac.

a. Explain why these are important issues when planning for management of the elderly discharge patient.

2. Identify three to five members to make up an interdisciplinary team to determine the most appropriate discharge placement for Mr. Trosack.

a. Describe the role expected of each person on the team.

3. Analyze the issues from the safety assessment that could affect the determination of discharge placement.



Note: You may include any other safety issues you think might be a problem if this patient returns home upon discharge.



B. Discharge Plan of Care (suggested length of 2 pages)

1. Explain to the family what care Mr. Trosack needs and how he should be discharged based on the interview data and the safety assessment. Your explanation should include the following:

a. Discuss the ability of the family to adequately care for Mr. Trosack if he is discharged home.

b. Discuss how social isolation affects an older adults recovery from surgery or illness.

c. Discuss the ways psychological factors play a role in the recovery process.

2. Recommend a discharge placement for Mr. Trosack with supportive documentation.


sources, include all in-text citations and references in APA format.

social unit could be a country: such as Japan, the United Kingdom and so on
You should complete this assignment in the following order:
Step One: Write a paragraph that redefines your social unit clearly and concisely and articulates how it is related to globalization ? either affect by it or is affecting it.

Step Two?find a total of FOUR (4) peer-reviewed sources that relate your social unit to globalization with regard to culture, population, and perhaps environment. Then list your four sources in proper citation format for items in a Reference List

Step Three?Write a full paragraph or two below each source that explains its 1) main argument, 2) a summary of the information in it relevant to your social unit, and 3) an explanation of how it helps you understand the relation of your unit to globalization with a reference to one of our course themes (culture and worldview, population, or the environment).

Social Unit Redefinition:Is the social unit redefined so it is no longer ethnocentric (i.e., American, or ?safe?)? Is the social unit delimited in scope so that it is both robust enough to be able to find information but also narrow enough to be tractable?


Source (1-4): Thesis and Summary: Does the paper provide a clear summary of the main argument(s) of the article with respect to the chosen social unit? Is the summary of the evidence sufficient to understand the primary argument?

Source 1-4: Relevance: Does the paper clearly explain how this article helps one to understand the relationship between the chosen social unit and globalization with an emphasis on a single global issue (culture, population, environment)?