Assessing Pain in in Post Operative Breast Cancer Patients

Assessing Pain in in Post Operative Breast Cancer Patients Comparison between Brief  Pain  Inventory (BPI) and Numerical Rating Scale (NRS) for post-operative pain assessment in Saudi Arabian  breast cancer patients. Questions Does  BPI assess  post-operative breast cancer pain  more  accurately than NRS? Summary: Effective pain assessment is one of the  fundamental  criteria  of the  management of  pain. It involves  the  evaluation of pain intensity, location of the pain and response to treatment. There are  a  number  of multi and one-dimensional assessment tools  that  have already been established to assess cancer pain. Among these  are the  Brief Pain Inventory (BPI) and  the  Numerical Rating Scale (NRS), Breast cancer is  a growing public  concern in Saudi Arabia  as rates continue to escalate, with patients  also  suffering multiple problems after surgery. Therefore, my research aim is to  conduct a  comparative study  of tools  used to  assess post-operative breast cancer pain  in  Saudi Arabian  patients  and determine which is the most effective. In this process I will use questionnaires for both nurses and patients to collect data,  followed by statistical analysis and  a  comparative  study between  the  BPI and NRS. Research Hypothesis: BPI assesses  post-operative breast cancer pain  in Saudi Arabian  patients  more  accurately than NRS.   Null hypothesis: There is no significant difference between BPI and NRS  as tools for  assessing post-operative breast cancer pain  in  Saudi Arabian  patients Background: Pain is defined as  Ã¢â‚¬Ëœthe normal, predicted physiological response to an adverse chemical, thermal or mechanical stimulus related with surgery, trauma or acute illness’ (Carr and Goudas, 1999).  Pain assessment is a crucial component for the effective management of post-operative pain in relation to breast cancer. The patient’s report is the main  resource  of information  regarding the  characterisation and evaluation of pain; as such, assessment is  the ‘dynamic method of explanation of the syndrome of the pain, patho-physiology and  the basis for  designing a protocol for its management’  (Yomiya, 2011). A recent survey  questioned almost 900 physicians  897 and found  that  76% reported substandard  pain assessment  procedures  as the single most important barrier  to  suitable  pain management (Roenn  et al, 1993). Breast cancer is characterized by  a  lump or thickening in  the  breast, discharge or bleeding,  a  change in colour of  the  areola, redness or pitting of skin  and a  marble like area under  the  skin (WebMD, 2014[A1]). Breast cancer  has a high prevalence rate globally and is the second most diagnosed cancer in women. Approximately  1.7 million cases were reported in 2012  alone  (WCRFI, 2014). In 2014,  just over  15,000  women  have  already  been  diagnosed with breast cancer: this figure is predicted to rise to around 17,200 in 2020 Breast cancer  has also been identified  as one of the major cancer related problems in Saudi Arabia, with 6,922 women were  assessed[A2]  for breast cancer between 2001-2008 (Alghamdi,  2013[A3]). D  Pain assessment tools Polit  et al  (2006) conducted  a systematic review of the evidence base  and  recorded a total of  80 different assessment tools that  contained  at least one pain item. The  tools were then  categorised into pain tools  (n=48)  and general symptoms tools  (n=32) . They were then  separated into uni-dimensional  tools  (which measure the pain intensity)  and multi-dimensional tools  (include more than one pain dimension). 33%  of all pain tools  (n=16) were uni-dimensional, and  50% of all  general symptom tools  (n=16)were uni-dimensional. 58% of the uni-dimensional tools  employed  single  item scales such as  the  Visual  Analogue  Scale (VAS), Verbal Rating Scales (VRS)  and NRS (Numerical  Rating  Scale). The most common dimension  included  was pain intensity, present in 60% of  tools. In  the assessed tools, 60% assessed pain  in a  multi-dimensional  format. Among  pain tools,  67% were found   to be  multi-dimensional  compared with 50% of the general symptom tools.  38% of all multi-dimensional tools were two-dimensional.  The most  commonly used  dimension was  Ã¢â‚¬Ëœintensity’,  present  in 75% of  all  multi-dimensional tools. Other common  dimensions  include  interference, location  and beliefs. All the dimensions were specifically targeted by two particular tools which were disease-specific tools and tools that measure pains affect, beliefs, and coping-related  issues[A4]. Multidimensional Pain assessment tools: F  The  adequate measurement of pain  requires  more than one tool. Melzack and Casey (1968)  highlight that  pain assessment  Ã¢â‚¬Ëœshould include three dimensions which are sensory-discriminative, motivational-affective and cognitive-evaluative’.  This builds on the  earlier  proposal of  Beecher (1959)  who considered that all tools should include the  two dimensions  of  pain and reaction to pain. Cleeland (1989)  considered that  the  two dimensions  should be classified  as sensory and reactive. Sensory dimensions  should record  the intensity or severity  of pain  and the reactive dimensions should include accurate measures of interference  in the  daily function  of the patient.   Multi-dimensional pain assessments generally consist of  six  dimensions: physiologic, sensory, affective, cognitive, behavioural and sociocultural (McGuire, 1992). Cleeland (1989)  interviewed patients and  found  that  seven items could effectively measure the intensity and effects of the pain in daily activities: these  comprise  of  general activity, walking, work, mood, enjoyment of life, relations with others and sleep. These elements were later subdivided  into two groups: ‘REM’  (relations with others, enjoyment of life and mood) and  Ã¢â‚¬ËœWAW’  (walking, general activity and work). Later, Cleeland  et al  (1996) developed  the  Brief  Pain  Inventory (BPI) in both  its  short and long form.  It was designed  to capture two  categories  of interference such as  activity and affect on  emotions.  The  BPI provides  a relatively  quick and easy method  of measuring  the  intensity  of pa in  and the  level of  interference  in the  daily activities of the  sufferer. With the BPI  tool, patients are graded  on  a 0-10 and it  was  specifically  designed  for the  assessment of  cancer related pain. Patients  are  asked  about the intensity of the pain that they are experiencing at present, as well as the pain intensity over  the last 24 hours as  the  worst, least  or  average  pain (also  on a scale of 0-10). Each  scale is bound  by the words ‘no pain’  (0) and  Ã¢â‚¬Ëœpain as bad as you can imagine’  (10). Patients are also  requested  to rate the degree to which pain interferes  with their  daily activities within the seven  domains  on a scale of 0-10.  that comprise general activity, walking, mood, sleep, work, relations with other persons, and enjoyment of life using similar scales of 0 to  10[A5]. These scales are only confined by the words ‘does not interfere’ and ‘interferes  completely[A6]’ (Tan  et al, 2004).  Validation of BPI across the world among the different language people has already been justified.  [A7]Additionally, the localization of the pain in the body  could be  [A8]assessed and details of current medication are assessed (Caraceni  et al, 1996). Uni-dimensional pain assessment tool:   Previous studies  have  shown  that  the  Numerical  Rating  Scale (NRS) had the power to assess pain intensity for patients  experiencing chronic pain and was also an effective assessment tool for patients with cancer related pain. The  NRS consists of a numerical scale range between 0-100 where 0 was considered as one extreme point represented no pain and 100 was considered other extreme point which represented bad/ worse pain  (Jensen et al, 1986). Turk  et al  (1993) developed  an  11 point  NRS (scale 0-10) where 0 equalled  no pain and 10  equalled  worst pain. Though cancer pain differs from acute, postoperative and chronic  pain experiences, the most common feature is its subjective nature. [A9]  In this regard a consensus meeting on cancer pain assessment and classification was held in Italy in 2009  with the  recommendation that  pain intensity should be measured  on a  scale  of  0-10 with  Ã¢â‚¬Ëœno pain’à ‚  and  Ã¢â‚¬Ëœpain as bad as you can  imagine[A10]’  (Hjermstad  et al.,  2011). Krebs  et al.  (2007) categorised NRS scores as mild (1–3), moderate (4–6), or severe (7–10). A rating of  4 or 5  is  the most commonly recommended lower limit  for moderate pain and 7 or 8 for severe pain. Aimed at moderate pain assessment,  For the purpose of clinical and administrative use the  recommendation for moderate pain assessment on the scale is a score of 4. Importance of post- operative pain assessment: Post-operative pains  is  very common after surgery  and  the  use of  medication  often  depends  on the intensity of pain  that the patient is experiencing  (Chung  et al, 1997). Insufficient assessment of post-operative pain  can have a  Ã¢â‚¬Ëœsignificant detrimental  effect on raised levels of anxiety, sleep disturbance, restlessness, irritability, aggression, distress and suffering’  (Carr  et al,  2005). Additional  physiological  effects can include  increased  blood pressure, vomiting and paralytic ileus, increased adrenaline production, sleep vein thrombosis and pulmonary embolus (Macintyre and Ready, 2002). Effective post-operative pain assessment ensures better pain management  and can significantly reduce the risk of the symptoms listed above, giving minimal distress or suffering  to patients  and reducing  potential complications (Machintosh, 2007). References: Alghamdi IG, Hussain II, Alhamdi MS, El-Sheemy MA (2013) Arabia: an observational descriptive epidemiological analysis of data from Saudi Cancer Registry 2001-2008. Dovepress. Breast cancer: Targets and therapy; 5: 103-109. Caraceni A, Mendoza TR, Mencaglia E (1996) A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain; 65: 87-92. Carr D and Goudas L. C. (1999) Acute pain. Lancet 353, 2051-2058. Carr EC, Thomas NV, Wilson-Barnet J (2005) Patient experiences of anxiety, depression and acute pain after surgery: a longitudinal perspective. International Journal of Nursing Studies. 42(5): 521-530. Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anaesthesia and Analgesia 85: 808-816.   Cleeland CS (1989) Measurement of pain by subjective report. Issues in pain measurement. New York: Raven Press; pp. 391-403. Cleeland CS, Nakamura Y, Mendoza TR, Edwards KR, Douglas J, Serlin RC (1996) Dimensions of the impact of cancer pain in a four country sample: new information from multidimensional scaling. Pain 67 (2-3): 267-273. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, Fainsinger R, Aass N, Kaasa S (2011) Studies comparing numerical rating scale, verbal rating scale and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. Journal of pain and symptom management. 41 (6): 1073-1093. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27: 117-126. Krebs EE, Carey TS, Weinberger M (2007) Accuracy of the pain numeric rating scale as a screening test in primary care. Journal of general medicine. 22(10): 1453-1458. Machintosh C (2007) Assessment and management of patients with post-operative pain. Nursing Standard. 22 (5): 49-55. Macintyre PE, Ready LB (2002) Acute pain management. Second edition, WB Saunders, Edinburgh. McGuire DB (1992) Comprehensive and multidimensional assessment and measurement of pain. Journal of pain and symptom management; 7(5): 312-319. Melzack R and Casey KL (1968) Sensory, motivational and central control determinants of pain: a new conceptual model. In: Kenshalo DR, editor. The skin senses proceedings. Springfield IL: Thomas; pp. 423-439. National Breast Cancer Foundation (NBCF): 2014;  http://www.nbcf.org.au/Research/About-Breast-Cancer.aspx Polit JCHC, Hjermstad MJ, Loge JH, Fayers PM, Caraceni A, Conno FD, Forbes K, Furst CJ, Radbruch L, Kaasa S (2006) Pain assessment tools: Is the content appropriate for use in palliative care? Journal of pain and symptom management, 32 (6): 567-580. Roenn JHV, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ (1993) Physician attitudes and practice in cancer pain management. A survey from the Eastern Cooperative Oncology Group. Annals of Internal Medicine, 119(2): 121-126. Tan G, Jensen MP, Thornby JI, Shanti BF (2004) Validation of the brief pain inventory for chronic non-malignant pain. The Journal of Pain. 5(2): 133-137. Turk DC, Rudy TE, Sorkin BA (1993) Neglected topics in chronic pain treatment outcome studies: determination of success. Pain (53):3–16. WebMD (2014)  http://www.webmd.com/breast-cancer/guide/overview-breast-cancer. World cancer research fund international (WCRFI): 2014;  http://www.wcrf.org/cancer_statistics/data_specific_cancers/breast_cancer_statistics.php. Youmiya K (2011) Cancer pain assessment. The Japanese Journal of Anesthesiology. 60(9): 1046-1052. [A1]I would consider using a more reputable source for describing medical symptoms themselves (Grey’s Anatomy, WHO guidelines etc) [A2]and treated? [A3]Is it worth commenting that breast cancer reporting rates in SA might be different from actual prevalence? Lack of awareness regarding certain cancers often results in late diagnosis or misdiagnosis. [A4]This sentence is unclear. I am assuming that you are stating that all dimensions are present in two particular tools? [A5]I’ve deleted this as you have highlighted the same domains in the previous paragraph and the reader will already be familiar with this term. [A6]Sentence shows up on copyscape / turnitin but it’s fine as a directly referenced quote. [A7]Is this sentence stating that the BPIs valid internationally because it has been adjusted culturally / linguistically for all groups? [A8]Are you making a suggestion that it could be assessed, or stating that sometimes people do assess localised pain in the body? [A9]Deleted as the next sentence deals with this already. [A10]Again shows up in turnitin: any quotes must be in inverted commas so that tutors / markers will not downgrade or suspect plagiarism.

Executive Privilege

Executive Privilege| | | | Virginia Commonwealth University November 14, 2012| | In the past, the power of executive privilege has been used by Presidents to conceal information that has to do with foreign affairs and negotiations, military, national security issues as well as deliberations and policy making that is done between the President and his top aides. This power is only used when Congress asks the President or one of his top aides to produce all of the information pertaining to an event or situation.If the President then feels that parts of this information needs to be kept secret to protect the best interest of the public, or the other issues listed previously, then he will use executive privilege in order to not give that information to Congress. A huge part of executive privilege is to protect the deliberations and advice given by the President’s aides. When the President’s advisors give him advice, they need to be able to give him the best advice possible and if there is a chance that everything they said could be made public.For instance if the President and advisors are discussing what needs to be done in relation to a foreign power and one suggests to nuke them, one suggests a covert attack and one suggests a peaceful resolution. If the final decision is a peaceful resolution, and Congress asks for all of the information on the subject, then the President should use executive privilege to keep those other possible outcomes from going public, both to keep the public from getting out of control or uneasy and to keep the other country from finding out the other options and retaliating.This power ensures that the President’s advisors can be completely honest and say what needs to be said without being worried about their words being taken the wrong way or too harsh or hurt their image. A big argument for those against executive privilege is that there is nothing in the constitution about it even though there is something about Congress keeping secrets.Article I states that â€Å"Each House shall keep a journal of its proceedings, and from time to time publish the same, excepting such parts as may in their judgment require secrecy† (US Constitution, Article 1 Section 5). Their argument is that the Constitution states that each House can withhold information that they think should be kept secret and there is nothing about secrecy when it comes to the President’s powers, however just because the words are not explicitly in the constitution does not mean that this power was not intended for the President.Even our founding fathers appreciated the importance of executive privilege and that is highlighted by this passage taken from The Works of Alexander Hamilton. In 1794, the Senate asked President George Washington, â€Å"‘to lay before the Senate the correspondences which have been had between the Minister of the United States at the Republic of France, and said Republic, and between said Minister and the office of Secretary of State. † Washington consulted his cabinet members, Henry Knox, Alexander Hamilton, and Edmund Randolph.Alexander Hamilton later wrote: General Knox is of the opinion that no part of the correspondences should be sent to the Senate; Colonel Hamilton is of the opinion that the correct mode of proceeding is to do what General Knox advises; but the principle is safe, by excepting such parts as the President may choose to withhold; Mr. Randolph is of the opinion that all correspondence proper, from its nature, to be communicated to the Senate, should be sent; but that what the President thinks is improper, should not be sent.Washington later told the Senate â€Å"After an examination of [the correspondence], I directed copies and translations to be made; except in those particulars, which, in my judgment, for public considerations, ought not to be communicated. † (Hamilton 1851) Three of these men signed the constitution and contribut ed a great deal towards it and they clearly believe that it is the President’s right to withhold information that he deems unfit to be made public. When it comes to foreign affairs it is very important that the President has the ability to use executive privilege.For instance, if the United States was making a treaty with another country, both countries may have to give things up in order to come to an agreement, and everything considered by both sides as well as everything agreed upon should not be made public for everyone, including other countries to see. This is best stated in 1796 by George Washington after the House of Representatives requested that he give them information concerning his instructions to the United States Minister to Britain regarding the treaty negotiations between the United States and Britain.Washington replied by saying: The nature of foreign negotiations requires caution, and their success must often depend on secrecy; and even when brought to a co nclusion a full disclosure of all the measures, demands, or eventual concessions which may have been proposed or contemplated would be extremely impolitic; for this might have a pernicious influence on future negotiations, or produce immediate inconveniences, perhaps danger and mischief, in relation to other powers.The necessity of such caution and secrecy was one cogent reason for vesting the power of making treaties in the President†¦the boundaries fixed by the Constitution between the different departments should be preserved, a just regard to the Constitution and to the duty of my office.. , forbids a compliance with your request. † (Richardson 1897) As Washington states, we cannot simply make every detail public because other countries may retaliate and they will also be less likely to deal with the United States in the future. However, by invoking executive privilege the President can protect that information from causing such havoc.As he stated, it is not only the President’s right to use executive privilege, but it is his duty to use it in situations that require secrecy. Without a doubt executive privilege can have its usefulness, but it should only be invoked in certain, specific situations. In our recent history this has not been the case, some of our Presidents have tried to abuse the power of executive privilege, giving it a bad name and encouraging people to believe it should be done away with. When President Richard Nixon was in office, the Watergate scandal surfaced and Congress asked him to produce all of the information he and his aides had on the case.In an attempt to conceal what had been done as well as to protect everyone from punishment, President Nixon tried to use executive privilege. This case was brought to the United States Supreme Court because the executive privilege was being used to protect one of Nixon’s advisors from criminal prosecution, thus obstructing justice. This was by far an abuse of executive privilege and leads many to want it gotten rid of, however just because a power can be abused does not mean that its use should stop; it just means that restrictions need to be put in to place.This is highlighted by the ruling of the Supreme Court. The Court acknowledged the need for the President to used executive privilege, but determined that in cases of inquiry into possible criminal actions, the Executive has to release relating information. If we want to curb the abuse of executive privilege, we need to put guidelines into place, because without them, the meaning of executive privilege is at the discretion of the President until checked by other branches. President Nixon was neither the first nor last President to abuse this power (United States v Nixon 1974).President Bill Clinton also tried to invoke executive privilege in a very wrong way as well. Clinton tried to use executive privilege to prevent his advisors from testifying on whether he had sexual relations with Monica Lewinski or not. However, this claim of executive privilege was shot down, rightfully so (Baker 2012). These instances of abuse may lead some to think it is just a better option to not have executive privilege, but as long as barriers and restrictions can be put into place on it to prevent this from happening in the future, this power needs to stay around.This comes with some exceptions; this power should only be used when the President truly believes that if this information were to get out it would either be damaging to the public or in the best interest of the public to not find out. This power should also be used in situations where the President needs to protect national security intelligence and other matters as well as being used to protect military secrets, operations and intelligence.Lastly, this power should be used in situations where the United States is dealing with a foreign power, whether it is a treaty, a negotiation, a meeting or anything else containing sensitive m aterial that either the United States or the foreign power needs to be kept secret. This brings up another argument against executive privilege. Some feel that this power should be done away with because Congress does not have the power of checks and balances over executive privilege; however that is not the case.If the President is refusing to give Congress the information that they are asking for, they can decide to stop funding things that the President is trying to do. They can also hold people in contempt of Congress, which was done as recently as this year in the Fast and Furious case where Congress demanded that Attorney General Eric Holder give them all the information on this case. President Obama stepped in and claimed executive privilege, however in a response to this, Congress moved, then voted to hold Holder in contempt of Congress unless he hands over the information (Silverleib 2012).Another thing Congress can do if the President continues to refuse to cooperate is to impeach him. This would obviously be only done in serious situations, but would work either to get their message across or to show future Presidents that they cannot just invoke executive privilege without consequence. On top of this, the courts can rule on cases where the President tries to use executive privilege like they did in the case with President Nixon.Articles II of the Constitution states that the President â€Å"shall from time to time give to the Congress information of the state of the union, and recommend to their consideration such measures as he shall judge necessary and expedient† (US Constitution Article II Section 3) As the Constitution says, the President does need to inform Congress on the State of the Union from time to time, however it does not say anywhere that the President is required to divulge all the information having to do with certain incidents.Between Article I and Article II, others take this to mean that Congress has an unlimited power of inquiry, but in reality that is not the case. This fact has been ruled on multiple times by different courts, where usually they determine that either the President does not have to give up the information, or that the President has to give up certain aspects of that information based on other laws. It is also Congress’s right and duty to challenge the President when he uses executive privilege, in order to make sure that the power is not being abused, which is the exact reason for having separate branches and a balance of power.If it wasn’t for executive privilege, other countries might be less inclined to deal with the United States because they fear that every detail could go public. Along the same lines the president’s advisors can’t give their best advice if they have to worry that anything they say could be made public. Military secrets and intelligence also needs to be protected to better ensure our troops safety as well as protect our country and citizens from retaliation after an exposed military operation. There is also information that needs to remain secret because it is in the best interest of the public to not find out.Lastly and most importantly, if it wasn’t for executive privilege, national security and military intelligence matters could be made public, exposing our informants and jeopardizing our national security. In order to keep this power alive and protect sensitive information, the United States needs to add guidelines or an amendment that properly codifies executive privilege to prevent its abuse. Once this is done, in theory, there would not be any more issues of whether power can or cannot be used.Everything would be stated to say that the President can only use executive privilege in the situations previously stated and any other instance where executive privilege is claimed would be thrown out. Executive privilege helps to protect our citizens, our national security and our good standing and abili ty to negotiate with other countries. If we were not able to guarantee that level of secrecy it would be nearly impossible to conduct policy making, decision making, foreign negotiations, treaties, as well as threaten the United States and their citizens’ safety.References Baker, Peter, and Susan Schmidt. â€Å"Washingtonpost. com Special Report: Clinton Accused. † Washington Post: Breaking News, World, US, DC News & Analysis. N. p. , 6 May 1998. Web. 8 Nov. 2012. http://www. washingtonpost. com/wp-srv/politics/special/clinton/stories/starr050698. Hamilton, Alexander, and John C. Hamilton. The works of Alexander Hamilton comprising his correspondence, and his political and official writings, exclusive of the Federalist, civil and military. New York: J. F. Trow, 1851.Print. Richardson, James D.. A compilation of the messages and papers of the presidents. New York: Bureau of national literature, 1897. Print. Silverleib, Alan. â€Å"House holds Holder in contempt  œ CNN. com. † CNN. com – Breaking News, U. S. , World, Weather, Entertainment & Video News. N. p. , 29 May 2012. Web. 5 Nov. 2012. http://www. cnn. com/2012/06/28/politics/holder-contempt/index. html. United States v. Nixon, 418 U. S. 683 (1974) (Justice Burger Opinion of the Court) United States Constitution, 1789

In the News: Pricing of Milk

This year so far milk sales have decreased and dairy farmers are stuck with large amounts of inventory that they can't do anything with. This called for them to lower the price of the milk to under three dollars a gallon in hopes that people would buy more milk. The content of this article is relevant to the class because it covers supply and demand. In addition to this it also covers business strategy. Ultimately dairy farmers were making a lot more money in 2014 because there was a very high demand for milk.When milk ales decreased the dairy farmers were left with inventory that they could not do anything with. At this point they had to make a decision to try to save some of the inventory they had left over. In regards to food products It's a little different compared to items that do not have a sell by date. Milk expires after a certain day and it can no longer be sold. For this reason the dairy farmers and retailers were forced to cut costs to try and get more people to but more milk. This could ultimately fix their overstock problem.By lowering he cost they were hoping that people would buy more milk. If people purchase more milk it can potentially help them get rid of left over inventory. This can also be bad for dairy producers because it they are losing money on every gallon of milk they sell. If they purchased more heavy machinery and hired more workers they may have to lay people off due to plummeting costs.

Jean Piaget And Vygotsky And Language Development In Children

Jean Piaget and Lev Vygotsky are two influential thinkers who have impacted the speech and language pathology field with their key theories. Piaget believed that there are four main stages in a child’s development that lead to a child learning language. Without these stages, Piaget argues that a child cannot cognitively grow at an appropriate pace (Kaderavek, 2105, p. 18 and p. 23). However, Vygotsky argues the Social Interactionist Theory, which states children develop language through social interacting with adults who are linguistically knowledgeable and the influence of the Zone of Proximal Development (Kaderavek, 2105, p. 18 and p. 23). With including these theories from Piaget and Vygotsky, this paper will explore how both of these†¦show more content†¦At this stage is when their mental lexicon expands, creating more complex sentences and holding conversations with their peers and other adults (Kaderavek, 2105, p. 18). Concrete operations is the next stage foll owing preoperational. This stage is developed between ages of seven to eleven where children begin the process of becoming logical thinkers, categorize objects and thoughts, and organize information (Kaderavek, 2015, p. 18). Lastly, the formal operation stage, from ages eleven to fifteen, is when children learn to be abstract thinkers by creating and testing hypotheses (Kaderavek, 2015, p. 18). Without these four important stages, Piaget believed that a child could not develop language accurately and in the future could develop a language disorder. Following next to Piaget, Lev Vygotsky, a developmental psychologist, believed that language â€Å"development does not proceed toward socialization, but toward the conversion of social relations into mental functions† (Dimitriadis and Kamberelis, 2006, p. 192). With this thought, Vygotsky developed the Social Interactionist Theory along with the Zone of Proximal Development. Since his theory emphasized children socially interact ing with adults and linguistically knowledgeable peers, Vygotsky perceives children’s language skills to develop at a higher rate due to their social interactions, which influences their cognitive abilities through success and failure. (Kaderavek, 2015, p.Show MoreRelatedVygotsky And Vygotsky Theories Of Learning1257 Words   |  6 PagesTheories of learning In this essay, I will compare and contrast jean Piaget and lev Vygotsky theories of learning. First, I will discuss Piaget followed by Vygotsky then I will compare and contrast both theorists. Jean Piaget was a Swiss developmental psychologist and philosopher, he is known for his contribution to a theory of cognitive development. Piaget became interested in the reasons why children gave the wrong answers to questions that required logical thinking. He believed that these incorrectRead MoreVygotsky And Vygotsky s Theory Of Choice908 Words   |  4 PagesDeveloping language becomes the avenue from which children cultivate their social-emotional cognition which allows them to have an understanding of their social world and accumulate their culture (Shulman Singleton, 2010). Jean Piaget and Lev Vygotsky are two well-known cognitive psychologist who each had theories regarding language development and cognition. Both Piaget and Vygotsky had similarities in their theories as well as differences between them. While they were both conveyed greatRead MoreVygotsky And Vygotsky s Theory Of Cognitive Development Of Thought And Language Essay1060 Words   |  5 Pagesteaching Delvalle, Ailà ­n Florencia Thought and Language: independent processes. With the passing of time, the development of thought and language has been the object of study for psychologists such as Jean Piaget and Lev Vygotsky. The former drastically influenced the study of thought and speech with his theory of cognitive development and his clinical method. The latter also made his contribution with his sociocultural theory. Although language and thought may be analysed as associate one to theRead MoreJean Piaget And Lev Vygotsky848 Words   |  4 Pagesthings about child development. Jean Piaget and Lev Vygotsky are two of those many theorists. Both of these theorists have their own beliefs on how children develop. Jean Piaget and Lev Vygotsky differ in their developmental theories, how their theories help the intellectual development in children and the similarities in their theories. A developmental theory is a theory that a scientist has proven to be true for a child’s development. According to Karen Stephens (2015), â€Å"Jean Piaget believes thatRead MoreWgu Fht Task 11675 Words   |  7 PagesJessica Odessa Shepherd Human Development and Learning - FHT4 Western Governors University Student ID 259630 FHT4 - Task 1 Cognitive Development refers to the construction of the thought process that includes problem solving, remembering and the ability to make decisions, from childhood up to the adulthood stage. Cognitive/Intellectual Development is the ability to learn, reason, and analyze the fact that a process begins from infancy and progresses as the individual (Educational Psychology)Read MorePiaget And Vygotsky s Cognitive Development Theory1114 Words   |  5 Pagescognitive development, you cannot help but to think about two specific contributors to this area of study, Jean Piaget and Lev Vygotsky. First, let us discuss what exactly is cognitive development. Cognitive development is the process of how thought is constructed. This includes language learning, problem solving, reasoning, decision-making, as well as any other mental abilities. Cognitive development begins in childhood and continues to develop all the way through adulthood. Piaget and Vygotsky theoriesRead MoreEducational Methods Influenced By Jean Piaget And Lev Vygotsky800 Words   |  4 Pagesresearch of Jean Piaget and Lev Vygotsky. Both of these men provided influential theories, which had a significant impact on evaluating children’s learning styles and abilities. After years of research and observation, Piaget determined that intellectual development is the result of the interaction of individual and environmental factors. He felt that as a child develops and always interacts with the world around him, knowledge was established. Through his observations of his children, Piaget developedRead MorePiaget Vs Vygotsky : Piaget And Vygotsky1314 Words   |  6 PagesCompare Two Famous Educators: Piaget vs. Vygotsky Jean Piaget and Lev Vygotsky are often considered the most influential cognitive development and learning psychologists of the 20th century. Their research efforts have inspired numerous interpretations and spawned new outlets of approaching developmental psychology. The following paragraphs will analyze the theories of Piaget of Vygotsky and discuss how their research can be used to advance the use of cognitive development in learning, both traditionalRead MorePiaget Of The Child : Theories Of Development Essay960 Words   |  4 Pagesthe Child: Theories of Development I† (Learning Seed, 1997), according to Vygotsky, the cognitive development in children is in direct relationship, and dependent on interaction with others. (Feldman 2010, pg. 20). Vygotsky believed to truly understand cognitive development; a child’s social and cultural experiences must be considered. Piaget believes theorists that focus on the mind are called cognitive theorists. Piaget was most interested in how children think. Piaget describes stages of cognitiveRead MorePiaget And Vygotsky Theory Of Cognitive Development Essay826 Words   |  4 Pagescognitive development and, highlight both Piaget and Vygotsky’s theory as it relates to cognitive development, and the significant differences between them. The term cognitive development refers to the process of growth and change in intellectual, mental abilities such as thinking, reasoning and understanding. It comprises of the acquisition and consolidation of knowledge. Infants draw on social-emotional, language, motor, and perceptual experience and abilities for cognitive development. According

How Bipolar Disorder Affects The Lives Of Those With It

Bipolar disorder is a difficult topic for myself. I have an aunt and an uncle that have bipolar disorder. My uncle committed suicide in 2010. On the other hand I feel that it is important to research and learn about this topic because it is something that I have a different perspective than those who have never had this personally affect their lives, and that can be helpful in treating those suffering from the disorder and also their family members. I knew that bipolar disorder could be diagnosed from a young age, however, I was not aware that early onset could mean a more severe psychosocial impairment or more difficulties with interpersonal relationships. 4I loved that both of these articles were about studies that were more client centered. They were not about the best treatment, medication, or statistics on prevalence. It is about how bipolar disorder affects the lives of those with it. We all have a personal identity that is shaped through what we have learned and the experience s we have had. The article by Maree (2008) described identity as, the framework from which individuals interact with the world. It enables a sense of continuity and agency with a capacity to commit to certain roles and self- representation that are self-defining. I read this sentence and thought about how bipolar disorder can take over someone s life. It is an all-encompassing disorder. The short video about rapid cycling and bipolarity, the narrator said that he is just a person likeShow MoreRelatedSymptoms And Symptoms Of Bipolar Disorder1700 Words   |  7 PagesIntroduction Bipolar disorders, also known as manic depression, are mental disorders characterized by shifting moods between depression and mania (Bressert, 2016). Those with a bipolar disorder, have extreme emotional states called mood periods. In the United States, more than 10 million people have bipolar disorder (Kennedy, 2015). It is lifelong, but can be treated. Although it can easily be treated, once patients choose to stop taking their medication their symptoms worsen. Around 15 percentRead MoreAbstract. Effects Of Bipolar Can Be Far-Reaching, Both1413 Words   |  6 PagesEffects of bipolar can be far-reaching, both into the lives of patients and those around them. Bipolar affects work, school, relationships, physical health and many other aspects of everyday life. The most severe effect of bipolar disorder is suicide. Unfortunately, 25% - 50% of people with bipolar disorder attempt suicide and 11% commit suicide. Bipolar disorder is a mental illness known as a mood disorder. In mood disorders, the patient suffers from severe emotional states. In bipolar disorder, the patientRead MoreMental Illness : A Mental Disorder1463 Words   |  6 Pagesbehavioral disorder. This means that around 510,600,000 people suffered from some form of mental or behavioral disorder in 2010 alone. Now, with all this information we must first ask, what is a mental illness? The definition given by the National Alliance of Mental Illness, or NAMI, states that â€Å"A mental illness is a condition that impacts a person’s thinking, feeling, or mood and may affect his or her ability to relate to others and function on a daily basis.† Many psychological disorders are developedRead MoreBipolar Disorder And Mental Illness1497 Words   |  6 PagesThis disorder where a persons’ mood changes without any triggering event is called Bipolar disorder. Bipolar disorder is a disorder where the affected person experiences periods of mania alternating with periods of depression, usually interspersed with relatively long intervals of normal mood. (Dictionary.com) Mania is a mental illness marked by periods of great excitement, euphoria, delusions, and over activity. Depression is a feeling of severe despondency and dejection. It is a disorder thatRead MoreBenefits And Concerns Of Predictive Genetic Testing998 Words   |  4 PagesSeveral studies have been performed using these new methods to test for bipolar disorder, specifically in those who have a family history of the disorder. In this paper, I will highlight the benefits and concerns of predictive genetic testing, discuss how it will affect society, and argue that those with a family history of mental illnesses such as bipolar disorder should have predictive genetic testing so that, if necessary, the disorder can be treated early and prevent any adverse effects. Opposing StanceRead MoreSymptoms And Treatment Of Bipolar Disorder1125 Words   |  5 Pageswith several mental disorders. The major diagnosis would be bipolar disorder. She also suffers from borderline personality disorder, Post-traumatic stress disorder (PTSD), and anxiety. The American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorder defines bipolar disorder as a recurrent mood disorder that includes periods of mania or mixed episodes of mania and depression (Murphy, 2012, p. 44-50). It was previously known as manic depressive disorder. It is most commonRead MoreSymptoms And Symptoms Of Bipolar Disorder1642 Words   |  7 Pagesrealize that few emotions can affect their lives. Bipolar disorder is a serious illness that causes the brain to shifts in mood, energy, and activity levels like excited for new change and became emotional suddenly. Most people think it is normal to have the moods, but they are different that everybody is having hard time to control it. Imagine a man who been together with his wife for 40 years and she suddenly died which it is part of the life because no one can live forever. He must feeling sadnessRead MoreSymptoms And Symptoms Of Bipolar Disorder Essay1278 Words   |  6 Pages1 HelenKeller541 Physiology October 26, 2016 Abstract: Bipolar Disorder Bipolar disorder is a mood disorder; also referred to as manic depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013). Bipolar disorder is a depressive disorder with manic episodes, it is placed between the chapters on schizophrenia spectrum and other psychotic disorders in recognition of their place as a bridge between the two diagnostics in terms of symptomology, family historyRead MoreThe Signs and Symptoms of Bipolar Disease758 Words   |  3 PagesIntroduction Bipolar disease is a very odd disorder affecting many people. This paper will describe what bipolar disease is, the signs and symptoms of this disease, and who it affects. It will also inform you of the causes of bipolar disease and how to diagnose and treat it. Description Bipolar disease, previously called manic-depressive illness, is a disorder in the brain characterized by extreme variations in mood, energy, and activity levels. Patients with bipolar disease find it strenuous completingRead MoreBipolar Disorder And Its Effects On Children1247 Words   |  5 Pagesfrom Bipolar disorder. Bipolar disorder or manic-depressive illness is a brain disorder that can affect one’s mood and ability to complete tasks. Bipolar disorder in children is under studied for many reasons. These include, lack of awareness and the difference in the disease seen in adults and children that can make it difficult to continue studies. Bipolar disorder has not been well studied despite harmful effects on growth and development in a child. As the child grows up, bipolar disorder may

Macbeth and Young Girl - 1441 Words

To what extent do you agree that, in gothic writing, fear and pain are sources of pleasure? Fear and pain are sources of pleasure that Shelley in ‘Frankenstein’ employs, especially within the character of Victor. The painful description of the monstrous birth is one example of this- having the element of disturbance to shock the reader, yet to Victor (the creator) his response is pleasure and he seems to enjoy the terrifying sounds made of the birth; ‘’I might infuse a spark†¦ into the lifeless thing’’, Here Shelley emphasises the gothic by playing with the dead and ‘infusing’ life- making the dead a scientific experiment for Victor to ‘play’ with. Shelley also reinforces the idea of fear and pain being a pleasure to Victor by the way he†¦show more content†¦Pleasure received from fear and pain are a main focus within Angela Carter’s ‘The Bloody Chamber’ collection; especially within the opening with the character of the Marquis- who enjoys inflicting pain and fear into his wives, both physically and physiologically- it is apparent that he does this not only on the current heroine but the other wives he has had due to the ‘’pool of blood’’ and the secret chamber in which is keeps the corpses of his ex-wives. However, it is through the events that happen to the heroine in opening of the bloody chamber that the reader gets the impression a similar situation has happened with his ex-wives- it becomes clear to the reader that once the heroine reaches sexual maturity that the Marquis feels as though he has to empower the female through the act of fearing him and causing pain in which he finds most pleasurable- this is evident when he describes ‘’the act of love as the act of torture’’- to the reader this seems fearful and we can imagine the act to be painful due to the connotations that can be taken from ‘’torture’. However- Carter employs a different approach from the young girl’s naà ¯ve nature, emphasising the dark nature of the gothic. It appears that she seems to gain a source of pleasure from being his seemingly ‘prey’: ‘’tender, delicious, ecstasy of excitement’’. Yet, Carter in her story shows a development ofShow MoreRelatedMacbeth Human Nature Essay1134 Words   |  5 Pagestimeless, and still very much alive today. Two of the richest ideas explored by Shakespeare in his play Macbeth revolve around the differing versions of reality and the pursuit of ambition through manipulation. These ideas are examined though the purposeful characterisation of the witches, King Duncan and Lady Macbeth. These themes are also highlighted in contemporary texts such as Mark Waters Mean Girls, Are you living an Insta lie? and Cameron Russel’s TED Talk Looks Aren’t Everything, which demonstratesRead MoreThe Theme Of Emotions In The Canterbury Tales1027 Words   |  5 Pagescaught and charged with the rape of an innocent girl. The queen is granted power of his punishment, she chose to instead give him a simple question to answer; yet you shall live if you can answer me: what is the thing women most desire? (Chaucer line 80). This quote shows sig nificance because, in this time period it was considered extremely unholy to be touched by the opposite sex without marriage. Since the knight forced himself onto the young girl, he was greedy enough to take the one thing awayRead MoreBook Thief Macbeth Comparison1656 Words   |  7 PagesMacbeth amp; The Book Thief: A Comparison between Ambition present in the Novels In comparing Shakespeare’s Macbeth and Zusak’s Book Thief, though the books deal with different time eras, characters and even language styles, there are some striking similarities between the themes in both novels. The themes are evident throughout both novels, these themes give a better understanding of the author’s message he wants to portray to his audience. Both books show ambition effectively in many situationsRead Moreâ€Å"Virginitie, Mariage And Widowhood† (Mainer). Stage One:1309 Words   |  6 Pagesâ€Å"Virginitie, Mariage and Widowhood† (MAINER). Stage one: A girl child is controlled by her father and other male figures around her. She grows up to be a young woman, a virgin, a prospective bride. Stage two: Marriage— decided again by powerful men around her. She has no freedom to choose her soul partner. No precedence for love or compatibility. This is the stage the submissive woman spends most of her life; her duty is to f ulfill her dominant husband’s every wish and demand. She is entrusted toRead MoreFar On The Sands : A Shakespearean Sonnets1536 Words   |  7 Pagesrhyme scheme for the ending of DEFDFE. Over the course of the poem, the tone changes from quietly appreciative to reverent of nature and the focus switches from admiration of the view and its divinity to an appreciation of that same divinity in a young girl by Wordsworth’s side. Wordsworth shifts from â€Å"It is a beauteous evening, calm and free,† to â€Å"Thy nature is not therefore less divine:† (ll. 1, 11). This shift in tone and focus after the first octave is emphasized by the unpredictable rhyme schemeRead MoreThemes Of Dr Jekyll And Mr Hyde And Macbeth1322 Words   |  6 Pageseverything is as bad as too little† (Ferber). The Strange Case of Dr Jekyll and Mr Hyde by Robert Stevenson and Macbeth by William Shakespeare both illustrate this idea. In Stevenson’s novel, a scientist named He nry Jekyll experiments with the phenomenon of separating one’s dual nature, which unfortunately kills him because he is not able to take control of his evil side. In Shakespeare’s play, Macbeth, a Scottish general, is consumed by the desire to become king and kills many people to achieve his goalRead MoreVladimir Nabokovs Lolita Essay1368 Words   |  6 Pagesand sexually involved with, as a predator and himself the victim of seduction. This degradation of an innocent child causes anger in critics because in the mindset of most Americans, an older man has more power and sexual drive than a twelve-year old girl. In his blaming of Dolores as the one who initiated sex between the two, Humbert is giving other pedophiles and child molesters a justification to blame innocent children for their evil. Mathew Bruccoli, when commenting on Humbert’s characterizationRead MoreWilliam Shakespeare s Macbeth 1492 Words   |  6 PagesFor my essay four I decided to read †Å"Macbeth† by William Shakespeare. The first time I read it, I kind of understood what it was about, but didn’t really understand it that well. So after doing some research about William Shakespeare and â€Å"Macbeth,† I re-read â€Å"Macbeth,† as well as watched the movie. After this I wondered what William Shakespeare was trying to portray by writing â€Å"Macbeth†. At first I thought that he was trying to present the audience with an experience of himself or he was writingRead MoreWilliam Shakespeare s Macbeth - The Natural And Supernatural World1313 Words   |  6 PagesDunn AP Literature 12/3/15 To be or not to be? That is the Question of Macbeth The idea that not everything is quite what it seems is not a new one, and has been explored even long before the time of William Shakespeare; however, the playwright whose name has remained the talk of dinner tables worldwide, did an exceptional job of weighing the plurality of the different forms of the natural world. In the Scottish play, Macbeth, Shakespeare both entertains his audience, and poses questions as to whatRead MoreWilliam Shakespeare s Macbeth 1163 Words   |  5 PagesMacbeth a play written by William Shakespeare in the early XVII is a tragic story where the protagonist,Macbeth,murders the king at the time who was King Duncan so he could get the throne for himself.The Crucible written by author Arthur Miller in 1953 tells the story of the salem witch trials and the downfall that follows.Both plays are classics and are essential to English literature.Many important and relatable themes can be found throughout the plays.In each of the plays we get to see different

Submission to the Disability Inclusion Action Plan- myassignmenthelp

Question: Discuss about theSubmission to the Disability Inclusion Action Plan. Answer: Disability depicts a mental or physical condition which constraints an individual`s activities, senses or even movements. It involves limiting the number of activities such an individual can take part with much ease in within the society (Barbra, 2014). He or she may be incapacitated either mentally, physically or at times socially. The disabled people normally face quite some discrimination in various aspects of life. This is particularly regarding their access to the normal daily services which other people without disabilities seek. The services range from social services, economic services, medical services, commuting services and recreation services among others (Thomas Nyla, 2017). Such discrimination inhibits the manner in which such people access important or rather basic services in the society. One such service is the transportation service particularly public transport system (Robert, 2010). For instance, you find that disabled people are highly excluded or left out when other people are boarding the various public transport means like the train and buses. People with disabilities are not awarded the required help when accessing these transport systems. This is sad since it is a trend that is replicated across the globe. The old people who are the highly affected by disability cases are facing shortage of assistive support. This is highly attributed to the fact that a majority of young people who can assist them in their mobility are out in the urban areas or they just neglect them (Benjamin, et al., 2014). As such, it is indispensable for people with disabilities to get special preferential treatment especially when it comes to the convenience of their transport around and within the cities and even in the rural areas. Keen attention should be given when drafting policies to enhance their mobility by using the transport systems. This will essentially help them to access other daily life services with ease. This evaluation will be centered on the strength and gap assessment of the draft policy from the public health lenses. One of the chief points that the disability inclusion plan for NSW has and that can bring remarkable transformation in public health is `liveable communities`. The ability of people with disabilities to get where they need to go in a safe and dignified manner, the ability to use public transport and facilities and the ability to get to enjoy similar convenience and comfort like any other customers or commuters are very paramount (Barbra, et al., 2017). This includes enhancing the accessibility of train stations, the accessibility of bus stops, accessibility of ferry wharves, enhancing the access to taxi services by disabled people, enhancing the pedestrian walk ways for all people with a special preference for people with disabilities and offer enhanced mobility support to disabled people in the peripheral and rural areas. Making the train stations more accessible to people with disability will aid in eliminating the struggle they go through when reporting to work and leaving for home (James, et al., 2015). This will reduce the stress they face in their movement. Furthermore, this will motivate other people who have disabilities to work harder and even grow their carriers in the long run. Similarly, it will allure and inspire other disabled people to actively seek for employment even in distant places since they can access train stations with much ease. Additionally, this will motivate potential employers to recruit more people who have disabilities who have been left out before just because of their disability yet they have the skills and expertise needed to get a decent employment both in the formal and informal sectors (Lisa, 2010). This applies to all other modes of transport. Another benefit of such an improvement is that it raises the affordability and accessibility of health services for people with disabilities. This implies that highly accessible train stations, bus stops, ferry wharves and pedestrian walkways among others facilitate the mobility of such people to get health care services from the various health centers and hospitals (Lisa, 2011). This plan addresses some principles of public health. Such principles include equality and universality. The two are achieved through the facilitation of an inclusive employment. This advocacy ensures that all people feel supported and valued in their workplace and any one can employment that matches their qualifications and skills regardless of whether they have disabilities or not. This will involve the provision of training that incorporates skills that are vital in handling people with disabilities. Employment forms part of social determinants of public health that impacts other such determinants. As such, when disabled people are holistically included in employment, it impacts social inclusion which is another overt principle of public health. The main strengths include: It sets out to involve all customers both those with disabilities and those without in the planning and decision-making meant for the transport system. The draft policy has extensively centered its action plan and the action items on the customer. This is evidently instrumental in ensuring that the overall health needs of the disabled people are highly considered and that they actually matter. Its strategic objectives are quite accommodative and diverse regarding the health needs of people with disability. This means that quite a majority of the public health needs of such people have been articulated in the draft policy. Also, the plan is generally workable in light of enhancing the accessibility of health care services for the disabled people in NSW. That is, this group of people will have their needs concerning proper accessibility to healthcare commendably met. One of the conspicuous weaknesses of the draft policy is the failure to include a framework for enforcing punishments for people who fail to fully observe the drafted rules. There should have been an inclusion of enforcement measures and possible punishments for transport operators who break the guidelines and rules. This could have aided in helping people desist from breaking the rules and guidelines. A journal article published by Disability and Society advocates the articulation of a wholly functional transport system particularly for people with disabilities. It highlights several follow-up and enforcement measures that can ensure that the established regulations and guidelines are well adhered to (Mike, 2013). Also, another article published by British journal of sociology of education outlines the policy framework that is functional in ensuring that disabled people are handled with the reasonable dignity especially when using public transport means (Mike Collin, 2010). References Barbra, A., 2014. Definitions, Concepts, and Measures of disability. Annals of Epidemiology, 24(1), pp. 2-7. Barbra, P., Chris, P. Vera, C., 2017. On making disability in rural places more visible, challenges and opportunities. Journal of rural studies, Volume 51, pp. 223-229. Benjamin, G., Christopher, K. Susan, M., 2014. Transportation and Socioemotional well-being of urban students with and without disabilities. Journal of prevention and intervention in the community, 42(1), pp. 31-44. James, R., John, L., Melinda, W. Sarah, R., 2015. Public Health Principles. s.l.: Springer. Lisa, L., 2010. Principles and practices of public health surveillance. s.l.: Oxford University Press. Lisa, L., 2011. Eliminating health and healthcare disparities among the growing population of people with disabilities. Health Affairs, 10(30), pp. 1947-1954. Mike, O., 2013. The social model of disability: Thirty years on. Disability and Society, 7(28), pp. 1024-1026. Mike, O. Collin, B., 2010. Disability studies, disabled people and the struggle for inclusion. British journal of sociology of education, 31(5), pp. 547-560. Robert, K., 2010. Institutional disability: the saga of transportation policy fo the disabled. s.l.: Brookings Institution Press. Thomas, D. Nyla, B., 2017. Disability models affect disability policy support through awareness of structural discrimination. Journal of social issues, 73(2), pp. 413-442.