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Walden University Week 2 Ethical and Legal Foundations Discussion

Walden University Week 2 Ethical and Legal Foundations Discussion.

By Day 6 of Week 2Respond to at least two of your colleagues by sharing cultural considerations that may impact the legal or ethical issues present in their articles.-2 Paragraphs each student response-4 paragraphs in total3- references each Response–STUDENT #1 Response and Articles links below-reporting abuse and neglectCOLLAPSEThe topic I chose for this discussion is child and elder abuse reporting. As healthcare providers and especially as healthcare providers in a specialty that focuses on how the past affects everyday thoughts, actions, and decisions, it is imperative that we are aware and thoroughly knowledgeable on how to manage and navigate through certain occurrences such as reporting child and elderly abuse. Legal and Ethical Considerations of Reporting Child Abuse The first article I selected is a user manual that discusses the expectations for a mental health professional when managing the care of an abused child, specifically incidents such as reporting child abuse and neglect, referring children for medical evaluations, and establishing quality assurance practices and standards. (Peterson & Urquiza, 1993). The primary reason for reporting abuse is to protect children from abuse and neglect. It is required by law for the mental health practitioner report abuse if any reasonable suspicion is discovered. Luckily, the nurse is protected by state law from any civil lawsuits and identity is also protected. The second article I selected discusses the ethical considerations of reporting child abuse and neglect as a healthcare professional. In a recent study, it was discovered that health care providers would not have reported 21% of suspected maltreatment cases that child abuse experts would have reported—leaving children potentially at risk. (Hlady & Allchurch, 2015). Failure to report a case of suspected abuse or neglect can stem from lack of training or providers being reluctant to address the concerns with the family. Failure to report abuse or neglect can lead to further injury and even death. Legal and Ethical Considerations of Reporting Elderly Abuse Nursing consultant, Dolores Alford, wrote an article discussing the legal issues within gerontological nursing in relation to abuse and neglect and emphasized on the consequences of not reporting suspected abuse/neglect. When working with the geriatric population, Alford (2006) states that it is imperative to be alert and constantly assess for abuse or neglect, whether it be physical, emotional, sexual, or financial because this population is at high risk for these circumstances. Nurses must first educate themselves about the use of appropriate screening and intervention measures. Next, nurses must incorporate screening for mistreatment as part of the comprehensive assessment performed in their specific practice setting. (Alford, 2006). Clients may ask that abuse is not reported in fear of the abuser, but this is why building a rapport with the client is essential. Building a relationship and comfortableness with the client and/or family will allow for the client to feel that the nurse has their safety and well-being as priority. (Dolores, 2006). Failure to report any suspected form of abuse or neglect can result in discipline by the board of nursing, the nurse’s employer, or even legal action taken against them. (Dolores, 2006).The second article covers ethical dilemmas within reporting abuse of elder adults and focuses on the duties of the healthcare provider when abuse has not occurred but the caregiver has voiced concerns of potential abuse. Does the healthcare provider report this? Bergeron and Gray (2003) recommend that the practitioner be knowledgeable of their state’s reporting laws, develop rapport with elder abuse specialists to refer to, and develop clear expectations to confidentiality guidelines in order to guide the client’s disclosure (Bergeron & Gray, 2003). The learned information from these four articles is very useful and can be applied during my practice because there will be occurrences where client’s express concern for their wellbeing or express traumas and it is important as a healthcare provider to be knowledgeable in how to manage these situations in order to protect not only the client but also my licensure as well. In Texas, it is required by law for the professional to report the suspected abuse within 48 hours and failure to report is a class A misdemeanor. (Rape, Abuse, Incest, and Neglect Network, n.d.)Alford, D. (2006). Legal issues in gerontological nursing. Part 1: abuse and neglect of older adults. Retrieved from: https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=3&sid=4f584baf-be01-46b0-922a-bcf3f78ac348%40pdc-v-sessmgr03Bergeron, R. & Gray, B. (2003). Ethical dilemmas of reporting suspected elder abuse. Retrieved from: https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=1&sid=b5758935-1164-4024-8e2f-34e857417d60%40sdc-v-sessmgr02Hlady, L.J., & Allchurch, H.E. (2015). A multidisciplinary approach to child maltreatment: suspected child abuse and neglect. Retrieved from: https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=11&sid=d00d337f-8af1-48d0-a575-b1fc24f80e2c%40sessionmgr4007Peterson, M., & Urquiza, Anthony. (1993). The role of mental health professionals in the prevention and treatment of child abuse and neglect. Retrieved from: https://files.eric.ed.gov/fulltext/ED363995.pdfRAINN.org (n.d.) The laws in your state. Retrieved from: https://www.rainn.org/laws-your-state-texas–STUDENT #2 -Ethical and Legal Foundations of PMHNP Care-Informed assent/consent and capacityWhile I am interested in many of the legal/ethical topics listed in this week’s lesson, I am especially interested in the topic of informed assent/consent and capacity as it relates to mental health and my practice as a PMHNP. I currently work at a voluntary facility and I often wonder where the line is as far as is this person who is floridly psychotic, truly able to consent to treatment? I often feel torn when some patients are accepted to our facility and arrive confused or disoriented but are still able to sign themselves in. Adolescents are another population where consent is often discussed and questioned- in the state of Arizona, a child is signed in by their parent, as a voluntary patient, whether they want to be admitted or not- often, the child does not want to be admitted, so it does not feel voluntary. In contrast, as a travel RN I have worked in states where minors can be petitioned for involuntary treatment by the county or be admitted by their parent but only if they are voluntary for treatment. When I was first exposed to ethics in the nursing world, I was taught that when something feels off or wrong, it is usually related to our own ethical code and values. This discussion will provide a summary of scholarly articles that touch on this topic, relating to legal and ethical considerations of adults as well as children and adolescents. Article 1- Legal & Ethical Considerations for Incarcerated Adults Deinstitutionalization has long been a topic of interest to me- working in state-level facilities highlights the need for an asylum-like setting for many individuals with serious mental illness (SMI) to achieve their highest quality of life. Segal, Frasso, & Sisti (2018) discuss the shift of mentally ill people into jails and prisons, noting that nearly between 20% and one-quarter of incarcerated individuals in the United States suffer from a SMI. This article covers a variety of topics of concern related to incarcerated individuals with mental illness, including a section on capacity or the ability to consent for mental health treatment. While the line between voluntary and involuntary treatment can sometimes be muddied in the community, it seems that it is more clear-cut within a jail or prison- even someone who is obviously suffering psychosis or mania due to a SMI may refuse treatment (Segal, Frasso, & Sisti, 2018). Without falling down the rabbit hole of the discussion of the lack of beds to meet the needs of this volume of mentally ill individuals, this writer will focus on the cycle experienced by SMI-individuals who refuse treatment while incarcerated. In the state of Arizona, if any individual in the community and is a danger to themselves (DTS), a danger to others (DTO), or gravely disabled (GD)/Persistently acutely disabled (PAD) because of their mental illness, they can be petitioned by the county and if the petition is upheld following an initial evaluation period, the individual will receive forced treatment. Conversely, an incarcerated person may meet criteria for involuntary treatment but be allowed to refuse treatment because they are an inmate (Segal, Frasso, & Sisti, 2018). This is a perfect example of ethics versus law- these individuals should be subject to the same laws as civil individuals but because of the legal system, they are not; is it acceptable for someone in state or federal custody to be left to decompensate when they can be helped? Article 2- Ethical & Legal Considerations of Elderly Adults Capacity to consent and ethics are two issues commonly experienced by mental health professionals. Considering elderly adults, this issue may be one that is a frequent challenge and one not quickly resolved. While it the role of the health care provider to encourage autonomy and to advocate for our patients, it is important to be able to recognize deterioration of mental status that is affecting the individual’s ability to make a sound decision. Cliff & McGraw (2018) note that a lack of capacity, or the ability to consent, may be a result of a developmental delay, injury to the brain, mental illness, dementia, or altered levels of consciousness at end-of-life. The article discusses the experiences of 14 allied health professionals in assessing an individual’s capacity to consent and how to carry out assessments within the home and with family members. This topic is increasing relevant, given the aging population in the United States. I would like to find articles that take a more in-depth look at how to navigate the concept of consent among the elderly with mental illness or dementia/Alzheimer’s process occurring. Article 3- Ethical Considerations and Forced Treatment of Adolescents Tucker, et al. (2018), highlight the ethical chasm that exists within the mental health community, with regards to whether adolescents should be forced into treatment, either by their parents or by some other formal process (I.e., by the county and designated mental health professionals). This article evaluates the effects of minors being transported voluntary or forced via a third-party transportation service, to wilderness therapy programs in the United States. Wilderness therapy programs include interventions such as immersion into the wilderness in groups, the education and preparedness that goes along with living outdoors, as well as individual and group therapy, and other therapeutic programming (Tucker, et al., 2018). Tucker, et al. (2018) describe that participation in these programs is usually involuntary, although participants are said to develop acceptance of their situation while in treatment and do achieve a reduction in mental health symptoms. With regards to the use of transport services, an estimated 30% of both private and state-run programs are found to be utilizing them, although they seem to be more widely used among private-pay programs (Tucker, et al., 2018). Transport via a third-party service usually involves two adult staff apprehending and transporting the adolescent to the wilderness site; transportation may last anywhere from several hours to a few days (Tucker, et al., 2018). The staff are trained in crisis management, including therapeutic holds/restraints, as well as therapeutic communication and support, and CPR/BLS (Tucker, et al., 2018). While this topic is unique, and the topic of wilderness camps specific, it does bring the ethical issue of a minor consenting to mental health treatment to the foreground- is it ethical to force a minor into treatment? Article 4- Legal Consideration for the Minimum Age of Consent to Mental Health Treatment As I mentioned previously, adolescents are a wild card when it comes to voluntary versus involuntary treatment, whether they are forced into treatment by a parent or some greater body or designee. This article examines the minimum age of consent to obtain mental health services, comparing it with the minimum age of criminal responsibility. I found this article especially interesting as it takes on a global perspective and because it looks at children or adolescents being able to seek out mental health treatment for themselves and without a parent. Noroozi, Singh, & Fazel (2018) begin by offering this statistic- globally, about 10%-15% of the child/adolescent population is experiencing some form of mental illness, yet only a small percentage can access appropriate care (Noroozi, Singh, & Fazel, 2018). On a national level, it is estimated that as many as 75% of 2 million minors who have some level of interaction with the justice system also experience mental illness. Of course, there are many different barriers to treatment include overall access to care; parental consent can also become a barrier to care, if the parent is unable to, or does not wish to, provide consent for treatment of their child (Noroozi, Singh, & Fazel, 2018). Nationally, in states where the minimum age of mental health consent (MAMHC) is not legislated on a state level, age 18 is used; however, MAMHC as low as age 7 exist (Noroozi, Singh, & Fazel, 2018). In contrast, there are many nations where mental health laws do not exist at all, while many of these same countries have minimum age for criminal responsibility well-defined (Noroozi, Singh, & Fazel, 2018). This article causes one to consider- should a minor be allowed to consent for mental health treatment, and if so, at what age should this be allowed to occur? ConclusionThese articles have each provided information on the topic of informed assent/consent and capacity in some respect, each bringing their own perspective on the topic. While we may each decide to take strikingly different paths once we begin our careers as PMHNPs, we should always be aware of ethical and legal dilemmas as they relate to our specialty. In examining the legal and ethical considerations for adults, I was reminded of my keen interest in bringing mental health law into prisons and jails. Researching adolescent issues with consent opened my eyes to the concept of a minor being able to consent for mental health treatment, especially when it is compared to a minor being culpable for crimes committed at a specific age. I look forward to continuing research in legal and ethical challenges related to mental health treatment of both adults and adolescents. Reference Cliff, C., & McGraw, C. (2016). The conduct and process of mental capacity assessments in home health care settings. British Journal of Community Nursing, 21(11), 570. Noroozi, M., Singh, I., & Fazel, M. (2018). Evaluation of the minimum age for consent to mental health treatment with the minimum age of criminal responsibility in children and adolescents: a global comparison. EVIDENCE-BASED MENTAL HEALTH, 21(3), 82–86. https://doi-org.ezp.waldenulibrary.org/10.1136/ebm… Segal, A. G., Frasso, R., & Sisti, D. A. (2018). County Jail or Psychiatric Hospital? Ethical Challenges in Correctional Mental Health Care. Qualitative Health Research, 28(6), 963–976. https://doi-org.ezp.waldenulibrary.org/10.1177/104… Tucker, A. R., Combs, K. M., Bettmann, J. E., Chang, T.-H., Graham, S., Hoag, M., & Tatum, C. (2018). Longitudinal Outcomes for Youth Transported to Wilderness Therapy Programs. Research on Social Work Practice, 28(4), 438–451. https://doi-org.ezp.waldenulibrary.org/10.1177/104… Articles Article 1 adult County Jail or Psychiatric Hospital_ Ethical Challenges in Correctional Mental Health Care – Andrea G. Segal, Rosemary Frasso, Dominic A. Sisti, 2018.html Article 2 elderly adults_ The conduct and process of mental capacity assessments in home health care settings.pdf Article 3 – widlerness therapy.pdf article 4-Evaluation_of_the_minimum_age_.pdf
Walden University Week 2 Ethical and Legal Foundations Discussion

different question in IT TOURISM. I’m stuck on a Business question and need an explanation.

1- In the last few years the co-called sharing economy represented by websites such as Airbnb has grown to become important channels connecting the supply and demand of lodging. Please briefly present your view on 1) how the sharing economy value; and 2) why it could be considered a “disruptive” force for the hospitality industry.
4- Imagine you are the marketing director of a convention and visitors to your website recently has decreased considerably. Please propose ( briefly) a general strategy and , if possible, specific analytics tools you could use to improve the traffic to the website and engage with visitors.
Please I need 1 page for each question
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different question in IT TOURISM

Share this: Facebook Twitter Reddit LinkedIn WhatsApp CELLULITIS IN OLDER PATIENTS – A PROSPECTIVE COHORT STUDY Older patient with cellulitis Abstract Aim: To examine differences in risk factors, clinical features and outcomes of cellulitis between those 75 years and those < 75 years admitted to a metropolitan hospital. Methods: A prospective study of patients with limb cellulitis requiring intravenous antibiotics conducted at Bankstown-Lidcombe Hospital, Australia from June 2014 to April 2015. Results: Thirty one patients were 75 years and 69 less than 75 years. A greater proportion of older patients resided in nursing home (25.8% vs 2.9% respectively, P=0.001) and mobilised with walking aid(s) (58.1% vs 11.6% respectively, P<0.001). Significantly more older patients had documented hypertension (45.2% vs 23.2% respectively P=0.035), atrial fibrillation (33.5% vs 5.8% respectively, P<0.001), dementia (22.6% vs 1.4% respectively, P=0.001) and malignancy (16.1% vs 1.4% respectively, P=0.010). The clinical presentation of cellulitis and cellulitis severity (Eron classification) did not significantly differ in both groups; however older patients were more likely to have dependent oedema (OR 4.0, CI 1.3-12.6, p=0.018) and less likely to be obese (OR 0.3, CI 0.1-0.8, p=0.012) or had a past history of cellulitis (OR 0.3, CI 0.1-1.0, P= 0.044) on presentation. Despite the age difference, there were no major differences in intravenous antibiotic choice, hospital length of stay, and hospital readmission rates in both groups. Older patients however, were more likely to experience complications such as falls and/ or decreased mobility (38.7% vs 15.9% respectively, P = 0.020) during the cellulitis episode. Conclusion: Older patients with cellulitis performed just as well as younger patients despite having more medical comorbidities and worse physical function. Keywords: Cellulitis, hospitalisation, older patients, prospective study, Introduction Cellulitis is a bacterial infection of the skin involving the dermis and subcutaneous fat. In Australia, cellulitis accounts for over 250,000 hospital bed days, or 10.5% of total bed days.1 While most episodes of cellulitis can be managed as an outpatient, a significant proportion, particularly older people, require hospitalisation. Over a 12-month period from 2014-2015, the cellulitis hospitalisation rate was 1100 per 100,000 in the 80 plus age group as opposed to 237 episodes per 100,000 in the general population.1 Cellulitis typically presents with pain, erythema, warmth and oedema. Systemic symptoms including fever and tachycardia may be presentalthough thought to be less frequent in older persons.2-6 Known risk factors for cellulitis are venous oedema, lymphoedema, skin conditions, traumatic injury, leg ulcers, peripheral vascular disease, fungal infections, past history of cellulitis and obesity. 7-10 Age alone does not alter treatment principles for bacterial cellulitis (including use of antibiotics); however age-related pharmacokinetics and pharmacodynamics, cognitive status and social circumstances11 may impact on treatment decisions particularly need for hospitalisation. Once hospitalised, age is an independent risk factor for increased length of stay for cellulitis with other factors being long duration of symptoms, tachycardia, hypotension, leukocytosis, hypoalbuminaemia, elevated serum creatinine, bacteraemia, obesity and diabetes mellitus. 12-15 Age is significantly associated with increased mortality from cellulitis although it is unclear if this is due to illness severity or underlying comorbidity.16 Other factors associated with mortality are delayed administration of antibiotics, presence of multiple comorbidities, previous myocardial infarction, congestive heart failure, liver disease, hypoalbuminemia, renal insufficiency, morbid obesity, lower limb oedema, Pseudomonas aeruginosa infection, bacteraemia and septic shock.14,17 Hospital readmission for cellulitis is also more common in older people18 particularly if there has been more than one prior episode of cellulitis19. Aims In this prospective study, we aimed to examine differences in risk factors, clinical features, management, and outcomes of cellulitis between those 75 years or more and those less than 75 years admitted to a large metropolitan hospital. Methods The study was conducted at Bankstown-Lidcombe Hospital, New South Wales, Australia from June 2014 to April 2015. The study was approved by the South-Western Sydney Local Health District (SWSLHD) Ethics Committee. Between June 2014 and April 2015, potential patients were identified through review of the Bansktown Hospital inpatient list three times a week by a study investigator. We included all identified patients aged 18 years or more with a diagnosis of cellulitis of the upper and/ or lower limb(s) and excluded patients with infected ulcers on presentation, pregnant patients and those with post-operative wound infections. The patients were then stratified into an older group (aged 75 years or more) and a younger group (74 years or less) and were followed up during their admission and for a total of 28 days post completion of intravenous antibiotics. Data collected included basic demographics, clinical characteristics, relevant investigations, treatment provided and clinical outcomes. The severity of cellulitis was rated using the Eron classification.20 Data were analysed with SPSS Version 24 and R version 3.3.1. Chi-square test was used to compare proportions. Student’s T-test was used to compare differences in means for normally distributed variables. For non-normally distributed continuous variables, non-parametric test was used to assess differences in the ranked median scores. Logistic regression was used to assess statistically significant risk factors for cellulitis in the older and younger age groups. Statistically significant results were set at an alpha level of 0.05. Results One hundred and thirteen patients were identified during the study period and 100 patients (88.5%) consented to participate. Thirty-one (31.0%) patients were aged 75 years and older and 69 (69.0%) patients were 74 years or less. The mean age was 84.4±5.8 years in the older group and 53.4±14.2 years in the younger group. The older patients had lower BMI than their younger counterparts [28.3 (±8.0) vs 36.0 (±12.3) respectively, P<0.001]. A higher proportion resided in residential aged care facilities (25.8% vs 2.9% respectively, P=0.001); and mobilised with walking aid(s) (58.1% vs 11.6% respectively, P<0.001). (Table 1) A significantly higher proportion of older patients had documented hypertension (45.2% vs 23.2% respectively P=0.035), atrial fibrillation (33.5% vs 5.8% respectively, P<0.001), dementia (22.6% vs 1.4% respectively, P=0.001) and malignancy (16.1% vs 1.4% respectively, P=0.010). (Table 1) In terms of cellulitis risk factors, after controlling for potential confounders, older patients were more likely to have dependent odema (OR 4.0 CI 1.3-12.6, p=0.018); but less likely to be obese (OR 0.3, CI 0.1-1.0, P=0.012) or had a prior history of cellulitis (OR 0.3, CI 0.1-1.0, P= 0.044) than younger patients. The risk of peripheral vascular disease, tinea pedis and cutaneous dermatitis were similar in both groups. Cellulitis presenting features such as pain, fever, chills and vital signs (temperature, heart rate and blood pressure) did not significantly differ between the two groups. The severity of cellulitis, as defined by the Eron classification also did not differ between groups with the majority of patients having Eron Classes I and II. (Table 1) Initial laboratory results revealed that older patients had lower hemoglobin [122.1 (±16.4) vs 135.0 (±19.4), P=0.002] and albumin [38.0 (±47) vs 41.4 (±4.1), P<0.001] and higher urea level [7.9 (5.8-12.4) vs 5.8 (4.8-8.4), P=0.011] compared to their younger counterparts. CRP white cell count (WCC) and positive rate of blood culture did not differ between the two groups. (Table 2) Older inpatients presenting with cellulitis were less likely to be referred to hospital in the home (HITH) antibiotic programs for completion of the course of intravenous antibiotics 32.3% vs 59.4% respectively, P=0.012) compared to younger patients. The antibiotic choices did not differ between the two populations, these included cephazolin, flucloxacillin or tazobactam-piperacillin. Older patients with cellulitis were more likely to experience falls or decreased mobility (38.7% vs 15.9% respectively, P = 0.020) compared to the younger group. (Table 2). Despite this, they had similar LOS to their younger counterparts [10 (7-15) vs 8 (6-13) respectively, P=0.403]. There was one death in each group and the rates of ICU admission, surgical intervention and 28-day readmission were similar in the two groups. Discussion In this study, we found that older people, despite being frailer than their younger counterparts, had similar treatment outcomes after presenting to hospital with mild to moderate limb cellulitis. In our study, most of the potential risk factors for cellulitis were similar in the older and younger age groups; however, older patients were more likely to have dependent oedema and impaired mobility, and less likely to be obese. Other conditions noted to be more common in the older group were congestive cardiac failure, atrial fibrillation, dementia and malignancy. We believe this finding reflected the higher prevalence of these conditions in the older population rather than an association with cellulitis. Over 25% of older patients with cellulitis lived in residential aged care facilities. This finding raised the opportunity for the provision of ambulatory care antibiotic programs in aged care homes potentially avoiding the need for hospitalisation for residents with cellulitis. There were no significant differences in the clinical presentation of cellulitis between the two age groups (i.e., duration of cellulitis symptoms, heart rate, blood pressure, temperature, white cell count, CRP and Eron severity classification). Atypical and blunted physiological response to infection with age has been documented in the literature. In severe sepsis, a reduced physiological response can lead to rapid progression of sepsis .2,3, 21 Our results did not support a blunted response to infection in older patients with cellulitis; we, however, did not have any patients with severe sepsis to examine the inflammatory response in more detail. In our study, older patients experienced more falls and impaired mobility during the admission for cellulitis compared to younger patients. While these factors might have made their hospital discharge planning more complex, they did not translate into an increased hospital length of stay. Previously described risk factors affecting LOS in cellulitis (comprising of age, hypoalbuminaemia, bacteraemia, obesity, diabetes mellitus, tachycardia, hypotension, leukocytosis, and elevated serum creatinine), 7,12,13,14,15 tended to be skewed towards age and hypoalbuminaemia for the older group and obesity for the younger group in our study. There were no statistically significant differences between the two groups in terms of mortality, ICU admission, and surgical intervention for cellulitis complications. The majority of patients in both groups had Eron Class I or II cellulitis and did not sustain physiological decompensations; however, in more severe cases of cellulitis, one would expect ageing physiology to sustain more physiological decompensations which may then influence the above parameters. A lower proportion of older inpatients discharged to HITH programs might have been attributable to their medical comorbidities and functional criteria not meeting HITH requirements. As such, additional health resources may allow HITH programs to manage these complex patients but this would require further study. Unlike previous published literature, 18we did not find a significant difference in the 28-day readmission rate between the two age cohorts in our study. As the readmission rate was less than 5%, a study with greater number of patients would have more power to detect small differences in readmission rates. One of the limitations of this study is the small sample size due to a short recruitment period; further study with a larger sample size would assist in validation of our findings. We decided to focus on inpatient cellulitis treatment; however a cellulitis management journey from hospital to community settings would have provided with a more complete picture. As the number of older patients presenting with cellulitis increases as the population ages, it is important to note that for mild to moderate cellulitis, older patients perform just as well as younger patients with standard cellulitis treatments on clinical and care indicators. No potential conflicts of interests were disclosed by all the authors. References National health performance authority analysis of admitted patients care national minimal data set 2013-2014 and Australian Bureau of statistics estimated resident population 30 June 2013 Anderson DJ, Kaye KS. Skin and soft tissue infections in older adults.Clin Geriatr Med. 2007; 23(3): 595–613. Laube S. Skin infections and ageing. Ageing Res Rev. 2004;3(1): 69–89. Weng QY, Raff AB, Cohen JM, Gunasekera N, Okhovat JP, Vedak P, et al. Costs and consequences associated with misdiagnosed lower extremity cellulitis. JAMA Dermatol. 2017;153(2): 141–146. Gunderson CG, Martinello RA. A systematic review of bacteremias in cellulitis and erysipelas.J Infect. 2012;64(2): 148–155. doi: 10.1016/j.jinf.2011.11.004. Esposito S, Noviello S, Leone S Epidemiology and microbiology of skin and soft tissue infections Current Opinion in Infectious Diseases 2016; 29(2):109–115. Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ. 1999;318(7198): 1591–1594. Björnsdóttir S, Gottfredsson M, Thórisdóttir AS, Gunnarsson GB, Ríkardsdóttir H, Hilmarsdóttir I. Risk factors for acute cellulitis of the lower limb: a prospective case–control study. Clin Infect Dis. 2005;41(10): 1416–1422. Karppelin M, Siljander T, Vuopio-Varkila J, Kere J, Huhtala H, Vuento R, et al. Factors predisposing to acute and recurrent bacterial non-necrotizing cellulitis in hospitalized patients: a prospective case–control study. Clin Microbiol Infect. 2010;16(6): 729–734. Halpern J, Holder R, Langford NJ. Ethnicity and other risk factors for acute lower limb cellulitis: a U.K.-based prospective case–control study. Br J Dermatol. 2008;158(6): 1288–1292. Kish TD, Chang MH, Fung HB. Treatment of skin and soft tissue infections in the elderly: a review. Am J Geriatr Pharmacother. 2010;8(6):485–513. Garg A, Lavian J, Lin G, Sison C, Oppenheim M, Koo B. Clinical characteristics associated with days to discharge among patients admitted with a primary diagnosis of lower limb cellulitis. J Am Acad Dermatol. 2017;76(4): 626–631. Morpeth SC, Chambers ST, Gallagher K, Frampton C, Pithie AD. Lower limb cellulitis: features associated with length of hospital stay. J Infect. 2006;52(1): 23–29. Figtree M, Konecny P, Jennings Z, Goh C, Krilis SA, Miyakis S. Risk stratification and outcome of cellulitis admitted to hospital. J Infect. 2010;60(6):431–439. Theofiles M, Maxson J, Herges L, Marcelin A, Angstman KB.Cellulitis in obesity: adverse outcomes affected by increases in body mass index. J Prim Care Community Health. 2015;6(4): 233–238. Tan R, Newberry DJ, Arts GJ, Onwuamaegbu ME. The design, characteristics and predictors of mortality in the North of England Cellulitis Treatment Assessment (NECTA). Int J Clin Pract. 2007;61(11): 1889–1893. Carratalà J, Rosón B, Fernández-Sabé N, Shaw E, del Rio O, Rivera A, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis. 2003;22(3): 151–157. Garg A, Lavian J, Lin G, Sison C, Oppenheim M, Koo B. Clinical factors associated with readmission among patients with lower limb cellulitis. Dermatology. 2017;233(1): 58–63. Karppelin M, Siljander T, Aittoniemi J, Hurme M, Huttunen R, Huhtala H, et al. Predictors of recurrent cellulitis in five years. Clinical risk factors and the role of PTX3 and CRP. J Infect. 2015;70(5): 467–473. Eron, L. J. 2000. Infections of skin and soft tissues: outcome of a classification scheme. Clinical Infectious Diseases. 31, 287 (A432). Norman DC, Grahn D, Yoshikawa TT (1985) Fever and aging. J Am Geriatr Soc 33: 859. Table 1. Patient Characteristics Age < 75 years (N=69) Age 75 years (N=31) P-value Age mean(SD) 53.4 (±14.2) 84.4 (±5.8) < 0.001 Female n (%) 23 (33.3%) 16 (48.5%) 0.12 BMI 36.0 (±12.3) 28.3 (±8.0) <0.001 Residential Aged Care Facility 2 (2.9%) 8 (25.8%) 0.001 Mobility <0.001 Mobile unaided 61 (88.4%) 13 41.9%) Mobile with aid 8 (11.6%) 18 (58.1%) Dependent oedema – 4.0 (1.3-12.6) 0.018 Risk factors† OR (95% CI) Peripheral vascular disease – 3.1 (0.9-10.6) 0.079 Obesity (BMI>30) – 0.3 (0.1-0.8) 0.012 Previous cellulitis – 0.3 (0.1-1.0) 0.044 Tinea pedis – 0.9 (0.2-4.1) 0.930 Venous dermatitis – 0.5 (0.1-2.0) 0.302 Comorbidities Diabetes 23 (31.9%) 6 (19.4%) 0.24 Hypertension 16 (23.2%) 14 (45.2%) 0.035 IHD 11 (15.9%) 10 (32.3%) 0.11 CCF 10 (14.5%) 9 (29.0%) 0.10 AF 4 (5.8%) 11 (33.5%) < 0.001 Dementia 1 (1.4%) 7 (22.6%) 0.001 Malignancy 1 (1.4%) 5 (16.1%) 0.010 DVT 3 (4.3%) 5 (16.1%) 0.10 PE 2 (2.9%) 5 (16.1%) 0.072 Steroid use last 3 months 3 (4.3%) 3 (9.7%) 0.37 Duration of symptoms median (IQR) 3.0 (2.0 – 6.0) 4.0 (2.0 – 14.0) 0.23 Fever and chills 19 (27.5%) 6 (19.4%) 0.46 Heart rate 92 (±17) 89 (±15) 0.384 BP – Systolic 136 (±18) 143 (±24) 0.158 BP _Diastolic 75 (±12) 72 (±11) 0.227 Temperature 37.4 (±1.0) 37.3 (±1.0) 0.796 Pain score 0.055 Mild 0-3 32 (51.6%) 14 (53.8%) Moderate 4-7 20 (32.3%) 12 (46.2%) Severe 8-10 10 (16.1%) 0 Pathology Haemoglobin 135.0 (±19.4) 122.1 (±16.4) 0.002 White cell count 11.3 (±5.1) 11.1 (±6.0) 0.61 Albumin 41.4 (±4.1) 38.0 (±4.7) 0.001 Creatinine – median (IQR) 88 (76-106) 93 (71-131) 0.692 Urea – median (IQR) 5.8 (4.8-8.4) 7.9 (5.8-12.4) 0.011 CRP – median (IQR) 33 (15-117) 60 (9-133) 0.919 Blood culture 29 (42.0%) 18 (58.1%) 0.071 Eron Classification 0.415 Class I 10 (14.5%) 2 (6.5%) Class II 55 (79.7%) 26 (83.9%) Class III 4 (5.8%) 3 (9.7%) Class IV 0 0 † Logistic regression – Chi-square = 17.868, p=0.007, df=6, Nagelkerke’s R2 0.230; BMI body mass index; IHD ischaemic heart disease; AF atrial fribrillation; CCF congestive cardiac failure; DVT deep vein thrombosis; PE pulmonary embolism; CRP C reactive protein. Table 2. Treatment, Complications and Outcomes Characteristics Age < 75 years (N=69) Age 75 years (N=31) P-value Completed treatment via HiTH 41 (59.4%) 10 (32.3%) 0.012 Duration of IV antibiotic – median (IQR) 6 (4-8) 4 (2-9) 0.059 Length of hospital stay – median (IQR) 8 (6-13) 10 (7-15) 0.403 Antibiotics 0.121 Cephazolin 47 (51.1%) 16 (32.7%) Flucloxacillin 20 (21.7%) 12 (24.5%) Tazobactam-piperacillin 7 (7.6%) 4 (8.2%) Complications DVT 0 0 1 PE 0 1 (3%) 0.31 Fall or decreased mobility 11 (15.9%) 12 (38.7%) 0.020 Nosocomial infection 1 (1.4%) 3 (9.7%) 0.087 Delirium 1 (1.4%) 2 (6.5%) 0.23 Outcomes Death 1 (1.4%) 1 (3.0%) 0.531 Needing surgical intervention 3 (4.3%) 2 (6.5%) 0.644 ICU admission 0 0 1 Readmission within 28 days 4 (5.8%) 0 0.308 HiTH hospital in the home; DVT deep vein thrombosis; PE pulmonary embolism Share this: Facebook Twitter Reddit LinkedIn WhatsApp
I need help with this assignment. Must be original work..

About Your Signature Assignment Signature/Benchmark Assignments are designed to align with specific program student learning outcome(s) in your program. Program Student Learning Outcomes are broad statements that describe what students should know and be able to do upon completion of their degree. Signature/Benchmark Assignments are graded with a grading guide or an automated rubric that allows the University to collect data that can be aggregated across a location or college/school and used for course/program improvements. Purpose of Assignment The purpose of this assignment is to allow students the opportunity to present a business idea supported by strong financial information. The student will be able to identify the possible challenges of doing business in a foreign country and how to approach them. Assignment Steps Resources: Microsoft® PowerPoint®, Signature Assignment: Financial Statement Analysis and Firm Performance TemplatePrepare a 16- to 20- slide Microsoft® PowerPoint® presentation showing the details of a business you are interested in starting in a foreign country, and for which you need $300,000. The presentation should include the following information:Business nameExecutive summaryDescription of the foreign countryBusiness description and structureMarket and company analysisMarketing and sales operational planHow you plan to use the $300,000Financial statements forecast (3 years)Business health assessment – using the following ratios:Liquidity ratiosSolvency ratiosAsset management ratiosProfitability ratiosMarket value ratiosAnalyze and calculate the following scenarios in 525 words, including which one would you choose and why, and which financing option is best for your busines:Investor #1 decided to loan you the $300,000, paying all of the interest (8% per year) and principal in one lump sum at the end of 5 years.Investor #2 offers you the $300,000, paying interest at the rate of 8% per year for 4 years and then a final payment of interest and principal at the end of the 5th year.Discuss in 525 words the challenges and risks you may face in starting a business in a foreign country including the following:Cultural, business, and political risks.How you plan to avoid operational, transaction, and translation exposure.Format your assignment consistent with APA guidelines. Click the Assignment Files tab to submit your assignment.
I need help with this assignment. Must be original work.

mini-unit of three

mini-unit of three.

For this benchmark, you will complete a mini-unit of three informational text-based lesson plans and a corresponding assessment plan. You should utilize the lesson plan and other materials that you have created throughout this course. COE Lesson Plan Template Complete three informational text-based lesson plans that will be taught as a unit for a grade level that you specify based on the “Class Profile.” Complete Parts I, II, and III of the “COE Lesson Plan Template” for three lessons. You will elaborate on Part III of the “COE Lesson Plan Template,” which includes examples of summative assessment, within your assessment plan. Each lesson plan should share a theme around your previously chosen informational text. Be sure to mention the materials and technology utilized within each lesson. Utilize research-based strategies and technology that facilitate critical thinking and problem solving. Provide opportunities for questioning, collaboration, and supportive interaction among your students within your lessons. Include at least two of the following strategies within each of your three lessons: Direct instruction Indirect instruction Collaborative learning Experiential learning Independent study Interactive instruction Describe how your activities would be differentiated for your students in the “Class Profile.” Create an assessment plan for your mini-unit that includes demonstrating alignment between formal and informal assessment strategies and techniques. Your assessment plan will consist of the following two parts: Part I – Introduction In a 100 word introduction, include the following: A brief summary of your mini-unit for context. A description that demonstrates alignment between the standards, learning targets/objectives, learning activities, and formative and summative assessments. Identify other content areas in which your theme could be utilized. Provide examples. Part II – Summative Assessment Three summative assessments (one for each lesson) with answer keys or rubrics.
mini-unit of three

CIS 210 Georgia Military College Java Programming Coding Task

assignment writing services CIS 210 Georgia Military College Java Programming Coding Task.

1, 6.12 Programming Activity 2: Using for LoopsIn this activity, you will write a for loop:For this Programming Activity, you will again calculate the total cost of the items in a grocery cart. This time, however, you will write the program for the Express Lane. In this lane, the customer is allowed up to 10 items. The user will be asked for the number of items in the grocery cart. Your job is to write a for loop to calculate the total cost of the items in the cart.InstructionsCopy the files in this chapter’s Programming Activity 2 folder in the source code provided with this text to a folder on your computer. Searching for five stars (*****) in the CashierDrawing.java code will show you where to add your code. You will add your code inside the checkout method of the CashierDrawing class (the method header for the checkout method has already been coded for you). Example 6.19 shows a fragment of the CashierDrawing class, where you will add your code:2, Write a program that takes a word as an input from the keyboard and outputs each character in the word, separated by a space.EXAMPLEInput – HelloOutput – H e l l oYour code should include comments to describe the program logic and use proper indentation for readability.Be sure to properly test your code before submitting.Upload your zipped assignment folder, which contains the java and class files. You should follow the assignment naming conventions listed in “How to Do A Programming Activity” under “Course Setup and Instructions”.
CIS 210 Georgia Military College Java Programming Coding Task

American Beauty: Micro Features Analysis

The film I have specifically chosen for my micro-features analysis essay is Sam Mendes’s Academy Award winning motion picture American Beauty winning numerous Oscars and praise from critics. The narrative follows the miserable and mundane lives of the Burnham family consisting of Lester, a middle aged man who is facing a severe mid-life crisis and is extremely depressed, married to Carolyn who is an independent business women and housewife and their naive daughter Jane. The films promotional tagline ‘look closer’ subconsciously implies that the appropriate suburban lifestyle depicted within the narrative is not as ideal as initially perceived, therefore exploring the corrupt and dysfunctional Burnham family fuelled entirely by materialism. The brief sequence chosen for microanalysis is the exposition, otherwise known as the opening which establishes themes, characters, inner and outer presence and the world they inhabit. Sam Mendes, the director must specifically use a contribution of all micro-elements including sound, mise en scene, cinematography and editing in order to grasp the viewer’s conscious attention and propel the narrative forward efficiently, however the two micro-aspects I have chose for analysis consist of mise en scene and cinematography which create meaning and evoke responses from the audience. American Beauty immediately commences with Jane Burnham being recorded by an anonymous character, the conversation between the two is extremely personal based on her ultimate intention to kill her father. The uncomfortable atmosphere compliments the compelling dialogue as it the amateur recording technique is specifically used in order to create realism which grasps the viewer into a submissive position due to the nature of the camera shot shifting into an intimidating low angle shot which consists of Jane dominating the frame with direct eye contacts creating an overwhelmingly intense atmosphere. The lighting within the room is severely limited thus being partially illuminated which creates a room filled with sinister shadows creating an ominous mood which emphasises her monotone clothing creating a mysterious persona that is unconventional for her age, more specifically sixteen therefore contradicting the typical ‘cheerleader’ stereotype. Jane’s eye line match within the camera shot detonates determination, zooming at a subtle pace whilst staring in a sinister way into the camera engages the viewer based on the cameraman refusing to allow her to escape voyeurism. Carolyn Burnham is seen doing traditional female associated activities based on her natural characteristics hence her growing and maintaining the flowers within her garden, more specifically the roses are often associated with love and romance which is reflective of her provocative image possibly fuelled by her intentions to find another sexual partner regardless of her husband’s consent however one could consider gardening mentally satisfies Carolyn which inevitably reduces her need for sex, although as an audience we seriously doubt Lester cares due to his lacklustre body language. Lester perhaps outcasts himself from which unfortunately makes him invisible and unnoticeable, captured significantly during the scene where he is seen eavesdropping on the conversation between Carolyn and the homosexual next door neighbour. The intentional use of a ‘cut in shot’ shows his lack of presence and participation within his wife’s life, master shot initially establishes the conversation which is predictably followed by shot-reverse-shot, the focus ruthlessly shifts between the dialogue where the previously distorted and blurred figure is seen in the window thus representing his fragmenting relationship with his wife and overall exclusion from society. Lester’s perspective shows his helplessness to achieve acceptance hence his much more laid back approach to life, rather than a mundane lifestyle adopted by the majority suburban population, possibly aspiring to occupy a more hectic lifestyle however according to his established motivational issues in the exposition this seems highly unlikely. The outside of the house is illuminated entirely by natural light thus being much more glamorous therefore more appealing however he still holds distain towards it, in contrast the interior of the house is fuelled by minimal lighting which is significantly more realistic. In addition the interior of the house is also impractically dark which coincides with Lester’s tone during the voice over narration thus displaying two conflicting worlds; unfortunately he occupies the miserable one alone. Lester comments on the coincidental matching of Carolyn’s attire and gardening apparatus, ‘handle on those pruning shears matches her gardening clogs’, stating it is not an accident which can be applied to the significance of the door and its colour, more specifically being an intense shade of red which distinctly different from majority of white therefore standing out with exceptional prominence which denotes violence which is depicted ruthlessly within the exposition and can be considered an important theme within the narrative. Lester has already foreshadowed his imminent death via voice over thus establishing the climax, building constant anticipation which makes the viewer become emotionally attached to the protagonist thus evoking empathy towards him and his circumstance. The explicit performance of Lester during the masturbation scene in the shower reflects the realistic approach to the film, the initial shock of this scene can be uncomfortable for less mature audiences, and however it entices the viewer into the realistic world of Lester which is uncountable to the majority of the population who indulge in similar activities. The claustrophobic experience within a shower cubicle can metaphorically represent a prison cell thus being imprisoned into a mundane suburban lifestyle. His body language during this scene is noticeably drained, the angle of his head on his own shoulders displays his lack of stability and main intention to sexually satisfy himself by his own means during the current moment regardless of anyone’s opinion, especially Carolyn thus referring to it as the ‘highlight’ of his day without sarcasm. Lester’s pleasured body language is due to the masturbation; however it could potentially be exaggerated based on the thrill of doing something against the norms of society hence the use of ‘highlight’. Undoubtedly the severe lack of intimacy and chemistry with his wife could possibly be the reason for the masturbation rather than traditional sex, perhaps he is probably bored with sex like the majority of other things due to his refusal to abide by social norms to maintain a stable relationship on order to satisfy one another’s needs. Whilst the Carolyn and Jane are waiting impatiently for Lester to proceed towards the noticeably expensive yet convention middle class car, basic processes such as making sure the suitcase is shut correctly emphasises his severe lack of motivation and commitment to life. Lester is seen casually collecting his work from a high angle perspective, kneeling down in an inferior position to his wife puts significant emphasis in his subordinate role within the dysfunctional family, thus switching gender roles with his wife, which in the current society is acceptable although not predominantly for the traditional male ego especially for dignity and pride; however the behaviour displayed by him implies that his couldn’t care less. Carolyn’s performance such as the raising of the eyebrows displays utter disappointment since she is married to an individual who is such a useless contribution to society thus making him obsolete or otherwise redundant, as he is expendable. Her formal makes her seem significantly more financially independent, reinforced by the low angle perspective of Lester, making her seem significantly more intimidating and authoritative thus not requiring his assistance, potentially holding her back economically. The camera cuts to the family motionless within the car, unresponsive to one another with a significant lack of acknowledgement reinforced the extent of the families communicational breakdown, Lester is seen sitting on the back seat of the car slumped, possibly even asleep whilst his wife and daughter sit in the front eager to get on with their social life, whether it is work or school. Lester positioned between the two within the medium shot, displays his prominence however his physical existence is lacking, possibly lost during the recent years which he has been entirely consumed by the capitalist society. The clothing worn by Lester is representative of his social class; social indicators including his house, car and clothing coincide with the typical middle class individual. Natural light is present within the scene but is obscured by the tinted windows, thus being restricted to reach its full potential, therefore subconsciously representing his constraints metaphorically hence the muted tones emphasising the lifeless atmosphere. In conclusion the micro-features within the exposition of American Beauty establishes key themes within the narrative, consisting of love, sexuality, identity, etc become more and more prominent as the narrative eventually progresses conveying numerous meaning during this brief sequence therefore dictating the characters personality and determining the choices they will make.

Study on death of a salesman

In Act 2 scene 7 of the play Death of a Salesman, the audience is given insight into Happy’s character and the theme Truth, Deception and lies is portrayed. The scene begins with Happy conversing with the waiter, Stanley, when he states that women will soon start entering the restaurant. A beautiful woman soon enters and Stanley is marvelled at Happy’s ability to sense a woman’s presence. Happy flirts with this young woman trying to find out if she is a prostitute when he states “you don’t happen to sell, do you?” Her answer being no, she then informs him that her name is Miss Forsythe and that she is in fact a cover girl as he queried. His brother Biff then joins him. Happy, like his father is living in denial as he is convinced that he is the assistant when he really is the assistant of an assistant. He too loves the thought of feeling like an accomplished success and lies to Miss Forsythe that he is a champagne salesman and that Biff is a professional football player from the West Coast. At this point the theme of deception and lies is highlighted. Happy lies to the woman so that he can feel like he measures up to her because of hearing her job and also to impress and lure her into entertaining him and his brother for the evening. Happy informs Biff that she is “on call” and persuades this young woman to cancel her day’s events and invite a friend to join him and his brother. Biff is upset that he had been waiting at Oliver’s office for six (6) hours to realize that he isn’t remembered. It is at this point in the play that Biff learns that he is not a salesman but in fact a shipping clerk. Biff had been fed with the lies of his father- Willy, his brother being an accomplice, that he was a salesman instead of allowing him to accept who he is and possibly push himself further in life to accomplish more if he so desired. To vent his frustration through living a lie to himself and not being remembered by Oliver, Biff steals Oliver’s pen from his office. The theme is highlighted once more when Biff seeks advice from Happy about what to tell Willy about his meeting with Oliver. Happy gave the advice that he should lie to Willy and tell him that Oliver is thinking over his proposition “… say Oliver is thinking it over. And he thinks it over for a couple of weeks, and gradually it fades away and nobody’s the worse” He states that Willy will soon forget about the meeting after a few months and until he forgets Biff should continue to lie. Another theme that may be explored in this scene is that of guilt. Biff is guilty that he has stolen the pen from Oliver’s office, “I did a terrible thing today Hap- I stole his pen”. This could mark the possibility of hope for Biff because he is able to realise the wrongs that he has done and he makes the effort to vent about it unlike his father who bottles up his feeling about things that he has done instead of talking to someone which later leads to his death. This scenario is also symbolic of Willy’s bad parenting skills as he justified Biffs’ stealing previously in the play and now Biff uses it as a mean of releasing his frustration. RACQUEL BROWN LITERATURES IN ENGLISH 6A1 ANALYSIS OF ACT ONE SCENE EIGHT- In Act two, scenes Eight Willy meets his sons in a restaurant. Biff is very eager to see Willy as he has something important to say to him. Likewise, Willy is eager to hear what Biff has to say to him, but little does he know that what he expects Biff to say is not exactly what he ( Willy) will hear. Act two scene eight is significant because it is in this scene that Biff is honest about his life. He realizes that it is time to ‘hold on to the facts’. There is no sense in pretending or hiding the truth. Willy, on the other hand, refuses to face the truth as he continues to oppose Biff when Biff tells him he is not a Salesman for Oliver; he is actually a shipping clerk. In addition, in this scene Biff desperately wants Willy to know of his ‘mishap’ as it relates to Oliver’s office and the pen. However, Willy does not give him the opportunity to do so; instead he constantly interrupts Biff every time he tries to speak. It is almost as if Willy senses that what Biff is trying to say is unfavourable and as a result he prevents Biff from saying anything, he does this by interrupting him, replacing what Biff wants to say with what he wants to hear. For instance, Biff says “well, it was kind of__”. Before Biff gets to finish what he is saying Willy interrupts, “I wonder if he’d remember you.” Another example is when Biff starts, “Well…he came in, see, and____”, and Willy interrupts Biff by saying, “what’d he say? Betcha he threw his arms around you.” Willy really wants to hear that Oliver and Biff had a very good conversation. Happy also aids in interrupting Biff, however, he does not say as much as Willy. Themes Appearance and reality Biff wants to be honest about his life and he wants Willy to be honest about it as well. He does not want to live a lie. He says to Willy “let’s hold on the facts tonight, Pop. We’re not going to get anywhere bullin’ around. I was a shipping clerk.” Biff wants Willy to see this truth and accept this truth as well. Willy is also truthful in this scene as he was able to tell his boys that he was fired from his job. Love and family relationship The theme love and family relationship is evident in this scene. Willy and his sons are able to sit inside the restaurant and have a discussion. They were being somewhat honest with each other. Guilt and Tension Biff feels very guilty about ‘stealing’ the pen and he tries desperately to tell Willy how it happened. However, he does not get the chance to do so because he is constantly interrupted by Willy who wants Biff to say exactly what he (Willy) wants to hear. There is also tension in this scene as Biff wants to be honest, but he is not given the chance to do so and for this reason he seems very angry, irritated and frustrated and he asks questions, such as ” Why don’t you let me finish?” and “…will you let me finish?”. He also shuts at Willy close to the end of the scene. He says, “Jesus, dad!” which symbolizes is frustration. Irony Willy refuses to be truthful about Biff’s life; nevertheless Biff is honest with himself. Willy opposes opinion of himself; he continues to say Biff is a salesman for Oliver. This is ironic because Willy was able to admit something truthful about his life, that he was fired from his job, yet he will not allow Biff to be truthful to himself about his life. It is also ironic that Willy tells Happy not to interrupt when Happy cuts into the conversation and says, “He told him of my Florida idea,” because he (Willy) constantly interrupts Biff when Biff tries to speak. This also significant because it is as if Happy does not really have a say. Symbolism Symbolism is evident where Willy says the “The woods are burning”. This is symbolic of the fact that his time is running out. His life is deteriorating. So many unfavourable things are happening. Biff’s words, “let’s hold to the facts” is also symbolic. It symbolizes Biff’s realization and honesty to himself about his life. COMMENTRY ON ACT TWO SCENE NINE The scene is a continuation from scene 7 and8 in Frank’s Cook shop. However it begins with Willy entering one of his reveries in his house with young Bernard frantically entering to inform Mrs. Loman of Biffs’ failure in mathematics and that he has left for Boston to seek his father’s help. In the present situation we see Biff trying to make every attempt to inform his dad about his meeting with bill Oliver honestly but Willy makes no attempt to listen. With all that is getting Willy stressed we see him once again blocking out Biff by entering a semi-day dream. Disoriented he shouts at Biff emphasizing that he is not to be blamed for Biffs’ failure in math. Frightened or confused as to why his father would be carrying things from the past he ignores this and continues talking about his meeting. Miss Forsythe and Letta returns and Biff along with Happy engage in deep conversations with the where we see Biff occasionally mentioning his father out of concern. Biff becomes overwhelmed and emotional about the situation and runs out of the restaurant. The scene ends with happy pushing Miss Forsythe and Letta through the door chasing biff and Willy in the restroom mumbling to himself. ANALYSIS Despite the lies shared between Willy and his sons, it is evident that Biff is frustrated and wants to change by being truthful. While Biff attempts to do this we see in several instances where Willy tries to block out all Biff has to say by entering his reveries. Entering his reverie at this stage in time highlights his inability to cope with reality or to accept that all he has are dreams. Willy seems disoriented in the first parts of the play and behaves out of the ordinary: ‘No, No! You had to flunk math! … Math! Math! Math! … If you hadn’t flunk math you’d be set by now! …Don’t blame everything on me, I didn’t flunk math you did! What pen?” In addition to Willy’s inability to cope with reality or the truth, him stating to biff that he should not blame him for everything highlights or shows that he feels responsible for Biff’s failure but wants to make it clear that he is not. Biff becomes flustered in his attempts to relay the truth to willy and based on willy’s behavior is forced to lie about his interview and it is here we see willy gaining some interest in what Biff has to say. Willy- “No, no…” Biff- (desperately standing over Willy) Pop, listen! Listen to me! I’m telling you something good. Oliver talked to his partner about the Florida idea. You listening? He- he talked to his partner and he came to me…I’m going to be alright, you hear? Dad, listen to me, he said it was just a question of the amount!” Here we also see Biff begging for his father to listen in order to get him to calm down. He does this to the point that he seems desperate, he wants to reach his father and connect with him. At this stage biff is reassuring Willy through lies. The following themes are highlighted in this scene; Truth, Deception and Lies, Love and Family relationship and male/female relationships. The theme truth, Deception and Lies is conveyed through the characters of Biff, Willy and Happy. Biff attempts whole heartedly to relay honest information about his meeting with Oliver to Willy, “Now, look, I’m gonna tell you what happened, and you’re going To listen to me… I waited six hours… I kept sending in my name but he wouldn’t see me . So finally he…” Even though he makes an attempt to tell his father the truth it was all in vain and he is later forced to lie. Even happy has to do the same. As highlighted above. When Willy responds positively to the lies this highlights that he is a liar and believes lies and in essence his entire life Is a lie that is the foundation on which it is based. In Biff’s lies we see that he really does not want to do it and later we see him being truthful but in a sarcastic way, when Letta says she has jury meeting; Letta- “I gotta get up early tomorrow. I got jury duty. I’m so excited! Were you fellows ever on a jury?” Biff- “No, but I been in front of them! ….” We see Happy lying to the women after Biff runs out after been overwhelmed by his father’s behavior. He does this because he feels embarrassed by Willy: Happy- “No, that’s not my father. He’s just a guy. Come on, We’ll catch Biff, and, honey, we’re going to paint this town!” A male / female relationship is highlighted in Biff, Happy, Miss Forsythe and Letta’s brief relationship. Their relationship can be described as a ‘one night stand’ relationship. It is based on sexual attraction and satisfaction thus it has no meaning or is not serious. Through the relationship prostitution is highlighted. The women are high class prostitutes who work with a particular clientele list, ‘rich men’. It is obvious that Happy is all about sexual satisfaction and based on what he says makes it even more obvious. Happy- ” Well, girls, what’s the programme? We’re wasting time. Come on, Biff gather round. Where would you like to go?” It is obvious that sex revolves around their world especially Happy. And it is obvious that they inherited this strong sex drive from their father’s genes separate and apart from it being in their nature. As Willy and the woman in the hotel room in Boston relationship was characterizes based on sexual attraction and satisfaction. Finally, the theme love and family relationships. It is in this scene that we realize that despite Biff resentment towards Willy, he deeply and genuinely cares about his welfare. And it is evident that he still wants his father to feel proud of him: Willy- “No, you’re no good. You’re no good for anything.” Biff- “I am, dad, I’ll find something else, you understand? Now, don’t you worry about anything. (He holds up Willy’s face) Talk to me dad.” In this instance and a previous one the way in which Biff speaks to his father is in a calm and caring tone like a father talking to his child reassuring him. We notice here that the roles have changed. He will go the extra mile to defend his father no matter what and this is evident from his response to Miss Forsythe’s line: Miss Forsythe-“Oh, he isn’t really your father!” Biff-(at left turning to her resentfully) “Miss Forsythe, you’ve just seen a prince walk by. A fine troubled Prince. A pal, you understand. A good companion always for his boys.” Biff- “Why don’t you do something for him?” Happy- “Me!” Biff-“Don’t you give a damn for him, Hap?” Happy-“What are we talking about, am the one who-“ Biff-“I sense it, you don’t give a good god damn about him. (He takes out the rolled- up hose from his pocket and puts it on the table In front of Happy). Look what I found in the cellar, for Christ sake. How can you Bear to let it go on?” Happy- “Me? Who goes away? Who runs off and-“ Biff- “yeah, but, he doesn’t mean anything to you. You could help him. I can’t. Don’t you understand what am talking about? He’s going to kill himself, don’t you know that?” Happy- “Don’t I know it! Me!” From this dialogue the critic analyses that Happy is not too concerned about Willy’s welfare as he denies almost everything or having knowledge of Willy’s situation. He seems to blame it all on Biff because he is Willy’s favorite. Some jealousy comes out here. He does not want to take responsibility in any way for Willy’s behavior. This highlights that he I s just like Willy unwilling to face the truth or take responsibility for anything as Willy did before regarding Biffs failure in math. ADDITIONAL NOTES Sarcasm is one figurative language used in the scene and is seen in biff’s response to Letta’s question: Letta- “I gotta get up early tomorrow. I got jury duty. I’m so excited! Were you fellows ever on a jury?” Biff- “No, but I been in front of them! ….” The hose is symbolic of Willy’s attempt to kill himself and highlights that Biff was the only one ready to help his father. Willy’s disorder has become dangerous.