Tuesday, August 25, 2020

International Joint venture Essay

Worldwide Joint Ventures (IJVs) are getting progressively mainstream in the business world as they help organizations to shape key partnerships. These key collusions permit organizations to increase upper hand through access to a partner’s assets, including markets, advancements, capital and individuals. Worldwide Joint Ventures are seen as a pragmatic vehicle for information move, for example, innovation move, from global mastery to neighborhood organizations, and such information move can add to the presentation improvement of nearby organizations. Inside IJV’s at least one of the gatherings is found where the tasks of the IJV occur and furthermore include a neighborhood and outside organization. Essential Elements of an IJV Legally binding Agreement. IJVs are built up by express agreements that comprise of at least one understandings including at least two people or associations and that are gone into for a particular business reason. Explicit Limited Purpose and Duration. IJVs are shaped for a particular business objective and can have a restricted life expectancy or be long haul. IJVs are every now and again settled for a restricted term in light of the fact that (a) the reciprocal exercises include a constrained measure of benefits; (b) the corresponding resources have just a restricted assistance life; as well as (c) the correlative creation exercises will be of just restricted viability. Joint Property Interest. Each IJV member contributes property, money, or different resources and hierarchical capital for the quest for a typical and explicit business reason. Along these lines, an IJV isn't only a legally binding relationship, yet rather the commitments are made to a recently framed business undertaking, typically an enterprise, constrained obligation organization, or association. In that capacity, the members procure a joint property enthusiasm for the advantages and topic of the IJV. Explanations behind Forming a Joint Venture There are numerous inspirations that lead to the development of a JV. They include: Hazard Sharing †Risk sharing is a typical motivation to shape a JV, especially, in profoundly capital escalated ventures and in businesses where the significant expenses of item improvement equivalent a high probability of disappointment of a specific item. Economies of Scale †If an industry has high fixed costs, a JV with a bigger organization can give the economies of scale important to contend all around and can be a compelling route by which two organizations can pool assets and accomplish minimum amount. Market Access †For organizations that do not have a fundamental comprehension of clients and the relationship/framework to disperse their items to clients, shaping a JV with the correct accomplice can give moment access to set up, proficient and successful circulation channels and responsive client bases. This is critical to an organization on the grounds that making new dissemination channels and distinguishing new client bases can be very troublesome, tedious and costly exercises. Topographical Constraints †When there is an appealing business opportunity in an outside market, joining forces with a neighborhood organization is alluring to a remote organization in light of the fact that entering a remote market can be troublesome both in light of an absence of involvement with such market and nearby boundaries to outside claimed or remote controlled organizations. Subsidizing Constraints †When an organization is gone up against with high forthcoming advancement costs, finding the privilege JVP can furnish vital financing and validity with outsiders. Advantages A significant number of the advantages related with International Joint Ventures are that they give organizations the chance to acquire new limit and mastery and they permit organizations to go into related business or new geographic markets or get new innovative information. Moreover, International Joint Ventures are by and large have a short life expectancy, permitting organizations to make momentary responsibilities as opposed to long haul duties. Through International Joint Ventures, organizations are offered chances to build net revenues, quicken their income development, produce new items, extend to new local markets, increase money related help, and offer researchers or different experts that have extraordinary abilities that will profit the organizations. Structure Worldwide Joint Ventures are created when two organizations cooperate to meet a particular objective. For instance, Company An and Company B initially start by recognizing and choosing an IJV accomplice. This procedure includes a few stages, for example, statistical surveying, accomplice search, assessing choices, dealings, business valuation, business arranging, and due perseverance. These means are taken on by each organization. There are additionally lawful methodology included, for example, IJV understanding, auxiliary understandings, and administrative endorsements. When this procedure is finished, the IJV Company is framed and during this last method the means taken are arrangement and the executives. The executives There are two kinds of International Joint Ventures: predominant parent and shared administration. Inside predominant parent IJV’s, all tasks are overseen by one parent who settles on all the practical directors for the endeavor. The directorate, which is comprised of officials from each parent, likewise assumes a key job in dealing with the endeavor by settling on all the working and vital choices. A prevailing guardian undertaking is gainful where an International Joint Venture parent is chosen for reasons outside of administrative info. Fund At the point when at least two accomplices get together and structure an International Joint Venture understanding, they should choose at an opportune time with respect to what the money related structure will involve as this will help in the executives and control. A portion of the means incorporate setting up the capital required to begin the IJV, the effect of making sure about a solid key coalition accomplice, and money related announcing. When a course of action is made, an expense arranged joint endeavor will be made which will help in augmenting the after-assessment forms. Elements influencing IJV Monetary Factors Poor arrangement and arranging Issues that emerge in joint endeavors are as a rule because of lack of common sense or the gatherings included being too rushed to even consider setting up shop. For instance, an advertising procedure may fall flat if an item was unseemly for the joint endeavor or if the gatherings included neglected to fittingly asses the components included . Gatherings must focus on a few examination both of nature and clients they want to work in. Inability to do this sets off a terrible tone for the endeavor, making future issues. Surprising poor money related execution Perhaps the quickest ways for a joint endeavor is money related debates between parties. This generally happens when the money related execution is less fortunate than anticipated either because of poor deals, cost invades or others. Poor monetary execution could likewise be because of lack of foresight by the gatherings before setting up a joint endeavor, inability to move toward the market with adequate administration proficiency and unforeseen changes in the market circumstance. A decent answer for this is to assess budgetary circumstances intensive previously and during very advance of the joint endeavor. The executives issues Probably the most concerning issue of joint endeavors is the incapable mixing of administrators who are not used to cooperating of have completely various methods of moving toward issues influencing the association. Many joint endeavors fall to pieces because of misconception over authority systems. For a fruitful joint endeavor, there hosts be understanding and bargain between gatherings, regard and reconciliation of the qualities of the two sides to defeat the more vulnerable focuses and make their collusion more grounded. Improper administration structure In an offer to have equivalent rights in the endeavor, there could be a loner of administrators. Thus, there is a significant lull of dynamic procedures. Day by day operational choices that are best made rapidly for more productivity of the business will in general be eased back down on the grounds that there is presently a ‘committee’ that is set up to ensure the two gatherings bolster each and every choice. This could divert from the master plan prompting serious issues over the long haul. Societies Factors At the point when a joint endeavor is framed, it is artistically an endeavor at mixing at least two societies in the desire for utilizing on the quality of each gathering. Absence of comprehension of the way of life of the individual gatherings represents a colossal issue if not tended to. A typical issue in these multi-social undertakings is that the way of life isn't considered in their underlying development. It is generally expected that the social issues will be tended to later when the new unit has been made. As a rule, bargains are reached and certain social from the gatherings are kept on while others will be others are either out appropriately disposed of or adjusted. Upsides and downsides for IJV The joint endeavor is turning into a well known route for organizations that redistribute their activities to hold a bit of the proprietorship pie. The production of another lawful element during the dispatch of a joint endeavor accompanies a lot of good and bad times. On the in addition to side: Joint endeavors empower organizations to share innovation and integral IP resources for the creation and conveyance of inventive products and ventures. Joint endeavors can be utilized to lessen political grating and improve nearby/national agreeableness of the organization. Joint endeavors may give pro information on neighborhood markets, passage to required channels of dispersion, and access to provisions of crude materials, government agreements and nearby creation offices. In a developing number of nations, joint endeavors with have governments have gotten progressively significant. These might be framed legitimately with State-possessed ventures or coordinated toward national bosses. On the less side: A significant issue is that joint endeavors are extremely hard to incorporate into a worldwide technique that includes considerable cross-

Saturday, August 22, 2020

Advertisement Is a Legalised Form of Lying Essay Example for Free

Ad Is a Legalized Form of Lying Essay Need is the mother of development is an oft-cited saying. Be that as it may, presently a-days the opposite of it is all the more evident. In present day business, development is mother of necessityIn this period of apparatus, newthings are delivered ordinary. Market is made for these things through advertisementBusinessmen promote their merchandise in different manners and in this way spread an information on their goodsamong the clients. It is through promotion that individuals start to feel a requirement for even those merchandise of whichthey had never heard. Promotion makes request. it is the foundation of business and Industry. No business can remain in the business world without commercial. An effective representative is one who grabs away cash from even the most stingy and hesitant client. In this way, the business world turns on the rotate of ad. As the world is advancing, so the methods for promotion are likewise expanding. We allknow that enormous banners are glued on the dividers, and handbills are disseminated to propel the offer of merchandise. Dividers are painted and huge billboards are shown on intersections and noticeable spots toserve this reason. In a film lobby, as a matter of first importance we see the promotion slides. A significant piece of thedaily papers is loaded with promotion. Circumstances Vacant, Tender Notice, Educational, Lostand Found, Matrimonial, film commercials, and notices of such a large number of different wares are normal highlights all things considered. Radio and Television additionally are being utilized asmeans of business promotion. A decent notice must have certain characteristics. To start with, it ought to be founded on human-brain science. A thing implied for women, ought to be publicized so that they are attractedtowards it. On the off chance that men are to be clients, at that point it should engage their preferences. Products for differentincome gatherings ought to be promoted, thinking about their buying power. An engine vehicle is a thing for the rich. Its ad should be contact the attitude of the rich. Usha SewingMachine ought to be promoted so that the family man, with standard pay, may feelthe financial points of interest of the speculation of his cash on it. Besides, notices ought to be appealing. This is basic. Individuals look towardsan notice just on the off chance that it is attractive. Great, fascinating pictures are viable structure this perspective. We as a whole think about Sanforised fabric. The commercials to show that nature of the material presentation a man wearing a suit of non-sanforized fabric. He seems interesting and awkward ashis suit has left fit by washing. Another man is demonstrated wearing a suit of Sanforised fabric. How savvy and dynamic he shows up. We quickly discover that Sanforised material is best on the grounds that itdoes not recoil. So a decent ad should be intriguing, appealing and eye-getting. Be that as it may, legitimate sacredness must be kept up and pointless introduction must be dodged. It should likewise befrequently rehashed, in any case individuals disregard the products publicized. try not to get a kick out of the chance to burn through their time on things which don't concern them. So to be successful,advertisement must be brief. Long unmistakable stories or authentications of applause about certain thing donot make great promotion. This is a significant point in publicizing and a decent sponsor mustkeep it as a primary concern. Ads are not worried about the fortunate or unfortunate nature of products. Indeed, even the mostinjurious products are promoted nowadays. Promotions of bothersome medications and meds andindecent writing, so normal. They essentially cheat general society. So we ought to be cautious while buying a promoted article. We should utilize our own brain, rather than indiscriminately following theadvice of the ad. In our nation, the craft of publicizing is in its earliest stages. in dynamic nations, likeAmerica, enormous business concerns have authorities and specialists for this reason. They spend hugeamounts of cash on promotion. However, it isn't so in our nation. Some representatives believe their items to be predominant. They think commercial superfluous. This is bothersome. Toget accomplishment in business each large or independent company concern must make powerful us of craft of publicizing merchandise. To maintain a business without its guide is beyond the realm of imagination in the cutting edge age. â€Å"the promotion for the body-splash, Impulse. The entire thought of a man assimilated in hisdaily routine being abruptly energized out of it by a whiff of Impulse and afterward experiencing a seriesof incautious activities to praise the woman wearing it, is sentimental and charming to most ladies. This joined with the light, tinkling piano backup and delicate center shooting makes theadvertisement an alluring one. At that point we have the paper and magazine promotions, invibrant shading, fascinating designs and clever trademarks. Investigate most restorative advertisementslike Maybelline or Cover young lady, where the page is appealingly sprinkled with the freshest hues themanufacturer has concocted a quite, vivacious young lady trapped in mid-chuckling. Subsequently, commercials today are commonly fascinating because of the visual and audio cues made conceivable yadvanced innovation in the different modes of print, sound and film, and a little imagination,especially when opponent organizations attempt their best to pull in buyers thus attempt to publicize better. It is safe to say that they are pointless? Not really. From numerous points of view ads help to keep the expense of most distributions low with the goal that we can manage the cost of them without any problem. This applies on account of our dailynewspaper â€Å"The Straits Times†, the Sunday â€Å"Asia Magazine†, the mainstream â€Å"Readers Digest† andespecially the distribution we are on the whole acquainted with, our individual school magazines. Theadvertisers pay to promote and this installment finances distributing cost with the goal that we pay less thanwhat we may somehow or another need to pay. Notices additionally help to facilitate our fatigue once in a while. How frequently have individuals been stirred out of an exhausted daze once they see an interestingadvertisement on a bulletin or transport or when sluggishly flicking through a magazine? Also,advertisements either intriguing or something else, particularly of something else, do advance conversationamong companions when they examine them, how a promotion is so senseless, or another is unordinary andimaginative but another is presenting a fascinating and alluring item which may beworth purchasing. This at that point carries us to the last point. Are ads misdirecting? One of their uses is that they educate us regarding what is accessible available, however is this informationwholly obvious? Their primary capacity is to pull in purchasers so normally, just certain insights about an item are featured while others are not given by any stretch of the imagination. We are made to accept that a productis durable, beneficial, multi-reason and bound to give us that bliss we can't findelsewhere. Scent commercials guarantee to bring the other gender falling at one’s feet,dictionary and reference book notices guarantee to give all of us the astuteness and information inthe world, corrective ad for â€Å"Ponderosa Steak Salad Restaurant† guarantees succulent andtender steak and delightful plate of mixed greens. I have eaten there and seen the steak as of extremely low quality,for an exceptionally significant expense, however the serving of mixed greens was everything the ad persuaded. Taking everything into account, I would state that modernAdvertisements are exhausting, except if and oftenmisleading. †

Sunday, August 9, 2020

MPA-DP Applying the SIPA Toolkit Abroad COLUMBIA UNIVERSITY - SIPA Admissions Blog

MPA-DP Applying the SIPA Toolkit Abroad COLUMBIA UNIVERSITY - SIPA Admissions Blog By now, Im sure  youve read a little about the Summer Field Placement  and/or internship requirement for MPA-DP students. So today, Im  sharing  the second post in a guest series by current student Amanda Grossi, MPA-DP 2016, in which she reflects on her summer in Nairobi, Kenya. Summer. For many students, the word means freedom from the grips of classroom lectures and taxing homework problems, a Houdini-like escape from the walls of Columbia’s libraries that seem to ensnare even the cleverest of students. For students in Columbia University’s MPA in Development Practice program, the word signals an explosion of fiery and impassioned development practitioners whose fallout scatters all over the globe, touching those with whom they work and leaving lasting marks as they carry out their summer internships. In doing so, students have the opportunity to unpack the SIPA toolkit from their first year on campus and take inventory of tools they need to acquire during their upcoming second year. This summer, I had the honor of working in Nairobi, Kenya as a Policy Innovation Fellow at the headquarters of the World Agroforestry Center (ICRAF), which is one of the 15 agricultural research centers that makes up  the Consultative Group of International Agricultural Research (CGIAR) consortium aimed at achieving a food secure future. In a nutshell, my tasks were to complete a knowledge needs assessment of the outreach partners of the CGIAR Research Program on Forests, Trees, and Agroforestry (FTA), as well as to distill the best practices of fellowship policies of FTA research centers. As I navigated these tasks, I looked into my own toolkit, both given and earned through SIPAâ€"the classes, conversations, skills, technologies and relationships that defined my first year. [Photo courtesy of Amanda Grossi | Amanda Grossi and her supervisor and office-mate in the Capacity Development Unit, Imelda, exploring the Karura Forest just behind the World Agroforestry Center campus during lunch break.] While the components of each student’s toolkit will differ, what I can say about mine is this. It was not the tools per se this summer that I found most valuable, but rather the box. Yes, I used the data analysis skills for dissecting information, the succinct and detailed writing skills SIPA has forced me to refine for compiling my research, and the visual aid tools to which I was exposed for communicating the ideas emerging forthwith. But all of these pale in comparison to the foundation that laid the success of my internship this summer, and that is speaking the language of development and science in conjunction with the ability to critically analyze. In conducting my interviews of the outreach partners for the needs assessmentwhether it was an organization describing payment for ecosystem services, the difficulties of impact evaluations, or the details of carbon sequestration or mitigation strategiesI hardly think I would have truly appreciated and understood the context of these conversations  if I did not understand the buzz words and the  meaning  behind them imparted to me through SIPA’s classes and atmosphere. And so, while the knowledge and skills imparted to me through SIPA are invaluable as they were for many students this summer and will be for students of future summers, internalizing the language of the development landscape and knowing how, when, and why to use the knowledge and skills in our toolboxes are all part of the fabric of SIPA life that has been woven into me as a student and professional in my field. [Photo courtesy of Amanda Grossi | Amanda Grossi explains her research findings regarding the knowledge needs assessment of the outreach partners of the CGIAR program on Forests, Trees, and Agroforestry.]

Saturday, May 23, 2020

Enron And Its Impact On Corporate Business Practices

Enron Enron is a company infamous for one of the largest scandals in American corporate history. Over twenty thousand employees and thousands of outside investors had billions of dollars worth of shares in the company that positioned the company to be valuated at about 70 billion dollars with shares trading at about 90 dollars a share in 2001. However, from August to November 2001 Enron s stock value dropped to $0.26, and those who had invested in Enron lost billions of dollars within a couple of months. This record breaking stock drop landed the company on the Exchange Commission and the U.S. Justice Department’s radar resulting in an investigation that revealed the company’s corrupt business practices ultimately shocking the world,†¦show more content†¦Sherron Watkins, a former Enron Vice President who was hailed as an â€Å"internal whistleblower†, said in an interview that Enron’s ambitious goals inflated many egos at the company. The mission statement went through several changes, but in 1995, its mission â€Å"to become the world’s leading energy company† â€Å"indicated a great deal of arrogance† says Watkins. In 2001, Enron’s mission statement was changed â€Å"to become the world’s leading company.† This rise in arrogance came from the company’s leadership, which would ultimately show evidence of fraud. Jeff Skilling was promoted to COO and â€Å"transformed Enron from a sleepy pipeline company to an unregulated financial services company trading in energy futures, paper and pulp products, weather derivatives, airport landing rights and commodities† (Tshaonline.org, 2015) This strategy allowed Enron to go from making $13 billion a year to $100 billion leading to Skillings next promotion as CEO in 2001. However, this growth was in large part due to accounting irregularities. These accounting irregularities were led by Andrew Fastow, the company’s CFO, who took advantage of the deregulation laws for energy companies in the 1990s to favor Enron. Following many deals as a result of the deregulations, Fastow was

Tuesday, May 12, 2020

The effects of parental bereavement in childhood

Sample details Pages: 22 Words: 6481 Downloads: 10 Date added: 2017/06/26 Category Sociology Essay Type Argumentative essay Tags: Childhood Essay Social Work Essay Did you like this example? The aim of this study is to present a general overview of the evidence base in relation to the effects of parental bereavement in childhood. The primary focus is upon research conducted during the past ten years, the available commentary and key theoretical ideas on the topic, notably from Bowlby (1969; 1980), Parkes (1986) and Worden (2003) together with an outline of the contemporary information and guidelines available for those directly involved with this phenomenon, particularly parents and children. An overview of the research suggests that there areconflicting findings, particularly in terms of the nature and extent ofpsychological difficulties, such as depression, that may present inlater life. Two clear messages seem to emerge. Firstly, a significantnumber of studies indicate that further research is needed into theinfluence of variables that potentially mediate, or facilitate, theoutcome for the bereaved child, such as the childs personality traits,family and school factors and other life events. Secondly, thereseems to be a need for more longitudinal studies in this area andstudies which ask similar questions and adopt similar research designand methodology, particularly in the qualitative field, so that usefulcomparisons may be made between different findings. Don’t waste time! Our writers will create an original "The effects of parental bereavement in childhood | Social Work Dissertation" essay for you Create order Chapter One Introduction The purpose of this literature review is to explore the evidence basein relation to the effects of parental bereavement in childhood. Theresearch and commentary on this topic is useful in terms of social workpractice because it offers much insight into the experiences and needsof children who have lost a parent. Furthermore, the evidence includesmuch background theoretical material regarding issues of attachment,loss, grief and the making and breaking of affectional bonds forchildren, offering useful insights for those working with children inneed. The death of a parent in childhood, by definition, is oftenpremature and unexpected. It is an event commonly understood tointerfere with the normal process of growing up. As the research andcommentary in this field demonstrates, the childs life is shaken fromits very foundations and the confidence the child has developed thusfar in the world around them and within themselves has effectively beendestroyed (Brown, 1999). This review offers a general overview of thecurrent literature relating to parental death in childhood to include arange of research studies undertaken within the last ten years,commentary by theorists and writers on the topic such as Bowlby (1969;1980) and Parkes (1986) underpinning much of the research and aselection of the advice, information and guidelines available onchildhood bereavement and offered to interested parties such asparents, service providers and the children themselves. This review differs from other reviews on the topic. Firstly, itconstitutes the most recent review of its kind, the latest review beingthat undertaken by Dowdney (2000), at least as far as can be determinedgiven the limitations on time available to search for such reviews.Secondly, this review includes an up-to-date indication of thepractical and accessible guidance and information available tointerested parties on child bereavement which is not present in otherreviews, such as that by Dowdney (2000). The choice of research papersto include in the review was determined by the availability of the fulltext of the articles found and the relevance of the subject studied tothis specific topic. Three further considerations were firstly, thatthe research discussed in detail would be contemporaneous, that iswithin a time span of the past ten years although earlier research isreferred to within the review, where this was adjudged to besufficiently influential and relevant to the issue under discussion. The second rationale, felt by the review author to be important, wasthat the research used would be that which was presented in a coherent,understandable and accessible way. Connected to this was the thirdimportant consideration, in that research material was selectedaccording to its validity and standing within the academic community.This was determined by the extent to which the researchers hadexplained their research design, methodology and analysis and whetherthe material had been cited by other well-established investigators inthe field. Decisions about how the review was to be organised, in terms ofgrouping the material, proved to be quite a difficult task due to thewide range of specific research aims and approaches found within thisfield. It must be stressed that the following four chapters representonly one way in which this material could be organised since there aremany issues and themes which tend to cut across all the studies,defying any rigid categorisation. Nevertheless, having considered allthe material, the chapter contents reflect the major themes to emergefrom the available literature from the past ten years. Two appendicesare included at the end of the review which outline the searchingstrategy used and its outcome, and the major themes emerging from thereview. Chapter Two Models of healthy mourning and the developmental perspective The death of a parent, and indeed any other significant figure, isunderstood as a very stressful experience for children. Worden (2003)notes the considerable controversy over some decades concerning theextent to which children are considered capable of mourning. He citesWolfenstein (1966) who suggested that children could not mourn untilthey have achieved full psychological differentiation within a fullyformed identity occurring at the end of adolescence. Others, hesuggests, such as Furman and colleagues (1974) and John Bowlby (1960),cite the age of capacity for mourning as much younger, at 3 years ofage and 6 months respectively (Worden, 2003). Worden himself assertsthat children do mourn and that the issue is rather that we need tofind a model of mourning that is appropriate for children themselves,rather than trying to fit childrens experiences into an adult model. Parkes (1986) and Worden (2003) have emphasised that mourning thedeath of a significant figure is characterised by a series of tasks tobe undertaken by the bereaved person over a period of time that isessentially unique to each individual. These tasks are summarised byBrown (1999) as accepting the reality of the loss, experiencing thepain of grief, adjusting to a new environment and investing in newrelationships (p.1). Brown (1999) points out that there are manyfactors which influence bereavement for children including their age,level of cognitive understanding and the relationship which they hadwith the person who died (p.18). She describes how these factors willimpact upon the childs emotional and behavioural responses to theirloss. John Bowlby, in his studies of attachment, loss and separation andaccompanying anxiety responses in children, asserted that bereavedchildren who had experienced secure relationships prior to the death,were more likely to achieve a healthy resolution to their loss (1969;1980). Furthermore, in his analysis of childrens responses to thedeath of a parent, Bowlby seems to place the responsibility for ahealthy resolution firmly with the significant adults around thechild. He suggests, for example, that the child is likely to behindered in his or her grieving process because the adults themselvesare often unable to bear the pain of mourning perhaps that of theirown mourning, certainly that of their childs, and especially that ofmourning together (Bowlby, 1980, p.272). Bowlby identified three key stages in the achievement of healthyresolution of childhood grief. Firstly, children need to be givenhonest and open information about the death, and to have theirquestions answered. Secondly, they need to be aware of adultsresponses to the loss and to be actively involved in the ritualssurrounding the death. Thirdly, they need a secure, continuedrelationship with a known and trusted adult (Bowlby, 1969; 1980).Bowlbys observations are given prominence here because they haveunderpinned much of the later work on childhood bereavement. Brown(1999), for example, outlines research evidence which emphasises thatthe most effective way to help bereaved children is to work with thefamily. She notes, also, that children adapting to grief need bothcognitive and emotional understanding of what has happened (Brown,1999, p. 18). Worden (2003) echoes this observation, pointing out thata certain level of cognitive development is required to fullyunderstand and integrate t he concept of death. He cites some of themajor cognitive concepts to be mastered as (1) time, includingforever; (2) transformation; (3) irreversibility; (4) causality; and(5) concrete operation (Worden, 2003, p.160). Worden (2003) describes the Harvard Child Bereavement Study whichhe, along with his colleague, Dr. Silverman, conducted in the early1990s with a total of 70 families, including 125 school-age children,over a two-year period following the death of one parent. Thenon-clinical sample of families was drawn from communities of varyingdemography and compared with a matched control group of non-bereavedfamilies. The researchers interviewed the children and survivingparents with the aim of studying the natural course of bereavementfor the children (Worden, 2003, p.160). Worden lists ten of the keyfindings from this survey study, the first of which is that mostbereaved children (80%) were coping well by the first and secondanniversaries (2003, p.160). The differences between the bereavedchildren (20%) who were not coping well and their control counterpartswere greater at two years than at one year, indicating that there was adelayed effect of the loss on these children, as pointed out by Word en(2003). This finding implies that childrens grief is developmental,fitting with the idea that the quality of childrens grief will changeover time, in line with their increasing mastery of the cognitiveconcepts mentioned earlier. The Harvard Child Bereavement research is cited as significant by anumber of commentators. Monroe (2001), for example, suggested thatthis study is probably the most important research study on childrenand bereavement to date (p.76). Monroe describes how children are aptto return to issues concerning bereavement and loss repeatedly overtime, especially at times of transition in their lives, as theirunderstanding develops and their questions change. Other key findingsfrom the research include the importance of active coping, cohesion andgood, open communication about the dead parent within the families.The most powerful predictor of a childs adjustment to the loss ofparent was stated as the functioning level of the surviving parent.Children with a poorly functioning parent showed more anxiety anddepression as well as sleep and health problems (Worden, 2003,p.161). This observation takes us back to Bowlbys assertion that aprime task in helping a child to overcome difficulties in the gri evingprocess is to provide the surviving parent with a supportiverelationship (1980, p.273), and this is a recurrent theme to which wereturn, especially in Chapter Five. A recent study conducted by Hurd (2004) contrasts with the Harvardresearch in many ways. Hurd employs a qualitative, single case-studyapproach in order to investigate the grief work of a 14-year old girlwhom he names Debbie. He describes his use of the interview method,audio-taping and transcribing all interviews into verbatim texts. Themode of data analysis used was the constant comparison method in whicheach interview session was coded for concepts, categories and majorthemes. Hurd describes his role as an engaged but dispassionatelistener committed to faithfully reporting and explicating (Debbies)bereavement experience and its meaning to her (2004, p.342). Datavalidity was established via interviews with Debbies mother andbrother to confirm factual accuracy. This differs from the surveymethod employed by the Harvard study in that it can produce therichness and complexity of individual experience in a way that theformer cannot. However, on the other hand, its limit to a single stud ycannot offer the kind of general overview of experiences within alarger population that the survey method allows. Recent commentators, such as Jacobs (1999) and Stroebe et al(2001), contribute to an ongoing debate that questions the perceptionof grief reaction as a psychiatric disorder, and therefore as somethingthat can be diagnosed and cured, rather than a natural response to theway that the death of a significant other can change a personsworld. Stroebe et al (2001), for example, have stressed the potentialfor healthy mourning during childhood after a parental death. Hurd,also, acknowledges the work of Bowlby (1980), stating that depressionas an outcome of a childhood bereavement experience was no longerconsidered as inevitable (2004, p.341). He also links this shift withan emergent contemporaneous interest in resilience in the lives ofat-risk children in this field, noting that there is, to date, verylittle research evidence on resilience in parentally bereavedchildren. From his single case study, Hurd concluded that Debbie was a stable andhappy 14 year old who had coped well with the loss of a much-lovedfather without having developed depression or other psychologicaldisorder. He notes the environmental factors deemed by Bowlby (1980)to be crucial for healthy mourning, as outlined above, and that thepositive presence of these in his analysis could help to explainDebbies success in coping. Hurd summarises by suggesting that theinternal and external protective factors were in place for Debbie tobecome a resilient adolescent able to experience healthy mourning andto develop her identity relatively unscathed by the psychological andemotional trauma that often accompanies a major loss (2004, p.351).Hurd ultimately calls for more single-case reports and large populationstudies enrich the knowledge base on resilience and suggest newdirections. Chapter Three Anticipated versus sudden parental death Many commentators have made a distinction between anticipated andsudden death in terms of the nature of grief responses. There seem tobe few studies which focus specifically upon childhood bereavement inthis respect, and where they do so they tend to be situated within thecontext of high-profile, public events such as the violence stemmingfrom the troubles in Northern Ireland, the September 11 attack on theWorld Trade Centre in New York and the genocide in Rwanda. Suchstudies, nevertheless, enhance our understanding of the specific impactof traumatic parental death upon children. Christ (2005) highlightshow the sheer numbers of parentally bereaved children following the 11September 2001 attack in New York prompted a range of novel groupinterventions with children and their surviving parents using ritualsand activities. These initiatives were centred upon the reconciliationprocesses of children at different cognitive and emotional levels,especially in the months following the death. Grace (2005) reviews the research into the relationship betweengrief and trauma responses in children. She notes that whilst earlierinvestigators stressed the need for the child to resolve the symptomsof trauma, where present, prior to being able to process bereavementissues successfully, more recent research suggests that the presenceof symptoms of trauma may not interfere with the childs ability togrieve (Christ, 2005, p.101). She cites evidence from her own workwith families of New York fire fighters who died which showed thatsymptoms associated with bereavement and trauma in children were oftenintertwined, suggesting that the two need to be addressedsimultaneously. Donnelly and Connon (2003) presented the findings from the childbereavement project group for the Social Services Trauma Advisory Panelin Belfast. They note that traumatic bereavement varies in nature andintensity as children grow and can also lead to the development of posttraumatic stress disorder and depression. Their research alsoidentified a number of children who were able to make use of bothsocial support and their internal resources to achieve understandingand cope with their grief without developing overwhelming symptoms orrequiring external interventions. Whilst acknowledging the usefulnessof resilience theory, emphasising the ability of children to cope wellwithout intervention, and other insights from research studies,Donnelly and Connon maintain that our current understanding oftraumatic bereavement underestimates the negative symptoms suffered bychildren (2003, p.3). They suggest that many researchers have reliedon assessing behaviours that do not accurately reflect the true rangeof childrens reactions (2003, p.3). Donnelly and Connon (2003), similarly to previously citedresearchers, acknowledge Bowlbys assertion of the loss of a parent, orprimary care giver, as one of the most influential events in a childslife, requiring radical adjustment to the childs daily routinealongside the establishment, or reinforcement, of a secure relationshipwith a trusted adult (Bowlby, 1980). They highlight the effects oftrauma on children, initial reactions depending upon the childs levelof exposure to the event, varying from hearing about it second-hand towitnessing, or being personally threatened by, the traumatic eventitself. They point out that the impact of trauma upon children can beso strong that emotions and thoughts about the event can remain vividfor years after the event and the threat have passed. Donnelly andConnon cite research by Terr (1991) which postulates traumaticbereavement as a particularly complicated process whereby the normalmourning rituals and social support which facilitate the resolut ion ofnon-traumatic bereavement are often not enough to overcome distresscaused by traumatic loss(2003, p.5). They go on to stress that iftrauma remains unresolved, or isnt fully understood by children, itinterferes with the normal grief process, engenders secondarydifficulties, and increases the period of distress (Donnelly andConnon, 2003, p.5). Many commentators, such as Brown (1999) and Worden (2003), point outthat bereavement is especially difficult when the death was sudden orviolent. The age of the child is important also; Brown (1999) notesthat where death has happened suddenly, many children will recallevents which immediately preceded the death, examining conversationsand their own relationship with the person in great detail (p.28).Brown records the observations of researchers such as Adams (1992), whopointed out that, for young people, a particularly difficult aspect ofa parents sudden death, often overlooked and misunderstood, is thatdeath and grief involve feelings of helplessness and lack of controlthat are exceptionally difficult to cope with when you are at preciselythe stage in your own life when you need to feel powerful and incontrol (1999, p. 28). Some researchers have addressed childhood bereavement within amedical model, emphasising the pathological features of certain griefresponses. Pfeffer (2000), for example, cites many research studieswhich stress how depressive symptoms seem to be the most consistentadverse outcome in bereaved children. He describes one study of 38children in which one-third of them suffered symptoms of majordepressive disorder within the first two months after parental deathfrom such causes as cancer, cardiopulmonary arrest, stroke or accident,and that these depressive symptoms lasted up to 14 months afterparental death in many cases (Pfeffer, 2000, p1). Pfeffer (2000)differentiates between grief following anticipated deaths, from cancer,for example, and grief following unexpected or violent forms ofparental death. Pfeffers study focused upon child survivors of parental death of twoparticular types, cancer (57 families, 64 children) and suicide (11families, 16 children). Children in both samples completed aself-report questionnaire, the Childrens Depression Inventory,described as an established and valid measure, within 18 months of thedeath. The data from both samples was compared using statisticalanalysis methods. Pfeffers findings indicate that althoughchildrens grief after all forms of parental death is characterised bysymptoms of depression, there are additional reactive symptomsfollowing sudden death, particularly suicide. These include severeanxiety, hyper arousal, and intrusive thoughts within the first yearafter parental death and the formation of childrens traumaticexpectations about the world and a sense of worry about personalintegrity and the security of interpersonal relationships(Pfeffer,2000, p.2). Chapter Four Long-term implications and retrospective studies Several researchers have demonstrated the increased risk ofdeveloping psychological and social difficulties in later life forchildren who have lost a parent through death (Weller et al, 1991;Black and Young, 1995). Some researchers have chosen to explore thelong-term consequences of childhood bereavement through conductingretrospective studies of adults, in contrast to those studies,highlighted in Chapters Two and Three, which primarily focus onchildren. Hurd (1999), for example, sought to discover how adults whohad been parentally bereaved in childhood had incorporated theexperience into their lives. Hurd was interested in the adequacy oftwo well-established, and contrasting, theories for explaining howyoung children cope with the death of a parent, and the implicationsfor their future mental health. Was the Freudian theory thatdepression is an inevitable consequence of the childhood bereavementexperience accurate? Or, did Bowlbys thesis of a more positive outcomefrom potentially he althy mourning fit better? Hurd (1999) used Q methodology, making use of both quantitative andqualitative measures, and including factor analysis, to organise andanalyse the subjective experiences of his 43 respondents. He foundthat 19 of the participants described their experiences of seriousdepressive illness at some time during adolescence or adulthood,another 19 recorded having never been depressed and none of them weredepressed at the time of the interview. Hurd concluded that the viewheld by Freudians of later behaviour and affective disorder was notconfirmed by the study (1999, p.31). In contrast, the data analysisconfirmed Bowlbys prediction that children were more likely to resolvetheir grief in healthy ways during childhood, reducing the potentialfor later depression if they have loving relationships with theirparents, if they experience strong emotional support from the survivingparent after the death occurs and are consulted during decision-makingabout the familys future, and if they experience the support ofextended family and others (Hurd, 1999, p.32). Hurd acknowledged the limitations of the study, such as reliance onself-reports by participants and the absence of validity confirmationregarding their childhood experiences and depression. Indications forfuture research include exploration of the role of siblings in thegrieving processes of children and longitudinal studies to explorefurther significant influences over time. Maier and Lachman (2000) observed that few research studies havebeen conducted into the long-term consequences of childhoodexperiences, including parental death, although, where they exist, theytend to focus upon the relationship between early parental death andspecific types of psychopathology in adulthood. Maier and Lachmansapproach is somewhat different from that of Hurd in that they chose tosurvey a large population sample to investigate a wide range offactors. Their study involved telephone interviews with a largesample, described as a national probability sample, of 4242 adults inthe USA. The respondents, aged between 30 and 60, completed aquestionnaire which was subsequently analysed according to measures ofmental health, depression, physical health, social support and natureof parental loss and separation. The research aim was to chart the consequences of early parental lossand separation for health and well-being in mid-life. One finding wasa stronger effect, in terms of mental and physical health anddepression, of parental divorce than for parental death in mid-life(Maier and Lachmann, 2000, p.188). The researchers conclude, in termsof early parental death, that greater autonomy was indicated for men inmid-life whilst depression was a more significant factor for women.However, they state that it is still unclear how parental divorce anddeath may differentially impact men and women (Maier and Lachmann,2000, p.189) and further research is flagged up for this particulararea. Another survey study was carried out by Mack (2001) of similar sizeto that of Maier and Lachmann (2000), using the self-completed reportsfrom 4,341 respondents for the analysis. Mack was also concerned tocompare adults who had experienced parental divorce with those who hadexperienced parental death prior to the age of 19. Mack is critical ofresearch on one-parent families that often has failed to distinguishbetween the effects of different types of family disruption upon adultwell-being. He points out that such research has typically notrecognised the possibility that events such as parental divorce orparental death are diverse experiences that are likely to affectchildren in very different ways (Mack, 2001, p.419). Mack draws on Bowlbys (1980) assertion that parents play animportant role in determining childrens responses to traumaticevents. He also refers to the social learning theory of Bandura (1971)which emphasises that children learn certain responses to stressthrough observation of parents and other significant carers. As Mack(2001) notes, accordingly, parental reactions to stressful events,such as divorce or death of a spouse, are particularly important indetermining how children develop responses to these same events(p.420). Mack suggests that these two theoretical approaches underpinhis own thesis that different types of childhood family disruption willdetermine qualitatively different outcomes for adult well-being. Thevariables used in Macks study to explore this theme were parent/childrelationship quality, self-confidence, depression and childhood familystructure and survey responses were analysed using statistical methods. Mack (2001) found that adults who had experienced early parentaldeath did not report significantly different parent/child relationshipsfrom those raised in intact families, contrasting with the negativeeffect found for parental divorce on parent/child relationships.Consistent with prior research, Macks study found that when comparedto adults who had been raised in intact families, adults whoexperienced parental death report lower levels of self-confidence andhigher levels of depression (2001, p.438). Whilst acknowledging thatnot all bereaved children and their parents necessarily respond in thesame way, Mack nevertheless makes a useful connection between his twokey background theories and the findings from his study. He observesthat regarding parental death, if permanent separations produceattachment-related feelings of despair and children also observe highlevels of parental guilt and sadness, then we should not be surprisedto find that these individuals have low confidence and symp toms ofdepression as adults (2001, p.438). Chapter Five Service Provision An exploration of the available literature on this topic revealsthat there is no shortage of advice and guidance for parentallybereaved children and their families from a wide range of sources.There are a number of accessible books aimed at children to help themunderstand and manage their feelings regarding loss and bereavement,for example, Michael Rosens Sad Book by Michael Rosen (2004),Remembering Mum by Perkins and Morris (1991) and It Isnt Easy byConnolly (1997). There are also books offering advice and support toparents coping with children in the context of bereavement and loss.For example, a book called Coping with Loss for parents by Elliot(1997) covers themes such as how bereavement, loss and change areconnected, how children think about death according to age, how aparents own grief impacts on his or her child and how to support agrieving child. In similar vein, a book by Wells (2003) covers thebroader perspective of children and loss, addressing the impact ofmajor losses, including parental death, as well as disability,ill-health and family traumas and how these affect children atdifferent ages within the family context. Service provision in the UK for children who have been parentallybereaved has been reviewed and researched in recent years and two ofthe key studies will be outlined here. Dowdney and colleagues (1999)sought to identify whether psychiatric difficulties in parentallybereaved children and surviving parents were related to serviceprovision. Using a representative community sample of 45 bereavedfamilies with children aged between 2 and 16 years from two Londonhealth authorities, they conducted a semi-structured interview witheach family. Information was gathered on the death, familial grievingactivities and adjustment of family members after the death togetherwith details of external bereavement support sought, offered andreceived by the family and children. Standardised checklists werecompleted by the parents to assess emotional and behaviouraldisturbance in the children and, for school-age children, by theteachers. Parental mental health was determined through a generalhealth questionn aire and probable psychiatric disorder wasidentified. Dowdney and colleagues found high levels of psychologicaldisturbance in the children and surviving parents during the 3 to 12month period after the death. Boys presented with greater symptomaticbehaviour than girls, particular through aggression and acting out(Dowdney et, al 1999). In terms of service provision for bereavedchildren, this was unrelated to probable psychiatric disturbance inchildren or parents or to parental desire for support and theresearchers concluded by suggesting that given resource limitations,service provision should be targeted at psychologically disturbedchildren or psychiatrically disturbed patients wanting parentingsupport, or both (Dowdney et al, 1999, p.?). It seems clear that Dowdney et als study, like that of Pfeffer (2000)described in Chapter Three above, adopts a medical model, viewing childand family bereavement responses and behaviour in pathological terms.It is interesting to note that they give no reference to the healthymodels of mourning, or natural processes of grief that have beenacknowledged by other authors, such as those outlined in Chapter Two ofthis review. Their focus is firmly upon those parentally bereavedchildren and families whom they have deemed to have shown psychiatricdisturbance and, therefore, service provision is viewed as necessaryonly within this context. A comprehensive survey of UK service provision for childhoodbereavement was carried out more recently by Rolls and Payne (2004).91 known services received postal questionnaires and from theresponses, 8 organisations were selected to be studied as in-depthcollective case studies. Both quantitative and qualitative researchmethods were used to analyse the data. Whilst services had a sharedobjective to help bereaved children, they were found to be very diversein terms of their location, type of services, service organization,management and funding arrangements, staffing types and levels and, toa lesser extent, types and range of interventions offered (Rolls andPayne, 2004, p.320). It was observed that since bereaved children werenot defined as children in need under the Children Act 1989, servicesaimed specifically for them were struggling financially in the face ofuncertain funding sources. It is also the case, however, that underthe present government initiative the Childrens National ServiceFramework standards are currently being defined to support thedelivery of services concerned with enhancing childrens mental healthand well-being. It is envisaged that childhood bereavement serviceswill respond to meet these. The Childhood Bereavement Network (CBN) is an umbrella federation ofservices, established in 1998, working in a variety of settings withbereaved children, their families and caregivers. Having secured threeyears funding from the Community Fund, the CBN aims to improve accessfor bereaved children, their parents and other caregivers throughoutEngland to a wide range of high quality information, guidance andsupport, including counselling (CBN, 2005). Other publicised resources include the charity Winstons Wish,begun in the mid 1990s, which has published a Charter for bereavedchildren. The Charter promotes respect for the rights of bereavedchildren in a number of areas, including bereavement support, theability to express feelings and thoughts associated with grief, toremember the person who has died, to receive information and educationand to have a voice in important decisions affecting their lives(Winstons Wish, 2003). The National Childrens Bureau, awell-established childrens charity, has also published its Guidelinesfor Best Practice for Bereavement Care for children and runs a websitegiving information about services, new initiatives and researchundertaken. Chapter Six Discussion and Conclusion Several themes and issues are raised by this review of the evidencerelating to the effects of parental bereavement in childhood. Firstly,the work of John Bowlby (1969; 1980) on issues of attachment,affectional bonds, loss and bereavement in childhood has clearly beenhighly influential in the research and commentary on this topic. Therewere references to Bowlbys theories in almost all the research sourcescited. Particularly pertinent, it seems, is Bowlbys notion ofhealthy mourning, that successful mourning in children can lead to ahealthy resolution of their loss and need not lead to psychologicaldisturbance in later life. The research studies of Worden (2003) andHurd (2004), cited in Chapter Two, while making use of contrastingmethodological approaches, illustrate this latter point effectively.Secondly, the developmental nature of childrens understanding ofdeath, and ability to cope with the loss of a parent over time, seemsto have been a key message from Wordens research, marking ou tchildrens bereavement as qualitatively different from that of adults. The theme of healthy mourning versus pathological mourningpermeated many research studies. It seems that there are many morestudies that focus on the detrimental psychological outcomes ofchildhood parental bereavement, both in children and in adults, thanthose which study healthy mourning. Studies of the former, notably,use terms such as psychological disturbance and psychiatricdisorder (Dowdney et al, 1999; 2000) and major depressive disorder(Pfeffer, 2000). Other examples of such research relating tochildhood parental death, found through a search on the internet, butnot described in this review, include phrases such as attachmentstyles and personality disorders (Brennan and Shaver, 1998),psychological symptomatology (Thompson et al, 1998) and earlyparental loss and psychiatric illness(Agid et al, 1999). It was muchharder to find research which sought to explore the normal course ofchildhood parental bereavement, with one or two exceptions. Worden(2003), for example, cited in Chapt er Two, found that 80% of thechildren in his study, who had been parentally bereaved, were copingwell by the end of the first and second year after their loss. Itwould seem, as some commentators have noted, that more work is neededinto children who do well after the death of a parent (Brown, 1999,p.28). Dowdney (2000) observes, from her review of the research literature,that there is continued support for the association between parentalloss, childhood disturbance and later psychiatric disorder,particularly depression, borne out by the findings in this review. Shepoints out that the strongest evidence for this tends to come fromretrospective studies of adults with mental health problems. However,many studies have not found this association, for example, Hurd (1999)and Mack (2001) cited in Chapter Four of this review, challenging thevalidity of this link. Dowdney (2000) points out that someresearchers, such as Tennant et al (1980) and Harris et al (1986), andthe study by Mack (2001) described earlier in this review, argue thatchild bereavement alone is unlikely to be associated with adultpsychopathology, including depression. It seems more likely to be thecase that, as Dowdney concludes, it is the factors associated withbereavement, such as the quality of parental care and the presen ce ofother adverse social and economic sequelae following the bereavement,that influence adult outcome (2000, p.819). The research on differences between anticipated and sudden parentaldeath for the bereaved child appears to be a relatively new field ofenquiry with some interesting findings, as outlined in Chapter Three.One of the key issues to emerge in this area is the debate around thedegree to which symptoms of bereavement and trauma are interconnected,as outlined by Christ (2005) and, therefore, whether interventions tohelp severely affected children need to be focused on thesesimultaneously or separately. Comparisons between the findings of the research studies outlined inthis review seem to be fraught with difficulties, largely becausemethodologies, sampling, research questions and design vary widely,making it hard to compare like with like. There are, unsurprisingly,conflicting conclusions, for example, regarding the manifestation ofdepressive illness later in life as a consequence of childhoodbereavement. There seems little doubt that, as Dowdney (2000)suggests, Commonly, bereaved children present with a wide range ofemotional and behavioural symptoms that constitute a non-specificdisturbance (p.827). A small, but significant percentage of thesechildren are likely to be sufficiently distressed to justify referralto specialist services (Dowdney, 2000; Worden, 2003). A number of theresearchers cited have highlighted the need for longitudinal studies toassess more accurately both the nature of childhood parentalbereavement itself and the extent of psychological vulnerability overtime. The qualitative case study undertaken by Hurd (2004) described inChapter Two is one example of research which can provide a rich,in-depth description of the experiences of one young person who hadbeen parentally bereaved. In the absence of large samples of recentlybereaved children, it seems that the development of rigorousqualitative methodology such as this latter study will be useful toprovide a framework for future empirical studies. Finally, the findings of researchers such as Mack (2001) suggestthat it may not be childhood parental bereavement per se that leads toprolonged or future psychological disturbance but any number ofexternal factors that may accompany this particular phenomenon. AsDowdney (2000) suggests, more research is needed to investigate theinfluence of variables that may mediate, or facilitate, the outcome forthe bereaved child. There may be individual child factors such astemperament or disposition, family and school factors and also the manylife events that may follow parental death (Dowdney, 2000, p.828). Agid, O, Shapira, B, Zislin, J and others (1999) Environment andvulnerability to major psychiatric illness: a case control study ofearly parental loss in major depression, bipolar disorder andschizophrenia, Molecular Psychiatry, 4, pp. 163-172 Black, D, Young, B (1995) Bereaved children: risk and preventativeintervention, in Raphael, B, Burrows, G (Eds) Handbook of Studies onPreventative Psychiatry, pp. 225-244, Elsevier, Amsterdam Bowlby, J (1969) Attachment and Loss: Attachment (vol. 1) Basic Books, New York Bowlby, J (1980) Attachment and Loss: Loss, Sadness and Depression (vol. 3) The Hogarth Press, London Brennan, K, Shaver, P (1998) Attachment styles and personalitydisorders: their connections to each other and to parental divorce,parental death and perceptions of parental care-giving, Journal ofPersonality, October 98, 66:5 Brown, E (1999) Loss, Change and Grief, David Fulton Publishers Ltd, London Child Bereavement Network (CBN) (2003), Service Development and BestPractice Guidelines for Bereavement Care for Children (July 2003-June2006), accessed via National Childrens Bureau (NCB) Christ, G (2005) Interventions with bereaved children, in Firth, P,Luff, G, Oliviere, D, Loss, Change and Bereavement in Palliative Care,Chapter 7, pp. 96-115, Open University Press, Maidenhead, Berkshire Connolly, M (1997) It Isnt Easy, Oxford University Press, Oxford Donnelly, P, Connon, G (2003) Traumatic bereavement: the impact onchildren and families, Trauma Advisory Panel of the Eastern Health andSocial Services Board, Belfast, Dowdney, L, Wilson, R, Maughan, B, Allerton, M, Schofield, P, Skuse, D(1999) Psychological disturbance and service provision in parentallybereaved children: prospective case control study, British MedicalJournal, 1999 (319), pp. 354-357 Dowdney, L (2000) Annotation: Childhood Bereavement followingParental Death, Journal of Child Psychology and Psychiatry, Vol.41,No.7, pp.819-830 Elliot, P (1997) Coping with Loss: for parents, Piccadilly Press Ltd, London Hurd, R.C (1999) Adults view their childhood bereavement experiences, Death Studies, Vol.23, pp. 17-41 Hurd, R (2004) Teenager revisits her fathers death duringchildhood: a study in resilience and healthy mourning, Adolescence,Vol. 39, No. 154 Jacobs, S.C (1999) Traumatic grief: Diagnosis, Treatment and Prevention, Bruner Mazel, Philadelphia PA Mack, K (2001) Childhood family disruptions and adult well-being:the differential effects of divorce and parental death, Death Studies,25, pp. 419-443 Maier, E, Lachman, M (2000) Consequences of early parental loss andseparation for health and well-being in mid-life, InternationalJournal of Behavioural Development, 24(2), pp. 183-189 Monroe, B (2001) Children and Bereavement, in Death Dying,Workbook 4, Section 10, pp. 76-88, The Open University, Milton Keynes Parkes, C.M (1986) Bereavement: Studies of Grief in Adult Life (2nd Edition), Penguin, Harmondsworth Perkins, G, Morris, L (1991) Remembering Mum, A C Black, London Pfeffer, C, Karus, D, Siegel, K, Jiang, H (2000) Child Survivors ofparental death from cancer or suicide: Depressive and behaviouraloutcomes, Psycho-Oncology 9: 1-10 Rolls, L, Payne, S (2004) Childhood bereavement services: issues in UK service provision, Mortality, Vol. 9, No.4, pp. 300-328 Rosen, M (2004) Michael Rosens Sad Book, Puffin Books, London Stroebe, M.S, Hansson, R.O, Stroebe, W, Schut, H (Eds) (2001)Handbook of Bereavement Research: Consequences, Coping and Care,American Psychological Association, Washington, DC Thompson, M, Kaslow, N, Kingree, J and others (1998) Psychiatricsymptomatology following parental death in a predominantly minoritysample of children and adolescents, Journal of Clinical ChildPsychology, Vol. 27, No.4, pp. 434-441 Weller, R.A, Weller, E.B, Frist, A, Bowse, B (1991) Depression inrecently bereaved pre-pubertal children, American Journal ofPsychiatry, Vol. 148, pp. 1536-1540 Wells, R (2003) Helping Children Cope with Change and Loss, Sheldon Press, London Winstons Wish (2003), Supporting bereaved children and young people Worden, W.J (2003) Grief Counselling and Grief Therapy, Routledge,London

Wednesday, May 6, 2020

Underwear as Outerwear Free Essays

According to Vivienne Westwood,a Queen of Punk, â€Å"Fashion is about eventually becoming naked†. She is a designer of punk rock and new wave, and the most influential British fashion designer of the late 20th century. To be specific, Vivienne Westwood reinvention’s collections, Madonna has influenced by her underwear as outerwear’s idea, she is the first singer who began to wear a corset-style top for her world tour concert. We will write a custom essay sample on Underwear as Outerwear or any similar topic only for you Order Now As a result, it has influenced many famous singers, such as Rihanna, Lady Gaga and Britney Spears. This trend became the today’s mainstream fashion. Thus, underwear as outerwear has changed an aspect of the women’s dressing in these day. Before the underwear as outerwear trend, Westwood shocked people by bringing punk culture to the British fashion’s mainstream. She made the most of British teenagers dressing in punk style. It was a phenomenon of punk on the streets of London. In 1980, the punk movement faded, Westwood started searching the history information for her new collection herself. She introduced the Buffalo Girls collection, this collection was inspired by Peruvian women which was her research. She combined traditional tailoring with her brilliant idea to create petticoats, bowler hats worn with head scarves, featuring layered skirts and adapting bras worn over blouses. It was a beginning of underwear as outerwear’s style. The corset was transformed to one of power and sexual freedom for women. Many well-known celebrities, film-stars and signers have worn the corset-style which has been influenced by Vivienne Westwood’s design. Also, a lot of famous designers have been inspired by this idea for their collections to show on the runway. If Westwood had not invented underwear as outerwear’s idea, it would never existed in fashion world. For this reason, it makes women feel more positive and confident to wear. Moreover, underwear as outerwear became Westwood’s signature over her all design. Vivienne Westwood is irony fashion designer, and she does not only sell the clothing style but what she offers is the attitude on her design. Particularly, corset is the Victorian upper class women’s underwear that holds the waist and the chest. It was cancelled because it was seen as a symbol of sexual oppression. Westwood solved it by modern sewing with stretch fabric for comfort and converted to wear on both sides. Therefore, her underwear as outerwear style is a variant that conveys to confidence of women who wear, it makes women look both sophisticated and sexy at the same time. Westwood had changed the image of corset coupled with the way women dress forever. How to cite Underwear as Outerwear, Papers

Saturday, May 2, 2020

Jazz Concert Review free essay sample

The first question I asked myself at the beginning of the quarter was how much do I actually know about jazz? I have always characterized jazz music as a rhythmic and instrumental form of music. My impression on the basis of the jazz has always been portrayed with the African-American race. I think this was build up from the rhythm C]n blues era and meaning according to the dictionary (style of music that was invented by African American musicians in the early part of the twentieth century and has very strong rhythms and often involves improvisation), But LouisArmstrong famous reply was if you had to ask, youll never know. Whatever else he meant, he was at least saying that jazz is noticeable, but not necessarily understandable by words. (do not really know exact cite where I have got this quote) For my concert review, I went to see the performance of Maynard Ferguson and his big band at Jazz Alley on Jan. We will write a custom essay sample on Jazz Concert Review or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page 12th 2005. I asked some of my friends to Join and they gladly agreed. Since two of my friends were a musician themselves and loved seeing live music whenever possible.They even went ahead and made a reservation. First mime In Jazz Alley, the place was filled with various groups of people eating, drinking, and chatting. Our table was in good position, plus I was able to see the stage very well. We ordered some cocktails and everyone looked relaxed and enjoying their evenings except me. As I was worrying about writing a paper. I started to write the names of the players and the instruments they play; getting ready to take some notes.But since when they started to play, I only wrote the names of the songs; cause my self was already busy enjoying the concert too. Maynard Ferguson, Jazz legend, internationally renowned big band leader and one of he worlds greatest trumpet players with his Big Bop Nouveau Band. He draws upon bebop, straight-ahead jazz, funk, swing, classical and contemporary music to create a fresh sound within the classic big band form. Cite from Jazz Alley web site) Because me being Korean, I personally was little surprised and Impressed by two Korean were members of his big band. A massive piano player, J Young Lee, pretty amazing in all pieces, her extended work on but beautiful was really lovely and the most memorable. Stockton. Powerful drum player, thrilled the audience especially one of my friend, with his solos. He was banging away using all his gear, play in energetic and lively. M. F. ND his band provided a remarkable arrangement of Anti No Sunshine When Shes Gone, as well as some elegant and very Impressive, as Maynard ended a song by playing a soft muted trumpet, while the rest of the band played softer and softer, creating the effect of a fade-out. Really high and loud all night long including my self and my friends, the audience seemed really appreciating his hit medley at the end. It made us to believe that he plays over the top with excellent showmanship. Our waitress was little busy most of hat night but the cocktail was good so it was okay and the lighting was perfect.Oh, one more thing, Jazz Alleys student discount was good deal. BY sorting 57 actually know about Jazz? I have always characterized Jazz music as a rhythmic and instrumental form of music. My impression on the basis of the Jazz has always been portrayed with the African-American race. I think this was build up from the rhythm On blues era and meaning according to the dictionary (style of music that was and has very strong rhythms and often involves improvisation). But Louis Armstrongs famous reply was if you had to ask, youll never know.Whatever else he meant, he was at least saying that Jazz is noticeable, but not necessarily time in Jazz Alley, the place was filled with various groups of people eating, drinking, evenings except me, as I was worrying about writing a paper. I started to write the bebop, straight-ahead Jazz, funk, swing, classical and contemporary music to create a me being Korean, I personally was little surprised and impressed by two Korean were memorable. Stockton, powerful drum player, thrilled the audience especially one of Sunshine.

Sunday, March 22, 2020

Fbs free essay sample

Teaspoonand Beverage Services (FBS) NC II Free Reviewer Types of Services Banquet (Bukcet) Service †¢ For group of person †¢ Fixed price †¢ e. g. typical function Family Service †¢ Food are prepared in the kitchen and served in platter in the table †¢ Started by head of the family English Service †¢ Private dinner †¢ Typical private dinner †¢ Fine dining set-up †¢ w/ Wine service Luriat Service †¢ A plate with rice, meat, vegetable dessert †¢ Big plate with complete meal Apartment/ Blue Plate Service †¢ Similar with family service, difference is location Located in apartment Tray Service Types of Menu 1. A la Carte combo meal 2. Table d Hote Specific Menu w/ specific price Classes of Menu 1. Special party e. g. weddings, baptismal 2. Cycle preparation of food is combination of lunch and dinner Menu Functions 1. Breakfast 2. Morning/ A. M. Snack 3 . Brunch (Breakfast + Lunch) 4. Lunch 5. Afternoon/ P. M. Snack (2 3 P. M. ) 6. Merienda Cena (5 P. M. ) 7. Dinner 8. Midnight Snack Food Sequence 1. Appetizer 2. We will write a custom essay sample on Fbs or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Soup 3. Salad 4. Main Course/ Entree 5. Dessert 6. Beverages Silverwares: Spoon SPOONS Sugar spoon a piece of cutlery used for serving granulated sugar. This type of spoon resembles a teaspoon except that the bowl is deeper and often molded in the shape of a sea shell, giving it the name sugar shell. Sugar spoons are sometimes called sugar shovels because of their rectangular shape and deep bowl.  · Ice Cream Spoon †¢ Dessert spoon — intermediate in size between a teaspoon and a tablespoon, used in eating dessert and sometimes soup or cereals. †¢ Teaspoon — small, suitable for stirring and sipping tea or coffee, standard capacity one third of a tablespoon. Examples: o Grapefruit spoon or orange spoon — tapers to a sharp point or teeth, used for citrus fruits and melons o iced tea spoon/ Long tea spoon — with a very long handle †¢ Soup spoon — with a large or rounded bowl for eating soup. Example: o cream-soup spoon — round-bowled, slightly shorter than a standard soup spoon †¢ Dinner spoon †¢ Table spoon Silverware: Forks  ·  · Cocktail fork A small fork resembling a trident, used for spearing cocktail garnishes such as olives.  · Cake fork

Friday, March 6, 2020

Acid Rain Essays (868 words) - Environmental Chemistry, Free Essays

Acid Rain Essays (868 words) - Environmental Chemistry, Free Essays Acid Rain Acid Rain The damaging effects of acid rain on society is becoming overwhelmed with great amounts of pollution from cars, factories and an large amounts of garbage. The immense amounts of sulphur dioxide put into the air causes high levels of acid in the atmosphere. When this sulphuric acid is absorbed into moisture in the air, then rain can be harmful to the environment. Acid rain is destroying lots of things in our environment. It is hurting lakes, air and thew rest of our ecosystem. Acid rain is killing lakes and decreasing the number of animals in these lakes. Acid rain greatly lowers the amounts of pH in the water. Each decade the pH levels of lakes around Ontario have become ten times more acidic. The high acid levels contained in lakes also causes a decrease in the number of fish living in these lakes. Also the high amounts of acid in the water can lead to fish being deformed. They have messed up and out of shape backbones, flattened heads and strangely curved tails. When there gets to be a lot of acid in the water, then there is barely anything left besides rock bass, pumpkinseed and lake herring. As with sulphur dioxide in rain, mercury is also discharged into the water. There is a direct connection between the mercury rich lakes as there is with those with high acidic levels. This metal becomes concentrated in the blood and tissues of fish. Acid rain causes traumatic effects in natural lakes and rivers. Acid rain causes air quality to deteriorate. As in water, acid rain causes the pH levels in the air to decrease. The sulphur dioxide, which diffuses into the air, mixes with moisture causing the pH levels to drop from the normal level. Again, the normal level is somewhere around seven, yet in some acidic air masses the levels can be as low as three. These lowered pH levels form a photochemical smog in the atmosphere. In the air Anitrogen oxides react with ozone and some hydrocarbons in the presence of sunlight to form photochemical smog, the kind of yellow-grey haze which it literally alive and growing in stagnant air [emailprotected] (Howard protected] (Howard & Perley, 1980, p. 32). Disruption in the life span of trees and plants is also another effect of acid rain. The acid rain corrodes the thin, waxy layer, which coats and protects the leaves letting the acid suffocate the leaves. This can cause an interference in the plants metabolism and photosynthesis may be altered meaning the leaves cannot produce and efficient amount of food which may result in death of the plant. Acid may obtrude fertilization , stunt or kill the growth of seeds and make them sterile. A second generation would be

Tuesday, February 18, 2020

Ideagora paper Essay Example | Topics and Well Written Essays - 1250 words

Ideagora paper - Essay Example Even revolutions have a certain degree of gradualness. Agora, which in the ancient Greece was the main place of gathering with the aim of conducting trade and crucial information sharing, has been used by modern innovators to come up with a modern common market. The common modern market has however mainly relied on the computer for ideas rather than eye-to-eye contact like in the ancient Greece. Using this idea of the Greece market, innovators have created Web sites on the internet for large number of people and businesses to converge with the common goal of sharing ideas and solutions for various problems. This is a shift from the ancient market setting where goods were the main items of trade while in the modern times it is ideas. This borrowing from the ancient Agora market to develop a market driven by ideas is termed as Ideagoras (Idea + Agoras). Ideagoras has influenced heavily on the management of many companies and has been in use in modifying the various production processes by different diverse companies. The venue of converging is the internet. The meetings in the internet have broken the various geographical and cultural barriers. Companies no matter their location in the world are able to interact freely, online. One such market is InnoCentive. InnoCentive is a company that helps other companies to precisely define, appropriately integrate and effectively execute the various innovative strategies that they may be having. InnoCentive emphasizes on extensive and intensive conclusive research and radicalized development on various diverse disciplines like engineering and business. After gathering the various proposals and areas of research from various managers or companies, the InnoCentive then posts them on the net as problems. This ideagoras company then calls on scientists to try to come up with the most appropriate

Monday, February 3, 2020

Should Veil Be Judgemental In Islam Essay Example | Topics and Well Written Essays - 750 words

Should Veil Be Judgemental In Islam - Essay Example It is a sacred fact that in Islam, Purdah is unnecessary for every woman approaching the age of puberty or who has already reached it. Many people and especially the non-Muslims sometimes tend to believe that Hijab is in a way restrictive or rigid and is aimed at keeping the women inferior to men. However, nothing could be far from the truth. Ignorance and misunderstanding happen to be the leading causes behind such beliefs. Purdah on the one side protects the women from exploitation from the strangers and on the other hand enjoins on the women the conditions of morality and purity (Guindi, 1999). Without in any way trying to dilute or disrespect the spirit of this great religion, with all due humility, it will also be true to conclude that many a women who may not adhere to purdah in the strict sense of the term, may still show respect for the innate morality and purity signified by the true intentions behind the cause of purdah. Many people believe that purdah and Hijab ought to be binding on women and any women who refutes the constraints of purdah and Hijab happens, not to be a believer in the true sense of the word. However, though such views do have relevance, it would not be wrong to say that Islam in no way tends to confine and limit the socio-economic status of women to the mere constraints of purdah and Hijab, and has multiple other women centric aims and ambitions, allowing for the full development of a female’s personality. Considering that nobody is perfect, there may not be a dearth of women who though not affiliating to purdah as interpreted by many, may be adhering to a range of Islamic values and morals. With the passage of time, as women are moving forward with the influx of globalization and the opening up of societies, there is no dearth of Muslim women who not only qualify to be called the career women and working mothers, but who also harbor a deep seated intention to inculcate Islamic values in their personal and professional life and identify themselves as practicing Muslims (Abdo, 2000). In fact, the spread of the modern education has opened up the minds of the contemporary Muslim men and women, and one particular thing about the modern Muslim women is that they are increasingly getting reconnected with Islam (Abdo, 2000). Yet, by the virtue of being modern Muslim women, these women also have a pragmatic need to be able to be mobile and practical in the wake of the demands being enjoined on them by their professions. Thereby, demoralizing such women by interpreting the requirements of purdah in a strict and conservative way will certainly not be an act of faith, especially more so when these women have an innate and deep seated respect and allegiance to the Islamic values and morality. For instance, there may be women who may don a veil in their public life, but, who may smoke, drink and dress in an unsuitable manner in their private life, when nobody is observing them. In contrast, there also may be women, who may wear a short scarf out of the need of being mobile and professionally effective, yet, who have the potential to be religious and follow the God’s will in all possible ways except for the scarf. In a practical context, Islam lays stress on the purity of an individual’

Sunday, January 26, 2020

Influence of Aspirin on Post Tooth Extraction Bleeding

Influence of Aspirin on Post Tooth Extraction Bleeding ABSTRACT Aim: The aim of the study was to evaluate the influence of aspirin on post extraction bleeding in a clinical setup. Materials and Method: 200 Patients aged between 50 to 65 years, who were indicated for dental extraction was selected from outpatient department of Oral and Maxillofacial Surgery. All the patients were randomly divided in aspirin continuing group (Group A) and aspirin discontinuing group (Group B). After checking all the vital signs extractions were carried out. Bleeding time and clotting time was recorded for evaluation by Chi Square Test. Results: Chi Square test asserted that the bleeding time increased (3.8Â ±0.75) in Group B patients who continued with the antiplatelet therapy while it decreased in Group A patients who discontinued aspirin. Similarly clotting time increased in group B patient and decreased in Group A patient. But in both the groups, bleeding and clotting time remained within normal limits. Conclusion: Assessing most of the dental and medical literature it can be concluded that there is absolutely no need to discontinue anti platelet therapy for any ambulatory dental procedure and even if practitioner wishes to discontinue, it should not be more than 3 days. This is also stated in the guidelines of American Heart Association. Keywords: Anti platelet drugs, Aspirin, Bleeding time, Tooth extraction. INTRODUCTION Medical practitioners commonly advice their patients who are on antiplatelet therapy to either stop or alter their medications prior to surgical procedures due to fear of excessive and uncontrolled bleeding. This is a proven fact that aspirin causes increased risk of intraoperative as well as postoperative bleeding and also increased risk of thromboembolic events such as myocardial infraction and cerebrovascular accidents if the drug is continued1. Thrombotic and thromboembolic occlusions of blood vessels are the main cause of ischaemic events in heart, lungs and brain2. In case of blood vessel injury hemostatic mechanism is responsible for stopping the extravasation. Mainly hemostatic mechanism in characterized by two consecutive phases primary and secondary. Primary mechanism arrests early bleeding as a result of platelet plug formation3. Secondary hemostasis phase is mediated by complex cascade of clotting factors which helps in formation of fibrin clot4. In recent years lot of re search and progress have been made in the field of antiplatelet agents and anticoagulants. These drugs have been utilized for the management of arterial thrombosis also2. Even though a number of antiplatelet and anticoagulant agents have been developed, aspirin and warfarin remains the standard drug of choice5. Development of aspirin dates back to 1897 and is considered as one of the safest and cheapest drug worldwide. A general practitioner Lawrence Craven prescribed low dose aspirin (Baby Aspirin) to his 400 patients and none of them developed myocardial infraction6. This was probably the first time in medical history where aspirin was used to prevent myocardial infarction. Since then it has become the drug of choice for cardiologists. The antithrombotic effect of aspirin is mediated by irreversible inhibition of cyclooxygenase activity in platelets. Phospholipase-A2 acts on the cell membrane to release arachidonic acid on activation. Cyclooxygenase acts on arachidonic acid to produce thromboxane A2. Thromboxane A2 is a potent platelet stimulant leading to degranulation of platelet and platelet aggregation. Aspirin inhibits cyclooxygenase enzyme and decreases the level of platelet stimulant thromboxane A2,5 thus increasing the bleeding time. This is the important reason for a medical practitioner to stop aspirin 3 to 7 days prior to any invasive surgery. The purpose of this study was to investigate the influence of aspirin on post extraction bleeding. MATERIALS AND METHOD This study was conducted at the outpatient Department of Oral and Maxillofacial Surgery. Patients who were on aspirin therapy, aged between 50 to 65 years and who had to undergo tooth extraction were selected for the study. Patients on warfarin, non-steroidal anti-inflammatory drugs, heparin, steroids or suffering from blood disorders and diabetes were excluded from the study. Informed consent was obtained from the patients with the ethical committee clearance. Two hundred patients including both males and females whose teeth were indicated for extraction were included in the study. Patients were randomly divided into Group A and Group B of 100 patients each. Group A patients continued to receive aspirin preoperatively while Group B patients were asked to stop aspirin 7 days prior to extraction. Pre operatively all the vital signs (Blood Pressure and Pulse) were measured. Bleeding time (White and Lee technique) and clotting time (Ivy’s technique) was calculated. Extractions were carried out only if the above parameters were within normal range. After tooth was extracted presence or absence of bleeding and bleeding time was recorded. Analgesics and antibiotics were prescribed as needed for pain and infection control. Chi square test was used to evaluate the relative frequencies of patients in both groups. Differences of parametric variables were tested with analysis of variance. RESULTS After applying Chi square test, mean bleeding time was calculated as 2.1Â ±0.52 minutes in the patients who discontinued baby aspirin (Group B) 7 days prior to extraction. Bleeding time of Group A patients who continued aspirin through the entire study was found to be 3.8Â ±0.75 minutes. This difference was statistically significant (p=0.002) [Table 1]. Although there is significant increase in the bleeding time of Group A patients it should be noted that bleeding time of both the groups was within the normal limits. Clotting time of Group B patients was 3.8Â ±0.75 and Group A was 4.7Â ±0.74 which was also within the normal limits (Normal range according to Ivy’s Method: 3 to 5 minutes). DISCUSSION Historically aspirin was used as an anti-inflammatory, analgesic and antipyretic drug for a short period of disease activity. Lawrence Craven in 1950 reported for the first time its long term use to prevent myocardial infarction6. He advocated a lower dose for antiplatelet action. Antiplatelet activity of aspirin occurs at doses ranging as low as 40 mg/day7 to 3208 mg daily. Doses above 320 mg/day decrease the effectiveness of aspirin as antiplatelet agent due to inhibition of prostacyclin production9. However recent clinical trial indicates that 160 mg/day is optimal for antiplatelet action10. In emergencies where urgent antithrombotic action is required a loading dose of 300 mg is advocated9. Usually in United States daily dose of 81 mg, 160 mg or 325 mg are prescribed while in Europe and other countries daily dose of 75 mg, 150mg or 300 mg are prescribed10. Risk of continuing aspirin therapy prior to surgery is that, with the alteration of platelet function longer time period is required to stop the bleeding from a surgical site. This is attributed to the alteration in primary hemostatic mechanism. Burger et al stated that, in patients on aspirin, the average risk of bleeding increases 1.5 folds. At the same time there is a risk in stopping the aspirin prior to surgery leading to a potential risk of rebound of thromboembolic vascular events. On stopping aspirin thromboxane A2 activity increases to a greater extent with decrease in fibrinolytic activity11. Ferrari et al showed the existence of biological platelet rebound phenomenon on interruption of aspirin therapy. This could create a prothrombotic state which may lead to fatal thromboembolic events. Approximately 20% of these episodes are fatal and another 40% can lead to permanent disability12. Practitioners who advocate the stoppage of aspirin have been debating among themselves regarding the time limit to stop aspirin. Literature wise the effect of aspirin on platelets is irreversible. The effect lasts for 7 to 10 days which is the life span of platelets13, 14. Therefore since early days it was recommended to stop aspirin 7 days prior to surgical procedure15-19. Sonksen et al in their study comprising of 52 healthy individuals showed that withdrawal of aspirin for more than 5 days was not recommended20. Wahl et al advocated that aspirin should be discontinued for 3 days only as after 3 days of interruption of aspirin, sufficient number of newer platelets would be present in circulation for hemostasis21, 22. Now again the debate arises whether to stop aspirin therapy or not? Fear for uncontrolled bleeding encourages the practitioners to discontinue the aspirin therapy. Few studies have shown that there is always an increased risk of bleeding in patients continuing aspirin23, 24. Hence few studies recommended stopping of aspirin therapy prior to surgical procedure17, 19, 25. However if the aspirin therapy is discontinued, there is increased risk of thromboembolic events which can be fatal but none of these have been reported in dental literature. Fijnheer et al in his article mentioned that there is scarcity of literature regarding dental surgeries involving patients on aspirin medication26. Little et al recommended that unless bleeding time is increased above 20 minutes aspirin affected platelets would not cause significant bleeding complication22. Similar claims were made by Sonksen et al and Gaspar et al20, 27. Canigral et al conducted a research involving surgical extraction in patients on antithrombotic therapy. In 92% cases bleeding stopped within 10 minutes with pressure alone. This result was in accordance with the present study4. Gaspar et al advocated that ambulatory oral surgical procedures can be performed in patients without discontinuing the use of aspirin27. A recent recommendation from American Heart Association and American College of Cardiology is that, either continuing aspirin or clopidogrel therapy for minor oral surgical procedures in patients with coronary artery stents or delaying treatment until prescribed regimen will be complicated. The present study demonstrated that there was significant increase in the bleeding time in both the groups but in no case it was difficult to stop the bleeding. Although bleeding time increased in the Group A patients but it still remained within the normal range, regardless of whether patients continued or discontinued their aspirin therapy28, 29, 30. This result was similar to the study done by Canigral et al4. Valerin et al conducted a study with 17 patients randomized to aspirin and 19 to placebo and found no differences in bleeding outcomes for patients on aspirin. This finding suggested that there was no need to discontinue aspirin prior to any ambulatory oral surgical procedures31. Adchariyapetch compared the postoperative bleeding on subjects who stopped or continued taking the aspirin for seven days prior to extraction. The mean bleeding time in both the groups was in normal range. After the procedure there was no difficulty in achieving hemostasis. Therefore they concluded that surgical extraction did not require discontinuation of antiplatelet therapy32. Matocha in his study concluded that risk of bleeding after dental extraction is very minimal in the patients with aspirin therapy and did not exceed 0.2 to 2.3%33. Murphy et al concluded with a survey that 86% of the dental practitioners who advised the patient to stop antiplatelet drugs prior to dental extraction did so with the consultation of the patient’s physician and found that the protocol followed by the physicians and dentists was not based on the current recommendations and guidelines34. Napenas et al concluded that the risk of stopping antiplatelet therapy and predisposing the patient to thromboembolic events overweighed the minimal risk of bleeding from dental procedures. Similar results were found in the study done by Nielsen et al35. Wahl in a research study reported that in 950 patients receiving anticoagulation therapy, only 12 required (

Saturday, January 18, 2020

The Twilight Saga 2: New Moon Chapter 10 THE MEADOW

JACOB DIDN'T CALL. The first time I called, Billy answered and told me that Jacob was still in bed. I got nosy, checking to make sure that Billy had taken him to a doctor. Billy said he had, but, for some reason I couldn't nail down, I didn't really believe him. I called again, several times a day, for the next two days, but no one was ever there. Saturday, I decided to go see him, invitation be damned. But the little red house was empty. This frightened mewas Jacob so sick that he'd needed to go to the hospital? I stopped by the hospital on the way back home, but the nurse at the front desk told me neither Jacob or Billy had been in. I made Charlie call Harry Clearwater as soon as he got home from work. I waited, anxious, while Charlie chatted with his old friend; the conversation seemed to go on forever without Jacob even being mentioned. It seemed that Harry had been in the hospital . . some kind of tests for his heart. Charlie's forehead got all pinched together, but Harry joked with him, blowing it off, until Charlie was laughing again. Only then did Charlie ask about Jacob, and now his side of the conversation didn't give me much to work with, just a lot of hmms and yeahs. I drummed my fingers against the counter beside him until he put a hand over mine to stop me. Finally, Charlie hung up the phone and turned to me. â€Å"Harry says there's been some trouble with the phone lines, and that's why you haven't been able to get through. Billy took Jake to the doc down there, and it looks like he has mono. He's real tired, and Billy said no visitors,† he reported. â€Å"No visitors?† I demanded in disbelief. Charlie raised one eyebrow. â€Å"Now don't you go making a pest of yourself, Bells. Billy knows what's best for Jake. He'll be up and around soon enough. Be patient.† I didn't push it. Charlie was too worried about Harry. That was clearly the more important issueit wouldn't be right to bug him with my lesser concerns. Instead, I went straight upstairs and turned on my computer. I found a medical site online and typed â€Å"mononucleosis† into the search box. All I knew about mono was that you were supposed to get it from kissing, which was clearly not the case with Jake. I read through the symptoms quicklythe fever he definitely had, but what about the rest of it? No horrible sore throat, no exhaustion, no headaches, at least not before he'd gone home from the movie; he'd said he felt â€Å"fit as a fiddle.† Did it really come on so fast? The article made it sound like the sore stuff showed up first. I glared at the computer screen and wondered why, exactly, I was doing this. Why did I feel so so suspicious, like I didn't believe Billy's story? Why would Billy lie to Harry? I was being silly, probably. I was just worried, and, to be honest, I was afraid of not being allowed to see Jacobthat made me nervous. I skimmed through the rest of the article, looking for more information. I stopped when I got to the part about how mono could last more than a month. A month? My mouth fell open. But Billy couldn't enforce the no-visitors thing that long. Of course not. Jake would go crazy stuck in bed that long without anyone to talk to. What was Billy afraid of, anyway? The article said that a person with mono needed to avoid physical activity, but there was nothing about visitors. The disease wasn't very infectious. I'd give Billy a week, I decided, before I got pushy. A week was generous. A week was long. By Wednesday, I was sure I wasn't going to live till Saturday. When I'd decided to leave Billy and Jacob alone for a week, I hadn't really believed that Jacob would go along with Billy's rule. Every day when I got home from school, I ran to the phone to check for messages. There never were any. I cheated three times by trying to call him, but the phone lines still weren't working. I was in the house much too much, and much too alone. Without Jacob, and my adrenaline and my distractions, everything I'd been repressing started creeping up on me. The dreams got hard again. I could no longer see the end coming. Just the horrible nothingnesshalf the time in the forest, half the time in the empty fern sea where the white house no longer existed. Sometimes Sam Uley was there in the forest, watching me again. I paid him no attentionthere was no comfort in his presence; it made me feel no less alone. It didn't stop me from screaming myself awake, night after night. The hole in my chest was worse than ever. I'd thought that I'd been getting it under control, but I found myself hunched over, day after day, clutching my sides together and gasping for air. I wasn't handling alone well. I was relieved beyond measure the morning I woke upscreaming, of courseand remembered that it was Saturday. Today I could call Jacob. And if the phone lines still weren't working, then I was going to La Push. One way or another, today would be better than the last lonely week. I dialed, and then waited without high expectations. It caught me off guard when Billy answered on the second ring. â€Å"Hello?† â€Å"Oh, hey, the phone is working again! Hi, Billy. It's Bella. I was just calling to see how Jacob is doing. Is he up for visitors yet? I was thinking about dropping by† â€Å"I'm sorry, Bella,† Billy interrupted, and I wondered if he were watching TV; he sounded distracted. â€Å"He's not in.† â€Å"Oh.† It took me a second. â€Å"So he's feeling better then?† â€Å"Yeah,† Billy hesitated for an instant too long. â€Å"Turns out it wasn't mono after all. Just some other virus.† â€Å"Oh. So where is he?† â€Å"He's giving some friends a ride up to Port AngelesI think they were going to catch a double feature or something. He's gone for the whole day.† â€Å"Well, that's a relief. I've been so worried. I'm glad he felt good enough to get out.† My voice sounded horribly phony as I babbled on. Jacob was better, but not well enough to call me. He was out with friends. I was sitting home, missing him more every hour. I was lonely, worried, bored perforatedand now also desolate as I realized that the week apart had not had the same effect on him. â€Å"Is there anything in particular you wanted?† Billy asked politely. â€Å"No, not really.† â€Å"Well, I'll tell him that you called,† Billy promised. â€Å"Bye, Bella.† â€Å"Bye,† I replied, but he'd already hung up. I stood for a moment with the phone still in my hand. Jacob must have changed his mind, just like I'd feared. He was going to take my advice and not waste any more time on someone who couldn't return his feelings. I felt the blood run out of my face. â€Å"Something wrong?† Charlie asked as he came down the stairs. â€Å"No,† I lied, hanging up the phone. â€Å"Billy says Jacob is feeling better. It wasn't mono. So that's good.† â€Å"Is he coming here, or are you going there?† Charlie asked absentmindedly as he started poking through the fridge. â€Å"Neither,† I admitted. â€Å"He's going out with some other friends.† The tone of my voice finally caught Charlie's attention. He looked up at me with sudden alarm, his hands frozen around a package of cheese slices. â€Å"Isn't it a little early for lunch?† I asked as lightly as I could manage, trying to distract him. â€Å"No, I'm just packing something to take out to the river† â€Å"Oh, fishing today?† â€Å"Well, Harry called and it's not raining.† He was creating a stack of food on the counter as he spoke. Suddenly he looked up again as if he'd just realized something. â€Å"Say, did you want me to stay with you, since Jake's out?† â€Å"That's okay, Dad,† I said, working to sound indifferent. â€Å"The fish bite better when the weather's nice.† He stared at me, indecision clear on his face. I knew that he was worrying, afraid to leave me alone, in case I got â€Å"mopey† again. â€Å"Seriously, Dad. I think I'll call Jessica,† I fibbed quickly. I'd rather be alone than have him watching me all day. â€Å"We have a Calculus test to study for. I could use her help.† That part was true. But I'd have to make do without it. â€Å"That's a good idea. You've been spending so much time with Jacob, your other friends are going to think you've forgotten them.† I smiled and nodded as if I cared what my other friends thought. Charlie started to turn, but then spun back with a worried expression. â€Å"Hey, you'll study here or at Jess's, right?† â€Å"Sure, where else?† â€Å"Well, it's just that I want you to be careful to stay out of the woods, like I told you before.† It took me a minute to understand, distracted as I was. â€Å"More bear trouble?† Charlie nodded, frowning. â€Å"We've got a missing hikerthe rangers found his camp early this morning, but no sign of him. There were some really big animal prints of course those could have come later, smelling the food Anyway, they're setting traps for it now.† â€Å"Oh,† I said vaguely. I wasn't really listening to his warnings; I was much more upset by the situation with Jacob than by the possibility of being eaten by a bear. I was glad that Charlie was in a hurry. He didn't wait for me to call Jessica, so I didn't have to put on that charade. I went through the motions of gathering my school-books on the kitchen table to pack them in my bag; that was probably too much, and if he hadn't been eager to hit the holes, it might have made him suspicious. I was so busy looking busy that the ferociously empty day ahead didn't really crash down on me until after I'd watched him drive away. It only took about two minutes of staring at the silent kitchen phone to decide that I wasn't staying home today. I considered my options. I wasn't going to call Jessica. As far as I could tell, Jessica had crossed over to the dark side. I could drive to La Push and get my motorcyclean appealing thought but for one minor problem: who was going to drive me to the emergency room if I needed it afterward? Or I already had our map and compass in the truck. I was pretty sure I understood the process well enough by now that I wouldn't get lost. Maybe I could eliminate two lines today, putting us ahead of schedule for whenever Jacob decided to honor me with his presence again. I refused to think about how long that might be. Or if it was going to be never. I felt a brief twinge of guilt as I realized how Charlie would feel about this, but I ignored it. I just couldn't stay in the house again today. A few minutes later I was on the familiar dirt road that led to nowhere in particular. I had the windows rolled down and I drove as fast as was healthy for my truck, trying to enjoy the wind against my face. It was cloudy, but almost drya very nice day, for Forks. Getting started took me longer than it would have taken Jacob. After I parked in the usual spot, I had to spend a good fifteen minutes studying the little needle on the compass face and the markings on the now worn map. When I was reasonably certain that I was following the right line of the web, I set off into the woods. The forest was full of life today, all the little creatures enjoying the momentary dryness. Somehow, though, even with the birds chirping and cawing, the insects buzzing noisily around my head, and the occasional scurry of the field mice through the shrubs, the forest seemed creepier today; it reminded me of my most recent nightmare. I knew it was just because I was alone, missing Jacob's carefree whistle and the sound of another pair of feet squishing across the damp ground. The sense of unease grew stronger the deeper I got into the trees. Breathing started to get more difficultnot because of exertion, but because I was having trouble with the stupid hole in my chest again. I kept my arms tight around my torso and tried to banish the ache from my thoughts. I almost turned around, but I hated to waste the effort I'd already expended. The rhythm of my footsteps started to numb my mind and my pain as I trudged on. My breathing evened out eventually, and I was glad I hadn't quit. I was getting better at this bushwhacking thing; I could tell I was faster. I didn't realize quite how much more efficiently I was moving. I thought I'd covered maybe four miles, and I wasn't even starting to look around for it yet. And then, with an abruptness that disoriented me, I stepped through a low arch made by two vine maplespushing past the chest-high fernsinto the meadow. It was the same place, of that I was instantly sure. I'd never seen another clearing so symmetrical. It was as perfectly round as if someone had intentionally created the flawless circle, tearing out the trees but leaving no evidence of that violence in the waving grass. To the east, I could hear the stream bubbling quietly. The place wasn't nearly so stunning without the sunlight, but it was still very beautiful and serene. It was the wrong season for wildflowers; the ground was thick with tall grass that swayed in the light breeze like ripples across a lake. It was the same place but it didn't hold what I had been searching for. The disappointment was nearly as instantaneous as the recognition. I sank down right where I was, kneeling there at the edge of the clearing, beginning to gasp. What was the point of going any farther? Nothing lingered here. Nothing more than the memories that I could have called back whenever I wanted to, if I was ever willing to endure the corresponding painthe pain that had me now, had me cold. There was nothing special about this place without him. I wasn't exactly sure what I'd hoped to feel here, but the meadow was empty of atmosphere, empty of everything, just like everywhere else. Just like my nightmares. My head swirled dizzily. At least I'd come alone. I felt a rush of thankfulness as I realized that. If I'd discovered the meadow with Jacob well, there was no way I could have disguised the abyss I was plunging into now. How could I have explained the way I was fracturing into pieces, the way I had to curl into a ball to keep the empty hole from tearing me apart? It was so much better that I didn't have an audience. And I wouldn't have to explain to anyone why I was in such a hurry to leave, either. Jacob would have assumed, after going to so much trouble to locate the stupid place, I would want to spend more than a few seconds here. But I was already trying to find the strength to get to my feet again, forcing myself out of the ball so that I could escape. There was too much pain in this empty place to bearI would crawl away if I had to. How lucky that I was alone! Alone. I repeated the word with grim satisfaction as I wrenched myself to my feet despite the pain. At precisely that moment, a figure stepped out from the trees to the north, some thirty paces away. A dizzying array of emotions shot through me in a second. The first was surprise; I was far from any trail here, and I didn't expect company. Then, as my eyes focused on the motionless figure, seeing the utter stillness, the pallid skin, a rush of piercing hope rocked through me. I suppressed it viciously, fighting against the equally sharp lash of agony as my eyes continued to the face beneath the black hair, the face that wasn't the one I wanted to see. Next was fear; this was not the face I grieved for, but it was close enough for me to know that the man facing me was no stray hiker. And finally, in the end, recognition. â€Å"Laurent!† I cried in surprised pleasure. It was an irrational response. I probably should have stopped at fear. Laurent had been one of James's coven when we'd first met. He hadn't been involved with the hunt that followedthe hunt where I was the quarrybut that was only because he was afraid; I was protected by a bigger coven than his own. It would have been different if that wasn't the casehe'd had no compunctions, at the time, against making a meal of me. Of course, he must have changed, because he'd gone to Alaska to live with the other civilized coven there, the other family that refused to drink human blood for ethical reasons. The other family like but I couldn't let myself think the name. Yes, fear would have made more sense, but all I felt was an overwhelming satisfaction. The meadow was a magic place again. A darker magic than I'd expected, to be sure, but magic all the same. Here was the connection I'd sought. The proof, however remote, thatsomewhere in the same world where I lived he did exist. It was impossible how exactly the same Laurent looked. I suppose it was very silly and human to expect some kind of change in the last year. But there was something I couldn't quite put my finger on it. â€Å"Bella?† he asked, looking more astonished than I felt. â€Å"You remember.† I smiled. It was ridiculous that I should be so elated because a vampire knew my name. He grinned. â€Å"I didn't expect to see you here.† He strolled toward me, his expression bemused. â€Å"Isn't it the other way around? I do live here. I thought you'd gone to Alaska.† He stopped about ten paces away, cocking his head to the side. His face was the most beautiful face I'd seen in what felt like an eternity. I studied his features with a strangely greedy sense of release. Here was someone I didn't have to pretend forsomeone who already knew everything I could never say. â€Å"You're right,† he agreed. â€Å"I did go to Alaska. Still, I didn't expect When I found the Cullen place empty, I thought they'd moved on.† â€Å"Oh.† I bit my lip as the name set the raw edges of my wound throbbing. It took me a second to compose myself. Laurent waited with curious eyes. â€Å"They did move on,† I finally managed to tell him. â€Å"Hmm,† he murmured. â€Å"I'm surprised they left you behind. Weren't you sort of a pet of theirs?† His eyes were innocent of any intended offense. I smiled wryly. â€Å"Something like that.† â€Å"Hmm,† he said, thoughtful again. At that precise moment, I realized why he looked the sametoo much the same. After Carlisle told us that Laurent had stayed with Tanya's family, I'd begun to picture him, on the rare occasions that I thought of him at all, with the same golden eyes that the CullensI forced the name out, wincinghad. That all good vampires had. I took an involuntary step back, and his curious, dark red eyes followed the movement. â€Å"Do they visit often?† he asked, still casual, but his weight shifted toward me. â€Å"Lie,† the beautiful velvet voice whispered anxiously from my memory. I started at the sound of his voice, but it should not have surprised me. Was I nor in the worst danger imaginable? The motorcycle was safe as kittens next to this. I did what the voice said to do. â€Å"Now and again.† I tried to make my voice light, relaxed. â€Å"The time seems longer to me, I imagine. You know how they get distracted† I was beginning to babble. I had to work to shut myself up. â€Å"Hmm,† he said again. â€Å"The house smelled like it had been vacant for a while† â€Å"You must lie better than that, Bella,† the voice urged. I tried. â€Å"I'll have to mention to Carlisle that you stopped by. He'll be sorry they missed your visit.† I pretended to deliberate for a second. â€Å"But I probably shouldn't mention it to Edward, I suppose† I barely managed to say his name, and it twisted my expression on the way out, ruining my bluff â€Å"he has such a temper well, I'm sure you remember. He's still touchy about the whole James thing.† I rolled my eyes and waved one hand dismissively, like it was all ancient history, but there was an edge of hysteria to my voice. I wondered if he would recognize what it was. â€Å"Is he really?† Laurent asked pleasantly skeptically. I kept my reply short, so that my voice wouldn't betray my panic. â€Å"Mm-hmm.† Laurent took a casual step to the side, gazing around at the little meadow. I didn't miss that the step brought him closer to me. In my head, the voice responded with a low snarl. â€Å"So how are things working out in Denali? Carlisle said you were staying with Tanya?† My voice was too high. The question made him pause. â€Å"I like Tanya very much,† he mused. â€Å"And her sister Irina even more I've never stayed in one place for so long before, and I enjoy the advantages, the novelty of it. But, the restrictions are difficult I'm surprised that any of them can keep it up for long.† He smiled at me conspiratorially. â€Å"Sometimes I cheat.† I couldn't swallow. My foot started to ease back, but I froze when his red eyes flickered down to catch the movement. â€Å"Oh,† I said in a faint voice. â€Å"Jasper has problems with that, too.† â€Å"Don't move,† the voice whispered. I tried to do what he instructed. It was hard; the instinct to take flight was nearly uncontrollable. â€Å"Really?† Laurent seemed interested. â€Å"Is that why they left?† â€Å"No,† I answered honestly. â€Å"Jasper is more careful at home.† â€Å"Yes,† Laurent agreed. â€Å"I am, too.† The step forward he took now was quite deliberate. â€Å"Did Victoria ever find you?† I asked, breathless, desperate to distract him. It was the first question that popped into my head, and I regretted it as soon as the words were spoken. Victoriawho had hunted me with James, and then disappearedwas not someone I wanted to think of at this particular moment. But the question did stop him. â€Å"Yes,† he said, hesitating on that step. â€Å"I actually came here as a favor to her.† He made a face. â€Å"She won't be happy about this.† â€Å"About what?† I said eagerly, inviting him to continue. He was glaring into the trees, away from me. I took advantage of his diversion, taking a furtive step back. He looked back at me and smiledthe expression made him look like a black-haired angel. â€Å"About me killing you,† he answered in a seductive purr. I staggered back another step. The frantic growling in my head made it hard to hear. â€Å"She wanted to save that part for herself,† he went on blithely. â€Å"She's sort of put out with you, Bella.† â€Å"Me?† I squeaked. He shook his head and chuckled. â€Å"I know, it seems a little backward to me, too. But James was her mate, and your Edward killed him.† Even here, on the point of death, his name tore against my unhealed wounds like a serrated edge. Laurent was oblivious to my reaction. â€Å"She thought it more appropriate to kill you than Edwardfair turnabout, mate for mate. She asked me to get the lay of the land for her, so to speak. I didn't imagine you would be so easy to get to. So maybe her plan was flawedapparently it wouldn't be the revenge she imagined, since you must not mean very much to him if he left you here unprotected.† Another blow, another tear through my chest. Laurent's weight shifted slightly, and I stumbled another step back. He frowned. â€Å"I suppose she'll be angry, all the same.† â€Å"Then why not wait for her?† I choked out. A mischievous grin rearranged his features. â€Å"Well, you've caught me at a bad time, Bella. I didn't come to this place on Victoria's missionI was hunting. I'm quite thirsty, and you do smell simply mouthwatering.† Laurent looked at me with approval, as if he meant it as a compliment. â€Å"Threaten him,† the beautiful delusion ordered, his voice distorted with dread. â€Å"He'll know it was you,† I whispered obediently. â€Å"You won't get away with this.† â€Å"And why not?† Laurent's smile widened. He gazed around the small opening in the trees. â€Å"The scent will wash away with the next rain. No one will find your bodyyou'll simply go missing, like so many, many other humans. There's no reason for Edward to think of me, if he cares enough to investigate. This is nothing personal, let me assure you, Bella. Just thirst.† â€Å"Beg,† my hallucination begged. â€Å"Please,† I gasped. Laurent shook his head, his face kind. â€Å"Look at it this way, Bella. You're very lucky I was the one to find you.† â€Å"Am I?† I mouthed, faltering another step back. Laurent followed, lithe and graceful. â€Å"Yes,† he assured me. â€Å"I'll be very quick. You won't feel a thing, I promise. Oh, I'll lie to Victoria about that later, naturally, just to placate her. But if you knew what she had planned for you, Bella† He shook his head with a slow movement, almost as if in disgust. â€Å"I swear you'd be thanking me for this.† I stared at him in horror. He sniffed at the breeze that blew threads of my hair in his direction. â€Å"Mouthwatering,† he repeated, inhaling deeply. I tensed for the spring, my eyes squinting as I cringed away, and the sound of Edward's furious roar echoed distantly in the back of my head. His name burst through all the walls I'd built to contain it. Edward, Edward, Edward. I was going to die. It shouldn't matter if I thought of him now. Edward, I love you. Through my narrowed eyes, I watched as Laurent paused in the act of inhaling and whipped his head abruptly to the left. I was afraid to look away from him, to follow his glance, though he hardly needed a distraction or any other trick to overpower me. I was too amazed to feel relief when he started slowly backing away from me. â€Å"I don't believe it,† he said, his voice so low that I barely heard it. I had to look then. My eyes scanned the meadow, searching for the interruption that had extended my life by a few seconds. At first I saw nothing, and my gaze flickered back to Laurent. He was retreating more quickly now, his eyes boring into the forest. Then I saw it; a huge black shape eased out of the trees, quiet as a shadow, and stalked deliberately toward the vampire. It was enormousas tall as a horse, but thicker, much more muscular. The long muzzle grimaced, revealing a line of dagger-like incisors. A grisly snarl rolled out from between the teeth, rumbling across the clearing like a prolonged crack of thunder. The bear. Only, it wasn't a bear at all. Still, this gigantic black monster had to be the creature causing all the alarm. From a distance, anyone would assume it was a bear. What else could be so vast, so powerfully built? I wished I were lucky enough to see it from a distance. Instead, it padded silently through the grass a mere ten feet from where I stood. â€Å"Don't move an inch,† Edward's voice whispered. I stared at the monstrous creature, my mind boggling as I tried to put a name to it. There was a distinctly canine cast to the shape of it, the way it moved. I could only think of one possibility, locked in horror as I was. Yet I'd never imagined that a wolf could get so big. Another growl rumbled in its throat, and I shuddered away from the sound. Laurent was backing toward the edge of the trees, and, under the freezing terror, confusion swept through me. Why was Laurent retreating? Granted, the wolf was monstrous in size, but it was just an animal. What reason would a vampire have for fearing an animal? And Laurent was afraid. His eyes were wide with horror, just like mine. As if in answer to my question, suddenly the mammoth wolf was not alone. Flanking it on either side, another two gigantic beasts prowled silently into the meadow. One was a deep gray, the other brown, neither one quite as tall as the first. The gray wolf came through the trees only a few feet from me, its eyes locked on Laurent. Before I could even react, two more wolves followed, lined up in a V, like geese flying south. Which meant that the rusty brown monster that shrugged through the brush last was close enough for me to touch. I gave an involuntary gasp and jumped backwhich was the stupidest thing I could have done. I froze again, waiting for the wolves to turn on me, the much weaker of the available prey. I wished briefly that Laurent would get on with it and crush the wolf packit should be so simple for him. I guessed that, between the two choices before me, being eaten by wolves was almost certainly the worse option. The wolf closest to me, the reddish brown one, turned its head slightly at the sound of my gasp. The wolf's eyes were dark, nearly black. It gazed at me for a fraction of a second, the deep eyes seeming too intelligent for a wild animal. As it stared at me, I suddenly thought of Jacobagain, with gratitude. At least I'd come here alone, to this fairytale meadow filled with dark monsters. At least Jacob wasn't going to die, too. At least I wouldn't have his death on my hands. Then another low growl from the leader caused the russet wolf to whip his head around, back toward Laurent. Laurent was staring at the pack of monster wolves with unconcealed shock and fear. The first I could understand. But I was stunned when, without warning, he spun and disappeared into the trees. He ran away. The wolves were after him in a second, sprinting across the open grass with a few powerful bounds, snarling and snapping so loudly that my hands flew up instinctively to cover my ears. The sound faded with surprising swiftness once they disappeared into the woods. And then I was alone again. My knees buckled under me, and I fell onto my hands, sobs building in my throat. I knew I needed to leave, and leave now. How long would the wolves chase Laurent before they doubled back for me? Or would Laurent turn on them? Would he be the one that came looking? I couldn't move at first, though; my arms and legs were shaking, and I didn't know how to get back to my feet. My mind couldn't move past the fear, the horror or the confusion. I didn't understand what I'd just witnessed. A vampire should not have run from overgrown dogs like that. What good would their teeth be against his granite skin? And the wolves should have given Laurent a wide berth. Even if their extraordinary size had taught them to fear nothing, it still made no sense that they would pursue him. I doubted his icy marble skin would smell anything like food. Why would they pass up something warmblooded and weak like me to chase after Laurent? I couldn't make it add up. A cold breeze whipped through the meadow, swaying the grass like something was moving through it. I scrambled to my feet, backing away even though the wind brushed harmlessly past me. Stumbling in panic, I turned and ran headlong into the trees. The next few hours were agony. It took me three times as long to escape the trees as it had to get to the meadow. At first I paid no attention to where I was headed, focused only on what I was running from By the time I collected myself enough to remember the compass, I was deep in the unfamiliar and menacing forest. My hands were shaking so violently that I had to set the compass on the muddy ground to be able to read it. Every few minutes I would stop to put the compass dowr and check that I was still heading northwest, hearingwhen the sounds weren't hidden behind the frantic squelching of my footstepsthe quiet whisper of unseen things moving in the leaves. The call of a jaybird made me leap back and fall into a thick stand of young spruce, scraping up my arms and tangling my hair with sap. The sudden rush of a squirrel up a hemlock made me scream so loud it hurt my own ears. At last there was a break in the trees ahead. I came out onto the empty road a mile or so south of where I'd left the truck. Exhausted as I was, I jogged up the lane until I found it. By the time I pulled myself into the cab, I was sobbing again. I fiercely shoved down both stiff locks before I dug my keys out of my pocket. The roar of the engine was comforting and sane. It helped me control the tears as I sped as fast as my truck would allow toward the main highway. I was calmer, but still a mess when I got home. Charlie's cruiser was in the drivewayI hadn't realized how late it was. The sky was already dusky. â€Å"Bella?† Charlie asked when I slammed the front door behind me and hastily turned the locks. â€Å"Yeah, it's me.† My voice was unsteady. â€Å"Where have you been?† he thundered, appearing through the kitchen doorway with an ominous expression. I hesitated. He'd probably called the Stanleys. I'd better stick to the truth. â€Å"I was hiking,† I admitted. His eyes were tight. â€Å"What happened to going to Jessica's?† â€Å"I didn't feel like Calculus today.† Charlie folded his arms across his chest. â€Å"I thought I asked you to stay out of the forest.† â€Å"Yeah, I know. Don't worry, I won't do it again.† I shuddered. Charlie seemed to really look at me for the first time. I remembered that I had spent some time on the forest floor today; I must be a mess. â€Å"What happened?† Charlie demanded. Again, I decided that the truth, or part of it anyway, was the best option. I was too shaken to pretend that I'd spent an uneventful day with the flora and fauna. â€Å"I saw the bear.† I tried to say it calmly, but my voice was high and shaky. â€Å"It's not a bear, thoughit's some kind of wolf. And there are five of them. A big black one, and gray, and reddish-brown† Charlie's eyes grew round with horror. He strode quickly to me and grabbed the tops of my arms. â€Å"Are you okay?† My head bobbed in a weak nod. â€Å"Tell me what happened.† â€Å"They didn't pay any attention to me. But aftet they were gone, I ran away and I fell down a lot.† He let go of my shoulders and wrapped his arms around me. For a long moment, he didn't say anything. â€Å"Wolves,† he murmured. â€Å"What?† â€Å"The rangers said the tracks were wrong for a bearbut wolves just don't get that big† â€Å"These were huge.† â€Å"How many did you say you saw?† â€Å"Five.† Charlie shook his head, frowning with anxiety, He finally spoke in a tone that allowed no argument. â€Å"No morehiking.† â€Å"No problem,† I promised fervently. Charlie called the station to report what I'd seen. I fudged a little bit about where exactly I'd seen the wolvesclaiming I'd been on the trail that led to the north. I didn't want my dad to know how deep I'd gone into the forest against his wishes, and, more importantly, I didn't want anyone wandering near where Laurent might be searching for me. The thought of it made me feel sick. â€Å"Are you hungry?† he asked me when he hung up the phone. I shook my head, though I must have been starving. I hadn't eaten all day. â€Å"Just tired,† I told him. I turned for the stairs. â€Å"Hey,† Charlie said, his voice suddenly suspicious again. â€Å"Didn't you say Jacob was gone for the day?† â€Å"That's what Billy said,† I told him, confused by his question. He studied my expression for a minute, and seemed satisfied with what he saw there. â€Å"Huh.† â€Å"Why?† I demanded. It sounded like he was implying that I'd been lying to him this morning. About something besides studying with Jessica. â€Å"Well, it's just that when I went to pick up Harry, I saw Jacob out in front of the store down there with some of his friends. I waved hi, but he well, I guess I don't know if he saw me. I think maybe he was arguing with his friends. He looked strange, like he was upset about something. And different. It's like you can watch that kid growing! He gets bigger every time I see him.† â€Å"Billy said Jake and his friends were going up to Port Angeles to see some movies. They were probably just waiting for someone to meet them.† â€Å"Oh.† Charlie nodded and headed for the kitchen. I stood in the hall, thinking about Jacob arguing with his friends. I wondered if he had confronted Embry about the situation with Sam. Maybe that was the reason he'd ditched me todayif it meant he could sort things out with Embry, I was glad he had. I paused to check the locks again before I went to my room. It was a silly thing to do. What difference would a lock make to any of the monsters I'd seen this afternoon? I assumed the handle alone would stymie the wolves, not having opposable thumbs. And if Laurent came here Or Victoria. I lay down on my bed, but I was shaking too hard to hope for sleep. I curled into a cramped ball under my quilt, and faced the horrifying facts. There was nothing I could do. There were no precautions I could take. There was no place I could hide. There was no one who could help me. I realized, with a nauseous roll of my stomach, that the situation was worse than even that. Because all those facts applied to Charlie, too. My father, sleeping one room away from me, was just a hairsbreadth off the heart of the target that was centered on me. My scent would lead them here, whether I was here or not. The tremors rocked me until my teeth chattered. To calm myself, I fantasized the impossible: I imagined the big wolves catching up to Laurent in the woods and massacring the indestructible immortal the way they would any normal person. Despite the absurdity of such a vision, the idea comforted me. If the wolves got him, then he couldn't tell Victoria I was here all alone. If he didn't return, maybe she'd think the Cullens were still protecting me. If only the wolves could win such a fight My good vampires were never coming back; how soothing it was to imagine that the other kind could also disappear. I squeezed my eyes tight together and waited for unconsciousnessalmost eager for my nightmare to start. Better that than the pale, beautiful face that smiled at me now from behind my lids. In my imagination, Victoria's eyes were black with thirst, bright with anticipation, and her lips curled back from her gleaming teeth in pleasure. Her red hair was brilliant as fire; it blew chaotically around her wild face. Laurent's words repeated in my head. If you knew what she had planned for you I pressed my fist against my mouth to keep from screaming.