The Crucible by Arthur Miller Essay Example for Free

The Crucible by Arthur Miller Essay The Crucible by Arthur Miller, is set in 1692, on the Salem witch trials and compared with McCarthyism in 1950s, the time it was written. The Crucible is a fictional retelling of events in American history surrounding the Salem witch trials of the seventeenth century, yet it is as much a product of the time in which Miller wrote it, the early 1950s, as it is a description of a Puritan society. I will be describing my ideas on the performance and the production of the asides in act one of The Crucible. One of the main motives of asides is to explain the similarities in 1690s and1950s. The Crucible is a story with an underlying meaning as well as the literal one. Although 1690s and 1950s are very different, Miller has portrayed the same allegory. Miller is trying to prove that history repeats itself. He does this by proving that people were stupid to believe in witches in the seventeenth century, just like people believed in McCarthyism in America in the 1950s. Today we are repeating similar mistakes, as we consider war as the solution to the Iraq crisis. Getting the message across to audience is very hard as it is no longer 1950s nor do people know much about McCarthyism. During the 1690s Puritans also repressed in England and power then was held by Church, theocracy, those who were landowners held a lot of power. Cromwell had taken power by junta. At that time Salem was in a state of unrest because the old laws were no longer as necessary. Witch-hunting was also causing unrest in Salem. The crisis, of witchcraft, began to increase and doubts began to develop concerning the vitality of the charge. Just like in America the educated people of the colony began efforts to end the witch-hunting hysteria that had surrounded Salem. To explain this complicated allegory successfully, asides are used. 1950s was a decade of unrest in America as there were a lot of economical depressions following world war two, democracy and capitalism problems. More over McCarthy was troubling people by misusing his powers. The hunting down and prosecuting of any Americans who were thought to have taken part in anti-capitalism. The accusations became hysterical and many people were asked to name names of people in meeting held many years previously. By 1962 many people started going against McCarthy. Miller uses the Salem witch-hunt to present his views on McCarthyism, The prosecuting of any Americans who were thought to have taken part in anti-capitalism, is similar to the hunting down of suspects of witchcraft. The asides are a very effective way of telling long story in short. The narrator may explain the situations, introduce new characters or even give his own opinion to get the message across to the audience. The narrator is particularly needed for Act 1, as the setting and different characters need to be introduced to audience. Another reason why asides are important to be narrated is, the allegory in the story for which the audience needs to follow the story right from the beginning. Therefore it is vital that the narrator of the aside is someone, who the audience is likely to pay attention to. Ideally a literate person who can judge people correctly and has the power to catch the audiences attention with his voice. I think its a good idea if the narrator is one of the charters from the play. Having one of the characters to narrate the play is a very effective method of providing information to audience. He is likely to get more attention because the audience is familiar with the person. In A view from the Bridge Miller uses a lawyer to narrate the play, which I think works really well because he used someone who is very intelligent and respected. Similarly a positive character could be used in this play to talk to audience. I chose Reverend John Hale, from this play to read the aside in act one, as the audience will be more familiar with the character when he comes later on in the act and introduces himself. Miller is interested in people who do not allow them to be caught up in hysteria but think for themselves and stand up for their believes against all odds. Similarly Hale backs this point, towards the end where he learns how things are going wrong. Hale changes his opinions as he gets more knowledge about the things going around him. The narrators opinion about things needs to be the same as that of author, because a person with different views cannot talk about views, which he does not believe in. Miller believes that society is never an excuse for our failings, and that we are responsible for ourselves, such a person is John. John tries to save the lives of innocent people wrongly accused of witchcraft. He is the only Judge who tried to save Reverend Proctor. However human weakness and guilt sometimes drag him down but still his character is positive. As millers describes John He feels himself allied with the best minds of Europe Miller is trying to say how self-centred John is but at the same time he is telling us that John is intelligent. The audience is more likely to listen to such person because of his reputation. The key reason for having a character from the play as a narrator is that the audience is familiar with the person; therefore Hale should narrate the asides in his normal character clothes, speech and movement. A good way of introducing characters is to let the person perform their most common role in the background and the narrator standing in front talking about the person. For example when Reverend Parris is introduced, John Hale could be standing in the front saying, there is very little good to be said for him. while Parris is in meeting in Church talking, but has no one listening. Since the asides in this play are not only introduction, doing so will lose the consistency of the asides, and the audience will not be clear whether its an aside or part of the play. Therefore while he is standing motionless on the stage and reading the asides where the stage is dark and a spotlight on the character and deep voice with no background music. The shining of bright light on Hale while the stage is all black will give him almost a god like image. Its only him talking and, there is no other option but listen to him. The pause in music will make the audience concentrate on the aside by having nothing else but John to listen to. His voice should have extra bass added to it. Radio experiments show that if the voice of presenters have bass then the listeners are more likely to remember what they listen to. The stage is all difficult to obscure and there is only one glow in the theatre approaching from John Hale while he states about Parris in his deep tone his house stood in a town but we would hardly call it a village today. The best way to perform asides in this play is to have a character from the play narrate the asides while full attention is given to him. The most suitable character would be Hale because the way he thinks about matters and his intelligence make him exceptional.

Role of Dietary Intervention in Ameliorating Disability

Role of Dietary Intervention in Ameliorating Disability The Role of Dietary Intervention in Ameliorating Disability Experienced by Multiple Sclerosis Patients Mark M. Makar Hypothesis: Diet modification can significantly improve disability and quality of life in multiple sclerosis patients. Abstract (word count: 213) Hypothesis: Diet modification can significantly improve disability and quality of life in multiple sclerosis patients. Methods: The PubMed database was searched on January 18, 2017 to identify studies relevant to this review. The database search combined terms from three themes: 1) multiple sclerosis patients 2) diet and 3) diet modification. This search yielded 118 articles for screening, with no duplicates. With abstract screening and inclusion criteria, 10 articles were included in this final review. Results: Modifying the diet of multiple sclerosis patients can greatly reduce fatigue and moderately help decrease symptoms experienced during this disease. Replacing animal based protein and saturated fatty acids from the diet, with plant-based alternatives that are high in starch showed noticeable improvement in symptoms experienced by multiple sclerosis patients. The plant based diet showed a decrease in inflammatory cells, damage of the blood brain barrier, demyelination, as well as axonal and oligodendrocyte injury. Conclusions: A variety of dietary modifications have been demonstrated to effectively improve quality of life and reduce disability in patients suffering from multiple sclerosis. More studies are needed to assess the efficacy of dietary intervention with respect to reducing episodes of disability experienced by multiple sclerosis patients and including diet modification into the current disease modifying therapies available. Key Words: multiple sclerosis, diet modification, review Ultramini Abstract: A search of the PubMed database yielded 10 articles for review. A variety of randomized controlled trials, cohort studies, case studies, cross sectional studies, and surveys regarding multiple sclerosis patients and diet modification to exclude animal protein from the diet and include only a plant based diet, can help to ameliorate disability. Introduction Multiple Sclerosis has an ongoing prevalence of 33% globally, with its incidence growing in North America and Europe (Evans C et al., 2013). Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. It is the number one cause of non-traumatic neurodegenerative disability in the young adult population, and is twice as common in women as men (Browne, P et al., 2014). The etiology of multiple sclerosis is still unknown; however, it is believed to have autoimmune origins. Patients tend to experience multiple sclerosis differently; the most common presenting symptoms include sensory (40%), motor (39%), fatigue (30%), and visual (30%), and urinary incontinence (17%) along with less common symptoms presenting as pain and cognitive decline (Evans C et al., 2013). The wide array of symptoms experienced in multiple sclerosis has sprung forth an influx of scholarly research on beneficial disease- modifying therapies (DMTs) and alternative non-traditional methods for treating multiple sclerosis. Many governments across the world subsidize the current platform therapies for multiple sclerosis across the world including interferon-beta and/ or glatiramer acetate (Browne, P et al., 2014). There is a considerable degree of variance between different levels of income groups in society with regards to accessibility of government-funded therapies for multiple sclerosis (Browne, P et al., 2014). Availability of government funded DMTs were accessible to 96% of high-income countries, 45% of lower to middle income countries, and none in the low-income countries (Browne, P et al., 2014). These surprising statistics have led to new research development, which focus on new treatment methods for multiple sclerosis that cannot only be efficacious, but also be economically accessible for all levels of socioeconomic statuses across the world. There is much speculation regarding cost effectiveness of current treatment regiments for multiple sclerosis with interferon-beta and/ or glatiramer ace tate. There is a common consensus that the current platform therapies are not cost effective for the long-term therapy of multiple sclerosis (Bogglid, M et al., 2009). Given the pathology of multiple sclerosis, it is believed that dietary factors play a key role in autoimmune degradation and can induce myelin breakdown in the central nervous system by molecular mimicry (Ashtari, F et al., 2015). Multiple sclerosis prevalence is believed to be high in regions furthest away from the equator, however recent research has found that these regions of the world also consume a greater amount of saturated fat and animal protein such as dairy (Swank, R et al., 1990). Diets high in animal protein saturated fatty acids tend to worsen progression of multiple sclerosis and increase relapse of symptoms (Hadgkiss, E et al., 2015).It has been proposed that dietary interventions such as low fat, plant-based diet may decrease autoimmune inflammation in the central nervous system and help maintain the protective integrity of the blood brain barrier (Riccio, P et al., 2016). Dietary modifications are thought to be both a cost effective and efficacious treatment option for mitigating symptoms experienced by multiple sclerosis patients such as loss of motor and or sensory function, as well as fatigue (Yadav, V et al., 2016). This paper aims to provide a practical overview of recent scholarly literature in order to answer the research question: Does diet modification significantly decrease the level of disability and improve the quality of life in patients suffering from multiple sclerosis? The review will be guided under the hypothesis: diet modification can significantly improve disability and quality of life in patients suffering with multiple sclerosis. Methods Articles about multiple sclerosis and diet modification were searched on January 19, 2017 using the databases Pub Med and Google Scholar. The database search combined terms from three themes: 1) multiple sclerosis patients (relapsing remitting multiple sclerosis OR primary progressive multiple sclerosis OR multiple sclerosis OR central nervous system demyelination OR autoimmune encephalomyopathy OR demyelinating disease 2) diet (food OR animal protein OR vegan diet OR plant based diet) and 3) diet modification (meal plan OR starch based diet). When searching for articles, screening settings were set to be within 10 years, English language, full text articles, review, meta-analysis, randomized control trials, and clinical trials. Boolean operators used were OR and AND; OR was used to extract specific terms from the three main themes. AND was used to connect the three themes used in this review. This search yielded 118 articles for screening, with no duplicates. With abstract screening and inclusion criteria, 10 articles were included in this final review. Inclusion Criteria All the articles used in this systemic review had to meet the following criteria: 1) English 2) patients with multiple sclerosis for at least 6 months 3) diet modification/ assesment or pharmacological treatment as intervention. The term multiple sclerosis was defined as patients showing symptoms for at least 6 months and diet modification was defined as any change in daily food intake. Exclusion Criteria Articles were excluded from the review if they were published prior to 2007 and/or were not written in the English language and/or if patients had any type of prior chronic disease other than multiple sclerosis. Results Randomized Controlled Studies In a randomized controlled study by Vijayshree Yadav et al, 61 patients with relapsing remitting multiple sclerosis were monitored for a one-year period. The participants were randomly allocated into two groups: Diet group and control group. The diet group was placed on a strict starch plant based diet (potatoes, corn, beans, bread, sweet potato and rice), while the control group was allowed to continue with their usual diet (meat, eggs, dairy products, fish) throughout the study. Each participant was surveyed once every three months or the duration of the study during which disability, and fatigue levels were recorded (by the expanded disability status scale, EDSS and fatigue severity scale, FSS/ modified fatigue impact scale, MFIS respectively). Serum lipid levels and brain MRI were also recorded at the end of the twelve months. The results observed demonstrated a significant reduction (pFigure 1 shows a summary of fatigue improvement throughout the duration of the study. These fin dings suggest that intervention with a plant-based diet does indeed help reduce fatigue in multiple sclerosis patients. Figure 1: Graph of Fatigue Scores as Measured by FSS score (A) and MFIS score (B) over a 12 Month Time Span In a similar randomized control trial by Anja Mahler et al, 18 patients with relapsing remitting multiple sclerosis were randomly divided into two groups. The intervention group was started on 600 mg green tea catechin capsule per day and the control group received a placebo capsule for 12 weeks. A 4-week period was allotted during crossover to assure a sufficient wash out period. The results observed determined there was a significant increase in efficiency of muscle work from 20 (SD= 3) in the placebo group to 25 (SD= 6) in the intervention group (p>0.004). This finding suggests that intervention with plant based green tea extract helps to decrease muscle fatigue in multiple sclerosis patients. Cohort and Cross Sectional Studies: Emily Hadgkiss et al surveyed 2087 patients with multiple sclerosis globally. The comprehensive online survey inquired about dietary habits, quality of life, disability, and relapse rate. Dietary habits were assessed using the Diet Habits Questionnaire (DHQ), baseline quality of life was calculated using the Multiple Sclerosis Quality of Life scale (MSQOL-54), and disability was calculated by using the Expanded Disability Status Scale (EDSS). Results of this study demonstrated that patients who reported higher intake of fruits and vegetables and low intake of fats had significantly higher physical health scores (PHC) ranging from 54 to 68 (pFigure 2 and Figure 3 shows a brief summary of these results. Figure 2: Mean Physical Health Composite by Dietary Factors   Ã‚   Figure 3: Mean Mental Health Composite by Dietary Factors Another significant finding in this study showed that patients who consumed meat and dairy had much poorer disability scores 624 (pTable 1. The frequency ofmultiple sclerosis disease activity was also significantly increased in meat and dairy consumers, 309% and 271% respectively (p Table 1: Level of disability and disease activity by dietary subgroups Soodeh Jahromi et al surveyed the diets of 75 women with multiple sclerosis from Iran. Dietary patterns were assessed using a 168-item food frequency questionnaire (FFQ). This study found patients whos diet consisted mainly of animal fat (high in animal fats, potato, other meat products, sugars, hydrogenated fats and low in whole grains, spices, and poultry without skin) had higher incidence of multiple sclerosis (OR = 1.99; CI: 1.63-2.94; P = 0.04), and patients who had a vegetable based diet (high in green leafy vegetables, hydrogenated fats, tomato, yellow vegetables, fruit juices, onion, and other vegetables) had lower incidence of multiple sclerosis. (OR = 0.42; 95% CI = 0.19-0.90; P = 0.026). These findings suggest an inverse relationship between high amount of hydrogenated fats, green leafy vegetables, fruit juices, and other vegetables and risk of multiple sclerosis. A longitudinal retrospective analysis was conducted by Weinstock-Guttman et al, where lipid levels of 492 multiple sclerosis patients were assessed for one a year time period. The study deduced that increasing LDL (p Geeta Ramsaransing et al investigated the levels of 23 dietary nutrients in 80 patients with multiple sclerosis: 27 with benign course multiple sclerosis, 32 with secondary progressive multiple sclerosis, and 21 with primary progressive multiple sclerosis. The secondary progressive group demonstrated significant decreases in magnesium intake (p In a cohort study by Mike Bogglid et al, 5583 multiple sclerosis patients in the UK were monitored from May 2002 to April 2005 in an effort to establish the long term cost effectiveness of current platform therapy (interferon-beta and/ or glatiramer acetate) for multiple sclerosis. Following the duration of the study, 49% of patients that were on platform therapy were found to have experienced progressive deterioration in EDSS 2.68 at baseline, 2.90 after one year, and 3.24 after two years (p Case Control Studies In a comparable study to Soodeh Jahromi et als work, a cross sectional analysis by Tatjana Pekmezomiv et al was conducted to investigate possible dietary trends in patients living with multiple sclerosis. The dietary habits of 110 multiple sclerosis patients were compared to 110 healthy controls. Results showed that meat intake such as chicken (OR=2.0, p=0.045), lamb (OR=2.1, p=0.013), and beef (OR=1.7, p=0.043) was significantly higher in multiple sclerosis patients as compared to healthy controls. Furthermore, the study found that multiple sclerosis patients consumed significantly higher levels of ice cream (OR=0.18, p=0.031) and butter (OR=1.7, p=0.056) in comparison to controls. Table 2 shows a brief summary of these results. These findings suggest that there is a significant association between dietary intake of meat products such as chicken, lamb, and beef, as well as ice cream and butter to the disease in question. This may suggest that removal or reduction of said food items may be beneficial in decreasing the incidence of multiple sclerosis. Table 2: Consumption frequency of different food groups and food items in MS patients and controls Fereshteh asharti et al conducted a case control study in order to evaluate cows milk allergy (CMA) in multiple sclerosis patients versus healthy individuals. The authors compared 48 multiple sclerosis patients with 48 healthy controls. After 16 weeks there were no differences in the frequency of CMA between the two groups. Contrary from the results of Emily Hadgkiss et als study, the study done by Vahid Shaygannejad et al, found that there was a higher frequency of dairy products consumed by healthy control individuals (67%, p=0.01) compared to multiple sclerosis patients. These findings suggest that there is no reliable association between milk consumption and risk of multiple sclerosis development. Discussion This review attempted to answer the question: Does diet modification significantly decrease the level of disability and improve the quality of life in patients suffering from multiple sclerosis? The general shared consensus of articles included in this review support the proposed hypothesis of diet modification can, indeed, significantly improve disability and quality of life in multiple sclerosis patients (Hadgkiss E et al., 2015; Jahromi S et al., 2012; Shaygannejad V et al., 2016; Yadav V et al., 2016; Ramsaransing G et al., 2009; Jahroomi S., 2012; Pekmezovic T et al., 2012). However, one article concluded that consumption of animal protein in the form of milk did not increase the risk of developing multiple sclerosis (Shaygannejad V et al., 2016). However, these findings should not be generalized to the general population as the sample size used was too small and did not represent a true spectrum of multiple sclerosis prevalence across the world. The remaining articles reviewed corroborated that removal of both animal based protein and saturated fatty acids from the diet, and their replacement, high starch, plant-based alternatives, provided improved disability and fatigue in patients suffering from this disease (Pekmezovic T et al., 2012; Yadav V et al., 2016). The plant based, high starch diet (potato and rice) was found not only be an efficacious treatment option for mitigating symptoms experienced by multiple sclerosis patients but is also economically accessible for all levels of society across the world. It is also evident that most clinicians involved in the articles reviewed, found enough evidence in their research to warrant providing advice to patients with multiple sclerosis about the importance of healthy diet modification in regards to their condition (Hadgkiss E et al., 2015; Jahromi S et al., 2012; Yadav V et al., 2016; Ramsaransing G et al., 2009;). Many of the articles reviewed used a survey platform to assess the diets of multiple sclerosis patients; this may have had some effect on the results due to the nature of the retrospective study design used, making way for possible recall bias, hence potential misreporting of dietary intake (Pekmezovic T et al., 2012; Hadgkiss, E et al., 2015;). As well, since many of the articles used a food frequency survey approach, it may have limited the interventions possible with regards to experimenting with different types of foods that may have improved or worsened multiple sclerosis outcomes. A common limitation in this review is that none of the articles inquired about portion sizes of their meals, just food items (Hadgkiss E et al., 2015; Jahromi S et al., 2012; Yadav V et al., 2016; Ramsaransing G et al., 2009; Jahroomi S., 2012;). Across all articles reviewed, mean age of the study population was between 30- 47 years; therefore the results of this review may not be true for younger or more elderly patients. Many of the researchers in this review found it difficult to recruit many subjects due to health concerns regarding a low protein diet (Hadgkiss E et al., 2015; Jahromi S et al., 2012; Yadav V et al., 2016; Ramsaransing G et al., 2009; Jahroomi S., 2012). It is possible that the results observed with regards to studying the diets of multiple sclerosis patients may have been due to associations with other confounding variables. It is also important to note that given the disabling nature of multiple sclerosis as a disease state, many of the patients may be relying on a caregiver or family member for their meals, which may influence their dietary intake. Limitations encountered in this review include only utilizing articles written within the past 10 years, articles collected from only two databases (PubMed and Google Scholar), and articles were only included only if they were published in the English language. Future research may consider standardizing meal portion sizes during experimentation as various parts of the world have varying standard portion sizes. Future studies should also consider accounting for possible supplementation use in the participants such as vitamin and mineral intake. This would help diminish possible confounding variable. Future research may also utilizing experimental analysis encompassing a larger age range. All together, these factors would help encompass a much broader spectrum of patients living with multiple sclerosis. Conclusion In conclusion, diet modification has been shown to be a viable option not only for effectively improving quality of life, and reducing disability in patients suffering from multiple sclerosis, but also in lowering the risk of developing the disease. Evidence showed that removal of both animal based protein and saturated fatty acids from the diet, and replacing them with plant-based alternatives which are high in starch showed noticeable improvement in muscle weakens and fatigue levels. Unfortunately we do not have sufficient research that definitively demonstrates that diet modification can be used alone without traditional medication to prevent and/ or treat multiple sclerosis. Additional studies are needed to assess the efficacy of dietary intervention with respect to reducing episodes of disability experienced by multiple sclerosis patients and including diet modification into the current disease modifying therapies available. References Ashtari, Fereshteh, Fatemeh Jamshidi, Raheleh Shokouhi Shoormasti, Zahra Pourpak, and Mojtaba Akbari. Cows milk allergy in multiple sclerosis patients. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences 18, no. Suppl 1 (2013): S62. PMCID: PMC3743324 Boggild, Mike., Palace, Jackie., Barton, Pelham., Ben-Shlomo, Y., Bregenzer, Thomas., Dobson, Charles., Gray, R. (2009). Multiple sclerosis risk sharing scheme: two year results of clinical cohort study with historical comparator. BMJ, 339, b4677. http://www.bmj.com/content/bmj/339/bmj.b4677.full.pdf. Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C., Taylor, B. V., Thompson, A. J. (2014). Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity. Neurology, 83(11), 1022-1024. http://doi.org/10.1212/WNL.0000000000000768 Guggenmos, Johannes, Anna S. Schubart, Sherry Ogg, Magnus Andersson, Tomas Olsson, Ian H. Mather, and Christopher Linington. Antibody cross-reactivity between myelin oligodendrocyte glycoprotein and the milk protein butyrophilin in multiple sclerosis. The Journal of Immunology 172, no. 1 (2004): 661-668. DOI: https://doi.org/10.4049/jimmunol.172.1.661 Emily J Hadgkiss, George A Jelinek, Tracey J Weiland, Naresh G Pereira, Claudia H Marck Dania M van der Meer (2015) The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis, Nutritional Neuroscience, 18:3, 125-136, DOI: 10.1179/1476830514Y.0000000117 Evans, Charity, S-G. Beland, Sophie Kulaga, Christina Wolfson, Elaine Kingwell, James Marriott, Marcus Koch et al. Incidence and prevalence of multiple sclerosis in the Americas: a systematic review. Neuroepidemiology 40, no. 3 (2013): 195-210. doi: 10.1159/000342779. Jahroomi, Soode., Toghae, Mansoureh., Razeghu Jahromi, M., Aloosh, Mahdi. (2012). Dietary pattern and risk of multiple sclerosis. Iranian Journal of Neurology. 11(2), 47-53. PMCID: PMC3829243 Joscelyn, Jennifer., Kasper, Lloyde. H. (2014). Digesting the emerging role for the gut microbiome in central nervous system demyelination. Multiple Sclerosis Journal, 20 (12), 1553-1559. DOI: 10.1177/1352458514541579 Mà ¤hler, Anja, Jochen Steiniger, Markus Bock, Lars Klug, Nadine Parreidt, Mario Lorenz, Benno F. Zimmermann, Alexander Krannich, Friedemann Paul, and Michael Boschmann. Metabolic response to epigallocatechin-3-gallate in relapsing-remitting multiple sclerosis: a randomized clinical trial. The American journal of clinical nutrition 101, no. 3 (2015): 487-495. DOI: 10.3945/ajcn.113.075309 Otaegui, David, Sara Mostafavi, Claude CA Bernard, Adolfo Lopez de Munain, Parvin Mousavi, Jorge R. Oksenberg, and Sergio E. Baranzini. Increased transcriptional activity of milk-related genes following the active phase of experimental autoimmune encephalomyelitis and multiple sclerosis. The Journal of Immunology 179, no. 6 (2007): 4074-4082. doi: 10.4049/jimmunol.179.6.4074 Pekmezovic, Tatjana D., Darija B. Kisic Tepavcevic, Sarlota T. Mesaros, Irena B. Dujmovic Basuroski, Nebojsa S. Stojsavljevic, and Jelena S. Drulovic. Food and dietary patterns and multiple sclerosis: a case-control study in Belgrade (Serbia). Italian Journal of Public Health 6, no. 1 (2012). http://ijphjournal.it/article/view/5808 Ramsaransing, Geeta, Mellema, Sanne. A., De Keyser, J. (2009). Dietary patterns in clinical subtypes of multiple sclerosis: an exploratory study. Nutrition journal, 8(1), 36. DOI: 10.1186/1475-2891-8-36 Riccio, Paolo, and Rocco Rossano. Nutrition facts in multiple sclerosis. ASN neuro 7, no. 1 (2015): doi: 10.1177/1759091414568185 Riccio, Paolo., Rossano, Rocco., Liuzzi, G. Maria. (2011). May diet and dietary supplements improve the wellness of multiple sclerosis patients? A molecular approach. Autoimmune diseases, 2010. http://dx.doi.org/10.4061/2010/249842 Riccio, Paolo, Rocco Rossano, Marilena Larocca, Vincenzo Trotta, Ilario Mennella, Paola Vitaglione, Michele Ettorre et al. Anti-inflammatory nutritional intervention in patients with relapsing-remitting and primary-progressive multiple sclerosis: A pilot study. Experimental Biology and Medicine 241, no. 6 (2016): 620-635. DOI: 10.1177/1535370215618462 Shaygannejad, Vahid, Nooshin Rezaie, Zamzam Paknahad, Freshteh Ashtari, and Helia Maghzi. The environmental risk factors in multiple sclerosis susceptibility: A case-control study. Advanced Biomedical Research 5 (2016). doi: 10.4103/2277-9175.183665 Swank, R. L., and B. Brewer Dugan Effect of low saturated fat diet in early and late cases of multiple sclerosis. The Lanet 336, no. 8706(1990): 37-39. DOI:10.1016/0140-6736(90)91533 Tlaskalovà ¡-Hogenovà ¡, Helena, Renata Ã…Â  tĆºpà ¡nkovà ¡, Hana Kozà ¡kovà ¡, Tomà ¡Ãƒâ€¦Ã‚ ¡ Hudcovic, Luca Vannucci, Ludmila TuÄ kovà ¡, Pavel Rossmann et al. The role of gut microbiota (commensal bacteria) and the mucosal barrier in the pathogenesis of inflammatory and autoimmune diseases and cancer: contribution of germ-free and gnotobiotic animal models of human diseases. Cellular molecular immunology 8, no. 2 (2011): 110-120. http://www.nature.com/cmi/journal/v8/n2/abs/cmi201067a.html Vieira, Silvio. M., Pagovich, Odelya. E., Kriegel, Martin. A. (2014). Diet, microbiota and autoimmune diseases. Lupus, 23(6), 518-526. doi: 10.1177/0961203313501401 Weinstock-Guttman, Bianca, Robert Zivadinov, Naeem Mahfooz, Ellen Carl, Allison Drake, Jaclyn Schneider, Barbara Teter et al. Serum lipid profiles are associated with disability and MRI outcomes in multiple sclerosis. Journal of neuroinflammation 8, no. 1 (2011): 127.DOI: 10.1186/1742-2094-8-127 Yadav, Vijayshree., Marracci, Gaild., Kim, Edward., Spain, Rebecca., Cameron, Michelle., Overs, Shanon., Murchison, C. (2016). Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial. Multiple Sclerosis and Related Disorders, 9, 80-90. DOI: 10.1016/j.msard.2016.07.001. Appendix First Author Population Year of Publication Study Design Outcome Ashtari, F. 48 patients with Multiple Sclerosis and 48 healthy patients as control group, mean age 30.7 March 18, 2013 Case control Study Serum IgE levels against cows milk antigen was taken from both groups. Results were very similar between both groups and showed no statistical significance (30.7  ± 6.9 vs. 30.9  ± 6.3 respectively, P value = 0.83) Boggild, M. 5583 patients with multiple sclerosis monitored from May 2002 to April 2005 from neurology clinics across the UK August 5, 2009 Prospective Cohort Study Patients received Interferon Beta treatment to determine long term cost effectiveness. Results showed worse disability progression than in the untreated group (deviation score of 113%; increase in mean disability status scale 0.28) Hadgkiss, E. 2087 patients with multiple sclerosis, mean age 45.5 participated in a comprehensive online survey March 17, 2014 Cross Sectional Study

A Brief History Of Blizzard Entertainment Media Essay

A Brief History Of Blizzard Entertainment Media Essay Well, Blizzard Entertainment was not always as we had known it, originally founded in 1991 February as Silicon Synapse by Chairman Allen Adham, president Michael Morhaime and vice president Frank Pearce All Graduates from UCLA. In the days of Silicon Synapse it was more on focused on making game ports for other Gaming studios. Until the Breakthrough Game The Lost Vikings, it was hailed as one of the forefathers of that Game Genre . A year after that they released Rock Roll Racing another Cult Hit that paved the way for its predecessors in the Racer Shooter Genre. In 1994 It was only then its name was reestablished as Blizzard Entertainment. The first big scale game it released by Blizzard Entertainment, was Warcraft: Orcs Humans and it was a hit with the gamers. Ever since they have made a benchmark in the game, the gaming world was at their fingertips now. After such success with Blizzard Entertainments original Warcraft game, Warcraft: Orcs Humans , was touted as one of the best strategy games of 1994, and the games epic sequel, 1995s Warcraft II : Tides Of Darkness, won numerous awards, including the companys first Game of the Year award. Warcraft III :Reign Of Chaoss, released in July 2002, has likewise won several accolades , just like Starcraft another hit Game Series released by Blizzard Entertainment, It has become a staple of professional tournament gaming, along with its expansion, the award-winnin g Warcraft III : The Frozen Throne, which was released in July 2003. II. Current Projects and a look at the rise of WOW ( World Of Warcraft) Well Blizzard has many notable achievements in its released games, None of it comes close To World Of Warcraft, more widely known as WOW. World of Warcraft stands as the greatest game in the popular Warcraft series. World of Warcraft has been an extraordinary success since its launch in November 2004. It has impressed game critics and has captivated millions of players, who adore the virtual world created by this game. It is no longer just a game but is now a genuine phenomenon, and one that shows no signs of abating. It is one of the key games of recent times, and stands as a landmark title for online gaming. World of Warcraft is the forth title in the series of Warcraft games, which has been entertaining people for over a decade To understand more about the appeal of World of Warcraft, let us recall the time when WOW was released. It was not merely some massively multiplayer online role-playing game. It created a truly engaging online world set in the heart of Azeroth, a fantastic land that is filled with heroes and monsters and many other creatures. The games strength is that it functions as an experience, as a world that exists on its own terms that you may visit and explore as you please. The game sold more than 240,000 copies in its first 24 hours on the market, more than any other PC game in history. Since then it released two other expansion sets which was a greater success then the one before. Blizzard is also making attempt to diversify beyond their original aim of just making games. Blizzard Entertainment is currently working with Legendary Pictures in making a live action Warcraft movie. III. tso The 8 Core Values are namely : Gameplay First, Blizzard Entertainments success can be attributed to the gaming experiences they provide the consumer or player. The goal of each discipline within the company regardless of job post be it art, programming or customer support, is to create games as fun as possible for as many people as possible. In order to achieve this aim, it is in Blizzard Entertainments prime belief that its workers also enjoy the process of game making. Commitment to Quality, This is the most well known core value of Blizzard Entertainment, which is not only applied in creating the best gaming experience for the consumers, but also practiced in every aspect of their job. They approach each task carefully and seriously, and seek honest feedback and use it to improve the quality of their work. Afterall, games are remembered for their high quality, and not how late they are released into the public. Play nice, Play Fair, In their business first impressions are important but lasting impressions are the ones that matter. Blizzard Entertainment strives to maintain a high level of respect and integrity in all interactions with us, players, colleagues, and business partners. The conduct of each Blizzard Entertainment employee, be it online or offline, can reflect on the entire company. Embrace your inner Geek, The employees at Blizzard are encouraged to show their geek side . Cutting-edge technology, comic books, science fiction, top-end video cards, action figures with the kung-fu gripà ¢Ã¢â€š ¬Ã‚ ¦. Whatever it is theyre passionate about, it matters that each employee embraces it! Their unique enthusiasm helps to shape the fun, creative culture of Blizzard Entertainment. Happy and truly passionate workers make better workers, and what Blizzard Entertainment is all about today. Every voice matters, Great ideas can come from anywhere. Blizzard Entertainment is what it is today because of the voices of our players and of each member of the company. Every employee is encouraged to speak up, listen, be respectful of other opinions, and embrace criticism as just another avenue for great ideas. All because Blizzard values its employees and listens to the different ideas. Think globally, Blizzard Entertainment is a global company and everywhere on the planet there are people who play Blizzard Entertainment games. While respecting the cultural diversity that makes people unique, we strive to grow and support our global gaming community. We also seek the most passionate, talented people in the world to enrich our company and help us forge the future vision of Blizzard Entertainment. No country is too big or too small for Blizzard to take on or think about. Lead responsibility, Blizzard Entertainment believes its products and practices can affect not only our employees and players but the industry at large. As one of the worlds leading game companies, they are committed to making ethical decisions, always keeping the players in mind, and setting a strong example of professionalism and excellence at all times and for other game companies to exemplify. Learn and Grow The games industry is ever-changing. Technology improves, techniques change, and design philosophies become outdated. Since the founding of Blizzard Entertainment, it has worked to improve through experience, teaching one another and cultivating the desire to be the best at what they do. They see this as an individual responsibility as well as the companys. Employees can count on their peers, managers, and the company itself to be supportive and help them gain the knowledge and training they need. IV. A in-depth SWOT Analysis This Analysis will help us better understand of Blizzard Entertainments Success and its weaknesses. Using The SWOT Analysis model we can see the opportunities and revaluate the strategies to cope with its weaknesses. Strengths Good market position globally One of the very best pc game developers and held in high esteem by its customers. Very large age group from its larger customer base. Takes Feedback from its players and customers quickly and seriously. Developed World Of Warcraft to huge success and acclaim. Weaknesses May lack some competitive edge in some market segments over rival companies Relies on its current game titles more than it should. Very slow to release its games, often over the stipulated release date. Opportunities Business can be further diversified into other industries, example, making a film which it is trying to do now. Acquire more gaming sectors. More varied games. Look at a brand new type of pc game to boomz everyone away. Opening up of other global markets, getting more customers worldwide further. Working together with another pc gaming company to have a co-project. Threats Other big pc game producing companies, might pose some competition with maybe more attractive graphics or different game genres, Example, FPS. The time it takes to release a game might turn some gamers off, or they might just stop waiting all together. Limited experience in other industries it might want to diversify into Piracy 3rd party clients such as Garena, lancraft blueserver and many others. Strengths Blizzard Entertainment has a good market position globally, meaning in the games market it has a huge cut of the customers and transactions that happen in it. Blizzard Is very well respected by the gamers, customers and other companies alike for their awesome games which are well designed and enjoyable for a very wide age group. When Blizzard comes out with a new game other companies will always try to better it learning from its strengths. From kids to adults, blizzard games have players every age range, making it well welcomed by all. Blizzard Entertainment leaves no gamer from the casual gamer to hardcore, professional gamer satisfied. The games Are simple enough and fast for the casual gamer to play, but also well balanced with good competitive potential. Intact, World Cyber Games (WCG) the worlds largest scale gaming competition has 2 Blizzard Entertainment games to compete in, Namely Starcraft 2, Warcraft 3 and Dota, which is a custom map made from Warcraft 3. Blizzard Entertainments World Of Warcraft easily overshadows all of its accomplishments with 12 million subscribers and increasing. Making it the most played online MMORPG, no small feat without its dedicated team of staff. If a bug is reported or game defect , blizzard will take it seriously and respond quickly to look into the problem and solve the issue. Weaknesses While Blizzard Entertainment is certainly a very successful company but it is not perfect or infallible. One of its Weaknesses is its most of its games revolve around the same genre of the real time strategy (RTS) or Role Playing Games (RPG). Some game diversity would be a fresh change and might get into a bigger cut of the market and different gamer groups. On top of that Blizzards Entertainments game graphics might be less visual compared to other games therefore might have less competitive edge in some market segments over rival companies example sports gaming or fps. Though Blizzard Entertainment has very good games it keeps expanding on the already expanded game stories, example Warcraft which has great gameplay and good storyline, however it Blizzard keep concentrating on the same story and how to make a better installment people might get bored to keep playing the same story thats over extended or stretched. While Blizzard Entertainment are showing great signs of market diversification by trying to make a movie, their experience is very little in that field and almost non-existent. Might hit many glitches and problems along the way it might hard to solve with little experience. Which Blizzard Entertainment is attempting to avoid by working with a experience movie company, Legendary Films. Everyone agrees that Blizzard Entertainment makes great games, but another thing they agree is they take a really long to do that often over the stipulated release date. An impatient customer is never a happy customer. Game Quality should never be compromised but still the releases could be faster. Opportunities No doubt Blizzard Entertainment is very successful in its games and products, it can further diversify into other game genres it might not have touched, example sports gaming or FPS. Warcraft has a very rich storyline and might be good as a comic or book, gaining more exposure for Blizzard Entertainment as well in the process. Gameplay improvements and Graphical improvements to its current games with patches or when a new game comes out because the gaming industry is always improving, and gamers demand more every time. Look at a brand new game Genre with a totally new gaming engine of which the likes were never seen before and Blizzard Entertainment is on its way to another great selling game. Working with another experienced gaming company will help expand its horizons and its pool of talent, with more ideas and more funding, Blizzard Entertainment has a great global market share and good global coverage, but there are still countries that have not even heard of it, with the expanding global market and opening of markets, it would be a great time to reach even more countries. Blizzard Entertainment is currently working with Legendary Pictures, the studio behind the feature films such as Watchmen, The Dark Knight, Batman Begins, Superman Returns, and 300, in making of a live-action Warcraft movie. Threats Blizzard Entertainment faces serious competition from other companies that have some game genres that other gamers find more fun, example FPS. On top of that though Warcraft 3 has great cinematics, its in game graphics cant be compared. So many other games out there with much better graphics. EA games has Tiberiam Wars with much better graphics but of the same RTS genre , how about Relic Gamings Company of Heros. The Time it takes for Blizzard Entertainment to release its games is a great internal threat, for it may lose many loyal customers that got sick of waiting for the usually delayed games. Customers hate to wait unnecessarily and may buy other games instead. Blizzard Entertainment move into diversifying its market by moving into the movie industry which it has little experience, and requires a lot of funding. By going into other Game Genres its not familiar with also can be a risky move that might spell disaster by spreading itself too thin. Piracy is without a doubt one of the greatest threats to Blizzard Entertainment, infact to any industry that relies on the IP law. File Sharing is now everywhere and very easily accessible, one can even get the game without going out of his home and without spending a single cent for the game. Piracy costs Blizzard Entertainment millions of dollars every year. Why would people pay if they can get it free? Along with Piracy is 3rd party clients that make it possible for the games to be played online for free without the need for a original cd-key. In the past without these programs playing online with a pirated game would be impossible, and that would be one of the reasons why original games where still popular for the fact it had a cd-key that allows it to be played online. With these programs it bypasses all these security measures and there is no longer the need to pay for the game. V. Final SWOT Evaluation It is clear enough from this evaluation that Blizzard Entertainment has a very successful business model, but at the same time has so much more that it could improve on and diversify into. The very rich storyline of Warcraft has so much potential from movies to books to comics to Television series. The move that Blizzard Entertainment decided to make by working on a Warcraft movie was a good market decision to capture the growing movie industry and movie fans. Its lack in experience in the industry is offset by doing the movie with a more experienced movie company Legendary Pictures, the studio behind the feature films such as Watchmen, The Dark Knight, Batman Begins, Superman Returns, and 300, with a proven track record. But it should be warned that yes Blizzard Entertainment can go into other industries, but it must not neglect its main market share the gamers, and some hardcore fans might be turned off by the change Blizzard Entertainment. The Strengths are many and can be further worked upon by looking at the same game with different angles. Continuing to make games based on the gamers demand would be the best bet, for that means their games will always be in demand. The threats and weaknesses are numerous as well, however with the right well thought strategies they can be avoided and countered to keep Blizzard Entertainment ahead in the gaming world. However the greatest threat is Piracy and 3rd party clients, which in the case the saying if you cant beat them , join em doing business with the 3rd party clients might help Blizzard Entertainment gain back its lost profits from the programs and piracy. VI. Conclusion Blizzard Entertainment is a great game developer, and to continue in a increasing volatile market it has to keep changing to meet the demands of the new world. But if it continues to deliver its mission statement Dedicated to creating the most epic entertainment experiencesà ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦.ever following its 8 core values. I dont doubt and not for a second that Blizzard Entertainment will continue deliver gaming experiences that redefine gaming.

To Kill a Mockingbird by Harper Lee :: essays research papers

Miss Harper Lee has chosen Scout as a first person narrator in this story. This narrative technique has many strengths and some weaknesses. Scout is a bright, sensitive and intelligent little girl. For all her intelligence, she is still a child and does not always fully understand the implications of the events she reports. This is sometimes amusing, as the time she thinks Miss Maudie's loud voice scares Miss Stephanie. Scout does her best to inform us of the happenings at the Tom Robinson trial. Yet, she is not certain what rape is, and is neither aware of the prejudice state surrounding her. Ultimately she represents the innocence within society. In To Kill A Mockingbird, Scout Finch, a little girl growing up in a small Southern town, tells the story of her childhood, when she witnessed the trial of a Negro falsely accused of raping a white woman. The Negro's lawyer is Scout's father, Atticus Finch. He defends the Negro vigorously, though he expects to lose the case. As well as being the story of childhood, it is also the story of the struggle for equality of the American Negro. To Kill A Mockingbird can be read as the story of a child's growth and maturation. Almost every incident in the novel contributes something to Scout's perception of the world. Through her experiences she grows more tolerant of others, learning how to " climb into another person's skin and walk around in it." On her first day of school she finds that there are both social and poor classes in society, some are respectable and others not. She also learns that her father is an extra-ordinary man, fighting for a Negro's rights in court. At the trial of Tom Robinson Scout learns about equality and inequality, about justice and injustice and finally about racial prejudice. Many times during the course of the novel the idea of the mockingbird comes to mind. We first hear of the bird when the children are given there first air rifles for Christmas, There father warns them to never shoot the songbird, saying to do so would be a sin. During the trial of Tom Robinson, it occurs to the reader that the Negro has many characteristics he shares with the mockingbird, He is a gentle man, who has never harmed anyone and only tried to help. His murder is as much a sin as the killing of any innocent creature.

Pop Art Comparison of Seated Woman and Lavender Disaster :: Essays Papers

Pop Art Comparison of Seated Woman and Lavender Disaster Pop Art was a Modern art movement that emerged durring the mid-twentieth century in both England and America. It first began to gain recognition in the early 1950’s, after about twenty years of Abstract, as artists altered their attention and looked to change. In the late 1950’s and early 1960’s, Pop Art became much more popular to the general public and successful for the movement’s artists due to the world growing tired of the repeditive forms of Abstract. Found in the Menil Collection, Seated Woman and Lavender Disaster are two examples of Pop Art. The comparison of these two pieces shows although they differ in medium and subject matter both Seated Woman and Lavender Disaster share common underlying themes possesed by all Pop Art. George Segal was an American artist from New York. He began experamenting with the use of a new kind of medical bandage designed for setting fractures, and he developed a techniquie using these bandages to make plaster casts. This allowed Segal to produce a figure that kept the essential human traits with out great detail, and also enabled these figures to be cast directly from a live model. It is in this way that George Segal created Seated Woman in 1967. Andy Warhol was a graphic artist, painter, and film maker, amoung other things, also associated with Pop Art. He moved to New York, around 1950, where he did his first advertisements as a comercial artist and, later, began showing in expositions. One technique employed by Warhol involved repeditive silk screen prints on canvas. He used this method to produce many series of prints with various, easily reconizable images. Between 1962 and 1964 in his self titled studio â€Å"The Factory†(Phaidon 484), Warhol produced over two thousand pictures. One of these, Lavender Disaster, was made in 1963 and belonged to a series of pictures all including the same image of an electric chair. The subjet matter of these two Pop Art examples is for the most part quite different, although there are some similarities. George Segal’s piece is a white plaster figure on a wooden chair with a vinyl seat pad. The figure is sitting sideways in the chair, with her right side being closest to the back of the chair.

Ethics Issues Essay

Ethics Issues Shawnez M. Mckenzie MGT/216 August 12, 2010 Carrie Baird The nature of business ethics is described as, what is fair, and Just. According to Jentz, Miller, and Cross (2002) states, business ethics concentrates on the beliefs, which is right and wrong actions in the business world and the philosophy of morality and how moral principles are consequentially applied to a person’s daily life in the business or social environment. Although some issues seem unethical, it is not necessarily illegal (Rainer ; Turban, 2002, p. 2) Society states the terms ethical and oral are not the same and used interchangeably. Here are three specific examples of ethical issues within todays businesses. Bribery, embezzlement and deceptive advertising can be defined and discussed in this essay. Bribery is considered offenses related to the improper influencing of people in position of trust. Bribery is a white-collar crime, intentions must be clear and verified, and the crime of bribery m ust occur when the bribe is offered. Bribery can affect the local legal system, which can leave the citizens in doubt of who is trustworthy in maintain the laws. An example of bribery would be to influence a public official to act in a manner that services a particular private interest. Bribery affects communities with dishonesty and mistrust of authority in any business or organization. Second, is embezzlement it is the act of stealing funds from a business or organization that was entrust to safeguard, and fraudulently mislead financial records. Embezzlement affects the community and people when a banking intuition is involved. According to Fridell (2009), two bank employees embezzled 1. 3 million dollars over the course of our years, by using hundreds of separated banking transaction. The two women cost six victims their homes, savings and investments by pocketing the funds from the bank and going on lavished vacations. The act of embezzlement can financially affect the lives of others as well as the business. It could leave any company with shame and humiliation, if proper protocol or policy was not enforced or in place to avoid such a crime. However, the act of betrayal within any business, the organization needs to rebuild the trust of the community. Last, is deceptive advertising, is onsidered when businesses are misleading or making false statements regarding a product to mislead consumer. The purpose of the advertising are hopes that advertising would convince consumers to purchase their products. The Federal Trade Commission states, advertising must be truthful and non-misleading, advertiser must be able to support their claims; and advertisement cannot be dishonest with consumers. Under the FTC Deception Policy Statement, an ad is deceptive if it contains a statement or leave out information that is; likely to misinform consumers cting convincingly under the circumstances and â€Å"material† that is vital to a consumer’s decision to purchase or use products. Deceptive advertising as a are genuine and the business are trustworthy, which can affect how consumers and the community view unethical issues. In conclusion, business ethics focuses on what makes up the right and wrong theory in the business and how ethical principles and morals are useful by business people. More important, ethical or moral standards guide our behavior, as parents, children, or students who apply to our everyday lives in the business or social profession. As current members of the business world, we have a moral and business obligation to be ethical in how we deal with others, no matter in what capacity. References Federal Trade Commission, Inc. (2010) Consumer Protection. Retrieved from http://www. ftc. gov. gov Gaylord,J. , Miller, R. , cross, B. F. (2002). wests Business Law. USA. Rainer, K. , & Turban, E. (2008). Introduction to Information Systems. Hoboken, NJ: John Wiley & Sons. Fridell, Z. (2009). Effects of embezzlement still felt as families, bank rebuild. Steamboat Today. Retrieved from http://www. steamboatpilot. com

Electronic Medical Records and Safety Essay

The article titled â€Å"Computer Security Expert’s Perspective on Electronic Medical Records† presents the views of an Information Technology (IT) security expert, Troy Thomas, on electronic medical records (EMR). Thomas is the Chief Security and Privacy Officer for KeyCorp which is the parent company of Key Bank. Thomas has a bachelor’s degree in Computer Information Sciences from Cleveland State University, Cleveland, OH. Thomas asserts that the medical industry is slowly becoming computerized and, eventually, electronic medical records will be the norm. He points out that, however, getting from a highly distributed, paper-based model to a fully computerized EMRs model will be challenging. Changing to a more computerized EMRs model will introduce risks that the current paper-based model does not have and will solve some of the inherent risks associated with the current model. The current paper-based model inherently has the following risks: records are susceptible to fire, flood, mold, termites, decay, fading of ink, and misplacement of an entire folder or subsections. Paper records are easily copied or stolen, easily accessed by office personnel or people who just happen to be near an unattended folder of medical records. An EMRs model inherently has the following risks: computer equipment can fail or break, technology changes quickly, and information stored a long time ago may not be easily accessed at a future date. Information that was once stored can become inaccessible; information can be accessed by unauthorized individuals. Electronic information can be altered. Electronic components do not react well to fire, water, dust, dirt, humidity, being dropped, or being abruptly unplugged. To mitigate these inherent risks, modern computer centers have strict environmental controls to ensure that computer equipment is run in an optimal environment and is backed up and available at an alternative site (for disaster recovery purposes) and has proper security controls deployed to ensure that information can be accessed by authorized personnel only. Technology controls exist that can prohibit information from  being altered. For example, there are direct access storage devices that allow information to be written once and read many times. The inherent risks of the paper-based model and the EMRs model are vastly different but mitigating controls exist that can adequately address the basic inherent risks described thus far. Typical, practicing physicians, however, cannot be expected to set up a dedicated computer center with all of the environmental, phy sical, and logical access controls that are needed to adequately safeguard their patient records. Therefore, for true EMRs to be really secure, a model or protocol is needed whereby physicians store their patients’ medical records at a reputable and secure data center that offers the physicians an outsourced service for accessing and storing EMRs. Unfortunately, a centralized computing model introduces new inherent risks: for example, are the outsource agencies reputable and can they be trusted with patient medical record information? With medical record information coming in from multiple physicians, a unique patient identification number would be needed so that records could be appropriately combined within patient files. With so much information in one place, clear controls would be needed to ensure that the people accessing the information receive only the information that is truly needed. Ensuring that quality information is captured and maintaining patient privacy will be the most challenging aspects of EMRs. Computers don’t improve quality. However, computers can make quality issues and mistakes much more visible and potentially harmful. The author highlighted that the EMRs journey will probably parallel some of the issues that exist with electronic voting where so many questions such as whether society can trust the vendors who sell the voting equipment. Can a vote be altered after it has been cast? How does society effectively centralize a highly decentralized model? Can foreign governments hack American voting equipment and influence an election? How is a person’s voting history stored and secured? In the end, EMRs will be a reality in the healthcare industry. The benefits of centralized electronic patient medical records outweigh the risks associated with changing the model. Ultimately, it is a question of trust, not technology. Will physicians trust their patients to stay with them when their patient medical records are more easily transferred to another doctor? Will patients trust that their medical records are appropriately safeguarded against inappropriate access and that the information contained within their records is accurate and of high quality? Ultimately, Thomas believes the answer to these questions is yes in the long run.