The fittest and dreams Essay Example For Students

The fittest and dreams Essay Steinbeck has indicated an immediate noteworthiness in parts 1 and 6 to show his view on natural selection and dreams. The tale is repetitive as we look at, starts and finishes in a similar spot. The starting included watchwords, for example, ‘twinkling’, ‘sunlight’ and ‘golden’, which causes the setting to appear to be practically similar to the Garden of Eden. It has likewise been cited that ‘a way had been beaten hard by boys’, depicting the topic of the novel, where nature being the frail and man decimating it with their capacity, shows the powerless never endure and it’s the skirmish of natural selection. Indeed, even all through the novel, occasions are foreshadowed all through. We will compose a custom exposition on The fittest and dreams explicitly for you for just $16.38 $13.9/page Request now Where the passing of Candy’s hound hints the demise of Lennie, Lennie murdering the mouse, the doggy, and afterward the young lady, all demonstrate a connect what exactly may occur. Both part 1 and section 6 component creatures to foreplay the story where Steinbeck can give us two plans to the topic of the novel and where he presents the water snake and heron. Where in the primary section everything is by all accounts quiet and leveled out and tranquil, yet in the last part it appears as though great (being nature) had been pulverized, where the heron at that point eats the water snake ‘plucked it out by the head, and the mouth gulped the little snake’. This scene gives us a feeling of the frail not having the option to endure yet then the scene is trailed by ‘re-birth’ or another life, ‘another little water snake swam up the pool’, which gives us another feeling that much after death and the sentiment of all expectation being lost, there may in any case be another opportunity. In section 6 then again, the setting is totally unique. All indications of expectation appear to have been proceeded to feature the conclusion to the ‘American dream, which could connection to how they have been demolished all through the novel. The entire radiant like climate has vanished where the serene environmental factors have now transformed into just about a hellfire like vision with ‘the sun had left the valley’, ‘a charming shade had fallen’, representing the demise of dreams and the utilization of regrettable error. We know from just by taking a gander at the scene where the entire novel had begun, which was situated in the area ‘Soledad’ meaning depression in Spanish, that forlornness is the principle topic, where each man is for himself, where they long for opportunity that they can never truly get.

The Accounting Cycle Steps Research Paper Example | Topics and Well Written Essays - 1000 words

The Accounting Cycle Steps - Research Paper Example A portion of the budget reports arranged during the bookkeeping cycle incorporate the monetary record, the salary proclamation, articulation of investors value, just as the income explanation (Agtarap-San, 2007). The bookkeeping cycle may occur with respect to time in which the association readies its fiscal summaries. For instance, a business may set up its budget summaries on a yearly, quarterly, or month to month premise (Warren, 2010). This paper will talk about the means of the bookkeeping cycle directly from the chronicle of exchanges to planning of fiscal reports. The Ten Steps of the Accounting Cycle Step 1-Analyzing Transactions There are ten stages engaged with the bookkeeping cycle; stage one to three happen during the whole bookkeeping time frame while different strides from four ten happen toward the finish of a bookkeeping period. The initial step incorporates the breaking down of exchanges. In this progression, an association take a gander at the source archives, which incorporate the depiction of the occasions and exchanges. Source reports can either incorporate electronic sources or printed versions. A portion of the source records that the association breaks down during this progression incorporate checks, bank explanations, just as buy orders. The bookkeeping branch of the association ought to get all the source records from different divisions (Warren, 2010). Stage 2-Journalize The second step in the bookkeeping cycle includes getting ready diary sections, which is performed after the investigation of source reports, occasions, and exchanges. During this progression, the organization’s bookkeeper utilizes the twofold passage bookkeeping strategy and rules to journalize. Along these lines, there ought to record of exchanges in two records; likewise, there is a prerequisite that the credits must be equivalent to the charges. Upon the utilization of the charge and credit runs, the exchanges are then recorded in a diary. A diary involves a record that has the total exchanges (Agtarap-San, 2007). Stage 3-Posting The third step in the bookkeeping cycle incorporates posting, which involves the exchange of data from the diary sections in the diary to the record. The diary section, involving both the charge and credit passages is posted in the record with both the credit and charge exchanges. Therefore, the posting step is the fundamental exchange of credits and charges from the diary and moving them to the record. Before they are presented on the record, the diary sections ought to be examined to guarantee that they are exact (Warren, 2010). Stage 4-Trial Balance The fourth step incorporates the planning of a balanced preliminary parity, which alludes to a rundown including all records, just as their equalizations. The data utilized in the planning of the preliminary parity is gotten from the record, with the record adjusts from the record being utilized in setting up a preliminary parity. In the preliminary parity, the re is posting of exchanges in the charge and credit section (Agtarap-San, 2007). Stage 5-Preparing Adjusting sections The fifth step of the bookkeeping cycle subtleties the arrangement of modifying passages, which includes altering the obligation or resource record to its genuine sum. What's more, the changing of diary passages additionally subtleties the refreshing of the cost or income account. To begin with, there is recording of the modifying passages in the general diary, after which they might be presented on the

Dissociative Identity Disorder (Multiple Personality Disorder) Guide (Causes, Symptoms, Treatments)

Dissociative Identity Disorder (Multiple Personality Disorder) Guide (Causes, Symptoms, Treatments) A BRIEF INTRODUCTION7.7 billion people are living on our planet Earth today and someone would say there are also 7.7 billion different personalities. After all, there are no 2 persons who are the same, not even identical twins.But is it true that each person has only one personality, only oneself?Up until the 1970s, many people would say yes.However, in the 1970s, after the publication of a very popular book Sybil, a disorder which was known as hysterical neurosis brought many people with what would later be multiple personality disorder and finally dissociative identity disorder (DID) to light.An official definition does not exist, but DID is most often described as a complex psychological condition which develops as a consequence of experiencing a great trauma in early childhood. The word dissociation means a“disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is”.There are three types of dissociative disorders:Dissociative identit y disorderDissociative amnesiaDepersonalization/Derealization disorderIn this text, we will focus on DID, and as we go through it, we will learn about DID’s history, causes, diagnosis, management and treatment and finally the prognosis.WHAT IS DISSOCIATIVE IDENTITY DISORDER?As we have already said dissociation means a “disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is”.This process is completely normal, and we experience it quite often, sometimes every day in the process of mild dissociation, such as daydreaming, looking at one spot and losing touch with the reality, getting lost in a book, or a movie, etc..However, there are horrible times when disassociation becomes a way of survival because the reality is too much to bear.In these situations, a person disassociates the memory of the event, feelings about it, the place where it happened and feels as if though disconnected from it altogether.It feels like a mental escape fro m the horror and pain.When trauma happens once, such as a car crash and to an adult, dissociation may happen in order not to remember it fully.However, when a continuous severe trauma keeps happening to a child who is between 0 and 6 years old, that causes a dissociative identity disorder in its full capacity.Dissociative identity disorder leads to having several personalities called alters in one human being due to exposure to those severe traumas, resulting in having a disconnected personality.Those alters are all parts of one “self” with different traits and behaviors who “wake up” thanks to different triggers and situations.These alters serve to protect a person and deal with the situations that they can’t.A BRIEF, AMAZING HISTORY OF DISSOCIATIVE IDENTITY DISORDERIt is said that DID existed in Paleolithic which lasted for around 2 million years up until 10,000 years B.C and was shown in different cave images of shamans.Others say that what we know as DID was known as d emonic possession in the Middle Ages.Opinions are different, but what we know for sure is that the first time it was written about this disorder was in 1791 and it was about the case of a 20-year-old German young woman who had two personalities- the German one and the French one who knew nothing about each other.There were a lot of studies about this phenomenon between the 1880s and 1920s, and they dropped drastically since other diagnoses such as schizophrenia appeared.Then, in the 1970s, the above-mentioned book Sybil was published, and suddenly many cases of DID were reported.As their number rose, the number of alternate personalities rose as well â€" from the original two in the cases reported in 1944 to a few dozen, with an average of 15.7 personalities in all of the cases that were documented later on in 1997.The names of this disorder changed through the last decades until its final name Dissociative Identity Disorder came to be: In 1995 it was thought to be a state in which anxiety is either “directly felt and expressed or . . . unconsciously and automatically controlled by various defense mechanisms, then in 1968, it got the name hysterical neurosis, dissociative type, in 1994 the name was multiple personality disorder and then finally dissociative identity disorder.CAUSES OF DISSOCIATIVE IDENTITY DISORDERAs we have already said, this disorder develops as a consequence of experiencing a great trauma in early childhood, such as physical, mental and sexual abuse, strong deprivation and or any other molestation with which a child cannot cope with.These traumas can be so severe, that the children being alone, scared, and even fearing for their life detach themselves from the body to not feel anything.This way, they feel as if those horrible things are happening to someone else; it is not them who are hurting, and this is how multiple, different personalities are born.Each one of them is a type of coping mechanism and has traits that the child doesnt, he lping them to deal with the situation in the best way possible.The number of alters differs from person to person and can be 2 of them, but also 100 when a person is not even aware of each one of them.What is fascinating is the fact that these alters are often not human beings.Now, why is this?Since we are talking about children, who are between 0 and 6 years old, we know that in that period their imagination flourishes and that by listening to fairytales and watching tv shows they start to believe in beautiful fairies, dragons, who are symbols of strength, mermaids and other creatures and this is exactly why some of their alters take these creatures shapes and traits.All of that happens to make the children stronger, more resilient, calmer, more patient, etc..This is a way of their brain to protect them from whatever situation they are in and help them survive with the least pain possible. SYMPTOMS OF DISSOCIATIVE IDENTITY DISORDERThe main characteristic of DID is the presence of t wo or more split identities that have control over the body.These identities are very different from each other, and some of the differences are age, sex, race, sexual orientation, interests, hobbies, gestures, postures, etc.What is very interesting is the fact that these identities can have different allergies, which has been reported in several cases â€" for example one alter has strong gluten allergy, but the other one enjoys eating bread quite a bit, or even more mind-boggling differences such as the diabetes presence, where one alter is a diabetic which is shown by the different tests, and the other one isnt, having the negative tests.The most common symptom is the amnesia which cannot be blamed on an everyday forgetfulness.We often cannot recall what we ate for breakfast a few days ago, or when exactly we had a certain activity, which is normal since our brain absorbs huge amounts of information every day and needs to erase some of them in order to make space for the new ones. However, if we often can’t recall what we did for the past few days, where we’ve gone, whom we’ve seen and if we feel like having a black hole instead of a memory, then we are certainly dealing with a problem.This is the problem that people suffering from DID deal with often daily.What actually happens is the following: since there are different, often numerous alters who “wake up” and take control of the body, they go on about their activities and create the memories, meet new people, create friendships, and so on, so when another alter wakes up, they don’t remember those things, nor does the “original” person.When alters are numerous and their switches regular, the person has constants bigger or smaller amnesias and realizes that something is going on.These switches can take seconds, minutes and sometimes days.What is another sign of DID is an out of body experience when a person feels detached from their body, feeling as if sitting in a passenger’s seat in its c ar.They are aware of a certain activity but dont understand why they are doing it.For example, someone with DID can start doing things they dont normally do, such as being violent, yelling, stealing, reckless driving, and they feel like having no control of the body.An interesting fact is that people with DID report that their alters can choose if they will let them be “co-conscious” with them, or if they will shut them out completely.The first case means the above mentioned: the person is conscious of the things being done, but doesn’t have control over them.This co-consciousness can have different levels: the person can hear and see everything but is a mere spectator, they can hear, but can’t see anything, or they cant hear nor see what the alter is doing, but they feel that something is happening and that the body is moving.The latter case means total amnesia, the alter chooses the to shut the “original” person out, and when the person wakes up, they have no idea abou t what happened and where they have been.As we said, alters are very different among themselves, however, they are not fully mature personalities, but parts of one dissociated identity.A creation of one complete identity is also something that has root in an early and later childhood.When we are born, we have no personality, and our wishes and activities are very disconnected. However, as we grow, see and realize the world around us, learn every day, our identity is created, and everything comes together like a puzzle.This is what happens in a calm, normal, serene childhood.However, when childhood is disrupted with different traumas, that formation fails to happen, leaving the pieces of one personality by themselves.These are called alters. They all keep different aspects of autobiographical information.There is usually the above mentioned “original” or “host”, which is a personality connected with person’s real name and often the host is unaware of the alters and doesn’ t know about them for a long time, or doesn’t understand what is happening. Some of the most common symptoms of dissociative identity disorder are:Depersonalization:  It is the above mentioned out-of-body experience when a person feels detached   from its body and loses control over it.Amnesia: The inability to remember major and important details about one’s life and experiences, such that it can’t be blamed or regular forgetfulness.   Since switches can be very often, this amnesia can be a micro one, and the person doesn’t remember a meaningful conversation or they can last for days and be very scary.Derealization: It is described as the feeling that the world is not real, and sometimes it is connected with the depersonalization.Identity confusion or identity alteration: This is the feeling of deep confusion. The person is unable to define important things such as interests in life, hobbies, sexual orientation, ambitions, political, religious and social viewpoints, etc. T his is all due to the presence of several alters, which all have their above-mentioned viewpoints, ambitions, thoughts, etc..HOW IS DISSOCIATIVE IDENTITY DISORDER DIAGNOSED?Diagnosing the dissociative identity disorder is usually not an easy process, and it takes time.There is an estimate that people who have DID have already spent around 7 years in the mental health system before its diagnosis.This is because this disorder never exists on its own, but has a lot of other symptoms which are characteristic for other psychiatric diagnoses. People who have DID are usually diagnosed with 5 to 7 similar disorders.Because of their overlapping symptoms, the diagnosis may include schizophrenia, normal and rapid-cycling bipolar disorder, epilepsy, borderline personality disorder, autism spectrum disorder, anxiety, and depression.It is important to measure all of the aspects of the possible DID diagnosis to be sure that it is DID, and not something similar.The therapist(s) need to make sure ho w persistent and consistent the person’s identities are in their behavior, how common amnesia is, they need to measure dissociation, and what is very important â€" listen to family members and other close people about their experiences with the person and their identity changes.The DSM-5 (The  Diagnostic and Statistical Manual of Mental Disorders) gives the following criteria for diagnosing dissociative identity disorder:There are at least two or more personality states, ”each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.”Amnesia must happen, defined as “gaps in the recall of everyday events, important personal information, and/or traumatic events”The person must have problems with functioning and everyday living due to this disorder, it must be distressed altogether by itThis disturbance is not in any way connected with what is believed to be normal cultural and religious practicesThese symptoms mustn’t be an effect of any substance (such as having no control during alcohol intoxication, having hallucinations after using certain drugs) or a general medical condition (such as having seizures)Besides the main symptoms, there is a variety of side ones that can be associated with dissociative disorders, such as:Mood swingsSuicidal tendencies (70% of people with DID have tied to commit suicide)DepressionPanic attacks and phobias (flashbacks and different “triggers”)Alcohol and drug abuseEpilepsyEating disorders DISSOCIATIVE IDENTITY DISORDER TREATMENTDissociative identity disorder doesn’t have a “cure”; it is a state with which people live their whole lives. It requires commitment and long-term treatments.What is necessary in the beginning is that the person who is diagnosed with the DID accepts that fact that it has it and that many people in the world (1% of the population) have it, thus is not alone.Even though it sounds scary to know that they have alters who can control the body, they shouldn’t be afraid.There is plenty of people who learned how to live with DID and who even came to meet their alters either through writing a diary together and reading each other’s thoughts and experiences or through their friend’s stories, since alters usually have different friends.In general, there is a lack of consensus in the treatment of DID, but thanks to numerous case studies and researches on possible therapies, three of them were found to be very effective:Psychotherapy: it is also called “talk therapy”. The therapist is there to talk to the patient and carefully listen to their stories and experiences and see what the triggers are. Their goal is to put different personalities as much together as possible and fuse them. Another goal is to help the patient control the triggers and with that their life as well. This therapy is sometimes even more effective when it includes family, friends and significant others. The psychotherapy has a variety of t echniques, such as cognitive-behavioral therapy (CBT), insight-oriented therapy, dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR).Hypnotherapy: The hypnosis was found to be very helpful since it is used to enter the unconsciousness and repressed memories and feelings. Very often people with the DID dont even remember their childhood and horrific details and feelings since they have been repressed and lived by their alters”. Thanks to the hypnosis these memories are relived and that way the person has a chance to heal and deal with that new information. It can also help control any problematic behavior and triggers. All of this leads to the integration of multiple personalities.Creative therapy: It includes therapies such as the movement and art ones, which bring relaxation and helps people reconnect with the parts of their mind that have been shut off. Those are the parts that keep the memories of the trauma.PROGNOSISPeople diagnosed w ith dissociative identity disorder usually react very well to their therapy.Those who have only dissociative and posttraumatic symptoms are given a better prognosis than those who have other disorders as well, especially those who are still in touch with their abusers.The latter ones usually have a much longer treatment, which requires much more effort and will.It is very common that people suffering from DID have suicidal thoughts, failed suicide attempts and self-harm happens often.Since every DID patient is a different case, their treatment type, duration, success rate, and other statistics differ quite a bit, and no one can say for sure.Some of the important factors in every treatment include patients will to tackle the problem and goals, which vary from only improving the communication and cooperation inside the system (all alters together make up a system), lowering amnesia occurrence, to the most ambitious one, and that is overall alter integration.Another very important fact or is the patients feeling of being safe. That feeling is something they were deprived of in their early childhood, which ultimately led to multiple alter creation, thus is linked with their switches.The less safe the person is, the more regular alter switches will be to protect them.This is why a person with DID must feel relaxed, safe, free from fear for their life â€" all of this calms the alters and they stop appearing that often.DID treatment is a long and complicated process, which requires years, a lot of patience, and most importantly, an adequate psychiatrist who has the much need knowledge and expertise in this field.FINAL WORDTaking into consideration the whole text and so much new information, I hope that it gives a clear picture of the dissociative identity disorder which remains unclear to many people.It is a disorder that requires so much more work, analysis, case studies, and deeper research to fully understand it, if ever.Even though most of us dont know anyone with this disorder, or like to think so, it is pretty common, with 1-2% of the population being diagnosed with it.That is 75-150 million people with the DID, but what is with the cases who remain hidden?

An Analysis Of Flannery O Connor - 1212 Words

The percentage of people who say they believe in God, pray, frequently go to religious services, embrace minimal religious practices or find their faith meaningful has declined over the last 50 years. A growing group of Americans do not believe in God or any organized faith. In fact, unbelief is even fashionable. Religious conviction is perceived as burdensome or an outdated attitude - easily discarded. This is the backdrop upon which 20th century American, Southern Gothic writer, Flannery O’Connor, wrote her books and short stories in the 1950s and 1960s. She, in her short stories and books of fiction, did not describe beautiful rooms or people living happily ever after; she wrote about the human condition in the American South and the state of religious conviction. She wrote about unbelievers, lukewarm souls, narcissists and the spiritually illiterate. She wrote about racists, white trash, busy bodies and poor, beaten down black folks. She wrote about the unraveling of faith where the default mode for her characters was apathy, smugness, desapir or indifference. She believed the South was haunted by religion but as a group were literally swimming in mediocrity, cynicism and emptiness – a rough and tumble nihilism. They might say their faith mattered or attended services, but many were just lying to their neighbors and themselves. To her, they were just checking the box with a faith bordering on tepid and pathetic. She felt, given their current status, they would not know aShow MoreRelatedAnalysis Of Greenleaf By Flannery O Connor1105 Words   |  5 Pagestheir place in the hierarchy of society. People become fixated on one idea they have of a person in a certain social class, that anybody who breaks out of specific stereotypes may often cause anger amongst others. In the short story â€Å"Greenleaf† by Flannery O’Connor, the main character, Mrs. May, is obsessive about the way others perceive her and her place in society. Mr. M ay’s identity is so strictly tied to her desire to get to a higher social class and her notions how society should work, that sheRead MoreAnalysis Of Flannery O Connor s A Good Man Is Hard Essay1426 Words   |  6 PagesResearch Analysis for A Good Man is Hard to Find Flannery O Connor s A Good Man is Hard to Find is certainly a surprising work of literature. With this story having a not so happy ending, it goes against all of the conventional ideas on what a typical storybook ending should be. Another unusual thing about A Good Man is Hard to Find is the use of the term good. 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So to adjust your philosophy and creativity in fashion to the time you re living in is the most important thing. - Donatella Versace In each of Flannery O’Connor’s stories there is a very different perspectives in the stories also in theRead MoreAnalysis Of `` Everything That Rises Must Converge By Flannery O Connor1479 Words   |  6 PagesSophie Halavy English 2—Prof. Sosner 6 May 2015 Self-Awareness in â€Å"Everything That Rises Must Converge† Flannery O’Connor’s short story â€Å"Everything That Rises Must Converge† emphasizes the hostility and racial discrimination that white southerners exhibited towards African Americans as a result of integration during the 1960’s. This short story focuses not only on the white American’s living in poverty, but also accentuates the ways in which two people born in different generations react to racialRead MoreAnalysis Of Everything That Rises Must Converge By Flannery O Connor981 Words   |  4 Pagesâ€Å"Everything That Rises Must Converge† the social concerns of the 1960’s â€Å"particularly the disorder of the modern world and the impact of cultural and social change--are prevalent† and addressed on multiple occasions (Schoenberg). The approach used by Flannery O’Connor might be seen as one that is ironic. Dorothy McFarland makes note of this by commenting on â€Å"whatever signs of convergence of social classes or races are evident in the story are dealt with by the characters in ways that minimize any realRead MoreAnalysis Of `` Everything That Rises Must Converge By Flannery O Connor1620 Words   |  7 PagesThe character of Julian in Flannery O’Connor’s â€Å"Everything That Rises Must Converge† is one that evokes conflicting emotions in readers. On an immediate judgment, it would be easy to view Julian as someone who is pretentious and narcissistic. Throughout the course of the piece, he is presented as being constantly bored and disgusted with those around him, because he believes he is more highly educated. 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Oxfam Non Commercial Organisation - 1218 Words

Introduction: Oxfam is non-commercial organisation which is fighting against poverty.Oxfam stands for Oxford Committee for Famine Relief.For the first time the creators of Oxfam met together in October 1942 in Oxford, to discuss with the government the opportunity to decrease(reduce) the allied blockade of occupied Europe and cover feeding of imperative alleviation key to civilians.Oxfam was created with 8 various members the(famous) powerful one was Jackson-Cole a London businessman(Web Cache,N/A).This became now Oxfam GB and still based in Oxford, Oxfordshire.Oxfam GB started to become more popular and well known by opening their first regular shop in 1948.Goal of this project is recognize the main stakeholders of the company and what†¦show more content†¦In 1995 Oxfam GB joined another 17 Oxfam s organization from all over the world to form Oxfam International which is helping in more than 90 countries(Oxfam International,2015). There are a lot of charity shops in the United Kingdom s elling with more or less the same price of Oxfam GB.These shops are the main competitors to oxfam.For

P2P Lending in Singapore - 13536 Words

Abstract This study focuses on demand of P2P market among SMEs and consumer market. The researcher has developed a framework based on how peer to peer lending platforms are important for SME’s and what are the governmental regulations to promote online lending platforms, how SMEs play an important role in the development of economy, how important is the peer to peer platform to them and the future position of peer to peer market in Singapore. The focal point lies on the demand of peer to peer lending platforms among small and medium enterprises and consumer market. The study illustrates a high demand of peer to peer lending among small and medium enterprises regardless of less security of investment. This study also includes risk and†¦show more content†¦According to forbes.com, Peer to peer accounts up to 90% of capital deployed in financial industry. Presence of Peer to peer lending is now an alternate financing platform to investors and companies without going through tradi tional methods of approaching banks or financial institutions due to fact that they offer higher returns. For Singapore, peer to peer lending is still considered as a new and developing sector. Singapore economy mainly consists of Small and Medium Sized Enterprises (SME), whereby most new start-up SMEs face problems in getting loan from bank or financial institutions due to lack of goodwill. This means, peer to peer lending in Singapore bridges the SMEs gap of getting loans for business development. This research mainly focuses on the future of Peer to peer lending in Singapore that is useful to have a practical insight of Peer to peer lending and its implications in Singapore. Peer to peer lending took a huge lead in financial industry during last few years and their accelerating presence holds a deep impact on financial sectors. 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Diet and the Dietitians Role for Irritable Bowel- myassignmenthelp

Question: Discuss about theDiet and the Dietitians Role for Irritable Bowel. Answer: Introduction: This report focuses on the case study of Bob Jackson who has been identified to be suffering with Crohns disease and ulcerative colitis based on his symptoms and past medical history. His presenting complaint was regarding diarrhoea and left lower quadrant (LLQ) abdominal pain and past medical history showed health issues of obesity, rhinitis, AF, hypertension, osteoarthritis right knee and AF. All the symptoms are linked to inflammation of the digestive tract. The purpose of this report is to analyze characteristics of pain in Bob and decide on one pain medication that would provide relief to patient. Secondly, as care of patients require multidisciplinary team approach, role of one multidisciplinary team member is discussed who would engage in Bobs care during the hospital stay. Choice of Medication for Bob: After admission to the hospital ward following abdominal pain and diarrhoea, Bob has pressed his call bell for pain relief. The assessment of his LLQ abdominal pain using COLDSPA denotes that he experiences a dull pain all the time in his , which increases to a strong pressure on the body. The issue is that the onset of pain has got worse since the last two days. His abdominal pain at rest was 6/10 and it has the potential to increase to 9/10 if appropriate pain medication is not provided to student. Among the choice of three medications, Endone 5-10mg PO PRN is considered to be the most appropriate pain killer to control pain in patient. This is because his pain has become worst for the past 2 days and Endone can start working within 10-15 minutes to relieve pain. The patient had taken Endone at 1130 am and since he is complaining of pain again at 1200 pm, this is an indication that Endone dose is needed again. This can give relief to patient for 3-6 hours and the nurse can adjust t he dose based on the severity of pain after consultation with the clinician(Endone | myVMC., 2017). Considering his LLQ pain and increase of pain on movement, giving Endone medication is necessary. The rational for using Endone is that it is an opioid analgesic consisting of the active ingredient ocxycodone hydrochloride and it influences the way body responds to pain. The opioid activates the opioid pain receptors in the central nervous system and disrupts the transmission of pain signals through the nervous. This consequently reduces the transmission of signal through the spinal cord and cause relied from pain(Oxycodone - DrugBank. , 2017). Bob particularly had symptoms of diarrhea and abdominal pain and Endone works to reduce neuronal excitability in response to pain signals. Impairment of gastrointestinal tract function was a major issue in Bob indicated by symptoms of LLQ pain, lower abdominal distension, loose stool and watery diarrhea. Research study has also supported the opioid analgesics as one of the treatment option for relieving pain in patients with Crohns disease or ulcerative colitis(Regueiro, 2017). One research study also proves that opioid analgesics are used for treating bowel dysfunction. However, as it is associated with flare up of the condition and risk of infection, it is necessary to combine oxycodone with peripherally acting opioid receptor antagonist to reduce adverse effect on Bob. Oral laxatives and opioid switch may also be considered in case of adverse side effects in patient(Leppert, 2012). Role of one Health Care Team Member in the Management of Bob: While caring for Bob, the role of dietician will be the most important for the recovery of patient. This is because Bob has been diagnosed with ulcerative colitis and Crohns disease, which is the most common type of inflammatory bowel disease, and management of diet will be most important for improving the symptoms in patient. Appropriate diet and nutrition will be the most important priority for dietician because reducing symptoms and promoting recovery in patient. Diet may not be regarded as a factor contributing to the disease, however it plays an important role on healing of patient. In inflammatory bowel disease like ulcerative colitis and Crohns disease, the inflammation of the intestine limits its ability to digest and absorb food. Hence, such unabsorbed nutrient may escape into large intestine, patients like Bob may suffer from diarrhea and malnutrition. Hence, the dietician can help to plan the diet chart of patient in such a way to reduce diarrhea and other adverse symptoms in patient. The British Dietetic Association also provided evidence-based guidelines for the dietary management of Crohns disease. As the disease is associated with acute flare ups and remissions, an expert dietitian plays a vital role in nutritional management of the disease condition(Lee, 2014). The dietician can make individualize diet plan for Bob based on the type of intestine affected. There is no blanket rule or recommendation related to specific diet for patients, however dietician can identify food items that can cause digestive problem for patients and restrict those foods for Bob. The dietician may also play a role in identifying food intolerance or allergies in patient and yet preventing malnutrition in patient by providing balanced diet. Secondly, balancing fluid intakes is also critical for them to reduce the risk of dehydration due to chronic diarrhea (Burke Ahmed, 2014). Research study also points out that dietician often prescribe low fibre or low residue diet for Crohns disease patient to reduce the risk of bowel obstruction and other symptoms. In addition, dieticians also consider providing probiotics and prebiotics to patients like Bob to manipulate intestinal microbiota to counterbalance harmful bacteria. Currently, dieticians also focus on reducing the d isaccharides, polyols and fermentable sachharides as a diet management strategy to prevent abdominal pain, bloating and diarrhea(Camilleri, 2011). Hence, regular engagement of the dietician with Bob will reduce risk of remission and promote recovery of patient. Conclusion: The paper discussed about the efficacy of Endone drug as a choice for managing pain in patients. It is considered effective to relieve pain, as it is an opioid analgesic that reduces transmission of pain signal. However, it was also argued that combining the drug with drugs is important as opioid analgesic increases the risk of infection in patient. Secondly, the role of dietician has been discussed to manage symptoms and promote recovery of patient. The report suggested that fluid management, balancing nutrition, preventing malnutrition and reducing fibre based diet are some important diet management strategies to manage care of patients with ulcerative colitis or Crohns disease. Bibliography Burke, A. . (2014). Diet and the Dietitians Role in the Management of Inflammatory Bowel Disease: An exploration of Patients and Healthcare Professionals Perspectives. Camilleri, M. (2011). Managing symptoms of irritable bowel. 60, 425428. Endone | myVMC. (2017, September 7). Retrieved from https://www.myvmc.com: https://www.myvmc.com/drugs/endone/ Lee, J. A. (2014). British Dietetic Association evidence?based guidelines for the dietary management of Crohn's disease in adults. Journal of human nutrition and dietetics, 27(3), 207-218. Leppert, W. (2012). The impact of opioid analgesics on the gastrointestinal tract function and the current management possibilities. Contemporary Oncology, 16(2), 125. Oxycodone - DrugBank. . (2017, September 7). Retrieved from https://www.myvmc.com: https://www.myvmc.com/drugs/endone/ Oxycodone - DrugBank. . (2017, September 2017). Retrieved from https://www.myvmc.com: https://www.myvmc.com/drugs/endone/ Regueiro, M. G. (2017). Etiology and treatment of pain and psychosocial issues in patients with inflammatory bowel diseases. Gastroenterology, 152(2), 430-439.