Bias or the Predisposition an Issue Assignment Example | Topics and Well Written Essays - 500 words

Bias or the Predisposition an Issue - Assignment Example The title itself gives away the author’s leaning against Karadzic using the word â€Å"mock† – a word that has harsh implications such as to treat somebody with scorn. Though according to the article the former Bosnian President has â€Å"demanded another nine months to prepare his defence† (Charter, 2009, para. 2) and â€Å"mock† can literally mean to prevent something, the choice of words connotes Karadzic’s actions to cause frustration or humiliation- a far too great accusation that becomes personal in relation to the judges present at the court. Other words used to describe Karadzic include â€Å"a psychiatrist who hoodwinked many with his disguise† (Charter, 2009, para. 3) and â€Å"wraithlike shadow† (Charter, 2009, para. 4). The first description already insinuates that the former Bosnian Serb leader is indeed already guilty of tricking his whole nation even before the trial has started. The writer here forgets that the t rial is ongoing in the first place to assess whether Karadzic is guilty or not. The second description, on the other hand, is plainly a figure of speech- a rhetorical device that appeals to the imagination of readers to suggest how evil Karadzic is. Upon further inspection of the way the article is written, the tone of the writer becomes apparent: he is the one who is, in fact, mocking Radovan Karadzic as he mimics the actions of the defendant by putting them into words in a demeaning way: It seems that his exasperation subsided when Karadzic â€Å"finally graced the UN war crimes court† (Charter, 2009, para. 1) – his tone condescending in even being patient for Karadzic’s arrival. The placement of certain facts and the pertaining to the defendant can put emphasis on ideas and also give away the inclination of the writer: The placement of â€Å"a psychiatrist who hoodwinked many with his disguise on the run as a New Age healer and who prides himself as a master of mind game†Ã‚  (Charter, 2009, para. 3) between dashes is sure to stick to the reader’s mind as the whole story of the life of Radovan Karadzic, not to mention the reference to Karadzic being a â€Å"master of mind games† (Char ter, 2009, para. 3) will surely make readers think twice before sympathizing with him.

Health Essays Myocardial Infarction Mortality

Health Essays Myocardial Infarction Mortality Myocardial Infarction Mortality 1.0 Introduction In the UK, about 838,000 men and 394,000 women have had a myocardial infarction (MI) at some point in their lives, (NICE clinical guideline 48, 2007). The latest statistics from the British Heart Foundation state that approximately 227,000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess the prognosis of patients below the glucose cut off threshold for DIGAMI treatment and whether or not this borderline category falls in to the highest risk group in terms of mortality and morbidity. To determine if there is both a clinical and analytical case to use fluoride oxalate tubes for plasma glucose and HbA1c collection and analysis in East Lancashire. To ascertain the effect of a previous DIGAMI audit conducted in 2006 by the Clinical Audit Team and reflect on any improvements of conformance to the protocol two years later. If there is a significant relationship between HbA1c and prognosis then a risk stratification chart and a more clinically and analytically robust inclusion criteria on to the intensive treatment protocol (DIGAMI Regime) can be determined. This could lead to a better prognosis for a group of patients that fall into a borderline category that are not currently treated under the current protocol who potentially should be depending on the results of this study. 1.3 Cardiovascular Disease 1.3.1 Incidence of CHD The incidence of CHD follows different trends across the UK depending on various factors including regional, socio-economic and ethnic differences. There is a definite North-South gradient, and mortality rates are at the highest in Scotland and the North of England. Social class inequalities in mortality rates show that male manual workers are 58% more likely to suffer premature death from CHD than non-manual workers. Statistics also show that South Asians (Indians, Pakistanis, Bangladeshis and Sri Lankans), are more likely to suffer premature death with figures of 46% for men and 51% for women. This ethnic grouping the highest risk (Figure 1.). The East Lancashire NHS Trust provides a service for over half a million people offering care across four hospital sites. The population of East Lancashire falls into one of the higher risk areas in the UK with local authority statistics for reflecting this fact. Age-standardised death rates per 100.000 in Blackburn with Darwen, Burnley, Rossendale, Nelson and Pendle show that these areas fall into the upper fifth quintile for men and upper fourth and fifth quintile for women (Coronary Heart Disease Statistics 2005). In the Lancashire NUTS-2 area, which includes Blackburn with Darwen Unitary Authorities 93.4% of the 1.41 million residents classified their ethnic group as white British, Irish or other white background. A further 5.3% gave their ethnic group as Asian or British Asian. This figure is 1.3% above the national average. Even more pronounced is when the East Lancashire population is singled out, where the percentage rises to 10.8%. (Appendix ). The sub region of East Lancashire contains the highest proportion of ethnic minorities which is a contributing factor to the high incidence of CHD in addition to the socio-economic differences compared with other regions. Myocardial Infarction 1.4.3 Risk Factors Pathophysiology 1.4.2 Morbidity and Mortality 1.4 Diabetes Although there have been significant advances in the care of many of the extrapancreatic manifestations of diabetes, acute myocardial infarction continues to be a major cause of morbidity and mortality in diabetic patients. Factors unique to diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Autonomic neuropathy may predispose to infarction and result in atypical presenting symptoms in the diabetic patient, making diagnosis difficult and delaying treatment. The clinical course of myocardial infarction is frequently complicated and carries a higher mortality rate in the diabetic than in the nondiabetic patient. Although the course and pathophysiology of myocardial infarction differ to some degree in diabetic patients from those in patients without diabetes, much more remains to be known to formulate more effective treatment strategies in this high risk subgroup. J Am Coll Cardiol, 1992; 20:736-744 Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis RM Jacoby and RW Nesto Myocardial function is further impaired in diabetic patients by the metabolic changes that occur in the early stages of myocardial infarction: insulin resistance and hyperglycaemia are induced by release of catecholamines, cortisol, glucagon, and growth hormone.10 At the same time, secretion of insulin by the pancreatic islets is reduced,11 which impairs the ability to compensate for this state of insulin resistance. The combination of low insulin concentrations and elevated catecholamine concentrations increases release of non-esterified fatty acids, which augment myocardial oxygen requirements and depress mechanical performance. 12 BMJ 1996;313:639-640 (14  September) Editorials Insulin infusion in diabetic patients with acute myocardial infarction 1.4.1 Pathophysiology Mention stress hyperglycaemia 1.5 Glycated Haemoglobin Glycation is a nonenzymatic process of adding a sugar residue to amino groups of proteins. Normal adult haemoglobin usually consists of Hb A (97%), Hb A2 (2.5%), and HB F (0.5%). HbA1c is one of a group of a minor haemoglobins separated from the major constituent Hb A. It has become the dominant measure of glycated haemoglobin because of improved analytical techniques and ease of routine separation and quantification. HbA1c is formed by the condensation of glucose with the N-terminal valine residue of the haemoglobin ÃŽ ²-chain to form an unstable Schiff base followed by dissociation or a Amadori rearrangement to form the stable ketoamine (Figure ). The glycation of haemoglobin is essentially irreversible and its level depends on the lifespan of a patient’s red blood cell and the blood glucose concentration. Tietz p791 HbA1c is primarily used as an indicator of glycaemic control and used in diabetic monitoring. The feasibility study of the DCCT trial (diabetes control and complications) published in 1993 provided evidence for the much hypothesised opinion that better glycaemic control would decrease long term complications of diabetes mellitus and that the HbA1c test can be used as a measure of this. The UKPDS (U.K. Prospective Diabetes Study) followed on from these findings and conducted the largest clinical research study of diabetes focussing on reducing life-threatening complications by appropriate treatment including maintaining a HbA1c result of 7.0% or below (see section 1.5.1). 1.4.1 Utility of HbA1c Type 2 diabetes can be diagnosed using two different criteria, the fasting plasma glucose (FPG) and the 2 hour glucose value of the oral glucose tolerance test (OGTT) which is the ‘gold standard’. The FDG cut-off value of 7.0 mmol/L has been calculated to roughly correlate to the OGTT 2 hour diagnostic value of 11.1 mmol/L and provides greater reproducibility. A major disadvantage to the patient is the requirement to fast prior to both of these protocols. Glycated haemoglobin concentration is an indicator of the average blood glucose level over approximately 90 days. Though the lifespan of a red blood cell is normally 120 days, the contribution of the plasma glucose concentration to glycated haemoglobin differs depending on the time interval, with the largest influence on the HbA1c value being the most recent. It provides a retrospective index of integrated plasma glucose levels and has been suggested to have a role to play in the screening and diagnosis of diabetes in addition to its primary role of monitoring diabetic control. The debate of whether an HbA1c result could be used for diagnosis continues despite the generally accepted argument that the test as a single entity is not sensitive enough to provide definitive cut-off values and determine reference ranges because the values of the two populations; non-diabetics and diabetes overlap. An HbA1c result above the upper reference limit however is specific for glucose intolerance. Another concern is the limitations of the HbA1c result in individuals with abnormal haemoglobinopathies and anaemias, especially when the latter is secondary to haemolysis or iron deficiency (Kilpatrick, 2005). Glycation depends on the lifespan of a patient’s erythrocyte and the blood glucose concentration so in these groups the results will not be accurately representative of metabolic control in comparison to reference ranges based on the general population. 1.4.2 Reason for the Study It is highly unlikely that the HbA1c test will replace routine glucose testing for the diagnosis of type 2 diabetes but it may still have an invaluable role in this area. HbA1c levels may be less influenced by acute stress induced by an ischemic event compared with plasma glucose and therefore could be useful as a tool for differentiating patients with diabetes, and identifying undiagnosed cases in the inpatient setting. Although the increased risk of CHD with type 2 diabetes is universally accepted, a study conducted by Khaw et al. of the general population showed that medically diagnosed diabetes only accounted for 20% of all CVD fatalities. The majority of fatal events came from apparently healthy individuals with a glycated haemoglobin > 6% in the absence of diabetes and this relationship was independent of other risk factors (Khaw et al., 2002). Minor glycometabolic dysregulation may be associated with an increased risk yet this route of research has been poorly explored. If a strong correlation exists then HbA1c could be used as a routine test in the primary prevention of CHD, and patients with suspected acute coronary syndromes can be diagnosed with dysglycemia. In this identified group of individuals, intensive treatment could improve the long term prognosis of the patient. 1.5 Previous Studies DIGAMI 1 and 2 DCCT VA Cooperative Study UKPDS 1.6 Current Situation at the RBH East Lancashire Hospitals NHS Trust provides a range of health care and acute services to the Boroughs of Blackburn, Burnley, Hyndburn, Pendle, Ribble Valley and Rossendale with a population of approximately 515,000 falling into its catchment area. The primary purpose of the Pathology Department at Blackburn Royal Infirmary is to provide a high quality testing service for the diagnostic, screening and monitoring of patient samples. Recent drivers for change revolve around The Pathology Modernisation Programme which was launched in 1999. This aims at improving the quality and efficiency of NHS pathology services and encourages the introduction of new technologies and practices to deliver high quality patient care and matching capacity with increased demand. England’s National Health Service has embarked on an ambitious program of system reform. The Labour Government has committed to increase NHS spending to implement changes of streamlining services and improving quality of service. One of East Lancashire Hospitals NHS Trusts Key Objectives is to streamline diagnostic services and to reduce overheads as part of a Trust wide cost improvement programme. The aim is to work ‘smarter’ rather than ‘harder’ to balance activity with demand. However, current capacity to meet demand is almost at saturation point and we have reached the inevitable point in which processes have to change. 1.6.1 Post MI Management DIGAMI 1.6.2 Laboratory Service to Users The decision of treatment for some patients with a suspected MI can rely on the venous glucose result. It is therefore paramount that the result validated is accurate and precise. 1.6.2.1 Glucose Stability The MI patients treated as per DIGAMI protocol are diabetic patients or non-diabetics with a glucose of >11.1mmol/L. An area of contention is the fact that for inpatients, serum glucose is collected in Startedt S-Monovette ® gel tubes containing no preservative and analysed on the VITROS 5,1 FS chemistry system. The manufacturers’ guidelines state the stability of glucose decreases by approximately 8% for every half an hour prior to separation of the serum from the cells (VITROS datasheet ). Though samples from A+E are dealt with urgently this is a short timeframe from collection to result. Some bloods are taken via a paramedic collection on route to the accident and emergency department and therefore are delayed even longer prior to analysis. The stability of serum glucose is a well known problem hindering the accuracy of results this is the reason that samples arriving from GP surgeries are processed routinely on the Thermo Konelab analyzer using blood collected in tubes containing a fluoride oxalate preservative. It has been discussed to also use such tubes for ward samples, with all glucoses being run on the VITROS analyzer. Up to now the stability issue of hospital samples has not been thought of as a clinical hindrance because they are prioritised and processed sooner than the GP samples and therefore there has been a ‘medically allowed tolerance’ The importance of the admission blood glucose result has come to light as it can be a deciding factor for the inclusion of MI patients on to the intensive DIGAMI treatment protocol, and as a direct consequence, will have a clinical impact on the prognosis of a patient. Due to the glucose being metabolised by the cells and giving a falsely lower result, a group of borderline patients may not meet the inclusion criterion for DIGAMI as a result and have a worse prognosis than they should have. Therefore this is an issue of great clinical importance. This project should indicate to what extent the stability is a problem and approximately how many patients it affects. If the HbA1c result could be utilised as a complimentary test to be used in conjunction with known diabetic status and admission plasma glucose then the inclusion criteria would be both more clinically and analytically reliable. Historically HbA1c analysis is performed by the haematology department on EDTA blood samples for logistical reasons. If analytical stability and comparison studies show that fluoride oxalate tubes can be used accurately and precisely for glucose and HbA1c analysis then one biochemistry tube would be sufficient for both tests. Laboratory practice for diabetic diagnosis and monitoring could then be a leaner process for cascade HbA1c testing in terms of archiving, retrieval and storage of samples. 1.7 Clinical Audit Clinical audit is a quality improvement process which is a component of clinical governance within the NHS introduced to improve patient care through a systematic review against explicit criteria and the implementation of change. Participation is recognized by the General Medical Council as an integral part of good practice and the results should be used to improve the quality of care. The Myocardial Infarction National Audit Project (MINAP) is funded by the National Institute of Clinical Excellence (NICE) and is carried out by the Royal College of Physicians (RCP). It was established in 1999 as a method of clinical audit to examine the quality of management of myocardial infarction and shows how hospitals in England and Wales are performing against targets in the NSF for CHD. 1.7.1 Summary of 2006 DIGAMI Audit In 2006, the clinical audit team conducted an audit with one of its’ main objectives being to assess whether the DIGAMI protocol was being adhered to. This was a retrospective study in which the casenotes of 46 patients were viewed and information extracted. These patients were either known diabetics or had a plasma glucose of >11.1mmol, and had presented with cardiac pain. A summary of the baseline characteristics was that over half of the patients were of Asian descent, there was a slight female prevalence and the majority included were known diabetics. They also concluded that the DIGAMI regime was only initiated in 24% of the cases, whereas all 46 patients should have been treated as per current protocol. Another non-conformance to the protocol was the fact that approximately 50% of the patients did not have a venous blood glucose checked by the biochemistry laboratory (Bharucha et al., 2006). The results of this audit will be re-addressed in this study to ascertain the effectiveness of the recommendations and the impact of the results two years on. Reasons for undertaking this project According to estimates there are as many as a third of undiagnosed diabetics (as cited in Greci et al., 2003). The DIGAMI regime is an intensive treatment protocol for the management of myocardial infarction in patients known to have diabetes mellitus or in patients with hyperglycaemia on admission. At East Lancashire NHS Trust, intensive treatment with intravenous dextrose and insulin reduce and control blood glucose levels to between 4-9 mmol/L. Currently, there is a standardised inclusion criterion and treatment protocol rather than a treatment programme which is graded in intensity, and tailored to individual glycometabolic status. Hospital glucoses are analysed using serum collected in Starsedt Monovet 4.2 ml gel tubes. The manufacturers’ guidelines state the stability of glucose could decrease by 7% every half an hour prior to separation of the serum from the cells. Although samples from A+E are dealt with urgently this is a short timeframe. Paramedic collection of samples on route mean even longer time delays before separation.

Eye Ball :: Literary Analysis, Spiegelman

What would you expect to be the mindset of a misfit kid who isn’t really that popular who is playing baseball with the other kids because he wants to fit in with them instead of being himself? There is such a boy in a first person short story that was written by a worldly-renowned author. In â€Å"Eye Ball,† Spiegelman uses characterization to develop the theme of be yourself and don’t try to fit in with others at the expense of showing your true self. Spiegelman’s use of the little misfit boy as a round character reflects the theme because he realizes that he doesn’t fit in so well with all the other boys. Being a kid with Amblyopia, or â€Å"lazy eye†, he already knew that he was at a disadvantage and he points out his condition when he is saying â€Å"since I’m virtually blind in my left eye† and when he said â€Å"Amblyopia, a â€Å"lazy eye,† made my whole world 2D† (130). He still tries to play baseball with the other boys, but he quickly finds out that he isn’t that good at it. Identification can be made with the out-of-place feeling that the little boy most have felt. Now he is most likely feeling down because he did poorly when he was up at bat. Most out of place people â€Å"must escape into fantasy and/or develop a rarefied sense of humor to survive† (130). The usual â€Å"boy in 1950s America, baseball was not optional and to be inept assured a place in the social hierarchy even lower than a girl’s† (130). This shows that there was a current stereotype of how little boys should be and he tried to be stereotypical with all of the other little boys. Spiegelman’s use of the little misfit boy as a dynamic character reflects the theme because he learns to be himself and not try to be something that he isn’t. He realizes that he is out of place when the boys placed him and he â€Å"was inevitably relegated to right field, far out of harm’s way† (130). While in the outfield he thought that his boredom took out his â€Å"anxiety that a ball might come† (130). He already knew before he went with the boys, that playing baseball with them wasn’t going to go smooth so he â€Å"often kept some comic book handy† (130). While he is thinking, he finally realizes that his true comfort is in comics and not sports.

Media and Children

Today I came here to discuss the topic media and children In this topic I will I tell you what is the influence of media on our childrens But First of all I will explain to you what is media? Media: Communication channels  through which  news,  entertainment,  education,  data, or  promotional messages  are disseminated. In my opinion Our media has negative impact on our children’s . because When children see scenes of violence, natural disasters, and crime reports on TV Which leads to stress, and fear among children leaving far reaching impacts on their personality.Now I will tell you some points with examples Blind Imitation: you have often seen that young girls and boys imitate celebrities blindly do you give a thought to whether they are doing right or wrong?. in such that the impact of media is wrong Wrong Message: in our society negatives are highlighted with the purpose of awakening people about them. For example, the negative effects of addiction are port rayed through advertisements. Newspapers, television and the Internet are used to convey social messages.But unfortunately sometimes, the message is misconstrued. Unhealthy Lifestyle: Media is responsible for the change in eating habits of teenagers and the unhealthy lifestyle they are adopting. Media Addiction: The negative effects of media on children are manifested in terms of their changing mental setup and the declining quality of their lifestyle. Health Problems: Media has negative effects on the physical and psychological well-being of society. People spending hours in front of a television or surfing the Internet experience eye problems.A survey is conducted by  Gilani Research Foundation, on January 20, 2011 According to that survey Fifty two per cent people believed that media has a valuable effect on culture and lives . Whereas,   29 per cent said that it left no impact on their lives. A considerable 19 per cent gave no comments because they were unsure. Now I will te ll you about a seminar which is organized by a Youth Forum on Tuesday, June 29, 2004 at Aga Khan University Auditorium. The speakers said that research had shown that children were prone to imitate what they saw on media.Teachers' Development Centre Director Prof Abbas Hussain said that children through media got aware about certain facts of life mysteries, contradictions, tragedies and violence, which were not considered suitable for them to know. suggestions parents should see what children were watching in order to minimize the effects of such programmes. â€Å"Television should not be used as a baby-sitter,† we should remove television sets from bedrooms, monitoring of the websites they visit, setting of time limitation and finding alternative activities for them would be very helpful in reducing negative effects on personality of children.

We all fall down – Essay in speech format

Good morning thank you for turning up to what will be an engaging analysis of the complexity of conflict in literature. If you ponder upon it, how many of us have experienced some form of conflict in our lives? No doubt all of you. But year 1 1, It Is the way In which we handle this conflict that moulds us Into the individuals we are today. My work In the novel We all fall down' has caused some controversy In schools simply because I paint the picture of characters who fall to metaphorically ‘get back up'.I've no doubt that if you look closely enough around this room you will associate money with these problems and that's what I'd like to explore today; the complex character that is Buddy Walker. The thing that really got the critics cranky was Buddy's escapist tendencies. The reason being that Buddy drinks, he drinks a lot to assist him in sanding down the rough edges in his highly conflicted life, and that will be the focus of our discussion today.Year 1 1, I would now offer you some valuable advice in the hope that you will learn from Buddy's mistakes, and that is that in life, it's not about how you fall down†¦ It's how you get up. Now, the main theme I implicitly explored In this novel through the experiences of Buddy Walker and Jane Jerome Is the concept of resilience. Evidently, these two vastly different characters both have vastly different levels of resilience, seen through the way they handle the conflict In their lives. But what exactly Is resilience?Resilience Is a person's ability to bounce back from setbacks, major or minor, and just the all-round ability to keep going, you could describe it differently as mental toughness. Buddy, as stated before, is an escapist. He uses many different things as tools for his escapism, the major one being his metaphorical ‘life crutch', his gin (alcohol). He uses alcohol as a form of escapism in many different instances, and I feel that the way I described the gin's significance to Buddy's escap ism perfectly sums up the character that Buddy is.A few of my favorite descriptions are â€Å"the way it (the alcohol) soothed and stroked him. † The alcohol was like his only friend. † and â€Å"The way it kept a certain haziness on the harsh realities of his life. † These quotes especially emphasize the high level of penitence Buddy has on the alcohol to act as a beacon to guide him through the fogginess of his existence, If you will. The alcohol symbolizes Buddy's weakness, It depicts his inability to overcome conflict on his lonesome and essentially characterizes him as someone who cannot ‘get back up'.Now year 1 1, Buddy is by no means a resilient character. He has little to no willpower and is perfectly happy to stand idly by while something despicable happens in front of him. I expressed this in the opening scene, the trashing. While I set the scene with a sinister tone and suspenseful language, I placed Buddy in a difficult position. A position wher e he had to choose to either test his courage and ‘be a hero' while running the risk of the losing his friends', or sit back and Just allow an utterly despicable act occur right In front of his own eyes.Of course, being the weak and nearly morally void character Buddy Is, he chose to let It happen. A stronger, more resellers character would more than likely opt to Intervene In this because they would have the mental strength to overcome It. Unlike Buddy, Jane Is a very resilient character and through all of the inflict and problems in her life, she always has the strength to bounce back. Two trashing, despite the considerable amount of physical damage to the house, mental damage to the whole family, and both physical and mental damage to Karen, Jane still finds the strength to get on with her life.Sure, she is noticeably rattled from the occurrence, but she still finds a reason to smile. That reason is Buddy. But after things with Buddy go down the drain and she is forced to p art ways with him as well as her claim to happiness and respite from everything bad in her life, she still engages to move on rather steadily. Ask yourselves year 11, if there is anyone you know that you would associate with either of these characters' traits. If you do, I'll wager that the Jane type character you know does not get along all too well with the Buddy type character.This is because strong and weak individuals obviously oppose each other, and their two personalities often conflict with each other. Likely, the Jane type character somewhat dislikes the Buddy type character you know, but the Buddy type is rather impartial to the Jane type. The Buddy's in our lives are often the type of errors to Just let things happen around them, while something may affect them in one way or another, they are generally not too bothered by it unless it is quite a burdening occurrence.We begin to detect this Buddy-Jane conflict in the scene where Buddy goes to Cane's temporary apartment to try and talk things over with her. Jane, of course because of her new discovery that Buddy was involved in the trashing of her house, is tired of Buddy. Tired of his hesitance and general indecisiveness. It is evident that she has gotten sick of Buddy's weakness as a person, and the resilience f their relationship has now worn out.Year 11, resilience is a fundamental human characteristic that we all need throughout the course of our lives. If you as a person are struggling to ‘get back up' time and time again, my advice to you is this: Don't let things get to you too much, and block out unnecessary sources of conflict. Like Jane, causes for grievance should be grieved over, but briefly and very occasionally. Because the most important thing in life, as corny as it sounds, is happiness. As they say year 11, life's for the living, so live it. Or you're better off dead.