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bressay history Bressay shelters Lerwick from the east and help with, can be reached by car ferry from the town in need writting under ten minutes. Noss lies off the east coast of apa research Bressay. Both islands feature striking landscapes, abundant bird life, coastal mammals and wild flowers. Bressay has almost everything that Shetland can offer the visitor: a ten minute ferry ride whisks you from the bustling centre of Lerwick to another world. Rich Vocabulary! You will find seabird cliffs, quiet bays, hill and coastal walks, a dozen freshwater lochs (many with good trout) and a profusion of archaeological and help with, historical sites. The east side of the island is sparsely inhabited, a place of peace and quiet where birds and sheep wander undisturbed. The Bressay ferry sails from Albert Buildings in the centre of Lerwick every hour, with later sailings scheduled on Friday and Saturday nights. The ferry berths in Bressay right next to love rita dove essay the Bressay Heritage Centre which features seasonal exhibitions on help with apa research paper the culture, history and natural heritage of the island. Online Design! The centre is open part time from May to September. Much of Bressay is help apa research accessible by car on the single-track roads which radiate from the shop and post office at Mail (the place-name means the sands and long pre-dates the Royal Mail).

The side roads are rough tracks unsuitable for haley cars and the best way to help apa research paper enjoy the wild east side of the island is on foot. The south-eastern corner in michael essays particular has some fine walking country but is nowhere more than three miles from the centre of help paper Lerwick. Bressay shelters Lerwick harbour from the North Sea and for many centuries Bressay Sound has been a port of bresland essay refuge for shipping, since long before Lerwick was founded in with paper the 17th century. This natural harbour and the unique strategic position of Bressay's highest hill, the Ward of Bressay (742'/258m), gave the island special significance from prehistoric times. From the summit, all of Shetland is visible: on a clear day, with binoculars, you can see through the natural arch in essays the Gaada Stack on with apa research paper Foula, away to the west, in essays the Atlantic; to the north-east lie Out Skerries; to the north Ronas Hill and Saxa Vord (Unst); and to the south Sumburgh Head. As our prehistoric and Viking ancestors would have noticed, you can also see Fair Isle; from there, as they'd also have discovered, you can see Orkney; and apa research paper, from Orkney you can see mainland Scotland. A thriving local history group A boating club Shop Pub Community hall where visitors are always welcome at concerts, dances, social evenings and for the love of books rita, the annual Up Helly A' fire festival in February.

Bressay is also home to the Northern Lights Holistic Spa where a variety of facilities and treatments are available. There is help apa research paper plenty of design birdlife to help with apa research paper see in Bressay, including most of the species found in Noss. The south eastern corner of the island includes the michael Puffin cliffs of the Ord and has a breeding colony of several hundred Great Skua around the loch at Sand Vatn as well as breeding Dunlin, Common Sandpiper, Snipe, Curlew, Whimbrel, Golden Plover and other moorland birds. The Merlin is sometimes seen and occasional sightings of Peregrine falcons, once a regular breeding bird, have been reported. Help With Apa Research Paper! Spring and autumn bring Bressay its share of migrating birds. Great flocks of Redwing and Fieldfare can be seen and the island has some rarities on its checklist including a Surf Scoter from North America.

In winter the help essay lochs are used by parties of up to a dozen Whooper Swans. Turnstone, Purple Sandpiper, Great Northern Diver, Grey Heron, Long tailed Duck, Widgeon, Teal, Tufted Duck and Goldeneye are common winter visitors. The native mammals are Otter, Grey Seal and Common Seal. Rabbits, hedgehogs, rats, mice (and sheep!) have all been introduced by humans over the centuries. There are no snakes or other reptiles but introduced frogs thrive. Bressay's breeding list also includes: The road north from Maryfield passes Bressay's most imposing building, Gardie House, a laird's mansion built in 1724 and noted for its walled gardens. Another little road north passes through the apa research paper crofting hamlet of Crueton (with its very 'birdy' copse of willows) and over the hill to need writting the townships of Beosetter and help with paper, Gunnista, overlooking Aith Voe which is one of the best birdwatching spots in the island, noted for rich vocabulary for essays waders, divers and sea ducks. Beosetter has a fine, sandy beach and Gunnista is the site of the ruined chapel of St Olaf, with an help with apa research paper interesting graveyard. The Bressay Kirk is a delightful little church with 19th century stained glass windows and two handsome memorial tablets to local landlords. For times of services and to view the interior, visitors should contact the minister of Lerwick and Bressay Parish Church at St Columba's Manse, St Olaf St., Lerwick (Lerwick 692125).

South from the Mail Shop the road winds past modern housing at Glebe Park and Fullaburn to essay the Bressay Lighthouse on Kirkabister Ness. Built in apa research paper 1858 by love of books essay Robert Louis Stevenson's father, the light is now automatic. The old lightkeepers' cottages are available as self-catering holiday accommodation. In the dramatic geo (cove) below the lighthouse the Lithuanian factory trawler Lunokhods was wrecked in a 1993 storm. All 60 crew were rescued by the Shetland Coastguard Helicopter and help with apa research paper, Lerwick Lifeboat.

The wreck site is now a popular dive with visiting scuba enthusiasts, lying next to a beautiful rock arch, Da Ovluss. The old kirkyard lies partly over a ruined broch. Here was found the Bressay Stone, apparently the memorial to the daughter of a Pictish chieftain, Naddod, and inscribed with Ogham script which has never been fully deciphered. There is a replica on site but the original is stored in the new Museum of Scotland at Edinburgh. Safety First - Remember, all the cliffs are extremely dangerous, particularly in the wet. Need Writting! On no account should you attempt to climb them or approach the edge nearer than two metres (six feet). Heed The Birds - Please be careful not to walk through nesting colonies of gulls and terns or you may cause them to desert their eggs. No Dogs, Please! - The owners and tenants of the land have given permission for these recommended walks to be included in this guide, on condition that visitors do not bring their dogs, even on help a leash. The best behaved dog can disturb livestock and wildlife and you are respectfully asked to comply with the farmers' and michael essays, crofters' wishes. Drop by the Bressay Heritage Centre and delve into the island's history Download a Shetland Heritage leaflet about help with Bressay Noss (.pdf) A short walk up the Burn of Setter is a good place for online design a close look at the distinctive, vertical-shaft Shetland watermills. There are several on this burn and many more throughout Bressay.

Once an essential part of every crofting community, these miniature mills have long fallen into decay but there is a restored one in working order at the Dunrossness Crofthouse Museum. A walk around the west shore of the Voe of Culbinsbrough brings you to the old stone and slate quarries in Aith Ness, topped by the remains of a six-inch naval gun from the First World War. Like the gun on help Bard Head at by alex the southern tip of Bressay, this one was installed in the last year of the war and was never fired in anger. If you have only a little time in Shetland, one of the best ways to sample most of what the islands have to help offer is to spend a day on this glorious walk round the uninhabited coast and hills between Noss Sound and the Bressay Lighthouse, taking in essay by alex haley some of the wildest scenery in apa research the islands. Follow the tarmac road to Noss Sound and then head south along the coast, past the volcanic vent of the Muckle Hell and its colony of Herring Gulls, until you come to john bresland video the waterfall below the ruined watermill on the burn from the Loch of Grimsetter. The boulder beach of Grutwick usually has Grey Seals fishing just offshore.

At Grutwick there is a stone cairn erected by the people of Bressay to commemorate the bravery of Coastguard helicopter winchman, William Deacon, who lost his life while rescuing the Norwegian freighter Green Lily which foundered here during a Force 11 storm in November 1997. Turning inland, the deserted hamlet of Wadbister has a prehistoric earthhouse. Across the help Loch of Grimsetter is the croft of Gorie, an oasis of trees and bushes in the hill. South of for the of books rita Wadbister the cliff walk gives superb views of caves and natural arches, including the help with apa research remarkable triple arch of the Stoura Clettstack - another favourite haul-out for Common Seals. Here too is the bresland video ruined medieval settlement of Stobister, where legend has it that the inhabitants fled when a violent storm sent fish raining down the chimneys - perhaps the same tidal wave that opened Noss Sound.

Walking on past the collapsed sea cave of the Gore's Kirn you come to the breeding territory of Great Skuas and Arctic Skuas; then the apa research wild, lonely loch of Sand Vatn where Red-throated Divers nest (please avoid disturbance). Haley! Beyond are the cliffs of Bard Head and the old WWI gun still standing on help with apa research its concrete plinth. Two hundred feet (61m) below is the tide race of the Bard a strom, a favourite fishing ground for Gannets and other seabirds. From here to need writting essay the 400 foot (122m) Ord cliffs there are panoramic views of southern Shetland. The Ord is Fulmar territory, with thousands of these graceful birds wheeling in the updraft, but here and in help apa research paper many corners of the Bressay cliffs you will also see Puffins, Guillemots, Razorbills and Tysties. From the help Ord there's an easy walk down to the lighthouse, through the ruined crofts of Scrana and Daal. Once back on help the tarmac, you have a pleasant three mile stroll past crofts and fields to the Lerwick ferry by video essay the Maryfield pub. Noss - The Perfect Island For Birds. As soon as you set eyes on the mile-long seabird cliffs of Noss you can see why the island was declared a National Nature Reserve in 1955: this is with apa research paper one of the most spectacular wildlife sights anywhere.

At the peak of the breeding season the stupendous chorus of around 150,000 birds and chicks is unforgettable - as is the smell of the guano which stains the cliffs white! In the words of resume design National Geographic photographer Franz Lanting: This is a world-class cliff. Millions of years of wind and ice have honeycombed thousands of nesting ledges in with apa research paper sandstone cliffs up to 592 feet (181m) high. As a result, many different species can find nest sites of the on roots by alex preferred size and shape. Although not the help with apa research biggest seabird colony in Britain, Noss is the most accessible one, combining very large numbers of crichton essays birds with a wide variety of species and spectacular scenery. The cliffs are only one of the Noss wildlife habitats: there's also extensive moorland, boulder beaches, sandy beaches, rich grazing and former cultivated land, all of which support other birds and animals. Resident seals and the visiting Otters feed in the dense kelp forest surrounding the 711-acre (313 hectare) island. The spectacle of: festooned over a mile of cliffs, up to 592’ (181m) high, is simply astounding, as is the help apa research roar of the mass ‘choir’ parents and chicks. Online Resume! There are two very different ways to experience Noss and many visitors choose to do both: Excursion boat from Lerwick. This is easily the best way to help apa research paper view most of the seabird nesting sites at close range (and the only way when the island is bresland essay closed to visitors) but it doesn't include a landing on Noss. Help Apa Research Paper! If you have mobility problems you can still see this wonder of the wildlife world: wheelchair users are welcome on a highly manoeuvrable boat with twin engines which can take you safely into the coves, right alongside the essays lower cliff ledges and, in help with apa research calm weather, even into the Cave of Noss, with an underwater camera to explore the kelp forest as well.

Details of daily sailings from the VisitScotland Information Centre, phone 01595 693434. The Noss Sound ferry operates five-days-a-week (not Mondays or Thursdays) during the summer season (late April - late August) while the wardens are living on the island. You first take the Bressay ferry from Lerwick, then walk or drive the three miles (5km) across Bressay to Noss Sound where the ferry, a small inflatable boat with an outboard motor, will take you across the narrow sound to the Noss landing place at essay haley Gungstie. For more information or to book, phone: 0800 107 7818. Arctic sandstorms and giant waves.

In addition to with apa research its ornithological importance, Noss is crichton essays also of great geological interest. It is help with apa research made of the online resume design same Devonian desert sandstones as Bressay but slightly finer-grained. The cliff face is usually a zone of rapid weathering due to a number of processes that can attack it. There are three types of weathering: physical (eg. Help With Paper! frost actions), chemical (involves hydrolysis) and biological (eg. growth of lichen or large amounts of guano). The products of weathering and weakened rocks are quickly removed by storm wave action. This causes roughened surfaces where further etching out of rich other rocks units is easy. Help Apa Research! The extraordinary erosion patterns are now favoured as seabird nesting sites. Noss Sound is a relatively new channel and was probably made by storm waves that breached the sandy spit that once joined Noss to Bressay. Rich Vocabulary For Essays! A clue is that the name Noss is a Viking word meaning 'headland shaped like a nose'.

If it had been an paper island when they arrived in the ninth century they would certainly have recorded the fact in their name for crichton essays the place and it would be 'Nossay' - 'island shaped like a nose'. There are physical traces of a gigantic wave along the Bressay coast south of Noss Sound, and also a legend of a clifftop croft washed out by the sea at Stobister. Because the grazing on Noss is help apa research restricted (and because even Shetland sheep can't find their way everywhere) the cliff vegetation of Noss is more luxuriant than in more heavily grazed areas, despite the plague of rabbits which each winter's cull only just keeps in check. In early summer, as the Sea Pinks and blue Spring Squill fade, the cliffs present a palette of white Sea Campion and Scurvy Grass, Red Campion, yellow Birdsfoot Trefoil and Roseroot and online design, the distinctive blue of help with apa research paper Sheep's Bit Scabious, to set off the brown Heather moorland with its patches of john Cotton Grass, Lousewort and paper, orchids. As well as its fascinating natural history, Noss has a long history of michael essays human occupation, starting with a burnt mound at Hellia Cluve which may be 4,000 years old. Place name evidence and the remains of a mediaeval chapel on Big Ness ('promontory of the buildings') suggest that Noss was home to help with paper a Celtic Christian community before the Viking invasion. Online Resume! What those marauders did to the priests in with paper Papil Geo ('the Priests' Cove') may be imagined. From time to time, winter storms shift the sands at Nesti Voe to reveal human bones from the ancient graveyard. The sandy soils around the 17th century house at Hametoun were easy to work - and to fertilise with seaweed from beaches such as Da Stinkin' Geos ('the smelly coves' where storm-blown seaweed lies and rots to vocabulary for essays this day). In subsistence times Noss was a very productive island, where good crops of oats and barley could grow and the grazing was so good there was even a milk surplus to help paper make cheese.

From the mid-18th century onwards, whenever the tenancy became vacant there were usually eager bidders. Need Help! Signs of help apa research paper that relative prosperity are still visible in the long, slightly curved 'rigs' on need writting essay Turr Ness - the traces of ploughing by oxen which were swum across the sound from Bressay at low tide and herded at night in Da Owsen's Pund (the oxen's enclosure') at apa research the north end of the big cliffs. In those days ordinary people tilled the ground with spades, not ploughs and oxen. By the early 19th century there was a second settlement on Noss, at Setter, half way between the low-lying western end of the isle and the cliffs to the east. By 1861 the population peaked at 24, but may have included some visiting fishermen who spent the census night in summer lodges at Booth's Voe. From 1871 to 1900 the Marquis of Londonderry took a lease of Noss to breed Shetland Ponies for his County Durham coal mines. On Roots Haley! A display in the old Pony Pund tells the story of this rather cruel trade, which also involved building a stone wall around the higher cliffs to stop the mares falling over. The stallions were kept in help paper Bressay until required. Successive farming tenants and their families lived year-round in Noss until 1939.

After that it was occupied in summer only until 1969 when the last resident tenant (who was also honorary RSPB birdwatcher and ferryman) gave up the lease. Since 1970 the island has been part of the Garth Estate's home farm and staffed by summer wardens who also provide the ferry service across Noss Sound. Noss is open to resume design visitors during the summer (except on Mondays and help, Thursdays) and need writting essay, closed in winter (September to mid-May) Boat trips which don't land on the island can visit Noss on any day of the year if the weather is suitable. In the summer season a warden is usually on duty at the Noss visitor centre to answer any questions. It is also possible to arrange guided tours with groups. If the help with paper weather's too bad for the Scottish Natural Heritage ferry to cross Noss Sound the wardens hoist a red flag outside their house but to avoid disappointment you should check with the VisitScotland Information Centre before setting out for Noss. If going to Noss by the Noss Sound ferry, be sure to wear sensible footwear - the rocks on both sides of the for the rita dove essay sound can be slippery. Take warm, waterproof clothing, as the weather on Noss can be very changeable.

Visitors' dogs are not welcome. Even well-trained dogs can disturb wildlife and sheep. Don't leave litter - it can kill or maim wildlife. Help With! Don't take plants, eggs, birds or animals - only photos. Stick to the shore path and don't disturb nesting birds, particularly Arctic Skuas. Vocabulary! If nesting Bonxies dive-bomb you on the moor, check that you haven't strayed from the perimeter track and, if you have, retrace your steps. Hold a stick above your head or wave your arms to deter the skuas - they're only defending their nests - and help paper, you'd do the same if some hairy monster invaded your child's bedroom! For more information see the SNH Noss website. Michael Crichton Essays! Contact: Scottish Natural Heritage, Ground Floor, Stewart.

Building, Alexandra Wharf, Lerwick, Shetland. ZE1 0LL. Telephone +44 (0)1595 693345.

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lupus article review Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects multiple organ systems including the skin, kidneys, and brain. The exact cause is unknown but genetic factors, ethnic origin, environmental factors, and with apa research paper medications may all be involved in its development. Women, African-Americans, and Hispanics are more likely to develop SLE. Earlier diagnosis and more effective treatment options have significantly improved 5-, 10-, and rich vocabulary 20-year survival rates. Apa Research Paper? Nonpharmacologic treatment is limited and for the love rita dove mainly involves proper sun protection—avoidance, protective clothing, and sunscreen. Pharmacologic treatment is usually tailored to the specific symptoms or organ systems that are involved. Treatment modalities include steroids, antimalarials, and cytotoxic/immunosuppressive agents. This review will examine the clinical course of help with SLE, various treatment options, and the treatment of specific manifestations of the disease such as lupus nephritis. (Formulary. 2011;46:178–194.)

Illustration by Christy Krames, MA, CMI. SLE predominantly affects adults, usually women of childbearing age (20 to 40 years), at a female to male ratio of 9:1 to 15:1. Approximately 8% to 15% of SLE cases occur in children. Older adults diagnosed with SLE, such as postmenopausal women, usually have a milder form. 5 Genetic and racial factors are also associated with an increased risk of developing SLE. African-American women have a 3 to 4 times higher prevalence of SLE than Caucasian women.

3,6 Additionally, those of resume Afro-Caribbean, Asian, Native American, and help with Hispanic descent have a higher incidence of SLE compared to Caucasian individuals. 2,3,7 This differs from drug-induced lupus erythematosus (DILE), which occurs at similar rates in men and women but with a higher incidence and severity in Caucasian compared to African-American patients. 8–10. The development of SLE is for essays, a complex immune process that is help with, brought about by dysregulation of B- and T-lymphocytes, the production of auto-antibodies, and essays the formation of immune complexes. 11 Cytokines are thought to play a key role in SLE; however, the extent to which they affect progression of lupus is not clear. Their involvement may help explain the variations seen in the clinical manifestations of patients. More research is needed to identify the help apa research paper role of cytokines in michael crichton essays order to better understand the with apa research disease progression as well as find new treatment options. While it is known that the immune system plays a role in the development of the michael disease, what causes the immune system to function abnormally is unknown.

It is speculated that environmental factors play a role, but the data have not consistently supported this theory. 12,13 There is, however, evidence to suggest that genetic components play a role. Several immunologic gene abnormalities (eg, interferon regulatory factor 5, protein tyrosine phosphatase nonreceptor type 22, and integrin alpha M) have been identified. Additionally, research in homozygous twins has shown a higher incidence of SLE in with families where the essay haley prevalence of the disease in other family members was low. 2,14 Furthermore, those with infantile-onset SLE occurring within the first year of life have a high incidence of having family members with a history of autoimmune diseases.

15. There is also some evidence that hormone abnormalities are associated with SLE. Estrogen and androgen metabolism have been found to differ in men and women with SLE compared with healthy controls. Apa Research Paper? 16 For example, women with SLE metabolize estrogen to resume design, a more potent form, 16a-hydroxyestrone, instead of 2-hydroxyestrone, and help apa research paper can have irregular menstruation cycles and increased risk of miscarriage. Prolactin levels can also be elevated in patients with SLE. 16 Use of hormone replacement therapy has also been shown to vocabulary for essays, increase the risk of developing SLE. 17 Infection with the Epstein-Barr virus has been associated with the production of autoantibodies that are present in up to 38% of help patients with SLE. 18 However, it is not clear if these actually lead to the development of vocabulary SLE or just occur concomitantly. Table 1 Some medications associated with DILE a. Several mechanisms have been implicated in help with DILE, including genetics and auto-antibody production.

Agents such as procainamide, hydralazine, and isoniazid generally cause DILE in patients with genetic abnormalities. These medications all undergo acetylation as part of their metabolism, so patients who are slow acetylators tend to have more problems with DILE compared with those who have normal or fast acetylation. Another potential cause of DILE involves hapten-like reactions where the drug or its metabolites bind to proteins rendering them foreign to the body. This in turn leads to an autoimmune response by the body. Other drugs, like the for the love of books rita essay anti-TNF agents, are thought to produce auto-antibodies by help with apa research paper causing direct damage to the immune system.

8–10. DIAGNOSIS AND CLINICAL PRESENTATION. Diagnosis is based on classification criteria established by for the love of books rita essay the American College of Rheumatology (ACR). A minimum of 4 of the 11 ACR criteria should be met in order to apa research, qualify as SLE for bresland video, clinical trials. The 11 ACR criteria are broken into systems: cutaneous, musculosketetal nonerosive arthritis, cardiopulmonary pleuritis or pericarditis, renal, neurological disorder with seizures or psychosis due to unknown causes, and help with apa research laboratory. 20 A rheumatologist or nephrologist may diagnose a patient if the patient meets only 3 of the criteria (1 must be clinical and 1 must be serologic) and has other clinical manifestations such as alopecia, skin vasculitis, Raynaud's phenomenon, or lung fibrosis. 5 Some patients may have only 1 organ system involved or only have some of the manifestations of SLE and will, therefore, not be diagnosed with SLE under the ACR criteria. These patients are classified as having incomplete or latent lupus. 16 Furthermore, patients might have SLE for essay by alex haley, years before enough criteria are met to classify them as having SLE, with a mean of 2 years between first manifestations and final diagnosis. 2.

Table 2 Lupus nephritis ­classification. Clinical presentation can include nonspecific symptoms (eg, severe fatigue, fever, weight loss, and lymphadenopathy). Common skin manifestations include a malar or butterfly rash, with sun-induced macules or papules occurring on the face, or a generalized rash occurring on the body, which may or may not be sun induced. Discoid lupus presents as a hyperkeratotic lesion associated with atrophy, scarring, and hypopigmentation. Ninety percent of patients have joint inflammation such as arthralgia, arthritis, tendinitis, or early morning stiffness generally in the knees, wrists, and hands. Joint inflammation tends not to cause permanent damage. Men with SLE tend to have less arthritis, but serositis can be more predominant than in help apa research paper women. 5. Another common feature, occurring in 50% of cases, is mucosal ulceration, usually oral.

Since methotrexate can also cause these ulcerations, it can be difficult to determine if the ulceration is induced by SLE or the drugs used to treat it. Diffuse alopecia can generally occur when the disease is active and rich vocabulary is usually reversible during remission. Patchy alopecia, on the other hand, may lead to scarring and can become permanent. 5 Cardiovascular and respiratory symptoms are also common and paper include chest pain on inspiration due to pleurisy or pericarditis. Cardiovascular disease (eg, myocardial infarction) is secondary to accelerated atherosclerosis and other risks (hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes, and heart failure), which can also exacerbate cardiovascular disease in online resume design SLE. The risk of hospitalization for an acute myocardial infarction was 2.27 times greater for lupus patients aged 18 to 44 years than for non-lupus patients. 22 Renal complications (glomerulonephritis and microvascular thrombosis) and neuropsychiatric complications (seizures, psychosis, neuropathies, stroke, and depression) are common as well. 23 Ophthalmic and gastrointestinal manifestations are usually uncommon but can be serious, including keratoconjunctivitis sicca, pancreatitis, hepatitis, and subacute bowel obstruction. Age at onset affects clinical presentation. Pediatric patients can have severe organ involvement, especially nephropathy. Neurologic and help with hematologic manifestations such as thrombocytopenia and hemolytic anemia are common early features in michael crichton pediatric SLE, whereas skin and joint manifestations are less common.

2 Arthritis, fever, serositis, sicca symptoms, Raynaud's syndrome, lung disease, and neuropsychiatric symptoms are more common in the elderly population with SLE, while malar rash, discoid lupus, and glomerulonephritis are less common. 4. DILE can present with different clinical features. Symptoms in help apa research DILE are generally milder, with arthralgia often being the for the of books only symptom that these patients have. Help Apa Research? Arthralgia and essay on roots by alex haley myalgia are both common, occurring in apa research paper 90% and 50% of patients, respectively.

Other common symptoms include fever, pleurisy, and help essay pericarditis. Skin manifestations are relatively uncommon; however, purpura, erythema nodosum, and erythematosus papules can be seen. Help With? Additionally, renal and central nervous system (CNS) damage do not occur in crichton essays the vast majority of cases. Onset of most symptoms generally occurs 4 to 20 weeks after initiation of therapy, but some cases of DILE have occurred after years of help paper therapy. 8-10.

MEASURING TREATMENT OUTCOMES. Disease activity. SLE activity has 3 patterns: flare, chronic, and long quiescence. A flare or relapsing remission is an exacerbation that occurs suddenly and michael unpredictably; patients are usually in good health between flares. With Apa Research Paper? Factors that may trigger a disease flare-up include stress, excessive work, emotional crisis, sunlight, ultraviolet light, infection, injuries, surgery, pregnancy, abrupt discontinuation of medications, treatment noncompliance, medications, and immunizations. Need Help? Serologic tests are not helpful in predicting flares because serologic activity of SLE may occur without clinical manifestations. Chronic SLE has persistent activity of with apa research paper some type such as chronic synovitis, chronic cytopenias, or active discoid lupus. This chronic activity may or may not require treatment.

Patients with long quiescence have a long remission period before having additional flare-up. 1,24 Patients can also have comorbid conditions associated with the main SLE activity (eg, nephritis and neuropsychiatric involvement). Outcome measures. John Bresland Video Essay? Disease activity may be measured with validated instruments such as the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the Safety of Estrogen in Lupus Erythematosus National Assessment (SELENA)-SLEDAI, the help with apa research British Isles Lupus Assessment Group scale (BILAG), the European Concensus Lupus Activity Measure (ECLAM), or the Systemic Lupus Activity Measure (SLAM), which are good predictors of online resume design damage, reversible inflammation, and with paper mortality. The European League Against Rheumatism (EULAR) Task Force on SLE recommends that at least 1 of these indices be used to monitor disease activity.

25 The Lupus Activity Index (LAI) is a visual analog scale for assessing overall activity and individual organs. The Systemic Lupus International Cooperating Clinics/ACR (SLICC/ACR) Damage Index documents the love of books rita essay number of items of irreversible organ damage that have occurred. Apa Research Paper? 26 To measure health status, the health-related quality of life (HRQOL) or 36-item short form health survey (SF-36) can be used. Follow-up. Patients with unstable disease may need to be seen as often as every week; those with stable disease can generally be seen every 3 to 4 months. Physical examination includes skin, mucous membranes, lymph nodes, chest, heart, abdomen, extremities, and the musculoskeletal and neurologic systems. Laboratory tests include complete blood count, platelet count, creatinine, liver function tests, and urinalysis. 27 Other monitoring may be required based on the patient's treatment regimen and specific organ system involvement. Specific monitoring parameters required for individual drugs are discussed below in the treatment section. There is little, if any, literature on nonpharmacologic management of SLE. Michael Crichton? Despite the lack of evidence, EULAR and ACR guidelines do make some recommendations.

24,25 All patients with SLE should practice proper sun protection as approximately one-third of patients are photosensitive. Patients should be instructed to avoid direct exposure to sunlight and use protective clothing and sunscreens that block both ultraviolet A (UVA) and UVB rays. Patients should also be counseled to avoid tanning beds. This is especially important for patients with cutaneous involvement. Smoking cessation is also recommended for with apa research paper, all patients with SLE because current smokers have been shown to have significantly higher SLEDAI scores than previous smokers or never smokers. Vocabulary? 28.

It is also important that patients maintain proper nutrition, including adequate intake of calcium and vitamin D. 25 These are especially important in patients receiving long-term glucocorticoid therapy. Vitamin D levels should be monitored periodically as well, since patients are encouraged to avoid sun exposure, which could cause problems with inadequate conversion of vitamin D in the skin. In addition, it is recommended that patients exercise routinely. Patients may also need other individualized nonpharmacologic therapy based on the different comorbid conditions that may be present (such as diet and exercise recommendations for patients with cardiovascular disease). Guidelines were developed by paper the ACR in 1999 and the EULAR taskforce in 2008. These are the online most commonly used guidelines but do have some limitations, particularly the ACR guidelines, because of the outdated nature of the material. With Apa Research Paper? Newer medications are not included in crichton essays the guidelines because they were not available. SLE treatment is highly individualized and depends on symptom manifestations, organ involvement, and disease severity. 24,25 Duration of therapy is apa research paper, also highly individualized and dove essay is based on the patient's response. Antimalarials and nonsteroidal anti-inflammatory drugs (NSAIDs) are useful in the treatment of mild symptoms such as arthralgias and help apa research paper cutaneous manifestations. Oral corticosteroids and cytotoxic agents are used in more severe disease.

Other medications (cyclophosphamide, immunosuppressive agents, tacrolimus) may be used depending on need essay the severity and various organ systems involved. Belimumab is a newer agent that is approved for patients with mild to moderate disease currently taking standard therapy. 29. NSAIDs. NSAIDs are commonly prescribed for patients with SLE because greater than 90% will develop arthralgias or polyarthritis. Help Apa Research Paper? Because there are limited data to support improved outcomes in SLE, NSAIDs should be used cautiously, and there are significant risks associated with long-term use. 25 NSAIDs work by inhibiting cyclooxygenase-2 (COX-2), which inhibits the production of video prostaglandins that mediate inflammation and with paper pain. In addition to COX-2 inhibition, NSAIDs can also inhibit COX-1, which in turn inhibits the love rita production of apa research paper prostaglandins that protect the essay on roots lining of the gastrointestinal tract. Therefore, gastrointestinal bleeding is a concern, especially in patients who are taking these medications long term and/or receiving corticosteroids. It is help, therefore recommended to use an NSAID with higher COX-2 selectivity, such as celecoxib, and to essay on roots, avoid agents with less selectivity such as piroxicam and with paper ketorolac. For Essays? Additionally, patients on long-term NSAIDs may require a proton-pump inhibitor or histamine-2 receptor blocker to help prevent complications and alleviate side effects.

30 Patients requiring long-term therapy should have a complete blood count and serum creatinine level measured annually and be instructed on how to monitor for with, signs/symptoms of bleeding (unusual bleeding, bloody stools, and love of books rita dove blood in the urine). 24. Antimalarials. Antimalarials are used to treat and prevent flares and are particularly useful for arthralgias that are not adequately controlled with NSAIDs. 24 They may also be useful in apa research paper patients with cutaneous manifestations. Hydroxychloroquine is the most commonly prescribed antimalarial agent, accounting for up to on roots haley, 95% of the prescriptions in with the United States. This is due to its decreased likelihood of causing ocular and gastrointestinal adverse reactions compared with other antimalarial agents. Hydroxychloroquine has also been shown to help maintain remission, possibly protect against vascular and thrombotic events, and to improve lipid levels. 31,32 Chloroquine is another antimalarial agent that can be used. 33. The mechanism of action of antimalarial agents in the treatment of crichton essays SLE is not fully understood but is believed to be due to their known immunosuppressive and anti-inflammatory properties.

They may also block UV light absorption, which may decrease cutaneous lesions. 33. The most common side effects are gastrointestinal upset, dermatologic reactions, headache, and lightheadedness. Rare but serious side effects include psychosis, convulsions, toxic neuropathy, skeletal myopathy, cardiac myopathy, and ophthalmologic toxicity, including permanent vision loss. Apa Research Paper? The ACR recommends that all patients undergo a baseline eye examination before beginning treatment with an antimalarial agent, followed by ophthalmologic assessments every 6 to essays, 12 months. Help With Apa Research Paper? 24 The American Academy of Opththalmology in 2002 published recommendations for for the of books rita, retinopathy screening. Help With? They base their recommendations on the economical burden of frequent screening, risk level of the patient, and online resume duration of antimalarial treatment. Since there are no standardized screening parameters, they recommend following the recommendations from the American Academy of Ophthalmology Preferred Practice Pattern based on the patient's age if they do not have risk factors.

34. Glucocorticoids. Systemic glucocorticoids used alone or in combination with other immunosuppressive agents are typically reserved for patients with significant organ involvement, particularly renal or CNS. 35 High doses (40 to 60 mg/d of prednisone or prednisone equivalent) are used in patients with severe SLE, while doses of 10 mg/d or less are used for milder SLE for treatment of with paper cutaneous and by alex musculoskeletal symptoms not responding to other therapies. With? 24 Doses and dosage forms may vary based on severity and complications but the shortest duration possible should be used to avoid long-term complications with these medications, which may include myopathy, osteoporosis, hypertension, diabetes, atherosclerotic vascular disease, and infections. Patients requiring long-term therapy should routinely be monitored for these complications. Total cholesterol and bone density should be checked annually, and blood glucose levels should be checked every 3 to 6 months. Help Writting Essay? 24. Cytotoxic/immunosuppressive agents. Patients who are not responsive to help paper, antimalarials or glucocorticoids should be considered for treatment with immunosuppressive agents for more severe manifestations of the disease.

Agents in this category include cyclophosphamide, azathioprine, mycophenolate mofetil, and methotrexate. The majority of data with these agents are in the area of SLE nephritis. It is important to note that mycophenolate mofetil, cyclophosphamide, azathioprine, and online design methotrexate must be avoided during pregnancy. Some of these agents have also shown promise in neuropsychiatric symptoms as well as in severe cutaneous manifestations of lupus. 23,25,36,37. The intravenous route for with apa research, administration of rich cyclophosphamide is generally preferred due to fewer side effects compared with oral administration. Apa Research Paper? Intravenous administration can be given with mercapto-ethanesulphonic acid (mesna) to decrease the risk of bladder damage that occurs with cyclophosphamide administration.

Mycophenolate has shown promise as compared with cyclophosphamide; however, long-term data are lacking, so cyclophosphamide is preferred in combination with steroids for proliferative nephritis. 38. Several other agents have been tried for patients with more severe and resistant disease, including fludarabine and help writting essay cladribine. Much of the evidence for these agents is from anecdotal, uncontrolled trials or very small controlled trials. Controlled trials are required before these agents can be recommended. 23,36,37,39–41. Belimumab. In March 2011, belimumab (Benlysta) was FDA approved for treatment of adults with active, autoantibody-positive SLE who are receiving standard therapy.

29 Belimumab has a unique mechanism of action targeting B-cell dysfunction by inhibiting B-lymphocyte stimulator (BLyS). It has been shown that decreases in help with BLyS levels are associated with improvement in SLE activity and increases in BLyS levels are associated with worsening SLE activity and mild/moderate flares. 42. Belimumab's safety and efficacy have been evaluated in 3 randomized, double-blind, placebo-controlled studies. In all 3 studies, patients met ACR criteria for SLE and for essays were on standard SLE therapies including corticosteroids, antimalarials, NSAIDs, and immunosuppressants (alone or in help apa research paper combination). Patients on other biologics or cyclophosphamide were excluded, along with patients with active lupus nephritis or CNS disease. On Roots Haley? 43–46. The phase 2 study included patients who had a history of measurable autoantibodies and help apa research had coprimary outcomes of on roots by alex percent change in the SELENA-SLEDAI score and time to first mild/moderate or severe flare. In the help with apa research paper study population as a whole, belimumab was well tolerated but did not significantly reduce SLE disease activity or flares. When the subgroup of seropositive patients (71.5% of rich vocabulary population) was evaluated, they had a significantly improved response. 43 This led to the evaluation and development of a novel composite end point called the SLE Responder Index (SRI) to paper, be used as the primary end point in both phase 3 studies.

The SRI uses the need writting SELENA-SLEDAI score to determine global improvement, BILAG scores to assure no worsening in a particular organ system, and help paper physician's global assessment scores. 44. The phase 3 trials (BLISS-5245 and help writting BLISS-7646) included only patients who were seropositive at screening, and both trials used SRI response rate at week 52 as their primary end point. BLISS-52 (n=865) and BLISS-76 (n=819) randomized patients to standard of apa research care plus placebo, belimumab 1 mg/kg, or belimumab 10 mg/kg for for essays, 52 weeks or 76 weeks, respectively. Both studies showed significant improvement in patient response according to the SRI using the belimumab 10 mg/kg dose compared with placebo at week 52: there was a 57.6% versus 43.6% response rate, respectively ( P =.0006), in BLISS-52 and 43.2% versus 33.5% response rate, respectively ( P =.017), in BLISS-76. Help With? The numbers needed to treat for the BLISS-52 and BLISS-76 were 8 and 11, respectively.

The 76-week results from BLISS-76 failed to show a statistically significant difference between belimumab 10 mg/kg compared with placebo in the percentage of patients responding according to the SRI (38.5% vs 32.4%, respectively; P =.13). 46 Safety data through week 76 showed that belimumab was generally well tolerated, with rates of adverse events, infections, and online design discontinuation that were similar to help paper, placebo. 46. TREATMENTS FOR SPECIFIC DISEASE MANIFESTATIONS OR PRESENTATIONS. Table 3 Summary of cytotoxic/immunosuppressive medications used in the treatment of lupus nephritis. Treatment of lupus nephritis consists of 2 phases: induction and maintenance. There is of books rita dove, some controversy as to what agent should be used due to issues with the individual agents and limited data, particularly with maintenance therapy.

Selection of the appropriate agent depends on the severity of disease, risk of adverse reactions with the different medications, desire to preserve fertility, and cost. Typically, patients will be started on a regimen of IV cyclophosphamide plus corticosteroids or mycophenolate mofetil. Meta-analyses of lupus nephritis therapies have generally shown that there is with apa research paper, similar efficacy between mycophenolate mofetil and cyclophosphamide for induction therapy. Studies included in these analyses generally lasted between 6 and 12 months. Cyclophosphamide in addition to corticosteroids has been shown to improve renal function by michael essays decreasing the risk of doubling serum creatinine levels (RR, 0.59; 95% CI, 0.4–0.88) and of relapsing (RR, 0.3; 95% CI, 0.1–0.94) when compared to with apa research paper, steroids alone. 50 They have, however, failed to show an improvement in mortality. Safety issues are a serious concern with cyclophosphamide, especially for women of child-bearing age. The risk of ovarian failure was significantly increased when cyclophosphamide was added to steroids compared with steroids alone (RR, 2.18; 95% CI, 1.1–4.34).

25,40,51–55 Patients with proliferative renal disease should also receive standard therapy for rich for essays, chronic kidney disease including angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists and lipid-lowering therapies. 25,40. Mycophenolate mofetil has been shown to with, improve outcomes in patients with more mild disease. 40 The risk of relapse at 3 years, however, was increased with mycophenolate mofetil plus steroids compared to cyclophosphamide plus steroids (RR, 2.98; 95% CI, 1.1–8.11). 25,38,47,51–55 According to the EULAR guidelines, more intensive therapy may be needed if patients do not have significant improvement (improvement in serum creatinine and reduction of proteinuria to rich, 1 g/d) after 6 months of treatment. 25.

Azathioprine is another possible treatment option for induction therapy. Apa Research Paper? When added to steroids, it decreased all-cause mortality (RR, 0.6; 95% CI, 0.36–0.99) when compared with corticosteroids alone but did not improve renal function. 47 Azathioprine did not increase the risk of ovarian failure. Triple combination therapy with cyclophosphamide, azathioprine, and steroids is john bresland video essay, not recommended since the only benefit seen was an help improvement in the risk of having the serum creatinine double. Design? 38,47. Studies examining long-term maintenance therapy are limited. The MAINTAIN trial was designed to compare the help long-term effects of mycophenolate mofetil and azathioprine. Patients had WHO class III–V renal disease and met ACR criteria for SLE.

Patients were randomized to the azathioprine (azathioprine + glucocorticoids + cyclophosphamide) or mycophenolate mofetil groups (mycophenolate mofetil + glucocorticoids + cyclophosphamide) and were followed for an average of 48 months. There was no difference in the time to renal flare (HR, 0.75; 95% CI, 0.33–1.71 for mycophenolate compared with azathioprine). Adverse reactions were similar among the groups. Michael? 56. Cutaneous lupus erythematosus. Apa Research? In addition to the sun protection measures mentioned above, intermediate-strength topical corticosteroids are generally helpful for patients with skin lesions. If patients do not respond adequately, stronger topical or oral medications may be used. First-line oral therapy consists of antimalarial agents, dapsone, or a short course of prednisone. If these treatments fail, then treatment can move on rich vocabulary to isotretinoin or gold compounds. For more severe, resistant cases, methotrexate, cyclophosphamide, cyclosporine, or long-term corticosteroids can be tried.

Surgery has been successful in some patients but caution is advised since surgery could potentially worsen disease activity. With Apa Research Paper? 23,25,41,57,58 Agents that have recently been tried include thalidomide, mycophenolate mofetil, and intravenous immune globulin. 58 Controlled trials are needed to determine the place of these agents in therapy. Tacrolimus and pimecrolimus have also shown promise in treating skin lesions. Tacrolimus when compared to clobetasol showed a decrease in side effects with a similar efficacy profile. 59 Both tacrolimus and pimecrolimus have shown improvement within a few weeks after initiation of therapy. 59 Tacrolimus showed improvement in photosensitive rash, and pimecrolimus showed improvement in cutaneous lesions. 59 Both medications also appear efficacious in subacute cutaneous lupus erythematosus. For discoid lupus, pimecrolimus appears to be more effective than tacrolimus.

59 The main issue regarding these medications is rich for essays, that they have not been compared to other agents in a controlled manner. Controlled studies are needed to with apa research, determine what role these agents may play in treating cutaneous symptoms. 59. Neuropsychiatric lupus. Need Help Writting? There are limited data on specific treatment for neuropsychiatric involvement. Treatment usually focuses on paper the psychiatric symptoms rather than on treating the lupus (eg, anticonvulsants to treat seizures or antidepressants for patients with depressive symptoms). In addition to these more serious symptoms, patients will often develop headaches, including migraine, that require preventive medications. Crichton? 23,25,41,60 There is some evidence to suggest that rituximab may be useful in these patients as well, but controlled trials are needed to help with apa research, confirm this. 61.

One randomized controlled trial has been conducted comparing cyclophosphamide and methylprednisolone for the treatment of neuropsychiatric symptoms in patients with lupus. Online Resume Design? 60,62 A statistically significant difference was seen between the groups with 18 of 19 patients in the cyclophosphamide group compared with 6 of 13 patients in with paper the methylprednisolone group responding at 24 months (RR, 2.05; 95% CI, 1.13–3.73). Therefore, cyclophosphamide may be a better treatment option than corticosteroids. 60,62 A risk/benefit analysis is bresland, needed before recommending cyclophosphamide in help with paper individual patients, due to the significant risk of adverse reactions. Drug-induced lupus. Treatment of DILE is essay, primarily withdrawal of the offending agent. Apa Research Paper? Symptoms will generally start to resolve within a few days to weeks after discontinuation.

If symptoms have not resolved, patients can be given cytotoxic agents to treat symptoms. Corticosteroids should be reserved for patients with organ damage. Patients who do not have complete resolution of symptoms should be worked up for help writting essay, development of idiopathic SLE, since some medications may just expose an paper underlying case rather than causing DILE. 8–10. Several agents have recently been or are currently being evaluated for safety and efficacy in rich for essays lupus. Help Paper? Many of these medications have failed to show a difference when compared to placebo or standard therapy, while others are still in the early stages of clinical trial testing. Leflunomide has shown some promising results in clinical trials.

63,64 Rituximab is another agent that has some limited data to michael essays, suggest that it may be beneficial in patients with SLE nephritis. 25,61,65 Clinical trials with rituximab are currently underway or have reached completion, and with paper will help to define its role in therapy. Systemic lupus erythematosus is an autoimmune disorder that can affect several organ systems, including the skin, kidneys, and CNS. Better and earlier recognition of SLE and more effective treatments have significantly improved survival rates. Treatment is vocabulary, generally individualized, based on clinical presentation of the patient. The main nonpharmacologic management strategies are proper sun protection (eg, avoidance, protective clothing, and sunscreen with both UVA and UVB protection) and proper nutrition. Glucocorticoids, NSAIDs, cytotoxic/immunosuppressive agents, and antimalarials are used for generalized symptoms and patients with more chronic or severe symptoms. Lupus nephritis is one of the most common manifestations and is generally treated with a combination of cyclophosphamide and corticosteroids.

Other disease manifestations may be treated with therapy targeting the specific condition, such as antipsychotic medications for psychiatric symptoms. Dr Bernknopf is apa research, associate professor, Ferris State University, Kalamazoo, Mich. Need Help Essay? Dr Rowley is assistant professor, Ferris State University. Dr Bailey is professor, Ferris State University. Disclosure Information: The authors report no financial disclosures as related to products discussed in this article. 1. Miah T, Hoque MA, Mahmood T, Tarafder BK. Help Paper? Clinical profile, management and resume design outcome of lupus. Mymensingh Med J . Help With Paper? 2008;17(suppl 2):S6–S11. 2. Jimenez S, Cervera R, Font J, Ingelmo M. The epidemiology of systemic lupus erythematosus.

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Benlysta® [prescribing information]. Help With Apa Research Paper? Rockville, MD: Human Genome Sciences, Inc., March 2011. Available at: http://www.hgsi.com/images/Benlysta/pdf/benlysta_pi.pdf| http://www.hgsi.com/images/Benlysta/pdf/benlysta_pi.pdf . Accessed March 29, 2011. 30. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation . 2008;118:1894–1909. 31. Alarcon GS, McGwin G, Bertoli AM, et al, for the LUMINA Study Group. Effect of john video hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from with, LUMINA, a multiethnic US cohort (LUMINA L).

Ann Rheum Dis . Resume? 2007;66:1168–1172. 32. Ruiz-Irastorza G, Egurbide MV, Pijoan JI, et al. Effects of antimalarials on thrombosis and survival in apa research patients with systemic lupus erythematosus. Lupus . 2006;15:577–583. 33. Shapiro T, Goldberg D. Chemotherapy of protozoal infections. In: Brunton L, Lazo J, Parker K, eds.

Goodman Gillman's The Pharmacological Basis of essay on roots by alex haley Therapeutics. 11th edition. New York: McGraw Hill, 2006:1032–1041. 34. Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF, for paper, the American Academy of Ophthalmology.

Recommendations on screening for online design, chloroquine and hydroxychloroquine retinopathy: a report by help with apa research the American Academy of rita dove Ophthalmology. Ophthalmology. 2002;109:1377–1382. 35. With Paper? Parker BJ, Bruce IN. High dose methylprednisolone therapy for the treatment of severe systemic lupus erythematosus. Lupus . 2007;16:387–393. 36.

Mok CC. Therapeutic options for resistant lupus nephritis. Online Resume? Semin Arthritis Rheum . 2006;36:71–81. 37. Bansal VK, Beto JA. Treatment of lupus nephritis: a meta-analysis of clinical trials. With? Am J Kidney Dis. 1997;29:193–199. 38. For The Rita Dove Essay? Houssiau F. Thirty years of cyclophosphamide: assessing the evidence.

Lupus . 2007;16:212–216. 39. Kuiper-Geertsma DG, Derksen RHWM. Newer drugs for help paper, the treatment of lupus nephritis. Drugs . 2003;63:167–180. 40. Navaneethan SD, Viswanathan G, Strippoli GFM. Treatment options for proliferative lupus nephritis: an update of clinical trial evidence. Drugs . Love Dove? 2008;68:2095–2104.

41. Bertsias G, Gordon C, Boumpas DT. Clinical trials in systemic lupus erythematosus (SLE): lessons from the past as we proceed to the future–the EULAR recommendations for the management of SLE and the use of end-points in clinical trials. Lupus . Apa Research Paper? 2008;17:437–442. 42. Petri M, Stohl W, Chatham W, et al.

Association of plasma B lymphocyte stimulator levels and disease activity in systemic lupus erythematosus. Online Resume Design? Arthritis Rheum . 2008:58:2453–2459. 43. Wallace DJ, Stohl W, Furie RA, et al. A phase II, randomized, double-blind, placebo-controlled, dose-ranging study of belimumab in with patients with active systemic lupus erythematosus. Arthritis Rheum . Resume Design? 2009:61:1168–1178. 44. Furie RA, Petri MA, Wallace DJ, et al. Help Paper? Novel evidence-based systemic lupus erythematosus responder index. Arthritis Rheum . 2009:61:1143–1151. 45.

Navarra SV, Guzman RM, Gallagher AE, et al; BLISS-52 Study Group. Efficacy and safety of belimumab in essay haley patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2001;377:721–731. 46. With Paper? Human genome sciences and GlaxoSmithKline announce full presentation at EULAR of BLISS-76 phase 3 study results for Benlysta in systemic lupus erythematosus. 17 June 2010. Available at: http://www.hgsi.com/latest/human-genome-sciences-and-glaxosmithkline-announce-full-presentation-at-eular-of-bliss-76-phase-3-study-results-for-benlysta-in-systemic-lupus-erythema-4.html| http://www.hgsi.com/latest/human-genome-sciences-and-glaxosmithkline-announce-full-presentation-at-eular-of-bliss-76-phase-3-study-results-for-benlysta-in-systemic-lupus-erythema-4.html . Accessed March 29, 2011. 47.

Flanc RS, Roberts MA, Strippoli GFM, Chadban SJ, Kerr PG, Atkins RC. Treatment for lupus nephritis. Cochrane Database Syst Rev . Help? 2004:CD002922. 48. Rheumatrex [prescribing information]. Fort Lee, NJ: DAVA Pharmaceuticals, July 2009. With Apa Research? Available at: http://www.rheumatrex.info/pdf/RheumatrexPackageInsert.pdf| http://www.rheumatrex.info/pdf/RheumatrexPackageInsert.pdf. Accessed July 20, 2010. 49.

CellCept [prescribing information]. South San Francisco, CA: Genentech, February 2010. Available at: http://www.gene.com/gene/products/information/cellcept/pdf/pi.pdf| http://www.gene.com/gene/products/information/cellcept/pdf/pi.pdf . Accessed July 20, 2010. 50. Imuran [prescribing information]. San Diego, CA: Prometheus Laboratories, April 2009. Available at: http://www.prometheuslabs.com/products_therapeutics_imuran.asp| http://www.prometheuslabs.com/products_therapeutics_imuran.asp . Accessed July 20, 2010. 51. Flanc RS, Roberts MA, Strippoli GFM, Chadban SJ, Kerr PG, Atkins RC.

Treatment of essay on roots haley diffuse proliferative lupus nephritis: a meta-analysis of randomized controlled trials. Am J Kidney Dis . Help With Apa Research Paper? 2004;43:197–208. 52. Zhu B, Chen N, Lin Y, et al. Mycophenolate mofetil in induction and maintenance therapy of severe lupus nephritis: a meta-analysis of need help writting essay randomized controlled trials. Nephrol Dial Transplant . 2007;22:1933–1942. 53. Kamanamool N, McEvoy M, Attia J, Ingsathit A, Ngamjanyaporn P, Thakkinstian A. Efficacy and adverse events of mycophenolate mofetil versus cyclophosphamide for induction therapy of help apa research paper lupus nephritis: systematic review and meta-analysis. Medicine . Essay On Roots Haley? 2010;89:227–235. 54. Mak A, Cheak AAC, Tan JYS, Su HC, Ho RCM, Lau CS.

Mycophenolate mofetil is apa research, as efficacious as, but safer than, cyclophosphamide in the treatment of proliferative lupus nephritis: a meta-analysis and meta-regression. Rheumatology . 2009;48:944–952. 55. Lee YH, Woo JH, Choi SJ, Ji JD, Song GG. Induction and maintenance therapy for lupus nephritis: a systematic review and design meta-analysis. Lupus . Help With? 2010;19:703–710. 56.

Houssiau FA, Cruz DD, Sangle S, et al; the MAINTAIN Nephritis Trial Group. Azathioprine versus mycophenolate mofetil for online design, long-term immunosuppression in lupus nephritis: results from the MAINTAIN Nephritis Trial. Ann Rheum Dis . 2010;69:2083–2089. 57. Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for cutaneous lupus erythematosus: American Academy of apa research Dermatology. J Am Acad Dermatol. 1996;34(5 Pt 1):830–836. 58. Callen JP.

Update on the management of cutaneous lupus erythematosus. Br J Dermatol. 2004;151:731–736. 59. Essay On Roots By Alex? Tzellos TG, Kouvelas D. Topical tacrolimus and pimecrolimus in the treatment of help with paper cutaneous lupus erythematosus: an evidence-based evaluation.

Eur J Clin Pharmacol. 2008;64:337–341. 60. Hermosillo-Romo D, Brey RL. Neuropsychiatric involvement in systemic lupus erythematosus. John Bresland Video Essay? Curr Rheumatol Rep . 2002;4:337–344. 61. Ramos-Casals M, Soto MJ, Cuadrado MJ, Khamashta MA.

Rituximab in systemic lupus erythematosus: a systematic review of off-label use in 188 cases. Lupus. 2009;18:767–776. 62. Trevisani VFM, Castro AA, Ferreira Neves Neto JJFNN, Atallah AN. Cyclophosphamide versus methylprednisolone for help apa research, treating neuropsychiatric involvement in systemic lupus erythematosus.

Cochrane Database Syst Rev. 2006:CD002265. 63. Zhang FS, Nie YK, Jin XM, Yu HM, Li YN, Sun Y. The efficacy and essays safety of leflunomide therapy in with apa research lupus nephritis by repeat kidney biopsy. Rheumatol Int . 2009;29:1331–1335. 65. Tam LS, Li EK, Wong CK, Lam CWK, Szeto CC. Double-blind, randomized, placebo-controlled pilot study of leflunomide in systemic lupus erythematosus. Lupus . 2004;13:601–604. 66.

Ramos-Casals M, Diaz-Lagares C, Soto-Cardenas MJ, et al. Rituximab therapy in michael essays lupus nephritis: current clinical evidence. Clin Rev Allergy Immunol. Help Apa Research? 2011;40:159–169. Managed Care Pharmacy Survey 2017. Take three minutes to answer our managed care pharmacy survey. As a thank-you to survey-takers, when the survey closes, we will hold a drawing to give away not one, but two $200 Visa gift cards.

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The 12 Dos and Don’ts of Writing a Blog. Thinking about writing a blog? Been writing a blog for some time now and have yet to establish any growth (and by “growth” I mean “increased pageviews”)? Over the past 10 years I’ve refined my blogging skills—that’s right, I started my first blog back in 2001 and it is so embarrassing by today’s standards that I’m almost unwilling to link to it … almost. Blogs for help with apa research, writers are everywhere, and there’s often good advice on them about writing a blog. There’s also plenty of not-so-good advice. It can be frustrating. Now I currently run several successful blogs, including The Life of Dad and this online editor blog. Help Essay? It’s been a challenge juggling them but, by sticking to these 12 specific dos and don’ts of writing a blog that I’ve developed over help with apa research, my years of experience, I’ve been able to john essay establish growth (increased pageviews).

I hope they can help you learn how to write a good blog too. To do this, you must first ask yourself this question: Who are your target readers? Once that’s settled, you can home in on help apa research paper a niche category (like this one focuses on writing) and john bresland video be the expert on it. What sets bloggers apart from newspaper article feeds is voice. Help Apa Research? Let your readers get to know you. Help? [Like this quote? Click here to Tweet and share it!] Your content is what draws them in help with paper while your personality, or your voice in writing, is what will keep them there. Use links within your posts. Whether you are linking to other blogs or websites that contain great information or linking to past posts on your own site, do it whenever you can. This will help not only increase your clicks but also help with your blog’s search engine rankings. While readers come to your blog for information and for the personality, they also need to be stimulated visually.

Not all posts will lend themselves to an image, but when they do, take advantage of it. Apa Research? Here’s some advice on finding free online images that you can use. This is an opportunity to connect directly with the need help, people who are reading your work. Apa Research? Not all comments need a response, but be sure to respond to online resume design ones that do. And sometimes it’s worth just popping on and posting “Thanks for reading my blog.” Post to Facebook, Twitter, Google+ and Anywhere Else You Can . Don’t be afraid to use social media to tout your posts. Anything that makes it easier for potential readers to find your blog is a must (and friends and family definitely qualify as potential readers). You know your schedule and with paper abilities better than anyone else, so don’t attempt to post every day if you can’t. Crichton Essays? Start out by paper, posting weekly and get in a groove.

As you streamline your process, increase your posting if you can. If you have something to say, say it. Readers (and search engines) prefer to get meatier pieces (500 words or more) to make clicking through worth their time. This doesn’t mean you can’t feature shorter pieces or that you should ramble on michael crichton essays just to meet a word count, but don’t be afraid to break down antiquated perceptions that blogs need to be short. When the time is right, go long. And, if you do, correct them immediately.

Folks on the Web tend to be more lenient about help with paper, typos, so don’t stress about it if you do make a mistake. But correct it as soon as you can. Remember, if you ever want readers to take you seriously, you have to take yourself (and your blog) seriously. Give it the professional quality it deserves. It’s generally unwise to air personal grievances publicly (unless, of course, that’s the theme of your blog). You’ll go a lot further by john bresland video essay, being positive, inspirational and supportive to the community that you’re writing to.

Long blocks of text are hard for readers to digest, especially when reading on computers and tablets. Break up your content into help with apa research, shorter paragraphs, bullet points and writting essay lists whenever possible. Also, if you can, work in some subheads. It’s important to let your blog evolve over time, and the only way this can happen is if you take risks every once in awhile. Whether it’s adding infographs or personal stories or guest bloggers, never be afraid to try something new. If you feel it can add something special to your blog, try it. 43 thoughts on “ The 12 Dos and Don’ts of Writing a Blog ” Very helpfull tips. With Apa Research Paper? Thank you! Yes i do for this again.

I thank you for resume, the informative article. These are excellent tips that I have either followed from day one or learned fairly quickly along my blogging journey. With Paper? Doing things as you described has helped me to of books rita build and help paper retain an audience of regular readers. When I started my blog I started by posting every day in rich vocabulary order to get into paper, the writing habit and for the love rita dove get used to help paper meeting a deadline. After a year of this I pared things down to john essay a more reasonable level of 3 days per week. Now I’m at 1 or 2 days per week. Posting fewer days has resulted in more comments per post as well as a bit less stress.

Still I think a starting out help with apa research, with the for the love dove, daily posts was a good tactic for me. That’s what got me in the groove until I could settle into apa research paper, a more comfortable place. A to Z Challenge Co-host. Hello Iam TABET ABDERRAOUF author from ALGERIA Mr Brian A. Klems i would like to inquire about the Seminars which held by writer’s digest and i would like to present in vocabulary these seminars i hope to send me an with, invitation to by alex haley be present in these seminars to get more informations for the of publishing in your site and know more new cultures and know also about with, publishing house. and finally i would like to thank you about this wonderful site. Hello Iam TABET ABDERRAOUF author from ALGERIA i would like to inquire about the Seminars which held by writer’s digest and i would like to present in these seminars i hope to resume send me an invitation to be present in these seminars to get more informations for the of publishing in help your site and know more new cultures and know also about publishing house. and finally i would like to thank you about this wonderful site.

Thanks for posting your first blog. I’m afraid to on roots by alex haley start a blog even though I have many ideas, because I’m afraid it will be lame. Your first blog wasn’t so lame, really. Mine wouldn’t be either. I really enjoy simply reading all of your weblogs. Simply wanted to with apa research inform you that you have people like me who appreciate your work. Definitely a great post. Hats off to you! The information that you have provided is need help writting essay very helpful. http://vipeez.com.

Thanks for help with apa research, sharing such a helpful list. Responding to blog comment is really an impotent thing to consider. It will helps you make interaction with your readers which make them feels good and give you chances to understand for what your targeted Audiences are searching. I’ve been playing with the vocabulary for essays, idea of starting a blog of my own for quite some time now, but I seem to have stumbled on a problem I could use some professional advice on: I have a wide variety of help apa research, topics I would like to bresland video write about; some of which are what I would call “fringe topics” with others being fairly mainstream. With? So here’s my actual question: Would it be legitimate to essay on roots make my blog about my hobbies and interests in general or should I pick one and stick to that? Thanks in advance for any help! You can’t just ask customers what they want and with apa research then try to on roots by alex give that to them. With? By the time you get it built, they’ll want something new. I liked the advice (and the Thanksgiving/Christmas story–always wondered how a birthday turned into online design, that mess). I just volunteered to blog on a library site for parents. The subject is teaching children to read, so I’m not interested in making money, but I do want to gather as large an help apa research paper, audience as possible.

Are there any other “nuggets of wisdom” or other articles I should read before beginning? Have you ever used any of those article rewriters or spinners? and it looks like it may help me write articles or blogs that have the essay on roots, same or near the same content but I don’t want to simply repeat the help with paper, same information. if you used any of these, what is your opinion regarding their use? Hey there, I recently undertook a blog-writing exercise taking in A Twelve Day Writing Exercise, which I mashed up with the above twelve steps to help me along. I then decided to for essays go one better and add to that list the help with paper, twelve steps of addiction into the mix too! Have a look at my final blog entry, below, summarising the last two weeks of writing to these specs, and please don’t be afraid to crichton essays leave comments, critique and flowers! Thanks for the good info..just a quick question…”what is a ‘positing’ ” ? (as your post states below…) When Writing a Blog Don’t … Set Unrealistic Goals. You know your schedule and abilities better than anyone else, so don’t attempt to post every day if you can’t. Start out by posting weekly and help with get in a groove.

As you streamline your process, increase your positing if you can. Thank you for this it was really helpful! The last couple of day’s I have been thinking about starting a blog and I have now decided to! Thank you so much ! This is a fantastic guide for creating a successful blog. Bresland? It definitely shares some great recommendations for appealing to a targeted audience. I like how you identify the importance of with paper, setting realistic and attainable goals. I have been writing a blog for almost a year (expressimpact.com) and I have learned a significant amount of information in essay on roots haley reference to keeping the conversation interactive. I think one of the most important things to remember is to listen to your feedback. My readers often communicate how much they value the help with paper, content posted on my site. Video? Overall, it helps me to with apa research learn more about my audience and online design often inspires the stories I post!

Thanks for sharing! Great advice! I will definitely keep this close at hand so I can refer to it often and help with keep myself on track. Thank you. I was just wondering. Has anyone thought that all the computer networking, blogging, internet sites, and self-promotion by an author really takes away from what a great writer would do, which is to write and write and write and find a publisher that actually has a job in that it is responsible for editing and marketing.

I really believe we will see terrible authors selling only because of self-promoted media. In other words media will be the content and writing will be but blither between the covers much like MTV might promote a pretty face even when the voice can’t sing and rich vocabulary for essays eventually make it impossible for real singers to emanate their voice, which is the only real content to the audience…I can only ask that if a publisher no longer advertises and no longer edits, what exactly is it that they do other than accept cash for with paper, that grammatically perfect piece of work that is delivered to need writting their desk only waiting printing. It’s all about balance. Writing is help with paper your job, first and for the love rita dove foremost. Help With Paper? But with the explosion of the internet/blogging, it’s essential to also spend some time building a platform to help sell your work when it’s ready. Thanks for john bresland essay, the note! Hi Brian. Help Paper? Love your blog. I am actually having a web designer add a blog to my website. My business, for almost 25 years has been specializing in john video true museum grade framing.

Though your blog says don’t be negative (and I understand that), over these years, I have seen many countless of important and with apa research paper rare items get damaged through a framer’s ignorance….and, even intentional (to save a buck!) It is a shame. Encountered a large framing franchise that mistakenly separated a woman’s illustrative poem from the text her father wrote and for the of books rita essay drew for her as a gift before he died …..you cannot take undo that unfortunate action! There’s a difference between honest, fair criticism and being negative. Thanks for the kind words and reading the blog! Hi Brian!

Having just launched my blog a month ago, I’m still getting my feet wet and learning about this “brave new world.” Simply stated, I’m having a blast inviting people into the world of the central character of my “work of art in help apa research paper progress.” Writing can be such a lonely world – isolation is necessary in order to focus upon the work at hand, but it can also make one feel more akin to a mushroom growing from a chair positioned before a computer. Your tips have been of great help – especially the online resume, need to determine where one should place their focus. I feel like a kid in a candy store with so many possibilities that it’s imperative to pick and choose wisely. After all, as bloggers, we are being cordially invited into the lives of help with paper, others, and it’s only right that we respect that privilege and their space/time. Thanks for writting, reaching out. I look forward to learning more as you roll out new information and hope you’ll come visit the blog as well! Glad you found it helpful (and thanks for with apa research, reading).

Great post full of sage advice for essay, new and seasoned bloggers Brian! Been years since I let my Writers Digest subscription go – but this post has not only inspired me to with paper join the Writers Digest community again – but to john video treat myself to a subscription! Look forward to reading more from you. #128578; Brian, thanks for the tip and have a gr8t weekend! Great advice Brian, especially for a newbie blogger and author (“B is for Bully” by with paper, Jacqueline Brathwaite) like me. My blog is leaning on for the the side of airing grievances for purging but I’m trying to paper work a positive twist into it as well. Check it out here at http://www.jacquelinebrathwaite.blogspot.com. Actually, commenting to rich vocabulary for essays you just now revealed to help me something else to help add focus into my blog. Anyway, I would love your experienced evaluation of my blog, since it’s at its beginning, so that I can correct my mistakes sooner than later. Please email me: [email protected]

PS: Don’t beat yourself up so much about your old blog. I thought your “Thanksgiving: AKA. The Start Of Christmas” piece was hilarious :). Thanks for the kind words! I really appreciate them. As far as a blog critique, the best way to get one is to sign up for online resume, this: Good luck with your blogging! If you’re going to air grievances, then that kind of thing has to apa research be your niche. You can be snarky if you’re always snarky, you know? Hello Mr Brian A. Klems I Rauf from Algeria author would like to recognize for online resume design, the exchange of information about the location of writer digest and about the meetings that are held about the with apa research, book in help writting essay America and how the presence of these circumstances forums and exchange of information where and sweating on the authors and new books and for translators to translate my books and I thank you. Great advice, Brian.

I’d go a bit further and say that anyone who writes, edits or otherwise maintains a regular blog should know the very basics of search engine optimization. With a slight bit of editing, it’s easy to make blog posts more visible in search engine results pages, and increase a particular blog’s traffic and audience. Great advice. Apa Research Paper? I hope to bresland video delve into SEO in a future post, but created this as a simpler list. SEO can be overwhelming at first. Thank you so much for help with apa research, the great advice. I’m really knew at blogging. I like your advice about putting pictures up to increase the readers interests.

Unfortunately, I don’t have any pictures yet so right now I am sticking to just using words to describe my short stories. If anyone would like to read my story then please go to need help this site http://jm-dreambig.blogspot.com/?spref=tw. Thanks again for the help. Images can be hard to incorporate. You don’t want to force it, but when you have an opportunity, run with it. Good advice. Another good tip is to with paper read and comment on other people’s blogs too.

Like this! #128521; Most definitely. Though, as writers and readers, we should be doing that anyway, whether we blog or not. Building community and networking have great benefits, including friendships. I recently started a blog targeting new writers and your post was really helpful. I will certainly refer to for essays it as I find my space in the blogesphere. No problem. Glad it helped! Brian: Very good information.

Just wanted to point out help with paper, a couple things: 1. I believe the term is “hone in” not “home in” and. 2. You have an outdated link at on roots the bottom of your article – best advice one. Thanks for help apa research paper, the note. In this instance, “home in” is the correct phrase. The mistaken use of “hone” for “home” is common, so awhile back I explained it on my Questions Quandaries blog. Hope this explanation helps: As for the related links, I’ll look into it. Brian: Thank you so much for the grammar lesson. I had never heard the term “home in” before.

I read your blog article and it makes perfect sense. Again, thank you for the clarification. Thanks for the solid advice. I’m writing a different kind of how-to book for writers, and blogging is one of the things I recommend to stay in shape. Well, guess what? At the time I wrote it, I hadn’t followed my own advice, which is pretty close to a capital offense. I’m about to need writting change that, however, and have been working furiously to help apa research paper produce worthwhile articles and launch my blog. Your article served as a nice checklist of what I’ve tried to do and need essay what I’ve read elsewhere that blogs should and should not do. It’s a good, quick summary of the major points that all of us blogging — or about to — should never forget. Thanks David! I’m glad it helped.

Keep me and the rest of the with apa research paper, WD community updated on you blogging progress. Rich Vocabulary For Essays? I always love to hear success stories when folks who read my blog strive to with apa research paper reach their goals. Great advice, thank you. I look forward to essay on roots by alex haley putting it to good use.

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Essay/Term paper: Domestic violence. Free essays available online are good but they will not follow the guidelines of your particular writing assignment. Help Apa Research! If you need a custom term paper on Domestic Abuse: Domestic Violence , you can hire a professional writer here to for essays, write you a high quality authentic essay. Apa Research Paper! While free essays can be traced by Turnitin (plagiarism detection program), our custom written essays will pass any plagiarism test. Our writing service will save you time and grade. national boundaries as well as socio-economic, cultural, racial and class. distinctions. It is a problem without frontiers.

Not only john, is the problem. widely dispersed geographically, but its incidence is also extensive, making it. a typical and accepted behavior. Only recently, within the past twenty-five. With Apa Research! years, has the issue been brought into the open as a field of crichton essays concern and. study (Violence Against Women in with paper the Family, page 38). Domestic violence is not an isolated, individual event but rather a. pattern of repeated behaviors that the abuser uses to gain power and control. over the victim. Unlike stranger-to-stranger violence, in domestic violence. situations the same perpetrator repeatedly assaults the same victim. These. assaults are often in the form of physical injury, but may also be in essay by alex haley the form. of sexual assault. However the abuse is not only physical and sexual, but also. psychological. Psychological abuse means intense and with apa research repetitive humiliation, creating isolation, and controlling the actions of the love of books rita dove, victim through. intimidation or manipulation. Domestic violence tends to become more frequent.

and severe over time. Oftentimes the paper, abuser is physically violent sporadically, but uses other controlling tactics on a daily basis. All tactics have profound. effects on crichton essays the victim. Perpetrators of domestic violence can be found in all age, racial, ethnic, cultural, socio-economic, linguistic, educational, occupational and. religious groups. Domestic violence is found in all types of intimate. Help Paper! relationships whether the individuals are of the same or opposite michael sex, are. married or dating, or are in a current or past intimate relationship. There are. two essential elements in every domestic violence situation: the help paper, victim and. abuser have been intimately involved at some point in time, and the abuser. consciously chooses to use violence and for essays other abusive tactics to gain control. over the victim. In some instances, the abuser may be female while the victim is. male; domestic violence also occurs in gay and lesbian relationships. Help With! However, 95% of reported assaults on spouses or ex-spouses are committed by men against. women (MTCAWA e-mail interview) It is bresland a terrible and with paper recognizable fact that for many people, home is. the least safe place (Battered Dreams, 9).

Domestic violence is real violence, often resulting in permanent injuries or death. Battering is a widespread. societal problem with consequences reaching far beyond individual families. It. is conduct that has devastating effects for individual victims, their children. and their communities. In addition to these immediate effects, there is growing.

evidence that violence within the family becomes the breeding ground for other. Online Resume Design! social problems such as substance abuse, juvenile delinquency, and violent. crimes of apa research all types (MTCAWA e-mail interview). Domestic violence against. Design! women is not merely a domestic issue; but, rather a complex socio-economical. crisis that threatens the interconnected equilibrium of the entire social. (Violence Against Women: The Missing Agenda, 29). Domestic violence against women accounts for approximately 40 to 70% of. all violent crime in North America. However, the figures don't tell the entire. story; less than 10% of apa research paper such instances are actually reported to police (The. Living Family, 204). The causes of domestic violence against women are numerous. Many claim. stress is the substantial cause of domestic conflict resulting in violence.

Though stress in the workplace is a contributing factor, it is by no means the. substantial one. Many people suffer from stress disorders, but most don't. resort to violence as a means of release. It is apparent that the substantial. causes have more to do with the online design, conditioning of males culturally, and within. the family of orientation than anything else. Historically, women have been treated more as belongings than human. beings; Old English Common Law permitted a man to abuse his wife and kids, as. long as he didn't use a stick thicker than the width of his thumb--Rule of. Thumb (The Living Family, 201). Culturally, men have been conditioned to. repress their feelings of emotion--always acting like the tough guy, the. With! linebacker, the cowboy. But, when confronted with an emotionally difficult. Haley! conflict, one which is impossible to shove down deep, they irrupt in volcanic. proportions, often taking out years of repressed rage on those closest to them, in particular their own family. Apa Research Paper! However, what seems to be the most significant cause of the male tactic.

of violent conflict resolution is violence within the family of orientation. Statistics show that 73% of male abusers had grown up in a family where they. saw their mother beaten, or experienced abuse themselves (MTCAWA e-mail. interview). Using the (relatively accepted) Freudian model, which claims that. Essays! all mental illness stems from traumatic childhood trauma, one can see how there. is a direct correlation between violence in the family of orientation and. violence within the family of procreation. And, indeed, abusers are mentally. ill, though the illness tends to be more subtle than others: many abusers. display a JekyllHyde personality, where they are nothing like their domestic. selves outside the home. In most cases the cycle of violence starts slowly; it usually consists. of a slap in the face or a hard shove.

But the frequency and degree of with violence. escalates with time. The abuser will justify the rich for essays, abuse by pointing out his. Help Apa Research! wife's inadequacies and faults. Bresland! But, no matter how wrong the help with apa research, wife is, there is. little, if no, justification for spousel abuse within a civil society. The real issue at hand is the neurosis within the male psyche. Resume! Just as. in rape, the key issue is control. Male abusers are laden with fear about. losing power. They inflict physical abuse on their spouse to with apa research, prove that they. have, still have, and will have control over their spouses (and/or children.) They won't stop there either.

The pattern of abuse involves severe mental. torture and humiliation--blaming, threatening, ignoring, isolating, forcing sex, monitoring phone calls, and restricting any form of social life. It is a. vicious cycle of abuse, where the wife is almost literally chained to essay on roots by alex haley, the. Help With Apa Research Paper! husband. Her self-esteem has been obliterated. She is financially, emotionally, and functionally helpless. She is online resume incapable of reaching out for help for. herself or for her children. At this point the apa research paper, abuse gets more routine; the. abuser sites his partner's pathetic state as more reason to beat her. And the. Need Help Writting Essay! victim sinks deeper, and more beatings ensue. She has been infected with. psychological-AIDS; she has no defense (immune system) to combat the disease. For women, escaping an abusive relationship is VERY difficult. And the. abuse usually doesn't stop at the discretion of the male.

An in-depth study of. all one-on-one murder and non-negligent manslaughter cases in Canada from 1980. to 1984 found that 62% of female victims were killed by a male partner (Violence. Against Women Homepage). It is with apa research painfully clear that victims have little but two. choices: leave or die. Sadly, the latter is the easier one. physical, mental and social well-being and not merely the absence of disease or. infirmity (In the Health of Women: A Global Perspective, 78). Resume Design! Based on this, domestic violence against women is clearly a health problem. With Paper! In 1984, the U.S. Surgeon General declared domestic violence against women as the number ONE. health problem (Violence Against Women Homepage). Physical violence is the most basic form of domestic violence, leading. to essays, extensive injury, unsuccessful pregnancies and even murder. As mentioned. above, in Canada 62% of women murdered were killed by with apa research, an intimate male partner.

These are deaths caused by a preventable social problem. For The Love Of Books Essay! Actual or threatened physical violence, psychological violence and the. denial of physical and economic resources all have an enormous impact on women's. mental health. A history of victimization is seen as a strong risk factor for. the development of with paper mental health problems (MTCAWA e-mail interview). These. problems take many forms, all affecting women's ability to attain a basic. quality of life for for the love dove essay, herself and her family.

Abuse is strongly associated with. alcoholism and drug use in women (Facts About Domestic Violence). It also can. lead to fatigue and passivity coupled with an apa research extreme sense of resume design worthlessness (Violence Against Women in the Family, 78 ). These symptoms together remove any. initiative and help with decision making ability from the for the rita dove, victim. This lethargy, coupled. with economic barriers, makes escape from the situation very difficult. The lack. of initiative also thwarts women's abilities to participate in activities. outside of the home.

High levels of stress and with paper depression are also extremely. common mental health problems for victims of family violence, often leading to. suicide (Facts About Domestic Violence). John Video! In the United States, one quarter of. suicide attempts by apa research paper, white women and one half of attempts by African American. women are preceded by abuse (In the need help, Health of Women: A Global Perspective, 128). The World Bank's analysis found domestic violence to with apa research, be a major cause of. disability and death among women; the burden of family violence is comparable. to by alex haley, that of HIV, tuberculosis, cardiovascular disease or cancer (Domestic. Violence Against Women: A Global Issue, 29). In industrialized nations one in. five healthy days of paper life are lost to women age 15 to 44 due to domestic. violence (Fact Sheet About Domestic Violence) Domestic violence diverts the scarce resources of national health care. systems to the treatment of a preventable social ill (Violence Against Women. in the Family, 87).

Medical costs for the treatment of abused women total at. least 3 to 5 billion dollars annually in the United States. Battered women in. the United States are four to five times more likely than non-battered women to. require psychiatric treatment, and over one million women in the U.S. Online Design! use. Help Apa Research! emergency medical services for injuries related to battering each year. Finally, families in the United States in which domestic violence occurs use doctors. eight times more often, visit the emergency room six times more often and use. six times more prescription drugs than the general population (Facts About. It is an important social issue. For The Love Of Books Rita Dove! Using the Systems Theory as a theoretical. framework helps show the resonating effect of such violence. The family unit. is one of many sub-systems. Together, all these different sub-systems make up. the one big system (i.e., society). The human body serves as a good example: when one organ (sub-system) is malfunctioning, all other organs are effected. (other sub-systems). This will have an effect on the whole body itself. Help Apa Research Paper! (society). Although the family unit is only one among the many sub-systems, it. is considered to be the most important of them all--the heart, if you will.

Since the family unit is responsible for the socialization of children who will. later go on to participate in other sub-systems, than it is logical to assume. Vocabulary! that a deterioration in the crucial family unit can result in a deterioration. within other sub-systems, and of course, the entire system itself. As mentioned above, the sub-system of health care is feeling the. pressure. Something as preventable as domestic violence against women is. diverting funds from an already under-funded health care system. There are. people out there who need serious medical treatment, but will never, or at the. very most, will get insufficient treatment.

In the U.S., domestic violence. against women ranks as one of the most expensive health problems (Facts About. Domestic Violence). Monies allocated to the medical treatment of abused women (3. to 5 billion dollars annually) diverts much needed funds from such already. under-funded institutions as education, law enforcement, social services etc. With Apa Research! Therefore the possibility exists that adults of the future will be sparsely. educated delinquents; crime will be on rich vocabulary the increase; and important social.

services won't be able to look out for the welfare of the people--such as. shelters for abused women. The result is long term decay within the entire. system, which will add further to the decay within the family, which will cause. the entire vicious cycle to continue. As previously mentioned, 73% of male abusers were abused, or saw abuse. as children. Thus an epidemic of violence within the family of orientation is a. primary cause of psychological disfunction--in specific, violent conflict. Help With Apa Research Paper! resolution--which is responsible for the breakdown of the entire social order. U.S. Justice Department statistics show that at for the love rita dove, least 80% of men in prison grew. up in violent homes (Facts About Domestic Violence.) And in at least half of. the wife abusing families, the children were battered as well. Paper! And 63% of boys. ages 11 to crichton essays, 20 who commit homicide, murder the man who was abusing their mother. breeding ground for other social problems such as substance abuse, juvenile. delinquency, and paper violent crimes of all types. For Essays! The all important family unit is. the centre of social universe. All other institutions revolve around it. If. the sun were to blow up the entire galaxy would go with it. With Paper! problem rather than a private issue imbedded within family -- a domestic issue. which can be easily ignored.

It must receive appropriate attention from the. various institutions within our society as an issue affecting the overall. Need Essay! standard of living. It is not only a women's issue, but also a problem that.

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essay on trademarks A trademark is a word, symbol, or phrase, used to paper identify a particular manufacturer or seller's products and distinguish them from the products of another. 15 U.S.C. ? 1127. Online Resume? For example, the trademark Nike, along with the Nike swoosh, identify the shoes made by Nike and distinguish them from shoes made by other companies (e.g. Reebok or Adidas). Similarly, the trademark Coca-Cola distinguishes the brown-colored soda water of with one particular manufacturer from the brown-colored soda of another (e.g. For The Love Of Books Dove Essay? Pepsi). When such marks are used to identify services (e.g. Jiffy Lube) rather than products, they are called service marks, although they are generally treated just the same as trademarks. Under some circumstances, trademark protection can extend beyond words, symbols, and phrases to with apa research paper include other aspects of a product, such as its color or its packaging. For example, the pink color of Owens-Corning fiberglass insulation or the unique shape of essays a Coca-Cola bottle might serve as identifying features.

Such features fall generally under the help apa research, term trade dress, and may be protected if consumers associate that feature with a particular manufacturer rather than the product in general. However, such features will not be protected if they confer any sort of functional or competitive advantage. So, for example, a manufacturer cannot lock up the use of a particular unique bottle shape if that shape confers some sort of functional advantage (e.g. is help easier to apa research paper stack or easier to grip). John Bresland Video Essay? Qualitex Co. v. Jacobson Products Co., Inc., 115 S. Ct. 1300 (1995). Trademarks make it easier for apa research, consumers to quickly identify the source of a given good. Instead of reading the fine print on a can of cola, consumers can look for the Coca-Cola trademark.

Instead of asking a store clerk who made a certain athletic shoe, consumers can look for love of books essay, particular identifying symbols, such as a swoosh or a unique pattern of help with paper stripes. By making goods easier to identify, trademarks also give manufacturers an incentive to invest in the quality of design their goods. After all, if a consumer tries a can of Coca-Cola and finds the quality lacking, it will be easy for the consumer to avoid Coca-Cola in the future and instead buy another brand. Trademark law furthers these goals by regulating the proper use of trademarks. Trademarks are governed by both state and federal law. Originally, state common law provided the help apa research, main source of michael essays protection for trademarks. Help With Apa Research Paper? However, in the late 1800s, the U.S. Congress enacted the first federal trademark law. Since then, federal trademark law has consistently expanded, taking over much of the ground initially covered by on roots by alex state common law. The main federal statute is the Lanham Act, which was enacted in 1946 and most recently amended in 1996. 15 U.S.C. ?? 1051, et seq..

Today, federal law provides the main, and by and large the most extensive, source of trademark protection, although state common law actions are still available. Apa Research? Most of the discussion in vocabulary, this summary focuses on federal law. In order to serve as a trademark, a mark must be distinctive -- that is, it must be capable of identifying the source of a particular good. Help With Paper? In determining whether a mark is distinctive, the courts group marks into four categories, based on the relationship between the for the of books dove essay, mark and the underlying product: (1) arbitrary or fanciful, (2) suggestive, (3) descriptive, or (4) generic. Because the marks in with paper, each of these categories vary with respect to their distinctiveness, the requirements for, and degree of, legal protection afforded a particular trademark will depend upon which category it falls within.

An arbitrary or fanciful mark is a mark that bears no logical relationship to the underlying product. For example, the for the love dove essay, words Exxon, Kodak, and Apple bear no inherent relationship to help apa research paper their underlying products (respectively, gasoline, cameras, or computers). Similarly, the Nike swoosh bears no inherent relationship to on roots by alex athletic shoes. Arbitrary or fanciful marks are inherently distinctive -- i.e. capable of with apa research identifying an underlying product -- and are given a high degree of protection. A suggestive mark is a mark that evokes or suggests a characteristic of the need help, underlying good. For example, the word Coppertone is suggestive of sun-tan lotion, but does not specifically describe the underlying product. Some exercise of imagination is help with apa research needed to associate the design, word with the underlying product. Help With? At the same time, however, the word is not totally unrelated to the underlying product.

Like arbitrary or fanciful marks, suggestive marks are inherently distinctive and are given a high degree of need help protection. A descriptive mark is a mark that directly describes, rather than suggests, a characteristic or quality of the underlying product (e.g. its color, odor, function, dimensions, or ingredients). For example, Holiday Inn, All Bran, and Vision Center all describe some aspect of the underlying product or service (respectively, hotel rooms, breakfast cereal, optical services). They tell us something about the product. Unlike arbitrary or suggestive marks, descriptive marks are not inherently distinctive and are protected only if they have acquired secondary meaning. Descriptive marks must clear this additional hurdle because they are terms that are useful for describing the underlying product, and help with apa research paper giving a particular manufacturer the exclusive right to use the for essays, term could confer an unfair advantage. Assuming that a trademark qualifies for protection, rights to a trademark can be acquired in one of two ways: (1) by being the first to use the mark in commerce; or (2) by being the first to register the mark with the U.S. Patent and Trademark Office (PTO). Help With Paper? 15 U.S.C. ? 1127(a).

Remember, however, that descriptive marks qualify for protection (and can be registered) only after they have acquired secondary meaning. Thus, for descriptive marks, there may be a period after the initial use of the love rita, mark in commerce and before it acquires secondary meaning, during which it is not entitled to trademark protection. Once it has achieved secondary meaning, trademark protection kicks in. The use of a mark generally means the actual sale of a product to the public with the mark attached. Thus, if I am the first to sell Lucky brand bubble-gum to the public, I have acquired priority to use that mark in connection with the sale of bubble-gum (assuming that the mark otherwise qualifies for trademark protection). This priority is help paper limited, however, to the geographic area in which I sell the bubble gum, along with any areas I would be expected to expand into or any areas where the reputation of the mark has been established. So, for example, if I sell pizza in Boston under the name Broadway Pizza, I will probably be able to prevent late-comers from opening up a Broadway Pizza within my geographic market. But I will not be able to prevent someone else from opening a Broadway Pizza in Los Angeles. The other way to acquire priority is to essay on roots register the mark with the PTO with a bona fide intention to use the mark in commerce. Help? Unlike use of a mark in commerce, registration of rich a mark with the with, PTO gives a party the right to need help essay use the mark nationwide, even if actual sales are limited to only a limited area. This right is limited, however, to the extent that the mark is already being used by others within a specific geographic area.

If that is the help with apa research paper, case, then the prior user of the mark retains the online, right to use that mark within that geographic area; the party registering the mark gets the right to use it everywhere else. So, for example, if I register the mark Broadway in connection with the sale of pizza, the existing Broadway Pizza in Boston retains the right to use the name in Boston, but I get the right to use it everywhere else. Although registration with the PTO is not required for a trademark to help apa research be protected, registration does confer a number of benefits to the registering party. 15 U.S.C. ? 1051. As described above, registration gives a party the right to use the mark nationwide, subject to the limitations noted above.

15 U.S.C. ? 1072. Haley? Registration constitutes nationwide constructive notice to others that the trademark is owned by the party. Registration enables a party to help with apa research bring an infringement suit in love rita dove essay, federal court. 15 U.S.C. ? 1121. Registration allows a party to potentially recover treble damages, attorneys fees, and help with apa research paper other remedies. Finally, registered trademarks can, after five years, become incontestable, at which point the exclusive right to use the mark is conclusively established. 15 U.S.C. ? 1065. Applications for registration are subject to approval by the PTO. The PTO may reject a registration on any number of grounds. 15 U.S.C. ? 1052.

For example, the michael crichton, PTO will refuse to apa research register generic marks or descriptive marks that have not attained secondary meaning. The PTO can also reject immoral or scandalous marks, certain geographic marks, marks that are primarily surnames, and marks that are likely to cause confusion with existing marks. Essay By Alex? As noted above, rejection of the mark does not necessarily mean that it is not entitled to trademark protection; it means only with apa research, that the mark is not entitled to vocabulary the additional benefits listed above. 15 U.S.C. Help Paper? ? 1125. Some states also have their own registration systems under state trademark law. The rights to a trademark can be lost through abandonment, improper licensing or assignment, or genericity. Rich For Essays? A trademark is abandoned when its use is discontinued with an intent not to resume its use. Such intent can be inferred from the circumstances.

Moreover, non-use for three consecutive years is prima facie evidence of abandonment. The basic idea is that trademark law only protects marks that are being used, and parties are not entitled to warehouse potentially useful marks. So, for example, a recent case held that the Los Angeles Dodgers had abandoned rights to the Brooklyn Dodgers trademarkMajor League Baseball Properties, Inc. v. Sed Non Olet Denarius, Ltd., 817 F. Supp. Paper? 1103 (S.D.N.Y. 1993). Trademark rights can also be lost through improper licensing or assignment.

Where the use of a trademark is john bresland essay licensed (for example, to a franchisee) without adequate quality control or supervision by the trademark owner, that trademark will be canceled. Similarly, where the rights to a trademark are assigned to another party in gross, without the corresponding sale of any assets, the trademark will be canceled. The rationale for these rules is that, under these situations, the trademark no longer serves its purpose of identifying the goods of help apa research paper a particular provider. On Roots Haley? Dawn Donut Co., Inc. v. Hart's Food Stores, Inc., 267 F.2d 358 (2d Cir. 1959). Trademark rights can also be lost through genericity.

Sometimes, trademarks that are originally distinctive can become generic over time, thereby losing its trademark protectionKellogg Co. v. Help? National Biscuit Co., 305 U.S. 111 (1938). A word will be considered generic when, in the minds of a substantial majority of the public, the word denotes a broad genus or type of product and not a specific source or manufacturer. So, for example, the term thermos has become a generic term and for essays is no longer entitled to trademark protection. Although it once denoted a specific manufacturer, the term now stands for help with, the general type of product. Similarly, both aspirin and rich vocabulary for essays cellophane have been held to be generic. Bayer Co. v. United Drug Co., 272 F.505 (S.D.N.Y.

1921). In deciding whether a term is generic, courts will often look to dictionary definitions, the use of the term in newspapers and magazines, and any evidence of attempts by help with apa research the trademark owner to help writting police its mark. If a party owns the rights to a particular trademark, that party can sue subsequent parties for with paper, trademark infringement. 15 U.S.C. ?? 1114, 1125. The standard is likelihood of confusion. Bresland Essay? To be more specific, the use of a trademark in connection with the sale of a good constitutes infringement if it is likely to cause consumer confusion as to with apa research the source of those goods or as to the sponsorship or approval of michael essays such goods. Help With? In deciding whether consumers are likely to be confused, the design, courts will typically look to a number of factors, including: (1) the strength of the mark; (2) the proximity of the goods; (3) the help with apa research, similarity of the marks; (4) evidence of actual confusion; (5) the essay on roots, similarity of marketing channels used; (6) the degree of caution exercised by the typical purchaser; (7) the defendant's intent. Polaroid Corp. v. Polarad Elect. Corp., 287 F.2d 492 (2d Cir.), cert. denied, 368 U.S. 820 (1961).

So, for example, the use of an identical mark on the same product would clearly constitute infringement. If I manufacture and sell computers using the mark Apple, my use of that mark will likely cause confusion among consumers, since they may be misled into thinking that the computers are made by Apple Computer, Inc. Using a very similar mark on the same product may also give rise to a claim of infringement, if the marks are close enough in sound, appearance, or meaning so as to cause confusion. So, for example, Applet computers may be off-limits; perhaps also Apricot. On the other end of the spectrum, using the same term on a completely unrelated product will not likely give rise to an infringement claim. Thus, Apple Computer and Apple Records can peacefully co-exist, since consumers are not likely to think that the computers are being made by the record company, or vice versa. Between the two ends of the spectrum lie many close cases, in which the courts will apply the factors listed above. So, for example, where the marks are similar and the products are also similar, it will be difficult to determine whether consumer confusion is help apa research paper likely. In one case, the for the of books rita dove, owners of the mark Slickcraft used the mark in connection with the sale of boats used for general family recreation.

They brought an infringement action against a company that used the mark Sleekcraft in help apa research paper, connection with the sale of high-speed performance boats. Because the two types of john boats served substantially different markets, the help apa research, court concluded that the products were related but not identical. However, after examining many of the factors listed above, the essay by alex haley, court concluded that the help paper, use of Sleekcraft was likely to cause confusion among consumers. AMF Inc. v. Sleekcraft Boats, 599 F.2d 341 (9th Cir. 1979). In addition to bringing an action for infringement, owners of trademarks can also bring an need essay action for help with apa research paper, trademark dilution under either federal or state law. Under federal law, a dilution claim can be brought only writting essay, if the apa research, mark is famous. In deciding whether a mark is famous, the need help essay, courts will look to the following factors: (1) the degree of inherent or acquired distinctiveness; (2) the duration and extent of use; (3) the help apa research paper, amount of advertising and publicity; (4) the geographic extent of the market; (5) the channels of trade; (6) the degree of recognition in love of books essay, trading areas; (7) any use of similar marks by third parties; (8) whether the mark is registered. 15 U.S.C. With Paper? ? 1125(c). Kodak, Exxon, and Xerox are all examples of famous marks.

Under state law, a mark need not be famous in order to give rise to a dilution claim. Instead, dilution is available if: (1) the mark has selling power or, in other words, a distinctive quality; and essay on roots by alex haley (2) the two marks are substantially similar. Mead Data Central, Inc. v. Apa Research? Toyota Motor Sales, U.S.A., Inc., 875 F.2d 1026 (2d Cir. Essay On Roots Haley? 1989). Once the prerequisites for a dilution claim are satisfied, the owner of a mark can bring an with action against any use of that mark that dilutes the need writting, distinctive quality of that mark, either through blurring or tarnishment of that mark; unlike an infringement claim, likelihood of confusion is help paper not necessary. Blurring occurs when the power of the design, mark is weakened through its identification with dissimilar goods.

For example, Kodak brand bicycles or Xerox brand cigarettes. With Apa Research? Although neither example is for the dove likely to cause confusion among consumers, each dilutes the distinctive quality of the mark. Tarnishment occurs when the mark is cast in an unflattering light, typically through its association with inferior or unseemly products or services. So, for example, in a recent case, ToysRUs successfully brought a tarnishment claim against adultsrus.com, a pornographic web-site. Toys R Us v. Akkaoui, 40 U.S.P.Q.2d (BNA) 1836 (N.D. Cal. Help Paper? Oct. 29, 1996). Although likelihood of confusion and rich vocabulary for essays dilution are the two main trademark-related causes of action, there exist a number of additional state-law causes of action under state unfair competition law: passing off, contributory passing off, reverse passing off, and misappropriation. Passing off occurs when the defendant tries to pass off its product as the plaintiff's product.

So, for example, manufacturing computers and claiming that they are made by Apple Computer, Inc. Contributory passing off occurs when the defendant assists or induces another (typically a retailer) to pass of its product as the paper, plaintiff's product. So, for example, inducing a computer store to represent that the computers are made by Apple, when in fact they are not. Reverse passing off occurs when the defendant tries to pass off the plaintiff's product as its own. So, for example, taking a computer made by Apple, removing the label, and john putting on with apa research, a different label. Finally, misappropriation is essay a highly unstable, but potentially fruitful source of additional trademark-related claims. Defendants in a trademark infringement or dilution claim can assert basically two types of affirmative defense: fair use or parody. Fair use occurs when a descriptive mark is help apa research used in john video essay, good faith for with apa research paper, its primary, rather than secondary, meaning, and no consumer confusion is likely to result.

So, for example, a cereal manufacturer may be able to describe its cereal as consisting of all bran, without infringing upon Kelloggs' rights in the mark All Bran. Such a use is purely descriptive, and essay on roots by alex does not invoke the secondary meaning of the mark. Similarly, in one case, a court held that the defendant's use of fish fry to describe a batter coating for fish was fair use and did not infringe upon the plaintiff's mark Fish-Fri. Zatarain's, Inc. v. Oak Grove Smokehouse, Inc., 698 F.2d 786 (5th Cir. 1983). Such uses are privileged because they use the terms only in their purely descriptive sense. Some courts have recognized a somewhat different, but closely-related, fair-use defense, called nominative use. Nominative use occurs when use of a term is necessary for purposes of identifying another producer's product, not the user's own product.

For example, in a recent case, the newspaper USA Today ran a telephone poll, asking its readers to vote for their favorite member of the music group New Kids on the Block. The New Kids on the Block sued USA Today for trademark infringement. The court held that the paper, use of the for the, trademark New Kids on the Block was a privileged nominative use because: (1) the help with apa research paper, group was not readily identifiable without using the mark; (2) USA Today used only so much of the mark as reasonably necessary to identify it; and (3) there was no suggestion of endorsement or sponsorship by the group. The basic idea is that use of a trademark is bresland essay sometimes necessary to identify and with paper talk about another party's products and services. When the above conditions are met, such a use will be privileged.

New Kids on the Block v. News America Publishing, Inc., 971 F.2d 302 (9th Cir. 1992). Finally, certain parodies of trademarks may be permissible if they are not too directly tied to for the of books essay commercial use. The basic idea here is that artistic and editorial parodies of trademarks serve a valuable critical function, and that this critical function is entitled to some degree of First Amendment protection. The courts have adopted different ways of incorporating such First Amendment interests into the analysis. For example, some courts have applied the general likelihood of confusion analysis, using the First Amendment as a factor in the analysis. Other courts have expressly balanced First Amendment considerations against the degree of likely confusion.

Still other courts have held that the First Amendment effectively trumps trademark law, under certain circumstances. In general, however, the courts appear to with apa research paper be more sympathetic to the extent that parodies are less commercial, and less sympathetic to the extent that parodies involve commercial use of the mark.

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