Choosing Appropriate Quantitative Research Design

Choosing Appropriate Quantitative Research Design Quantitative research is designed to provide quantitative (numerical) data that answers questions related to trends, attitudes, opinions, or the impact of treatment on a population. Before quantitative research begins, it is necessary to identify the purpose of the study, the population to be studied, the variables involved in the study, and the type of data that would be most useful as an end product. After identifying these components, researchers can next hone in on the design of the research, the design of the research collection tool, sampling procedures, the survey or measurement instrument, data collection methods, and data analyses methods (data organization, data interpretation, scaling, etc.) and issues (validity, reliability, threats to validity, etc.).The research is based on theory or hypotheses and is usually tests for the impact of an intervention on a population. The impact of an intervention or treatment may be measured using traditional experimental methods and proc esses or by survey methods. Survey methods include personal interviews, telephone interviews, mailed questionnaires, group administered questionnaires, or dropped-off household surveys (Trochim, 2006). Though the process is presented in simple terms in this paper, the actual design process is a very complex set of decisions related to the methodologies and procedures of quantitative research. This paper seeks to outline the strengths and limitations of the most widely used research design models to determine the appropriate research design for quantitatively researching the use of technology web 2.0 innovations to determine its effect on learning and test performance in the elementary classroom. The quantitative study of the social science is especially challenging because of the fact that the independent variables cannot be manipulated and that the research must often be performed in real time in a natural setting. The research is characterized by the manipulation of a variable but extreme care must be taken not to harm the study participants in any way throughout the study. Research is usually centered around the determination of a property-disposition relationship (attitude-focused) or a stimulus-response relationship (behaviorally-focused). Quantitative researchers must determine which type of relationship is best suited for their specific study. The following are critical factors in making this critical determination: Time Interval: the period of time between introduction of the independent variable and the response to the variable Degree of specificity: isolation of the independent variable to determine its effect Nature of comparison groups: comparison of before/after groups or experimental/control groups for statistical analysis Time sequence of events: determining the timeline for the relationship between cause and effect These elements of quantitative research drive the decisions regarding research methodologies and procedures related to choosing an appropriate research design. The following is a brief overview of the research designs used in social sciences. Quantitative Research Design Comparison Experimental Design Experimental design is usually associated with the life and physical sciences where independent variables are easily manipulated. Experimental design compares the results of an experimental group (that receives exposure to an independent variable) with a control group (that does not receive exposure to an independent variable). This design often uses a pretest and posttest measurement to analyze the differences between groups. The advantages of this type of research design for studying social science include the ability of the researchers to introduce and control extrinsic and intrinsic (independent) variables as well as the easy identification of causal inferences that strengthen the validity of the research. Disadvantages of experimental design for social science includes the inability to replicate the experiment in a real-life social setting resulting in weak external validity and the reliance on volunteers or self-selected participants who may not represent the actual population. As a result, generalizability is decreased due to the small sample of participants selected for the study. Cross-Sectional and Quasi-Experimental Designs Cross-sectional design is recognized by its utilization of surveys to determine study participants backgrounds, past experiences, and attitude to determine the relationship between research variables. This type of research is not conducive to experimental design because of the difficulties in manipulating the independent variable during the study. Cross-sectional design relies on statistical analysis to approximate the relationship between variables and may not produce accurate causal inferences. Internal validity is weak as a result. Quasi-experimental design is identified by random selection of study participants without the requirement of random selection of participants to a comparison group, study of more than one population sample, and studies conducted over time. It is difficult to disaggregate the data produced by this type of study since the population sample will consist of a mixture of subjects with various traits and characteristics. Causal inferences are difficult to determine with this design. Performing the study over time and the analysis of data by (similar) categoric or contrasted (different) groups are strategies used to increase the validity of this design for social science research. Planned variation design, panels, time-series designs, and control-series designs are alternative quasi-experimental social science research designs that attempt to increase internal and external validity by controlling stimuli introduction, research methods, cause-and-effect identification, and causal inference determination respectively. Combined designs employ two or more of the designs mentioned above in effort to assess the causal effects of variables using a multi-method, multi-design approach to studying social science. The advantages offered by these designs include increased internal and external validity as a result of the ability to perform research in real-life, natural settings with a representative population. Since there is no assignment of participants to treatment or comparison groups, researchers are able to perform studies that could be considered unethical or impossible using traditional experimental designs. The disadvantages associated with these designs include difficulty determining causal inferences (due to a wide variety of differences inherent in the study population) and the inability of researchers to manipulate the independent variable. Pre-Experimental Design Pre-experimental design is appropriate when no other design is able to study a population due to limitations in time, population, or a specified event. If there is a single event that occurs at a specified time for a specified group of people, there is only one opportunity to study the impact of a treatment. For this reason, pre-experimental design is considered to be the weakest type of research design with a high risk of causal inference error. There is usually not an assignment of subjects to an experimental or control group and this design usually does not include a comparison group. A one-shot case study is often used with this type of design and does not offer high validity due to the limited ability to generalize study results to a wider population. An advantage of this design includes allowing researchers the ability to scientifically show that more research is needed to explore a particular hypothesis. Weak internal and external validity and the inability to make causal infe rences are considered to be disadvantages for this research design. Determining Which Design is Most Appropriate My research problem studies the relationship between the use of web 2.0 innovative technologies (such as Skype, Second Life, etc.) and depth of research, test performance, and self- motivated learning for grade 3 through 8 students. Important factors that are necessary to consider are the identification of the independent variable, identification of dependent variables, availability of a control or contrast group, ethical implications of this study, and availability of the study (treatment) population. The independent variable in the study is the use of web 2.0 technologies for research. Dependent variables are research depth, test performance, and student self-motivation to learn. The grade 3 through 8 students for the control group and experimental group are available at my current place of employment. Since the treatment involves using technology to learn, there is no presumed risk or ethical issue since using technology is an ordinary part of the students day of learning. The tre atment of using technology for communication over the Internet is a manipulation of the use of technology in the classroom. Special care will be taken to ensure that students adhere to Internet safety rules during communication sessions. Experimental design is the most appropriate research design for this study for the following reasons: Availability and randomization of control and experimental groups Variables can be easily manipulated Pre-test and post-test measurements are possible Causal inferences will be easily identified Johnson and Christensen (2007) state that quantitative research is appropriate for describing what is seen and generating new hypotheses and theories. Since the measurements of the dependent variables reflect behavioral rather than cognitive outcomes, the tools used to measure the study outcomes will not include surveys but rather observational logs. This further supports the use of the experimental design for this study. Other Considerations Other research designs are not considered appropriate and are detailed for the following reasons. Cross-sectional design is not appropriate for this study because surveys are not necessary to determine the participants backgrounds, past experiences, or attitudes. Also, since the independent variable can be manipulated, statistical analysis will not be necessary to approximate causal inferences. Quasi-experimental design should not be employed since the assignment of participants to a control or comparison group is possible and there is no need for an extended period of time for this study. Also, there is no need to systematically introduce stimuli, use panels, or take measurements over a number of time periods. Data is not expected to change for individuals due to history, maturation, or test-retest effects. Furthermore, there are no ethical considerations present in the experimental design for the study. Lastly, the pre-experimental design is not appropriate for this study since thi s is not an event-based or time-sensitive study.

Medical Tourism: Study Case of Ijn

Medical Tourism Sustainability through the Export Market Orientation Behaviours: The Case Study of Institut Jantung Negara (IJN) Ili-Salsabila Abd-Razak1 and Asmat Nizam Abdul Talib Universiti Utara Malaysia, Kedah, MALAYSIA The inclusion of tourism sector as one of the 12 recognized national key economic areas (NKEA) for the 10th Malaysia Plan represent the sector’s prospect in not only driving the nation’s economy, but also transforming the country into a high-income economy by 2020. With approximately 10 years left, many concerned groups are keen to know how this will be achieved.This paper aims at exposing the prospects of medical tourism as an essential subsector of tourism which would offer a number of proven benefits, and hence contribute to accomplishing the government aspiration of transforming the nation’s economy via the said sector. In discussing the subject, the case study method is employed involving Institut Jantung Negara (IJN) as an emerging medi cal tourism provider in the country. Findings of the case study are presented herein. Key words: medical tourism, economy, Institut Jantung NegaraIntroduction The promising prospect of tourism as an economic stimulator has enabled it to be included in the list of 12 National Key Economic Areas (NKEA), which has been specifically drafted to transform the Malaysian economy into high-income economy by year 2020. While there are tremendous numbers of tourism categories, ranging from environment, cultural, sports, and entertainment, to name a few, this paper intend to highlight on the prospects of medical tourism as a significant tourism-related economic contributor in this country. Connell (2006) defined medical tourism as health-related tourism involving specific medical intervention. Among the most popular medical tourism products are orthopaedic and cardiac surgery, which are very popular among Asian medical tourism providers, as well as executive health evaluations, cosmetic surgery , joint replacement, and similar complex medical, surgical and dental procedures (Horowitz and Rosensweig, 2007).Therefore this is a distinguished industry than that of the wider health tourism industry which involves tourists travelling to search for spas, yoga and meditation, or any other forms of health tourism (Connell, 2006; Garcia Altes, 2005). 1 Email: ili. [email  protected] com 169 In a relatively detailed account of medical tourism development which began in 1800s, Schroth and Khawaja (2007) proposed that the current phenomenon is different due to the unique combination of global demand and supply within the international medical market.As observed in the region, this proposition is regarded as well-founded. The present development of medical tourism in the international market is very unique, manifested by the escalating statistics of players, patients and revenues generated around the globe of late. How Malaysia is positioned within this backdrop, and how it would affe ct the development of this fast emerging economy, are among the focus of discussion of this paper. The Statistical Development of Medical Tourism Medical tourism has been a very significant industry over the years.By judging from its health travel umbrella, the sector is expected to generate some handsome revenue of RM240 billion (roughly USD73 billion) in 2010, with ASEAN contributing RM9. 6 billion (roughly USD3 billion) (PEMANDU, 2010). Specifically focusing on medical tourism industry, the anticipated revenue to be generated in Asia is RM14. 2 billion by 2012 (roughly USD4. 3 billion), with Malaysia is expected to bring in RM2. 1 billion (roughly USD64 million) from that amount (Ang, 2009).As a comparison, India, another top Asian medical tourism destination, expects to gain USD2 billion by the same year (Connell, 2006; Horowitz and Rosensweig, 2007). These statistics surely are translated by a growing number of medical tourists around the globe. The movement of medical tourists is another significant indicator of this trend. At the global stage, approximately 350 000 medical tourists moved from developed nations to less developed countries for treatment in 2003, while a year later 1. 18 million patients travelled to India alone and another 1. million to Thailand for the same reason (Horowitz and Rosensweig, 2007). Glancing at the local development, the Association of Private Hospitals of Malaysia (APHM) has been projecting for a stable 30% growth of takings from foreign patients until 2010. This is apparent from the steady increase of foreign patients to Malaysia which recorded a total of 39 114 patients in 1998 and 374 063 patients ten years later (APHM; Liow, 2009). In terms of revenue, RM14. 1 million was documented in 1998 before jumped to RM299. million in 2008 (APHM; Liow, 2009), and is expected to contribute to another RM540 million in 2010 (Leonard, 2009). The revenue per patient has almost tripled from RM360 in 1998 to RM800 in 2008 (Choy, 2010). In the latest development, medical tourism is expected to generate RM4294. 4 million of Gross National Income, together with 5295 jobs in 2020 (PEMANDU, 2010). This occurrence has readily attracted a number of giant MNCs with diversified structure such as General Electric (GE) to invest further in the industry (Panjanadan, 2010). The Revolution of Medical TourismThe presented statistics did not appear by chance. The numbers occurred out of plausible factors. The development of medical tourism industry is indeed different (Horowitz and Rosensweig, 2007). As mentioned earlier, Schroth and Khawaja attributed the uniqueness of the industry’s current development to the forces of market’s demand and supply, which is in resonance with Horowitz and Rosensweig (2007) who ascribed it to the movement of patients from industrialized nations to less developed countries. Connell (2006) argued that medical tourism is a niche which 170 xperienced rapid growth and has become an indust ry. The said paper also enlisted several factors promoting the development of medical tourism, such as the low costs factor, the long waiting list, the relatively affordable international air travel and favourable exchange rate, plus the aging of the baby boomers generation. These factors are also often cited in a number of studies regarding medical tourism such as Hansen (2008), Herrich (2007), Horowitz and Rosensweig (2007), Garcia Altes (2005), Marlowe and Sullivan (2007), and Schroth and Khawaja (2007), to name a few.Apart from these popular factors, other notable factors motivating the development of the industry spotted in the literature extent are the use of internet and mobility of technology, the unavailability of certain procedures in the local market, and the reduced trade barriers encouraging the mobility of workforce. Hansen (2008) argued that the revolution in medical tourism today is consumer-driven. This is in line with Horowitz and Rosensweig (2007) who argued that the industry is market driven with complex involvement of multitude medical, economic, social and political factors.While the progress of the industry seems to be very promising, the general overview of Malaysia’s involvement at the international level is not very charming. Even though medical tourism experienced an astounding per annum growth of 22% from 2004 to 2009, the global share is still considered as small with RM350 million in 2010 (PEMANDU, 2010). Furthermore, PEMANDU also reported that while the global healthcare travel is a multi-million dollar industry, Malaysia is yet to get a sizeable share.The said industry is expected to generate USD75 billion of revenue in 2010 at the global level, while Malaysia is expected to make about USD0. 1 billion. The statistics provide a brief sight on the development in the country weighted against the global development. Malaysia should therefore be proactive enough to catch up with the global progress to stay competitive in the i ndustry. To enable this, the players and responsible parties must quickly recognize potential constraints that can hamper the development and address the issues well.The Required Expertise and the Potential Economic Opportunities Based on previous arguments, medical tourism offers bountiful opportunities and chances. In order to remain competitive at the global stage, marketing strategies should be revised against the present circumstances. Marketing the medical expertise and offerings should be distinctively conducted. The primary concern of assessing an excellent marketing strategy is the effectiveness of the strategies implemented.StuartKregor (2005) argued that defining marketing excellence for medical-related industry is different with that of the commercial-based industry. As customer is the centre of marketing excellent in the industry, the paper suggested that the effectiveness of marketing strategies should then be done by measuring the customer’s satisfaction over t he service provided. Therefore, all other marketing excellence measured by considering the profit, return on investment or sales as in any other commercial industries should be changed to be more customer-oriented rather than organizationaloriented. Building he strategies can be done by â€Å"developing, communicating and delivering the right emotional benefits to the targeted customers† (Stuart-Kregor, 2005, pp. 117). The right emotional benefit here is viewed as brand by Stuart-Kregor (2005). This paper is in agreement with the argument, which is to develop the marketing strategies by focusing on the emotional benefits (brands), and assess the effectiveness of the strategies by measuring the satisfactions of the customer. Further discussion on this is available in the next section. 171 The science of excellent marketing strategies would be wasted without a good delivery system.The state of local expertise, technologies and facilities must be attended to in order to assess t he quality of the service offered against the global level. This is where the industry should strive to be as similar as other excellent providers. The commodification of medical tourism (Chee, 2007) is an evident of this occurrence. Dunn (2007) argued that patients are making choices on medical tourism destinations based on how similar is the service delivered, especially concerning patients from industrialized nations, and the service is expected to come with much lower price.Consequently, it is observed that patients are not looking for low cost products at the expense of the quality in the industry. Successful players realize this and capitalize on the factors well. This explains the rapid movement of workforce and technologies across the four corners of the world. India as an example has been successful in luring its medical doctors who have been trained and worked abroad to return with their internationally recognized expertise and work in the country.Thailand and United Arab Emirates have been successful in rearranging for international collaboration in the industry (Schroth and Khawaja, 2007). Through these strategies, the countries have been able to keep their expertise, technologies and facilities up with the global standard. Proposed Strategies of Reviving and Sustaining Medical Tourism: The Case of IJN With the national governments’ involvement recently (Chee, 2007; Noor Hazilah, Roslan Johari and Kadar, 2010; PEMANDU, 2010), the industry has been attracting the interest of many concerned parties.Since the medical tourism is fast becoming a commodity (Chee, 2007), its marketing strategies should be focusing more on brands and less on products to be distinctive than other providers. As in Malaysia, the country is capable of offering similar products with the rest of other players in the world. While Malaysia has been focusing on cost all this while, it is suggested then for the country to deliver a unique brand which is capable of attracting the interest of potential medical tourists, without desecrating the cost advantage.In order to do so, it is particularly important for the players to implement the export market orientation behaviours within their organization, which are generating, disseminating and responding to the export market intelligence (Cadogan, Diamantopoulos and de Mortanges, 1999). Consequently, Malaysia is expected to be able to woo medical tourism patients even more. Hazilah et al. (2010) reported that a medical tourist spends double than a regular tourist while they are in the country. This high buying power therefore is capable of generating more economic opportunities.The medical tourist needs are also offering a lot of opportunities for Malaysian. Apart from medical attention, they need to have accommodation for their accompanying family members. New jobs have been underway to better serve the medical tourists, such as the healthcare broker. A healthcare broker assists the patient to choose a medic al institute and arrange for the patient’s needs while in here, including visa, accommodation and holiday arrangement. Thanks to the internet, these can be arranged prior to the patient’s arrival in the country.To describe more of these strategies and opportunities, this paper choose to present the IJN as a case study merit the discussion. The National Heart Institute or Institut Jantung Negara (IJN) has been established in 1992. The privatization of the institute was done on many premises, especially concerning the potential it has to expand its expertise and to liberalize the 172 financial capabilities of the institute. IJN did not take long to materialize that. A year after its privatization the institute has been able to be financially liberalized and hence reduce the government intervention in its administration.By now, IJN has accomplished a great number of medical milestones recognized not only in the country and the region, but also internationally. To further advance ahead in medical industry, IJN is joining its local peer private institutions to take part in the global medical tourism industry. The previous mentioned factors of global medical tourism industry’s progressive development served as the basis for IJN to be a part of the industry. Besides, like Singapore, the medical tourism industry in Malaysia is receiving a lot of government’s assistants.Being a nationally structured industry, medical tourism therefore is regarded as a potential industry in which would be able to position IJN better. The Malaysian government has been playing an active role in developing the industry in Malaysia since 1998. The main driver of this is to revive the private medical industry after the 1997 Asian economic downturn which has affected the industry very badly. The success story of Thailand which managed to get the industry out of the crisis by focusing on delivering the service to foreign patients has prompt the government to encoura ge private players to do the same.Consequently, while Thailand has been restructuring the industry without much government involvement, Malaysia and Singapore has been leveraging the industry well with cooperation between the public and the private sectors. IJN has been viewing this very positively and has since become a significant player in the region. While being rapidly developing the industry, the players recognized several major constraints which are able to slow down the progress. Coordination is a key constraint. To increase coordination, the Association of Private Hospitals of Malaysia (APHM) was formed to increase coordination between the private players.The steadily increasing number of foreign patients and revenues generated since 1998 as shown in Table 1 is an evident of the successful strategies implemented. However the industry, weighted against the global development, was still considered as insignificant. Resulting from the government’s enthusiasm towards med ical tourism as a prospective economic driver industry, and the intensity and potentials portrayed by private sectors, the Malaysia Healthcare Travel Council (MHTC) was established in July 2009.The main purpose of the council is to coordinate promotional activities of medical and healthcare tourism industry in the country. As a part of the economic transformation program, the industry is expected to shift their attention to generate higher patients’ volume, expand the target market beyond Indonesia which is currently the main market of the industry, create alliance across border, and enhance customer experience in the first phase of the strategy. In the following phase, more attention is given on mproving the infrastructure and specialists capacity to attract the more profitable in-patient segment (PEMANDU, 2010). 173 Table 1. The Volume of Foreign Patients and Revenue Generated by Medical Tourism Industry in Malaysia Year 1998 2001 2002 2003 2004 2005 2006 2007 2008 Medical Tourists/Foreign Patients 39,114 75,210 84,585 102,946 174,189 232,161 296,687 341,288 374,063 Revenue (RM million) 14. 1 n/a 35. 9 58. 9 105. 0 150. 9 203. 66 253. 84 299. 1 Another strategy to improve the medical tourism performance is through focusing on specific players.There are approximately 223 private hospitals operating in the country in 2008 (Frost & Sullivan, 2009). Of this number, the government has decided to focus on 35 private hospitals to capitalize on the industry with several characteristics outlined. The characteristics include being a member of APHM, has obtained the Malaysian Society for Quality in Health (MSQH), ISO or other international accreditations, offers major specialties and/or some sub-specialties, provides for a minimum 50 beds, and has its own websites.IJN has been one of the selected 35. The commitment demonstrated by IJN towards the industry is paramount. In order to be internationally recognized, the institute has been striving hard to be in the s ame par with the other international organizations. IJN has been accredited by JCI in 2009, which is a recognition of the strong culture of safety and quality within the organization. The internationally recognized accreditation is expected to improve IJN’s international positioning in the future.IJN realizes that in order to make the most of the industry, it needs to build a customer-oriented system. Beginning in 2006, the institute has been conducting the Customer Focused Program. The program was aimed at transforming IJN into a global centre of excellence by ensuring customers’ satisfaction. In 2008, the institute launched what was designed as the second phase of the program, called Customer Focused Culture. While the CFP was initiated to increase awareness of ensuring customers’ satisfaction, the CFC aimed at internalizing the institute’s shared values across the rganization. IJN also comprehend its capacity constraint which is becoming the largest hi ndrance from going big in the global medical tourism industry. Apart from improving on its culture system, the institute has been adamant in enhancing its infrastructure capabilities. A major extension work has been carried out at IJN to expand its capacities from 270 beds to 432, eight wards to 13, 23 outpatient clinic rooms to 59, and an international patient centre, to improve its service for customers.This is in line with numerous governments’ incentives offered to the private hospitals embarking on medical tourism industry to expand their infrastructure capacities. In August 2009, IJN has its new wing officiated by the Malaysian Prime Minister, who acknowledged that the institute has undergone RM230 million expansion program since 2005. In the same ceremony, the Prime Minister has also announced the proposal for IJN to become a research and development institute, measuring itself against the international best heart institute such as the Cleveland Clinic Heart Centre in the US.These are all evidences of how IJN has been greatly employing the export market orientation behaviors within its organization. In commenting the current development of the industry, IJN has expressed its concern for the country to be more progressive towards promoting medical tourism. 174 The IJN Holdings Group Managing Director, Datuk Mohd. Radzif Mohd. Yunus mentioned that the failure for Malaysia to capitalize on its capabilities in the industry would result to the loss of human capital as they will migrate to other countries with better offers.This is also reiterated by Datuk Syed Hussien Al-Habshee, the Secretary General of National Chambers of Commerce and Industry Malaysia (NCCIM) who said that the country need to step up its marketing efforts of medical tourism if it wants to catch up with Thailand and Singapore. PEMANDU (2010) has confirmed the assertion by reporting on the stronger growth of the industry by neighboring Thailand and Singapore. The set up of MHTC and several other initiatives are therefore deemed as timely to help Malaysia to rise in the industry at the global stage.Conclusion and Recommendation As exemplified in the discussion, medical tourism offers a lot of economic opportunities and hence is indeed a potential contributor to economic growth. However, Malaysia, while has been enjoying the growth of the industry vehemently over the pass few years, has not been capitalizing the industry well compared to the other global players. Therefore, the Malaysian players need to revise their marketing strategies and delivery system, as represented by IJN.The cooperative efforts between the public (government) and the private sectors too must be further carried on, especially for the sake of protecting the interests of the local society and the survival of the medical tourism players. It is strongly suggested for medical tourism players in the country to leverage on their expertise by focusing the marketing strategies on brands rather tha n on products, as well as enhancing on their infrastructure and culture systems to be more export market-oriented. In doing so, however, the players must not disregard the country’s current edge, which is the competitive cost.In terms of theoretical development, this paper is believed to be able to expose the medical tourism niche and its economic opportunities, as well as the marketing strategies fitting the industry. Quite a number of studies involving Malaysian medical tourism industry have been conducted. Nonetheless, this paper presents the scenario from the view of a single case study. It is highly suggested for similar studies to be conducted with the presence of empirical data to see the quantifiable aspects of the industry in the future.With such studies, it is expected that further theoretical contributions can be made, and hence the progress of the industry can then be expedited even more. Reference Ang, Elaine. Malaysian Medical Tourism Growing. The Star, February 14, 2009. Cadogan, J. W. , Diamantopoulos, A. , & de Mortanges, C. P. (1999). A measure of export market orientation: Scale development and cross-cultural validation. Journal of International Business Studies, 30(4), 689-707. Chee, H. L. (2007, January). Medical tourism in Malaysia: International movement of healthcare consumers and the commodification of healthcare. ARI Working Paper, No. 3. Retrieved from www. ari. nus. edu. sg/pub/wps. htm Choy, L. B. (2010, April 13). Medical tourism good for Malaysia’s health. News Straits Times. Retrieved from http://findarticles. com/p/news-articles/newstraits-times/mi_8016/is_20100413/ medical-tourism-malaysias health/ai_n53130944/ 175 Connell, J. (2006). Medical Tourism: Sea, sun, sand and †¦ surgery. Tourism Management, 27. 1093-1100. Dunn, P. 2007. Medical Tourism Takes Flight. Hospitals and Health Networks, 81(11): 40-44. Frost & Sullivan (2009, October 28). Frost & Sullivan: Growing healthcare tourism in Malaysia. Retrieved from http://www. alaysiahealthcare. com/ Garcia-Altes, A. (2005). The development of health tourism services. Annals of Tourism Research, 32 (1): 262-266. Hansen, F. (2008). A revolution in healthcare. Review-Institute of Public Affairs, 59(4), 43-45. Health and medical tourism will boost growth: Datuk Liow Tiong Lai. The Star, November 08, 2008. Retrieved from http://www. wellnessvisit. com/liowhealth-and-medical-tourism-will-boost-growth. php Herrick, D. M. (2007, November). Medical tourism: Global competition in health care. NCPA Policy Report, No. 304. Retrieved from www. ncpa. org/pub/st/st304 Horowitz, M. D. Rosensweig, J. A. , & Jones, C. A. (2007). Medical tourism: Globalization of healthcare marketplace. Medscape General Medicine, 9(4), 33. Leonard, T. (2009, October 28). Medical tourists to bring in RM540mil by 2020. Retrieved from http://www. malaysiahealthcare. com/ Marlowe, J. , & Sullivan, P. (2007). Medical tourism: The ultimate outsourcing. HR. Human Resource Planni ng, 30(2), 8-10. Noor Hazilah Abd Manaf, Roslan Johari Dato’ Mohd Ghazali, & Kadar Marikar. (2010). â€Å"Positioning Malaysia in Medical Tourism†. Paper presented at the International Conference on Marketing (ICMAR), June 2010, in Kuala Lumpur.Panjanadan, S. (2009, August 9). GE looking into enhancing presence in tourism Retrieved from healthcare. http://bernama. com/bernama/v5/newsbusiness. php? id=519842 PEMANDU (2010, September 21). Healthcare-EPP Panels. Retrieved from http://www. pemandu. gov. my/index. php? option=com_content&view=article&i d=619&Itemid=139&lang=en Schroth, L. , & Khawaja, R. (2007). Globalization of healthcare. Frontiers of Health Services Management, 24(2), 19-30. Speech by YB Dato’ Sri Liow Tiong Lai, Minister of Health Malaysia, at the APHM International Healthcare Conference and Exhibition at KLCC,

What You Dont Know About Diagnostic Essay Samples

What You Don't Know About Diagnostic Essay Samples Rumors, Deception and Diagnostic Essay Samples The very best outline which is appropriate for the diagnostic essay is a standard five-paragraph structure. If you're anxious about the approaching writing of your diagnostic essay, you can get in touch with our essay service for the in depth advice. Any excellent essay should end with a highly effective conclusion. Keep in mind you need to only proceed to writing your introduction whenever you have made sure that you comprehend the topic and already understand what you will write in the major body of your diagnostic essay. To put it differently, before writing your essay introduction, you have to understand just what you are introducing. Next, you've got to rephrase the thesis statement and complete the essay with a sentence that encourages the reader to find out more about your topic. A diagnostic paragraph example would consist of writing based on every one of the 3 reasons keeping your essay thesis for a focus. Without further ado, here is a good example of diagnostic essay, written as a response to the subject of the importance of education. Stressing out about the whole writing process isn't going to assist you in any manner. Simply take a while to find the most important idea and just then you can begin writing. Ultimately, make certain that you allot plenty of time for every one of the writing steps. If you aren't sure in your speed of writing, it is a good idea to practice time after time. What Diagnostic Essay Samples Is - and What it Is Not Students must compose diagnostic essays to be able to showcase the skills they already have. They are expected to time themselves and use proper prewriting skills. Sometimes, they don't know how to start writing. To decide on a college major, they should enroll in a variety of courses and speak with people who work in their potential fields of study. Seeking for a response to the question how to compose a diagnostic essay, it's essential to look at all aspects that will enable you to impress your teacher. Answering the incorrect question won't help you showcase your abilities and will cause you to look to be an inattentive student. The Master's thesis isn't a last assignment, so an interview won't be completed. Try to remember that good proofreading skills ought to be there too! For instance, you could discuss the mental effort you had to make to be able to finish the assignment. In order to earn an excellent first impression at a job interview, a candidate must be correctly prepared. As soon as you've read the prompt and answered the question, examine your answer and write down three explanations for why you believe your answer is accurate. In the majority of situations, you will be provided a particular prompt or question to write about. In fact, diagnostic essay isn't really functioning like a regular research paper. O nce you are aware of how to compose the paper, obviously, you are going to want a topic and thesis statement. The paper has to be typed, double-spaced. Note, which you aren't alone in writing diagnosis paper. In the 2nd major body paragraph of your essay, you speak about the 2nd hardest decision you had to make. After our example with the subject of hard decisions, the very first paragraph would chat about the hardest decision you had to make, in your opinion. The very first body paragraph ought to be the strongest one. To start off, it's a superb notion to paraphrase the topic which you were given to write about. The introductory part of your work ought to start with the reiteration of the subject or the response to the question that was given as your prompt. You will discover that lots of the topics can be adapted to suit almost any sort of writing assignment. Don't make the error of writing all of the info you know regarding a specific topic. Men and women who need to entice prospective dates want to establish an appealing on-line profile. New information can't be introduced. If you lose out on the important elements they wish to see, nobody will have interest to carry on reading your work. The Hidden Truth About Diagnostic Essay Samples An evaluation essay resembles a review because you have to examine both the beneficial and negative facets of something. Obviously, there's a specific sort of folks who start acting efficiently in the stressful circumstance. The principal issue is that I am too shy. Depression is the commonest mental illness on earth yet just a few can let you know what exactly it is. Diagnostic Essay Samples - Dead or Alive? If you're discussing a theory or research study make sure that you cite the origin of the info. Collect as much information as possible and make sure that the content is diverse. If your topic came in the shape of a prompt, then you need to just make sure you have answered it. Following that, you should introduce the subject.

Animal Testing No Harm, Only Benefits - 1710 Words

Korey Gonzales ENGWR 300 Ms. Perales April 5, 2016 Animal Tests: No Harm, Only Benefits As the years have passed the human race has come across and discovered many different diseases. Many of the diseases were lethal due to the fact that there was no cure to be found. But as years went on our technology began to â€Å"evolve†, we found cures for what many would think are incurable. The practice of using animals in biomedical research has led to significant advances in the treatment of various diseases. Animals would be injected with the disease and through series of tests they created a vaccine to fight off the disease. Many animals are related to humans and share the same emotional status as humans do. There are experiments where dogs are†¦show more content†¦Another fact about animal testing is that â€Å"The polio vaccine tested on animals, reduced the global occurrence of the disease from 350,000 cases in 1988 to 223 cases in 2012† (Curie). Research on animals granted scientists with major advances in the c omprehension and treatment of breast cancer, brain injury, childhood leukemia, malaria, and an immense amount of others, and involved in the creation of pacemakers, cardiac valve substitutes and anesthetics. Chris Abee, the director of M.D. Anderson Cancer Center animal research center explains, â€Å"We would not have a vaccine for Hepatitis B without chimpanzees...the use of chimpanzees is our best hope for finding a vaccine for Hepatitis C† (Education Research). If the vaccines created by humans were not tested on animals, millions of animals would have died from rabies, distemper, feline leukemia, infectious hepatitis virus, tetanus, anthrax, and canine parvovirus (Biomedical research). There are even treatments for animals that were developed using animal testing. Pacemakers for heart disease and remedies for glaucoma and hip dysplasia (Biomedical Research). Rachel Hajar, a Biologist, states â€Å"Animal testing has also been a great help in saving endangered species fr om extinction, including the black footed ferret and the Condor species. Even Koala bears are catching sexually transmitted chlamydia and now classified as endangered in some regions of Australia (Hajar).

Foreign Language As A Foreign Country - 1729 Words

The first word that comes out from one’s mouth decided what his or her native language is. Although if one can be born and raised in the United States, but if his or her first word was Korean, then that would be his or her native language. Today, many countries try to advocate their students to be a bilingual;fluent in the native language as well as a foreign language. Without being able to go abroad with a natural learning environment that can help one to practice his or her language skills, would it be effective to learn a foreign language in a foreign country? In fact, not everyone is given the opportunity to learn a foreign language abroad, but to learn it in a classroom. In a language school, the lessons is focused on writing and speaking. Since there are many learning styles such as visual, auditory, and tactile, what is the best way to pick up a foreign language? Learning does not have to be limited to books and classroom instruction; therefore, I want to find ou t the best way to learn a foreign language. As a result, the most efficient way to learn a language is to practice it. Everyone has a different learning style. There are visual learners, auditory learners, and tactile learners. It all depends on one’s learning style to determine the best way for them to learn. Visual learners need to learn through reading or seeing pictures. Their way of understanding the lessons are to sight it with their eyes. For example, reading from textbooks rather thanShow MoreRelatedEnglish Language Vs. Foreign Countries Essay1186 Words   |  5 PagesEnglish Language Education in Japanese Schools Introduction Teaching a second language always has its unique challenges, unlike teaching other subjects, in which instruction is in the learners’ first language. English, being an international language is taught across, most, if not all modern day nations. 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A Game of Thrones Chapter Thirty-three Free Essays

string(26) " turned to face his Hand\." Eddard Robert, I beg of you,† Ned pleaded, â€Å"hear what you are saying. You are talking of murdering a child.† â€Å"The whore is pregnant!† The king’s fist slammed down on the council table loud as a thunderclap. We will write a custom essay sample on A Game of Thrones Chapter Thirty-three or any similar topic only for you Order Now â€Å"I warned you this would happen, Ned. Back in the barrowlands, I warned you, but you did not care to hear it. Well, you’ll hear it now. I want them dead, mother and child both, and that fool Viserys as well. Is that plain enough for you? I want them dead.† The other councillors were all doing their best to pretend that they were somewhere else. No doubt they were wiser than he was. Eddard Stark had seldom felt quite so alone. â€Å"You will dishonor yourself forever if you do this.† â€Å"Then let it be on my head, so long as it is done. I am not so blind that I cannot see the shadow of the axe when it is hanging over my own neck.† â€Å"There is no axe,† Ned told his king. â€Å"Only the shadow of a shadow, twenty years removed . . . if it exists at all.† â€Å"If?† Varys asked softly, wringing powdered hands together. â€Å"My lord, you wrong me. Would I bring ties to king and council?† Ned looked at the eunuch coldly. â€Å"You would bring us the whisperings of a traitor half a world away, my lord. Perhaps Mormont is wrong. Perhaps he is lying.† â€Å"Ser Jorah would not dare deceive me,† Varys said with a sly smile. â€Å"Rely on it, my lord. The princess is with child.† â€Å"So you say. If you are wrong, we need not fear. If the girl miscarries, we need not fear. If she births a daughter in place of a son, we need not fear. If the babe dies in infancy, we need not fear.† â€Å"But if it is a boy?† Robert insisted. â€Å"If he lives?† â€Å"The narrow sea would still lie between us. I shall fear the Dothraki the day they teach their horses to run on water.† The king took a swallow of wine and glowered at Ned across the council table. â€Å"So you would counsel me to do nothing until the dragonspawn has landed his army on my shores, is that it?† â€Å"This ‘dragonspawn’ is in his mother’s belly,† Ned said. â€Å"Even Aegon did no conquering until after he was weaned.† â€Å"Gods! You are stubborn as an aurochs, Stark.† The king looked around the council table. â€Å"Have the rest of you mislaid your tongues? Will no one talk sense to this frozen-faced fool?† Varys gave the king an unctuous smile and laid a soft hand on Ned’s sleeve. â€Å"I understand your qualms, Lord Eddard, truly I do. It gave me no joy to bring this grievous news to council. It is a terrible thing we contemplate, a vile thing. Yet we who presume to rule must do vile things for the good of the realm, howevermuch it pains us.† Lord Renly shrugged. â€Å"The matter seems simple enough to me. We ought to have had Viserys and his sister killed years ago, but His Grace my brother made the mistake of listening to Jon Arryn.† â€Å"Mercy is never a mistake, Lord Renly,† Ned replied. â€Å"On the Trident, Ser Barristan here cut down a dozen good men, Robert’s friends and mine. When they brought him to us, grievously wounded and near death, Roose Bolton urged us to cut his throat, but your brother said, ‘I will not kill a man for loyalty, nor for fighting well,’ and sent his own maester to tend Ser Barristan’s wounds.† He gave the king a long cool look. â€Å"Would that man were here today.† Robert had shame enough to blush. â€Å"It was not the same,† he complained. â€Å"Ser Barristan was a knight of the Kingsguard.† â€Å"Whereas Daenerys is a fourteen-year-old girl.† Ned knew he was pushing this well past the point of wisdom, yet he could not keep silent. â€Å"Robert, I ask you, what did we rise against Aerys Targaryen for, if not to put an end to the murder of children?† â€Å"To put an end to Targaryens!† the king growled. â€Å"Your Grace, I never knew you to fear Rhaegar.† Ned fought to keep the scorn out of his voice, and failed. â€Å"Have the years so unmanned you that you tremble at the shadow of an unborn child?† Robert purpled. â€Å"No more, Ned,† he warned, pointing. â€Å"Not another word. Have you forgotten who is king here?† â€Å"No, Your Grace,† Ned replied. â€Å"Have you?† â€Å"Enough!† the king bellowed. â€Å"I am sick of talk. I’ll be done with this, or be damned. What say you all?† â€Å"She must be killed,† Lord Renly declared. â€Å"We have no choice,† murmured Varys. â€Å"Sadly, sadly . . . â€Å" Ser Barristan Selmy raised his pale blue eyes from the table and said, â€Å"Your Grace, there is honor in facing an enemy on the battlefield, but none in killing him in his mother’s womb. Forgive me, but I must stand with Lord Eddard.† Grand Maester Pycelle cleared his throat, a process that seemed to take some minutes. â€Å"My order serves the realm, not the ruler. Once I counseled King Aerys as loyally as I counsel King Robert now, so I bear this girl child of his no ill will. Yet I ask you this—should war come again, how many soldiers will die? How many towns will burn? How many children will be ripped from their mothers to perish on the end of a spear?† He stroked his luxuriant white beard, infinitely sad, infinitely weary. â€Å"Is it not wiser, even kinder, that Daenerys Targaryen should die now so that tens of thousands might live?† â€Å"Kinder,† Varys said. â€Å"Oh, well and truly spoken, Grand Maester. It is so true. Should the gods in their caprice grant Daenerys Targaryen a son, the realm must bleed.† Littlefinger was the last. As Ned looked to him, Lord Petyr stifled a yawn. â€Å"When you find yourself in bed with an ugly woman, the best thing to do is close your eyes and get on with it,† he declared. â€Å"Waiting won’t make the maid any prettier. Kiss her and be done with it.† â€Å"Kiss her?† Ser Barristan repeated, aghast. â€Å"A steel kiss,† said Littlefinger. Robert turned to face his Hand. You read "A Game of Thrones Chapter Thirty-three" in category "Essay examples" â€Å"Well, there it is, Ned. You and Selmy stand alone on this matter. The only question that remains is, who can we find to kill her?† â€Å"Mormont craves a royal pardon,† Lord Renly reminded them. â€Å"Desperately,† Varys said, â€Å"yet he craves life even more. By now, the princess nears Vaes Dothrak, where it is death to draw a blade. If I told you what the Dothraki would do to the poor man who used one on a khaleesi, none of you would sleep tonight.† He stroked a powdered cheek. â€Å"Now, poison . . . the tears of Lys, let us say. Khal Drogo need never know it was not a natural death.† Grand Maester Pycelle’s sleepy eyes flicked open. He squinted suspiciously at the eunuch. â€Å"Poison is a coward’s weapon,† the king complained. Ned had heard enough. â€Å"You send hired knives to kill a fourteen-year-old girl and still quibble about honor?† He pushed back his chair and stood. â€Å"Do it yourself, Robert. The man who passes the sentence should swing the sword. Look her in the eyes before you kill her. See her tears, hear her last words. You owe her that much at least.† â€Å"Gods,† the king swore, the word exploding out of him as if he could barely contain his fury. â€Å"You mean it, damn you.† He reached for the flagon of wine at his elbow, found it empty, and flung it away to shatter against the wall. â€Å"I am out of wine and out of patience. Enough of this. Just have it done.† â€Å"I will not be part of murder, Robert. Do as you will, but do not ask me to fix my seal to it.† For a moment Robert did not seem to understand what Ned was saying. Defiance was not a dish he tasted often. Slowly his face changed as comprehension came. His eyes narrowed and a flush crept up his neck past the velvet collar. He pointed an angry finger at Ned. â€Å"You are the King’s Hand, Lord Stark. You will do as I command you, or I’ll find me a Hand who will.† â€Å"I wish him every success.† Ned unfastened the heavy clasp that clutched at the folds of his cloak, the ornate silver hand that was his badge of office. He laid it on the table in front of the king, saddened by the memory of the man who had pinned it on him, the friend he had loved. â€Å"I thought you a better man than this, Robert. I thought we had made a nobler king.† Robert’s face was purple. â€Å"Out,† he croaked, choking on his rage. â€Å"Out, damn you, I’m done with you. What are you waiting for? Go, run back to Winterfell. And make certain I never look on your face again, or I swear, I’ll have your head on a spike!† Ned bowed, and turned on his heel without another word. He could feel Robert’s eyes on his back. As he strode from the council chambers, the discussion resumed with scarcely a pause. â€Å"On Braavos there is a society called the Faceless Men,† Grand Maester Pycelle offered. â€Å"Do you have any idea how costly they are?† Littlefinger complained. â€Å"You could hire an army of common sellswords for half the price, and that’s for a merchant. I don’t dare think what they might ask for a princess.† The closing of the door behind him silenced the voices. Ser Boros Blount was stationed outside the chamber, wearing the long white cloak and armor of the Kingsguard. He gave Ned a quick, curious glance from the corner of his eye, but asked no questions. The day felt heavy and oppressive as he crossed the bailey back to the Tower of the Hand. He could feel the threat of rain in the air. Ned would have welcomed it. It might have made him feel a trifle less unclean. When he reached his solar, he summoned Vayon Poole. The steward came at once. â€Å"You sent for me, my lord Hand?† â€Å"Hand no longer,† Ned told him. â€Å"The king and I have quarreled. We shall be returning to Winterfell.† â€Å"I shall begin making arrangements at once, my lord. We will need a fortnight to ready everything for the journey.† â€Å"We may not have a fortnight. We may not have a day. The king mentioned something about seeing my head on a spike.† Ned frowned. He did not truly believe the king would harm him, not Robert. He was angry now, but once Ned was safely out of sight, his rage would cool as it always did. Always? Suddenly, uncomfortably, he found himself recalling Rhaegar Targaryen. Fifteen years dead, yet Robert hates him as much as ever. It was a disturbing notion . . . and there was the other matter, the business with Catelyn and the dwarf that Yoren had warned him of last night. That would come to light soon, as sure as sunrise, and with the king in such a black fury . . . Robert might not care a fig for Tyrion Lannister, but it would touch on his pride, and there was no telling what the queen might do. â€Å"It might be safest if I went on ahead,† he told Poole. â€Å"I will take my daughters and a few guardsmen. The rest of you can follow when you are ready. Inform Jory, but tell no one else, and do nothing until the girls and I have gone. The castle is full of eyes and ears, and I would rather my plans were not known.† â€Å"As you command, my lord.† When he had gone, Eddard Stark went to the window and sat brooding. Robert had left him no choice that he could see. He ought to thank him. It would be good to return to Winterfell. He ought never have left. His sons were waiting there. Perhaps he and Catelyn would make a new son together when he returned, they were not so old yet. And of late he had often found himself dreaming of snow, of the deep quiet of the wolfswood at night. And yet, the thought of leaving angered him as well. So much was still undone. Robert and his council of cravens and flatterers would beggar the realm if left unchecked . . . or, worse, sell it to the Lannisters in payment of their loans. And the truth of Jon Arryn’s death still eluded him. Oh, he had found a few pieces, enough to convince him that Jon had indeed been murdered, but that was no more than the spoor of an animal on the forest floor. He had not sighted the beast itself yet, though he sensed it was there, lurking, hidden, treacherous. It struck him suddenly that he might return to Winterfell by sea. Ned was no sailor, and ordinarily would have preferred the kingsroad, but if he took ship he could stop at Dragonstone and speak with Stannis Baratheon. Pycelle had sent a raven off across the water, with a polite letter from Ned requesting Lord Stannis to return to his seat on the small council. As yet, there had been no reply, but the silence only deepened his suspicions. Lord Stannis shared the secret Jon Arryn had died for, he was certain of it. The truth he sought might very well be waiting for him on the ancient island fortress of House Targaryen. And when you have it, what then? Some secrets are safer kept hidden. Some secrets are too dangerous to share, even with those you love and trust. Ned slid the dagger that Catelyn had brought him out of the sheath on his belt. The Imp’s knife. Why would the dwarf want Bran dead? To silence him, surely. Another secret, or only a different strand of the same web? Could Robert be part of it? He would not have thought so, but once he would not have thought Robert could command the murder of women and children either. Catelyn had tried to warn him. You knew the man, she had said. The king is a stranger to you. The sooner he was quit of King’s Landing, the better. If there was a ship sailing north on the morrow, it would be well to be on it. He summoned Vayon Poole again and sent him to the docks to make inquiries, quietly but quickly. â€Å"Find me a fast ship with a skilled captain,† he told the steward. â€Å"I care nothing for the size of its cabins or the quality of its appointments, so long as it is swift and safe. I wish to leave at once.† Poole had no sooner taken his leave than Tomard announced a visitor. â€Å"Lord Baelish to see you, m’lord.† Ned was half-tempted to turn him away, but thought better of it. He was not free yet; until he was, he must play their games. â€Å"Show him in, Tom.† Lord Petyr sauntered into the solar as if nothing had gone amiss that morning. He wore a slashed velvet doublet in cream-and-silver, a grey silk cloak trimmed with black fox, and his customary mocking smile. Ned greeted him coldly. â€Å"Might I ask the reason for this visit, Lord Baelish?† â€Å"I won’t detain you long, I’m on my way to dine with Lady Tanda. Lamprey pie and roast suckling pig. She has some thought to wed me to her younger daughter, so her table is always astonishing. If truth be told, I’d sooner marry the pig, but don’t tell her. I do love lamprey pie.† â€Å"Don’t let me keep you from your eels, my lord,† Ned said with icy disdain. â€Å"At the moment, I cannot think of anyone whose company I desire less than yours.† â€Å"Oh, I’m certain if you put your mind to it, you could come up with a few names. Varys, say. Cersei. Or Robert. His Grace is most wroth with you. He went on about you at some length after you took your leave of us this morning. The words insolence and ingratitude came into it frequently, I seem to recall.† Ned did not honor that with a reply. Nor did he offer his guest a seat, but Littlefinger took one anyway. â€Å"After you stormed out, it was left to me to convince them not to hire the Faceless Men,† he continued blithely. â€Å"Instead Varys will quietly let it be known that we’ll make a lord of whoever does in the Targaryen girl.† Ned was disgusted. â€Å"So now we grant titles to assassins.† Littlefinger shrugged. â€Å"Titles are cheap. The Faceless Men are expensive. If truth be told, I did the Targaryen girl more good than you with all your talk of honor. Let some sellsword drunk on visions of lordship try to kill her. Likely he’ll make a botch of it, and afterward the Dothraki will be on their guard. If we’d sent a Faceless Man after her, she’d be as good as buried.† Ned frowned. â€Å"You sit in council and talk of ugly women and steel kisses, and now you expect me to believe that you tried to protect the girl? How big a fool do you take me for?† â€Å"Well, quite an enormous one, actually,† said Littlefinger, laughing. â€Å"Do you always find murder so amusing, Lord Baelish?† â€Å"It’s not murder I find amusing, Lord Stark, it’s you. You rule like a man dancing on rotten ice. I daresay you will make a noble splash. I believe I heard the first crack this morning.† â€Å"The first and last,† said Ned. â€Å"I’ve had my fill.† â€Å"When do you mean to return to Winterfell, my lord?† â€Å"As soon as I can. What concern is that of yours?† â€Å"None . . . but if perchance you’re still here come evenfall, I’d be pleased to take you to this brothel your man Jory has been searching for so ineffectually.† Littlefinger smiled. â€Å"And I won’t even tell the Lady Catelyn.† How to cite A Game of Thrones Chapter Thirty-three, Essay examples

Sylvia Plath Theme of Honesty free essay sample

D. Salinger’s character ‘Holden Caulfield’ in ‘Catcher in the Rye’. Both characters have a cynical tendency to constantly reveal their inner most opinions about the society around them, discussing their feelings about personalities and appearances. Plath and Salinger were both born in the early twentieth century, despite this had completely opposing backgrounds and upbringings. Plath experienced a quiet and subtle early life in Winthrop Massachusetts, a small seaport town. Whereas Salinger endured a mainstream, fast paced and fashionable beginning in the city of New York. Both these places can make a person incredibly sociable or utterly isolated. Emily Dickinson’s ‘Selected Poems’ also reveals honesty and she confesses her depression very openly and concisely. Being born in the nineteenth century, Dickinson often expresses her opinions of the social placement of women and their restricted lives. She is unlike the ‘stereotypical woman’ of her era, and retaliates in her writing against the inequalities between the sexes. Many critics believe her to be a feminist. Throughout the ‘Coming of age’ novel ‘The Bell Jar’, Greenwood, the protagonist narrator, is constantly breaking down situations, people and objects around her, like saliva to food. She over analyses the nature of society all around her, and enjoys criticising. When Greenwood first introduces the reader to ‘Doreen’, the mischievous opposite to Greenwood, she contradicts her description beginning with ‘I guess one of my troubles was Doreen’. This statement makes the reader begin to build a negative, unpleasant personality in their minds. However she concludes her escription with ‘a mysterious sneer, as if all the people around her were pretty silly and she could tell some good jokes on them if she wanted to’. This statement shows a clear admiration for Doreen, differing from the initial introduction, however also shows Esther expressing her opinion of Doreen being a mean kind of person, but likes that about her. This cou ld be considered to be a hidden metaphor, for Greenwood’s slow decent into depression and madness, beginning with confusion and uncertainty, typical signs of insanity, which reflects the rest of her story. This is an upfront and honest introduction to the novel. This shows a friendship between the two characters, but a kind that is of a girlish jealous nature. Greenwood clearly admires Doreen’s personality but envies her social power at the same time. Plath also reveals Greenwood’s detachment and alienation from others throughout the novel, isolating her character. This could be to remind the reader of her insane self compared to the sane society and people around her. This can be explained through Greenwood stating ‘I felt myself shrinking to a small black dot against all those red and white rugs, and that pine-panelling. I felt like a hole in the ground’, in this short description of her feelings, she shows vast indications of isolation and depression. The use of the words ‘shrinking’ and ‘small’ reflect her feelings of disappearing and becoming non-existent to the world. Also, describing herself as ‘black’ compared to the ‘red and white rugs’ is a use of juxtaposition in the colours, which show how uninteresting she finds herself, being dull and dark in comparison to the bright vibrant rugs, which could imply the rest of society around her. This identification of herself could be considered an honest view of how others perceive her. Another character that is slated by Esther’s criticism is Dr. Gordon. She belittles him by saying ‘How could this Dr. Gordon help me anyway? With his beautiful wife, and his beautiful children, and his beautiful dog, haloing him like a Christmas card’. Dr. Gordon is the psychiatrist who made a mistake during Esther’s electroshock therapy in a terrible way. As the patriarch of the ideal American family, Dr. Gordon seems to represent American society, punishing Esther for going against social expectations, rejecting marriage and family. This shows her honesty and awareness of her social differences and views with the rest of society, and is mocking them for being so stereotypical. Her repetition of the word ‘and’ reminds the reader of a list, almost as though Esther is expressing that there are endless differences between society and herself. J. D. Salinger uses the character of Holden Caulfield in parallel with Plath’s character Greenwood, a first person, and protagonist narrator. Holden also suffers with the illness of contradiction, alongside insanity of course, this is another similarity the two characters share. The reader is introduced to an upfront, confident Holden, whom from the setting of the novel, is obviously tense with the topic of family, and starts by stating ‘I don’t feel like going into all of it’, then continues to ‘go into it all’ by describe how annoyed his parents would be if he disclosed any personal information, ‘Especially my father’. He is building a personality of his father without realizing, showing a particular conflict with his father, more so than other members of the family. He is also separating himself from his family in that he would openly discuss their issues, whereas his family would not. Essentially, the readers receive an immediate separation and self alienation from his family, and recognise Holden’s critical personality from the start. It is clear that throughout ‘The Bell Jar’, the character of Esther is used by Plath to explore the theme of sexuality, and the effect the 1950’s attitude towards sex had on the women of that time. ‘Then he just stood there in front of me and I kept staring at him. The only thing I could think of was turkey neck and turkey gizzards and I felt very depressed. This description of Buddy’s penis does not only reveal Esther’s criticisms of other further, but we begin to see her real attitude towards sex and Buddy himself. The general theme between Esther and Buddy is that of sexual tension and virginity, however, although Esther is supposed to be ‘in love’ with buddy, it’s quite clear that she is not attracted to him and is not very fond of him altogether, we see this at the point where she is supposed to be at her most happy or intimate, when Buddy becomes naked in front of her, she feels ‘very depressed’. This may not be completely down to the appearance of Buddy’s private parts, but may be Esther’s attitude towards sex altogether, that she is only so eager to lose her virginity because it was the social norm, and wanted to be ‘part of a great tradition’. Esther shows her honest view upon societies attitude towards sex and its sexist inequalities towards sex when she says ‘I couldn’t stand the idea of a woman having to have a single pure life and a man being able to have a double life, one pure one not. ’ Plath is trying to portray through Esther her rebellious opinions towards sexual inequalities between men and women. In the novel, Esther discovers that sexuality is divorced from any expression of love and passion. Sex for women is only a necessity within marriage to have children, and has no relevance with romance or intimacy, Esther could be showing the reader her honest feelings of wanting to have a double life like the men of her era, and be able to experience sexual encounters out of passion and love, no just for starting a family, without being judged. However could also be suggesting her view that all people should remain celibate until marriage, both men and women, but on both interpretations, she is yearning for equality amongst the sexes. With Emily Dickinson’s unconventional style of writing and rebellious grammar, it is not a surprise that her poems do not meet the same literacy concepts as Plath and Salinger. Her poem ‘A Narrow fellow In the Grass’ reflects her individuality and opposing touch of honesty towards sexuality in every stanza. The literal and logical interpretation for the poem is her longing to see a snake in the grass, but only being able to glance at sections of the snake. However, Luann Suhr claims that the poem ‘is in fact about the fear a virgin has towards sex’. This differs from Plath and Salinger’s habit of blurting constant criticism of others, and shows a clear self aggravation and criticism. There are many literary devices used to allude to its sexual theme. Dickinson shows the fear of a virgin by knowing the naturalness of sex yet still being afraid of it. This is accomplished through the literary devices of personification, metaphor, and visual imagery. In the first line of the first stanza, by using the word â€Å"fellow† in her description of the snake she alludes to the snake in regards to man. In colloquial terms, the word snake is often used with regards to male genitalia. A â€Å"narrow fellow† can therefore be read as the male penis. This could also relate to her opinion of men being sneaky like snakes towards the concept of sex, compared to the expectations of a woman to remain celibate, showing her honest neglect of the sexist attitude that society has to sexuality. The second stanza ‘The grass divides as with a comb- Aspotted shaft is seen- And then it closes at your feet and opens further on’ Dickinson has purposely used opposing adjectives to represent her curiosity about sex, how one moment she is captivated by the idea of losing her virginity, then the next her mind closes’ her imagination because she knows she must remain celibate until marriage. It could also represent a previous sexual encounter that was never fulfilled, she is giving the reader an insight into her mind and how ‘dividing’ her mind like this could cause her mental illness to thrive. Once she has captured a small snippet of understandin g ‘Aspotted shaft’, her sub conscious ‘closes’ her out. Dickinson’s confusion is clear, it sounds almost as though she is at war with herself, insanity, society and again differs from Plath and Salinger in that she does not alienate herself from society, but from her own emotions and desires. Despite this, she carries on fantasizing about this sexual encounter by saying â€Å"sudden is† Dickinson is stating that this male is quick to ejaculate. This can be further proved by the line before which says, â€Å"you may have met him†. The word â€Å"met† can be referring to the sexual meeting, and therefore puts a sexual connotation to the next line. When Dickinson reaches for this thing that scares her so much, it disappears. In the end of stanza four, she says, â€Å"it wrinkled, and was gone†. This is the visual imagery of a penis becoming flaccid. This man she is describing may represent her constant need to please, and fit in. Her honest desperation to communicate her frame of mind seeps through, when the reader finishes the poem to discover, that not even in the final stanza, does she reveal the root of the poem or what its meaning is, leaving readers to feel her confusion, to have a sense of what it would be like to suffer from mental illness, not knowing why or understanding the thoughts she has. Her complete sincerity leaves the reader, in a state of confusion, reflecting her everyday agenda. An aspect of honesty which can be related to all three authors is the honesty with the self and self reflection. Sylvia Plath uses the character of Esther Greenwood to portray her own personal attributes that she struggled to express in reality. We see this when greenwood describes her drink as ‘wet an depressing’, the very statement that a drink is depressing shows how irritating her character is, in the sense that she complains and reverts anything and everything she sees or touches to seem as depressing as she is. This could be Plath expressing through Greenwood that she is irritated by herself and her own character, the illness is not only discovered, but it irritates her, revealing a full acknowledgement of its existence. This honest analysis in itself portrays that Greenwood sees herself as an irritation to society and this could explain her isolated behaviour, a fear of not being accepted. Another self reflective part of the novel is stage in which Esther begins to lose touch with herself worth, ‘I started adding up all the things I couldn’t do’ I felt inadequate’. Up until the summer before Esther’s senior year, she had done a good job at being a student of literature. However the thought of entering the real world terrifies her. The world she lives in seems to have no place for the literary ideals that she cherishes, which of course is her being pessimistic. This could be forcing her to doubt herself, and self worth towards the world, which may represent Plath attempting to portray Esther as feeling worthless and useless. Or, another view could be that Esther sees herself as being too complex and misunderstood for the simple minds and dreams of the typical American girl of that era. Emily Dickinson shows honesty with the self and self reflection in the poem ‘The soul has Bandaged moments’ which explores through symbolism, an internalised spiritual and psychological state of experiences of the soul. Which is personified as a woman, and some may interoperate the personification to be Dickinson herself. In the first stanza it says ‘The soul has bandaged moments’ which shows a physical and abstract outlook and insight of the soul. It also implies injury and pain that could metaphorically mean that the soul being personified as Dickinson, she is hurt by her mental illness and attempts to heal herself when ‘she feels some ghastly fright come up to stop and look at her’. This could represent her soul searching and not being fond of what she finds in her mind, or it could alternatively represent her mental illness of depression creeping up on her, it has a sinister feel and may be considered that the mental illness is trespassing, on the privacy of her soul and self. She views this as a form of psychological assault and molester by using words in stanza two such as, ‘caress’ and ‘hovered-o’er’. These bring feelings of uncomfortability and helplessness to the reader. Dickinson is trying to express the mercilessness of insanity. This shows Dickinson’s fear of herself and her capability, some may view it as a panic towards her ever-growing stronger insanity and her ever-growing weaker free will against is. To conclude, a critic once claimed that ‘Writers, who suffer with mental illness, are likely to revolve their writing around complete honesty of their mind. Which, in a sense, creates more emotional and believable connections with the reader, making the insanity seem normal, and allow the reader to feel an attachment with the author’, some may consider this statement to be complete nonsense, however, the analytical evidence shows that there may be some truth in this observation. One may find the ability for Plath, Dickinson and Salinger, all of different era and lifestyle, to have managed to create such personalities and mind wondering scenarios with just the use of a single concept of honesty to be greatly admired.