Research entry on John Rawls Paper Example | Topics and Well Written Essays - 250 words

Entry on John Rawls - Research Paper Example On November 24, 2002, the entire American nation encountered the sad demise of John Bordley Rawls. Rawls acquired his dignified professorship degree of James Bryant Conant University from the Harvard University (Wenar 1). He also successfully attained his achievement of Fulbright fellowship at Christ Church, Oxford. Rawls also got several awards of honor and admiration for his services for America. Being truly deserving, Rawls was given Schock Prize for his Logic and philosophical intellect. In 1999, he was given a Medal of recognition for keeping up the spirit of American democracy. Two famous theories of Rawls are ‘Theory of Justice’ and ‘Law of People’. Rawls believed that there was no valid existence of conflict between equality and justice. He tried his level best to clear the opposing pictures of freedom and equality that were developed within the assumptive minds of people. Via his theory of Justice, in 1971, Rawls tried to recreate the prevailing concepts of equality and freedom, and explained to the entire nation that both of the notions have overlying attributes. Both are not perpendicular, in fact they run parallel to each other (Iep.utm.edu 1). Both can together generate an intense power of union that would always have utter fair and just consequences. This theory unfortunately did not bring out much impactful effects as expected. Practically, it wasn’t that balanced and one claim always out ruled the other. Late during his career, Rawls perceived the devastating impact of the international politics those days. Therefore, he outlined the ‘Law of People’ and stated that people having moral values are either ‘liberal’ or ‘decent’ (Wenar 1). He could foresee the excruciating consequences of decent minorities if ways of handling politics were not changed. Law of People was to protect the rights of participation of minorities in the elections as the political scenario was targeting the deprivation of decent people from

English as a Foreign Language in the Saudi Schools Essay

English as a Foreign Language in the Saudi Schools - Essay Example With reference to its effect on student first language oral communication, the study concludes that this is an important issue worth investigation. In 2004, driven by its aims to improve education and cope with achievements in science and technology, the Saudi government decided to initiate a program to begin teaching English as a foreign language to students in the in sixth grade. It was an initial step toward its ultimate goal to teach English in all elementary grades. The resolution was possibly based on the belief that English is the language of the globalized world economies, and that young people would not only benefit from speaking the language but could learn it more easily at a younger age. The general consensus among experts is that younger minds absorb other languages easier than do adults. In the light of this, the paper attempts to measure attitudes of Saudi students in Brighton towards EFL. The paper also formulates recommendations on EFL in the Saudi elementary state schools and invites further discussion of and research into this issue. The following historical background frames the discussion. Since the country has never been colonized by a foreign power, the exact date of or the situational emergence of English in Saudi Arabia is unknown. However, some researchers claim that when oil was found in the 1930s, English emerged with the arrival of American oil companies and their employees. Later, the Saudi government took the initiative and officially introduced and approved the use of English in the country.  

Questionnaire for Bachelor Thesis with topic JSR170 and the Content Essay

Questionnaire for Bachelor Thesis with topic JSR170 and the Content Management Industry - Essay Example 17. Specifications are not available for the kind of applications that we use in our company. 4. Technology: Can Conventional Database Abstraction Layers (DBAL) and Web Services be used for solving the same issues 18. DBAL and web services are capable of solving all of the issues listed in section 2. 19. DBAL and Web services solves the relevant issues for us. 20. DBAL is tunable and can be used to realize additional controls that may be needed. 21. Our people are comfortable with DBAL / Web services 22. DBAL and web services are easier to adopt and use than the new standard processes 23. Many of the disadvantages of DBAL / web services are taken care of JSRs and JSRs are growing. Statements Very Un Important (1) Un Important (2) Neutral (3) Important (4) Very Important (5) 5. Technology: Is Data Access more comfortable with JDBC or other Data mining / warehousing software 24. Additional features on JDBC for connecting dissimilar databases. 25. Generic warehousing tools are good enough for our requirements. 6. General: Closing Remarks 26. JSR 170 is the future standard for all kinds of applications from Java stable. 27. JSR 170 is easy to adopt and use. 28. JSR 170 is compatible with most of the Enterprise Content Management Vendor products. 29. JSR 170 has advantages that are better than the other equivalent standards and products. 30. Adopting JSR 170 would improve our performance in the company. Signature of the person filling the form Thanks for your cooperation Question Selection and grouping. Categorization is done on the basis of the following: 1. Size of the company 2. Turnover of the company 3. Nature of business 4. Database employed on the website The...This would help in analyzing the advantages with respect to the size of the company, nature of business, database employed and also on the turnover. This would help in understanding whether the companies of similar traits think alike or differently; if so why Answers to be evaluated in line with the standard evaluation practices of assigning 1 for very unimportant and 5 for very important. Based on these numeric assignments of the choice, the other factors are also evaluated in line with the grouping and the related questions. Answers for specific groups could be averaged and viewed as a relevancy factor for the heading / group from the specific company type / size.

Culture and purchase intention for luxury consumption Literature review

Culture and purchase intention for luxury consumption - Literature review Example ect of culture has become more relevant in the globalized world where organizations are targeting the international market in a strategy to increase their revenue. Cultural aspects such as attitude, religions, behavior and information-access influence the consumer decision making process. The hospitality and tourism industry have faced a big challenge while targeting this portion of the customer profile as they enter new markets (Truong, McColl & Kitchen, 2009). Understanding the intention of consumers as they buy luxury products is a priority if such companies have to suit the needs of their target market. The purpose of this review is to establish cultural influence within the luxury market and how this may impact a tourism and hospitality industry. While there is a concession that different countries have different luxury consumption patterns, the influence of culture in this market still remains a contentious issue (Blevis et al., 2007). Secondly, the review seeks to analyze the customer intention and the way culture impacts on this intention within the luxury market. The priority of any managers is to satisfy customers, which can only be accomplished when companies understand customers’ purchase intentions. Through a critical review, the article will analyze the impact of culture and customer intention in the purchase of luxury brands and provide conclusions and implications for the analysis. Therefore, the article will provide a platform through which luxury companies can launch successful brands that satisfy the global luxury market. The luxury market has become one of the potential investment markets in the 21 century. Currently, the luxury market is estimated to have a value of over 300 billion Euros and statistic projections shows that the market is rapidly growing. The luxury market is expected to grow by more than 7% percent each year, which promises high revenue in the future of the market. Besides, countries such as Middle East that have shown

Establishment Notions of Englishness Essay Example for Free

Establishment Notions of Englishness Essay In what ways did the iconography, the music, the lyrics and the performances and behaviour of punk rock acts present a challenge to ‘establishment notions of Englishness’ in 1976-77? The early roots of Punk rock were appearing in the form of The Velvet Underground in 1965, closely followed by The Stooges and MC5 in 1969, but it wasn’t until the early 1970s that punk began to globalise, hitting Australia in 1972 with The Saints. Within a year, legendary Punk club CBGB’s opened it’s doors for the first time, becoming a constant dwelling for the up and coming acts of the 70’s, and more importantly, providing a regular crowd of punk kids to listen to them. Britain in the early 70s, according to Spicer, was filled with ‘political frustration, surging unemployment and a gag-reflex to the patriotic froth generated by in celebration of Queen Elizabeth’s Silver Jubilee, giving punk’s raw noise a particular spice and vigour. The UK had either been in decline, recession, stagflation or worse since the end of the swinging sixties.’ (Spicer, 2006: 3). ‘Eight years later when the idealism of the 60s had well and truly faded, the strategies and rhetoric of street protest were still going strong. So when mainstream politics wouldn’t even listen to what was driving the kids insane, the Sex Pistols’ cry of â€Å"Anarchy in the UK† seemed like a viable alternative.’ (Spicer, 2006: 5) ‘Punk came with a philosophy that was influenced by the anti-establishment turmoil reverberating from the 60’s.’ (Spicer, 2006, Page 4), so in a time when the youths of Britain were so ignored and undervalued as a part of society, it seemed like a natural outlet to make the government and the authorities stand up and take notice of what they were saying. Renowned Manchester based punk journalist and singer John Robb stated that ‘Punk Terrified the establishment’ (Robb, 2006: 3), suggesting this outcry for non-conformism was having an impact and the message of challenging the government was being heard. Despite this, however, critics are still divided about whether the punk phenomenon was in fact a significant cultural shift. ‘Was it just another youth craze (with a hairstyle calculated to drive the parents crazy), or did it offer a real challenge to the  complacency of the times? A Challenge that was more than just musical and sartorial, but p olitical as well?’ (Spicer, 2006: 2). Hebdige stated that ‘the punks were not only directly responding to increasing joblessness, changing moral standards, the rediscovery of poverty, the Depression, etc., they were dramatizing what had come to be called â€Å"Britain’s decline† by constructing a language which was, in contrast to the prevailing rhetoric of the Rock Establishment, unmistakeably relevant and down to earth (hence the swearing, the references to â€Å"fat hippies‟, the rags, the lumpen poses). The punks appropriated the rhetoric of crisis which had filled the airwaves and the editorials throughout the period and translated it into tangible (and visible) terms’ (1991: 87). A significant part of the construction of the punk rock movement in the British media was the fashion of the stars, which was later emulated by the fans, with the iconic style quickly becoming a obligatory staple of â€Å"being punk†. According to Paul Gorman, speaking in Punk: The Whole Story, ‘Almost every element of punk’s style, attitude, politics, musical tastes and even personnel emanated from two tiny clothes shops on Chelsea’s King’s Road 30 years ago.’ (2006: 84) These two shops were Acme Attractions and SEX, both in London. Don Letts, ex-employee of Acme, and later member of Big Audio Dynamite said in Punk: The Whole Story, ‘Acme was more than a shop. It was a club, a lifestyle, a forum for talent. It reflected the way London was going – it was about multi-culturism’ (2006: 84). I think this really exemplifies the importance of the fashion and self-representation of the punk movement, even at the beginning. Robb recalls, ‘I saw photos of punk rockers in the papers, and I knew instantly what they sounded like. Never had a music and its threads been so closely associated’ (2006: 2). Hebdige also observed, ‘The various stylistic ensembles adopted by the punks were undoubtedly expressive of genuine aggression, frustration and anxiety. But these statements, no matter how strangely constructed, were cast in a language which was generally available – a language which was current’ (1991: 87). I feel this rings true in a big way, especially when you contrast another artist of ’74 with the way, for example, the Sex Pistols presented themselves. In image one, we see the Sex Pistols wearing typical punk style  clothing, however, in image 2, The Who, another British band making music in 1974, are seen to be sporting a much more reserved fashion, that could be classed as smart/casual, due to the tailored trousers, tucked in shirts and sports jackets, and even be called patriotic, with the presence of a union flag jacket. In contrast, while the Sex Pistols are also wearing union flag attire, however, it seems to be done so in a satirical, ironic way. The flag is cut into and is covered in holes, which could suggest the way that the punk youth saw the state of the government, or at least what they thought of it. Similarly, there is also a sports jacket being worn, however, it is teamed with a punk print T-shirt, which could easily be seen as a rebellion against the notion of looking presentable and dressing in your Sunday best. Ruth Adams discusses Hebdige’s notion of punk fashion being a bricolage, and states ‘Bits and pieces of both officially sanctioned and popular English culture, of politics and history were brought together in a chaotic, uneasy admixture to form a new culture’ (2008). I feel this accurately describes the way punk took what it wanted from English culture and used it as a way to challenge the established notions of â€Å"Englishness†. Icons such as swastikas were often wore as a fashion statement , however, ‘for punks like Siouxsie and Sid Vicious it became just one more ingredient in the imagery of offence – not devoid of meaning, but mainly a way of getting up the noses of the straight and the narrow’ (Spicer, 2006: 4). You can imagine that this explicit and in your face approach to fashion and iconography would starkly contrast with the dreary fashion of the 70’s. Spicer states that ‘as the decade that saw beige, brown, orange and gold recommended as a desirable colour scheme for the home, the 70’s had little going for it stylistically either’ (2006: 3). I feel that this contrast in style would have made punks even harder to ignore, insuring that someone was always looking at them and listening to what they had to say. ‘Punk rock lyrics are typically frank and confrontational; compared to the lyrics of other popular music genres, they frequently comment on social and political issues’ (Laing, 1985: 27). An obvious example of this would be â€Å"God Save The Queen† by the Sex Pistols (1977, Sex Pistols). At the time of  release, the song was highly controversial, mainly for the fact it was explicitly ‘anti-monarchy’, implying that the Queen was a part of a fascist regime, as shown by the lyrics ‘God save the queen, the fascist regime’, and also for quite blatantly writing England off as being bleak and without any hope, shown in the lyrics ‘There is no hope in England’s dreaming’ and ‘There’s no future, no future, no future for you’. This contrasted significantly with the jingoistic ideals that were being put forward in the wake of the Queen’s silver jubilee. Savage stated, ‘â€Å"God Save the Queen† was the only serious anti-Jubilee protest, the only rallying call for those who didn’t agree with the Jubilee because [†¦] they resented being steamrollered by such sickening hype, by a view of England which had not the remotest bearing on their everyday experience’ (2001: 352-353). Laing speculated that ‘Punk was a total cultural revolt. It was a hardcore confrontation with the black side of history and culture, right-wing imagery, sexual taboos, a delving into it that had never been done before by any generation in such a thorough way’ (1985: 27). I feel this really sums up the ideology at play with ‘God Save The Queen’, as it was a total revolt of the dominant ideology at the time it was released. Punk rock is not known for its musical ingenuity, its creativity, or even its skill. John Robb described punks as ‘The DIY brigade fumbling with musical instruments, trying to make sense of the world with three chords learned last week on second hand guitars’ (2006, Page 3). I feel this expresses the rebelling of the establishment in a way that goes above lyrics or fashion. Here we can see that punk was not about pleasing people or making everyone happy, it was about doing what you wanted because you could, and not caring if people liked it or not. This directly challenged the English ideology of the 1970s, which was predominantly all about keeping a stiff upper lip, being polite, and being, for lack of a better word, nice. Rock journalist Caroline Coon wrote about the Sex Pistols live performances, stating that ‘participation is the operative word. The audience revels in the idea that any one of them could get up on stage and do just as well, if not better than the bands already up there’ (1982: 98). This again draws on the angry, challenging, do-it-yourself attitude attached to the punk genre. Machin describes the discourse of the melody of â€Å"God Save The Queen† by the Sex Pistols in a way that epitomises the ideology of the genre. ‘Here [image 3] we can see that much of the melody remains on the first note. There is therefore very little outward giving of emotion or positive energy. This means that there is something very contained about the way it is sung. In fact, the vocalist sings the song generally at a high pitch which conveys emotional intensity. Yet in this intensity there is no emotional outpouring or pleasure. There are only short sharp occasional outbursts on the 4th note. This is fitting of the punk discourse of nihilism and cynicism.’ (Machin, 2010: 105) Philip Auslander proclaimed that ‘we may not usually think of musical performance, apart from opera and musical theatre, as entailing characterisation in the conventional dramatic sense. Nevertheless, we must be suspicious of any supposition that musicians are simply ‘being themselves’ on stage’ (2004: 6). Auslander goes on to quote Frith, who states that musicians are ‘involved in a process of double enactment: they enact both a star personality (their image) and a song personality, the role that each lyric requires, and the pop star’s art is to keep both acts in play at once’(2004: 6). I feel that this observation directly applies to the punk rock era, as it exemplifies the explicit and hyperbolic style of the genre. This can be exemplified by Sex Pistols front man, John Lydon (aka Johnny Rotten). In the public eye he is an anarchist punk rebel who is not scared to speak his mind and does not care who he offends, however in real life he is a man who was bullied as a boy for having an English accent while at his grandparents’ home in Cork, Ireland. This performance persona is a prime example of the way that punk challenged the notion of Englishness, as everything about â€Å"Johnny Rotten† was anti-establishment. This is typified with the quote from Rotten himself, stating Id listen to rock n roll, but I had no respect for it. It was redundant and had nothing to do with anything relevant†. Here, he is dismissing everything that already exists in England as not being relevant or influencing him in any way, suggesting that he was the change that England needed. Auslander later goes on to discuss that ‘both the line between real person  and performance persona and the line between persona and character may be blurry and indistinct, especially in the case of pop music performers whose work is heavily autobiographical’ (2004: 7). Again, I think this is extremely relevant to the analysis of the performance of John Lydon as Johnny Rotten, as punks felt this allegiance with him through his work as he was them while he was on stage. He was also a working class, angry young person with no money who resented the royal family and the government. Al Spicer asked the question, ‘was it just another youth craze (with a hairstyle calculated to drive the parents crazy), or did it offer real challenge to the complacency of the times?’ (2006: 2) and I think the answer to this would have to be that they really did challenge the system, in every possible way. Punk as a movement intended to shock and defy the norm of 1970s England, to rebel against the complacent and austere ideals of the time and radically confront the patriotic notions of Englishness put forward by the royal Jubilee, and I think that they succeeded. Instead of merely writing protest songs, punk bands were a protest. Every fibre of their existence protested, whether it was scandalous lyrics, deplorable fashion choices or unrestrained, extroverted stage personas who would say what they thought, and never care about the repercussions. Punk was one vast protest across England and the notion of English ideals. Bibliography Machin, David. (2010) Analysing Popular Music: Image, Sound, Text, London: Sage. Spicer, Al. (2006) A Rough Guide To Punk, London: Rough Guides. Blake, Mark (Editor) (2006) Punk; The Whole Story, London: Dorling Kindersley. Sabin, Roger (Editor) (1999) Punk Rock, So What?, London: Routledge. Robb, John (2006) Punk Rock; An Oral History, London: Elbury Press. Adams, Ruth (2008) â€Å"The Englishness of English Punk: Sex Pistols, Subcultures and Nostalgia.†Popular Music and Society, 31.4, P. 469–488. Hebdige, Dick (1991) Subculture: The Meaning of Style. London: Routledge. Savage, Jon (2001) England’s Dreaming: Sex Pistols and Punk Rock, London: Faber Faber. Laing, Dave (1985) One chord wonders: power and meaning in punk rock, Milton Keynes: Open University. Auslander, Philip (2004) Contemporary Theatre Review, Vol. 14, London: Routledge. Boyd, Brian (2010), The Making of a Rotten Public Image, The Irish Times: 08 Aug 2010 Issue. Coon, Caroline (1982) The New Wave Punk Rock Explosion, London: Omnibus Press. IMAGE 1: http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2008/12/30/1230675664257/Sex-Pistols-in-1978-001.jpg IMAGE 2: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibPsh54t4a3lMww8cmCWQKdWziC6-cUl18qS5RK0BhDfa8pULXzXv7q7IRqYDKItWJ90HPaeYnC9jxpYFufwQWYnIRehrWrftvvCVIiSX0eGgXx6Ja_dLFfJ-sSuCjjhDAKCvE4t2QoD0/s1600/The+Who.jpg IMAGE 3: Machin, David. (2010) Analysing Popular Music: Image, Sound, Text, London: Sage. Page 104.

Spanish Conquest of South America Essay Example for Free

Spanish Conquest of South America Essay The Age of Exploration was an important time period in history without which the modern map would not be as we see it today. During this era, Europeans had a sudden urge to explore, discover, a feeling they had never had before. With the advancement in technology, the Europeans, as well as the Asians were able to explore the uncharted seas and discover the unknown land. During this time, many discoveries were made, but the one most remembered is the discovery of the Americas. This was a big discovery which added a whole new continent, never known about, onto their map. As soon as the land was discovered, so was the curiosity of the Spanish. The land was soon inhabited by the Spanish as well as the indigenous. The two races lived side by side happily, but soon the Spanish greed for gold, glory became too much and disaster struck. Whole communities were torn, murders committed and whole communities exterminated. Genocide: a terrible crime against the indigenous. Apart from the wars, more deaths were occurring, however they were not intentional. Both Spanish and the Indigenous were falling victims to new diseases. There were many reasons for death/murder whether intentional or not but no races or cultures were put to extinction due to the attack by the Spanish proving that the Spanish Conquest was not a genocide. After the discovery of America, the Spanish had access to a whole new continent, a whole new way of life as well as people. The Spanish were eager to lay claims on whatever they could, build their power, and gain wealth. The Spanish built communities, they scavenged for the land, for power and for control. The Spanish bred happily, sharing their way of life with the indigenous, learning new techniques, mastering technology and living peacefully. However, soon the Spanish wanted more; their greed was for more than what they had and soon war struck out. To gain power, land and wealth, the Spanish attacked the indigenous, taking as much as they could. The war raged on until the Spanish had full control, the indigenous people were forced to retreat. The land was destroyed. The Spanish had killed so many for a mere piece of land. Exploration wasn’t always safe. It exposed the explorers as well as the indigenous people to diseases, foods, animals they had never encountered before and this was going to prove dangerous. The indigenous people were exposed to diseases such as Influenza or Tuberculosis against which their immune systems had no power having never encountered them before. These diseases killed more people the wars fought between the Spanish and Indigenous. As the time passed, the indigenous people developed immunity against these diseases however these diseases never stopped and forever remained on the island infecting and maybe even killing more people over time. This effect didn’t happen only to the Indigenous. The Spanish were also exposed to new diseases such as Polio and Hepatitis which were even carried back overseas to Europe infecting a much larger population. Apart from only the diseases, new foods were also stumbled upon. These foods could make you fatally sick due to the fact that your body (as with the diseases) has never encountered them. Some foods that the Spanish came across were Tobacco and Tomatoes while the indigenous came across Coffee and Rice. During the Spanish Conquest of South America, many deaths occurred. There were intentional killings through the wars and equally unless more due to the exposure to a new environment. The Spanish killed many people, destroyed many communities, however they did not exterminate whole races as in the definition of genocide. Races or cultures might have been put to extinction later due to the diseases that were imported to America from Europe. The Spanish killed and destroyed however no races or cultures were put to extinction by this attack proving that the Spanish Conquest was not genocide. The Age of Exploration was an important time period in history without which we would not know of half the world available to us. Now the Europeans too to exploring the seas, discovering new land, it was now that the continent of America was discovered. This was an exciting new discovery for the Spanish. The Spanish were eager to inhabit the newly found land and gain power and wealth. They found the indigenous and continued living peacefully together. The Spanish greed soon became more than they could handle and war was started. However, those were not the only problems occurring in South America. The Spanish had brought with them diseases. People were dying everywhere, but was the question is whether it was genocide. Looking carefully, we can conclude this was not genocide as there were no cultures or races put to extinction by the Spanish.

Childhood Maltreatment and Diabetes Relationship

Childhood Maltreatment and Diabetes Relationship Study Rationale The primary goal of this study is to conduct an empirical investigation of the association between an early life stressor such as childhood maltreatment and subsequent diagnosis of Type II diabetes in adulthood. This study will specifically explore if a relationship exists between the type and severity of childhood maltreatment encountered and participants diabetes-related quality of life. To provide a context for the current study, background literature focusing on two dimensions that have received considerable attention in the psychological literature is first thoroughly reviewed: definition and effects of childhood maltreatment and the biopsychosocial aspect of Type II diabetes. The current studys purpose, hypotheses, method, and data analytic strategy will then be proposed. Background Information Childhood Maltreatment Childhood maltreatment refers to, any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child (Centers for Disease Control [CDC], n.d., para. 1). In their report, Child Maltreatment Surveillance, Leeb, Paulozzo, Melanson, Simon, Arias (2007) defined acts of commission as deliberate and intentional use of words or actions that cause harm, potential harm, or threat of harm to a child. Examples of acts of commission include physical, sexual, and/or psychological abuse. Acts of omission, on the other hand, are the failure to provide for a childs basic physical, emotional, or educational needs or to protect a child from harm (Leeb et al., 2007). Thus, acts of omission include physical, emotional, medical, or educational neglect, the failure to supervise or insufficient supervision, and/or exposure to a violent environment. According to the most recent publication by the U.S. Department of Health and Human Services (USDHHS) on childhood maltreatment, an estimated 905,000 children were determined to be victims of abuse or neglect (USDHHS, 2006). Specifically, 64.2 percent of child victims experienced neglect, 16.0 percent were physically abused, 8.8 percent were sexually abused, and 6.6 percent were emotionally or psychologically maltreated. The report suggests that rates of victimization by maltreatment type have fluctuated only slightly during the past several years. The long-term consequences of child maltreatment are significant and include the risk of alterations of brain structure and function, sexual risk taking behaviors, eating disorders, suicidal intent and behavior, lower self-esteem, adjustment problems, internalizing problems (i.e. anxiety and depressive disorders), externalizing problems (i.e. personality disorders and substance abuse), adult trauma, continuation of intergenerational violence and/or neglect, and developmental and cognitive disabilities (Anda, Felitti, Bremner, Walker, Whitfield, Perry, Dube, Giles, 2006; Arata, Langhinrichsen-Rohling, Bowers, OFarrill-Swails, 2005; Bardone-Cone, Maldonado, Crosby, Mitchell, Wonderlich, Joiner, Crow, Peterson, Klein, Grange, 2008; Johnson, Sheahan, Chard, 2003; Kaplow Widom, 2007; Kaslow, Okun, Young, Wyckoff, Thompson, Price, Bender, Twomey, Golding, Parker, 2002; Lewis, Jospitre, Griffing, Chu, Sage, Madry, Primm, 2006; Medrano, Hatch, Zule, Desmond, 2002; Smith, 1996; Sobsey, 2002; Taft, Marshall, Schumm, Panuzio, Holtzworth-Munroe, 2008). A consistent relationship between abuse history and poorer overall health has also been demonstrated in a stratified, epidemiological sample of both men and women within the United States (Cromer and Sachs-Ericsson, 2006). Childhood Maltreatment and Physical Health Problems A consistent dose-relationship between abuse history, poorer overall health, and sustained losses in health-related quality of life has been well established (Cromer Sachs-Ericsson, 2006; Golding, 1994; Corso, Edwards, Fange, Mercy, 2008). Childhood sexual abuse has been associated with physical complaints such as migraine, irritable bowel syndrome, fibromyalgia, and chronic pain (Goldberg, Pachas, Keith, 1999; Goodwin, Hoven, Murison, Hotopf, 2003; Ross, 2005; Walker, Keegan, Gardner, Sullivan, Bernstein, Katon, 1997). Furthermore, using data from the National Corbidity Study, a nationally representative general population study, Arnow (2004) found that abused children were likely to have pelvic and musculoskeletal pain as adults, and utilize health care services at a greater proportion in adulthood. However, a major limitation of these studies is exclusion of emotional and/or psychological abuse experienced in childhood. Additionally, results regarding the incidence of types o f childhood maltreatment and diabetes have been mixed. Diabetes Diabetes is a chronic disease characterized by the deficiency or resistance to insulin, a hormone needed to convert sugar, starches and other food into energy needed for daily living. As such, insulin deficiency compromises the body tissues access to essential nutrients for fuel or storage. According to the American Diabetes Association (ADA), there are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes, many of which unaware that they have the disease (ADA, n.d., para. 2). Diabetes occurs in two primary forms. Type I diabetes is characterized by absolute deficiency and typically occurs before the age of 30. Type II diabetes, however, is typified by insulin resistance with varying degrees of deficiencies in the bodys ability to secrete insulin. Sedentary lifestyle and diet have been linked to the development of Type II diabetes. Other risk factors for this type of diabetes include obesity, pregnancy, metabolic syndrome, and various medications. Physiologic and emotional stress has also been thought to play a key role in the development of Type II diabetes specifically. Prolonged elevation of stress hormones, namely cortisol, glucagon, epinephrine, and growth hormone, increases blood glucose levels, which in turn places increased demands on the pancreas. Such stress ultimately leads to the inability of the pancreas to keep up with the bodys need for insulin and high levels of glucose and insulin circulate in the bloodstream, setting the stage for Type II diabetes (Diseases, 2006). Role of Stress in the Onset of Diabetes Animal Studies Researchers have found that both a history and presence of existing stressors play a significant role in the onset and course of diabetes. Through the use of animal studies, researchers have been able to prospectively test the influence of stress on both types of diabetes. For example, Lehman, Rodin, McEwen, and Brinton (1991) investigated whether an environmental challenge promoted the expression of diabetes in bio-breeding rats. Researchers introduced a triad of stressors to the animals over a 14-week period, including rotation of the cage, vibration, and restraint in individual containers. They found that the administration of these stressors repeatedly increased the likelihood of the rats developing Type I diabetes as indicated by elevated blood sugar levels (Lehman et al., 1991). One of the first observations that stress could contribute to the expression of Type II diabetes was made during metabolic studies of the native North African sand rat (psammonys obesus). Once fed with laboratory chow and allowed to become obese, the North African sand rat will eventually develop Type II diabetes in response to an environmental stressor (Surwit, Schenider, Feinglos, 1992). Notably, Mikat, Hackel, Cruz, and Lebowitz (1972) administered an esophageal intubation of saline in an effort to control the dietary intake of the sand rat. This tube feeding resulted in an alteration of glucose tolerance and precipitated the onset of Type II diabetes in these rats. Similar research was done on the genetically obese (ob/ob) mouse, which is used as a prototype of Type II diabetes in humans because of its pattern of obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and glucose intolerance (Surwit, Feinglos, Livingston, Kuhn, McCubbin, 1984). To study the effects of env ironmental stress and sympathetic nervous system arousal on plasma glucose in ob/ob mice, Surwit et al. (1984) designed two experimental conditions. In the first condition, 15 ob/ob mice were shaken in their cage at a rate of 200 strokes per minute for five minutes. In the second condition, 16 ob/ob mice were injected with epinephrine bitartrate, a chemical whose effects mimic those of the stress response. Plasma glucose levels in mice from both conditions were found to be significantly elevated. The researchers concluded that environmental stress was partially responsible for the expression of the diabetic phenotype in this animal model of diabetes. Role of Stress in the Onset of Diabetes Human Studies Data gathered on the impact of life events on Types I diabetes in a human sample has yielded inconsistent results. An early study by Grant, Kyle, Teichman, and Mendels (1974) examined the relationship between the occurrence of life events and the course of illness in a group of 37 diabetic patients. Using Holmes and Rahes Schedule of Recent Events (SRE), a scale in which 43 significant recent life events are assigned a numeric value of life change units as a measurement of life stress, Grant et al. (1974) found that of the 26 participants who had a positive correlation between undesirable life events and illness, 24 had a positive correlation between undesirable events scores and diabetic condition. This data suggests that negative events were primarily responsible between life events and changes in diabetic condition since the inclusion of neutral and positive events did not increase the magnitude of the correlations. Despite the significant results, this study had a number of limit ations, including the utilization of a small sample size, difficulty in establishing reliable criteria for assessing subtle changes in the diabetic condition, lack of sufficient time to elapse between assessments for significant life changes to occur, and the lack of delineation of the types of diabetes studied (i.e. Type I vs. II). However, in a more recent meta-analysis, Cosgrove (2004) found no evidence to support the hypothesis that life events cause or precipitate Type I diabetes. Using an electronic and manual literature search of appropriate key words (namely, diabetes and depression, diabetes and depressive, diabetes and life events, diabetes and stress) in the literature up to July 2003, Cosgrove (2004) aimed to establish whether there might be a link between depression, stress, or life events and the onset of Type I diabetes. A total of nine papers were found from the electronic and manual search. It was concluded that when the number and severity of life events was compared to controls in all nine reviewed studies, no differences were detected in the diabetics (Cosgrove, 2004). Though data from small, older studies and large, randomized studies showed that early losses in childhood increase the risk of developing Type I diabetes, no evidence was found to support the hypothesis that life events cause o r precipitate this diagnosis. Meta-analyses with more recent studies have not been found studying the relationships between stressful life events in both types of diabetes. As such, it is unknown whether links have since been found by other researchers. More consistent evidence was found supporting the notion that stressful circumstances precipitate Type II diabetes. In their study of environmental stress on Type II diabetics, McCleskey, Lewis, and Woodruff (1978) measured glucagon and glucose levels on 25 patients who were undergoing elective surgery, a physical stressor. Ten samples were obtained during pre-operative, intra-operative, and post-operative periods for each patient. It was found that throughout the sampling period, diabetic patients had two times the amount of glucagon (a hormone produced by the pancreas that stimulates the increase of blood sugar levels) in their body compared to their non-diabetic counterparts (McCleskey, Lewis, Woodruff, 1978). This effect was also found in Pima Indians, who have an approximately 60% chance of eventually developing Type II diabetes, compared with 5% of the Caucasian population (Surwit, Schenider, Feinglos, 1992). The effects of a simple arithmetic task on blood glucose levels were studied in both Caucasian and Pima Indian samples. Surwit, McCubbin, Feinglos, Esposito-Del Puente, and Lillioja (1990) found that blood glucose was consistently higher during and following the stressful task in ten of 13 Pima Indians, concluding that altered glycemic responsivity to behavioral stressors anticipates the development of Type II diabetes in individuals who are genetically predisposed to the disease (Surwit et al., 1990). Results from The Hoorn Study further illustrated the effects of stress on Type II diabetes. Mooy, De Vries, Grootenhuis, Boutner, and Heine (2000) analyzed data from a large population-based survey of 2,262 adults in the Netherlands upon which the researchers were able to explore whether chronic stress is positively associated with the prevalence of Type II diabetes. Analysis of data confirmed their hypothesis; a high number of rather common major life events that are correlated with chronic psychological stress, such as death of a spouse or relocation of residence, were indeed found to correspond to a significantly higher percentage of undetected diabetes (Mooy et al., 2000). Because the study was conducted in the Netherlands on a Caucasian, middle-aged population, it is uncertain whether these findings are generalizable to other demographics in different geographic regions. Childhood Maltreatment and Diabetes Thus far, with the exception of one study, the research discussed has demonstrated a positive correlation between a variety of recent or current environmental stressors, such as anesthesia, surgery, cognitive tasks, death of a loved one, and other significant losses, and the onset of Type I and/or II diabetes in animals and human beings. However, the literature is somewhat limited as to the relationship between a past environmental stressor, namely childhood maltreatment, and Type II diabetes in adulthood. Numerous researchers examined the prevalence of medical problems in abused populations and have reported that diabetes is one of the most common health conditions among those who have experienced maltreatment. For example, using data drawn from the National Comorbidity Study conducted in the early 1990s, Sachs-Ericsson, Blazer, Plant, and Arnow (2005) examined the independent effects of childhood sexual and physical abuse on adult health status in a large community sample of 5,877 men and women. Sachs-Ericsson et al. (2005) found that childhood sexual and physical abuse was associated with the one-year prevalence of serious health problems for both men and women. Specifically, participants who experienced any form of childhood abuse were more likely to report having a medical condition, including AIDS, arthritis, asthma, bronchitis, cancer, diabetes, high blood pressure, kidney or liver disease, neurological problems, stroke, gastrointestinal disorders, or any other serious health pr oblem (Sachs-Ericsson et al., 2005). Though data from this epidemiological study likely represents the U.S. demographics, a number of limitations exist. Specifically, the researchers did not report the prevalence of each disorder endorsed and thus, the actual incidence of diabetes in the population sample is unknown. Furthermore, Sachs-Ericsson et. al (2005) did not look at additional forms of maltreatment, such as verbal abuse, emotional abuse, and neglect. Similarly, Walker, Gelfand, Katon, Koss, Von Korff, Bernstein, and Russo (1999) found a significant association between childhood maltreatment and adverse adult health outcomes. In particular, the researchers administered a survey to 1,225 women randomly selected from the membership of a large HMO in Washington State. Results indicated that women with childhood maltreatment histories were more likely to have an increased number of physician-coded ICD-9 diagnoses, grouped together as high blood pressure, diabetes, dermatitis, asthma, allergy, acne, and abnormal menstrual bleeding. Though the group of women in this study who reported threshold levels of sexual maltreatment had the poorest health outcomes, a major limitation of this study is the uncertainty as to whether additional forms of maltreatment were concomitantly experienced. Specifically, the authors do not establish whether sexual abuse solely was the cause of poorer health or is largely due to multiple forms of maltreatment in girls who were not properly protected in their early families. Moreover, Walker et al. (1999) do not differentiate between types of diabetes. Gender differences have been established in the association between physical abuse in childhood and overall health problems in adulthood. Analysis of data from 16,000 individuals interviewed in the National Violence Against Women Survey found that female abuse victims were at greater risk for health problems than their male counterparts (Thompson, Kingree, Desai, 2004). Furthermore, women with maltreatment history tend to have more distressing physical experiences, have an increased number of physician-coded diagnoses, and were more likely to engage in multiple health risk behaviors, including obesity a significant risk factor associated with Type II diabetes (Trickett, Putnam, Noll, 2005; Walker, Gelgand, Katon, Koss, Von Korff, Bernstein, Russo, 1999). Moreover, sexual assault history throughout ones lifespan was also associated with chronic disease (i.e. diabetes, arthritis, and physical disability) in a sample of women from Los Angeles (Golding, 1994). Conversely, in their sa mple of 680 primary care patients, Norman, Means-Christensen, Craske, Sherbourne, Roy-Byrne, and Stein (2006) found that the experience of trauma significantly increased the odds of arthritis and diabetes for men, while trauma was associated with increased odds for digestive disorders and cancer in women. Although the data suggests that childhood maltreatment is related to adverse health outcomes in adulthood, they do not address as to why associations differed by gender. Analyzing data from the Midlife Development in the United States Survey (MIDUS), Goodwin and Weisberg (2002) sought to determine the association between childhood emotional and physical abuse and the odds of self-reported diabetes among adults in the general population. Their results revealed that self-reported diabetes occurred in 4.8% of its representative sample of 3,032 adults aged 25-74 years. Childhood abuse was associated with significantly increased odds of self-reported diabetes, which persisted after adjusting for differences in socio-demographic characteristics and mental health status (Goodwin Weisberg, 2002). Moreover, individuals who specifically reported maternal emotional abuse and maternal physical abuse had significantly higher rates of diabetes (Goodwin Weisberg, 2002). Furthermore, data gathered from a sample of 130 patients (65 abused, 65 non-abused controls) drawn from an adult primary-care practice in a small, affluent, predominantly Caucasian community in northern New England revealed that patients with a history of victimization were more likely to report diabetes or endorse symptoms of this illness than non-abused participants (Kendall-Tackett Marshall, 1999). Specifically, four patients in the abused group reported diabetes, with none in the control group. Interestingly, those patients in the abused group did not have a significantly higher family history of diabetes than those in the non-abused group and a higher percentage of patients in the abused group reported having three of more symptoms than did those in the control group. Kendall-Tackett and Marshall (1999) assert that although only four people identified themselves as having diabetes, this number should be interpreted in the broader context of incidence of diabetes in the general population. Nonetheless, this finding could have been due to chance and many of the symptoms endorsed could have been related to other diseases (Kendall-Tackett Marshall, 1999). Additional limitations include the failure to differentiate between the types of abuse endured and the use of a non-empirically validated measure to gather data. Furthermore, the researchers did not specify which type of diabetes the participants were diagnosed with and did not indicate the severity of the disease. Data from the Adverse Childhood Experiences Study (ACE), however, found alternative results. Researchers Felliti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, and Marks (1998) mailed questionnaires about adverse childhood experiences to 9,508 adults who had completed a standardized medical evaluation at a large HMO in California. It was found that abuse and other types of household dysfunction were significantly related to the number of disease conditions, with the exception of diabetes. Specifically, when those who had experienced multiple forms of childhood maltreatment were compared to those with no experiences, the odds-ratio for the presence of diabetes was a non-significant 1.6 (Felliti et al., 1998). The researchers believe that their estimates of the long-term relationship between adverse childhood experiences and adult health are conservative. Specifically, it is likely that, consistent with well-documented longitudinal follow-up studies, that reports of childhood abu se were underestimated due to the premature mortality in persons with multiple adverse childhood exposures (Felliti et al., 1998). Similarly, in a sample of 1,359 community-dwelling men and women aged 50 years or older, Stein and Barrett-Connor (2000) found no relationship between sexual assault history in participants lifetime and reported rates of diabetes. Rather, a history of sexual assault was associated with an increased risk of arthritis and breast cancer in women and thyroid disease in men (Stein Barrett-Connor, 2000). In this study, the researchers posit that the possibility of response bias is a major limitation. Namely, Stein and Barrett-Connor (2000) consider the likelihood that previously assaulted respondents have a greater tendency to visit doctors, leading to the increased opportunities for health conditions to be detected. Additional limitations include the lack of consideration for other types of abuse encountered in childhood. The Link between Childhood Maltreatment and Diabetes The above findings provide support for the hypothesis that childhood maltreatment may be associated with increased likelihood of the diagnosis of a medical condition, with the inclusion of diabetes in some studies. An essential question posed by this observation is by what mechanisms are adverse childhood experiences linked to health risk behaviors and adult diseases? A number of researchers have found that psychological stress, in particular, has been associated with the onset of Type II diabetes. This impact of stress on the etiology and course of Type II diabetes can be considered via the metabolic pathways by means of obesity and/or activation of the hypothalamic-pituitary-adrenal (HPA) axis, the gene-environment interaction, and the correlation of coping with diabetes and stressors. The stress response is a physiological coping response that involves the HPA axis, the sympathetic nervous system, the neurotransmitter system, and then immune system. There is growing evidence that victims of various forms of abuse and stressors often experience biological changes, particularly in the neuroendocrine system implicated in the stress response, as well as the brain (Glaser, 2000; Goenjian, Pynoos, Steinberg, Endres, Abraham, Geffner, Fairbanks, 2003; King, Mandansky, King, Fletcher, Brewer, 2001; McEwen, 2000). The HPA axis is the primary mechanism studied in the literature on the neurobiology of stress and is estimated through the non-invasive measurement of cortisol in saliva samples. During psychological stress, cortisol is elevated beyond normal levels in response to adrenocorticotropic hormone from the pituitary, mobilizing energy stores, and facilitating behavioral responses to threat (Diseases, 2006). In the presence of prolonged stress, especially in which the individual has difficulty coping, this physiological response may occur to an atypical extent and prove harmful. Dienstbier (1989) asserts that prolonged and/or extreme stress can create a vicious cycle of pathology, as individuals with a history of abuse may become even more vulnerable in the face of new victimization because they become threat-sensitized, resulting in either an over- or under-reaction of the HPA system to new stressors. As Vaillancourt, Duku, Decatanzaro, Macmillan, Muir, and Schmidt (2008) cite, this process is best illustrated by Cicchetti and Rogoschs (2001) study of maltreated children attending a summer day camp. These authors found that in comparison to non-abused children, children who had been both sexually and physically abused, in addition to emotionally maltreated or neglected, exhibited higher morning cortisol levels, whereas a subgroup of children who had only been physically abused exhibited lower levels. Recent evidence suggests that increased cortisol concentrations may contribute to the prevalence of metabolic syndromes, such as Type II diabetes. For example, in their assessment of 190 Type II diabetic patients who volunteered from a population study of 12,430 in suburban Germany, Oltmanns, Dodt, Schultes, Raspe, Schweiger, Born, Fehm, and Peters (2006), sought to assess the relationship between diabetes-associated metabolic disturbances and cortisol concentrations in patients with Type II diabetes. The target population comprised of men and women born between 1939 and 1958 who completed a postal questionnaire about their health status. Results demonstrated that in patients with Type II diabetes, those with the highest cortisol profiles had higher glucose levels and blood pressures (Oltmanns et al., 2006). Their findings suggest that HPA axis activity may play a role in the development of Type II diabetes-associated metabolic disturbances. Cartmell (2006) proposes a model by which this may occur. Namely, high levels of cortisol decreases metabolism of glucose and increase mobilization and metabolism of fats. This decreased metabolism of glucose contributes to increased blood glucose levels. Furthermore, increased blood fat levels contribute to insulin resistance. This increase level of blood glucose and fats are characteristic symptoms of diabetes (Cartmell, 2006). Researchers Chiodini, Adda, Scillitani, Colleti, Morelli, Di Lembo, Epaminonda, Masserini, Beck-Peccoz, Orsi, Ambrosi, and Arosio (2007) extended the literature by studying HPA axis secretion of cortisol and chronic diabetic complications. An evaluation was conducted on HPA activity in a sample of 117 Type II diabetic patients with and without chronic complications and in a sample of 53 non-diabetic patients at a hospital in Italy. Chiodini et al. (2007) found that in diabetic subjects without chronic complications, HPA axis activity was comparable with that of non-diabetic patients, whereas in diabetic subjects with chronic complications, cortisol level was increased in respect to both diabetic subjects and control subjects. Though the design of their study did not look for a cause-effect relationship, Chiodini et al. (2007) purport that higher levels of cortisol, either due to a constitutive HPA axis activation or secondary to a chronic stress condition, may predispose an individua l to the development of chronic diabetic complications. Type II diabetes is now a well-recognized syndrome characteristic of hyperglycemia, insulin resistance, obesity, dyslipidemia, and hypertension (Sridhar Madhu, 2001). One theory that purports the biological plausibility of a stress-diabetes association has been formulated by Swiss researcher, Dr. Per Bjà ¶rntorp. Bjà ¶rntorp (1997) postulated that stress could be responsible for sympathetic nervous system activation, hormone abnormalities, and obesity. This theory states that perceived psychological stress with a defeatist or helplessness reaction leads to an activation of the HPA axis. This in turn results in endocrine abnormalities, including increased cortisol and decreased sex steroid levels that disrupt the actions of insulin. In addition, this hormonal imbalance causes visceral adiposity, which plays an important role in diabetes and cardiovascular disease by contributing to the development of insulin resistance (Cartmell, 2006). Researchers of The Hoorn Study described above tested Bjà ¶rntorps theory and found only partial support (Mooy et al., 2000). Specifically, the accumulation of visceral fat did not seem to be the major mediating factor between stress and diabetes and fasting insulin concentration, which is an approximation of insulin resistance, was not higher in the individuals in their sample who had experienced more stressful events. Study Significance The significance of this study is its potential to provide medical practitioners with information regarding the impact of past psychosocial factors, such as childhood maltreatment, on the current physical health of Type II diabetics. Diabetes and its complications affect a significant portion of the United States population and has become the fifth leading cause of death in the country (Florida Department of Health, 2008). As researchers continue to look for the cause(s) of diabetes and methods to treat, prevent, or cure the disorder, it is vital that practitioners take a holistic and comprehensive approach to assessing the diabetics life. As long as abuse and other potentially damaging experiences in childhood contribute to the development of risk factors, then these childhood exposures should be recognized as the basic causes of morbidity and mortality in adult life (Felliti et al., 1998). Major limitations of past literature include lack of specificity of type of diabetes, family history, and self-reported diabetes without data on physiological measures. In addition to replication, future studies should include detailed studies on diabetes-type, a ruling-out of serious medical conditions that could potentially act as confounds, and identify maltreatment subtypes experienced. This study aims to uncover a relationship between childhood maltreatment and adult physical health, namely with Type II diabetes, so as to assist with screening and intervention. If doctors caring for adults who suffer from a medical condition associated with diabetes are unaware of this relationship, they will neither obtain early maltreatment history nor make appropriate patient referrals leading to higher health care utilization and poorer outcomes (Arnow, 2004; Springer, Sheridan, Kuo, Carnes, 2003). Research Questions and Hypotheses This study aims to answer the following questions: Is a history of childhood maltreatment associated with diabetes-related quality of life? If so, is a decrease in diabetes-related quality of life associated with an increase in the types of childhood maltreatment experienced? It is hypothesized that the more types of abuse endured during childhood (i.e. physical, emotional, and/or sexual, neglect, and/or the witnessing of family violence), the more chronic and severe an individuals diabetes will be and the greater impact of their illness on their reported quality of life. Method Participants Data will be collected from individuals with Type II diabetes, recruited from psychiatric practices located in Plant City and Tampa, Florida. Participants will be recruited from these sites due to likelihood that patients receiving psychiatric care have a history of childhood maltreatment. Participants will be included in the study if they are aged 40 and older, as non-insulin dependent diabetes appears after this age. Participants will be excluded fro