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Book Report on #8220;Girl with a Pearl Earring#8221; Girl With a Pearl Earring Author: Tracy Chevalier Genre: Historical Fiction/Romance This engaging book tells a story about the Get Metrobank Statement events surrounding the Word Receipt creation of the painting “Girl With a Pearl Earring” by Get Metrobank Of Account Online?, 17th century Dutch master Johannes Vermeer. Chevalier presents a fictional account of the artist, the Sample Management - 9+ In Word, Pdf model, and the story behind the painting. It follows the How To Statement Online? 30423 experiences of young Griet over Die Besten Ideen, the two years she serves in Get Metrobank Of Account - Banking 30423, the Vermeer household and slowly grows apart from her grief-stricken family. After an Die Besten Manager Ideen Auf Pinterest, explosion in the kiln in How To Online?, the tile factory where he works, Griet#8217;s father lost his sight and his trade. Forced by Word, this tragic accident to get a job, she is Get Metrobank Online? hired as a maid by Daniel Young With Voice, the painter. Being a Protestant in a Catholic home, and oddly quiet and obedient, the Vermeer family, with the exception of the painter himself, is How To Online? - Banking 30423 not fond of Griet. She must find her place in Free-Blank-Rubric-Template.jpg, the chaotic household, filled with five children (and counting) dominated by How To Get Metrobank Statement Of Account - Banking 30423, mischievous six-year-old Cornelia, who is fond of meddling and Receipt spying, run by Statement Of Account - Banking, his volatile wife Catharina and his shrewd mother-in-law Maria Thins, and her fiercely loyal maid Tanneke. The real trouble, however, begins when the Formal | Formal Template artist takes a liking to the mysterious girl and allows her to clean his studio, a room forbidden even to Catharina, and How To Get Metrobank Statement Online? - Banking this arrangement soon generates tension within the household.

The innocent and perceptive manners of the Sign Up Calendar Sign-Up Sheet Template 27 40 girl attract Vermeer#8217;s attention, and Statement - Banking he slowly draws her into his world. Growing closer together whilst she accompanies him in Free-Blank-Rubric-Template.jpg, his painting, Griet is secretly granted a great privilege assisting him in his work. Statement - Banking 30423. She begins by cleaning the objects he will later paint, but as he grows fonder of her she acquires greater responsibilities like grinding the Process Chart Powerpoint Templates paints and even purchasing the materials for How To Get Metrobank Of Account Online? 30423 the colors, an extremely delicate task. As if these “privileges” were not causing enough turmoil among the members of the family, matters worsen when Vermeer agrees, at Templates, his master, van Ruijven#8217;s, request, to secretly paint Griet. How To Of Account - Banking 30423. Van Ruijven#8217;s desire to Free-Blank-Rubric-Template.jpg, get a painting of Griet arises from How To Statement Of Account - Banking, hislust for her. Sign-Up Up. Page 2 Book Report on #8220;Girl with a Pearl Earring#8221; Essay. How To Get Metrobank Of Account - Banking 30423. As she approaches womanhood, wide-eyed Griet contends with the Letter Of Resignation | Formal growing attention of Statement Of Account 30423 men, including the family#8217;s butcher#8217;s son Pieter, who makes no attempt to Free-Blank-Rubric-Template.jpg, keep secret his desire to marry her. How To Online? - Banking. In order to dissipate the suspicions of her intimate relationship with Vermeer, she agrees to becomehis lover, whilst trying to Medical Questions Pdf, escape from van Ruijven#8217;s groping hands. While he paints her, Griet describes her feelings and Statement Of Account - Banking 30423 thoughts as she tries to sit impossibly still under the Word Template Receipt close eye of the intriguing man she has grown to love. Because she has been taught not to Get Metrobank Statement Online? 30423, allow men to look closely at her, she feels guilty when posing (fully clothed) for her master, even resists revealing her ear, her hair; more than immodest, such gestures seem to her immoral, but the young maid, devoted to Template Receipt, his master, obeys his every wish while holding back her tears.

Feeling like the Statement Online? - Banking 30423 painting lacks life, Vermeer orders Griet to wear his wive#8217;s pearl earrings; not wanting to Top 52 Medical Questions And Answers Pdf, infuriate him, she agrees to How To Statement Of Account - Banking, wear the Letter Of Resignation | Formal Letter Template earrings, even when she knows that the doing so could lead to Statement, her downfall. Dictated by Top 52 Secretary And Answers Pdf, her meddling ways, Cornelia, suspecting the intimacy between the Statement 30423 maid and her father, intrudes his studio and finds the finished painting. After being shown the painting by Cornelia, Catharina explodes in Chart Templates, a rage and Statement Online? - Banking 30423 Griet is Up Calendar Sign-Up Template Up forced to - Banking 30423, run away. Medical Secretary Interview And Answers Pdf. To everyone#8217;s surprise, Vermeer does not intercede before his furious wife in Get Metrobank Statement Online? - Banking 30423, Griet#8217;s behalf, but watches her go. Broken, the girl soon realizes that after his artistic needs have been fulfilled and Word Receipt his curiosity towards her had been quenched, she is How To Get Metrobank Statement - Banking 30423 of no worth whatsoever to Sample Project Pdf, her beloved painter, but a simple servant once again. Of Account 30423. After returning home, Griet agrees to Templates, marry Pieter. Several years later, now with two sons, Tanneke finds her in Of Account Online?, the butcher#8217;s stall in the market place, and, to Template Receipt, Griet#8217;s surprise, asks her to visit the house upon How To Get Metrobank Statement - Banking 30423 Catharina#8217;s request.

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resume withdrawal Protracted Withdrawal Syndromes. Journal of Substance Abuse Treatment. Vol. How To Get Metrobank Of Account Online? - Banking? 8 pp. Sign-Up 27 40 Sign Up? 19-28 · 1991. Professor C Heather Ashton DM, FRCP. School of Neurosciences. Division of Psychiatry. The Royal Victoria Infirmary. Queen Victoria Road.

Newcastle upon Tyne NE1 4LP. Abstract: The benzodiazepine withdrawal syndrome is a complex phenomenon which presents serious difficulties in definition and measurement. It is particularly difficult to How To Get Metrobank - Banking 30423, set out precise limits on its duration. Many withdrawal symptoms are a result of pharmacodynamic tolerance to benzodiazepines, some mechanisms for which are discussed. Such tolerance develops unevenly in different brain systems and may be slow to Chart, reverse. How To Get Metrobank Of Account - Banking 30423? Withdrawal symptoms occurring in the first weeks after cessation of drug use tend to merge with more persistent symptoms that may last for Letter Of Resignation Letter Template, many months.

These prolonged symptoms do not necessarily constitute true pharmacological withdrawal symptoms, but are nevertheless related to long-term benzodiazepine use. Statement Of Account - Banking 30423? Such symptoms can include anxiety, which may partly result from a learning deficit imposed by the drugs, and a variety of sensory and motor neurological symptoms. The protracted nature of some of these symptoms raises the possibility that benzodiazepines can give rise not only to slowly reversible functional changes in the central nervous system, but may also occasionally cause structural neuronal damage. Keywords: benzodiazepines; withdrawal syndrome; tolerance; protracted symptoms; tinnitus; brain mechanisms. Drug withdrawal syndromes, in general, tend to consist of mirror images of the drugs' initial effects. Thus, abrupt withdrawal from chronic usage of Daniel With Great Voice All Set His beta adrenoceptor antagonists such as propranolol may give rise to tachycardia and Statement Of Account Online?, palpitations; abrupt withdrawal from antihypertensive doses of clonidine may be followed by hypertension, anxiety, and other signs of increased sympathetic activity.

Benzodiazepines are no exception: On sudden cessation after chronic use, anticonvulsant effects may be replaced by epileptic seizures, muscle relaxation by increased muscle tension, hypnotic effects by increased anxiety. The same symptoms can occur in attenuated form when the Letter, drugs are withdrawn slowly. However, all of How To Get Metrobank Statement Of Account these symptoms are not inevitable in Project Plan Examples Pdf any individual patient. The particular features of the withdrawal syndrome and their time of onset, duration, and How To Of Account 30423, severity are greatly modified by many other factors. Such factors include pharmacokinetic variables, dosage and duration of drug use, rate of Chart Powerpoint Templates withdrawal, the presence or absence of the Statement Online?, original disorder (such as anxiety) for which the drug was prescribed, personality characteristics, physical makeup and susceptibility, and the use of concomitant treatments. These variables alone make it difficult to characterise specific features of the withdrawal syndrome. This difficulty is compounded by the fact that, as long-term medication, benzodiazepines have mainly been prescribed for anxiety and insomnia, disorders which themselves include most features of the drug withdrawal syndrome. When such patients undergo reduction of benzodiazepine dosage, especially slow reduction, how can one specify which emergent symptoms are true, drug-related withdrawal symptoms, which are pseudowithdrawal symptoms (Tyrer, Owen, Dawling, 1983), which represent a return of the original anxiety state, and which are the natural reactions of an anxious personality undergoing the stress of withdrawal? In circumstances such as these, the benzodiazepine withdrawal syndrome becomes largely a matter of definition.

Nevertheless, the existence of a benzodiazepine withdrawal reaction, from Die Besten 25+ Retail Auf Pinterest both high and low (therapeutic) doses of benzodiazepines, is no longer in dispute, and many attempts have been made to define and measure it and to estimate its incidence and duration. Definitions and Get Metrobank Online? - Banking 30423, Measurements. Symptoms occurring during benzodiazepine withdrawal have been described by many authors (Ashton, 1984, 1987; Busto, Sellers, Naranjo, Cappell, Sanchez, Sykora, 1986; Hallström Lader, 1981; Murphy, Owen Tyrer, 1983, 1984; Petursson Lader, 1981a, 1981b; Smith Wesson, 1983; Tyrer et al ., 1983; Tyrer, Rutherford, Higgett, 1981; Winokur, Rickels, Greenblatt, Snyder, Schatz, 1980; among others). Commonly described symptoms are shown in Secretary Pdf Figure 1. None of these symptoms are specific to benzodiazepine withdrawal: They include all of the psychological and somatic symptoms of anxiety, although certain symptom clusters are characteristic. Owen and Tyrer (1983) and Petursson and Lader (1981a b) emphasised the appearance of new symptoms, not experienced before withdrawal and uncommon in anxiety states. These new symptoms include hypersensitivity to Statement Of Account Online? - Banking 30423, sensory stimuli (sound, light, touch, taste, and smell) and perceptual distortions (e.g., sensation of the floor undulating, feeling of motion, impression of walls or floor tilting). There also appears to be a higher incidence than usually seen in anxiety of depersonalisation, derealisation, paraesthesiae, and extreme dysphoria, an amalgam of anxiety, depression, nausea, malaise, and depersonalisation (Petursson Lader, 1981a, 1981b). Visual hallucinations, distortion of body image, psychotic reactions, formication, muscle fasciculation and twitching (occasionally resembling myoclonus), and considerable loss of Formal Of Resignation | Formal Letter weight are also described during benzodiazepine withdrawal and Get Metrobank Of Account Online? 30423, are unusual in anxiety states. Smith and Wesson (1983) and Ashton (1984) drew attention to the characteristic fluctuation of symptoms, which may wax and wane without obvious psychological provocation.

Smith and Medical Questions, Wesson (1983) suggest that this wavelike symptomatology is an important marker for distinguishing the low-dose benzodiazepine withdrawal syndrome from symptom re-emergence. How To Get Metrobank Statement? However, since symptoms may fluctuate in the course of the day or over periods of days or weeks, accurate recording is Sign Sign Up, difficult. Since no particular symptom is exclusive to Statement Online? - Banking 30423, benzodiazepine withdrawal, how can one define the Sample Plan - 9+, syndrome? Tyrer et al . (1981, 1983) have attempted various methods in placebo controlled studies: The appearance of How To Statement two or more new symptoms during the withdrawal period. New symptoms in Formal one study included perceptual disturbances, sensory hypersensitivity, and fear of imminent death (1981), and in another study (1983), psychotic symptoms, depression and Get Metrobank Of Account Online? - Banking, dysphoria, muscle twitching, and abnormal sensations of movement. The choice of two new symptoms as the minimum number necessary to qualify as withdrawal is clearly arbitrary. An increase in self-rated symptoms (Comprehensive Psychiatric Rating Scale) to greater than 50% of baseline levels, followed by a return to lower values. Young Singer All Set To Launch His? Symptom resolution is How To Of Account Online? - Banking 30423, clearly an important feature in differentiating between symptoms due to Chart, withdrawal and symptom re-emergence, emergence, or overinterpretation. As Smith and Wesson (1983, p. 88) point out: Withdrawal symptoms subside with continued abstinence, whereas symptoms of Get Metrobank Statement Online? 30423 other aetiology persist. However, a measure of Medical Secretary Questions And Answers symptom resolution is not applicable to patients who drop out of Get Metrobank withdrawal studies, perhaps because of intolerable true withdrawal symptoms.

It is noteworthy that 45% of patients dropped out of one study (Tyrer et al ., 1981). A combination of methods (1) and (2) so that a withdrawal reaction is defined as the appearance of new symptoms that resolved before the end of the Auf Pinterest, study (20 and 14 weeks after the end of withdrawal [Tyrer et al ., 1983]). More recently Tyrer, Murphy, Riley (1989) have produced a questionnaire of symptoms that are relatively specific to benzodiazepine withdrawal in that they mainly occur during periods of drug withdrawal and return towards baseline levels after withdrawal. Pseudowithdrawal symptoms were defined as symptoms occurring when patients thought they were reducing but their drug consumption and blood concentrations of benzodiazepines were unchanged. Such definitions, derived from double-blind, placebo-controlled studies, have been extremely helpful in the recognition of benzodiazepine dependence, especially low-dose dependence. However, they are of necessity arbitrary and can only be approximate, since the appearance or severity of any particular symptom or symptom cluster may actually represent a variable combination of true withdrawal, pseudowithdrawal, and re-emergence of Of Account Online? - Banking 30423 anxiety, and the same patients liable to Process Templates, pseudowithdrawal reactions are also likely to Online? - Banking, be most vulnerable to true withdrawal effects. Furthermore, definitions based on differences from prewithdrawal symptoms do not take into account the possibility that, due to the development of tolerance, withdrawal symptoms may already be present while patients are still taking benzodiazepines. Such a situation is most clearly seen with relatively short-acting benzodiazepines.

For example, patients taking triazolam as a hypnotic commonly develop daytime anxiety (Oswald, 1989) and even hallucinations or psychotic reactions. These are almost certainly withdrawal effects since they are immediately relieved by taking the drug but eventually disappear after the drug is stopped (Ashton, 1987). Similarly, with lorazepam and Sample Project Plan, alprazolam (Hermann, Brotman, Rosenbaum, 1987) patients often develop increasing anxiety and panic as well as craving between doses (Ashton, 1984). They appear to undergo a miniwithdrawal between each dose, which is temporarily relieved by How To Get Metrobank Online? - Banking the next tablet, but disappears after total cessation. Top 52 Secretary? An analagous condition is How To Get Metrobank Of Account 30423, seen with alcohol: alcoholics commonly complain of tremor and insomnia, symptoms which are temporarily relieved by alcohol but which only Die Besten 25+ Retail Manager Ideen disappear after a period of How To Statement 30423 abstinence. Die Besten 25+ Retail Auf Pinterest? Even with long-acting benzodiazepines such as diazepam, there is usually a history in long-term users of steadily increasing anxiety, with the development over the years of new symptoms such as agoraphobia, often with perceptual distortions and How To Statement Of Account - Banking 30423, depersonalisation, despite continued usage of Project Management Plan - 9+ Examples Pdf these supposedly anxiolytic drugs. How To Online? - Banking 30423? These symptoms have often been temporarily alleviated by a moderate increase in dosage or the addition of another benzodiazepine, but eventually re-emerge during further chronic use and only disappear after the benzodiazepine is stopped (Ashton, 1984, 1987).

Mechanisms of tolerance and withdrawal symptoms are discussed below, but tolerance is difficult to demonstrate in clinical practice. Because of these many immeasurable factors, it is doubtful whether the boundaries of a true benzodiazepine withdrawal syndrome can ever be clearly demarcated. The overall incidence of the benzodiazepine withdrawal syndrome is unknown. Skye With Great To Launch His? As with cigarette smokers (Ashton Stepney, 1982), there may be a large, uncounted population who quit regular benzodiazepine usage after months or years without ever coming to medical attention. Tyrer (1990) notes that it is How To Get Metrobank Statement Of Account Online?, surprising how many patients in ordinary practice have no difficulties whatsoever in reducing their benzodiazepines, and the incidence of a benzodiazepine withdrawal syndrome in general practice appears to be around 30% (Tyrer et al ., 1981, 1983; Tyrer, 1989; Tyrer, Murphy, Riley, in Formal press; Tyrer, 1990). On the other hand, in selected patients referred for specialist treatment, the Get Metrobank Of Account Online? 30423, incidence may be 100% (Ashton, 1987; Lader Olajide, 1987; Petursson Lader, 1981a). It is also worth noting that withdrawal syndromes in the form of rebound insomnia (Kales, Scharf, Kales, 1978) or more general symptoms can occur in experimental subjects and in Die Besten Ideen nonanxious patients prescribed benzodiazepines for sports injuries (Lader, 1988). In addition, a benzodiazepine withdrawal syndrome has been described in neonates whose mothers took therapeutic doses of Statement Of Account benzodiazepines during pregnancy (Rementeria Bhatt, 1977). Not surprisingly, the observed incidence of benzodiazepine withdrawal reactions depends not only on patient selection but also on the criteria used for measurement.

In the study of Tyrer et al . Powerpoint Templates? (1983), when definitions of withdrawal (1) and How To Get Metrobank Online? 30423, (2) (see above) were used singly, the 25+ Retail Ideen, incidence of pseudowithdrawal reactions was around 20%. With the combined definition (3) (see above) the incidence of true withdrawal symptoms was 44% and there were no pseudowithdrawal reactions. This incidence of course only applies to How To Statement Of Account - Banking, those consenting to take part in the study and managing to Chart Templates, finish it. Statement Online?? It cannot account for Sample Management Plan - 9+, dropouts during withdrawal or for individuals declining to undergo withdrawal (45.5% of eligible patients in Get Metrobank Online? - Banking the study of Tyrer et al ., 1981). Thus the incidence of benzodiazepine withdrawal, like its diagnosis, becomes largely a matter of Template. Sign-Up Template 27 40 Sign Up definition. The identification of the benzodiazepine withdrawal syndrome is Statement Of Account Online? - Banking 30423, difficult enough; its duration is Up Calendar Template. Sheet Up, even more difficult to How To Get Metrobank Online? 30423, delineate. Top 52 Interview And Answers Pdf? Most estimates suggest a duration of approximately 5-28 days, with a peak in How To Get Metrobank Statement Of Account - Banking severity around 2 weeks post withdrawal, after which most symptoms return to prewithdrawal levels (Busto et al ., 1986; Murphy et al ., 1984; Owen Tyrer, 1983; Petursson Lader, 1981a, 1981b; Tyrer et al ., 1981, 1983).

To a large extent the apparent duration depends upon how long the patients are followed up, and several authors have drawn attention to the prolonged nature of postwithdrawal symptoms in some cases. For example, Smith and Wesson (1983) observed that symptoms after withdrawal from low-dose benzodiazepine typically take 6-12 months to subside completely. Prolonged symptoms included anxiety, insomnia, paraesthesiae, altered sensation, muscle spasms, and psychosis. Ashton (1984, 1987) reported a similar protracted time-course. Tyrer (1990) refers to a post-withdrawal syndrome in the 6 months after withdrawal. Formal Of Resignation | Formal Template? Hallström and Lader (1981) found the Hamilton Anxiety Score still raised above baseline levels by follow-up several months later when successfully withdrawn patients had resumed their normal life (Hallström Lader, 1981 p. 237). How To Online? - Banking? Olajide and Die Besten Ideen, Lader (1984) suggested that depression may be an integral part of the benzodiazepine withdrawal syndrome and may last several months after withdrawal in susceptible individuals; this phenomenon was also observed by Ashton (1987). Busto, Fornazzari, and Naranjo (1988) described two cases in whom severe tinnitus first appeared during benzodiazepine withdrawal and persisted for How To Get Metrobank Of Account Online? 30423, 6 and 12 months after discontinuation before finally diminishing or disappearing. In one of these cases the tinnitus was immediately alleviated by diazepam in Die Besten 25+ Retail Ideen Auf Pinterest a double-blind placebo-controlled trial conducted over How To Get Metrobank Statement Online? - Banking 1 week, 6 months after withdrawal; after a further 6 months of abstinence the Sign Template, tinnitus had became tolerable. In a recent study of 68 patients who were withdrawn from How To Get Metrobank benzodiazepines over a 6-week period and followed for a further 4 weeks, Tyrer et al . (1989), using a self-report scale, found a wide variation in the time at which individual symptoms peaked.

Mean scores for some symptoms (depression, dizziness, paraesthesiae, feeling of Singer Great Voice All Set His unreality) peaked early, while mean scores for Get Metrobank - Banking 30423, others (nausea, memory impairment, faintness, touch sensitivity, and motor impairment) were maximal 8 weeks after the start of withdrawal. Although individual patient's scores were not reported, and Top 52 Secretary And Answers, 30% withdrew from the study, these findings suggest that symptoms can persist beyond the Get Metrobank Of Account - Banking, 5-28 days usually regarded as the duration of the withdrawal syndrome. Ashton, Rawlins and Tyrer (1990) used the rating scale shown in Figure 1 to record the symptoms of patients undergoing diazepam withdrawal under double-blind placebo controlled conditions. Withdrawal took place over 4 weeks, and patients were followed for 25+ Retail Manager Ideen, 8 weeks after the end of How To Statement Of Account 30423 withdrawal. Half the patients received placebo and the other half withdrawal. Analysis of the time-course of selected symptoms in the 11 out of 12 patients in Sample Project Management In Word, Pdf the placebo group who successfully completed withdrawal is shown in Table 1. Eight weeks after the How To Get Metrobank Statement Of Account Online? 30423, end of withdrawal, mean scores for headache, dizziness, depression, tinnitus, paraesthesiae, and motor symptoms remained higher than prewithdrawal scores; other symptoms had declined although few had disappeared. These findings again show that duration of symptoms after benzodiazepine withdrawal is often a matter of months rather than weeks. Different symptoms persisted in the Tyrer et al . (1989) and Ashton et al . (1990) studies, which differed also in size of sample, patient selection, and rate of withdrawal.

To what extent such persistent symptoms are true withdrawal symptoms is unknown. A further problem in assessing the duration of the withdrawal syndrome is the interpretation of the baseline (prewithdrawal) symptoms and anxiety scores. Patients presenting for Auf Pinterest, benzodiazepine withdrawal often have high levels of Get Metrobank Statement anxiety and many psychological and somatic symptoms. Figures 2 and 3 show Hospital Anxiety Depression (anxiety) (Zigmond Snaith, 1983) and symptom rating scores for 12 patients on benzodiazepines compared with the scores of Young Singer With Voice To Launch 18 healthy university students approaching their exams. Both groups took placebo tablets and were followed for 20 weeks. The benzodiazepine group withdrew from the benzodiazepines between weeks 8 and 12. It is How To Get Metrobank Online?, clear that the patients had considerably higher scores than the normal subjects on Process Chart Powerpoint Templates, both scales, even at the beginning of the study while they were still taking benzodiazepines. Certainly in these patients the benzodiazepines were not effectively controlling anxiety and, as argued above, it is possible that at least some of the presenting symptoms were due to withdrawal symptoms even in the presence of the drug, as a result of the development of drug tolerance.

Such symptoms would be expected to disappear after withdrawal, but they could be slow to resolve. There was no evidence of resolution below baseline levels 8 weeks after withdrawal, but unfortunately (as in How To Get Metrobank - Banking 30423 most studies) formal assessment stopped at this point. However, continued clinical contact with most of these patients has shown that anxiety symptoms have declined over Sample Management time. This slow improvement bears out the How To Get Metrobank Statement Of Account - Banking, observations quoted above (Ashton, 1984, 1987; Busto et al ., 1988; Hallström Lader, 1981; Olajide and Lader, 1984; Smith Wesson, 1983) that symptoms improve gradually for many months after withdrawal, and some patients are able to resume normal lives after years of incapacity before withdrawal. Which of these long-lasting symptoms can one attribute to true drug withdrawal effects? Is it possible to pinpoint a time at which the benzodiazepine withdrawal syndrome ends and to say with certainty that any residual symptoms must be due to Top 52 Medical, other factors? The problem is similar to Statement Online?, that of designating which effects of a bout of Process Chart influenza or infectious mononucleosis can be attributed to How To Get Metrobank Statement 30423, the specific virus. Top 52 Secretary Questions? Do such effects include only those of the viral toxaemia? Do they include secondary bacterial infection consequent upon the impact of the virus? Do they include the period of postviral lethargy and How To Statement 30423, depression which, like benzodiazepine withdrawal symptoms, tends to recur in Top 52 Medical Secretary Questions wave-like fashion for How To 30423, several months? Once again, the benzodiazepine withdrawal syndrome appears to slip through the fingers and 25+ Retail Auf Pinterest, one is led back to a question of definition.

Probably a clear definition of Get Metrobank - Banking 30423 duration is impossible because drug-induced perturbations of central neurotransmission merge imperceptibly into the background of individual, genetically determined, and learned patterns of brain activity. Protracted Symptoms After Benzodiazepine Withdrawal. All the problems of definition discussed above are multiplied in any attempt to describe protracted benzodiazepine withdrawal syndromes. Yet anyone observing patients for long periods after withdrawal cannot fail to be struck by the persistence of certain symptoms in Die Besten 25+ Retail Manager Ideen Auf Pinterest some patients. These may not be true benzodiazepine withdrawal symptoms; nevertheless they are possibly related to Of Account - Banking 30423, benzodiazepine use and often present a clinical problem.

Listed below are examples of some protracted symptoms that from personal observations and other reports appear to be relatively common after benzodiazepine withdrawal. Unfortunately, there are no data available on the incidence and duration of such symptoms in comparable patients not treated with benzodiazepines, nor of their relative incidence in patients undergoing benzodiazepine withdrawal. Nor are there any known predictive factors to indicate which patients might be especially vulnerable. Anxiety: As discussed above, anxiety may persist for many months after benzodiazepine withdrawal, yet slowly decline below prewithdrawal levels after 1-2 years (Ashton, 1987). One reason for the slow resolution may be that benzodiazepines inhibit the learning of stress-coping strategies. Such effects have been demonstrated in animals and man (Gray, 1987). Consequently there is Sign Template. Sign-Up Sheet 27 40 Sign, a long period after benzodiazepine withdrawal when patients have a decreased ability to cope with stressful situations (Ashton, 1989; Murphy Tyrer, 1988; Owen Tyrer, 1983).

Recovery may require many months of learning new strategies of How To - Banking 30423 stress control to replace the years of Daniel With Great His coping with stress by means of exogenous drugs. Hence persisting anxiety after benzodiazepine withdrawal does not necessarily imply the re-emergence of an anxiety state existing before benzodiazepine treatment; it may represent the uncovering of a type of learning deficiency induced by long-term benzodiazepine use. People who take benzodiazepines tend to have high ratings for Get Metrobank Statement Of Account - Banking, trait anxiety (Ashton and Golding, 1989; Golding Cornish, 1987; Golding, Harper, Brent-Smith, 1983) which may confer a particular vulnerability to the stress of withdrawal. Nevertheless, even without formal treatment, protracted anxiety symptoms, including agoraphobia and Ideen Auf Pinterest, panic, may gradually resolve after benzodiazepine withdrawal (Ashton, 1987) although the Get Metrobank Online? - Banking 30423, process may be hastened by behavioural treatments. Depression: Depression can be caused or aggravated by chronic benzodiazepine use (Lader Petursson, 1981), yet it also appears to be a feature of the withdrawal syndrome (Olajide Lader, 1984). It may be severe enough to qualify as a major depressive disorder (Ashton, 1987) and may persist for some months. Olajide and Lader (1984) suggest that the Formal Letter Template, mechanisms for postwithdrawal depression may be central serotonin depletion, but there is no direct evidence for this.

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No abnormality detected on skull x-ray, CAT scan, EEG, or ENT examination, apart from slight bilateral (symmetrical) high-tone deafness. Not clinically anxious or depressed; all other withdrawal symptoms resolved quickly. Taking no medication. Case 2: Female, aged 62. Duration of Get Metrobank - Banking benzodiazepine usage: 18 years. Withdrawn slowly from Sign-Up Up diazepam 15mg daily in 1988. How To Get Metrobank Statement Of Account Online? - Banking 30423? Bilateral tinnitus first noticed during previous attempts at withdrawal, becoming severe after final withdrawal, and Interview Questions And Answers Pdf, still present, severe, and continuous 1 year later.

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Two of the Letter Of Resignation Letter Template, above patients also complained of unilateral headaches. Paraesthesiae: Paraesthesiae, in Of Account the form of Medical Secretary Interview Questions And Answers Pdf tingling, pins and needles or numbness of the extremities or circumoral region, is another common symptom of benzodiazepine withdrawal. How To Get Metrobank Statement Online? 30423? The symptom also occurs in anxiety and possibly results from Sign Up Calendar Template hyperventilation. Benzodiazepines depress the sensitivity of the respiratory centre to carbon dioxide (Gilmartin, Corris, Stone, Veale, Gibson, 1988) and it is possible that the respiratory centre becomes hypersensitive during withdrawal, triggering hyperventilation. How To Get Metrobank Statement Of Account - Banking 30423? Resolution of Formal Letter Letter Template paraesthesiae usually occurs within a few weeks of withdrawal.

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No abnormal signs; good peripheral pulses. Medication; promethazine 50mg nocte since 1988. Case 2: Female, aged 67. Duration of benzodiazepine usage: 12 years. First noticed severe burning pain in feet and legs in 1981 during reduction of medazepam 15mg to 5mg daily. Pain persisted during diazepam substitution and slow withdrawal in 1985. 1986: still severe burning pain in legs not relieved by chlordiazepoxide. 1989: pain still present. Neurological examination, nerve conduction studies, serum foliate and B 12 levels normal; peripheral pulses present and normal. Formication is also common during benzodiazepine withdrawal, and Daniel Skye Young Great To Launch, many patients temporarily complain of a feeling of insects crawling on Get Metrobank Of Account - Banking 30423, the skin or of lice or nits in the hair. Project Management Plan - 9+ Examples In Word, Pdf? Occasionally, more bizarre sensations are reported, such as a feeling of slime or water running over the body, a sense of inner vibration, or a feeling of trembling inside, and these symptoms may be protracted.

Such symptoms may be variants of the burning sensations described above or may possibly be psychotic, but have a temporal relationship to benzodiazepine withdrawal. Motor Symptoms: Increased muscle tension, hyperreflexia, tremor, fasciculation, and muscle jerking are common features of benzodiazepine withdrawal but usually resolve within weeks. Occasionally muscle jerking persists for Of Account Online?, a year or more after withdrawal, and Process Powerpoint Templates, the clinical picture may suggest myoclonus, tics, or exaggerated startle reactions. Shoulder girdle and limb muscles are usually affected, but blepharospasm can occur. Some patients complain of violent jerking of the Get Metrobank Of Account - Banking, whole body at the onset of Sample - 9+ Pdf sleep, which may occur 20 or more times a night. Restless legs syndrome may also be protracted. Some of these symptoms may result from increased peripheral sympathetic tone since they are often improved by propranolol. How To Get Metrobank Of Account? Others may be centrally generated and at least partially respond to carbamazepine. Process Powerpoint? Blepharospasm can be controlled by local injection of botulinum toxin at Get Metrobank Statement Of Account - Banking 3 monthly intervals.

Protracted motor symptoms such as these raise the Die Besten Ideen, possibility that benzodiazepines are capable of causing long-term hyperexcitability of motoneurons or central motor pathways. Gastrointestinal Symptoms: Gastrointestinal symptoms are extremely common during chronic benzodiazepine use and in withdrawal. Many chronic benzodiazepine users have been investigated by How To Of Account Online? 30423 gastroenterologists and Powerpoint Templates, found to Get Metrobank Of Account - Banking, have irritable bowel syndrome (Ashton, 1987). Top 52 Interview? Gastrointestinal symptoms may be aggravated by Statement Online? - Banking 30423 hyperventilation (Lum, 1987) and may disappear completely after benzodiazepine withdrawal, even in patients who have had irritable bowel syndrome for years. Nevertheless, there remains a sizeable core of patients who complain of food intolerance and gaseous abdominal distension which first appears during withdrawal and is protracted for many months. Tests for specific food allergies almost always prove negative, and the condition is unresponsive to conventional treatment. Patients often turn to Sign Up Calendar Sign-Up Template Sign Up, alternative or fringe medicine, undergo various forms of diet, and become convinced that they have intestinal candidiasis or damage to the immune system. None of these claims have scientific support, although Lum (1987) reports that hyperventilation provokes histamine release and that the incidence of food intolerance and pseudo-allergic reactions is How To Get Metrobank Of Account - Banking 30423, high in chronic hyperventilators. The effect of benzodiazepine withdrawal on gastrointestinal function and on coriocosteroid and immune responses (known to be affected by stress) perhaps merits further attention. Brain Mechanisms of Benzodiazepine Withdrawal Symptoms. The primary effect of benzodiazepines is enhancement of gamma-aminobutyric acid (GABA) activity on 25+ Retail Manager Ideen Auf Pinterest, postsynaptic GABA-A receptors in the brain.

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Thus benzodiazepine actions are by no means confined to a particular neurotransmitter or brain pathway. Any chronically used drug gradually engenders a series of homeostatic responses which tend to restore normal function despite the presence of the drug. Sample Project Management Plan - 9+? With chronic benzodiazepine use, compensatory changes occur in GABA receptors. Such changes consist of Statement Of Account - Banking 30423 decreased sensitivity of these receptors to GABA, probably as a result of Die Besten Manager Auf Pinterest alterations in affinity state and decreased density (Cowan Nutt, 1982; Nutt, 1986). How To Get Metrobank Of Account - Banking 30423? In addition, there are changes in the secondary systems controlled by GABA, so that the output of excitatory neurotransmitters tends to be restored, and/or the sensitivity of their receptors increases.

The whole complex of primary and secondary changes eventually results in Skye Young Singer With Great Voice benzodiazepine tolerance. This pharmacodynamic tolerance develops unevenly to Get Metrobank Of Account - Banking, different benzodiazepine effects. For example, tolerance appears more rapidly to hypnotic and anticonvulsant than to Sign Sign, anxiolytic effects (Sepinwall Cook, 1979). Tolerance to different effects may also vary between individuals, possibly due to variations in intrinsic GABA activity in different parts of the brain, which are in Get Metrobank Of Account Online? 30423 turn reflected in personality characteristics and susceptibility to stress. Tolerance is Template. Sign-Up Template Sign Up, never complete and How To Statement Online? - Banking 30423, probably never reaches a perfect equilibrium in all brain systems, which may be one reason for Project Management Examples Pdf, the high morbidity amongst chronic benzodiazepine users (Ashton, 1987).

Acute tolerance, especially to hypnotic effects, can be manifested rapidly, but chronic tolerance develops over a time-course of several weeks. Once established, chronic tolerance can last for months or even years after cessation of some central nervous system depressants such as alcohol (Cicero, 1979) and probably also benzodiazepines. The development of pharmacodynamic tolerance sets the scene for the withdrawal syndrome. Cessation of the drug exposes all the adaptations which have accrued to counteract its presence, releasing a rebound of unopposed activity involving many neurotransmitters and their receptors and How To Of Account - Banking, many brain systems. Clinically this state is manifested as the withdrawal syndrome, consisting of effects that are largely the opposite of those originally induced by Top 52 Pdf the drug. The distribution, duration, and severity of symptoms depend on the particular systems that have undergone adaptive modulations and the degree of the adaptive changes induced, as well as on the rate of drug withdrawal.

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Like alcohol, benzodiazepines are lipid soluble, are highly concentrated in the brain, and impair cerebral cortical, cerebellar, and limbic system function. It is possible that use over many years could cause physical changes such as cortical shrinkage, which may be only partially reversible. Such changes have been demonstrated by CAT-scan studies in young alcoholics (Lee, Möller, Hardt, Haubek, Jenson, 1979; staff, British Medical Journal, 1981) although not conclusively in chronic benzodiazepine users (Lader Petursson, 1984; Perera, Powell, Jenner, 1987). However, such techniques may not be sensitive enough to detect subtle changes. Nor are standard tests of intellectual function sensitive enough to detect minor degrees of Manager cognitive impairment that may persist after withdrawal in some long-term users. Get Metrobank Statement Of Account Online? 30423? It remains possible that some protracted benzodiazepine withdrawal symptoms (including tinnitus and Daniel Skye With Voice All Set, other neurological and psychological symptoms) could result from physicochemical neuronal damage. These symptoms would not be fully relieved by restarting benzodiazepines. There are still many puzzling features of benzodiazepine withdrawal, and the benzodiazepine story remains unfinished (Ashton, 1984). Ashton, H. Get Metrobank 30423? (1989). Risks of Daniel Young Singer Great dependence on benzodiazepine drugs: A major problem of long-term treatment.

British Medical Journal , 298, 103-104. Ashton, H., Golding. J.F. Statement Of Account Online? - Banking 30423? (1989). Tranquillisers: Prevalence, predictors and possible consequences. Project - 9+ Examples Pdf? Data from a large United Kingdom Survey. British Journal of Addiction , 84,541-546. Ashton, H., Rawlins, M.D. Tyrer, S.P. (1990). Get Metrobank Online? - Banking 30423? A double blind placebo controlled study of buspirone in diazepam withdrawal in chronic benzodiazepine users.

British Journal of Sample Project Plan Pdf Addiction, 157, 232-238. Ashton, H., Stepney, R. (1982) Smoking: Psychology and Statement Of Account, pharmacology , London: Tavistock Publications. Benton, D., Rick, J.T. (1976). The effect of increased brain GABA produced by amino-oxyacetic acid on arousal in rats. Psychopharmacology , 49, 85-89. Bloom, F.E. (1985). Neurohumoral transmission in the central nervous system. In A.G.

Gilman, L.S. Goodman, T.W. Rall, F. Muland (Eds.), The pharmacological basis of therapeutics (pp. 236-259). New York: Macmillan. Busto, U., Fornazzari, L., Naranjo, C.A. Top 52 Medical Secretary Interview Questions? (1988). Protracted tinnitus after discontinuation of How To Statement - Banking 30423 long-term therapeutic use of benzodiazepines. Journal of Clinical Psychopharmacology , 8, 359-362.

Busto, U., Sellers, E.M., Naranjo, C.A. Formal Of Resignation? Cappell, H.P., Sanchez, C.M., Sykora, K. (1986). Withdrawal reaction after long-term therapeutic use of benzodiazepines. New England Journal of Medicine , 315, 654-659. Cicero, T.J. (1979). Tolerance to and physical dependence on alcohol: Behavioural and How To - Banking, neurobiological mechanisms. in Brain and Daniel Great Voice All Set To Launch, pituitary peptides (pp.1603-1617). Munich: Ferring Symposium 1979.

Costa, E. How To Of Account 30423? (1981). The role of gamma-aminobutyric acid in the action of 1,4 benzodiazepines. Process Chart Templates? In J.W. Lamble (Ed), Towards understanding receptors (pp. 176-183). Amsterdam: Elsevier/North Holland. Cowen, P.J., Nutt, D.J. (1982).

Abstinence symptoms after withdrawal from tranquillising drugs: Is there a common neurochemical mechanism? Lancet ,2,360-362. Gilmartin, J.J., Corris, P.A., Stone, T.N., Veale, D., Gibson, G.J. (1988). Effects of diazepam and chlormethiazole on ventilatory control in normal subject. British Journal of Clinical Pharmacology , 25, 766-770. Golding, J.F., Cornish, A.M. (1987).

Personality and life-style in medical students: Psychopharmacological aspects. Psychology and Health , 1, 287-301. Golding, J.F., Harper, T., Brent-Smith, H. (1983). Personality, drinking and drug-taking correlates of cigarette smoking. Personality and Individual Differences , 4, 703-706. Gray, J.A. (1981). Anxiety as a paradigm case of How To Statement - Banking 30423 emotion.

British Medical Bulletin , 37, 193-197. Gray, J. A. (1987). The neuropsychology of emotion and personality. In S.M. Stahl, S.D. Iverson, E.C. Goodman (Eds.), Cognitive neurochemistry (pp.171-190). Oxford: Oxford University Press. Haefley, W., Pieri, L., Pole, P., Schaffer, R. Top 52 Medical Secretary? (1981). General pharmacology and neuropharmacology of benzodiazepine derivatives. In H. How To Get Metrobank Of Account - Banking? Hoffmeister, and G. Stille (Eds.), Handbook of Ideen Auf Pinterest experimental pharmacology (Vol.

55, 11, pp. 13-262). Berlin: Springer-Verlag. Hallström, C., Lader, M. (1981). Statement 30423? Benzodiazepine withdrawal phenomena. International Pharmacopsychiatry , 16, 235-244. Hermann, J.B., Brotman, A.W., Rosenbaum, J.F. (1987). Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines.

Journal of Clinical Psychiatry , 48 (suppl. 10), 22-28. Kales, A., Scharf, M.B., Kales, J.D. (1978). Rebound insomnia: A new clinical syndrome. Science , 201, 1039-1041. Lader, M. (1988). The psychopharmacology of addiction - Benzodiazepine tolerance and dependence.

In M. Lader (Ed.), T he psychopharmacology of addiction (pp. 1-14). Oxford: Oxford University Press. Lader, M.H., Olajide, D. Top 52 Medical Secretary Questions And Answers? (1987). A comparison of buspirone and placebo in relieving benzodiazepine withdrawal symptoms. How To Of Account Online?? Journal of Clinical Psychopharmacology , 7, 11-15. Lader, M.H., Petursson, H. Sample Plan In Word, Pdf? (1981). Benzodiazepine derivatives - Side effects and dangers. Biological Psychiatry , 16, 1195-1212.

Lader, M.H., Ron, M., Petursson, R.H. (1984). Statement - Banking 30423? Computed axial brain tomography in long-term benzodiazepine users. Psychological Medicine , 14, 203-206. Lee, K., Moller, L., Hardt, F., Haubek, A., Jenson, E. (1979). Alcohol-injured brain damage and liver damage in Die Besten 25+ Retail Manager young males. Lancet 2, 759-761.

Lum, L.C., (1987). Hyperventilation syndromes in medicine and psychiatry: A review. Journal of the Statement Online? - Banking 30423, Royal Society of Medicine , 80, 229-231. Möhler, H., Okada, T. (1977). Project Pdf? Benzodiazepine receptors: Demonstration in the central nervous system. Science 198, 849-851.

Murphy, S.M., Owen, R.T., Tyrer, P.J., (1984). Withdrawal symptoms after six week’s treatment with diazepam. Lancet , 1389. Murphy, S.M., Tyrer, P. (1988). The essence of benzodiazepine dependence. (pp. 157-167). Oxford: Oxford University Press.

Nutt, D. (1986). Benzodiazepine dependence in the clinic: Reason for anxiety? Trends in Get Metrobank Statement Online? - Banking 30423 Pharmacological Sciences 7, 457-460. Olijade, D., Lader, M. (1984). Depression following withdrawal from Young Singer With Great Voice To Launch His long-term benzodiazepine use: A report of four cases.

Psychological Medicine , 14, 937-940. Oswald, I. (1989) Triazolam syndrome 10 years on. Lancet 1, 451-452. Owen, R.T., Tyrer, P. How To Online?? (1983) Benzodiazepine dependence: A review of the evidence. Sheet Template 27 40? Drugs , 25, 385-398. Perera, K.M.H., Powell, T., Jenner, F.A. (1987). Computerised axial tomographic studies following long-term use of benzodiazepines. Psychological Medicine , 17, 775-777.

Petursson, H., Lader, M.H. (1981a) Withdrawal from long-term benzodiazepine treatment. British Medical Journal , 283, 634-635. Petursson, H., Lader, M.H. Get Metrobank Statement Of Account Online? 30423? (1981b). Benzodiazepine dependence. British Journal of Addiction , 76, 133-145. Rementeria, J.L., Bhatt, K. (1977).

Withdrawal symptoms in neonates from Sample Project Plan intrauterine exposure to 30423, diazepam. Journal of Paediatrics , 90, 123-125. Sepinwall, J., Cook, L. (1979). Mechanisms of Formal Letter action of the benzodiazepines: Behavioural aspects. Federation Proceedings 39, 3024-3031. Smith, D.E., Wesson, D.R. (1983). Get Metrobank Of Account? Benzodiazepine dependency syndromes.

Journal of Psychoactive Drugs , 15, 85-95. Squires, R.F., Braestrup, C. (1977). Benzodiazepine receptors in the rat brain. Nature , 266,732-734. Staff. (1981). Minor brain damage and alcoholism. Die Besten Manager Ideen? British Medical Journal , 2, 455-456. Tyrer, P. How To Get Metrobank Of Account Online? 30423? (1990) Diagnosis of Sample Management Plan - 9+ Examples Pdf benzodiazepine dependence . Unpublished manuscript. Tyrer, P., Murphy, S., Riley, P. (1989). The benzodiazepine withdrawal symptom questionnaire.

Journal of Affective Disorders , 19, 53-61. Tyrer, P., Owen, R., Dawling, S. (1983). Gradual withdrawal of diazepam after long-term therapy. Lancet 1, 1402-1406. Tyrer, P., Rutherford, D., Higgett, T. (1981). Benzodiazepine withdrawal symptoms and How To Get Metrobank, propranolol. Lancet , 1, 520-522. Winokur, A., Rickels, K., Greenblatt, D.J., Schatz, N.J. (1980). Withdrawal reaction from long-term low dosage administration of diazepam.

Archives of General Psychiatry , 37, 101-105. Young, W.S., Kuhar, M.J. (1980). Radiohistochemical localisation of Formal Of Resignation | Formal Letter Template benzodiazepine receptors in rat brain. How To Get Metrobank Of Account 30423? Journal of Pharmacology and Young Great Voice His, Experimental Therapeutics , 212, 337-346. Zigmond, A.S., Snaith, R.P. (1983). How To Statement Online? - Banking? The hospital anxiety and depression (HAD) scale. Acta Psychiatrica Scandinavica , 67, 361-370. FIGURE 1. WITHDRAWAL SYMPTOMS RATING SCALE. Ratings: 0=none 1=mild 2=moderate 3=severe.

FIGURE 1. Withdrawal Symptoms Rating Scale. FIGURE 2. Hospital Anxiety Depression (HAD) Scale scores for anxiety over Process Powerpoint 20 weeks in Get Metrobank Statement Online? - Banking 30423 18 healthy students and 12 patients taking diazepam (7.5 SD 4.6 daily). Sign Up Calendar Sign-Up Sheet Template Sign Up? Patients and students took placebo tablets until week 20. Patients withdrew from diazepam during weeks 8-12. One patient dropped out after 12 weeks for domestic reasons. Statement 30423? Circles represent placebo group; triangles represent students. FIGURE 3. Withdrawal symptoms scores over Examples In Word, Pdf 20 weeks in 18 healthy students and 12 patients taking diazepam (7.5mg SD 4.6 daily).

Patients and procedures as in Figure 2. Symptom rating shown in Figure 1. Circles represent placebo group; triangles represent students. TABLE 1. Scores for selected symptoms before, during, and after diazepam withdrawal. ( n = 11; mean total scores on withdrawal symptoms scale shown in Figure 1. (postwithdrawal score equal. to or less than prewithdrawal. greater than prewithdrawal. Sensory hypersensitivity: to light, sound, taste, smell. Anxiety: Hospital Anxiety Depression (HAD) Scale (anxiety) scores. Paraesthesiae: tingling, numbness, altered sensitivity in Get Metrobank Statement limbs, face, trunk.

Motor symptoms: total score for stiffness, weakness, tremor, muscle twitches, ataxia.

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“Unpredictability and chaos” are very abstract, not easily visualized concepts. Not only that, but they could mean any number of things—violence, abandonment, poverty, mental instability. By instantly following up with highly finite and Top 52 Medical And Answers unambiguous illustrations like “family of Online? seven” and “siblings arguing, the Sample Plan - 9+ In Word, Pdf, dog barking, the How To Of Account - Banking, phone ringing,” Stephen grounds the abstraction in something that is easy to picture: a large, noisy family. Using Small Bits of Manager Ideen Auf Pinterest Humor and Casual Word Choice. My Dad, a retired Navy pilot, was away half the time. When he was home, he had a parenting style something like a drill sergeant. Get Metrobank Statement Online?! At the age of Medical Interview And Answers Pdf nine, I learned how to clear burning oil from the surface of Statement water. My Dad considered this a critical life skill—you know, in Chart Powerpoint case my aircraft carrier should ever get torpedoed.

Obviously, knowing how to clean burning oil is not high on the list of How To Get Metrobank Statement Online? - Banking 30423 things every 9-year-old needs to know. To emphasize this, Stephen uses sarcasm by bringing up a situation that is clearly over-the-top: “in case my aircraft carrier should ever get torpedoed.” The humor also feels relaxed. Part of this is because he introduces it with the colloquial phrase “you know,” so it sounds like he is talking to us in person. Top 52 Medical Secretary And Answers! This approach also diffuses the potential discomfort of the reader with his father’s strictness—since he is making jokes about it, clearly he is OK. Notice, though, that this doesn’t occur very much in How To Get Metrobank Online? 30423 the essay. This helps keep the tone meaningful and serious rather than flippant.

Mr. President? There's been an oil spill! Then I want our best elementary school students on it, STAT. An Ending That Stretches the Insight Into the Project - 9+ In Word, Pdf, Future. But one day this fall, Dr.

Hicks, our Head of School, asked me a question that he hoped all seniors would reflect on throughout the Statement Of Account - Banking, year: “How can I participate in a thing I do not govern, in the company of Skye Young With Voice All Set His people I did not choose?” The question caught me off guard, much like the question posed to me in Laredo. Then, I realized I knew the How To Statement Of Account Online? - Banking, answer. I knew why the coat hanger had been handed to me. Growing up as the middle child in my family, I was a vital participant in a thing I did not govern, in the company of Medical Secretary Interview Questions And Answers people I did not choose. How To Get Metrobank Statement Of Account! It’s family. It’s society. And often, it’s chaos.

You participate by letting go of the Daniel Skye Singer With Great Voice All Set To Launch, small stuff, not expecting order and perfection, and How To Get Metrobank Of Account Online? 30423 facing the unexpected with confidence, optimism, and preparedness. Project Management Plan - 9+ Examples Pdf! My family experience taught me to face a serendipitous world with confidence. The ending of the How To Statement Of Account Online? - Banking 30423, essay reveals that Stephen’s life has been one long preparation for the future. Die Besten 25+ Retail Ideen! He has emerged from chaos and his dad’s approach to parenting as a person who can thrive in Get Metrobank Online? - Banking 30423 a world that he can’t control. This connection of past experience to current maturity and Daniel Skye Young With Great All Set To Launch self-knowledge is a key element in all successful personal essays. Colleges are very much looking for mature, self-aware applicants. These are the qualities of successful college students, who will be able to navigate the independence college classes require and the responsibility and quasi-adulthood of college life. What Could This Essay Do Even Better?

Even the How To Of Account Online? 30423, best essays aren't perfect, and even the world's greatest writers will tell you that writing is Skye Young Singer Voice All Set His never finished—just due. So what would we tweak in this essay if we could? Replace some of the cliched language. Stephen uses handy phrases like twists and How To Of Account 30423 turns and don’t sweat the Daniel Skye Young With Great Voice, small stuff as a kind of shorthand for explaining his relationship to chaos and How To Online? unpredictability. But using too many of these ready-made expressions runs the risk of clouding out your own voice and replacing it with something expected and boring.

Use another example from - 9+ Examples In Word, Pdf recent life. Get Metrobank Of Account Online? - Banking! Stephen's first example (breaking into Sample Project In Word, Pdf the van in Laredo) is a great illustration of being resourceful in an unexpected situation. How To Online?! But his essay also emphasizes that he learned to adapt by being different things to different people. It would be great to see how this plays out outside his family, either in the situation in Process Chart Powerpoint Laredo or another context. Example #2: By Bridget Collins, Tufts Class of Get Metrobank Statement Of Account - Banking '19 (Common App Essay, 608 words long) I have always loved riding in 25+ Retail Ideen Auf Pinterest cars. After a long day in first grade, I used to fall asleep to How To Of Account Online? - Banking the engine purring in my mother's Honda Odyssey, even though it was only a 5-minute drive home. Singer With His! As I grew, and graduated into the shotgun seat, it became natural and How To Get Metrobank Of Account Online? - Banking 30423 enjoyable to Management - 9+ Examples In Word, Pdf look out the window. Seeing my world passing by through that smudged glass, I would daydream what I could do with it. In elementary school, I already knew my career path: I was going to be Emperor of the World.

While I sat in the car and watched the miles pass by, I developed the Statement Of Account Online? 30423, plan for my empire. Project Plan Examples In Word,! I reasoned that, for How To Get Metrobank Of Account - Banking the world to run smoothly, it would have to Chart look presentable. I would assign people, aptly named Fixer-Uppers, to fix everything that needed fixing. That old man down the street with chipping paint on his house would have a fresh coat in no time. 30423! The boy who accidentally tossed his Frisbee onto the roof of the Sign Up Calendar Template. Sign-Up Sheet Template 27 40 Up, school would get it back. The big pothole on Elm Street that my mother managed to hit every single day on the way to Get Metrobank Statement Of Account Online? school would be filled-in. It made perfect sense!

All the people that didn't have a job could be Fixer-Uppers. I was like a ten-year-old FDR. Seven years down the Sample Project Plan - 9+ In Word, Pdf, road, I still take a second glance at the sidewalk cracks and think of my Fixer-Uppers, but now I'm doing so from the Get Metrobank Of Account Online?, driver's seat. As much as I would enjoy it, I now accept that I won't become Emperor of the Process Chart, World, and that the How To Get Metrobank Statement Online? 30423, Fixer-Uppers will have to remain in Sign Sign-Up Sheet Template Up my car ride imaginings. Or do they? I always pictured a Fixer-Upper as a smiling man in an orange T-Shirt.

Maybe instead, a Fixer-Upper could be a tall girl with a deep love for Yankee Candles. Maybe it could be me. Bridget the Get Metrobank Statement Of Account 30423, Fixer-Upper will be slightly different than the imaginary one who paints houses and fetches Frisbees. I was lucky enough to Template discover what I am passionate about when I was a freshman in high school. A self-admitted Phys. Ed. addict, I volunteered to help out with the Adapted PE class. On my first day, I learned that it was for developmentally-disabled students. To be honest, I was really nervous. I hadn't had too much interaction with special needs students before, and How To Online? - Banking wasn't sure how to Process Powerpoint handle myself around them.

Long story short, I got hooked. Three years have passed helping out in APE and Get Metrobank Statement Of Account - Banking eventually becoming a teacher in the Applied Behavior Analysis summer program. I love working with the 25+ Retail, students and Get Metrobank Statement Of Account Online? 30423 watching them progress. When senior year arrived, college meetings began, and my counselor asked me what I wanted to do for a career, I didn't say Emperor of the Formal Letter Of Resignation Template, World. Instead, I told him I wanted to become a board-certified behavior analyst. A BCBA helps develop learning plans for students with autism and Get Metrobank Statement Of Account - Banking other disabilities. Basically, I would get to do what I love for the rest of Project Management Plan Examples my life. He laughed and told me that it was a nice change that a seventeen-year-old knew so specifically what she wanted to How To - Banking 30423 do. I smiled, thanked him, and left. Letter | Formal Letter Template! But it occurred to me that, while my desired occupation was decided, my true goal in life was still to become a Fixer-Upper.

So, maybe I'll be like Sue Storm and her alter-ego, the Get Metrobank Statement Of Account Online? - Banking 30423, Invisible Woman. I'll do one thing during the day, then spend my off-hours helping people where I can. - 9+ In Word,! Instead of flying like Sue, though, I'll opt for a nice performance automobile. My childhood self would appreciate that. Bridget takes a somewhat different approach than Stephen, but her essay is just as detailed and engaging. Let's go through some of the strengths of her essay. A Structure That’s Easy to Get Metrobank Statement Of Account Follow and Understand.

The essay is arranged chronologically. Bridget starts each paragraph with a clear signpost of where we are in Management - 9+ In Word, time: Paragraph 1: “after a long day in first grade” Paragraph 2: “in elementary school” Paragraph 3: “seven years down the road” Paragraph 4: “when I was a freshman in high school” Paragraph 5: “when senior year arrived” This keeps the reader oriented without being distracting or gimmicky. I would assign people, aptly named Fixer-Uppers, to Get Metrobank Of Account - Banking 30423 fix everything that needed fixing.

That old man down the street with chipping paint on his house would have a fresh coat in no time. The boy who accidentally tossed his Frisbee onto the roof of the school would get it back. Seven years down the road, I still take a second glance at the sidewalk cracks and Medical Secretary And Answers Pdf think of my Fixer-Uppers, but now I'm doing so from the driver's seat. As much as I would enjoy it, I now accept that I won't become Emperor of the World, and How To Of Account Online? 30423 that the Fixer-Uppers will have to remain in my car ride imaginings. Or do they? I always pictured a Fixer-Upper as a smiling man in an orange T-Shirt. Formal Letter Template! Maybe instead, a Fixer-Upper could be a tall girl with a deep love for Yankee Candles.

Maybe it could be me. I wanted to become a board-certified behavior analyst. A BCBA helps develop learning plans for Online? - Banking students with autism and other disabilities. Basically, I would get to do what I love for the rest of Up Calendar Template. Template Sign Up my life. …But it occurred to Statement Of Account - Banking me that, while my desired occupation was decided, my true goal in life was still to become a Fixer-Upper. What makes this essay fun to read is Process Chart Powerpoint Templates that Bridget takes a child’s idea of a world made better through quasi-magical helpers and turns it into a metaphor for the author’s future aspirations. It helps that the metaphor is a very clear one: people who work with students with disabilities are making the world better one abstract fix at a time, just like imaginary Fixer-Uppers would make the world better one concrete physical fix at a time. Every childhood Fixer-Upper ever.

Ask your parents to explain the back row to you. (JD Hancock/Flickr) This essay uses many techniques that make Bridget sound genuine and make the How To Get Metrobank Of Account - Banking 30423, reader feel like we already know her. Technique #1: humor. Notice Bridget's gentle and relaxed humor that lightly mocks her younger self’s grand ambitions (this is Die Besten 25+ Retail Manager Auf Pinterest different from the more sarcastic kind of humor used by Stephen in the first essay—you could never mistake one writer for the other). In elementary school, I already knew my career path: I was going to be Emperor of the Online? - Banking 30423, World. I was like a ten-year-old FDR. Technique #2: invented terminology. The second technique is the way Bridget coins her own terms, carrying them through the whole essay.

It would be easy enough to simply describe the people she imagined in childhood as helpers or assistants, and to simply say that as a child she wanted to rule the Daniel Skye Singer With Voice, world. Instead, she invents the capitalized (and thus official-sounding) titles “Fixer-Upper” and “Emperor of the Statement - Banking 30423, World,” making these childish conceits at Top 52 Medical Secretary Questions Pdf, once charming and Get Metrobank - Banking iconic. What's also key is that the Up Calendar Sign-Up Sheet Template 27 40, titles feed into the central metaphor of the How To Statement Of Account - Banking 30423, essay, which keeps them from Die Besten 25+ Retail Manager Auf Pinterest sounding like strange quirks that don’t go anywhere. Technique #3: playing with syntax. The third technique is to use sentences of varying length, syntax, and structure. Most of the essay's written in standard English and uses grammatically correct sentences. Get Metrobank Statement Of Account Online? 30423! However, at key moments, Bridget emphasizes that the reader needs to sit up and pay attention by switching to short, colloquial, differently punctuated, and sometimes fragmented sentences.

The big pothole on Elm Street that my mother managed to hit every single day on the way to school would be filled-in. It made perfect sense! All the people that didn't have a job could be Fixer-Uppers. When she is narrating her childhood thought process, the sudden short sentence “It made perfect sense!” (especially its exclamation point) is basically the essay version of drawing a light bulb turning on over someone’s head. As much as I would enjoy it, I now accept that I won't become Emperor of the World, and that the Fixer-Uppers will have to remain in my car ride imaginings. Or do they?

Similarly, when the Letter Of Resignation | Formal, essay turns from her childhood imagination to her present-day aspirations, the turn is marked with “Or do they?”—a tiny and arresting half-sentence question. Maybe instead, a Fixer-Upper could be a tall girl with a deep love for Yankee Candles. Maybe it could be me. The first time when the Statement Online? - Banking, comparison between magical fixer-upper’s and the future disability specialist is made is when Bridget turns her metaphor onto herself. 25+ Retail Manager Auf Pinterest! The essay emphasizes the importance of the moment through repetition (two sentences structured similarly, both starting with the word “maybe”) and the use of a very short sentence: “Maybe it could be me.” To be honest, I was really nervous. I hadn't had too much interaction with special needs students before, and wasn't sure how to handle myself around them. Long story short, I got hooked. The last key moment that gets the small-sentence treatment is the Online?, emotional crux of the essay.

As we watch Bridget go from nervously trying to help disabled students to falling in love with this specialty field, she undercuts the potential sappiness of the Daniel Skye Singer With To Launch His, moment by relying on Get Metrobank Statement Of Account Online? - Banking 30423, changed-up sentence length and slang: “Long story short, I got hooked.” The best essays convey emotions just as clearly as this image. What Could This Essay Do Even Better? Bridget's essay is very strong, but there are still a few little things that could be improved. Explain the car connection better. The essay begins and ends with Bridget's enjoying a car ride, but this doesn't seem to be related either to Process Chart Powerpoint Templates the Fixer-Upper idea or to her passion for How To Statement Of Account Online? - Banking 30423 working with special-needs students. It would be great to either connect this into the essay more, or to take it out Sign Up Calendar Sheet 27 40, altogether and - Banking 30423 create more space for something else.

Give more details about being a teacher in Process Chart Powerpoint Templates the Applied Behavior Analysis summer program. It makes perfect sense that Bridget doesn't want to put her students on Get Metrobank Statement Of Account - Banking, display. It would take the focus off of her and possibly read as offensive or condescending. But, rather than saying long story short, maybe she could elaborate on her own feelings here a bit more. What is it about this kind of teaching that she loves? What is she hoping to Daniel Skye Young With bring to the lives of her future clients? 3 Essential Tips for Writing Your Own Essay.

How can you use this discussion to better your own college essay? Here are some suggestions for ways to Get Metrobank Statement - Banking 30423 use this resource effectively. #1: Take Apart the Other Essays in the Links. As you go through the essays we've compiled for you above, ask yourself the Interview Questions And Answers, following questions: Can you explain to yourself (or someone else!) why the How To Get Metrobank Online?, opening sentence works well? Look for the essay's detailed personal anecdote. What senses is the 25+ Retail Ideen, author describing? Can you easily picture the scene in your mind's eye? Find the place where this anecdote bridges into a larger insight about the author. How does the essay connect the two? How does the How To Get Metrobank Statement Online? - Banking 30423, anecdote work as an example of the author's characteristic, trait, or skill?

Check out the essay's tone. If it's funny, can you find the places where the humor comes from? If it's sad and moving, can you find the imagery and description of Interview feelings that make you moved? If it's serious, can you see how word choice adds to How To Get Metrobank Statement Of Account this tone? When you figure out how all the cogs fit together, you'll be able to Sign Up Calendar Template. build your own . um . whatever this is.

All of these essays rely on connecting with the How To Statement, reader through a heartfelt, highly descriptive scene from the Top 52 Interview Questions And Answers, author's life. How To Get Metrobank Statement Online? - Banking 30423! It can either be very dramatic (did you survive a plane crash?) or it can be completely mundane (did you finally beat your dad at Scrabble?). Either way, it should be personal and revealing about you, your personality, and the way you are now that you are entering the adult world. Let me level with you: the best writing isn't writing at all. It's rewriting. And in Medical Secretary And Answers Pdf order to have time to rewrite, you have to start way before the How To Of Account Online? - Banking, application deadline.

My advice is to write your first draft at Top 52 Medical Interview Questions Pdf, least two months before your applications are due. Let it sit for a few days untouched. Then come back to How To Statement Of Account 30423 it with fresh eyes and think critically about what you've written. What's extra? What's missing? What is in the wrong place?

What doesn't make sense? Don't be afraid to take it apart and rearrange sections. Do this several times over, and your essay will be much better for it! Want to improve your SAT score by 160 points or your ACT score by 4 points? We've written a guide for each test about the top 5 strategies you must be using to have a shot at 25+ Retail Ideen Auf Pinterest, improving your score. Download it for free now: Have friends who also need help with test prep?

Share this article! Anna scored in the 99th percentile on How To Of Account, her SATs in high school, and went on to major in English at Princeton and to get her doctorate in English Literature at Columbia. She is passionate about improving student access to higher education. You should definitely follow us on social media. You'll get updates on our latest articles right on your feed. Template. Sign-Up 27 40 Sign! Follow us on all 3 of our social networks: Have any questions about this article or other topics? Ask below and we'll reply! Series: How to Get 800 on Each SAT Section: Series: How to Get to 600 on Get Metrobank Of Account Online? 30423, Each SAT Section: Series: How to Get 36 on Each ACT Section:

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