Saturday, August 31, 2019

Junk food in schools Essay

The Government had set out a ban to prevent junk food from being sold to children at canteens. Mark Fraser had written a letter to a newspaper company called Community Chronicle on the 29th of October 2010 to share his disbelief at the government’s vain attempt to prevent obesity. Throughout this piece, he uses an attacking tone. He aims to target the audience of parents with children in schools to agree with him on his contention that this vain attempt will not benefit the children. Since the beginning, Fraser believes that eating habits are heavily influenced by the parents. He urges parents to take responsibility of their own children. He admits that he weighs â€Å"close to 100 kilograms† and further strengthens his statement by claiming that he is a â€Å"responsible parent.† He personalizes the statement and enables the audience to see him as a regular person and also being a responsible parent for his children despite being overweight. Fraser argues that children need to learn â€Å"self-restraint† and that parents should be responsible to make â€Å"informed decisions† for their children. He implies to the audience that a responsible parent should educate their children on their food choices. Fraser quoted Dr Peter Clifton who said â€Å"37 percent† of their daily energy intake is consumed at school, but only â€Å"14 percent† was lunch bought from the school canteen and â€Å"schools should be a focus for combating childhood obesity but strategies were needed to tackle the lunchbox, not just the school canteen.† He shifts the blame from the school cafeteria to the parents, implying that the parents should make good decisions for their children when packing for them. Fraser believes that the bans will have no impact on children’s eating habits. He begins by claiming this â€Å"strategy will not make our children perfectly healthy eaters† and † it will not encourage our kids to get out and get fit.† He implies that they’re other more effective solutions out there other than â€Å"canteen policing†. Fraser had also quoted two major principals’ associations that â€Å"young people consume at most 5 of their 21 meals a week at school† and the policy would make kids feel that â€Å"junk food is an attractive â€Å"taboo†.† He reinforces his contention by implementing the use of expert opinion, leading the audience to be more likely to believe his contention. Lastly, Fraser expresses his concern regarding the schools’ finances by stating that the â€Å"canteen is a major revenue stream for school funding.† He suggests that once the ban is put into place, sales wouldn’t be too great and there schools would lose it’s main source of revenue. Fraser also questioned whether the government would be â€Å"allocating additional funds for the revenue shortfall† He also suggested that the government might not fund the school’s revenue shortfall even if the school is affected by the ban. Fraser suggests that the ban will most likely cause major financial problems regarding the schools’ revenue steam. Fraser believed that the ban proposed by the government was merely a waste of time. He had strongly conveyed his negative opinion toward the government’s approach from the very start. He believes that children’s eating habits are majorly influenced by the parents, not the school canteen’s food choices. Fraser also believes that the bans will be off no impact toward children’s eating habits and at the same time also cause major financial problems for the school. He urges for the state government to â€Å"wake up† and see that â€Å"kids need opportunities to make their own decisions† and â€Å"stay active.†

Friday, August 30, 2019

Listening to Rap: Cultures of Crime, Cultures of Resistance

Listening to Rap: Cultures of Crime, Cultures of Resistance Julian Tanner, University of Toronto Mark Asbridge, Dalhousie University Scot Wortley, University of Toronto This research compares representations of rap music with the self-reported criminal behavior and resistant artirudes of the music's core audience. Our database is a large sample of Toronro high school studenrs (n = 3,393) from which we identify a group of listeners, whose combination of musical likes and dislikes distinguish them as rap univores. We then examine the relationship between their cultural preference for rap music and involvement in a culture of crime and their perceptions of social injustice and inequity. We find thar the rap univores, also known as urban music enthusiasts, report significantly more delinquent behavior and stronger feelings of inequity and injustice than listeners with other musical tastes. However, we also find thar the nature and strengths of those relationships vary according to rhe racial identity of different groups within urban music enthusiasts. Black and white subgroups align themselves with resistance representations while Asians do not; whites and Asians report significant involvement in crime and delinquency, while blacks do not. Finally, we discuss our findings in light of research on media effects and audience reception, youth subcultures and post-subcultural analysis, and the sociology of cultural consumption. Thinking About Rap The emergence and spectacular growth of rap is probably the most important development in popular music since the rise of rock ‘n' roll in the late 1940s. Radio airplay, music video programming and sales figures are obvious testimonies to its popularity and commercial success. This was made particularly evident in October 2003 when, according to the recording industry bible Billboard mzgnzme, all top 10 acts in the United States were rap or hip-hop artists;' and again in 2006, when the Academy award for Best Song went to It's Hard Out Here for a Pimp, a rap song by the group Husde & Flow. Such developments may also signal rap's increasing social acceptance and cultural legitimization (Baumann 2007). However, its reputation and status in the musical field has, hitherto, been a controversial one. Like new music before it (jazz, rock ‘n' roll), rap has been critically reviewed as a corrosive influence on young and impressionable listeners (Best 1990; Tatum 1999; Tanner 2001; Sacco and Kennedy 2002; Alexander 2003). Whether rap has been reviled as much as jazz and rock ‘n' roll once were is a moot point; rather more certain is its pre-eminent role as a problematic contemporary musical genre. Direct correspondence to Julian Tanner, Department of Social Science University of Toronto at Scarborough, 1265Military Trail, Scarborough, Ontario, Canada, MIC 1A4. Telephone: (416) 287-7293. E-mail: Julian. [email  protected] ca. † rh8 Uniiersily of North Carolina Press Social Forces 88121 693-722, December 2009 694 †¢ Social Forces 88(2) In an important study of representations of popular music. Binder (1993) examined how print journalists wrote about rap and heavy metal in the 1980s and 1990s. While both are devalued genres (Roe 1995), she nevertheless contends that they are framed differently: the presumed harmful effects of heavy metal are limited to the listeners themselves, whereas rap is seen as more socially damaging (for a similar distinction, see Rose 1994). The lyrical content of the two genres is established as one source of this differential framing: rap lyrics are found to be more explicit and provocative (greater usage of â€Å"hard† swear words, for example) than heavy metal lyrics. The second factor involves assumptions made (by journalists) about the racial composition of audiences for heavy metal and rap-the former believed to be white suburban youth, the latter urban black youth. According to Binder, rap invites more public concern and censorious complaint than heavy metal because of what was assumed to be its largely black fan base. At the same time, she identifies an important counter frame, one component of which elevates rap (but not heavy metal) to the status of an art form with serious political content. In both the mainstream press (i. e.. The New York Times) and publications targeting a predominately black readership (i. e.. Ebony and/^i), she finds rap lauded for the salutary lessons that it imparts to black youth regarding the realities of urban living; likewise, rap artists are applauded for their importance as role models and mentors to inner-city black youth. Thus, while rap has been framed negatively, as a contributor to an array of social problems, crime and delinquency in particular, it has also been celebrated and championed as an authentic expression of cultural resistance by underdogs against racial exploitation and disadvantage. How these differing representations of rap might resonate with audience members was not part of Binder's research mandate. ^ Furthermore, while she does acknowledge that ournalistic perceptions of the racial composition of the rap audience are not necessarily accurate-that more white suburban youth, even in the 1980s and 1990s, might have been consuming the music than black inner-city youth-this acknowledgment does not alter her enterprise or her argument. At this point in time, when the listening audience for rap music has both expanded and become increasingly diverse, our research concerns how young black, white and Asian rap fans in Toronto, Canada relate to a musical form still viewed primarily in terms of its criminal and resistant meanings. Researching Rap Much of the early work on audiences preoccupied itself with investigating the harmful effects of media exposure, especially the effects of depictions of violence in movies and TV on real life criminal events. Results have generally been inconclusive, with considerable disagreement in the social science research community regarding the influence of the media on those watching the large ot small screen (Curran 1990; Abercrombie and Longhurst 1998; Freedman 2002; Sacco and Kennedy 2002; Alexander 2003; Newman 2004; Savage 2004; Longhurst 2007). Listening to Rap †¢ 695 Listening to popular music has, on occasion, been said to produce similarly negative effects, although these too have proven difficult to verify. For example, in one high profile case in the 1980s, the heavy metal band Judas Priest was accused of producing recorded material (songs) that contained subliminal messaging diat led to the suicides of two fans. This claim was not, however, legally validated because the judge hearing the case remained unconvinced about a causal linkage between the music and the self-destructive behavior of two individuals (Walser 1993). Strong arguments for the ill effects of media consumption rest on the assumption that audiences are easily and direcdy influenced by the media, with frequent analogies made to hypodermic syringes that inject messages into gullible and homogenous audiences (Abercrombie and Longhurst 1998; Alexander 2003; Longhurst 2007). In contesting this view of audience passivity, critics also propose that texts are open to more than one interpretation. Again, TV udiences have been studied more frequently than audiences for popular music, although research on the latter has illustrated how song lyrics are not necessarily construed the same way by adolescents and adults. Research conducted by Prinsky and Rosenbaum (1987) indicates that songs identified by adults as containing deviant content (references to sex, violence, alcohol and drug use, Satanism) were not similarly categorized by adolescents. Evidence that there are diflferent ways of watching television or listening to recorded music has led to an alternative conception of audiences-one more concerned with what audiences do with the media than what the media does to audiences. The development within communications research of the uses and gratifications model (McQuail 1984) is one result, with TV once more the media form most commonly investigated. Nonetheless, a few studies have documented how young people listen to popular music in order to satisfy needs for entertainment and relaxation (among other priorities), and utilize it as an accompaniment to other everyday activities, such as homework and household chores (Roe 1985; Prinsky and Rosenbaum 1987). More recent research has added identity construction as a need that popular music might fill for young listeners (Roe 1999; Gracyk 2001; Laughey 2006). One particular usage emphasized by British cultural Marxists associated with the now defunct Birmingham Centre for Contemporary Cultural Studies has focused attention on how active media audiences counter dominant cultural messages in their consumption of popular culture. In what has, by now, become a familiar story, a series of music-based, post-war youth cultures (Teddy Boys, Mods, Rockers, Skinheads, Punks) in the United Kingdom have been represented as symbolically resisting the dominant normative order (Hall and Jefferson 1976; Hebdige 1979). This argument has, however, relied on a reading of cultural texts and artifacts for its evidentiary base, rather than observations of, or information from, subcultural participants themselves (Cohen 1980; Frith 1985; Tanner 2001; Bennett 2002; Alexander 2003). 696 †¢ Social Forces 8S(2) More recently, the utility of the term subculture for understanding young people's collective involvements in music has been questioned. The focus of this criticism is, once again, the Birmingham school and its conceptualization of subculture. Its critics argue that, nder conditions of post modernity, music audiences have fragmented, and young people are no longer participants in distinctive subcultural groups (Bennett 1999b; Muggleton 2000). Instead of subcultures, they are now involved v^^ith neo tribes and scenes (i. e. , Bennett 1999b; Bennett and Kahn-Harris 2004; Hesmondhalgh 2005; Longhurst 2007; Hodkinson 2008). Post subcultural research has been much less inclined than the Birmingham era researchers to decode and decipher texts, and much more likely to engage in ethnographic studies of music and youth groups (Bennett 2002). However, while there has been occasional work on modes of (female) resistance in the â€Å"tween scene† (Lowe 2004) and â€Å"riot girrrl scene† (Schily 2004), there has been no equivalent research on rap scenes and resistance. Examinations of audience receptions of rap are not numerous and have been of two main kinds: a few studies have explored how young people perceive and evaluate the music, while others have studied the harmful effects of rap by trying to link consumption of the music with various negative consequences. An early study by Kuwahara (1992) finds rap to be more popular with black than white college students, and more popular among males than females. However, reasons for liking the music varied little by race, with both black and white audience members prioritizing the beat over the message. A more recent study by Sullivan (2003) reports few racial differences in liking the music, although black teenagers were more committed to the genre and more likely to view rap as life affirming (Berry 1994) than those from other racial backgrounds. In a small but important study conducted in California, Mahiri and Connor (2003) investigated 41 black middle school students' perceptions of violence and thoughts about rap music. In focus group sessions and personal interviews, informants revealed a strong liking for rap music, valuing the fact that it spoke to their everyday concerns about growing up in a poorly resourced community. They did not, however, like the way that rap music on occasion (mis)represented the experiences of black people in the United States. They challenged the misogyny evident in some rap videos and rejected what they saw as the glamorization of violence. Overall, their critical and nuanced engagement with rap music fitted poorly with depictions of media audiences as easily swayed by popular culture (Sacco 2005). The search for the harmful effects of rap music has yielded no more definitive results than earlier quests for media effects. While some studies report evidence of increased violence, delinquency, substance use, and unsafe sexual activity resulting from young people's exposure to rap music (Wingood et al. 2003; Chen et al. 2006), other researchers have failed to find such a link or have exercised extreme caution when interpreting apparent links. One review of the literature, conducted in the 1990s, could find a total of only nine investigations-all of them Listening to Rap †¢ 697 mall-scale, none involving the general adolescent population-and concluded that there was an even split hetween those that found some sort of an association between exposure to the music and various deviant or undesirable outcomes, and those that could find no connection at all Moreover, in those studies where the music and the wrongdoing were linked, investigators were very circumspect about whether or not they were observing a causal relationship, and if so, which came first, the music or the violent dispositions (Tatum 1999 ). A mote recent investigation conducted in Montreal is illustrative of such interpretative problems. While a preference for rap was found to predict deviant behavior among 348 Frenchspeaking adolescents, causal ordering could not be established, nor an additional possibility ruled out: that other factors might be responsible for both the musical taste and the deviant behavior (Miranda and Claes 2004). The notion that rap is or can be represented as cultural resistance-the counter frame identified by Binder-has become increasingly prominent in the rap literature over the past 20 years (Rose 1994; Krims 2000; Keyes 2002; Quinn 2005). In his influential book. Why White Kids Love Hip Hop: Wankstas, Wiggers, Wannabes, and the new Reality ofRace in America, Kitwana (2005) expounds at length on his emancipatory view of rap's history and development. Kitwana sees hip-hop as a form of protest music, offering its listeners a message ofresistance. He also makes the additional claim that the resistive appeal of hip-hop is not restricted to black youth. Indeed, as the tide of his book suggests, he is patticularly interested in the patronage of rap music by white youth, those young people who might be seen as the contemporary equivalents of Mailer's â€Å"White Negro† or Keys' â€Å"Negro Wannabes. (Keyes 2002:250) In his view, the global diffusion of rap rests on the music's capacity for resonating with the experiences ofthe downtrodden and marginalized in a variety of cultural contexts. Quinn (2005) similarly explains the crossover appeal of gangsta rap in the United States in terms ofthe â€Å"common sensibilities and insecurities shated by post Fordist youth. † She continues: â€Å"many young whites, facing bleak labor market prospects, were also eager for stories about fast money and authentic belonging to ward off a creeping sense of placelessness and dispossession. (Quinn 2005:85-86) Thus, rap's appeal is as much about class as it is about race. Nor is the resistive view of rap restricted to the North American continent. At least one French study-conducted in advance ofthe riots in the fall of 2005 -has noted how French Rap has become the music of choice for young people of visible minority descent who have grown up in the suburban ghettos (Les Cities) of major cities. They have been routinely exposed to police harassment on the streets, subjected to prejudice and discrimination at school, and struggled to find decent housing and appropriate jobs (Bouchier 1999, cited in Miranda and Claes 2004). The idea that popular music might serve as an important reference point for rebellious or resistive adolescents is not a new one. As we have already noted, this is how a British school of subcultural analysis once interpreted the cultural activity of wotking-class youth in the United Kingdom (Hall and Jefferson 1976; Hebdige 698 †¢ Social Forces 88(2) 1979). Some attempt has been made to understand rap fandom in similar terms. Bennett's (1999a) ethnographic study, set in Newcastle, reveals how one group of white rappers translate the racial politics of blacks into the language of class divisions in the United Kingdom. However, for the most part there has been limited application of this kind of analysis to young people's involvement with rap music. Rap scholars who construe the music as an authentic expression of cultural resistance directed against exploitation and disadvantages at school, on the streets, or in the labor market, do so primarily without much input from the young people who make up its listening audience. Because they have not often been canvassed for their views about the music, we do not know to what degree they share in or identify with the message of resistance readily ound in content analysis of the rap idiom (Martinez 1997; Negus 1997; Krims 2000; Stephens and Wright 2000; Bennett 2001; Sullivan 2003; Kubrin 2005; Quinn 2005; Lena 2006). Thus contemporary rap scholarship follows British subcultural theory in gleaning evidence of resistance from the texts, not the audience. Resistance is sought, and found, in the words and music rather than in the activities and ideologies of subcultures or audience members. We can suggest, echoing Alexander's (2003) earlier critique of British cultural studies, that the audience for rap music has been theorized rather more thoroughly than it has been investigated. The Present Study The present study is concerned with three key questions: First, is there a relationship between audiences for rap and representations of the music? Second, as compared to other listening audiences, are serious rap fans participants in cultures of crime and resistance? Third, if such a link is found, what are the sources of variation in their participation in these cultures of crime and resistance? The need to address these questions, as we see it, emerges from several limitations in the existing research on rap. These limitations are as follows: First, there is a significant disjuncture between dominant representations of the music as a source of social harms and evidence unambiguously supportive of this proposition. Second, the case for a resistant view of rap music is usually advanced, as we have already intimated, by examination of the designs and intentions of musical creators, both artists and producers, as well as music critics. We do not know whether or not resistant messages register and resonate with those who listen to the music. Third, we do not have an accurate gauging of the sociodemographic composition, particularly racial and ethnic, of the audience for rap music. Rap's dominance of the youth market is widely understood as a crossover effect-the original black audience now joined by legions of white fans (Spiegler 1996; Yousman 2003). However, purchasing habits-the usual arbiter for claims about rap's increasing popularity with white consumers-may not be an entirely reliable measure of either rap's popularity or racial and ethnic variations therein (Krims 2000; Quinn 2005). The system devised by the recording industry to gauge record Listening to Rap †¢ 699 sales-Nielson Soundscape-does not gather data on the race, or indeed any other personal characteristic, of purchasers. What it does do is categorize sales in terms of whether they were made in retail stores in high-income locations or in lowincome locations. Record companies, journalists or academics then choose to equate those high-income sales with white suburban youth, and low-income sales with inner-city black youth, but are doing so without any direct measures of the racial background or identity of buyers (Kitwana 2005). Moreover, it has been argued that sales figures â€Å"under represent the taste preferences of the poor. † (Quinn 2005:83) As Rose (1994) explains it, in the black community, particularly in impoverished neighborhoods, many more rap CDs are listened to than bought-a single purchase being passed on from one fan to another. Similarly, homemade tapes and bootleg CDs are often produced and shared within local fan networks. The implications of this point are clear enough: the appropriation of rap music by suburban white teens might not be as extensive as is commonly supposed. Finally, we do not know whether or how the rap audience relates to the dominant frame of the music as a catalyst for crime and delinquency or to the counter frame of the music as an articulator of social inequity. The mainstreaming of rap may have cost the genre its underground or counter-culture status as protest music, or made it less attractive to delinquent rebels. Rap also may play no part in crime or resistance subcultures because, under post modern conditions, young people have become increasingly eclectic and individualized in their musical tastes; the close relationship between musical tastes and lifestyles, implied by subcultural theory, no longer applies. On this formulation, therefore, we would not expect to find strong connections between a preference for rap music and subcultures of crime and subcultures of resistance. On the other hand, reasons for believing that rap music may be a basis for subcultural lifestyles, at least among black youth, are more compelling. At the time that we were conducting our research there was considerable debate, in the local media and among local politicians, about issues involving race and crime-racial profiling and the desirability of collecting race-based crime statistics, for example. Contributing to this debate were findings from another study, confirming what black youths in Canada have always suspected, namely that they are much more likely to be arbitrarily stopped and searched by police officers than are members of other racial and ethnic groups-even when their own self-repotted deviant activity is statistically controlled for (Wordey and Tanner 2005). In addition, contemporaneous research on the media coverage of race and crime in Toronto newspapers carried out by Wortley (2002), found black people disproportionately portrayed in a narrow range of roles and activities (principally those involving crime, sports and entertainment) than members of other racial and ethnic groups; and when featured in crime stories, depicted primarily as offenders. Capricious policing and media misrepresentation may therefore contribute to a sense of injustice among black youth, a sense of injustice that has them gravitating to rap as an emblem of cultural resistance. 00 †¢ Social Forces SS{2) Commercial success and artistic valorization has not diminished rap music's capacity to provoke moral panic. The music is still seen as threatening, dangerous and socially damaging by many political figures and established authority. ‘ Previous research suggests that negative media coverage ofthe cultural preferences and practices of adolescents often intensifies subcultural identifications (Cohen 1973; Fine and Kleinman 1979; Thornton 1995). Rap based moral panics may therefore tighten connections between the music and delinquent lifestyles and/or resistive attitudes and behaviors. The lack of attention paid to rap's consumers renders these questions relatively open ones, the meaning of rap music still to be discovered. Methods Whereas most contemporary research on rap focuses on those who create the music-artists and producers, and those who write about it, music critics-we pose questions about rap's audience. Further, while audience studies usually employ qualitative data-gathering techniques (for example, Morley 1980; Radway 1984; Shively 1992), we use the methods of survey research. We are more concerned with how audience members interact with the music than with the issue of cause and effect. We are interested in how music might be used as a resource in their everyday lives (Willis 1990; DeNora 2000), how it might contribute to identity formation (Roe 1999) and, especially, how audiences might align themselves with (or distance themselves from) cultures of crime and resistance. Nonetheless, in our analyses, we treat rap fandom as a dependent variable. While there is considerable academic and public debate about whether music produces or is a product of cultural activities, legal or otherwise, existing research has failed to provide a compelling or consistent rationale for any particular causal logic. As we have seen, the idea that exposure to rap music causes crime is not unequivocally supported in the research literature. Research on resistant youth cultures, by contrast, is much more likely to reverse the relationship and see musical style as a result of subcultural activity (Willis 1978; Hebdige 1979). Hebdige, for example, infers that punk rock in the United Kingdom was a cultural response to the subordination of existing working-class youth groups. Laing (1985) has countered that punk the musical genre existed before punk the subculture. In the absence of agreement about the direction of the relationship between musical taste and cultural practices, our decision to operationalize rap appreciation as a dependent variable is made more for pragmatic, heuristic reasons than unassailable theoretical ones. Our strategy is to focus on listening preferences rather than purchasing habits. By asking students to report on and evaluate the music that they like, dislike and in what combinations, we gain a clearer and more detailed picture of where rap is situated in the consumption patterns of groups of students differentiated by, among other factors, their racial identity. Our goals are to: (1. distinguish students with a serious, exclusive taste for rap from more casual fans; (2. to calculate the Listening to Rap †¢ 701 size and racial makeup of rap music's prime audience; and (3. to map relationships between that core audience and resistant and delinquent repertoires. Few surveys of general populations of young people have established any kind of connection between rap and deviancy, net of other factors. We contend that rap's reputation as a corrosive force is validated by that linkage, and that without it that representation becomes more ontestable. A similar logic applies to the relationship between rap and social protest. The claim that the music carries a serious message-that it is an expression of resistant values and perceptions-is substantiated with evidence of a link between the music and a collective sense of inequity, and weakened by its absence. Data The data for this research are drawn from the Toronto Youth Crime and Victimization S tudy, a stratified cross-sectional survey of Toronto adolescents carried out from 1998 through 2000 (Tanner and Wordey 2002). Self-administered questionnaires were completed by 3,393 Toronto students ages 13-18, from 30 Metropolitan Toronto high schools in both die Cadiolic (10 schools) and larger Public School (20 schools) systems. Within each school, one class from each grade, 9 (ages 13 and 14) through 13 (ages 18 and 19), was randomly selected. The overall response rate was 83 percent (83. 4% for Catholic vs. 83. 1% for public schools), and is a conservative estimate as it was based on the number of students enrolled in each class rather than those present the day of the study. Informed consent was given for participation in the study. Surveys were completed during class under the supervision of a member of the research team (and without a teacher present) and took approximately 45 minutes to complete. The survey asked young people about a broad range of topics, including family life, educational experiences, leisure activities, delinquent involvement, victimization experiences and so forth. The survey instrument was designed by members of the research team and evolved out of a series of 11 focus groups with adolescents in Toronto schools. The completed survey was reviewed by a series of institutional ethics boards, including those at the University of Toronto, the Toronto Public School Board and the Catholic School Board. As the survey does not include high school dropouts, institutionalized youth and street youth, it is a school sample and thus any generalizations speak only to the experiences of school-based adolescents. Our sample is ethnically and racially diverse and is representative of the Metropolitan Toronto high school population. Measures Musical Preferences Guided by Bourdieu's work (1984) and Peterson's recasting of musical taste in terms of omnivorous and univorous patterns (1992), we focus our attention on 702 †¢ Social Forces 88(2] how musical choices are combined: if young people liked (or disliked) one style or genre, what other styles or genres did they like or dislike (what Van Eijck 2001 has referred to as â€Å"combinatorial logic†). Indicators of musical taste were derived from the question: â€Å"How much do you like each of the following types of music? Respondents were then asked to evaluate each of 11 contempotary musical genres: Soul, Rhythm and Blues, Jazz, Hip/Hop and Rap, Reggae and Dance Hall, Classical and Opera, Country and New Country, Pop, Alternative (including Punk, Grunge), Heavy Metal (Hard Rock), Ethnic Music (traditional/ cultural), and Techno (Dance). Musical tastes were assessed on a five-point Likert scale that addresses whether respondents liked the musical genre very mu ch, quite a lot, a little bit, not very much or not at all. Unlike previous research that dichotomized musical tastes, focusing exclusively on the musical genres most liked (Peterson and Kern 1996) or disliked (Bryson 1996), we target the level of appreciation (or lack of appreciation) each respondent has for a particular musical genre. For space considerations a detailed overview of the clustering procedure has been omitted but is available upon request. We employed a two-stage cluster analysis (hierarchical agglomerative and ^-means) procedure to derive groupings of adolescent musical tastes. Cluster analysis assembles respondents based on their common responses to questions/ measures, and is useful for identifying relatively homogenous groups, groups that are highly intetnally homogenous (members are similar to one another) and highly externally heterogeneous (members are not like members of other clusters) (Aldenderfer and Blashfield 1984). Employing cluster analysis techniques, we uncovered seven musical taste clustets. Table 1 outlines the results of our cluster analysis. The largest group (n = 616) was the Club Kids, composed of those who report an above average enjoyment of techno and dance, mainstream pop, and hip-hop and rap. Next were the Urban Music Enthusiasts (n = 605). Members of this group combined a strong appreciation of Rap and Hip Hop with considerable disinterest in most other musical styles. These adolescents are the primary focus ofthe current study. Then there was a fairly large (n = 482) group of youth, the New Traditionalists, who have an above average liking of classical music and opera, jazz, soul, R&B, country music and mainstream pop. The fourth largest (n = 425) group, the Hard Rockers, comprised a sizeable number of heavy metal and hard rock, alternative, punk and grunge fans. Then there was a surprisingly large (n = 384) group of adolescents, the Musical Abstainers, who are only marginally interested in any kind of music. The group we call the Ethnic Culturalists (n = 380) were so described because of a dominant preference for a quite wide range of ethnic music, as well as a greater than average liking for soul and R&B, jazz, classical music and opera, country music techno and dance, and mainstream pop. The smallest group (n = 338), the Musical Omnivores, was composed of those who have an above average appreciation for all 11 musical genres. These clusters vary considerably, not only in the musical Listening to Rap †¢ 703 Q-CM O O U O O U O O U O O -COIOCOCOCNJCJ>COIO † †¢ ^ – T— c3^ h ^ h†¦ c o 3†² UJ CD o .Si i -T— COCOCDCO s m eu rocMincDco -T— CMC3 co co i Q. CL tu . S o .2 U) o tu tpcooin CNJcOCOCOcdcOCMCOM-‘^COCNI co T—CMOCI5 ? CO en (U ro â€Å"o 0} Q. CL ro â€Å"o en CM CM co â€Å"cD t n tu . 2 2 Oi tn -D C to to CZJ eu co CNI co o tD tu. —. _ 2 CD â€Å"O en ! c: o c: 03 sa | ^ sV ndical . 0011 V CL ro o tu . S P o | idd tn tu V p. 704 †¢ Social Forces 8H2) likes and dislikes, but also with respect to sociodemographic, socioeconomic class indicators, and measures of school experience, cultural capital, leisure patterns and subcultural delinquency (Tanner, Asbridge and Wortley 2008). Social Injustice, Property Crime and Violent Crime The sense of injustice that rap is said to speak to often involves the dealings that young people have with the police and courts. Six items in our questionnaire invited respondents to evaluate their perceptions of the equity of the criminal justice system, fairness in the educational system, and more general perceptions of the equality of opportunity in Canada. Some of the questions addressed racebased inequality, while others invoked age, class- and gender-based discrimination. These six items were condensed into a scale and standardized (alpha = . 65) with higher values indicating greater feelings of social injustice. Respondents were also invited to report their participation in illegal activities. Our measures of crime and delinquency covered a spectrum of activities, varied by type and seriousness. Two scales items are constructed based on the following question: â€Å"How many times in the past year have you done any of the following things? Would you say never, once or twice, several times, or many times? † The first scale captures involvement in property crime, including self-reported property damage, theft under $50, breaking into a car, stealing a car, stealing a bike, breaking and entering a home, drug dealing and theft over $50 (alpha = . 6). The second scale measures violent offending and includes carrying a hidden weapon such as a gun or knife in public, using physical force on another person to get money or other things, attacking someone with the idea of seriously hurting him or her, hitting or threatening to hit a parent or teacher, getting into a physical fight with someone, and taking part in a fight where a group of friends were up against another group (alpha = . 81). SES, School Measures and Cultural Capital The impact of students' sociodemographic backgrounds is initially examined in terms of demographic variables-age, gender, Canadian identity (â€Å"Do you think of yourself as Canadian? â€Å"-a measure of perceived inclusion in Canadian society), and race. Socioeconomic status is captured through indicators of parents and family situation, and includes measures of parental educational attainment (whether or not they had attended postsecondary education), family intactness (whether or not respondents grew up in a two-parent household), a measure of subjective social class based on perceptions of family income. Next we include a set of measures related to educational attainment, experiences and expectations: self-reported grades (proportion receiving mostly As), skipping school, suspension from school, educational stream (general or academic stream) and a more evaluative question about the degree of importance that young people attached to education. Listening to Rap †¢ 705 Finally, we include a measure of respondents' own cultural capital activities. While mainly used as an explanation of educational and occupational attainment (DiMaggio 1982; DiMaggio and Mohr 1995; Aschaffenburg and Maas 1997), measures of cultural capital have also been deployed to uncover dispositions, or orientations, towards the arts (Bourdieu 1984; Swartz 1997). We use it here as a further measure ofthe characteristics and lifestyles ofthe audience for rap-its possession bestowing status upon individuals and the music that they listen to, its absence denoting the opposite. Our seven-item cultural capital index comprises both traditional highbrow pursuits-going to the symphony, visiting museums-and the sorts of respectable leisure activities (playing a musical instrument, attending cultural events, going to the library, reading a book for pleasure and hobbies) that contribute to the cultural resources available to young people. The sum of these seven items is standardized and has an alpha of . 65. Descriptive statistics and other details on all measures can be found in Appendix A. Analytic Procedure Multivariate logistic regression is employed in four separate analyses. First, a strong preference for Rap and Hip/Hop-being an Urban Music Enthusiast-is regressed on sociodemographic, socioeconomic status and school measures. Next, we regress being an Urban Music Enthusiast on sociodemographic, socioeconomic status and school measures for three racial groups-white, black and Asian/South Asian youth. For each racial group we run four separate models that include baseline measures only, followed by models that add social injustice, property crime and violent crime. All analyses were conducted with the Stata 8. computer program (StataCorp 2001) using the survey commands that account for intra-cluster correlation due to the complex sampling strategy. Results We can quickly confirm the enormous popularity of rap with our respondents. It has the highest average approval rating of any musical genre, with some 33 percent of students saying that they liked it â€Å"very much,† and 21 percent saying that they liked it â€Å"quite a lot. † Rap clearl y appeals to a broad range of young listeners and is, therefore very much part of a common music culture among high school students. But our cluster analysis (Table 1) also isolates a group of students who enjoy rap music and little else. Examining the approval radng for each music genre relative to the cluster means, where scores approaching 1 indicate a strong approval ofthe genre, and scores approaching 5 indicate a strong dislike, demonstrates that Urban Music Enthusiasts have a strong preference for rap and hip-hop, reggae and dance hall; a more moderate liking for soul and R&B, and a below average liking for all other musical genres. We think that our Urban Music Enthusiasts fit the profile of music univores-individuals who appreciate a few musical styles while disliking everything 706 †¢ Social Forces mi) else-as described in the research of Peterson (1992) and Bryson (1997). Bryson links univorous taste among American adults to low status, particular racial and ethnic groups, and regional differences. She also notes that univorous taste, when compared to omnivorous taste, is more likely to be related to what she calls â€Å"subcultural spheres. † (Bryson 1997:147) Our Urban Music Enthusiasts appear to be rap univores who may also be adhering to â€Å"sub-cultural spheres. Of the 605 Urban Music Enthusiasts in our sample, 275 {A6%) are black, 117 (19%) are white, 115 (19%) are Asian or South Asian, and 98 (16%) are from other racial groups. These figures tell us that young black people still comprise the central component of the rap audience; moreover, roughly 57 percent of black youth is Urban Musi c Enthusiasts). At the same time, we observe evidence of a significant racial crossover. White Urban Music Enthusiasts constitute 8. 6 percent of the white students in our sample, while Asian Urban Music Enthusiasts make up 9. 5 percent of all Asian students. The racial composition of the Urban Music Enthusiast taste culture prompts two further questions: Eirst, of the black students surveyed, what factors in addition to race predict their univorous interest in rap? Second, of white and Asian students, what factors encourage their involvement in an essentially black music culture, an involvement that clearly sets them apart from other white and Asian students? Table 2 provides results for Urban Music Enthusiasts membership regressed on sociodemographic, socioeconomic status and school measures, with separate analyses for white, black and Asian/South Asian young people. Paying particular attention to the findings for each racial group, what is common to all three groups of Urban Music Enthusiasts is that, compared to other students in our sample, they are poorly endowed with cultural capital and are not especially good students. Few other background factors have any significant or consistent impact upon a disposition towards Urban Music. For white students, parental SES, family structure and subjective social class, have no bearing upon their musical preferences, whereas school suspension and poor grades are strong predictors. For black students. Urban Music enthusiasm is more common among younger students and those less likely to identify as Canadian. Being a black youth identified as an Urban Music Enthusiast is also strongly related to growing up in a single-parent family and skipping school. For their part, Asian/South Asian youth are something of an anomaly-among them. Urban Music Enthusiasm is positively associated with social class and having well-educated mothers-but like other Urban Music Enthusiasts it is also strongly related to school suspension and skipping school. We are less interested, however, in the sociodemographic and socioeconomic factors that may lead to being an Urban Music Enthusiast than in the relationship between being a Urban Music Enthusiast and representations of rap-either as part of a culture of resistance and/or as a basis for subcultural delinquency. Tables 3 through 5 describe the distribution of being an Urban Music Enthusiast across three racial groups (white, black, Asian/South Asian) as shaped by perceptions Listening to Rap †¢ 707 I i I u (O re (/> CO o (U 1. 76 4. 37 ,01a ‘V— re . r; o — U; c n t – – CO CO cr; – ^ †¢ ^ CD – ^ CO CO CD CM CNl T – CD CN? -â€Å"i^ CO CNJ – . 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E Q. / fV le 0 S ^^ 0  « †¢rat †¢g CO t-~ - «aO5 CIS co co CM r~. – ^ CM r – i r j co cz> †¢ ^ co co OO m LO co r-.. co †¢ ^ T — en lO CM LO † CO o †¢ †¢ – r— cz; CM r— UO OO T l – I— CD ^ 1 – LO CD T— O ‘ CSI CO CO T T- T-^ OO ^ CO oq – ^ †¢ LO O I— ^† 05 †¢ h – co LO C3 CSl i T-^ c s i T-^ ‘ c s i re re 3 s o: 0 CM LO †¢;* O; CD CD CJ C 3 CO T— CO – ^ co Ti† i^.. OO co T – 1 ^ CM CD O ) OO CD co eu r O r co CD ci> u 3 S ice a Bas iViod _o d) ro .? † 5 ‘S V 3 iO r- co CM CM LO CD CD CM LO †¢ < – CD LO co o LO T^ T-^ T^ cri i~~- c o h – †¢>— c o CM – †¢ – o ^ – CD CM OO h-; oq CO csi T-: csi T-^ ‘†¢ CD †¢s c 0 ?ai ir 1 ? ir _3 s oc 0 CSJ T— I— CD CD c o CN – ^ co OO co i csi CSI C3 co CD T t co O; CD o 3 o u 0 coiSS ? 3 (O re à ‚ «^ CL O) O a; ro .^ re 0) Logi! .†¢^ O fe 5 5 ID ? -O ^Et » {‘iyMA-d3. †¢ 1997. â€Å"What About the Univores? Musical Dislikes and Group-Based Identity Construction Among Americans with Low Levels of Education. † Poetics 25(2-3): 141-56. Chen, Meng-Jinn J. , Brenda Miller, Joel Grube and Elizabeth Waiters. 2006. â€Å"Music, Substance Use and Aggression. † Journal of Studies on Alcohol 67(3):373-81. Cohen, Stanley. 973. Folk Devils and Moral Panics. MacCibbons and Kee. †¢ 1980. Folk Devils and Moral Panics. 2†³Ã¢â‚¬Ëœ Edition. Martin Robertson. Curran, James. 1990. â€Å"The New Revisionism in Mass Communication Research: A Reappraisal. † European Journal of Communication 5 (2): 135-64. DiMaggio, Paul. 1982 â€Å"Cultural Capital and School Success: The Impact of Status Culture Participation on the Grades of U. S. High School Students. † American Sociological Review A7(2):\%9-1Q. DiMaggio, Paul, and John Mohr. 1985. â€Å"C ultural Capital, Educational Attainment and Marital Selection† American Journal of Sociology 90(6):I231-6l. DeNora, Tia. 2000. Music in Everyday Life. Cambridge University Press. Fine, Gary Alan, and Sherryl Kleinman. 1979. â€Å"Rethinking Subculture: An Interactionist Analysis. † American Journal of Sociology 83(l):l-20. Ereedman, Jonathan. 2002. Media Violence and Its Effect on Aggression: Assessing the Scientific Evidence. University of Toronto Press. 718 †¢ Social Forces 88(2] Frith, Simon. 1985. â€Å"The Sociology of Youth. † Pp. 301-68. Sociology: New Directions. Michael Haralabos, editor. Ormskirk: Causeway Press. Gracyk, Theodore. 2001. / Wanna Be Me: Rock Music and the Politics ofIdentity. Temple University Press. Hall, Stuart, and Tony Jefferson. 1976. Resistance through Rituals. Hutchinson. Hehdige, Dick. 1979. Subculture: The Meaning of Style. Routledge. Hesmondhalgh, David 2005. â€Å"Subcultures, Scenes orTribes? None ohe. Ph(ywt! ‘ Journal of Youth Studies 8(l):21-40. Hicks, Jeffrey. 2006. â€Å"How Hip-Hop Destroys the Potential of Black Youth. † Project 21 New Visions Commentary: National Leadership Network of Conservative AfricanAmericans. 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Kubrin, Charis E. 2005. â€Å"Cangstas, Thugs, and Hustlas: Identity and the Code of the Street in Rap Music. † Social Problems 52(3):360-78. Laing, Dave. 1985. One Chord Wonders: Power and Meaning in Punk Rock. Open University Press. Laughey, Dan. 2006. Music and Youth Culture. Edinburgh University Press Lena, Jennifer. 2006. â€Å"Social Context and Musical Content of Rap Music, 1979 -1995. † Social Forces %G{)A^^-(>. McQuail, Denis. 1984. â€Å"With the Benefit of Hindsight: Refiections on Uses and Gratifications Research. † Critical Studies in Mass Communication 1(2): 177-93. Middleton, Jason, and Roger Beebe. 002. â€Å"The Racial Politics of Hybridity and ‘NeoEclecticism' in Contemporary Popular Music. † Popular Music 21(2):159-72. Miranda, Dave, and Michel Claes. 2004. â€Å"Rap Music Cenres and Deviant Behaviors in French-Canadian Adolescents. † Journal of Youth and Adolescence 33(2): 113-22. Morley, David. 1980. The â€Å"Nationwide† Audience: The Structure and Decoding. London: British Film Institute. Muggieton, Dave. 2000. Inside Subcultures. Berg Publishing. Listening to Rap  » 7 1 9 Negus, Keith. 1999. Music Genres and Corporate Cultures. Routledge. Newman, Katherine. 2004. Rampage: Social Roots of School Shootings. Basic Boob. Patterson, Orlando. 006. â€Å"The Poverty of the Mind. † The New York Times. Available at: http://www. nytimes. com/2006/03/26/opinion/26patterson. html. Peterson, Richard A. 1992. â€Å"Understanding Audience Segmentation: From Elite and Mass to Omnivore to Univore. † Poetics 2{2):243-58. Peterson, Richard A. , and Roger Kern. 1996. â€Å"Changing Highhrow Taste: From Snob to Omnivore. † American Sociological Review 61 {^):900-07. Prinsky, Leslie E. , and Jill Rosenbaum. 1987: † ‘Leer-ics'or Lyrics: Teenage Impressions of Rock n' Roll. † Youth and Society 18(4):384-97. Quinn, Eithne. 2005. Nuthin'but a â€Å"G† Thang. Columbia University Press. Radway, Janice. 1984. 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Schilt, Kristin. 2004. † ‘Riot Grrrl is†¦ ‘: Contestation over Meaning in a Music Scene. † Pp. 115-30. Music Scenes. Bennett, Andy and Richard Peterson, editors. Vanderhilt University Press. Swartz, David. 1997. Culture and Power: The Sociology of Pierre Bourdieu. University of Chicago Press. Shively, Jo Ellen. 992. â€Å"Cowboys and Indians: Perceptions of Western Films among American Indians and Anglos. † American Sociological Review 57(6):725-34. Spiegler, Mark. 1996. â€Å"Marketing Street Culture: Bringing Hip-Hop Style to the Mainstream. † American Demographics 18(l):28-34. Stata Co rp. 2001. Stata StatisticalSoflwarv: Release 8. 0. College Station, TX: Stata Corporation. Stephens, Ronald J. , and Ead Wright III. 2001. â€Å"Beyond Bitches, Niggers, and Ho's: Rap Music and the Sociology of Knowledge. † Race and Society 3(l):23-40. Sullivan, Rachel E. 2003. â€Å"Rap and Race: It's Got a Nice Beat, but What about the MessigeV Journal of Black Studies 33(5):605-22. Surette, Ray. 1992. Media, Crime and CriminalJustice: Tmages and Realities. Brooks/Cole. Tanner, Julian. 1981. â€Å"Pop Music and Peer Croups: A Study of Canadian High School Student's Responses to Pop Music. † Canadian Review ofSociology and Anthropology 18(1):1-13. †¢ 2001. Teenage Troubles: Youth and Deviance in Canada. 2^ Edition. Toronto: Nelson Canada. 720 †¢ Social Forces BH2) Tanner, Julian, Mark Asbridge and Scot Wortley. 2008 â€Å"Our Favourite Melodies: Musical Consumption and Teenage Lifestyles. † British Journal ofSociology 59(1): 117-44. Tanner, Julian, and Scot Wortley. 2002. The Toronto Youth Crime and Victimization Survey: Overview Report. Toronto: Centre of Criminology. Tatum, Becky L. 1999. â€Å"The Link Between Rap Music and Youth Crime and Violence: A Review of the Literature and Issues for Future Research. † Justice Professional ll(3):339-53. Thornton, Sarah. 1995. Club Cultures: Music, Media and Subcultural Capital. Polity Press. Tsunokai, Glenn, and Augustine Kposwa. 2002. â€Å"Asian Cangs in the United States: The Current State ofthe Research Literature. † Crime, Law and Social Change 37(l):37-50. Van Eijck, Koen. 200 L â€Å"Social Differentiation in Musical Taste Patterns. Social Eorces 79(3): 1163-85. Walser, Robert. 1993. Runningwith the Devil: Power, Cender, andMadness in Heavy Metal Music. Wesleyan University Press/University Press of New England. Weinstein, Deena. 2000. Heavy Metal: The Music and Its Culture. Da Capo Press. Willis, Paul. 1978. Profane Culture. Routledge and Keegan Paul. . 1990. Common Culture. Open Univer sity Press Wimsatt, William. 1994. We Use Words like ‘Mackadocious,'Bomb the Suburbs. Subway and Elevated Press. Wingood, Cina M. , Ralph DiClemente, Jay Bernhardt, Kathy Harrington, Susan Davies, Alyssa Robillard and Edward Hook. 2003. A Prospective Study of Exposure to Rap Music Videos and African-American Female Adolescents Health. † American Journal ofPublic Health 93(3):437-39. Wortiey, Scot. 2002. â€Å"The Depiction of Race and Crime in the Toronto Print Media. † Pp. 55-82. Marginality and Condemnation: An Introduction to Critical Criminology. Bernard Schissel and Carolyn Brooks, editors. Fernwood Publishing. Wordey, Scot, and Julian Tanner. 2004. â€Å"Social Groups or Criminal Organisations? The Extent and Nature of Youth Gang Activity in Toronto. † Pp. 59-77. Enforcement and Prevention to Civic Engagement: Research on Community Safety. Bruce Kidd and Jim Phillips, editors. Toronto: Centre of Criminology. . 2005. â€Å"Inflammatory Rhetoric? Baseless Accusation? A Response to Gabors Gritique of Racial Profiling Research in CAm. a2i. † Canadian Journal of Criminology and Criminal Justice 47(3):581-609. Yousman, Bill. 2003. â€Å"Blackophilia and Blackophobia: White Youth, the Gonsumption of Rap Music, and White Supremacy. † Communication Theory 13(4):366-91. Listening to Rap †¢ 721 Appendix A. Descriptive Statistics for all Measures Variables Independent Measures Age Gender Do you identify yourself as Canadian Race Coding Years Male Female Mean/ Cases Percent 3331 1696 1700 2533 16. 62 49. 9 50. 1 74. 8 25. 39. 4 14. 2 11. 5 19. 3 15. 7 31. 5 68. 4 27. 0 73. 0 76. 7 23. 3 3. 26 Yes No White Black Asian South Asian Other 850 1334 Father Received Postsecondary Education Mother Received Postsecondary Education Two-Parent Family 480 391 653 531 1073 2327 Subjective Social Class 1 (poor) to 5 (rich) Z-score Cultural Capital Leisure (index o f frequency of involvement in playing a musical instrument, attending cultural events, volunteering, going to meetings/ belonging to organizations, going to the library, going to the symphony or opera, going to the museum, reading a book for pleasure, and involvement with hobbies, with an a=. O). Have been suspended from school at least once Have skipped school at least once Primarily receive â€Å"A† Grades Educational Stream Education is Important Part of Life Yes No Yes No Yes No 917 2483 2609 791 3032 3325 Yes No Yes No Yes No Educational General 450 2950 2493 907 1092 2308 2642 13. 2 86. 8 73. 3 26. 7 32. 1 7. 9 78. 0 22. 0 71. 8 28. 2 18. 7 81. 3 736 2309 Yes No 905 605 2625 3277 Dependent Measures Yes ~ Urban Music Enthusiasts No Social Injustice (index of amount of agreement or Z-score disagreement regarding the following statements: people from my racial group are more likely to be unfairly stopped and questioned by the police than people from other racial groups; discrimination makes it hard for people from my racial group to find a good job; discrimination makes it difficult for people from my racial group to get good marks in school; students from rich families have an easier time getting ahead than students from poor families; everyone has an equal chance of getting ahead in Canada; it is rare for an innocent person to be wrongly sent to jail, with an a=. 65). continued on the following page 722 †¢ Social Forces 88(2] Appendix A. ontinued Coding Variables Independent Measures Property Crime (index of frequency of involvement Z-score in breaking into cars, minor theft under $50, property damage, stealing bikes, breaking and entering into homes, ste aling cars, major theft over $50, and drug dealing, with an pi=. 86), _ . ^ Violent Crime (index of frequency of carrying a hidden Z-score weapon like a gun or knife in public, using physical force on another person to get money or other things; attacked someone with the idea of seriously hurting that person, hit or threatened to hit a parent or teacher, getting into a physical fight with someone, and taken part in a fight where a group of friends were up against another arouD. with an a=. 81). Mean/ Cases Percent 3344 3288 Copyright of Social Forces is the property of University of North Carolina Press and its content may not be copied or emailed to multiple sites or

Thursday, August 29, 2019

Advanced pathophysiology Case Study Example | Topics and Well Written Essays - 750 words

Advanced pathophysiology - Case Study Example The elevated WBC is from the proliferation of immature WBC which continue to increase, however do not mature (Harrison, 2011). The accumulation of immature white blood cells in the bone marrow and blood leads to the replacement of normal cells such as thrombocytes, which leads to thrombocytopenia and a disruption of blood clotting (Harrison, 2011). Therefore, this patient presents with gum bleeding and easy bruising. In addition, decreased levels of leucocytes also increase the patient’s vulnerability to bruising. The replacement of cells also leads to a decrease in the number of red blood cells which are responsible for oxygen transport. This in turn is the reason why the patient developed fatigue and shortness of breath may also have been present (Harrison, 2011). The splenomegaly occurs as a result of extamedullary hematopoiesis as the bone marrow becomes less competent. The reduction of red blood cells due to replacement also leads to paleness. Upper abdominal tenderness c ould be attributed to splenomegaly. Opportunistic infections that occur as a result of the comprised immune system may lead to arthalgia. Describe pathophysiology of ALL. Compare it with other leukemia forms in children The development of ALL is assumed to occur as a result of alteration of a progenitor cell responsible for continuous clonal expansion (Bassan & Hoelzer, 2011). This event can occur in cells of T of B cell lineage which give rise to different types of acute lymphoblastic leukemia. These subtypes are based on the stage of cell development which the transformation occurred. Approximately 80% of ALL cases have been found to originate from B lymphocyte precursors (Onciu, 2009). Several factors have been found to influence the development of this cancer and these include radiation exposure, genetics, chemical exposure and some viral infections such as HTLV-1 (Onciu, 2009). As mentioned above the alteration of the precursor cells leads to an arrest in development. This then leads to the proliferation of immature white blood cells in the bone marrow which replace its physiological components. Therefore, there is a marked decrease in the formation of several blood elements. This may lead to other complications such as thrombocytopenia, anemia and neutropenia (Pui, Relling & Downing, 2004). In addition, the disruption of bone marrow function leads to extramedullary hematopoiesis which occurs in the spleen, liver and lymph nodes (Pui, Relling & Downing, 2004).These organs will then increase in size resulting in hepatomegaly and splenomegaly. This leukemia is different from AML which involves the myeloid blast cells whilst ALL involves lymphoblasts. In the pathogenesis of Acute Myeloid Leukemia, the pathological defect will involve numerous precursor cells which will develop immature (Pui, Relling & Downing, 2004). Meanwhile in Acute Lymphoblastic Leukemia, the effect is on a precursor cell that that will proliferate and produce several immature cells. The etiological factors between the two types of leukemia are also different. AML often occurs as a result of certain preleukemic blood disorders whilst ALL often associated with genetic factors and a prolonged exposure to radioactive substances (Pui, Relling & Downing, 2004). What is the purpose of chemotherapy in ALL? What is a common side effect of Therapy? Chemotherapy is necessary in this condition as the drugs are injected intravenously and can be used to treat cancerous cells that have

Wednesday, August 28, 2019

Heuristics and Bias (DB) Essay Example | Topics and Well Written Essays - 500 words

Heuristics and Bias (DB) - Essay Example Similarly, the succeeding activities demonstrated the same kind of analysis required to come yup with the most rational-correct-response to the exercise. In the string exercise (Activity #2), this depth of understanding of how reasoning works is once again shown. Looking at the way the Xs and Os were arranged, it became evident that Option 1 makes more sense because it provides an equal chance for the Xs and Os to assume an arrangement adopted by the initial arrangement of Xs and Os. The randomness of order of the two letters in the second option may seem to indicate a more random and more probable ordering of the Xs and Os. However, this randomness has no order nor logic; if, looking at the two sets of strings by themselves, the first option has more order and logic rather than the second set of letter string. Again, like the first activity in the set of exercises, the second activity challenges the individual to think within the given information of the problem. In this particular exercise, individuals are to think within this set of information. While in some way it constrains the individual to think within the given information, this is only logical and reasonable since the answer to these exercises lies within the information provided.

Tuesday, August 27, 2019

Compensation Management Coursework Example | Topics and Well Written Essays - 250 words

Compensation Management - Coursework Example Considering the FMLA or Family and medical leave act, it can be said that it is another very important lawsuit in the US federal Law. It enables the employees of an organization to take paid leave for family and medical reasons having complete job security during leave. The group health insurance will also continue under same terms and conditions as if the employee had not gone on leave. Knowing about FMLA and all of its clauses is very critical to know because with this information employees will be aware of their leave rights. Moreover, they may apply for leave when necessary staying within the clauses of eligibility of FMLA. Moving forward to COBRA, â€Å"The consolidated omnibus budget reconciliation Act† is a federal law that enables workers to get health benefits for a period of time in which they may have lost their job (voluntary or involuntary), worked lesser number of hours, death case, divorce or facing issues in transition between jobs. COBRA also benefits employees of an organization having 20 or more employees where, they can extend their group health plans for an extended period, otherwise it could have ended (Mathis, Jackson, & Valentine, 2013). COBRA enables employees to elect their continuation of health plan and employers are also required to put up a notice for the cause.  COBRA is very integral lawsuit in health and insurance and it benefits every common man of any organization. Its knowledge and application is necessary not only as an employee but as an employer too. The reason behind this is that COBRA can benefit through group health plans and during any tough times. Anyone can be able to apply for the optional benefits knowing the eligibility criteria of

Monday, August 26, 2019

Planning Function of Management in an Organization Essay

Planning Function of Management in an Organization - Essay Example Strategic planning is a process in which organizations strategies are determined, which utilizes major resources of the organization to achieve the goals. The company, EVENTIS is an event creator, organizer and manager. It has organized various events in its short history of 8 months and has come to be known as a very competent company. The company's portfolio includes organizing events such as weddings, concerts, gigs, conferences, seminars and the biggest event as yet, the Australian Cultural Festival. In this short span of time, EVENTIS has gathered a force of 400 young, talented and highly motivated employees through its friendly and goal oriented work environment. The satisfied customer base is increasing day by day and the future looks bright for EVENTIS at least for the near future. Planning is an essential process in EVENTIS, it helps the organization in achieving its goals and competing better with other and progressing in future. It consists of setting strategic objectives that define the desirable business aims to be achieved. Optimizing the strategic objectives by choosing the best considered mechanisms and to ensure the best use of organizational resources in given time is by developing operational plans. It also consists of organizing the management process in such a way that it helps in making the most effective decision and implementation plan. It also includes proper management of information that helps in support in management process by developing the communications system. This planning process is not consistent; it's changing along with the environment which governs the organization's entities. Thus the company makes sure that they monitor the environment which includes the competition, latest technology, government's rules and regulations and update their planning accordingly. [2] Impact of the following on the Management Planning in the Organization EVENTIS is an organization that deals with legal issues, ethics and corporate social responsibility very effectively as they play a very essential part in its remarkable planning management. Legal Issues EVENTIS as an event management company knows its responsibilities under law and organizes event taking special care of a variety of legal issues. It is their legal responsibility to make sure whether their event available within a particular time. EVENTIS ensures who actually owns the event as it involves various rights and liabilities and clarifies whether they can enter into a contract with the third party regarding the event. It becomes necessary in some cases to take official permission from the sanctioning body in order to host or manage events. The sanctioning is usually required for any national and international event under international rules and it ensures that the event is delivered according to the standards of the governing body. It is necessary to take license or permission before holding an event at any place and these licenses are issued by the local authorities. EVENTIS require the following licenses: Public Entertainment License - this is issued to conduct events in open air, can be for more than one occasion and issued by local

Sunday, August 25, 2019

The impact of stressful employment in the public sector Literature review

The impact of stressful employment in the public sector - Literature review Example ng the theoretical concepts, Christiana & Mahalakshmi (2013) stated that the strategic decisions being practiced by contemporary organisations, with the aim of empowering organisational control mechanism have become a major consideration of the public service organisations. From the last few decades, public organisations across different geographical locations have been observed to become increasingly transparent by deploying effective auditing as well as visualising technologies to prevent stress within the workforce (Christiana & Mahalakshmi, 2013). Employee or workforce stress, identifiable as job dissatisfaction or absenteeism impose direct influences on the organisation that can further lead to increased cost for the organisations and conveys different potential hazards. In relation to the present day scenario, Obiora & Iwuoha (2013) critically asserted that organisations from different publicly owned corporations have been facing a major concern associated with employee stress that is further observed to increase constraints for these organisations to achieve their operational and financial goals. Moreover, organisations are often recognised to face significant constraint due to the continuous and increasing workload on employees. For instance, the workforce in different healthcare and law enforcement departments in a public sector frequently have to experience an increased level of their stress while performing their pre-allocated job roles and responsibilities, given the influences of continuous innovation and instability in the business environment (Obiora & Iwuoha, 2013). Sigler & Thweatt (n.d.) in this regard have clearly stated that stress can be formed in a number of ways derived from both internal and external sources in a public sector organisation. In this context, conflicts amid members within the family structure and/or within the occupational environment and deficiency of self-confidence amid the personnel can be identified as the most common

Saturday, August 24, 2019

Compare what it book says and what textbook says. Ten words from Essay

Compare what it book says and what textbook says. Ten words from textbook - Essay Example At the beginning of the book, Corrie describes the old and strangely built Dutch house, which was the house of her birth because this was to go on to, being the main setting of the book. Inside this house is a secret room where political prisoners and Jews who were getting away from the Nazis were hid. We see from the very beginning of the book that the Ten Booms were essentially very kindhearted people who went out of their way to help the poor and bonded well amongst themselves. Corrie's siblings are portrayed as people she found her best friends in and her aunts as grownups she looked up to. Taking in people to provide refuge started when one Jewish woman ended up at the Ten Booms' doorstep and asked for protection following her husband's arrest by the Nazis. This gave a start to the hiding place for the Jews. However, the story is not a bed of flowers as Corrie and her family soon had to face the Nazi Invasion of Holland, their country of residence. The Ten Booms became an essential part of the Resistance Movement and provided shelter for people fleeing the Nazi forces in a hidden room should the house ever be raided. The book talks about how they did practice runs everyday in case their house was ever raided. During the time all this was happening, Corrie sometimes had serious doubts about whether what she was doing was right or not but always came up with the conclusion that she was by keeping her faith in God strong. Even though the family and their wards prayed very hard that a raid should not happen, it eventually did due to the Dutch traitor named Jan Vogel. Ironically, the Jews in the secret hiding place were saved but the Nazis took the Corrie, her father and sister Betsie into custody. As luck would have it, the father died ten days after arrest and Corrie who was unwell at the time of arrest was put into solitary confinement. The book talks about ho every time Corrie came near despair, her faith in God kept her going y giving her something to do. During her solitary confinement, she just had a black ant for company with whom she shared her bread. This alone gave her the strength she needed to pass the lonely days and nights of her confinement when she saw this ant struggling to take the piece of bread back through the crack in the floor. A few months later both Corrie and Betsie were reunited at Vught Prison and the two sisters were able to catch up on what happened to both of them during the separation. Betsie had a weak heart from birth and Corrie knew she had to be with her sister ever more now. Both sisters wished for release but instead were transported in boxcars into the infamous Ravensbruck Prison in eastern Germany where living conditions were so horrific that Betsie became more and more ill. Despite the uncomfortable living premises and Betsie's continuously failing health, the two sisters kept bringing the word of God to any prisoner who listened and found strength in it. Corrie habitually sneaked in a tiny vitamin bottle for Betsie and also distributed vitamins to whoever needed them. Betsie was very sure that they will be released at the beginning of the year 1945 which

Friday, August 23, 2019

Court case Essay Example | Topics and Well Written Essays - 500 words

Court case - Essay Example On 26th October 2010 the accused was arrested again and jailed on several charges, namely: Grand Larceny on the 2nd and 8th of June, breaking and entering with intent on 8th June, credit card theft on 22nd January and receipt of stolen property on 18th June. Pre-sentence report was ordered on 12th November. Evidence for the preceding charges was submitted on 14th December and a true bill was issued by the Grand Jury. A review of all the charges and the case was made on 21st December and a trial was scheduled for 22nd February 2011. The case was postponed again and set on 28th March. The judicial body deciding on the case was the County Circuit Court Criminal Division. The accused was facing 30 years for 7 counts of grand larceny, 2 counts of receipt of stolen property, 1 count of credit card theft and 1 count of breaking and entering with intent to commit other misdemeanors. On top of this, the accused was already serving probation for driving under influence. Accused was ordered to pay restitution in the amount of $29,328.15. Due to the number of evidence and witnesses, the accused plead guilty. Consequently, the sentence was reduced to 2 years and 8 months with supervised probation for 5 years succeeding release from prison. Because the accused had committed the same crime several times, it is the victims’ opinion that the offender did not deserve the plea bargain and subsequent reduction in prison term. Although I do not share the victims’ feeling of unfairness, I found a couple of things surprising. First is the offer for plea bargain. The accused committed seven (7) similar offenses in a span of six (6) months. Obviously, any feeling of remorse is doubtful as he seems to jump into one offense after another. Leniency in prison term does not seem to be appropriate. Secondly, I wonder about the chronological aspect of the arrests made. The first arrest was made for offenses on 15th March, 18th

Immigration Essay Example | Topics and Well Written Essays - 500 words - 8

Immigration - Essay Example According to him immigrants do not care for American values and only care for money. They are not ideal for a nourishing American society and distort the constituency of the country. They destruct the Ameircan solidarity and their own. Stoll does not think that immigrants have any contribution to the country rather than providing cheap labor. Well this is not agreeable as many respectful jobs are done by immigrants. Mead however has a different view that Stoll and think immigrants has shaped America as we see it today. I agree with Mead in this approach as he calls America has been known as the â€Å"melting pot† of assimilation of cultures and has given new opportunities to immigrants throughout history. Mead argues that while coming to the country without following the right jurisdiction is never encouraged, forgiving this act and allowing individuals to have new opportunities. Mead is a person who wants to protect immigrants. Stoll suggest that immigrants are poor can adversely affect the American workers. However Stoll think these poor people can be given opportunity to live in the country but he does not think it is the responsibility of the America to help poor people. Mead does not think these immigrants have to rush to America but these poor people need to given shelter and facilities by their respective countries. He believes that entry of people from all around world to Europe and US will and disrupt the wealth and moral value of these countries. This is a fact; actually there are many illegal immigrants in America and UK which damages the socio and economic infrastructure of these countries. It also steals the opportunity of the citizens and put pressure on the country’s population. . Mead argues that r while coming to the country without following the right jurisdiction is never encouraged, forgiving this act and allowing individuals to have new opportunities represent the true face of America itself. The

Thursday, August 22, 2019

Motherhood no longer fitting in the schedule Essay Example for Free

Motherhood no longer fitting in the schedule Essay The younger generation of women are more highly educated than ever before and will continue to postpone child bearing until they are certain they have established a stable career and lifestyle. Another cause of this delay is the difficulty of balancing home life with work life. For too many Australians the choice to have children weighs heavily. When many people check their savings account, it is quite rational for them to delay or decide against having children. Unfortunately, increasing numbers of women put off having children and wait for a better time that simply never comes. The average age at which Australian women have their first child is now 29. This is because women come closest to equality with men when they do not have family responsibilities. As more and more women postpone having children, pursue education and improve their employment prospects, those who have their children young, and who have a lower socioeconomic background, tend to fall behind both socially and economically. So many women find themselves stuck. Having a career makes it harder to have children, but having children makes it increasingly necessary to have a career for support. Therefore it is not always women deciding not to have children, but it seems as though the decision has already been made. If women are provided with opportunities equivalent to men but these opportunities are severely limited by having children then women almost have no choice but to restrict the number of children they have. However this is not always the case. There are a small percentage of women who choose not to ever have children. These women want the benefits of stability in community life and financial independence, but at the same time are unwilling to pay the cost of giving up any degree of personal freedom. It may seem selfish, but who wouldnt? A modern womans desire for a successful career is simply a case of choosing luxury apartments and designer shoes over changing nappies. For many women, children do not quite fit in the image of the cosmopolitan lifestyle they wish to lead. They would prefer freedom, fun, independence, time and money rather than responsibility, restrictions, stress, worry, financial struggles and chaos. Ok, maybe in reality it isnt that black and white. Love is the only main advantage of having children but who can guarantee that that will always be the case? Is an uncertain love really worth it? For me, I dont know if Ill ever feel the joy of holding my own baby in my arms. Im sure most women had a similar opinion at one stage. For many women who decide not to ever have children, motherhood is viewed as a burden rather than an experience of personal fulfillment. Another significant factor of the reduction of the birth rate is the breakdown of long term relationships. Most women still want children in marriage, but with divorce rates so high and children being put off until later in life, relationships often end before the kids come along. No matter how happily married, statistically speaking, a woman still faces a greater than 40% chance of ending up a single parent. Many women who would like to have children may possibly not have yet found a suitable partner, further delaying childbirth. Now Australia must face the issue of increasing the birth rate once again. Demographers now realise that the accelerating trend in fertility decline is not a temporary phase but an indication of a long-term change. Most Australian women do want children but find it too difficult to balance family life and work. Conservatives will ask women to give up work to satisfy their notion of what is an ideal life. In my opinion, Australias birth rate is not about telling women to go back in to the kitchen. Promoting a better balance between work and family life, with some flexibility for all employees can be achieved without compromising productivity. The population debate in Australia must start by focusing on the family. A good family policy, particularly a better balance between the demands of work and child bearing responsibilities, will ultimately provide the start of a better future.

Wednesday, August 21, 2019

The scope and limitations of Reiss text typology

The scope and limitations of Reiss text typology Reiss translation-oriented text-typology provides a systematic approach to translation. More interestingly, it approaches translation at the text level. This essay will examine Reiss typology with focus on Parting the Waters, published in National Geographic, a monthly magazine that borders on science, geography, history and culture. REISS TEXT-TYPOLOGY Reiss sees translation as an act of communication whereby the translator acts as a medium (secondary sender). This presupposes that a message has to be passed across, from a primary source to a target receiver. The major media are the source language and the target language. The aim here is to produce a target language text that is functionally equivalent to the source language text (Reiss 2000:160). This means the source text should be the consultative point for the translator. In order to achieve this functional equivalence, Reiss proposes a functional approach of text-typology. This approach takes into account the major communicative function of a source text as a basis for translating into the target text. In other words, a target text that does not have the same function as the source text is not entirely a translation, but what Reiss calls transfer. Reiss text-typology includes a two-phase approach in translating a text: Phase of analysis and phase of reverbalization. The analy sis phase basically involves establishing the text type, genre and style (linguistic form).The phase of analysis is the most important as that is what would inform the translation method to employ. Text-type of Parting the Waters Reiss identifies three text-types according to their communicative function namely: the informative type (communication of content), the expressive type (communication of artistically organised content) and the operative type (communication of content with a persuasive character). There is another hyper-type which she calls the audio-medial text type. This is more of a super-ordinate term for the other three and does not concern the text in question since it is a written text. Parting the Waters can be seen chiefly as an informative text type; first given the context of the text: magazine and second because it gives factual information about a place: Korea, and the geographical events that take place there. The translation strategy recommended in this case by Reiss should thus focus on conveying content. Text variety of Parting the Waters This stage has to do with the conventions of structure and language adopted by the text. However, Reiss explains that they may differ according to different cultures. The importance of this is to be able to find a functionally equivalent convention in the target text culture. In this light, Parting the Waters is a kind of popular scientific text. This suggests also that it seeks a wider audience other than scientists. This leads to the final stage of analysis: style. Style in Parting the Waters The final stage of analysis has to do with detailed semantic, syntactic and pragmatic analysis of the language use (Reiss, 2000:166). Ordinarily, one would expect that when a text is an informative type, even the language used should be such that it is aimed only at giving facts. But that is often not the case, as Reiss herself admits, not in one single language do form and function show a 1:1 relation (2000:166). Hence, looking at the text, one would find a similar occurrence. The text has expressive language such as the internal rhymes: tides, divine, divide; of 15 feet. There is also an allusion to a biblical story: not divine interventions, an expression that answers the presupposition in the title itself Parting the Waters. Reiss thus considers this stage of analysis the most important, as the translator is faced with a decisive battle on what would inform the translation: the language or the function of the text. At this point, Reiss posits that if using an equivalent language style may weigh on the content of the text, then the translator should stick to the predominant function of the text. Translating Parting the Waters to Yorà ¹bà ¡: limitations Taking into consideration the content-focused function of the text, the translator is expected to employ a method that would achieve the same function as that of the target text by translating according to the sense and meaning (Reiss 2000:167). This suggests that the meaning conveyed by the target text should be equivalent to the meaning in the source text. Being a popular science text, and specifically about geography, Parting the Waters has terms such as peninsula, southwestern, mile, width, feet, and spring. While some of them might have some kind of equivalence (i.e. peninsula, mile width), a climatic description like spring poses a problem because Yorà ¹bà ¡ neither has a word nor group of words for it. This is basically due to the different weather conditions. The question is: what should the translator convey here? This is important because spring as used in the text plays a major role in the content; by telling us when an event takes place. The only alternative here would be to replace the word with the time of the year this season occurs in Korea. The problem with this is that it might change the meaning, as the sense of season is different from the calendar year. To solve this translation problem, the translator could adopt Nidas gloss translation of formal equivalence, that is, the use of footnotes in order to make the text fully comprehensible (Nida 2000:129). What this means is that Reiss method is not sufficient to solve this translation problem. The expression divine interventions in the text makes allusion to a biblical story about the Red Sea. This could be because the author had a target audience in mind and presumes they know about the story in the Bible. Although this can also be linked to the use of expressive language, it is however difficult to ignore the fact that this type of language use plays a role in the text- to maintain the interest of the reader. If the original audience for the source text were specialists, there is doubt as to whether expressive language would have been used at all, since all that would be needed are facts. The question is whether or not to include it in the translation. The answer to this is dependent on another question: who are the audience? Sacrificing the expressive form might change the text to an entirely scientific or historic one. This means a different readership, as it may not appeal to a common reader. The problem here is that Reiss method overlooks the fact there is an address ee for even an informative text type. She acknowledges this only in the text variety stage. However, communication itself is not complete without a receiver, in this case the readers. The title, Parting the Waters, also draws attention. It first makes the reader think of the biblical story of the Red Sea, and then makes a reader assume that is what the text is about. But this effect can only be achieved based on a shared knowledge between the author and the reader about the biblical story of the Red Sea. This assumption too must have been informed by the fact that the author had an audience in mind. However, the author quickly attends to this curiosity and possible misconception by the following opening sentence Tides, not divine interventions, divide Unfortunately, the target language (Yorà ¹bà ¡) audience is a mixture of different religions. In this text the title performs an expressive function, but that is not to say its predominant function is expressive. Since it is an informative text, one would expect again that the title would be informed by the major content being conveyed. But this is not the case. Moreover, attractive titles seem to be a common featu re of this genre. This is also a common feature of Yorà ¹bà ¡ magazines (Salawu 2004:100). The question here is: since content is the aim, should the target title be informed by the content alone and leave the use of expressive language? This of course is possible, as Reiss already advises on ignoring such language use especially if it will weigh on the content. Thus the translation can simply have à pa-Õnà   Ã’kun Korea which means The Path between Korean Waters. The consequence of this however is that it might not appeal to the wider audience except a few, specialists. This brings up again the question: who are the audience? Reiss considers this an appropriate factor only when the function of the target text is different from the source text (Reiss 2000:170). What her typology fails to recognise is that both source and target texts can have the same function (as in the case of Parting the Waters) but different addressees. CONCLUSION While Reiss translation-oriented text-typology provides a systematic method of approaching a translation task, it does not provide a complete solution to some problems in English to Yorà ¹bà ¡ translation of Parting the Waters. This suggests that it is not absolute that a text function will provide a translation strategy. Fawcett (1997: 107) makes this same point: There is simply no necessary link between text function and translation strategy. Just because we have identified a text functiondoes not mean that we are led inexorably to any logical or translation-scientific imperative to take this function as an overriding parameter to which we subordinate our translation decisions. (Fawcett 1997, p.107) This further suggests that other translation theories are valid and useful to the extent to which they proffer a solution to a translation problem.

Tuesday, August 20, 2019

Case Study On A Patient With Heart Failure

Case Study On A Patient With Heart Failure Mr. SB, 60-year-old male is a retiree and was admitted to the hospital accompanied by his daughter. He is 100kg at a height of 180cm so his calculated body mass index (BMI) was 30.9 indicating that he was overweight. When admitted, patient was complained of shortness of breath for 2 weeks and was worsening on the day of admission. Besides, he also experienced orthopnea, fatigue, paroxysmal nocturnal dyspnea and leg swelling up to his thigh. Mr. SB was admitted to the hospital for to the same problem last year. Mr. SB had known case of heart failure since 3 years ago and he had also diagnosed with hypertension for 5 years. Before admitted to the hospital, patient was taking frusemide 40mg, aspirin 150mg, metoprolol 50mg, amlodipine 10mg, and simvastatin 40mg for his hypertension and heart failure. Patient does not allergic to any medication and he does not take any traditional medicines at home. His family history revealed that his father had died of ischemic heart disease 4 years ago while his brother has hypertension. As for his social history, he smokes 2-3 cigarettes a day for 35 years and the calculated smoking pack years was 5 pack years. Besides, Mr. SB also drinks occasionally. On examination, Mr. SB was found to be alert and conscious but he was having pedal oedema up to his knee. Besides, the patient was noted with bibasal crepitations with no rhonchi. His body temperature was normal. However, his blood pressure was found to be elevated upon admission with a record of 159/100 mmHg with an irregular pulse rate at 85beats/min. His echocardiogram showed that he had left ventricle hypertrophy while chest X-ray was conducted and revealed that the patient had cardiomegaly. Lab investigations such as full blood count, liver function test, urea and electrolyte test and cardiac enzyme were done upon admission. His creatinine concentration was found to be 143 µmol/L. Therefore, the calculated creatinine clearance was 68.8ml/min. Besides, there was also blood found in the urine and the echocardiography showed that the patient has sinus tachycardia. In addition, ECG test was performed on day 1 and the result indicated that there was a T-wave inversion. The patients INR was 1.04 which was lower than normal while APTT was found to be slightly higher (59.4 seconds). Mr. SBs random blood glucose was found to be normal during his hospitalization. Mr. SB was diagnosed with congestive cardiac failure (CCF) with fluid overload. The patient also suffered from hypertension. The management plan included intraveneous frusemide 40mg twice daily, aspirin 150mg once daily, simvastatin 40mg once at night and ramipril 2.5mg once a day. Besides, patient was asked to restrict his fluid intake to 500ml per day and oxygen therapy was given to patient at high flow using a face mask when patient experiencing shortness of breath. As for his clinical progression, on day 1, the patient was complained of shortness of breath, leg swelling and orthopnea. Enchocardiogram showed that he had cardiomegaly. Treatment of CCF was given. Throughout the stay in the hospital, Mr. SB had responded well to the heart failure therapy as there was no more complaint of chest pain or shortness of breath on day 13 and his pedal oedema had gradually improved. However, patients blood pressure throughout day 1 to 9 was fluctuating between the range of 102/67-160/100 mmHg and therefore, hypertension treatment was given and blood pressure on day 10 onwards had been seen fell within the normal range. Furthermore, Mr. SBs renal function became progressively worse from 143 µmol/L on admission to 175 µmol/L on day 11 and the calculated creatinine clearance on day 11 was 56.2ml/min. 2. Pharmacological Basis of Drug Therapy 2.1 Disease Summary Congestive cardiac failure (CCF) is a complex syndrome that is usually caused by the inability of heart to pump sufficient blood to meet metabolic needs of body during exercise. It is more commonly known as heart failure38 and it can affect either left or right ventricle or both39. The risk factors predisposing one to heart failure are obesity, high blood pressure, diabetes, and smoking. Heart failure is commonly characterized by typical signs of fluid retention with symptoms of breathlessness, fatigue, paroxysmal nocturnal dyspnoea, and reduced exercise tolerance39. CCF is a common disease which affects approximately 1-2% of the general population in developed countries1. Prevalence increases with age especially those aged above 75 years where the prevalence of CCF could be as high as 10%2. In addition, men are prone to getting heart failure as compared to women1. Each year, there are about 1-5 new cases of CCF per 1,000 population and it also increased with age40. In United Kingdom, the incidence of CCF is about 0.02 cases per 1000 per annum between the ages of 25-34. However, the incidence increased to 11.6 cases in those above 86 years old1. The prognosis for CHF is relatively poor. Approximately 40% of individuals with CCF die within a year after diagnosis3. There are many causes of CHF but the most common underlying causes are heart attack, coronary heart disease, and high blood pressure. Others such as cardiomyopathy, valvular heart disease and diabetes may also precipitate heart failure4. An early diagnosis of CHF is often based on the signs and symptoms which the patient is experiencing5. Other tests are needed to confirm or rule out the diagnosis. These include chest X-ray examination, physical examination, electrocardiograph (ECG), echocardiography and exercise testing. The severity of heart failure can be classified according to the New York Heart Association (NYHA) classification system. This system consists of four classes which relate patients symptoms to physical activities and quality of life. Table 1: New York Heart Association (NYHA) Classification5. Class Patient Symptoms I (Mild) No symptoms with ordinary physical activity (walking and climbing stairs) II (Mild) Slight limitation of activity with dyspnoea to severe exertions (climbing stairs or walking uphill) III (Moderate) Marked limitation of activity. Less than ordinary activity causes dypsnoea. (restricting walking distance and limiting climbing to one flight of stairs) IV (Severe) Severe disability, dyspnoea at rest. (unable to carry on physical activity without discomfort) 2.2 Drug pharmacology in treatment of congestive cardiac failure Chronic cardiac failure should be treated immediately once it is diagnosed. The goal of treatment is to improve patients quality of life by alleviating the symptoms, improving exercise tolerance, preventing the progression of myocardial damage as well as reducing hospital admission and mortality. Angiotensin-converting enzyme inhibitors (ACEis) ACE inhibitors are considered as first line therapy in patients with CCF5. They bind to and inhibit angiotensin converting enzyme which subsequently inhibit the action of angiotensin I. As a consequence, the production of angiotensin II is prevented. Angiotensin II is a potent vasoconstrictor which has a direct action on kidney to stimulate the secretion of aldosterone and antidiuretic hormone (ADH). This will cause sodium and water retention. Hence, ACE inhibitors improve cardiac function and relieve symptoms of oedema by promoting sodium and water excretion41. Besides, they also increase the concentration of a potent vasodilator, bradykinin. This results in a fall in blood pressure as bradykinin is associated with the release of nitric oxide and prostacyclin. However, high levels of bradykinin also responsible for the main adverse effect of ACE inhibitors, dry cough42. Other common side effects include hyperkalaemia, profound hypotension and gastrointestinal disturbances15. ACE inh ibitors are contraindicated in patients with renal impairment even though some studies have shown that they have renal protective properties43. Example of ACE inhibitors are captopril, enalapril, and ramipril. The starting dose for ACEis should be low and the dose should be increased gradually to target doses5. Beta blockers Beta blockers used to be contraindicated in patients with CCF as it may worsen the condition of the heart due to its negative inotropic effect. Nowadays, beta blockers should be considered in all patients with heart failure unless contraindicated5 as they have been shown to reduce the mortality, hospitalization and the progression of heart failure7. Beta blockers should be introduced following treatment with ACE inhibitor once the patients condition is stable7. Only bisoprolol, carvedilol, and nebivolol are currently licensed to be used in the treatment of heart failure in UK8. Both nebivolol and bisoprolol are cardioselective where they act on beta ­1 receptors. On the other hand, carvedilol is a non-selective beta blocker9, 10. The mode of action of beta blockers in heart failure is poorly understood but the proposed mechanisms include antiarrhythmic action, anti-ischaemic action, and attenuation of cathecholamine toxicity as well as reduced cardiac modelling through blockade of sympathetic influences on the heart9. Besides, carvedilol has an additional antioxidant property which may be thought to slow down the process of atherogenesis by inhibiting the oxygen-free radicals11, 12. The starting dose should be low as high doses may worsen the condition of heart failure7. Over time, the dose of beta blocker should be gradually titrated upward if the patient is well tolerated until target dose is reached5. Diuretics Diuretics are often used to relief the congestive symptoms and fluid retention7. Hence, they should be used in heart failure patients with the symptom of oedema7. Frusemide, a loop diuretic is the most commonly used agent in heart failure. It is considered as the first choice of drug for the long-term treatment of CCF with the advantages of improves cardiac function, exercise tolerance, as well as symptoms of breathlessness and oedema13. The main site of action is at the thick ascending limb of the loop of Henle. Furosemide acts at the Cl- binding site of Na+/K+/2Cl- co-transport and as a result, sodium reabsorption is inhibited. This promotes the excretion of sodium up to 20-25% as well as enhances water clearance13. Consequently, it reduces the blood volume thus reducing the preload on the heart. As a result, ventricular ejection is improved and the heart is able to pump more efficiently14. The most common side effect is hypokalaemia. Hence, it is important that patients potassium level and the renal function are closely monitored. Aldosterone Antagonists Patients with moderate to severe heart failure should be considered for the treatment of aldosterone antagonists such as spironolactone15. It is a potassium sparing diuretic where its action is mainly on the renin-angiotensin-aldosterone (RAA) system18. Spironolactone prevents the synthesis of basolateral Na+/K+-ATPase pump protein by acting as a competitive inhibitor at the aldosterone receptor site in the distal convoluted tubules. As mentioned earlier, aldosterone promotes sodium and water retention and the use of spironolactone therefore inhibits sodium and water reabsorption while retains potassium. As a result, spironolactone reduces the workload of the heart and the heart is therefore able to work more efficiently18. It is often use in conjunction with other agents such as diuretic in the management of CCF44. Nevertheless, spironolactone may cause hyperkalaemia, particularly in patients with renal impairment due to the inhibition of potassium excretion. Hence, the patients pot assium level and the renal function should be closely monitored. 3. Evidence for treatment of the condition(s) Angiotensin-Converting Enzyme Inhibitors (ACEis) ACE inhibitor, ramipril prescribed for my patient Mr. SB was proven to be the mainstay therapy in the management of CCF. NICE and SIGN guidelines recommended that ACE inhibitor therapy should be started once the patient is diagnosed with CCF before beta blocker is initiated5, 32. It should be prescribed to the patients with heart failure due to left ventricular dysfunction as studies have demonstrated that ACE inhibitors alleviate symptoms and reduce rehospitalisation as well as slow down the progression of the disease in all NYHA classes5, 33. The benefits of ACE inhibitor in CCF can be seen based on the systemic review of 5 randomised, controlled trials which involve a total of 12763 patients. Results shown that in comparison to placebo group, long term treatment with ACE inhibitors were shown to have statistically significant reduction in mortality rate (23.0% vs 26.8%; p