Chronic Low Back Pain and Pelvic Floor Muscle Strengthening

Chronic Low Back Pain and Pelvic Floor Muscle Strengthening Introduction Chronic Low Back Pain is a common condition now a days and refers to pain localized to lower back or lumbar spine. It is common with in adult population and there is limited research available about using the Pelvic Floor Muscle Strengthening Exercise as a physiotherapy treatment for this condition. In this essay, Chronic Low Back Pain and Pelvic Floor Muscle Strengthening Exercise will be explained briefly and its significance to physiotherapy practice will be discussed with reference to a Randomised Control Trial (RCT) by Manisha Rathi (Appendix A). Furthermore, the philosophical assumptions underpinning this study will be analysed. Finally, by using a critiquing tool (Appendix B) ,the study will be then critiqued for its strengths and limitations. Significance of the Issue Chronic Low Back Pain is a common musculoskeletal problem in modern society. Around 70 % to 85% of population will experience low back pain at some time in their life; and 5% to 15% will develop chronic low back pain (Liddle, Baxter, Gracey, 2004). Low back pain is defined as pain, muscle tension, or stiffness below the costal margin and above the inferior gluteal folds, with or without leg pain (Koes, Tulder Thomas, 2006) and Chronic low back pain is classified as pain and disability lasting for more than 12 week duration (Philadelphia panel, 2001). It commonly occurs in young age when people are in their twenties. Back and spine impairments are common in women with the value of 70.3 per 1000 population than in man where there is 57.3 per 1000 population( Andersson Gunnar, 1999). The common causes of low back pain includes stressed or irritated muscle or ligament. The strain develops over a period of time due to poor posture and when posture is not corrected, strain builds up and eventually stretches or irritates muscle or ligament producing low back pain (E.R. Viera, S Kumar 2007). Another important cause related to the development of chronic low back pain includes imbalance between flexor and extensor muscles of trunk including respiratory muscles and muscles of continence, which are responsible for spinal and pelvic support (Hides et al.,2001, Cholewicki et al., 2005) . Most important symptoms of chronic low back pain are functional disability and pain (Koes et al.,2006). Exercise therapy is widely recommended for the treatment of low back pain (Rasmussen- Barr, Ang, Arvidsson and Nilsson Wikmar, 2009). Pelvic floor exercises that contribute to the contraction of abdominals and lumbopelvic stability seems to be more effective than conventional treatment.( Manisha Rathi,2013). Pelvic Floor Muscles (PFM) form the base of abdominal cavity. Except for, their importance in patients with urinary and faecal incontinence, PFM also play vital role in proper muscle activation for stabilization and unloading of lumbar spine. Furthermore, Pelvic floor muscle contraction have also shown to produce contraction of abdominal muscles and vice -versa (Sapsford and Hodges, 2001). Morkved et al.(2007) suggest that group training (Pelvic floor muscle exercises, aerobic exercises and additional exercises) during pregnancy also provide evidence of beneficial effects in preventing lumbopelvic pain. According to Manisha Rathi (2013), there are very little published evidence to measure the effect of Pelvic floor muscle exercises in the management of chronic low back pain and hence the study was conducted, which further supported the effectiveness of pelvic floor muscle exercise in females with chronic low back pain. Moreover, this physiotherapeutic intervention combined with conventional treatment seems to refurbish the functional ability as well as manage the pain in the females with chronic low back pain. Philosophical Assumptions Underpinning Quantitative Research Understanding of research can improve the depth of professional healthcare practice. Being a person trained in healthcare calls for clinical choices based on best existing research evidence (Polit and Beck 7th ed. p. 4). There are various research designs present, to offer us the appropriate information to support our clinical reasoning. This segment will discover the philosophical assumptions underpinning the research methodology used by Manisha Rathi (2013) in her study regarding the effect of Pelvic Floor Muscle strengthening exercises in chronic low back pain. This is a randomised control trial which is a true experimental type of research characterised by randomisation and control group to minimise systematic bias (Polit and Beck 7th ed. p. 225-226). The Positivist Paradigm The positivist paradigm underlies the existence of some reality and in this, much research activity is directed towards understanding and knowing it (Polit and Beck,7th ed. p.15). The recent evidence-based practice movement is an example of positivist approach to knowing (Grant Giddings, 2002, pg.14) . According to the Grant Giddings Knowledge is to be discovered so that people can explain, predict and control events. The knowledge can be acquired through research and helps with professional decision making and practice, which can lead us to best quality in health care (Polit Beck,7th ed., Grant and Giddings, 2002). Exploring the Research title Effect of Pelvic Floor Muscle strengthening exercises in chronic low back pain, the title makes it understand that the authors were trying to find out the effects of pelvic floor muscle exercises aspiring to improve the treatment plan for a group of individuals. It shows the approach of Manisha Rathi (2013) to be following the Positivist Para digm. In a positivist approach, RCT is valid to a great extent as its methodology is rated higher than others because of the type of evidence it produces(Grant and Giddings, 2002). This is another hint that Manisha Rathi(2013) was utilizing the positivist approach, as she is attempting to give information about a treatment plan by conducting a randomised control trial which is believed to produce the best evidence (Grant Giddings, 2002). Determinism Determinism is an assumption of positivist paradigm and refers to belief that phenomena i.e. observable facts and events are not haphazard or random but rather have antecedent causes (Polit and Beck, 7th ed.). Specifically, it can be said that all events occur pursuant to preceding laws or events. Manisha Rathi(2013) demonstrate determinism in her study by giving the evidence that chronic low back pain can be caused by imbalance between various muscles of trunk including respiratory muscles and muscles of continence (Pelvic floor muscles), which are responsible for spinal and pelvic support and that pelvic floor muscle exercise may show positive effects on the population suffering from this ailment. Deductive Reasoning Deductive reasoning is the process of developing specific predictions from general principles (Polit and Beck 7th ed. p.11). In other words, it is the formation of reasoning from various general statements and involves pre specified design and emphasis on specific concepts. According to Roberts and Burke (1989) It refers to an approach in which a narrow conclusion is reached, based on broader set of premises i.e. general knowledge or other research findings. For positivists, the deductive process is an approach from which one can become aware of a single reality and hypotheses are tested on the basis of a theory (DePoy Gitlins, 2005). Deductive reasoning was demonstrated by Manisha Rathi (2013), as a proper review of the study was done, which helped to form and test the hypotheses that Pelvic Floor Muscle exercise could be beneficial for patients with Chronic low back pain. Objectivity Objective methods are appreciated in quantitative research as much as possible. Objectivity is the extent to which two independent researchers would turn up to an identical or uniform conclusion i.e. judgements are not biased on the basis of personal beliefs (Polit and Beck, 7th ed. p. 340, 562). Manisha Rathis (2013) study demonstrates the basis of objectivity, as the participants had to undergo a particular inclusion and exclusion criteria which assured that only subjects (married females) of a particular age group with chronic low back pain, having persistent symptoms of pain and functional disability for more than twelve weeks must be included in the study. Pregnant females, females having Urogenital dysfunction, Pelvic inflammatory disease, Nerve injury to pelvic floor muscle, any pathology of spine or lower limb were excluded in order to avoid the bias. Defined Protocol and Empirical Evidence In Experimental research, researchers have the Independent variable, which means that the participants are exposed to different treatments or conditions. An Intervention protocol is necessary for the study to develop and specify exactly what intervention will entail i.e. who would administer it, how frequently and for how long a treatment would last. (Polit and Beck, 7th ed.). Manisha Rathi (2013) has followed a specific modules which included subjects enrolment process, their allocation of control group and treatment group and data analysis through different statistical methods. A proper treatment protocol was executed to confirm that the type of treatment and duration received by all the subjects were same. Empirical evidence, according to Polit et al. (7th ed.) is the evidence rooted in objective reality and collected through data collection, utilizing ones own senses rather than through personal beliefs or hunches. Evidence for a study in a positivist paradigm is gathered systematically, using formal instruments to collect the required information. In the study Manisha Rathi (2013) manipulated the independent variables to observe the results. The pain was determined by using the Visual Analogue Scale (VAS) and the functional disability was determined by Oswestry Disability Index. Critique According to Polit Beck,(7th ed.) A studys strengths and limitations can be assessed by critiquing of the research. The reviewers summary of the merits of the study, advice regarding the value of the evidence, and suggestions about improving the study or the report is concluded in a critique. According to Polit and Hungler (6th ed.), the quality of a research is closely related to the kinds of decisions the researcher has made in conceptualizing, designing, executing and interpreting the results of the study and critiquing further helps to provide a feedback. A Critiquing tool (ref. to Appendix B) has been used to explore and examine the strengths and limitations of the study done by Manisha Rathi (2013), which will be discussed in the following paragraphs. The Title, Abstract and Study Purpose The title of the study by Manisha Rathi (2013), is concise and gives us the information and indication about the content of study. It also reflects the research approach and the population examined. The abstract compiles the aim, research design, population, method used, results and a conclusion which provides us a brief information about the overview of the theoretical model underlying the research along with what a reader is going to find in the research paper. The result and conclusion provides a basis and creates a curiosity for a further detailed reading. Manisha Rathi (2013) has precisely determined the studys purpose of investigating the efficacy of a therapeutic exercise (Pelvic Floor Exercise) method, on a particular population, in the studys title and abstract. This is an important issue in the field of physiotherapy practice, as Chronic low back pain is a very common ailment within the adult population and the symptoms like increased pain and disability hampers the activities of daily living and is required to be addressed properly. Research Design and Research Hypotheses Manisha Rathi (2013) has applied a true-experimental design (pre test post test control group design ) and cause effect was tested through the hypothesis that PFM exercises could be of benefit for the patients with chronic low back pain. In this study the hypothesis was formulated, followed by a literature review, and then hypothesis was confirmed by process of various measurements and statistical methods. The research design was appropriate as per the research purpose and it also minimized bias and replication of this study is also possible as the study was well explained. Literature review The literature review done by Manisha Rathi (2013) was brief, up to date and included all the important information required for the study. It provides a solid basis for the new study. It was also portrayed and organised in an easy manner to understand, as it started with an introduction of low back pain, its classification, clinical factors and symptoms followed by brief information about the pelvic floor muscles exercises. Study Sample Manisha Rathi (2013) conducted a randomised control study on thirty married females, under the age group between 20- 40 years, with chronic low back pain. They were divided by random allocation into two groups i.e. an experimental and a control group. The researcher has given a good information and has well described the study sample of females with Chronic low back pain. She has followed a particular inclusion criteria and exclusion criteria for the selection of participants in order to minimize bias which strengthens the studys internal validity and also might help in getting efficient results. However, the trial was carried on a small sample size i.e. only on thirty females, 15 in each group (group A and group B). Ethical Considerations The ethical approval was granted for Manisha Rathis(2013) study by the Institutional Ethical Committee of Dr. D.Y. Patil College of Physiotherapy, Pune. The study was conducted in the Out Patient Department of the college and an informed consent was obtained from all the participants. However, it is not mentioned whether the participants were fully aware about the nature of the research or not. Data Collection and Analysis Methods of gathering data was appropriate. Pre intervention readings and post intervention readings were taken on the 1st day of visit and at the end of 4 weeks respectively. However, there were no follow ups. Manisha Rathi (2013), in her study, assessed pain intensity, in a subjective way, by utilizing Visual Analogue Scale and functional disability was also assessed in a subjective way, by utilizing Oswestry Disability Index , which is a reliable questionnaire. Study Results The study done by Manisha Rathi (2013) shows that the research hypotheses was adequately answered as there was improvement in pain and functional disability levels, following the treatment. Manisha Rathi(2013) has shown her findings in the graphs and has given the P value, which makes it easy to understand and co-relate the results with her conclusion. The Findings based on Manisha Rathis (2013) study would help physiotherapists to achieve better and efficient results while treating patients of Chronic low back pain with the help of Pelvic Floor Muscle exercises. However, limitations of the study includes that the pain intensity and functional disability were measured in a subjective way, on a small sample size and no follow up for treatment was done. Also, EMG and ultrasound was not done for objective outcome measures such as muscle activity and muscle thickness. Discussion The study done by Manisha Rathi(2013) supports the hypothesis that Pelvic Floor Muscle exercise could be of benefit for the patients with Chronic low back pain. Furthermore, the findings and results of her study were well linked to the facts and information provided by her in the literature review which forms a strong base of the study. Refrences Manisha Rathi (2013), has explored and gathered an ample amount of literature from various studies done in the past. This might be because low back ache is a very common condition and many studies have already been done on this ailment and its treatment. Appendix B Critiquing Tool The title Is it concise yet informative? Is the research approach suggesting the key phenomenon? Is the population group identified? The abstract Are the study area, methods, processes, conclusions and implications correctly and concisely described? Where the aims and/or objectives stated ? Does it provide a good basis for deciding whether or not the study is worth reading? Study purpose Is the purpose of the study/research problem clearly identified and relevant to your practice? Research design and research hypothesis Is there a framework/theory to guide the study? Is it appropriate? Who will be studied? What is the plan for conducting the study? Are all variables described? Does the hypothesis reflect the purpose of the study? Literature review Is the literature review provide a solid basis for the new study? Study sample Who is identified as the target population? How were the subjects chosen (e.g., randomly, conveniently)? Who is included? Who is excluded? Is the sample size sufficient? Ethical considerations Were the participants fully informed about the nature of the research? Was ethical permission granted for the study? Data collection and analysis What steps were taken to collect the data? How often was data collected and for how long? What instruments or tools were used? Are the tools adequately described for you to understand what the score means? Were data analysis procedures appropriate? Study results Is the research hypothesis answered? Could you make a change in your practice based on the results of this study? What are the strengths to using the information learned? What are the limitations or the gaps in the study? Discussion Are the findings linked back to the literature review? If a hypothesis was identified, was it supported? References Were all the books, journals and other media alluded to in the study accurately referenced? Sources Polit Beck.(2010) Essentials of nursing research: Appraising evidence for nursing practice(7th ed.) Lippincott.(pg no.102-103) Ryan, F., Coughlan , M., Cronin, P.(2007). Step-by-step guide to critiquing research. Part 2: qualitative research. British Journal of Nursing, 16, 11, 738-744. Schneider , Elliott , Lo Biondo Wood, Haber (2003), Nursing research methods, critical appraisal and utilisation. (2nd ed.). . 1

Why Write Reports? Essay -- Writing

Have you ever felt irritated or discouraged when asked to write a report? Do we do report writing because of some bureaucratic regulation? We would rather do the ‘real’ work by recruiting workers and training them besides organizing meetings instead of the boring writing. Function of the introduction is to state clearly the reasons for discussing the particular subject. Just why was the report written? This is to indicate the importance of the subject to the reader, relate the report to previous and similar work, and to make the objectives clear. The extent to which background is given depends largely on the type of paper being written. Often a few, references are available to tie the new work to what preceded it and to the few studies that it touches immediately and directly. Summary papers that establish stepping stones in the advance of a field help relate increments to the background. Function of introduction is to lay out the organization that will be followed in the report. Just how is your subject going to be discussed? We should give the readers a peek to what to do; furnish them an itinerary. Meanwhile for the style of the Introduction is to construct the first, or theme, sentence so that we can capture the attention and immediately focused on the precise subject to be treated besides, on the method of approach. Again, keep your readers' viewpoint uppermost in mind. The ease of writing this sentence is in direct proportion to the clarity of the subject being presented. Where you have a clean-cut, definite accomplishment to report, the theme can be stated easily. But if the work has wobbled and wandered the theme can be stated only with great difficulty. Keep in mind about the remarks about the ease or di... ...e told in the report: what it is about, why it is being told, and how it will be told. Write continuously without breaking the flow of ideas and clear understanding. Then criticize and revise the finished report. Some writers may need to rewrite the Introduction and the theme sentence several times. This is essential to make a good report because it is undeniable that to rate a good report, it shall start from the introduction itself. Just like a thick novel, a reader will read the synopsis or introduction first and buy whichever book that succeeds in catching their attention. Works Cited ï‚â€" Eunson, B 1994, Writing and presenting reports, The Communication Skills Series, John Wiley & Sons, Milton, Queensland. ï‚â€" Guidelines for essay and report writing, 1995, Elton Mayo School of Management, UniSA, Adelaide. ï‚â€" www.canberra.edu.au ï‚â€" www.itmatchonline.com

United Nations Millennium Goal Essay -- World Issues, Interventions

Target C of the seventh United Nations Millennium Development Goal is to ‘halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation’ (UN, 2000). With our current model of sanitation, the flush toilet, we are simply unable to provide sanitation to everyone as the flush toilets are grossly inefficient, requiring large amounts of water and sewer infrastructure to function, two things increasing hard to possess in the developing world (Bill and Melinda Gates Foundation, 2011). This lack of possession leads to defecation and urination into unsafe sources, such as nearby streams and rivers which also provide drinking water for these people. The unsafe urination and defecation increases the incidence of fecal-oral contamination and occurrences of other communicable diseases. It also forces the poor villagers to walk farther in search of uncontaminated water sources. Interventions and the redevelopment of the sanitation system can bring about many positive changes in developing countries where present knowledge and present development of sanitation is poor. Optimum benefit from water sanitation interventions can be achieved if the communities are made aware of the links between hygiene practices, poor sanitation, polluted water, and disease (UNHRC, 2011). The redevelopment of the sanitation system is essential for the third world countries; however, the global community must overcome challenges before implementation to ensure lasting success. The redevelopment of the sanitation system, particularly the reinvention of the toilet is an efficient and significant way of improving health and hygiene, and women’s education and personal safety. Currently, 40% of the world’s populati... ...blem of implementation by spending more money on education and actual procurement of the reinvented toilets rather than the administration. It is great to take the increased education of the developing country to our advantage by using the school children to spread the message about sanitation to their families and deep into their communities. School Environment and Sanitation and Rural India states that â€Å" The best way to break bad practices is to cultivate good practices and childhood is the best time for that as children are receptive to all influences† (Majra and Gur, 2010). From these two suggestions for implementation, it seems very logical that the global community should focus on providing access to proper sanitation facilities at schools and on providing water, hygiene, and environment education at primary schools to further spread the reinvented toilet.

Great Rock Musicians: Their Achievements And Effect On Rock And Roll Es

Great Rock Musicians: Their Achievements and Effect on Rock and Roll The blues are undeniably the roots of early rock and roll. Rock today has mutated so much that the basic blues patterns have been all but lost. The purpose of this paper is to illustrate the birth of, and evolution of rock and roll by focusing on three of the arguably greatest rock musicians of the sixties and seventies. The origin of the blues can be traced to the emancipation of the slaves in the rural black areas of the south, where most of the people worked on share- cropping farms. Musically the blues are defined as a 12-bar chord progression, harmonized with the corresponding scales and patterns. The chord progression pattern is four measures of tonic chords followed by two measures of sub- dominate chords, two more measures of tonic chords, one measure of dominate chords, one measure of sub dominate chords, and finally two measures of tonic chords. Blues performers would travel around the south singing about their loss of love and family, and the pains they were forced to endure. The music became popular because nearly every one who heard it could identify with its message. This type of Blues later became known as country blues because it was rooted in rural areas. The Blues became more main stream and popular in the 1920's because of the recording industry coming into existence. More instruments were added such as pianos, organs, and wind instruments. Big Band and Rhythm and Blues stemmed from City Blues. Rock and Roll then stemmed from Rhythm and Blues, in fact, many of the first recorded "Rock" songs where simply white musicians re-recording Rhythm and Blues songs originally written by black artists. It took Bob Dylan 23 years to realize that he wanted to become a rock musician. Bob Dylan, whose birth name was Robert Allen Zimmerman, had a relatively uneventful childhood in a Minnesota mining town. He adopted his pseudonym when he went to the University of Minnesota. "Dylan" came from the Welsh poet Dylan Thomas, with whom Zimmerman was frequently compared in the University folk circles. After leaving the University, Dylan moved to New York's Greenwich Village to follow his folk hero, Woodie Gunthrie. In fact, his main goal of moving to the Village was simply to meet his hero. He not only met the fo... ... Lady Land, which contained his most successful single: Dylan's "All along the Watchtower". Hendrix's most memorable performance was in 1969, at Woodstock, where he played his immortal "Star-spangled Banner", however it is still unclear if he played the song in such an unpatriotic, angry style in protest of the war, or from the pressure from black militant groups. In 1970 Hendrix died from inhaling his own vomit after an intoxication of barbiturates. The debate has never been put to rest over whether it was suicide or carelessness. "Jimi Henrix was and original, and, unlike most great rock musicians suffered no imitators" (Rock Giants). Rock and roll has become one of America's greatest musical culture contributions. Indeed, America would not be the same if it did not have rock and roll. One of the reasons rock has become so great is that rock groups in more present time have tried to follow the highly creative musical standards set by the musicians in this paper. If rock continues to follow the trends set fourth by the greats, Neil Young's lyrics may prove true, "Hey, hey, my, my, rock and roll will never die."

Amazing Grace Review

In the 18th century millions of men, women and children were taken from their homes in Africa and sold into slavery. Few survived the slave ships, and even fewer lived through their slave labors. Some people thought the slave trade was wrong, but to find someone who had the courage to stand-up to make a stop was hard. â€Å"Amazing Grace†, is a movie based on a true story. Written by Steven Knight and directed by Michael Apted, it is about William Wilberforce and his quest to abolish the slave trade in the United Kingdom, and his battle against the British parliament of the 18th century. The film narrates William Wilberforce’s journey through time with many flashbacks. William, the son of a rich merchant, studied at Cambridge; this is where he met his close friend and future priminister, William Pitt. Pitt encourages Wilberforce to outlaw the slavetrade and fight against parliament. With his support and advice on how to conquer the government, they get over 3,000 signatures wanting to abolish the slave trade. Without his connections it would have taken Wilberforce much longer to achieve these goals and to see progress. Wilberforce committed many years, so many that he neglects his health, and becomes very ill. Wilberforce then meets Barbara Spooner, who pushes him to keep on going and fight for what he believes and gets him back on his feet. â€Å"Amazing Grace† is a portrait of faith and persistence. These themes are very evident as Wilberforce’s devotion to abolish the slave trade is number one priority- even over his own health. Wilberforce and Pitt also must have faith and believe that they will win the battle. This also leads into another theme, fighting for what you believe, and the theme of racism The theme that occurs continuously and ties all the above themes together is monstrosity. This theme is also shown throughout the novels of To Kill a Mockingbird (Harper Lee) and Frankenstein (Mary Shelley), when racist acts are made in To Kill A Mockingbird, and the real monster is revealed today’s society in Frankenstein. Throughout the movie, William Wilberforce (Ioan Gruffudd) shows the characteristics of a hero, and people around the world look up at him for his effort. Since the beginning of the movie, William Wilberforce shows signs of sympathy and care. When passing by a suffering horse, he stops and makes sure the abusing stops. Small details like this already give the viewer an instant idea of what sort character he is. As well as the amazing in-role acting the sound and lighting are the finishing touch. The lighting increases many aspects of the movie. When Wilberforce had flashbacks and was thinking of the slavery and the slave ships, the lighting became darker and the music also adjusted. To the viewer it isn’t that obvious until you specifically look for lighting and other technical edits. But without these things the movie the impact the movie gives wouldn’t be as great. As well as lighting, the camera angles where also very specific. There would always be close up shots when difference of facial expressions were shown, this emphases more emotion in the movie and also attracting the viewer. Amazing Grace, is a extremely intense and an instructive movie, as well as interesting and exciting. The viewers really feel pulled into the story and really get motivated to stand up for what they believe. William Wilberforce really was a role model sending out positive messages and leaving the audience with a winning smile on their face.

Modified Food Essay

The fact of the matter remains, there is potential for an amazing breakthrough in modifying the genetic components of our foods. If such a breakthrough were to come about, it could lead to a promising future of provisions for people who may not currently receive the benefits of a direct agricultural provider. There are current efforts to achieve insect, herbicide, and disease resistant crops of which could grow faster and in less fertile regions. In addition, these crop varieties could also pack in extra nutrients, take longer to ripen (extending their shelf life), and even contain essential vaccines for specific regions of the Earth. These predicted ‘super-crops’ could potentially put a large dent in the world issues of starvation, malnutrition, and disease. Obviously the future prospects of genetically modified foods are very exciting, and should continue to be explored. In my opinion, the money spent now researching and applying genetic theory could bring these possibilities to fruition and ultimately make a much larger impact then would allocating that money elsewhere. All things considered, there will always be the unknown and uncertain; in this case that remains the extension of genetically modified food use over time. Lab rat testing has warranted varying results of cancer and sickness on a minuscule level. Looking at this, we can surmise that the possibility of repercussions stemming from a continual and consistent diet of food that has been genetically tinkered with remains small. With this in mind, I would venture to guess that if we continued with the current implementation of genetically modified food into society, as well as the continual research into their future possibilities, it will end up benefiting us far beyond the influence of these negative implications. I agree that GE foods are not a direct solution to world hunger, malnutrition, and starvation; and I agree that alternative solutions should continue to be explored. Therefore, I entirely support the further investigation of genetically modified foods with the hope that it will not only lighten these societal burdens but potentially put a large dent in them. Anything will help at this point, considering how well the current system of resource distribution is working. All in all, with the prospects of what could be a fruitful future coming from genetically engineering and modifying our food, I’m all for it. BMJ 1999;318:581-584 ( 27 February ), Clinical review, Science, medicine, and the future, Genetically modified foods, Editorial by Dixon: (http://www. bmj. com/cgi/content/full/318/7183/581). Wikipedia! (of course†¦): (http://en. wikipedia. org/wiki/Genetically_modified_food) GM Food, Controversies Surrounding the Risks and Benefits of Genetically Modified Food: (http://scope. educ. washington. edu/gmfood/).

Part Five Chapter XI

XI Howard had told Shirley that he did not feel well, that he thought he had better stay in bed and rest, and that the Copper Kettle could run without him for an afternoon. ‘I'll call Mo,' he said. ‘No, I'll call her,' said Shirley sharply. As she closed the bedroom door on him, Shirley thought, He's using his heart. He had said, ‘Don't be silly, Shirl', and then, ‘It's rubbish, bloody rubbish', and she had not pressed him. Years of genteel avoidance of grisly topics (Shirley had been literally struck dumb when twenty-three-year-old Patricia had said: ‘I'm gay, Mum.') seemed to have muzzled something inside her. The doorbell rang. Lexie said, ‘Dad told me to come round here. He and Mum have got something to do. Where's Grandad?' ‘In bed,' said Shirley. ‘He overdid it a bit last night.' ‘It was a good party, wasn't it?' said Lexie. ‘Yes, lovely,' said Shirley, with a tempest building inside her. After a while, her granddaughter's prattling wore Shirley down. ‘Let's have lunch at the cafe,' she suggested. ‘Howard,' she called through the closed bedroom door, ‘I'm taking Lexie for lunch at the Copper Kettle.' He sounded worried, and she was glad. She was not afraid of Maureen. She would look Maureen right in the face †¦ But it occurred to Shirley, as she walked, that Howard might have telephoned Maureen the moment she had left the bungalow. She was so stupid †¦ somehow, she had thought that, in calling Maureen herself about Howard's illness, she had stopped them communicating †¦ she was forgetting †¦ The familiar, well-loved streets seemed different, strange. She had taken a regular inventory of the window she presented to this lovely little world: wife and mother, hospital volunteer, secretary to the Parish Council, First Citizeness; and Pagford had been her mirror, reflecting, in its polite respect, her value and her worth. But the Ghost had taken a rubber stamp and smeared across the pristine surface of her life a revelation that would nullify it all: ‘her husband was sleeping with his business partner, and she never knew †¦' It would be all that anyone said, when she was mentioned; all that they ever remembered about her. She pushed open the door of the cafe; the bell tinkled, and Lexie said, ‘There's Peanut Price.' ‘Howard all right?' croaked Maureen. ‘Just tired,' said Shirley, moving smoothly to a table and sitting down, her heart beating so fast that she wondered whether she might have a coronary herself. ‘Tell him neither of the girls has turned up,' said Maureen crossly, lingering by their table, ‘and neither of them bothered to call in either. It's lucky we're not busy.' Lexie went to the counter to talk to Andrew, who had been put on waiter duty. Conscious of her unusual solitude, as she sat alone at the table, Shirley remembered Mary Fairbrother, erect and gaunt at Barry's funeral, widowhood draped around her like a queen's train; the pity, the admiration. In losing her husband, Mary had become the silent passive recipient of admiration, whereas she, shackled to a man who had betrayed her, was cloaked in grubbiness, a target of derision †¦ (Long ago, in Yarvil, men had subjected Shirley to smutty jokes because of her mother's reputation, even though she, Shirley, had been as pure as it was possible to be.) ‘Grandad's feeling ill,' Lexie was telling Andrew. ‘What's in those cakes?' He bent down behind the counter, hiding his red face. I snogged your mum. Andrew had almost skived off work. He had been afraid that Howard might sack him on the spot for kissing his daughter-in-law, and was downright terrified that Miles Mollison might storm in, looking for him. At the same time, he was not so naive that he did not know that Samantha, who must, he thought ruthlessly, be well over forty, would figure as the villain of the piece. His defence was simple. ‘She was pissed and she grabbed me.' There was a tiny glimmer of pride in his embarrassment. He had been anxious to see Gaia; he wanted to tell her that a grown woman had pounced on him. He had hoped that they might laugh about it, the way that they laughed about Maureen, but that she might be secretly impressed; and also that in the course of laughing, he might find out exactly what she had done with Fats; how far she had let him go. He was prepared to forgive her. She had been pissed too. But she had not turned up. He went to fetch a napkin for Lexie and almost collided with his boss's wife, who was standing behind the counter, holding his EpiPen. ‘Howard wanted me to check something,' Shirley told him. ‘And this needle shouldn't be kept in here. I'll put it in the back.'