1.3.7: Situational (Contingency) Approaches to Leadership
-
- Last updated
- Save as PDF
Learning Objectives
- What are the situational perspectives on leadership?
As early as 1948, Ralph Stogdill stated that “the qualities, characteristics, and skills required in a leader are determined to a large extent by the demands of the situation in which he is to function as a leader.” 70 In addition, it had been observed that two major leader behaviors, initiating structure and consideration, didn’t always lead to equally positive outcomes. That is, there are times when initiating structure results in performance increases and follower satisfaction, and there are times when the results are just the opposite. Contradictory findings such as this lead researchers to ask “Under what conditions are the results positive in nature?” and “When and why are they negative at other times?” Obviously, situational differences and key contingencies are at work.
Several theories have been advanced to address this issue. These are Fiedler’s contingency theory of leadership, the path-goal theory of leader effectiveness, Hersey and Blanchard’s life cycle theory, cognitive resource theory, the decision tree, and the decision process theory. 71 We explore two of the better-known situational theories of leadership, Fred Fiedler’s contingency model and Robert J. House’s path-goal theory, here. Victor Vroom, Phillip Yetton, and Arthur Jago’s decision tree model also applies.
Fiedler’s Contingency Model
One of the earliest, best-known, and most controversial situation-contingent leadership theories was set forth by Fred E. Fiedler from the University of Washington. 72 This theory is known as the contingency theory of leadership . According to Fiedler, organizations attempting to achieve group effectiveness through leadership must assess the leader according to an underlying trait, assess the situation faced by the leader, and construct a proper match between the two.
The Leader’s Trait
Leaders are asked about their least-preferred coworker (LPC) , the person with whom they least like to work. The most popular interpretation of the LPC score is that it reflects a leader’s underlying disposition toward others—for example: pleasant/unpleasant, cold/warm, friendly/unfriendly, and untrustworthy/trustworthy. (You can examine your own LPC score by completing the LPC self-assessment on the following page.)
Fiedler states that leaders with high LPC scores are relationship oriented —they need to develop and maintain close interpersonal relationships. They tend to evaluate their least-preferred coworkers in fairly favorable terms. Task accomplishment is a secondary need to this type of leader and becomes important only after the need for relationships is reasonably well satisfied. In contrast, leaders with low LPC scores tend to evaluate the individuals with whom they least like to work fairly negatively. They are task-oriented people, and only after tasks have been accomplished are low-LPC leaders likely to work on establishing good social and interpersonal relations.
The Situational Factor
Some situations favor leaders more than others do. To Fiedler, situational favorableness is the degree to which leaders have control and influence and therefore feel that they can determine the outcomes of a group interaction. 73 Several years later, Fiedler changed his situational factor from situational favorability to situational control—where situational control essentially refers to the degree to which a leader can influence the group process. 74 Three factors work together to determine how favorable a situation is to a leader. In order of importance, they are (1) leader-member relations —the degree of the group’s acceptance of the leader, their ability to work well together, and members’ level of loyalty to the leader; (2) task structure —the degree to which the task specifies a detailed, unambiguous goal and how to achieve it; and (3) position power —a leader’s direct ability to influence group members. The situation is most favorable for a leader when the relationship between the leader and group members is good, when the task is highly structured, and when the leader’s position power is strong (cell 1 in Exhibit 13.10). The least-favorable situation occurs under poor leadermember relations, an unstructured task, and weak position power (cell 8).
Exhibit 13.10 Fiedler’s Contingency Model of Leader-Situation Matches Source:Adapted from F. E. Fiedler and M. M. Chemers. 1974. Leadership and effective management. Glenview, IL: Scott, Foresman.
Leader-Situation Matches
Some combinations of leaders and situations work well; others do not. In search of the best combinations, Fiedler examined a large number of leadership situations. He argued that most leaders have a relatively unchangeable or dominant style, so organizations need to design job situations to fit the leader. 75
While the model has not been fully tested and tests have often produced mixed or contradictory findings, 76 Fiedler’s research indicates that relationship-oriented (high-LPC) leaders are much more effective under conditions of intermediate favorability than under either highly favorable or highly unfavorable situations. Fiedler attributes the success of relationship-oriented leaders in situations with intermediate favorability to the leader’s nondirective, permissive attitude; a more directive attitude could lead to anxiety in followers, conflict in the group, and a lack of cooperation.
For highly favorable and unfavorable situations, task-oriented leaders (those with a low LPC) are very effective. As tasks are accomplished, a task-oriented leader allows the group to perform its highly structured tasks without imposing more task-directed behavior. The job gets done without the need for the leader’s direction. Under unfavorable conditions, task-oriented behaviors, such as setting goals, detailing work methods, and guiding and controlling work behaviors, move the group toward task accomplishment.
As might be expected, leaders with mid-range LPC scores can be more effective in a wider range of situations than high- or low-LPC leaders. 77 Under conditions of low favorability, for example, a middle-LPC leader can be task oriented to achieve performance, but show consideration for and allow organizational members to proceed on their own under conditions of high situational favorability.
Controversy over the Theory
Although Fiedler’s theory often identifies appropriate leader-situation matches and has received broad support, it is not without critics. Some note that it characterizes leaders through reference to their attitudes or personality traits (LPC) while it explains the leader’s effectiveness through their behaviors—those with a particular trait will behave in a particular fashion. The theory fails to make the connection between the least-preferred coworker attitude and subsequent behaviors. In addition, some tests of the model have produced mixed or contradictory findings. 78 Finally, what is the true meaning of the LPC score—exactly what is being revealed by a person who sees their least-preferred coworker in positive or negative terms? Robert J. House and Ram N. Aditya recently noted that, in spite of the criticisms, there has been substantial support for Fiedler’s theory. 79
Path-Goal Theory
Robert J. House and Martin Evans, while on the faculty at the University of Toronto, developed a useful leadership theory. Like Fiedler’s, it asserts that the type of leadership needed to enhance organizational effectiveness depends on the situation in which the leader is placed. Unlike Fiedler, however, House and Evans focus on the leader’s observable behavior. Thus, managers can either match the situation to the leader or modify the leader’s behavior to fit the situation.
The model of leadership advanced by House and Evans is called the path-goal theory of leadership because it suggests that an effective leader provides organizational members with a path to a valued goal . According to House, the motivational function of the leader consists of increasing personal payoffs to organizational members for work-goal attainment, and making the path to these payoffs easier to travel by clarifying it, reducing roadblocks and pitfalls, and increasing the opportunities for personal satisfaction en route. 80
Effective leaders therefore provide rewards that are valued by organizational members. These rewards may be pay, recognition, promotions, or any other item that gives members an incentive to work hard to achieve goals. Effective leaders also give clear instructions so that ambiguities about work are reduced and followers understand how to do their jobs effectively. They provide coaching, guidance, and training so that followers can perform the task expected of them. They also remove barriers to task accomplishment, correcting shortages of materials, inoperative machinery, or interfering policies.
An Appropriate Match
According to the path-goal theory, the challenge facing leaders is basically twofold. First, they must analyze situations and identify the most appropriate leadership style. For example, experienced employees who work on a highly structured assembly line don’t need a leader to spend much time telling them how to do their jobs—they already know this. The leader of an archeological expedition, though, may need to spend a great deal of time telling inexperienced laborers how to excavate and care for the relics they uncover.
Second, leaders must be flexible enough to use different leadership styles as appropriate. To be effective, leaders must engage in a wide variety of behaviors. Without an extensive repertoire of behaviors at their disposal, a leader’s effectiveness is limited. 81 All team members will not, for example, have the same need for autonomy. The leadership style that motivates organizational members with strong needs for autonomy (participative leadership) is different from that which motivates and satisfies members with weaker autonomy needs (directive leadership). The degree to which leadership behavior matches situational factors will determine members’ motivation, satisfaction, and performance (see Exhibit 13.11). 82
Exhibit 13.11 The Path-Goal Leadership Model (Attribution: Copyright Rice University, OpenStax, under CC-BY 4.0 license)
Behavior Dimensions
According to path-goal theory, there are four important dimensions of leader behavior, each of which is suited to a particular set of situational demands. 83
- Supportive leadership —At times, effective leaders demonstrate concern for the well-being and personal needs of organizational members. Supportive leaders are friendly, approachable, and considerate to individuals in the workplace. Supportive leadership is especially effective when an organizational member is performing a boring, stressful, frustrating, tedious, or unpleasant task. If a task is difficult and a group member has low self-esteem, supportive leadership can reduce some of the person’s anxiety, increase his confidence, and increase satisfaction and determination as well.
- Directive leadership —At times, effective leaders set goals and performance expectations, let organizational members know what is expected, provide guidance, establish rules and procedures to guide work, and schedule and coordinate the activities of members. Directive leadership is called for when role ambiguity is high. Removing uncertainty and providing needed guidance can increase members’ effort, job satisfaction, and job performance.
- Participative leadership —At times, effective leaders consult with group members about job-related activities and consider their opinions and suggestions when making decisions. Participative leadership is effective when tasks are unstructured. Participative leadership is used to great effect when leaders need help in identifying work procedures and where followers have the expertise to provide this help.
- Achievement-oriented leadership —At times, effective leaders set challenging goals, seek improvement in performance, emphasize excellence, and demonstrate confidence in organizational members’ ability to attain high standards. Achievement-oriented leaders thus capitalize on members’ needs for achievement and use goal-setting theory to great advantage.
Cross-Cultural Context
Gabriel Bristol, the CEO of Intelifluence Live, a full-service customer contact center offering affordable inbound customer service, outbound sales, lead generation and consulting services for small to mid-sized businesses, notes “diversity breeds innovation, which helps businesses achieve goals and tackle new challenges.” 84 Multiculturalism is a new reality as today’s society and workforce become increasingly diverse. This naturally leads to the question “Is there a need for a new and different style of leadership?”
The vast majority of the contemporary scholarship directed toward understanding leaders and the leadership process has been conducted in North America and Western Europe. Westerners have “developed a highly romanticized, heroic view of leadership.” 85 Leaders occupy center stage in organizational life. We use leaders in our attempts to make sense of the performance of our groups, clubs, organizations, and nations. We see them as key to organizational success and profitability, we credit them with organizational competitiveness, and we blame them for organizational failures. At the national level, recall that President Reagan brought down Communism and the Berlin Wall, President Bush won the Gulf War, and President Clinton brought unprecedented economic prosperity to the United States during the 1990s.
This larger-than-life role ascribed to leaders and the Western romance with successful leaders raise the question “How representative is our understanding of leaders and leadership across cultures?” That is, do the results that we have examined in this chapter generalize to other cultures?
Geert Hofstede points out that significant value differences (individualism-collectivism, power distance, uncertainty avoidance, masculinity-femininity, and time orientation) cut across societies. Thus, leaders of culturally diverse groups will encounter belief and value differences among their followers, as well as in their own leader-member exchanges.
There appears to be consensus that a universal approach to leadership and leader effectiveness does not exist. Cultural differences work to enhance and diminish the impact of leadership styles on group effectiveness. For example, when leaders empower their followers, the effect for job satisfaction in India has been found to be negative, while in the United States, Poland, and Mexico, the effect is positive. 86 The existing evidence suggests similarities as well as differences in such areas as the effects of leadership styles, the acceptability of influence attempts, and the closeness and formality of relationships. The distinction between task and relationship-oriented leader behavior, however, does appear to be meaningful across cultures. 87 Leaders whose behaviors reflect support, kindness, and concern for their followers are valued and effective in Western and Asian cultures. Yet it is also clear that democratic, participative, directive, and contingent-based rewards and punishment do not produce the same results across cultures. The United States is very different from Brazil, Korea, New Zealand, and Nigeria. The effective practice of leadership necessitates a careful look at, and understanding of, the individual differences brought to the leader-follower relationship by cross-cultural contexts. 88
Concept Check
- Identify and describe the variables presented in Fiedler’s theory of leadership.
- What are the leadership behaviors in the path-goal theory of leadership?
- What role does culture have in how leadership is viewed?
- What are the differences between the trait, behavioral, and situational approaches to defining leadership?
References
70. Stogdill, 1948, 63.
71. House & Aditya, 1997.
72. F.E. Fiedler & M.M. Chemers. 1974. Leadership and effective management. Glenview, IL: Scott, Foresman.
73. F.E. Fiedler. 1976. The leadership game: Matching the men to the situation. Organizational Dynamics, 4, 9.
74. Personal conversation between Robert J. House and Fred Fiedler in September 1996, as reported in House & Aditya, 1997.
75. F.E. Fiedler. Sept.–Oct. 1965. Engineering the job to fit the manager. Harvard Business Review, 115–122.
76. See, for example, the supporting results of M.M. Chemers & G.J. Skrzypek. 1972. Experimental test of the contingency model of leadership effectiveness. Journal of Personality and Social Psychology 24:172–177; and the contradictory results of R.P. Vecchio. 1977. An empirical examination of the validity of Fiedler’s model of leadership effectiveness. Organizational Behavior and Human Performance 19:180–206.
77. R.B. Dunham. 1984. [Interview with Fred E. Fiedler.] Organizational behavior: People and processes in management. Homewood, IL: Irwin, 368; J. L. Kennedy, Jr. 1982. Middle LPC leaders and the contingency model of leadership effectiveness. Organizational Behavior and Human Performance 30:1–14.
78. Chemens & Skrzpek, 1972; Vecchio, 1977.
79. House & Aditya. 1997; L.H. Peters, D.D. Hartke, & J.T. Pohlman. 1985. Fiedler’s contingency model of leadership: An application of the meta-analysis procedure of Schmidt and Hunter. Psychological Bulletin 97:274–285.
80. R.J. House. 1971. A path goal theory of leader effectiveness. Administrative Science Quarterly 16:324.
81. R. Hoojiberg. 1996. A multidimensional approach toward leadership: An extension of the concept of behavioral complexity. Human Relations 49(7):917–946.
82. R.J. House & T.R. Mitchell. 1974 (Autumn). Path-goal theory of leadership, Journal of Contemporary Business , 86; R.J. House & G. Dessler. 1974. The path-goal theory of leadership: Some post hoc and a priori tests. In J. Hunt & L. Larson (eds.) . Contingency approaches to leadership . Carbondale, IL: Southern Illinois University Press.
83. House & Mitchell, 1974; House & Dessler, 1974; R.T. Keller. 1989. A test of the path-goal theory of leadership with need for clarity as a moderator in research and development organizations. Journal of Applied Psychology 74:208–212.
84. G. Bristol. 2016. Why Diversity in the Workplace is Imperrative. Entrepreneur , March 25. (Accessed august 4, 2017) https://www.entrepreneur.com/article/270110
85. J.R. Meindl, S.B. Ehrlich, & J.M. Dukerich. 1985. The romance of leadership. Administrative Science Quarterly 30:78–102.
86. C. Robert, T. M. Probst, J. J. Martocchion, F. Drasgow, & J. J. Lawler. 2000. Empowerment and continuous improvement in the United States, Mexico, Poland, and India: Predicting fit on the basis of the dimensions of power distance and individualism. Journal of Applied Psychology 85:643–658.
87. P.W. Dorfman & S. Roonen. 1991. The universality of leadership theories: Challenges and paradoxes . Paper presented at the Academy of Management Meetings, Miami.
88. P.W. Dorfman, J.P. Howell, S. Hiblino, J.K. Lee, U. Tate, & A. Bautista. 1997. Leadership in Western and Asian countries: Commonalities and differences in effective leadership processes across cultures. Leadership Quarterly 8(3):233–274.


16.7: Limited Liability Entities
A limited liability company (LLC) is a “hybrid” form of business organization that offer the limited liability feature of corporations but the tax benefits of partnerships. Owners of LLCs are called members . Just like a sole proprietorship, it is possible to create an LLC with only one member. LLC members can be individuals or other LLCs, corporations, or partnerships. LLC members can participate in day-to-day management of the business.
Members are not personally liable for the debts of the business. Like shareholders of a corporation, members of an LLC risk only their financial investment in the company.
Taxation of LLCs is very flexible. Every year the LLC can choose how it will be taxed. It may want to be taxed as a corporation, for example, and pay corporate income tax on net income. Or it may choose instead to have income “flow through” the corporate form to the member-shareholders, who then pay personal income tax just as in a partnership. Sophisticated tax planning becomes possible with LLCs because tax treatment can vary by year.
Figure 16.1 LLC Taxation
LLCs are formed by filing the articles of organization with the state agency charged with chartering business entities, typically the Secretary of State. Starting an LLC is often easier than starting a corporation. Typical LLC statutes require only the name of the LLC and the contact information for the LLC’s legal agent. Unlike corporations, there is no requirement for an LLC to issue stock certificates, maintain annual filings, elect a board of directors, hold shareholder meetings, appoint officers, or engage in any regular maintenance of the entity. Most states require LLCs to have the letters “LLC” or words “Limited Liability Company” in the official business name.
Although the articles of organization are all that is necessary to start an LLC, it is advisable for the LLC members to enter into a written LLC operating agreement. The operating agreement typically sets forth how the business will be managed and operated. It may also contain a buy/sell agreement just like a partnership agreement. The operating agreement allows members to run their LLCs any way they wish.
Since LLCs are a separate legal entity from their members, members must take care to interact with LLCs at arm’s length, because the risk of piercing the veil exists with LLCs as much as it does with corporations. Fundraising for an LLC can be as difficult as it is for a sole proprietorship, especially in the early stages of an LLC’s business operations. Most lenders require LLC members to personally guarantee any loans the LLC may take out. Finally, LLCs are not the right form for taking a company public and selling stock. Fortunately, it is not difficult to convert an LLC into a corporation, so many start-up business begin as LLCs and eventually convert into corporations prior to their initial public offering (IPO).
| Advantages of LLCs | Disadvantages of LLCs |
|
|
Limited Liability Partnerships
A related entity to the LLC is the limited liability partnership, or LLP. Be careful not to confuse limited liability partnerships with limited partnerships. LLPs are just like LLCs but are designed for professionals who do business as partners. They allow the partnership to pass through income for tax purposes, but retain limited liability for all partners. LLPs are especially popular with doctors, architects, accountants, and lawyers. Most of the major accounting firms have now converted their corporate forms into LLPs.
Professional Corporations
Professional Corporations (PCs) are mostly a legacy form of organization. In other words, before LLCs and LLPs were an option, PCs were the only option available to professionals who wanted limited liability. Some states still require doctors, lawyers, and accountants to organize as a PC.
If a member of a PC commits malpractice, the PC’s assets are at risk along with the personal assets of the member who committed malpractice. However, the personal assets of the non-involved members are not at risk. PCs do not shield individuals from their own malpractice but they offer limited liability to innocent members.
PCs are a separate taxable entity but they are not flow-through entities like partnerships. As a result, taxation of PCs is complicated and a major drawback of this form of business entity.
| Type of Business Organization | Ease of Formation | Funding | Personal Liability for Owners | Taxes | Ease of Transferring Ownership | Perpetual Existence | Dissolution |
| Sole Proprietorship | Very easy | Same as owner | Yes | Flow-through | Must sell entire business | No | When & how owner decides |
| General Partnership | Easy | Partners contribute capital | Yes | Flow-through | Hard | No | Upon death, bankruptcy, agreement, or termination of partnership |
| Limited Partnership | Easy | Partners contribute capital | General partner is personally liable; limited liability for limited partners | Flow-through | Hard | No | Upon death, bankruptcy, agreement, or termination of partnership |
| Corporations | Difficult | Sell stock to raise capital | No | Subject to double taxation | Easy | Yes | By resolution of board of directors, bankruptcy, or court order |
| S Corporations | Difficult | Sell stock to raise capital | No | Taxed only on dividends | Transfer restrictions | Yes | By resolution of board of directors, bankruptcy, or court order |
| Limited Liability Companies (LLCs) | Medium | Members make capital contributions | No | Flow-through | Depends on operating agreement | Varies by state; yes in most states | Upon death, bankruptcy, agreement, or court order |
| Limited Liability Partnerships (LLPs) | Difficult | Members make capital contributions | Non-acting partners have limited liability; state law varies regarding liability of acting partners vs. partnership | Flow-through | Depends on the partnership agreement | Depends on partnership agreement | Upon death, bankruptcy, agreement, or termination of partnership |
| Professional Corporations | Difficult | Members make capital contributions | No | Complex tax issues | Transfer restricted to members of the same profession | Yes, as long as it has shareholders | Upon death, bankruptcy, agreement, or court order |


5.4.1: Ancient Greece- The Iliad
In Chapter 4, we explored the origins of European opera and the influence of ancient Greek music on the genre. One of the aspects of ancient Greek music that directly inspired the creation of opera was the notion that ancient Greek poetry and drama were sung in their entirety, not spoken (like what is witnessed when attending a Shakespearean play). Although the lack of surviving musical notation from the period leaves us with little evidence as to how ancient Greek drama actually sounded, the few surviving musical fragments and our theoretical knowledge of both music and poetic recitation in ancient Greece provide us with a good idea as to how Greek poetry and drama might have been sung.
Greek drama grew out of a tradition of community gathering and singing, particularly during festivals and sacrifices in praise of gods such as Dionysus or Apollo. To accompany these celebrations, there would be songs of praise setting dramatic poetry pertaining to the celebrated figures or other mythical beings. Although the tradition began with the community singing these songs in a chorus setting, eventually solo singers would emerge from the chorus to act out the part of the god or hero, while the chorus acted as a narrator or took part in sung dialogue with the soloist. Thus, the beginnings of Greek theatre emerged, and the solo actor and chorus dynamic became a staple in the Greek theatre tradition.
Poetic Meter and Sung Recitation
Many Greek dramas have been preserved through their texts, and many have become well-known classics in today’s world. However, through further study of some of the fragments of poetry from ancient Greece, it is now believed that the poetry and dramas were meant to be performed in musical settings. In later Greek dramas, melodic notation has preserved the ancient sung melodies, but there has yet to be found any surviving form of rhythmic notation from this time. It is understood, however, that the rhythm of the sung words was based off the prosody or meter of the poetry. Poetic meter, similar to musical meter, structures the rhythm of spoken (or in this case, sung) prose. A common example of a poetic meter used in Greek drama is dactylic hexameter . In this type of meter, a poetic phrase is divided into six feet (similar to measures in musical notation). Each foot is divided by what is called a dactyl, a long syllable followed by two short syllables (in this type of meter, a dactyl can also be substituted by a spondee, or two long syllables). When recited, the spoken or sung phrase would follow this pattern of long and short syllables, producing a steady rhythm:
(long-short-short) (long-short-short) (long-short-short) (long-short-short) (long-short-short) (long-short-short)
One famous example of a Greek epic in dactylic hexameter is Homer’s Iliad . The Iliad was written to be accompanied by a four-stringed lyre, and although there are no surviving fragments of actual melodic notation attached to the poetry, it is believed that this epic was meant to be sung in its entirety. In our example, an interpretation of a passage from the Iliad 10 by classicist Stefan Hagel, the consistent “long-short-short” rhythm of the dactylic hexameter is apparent. The sung melody is an improvisation based on the inflection of the text; for instance, if the approximate pitch goes up at the end of the word in natural speech, it likewise ascends to a higher note when sung. As in this example, the melodies of poetic recitations were probably folk-like in nature: that is to say, simple and repetitive. The tempo is set by the content of the text. In scenes of heightened tension the music may be fast, while the music used in describing a more solemn scene may be slow.
|
10. The Iliad Performance: Stefan Hagel (2017) |
Although most of the musical elements of Homer’s dramas are uncertain and therefore must be left up to the performer’s interpretation, which is based on the nature of the text, there are several surviving fragments of poetry and drama written in stone or on papyrus that are accompanied by written musical notation. The ancient Greeks had a system of musical notation in which a pitch would be associated with a particular symbol, usually a symbol from the Greek alphabet. This pitch’s symbol would be written above the syllable of the sung word. One of the few surviving fragments of music, written on papyrus, comes from Euripides’s Orestes. The play tells the story of Orestes, the son of Clytemnestra and Agamemnon, who kills his mother to seek revenge for his father’s death. The fragment is of a song sung by the chorus in unison. They sing of Orestes being chased by his mother’s furies, or spirits of revenge.
Unlike the simple, repetitive melody that Homer’s words would have most likely been performed to, the melody of the Orestes chorus,11 believed to be composed by Euripides himself, is through-composed. The melody also differs from the Homeric poetry in that it doesn’t follow the natural inflection of the spoken Greek text, though there are instances in which important words are sounded at a higher pitch for emphasis. The rhythm follows the dochmiac poetic meter, a meter typically used to convey agitation, anxiety, or distress. This sense of distress can certainly be heard in our example. There, we also see the choir accompanied by an aulos, a double pipe instrument. This instrument was often used to accompany choruses in dramatic productions.
Ancient Greek epic recitation can be contrasted with this surviving vocal composition, which does not follow the natural inflections of Greek text. As is evident through this performance, with musical translation and a bit of reconstruction this ancient music is now able to be performed with near-perfect historical accuracy. The revival of the music alongside the poetry sheds a new light on the emotional impact of this drama on ancient audiences and allows modern audiences a glimpse of this once-forgotten art that inspired future forms of sung drama.


Skip to main content
-
acromegaly
-
an abnormal growth caused by overproduction of the growth hormone by the pituitary gland
-
Addison’s disease
-
a long-term condition in which the adrenal glands do not produce enough cortisol and aldosterone
-
adenohypophysis
-
anterior pituitary gland
-
adrenal cortex
-
the outer portion of the adrenal glands that produce hormones, which support vital body functions
-
adrenal glands
-
a small gland at the top of each kidney that produces steroid hormones, adrenaline, and noradrenaline
-
antidiuretic hormone (ADH)
-
a chemical produced in the brain that causes kidneys to release less water
-
cortisol
-
the hormone produced by the two adrenal glands that plays an important role in stress response
-
Cushing’s syndrome
-
a condition in which the body overproduces the hormone cortisol
-
diabetes insipidus
-
a disease in which the secretion of or response to vasopressin is impaired, resulting in the production of large quantities of hypotonic urine
-
endocrine system
-
a messenger system of glands and organs that produce and release hormones to maintain homeostasis within the body
-
glucocorticoids
-
a group of steroids involved in carbohydrate, protein, and fat metabolism that has anti-inflammatory properties
-
homeostasis
-
a state of balance
-
hypophysis
-
the pituitary gland
-
hypothalamus
-
a region in the forebrain that coordinates the autonomic nervous system and pituitary gland activity
-
mineralocorticoids
-
steroids that are involved in maintaining fluid, sodium, and potassium balance within the body
-
neuroendocrine system
-
the communication system between the nervous and endocrine systems
-
neurohypophysis
-
the posterior pituitary gland
-
pituitary gland
-
a pea-sized gland located at the base of the brain that is part of the endocrine system, also known as the master gland
-
Prader-Willi syndrome
-
a genetic disorder resulting in physical, mental, and behavioral problems
-
renin-angiotensin-aldosterone system (RAAS)
-
a hormone system that regulates fluid and electrolyte balance, blood pressure, and systemic vascular resistance
-
syndrome of inappropriate antidiuretic hormone secretion (SIADH)
-
occurs when excessive levels of antidiuretic hormones are produced
-
vasopressin
-
a nonapeptide synthesized by the hypothalamus and stored in the posterior pituitary, also known as ADH or human vasopressin, which helps to regulate fluid volume
-
zona fasciculate
-
the middle layer of the adrenal cortex
-
zona glomerulosa
-
the outermost layer of the adrenal cortex
-
zona reticularis
-
the innermost layer of the adrenal cortex


12.5: Assessing Student Success
selected template will load here
This action is not available.
In the British Columbia Transfer System, as in many other systems, the effectiveness of the transfer system is subject to intense examination. One approach to this is to assess the performance of students after transfer, to evaluate the extent to which their sending institution has prepared them well for more advanced courses, and by extension whether the articulation process can hold up to scrutiny. Numerous research approaches have demonstrated consistently that the transfer system in British Columbia is very effective indeed. Students graduate at similar rates to those students who enter universities directly from secondary school (direct entrants), and achieve comparable grades. Five years after graduation, transfer students are virtually indistinguishable from direct entrants.
In one case, however, research into student performance pointed to an issue affecting an online course: students were enrolling in suspiciously large numbers for a English course offered online by a college, and achieving higher grades than appeared warranted by their scores in English placement tests. Due to effective communication between the institutions involved, the issue was addressed immediately by the responsible institution and steps were taken to rectify the situation, caused by insufficient oversight of student assignments and exams. However, such instances can shake the faith of many in the system in online course integrity and contribute to the hesitancy with which some evaluators approach the awarding of transfer credit for online learning. It is imperative that, in an articulated system, both sending and receiving institutions are open to scrutinizing the effectiveness of their transfer agreements, and the integrity of their course delivery methodologies.


7.2E: Exercises
Practice Makes Perfect
Determine the Values for Which a Rational Expression is Undefined
In the following exercises, determine the values for which the rational expression is undefined.
1. a. \(\dfrac{2x^2}{z}\) b. \(\dfrac{4p−1}{6p−5}\) c. \(\dfrac{n−3}{n^2+2n−8}\)
- Answer
-
a. \(z=0\)
b. \(p=\dfrac{5}{6}\)
c. \(n=−4, n=2\)
2. a. \(\dfrac{10m}{11n}\) b. \(\dfrac{6y+13}{4y−9}\) c. \(\dfrac{b−8}{b^2−36}\)
3. a. \(\dfrac{4x^2y}{3y}\) b. \(\dfrac{3x−2}{2x+1}\) c. \(\dfrac{u−1}{u^2−3u−28}\)
- Answer
-
a. \(y=0\)
b. \(x=−\dfrac{1}{2}\)
c. \(u=−4, u=7\)
4. a. \(\dfrac{5pq^2}{9q}\) b. \(\dfrac{7a−4}{3a+5}\) c. \(\dfrac{1}{x^2−4}\)
Simplify Rational Expressions
In the following exercises, simplify each rational expression.
5. \(−\dfrac{44}{55}\)
- Answer
-
\(−\dfrac{4}{5}\)
6. \(\dfrac{56}{63}\)
7. \(\dfrac{8m^3n}{12mn^2}\)
- Answer
-
\(\dfrac{2m^2}{3n}\)
8. \(\dfrac{36v^3w^2}{27vw^3}\)
9. \(\dfrac{8n−96}{3n−36}\)
- Answer
-
\(\dfrac{8}{3}\)
10. \(\dfrac{12p−240}{5p−100}\)
11. \(\dfrac{x^2+4x−5}{x^2−2x+1}\)
- Answer
-
\(\dfrac{x+5}{x−1}\)
12. \(\dfrac{y^2+3y−4}{y^2−6y+5}\)
13. \(\dfrac{a^2−4}{a^2+6a−16}\)
- Answer
-
\(\dfrac{a+2}{a+8}\)
14. \(\dfrac{y^2−2y−3}{y^2−9}\)
15. \(\dfrac{p^3+3p^2+4p+12}{p^2+p−6}\)
- Answer
-
\(\dfrac{p^2+4}{p−2}\)
16. \(\dfrac{x^3−2x^2−25x+50}{x^2−25}\)
17. \(\dfrac{8b^2−32b}{2b^2−6b−80}\)
- Answer
-
\(\dfrac{4b(b−4)}{(b+5)(b−8)}\)
18. \(\dfrac{−5c^2−10c}{−10c^2+30c+100}\)
19. \(\dfrac{3m^2+30mn+75n^2}{4m^2−100n^2}\)
- Answer
-
\(\dfrac{3(m+5n)}{4(m−5n)}\)
20. \(\dfrac{5r^2+30rs−35s^2}{r^2−49s^2}\)
21. \(\dfrac{a−5}{5−a}\)
- Answer
-
\(−1\)
22. \(\dfrac{5−d}{d−5}\)
23. \(\dfrac{20−5y}{y^2−16}\)
- Answer
-
\(\dfrac{−5}{y+4}\)
24. \(\dfrac{4v−32}{64−v^2}\)
25. \(\dfrac{w^3+21}{6w^2−36}\)
- Answer
-
\(\dfrac{w^2−6w+3}{6w−6}\)
26. \(\dfrac{v^3+125}{v^2−25}\)
27. \(\dfrac{z^2−9z+20}{16−z^2}\)
- Answer
-
\(\dfrac{−z−5}{4+z}\)
28. \(\dfrac{a^2−5z−36}{81−a^2}\)
Multiply Rational Expressions
In the following exercises, multiply the rational expressions.
29. \(\dfrac{12}{16}·\dfrac{4}{10}\)
- Answer
-
\(\dfrac{3}{10}\)
30. \(\dfrac{3}{25}·\dfrac{16}{24}\)
31. \(\dfrac{5x^2y^4}{12xy^3}·\dfrac{6x^2}{20y^2}\)
- Answer
-
\(\dfrac{x^3}{8y}\)
32. \(\dfrac{12a^3b}{b^2}·\dfrac{2ab^2}{9b^3}\)
33. \(\dfrac{5p^2}{p^2−5p−36}·\dfrac{p^2−16}{10p}\)
- Answer
-
\(\dfrac{p(p−4)}{2(p−9)}\)
34. \(\dfrac{3q^2}{q^2+q−6}·\dfrac{q^2−9}{9q}\)
35. \(\dfrac{2y^2−10y}{y^2+10y+25}·\dfrac{y+5}{6y}\)
- Answer
-
\(\dfrac{y−5}{3(y+5)}\)
36. \(\dfrac{z^2+3z}{z^2−3z−4}·\dfrac{z−4}{z^2}\)
37. \(\dfrac{28−4b}{3b−3}·\dfrac{b^2+8b−9}{b^2−49}\)
- Answer
-
\(\dfrac{−4(b+9)}{3(b+7)}\)
38. \(\dfrac{72m−12m^2}{8m+32}·\dfrac{m^2+10m+24}{m^2−36}\)
39. \(\dfrac{c^2-10c+25}{c^2−25}·\dfrac{c^2+10c+25}{3c^2−14c−5}\)
- Answer
-
\(\dfrac{c+5}{3c+1}\)
40. \(\dfrac{2d^2+d−3}{d^2−16}·\dfrac{d^2−8d+16}{2d^2−9d−18}\)
41. \(\dfrac{2m^2−3m−2}{2m2+7m+3}·\dfrac{3m^2−14m+15}{3m^2+17m−20}\)
- Answer
-
\(\dfrac{(m−3)(m−2)}{(m+4)(m+3)}\)
42. \(\dfrac{2n^2−3n−14}{25−n^2}·\dfrac{n^2−10n+25}{2n^2−13n+21}\)
Divide Rational Expressions
In the following exercises, divide the rational expressions.
43. \(\dfrac{v−5}{11−v}÷\dfrac{v^2−25}{v−11}\)
- Answer
-
\(−\dfrac{1}{v+5}\)
44. \(\dfrac{10+w}{w−8}÷\dfrac{100−w^2}{8−w}\)
45. \(\dfrac{3s^2}{s^2−16}÷\dfrac{s^3−4s^2+16s}{s^3−64}\)
- Answer
-
\(\dfrac{3s}{s+4}\)
46. \(\dfrac{r^2−9}{15}÷\dfrac{r^3−27}{5r^2+15r+45}\)
47. \(\dfrac{p^3+q^3}{3p^2+3pq+3q^2}÷\dfrac{p^2−q^2}{12}\)
- Answer
-
\(\dfrac{4(p^2−pq+q^2)}{(p−q)(p^2+pq+q^2)}\)
48. \(\dfrac{v^3−8w^3}{2v^2+4vw+8w^2}÷\dfrac{v^2−4w^2}{4}\)
49. \(\dfrac{x^2+3x−10}{4x}÷(2x^2+20x+50)\)
- Answer
-
\(\dfrac{x−2}{8x(x+5)}\)
50. \(\dfrac{2y^2−10yz−48z^2}{2y−1}÷(4y^2−32yz)\)
51. \(\dfrac{\dfrac{2a^2−a−21}{5a+20}}{\dfrac{a^2+7a+12}{a^2+8a+16}}\)
- Answer
-
\(\dfrac{2a−7}{5}\)
52. \(\dfrac{\dfrac{3b^2+2b−8}{12b+18}}{\dfrac{3b^2+2b−8}{2b^2−7b−15}}\)
53. \(\dfrac{\dfrac{12c^2−12}{2c^2−3c+1}}{\dfrac{4c+4}{6c^2−13c+5}}\)
- Answer
-
\(3(3c−5)\)
54. \(\dfrac{\dfrac{4d^2+7d−2}{35d+10}}{\dfrac{d^2−4}{7d^2−12d−4}}\)
For the following exercises, perform the indicated operations.
55. \(\dfrac{10m^2+80m}{3m−9}·\dfrac{m^2+4m−21}{m^2−9m+20}÷\dfrac{5m^2+10m}{2m−10}\)
- Answer
-
\(\dfrac{4(m+8)(m+7)}{3(m−4)(m+2)}\)
56. \(\dfrac{4n^2+32n}{3n+2}·\dfrac{3n^2−n−2}{n^2+n−30}÷\dfrac{108n^2−24n}{n+6}\)
57. \(\dfrac{12p^2+3p}{p+3}÷\dfrac{p^2+2p−63}{p^2−p−12}·\dfrac{p−7}{9p^3−9p^2}\)
- Answer
-
\(\dfrac{(4p+1)(p−4)}{3p(p+9)(p−1)}\)
58. \(\dfrac{6q+3}{9q^2−9q}÷\dfrac{q^2+14q+33}{q^2+4q−5}·\dfrac{4q^2+12q}{12q+6}\)
Multiply and Divide Rational Functions
In the following exercises, find the domain of each function.
59. \(R(x)=\dfrac{x^3−2x^2−25x+50}{x^2−25}\)
- Answer
-
\(x\neq 5\) and \(x\neq −5\)
60. \(R(x)=\dfrac{x^3+3x^2−4x−12}{x^2−4}\)
61. \(R(x)=\dfrac{3x^2+15x}{6x^2+6x−36}\)
- Answer
-
\(x\neq 2\) and \(x\neq −3\)
62. \(R(x)=\dfrac{8x^2−32x}{2x^2−6x−80}\)
For the following exercises, find \(R(x)=f(x)·g(x)\) where \(f(x)\) and \(g(x)\) are given.
63. \(f(x)=\dfrac{6x^2−12x}{x^2+7x−18} \quad g(x)=\dfrac{x^2−81}{3x^2−27x}\)
- Answer
-
\(R(x)=2\)
64. \(f(x)=\dfrac{x^2−2x}{x^2+6x−16} \quad g(x)=\dfrac{x^2−64}{x^2−8x}\)
65. \(f(x)=\dfrac{4x}{x^2−3x−10} \quad g(x)=\dfrac{x^2−25}{8x^2}\)
- Answer
-
\(R(x)=\dfrac{x+5}{2x(x+2)}\)
66. \(f(x)=\dfrac{2x^2+8x}{x^2−9x+20} \quad g(x)=\dfrac{x−5}{x^2}\)
For the following exercises, find \(R(x)=f(x)g(x)\) where \(f(x)\) and \(g(x)\) are given.
67. \(f(x)=\dfrac{27x^2}{3x−21} \quad g(x)=\dfrac{3x^2+18x}{x^2+13x+42}\)
- Answer
-
\(R(x)=\dfrac{3x(x+7)}{x−7}\)
68. \(f(x)=\dfrac{24x^2}{2x−8} \quad g(x)=\dfrac{4x^3+28x^2}{x^2+11x+28}\)
69. \(f(x)=\dfrac{16x^2}{4x+36} \quad g(x)=\dfrac{4x^2−24x}{x^2+4x−45}\)
- Answer
-
\(R(x)=\dfrac{x(x−5)}{x−6}\)
70. \(f(x)=\dfrac{24x^2}{2x−4} \quad g(x)=\dfrac{12x^2+36x}{x^2−11x+18}\)
Writing Exercises
71. Explain how you find the values of x for which the rational expression \(\dfrac{x^2−x−20}{x^2−4}\) is undefined.
- Answer
-
Answers will vary.
72. Explain all the steps you take to simplify the rational expression \(\dfrac{p^2+4p−21}{9−p^2}\).
73. a. Multiply \(\dfrac{7}{4}·\dfrac{9}{10}\) and explain all your steps.
b. Multiply \(\dfrac{n}{n−3}·\dfrac{9}{n+3}\) and explain all your steps.
c. Evaluate your answer to part b. when \(n=7\). Did you get the same answer you got in part a.? Why or why not?
- Answer
-
Answers will vary.
74. a. Divide \(\dfrac{24}{5}÷6\) and explain all your steps.
b. Divide \(\dfrac{x^2−1}{x}÷(x+1)\) and explain all your steps.
c. Evaluate your answer to part b. when \(x=5\). Did you get the same answer you got in part a.? Why or why not?
Self Check
a. After completing the exercises, use this checklist to evaluate your mastery of the objectives of this section.
b. If most of your checks were:
…confidently. Congratulations! You have achieved your goals in this section! Reflect on the study skills you used so that you can continue to use them. What did you do to become confident of your ability to do these things? Be specific!
…with some help. This must be addressed quickly as topics you do not master become potholes in your road to success. Math is sequential - every topic builds upon previous work. It is important to make sure you have a strong foundation before you move on. Who can you ask for help? Your fellow classmates and instructor are good resources. Is there a place on campus where math tutors are available? Can your study skills be improved?
…no - I don’t get it! This is critical and you must not ignore it. You need to get help immediately or you will quickly be overwhelmed. See your instructor as soon as possible to discuss your situation. Together you can come up with a plan to get you the help you need.


6.2: Introduction
After reading this chapter, you should be able to answer these questions:
- What are the basic characteristics of managerial decision-making?
- What are the two systems of decision-making in the brain?
- What is the difference between programmed and nonprogrammed decisions?
- What barriers exist that make effective decision-making difficult?
- How can a manager improve the quality of her individual decision-making?
- What are the advantages and disadvantages of group decision-making, and how can a manager improve the quality of group decision-making?
Superstar Taylor Smith became a billionaire through hard work and good decision-making. More than $500 million of Swift’s fortune is from music royalties and touring. She made an estimated $190 million after taxes from the first leg of the Eras tour and another $35 million from the first two weeks of screenings of the corresponding concert film, Taylor Swift: The Eras Tour, which became the highest-grossing concert movie in history (Mercuri, 2024).
Meanwhile, another $500 million of her earnings came from the increasing value of her music catalog. Her masters (Swift’s first six albums) were infamously purchased in 2019 by Scooter Braun and eventually sold to Shamrock Capital for $300 million in 2020. When Swift was fifteen years old, she signed a music contract without understanding the term "loyalty." Swift later came to understand her contract greatly deprived her of most of her work earnings. So, the pop star decided to join Universal Music Group’s Republic Records, a deal that would give the superstar complete ownership over songwriting and recordings. This insightful decision-making would soon catapult Taylor Swift to Forbes’s billionaires list. On April 19, 2023, Swift released her 11th studio album, The Tortured Poets Department , which also added to her substantial earnings. Swift announced the new record during her Album of the Year acceptance speech at the 2024 Grammy Awards (Mercuri, 2024).
While becoming a billionaire, the pop star made a significant financial impact on the NFL. Swift created a brand value equivalent of $331.5 million for the Chiefs and the league, according to data from Apex Marketing Group. That figure was derived from print, digital, radio, TV, highlights, and social media mentioning Swift during the football season. To add to all of this, Swift was named Time Magazine’s 2023 Person of the Year. (Mercuri, 2024).
EXPLORING MANAGERIAL CAREER
Up, Up, and Away: How Stephanie Korey and Jen Rubio founded their luggage company
Jen Rubio and Stephanie Korey faced a number of important decisions in starting their luggage company, Away—beginning with the decision to start a business! That decision came about after Rubio’s luggage broke on a trip. She found it frustrating that all the luggage options were either inexpensive ($100 or less) but low quality or high quality but incredibly expensive ($400 and above). There was no mid-range option. So, in 2015 Rubio and her friend Stephanie Korey began researching the luggage industry. They found that much of the reason for the high prices on quality luggage was how it was distributed and sold through specialty retail shops and department stores. If they opted instead for a model in which they sold directly to consumers, they could provide high-quality luggage at more of a midrange ($200-$300) price. After considerable research, the two were convinced they had an idea worth pursuing. Rubio and Korey settled on the company name “Away,” intended to invoke the pleasure of traveling.
Both of the founders had prior experience working for a start-up in the e-commerce space (Warby Parker), which helped them with making sound choices. Rubio’s background was more in branding and marketing, while Korey’s was in operations and supply chain management—so each was able to bring great expertise to various aspects of the business. They raised money initially from friends and family, but within a few months they sought venture capital funding to ensure that they had enough money to get off to a successful start.
A big decision that Rubio and Korey had to make fairly early in the process of establishing their business was to settle on an initial design for the product. This decision required extensive marketing and consumer research to understand customer needs and wants. They asked hundreds of people what they liked about their existing luggage, and what they found most irritating about their existing luggage. They also contracted with a two-person design team to help create the first prototype. This research and development ultimately led to the design of an attractive hard case that is surprisingly lightweight. It also boasts extremely high-quality wheels (four of them, not two) and high-quality zippers. As a bonus, the carry-on includes a built-in battery for charging phones and other devices.
The two founders also had to choose a partner to manufacture their product. Because their product had a hard, polycarbonate shell, Rubio and Korey discovered that manufacturing in the United States was not a viable option—the vast majority of luggage manufacturers using a polycarbonate shell were based in Asia. They researched a number of possible business partners and asked lots of questions. In addition, they eventually visited all of the factories on their list of options to see what they were actually like. This was an important piece of research, because the companies that looked best on paper didn’t always turn out to be the best when they visited in person. Rubio and Korey ended up working with a manufacturing partner in China that also produces luggage for many high-end brands, and they have been extremely pleased with the partnership. They continue to devote time to building and maintaining that relationship, which helps to avoid issues and problems that might otherwise come up.
By the end of 2015, Rubio and Korey had developed their first product. Because the luggage was not going to be available in time for the holiday shopping season, they decided to allow customers to preorder the luggage. To drum up interest, the duo engaged in a unique storytelling effort. They interviewed 40 well-respected members of the creative community about their travel experiences and created a hardcover book of travel memoirs called The Places We Return To . Not only was the book interesting and engaging, it also made lots of people in the creative community aware of Away luggage. Starting in November 2015, the travel memoir book was available for free with the purchase of a gift card that could be redeemed in February 2016 for luggage. The book project generated tremendous advance interest in the product, and the 1,200 printed copies sold out. Away generated $12 million in first-year sales.
Stephanie Corey and Jen Rubio faced many important and novel decisions in initially developing and building their business. They have been successful in part because they made those decisions wisely—by relying on shared knowledge, expertise, and lots of research before reaching a decision. They will continue to face many decisions, big and small. They have expanded their product line from one piece of luggage to four, with more luggage—and other travel accessories—in the works for the future. Their company, which is based in New York, has grown to over 60 employees in the first two years. These employees include the two design-team members who were contracted to help create their first prototype; Rubio and Korey appreciated working with them so much, they offered them full-time positions with Away. Each new hire represents new decisions—decisions about what additional work needs to be done and who they should hire to do it. Each new product also brings additional decisions—but it seems Rubio and Korey have positioned themselves (and their business) well for future successes.
Sources:
Bakeer, K. (2016). “An Interview With the Co-Founder of Away,” The Hustle, December 5, 2016, https://thehustle.co/interview-co-founder-away .
Bond Street Blog. “Up and Away,” Bond Street, https://bondstreet.com/blog/jen-rubio-interview/ ; site inactive on April 4, 2024.
Constine, J. (2017). “Away Nears 100k Stylish Suitcases Sold As It Raises $20M,” TechCrunch, https://techcrunch.com/2017/05/19/aw...cel%20Partners .
Duff, A. (2017). “The T&L Carry-On: Away Travel Co-Founders Jen Rubio and Stephanie Korey,” Travel & Leisure, March 9, 2017, http://www.travelandleisure.com/ ; site inactive on April 4, 2024.
Helm, B. (2017). “How This Company Launched With Zero Products –and Hit $12 Million in First-Year Sales,” Inc.com, https://www.inc.com/magazine/201707/...ubio-away.html .
Hyland, V. (2015). “The Duo Trying to Make Travel More Glamorous,” The Cut, December 22, 2015, https://www.thecut.com/2015/12/away-...interview.html .
Mercuri, M. (2024, April 3). Taylor Swift didn’t need lucrative side hustles to become a billionaire. Forbes . https://www.forbes.com/sites/monicam...a-billionaire/
*Photo: Taylor Swift at the 2023 MTV Video Music Awards iHeartRadioCA
Managers and business owners—like Jen Rubio and Stephanie Korey—make decisions on a daily basis. Some are big, like the decision to start a new business, but most are smaller decisions that go into the regular running of the company and are crucial to its long-term success. Some decisions are predictable, and some are unexpected. In this chapter we look at important information about decision-making that can help you make better decisions and, ultimately, be a better manager.


15.22A: Cryptococcosis
- Recognize the causes and symptoms associated with cryptococcosis
Cryptococcosis, or cryptococcal disease, is a potentially fatal fungal disease. It is caused by one of two species: Cryptococcus neoformans and Cryptococcus gattii. These were all previously thought to be subspecies of C. neoformans, but have now been identified as distinct species. Cryptococcosis is believed to be acquired by inhalation of the infectious propagule from the environment. Although the exact nature of the infectious propagule is unknown, the leading hypothesis is the basidiospore created through sexual or asexual reproduction.
Causes
Cryptococcal meningitis (infection of the meninges, the tissue covering the brain) is believed to result from dissemination of the fungus from either an observed or unappreciated pulmonary infection. Often there is also silent dissemination throughout the brain when meningitis is present. Cryptococcus gattii causes infections in immunocompetent people (those having a functioning immune system), but C. neoformans v. grubii, and v. neoformans usually only cause clinically evident infections in persons who have some form of defect in their immune systems ( immunocompromised persons). People who have defects in their cell-mediated immunity; for example, people with AIDS; are especially susceptible to disseminated cryptococcosis. Cryptococcosis is often fatal, even if treated. The ten-week survival averages near 70% with optimal therapy.
Although the most common presentation of cryptococcosis is of C. neoformans infection in an immunocompromised person (such as persons living with AIDS), the C. gattii is being increasingly recognised as a pathogen in presumptively immunocompetent hosts, especially in Canada and Australia. This may be due to rare exposure and high pathogenicity, or to unrecognised isolated defects in immunity, specific for this organism.
Cryptococcosis is a defining opportunistic infection for AIDS. Other conditions which pose an increased risk include certain lymphomas (e.g. Hodgkin’s lymphoma), sarcoidosis, liver cirrhosis, and patients on long-term corticosteroid therapy. Distribution is worldwide in soil. The prevalence of cryptococcosis has been increasing over the past 20 years for many reasons, including the increase in incidence of AIDS and the expanded use of immunosuppressive drugs.
Treatment
Treatment options in non-AIDS patients who have reduced immune-system function is not well studied. Intravenous Amphotericin B combined with oral flucytosine may be effective. Every attempt should be made to reduce the amount of immunosuppressive medication until the infection is resolved. Persons living with AIDS often have a greater chance of disease and higher mortality (30-70% at ten-weeks), but recommended therapy is with antifungal agents such as Amphotericin B and flucytosine.
Cryptococcosis in Animals
Cryptococcosis is also seen in cats and occasionally dogs. It is the most common deep fungal disease in cats, usually leading to chronic infection of the nose and sinuses, and skin ulcers. Cats may develop a bump over the bridge of the nose from local tissue inflammation. It can be associated with feline leukemia virus infection in cats. Cryptococcosis is most common in dogs and cats, but cattle, sheep, goats, horses, wild animals and birds can also be infected. Soil, fowl manure, and pigeon droppings are among the sources of infection.
Key Points
- Cryptococcal meningitis is caused when the disease-causing fungus gets in the membranes around the brain.
- Cryptococcosis is an opportunistic infection, it often affects people who are immune -compromised, such as people who have AIDS.
- As people who get cryptoccosis often have other health problems, even treatment with anti- fungal agents may not cure the infection.
- Cryptococcosis can infect animals such as cats; it is not solely a human pathogen.
Key Terms
- meninges : The three membranes that envelop the brain and spinal cord.
- propagule : A reproductive particle released by an organism that may germinate into another.


8.3: Prescription Drugs
-
- Last updated
- Save as PDF
Most people take medicines only for the reasons their doctors prescribe them. But an estimated 20 percent of people in the United States have used prescription drugs for nonmedical reasons. This is prescription drug abuse. It is a serious and growing problem.
Abusing some prescription drugs can lead to addiction. You can develop an addiction to:
- Narcotic painkillers
- Sedatives and tranquilizers
- Stimulants
Experts don't know exactly why this type of drug abuse is increasing. The availability of drugs is probably one reason. Doctors are prescribing more drugs for more health problems than ever before. Online pharmacies make it easy to get prescription drugs without a prescription, even for younger people.
Commonly Abused Prescription Drugs
Medications can be effective when they are used properly, but some can be addictive and dangerous when abused. Some prescribed medications that - when used in ways or by people other than prescribed - have the potential for adverse medical consequences, including addiction.
In 2010, approximately 16 million Americans reported using a prescription drug for nonmedical reasons in the past year; 7 million in the past month. After marijuana, prescription and over-the-counter medications account for most of the commonly abused drugs.
What types of prescription drugs are abused?
Three types of drugs are abused most often:
- Opioids—prescribed for pain relief
- CNS depressants—barbiturates and benzodiazepines prescribed for anxiety or sleep problems (often referred to as sedatives or tranquilizers)
- Stimulants—prescribed for attention-deficit hyperactivity disorder (ADHD), the sleep disorder narcolepsy, or obesity.
How can you help prevent prescription drug abuse?
- Ask your doctor or pharmacist about your medication, especially if you are unsure about its effects.
- Keep your doctor informed about all medications you are taking, including over-thecounter medications.
- Read the information your pharmacist provides before starting to take medications.
- Take your medication(s) as prescribed.
- Keep all prescription medications secured at all times and properly dispose of any unused medications.
Prescription Drug Advertising
Your healthcare provider is the best source of information about the right medicines for you. The Food and Drug Administration (FDA) protects public health by assuring the safety, effectiveness, and security of a wide range of products, including human prescription drugs. We also advance public health by helping people get the accurate, science-based information they need to use medicines appropriately and improve their health. Prescription drug advertisements can provide useful information for consumers to work with their health care providers to make wise decisions about treatment.
FDA Authority Over Advertising
The FDA serves the public health and welfare in many ways. One way is overseeing the approval and marketing of prescription drugs. It's authority is based on a number of federal laws, including the Federal Food, Drug, and Cosmetic Act. Among other areas, this law specifically addresses prescription drug advertising. This law requires that advertisements for prescription drugs be accurate and not misleading.
Direct-to-consumer (DTC) advertising is a relatively new area of prescription drug promotion. No federal law has ever banned DTC advertising. Until the mid-1980s, drug companies gave information about prescription drugs only to doctors and pharmacists. When these professionals thought it appropriate, they gave that information to their patients. However, during the 1980s, some drug companies started to give the general public more direct access to this information through DTC ads.
The law requires that product claim ads give a "fair balance" of information about drug risks as compared with information about drug benefits. This means that the content and presentation of a drug's most important risks must be reasonably similar to the content and presentation of its benefits.
This does not mean that equal space must be given to risks and benefits in print ads, or equal time to risks and benefits in broadcast ads. The amount of time or space needed to present risk information will depend on the drug's risks and the way that both the benefits and risks are presented.
Think about the following questions when you see an ad for a prescription drug. Also, think about asking these questions when you talk to your doctor or pharmacist about a drug.
- What condition does this drug treat?
- Why do I think that I might have this condition?
- If I have the condition, am I part of the population the drug is approved to treat?
- Should I take this drug if I have a certain condition?
- Should I take this drug if I am taking certain other drugs?
- Which of the drug's possible side effects am I concerned about?
- How will this drug affect other drugs I am taking?
- Will foods, beverages (alcoholic or non-alcoholic), vitamins, or other supplements affect how this drug works?
- Are there other drugs that treat my condition?
- Is there a less costly drug I could use to treat my condition?
- What else can I do to help deal with my condition? For example, should I exercise or change my diet?
- Do other drugs for my condition have different side effects?
- How can I learn more about this condition and this drug?
Harmful Interactions: Mixing Alcohol with Medicines
You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body. Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.
Medications are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.
Did You Know…
Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.
Medicines may have many ingredients
Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking.
Some medicines contain alcohol
Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.
Alcohol affects women differently
Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.
Older people face greater risk
Older people are at particularly high risk for harmful alcohol– medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.
Timing is important
Alcohol and medicines can interact harmfully even if they are not taken at the same time.
Remember…
Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.


2.7: Skewness and the Mean, Median, and Mode
-
- Last updated
- Save as PDF
Consider the following data set.
4; 5; 6; 6; 6; 7; 7; 7; 7; 7; 7; 8; 8; 8; 9; 10
This data set can be represented by following histogram. Each interval has width one, and each value is located in the middle of an interval.
The histogram displays a symmetrical distribution of data. A distribution is symmetrical if a vertical line can be drawn at some point in the histogram such that the shape to the left and the right of the vertical line are mirror images of each other. The mean, the median, and the mode are each seven for these data. In a perfectly symmetrical distribution, the mean and the median are the same. This example has one mode (unimodal), and the mode is the same as the mean and median. In a symmetrical distribution that has two modes (bimodal), the two modes would be different from the mean and median.
The histogram for the data: 4; 5; 6; 6; 6; 7; 7; 7; 7; 8 is not symmetrical. The right-hand side seems "chopped off" compared to the left side. A distribution of this type is called skewed to the left because it is pulled out to the left.
The mean is 6.3, the median is 6.5, and the mode is seven. Notice that the mean is less than the median, and they are both less than the mode. The mean and the median both reflect the skewing, but the mean reflects it more so.
The histogram for the data: 6; 7; 7; 7; 7; 8; 8; 8; 9; 10 , is also not symmetrical. It is skewed to the right .
The mean is 7.7, the median is 7.5, and the mode is seven. Of the three statistics, the mean is the largest, while the mode is the smallest . Again, the mean reflects the skewing the most.
Generally, if the distribution of data is skewed to the left, the mean is less than the median, which is often less than the mode. If the distribution of data is skewed to the right, the mode is often less than the median, which is less than the mean.
Skewness and symmetry become important when we discuss probability distributions in later chapters.
Example \(\PageIndex{1}\)
Statistics are used to compare and sometimes identify authors. The following lists shows a simple random sample that compares the letter counts for three authors.
- Terry: 7; 9; 3; 3; 3; 4; 1; 3; 2; 2
- Davis: 3; 3; 3; 4; 1; 4; 3; 2; 3; 1
- Maris: 2; 3; 4; 4; 4; 6; 6; 6; 8; 3
- Make a dot plot for the three authors and compare the shapes.
- Calculate the mean for each.
- Calculate the median for each.
- Describe any pattern you notice between the shape and the measures of center.
Solution
a.
- Terry’s mean is 3.7, Davis’ mean is 2.7, Maris’ mean is 4.6.
- Terry’s median is three, Davis’ median is three. Maris’ median is four.
- It appears that the median is always closest to the high point (the mode), while the mean tends to be farther out on the tail. In a symmetrical distribution, the mean and the median are both centrally located close to the high point of the distribution.
Exercise \(\PageIndex{1}\)
Discuss the mean, median, and mode for each of the following problems. Is there a pattern between the shape and measure of the center?
a.
b.
| The Ages Former U.S Presidents Died | |
|---|---|
| 4 | 6 9 |
| 5 | 3 6 7 7 7 8 |
| 6 | 0 0 3 3 4 4 5 6 7 7 7 8 |
| 7 | 0 1 1 2 3 4 7 8 8 9 |
| 8 | 0 1 3 5 8 |
| 9 | 0 0 3 3 |
| Key: 8|0 means 80. |
c.
Review
Looking at the distribution of data can reveal a lot about the relationship between the mean, the median, and the mode. There are three types of distributions. A left (or negative) skewed distribution has a shape like Figure \(\PageIndex{2}\). A right (or positive) skewed distribution has a shape like Figure \(\PageIndex{3}\). A symmetrical distribution looks like Figure \(\PageIndex{1}\).
Use the following information to answer the next three exercises: State whether the data are symmetrical, skewed to the left, or skewed to the right.
Exercise 2.7.2
1; 1; 1; 2; 2; 2; 2; 3; 3; 3; 3; 3; 3; 3; 3; 4; 4; 4; 5; 5
Answer
The data are symmetrical. The median is 3 and the mean is 2.85. They are close, and the mode lies close to the middle of the data, so the data are symmetrical.
Exercise 2.7.3
16; 17; 19; 22; 22; 22; 22; 22; 23
Exercise 2.7.4
87; 87; 87; 87; 87; 88; 89; 89; 90; 91
Answer
The data are skewed right. The median is 87.5 and the mean is 88.2. Even though they are close, the mode lies to the left of the middle of the data, and there are many more instances of 87 than any other number, so the data are skewed right.
Exercise 2.7.5
When the data are skewed left, what is the typical relationship between the mean and median?
Exercise 2.7.6
When the data are symmetrical, what is the typical relationship between the mean and median?
Answer
When the data are symmetrical, the mean and median are close or the same.
Exercise 2.7.7
What word describes a distribution that has two modes?
Exercise 2.7.8
Describe the shape of this distribution.
Answer
The distribution is skewed right because it looks pulled out to the right.
Exercise 2.7.9
Describe the relationship between the mode and the median of this distribution.
Exercise 2.7.10
Describe the relationship between the mean and the median of this distribution.
Answer
The mean is 4.1 and is slightly greater than the median, which is four.
Exercise 2.7.11
Describe the shape of this distribution.
Exercise 2.7.12
Describe the relationship between the mode and the median of this distribution.
Answer
The mode and the median are the same. In this case, they are both five.
Exercise 2.7.13
Are the mean and the median the exact same in this distribution? Why or why not?
Exercise 2.7.14
Describe the shape of this distribution.
Answer
The distribution is skewed left because it looks pulled out to the left.
Exercise 2.7.15
Describe the relationship between the mode and the median of this distribution.
Exercise 2.7.16
Describe the relationship between the mean and the median of this distribution.
Answer
The mean and the median are both six.
Exercise 2.7.17
The mean and median for the data are the same.
3; 4; 5; 5; 6; 6; 6; 6; 7; 7; 7; 7; 7; 7; 7
Is the data perfectly symmetrical? Why or why not?
Exercise 2.7.18
Which is the greatest, the mean, the mode, or the median of the data set?
11; 11; 12; 12; 12; 12; 13; 15; 17; 22; 22; 22
Answer
The mode is 12, the median is 12.5, and the mean is 15.1. The mean is the largest.
Exercise 2.7.19
Which is the least, the mean, the mode, and the median of the data set?
56; 56; 56; 58; 59; 60; 62; 64; 64; 65; 67
Exercise 2.7.20
Of the three measures, which tends to reflect skewing the most, the mean, the mode, or the median? Why?
Answer
The mean tends to reflect skewing the most because it is affected the most by outliers.
Exercise 2.7.21
In a perfectly symmetrical distribution, when would the mode be different from the mean and median?


21.2: Reading Links- Introduction
Purpose
Before you can move forward in this class, it’s important that you understand the basic definitions of physical activity and exercise. In addition, the article below lists some of the common barriers to physical activity and how to overcome them.
Directions
- Read the following article: Barriers to Physical Activity (Brinks, Jenna & Franklin, Barry “Physical Activity, Barriers to” Encyclopedia of Lifestyle Medicine & Health . Ed. James M. Rippe Vol. 2 Thousand Oaks: SAGE, 2012. 863-872. Gale Virtual Reference Library.
CC licensed content, Shared previously
- Lifetime Fitness and Wellness. Provided by : Extended Learning Institute of Northern Virginia Community College. Located at : https://eli.nvcc.edu/ . License : CC BY: Attribution


22.2: The Black Cat
FOR the most wild, yet most homely narrative which I am about to pen, I neither expect nor solicit belief. Mad indeed would I be to expect it, in a case where my very senses reject their own evidence. Yet, mad am I not—and very surely do I not dream. But to-morrow I die, and to-day I would unburthen my soul. My immediate purpose is to place before the world, plainly, succinctly, and without comment, a series of mere household events. In their consequences, these events have terrified—have tortured—have destroyed me. Yet I will not attempt to expound them. To me, they have presented little but Horror—to many they will seem less terrible than barroques . Hereafter, perhaps, some intellect may be found which will reduce my phantasm to the common-place—some intellect more calm, more logical, and far less excitable than my own, which will perceive, in the circumstances I detail with awe, nothing more than an ordinary succession of very natural causes and effects.
From my infancy I was noted for the docility and humanity of my disposition. My tenderness of heart was even so conspicuous as to make me the jest of my companions. I was especially fond of animals, and was indulged by my parents with a great variety of pets. With these I spent most of my time, and never was so happy as when feeding and caressing them. This peculiarity of character grew with my growth, and in my manhood, I derived from it one of my principal sources of pleasure. To those who have cherished an affection for a faithful and sagacious dog, I need hardly be at the trouble of explaining the nature or the intensity of the gratification thus derivable. There is something in the unselfish and self-sacrificing love of a brute, which goes directly to the heart of him who has had frequent occasion to test the paltry friendship and gossamer fidelity of mere Man .
I married early, and was happy to find in my wife a disposition not uncongenial with my own. Observing my partiality for domestic pets, she lost no opportunity of procuring those of the most agreeable kind. We had birds, gold-fish, a fine dog, rabbits, a small monkey, and a cat .
This latter was a remarkably large and beautiful animal, entirely black, and sagacious to an astonishing degree. In speaking of his intelligence, my wife, who at heart was not a little tinctured with superstition, made frequent allusion to the ancient popular notion, which regarded all black cats as witches in disguise. Not that she was ever serious upon this point—and I mention the matter at all for no better reason than that it happens, just now, to be remembered.
Pluto—this was the cat’s name—was my favorite pet and playmate. I alone fed him, and he attended me wherever I went about the house. It was even with difficulty that I could prevent him from following me through the streets.
Our friendship lasted, in this manner, for several years, during which my general temperament and character—through the instrumentality of the Fiend Intemperance—had (I blush to confess it) experienced a radical alteration for the worse. I grew, day by day, more moody, more irritable, more regardless of the feelings of others. I suffered myself to use intemperate language to my wife. At length, I even offered her personal violence. My pets, of course, were made to feel the change in my disposition. I not only neglected, but ill-used them. For Pluto, however, I still retained sufficient regard to restrain me from maltreating him, as I made no scruple of maltreating the rabbits, the monkey, or even the dog, when by accident, or through affection, they came in my way. But my disease grew upon me—for what disease is like Alcohol!—and at length even Pluto, who was now becoming old, and consequently somewhat peevish—even Pluto began to experience the effects of my ill temper.
One night, returning home, much intoxicated, from one of my haunts about town, I fancied that the cat avoided my presence. I seized him; when, in his fright at my violence, he inflicted a slight wound upon my hand with his teeth. The fury of a demon instantly possessed me. I knew myself no longer. My original soul seemed, at once, to take its flight from my body and a more than fiendish malevolence, gin-nurtured, thrilled every fibre of my frame. I took from my waistcoat-pocket a pen-knife, opened it, grasped the poor beast by the throat, and deliberately cut one of its eyes from the socket! I blush, I burn, I shudder, while I pen the damnable atrocity.
When reason returned with the morning—when I had slept off the fumes of the night’s debauch—I experienced a sentiment half of horror, half of remorse, for the crime of which I had been guilty; but it was, at best, a feeble and equivocal feeling, and the soul remained untouched. I again plunged into excess, and soon drowned in wine all memory of the deed.
In the meantime the cat slowly recovered. The socket of the lost eye presented, it is true, a frightful appearance, but he no longer appeared to suffer any pain. He went about the house as usual, but, as might be expected, fled in extreme terror at my approach. I had so much of my old heart left, as to be at first grieved by this evident dislike on the part of a creature which had once so loved me. But this feeling soon gave place to irritation. And then came, as if to my final and irrevocable overthrow, the spirit of PERVERSENESS. Of this spirit philosophy takes no account. Yet I am not more sure that my soul lives, than I am that perverseness is one of the primitive impulses of the human heart—one of the indivisible primary faculties, or sentiments, which give direction to the character of Man.  Have we not a perpetual inclination, in the teeth of our best judgment, to violate that which is Law , merely because we understand it to be such? This spirit of perverseness, I say, came to my final overthrow. It was this unfathomable longing of the soul to vex itself —to offer violence to its own nature—to do wrong for the wrong’s sake only—that urged me to continue and finally to consummate the injury I had inflicted upon the unoffending brute. One morning, in cool blood, I slipped a noose about its neck and hung it to the limb of a tree;—hung it with the tears streaming from my eyes, and with the bitterest remorse at my heart;—hung it because I knew that it had loved me, and because I felt it had given me no reason of offence;—hung it because I knew that in so doing I was committing a sin—a deadly sin that would so jeopardize my immortal soul as to place it—if such a thing wore possible—even beyond the reach of the infinite mercy of the Most Merciful and Most Terrible God.
On the night of the day on which this cruel deed was done, I was aroused from sleep by the cry of fire. The curtains of my bed were in flames. The whole house was blazing. It was with great difficulty that my wife, a servant, and myself, made our escape from the conflagration. The destruction was complete. My entire worldly wealth was swallowed up, and I resigned myself thenceforward to despair.
I am above the weakness of seeking to establish a sequence of cause and effect, between the disaster and the atrocity. But I am detailing a chain of facts—and wish not to leave even a possible link imperfect. On the day succeeding the fire, I visited the ruins. The walls, with one exception, had fallen in. This exception was found in a compartment wall, not very thick, which stood about the middle of the house, and against which had rested the head of my bed. The plastering had here, in great measure, resisted the action of the fire—a fact which I attributed to its having been recently spread. About this wall a dense crowd were collected, and many persons seemed to be examining a particular portion of it with very minute and eager attention. The words “strange!” “singular!” and other similar expressions, excited my curiosity. I approached and saw, as if graven in bas relief upon the white surface, the figure of a gigantic cat . The impression was given with an accuracy truly marvellous. There was a rope about the animal’s neck.
When I first beheld this apparition—for I could scarcely regard it as less—my wonder and my terror were extreme. But at length reflection came to my aid. The cat, I remembered, had been hung in a garden adjacent to the house. Upon the alarm of fire, this garden had been immediately filled by the crowd—by some one of whom the animal must have been cut from the tree and thrown, through an open window, into my chamber. This had probably been done with the view of arousing me from sleep. The falling of other walls had compressed the victim of my cruelty into the substance of the freshly-spread plaster; the lime of which, with the flames, and the ammonia from the carcass, had then accomplished the portraiture as I saw it.
Although I thus readily accounted to my reason, if not altogether to my conscience, for the startling fact just detailed, it did not the less fail to make a deep impression upon my fancy. For months I could not rid myself of the phantasm of the cat; and, during this period, there came back into my spirit a half-sentiment that seemed, but was not, remorse. I went so far as to regret the loss of the animal, and to look about me, among the vile haunts which I now habitually frequented, for another pet of the same species, and of somewhat similar appearance, with which to supply its place.
One night as I sat, half stupified, in a den of more than infamy, my attention was suddenly drawn to some black object, reposing upon the head of one of the immense hogsheads of Gin, or of Rum, which constituted the chief furniture of the apartment. I had been looking steadily at the top of this hogshead for some minutes, and what now caused me surprise was the fact that I had not sooner perceived the object thereupon. I approached it, and touched it with my hand. It was a black cat—a very large one—fully as large as Pluto, and closely resembling him in every respect but one. Pluto had not a white hair upon any portion of his body; but this cat had a large, although indefinite splotch of white, covering nearly the whole region of the breast. Upon my touching him, he immediately arose, purred loudly, rubbed against my hand, and appeared delighted with my notice. This, then, was the very creature of which I was in search. I at once offered to purchase it of the landlord; but this person made no claim to it—knew nothing of it—had never seen it before.
I continued my caresses, and, when I prepared to go home, the animal evinced a disposition to accompany me. I permitted it to do so; occasionally stooping and patting it as I proceeded. When it reached the house it domesticated itself at once, and became immediately a great favorite with my wife.
For my own part, I soon found a dislike to it arising within me. This was just the reverse of what I had anticipated; but—I know not how or why it was—its evident fondness for myself rather disgusted and annoyed. By slow degrees, these feelings of disgust and annoyance rose into the bitterness of hatred. I avoided the creature; a certain sense of shame, and the remembrance of my former deed of cruelty, preventing me from physically abusing it. I did not, for some weeks, strike, or otherwise violently ill use it; but gradually—very gradually—I came to look upon it with unutterable loathing, and to flee silently from its odious presence, as from the breath of a pestilence.
What added, no doubt, to my hatred of the beast, was the discovery, on the morning after I brought it home, that, like Pluto, it also had been deprived of one of its eyes. This circumstance, however, only endeared it to my wife, who, as I have already said, possessed, in a high degree, that humanity of feeling which had once been my distinguishing trait, and the source of many of my simplest and purest pleasures.
With my aversion to this cat, however, its partiality for myself seemed to increase. It followed my footsteps with a pertinacity which it would be difficult to make the reader comprehend. Whenever I sat, it would crouch beneath my chair, or spring upon my knees, covering me with its loathsome caresses. If I arose to walk it would get between my feet and thus nearly throw me down, or, fastening its long and sharp claws in my dress, clamber, in this manner, to my breast. At such times, although I longed to destroy it with a blow, I was yet withheld from so doing, partly by a memory of my former crime, but chiefly—let me confess it at once—by absolute dread of the beast.
This dread was not exactly a dread of physical evil—and yet I should be at a loss how otherwise to define it. I am almost ashamed to own—yes, even in this felon’s cell, I am almost ashamed to own—that the terror and horror with which the animal inspired me, had been heightened by one of the merest chimaeras it would be possible to conceive. My wife had called my attention, more than once, to the character of the mark of white hair, of which I have spoken, and which constituted the sole visible difference between the strange beast and the one I had destroyed. The reader will remember that this mark, although large, had been originally very indefinite; but, by slow degrees—degrees nearly imperceptible, and which for a long time my Reason struggled to reject as fanciful—it had, at length, assumed a rigorous distinctness of outline. It was now the representation of an object that I shudder to name—and for this, above all, I loathed, and dreaded, and would have rid myself of the monster had I dared —it was now, I say, the image of a hideous—of a ghastly thing—of the GALLOWS!—oh, mournful and terrible engine of Horror and of Crime—of Agony and of Death!
And now was I indeed wretched beyond the wretchedness of mere Humanity. And a brute beast —whose fellow I had contemptuously destroyed— a brute beast to work out for me —for me a man, fashioned in the image of the High God—so much of insufferable wo! Alas! neither by day nor by night knew I the blessing of Rest any more! During the former the creature left me no moment alone; and, in the latter, I started, hourly, from dreams of unutterable fear, to find the hot breath of the thing upon my face, and its vast weight—an incarnate Night-Mare that I had no power to shake off—incumbent eternally upon my heart!
Beneath the pressure of torments such as these, the feeble remnant of the good within me succumbed. Evil thoughts became my sole intimates—the darkest and most evil of thoughts. The moodiness of my usual temper increased to hatred of all things and of all mankind; while, from the sudden, frequent, and ungovernable outbursts of a fury to which I now blindly abandoned myself, my uncomplaining wife, alas! was the most usual and the most patient of sufferers.
One day she accompanied me, upon some household errand, into the cellar of the old building which our poverty compelled us to inhabit. The cat followed me down the steep stairs, and, nearly throwing me headlong, exasperated me to madness. Uplifting an axe, and forgetting, in my wrath, the childish dread which had hitherto stayed my hand, I aimed a blow at the animal which, of course, would have proved instantly fatal had it descended as I wished. But this blow was arrested by the hand of my wife. Goaded, by the interference, into a rage more than demoniacal, I withdrew my arm from her grasp and buried the axe in her brain. She fell dead upon the spot, without a groan.
This hideous murder accomplished, I set myself forthwith, and with entire deliberation, to the task of concealing the body. I knew that I could not remove it from the house, either by day or by night, without the risk of being observed by the neighbors. Many projects entered my mind. At one period I thought of cutting the corpse into minute fragments, and destroying them by fire. At another, I resolved to dig a grave for it in the floor of the cellar. Again, I deliberated about casting it in the well in the yard—about packing it in a box, as if merchandize, with the usual arrangements, and so getting a porter to take it from the house. Finally I hit upon what I considered a far better expedient than either of these. I determined to wall it up in the cellar—as the monks of the middle ages are recorded to have walled up their victims.
For a purpose such as this the cellar was well adapted. Its walls were loosely constructed, and had lately been plastered throughout with a rough plaster, which the dampness of the atmosphere had prevented from hardening. Moreover, in one of the walls was a projection, caused by a false chimney, or fireplace, that had been filled up, and made to resemble the red of the cellar. I made no doubt that I could readily displace the bricks at this point, insert the corpse, and wall the whole up as before, so that no eye could detect any thing suspicious. And in this calculation I was not deceived. By means of a crow-bar I easily dislodged the bricks, and, having carefully deposited the body against the inner wall, I propped it in that position, while, with little trouble, I re-laid the whole structure as it originally stood. Having procured mortar, sand, and hair, with every possible precaution, I prepared a plaster which could not be distinguished from the old, and with this I very carefully went over the new brickwork. When I had finished, I felt satisfied that all was right. The wall did not present the slightest appearance of having been disturbed. The rubbish on the floor was picked up with the minutest care. I looked around triumphantly, and said to myself—”Here at least, then, my labor has not been in vain.”
My next step was to look for the beast which had been the cause of so much wretchedness; for I had, at length, firmly resolved to put it to death. Had I been able to meet with it, at the moment, there could have been no doubt of its fate; but it appeared that the crafty animal had been alarmed at the violence of my previous anger, and forebore to present itself in my present mood. It is impossible to describe, or to imagine, the deep, the blissful sense of relief which the absence of the detested creature occasioned in my bosom. It did not make its appearance during the night—and thus for one night at least, since its introduction into the house, I soundly and tranquilly slept; aye, slept even with the burden of murder upon my soul!
The second and the third day passed, and still my tormentor came not. Once again I breathed as a freeman. The monster, in terror, had fled the premises forever! I should behold it no more! My happiness was supreme! The guilt of my dark deed disturbed me but little. Some few inquiries had been made, but these had been readily answered. Even a search had been instituted—but of course nothing was to be discovered. I looked upon my future felicity as secured.
Upon the fourth day of the assassination, a party of the police came, very unexpectedly, into the house, and proceeded again to make rigorous investigation of the premises. Secure, however, in the inscrutability of my place of concealment, I felt no embarrassment whatever. The officers bade me accompany them in their search. They left no nook or corner unexplored. At length, for the third or fourth time, they descended into the cellar. I quivered not in a muscle. My heart beat calmly as that of one who slumbers in innocence. I walked the cellar from end to end. I folded my arms upon my bosom, and roamed easily to and fro. The police were thoroughly satisfied and prepared to depart. The glee at my heart was too strong to be restrained. I burned to say if but one word, by way of triumph, and to render doubly sure their assurance of my guiltlessness.
“Gentlemen,” I said at last, as the party ascended the steps, “I delight to have allayed your suspicions. I wish you all health, and a little more courtesy. By the bye, gentlemen, this—this is a very well constructed house.” [In the rabid desire to say something easily, I scarcely knew what I uttered at all.]—”I may say an excellently well constructed house. These walls—are you going, gentlemen?—these walls are solidly put together;” and here, through the mere phrenzy of bravado, I rapped heavily, with a cane which I held in my hand, upon that very portion of the brick-work behind which stood the corpse of the wife of my bosom.
But may God shield and deliver me from the fangs of the Arch-Fiend! No sooner had the reverberation of my blows sunk into silence, than I was answered by a voice from within the tomb!—by a cry, at first muffled and broken, like the sobbing of a child, and then quickly swelling into one long, loud, and continuous scream, utterly anomalous and inhuman—a howl—a wailing shriek, half of horror and half of triumph, such as might have arisen only out of hell, conjointly from the throats of the dammed in their agony and of the demons that exult in the damnation.
Of my own thoughts it is folly to speak. Swooning, I staggered to the opposite wall. For one instant the party upon the stairs remained motionless, through extremity of terror and of awe. In the next, a dozen stout arms were toiling at the wall. It fell bodily. The corpse, already greatly decayed and clotted with gore, stood erect before the eyes of the spectators. Upon its head, with red extended mouth and solitary eye of fire, sat the hideous beast whose craft had seduced me into murder, and whose informing voice had consigned me to the hangman. I had walled the monster up within the tomb!


4.8: Evaluation
Evaluation is the sixth step of the nursing process (and the sixth Standard of Practice set by the American Nurses Association). This standard is defined as, “The registered nurse evaluates progress toward attainment of goals and outcomes.” [1] Both the patient status and the effectiveness of the nursing care must be continuously evaluated and the care plan modified as needed. [2]
Evaluation focuses on the effectiveness of the nursing interventions by reviewing the expected outcomes to determine if they were met by the time frames indicated. During the evaluation phase, nurses use critical thinking to analyze reassessment data and determine if a patient’s expected outcomes have been met, partially met, or not met by the time frames established. If outcomes are not met or only partially met by the time frame indicated, the care plan should be revised. Reassessment should occur every time the nurse interacts with a patient, discusses the care plan with others on the interprofessional team, or reviews updated laboratory or diagnostic test results. Nursing care plans should be updated as higher priority goals emerge. The results of the evaluation must be documented in the patient’s medical record.
Ideally, when the planned interventions are implemented, the patient will respond positively and the expected outcomes are achieved. However, when interventions do not assist in progressing the patient toward the expected outcomes, the nursing care plan must be revised to more effectively address the needs of the patient. These questions can be used as a guide when revising the nursing care plan:
- Did anything unanticipated occur?
- Has the patient’s condition changed?
- Were the expected outcomes and their time frames realistic?
- Are the nursing diagnoses accurate for this patient at this time?
- Are the planned interventions appropriately focused on supporting outcome attainment?
- What barriers were experienced as interventions were implemented?
- Does ongoing assessment data indicate the need to revise diagnoses, outcome criteria, planned interventions, or implementation strategies?
- Are different interventions required?
Putting It Together
Refer to Scenario C in the “Assessment” section of this chapter and Appendix C . The nurse evaluates the patient’s progress toward achieving the expected outcomes.
For the nursing diagnosis Fluid Volume Excess , the nurse evaluated the four expected outcomes to determine if they were met during the time frames indicated:
- The patient will report decreased dyspnea within the next 8 hours.
- The patient will have clear lung sounds within the next 24 hours.
- The patient will have decreased edema within the next 24 hours.
- The patient’s weight will return to baseline by discharge.
Evaluation of the patient condition on Day 1 included the following data: “ The patient reported decreased shortness of breath, and there were no longer crackles in the lower bases of the lungs. Weight decreased by 1 kg, but 2+ edema continued in ankles and calves .” Based on this data, the nurse evaluated the expected outcomes as “ Partially Met ” and revised the care plan with two new interventions:
- Request prescription for TED hose from provider.
- Elevate patient’s legs when sitting in chair.
For the second nursing diagnosis, Risk for Falls , the nurse evaluated the outcome criteria as “ Met ” based on the evaluation, “ The patient verbalizes understanding and is appropriately calling for assistance when getting out of bed. No falls have occurred. ”
The nurse will continue to reassess the patient’s progress according to the care plan during hospitalization and make revisions to the care plan as needed. Evaluation of the care plan is documented in the patient’s medical record.
- American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
- American Nurses Association. (n.d.) The nursing process . https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/ ↵