Irritable Bowel Syndrome Health And Social Care Essay

Irritable Bowel Syndrome Health And Social Care Essay This essay aims to provide a comprehensive account of the gastrointestinal disorder, Irritable Bowel Syndrome. The aetiology, pathology, and prognosis of the disorder will be described, along with details pertaining to its epidemiology. The diagnosis and management of the disorder will be described, followed by a discussion of the health implications experienced by patients and the economic costs of the disorder. Conclusions will be made based on the information and evidence discussed throughout the essay. Irritable Bowel Syndrome (IBS), also known as spastic colon, nervous diarrhoea, and functional bowel, is one of the most common gastrointestinal disorders worldwide (NICE, 2008). It is a chronic, functional disorder of the gastrointestinal tract which is characterised by symptoms of abdominal pain or discomfort of the lower abdomen, bloating, and disordered defecation (Silk, 2003). This latter symptom can manifest in four different forms (Allison, 2002): constipation predominant; diarrhoea predominant; alternating between constipation and diarrhoea; or, non-extreme. Furthermore, although symptoms are predominantly gastrointestinal, other symptoms can include back ache, nausea, heartburn, lethargy, urinary problems, faintness, palpitations, and loss of appetite (Fortson and Lee, 2004). Symptoms are usually worse after eating and most people experience flare-ups lasting between 2-4 days. Indeed, a key characteristic of IBS is a cycle of relapse and remission (Silk, 2003). Worldwide, IBS affects an estimated 10-20% of the population at any one time, although the figure may be higher because not everyone seeks help for the condition (Hungin et al. 2003; Hungin et al., 2005). IBS can affect both genders of all ages, although it is twice as common in females (Voci and Cramer, 2009). It can occur at any age, but typically develops in individuals who are 20-30 years old (Wangen, 2006). Incidence tends to reduce with age (Wilson et al., 2004). Furthermore, more women report constipation predominant IBS, while more men report diarrhoea predominant IBS (Heitkemper and Jarrett, 2001). Women also tend to report a worsening of symptoms during menstruation, suggesting a hormonal link with IBS (Moore et al., 1998). Despite there being no clear aetiology for IBS, there is a general consensus that it is a multifactorial disorder of a biopsychosocial nature (Allison, 2002). Possible factors involved in its development include an abnormality with how the muscles move food through the digestive tract, pain-sensitive digestive organs, a malfunctioning immune system, a problem between the central nervous system and the digestive system, or an abnormal response to infection. Environmental, dietary, and genetic factors that are as yet known are also suspected to play a role in the aetiology of IBS. Diagnosis A diagnosis of IBS can be made using the Rome III criteria of red flag symptoms (Paterson et al., 1999). According to these criteria, an individual is diagnosed with IBS if they have experienced, for at least 6-months, any of the following symptoms: abdominal pain or discomfort; bloating; or, change in bowel habit. In addition, the individual has to present with abdominal pain or discomfort that is relieved by defecation or associated with changes in bowel frequency or stool formation, and have at least two of the following: altered stool evacuation (i.e. straining, urgency, incomplete evacuation); abdominal bloating (i.e. distension, tension, or hardness); symptoms made worse by eating; mucus from the rectum. Reported lethargy, nausea, backache and bladder symptoms are also indicators that might inform a diagnosis of IBS. Furthermore, there are a number of tests that are carried out to exclude other diagnoses. These include a full blood count, erythrocyte sedimentation rate or plasm a viscosity (screening test), c-reactive protein (found in blood), and, antibody testing for coeliac disease (RCN, 2008). The red flag symptoms that require the individual to be referred to secondary care for further investigation include unintentional and unexplained weight loss, rectal bleeding, and, a family history of bowel or ovarian cancer (NICE, 2008). In people aged 60-years or over, a change in bowel habit lasting more than 6-weeks with looser and/or more frequent stools also acts a red flag. Other indicators for referral include anaemia, abdominal or rectal masses, and inflammatory markers for inflammatory bowel disease (NICE, 2008). Treatment There is no cure for IBS, but it can be managed and controlled through lifestyle changes and medicine. NICE provide clinical guidelines on the management of IBS in primary care, which were developed through input from the National Collaborating Centre for Nursing and Supportive Care (NCC-NSC). These guidelines include the provision of general lifestyle advice, particularly in terms of dietary and physical activity advice (NICE, 2008). The treatment and management of IBS is largely focused on providing individuals with the information required to self-manage their condition through diet, physical activity, and medication for specific symptoms. Dietary advice includes having regular meals, taking time to eat, drinking at least eight cups of water daily, and restricting consumption of tea, coffee, alcohol, fizzy drinks, high-fibre foods, resistant starch (i.e. whole grains, legumes, seeds), and fresh fruit. Individuals with diarrhoea are advised to avoid sorbitol, which is an artificial sweetener found in sugar-free sweets and drinks. Individuals with wind and bloating, on the other hand, are advised to increase intake of oats and linseeds. If diet is assessed as being a key factor in the IBS symptoms, the individual is referred to a dietician for single food avoidance and exclusion diets. In terms of physical activity, individuals who score low in physical activity on the General Practice Physical Activity Questionnaire (GPPAQ) are provided with brief advice and counselling aimed at increasing their activity. The importance of physical activity in the management of IBS cannot be underestimated. Indeed, a study conducted in Sweden demonstrated that even a minimal increase in physical activity can improve symptoms of IBS (n=102) (Johannesson et al., 2011). First-line pharmacological treatment is dependent on the primary symptoms reported by the individual. For example, there is support for the provision of antispasmodic agents such as hyoscine or peppermint oil to control symptoms of abdominal pain and spasms (Ford, 2008). Laxatives are an option for constipation, whilst loperamide is the recommended first choice of antimobility agent for diarrhoea (NICE, 2008). Second-line pharmacological treatment includes the consideration of tricyclic antidepressants for mood and analgesic (pain relieving) effect if first-line treatments do not work (Bell, 2004). Selective serotonin reuptake inhibitors are considered if tricyclic antidepressants do not work. However, due to the potential side-effects of these second-line medications, follow-up after 4-weeks and then every 6-12 months is advised (NICE, 2008). Psychological Implications If individuals with IBS do not respond to second-line pharmacological treatments after 12-months, referral for psychological support such as cognitive behavioural therapy (CBT), hypnotherapy, or psychotherapy requires consideration (NICE, 2008). Indeed, although it is not a life-threatening condition, IBS can result in a great deal of psychological distress. One study found that half of the patients attending IBS clinics presented with a diagnosable psychiatric disorder (Silk, 2003). Anxiety and depression have been reported in people with IBS and stress and major life events have been found to often precede the onset of bowel symptoms (Silk, 2003). Strong associations have been found between IBS and Generalised Anxiety Disorder (GAD), with this comorbidity adding to social impairments (Lee et al., 2009). There is also a higher prevalence of childhood physical and sexual abuse among individuals diagnosed with IBS, further indicating the potential efficacy of providing psychological s upport (Allison, 2002). The psychological impact of IBS is likely to result from that fact that it can be extremely debilitating and can severely impact quality of life (Heitkemper and Jarrett, 2001). Activities of daily living can be detrimentally impacted and individuals with IBS often experience lethargy and fatigue, which can limit physical activity and social life (Jones et al., 2000). Bertram et al. (2001), who conducted focus groups with people diagnosed with IBS, found that the condition resulted in high levels of frustration and social isolation. There was also an inconsistency in how individuals with IBS perceived their illness and how they felt others perceived their illness. In particular, there was frustration with a lack of understanding from family, friends, and colleagues in terms of the severity and unpredictability of the illness. Many participants also felt that health care professionals did not take the illness seriously. There is some evidence, however, to suggest that health profession als attitudes towards IBS are changing. In a study conducted by Nunn (2003), the majority of nurses disagreed with a statement suggesting that patients with IBS were demanding and lazy. Nevertheless, the stigma surrounding IBS can result in individuals with IBS not accessing the support they need. When combined with the general lack of effective treatments for IBS, people often try to treat themselves. It has been estimated that 50% of people with IBS use complementary and alternative medicine (Hussain and Quigley, 2006). The NICE (2008) guidelines on the use of complementary and alternative medicine, however, recommend against encouraging their use, especially acupuncture and reflexology. Economic Implications Evidence suggests that disease relapse and remission accounts for 36-50% of all gastrointestinal consultations, although many patients do not seek help and often attempt to self-treat (Gunn et al., 2003; Parker, 2004). IBS has a significant impact on healthcare resources in both primary and secondary care (Ringstrom et al., 2007). It also contributes to both direct and indirect costs. Evidence suggests that disease relapse and remission accounts for 36-50% of all gastrointestinal consultations, although many patients do not seek help and often attempt to self-treat (Gunn et al., 2003; Parker, 2004). IBS can lead to increased absenteeism at work and higher rates of health care utilisation, making it a public health problem (Talley, 2008). In a systematic review of the economic cost of IBS in the UK and US, total direct cost estimates per patient per year ranged from $348-8750 ( £211.79-5325.25) (calculated for year 2002) (Maxion-Bergemann, Thielecke, and Bergemann, 2006). The average number of days off work per year because of IBS was between 8.5 and 21.6; indirect costs ranged from $355-3344 ( £216.25-2037.04). Of note, however, is that the total costs and cost components of IBS were influenced by factors such as the demographic of the patient group and study variables, such as design and databases used. Further research is needed on the cost-effectiveness of diagnostic procedures and  treatments for IBS in order to help define strategies to help IBS patients improve their quality of life and, in turn, reduce related healthcare and economic costs. Conclusion This essay has outlined the aetiology and epidemiology of Irritable Bowel Syndrome, which is one of the most common gastrointestinal disorders worldwide. IBS is a chronic disorder that cannot be cured, but requires self-management through lifestyle, pharmacological treatments, and psychological support. The direct and indirect costs of the condition are vast due to the relapsing and remitting nature of the symptoms. Due to there being no clear cause for IBS, stigma still exists regarding its seriousness, which can prevent people seeking medical support. In order to reduce the direct and indirect costs of this common, quality of life depleting illness, healthcare professionals need to take it seriously and assist patients in the long-term management of the physically and psychologically limiting symptoms.

Essays --

In my thesis, I would like to analyse the representation of football stars in two iconic British magazines. My aim is to show how two distinct magazines contribute to the ongoing narratives of football players and managers. The first is one of the most famous football magazines around the globe, the authoritative FFT and the second is the original lad’s magazine, Loaded. Naturally, the proper investigation of this complex topic requires knowledge from various fields of cultural studies. In the following, I will introduce the theories and ideas related to my study. First of all, the term ‘football star’ should be examined closely. Although stars permeate the media, the meaning of sport star is not necessarily self-evident. Everyone has a rough idea about stars and stardom, but as I concentrate strictly on football stars in my study, a precise definition cannot be omitted. The main reason for this is that sport news is not only about sport stars but also players and managers who are not part of the star system. Smart states that the foundation of becoming a sport star is a unique sporting moment which shows the player’s exceptional talent. In order to keep this status, the player has to demonstrate his special skills repeatedly under pressure, against opponents in a highly competitive field (Smart 2005, 156). In addition, he has to grab the audience’s attention through media coverage and promotion. Cultural intermediaries and the audience together elevate the player to the star level. When this happens, exceptional qualities and original characteristics are being attached to the player’s name (Smart 2005, 156-157). Smart points out that appearance strongly increases media attention. He supports this point by claiming that David Be... ...hat Europe is a collection of individual nations. Even when discussing teams and fans of other nations, national reference points are frequently used. Pan-European identity almost exclusively appears in conjunction with references to the nation. Typically, Europe is only imagined as ‘self’ when it is dominated by English culture and fits into the framework of the English nation, otherwise it is considered to be ‘other’. The author concludes that the nation is essential to the sports media industries, as football basically relies on the idea of national ‘us’ and ‘them’. Moreover, the concept of nation is at the centre of fan cultures and popular culture surrounding football. In football culture, national stereotypes are a key source of humour. While all Europeans seem to celebrate football similarly, they are divided into national collectives (Inthorn 2010, 791-798).

Delamere Vineyard Essay

â€Å"Delamere Vineyard is a small, integrated winemaking business in Tasmania, specializing in pinot noir (red) and chardonnay (white) wines. Richard Richardson, Delamere’s owner and winemaker, manages and operates the vineyard and winery largely alone. His products have won praise and awards in the past, but Richardson strives continuously to improve. Delamere competes in the high-priced segment, in which quality is paramount. Richardson is well equipped as a winemaker–with a Ph.D. in agricultural chemistry and 15 years’ experience.† (Harvard Business School, 2000) Winemaking is a very exclusive, yet competitive business that requires great care and understanding of customer demands. Problem Richard Richardson, winemaker at Delamere Vineyard, is facing a change in his production of wine with uncertainty because of his ongoing desire to improve quality and sales. He has relied on his scientific knowledge to steer his company and now would like to move forward and improve his quality of wine and increase profit. Richardson is in the process of upgrading his production process to produce a better quality product based on customer satisfaction and wine critics, and needs to make a decision on how he will implement this. Objectives/Goals Richard Richardson is facing challenges for the new direction of his company. He needs to make some decisions as to his innovative way of wine production to enhance the quality and increase his profit and sales. Richardson needs to improve customer satisfaction for his pinot noir and chardonnay wines. Richardson has to improve his marketing and advertising for the vineyard to increase sales and profit. Richardson needs to find a niche in the wine industry and set his wine apart from the other vineyards. Richardson has been making mediocre wine for the past 15 years and desires to set his company apart by increasing the quality and production of his wine to boost profit and sales. â€Å"At the establishment of his vineyard, Richardson had drawn inspiration from his scientific training and the advice and example of others who preceded him† (Harvard Business School, 2000). Richardson needs to focus on the process of developing quality wine with the purpose of meeting a large percentage of customer satisfaction without sacrificing capital or increase costs in production over a long period of time. Since Richardson is fixated on two types of winemaking, he needs to focus on the ways to improve quality and control outcome to maintain consistency throughout the years. Customers are quick to notice subtle changes in wine quality and are apt to err on the side of caution when deciding on future purchases. Wholesalers are the wineries main source of sales and they â€Å"sought consistent quality at a moderate price, and favored wines that would have wide appeal by being made in a recognizable and popular style† (Harvard Business School, 2000). Richardson is very emotionally attached to his business and takes the entire role of decision making upon himself. Richardson needs to consider insight into new trends in winemaking and procedures that have worke d in the past with other vineyards. Delamere Vineyards should be a family business built on the constant goal of improving production, distribution, sales and quality. Analysis Delamere Vineyard is currently producing pinot noir and chardonnay wines at varying qualities to satisfy the demands of the consumers. Richardson has been working on his wine selection and vineyard for 15 years and is now in search of improvement of for quality of wine. Scientific knowledge has allowed him to start and continue his business of wine making with little knowledge of the process most winemakers go through to produce a quality and enjoyable wine selections. Richardson, while his process so far has yielded positive results, is in need of reevaluating his production process and possibly the distribution process to increase his business. Richardson bears the entire responsibility of decision making for the company. â€Å"While instinct coupled with analysis may make a powerful decision-making combination, beware intuition’s pitfalls. Often, your gut is just plain wrong – because it’s subject to biases† (HBR, 2001). Decisions that involve where a company’s future is headed and changes in operations must be made with a clear head, and the long time notion of three heads are better than one should come into play. Richardson admits that sales is dependent on the quality of the wine. The process of winemaking is difficult to specifically characterize and replicate for consistency. Richardson has pinpointed some areas in his business where improvement can be made to set his wine apart from the competition while increasing productivity and sales. His first option involves â€Å"consideration to amend winemaking procedures to eliminate the possibility of oxidation as the wine matured. Excessive contact with oxygen, along with other chemicals, induced compounds called aldehydes, which could create a distinct and unpleasant flaw in the wine’s taste, unforgettable bitter aroma somewhat akin to stale oil, along with an unattractive browning of the color† (Delamere Vineyard, 2000). This option leads to a constant output of good quality wine. This process will allow Richardson to attract a large amount of customers through both mail order and wholesalers due to the fact that this process can produce the same type of wine product every year. Customers tend to feel at ease purchasing wine from distributors who have produced the same product on a constant b asis and feel comfortable with the level of quality. Sulfur Dioxide (SO2) is the â€Å"wonder drug† to combat oxidation in the winemaking process. Considering the fact that most winemakers tend to agree that the introduction of sulfur dioxide (SO2) is the failsafe solution to preventing oxidation, the decision to incorporate some level of sulfur dioxide should be definitely considered and implemented. Richardson claims that he presently includes a small amount of sulfur dioxide into his winemaking process and it debating his new approach; continue his current process, increase his SO2 or spend time and money and waste some of his product to develop the correct scientific method for the incorporation of sulfur dioxide. Logic and reasoning would conclude that Richardson should stick with industry standards when it comes to the level of sulfur dioxide to add to the winemaking process since it has been proven time and again with success. He is dissatisfied with his current wine production, and therefore, he should not even consider the approach of â€Å"doing nothing† when it comes to preventing oxidation in his wine. The long term benefits of spending time perfecting the process of how much sulfur dioxide to add to the mix could be beneficial to Delamere Vineyard. Richardson has the ultimate goal of setting his wine apart from other manufacturers while keeping the small family business image. He is already well versed and educated in science and would not need to enlist in outside help to spend time perfecting his process. Sticking with the status quo on the mixture will likely ensure consistency in the short run, but prove to be a common type of wine in the industry. â€Å"Over the years, various management studies have found that executives routinely rely on their intuitions to solve complex problems when logical methods (such as a cost-benefit analysis) simply won’t do. In fact, the consensus is that they higher up on the corporate ladder people climb, the more they’ll need well-honed business instincts. In other words, intuition is one of the X factors separating the men from t he boys† (HBR, 2001). Richardson is more likely to trust his scientific knowledge and experiment with possible scenarios to advance his understanding of the winemaking process to guide him towards perfection. Richardson’s second possible project involves finding a way to deepen the color of his red wine. Richardson is convinced that his main market Australians would be more likely to purchase his wine if it had a fuller red hue. Richardson identified that other manufacturers succeeded in darkening their wine by providing a longer maceration before and following fermentation and introducing higher temperatures during fermentation. The dilemma was that Richardson was already performing these tasks with his current wine, which meant his only option would be to transition from his currently fermentation process to a more sophisticated one. This process would cost the vineyard $30,000 to purchase and at least 10% of product with no real assurance that it will be successful. The cost-benefit of this approach will lead to Richardson risks capital that he doesn’t have available to waste to hopefully produce a product that has a hue preferred by his customers. Managers â€Å"apply factual research to historical precedent that’s so widely accepted in an organization that it’s no longer challenged. Things deemed to be common knowledge are often the result of inferences made by the ‘primal’ mind – they’re a product of evolution, and so tend to be governed by emotions and instinct† (Harvard Management Update, 2002). Richardson has conflicting views on his long-term goals for his vineyard. On one spectrum he is focused and passionate about improving the quality and consistency of his wine and winemaking process to increase sales and profit. Richardson would also like to accomplish this in his small family owned business with almost the entire operating burden placed solely on himself. On the other hand, Richardson has mentioned the potential long-term growth benefits of quality improvements to his vineyard. Richardson has not made note to how his family owned vineyard would continue to operate should they increase production and sales of their product. Investing time and money into growing the company would require increased staff and land to store the wine barrels before sales and distribution. Richardson needs to weigh his options and focus on his own long term personal goals in addition to the organization. Does he want to be working for the next 30 years? Employing in outside sources of help will bring a fresh perspective to Richardson’s winemaking approach. Richardson’s third possible improvement is to determine the best mix of whole bunches, stalks, and de-stemmed grapes to include in his crush to speed up and automate production. When Richardson was evaluating this option, red flags were popping up at every point. Initially, he specified that is option did not solve any foreseeable problem with his winemaking process; therefore if there is no problem a solution cannot be developed. Second, this type of fermentation would require more space in his winery and limit his ability to control the entire winemaking process. Since most of his potential projects focused on more control in the development of wine, this idea actually contradicts Richardson’s problem with his vineyard. â€Å"The ability of managers to solve problems and make decisions rationally has long been assumed to be one of the valuable products of experience on the job. But close observation of their actually practices has shown that even veteran managers are likely to be very unsystematic when dealing with problems and decisions. And their hit-or-miss methods often produce decisions based on erroneous conclusions, which means that the decisions must also be wrong† (HBR, 1965). Any option that would increase his cost while not ensuring a definite increase in profit would be making a decision which would hinder the ability to prosper in the future. The small chance that altering the mix of grapes would result in a more complex and aromatic wine does not outweigh the potential result that the wine could rapidly turn to vinegar spoiling his entire vintage. Recommendations â€Å"Winemaking is capital intensive, in terms of both investment and working capital. Startup costs for even a small vineyard and winery were heavy, relative to anticipated cash flow† (Harvard Business School, 2000). Richardson needs to consider enlisting outside help experienced in the business of winemaking who can lend some insight into new trends in winemaking and procedures that have worked in the past with other vineyards. The ability to bounce ideas off other people who have knowledge in winemaking will allow Richardson to make future decisions without bias. He currently relies on intuition, past experience in his vineyard, and his scientific background to produce his wine. Richardson needs to incorporate a full-time staff that can use his ideas and industry standards to not only improve the quality of wine, but improve the manufacturing process which can develop his company as well. Richardson will not be able to run his family business as a one man shop when his sales double. Richardson would also benefit from removing his cognitive blinders in his company and investigate other vineyards that have been experiencing the same type of situations. Usually businesses experience the same types of problems in manufacturing and distribution, and learning from other companies mistakes will allow managers to make reasonable decisions with minimal risk. Richardson should prioritize his projects and develop a time line for completion based on the risk assessment. The idea of eliminating the oxidation in the mine is an option that will provide the least amount of financial loss. Richardson would be smart to start his project with industry standards for the introduction of sulfur dioxide while also taking time to use his scientific knowledge to find the perfect mixture for future vineyard growth and quality development of the pinot noir. Richardson would be foolish to entertain the idea of spending $30,000 which is almost half of his net income on a rotofermenter. The outcome would only generate a 10% increase in price and the cost-benefit/long-term benefit is nonexistent. In decision making, managers can take on the six thinking hats to solve the problem. The â€Å"black hat† in decision making allows â€Å"participants to identity hazards, risks, and other negative connotations. This is critical thinking, looking for problems and mismatches† (Six Thinking Hats, 2010). His â€Å"black hat† decision making skills should see that a 10% increase over a period of 1 year would only yield $25,000 if it succeeds. Richardson’s third project idea of switching to whole bunch fermentation will cost him too much in wine product spoilage, take away valuable winery space that could be used for extra wine barrels and produce no guaranteed profit if successful. This idea would be beneficial if Richardson would commit to long-term goals of increased staff, especially in the managerial capacity. This would also allow him to focus on perfecting his winemaking process while someone else could focus on day-to-day operations. Works Cited (2010, Aug. 6 ). In Six Thinking Hats. Retrieved Aug. 17, 2010, from http:en.wikipedia.org/wiki/Six_Thinking_Hats Hayashi, A. (2001). When to Trust Your Gut. Harvard Business Review, pp. 3-11. Stauffer, D. (2002). How Good Data Leads to Bad Decisions. Harvard Management Update, pp. 1-5. Stryker, P. (1965). Can You Analyze This Problem?. Harvard Business Review, pp. 73-78. West, J. (2000). Delamere Vineyard. Harvard Business School, pp. 1-21.

Case History of Eric B. Essay - 1148 Words

Case History of Eric B. Eric is a 6-year old African-american male who was raised in an impoverished inner city neighborhood in Chicago. Drugs and violence surrounded his daily life. With a single-mother who involved herself in a series of relationships with abusive boyfriends, Eric found himself beat with a belt, and may have been sexually assaulted. His mother was not home that often, and he was forced to sit outside on the stoop so that his grandmother, that also lived with them, could sell drugs. His mother was uneducated and supported the family with her public assistance grant. He has never met his father, and his uncles are in jail. His father was convicted of robbery and drug charges but Eric was told that he was shot to†¦show more content†¦If his mother does not allow him to take iniative then he will feel guilt for his attempts at independence. He may also be in the industry vs. inferiority stage. This means he should be aware of his responsibilities such as homework and chores . He should be able create a sense of industry, if praised and rewarded by his mother. If not, then he will feel inferior. He would also be influenced by his peers and teachers. However, this is merely how is should be, but is not how it is for Eric. Lack of iniative is not the problem. Without a parental figure present, Eric was forced to take on too much iniative and make too many decisions on is own. He feels no guilt in being independent but according to Erikson, should feel inferior due to the lack of praise and reward from his mother. According to Jean Piaget, and his stages of cognitive development, kids construct their knowledge of the world through reorganization and they move to higher levels of psychological functioning. Piaget looked at how kids think of themselves and their environment, when moving through each stage. In these stages, children select what they see and they interpret. In the preoperational stage, ranging from ages 2-7, children should have a mastery of language and use words to represent objects. In this stage, children cannot use developmental capacities systematically. They are quite egocentric,Show MoreRelatedColumbine High School Massacre : The Facts, Theories, Issues, And Solutions Essay1601 Words   |  7 PagesColumbine High School Massacre: The Facts, Theories, Issues, and Solutions On April 20, 1999, one of the largest school shootings in American history took place at Columbine High School in Littleton, Colorado. Two teens, Eric Harris and Dylan Klebold, shot and killed 13 people and wounded more than 20 others both before committing suicide. Many believe the two teens decided to hold this school massacre because both were bullied and were outcasts. 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