Advanced Paramedical Science

Nausea and vomiting is a commonly encountered problem in the emergency department as it accompanies a multitude of conditions ranging from seemingly benign conditions such as migraine and gastroenteritis to potentially lethal conditions such pancreatitis and the acute abdomen.Studies from the U.S have shown that each year, almost 8 million individuals present to the emergency department with complain of nausea and vomiting, either as a principal complain or as a part of another disease etiology (Braude, Soliz, Crandall, Hendey, Andrews, & Weichenthal, 2006, p. 77).Nausea and vomiting are not distinct disease entities. Rather, they are symptoms which can be present in a wide range of disease conditions and are considered to be the ‘end-points’ of several pathological processes (Klosterhalfen and Enck cited in Kowalski, Rapps, & Enck, 2006 p.28). The term nausea refers to the subjective feeling or the urge to regurgitate gastric contents (Kuver, Sheffield, & McDonald, n.d. ).From a physiological point of view, this is associated with reduced gastric motility and increased smooth muscle tone of the small intestine. Moreover, there might also be the presence of reverse peristalsis in the small intestine, which can cause the feeling of imminent regurgitation (Bowen, n.d.).On the other hand, vomiting refers to ‘the forceful discharge of gastric contents’ (Kuver, Sheffield, & McDonald, n.d.) which is meant to serve the purpose of protecting the gastrointestinal tract from potentially harmful substances by preventing their entry and transit through the gastrointestinal tract (Kuver, Sheffield, & McDonald, n.d.).Vomiting, if persistent can have several potentially hazardous consequences such as dehydration, electrolyte imbalances, metabolic derangements, manifesting as alkalosis and even bleeding and esophageal perforation (Kuver, Sheffield, & McDonald, n.d.). Moreover, from the patient’s perspective, nausea and vomiting can be distressfu l and thus appropriate and timely management of these two conditions is imperative.The Physiology of Nausea and Vomiting – an overview of the stimuli and pathway involvedFor several decades now, it has been established that the chemoreceptor trigger zone in the brain which is responsible for emesis is the area posterema. This is a region located at the dorsal surface of the medulla oblongata near the caudal end of the fourth ventricle. It is one of the ‘circumventricular organs’ and by the virtue of possessing a relatively permeable blood-brain barrier, is sensitive to a variety of stimuli (Sanger & Andrews, 2006, p. 5).Thus, it plays an important role in emesis. Studies have shown that there are five main kinds of stimuli which can trigger nausea and vomiting via different pathways viz. the presence of toxic materials within the gut lumen, presence of toxins in the blood, a pathology within the gut, a central nervous system (CNS) stimulus or disturbances in the vestibular system (Sanger & Andrews, 2006, p. 5). The mechanism whereby each of these stimuli brings about nausea and vomiting is discussed below.The presence of toxic materials within the gut lumen:The presence of toxins, such as drugs has been shown to stimulate the enteroendocrine cells, such as the enterochromaffin cells, located in the gut mucosa and result in the release of several mediators such as 5HT3, Substance P and CCK.This results in the stimulation of vagal afferent neurons which are located in the abdomen. These neurons traverse through the nucleus tractus solitarius (NTS) and are projected to the dorsal brainstem, with some projection in to the area posterema (Sanger & Andrews, 2006, p. 5).Presence of toxins in the bloodToxins which have been absorbed and are circulating in the bloodstream can directly stimulate the area posterema and cause induction of emesis (Sanger & Andrews, 2006, p. 5). This is the most common mechanism whereby ingested or parenterally administe red drugs, such as chemotherapeutic agents and other toxins such as drugs of abuse, invoke the emetic response.Gastrointestinal tract pathologiesCertain pathologies of the gastrointestinal tract, such as gastritis or hypertrophic pyloric stenosis can stimulate the vagal afferents or directly activate the pathways leading to emesis (Sanger & Andrews, 2006, p. 6).Central nervous system (CNS) stimuliCertain stimuli such as intense fear, anticipatory anxiety, injury to the brain or a sudden increase in the intracranial pressure can induce emesis (Sanger & Andrews, 2006, p. 6). The mechanism involved in such a response has not yet been elucidated clearly.Disturbances in the vestibular systemAmongst other manifestations of disturbances in the vestibular system, such as dizziness, nausea and vomiting is also an important symptom. The vestibular system has been shown to directly stimulate the pathways involved in the emetic response and hence produce nausea and vomiting (Sanger & Andrews, 2 006, p. 6).All these stimuli have been shown to stimulate various pathways which have one common outcome viz. the stimulation of the emetic center in the area posterema. (Kuver, Sheffield, & McDonald, n.d.). Several receptors, both central and peripheral, have been implicated in bringing about emesis.Amongst these the most pertinent ones are Dopaminergic receptors (particularly D2), Histaminergic receptors (especially H1), Muscuranic receptors (including M3/M5), 5-hydroxytryptamine receptors, in particular, 5-HT3 and the neurokinnin receptor, NK1 (Sanger & Andrews, 2006, p. 8)Once any of the above mentioned stimuli are encountered, an afferent response as discussed above is generated. This results in the activation of the chemoreceptor trigger zone in the area posterema. Subsequently, a motor response is generated, whereby efferent pathways involving the cranial nerves V, VII, IX and X are activated. Moreover, autonomic responses are also generated (Kuver, Sheffield, & McDonald, n.d .).The vagal efferents to various muscle groups such as those located in the esophagus, stomach and the intestine are activated bringing about stimulation of these muscles (Sanger & Andrews, 2006, p. 6). Moreover, abdominal muscles, phrenic muscles and the diaphragm are also stimulated to bring about the required increase in the intra-abdominal pressure. The combination of both these effects leads to the regurgitation of the gastric contents.Moreover, this is also accompanied by various other manifestations such as an increase in salivation, brought about by the stimulation of the chorda tympani branch of the facial nerve, autonomic stimulation of the cardiovascular and respiratory systems and vasoconstriction of skin vessels (Sanger & Andrews, 2006, p. 6).Antiemetic drugs used in pre-hospital careNausea and vomiting are commonly encountered clinical problems. Over the years, several anti-emetic medications have been discovered to effectively alleviate the symptoms of nausea and vom iting.These drugs work by blocking the pathways involved in the initiation and production of emesis. Various drugs have been developed which block the different receptors, both central and peripheral, involved in producing emesis.The anti-emetic medications which are used in common clinical practice can be grouped in to seven major categories according to their mode of action. These include anti-cholinergics, antiserotonins, antihistamines, Benzamides, Butyrophenones, Phenothiazines and steroids (Scuderi, 2003, p. 43).The mechanism of action and the dosages of the four main anti-emetics used in Ambulance Services in Australia are discussed below:1.  Ã‚  Ã‚  Ã‚  Ã‚   Metoclopramide (Maxolon):Metoclopramide has been used in clinical practice for several decades now as an antiemetic and a prokinetic agent (Walkembach, Bruss, Urban, & Barann, 2005, p. 50). These antiemetic functions are thought to be brought about by the antagonistic actions of Metoclopramide on the dopamine (D2) rece ptors, both central and peripheral, and also on the 5HT3 receptors (Walkembach, Bruss, Urban, & Barann, 2005, p. 50).On the other hand, the prokinetic action of Metoclopramide are brought about by the relaxation of the pyloric sphincter, the increase in the strength and frequency of peristalsis and an increase in the tone of the lower esophageal sphincter (Australasia, 2008).This drug is available in both tablet (white, round, 7mm in diameter) and injection (colorless, aqueous solution) forms (Australasia, 2008). The maximum dose of Metoclopramide commonly used in all age groups is up to 0.5 mg/kg body weight.The recommended dosage regimen for adults is 10mg three times daily while for children it varies between 2.5mg-5mg   three times daily (Australasia, 2008). The metabolism of Metoclopramide takes place in the liver and it is eliminated from the body predominantly via the kidney. (Australasia, 2008)2.  Ã‚  Ã‚  Ã‚  Ã‚   Prochlorperazine (Stemetil)Prochlorperazine is a phenothi azine which has been shown to block the dopamine receptors (D2) in the chemoreceptor trigger zone located near the area posterema. By blockage of these receptors, Prochlorperazine exerts its antiemetic actions. The recommended dosage of Prochlorperazine in is 10 mg intravenously (Goodman and Gilman’s: The Pharmacologic Basis of Therapeutic cited in Ernst, Weiss, Park, Takakuwa, & Diercks, 2000, p. 92).In emergency practice, IV administration of 2.5-10 mg of Prochlorperazine at a rate of up to 5mg/min is recommended for adults. The maximum dose should not exceed 40mg per day. Moreover, IM injections of this drug are also available. They are administered at a dose of 5-10 mg every 3-4 hours (Bartlett, 2009, p. 861).3.  Ã‚  Ã‚  Ã‚  Ã‚   Ondansetron (Zofran)Ondansetron is a carbazole derivative and is a potent antiemetic drug which is widely used in alleviating the symptoms of nausea and vomiting associated with chemo- and radio- therapies and also in the management of post-ope rative nausea and vomiting (Scuderi, 2003, p. 59). Its proposed mechanism of action is via selective antagonism at the level of the 5 HT3 receptors (Scuderi, 2003, p. 59).Chemotherapeutic agents are thought to bring about nausea and vomiting via the stimulation of enterochromaffin cells in the gut mucosa leading to 5HT3 production and subsequent vagal stimulation. This pathway is blocked by 5HT3 antagonists such as Ondansetron.Ondansetron has been shown to have a short half life of approximately 3 to 5 h (Ho & Gan, 2006, p. 607). The recommended dosage of Ondansetron varies between 8-16 mg twice daily (Bartlett, 2009).4. Promethazine (Phenergan)Promethazine is also a phenothiazine but is shown to have dual modes of action. It not only blocks the dopamine receptors (D2) but has also been shown to have anti-H1 histamine receptor effects. It is used for a wide range of purposes including in the treatment of motion sickness, vertigo and even allergies (Bartlett, 2009, p. 869).The recomm ended oral dose of Promethazine is 25 mg twice daily. It can also be administered intravenously at a dose of 12.5-25 mg every four hours. The maximum dose is 150 mg/day (Bartlett, 2009, p. 869).PART IIThere are several clinical conditions which can present with the symptoms of nausea and vomiting. Amongst these the most common condition is gastroenteritis, migraines and pancreatic amongst others.The adequate and timely management of patients with nausea and vomiting has posed a challenge for the clinicians for several decades and although several effective anti-emetics have been discovered, there has been a quest for a single anti-emetic which is efficient, fast acting and relatively safe.In the practice of ambulance services and emergency situations, different anti-emetics are commonly used including Metoclopramide, Chlorpromazine, Ondansetron and Promethazine. Amongst these, in my opinion, the most suitable drug for use in the ambulance service and emergency departments is Metoclo pramide.This is because on comparing the onset of action, clinical efficacy and side effect profiles of the most common anti-emetic agents, it is apparent that Prochlorperazine is superior to all other agents used. Moreover, its cost, availability and easy administration make it suitable for use in the emergency practice. Following is a comparison of the four most commonly used anti-emetic drugs.A common concern with the use of any drug is its safety and side effect profile. Safety becomes more important while dealing with patients in the emergency or ambulance care since limited resources, time and personnel are available in such settings, and the prime concern is the stabilization of the patient and alleviation of his symptoms.Drugs which have potentially unsafe need to be administered with caution and the patients need to be monitored for the occurrence of adverse effects. This is not feasible in emergency and ambulance practice and thus the ideal drugs for use in such settings a re those which have no or minimal side effects.With Metoclopramide, there is a 10-20% incidence of side effects and these side effects are mild. The most common side effects observed with this drug are CNS effects such as anxiety, restlessness and insomnia which can vary in severity (Australasia, 2008).Moreover, it has also been shown to cause fatigue and occasionally can cause extrapyramidal side effects. Another relatively common side effect of Metoclopramide is gynecomastia which occurs as a result of enhanced prolactin secretion (Kuver, Sheffield, & McDonald, n.d.).A rare complication associated with the use of Metoclopramide is Neuroleptic Malignant Syndrome which is a medical emergency and can lead to death. However, it is observed in only less than 1 in 10,000 cases (Australasia, 2008) .On the other hand, the phenothiazines including Prochlorperazine and Promethazine have been shown to have a greater number of side effects. Amongst these the ones which arouse the most concern are extrapyramidal symptoms.Extrapyramidal symptoms can range from tremor to akathisia and the potentially hazardous tardive dyskinesias (Australia, 2009). Moreover, they can also manifest as dystonic reactions are similar to the manifestations of Parkinson's disease. Less commonly, Neuroleptic Malignant Syndrome, which is a medical emergency, can also result from the use of these drugs.These effects are thought to be caused due to the central antidopaminergic properties of the phenothiazines on the dopamine receptors. The occurrence of these symptoms is noticed most commonly within 36 hours of initiation of treatment. However, these symptoms are reversible and once the drug is discontinued, they disappear within 24 hrs (Australasia, 2008).It is important to note that with Metoclopramide, the occurrence of extrapyramidal side effects is not very common. On the other hand, the phenothiozones such as Prochlorperazine and Promethazine have a much greater incidence of these side effect s.Drotts and Vinson (1999) in their study showed that with the use of Prochlorperazine, incidence of akathisia was 44% within 1 hour and 5% within 48 hours. (Braude, Soliz, Crandall, Hendey, Andrews, & Weichenthal, 2006, p. 181). Other studies, such as those of Ernst et. al., have supported these findings.These extrapyramidal symptoms, if severe, have to be treated with intravenous infusions of an anti-cholinergic agent such as diphenhydramine (Ernst, Weiss, Park, Takakuwa, & Diercks, 2000, p. 92).Other common side effects of phenothiazines include constipation, blurred vision, mild elevation of the hepatic enzymes (if the patient develops cholestatic jaundice), ECG changes, arrhythmias and hypotension (Australia, 2009).Hypotension in patients who are already dehydrated due to vomiting can lead to significant patient distress and is also important from the point of view of health care professionals, as it poses difficulties in patient management in emergency and ambulance settings. Moreover, most phenothiazines, in particular Promethazine are known to cause sedation due to histamine blockade.Promethazine has also been shown to reduce the seizure threshold. Due to the multitude of serious adverse effects of Promethazine the Food and Drug Administration (FDA) has restricted its use in children under two years of age (DeCamp, Byerley, Doshi, & Steiner, 2008, p. 859).As compared to Metoclopramide, Ondansetron has relatively lesser side effects. The most commonly encountered adverse effects of this agent include headaches, constipation and mild elevation of serum transaminases (Kuver, Sheffield, & McDonald, n.d.).But this drug is not preferred over other anti-emetic agents due to its cost and availability issues (Ernst, Weiss, Park, Takakuwa, & Diercks, 2000, p. 92). Moreover, it is used more commonly to prevent post-operative nausea and vomiting and in patients receiving chemotherapy and its role in acute settings has not been extensively studied.Pregnancy is one of the most common conditions which present with nausea and vomiting.   Amongst the commonly available anti-emetics only a few are safe to use in pregnancy.Studies have shown Metoclopramide to be safe for use during pregnancy and this drug has not been shown to cause any long term complications in children of mothers using it during pregnancy (Sà ¸rensen, Nielsen, Christensen, Tage-jensen, Ekbom, & Baron, 2000). Similarly the safety of Ondansetron has also been proven by several studies conducted recently (Einarson, Maltepe, Navioz, Kennedy, Kennedy, & Koren, 2004, p. 940).However, both Promethazine and Prochlorperazine belong to Category C and thus   have limited use in pregnancy (Australia, 2009).Another advantage of Metoclopramide is its ability to provide faster relief from the symptoms of nausea and vomiting. Metoclopramide has been shown to have a rapid onset of action. Following IV administration, its effects start manifesting in around 1 to 3 minutes, whereas following intramuscular administration, 10 to 15 minutes is required (Australasia, 2008). This rapid action makes it suitable for use in emergency practice,Although there is a paucity of studies comparing the cost effectiveness of Metoclopramide with other antiemetics, studies comparing the cost-effectives in patients undergoing chemotherapy have shown that Metoclopramide to be more cost effective than Ondansetron (Ballatori, et al., 1994).Thus, in conclusion, keeping the side effect profiles, the availability and cost effectiveness of all the anti-emetics in view, in my point of view Metoclopramide is best suited for use in ambulatory settings. Metoclopramide has several benefits over other anti-emetics.It has a fast onset of action which makes its practical for use in emergency settings. Moreover, it has lesser and milder adverse effects as compared to other anti-emetics. In addition, it can be used in all age groups and is safe in pregnancy. Thus, all these properties make Metoclopramide i deal for use in ambulatory care settings.ReferencesAustralasia, V. P. (2008, October 22). Metoclopramide hydrochloride-Data sheet. Retrieved May 1, 2009, from Medsafe-INFORMATION FOR HEALTH PROFESSIONALS: http://www.medsafe.govt.nz/Profs/datasheet/m/Maxolontabsyrinjsupp.htmAustralia, S.-A. (2009). Sanofi-Aventis Australia. Retrieved May 1, 2009, from Product Information: http://www.sanofi-aventis.com.au/products/aus_pi_phenergan.pdfBallatori, E., Roila, F., Berto, P., De Angelis, V., Neri, C., Olivieri, A., et al. (1994). Cost and cost-effectiveness analysis of ondansetron versus metoclopramide regimens: a hospital perspective from Italy. Pharmacoeconomics , 227-37.Bartlett, J. &. (2009). 2009 Nurse's Drug Handbook . Jones & Bartlett .Bowen, R. (n.d.). Physiology of Vomiting. Retrieved May 1, 2009, from The Stomach: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/vomiting.htmlBraude, D., Soliz, T., Crandall, C., Hendey, G., Andrews, J., & Weichenthal, L. (2006). Anti emetics in the ED: a randomized controlled trial comparing 3 common agents. American Journal of Emergency Medicine , 177–182.DeCamp, L. R., Byerley, J. S., Doshi, N., & Steiner, M. J. (2008). Use of Antiemetic Agents in Acute Gastroenteritis:A Systematic Review and Meta-analysis. Archives of pediatric and adolescnet medicine , 858-865.Drotts, D. L., & Vinson, D. R. (1999). Prochlorperazine Induces Akathisia in Emergency Patients. Annals of Emergency Medicine .Einarson, A., Maltepe, C., Navioz, Y., Kennedy, D., Kennedy, D., & Koren, G. (2004). The safety of ondansetron for nausea and vomiting of pregnancy:a prospective comparative study. BJOG: an International Journal of Obstetrics and Gynaecology , 940–943.Ernst, A. A., Weiss, S. J., Park, S., Takakuwa, K. M., & Diercks, D. B. (2000). Prochlorperazine Versus Promethazine for Uncomplicated Nausea and Vomiting in the Emergency Department: A Randomized,Double-Blind Clinical Trial. Annals ofEmergency Medicine , 89-94.Ho, K .-Y., & Gan, T. J. (2006). Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Current Opinion in Anaesthesiology , 606–611.

Chinese Cinderella Response to Lit

Big Brother and Second Brother Two of Deadline's brothers are malicious and mischievous. Why you say? Well, because clues in the context of Chinese Cinderella tell me so. I can tell you that Deadline's eldest brother is mischievous from Just two quotes of the book. One Is, â€Å"Silently but swiftly, Big Brother suddenly approached Ye Ye and carefully pinched the nasal hair between his forefinger and thumb. † This Illustrates that Big Brother thinks It's funny to pull out one of his grandfather's nose hairs while his senior Is leaping.Another quote Is, â€Å"Laughing hysterically, Big Brother rushed out of the room, slid down the banister and made a clean getaway Into the garden, all the time holding Ye Yes's hair aloft Like a trophy. † This quote shows that Big Brother Is so mischievous that he would even pluck out a nasal hair of his grandpa's and even evade his old man's anger for the fun of it! Second Brother also has a very distinct personality. He is malicious to Deadline because of jealousy and everything that goes wrong for him.To support my claim, ere are two quotes and why I chose these quotes. â€Å"Deliberately he took my right arm under the table and gave it a quick, hard twist while no one was looking. † Second Brother is so cruel that he hurts Deadline right at the dinner table where anyone may see him. â€Å"n. You ugly little squirt! This'll teach you to show off your medal! † Deadline's brother openly shows that he acts maliciously not Just for no reason, but also because he is Jealous of the attention that Deadline is getting because of an award she received.

Comparing difference essay Example | Topics and Well Written Essays - 1250 words

Comparing difference - Essay Example While Ms. Gilman portrayed the development of postpartum depression and its aftermath in her main character Jane, who is also the narrator of the story, during an era when men ruled the world and women were expected to merely bear children and ensure that their husband was a success in life. It is because of this difference in the way that the topic of developing madness was dealt with and the complex issues surrounding it that made â€Å"The Yellow Wallpaper† the more prominent fictional study of the development of madness. " The Black Cat," and "The Yellow Wall Paper," display aspects of psychological issues; however, the complexity of these issues are more prominent in " The Yellow Wall Paper." In â€Å"The Black Cat†, Poe continues his tradition of recalling the spiral into madness of his lead characters through flashbacks detailing the events that led to the protagonists descent into madness. This is a trend that we can clearly see in his previous works such as â€Å"The Cask of Amontillado† and â€Å"The Tell-Tale Heart†. In â€Å"The Black Cat†, the only driving factor for the madness of the unnamed narrator seems to be the fact that he is alcoholic and as such, has delusions and suspicions about anything and everyone around him. Including, the black cat that was their family pet. As we can see in the following passage, the madness of the narrator was not brought about by any traumatic experience or frustration in life, but rather, because of his love of alcohol. He narrates: ..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. (Poe 2) This where the weakness of the development of the mental illness lies in Poes story. For just like in all his previous works, the reason for the onset of madness stems from the love of drink and th

Developing Management Capability Speech or Presentation

Developing Management Capability - Speech or Presentation Example Your first lines, therefore, should be creative, exciting and interesting. b) 'These next lines are good, and they can be effective if said with passion that will show the listeners how significant a small percentage (like 2 per cent) can be when considered in context of the base amount which, in this case, is 1.2 billion in euro. Assuming that these figures are all well-researched and accurate, this part should serve to be when the you - the speaker - convince the listeners that what you are presenting is worth looking into. The presentation slides used to highlight these lines should show pictures of the market that the listeners would want to tap. Without such critical slides, the important point relayed by this part of the presentation - the market you want them to target - will just be missed by the listeners. c) These lines should never be said, "What sort of things do I mean by informational-educational This is not the best example, but it will help to illustrate the idea: Sotheby's has produced a video guide to eighteenth-century French furniture." They are ineffective points that will only ruin your presentation. These lines give your listeners the feeling that your presentation is not the best that you can give or do. Citing examples to make things clear would be effective only if the examples used for the purpose are the best and the most fitting. It is one big blunder to use second-best examples to illustrate a point; and it is another equally big blunder to actually tell the listeners that the example you are about to name is actually not the best. To be persuasive and convincing, your listeners should be made to feel that you took pains to put together for them a great presentation that contains accurate data and intelligent choices of words, examples, and lay-out of the slides. d) "Now I'd like to talk about where I see the opportunities in this market. I see them at the high end - the affluent - I think it's a defined target, it has a lot of discretionary income, and its interests lie in the areas I want to market into." These lines are ineffectively worded. There are better ways to put the points therein to words. Instead of those lines that rather sound dragging, you should instead use a slide or two to show the listeners a diagram of the entire DVD-renting population and then to specifically point out the specific part of it that represents the market niche that you want to capture. Attaining such goal should be doable if your listeners will be fired up and become enthusiastic and passionate believers of what you yourself believe in. e) "The project would investigate the viability of starting a production and distribution outfit in Europe; it would investigate the potential product portfolio in the market, and would essentially turn an idea into a business proposition that can be put to a bank to raise capital." These lines would dampen the excitement roused by your earlier lines. These are ineffective points, unless they are rephrased and discussed with more optimistic and energy. The financing concerns are to be dealt with by the finance people, and maybe the conservative and serious words are the ones to use when talking with them. But when talking to a group for the purpose of

Conlon Nancarrow's career and his relation to player piano Research Proposal

Conlon Nancarrow's career and his relation to player piano - Research Proposal Example The interview is considered as quite important for understanding the actual view of composer for a series of critical issues related to his life and career. The findings of the literature review will be categorized, so that they are presented in separate sections according to their relevance to the study’s issues. The career of Conlon Nancarrow can be characterized as rather impressive. As for all artists, for Conlon Nancarrow also communicating effectively with his audience has been a key priority. Media and technology have helped Conlon Nancarrow to achieve this target. Has this support intervened in the development of the composer’s career? Was the involvement of media and technology in the career of Conlon Nancarrow fully justified? Duffie, Bruce. â€Å"Composer Conlon Nancarrow. A Conversation With Bruce Duffie.† Archive of Contemporary Music. Northwestern University. October 12, 1987. Accessed at 25 February 2013.

Legacies Essay Example | Topics and Well Written Essays - 500 words

Legacies - Essay Example It wanted to free itself from the United States. This led to a bloody war between these two parties for four years. The Confederacy  was disadvantaged  in this war. This is because the U.S. government had  support  from twenty five  free  states from the north and the borders. They had a tremendously strong population base that helped them to  defeat  the Confederacy. Abraham Lincoln’s Republican Party was against the promotion of slavery into other states that it never existed. The Republicans were victorious in their campaigns. This led seven states to  declare  secession from the U.S. federal government. These states united and formed the Confederacy States of America in 1860. The war began in 1861 after a U.S. military base  was attacked  by Confederate forces.  The U.S. federal government called on other states to  volunteer  their armies to fight back.  Both parties formed strong armies that fought against each other. There was a bloody  war  for four years (the American civil war). After the war, slavery  was brought  to an end. Slaves from the border and other Confederate slaves  were freed  by the state. There were numerous and tireless efforts to  reconstruct  the U.S. All in all, many historians today are of the opinion that the reconstruction was never a  success. It was a complete failure because many issues still remain unresolved.

CF&F Employee Survey Essay Example | Topics and Well Written Essays - 750 words

CF&F Employee Survey - Essay Example It also involves diagnosing those areas where employees are likely to be most sensitive to change. All of these factors for overcoming resistance to change can be achieved through a well-devised and thoughtfully implemented employee survey. The survey that is outlined within this document is designed to determine the extent of employee engagement with the organization in its current state, as well as how engaged employees would feel if certain changes were implemented. Ideally, the survey would be administered by the company's human resources department so that all employee levels could participate objectively. Indeed, resistance to change can certainly be prevalent at every level - from front line workers to senior management. In this case, many employees and managers have a vested interest in the established culture and do not want to see any changes. Nepotism has been identified as a significant problem within the organization; and there is a growing resentment of management among hourly workers due to the authoritarian manner in which they have been managed. Moreover, the level of concern for regulatory compliance is unacceptably low, an attitude that has trickled down from management to the hourly employees. Please select the number that corresponds to your level of ... 1 2 3 4 5 My immediate supervisor cares about my success. 1 2 3 4 5 There is a direct relationship between my work and the company's success. 1 2 3 4 5 I have an equal chance of advancing within the company to any of my co-workers. 1 2 3 4 5 I am fairly compensated for the work I do in my company. 1 2 3 4 5 I share some responsibility for ensuring the company operates ethically and legally. 1 2 3 4 5 My company cares about my individual opinion and needs. 1 2 3 4 5 My company has provided me with the resources I need to do my job effectively. 1 2 3 4 5 I would recommend my company as a place of employment to friends and associates. 1 2 3 4 5 I am confident in my company's senior management. 1 2 3 4 5 My company needs to make changes in order to ensure future success 1 2 3 4 5 What is your job function: 1: hourly worker 2: frontline manager 3: mid-level manager 4: senior manager Results and Communication of Findings The survey is likely to show that hourly employees are relatively unhappy with the present state of the organization as compared to the managers. They will probably be more likely to indicate a lack of connection between their own success and that of the organization. They will probably also disagree with the statement that management cares about their success, and that they have an equal chance for advancement within the organization as compared with their coworkers. Hourly employees will be more likely than managers to indicate that the company needs to make changes. Managers will express a higher level of confidence in senior management than will hourly employees; and they will likely feel more fairly compensated for their work. All levels will express some level of

Brain Drain in Louisiana Essay Example | Topics and Well Written Essays - 750 words

Brain Drain in Louisiana - Essay Example Of grave concern, then, was the emigration of those with scarce professional skills, like Doctors, Nurses, Engineers etc, who had been trained at considerable expense, in most cases, by means of highly subsidized tertiary educations or Government grants. (Cohen 1). The mere fact of the weak and poor society losing skilled people is a terrible occurrence. It plunge the society into a far deeper economic situation. The implications for the poor sending communities, is therefore, stark. (Dhananjayan 2). The factor driving brain drain emigration are not far fetched. The human nature always tend towards a better and more secured living conditions. Wherever such condition is not obtainable in a community, there is bound to be movement outwards, in search of a better environment. It is obvious, therefore, that inequalities in opportunities available to different societies or nations, is one primary factor at the root of brain drain emigration. Several decades back, 'brain drain' was a name reserved for citizens of poor developing nations moving into America and Europe. A US presidential candidate, Ross Perot, even once talked about a "giant sucking sound" made as American jobs went out to emigrants (Dhananjayan 2), but America seems to be having her own share of the phenomenon within its shores. According to a story on CBS News, Williams Frey, a demographer at the University of Michigan, studied population migration in Louisiana, long before Hurricane Katrina. He concluded that Louisiana has basically been a poster child for brain drain, especially among whites with college degrees (Katrina Accelerates). Brain drain has been seen as a growing trend in New Orleans and Louisiana over several decades now. It is observed that the opposite of the growth trends seen elsewhere in the New South is the case at Louisiana. The loss of skilled labor power began decades back, in the late 1980s, when, probably due to dwindling image outside, Louisiana keep failing to attract new residents. Basically, the Louisiana problem could be said to be due to a failing economy, unhealthy image and the resultant failure to attract in-migration of new residents (Katrina Accelerates). The economy of the city is already on a downward turn and its image battered, losing several of her best educated residents could lead to a vicious cycle. It definitely would further damage the 'sick' economy, tear the city's social fabric apart, and thus further creating a better excuse for the few, staying back, to emigrate and keeping new residents at bay. Brain drain sure does have a resounding effect, it takes away the good ones from a society, cutting out ideas and growth from the few ones left. Hurricane Katrina has further added to this scourge. According to experts, the health care industry was one of the very few industries experiencing growth in Louisiana and also the number one employer in the city. But, Hurricane Katrina almost obliterated the hospital, nursing homes, mental health systems and other health care institutions in the whole of New Orleans. These institutions employ thousands of people and many of them are already migrating for better opportunities. In the wake of Katrina, several competitors have been perfecting their strategies to better attract the numerous nurses, doctors and other health care workers stranded in the city. For instances, it is reported that, Joe Ann Clark, Executive Director of the

Write choose Term Paper Example | Topics and Well Written Essays - 1000 words

Write choose - Term Paper Example In this respect, the question of how man started hunting and the methods that he applied comes into the fore. Thus, this discussion seeks to assess the methods applied by the early man during hunting. Hunting by fire is one of the methods that have been discovered being used by the early man. Fire was among the first discoveries that early man made, which changed the lifestyle of early man drastically, especially as related to the eating habits of man (Nitecki, 5). The earliest archeological evidences have indicated that the early forms of man were eating raw foods, but the discovery of fire came in handy as a means of enabling man eat a variety of food, as well as helping man insulate against cold. The sooner fire was discovered to be an important item that could change the life of man in different ways, the sooner it was also adapted as a hunting tool, where man could chase after the animals with a lit torch of fire towards the cliffs (Stanford and Bunn, 4). This way, the animals could get injured as they fell down the cliff and man would be able to take them and use them for food. Another method that has been discovered as having been used by early man in hunting is the use of crude weapons such as stones (Nitecki, 12). Amongst the important tools that have proven useful for man during the early human forms is the stones, which were not only used as weapons for protection and security against harmful animals, but also as a tool for digging tubers and roots that man used as food during those days. Eventually, man adapted the stones as tools for hunting, which they could use to chase after animals and throw at them, thus injuring and incapacitating the animals (Stanford and Bunn, 9). The same tools would be used to kill and then slaughter the animals, owing to the fact that the early form of humans had not discovered metallic or any other form of

Piagets Developmental Psychology Essay Example for Free

Piagets Developmental Psychology Essay Piaget (1896-1980) believed that there was a quantitative difference between the intelligence of adults, young children and older children. He believed adults have better knowledge of the world and because children do not use the same logic in there thinking. He believed that childrens logic changed as they developed through their four stages of life Piaget came to this conclusion after completing his cognitive development test. Unlike psychologist Siegler and Huges, Piaget is a theoretical psychologist and carried out many experiments to illustrate his theories. These stages have been critisied by many psychologist including Hughes, Siegler, Rose, Blank. Sensorimotor Stage Piaget believed that a new born had basic biological motivations, and acquired knowledge by accommodation and assimilation, and once a child has acquired these schemas it would be at equilibration. It has been argued that Piaget underestimated the intelligence of a newborn. Piagets sample did not illustrate a wide variety of children therefore his experiment cannot be related to every child at that relevant age. His study was also only preformed on his own children therefore results could have been bias. Similar experiments were devised by other psychologist giving different conclusions, indicating Piagets results were not always reliable. Piagets first stage stated that a baby (0-2) first explores the world using motor and reflex actions. For example a child reaches towards an object and after many attempts will be able to eventually grasp the object and then bring the object to its mouth and will continue to explore it uses the senses of taste and smell. A child is said to have completed this stage of development once they have obtained object permanence (a child understands that an object still exists even when it is not visible). This theory was tested by giving a 5-6 months old child a toy to play with, the toy was covered with a cloth and the babys behavior observed. Results showed that a baby immediately lost interest as if the object never existed. However when tested with a 10 month old child it would continue to reach for the toy although it could not see it. Another explanation is that the child did not think the toy had seized to exist but was distracted by the movement of the cloth, which is why the child looks away and appears to have forgot the toy. Bower and Wishart (1972) argued that it does still exist in a babies mind even when it may not be visible. There experiment was done on a baby less than four months; the baby was offered a toy but as it reached for the toy the lights were switched off this showed that even when the lights were off the child continued to reach for the toy. It can be argued that the child was not reaching out for the toy but was just reaching due to the discomfort of the sudden darkness. This study could also go against the ethics as the child could have been experiencing fear from the sudden loss sight. Pre-operational Stage At this stage a child develops symbolic thinking; another characteristic of this stage is egocentrism. Piaget devised a three mountain task to test this theory. A child was sat in front of a three mountains model, a doll was then placed at varies positions in the modeled mountains and pictures were presented, they were asked to pick the picture that represented what the doll could see. Four and five year olds selected the picture showing what they could see, this suggested that they thought the doll could see what they could identifying egocentrism. However most seven years old were able to identify the correct picture. Due to Piagets selection of children it was very difficult to apply his findings to others, his own children were used throughout most of his experiment and any others were from well educated backgrounds. It can be argued that this experiment lacked ecological validity as the child could not relate to the situation they were presented with. Hughes devised a task to test egocentrism in a child but relating to an everyday situation, children as young as three and a half answered the question correctly, and 90% of children tested altogether were able to give the correct answer. Concrete operational stage A child enters this stage when they understand the appearance of something may change although the item itself remains the same. Piaget tested this stage by setting out a row of counters in front of each child, than asking the child to make another row the same as the first one. Piaget would than spread out his row of counters and ask the child if there were still the same amount of counters. This experiment tested a childs conservation of numbers. Most seven year olds were able to answer this question correctly concluding by the age of seven children are able to conserve numbers. To test the conservation of liquid Piaget collected two identical glasses A + B and a taller thin container C and asked the child which container held more, he then transferred the liquid from A+B to C and asked the child again. When a child was able to identify that both containers held the same amount of liquid they had achieved the concrete operational stage. Many aspects of this test have been criticized, including the social context of the childs understanding. Rose and Blank argued that when a child is asked the same question twice they assumed there first answer was incorrect and changed their answer. When Rose and Blank replicated this experiment and only asked the question once most six years olds gave the correct answer. McGarriglr and Donaldson (1974) argued that as the adult changed the appearance children would assume this was significant so devised an experiment were the appearance of the items were changed accidently. Children tested were between four and six, results showed that more than half tested gave the correct answer. Confirming children conserve at a younger age than Piaget claimed. Formal Operational Stage A child shows logical thinking but generally needs to be able to work through sequences with actual objects. Once a child can manipulate ideas in their head it has entered the formal operational stage. Piaget tested this by giving each child string and weights and told them to find out which factors affects a complete swing of the pendulum they could vary the weights, length of string and strength of push. Piaget found children who had entered the formal operational stage approached the task systematically testing one variable at a time. Psychologist Robert Siegler (1979) tested children aged five and upwards, by using the balance beam test. Results showed that eventually the child would take into account the interaction between the weight and the disc but would not achieve this ability until they were between 13 and 17. This concluded that childrens cognitive development is based on acquiring and using rules in increasingly more complex situations instead of stages. Conclusion Piaget tested his children and well-educated professionals therefore making his findings ungeneralised and potentially bias. Subsequent questions relating to the childs individual answer may have led children to give the answer researchers were looking for. Piaget underestimated the ability of childrens social understanding. A childs perception of an adult the importance of a familiar context and the meaning of a second question all affect a childs performance. Weaknesses in Piaget experiment prevent children from showing what understood. Piaget overestimated the age at which children entered the formal operational stage (Siegler). As Piaget focused on individual children he failed to take social settings into account. He failed to show that development is continuous and not in stages Evidence suggests that environmental factors, ethics and gender could alter a childs development. Small samples and controllability of variables were not taken into account. Piagets had very little evidence to support his findings and believed that his finding could be applied to every child. Piagets focus on qualitative development has played an important role on education. Piaget opened the opportunities for others to learn and discover more on how children development.

Social Work Roles And Criminal Justice Settings Social Work Essay

Social Work Roles And Criminal Justice Settings Social Work Essay There are many competing pressures to direct the service in ways that may not be consistent with Social Work principles towards greater penal and correctional models. It is therefore essential to have a clear understanding of the policy and legal framework that creates the remit and legitimacy for the operation of Social Work in the Criminal Justice process (Whyte, 2001, p.7). Statute law is created by Acts of the UK and Scottish Parliaments and relies upon rulings made in Court Hearings to set precedents that define and interpret key terms i.e. Case Law. Understanding the law is fundamental to practice in Criminal Justice settings. Criminal Law is a powerful instrument of social control and sanctions and the Criminal Courts have the potential to impose restrictions of liberty of individuals. Social Workers have a responsibility towards the general public and the courts to protect the public and ensure their wellbeing however, there is also obligation towards those who are in the Criminal Justice process who may be vulnerable and in need of services provided by Social Work. It is therefore essential that all workers have an understanding of the legal frameworks that govern Criminal Justice Social Work and are aware of the scope and limitations of their mandate (Whyte, 2001). However, law is subject to change and criminal justice policy is more liable to su dden, politically motivated changes of direction than is social policy in other fields (Smith, 2002, p.309) The law defines what a crime is, rules of evidence and criminal procedure. However, discretion is given to those involved and therefore, the criminal justice process is not systematic. The judiciary, police and social work have differing roles, agendas, values and beliefs which are shaped by training and cultures which can make working within the system difficult due to lack of shared understanding of common aims and individual roles. Social Work involves working with the marginalised and disadvantaged and can be both vulnerable to crime and susceptible to criminalisation and practice involves work with victims or offenders. Local Authorities have statutory responsibility to provide Criminal Justice Social Work Services to support the Criminal Justice Process through assessment of individuals, information to the Courts and supervision of offenders. Scotland differs from the rest of the UK in that there is a unique cultural and political heritage and a separate legal system. Social Work therefore, has a central role within the Criminal Justice process in Scotland which is in contrast to England and Wales where probation work is commissioned by the National Offender Management Service (NOMS) which is separate from Local Authority control and Social Work functions and shows a difference in their approaches in responding to crime. As McAra (2005) suggests a more welfare orientated approach has been adopted due to its legal culture and political history. The legal framework outlining powers and duties of Criminal Justice Social Work is the Social Work Scotland Act 1968 (as amended). Section 27 of this Act outlines the duty by Local Authorities to provide specific Criminal Justice services (e.g. social background reports, supervision of offenders on an Order or Licence) in respect of central government funding however, it does not explain the objectives of these services or provide guidance on their exercise. Section 12 gives Local Authorities (LAs) discretion to provide additional services (e.g. victims) as part of the general responsibility to promote social welfare. Probation or offender services became the responsibility of the Local Authority Social Work Departments in 1968 and had a general duty to promote social welfare in their locality (S12, Social Work (Scotland) Act 1968). This was due to the Kilbrandon Committee (Kilbrandon, 1964) being appointed to investigate increasing juvenile crime. The Kilbrandon Report recommended a new approach to childrens services based on the needs of children and families and those who offend should be treated the same as those children requiring care and protection. Kilbrandon also suggested diversion and early voluntary intervention as crime prevention and one department for children and adults. This merge of work with adult offenders was pivotal in recognising work with offenders as having a welfare component admittedly with a level of control. Although the Kilbrandon philosophy followed trends of the time which advocated rehabilitation and treatment of offenders and an awareness of the social causes of c rime, this is still highly relevant to todays practice. From the 1980s onwards Criminal Justice in Scotland has undergone major legislative and policy change due to successive governments. As there was concern for public protection and community disposal effectiveness in 1991, 100 per cent central government funding was introduced and the National Objectives and Standards were published which set out core objectives, service provision and guidance on their delivery (Social Work Group, 1991). This resulted in the government committing to Social Work delivering this role. This policy arrangement outlined by Rifkind in 1989 has survived changes in political administration although, it has been suggested that devolution has caused a sudden and dramatic politicisation of Criminal Justice issues and could undermine the welfare tradition (McNeill and Batchelor, 2004: Croal, 2005). Social Work with offenders should aim to address and reduce offending behaviour. Whilst the law provides a framework for practice, effective work with offenders requires Social Work skills such as communication, therapeutic relationships in supervision, assessment and risk management. The task is therefore, varied and complex as Social Workers have the power to control the individuals who are referred via the Courts and enforce any Court Orders but must also work with an offender in a holistic, inclusive way to have a positive impact on their offending behaviour and this can be through support and assistance in relation to personal and social problems but also the individual taking responsibility for their actions. Effective and ethical practice is therefore, about considering and managing the needs and rights of the Courts, the general public, victims and offenders. Although Social Workers have statutory duties and powers to interfere in peoples lives this is not always welcome but is necessary in promoting public safety. Under the Scottish Social Work Services Council (SSSC) Code of Practice Social Workers have an obligation to uphold public trust and confidence and the Criminal Justice Authorities (CJAs) are required by Scottish Executive guidance to develop a strategy to address this (Scottish Executive, 2006b). This strategy includes both offenders and their families and Social Workers should engage these individuals and recognise their views in the development of services. Both Criminal Law and Social Work recognise the autonomy of individuals choices on how they lead their lives and with this capacity is criminal responsibility. Those of which who lack capacity (e.g. children and the mentally disordered) are not culpable in the eyes of the law and may be treated differently. It is therefore recognised that criminal behaviour is not just a choice but may be about social circumstances to which they have minimal control. Social Workers should assist in allowing individuals to improve their capacity for making choices together with consequences to their actions (ADSW, 1996a). Although Social Workers are obliged to protect the rights and interests of service users there is a belief amongst the general public that they have forfeited these rights when they have offended. All Criminal Justice agencies must comply with the Human Rights Act 1988 which incorporates into domestic law the fundamental rights set out in the European Convention of Human Rights (ECHR). Public Authorities are required to respect all of the provisions however, the two articles with particular relevance to Criminal Law and Social Work are the right to liberty and security (Article 5. ECHR) and the right to a fair trial (Article 6, ECHR). However, the state can impose restrictions on those who breach criminal law or are a threat to public safety as long as the detention is authorised by law and there is a balance between the individual, their victims and the general public. The Social Worker must assess this balance through rigorous assessment and analysis of risk. The Social Work role r equires respect to offenders as individuals and ensure that the offenders ability and right to function as a member of society is not impaired to a greater extent than is necessary in the interests of justice (ADSW, 1996a). Criminal Justice Social Work services are delivered in partnership with various statutory and non-statutory agencies and this can present challenges due to conflicting professional values and aims. The Management of Offenders etc. (Scotland) Act 2005 was introduced to improve joint working and co-ordinate the management of offenders especially in the transition from custody to community supervision and places a duty on Criminal Justice Authorities (CJAs) to have an information sharing process in order that relevant information is shared between agencies (s.3 (5)(g)) for improving offender and risk management. However, sensitive personal information must be handled carefully and be under the principles of the Data Protection Act 1988 and local agency protocols. Practitioners within Social Work must ensure that any information sharing decisions are fully explained and understood by the offender even when their consent to disclosure is not required. Organisations who deliver public services have general duties to eliminate unlawful discrimination and promote equality of opportunity on the grounds of race (Race Relations (Amendment) Act 2000), sex (Equality Act 2006), and disability (Disability Discrimination Act 2005). Individuals who are involved with Criminal Justice organisations are entitled to the protection of discrimination laws which relate to sex, race, disability, religious beliefs and sexual orientation, with exception to exercising judicial functions or carrying out Court orders. In these circumstances it may be within Article 14 of the ECHR which prevents to the right to liberty and security of the individual or the right to a fair trial being interfered with on a wide range of discriminatory grounds. Criminal Justice is still influenced by prejudicial and discriminatory views. Research has been carried out by both the Social Work and Prisons Inspectorate for Scotland (1998) which highlighted concerns about the treatment of female offenders in the Criminal Justice process. In addition to this, several inquiries in England and Wales in relation to racial discrimination by the police and prison services has subsequently raised public awareness (Macpherson, 1999; Keith, 2006). The Scottish Government has a duty to publish information of discrimination of any unlawful grounds (s.306 (1)(b) Criminal Procedure (Scotland) Act 1995) and therefore, all workers need to practice in an anti-discriminatory way. The law outlines the limits of Social Work intervention and knowledge of the law is essential to anti-oppressive practice. The only legitimacy for intervening in the life of the individual within the criminal justice process is the individuals offending behaviour†¦if individuals have social needs which require to be met but are not crime related or crime producing, or if the offence is not sufficiently serious to fall within the criteria of the twin-track approach, services should be offered, as far as possible, through voluntary provision†¦No-one should be drawn into the criminal justice processes in order to receive social work help (Moore and Whyte, 1998, p.24). Rehabilitative intervention is not just about helping; it imposes limitations on the rights of the individual who is subject to the intervention. Risk assessment and offence based practice is an ethical approach. It aims to ensure that the most intensive and potentially most intrusive services are focused on those service users who pose the greatest risk of causing harm to others (ADSW, 2003) and to prevent socially disadvantaged individuals being taken further into criminal justice control which can result in further social exclusion. Criminal Justice Social Workers must take note that the role involves work with disadvantaged social groups. Certain types of crimes and offenders often criminalise the young, deprived, unemployed and undereducated male with an experience of the care system and this is clear from Social Work and prison statistics (Croall, 2005; McAra and McVie, 2005). There is often a complex relationship between social exclusion and offending behaviour and often the Criminal Justice process displays existing injustices within society. It is important that issues in relation to class, age and social context should be recognised together with vulnerability to discrimination. The Social Workers role should be to address issues of social exclusion and empower individuals to lead law abiding lives by addressing their offending behaviour. Social Work can help offenders develop capacity to make informed choices by actively encouraging their participation in the supervision/change process and their engagement with improving their current social situation (McCulloch, 2005; McNeill, 2004). Assisting offenders to focus on their strengths as opposed to their risk and needs can have a positive impact as they learn to recognise the value in their own lives and respecting the value of others. The sentencing stage in the criminal justice process generates the majority of Criminal Justice Social Work through provision of information to the Court in the form of Social Enquiry Reports (SERs) and the administration of community disposals, with the exception of liberty orders (tagging). SERs have no legal basis but there is a statutory duty on criminal justice social work to provide reports to the Court for disposal of a case (s.27(1)(a) SWSA 1968. Reports provide the court with the information and advice they need in deciding on the most appropriate way to deal with offenders. They include information and advice about the feasibility of community based disposals, particularly those involving local authority supervision. In the case of every offender under 21 and any offender facing custody for the first time, the court must obtain information and advice about whether a community based disposal is available and appropriate. In the event of custody, the court requires advice abo ut the possible need for a Supervised Release order or Extended Sentence Supervision on release. (Scottish Executive, 2004d, para. 1.5) The Criminal Procedure (Scotland) Act 1995 sets out when the court can or must obtain an SER. Failure to request a report, where required by law, can result in a sentence being quashed on appeal. The Court is not obliged to follow recommendations or opinions in the SER however, Social workers can have a direct influence on the sentence passed. Preparing SERs demands a high standard of professional practice. It requires skilled interviewing, the ability to collect and assess information from different sources, and the art of writing a report which is dependable, constructive, impartial and brief (Social Work Services Inspectorate (SWSI), 1996, Foreword). The law imposes time limits in compiling reports. The Courts require a report within three weeks (s.201(3) (a) if an offender is remanded in custody and within four weeks if the offender is on bail (s.21(3)(b) of the 1995 Act). This means in practice that there are increased demands on a workers time that places increased pressure in the preparation of SERs especially if there are high numbers of worker absence due to leave or whether the worker knows the offender and their individual circumstances. Whilst conducting interviews the worker must ensure that the offender understands the purpose of the report, the relevance of questions (health, addiction issues, and personal relationships) and the limits to confidentiality of this information. Social workers must balance between an informed recommendation and an awareness of the severity of the offence. The report author should be impartial and not minimise the seriousness of the offence and its impact (NOS, Scottish Executive, 2004d, p ara 5.5) and phrases that imply moral judgements, label or stereotype offenders should not be used (para. 5.1). When compiling an SER workers are required to consider the suitability of disposals in relation to the risk posed by an offender and to target appropriate resources which are most appropriate and successful in addressing offending behaviour. Guidelines for the assessment and management of risk are outlined in the Management and Assessment of Risk in Social Work Services (SWSI, 2000) and there are also additional risk assessment frameworks which specifically relate to serious violent and sex offenders. In Criminal Justice the focus has moved from risk of custody to risk of reoffending and risk of harm. Risk assessment is complex and there has been a shift from concern for the offender and their needs to concern about public safety and the offender being a potential source of risk to others. Although the legislation is not explicit about offending behaviour, National Standards state that SERs should provide information and advice which will help the Court decide the available sentencin g options†¦by assessing the risk of reoffending, and†¦the possible harm to others. This requires an investigation of offending behaviour and of the offenders circumstances, attitudes and motivation to change (Scottish Executive, 2004d, 1.6). Risk is defined by Kemshall (1996) as the probability of a future negative or harmful event and assessment of risk includes: the likliehood of an event occurring, who is likely to be at risk, the nature of the harm which they might be exposed and the impact and consequences of the harmful event. Risk assessment has changed over the years and prior to the introduction of risk assessment tools workers relied on clinical methods or professional judgement which was based on an offenders history. These methods were criticised for being too subjective, inaccurate, open to worker bias and dependent on information given by the offender. In the 1990s workers moved towards objective and empirically based risk assessment tools (actuarial) to support their assessment. Actuarial risk assessment tools rely on static (historical) risk factors together with dynamic (criminogenic) risk factors and to assess the risk of reoffending. The static factors (which cannot change) take into account gender, age at first conviction, number of previous offences and custodial experiences, school progress, previous employment and personal history. The criminogenic factors (focus on current areas) include current employment, personal relationships, peer associates, use of time, substance use, mental health and attitudes and behaviour. All of these factors impact on the risk of reoffending (Bonta, 1996). The most widely used assessment tool, The Level of Service Inventory Revised (LSI-R) devised by Andrews and Bonta (1995) incorporates both static and dynamic factors. However, it does not assess risk of harm and this shows that both actuarial and clinical risk assessments are crucial for an effective and comprehensive risk assessment. Clinical methods combine knowledge of the offenders personality, habits lifestyle and an analysis of the circumstances of the offending behaviour and are therefore, the most appropriate assessme nt tool at identifying those who are likely to cause serious harm. Although more time consuming and require more in-depth analysis of both the offender and the offence risk is assessed on predispositions, motivation towards certain behaviours and triggers that may contribute to harmful behaviour. Actuarial tools are not totally accurate (Kemshall, 1996) and although this is improved upon through use of clinical methods in decision making, professional judgement is also crucial. Social workers must be aware that social disadvantage plays a part and this can contribute to a higher assessment of risk and need and to be cautious about the total reliability of these factors when making recommendations that may affect an offenders liberty. Risk assessment and intervention or supervision should be informed by valid, reliable and ongoing assessment and Social Workers should familiarise themselves with research emerging in this area and the many assessment tools and change programmes available (Levy et.al., 2002). To support change Social Workers have to not just think about what work is done with the offender but how that work is done. Offenders under supervision have very high levels of need. Moreover, although most offenders have many needs in common, there are also significant variations that necessitate the thoughtful tailoring of individual interventions if the effectiveness of practice is to be maximised. In delivering effective practice, the accumulated weight of evidence†¦drives us towards recognition that practice skills in general and relationship skills in particular are at least as critical in reducing re-offending as programme content (McNeill et al., 2005, p.5). This recent review of core skills required for effective Criminal Justice Social Work practice raises challenges in practising ethically and effectively but when applied critically and reflectively this could achieve positive outcomes that are in the interest of the public, victims and offenders. Although the law is crucial in framing Social Work practice in the Criminal Justice process it is equally important that Social Work skills and values are central to effective interventions as the role is both demanding and rewarding. Crime has become increasingly prominent both in the public and political agenda and therefore, Social Work has become more prominent and complex. Social Workers have a professional responsibility towards victims, the Court, community and offenders. To fulfil this role effectively, Social Workers must have a clear, confident understanding of their role, the legislative and policy context and a commitment to increasing and developing knowledge, skills and values required for effective and ethical practice.

Nikola Tesla Essay -- essays research papers

Nikola Tesla Few people recognize his name today, and even among those who do, the words Nikola Tesla are likly to summon up the image of a crackpot rather than an authentic scientist. Nikola Tesla was possibly the greatest inventor the world has ever known. He was, without doubt, a genius who is not only credited with many devices we use today, but is also credited with astonishing, sometimes world-transforming, devices that are even simply amazing by todays scientific standards. Tesla was born at precisely midnight between July 9th and 10th, 1856, in a small Hungarien village. He was born to his father, a priest, and his mother, an unschooled but extremely intelligent women. Training for an engineering career, he attendedthe Technical University of Graz, Austria and was shortly employed in a government telegraph engineering office in Budapest, where he made his first invention, a telephone repeater. Tesla sailed to America in 1884, arriving in New York City with four cents in his pocket, and many great ideas in his head. He first found employment with a young Thomas Edison in New Jersey, but the two inventors, were far apart in background and methods. But, because of there differences, Tesla soon left the employment of Edison, and in May 1885, George Westinghouse, head of the Westinghouse Electric Company in Pittsburgh, bought the patent rights to many of Tesla's inventions. After a difficult period, during which Tesla invented but lost his rights to many inventions, he established his own laboratory in New York City in 1887, where his inventive mind could be free. In 1895, Tesla discovered X-rays after hours upon hours of experimentation. Tesla's countless experiments included work on different power sources and various types of lightning. The Tesla coil, which he invented in 1891, is widely used today in radio and television sets and other electronic equipment for wireless communication. That year also marked the date of Tesla's United States citizenship. Brilliant and eccentric, Tesla was then at the peak of his inventive powers. He managed to produce new forms of generators, transformers, he invented the fluorescent light, and he became extremely involved with the wireless transmission of power. During the 1880a and 1890's Tesla and Edison became rivals, fighting to develop there inventions as quickly as possible. In 1915 he was severely disappoin... ...ever existed and declared others as "lost". Was he working on particle weapons and cloaking devices for the United States Government when he died? Was Reagan's Strategic Defense program known as "starwars" the result of secret research based on Tesla's discoveries half a century before? Nikola Tesla allowed himself only a few close friends. Among them were the writers Robert Underwood Johnson, Mark Twain, and Francis Marion Crawford. In his later years, Tesla was alone with only his inventions and calculations, although he did bred pigeons later in life, who he gave all the affection to that he was unable to give human beings. Telsa's name holds over 700 patents. Tesla died privately and peacefully at 87 on January 7, 1943 New York hotel room from no apparent cause in particular. Hundreds filed into New York City's Cathedral of St.John for his funeral services, and a flood of messages acknowledged the loss of a great genius. Three Nobel Prize winners in physics (Millikan, Compton, and W.H. Barton) addressed their tributes. One of the outstanding intellects of the world who paved the way for many of the technological developments of modern times, Nikola Tesla.

Graduation Speech: Lets Change the World -- Graduation Speech, Commen

Look at us, the class of 2012, with our diversity and respect for one another, I can see that our society has changed enormously in the last forty years a mere decade before County High School opened. I would even say that most of the world has changed from judging people by their race or nationality to judging them by their character. Although the world has matured a great deal we cannot remain in this single state of maturity, we must continue to grow. Now is the time to make a change in the world again. The ambassador of this change is County High School's class of 2012. We can change the world this very hour, this very minute, this very second. The key to changing the world is in each and every one of you. By looking inside yourself and truly understanding who you are you can change the world. By finding out who you are now you can prevent yourself from becoming a victim of the void that lives in the people of today's society. People are in a sea of darkness this day. They continually look for something meaningful that they can hold onto, but are easily distracted by temporary pleasures. While the bell was sounding for them to find themselves they were at the club checking-out the people that just walked in. They were trying to get the high paying job so they could buy the luxury cars. They were trying to fill their emotional void with material objects and lustful fantasies. They never found out what their true delights were, they only listened to what society said could fill their heart and make their pain go away. They never knew themselves. Do not make this mistake in your life. Re-examine your life and find out what made you happy. What class excited your imagination? What was truly great about your past boyfriend ... ...test joys in life seldom come from material objects or non-challenging activities. To truly reach your potential you must conquer your fears and face the challenges that come before you. To be a great person you must be willing to do great things. Every person here is capable of excellence. It is my hope that you take these words and apply them to your life. You are graduating from high school and entering the world of possibilities and responsibilities. You have made friends, had relationships, and gained useful knowledge, all of which has prepared you to harness the possibilities and accept the responsibilities. The greatest lesson you can now learn is be true to yourself. Find out who you are and who you want to be. Fate will dominate your life as long as you let it do so. Take control of your destiny and help our world to become a better world for everyone.

Phantom Limbs, Phantom Pain, And The Essay -- Biology Essays Research

Phantom Limbs, Phantom Pain, And The "I-Function" The so-called "I-function" which describes the brain's sense of self takes on interesting connotations when discussing phantom limbs and associated phantom pain. The loss of an arm or leg through amputation is not an easy experience to endure, and is even more difficult when the patient begins to feel sensations in their now missing limb. These feelings, sometimes referred to as "stump hallucination", is the subjective sensation, not arising from an external stimulus, that an amputated limb is still present (1). Although they no longer exist, patients perceive these limbs as still being essential components of their body-image, and continues to move in sync with their torso and other limbs. For some amputees, these phantom sensations may be no more than painless distractions of pressure, warmth, and cold that do not interfere with their everyday lives. But for the majority of amputees, about 50% to 80% (2), they experience phantom pains that vary in classification from cramping, burning, tingling, shocking, shooting and stabbing pains. These episodes are severe enough to interfere with work, sleep and normal function and do require some kind of treatment. Phantom pain can occur anytime, from immediately after an amputation to several years later. The powerful impression of a stable, embodied self is taken for granted. But it's an perception that's possible only because of the body image created by the brain. A significant element of that image is a mental map of the body surface, generated by the cortex using the sensory signals it receives from the skin. Other regions of the cortex control other components, such as the position of muscles and joints (proprioception),... ... http://www.bfe.org/protocol/pro05eng.htm 3)THEY DO IT WITH MIRRORS , From New Scientist http://infotrac.galegroup.com/itweb/brynmawr_main?http_rc=400&class=session&sev=temp&type=session&cause=http%3A%2F%2Fweb1.infotrac.galegroup.com%2Fitw%2Finfomark%2F805%2F448%2F25790840w3%2Fpurl%3Drc1_EAIM_0_A63676311%26dyn%3D4!ar_fmt%3Fsw_aep%3Dbrynmawr_main&cont=&msg=No+Session+cookies&sserv=no 4) Harris, J. A. "Cortical Origin of Pathological Pain." in Lancet, vol. 354 (pg. 1464-1466) 1999 5)Scientific American, Ronald Melzack article http://serendip.brynmawr.edu/bb/neuro/neuro01/web1/= 6)Discover Phantom limbs , Brief Article http://www.findarticles.com/p/articles/mi_m1511/is_n2_v19/ai_20159526 7) Ramachandran, V.S. & Rogers-Ramachandran, D. "Phantom Limbs and Neural Plasticity." in Archives of Neurology. Vol. 57 (pg. 317-320), 2000, Ramachandran article

Compare and contrast Hamlet vs. Laertes Essay

No two individuals are alike, regardless of similar upbringing. It is reasonable to assume that even twins brought up in exactly the same environment, sharing the same daily activities, and living practically the same life, will act differently when faced with the same situation. Each individual evolves with his or her own uniqueness, style, and way of life. The audience witnesses this phenomenon in Shakespeare’s Hamlet. Lord Hamlet and Laertes experienced similar childhoods, and shared similar family attributes. They were both born into royalty and throughout their lives were treated as such. Hamlet and Laertes were reared with the same forms of schooling, and were taught to abide by the same ethics and morals. Although Hamlet and Laertes seem to be â€Å"twined† with regard to family, royalty, and school, it is evident to the audience how such environmentally similar people can react so differently when faced with comparable situations. One such example arises when Ha mlet and Laertes are consumed by a very basic human characteristic, that of revenge. Hamlet and Laertes, although very similar in most respects, differ in that Laertes is driven by passion and Hamlet is driven by reason. Shakespeare exposes to his audience the similarities between Hamlet and Laertes in various instances throughout the play. It is known to the reader that Hamlet and Laertes are both sons of royalty, Hamlet being the son of the former true king of Denmark, King Hamlet, and Laertes being the son of the trusted counselor to the king, Polonius. The reader is able to deduce from the manner of both families, that although they differ, they live very similar lives, and their sons Hamlet and Laertes are quite alike. For example, Hamlet and Laertes have a unique similar respect for their fathers. In one instance, in Hamlet’s first soliloquy, he proclaims respect towards his father in saying that he was an excellent king, like the glorious sun god of classical mythology, and that he is so loving to his wife, Gertrude. â€Å"Hamlet: So excellent a king, that was to this Hyperion to a satyr, so loving to my mother that he might not beteem the winds of heaven visit her face too roughly.† (Shakespeare 14) As well, although Laertes does not know who killed his father, out of respect for him, he swears he will have his vengeance regardless of what will happen to him in this world or the next. † Laertes: To this point I stand, that both the worlds I give to negligence,  let come what comes, only I’ll be reveng’d most thoroughly for my father.† (Shakespeare 118) From here, the audience observes how similarly Hamlet and Laertes each have great respect for their fathers. Another comparison to the seemingly similar manor of Hamlet and Laertes is that of the admirable mutual respect they have for each other, even throughout the twisted murders and losses of their loved ones. Hamlet and Laertes are on the verge of fighting a duel, a duel whose final purpose is hidden from Hamlet. Finally to Hamlets dismay he learns that the hidden purpose of the duel was for Laertes to exact revenge for the death of his father and sister. Yet, all the while Hamlet obliterates his antic disposition and publicly apologizes to Laertes for the deaths of Polonius and his sister, Ophelia. With that Laertes replies he has forgiven Hamlet but in order to save his honor and the honor of his house he must continue with the duel. Hamlet accepts graciously: Hamlet †¦Sir, in this audience, Let my disclaiming from a purpos’d evil Free me so far in your most generous thoughts That I have shot my arrow o’er the house And hurt my brother. Laertes I am satisfied in nature, Whose motive in this case should stir me most To my revenge; but in my terms of honour I stand aloof, and will no reconcilement Till by some elder masters of known honour I have a voice and precedent of peace To keep my name ungo’d. But till that time I do receive your offer’d love like love And will not wrong it. Hamlet I embrace it freely, And will this brothers’ wager frankly play.- Give us the foils. (Shakespeare 149) With all the similarities between Hamlet and Laertes displayed throughout the play there is an obvious dissimilarity between them; the way they react when they are faced with the uneasy task of revenge. It is evident that Hamlet’s character and nature, which leads to his action of revenge, is that based on reason, while Laertes’s form of revenge is that based on passion and impulse. When Hamlet’s father appeared to him in the form of a ghost claiming the current king, Claudius, Hamlets uncle, had murdered him; Hamlet did not heed the information and obtain his revenge right away. Hamlet’s reaction was that of a wise methodical individual. It took Hamlet some time to convince himself that the ghost truly was a good spirit of his father, relaying truthful words in order that his soul may rest in peace, and even then  Hamlet still wanted more proof. Only until Hamlet was certain and had confirmation of Claudius’s guilt was he ready to take action. The reader sees how Hamlet finds his final convincing piece of verification through a conversation Hamlet has with his good friend Horatio: Hamlet †¦There is a play tonight before the king: One scene of it comes near the circumstance Which I have told thee of my father’s death. I prithee, when thou seest that act afoot, Even with the very comment of thy soul Observe my uncle. If his occulted guilt Do not itself unkennel in one speech, It is a dambed ghost that we have seen, And my imaginations are as foul As Vulcan’s stithy, give him heedful note; For I mine eyes will rivet to his face, And after we will both our judgements join In censure of his seeming. (Shakespeare 75) Throughout the scene Hamlet added in the play, which was re-enacting the death of his father, Hamlet and Horatio were able to confirm the truth relayed by ghost of his father and reveal the guilt of Claudius. Up until this point Hamlet was experiencing moral struggles and doubts. Hamlet wanted to be absolutely certain Claudius was the murderer of his dear father before any more blood was spilt. In order for Hamlet to be absolutely certain it took reason and evidence of Claudius’s guilt to allow himself to avenge his father. Conversely, Laertes did not need the degree of evidence in order to avenge his father and sisters death. Even without knowing the one responsible for either, Laertes is quick to promise revenge. â€Å"Laertes: And so have I a noble father lost, a sister driven into desp’rate terms, whose worth, if praises may go back again, stood challenger on mount of all the age for her perfections. But my revenge will come.† (Shakespeare 123) Despite Laertes limited knowledge of what truly happened to his father and sister, he, passionately, is quick to swear revenge regardless of the consequences. Shakespeare has revealed to the audience that the revenge they wish to exact is driven by passion in the case of Laertes and reason in the case of Hamlet. Shakespeare’s approach to this was to reveal to the audience how Hamlet and Laertes were similar. He accomplished this through discussing and illustrating the similarities between family, childhood, and royalty as well as showing the similar admiration and respect they had towards their fathers, seen through Hamlets kind admirable words towards the late King Hamlet, and Laertes’s hastiness to avenge his fathers death and sisters madness regardless of what he may suffer. Furthermore, Shakespeare expresses the mutual respect between Hamlet and Laertes as seen in the opening of the duel and the exchange of sincere heartfelt words. While Shakespeare made Hamlet and Laertes’s similarities known to the reader he also illustrated their differences when faced with a difficult situation. Shakespeare was able to do this through expressing to the reader how Hamlet was able to control his primal urge of revenge through rational, and Laertes’s uncontrollable desire to avenge motivated by passion and love. With life comes experience. Every moment one lives, is a lesson, a lesson on how to act and react in every situation. Individuals can be reared with similar parenting, family and school environment, and still react quite differently under the same set of circumstances. When one is faced with a situation so extreme as avenging a loved ones death, it is impossible and wrong to say that another would have done the same in that situation. The challenges of life are what guide one to the next level; no two challenges are ever the same, no matter how similar they may be.

Health Assessment and Health Promotion Plan Essay

Abstract Constipation is a common condition that affects people of all ages. It may be described as a variation in an individual’s normal bowel habit with discomfort and diminished quality of life. Medical assessment is required as the underlying cause may be due to a serious medical condition. Managing patients with constipation presents many challenges to the health care professional, not only overcoming communication barriers associated with bowel habits but also because there is no universally accepted definition. Constipation is usually multifactorial, often with complicated underlying patho-physiology and it can be influenced by physical, psychological, physiological, emotional and environmental factors. Chronic constipation is one of the most common lower gastrointestinal disorders affecting people in America and is a key health concern for healthcare providers. This is mainly accurate for patients in high-risk groups such as the elderly, patients suffering from immobility, neurologically impaired patients and those with multiple health-care needs, as well as and those admitted to the hospital or residing in a healthcare facility. Unfortunately, constipation may be regarded as less important than other conditions commonly seen in general practice. Constipation has cost implications in terms of medications, containment equipment and nursing time. The following paper will investigate a patient suffering from constipation while developing a better understanding and approach of management for such ailment. Health Assessment and Promotion Plan Mrs. Burns a 64 years old female presents with chief complaint of being â€Å"constipated†. She states she has a bowel movement about every 3 to 4 days, feels the need to strain at defecation and her stools are hard and painful to excrete. She also has stated having frequent headaches, fatigue, a feeling of bloatedness and loss of appetite. As mention in the book, â€Å"Physical Examination and Health Assessment† by Jarvis, the aging adult frequently reports constipation signs and symptoms, such as reduced stool frequency (less than 3 bowel movements per week), and other common and troubling associated symptoms like straining, lumpy or hard stool, feeling of incomplete evacuation, feeling of anorectal blockage and use of manual maneuvers. Common causes of constipation include decrease in physical activity, inadequate intake of water, a low-fiber diet, side effects of medications (opioids, tricyclic antidepressants, and antacids), irritable bowel syndrome, bowel obstruct ion, hypothyroidism, and inadequate toilet facilities. Upon obtaining subjective data it was found that Mrs. Burns lives by herself after the death of her husband 6 months ago. She states no longer being able to eat as she used to when her husband was still alive and she cooked every day; now she usually eats by herself. She stated she has lost over 20 lbs. since her husband’s dead. She also reported usually feeling lonely and very sad. Client also stated her usual meals of the day include breakfast starting with a cup of coffee and a slice of toast, lunch is usually eaten between 1 and 2 pm and include can soup or a tuna sandwich if she feels hungry and for dinner tea. Anorexia is a loss of appetite, and the purpose for obtaining information about signs and symptoms of anorexia is vital to prevent the dangerous psychological and behavioral effects on all aspects of an individual’s life. The individual can become seriously underweight, irritable and easily upset which can lead to depression and social withdrawal. Anorexia can also affect sleep and lead to fatigue during the day, as well as decrease attention and concentration (Prynn, 2011). Mrs. Burns does not often consume fruits and vegetables or other additional source fiber. She does not like the taste of water, so is very rare for her to consume it. She states not having trouble chewing, swallowing, or feeling nauseous or vomiting, but she likes to take naps after eating. Mrs. Burns also reported having signs and symptoms of abdominal pain located in the right and left lower quadrants of the stomach. The pain usually starts after the third day of constipation, which she describes as cramping (colic type) and usually relieved after she ambulates or has a bowel movement. Mrs. Burns describes her bowel habits as changed from going on a daily basis to only having a bowel movement every 3 to 4 days with a hard consistency. In her past abdominal history she reports not ever having an abdominal surgery. She brought an abdominal x-ray report, which concludes fecal matter to be present. She reports her list of medications including calcium, iron supplements and antacids, which she takes on a daily basis. The patient reports that being constipated all the time makes it really difficult for her to have a normal life. She reports her coping mechanisms as taking over-the-counter preparations especially laxatives, the use of digital stimulation and taking ibuprofen as necessary to relieve the pain when food or ambulation are not effective. A throughout functional assessment was performed and found that Mrs. Burns is able to ambulate, perform activities of daily living, including instrumental activities of daily living and has no problems with mobility. In the other hand, she has reported that she used to be much more active while her husband was alive and remembers walking the park for at least 20 minutes three times per week. Upon physical examination the following anthropometric measures and vital signs were obtained: Height: 162 cm (5†²4†²Ã¢â‚¬ ²), Weight: 65 kg (143 lbs.), Temperature: 36.2 °C (97.2 °F), Pulse: 82 BPM, Respirations: 20/minute, Blood pressure: 128/74 mm Hg, Active bowel sounds in all four quadrants and abdomen slightly distended without pain or tenderness at the present time. Gait and posture are normal for a patient of her age. There are no complaints related to lower back symptoms, perineal area observed free of any abnormalities or redness, perineal movement and anal sphincter squeeze noted with moderate muscle coordination. Digital rectal examination performed: hard fecal material noted, anal sphincter tone was normal, no rectal prolapse, no hemorrhoids, and no skin tags or anal lesions were noted. Labs results for hemoglobin, 11.8 and urinalysis, negative. Effective assessment provides nurses with the relevant information on which advice, interventions and management can be planned. In addition, it contributes to the path of outcomes measured and evaluation of care. Assessing patients with constipation presents many challenges to the health professional, not only by overcoming communication barriers associated with bowel habits and the embarrassment associated with an intimate rectal examination, but also because constipation may not result from a single straightforward cause. The subjective nature of constipation adds to the difficulty of the assessment, especially as nurses tend to use the objective measurement of bowel frequency rather than using a subjective symptom tool (Kyle, 2011). Assessment is based on a consideration of all the possible causes, while particularly assuring that it is not caused by an underlying undiagnosed medical condition. The aim of assessment is to establish a symptom profile in order to plan individualized bowel care. The main goal of treatment and management for constipation is prevention and relief. Establishing an ideal bowel action should prevent recurrence. Therefore, effective assessment provides nurses with the information on which advice and interventions of management can be planned effectively. Establishing a symptom proï ¬ le assist in identifying the most likely causes for the bowel symptoms based in the context of a more relevant medical/surgical/obstetric history and functional ability. Three main components have been identified as part of the plan of care developed for Mrs. Burns’ current chief complaint. These primary components include: the implementation of an exercise routine, as well as a dietary regimen that will include more ï ¬â€šuids and ï ¬ ber. This is better known as lifestyle advice or step one of a stepped approach to bowel care, which is often recommended for promoting a healthy bowel and is still considered the ï ¬ rst-line treatment for constipation (Kyle, 2010). The implementation of this approached will be monitor by a dietitian, along with the nurses who will provide Mrs. Burns with dietary education and lifestyle modification strategies. In addition, other very important components will be included as well. Mrs. Burns will have a psychological consult as she is at risk for depression as evidenced by her husband’s recent death and feelings of loneliness and sadness. Nurses should develop a more proactive and evidence-based approach to the prevention of constipation rather than continuing with the existing reactive response to this distressing symptom. Such an approach is dependent primarily on improving the education and the skill-base of nursing and those with whom they work. Finally, further research and discussions will add to the knowledge framework of such a significant condition, since so many complications are rooted from unhealthy digestive systems. References Jarvis, C. (2012). Physical Examination. (6th edition ed.). St. Louis: W B Saunders Co. Kyle, G. (2011). Risk assessment and management tools for constipation. British Journal of Community Nursing,16(5), 224-230. Kyle, G. (2010). Considering the options for treating constipation. Practice Nursing, 21(3), 124. Prynn, P. (2011). Managing adult constipation. Practice Nurse, 41(17), 23-28.

Ielts Homework

l1. Look at the list of energy sources and answer the questions below. Wood Wind Water Nuclear Coal Human power Animals Gas Oil a. How has one had an impact on human history? b. Which sources do you think have a future? c. What other sources are there? 2. Look at the diagram and answer the questions a and b. a. What does the diagram show? b. What types of words are needed to label the diagram? Make some predictions. 3.Label the diagram using no more than TWO words from the passage below for each blank space. Thomas Newcomen’s steam engine was one of the first devices to use the power of steam for mechanical work. It was originally used to pump water from mines. A boiler, encased in brick and sitting over a coal fire, generated steam, which drove the piston in the open top cylinder above the boiler. When the steam built up, the pressure opened a value allowing the steam to fill the cylinder and push the piston up.When the piston reached the top of the cylinder, the first valve was closed and the second valve opened. This second valve sprayed cold water into the cylinder from a cistern, condensing the steam and creating a vacuum. The air pressure from the open-top cylinder pushed the piston down again, thus pulling the rod down with it. The cycle then repeated itself all over again. 4. Decide if the following sentences about machines are true or false. Use a dictionary to help you. a. Read also  Homework Solutions – Chapter 3A washing machine contains a pump and motor. b. An air conditioning unit contains a coin and a fan. c. A photocopier has various components, including rollers and a piston. d. A filter and a tube can be found in a television. e. A lever and a spring are component parts of a toaster. f. A valve and a switch can be found in an aerosol spray. g. Inside a hoover, there is a filter and rotating brushes. 5. Name one object for each of the following components. Battery Axle Blade Handle Lens Turbine Switch

Overseas M&A of Chinese Enterprises Essay

The purpose of this article is to summarize the problems related to the overseas M&A of Chinese firms and to propose suggestions on its corresponding improvements. It firstly describes the brief history of China’s overseas M&A in three phases and its current status including the growth trend, the location preference and the sector distribution ; iand illustrates one succesussfulrvived case of Lenovo and two failed cases of Chinalco and SAIC. Then Seondly it analyzes the factors contributing to the success: economy growth, exchange rate, foreign currency reserve and proper management; points out the reasons of failure: political resistance, strategy error, integration difficulty and cultural difference. After that it refers to the practice of Japanese enterprises on image making, strategy selection, management localization and relation maintaining. Finally it provideoffers recommendations to improvebetter the execution of China’s overseas M&A including regarding public relationship, strategic thinking, management enhancement and cultural communication and ; draws a conclusion that whether the overseas M&A is ‘cake’ or ‘trap’ depends on what we choose to do. Overseas M&A of Chinese Companies: Cake or Trap? Introduction On 26th February 2013, China National Offshore Oil Company (CNOOC) announced in Beijing that it successfully completed the 15. 1 billion US$ acquisition of a Canadian oil and gas company Nexen Inc NXY. TO, which was China’s largest-ever foreign takeover. This was exactly the epitome of the ‘Great Leap Forward’ of overseas M&A of Chinese companies. Along with the economic boom in more thanof 30 years, encouraged by the ‘go-out’ strategy of the government, Chinese companies have madeseen robust strides in international investment markets. However, wereas most M&A cases closed as successfully as the case of CNOOC’s acquisition of Nexon? The answer must be negative should you pay attention to many failures such as Chinalco1’s acquisition of Rio Tinto2. Did every successful starting reach a happy ending? Neveror the answer would be affirmative since the bloody costs Chinese companies have paid in overseasabroad m markets. The aim of this article is to raise a critical question to the overheated enthusiasm on international acquisitions of Chinese enterprises: would it bring a worthy return or rather a bottomless pit? Serving this purpose, the article will firstly draw a brief portrait of the history and the present situation of China’s overseas M&A and summarize its characters, experiences and lessons. Then it will analyze the reasons for the successes and failures and compare China’s performance with the practice of its international peers. FinallyIn the end, t, he authorit would like to propose some recommendation on the improvement of the M&A operation of Chinese enterprises. Status quo The overseas M&A of Chinese enterprises started in the 1990s and could be roughly divided into three phases. The first phase was from the 1990s to the year 2001, when Chinese enterprises just entered the international market and tried to ‘cross the river by feeling the stones’ and to discover acquisition opportunities. The annual amount figure of transactions at that time was below 0. 1 billion US$. The second stage was after China joined the World Trade Organization in 2001 when the volume of overseas purchase takeovers reached 1 billion for the first time and till 2005 when the amount climbed to about 5 billions. The third period was fromafter 2006 till now especially after 2009 afterwardswhen global financial crisis seriously grilled struck the world’s major economies. During this period, the scale of China’s abroad overseas acquisitions exploded and each year it saw a total deal of tens of billions of dollars. In 2010, it was up to the height of 38 billion dollars, occupying 11% of the world’s transactions amount of that year3. There were some trends underlying the wavesis of overseas acquisitions waves. In terms of the quantity of deals, it was climbing climbed constantly with a number of 27 in 2003, 45 in 2005, 61 in 2007, 97 in 2009 and arrived at the record-breaking 147 in 20104. Meanwhile, the size of one transaction increased remarkably and the significant example was the abovementioned takeover of NEXON by CNOOC in 2013, a single deal of 15. 1 billion US$, overpassing exceeding the annual total of many previous years. With regard to the areas where China’s enterprises invested, American,USA Europe and Asia were their top 3 priorities, making up 27%, 21% and 15%5 respectively of the abroad acquisition volumes in 2010. About the sectors where they were interested in, the energy and mining fields were undoubtedly their first choice since 65%6 of the transactions occurred in this industry in 2010. Nonetheless, compared with the general traits, the individual cases are worth researching more carefully. A perfect example is the caseTake the story of China’s giant PC producer Lenovo7 as example, i. In December 2004 Lenovo acquired the PC department sector of IBM at the price of 1. 75 billion US dollars. After almost 10 years’ development, it was impressive that IBM became a super brand of business laptops and PCs and Lenovo had successfully enhanced its brand value and market share during the integration of two firms. It was this deal that made Lenovo a world PC giant. Conversely, the majority of Chinese buyers tasted the bitter flavor of defeats. According to the statistics of Mckinsey8 published in 2010, in the past 20 years, the success rate of international M&A was less than 50% while the failure rate of China’s overseas acquisitions was more that 67%9. In 2008, the total loss of China’s multi-national deals was nearly 35 billion US$10. For instance, in June 2009, Rio Tinto Group unexpectedly announced to breach the acquisition agreement with Chinalco and although Rio Tinto paid 0. 195 billion US$ break-up fee to Chinalco, the latter had to must pay multifold btimes of breaching compensation to China’s state-owned commercial banks and assume tremendous losses resulted from the dropping share price of Rio Tinto. Another perfect example is the case SAIC Motor11 took over SsangYong Motor12 which illustrated a failing integration after a triumphant acquisition. SAIC invested 0. 5 billion US$ to buy 48. 92% shares of SsangYong Motor in 2004 and increased its to 51. 33% in 2005. However, a smooth deal did not forecast a disaster of cultural integration. Neither SAIC achieved the aim of technology importation nor the new management team solved the annoying strikes and salary disputes so that the new enterprise staggered till 2009 when the local court approved the bankruptcy protection of SSangYong Motor, indicating the death of this acquisition. Analysis Based on the facts and cases revealed in previous chapter, we could can not help wondering that what was inside the box? In other words, what experiencepoints we can summarizecould summarize from the successful cases and what lessons we should learn from the failed ones? On one hand, the significant development of China’s overseas M&A might be generated by the following contributing factors. Firstly, the rapid economy growth drove solid requests forof the raw materials such as oil, gas or mining but subject to the limited domestic resources, Chinese enterprises turned their attention to global markets by active merging and acquiring. Secondly, since the exchange rate reform starting from 2005, the Chinese Currency RMB was appreciating gradually, for example the rate of US$ to RMB was 1: 8. 2 in 2005 but is 1: 6. 1 in 2014. In addition, the global financial crisis resulted from the subordinated debts storm in the USA remarkably dropped the share prices of listed companies in global capital markets. Both factorsThis change considerably lowered the costs of international acquisitions in recent years and created realistic opportunities for Chinese companies. Thirdly, holding the massive foreign currency reserve, for instance, 3820 billion US$ in the end of 201313, the central government of China broadened the control of foreign exchange and launched a ‘go-out’ policy to stimulate the internationalization of domestic enterprises, creating a relatively loose macro surroundings for Chinese companies. Fourthly, some Chinese companies were playing games in global markets more and more expertly. They adopted correct strategy to obtain global assets and products, executed it in accordance with international conventions, gained the advanced technology and sales networks, expanded the market share, established competitive edge and moved forward to the aim of multi-nationalization. On the other hand, it is indeed necessary to figure find out what caused the noticeable failure of Chinese acquirers. From my point of view, the reasons could be explained in four aspects. Political resistance:Political factors bear the brunt of the failure of China’s overseas acquisitions. Most Chinese enterprises engaging in international M&A were state-owned enterprises, which in the westerners eyes were regarded as the representatives of Chinese government. Although they emphasized the independence status and commercial orientation when doing business in other countries, the host governments were as prone to link them to the Communist Party of ChinaChinese government. Even if they were not state-owned, the public media often mislabeled them as Chinese SOEs because it was hard for the foreigners to distinguish the nature of one Chinese firm from the other. This was truly an extra risk of Chinese firms and constituted one fundamental obstacle toof China’s overseas acquisitions. Unfortunately, in most cases, Chinese firms had no say and did not know how to communicate with the local government or the public, only to accept the destiny of defeat. For example, the government of USA denied the 18. 5-billion-dollars acquisition of UNOCAL14 by CNOOC for the reason of state security. The failure of Chinalco’ acquisition of Rio Tinto was also attributed to the concern of economic safety of Australia. Strategic error:The core value of enterprise M&A probably is increasing the critical competitive advantage and sustainable development capacity thorough obtaining the essential resources of acquired firms, which requires thorough and appropriate strategies. Nevertheless, most Chinese enterprises, when operating international M&A, did not have a complete and clear strategiesy or did have a strategiesy but lost control of the operation and could not survive the ever-changing global markets. Some of them failed to properly evaluate their overall strengths and to completely understand the rules of international acquisitions therefore executed rush transactions blindly just catering for the individual preference of the boss or following the ‘going-out’ fashion of ‘going-out’. TheA lack of strategiesy must not realize an anticipated results. After a series of losses in international acquisitions, TCL15 admitted that the insufficient strategic preparation was the major reason contributed to its failure16. Another relevant case is the bidding for Hummer17 by Tengzhong18. Although had published an official industrial planning aiming at developing new energy vehicles in 2009, Tengzhong announced a bid for Hummer, the producer of large displacement vehicles, which completely contradicted its strategy of energy saving and emission reduction. Integration difficulty:After applause, flowers, champagnes and wines in the signature ceremony, the real challenge just starts because of the integration or management difficulties of Chinese firms. Though more and more Chinese enterprises enlarged tremendously in recent years, for example, 100 Chinese firms were listed on the Fortune Global 500 Rankings 201419, taking up one fifth of the world’s biggest companies. But compared with international giants such as Exxon Mobile, BP or Shell, Chinese firms are weak on management issues such as corporate governance, business operations, management communication skills, international reputation and marketing channels and internal integration etc. Multi-national acquisition and integration is so complicated that Chinese companies are short of not only managers who could communicate professionally with their counter-parts and standardize the operation with global horizon but also experts who are familiar with international market operations from legal, financial or managerial background20. Take TCL’s acquisition of Thomson21 for instance, after the deal was done, in less than three years, all the former executives of Thomson left the ‘new’ company22 and it fell into a crisis of management resulting in huge profit losses in the following fiscal years. It was truly a failure of team integration due to managerial incompetence. Even worse, Chinese firms were used to manage the integration after acquisitions with domestic management styles and most of them were caught in serious internal frictions, causing which caused productivity declining and profit dropping. Moreover, Chinese firms were merely accustomed to employ Chinese workers no matter where they were doing business, which exerted extensive concerns in the host country. For example, when Chinese firms acquired a local mining, a railway or harbor construction project in Africa, thousands of Chinese workers were hired to work there. It maybe impressive for many when we watched TV that more than 30,000 Chinese workers retreated from Libya after the civil war following the collapse of the Gaddafi regime in 2010. In the countries with tight policies on foreign labors, the employment patterns of Chinese acquisitions were controversial. Culture difference:Cultural is an indispensible influential factor in international M&A yet ignoring its significance is a common failing of Chinese acquirers. Many host countries complained that Chinese firms were mining robots or money machines, developing business simply on their own without incorporating themselves into the local communities and respecting the unique cultural backgrounds. The failure of SAIC’s acquisition of SsangYong, discussed mentioned in previous episode, could cast light on how the culture conflict ruined a takeover. It seems that the primary reason was SAIC’s insufficient acknowledgement of culture difference. Korea is an island country and its people have tremendous national pride therefore when SsangYong was acquired by SCIA which is from an undeveloped country of China, its employees were reluctant to accept the reality of control change and to co-operate well with the new boss. That was why they behaved negatively in the integration and apparently SAIC failed to figure out a proper strategy to deal with this issue. Moreover, SAIC underestimated the power of Labor Union and the complexity of labor disputes while paid more attention to enhance the relationship with the governmental authorities, which is anan exact reflection of Chinese culture, not suitable in Korea. The result of ignoring it was remarkable. Comparison After the analysis of what caused Chinese firms’ poor performance, before giving advice on how to improve it, it seems necessary to catch a glance at how the international peers did their M&A deals. Japan, one neighbor of China, is a perfect model we could refer to. Similar as today’s China, Japan is a country short of natural resources, from the 1960s when Japanese economy began to soar, Japanese enterprises invested massively in overseas markets to pursue a steady resource supplies. In the 1970s and 1980s, they also encountered various barriers and obstacles but Japanese firms gradually diminished the hostility and cautiousness and successfully took initiatives in global investment sectors23. Image-making:Japanese firms laid emphasis on image-polishing via the ‘think tank’ and the news media. In the 1980s, in response to the increasing hostility, Japanese firms implemented diverse strategies to turn them acceptable to the American society. Since most official critics were from the Congress, major Japanese companies established or enlarged the representative offices in Washington, DC. They tried to create the mainstream opinion via the cooperation with the think tanks, journalists orand former governmental officials and in return the think tanks held periodically forums on Japanese investments and published reports arguing that Japanese investments were beneficial to the USA economy. In most cases, Japanese firms sponsored or funded the researches or cooperated with the scholars in this field. Sustainable strategy: Japanese firms focused on a long-term effect of investments, pursued a resource-preferred acquisition strategy and did not deviate from the aim easily even if confronting temporary losses or missing profitable opportunities. As a result, the investment terms of Japanese firms were longer than those of Chinese firms. In addition, Japanese companies coordinated well with each other and avoided internal malicious competitions (which often happened among their Chinese peers) to maximize their coalition strength. Differing from Chinese acquirers in Australian market, Japanese companies were used to form an acquisition group of 3-4 firms to optimize the bargaining potential and profit margin. Local management: Unlike Chinese companies which preferred to appoint Chinese executives in overseas subordinates, Japanese investors trusted localAmerican managers and appointed them as executives. Besides, they tried to localize material supplies as much as possible. According to the report published in 2002 by the Bureau of Economics Analysis24, USA, from 1982 to 2002, the number of American suppliers of Honda25had climbed from 40 to 55026. Likewise, when negotiating with partners for acquisition deals, Japanese companies seldom requested to participated in the business operation so that they could avoid the employment, salary or land disputes, which considerably reduced the management risk and integration failure. Community relation: When investing in overseas countries, Japanese firms endeavored to integrate themselves to local culture and contribute to the construction of local communities. For example, sponsoring a baseball team or funding a cancer research center, Japanese firm had donated millions of dollars for local charity. All of these merits of goodness conveyed the information that Japanese firms respected local culture and put high value on local development. This is a sharp contrast to Chinese firms’ behavior in that they were only keen on making money but were indifferent to the lives of local residents. Recommendation Corresponding to the problems figured out discussed and the comparisons analyzed above, I would like to share my view on how to improve the overseas M&A operations of Chinese enterprises. Firstly, we should reduce the role the state plays in international acquisitions and create effective communications with stakeholders. To be honest, many overseas M&A cases illustrated the economic targets of Chinese government, which is the most controversial issue and the biggest concern in foreign markets. As the government, it must be aware of its duty and the boundary of public power, decrease the interference to micro economic operation and liberate the creativities of Chinese enterprises in overseas markets. On the other hand, Chinese government should provide necessary supervision and guidance of overseas acquisitions, reform improper and complicated formalities of abroad transaction and facilitate the currency flow by loosing strict exchange control. However, to eliminate political obstacles, the majority of the tasks are at the shoulder of Chinese enterprises themselves. It shouldmay be necessary for them to put public relationship management top of their agenda. For example, learn to communicate with the public media and the local communities in the language and style they could understand, find spokesmen in think tanks and sponsor local research academies or educational institutions are all constructive measures to enhance the soft powerimage of Chinese enterprises. In principle, we must try to let the host country, the local public, the local staff and other stakeholders believe that Chinese acquisitions are not only a business but also a kindness, not a threatens but an opportunitiesy, to all of them. Secondly, it is essential to break the spell of speculation and to adopt strategic thinking. Acquisition is not gambling but rather implementation of strategy, hence before initiating offers Chinese buyers must set up definite targets and strategies. In short, what do we exactly want? Every overseas acquisition case must have a clear strategic demand: to enhance the buyer’s weight in the value chain; to extend the brand reputation; to expand the production line or to extend the market share? We should not launch an acquisition merely because the target company is cheap or the acquisition is an eye-catching advertisement. Nothing would be more surprising than the news that a Chinese Millionaire Chen Guangbiao, whose business is recycle resourcing, announced a plan to buy New York Times. After the aim is set up, Chinese enterprise should establish and hold a firm strategy, draw an feasible plan in details to implement the strategy step by step and unless the market surroundings changes fundamentally, do not give up the fixed strategy easily. Thirdly, it could be urgent for Chinese firms to substantially enhance their management strength to survive the integration difficulties after takeovers. It is desirable for the acquirer to keep the previous management team of the acquired firm as much as possible and to pursue a ‘win-win’ target by satisfying both the requirements of the buyer and the demands of the seller as well asand its employees. Plus, they also should build a thorough management systems in accordance with international convention, enhance overall managerial strengthability, perfect internal corporate governance and establish rational incentive mechanism, to achieve a smooth integration and a sustainable development. Fourthly, it is not exaggerating to say that the failure of an overseas acquisition is actually the failure of cultural communication, which reminds Chinese buyers to take care of the cultural difference. Currently, most of the targeted firms are matured western enterprises which have built their own tradition and culture and hope to maintain rather than change it. In the contrary, Chinese firms have not developed a systematic and matured cultures. That is, China buyers have to absorb the advanced elements of the existing cultures and mix them in the formation of a new culture. Under some unique circumstances it is necessary to give up or reform the unreasonable parts in our own cultures that iare s unacceptable to the host country. Conclusion To summarize, overseas M&A is an effective way for Chinese enterprises to realize the hyper-normal development in global markets. But every opportunity could also be seen as a crisis and vice versa. It is a cake or a trap merely depends on what areis our choices. Friendly market, clear strategy, efficient management and proper communication may bring you a bright perspectives while hostile surrounding, blind expansion, poor administration and cultural conflict could catch usyou in a deep traps. For the better preparation to survive international M&A competitions, it is high time for Chinese enterprises to sum up the successful experiences and to learn from the costly lessons. If this article could provide some advisable suggestions on this topic, it would be my greatest pleasure.