Essay on Literary Analysis The Red Convertible

When reading literature we often attempt to use particular threads of thought or lenses of critique to gain entry into the implied historic or legendary nature of literature. To accurately process a tale in the light in which it is presented, we have to consider the text from multiple viewpoints. We must take into consideration intentional and affective fallacies and the socioeconomic circumstances of the presenter/author/narrator. We also have to consider how our personal experience creates bias by placing the elements of the story into the web of relationships that we use to interpret the external world. There also is the need to factor in other external pressures, from societal norms, cultural ideals, and psychological themes, and how†¦show more content†¦Other stories, perceived as unrealistic, often are posited so because they contain elements we do not see in the real world; metaphoric fantasy, symbolism, abstractness. These concepts are all based on our own filters o f perception – we discern what is historically accurate and what is legend, or myth, based on our position in culture and the lenses which we view ourselves. In â€Å"The Red Convertible†, we can see these concepts at play – Lyman, narrating the story of the relationship with his brother Henry, tells a story that flows very effortlessly. Things that happen around him seem to brush off of him, as if they are no big deal. An example of this is when the brothers are watching the television Lyman purchased, as it is an example of how Lyman uses defenses to repress the reality of what is occurring to his brother and subsequently their relationship. Rather than experience the shock of Henry biting through his tongue, he ascribes all of the reasoning to the objects surrounding them – in essence he removes the difficulty of actual experiencing the trauma he sees, instead creating a mythical representation of the reality he is experiencing. That he goes to attack the television after seeing the blood on Henry’s lip demonstrates an example of displacement, as he is taking his anger out on something he sees as the cause of trauma, ratherShow MoreRelatedThe Red Convertible By Louise Erdrich931 Words   |  4 Pages In the short story â€Å"The Red Convertible,† by Louise Erdrich, there are multiple literary devices used throughout. However, Erdrich most commonly utilizes theme and symbolism. She uses certain themes throughout most of her work, as noted by Keri L. Overall in a literary analysis. â€Å"Indeed, the themes of Erdrich’s stories range from the effects of war on families and personal identity to loss of heritage and family and personal relationships.† Erdrich also employs the use of symbolism in this storyRead More India Risk Analysis Essay3459 Words   |  14 Pagesto recognize these opportunities to gain Foreign Direct Investment by realigning government policy towards new business potential. 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Male vs Female Friendships Free Essays

Male vs Female Friendships BY sf0409928 Male Vs. Female Friendships How different is a friendship with a woman from the one with a man? What do you prefer? Are they the same kind of friendship or does it depend on the person? I have my own opinions to compare and contrast about these two kinds of friendships, such as confidence, places to go out and the way of thinking. Confidence is very important to establish in a friendship. We will write a custom essay sample on Male vs Female Friendships or any similar topic only for you Order Now Confessing something is difficult but when you have someone important who can listen to you and give you ome advice is great. I think most women tend to criticize you or be more gossipy with what you tell them. On the other hand, men are more reliable with your secrets and most of the time listen to you without criticizing. Another important aspect to consider is the places to go out. I think I have more options with female friends than with male friends. With female friends you can go shopping, since girls can shop forever with no problem. Also girls can go to clubs ogether and get discounts on drinks, Just because they are women. A male friend doesn’t like to shop as much as females. One advantage is you can go to clubs with men and never feel alone, because he is always going to be taking care of you. The way of thinking influences so much in a friendship. Most women think with their hearts and always try to give you the best advice. Men on the other hand, are more blunt. They will tell you exactly how they feel even if it’s going to hurt your eelings. The one thing to remember is that a true friend will always tell you the truth. I think women and men both make excellent friends. It depends on the situation your in whether you want to chill with men or women at the time. Depending on what you want to do or want to talk about is when you will make that decision. Just remember good friends are hard to come by. Whether they are male or female Just remember the happiness that he or she brings into your life. How to cite Male vs Female Friendships, Papers

Labor Market Trends - Employer of Choice - and Staff turnover

Question: Describe about the Labor Market Trends, Employer of Choice, and Staff turnover? Answer: It is very important for every business to understand the importance of labor market trends so that the organizations growth can be planned accordingly. Labor market will help the organization to understand the below things. Certain skills are very rare so if an organization is planning to hire people with those skills then they will face difficulty. At the same time, the available resources in the market would charge lucrative salary or wages. In the UK, acquiring employees for construction industry is one of the most difficult things to do. In the past, there were government apprenticeships schemes, which help the employers from construction industry to acquire the required set of people. Today, government is motivating the youth to undertake higher studies, and hence, there is a scarcity of people who are willing to work in the construction industry (Chen 2014). Location also creates an impact on the availability of skills. Employees are willing to work in certain locations as compared to that of the other locations. The mining industries, which are located in Yorkshire and South Wales, faces a lot of complexities in acquiring people for the vacant positions in the organizations. On the other end, there are locations, wherein people are overwhelming to be a part of it (Serban 2015). Labor force trends in different countries contexts The population of the nation creates a great impact on the availability of labor. If the youth population in the nation is very high then the country need not be worried about the lack of availability of skills. On the other end, if the aging population is more then this is not a good sign for the employers as the employers will have a tough time in hiring employees. Looking at the population growth, it can be said that the population was developing nation is growing continuously, but the case is not same with developed nations. According to the United Nations Population research report, the world population was 7 billion in 2011, and is expected to reach 9 million by 2050. This population will exceed more than 10 billion by the end of 2100, but the fact is that the population growth is not equally divided among all the nations (Chen 2013). The population growth in developing nations is higher than that of population growth in developed nations. The population of developed nation is 1.24 billion in 2011, and it will grow only to 1.34 billion in 2100. Europe and Japan has noticed that there is a steady decline in the fertility rates, and at the same time, the existing population is also aging. Spain, Italy and Germanys population is expected to reduce further by 15 to 25 percent. Countries like United States, Great Britain, Australia, and Canada i s safe because of the growing immigration population from developing nations (Harding 2013). Tightening and loosening marketing trends Off shoring is one of the keys trends which are being followed by the developed nations. With the growing population, the developing countries are trying to urbanize so that they can avail the best of education. Increase in educational qualification allows them to take them off shoring opportunities that are available in the developed nations. Most of the white collar jobs in the US are outsourced to developing nations (Ciuhureanu 2014). IT Outsourcing, and Business Process Outsourcing are the two common jobs which have been outsourced to developing nations from most of the developed nations. In the past, these tasks were completed by college graduates, but today, the number of graduates is less as compared to that of the work which needs to be completed. On the other end, there are jobs like that of accounting, engineering and finance, which cannot be undertaken by people from developing nations or any other for that market. The US taxation system cannot be well understood and imple mented by a student from Chinese or Indian university. The employer should identify the tasks that can be outsourced in a developing nation, and the tasks which will have to be completed by the local people only. The increasing number of organizations is giving a tough time to the multinationals which are present in developed countries like that of the US, and the UK. In the past, increasing number of graduates was willing to work in developed nations, but that is not the situation anymore. The number of multinationals in developed nations is acquiring the educated youth for the betterment of their nation, and hence, the developed nations are no more a desired destination for many graduates. In 2011, the ten largest economies of Asia spend around $399 billion on research and development, and the US economy spare $400 billion for the same research and development. The graduates who are willing to work in research and development need not be dependent on the developed nations as now they can get the desired job in their own country (Cipollone 2014). Role of government, employers and trade unions The government should understand the future needs of the employers and accordingly come up with new educational courses so that the young generation is employable. If the young generation continues to study the outdated information then they may be unemployed. The employers will have to ensure that the employees are updated with the technologies that will be used in the organization. Continuous training and on-the-job training will help the employees to grow further and stay updated with the market requirements. The trade unions should support the various training programs which are prevalent in the organization. They should accept the fact that the organization is willing to grow with the existing employees and it is a good sign. Summary Looking at the current labor trend, it can be said that the labor need of developed nation is dependent on the developing nations. People in the developed nations are willing to take up jobs that match their educational qualification. If a construction industry is looking for manpower then they will be available with overqualified graduates, who are not able to find an opportunity matching to their qualifications. These graduates will take up an opportunity in construction industry, but simultaneously, they will look for an opportunity in the open market so that they can find something that best matches with their educational qualification (Aurora 2013). The population of developing nations is increasing, and the population of developed nation is getting stagnated. Due to this, the management of organizations will have to outsource many white collar tasks to the developing nation. Similarly, there are plenty of multinationals, and hence, the youth from different corners of the world arent willing to migrate to developed nations. The management of the organization will have to track the daily activities in the organization. Accordingly, they should decide on the tasks that can be outsourced, and also the tasks that will have to be completed by the local people. This report will help the CEO to understand the hiring that they need to do. It is always financially feasible to outsource the tasks rather than getting it done by paying extra (Giovanni 2014). Strengths and weaknesses of labor market competitors There are plenty of organizations which are competing for the same labors that are available in the market. Two such competitors are Starbucks and McDonalds. The strengths and weaknesses of each of the competitor are elaborated below. Strengths of Starbucks Weaknesses of Starbucks Starbucks holds a reputation name in the market and hence, employees are willing to be a part of Starbucks In the past, Starbucks was offering great remuneration to the employees but now, the remuneration and also the employee benefits have reduced. More than 13000 employees are associated with the organization The employees have to work for long hours and that is disliked by many employees because the employees arent paid sufficient for the overtime that we do. Strengths of McDonalds Weaknesses of McDonalds The employees in trained and groomed to meet the organizational requirements. This makes them better and employable. Long working hours is a problem in McDonalds. Many a times, the employees are tired of the long working hours. The employees in the organization are offered internal growth. This allows the employees to improve so that they can reach the managerial designation quickly. Lack of incentives of the employees doesnt motivate the employee to perform better or stay longer. Employer of choice What is employer of choice? Being employer of the choice is not a random thing that has happened to organization overnight. Organizations will have to put in lot of efforts so that they can achieve this tag of being the employer of choice. Employer of choice means the employer has created an environment wherein employees are willing to work, and at the same time, the organizations should promise a long-lasting career to the employees. Employees prefer to work with en employer of choice organization because they believe that they can gain better experience in terms of training, perks, salary, incentives, development, opportunities and purpose for being. In the past, having a gym and daycare center was great deal, but today, this has become a very basic thing, and hence, employees expect more than that. Employees want to feel motivated and engaged throughout the day so that they can achieve a sense of satisfaction (Jacques 2013). Why to be employer of choice There are various advantages of being an employer of choice, and hence, plenty of organizations are trying hard to achieve that tagline. Few of the advantages of being an employer of choice are as follows- Employees, across the globe, are willing to be a part of an organization which is termed as employer of choice. The potential employees will themselves come to the employer, looking for an opportunity. The organization need not invest much of cost in recruiting and marketing about the open vacancies in the organization. The organization will have the best of employees, and hence, they can be rest assured that the productivity in the organization would be more. Apart from that, the senior employees will take care of the new resources. Employees in the organization become more productive when they decide to stay with the organization for longer period. The employees prefer to stay with employer of choice because of the continued benefits that they receive from the organization. These employees will understand the organizations suppliers and vendors. This will help the vendors and suppliers to be more connected with the organization (Bellou 2015). Finding better people will be an easy task for the employer of choice. Lot of people will apply for the open positions in the organization, and these applicants would be from the best of lot available. The mediocre employees will be skeptical about applying with the employer of choice, and hence, the resumes received for vacant positions would be better (Maas 2014). How to be the employer of choice? The organization will have to undertake various activities so that they can be termed as the employer of choice. Few of the strategies that can be undertaken by an organization to achieve the employer of choice position are as follows: - Employee engagement is one of the important things that need to be undertaken by the organization. All the employees in the organization are engaged at all point of time. The management of the organization will have to come up with creative ways by which the employees are completely occupied. The immediate managers should personally know the employees so that the employees can be understood better, and simply retained. Employees expect the employers to reward them so that they can feel good about their association with the organization. The employers should benchmark their reward system against the standard market rates so that the employers can pay them better than that of the other companies (Geisel 2013). Succession planning needs to be undertaken by the organizations so that the organization can get in more youngsters. The management of employer of choice will have to help employees plan about their complete life (Brown 2014). Positioning as employer of the choice Different organizations have been named as employer of choice because of various reasons. Few of the reasons due to which employers are named as the employer of choice are discussed below. Time and again, Google has proved that it is a desired employer for lot of employees. Google ensures that they care of the employee needs. Google offers a variety of breakfast, lunch, and dinner (if the employees stay late). Google campus has coffee bars and juice bars as well (Dafny 2013). The employees believe that this helps them to enjoy good food in the office area, and they also get to know their colleagues better. Googles management believes that this saves their time, and hence, the productivity of employees also increases. Google provides travel insurance and emergency assistance to all its employees. This is applicable to employees even when they are on personal vacation (Clark 2014). Apple is known in the market for the best perks that they offer to the employees. All the employees at Apple are given an option to choose from the wide range of options that the organization has to offer. These benefits are offered to part-time employees as well. There are plenty of benefits like 401K, flexible spending for childcare, medical expenses, and others. Apple employees are given discounts on the Apple product that we buy (McDevitt 2014). Staff turnover Why employees leave organization? There are various reasons due to which employees look for job change rather than continuing with the same organization. Few of the reasons due to which the employees leave the organization are as follows: - Compensation is one of the biggest concerns for most of the employees. Employees decide to leave the organization so that they can get paid well, in some other organization. This will help them to take care of their financial requirements better (Swarnalatha 2014). If an employee feels that the growth opportunities in a particular organization are lesser then they will start looking for a change in their job. Initially an employee may be willing to work as a software developer, but later, they will be willing to move to managerial role rather than continuing as a software developer for the rest of the life. If they feel that in this particular organization, they will not be able to grow then they will look for organizations that offer them growth (Schulthesis 2015). If the employee feels that they are not getting what they expected from the job then the employees may leave the job. In many cases, it happens that if the software developers are put in maintenance project for a long time period then they start looking for a change. Software developers look for fresh projects wherein they can do the basic coding rather than just correcting the codes which have been already written (Deery 2015). If there is no work-life balance then the employees will start looking for an opportunity. Many employers believes that keeping employees busy and occupied is one of the best ways by which they can be retained, but this cannot be proven to be right at all point of time. If the employees are staying late in the evenings, on all days, then slowly and steadily, they will start looking for an opportunity outside (McCann 2013). Costs associated with dysfunctional employee turnover The dysfunctional employee turnover needs to be avoided by the employer at any cost so that they can save the organization from the loss that they would make. Few of the costs associated with dysfunctional employee turnover are as follows: - Dysfunctional employees can directly create an impact on the profit that the organization makes so this can create an impact on the revenue generated by the organization. Create an impact on the existing workforce as they might be losing their best team member, colleague or mentor. The employee turnover of the organization can be calculated using the below formula. Yearly turnover rate = (Number of employees who left the organization in a year/Average number of employees in the year) X 100 (Anna 2013) Approaches to retaining talent If an organization thinks that there are plenty of potential employees available in the open market, and hence, retention of employees is not much important then the organization is thinking on the wrong track. There are various reasons due to which retention needs to be undertaken by the organization. Few of the reasons on importance of retention are as follows: - The cost of turnover is higher, and this needs to be understood by the employer. When an employee is higher, the organization spends money on recruitment. On the other end, an employee in the organization is given lot of training, and the organization invests lot of efforts in them so when an employee leaves the organization, the expenses are costs which cannot be recovered (Derek 2013). An employee in the organization is aware of plenty of things that are happening in the organization. When an employee leaves the organization, he takes all the company knowledge with him (Kalsbeek 2013). Excess attrition in the organization means that the organization is not a great place to work. Potential employees will not be willing to be associated with the organization. This can spoil the reputation of the organization among the employees. A new employee who comes in the organization will take some time to settle in the new environment, and hence, there would be an interruption in the services that are provided by the organization to the customer. The new employee will take some time to understand the organization, the environment, and also the customers. This time period is very crucial (Spittle 2013). Strengths and weaknesses of different approaches of employee retention Each of the strategy used by the organization to retain the employee has its own strengths and weaknesses. The strengths and weaknesses are few of the strategies are discussed below. Paying an employee above the market standards is one of the common strategies used by employers. In this case the organization pays the employee so that the employee can stay with the employer for a longer time period. The organization is paying more than the market standard and hence, the employee will expect more from the organization. Apart from that, always there would be some or other organization which is willing to hire these employees. Training the employees is another strategy used by organization to retain the employees. These employees may leave the organization once the training program is complete so this can considered as a loss to the organization. With the help of appropriate training, the performance of the employee is improved and hence, this is a positive sign. References Anna, I, 2013, Dealing with alternatively organized workers: Recruitment and retention strategies among Danish Shop Stewards, Nordic Journal of working life studies, vol. 3, no. 4, pp. 85-89 Aurora, A, 2013, Trends in labor market participation and fertility behavior: a first look to the Italian experience in recent, vol. 71, no. 1, pp. 125-148 Bellou, V, 2015, Employer of choice: does gender matter? Gender in Management: An international journal, vol. 30, no. 8, pp. 613-634 Brown, A, 2014, Employer of Choice failing general staff, Agenda, vol. 22, pp. 27-32 Cipollone, A, 2014, Female Labor market participation in Europe: Novel evidence on trends and shaping factors, IZA Journal of European labor studies, vol. 3, no. 1, pp. 1-40 Ciuhureanu, A, 2014, Identification of labor market trends from the perspective of the competencies and the skills requested as well as the recruitment sources used by the employees from the Centre Development region, vol. 14, no. 1, pp. 19-30 Clark, R, 2014, The effects of retiree health insurance plan characteristics on retirees choice and employers cost, vol. 38, no. 1, pp. 119-129 Chen, W, 2013, Demographic or labor market trends, OECD Journal Economic studies, vol. 2013, no. 1, pp. 179-207 Chen, W, 2014, Demographic or labor trends: What determines the distribution of household earnings in OECD countries? OECD Journal: Economic studies, pp. 179-207 Dafny, L, 2013, Let them have Choice: Gains from shifting away from employer-sponsored health insurance and toward an individual exchange, American Economic Journal: Economic Policy, vol. 5, no. 1, pp. 32-58 Deery, M, 2015, Revisiting talent management, work-life balance and retention strategies, International journal of contemporary hospitality management, vol. 27, no. 3, pp. 453-472 Derek, S, 2013, Recruitment and Retention strategies for Hospital laboratory Personnel in Urban and Rural Settings, Clinical Laboratory Science, vol. 26, no. 1, pp. 10-17 Geisel, J, 2013, Firms face hard health cover choices; some employers may offer health insurance, despite mandate delay, vol. 47, no. 14, pp. 1-7 Giovanni, B, 2014, Trend Inflation, the labor market edge, and the non-vertical Philips Curve, Journal of Policy Modeling, vol. 36, no. 6, pp. 1022-1035 Harding, S, 2013, Trends in Mortality by labor market position around retirement ages in three European countries with different welfare regimes, International journal of public health, vol. 58, no. 1, pp. 99-108 Jacques, A, 2013, Becoming an employer of choice from inside out, Public relations tactics, vol. 20, no. 5, pp. 13-19 Kalsbeek, D, 2013, Reframing Retention Strategy: A Focus on Promise, New Directions for higher education, vol. 2013, no. 161, pp. 49-57 Maas, I. 2014, Employers choice Selection through job advertisements in the nineteenth and twentieth centuries, Research in Social Stratification and Mobility, vol. 36, pp. 49-68 McCann, J, 2013, Effective Recruitment and Retention strategies in community health groups, Health promotion Journal of Australia: Official Journal of Australian Association of Health Promotion Professionals, vol. 24, no. 12, pp. 104-110 McDevitt, R, 2014, Risk Selection into consumer-directed health plans: An analysis of family choices with large employers, Health service research, vol. 49, no. 2, pp. 609-627 Swarnalatha, C, 2014, Employee Retention Strategies, Golden Research Thoughts, vol. 3, no. 12, pp. 1-3 Schulthesis, S, 2015, Expanding the Admissions Mission to include retention strategies, Strategic enrolment Management Quarter, vol. 3, no. 1, pp. 18-28 Spittle, B, 2013, Reframing Retention Strategy: A Focus on Progress, New Directions for Higher Education, vol. 2013, no. 161, pp. 27-37 Serban, A, 2015, Current demographic trends A new challenge for the labor marker, Theoretical and Applied Economics, no. 4, pp. 309-320

The Meaning Of Hitler Essays - Adolf Hitler, German Re-armament

The Meaning Of Hitler The Meaning of Hitler was written by a German journalist by the name of Sebastian Haffner. In this book, Sebastian Haffner probes the historical, political, and emotional forces that molded Adolf Hitler's character. Sebastian Haffner also examines closely Hitler's rise to power as F?hrer of Germany, as well as his great achievements. Adolf Hitler began by making a mess of his life. He dropped out of school at the age of 14, failed his entrance exam at the Vienna Academy of Arts twice, and spent the time from his eighteenth to his twenty-fifth year in Vienna and then in Munich doing nothing and aspiring to nothing. Then, in 1914 when World War I broke out, Hitler volunteered for the Bavarian army. Hitler was a good soldier and received a couple of awards for bravery but never ranked higher than corporal. In 1918, when Germany finally surrendered, Hitler was very upset. He believed that it was the Jews and the Communists who betrayed the fatherland, and it was at this time that his hatred for the Jews most likely began. In 1919, Hitler joined a small radical Right-wing party, which called itself the National Socialist German Workers' Party, or Nazi party, where he soon became the leader. The party was small at first but Hitler's great skill at deliberating speeches attracted more and more listeners, and it soon became a major political party with many followers. Since the country was in chaos after World War I and was faced with the Great Depression, the Germans saw hope in Adolf Hitler. Unemployment was at about 40% and rising and people were starving and poor. In his speeches, Hitler blamed the Jews and Communists for their misfortunes. So why did so many Germans follow Hitler? When he took power, Germany and all of Europe was suffering from the Great Depression and were looking for answers and hope. Hitler was their answer. No factor contributed more to Hitler's success than the economic crisis. He promised to bring economic recover and national unity. Soon, factories started putting out weapons and now had jobs. To the German workers this was a very good sign. In 1933, when Hitler became Reich Chancellor, the Nazi party took control of every aspect of every day life. Hitler's goal was to eliminate the Jewish race from the European continent and to take control of Germany and turn it into a national socialist nation. He created a special police force called the Gestapo to make sure that anyone who opposed him would be eliminated. He took away the Jews' civil rights. Soon, Jews, communists, homosexuals and others who were viewed as ?inferior? according to the Nazi racial theory were thrown into concentration camps for extermination. In those camps, the Nazis killed 6 million Jews and many others. Hitler was unstoppable. World War II began in 1939 when German armies and warplanes attacked Poland. Two days later Britain and France jumped in and declared war on Germany. The Polish army was no match for the German army, and Hitler's armies crushed Poland in four weeks. In the meantime, German armies occupied Denmark and Norway and trapped the British army on the beaches of Dunkirk. France was now taken by the Nazis. Next, Germany attacked Britain by air, but Britain would not back down and eventually Germany backed off. Then, in June 1941 Germany turned and attacked the Soviet Union. However, the Germans completely underestimated the Soviet Union's ability of its government to control and mobilize the country's resources and were defeated in 1943. By June 1944, the war was going very badly for Hitler. A series of losses to the Allies and failure to defeat the Soviets had left Hitler's armies severely weakened. Germany had also changed a great deal. British and American bombers were devastating its indus tries and cities. Underestimating the Americans, Hitler launched his last reserves west into Belgium and Luxembourg in the Battle of the Bulge. He felt that a hard blow would cause popular support for the war in America to collapse, and would lead to the breakup of the coalition arrayed against him. All he accomplished, however, was to draw away troops needed in the east, allowing the Soviet army's

Lt Col Owens Big Assignment essays

Lt Col Owen's Big Assignment essays The 1948 movie Fort Apache directed by John Ford and starring Henry Fonda and John Wayne is a fairly straightforward tale of a bitter Civil War officer, Lt. Col. Owen Thursday, sent to command a remote army outpost in Arizona, Fort Apache. He is accompanied by his beautiful daughter, Philadelphia Thursday. Lt. Col. Thursday was trained at West Point, but his glory days are long gone and hes pretty steamed about it. I think a case could be made that Thursday had already decided on the stagecoach ride to Fort Apache that he would self destruct. Of course, he was a product of privilege, the American Dream, and wasnt prepared for it not quite working as promised, unlike the NCOs (peons) who, if smart or lucky, eventually come to understand theyll be lucky to have a pot when its all said and done. Thursday can no longer tolerate himself, and barely tolerates his beloved daughter, as witnessed by his withering stare when he dumps into a humiliating position in the chair she has secured for his home. It seems unlikely a great commander would arrive at his new assignment without some accommodation (planning) for home provisions, another clue the great Thursday is already bent on self destruction. Rigid Lt. Col. Thursday would certainly make plans for some basic needs, if not before then shortly upon arrival. But he did not. In this case, Thursday had made a directional plan something to the effect of, I will arrive, I will conquer, and I will die in glory (and screw everyone else). In the meantime, he manages to implement some specific goals (training of the men, and polishing their image). He does not conform to MBO, however, as he entirely leaves out the participative decision making, explicit time periods, and performance feedback, other than perfunctory. Perhaps that is enough; it certainly is for his goal. Of the four grand strategies of planning (Robbins, 99), Thursday h...

A Comparison of The Poplar Field by William Cowper and Binsey Poplars Felled 1879 by Gerard Manley Hopkins

Comparison of William Cooper and Bentley's Poplar Fields In 1879 Gerard Manley Hopkins was first defeated in that the two poems were about the riverside tree collection. Another thing in common with these poems is that they were cut afterwards, so the writers are now deprived of their pleasure in cold through colored. However, there are many differences between verses. Initially, we noticed that Hopkins used a more complex prosodic system to capture readers. Choose two verses given in the lecture. Let's compare and contrast these two poems (Binsey Poplars by Gerard Manley Hopkins and The Trees by Phillip Larkin). In a recent article by The Guardian, Billy Mills wrote that Trees have been rooted in poetry for centuries. - These two poems have many similarities in their contents. They all have a poetry relationship. The author wrote that his son is his father. My father thought that he was committing a crime, but this is a crime that God does not like. These two poems are related to th e life of the author. After Hopkins leaves his hometown and replaced his position in the world, the competition and cooperation between the father and his son lasted for a long time. For example, in 1879, Gerald Manley Hopkins wrote a letter to the bridge. I included some of my father's lines in Well Walk (Jots and other funny things.) Two months later, Hopkins created Bingxi Poplar Tree to celebrate the cutting of forest near Oxford Did. Clearly, competition with father is an important creative stimulus. Binsey Poplars is a religious poem, Hopkins has no personality. Everywhere in Binsey Poplars, the tone of poetry is sadness, appealing, anger, determination, and religion. This poem is written in spring rhythm which is an innovative metric format developed by Hopkins. In the spring rhythm, the number of accent in a line is calculated, but the number of syllables is not calculated. How to rhyme is different in each section. Since Binsey Poplars has only two sections, the system of v erse is AB, AC, BA, CC. This is also irregular. The position of the line of Binsey Poplars indicates that it is effective to run that line. This poem compares the line of a tree with the rank of a soldier. A military image means that the development of industry in rural areas is equivalent to war 'Binsey Poplars' was published in 1918. This is elegy of the scenery Hopkins knows intimately during Oxford. It has many atmospheric and landscape words like jumping sun - which means that the sun seems to interact with the environment. On the third line of the first quarter, he used felling three times. He did this to convey the sound of an ax hitting a tree. Hopkins believes that natural objects are like expressions created by God and that they use self to capture it. This poem is about Hopkins' love for Him and tells more about poplar logging.

Victimology Coursework Example | Topics and Well Written Essays - 250 words - 1

Victimology - Coursework Example The occurrence of such violence is attributable to bitterness towards the old, retaliatory attacks by younger adults, insufficient love and friendliness and general social plight. Reportedly, abusers are relations of the elderly individual who are supposedly caregivers. CVS (2011) reports several incidences of elder abuse. For instance, the year 2007 there were over 91590 individuals above the age of 65 who experienced violent misdemeanor. Of all police crime reporting rate across the various age groups, the age group of 65 five and above had 61% of the total crime reports in the year 2007. This is indicative of the increased crime across this age group. Reportedly, the same year witnessed individuals above the age of 65 lose a massive 1.3 billion dollars in terms of individual and possessions crimes. People aged 60 and constituted 8% of the total deceptive crime reported to the federal trade commission in the year 2008 (CVS, 2011). Consequently, about 12% of identity theft victims reported to the institution was age 60 years and above (CVS, 2011). This is indicative of the increasing criminal activity directed towards this age. According to CVS (2011), five ways to of preventing elder abuse includes individual awareness of the persistence of the problem and its causative factors. The elderly person should make the concerned authorities aware of the quandary. Secondly, one must plan a head to establish caregivers preparedness in terms of financial, physical, and psychological resources. One should arrange for an alternate care to take charge in the event of failure by the preliminary plan. The elders are encouraged to stay sociable by participating in communal activities and sustaining a well established association of friends. Lastly, one should obey the scheduled medical care and other many social engagements (CVS). CVS (2011) outlines several ways of identifying elder

Government Structure Essay Example | Topics and Well Written Essays - 750 words

Government Structure - Essay Example tract function model of government is connected deeply with the idea of the modern democracy where the government is formed with the will of the people. It is different from a constitutional monarchy such as the one present in the UK since the monarch remains the head of the government as well as the country while in a pure contract function model of government an elected representative becomes the head of state and leads the country (Hawkesworth and Kogan, 1992). The contract function model is based on the ideas of a social contract which has been credited to the ideas presented by Hobbes. His philosophy of government suggested that governments are formed by the banding of people and they earn their right to govern with the will and acceptance of the people. Thus there is an established (if often unwritten) contract between the people and their government regarding the social order which is maintained from both sides (Hawkesworth and Kogan, 1992). Violations of the contract from the side of the government give the people the right to revolt against the government while violations of the contract from the side of the people give the government the right to imprison them or ever deprive them of their lives in certain cases such as treason. While governments affect the people they govern in many different ways, the people who form a government also affect it in terms of their culture with regard to the political culture and the social culture. For example, even though countries such as China are democracies in a technical sense, the culture of the country remains a communist one for the most part. Of course the Chinese system of government has been affected by cultural changes that have come as a part of the economic development that China has seen in recent years but the government systems and bureaucracies remain connected with communism as a cultural artifact (Wortman, 1987). In this way, the political culture and the social culture affect how governments are

Health Insurance Portability and Accountability Act of 1996 Essay Example for Free

Health Insurance Portability and Accountability Act of 1996 Essay Today we will be discussing the Health Insurance Portability and Accountability Act of 1996 or HIPAA. As some or most of you may know HIPAA was enacted by the federal government in 1996 and by definition is a federal law that mandates insurance portability and sets up procedures for electronic data exchange (Austin Wetle, 2012). This law’s purpose is to protect patients privacy, none of a Patient’s Health Information (PHI) is to be used or released without the patient’s consent. HIPAA is superior to state laws, so that no matter where the patient lives they are protected. The only time HIPAA is not superior to state law is if the state law has a higher standard, as in keeping an account of disclosures for eight years rather than the six required by HIPAA law we would follow the state law in this case. Key factors that all health care employees should know about HIPAA are as follows. Who is covered by HIPPA? Health care providers, clearinghouses, and health plans that are compelled to protect PHI for oral, paper, and electronic communications (Harman, 2005) are all covered by HIPAA. Another key factor about HIPAA is, knowing what information is protected and what is ok to be disclosed. PHI is not to be disclosed unless the patient gives their consent, anything with personal identifiers is off limits, demographic data, past, present and future health conditions, provisions of care and past, present, or future payment information (U. S. Department of Health Human Services, n. d. ) are all protected. Information that can be disclosed is called de-identified health information, information without any identifying factors. The only required PHI disclosures are to the patient if they request it. If a facility fails to abide by the laws they will be fined. Any person who obtains or discloses identifiable PHI can face a criminal penalty of up to $50,000 and up to one year in prison (U. S. Department of Health Human Services, n. d. ) the person will likely be terminated from their position as well. These regulations effect the management of employees, patients, resources, and ealth care because everyone needs to be trained in HIPAA practices and know the laws and regulations. Patients need to understand and sign consent forms and be made aware of what their rights are through the policy. One could say HIPPA makes for more paperwork; however it is crucial to protect our patient’s privacy and the relationship with our outside resources. Once completely understood by all of the staff, and patients everyone will understand how valuable HIPAA really is.

Essays on Death and Suicide - Death Happens :: Personal Narrative Essays

Death Happens Brothers and sisters are rarely friends. Perhaps comrades and confidants, even inseparable-but rarely do they actually agree. Take my sister and me, for example: she knew how, in my eyes, chocolate had no rival in the bliss stakes, so she'd wait until she knew I was salivating (every hour or so) and she'd filch it and feed it to our abjectly grateful dog. She loathed grunge music, so I, in retaliation, would play my raucous selection until it reverberated off the walls. You get the idea. But we were the only two girls in the family, you see, and very close. Although we betrayed each other's secrets on a daily basis we still told each other everything. Young and naive. When I was almost four, I remember her gloating about her new boyfriend. I was indignant, invidious, so I got a boyfriend in revenge. Phantom phone calls, withered flowers in the mailbox, love notes posted to my door...until she found out "Jerome" didn't exist. I never did live that experience down. Five, six, pick up sticks...the era of the bike. She got off her training wheels before me, so I let her tires down. Seven, eight, stay up late...by nine, it was boys' germs, girls' germs...and according to me, my brothers had them with a vengeance. According to them, even germs would die if they touched me. Nine, ten, friends again. I got pocket money that year, and I bought my own chocolates, but no matter how carefully I concealed them, the dog always enjoyed them more often than I did. Just before her thirteenth birthday, my sister started walking funny, sticking her chest out and squeezing her behind in. She'd look at Mother cryptically, and ignored me completely. One day I found a tape measure discarded on her bedroom floor, and still I had no idea. It was only when I found two triangles held together by a bit of elastic that I finally filled in the jigsaw. It grew worse...she became moody...always yelling or bursting into tears. When I asked Mother what was happening, she said ominously, "Your sister's a woman now." How come she got to be a woman, while I was stuck being a girl? Then, I discovered the opposite sex and knew what she meant. My God, he LOOKED at me?

Education Essays – Egypt Education System

Egypt Education SystemThe extension of the free compulsory instruction jurisprudence in 1981 was one of the grounds to unite the Preparatory Stage, both Primary and Preparatory stages ( Ages 6 through 14 ) together under the label Basic Education, as instruction beyond this phase depends on the pupil ‘s ability. Egypt operates two corresponding instruction systems: the secular system and the spiritual, or Al-Azhar system. The secular system consists of basic instruction which covers the first 8 eight old ages of schooling. The 2nd degree divides pupils between three-year general academic secondary schools and three or five-year vocational schools, as there are three different types of secondary instruction which are general, proficient, and vocational Technical instruction. These types of instruction are provided in three-year and five-year plans, and include schools in three different Fieldss: industrial, commercial and agricultural. The 3rd degree is universities. The Al-Azhar system, which maintains separate installations for male and female from primary to university degree, enrolls 4 per centum of the country’s entire pupils, and is responsible for conveying the mission of Islam and uncovering its part to humanity’s public assistance and advancement. In this system, primary school extends over the first 6 old ages, and preparative school for the following three old ages. Students who successfully complete 4 old ages of secondary school can inscribe at Al-Azhar University.2 Al-Azhar University, which is considered to be the bastion of Islamic cognition in Egypt, was founded in AD 970. There are two sorts of authorities schools in Egypt which are Arabic Schools and Experimental Language Schools. Arabic Schools provide the governmental national course of study in the Arabic Language ; nevertheless, experimental Language Schools teach most of the authorities course of study in English, and add Gallic as a 2nd foreign linguistic communication. Furthermore, there are three sorts of private schools. As Government schools, private schools besides has different types such as ordinary schools, linguistic communication schools, and spiritual schools. First, Ordinary schools have the same manner of instruction of the authorities schools with more concentration on the pupils want and services provided to them. Second, linguistic communication schools have the same educational stuffs as the authorities with the exclusion that all those stuffs are taught in different linguistic communications ; this is beside the high fees those schools requires. The 3rd type of private instruction is spiritual that are established or controlled by Muslim Brotherhood. Their educational course of study is wholly unlike the authorities and Azhar schools. Private schools on Egypt are considered the best instruction because of high and assorted installations offered by those schools. This educational system is supervises by the ministry of instruction However, the Azhar instruction system is supervised by the Supreme Council of the Al-Azhar Institution and considered to be independent from the Ministry of Education, but is finally under supervising by the Egyptian Prime Minister. The Azhar schools are named â€Å" Institutes † and besides portion the same phases as the normal educational system which both include primary, preparatory, and secondary instruction. The Azhar schools in all stages teach non-religious topics, to a certain grade ; nevertheless, the bulk of the course of study consists of spiritual topics. All the pupils are Muslims, and males and females are separated in all stages. The Azhar schools are spread all over the state, but overly in rural countries. The alumnuss of the Azhar secondary schools are eligible to go on their surveies merely at the Al-Azhar University. In the early 2000s, the Azhar schools accounted for less than 4 % of the entire registration. There are both private and public universities of higher instruction in Egypt. The difference between them is that Public higher instruction is free in Egypt, and Egyptian pupils merely pay enrollment fees, but Private instruction is much more expensive and is considered to b for the elite, as alumnuss of such schools by and large do really good on their concluding secondary school scrutinies, which ensures them entree to what are considered as elect modules. Presently 98 per centum of alumnuss from secondary schools enter higher instruction. The higher instruction sector in Egypt is comprised of universities and establishments of proficient and professional preparation. The system is made up of 12 public universities, 51public non-university establishments, and 4 private ( for net income ) universities. In May 2000, there were 18 pending applications to open extra private for net income higher instruction establishments. Of the 51 non-university establishments, 47 are biennial in-between proficient institutes ( MTI ) , and 4 are four or five-year higher proficient institutes ( World Bank, 2000:1 ) . The major public universities are Cairo University ( 100,000 pupils ) , Alexandria University, Ain Shams University, and the 1,000-year-old Al-Azhar University. While the American University in Cairo, the German University in Cairo and the Universite Francaise d'Egypte is of the taking private universities in Egypt. Entry into the secular university system is based on the consequences of the Secondary Educational stage. Harmonizing to the article â€Å"Egypt, † â€Å"only pupils go toing general academic secondary schools were eligible to matriculate ; nevertheless since 1970 universities have been inscribing some pupils from vocational schools. The Placement Bureau of the Ministry of Higher Education controls admittance, and there is alegion clausesimposed by the Supreme Council of Universities ( SCU ) on admittance at institutional and province levels† . Al-Azhar University system, unlike other systems, requires certain certifications like a Secondary School Certificate from the Al-Azhar instruction system and a Certificate of Koran Recitation from a Koran Recitation Institute or keep an Al-Azhar sheepskin. Non-university instruction is offered by industrial, commercial, and proficient institutes which provide 2-year classs taking to diplomas in accounting, secretarial work, insurance, computing machine or wellness scientific disciplines and electronics. Technical instruction schools provide 5-year classs taking to progress proficient instruction sheepskin in commercial, industrial, and agricultural Fieldss. Although the American University in Cairo ( AUC ) has existed since 1919 as a private university, Egypt merely legalized Egyptian private universities in 1992 when the People’s Assembly passed a Law # 101 leting the constitution of private universities. The most indispensable consideration is that the Minister for Education must O.K. the assignment of private university, as presidents, and non-Egyptians can non busy taking places in private universities without the ministry’s blessing. The 2nd critical facet is that the Supreme Council of Universities indirectly supervises private universities and is responsible for monitoring criterions to guarantee that graduation certifications from province and private universities represent an equal instruction degree compared with the governmental certifications. â€Å"In May 2002, the private universities’ commission was replaced with theprivateuniversities’ council.The council has the same powers as the Supreme Council of Universities, which regulates public universities.† Many Peoples assume that private higher instruction establishments in Egypt are s establishments that â€Å"sell†grades to those who can afford the university expanses. Critics of private higher instruction in Egypt besides argue that private higher instruction is at odds with the rules of the1952 Revolution, which called for equal entree to educational chances for all citizens. Egypt is considered the state that has the largest higher instruction systems in the 3rd universe as it contains about 1.670 million pupils. Egypt relies in its instruction on biennial proficient institutes to go on supplying entree to all secondary school alumnuss while protecting the already overfed universities. Technical institutes enroll 40 per centum of all secondary school alumnuss. This deficiency of fiscal, human, and material resources consequences in hapless quality instruction in most universities and is considered by many people as non academic establishment. The figure of higher instruction pupils per 100,000 dwellers is 1,900 in Egypt compared to 1,132 in Morocco ; 1,236 in Algeria ; and 1,253 in Tunisia. Surveies on the societal category and educational backgrounds of province university pupils have revealed inequalities of entree to what are considered as high status/elite modules. To better the educational system in Egypt administration and control of higher instruction should be obtained by the Ministry of Higher Education, the Supreme Council of Universities ( SCU ) , and the Central Administration of Al-Azhar Institutes. The Ministry of Higher Education has a legal authorization over higher instruction by oversing and commanding the instruction, planning, policy devising, and quality control on primary and preparative schools and developing for basic instruction for instructors. The Supreme Council of Universities formulates is the 1 responsible for policy devising and decision making or commanding the figure of pupils to be admitted to each module in each university. Furthermore, supervising and disposal of the Al-Azhar higher instruction system is the duty of theCardinal Administration of Al-Azhar Institutes, which is a section of the Supreme Council of Al-Azhar that is responsible for the development of the general policy and planning to enable the spread of Islamic civilization and Arabic linguistic communication. In official discourse, instruction in Egypt is â€Å"free† from basic to higher instruction. While officially the province is responsible for funding higher instruction in Egypt, the state’s portion of higher instruction finance for universities was reduced to 85 per centum in 1994-1995, go forthing the universities to bring forth the staying 15 per centum through assorted gross variegation schemes. Sanyal ( 1998:16 ) , and the World Bank ( 2000:40-41 ) place the undermentioned gross variegation schemes adopted by Egyptian universities: ( a ) Charging nominal tuition fees for alternate academic plans that are perceived to be of high quality and presenting other relevant fees. For illustration, province universities have introduced foreign linguistic communication plans for which they charge tuition. Some public universities charge ?E1,000 as tuition for a degree plan in Commerce which uses English as a medium of direction. The figure of appliers in some degree plans in public universities exceeds available infinites, a phenomenon which gives room for universities to bear down tuition. While the tuition charged in this instance is still merely about 33 per centum of the existent cost of the plan, this agreement sets a case in point towards cost recovery in public establishments ( World Bank, 2002:40 ) . Besides, in recent old ages, a new system of admittance to the modules of Law, Commerce, and Humanistic disciplines allows a less qualified pupil to obtain a topographic point on paying an admittance fee of ?E 360 ( Sanyal, op cit ) . The impact of this pattern on the quality has been negative as manifested by a high figure of reiterating pupils in universities. Egyptian pupils pay between ?E30-?E150 per twelvemonth as a nominal tuition fee in authorities funded universities. In add-on, they besides pay necessary equipment, books, transit, and abode fees. The pattern of bear downing nominal tuition fees in Egyptian public universities goes as far back as 1924 when the Egyptian University ( now Cairo University ) started bear downing ?E30 per twelvemonth for all modules with the exclusion of the pharmacological medicine section that charged ?E20 per twelvemonth. This university besides imposed a non-refundable scrutiny fee of ?E1.16 Tuition fee in private universities range from E15,000-25,000. The American University in Cairo-the oldest private university in Egypt, charges a tuition fee of US $ 2,813 for 6 credits and US $ 469 for each extra recognition. ( B ) Income coevals by specialised university centres from: ( 1 ) Cooperation with industry ; ( 2 ) Patent rights ; ( 3 ) Provision of go oning instruction to industrial employees ; ( 4 ) Entree to research lab and scientific equipment ; ( 5 ) Manufacturing intermediate industrial merchandises ; In add-on, In 1998, theInternational Finance Corporation ( IFC) conducted an extended feasibleness survey onthe market for pupil loans in post-secondary instruction in Egypt.This survey recommendedagainstestablishing a pupil loan plan due to the undermentioned grounds: ( a ) limited market size ; ( B ) underdeveloped debt/credit market ; ( degree Celsius ) cultural attitude uncomfortable with personal debt and loans ; and ( vitamin D ) deficiency of a consumer recognition bureau ( World Bank, 2000 op cit: 41 ) . As a consequence of the above recommendations, the Egyptian Government by 2000 was be aftering to set upa ?E100 million-loan planfor destitute university pupils. Under this proposed loan strategy, pupils who canprovethat they are in demand of fiscal aid for education-related disbursals will be eligible to have up to?E1000 pertwelvemonthin authorities loans. The loans are to be involvement free and refund will be spread out over a period of 40 old ages after graduation. Problems and challenges in Egyptian higher instruction system are analyzed in the World Bank’sHigher Education Enhancement Project,which is a portion of a comprehensive reform scheme for higher instruction in Egypt. The higher instruction reform docket was influenced by the National Conference on Higher Education, held in February 2000, and aims to turn to Egypt’s demand to upgrade educational quality in the university sector. Egyptian higher instruction sector faces a figure of challenges including: ( I ) antiquated system-wide administration and direction ; ( two ) low quality and relevancy at the university degree ; ( three ) low quality and relevancy at the in-between proficient degree ; and ( four ) limited financial sustainability of publically financed registrations ( World Bank, 2000:1 ) . The job of financially weak registrations is related to the dramatic addition in registrations in university instruction.For illustration, registrations increased by 42 per centum between 1997/98 and 1998/99 taking to an 8 per centum diminution in per -student disbursement that exacerbated disparities in resource allotment between modules ( World Bank, 2002:41 ) . While the overall outgo on instruction as a proportion of GDP has grown from 3.9 per centum in 1991 to 5.9 per centum in 1998 with higher instruction having a 28 per centum portion of entire outgo in 1998, the dramatic growing of the higher instruction pupil population in Egypt creats a serious job in funding higher instruction. Given the high population growing in higher instruction, to merely keep the portion of 18-22 age group at its present 20 per centum degree ( this is an official policy ) would necessitate on norm an extra 60,000 new registrations in higher instruction for the following 10 old ages ( World Bank, 2000:2 ) . The authorities has no fiscal ability to make this.

Mary Rowlandson’s “The Captive” Essay

In the sixteenth, seventeenth, and eighteenth centuries of America, many settlers and colonists were taken captive by the Native Americans, commonly known as Indians. The Native Americans had many reasons and motives for capturing the settlers or colonists. Captives were often taken to be traded, ransomed, or â€Å"adopted,† which Native Americans did to replace tribal members who had passed or who had been killed. Two very famous captivity narratives are those of James Smith and Mary Rowlandson, whose stories are very different due to their captors, gender, and religion. James Smith was 18 years old when he was captured by the Indians just miles above Bedford. Smith was captured by three Indians, one was a Canasatauga and the two others were Delawares. With the exception of being flogged, Smith’s experiences with the Indians were not terrible. He was essentially treated as an Indian. This stems from the fact that he was adopted by the Natives. James Smith was given man y freedoms. Smith was very trusted by the Indians. They allowed him to hunt with them or on his own, they expected him to act as an Indian, and they also trusted him to take care of them when needed. Smith also had the option to leave whenever he pleased. He did not have to remain with the Indians for the four years, 1755-1759, that he did. These experiences are very different compared to those of Mary Rowlandson. Mary Rowlandson’s hometown of Lancaster, Massachusetts was destroyed by the Indians in King Philip’s War and she was taken captive during the destruction. Mary Rowlandson was captured in 1676 and remained a captive for three months before the requested ransom was paid. Rowlandson had very different experiences from James Smith with the Indians. At her capture, she witnessed the Indians killing or harming many in her family. Rowlandson, herself, suffered a gunshot wound. James Smith was also harmed when first captured by the Indians; however, he had been aided by French doctors. Mary Rowlandson dealt with her gunshot wound on her own. She also had to carry her sick child for six days before the child passed away. Rowlandson was not able to read freely in front of the Indians, she was not given a fair share of th e food, and was often forced to find other Indian tribes to spend the night with, or to receive food from. Rowlandson was sometimes allowed to go and meet with family members who were with neighboring tribes. Compared to James Smith’s experiences, Mary Rowlandson had it tough when she was a captive of the Indians. Gender had a major effect on how the captives were treated. Native Americans often captured women because they were easier to capture, could bring in more ransom, and the Indians also believed that the women would be easier to control. Mary Rowlandson had to make clothes for others in order to either trade with them or to get money that she could then use to obtain food with. James Smith, on the other hand, was able to go out and hunt for the food he needed. The food that he and his fellow Indians gathered was evenly divided amongst the tribe. Rowlandson, however, was treated better by some tribes than the one she was being held captive in. Some Indians from other tribes would offer her food or opportunities to get money or goods that she needed. This was likely due to the fact that women had more powers and were more respected in some Indian tribes. Smith was expected to help and fend for himself while Rowlandson was often provided with food, though it was not a fair share and was often not of the same value that Smith’s was. Overall, Mary Rowlandson was treated disrespectfully, unfairly, and as though she was inferior. Rowlandson had to fight harder to live, as her food was often stolen and her religion, her greatest hope and strength, was frowned upon during her captivity. Religiously, Mary Rowlandson was affected more than James Smith. Mary Rowlandson was very religious. Rowlandson was married to a minister of Lancaster. Mary Rowlandson’s faith and religion were the only things that kept her going during her captivity. The only thing she had to look forward to was reading her bible, though she had to do it secretly because once, her mistress caught her reading it, grabbed it out of her hands, and threw it ou tside. Rowlandson recovered her bible, but from then on she read it more secretly. Mary Rowlandson believed that all of the trials that she survived and the blessings that she received were from God. Rowlandson wrote of leaving her captivity, â€Å"I have been in the midst of those roaring lions and savage bears that feared neither God nor man nor the devil, by night and day, alone and in company, sleeping all sorts together, and yet not one of them ever offered the least abuse of unchastity to me in word or action; though some are ready to say I speak it for my own credit; but I speak it in the presence of God, and to His glory. God’s power is as great now as it was to furnace. Especially that I should come away in the midst of so many hundreds of enemies and not a dog move his tongue.† Mary Rowlandson often quoted bible verses, one being Psalsms 27: â€Å"Wait on the Lord.† Rowlandson used this particular verse to persuade another captive against trying to escape and run away. and metaphorically related her experiences to stories of the bible .Mary Rowlandson depended upon her religion to survive her captivity. Without, her faith, religion, and God, Mary Rowlandson would have had no hope, no reason to go on, or no encouragement to persevere through her captivity. James Smith was not extremely religious. Unlike Mary Rowlandson, James Smith did not depend upon religion to survive his captivity with the Indians. The Indians that Smith was with did not mind him practicing his own religion and they did not force their religion upon him. James Smith was, towards the end of his captivity, traveling with an Indian by the name of Tecaughretanego and his son Nunganey. After Smith laughed at Tecaughretanego’s religious ceremonies, Tecaughretanego said to him, â€Å"Brother,–I have somewhat to say to you, and I hope you will not be offended when I tell you of your faults. You know that when you were reading your books in town I would not let the boys or any one disturb you; but now, when I was praying, I saw you laughing. I do not think that you look upon praying as a foolish thing; I believe you pray yourself. But perhaps you may think my mode or manner of praying foolish; if so, you ought in a friendly manner to instruct me, and not make sport of sacred things.† Smith learned a lot about the Indians’ religion through his experiences with them and learned to respect their beliefs. Though the experiences of James Smith and Mary Rowlandson were very different, neither story will ever be forgotten. Perhaps that was their purpose for recording their exploits. The differences in their stories can be attributed to their sex, religion, and captors. Had Mary Rowlandson not been female, religious, or captured by the Indians she was, her story may have been very different. Also, for James Smith, had he not been male or taken by the Indians he was his story would have been completely altered. The qualities, beliefs, and characteristics of Mary Rowlandson and James Smith were essentially what saved their lives.

Gettsyburg essays

Gettsyburg essays During 1863, the Civil War continued to wage on between the two extremely divided factions. In the first two years of the Civil War, neither side had gained any real advantage. Thirty-three conflicts occurred leading up to the Battle of Gettysburg, some major and some minor, but none had the effect that Gettysburg had on the course of the Civil War. This decisive battle occurred during the first three days of July 1863, which changed the course of the Civil War and determined the fate of the United States. Gettysburg was a small market town of 2400 at this time, in southern Pennsylvania, located at a spot where a number of small roads converged. Although neither commander of the armies was prepared for, nor wanted to fight in this region, it proved to be a pivotal point in the Civil War. The Battle of Gettysburg was ultimately the turning point in the Civil War because it put the South on the defensive for the rest of the war and definitively ended in the defeat of the Confed erate States. Although the location and timing of the Battle of Gettysburg was almost an accident, the fact that a huge battle took place in Pennsylvania in July 1863 was certainly no accident. General Robert E. Lee, the commander of the Confederate Army of Northern Virginia, had chosen a course that meant a major battle was almost unavoidable. Two months earlier, General Lee found himself at a dilemma. He had recently defeated the federal Army of the Potomac, in a daring example of superior generalship at the Battle of Chancellorsville. Although Chancellorsville had been a decisive victory for the Confederacy, Lee himself knew that all he had really accomplished was buying a little more time. The battle had succeeded in repelling the Federals from much of Virginia, which contained the important capital of the Confederacy at Richmond. However, Lee knew it wold only be a matter of time before the powerful Federal host moved south again. Lee...

Gender Disparities and Gendered Miseries in Divakarunis One Amazing T Essay

Gender Disparities and Gendered Miseries in Divakarunis One Amazing Thing - Essay Example In One Amazing Thing, Divakaruni argues that gender discrimination produces women who are unhappy with themselves and their lives because of the gender norms and expectations that hinder them from developing their abilities and taking risks for their loved ones. Womanhood does not necessarily mean personhood, and without personhood, happiness and self-development are elusive. Gender discrimination, despite state policies that promote gender sensitivity and equality, manifests through gender norms, including son preference. In â€Å"Explaining Son Preference in Rural India: The Independent Role of Structural versus Individual Factors,† Pande and Astone studied the reasons for son preference in rural India. They concentrated on son preference as an effect of interest, and they theorized that a person’s son preference is a product of a complex process that the society, the household, and the individual factors shape. They investigate these factors that affected son preference from the late 1980s and early 1990s. Their sampling included 50,136 ever-married women. Findings showed that social norms, household and individual factors impact the decision to prefer sons over daughters. The same practice is evident in One Amazing Thing. Mohit’s parents do not want him to marry a Chinese woman, whom they think does not deserve to marry an affluen t rich Indian man. Their preference for the son superseded their preference for their son’s happiness. Gender discrimination produces unfair gender norms and expectations that delimit women’s capacity for self-development. Mrs. Pritchett wants to feel loved, but she feels it is too late for she married a self-centered man who is unaware of her needs as a woman. She has not developed her personhood because of her restrictions as a woman. Mangalam experiences sexual harassment, though this gives her power over a life of poverty. Nevertheless, her experience shows that because she  is poor and a woman, she cannot attain the kind of life she wants to have. Sexual harassment is common in patriarchal countries (Gupta 95).

Ig E deficiency Case Study Example | Topics and Well Written Essays - 1000 words

Ig E deficiency - Case Study Example The immunoglobulin E (IgE) binds the environmental antigens or the parasitic infection agents, and then causes the release of substances from the mast cells, which causes inflammations. It is following the binding of the immunoglobulin E (IgE) to the mast cells that a cascade of the allergic reactions then occurs (Kim, Bouchard & Renzix, 2008). The surface of the mast cells is designed such that it contains special receptors that bind the IgE cells. Therefore, when two adjacent mast-cells that are already bound with the IgE antibodies come closer, they attract allergens and attach the allergens to both of them, thus cross-linking the IgE antibodies together (Scadding & Kariyawasam, 2009). After a critical mass of the IgEs have become cross linked, they release histamine and other related substances, thus beginning the cascading allergic reactions. The pathophysiology that results in the symptoms of sneezing, mucous production and airway constriction begins after a repeated exposure of the IgE to a particular allergen, for example a dust mite (Bourdin, Gras, Vachier & Chanez, 2009). The exposure to such allergens first produces an initial immune system reaction referred to as the early phase reaction, which is followed by another phase referred to as the late phase reaction, which is a more severe reaction (Scadding & Kariyawasam, 2009). Therefore, the pathophysiology of IgE reaction starts with the sensitization phase, where the IgE are exposed to an allergen for the first time. The sensitization phase where the IgE gets exposed to the allergen for the first time may occur through different forms such as inhalation, for example of dust mites, pollen or molds, or through ingestion of a certain type of parasite, food or medication (Kim, Bouchard & Renzix, 2008). The sensitization can also occur through touch, for example coming into contact with a poison ivy or latex, or through injection, for example under medication or through being stung by an

How, in your judgment, can one evaluate the ethical nature of an act Research Paper

How, in your judgment, can one evaluate the ethical nature of an act - Research Paper Example Nature of ethics has three main features that are worth examining. The first feature is that the nature of ethics is closely correlated with duties, which are generally the other side of morals and moral rights. For instance, an individual’s right to work implies that the government has a duty to ensure that jobs are available for people (Gotsis and Kortezi, 2010). Secondly, ethics gives people equality and autonomy in the pursuit of their interests. The last main feature of the nature of ethics is that it provides a basis for justification of an individual’s actions and for invocation of aid or protection of others (Gutmann and Thompson, 2006). Over the years, there has been increased concern over the need to find ways of evaluating the ethical nature of organizations including non-profit organizations, private association, or government agency. Since ethics is such an important aspect in any organization, there has been heightened need in recent years to evaluate the ethical nature of organizations in order to ensure that they derive maximum benefits from adherence to valuable ethics (Cooper, 2012). It is against this background that this paper will discuss how one can evaluate the ethical nature of a government agency: The Court Services and Offender Supervision Agency (CSOSA). It will create a format for the systematic evaluation of the agency’s ethical commitment. Nature of Ethics and Government Agencies It is commonly accepted that ethics is an essential part of operation of government agencies. Unethical behaviors can have very devastating consequences for any given government agency, while sound ethical behavior can greatly facilitate effectiveness and efficiency in the delivery of services within a particular government agency (Hayden, 2005). Acknowledgement of the importance of ethics requires commitment and establishment of an organizational ethical capacity in a structured and concerted way. Therefore, it is important that gover nment officials be competent in managing of the ethical dimensions of the government agencies. In order to produce sustainable ethical behavior, there is need to cultivate an ethical organizational culture or an ethical way of thinking and ethical behavior (Gotsis and Kortezi, 2010). The officials of the government agency need to set specific ethics objectives for their respective agencies, as well as designing and implementing a strategy that is geared towards achieving these objectives (Cooper, 2012). In addition, they need to institutionalize ethics, monitor and report on the ethical performance of all the employees of the agency. When looking at ethics in the government agency domain, ethics is a prerequisite for the improved performance and reputation of the government agency and therefore should be the foundation element in the government agency’s operations strategy (Gutmann and Thompson, 2006). Effective management of ethics in government agencies requires that there is a comprehensive evaluation of the nature of ethics in those agencies. The government officials of respective government agencies should engage in a concentrated effort of establishing mechanisms and criteria of

Health education Assignment Example | Topics and Well Written Essays - 500 words

Health education - Assignment Example The hair should be washed everyday using shampoo and rinsed well before it is dried. When bathing children, one should pay attention to all folds including the underarm, neck, ears and in between the feet. Clean clothes and shoes should be put on after taking a bath. Shoes should be polished; wiped or washed according to their make to improve their appearance and to make them last longer. Children should wear clean socks in closed shoes. This will absorb sweat and keep their feet dry and comfortable. They should brush their teeth before going to bed and after every meal to fight against tooth decay. They should learn how to brush their teeth by themselves, and it is better if they do it together with an adult. During the day, a child should fill his or her mouth with water and swish it to remove anything that is stuck in the teeth. Taking large quantities of sugary foodstuff should be avoided as it promotes tooth decay. Under clothes should be changed more often with clean, dry ones. They should well fitting and in good condition. This should be done because under clothes are worn directly next to the skin and they gather a lot of sweat and dead skin. Wearing clean under clothes prevents skin diseases such as itchy rashes and ringworms. The child also smells good and thus, he is confident to interact with adults and other children. Children should be encouraged to wash their hands with soap and clean water regularly. This should be done before and after handling or eating of food and after visiting the toilet. Children should be discouraged from inserting their hands in their mouths. |This is because, at playtime, they gather lots of dirt in their hands because of touching anything that interests them. Regular washing of hands reduces them from the risk of getting diseases like diarrhea, stomach upsets and typhoid. Both hand and toe nails should be trimmed as long nails collect lots of germs and bacteria during playtime. In

Health Inequalities In Mental Illness Health And Social Care Essay

Health Inequalities In Mental Illness Health And Social Care Essay In this assignment the author will critically analyse the health inequalities that are evident for people with a diagnosis of a severe mental illness. He will particularly focus on the inequalities that exist in relation to the prevalence, identification and management of the physical health aspects for this set of complex conditions. In the course of the assignment he will critically evaluate these health inequalities from an international, a national United Kingdom and a more local Scottish perspective. In doing so he will critically examine a selection of health promotion approaches which underpin the physical healthcare of people with severe mental illness. He will also systematically evaluate the effectiveness of some of the differing approaches which contribute to the management of these conditions and the enhancement of the health and social wellbeing of mental illness sufferers across the world. Definitions In order to analyse the health inequalities the author will first define some of the key terms that he will refer to throughout the assignment. Health was defined by the World Health Organisation (WHO) (1948) as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.Though this is a useful and accurate definition, some would consider it idealistic and non-realistic. Using the WHO definition classifies 70-95% of people as unhealthy. However Davis (2009) declared the added importance of the wider definition of health stating There is a biomedical component to health, but it exists in a setting that includes biological, personal, relational, social, and political factors Looking at health in a little more detail the determinants of health are defined by the WHO (2010) as Many factors combine together to affect the health of individuals and communities. Whether people are healthy or not, is determined by their circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact. The determinants of health include: the social and economic environment, the physical environment, and The persons individual characteristics and behaviours. Alternatively European Union public health information system (2009) define determinants of health as Many, often interacting factors that determine a persons health or disease state. These include Socio-economic factors: education, occupation, employment, poverty and income distribution; Environment: social support, airborne particulate matter and working conditions; Health behaviours: smoking, alcohol use, drug use, food consumption, physical activity and breastfeeding; and Biological and personal factors: overweight and blood pressure. WHO (2010) declared that Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. For example, differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes. It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. Whereas Samuel (2000) describes health inequalities in a more simple fashion as unjust or unfair differences in health determinants or outcomes within or between defined populations. Severe Mental Illness The Rethink operational definition of severe mental illness (2008) is when people: Are diagnosed as suffering primarily from a mental illness, typically schizophrenia or a severe affective (mood) disorder. Suffer substantial disability as a result of their illness, such as inability to care for themselves independently, sustain relationships or work Are currently displaying florid symptoms or are suffering from a chronic enduring condition. Have suffered recurring crises leading to frequent hospital admissions or interventions and/or place a significant burden on their informal carers. Occasion significant risk to their own health or safety or to that of others. The Ottawa charter for health promotion WHO(1986) defines Health promotion as the process of enabling people to increase control over and improve their health They describe it as not just the responsibility of the health sector and that it goes beyond healthy lifestyles to well being. Health promotion has been defined by the World Health Organizations (2005) Bangkok Charter for Health Promotion in a Globalized World as the process of enabling people to increase control over their health and its determinants, and thereby improve their health The United Nations Convention on the Rights of Persons with Disabilities (2006) claim that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination. States should take all appropriate measures to ensure access to health services with the same range, quality and standard as provided to other persons. A UK based study by the Disability Right Commission (2006) Equal treatment: Closing the gap described an analysis of 8 million health records. It confirmed that people with severe mental illness have rates of cardiovascular and diabetes problems that are 2-3 times more common than would be expected in the general public. Bowel cancer is 90% more common in males with schizophrenia and women are 42% more likely to get breast cancer. The author will now go on to explore the phenomenon where many thousands of people with severe mental illness are at high risk of dying early with physical health problems. He sees this as a significant health inequality across the world and will examine some of the health promotion activities that have been attempted to reduce this inequality. Appendix 1 gives an analysis of the search criteria and the database results that he used in order to critically examine this topic. Evidence of Health Inequalities United States of America Miller et al (2006) in a well conducted and robust clinical study in the USA examined the mortality and medical morbidity of 20,018 patients admitted to psychiatric services with a diagnosis of psychosis in Ohio between 1998 and 2002. It identified that 21 percent of cases died from heart disease and 7 percent from a cancer related disease and 3 percent from diabetes related disorders. They cited the possible causes of these problems as medication induced weight gain, poor personal hygiene, reduced physical activity, and increased prevalence of smoking, increased substance misuse and a reduced social support network. In the study they were also able to report that deaths in this client group were three times higher than expected in the general USA population (with Heart disease being the main cause) and the average age of death at 47.7 years was 32 years younger than the general population figures. They acknowledged in their report the need to better integrate the delivery of both me ntal and physical healthcare by collaborating with all stakeholders to improve the quality of life outcomes for this population. They do not however go on to explain how they would take this agenda forward. Australia These international findings are also supported by statements from the Australian National Mental Health consumer and carer forum (2010) who state that the appalling health and early mortality of people with persistent mental illness is unacceptable. These comments from a national user and carer forum are not defined from one particular study but from a body of research and audit from across Australia focussing on outcomes of a series of studies. The national voice and recommendations from a major player in Australian healthcare with a focus on the needs of the patient rather than services is as significant in the authors eyes as a single robust study. They add that these issues are having a significant impact on the persons wellbeing and is also contributing to their social exclusion. They add to the argument by stating that these causes are iatrogenic (occurring as a result of the disorder or its treatment ) They go on to add the other areas that are common in this group and that can add to the impact being poverty, neglect, discrimination, smoking, substance misuse and poor dietary habits. They add that the screening for these conditions occurs less often in patients with mental illness hence they are less likely to be treated. The Australian report adds that the life expectancy of this client group is 25 years less than the general population. An interesting fact that they add though is that their evidence suggests that the client group do not have higher than average rates of disease like cancer and heart disease but they die from the disease 2 to 3 times more often than the general public. They suggest again like the USA repo rt that this is due to patients not receiving appropriate preventative screening and treatment for these illnesses. They go on to state that psychiatrists, GPs and other prescribers of psychotropic medication have a responsibility to monitor the effects of medication on a persons physical state as well as its impact on their mental wellbeing. They go on to recommend a series of actions for the future which include State and territory governments undertake to educate all stakeholders on Physical Health Impacts of Mental Health Problems and Disorders They enable appropriate screening, assessment and physical health checks for all persons with identified mental illness, including attention to dental health The Australian Government takes leadership on these issues by requiring all identified mental health funding to be accountable for physical health maintenance All mental health programs and policy areas report on physical health screening, assessment and monitoring for all mental health consumers in receipt of services Given the nature of mental illness, service providers need to innovate and respond creatively to address the physical health impacts of mental health disorders and their treatment Doctors take responsibility, when prescribing medications for people with mental health issues, to treat them holistically and monitor their physical health changes and needs. United Kingdom Likewise in the United Kingdom Cormac (2009) in a Royal College of Psychiatrists paper cites several papers which indicate a higher incidence of physical health problems in people with severe mental illness. Phelen et al (2001) stated that people with mental disorder have a higher risk of poor health and premature mortality and a meta-analysis of 27 studies almost 10 years ago by Harris and Barraclough (1998) showed a standardised mortality ratio of at least 1.5 for this group of patients however it varied with the severity and type of disorder. Patients with schizophrenia had increased mortality ratios of almost 3-4 times that of the general public with deaths mainly caused by cardiovascular and endocrine type disorders. These findings were reported by Brown et al (2000), Osby et al (2000 and Enger et al (2004). More recent findings in the UK has been the high escalation of the risk of developing metabolic syndrome for schizophrenics which has been found to be 2-4 times higher than the general public, finding borne out in the study by Saari et al(2005) and Thakore (2005). Joukamaa et al (2006) added some additional evidence to suggest that the risk of sudden death in patients with schizophrenia increases with the addition of each different psychotropic medication that is prescribed. Likewise the Department of Health (2010) in the Our health and Wellbeing report suggest that looking beyond neighborhoods and deprivation, certain groups have poorer health and some are uniquely disadvantaged because of a combination of their circumstances. For example: People with schizophrenia: A total of 0.4% of the population experience psychosis each year. A recent UK study found that, of those living with schizophrenia in the community, men experienced 20.5 years lower life expectancy and women 16.4 years lower life expectancy than the general population. The largest single cause of this inequality is an increased rate of smoking, more than three times that of the general population. Scotland Moreover the NHS in Scotland (2008) in their report Improving the physical health and wellbeing of those experiencing mental illness again cite evidence from studies across the world that the physical health of patients with severe mental illness is compromised. They state that research in Europe and the USA has shown that mortality rates from physical illness for those with mental illness is significantly higher than the general population. Schizophrenia is generally acknowledged as a life shortening illness with sufferers dying on average 10 years earlier than the general population. Two thirds of this excess mortality is due to poor physical health. They also identified that this group are developing these illnesses at a younger age and are dying from them earlier with 5 year survival rates reduced by up to 16%. NHS Scotland (2008) also refers to the aspects of stigma and discrimination. They state that Legislation requires that all Agencies dealing with the public remove discrimination and promote equality, yet a See Me(2006) survey reports that some people with mental health problems still feel stigmatised. The Highland Users Group ( 2008) have found that when it comes to their physical health needs they can be subject to unequal access to services and can feel stigmatised and discriminated against when they try to access general health care services. They feel their physical health concerns are too often put down to their mental health problem, especially if their symptoms are medically unexplained. Frayne et al (2005) suggest that research has confirmed that they do not always receive the same medical treatments as the rest of the public and consequently their health outcomes can be worse. Additionally the Scottish Government (2008) in the equally well report highlights Mental Illness and Mental wellbeing as important factors in the argument. They state that Mental illness and mental wellbeing are specific priorities for the Task Force. People with mental illness are more likely to die earlier from suicide, or illnesses such as cardiovascular disease (CVD) and tend to have generally poorer health through conditions such as diabetes. Mental wellbeing is associated with good mental health, but is not necessarily the same as absence of mental illness. Much of the Task Forces work is based on the importance of factors such as resilience, hopefulness and optimism that create mental wellbeing and quality of life. These allow people to deal effectively with lifes problems and normal stresses, to make the most of their abilities and the opportunities available and to play a positive part in their community. People whose wellbeing is good are more likely to look after their own health. However, depression is closely associated with poor physical health, for example increasing significantly the risks of CVD. The author concludes from the overriding evidence across the world that those suffering from a severe mental illness have much poorer physical health which causes them to have a shorter life expectancy. These conditions are identified as mostly cardiovascular and metabolic type problems. There is evidence that this client group has unequal access to health services and feel stigmatised and discriminated against. Health Promotion Models and Interventions Naidoo and Wills (2000) identify 5 approaches to health promotion. Medical or preventative approaches which target the whole population and are aimed at reducing premature deaths and avoidable diseases. Behavioural Change approaches view health as the property of the individual and encourages them to adopt healthy behaviours that are regarded as key to improving health. Educational approaches are strongly linked to heath education and seek to provide knowledge, information and develop skills so that people can make informed choices about their health behaviour. Empowerment approaches are bottom up approaches which encourage communities to identify their needs, develop skills and make appropriate life changes. Social change approaches is a top down approach which targets specific groups and populations and defined by a belief that socio-economic circumstances determine health status in individuals. Its focus is usually at policy or environmental levels. The author will now explore some of the interventions used across the world within the models/approaches above. In the United Kingdom Phelan et al (2004) introduced a physical health check tool to support the monitoring and management of physical health issues with patients with severe mental illness. This would be seen in the above model as a medical or preventative approach which aims to assess need in a target population and then develop an agreed action plan with the patient on how they are going to address the defined health needs. The assessment is completed on a 12 monthly basis and is designed to supplement normal medical care and review. The results showed that 50% of clients had a diagnosed physical illness with 78.3% saying they had one or more physical symptoms. 65% of patients agreed to one or more of the actions available which included getting advice about smoking cessation, diet and starting regular exercise. The outcomes have seen an increase in the quality of the assessment and recording of the physical needs of the patients as well as a huge jump in the activities being care planned within a structured care programme approach care plan. The study compared the group with a neighbouring community mental health team and demonstrated that the use of the structured assessment and care planning tools significantly improved the quality of information recorded. The failings in the report highlight that although the staff were able to assess and plan care there was as yet no evidence that this approach had improved the health outcomes of patients and the life expectancy of them. When we relate this to the models above we identify that the medical and organisational policy approaches are easier to do and measure compared to the change behaviour that is required by the individuals concerned. The author suggests that further longer term studies are required to evaluate the long term health impact of this approach to the organisation of physical healthcare management. Likewise the Department of health (2006) in their commissioning framework document choosing health give examples of case studies which reflect some of the health promotion interventions across the UK. In one study a selection of clients from across a city were involved in a physical health consultation with a senior nurse. This assessment took place in their own home as there had been a previous reluctance to attend clinics for this purpose. Once the health issues were identified in an assessment patients were selected for inclusion in 2 healthy working groups. One focussed on healthy living and was attended by 15 patients whilst the other had a focus on physical activity, was based in the local sports centre and had an attendance rate of about 20 patients per week. A voluntary walking group was also available. There were very positive outcomes from the study which included the following 57% reduction in alcohol consumption Only a 1% DNA rate at activities 32% reduction in smoking 44%weight loss 50% increase in activity levels 95% improvement in patient self esteem Dietary improvements These significant health improvements for patients can only contribute to improving their life expectancy. The author believes that the above interventions fall into a number of the approaches to health promotion identified by Naidoo and Wills (2000) for the following reasons. Medical and preventative- These interventions are targeted at a particular sector of the population in order to prevent the formation of disease in an identified vulnerable group. The initial screening selects those that go forward for health promotion activity. This is a top down expert led approach to target interventions at a vulnerable client group reducing costs in the long term and improving outcomes. Behaviour change- information, support and improvements in access to health, social, lifestyle and sports facilities has encouraged people to make informed choices to adopt more healthy behaviours. The evidence in the outcomes has shown that people have made real improvements in their health by taking responsibility (even though in some cases it was supported initially by staff) and changing their lifestyle significantly. Health education- the specific classes and education provided by staff supported the individuals to make informed choices about their health and the behaviours that they were adopting to support it. Empowerment in this area the nurses were being seen as catalysts of change or facilitators in order to support individuals. The fact that local sports and leisure facilities was involved was evidence of a social inclusion aspect of the service where it was seen to be normal to engage with local facilities and not in specialist hospitals or clinics. Social change approaches- the targeting of this client group in a top down approach by clinicians in many ways is evidence of this approach across the uk. Likewise in the United Kingdom another approach which identifies this social change approach is the mental health component of the general practitioners contract and the quality and outcomes framework that they work to. British Medical Association (2009) states in their advice on interventions to General practitioners that Patients with serious mental health problems are at considerably increased risk of physical ill-health than the general population. It is therefore good practice for a member of the practice team to review each patients physical health on an annual basis. Health promotion and health prevention advice is particularly important for people with serious mental illness however there is good evidence that they are much less likely than other members of the general population to be offered, for example, blood pressure checks and cholesterol checks if they have concurrent coronary heart disease, and cervical screening. They feel the importance of this by identifying a number of targets in mental health two of which relate to physical health and are detailed below. MH 8. The practice can produce a register of people with schizophrenia, bipolar disorder and other psychoses MH 9. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the preceding 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health status. They also recommend that a review of physical health will therefore normally include: 1. An enquiry about smoking, alcohol and drug use 2. A blood pressure check 3. A cholesterol check where clinically indicated 4. Measurement of body mass index (BMI) 5. A check for the development of diabetes 6. Cervical screening where appropriate 7. An enquiry about cough, sputum, and wheeze. Reports on the two targets have seen achievements in the high 90% range across the country hence showing evidence of improvement in screening. This approach in primary care is commendable but there are a number of patients who still find it difficult to engage and access services. This client group require additional support to access services and NHS Quality Improvement Scotland (2007) felt it was an important enough matter to include it in their Mental Health Integrated Care Pathway standards. The GP targets which only include the offer of health assessment are enhanced further and include a recording of the completion of an assessment and actions relating to the outcome which include health promotion, communication with interested parties and evidence that action has been taken on the findings. The author agrees with NHS QIS that it was necessary to take this top down social change approach in order to bring about change which will enhance the health promotion of this complex client group. Standard 13: A general physical health assessment and management of the findings are recorded. Criteria 13a The care record shows that physical health needs are assessed at least annually using the following features: à ¢Ã¢â€š ¬Ã‚ ¢ the completion of a physical health assessment à ¢Ã¢â€š ¬Ã‚ ¢ the provision of health promotion advice, and à ¢Ã¢â€š ¬Ã‚ ¢ service users receiving medication should have side-effects and physical health assessed and managed according to the appropriate algorithm for that medication. 13b The care record shows information on the management of physical health needs, including: à ¢Ã¢â€š ¬Ã‚ ¢ information on who is responsible for the physical health assessment (primary care or specialist services) à ¢Ã¢â€š ¬Ã‚ ¢ evidence that results have been shared à ¢Ã¢â€š ¬Ã‚ ¢ evidence that results have been acted upon, and à ¢Ã¢â€š ¬Ã‚ ¢ evidence that information and/or advice on promoting a healthy lifestyle has been provided. Marder et al (2004) make a number of recommendations in their paper in the American journal of psychiatry regarding the monitoring and appropriate prescribing of antipsychotic medications. They suggest that the key is to identify the risk factors for each individual patient and tailor the prescribing according to their presentation and the potential adverse side effects of a number of the medications available. They present evidence of side effects of diabetes and cardiovascular issues and suggest that appropriate prescribing will reduce the risks or developing or exacerbating these conditions in patients with schizophrenia. This is borne out also in the NHS QIS (2007) standards above in Scotland where they recommend that service users receiving medication should have side-effects and physical health assessed and managed according to the appropriate algorithm for that medication NHS boards have been asked to develop prescribing algorithms and audit tools that will guide clinicians in assessing the physical health needs and using this information to make informed choices on the best medications for patients which have reduced risks associated with their physical health. These systems are currently under development across Scotland but can in the future only improve the outcomes in the physical health management of patients with schizophrenia. Conclusion The author in this assignment has demonstrated some of the health inequalities that are evident for people who suffer from severe mental illness from across the world. Some of the inequalities are a product of the diagnosis itself where patients often have symptoms that cause them to have reduced motivation to help themselves in many situations. Often this patient group also comes with a lower socio economic deprivation with a poor employment and education history which again provides barriers to their self management in respect to their physical health. Recent advances in the treatments available for psychoses which have physical health related side effects and the introduction of the disability human rights legislation which stipulates the requirement of equal access for all has further highlighted some of the health inequalities that exist for this complex patient group. The needs identification and health promotion interventions that the author has looked at separate themselves into key areas. This client group requires support to access to services and all of the interventions identified this need and had both support to access, structured recall systems and the facilitation of services close to patients home as their key themes. Assessment of physical health needs and the prescribing of the most appropriate psychotropic medication for their mental illness requires to be structured and coordinated in an improved fashion. Structured physical health assessments frameworks and prescribing guidelines associated with physical health symptoms appeared to be the best way of coordinating this process for this patient group. A mixture of a social change and educational approach is a model that appears to mix well with the review of mental health nursing in Scotland and across the world with mental health services now promoting a more patient inclusive and community involvement role. This allows nurses in particular to facilitate ownership of these health problems and use their teaching skills to teach patients how to change their lifestyles and effectively manage the physical health difficulties that they have. Nurses will engage with local leisure and sports facilities to make support available in a more normal rather than institutional fashion. Reflection The author in completing this assignment has been able to explore different aspects of this problem that exists in Scotland and compare the Scottish approaches with what is happening in other areas. He has found a very similar pattern of difficulties and also some similar solutions although they seem to be at different levels of implementation. He noticed the American studies focussed a lot on the prescribing issues and getting appropriate prescribing correct. He felt this was probably due to the costs and charging policies associated with the American system and possible litigation if there are side effects of prescribed medications which go on to cause disease where risks are known and identified. He felt this is becoming more apparent in the UK now but the study in America was several years ago. The approaches used were similar but there seemed to be a more coordinated approach to the assessment and monitoring of patients in the UK. The author felt that this was due to the NHS role in the coordination of care across the country where the USA has many different health economies and is focussed on a charging and insurance type policy. Recommendations Mental health nurses should continue work in a patient focussed way encouraging patients to take individual ownership of their needs and promote healthy living. The services in Scotland should coordinate themselves to ensure a physical health check is commissioned; takes place and the appropriate actions are followed through. Patients should be supported to access primary care services to enable this screening to take place. Medication algorithms should be developed and audited to ensure that prescribed medications are appropriate to the health profiles of patients and that medication for psychiatric reasons does no harm in relation to the patients physical health.