Electronic Media Essay

Electronic media  are  media  that use  electronics  or  electromechanical  energy for the  end user  (audience) to access the content. This is in contrast to static media (mainly  print media), which are most often  created electronically, but don’t require electronics to be accessed by the end user in the  printed  form. The primary electronic media sources familiar to the general public are better known as  video recordings,  audio recordings,  multimedia presentations,  slide presentations,  CD-ROM  and  Online  Content. Most  new media  are in the form of  digital media. However, electronic media may be in either  analog  or  digital  format. Although the term is usually associated with content recorded on a  storage medium, recordings are not required for live  broadcasting  and  online networking. Any equipment used in the  electronic communication  process (e. g. television,  radio,  telephone,  desktop computer,  game console,  handheld device) may also be considered electronic media. USES : Electronic media are ubiquitous in most of the developed world. As of 2005, there are reports of satellite receivers being present in some of the most remote and inaccessible regions of China. Electronic media devices have found their way into all parts of modern life. The term is relevant to  media ecology  for studying its impact compared to printed media and broadening the scope of understanding media beyond a simplistic aspect of media such as one delivery platform (e. g. the World Wide Web) aside from many other options.

Important Choice in of Mice and Men

Choices are made by everyone at some point in life. Choices can be complicated or as simple as yes or no. Decisions can be difficult or easy to make. Some choices are impulsive while some require a lot of premeditation to make. In the novella, Of Mice and Men, written by George Steinbeck, George chose to kill his best friend Lennie. Lennie and George were friends for a long time. They both worked at a farm together. Lennie was retarded and George took care of him and watched over him. Throughout the book Lennie displays blind loyalty to George and their hope of a better life.George is a very dynamic character through the book while Lennie is constant displaying incredible amounts of physical strength and being dim witted. Killing Lennie was no easy task for George. This important choice was a choice that affected others, affected George, and had to be motivated to be made. George was motivated to kill his friend, Lennie. Lennie had always loved to pet soft things. He would often kill mice just by petting them. Lennie had also killed a puppy on accident. These incidents occurred out of his innocence.He was unaware of his own strength and killed animals because of it. Lennie killed Curley’s wife in an effort to simply pet her soft hair. A mob of people from the farm chased Lennie and George from the farm in an effort to kill Lennie. Curley said he wanted to kill Lennie in the most painful way possible. George and Lennie effectively escaped their pursuit for a brief minute. In this moment George tried to calm Lennie down by reminding him of their shared dream of a better life. This involved them owning their own farm and tending rabbits for Lennie to pet.This undoubtedly brought Lennie to a calm place. In that moment when people began to close in, George killed Lennie by shooting him in the back of the head. This act was influenced by the impending doom Lennie had coming. The other men from the farm that had chased Lennie would have killed him much less pea cefully. If George did not do it, Curley would have done it much less humanely. While this reason for killing Lennie may seem to be merciful, what if George had killed him for selfish gain? George was held back by Lennie as long as he had been accompanying him.This was not the first time they had gotten in trouble with the law. Lennie also kept George from getting any type of romantic relationship or even a stable job. Is it possible George was motivated by his own selfish inclinations? Several factors influenced George to kill Lennie. George’s choice to kill Lennie was motivated by others but also affected him. It is reasonable to believe that George looked out for both Lennie and his own interest in deciding what how he must confront the situation mentioned earlier. Killing Lennie affected George’s life in depth.In the entire book George and Lennie are depicted as being together. George would have to adjust to being slightly more lonesome for the time being. Lennie w as a companion to George but he was also a hindrance. George had said how Lennie keeps him from doing many things. George was upset at this and said â€Å"If I was alone I could live so easy. I could go get a job an’ work, an’ no trouble. No mess at all, and when the end of the month come I could take my fifty bucks and go into town and get whatever I want. Why, I could stay in a cathouse all night.I could eat any place I want, hotel or any place, and order any damn thing I could think of. An’ I could do all that every damn month. Get a gallon of whisky, or set in a pool room and play cards or shoot pool. † Lennie knelt and looked over the fire at the angry George. And Lennie’s face was drawn in with terror. â€Å"An’ whatta I got,† George went on furiously. â€Å"I got you! You can’t keep a job and you lose me ever’ job I get. Jus’ keep me shovin’ all over the country all the time. † Here George act s as if he doesn’t want Lennie so it would be natural to assume that with Lennie dead George would be happy.On the contrary George is disappointed at the loss of his friend as he does not want to live an isolationist life like the other members of the ranch. The choice George made affected him negatively from his own viewpoint but also allowed him to live a less tethered lifestyle. The adverse effects of this choice affected George the most. In addition to having affected George, this choice also affected others in the ranch. Lennie was the one most affected. Obviously Lennie died because of George's decision to kill him. What could have happened had an alternate ending taken place?Instead of killing Lennie, George could have escaped and found other work. This scenario was spelled out in the beginning of the book when it says how the duo had left a ranch in Weed for undisclosed reasons. There is no reason why Lennie could have been spared in this fashion. Perhaps George reali zed the cycle that could have proceeded where they escape to another ranch only to find Lennie falls into the same pattern where they end up repeating the same steps over and over. In that case George's decision was still the right one. Lennie did not understand what death was in its full sense.When he killed animals he did not care they were dead but wanted them for comfort. In the same way George killed Lennie while he was in a comforted state. Lennie most likely wanted it that way. When Lennie was killed, their dream of the ranch was also killed. This deeply hurt those like Candy and Crooks who emotionally invested in this dream that had become theirs as well. Candy insisted that George goes ahead and buys a farm anyway. The represented freedom and lack of prejudice for Candy and Crooks. When the idea was gone, they were very upset as their dreams of a better life did the same.George's decision to kill Lennie affected others as well as him. The important choice to kill Lennie was a choice that was motivated by others, affected George and affected others. The decision was motivated by Curley’s desire for revenge. George will be forced to live an isolationist life just like the other members of the ranch in the Great Depression. Crooks and Candy’s dream of an improved life was crushed with George’s choice. Everyone has to make important choices in their life and they will usually be for the better and the worse.

Extinction of Certain Species

In the late century, extinction becomes common topic in our daily discussion and debates. An average of 27,000 species is currently extinct each year and there is a possibility of 22% of extinction in the overall species if action is not taken. Animal extinction is due to human immorality and irresponsible behavior just for their own benefits. Since the year 1600, a total of 83 mammals species are known to have become extinct. Wildlife population depleted the trade in live animals, damaged habitats and the countless animals of suffering. Wildlife International, 2008) Apart from that, animal is a good source to make traditional medicine. For example, Chinese believes that snake galls are good to cure diseases and strengthen immune system of the body. Sometimes, human thoughts are powerful which may kill many innocent animals. According to Jeanette McDermott, the book of Bear Muze stated that every year, approximately 10,000 Asiatic black bears are locked in cages the size of their own bodies just to have their bile drained and sold the use in traditional medicine.Besides, many ocean mammals are suffering due to the business benefits. For example, Chinese culture like to consume shark fin soup as part of the cuisine. Businessman will take the advantage to hunt shark fin for money because of its high demand. An organization devoted to preserve marine life, Ocean Environment, stated in Asian Geographic(Nov-Dec 2008) that shark fin soup prized as a delicacy in Chinese cuisine. It is becoming un-cool to consume because 90% of the sharks are un-finned while alive thrown into the sea.

Introduction to Organisations and Management Essay - 10

Introduction to Organisations and Management - Essay Example As such, this report seeks to critically evaluate how these concepts are implemented by two different organisations namely; Watsons Engine Components and H & M Consulting. The report starts by giving a brief description of the two organisations followed by a critical discussion of how these organisations differ in the implementation of the above mentioned concepts in their operations. Similarities and differences between the implementation of these concepts will be outlined and a conclusion to sum up the major points discussed will be given at the end of the report. 1.1 Description of the organisations Watsons is an independent, family-owned company which specialises in mass-production of engine parts for cars in North East London. The company employees 200 people in total and these comprise of 125 semi-skilled production workers, 15 clerical workers, 20 technical staff and 40 managers. On the other hand, H&M Consulting is a large global management, engineering and development consul tancy which was established in 1989 when two consultancy businesses merged. The company has grown from strength to strength since then and in 2007, it bought an educational consultancy in Romania, an environmental firm in the Netherlands and a power engineering company in the USA in a bid to strengthen its market sectors in these countries. The company employs more than 13  000 employees. 2.0 Organisational design and structure Structuring the flow of work involves decisions about how the organisation as a whole is structured (Swanepoel, 1998). Basically, organisation design essentially means choosing an organisational structure that is appropriate for strategy implementation and mission accomplishment. Kleynhans (2007) suggests that there are different structural variables that come into play in the process of designing an organisation and these include the following: configuration which deals with the number of levels in hierarchies, formalisation which concerns the use of forma l procedures in policy formulation, specialisation as well as centralisation which refers to the extent to which power and authority are delegated. As can be seen, all these variables hold important implications in respect of different types of organisational structures. Whilst there are different types of organisational structures, it can be noted that Watsons Engine Components has a bureaucratic organisation structure. This is also known as a mechanist approach to organisation design which is described as an â€Å"organisation design emphasising the importance of achieving high levels of production and efficiency through extensive use of rules and procedures and authority.† (Gibson & Donnelly, 1994 as cited in Swanepoel, 1998). A close analysis of the case study for this organisation shows that its structure is very old-fashioned and hierarchical. The organisation is highly unionised and has a very poor history of relations between the management and the employees. This has often led to job actions and is mainly attributed to lack of trust between the management and the employees. Another aspect that illustrates the hierarchical structure of the organisation is that the people in the Marketing Department for instance rarely speak to anyone in the Manufacturing Department given that it is the firm’s procedure that interdepartmental liaison should go

Literacy and ESOL Theories and Frameworks Essay

Literacy and ESOL Theories and Frameworks - Essay Example The learning theories and frameworks can in another way be termed as the philosophical or conceptual orientations that seek to explain the ways of human learning. One of the popular and applicable theories of teaching English is known as the Behaviourist Theory, and was influenced European empiricism around 1914. In this theory, [English] writing, which includes both writing and speaking, occurs as a response to environmental stimuli (Harasim, 2012, p. 13). This means that it can be observed, described, and manipulated. As an English instructor, one can apply this theory in ensuring effective learning is achieved. In explanation, teaching can be perceived of as a process that involves practice, repetition, and rewards. In practice, the instructor should ensure that the teaching they give is put to use such as in writing compositions or oral reading. In repetition, learning can be effected by going over what is being taught over and over again. Finally, rewards should be applied by me thods such as testing what has already been taught. These tests determine the level of learning that has been influenced. The second effective learning/teaching framework in an ESOL language is defined by the Cognitive Theory. This theory has been applied in this context since the 1950s. In its application, the Cognitive Theory defines learning as complex and deep psychological phenomena such as schemas (organized patterns of thought or behaviour), processes for learning, and motivation. In short, English learning can be effectively taught through phases occurring with gradual complexity. In a good way, linguistic learners learn English from playing an active role in the process as well as making their own mistakes. In applying such, memory and problem-solving skills are put into consideration. Instructors apply this theory by subdividing it into three variables, namely

Sexual Deviance Term Paper Example | Topics and Well Written Essays - 1000 words

Sexual Deviance - Term Paper Example This essay will examine each of these, as well as looking at one particular deviancy, voyeurism, and determine how this is assessed. Assessing Sexual Deviance One way to assess sexual deviancy is a method known as penile plethysmograph (Simon et al. 1991). This is a way of measuring tumescence in response to fantasy or laboratory stimuli. According to Simon (1991), this method assumes a somewhat controversial theoretical explanation of sexual deviance. And this theoretical explanation for sexual deviance is that if there is a penile arousal, then there would be corresponding overt sexual acts. As noted above, however, this method is considered to be controversial because many sexual deviants actually are not able to obtain erection – for instance, many pedophiles are actually impotent, and sometimes there are exhibitionists who also cannot get an erection. However, this is one method of assessment, so it should be examined further (Simon, 1991). According to Simon (1991), phal lometric measures are commonly obtained by using a strain gauge or mercury in rubber gauge. Penile volume measures, by design, assess volume changes in terms of penis diameter and length. The patient, who is the alleged sexual deviant, is then showed different erotic cues and the degree of sexual arousal is measured. The stimuli might include movies, erotic stories, nudes and audiotaped narratives. Among the stimuli are materials which are considered to be inappropriate in some way. For instance, a pedophile may be assessed by showing the individual pictures of children who are nude and gauging the penile reaction to this. Moreover, in addition to the actual tumescence of the penis, another factor is how long the stimulus is presented. The man is then scored according to how much he was aroused in looking at different inappropriate stimuli (Simon, 1991). This is one way to assess sexual deviancy. There are other ways, and these are described by Hanson and Thornton (2000). They descr ibe ways to conduct risk assessment of pedophiles, and these assessments are used to predict the danger of future recidivism. Hanson and Thornton (2000) describe three different kind of actuarial scales which are used to predict future behavior of pedophiles. One is the Rapid Risk Assessment for Sex Offense Recidivism (RRASOR). This is a test that uses variables which are easily scored – the seven items on this scale are prior sex offenses, prior nonsex offenses, any male victims, any stranger victims, any unrelated victims, marital status and age. The variables are then correlated and calculated into seven different datasets, then averaged using meta-analytic techniques. Another is the Structured Anchored Clinical Judgment (SACJ). This is an assessment technique that uses a stepwise approach – the first step is classifying the person into low, medium or high risk, and this assessment is based upon the offenders convictions; then, in the next steps, the offenders are r eclassified according to protective or aggravating factors. In other words, the offender may be initially considered high risk, but may be reclassified as a lower risk, depending upon different factors. A third type of assessment is known as the Static-99. This is a scale that uses the previous two, and the Static-99 adds together the items from the other two assessments, by using the static factors (Hanson & Thornton, 2000). Another way of assessing sexual deviancy is through the Abel

Article critics Essay Example | Topics and Well Written Essays - 250 words

Article critics - Essay Example mization to receive 40 infusion of 500ml chelation solution or a placebo 40 infusion to an oral vitamin and chelation solution or oral placebo (Research Grant, 2012). Researchers found that patients receiving the chelation solution had fewer serious cardiovascular events than the control group 26% vs. 30%, and the trail was conducted in 134 sites in the United States and Canada from 2002-2012. However the article fails to report that there was high drop out in the placebo group than in the chelation. They were getting a placebo and the side effects of it. The Chelation group was significantly different in life outcomes measured with the assessment, as opposed to the Placebo group. According to the cnn analysis, the four percentage point difference between was â€Å"barley statistically significant†. The difference may have been by chance not because chelation actually works or they necessarily have bad side effects. The high dropout contributed to less accuracy in the study. It is less

Art Michelangelo Essay Example | Topics and Well Written Essays - 250 words

Art Michelangelo - Essay Example Sculpture and painting are both beautiful forms of expression that have enchanted the viewers for centuries. However both are different in the ways they are created by the artists and perceived by the viewers. Personally I prefer that both have equal merits and one should not be held above the other. Painting involves colors, light, shades which provides more meaning and life to the artist’s idea. As opposed to painting, sculpting is done on something much more substantial than a canvas and therefore it has a greater presence and feels much more real to the viewers. Also the sculptures are three dimensional which give them power and make them appear more realistic. Even though the lack of dimension is considered a demerit in painting, the effect is quite easily achieved by ‘relievo’ which can be done through adequate modeling and shaping. Both are equally expressive and it only depends on person

Samsung Singapore Essay Example | Topics and Well Written Essays - 1500 words

Samsung Singapore - Essay Example The strategies, projections, and future scenarios of the company are significantly reliant on the tastes, decisions, views, and preferences of the customers. A close attention to the changes in customers’ preferences and opinions is important for the survival of the business. In order to have a competitive advantage Samsung must invest in continuous research practices and maintain feedback mechanisms through social media. This would help the company to carry out necessary changes in line with the market realities. Companies in the telecommunication industry in Singapore have developed strategies for retaining both high-level and low-level clientele through promotions and improved customer care services. Suppliers In the past Samsung has had to contend with the bargaining power of suppliers. Few suppliers operate on the level of standards that meet Samsung thresholds of value. There have been tendencies of these suppliers to use their privileged positions to make arbitrary chan ges in prices, which affect the operations of Samsung precisely because there are no suitable substitutes for the products. In order to survive such eventualities, Samsung would have to cultivate positive working relations with the suppliers or enter into long-term contracts that have the element of stability. This would impact positively on the growth of the company. Economics and Geography Economic and geographical factors have had some significant impact on the performance of Samsung Singapore in the previous financial periods. The growth of the country’s economy has had significant impacts on Samsung Singapore. For instance, the tourism industry and the information and technology sectors have experienced significant growth in the past decade. One of the...56). However, new market realities have emerged demanding some changes in the way, which companies operate their businesses in. Samsung Singapore will have to carry out strategic changes in its operations in order to kee p up with the pressure of competition from emerging competitors and other macro-economic forces that affect the status of the industry. In the recent past global Samsung has taken advantage of the synergies of globalization and liberalization to spur growth and positive performance (Niewwenhuizen, 2009 p. 58). The need for strategic reorganization is based on the necessity of total quality management policies within the company. Competitors The past two decades have witnessed a consistent growth of stiff competition on the mobile telephone sub-sector in Singapore. Favourable government regulation policies and the policies of liberalization are some of the external factors that contribute to the competitive factor on the market. In order to survive, many companies have engaged in promotions, expensive advertisements, and value addition services that are aimed at increasing their influence in the vast mobile telephone market. Samsung utilizes its strong revenue base and modern market practices to maintain its profile on the competitive market environment (Adekola & Sergi, 2007). Multiple strategies ranging from strategic marketing to price modulations have also ensured the growth of the company. The process of planning cuts across the various levels of the organization.

The Australian Automobile Market Essay Example | Topics and Well Written Essays - 2000 words

The Australian Automobile Market - Essay Example Videos of new launches and product features should be hosted on YouTube which would draw an attractive viewership. Traditional mass media advertising has to be maintained through TV, radio, Billboard advertising and outdoor advertising. Distribution channels should be both direct and indirect. The direct channel should be through the internet which would allow the customers to place orders, make suggestions, see the presentations, and customize their own vehicles. The indirect channel through the dealers is necessary as many would first like to physically see the product before ordering it. Thus a change in the marketing mix can help the company to face the challenge of the downturn. The car sales in Australia have been steadily decreasing throughout 2008. Recorded sales of the automobile industry in November 2008 were lowest for five and half years. As such the current position of Holden SS Ute would help to suggest recommendations for its future marketing mix. The Holden SS Ute was launched in Australia in August 2007. It is a coupe utility built by Holden, the Australia subsidiary of General Motors. This car-truck hybrid range has a number of models in its series and is a sports utility vehicle. It comes with 6-Disc CD Audio system with MP3 compatibility and its safety and security system are in place. It also has side curtain and side-impact airbags for the safety of the passengers and the crew. The vehicles have 17† alloy wheels and Sports Suspension. Customers find the interiors extremely comfortable and the service costs are very cheap (Product Review, 2009). Overall it is a premium performance product with high-end performance. Customers have more choice, more flexibility, and more features. The vehicle integrates sports car performance, ride, and handling, together with a functional load carrying capability.

Keep Fit Essay Example for Free

Keep Fit Essay To keep fit and healthy, follow a healthy and balanced diet everyday. Make sure that your everyday diet includes lots of fruits, vegetables, and protein. You should cut down on red meat, junk foods, caffeine, and sugar intake. Avoid soft drinks or canned fruit juices. Instead, opt for a variety of fresh fruits, vegetable salads, freshly made fruit juices, milk, nutritious energy drinks, etc. You need to be more active in order to keep fit and healthy. Modern life has become very sedentary, with fewer scopes for physical activities. You need to exercise in order to burn those calories. Minimum physical activity slows down your metabolism rate. So, you can put on weight even when you eat less. On the other hand, exercise and a more active life will burn up the calories, even when you eat a little more. You can simply go for a brisk walk, or jog, or you can join a gym. The important thing is that you must include some physical exercise in your everyday life, because fitness and health cannot be achieved without some physical exercise. For a healthy life sufficient sleep is important. Lack of sleep can make you feel tired the next day. So work hard, but make sure that you have enough sleep; so that your body gets the time to replenish itself. Do not skip your breakfast, no matter how busy you are. Breakfast is the first and most important meal of the day. It works as a fuel for your body and keeps you going for the rest of day. If you skip breakfast, you will feel hungrier in the latter part of the day, and you may end up eating more! So, you may run a risk of gaining weight, if you skip your breakfast frequently. If you are not a healthy eater and find it difficult to improve your food habits due to busy, erratic, work schedules, then you may be depriving your body of the essential nutrients that are important for good health. In the long run, unhealthy food habits can lead you to serious health hazards. An easy solution to this problem is to include multi-vitamin supplements in your daily food intake. Multi-vitamins can be taken to replenish the nutritional deficiencies in your daily diet.

Health Care Spending Essay Example for Free

Health Care Spending Essay Healthcare is a very important sector in the countries around the world. The countries and the government always keep some money in their budget in relation to the health care activities in their countries. In the United States of America also, there are certain provisions in relation to the health care. The paper shall discuss about the health care spending in relation to United States of America. It shall discuss about the current level of health care expenditure in United States of America. There are shall be a lot of discussion in relation to the fact that whether the expenditure on health care in United States of America is appropriate or not. It shall also discuss about the manner in which the health care needs of the people in United States of America are paid by the government. In the end of the paper, there shall be a forecast in relation to the health care spending in United States of America. All the above said things shall be discussed in detail in the current paper. The government of United States of America has made a lot of provisions in relation to the expenditure of health care facilities in United States of America. In the United States of America, the health care spending has been increasing continuously (Hawe, 2008). There have been a lot of funds kept by the government of United States of America in its budget in relation to the health care services. In the year 1990, the expenditure made by the government of United States of America in relation to the health care spending was $714 million. Since then, the amount of expenditure on health care has increase to $2. 3 trillion. This is around 3 times of what it was in the year 1990. The government of United States of America is spending around 16% of its total gross domestic production on providing the health care facilities to the people. It is estimated that around $7600 are spent by the government of United States of America for each and every resident in the country. In this way, it can be said that the expenditure in relation to health care in United States of America is quite good and the country is taking adequate steps for making sure that adequate health care facilities are provided to the people in a proper and appropriate manner. The health care spending of the United States of America is the highest all around the world. There is no problem with the extent of money spend by the country towards the health care. Other countries around the world are also spending some money towards the health care but the expenditure made by the government of United States of America is the highest. Currently the expenditure incurred in United States of America towards is adequate and appropriate. It has to increase only with the increase in population. According to the per capita expenditure, the current expenditure in the country towards the healthcare is appropriate. When the country makes the budget in relation to the health care expenditure, then it has to take care that adequate expenditure is incurred on each and every activity related to health care. The government of United States of America should make sure that it spends appropriate expenditure on each and every area of the health care. The expenditure should be more on the critical areas and it should be reduced on the areas which are not very difficult to handle for the government. The government of United States of America should make sure that it increases the expenditure of the health insurance of those people which are not in a position to afford the costs for themselves (U. S. Health Care Costs, n. d. ). The government should also increase the expenditure in relation to the funds provided to the health care organizations for providing the benefits to the poor people in the United States of America. The government of United States of America should also increase the expenditure in relation to some specific and high risk diseases such as Cancer, Aids etc. If the expenditure shall be reduced in relation to the above said activities then, there is a possibility that the people in United States of America shall be benefitted to a very high extent. Other than the above areas, there are certain areas in which the government of United States of America should look to reduce the expenditure. The cost on some of the areas in the health care should not be reduced to the extent it hampers the health care services. If there is a requirement to reduce the health care costs then, these should be reduced only till the services are not affected in a negative manner. The areas in which unnecessary costs are incurred by the government should be recognized and the costs should be reduced in those areas. In the United States of America, there are adequate sources used for the purpose of financing the health care services in the country. In the country, the funding for the health care services is done together by the government and the non government agencies in the country. While preparing the budget, the government of United States of America keeps a percentage of funds in relation to providing the health care services to the people who are in need and also the people which are not able to have the health care insurance for themselves. Other than the government of United States of America, there are various other forms of associations which work for the purpose of providing the health care services to the people. They not only provide the health care services but also provide the financial for the insurance of the patients. There are few programs also in relation to the same. The programs include Healthcare Facilities Accreditation Program, Community Health Accreditation Program and various other programs. The health care finance in the United States of America are funded by the above said facilities and things. In the United States of America, the government and the non government associations share 50% of the expenditure each. In this way, there is a proper sharing the expenditure. For the last few years, the healthcare expenditure in United States of America has been increased considerably at an increasing rate. It is expected that the healthcare expenditure in United States of America shall increase in the same rate as it was increasing earlier (Scambler, 2008). In the year 2007, the health care expenditure in United States of America was $2. 2 trillion. This amount increased to $2. 3 trillion in the financial year 2008. In this way, there was a definite increase in the health care expenditure in the two years. It is expected that the health care expenditure will grow even more. In the year 2013, the healthcare expenditure is expected to reach the figure of $3 trillion and in the year 2017, it is expected that the health care expenditure shall reach the figure of $4. 3 trillion. In this way, it can be said that there is a forecast of increased expenditure on health care in the years to come. The chart below provides the forecast for health care in a proper manner. This chart is showing the healthcare expenditure in United States of America. The government of United States of America is spending a lot of money on the healthcare services in the country. With the kind of expenditure, the government of United States of America is spending on the health care facilities in the country, it can be said that the government is spending sufficient amount of money on the health care facilities.

An evaluation of crime statistics

An evaluation of crime statistics Crime Statistics Evaluated. Crime statistics ought to be evaluated in light of a number of factors that can mislead social constructions of offending. Conclusions drawn from individual data sets are to be evaluated against the dark figure of crime and commonly held myths. Statistical data are mostly gathered and interpreted to suit political and corporate agendas (Chambliss, 2001; Croall, 1998; Rampton Stauber, 2001; Slapper Tombs, 1999). The criminalization/decriminalization of specific activities/behaviours, for instance, can considerably transform crime trends (Croall, 1998). Male homosexuality, for instance, wasnt decriminalized in Britain until the 1960s (Croall, 1998; Downes Morgan, 1997). Other issues stem from how the data is collected. Surveys conducted by household, for instance, dont include the victimization of homeless people (Kershaw et al., 2000). Furthermore, crimes in which offenders and victims are consenting parties (for example drug dealing) are largely unreported (Kershaw et al., 2000; M aguire, 1997). A lot has been done to refine the collection of crime data. The introduction of victims surveys in the British Crime Survey, for instance, has improved the quality of data collection on crimes that are not recorded by the police (Kershaw et al., 2000; Zedner, 1997). Nevertheless, the reliability of statistics on offending remains questionable. Public myths over the crime problem, combined with corporate interests, drive political activities, which in turn work to mould public perceptions. These are perpetuated by the media who tend to sensationalize street crime, for instance, in order to attract the readership (Chambliss, 2001; Reiner, 1997; Slapper Tombs, 1999). The proceeding lines will provide an account of current statistics and trends, following this line of reasoning. Looking at the shape of crime as it appears from the 2004 BCS summary of trends, it appears that rates of offending have consistently dropped in the past decade (Dodd et al., 2004). More in detail, since 1995 violent crimes have decreased by 36%. Acts of vandalism have decreased by 27%. Vehicle theft, theft from the person, other types of theft and burglary rates appear to have declined, respectively, by 51%, 9%, 36% and 47% (Dodd et al., 2004). Though the validity of these figures, to an extent, cannot be totally dismissed, particularly in sight of their statistical significance, they should be further investigated. Many of these crimes, including vandalism and theft, for instance, are assessed by household (Dodd et al., 2004). Therefore theft offences from homeless people may not appear in these figures. Crimes of violence, on the other hand, are statistically assessed against the overall number of adults in England and Wales (Dodd et al., 2004). In this case, illegal immigrants who do not appear in official registers are not included. The table published by the Home Office also contains a definitional bias. As it was acknowledged by the authors themselves: The BCS common assault definition includes minor injuries. From 2002/03 the recorded crime definition does not include minor injuries  (Dodd et al., 2004). This means that figures related to common assault included a larger variety of violent episodes in the years prior to 2002. This can account for the 43% drop in common assault since 1995 (Dodd et al., 2004).The monitoring of other types of offending, such as cybercrime, has been introduced by external agencies (Power, 2000), though the Home Office themselves have addressed the problem in current publications (Morris, 2004). Cybercrime refers to a variety of offensive activities, to include theft of proprietary information [ ¦], financial fraud [ ¦] [and the] creation and distribution of computer viruses  (Power, 2000: 4). According to the Computer Emergency Response Team (2000), there was a considerable increase in the reporting of internet alerts between 1988 and 1999. It should be noted that this could be largely due to the limited access and technological tools available in the 1980s, compared to the 1990s. Internet alerts, however, fell by the year 2000 (Power, 2000), maybe due to more advanced preventative measures. Financial fraud can currently be denounced as a type of cybercrime, in that it often employs a network of internet transactions, involving large amounts of money and large scale victimization, internationally and over long periods of time (Levi, 1987; Rampton Stauber, 2001; Slapper Tombs, 1999). Corporate and internet offending tend to be largely undetected due to their complex nature (Levi, 1987; Rampton Stauber, 2001; Slapper Tombs, 1999). Because of this, corresponding data tends to be scattered between a variety of agencies (Power, 2000; Slapper Tombs, 1999). A strategic and more advanced model, therefore, should be developed to effectively address the emerging new trends of offending. References Chambliss, W. J. (2001) Power, politics and crime, Oxford, Westview Press.Croall, H. (1998) Crime and society in Britain, London, Longman.Dodd, T., Nicholas, S., Povey, D. Walker, A. (2004) Crime in England and Wales 2003/2004, http://www.homeoffice.gov.uk/rds/pdfs04/hosb1004.pdf Downes, D. Morgan, R. (1997) Dumping the Hostages to Fortune? The politics of Law and Order in Post-War Britain, in: Maguire, M., Morgan, R. Reiner, R. (eds.) 1997, The Oxford Handbook of Criminology, Oxford, Oxford University Press.Kershaw, C., Budd, T., Kinshott, G., Mattinson, J., Mayhew, P. Myhill, A. (2000) Home Office Statistical Bulletin: the 2000 British Crime Survey, London, Home Office.Levi, M. (1987) Regulating Fraud, London, Tavistock.Maguire, M. (1997) Crime statistics, patterns, and trends: changing perceptions, in: Maguire, M., Morgan, R. Reiner, R. (eds.) 1997, The Oxford Handbook of Criminology, Oxford, Oxford University Press.Morris, S. (2004) The future of netcrime now: Part 2 -respon ses, http://www.homeoffice.gov.uk/rds/pdfs04/rdsolr6304.pdfPower, R. (2000) Tangled Web: tales of digital crime from the shadows of cyberspace, Indianapolis, Que.Rampton, S. Stauber, J. (2001) Trust us, were experts, New York, Penguin/Putnam.Reiner, R. (1997) Media made criminality: the representation of crime in the mass media, in: Maguire, M., Morgan, R. Reiner, R. (eds.) 1997, The Oxford Handbook of Criminology, Oxford, Oxford University Press.Slapper, G. Tombs, S. (1999) Corporate Crime, London, Longman.Zedner, L. (1997) Victims, in: Maguire, M., Morgan, R. Reiner, R. (eds.) 1997, The Oxford Handbook of Criminology, Oxford, Oxford University Press.

Necrotizing Fasciitis (flesh eating bacteria) :: essays research papers

Necrotizing Fasciitis (flesh eating bacteria ) from an essay by Katrina Tram Duong, edited by S.N. Carson M.D. Necrotizing fasciitis, known commonly known as "flesh eating bacteria [infection]", occurs in a wide range of people 1. It occurs in the elderly, middle aged and younger patients. It occurs in athletes and debilitated individuals. It can occur in drug abusers with self inflicted wounds and healthy individuals with incidental injuries. It may occur in those with metabolic disorders such as diabetes and those with suppressed immune systems. It may occur in those with no underlying disorders and no known particular injury. It occurs under ordinary circumstances such as a seemingly harmless cut or scrape and in wounds resulting from major trauma such as an auto accident. There is no single way of contracting necrotizing fasciitis. One patient reported that he caught it while he was at the beach and may have scraped his skin. There are some cases that have been reported after bug or dog bites. We have also seen confirmed drug users who got the infection but declared they didn’t know how the bacteria could have entered their body. There have been numerous cases where injection of illicit drugs can produce infections that present with signs of a simple cutaneous abscess and yet unpredictably evolve into an extensive necrotizing soft tissue infection 1. Fig1. This is a picture of a leg with full blown necrotizing fasciitis, just prior to surgery. Note the discoloration. The skin feels crepitant and the area is extremely tender. A larger picture with detail is available by clicking this thumbnail print. Necrotizing fasciitis is a deep infection of the subcutaneous tissues that results in progressive destruction of fat and fascia. The progression is usually rapid and, as an example, this author has seen it spread throughout one leg in a little over one hour. Of course, this has an instant effect on the blood supply to these areas. Alternative names for necrotizing fasciitis are fasciitis-necrotizing; infection-necrotizing subcutaneous; subcutaneous infection-bacterial5. Untreated and unconstrained, it can destroy massive amounts of tissue and result in amputation and even death in a short period of time. Fig. 2. Another leg as above presurgical for necrotizing fasciitis. When first seen two hours prior, the discoloration was only present at the ankle. A larger picture with detail is available by clicking this thumbnail print. Necrotizing fasciitis is caused most commonly by Streptococcus pyogenes, group A streptococcus, which is the same bacteria that causes common strep throat 8.

Classroom Discipline and Management Philosophy Essay -- Classroom Manag

The goal in our classroom is to teach self-discipline, responsibility, cooperation, and problem-solving skills. Common causes of misbehavior include an attempt to meet unmet needs (belonging, significance, fun); a lack of needed skills (social and academic); inappropriate expectations; lack of structure; and a lack of sense of relevance. We will be focusing on non-punitive solutions to problems based on kindness, firmness, dignity and respect. True discipline comes from an internal locus of control (self-discipline), not an external locus of control (punishments and rewards inflicted by someone else). Some of the strategies used in our classroom will be proactive and some will be reactive. Many proactive strategies will be in place so that the use of reactive strategies is limited. These strategies include, but are not limited to: . Classroom Organization- Typically a Proactive Strategy although can be reevaluated as a Reactive Strategy- Classroom is thoughtfully designed to welcome all children, value everyone’s ideas and work, support active and engaged learning, support diverse developmental levels and learning styles, fosters independence, responsibility and cooperation, cultivates the care of materials and equipment, and gives students some choices in the learning process . Reinforcing teacher language- Proactive Strategy- Based on the idea of noticing what students are doing that we want them to keep doing; Names concrete or specific behaviors; Reflects important goals and values . Reminding teacher language- Proactive and/or Reactive Strategy- Reflects clearly established expectations; May be a question or a statement; Is brief and direct; is used when both the teacher and th... ... be sent to a â€Å"buddy room† to allow them a new environment to regain composure within) . Referral to Director, Assistant Director, or School Counselor- Reactive Strategy- Referrals to individuals outside of our classroom occur occasionally when o A Student’s behavior prohibits the class from moving forward in a productive way o If something occurs that the teacher believes needs immediate attention that cannot be given by the teacher at that moment o Others are perceived to be in danger References Nelsen, Jane. Positive Discipline. New York: Ballantine Books, 2006. Nelsen, Jane, Lynn Lott, and H. Stephen Glenn. Positive Discipline in the Classroom, 3rd ed. New York: Three Rivers Press, 2000. Responsive Classroom, Level II Resource Book. Turner Falls, M.A.: Northeast Foundation For Children, Inc., 2008.

Greed and Malevolence in Macbeth :: Macbeth essays

The Power of Greed and Malevolence in Macbeth William Shakespeare's Macbeth is not necessarily a play of fate, but rather a tragedy that occurred as a result of uncontrollable greed and malevolence by Macbeth and his wife. The weird sisters only make suggestions about Macbeth's road to kingship; they do not cast spells to make true all their predictions. These interpretations lead Macbeth and Lady Macbeth to kill Duncan and secure the title Thane of Clawdor. While in kingship Macbeth elects to kill Banquo and his son, Fleance, for Macbeth was fearful about losing his throne to Fleance. Senseless violence and inner rage cause the King of Scotland to murder Macduff's children and wife. The predictions of the witches are only temptations. The weird sisters never tell Macbeth what to do with these suggestions. He is initially curious and disbelieving about these deceptive hags, but he takes their forecasts literally. The witches only make predictions about the future kingship of Macbeth: "All hail, Macbeth! Hail to thee, Thane of Cawdor." Macbeth, along with Lady Macbeth, was responsible for making the judgments that leads to the downfall and destruction of himself. The prophecies predicted by the weird sisters do occur, but one can conclude that latter events, such as the death of Macbeth, were not caused by their direct powers, but they were simply the witches' foreknowledge: "He (the apparitionist) will not be commanded. Here's another / More potent than the first." The vaulting ambitions of Macbeth and Lady Macbeth lead to the death of King Duncan. For the sake of Macbeth's ambition, he is willing to murder his cousin, Duncan. Macbeth realizes that murdering his king is perfidious and blasphemous because every king is set on throne by God; he is driven by his undying aspiration to steal the throne and be king: "I have no spur / To prick the sides of my intent, but only / Vaulting ambition, which o'erleaps itself / And falls on th' other." Lady Macbeth is also moved by her avarice to be alongside her husband on the throne. She uses all her strength and intelligence for evil purposes; this confident and arrogant authoritarian instills the plan of the murder (of Duncan) to Macbeth: "We fail? / But screw your courage to the sticking place / And we'll not fail. When Duncan is asleep." Macbeth is the only individual responsible for the death of his friend Banquo and the flight of Banquo's son, Fleance.

Teachers with Guns

How much should we trust our teachers? Schools have been going from bad to worse, in terms of safety. There have been a lot of shootings at schools over the years, but recently they have been over the top in horror. If teachers had guns, would the students be safer? We are going analyze schools safety, shootings in schools, and armed guards or teachers with guns. Schools have been doing a lot to limit, if not stop, the violence on school grounds. There are districts in Oklahoma that have already done a lot to prevent school violence. Putnam City School district already has security cameras in it; as a matter of fact about 30% of high schools have security cameras installed. They also have a police officer walking the halls and working as security on school grounds. The real question is, is all this security helping the district on keeping the violence down? In the case of the Putnam City district the security measures are helping. With the 750 security cameras over the 27 schools, police officers and security officers in schools, secure access entrances, lockdown drills, etcetera†¦ the schools have had a low violence rate compared to other schools across the country.Teacher Cadet Essay The bad part about this is that kids are still getting weapons into the schools. In this situation a kid can just put a weapon into his or her bag and take it into class. One of the security measures that this district is missing would be police officers with metal detectors in the entrances, when the kids are coming into class. If more school districts carried security policies as strict as Putnam City does, there would be less violence in the schools. All this is helping to lower violence in schools, rather than teachers having guns. Giving teacher guns will increase the pressure on schools and may cause more harm then good. Even though the Newton, Connecticut shooting was horrible not all situations are like this. There were 27 people killed in the Sandy Hook Elementary School shooting. This was done by a mentally ill person. Not all situations are going to be like this one. He forced himself into the school by shooting the door and crawling through it. While there was very little to stop a person like this, however if a police was officer at the school to stop him once he was in the building thing would have been different. Having teachers with guns in schools, to help stop violence, is basically contradicting itself. Having untrained teachers carrying guns is dangerous. Being in a stressful situation that you are not ready for or trained for, will make you act out of randomness not thinking clearly of what is really going on. The situation I am referring to is a shooting in school. Very few teachers have had any experiences with guns. Out of all of the years I was in school, not including college, I had two teachers with military backgrounds. Those actually have used guns on other people. To have a teacher, that has only taught his or her entire life, pull a gun on a student would be very stressful and may not be able to act under that situation. Also many teachers may have a short temper in the first place and pull a gun on a student. That would be an entirely different situation that the school would need to handle in long hours of court time. Many teachers do not teach for the money. The range of salary for a high school teacher in Oklahoma it anywhere from $41,000. 00 to $61,000. 00. This is just for high school, the pay decreases from middle school all the way the elementary. Also most of the teachers are closer to the $41,000. 00 then the $61,000. 00, the teacher with the high end pay will mainly be more for private school teachers then public schools. This being said, teacher love their students. They think of them more as family, because more time is spent with them than with their real families. Many teachers would quit if guns could be carried by teacher. Like I said teacher are become teacher for the kids not for the money. If they were in it for the money, they would choose a different career past. The teacher lover there students, and they would rather quit than have a gun on them to protect them. The teacher lover there students so much they would rather quit then being in more danger into the schools. Guns on school premises would bring in a lot of different issues. The main one that I would see right off the bat would be storage of the guns. Would each teacher need to carry the gun with them at all times? If not that are there going to be safes in each of the class rooms to have the gun in, because any student can overpower a teacher and just take the gun if they wanted to. This would make the situation worse; the students would already have the weapons on school grounds. All they need to do is find a way to get it, and there will be students that will want to get the guns to cause harm, make a since, or just to prove a point. Teacher with guns just sounds bad. Making this a reality across the country will take a long time, because all the teachers will need to be trained to use guns. There needs to be many hours of training, so they would be shooting in a different direction when things like shooting happen. Also they will need to be trained on when to use the guns. Just when there is an intruder or when there is big outburst in school like a massive fight that gets out of control with a teacher and they are scared for their life. On the other hand you can have an armed police officer at the schools to prevent the shooting and even the violence. Just having a police officer present will help keep the students in line. The title of police officer has too many students, respect behind it and the students know that; students will have more respect for a police officer than one of their teachers with guns. This is because to them teachers are there to teach and the police officer is there just to keep everything in order. You may even go out and say for the principle of the school have a gun in his office, if the school does not have the funds to obtain an armed police officer as security. Having the principle of the school carry a gun is more understandable then every teacher having a gun. The principal has an office that no student is allowed into without the principal in the office with them. They would be much easier to keep track of, because everyone will know who has the gun and if anything happens someone can help from within the school. This would be much cheaper than having an armed police officer and teaching every teacher to shoot and carry a gun properly. This would be a good idea for low funded school, not the best idea but will help. I have looked into taking gun control classes. I have asked around for people to teach me, and the average cost per hour is anywhere from $25. 00 to $75. 00. They also charge per person that wants to learn how to shoot. The average cost hour may go down if there is a big group, but this is still a big number. As you can see the cost to teach all the teachers in a school will be an extraordinarily large amount. This is just cover the cost of shooting, not including the mental strength that needs to be taught in order to handle a gun against another person. This being said, having a police officer as guard at the schools would be cheaper. The average pay for an Oklahoma City Police Officer is about $47. 000. 00. This is a fairly large amount, but the advantages are much greater. They already have their gun training and mental strength to handle stressful situations. â€Å"No matter the risk, so that others may live†, this is said by many law enforcement officers. They are ready to do anything to save lives, even though they have their own families. This is there chose, now how many teachers are able to do this? The truth is that teacher my love their students, but some may think twice before acting in a harmful situation. This hesitation, if even for a second, can cost the lives of more people than good that it could bring. Schools are safer with policemen, not enough to stop a mentally ill person from getting in, but to stop violence in school. Even though the shooting in Newton was horrible, not all shootings are going to be like this one. Teaching teachers to shoot will cost more then, the actual cost of getting a police officer to guard to school grounds. Police officers will always be on top of their game in any harmful situation, this is their main priority keeping people safe. Police officers will be more alert on school shooting and the extra security installed will help prevent violence in the schools. Police officers are trained to be in stressful situations; and in case of a shooting, most teachers will not have the proper mental strength to pull the trigger. Over all a police officer will be able to act and live with whatever happens. Teachers will not be able to handle the situation as will, and for us to ask them for that is just wrong.

Ketamine Pain Mechanism

Pain is communicated from the brain to other parts of the body by the CNS (Central Nervous System) and nerve endings. (Mayer, Mao, Holt, Price, 7731-7736) The ligand-gated ion channels, also referred to as LGICs, or ionotropic receptors, are a group of intrinsic transmembrane ion channels that are opened in response to binding of a chemical messenger. (Collingridge, Singer, 290-296) (Dickenson, 307-309) (Dickenson, Chapman, Green, 633-638)The ion channel is regulated by a neurotransmitter ligand that is very selective to one or more ions like potassium, sodium, calcium, and chloride. (Kandel, Schwartz, Jessell, 178-180)   Such receptors located at synapses converting the chemical signal to an electric signal in the post-synaptic cell. (Connolly, Wafford, 529-534)   The NMDA receptor (N-methyl-D-aspartate) is such an ionotropic receptor for glutamate. (Dingledine, Borges, Bowie, Traynelis, 7-61) (Lodge, Johnson, 81-86) (Meller, 435-436)   By X-ray crystallography, the NMDA recep tors have an heterodimer subunits, which are involved in the binding of agonists and antagonists like Ketamine. (Hirota, Lambert, 441-444)This channel complex contributes to excitatory synaptic transmission at sites throughout the brain and the spinal cord, and is modulated by a number of endogenous and exogenous compounds. (Rabben, Skljelbred, Oye, 1060-1066)   NMDA receptors play a key role in a wide range of physiologic and pathologic processes. (Hoffman, Coppejans, Vercauteren, Adriemsen, 240-242) (Klepstadt, Maurset, Moberg, Oye, 513-518) (Coderre, Katz, Vaccarino, Melzack, 259-285) Ketamine is primarily a non-competitive antagonist, which opens in response to binding of glutamate. This NMDA receptor mediates the reduction of pain effects of ketamine at low doses. (Lofwall, Griffiths, Mintzer, 439-449)Evidence for this is reinforced by the fact that naxolone, an opioid antagonist, does not reverse the analgesia. Studies also seem to indicate that ketamine is ‘use depend ent' meaning it only initiates its blocking action once a glutamate binds to the NMDA receptor. (Sorensen, Bengtsson, Ahlner, Henriksson, Ekselius et al., 1615-1621)   At high level doses, ketamine has also been found to bind to opioid mu receptors and sigma receptors. Thus, loss of consciousness that occurs may be partially due to binding at the opioid mu and sigma receptors. (Lonnqvist, Norton, 617-621)(Menigaux, Fletcher, Dupont, Guignard, Guirimand, et al. 129-135) (Koppert, Sittl, Scheuber, Alsheimer, Schmelz, 152-159) (Bushell, Endoh, Simen, Ren, Bindokas, 55-64)Works CitedMayer DJ, Mao J, Holt J, Price DD. Cellular Mechanisms of Neuropathic Pain, Morphin Tolerance, and their Interactions. Proc. Natl Acac. Sci. USA. 1999, 96(14): 7731-7736.Collingridge G, Singer W. Excitatory Amino Acid Receptors and Synaptic Plasticity. Trends Pharmacol Sci. 1990 11: 290-296.Dickenson AH. A cure for wind-up: NMDA receptor antagonists as potential analgesics. Trends Pharmacol Sci 1990 11: 30 7-309Dickenson AH, Chapman V and Green GM. The pharmacology of excitatory and inhibitory amino acid-mediated events in the transmission and modulation of pain in the spinal cord. Gen Pharmacol 1997 28: 633-638Kandel ER, Schwartz JH, Jessell TM. Principles of Neural Science, 4th ed. McGraw-Hill: New York, (2000), pp.178-180Connolly CN, Wafford KA. The Cys-Loop Superfamily of Ligand-Gated Ion Channels – the Impact of Receptor Structure on Function. Biochemical Society Transactions (2004) Vol. 32: 529-534.Dingledine R, Borges K, Bowie D, Taynelis SF. The Glutamate Receptors Ion Channels. Pharmacology Reviews, 1999 51(1): 7-61Lodge D and Johnson KM. Non-Competitive Excitatory Amino Acid Antagonists. Trends Pharmacol Sci 1990 11: 81-86Meller ST. Ketamine: Relief from Chronic Pain through Actions at the NMDA Receptor? Pain   1996 68: 435-436Hirota K, Lambert DG. Ketamine: Its Mechanism (s) of Action and its Unusual Clinical Uses. Br. J. Anesth. 1996, 77(4):441-444.Rabben T, Skjel bred P, Oye I. Prolonged Analgesic Effects of Ketamine, an N-Methyl-D-Aspartate Receptor Inhibitor, in Patients with Chronic Pain. The Journal of Pharmacology and Experimental Pharmaceutics. 1999, 289(2):1060-1066.Hoffmann V, Coppejans H, Vercauteren M and Adriaemsen H Successful Treatment of Postherpetic Neuralgia with Oral Ketamine. 1994 Clin J Pain 10: 240-242Klepstad P, Maurset A, Moberg ER and Oye I Evidence for a Role for NMDA Receptors in Pain Perception. Eur J Pharmacol   1990 187: 513-518Coderre TJ, Katz J, Vaccarino AL and Melzack R.   Contribution of Central Neuroplasticity to Pathological Pain: A Review of Clinical and Experimental Evidence. 1993 Pain 52: 259-285.Lofwall MR, Griffiths RR, Mintzer MZ. Cognitive and Subjective Acute Dose Effects of Intramuscular Ketamine in Healthy Adults. Ex. Clin. Psychopharmacol. (2006), 14(4):439-449Sorensen J, Bengtsson A, Ahlner J, Henriksson KG, Ekselius L and Bengtsson M.   Fibromyalgia. Are there different mechanisms in the processing of pain? A double Blind Crossover Comparison of analgesic Drugs. 1997 J Rheumatol 24: 1615-1621Lonnqvist PA, Norton NS. Pediatric Day-Case Anesthesia and Pain Control.   Curr. Opin. Anaest. (2006), 19(6): 617-621.Menigaux C, Fletcher D, Dupont X, Guignard B, Guirimand F, Chauvin M. The Benefits of Intraoperative Small-Dose Ketamine on Postoperative Pain after Anterior Cruciate Ligament Repair. Anesth. Analg. 2000 90(1): 129-135Koppert W, Sittl R, Scheuber K,Alsheimer M, Schmeltz M, Schuttler J. Differential Modulation of Remifentanil-Induced Analgesia and Post-Infusion Hyperalgesia by S-Ketamine and Clonidine in Humans. Anesthesiology. 2003, 99(1): 152-159.Bushell T, Endoh T, Simen AA, Ren D, Bindokas VP, Miller RJ. Molecular Components of Tolerance to Opiates In Single Hippocampal Neurons. Mol. Pharmacol. 2002, 61(1): 55-64.

Accreditation Audit AFT Essay

A1. Compliance Status The ongoing survey readiness audits that are conducted in the hospital on a daily basis have identified areas we will focus on to ensure that our accreditation survey results are exceptional. Audits are performed on an ongoing basis with a focus on trends that are most commonly cited by the Joint Commission. Nightingale hospital has proven to have made great improvements over prior survey findings in Emergency Management, Human Resources, Leadership, Medical Staff, Nursing Care, Provision of Care, Treatment and Services, Information Management, Handoff Communication and critical value reporting. We have placed an abundance of resources and efforts into improvement in these categories and will continue to make strides to further improve every aspect of the care we provide to our patients. (The Joint Commission, 2013) A2. Noncompliant Trends The areas we have identified that are not in compliance with the Joint Commission standards are: 1) Environment of care findings with numerous smoke wall penetrations, interim life safely measures for construction projects, blocked fire extinguishers, lack of sufficient evidence of adequate fire drills, lack of testing for medical gas alarm panels, blocked sprinkler clearance as well as cluttered hallways. 2) Falls has continue to be a challenge for our organization and will continue to be a focus for every department in our hospital. 3) Moderate sedation is an area that has been identified that needs a hardwired process for not only the hospital but for the anesthesia providers. The Joint Commission standards for moderate sedation compliance will require teamwork from the hospital and anesthesia group. 4) Pain assessment and reassessment is an ongoing primary focus area that we have not mastered in our organization. We have developed performance improvement processes to work toward compliance. This standard is a focus for every inpatient and outpatient department of our hospital. 5) Authentication of verbal orders continues to be monitored, but remains a challenge for our hospital. 6) Prohibited abbreviations are used periodically throughout our organization and is a piece of our daily audits when performing open record reviews. 7) Medication Management is a  priority focus area for our hospital, which we continue to struggle with various elements of this standard. We are focusing in particular on range order compliance and labeling medications. A3a. Staffing Patterns The case study shows that on unit 4E has the most opportunity for improvement in the number of patient falls and hospital acquired pressure ulcers. The comparison of falls and nursing care hours appears to be inconclusive, however appears to be a trend developing. The data appears that the staffing nursing hours per patient day have increase during the fourth quarter. In October, the falls per 1000 patient days was around 9. During October, the nursing hours per patient day were approximately five. November shows an increase in falls per patient day to 11.5 with nursing hours per patient day of 15.5. December continues the trended increase to 15 falls per 1000 patient days and 15 nursing hours per patient day. The data shows that the more hours per patient day we have, the more falls per 1000 patient days we experience. The data for pressure ulcer prevention follows the same trends. A3b. Staffing Plan The study has shown that the number of staff available is not causing the increase in the patient falls. The staff are obviously not rounding effectively on their patients, and being proactive in fall prevention. The plan to decrease nosocomial pressure ulcers and prevent falls will be presented to all staff on 4E by 4/15/2014 and fully implemented immediately. The new action plan will be evaluated for the remaining second quarter and if successful, will be implemented throughout the organization. The plan will utilize 10 hours per patient day, which is the average of the last quarter. The plan will require the staff to be more efficient and round with purpose in order to stay focused on the needs of the patients. This increased focus should prove to decrease the number of falls per 1000 days. Action Plan: 1) Mandatory education by 4/15/2014 to all staff on 4E 2) All patients will be rounded on hourly beginning 4/16/2014 3) All hourly rounds will address the 4 P’s (Pain, potty, possessions and position) a. Pain i. Is patient experiencing pain at this time ii. If so, ask patient to rate their pain iii. Depending on pain level, offer medication or other intervention b. Potty i. Does the patient need to use the restroom, urinal or ambulate to bathroom and if so, assist them to prevent falls and stay with them until completed c. Possessions i. Is call light, phone, meals, etc†¦ within reach of patient? The patient having their possessions within reach will minimize their need to reach or ambulate without assistance to answer the phone, etc†¦ which will prevent falls d. Position i. Is it time to change the patient’s position (left to right, ambulate, etc†¦) the changing of position frequently will assist in the prevention of pressure ulcers. 4) Each staff member ta performs the hourly round will document each round on the rounding log that will be located in the patient room. Rounds can be done by either the nurse or nurse’s assistant, as long as all needs for medication or other special needs will be immediately addressed by the nurse. The action plan presented will ensure that the patients are seen and their needs are met on an hourly basis. The staff will anticipate the needs of all patients by addressing the areas that cause the majority of falls. The patients will know the staff will be returning within an hour and will no longer have a need to utilize their call light unless in an emergency. The call lights will decrease, which will create a more organized unit that is very focused on being proactive with all patients. The results will be evaluated and changes and update to the plan will be made where necessary to continue improving the fall and pressure ulcer rate on this unit. B. Sources NONE

Effective Approaches to Leadership Essay

There is talk that the nursing shortage is over, but the facts show that there is a substantial nursing shortage which is projected to intensify over the next several years. This fact alone will increase the demand on the remaining nurses leading to nurse burn out and increased turnover rates. Nurses are the largest group of health care professionals in America, but the majority of the nurses are close to retirement age (Institute of Medicine [IOM], 2010). This paper will address the issue of nursing shortage, nurse turnover and how nurse leaders and managers are approaching these issues, along with the personal and professional philosophy of nursing of the author of this paper. There are many reasons why a nursing shortage exists, and why it is only going to get worse over the next several years. The median age of the nursing workforce is 46 years of age and almost 50 percent of all nurses are close to retirement, which will substantially impact the nursing shortage (American Nurses Association, 2013). The Affordable Care Act of 2010 ensures that every American have access to affordable health care (U. S. Department of Health & Human Services, 2013). This places an additional demand for nurses, and further increases the shortage. The results of the advances in medicine has increased the average life span, increasing the number of people living with chronic illness, and also increasing patient acuity levels which in turn increases the demand for advanced educated practioners. Nursing colleges and universities across the county are struggling to expand their enrollment levels in order to meet the rising demand for nursing care (American Association of Colleges of Nursing, 2012). Reductions in nursing budgets together with the growing nursing shortage has resulted in nurses working more, taking care of sicker patients and at risk for making mistakes. This further complicates the nursing shortage as this type of environment only drives the current nursing force away from the bedside. The current Registered Nurse turnover rate is 14% (American Association of Colleges of Nursing, 2012). One incentive that management and leadership nurses should be aspiring to is Magnet Status. The American Nurses Association in 1990 developed the Magnet status in an effort to reward hospitals that attract and retain nurses who demonstrate excellence in nursing practice (American Nurses Credentialing Center, 2013).

A New Intervention to Reduce Anhedonia in Schizophrenia

Meta-analyses of cognitive behavioral therapy for positive symptoms of schizophrenia have demonstrated its effectiveness in reducing hallucinations or delusions. In schizophrenia â€Å"negative symptoms’ refer to a reduction of normal functioning, and it encompasses apathy, anhedonia, flat effect, avolition, social withdrawal, and, sometimes, psychomotor retardation. The purpose of this study is the idea that Anhedonia is a challenging symptom of schizophrenia and remains largely recalcitrant to current pharmacological treatments. The goal of this exploratory pilot study was to assess if a cognitive-sensory intervention could improve anticipatory pleasure. Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Daily activities of the patients were also increased. In nursing research, it has been shown that the sense of mastery is negatively correlated with negative symptoms or even with the fact of being left alone. Two research questions were addressed in a sample of five participants. Does cognitive-sensory training in anticipatory pleasure in persons with schizophrenia? Does cognitive-sensory training in anticipatory pleasure lead to an increase in the number and complexity of daily activities performed by persons with schizophrenia? They did not expect that anticipatory pleasure cognitive skills training would directly improve consummatory pleasure. If persons with schizophrenia show a deficit in their ability to anticipate pleasure rather than consummatory pleasure, then it becomes possible to consider cognitive training might help these individuals anticipate pleasure from foreseeable, future activities. I feel the author did a good job using literature to support their predictions and I was convinced by their argument. The author used well supporting concepts to prove their points as they discussed theories about Anticipatory Pleasure Skills Training: A New Intervention to Reduce Anhedonia in Schizophrenia. I particularly liked the idea that they did a two year comprehensive program including assertive community treatment, social skills training, and multifamily therapy groups that led to significantly less positive and negative symptoms, less comorbid substance buse, and significantly greater satisfaction with treatment. The author thought a more specific and symptom-centered approach because they felt it might lead to specific improvement in a shorter period of time. This symptom-specific strategy has been used in other studies for positive symptoms, allowing the development of successful specific therapeutic techniques. The case studies presented in this article highlight the use of this specific symptom approach for Anhedonia. Anhedonia has been defined as a reduction in the ability to experience pleasure. It has been regarded as a core clinical feature of schizophrenia. Research has produced a paradoxical set of findings, raising questions about its nature. Individuals with schizophrenia typically report experiencing lower levels of pleasure in their daily lives than non-patients on self-report measures of trait social and physical Anhedonia. Anticipatory pleasure is linked to motivational processes that promote goal-directed behaviors; consummatory pleasure is associated with satiety. The Temporal Experience of Pleasure Scale is a trait measure of pleasure that distinguishes between â€Å"momentary pleasure† and â€Å"anticipation of future pleasure activities. The illumination of a new way of conceptualizing Anhedonia in schizophrenia permits redefinition and calibration of the symptom complex as a target for treatment. If persons with schizophrenia show a deficit in their ability to anticipate pleasure rather than consummatory pleasure, then it becomes possible to consider that cognitive training might help these individuals anticipate pl easure from foreseeable, future activities. Greater ability to anticipate pleasure would lead to a meaningful increase in spontaneous daily activities performed. Five participants were included in this pilot study. The participants were recruited from the regular clinical practices of the authors. The first and second authors were working in a mobile team of a community psychiatry outpatient service. The different members of this team worked as clinical case managers and were specialized in engaging difficult-to-reach patients in a comprehensive recovery program including therapeutic, occupational, and vocational services. The third author was working in a nursing home for psychiatric patients. The intervention was proposed to the patient when Anhedonia was reported as a challenging behavior impeding improvement in the care of the patient. To be included, participants had to be on a moderate dose of maintenance antipsychotic medication, with stable dosage for at least the past 3 months, and not be suffering from a major depression (score less than 12 on the Calgary Depression Scale for Schizophrenia [CDSS]). As the intervention was delivered in the routine care, signed informed consent to use the gathered data was obtained retrospectively for patients 1, 2, and 3. The internal review board of the nursing home approved the study, and patients 4 and 5 signed the informed consent form before their participation in the study. The participants were four men and one woman. All participants met the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) criteria for schizophrenia (American Psychiatric Association, 2000). Diagnosis was obtained at the referral time with discussion with the referring psychiatrist. Participant 1 left school by the age of 16 and had no further education or training. He had been housebound for 3 years except during acute somatic or psychiatric care. Participants 2 and 3 were working part time in competitive employment. Participants 1 and 2 lived at home with their parents; participant 3 lived alone in her own apartment. Participants 4 and 5 had been institutionalized in a nursing home for 14 years and 30 years, respectively, and did not work. Participants 1, 4, and 5 had a history of alcohol abuse. Participant 1 used cannabis when friends visited him at home. The intervention is a cognitive-sensory intervention that aims at increasing anticipatory pleasure. Participants are trained in state of relaxation to anticipate pleasure from potential enjoyable activities and to get the sensation of the pleasure in their bodies. The different steps of the program are described below. 1. Building the rationale for the intervention. The rationale is built by asking questions to participants in order to elicit the importance of being able to anticipate pleasure from future activities, and the links between desire and motivation. Examples of these questions are: How do you prompt yourself to engage in activities? What makes an activity more or less attractive? What are your criteria to assess if the effort to engage in an activity is worthwhile? 2. List of pleasant activities. The therapist and the patient will list past enjoyable activities that the person would like to resume, actual activities that the person would like to increase, and novel activities associated with new roles that the person would like to assume. For example, a participant who wants to be closer to his/her sister could engage in the activity of preparing a dinner for his/her sister and her boyfriend. . Classifying activities according to their difficulty. These listed activities are then classified according to the difficulty and complexity of the task. The classification is done from easy-to-do to difficult-to-do. Examples of simple activities are (a) going to the corner of the street and having a kebab, (b) taking a walk with a good friend, (c) taking a shower, etc. Complex activities related to social or professional roles are split in smaller reachable units before engaging in a more challenging activity. For example, going to the stadium to support one's favorite hockey team could be split in a more achievable goal such as inviting a friend to watch one's team on TV if going to a crowded sports arena is an obstacle to engaging in the activity. 4. Anticipating pleasure. During the first sessions, the therapist uses standardized material to teach the anticipatory skills. The material is composed of attractive picture-viewing activities such as biting an appetizing apple, drinking a frothy coffee presented in a lovely cup, or walking in a beautiful park. In subsequent sessions, the training focuses on the activities listed with the patient. At the beginning of each session, as patients may be â€Å"contaminated† by co-occurring unpleasant emotions (Horan, Green, Kring, & Nuechterlein, 2006), the therapist will start with a mindfulness or relaxation exercise to help the patient be in a comfortable, pleasant emotional state. Then, the patient is asked to imagine doing the chosen activity. The therapist guides the patient to imagine the sensations linked to the activity through the senses involved (sight, hearing, touch, smell, and taste). The patient is invited to remember past positive experiences of the activity (e. g. , Imagine that you are smelling the odor of the best kebab you have ever eaten . . . Feel the smell of the grilled meat in your nose . . . Concentrate on this odor . . . Try to feel it as vividly as possible). The patient is asked to anticipate pleasant emotions (e. g. , Feel the sensations associated with the joy of being with your friend . . . You told me that this friend is funny . . . Imagine the sensations that go with laughing. Scan your body and remember how it is to laugh . . . ). According to the anticipated activity, the patient may be guided to anticipate the feeling of accomplishment (e. g. , Feel the contentment of getting out of the shower. . . How is it to feel clean and fresh? Try to get this feeling fully . . . Anticipate the sensation of reward. . . How is it? ). If the patient shows difficulty in imagining sensations and feelings, pictures can be presented. Patients have to assess their desire to perform the activity on a 5-point scale before and after each exercise. 5. Prescribing homework exercises. As participants develop anticipatory pleasure skills, the therapist prescribes homework exercises. After participants accomplish single activities in daily living, more difficult activities are trained. Participant 1 received 10 hours of training at home, aimed at giving him the desire to go outside. Participants 2 and 3 received, respectively, 25 hours and 20 hours of training at the therapist's office. Participants 4 and 5 received 11 sessions of 1. 5 hours of training each in a weekly group session. Instruments: The therapists have administrated the instruments as clinical tools to assess anticipatory and consummatory pleasure, time budget, negative symptoms, and depression. The TEPS. The TEPS measures momentary pleasure and pleasure in anticipation of future activities. It is an 18-item self-report measure of trait, and anticipatory (10 items) and consummatory (8 items) pleasure (Gard et al. , 2006). The validation of the French version of the TEPS shows psychometric characteristics similar to the original version (Favrod et al. , 2009) with a satisfactory internal and external validity. The mean theoretical range of the two scales goes from 1 to 6; higher scores indicate more pleasure. The scale was administrated in pretests and posttests. The Time Budget Measure: The measure developed by Jolley et al. (2005, 2006) takes the form of a weekly diary completed retrospectively during a structured interview with the participant. In completing the measure, interviewers probe for activities, degree of independence in activities, and number and nature of social contacts. They also check that the week is a typical or average week, and, if not, complete the time budget on a different occasion to assess an average week. Each day is divided into four time blocks (morning, lunchtime, afternoon, evening). Each time period or block is then rated from 0 to 4 as below: 0 = nothing – lying, thinking, sleeping, sitting, etc. , 1 = predominantly passive activity (e. g. , watching TV, listening to the radio), 2 = an independent activity requiring some planning and motivation, but relatively simple or brief (e. g. , a walk to the local shops to get cigarettes, tidying room, washing up, preparing a simple meal for oneself), 3 = several two-rated activities completely filling a time period, sounding ‘busy', or a more complex and demanding, but unvaried or shorter activity (e. g. a visit involving public transport, prolonged social contact with others), and 4 = time period filled with a variety of demanding independent activities requiring significant motivation and planning, and with some variation in tasks (e. g. , work, a course of study, a trip out requiring organization). When more than one activity is present, the highest scoring activity is rated. There are 28 time blocks for the week, and the total possible score ranges from 0 to 112. The time budget was not used for the patients in the nursing home because the time-budget of these patients depended on the institutional routine. The week assessed should be a typical or average week, and if not, the time budget is completed in relation to a week chosen to be more representative. Time budget has a satisfactory criterion and construct validity, and shows good inter-rater reliability and test-retest reliability (Jolley et al. , 2005, 2006). In the present study, the participants were interviewed on their time budget starting from the day before the assessment meeting until 7 days before this meeting. The time budget was assessed in pretests and posttests. The CDSS. The CDSS was used to assess depressive symptoms (Addington, Addington, Maticka-Tyndale, & Joyce, 1992). The CDSS is a largely validated interview-based measure that has been shown to assess depression rather than positive, negative, or extrapyramidal symptoms (Addington, Addington, & Maticka-Tyndale, 1993, 1994; Addington et al. , 1992). The scale is validated in French (Lan?on, Auquier, Reine, Bernard, & Toumi, 2000; Lan?on, Auquier, Reine, Toumi, & Addington, 1999). The CDSS was administrated in pretest only to assess the severity of depression. Depression defined by the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) criteria for major depressive episode corresponds to a mean score of 11. 8 (standard deviation [SD] = 3. 8) on the CDSS (Kim et al. , 2006). The Scale for the Assessment of Negative Symptoms Anhedonia/ Asociality. The Scale for the Assessment of Negative Symptoms (SANS) assesses five symptom complexes to obtain clinical ratings of negative symptoms in patients with schizophrenia. They are affective blunting, alogia (impoverished thinking), avolition/apathy, anhedonia /asociality, and disturbance of attention. The final symptom complexes seem to have less obvious relevance to negative symptoms compared with the other four complexes. Assessments are conducted on a 6-point scale (0 = not at all to 5 = severe; Andreasen, 1989). The SANS is a valid instrument (Peralta & Cuesta, 1995); however, interrater reliability is reduced when clinicians use it in comparison to highly trained research assistants (Norman, Malia, Cortese, & Diaz, 1996). In the present study, only the anhedonia /asociality scale of the SANS was administrated in the pretest to assess the severity of Anhedonia. I feel the researchers can test their predictions using these methods because of what lengths they went to in presenting their techniques. They incorporated a lot of various useful ideas when testing their participants. Many angles were used to go into full detail in what steps were taken to evaluate each participant in this study. The authors I feel gave a very detail analysis of each step that was taken as to not leave out any variables in each case scenario. A cognitive-sensory training package focusing on anticipating future pleasant feelings about performing activities appears to improve anticipatory pleasure as measured by the TEPS. The high RCI indicates that the posttest scores of the anticipatory pleasure scale are reflecting important change for the five participants. These results, although preliminary, are very interesting because Anhedonia remains a particularly challenging symptom. Our second question related to whether an increase in anticipatory pleasure would be accompanied by an increase in daily activities. Concurrently, change in anticipatory pleasure, as measured by the scale, was accompanied by an increase in activity for the three participants for whom it was possible to fulfill the time budget. Participant 4 had been ritually visiting his mother once a week for years before training. At the end of the training, the nursing home team observed that the patient had added in every week a new spontaneous activity such as going to town to do shopping, planning a little trip, or spontaneously organizing an appointment with the hairdresser outside of the nursing home. Participant 5 had been accomplishing five household chores a day for many years and did not change his program at the end of the training. The participant had been institutionalized for a great part of his life. In previous work, we found a significant negative correlation between anticipatory pleasure and the avolition/apathy of the SANS (Favrod et al. , 2009). This correlation was lower than the one with the Anhedonia/asociality scale of the SANS, indicating a weaker link between these two variables. Apathy and avolition are probably associated with anticipatory pleasure. However, several other variables may affect activity and willingness, such as planning skills, motor skills, reinforcements provided by the environment, etc. The results indicated that the training did not seem to improve consummatory pleasure as a consequence of an increase in anticipatory pleasure. The lack of follow-up assessment did not allow observation of an eventual delay for improvement in consummatory pleasure as a consequence of improvement of anticipatory pleasure and engagement in new activities. Another explanation could be that both kinds of pleasure have some independence between them. Anticipatory pleasure is linked to motivational processes and consummatory pleasure with satiety processes. I feel the researchers did a very good job in describing every detail of their research. My reaction to this article is that I think Pleasure Skills Training can really help people with schizophrenia if done properly over an extended period of time under the right conditions. I as well sense that the article does contribute something interesting and important to the field. Individuals with schizophrenia already have a hard enough time in life and to go on living without experiencing a sense of pleasure is disheartening. This study shows that people living with schizophrenia if trained with the right circumstances can eventually learn how to experience pleasure. I felt this article was presented well and easy to read with what was presented. Going through this article it was clear where each step was and what was going on. The authors used wording appropriate to this article without using too much technical jargon where it was not needed. The readability for me was quite familiar because I have had to do assignments like this before. I think when any author presents an empirical article to the world where others besides advanced Psychologists read it; they indeed try and make it easily readable so that their ideas presented get across in the best way possible.

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