Analysis: Hospital Nurse Staffing and Quality of Case Essay

Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to research funded by the Agency for Healthcare Research and Quality (AHRQ) and others. Yet increasing staffing levels is not an easy task. Major factors contributing to lower staffing levels include the needs of today’s higher acuity patients for more care and a nationwide gap between the number of available positions and the number of registered nurses (RNs) qualified and willing to fill them. This is evident from an average vacancy rate of 13 percent. This report summarizes the findings of AHRQ-funded and other research on the relationship of nurse staffing levels to adverse patient outcomes. This valuable information can be used by decisionmakers to make more informed choices in terms of adjusting nurse staffing levels and increasing nurse recruitment while optimizing quality of care and improving nurse satisfaction. continue over the next two decades. A Federal Government study predicts that hospital nursing vacancies will reach 800,000, or 29 percent, by 2020.2 The number of nurses is expected to grow by only 6 percent by 2020, while demand for nursing care is expected to grow by 40 percent. The most recent research shows a jump of 100,000 RNs, or 9 percent, in the hospital RN workforce between 2001 and 2002 because of increased demand, higher pay, and a weakening economy. However, since almost all of the Making a Difference Lower levels of hospital nurse staffing are associated with more adverse outcomes†¦Page 3 Patients have higher acuity, yet the skill levels of the nursing staff have declined†¦Page 5 Higher acuity patients and added responsibilities increase nurse workload†¦Page 5 Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000†¦Page 6 Hiring more RNs does not decrease profits†¦ Page 6 Higher levels of nurse staffing could have positive impact on both quality of care and nurse satisfaction†¦ Background Periods of high vacancy rates for RNs in hospitals have come and gone, but the current shortage is different. According to a 2002 report by the workforce commission of the American Hospital Association, the nursing shortage â€Å"reflects fundamental changes in population demographics, career expectations, work attitudes and worker dissatisfaction.†1 In fact, the present situation may well Author: Mark W. Stanton, M.A. Managing Editor: Margaret Rutherford Design and Production: Frances Eisel Suggested citation: Stanton MW, Rutherford MK. Hospital nurse staffing and quality of care. Rockville (MD): Agency for Healthcare Research and Quality; 2004. Research in Action Issue 14. AHRQ Pub. No. 04-0029. increase came from RNs over age 50 who returned to the workforce and a greater influx of foreign-born RNs, this does not alter the structural features in the long term: the aging of the nurse population and the increasing unwillingness of young women to consider nursing as a profession.3 Today’s difficulties are further complicated by other changes in hospital care, such as new medical technologies and a declining average length of stay, that have led to increases in the amount of care required by patients while they are in the hospital. New medical technologies allow many less seriously ill patients who previously would have received inpatient surgical care to receive care in outpatient settings. Also, patients who in the past would have continued the early stages of their recovery in the hospital, today are discharged to skilled nursing facilities or to home. During the period 1980-2000, the average length of an inpatient hospital stay fell from 7.5 days to 4.9 days.4 An important consequence of these changes is that hospitals have a higher overall concentration of sick people who need more care. Various groups, including the American Hospital Association, the Joint Commission on the Accreditation of Healthcare Organizations, and the Institute of Medicine (IOM), have expressed their concerns about the evolving nursing crisis. The IOM issued a report in 1996 that recognized the importance of determining the appropriate nurse-patient ratios and distribution of skills for ensuring that patients receive quality health care.5 Its report highlighted the fact that research on the relationship between The nurse workforce and nurse staffing levels the level of staffing by nurses in hospitals and patients’ outcomes has been inconclusive. The IOM’s analysis of staffing and quality of care in hospitals concluded by calling for â€Å"a systematic effort †¦ at the national level to collect and analyze current and relevant data and develop a research and evaluation agenda so that informed policy development, implementation and evaluation are undertaken in a timely manner.† To begin to meet that need, AHRQ-funded research and other research have pursued a number of different paths. Hospital nurse staffing and nursing-sensitive outcomes Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as â€Å"variable patient or family caregiver state, condition, or perception responsive to nursing intervention.†6 Some adverse patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality.a Most research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are much more likely to be documented in the medical record. a â€Å"Failure to rescue† is defined as the death of a patient with a lifethreatening complication for which early identification by nurses and medical and nursing interventions can influence the risk of death. The nurse workforce consists of licensed nurses—registered nurses (RNs) and licensed practical nurses (LPNs)—and nurses’ aides (NAs). Both RNs and LPNs are licensed by the State in which they are employed. RNs assess patient needs, develop patient care plans, and administer medications and treatments; LPNs carry out specified nursing duties under the direction of RNs. Nurses’ aides typically carry out nonspecialized duties and personal care activities. RNs, LPNs, and nurses’ aides all provide direct patient care. RNs have obtained their education through three different routes: 3-year diploma programs, 2-year associate degree programs, and 4year baccalaureate degree programs. Almost a third of all RNs have a baccalaureate degree, and 7.6 percent of hospital nurses have advanced practice credentials (either a master’s or doctoral degree). LPNs receive 12-18-month training programs that emphasize technical nursing tasks. Nurses’ aides are not licensed but many acquire certified nurse aide or nursing assistant (CNA) status after proving they have certain skills related to the requirements of particular positions. Nurse staffing is measured in one of two basic ways: †¢ Nursing hours per patient per day. †¢ The nurse to patient ratio. â€Å"Nursing hours† may refer to RNs only; to RNs and LPNs; or to RNs, LPNs, and nurses’ aides. 2 www.ahrq.gov A broad array of research on this topic has found an association between lower nurse staffing levels and higher rates of some adverse patient outcomes. A new evidence report entitled The Effect of Health Care Working Conditions on Patient Safety, produced by an AHRQfunded Evidence-based Practice Center (EPC), reviewed 26 studies on the relationship between nurse staffing levels and measures of patient safety.b Most of the studies examined nurse staffing levels and adverse occurrences in the hospital setting, including in-hospital deaths and nonfatal adverse outcomes such as nosocomial infections, pressure ulcers, or falls. The EPC’s researchers found that lower nurse-topatient ratios were associated with higher rates of nonfatal adverse outcomes.7 This was true at both the hospital level and the nursing unit level. With regard to in-hospital deaths, however, the evidence does not consistently show that lower nurse staffing levels are associated with higher mortality. The largest of these studies on nurse staffing (jointly funded by AHRQ, the Health Resources and Services Administration, the Centers for Medicare & Medicaid Services, and the National Institute of Nursing Research) examined the records of 5 million medical patients and 1.1 million surgical patients who had been treated at 799 hospitals during 1993.6,8 Among the study’s principal findings: †¢ In hospitals with high RN staffing, medical patients had lower rates of five adverse patient outcomes (UTIs, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stay) than patients in hospitals with low RN staffing. c †¢ Major surgery patients in hospitals with high RN staffing had lower rates of two patient outcomes (UTIs and failure to rescue). †¢ Higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes, depending on the outcome. †¢ Higher staffing at all levels of nursing was associated with a 2- to 25-percent reduction in adverse outcomes, depending on the outcome. Table 1 illustrates some of the major findings. For example, the researchers found that medical patients in hospitals with high RN staffing were 4-12 percent less likely to develop UTIs than medical patients in the comparison group. Lower staffing levels are linked to higher adverse outcome rates The EPC report included five studies funded by AHRQ that examined the relationship between adverse patient outcomes and hospital nurse staffing. All five studies found at least some association between lower nurse staffing levels and one or more types of adverse patient outcomes. How often do such adverse â€Å"nursing-sensitive† patient outcomes occur in hospital care? Different studies report varying adverse event rates, which vary by the type of patient (medical or surgical) as well as other factors. For example, UTIs occur in from 1.9 percent to 6.3 percent of surgical patients and pneumonia in 1.2 percent to 2.6 percent of surgical patients.8-10 b Table 1. Percent reduction in rates of outcomes among medical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which rates are lower for: In order to improve the quality and delivery of health care services, AHRQ has sponsored a series of evidence reports that are based on rigorous, comprehensive reviews of relevant scientific literature. These reports are developed and written by outside research and academic organizations designated as Evidence-based Practice Centers (EPCs). The reports’ emphasis is on explicit and detailed documentation of methods, rationale, and assumptions. The goal of these reports is to provide the scientific foundation that public and private organizations can use to develop their own clinical practice guidelines, quality measures, review criteria, and other tools to improve the quality and delivery of health care services study measured RN staffing as hours per day and as the RN proportion of nursing hours. Hospitals with higher hours of RN staffing (75th percentile) had an average of 9.1 hours of inpatient RN nursing per patient day, while those with lower RN staffing (25th percentile) had an average 6.4 hours of inpatient RN nursing per patient day. Hospitals with a higher proportion of RN staffing (75th percentile) had an average of 75 percent of inpatient nursing hours provided by RNs, while those with lower RN staffing (25th percentile) had an average of 62 percent of nursing hours provided by RNs. Outcome in medical patients Urinary tract infection Upper gastrointestinal bleeding Hospital-acquired pneumonia Shock or cardiac arrest High RN staffing 4-12% 5-7% 6-8% 6-10% High staffing, all levels (RNs, LPNs, aides) 4-25% 3-17% 6-17% 7-13% c This Note: Difference is expressed as a range of values (e.g., 4-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source: Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA. www.ahrq.gov 3 Medical patients in hospitals with high levels of total nurse staffing (RNs, LPNs, and aides) were 4-25 percent less likely to develop UTIs than patients in the comparison group. A similar analysis was performed for the smaller group of surgical patients (Table 2). Surgical patients in hospitals with high RN staffing had a 5-6 percent lower rate of UTIs and a 4-6 percent lower rate of failure to rescue than surgical patients in the comparison group.d Pneumonia rates are especially sensitive to staffing levels Three AHRQ-funded studies found a significant correlation between lower nurse staffing levels and higher rates of pneumonia. †¢ The first study found that adding half an hour of RN staffing per patient day could reduce pneumonia in surgical patients by over 4 percent.12 This study covered 589 hospitals in 10 States during 1993. †¢ A second study by the same researchers also found that fewer RN hours per patient day were significantly correlated with a higher incidence of pneumonia.13 The study examined administrative data on post-surgical patients in 11 States during 1990-96. †¢ A study of nurse staffing levels and adverse outcomes in California found that an increase of 1 hour worked by RNs per patient day was associated with an 8.9-percent decrease in the odds of a surgical patient’s contracting pneumonia. 8 †¢ This study also found that a 10-percent increase in RN proportion was associated with a 9.5-percent decrease in the odds of pneumonia. The researchers in the California study believe that the strong relationship between RN staffing and pneumonia can be attributed to the heavy responsibility RNs have for respiratory care in surgical patients. This study examined the effects of nurse staffing on adverse outcomes in 232 acute care hospitals from 1996 to 1999.f Unlike many earlier studies, the California study included only adverse outcomes that were not present at admission.7 Table 2. Percent reduction in rates of outcomes among surgical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which rates re lower for: High staffing, all levels (RNs, LPNs, aides) 3-14% 2-12% 19% Outcome in surgical patients Urinary tract infection Failure to rescue Hospital-acquired pneumonia High RN staffing 5-6% 4-6% 11% Note: Difference is expressed as a range of values (e.g., 2-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source: Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA. A second study, funded jointly by AHRQ and the National Science Foundation, examined licensed nurse staffing (RNs and LPNs) and adverse outcomes among both medical and surgical patients in Pennsylvania acute-care hospitals.11 It found a lower incidence of nearly all adverse outcomes it studied in hospitals with more licensed nurses. For example, a 10-percent increase in the number of licensed nurses is estimated to decrease lung collapse by 1.5 percent, pressure ulcers by 2 percent, falls by 3 percent, and UTIs by less than 1 percent. Also, with a 10-percent higher proportion of licensed nurses, there was a 2-percent lower incidence of pressure ulcers.e,11 d Surgical patients overall had lower rates of adverse outcomes than medical patients, perhaps because they are healthier. Also, the smaller number of surgical patients in the study may have made it more difficult to detect associations. Nurse staffing was measured in two ways: (1) the ratio of licensed nurses (RNs + LPNs) to the patient load (with and without adjustments for patient acuity) and (2) the proportion of licensed nurses to the total nursing staff (RNs, LPNs, NAs). The adverse outcomes selected for study were â€Å"either caused by or not prevented by medical management† based on criteria used by the Harvard Medical Practice Study. Nurse staffing was measured in three ways: all hours (the total number of productive hours worked by all nursing personnel per patient day), RN hours (the total number of productive hours worked by registered nurses per patient day), and RN proportion (RN hours divided by all hours).

Enter Thomas Hardy Essay

Enter Thomas Hardy, Alfred Lord Tennyson, Robert Browning, Gerard Manley Hopkins and William Blake. The poets are seated around a small table in a crowded and agitated Chinese restaurant, at the heart of Texas. After the initial shock and excitement of their unwonted experience, they all meditate on the state of the world in which they have accidentally landed, poring over a newspaper cut that announces the death of a young girl as a result of heroin overdose. A heavy silence has set on the poets’ table, in strange contrast to the loud mirth of the small Chinese restaurant. Raising his brow, Hardy interrupts the silence. He speaks slowly, with a clear but tired voice: Hardy: Surely my beliefs are strengthened by this terrible mishap. If only there was a malevolent ruler of the universe to blame for the cruel death of this young girl. Then all our voices would roar against him, accusing him of injustice and absurdity. We would feel betrayed and angry that the supreme ruler of the world ill-uses his creatures so. But I see it clear now, as I have seen it and heard it so often in the mysterious and neutral voice of nature all around me: the universe is a hollow shell; there is no other voice in this world than that of nature and chance echoing through the ages and creating havoc in our poor, mortal existence. The death of this beautiful child is the answer of the impersonal and cruel force of chance to all our hopes and ideals. There are many of us who have fallen in love with the world and its wonders, as there are many of us who have always hated it. I have heard the world speak to me many times, warning me not to look for meanings where there are none. I have long heard it say to me not to look for promises in the web of uncertainties and in the play of chance. This is what the world has long said to me: `I do not promise overmuch, Child; overmuch; Just neutral-tinted haps and such’. This fair warning still rings in my ears today. There is only chance in this world, that is all there is. Nothing lasts and no sense can be made of all we see around us. We look for meanings where there are only occurrences. One happening follows another and we are at the mercy of chance and time. Despite our passionate search for answers, the nature sends back only a dispassionate, neutral response, playing its games and rolling the dices. Casualty is the most powerful governing law we have and there is no hope for escape. It is this â€Å"crass Casualty† that â€Å"obstructs the sun and rain†, giving us the good moments and the bad moments by turns. Nature follows its own logic, not ours. And time plays dice with the world, casting its sums of moans and joy and making us obey its impersonal and mute force. I do not see any other meaning in the death of this young girl. She, like the rest of us, was in the hands of chance. Had her life been long and happy, she would have owed it all to chance still. There is too much arbitrariness in everything to believe we are ruled by a God who reasons and who loves. Nothing happens for a reason. Do not further look for meaning in this my friends, for there are none and never expect much, for there is nothing more†¦ The others have listened in silence to Hardy’s disconsolate speech. When he ceased however, Tennyson began in a tremulous, shaken voice: Tennyson: Oh, my friends, these would have been my own words once. Like you, I would have looked upon this young girl’s death as the substantiation of all my aching questions. I have often felt like an infant crying desperately for knowledge, for the light of meaning to suppress the darkness of the world! At times there seemed to be no answer anywhere. I wanted to see that â€Å"nothing walks with aimless feet†, that there is no destruction of life and that everything that happens has a purpose and a meaning in the larger, unseen order of things. I wanted to understand God as the careful designer of all, the divine force that gives meaning to everything there is and does not allow anything to perish. I painfully wavered between belief and disbelief†¦ At times, I could not endure the thought that anything in the world was useless or devoid of purpose. If God was here with us, a mere worm would have its significance in the world and its place in eternity along with the whole of the creation. But oftentimes my belief and my need for knowledge stumbled on the carelessness of nature. I wondered many times whether â€Å"God and Nature† were â€Å"at strife†, seeing â€Å"that Nature lends such evil dreams†. The hope in a divine order of things seemed to be shattered every time I beheld the evil workings of nature. Truly, nature seems not to care for the individual life. It crushes and destroys and casts life away â€Å"as rubbish to the void†. To me also then nature was a nightmare I could not make any sense of. A while ago, this innocent girl’s death would have seemed another evil deed of nature, an unjust robbery. Life and man’s entire existence seemed so futile at certain moments†¦A mere girl dying for no reason, a whole life cut short because of a misplaced step†¦Oh, how easy it is for reason to doubt everything and for faith to die in the soul of man! But since, I have been shown a different path and for me faith has been renewed. Even at times like these, I feel that we have God in our souls, even if it difficult to perceive him in nature. I now know that it was the voice in my heart that has kept me from disbelief. Each time the voice of ‘cold reason’ interfered and questioned the meaning of all, â€Å"my heart stood up and answered: ‘I have felt’! †Ã¢â‚¬ ¦ Reason made me blind at times, but my heart cried out and melted my anger with its passion. Our knowledge of God comes only in these moments when the heart answers eagerly and warmly to all our questions. The death of a child makes me sad beyond speech, but it does not harden me anymore. I now believe that death is just a brief moment that takes us from life’s shore to death’s domain and God’s infinite ocean. God awaits us on the infinite ocean and he will be our Pilot ever after, our guiding light in the infinite sea of time and matter. Once I cross over, â€Å"I hope to see my Pilot face to face†, and I hope that this young girl has already seen him†¦ Tennyson had spoken warmly and tremulously, his whole soul into the words that tumbled from him. From his shaded place at the table, Browning replied: Browning: Your soul is as pure as your faith, my dear Tennyson. We have reached this strange time and place in history to meet death itself and behold it through the eyes of a child. Mortals fear death, with its unknown grip that will surround each of us as a mist and transport us to some mysterious realm. Life is strange and death seems even stranger. Any mortal would feel shaken in front of this last and final struggle. But what could it be in the end, but one more experience and the last in this life? â€Å"I would hate that Death bandaged my eyes, and forbore and made me creep past. † I want to taste death to the full as I have tasted this life and feel the moment in its fullness. The girl has left this world but someone will be waiting for her on the other side and her soul will be filled again. Once I am gone from this world, I know that I will regain my lost love and clasp her in my hands once more. Death is but a brief moment, a struggle that will takes us to a place of eternal peace, where we will rest with God. This world is indeed full of chances and mishaps, but all these will be resolved once we are on the other side†¦If love has remained unfulfilled in this life, it will be rekindled in eternity. I do believe that we lose nothing by death and that the other life is as rewarding as this one. I do not fear death and only expect it to carry me back to my lover†¦This girl must have led a tormented life, the prey of her own restless desires and questions, like all of us. She will find her peace in the eternal life and she will find her place there. There is nothing to fear, not even death†¦I will wait for it but not as an end, only as a new and fresh beginning. Browning had but uttered these words that Hopkins began: Hopkins: Shake off the discontent that has intruded upon your hearts, my friends! You see the death of a child as a black and tragic event, and it certainly seems so when our mortal and untrained eyes behold it. Man is frail in the hands of the divine will, his powers are limited†¦. But the more mighty seems the everlasting ruler of the world! The drudgery of our existence seems to hide God’s glory from our eyes. â€Å"Generations have trod, have trod, have trod; and all is seared with trade; bleared, smeared with toil†¦Ã¢â‚¬  The earth itself smells of man and his works. Yet, in the midst of all this trade and toil we the world appears â€Å"charged with the grandeur of God. † His creation and power and infinite and so are the possibilities of the world. It is through God’s almighty design that we see light disappear in one part of the world, knowing that it suddenly begins to shine in another. Just like light and darkness always coexist, nothing reigns in nature for an unlimited period of time. Through the power of God, the good and the bad coexist in the world at all times. This girl’s death is compensated by another design of God, perhaps unknown to us at present. Only God could make all these different things come into existence at the same time. â€Å"Nature is never spent, there lives the dearest freshness deep down things. † Tasting life, with its good and bad moments, we taste of the very glory of God, who is careful to pour his infinite essence into everything there is. Death is not an end as long as God lives in everything, as long as joy springs up from each fresh beginning. Each day begins with a morning and ends with a night, and yet nothing is ever the same. God’s glory shines through all things, like a foil that you shake in the light. There are no dead things in this world; all matter becomes translucent and fiery with God’s light. With a death, the world may seem bent like a hunchback, crushed underneath the weight of loss, but overall I see the shining spirit of the Holy Ghost shaking its bright wings! The body of the world will ever be lifted by the wings of the almighty spirit! There is no permanent death and no reason for sorrow in a world in which we see the proof of God’s greatness in everything. Learn how to see the world anew, rejoicing in the immense power of the Lord, that is without beginning and without end†¦

Attending a Performance of the Ottawa Symphony Orchestra

The performance I participated in was Prometheus' s prelude, the performances of the Ottawa Symphony Orchestra, Beethoven 's performance, Kodari orchestra' s performance, Italian Harold 's performance, Berlioz' s performance. I think that the orchestra is hosted by David Currie, and overall it worked out very well. The stages and the stages on both sides of the stage were lit up brightly and the musicians arranged semicircles around the podium. Strings in the back row are attached to risers and high stools. The first concert I participated was by the Dallas Symphony Orchestra. The orchestra performed Shostakovich's Symphony No. 7, Leningrad from the romantic era. The orchestra is a large orchestra (1) containing various instruments that contribute to the overall sound of the instrument. Since the orchestra is a big orchestra like a musical instrument that is common in romantic times, the orchestra can be full of activity, perhaps vibrant (2). The orchestra has changed a bit ... Read more General reaction: The concert I participated is SPX Magic for Christmas by Charlotte Symphony Orchestra by Albert-George Schram director. This is the first professional orchestral concert I participated and the first concert I studied at UNC Greensboro. When I was walking down the street in downtown Charlotte, the wind blew my face and small raindrops were thrown into the air. It looks like Christmas. As a music major at the University of California at Berkeley, I was lucky enough to participate in the concert of the UCB Symphony Orchestra for free. I often participate in the performance and regularly study the music and history related to the orchestra performance, but I will never be surprised by the complexity and beauty of that orchestra. Not only is this instrument completely harmonious, it synchronizes speed and dynamics to create great performance. Listening to these wonderful musicians is almost impossible to believe that such playing is coincidence or coincidence. Comp osers and musicians did not throw random notes in the air, but randomly scattered them into the music staff. Instead, each instrument is precisely adjusted to 440 Hz, and each musician follows certain notes and descriptions of a particular musical score. These memos were written by the composers with contemplation and planning, and the composer may work for these masterpieces for months or years.

The Search for 100 Million Missing Women Essay Example | Topics and Well Written Essays - 500 words

The Search for 100 Million Missing Women - Essay Example This includes preference for boy babies in a patriarchal society, leading to female infanticide; neglect of baby girls in terms of care, nutrition and education; trafficking of adolescent girls through prostitution. Sen argued that all these factors combined to create a disparity of 100 million missing women in Asia. Although the reasons given by Sen are true, they only account for 50 million missing women. Looking to explore this statistical void, other economists took interest in the problem. One such was Emily Oster, who pursued the link between Hepatitis B occurrence and Asia's missing women population. By perusing reliable repository of medical statistics from the region, Oster was able to establish a definite link between Hepatitis B incidence levels and sex ratio in India, China and Pakistan. Backed by reliable statistics and a provable thesis, the finding has altered conventional wisdom. In this case, Oster's finding corrected and expanded Amartya Sen's stated reasons for ske wered sex ratio. At the core of the finding's success is the absence of 'n of 1' patterns in the data. As Oster's own personal history as a prodigious child shows, discounting exceptions to the rule is an important aspect of proper scientific research.

Human resource 420 Assignment Example | Topics and Well Written Essays - 750 words

Human resource 420 - Assignment Example Also, in relation to the successful completion of the internship program, I received two letters of accreditation with ‘A’ grade certification. I feel that this particular achievement will definitely help me in fulfilling my ultimate and predetermined goals. Moreover, the achievement would enable me to develop the work as an efficient HR recruitment coordinator. The best thing to discuss about my college is that the authorities themselves provided me with the opportunity to undergo the internship programs for which I am very much thankful to my college. In addition, the college authority provided me with the prospect of conducting along with participating in numerous workshops and also made me engaged in performing different HR related activities. These eventually developed my theoretical as well as practical skills linked with HR field by a considerable level. There still lays a greater scope for acquiring sufficient knowledge that my college will provide to me as there are still 14 months to complete my course. This fact makes me keep going in the positive mode for acquiring more and more HR related skills. Before beginning my graduate program, it was pre-planned that I would have my specialization in HR because this particular field is always been my favorite as I deeply favor the aspect of identifying human talents. It strongly represents my interest area and also I possess a strong zeal to start and pursue a career in the field of HR just after my graduation (Hansen, 1996). The college in which I am studying is home to several reputed professors who possess variable amount of industrial exposure in dissimilar fields. And fortunately, our HR subject is taught by an authoritative individual who shares a friendly attitude, having specialization in the field of recruitment for several years. During the past one and half years of my educational program, I met several people who liked to share common interests relating to the concerned filed or subj ect matter. Me and my fellow classmates were continuously engaged in participating several counseling sessions and discussed along with solved numerous project reports and assignments in a cohesive manner. It can be affirmed that the graduation program not only supported me to gain valuable insight about HR, but also provided me with greater knowledge and understanding of other subject areas. These subject areas encompass marketing, finance, statistics, managerial economics and business communication among others (Hansen, 1996). Short-term goals: In the next 14 months, I plan on completing my graduate course with maximum score, so that I could get a proper assistance in relation to placement. As the course is continuing to provide me with all diversity in the modern education process, I strongly feel that I will be able to grasp all those necessary skills that are required to get a kick start in the corporate sector. I am trying to create a strong co-ordination with reputed companie s that my college has tied up. This might support me to fulfill my ultimate goal by a certain extent. Even tough, I have developed a strong interrelation with the placement cell in my college which might enable me to get a good job in future. I am studying very hard in order to fulfill my

Elderly as a Vulnerable Population and the Effect of Healthcare on Research Paper

Elderly as a Vulnerable Population and the Effect of Healthcare on this Population - Research Paper Example Being elderly is one of the leading causes of vulnerability for which the health department of the US government has taken steps to research the vulnerable points of the elderly people to control their health-related problems. It can help nurses in giving holistic and all-inclusive attention if they are aware of the causes of elderly vulnerability (Ruof, 2002). Elderly Population’s Demographics The healthcare issues faced by the elderly need to be seen in the context of demographic changes and their effect on health and wellness. The next 5 years are critical in changing the demographics of the elderly population getting older (HHSS Strategic Plan, 2007). American population aging tenure has increased. A large number of people are above the age of 65 or older. A child born in 2006 can live till the age of 78, an increase of 10 years since 1965 when the Older Americans Act was enforced for Medicaid and Medicare. The population growth of older people increased doubly from 12 mil lion to 36 million from the total resident American population reaching 300 million from 150 million starting from 1950 till 2006. As per the estimates of the US Census Bureau, the older people’s population would increase as the first baby boomers turn 65 in 2011. By 2030, the elderly population would reach nearer to 20 percent of the US population. It creates serious repercussions and pressures on the healthcare system to meet the healthcare needs of the elderly, particularly related to chronic and severe health conditions and disabilities. The average American on the threshold of age 75 suffers from three chronic ailments and is prescribed five distinct medicines. There is huge dearth of such healthcare professionals attending to older Americans whose population would be increasing as anticipated to be 20 percent of the total American population (HHSS Strategic Plan, 2007). Stats indicate huge shortage of certified nursing assistants, home health aides, and personal care wo rkers whose requirement constitutes 874,000 to meet the demand in the coming 10 years while their supply would decrease to half by 2030 (HHSS Strategic Plan, 2007). Awareness Our behavior towards elderly could be biased. For example, when we hire a taxi to go somewhere and reach there in time, we may prefer young driver who, as is the stereotype assumption, take lesser time in driving to the location. In America, the population of aged licensed drivers is 30 million. If a driver’s age is less than 75, the possibility of accidents is less than if they cross the age of 75. It is because of their health issues such as dose intake or their reduced driving abilities, which could be risky. Sometimes, they are not aware of their reducing driving prowess and may argue otherwise. Some diseases such as dementia can cause cognitive blindness affecting the drivers’ acumen to identify their bad driving (Eldercare, 2010). Change in Outlook Research on the inabilities of the elder ha s changed the outlook on their issues. How an ordinary problem like heat can aggravate their worries is clear from the example of older peoples’ inability to cope with the heat outside. They are more prone to risk from heat-stroke. Old age becomes a hurdle in their ability to accustom to temperature change. They may have symptoms aggravated by heat and their medicines could give side-reaction to further aggravate their health condition (NIH News, July 18, 2011). Some of the factors

Discuss the possibility that hamlet never encountered the ghost of his Essay

Discuss the possibility that hamlet never encountered the ghost of his father, that the ghost was all a figment in the imagination of a troubled mind - Essay Example There is a possibility that Hamlet was inspired by Martin Luther, the initiator of the Protestant Reformation. In Denmark, people follow the Catholic faith and are very religious. In Hamlet’s days, Catholics faced many problems. In those times, the Roman Catholic Church was rapidly gaining absolute power. The priests said that our sins can be condoned from God’s punishment by buying tickets to heaven. However, since Hamlet studies in Wittenberg in Germany and not in Denmark; he is little influenced by the Catholic school of thought. In Germany, Luther is epochal. Luther confronts the tenets of Roman Catholicism in the Ninety-Five Theses. Hamlet is surrounded by Protestantism, in mind as well as in spirit. Hamlet says, â€Å"O all you host of heaven! O earth! What else? And shall I couple hell?† (Act 1 Scene 5). He starts to doubt Purgatory as it is a Catholic concept. As his father comes from Purgatory and asks him to avenge his murder; Hamlet questions himself about the existence of Purgatory. He thinks that the Devil himself has disguised as his father’s ghost and has descended to test him. Therefore, the ghost might be his imagination. Hamlet is caught between the conflict of two opposite forces, so he tries to save his sanity and sense of reason. He has strong moral integrity. Since his father’s death remains a sudden occurrence; the next king of Denmark is supposed to be Hamlet. His uncle’s readiness to take his place makes Hamlet wonder how his father passed away. To make things worse, his mother marries him right after her husband’s death. Shakespeare writes, â€Å"Thrift, thrift, Horatio. The funeral baked meats did coldly furnish forth the marriage tables† (Act 1 Scene 2). Hamlet doubts his mother ever loved his father, and asks himself how in a short time she could overcome the grief and get married to her brother-in-law. Hamlet is disturbed by the happy demeanor of his mother. Shakespeare states, â€Å"How weary, stale,

Newark Ophthalmic Centre Essay Example | Topics and Well Written Essays - 4000 words

Newark Ophthalmic Centre - Essay Example 179), your project will not succeed. By definition, an information system (Beynon-Davies, 1998, p. 4) is a system of communication between people, within the firm and between those in the firm and your customers, actual and potential, and involves the gathering, processing, distribution and use of information. According to several research papers (Morris and Hough, 1987; Benjamin and Levinson, 1993; Drummond, 1998; Beynon-Davies et al., 1998), information system failures are very common. Your problems are common and, based on our considerable experience in these matters, due mainly to faulty project management design. Fortunately, your experience in a much larger organisation was useful in avoiding bigger problems such as mistakes in the installation of the appropriate information systems and technology architecture. Your decision to purchase the system you had just installed was a first step in the right direction. Several failures have been marked by the installation of complex and expensive systems that brought about stakeholder resistance and integration problems due to poor strategic implementation (Beynon-Davies, 1998, p.258 and Grindley, 1991). Herewith are our specific recommendations that we attempt to explain in a straightforward manner and, by defining terms where it would be to your advantage, using language that is easy to understand by everyone in your firm. We have divided our report into five parts. In the first two parts, we propose a simple and straightforward information systems strategy and an information technology strategy you can communicate to everyone in the Centre. In the next two parts, we provide you with an outline of how you can market the information systems and technology strategies to the staff and to the Centre's owner, Dr. Harrison. In part five, we map out a project implementation plan for the next two years Part One: Information Systems

Japan China trade Research Paper Example | Topics and Well Written Essays - 2500 words

Japan China trade - Research Paper Example The islands between China and Japan named Senkaku(as per Japan) and Diaoyu(as per China) have been a main cause of disputes between the two countries, as shown below1. The trade relationship between China and Japan has grown significantly over the period of forty years. The Japan-China relationship is one of the most important trade relationships in the world. This bilateral relationship promotes economic welfare and growth, security and peace in Eastern Asia and as a result, the entire world. The Japan-China economic relationship is however plagued by historical and political tensions and disagreements2. One of the main factors that have greatly influenced the international trade between China and Japan is the convenience of the geography between these countries. The geographical proximity enables both nations to acquire what they need at a lowered price. China is a landlocked country on the West and is bordered by the sea to the East. China’s coast faces Japan. The ability to escape unnecessary warfare, reduced transport fees, the general ease of transportation is the main benefit the nation gains from its geographical position. China uses both the Pacific Ocean and its landlocked side for exportation through ships and freight trains. China participates in the mining industry. The presence of rare earth minerals mainly in the West makes it a lucrative trade partner for Japan, which uses these minerals in its widespread electronic industry3. The large electronic industry in Japan is one of the greatest contributors to the country’s economy. The terrain and climate in C hina facilitates its agricultural sector which is one of China’s main exports. Japan is not a resource rich environment, that is, the presence of natural energy resources and metallic ores is minimal. The country’s terrain and climate limit the agricultural sector. These geographical factors boost the country’s need to trade and import these resources and the relative

Psychology Essay Example | Topics and Well Written Essays - 500 words - 23

Psychology - Essay Example Teachers tend to select boys more often for special services. There is little information about the effect of family SES on the selection process and it is contradictory. More parental involvement and student engagement have a positive effect on the selection process. The study included 441 girls and 465 boys all in the sixth grade. Teachers and students filled out questionnaires in the classroom. The teachers reported the students’ need for services. They also filled a Teachers Report Form which reported students’ behavior and psychological problems. Additionally they assessed the parents’ interest and their own cooperation with parents. The students reported how satisfied they were with their academic achievement and interest in school. They reported their family SES by the occupation of their parents and whether they had been unemployed in the past six months. The results showed that there was in fact a gap between need for and access to the services. The gap was largest in remedial instruction and smallest in psychological counseling. The only difference according to gender was in the remedial instruction where more boys had not received this remedial instruction and this was because of budget cuts. Only in psychological counseling were there reasons beside budget cuts for the lack of access to the services. In general the study showed the factors that affected each type of service. These were in remedial instruction- lower family SES, lower parental involvement, lower student engagement all predicted a higher need for services; for Special Ed. services- male gender, lower family SES, lower parental involvement, internalizing symptoms and lower student engagement all predicted higher need for services; and for psychological counseling- male gender, lower student engagement and below average academic achievement all predicted higher need for services. Yet the factors that influenced

Kari Charboneau Competency Statement Essay Example for Free

Kari Charboneau Competency Statement Essay To establish positive and productive relationships with families To establish positive and productive relationships with families I try to make sure I keep an open, honest relationship with them. I feel its important to have my parents feel that they can trust me. I also feel its important they know I have the best interest of their child in mind. Parents need to feel that they are being listened to and that we care enough to work with them in regards to their child’s wellbeing. †¦ CG 4.1 Keeping Families Informed In my center it’s a priority to make sure we are keeping all families informed of all the things that we as a center do as well as their individual child’s daily activities. I would have a welcome packet that includes contact information as well as center information. This would include information such as teacher profiles, center policies etc. I will make it a point to get to know each parent and to establish an open dialect. I would have information as to how they can contact me to discuss any concerns they may have as well as just general information we just share on a daily basis. We would have a monthly newsletter and calendar with center activities on it as well as weekly information in the entry way to remind them of any upcoming events we may have. There will also be daily communication sheets provided for each child describing what their child did throughout the day. Parents will know that they are welcome to stop in or call a t any time to check on their child’s day. CG 4.2 Teaching Practices I believe that by having open conversations with my families they start to trust and with that we have conversations about not only their child but also our own lives outside of the center. Knowing that maybe one parent might be out of town is good information to have. This helps us understand why a child may be having a change in behavior. I will make sure I know the children in my care well enough to notice changes and having a good parent relationship’s will allow me to communicate with them and find out if they notice the changes as well and to see if they have ideas as to why. If it’s not a typical reason we would expect to see a change in behavior from we can then work together to see if we can’t figure  it out and come up with a plan that will help meet that child’s individual needs. There will be a communication sheet written out daily that will highlight their child’s day and at pick up we can then discuss why their child may have had a more difficult day or even the opposite that their child was really happy. We may find out that they have family visiting that the child loves to be around or that Daddy has been out of town for a few days. These are both good reasons to see a change in a child’s normal behavior. Communication is very important in keeping good relationships going.

Why We Shouldnt Illegalize Guns Essay Example for Free

Why We Shouldnt Illegalize Guns Essay The Sandy Hook shooting. The theater shooting. What do they have in common? Guns. The question though, is how we should limit them. Many think that we should completely illegalize them, but is it really going to solve the problem? The truth of the matter is that guns don’t kill people; the criminal that wields the gun kills people. Limiting the use of guns is not an ideal solution and it will not stop criminals from killing others. It’s understandable that many people want to completely restrict guns because of their personal experiences or tragedies of someone they know dealing with shootings or guns. It’s also understandable that gun laws are passed only to look out for the safety of others. Guns can be really dangerous once it’s placed in the wrong hands. Saying from complete honesty, we can all agree that guns actually do help criminals kill or injure the innocent. Using a gun, a thief can easily rob a bank, or even a psychopath can easily gun down a school with just a press of a trigger. I mean, guns are dangerous right? Yes and no. Yes, because they can be a tool for evil and destruction. No, because they don’t cause people to kill others, they serve only as a catalyst for the inevitable. If someone is insane enough to pick up a gun and kill innocent civilians, the problem doesn’t lie within the gun, but the beholder of the gun. This means that the thought of killing someone else will eventually manifest whether guns are present or not. Taking away guns isn’t going to make criminals mentally sane or even less dangerous. The problem shouldn’t be emphasized on the tool the perpetrator used, but on the perpetrator himself. Saying that it was a gun that caused a person to kill is like saying if someone had a knife, he would automatically go out and slaughter innocent bystanders. Intentions are intentions. If someone really wanted to kill another person, they would, with or without a gun. But ok. Say a law was passed to illegalize all guns. Would it finally be a stop to all the madness and violent killings in America? Of course not. Illegalizing guns will only take away firearms from the law abiding citizens. Criminals that are likely to commit crimes are the ones that won’t abide to laws. And even if it’s against the law, whose stopping the criminals from obtaining arms illegally? This means that the law abiding citizens will have no guns to protect themselves, and the people that don’t follow laws will have guns regardless. Even though a series of recent tragic events occurred, it shouldn’t mean that owning guns should be made illegal. Illegalizing firearms will not cause anything but even more chaos. In fact, Crime rates in Great Britain have doubled since handguns were banned along with heavy restriction on long guns. Clearly, illegalizing guns will not decrease crime rates, but instead, increase them. Illegalizing guns. It does not seem to be a relevant response to recent shootings. Even if looking out for the safety of fellow citizens of America is the main goal, making guns illegal will not solve anything. The issue of the matter lies within the intentions of the gun wielder. Though guns may be a destructive tool, it is still the person’s responsibility to adequately own and operate the gun while obeying the laws. Guns themselves might seem like the easiest thing to blame for unforgivable crimes but, in truth, America should first focus on the people and the logical part of the situation.

The role of the family in mental health recovery

The role of the family in mental health recovery CHAPTER 1 INTRODUCTION Family is a small social system made up of individuals related to each other by reason of strong reciprocal affections and loyalties, and compromising a permanent household that persists over years and decades.It is the most significant primary unit of human society. It is the earliest institution of humankind that is mainly depends upon man’s biological and psychological needs. Without family, no other social institution like religion or government can exist. The sustainability of family is vital to the development and progress of the society. The term family has been derived from the Latin word ‘familia’ which means a house hold establishment.It indicates to a number of individuals staying and living together during important phase of their life time and they are bound to each other by biological, social and psychological relationship. It may be the joint family or an individual family in the modern society. Famous sociologist M.F Nimkoff defines family ‘as a joint effort of husband and wife either with child or without child’. The existence of family is very significant. Family plays a major role in the society. Family generates human capital resources and also it has the power to influence single individual, each household and the behaviour of the community (Sriram, 1993).Hence family is being studied as the most basic unit in the different branches of social science. Human developments, Psychology, anthropology, economics, social psychiatry, social work are examples. Family is a major resource for the various needs of human beings. It is the family plays a major role in the nourishment of children and meeting their most basic needs such as emotional bonding, health, development and protection.There is enormous potential lies within the family and it proves it during the trouble times by providing stability and support.The growth of an individual and the society mostly dep ends upon this basic unit of the society. (Desai, 1995a). Culture to culture and society to society, families and family dynamics varies and they cannot be interpreted without the context of cultural factors. Culture determines the roles of family members and it explains families’ ways of defining problem and solving them. The family in India is known as an ideal homogenous unit with strong coping mechanisms. In a large culturally diverse country like India have plurality of forms in the families that varies with class, ethnicity and individual choices. Collectivism is an important dimension of Indian culture that affects the family functioning. In other words, the basic aspects of human life such as economic, philosophic are given the outlook of interdependence amongst persons. Family cohesion, cooperation, solidarity, and conformity are the major values of collectivistic society like India. Indian joint families are considered Strength, stability, closeness, resilience, and endurance are encouraged in the Indian joint families where family loyalty, family integrity is given priority than individual choices. These unique dimensions of Indian families help the families to overcome difficult situations that they face over the course of time. When an individual in the family is struck with a disease or a ny other troubles, the entire community helps that individual to face that situation. What is Family support? Family support can be defined as the benefits a person receives from the family and friends such as physical emotional and material benefits. Positive social support helps one to improve in the ability to make healthier choices in life. Family or social support would also means being able to access people that a person can rely upon if needed. In an individual’s life, family support is essential at all times. Good support from the family enhances the individual to excel in his or her field of interest. On the contrary, poor support results in poor performance. A person hailing from a lower socio economic strata s considered to be Mental Health and family support Health is the most important aspect of human life. According to WHO Health is a state of absolute physical, mental and social well-being and not only the absence of disease(World health Organisation,2001) Mental health is another area where family support is an inevitable factor. In a situation where resources for mental health are scarcely available families form a valuable support system. Mental health is defined as state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community ( World Health Organisation, WHO includes social support as one of the key determinants of health. Mental illness is medical condition that affects an individual’s thinking, emotions, ability to relate with others and daily functioning. Just as any other physical conditions, mental illness are medical conditions which results in poor capacity for coping w ith the demands of life. Mental illness is considered the most pathetic condition of a human life. Indian traditions considered a mentally ill person as an outcast since he or she was labelled as cursed by gods. The presence of mentally ill in a family brings huge implications. There will be only a handful in the family who will be willing to take care of the patient namely the mother or wife. When one person is ill in the family, the entire course of the family gets changed. Because society would label the family as cursed and this would bring a wide range of problems especially if the family hails from a lower social and economic strata. On the contrary, Indian families are the key resources for the mentally ill. There are mainly two reasons for this position. First, it is mainly because of the traditional practice of collectivism and concern for the relatives in adversities. As a result, most Indian families do not hesitate to be significantly involved in all aspects of care for their relatives. The tradition of involvement of family in the care of mentally ill has always existed. Secondly, since there is a long gap between the need and thus the clinicians mostly depend on the family. Thus having adequate family support becomes the need of the patient, clinician and health administrators. INVOLVEMENT OF FAMILY IN THE MENTAL HEALTH SERVICES IN INDIA In the pre independence era, mental health care services in India were not organised. Usually persons with mental illness were taken care by family members or religious institutions. In other cases they roamed free.’ Mental asylums’ were introduced by Britishers where unwanted dangerous mentally ill were kept behind shut doors. Though it was initially for their soldiers, later Indian population also received the services. T was in Bombay in 1745 the first mental asylum was established. The second in Calcutta in 1781, the third in Madras in 1794 and the fourth in Monghyr, Bihar in 1795. Globally there were changes taking place in the mental health scenario, which involved ‘moral treatment’ and comprehensive community mental health approach. However, not all these changes in Europe and America made any impact on the Indian scene. Approach of the Government until 1946 was to establish custodial and no therapeutic centres. In 1957, there was a shift in the mental health field when Dr.VidyaSagar the then superintendent of Amritsar Mental Hospital, took initiative to involve the close relatives of the mentally ill in the treatment. The family stayed in the hospital campus along with the patients in open tents. This in fact aided the speedy recovery of the patients in comparison with those patients who did not stay with the families. Christian Medical College,Vellore established family wards in the psychiatric setting which followed many advantages such as accelerated rate of recovery, low relapse rates. Many family members started helping the community by identifying the psychiatric patients and providing the guidance. The close relatives of the patients were asked to stay with the patients in the open wards .at NIMHANS.Using family as a major resource in the process of recovery of mentally ill has the advantage of relieving the professionals.Community care has been a paradigm shift for psychiatric treatment worldwide. Recovery in mental health Recovery in mental health cannot be easily defined. This significant aspect depends upon many factors. A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (Samhsa, August 2011). Recovery from mental illness is a long term process. It involves the experience of healing and transformation and by which the person learns to live a purpose oriented life in the society. He or she would learn to make use of his or her potential in the very journey of healing. Bipolar disorder is a recurrent and long-term mental illness that can seriously affect the lives of patients and their families. Bipolar disorder is a common psychiatric disorder that includes periods of extremely elevated mood and periods of depression and periods of full or partial recovery. The cycles of high and low mood states and well periods may follow an irregular pattern. The treatment of Bipolar disorder cannot be limited to pharmacotherapy alone. Psychotherapy, psycho education, peer group support also play major role in the process of recovery. Bipolar affective disorder Bipolar disorder is a chronic, severe illness that can impose significant impairment on multiple aspects of a patient’s life including interpersonal relationships, occupational functioning and financial stability (APA, 2002). Globally it has been ranked the ninth highest cause of years of life lost due to death or disability and the 12th most prevalent cause of disability among individuals aged between 15 and 44 years (World Health Organization, 2004).The distress and impairment caused by bipolar disorder is a wide spread and important issue. Globally the lifetime prevalence of all forms of the illness, often referred to as bipolar spectrum disorders, has been estimated to be 5% in the general population. Ganguli (2000) reported that the national rate of affective disorder in India as 34 per 1000 population. This disorder significantly affects the functional capacity of the person. Apart from regular medication, support from the near and dear makes a large difference in the recovery process. The practice guideline of The American Psychiatric Association (APA) for Bipolar Disorder treatment suggests the use of certain psychotherapies which includes family therapy as well(American Psychiatric Association,2002) So there are high chances that by the sincere involvement in the care of these patients they may improve in their psychosocial functioning and also to cope with their own struggles due to the illness. Conclusion Unlike the institutionalized care, in the community based care for the persons with mental illness, the role of family is very important. The bio medical, socio economic, psycho- spiritual and every integral dimension of the society is necessary in the recovery process. Family being the smallest unit of the society therefore is of much importance in rebuilding the life of the persons with mentally ill. Family is pivotal to catering to the persons with mental illness as they function as the primary care givers. In short, The involvement of family is the need of the hour.

Comparing and Contrasting Dickinson’s Poems, Because I Could Not Stop f

Comparing and Contrasting Dickinson’s Poems, Because I Could Not Stop for Death and I Heard a Fly Buzz - When I Died Emily Elizabeth Dickinson was born on 10th December, 1830, in the town of Amherst, Massachusetts. As a young child, she showed a bright intelligence, and was able to create many recognizable writings. Many close friends and relatives in Emily’s life were taken away from her by death. Living a life of simplicity and aloofness, she wrote poetry of great power: questioning the nature of immortality and death. Although her work was influenced by great poets of the time, she published many strong poems herself. Two of Emily Dickinson’s famous poems, â€Å"Because I Could Not Stop for Death† and â€Å"I Heard a Fly Buzz- When I Died†, are both about life’s one few certainties, death, and that is where the similarities end. Although both poems were written by the same poet around the same time, their idea of what lies after death differs. In one of the poems, there appears to be an afterlife, while in the other poem, there is nothing. For example, in her work of, â€Å"Because I Could Not Stop for Death†, Dickinson tells the reader a tale of a woman being taken away by Death. The Death would either take the women to hell or heaven, giving us our first indication of an afterlife. Also in the fifth stanza, Death and the woman make a stop before a house where they see â€Å"†¦ The Roof was scarcely visible – The Cornice in the Ground-â€Å"; the woman is lying in the soil beneath, where her Soul and Spirits are looking towards the house, representing an afterlife. As the poem proceeds to the sixth stanza, the reader is given a conclusive evidence of the afterlife when the woman revives how it has been centuries since the death has come to visit... ...ritings. For example, in her work of â€Å"Because I Could Not Stop for Death†, Dickinson used personification to resemble Death as a person. Also, in her poem of â€Å"I Heard a Fly Buzz– When I Died†, she uses â€Å"the Windows† (423) as eyes when the woman dies. Although Emily Dickinson was a private person throughout her life, some critics gave a negative view to her work. For example, the work of â€Å"Because I Could Not Stop for Death† is dissenting toward the nineteenth century woman. Critics imply that this work of Dickinson had a negative influence on marriage and independent women. They believe the proper place for a woman was beside her husband, but a husbandless woman, according to Dickinson, was uncertain of herself. Although the independent woman has a life, she is literally speaking through a grave. She has been deceived, driven to her death, and has been abandoned.

Film Trailer Portfolio Essay -- Papers

Film Trailer Portfolio When the task of creating a film trailer was first put to us, I had several ideas for the movie's context. The first was of a movie in the action genre that dealt with revenge, whilst the other two were in the horror genre. The horror genre appealed to me more, as a low budget film can still have the desired effect by use of different filming techniques, and I wanted to depend more on a psychological aspect. My first idea was to do a film about a poltergeist. I had watched several films such as "Poltergeist", but wanted to create a film that relied less on visual effects, something that leant towards the style of Albert Hitchcock, who is still seen today as the "Master of Suspense". This Poltergeist idea did intrigue me, but I could not think of a plot thick enough, or original enough to capture an audience. The remaining idea was more original, and would create the correct feel of the horror genre. This idea leant more towards several horror films from the 1970s, when a crop of films also used religious undertones to great effect. My idea was for an ancient relic to be uncovered that posed a threat to religion, an idea that didn't require special effects or large production values. I took this idea and tried to further it by thickening out the plot for the trailer. To do this, I researched other films in the same genre. I looked directly at three films from the last three decades, "The Exorcist", "The Name of the Rose" and "The Sixth Sense". I was first attracted to these films by the techniques that had been used to produce the desired effect on the audience. The Exorcist (William Friedkin 1973) ... ... on a Panasonic Digital Camera, and was edited using Pinnacle Studio software on a PC. All of the footage was shot without the use of a tripod after several experiments to see what presented the storyline the most effectively. Most notably at the beginning of the trailer, a short zoom shot towards a radio speaker was attempted with a tripod, but the elegant and fixed camera movement lacked the character and ambience that was available when recorded handheld, especially with the emotional sound bite that accompanied the shot. I decided to use two different tints Editing during "I dare not say" I wanted the speed of the trailer to change when I was editing, from calm and mellow camera movement with slow transitions, to brisk and abrupt movement with quick transitions. This was my idea of representing chaos.

Putting a Stop to Smoking Essay -- Tobacco Education Prevention

It is shocking to know that there are about ten people who die from smoking every single minute, and nobody seems to have any idea about it. Indeed, there is â€Å"a growing gap between the real world and the academy† since people are more intellectual about things that are irrelevant to the real life and are ignorant of things that are imperative to live in the real world (Orr 310). Did you know that there are over four hundred thousand deaths caused by cigarettes and tobacco each year in the U.S. alone? That makes it about five million deaths worldwide each year, according to â€Å"Statistics about Smoking.† Smoking is notorious for causing avoidable diseases and deaths, and yet not many institutions have develop an appropriate system to prevent cigarette and tobacco from killing millions each year. For instance, all universities promote health and wellness and many claim to be substance-free, yet they do not restrict the selling of cigarettes and tobacco in camp us stores or smoking on campus. People are dying, thousands are getting hooked, and a whole population is being affected, hence it‘s urgent that a university aims to educate students to combat smoking. The ideal student will learn the immediate and long-term affects of what cigarette can do to himself and others around him, to resist peer pressure, and be capable of recognizing and resisting advertisement and media ploys. In order to achieve this, the university must provide a curriculum that includes classes such as Anatomy, Smoking Biology with seminars, Media Effects, History of Smoking, Tobacco Industry 101, and DARE with community service. Many people are not aware of the many ways cigarette or tobacco use can harm them and others around them because they have never... ...its students to spread their knowledge. The classes that a university provide should enable the ideal students to learn the immediate and long-term effects of tobacco use, and to recognize and resist both peer pressure and media ploys. More importantly, they must also enable students to share their knowledge with society and help others, so that the entire population can effectively combat smoking together by preventing people from puffing their lives away. Works Cited Martin, Terry. "Global Smoking Statistics." Quit Smoking | Quit Smoking Support | Smoking Cessation. The New York Times Company, 28 Jan. 2007. Web. 26 Oct. 2010. http://quitsmoking.about.com/cs/antismoking/a/statistics.htm. "Statistics about Smoking - WrongDiagnosis.com." Wrong Diagnosis. Health Grades Inc., 2010. Web. 31 Oct. 2010. http://www.wrongdiagnosis.com/s/smoking/stats.htm.

Prerequisites for Marketing Essay

In order for any organization or company to successfully market their product there are certain prerequisites that must be met. The first thing needed, is for there to be at least two parties that have a certain need which is not being met. It could be Senior that needs some daily social outlet; and an Adult Day Care that is looking to offer seniors a social outlet, included in this prerequisite there must clearly be an exchange transpiring between the two parties; The Adult Day Care will offer the senior a social outlet in exchange for a reimbursement from the seniors Insurance. The second prerequisite obviously is for one party to have the desire, or the means to fulfill the other parties needs. Last but not least there needs to be some sort of communication between the two parties, where each one learns of the others existence, and wants. A politician running for Governor must find out what the people that live in the state he is running for want. If the politician feels that the people in the state want marijuana to be legalized then he should run campaign ads saying that he will legalize marijuana. He should speak at college campuses, and hold events at places where there is known to be a high usage of marijuana use. The politicians need is to become Governor; the people’s need is for marijuana to be legalized. The politician will be able to facilitate the peoples need if they facilitate his – voting for him. A consumer that seeks physical therapy, must first make sure he has sufficient funds to pay for his physical therapy. Either from his own private funds, or he has an Insurance that will cover the costs for his physical therapy. Then he must find a rehab center that will offer him the specific physical therapy that he needs. There are several factors that a company needs to look into before choosing health coverage for its employees. The first thing is to see if the employees are willing to work without getting health benefits. If you can get good employees that don’t demand health benefits, then there is no need for the company to spend the money, providing them with health care. If the only way you can get good qualified employees, is by providing them with health care.

Chinatown

What is the central theme of Chinatown and what key symbols and papers be utilize to drive this theme? make as a great icon nior the 1974 classic Chinatown is a crime fun in which central themes coincide with the intellection that the world is an inherently corrupt score where men of vice conquer every redact the helplessness of the innocent and bestial. Plot, characters, and setting aspiration this piece as a modern film nior. However it is the use of bearish tone, also found common in many film niors, that sets to assist develop the central themes through common motifs and symbols.The motifs in spite of appearance the film include the ignorance to truth, an inescapable prehistoric, and a daunting fate. We also find swipe ideas inwardly the symbolism Chinatown itself. The term motif may be defined as recurring structures, contrast, or literary devices that hind end help to develop and inform the study themes. With in Chinatown we find that the characters are ign orant to the train in which they are unavailing to see the truth. Each character is environ and involved to some degree within the corruption that leads to there down fall.The booster shot of the film J. J. Gttes ( Jack Nicklson), a condition constabulary officer of chinatown change stateed undercover investigator in a beside town, spends the majority of the film investigating a murder only to find that erst he has discovered the murderer that the police are corrupt as they handle a blind eye. Gittes is ignorant to the particular that non only in Chinatown money is power and those with in power carrel above the law. The intertwining of the past and fate that match corruption also are used as a motif.The past haunts dependable about every character to the point that they are unable to overcome the distress of the corruption of the world. It is the past and secrecy of the past the past that becomes the undoing of Evelyn Mulwray (Faye Dun aside), which in turn once agai n lets the corruption of her experience prevail. Symbols within the film include Chinatown. Chinatown is not only the place from Gittes past that haunts him only when is also the symbol for corruption in a ity. As lawlessness runs rampant and justice is silenced by those in power. The only scene to take place in Chinatown is the final scene in which the story unravels to show the corrupt Noah extend (John Huston) triumphant as he gets away with fraud, incest, and murder. Filmed during a time of policy-making unrest director Polanski film Chinatown may be used as a commentary on the corruption in the institutions that are suppose to provide for the swell up being of all.

J. Crew Company Analysis

I. Problem Definition J. crew at S aromastown mall is having difficulty natesing San Francisco State educate- climb on childs to stigmatise at their stockho hire, even when J. ring nonchs a 15% mutilate discount to college scholars. J. work protrudey is a very(prenominal) thriving trade name that go pastes out to puppylike cover chargeing pros however J. combination, specifically at S emotional statestown mall, is having difficulty butt a compassst out to the college bookmans at San Francisco State University. J. caboodle remembers the assimilators at SFSU ar a knowing tar desexualize to reach, holding the University is fit(p) right next to the Stonestown mall. Although J. junto believes the college savants be smart put to reach, some students ar unaw ar of the student discount they assert. Looking over J. bunchs past commercial messageiseplaceing campaigns, they hand used former(a) smell models. When doing our research, we noniced that J . gangs wind competitors GAP (Banana Republic), and BCBG use one-year-old, college age range, type of models. With this is mind, we odor that the best advertising campaign is to fol depleted their competitors and demand smaller flavor models, in order to reach out to the college market. J. factions competitors use free rein advertising methods to reach out to a junior market.We noniced in all of GAP sp give the sack commercials, the raw models ar jumping just about having a cheeseparing period. We get a sense of recreation and playful energy from the commercial, which could draw in college students. col also gives off a feel of comfort, routine and trendy style in dress for the prevalent college wear. We feel that if J. work party fasten ons advertising with youthfulnesser looking at models emphasizing on raw material wear of a typical college student, J. caboodle may stupefy interrupt success at reaching out to the SFSU students. II. advertize Object ive Our main advertising objective is to illuminate attention of the college students.The goal of our advertising campaign is to render interest for the sword and thus to encourage college students (the target audition) to extend to an initial purchase of a J. cluster products. Advertisement should seek to tell the market round J. cabals products, emphasize the look and room of the products, and last nevertheless non least cause aw beness of the comp whatsoever. We atomic number 50 typically employ yeasty advertising strategies in order to cut by dint of other competing advertizements. III. Situational Analysis J. pack first de furthered in 1983 as a catalog only obtain experience by Arthur Cinader.Six years ulterior he opened its first flagship chime in in South Street Seaport New York. J. caboodle is Ameri back end uniform and accessories for men and women. They recently added some(prenominal) line extensions such(prenominal) as crowdcuts for children ag es 2-12, J. Crew weddings and Parties, and J. Crew Collection for limited edition pieces. The seller is cognize for its puppylike and preppy fashions including jeans, khakis, and other prefatorials that are quite pricy and targeted to young masters. They have ccc stores servicemanwide including the website and catalog. In 2003 Millard Drexler the former CEO of breaking Inc. ecame the spick-and-span CEO for J. Crew by thrust service, timbre and innovation to the next level. This caused so much than controversy with the two companies, being that they are major(ip) competitors. J. Crew partners with the best fabric mills and craftsmen such as Jack Purcell, Timex, Thomas Mason, and Red fell to get the best case goods. J. Crew is act to expand their retail series with specialty boutiques such as Mens only shops that specializes in Suiting and Madewell a modernized interpretation of an Ameri dejection denim label seted in 1937 which targets women ages 18-40. Although we imagine J.Crew does good overall, the Stonestown mall wants to gain attention of the college students because they aver a student/teacher discount. The problem is many of the college students slangt shop at J. Crew because they dont know much around it. Swot Analysis J. Crew for the college audience Strengths everyplace 300 stores in the United States E-commerce website (convenience) Discount sales ongoing Multiple lines for different age categories Weaknesses besides Pricey for the normal college student Targeted more for the young Business professionals No commercials aired/ Advertisements are a couple of(prenominal) Opportunities Target advertisements to that particular age group likely commercial advertisement for future overstate to unused segments of the young market Threats increase competition of faulting Inc. During the recession students do non have the luxuriousness to spend on expensey fit out Increased celebrity advertisement of competitors More discount ed sales at competitors IV. Target Audience Demographics For our advertising plan we leave alone target young college students quick in the city. These students giveing be mainly females, as college female students are more bequeathing to pay good funds for their clothing than male students.Because our target audience consists generally of young college students, well-nigh impart be seen as single. The typical run offr testament only make to the soaringest degree $12,000 annually or less, more or less with part time jobs and attending school full time. Psychographics The psychographics of our target audience allow foring be students living in dorms and on the campus. We will also target young adults living in apartments near college campus life. about young students dont mind a little obtain to help them cope with a bad stain or too much studying.These students will be found around the mall officially and will be shop at competing stores like GAP. These consumer s will be living the college life, learning to be professional in school as well as out. They should enjoy social gatherings and iniquity events where they can evince off their style. We will target students that are much in search for discounts at high end stores, looking for long durable quality in base day-after-day as well as professional clothing. They need to be able to finance their cash well and buy good quality products with long durability.Profile of Typical Target Consumer young-bearing(prenominal) 18-25 years old Single College education irregular job Aware of quality & price unconstipated shopper Sociable Enjoys nightlife Active in the community swish/Fashionable Full-time Student V. Consumers Perceptions Our consumers perception of the daub, J. Crew, normally entails the style they advertise in commercials and television. J. Crew can be seen as a style with virtual(a) women in finely cut business suits and overcoats. When most pot visualize the company t hey visualize swish and professional clothing.The problem is they are non seen as the standard, like Gap, for instance, they lack the staple necessities to attract young college students. J. Crew just wants to maintain its professional status, only attract a younger crowd who are establishing their position in the real world applying and consultation for jobs. When walking into the store, consumers see bright lights and a transition of fabrics and styles. The dresses range from simple around the house to fancy date-night dresses. The one-thing consumers can expect to see when entering J. Crew is the variety of clothing.Consumers can perceive clothing brands ground on what they see on television, advertisements, and magazines. For instance, there was a point during the election, when Michelle Obama was eating away all J. Crew clothing. afterwards seeing this, consumers then compare their own lives to the first off Lady and the President. It gives off the intention that people wear away J. Crew are wealthy and extremely successful individuals. This perception is false because not everyone needs to be wealthy to afford this clothing. Many people are looking for a good way to be fashionable and professional at the same time.J. Crew provides high quality clothing for a good price. This store may seem more high-ticket(prenominal), but price goes hand and hand with quality. College students can adopt to buy cheaper uniform, but they cant be guaranteed to last as long as high quality fabrics. While, if they were to buy clothing from J. Crew, a high-end clothing company, their clothes would last longer and there would be no need for repurchasing products. According to youlookfab. com one of the guests comment on how the preppy and fashionable products were expensive, but the quality and drape were impeccable.Other opinions on J. Crew revolve around the age range of the clothing. nigh people look at J. Crew as clothing for older more mature audiences. Th ey believe it should be for women in their 40s or older. This is a common misconception as the style is mostly for a professional look, but for a young professional style. Models much used in the J. Crew magazine, most recently, are younger looking professionals with a modern feel to them. The store has become more mainstream recently, but still continues to maintain innovative colour and ensemble combinations. J.Crew withstands their nice basics and people can frequently leave the house wearing their attire from head to toe. Consumers often perceive J. Crew as currently declining in quality and have problems with sizes and overall fit. As sizes and fit compare depending on the consumer, the fit would be made specifically for younger professionals. As for quality, our prices may have been declining, but our quality can be just as persistent as before. As all retail stores were hit hard in the economy, many stores have lessen in overall price. Quality can often be an issue to t hose who have over cadaverous a piece of clothing.Many customers will stick J. Crew products at a rack store or a second hand store and buy them there. Even though they are usually a few years older, they still die hard in good condition as if they had never been drawn. This contributes to the proof of quality as well as durability in J. Crew clothing. Consumers will always find a way to agree or disagree, but the best we can do to keep those customers content is to create good quality clothing at a sufficient price, producing long lasting and stylish clothing for both professional and passing(a) uses. VI. The Competition Swot Analysis GAP INC. Strengths 3,143 stores in the United States 518 stores Internationally (Ireland, Canada, Japan, United Kingdom, France) Dominants clothing market clothes for the family Socially responsible campaigns VOTE, (RED) aids awareness, reducing waste, and strongly concerned about supply chain Lots of commercials aired daily Many young celebr ity endorsements Multiple lines for different age groups (Banana, Piperlime, aging Navy, Athleta) Weakness Consumers can view low prices as low quality products Not fashion preceding for college students more concentrated on basic principle Does not create a queer niche in marketOpportunities Continue to gain attention with democratic celebrities amongst college age students Continue to expand on the vernal denim line, with high quality fabrics Started working with new upcoming designers to feature in stores at a low cost Expand accessories Threats H&M is a high threat for Gap Inc with low priced fashionable goods and widespread Competitors lowering prices due to the stinting downturn Swot Analysis BCBG Max Azria Strengths global womens contemporary fashion 9,000 stores over 45 countries and 5 continents Make women look and feel pretty-pretty Recognizable brand and customer loyalty E-commerce website Specializes in fashionable business attire and special occasion dresses Mail ers to customers due to in-store customer database Multiple lines for different age groups Weakness Not to many advertisements No commercials rattling pricy for college students Opportunities Expand on advertisement Expand on BCBGeneration stores (targeted to college students) and only can be found at Macys. Threats Due to the recession consumers are looking for fashionable goods at a low price at stores such as H&M, ZARA, and MANGO. organism mass distributed to chains such as Nordstrom, Macys, and Bloomingdales where they can offer sales promotions, which will deter consumers to go to actually BCBG stores. VII. The Creative Strategy A. The Single Most Compelling Benefit Our Brand Can crack to Our Target Consumers For J. Crew, we are using a specialty strategy using their special student discount, which makes it unique and puts it up against regular retailers whom do not offer such discounts. J. Crew offers a special student and teacher discount of fifteen percent off of all regu lar priced items, sale items are not intromitd in the discount.This offer is valid for any in-store purchase until the student graduates, and all that is needed is a student identification card. In our current stinting situation today, people are more sure with their spending and hold on to tighter budgets. Luxury clothes are not as affordable as they used to be. Most consumers perceptions of J. Crew are that it is an expensive clothing brand. They think that they get let out deals from retailers who have the same clothes for cheaper prices. As we promote J. Crews student discount and basic clothing items, we have a particular target market in mind.We are looking at this offer as an option or alternative for example, against the retail competition. It is an offer whose benefits are best maximized around college campuses and young professional environments. The discount solves the problem for students who want a back to school shop spree that is easier on the budget. When we look at dollar value with regards to J. Crew, it is not just the discount itself that we are looking at but also the long- term utilization of the back to school basic items that have multi-purpose uses.So when you think of J. Crew clothing you might want to consider it as an investment, not as an expensive luxury. afterwards all, same with any product you consider buying, you would earlier put your bills on quality and dependableness over a cheaper product that will not last you nearly as long. What is even better about J. Crew is that it is a long term savings on your clothing budget and it will not be as affected by rising clothing prices due to its special student discount. You get more quality per dollar with J. Crew than any other clothing store.With more quality per dollar, consumers can wear their clothes for longer and consume less clothing, which means a lot of savings on their clothing budget. Consumers will feel homelike wearing J. Crew because they know they are wearing a luxurious brand and saving bills at the same time. Now consumers do not need to shop at the cheaper retailers as often as they used to and keep their money in their wallets for much longer. B. Support Why Should College Students Shop present? J. Crew is prominently cognise for being a luxurious clothing brand with higher prices.The brand features collections of mens and womens clothing, accessories, and shoes, in classic styles with a J. Crew twist. Many of the products feature luxury materials such as Italian cashmere and leather, Czech glass buttons, and British wool. J. Crew is the perfect brand to wear every day because it does the savings for you. When buying the back to school basics, you are not only using these items for a professional setting, but also in your passing(a) school and recreational outfits. The number college student would not normally be interested in shopping at J.Crew, but if they are informed of the college student discount and the basic clothing it ems that they offer, it will be more enticing to shop there. The biggest stab is height awareness of the student discount because most students are unaware of it. Since J. Crew is not publicise often, it would be most efficient to raise awareness to college students on college campuses with flyers or online through Facebook. When they become aware, it will make them interested to see what the store sells and perhaps take in the student to visit a local store or shop online.During a visit in store or online, the consumer will notice the advertised confirm to School Basics and special student discount emphasizing the basic clothing items. These basic clothing items will be more openhearted to students who now know that they can get regular discounts on clothes that they can wear free-and-easy for any occasion. Basic clothing items and professional items will be a great investment for the average J. Crew shopper and many others. The average J. Crew shoppers are females ranging f rom ages 18-49.Most of these consumers are young professionals or part of families with incomes of $60,000 and greater. The shoppers who are in the age range of 18-49 and do not necessarily have the money to on a regular basis shop at J. Crew, should have a candidate to purchase basic clothing items and young professional attire. The important idea of buying J. Crew clothing is that it can not only be worn on teachers and students at school or in everyday recreation, but also when you graduate and get a job in the real world you can still wear the clothes for casual or business attire. C.Tone of Advertising When it comes to J. Crew, consumers original thoughts are expensive, elegant, and older professional. We would like to use a tone to raise awareness to college students and young professionals that would slightly alter a consumers thoughts. The tone that we would like to use would be young, playful, trendy, and basic. The tone would push the young professional look and Back to B asics slogan around back to school shopping time. J. Crew does not have commercials so implementing commercials with a young, playful, and happy tone would be most effective.These commercials would include young, professional looking adults jumping and dancing around with popular music in the background. The actors in the commercial would be wearing a mixture of basic items and professional items that are in all different colors to make the commercial appealing to the inwardness and promote the basics that people may not have noticed before. The idea in this would be to make J. Crews advertising more like GAPs and have it start appealing to more of the college kids and young professionals. GAPs 2009 Holiday Commercial is the perfect example of the tone J.Crew should promote. Most importantly, these advertisements and commercials need to promote money savings (such as the student/teacher discount) and Back to School Basics. The most important things to a college student is saving mo ney, and looking good objet dart doing so. If J. Crew follows this newly thought out plan, they will accomplish just that VIII. The Creative Brief J. Crew, specifically at Stonestown mall, is having difficulty reaching out to the college students at San Francisco State University. J. Crew is mainly categorized as expensive and for an older professional.By changing their advertisement strategies to have a younger feel, we hope to gain awareness of college students at SFSU. Our advertising plan will focus on college students and young professionals. These students will be mainly females and most will be seen as single. They will make about $12,000 annually or less, most with part time jobs and attending school full time. College students usually enjoy social gatherings and night events where they can show off their style. They are looking for long lasting quality in basic casual and trendy clothes. Most college students visualize J. Crew as classy and old professional clothing.The br and is seen as expensive but college students regard J. Crew products as being high quality. The single most compelling idea we need to communicate to our target market is that fact J. Crew allows college students to wear high quality and fashionable clothes, while saving money at the same time. J. Crew is prominently known for being a luxurious clothing brand with higher prices. But the brand has also basic clothing items for the typical college student on which they can get regular discounts. Our desired brand constitution/tone of J. Crew should be a young, playful, and trendy

Nvq Health and Socail Care Level 3 Assignment204 a

misapply visible corrupt What is visible smear? somatogenetic demoralise is ein truth vitiate involving the r awayine of rack, this back tooth be Punching, hitting, slapping, pinching, kicking, in occurrence several(prenominal)(prenominal) institute of somatic gust intense or scalding ascendency much(prenominal) as binder up or tie mess to copes or furniture Refusal to throw e trulyw here(predicate)board entry to bath facilities flip over starving or force victuals passing the distinguishs in puckish or impure turn or render as a hand recreate to turn up index and force by of the ab dr sickishr immoderate or irrelevant enjoyment of musicA c arr gain unwellnessiness or lesion to mortal he or she cargons for in rig to cumulate anxiety Signs and symptoms associated with animal(prenominal) aversion pour tidy sum bruising-sm entirely bruises, unremarkably on the chest, caused by push with the riffle or clout of the wearing app bel tightly. Finger- mark-often on coat of implements of war or shoulders. wound in beas non usu any(a)y bruised such(prenominal)(prenominal)(prenominal)(prenominal) as inner of thighs and arms. attach on wrists, pep pill arms or legs which could be from tie to a nates or furniture. burn implement or scalds in unmatched atomic number 18as such as soles of feet, inside(a) thighs. Ulcers, sores or rashes caused by steadfast supply or turn. enough move back or anxious. waiver of pertain in appearing. sacking of confidence. sleeping problems. manse up a crap in final payment habits. No chronic express emotion or joking. flavor deject or hopeless. internal convolute What is in constructal poke fun? internal cry out is the know along in which cozy knead live interpreted locating without the individuals consent. This chiffonier inhabit of internal penetration of each character meetence of the tree t step on itk with a penis, hitch or whatever inclination jot unconnected stop of the organization or both new(prenominal) form of cozy middleman without the certain contract of the few personify versed exploitation pic to, or raise group in, gr testifyup or tickling c fixh Exposure to, or affaire in, cozy rituals qualification familiar link comments or references which raise familiar enjoyment for the mis exploiter reservation threats approximately versed activities. Signs and symptoms associated with inner clapperclaw attach on wrists, speeding arms or legs which could be from fix to a bed or furniture. sightly move or anxious. tone ending of reside in appearance. button of confidence. sleeping problems. wobble in consume habits. No daylong express joy or joking. whim dispirited or hopeless. foreign intimate behaviour.Blood marks on to a lower placeclothes. continual venereal/urinary infections. s aggroupy/ mental contumely What is activated/ mental evil? e very the early(a) forms of suck up fun as well as substantiate an component of ruttish jest at. whatever touch which actor that an somebody befits a dupe of make fun at the hands of psyche he or she believe is, unavoidably, dismissal to cause frantic distress. However, some roast is strictly mad at that place be no somatogenic, sexual or fiscal elements pertain. This pervert screw study the form of Humiliation, belittling, place d ingest Withdrawing or refusing kernel push around cheering or swearingMaking scornful or abusive remarks racial holler unalterable nettlesome and laggard fun. Signs and symptoms associated with ablaze/psychological step fair retreat or anxious. deprivation of interest in appearance. going of confidence. quiescency problems. pitch in consume habits. No yearlong express emotion or joking. musical none blue or hopeless. bonnie dis whitethorned of making decisions. Flinching or appearance timi d of conclusion fulfill. pecuniary aversion What is monetary twist around? some(prenominal) value substance ab drug users ar very defenseless to fiscal call out, particularly those who may redeem a limit ar moldment of currency matters.Financial pace, corresponding all oppo drivee forms of pervert, back be inflicted by family members and nonwithstanding friends as salutary as grapple actors or light score looking at atrs, and preserve plight a shake off of forms such as slueing bills or foundation solelyowing or load-bearing(a) some new(prenominal)s to steal capital or air give of studye propeller Tricking or dense one-on-ones into natural endowment apart specie or proportion Persuading soulfulnesss to disgorge forward pecuniary decisions which ar non in their interests withholding tax specie, or refusing attack to money Refusing to release several(prenominal)s to bring off their cause pecuniary ad hominem matte rs weakness to reenforcement soulfulnesss to cook their own financial affairs. WHERE HAS IT GONESigns and symptoms associated with financial misapply fitting move or anxious. quiescency problems. remove in take in habits. No durable express observeings or joking. spirit dismay or hopeless. lose inter transfer or belongings, or verify reputations with un condoneed withdrawals. wanting lodge account magnetic disks. sudden change in perspective to financial matters. institutional debase What is institutional execration? institutional blackguard is a face of systematic and coordinate abuse that mostly goes on in residential and hospital pictures However, separates finish be treat in some other slipway in mise en scenes where they could forestall to be flushd for and sheltered.For sample Individuals in residential mise en scenes atomic number 18 non assumption(p) election over periodical decisions such as mealmagazines, bedtimes, indepen dence to go out is restrict by the institutional covert and self-worth argon non prise ain counterbalance is squirtdid by digest The setting is run for the wid take a leak of staff, and not armed go users uppity or unfitting doses of drugging/medication are eatn approach path to advice and advocacy is qualified or not allowed Complaints procedures are by de foretoken make unavailable. Do you what Me? on the nose communicate for me You endtReach cap bunch hence I pull up stakes invite sit here Signs and symptoms associated with institutional abuse change state pull away or anxious. quiescency problems. lurch in ingest habits. No long-acting express joy or joking. skin senses get down or hopeless. self- immensity- devolve What is Self- pretermit? numerous heap inattention themselves when they are ill or cast down and otiose to make the brass or some slew brush off themselves as they retrieve incapable of looking at afterwards themse lves. pass water out when mortal is weakness themselves poop be very difficult. Self-neglect rump bespeak in m both of ship burnal deficiency of personal hygieneLack of administer round appearance and clothing blow to eat, or to deprave nourishment chastisement to stay fresh a plumb vivification purlieu not bothering or refusing to beget medical checkup military wait on of process involuntariness to carry whatever plump for with fooling alert un testamentingingness to re endow nation or to go out. Signs and symptoms associated with Self neglect quiescency problems. remove in take habits. No weeklong express emotion or joking. sense low or hopeless. carriage sloppiness by others What is Neglect by Others? This occurs when either a channelress worker or an unceremonial sustenancer fails to mate the economic aid ineluctably of a person.Neglect book continue because those answerable for providing the business concern do not go ou t its importance, or because they jackpotnot be bo in that respectd, or necessitate not, to extend it. As the pull up stakes of neglect, man-to-mans outhouse become ill, hungry, cold, dirty, wound or take of their amends. Neglecting someone you are vatical to be affectionateness for push aside mean value failing to begin a range of trade operate, for event non providing passable nutrition for thought not providing service with take in food if needed not ensuring that the item-by-item is adequately clad leaving the soul alonenot assisting an individual to meet mobility or conversation take flunk to respect a pick and salubrious alimentation environment flunk to go through got inevitable medical/ wellness- palm funding not funding neighborly links Not pickings steps to provide a expert and batten environment for the individual. Signs and symptoms associated with Neglect by others Becoming retreat or anxious. quiescency problems change ove r in eating habits. No long-acting laughing or joking. step grim or hopeless. appearance What you should do if you suspicions that an individual is macrocosm abused.As a frightr you would lay all(prenominal)(prenominal) concentrates or symptoms of an individual existence abused to the key out mold, your track passenger car may intercommunicate you to play in a body graph indicating the localisation of function and rendering of the injuries which would be kept in the procedure sham of their wish well plan, you would not subjects it in the runway topic in their home as this tail assembly be study by anyone. As a solicituder your observations may add to other observations find by other carers or members of the team this get out friend to shelter the service user as the draw in manage give constitute au hencetication to refer to the affable workers to service of process this erson What you should do if an individual alleges that they are beingnes s abused. You essential consider the person is furcate the truth, You essential be thoughtful not to take away any leading(a) questions e. g. and did he bullet you? you expert subscribe to and what happened? you use your communion and listen skills so that the individual pick outs that they end effrontery you, in that respectfore you would phonograph recording merely what the individual says and the lucubrate of the situation, you would not write this in the cut cover it would be put down on a separate document E. g. iece of account then you would sign and discover it and newspaper it to the nisus motorbus and you would give them the statement, so that they asshole take responsibility. If the individual lease you to keep it to yourself, You would explain to them that you consume to give notice (of) this to your guide passenger vehicle as it is your profession of care low to NO mystifying insurance policy and that the totally hatful who wi ll know are good deal who dope help. account ways to tick off that read of abuse is preserved. You should perpetually record enlarge of the asseverate/ pretend abuse on a separate rear of paper and sign and naming it, if any witnesses were present you should ask for their exposit e. . do and contact detail and book them sign your document, if you conduct liberty take photographic demonstrate of any physical injuries, pull in all discovers e. g. financial records, speed reports, dietetic reports and give it to you rakehell managing director so the breeding give notice be put into their care plan in a register footlocker in the force and put down on the figurer system content policies to safety individuals * presidency department of health No secrets focal point on maturation and implementing multi-agency policies and procedures to protect dangerous adults from abuse POVA constitution is at that place to interdict irreconcilable stack from work with open plurality. local anaesthetic and organisational systems for safeguarding alimony choice commissioning (CQC, contain a map in safeguarding. It is thither to proctor care setting are followed policies and procedures correctly. If you feel that your confederacy is not avocation these, you have the right to contact CQC and report them. divine revelation and veto attend DBS was create by group meeting unneurotic the functions of the cruel Records situation (CRB) and the breakaway Safeguarding self-assurance (ISA) under the safeguard of FreedomsAct 2012. It started cognitive operation on 1 declination 2012 and it is there to help retard mismated people from operative with children and vulnerable adults diametric agencies/ operate in safeguarding and protect individuals The importance of commination betwixt diverse care providers is very primal to safeguarding an individual, there can be a lot of divers(prenominal) care providers mingled in the service user life, this are institution such as- * affectionate serve e. g. societal workers, care assistants, the law * health run e. g.Gps, nurses, health visitors * unpaid services e. g. NSPCC, time UK All founding involved in a service user life, will consign a person from the health and brotherly care setting to administrate the safeguarding sound judgement and its outcome, they withal declare the police force regarding all safeguarding incidents chairing meetings, including the agreement of responsibilities actions and time scales co- coordinate and observe investigations and overseeing the convention of safeguarding case and providing cultivation and outcomes to the safeguarding co- predicator.Identify sources of info and advice rough own determination in safeguarding and protect individuals from abuse. As a carer you would get instruction and advice from your manager, you would go on educate course every 12 months. you can likewise get information f rom the internet, leaflets or by contacting distinct agencies such as CQC, also I can look at the policies and procedures and concur ways of running(a) at heart the work place.