The Importance Of The National Association For Young...

The History of NAEYC By: Katie A. Wnukoski ECED 776 Dr. Shaffer 10/13/2016 Throughout our career as childhood educators, we observe the significance of the National Association for Young Children or NAEYC. It is recognized as â€Å"the nation’s premier organization for early childhood professionals-setting research based standards and providing resources to improve early childhood program quality† (Copple NAEYC, 2001) for teachers, students, and families. Despite exercising the knowledge of what NAEYC means for our classrooms and the students in them, some may not know who or how the organization was founded. Knowing the background of NAEYC is important because it has a reputable history of providing universities and educators with high quality, researched, information. In order to ascertain a further purpose to why these standards matter and the importance of NAEYC in education, we must learn its history and its founders. The standards written for NAEYC have been chosen through the appropriate research, to suite multiple situations and prac tices. By learning more in depth of the theorists and researchers that have made NAEYC what it is today, allows us to see origins of each standard and how they have developed from theory, into a standard in today’s education. Through learning its history, we can fully understand the connotation of seeking the best solutions for achieving successful educational outcomes through research and observation of needs. TheShow MoreRelatedQuality Of Education : State And Federal Involvement1642 Words   |  7 Pages Introduction The world today is globally competitive and education is at the center of it all. John F. Kennedy, a former U.S. President, once stated, â€Å"A child miseducated is a child lost.† The importance of education has been hammered and embedded into our minds from the first day of school. We are constantly told education is the key to life. This is because education is â€Å"the act or process of imparting or acquiring general knowledge, developingRead MoreDevelopmentally Appropriate Practice1675 Words   |  7 Pagesinflux number of families that needed it. This led the National Association for the Education of Young Children (NAEYC) to â€Å"begin planning a national voluntary accreditation system for early childhood programs†(NAEYC, 2014). With this planning came a need for a more specific description with regards to accreditation guidelines. Therefore, NAEYC issued a formal statement defining DAP. DAP is â€Å"based on the accumulation of data and facts of what children are like† (Gestwicki, 2011). Addtionally, DAP isRead MoreThis Chapter Will Provide The Theoretical Framework For1281 Words   |  6 PagesThis chapter will provide the theoretical framework for training teachers for family engagement followed by a current and comprehensive literature review of: (1) Importance of family engagement, (2) Family engagement and educational equity, (3) Current state of teacher preparation for family engagement, (4) Teachers’ beliefs and attitudes towards family engagement, and (5) Best practices for teacher preparation. Following the literature review, the summary at the end of the chapter will proposeRead MoreI Am Considering For My Newsletter Is About Reading / Literacy869 Words   |  4 Pagesimportant that children read not only in school but at home as well. I want children and their parents to be inspired to read more and understand how early literacy makes an impact on children’s development. It is important that the community, teachers, parents, and caregivers understand how important reading is in a child’s development. Reading books provides a lifelong relationship with the printed word while teaching children the importance of language and literacy. Reading will help children developRead MoreKey Principles of Developmentally-Appropriate Practices589 Words   |  2 Pagesare the key principles o f developmentally-appropriate practices? Explain the importance of NAEYC and share some of its goals. Developmentally-appropriate practice, often shortened to DAP, is an approach to teaching grounded both in the research on how young children develop and learn and in what is known about effective early education (DAP, 2013, NAEYC).The NAEYC (National Association for the Education of Young Children) makes the principles of developmentally-appropriate practice one of its cornerstonesRead MoreNAEYC Code Of Ethical Conduct5379 Words   |  24 Pages1 NAEYC Code of Ethical Conduct Revised April 2005 POSITION STATEMENT naeyc Code of Ethical Conduct and Statement of Commitment Revised April 2005 A position statement of the National Association for the Education of Young Children Endorsed by the Association for Childhood Education International Adopted by the National Association for Family Child Care Preamble NAEYC recognizes that those who work with young children face many daily decisions that have moral and ethical implications. The NAEYCRead MoreEthical Principles3652 Words   |  15 PagesThe National Association for the Education of Young Children (NAEYC) is a nonprofit corporation dedicated to act on behalf of the interests of young children. The NAEYC Code of Ethical Conduct offers guidelines for responsible behavior and sets forth a common basis for resolving the principal ethical dilemmas encountered in early childhood care and education promoting a commitment to integrity, veracity, fairness, and human dignity at all levels; nevertheless, further research and/or developmentsRead MoreThe Analytical Effectiveness Of The Assessment935 Words   |  4 Pagesscores limits their ability to understand external factors or barriers that influence a child’s literacy. McKenna and Picard (2007) discuss the importance for teachers to view students’ word miscue analysis beyond the checks on paper and formulas. McKenna and Picard caution teachers to avoid focusing on the assessm ent scores because they believe children reading strategies to decode words or understand a word meaning does not always mean reading proficiency. Moreover, I found that a differenceRead MoreThe National Association For The Education Of Young Children Essay1140 Words   |  5 PagesPreschools offer a variety of services including social skills, health, nutrition, and aids in developing basic cognitive skills for toddlers up to the age of four years. The National Association for the Education of Young Children (NAEYC), advocates excellence in early childhood education. According to the NAEYC, extensive research has proven that â€Å"a high quality developmentally appropriate early childhood programs produce short-and-long term positive effects on children’s cognitive and social developmentRead MoreThe First Few Years Of Young Children’S Lives Are Very1094 Words   |  5 PagesThe first few years of young children’s lives are very critical to their overall development because new learning is happening every day, either during time spent with a teacher or parent. When children are four years old, they are with a teacher full time or part time. That teacher is a professional individual who plays an active role in children’s early childhood development and has a genuine desire to help them learn, grow and succeed in their education. These are just a few roles that early childhood

Evidence-based Interventions for a Patient Suffering from Dementia Free Essays

Introduction Evidence-based practice has been promoted in all healthcare levels in the NHS (Department of Health, 2012). This is done to ensure that interventions are supported by current evidence in healthcare and have been found to be effective for most patients (Pearson et al., 2009). We will write a custom essay sample on Evidence-based Interventions for a Patient Suffering from Dementia or any similar topic only for you Order Now The use of evidence-based practice is rooted in the belief that patients should only receive quality care (Pearson et al., 2009). The same approach is used when caring for patients with mental health conditions. In the policy, No Health without Mental Health (Department of Health, 2012), the NHS has emphasised that patients suffering from mental health conditions should receive quality and evidence-based care. This brief aims to critically discuss the case of an 80-year old woman who is suffering from dementia and the different forms of interventions that could be applied to the case. Consistent with the Nursing and Midwifery Council’s (NMC, 2008) code of conduct, a pseudonym will be used to hide the identity of the patient. This brief discusses the purpose of evidence-based practice in managing patients with a progressive condition such as dementia. An investigation on the different forms of evidence-based interventions and their potential impact for promoting inclusion would also be presented. A discussion on interventions as means to develop a shared understanding of the patient’s needs would also be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process. Using Evidence-based Interventions for Patients with Dementia The Nursing and Midwifery Council’s (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised that the past model of evidence-based intervention relies only on current evidence from literature to support clinical decisions. Current studies that are of high quality are often used to inform current practices. Fitzpatrick (2007b; 2007c) exmphasised that nurses and other healthcare professionals should have the skills to critically assess the quality of a study and determine whether the findings are applicable to one’s current and future practice. Evaluating the strength of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has included best practices, personal experiences of healthcare professional on providi ng care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a; 2007b, 2007c; Greenhalgh, 2010). This new definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care. Communicating evidence from published literature is also essential in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthened first. Kizer (2002) observe that, â€Å"this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient† (p. 117). In the UK, The National Institute for Health and Clinical Excellence (NICE, 2006) and the National Collaborating Centre for Mental Health (2007) have provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues’ experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patient’s name is Laura (not her real name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, aggressive behaviour and agitation (Department of Health, 2009). A psychiatric consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and psychiatrist are discussing alternative drugs to reduce her anxiety level and regulate her sleeping patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. While she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion. Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the Mental Health Act 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patient’s immediate family members or appointed guardian (Depart ment for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patient’s case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will include the patient’s carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise. Evidence-based Interventions and Potential Impact for Promoting Inclusion A number of studies (Casartelli et al., 2013; Monaghan et al., 2012; Ewen et al., 2012) have shown that exercise could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patient’s mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise intervention to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking e xercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012; Hopper et al., 2013) has also been shown to be effective in reducing anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis. It should be noted that the psychiatrist and the GP in the healthcare team are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side effects on the cognition of patients (Porsteinsson et al., 2013; Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Laura’s case, she is pro gressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura. Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Laura’s case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patient’s case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. Similar to animal-assisted therapy, there is also strong evidence on the e ffectiveness of music therapy in managing anxiety, depression and aggression amongst patients with dementia (Sakamoto et al., 2013; Wall and Duffy, 2010). Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patient’s end-of-life care. All these realisations could influence the carer’s own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013). The patient in my care is also suffering from type 2 diabetes. Pharmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in hospitals, the new environment and lack of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital stay could be influenced by changes in her behaviour. It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have sufficient diet. This is seen as a challenge in Laura’s case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Laura’s type 2 diabetes through proper feeding would be an added challenge to her care. Legal, Ethical and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary admission to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. Apart from the legal aspects that influence the delivery of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and other healthcare practitioners should ensure that the interventions would be benefici al to the patient (Beauchamp and Childress, 2001). In Laura’s case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patient’s behaviour. In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Laura’s case, her autonomy would be respected. Allowing patients to participate in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. Justice will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patient’s background, religion, race, gender, ethnicity, she should receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Laura’s healthcare needs. While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive sufficient funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007). Role of the Nurse in the Intervention Process On reflection of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMC’s (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Laura’s family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful stage in the patient’s disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient is experiencing. Since nursing is a continuing process, I have to inform the family members that the patie nt will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage. Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her dignity would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will attend courses on how to conduct end-of-life care for patients with dementia. Through Laura, I realised that a patient’s dignity should always be observed. It is recommended that in my future and present practice, I will continue to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patient’s experiences on how to choose and deliver interventions. Conclusion Evidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patient’s rights, act as her advocate and ensure her safety during the trajectory of the condition. For future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patient’s preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions. References Baillie, L. Gallagher, A. (2011). ‘Respecting dignity in care in diverse care settings: Strategies of UK nurses’. International Journal of Nursing Practice, 17, pp. 336-341. Beauchamp, T. Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. Casartelli, N., Item-Glatthorn, J., Bizzini, ., Leunig, M. Maffiuletti, N. (2013). ‘Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-moth postoperative comparison’. BMC Musculoskeletal Disorder, 14:176 doi: 10.1186/1471-2474-14-176. Croker, J., Swancut, D., Roberts, M., Abel, G., Roland, M. Campbell, J. (2013) ‘Factors affecting patients’ trust and confidence in GPs: evidence from the national GP patient survey’, BMJ Open, 3(5). Pii: e002762. Doi: 10.1136/bmjopen-2013-002762. Department of Health (2012). No Health Without Mental Health. London: Department of Health. Department of Health (2009). Living Well with dementia: A National Dementia Strategy. London: Department of Health. Department for Constitutional Affairs (2007). Mental Capacity Act 2005 Code of Practice. Norwich: The Stationery Office. Ewen, A., Stewart, S., St Clair Gibson, A., Kashyap, S. Caplan, N. (2012). ‘Post-operative gait analysis in total hip replacement patients- a review of current literature and meta-analysis’. Gait Posture, 36(1), pp. 1-6. Filan, S. Llewellyn-Jones, R. (2006). ‘An animal-assisted therapy for dementia: a review of the literature’. International Psychogeriatrics, 18(4), pp. 597-611. Fitzpatrick, J. (2007a). ‘Finding the research for evidence-based practice: Part one- The development of EBP’. Nursing Times, 103(17), pp. 32-33. Fitzpatrick, J. (2007b). ‘Finding the research for evidence-based practice: Part two-selecting credible evidence’. Nursing Times, 103(18), pp. 32-33. Fitzpatrick, J. (2007c). ‘How to turn research into evidence-based practice: Part three- Making a case’. Nursing Times, 103(19), pp. 32-33. Greenhalgh, T. (2010). How to read a paper: the basics of evidence-based medicine. West Sussex, UK: John Wiley and Sons. Hopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. Schooling, T. (2013). ‘An evidence-based systematic review on cognitive interventions for individuals with dementia’. American Journal of Speech and Language Pathology, 22(1), pp. 126-145. Kizer, K. (2002). ‘Patient centred care: essential but probably not sufficient’. Quality and Safety in Health Care, 11, pp. 117-118. Kurz, A., Thone-Otto, A., Cramer, B., Egert, S., Frolich, L., Gertz, H., Kehl, V., Wagenpfeil, S. Werheid, K. (2012). ‘CORDIAL: Cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: a multicenter, randomized, controlled trial’. Alzheimer Disease and Associated Disorders, 26(3), pp. 246-253. Monaghan, B., Grant, T., Hing, W. Cusack, T. (2012). ‘Functional exercise after total hip replacement (FEATHER): a randomised control trial’, BMC Musculoskeletal Disorder. 13:237 doi: 10.1186/1471-2474-13-237. Moncrieff, J. Cohen, D. (2009). ‘How do psychiatric drugs work?’. British Medical Journal: 338 [Online]. Available from: http://www.bmj.com/content/338/bmj.b1963#alternate. Morrissey, J. Callgahan, P. (2011). Communication skills for mental health nurses. Maidenhead: Open University Press. National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell and Social Care Institute for Excellence and NICE. National Institute for Health and Clinical Excellence (NICE) (2013). Falls: assessment and prevention of falls in older people: NICE clinical guideline 161. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2008). Type 2 Diabetes: The Management of type 2 diabetes. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2006). Dementia: Supporting people with dementia and their carers in health and social care. London: NICE. Nursing and Midwifery Council (NMC) (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Pearson, A., Field, J., Jordan, Z. (2009). Evidence-Based Clinical Practice in Nursing and health Care. Assimilating Research, Experience and Expertise. Oxford. Blackwell Publishing. Polit, D. Beck, C. (2010). Essentials of nursing research: appraising evidence for nursing practice. 7th ed. London: Lippincott Williams and Wilkins. Popp, J. Arlt, S. (2011). ‘Pharmacological treatment of dementia and mild cognitive impairment due to Alzheimer’s disease’. Current Opinion in Psychiatry, 24(6), pp. 556-561. Porsteinsson, A., Drye, L., Pollock, B., Devanand, D., Frangakis, C. Ismail, Z., Marano, C., Meinert, C., Mintzer, J., Munro, C., Pelton, G., Rabins, P., Rosenberg, P., Schneider, L., Shade, D., Weintraub, D., yesavage, J. Lyketsos, C. (2013). ‘Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial’. JAMA, 311(7), pp. 682-691. Repper, J. Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. London: Balliere Tindall. Sakamoto, M., Ando, H. Tsutou, A. (2013). ‘Comparing the effects of different individualized music interventions for elderly individuals with severe dementia’, International Psychogeriatrics. 25(5), pp. 775-784. Smith, G., Greogry, K. Higgs, A. (2007). An integrated approach to family work for psychosis. London: Jessica Kingsley Publishers. UK Legislation (2007) Mental Health Act 2007 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2007/12/contents (Accessed: 13th May, 2014). Wall, M. Duffy, A. (2010). ‘The effects of music therapy for older people with dementia’. British Journal of Nursing, 19(2), pp. 108-113. Wright, N. Stickley, T. (2013). Concepts of social inclusion, exclusion and mental health: A review of the international literature. London: SAGE. Wright, J., Turkington, D., Kingdon, D. Basco, M. (2009). Cognitive-behaviour therapy for severe mental illness: An illustrated guide. USA: American Psychiatric Publishing Inc. How to cite Evidence-based Interventions for a Patient Suffering from Dementia, Essay examples

Justin Bieber - My World free essay sample

On November 17, 2009, Justin Bieber, a 15-year-old discovered on YouTube, came out with his first album. Island Records and the pop star Usher helped young Justin put together â€Å"My World.† Bieber has quickly won over the hearts of many young girls because of his adorable smile and innocent stage presence. The CD is mostly upbeat, happy songs of love for and admiration of a certain girl in the singers life. His most popular song, â€Å"One Time,† is by far the best here and will make listeners sing along. It describes how he felt when he met a girl and how she is now his â€Å"one love.† Another great song is â€Å"Down to Earth,† which displays the artists strength and talent. Although not specifically about love, it conveys the struggles people face, including divorce, and the importance of compromises. The next track, â€Å"Love Me,† is familiar since it is Biebers cover of the song by The Cardigans. We will write a custom essay sample on Justin Bieber My World or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The lyrics have been  ­altered to fit the life of a 15-year-old and have a somewhat techno genre feel. I feel like at my age, 17, I can relate to these songs more than some of the others on the CD. The majority of the songs are easy to become a fan of, but a few are not as catchy or appealing. The lyrics of â€Å"Bigger,† about a young player who has grown up to find love, are  ­confusing and childish, and Biebers voice sounds very high-pitched. â€Å"First Dance†  ­begins with an unknown rapper and then introduces Bieber, who sings about dancing with his date, â€Å"tasting her lip gloss,† and having to be home by nine. This song will only appeal to very young kids, even younger than Justin. Throughout the CD Bieber displays a number of annoying traits, unfortunately: two songs begin with him whispering â€Å"Mafia,† and he refers to himself by his nickname, â€Å"JB,† in every song. The cute and talented Bieber has been very successful in both the United States and his home, Canada. I am glad that we now have a young artist who is truly innocent, and has not (yet) been changed by fame and money. I am a fan of the image he portrays. I look forward to more performances, songs, and success by Bieber.

These strange Americans Review Essay Example

These strange Americans Review Paper Essay on These strange Americans Write a book (as it is, and it is said), the typical American in origin and life. Stephanie Faul freelance artist, who lives in the capital, Washington, DC Miss Foul descendant of Czech immigrants and Connecticut Yankee, her grandmother spoke German, and cousins ​​lived in Canada her idea of ​​another world enriched education in French primary school, Swiss boarding school, as well.. also numerous booze in English pubs during student holidays. Can we blame the incompetence of the author analysis was applied to all aspects of American life here and about their live thinking, bloated under the so-called delicacy (Im talking about discrimination on various grounds) and directly related to this struggle for the rights of minorities (who were It will soon become the majority), with respect to the work, the general promotion of healthy lifestyles and in particular obsession with hair, teeth and smell them really pop culture, cult financial success, etc. In general, to dissect the lives and thoughts. The style of presentation of course ironic. In some ways, my knowledge of them confirmed (adolescent identity, friendship, attitude towards foreigners, etc.). But some aspects of surprised me. I was genuinely convinced that the American system really the best system in the world, and the American justice is that right. In fact, it turns out that myths myths and the reality is that our country this is not so different. Russians and Americans in general somewhat similar. Maybe thats why we are so not like see in America a possible variant Russia We will write a custom essay sample on These strange Americans Review specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on These strange Americans Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on These strange Americans Review specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Quote: Every time he sat down at the table, the Americans freeze from the terrible thought that because of. food can be and die, or, worse, of getting fat. Malnutrition leads to disease, especially heart, and you never know what kind of piece would kill you eventually. The most suspect foods are steak ( heart attack on a plate) and all that much fat, cholesterol, calories and low in fiber sugar, butter, cheese, ice cream, . Ulka and everything fried was recently discovered that the main American Food sausage causes leukemia children Even spinach and beets far from harmless -.. They Prorva oxalic acid, which is harmful Food stands at the forefront of the struggle for eternal youth in large numbers , good health and a slim figure, and has already suffered its first loss loss of taste the Americans are obsessed with nutrition, aided by endless research to prove the harmfulness or usefulness of the order, then this Americans as possible to feed any tasteless crap, you just have to convince him that he is on this pozdoroveet and lose weight. In the restaurant menu, special badges marked dishes heart-healthy (low in cholesterol and saturated fat) and diet (a vague term that implies, although it is not necessary, low in calories or fat). In supermarkets there are entire shelves with products labeled low-salt, low calorie, low fat, cholesterol-free, diet or synthetic ( tasteless can no longer write so clear). Americans eat bacon made from soy, fake eggs in plastic cups, low fat cheese, similar in appearance to the chewed shoes, soda pop of chemicals with unpronounceable names, and rich in fiber bread, which for grandeur mixed cellulose. Forbidden foods, especially chocolate, causing Americans to shudder secret rapture, which in other nations is sex. By sending in your mouth every piece of chocolate cream cake or butter, Americans are overwhelming feeling that destroy your soul. Bold sinful desserts provide a sinister names devils foot, Chocolate Madness, Death by Chocolate. This is a reminder that, and so it is known to every American: food is dangerous for your health .

Get Inspired By 21 Of The Best Content Marketing Examples In The Biz

Get Inspired By 21 Of The Best Content Marketing Examples In The Biz Content marketing has been around forever. *Fun fact* many accredit Benjamin Franklin as the first ever content marketer  when he published the yearly Poor Richard’s Almanack in 1732. Historical marketing fun facts aside, every marketer worth their salt has likely experimented with content marketing tactics. So much so, that the very concept might be starting to feel stale and overdone. But the stats speak for themselves, content marketing remains one of best tools in a marketers tool belt. Here’s what we know: 78% of consumers prefer getting to know a company through articles rather than ads. content marketing costs 62% less than traditional Marketing. Per dollar spent, content marketing generates approximately 3x more leads than traditional marketing. Companies that published 16+ blog posts per month got almost 3.5 times more traffic and 4.5 times more leads than companies that published zero to 4 monthly posts. 55% of marketers say blog content creation is their top inbound marketing priority. 47% of buyers viewed 3-5 pieces of content before engaging with a sales rep. Visual assets are the single biggest content contributor when it came to social media in 2017. After watching a video, 64% of users are more likely to buy a product online. 53% of content marketers use interactive content in lead generation efforts. Lead generation, sales, and lead nurturing are the top three organizational objectives for content marketers. Sources:  https://www.lyfemarketing.com/blog/why-is-content-marketing-important/;  https://www.hubspot.com/marketing-statistics #didyouknow that #contentmarketing costs 62% less than traditional marketing?If you’ve become disgruntled with the state of your own content marketing and are feeling less than inspired, you’ve come to the right place. We’re breaking down 21 of our favorite content marketing campaigns to get your creative juices flowing. Download Your Free Content Marketing Template Bundle First things first†¦ what do all these amazing content marketing examples have in common? They are expertly executed and distributed seamlessly. Are you prepared to do the same? It’s going to be  awfully hard to rock your killer content marketing campaign if your implementation and team coordination is a mess. Download our free content marketing template bundle. It contains everything you need†¦ A content plan template to help you measure and learn from your success. An Email Marketing template to distribute and communicate your new initiative. A blog calendar template to plan every post ahead of time in one place. Download your *FREE* #contentmarketing template bundle to make planning your next campaign a cinch.Get More Organized Than Ever With When you’re completely fed up with managing spreadsheets, sifting through countless emails, and all the time-consuming meetings just to get your marketing team on the same page, considering upgrading to . It’s the only way to get all your marketing organized in one place. Get a bird’s eye view of everything your team is working on; and collaborate, plan and execute your entire marketing strategy in one place. From social media promotion to blogging†¦ you can plan it all with . No more bouncing from tool-to-tool or hacking project management platforms that weren’t made for marketing teams. brings everything you need into one place. Table of Contents Charmin Nerd Wallet IKEA Facebook Make-a-Wish Babylist Primary ASOS Wistia Hershey's Bank of America Headspace Zillow Four Seasons Magazine Nike AirBnB Save the Food Blendtec Pandora Shopify Glossier

Analysis of Scene 2 of Blue Remembered Hills Essay Example for Free (#2)

Analysis of Scene 2 of Blue Remembered Hills Essay In scene 2, the audience can see a slight change of pace. This is shown through the lack of physical violence in this scene in comparison to the previous scene 1. The pace starts off as fidgety as the two seven year old boys-Peter and Willie- can barely keep still but the pace hardly reaches any faster than this through the rest of the scene. The point in which they are both laughing and giggling uncontrollably is the only real point where the pace picks up a bit. This is when the boys are both laughing about Wallace peeing on a gorse bush due to the fact that he thought it â€Å"was on fire†. The subject of Wallace visibly fastens the pace, as is evidence in many other scenes. I think the slow pace of this scene shows the actual weakness of these two boys as their dilemmas and problems at their age are partially revealed through their banter and conversation. The seemingly raw subject of Donald and the beatings he receives at home seem to strike a misunderstood chord with the two boys but they shrug off the confusion and potential sadness and envelope themselves into another situation. This awkwardness is shown in the stage directions alone as â€Å"they fall silent† and the â€Å"tension that they do not understand† is quickly broken by more childishness, and they quickly run themselves into another less sensitive subject. The moments where there is quite a fast pace in this scene is only created by the characters purposely after they are bored and have nothing else to do or interesting to say. The subject of Donald is quickly followed by a purpose running about and â€Å"swooping† around by the two boys to bring up the energy levels. The back and forth conversation about the Dandy and Beano gets quite tedious for Peter and he quickly is distracted by something else more active and exciting. The characters in this scene are still both Willie and Peter and the relationship between the boys familiarly stays the same. In the previous scene, the audience saw that Peter was dominant in the relationship and frequently craved control of it and of Willie, often with physical violence but in this scene, he no longer results to this and uses his words more to cajole Willie into telling him where the jam jars are. Willie also still seems to have the upper hand in the argument though as he knows all the information Peter wants to get. Because of this, Peter has to still be moderately controlled in how he acts towards Willie to get the location of the jam jars out of him. This unexpected control Willie has is evident as when Peter once again threatens Willie with physical violence-his fist- he sees that this may completely blow his chance of getting any information so he rethinks and offers him his Dandy. Willie is now in control as he shows to Peter that he doesn’t care and that he could buy his own comic. This under-valued control that Willie has is still present in scene 2 and similarly continues on in the play. Concluding, there is small change of pace and characters in Scene 2 but not on a large scale. The pace is slowed down visibly from Scene 1 as there is not as much playing about and fighting between the two characters. Apart from the stage directions in Scene 1 where it clearly stated if they were moving and what actions they were doing if they were talking, this was no stated in Scene 2, therefore, I have no choice but to assume most if their conversation was given mostly in stationary mode. There was no real change in characters in Scene 2 other than the fact that In scene 1, Peter was triumphant in his method of physical beating to get Willie to give him the apple and in scene 2, Willie was triumphant in his knowledge of information to keep a secret the information about the jam jars but that was only really successful because of the distraction of the squirrel. Analysis of Scene 2 of Blue Remembered Hills. (2017, Oct 05).

MANAGEMENT DEFINITION AND FUNCTIONS Essay Example | Topics and Well Written Essays - 750 words

MANAGEMENT DEFINITION AND FUNCTIONS - Essay Example In the past few years; health care sector has undergone dramatic changes ranging from, changing client characteristics to contributions of technology among others. These inputs directly impact on provision as well as management of the healthcare sector. Changing demographic patterns is a factor which impacts on facilities and specialization of healthcare providers. Current increase in the population of old people calls for development of specialty and wellness programs, to promote healthy aging. In addition; though an ever-present condition, diseases and illnesses have taken a different dimension, as some recur after long periods of absence. However, the sector faces constraints from increasing autism and childhood obesity (Liebler and McConnell 3.) Despite facing constraints from increasing diseases in the current generation, healthcare services adhere to laws and regulations. Such policies are made by the federal government for the benefit of all citizens and imply to private as well as public institutions. Such laws mainly focus on the increasing cost of health services that make it inaccessible to majority poor. Healthcare service fees face increments due to advancements in technology as well as pharmaceuticals among others (Liebler and McConnell4). However; in the face of increasing number of new diseases and infections; inputs such as, technology and pharmaceuticals are important aspects in ensuring effective delivery of healthcare services. In addition, increasing costs of healthcare services force government and insurers to act upon the sectors money. As a result, this forces healthcare providers to operate on less money than they actually require (Liebler and McConnell 5). Income limitations on the healthcare sector thus; forces the providers to close, down size or form large systems which take advantage of economies of

IT Strategy and Management Essay Example | Topics and Well Written Essays - 1000 words

IT Strategy and Management - Essay Example This translates to the process of evaluation in order to have the right personnel attending to it (Jenner & Kilford, 2011). Therefore, the planning includes preparation, startup, feasibility, definition and planning, implementation and closing down the programme. With this in place, the programme manager deliberates on the right people to work on the programme. Programme manager is mandated to develop a definition of the programme. He is responsible for the timely delivery of the programme. This translates to proper coordination of the project at all stages. He has to ensure that every individual in the execution of the project delivers on his part. This involves coordinating with supervisors in order to have updates on the progress of the programme. The programme manager has to ensure that the programme is of the required quality. All resources required for completion of the programme are on his hands. The sponsor is considered to be the most senior member of a programme. Therefore, the sponsor is mandated in authorizing a programme in regard to its intended purpose. Sponsor has also the mandate of appointing senior responsible owner who is responsible for representing the interest of the sponsor. In situations where the owner is not around, the senior responsible owner has to ensure that the programme goes as planned. He is responsible for approving several operations of the programme in the absence of the sponsor.

Transhiatal Approach Essay Example for Free

Transhiatal Approach Essay Abstract: Tethered cord syndrome (TCS) is a stretch-induced functional disorder of the spinal cord, which is directly related to filum fixation. Classic surgical approaches to the filum involve open surgery and include varying amounts of spinal bone removal. In an effort to reduce the morbidity and mortality of these procedures, we explored a less invasive method. We evaluated the ability, safety and feasibility for extradural endoscopic dissection of the filum terminale by performing upward orientated navigation in the sacral spinal canal through the sacral hiatus using a rigid endoscope. Four adult, phenol-formalin embalmed cadavers were used for extradural endoscopic dissection of the filum at the tip of thecal sac. After preparing the anatomical area of sacral hiatus, a rigid endoscope (Storz, of 3.8 mm external diameter with one working channel) was inserted into the sacral spinal canal and the filum was identified and cut easily. In all cases, it was possible to manipulate the rigid endoscope and inspect the full length of the extradural sacral spinal canal, especially at the S1-S2 level. Our results indicate that the tested transhiatal approach for upward orientated extradural endoscopy represents a minimally invasive procedure that provides an appropriate and feasible route to the extradural sacral spinal canal. Furthermore it is an attractive alternative for filum dissection in cases where tethered cord syndrome is not accompanied by any other pathology. Introduction Physicians and scientists have explored the clinical usefulness of spinal endoscopy over six decades. Endoscopic spinal surgery represents a major advance in the treatment of spinal disorders. It involves the use of small incisions that preserve normal tissues while allowing the spinal pathology to be fully treated. This technique carries interesting clinical benefits, and its utility continues to expand as technology advances. Tethered cord syndrome (TCS) is a manifestation of spina bifida occulta and can occur as a complication of surgically closed spina bifida aperta. The mechanical cause of TCS is an inelastic structure anchoring the caudal end of the spinal cord and preventing cephalad movements of the lumbosacral cord. Stretching of the spinal cord occurs in patients either when the spinal column grows faster than the spinal cord or when the spinal cord undergoes forcible flexion and extension. Symptomatic TCS can occur in adults as well as in children, manifesting with various clinical symptoms (Dachling, 1982; Kaplan, 1980; Klekamp et al. 1994), such as pain, neurological deficits, and bowel and bladder dysfunction. Further studies have shown that early surgical correction in adults is recommended because of the high risk for irreversible neurological deficits (Bermans et al. 2001). In recent years, further research efforts of scientists have ranged from full-fledged neurosurgery to minimally invasive approaches and have involved the use of flexible and rigid endoscopes for diagnosis and treatment of certain pathological entities (Heavner et al. 1991; Sabreski Kitahata, 1995 1996; Warnke et al. 2001, I, II; Warnke et al. 2003). Encouraging results from the performance of co-axial downward orientated thecaloscopic procedures, with flexible steerable endoscopes in the lumbar subarachnoid space in living humans (Warnke et al. 2003), prompted us to study further thecaloscopic procedures for filum terminale dissection by using a rigid endoscope. This procedure usually offers a better optical view of the studied anatomic structures. The aim of the present anatomic study was not only to determine if the tip of thecal sac could be clearly visualized. Based on the fact that epidural endoscopy through sacral hiatus was proved to be safe and possible (Sabreski Kitahata, 1995 1996; Sabreski Gerens, 1998), it also sought to explore the possibility of using a rigid endoscope to untether prefixed filum terminale. Materials and Methods For this study, four adult phenol-formalin embalmed male cadavers from the Anatomy Department of the Medical School of the University of Athens were dissected using microsurgical and endoscopic techniques. Neurosurgical   technique Fig.2Insertion-of-the-rig Fig.1Sacral-Hiatus Cadavers were placed in the prone position. A midline skin incision was centered over the sacral hiatus [fig. 1]. After anatomical preparation, the rigid endoscope [fig.2] was inserted through the sacral hiatus and directed into the sacral spinal canal cephalad. It was angled in that manner in order that it would face the tip of thecal sac. The filum, which was holding thecal sac, was identified and dissected [fig.3]. The rigid endoscope used was a Storz with a 3.8mm external diameter and one working channel. For the documentation, a video-tape (Fuji VHS) was used and digital photographs were taken using a Fuji AS-205.    Results With the help of a rigid endoscope, it is possible to visualize directly the tip of thecal sac and to perform a dissection of the filum terminale. A rigid endoscope was inserted into the sacral spinal canal and, with the benefit of the visibility it granted, was advanced cephalad with relative ease. The rigid endoscope provided a large field of view, which enabled the anatomical structures to be seen. The filum can be easily identified in fine detail, as it is the only structure adherent to the tip of thecal sac at the S1-S2 level. This procedure represents a minimally invasive method for direct visualization of the tip of thecal sac and dissection of filum terminale. Discussion Diseases of the spine predispose persons to chronic complaints ranging from mild discomfort to intense pain. Endoscopy of the anatomic structures contained within the spine makes possible thorough examinations for existing pathology and facilitates the application of appropriate methods of therapy (Warnke et al. 2003; Sabreski Kitahata, 1996). Use of neuroendoscopy has become widespread in spinal surgery for conditions ranging from degenerative disease to deformity correction (Heavner et al. 1991; Sabreski Gerens, 1998; Sabreski Kitahata, 1995 1996). The growth in the number of minimally invasive spine surgical procedures being performed has been spurred by both technical advances and by its associated reduction in operative morbidity (1998; 1995; 1996). However, minimally invasive techniques are primarily employed in extradural procedures. Transhiatal extradural filum untethering provides the ability to untether a prefixed filum in a minimally invasive way. When referred to a neurosurgical clinic, adult patients with tethered cord syndrome tend to show significant progressive neurological deficits (Klekamp et al. 1994; Dachling, 1982).   Some authors (van Leeuwen, et al. 2001) have advocated prophylactic surgical treatment for the prevention of progressive neurological symptoms, which is, in this case, related to low morbidity. As an alternative to the risky open surgical treatment procedure, we evaluated the extradural endoscopic procedure for untethering of filum in cadavers. Extradural filum untethering could be indicated in cases of prefixed filum without other accompanying pathology such as meningomyelocele, CSF fistula, or arachnoidal cysts. It could also be performed before a surgical intervention, which generally include dura opening and removal of various amounts of spinal bone. During inspection of the sacral spinal canal with the rigid endoscope, the declination of the sacral spinal canal did not bring difficulties for the upward manipulation of the endoscope. Following the physical inclination of the sacral spinal canal, the filum could be approached and dissected before reaching the lumbosacral angle. In some instances, it was difficult to dissect the filum because of its elasticity. However, the minimally invasive nature of neuroendoscopy provided by this procedure, and by the employment of the rigid endoscope, allows for a larger field of view at the sacral spinal canal through a smaller incision. This access and the ability to perform extradural inspection and filum dissection using this transhiatal approach are comparable with other therapeutic interventions used in neurosurgery, such as the endoscopic epidural placement of catheters in anaesthesiology. Conclusions This method of extradural endoscopic dissection of the filum terminale minimizes surgical trauma and provides excellent visualization of and access to the extradural sacral spinal canal. Furthermore, it enables the filum to be identified and thus provides a minimally invasive alternative to current open surgical procedures indicated for filum untethering. Utilization of this procedure could: (1) facilitate untethering of prefixed filum terminale without opening the dura and (2) minimize patient morbidity thereby presenting an overall attractive alternative to current methods of filum dissection. At present, neuroendoscopy is most widely used in minimally invasive spine surgery, but novel uses continue to emerge in the literature. As technology evolves and more experience is obtained, neuroendoscopy will likely achieve additional roles as a mainstay in spinal surgery. References Heavner JF, Cholkhavatia S, Kizelsheeyn G. (1991). Percutaneous evaluation of the   Ã‚  Ã‚  Ã‚  Ã‚   epidural and subarachnoid space with flexible endoscope. Reg. Anesth. 15 S1: 85. Iskandar BJ, Fulmer BB, Hadley MN, Oakes WJ. (2001). Congenital tethered spinal cord   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   syndrome in adults. Neurosurg. Focus 10(1): Article 7. Kaplan JQ, Quencer RM. (1980) The occult tethered conus syndrome in the adult.  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚   Radiology 137:387-391. Klekamp J, Raimpondi AJ, Samii M. (1994) Occult dysraphism in adulthood: clinical   Ã‚   course and management. Child Nerv Syst 10:312-320. van Leeuwen R, Notermans NC, Vandertop P. (2001). Surgery in adults with tethered   Ã‚   cord syndrome: outcome study with independent clinical review.   J. Neurosurg.   Ã‚  Ã‚   (spine) 94: 205-209. Pang D, Wilberger JE. (1982) Tethered cord syndrome in adults. J. Neurosurg. 57: 32-47. Sabreski LR, Gerens, F. (1998) Safety of epidural endoscopy. Reg. Anest. Pain Med.   Ã‚  Ã‚  Ã‚   23: 324-325. Sabreski LR, Kitahata LM. (1995) Direct visualization of the lumbosacral epidural   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   space through the sacral hiatus. Anest. Anal. 60: 839-840. Sabreski LR, Kitahata LM. (1996) Persistent radiculopathy diagnosed and treated with  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   epidural endoscopy. J. Anesth. 10: 292-295. Warnke JP, Tschabitscher M, Nobles A. (2001). Thecaloscopy Part I.: The endoscopy of   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   the lumbar subarachnoid space: Historical review and own cadaver studies.  Ã‚  Ã‚   Minim. Invas. Neurosurg. 42: 61-64 Warnke JP, Mourgela S, Tschabitscher M, Dzelzitis J. (2001) Thecaloscopy Part II:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Anatomical Landmarks. Minim. Invas. Neurosurg 44:181-185. Warnke JP, Kà ¶ppert H, Bensch-Schreiter B, Dzelzitis J, Tschabitscher M. (2003)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Thecaloscopy Part III: First Clinical Application. Minim. Invas. Neurosurg   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   46:94-99.

Nursing Practicum Proposal Essay -- nursing educator, practicum experi

Nursing students today are diverse with different learning styles. Nursing educators must shape students to become critical thinkers and there are a host of approaches for instructors to develop needed teaching skills (Kostovich et al., 2007). There are many models of education styles; one to fashion teaching after is from Kolb’s model in 1985 which suggests matching learning methods to teaching approaches. However, educators need to become proficient in identifying individual student learning styles. Nursing educators should also recognize their own teaching style and the effect it has on learner development and socialization (National League for Nursing, 2007). The National League for Nursing (NLN) has developed eight core competencies for nurse educators. The NLN proficiencies serve as a guide for faculty to follow in order to provide high quality education for nursing students (NLN, 2007). This paper is aimed at proposing a student teaching practicum at North Central M ichigan College (NCMC) in the nursing high fidelity simulation/skills lab for the winter 2014 semester. Scholarly Practicum Proposal The NLN has developed eight core competencies for nurse educators. The NLN proficiencies serve as a guide for faculty to follow in order to provide high quality education for nursing students (NLN, 2007). With a diverse student population, educators must be able to incorporate varied teaching strategies into curricula to meet the needs of each student. Older students have a tendency to prefer on line discussion and problem-based learning, while younger students prefer simulations and skills demonstration (Pettigrew, Dienger, & King, 2011). Used as a teaching tool, simulation promotes clinical skills, interperson... ...eved from http://www.nln.org/profde/corecompetencies.pdf . North Central Michigan College. (2013-14). Nursing program handbook. Retrieved from http://www.ncmich.edu/ Penn, B., Wilson, L., & Rosseter, R. (2008). Transitioning from nursing practice to a teaching role: The Online Journal of Issues in Nursing, 13(3):3 Pettigrew, A., Dienger, M., & King, M. (2011). Nursing students today: Who are they and what are their learning preferences? Journal of Professional Nursing, 27(4), 227-236. doi:10.1016/j.profnurs.2011.03.007. Rattray, J., & Jones, M. (2007). Essential elements of questionnaire design and development. Journal of Clinical Nursing 16, 234-243. Wayne, D., & Lotz, K. (2013). The simulated clinical environment as a platform for refining critical thinking in nursing students: a pilot program. Nursing Education Perspectives, 34 (3), 163-166.

Succubus Heat CHAPTER 16

â€Å"Georgina.† My name came to me from far away, from far down a tunnel without an end. It echoed off the walls of my mind, loud at first and eventually fading to nothing. â€Å"Georgina. Look at me, sweetie.† â€Å"Let her sleep, Hugh.† â€Å"No, I need to talk to her and make sure she doesn't have a concussion. Georgina, come on. Open your eyes for me.† Through a mist of black fog, my brain parsed the words and slowly found meaning in them. Some basic response in me wanted to comply, but my eyelids felt like they were stuck together. Thinking-let alone answering-was too hard, but more words came to encourage me. â€Å"There you go, sweetie. Try it again. You almost had it.† With much effort, I finally managed to open my eyes. It was excruciating. My lids felt like they were made of lead. At first, I could only perceive one thing: light. I winced, wanting to sink back into that oblivion I'd been pulled from. And with this slight stirring of consciousness, all the pain I'd escaped from before suddenly returned. My head throbbed. My back burned. The clich? ¦ about breaking every bone in the body seemed like a very real possibility all of a sudden, and I was pretty sure I'd broken a few that weren't in my body. Sure, that didn't make sense, but with as bad as I felt, little did. â€Å"Oh God.† At least, that's what I tried to say. It came out as more of an indistinct moan. â€Å"Easy there. You don't have to say anything.† I opened my eyes again, this time making out a figure leaning over me. I knew his voice so well that I didn't need to see his face, which was a blur anyway. â€Å"Hugh,† I croaked. â€Å"Hey, ask her what-â€Å" â€Å"Shut up,† Hugh snapped. The jerky movement of his head made me think he'd glanced behind him, but I couldn't be certain. He moved his face closer to mine, bringing his features into sharper relief. He was paler than I'd ever seen him, his face filled with lines of worry and fear I'd never thought him capable of. He looked even more upset than when he'd come to tell us about Jerome's summoning. Reaching out, Hugh held the lids of one of my eyes open and shone a small light into it. I squirmed at the brightness-or at least I tried-but he was fast and did it to the other eye before it caused too much discomfort. When he finished, he moved his finger around in the air and studied my eyes as I followed it. â€Å"What's your name?† he asked. The voice behind him piped up. â€Å"You already said her name.† Hugh sighed and jerked a thumb over his shoulder. â€Å"What's his name?† â€Å"Cody,† I said. It was getting easier to speak, but the pain was going up the more conscious I became. Cody's voice was as familiar to me as Hugh's, and I felt certain Peter was here too. Hugh asked me a few other factual questions, like the current year and the location, and also if I was nauseous. â€Å"It all hurts,† I said, voice still slurred. I couldn't even move, let alone distinguish nausea from the rest of my pain. â€Å"Yeah, but do you feel like you're going to throw up? Right here? Right now?† I thought about it. My stomach hurt, but it was less of a queasy discomfort and more of a someone-just-kicked-me-with-stilettos discomfort. â€Å"No,† I said. Hugh sat back, and I heard him sigh in relief. â€Å"It all hurts,† I repeated. â€Å"Can you†¦make it stop?† He hesitated, and a moment later, Cody appeared beside him. â€Å"What's the matter? You've gotta give her something. Look at her. She's suffering.† â€Å"Understatement,† I mumbled. Hugh's face was still drawn. â€Å"I'm not gonna knock her out if she's got a concussion.† â€Å"She passed your tests.† â€Å"Those are field tests. They're not one hundred percent accurate.† â€Å"Please,† I said, feeling tears well in my eyes. â€Å"Anything.† â€Å"We know it won't kill her,† I heard Peter say. I'd been right about him being here. Hugh hesitated only a little longer. â€Å"Go get some water.† Cody disappeared, and Peter replaced him by Hugh's side. Hugh's expression was still grim. â€Å"Sweetie, I've got to clean up your back, and it's going to hurt.† â€Å"Worse?† â€Å"A different kind of hurt. But this has to be cleaned up so you don't get an infection, and then I need to shift you to check out the rest of you. The drugs'll help, but it's all going to hurt at first.† â€Å"Go for it,† I said, steeling myself. At this point, I couldn't really imagine worse pain. Besides, Hugh was a doctor. Everything was going to be okay now. Cody returned with a glass of water. Hugh made me drink some first, just to make sure I could keep it down. When I did, he gave me two pills to take with the rest of the water. I nearly choked on them-my throat felt raw and swollen, maybe from screaming-but I got them down. I wanted to ask what I'd just taken, but it seemed like too much work. â€Å"Should kick in in about twenty minutes,† Hugh said. I could see him fumbling with something in his lap. Standing up, he leaned over my back. Something wet touched my skin. â€Å"Son of a bitch!† Again, my words were slightly incoherent, but I think he caught my meaning. Stinging pain-a â€Å"different† pain, indeed-raced across my skin where he'd touched it. It was electric, sharp where the rest of my body throbbed. My desire to get away from that horrible stinging was so strong that I actually managed to move a little, but all that did was trigger the hurt in the rest of my body. The world blurred once more. â€Å"You're making it worse,† he warned. â€Å"Stay still.† Easy for him to say. I bit my lip as he continued. He was using antiseptic to clean the places Nanette had cut me. Necessary, as he'd said, but God, did it hurt. â€Å"Talk to her,† Hugh said to no one in particular. â€Å"Distract her.† â€Å"What happened?† asked Peter. â€Å"Who did this to you?† â€Å"Nice distraction,† said Hugh. â€Å"Nanette,† I said. Saying her name made my stomach turn, and I hoped I wouldn't have to go back on what I'd said to Hugh about throwing up. â€Å"She was†¦mad.† â€Å"I guess,† said Peter. â€Å"Mad I told Cedric about her†¦Ã¢â‚¬  â€Å"Doesn't this kind of confirm your suspicions, then?† asked Cody. Yeah, if beating up the person who'd ratted out your secret plans didn't sound suspicious, I didn't know what did. But if Nanette really was behind Jerome's summoning, why not just kill me outright and leave no witnesses? Explaining that would take too many words and too much effort, so I just said, â€Å"I don't know.† â€Å"There,† said Hugh, straightening. â€Å"That wasn't so bad, was it?† I tried to glare, but I don't think he noticed. He rummaged in his kit once more and then leaned back over to start bandaging up the wounds. With as much as he was piling on me, I had the feeling I was going to look like a mummy. â€Å"Why didn't Dante stick around?† asked Cody. â€Å"Huh? Dante?† The bandage pressure wasn't as bad as the cleaning, but it was still uncomfortable. I wondered when those goddamned drugs were going to kick in. â€Å"He was here,† said Cody. â€Å"He called Hugh and told him to come over.† Some of the exact details of what had happened with Nanette were foggy, but I felt pretty confident, head trauma or no, that I would have remembered Dante being around. â€Å"Dante wasn't here,† I said. Hugh paused and looked me in the eye. â€Å"Then who called me? It was a guy, from your cell phone. Said to get over here and bring medical supplies-that you'd been hurt.† I frowned, and it came back to me, a shadow in the pain-filled haze of my memory. The strong arms and gentle voice. â€Å"There was someone here†¦Ã¢â‚¬  I began slowly. â€Å"Not Dante. Someone else. He put me to bed.† Silence fell. A slight fuzziness was starting to tingle the edges of my senses, which I took as a good sign. It was more of a pleasant, dreamlike fuzziness-not the I-can't-handle-this-pain-anymore kind. There was still a fair amount of that, though. The guys exchanged puzzled looks. â€Å"Are you sure it wasn't him?† asked Cody. â€Å"Why would Dante leave her, though?† asked Peter. Hugh snorted. â€Å"No telling with him.† â€Å"Stop,† I mumbled. â€Å"It wasn't him.† â€Å"You can't remember a face or anything?† Peter asked. â€Å"Was it even someone you knew?† I thought again, desperately trying to dig out the memory. There was nothing, though. Only that he'd been someone familiar. â€Å"I knew him†¦Ã¢â‚¬  That pleasant drowsiness was growing stronger. I wished it would hurry up. â€Å"There,† said Hugh. â€Å"All bandaged up. Help me move her so I can look at her ribs.† That was not fun, and the discomfort of the three of them turning me over-no matter how gentle they tried to be-was enough to momentarily break me out of the drug's soothing embrace. They managed to flip me over, putting moderate pressure on my back when I rested back against the bed, but allowing Hugh to examine the rest of me. He poked and prodded and had me take deep breaths. His final analysis was that I had a couple of broken ribs and a lot of bruising and pain that would just go away with time. â€Å"Great,† I said. I was so loopy by that point that I didn't even know if I was being sarcastic or not. Cody was still unable to give up my benefactor. â€Å"But who was here?† â€Å"The man†¦Ã¢â‚¬  I said. â€Å"You aren't going to get anything else out of her,† said Hugh wearily. â€Å"Not for a while. She's going to be in Dreamland any minute now.† â€Å"Dreamland. The man†¦Ã¢â‚¬  I repeated. Suddenly, I giggled. â€Å"The man in the dream†¦Ã¢â‚¬  I saw them exchange pitying looks, just before my eyelids drooped closed. They thought I was talking nonsense. None of them knew about the story of the man in the dream, of that alluring and improbable alternate life that Nyx had shown me. But as I drifted off to Dreamland, it wasn't Nyx's vision I saw. It was more of that same, painless black†¦at least, it was until I got jolted by a million volts of electricity. I let out a small cry of surprise, my eyes popping open. It felt like hundreds of icy needles were dancing along my body, piercing every nerve. The room's details, as well as my friends, came to me in sharp, crystalline detail. No more fuzziness. Turning my head slightly, I saw a fourth person. Mei. She stood beside my bed, face blank and emotionless, arms crossed across her black silk blouse. â€Å"What happened?† I asked. My words were still thick, but my speech capabilities had improved by leaps and bounds. â€Å"I healed you,† she said flatly. â€Å"Inasmuch as I can. You're still going to hurt.† Demons, though once angels, didn't possess that power to heal that their heavenly counterparts had. They could do it in small bursts, however, and in expanding my senses to assess my body, I could feel how she'd gotten rid of the worst of my pain. I still ached in some places, and even bandaged, my back still stung. I no longer wanted to die, however, so that was definitely an improvement. â€Å"Thank you,† I said. Mei didn't look particularly compassionate or benevolent. Her expression darkened. â€Å"They say Nanette did this?† I hesitated. I'd already gotten in enough trouble with the archdemoness for telling on her. Of course, my friends had undoubtedly already told Mei the truth, and anyway, she was the closest I currently had to a boss. I wasn't entirely sure if I could trust her, but if I had to place my money on the demon most likely to have my back right now (no pun intended), it was her. â€Å"Yeah,† I admitted. â€Å"I told Cedric that Nanette had met with Jerome. She'd met with Cedric too, so it seemed kind of like she was manipulating both of them.† Mei's face grew harder still. Whether she agreed with me or not, she didn't reveal. â€Å"Nanette won't bother you again.† And with no more than that, the demoness vanished. â€Å"Girl fight,† said Hugh, looking the happiest I'd seen him today. â€Å"I don't think it's going to be in creamed corn or anything like that,† I remarked dryly. â€Å"Her sense of humor returns,† said Peter. â€Å"Definitely on the road to recovery.† I tried to sit up and winced. â€Å"Or not.† â€Å"Don't push it,† warned Hugh. â€Å"Mei can only do so much-â€Å" â€Å"What the hell's going on?† We all turned. Dante stood in the doorway to my bedroom. His face was a mixture of incredulity and utter confusion. Without waiting for an answer, he hurried over to the bed and knelt down so that he was at my level. â€Å"Are you okay? What happened?† His expression was so tender, so full of concern that I was momentarily taken aback. Dante was indeed selfish and arrogant, but he did care about me, no matter what my friends thought. And in dire situations-like now-that bitter faà §ade of his fell, revealing someone whose soul hadn't turned completely black yet. He tried hard to hide this side of himself, but I knew it was there. â€Å"I had a run-in with a demon,† I said. I gave him a brief explanation of what had happened. He grew more and more incredulous as I spoke. When I finished, he glanced around the room, studying everyone accusatorily. â€Å"How does something like this happen? I thought demons couldn't go around roughing people up. Aren't you under some kind of protection?† â€Å"Technically Jerome's,† I said. â€Å"But he's kind of busy right now.† â€Å"Maybe you're under Grace and Mei's protection now,† mused Cody. â€Å"Mei looked pissed.† â€Å"She always looks pissed,† said Hugh. â€Å"I should hope so,† snapped Dante. â€Å"Are they going to go kick this other demon's ass?† â€Å"She's not likely to smite her, if that's what you mean,† said Hugh. â€Å"Grace and Mei are under the same scrutiny as everyone else, but I bet Mei'll bitch Nanette out.† â€Å"Great,† said Dante. â€Å"A stern talking-to. That'll show her.† â€Å"It's unlikely Nanette'll do anything else. If she was going to kill Georgina, she would have already.† There was an almost gentle tone in Peter's voice. I think Dante's outrage and concern had convinced the vampire that Dante might not be the complete and total bastard he'd always believed. My immortal (or not so immortal) friends finally decided I was in reasonable enough condition to leave me in Dante's care. Hugh promised to check on me tomorrow, and I thanked him again for his help. He and the others looked like they wanted to hug me, but with my back, they knew better. When they were gone, Dante went out to the kitchen and came back with a bowl of ice cream. â€Å"Good for what ails you,† he said. I was surprised to discover I had a considerable appetite. Judging from the time, I'd been out quite awhile before Mei had shown up. It had only felt like a few seconds. â€Å"Careful,† I teased. â€Å"People are going to think you're a nice guy.† â€Å"Well, I'll have to go rob some orphans to save my reputation.† He lay in bed beside me, curled on his side so that he could gently keep his hand on my arm and talk to me. As the evening passed, our conversation mostly touched on inconsequential things, topics to distract me from Seattle's increasingly dangerous situation. Finally, when it came time for both of us to sleep, Dante brought up the attack again. â€Å"Succubus†¦who was here earlier?† I knew he didn't mean Hugh and the vampires. I frowned. Even with Mei's healing, my memories were sketchy. â€Å"I don't know. But I think†¦I think it might have been Carter.† â€Å"Really? I still can't believe that angel hangs out with you guys. But if it was him, why didn't he heal you? He could have fixed everything.† Through the fog of that ordeal, I recalled my rescuer's words. I can't heal you . â€Å"Because he's not supposed to interfere,† I said slowly, remembering my earlier rumination on whether blowing up a stove was interference. â€Å"Heaven's supposed to stay out of this. He probably shouldn't have even carried me to bed-which is why he would have then gotten out of here and left it to Hugh to patch me up.† â€Å"An angel breaking the rules and a demon healing the sick,† Dante said. â€Å"You and your associates just get more and more fucked up.† I shifted slightly, cautious of my back, and rested my head against him. â€Å"That's for damned sure.†

Greenhouse Effect Is the Result of Deforesting

Can you imagine our world facing everyday hurricanes, tsunamis, earthquakes, climate change, extinction caused indirectly by human activities? Yes, you can because it is happening right now while you are staying here in the classroom. A few days ago, Japan has been devastating by a massive earthquake of 8. 9 magnitudes, followed by a powerful force of a tsunami. Some scientists will say that it is a natural disaster and we have nothing to do with it, other will say that human activities help to accelerate these natural phenomenons.Human footprint has left behind him not only a new era of technology’s revolution, but also the destruction of nature. Today, environmental concern such as the growth of carbon emission in the atmosphere seems of high importance in global news. The greenhouse effect continues to increase rapidly and meanwhile accelerate global warming. In fact, your car, your house and even your air conditioning are used to produce energy and, meanwhile, used to enha nce greenhouse effect. Indeed, human activities such as burning fossils fuels contribute to accelerate the natural phenomenon of greenhouse effect on Earth.More carbon dioxide in the air, more infrared rays are being trapped in the Earth and as a result temperature increased. Can you imagine living with a high temperature? Believe it or not, but this happened. In 2005, Las Vegas has almost reached 50oC, a temperature record in North America in 21st century. Although, many scientists believe that the Earth has always had natural disaster. Nonetheless, it is not a coincidence if the number of natural disaster increases while the number of human activities increases. We play a major role on the vulnerability of natural disaster. The whole world is interconnected. Climate change doesn't just affect the atmosphere and the oceans but the earth's crust as well. ’’ said Professor Bill McGuire of University College London. He also added that â€Å"When the ice is lost, the ear th's crust bounces back up again and that triggers earthquakes, which trigger submarine landslides, which cause tsunamis†. According to experts, human activities influence the equilibrium of nature. We must begin to consider the consequences of greenhouse effect. We must begin to preserve our nature. We must begin to stop deforesting. We must begin to see life in green.In every consciousness of human beings, we must find an ecological thinking. Men, women, children, human beings of this planet, we must begin to recognize the alarming situation of our environment and together work to solve it. For the sake of our lives and for future generation, it is time we stopped ignoring our responsibility on the environment. Today, we can change and this will certainly serve as a milestone in our environment. Thank you We must stop pointing others, and see that our three other fingers are pointing ourselves, because we are the one who can change things.

Definition and Examples of the Bandwagon Fallacy

Definition and Examples of the Bandwagon Fallacy Bandwagon is a  fallacy based on the assumption that the opinion of the majority is always valid: that is, everyone believes it, so you should too. It is also called an appeal to popularity, the authority of the many, and argumentum ad populum  (Latin for appeal to the people).  Argumentum  ad populum proves only that a belief is popular, not that its true. The fallacy occurs, says Alex Michalos in  Principles of Logic, when the appeal is offered in place of a convincing argument for the view in question. Examples Carling Lager, Britains Number One Lager (advertising slogan)The Steak Escape. Americas Favorite Cheesesteak (advertising slogan)[Margaret] Mitchell enhanced the GWTW [Gone With the Wind] mystique by never publishing another novel. But who would be so churlish as to want more? Read it. Ten million (and counting) Americans cant be wrong, can they? (John Sutherland, How to be Well Read. Random House, 2014) Hasty Conclusions Appeals to popularity are basically hasty conclusion fallacies. The data concerning the popularity of the belief are simply not sufficient to warrant accepting the belief. The logical error in an appeal to popularity lies in its inflating the value of popularity as evidence. (James Freeman [1995), quoted by Douglas Walton in  Appeal to Popular Opinion. Penn State Press, 1999) Majority Rules The majority opinion is valid most of the time. Most people believe that tigers do not make good household pets and that toddlers shouldnt drive...Nonetheless, there are times when the majority opinion is not valid, and following the majority will set one off track. There was a time when everyone believed the world was flat and a more recent time when the majority condoned slavery. As we gather new information and our cultural values change, so too does the majority opinion. Therefore, even though the majority is often right, the fluctuation of the majority opinion implies that a logically valid conclusion cannot be based on the majority alone. Thus, even if the majority of the country did support going to war with Iraq, the majority opinion is not sufficient for determining whether the decision was correct. (Robert J. Sternberg, Henry L. Roediger, and Diane F. Halpern, Critical Thinking in Psychology, Cambridge University Press, 2007) "Everyone's Doing It" The fact that Everyones doing it is frequently appealed to as a reason why people feel morally justified in acting in less than ideal ways. This is particularly true in business matters, where competitive pressures often conspire to make perfectly upright conduct seem difficult if not impossible. The Everyones doing it claim usually arises when we encounter a more or less prevalent form of behavior that is morally undesirable because it involves a practice that, on balance, causes harm people would like to avoid. Although it is rare that literally everyone else is engaged in this behavior, the Everyones doing it claim is meaningfully made whenever a practice is widespread enough to make ones own forbearing from this conduct seem pointless or needlessly self-destructive. (Ronald M Green, When Is Everybodys Doing It a Moral Justification? ​Moral Issues in Business, 13th ed., edited by William H Shaw and Vincent Barry, Cengage, 2016)​ Presidents and Polls As George Stephanopoulos wrote in his memoir, Mr. [Dick] Morris lived by a 60 percent rule: If 6 out of 10 Americans were in favor of something, Bill Clinton had to be, too... The nadir of Bill Clintons presidency was when he asked Dick Morris to poll on whether he should tell the truth about Monica Lewinsky. But by that point he had already turned the ideal of the presidency upside down, letting arithmetic trump integrity as he painted his policies, principles and even his family vacations by the numbers. (Maureen Dowd, Addiction to Addition, The New York Times, April 3, 2002)

Computerized Management Systems Research Paper Example | Topics and Well Written Essays - 1250 words

Computerized Management Systems - Research Paper Example sharing of information such as lab results and patient information has been well facilitated between medical practitioners, clinics, healthcare providers and pharmacists. This tends to harmonize consultation process that improves the delivery of healthcare. The cumbersome nature of doctors in Emergency room(ER) that operate without computerized systems always delivers (Goldsmith, 2010) dismal performance as they have to work with manual student records. It is through the availability of interoperable tools that clinicians are well able to make sound decisions that improve their chances of saving lives and minimizing suffering. Through computerized management healthcare systems, its interoperability nature is able to provide clinicians with access to updated medical decision support. Furthermore they are capable to provide (Goldsmith, 2010) standard protocols to multiple medical situations. Clinicians and especially doctors will be better placed to select the protocol they find suitable and which can be revised from time to time to improve the standards health care practices. There are many types of computerized health care that can be adopted in any clinical settings. Common to these are electronic medical record systems (EMR). These are systems that provide for a paperless interoperable medical recording system. The present reality of these systems have been greatly favored on grounds of offering quality and cost effective means of handling medical information and data. Secondly we have the electronic healthcare record systems (EHS). This unlike the electronic medical recording systems (EMS), provides a means for which patient records are distributed across several institutions (Frans Turisco, 2008). This furthermore allows for knowledge and decision-support systems that improves quality and safety of patients care across different healthcare sectors. These are just but a few among several computerized healthcare systems that are used in the medical scene

Politics vs. Religion Essay Example | Topics and Well Written Essays - 500 words

Politics vs. Religion - Essay Example It is based on reason and practicability and seeks to improve the way and quality of life of the people. Politics is basically focused on the life here on earth on how to better it. Religion on the other hand is concerned on the life after our earthly existence. It seeks for the greater glory of God of whatever name it may call. It seeks to implement policy of what it believes to be consistent with divine mandate which could be impractical and counter-progressive. The classic example is the current debate in the Philippines where the Catholic Church is blocking the Reproductive Health Law because it believed it run counter to the Catholic teaching which is to go forth and multiply. This theological policy is impractical from a public policy point of view because higher population means more people to feed, shelter, educate not to mention that the resources needed to support overpopulation can take its toll to our already degraded environment. Such, the secular state is conceived to avoid this problem. According to Laborde, â€Å"the secular state is not a state committed to substantive atheism or to the marginalisation of religion from public and social life. It is, rather, a state in which citizens share a language – a secular language – for discussing political matters. So, religious believers can be secularists and secularists can also be religious believers†.   Baggini mentioned that secular state is â€Å"neutral with regards comprehensive world-views at its core, but relaxed about the expression of such views in the public square†. It meant that citizens can freely elect their mode of worship but cannot impose its theological belief on policies which concerns public life and government. Secular state can also prevent branding of certain religions. If there is a sectarian state which could be Catholics or

The Body Assignment Example | Topics and Well Written Essays - 250 words

The Body - Assignment Example 571). The notion of being in a pageant is like an obsession in the society, going beyond the bounds of schooling and social ethics, where most of them are geared towards socializing of womens bodies (Anderson-Fye, 2004, p. 572). The community’s perspective is inclined towards pleasing the tourists and many will do whatever it takes to look good to them by getting thinner bodies. This craze makes even parents encourage their daughters to get thinner and please the many tourists visiting the country (Anderson-Fye, 2004, p. 579). Further, the strip clubs frequented by tourists prefer thinner women and thus girls are encouraged to eat less to get better pay and recognition to them (Anderson-Fye, 2004, p. 580). The tourists are a motivation towards getting better body images as a promise of employment and other future career benefits like the threat of Kara. The extent of connectivity in the global scene has indeed influenced the bodily aspects of the people in the country. Most girls who have gone on trips in other countries have been influenced to take up their traits, in the example of the United States (Anderson-Fye, 2004, p. 586). Further, the interconnectivity through media has also influenced the body aspects of the people in the way that outside influences determine their attitudes towards body size (Anderson-Fye, 2004, p.

Commodity Paper Essay Example | Topics and Well Written Essays - 1000 words

Commodity Paper - Essay Example The Chinese used hand fans as coolant since time immemorial. In the 1800, American engineers made an attempt to create air conditioners as they had money and resources for doing this. The 20th century saw major development in this area majorly contributed by the discovery of electricity. Willis Carrier a 25 year old American invented the first model of air conditioning which was not designed for human comfort but was made to reduce humidity at his printing plant. It was made of mechanical unit that cooled air through circulating it in cooled water coils. He later added a centrifugal cooler to this unit greatly reducing its size. By 1930s, air conditioners were been used in offices, department and cars and this increased the workers productivity during the hot summer periods. This was a major development for Carrier Corporation which grew incredibly during these years. At some point the use of Air conditioning in the workplace was seen as an unnecessary luxury. However, evidence from several researches conducted showed that the use of air conditioning during the hot summers came with increased productivity. Organization therefore started getting the air conditioners for their offices in order to leap off benefits (Street et al 629). The air conditioners were not very common in homes with only 10% of the American homesteads using air conditioning. The rest of Europe and eastern countries slowly stated using the air conditioning mostly in the workplace. Outside work people still use the traditional methods of staying cool like dipping their underwear in iceboxes. Some of the popular air conditioning companies include Carrier Corps, Daikin Industries, LG and Samsung and lastly Haier, Midea and Gree. Carrier Corporation is the biggest layer in the market. This can be as a result of the fact that it was the pioneer in this industry and has therefore has the competitive advantage over the others that mushroomed after it was established. The company has established its operations in almost every part of the globe. It engages in the production of a wide varied range of products including indoor units, outdoor units, heaters of all kinds and HVAC equipment. It has several established brands such as the weathermaster, weathermaker, centurion, Byrant and Payne among others. Daikin Industries is based in Japan which is responsible for the creation of the Variable Refrigerator Flow HVAC systems. This is a special kind of system that is used to supply cooling or heating to a room depending on the demand. It can also provide cooling and heating simultaneously in different parts of a building. In order to get to its current position, the company has wielded to the wind of globalization. For instance in the year 2006, it acquired the OYL group company based in Malaysia. This expanded its scope and also increased the company’s brand giving it a stronghold in the market. Some of the brands associated with this company include the J& E hall and AAl (Am een, 72). Acquisition has made Daikin the second largest company in the production of air condition equipments after Carrier Corporation. There are other players in this industry in Japan and they include Sanyo, Toshiba, Mitsubishi and Panasonic. LG and Samsung are the third largest companies in this industry both based in South Korea. In a united effort to have a large market share in the globe,

Strategic Analysis Of Wholesale Company Costco Marketing Essay

Strategic Analysis Of Wholesale Company Costco Marketing Essay This report has performed a brief strategic analysis of the internal resources and external factors that affect Costco. The report includes an over view of the firms strategies using Porters five force model as well as a SWOT analysis of the firm. The report illustrates why Costco remains the Anti-Wal-Mart using aggressive scare tactics to achieve the lowest possible prices for its customers even if it means dropping high brand names. The report includes recommendations for the wholesalers, the main one being to carry on with their current successful strategies in order to maintain the fight for industry leadership and further their globalisation in to Eastern countries 1.0 Introduction to Costco Costco is a wholesale cash and carry, which operates through warehouses using a membership only service. The company sells high quality, private label merchandise at low prices to businesses buying for commercial use as well as individuals that are members of specific employment groups , for example NHS or government employees. The basis of the company is to achieve high sale volumes and rapid inventory turnover, offering a limited array of merchandise, with a wide product category at low prices (www.costco.co.uk). Additionally Costco operates customer services ranging from health insurance to financial planning. The main competitor of the company is Wal-Marts -Sams club within the US, although they have 200 more stores operating in ten more states than Costco , Sams club does not experience the same revenues. Yet there is still a constant battle for increased market share with newer entrants such as BJs Wholesale Club (Hughes, 2007). Operating internationally the company has divisio ns in the US, Canada, Mexico, UK, Taiwan, Japan and Korea, Australia and an internet site operational in the US and Canada. Some of the stores include pharmacies, food courts, opticians, photo centres, travel desks and hearing aid centres within the warehouses. The company also operates 307 petrol stations with some of the US and Canada stores. Named as the only company Wal-Mart fears James Signal (2004) of Costco has captured a breed of urban sophisticates, who trade up for exiting products and trade down to private labels of more prosaic products (Duff,2009). 2.0 Costco existing missions/strategies Costcos Mission Statement; To continually provide our members with quality goods and services at the lowest possible prices (www.findarticles.com) In order to sell at the lowest possible prices Costco implement various pricing strategies through bargaining with suppliers and only adding a maximum mark up of 14% to each product, even in cases where demand is high as CEO Signal stated you always give the customer the best deal'(Shapiro, 2004). Costco falls into the Overall Price Leadership category one of Porters four generic competitive strategies (Mitchell, 2001). Price leadership is achieved by implementing a successful strategy using continual exceptional efforts to reduce costs, without excluding services or products which customers perceive to be essential. There strategies include; ? Low advertising costs to keep merchandise price down, using word of mouth ? High employee wages to retain employees and reduce new staff that would require training ? Merchandise stock on pallets to reduce labour and allow for maximum sales ? Inventory system detects items that are reaching thresh hold for re order ? Just in time approach to reduce over stock, buying direct from manufacturers and sent directly to warehouses within 24 hours ? Provide low prices through volume buying ? Willing to change manufacturers to gain the best possible price on a product 3.0 Strategic Management Costco Strategic management shows an ability to develop and sustain competitive advantage, resulting in of added value to their brand (Ramachandran et al, 2006). Illustrated by Costcos rise in net income by 1.1% to $266 million and revenue soared to $71.4 Billion compared to Sams club at $46.8 billion and BJs at $10 billion for the first fiscal quarter ended Nov 22nd 2009 (Business News, 2009) compared to Wal-Mart net sales which increased by 1.2%. The just in time approach implemented by the company means products are sold for cash before the payment to the suppliers is due ,creating a high operating cash flow. This operating advantage improves Costcos working capital and efficiency, resulting in a long lasting value difference in the product, compared to the competitors and as perceived by the customers (Duncan et al, 1988). 4.0 Porters Five Forces The nature of competition in an industry rely on five forces including; the threat of new entrants, the bargaining power of new entrants, the bargaining power of customers, the bargaining power of suppliers and the threat of substitute products or services (Porter, 1979). These are all competitors that may be more or less prominent or active depending on the industry. A companys awareness of Porters five forces can allow the organisation to stake out a position within its industry that is less vulnerable to attack (Bruton, 2008). 4.1 The threat of new entrants- medium threat There are many potential new entrants into the industry, which could pose as a threat including, wholesale clubs, discounters and hypermarkets such as Aldi and Netto, which are both limited range discounters. Other large existing wholesale competitors such as Wal-Mart could gain market share through acquisition giving them new resources. However, barriers to entry in to the wholesale food industry are relatively high, as huge costs would be involved in imitating established distribution networks, brand name and financial capital that Costco have established. Furthermore it is unlikely customers will switch to a competitor when they have already paid a yearlong membership fee (Costco reported 85% of cardholders renewed their membership in 2009, www.phx.corporate-ir.net). 4.2 Bargaining power of suppliers-low/medium threat The bargaining power of Costco sells to many business owners, the power over their suppliers is very high, as suppliers are forced to cut prices to lessen the risk of them losing their contract. Costco have a small range of brands for each product, yet sell high quantities. They could be losing a large amount of sales compared to Wholesalers like Wal-Mart, whom give customers a larger amount of choice and therefore spread their sales between suppliers. Furthermore Costco have proven they are willing to lose even major brands to improve their leverage, margins and lower prices, forcing suppliers to compete amongst themselves and with the wholesalers cheaper own brand products. Highlighted through Costcos most recent decision to stop selling Coca-Cola in a pricing dispute due to growing power of private labels, by using details received from loyalty cards retailers are more aware of which brands to keep and lose (Neff, 2009). 4.3 Bargaining power of customers- low threat According to Bruton (2007) the threat is low because there is only a small concentration of wholesale buyers, predominantly middle class consumers, small business owners and families. The latter two however have a greater power over the higher and middle class customers as they would buy to satisfy needs rather than luxury items. They are likely to resort to finding alternative stores such as competitors to get what they want at the price they can afford to pay for their regular purchases, due to the growth and alternative availability in discount stores. 4.4 The threat of substitute products- low threat The threat of substitutes limits the profit potential of the wholesale industry by identifying the effectiveness of volume of sales at a particular price level. Substitutes include specialised stores, for instance The Home Depot in America and BQ in the UK competing against the non-food sales through discounting as well as hypermarkets. For these reasons, the threat of substitutes is low for the wholesale notion. However, there is an increased threat to particular sections such as furniture and electronics especially because supermarkets are now selling a wider array of products for example Tescos. A further threat is e-commerce businesses and sites such as EBay focusing on the customer directly (Bruton, 2007). 4.5 Rivalry among competitors-medium threat Rivalry between competitors in the growing wholesale industry is particularly low because the three main competitors concentrate on different consumer groups. Furthermore price wars are minimal due to the lack of advertising with the rivals especially Costco. However as Costco is gaining strength through globalisation, there are different levels of threats in particular countries. 5.0 SWOT analysis The basis of strategic management is the notion that strategy creates an alignment between an enterprises internal strength and weaknesses as well as its opportunities and threats (SWOT) in its external environment (Andrews, 1987). The following table illustrates alignments factors within and outside of Costco; 6.0 External factors Focusing on the external, broader environment in which the company operates it is clear the next stage in the Costco globalisation process would be expansion. Due to the fierce market in the US and saturation a large opportunity for the company would be to enter the Chinese and Eastern European market and according to Baker (2001) Globalisation of the markets is at hand. Competitor Wal-Mart have already entered the fast growing market in China through purchasing 35% of the recognised hypermarket- Trust-Mart. The alliance benefits Wal-Mart , gaining expertise in operations and logistics and allow Chinese consumers to build trust with their brand name- an important part of their culture. Globalisation forms markets where economies of scale lead to reduction of costs and prices according to Baker (2001). Therefore, Costco may have to adapt their strategy when entering new countries due to the barriers of entry; it would be difficult to compete with local companies that are already established as well as suppliers to cut prices as low as they do in the West. The main threat to Costco currently is online speciality stores, which can compete through lower operating costs and manufacturing abroad thus increasing the power of existing buyers. The economic slowdown in 2007 with the credit crunch attracted more customers to the company due to its low prices and bulk products which allowed customers to stretch their money in the economic crisis enabling sales to grow by 13% by 2008. However the net income still decreased by 15.3% by 2009 as of the weakened economy. Even fiercer pricing strategies reduced the impact of the recession by reducing costs on a range of popular products two weeks before the reduction came through anticipated from manufacturers. Thus allowing them to get ahead of competition by taking advantage of the opportunity to attract customers through surrendering their profit (Duff, 2009). 7.0 Conclusions From carrying out the report on one of the leading wholesale suppliers it is clear they refuse to buy from suppliers that are not willing to pass on the reduction in manufacturing costs on to Costco. They are willing to remove high named brands from their shelves if they think they are being charged too much for the product. Through these publicly made choices it seems clear that Costco are on the customers side when it comes to prices, and are willing to lose profit to satisfy their customers. Both the Porters Five Forces Model and the SWOT analysis identify the main internal and external threats to the company, the highest threat of all being the power of suppliers. Costcos strategy of merging high wages with innovative ideas, and low cost products highlights that consumers, workers and shareholders can all benefit from a cost-leadership strategy. 8.0 Recommendations ? Continuation with their current successful pricing strategies of low prices and high volumes in order to maintain barriers against buyer power, supplier power and new entrants. Porters low cost leadership will also allow growth in revenues from further international expansion. ? The main threat to Costco currently is the threat of substitutes especially in discount stores and hypermarkets and the alternative to this is online speciality stores which can compete through lower operating costs and manufacturing abroad thus increasing the power of existing buyers. ? In order to compete with the threat of e-commerce businesses a further development in the online sales capability is likely to increase the companys strengths. Cannibalisation is unlikely to occur until the industry becomes completely saturated in the US in which case the company can then be ahead of competitors through the internet or through global expansion. ? Subsidiaries or Joint venture are a possibility as in Mexico where the 31 warehouses are 50% joint ventures, this strategy may benefit within the foreign Indian and Chinese market, to allow for a better integration and brand loyalty ( www.slideshare.net). The firm is likely to have the logistical capabilities to enter the Chinese market as they have entered nearby Japan successfully, and some networks would be partially formed through transportation. ? More strategic alliances with manufacturers as with Kirkland in expanding countries to gain trust from customers, enabling them to recognise brand names and build loyalty 9.0 References Andrews, K.R (1987), The concept of Corporate Strategy, Homewood: Irwin Baker.M.J Critical perspectives on business and management, Routledge, London Bruton. A, (2007) Five Forces Analysis, www.books.google.co.uk/books?id=9lmR75vPpEACprintsec=frontcover#v=onepageq=f=false accessed 21/02/10 Costco Financial Report 2009, www.phx.corporate-ir.net/phoenix.zhtml?c=83830p=irol-reportsannual, accessed 16/02/10 Ducan, W.J, Ginter, P.M Swayne, L.E (1998), Competitive advantage and internal organisational assessment, Academy of Management Executive Duff. M (2009) Costco Surrenders Profits To Make a Point www.industry.bnet.com/retail/1000461/costco-surrenders-profits-to-make-a-point/ accessed 19/02/10 Hughes, M.T (2007) Costco wholesale strategic analysis, Washington College Business Management Ireland, R.D, Hitt, M.A Simon, D.G (2003), A Model of Strategic Entrepreneurship: The construct and its dimensions, Journal of Management, 29, 963-989 Mitchell. R.C, (2001), Strategy Formulation, TAOFS Formulation, www.csun.edu/~hfmgt001/formulation.doc, accessed 20/02/10 Neff, J (2009) From CVS to Costco, retailers put the screws to brands, Advertising Age,Business Source Premier, 11/30/2009, Vol. 80, Issue 40 Porter. M.E, (1979) How competitive forces shape strategy, Harvard College, Harvard Business Review Porter, M.E, (1985), Competitive advantage: creating and sustaining superior performance, New York: The Free Press Prahalad, C.K Hamel, G. (1990), The Core Competence Of The Corporation, Harvard Business Review, 68, 79-91 Ramachandran, J.M Sud. M, (2006) Strategic Entrepreneurship in a Globalising Economy: Evidence from Emerging Economies, IIMB Management Review, 28, 291-302. Trout. J, (2004), Trout on Strategy: capturing mindshare, conquering markets, McGraw-Hill (Jan 14th 2008) Food industry , BNET UK, www.findarticles.com/p/articles/mi_hb3235/is_1_25/ai_n29402690 accessed 16/02/10 Shapiro, N. 2004. Company for the people. Seattle Weekly, December 15. Retrieved from www.seattleweekly.com/ generic/show_print.php on 15/02/2010. www.slideshare.net/guestce0202a/costco-strategic- plan accessed 20/02/10 www.findarticles.com/121753md5=91af14cebe7ede4/c72/169594b2badc8b accessed 20/02/10 www.costco.com accessed 21/02/10 Contents Page Executive Summary 1.0 Introduction to Costco 2 2.0 Costco existing missions/strategies 2 3.0 Strategic Management 3 4.0 Porters five forces 3 4.1 The threat of new entrants 3 4.2 Bargaining power of suppliers 3 4.3 Bargaining power of customers 4 4.4 The threat of substitute products 4 4.5 Rivalry among competitors 4 5.0 SWOT analysis 5 6.0 External Factors 6 7.0 Conclusion 6 8.0 Recommendations 7