Bba 360 Mid Term Exam - 1773 Words

BBA 360 Mid Term Exam 1. What were the traditional 4 functions of mgmt developed in 1912 by Fayol? What functions do you think are effective in the 21st century? The traditional 4 functions of management by Fayol are; Planning, Organizing, Leading, and Controlling. Planning is the step where an action plan is created based on the organization and team goal, objectives are created and deadlines. Organizing is the step where team roles, responsibilities and task are assigned. Leading is the step where managers motivate, and encourage team members to achieve the objectives and goals of the company. Effective leaders motivate and influence others to achieve their work. Controlling is the step where managers measure the achievement of objectives and goals set, and to ensuring that the organization is operating successfully. In the 21st Century, I believe that all the traditional 4 functions are essential for the success of a company. Any function is less effective than the other one. In order to have an effective management and leadership the 4 functions are essential to accomplish the objectives and goals of the organization. 2. What are Tuckman’s 5 Stages of Group Development? Tuckman’s 5 Stage of Group Development are; Forming, Storming, Norming, Performing, and Adjourning. Most teams follow this 5 stages for high performance. Forming is the stage where people get to know their coworkers and team roles and responsibilities are not clear. Storming is the stage where conflictShow MoreRelatedMarketing Mistakes and Successes175322 Words   |  702 Pagestaught a variety of undergraduate and graduate courses in management, marketing, and ethics. Prior to that he taught at the University of Minnesota and George Washington University. His MBA and Ph.D. are from the University of Minnesota, with a BBA from Drake University. Before coming into academia, he spent thirteen years in retailing with the predecessor of Kmart (S. S. Kresge), JCPenney, and Dayton-Hudson and its Target subsidiary. He held positions in store management, central buying, and

Essay Changes in American Society 1920s - 1228 Words

Republicans dominated the 1920s political scene. During this time period, many changes occurred in the United States. Both culturally and economically. This period is known as the roaring twenties. Republican Warren G. Harding, an obscure republican from Ohio, won the election of 1920. During this time period, republicans held the position of being against the admittance of the United States into the League of Nations. During his ineffective presidency, he helped streamline the budget, approved measures assisting farm cooperatives and liberalizing farm credit. After his presidency however, many scandals arose. Among them was the Veterans Bureau scandal in which the director of Veterans Bureau, Charles R. Forbes, was†¦show more content†¦It brought about yellow dog contracts, in which employee agrees not to join a union. And it also guaranteed trials for strikers held for contempt of court. The biggest change during the twenties was the social scene. In the 1920s there was a huge boom in consumer products. Due to consumerism, patterns of consumption and leisure made the 20s a distinctive decade. One of the biggest pushes for materialistic desires was advertising and the popularity of movies. Whether rich or poor, Americans began purchasing goods for pleasure as well as for need. Americans bought appliances, mass-produced automobiles, cosmetics, and fashions. What brought this huge boom in consumption was the introduction of installment buying. Installment buying was often utilized in the purchase of automobiles. Soon this buy now, pay later concept applied to buying radios, sewing machines, and refrigerators. The 1920s also saw the growth of the motion picture industry. It was highly influential and helped shape popular culture by promoting the diffusion of common values and attitudes nationwide. Soon movie studios began building elaborate movie palaces in cities, and by 1930, the movie attendance grew to about 115 million. Movies performed many purposes. It created national trends in clothing and hairstyles and even served as a form of sex education. Another form of entertainment spawned around this time period wasShow MoreRelated The Roaring Twenties Essay836 Words   |  4 Pagesof prosperity and change. The United States experienced a recession that was followed by a period of unlimited prosperity. Although the United States encountered both positive and negative experiences, it proved to be very influential in the future. The 1920s were definitely Roaring in more ways than one. There were major changes in American Society during the 1920s that took place. Many new industries emerged during this decade that influenced society and the American way of life. EvenRead MoreWomen Of The 1920 S 19391305 Words   |  6 PagesWomen of the 1920’s-1939 The 1920’s was an era of dramatic political and cultural change, where many Americans lived in cities rather than farms. Many inventors came to be noticed as new cars were invented and as music entered the entertainment industry. A new style of music was invented mainly in the African American community, creating the Harlem Renaissance; which was an evolution of music and entertainment in Harlem, New York City. The women of America began to evolve in the 1920s, adding newRead MoreThe Roaring 20 s Era Of Growth And Reform1309 Words   |  6 PagesThe era of the 1920s, also known as the Roaring 20’s, was a revolutionary time in which radical changes struck the American nation, drastically increasing advances in society and economy. New and different forms of dance, music, clothing, behavior, and lifestyle were developed nationwide. The Antebellum Period in the late 1700s increased rebellion, similar to the Roaring 20’s era of growth and reform. As this time per iod brought profound changes, conflict, cultural excitement, and experimentationRead MoreSimilarities And Differences Between The 1920s And 1950s908 Words   |  4 PagesThe 1920’s were a very important era in America for better or worse. There were many issues in relation to race and how people of different ethnic groups were treated. African American had a cultural rejuvenation that being the Harlem Renaissance. The advent of the Ford Model T change the way how people traveled. Many may say an era like the 1950’s were highly comparable. Race related issues were on a decline as America as whole sought to be more accepting and the oppressed started to speak out onRead MoreImpact Of Sports On Society1371 Words   |  6 Pages1920’s Impact of Sports on Society The 1920’s were an important time period in America’s history. The horrors of World War one were at long last over and society was collectively ready to move on to greener pastures. Americans proceeded vigorously to make life feel more refined than before the war. From the mass production of automobiles and the automation of everything imaginable to the rebirth of African-American culture and fine arts, the world had drastically changed. One such instrument inRead MoreThe 1920 S1718 Words   |  7 Pages The 1920’s were mainly known for the beginning of the Harlem Renaissance, Prohibition, and the generation where women were guaranteed the right to vote. The 1920’s has been argued to be either very conservative or liberal, but it can go either way. Although the 1920’s are conservative because of economic reasons involving immigration, the 1920’s are liberally revolutionary because of cultural changes with women and religious changes from th e Scopes Trial. Granted, the 1920’s were majorly conservativeRead MoreThe Great Depression1731 Words   |  7 PagesThe 1920’s was a decade of discovery for America. As mentioned in â€Å"who was roaring in the twenties? —Origins of the great depression,† by Robert S. McElvaine America suffered with the great depression due to several factors but it managed to stay prosperous at the end. In â€Å"America society and culture in the 1920’s,† by David A. Shannon there was much more to the great depression. It was a time of prosperity an economic change. Women and men were discovering who they were and their value to societyRead MoreThe Great Gatsby By F. Scott Fitzgerald1210 Words   |  5 Pagesconsidered the 1920s as a transitional period that shifted Americans society from traditional values to a new era of modernization. During this time, the economy boomed, which made the 1920s one of the most prosperous era in the U.S. The Roaring twenties was associate as the era of consumerism, the prohibition and the disillusionment with the American dream. Many historians and Literature scholars recognized F. Scott Fitzgerald s novel, The Great Gatsby, as the iconic book of the 1920s. In the novelRead MoreModernism : The Age Of Rebellion Essay1228 Words   |  5 Pages Modernism was a progress to society, in many ways it helped shape and form what we call the western culture. Modernism was a time period during the 20th century that promoted changes to the Western culture. Many of the changes occurred in the attitude and functioning of society, modernism is often referred to the age of rebellion. During this time many people were rejecting the social norms that have been practiced for years and finding more about their own individuality. Modernism was not onlyRead More Response to The Damned and the Beautiful: American Youth in the 1920s 1408 Words   |  6 PagesPaula Fass’s The Damned and the Beautiful: American Youth in the 1920s delves into the social and cultural climate of the 1920’s middle-class youth in America. Fass observes the multidimensional dynamics of the post-World War I society as citizens adjust to pertinent matters such as industrialization, prohibition and immigration. Amidst the ongoing social, political and eco nomical issues of the early twentieth century, youth played an active role in contemporary life. Adolescents responded to issues

Health Policy Role of the Proof in the Making of Health Policy

Question: Analysis about the Health Policy and Planning? Answer: Introduction: This study sets out proper framework for examining the function of research evidence within the health policymaking. This framework would be used for exploring ways in which, and reasons why as well as the time when national ministries regarding health utilization research proof in process of the health policy-creating, as well as which factors plus conditions support or hinder the evidence use. Additionally, it also analyzes as well as examines the ways in which role of the proof in the making of health policy could be compared amid nations. Proper theoretical framework also sets out here all the objectives and aims towards helping people to better understand about an institutional loom that can be helpfully applied towards exploring the differences within policy procedures in nations at vital government level, as well as whether such differences within processes also translate into dissimilarities in use of the research evidence within the making of the health policy (Brewah, 2009) . And through such people also aim towards contributing to literature upon international assessment in the public administration as well as public policy. While properly established within the comparative public strategy, institutions also have been underutilized because an investigative lens towards understanding factors which influence things like whether, why plus how research proof is utilized in the making of the health policy. Study on evidence utilization within the health policy also suggests that extent till which the policy-makers actually draw upon proof varies amid policies plus settings, as well as is prejudiced by the variety of factors allied with context as well as politics of the policy-making (Scott et al., 2003). But researchers of health policy often discover it difficult towards conceptualizing what they actually mean by the context otherwise politics. Such a task on such a topic thus seeks to discover whether a superior understanding of the institutional factors could help shedding the light upon context as well as politics of the use of evidence. The present reluctance towards use of the institutional analysis fo r explaining the differences within practices of the evidence utilization in a proper cross-country viewpoint might also be explained through divisions amid the academic disciplines as well as their dissimilar preferences regarding both foci on research as well as theoretical frameworks worn to examine all these. Institutions also are vital concepts within the political science as well as properly established like a path of analyzing all the political makings of decision and other processes (Coleman and Nicholl, 2001). Discussion: Public programs actually have absorbed very vast and huge quantity of money into health enhancement, social welfare and education, as well as justice. Moreover, result of programs is yet actually unknown whether to perk up lives of people or not as well as experts information is also not used within the policy choices. Gaps amid the research of the effectiveness plus policy implementation also are clearly demonstrated. Such gaps occur just because makers of the policy have dissimilar priorities. Some researchers have argued that ideological blinders, financial pressures in governmental financial plan as well as their self campaign coffers and also electoral realities as well as bureaucratic inertia, plus a host of some other factors which could make good information irrelevant, manipulate policy maker within the decisions making. Researchers also have also stated about the political concerns that it leads to some immune towards facts within the policy makers. Some people also said th at process of creation of public policies could be complex as well as messy plus policies are never merely technically sound, yet even politically as well as administratively practicable (CREESE, 1991). The most initial step of the process for making of the health-policy is the identification of the problem as well as agenda setting. In such stage, public issues can be political policy and agenda if problems are actually converted to the political issue. Evidence-oriented public health also enables to manipulate policy makers within the decisions of public health as evidence-based live out uses a proper form of evidence as well as focus upon clear reckoning in process of appraisal as well as evidence explanation. Evidence-oriented practice rises the evidence from a research that encompass very wide assortment of research for public health. Many types of researches which utilized evidence-based and proper proof oriented public health like descriptive and taxonomic, plus analytic, in terpretive as well as explanatory plus evaluative were seen to be very successful. Evidence as well as information also contribute to the making of the policy process via research plus consultative procedure or even published documents otherwise reports. However, expanding upon earlier arguments some researcher argued that actually evidence-based decisions of public health could be hold up by three forms of scientific confirmation. Type 1 is that something has to be done which is recognized by reasons as well as magnitude of the disease, severity as well as preventability. Second type of evidence demonstrates that which involvement or policy must be performed that might also effective exact intervention towards promoting the health. Type 3 confirmations describe the way on which something must be performed that how as well as under what situations interventions were applied plus how they actually were received. Such type of confirmation is useful within the decisions taken for publi c health because they might also improve quality as well as availability of evidence (Davis, 1987). Evidence intended for evidence-oriented policy could be recognized in two forms, quantitative evidence as well as qualitative evidence. In reality both of these forms are vital for evidence that are policy relevant. Quantitative evidence intended for making of policy, that provides information and data within the numerical quantities, gets collected from several sources, like the scientific data and information in the journals that are all peer-reviewed, public health observation systems, otherwise evaluations of people programs otherwise policies. Quantitative confirmation, for instance occurrence, incidence as well as cumulative incidence, might also express magnitude plus severity of the public health issues through regularity or the proportion as well as rates measurements yet this form of evidence gives little know-how and less understanding of the reasons why few relations exists. On other hand, the qualitative evidence otherwise non mathematical data might be undertaken from p rocesses like participants, assemblage interviews, and otherwise focus sets. Such qualitative evidence might also influence policy discussions, setting priorities plus proposing the policy answers by telling the persuasive stories. Moreover, as per Rychetnik et al (2004) a qualitative evidence which is expert choice is positioned on lowest phase in levels of the evidence and hierarchies as well as identified like least reliable type of the evidence on effectiveness of the interventions. Nonetheless, combination amid two forms of the evidence leads towards a stronger influential impact within making of the policy procedure than utilizing only single type of the evidence (Delcheva, Balabanova and McKee, 1997). Evidence-oriented practitioner must also build brutal evidence towards convincing the public health makers of the policy. It has been proposed by several researchers that three concept exist towards achieving an extra evidence-oriented loom towards policy of the public health. First, the scientific data and information upon programs plus policies is needed to make extra effective within health endorsement. Second, mix amid the information about the evidence-based making of policy from peer-reviewed journals and realities of very specific entertainment of the real-world are needed to decipher science towards practice. Third is proof of the effectiveness of interference that must be learned in varied-scale constantly at state as well as local levels (Rutten and Freens, 1986). It is also suggested that evidence must show the public health saddle, identify precedence of the issue over several others, current relevance at regional level, demonstrate benefits as well as harm from the invol vement, clarify issue through how much populace lives are exaggerated, plus estimation of the cost of the intervention. Analysis: In article instance that is related to HBV immunization policy within US, this is obvious that policy also was based upon convincing the evidence, in such case and was an epidemiological information and data. As per these data that were taken from several sources, like society for cancer within America and the centers for any disease control as well as Prevention demonstrated that the chronic HBV contagion is also responsible for majority of the morbidity related to the HBV and the mortality. Few quantitative evidence also were provided like 1.4-2 million (0.4%) populace had persistent HBV infection. This policy even relied upon many other winning policy interventions that might also produce same result if HBV immunization also was implemented within the population. CDC even reported that occurrence of the acute infection of HBV has decreased to some 80% which also was largely because of universal programs for vaccination intended for children. Trait of the HBV infected populace was even identified like 2.7-11% all among injecting the drug users. The evidence convincingly demonstrated that there existed some or other correlation amid the HBV as well as HIV infection. Natural past of disease even clearly recognized led towards assumption which HBV vaccination also was vital for the community (Donaldson and Gerard, 1989). Next phase of process for making of the health policy is in reality the formulation of the policy. In such a stage, policies also are devised otherwise changed to some novel policies. Formation pahse, which also is referred to the policy design otherwise development, precise attention would be supplied when the policies are also examined regarding issues. As per researchers like Brownson Stamatakis (2009) the making of the health policies within public health carry out is multifaceted and also depends upon assortment of the scientific, financial, social, as well as political forces. Moreover, vast quantity of people also wants policy as well a s practice to get relied upon best systematic evidence. Also maximizing the effectiveness of the policy as well as efficiency depends upon evidence base. On other hand, the policy makers need a sensible as well as justifiable policy answer. Therefore, health public carry out must develop a very convincing message on the basis of study evidence towards explaining the policy makers the ways for intervention that might solve problems of the public health. Towards developing the policy formulation, study evidence must be reviewed as well as evaluated prior to getting proposed to the policy makers. Main objective and aim of research evaluation actually is to establish degree of the credibility which is validity plus dependability of the information as well as usefulness like the relevance plus the generality within a diverse context. Systematic Reviews as well as Critical Appraisal also are needed in the process of evidence review as the guide to comprehend research processes. Methodical review accomplishment leads towards the practitioners as well as policymaker to comprehend all of the relevant data and information, the ways in which evidence was gathered as well as assembled, plus ways through which conclusions in addition to recommendations speak about information (Gaal, Evetovits and McKee, 2006). Then, result of the evidence review would be incorporated within the social consideration that also is obtained from all the practitione rs, makers of the policy plus customer to produce the evidence on the basis of suggestions. Via the methodical appraisal of the research, the actual public health carries out enables to display effectiveness of the interventions on the basis of the available evidence. In some other words, evidence-oriented recommendations also are on the basis of the nature as well as strength of evidence. Additionally, recommendations must be evaluated regarding balance of the advantages as well as disadvantages otherwise benefits of the interventions should be considered against costs. Moreover, systematic review even tends to carry a narrow plus regressive understanding of nature of the evidence that leads to keep out a varied range of study-based data plus professional knowledge that might be vital to development of the policy. Thus, mixes amid the systematic review as well as narrative appraisal might bring believable evidence other than the methodical review alone (RUSSELL, 1996). It is also obvious within article instance that recommendation of the HBV immunization within US was on the basis of previous study evidence. If any study is adequately good, it would confirm as well as quantify causal relationship amid intervention as well as its belongings where such a relationship exists. A proper and good research would also help people to understandthe reasons whyan involvement seems to be very effective or useless. It also has very long been understood thatthe policy for public health, in type of the laws, regulations, as well as guidelines, also has a philosophical effect upon the health status. Such as, in the review of some great achievements of the public health of 20th century,every single study was prejudiced by the policy alterations like seat laws regarding belt otherwise regulations the govern the permissible place of work exposures. Because along with several decision-making procedures within the public health carry out, formulation of the health policies also is very complex as well as depends upon a varied scientific, financial, social, as well as political forces (Nyakunu and Rogerson, 2 014). Implementation of the policy for evidence-based is getting encouraged within every public sector, counting health care, within several developed nations (Gpffarth and Henke, 2013). Although utilization of the evidence-based carry out started within the medicine and its influence now is seen in all the public health, carry out in several nations is being distorted by the medicine which is evidence-based, as well as an alike transformation within the health scheme is greatly needed. In United Kingdom as well as some other developed nations much concentration has been actually paid to role of the evidence could have in enhancing and improving the health policy, yet there is less research upon progress of the policy that is evidence-based in nations that are still developing. In addition, fields of the public health plus the care intended for people along with the mental illness also are rarely analyzed to determine extent of continuation of the policy that is evidence-based. Evidence-based and evidence oriented decisions upon value as well as applicability of the intervention which is drawn on the knowledge of effectiveness of the identical, similar otherwise analogous involvement, usually which is carried out as well as evaluated within a dissimilar setting at some different time. Towards assessing transferability of the evidence related to the intervention data and information is also required upon the intervention and the assessment context, as well as relations amid intervention as well as its context. Some major restriction of the conventional appraisal criteria also is their inattentiveness to sufficiency of these contexts of evidence. The public health intrusion is rarely the standard package. Towards assessing the transferability, data and information is also required on multiple elements of the intervention. This must also include all the details about design, growth and release of several intervention plans and strategies. Data and information is even needed upon characteristics of populace for whom intrusion was effective, as well as characteristics of all those intended for whom this was fewer effective otherwise even damaging. For several interventions, understanding and knowledge of aspects which influence the sustainability as well as dissemination would also be extra vital and important. Such factors might also be intrinsic to path of intervention plans and strategies were also delivered, otherwise related to background in which they also were implemented. The accessibility of any such data and information is the marker of quality of the evidence upon interventions of the public health (Leys, 2003). Background factors generally interact along with the interventions, still simple interventions like educational carry out and programs.Consequence modification might also arise through elements of the intervention like, skill as well as experience of professional and expert public health employees responsible for particu lar intervention, otherwise context for instance, cultural individuality of community within which intervention also is studied. All the interactions amid the interventional as well as contextual elements can also have some vital implications. Initially, they also are probable to influence transferability of intrusion as well as they even make an evaluation of the transferability extra difficult. Secondly, the interactions deeply complicate all the attempts to group the outcomes of several dissimilar studies (Kiil, 2012). Conclusion In conclusion, the evidence-oriented public health also is vital in the making of the policy for public health because the evidence-based loom also enables towards providing the policy suggestion on the basis of convincing the evidence brought in from the rigorous study. Since several determinants also influence the public health, psychoanalysis of the quality as well as quantity evidence even is indispensable to induce policy makers within the identification of the policy priorities as well as best public health interference. Such an essay even suggest that earlier as well as better scientific data and information might also influence the public assumption within the public health that also leads towards supporting the evidence-based making of the policy in the public health involvement. Actually there exists a substantial gap amid what research demonstrates is effectual as well as policies which are endorsed plus enforced. Proper definition of the policy is generally very broad, co mprising of laws, regulations, as well as judicial rulings in addition to the agency guidelines as well as priorities of the budget.In very systematic investigation of the model public health regulations such as public health rule or personal policy which is publicly suggested by minimum single firm for acceptance by the government bodies otherwise by the specified confidential entities. Most general model laws actually were intended for the control of the tobacco, injury prevention, as well as school health, while least general enclosed topics comprised of hearing, and prevention from heart disease plus also public health communications, as well as rabies control. The researchers are most probable to control policy development via a comprehensive procedure of the communication as well as interaction. In a nutshell here are all the details related to the need and importance of evidence in the policy making for the health care issues and many other aspects and programs related to the health care and interventions regarding the same. This study will help the reader to properly understand all the facts and details and data as well as all information regarding the utilization of proper evidence based and proof oriented study for formulation of any current health care and health considering strategy plus plan as well as policy. References Brewah, H. (2009). Policy formulation and implementation. Primary Health Care, 19(2), pp.35-38. Coleman, P. and Nicholl, J. (2001). Influence of evidence-based guidance on health policy and clinical practice in England. Quality and Safety in Health Care, 10(4), pp.229-237. CREESE, A. (1991). User charges for health care: a review of recent experience. Health Policy and Planning, 6(4), pp.309-319. Davis, K. (1987). Research and policy formulation. Health Policy, 7(3), pp.295-296. Delcheva, E., Balabanova, D. and McKee, M. (1997). Under-the-counter payments for health care: Evidence from Bulgaria. Health Policy, 42(2), pp.89-100. Donaldson, C. and Gerard, K. (1989). Countering Moral Hazard in Public and Private Health Care Systems: A Review of Recent Evidence. Journal of Social Policy, 18(02), p.235. Gaal, P., Evetovits, T. and McKee, M. (2006). Informal payment for health care: Evidence from Hungary. Health Policy, 77(1), pp.86-102. Gpffarth, D. and Henke, K. (2013). The German Central Health FundRecent developments in health care financing in Germany. Health Policy, 109(3), pp.246-252. Kiil, A. (2012). What characterises the privately insured in universal health care systems? A review of the empirical evidence. Health Policy, 106(1), pp.60-75. Leys, M. (2003). Health care policy: qualitative evidence and health technology assessment. Health Policy, 65(3), pp.217-226. Nyakunu, E. and Rogerson, C. (2014). Tourism SMMEs and Policy Formulation: Recent Evidence from Namibia. Mediterranean Journal of Social Sciences. RUSSELL, S. (1996). Ability to pay for health care: concepts and evidence. Health Policy and Planning, 11(3), pp.219-237. Rutten, F. and Freens, R. (1986). Health care financing in the Netherlands: recent changes and future options. Health Policy, 6(4), pp.313-320. Scott, T., Mannion, R., Marshall, M. and Davies, H. (2003). Does organisational culture influence health care performance? A review of the evidence. Journal of Health Services Research Policy, 8(2), pp.105-117.

Narrative Technique in Gullivers Travels free essay sample

Despite the obvious satirical elements in this text, Gullivers unreliable narrative voice is a satire within itself. Mocking the travel narratives contemporary of his time, Swift utilizes the narration of Gulliver in order to criticize the naive and gullible English men and women who read travel narratives as factual documents despite the overt Royalist paraphernalia and overly descriptive aspects. The text commences with A Letter from Captain Gulliver to His Cousin Simpson, creating the framework of Swifts satire of contemporary travel documents. Within the very first sentence of this letter Gulliver already states that he urgently published this very loose and incorrect account of [his] travels. This statement signals to the reader that Swift is purposely conveying his narrator as unreliable, and furthermore, he writes I do here renounce a paragraph about her Majesty the late Queen Anne, of most pious and glorious memory. The statements conjointly set up Swifts satire of the travel narrative with both elements of loose and incorrect travel accounts, as well as a parody of Royalist paraphernalia. We will write a custom essay sample on Narrative Technique in Gullivers Travels or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The writing flows along as the narrators thoughts and memories surface within his mind, with some ideas sparking new ones, which leads to a chain of connected clauses. This style gives the writing a diary or travelogue like quality, where one continues the train of thought unabated. Another particular style found in the writing is the deadpan explanation of details, especially quantitative details. The narrator rarely elaborates on how he is feeling or thinking, but supplies the reader with an abundance of facts and figures of his surroundings and situation. The unreliability of the narrator runs throughout the text, and is presumably Swifts method of satirizing the unreliable narrations of English traveller’s accounts of their own travels to new lands. In Part I, A Voyage to Lilliput, Swift writes that when Gulliver first arrived upon Lilliput he conjectured [it] was about eight oclock in the evening was extremely tired drank [brandy] and slept above nine hours. The most intriguing aspect of this section is that Swift conveys his narrator as overly exhausted, drunk off of brandy, and delirious from his swim to shore; therefore, Swift is purposely setting up a narrator who is obviously not in a state of mind where his perception is unclouded. Swift could possibly be satirizing the delusions of the English travellers who were writing back to England at the time, mocking that these captains were also drunk and delirious from their travels, and they quite possibly could be imagining the wonders that they described. Anyone who has read Samuel Taylors The Rime of the Ancient Mariner is aware of the effect that the desolation of the sea can have of ones psyche. Swifts inclusion of exceedingly exact measures and time frames is also notable in his attempt to satirize the travel narratives. For example, the narrator was aware of the exact time of day, and exactly how long he slept in the previous quotation. Furthermore, Gulliver narrates an entire paragraph concerning the description of the ancient temple in which he was to stay in Lilliput which exhaustively explains exact measurements of the gate being four foot high and almost two foot wide, and a small window not above six inches from the ground. Swift is able to mock the overly descriptive narratives of his contemporary British travellers by including overly descriptive and unbelievable measurements into the narrative of his protagonist Gulliver. Gulliver describes how the island of Laputa moves using this giant magnet, which is attracted to the Earth on one side and repulsed by it on the other. If they stand the stone upright with the attracting side face down, the island goes down, and vice versa. Gulliver is using the formal mathematical and scientific language of his day with all of this stuff about parallelism, attraction, and repulsion. But its clearly an imitation – none of Gullivers regular descriptions of things sound this stiff and difficult. Swift imitates different kinds of jargon and technical writing to show that the weakness of mankind isnt just limited to politics and morals; we write pretty badly, too. The Royalist paraphernalia within Swifts text is equally significant in his parody of travel narrators unreliability in which English men and women at the time believed as factual. Every instance in which Gulliver says something (or provokes from another) a negative response about England or Englands monarchy, Gulliver augments the statement with praise of England and/or the monarchy. For example, in Part II Chapter VII the narrator uses a pre-verification before he begins to tell a story in which his noble and beloved country was so injuriously treated. Swift then writes a strange effect of narrow principles and short views! in relation to the King of Brobdingnags lack of interest in gunpowder. Gullivers sarcastic tone could not possibly be any more obvious in this line, as Swift utilizes his narrator Gulliver as a representation of England as a morally corrupt and violent society. In this same section, Swift writes that Gulliver will hide the frailties and deformities of [his] political mother, and place her virtues and beauties in the most advantageous light. This statement is further demonstrative of Swifts opinion of the travel narratives in which the authors continuously praise their mother country, not because they were particularly Royalist Englishmen, but because their travels were funded by the monarchy, and therefore they must bootlick and grovel as much as possible so that their funding continues. The satirist finally satirized himself after exhausting every other subject possible. Or perhaps Swift instead admits that folly, finally, will always be part of humanity, and the self-awareness and cynical distance of the satirist are not the answer. Gulliver learns from the Yahoos the weaknesses of humanity, because he sees them without any redeeming qualities. But there is no place for Gulliver in a world without any of those vices either, because they cannot tolerate him. If there are two possibilities, as Swift seems to be saying, run from all humanity or accept humanity, Gullivers solution does not work. He is miserable at the end. He has rejected humanity, and his ideal world will not have him. This is not where Swift wants the reader to be at the end. If Gulliver has no compassion for the weakness of humans, then the reader must. If Gulliver cannot see the good in people, such as the wise sea captain, then the reader should. Essentially, Swifts Gullivers Travels is a text compiled of various layers of satire, and Gullivers narrative voice is satirical within itself. In representing the unreliability of contemporary travel narratives, as well as their Royalist purposes, Swift criticizes the English men and women who naively determined them as factual documents while he criticised the English imperialist acquisitions and aspirations.

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Death Penalty Ethics Essay Sample

Death Penalty Ethics Essay Sample Death Penalty Ethics Essay The death penalty has a long history in the society. During older times, the death penalty was used in giving justice to grave crimes which gave the idea that grave crimes definitely cost people their lives. The discourse on death penalty involves different concepts in the society especially ethics and morality. In the context of ethics and morality, capital punishment is never seen as the righteous way to achieve justice. This follows the idea that taking one’s life is equated to devaluing it. Of course, death penalty also exists in a religious context. Throughout history, the Church has been prominent in voicing out its strong opinion against capital punishment. Despite this, history also says the Church has somewhat given the state civil liberties in how justice is practiced. In these juxtaposing concepts, it is seen that the issue of capital punishment is an issue that gathers strong opposing opinions which identifies it as an important moral and ethical problem. The Ethics of Capital Punishment The ethical constraint that lies within capital punishment is the idea of life being taken willfully from an individual. For many, this follows a barbaric form of the justice system just like the â€Å"eye for an eye† concept. Furthermore, in the case of religion, taking a life of another human being is already sin in itself which widens the moral grounding against capital punishment. In short, this form of penalty is not reasonable enough to be considered â€Å"right.† This thinking has developed over present times which produced progressive movements against capital punishment. Many consider that the uproar against capital punishment is mostly ruled by emotions but it is important to know that this is completely fine. The discourse on death will never be technical and emotions can be associated to the functionality of morality in the society. Morality speaks of what is right or wrong, based on our inherent perceptions of the society. Just like with other ethical issues, capital punishment is perceived as unjust because it does not truly bring justice to those who need it. On the other hand, it is only a premature form of vengeance that does not truly satisfy anyone. In light of this, it is important to explore the different underpinnings of capital punishment in the society and how different nations have legalized it despite the continuous retort of several advocacy groups. Capital Punishment in the Society In the United States, some states allow capital punishment as the highest level of crime punishment. This is dedicated to grave crimes such as murder and the likes. For some people, this form of punishment can be considered as a â€Å"grave† or excessive showcase of authoritarian power. It does not give space or reform for change in the society; rather it instills a sense of fear among people that is usually misguided. Aside from this, the idea itself of capital punishment tends to paint a picture of justice which is cut short. Of course, death is not the solution in achieving justice. In nations that approve of capital punishment, their reasoning lies in the idea that through death penalty, people would avoid making crimes that would lead to their death. State ruling also reasons out that through capital punishment, people would fear being involved in great crimes. For experts on crime and psychology, capital punishment may have an effect that is opposed to this belief. Criminals who get involved in grave crimes do not have time thinking of this sort of logic; criminals would be more focused on committing their crimes rather than the repercussions of their actions. Instead, capital punishment in itself can trigger more grave crimes for criminals would see the crimes they commit as their last. Of course, this is only one side of the story and this also proves the multi-faceted orientation of the discourse of capital punishment depending on what context it is situated in. Despite all this, when the discourse is focused on morality, the automatic understanding is tha t the death penalty is unreasonable. Cutting short the life of a criminal may be reasonable to the victims but this is a blinded perception of the justice system. Ultimately, the issue of death penalty continues to raise debates because of how life is connected to what is ethical and death penalty is just one of the many wherein ethics is erased.

Unit 1 Individual Project Essay Example | Topics and Well Written Essays - 500 words

Unit 1 Individual Project - Essay Example This encompasses the specific allocation of goods for individuals and households. For an individual, it can be as simple as choosing the activity for the day. For a business organization, it includes the setting of the price level for a product or service and finding the equilibrium quantity which can maximize the profit to be generated. Macroeconomics, on the other hand, is more comprehensive as it involves the examination of the performance of the economy as a whole. Instead of simply looking at a single business organization, this means focusing on the entire industry taking into account all industry players regardless of size or bargaining power (Cybereconomics 2008). An example of the macroeconomics is the determination of the factors which causes the increase in the Gross Domestic Production of China which has showed significant growth in the recent years. Being the vice president for sales for a reputable business organization, I am responsible for the purchasing decision for the company. At other times, I also handle the recruitment and application processing for prospective employees. These tasked have allowed me to utilize microeconomics in making my decisions. The purchase of input for the company’s operation has a lot of implication for the price of the product that we manufacture and in turn, the level of profit that we generate. Employing the skills and techniques that I have learned in microeconomics, I always make sure that I am buying inputs at the lowest possible cost which includes minimizing the cost per item, cost of ordering, and cost of handling the inventory. I make use of the economic quantity model which really helped our business organization maximize profits by the elimination of unwanted cost. The macroeconomics portion concerns my task in hiring prospective applicants. When searching for the right person for the job, I look beyond the knowledge and the skill of the candidate and also look at the people working for

Research paper based on the life of Edgar Allan Poe Essay

Research paper based on the life of Edgar Allan Poe - Essay Example aware of his life story realize that he was orphaned at a very young age and was never able to achieve any sense of connection to his foster parents, the Allans. The author is also famous for his marriage to a young girl. At the age of 27, Poe decided to marry his 13-year-old cousin Virginia, the only girl he ever truly loved and who tragically died while still considered a young girl. Contributing both to his despair and his alienation from his foster father, Poe is known to have also engaged in a number of poor personal habits such as drinking, gambling and using opium, perhaps even as an addict. Despite these issues, he was able to find early commercial success as a writer. He published his first book of poems at the age of 19 and began publishing his short stories by the age of 23. Unfortunately, though, he never achieved the kind of financial success he felt his innovation and talent were entitled to and he remained a mostly disillusioned and miserable man through most of his li fe. Setting the rules for the art of the short story he’d brought into popularity, Poe said â€Å"If any literary work is too long to be read at one sitting, we must be content to dispense with the immensely important effect derivable from unity of impression† (Mowery, 1997). Like many writers, though, Poe wrote of what he was most intimately familiar with, in this case his own inner demons, and his stories were thus themed primarily around the concepts of sorrow and loss. By examining works such as â€Å"The Fall of the House of Usher† or â€Å"Ligeia,† one begins to understand much about the author’s personality and inner character through the revelation of his anima. The term anima was introduced by Carl Jung’s work on dream analysis as a means of understanding the psyche on a different level than what had been proposed by Sigmund Freud. According to Neumann (1954), â€Å"the Anima is the personification of all feminine psychological tendencies within a man, the

Managerial Economics Week 6 Individual Work 2 Assignment

Managerial Economics Week 6 Individual Work 2 - Assignment Example This is because as the output increase at one point, it does not necessarily increase at another point and the inverse is true. The increase in the operating expenditures per student does not bring out a large decrease to enrollment but rather there is an explicit nature of the function. Apart from enrollment, the other important variable in explaining the variations in operating expenditures per student is the teacher salary variable. This teacher salary variable is significant in the sense that it promotes a higher level of motivation thus the operating expenditure per student will decrease. A decrease in teacher salary brings about an increase in the operating expenditure per student. When there is a higher rise in teacher salary, the operating expenditure per student will also rise significantly. Minimization is always ideal achieving the best of benefits in every institution. In this case, expenditures reduce and at the same time, there is a reduction in the enrollment level. Barriers towards enrollment also do not exist and it is a case of unconstrained optimization. To minimize on the operating expenditure per student the calculation takes the derivative of the operating expenditure with respect to enrollment. 30.9 is the reduction level towards the operating expenditure per student that will occur upon adding one more student. This is because at this point (500) there are economies of scale and there are positive externalities. The regression value does not show a good fit value since it is less than 0.75. This is because the right hand side variables also do not fully explain most of the variations or changes. There is an inverse relationship between enrollment level and expenditure whereby the enrollment level increases as the operating expenditure declines. Economies of enrollment that can also show the size can decrease whenever the expenditures reduce as the enrollment

Quantitation by Extraction

Quantitation by Extraction Syed Masood Hassan Akbari INTRODUCTION A liquid-liquid extraction phase consists of a component (a) which is to be removed from the feed phase. The addition of a second phase (b) a solvent phase which is immiscible with the feed phase but the component (a) is soluble in both the feed phase and the solvent phase. As it happens the solute (a) is transferred from the feed phase to the solvent phase. After extraction the feed and solvent phases are called the raffinate and the extract phases respectively. Usually one of the two phases is an organic phase while the other is an aqueous phase. Under equilibrium conditions the distribution of the solute (a) over the two phases is determined by the distribution law. After the extraction the two phases can be segregated because of their immiscibility. Component (a) is then separated from the extract phase by distillation and the solvent is then regenerated. Further extractions may be carried out to remove more of the component (a). Once the product of interest has been extracted finally an absorbance reading can be found at its corresponding ÃŽ »max. Figure 1: Shows the chemical structure of trimethoprim. Figure 2: Shows the chemical structure of sulfamethoxazole. This experiment consisted of three main components: The quantification of trimethoprim and sulfamethoxazole in a suspension of Septrin. Interpreting the data gathered and using it in calculating the content of trimethoprim in Septrin. Interpreting the data gathered and using it in calculating the content of sulfamethoxazole in Septrin. EXPERIMENTAL Extraction of trimethoprim and sulfamethoxazole from SEPTRIN. Figure 3: Illustrates a schematic of the entire extraction procedure consisting of trimethoprim and sulfamethoxazole in SEPTRIN oral solution. Sulfamethoxazole (Standard, Sample and Blank prep) Figure 4: Illustrates sulfamethoxazole’s sample preparation. The standard was prepared in the exact manner in a 250ml volumetric flask with using 0.2g of sulfamethoxazole in 50ml 0.1M NaOH and topping up with water. The procedure to follow was the exact same as the sample prep. The blank was prepared in the same manner and water was used along with the reagents outlined above in sample prep. Trimethoprim (Sample and Blank prep) The already extracted bottom layer with chloroform was extracted again using four 50ml quantities of 1M acetic acid and the top layers were combined and washed with 5ml chloroform and the top layer added to a 250ml volumetric flask and filled with 1M acetic acid to the mark. 10ml of this solution was then added to another 100ml volumetric flask and 10ml of 1M acetic acid was also added and topped up with water. The blank was made by using 0.2M acetic acid solution. RESULTS Determining the quantity of trimethoprim and sulfamethoxazole in an oral suspension of SEPTRIN. Table 1: Shows the absorbance values obtained at each respective Ɔºmax for trimethoprim and sulfamethoxazole. Calculations: Trimethoprim The sample had a dilution factor of 1:1000 which meant that there were two dilutions carried out where the suspension was diluted to 250ml, which is a 1:100 dilution. Secondly the sample was diluted too 100ml, which is a 1:10 dilution. These two dilutions steps combined gave a 1:1000 dilution factor. The calculations were carried out as below. 2.5ml in 250ml 1:100 (Dilution ratio) 1:10 (10ml in 100ml) Therefore 1:1000 dilution factor. Absorbance: 0.332 x 1000 = 332 A1%/1cm=204 so 1% solution has 204 absorbance 1%conc = 204 X = 332 332(1)/204 = x X= 1.627% w/v It complies with the compliance limit of (1.44-1.76)% w/v. Sulfamethoxazole 0.2g in 250ml 200mg in 250ml (1:100 dilution ratio) 0.8mg in 1ml (1:50 dilution) 0.016mg in 1ml (1:10 dilution) 0.0016mg in 1ml Sample of sulfamethoxazole absorbance = 0.075 So, 0.0016mg in 1ml = 0.293 And, x = 0.025 0.0250.0016/0.293 = x X = 0.0001365mg in 1ml 0.0001365mg in 1 ml x 50000 = 6.826mg in 1ml 6.826mg in 1ml à ¯Ã†â€™Ã‚   0.06826g in 1ml à ¯Ã†â€™Ã‚   6.826g in 100ml X = 6.826% w/v It does not comply with the compliance limit of (7.4-8.6)% w/v. Trimethoprim and Sulfamethoxazole The concentration of trimethoprim and sulfamethoxazole in 5ml of SEPTRIN were calculated as shown below. Trimethoprim: 1.627% à ¯Ã†â€™Ã‚   1.627g in 100ml So, x in 5ml 100x = 8.135g X = 0.08135g in 5ml SEPTRIN Sulfamethoxazole: 6.826% à ¯Ã†â€™Ã‚   6.826g in 100ml So, x in 5ml 100x = 34.13g X = 0.3413g in 5ml SEPTRIN CONCLUSION The active ingredients in SEPTRIN, trimethoprim 1.627% w/v and sulfamethoxazole 6.826% w/v were segregated by extraction. The concentrations of trimethoprim and sulfamethoxazole in the 2.5ml suspension were calculated to be as stated above respectively. The content of trimethoprim fell within the compliance limit but for the sulfamethoxazole the content fell a bit short of the compliance limit suggesting apparatus malfunction or human error in making up sample. Trimethoprim complies with the limit set out on the BP but for sulfamethoxazole it falls under the limit stated on the BP. QUESTIONS Illustrate the extraction procedure. Support the separating funnel in a ring clamp on a ring stand. Make sure the stopcock of the funnel is closed. Place a stemmed funnel in the neck of the separating funnel. Add the liquid to be extracted, then add the extraction solvent. The total volume in the separating funnel should not be greater than 75% of the funnel volume. Insert a stopper in the neck of the separating funnel. Pick up the separating funnel with the stopper in place and the stopcock closed, and shake it once gently. Point the stem away from your face and slowly open the stopcock to release some build-up of excess pressure, reclose the stopcock and repeat this procedure until only a small amount of pressure is released with it is vented. Shake the funnel vigorously for a minute, release the pressure and then again repeat the step of shaking a few times till there is less pressure and the solutes are at equilibrium between the two solvents. Place the funnel back into the ring and let it rest undisturbed until the layers are clearly segregated. While waiting, remove the stopper and place a beaker under the separating funnel. Carefully open the stopcock and allow the lower layer to drain into the beaker. Drain just to the point that the upper liquid barely reaches the stopcock. The top layer can be left in the separating funnel if further extractions need to be carried out which do need to be carried out. When finished with the separating funnel store the stopper away from the funnel. Explain why sulfamethoxazole is soluble in the alkaline aqueous solution and trimethoprim is not? It is already known that trimethoprim is classified as a benzylpyrimidine and it protentiates the antimicrobial activity of sulphonamides eg., sulfamethoxazole. So trimethoprim has a tendency to form insoluble complexes when combined with sulfamethoxazole in alkaline aqueous media. Write out the chemical reaction which leads to the coloured product. The reaction mechanism above shows the coloured dyeing agent N-(naphthalene-1-yl)ethane-1,2-diamine reacting with the diazonium to form the coloured product. Why is ammonium sulphanate added? What would happen if it was forgotten? AMS is used as a reagent to speed up the chemical reaction if it is not included in the reaction before adding the dying agent then the process will either delay in reaching to its completion or not reach it at all. After extraction of sulfamethoxazole, how is the organic solvent processed? The organic solvent was extracted in four 50ml quantities of 1 M acetic acid. The upper layers were all combined and kept and washed with 5ml of chloroform. The top layer was then dispensed into a 250ml volumetric flask and topped up with 1 M acetic acid. 10ml of this solution was transferred to a 100ml volumetric flask, 10ml of 1 M acetic acid was also added and the flask was topped up with water. A blank was made and the sample from the organic layer was read at 271nm.

Biopure Case Study Essay

The key issue is to determine when Oxyglobin should be introduced to the market without jeopardizing Hemopure’s potential and how it should be marketed. In addressing the issue, the following were considered: a sensitivity analysis for potential consumption of different price series, associated revenues and costs, and gross profit from different distribution methods. It is recommended that Biopure: 1. Introduce Oxyglobin immediately at a price of $100 to veterinarians. 2. Have an independent sales force distribute the product to maximize profits. 3. Advertise Oxyglobin in both veterinarian journals and trade shows. 4. Establish a successful brand to launch Hemopure in the future. 5. Oxyglobin should be advertised Based on other Massachusetts companies’ initiatives that have not gotten FDA approval in the last few years, it is safe to assume that it is a possibility not to get the approval or to be given the approval rather late as it happened to Baxter. Further, the potential dip in the stock price if Hemopure were rejected can be avoided if the company acts quickly and takes advantage of a market that currently has no competition: the animal blood substitute market. Obtaining market share is critical now that Biopure’s Oxyglobin has been approved. Biopure has a chance to be the first player to enter this market and recover its research and development costs within two years. Even when Biopure was primarily focused on developing a human blood substitute, the opportunistic development and later approval of Oxyglobin, an animal blood substitute, is a valuable opportunity that has to be considered. Exhibits A and B place potential demand (1995) at 3.9 million units for noncritical cases and 0.35 million units for critical ones. Further, Exhibit C shows the probability of consumption in units after factoring in the probability that veterinarians and pet owners would try Oxyglobin at different price series. The table shows that at $100 a unit, Oxyglobin would be used in 81% of critical cases and in 28% of noncritical cases. Hemopure, the human blood substitute, was only about to enter the third phase of the FDA clinical trials. Only because Oxyglobin and Hemopure are almost identical in physical properties and appearance, it does not mean that they cannot be priced differently. There are currently different medical products and services for humans and animals that are differently priced. Exhibit 8 from the case shows that very few veterinarian procedures are priced over $100. In contrast, a human blood transfusion is priced above $1500 without insurance according to the Houston Memorial Hospital. Hemopure’s market consists of people who lose blood in large quantities like in accidents, gunshots. And and aging population (double of what it is today by 2030) in need of Red Blood Cells to treat certain conditions like chronic anemia and acute blood loss. Launching Oxyglobin at a low price would not necessarily create an unrealistic price expectation for Hemopure because human health care is far more expensive than animal care. Additionally, the emerging and growing necessity for blood substitutes will yield great demand in the following years which will translate to higher selling prices for Biopure, all things equal. Despite the fact that Baxter International launched the first human blood substitute, HemAssist (presumably priced between $600 and $800), Baxter International’s and Northfield Laboratories’ blood substitutes rely on outdated human blood as a source of hemoglobin which is more expensive than Biopure’s raw materials (bovine blood) at $1.50 a unit. Moreover, their products need to be frozen until used, while Biopure’s products are shelf-stable at room temperature. This makes Biopure’s products more advantageous because buyers can save money on refrigeration costs as the company makes a higher profit because of their raw material’s lower price. In terms of production, Biopure has capacity to produce only one product at a time, namely, an annual capacity of 300,000 units of Oxyglobin or 150,000 units of Hemopure or some linear combination of the two. On the other hand, Baxter has a production capacity of 1,000,000 Northfield’s capacity is at 10,000 units per year, which is considerably less than Biopure. According to Exhibit D, potential demand for Oxyglobin alone priced at $100 is 1.3 million. Biopure does not have any competition but cannot supply that level of output presently, which would potentially raise prices as demand skyrockets once the product is introduced in the market. Biopure conducted two surveys that showed customers’ willingness to try the product at a higher price depends on the gravity of the emergency. Exhibit E shows that by selling the product at $100 a unit, $137 million can be generated in revenue, which is more than the revenue that can be obtained when selling it at any other price. This has to do with the probability of consumption and its correlation to the gravity of pets situations in general. Veterinarians have expressed their frustration with current animal blood distribution. Biopure has two options distribution options: National-Regional-Local and Independent Sales Force. Comparing distribution costs from Exhibits F and G, it is clear that going for the independent sales force approach Biopure can more than reduce costs by half. Distributing the product (at $100 a unit) with the NRL option would cost around $41 million as opposed to $18 million with independent sales distribution. Exhibits H and I show that the highest gross profit attainable is $120 million when using an independent sales force and pricing Oxyglobin at $100 a unit for veterinarians. These and all exhibits show that Biopure should launch Oxyglobin immediately and recoup the $200 million developing costs in only two years.

Political Competence Essay

In almost any affair that involves multiple stakeholders the idea of partnership and collaboration have essential roles. This is also applicable in building a strong society or country especially since it is composed of numerous people with varying needs that must be addressed. In relation to this the concepts of good corporate citizenship and political competence are vital in giving the necessary services to the people. Corporate citizenship pertains to â€Å"a new contract between business and society, a vision of partnership between different sections of community, which allies profitable companies with healthy communities because what happens to societies happens to business† (Benchmarks, n. d. ). On the other hand, political competence involves skills and attributes that make it possible for the achievement of organizational goals (Wells, n. d. ). Good corporate citizenship and political competence are related because these are interdependent upon each other. In order for good corporate citizenship to make successful partnerships it needs political competence that will make sure that the plans they made will be properly applied so that their objectives can be realized. Since the past up to the contemporary time, the government plays an important role in the organization, information dissemination, budgeting, and funding of a country’s healthcare system. The government is the primary body that is responsible in passing laws for the planning as well as the implementation of various concerns regarding the healthcare system of the country. This is greatly observable in countries like the United States of America, states in the European Union as well as in other parts of the world. However, this kind of system is not always as effective as it seem to be. There are still many people who lack the proper healthcare attention, which is always the reason that there are various sicknesses that most citizens suffer from. The main problem why such incompetence takes place is due to the lack of political will coming from the government and also the improper and sometimes illegal contracts that are happening among the public agencies and corporations. This could be seen in the common practice that is observable in the distribution of the needed medicine for most healthcare centers. Government funded organizations are responsible in commissioning private corporations in buying the needed medicinal paraphernalia. Nevertheless, anomalies often happen in this kind of dealings. Corrupt government officials would allot a huge amount of budget in order to buy medicinal necessities but this money is not consumed for this sole purpose. Some of it tends to fall in the pocket of officials who are only thinking of their vested interests. They would engage in illegal contracts with private corporations who would also gain benefit in the process (Messerli, 2008). This kind of issue is clearly an ethical dilemma that needs to be address immediately. A good solution for this problem is to create an objective, independent body that would see to it that the budget allotted for the healthcare of the citizens are use for the right purposes. This is one good way in order to do something to prevent this kind of anomaly from happening. The healthcare of citizens is a very important aspect of an individuals’ right, which is why it should be given due attentions and importance.

Free Essays on Disintegration of USSR

Running head: DISINTEGRATION OF USSR Disintegration of USSR Nitasha XYZ University Disintegration Of USSR (Soviet Union) The great Union of Soviet Socialist Republics (USSR), which emerged as a result of the spectacular October 1917 revolution, disintegrated even more dramatically in December 1991. The fall of Soviet Union with its far-reaching consequences on the global politics is regarded as the most important political event of the 20th century. It would be interesting to study the political, economic and social factors, which contributed to the fall of this great country. As Sam Marcy (http://eserver.org/history/collapse-of-ussr.txt) says The collapse of the USSR has inevitably caused wholesale desertions from Marxism. This is not uncommon when great catastrophes are experienced by the world working class. Nevertheless, over a protracted period, the working class has always shown astonishing recovery and regeneration. We believe that the dissolution of the USSR will be no exception.1 Historical Background The recorded history of the Soviet Union dates back to the 8th century A.D. when the European and Middle Eastern traders explored this region. At that time it was inhabited by the Slavic tribes. However the Scandinavian chieftains established the first Russian empire in the 9th century, which centered round Kiev and Novgorad. Later on this region remained under the control of the Mongols from 13th to the 15th century. Ivan the Great was declared the first Tsar of unified Russian principality in 1547. Ivan conquered Kazan and Astrakhan and established trading links with England. After that Peter the Great (1682-1725) remained the Tsar and emperor of Russia from 1682 to 1725. Peter introduced many reforms in the country and in 1703 founded the city of Petersburg. Thus the Great Russian Empire was founded which in future was destined to play important role in the politics of the world. By the 19th century Russian ... Free Essays on Disintegration of USSR Free Essays on Disintegration of USSR Running head: DISINTEGRATION OF USSR Disintegration of USSR Nitasha XYZ University Disintegration Of USSR (Soviet Union) The great Union of Soviet Socialist Republics (USSR), which emerged as a result of the spectacular October 1917 revolution, disintegrated even more dramatically in December 1991. The fall of Soviet Union with its far-reaching consequences on the global politics is regarded as the most important political event of the 20th century. It would be interesting to study the political, economic and social factors, which contributed to the fall of this great country. As Sam Marcy (http://eserver.org/history/collapse-of-ussr.txt) says The collapse of the USSR has inevitably caused wholesale desertions from Marxism. This is not uncommon when great catastrophes are experienced by the world working class. Nevertheless, over a protracted period, the working class has always shown astonishing recovery and regeneration. We believe that the dissolution of the USSR will be no exception.1 Historical Background The recorded history of the Soviet Union dates back to the 8th century A.D. when the European and Middle Eastern traders explored this region. At that time it was inhabited by the Slavic tribes. However the Scandinavian chieftains established the first Russian empire in the 9th century, which centered round Kiev and Novgorad. Later on this region remained under the control of the Mongols from 13th to the 15th century. Ivan the Great was declared the first Tsar of unified Russian principality in 1547. Ivan conquered Kazan and Astrakhan and established trading links with England. After that Peter the Great (1682-1725) remained the Tsar and emperor of Russia from 1682 to 1725. Peter introduced many reforms in the country and in 1703 founded the city of Petersburg. Thus the Great Russian Empire was founded which in future was destined to play important role in the politics of the world. By the 19th century Russian ...

A Comprehensive Cheat Sheet for Fractions

A Comprehensive Cheat Sheet for Fractions Fractions Cheat Sheet This cheat sheet provides a basic outline of what you need to know about fractions when you are required to perform computations that involve fractions. Computations refer to addition, subtraction, multiplication and division. You should have an understanding of simplifying fractions and calculating common denominators prior to adding, subtracting, multiplying and dividing fractions. Multiplying Fractions Once you remember that the numerator refers to the top number and the denominator refers to the bottom number of a fraction, you are on your way to being able to multiply fractions. You will multiply the numerators, then multiply the denominators and will be left with an answer that may require one additional step: simplifying. Lets try one: 1/2 x 3/41 x 3 32 x 4 8Therefore the answer is 3/8 Dividing Fractions Again, you need to know that the numerator refers to the top number and the denominator refers to the bottom number. In the case of division of fractions, you will invert the divisor and then multiply. Put simply, turn the second fraction upside down (this is called the reciprocal) and then multiply. Lets try one: 1/2 x 1/31/2 x 3/1 (we just flipped 1/3 to 3/1)3/3 which we can simplify to 1 Notice that I began with Multiplication and Division? If you remember the above, you wont have much difficulty with those two operations as they dont involve calculating the like denominators. However, when subtracting and adding fractions, were are often required to calculate the like or common denominators. Adding Fractions When  adding fractions with the same denominator, you leave the denominator as it is and add the numerators. Lets try one:3/4 9/413/4 Of course, now the numerator is larger than the denominator so you would simplify and have a mixed number:3 1/4 However, when adding fractions with unlike denominators, a common denominator needs to be found prior to adding the fraction. Lets try one:2/3 1/4 (the lowest common denominator is 12)8/12 3/12 11/12 Subtracting Fractions When subtracting fractions with the same denominator, leave the denominator as it is and subtract the numerators. Lets try one:9/4 - 8/4 1/4However, when subtracting fractions without the same denominator, a common denominator needs to be found prior to subtracting the fraction. Lets try one:1/2 - 1/6 (the lowest common denominator is 6) 3/6 - 1/6 2/6 which can be reduced to 1/3 There are times when youll simplify the fractions when it makes sense.

Practicum Project Goals, Objectives, and Justification Term Paper

Practicum Project Goals, Objectives, and Justification - Term Paper Example My proposed practicum project is implementation of various best practices related to nursing operations: purposeful rounding, bedside reporting, and multidisciplinary rounding. Starting July of 2015, daily staff meetings will be conducted in my organization from 8am to 9am from Monday to Friday. The objectives of these daily meetings will be to equip staff with skills, knowledge, and competence necessary for the implementation of best practices. In these meetings, the rationale for purposeful rounding, bedside reporting, and multidisciplinary rounding as best practices will be established, a membership development committee comprising of nurse managers will be created to oversee implementation of best practices, and also recommendations for implementation will be established. Based on past surveys conducted in my organization and feedback from patients, management has inferred low levels of patient satisfaction. The current nursing processes or procedures characterized by unstructured rounds and poor reporting techniques have significantly reduced patients experiences in my organization. King and Gerald (2012) posits that purposeful rounding, bedside reporting, and multidisciplinary rounding are essential practices in managing patients expectations. For instance, King and Gerald (2012) notes that bedside reporting allows nurses to exhibit empathy and show concern to patients and could thus elevate levels of patient satisfaction. In nursing perspective, King and Gerald (2012) points out that multidisciplinary rounding helps nurses gain experience in working in a multidisciplinary environment and consequently gain skills and competencies in working with and managing a diverse population of staff, and also develop leadership abilities. Goal: In this project, the learner will create an implementation plan for purposeful rounding, bedside reporting, and multidisciplinary rounding in order to improve patients experiences and help staff develop their leadership

Annotated Bibliography Example | Topics and Well Written Essays - 750 words - 17

Annotated Bibliography Example Though the power coefficient of some of these turbines may be relatively low, they also work under low-quality winds. The writer claims that air flow approaching a wind turbine slows down by creating a low- pressure region behind the turbine. This pressure difference between the two sides of the propeller blades reduces the efficiency of doing work and increases the cost of wind power generation. Following to such loss a wing structure placed at a distance around the turbine is used to increase the power of the wind turbine by a factor of 2.0. The propeller is tightly fitted onto the inner shroud without leaving space between the tips of the propeller blades and the shroud. This method of improving wind turbine efficiency reduces the cost of generating wind power. These authors believe that the use of mantle’s nozzle which can be regulated can generate more quantities of electric power in wind turbine. The nozzle that is aerodynamically shaped ring induces a centrifugal force in the wind stream thus replacing free air stream with a concentrated stream of air. As a result, higher mass of air flows and velocity of this air behind the rotor reduced giving a higher energy output from the wind turbine in the nozzle. This increases the profit and reduces the cost of generating wind power. Though speed variation will increase, the concentration factor fc=2.5, it becomes inconvenient to work with wind at speeds exceeding the rated one. It is for this reason that control blades are installed on the frame side to let the excess air bypass the turbine rotor. This is however an additional cost and weight whose effects are adverse as well. These experts argue that steering aero foils are used to increase the rotational speed of wind blades. They are fixed surrounding the wind blades at an optimum distance whereby the angle of inclination can be valid. By adjusting the length and the angle of tilt, the rate can be

Homework Essay Example | Topics and Well Written Essays - 500 words - 29

Homework - Essay Example The affected age group being mostly children, the analysis is that OM generates indirect costs owing to lost time from school and work creating a significant social burden. A good nurse protocol for otitis media in children aged six to twelve years old should clearly define OM; identify its natural history without antibacterial treatment, measure relative effectiveness of these antibacterial regimens in prevention of clinical failure (Forgie and Zhanel et al., 2009, p. 457). Otitis media is the presence of purulent fluid inside the middle ear, which is associated with symptoms and signs of systemic or acute local illness. It is most prevalent during winter months in children especially six to seven years old and below. Otitis media is commonly seen after a viral infection of the upper respiratory tract. It has been especially noted to result from dysfunction of the Eustachian tube preventing the effective drainage of middle ear fluid. The clinician or nurse should be aware that the client has an antecedent event, either an allergy or infection that results in congestion and edema of the mucosa of the middle ear, Eustachian tube, as well as the nasopharynx. Flow of the middle ear secretions is impeded following the Eustachian tubes congestion. This often increases negative pressure further causing fluid to be pulled into the middle ear. Increase in middle ear secretions causes growth of microbial pathogens resulting in otitis media. Treatment protocol in diagnosis and prescription establishes common pathogens as Streptococcus pyrogenes, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, as well as viral infection. Recent studies show that in 6 – 12 year olds infections have increased because of organisms that produce beta-lactamase and bacterial resistance to drugs (Barnett and Klein,

Patient Risk Essay Example for Free

Patient Risk Essay This example of a reflective essay is presented in association with Price, B and Harrington, A (2013) Critical Thinking and Writing for Nursing Students, London, Learning Matters. Readers are introduced to the process of critical and reflective thinking and the translation of these into coursework that will help them to achieve better grades in nursing courses. Stewart, Raymet, Fatima and Gina are four students who share their learning journey throughout the chapters of the book. In this essay on the assessment of pain, Raymet demonstrates her reflective writing skills near the end of her course. Raymet had by this stage written several reflective practice essays and gained good marks. This time though she was encouraged to deepen her reflections, speculating selectively on how the account of pain experienced by a patient (Mrs Drew) might help her to work more creatively with patient perceptions and reported needs. N.B. Remember, copying essays such as this, submitting them as a whole or in part for assessment purposes, without attributing the source of the material, may leave you open to the charge of plagiarism. Significant sanctions may follow for nurses who do this, including referral to the Nursing and Midwifery Council. Assessing Mrs Drew’s Pain Mc Caffery and Pasero (1999) state that pain is what the patient says it is. If we accept that point, then nurses need to explore the patient’s perceptions of pain, as well as their report of experiences. The two are not quite the same. Patients may report their pain in a variety of ways, dependent on the nature and the intensity of pain and the context in which it is felt (e.g. whether they are ever distracted from the pain). Their perception of pain is a little more though and it includes the meaning that the pain has for them. It includes explanation of why the pain is there in the first place, what it indicates about their body and what it could  suggest might happen in the future (getting better, getting worse). The nurse assesses the account of pain shared by the patient, and this may be given in the form of a story. This is how it began, this is how it felt, this is what that meant to me and this is what I did about it (Mishler et al. 2006) In this essay I explore the assessment of pain as conducted with one 60 year old patient whom I will call Mrs Drew. Whilst the essay describes an assessment of pain with a single patient, I try to share too some ideas and questions that this provokes within me about pain assessment more generally. Mrs Drew made me think about other patients, future assessments and what I had to do as a nurse to help patients. To help structure this essay I use the framework described by Gibbs (1988). Whilst the episode concerned relates a stage in Mrs Drew’s illness when she challenged her treatment protocol, it also includes some of the memories and thoughts that this patient refers to regarding her earlier illness and past ways of coping with pain. In particular, it prompted me to question to what extent I as a nurse should recommend analgesia, drawing on what I had been taught about the effective control of pain. I had learned that it was better to control rather than to chase pain ( e.g. Mann and Carr, 2006; Forbes, 2007). Mrs Drew was diagnosed with lung cancer a year earlier and had initially had her illness treated by chemotherapy. This had helped her to achieve a remission that lasted for nearly ten months (Hunt et al, 2009 describe the prognosis of this disease). The cancer had returned though and spread to her spine and it was here that she experienced most of her pain.It was at this stage that the doctors explained that her care would now be directed towards her comfort rather than a cure—to which she had replied, ‘you mean palliative care’. Mrs Drew was supported at home by her husband Neil and visited on a regular basis by community based nurses to whom I was attached as part of my student nurse training. She was prescribed oral morphine and could decide within stated limits how many tablets she could take in any one 24 hour period. The situation I had visited Mrs Drew on several occasions over the period of a month when the community nurse and I were confronted by a tearful patient who announced that she did not wish to take the oral opiates quite as often as we were recommending. As she spoke she held her husband’s hand tightly, looking across to him as she described her experiences and feelings about the matter. Yes, there had been some bad nights when the pain had woken her and she had to sit up and watch television to try and distract herself. Yes, sometimes the pain made her feel nauseous, but she was alarmed at how frequently she was taking the ‘pain tablets’ and how this made her feel about herself. However well meant the medication was, it didn’t feel dignified to be so reliant on drugs, or quite so sleepy and unresponsive for such a high percentage of the day. Whilst the analgesia was working well when she took the tablets, the quality of life wasn’t what she wanted. The community nurse listened patiently to Mrs Drew and then explained that it was normal to have panic moments about such medication. Morphine had a reputation, one that people associated with misuse of drugs, rather than their therapeutic use. Used on a regular basis, the drug wouldn’t cause addiction and it would provide a great deal of reassurance to Mr Drew as well. The community nurse stated that she was quite sure that he respected his wife’s need to sleep when she wished and to build the rhythm of the day around her needs. At this point Mrs Drew shook her husband’s hand, and said, ‘tell her†¦tell her what we’ve talked about!’ Mr Drew then explained that his wife was used to dealing with pain, she had suffered recurrent pain in her neck and shoulder after a road traffic accident some years before. The pain had sometimes been severe, but he had massaged her shoulders and used heat packs that she found soothing. They had decided that they wished to use this technique now, keeping the morphine for absolute emergencies, when she was losing sleep and couldn’t eat as a result of the discomfort. The community nurse assured them that they were in charge of the analgesia and would be allowed to make their own decisions. She started to make notes though, and announced that she was making a referral to the cancer pain clinic, something that would help them to take stock of the situation. There was very good reason to suppose that this might be a problem associated with choosing the right dosage of the  morphine, rather than using supplemental pain relief measures. Mrs Drew responded sharply, ‘You’re not listening to me though Jane (the community nurse’s name—a pseudonym is used here), I want to use heat packs instead of morphine, at least during the day. I want to be more alive with my husband.’ The community nurse assured Mrs Drew that she had heard what she had said and respected her point of view. There would though be nothing lost by using the clinic to gain a further check on this matter. With that she excused us, explaining that we had a further appointment that morning and we left, having checked that Mrs Drew had a sufficient supply of her different medicines. As we walked to the car the community nurse empathised with Mrs Drew’s plight, saying that if she had lung cancer she would probably grasp at straws too. She would reach out for things that seemed more normal, and then observed, ‘but this isn’t normal is it, the pain she has isn’t normal. It’s not just a whip lash injury and old age.’ Feelings I remember that during this episode feeling a mixture of confusion, surprise, anger and impotence. Mrs Drew had surprised me by the way she had spoken, using what seemed to be a planned announcement. They had waited for and perhaps rehearsed this moment. Nothing in my experience to date had prepared me for such an encounter, at least in such circumstances, where we as nurses were so obviously working to support the patient. It was only later that I called the episode a confrontation. Mr and Mrs Drew had confronted the community nurse and I had been the largely silent witness to the event. As the discussion proceeded I remember making supportive noises, remarking how useful heat packs sometimes were and glancing across at Jane, who seemed to be signalling with her expression that I should leave this debate to her. I was trying to read her reactions to the Drew’s points and concluded that if I couldn’t support her arguments to the patient, then I should remain silent. The re were issues here that I perhaps hadn’t enough experience to deal with, at least, whilst ‘thinking on my feet’. My initial anger (with Mrs Drew for not acknowledging all that we were trying to do) quickly became displaced towards my colleague Jane. During the event I couldn’t explain why that was, but afterwards, when I made notes, I realised that it was because she seemed to have set the agenda in her own mind and to be requiring the patient to comply with concerns of her own. Put rather crudely, Jane seemed to be saying, listen I know about these things, this is a phase, an anxiety; you can work through all this. I believed at this point that she had missed the significance of the event, the way in which the Drew’s had arranged the conversation. For them, this was not a phase at all, but a considered and very important decision, one that they wanted the nurses to accept (Freshwater, 2002 and Edwards and Elwyn, 2009 emphasize the importance of negotiated care planning). My feelings of impotence were associated strongly with my lack of clinical experience. I have met this before. No matter how many placements I do, no matter how good the mentoring I receive, I keep meeting situations where I am unsure about how to respond next. I feel younger, less knowledgeable than I should be at this stage in my training. I want to reassure patients, to support colleagues and to give good advice, but there is not enough confidence to do that. If I felt unsettled and uncertain about Jane’s response to the Drew’s, right then I couldn’t easily explain that. I couldn’t offer a second opinion, couldn’t suggest an idea that might help support the patient. To my annoyance I couldn’t manage that either as we left the house. Jane had made some fair points, she  clearly seemed concerned about the patient’s needs, but perhaps she hadn’t spotted the right need—for Mrs Drew to determine in greater part how she de alt with her illness. Experience evaluated Afterwards, this short episode prompted doubts and debates about several important aspects of nursing for me. Setting aside the etiquette of learning in clinical practice, not challenging a qualified nurse in front of a  patient, there were problems here associated with supporting patient dignity, with my assumptions relating to analgesia and pain control strategies, and I realised, with my assumptions about types of pain and who had the expertise to define these. Dignity is more than simply using the appropriate terms of address, protecting the privacy of patients and attending to their expressed concerns (Price, 2004). It is about clarifying the ways in which they live and accommodate illness or treatment. It is about finding out what benchmarks they use to say that ‘yes, I am doing well here, this makes me feel good about myself’. Upon reflection, I sense that we on this occasion had not worked hard enough to discover how Mr and Mrs Drew define quality of life, or being in charge of their situation. We were more concerned with providing resources, sharing research or theory about medication and questioning the familiar misconceptions associated with morphine. To put it simply, we were ‘missing a trick’, reading the encounter as something that had happened many times before—the report of problems or anxieties, a request for help, rather than a decision that the patient and her carer had already come to. Reading situations well seemed, with the benefit of hindsight, to be the first basis for dignified care. ‘What is happening here, what will help the patient most?’ were questions that we perhaps assumed that we already knew the answer to. I realised that in my training I had already accepted the argument that patients would wish to remain pain free come what may and that the tackling of fears about prospective pain, was something that nurses engaged in. I assumed that because cancer pain represented such a major threat, because it was greater and more all encompassing, that there was little or no doubt that it should be removed. What was so unsettling, and took so much time to examine, was that Mrs Drew acknowledged the possible severity of metastatic cancer pain, but that she still preferred to respond to it using measures that had worked for her whiplash neck injury. Mrs Drew was willing to trade off a pain free state for something that gave her a greater sense of control and which perhaps enabled her husband to express his support for her in a very tangible way (preparing heat packs, massaging her back, rather than simply giving her the tablets). Mr and Mrs Drew questioned all my assumptions about best analgesia pr actice, and seemed to write a large  question mark on the textbooks I had read about chasing rather than controlling pain in palliative care situations (Mann and Carr, 2006). Reflections (learning opportunities) The episode with Mrs Drew left me uncomfortable because my past approach to pain management was theoretical. I (and I believe Jane too) regularly made use of science to decide what could be done as regards pain relief and to assume that patients would wish to achieve all of those benefits. This wasn’t about local applications of heat versus morphine, Mrs Drew could use both, it was about choice and how patients made choices—why they reached the decisions that they did. It was for me, about accepting very personally, that providing that patients are given all the relevant facts, alerted to the options, that they really are able to make choices that work for them. The very fact that Mrs Drews illness was now incurable, that she and her husband usually tackled pain together, meant that her solution to the challenge was different to those that many other patients arrived at. Having dealt with this pain for some time, knowing that it could and probably would get worse, meant that she was better equipped than other less experienced patients to make a decision here. This took nothing away from the benefits of sharing further discussion with pain clinic experts. I thought, Mrs Drew will stand her ground, she will insist on doing things her way if her husband is strong too. What it did highlight though was the importance of listening to patients, hearing how they perceive pain, how they narrate not only the pain but what they did about it. In this instance the narration was all about dignity, and coping, and finding ways to help one another and how this enables us to feel in the face of such a terrible illness. So, in telling us about her pain, what she did about it, using morphine when it was ‘absolutely required’, Mrs Drew was not reporting her ignorance of what could be achieved if the medication was used differently, but what she preferred to do as it enabled her to achieve different goals. Mrs Drew’s goals were about liveliness, alertness and stoicism, showing that she could bear at least a measure of pain. I wondered why I hadn’t listened carefully enough to such a story? Was it because of time pressure, or perhaps complacency, that Jane and I felt that we already knew what account would be  shared? Did we think that the patient would ask for help, more help, as the pain continued? If so, then our guesses had prompted us to behave as experts, and problem solvers, on the patient’s behalf. Perhaps hearing a patient narrative is about discovering what sort of role they would like you to fulfil. If so, then it might be a difficult role. I thought hard about how hard this was for Jane. She was going to be asked to witness Mrs Drew’s future pain, one that was now less perfectly controlled. She was going to be asked to reassure, to suggest measures that might help, without reminding the patient that she ‘already knew that you couldn’t manage pain that way!’ When I think about it now, that is very stressful for a nurse. It is about caring and allowing patient’s to make choices that we personally might not make. Conclusions I have drawn then three conclusions from the above reflection. First, that being patient centred is never easy and requires real listening and interpretation skills. My criticism of what Jane chose to do, to try and dissuade Mrs Drew from a course of action, recommending further appraisal of the situation, is an easy one to make. Nurses confront situations such as this relatively unprepared and react as considerately as possible. It is easy in hindsight to recommend other responses, a further exploration of what motivated Mrs Drew’s pain management preferences. Second, that experience can be a valuable teacher, the equal of textbooks. If nurses are interested in care, then we should be concerned with the sense that patients make of their own illness, the treatment or support that they receive. We need to understand what patients have to teach us and have to acknowledge that this means that we won’t always seem in control ourselves, expert and knowledgeable. Our expertise might be elsewhere, helping patients to reach their own decisions. Third, that one way to understand patient perspectives on illness or treatment, on pain management in this example, is to hear how they talk  about the situation. How do they describe the pain, how do they refer to what they did about it? The way in which the story is shared, how we coped, how this made us feel, is as important as the facts related. Sometimes a patient needs to feel stalwart, even heroic in the face of illness. Future care It would be foolish and unprofessional to recommend to other patients that they might not wish to remove pain, or that overcoming pain doesn’t always mean we don’t continue to experience it. For every Mrs Drew there may be many other patients who would welcome the complete removal of pain, so that they can die calmly, quietly, with their own version of dignity. But it does seem to me, that it will be worth thinking about the diversity of patients and how they prefer to cope when I assess pain and help manage this problem in the future. I won’t be able to walk away from the responsibility of debating whether I have explained all that I could, detailed the strengths and limitations of different ways of coping. I will need to find reflection time to ponder what patients have said and if necessary to go back and say, ‘I’ve been thinking some more about your words last week..’ knowing that this doesn’t make me any the less professional. References Edwards, A and Elwyn, G (2009) Shared decision-making in health care: achieving evidencebased patient choice, 2nd ed. Oxford, Oxford University Press Forbes, K (2007) Opiods in cancer pain, Oxford, Oxford University Press Freshwater, D (2002) Therapeutic nursing: improving patient care through self awareness, London, Sage. Gibbs G (1988) Learning by doing: a guide to teaching and learning methods, Oxford, Oxford Polytechnic Further Education unit Hunt, I., Muers, M and Treasure, T (2009) ABC of lung cancer, Oxford, Wiley-Blackwell/BMJ Books Mann, E and Carr, E (2006) Pain management, Oxford, Blackwell McCaffery, M and Pasero, C (1999) Pain: Clinical manual, Mosby, Philadelphia Mishler, E., Rapport, F and Wainwright, P (2006) The self in health and illness: patients, professionals and narrative identity, Oxford, Radcliffe Publishing Ltd Price, B (2004) Demonstrating respect for patient dignity, Nursing Standard, 19(12), 45-51