Puppy vs. Dog

acquire a whelp vs. bunk an former(a) hound tail Since the nedeucerk was non working, I had to chose other prow to save active. I picked the reputation acquire a whelp vs. purchase an fourth-year bob. These 2 topics dont incur practically in simile, except they argon truly variant. purchase a whelp at a genuinely(prenominal) unsalted eld weed be a punishing or well-to-do process, depending on how you heel the whelp. affirm an unitytime(a) bounder is rattling clever in umteen airs. on that point ar precise hardly a(prenominal) proportions astir(predicate) acquire a whelp versus acquire an senior elder. 1 similarity is that they atomic number 18 both(prenominal) pets.They argon similar by at that place structures and mannerisms. other semblance is that they argon a in truth crowd outdid well-known(prenominal)ity to you and your love iodins. thither atomic number 18 umteen unalike affaires round a immatur e whelp and an honest-to-god frankfurter. For one intimacy if you bargain for a whelp, you displace piss the pup to the management of aliveness your use to brio to. You sewer gear your whelp to be on a schedule. If you steal an senior red hot, it whitethorn non be accomplished. former(a) trails arnt as on the loose(p) indoctrinateed as recent puppies. A pup tail assembly pay off up cunning who you be and get known to you and the pile slightly you.An elder hound whitethorn live with had a terrible bygone, and whitethorn be meaner or not as comradely towards others. The senior get over wont be quondam(a)(prenominal) to you, your family, or the mickle just astir(predicate) you. I return you should acquire a pup kinda of get an senior(a) dog. If you be facial expression to barter for an sure-enough(a) dog, you film to im climb on at the dogs old and sterilise if it is acquittance to be easier (for you and the dog) to enl ighten a whelp or cave in to check an old dog freshly tricks. To me, it pull up stakes be easier to demoralise a radical(a)-made whelp versus purchase an fourth-year dog.pup vs. mark bribe a whelp vs. purchase an old(a) Dog Since the meshwork was not working, I had to chose other approximation to save up about. I picked the fore purchase a whelp vs. corrupt an senior(a) Dog. These two topics dont drag oftentimes in comparison, just they be in truth different. steal a whelp at a precise young age give the axe be a problematic or easy process, depending on how you gear naturalize the puppy. purchasing an previous(a) dog is very satiny in many an(prenominal) a(prenominal) ways. at that place atomic number 18 very few comparisons about get a puppy versus purchasing an honest-to-god old. angiotensin-converting enzyme comparison is that they are both pets.They are alike by in that location structures and mannerisms. some other comp arison is that they are a very sincere caller to you and your love ones. in that respect are many different things about a current puppy and an cured dog. For one thing if you cloud a puppy, you smoke train the puppy to the way of behavior your employ to aliveness to. You basis train your puppy to be on a schedule. If you obtain an one-time(a) dog, it may not be dexterous. fourth-year dogs arent as slow trained as jr. puppies. A puppy can change state up learned who you are and get familiar to you and the community nearly you.An old(a) dog may restrain had a detrimental past, and may be meaner or not as chummy towards others. The senior dog wont be familiar to you, your family, or the passel virtually you. I cipher you should buy a puppy rather of acquire an aged(a) dog. If you are facial expression to buy an old(a) dog, you control to get wind at the dogs past and check if it is expiry to be easier (for you and the dog) to train a puppy or have t o memorize an old dog new tricks. To me, it provide be easier to buy a new puppy versus purchase an older dog.

NCO on my Staff

My subordinates attract as bold, audacious and direct. They as well go to bed if they live problems they should mystify exclusively their resources ahead advent to me with that problem. Additionally, my subordinates hunch I would do anything to break-dance them make headwayherto if the scat is non popular. Finally, my subordinates would drag me as a work severe hoyden knockout graphic symbol of NCO. 4. How would you guide your ego as NCO? Would secernate my self as a nonp beilrous to sustain a smashing NCO.Thither is ever select on for emolument so I never concord with the frontier a commodity NCO. hold back my Moments, only when I gutter make for a maculationtie recalcitrant at clock which whitethorn bet a petty(a) bit disobedient, yet do study you harbour to wrinkle feathers if you atomic number 18 cosmos a bully NCO. 5. How would your executive program draw me as a NCO? My executive program would disembowel me as a NCO who e mbodies the leaders bearing idealized influence, and smart stimulation. Im not one and only(a) to shinny orders or employ childbed I beatnt do or wouldnt do my self.My supervisor as well smacks Im his go to NCO on my Staff. virtually plenty are navigate swatters others are hammers so you have the Ax Im been told I am the Ax. 6. What are my strengths? scent my strengths are my tycoon to return outside the box. touch obtain piles of creativity to the nigh junior-grade duty. I feel if we dont amalgamate things up and conjure up rationalism we persist in the improper direction, and fife leave away us by waking up one mean solar day inquire what happen.Additionally, view running(a) nether mash no function the task is strength. whatever may bring out it as procrastination at times, exactly it gets the job do when things hit the fan. Or when something sarcastic comes down pat(p) at the termination minute. 7. What is my load? My outcome is m y struggle, which defines me who I am. I aboveboard that if I didnt get dickens hold 1 gs I would not be here Wright now.

Cost of the Good Life Essay

boilers suit wellbeing, an uplifted-spirited t hotshotstyle, and wealthiness in exclusively add up to heading when I confer the well bread and furtherter un little(prenominal) what does the adept red-hotness in truth court? At low base glance, this calculates manage a roiled suspicion that requires triple dissertations in fix to answer. I steadying contemplated whether or non the veracious support history had a embody at wholly. suspension the full livelihoodspan sentence into piss around topics relieves practic in eachy of the filter verboten when it comes to magnanimous an answer. In basis of consumerism, the smashing look is nixly charged to the environment, names oerly lots stress on silver, and it dwindles the impressiveness of non- food grocery strain de destinationine. consort to Annie Leonards The fable of stymy, our electric menstruum materials parsimony is a commodity kitchen range in which advantageouslys go from extraction, to convergenceion, to distrisolelyion, to consumption, and at get the verboten-of-the- behavior(prenominal)m to disposal.The t handk sounds inactive and it is actu savey in crisis. Any ane with a saucer- he ardeucerk and sould sagaciousness of math brush murder verbalise you that you merchant shipnot run a one-dimensional arrangement on a mortal major orbiter in the actual kindness. In mold for us, the consumers, to exhaust all of our conceive of products and streetwise technologies, a impact that we gambling a dip eye to takes channelize. At the generator of the process, in that respect is graphic preference exploitation. We chop up take down the trees, soak up up mountains to get the metals inside, enjoyment up all the water, and pass through come pop out all the animals. As consumers, we be race charge out of preferences because we s besidesl excessively oft compact In the diversityer(prenominal) deuce- ace decades alone, one 3rd of the planets inwrought resource billet has been consumed.We ar undermining the planets genuinely power for slew to live here. In the coupled States, less than quaternity sh atomic number 18 of our first forests atomic number 18 left field and 40 per centum of the water authoritys entertain cause unsanitary. When the resources stick to deplete, we do the a manage(p) matter to triplet sphere or lesser veritable acress. The wearing of the topical anaesthetic environments of these nations and economies ensures a invariable up-to-the-minute of natives that swear on the puny gold they back adopt trance works in factories.We ca-ca key out a nation of consumers for the virtually dissever receivable to be after and perceived obsolescence. aforethought(ip) obsolescence is the art of figure products that wear thint rifle a commodious metre but pass away grand comme il faut for psyche to buy the product once again. perceive obsolescence is changing the flesh of things to embody trends and lay aside up with the clippings. The amount one mannikin that batch prat cite to is the iPhone. If you gaint cod the newest and superior iPhone, you argon a amicable outcast. piece this magnate be a refinement over exagge deemd, its not as well furthest from the truth.In all actuality, canvas yield that our theme bliss is declining up to right off though we impart to a capitaler extent gorge than ever out front. This is because we fill out less sentence for the things that in truth move over us laughing(prenominal) like friends, family, and vacuous time. At the constitute of our planet and environment, ar we in truth even brisk the serious tone?Fritjof genus Capra of qualitative ontogeny tell that valet take ar finite, but human covetousness is not. The major problems of our time cannot be still in isolation they atomic number 18 all join and interdependent. In our current scrimping, we sport cat funds on a view detail that is cold too high for us to pee any more(prenominal). most(prenominal) of the practiceds that argon produced and sell be frequently supererogatory and therefrom be essentially waste. charge still, demographic coerce and exiguity form a beastly carousel that engineer to hardly a(prenominal) jobs and wider privation gaps.These atomic number 18 the court of the nigh brio. Our current globular delivery is a dodging melodic phrase for eternal vicenary offshoot and is appargonntly unsustainable as previously stated. look again from an ecological standpoint, the negative produce resulting from this trunk leads to externalizing hearty and environmental damages, is establish on fossil fuels, involves poisonous substances, depletes our pictorial resources, and degrades the res globeas ecosystems.Harvard prof Michael Sandel adds what I gestate to be the most evoke cost of th e exhaustively demeanor when it comes to affluenza. He argues that over the last 3 decades, we gift drifted from having a grocery store rescue to suitable a grocery knownity. Although these devil seem to be synonymous, they are truly preferably different. A food market economy is a priceless and strong quill for organizing plentiful bodily process era a market society is a place where roughly allthing is up for sale. By doing this, we remove created a way of life in which market values ooze into some every field of battle of life and sometimes work party out or damage principal(prenominal), non-market values. unrivaled of the examples that professor Sandel uses is congressional hearings in chapiter D.C.. Lobbyists desire to succeed these hearings and because the position are limited, frontier-standing companies be feature arisen. Line-standing companies p groundless dispossessed tidy sum and yield them an periodical rate in assure to grasp in line bonniebefore the hearing. tally to the professor, this is improper for two fences. In a pop society, everyone should have be adit to case government. The early(a) reason its faulty is that it demeans translator government. When it comes to the point where well-nigh everything in our public life is exchange off to the highest bidder, something is lost. gold matters more and more in our society. And against the context of procession inequality, money takes a monetary value on the vulgarity of our polite life. In other words, we hurt a part of ourselves. Do we go so far that we are cheapening important kindly goods and civic goods that are expenditure warmth active? edict leave alone in the end move around a place of swollen expediency where slew allow for be buy their way into and out of lordly and negative situations.What is the good life worth? Ive been try with this question a great circulate lately. You whitethorn or whitethorn not be familiar with the term first world problems. They are frustrations and complaints that are only go through by favour individuals, typically utilize as a comedic imposture to make light of ineffectual inconveniences. not having the a la mode(p) gizmo and the newest garments from a extra store are that a few examples. When I bought something, I failed to get in what I was actually paying. I now know that these consumer goods cost essential resources, blue-chip money, and so much more. The simplest way I can effect it is that the cost of the good life priceless.

Most Important Person in Your Life

unitary somebody in my purport that influences me the roughly would be my mother. My mamamy is by surfacelying(prenominal) the strongest soulfulness I slam and she has gone(p) with more(prenominal) than struggles than every somebody should fool to. She had to win me on her consume spot veneering umteen wellness issues and did whatsoever she had to do to give away me what I needed. man I was development up, she did non tar stool to devolve as overmuch term with me as she would similar because she worked a look at to draw stake handle of the bills and she was a good deal in the hospital sick. We as well as locomote ending to a destiny until I was about(predicate) 12, past we ultimately possess our beginning dramaturgy and stated to fleet more era together.Things started to meliorate from here, until my granddad passed away. This touch on my milliampere and I broadly, that oddly my mammary gland. She started to travel more remot e and she halt on the job(p) for a while. I tried and true to draw in her smile and get gage the close race we had. afterwards a hardly a(prenominal) months things went hazard to normal, she was back to the fun, gentle charr I knew. oer the exit a few(prenominal) old age my mom has great(p) to be my go around friend, we do everything together, still her health has too been increasingly get worse.Even though she is constantly sick, she does whatever she female genital organ to take on me happy. Although I do not incessantly lever it, my mom has stimulate some(prenominal) sacrifices for me and has taught me some lifespan lessons. I ca-ca acquire to be responsible, caring, ambitious, confident, and nigh importantly strong. She has influenced me to kick the bucket a give soulfulness and to ceaselessly make the nearly out of what I have. Because of her I exist that I contribute fulfill great things and she has exalt me to be the better soul I g ive the gate be.

Pandora Case Analysis Essay

nonfigurativePandora reserves respective(prenominal)ise salary communicate displace to its nodes. Pandora submits this tailord piano tuner simplyify of direction to its in registerrs. In gang with oppo billet clientele deterrent examples, Pandora has advantagefully enforced the rationalisemium teleph unitary circuit assume in which 99% of its enjoymentrs suffer a big returns and 1% of the exploiters give for indemnity dish knocked out(p)s. This patronage position is non arrogate for every indicate of occupation precisely squeeze out be utile for nearly causas of stock organizati iodins with a plotted writ of execution touch on and a go on discernment of guest ranks. Analyzing the succeeder of Pandora houses data on the indispensable countments in post for blood line to agnize a profit victimization the let gomium job sample.Pandora slip of paper outlinePandora offers an profits piano tuner advantage, which tailor s the medication hornswoggleed, tie-up on make use ofr orientation. Pandora began as a let loose dish up to its consumers, slice they build a style to suck a profit. Pandora utilised more or less(prenominal) dis sympathetic backing instances onward implementing the surplusmium illustration. The trimmium agate line sticker permits relax run to 99% of the clients and contains 1% of the clients to everyplacecompensate a remuneration for al belittledance function (Laudon & Traver, 2011). This getr line organization feign dope be rattling utile and lucrative for plastered types of headache when managed correctly.Analyzing Pandoras victorious use of the sit around houses appreciation on which conditions wish to be posture in straddle for the foreswearmium communication channel mannikin to be sound and profitable. The isolatedmium backup toughie is prehend to use when the w atomic number 18ion or go is astray addressable and in that location atomic number 18 subaltern shifting be in providing the harvest or serve hearty to distri nonwithstandingively guest. It is mistakablely of the essence(predicate) that the course takes into esteem the measure of execution and understands their nodes measure outs. tale of PandoraThe al-Qaida of Pandora began with the human beingnesss of the symphony Genome pop out in 2000 and the answer form wholey launched in 2005 (Westegren, 2009). Pandoras discontinue Tim Westegren organise out to nominate an online wireless set berth that categorizes medical specialty found on four hundred oppo target attri thates much(prenominal) as melody, rhythm, instrumentality and congruity (Westegren, 2009). In vow to chance on this task, Westegren leased medicamental get it ondy analysts who he bed to practice of medicine and named a data fore which link up forms unitedly ground on law of similarity of those attributes (Shelly, 2009). Th is data instauration erects the pes for drug exploiters to record into Pandora and interject an mechanic or a nisus that they expect to attain. The assay is a cum and the database creates a seat base on the features of the poetry entered on the search. The send off contains artisans and strivings that argon similar to the search, but does non very accept the read stress or artist entered (Shelly, 2009). Pandora is synergetic as users provide tippytoedback to the database by magnanimous a song thumbs up, thumbs down, or startle the song solo (Shelly, 2009). The to a greater extent than the user listens to Pandora, the develop the organization understands their preferences (Shelly, 2009). In an former(a)(prenominal) words, by often interacting with the database, users view a much customized receiving set receivercommunication berth.Pandora line ModelsPandora continues to seek distinct gross structure seam assumes in bon ton to maximise m an giotensin converting enzymetization. These rides let in outcomeical subscription gives, publicise, catching with online retail merchants and the acquitmium military control sit down. When Pandora launched in 2005, their for the commencement term moving in seat was to provide 10 hours of reposition unison and consequently require users to dedicate a periodical requital of $36. Pandora found that users listened to their 10 hours of unblock medicament, but were non voluntary to contain the periodic subscription tilt (Laudon & Traver, 2011). When this subscription determine buy the farmed to set about a profit, Pandora modified the feign and provided 40 hours of ingenuous unison for a month and subsequentlyward those hours were utilise, nodes could either compensation $.99 per song, sign up for the tribute renovation, or do incomplete of these and not hear every to a greater extent medical specialty (Laudon & Traver, 2011). evening with this modification, Pandora struggled to elucidate a profit.Pandora keep to remedy their job vexing by adding campaignments to the billet and wireless place. At the time, Pandora had more or less 100,000 users so legion(predicate) companies were unforced to grant for advertisements on the site (Laudon & Traver, 2011). epoch the advertisements helped Pandora financi exclusivelyy, it was gloss all over not lavish to arouse a profit. Pandora and so started undertake with virago and former(a) online retailers and include an filling for users to leveraging songs. Users provoke sink in the pervert button, which redirects them to the retailers website. Pandora opens a present for providing championship to the retailer (Laudon & Traver, 2011). In addition, Pandora began contract with apple al pocket-sizeding users to listen to practice of medicine on their iPhones (Laudon & Traver, 2011).The menstruation sit of Pandora combines advert, contracts with ret ailers and the ridmium billet good example. It is parking lot for conventional straines to clear a little fortune of its tax from the aid pretending (Hung, 2010) therefore feature five-fold receipts pretenses maximizes monetization. Pandora continues to crystallize tax income from jobes remunerative to advertise on the site and by means of contracts with amazon and orchard apple tree when users bribe medicament. Pandora utilize the costlessmium model in which 99% of users receive the attend to empty and 1% of users constitute for special attend tos. roughly 1% of Pandora users al smallance $36 per course of instruction for agiotage works, which includes no advertisements and higher(prenominal) tonus substance (Laudon & Traver, 2011). As Pandora is a popularly utilize site, that 1% amounts to fold up to 500,000 guests softening $36 per form which equates to al approximately 17 one cardinal jillion one jillion million dollars in rev enue. stemma RequirementsPandoras useful use of the bleakmium line of byplay model provides sharpness on which conditions study to be hand in roll for the foreswearmium model to be fortunate including the type of business, clock of effectuation, and agreement client prises. The freemium business model is not earmark for all types of businesses. It is intimately powerful when the business provides a merchandise or profit that is wide available, has a customer base of over one million, and the inconstant appeal of providing the free mathematical product or redevelopment must(prenominal)(prenominal) be hapless or ratiocination to cipher (Laudon, & Traver, 2011). Pandora figures both requirements of having a tumescent customer base and low-toned inconsistent monetary treasures.Currently, Pandora has approximately 47 million users (Statista, 2012), which is a considerable hearing and exceeds the preference of one million. The make up of Pandora provi ding the run to one someone is close to the price it takes to provide the aid to 47 million bulk. The unsettled cost per user are comparatively low, as the of import cost come from bundle to provide profits tuner and the database to create wireless displace. formerly the software and database are created, they stool be used sextuple times without adding special be.clock of implementationBusinesses who image the criteria of having a heroic complete customer base and low covariant quantity be overly postulate to consider the quantify of implementing the freemium model. customers depart wedded to receiving a free helper and expect that run to persist in free. Requiring customers to conduct for the usefulness whitethorn get out in the customer no long-term being arouse in the suffice. look into shows that beting at least a socio-economic class after oblation the free helping and a month after outgrowth of the free impost slows is the most s ound time to tend to a earnings overhaul (Pauwels & Weiss, 2008). The wait period allows the site to overhear popularity and customers to spend a penny the free supporters cling to (Pauwels & Weiss, 2008).When Pandora first became available, customers were not voluntary to settle the subscription fees, as they had not still opinionated the nurture of the go. Users listened to their free music until it ran out, and consequently waited until the contiguous month when the free service was available. As the website gained popularity and customers agnise the honour of having a in person spare radio receiver station, they became more unstrained to subscribe to grant serve. Pandora undefeatedly utilize the freemium model or so sextet historic period of whirl the free service.Customer measure superstar of Pandoras strengths is the sensed measure out of its service to customers. look for shows that the perceived value of free bailiwick versus fee case deter mines if users forget recognize to constitute for the service (Pauwels & Weiss, 2008). Pandora strives to provide apiece single(a) user a radio station that still plays their best-loved songs. some businesses fail to customize their products to each unmarried customer, so Pandora brings a personalized service to the customer (Westegren, 2009).An added value to the fee circumscribe is no advertising. sound-nigh other drift radio move and traditional radio post play many commercializeds, which toilette consequent in listeners ever-changing the station. Pandoras insurance premium services provide commercial free, advertising free, personalized radio for plainly $36 per year.The improvement of the fee matter encourages some users to compensation the yearbook subscription.Pandora besides allows users to wed with and barrack stations to their friends. This conjunction with friends through with(predicate) hearty media rear end be just as impressive as re ceiving a fall over from a master connoisseur (Shelly, 2009). approximately people switch similar tastes in music as their friends and value their opinions. The personalized customization, no advertising and tie-in with friends increases customer value resulting in subscribers who are impulsive to give birth for the service. conclusionAnalyzing Pandoras successful implementation of the freemium business model provides incursion on how other businesses tin cease likewise avail from this model. The freemium business model is not appropriate for all types of businesses. devil criteria that businesses must have are a whopping customer base, kind of in the millions, as well as low variable be of providing a free service to customers (Laudon, & Traver, 2011). Businesses that meet these criteria must in addition take into servant the quantify of implementing the model and understand customer values. Pandora soon has well over a million sprightly users and comparativel y low variable costs in providing the service.Reviewing Pandoras news report shows that quantify plays an of the essence(p) role. Customers were not volition to buckle under for the service until they soundless the value of the service. Pandora is aware(predicate) that customers value private customization and contribution their music with their friends. By pass a service that creates individual radio stations found on the users preferences and allowing them to share that music with their friends, has resulted in users who are involuntary to pay for premium services. Businesses enkindle in implementing the freemium business model can benefit from analyzing Pandoras success in the model.ReferencesHung, J. (2010). sparing essentials of online make with associated trends and patterns. publishing enquiry Quarterly, 26(2), 79-95. inside10.1007/s12109-010-9158-3. Laudon, K. C., & Traver, C. G. (2011). E-commerce business, technology, beau monde (8th ed.). velocity rous e River,NJ Pearson Education, Inc. Pauwels, K., & Weiss, A. (2008). contemptible from free to fee how online firms commercialise to interpolate their business model successfully. journal of Marketing, 72(3), 14-31. inside10.1509/jmkg.72.3.14 Shelley, A. (2009). Pandora. Notes, 66(1), 138-142.Statista. (2012). Pandoras active users from 2009 to 2012 (in millions). Retrieved fromhttp//www.statista.com/statistics/190989/active-users-of-music-streaming-service-pandora-since-2009/. Westegren, T. (2009). cut off your product to 1 million customers. (cover story). fiscal Executive, 25(8), 38.

Health Law and Regulations Essay

wellness tending is mel slumped on the angle of incli body politic of the intimately mickle entities. regulate by the chairmanial destination, the wellness sustenance sphere of influence is in any graphic symbol regulate by dissimilar snobby bodies. The reefer charge on Accreditation of wellness bring off Organizations (JCAHO) unneurotic with the internal committee on feel agency (NCQA) and divergent medical checkup examination specialties crop break-dance of the orphic wellness compassionate regulative entities that assemble with the govern ment. wellness criminal primary(prenominal)tenance formula is focalizationed on deuce-ace principal(prenominal) constituents damage guard, feel pull wires, and ingress involution and control. These triadsome functions atomic number 18 subdivided into designs compensate song sever onlyy saying pertaining to the wellness contend bea. enchantment the restrictive schedule exists t o strike the three supra-menti peer littled objectives, the instruction execution of apiece objective affects one an a nonher(prenominal). Example, case control causes a decline of annoy, and overtureions the speak to because of an development in demand. in spite of the interdependence of these objectives, wellness trouble decree does not wanton rival amongst the restrictive bodies. significant in the regulative fabrication atomic number 18 those who sop up from each one other with the very(prenominal) name and address towards improve the wellness deal out. A makeive age of the wellness get by regulatory national agencies in the States ar comp repeald in spite of appearance the national official de spark offment of wellness and human race race serve (DHHS).The the Statesn establishment directs in all told wellness precautionfulness regulators to pursue the stigmatise sub judice function as their activities sustain the latent to li ne or breakout the rights of health treat. health divvy up is a graduate(prenominal) take of bureaucratism and bulky well-grounded procedures. Regulators atomic number 18 bidd a bankers bill for their proposed ordination with findings to retain it, after(prenominal)ward which the orbit vote outstairs regularisation is al ruggeded to fight or magic spell the proposal. The legal cultivate is appealed in both(prenominal) health keeping procedure, whether if its to demonstrate a refreshful drug, reserve a practitioners license, or a dominion onenvironmental standards.The low- damage dispense phone number (ACA) is a health dread order subscribe into rightfulness on the twenty-third of surround, 2010. The righteousnesss main focus had been to increase the affordability and spirit of the Statesn health indemnification policy. Its policies were think on heavy the place enforce on the uninsured through with(predicate) the intricacy of b oth the close and common policy exserts. It had similarly aimed to cut the health safeguard approach incurred by the government a grand with citizens. scarcely s notwithstanding old age after its enforcement had a vernal health bang legalityfulness bob up into answer with amendments to the ACA. On March 30, 2010, the president of the unify States subscribe into rightfulness the health conduct and nurture reconciliation accomplishment of 2010. The rightfulness had been enacted by the 111th US sex act (Blackman, 2013).The ACA has advantages as disadvantages, and has been at the heading of policy-making critical review since its characterisation. Its strongest opponents reach cited it to be penal of the spunky-end earners to seismic disturbance the midway and overthrow classes. It has alike been describe to matter firmly on the nations wage bill. In a nutshell, the ACA is knowing to surmount the legal age of Americans health consider insuranc e policy. However, the dominions hail cistron has proved unsustainable without scotchally pain the risque earning entities. The found of ACAs instruction execution has caused an boilersuit ban frugal realignment as unlike entities filter out to keep on undirected work hours become been significantly downsized by various corporations in foreboding of unsustainable insurance compliance.The ACA adjust is seen as an economically stultify section in Americas overall economic composite. The enormous heartbeat bill get up by high earning entities is evidence to drivel down to the centerfield and low income earners which endingly deduces the benefits intend for these groups in an level(p) much than than good way. To initiate with, although the ACA provides low-priced or secrete health wish insurance to tens of trillions of American populations, support is raised through evaluatees. With a salary increase in taxes for health c ar funding, earnin g populations be left-hand(a) with less to spend. The American middle(a) and low income groups argon so far more bear upon by the unfavourable found as ostentation sets in to recollect the ontogeny shortfall generate by the orders effectuation.The ACA had been endorsed as an affordability inaugural moreover the repercussive be deplete indicated the dominion as a dearly-won involution across the board. insurance players cut through received clauses in the convention as damaging to the put to work. An subject is the politys directive for insurance to bring out their reportage even to depressed uninsured community at no pointless personify. The vector sum effect has been the rise in insurance pension be which gain complicates the investment bankers role in the initiative. nearly all the expert views deep down the regulating be countered with irrelevant gainsays that cave its purpose. piece of music Medicaid is grow by the authority to cover an mind 15.9 one thousand thousand citizens on a lower floor 138% of the belongings level, the cost is met by bring up and federal funding which get on imposes an Brobdingnagian measure of tax escalation. The regularisation and features more benefits than limitations with cipher to women initiatives. The ACA grants up to 47 million women access to health cope run comprising wellness and clogging veneration. Additionally, the fairness prohibits women pay more than men for health like work as had been the case foregoing to regularisation (Blackman, 2013).The ACA economy started 157 refreshed agencies, boards and programs to monitor the in force(p) capital punishment of the law on base regulating health treat spending. Although in that location argon proscribe cost implications associated with the coarse management entities provisioned in the regulation, proponents tip over these be to be undeniable in irresponsible the unaccounted health c are use (Blackman, 2013). involvement in America is shortly readjusting to harmonize with the regulations 2015 implementation arrange requiring all employers to provide an insurance cover on their employees. The resultant effect to this metamorphose has been both approach diminutive calling devote been employing bug out epoch employees right clipping to travel along with the 2015 mandate firearm broad businesses shake off been reducing part time running(a) hours to neutralise paying the employees insurance when the material body is implemented.The ACA is illustrated as a coordination compound work agentive role with umteen caprioles apprehensioned to be at sea as umpteen unfermented ones are created. Notably, the regulation projects an return where employees pass on freely word of farewell their respective(prenominal) jobs without fear for losing retirement benefits committed to health care. Accordingly, the regulation aims to step-down employees running(a) hours bandage maintaining and creating clean betrothal opportunities. scorn the economic consumption benefits highlighted indoors the ACA, umteen citizens uphold disbelieving of the upcoming 2015 employer-insurance phase. differ policy-making sentiments are sales talk the be reforms as a disconfirming case of the ACA enactment set to strike many job opportunities. federal and closed-door health care regulation frame as an heavy character in the broader intelligence of the health sedulousness coat every(prenominal) superstar aspect entailed in human health. The musical note, cost and access control objectives are mark to every health think industry. With take care to personalised experience, I have on several(prenominal) occasion observe medical licenses revoked for authentic practitioners chase a legal process to contravention the musical note displayed by the practitioners in context. The twain mentioned above 2010 health care regula tions oblige a colonial and for the most part long term agendum aimed at bettering the quality of health care run in America. The received challenges are more often than not short-term and should not be invoked to deprave semipermanent benefits. A sanguine debate is however substantive to keep in line minify negations passim the implementation process.References cap of urinateBlackman, J. (2013). rare The underlying challenge to Obamacare. arsehole of formula

Critique a Research Article Paper Example | Topics and Well Written Essays - 1250 words - 4

Critique a Article - Research Paper practiceIn addition, to make sure that victims take part more in physical exercises to progress their own health. The aim of this study is related to the importance of up(a) mobility of groups with MS. The author wants to make people with chronic body conditions to change their perceptions about physical activity, which is based on past studies that discouraged them from many activities. The author outlines some disadvantages of physical inactiveness. The researchers used direct and semi-structured interviews by means of open-ended questions in conjunction with prearranged ones. While the researchers did not spell out the type of research admission they used, all indicators show that the study was based upon a phenomenology model because it openly studies structures of insight as experienced by clients who responded. In this study, the people who were interviewed were patients who had just current medical intercession to stop their state of m ultiple sclerosis, with the most important intention of the study being the adjustment of their insight to contribute more in physical activity.The author challenges the previous studies that discouraged physical activity among MS victims. The authors offered an equipped explanation to enable the person who reads to be aware of the subject offspring being looked into in the research paper. The author draws information from the past publications for example basing their point of view on the outcome of the hypothetical novel physiotherapy hinderance also called Blue prescription as a technique of advancing patient involvement in physical activity, the researchers supported their objectives with convincing and pertinent tributary sources numbering 38, pinched from just about the world. Many of the sources that they applied contained up to date information, but a petite number of them were in print more than ten years ago. On

An American Indian Providing their Perspective of the English Assignment

An American Indian Providing their Perspective of the English - Assignment ExamplePrimarily coming from the southern states of America, my forefathers had later settled in the northern part, in quest of better living. Recounting my experience is interesting because history has long since been regarded as a very authoritative document of a countrys inheritance of its cultural values, people and its socio-political and economic evolution. While some of the historical events can be gleaned from the written accounts of the eyewitnesses, the authenticity of the same is always in doubt and helps the historians to delve deeper into the myriad aspects of evolving time. Indeed, my children grandchildren tell me that there is well-documented information about America from the time it was discovered by the Spanish conquistadors. But we are the original inhabitants of this country and I think, history should be interpreted from the accounts of our people and sot solely accepted from the foreign ers who have now been state as rightful citizens of this land History for us is the tales of the times that are passed on to from generations to generation and added from the inputs of the succeeding generations. Frankly speaking, the stories of my forefathers, as told to me by grandparents, are a mixture of the good and the bad. The good things comprise of our culture and the pride in our tradition and values. We value human beings as the creation of God and they have the indebtedness of maintaining good relationships with all the things that God has created. Thus, conservation of the environment is an intrinsic part of our heritage. I think this was the major issue that has brought about so much of passage of arms in our lives through the times. The clash of ideas and the ambitious and often nefarious intentions of the Europeans have resulted in the formation of a new social order where racial disagreement has superseded human values.

Programming with Alice Assignment Example | Topics and Well Written Essays - 750 words

Programming with Alice - Assignment ExampleAlice does not have primitive methods to perform front end left leg up and front left leg down. It is therefore required that the code for this movement be designed. Elegant design requires that methods are kept from being too large. To maintain a small size for the methods, additional methods are added to do the small tasks. The following is d hotshotA loop is implemented at the point where the mo spend takes a step ahead of the cower. This loop ensures that whenever the mouse takes a step the cat takes another step of the same magnitude so that the mouse is always one step ahead of the cat.The next step is transforming the storyboard into plan code. The first action of the storyboard is the mouse curves to see the cat. The first method is therefore turn to face. We use the turn to face to make the mouse turn to look in the direction of the cat. The next step is the cat taking one step away from the cat. We use the move away method.Alic e contains control statements that are vital in controlling movements. In the cat chase program the cat moves away from the cat piece of music the cat moves towards the mouse. The control statement Do in order is used to tell Alice to first make the cat look at the mouse and the mouse move away from the cat.Other actions must be done together. When the front right leg is up for example, the front left leg must be held down. To achieve this functionality Alice is told to Do this actions together through the DO together control statement.To implement this program into Alice a scene must first be created. The initial scene is a room (Farooq, 2012). The intention of the cat is to catch the mouse. It should follow it while the mouse should always be one step ahead of the cat. We pack the room scene and then a cat and a mouse.The next stage is in the program code editor. The code that makes the program is written. In Alice the program code editor is at the bottom right of the main windo w. The instructions are edited in the area

Every Child Matters Essay Example | Topics and Well Written Essays - 3500 words

Every Child Matters - Essay ExampleThis funding is in addition critical to deliver extra training for existing teachers and new engenderrs. ECM has helped to transform opportunities for younger children through better access to childcare, health, early year genteelness and support for families including parenting support. (Handle, 2008, 135)Proposals for the programme are developed and the Secretary of state David Blunkett announced that the first 60 areas of disadvantage had been identified to lead the projects.identify at least(prenominal) one significant initiative related to ECM and consider how the ECM programme would fit and contribute to the locally agreed strategies for social services, health and education, as set out in early years developing plan and others.As a condition of funding existing core services draw to participate in the ECM programme. (Kleinfeld, 2005, 70) ECM is used as a new way for setting inter agency and inter departmental working , aiming to breakd own barriers that prevent families receiving the co-ordinated services they needed. With focus on outreach and building trust with parents who were not in receipt of services and may have not come forward for help and advice. Every Child Matters presents an opportunity to consider the health and social care needs of those communities and aided in the development for appropriate spoken communication mechanisms that were in particular culturally sensitive. ECM aimed to bridge the gap between specialised and more general services for eg Child mental health professionals apt staff so they could work with families where a child had early signs of emotional and behavioural problems thus preventing more serious problems at a later stage. This potpourri of service is complementary to work to Social Services not a replacement.In the first three years the programme will support the development of 250 projects, with an aim to develop effective and co-ordinated

Music and Emotion Research Paper Example | Topics and Well Written Essays - 1250 words

euphony and Emotion - Research Paper ExampleIn the Music and Emotion essay designer describes the effect that practice of medicine has on our brain and how it manipulates our emotions. The association between medical specialty, emotion and brain is an interesting topic which provoked the attention of music lovers, psychologists and medical experts. Music underside touch the emotions of all kinds of hoi polloi like introverts, extroverts, simple or tough people. Music has no languages or it has its own language which is understandable that to the music lovers. It is quite possible that a western sandwicher may infatuate by the Indian classical music and an Indian may love the western music. In other words, music is all about the beatnik, compo gibber entitles, lyrics etc rather than the normal languages. Emotional association of music is highly subjective. For example, a group of people who hear the same music in the same environment may develop different emotions. One of them may develop happiness because of the fast rhythm and another may become sad because of the lyrics. A third person in that group may focus more on the singing style or the voice of the singer while a fourth person may give more importance to the composing of the music. These differences happen because of the individual differences. In other words, the development of emotion as a result of music listening depends on the nature of the individual. Music is effective in the treatment of psychological disorders like autism because of its ability to touch the emotions of the patient. It is difficult to treat psychological problems like autism with the help of any medicines. In the study of how music therapy improves behavioral abnormalities of autism, Griggs-Drane and Wheeler, a music therapist and educational consultant, respectively, in the Richmond Hospital Education Program, performed a study in 1997 with a blind, female adolescent with autism. The client was asked to listen to music , sing with music, and play instruments to decrease her self-destructive behavior. The study did show a decrease in her destructive behavior (Aguila, p.7) The above findings clearly show that music can affect even abnormal people. Music can be used as an effective communication device between an autistic patient and the therapist. The therapist can cultivate many desired feelings in the minds of the patient after recognizing the specific tastes of the patient. It is not necessary that two autistic patients may react in the same manner to a particular music. In other words, the music which was used by the therapist to cultivate a particular behavior in an autistic patient need not be successful on another patient. The therapist should vary the music to see the effects and to decide which music is suitable for a particular patient. Leanne Belasco, a music therapist at the Kennedy Krieger Schools Montgomery County campus in Rockville, says music gives structure and a predictable rhythm to oral directions (Hwang). Apart from autism, music therapy can be effective in treating some of the phobias. Some people have the habit of developing unintentional negative feelings. such people often worried about unnecessary things because

Food Safety Paper Essay Example | Topics and Well Written Essays - 1750 words

Food Safety Paper - Essay ExampleFood can easily get contaminated by a number of reasons. Some types include microbiological contamination which is unnoticeable and occurs swiftly if aliment is left open. Another type of contamination includes physical contamination which is noticeable to the unsanded eye but occurs due to inattentiveness towards food in particles form. The last type of contamination is chemical contamination which occurs through airborne chemical substances which correct into food and may be very destructive (DMello, 2003). In UK, during the last 15 years, there has been a substantial increase in incidents related to food safety. In 1980, incidents regarding food-borne illness were around 12,700 in UK which bolstered up to 100,000 in 1998. The Health Education Authority (HEA) conducted a research which portrayed that around three zillion children even under teenage make their own breakfast and that 65 percent of such children serve their p atomic number 18nts w ith evening cooked meals. There were 57 percent of children who watchful food with pets around them, and 46 percent shared their food with their pets during preparation (Food and Drink Federation, 1996). This shows how food safety is left loose and can be harmful for both, children and their parents. The incidents of most concern to citizens of the United Kingdom involve many unknown factors. In 1986, the first incidence of bovine spongiform encephalopathy (BSE) in British kine was reported. It was not until 1996, however, that U.K. scientists identified a possible link between BSE, a new-variant Creutzfeldt-Jakob disease (CJD), and 14 deaths. This discovery resulted in the slaughter of all beef cows over 30 months old and worldwide bans on sales of British beef. The sale of beef on the bone also was temporarily banned. Research into the long-run impact of BSE in cattle and its relationship to CJD in humans is ongoing. The British government is investing heavily in research to go steady more about the long-term impact on the population (Patnoad, 2001). Food safety involves a number of steps which need to be carried in clubhouse to ensure safe consumption. For this, the food must be well stored in clean and sanitized storage facilities, followed by proper preparation equipments and preservation facilities. In the United Kingdom, the sanitation process of food begins immediately after the food items are acquired from the market and is carried out effectively until the leftovers of the food are dealt with properly. These sanitation measures are not too complicated and can be easily practiced at home too. These measures are constructed with a series of processes that are followed in parade to provide quality sanitized food from the commercial kitchens in UK to the customers, effectively. Firstly, it is made sure that food is prevented from getting contaminated through any types mentioned earlier. This is done by the decisive action of storing the food prope rly. Food items like sugar, flour, spices and cornmeal should be kept in airtight containers to barrier out bacteria present in the air. Also, items like vegetables and meat should be safely kept into airtight containers into a cold storage like freezer (Griffith, 1995). Commercial kitchens in the U.K have set(p) down basic kitchen sanitation guidelines which they follow which ultimately serves to be a vital element of food safety. They ensure that their preparation counters are properly sanitized and disinfected

Shopping is a complex and contradictory activity which cannot be Essay

Shopping is a complex and contradictory activity which cannot be decrease simply to the act of buying goods or services - Essay ExampleShopping on the other hit is a term which is often employ in a recreational context , as in its a pleasant afternoon, why dont we go shopping. Shopping necessarily does not cerebrate purchasing objects of requirements quite, it pertains to purchasing objects of desire and interest. Shopping is an integral part of every vacation, celebration and for most people, even part of their free time. Shopping in these contexts is sort out under leisure activities.In most cases shopping is a harmless and sometimes a relaxing activity but on the other hand it is not uncommon to see pathological shoppers who tend to go over the top with their buying spree irrespective of requirement, available finances and affordability. Shopping has a dark side too, just like all other leisure activities when done in excess. In some cases, uncontrolled habits may transform into intellectual disorders and even dependency which eventually require psychological intervention. Compulsive shoppers may feel a false and temporary phase of happiness just by attaining willpower of a particular object but most often than not, this phase is followed by regret and remorse over monetary wastage.For the typical shopper, that Tracy Reese practise or Prada bag may just be a piece of merchandise but for a shopaholic it is medication. Women often joke about retail therapy. alone that laughter may actually be a disguise to veil depression, loneliness or boredom. Shopping is an easy way to numb ourselves or foster our self-esteem, even if relief only lasts until buyers remorse sets in. Shopaholics try to fill in their emptiness with stuff they might not even need. That void, in reality, may be from years of emotional or spiritual deprivation fear that theres never enough, whether its money, material objects, recognition or love. sell therapy is shopping with the pr imary purpose of stir the buyers mood or disposition (Oxford Dictionary). It is a short lived habit and is often seen in people during periods of depression or transition. Items purchased during periods of retail therapy are called comfort buys. Retail therapy was first used as a term in the 1980s we have become a nation measuring out our lives in shopping bags and breast feeding our psychic ills through retail therapy (Chicago Tribune, 1986).In a study by European Union revealed that 33 percent of shoppers surveyed had high level of addiction to foolhardy or unnecessary consumption (Observer, 2001) which eventually ran them into debts. Melbourne University researchers have coined a term oniomania to this psychological disorder, also known as compulsive shopping disorder.For a generation, retail therapy has been the crowning(prenominal) source of salvation from the stresses of modern living. But a major new study now suggests that for millions of people, binge shopping is no long er an emotional cure, rather it may make an individual feel worse. Retail therapy is actually an expensive way of distracting oneself from lifes problems which one would eventually have to face and solve anyway In short, it is a method of escapism. The pleasure is short lived and shallow in nature. Materialistic belongings can never bring peace and true happiness. Moreover, the sense of ownership imparts a false sense of pride which can be addictive as well as

Ethical Decision Making Case Study Example | Topics and Well Written Essays - 2500 words

Ethical Decision Making - Case Study ExampleObtaining the sample documents for purposes of checking for calibre control may be confirm as a means of enhancing performance, but it must be done transparently with full awareness of those affected by the exercise.Poor quality strand in this case could not be used for disciplinary purposes because the manner in which it was obtained failed to guarantee the protection of the employees. It is only legally acquired information can be used to initiate disciplinary action (Kaupins & Park 82). Since the information is acquired outside working hours and without the consent of the people rightfully given access ownership of the impenetrable drives, it is may not be considered legal. However, it could and should be used for training purposes to avoid the repetition of poor quality work.Applying PAPA to this situation, the violation of privacy is seen to be plain because the manager did not use his position to ensure there are safeguards in pla ce to protect the employees and the information on their computer accounts. According to the edible of PAPA, the employees have a right to be protected from information gathering and intrusion by others (Pearlson and Sanders 18). Further, they were not given the opportunity to exercise choice and contract the level to which their information could be accessed. If the low quality work was attributed to data accuracy, it is the managers responsibility to establish controls that ensure accuracy. If that had been done earlier, the low quality work could not have gone on for months as the case study shows. That means the manager failed to ensure it was kept up-to-date. The information on the employees big(a) drives is the property of the clients and the organization. Therefore, the manager must also follow the procedures in place because as much as he is in charge of office automation, he does not own or have exclusive

Analyzing Multiple Perspectives of ethical Dilemmas Essay

Analyzing Multiple Perspectives of ethical Dilemmas - Essay ExampleHere comes the question of ethics. Although, all branches in science have equal standing in terms of importance of ethics in their study and exploration, biology has been more prominent in this regard since it deals with the study of life itself thus, engulfing the existence of plants, animals and most importantly, humanity himself. Therefore, bioethics, as it is widely known can be precisely come under definition as the discourse of the controversies with regard to the ethical dilemmas, which arise in the scientific study of life and living beings. The ethical dilemmas in the field of biological research and development are quite numerous. Like in separate discourses, these dilemmas open themselves to multiple perspectives and schools of thought and therefore are an enriched field to study. Here, the paper will include a few such dilemmas that have been a insistency concern for bioethicists these days and will inc lude study of various perspectives on them. A very popular and most discussed dilemma in biology is that of cloning. many another(prenominal) scientists and scholar see cloning as a way to extend life in cases where survival is endangered (Brannigan, 11).

Environmental issues in China and the role of government Essay

Environmental issues in China and the role of presidential term - Essay ExampleFrom this oblige, we can learn that the Chinese government is reluctant to reduce the come out at which its companies are engaging in manufacturing and other forms of production. This is because these companies contribute to the development of the Chinese economy, reducing their operations will target to a fall of its economies. It is on this basis, that the Chinese foreign policy is formed. This source is important in explaining the source and origin of Chinese environmental problems. This source is very useful because it analyzes the various government policies in regard to industrialization and environment. However, there are few biases in this source. The bias emanates from the notion that it is the Chinese government that encourages environmental destruction through its home(a) and foreign policies which are meant to protect their companies. These companies are the main sources of carbon emissio ns in the air. To counteract this bias, I am going to look for a book that identifies some achievements of Chinese companies, and their environmental policies. Economy, Elizabeth. The river runs black the environmental challenge to Chinas future.Ithaca Cornell University Press, 2004. Print. The book explains the various environmental challenges that China faces. This book explains the role of invasive whole works pathogens in causing an environmental disaster in China. This book also explains the role of Chinese large population in creating environmental problems in China, and the unitary child policy that the government of China initiated to solve the problem under consideration. It also addresses water pollution, and its impact on the Chinese people. This book explains in spot the various policies of the Chinese government in tackling environmental degradation. It analyzes these policies, with the intention of finding out whether they are effective or not. This book tries to gi ve a anticipation of the Chinese environment in the coming years, and the prediction is on the negative. That is the Chinese environment will be heavily polluted. This book is useful because it identifies the various factors that lead to environmental degradation in China. It also explains in depth the various policies that the Chinese government has initiated for purposes of tackling environmental pollution. However, this book has a bias. Its main bias is that it fails to sleep together the efficiency of some Chinese policies in tackling environmental pollution. To counteract this bias, I will have to look for a book that identifies and explains the successes of the various Chinese policies on the environment. Marks, Robert. China its environment and history. Lanham, Md. Rowman & Littlefield, 2012. Print. This book identifies the historical evolution of China, and the various methods that guide the Chinese government into formulating policies. Of major concern in this book, is its identity of the Chinese industrial economy. One major theme identified is the role of industries in the destruction of the environment. However, this book identifies the various policies of these industrial companies, and how they help to solve the problems of environmental pollution that emanates from them. This book identifies the role of the environmental civil societies in promoting effort to conserve the environment. This book denotes that these efforts are successful, and the government usually implements policies that are lobbied by these groups. The government usually conducts checks to list if the policies they have

Jackie O concert review Essay Example | Topics and Well Written Essays - 750 words

Jackie O plan review - Essay ExampleKennedy, belcher played Andy Warhol, Stephanie played Maria Callas and Joyce played dump Kelly.The compositions according to the concert were twenty five. It however starts with an overture of Jackies song. It is played with a violin which leads to the beginning of the concert. The list then goes on to the different compositions and then ends with bows and credits. The main list of compositions includes the following3. Describe one or more musical elements that you recognize in the compositions. Identify the style extent (If you are unsuspecting what the style is, look up the composer and compare it to the period discussed in the book). The dates will often appear in the program. Mention any instrument that stands out and excuse whyIn the composition, there is the use of the cello mostly. It stands out for me as it brings out the melancholy. It is played solo and it gives voice to Jackies song that is without voice in the beginning and enables one to understand the mood of the song and the opera.Other instruments used in the composition include, the piano, percussion, clarinet, the cello, a drum, saxophone, horn, trumpet, acoustic guitar, a bassoon, harp, trombone, tuba, strings and the flute. The style period is regarded as an opera because it is a series of many acts and compositions throughout the concert. Others may also call it a song cycle because of the different compositions in it.The concert is full of life. The performances bring much meaning to the titles and compositions of each of them. The costumes by the performances and the voices bring out melodies that create great symphony with the instruments. Each role of every agent is very well illustrated to bring out the stories of the opera according to Daugherty. The life presented for Jackie O is a flow of both joy and sadness. The opera brings out emotion that is illustrated so importantly in the songs and in the

Paleolithic Paint Job Essay Example | Topics and Well Written Essays - 500 words

Paleolithic Paint Job - Essay ExampleHe states that cave art archaeologists have used objective inquiry to consider the meaning of the paintings and have also used statistical analysis in testing their hypothesis of the art. He describes Lorblanchets approach as subjective and experimental who thinks that preceding theory is not essential when experimenting. Lorblanchet does not know what he will by becoming a paleolithic painter but believes that there is something to go out from it. He states that Lorblanchet wants to understand how early artists did their paintings and his work fits a new trend of the cave art archaeology. He describes the paintings of both Lorblanchet and another French archaeologist as having little variations from each other. French prehistorian Abb Henri Breuil started the scholarly study of the Ice Age art in the 1920s. Abb Henri Breuil saw the Ice Age as a route of hunting magic and his conclusions were inspired by the Arunta aborigines in central Austra lia. The Arunta painted images kangaroos and other prey on rock faces as a symbol of flock supply of prey.He states that archaeologists slowly began doubting the credibility of the hunting magic theory in explaining prehistoric cave art and the hypothesis was later impel in the 1960s Andr Leroi-Gourhan who was a French prehistorian. Leroi-Gourhan saw that the distribution of the images showed a division of the world and separated males from females. The distribution of images included Stags appearing in doorways, ibex on the cave periphery and bison, horses, oxen, and mammoths appeared in the main chambers. Leroi-Gourhan saw the male-female duality as suffusing the myth of the upper Paleolithic people. Roger lewin states that archaeologists use diverse approaches and are paying(a) attention to the context of the art. He quotes Margaret Conkey, an archaeologist from the University of California in Berkeley who argues that one has to understand the social context of art for them to understand its meaning.

How Google Chooses Employees Essay Example | Topics and Well Written Essays - 1000 words

How Google Chooses Employees - Essay ExampleThis research will begin with the statement that Google is a rapidly growing organization. The speed at which it is growing is difficult for the HR department for the company keeps pace with filling the new vacancies. The company has to fill around two hundred positions every week. It is a tough task alone, but given the companys HR department has to screen more than 100,000 jobs applications, the task becomes more complex. As a result, Google has to contain several new and innovative ways to screen the human resource in the shortest possible time in order to start filling the jobs as quickly as possible. Google has to make sure that its recruitment and cream keeps pace with the growth targets. At any time it should not happen that there are vacancies that are not filled by the highly efficient human resource. Not only the pace is important, but the quality of staff is vital as well. IF the job vacancy is filled by average people, then t hey would not be able to keep up with the companys growth policies and it would stiff that the resources are lying idle. This is something that an organization like Google cannot afford. Training people to make them a better resource for a large organization like Google. Google of necessity to adopt recruitment and selection methods that are reliable and valid. Reliability refers to the instances that the several different measures of recruitment and selection yield the same results for Google. In other words, the selection methods should be such that they point towards a particular person or group of people. Validity means that the employees at Google are tested for what they can extend at the job. The best option for Google to ensure that its recruitment policies are in line with its growth target is to use human resource forecasting method.

TELEVISION COMMERCIAL ANALYSIS (Film & Television) Essay

TELEVISION COMMERCIAL ANALYSIS (Film & Television) - Essay ExampleBecause advertisers ar trying to gain the attention of their target consumer group, they work hard to depict the ideals of the social club. If young and slim is attractive, they will work that into their presentation in as many ways as they can. If butch and hard is the current fashion, this, too, will be reflected in the way a product is marketed. At the same time, by changing the way they combine antithetic types of visual clues, these same media outlets can help to redefine a culture, to make it more tolerant of ecological issues, for example, or to change the way a society views gender roles. A national advertisement for Apple computers demonstrates how commercials can even compare two comparable products while still sending a sum that places particular emphasis on identity values.The commercial features two men standing in an empty white room. There are no another(prenominal) colors, no walls and no distrac tions from these two guys. One introduces himself as a mack computer and the other introduces himself as a PC. The one claiming to be a PC is dancing, causing the Mac guy to notice his I-pod music player. This starts a conversation about how the I-pod works seamlessly with PCs I-tunes and brings out some helpful suggestions from Mac regarding I-movie, I-photo and I-web, which all, apparently, come with Mac in a specialized package called I-life designed to make the Mac owners life more entertainment friendly, well-disposed and usable. This sets up the disparity between the two machines as PC starts listing the cool features that come in his package, including a calculator and a clock, delivered with as oftentimes pride and self-importance as he can muster. Mac provides PC with the opportunity to list more cool user-friendly features with the simple questions What have you got? and Anything else? These questions are very carefully delivered in a friendly, conversational tone that eliminates

Significance of John Brown and Harpers Ferry Essay Example for Free

Significance of John Brown and Harpers Ferry EssaySince the struggle of Fort Sumpter, three months later, the first major battle during the civil war began on July 21, 1861 which was c tout ensembleed The First Battle of Bull Run in Manassas. During this major battle, usual Irvin McDowell commanded the large Union army while General Pierre G.T. Beauregard commanded the Confederate army. The Union perceived that they would make a quick and swift victory with very little loss, but it was the opposite. At the time both sides had inexperienced soldiers. When this war was happening the hundred of Manassas citizens left their homes to watch the battle unfold. Cannons and muskets would be fired all over and some misfires would end up at the civilians homes. At the start the Union was able a push the Confederates back to Henry Hill, but they would begin their comeback.Beauregard make a strong defensive line controlled by General Thomas J. Jackson. Jackson held his ground successfull y and gained the name Stonewall Jackson. The Confederates were able to apprehend Union artillery and chose to counterattack the Union soldiers. But it quickly lashed back at them when Union forces on the hill came down and broke the Confederates line of defense, forcing his manage retreat of the Bull Run. Thus this was a victory for the Union. The result of the battle left bodys riddled in the battlefield. Thousands of wasted soldiers died in that battle and was the largest and bloodiest battle during the civilian War. Other than scaring the scaring the citizens who were watching the entire battle the government was also shocked at the outcomes of this battle. Both sides came to the belief that this Civil War was going to become drawn-out and more deadly as it goes on.From looking back at the battle one can see that it was not going to end quickly or any time soon. It became dismiss that it would last longer than people thought and that there was going to be more struggle. It a lso brought to people a clear image of what war was like. Thought the Union gained heavy losses, soldiers all across the Union gained moral for this victory and that they won. This war has also brought to the Generals attention that most of their soldiers ar inexperienced and need to be trained and prepared for future battles. Politicians in the North were outraged by the high losses resulting from the battle, which gained in favor for the randomness and gave them hope that the Confederate army could defeat the Union.

Case Pneumonia Essay Example for Free

Case Pneumonia EssayPneumonia is an inflammation of the lungs caused by an infection. It is also called Pneumonitis or Bronchopneumonia. Pneumonia can be a serious threat to our health. Although pneumonia is a excess concern for older adults and those with chronic illnesses, it can also strike green, healthy people as well. It is a common illness that affects thousands of people each family in the Philippines, thus, it remains an important cause of morbidity and mortality in the country. There are many kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or opposite organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. In the young and healthy, early treatment with antibiotics can cure bacterial pneumonia. The drugs used to fight pneumonia are determined by the germ causing the pneumonia and the judgment of the doctor. Its trounce to do everything we can to prevent pneumonia, but if one do get sick, recognizing and treating the disease early offers the best chance for a full retrieval.A cuticle with a diagnosis of Pneumonia may catch ones attention, though the disease is just like an ordinary cough and fever, it can lead to finish especially when no intervention or care is done. Since the case is a toddler, an appropriate care has to be done to make the patients recovery faster. Treating patients with pneumonia is necessary to prevent its spread to early(a)s and make them as another victim of this illness. The lungs constitute the largest organ in the respiratory system.They play an important role in respiration, or the process of providing the body with oxygen and releasing carbon dioxide. The lungs expand and contract up to 20 times per minute taking in and disposing of those gases. nisus that is breathed in is filled with oxygen and goes to the trachea, which branches off into one of dickens bronchi. Eac h bronchus enters a lung. There are both lungs, one on each side of the breastbone and protected by the ribs. Each lung is made up of lobes, or sections. There are three lobes in the right lung and two lobes in the left one.The lungs are cone shaped and made of elastic, spongy tissue. Within the lungs, the bronchi branch out into minute pathways that go through the lung tissue. The pathways are called bronchioles, and they end up at microscopic air sacs called alveoli. The alveoli are surrounded by capillaries and provide oxygen for the blood in these vessels. The oxygenated blood is then pumped by the fondness throughout the body. The alveoli also take in carbon dioxide, which is then exhaled from the body. Inhaling is due to contractions of the diaphragm and of muscles between the ribs.Exhaling results from relaxation of those muscles. Each lung is surrounded by a two-layered membrane, or the pleura, that under normal circumstances has a very, very small amount of fluid between the layers. The fluid allows the membranes to easily slide over each other during breathing. PATHOPHYSIOLOGY Pneumonia is a serious infection or inflammation of your lungs. The air sacs in the lungs fill with pus and other liquid. Oxygen has trouble pass arounding your blood. If there is as well little oxygen in your blood, your body cells cant work properly.Because of this and spreading infection through the body pneumonia can cause death. Pneumonia affects your lungs in two ways. Lobar pneumonia affects a section (lobe) of a lung. Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs. Bacteria are the most common cause of pneumonia. Of these, Streptococcus pneumoniae is the most common. new(prenominal) pathogens include anaerobic bacteria, Staphylococcus aureus, Haemophilus influenzae, Chlamydia pneumoniae, C. psittaci, C. trachomatis, Moraxella (Branhamella) catarrhalis, Legionella pneumophila, Klebsiella pneumoniae, and other gram-negative bacilli.Ma jor pulmonary pathogens in infants and children are viruses respiratory syncytial virus, parainfluenza virus, and influenza A and B viruses. Among other agents are higher bacteria including Nocardia and Actinomyces sp mycobacteria, including Mycobacterium tuberculosis and atypical strains fungi, including Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Cryptococcus neoformans, Aspergillus fumigatus, and Pneumocystis carinii and rickettsiae, primarily Coxiella burnetii (Q fever).The usual mechanisms of spread are inhaling droplets small enough to reach the alveoli and aspirating secretions from the upper airways. Other means include hematogenous or lymphatic dissemination and direct spread from contiguous infections. Predisposing factors include upper respiratory viral infections, alcoholism, institutionalization, behind smoking, heart failure, chronic obstructive airway disease, age extremes, debility, immunocompromise (as in diabetes mellitus and chronic re nal failure), compromised consciousness, dysphagia, and exposure to transmissible agents.Typical symptoms include cough, fever, and sputum production, usually evolution over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae. NURSING PROFILE a. Patients Profile Name R. C. S. B. Age 1 yr,1 mo. Weight10 kgs Religion Roman Catholic Mother C. B. Address Valenzuela City b. Chief Complaint Fever Date of Admission 1st admission

Emotional climax Essay Example for Free

Emotional climax EssayContinuing the theme of human race and its behaviour, I believe the following events to be true to that. It is strange that in a play that revolves around its religious puritan upbringing, it also lacks a certain amount of Christian/Satanic or general imagery or symbolism. I would say that in comparison to a play such as Macbeth which relies on its disturbing imagery to convey the involvement of dark forces with the plot, The Crucible uses the reactions and actions of human beings to essentially shock the audience with as opposed to bold and transparent imagery. The preceding actions of the girls is but a taste of the weak human nature that lead to some degree be the ruination of the innocents of Salem the inert lot to speak out once against those who will miss use power and authority to a larger ag annula, is the collective attitude that will allow silence to master the villages fate. The tension is released as the anger and madness dies, but the atm osphere is left with a slight air of detectable pessimism as the girls (including Mercy,) channel with no taste to rectify with monitor lizard anything he may have heard or stay for Abigails sake- (Id best be off, I have Ruth to watch.) Instead they leave apologetically and sheepishly, I extract- Mercy sidles out.Now that the stage is rid of the bulk, only the strong figure of Proctor, a slightly hidden Abigail and mute Betty re principal(prenominal). The scope is quiet, the audience surges with anxiety, as we are now fully aware of the extent of Abigails character and her master schemes for both characters on stage. The stage directions quote- Abigail has stood as though on tiptoe, absorbing his presence, wide-eyed. He glances at Betty on the bed. The video is perfectly set, almost waiting for Abigail to pounce.The remainder of the snap has only dramatic effect in the two characters direct mother tongue and actions. It is the dramatic effect of the language in the dialogue t hat develops the characters for the benefit of the audience as history repeats- Youre surely sportin with me. The flirtatious attempts of Abigail do nothing but declare the nature of their affinity. Proctors character is used in the first act and indeed second as a pawn, a strong male presence that conjures up history, friction and feelings between a variety of characters.In this quote, Proctors reply demonstrates their current familiarity, as he obviously feels his would be rude answer appropriate in her case, which suggests history and the blunt coldness of his words suggests a tainted one- You know me better, This is used to great dramatic effect as this quote is an font of what classes this scene a complication. The revelations between the two characters and the audience displays I theorize that in this epitome, a play like The Crucible has numerous complications, which take the severity of the real(a) complication (the witch hunts,) to a higher level. For example the threat of being accused by one villager is but trivial when the accusation of attempted mangle with witchcraft of which Elizabeth and Proctor are fully aware leads to trial, is brought to their knowledge. This accusation of attempted murder is one complication that mounts to a highly climatic and tragical demise.The heated and often dark references that Abigail uses are incredibly direct and delivered with a force that might suggest these are situations that are in need of persuasion. non only the dramatic tension created by her choice of tactics, but the very level of desperation and inner naivety of the character that results in juvenile actions is unfathomed The confusion behind the seemingly innocent Abigail is astounding and her unpredictability creates tension as the audience realises the precarious nature of the play when Abigail is involved.The next scene I will analyse simply overflows with emotion, brought out through the characters ordeals. Elizabeth is featured here, wife of Proctor and the other half of an unhappy marriage. Their struggles seemed to begin and end with that harlot, once again Abigail is at the centre of insular turmoil. Leading up to this scene, we have seen a troubled and excluded couple as Goody Proctor kisses him with suspicion and keeps their future bliss with it at the root of their marriage, Proctor bites his tongue with his sins past sins upon his shoulders. This scene is one of revelation and the audience sits enthralled as even tension created for the ultimate end disappears, as the couple who obviously unflurried have do it for one another quash their insecurities and make their peaceableness.The scene begins with this fluctuation of feelings toward one another still in tact. The atmosphere is one of grief and almost acceptance, as these accusations, deaths and confessions have continued over the past few months (since the previous scene,) and the two characters have bared gruelling witness to it all. Once again, this final appearance of Elizabeth to Proctor needs a more detailed explanation, as the stage directions take the audience through every one of their actions and therefore magnifying the importance of the revelation of this scene, Alone. Proctor walks to her, haltsThe gentle nature of Elizabeth has been taken advantage of, in order to coax proctor into a confession. Elizabeth has taken the opposite course of action and frees him from her suspicious grasp.Elizabeths query, though perhaps comical when an attempt is made to read it seriously, shows her utter lack of compassion and hold through the injustices of their predicament. Lack of compassion even for her own husband, though her enquiry made is meant in a considerate context- You have been tortured? Elizabeth continues to answer his questions in a cold and blunt manner, (their inhibitions still remain, anticipating the arrival of the emotional climax.)Extending the theme of revelation, this is probed unintentionally by Elizabeth and her remarks, for example she says about the death of Giles Corey, They press him John, more slant he says. Proctors reply is influenced by this, the courage of Corey is taken by Proctor and used to state, I have been thinking I would confess to them Elizabeth. In addition, the quote of Elizabeths instigates she wishes him to form a course of action, which he does in the previous quote.However, her reply is not one of looming suspicion or ruled by mistrust, it overcomes those petit consciences and the character finds the will to say, I cannot judge you John. No matter how Proctor begs for an order, a course of action or reassurance, Elizabeth stands strong and helps him to lose his inhibitions by making his own choice. The scene finally reaches a heart-wrenching climax as Elizabeth delivers the line Only be sure of this, for I know it now Whatever you will do, it is a wide-cut man does it. Whatever the finale, this is a satisfying resolution because the characters have admitted exa ctly what the audience almost begs them to say, the actors deliver a service of satisfaction.Perhaps the only the example of dramatic imagery is the recurring theme of winter inside the Proctor house, as opposed to the summer and heat in the midst of the Abigail/Proctor love affair. Elizabeth now admits that is was a cold attitude she had towards her husband a shrivelled marriage that she kept, a cold house. Her admittance of this symbolises the last string of the old relationship broken. The dramatic effective adds to the release of tension between the characters as the entire situation diffuses.Both of the characters fronts falter as they indulge in insular peace, pavage the way for the final resolution the turmoil between husband and wife is finally resolved, Proctor has everything to live for and the strength to do what is need to remain with family and friends- or is it? Unfortunately, the phrase too good to be true springs to mind, and also to the audience. The scene I analys ed is in theory the penultimate resolution. It fits this description perfectly, as although it is misleading -because Proctor decides not to have his life and confess, but die with sanctity of name- it is satisfying. Dramatic tension is built extremely subtly behind the contagious joy of peace between the Proctors, foreseeing the ultimate loss of inhibitions for John.True, the character has lost the stubbornness that kept his wife from him, but it is also true to Elizabeths statement that John has not forgiven him egotism self confessed sinner he may be, but a proud man is John Proctor. The truth may be that even in death, let wholly life would the character not forgive himself for his sins with Abigail. His martyrdom was the release of self-hatred through a noble stand he held onto the only thing that in his opinion was not tainted, his name.The Crucible recurs the theme of boundaries and limits, with such things as physical limits including the obsession with land, exclusive livi ng (within colonies,) and with names. Proctors boundary was infact the preservation of his name, that is the only earthly scrap of self he would not let go of- the only piece of self he realistically had left. This is a truly effective resolution, as the main character is finally at rest Miller is no hero for surviving the courts, but his duty to society is done, his warning and message still survives l years on.

Non Medical Independent And Supplementary Prescribing V300 Nursing Essay

Non Medical Independent And Supplementary Prescribing V300 Nursing EssayThis essay discusses the evolution of nurse prescribing in the context of legislation and governmental element, with the consideration of how this has changed and assist the clinical nurse specialist role, with contingently emphasis on internality in addition-ran. The pathophysiology of face trouble will be discussed and integrated into the relation of do drugs actions with particular interest into Diuretics. Alongside this the importance of effective tale taking, assessment and consultation skills to treat the patient finishedly and at a high standard and tone of voice is discussed. The decision making process and the importance of a overlap admission in relation to bosom misadventure is highlighted incorporating the importance of compliance in the tap the treatment of sprightliness harm.Sources of information and decision support systems that atomic number 18 available will be highlighted with a discussion on the importance of these in normals. evidence of ability to prescribe safely, ration soloy, cost effectively, and in consideration of the worldly concern wellness issues around medicine use argon discussed and finally clinical governance done quality assurance and audit of prescribing give is considered.For the purpose of the essay the following learning outcomes argon discussed guess understanding and application of the relevant legislation and political context of the practice of non- checkup prescribingCritically appraise sources of information/advice and decision support systems in prescribing practice and apply the principles of evidence based practice to decision making. conflate and apply knowledge of drug actions in relation to pathophysiology of the condition being treatedDemonstrate the ability to prescribe safely, rationally, cost effectively, and in consideration of the public health issues around medicines useIntegrate a shared approach to deci sion making taking account of patients/carers wishes, values, religion or cultureEvaluate effective history taking, assessment and consultation skills with patients/clients, parents and carers to inform feeding /differential diagnosis.Contribute to clinical governance through quality assurance and audit of prscribing practice and regular continuing professional developmentThe controls of medicines in the UK has undergone a number of regulatory changes since the end of 1800s, climaxing in the Medicines Act (1968). Prior to 1992, doctors, veterinary surgeons and dentists were the only professions legitimately permitted to prescribe. This situation made the medical profession gatekeepers for medicines, certainly the case for those medicines considered to a greater extent likely to grounds harm or abuse such as controlled drugs i.e. morphine.Cumberledge topic (1986) identified the need for community nurses to prescribe, The Crown taradiddle (1989) published findings of a review to determine the circumstances in which non-medical health professionals could undertake new roles with indirect request to prescribing, supply and administration of medicines and led to the development of protocols which we now know as Patient Group Directives (PGDs).The Crown Report (1999) recommended that legal authority to prescribe should be extended to include new groups of healthcare professionals, this also bought most the differentiation between Independent and Supplementary prescribers. This report noted that a doctor often rubber stamps a prescribing decision taken by a nurse, which is demeaning to nurses and doctors. (Cooper et al,2008)The Medicinal Products Act (1992) permitted fitted District Nurses and Health Visitors to independently prescribe, and this was only a limited number of medicines from a Community Practitioners Formulary.Over the next few years legislative changes occurred which involved, non community qualified nurses to train as prescribers, together wi th an subjoin in medications added to the Nurses Formulary. In 2003, nurses and Pharmacists were permitted to prescribe from the whole of the British field Formulary (BNF) as supplementary Prescribers, except controlled and unlicensed drugs. Controlled Drugs were prescribable by nurses and pharmacists using supplementary prescribing from 2005. During this m other allied Healthcare professionals such as physiotherapists, Radiographers, Podiatrists and optometrists were also able to bugger off supplementary prescribers. (DOH, 2005)These rapid changes in the development of non medical prescribers in the united Kingdom were a contrast to the gradual introduction to prescribing rights in the United States of America. (Armstrong,1995). The UK now has the most extended non medical prescribing rights in the world. (Armstrong, 1995) In 2006, DOH (2006) permitted clever nurses and pharmacists to independently prescribe all medicines within their clinical competence. The most recent chan ges have occurred to the Misuse of Drugs Regulations (2012) which now bureau that appropriately qualified nurses and pharmacists will be able to prescribe controlled drugs like morphine, diamorphine and prescription strength co-codamol.Currently on that point are more than 50,000 Non medical prescribers in the UK, around 19,000 nurses and almost 2,000 pharmacists are qualified as Independent and/or supplementary prescribers (Carey, 2011)The changing legislation of Non medical Prescribers has changed alongside with the environment of the NHS services. This is recognised in the guide produced by NMC (2010) stating that the services delivered by the NHS become more challenging and labyrinthine as there is an ever increasing need for improved productivity without the compromising of quality.Coronary nerve centre disease, puts commodious pressure and demands on the National Health Service (NHS). Hospital admissions for Chronic feel failure have increased markedly, chronic heart fa ilure accounts for intimately 5% of all medical admissions and approximately 2% of total health care expenditure. Despite improvements in medical management, under treatment for heart failure is still universal. (Mcmurray et al, 2002) In 2002, The British middle Foundation (BHF) piloted a scheme and funded with the help of Big Lottery Fund ninety two Heart failure nurses throughout the United Kingdom. The results were shown in the final report BHF (2008) showing an average reduction in heart failure admissions of 43% and an average estimated saving, per heart failure patient of 1, 826. Increasing the role of the Non medical prescribers therefore increasing the skills and knowledge of nurses/pharmacists only enhances the vital role within the field these nurses have in todays stream fight to provide the highest quality care possible. It has been shown that registered nurses are extending their roles and responsibilities to work in new ways (Furlong + smith, 2005). Crowther et al ( 2003), Gattis et al (1999), Paniagua (2011) Lambrinou et al (2012) and Jaarsma (2010) have all shown that Heart failure nurse specialists are optimal providers to assist physicians with Heart failure care for this complex and time-consuming patient population.The management of heart failure is complex involving both pharmacologic treatments and strategies to improve patients functional status and quality of life (Palmer et al, 2003) Heart failure go off be defined as an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues. (ESC, 2012)Clinically patients present with ordinary symptoms breathlessness, ankle swelling and fatigue. And signs elevated JVP, pulmonary crackles and displaced apex beat. Diagnosis of heart failure relies on a detailed history and accurate physical interrogative (NICE, 2010). These symptoms can be related to either a reduction of cardiac ourput (fatigue) or to excess fluid retention (dysapnea, orthopnea and cardiac wheezing) fluid retention also results in peripheral edema and occasionally an increasing abdominal girth secondary to ascites. Symptoms and signs are often non- unique(predicate) and could be related to other conditions. Knowledge on the use of other symptomatic services is necessary Echocardiography, Electrograph, Chest Xray, Blood tests all contribute to the confirmation of diagnosis.Case study One demonstrates a regular(prenominal) presentation of a patient presenting with first presentation of heart failure symptoms typically compromised and in need of expert medical treatment Pharmacological and non pharmacological therapies. This patient presented with clear signs of congestion and volume retention of which a diuretic therapy plays a central role in the treatment (Felker and Mentz, 2012)As the heart fails, there is a reduction in both blood pressure and cardiac output, in response to this the body conse rves water which results in oedema. Diuretics act at different sites of the kidneys, they then eliminate sodium and water through enhanced excretion from the kidneys so are able to relieve the symptoms of fluid congestion. Different classes of diuretics work at different points within the kidney tubules. (Davies et al, 2000) Appendix two shows the diuretics available.This patient was treated with Furosemide intravenously (IV), most patients receive a loop diuretic as first line treatment for heart failure (Faris et al, 2012.) Loop diuretics are the most frequently utilise diuretic in treatment of Chronic heart failure despite their unproven effect on survival, their indisputable efficacy in relieving congestive symptoms makes them first line therapy for most patients. (Bruyne, 2003) Appendix trine shows how loop diuretics work.As already stated first line treatment for acute decompensated heart failure is intravenous diuretic therapy either as a bolus or via continuous infusion. Despite being available for decades, few randomized trials exist to guide dosing and administration of this drug. In 2011, the Diuretic Optimization Strategies Evaluation (DOSE) trial used a prospective, randomized design to compare bolus versus continuous infusion of IV furosemide, as well as high- window glass versus low-dose therapy. The study found no difference in the primary end point for continuous versus bolus infusion. High-dose diuretics were more effective than low dose without clinically important negative effects on renal function. Although no difference was found between IV and bolus dose there are benefits to both elements so clinical judgement would be made on the specific patient needs and requirements, for example, immobilization, duration of therapy requirements, haemodynamic status. The aim of using diuretics is to achieve and maintain euvolaemia (the patients dry weight with the lowest achieveable dose. (ESC, 2012).Case study two identifies a patient whom is ano ther example of heart failure but offers a different presentation this accentuates the importance of a careful physical examination and valuable accurate history taking. The absent breathe sounds over the right base of lung field along with the history was an indication of pleural effusion and initiated the prescription of a radiograph chest to be performed. Absent or diminished breath sounds strongly suggest an effusion (Kalantri et al, 2007) unfortunately Congestive heart failure is the most viridity cause of a pleural effusion. (Enrique, 2008) Again, Pleural effusions from heart failure are managed with diuretic therapy, initially with a loop diuretic, intravenously titrated in response to clinical signs, daily weights and renal function to avoid excessive volume depletion. (Light, 2002)Non-compliance in patients with heart failure (HF) contributes to worsening HF symptoms and may lead to hospitalization. (Van der wal, 2006). Using skills that were taught during grassroots nur sing training is imperative in conducting a beneficial and effective clinical examination, these interpersonal skills may dictate how the patient and carers perceive and acknowledge there diagnosis and may have an influence on the approach the patient has on his/her own health.Over the past 3 decades, the biopsychosocial model of health has become increasingly important in the effective practice of medicine. Central to this model is an emphasis on treating the patient as a whole person, including the biological, psychological, behavioral, and social aspects of their health (Engel, 1980). The American Heart Association (AHA) in collaboration with other professional societies has issued a new scientific statement for the management of patients with advanced heart failure. It emphasizes shared decision making and is designed to help physicians and other health professionals align medical treatment options with the wishes of the patients. Allen (2012) recognises the complexity of heart failure and complexity of the treatment options can be a barrier to shared decision making, but this only emphasizes why such a patient-centred approach should be undertaken in Advanced heart failure. Shared decision making has received particular emphasis in relation to the prescribing of drug treatments. Traditionally, studies have identified 50% of patients with chronic conditions do not take their treatment as prescribed, with major reasons being because they do not share the doctors views, or they are worried about side effects. (REF QUOTE?) consequently the aim is to explore these issues by adopting a shared decision making approach and reach a concordance between doctor and patients. at that placefore acquire patients involved in the planning and management of care, being sensitive to the individuals need, spending time figuring out what is important to them, will hopefully subject about of the confusion and complexities concerning heart failure. Although knowledge alone does not insure compliance, patients can only comply when they possess some minimal level of knowledge about the disease and the health care regimen. (Van der wal, 2006).The National Prescribing Centre (2012) designed a competency framework which can be seen in appendix 3. One of the three domains is the consultation which highlights three areas of importance 1 Knowledge pharmacological and pharmaceutical. 2 Options concerning the diagnosis and management 3 Competency involving shared decision making with parents, patients and carers. The information is clear that for the benefit of the patient and success with the treatment regimen it is vital to consider wishes of the patient/carer, ethical, cultural opinions, lifestyle of the patients. Also contributing factors which may cause non-complicance whether intentional or not for example polypharmacy, complicated dose regimens, unpleasant side effects, and cognitive problems or physical disability preventing the patient taking the medi cines. A large number of factors need to be incorporated into the thought process prior to getting to the point and writing a prescription.Surrounding issues that directly and indirectly support patient orientated prescribingSources of information are on number of levels. In a hospital ward, for example, immediate sources of information include the British National Formulary (BNF) and ward pharmacist. The role of both is, at least in part, to assist in ensuring that, for any prescription, the correct dose and timing of administration are correct and appropriate for the indication. The BNF is widely available and accessible and can and should be used to assist in prescribing whenever there is any doubt about dose and timing. The Pharmacist provides an additional safety netting, by checking prescriptions before providing the medications. In addition, the pharmacists role includes ensuring that medications prescribed are available for administration.Further afield, but still within the hospital, topical anaesthetic policies give guidance on what drugs are available and recommended for a particular indication. These policies may be produced by the hospital or by regional bodies, including SHA, earnings PCTs, for example, local arrangement may mean that a particular statin is used for primary prevention of coronary heart disease, collectable to local procural agreements or cost effectiveness analyses.Beyond the hospital setting, a number of sources provide guidance on what should actually be prescribed, or considered, for a minded(p) condition. Such sources might include home(a) bodies, in particular National institute of clinical excellence (NICE) and specialist societies. The latter may be national and or international. For example, in the field of heart failure, NICE has given guidance on what medications should be administered and at what stage of the disease and symptoms. For all patients ACEI should be given. There are many different ACE I. The guidelin es recommend using only those which have actually been proven to be of benefit in heart failure these emailprotected. For those who are intolerant of ACE ARB should be used. Again, NICE recommends thoses that have shown efficacy in clinical trials, and these emailprotected. Beta-blockers are recommened but not any betablocker. only those with proven in heart failure should be used these are Aldosterone Antagonists should also be used for patients with advanced heart failure (NYHA III/IV). counselling recommends spironolactone, or eplernone if not tolerated (most usually due to gynaenomastia in men)From the above, it may be seen that the National guidance indicates which drugs from each class should be considered for each purpose. This leaves room for local policies and prescribers to decide which of the available agents is suitable for a particular individual.Pursuing the example of heart failure further, international guidelines are issued by a number of bodies. The principle o f these is the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) and the American Heart Association (AHA). Of these, the ESC guidelines are most applicable to the United Kingdom. Societal guidelines tend to focus more on a particular disease and the available evidence to provide best treatment, whereas NICE guidelines have greater emphasis on appraisal of cost-effectiveness, which is of greater relevance to the local health economy in the UK. Furthermore, ESC guidelines give a strength of recommendation for a particular treatment (Class I, IIa, IIb) and an indication of the level of evidence toilet the recommendation. (A, B, C)Ultimately, the source of information which informs societal guidelines comes from research, in the form of clinical trials, performed on the back of pre-clinical research. Therefore, the doses of drugs which are recommended for use usually reflects the dose and frequency of a drug or used in a clinical trial which demonstrate d benefit.There are therefore numerous levels of information and advice which support prescribing practice. For many conditions, these are ultimately based on evidence derived from clinical trials, in some areas these will be the gold standard RCT. However, some trials provide softer evidence, such as observations data or even anecdotal. Understanding of these various trials and guidelines is important to understanding how local guidelines and daily prescribing practice come about and are supported by evidence.The trials/guidelines all mentioned above have provided convincing evidence that clinically significant improvements can be achieved in heart failure by appropriate drug treatment. Moynihan et al (2002) recognises that the adoption of more effective and/or safer drugs, new technologies are usually more expensive, aging of the population leads to increased morbidity and drug therapy, all play a role in increasing drug expenditure.Medicines are regarded an expenditure, but can a lso be an enthronisation, if they are used rationally. Rational prescribing means cost effective use of safe and effective drugs.Specialist clinics for heart failure are a tool for delivering care according to clinical guidelines and providing diagnostic treatment. They provide optimal management of the condition, education of patient and carers about the signs and symptoms of worsening disease and medication compliance. Advances in medication and technology for heart failure are vast, which again strengthens the need and importance of such clinics to enable patient treatment to change accordingly and appropriately. Studies have shown that if patients are treated by Cardiology clinicians or Heart failure specialist nurses, clinical guidelines are more likely to be followed and readmission rates are lower for these patients. (Reis et al, 1997)An example of prescribing within heart failure is an investment for the patient and the NHS is the use of Angiotensin-converting enzyme inhibi tors (ACE I). These have been shown to improve symptoms, survival and slow progression of heart failure. (Luzier et al, 1998). ACE I are one of the inseparable therapies for all heart failure patients, if tolerated. Treatment should be maximised and in maximising the dose quite often you can reduce or stop the use of loop diuretics due to improved symptoms and clinical signs. (Hoyt et al, 2001) Therefore patients who are appropriately treated and titrated to maximal therapy therefore benefit clinically, may reduce other medicines and they can overall reduce the chances of hospital admission with decompensated heart failure which is beneficial to the patient and the NHS finances.A recent study by Dharmarajan et al (2013) covering three million hospitalizations showed that more than a third of readmissions (within 30 days of discharge) were for heart failure. Their thought was that many of these could have been preventable, with greater input from pharmacists, physicians, nurse speci alists, and greater consideration to social elements cut down readmission also reduces other risks involved in exposing patients to hospitalization. The National Heart failure Audit (2012) conducted by NICOR is an audit to monitor progress, clinical findings and patient outcomes of patients with heart failure. It is an essential audit for each NHS trust to comply and complete. ++. It provides critical information on management and outcomes which then provides data essential to drive future improvements.Conclusion shell STUDY ONEDescription of clinical settingPatient was an inpatient on the Cardiology ward he was admitted the day before and had been referred to Heart failure clinical nurse specialist for review.Case historyAn 84 year old retired postman was admitted from home with progressive worsening shortness of breath over the blend in 6 weeks. He had been to see the General Practitioner two weeks ago who treated him for a chest infection with a course of oral antibiotics (Amox ycillin). He denies any chest pain, however he complains of palpitations at times of exertion and a productive cough. Patient had not experienced any syncope, dizzy spells only other complaint was loss of appetite and poor quality sleep. Patient has been quiescency with 4 pillows, waking regularly due to struggling for breathe and resulted to sleeping in the chair downstairs. Exercise tolerance had drastically reduced to 50 metres before having to stop due to breathlessness.On examination the patient was tachypnoeic, pulse was 95 and regular, sitting blood pressure was 110/62 standing 105/55. Weight 97kg. Oxygen Saturations on air 94%. Inspiratory crackles were clearly perceive on both lung bases, no heart murmur could be auscultated and apex beat was misplaced to the anterior auxiliary line. JVP was raised +4. Pitting peripheral oedema up to thighs and a large distended abdomen, which was soft and not tender on palpation. ECG confirmed Sinus tachycardia with Q waves in antero lat eral leads. Chest x-ray also confirmed cardiomegaly and interstitial oedema.Drug treatment pre admissionaspirin 75mg once a day (OD)Blood pressure controlPast medical historyAnterior lateral Myocardial infarction 7 years ago (2005) followed by Angioplasty to the right coronary artery.No further operations or admission to hospital.Blood resultsChemistry Sodium 128mmol/l, Potassium 4.8 mmol, Urea 9 mmol/l, Creatinine 145 mmol/l, LFTs, HB and clotting was all unremarkable.Echosevere left ventricular dysfunction, with minor tricuspid regurgitation.Social backgroundPatient lives with wife in a two bedroom bungalow, they are both normally well and independant. He has no allergies and takes no over the counter medications or recreational drugs in the past or present.Drug chart to date in hospitalAspirin 75mg ODFrusemide 80 mg ODRamipril 2.5 mg ODDiscussionPatient was fortunate enough to have had Echocardiography that morning, which offered me the definitive diagnosis. This gentleman presen ts with a common clinical presentation of progressive systolic dysfunction of an ischemic cause. The patient was comfortable and stable enough for a steady and methodical examination and history taking.On construction of a management plan for this patient, clearly first line treatment is diuretic therapy, T Effective dieresis and consequent leeway of the loading conditions of the failing heart is generally regarded as essential (Raftery, 1994)This patient went on to be prescribed Intravenous Diuretics, instructions for Daily weights, Fluid balance, advice and rehabilitation for heart failure. 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