A Nurse Is Caring For A Diabetic Patient With A Diagnosis Of Nephropathy Essay Samples
Wednesday, December 25, 2019
New Orleans The Confederate Era Monuments - 1283 Words
New Orleans Monument Takedown The confederate era monuments in New Orleans have been a hot topic of debate. People on both sides feel passionately about whether these local historic landmarks should remain standing or be torn down because of the atrocities the men they honor committed well over one hundred years ago. Whether over racial or personal beliefs there are strong motives on either side. As of now the future of the cityscape lays in limbo. Will history prevail over emotion? In 2015 there was a racially motivated shooting at a historic Emanuel African Methodist Episcopal Church in Charleston, South Carolina (Horowitz, Corasaniti, and Southall). There was a total of nine victims total that died (Horowitz, Corasaniti, and Southall). Local Church leaders felt that there was no other explanation than racial discrimination (Horowitz, Corasaniti, and Southall). Later investigators ruled the shooting a hate crime fueling the fire on the confederate monument removal. New Orleans, Lo uisiana is a city known for its historic beauty. Everything in Down Town New Orleans has a long history. Whether the histories are beautiful or distasteful they tell our cityââ¬â¢s story. In 1960 Jackson Square was declared a national historic landmark due to its growing popularity. New Orleans was built around Place dââ¬â¢Armes which was the original name of Jackson Square (Wegmann). Place dââ¬â¢Armes was changed to Jackson Square shortly after Jacksonââ¬â¢s death in honor of him (Wegmann). A few shortShow MoreRelatedMitch Landrieu Speech Analysis1642 Words à |à 7 Pagesspeech Speech Upon the Removal of Confederate Monuments by Mitch Landrieu, the Mayor of New Orleans, the removal of the Confederate monuments in New Orleans is discussed. The speech emphasises the fact that the Confederacy was wrong pertaining to their treatment of African Americans, and instead of teaching history, the Confederate monuments convey an image of inequality and violence. Mitch Landrieu a rgues for the deconstruction of historic Confederate monuments through his allusions to past historicRead MoreThe Great City Of New Orleans2217 Words à |à 9 PagesIn this great city of New Orleans, we have so many extravagant elements that distinguishes us from other cities. From Mardi Gras to the French Quarters to Canal St., they all play an important part in this city s history. The different historical statues we have scattered about the city also cause major attractions and either people love or hate them. Lately, four specific statues have been getting a lot of attention around town from not only the citizens, but from our very own mayor, Mitch LandrieuRead MoreEssay about Kentuckys Divided Loyalties During the Civil War4664 Words à |à 19 Pagesand Mississippi rivers for transporting their produce wanted access to both waterways and the international port of New Orleans. If the South separated itself from the North, this free access would be impeded. On the other hand, i nfluential plantation owners and state rights advocates sided with the Confederacy. As a result, Kentuckians could be found in both Union and Confederate armies. What side was the State of Kentucky on and was she truly neutral in the beginning. Lowell H. Harrisons argued
Tuesday, December 17, 2019
Adolf Hitler And His Nazi Party - 2070 Words
Adolf Hitler and his Nazi party are key in the story of the modern Jewish plight within central Europe. Despite a vast number of the laws passed within Nazi Germany and then Nazi occupied Europe being applicable to the Jewry of Germany, and Europe it is clear that it was not exclusively for the Jews and the effect of this was not worse for one or another. However, this essay endeavours to discuss the main characteristics of the Nazi policies on the Jewish population and it is easy to see that the main characteristic was exclusion aided by terror, which only appeared to brew with the well-established feelings of anti-Semitism and become increasingly more extreme. However it is important to acknowledge the debate around the subject, as suggested by Wildt it is important to not willingly accept and ââ¬Å"adoptâ⬠the school of thought as a clear cut unfolding of Nazi policy, where he suggests that anti-Semitism has been a part of Germanic life for centuries and not a product of the regime. Before going into the characteristics of the policies of the Nazi party it is important to understand about the origins of the party itself and therefore the origins of the partyââ¬â¢s anti-Semitic nature. The National Socialist German Workers Party commonly known in English as the Nazi Party was a political party in Germany active between 1920 and 1945. The party grew from the German Nationalist, racist and populist anti-communist paramilitary culture which fought against the communist uprisingsShow MoreRelatedAdolf Hitler : Leading The Genocide1182 Words à |à 5 PagesMarch 2015 Adolf Hitler: Leading the Genocide The Holocaust was the mass murder of Jews under the German Nazi regime in 1941 to 1945. There are many components of this significant event. One important component was Adolf Hitler, the leader of the Nazi Party and Chancellor of Germany from 1933 to 1945. Hitler contributed to the execution of Jews during WWII through his ideology, his dictatorship, and his leadership of the Nazi Party. To initiate, Hitlerââ¬â¢s early life had a great impact on his ideologyRead More Adolf Hitler Essay1212 Words à |à 5 Pages Adolf Hitler On April 20, 1889, the world was changed forever when Adolf Hitler was born to Alois and Klara Hitler in a little town named Braunau-am-Inn, Austria. Alois worked as a customs officer on the border crossing near their hometown. Adolf was the third born in his family, but first to survive. Later would come Edmund, who would live to the age of six, and Paula who would live to out survive Adolf himself. With a poor record in school, Adolf Hitler dropped out with ambitions of becomingRead MoreAdolf Hitler: Propaganda And The World War At 1937-1945.1364 Words à |à 6 Pages Adolf Hitler: Propaganda and the World War at 1937-1945 Phillip E. Greaves American Military University Professor Brian Weber Adolf Hitler: Propaganda and the World War at 1937-1945 Introduction Deemed as an empire that was a creation of propaganda and thrived by propaganda, the Nazi empire under Adolf Hitler was one of the strongest forces in the Second World War between 1937 and 1945. Defined by propaganda, the Nazi Party under the leadership of Hitler dictated the economyRead MoreThe Treaty Of Versailles Was A Peace Treaty921 Words à |à 4 PagesAdolf Hitler was born on April 20, 1889 in Austria. Hitler was a German politician and the leader of the Nazi Party. Adolf Hitler was a decorated veteran from World War I. The Treaty of Versailles directly affected the German people and Hitler. The Treaty of Versailles was a peace treaty set in place at the end of World War I to end the war. One of the most crucial and contentious problems with this treaty was it required that the country of Germany to disarm, take guilt and pay apologies toRead MoreThe Tragedy Of The Holocaust922 Words à |à 4 Pagesoccurred throughout history across the world. Perhaps one main tragedy that leaves people feeling baffled is the Holocaust. Eric Lichtblau described the Holocaust in his article, The Holocaust Just Got More Shocking, as a genocide in which Adolf Hitlerââ¬â¢s Nazi Germany and its associates killed around six million Jewish people because the Nazis believed that exterminating the Jewish people was justified. They believed this for the reason that Jewish people were not only a ââ¬Å"lowâ⬠and ââ¬Å"evilâ⬠race, but wereRead MoreEssay on Adolf Hitler927 Words à |à 4 PagesAdolf Hitler Adolf Hitler, to some, was a great ruler, but to others he was a murderer. Hitler was the leader of the Nazi party and was the dictator of Germany. He ordered to have millions of Jews murdered or thrown in prisons. Adolf Hitler was born April 20, 1889, in a small town in Australia called Branuan. His dads name was Alios Hitler and was a customs official. He was 51 years old when Adolf was born. Klara Polz, Adolfs mother, was a farm girl and was 28 when Adolf was bornRead MoreAdolf Hitler Essay1373 Words à |à 6 PagesAdolf Hitler Adolf Hitler was born on April 20,1889. This was the beginning with horrible plans for power and control of other people.Some of the things that Hitler did throughout his life were very cruel things; first of all, he was a man who loved war and fighting. Second, he was in charge of putting all of the innocent Jews into Concentration Camps and killing them. Third, he wanted one dominate race of all the same kind of people. Fourth, he had a life long obsession with danger. FifthRead MoreHitler s Impact On The World War II1636 Words à |à 7 Pagesa square, saluting and chanting Hitler s name. World War II has begun and many Germans hope for improvements in the economy. Their leader is Adolf Hitler. Adolf Hitler, dictator of Germany in World War II, was a powerful speaker who caused over 5 million deaths in concentration camps. Though Hitler s impact can be felt in modern times, the roots of his atrocious behavior began at childhoodââ¬âmore specificallyââ¬âhigh school. Years before Adolf Hitler was born, Hitler s great grandfather, Johann GeorgRead MoreThe Tragedy Of The Holocaust945 Words à |à 4 Pagesthroughout history across the world. Perhaps one main tragedy that leaves people feeling baffled is the Holocaust. Eric Lichtblau described the Holocaust in his article, The Holocaust Just Got More Shocking, as a genocide in which Adolf Hitlerââ¬â¢s Nazi Germany and its associates killed approximately six million Jewish people because the Nazis believed that exterminating the Jewish people was justified. They believed this for the reason that Jewish people were not only a ââ¬Å"lowâ⬠and ââ¬Å"evilâ⬠race, but wereRead MoreAdolf Hitler and His Regime Essay1481 Words à |à 6 PagesAdolf Hitler and His Regime Adolf Hitler and his regime had a devastating effect on the twentieth century. Hitlerââ¬â¢s third Reich (1933-1934) was supposed to last for 1000 years but only lasted twelve. This evil man legalised the destruction of an entire race of people. He plunged ââ¬Å"the world into one of the bloodiest and most destructive wars in history.â⬠(Shirer, 1961) Hitler was a genius but an evil genius. He had the ability to convince millions of Germanââ¬â¢s of his ideas to extent the
Monday, December 9, 2019
Terms and their Related Health Risks
Questions: Part 1: Define these terms and list the potential health risks of each: Include the definitions the resource where the definition was obtained. Normal weight Overweight Underweight Obese Morbid obese Ethnocentrism Part 2: For this assignment either find a willing participant or you may use yourself and calculate BMI. Check the BMI chart and decide what category the person is in according to the WHO. Develop a diet teaching plan according to the category. Use the guidelines and information in the previous modules for formulation of your complete dietary teaching, research, and information given to the patient. A good assessment tool to use is available here? Answers: Introduction: This assignment provides insight on the relevant medical terms and their associated health risks thus reflecting the significance to maintain a healthy lifestyle, food habit and health checks. Identification of BMI and relevant diet plan provided in this study presents sound knowledge of health and well-being. Part 1: Definitions of terms and their related health risks Normal weight- The normal weight is highly subjective. It refers to the body weight possessed by people with relevant height matches. The range of normal weight varies with age and sex. As stated by Barasi (2013), possessing a normal weight indicates that the body fat and height ratio of an individual is exactly as per need to consider the person healthy and strong. It not only affects the lifestyle of the individual but also the physical and emotional perspectives as well. Maintenance of a normal weight prevents the occurrence of potential health diseases by reducing the health risks. Normal weight of an individual is an indication that the persons height and weight are in alignment and the health condition is at optimum (Rolfes, Pinna Whitney, 2012). However, negligence of health by a normal weight person can readily put into the underweight or overweight categories, which are detrimental to health. Therefore, a normal weight person needs to put effort to maintain the normal weight consistently to avoid the occurrence of any serious illness or diseases. Barasi (2013) opined that a healthy diet with relevant exercise regimen execution is an efficient process to maintain normal weight of an individual. Overweight- Although increase in body fat is one of the major reasons for a person becoming overweight, other causes are also there as increase in lean muscle mass. Aranda McGreevy (2012) stated that plenty of food supply and a sedentary lifestyle leads to an individual becoming overweight due to accumulation of excess body fats and not being able to lose them due to lack of activity. A weight of 10 % or more of the normal weight of a person is considered overweight. A number of health risks are associated with overweight. As per studies, it is revealed that being overweight at 40 years of age reduces a persons life expectancy by 3 years. In 2013 survey overweight is closely associated with the risk of azoospermia and oligospermia in men. It is also highlighted that overweight affects the psychological health of individuals above 8 years of age due to social discrimination (Cdc.gov, 2015) . Underweight- The people who have a body weight that is below the allowable range to consider a person healthy are called underweight, considering the height, weight, age and sex of the individual. Barasi (2013) believe that lack of adequate amount of body fat results in underweight. Being underweight is an indication of low levels of essential vitamins and minerals that keeps the body strong and healthy. The underweight individual is at high risk of infections, osteoporosis and other health issues (Habibzadeh, 2010). Health issues as weak immune systems, hair loss, disrupted hormone regulation and low muscle mass are common in underweight people. Higher risk of dementia is evident in people who are underweight in their middle ages. Anaemia is another potential disease related to underweight. Underweight persons face the lifestyle problems of low energy, getting tired quickly and psychological problems for social discrimination. Fatima et al. (2015) highlight the issues in menstruation of women due to underweight that ultimately increases the risk of fertility problems. Obese- Bagchi Preuss (2013) opines obese as the weight that indicates the possession of a lot of body fat by an individual. Obese is a condition with excessive body fat proving unhealthy for humans. People with a BMI of over 30 are considered obese. Obesity exposes a person to health risks of developing several life-threatening medical conditions as Type 2 Diabetes, stroke, coronary heart disease and certain types of cancer such as bowel and breast cancer (Who.int, 2015). Along with these, the quality of life of the individuals is also affected by obesity. In US, studies reveal a number of mental issues originating in individuals due to obesity. Therefore, the obesity seems to affect psychological health of individuals as well. Morbid obese- It is a serious health condition interfering with the basic physical functions of a human such as breathing and walking (Miller, 2011). A person with a BMI of 40 or more falls under the morbid obesity category. It indicate around 100 pounds over own normal body weight. Morbid obese individuals face a higher risk for illness such as sleep apnea, osteoarthritis, cancer, gastrooesophageal treflux disease (GERD), diabetes, heart disease and gallstones. Morbid obesity raises a persons resistance to insulin thus resulting in Type-2-diabetes. Due to additional weights on knees and hips, wear and tear along with pain inflammation in joints is evident in a morbid obese individual. Verissimo (2014) pinpoint the deposition of fats in neck and tongue as causative factors of sleep apnea and respiratory problems. Psychological issues as depression is also evident associated to this condition. Morbid obesity is also closely related to infertility and urinary stress incontinence. Ethnocentrism- It is the phenomenon of judging another culture solely on basis of ones own cultural values and standards. Language, religion, behavior and customs form the major criteria of judgment in ethnocentrism. It identifies the unique cultural identity of each ethnicity. Capucao (2010) criticizes the aspect of ethnocentrism that reflects the inherent superiority of ones own culture. Since ethnocentrism directs people practicing it to false assumptions regarding cultural differences and disrespect or looking down upon other cultures it puts a detrimental effect on the society. It is often seen to result in communication distortions and cultural misinterpretation among people (Home.snu.edu, 2015). Part 2 I have calculated my own Body Mass Index (BMI). For calculating the BMI, I have collected the relevant data as my weight and my height. The BMI calculation formula is: BMI= Weight in Kg / (Height in meter)2 My BMI came to be of 22.9 As per the BMI chart by WHO, my BMI belongs to the normal range between 18.5 to 24.9 The BMI in the range of less than 18.5 is considered overweight. BMI in range of 25 to 29.9 indicate overweight and over 30 indicate obese (Mayoclinic.org, 2015). Although my BMI is in the normal range, the maintenance of the healthy BMI is essential as it reduces the risk of heart diseases, high blood pressure and diabetes. In order to maintain this BMI, the correct eating habits are important. Therefore, a relevant diet plan for the maintenance of a normal BMI is provided in the following section. Diet plan- Considering my BMI, a daily goal of food minus fitness for calorie intake must be 1904 calories. The water intake needs to be maintained at 64 ounces. From food, the calorie intake must be 2004 calories maximum. An aim to burn 100 calories per day and 700 calories per week through fitness activities is necessary. The necessary proteins, vitamins, carbohydrates and minerals needed to maintain. For women, the daily intake of 2000 Kcal of energy, 45 g protein, 230 g carbohydrates, 90 g sugar, 70 g fat, 20 g saturates, 24 g fiber and 6 g salt is maintained (Womens Fitness, 2015). Conclusion: This study thus reveals the significance of maintaining a BMI in the normal range of 18.5 to 24.9 as evident in the case. However, even having a normal BMI is not sufficient but its consistent maintenance is also important as stated in the study. References Aranda, K., McGreevy, D. (2012). Embodied empathy-in-action: overweight nurses experiences of their interactions with overweight patients. Nursing Inquiry, 21(1), 30-38. doi:10.1111/nin.12015 Bagchi, D., Preuss, H. (2013). Obesity. Boca Raton, FL: CRC Press. Barasi, M. (2013). Nutrition at a Glance. Hoboken: Wiley. Capucao, D. (2010). Religion and ethnocentrism. Leiden: Brill. Cdc.gov,. (2015). Obesity and Overweight for Professionals: Adult: Defining - DNPAO - CDC. Retrieved 27 April 2015, from https://www.cdc.gov/obesity/adult/defining.html Fatima, S., Gerasimidis, K., Wright, C., Malkova, D. (2015). Impact of High Energy Nutritional Supplement Drink consumed for five consecutive days on cardio metabolic risk factors in underweight females. Proc. Nutr. Soc., 74(OCE1). doi:10.1017/s0029665115000506 Habibzadeh, N. (2010). Preventing Osteoporosis among Underweight and Obese Sedentary Young Women. Baltic Journal Of Health And Physical Activity, 2(2). doi:10.2478/v10131-0009-6 Home.snu.edu,. (2015). Why is ethnocentrism bad?. Retrieved 27 April 2015, from https://home.snu.edu/~hculbert/ethno.htm Mayoclinic.org,. (2015). Tool: BMI calculator - Mayo Clinic. Retrieved 27 April 2015, from https://www.mayoclinic.org/bmi-calculator/itt-20084938 Miller, D. (2011). Morbid Obesity. Anesthesiology, 115(4), 906. doi:10.1097/aln.0b013e3182230f2b Rolfes, S., Pinna, K., Whitney, E. (2012). Understanding normal and clinical nutrition. Belmont, CA: Wadsworth, Cengage Learning. Verissimo, R. (2014). Morbid obese patients' psychopathology and affect (dys)regulation. Journal Of Psychosomatic Research, 76(6), 516-517. doi:10.1016/j.jpsychores.2014.03.089 Who.int,. (2015). WHO | Obesity and overweight. Retrieved 27 April 2015, from https://www.who.int/mediacentre/factsheets/fs311/en/ Womens Fitness,. (2015). Healthy eating meal plan. Retrieved 27 April 2015, from https://www.womensfitness.co.uk/healthy-eating/781/healthy-eating-meal-plan
Monday, December 2, 2019
Role of Fungi in Biodeterioration free essay sample
Additionally, stone objects may support novel communities of microorganisms that are active in biodeterioration process. This investigation focuses on mycological analyses of microbial biofilm from two important buildings, made of granite and sandstone, and which were heavily colonized by fungi. The 23 fungal taxa including filamentous microfungi and yeasts with specific distribution on sandstone and granite substrate were isolated. Melanized fungi from Dematiaceae (Deuteromycotina) were dominant. The identified microfungi cause discoloration, as well as mechanical exfoliation of building stone material that was analyzed through mechanical hyphae penetration and production of dark pigments and organic acids. KEY WORDS: biodegradation, cultural heritage, fungi Numerous factors affect the stone durability. Stone surfaces are continuously exposed to physical, chemical and biological degradation. Physical, chemical, and biological agents act in co-association, ranging from synergistic to antagonistic, to the deterioration. Among biological agents miroorganisms have critical importance, in stone deterioration. They can cause various damages on the stone surface, such as: formation of biofilm, chemical reactions with substrate, physical penetration into the substrate as well as pigments production. We will write a custom essay sample on Role of Fungi in Biodeterioration or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Numerous studies have been dealing with establishing the role of biological agents in the stone deterioration During the recent decades there has been a general concern about the deterioration of historic buildings. Along with chemical and physical factors, microbial growth plays an important role in this process (S u i h k o et al. , 2007). Microbial colonization of stones depends on environmental factors such as water availability, pH, climatic exposure, nutrient sources, and petrologic 245 parameters such as mineral composition, type of cement, as well as porosity and permeability of rock material (W a r s c h e i d and B r a a m s, 2000). The stone ecosystem is subject to harsh environmental changes, especially temperature and moisture, exerting extreme selective pressure on any developing microbial community (M a y, 2003). Bioreceptivity of stone depends on its structure and chemical composition, while the intensity of microbial contamination is determined by the climatic conditions and anthropogenic eutrophication of the atmosphere (P r i t o and S i l v a, 2005). Biofilm formation on clean surfaces usually starts with phototrophic organisms (algae, cyanobacteria) which use CO2 from the atmosphere as their carbon source and sunlight as their energy source. Heterotrophic organisms (most bacteria and all fungi) need some organic source for their growth, which is provided by metabolites of phototrophic organisms or by air-borne deposition. It has been shown that very low nutrient requirements of some rock inhabiting heterotrophic microorganisms may be fulfilled by remains of polluted air and rain or animal remains and secretion (S u i h k o et al. , 2007). The aim of this work was to study the microfungi community on biodeteriorated stone samples originating from two historical buildings by using cultivation and microscope observations in order to evaluate the potential damage caused by fungal species. Sampling Samples of stone were collected from two localities: ââ¬Å"Monument of the Unknown Hero (Avala Mountain near Belgrade) and ââ¬Å"Brankov most (Sava river, Belgrade), and two types of stone: granite and sandstone. After a careful observation visible alterations and degradation were mapped and after that the samples were taken. Granite and sandstone samples were taken for mycological analyses by swabbing surfaces with sterile cotton swabs. The samples were then stored at 4à °C. Cultural media and inoculations Swab samples were diluted in 10 ml sterile distillated water and shaken mechanically for 10 minutes. Malt-streptomycin-agar (MSA) medium (MA according to B o o t (1971), with 500 mg streptomycin per liter) was inoculated with 1 ml of the resulting suspensions. Each sample was repeated in triplicate. The plates were incubated at 24à °C in thermostat. Isolation of the formed colonies was done successively, using standard mycological medium (Malt extract agar, Potato-dextrose agar and Czapeks solution agar). All the cultures were grown 7 days in thermostat at 24à °C. Macroscopic and microscopic characteristics of the obtained isolates were examined. The mentioned fungal species are typically soil fungi, which is in accordance with the results who noted considerable number of the same genus and species. The identified microfungi cause discoloration, as well as mechanical exfoliation of building stone material that was analyzed through mechanical hyphae penetration and production of different pigments (Aureobasidium, Cladosporium, Alternaria) and organic acids (some species of genus Aspergillus, Alternaria, Penicillium).
Tuesday, November 26, 2019
Free Essays on Desirees Baby
ââ¬Å"Desireeââ¬â¢s Baby,â⬠by Kate Chopin In her short story, ââ¬Å"Desireeââ¬â¢s Baby,â⬠Kate Chopin uses irony and symbolism to enhance the story, and convey a surprise ending. In the beginning of the story, Madam Valmonde is on her way to visit her daughter and new born grandson, when she flashes back to the day her husband, Monsieur, found little Desiree ââ¬Å"lying asleep in the shadow of the big stone pillar.â⬠The unknown origin of Desiree is a major question throughout her life and throughout the story. Eighteen years after her initial discovery, Desiree is again under the same pillar when Armand Aubigny sees her and instantly falls in love ââ¬Å"as if struck by a pistol shot,â⬠(182). In both times using the stone pillar as the place where Desiree is found, the reader becomes aware that this place is a continuing factor in Desireeââ¬â¢s true identity. Lââ¬â¢Abri, was a dark and solemn place, where, since the rule of Armand had been so strict, the slaves were no longer gay as the once were during the elder Aubignyââ¬â¢s rule (183). Desiree is described as wearing ââ¬Å"soft white muslins and laces,â⬠creating a conflicting image of life at Lââ¬â¢Abri (183). While the outside of the house is dark, the inside is almost lit up from Desireeââ¬â¢s presence, showing the impact she has had on life at Lââ¬â¢Abri. Desiree says that she is so happy that it ââ¬Å"frightensâ⬠her, another indication that things at Lââ¬â¢Abri may not be all well (183). After three months, it becomes evident that the baby is not white, but black, which Armand blames Desiree for because of her suspicious origins. When Desiree leaves the plantation to return to her motherââ¬â¢s, at Armandââ¬â¢s request, she did not take a well worn path, symbolizing her struggle. Instead, she cut through a field where the ââ¬Å"stubble bruised her tender feet . . . and tore her thin gown to shreds.â⬠The torn gown represents her shattered home and marriage, the complete opposite of what the gown stood for ... Free Essays on Desiree's Baby Free Essays on Desiree's Baby ââ¬Å"Desireeââ¬â¢s Baby,â⬠by Kate Chopin In her short story, ââ¬Å"Desireeââ¬â¢s Baby,â⬠Kate Chopin uses irony and symbolism to enhance the story, and convey a surprise ending. In the beginning of the story, Madam Valmonde is on her way to visit her daughter and new born grandson, when she flashes back to the day her husband, Monsieur, found little Desiree ââ¬Å"lying asleep in the shadow of the big stone pillar.â⬠The unknown origin of Desiree is a major question throughout her life and throughout the story. Eighteen years after her initial discovery, Desiree is again under the same pillar when Armand Aubigny sees her and instantly falls in love ââ¬Å"as if struck by a pistol shot,â⬠(182). In both times using the stone pillar as the place where Desiree is found, the reader becomes aware that this place is a continuing factor in Desireeââ¬â¢s true identity. Lââ¬â¢Abri, was a dark and solemn place, where, since the rule of Armand had been so strict, the slaves were no longer gay as the once were during the elder Aubignyââ¬â¢s rule (183). Desiree is described as wearing ââ¬Å"soft white muslins and laces,â⬠creating a conflicting image of life at Lââ¬â¢Abri (183). While the outside of the house is dark, the inside is almost lit up from Desireeââ¬â¢s presence, showing the impact she has had on life at Lââ¬â¢Abri. Desiree says that she is so happy that it ââ¬Å"frightensâ⬠her, another indication that things at Lââ¬â¢Abri may not be all well (183). After three months, it becomes evident that the baby is not white, but black, which Armand blames Desiree for because of her suspicious origins. When Desiree leaves the plantation to return to her motherââ¬â¢s, at Armandââ¬â¢s request, she did not take a well worn path, symbolizing her struggle. Instead, she cut through a field where the ââ¬Å"stubble bruised her tender feet . . . and tore her thin gown to shreds.â⬠The torn gown represents her shattered home and marriage, the complete opposite of what the gown stood for ... Free Essays on Desiree's Baby ââ¬Å"Desireeââ¬â¢s Babyâ⬠: A Case of Embarrassment or Something Deeper? What is it exactly that caused Armand to cast his wife, Desiree, and their child aside? Disappointment, shame, and a deep sense of bitterness factored into his actions. The child was a symbol of his masculinity and a legitimate heir to his family name. When you factor in the accumulative sense of betrayal he must have felt towards Desiree and her supposed lack of pure blood, his actions are justified. Despite all other feelings one could possess in such a predicament, embarrassment was the overlying element. The shock and horror Armand endured upon finding out his child is not worthy of his familyââ¬â¢s name or position in life was nothing short of overwhelming. ââ¬Å"He no longer loved her, because of the unconscious injury she had brought upon his home and his name.â⬠(180) Now imagine Armandââ¬â¢s embarrassment at finding out that he is the one who caused his child to become a social pariah. Imagine the embarrassment when he discovered he was living a lie. Armandââ¬â¢s embarrassment and his deep seeded resentment of the entire situation caused him to act impetuously, to the point that he allowed Desiree and their child to leave, burned their belongings, removing every trace of them from his life. Armand fell in love with Desiree despite her being a foundling with no familial ties. He proclaimed her lineage did not matter, in fact, ââ¬Å"what did it matter about a name when he could give her one of the oldest and proudest in Louisianaâ⬠(178). Once she conceived their child, neither one of them gave any thought to the fact that their child would be anything other than of pure blood. With no knowledge that Armand was the carrier of this ââ¬Å"diseaseâ⬠, they still delivered a child, which would later become his greatest embarrassment. This child was theirs, and neither one of them was black in any visible way. His subsequent disappointment in his offspring and wife fue... Free Essays on Desiree's Baby In the story ââ¬Å"Desireeââ¬â¢s Babyâ⬠there are many underlying connotations, which make the analyzing of the story somewhat difficult. These connotations are what make the story interesting and enjoyable to read. One could argue that love and lust played a large roll in this story. Also it would be easy to say that Desiree was not loved but lusted after throughout the story. It is very apparent to me that Desireeââ¬â¢s husband did not love her as much as should have. It would also be justifiable to say that his relationship with her was purely based on his love for her body and not her mind. The story tells us that when he fell in love with her, it was similar to a prairie fire or an avalanche. Both a prairie fire and an avalanche start from the smallest thing and grow into a fierce power. But both the prairie fire and the avalanche only last for a small amount of time. If his love for her is being compared to both of these, then it was not true love, for love truly cannot be measured. The description of Armand Valmonde led me to think that he was a very stern man whose beliefs and morals overpowered his ability to think reasonably. I believe that the most important thing in his life was the purity of his family name. It seemed that he was raised to be someone of importance, raised to be the distinguished gentlemen or even raised to be royalty. Armand was a slave owner and was raised in a time when it was thought that black people were inferior to white people, so there is definitely a sense of racism in the story. Racism played a role in the story but its role is mainly to apply irony to story in the end. If the reader was disgusted with Armand, the ironic racism adds a twist at the end of the story which is quite enjoyable. Racism and love are two clashing tones in the story also because, if you have one you cannot have the other. This is another one of my points. If Armand truly loved Desiree, then it would not matter if...
Saturday, November 23, 2019
Battle of Trenton in the American Revolution
Battle of Trenton in the American Revolution The Battle of Trenton was fought December 26, 1776, during the American Revolution (1775-1783). General George Washington commanded 2,400 men against a garrison of about 1,500 Hessian mercenaries under the command of Colonel Johann Rall. Background Having been defeated in the battles for New York City, General George Washington and the remnants of the Continental Army retreated across New Jersey in the late fall of 1776. Vigorously pursued by the British forces under Major General Lord Charles Cornwallis, the American commander sought to gain the protection afforded by the Delaware River. As they retreated, Washington faced a crisis as his battered army began to disintegrate through desertions and expiring enlistments. Crossing the Delaware River into Pennsylvania in early December, he made camp and attempted to reinvigorate his shrinking command. Badly reduced, the Continental Army was poorly supplied and ill-equipped for winter, with many of the men still in summer uniforms or lacking shoes. In a stroke of luck for Washington, General Sir William Howe, the overall British commander, ordered a halt to the pursuit on December 14 and directed his army to enter winter quarters. In doing so, they established a series of outposts across northern New Jersey. Consolidating his forces in Pennsylvania, Washington was reinforced by around 2,700 men on December 20 when two columns, led by Major Generals John Sullivan and Horatio Gates, arrived. Washingtons Plan With the morale of the army and public ebbing, Washington believed that an audacious act was required to restore confidence and help boost enlistments. Meeting with his officers, he proposed a surprise attack on the Hessian garrison at Trenton for December 26. This decision was informed by a wealth of intelligence provided by spy John Honeyman, who had been posing as a Loyalist in Trenton. For the operation, he intended to cross the river with 2,400 men and march south against the town. This main body was to be supported by Brigadier General James Ewing and 700 Pennsylvania militia, which were to cross at Trenton and seize the bridge over Assunpink Creek to prevent enemy troops from escaping. In addition to the strikes against Trenton, Brigadier General John Cadwalader and 1,900 men were to make a diversionary attack on Bordentown, NJ. If the overall operation proved a success, Washington hoped to make similar attacks against Princeton and New Brunswick. At Trenton, the Hessian garrison of 1,500 men was commanded by Colonel Johann Rall. Having arrived at the town on December 14, Rall had rejected his officers advice to build fortifications. Instead, he believed that his three regiments would be able to defeat any attack in open combat. Though he publicly dismissed intelligence reports that the Americans were planning an attack, Rall did request reinforcements and asked that a garrison be established at Maidenhead (Lawrenceville) to protect the approaches to Trenton. Crossing the Delaware Combating rain, sleet, and snow, Washingtons army reached the river at McKonkeys Ferry on the evening of December 25. Behind schedule, they were ferried across by Colonel John Glovers Marblehead regiment using Durham boats for the men and larger barges for the horses and artillery. Crossing with Brigadier General Adam Stephens brigade, Washington was among the first to reach the New Jersey shore. Here a perimeter was established around the bridgehead to protect the landing site. Having completed the crossing around 3 a.m., they began their march south toward Trenton. Unknown to Washington, Ewing was unable to make the crossing due to the weather and heavy ice onà the river. In addition, Cadwalader had succeeded in moving his men across the water but returned to Pennsylvania when he was unable to move his artillery. A Swift Victory Sending out advance parties, the army moved south together until reaching Birmingham. Here Major General Nathanael Greenes division turned inland to attack Trenton from the north while Sullivans division moved along the river road to strike from the west and south. Both columns approached the outskirts of Trenton shortly before 8 a.m.à on December 26. Driving in the Hessian pickets, Greenes men opened the attack and drew enemy troops north from the river road. While Greenes men blocked the escape routes to Princeton, Colonel Henry Knoxs artillery deployed at the heads of King and Queen Streets.à As the fighting continued, Greenes division began to push the Hessians into the town. Taking advantage of the open river road, Sullivans men entered Trenton from the west and south and sealed off the bridge over Assunpink Creek. As the Americans attacked, Rall attempted to rally his regiments. This saw the Rall and Lossberg regiments form on lower King Street while the Knyphausen regiment occupied Lower Queen Street. Sending his regiment up King, Rall directed the Lossberg Regiment to advance up Queen toward the enemy. On King Street, the Hessian attack was defeated by Knoxs guns and heavy fire from Brigadier General Hugh Mercers brigade. An attempt to bring two three-pounder cannon into action quickly saw half the Hessian gun crews killed or wounded and the guns captured by Washingtons men. A similar fate befell the Lossberg regiment during its assault up Queen Street. Falling back to a field outside of town with the remnants of the Rall and Lossberg regiments, Rall began a counterattack against the American lines. Suffering heavy losses, the Hessians were defeated and their commander fell mortally wounded. Driving the enemy back into a nearby orchard, Washington surrounded the survivors and forced their surrender. The third Hessian formation, the Knyphausen regiment, attempted to escape over the Assunpink Creek bridge. Finding it blocked by the Americans, they were quickly surrounded by Sullivans men. Following a failed breakout attempt, they surrendered shortly after their compatriots. Though Washington wished to immediately follow up the victory with an attack on Princeton, he elected to withdraw back across the river after learning that Cadwalader and Ewing had failed to make the crossing. Aftermath In the operation against Trenton, Washingtons losses wereà four men killed and eight wounded, while the Hessians suffered 22 killed and 918 captured. Around 500 of Ralls command were able to escape during the fighting. Though a minor engagement relative to the size of the forces involved, the victory at Trenton had a massive effect on the colonial war effort. Instilling a new confidence in the army and the Continental Congress, the triumph at Trenton bolstered public morale and increased enlistments. Stunned by the American victory, Howe ordered Cornwallis to advance on Washington with around 8,000 men. Re-crossing the river on December 30, Washington united his command and prepared to face the advancing enemy. The resulting campaign saw the armies square off at Assunpink Creek before culminating with an American triumph at the Battle of Princeton on January 3, 1777. Flush with victory, Washington wished to continue attacking up the chain of British outposts in New Jersey. After assessing his tired armys condition, Washington instead decided to move north and enter winter quarters at Morristown.
Thursday, November 21, 2019
Teaching Turkish through Turkish novels Essay Example | Topics and Well Written Essays - 500 words
Teaching Turkish through Turkish novels - Essay Example This essay discusses that the Turkish language is blessed with significant writers who took pains to write exquisite books portraying life around a plethora of backgrounds and events that had readers glued to the books they wrote. They are interesting and make the business of language learning so much simpler and easier (Dino, Guzine; 1986).Teaching Turkish through Turkish novels is a wonderful challenge. The teacher has only to encourage the hesitant student to take the plunge. The process may be slow initially because the student has to stop time and again to check grammar and vocabulary. But soon, armed with improving language, the student will gain confidence and discard the use of grammar text books and the dictionary. Today, learning the Turkish language using novels makes learning a quicker and simpler proposition. It works well when these novels are translated into English or the learnerââ¬â¢s mother tongue. The student can then read the novel in his own language and then continue with the novel in the Turkish language.This depends on the capacity of the student to learn, and a written test at the end of the course. Some basic expressions can be learnt fairly quickly. Simple expressions such as: Ne yapà ±yorsun? (What are you doing?), Evli misiniz? (Are you married?), or Selam Ãâ"zge, nereden geliyorsun? (Hi Ozge, where are you from?) are capable of being learnt fast. However, grammar and vocabulary takes time. But novel reading helps in learning grammar and vocabulary faster (Ãâ"ztopà §u, Dr. KurtuluÃ
Ÿ; 2006).
Tuesday, November 19, 2019
Social and cognitive constructivism Essay Example | Topics and Well Written Essays - 3000 words
Social and cognitive constructivism - Essay Example However, to know, how successful technology-incorporated learning behavior concerning advanced order thoughts skill will dependent upon the strategy taken to the design, delivery, choice, and operation of suitable and efficient technologies with a support arrangement to preserve and maintain the learning transactions. For this purpose educationalists must attain fresh perception in numerous diverse regions mainly of philosophical direction to education and learning. A personââ¬â¢s philosophical orientation will speak how educationalists will analysis teaching, learning, knowledge, and the use of technology. Educationalists those who explain and eloquent in their rational situation concerning the use of technologies in the learning procedures make out what they are doing as they use technologies to facilitate the learning. Till now, the common rational course in instructional technology was instructivism. Instructivists - often as well referred to as objectivism - dispute that usin g an educational methods design replica can be useful to instructional planners to methodically recognize the syllabus to be taught , decide how it will be taught, and assess the teaching to decide its effectiveness. Particularly, educationalists require to be cautious on to what is that is to be taught and what is that already know earlier to the learning transactions. Further they are gradually arranged starting lower order to higher order learning. The instructionist stresses the significance of using an educational methods design model.
Sunday, November 17, 2019
Gay marriage in America Essay Example for Free
Gay marriage in America Essay America was built on the foundation of equality for all men; however, not until recently have gay and lesbian individuals inherited such civil rights. One of the largest and most pressing issues effecting the gay population is the issue of gay marriage. Marriage is defined as ââ¬Å"the relationship that exists between a husband and wife or a similar relationship between people of the same sexâ⬠(Websters). Within the past ten years fifteen states have legalized gay marriage. ââ¬Å"As of Nov. 13, 2013, gay marriage has been legalized in 15 US states (CA, CT, DE, HI, IA, MA, MD, ME, MN, NH, NJ, NY, RI, VT, and WA) and the District of Columbia. 34 states have gay marriage bans through either laws or constitutional amendments or both.â⬠(Procon) Fifteen states legalizing gay marriage in ten years is a strong the accomplishment however, it is still, and continues to be, a very polarizing issue within the country. The passage and acceptance of gay marriage effects many different diversity categories including but not limited to age, religion, and ethnicity and race, and economic status. Age There is a direct correlation between age and the opinion of same sex marriage in America. According to The Pew Research Center, younger Americans are much more accepting and favor same sex unions over older Americans (PewResearchgroup). ââ¬Å"Individuals, born after 1980, favor allowing gays and lesbians to marry legally by a 53%-to-39% margin, while there is less support for same-sex marriage among Baby Boomers those born 1946 to 1964 than among younger age groups. Currently, 38% favor allowing gays and lesbians to marry legally while 52% are opposedâ⬠(Pew Research) These recent poling numbers would suggest a continuing trend from generation to generation; each new generation is more in favor of same sex marriage than the previous. With more Americans favoring same sex marriage than ever before, one would believe this trend of acceptance of gay marriage will continue over the next generations to come. Religion There is a strong relationship between how religious you see yourself and your views and attitudes toward gay marriage. This idea is not very surprising although very important as it contributes to an understanding of the religious factors that influence opinions about issues directly impacting the gay population. ââ¬Å"Religious attendance is associated with negative attitudes towards gay and lesbians and less support to gay and lesbian civil rights.â⬠(Todd and Ong, 1) There is a positive link between high religious attendance and negative attitudes towards gay marriage; religious attendance is a constant predictor of attitudes towards gay marriage. Within subgroups of religion such as Christian Orthodoxy and conservative Protestant, ââ¬Å"with such an identification, therefore reducing the odds of supporting gay marriage.â⬠(Todd and Ong, 1) Findings suggest the more one identifies and strictly follows their religious views has a direct link to their views on gay marri age. Ethnicity and Race Views and opinions, whether they be negative or positive regarding gay marriage changes and varies within ethnicities and race. African-Americans are generally more opposed to gay marriage versus their white counterparts. ââ¬Å"African-American religiosity is primarily responsible for their conservative views about homosexuality and same-sex marriage.â⬠(Sherkat, Mattias de Vries, and Creek, 81) The factors of race and religion closely relate to each other in this aspect and help to influence each other. As stated above religion has great influence on ones views of same-sex marriage and ââ¬Å"African-Americans have the highest rates of religious participation of any subgroup of the U.S. populationâ⬠(Sherkat, Mattias de Vries, and Creek 81) ââ¬Å"Between 1998 and 2004, white opposition to same-sex marriage declined to under 54 percent, and it dipped to under 46 percent by 2008. Opposition to same-sex marriage also declined substantially for those of ââ¬Å"otherâ⬠races, decreasing to under 40 percent in the 2004 survey, and fluctuating between 45percent in 2006 and 43 percent in 2008. Yet, African-American opposition did not decline substantially between 1988 and 2006.â⬠(Sherkat, Mattias de Vries, and Creek 81) Within different races the opinions of gay marriage seem to be changing with the times except for the African-American race. Again, whether it is due to outside factors of religion, culture, or tradition, the African-American race seems to be lagging in the forward movement of gay marriage. Summary As Americans we are guaranteed certain inalienable civil rights and liberties, however as we have seen and know that is not always true. Based on an individualââ¬â¢s sexual preference the ability to marry is not always assured. Factors such as age, religion, ethnicity and race, and economic status greatly influence ones opinion on same sex marriage. Those who are older and more religious oppose gay marriage more than their counterparts who are younger and less religious. Is this to say every older religious individual does not believe in same sex marriage? The answer is no; however, these factors such as age and religiousness tend to follow these trends. There is also variation in opinions within races and ethnicities. White Americans seem to be the most accepting of gay marriage over African-Americans and other races. Discussion The decision on choosing gay marriage legalization and views in America today comes from the realization that there are more gay couples seeking marriage in todayââ¬â¢s society than ever before. Gay marriage is no different than heterosexual marriage between a man and a woman with the one obvious exception of gay marriage being between two individuals of the same-sex. Often times, gay marriages are not granted the same civil rights and civil liberties as their heterosexual counterparts. Age, religion, ethnicity and race, and economic status greatly factor into ones positive or negativeà views on gay marriage. Throughout this course I have learned that some individuals or even groups of people, such as the gay population, have a very difficult time obtaining the same advantages as their peers. In the past, homosexuality was something to be feared, however, today the public opinion of gay marriage is changing for the better. Stereotypes and prejudices still exist today however they are slowly being phased out by an understanding and more positive attitude towards gay marriage. As of today fifteen states have legalized gay marriage with many other states predicated to soon follow suit. This research has helped me better understand the struggle and plight that the gay community often faces for basic civil rights. Liberties and benefits that I take for granted that come along with marriage are not often extended to the gay community based solely on sexual orientation. I have gained a new appreciation of marriage because I know it is not something that is equal for everyone as well as not obtainable for every individual at this present time. Marriage is not something to be taken for granted because there are those that still cannot share in its wealth. American was built on the foundation of freedom for all regardless of differing diversities; I believe this should hold true for all regardless of sexual orientation. Work Cited ââ¬Å"Gay MarriageProCon.org.â⬠ProConorg Headlines. ProConorg, 11 Nov.2013. Web. 17 Nov. 2013. Kohut, Andrew. ââ¬Å"Less Opposition to Gay Marriage, Adoption and Military Service.â⬠Pew Research Center for the People and the Press RSS. People Press, 22 Mar. 2006. Web. 06 Nov. 2013 ââ¬Å"Marriage.â⬠Marriage. N.p., n.d. Web. 17 Nov. 2013. Sherkat, Darren, Kylan Mattais De Vrias, and Stacia Creek. Race, Religion, and Opposition to Same-. Social Science Quarterly (2010): 80-100. EBSCO. Web. 17 Nov. 2013. . Todd, Nathan R., and Katherine S. Ong. Political and Theological Orientation as Moderators for the Association between Religious Attendance and Attitudes toward Gay Marriage for White Christians. Psychology of Religion and Spirtuality 4.1 (2011): 56-70. EBSCO. Web. 2013. .
Thursday, November 14, 2019
Divine Comedy Essay -- essays research papers
The Divine Comedy à à à à à The Divine Comedy, written by Dante Alighieri is considered by many to be one of the greatest literary masterpieces of not just Latin literature, but of all poetry. Little is known of Dante Alighieri, mainly what we know if from what he tells us of himself in his poetry. In The Divine Comedy, Dante comes across as a resentful, yet passionate man who used this poem to alert Florentines of the tribulations that awaited them for their sins and for the corruption of their government. Like many great literary masterpieces, The Divine Comedy has a central character, Dante, who goes on a journey - through the nice circles of Inferno, to the top of the mountain Purgatory, and finally Beatrice takes him to Paradiso. The Divine Comedy is the story o...
Tuesday, November 12, 2019
Sociology Evaluation of Method
One good aspect that my method had was that it allowed me to collect very in depth data, people were able to open up to me as it was unstructured interviews, I did have a problem with this though, as I didn't have prepared questions it was hard to compare my participants points of views afterwards and by talking so in depth about a sensitive subject like divorce things could get out of hand, one of my participants even began to cry as she became very emotional. The location to do my interviews in were varied, some were good and some were bad, one of them I had to do in my room and privacy was hard to come by. In my opinion my results are unreliable, but I believe that when talking to people about something as private as this, results will always be this as people feel awkward and don't want a stranger, or somebody from outside of the family to know their business. The participants I believe were the correct ones to interview and had enough experience and met with my criteria, the problem which I found though was that I hadn't interviewed enough; I only interviewed one of each that I wanted. I.e. ONE married couple, ONE cohabiting couple etc. If I had interviewed more people my results would have been more representative, I hadn't thought of this until after. The sampling method I used I thought was appropriate; people knew that they could confide in me and no problems arose with this. If I were to repeat this project I would defiantly change my method, I would do structured interviews as I believe that for my content and analysis it would be a lot easier to compare and that it is also possible to get in depth data this way. I would also interview more people. Evaluation of findings In relation of my first aim, to find out whether divorce on the increase is really seen as a negative aspect of today's society I found that people do take divorce less seriously than before but they don't give it less importance, I know this because nearly all of the couples I interviewed seemed slightly scared of divorce but would mostly consider it, I have found that, on contrary to my beliefs people don't rush into marriages and just get divorced when they find that marriage isn't what they expected, couples nowadays tend to cohabit first so that when they do get divorced they know it is the right thing to do, and the only way out. They cohabit to test their relationship, in order to avoid divorce. Some couples do not marry because of the threat of divorce. I found that people who are more religious see divorce as a problem. I also found that people feel divorce can affect mental health, respondents stated that divorce is not good for your health. The reasons given for the rise of divorce including the fact that marriages are now based of love rather than expectations and the changing role of women. In relation to my second aim, to find out the main reason for more divorces I found that most people believe that it is due to women having more independence, less sexism. This was the one and only thing that all my participants had in common. My findings were similar to previous studies in this area such as Robert Chester who found that nuclear families would never stop existing; he found that families would just change their forms. By having divorces this is what happens, children don't just stop having one of their parents, they still have both, the way in which families tend to be perceived just changes, cohabiting couples are on the up and so is divorce. People see divorce as something negative and positive at the same time, it affects you in both ways and people realise this, they also know that divorce can give them a second start in life when most of their hope is gone. What was interesting about my project was that I was able to research on something that causes hundreds and thousands of people heartbreak and depression everyday but is also seen as normal, I learnt a lot from doing this project, I used to think that people were just careless and got married and divorced as if it doesn't mean a thing, I've found that this is not the case, although more people are getting divorced it doesn't mean that more people are getting married, people stand up for themselves more nowadays, and despite my previous beliefs people DO see divorce as a problem, but also as something positive. By doing this project I have learnt a lot.
Sunday, November 10, 2019
Mscquiz1
Chapter one ââ¬â A The U. S, and indeed much of the world, has been described as a ââ¬Å"knowledge society. â⬠How does this affect productivity measurement and comparison of productivity between the U. S. and other countries? Illustrate with an example. Productivity is the ratio of out puts (goods and services) divided by inputs (resources and capital). The creation of goods and services requires changing resources into goods and services; the more efficiently we make this change, the more productive we are, and the more value is added to the good or services provided.By applying the ten decisions of operation management (om) help us to be efficient: developing and using the correct strategy helps us to be effective. The measurement of productivity is an important way to evaluate a countryââ¬â¢s ability to provide a high stander of living for its people. Only through the increase of productivity, improve the stander living, and labor, capital and management receive high salary. When productivity increase using the same resources, the prices will go down, and if labor and capital increase without increase in productivity raises the prices. The U.S has been able to increase productivity at an average rate of almost 2. 55 per year which has double the U. S. ââ¬Ës wealth every 30 years. Three factors are important in improving the productivity; such as, labor, capital, and management. In order to improve the labor productivity, the labor force should be better utilized with a stronger commitment; training, motivation, team building and human resource strategies, and improved education are some of the techniques which contribute to increase productivity. The effective sue of capital increase the productivity, and management accounts for over half of the annual increase productivity.The postindustrial societies are known as knowledge societies, and using knowledge and technology are essential in postindustrial societies. In these societies much of th e labor force has migrated form manual work to technical and information processing tasks require on going education. Compare to other industrialized countries, the U. S. remains the world leader in overall productivity and services productivity; despite having the same problems with service productivity as other countries. The productivity challenge is difficult.A country cannot be world class competitor with second class inputs such as poorly educated labor insufficient capital, and dated technology. High productivity and high quality out puts require high quality inputs, including good operation managers. Since education is foundation to efficient operation in a technological society, countries are focusing on highly skilled workforce which is essential for global competitiveness. Example: From the text Siemens, the multi-billion-dollar German conglomerate, has long been known for its apprentice programs in its home country.Due to education is often the key to efficient operation s in a technological society, Siemens has spread its apprentice-training programs to its U. S. plants. These programs are laying the foundation for the highly skilled workforce that is essential for global competitiveness. Chapter One ââ¬â B David Upton is president of Upton Manufacturing, a producer of G0-kart tires. Upton makes 1,000 tires per day with the following resources: Labor:400 hours at $12. 50 per hour Raw Material:20,000 pounds per day at $1 per pound Energy:$5,000 per day Capital:$10,000 per day . What is the labor productivity for these tires at Upton manufacturing? Productivity = units of output hours of labor Productivity = 1,000 400 = 2. 5 units per labor hours b. What is the multi-factor productivity for these tires at Upton manufacturing? 400 * 12. 50 = $5,000 a day Productivity = _______ _Output__________________ _______ Labor+ material +Energy+ Capital+ Miscellaneous = _____________ 1,000___________________ $5,000 + $20,000 + $5,000 + $10,000 + 0 = 1,000 un its $40,000 = 0. 25 unit per $ c. What is the percent change in multi-factor productivity if Upton can reduce the energy bill by $1,000 without cutting production or changing any other inputs? Productivity = _______ _Output__________________ _______ Labor+ material +Energy+ Capital+ Miscellaneous = _____________ 1,000___________________ $5,000 + $20,000 + $4,000 + $10,000 + 0 = 1,000 units $39,000 = 0. 02564 units per $ Percentage Change in multi-factor productivity = 0. 02564 0. 025 = 1. 0256 or 2. % Chapter Two ââ¬âA In order to sustain a competitive advantage, restaurants must employ one the following three strategies: 1. ) Cost leadership; 2. ) Response; and 3. ) differentiation. Give one original example (one not mentioned in the text) of each of three restaurant chains that you could associate with each one of these strategies. (Use a fast food restaurant for only one of your three examples. Strategy is an organizationââ¬â¢s action plan to achieve the mission: the strat egy exploits opportunities and strengths neutralize threads and avoid weaknesses.The firms achieve missions in three conceptual ways: differentiation, cost leadership, and response which mean that operations managers are abele to deliver goods and services that are better, or at least different, cheaper and more responsive. The three strategic concepts can generate a system that has a unique advantage over competitors, and provides an opportunity for operations managers to achieve competitive advantage. Differentiation is concerned with providing uniqueness: a firmââ¬â¢s opportunities for creating uniqueness are not located with a particular function or activity, but can arise in virtually everything that firm does.The opportunities creating this uniqueness are limited only by imagination due to most products include some service, and most services include some products. So, effective operations mangers assist in defining everything about product or services that will influence t he potential value to the customers. Example: In Differentiation, the best example that will fit the description would be Illusitions (Thai Cuisine) where you sit around a big pan in the middle and they cook the food in front of you which takes about 10-15 minutes. The difference is the uniqueness of the style of cooking.I have heard that in Thailand, the food is eaten when itââ¬â¢s very hot. So by having a big pan in the middle, kind of brings the essence of Thai food. They also provide the samples of different foods for you to try. Cost leadership entails achieving maximum value as defined by the customers. It requires examining each of the ten operations management decision in a relentless effort to drive down costs while meeting customer expectations of value: a low cost strategy does not imply low value or low quality. Example: The best example which can fit in the description of Cost leadership is McDonald.They provide fast food in low prices which are unbeatable and provid e an exceptional quality. They have grown tremendously in few years in national and international perspective. They are the one of the largest fast food chains in US and other countries. Response is define as including the entire range of values related to timely product development and delivery, as well as reliable scheduling and flexible performance. Flexible response is ability to match change in a marketplace where design innovations and volumes fluctuate substantially.The reliability of scheduling is another aspect of response: it manifests it self in reliable scheduling and it has value to end customers. Quickness is an other aspect of response; the operation mangers who develop system that respond quickly can have a competitive advantage. The operation management can increase productivity and generate a sustainable competitive advantage. Example: The restaurant that I think is suitable for this criterion is Olive garden. They serve with love and tradition. It has a different environment then any other restaurants.It gives a very cozy feeling. The people eat there are mostly families. Chapter Two ââ¬â B In your own words (i. e. , not using sentences or phrases taken form the text or other resources), explain the difference between an international strategy and a transnational strategy. Identify on company (not mentioned in the text) that employs an international strategy and one that employs a transnational strategy. The difference between the international strategy and transnational strategy is that international strategy is on international level.The company takes its products to a different country and launches it in that country. They introduce their product in a different country where the competition is low and also the costs are low. Some companies have their raw products come from a different country where they pay less for their purchases. Some companies such as Whirlpool started out in a US state Michigan which now has more than 50 plants i n different countries that make washing machines, refrigerators, and stoves. The biggest reason is the cost and cheap labor.On the other hand, transitional strategy is when a US company takes its products to a different state where their competitors are few and also the product margin is high and costs are low. In the field of Transitional strategy, one of the most common examples is Wal-Mart. They are dominating the market because they have low prices and acceptable quality. They have different plants in different states in US. They compete with their competitors in every way which is cost, quality, and expediency. They buy goods from different states in US and other countries.
Thursday, November 7, 2019
Newspapers and the Future of Print Journalism
Newspapers and the Future of Print Journalism For anyone interested in the news business, itââ¬â¢s hard to avoid the sense that newspapers are at deathââ¬â¢s door. Every day brings more news of layoffs, bankruptcies, and closings in the print journalism industry. But why are things so dire for newspapers at the moment? Decline Begins With Radio TV Newspapers have a long and storied history that dates back hundreds of years. While their roots are in the 1600s, newspapers thrived in the U.S. well into the 20th century. But with the advent of radio and later television, newspaper circulation (the number of copies sold) began a gradual but steady decline. By the mid-20th century, people simply didnââ¬â¢t have to rely on newspapers as their only source of news anymore. That was especially true of breaking news, which could be conveyed much more quickly via broadcast media. And as television newscasts became more sophisticated, television became the dominant mass medium. This trend accelerated with the rise of CNN and 24-hour cable news networks. Newspapers Begin to Disappear Afternoon newspapers were the first casualties. People coming home from work increasingly turned on the TV instead of opening a newspaper, and afternoon papers in the 1950s and 1960s saw their circulations plunge and profits dry up. Television also captured more and more of the advertising revenue that newspapers had relied on. But even with Television grabbing more and more audience and ad dollars, newspapers still managed to survive. Papers couldnââ¬â¢t compete with television in terms of speed, but they could provide the kind of in-depth news coverage that TV news never could. Savvy editors retooled newspapers with this in mind. More stories were written with a feature-type approach that emphasized storytelling over breaking news, and papers were redesigned to be more visually appealing, with a greater emphasis on clean layouts and graphic design. Emergence of the Internet But if television represented a body blow to the newspaper industry, the World Wide Web may prove to be the nail in the coffin. With the emergence of the internet in the 1990s, vast amounts of information were suddenly free for the taking. Most newspapers, not wanting to be left behind, started websites in which they essentially gave away their most valuable commodity- their content- for free. This model continues to be the predominant one in use today. Many analysts now believe this was a fatal mistake. Once loyal newspaper readers realized that if they could conveniently access news online for free, there seemed to be little reason to pay for a newspaper subscription. Recession Worsens Prints Woes Economic hard times have only accelerated the problem. Revenue from print ads has plunged, and even online ad revenue, which publishers had hoped would make up the difference, has slowed. Websites like Craigslist have eaten away at classified ad revenue. ââ¬Å"The online business model just wonââ¬â¢t support newspapers at the level Wall Street demands,â⬠says Chip Scanlan of The Poynter Institute, a journalism think tank. ââ¬Å"Craigslist has decimated newspaper classifieds.â⬠With profits plunging, newspaper publishers have responded with layoffs and cutbacks, but Scanlan worries this will just make things worse. ââ¬Å"Theyââ¬â¢re not helping themselves by whacking sections and laying people off,â⬠he says. ââ¬Å"Theyââ¬â¢re cutting the things that people look for in newspapers.â⬠Indeed, thatââ¬â¢s the conundrum facing newspapers and their readers. All agree that newspapers still represent an unrivaled source of in-depth news, analysis, and opinion and that if papers disappear entirely, there will be nothing to take their place. What the Future Holds Opinions abound as to what newspapers must do to survive. Many say papers must start charging for their web content to support print issues. Others say printed papers will soon go the way of the Studebaker and that newspapers are destined to become online-only entities. But what actually will happen remains anybodyââ¬â¢s guess. When Scanlan thinks of the predicament the internet poses for newspapers today, heââ¬â¢s reminded of the Pony Express riders who in 1860 started what was meant to be a speedy mail delivery service, only to be rendered obsolete a year later by the telegraph. ââ¬Å"They represented a great leap in communication delivery but it only lasted a year,â⬠Scanlan says. ââ¬Å"As they were whipping their horses into a lather to deliver the mail, beside them were these guys ramming in long wooden poles and connecting wires for the telegraph. Itââ¬â¢s a reflection of what changes in technology mean.ââ¬
Tuesday, November 5, 2019
12 Types of Characters Featured in Almost All Stories
12 Types of Characters Featured in Almost All Stories 12 Types of Characters Featured in Almost All Stories They say it takes all kinds to make the world go round - and the same is true of stories. Whether youââ¬â¢re writing fantasy, romance, or action-adventure, youââ¬â¢re going to need certain types of characters to keep the plot moving and your readers intrigued!Thatââ¬â¢s why weââ¬â¢ve put together this handy-dandy guide of 12 character types featured in almost every story: to help you figure out which ones you need, how they relate to one another, and what purposes they can serve. 12 characters featured in almost all stories What are the different types of characters?Most writers have an inherent understanding of how to categorize their characters based on classic, ââ¬Å"comic book-styleâ⬠labels: heroes, villains, sidekicks, etc.à But in the ever-intricate realm of stories, there are many more nuanced types to consider!Before we explore these types, however, you should know that there are two main ways to classify them: by role, and by quality.RoleCharacter role refers to the part that one plays in the story. As you probably know, the most important role in any story is the protagonist (which weââ¬â¢ll discuss below). This means all other roles stem from their relationship to the protagonist. Basically, these types define how characters interact and affect one another.Types based on role include:ProtagonistAntagonistDeuteragonistTertiaryConfidanteLove interestFoilSome of these roles can overlap. A deuteragonist might be the MCââ¬â¢s confidante. The antagonist might be their foil. Or the an tagonist might eventually become the protagonistââ¬â¢s love interest! (Any fans of the enemies-to-lovers trope up in here?)But weââ¬â¢re getting ahead of ourselves. Letââ¬â¢s quickly touch on the second major category of character types.QualityCharacter quality has to do with what kind of character someone is. This doesnââ¬â¢t refer to their temperament, such as being nice or mean, but rather their nature within the story, such as being dynamic or static. Scout Finch - the archetypical child. Image: Universal Pictures11. Symbolic characterAs we mentioned earlier, a symbolic character is used to represent something larger and more important than themselves, which usually ties into the overall message of the book or series. This type must also be used sparingly - or at least subtly, so the reader doesnââ¬â¢t feel like the symbolism is too heavy-handed. As a result, the true nature of a symbolic character may only be fully understood at the very end of a story.Symbolic examples: Aslan (symbolizes God/Jesus in The Chronicles of Narnia), Jonas (symbolizes hope in The Giver), Gregor Samsa (symbolizes the difficulty of change/being different in The Metamorphosis)12. Round characterDonââ¬â¢t get this one confused with Humpty-Dumpty. A round character is very similar to a dynamic one, in that they both typically change throughout their character arc. The key difference is that we as readers can intuit that the round character is nuance d and contains multitudes even before any major change has occurred.The round character has a full backstory (though not always revealed in the narrative), complex emotions, and realistic motivations for what they do. This doesnââ¬â¢t necessarily mean theyââ¬â¢re a good person - indeed, many of the best round characters are deeply flawed. But you should still be interested and excited to follow their arc because you can never be quite sure where theyââ¬â¢ll be led or how theyââ¬â¢ll change. Needless to say, the vast majority of great protagonists are not only dynamic, but also round.Round examples: Amy Dunne, Atticus Finch, Humbert Humbert, Randle McMurphy, Michael Corleone All the best characters are round ðŸÅ'Ž With this wide-ranging arsenal of character types at your disposal, your story might just be the stuff of legends (or bestseller lists). Now go put them to use - if you havenââ¬â¢t already!Which of these types do you have in your story? How do they overlap? Tell us in the comments below.
Sunday, November 3, 2019
Research paper about famous photographer Ansel Adams
About famous photographer Ansel Adams - Research Paper Example He started school in 1908 but he was a poor student. He started to hate going to school. In 1915, his father took him out from school and had him home-schooled. During that time, Charles bought his son a pass to the Panama Pacific International Exposition. This Exposition had exhibits on science, arts, machinery and photography. That was the first time young Ansel encountered photography as a form of art. There were three prints exhibited by the great photographer Edward Weston ââ¬â whom he would collaborate much later in a group project and will become a great friend. His unconventional education opened the doors for young Ansel: He became interested in piano and began to teach himself how to play. He was a serious student of music, and recognizing this, his father hired a piano tutor for Ansel. Her name was Marie Butler and she tutored Ansel for three years. At this point, Ansel was seriously considering becoming a concert pianist. In 1916, Anselââ¬â¢s family took a trip to Yosemite and on this trip, his father gave him a camera. This trip made him interested in photography as a result. ââ¬Å"With his camera, a Kodak Box Brownie, Anselââ¬â¢s life as a photographer began ââ¬â an interest which was to endure for the rest of his life. With his first attempts at committing the magic of Yosemite to film, he demonstrated the beginnings of an immense talent which was to make him a world-class photographerâ⬠(1). Ansel was then persuaded to attend school again and he did. He went to Mrs. Kate Wilkinsââ¬â¢ private school. He graduated from eighth grade in 1917 at Mrs. Wilkinsââ¬â¢ school. His graduation marked the end of his academic career. He continued to pursue piano and music, as well as his new passion ââ¬â photography ââ¬â after graduation. Like the way he taught himself piano, he began teaching himself the basic principles of photography. Then he got a job working part-time for a photo finisher in San Francisco, Fred Dittman. T his is where Ansel had his first darkroom experience. Will Dassonville, a neighbor, was a technician and manufacturer of photographic papers. ââ¬Å"It was Will Dassonville who was Anselââ¬â¢s true inspiration and who brought his attention the true extent to which photography could be developed into an art form.â⬠(2) This picture is called The Tetons ââ¬â Snake River. This iconic picture is taken at the Yosemite Park and is probably one of the most famous photographs that inspired environmentalism in America. Many photographers agree that Ansel Adams made a huge impact in photography that you can actually denote the history of photography into before Ansel Adams and after Ansel Adams. It has been said that before Ansel Adams, photography is not taken seriously, and was not considered an art form. The photographers then used extreme manipulations on their photographs to make them resemble paintings. However, Ansel came to the scene declaring ââ¬Å"photography is poetry of the realâ⬠and eschewed manipulations. He practiced the value of ââ¬Å"pure photographyâ⬠using only light, shutter speed and other simple manipulations of the camera. Ansel clung to the large format camera even if the point and shoot ones were readily available. Because of his beautiful pictures of nature, Ansel changed how photography was seen (it is now art) and has influenced America about how to take care of their environment. Because of him, Kingââ¬â¢
Friday, November 1, 2019
Why do cannibals eat their deceased family Essay
Why do cannibals eat their deceased family - Essay Example There were two types of cannibalism: exocannibalism (eating members of an enemy group), and endocannibalism (eating members of one's own group). Endocannibalism symbolized very different things: reverence for the dead, an incorporation of the spirit of the dead into living descendants, or a means of insuring the separation of the soul from the body. Endocannibalism is often associated with ritual burial ceremonies and has been controversially referred to on occasion as "compassionate cannibalism." Mortuary cannibalism has been considered to be the most widely practiced form of endocannibalism, often excluding murder and focusing on already deceased corpses (Arens 18-35). Cannibals would eat their deceased family members to acquire qualities, show respect and gain virtue of the deceased. There have been reports of such cases in Latin America, Australia, India, China, Papua New Guinea. Latin America. The Wari' (tribe on the territory of Brazil), prior to about 1960, ate as much of the corpse of a dead person as they could. If a corpse was too decayed to eat, most of it was cremated, which was believed to be superior to burial. For the Wari', allowing a loved one to be put in cold, wet ground was as horrifying a notion as cannibalism is to us. In various myths, Wari' are told that humans are eaten as a step in a cycle in which humans also eat animals. At the moment when a body is dismembered, it was believed that its spirit was reawakened by ancestral spirits in the underworld (Conklin 210-234). A Mayoruna man once expressed a wish to remain in his village and be eaten by his children after his death rather than be consumed by worms in the white man's cemetery. In recent times the Panoan, Yanomamo, and other lowland groups have consumed the ground-up bones and ashes of cremated kinsmen in an act of mourning. This still is classified as endocannibalism, although, strictly speaking, "flesh" is not eaten. The Yanomam mix the bones and ashes with plantain soup before consuming the mixture. The Cashibos eat their aged parents, but perhaps more from religious sentiment than from cruelty. Before their conversion, it was the practice of the Cocomas of the Hualaga to eat their dead relations, and to swallow the ground-up bones in fermented drinks, on the plea that it was better to be inside a warm friend than buried in the cold earth. Theories that a lack of protein in the South American tropical forest environment stimulated cannibalism have not received support from recent studies showing that tropical forest tribes have a more-than-adequate protein intake and are successful hunters despite environmental limitations (Metraux 383-409). Australia. In Australia, cannibalism was mostly practiced to gain the powers of the particular person who was being eaten. Some tribes ate their enemies only, some their own people, and some both. When tribes ate their enemies, they only ate certain body parts, such as the brain, heart, legs, or tongue. The brain was eaten for knowledge, the heart for courage and power, the legs were only eaten in the case of swift runners, for speed, and the sweat and tongue were consumed for bravery. When tribes ate their own people, family members would eat small portions of fat from their dead relative as a sign of respect. Only people of worth were eaten. People who died of disease or
Tuesday, October 29, 2019
Analyze the in Office Ancillary Services Exception to the Stark Act as Research Paper
Analyze the in Office Ancillary Services Exception to the Stark Act as it relates to block leases - Research Paper Example he medical practitioner is financially associated with the care services; and d) the medical practitioner implements referrals to a care provider for purposes of furnishing the DHS. Physicians and health practices depend on the in-office ancillary services and related medical practice exceptions to the Stark law to permit DHS referrals within the parameters of the practice. Of these, Washlick (2008) noted that the in-office ancillary services exception is most commonly applied because it enables physicians providing various services to: a) make referrals for select DHS within the confines of medical practice; b) inform those DHS to provide the necessary patient care; c) apply Medicare and Medicaid cover to defray the costs resulting from the services; and d) retain and channel the revenues collected from rendering the services within the practice for settling practice expenditure and physician remuneration. These exclusions are therefore of great value to the rendering of patient services and other internal activities. As Micklos and Sevell (2004) noted, the in-office ancillary services exception (IOASE) is arguably the most significant allowance given under the outlaw of self-referrals of select health services by medical practitioners. In the recent past, however, renewed attempts to revisit referral rules have threatened the effectiveness of physician practice. For instance, the federal budget for the 2014-2015 financial year contains a number of measures which are intended to enhance a greater level of proper remuneration for the proper rendering of health care under the Medicare platform. The budget is responsive to various recommendations by the Government Accountability Office (GAO) and MedPac that self-referral of simpler services culminates in a higher volume of care when they are integrated with payments for the service fees (Clark, Johnstone, Lynch, & Cardenas, 2004). The Budget seeks to limit the IOASE by permitting only practitioners who meet given
Sunday, October 27, 2019
Pharmacists Role in Complementary Alternative Medicines
Pharmacists Role in Complementary Alternative Medicines Pharmacists Role in Complementary Alternative Medicines The first section of this paper will provide background information on the use of complementary and alternative medicines (CAMs) and their associated risks and benefits. Additionally, information on the pharmacistsââ¬â¢ role in CAMs and services in their pharmacies will be discussed. Next, the theory that potential ethical conflicts arise for pharmacists between keeping the health and wellbeing of clients and the community as their primary concern versus the prospect of turning a profit will be considered. Before concluding, other important ethical issues including duty of care, and liability will be discussed. Background The term CAM refers to any healing practise that doesnââ¬â¢t fall under the heading of conventional medicine. It encompasses not just pharmaceutical preparations, but diet, and traditional forms of health care including acupuncture, Chinese medicine, homeopathy, etc.1 In the past, people who sold CAMs were sometimes referred to as quacks, or someone who promotes unsupported methods that lack scientifically credible rational.2 CAMs were regarded as old wives tails, and their claims dismissed by the medical community.3à More recently CAMs have become a prominent feature in todayââ¬â¢s health care regimens. In 2000 according to the Therapeutic Goods Administration (TGA) 52 percent of Australians were using at least one non-prescribed complementary medicine.4 The Therapeutic Goods Act of 1989 effectively legitimised CAMs by allowing them to be entered into the Australian Register of Therapeutic Goods (ARTG) as a listed medicine. They have to meet a lesser set of standards than conventional medicines, which is one of the major concerns of allopathic practioners.5 With the passing of this act, pharmacies could legitimately sell two types of products; medicines for which there is scientific evidenceà (prescription and over the counter products) and unproven medications (some CAMs) that may lack efficacy.à There are many risks associated with using CAMS including direct risks, substitutions made, nonprofessional advice received, and unreliable diagnostic tests.6 In some cases, CAMs have caused serious harm. The adverse effects range from infection due to dirty acupuncture needles, altering the effectiveness of other pharmacologically proven agents, to death from chiropractic manipulation. Substitutions pose a great risk for serious conditions. Replacing conventional treatments with CAMs can lead to many adverse effects. For example, treating melanoma with a herbal ointment rather than surgery, radiotherapy, or chemotherapy can have disastrous consequences. Some patients, especially those with life threatening illnesses, will try anything to improve their symptoms. Some CAM practitioners take advantage of this and recommend treatments that are very costly and at the expense of other proven treatments. Unproven tests include, but arenââ¬â¢t limited to, reflexology and electro-dermal t esting.6 The danger in this type of testing is the high likelihood of misdiagnosis.à Despite the large body of evidence in the scientific community of the poor efficacy of CAMs, there is some evidence for their use as seen in cranberry for urinary tract infections St. Johnââ¬â¢s Wart for depression and a variety of others.7 In 1993 Australians spent an estimated 1 billion dollars on CAMs and by 2000 that number had risen to 2.3 billion.8 à Shockingly, only 57 percent of Australians reported or discussed the use of these products to their doctors.9 The potential dangers outlined above and these statistics show the need for a pharmacists intervention. Pharmacistââ¬â¢s Role Pharmacists are a vital part of the allopathic health care team, often being the first port of call for patients requesting CAMs.10à The community pharmacy is an ideal environment to deliver quality, cost effective, and professional services to the general public. Patientââ¬â¢s safety and access to this high quality care is of paramount importance.11 Pharmacists counsel life style choices, recommend an appropriate non-prescription medication, or refer patientââ¬â¢s to a physician to improve outcomes.12 à à When responding to enquiries about CAMs pharmacists need to consider a variety of issues. The customersââ¬â¢ cultural and social beliefs and desire to take control of their own treatment should be viewed non-judgementally. Pharmacists need to stay up to date, and be aware of evidence to support the use of different products. Information about CAMs should be provided on an evidence-based level so the most accurate information is delivered to the patient. Pharmacist s also need to be aware of potential interactions with conventional products, and report adverse drug reactions to both the Adverse Drug Reactionââ¬â¢s Committee and the productââ¬â¢s sponsor.7 Furthermore, pharmacists must remind patients that CAMs are medications and should be openly discussed so potential interactions and side effects can be identified. Ethics and profit In a 2005 study of 484 community pharmacists in New South Wales 77% of respondents personally used CAMs and said that they offered CAM products for sale in their pharmacies. A majority of the pharmacists believed CAMs enhanced customersââ¬â¢ image of the pharmacy and 87% reported they increased customer numbers and annual sales.13 From these results it is evident that a potential conflict between promoting and selling CAMs and ethics could arise. Pharmacists are intrinsically placed in an ethical dilemma daily. They have dual roles as health care providers and businesspeople. As health care professionals they are expected to provide a high level of unbiased health care, while their business side is expected to sell products and generate a profit. Professional and business roles are generally believed to be in conflict with each other and roles are traditionally viewed as being exclusive. According to Chappell et al community pharmacists are one of the few occupations where professional and business values co-exist.à They found no correlation between the value placed on business and the level of care or ââ¬Å"professionalismâ⬠displayed by the pharmacists. This suggests pharmacists are able to act dually as a salesperson but still deliver professional information.14 The degree of professionalism has been called into question by Kennedy et al. They demonstrated that in some cases pharmacists, especially proprietors, sometimes recommend more expensive products when a cheaper generic version is available, but the overall outcome was satisfactory. All pharmacists recommended an appropriate treatment for the condition but the product selected differed among owners and employee pharmacists. Although the patient received a high level of care, the fact that he or she had a cheaper option calls the level of professionalism into question.à à à Further evidence for professionalism is seen in a study by Perepelkin et al. where they found pharmacists, regardless of their ownership structure, are professionally oriented in their practise. The difference in services provided was only seen in terms of professional autonomy, decision-making and amount of control. There was no difference in the amount of profit-driven goals between the groups.16 Similarly, in a recent study, Kronus found that pharmacists, regardless of their role orientations (business versus professional), were similarly motivated by service and income values. She suggested that the theoretical model suggesting that business is based on extrinsic values and professionalism is based on altruistic values should be revised when talking about pharmacy. She found altruism (professionalism) was the dominant factor in the field of pharmacy. Since most pharmacists are salaried employees there is little pressure to increase profit by pushing CAMs with no supporting evidence. It would be very easy to jump to the conclusion that the need to make a profit would in some way have a negative effect on pharmacy owners or employed pharmacists (reward systems) to act as independent ethical health care providers when CAMs are viewed as huge profit generators.17 Wingfield et al suggest that ââ¬Ëethics is so integrated and intrinsic to daily practise that there is no need to single ethical issues for special attention,ââ¬â¢ as demonstrated by a lack of a journal dedicated to pharmacy ethics (there are ethical journals for medicine and nursing). Rather the ethical behaviour of the pharmacist is displayed in all aspects of daily practise culling the drive for profits.18 In Australia the behaviour of pharmacists is guided by the Pharmaceutical Society of Australiaââ¬â¢s Code of Professional Conduct (PSACPC).7 Pharmacists sell CAMs in pharmacies that does give credibility to CAMs and to some extent promote their usage.à Also, pharmacists are in a unique position to influence the sale of certain products. For example, CAMs are used by 60 to 80% of oncology patients. According to the British Columbia Cancer Society the psychosocial needs of patients including ââ¬Ëincreased anxiety, need for information, maintenance of a sense of hope, a sense of control, negative experience with conventional medicine, and perceived holistic nature of complementary medicine,ââ¬â¢ is the reason for the high percent of people using the medicine and not the availability of the product in pharmacies.19 Pharmacists donââ¬â¢t need to promote these products as psychosocial needs are very powerful and patients are clamouring for these medications in increasing numbers. Although the pharmacy is a business, business objectives wouldnââ¬â¢t necessarily suffer, as knowledgeable and honest patient counselli ng plays an important role in customer satisfaction and thus profitability. An unsatisfied customer would certainly seek another pharmacy.20 These satisfied customers will keep coming back to the pharmacy not just for CAMs but for prescription and personal products as well. This is a win-win situation for both the customer and the pharmacist who now has the opportunity to play an active role in the health of the patient as well as make a decent living. It is the pharmacist who provides the factual advice for patients who seek out these products. Through professionalism this temptation to take advantage of this behaviour is easily removed. Pharmacists develop close relationships with their customers by taking time to talk about medications. Professional orientation happens because patient counselling of all medications including CAMs is at the cornerstone of ethical pharmacy practice and high quality care. As previously stated, the pharmacistââ¬â¢s role in counselling in the use o f CAMs is the most effective in ensuring the health and safety of patients.à When counselling patients, pharmacists follow the PSACPC. By following the PSACPC pharmacists remain in the scope of their practice, are covered for malpractice liability for negligent care and for informed consent issues, and foremost, ensure the health and well-being of clients and the Australian community. Under the 9 key principles of PSACPC, counselling advice for CAM usage is about adhering to the principles of evidence based medicine and critically examining and honestly informing patients of unproven medications and therapies. Pharmacists must also respect the beliefs and judgements of patients and other health professionals while regarding the patientââ¬â¢s autonomy to make decisions regarding their own treatment but at the same time offering guidance and advice based on evidence-based information.21à à Thus, when a pharmacist gives advice on the use of Cams based on PSACPC guidelines after considering clinical and patient factors there may be commercial benefits but they do not necessarily compromise the quality of the recommendations. In pharmacy, ethics and profit can and do exist without conflict in the sale of all products.à Duty of care regarding informed consent As outlined above a majority number of Australians are using and want to use CAMs. It is therefore the duty of pharmacists to discuss these treatments with their patients.22 A study in the US found almost three-quarters of the pharmacists surveyed worked in stores where herbal medicines were sold.23 Almost half of the pharmacists agreed with the statement, ââ¬Ëherbal medicines are not accepted by the majority of my colleaguesââ¬â¢ and only a quarter agreed with the statement ââ¬Ëherbs are efficaciousââ¬â¢.24 25 It can be seen that most pharmacists donââ¬â¢t believe in the products so recommending them is difficult. But, they have an ethical obligation to adhere to the PSACPC and respect the autonomy and dignity of the patient to make informed decisions.21 Once the pharmacist has disclosed and openly discussed the different treatment options his or her ethical obligation has been fulfilled. In the United States this is taken one step further.à It is a legal obligatio n for practioners to disclose information for CAMs if they are generally accepted within the medical community. Failure to do so can result in legal action.26 Liability in referring to CAMs Liability issues are new territory for pharmacists recommending CAMs to patients. Homeopathy, for example, is completely contradictory to the principles of modern pharmacology. The incompatibility of homeopathic paradigms with all of basic science must be taken into consideration.22 à Keeping in line with the PSACPC, pharmacists cannot ethically recommend a product or service to which they know there is no evidence to support its use, and is not in the best interest in the health and well being of the patient or community. In Canada, The Pharmacy Code of Ethics requires pharmacists to never knowingly provide any products which are not good quality.27à In the United States medical practitioners can be held liable for referring patients to a CAM practitioner if they ââ¬Å"should have knownâ⬠the CAM practitioner might be ââ¬Å"incompetentâ⬠. This shows that medical professionals are not just ethically but legally responsible for protecting patients from inferior medical treatments.28 CAM practitioners argue that their treatments are holistic and some of the therapeutic benefits are unmeasurable. Because western medicine supports evidence based on quantifiable outcomes the two doctrines of practise often clash. It is very difficult to compare the s piritual healing power of CAMs to the physical healing of western medicine.28 As long as the CAM treatment is not interfering with a patientââ¬â¢s level of care, there is no reason to discredit a potential treatment that may make a patient ââ¬Ëfeelââ¬â¢ better. An honest answer to the efficacy of a specific CAM and reporting that some people say it makes them feel better is the best course of action.à à Further compounding the issue is the training level of the CAM providers. Most are not ââ¬Ëhealth care professionalsââ¬â¢ and have inadequate understating of biology, pharmacology, patho-physiology, and other sciences that govern western medicine. Since pharmacists cannot ethically refer a patient for a treatment that they believe may affect their health or wellbeing the ethical dilemma of whether to recommend this option is exacerbated. Although, a recent Canadian study reported only 2% of pharmacists felt they had adequate information about complementary and alternative health care, they are still better suited than CAMs to provide information on the prodcuts.10 A pharmacists guidance is based on principles 1 and 8 of the (PSACPC), advising patient of the scientific evidence available while still respecting their autonomy.28 Where CAM providers have no such code of ethics. Conclusion This paper examined the background issues associated with complementary and alternative medicines (CAMs) and the associated risks and benefits that go along with them. Additionally, the pharmacistsââ¬â¢ role in providing CAMs was discussed. The many ethical issues, including profit, although seemingly complex can and should be negotiated using the PSACPC guidelines. The introduction and sale of CAMs have not changed the pharmacistââ¬â¢s code of ethics where the patientââ¬â¢s well-being and health remains the focus. As CAMs are becoming more popular and accepted by the public, pharmacists need to have a high level of understanding of the many issues associated with them. The ethical issues pharmacists face daily are apparently being handled appropriately according the literature cited, and based on the publicââ¬â¢s perception of pharmacists being one of the most trusted health professionals.
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