Breast Cancer Treatment

Bosom Cancer Treatment â€Å"Cancer is the uncontrolled development of irregular cells in the body† (Carlson et al., 2009). Destructive cells are additionally alluded to as threatening cells. â€Å"Cells go about as the structure squares of organisms† (Carlson et al., 2009). Under typical conditions, cells will experience cell division relying upon the body’s needs, and afterward pass on once their capacity ends.Advertising We will compose a custom article test on Breast Cancer Treatment explicitly for you for just $16.05 $11/page Learn More furthermore, harmful cells isolate quick and now and again neglect to bite the dust. Malignant growth creates in various tissues and organs of the body. Harmful cells have the trait of spreading from their source to different pieces of the body (intrusive). Carcinogenic cells that stay at their source are supposed to be noninvasive. The bosom is one normal organ that disease influences. Bosom malignant growth happens in two principle classes (Carls on, et al., 2009). Ductal harm: this is the most widely recognized sort of malignancy. This kind of bosom malignant growth shows itself in the cylinders/conduits which structure the channel for moving milk from the bosom to the areola. â€Å"Lobular carcinoma: this kind of disease as a rule starts in the milk delivering districts of the bosom (lobules)† (Breast malignant growth, 2011). Once in a while does malignant growth create from different pieces of the bosom. â€Å"Breast malignant growth is known to happen in intrusive or noninvasive form† (Breast disease 2011). Therefore, malignant cells in the bosom may metastasize to different pieces of the bosom from their source. The predominance and reasons for malignant growth shift. â€Å"Cancer scientists have found that most bosom carcinomas are delicate to the hormone estrogen† (Breast malignancy, 2011). The hormone makes the dangerous cells develop. The bosom disease cells that react to estrogen have estrogen receptors on their surfaces (Breast malignancy, 2011). Malignant growth scientists allude to these estrogen receptor having bosom disease cells as receptor-positive/EP-positive malignant growth cells. Researchers have found a specific quality called HER2 that causes bosom disease cells to increase and fix themselves. It has additionally been noticed that ladies with this sort of quality have an extreme bosom disease than their female partners who need it. Likewise, HER2 bearers have a higher danger of bosom disease reoccurrence. For the most part, odds of creating malignant growth increment with age. The more seasoned one turns into, the higher the hazard. Ladies over 50 years have propelled bosom malignant growth cases. Ladies are twice bound to create bosom malignant growth than men. Family ancestry assumes a focal job in directing the odds of somebody creating bosom malignant growth. People whose nearby family members had ovarian, uterine, bosom or colon disease are at a high-dan ger of creating bosom malignancy. Researchers have likewise found that ladies who experience early periods (before the age of 12), and the individuals who keep on encountering periods through menopause (after age 55) have a higher danger of creating bosom disease. In addition, over the top liquor (for grown-ups) and radiation treatment around the chest region in kids present a danger of creating bosom cancer.Advertising Looking for article on wellbeing medication? We should check whether we can support you! Get your first paper with 15% OFF Learn More Women who have gotten hormone supplanting treatment with estrogen and those that pre-owned diethylstilbestrol (DES) are at a higher hazard. Labor has likewise been found to affect bosom malignant growth. Bearing a few kids and at an early age, diminishes the hazard. Then again, ladies who bear kids after the age of 30 or the individuals who don't bear youngsters at all represents an incredible danger of creating bosom malignancy (Giuli ano et al. 2011). Bosom malignancy at a beginning time doesn't present any manifestations (Hayes, 2007). That is the reason specialists urge ladies to go for standard tests. In any case, after it has advanced it might introduce the accompanying manifestations. A hard protuberance in the bosom or armpit that doesn't instigate torment is a pointer of bosom malignant growth. The knot has lopsided edges. Change in the appearance (size and state) of the areola might be another marker. The areola may show some blushing, dimpling or puckering. The areola may likewise deliver a release. The liquid could be ridiculous, clear, and yellow or seem like discharge. â€Å"Symptoms of cutting edge bosom malignant growth are bone agony, bosom torment and distress, skin ulcers, weight reduction and expanding of one arm close to the bosom with cancer† (Breast disease, 2011). The treatment of disease relies upon the sort, stage, affectability to specific hormones or whether the malignant growth over communicates HER2/neu quality (Carlson et al., 2009). Specialists typically direct certain tests before choosing the sort of treatment to give. Such tests incorporate bosom MRI, biopsy, ultrasound, mammography, sentinel lymph hub biopsy or CT/PET sweeps. Three alternatives might be utilized. Chemotherapy or radiation treatment (to murder disease cells) and medical procedure to evacuate the malignant tissue (could be lumpectomy or mastectomy). Hormone treatment might be endorsed to ladies with ER positive bosom malignant growth to repress certain hormones that cause uncontrolled cell division. More current procedures incorporate biologic/directed treatment and immunotherapy (Carlson et al., 2009). â€Å"In focused on treatment, anticancer medications are utilized to perceive and hinder certain adjustments in cells that may prompt cancer† (Breast disease, 2009). Immunotherapy uses initiated safe framework cells to treat disease cells. More examination is being done to conc eal all the more light on the utilization of immunotherapy. References Breast Cancer (2009). Bosom Cancer. Web. Bosom Cancer (2011). Bosom Cancer. Web.Advertising We will compose a custom article test on Breast Cancer Treatment explicitly for you for just $16.05 $11/page Learn More Carlson, R. et al. (2009). Bosom Cancer: Clinical Practice Guidelines in Oncology. Diary of Comprehensive Cancer Network, 7(2), 122-92. Giuliano, A. et al. (2011). Axillary Dissection versus no Axillary Dissection in Women with Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Controll Trial. Diary of the American Association (JAMA), 305(6), 569-75. Hayes, D. (2007). Clinical Practice: Folow-up of Patients with Early Breast Cancer. The New England Journal of Medicine, 356(24), 2505-13.

Essay Topics on Water Conservation

Essay Topics on Water ConservationEssay topics on water conservation can be found all over the internet. Whether you are researching the topic for your school paper, an exam, or just to pass time, you need to keep in mind that a water conservation essay is your only chance of getting your point across in the allotted time. Here are the guidelines to follow when writing a water conservation essay.The very first thing you need to do before writing your essay is to determine the theme and main idea of your essay. What is the theme of your essay? Consider the subject of your essay, whether it is about people nature, or how your country can improve its environmental condition.The second thing you need to consider when writing essay topics on water conservation is the place where you will be sharing the essay. What will you be covering on this topic? Is it your country?When it comes to essay topics on water conservation, most people focus only on the question 'What should we do about water ?' While the first part of the question seems quite simple, you should also consider the second part of the question. You should also know what exactly is your goal in writing your essay. Once you have understood the question, it will be easier for you to write.The third thing you need to do when writing an essay about water conservation is to take a look at your writing skills. You can try to prepare your essay all by yourself, but this will take too much of your time. Therefore, you need to seek the help of someone who is already skilled with water conservation.Now that you have looked at these three tips, you will definitely want to try to incorporate these three essay topics on water conservation ideas into your essays. If not, you need to come up with your own solution on how to write. There are many different essay topics on water conservation ideas to be found online. However, writing an essay is not an easy task.If you are not skilled with writing, it is best that you seek t he help of a college or university so that they can help you learn how to write. Even if you do not want to write essays all by yourself, you can always hire a writer to write it for you.One of the things that you should keep in mind when writing essay topics on water conservation is that you need to be able to write about water conservation in an interesting way. You can only achieve this if you write about topics that can interest your readers.

Impact of Surgical Complications †Free Samples to Students

Question: Talk about the Impact of Surgical Complications. Answer: Presentation: The investigative procedure has incomparable significance for the appraisal and audit of the monetary information that has been accumulated from the fiscal reports of the organization viable. During the hour of developing the arrangement of review for Double Pink Printers Ltd (DIPL), the systematic instrument of money related information is viewed as the most fitting and treasured part. It requires to be refered to that the review plan of the associations provides fundamental way and guidance to the inspectors while undertaking the procedure of review during a predetermined timespan. With the assistance of an unmistakable note, the review plan helps the examiners to monitor the review costs so as to confine any miscommunication and misconception with the customers who require review (Hardy 2014). The diagnostic procedure of the money related information of DIPL answers to the strategy for dispersing the monetary information from different sorts of budgetary exposures of the firm. It is even observed that there are different classifications of methods that guides in doing the systematic instrument of the budgetary information. By taking assistance of the expository procedure for the assessment of the money related information, the bookkeepers and the supervisors of fund of the firm endeavors this information so compelling and a few sorts of choices concerning bookkeeping and account can be embraced. Besides, by taking assistance of the general measured scientific methodology of the money related information, the fund administrators of the associations gain the power to dichotomize the monetary exposures of the firm from different budgetary experiences (Kend et al., 2014). It has been seen that one of the huge favorable circumstances of this is it helps to give out help for the development of the fiscal reports and embrace an examination of the budget summaries of the organizations for the last three bookkeeping years. By taking assistance of the diagnostic procedure, the account chiefs of the associations can misuse the money related data from the fiscal reports and they can verify the strategy for monetary telecom of the featured information. For example, the procedure of money related revealing of the net liabilities and the proprietor of the value can be pondered in this regard alongside the outing of the information (Moroney et al., 2014). It requires to be refered to that benchmarking has been taken as the boss diagnostic procedure of money related information and it very well may be misused for the development of the review plan of the organization. By taking assistance of the procedure of benchmarking, the account directors can perceive the changes in the fiscal reports of the associations. Moreover, the real factor of these changes alongside their center variables can be perceived. Alongside the technique benchmarking, proportion investigation is viewed as a urgent diagnostic procedure of the budgetary information (Min, Lv 2017). The technique for proportion investigation helps in the development of the review plan by attempted a correlation of the money related reports of more than one association. Clarification: Concerning the contextual analysis, the actualized explanatory procedure significantly affects the development of the review plan. Also, it even has the importance in appropriating the monetary information inside a few bookkeeping and money related divisions of the firm. The accompanying proportions can be built as these are a piece of the systematic procedure. Specifics 2013 2014 2015 Current proportion 1.42 1.46 1.50 Net revenue 0.068 0.60 0.06 Dissolvability proportion 0.62 0.44 0.21 Table 1: Ratio Analysis (Source: as made by Author) With the assistance of the table that has been built above, it is seen that there has been an ascent in the present proportion of DIPL from the year 2013 to 2014 and the worth has expanded from 1.42 to 1.46. In the year 2015, the present proportion accounted to 1.50 with an ascent of 0.4. It has been seen that there has been a significant variety of the monetary report of DIPL throughout the previous three years which has indicated the entirety of the net benefit of the firm from the net deals. Besides, by taking assistance of the benefit investigation of DIPL, the money supervisors get an understanding about the costs of the association. It is seen that by taking assistance of the assessments of the money related reports, the fund directors can pick up the data about the proficiency of the associations financial plan as for the enhancement necessity of the organization (Green et al., 2017). The DIPL inspectors can pick up information and thought regarding the present monetary state of the firm by looking at the money related issues and the proportions. By watching the table portrayed above, it tends to be refered to that there has been a decrease in the dissolvability proportion of DIPL from the year 2013 to 2015. This particular example in the dissolvability proportion helps the directors in the comprehension of the money related execution of the firm. By taking assistance of the proportion examination, the fund supervisors can decide the income sum so as to meet the short and long haul obligations of the firm. Besides, it tends to be refered to that the appraisal and the examination of the presentation and the proportions of the organization can help the budgetary directors to decide the money related condition and execution of DIPL in the course of the last multi year timespan. Furthermore, the money administrators can decide if the present budgetary circumstance of the firm is negative or not (Shah et al., 2017). In conditions of a troublesome the DIPL supervisors requires healing activities so as to bring back the effective money related state of DIPL. Thusly, by looking at the tables that have been developed above, it very well may be refered to that the systematic methods of the budgetary information has critical figures for the association. The dangers that are in relationship to a business can be depicted as the probability of the hierarchical failure so as to arrive at the targets of the association. There have been different components of hazard that are identified with DIPL and this makes the firm ineffectual to accomplish their targets. It has been seen that DIPL has been not able to record different money related exchanges of their exercises (Rahim Idowu 2015). By taking a gander at the contextual investigation, the issues of the administration have an immediate connection with the questionable and pointless arranging of the few deals, money related and showcasing activities of DIPL. As for the contextual investigation there have been explicitly two elements of hazard that significantly affect confining DIPL to achieve their objectives. They are clarified as follows: Money related Risk The hazard related with account can be clarified as the insufficiency of an association so as to payout their liabilities that are in nature long haul. With the ascent in the extraneous liabilities, the degree of hazard even gets raised. The obligation level of DIPL in agreement to their value by contrasting and the figures got throughout the previous three years have expanded altogether in the year 2015. It is even seen that there has been an ascent in the installment pressure that are comparable to liabilities of advance payout and the fixed rate interests of the organization inside a specified timespan (Carson et al., 2014). The perceptions have shown that there exists a test to the dissolvability state of DIPL over the long haul if DIPL can't make installments for the rule and the intrigue sum. Error of the fiscal reports: There exists an opportunity that DIPL may hope to cause changes in their fiscal summaries so as to keep up their obligation to value and their present proportion in accordance with the agreement concurrence with the getting firm. DIPL so as to protect their present proportion may hope to expand their present resources with the assistance of the rising receivables or stock qualities also. DIPL attempts to save their obligation to-value proportion hopes to expand their value esteems with the assistance of the rising held profit esteem. The utilization of data innovation inside DIPL makes a genuine measure of challenge for them. The shortage in the control of data innovation may have extraordinary impact on DIPL. There was a lot of weight that was worried over to the IT staff by the administration of DIPL so as to finish up the method in the year 2015. The bookkeeping data process has danger identified with security and this has for the most part been because of the normal and man-made cataclysms (Sutherland 2017). DIPL has been not able to keep up the equivalency among the present programming process and the imaginative bookkeeping framework. There has been an issue of the incapable exchange portion. The periodicity idea of bookkeeping has not been trailed by DIPL. Along these lines, it tends to be seen that it could prompt an insufficient exposure of the benefit condition just as the budgetary state of DIPL (Varughese et al., 2014) The background information of DIPL that has been assembled with the assistance of the contextual investigation has unveiled the probability of the presentation of the in successful budget report development procedures of DIPL. The significant elements of hazard that are related with the utilization of these practices can be depicted as follows: Kinds of Risk Subtleties and Identification False Risk By inspecting the data assembled from the DIPL contextual investigation, it very well may be seen that the key danger of fake is connected with the staffs and the workers of the association, as they have the likelihood to be related with the tasks. The key factor that is related with the hazard is the discontent inside the representatives of the company (Joshi et al., 2014). As indicated by the contextual investigation that is related with DIPL, there has been a perception that there has been broad worry from th

Geriatrics and Depression - Free Essay Example

When a person reaches the age of 65, their chances of getting dementia doubles every five years (Buettner, Fitzsimmons, Dudley, 2010; Mansah et al., 2014). Once a person has an altered mental state, like dementia, they often exhibit agitation, passivity, and depression (Buettner, Fitzsimmons, Dudley, 2010; Mansah et al., 2014). Since these interactions affect ones cognition, personality, and daily activities, the quality of life seen is often decreased, making engagement and perception of life also lessening (Buettner, Fitzsimmons, Dudley, 2010; Mansah et al., 2014). As a person gets older, multiple factors can lead to a decline in the quality of life including loss of partners, siblings, or friends and even control of their everyday life events (Babatsikou et al., 2017; Kawamura, Niiyama, Niiyama, 2009; Prosser, Townsend, Staiger, 2008). Age is an inevitable thing that brings health problems along with physical and emotional changes (Adam, Shahar, Ramli, 2016; Gopi Preetha, 2016; Kawamura, Niiyama, Niiyama, 2009; Wang, Ying Chair, Mi Ling Wong, Li, 2016). Depressive symptoms in the elderly population will continue to rise as the baby boomer population reaches the geriatric stage of their life (Adam, Shahar, Ramli, 2016; Babatsikou et al., 2017; Wang et al., 2016). Unfortunately, most nurses admit to not knowing enough about geriatrics and that they would rather work with the patients who had easy and quick-to-apply interventions rather than the ones who had more time-consuming ones (Bleijenberg et al., 2016). A study done by Bleijenberg et al. (2016) shows that there is room for nurse to improve when it comes to how they divide their care and what quality they put into it. Significance to Nursing Depression is seen in 77% of older people with dementia, yet it often goes unrecognized even with its effects on the quality of life (Buettner, Fitzsimmons, Dudley, 2010; Mellor et al., 2008). Since some nurses feel like depression symptoms take longer to treat, appropriate medical attention is not achieved for these residents (Buettner, Fitzsimmons, Dudley, 2010; Mellor et al., 2008). However, caregivers often feel like they lack proper skills needed to recognize and help residents with depressive symptoms, so many feel like educational programs on the different types interventions would be beneficial, interesting, and used daily (Buettner, Fitzsimmons, Dudley, 2010; Mansah et al., 2014; Mellor et al., 2008). Education provided to nurses and care givers is one way to improve care to patients (Mansah et al., 2014). When nurses were provided with educational material and assessment tools, completed training programs, and implemented reflection techniques, they felt like the care they provided to each patient was improved (Bleijenberg et al., 2016; Mansah et al., 2014; Mellor et al., 2008). When a nurse implements their skills, they were able to increase the care and communication they provide to the nursing home residents, gain knowledge about care, and accomplish a sense of self-efficacy (Mansah et al., 2014; Mellor et al., 2008). With the geriatric population rising and nurses being the advocates for residents, an open mind and new innovative types of care need to be looked at to create an individualized treatment plan for residents (Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010; Mansah et al., 2014). Oftentimes, pharmacologic interventions are the first, if not only, line of defense used in patients with an altered mental state (Buettner, Fitzsimmons, Dudley, 2010), but they typically lead to medication intolerance, increased fall risk, and daytime confusion (Wang et al., 2016). There are multiple structures therapeutic interventions that nurses can lead and implement to impact the geriatric populations quality of life (Adam, Shahar, Ramli, 2016; Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010; Sampoornam et al., 2016). Since every person is different though, it is important to remember to keep interventions individualized to the patient/resident. The purpose of this paper is to com pare how structured versus nonstructural interventions affect the quality of life in geriatric nursing home residents. Review of Literature Structured therapeutic interventions that nurses can apply Initiating a personalized exercise program for each resident based on needs and abilities. As time passes and a person ages, the perception of the quality of life tends to decrease (Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010) and the presence of insomnia increases (Sampoornam et al., 2016). Exercise has been shown to have positive effects on an older persons perception on the quality of life, while also decreasing fall incidents that can lead to morbidity and mortality (Babatsikou et al., 2017; Buettner, Fitzsimmons, Dudley, 2010; Sampoornam et al., 2016; Wang et al., 2016). Some studies done show a positive correlation between exercise and the perception of quality of life, sleeping patterns, and the meaning of life experiences (Adam, Shahar, Ramli, 2016; Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010; Sampoornam et al., 2016). Changes in the central nervous system from age can cause a person to lose balance, muscle strength, and mobility all together (Adam, Shahar, Ramli, 2016). There are many types of exercise training techniques that can be implemented to improve the overall quality of life and slow the physical limitations down. Some of these implementations include, but are not limited to, walking (Sampoornam et al., 2016), cardiorespiratory endurance, strength and balance training, flexibility (Justine Hamid, 2010), cross training (Buettner, Fitzsimmons, Dudley, 2010), resistance training, Tai Chi, and dancing (Adam, Shahar, Ramli, 2016). Dancing was implemented in a study done by Adam, Shahar, and Ramli (2016) that allowed the residents to be themselves, have fun, and enjoy the exercise while they were partaking in it. Providing animal interaction opportunities or ability for residents to have pets. Companion animals can help minimize the feeling of loneliness and assist with transition of the normal aging processes by providing a companion, being someone the older person can to talk to and have physical contact with, and being a topic that can be brought up with a stranger (Kawamura, Niiyama, Niiyama, 2009; Prosser, Townsend, Staiger, 2008). By animals increasing social interactions, a positive effect occurs and decreases agitated and depressive behaviors (Kawamura, Niiyama, Niiyama, 2009; Moretti et al., 2011; Prosser, Townsend, Staiger, 2008; Thodberg et al., 2016). Pets also allow the older patient with something to touch and since older patients have a more positive response to touch rather than communication, animals can be a perfect addition to those who have lost loved ones (Prosser, Townsend, Staiger, 2008). In a study done by Moretti et al. (2011), pet therapy was able to decrease symptoms associated with depression by 50% and increased the quality of life measured in long-term care facility residents. During the post-intervention interview in the study done by Prosser, Townsend, and Staiger (2008), many residents wanted the companion program to continue because they enjoyed contact with the animals, they had more social interactions, and it brought variety to their lives. Participants often found pleasure knowing the animals were coming and felt like it provided them with a positive experience at the nursing home (Kawamura, Niiyama, Niiyama, 2009; Moretti et al., 2011; Prosser, Townsend, Staiger, 2008). Using pets as therapy for elder nursing home residents is often implemented when the animals are brought in by a volunteer, but nurses can help encourage protocols to be developed that motivate animal therapy as a common occurrence (Kawamura, Niiyama, Niiyama, 2009; Prosser, Townsend , Staiger, 2008; Thodberg et al., 2016). Offering music and singing programs that residents can be involved in. Music and singing therapy can be used to manage the effects aging has on health maintenance, daily functioning, and the quality of life (Gopi Preetha, 2016; Wang et al., 2016). Through the use of music and singing, depressive symptoms can be decreased and the meaning of quality of life can be more significant to residents (Gopi Preetha, 2016; Wang et al., 2016). Since music interventions are safe, easy, and generally effective at decreasing depressive symptoms, along with increasing the quality of sleep, music could be a simple implementation to add to a nursing home residents daily activities (Gopi Preetha, 2016; Wang et al., 2016). Music that has tranquilizing effects have been thought to calm the body and suppress the sympathetic nervous system and turn on the parasympathetic nervous system (Wang et al., 2016). In addition, music also lets the mind focus on something other than thoughts, which allows the mind to relax (Gopi Preetha, 2016) and can even initiate sleep (Wang et al., 2016). When music is blended with different tones, restoration of emotions, physical relaxation, and spiritual wellbeing is met (Gopi Preetha, 2016). Implementing different massage and relaxation techniques that residents can partake in. There are many types of massage and relaxation techniques that can be used on nursing home residents daily (Adam, Shahar, Ramli, 2016; Keerthi, Malathi, and Nidagundi, 2018). In a study done by Keerthi, Malathi, and Nidagundi (2018), the use of footbath on joint pain was tested. A foot bath was given to the residents in the experiment twice a week and the effects were tested based on the amount of joint pain the residents felt afterward (Keerthi, Malathi, and Nidagundi, 2018). The footbath is able to cause blood vessels to dilate, which then increases the blood flow to other parts of the body (Keerthi, Malathi, and Nidagundi, 2018). When the dilation occurs, the blood movement causes the muscles to relax and release tension which leads to pain being relieved (Keerthi, Malathi, and Nidagundi, 2018). Relaxation therapy is another technique that has been used for a while to treat stress and anxiety (Adam, Shahar, Ramli, 2016). This type of therapy has been used to restore harmony in the body, reduce physical and mental tension, decreasing depressive symptoms, and creating an overall positive outlook (Adam, Shahar, Ramli, 2016). There are many different types of relaxation techniques that can be used, but some of the most common ones are breathing, meditation, and progressive muscular relaxation (Adam, Shahar, Ramli, 2016). Perception on the quality of life for nursing home residents The depression rates decreased in geriatric residents. In a study done by Buettner, Fitzsimmons, and Dudley (2010), agitation, passivity, and depression were all measured at the start and after two weeks of exercise treatments for each patient. This measurement showed that agitation in patients with depression was lowered after the individualized treatments were performed and went hand in hand with changes in passivity (Buettner, Fitzsimmons, Dudley, 2010). Contrary, Justine and Hamid (2010) found that participants had an improvement in their life satisfaction, but there was no change when it came to their levels of depression. Dancing however was shown to have a positive outlook for residents with depression and anxiety (Adam, Shahar, Ramli, 2016). This exercise not only implements movement, it also incorporated music, which allows muscles to be worked, stress to be released, and fun to be had (Adam, Shahar, Ramli, 2016). Since music is so easy to implement and use, it is a simple thing to add to an exercise routine (Adam, Shahar, Ramli, 2016; Gopi Preetha, 2016; Wang et al., 2016). Music therapy is able to allow relaxation of the mind and body to occur, which in turn has a positive effect on mood and feelings (Gopi Preetha, 2016). Ensure that residents obtain a more consistent sleeping pattern. When quality of sleep is measured after walking exercise is implemented, a decrease in chronic insomnia was seen and sleeping habits were improved (Sampoornam et al., 2016). Sleeping disorders are common as age increases as falling asleep becomes harder and waking up early happens more often (Sampoornam et al., 2016). Circadian rhythm problems have been thought to go hand in hand with cognitive issues (Sampoornam et al., 2016). If cognitive issues are able to be assessed and put in check, sleeping problems could be resolved also. Slow the onset of dementia for nursing home or long-term care facility residents. Since dementia is a progressive brain disease, reversal of this disease is not likely, but some interventions were able to slow the onset down or minimize symptoms (Thodberg et al., 2016). When residents affected with dementia are able to engage in animal interactions, improvement in cognitive functions, motivation, and emotions was seen (Moretti et al., 2011). Meaningful life experiences are important for residents with dementia and these events can change both passive and agitative behavior (Buettner, Fitzsimmons, Dudley, 2010). Conclusion Summary When a nurse is able to work with other healthcare professionals, the resident, and their families, stronger therapeutic communication skills are gained, interpersonal relationships are improved, knowledge about personal events are shared, and multiple assessment tools are looked at to create an improved and individualized treatment approach (Buettner, Fitzsimmons, Dudley, 2010; Mansah et al., 2014; Mellor et al., 2008). When nurses have the proper knowledge and education needed to help care for residents (Mansah et al., 2014; Mellor et al., 2008), implementations like exercise programs (Adam, Shahar, Ramli, 2016; Justine Hamid, 2010; Sampoornam et al., 2016), animal therapy (Kawamura, Niiyama, Niiyama, 2009; Moretti et al., 2011; Thodberg et al., 2016), music and singing (Gopi Preetha, 2016; Wang et al., 2016), and relaxation techniques (Adam, Shahar, Ramli, 2016; Keerthi, Malathi, and Nidagundi, 2018), can be implemented and individualized for each elder. All of the interven tions talked about previously can be applied into a residents activity schedule based on what their interests are and their physical ability. It would also be beneficial to educate nurses on how to properly implement structured therapeutic interventions and provide nursing homes with the ability to offer those interventions. Areas for Future Research Most study researchers felt like they needed a longer adaptation period during their study so they could have more observations (Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010; Mansah et al., 2014; Moretti et al., 2011; Sampoornam et al., 2016; Wang et al., 2016). This longer period might allow more time for the positive impact on the quality of life to occur and ensure that the participants are comfortable and familiar with their new interventions (Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010; Moretti et al., 2011; Sampoornam et al., 2016; Wang et al., 2016). It was also a common that authors thought there needed to be a larger test group with more diversity in a future study done (Buettner, Fitzsimmons, Dudley, 2010; Justine Hamid, 2010; Kawamura, Niiyama, Niiyama, 2009; Keerthi, Malathi, and Nidagundi, 2018; Moretti et al., 2011; Sampoornam et al., 2016). Research can also be done to test the effects on younger children visiting and interacting with nursing home residents. This would provide the resident with someone to talk to that they can teach and do activities with. Gardening and cooking might be other areas that can be looked at. It might be hard for aging residents to partake in activities like this that they once enjoyed, but if modifications could be made to help them adapt to physical changes, these activities might be achievable.

Describing Sizes and Dimensions in Spanish

Here are three common ways to express measurements in Spanish. Deciding which ones to use is largely a matter of personal preference since they are interchangeable in most cases.   1. Medir   This verb, which is conjugated irregularly, generally means to measure. Examples: Mido cinco pies y cinco pulgadas de alto. (I measure 5 feet, 5 inches tall.) Los cientà ­ficos hallaron un fà ³sil que mide dos metros de largo. (The scientists found a fossil that measures two meters long.) 2. Tiene This verb literally means to have. It can be used to directly indicate dimensions. It also is conjugated irregularly. Examples: El centro comercial tiene tres kilà ³metros de largo. (The commercial center is three kilometers long.) Si antes tenà ­a cinco metros de profundidad, ahora tiene dos. (If it was five meters deep before, its now two meters.) 3. Ser de This is the rough equivalent of saying in English that something is a certain size. Note the use of the preposition de, which is not translated to English. This method of describing dimensions is less common than the other two. Examples: El à ¡rea es de 160 metros cuadrados. (The area is 160 square meters.) Las dimensiones del nuevo almacà ©n son de 25 por 70 metros, y la altura es de ocho metros. (The horizontal dimensions of the new warehouse are 25 by 70 meters, and its height is 8 meters.)

The Wild City Of Bangkok - 1778 Words

When my family first arrived in the dirty city of Bangkok, one of the first things my little sister asked me was â€Å"Why are there so many dogs everywhere?† Being the dog lover that she is, she was extremely disappointed to learn that these dogs were not only nobody’s pets, but that she also couldn’t pet them unless she wanted to get some weird fungus or sickness on the first couple days of her vacation. As I explained to them that the reason for all the dogs was because Thailand is mainly Buddhist and it is not in their fashion to kill these dogs, they still had a hard time accepting this fact seeing how miserable many of them look. I didn’t really feel like getting into the deeper reasons at the time mainly because they knew nothing about Buddhism and they had so many other questions about the wild city of Bangkok, so I just left the explanation at a â€Å"I know, it’s really sad.† What I didn’t further explain to them was that the main reasons for the allowance of these dogs was that it is against the first precept to harm them, as well as the basic idea of karma. Although Buddhism saves and protects many animals, it is also the reason millions of animals are suffering in Thailand as well as causing many ecological problems. As one first starts learning about Buddhism, they will learn that the most fundamental guideline of living a meaningful life is to follow the 5 precepts. Fortunately you don’t have to go too deep into these precepts before you come across the first preceptShow MoreRelatedEssay Why Fly to Bangkok?: Top 10 Attractions to See in Bangkok813 Words   |  4 PagesWhy fly to Bangkok? Bangkok, the capital of Thailand as well as it is the most crowded city. It name of this city in Thai as Krung Thep Maha Nakhon. Over 14 million people live within the nearby Bangkok urban Region, making Bangkok a great primate metropolis, dwarfing Thailands other town centres in terms of significance. The city is now a chief regional strength in business and finance. It is a global hub for transport and health care, and is appearing as a local centre for the fashion, artsRead MoreThailand Vacation Essay883 Words   |  4 Pagesif it is in a 5 star resort or a beach side hut. Package Thailand holidays provides you best sightseeing, variegated shopping, colorful history, gourmet. Thailand has an outstanding beauty and has occupied an esteemed place on the map of world. Wild life lovers as well as vacationers should plan their vacation to Thailand. Thailand holiday packages are like blessings for those, who wish to travel across the rich flora and fauna of the region. The splendid Buddhist temples, vibrant culture andRead MoreMoney And People Who Are Rich989 Words   |  4 Pagesregions. Thus, the top ten most visited cities across the world is Paris, France. Paris is a very romantic and beautiful place to visit. There are many things one can do if money were no object. They can visit they beautiful, iconic, historic Eiffel Tower. Paris, France, is one of the most romantic places on earth one could visit if no were no object. Another top ten cities that is most visited is Bangkok, Thailand. There are many possibilities one can do in Bangkok. There is something for every personRead MoreWater Dams Essay examples750 Words   |  3 Pagesthe river refer to the d ams constructions as evil and they say that they have destroyed the happiness of their family. Like in many other places in the world the constructions of dams in the Mekong has caused deforastation, it has destroyed the wild life and has caused the displacement of thousands of poor people who live along the river. These types of damages are being revaluated to see if the benefits of these dams are superior to the environmental and social costs. The Comision of The MekonRead MoreGlobal Warming Is A Threat Essay1533 Words   |  7 Pagesproven that the coasts of Antarctica are receding at a much faster pace than in recent history (Conway). This retreat can cause many dire situations for our future generations to come, including sea level to rise, and ultimately flooding our low-lying cities. The third confirmation of global warming are the introductions of unnaturally greenhouse gases. Examples are CFC’s (chlorofluorocarbon’s,) HFC’s (hydrofluorocarbons,) and PFC’s (perfluorocarbons).These gases act as a blanket in the atmosphere, thickeningRead Mor eTourism in Bangladesh1493 Words   |  6 Pagesa land of enormous beauty, hundreds of serpentine rivers, crystal clear water lakes surrounded by ever green hills, luxuriant tropical rain forests, worlds largest mangrove forest preserved as World Heritage, home of the Royal Bengal Tiger and the wild lives, wind in the paddy fields, abundance of sunshine, worlds longest natural sea beach, rich cultural heritage, relics of ancient Buddhist civilizations and colorful tribal lives, -Bangladesh creates an unforgettable impression of a land of peaceRead MoreThe Heroes Of Elephants From The Early Movies Of The Disney1824 Words   |  8 Pageselephants are due to factors such as habitat loss, conflicts with human, ivory poaching, and illegal hunting and trade. In order to preserve and increase the number of the elephants in Asia, these animals should be protected and reintroduced to the wild and their habitats must be restored and expanded. One of the greatest threats to Asian elephants in Asia is the loss of habitat. Throughout the tropical regions of Asia, humans have cleared large areas of forest and river valleys for settlement (AMNHRead MoreEnvironmental Text: Paolo Bacigalupis The Windup Girl1820 Words   |  8 Pagesthe world will be lost and maybe even forgotten. Buell’s third criteria is the idea that the natural environment is evident as it shapes the destiny and fortune of those who live within that nature. Paulo Bacigalupi’s novel depicts a world that is wild, full of conflict, and highly unpredictable. It makes us question the fate of both nature and people within the same constraints. Many questions come to mind as you are reading that remind us of the relevance of the nonhuman environment beyond theRead MoreThai Elephants and Its Significant to Thai Culture and History2061 Words   |  9 Pagesplace in high esteem and reverence to Thai people, and white elephants are representing as high dignity and majesty. Therefore, the white elephant was a national emblem on Siam’s national flag. Moreover, the elephants are on Thai’s stamps, Navy flag, Bangkok Metropolitan Administration, coins, architectures, Buddhist art, temples and many more. The country annually celebrates the 13th of March as Elephant Day. In general, elephants are the largest land animal that exists now. They are great in sizeRead MoreEssay on Elevating the Power of a Novel through Symbolic Objects1635 Words   |  7 Pagesis believed to have made Holly live a tightly confined life in Texas. Her time of confinement in Texas is the reason Holly choose to leave and live a free-spirited life in New York City. Capote has used the bird cage to elevate the power of the novel, by developing the concept that Holly views herself as a type of wild animal that has a fear of commitment and confinement. In comparison to Capote’s idea of a bird cage symbolizing a fear of being held captive, Plath uses a fairly different object to

The Empires of Persia free essay sample

1. Why does the book say that Darius was more important as an administrator than as a conqueror? Darius built a new capital at Persepolis Center of a sophisticated bureaucratic state Created the Twenty-three satrapies(governors) Created weights and Measurements One central Coinage (Currency) and standardized taxation He had tolerance: Spies to check every level of govt 2. How did Darius organize his empire politically – how did he govern, what were the levels of government in the empire? Set up an efficient administration of twenty-three satrapies (provinces) Created a fine balance between central and local control( Satraps, Spies Provincial rulers, satraps Constrained by the presence of imperial troops and tax collectors While traveling bureaucrats also monitored their actions 3. What systems did Darius establish to rule such a large empire? 23 Satrapies (provinces) that created a fine balance between central local control Taxes and soldiers Traveling Bureaucrats Centralized Coinage, Unified taxes, (Common weights and measurements) -Postal Systems 4. In what ways did Darius, and his successors, promote communication and commerce throughout the empire? They created the Persian Royal Road stretched for 1600 miles from the Aegean Sea to Iran. -It provided communication w/ large parts of the empire. Used uniform taxes which allowed every Satrap to collect Darius had bureaucrats who monitored their actions Coinage- This was to unify the entire empire Bureaucrats- They monitored the tax collectors Postal Stations 6. How did the Parthians come to control the Persian Empire? Power of Parthian was heavy cavalry Mithradates I established a empire through conquests from 171-155 B.C.E. Parthian government followed the example of Achaemenid administration Conquered Seleuds 7. What was the role of the imperial bureaucrats in Persian society? How did they fit in with the other social classes? Imperial administration called for educated bureaucrats Shared power and influence with warriors and clan leaders(fell under the warrior class) Administrators, tax collectors, record keepers, and translators 8. What agricultural technologies and techniques did the Persians use to produce the large surpluses they needed to feed their huge population of nonfood producers? The Persians came up w/ underground irrig. Canals (Qanats) does not evaporate It makes its way to the crops. Extensive road building -Persian Royal Road -Courier Service 9. The Persian Empires were noted for being part of a trade route critical to the economy of the classical world. What did the rulers do to facilitate trade? They: Used long-distance trade Imported products from India Their lands were fertile Persian elites considered trade to be a profession of lies and deceit Most Persian communities and estates were self-sufficient Local merchants and traders continued to deal with trade along key routes: -Silk Road (East) -Trans-Arabian (West) -Red Sea Maritime Trade (West) -Mediterranean Coastal Trade (Northwest) 10. What were the basic teachings of Zoroastrianism? Why is it considered a highly moralistic religion? How did Zoroastrianism influence other religions? Ahura Mazda super deity with 6 lesser deities There was a cosmic conflict between Ahura Mazda and ANgra Mainyu Heavenly paradise and hellish realm as reward and punishment Saw the material world as a blessing. The moral formula was good words, good thoughts, and good deeds. Influenced the Jewish religion (belief in future reward and punishment); Christianity (concepts of heaven and hell Moral formula Good deeds, Good Words, and Good thoughts Islamic conquerors toppled the Sasanid empire, seventh century C.E. Some Zoroastrians fled to India (Parsis) Most Zoroastrians in Persia converted to Islam Some Zoroastrians still exist in modern-day Iran 11. The authors refer to the Persian Empires as cosmopolitan. What does this mean? In what ways did the rulers promote this cosmopolitanism? Fashion and Art—ethnically diverse  Broad culture  Persian arts, or Iranian arts is one of the richest art heritages in world history and encompasses many disciplines including architecture, painting, weaving, pottery, calligraphy, metalworking and stonemasonry. There is also a very vibrant Iranian modern and contemporary art scene. 12. The authors suggest that classical societies were more complex and more sophisticated than the early societies discussed in part. What evidence do you see of this in the development of the Persian Empires? Classical Civilizations: (1000 BCE 600 CE) Change political centers Improve technology Establish more elaborate philosophical and religious traditions Expand science and math  Methods for territorial expansion; Embraced diverse group of people Integrated aspects of their institutions and traditions  Each civilization operated separately despite contacts with each other Sophisticated internal organization  Roads for better internal trade and travel

Liquids and Solids free essay sample

It is useful for you to know the boiling and melting point of a substance so that you can know if the substance is a pure form or if it has any additional chemicals added to it. B. How would you determine the melting of a substance whose melting point is higher than 100Â °C? Another substance other than water in the beaker would have to be used to see melting point that would be higher than 100 ? C such as glycerol or silicon oil. C. What would be the effect of increasing the amount of crystals in the capillary tube? *There would be no difference if the amount of crystals were in the capillary tube because the melting point is still at the same temperature. D. List sources of error and explain how they would affect your end results. My sources of error were not logging the temperature at the exact time that the last bubble came out and the exact time the chemical melted. We will write a custom essay sample on Liquids and Solids or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page That affected my ended results by being slightly off then what the actual melting point of boiling point actually were. Conclusion: In conclusion today I learned how to determine the melting point of a substance and how to determine the boiling point of a liquid using the capillary tube which I found very fascinating. I also learned the importance of know the melting point and boiling point of a substance.

Movie research paper The Truman Show Essays

Movie research paper The Truman Show Essays Movie research paper The Truman Show Essay Movie research paper The Truman Show Essay The truman show is founded on an enormous secret that all of the studios advertising has been determined to reveal. I didnt know the secret when I saw the film, and was able to enjoy the little doubts and wonderings that the filmmakers so carefully planted. () Those fortunate audience members () will be able to appreciate the meticulous way director Peter Weir and writer Andrew Niccol have constructed a jigsaw plot around their central character, who doesnt suspect that hes living his entire life on live television. (Ebert 1) This film by director Peter Weir and writer Andrew Niccol tells about a man (Truman Burbank) who who finds out that his whole life is actually TV show. The movie has an incredible influence on America and the international community. What maybe no one would expect, this movie inspired some producers especially a famous European producer, John De Mol, to produce a reality TV show called Big Brother. He is also very famous for his produced TV shows Fear Factor and Who wants to be a Millionaire? (DooYoo 1). The Truman Show is not only famous because it is a typical 20th century movie, it also includes one of the todays best actors. Jim Carrey , Ed Harris , and Laura Linney are only three of many actors of this movie who performance their role in a perfect way. Also the strange storyline makes the movie to special in its genre. The storyline is deceptive, almost maliciously so (Myers 1), and is based on several movies like Edtv (1999), which is also about a man whose life is broadcast li ve 24 hours a day on television, he plays a similar character (IMDB 2). It is also very famous because it contains never before seen technical aspects like the directors office of the TV show. The many camera shots from every position, like garbage cans, behind car radios, and billboards, make it very individual. Truman Burbank, played by Jim Carrey, is living in a suburban setting and works as a salesman. He doesnt realize that he is living in a fake world with actors all around him. His lifestyle is like an ordinary Joe whose life seems to be pretty idyllic. He has a good job, a nice house, and a beautiful wife (Jardine 1); he goes to work everyday and is totally satisfied with his life. Only one day, when he his on his way to work, a camera light, from the film producers falls down from the sky and lands close to him. He picks it up, but doesnt really think about it. In the car, after hitting the radio because it is not working properly, he can hear directions about where he is going coming out of his speakers. The last strange and most important scene is when he recognizes his father, who was purposely drowned while sailing with Truman, on the street. When Truman recognizes him, his father is taken away by some mysterious, casually dressed men. He begins wondering what is wrong with him or his world. After watching his environment with more attention, he realizes that everything is repeated over and over. For example he sees a yellow bug, a man with flowers, and a woman on a bicycle is passing his house every ten minutes. Something is missing [in his life], and he thinks perhaps he might find it in Fiji, where Lauren (Natascha McElhone), the only woman he really lo ved, allegedly has moved with her family (Ebert 1). However he cant take a boat because he always remembers the day when he lost his father. The TV show director also indirectly doesnt allow him to escape, because it would ruin the TV show. When Truman is sleeping and the producers of the TV show dont pay attention, Truman is finally able to escape with a boat by himself. Christof, the director, tries everything to stop him, before can escape from the set. After Truman almost drowned in a manufactures heavy thunderstorm, Truman reaches the edge of the set and tries to walk out. That is the first scene in which Christof and Truman have their first conversation. Christof tries to keep Truman from leaving the film set arguing argues, that he has created him and the world he has created for [Truman] is the good world, not the sick world [outside of the set] (The Truman Show). However, Truman decides to step out of the set and says the sentence he always said to his neighbors every morning; Good morning! And in case I dont see you: good af ternoon, good evening and good night! (The Truman Show). After that you can only see Trumans back as he steps into a black background and Christof shutting down his little desktop, through which he watched Truman talking to him. The directing by Peter Weir plays a big role in making The Truman Show a terrific movie. He selected several actors who were not very typical for their role. Truman, played by Jim Carey, who might simultaneously break your heart as easily as he makes you laugh (Turan 1) was not expected to present this role that perfect. Also Cristof (Ed Harris), who won the Golden Globe as Best Performance by an Actor in a Supporting Role in a Motion Picture (HFPA 1), and Hanna Gill (Laura Linney), who was nominated for Favorite Supporting Actress Drama by the Blockbuster Entertainment Awards (Blockbuster 1), make this movie to a highlight in his genre. It seems that Weir wanted to make up a total different kind of movies. He says about the movie: The Truman Show was based on Michael Jackson. You watch The Truman Show and, I mean, Jim Carrey did a fantastic job, but Michael Jackson is Truman. Hes who I based him on and he is the nearest thing to Truman. The director continues to say, The connection between Michael and Truman is simple they both have a heart, and people treat them like objects for entertainment value. (Justice Prevailed 1)

Introduction to management accounting Essay Example | Topics and Well Written Essays - 1500 words

Introduction to management accounting - Essay Example The company is also intending to manufacture natural toothpaste, which is expected to attract a large number of consumers considering that there is an increasing attention in regards to health issue. In this respect, the company expects its sales to grow consistently. 2.0 Target selling price and cost card The selling price of the company’s products is targeted to be low-priced relative to other similar products on the market. However, the company would take into consideration the costs associated with labor, raw materials, direct expenses and other variable costs, as well as fixed costs in calculating reasonable prices for both toothbrush and toothpaste. The use would use the marginal costing with an intention of calculating easily the break-even point (Siegel, & Shim, 2010). The company’s direct material cost for every product is expected to be ?0.15 and ?0.1 for toothbrush and toothpaste respectively. The direct labor cost is anticipated to be ?0.05 and ?0.1 for toot hbrush and toothpaste respectively. Direct expenses are expected to stand at ?0.05 for every product. Other variable costs would also stand at ?0.05 for toothbrush and toothpaste. ... This would ensure that toothbrush and toothpaste are priced at ?0.5 and ?0.6 correspondingly. In relation to the market prices, the company’s prices would be slightly higher relative to Fluoridine Active Fresh of ?0.45 and Tubes High Quality of ?0.3. Conversely, it would be relatively lower with respect to Aquafresh of ?6 and Natural Paste of ?7. Additionally, the company’s toothbrush prices would comparatively lower to that of other firms on the market. 3.0 Breakeven point In order to calculate the breakeven point, there was a need to calculate the contribution margin per product using the marginal costing principle. In this regard, the company calculated the total variable costs, which was estimated at ?0.3 for each of the product (toothbrush and toothpaste). Moreover, the company subtracted the total variable costs for every product from the selling price to arrive at the marginal contribution for both toothbrush and toothpaste. Given that the selling price of toothp aste is ?0.5; its contribution margin per product is bound to be ?0.2. Similarly, considering that the selling price of toothpaste is ?0.6, then, the contribution margin per product would be ?0.3. For an individual to arrive at the breakeven point, one should calculate the number of products that may result in the profits of a firm being zero (Kieso, Weygandt, & Warfield, 2012). In this regard, it is estimated that 2,000 pieces of toothbrushes should be sold to meet the total fixed costs of ?400. On the other hand, it is expected that 1,500units of toothpastes should be sold to pay the total fixed costs of ?450. The company’s average contribution margin is estimated at ?0.25, while the total fixed costs are ?850. As a result, the company would breakeven by selling a total

Intermodal Transportation Research Paper Example | Topics and Well Written Essays - 1500 words

Intermodal Transportation - Research Paper Example However, recent findings and literature regarding intermodal transportation ports review a contradictory outcome of these measures. The following paper investigates and discusses the effects of actions taken to up security at ports. Actions taken to improve the security at ports has negatively affected throughput, increasing costs and reducing the quality of operations. In 2005, a research by Ronald W. Tarr, Vicki McGurk, and Carol Jones made the realization that there are dangers facing intermodal transport ports after 9/11 are volatile (Tarr, et al., 2005). This unpredictability arises from the likelihood that terrorists may use intermodal transport to deliver weapons and explosive material. Oversized significance of stepping up security measures in these ports. The article explores the effects of training through collaboration and decision-making and its support of the response of transit organizations in the course of the 9/11 attacks (Tarr, et al., 2005). These effects revealed the substandard quality of intermodal transportation during the attacks and the ways the harmed output during the implementation of the already established security measures. A recent research by Nil Kula Degirmenci and Gul Denktas Sakar recognized number of security-linked challenges the intermodal transportation sector has been dealing with for the past several years (Degirmenci and Sakar, 2012). Among these challenges are piracy and terrorism. The researchers noted that security measures alone could not address the many low-quality operations, equipment, and industry players. Degirmenci and Sakar proceed to propose a system for gaining a general insight of the current security concept in intermodal transportation ports. This system takes into account the legal, innovative, and economic aspects. Consequently, system identifies key elements of security in intermodal transport by concentrating on requirement

The Affordable Care Act and Primary Care Essay Example for Free

The Affordable Care Act and Primary Care Essay The purpose of this paper is to discuss the importance of providing increased access to primary care and the expected impact of the 2010 Affordable Care Act on the delivery of primary care in the United States, extending current trends through the year 2023. Addressed topics will include a brief overview of the Affordable Care Act, current state of primary care and the impact of the Affordable Care Act upon primary care patients, providers and payers. The Affordable Care Act In March 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA) into law. This law makes preventive care, including primary care, family planning and other services more accessible and affordable for many Americans. According to the Center on Budget an Policy Priorities , the ACA would expand health care coverage to 32 million citizens who are currently uninsured. Expanded coverage of Medicaid and Medicare allows for increased inclusion of individuals who previously were not eligible for state and federal health insurance programs. The Medicaid expansion is 100% federally funded for the first three years (2014-2016) and at least 90% federally funded through 2022 and beyond (CBO, 2013). Included in the law is health insurance reform that makes illegal preexisting condition clauses in health insurance coverage and provides coverage for young adults under a family health insurance plan. Affordable Care Act and Primary Care 3 The uninsured and self employed would be able to purchase health insurance through state-based â€Å"exchanges†. Subsidies would be available to those who cannot afford to purchase insurance if they meet income requirements. Primary Care in the United States In the United States medical practice was not regulated until the 20th Century. Medical care was provided by a â€Å"doctor† who may or may not have been trained at a medical school. Many doctors received no formal training, learning as apprentices. These early practitioners provided a multitude of medical services to an entire family including delivering babies, setting fractures, surgeries, diagnosing and dispensing medications. Through organizations such as the American Medical Association the practice of medicine became regulated. These early pioneers were the early practitioners of primary care. Influenced by American ideals and desire for technology and wealth, the number of medical students choosing a path in primary care diminished in favor of specialty practice such as surgery, cardiology, radiology, etc. For several years there has been a decline in the United States primary care workforce. Primary care providers include general practitioners, general internal medicine practitioners, family physicians, physician assistants and nurse practitioners. The United States healthcare system has been facing a decline in its primary care Affordable Care Act and Primary Care 4 workforce, infrastructure and access to primary care services for several years. According to research (Petterson,2013) a number of factors, including poor reimbursements to primary care providers, low comparative income, and poor quality of work life due to high patient loads, have contributed to more providers choosing to train and practice in specialty medicine. This trend has led to a shortage of primary care providers across the country, likely contributing to fragmented care, inappropriate use of specialists, and less emphasis on prevention. Patients People who have access to a regular primary care physician are more likely  than those who do not, to receive recommended preventive services and timely care for medical condi ­tions before they become more serious and more costly to treat by visiting the emergency room instead of a primary care provider (Abrams, 2011). Patients are more likely to adhere to physician recommendations when seen by a primary care provider. Among low-income patients, access to primary care is associated with better preventive care, better management of chronic conditions, and reduced mortality. Preventing illness is as much a part of primary care as is the diagnosis and treatment of health conditions. The Affordable Care Act provides positive incentives to encourage people to obtain preventive primary care services. Through provisions in the act, applying to Medicare and Medicaid beneficiaries, as well as the privately insured, the law eliminates coinsurance, deductibles, and co payments for approved preventive services Affordable Care Act and Primary Care 5 and tests, such as blood-pressure and cancer screenings, mammograms and Pap tests, and immunizations. Studies have shown full coverage of preventive services with no patient cost, increases use of preventive screening services over time (Abrams, 2011). In a study of low-income patients, researchers found that even small incremental changes in co-payments had a substantial impact on the afford ­ability and utilization of care. Included in the ACA is the concept of a patient â€Å"medical home.† This is a pri ­mary care site that provides patients with timely access to care, including availability of appointments after regular office hours with patients to manage health conditions and prevent complications, coordinates all care, and engages in continuous quality improvement (Abrams, 2011). Primary care providers will be the coordinators of the medical home. These medical homes will also ensure greater coordina ­tion between the primary care site and local emergency departments. Primary Care Providers With the ACA the total number of primary care office visits is expected to increase from the 462 million visits in 2008, to 565 million in 2015. Also  expected is the need for an additional 52,000 primary care providers by 2025 due to insurance coverage expansion (Hofer, 2011). The ACA will entice primary care providers to accept more of the newly covered by increasing Medicare and Medicaid payments for primary care services. There are two Affordable Care Act and Primary Care 6 provisions in the ACA that augment payments to primary care providers, one provides a bonus to providers whom participate in Medicare, the second increases reimbursements for Medicaid participation. The goal of these financial incentives is to stabilize and expand the existing primary care workforce. The Affordable Care Act invests an estimated $3.5 billion in the primary care provider bonus program from 2011 to 2016. As a result, Medicaid primary care phy ­sicians are estimated to gain an additional $8.3 billion in reimbursement between 2013 and 2019 (Abrams, 2011). To address this growing shortage of primary care providers, the Affordable Care Act provides support of education and training for primary care providers and community health centers. The Affordable Care Act includes $1.5 billion authorized over 2011 to 2015 for the National Health Service Corps to provide scholarships and loan forgiveness for primary care physicians, nurse practitioners, and physician assistants practicing in health professional shortage areas (Abrams, 2011). Other provisions that offer financial support for training new primary care physicians include more favorable loan repayment require ­ments for the federally supported Primary Care Loan Program and a loan repayment pro ­gram for pediatric sub specialists and child or adoles ­cent mental or behavioral health providers working in underserved areas. The necessary midlevel primary care practi ­tioner is recognized through scholarships, loans, and loan repayment programs, as well as through the creation and expansion of training opportunities. Affordable Care Act and Primary Care 7 Payer The Affordable Care Act brings an unprecedented level of scrutiny and transparency to health insurance companies. The concept of an insurance exchange is a major component of the federal Affordable Care Act. An important component of the federal law is that individuals must have health insurance with federal subsidies to help them pay for it. To improve access and protect patient rights, ACA introduces new commercial insurance standards, such as the removal of medical underwriting, elimination of lifetime limits, prohibition of pre-existing condition exclusions, and removal of cost-sharing for preventive services. Insurance plans will be required to cover essential health benefits which are defined under the ACA (Rosenbaum, 2011). Insurance companies expect significant changes in enrollment, demographics, and plan types. Economic, behavioral, political, and strategic influences are expected to shape the changing insurance coverage landscape, according to a Department of Health and Human Services Report. Implications for insurance industry stakeholders are considerable, due to being regulated by state and federal government. Insurance companies and insurance trade publications are stating they will be forced to raise premiums due to ACA requirements, fess and taxes forced upon them ( DHHS,2013). The ACA imposes an annual fee or excise tax on most businesses that provide health insurance, starting in 2014. The fee will be raised proportionately each year among Affordable Care Act and Primary Care 8 insurance providers based on their share of the health insurance market (DHHS, 2013). Certain insurers are exempt from federal excise tax, including public charities and social welfare organizations. In addition, nonprofit insurers that receive more than 80 percent of their gross revenue from government programs that target low-income individuals, seniors, and people with disabilities (including Medicare, Medicaid, and the Children’s Health Insurance Program) are not subject to the tax. Supply and demand will determine how the excise tax is ultimately split between insurance companies and purchasers. Insurers have recently turned in strong financial results and thus are well positioned to bear some of the tax (DHHS, 2013). It is speculated they will pass a portion on to consumers. The Joint Committee on Taxation estimates that premiums subject to the fee will be 2 to 2 ½ percent higher than they would otherwise be. The Congressional Budget Office estimates that ACA will slightly reduce premiums for employer-sponsored health insurance in the near future. For employers with more than 50 workers, CBO estimates that the law will reduce average premiums by up to 3 percent in 2016. For small employers, the estimated change in premiums ranges from an increase of 1 percent to a reduction of 2 percent . It is important to note that the health insurance industry will gain millions of new enrollees in the next few years as a result of ACA. Insurance plans providing preventative health coverage will benefit financially by providing less expensive care for treatable Affordable Care Act and Primary Care 9 chronic conditions and early diagnosis on other medical conditions. Summary  With the oncoming implementation of the Affordable Care Act the benefits of the plan encourage the active role of the primary care provider. The uninsured patient now has access to health care that will afford him a better quality of life and address the financial implications of a poorly managed health care system in the United States. The ACA provides a means to entice more into the field of primary care. While it is in the early stages of scrutiny, the health insurance industry is a growing industry and is positioned to be profitable as a result of ACA, even with increased regulation. Conclusion With the implementation of the Affordable Care Act, the United States is positioned to provide a more sustainable and stronger health care system, due in part to the primary care provisions provided with the ACA. The health care system outlined would provide expanded service for patients, improve outcomes and quality and reduce future health care spending for the nation. References Abrams, M., Nuzum, R., Mika, S. and Lawlor, G. (2011, January). Realizing Health Reform’s Potential. The Commonwealth Fund. 1, 1-8. http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Jan/Strengthen-Primary-Care.aspx Center on Budget and Policy Priorities. (2013, July). Status of the ACA Medicaid Expansion After Supreme Court Ruling. Retrieved from http://www.cbpp.org Congressional Budget Office. (2013). CBO’s Estimate of the Net Budgetary Impact of the Affordable care Act’s Health Insurance Coverage Provisions Has Not Changed Much Over Time. (CBO Publication No. 144176). Washington, D.C. U.S. Government Printing Office. http://www.cbo.gov/publication/44176. Department of Health and Human Services. (2013, February). Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act. (DHHS. Research Brief). Washington, D.C. http://aspe.hhs.gov/health/reports/2013/RateIncreaseIndvMkt/rb.cfm Hofer, A., Abraham, J., Moscovice, I. (2011, March). Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization. Milbank Quarterly. 89(1): 69-89. http://www.milbank.org/publications/the-milbank-quarterly Patient Protection and Affordable Care Act, 42 U.S.C.  § 18001 (2010). Petterson, S., Liaw, W., Phillips, R., Rabin, D., Meyers, D. and Bazemore, A. (2013). Projecting US Primary Care Physician Workforce Needs: 2010-2025. Annuals of Medicine. 6, 503-509. http://annfammed.org/content/10/6/503.full Rosenbaum, Sara. (2013, February). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports. 126, 130-135. http://www.publichealthreports.org/

Of Mice And Men :: essays research papers

The same gun is used in the same manner to kill two beings, a smelly, old dog and a man named Lennie, in the novel "Of Mice And Men." This story deals with love and death while displaying an everyday scenario about friends and isolation. The symbols in this book represent the basic elements of human love. Some of the characters in this novel, such as Lennie, Crooks, and Curley’s wife, epitomize loneliness. Lennie, bearing his retardation, has trouble fitting in with the current workers at the ranch. Even though all the ranch hands praise Lennie for his hard work, they leave him out of nightly activities such as horseshoes. George, Lennie’s traveling buddy, is smart and fits right in with all of the employees of the ranch, adding to Lennie’s isolation. The black stable hand, Crooks, sleeps alone in a tiny room in the stable and is disliked by everyone except for Lennie. Since he is black, segregation is the ultimate reason why no one tries to like or befriend Crooks. Lennie, who, as an innocent person, has no bigotry in him, visits Crooks one night when everyone else is in town. Even thought Crooks does not show it, he enjoys Lennie’s company, and it seems that he and Lennie form a small friendship that would had developed more has the book been longer. Anot her soul not included with the ranch clique, Curley’s wife, whose name is not mentioned in the book, is new to the ranch as well. She married Curley just weeks before Lennie and George arrived. The ranch hands do not accept this lonely soul into their social group because she is new. However, the ranch hands also do not accept Curley’s wife because she obviously is so lonely that the only way she can get attention is by flirting. The only one who does not dismiss her when she flirts is Lennie who is obviously trying to make a friend with another lonely person. These lonely individuals make this novel into a very sad story of real life situations of when people really do not "fit in." The idea of obtaining a little farm with animals and crops raised by George and Lennie, and later joined by Candy, an old man, shows how dreams may cause a man to do anything to fulfill that dream. Lennie is the most enthusiastic and determined to gain the small farm and the all-important things -- the rabbits.

Research Ethics

A research study is defined as an activity involving collection of data with an aim of solving a specific selected problem. The above is followed by recording of the data then subsequently its analysis so as to arrive at meanings. Finally the results are generalized so as to make the findings applicable to whole populations and therefore deductions as well as suggestions also known as recommendations. Finally the researcher makes conclusions which are an opinion which expresses the researchers stand concerning the research problem. A researcher should ensure that the suitable data collection instruments and methods are used. The suitable data analysis techniques should be employed so as to enable the researcher draw the relevant conclusions of a study. A research study involves costs, which are incurred in various ways including data collection, carrying out interviews as well as costs associated with data analysis. In any given research study there is usually an involvement of usually three or more groups of participants. The participants include the researcher, the respondent and the sponsor. For a marketing research, the sponsor is usually the supplier. Research studies require that some ethical norms be considered to ensure that the research being carried out is meets ethical standards as well as regulations guiding various professions. These ethical norms are usually observed with reference to the rights and obligations of each participant in a research. In any given study, the researcher is supposed to adhere to ethical norms something aimed at ensuring that, the research does not interfe with peoples fundamentals rights no harm the research subjects in any way. All particiapants in a research are required to adhere to the given regulations in their interactions amongst themselves as well as in their interactions to the public in whose midst the research is conducted. When handling the respondent a researcher should apply certain ethical norms in order to observe and guarantee the respect of respondent’s rights. Such respondent’s rights in an interview can include amongst others: (i) Informed consent – it’s the right of the respondent to be informed about a certain research to be carried out and that the respondent is supposed to be a participant. The researcher is obliged to respect the respondent and give details of the research study. With an informed consent, the relationship between the researcher and that of the respondent is enhanced something which results into a good working rapport hence contributing to the success of the research study. Incases of lack of consent before a research begins co-operation lacks in the data collection process and therefore chances that the data gathered may be unreliable become high. (ii) Confidentiality – Ethical norms dictate that the respondent should be treated with a sense of confidentiality in handling the respondents’ information. The respondents’ information should not be exposed to third parties or used for purposes other than those for which consent was sought for. The information obtained from the respondent should be given to the right person. Incase of a marketing research the supplier should get the information. The researcher should make sure that he/she remains truthful and ensure that he /she does not expose the respondents’ information (Dooley, 2002, P160-170). (iii) Anonymity – It is the right of the respondent to maintain his or her anonymity. Anonymity refers to the concealing of the respondent’s identity. It is the right of the respondent to decide about his identity hence the researcher should respect that decision. The researcher should not disclose the identity of the respondent when the instructions demand so. The researcher should posses the value of promise keeping so as to succeed (Emerson 1990, P89-103) The researcher should be able to be responsible when handling the respondents’ identity. He/she should not be able to misplace any documents containing the respondents details this would contravene the respondents right to immunity. The researcher should be honest to the extent of involvement of respondent in the research study. The researcher should inform the respondent whether there is any risk of harm involved. This will help the respondent in preparing himself or herself. This honesty should not be compromised. This point to the obligation of the researcher in taking into consideration the respondent’s safety. The researcher has the obligation towards the research staff. Ethical issues will enable him or her handle the research team as per the ethical norms (Gray 2003 p 67-83) The researcher should be honest towards the research staff in terms of their remuneration. The researcher should also consider the safety of the research team. He or she should ensure that no acts of negligence or carelessness should occur which might cause safety risk of the research team. The researcher should also ensure that he or she practices patience while handling the respondent, the research team and also the sponsor (incase of a market research study; the supplier) Patience will be required in negotiations and discussions since a research study mostly involves teamwork. Each participant in a research study usually has a set of obligations to be taken care of. The researcher usually has an obligation towards the supplier who is the sponsor of a research study. The researcher is supposed to achieve these obligations through the guidance of ethical norms. The obligations of the researcher to the sponsor executable through application of ethical norms include: (i) Obligation to submit a conclusive research study worthy of the cost paid. The sponsor usually takes more of the research cost; therefore the researcher has to submit research work, which is worthy the amount paid for. To succeed in these obligations the researcher should remain honest. The researcher should be ready to account for the research project to the satisfaction of the sponsor; In the case of a marketing research the supplier ***** (ii) The researcher has the obligation of submitting the researcher has the obligation of submitting the research work within the specified time frame. This obligation requires that the researcher posses the quality of commitment. The researcher should be truthful in giving the expected time for completion of the research work. (iii) The researcher has the obligation of submitting research work of the right quality. The supplier or sponsor will expect the researcher to carry out a research study, which serves the purpose. This will include use of the suitable data collection methods, proper analysis and reasonable conclusions drawn. The supplier (sponsor) will expect the researcher to provide him or her with the suitable data evaluation techniques so that he may be able to understand well the research work (flick 1983 p 10-26) We must be aware of the fact that the sponsor who is usually the supplier in a market research study has an obligation towards the researcher. The sponsor has to be honest towards the researcher in terms of the scope of the research work required. He should not exaggerate on details required in a research study, which might be out of scope. Failure to be honest the researcher will definitely submit irrelevant information upon research (Johnson 1985 p 17-36) The supplier (sponsor) should remain truthful about the research costs. The sponsor should clear the costs of research and also remunerate the researcher. The supplier should not create complications after the research work has been completed. This would contravene the researcher’s right of remuneration. CONCLUSION Research studies are aimed at alleviating certain problem or learning more about a specific problem. For any research study to be successful the participants should be able to co-operate well towards attainment of the research objective. This co-operation will be brought about by each participant playing his or her role under the guidance of the ethical issues required in a research study. The ethical issues shouldn’t be largely dependent on the specific participants’ rights and obligations.

Miguel de Cervantes, Influential Spanish Novelist

No name is more associated with Spanish literature—and perhaps with classic literature in general—than that of Miguel de Cervantes Saavedra. He was the author of El ingenioso hidalgo don Quijote de la Mancha, which is sometimes referred to as the first European novel and which has been translated into nearly every major language, making it one of the most widely distributed books after the Bible. Cervantes Contribution to Literature Although few people in the English-speaking world have read Don Quijote in its original Spanish, it nevertheless has had its influence on the English language, giving us expressions such as the pot calling the kettle black, tilting at windmills, a wild-goose chase and the skys the limit. Also, our word quixotic originated from the name of the title character. (Quijote is often spelled as Quixote.) Despite his immense contributions to world literature, Cervantes never became wealthy as a result of his work, and not much is known about the early parts of his life. He was born in 1547 as the son of surgeon Rodrigo de Cervantes in Alcalà ¡ de Henares, a small town near Madrid; it is believed that his mother, Leonor de Cortinas, was the descendant of Jews who had converted to Christianity. A Brief Biography of Cervantes As a young boy Cervantes moved from town to town as his father sought work; later he would study in Madrid under Juan Là ³pez de Hoyos, a well-known humanist, and in 1570 he went to Rome to study. Ever loyal to Spain, Cervantes joined a Spanish regiment in Naples and received a wound in a battle at Lepanco that permanently injured his left hand. As a result, he picked up the nickname of el manco de Lepanto (the cripple of Lepanco). His battle injury was only the first of Cervantes troubles. He and his brother Rodrigo were on a ship that was captured by pirates in 1575. It wasnt until five years later that Cervantes was released — but only after four unsuccessful escape attempts and after his family and friends raised 500 escudos, an enormous sum of money that would drain the family financially, as ransom. Cervantes first play, Los tratos de Argel (The Treatments of Algiers), was based on his experiences as a captive, as was the later Los baà ±os de Argel (The Baths of Algiers). In 1584 Cervantes married the much younger Catalina de Salazar y Palacios; they had no children, although he had a daughter from an affair with an actress. A few years later, Cervantes left his wife, faced severe financial difficulties, and was jailed at least three times (once as a murder suspect, although there was insufficient evidence to try him). He eventually settled in Madrid in 1606, shortly after the first part of Don Quijote was published. Although publication of the novel didnt make Cervantes rich, it eased his financial burden and gave him recognition and the ability to devote more time to writing. He published the second part of Don Quijote in 1615 and wrote dozens of other plays, short stories, novels, and poems (although many critics have little good to say about his poetry). Cervantes final novel was Los trabajos de Persiles y Sigismunda (The Exploits of Persiles and Sigismunda), published three days before his death on April 23, 1616. Coincidentally, Cervantes date of death is the same as William Shakespeares, although in reality Cervantes death came 10 days sooner because Spain and England used different calendars at the time. Quick — name a fictional character from a literary work written about 400 years ago. Since youre reading this page, you probably had little difficulty coming up with Don Quijote, the title character of Miguel de Cervantes famous novel. But how many others could you name? Except for characters developed by William Shakespeare, probably few or none. At least in Western cultures, Cervantes pioneering novel, El ingenioso hidalgo don Quijote de la Mancha, is one of the few that has been popular for so long. It has been translated into nearly every major language, inspired some 40 motion pictures, and added words and phrases to our vocabulary. In the English-speaking world, Quijote is easily the most well-known literary figure who was the product of a non-English-speaking author in the past 500 years. Clearly, Quijotes character has endured, even if few people today read the entire novel except as a part of college coursework. Why? Perhaps it is because there is something in most of us that, like Quijote, cant always distinguish totally between reality and the imagination. Perhaps its because of our idealistic ambitions, and we like seeing someone continuing to strive despite the disappointments of reality. Perhaps its simply because we can laugh at a part of ourselves in the numerous humorous incidents that happen during Quijotes life. A Quick Look at Don Quixote Here is a brief overview of the novel that might give you some idea what to expect if you decide to tackle Cervantes monumental work: Plot Summary The title character, a middle-aged gentleman from the La Mancha region of Spain, becomes enchanted with the idea of chivalry and decides to seek adventure. Eventually, he is accompanied by a sidekick, Sancho Panza. With a dilapidated horse and equipment, together they seek glory, adventure, often in the honor of Dulcinea, Quijotes love. Quijote doesnt always act honorably, however, and neither do many of the other minor characters in the novel. Eventually Quijote is brought down to reality and dies shortly thereafter. Major Characters The title character, Don Quijote, is far from static; indeed, he reinvents himself several times. He often is a victim of his own delusions and undergoes metamorphoses as he gains or loses touch with reality. The sidekick, Sancho Panza, may be the most complex figure in the novel. Not particularly sophisticated, Panza struggles with his attitudes toward Quijote and eventually becomes his most loyal companion despite repeated arguments. Dulcinea is the character that is never seen, for she was born in Quijotes imagination (although modeled after a real person). Novel Structure Quijotes novel, while not the first novel written, nevertheless had little on which it could be modeled. Modern readers may find the episodic novel too long and redundant as well as inconsistent in style. Some of the novels quirks are intentional (in fact, some portions of the latter parts of the book were written in response to public comments on the portion that was published first), while others are products of the times. Reference: Proyecto Cervantes, Miguel de Cervantes 1547-1616, Hispanos Famosos. Quick Takeaways Miguel de Cervantes was one of the most influential writers of all times, writing the first major European novel and contributing to both the Spanish and English languages.Although known best for Don Quijote, Cervantes also wrote dozens of other novels, short stories, poems, and plays.The main characters of Don Quijote are the title character; his sidekick, Sancho Panza; and Dulcinea, who lives in Quijotes imagination.