Biomechanics of a Sporting Movement Essay Example | Topics and Well Written Essays - 2250 words

Biomechanics of a Sporting Movement - Essay Example Biomechanics explains and describes and even predicts the mechanical side of human sports, exercises and play body movements. Biomechanics usually studies the mechanics of living things, including the forces that exerted by muscles and gravity on the animal's skeletal framework. Some examples of Biomechanics researches include the study of forces that is exerted on a bird's wings, the aerodynamics of a flying bird or insect, the beauty of a fish swimming in the water and the locomotion in animals and plants. Biomechanics of human beings falls under the study of Kinesiology. People sometimes wonder why the shark swims faster than its prey. In sports, there is a need for coaches and trainers that aid the athletes excel in their sports thru the study of biomechanics. This essay shows technically what biomechanics and how it helps the athlete win tournaments. BIOMECHANICS (Mccomb, 2004) is concerned with the application of physic's law of mechanics to living organisms just as they affect non-living things. The structural stresses of the branch of a tree and the reasons why sharks and dolphins swim faster than other fishes is an example of biomechanics study. The scientific mechanics law explains the effect that certain movements that a high jumper has on the amount and beauty of water displaced during water entry in a swimming pool contest. ... The scientific mechanics law explains the effect that certain movements that a high jumper has on the amount and beauty of water displaced during water entry in a swimming pool contest. In physics, we are taught, using the mechanics law, reasons why a piece of wood slides in such a particular way. Biomechanics (Massimino , 1997) seeks to explain the mechanical cause and effect relationship of plants, animals and human beings. Biomechanics explains and describes and even predicts the mechanical side of human sports, exercises and play body movements. Biomechanics (Greeves, 2002) usually studies the mechanics of living things, including the forces that exerted by muscles and gravity on the animal's skeletal framework. Some examples of Biomechanics (Lee, 1993) researches include the study of forces that is exerted on a bird's wings, the aerodynamics of a flying bird or insect, the beauty of a fish swimming in the water and the locomotion in animals and plants. Biomechanics of human bein gs falls under the study of Kinesiology. BIOMECHANICS OF THE SOCCER KICK. Soccer is a very popular sport around the world. The soccer game revolves around the KICK. The soccer Kick is also used in other popular sports like Rugby league and union, Australian rule Football, grid iron football, Gaelic Football, American Football and also beach volleyball. There are names given to the different soccer kicks are PLACE KICK, SOCCER -STYLE KICK, and the ROUND THE CORNER KICK. Physiology and development. Although the soccer kick lasts for only a few seconds, the intensity force and angle of the anaerobic metabolic pathway produces the kick thereby causing the ball to travel fast, slow, high, low, left or right which causes uproars and clap from the fans.Adenosine

Promoting Brand Loyalty at Abercrombie & Fitch Essay Example for Free

Promoting Brand Loyalty at Abercrombie Fitch Essay Abercrombie and Fitch is an American retailer that focuses on casual wear for consumers aged 18 to 22. It has over 300 locations in the United States, and is expanding internationally. The company also operates three offshoot brands: Abercrombie, Hollister Co., and Gilly Hicks. The company operated a post-collegiate brand, Ruehl No.925, that closed in early 2010. The company operates 1,073 stores across all four brands. The AF brand has 316 locations in the United States, four in Canada, one in London, one in Milan, one in Tokyo, one in Copenhagen, one in Madrid, one in Paris, one in Brussels, one in Dublin, and one in Hong Kong. AF stores range from 6,000 to 36,000 square feet. The company focuses on providing high-quality merchandise that compliments the casual classic American lifestyle. selling casual sportswear apparel, including knit and woven shirts, graphic t-shirts, fleece, jeans and woven pants, shorts, sweaters, outerwear, personal care products and accessories for men, women and kids under the Abercrombie Fitch, abercrombie kids, and Hollister brands. The Company determines its operating segments on the same basis that it uses to evaluate performance internally. The operating segments identified by the Company are Abercrombie Fitch, abercrombie kids, Hollister and Gilly Hicks. The operating segments have been aggregated and are reported as one reportable segment because they have similar economic characteristics and meet the required aggregation criteria. The Company believes its operating segments may be aggregated for financial reporting purposes because they are similar in each of the following areas: class of consumer, economic characteristics, nature of products, nature of production processes, and distribution methods. The Company views the customer’s in-store experience as the primary vehicle for communicating the spirit of each brand. The Company emphasizes the senses of sight, sound, smell, touch and energy by utilizing visual presentation of merchandise, in-store marketing, music, fragrances, rich fabrics and its sales associates to reinforce the aspirational lifestyles represented by the brands. The Company considers the in-store experience to be its main form of marketing. The Company emphasizes the senses to reinforce the aspirational lifestyles represented by the brands. The Company’s flagship stores represent the pinnacle of the Company’s in-store  branding efforts. The Company also engages its customers through social media and mobile commerce in ways that reinforce the aspirational lifestyle of the brands. Flagship stores and social media both attract a substantial number of international consumers, and have significantly contributed to the Company’s worldwide status as an iconic brand. The in-store marketing is designed to convey the principal elements and personality of each brand. The store design, furniture, fixtures and music are all carefully planned and coordinated to create a shopping experience that reflects the Abercrombie Fitch, abercrombie kids, Hollister or Gilly Hicks lifestyle. The Company’s sales associates and managers are a central element in creating the atmosphere of the stores. In addition to providing a high level of customer service, sales associates and managers reflect the casual, energetic and aspirational attitude of the brands. Every brand displays merchandise uniformly to ensure a consistent store experience, regardless of location. Store managers receive detailed plans designating fixture and merchandise placement to ensure coordinated execution of the Company-wide merchandising strategy. In addition, standardization of each brand’s store design and merchandise presentation enables the Company to open new stores efficiently. The Company had net sales of $2.929 billion for the fifty-two weeks ended January 30, 2010, down 15.9% from $3.484 billion for the fifty-two weeks ended January 31, 2009. Operating income for Fiscal 2009 was $117.9 million, which was down from $498.3 million in Fiscal 2008. Net income from continuing operations was $79.0 million and net income per diluted share from continuing operations was $0.89 in Fiscal 2009, compared to net income from continuing operations of $308.2 million and net income per diluted share from continuing operations of $3.45 in Fiscal 2008. Net income per diluted share from continuing operations included non-cash, store-related asset impairment charges of $0.23 and $0.06 for Fiscal 2009 and Fiscal 2008, respectively. Net cash provided by operating activities, the Company’s primary source of liquidity, was $402.2 million for Fiscal 2009. This source of cash was primarily driven by results from operations adjusted for non-cash items including depreciation and amortization and impairment charges. The Company used $175.5 million of cash for capital expenditures and had proceeds from the sale of marketable securities of $77.5 million during Fiscal 2009. The Company’s Market Share may be  Adversely Impacted at any Time by a Significant Number of Competitors. The sale of apparel and personal care products is a highly competitive business with numerous participants, including individual and chain fashion specialty stores, as well as regional and national department stores. The Company faces a variety of competitive challenges, including maintaining favorable brand recognition and effectively marketing its products to consumers in several diverse demographic markets. And sourcing merchandise efficiently and countering the aggressive promotional activities of many of the Company’s competitors without diminishing the aspirational nature of the Company’s brands and brand equity. There can be no assurance that the Company will be able to compete successfully in the future. The science of the Deal Ch.7 Genentech is a biotechnology corporation, founded in 1976 by venture capitalist Robert A. Swanson and biochemist Dr. Herbert Boyer.   Today, Genentech has the biggest market capitalization in biotech at US $88 billion, with an incredible reputation in drug development, especially in oncology, and a number of blockbuster drugs under its belt. Genentech has multiple products on the market for serious or life-threatening medical conditions. In March 2009, Genentech became a member of the Roche Group, and Genentech now serves as the headquarters for all Roche pharmaceutical operations in the United States. Accordingly, the list below includes products which were previously marketed as Roche products that are now being marketed by Genentech in the United States. Genentech’s relationship with Roche Holding began in 1990, when the Swiss company bought a 60 percent stake in Genentech for $2.1 billion. As a result of additional stock purchases and sell offs, Roche owned about 56perce nt of Genentech in 2008. The success of Genentech as a biotechnology company is indeed in no small part derived from its strategy of forming alliances with smaller companies, whose proprietary drugs and technology platforms have the potential to become blockbusters. The commercialized drug, called Tarceva, is a drug used to treat non-small cell lung cancer, pancreatic cancer and several other  types of cancer, which was released in 2004 and quickly acquired blockbuster status. It is marketed in the United States by Genentech and OSI Pharmaceuticals and elsewhere by Roche. In lung cancer, it extends life by an average of 3.3 months at a cost of CDN$95,000. Historically, this approach has brought Genentech great rewards, particularly in the field of oncology, and now the company is hoping to achieve similar success in new therapeutic areas. To support small companies with promising technologies and/or drugs in development that are at too early a stage for licensing. In this way, Genentech has developed a highly competitive approach, singling out small companies with enormous future potential and establishing mutually beneficial relationships at the earliest possible stage. A significant proportion of the Genentech pipeline has always consisted of proprietary technology platforms and drug candidates, and its brave approach to RD spending reflects this. In 2003, 24% of Genentechs revenues were directed into RD, to address the top-heavy position of its pipeline at the time. To balance resource use with the strongest likelihood of success, Genentech continuously evaluates its pipeline products in order to determine which are the most promising projects to move through the many phases of clinical testing. The pipeline includes both breakthrough innovations and new indications for existing, well understood products that may fight more than one disease or more than one form of a disease.

Minimizing Cost of Volatile Inhalational Anesthetics

Minimizing Cost of Volatile Inhalational Anesthetics P The population that will be examined are male and female patients with a physical status (PS) of I-II requiring general anesthesia for surgery, ages 20-40. I The intervention being introduced is utilizing Sevoflurane (UltaneÂÂ ®) as the inhaled anesthetic for surgeries requiring general anesthesia lasting less than one hour. C The comparison group will be those utilizing Desflurane (SupraneÂÂ ®) as the inhaled anesthetic for surgeries requiring general anesthesia lasting less than one hour. O The use of Sevoflurane for surgery cases requiring general anesthesia for less than one hour will save money for the anesthesia department rather than using Desflurane. PICO Question: Will the use of Sevoflurane rather than Desflurane in surgeries requiring general anesthesia lasting less than one hour save money for the anesthesia department? Abstract Inhalation anesthetics are used millions of times every single day in surgeries requiring general anesthesia all over the world. Cost containment is anesthesia is no longer an option, it is an absolute necessity. Anesthetic drugs account for up to 6 percent of total hospital pharmacy costs and inhalation agents comprise over twenty percent of that as a whole. One of the areas most amenable to cost reduction in the anesthesia department budget is the use and choice of inhalational anesthetic. A quantitative quasi-experimental controlled trial was developed to determine if money could be saved in the anesthesia department by utilizing Sevoflurane as the inhalational anesthetic for surgeries requiring general anesthesia less than one hour rather than Desflurane. The study chose males and females, ages twenty to forty, requiring general anesthesia at a mid-sized, urban, teaching hospital in South-Western Pennsylvania. Prices of anesthetic agents were gathered from the same facility and c alculated to determine the total cost savings that would ensue with the use of the interventional inhalation agent rather than that used by the control group. The use of Sevoflurane for two-thirds of the cases which Desflurane was used saved the institution over twenty thousand dollars. Key Words: Inhalational Anesthetics, Pharmacoeconomics, Desflurane, Sevoflurane, Anesthesia Introduction Research Problem: The cost of health services and technologies continue to increase exponentially while resources are finite. Developing effective strategies to minimize costs without compromising patient safety and quality of care are the most difficult challenges medical professionals experience.13 Inhalational anesthetics comprise twenty percent of the drug expenses in anesthesia departments. The cost of inhalational anesthetics depend on their potency, which is their minimum alveolar concentration (MAC), the minimum amount of inhalational anesthetic needed in the lungs to facilitate the absence of movement to noxious stimuli, the fresh gas flows (FGF) used to deliver the anesthetic gas, the amount of anesthetic vapor released by each milliliter of liquid, and the price of the inhalational anesthetics themselves.2,16 Inhalational anesthetics are used when general anesthesia is needed for surgery and patients do not have diseases or conditions which would preclude them from being able to utilize them (e.g. those who have malignant hyperthermia). The anesthesia provider decides which inhalational anesthetic is best for a given patient, based on their history and needs for the surgery. The problem exists when providers just use whichever anesthetic is most easily accessible at that time without minding any consideration as to the cost of the particular gas and the level of FGF they are using, which is purely a waste of money as the patient will lose heat and humidity, waste high levels of inhaled anesthetic, and demise cost containment for the anesthesia department. Statement of Purpose The purpose of this research study is to determine whether the implementation of Sevoflurane as the choice inhalation anesthetic for surgery requiring general anesthesia for procedures lasting less than one hour rather than using Desflurane will provide cost containment for the anesthesia department. Objectives/Aims The objective of this study is to provide an avenue of cost containment for the anesthesia department of a mid-sized, urban, teaching hospital and overall savings for the medical health system. This will allot more money in the department budget to be spent on technological advances, and equipment used to better develop opportunities for patient safety, the ultimate goal of all medical professionals. Review of Literature: Many studies explore different methods of cost containment in the anesthesia department. Almost all of the studies exclusively develop the notion of cost savings related to the fresh gas flows used to deliver inhalation anesthetics. Cost containment requires primarily a decrease in FGFs, but it may also be influenced by a rational use of the available halogenated agents.3 With the advances in technology and the ultra-modern anesthesia machines available, anesthesia providers should feel safe in using minimal FGFs to deliver anesthesia that would not harm their patients in any way.3 Anesthetists can directly influence healthcare costs through the patterns in which they practice, which includes reducing the FGFs chosen during inhalational anesthesia, which will directly affect the amount of inhaled anesthetic delivered to the patient and ultimately the costs which are attributable to inhaled anesthetics.10,15 Depending on breathing systems used, which are mostly semi-open today, up to ninety percent of the anesthetic gases delivered escapes into the atmosphere completely unused. By using low-flow anesthesia, most of the patients air they exhale is recycled and then returned to the patients lungs after the carbon dioxide from the exhaled air has been absorbed.15 There are also advantages of using low-flow anesthesia such as conserving the patients heat and humidity, making it less of a need to warm the patient externally, which will cut down costs on heating blankets and the like, as well as maximized the rebreathing of the exhaled anesthetic, which will cut down on the amount of gas vented into the environment,6 but there are cautions that anesthesia providers must take when using low FGFs, as titration in inhalation anesthetic is not as easily predicted. Product labeling for Sevoflurane does include a warning that patient exposure should not exceed two hours using FGF rates greater than one and less than two liters per minute.7 Also, it is not recommended at all to maintain FGFs less than one when using Sevoflurane as the patients inhalational anesthetic of choice. These recommendations are to minimize the risk of exposure of the patient to compound A which in laboratory animals, has been shown to be linked to nephrotoxicity. There are no minimum flow rate designations that exist for Desflurane.7,8 Isoflurane is less expensive than Sevoflurane and Desflurane at equal dose and the same FGFs.7 When comparing Sevoflurane with Desflurane as they are being used for surgeries lasting less than two hours, there was a ninety percent decrement time for Sevoflurane which approached the short duration of anesthesia matching that of Desflurane. However, when the duration of anesthesia increased over two hours, Sevofluranes ninety percent decrement time approached that of Isoflurane.7 The cost of inhaled anesthetic agent can be estimated by using an equation that provides the cost of anesthetic per MAC hour: Cost per MAC hour ($) = [(Conc.)(FGF rate)(Duration)(MW)(Cost per mL)] / [(2412)(D)]6 The cost of one milliliter of Isoflurane is twenty-three cents, Sevoflurane is forty-one cents, and Desflurane is eighty-three cents. Regardless of the fast onset and emergence Desflurane offers, the cost of administering Desflurane is greater than the cost of Sevoflurane at any FGF rate.10,11 The cost of inhaled anesthetic agent can be estimated by calculating the cost per MAC hour, which is the administration of inhaled anesthetic agent at 1 MAC for a one hour time interval. The cost can be calculated using the concentration percent on the anesthetic dial of gas delivered, the FGF rate chosen, the duration of the anesthetic (sixty minutes in this case), the molecular weight of the anesthetic agent (MW in grams), cost per mL of liquid agent (in dollars), a factor accounting for the molar volume of a gas at twenty-one degrees Celsius (a constant of two thousand four-hundred twelve), and the density of the agent (D in grams/mL). Cost per MAC hour ($) = [(Conc.)(FGF rate)(Duration)(MW)(Cost per mL)] / [(2412)(D)]6 The cost per MAC hour can be seen in Table 2. Desflurane is associated with a shorter recovery as is Sevoflurane, but the differences between the two in terms of patient discharge cannot be consistently shown in research studies.13 Gupta evaluated n=246 patients for recovery time after undergoing surgeries less than two hours with either Sevoflurane or Desflurane. Patients given Desflurane were able to open their eyes sixty seconds before those who received Sevoflurane, P When comparing Sevoflurane and Isoflurane for patients who are undergoing surgery for more than two hours, Gupta evaluated n=634 patients. The patients who underwent Sevoflurane were able to open their eyes sooner, P Savings of more than one hundred thousand dollars resulted from the change of using Desflurane to using Sevoflurane in the operating rooms at Montefiore Medical Center in the Bronx, New York. Traynor noted that three bottles of Desflurane are needed to maintain a level of anesthesia equal to that of one bottle of Sevoflurane, making this agent much less expensive for the hospital to utilize, with no difference in patient discharge times. Reviews of Literature indicated that patients who received Desflurane could be extubated in the operating room about two minutes sooner than the patients who received Sevoflurane; an advantage seen meaningless in the large scale of the operating room sequences.9,15 Methodology The research design chosen was a quasi-experimental study. It involved the use of an experimental group and a control group. It is important to mention that the control group was compiled from hospital anesthesia records. The study did not involve randomization as a medical facilitys computer database cannot throughput this information. Permission from a mid-sized, Southwestern Pennsylvania teaching hospital was granted and all information gathered from the facility involved no patient identifiers, including gender or age. The hospitals Institutional Review Board (IRB) was provided all details of the research study and deemed the research experiment to be exempt and permission was granted to start the study without any changes in the studys design. General anesthesia data spreadsheets were gathered from the hospital exemplifying a patient anesthesia case total for the month of July, 2012. From this information, it was determined there were a total of n0=1,459 general anesthesia cases and after careful analysis, it was found that n1=500 cases lasted less than one hour and n2=959 cases lasted equal to or more than one hour in length from the beginning of anesthesia delivery to the end of the surgical procedure, as seen in Chart 1 in Appendix A. The Southwestern Pennsylvania hospital was asked to provide their costs for Desflurane, Sevoflurane, and Isoflurane inhalation anesthetics. These prices can be seen in Table 1 of Appendix A. Utilizing the equation to calculate the amount of inhaled anesthetic used during a general surgical case in a sixty minute time duration, MAC hour costs could be calculated as seen in Table 3. The pharmacy was also asked to provide how many bottles of inhalational anesthetic are bought and used annually in their operating rooms. These results are seen in Chart 2 and calculated annual costs of the anesthetics are shown in Chart 3 in Appendix C The experimental group for the research procedure involved men and women, ages twenty to forty, with PS scores of I and II, who were undergoing general anesthesia for surgery cases lasting less than one hour. These patients were administered Sevoflurane as their inhalational anesthetic during surgery at a FGF rate of 2 liters per minute (LPM). To be sure all patients were given the same standard induction regimen, all drug doses were based on current body weight calculations. Propofol, a sedative hypnotic was given at 2 milligrams per kilogram (mg/kg). Fentanyl, an opioid analgesic was given at 5 micrograms per kilogram (mcg/kg). Midazolam, a benzodiazepine sedative was given at a standard dose of 2mg/kg. Lidocaine, a class 2 anti-arrhythmic agent was given at 1.5 mg/kg. All patients participating in the study were given their induction medications at these doses provided. In the preoperative area, all patients were given the right to participate or not participate in the research experiment as they were provided a letter of informed consent, which described completely that they would be treated no differently than any other patient and they were voluntarily consenting to participate in a research study as an individual, and in no way obligated to participate if they were unwilling to do so. Those who were not involved in the experimentation are those patients who were unwilling to consent to participate in the experiment as an individual. Those with malignant hyperthermia were excluded from the study as they could not receive volatile inhalational anesthetics. Patients who required additional narcotic for pain during surgery were excused from participation. Those with chronic kidney disease or kidney failure were also not involved in the experiment as Sevoflurane, the experimental variable could lead to kidney complications. Participants who only were given inhalational anesthetic for painful stimulation during intravenous sedation were also excluded from participation in this study. It was important to determine which inhalational anesthetic was favored most by anesthesia providers at the Southwestern Pennsylvania hospital between Sevoflurane and Desflurane for general anesthesia cases lasting less than one hour. Surveys were sent out to all members of the anesthesia team as titled Survey 1 in Appendix D. Ethics/Professionalism Ethical considerations were regarded during the completion of the study from start to finish. All information gathered from a Southwestern Pennsylvania hospital was kept in confidence and destroyed at the finish of the study by professional paper shredding services. Participant names, ages, race, nationality, and medical histories were not gathered from the hospital and were blinded from the investigator, owing to complete confidence of all those who participated during a twelve month interval. Results Results are pending until the quasi-experimental research study is completed. Discussion Volatile inhalational anesthetics account for twenty percent of pharmacy costs in the anesthesia department.10,16 By using a pharmacoeconomic model, it can be seen that careful choice of anesthetic for patients can represent a large cost containment for the anesthesia department in the hospital, without compromising patient care. All patients need to be considered a new case and may not fit into the pharmacoeconomic model because of family histories (e.g. malignant hyperthermia). However, when possible, using Sevoflurane for the choice inhalation anesthetic for general surgery cases rather than Desflurane for those lasting less than one hour can result in large cost savings for the anesthesia department. Over twenty thousand dollars could be saved if the Southwestern Pennsylvania hospital would utilize Sevoflurane over Desflurane for two-thirds of their total surgeries requiring general anesthesia for less than one hour. It is important to mention that as a professional anesthesia student, FGF commonly observed with Sevoflurane are 2 LPM and FGF with Desflurane commonly observed are 2 LPM. The nephrogenicity associated with Sevoflurane is not commonly observed when this amount of FGFs are used.7 With the use of 1 LPM FGF when using Desflurane, as there is no minimum FGF required to avoid physiological aberrance, 17,19 there is also a great cost savings maintained for the anesthesia department. Limitations There are limitations in any study when research is conducted and from this study, results are limited to a single institution and this limits its external validity as a result. Randomization was not included in this research study as a convenience sample population was used at one hospital location. The study was not extremely descriptive as patients with higher PS scores were not studied in this particular research project. This study is also missing research on older age groups, as participants age twenty to forty were included only. As all of these limitations can be seen in the experimental study, the results from this research study cannot be imposed on larger populations and therefore generalizability is poor. Future research can make these findings representable and provide for better generalization. Future Recommendations for Research In future research, randomization should be used when developing research as this will strengthen the results. Larger sample populations should be used in defined, smaller age variances to be able to impose the results on a specific group of patients. Defined surgeries should be used in sample populations to show stronger significance when looking at varied surgical procedures their results. With the inclusion of the above criteria, the research study would be experimental rather than quasi-experimental, and results could be superimposed onto given populations with much stronger data observance. Dissemination This research project will appear in the May, 2013 edition of Anesthesia and Analgesia in its entirety with all results included. There will also be one hour lectures provided on these research findings at the University of Pittsburgh at Greensburg, Robert Morris University, and St. Vincent College, times and final adjusted locations are to be announced via bulletins, which be hung in the cafeterias of each of these locations. Conclusion Inhalational anesthetics represent a significant cost for pharmaceutical costs in the anesthesia department. It is important for professional anesthesia providers to deliver cost-effective, safe anesthesia care to patients in surgery. When analyzing surgical procedures requiring general anesthesia for less than one hour, the use of Sevoflurane rather than Desflurane as the choice inhalation anesthetic in surgery can provide the anesthesia department an avenue of cost savings without compromising patient care. When Desflurane must be used for patients who cannot be administered Sevoflurane, it is important to keep in mind there is no recommendation for FGF rates, and cost savings can also be preserved by utilizing low FGFs when using Desflurane. References Weinberg L, Story D, Nam J, McNicol L. (2010). Pharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis. Anaesthesia and Intensive Care, 38(5), 849-854. Lockwood GC White DC (2001). Measuring the costs of inhaled anesthetics. British Journal of Anesthesia, 87(4), 559-563. Odin I, Feiss P. (2005). Low flow and economics of inhalational anaesthesia. Best Practice Research Clinical Anaesthesiology, 19(3), 399-413. Strum EM, Szenohradszki J, Kaufman W, Anthone GJ, Manz IL, Lumb PD (2004). Emergence and Recovery Characteristics of Desflurane Versus Sevoflurane in Morbidly Obese Adult Surgical Patients: A Prospective, Randomized Study. Anesthesia and Analgesia, 99, 1848-1853. Boldt J, Suttner S. (2000). Low-Flow Anesthesia: Does it have Potential Pharmacoeconomic Consequences? Pharmacoeconomics, 17(6), 585-590. Golembiewski J. (2010). Economic Considerations In the Use of Inhaled Anesthetic Agents. American Journal of Health-System Pharmacy, 67(4), 9-12. Meyer T. (2010). Managing inhaled anesthesia: Challenges from a health-system pharmacists perspective. American Journal of Health-System Pharmacy, 67(4), 4-8. Boldt J, Juan N, Kumle B, Heck M, Mund K. (1998). Economic Considerations of the Use of New Anesthetics: A comparison of Propofol, Sevoflurane, Desflurane, and Isoflurane. Anesthesia and Analgesia, 86, 504-509. Agoliati A, Dexter F, Lok J, et al. (2010). Meta-Analysis of Average and Variability of Time to Extubation Comparing Isoflurane with Desflurane or Isoflurane with Sevoflurane. Anesthesia and Analgesia, 110(5), 1433-1439. Dolk A, Cannerfelt R, Anderson RE, Jakobsson JP. (2002). Inhalation anesthesia is cost-effective for ambulatory surgery: a clinical comparison with propofol during elective knee arthroscopy. European Journal of Anesthesiology, 19(2), 88-92. Chernin EL (2004). Pharmacoeconomics of inhaled anesthetic agents: Considerations for the pharmacist. American Journal of Health-System Pharmacy, 61(4), 18-22. Beaussier M, Deriaz H, Abdelahim Z. (1998). Comparative effects of desflurane and isoflurane on recovery after long lasting anaesthesia. Canadian Journal of Anaesthesia, 45(5), 429-434. White PF. (2010). Facilitating Recovery from Anesthesia: Assessing the Costs and Benefits of Anesthetic Drugs. Anesthesia and Analgesia, 110(2), 273-275. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker S, Fleisher LA (2004). Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review. Anesthesia and Analgesia, 98, 632-641. Traynor K. (2009). Inhaled anesthetics present cost-saving opportunity. American Journal of Health-System Pharmacy, 66(7), 606-607. Kapur P. (1994). Pharmacy Acquisition Costs: Responsible Choices Versus Overutilization of Costly Pharmaceuticals. Anesthesia and Analgesia, 78, 617-618. Dexter F, Bayman EO, Epstein RH (2010). Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane. Anesthesia and Analgesia, 110(2), 570-580. Southwestern Pennsylvania Hospital. (2012). Annual Anesthesia Data Tracking Information. Accessed 08/30/2012 with Permission from Corporate Department. Southwestern Pennsylvania Hospital. (2012). Pharmacy Records. Accessed 08/30/2012 with Permission from Corporate Department. Appendix A Table 1: Cost of Inhalational Anesthetic per a Southwestern Pennsylvania Hospital Pharmacy Records Inhalational Anesthetic Cost Per Bottle ($) Total Volume in Bottle (mL) Cost per mL of Liquid ($) Sevoflurane (Ultane) 100.82 250 0.40 Isoflurane (Forane) 9.73 100 0.09 Desflurane (Suprane) 136.37 240 0.56 Reference 19. Table 3: Calculated MAC Hour Inhalation Anesthetic Cost at a Southwestern Pennsylvania Hospital FGF Rate (L/Min) Isoflurane ($) Desflurane ($) Sevoflurane ($) 1 0.31 9.68 2.71 2 0.62 19.36 5.43 3 0.93 29.04 8.14 All estimated costs are based on duration of 60 minutes and the formula proposed by Golembiewski. Isoflurane calculations are based on concentration of 1.15%, MW of 184g, cost per mL=$0.09 and D of 1.49 g/mL Desflurane calculations are based on concentration of 6%, MW of 168g, cost per mL=$0.56, and D of 1.45g/mL Sevoflurane calculations are based on concentration of 2.0%, MW of 201g, cost per mL=$0.40, and D of 1.51g/mL Appendix B Chart 1: Total Anesthesia Cases in July, 2012: Time Intervals from a Southwestern Pennsylvania Hospital Reference 18. Table 2: Estimated Cost per MAC Hour ($) of Inhaled Anesthetic Gases: Based on FGF Rates FGF Rate (L/Min) Isoflurane ($) Desflurane ($) Sevoflurane ($) 1 0.5 12.9 6.0 2 1.0 25.9 12.1 3 1.5 38.8 18.1 All estimated costs are based on duration of 60 minutes and the formula proposed by Golembiewski. Isoflurane calculations are based on concentration of 1.15%, MW of 184g, cost per mL=$0.15 and D of 1.49 g/mL Desflurane calculations are based on concentration of 6%, MW of 168g, cost per mL=$0.96, and D of 1.45g/mL Sevoflurane calculations are based on concentration of 2.0%, MW of 201g, cost per mL=$0.90, and D of 1.51g/mL Reference 7. Appendix C Chart 2: Number of Bottles of Inhalational Anesthetic Used Annually at a Southwestern Pennsylvania Hospital Reference 19. Chart 3: Annual Expenditure on Inhalational Anesthetics at a Southwestern Pennsylvania Hospital

Lives of the Saints Essay -- Lives Saints Essays

Lives of the Saints   Ã‚  Ã‚  Ã‚  Ã‚  Lives of the Saints is a story that examines the complexities and tribulations of everyday life in a small town. Throughout the novel, we discover that even the most trustworthy and caring individuals live secret lives behind closed doors, and that the surface appearance of minor communities can be very deceptive. Some people spend their entire adult-lives trying to knock down these doors and discover the truth, but perhaps they are overlooking the key to the lock†¦ our children. Vittorio Innocente is a young boy who has not always lived up to his name. ‘My attendance at school had not been very regular-it had somehow fallen out that I’d spent much of class time wandering up to the top of Colle di Papa or down to the river with my friend Fabrizio, sharing with him the cigarettes he filched from his father. La Maestra had paid a visit to my mother one afternoon, to advise her of my truancy and vices†¦.’ (9). We find that Vitto is trying to turn around his poor school habits, and has been trying to read through a novel called Principi Matematici, but to no avail. As he sat stranded on page three of his mathematical conquest, he was overcome by a wealth of distractions. The golden sun was shining down on him that day, or so it seemed, for as he was drifting off to sleep the muffled shout of a man shattered what would appear to be his last enjoyable day; at least for a long time. Childhood can be a fragile thing. It is commonly believed that children see the world through different eyes. Everything seems fresh and interesting to them, where we become saturated with the details of our everyday lives. The eyes of Vittorio Innocente act as a safeguard, seemingly protecting him from truth and danger that he cannot see. Since the incident with the snake, Vittorio had noticed that his mother had been keeping to herself, working in the garden. However, he could not understand what was wrong with her, and could not figure out why the household seemed so empty. ‘†¦A veil seemed to have fallen between us, and for a while I had nursed this estrangement like a precious wound I could somehow turn to advantage; but the passing days brought only a growing awkwardness, as if my mother and I had suddenly become strangers, with no words now to bridge the silence between us’ (74). Vittorio’s ‘safety-goggles’ also help him when the gang of b oys inv... ...ctor to tell him of his mother’s pains, he is uninterested. â€Å"My mother wants you to come†, says the young boy. â€Å"Leave me alone†, replies the doctor in a drunken stupor. â€Å"You’re that woman’s son, aren’t you, the pregnant one who thinks she’s a princess† (221). When the doctor is finally convinced to check up on Cristina, he only makes matters worse. Upon his arrival in Vitto’s room, Cristina notices his condition and says: â€Å"You smell-like a liquor factory† (225). He takes no notice of these remarks, showing no concern for the life of the baby or Cristi. Although he manages to deliver the baby, we find that Vittorio’s mother has died during the night due to excessive bleeding. Dr. Cosabene’s ignorance has brought death and pain to a family that has been reduced to two, a young boy and his little sister.   Ã‚  Ã‚  Ã‚  Ã‚  Vitto will no longer have a normal life. He has no mother or father. He has no money, and he has nowhere to live. Consequently, he has a newborn child to look after. Where has his childhood gone? It looks as though the doctor has taken it from him, and he will never get it back. One thing remains certain†¦ Vittorio Innocente will never look through the eyes of a child again. Lives of the Saints Essay -- Lives Saints Essays Lives of the Saints   Ã‚  Ã‚  Ã‚  Ã‚  Lives of the Saints is a story that examines the complexities and tribulations of everyday life in a small town. Throughout the novel, we discover that even the most trustworthy and caring individuals live secret lives behind closed doors, and that the surface appearance of minor communities can be very deceptive. Some people spend their entire adult-lives trying to knock down these doors and discover the truth, but perhaps they are overlooking the key to the lock†¦ our children. Vittorio Innocente is a young boy who has not always lived up to his name. ‘My attendance at school had not been very regular-it had somehow fallen out that I’d spent much of class time wandering up to the top of Colle di Papa or down to the river with my friend Fabrizio, sharing with him the cigarettes he filched from his father. La Maestra had paid a visit to my mother one afternoon, to advise her of my truancy and vices†¦.’ (9). We find that Vitto is trying to turn around his poor school habits, and has been trying to read through a novel called Principi Matematici, but to no avail. As he sat stranded on page three of his mathematical conquest, he was overcome by a wealth of distractions. The golden sun was shining down on him that day, or so it seemed, for as he was drifting off to sleep the muffled shout of a man shattered what would appear to be his last enjoyable day; at least for a long time. Childhood can be a fragile thing. It is commonly believed that children see the world through different eyes. Everything seems fresh and interesting to them, where we become saturated with the details of our everyday lives. The eyes of Vittorio Innocente act as a safeguard, seemingly protecting him from truth and danger that he cannot see. Since the incident with the snake, Vittorio had noticed that his mother had been keeping to herself, working in the garden. However, he could not understand what was wrong with her, and could not figure out why the household seemed so empty. ‘†¦A veil seemed to have fallen between us, and for a while I had nursed this estrangement like a precious wound I could somehow turn to advantage; but the passing days brought only a growing awkwardness, as if my mother and I had suddenly become strangers, with no words now to bridge the silence between us’ (74). Vittorio’s ‘safety-goggles’ also help him when the gang of b oys inv... ...ctor to tell him of his mother’s pains, he is uninterested. â€Å"My mother wants you to come†, says the young boy. â€Å"Leave me alone†, replies the doctor in a drunken stupor. â€Å"You’re that woman’s son, aren’t you, the pregnant one who thinks she’s a princess† (221). When the doctor is finally convinced to check up on Cristina, he only makes matters worse. Upon his arrival in Vitto’s room, Cristina notices his condition and says: â€Å"You smell-like a liquor factory† (225). He takes no notice of these remarks, showing no concern for the life of the baby or Cristi. Although he manages to deliver the baby, we find that Vittorio’s mother has died during the night due to excessive bleeding. Dr. Cosabene’s ignorance has brought death and pain to a family that has been reduced to two, a young boy and his little sister.   Ã‚  Ã‚  Ã‚  Ã‚  Vitto will no longer have a normal life. He has no mother or father. He has no money, and he has nowhere to live. Consequently, he has a newborn child to look after. Where has his childhood gone? It looks as though the doctor has taken it from him, and he will never get it back. One thing remains certain†¦ Vittorio Innocente will never look through the eyes of a child again.

For the first time

Time consumption also to be considered with these factors, being efficient is what all catering services needed and that would only be provided to us by our own technology. The significance of this proposal aims to give as alternative and replacement to the manual system that Belle's Catering Services is currently using. We know that all catering services are a big part of events. This proposal gives a computerized system to be able to have faster, easier and more convenient and more efficiency to the information system.This proposal also aims answer and makes the Belle's catering services mission and vision completely. Online Infringement's of Belle's Catering Services our system,delimitation systems (IS) is the study of complementary networks of reward and software that people and organizations use to collect, filter, process, create, and distribute data. The study bridges business and computer science using the theoretical foundations of information and computation to study variou s business models and related algorithmic processes within a computer science discipline.Computer Information System(s) (SIS) is a field studying computers and algorithmic processes, including their principles, their software and hardware designs, their applications, and their impact on society while IS emphasizes functionality over design. [Walk 2013] Our system focuses in Catering Services. It is the business of providing foddering at a remote site or a site like a hotel, public house and other various locations. This is a food or service that is catered to you, in other words,you pay them to bring you their services, most likely a food Joint. Online Infringement's for Belle's Catering Services 1. Background of the Study Maria Plainclothes started as an employee of a catering service. While her husband Leo Apaches is a set-up crew for the same catering service. When a friend suggest that they should start a small business in 2005. At first, they have a few customer who always orde r for them, then suddenly they have been recommended by a customer to have their own catering services, â€Å"The Belle's Catering Services†. The project titled Online Information System is a Catering Characteristic gives information about the services of Belle's Catering Services.The project â€Å"Online Information System† is developed in HTML using Adobe Dreamier CSS. 5 , which focuses on giving information, suggestions, and mainly catering events â€Å"Online Information System† is a web-based application that runs in any web browsers, designed to help users choose the catering services they want for their events. Recruiters is easy to use for both beginners and advanced users. It features a familiar well thought-out, an attractive user interface, combined with strong searching, and reporting capabilities.The report generation facility of information system's to get a good idea of which is the best package suitable for the person that is having their events. Problem 1. 1. 1 General Problem Statement of the How the proponents will develop an online information system that will provide efficiency in processing information and a module to update the customer's needs for the catering service events. . 1. 2 Specific Problem How the proponents will help the user to decide on the package that they will afford.This problem will specify on the decision support system that the proponents will use according to their money and according on how many persons are coming to the event. How the proponents will develop a module for the decision support system. This problem will specify on how will the proponents develop an easy and efficient decision support system 1. 2 Statement of Objectives 1. 2. 1 General Objectives To be able to develop a web-based application for Belle's Catering Services improve the processing of information and capability of a module to update the customers needs for the catering service events. . 2. 2 Specific Objectives To be a ble to help the user to decide on the package that they will afford . The system uses a Decision Support System (ADS) that will create an information and manipulate the user's choice of package. To be able to develop a module for the decision support system . Focuses on the condition of demonstrations needed by the users to identify the package for their given events. Study 1. 3 Significance of the Catering Services is a business that focuses between the caterer and the customer.It is transaction on what will be the request of the customer for them to satisfy their needs and to give an accurate information about the services of the caterer. The main objective of our group is to make the proposed system exist to help Belle's Catering Services to makeshift business automated. So that the process of the transaction will be more efficiently and faster. Students To improve their analytical thinking and to unproven their programming skills in the field of online information system. Benefi ciary To provided a well-defined proposed system in order to support their business in renovations between the customers.Customers To provide an information for them to know the choices that they want for their events,and for the suggestions they can say to the caterer in order for them to have a harmonium flow of the event. 1. 4 Scope and Limitation of the Study Scope of the Study The impact of technology has greatly expanded the scope and capacity of the average catering service. This is an on-going and developing relationship between the customer and the caterer as the computer's full capabilities are gradually explored and applied to the online information system.Without internet, advertising catering services is difficult to manage, as well as publishing of the proposed system. It is also time consuming for the transactions and will do much more delay for the events. Scope of the System 2. 0 Methodology of the Study This chapter starts on the discussion about the project resear ch disintermediation. The second part presents the development of the system . Project Development Spiral model The spiral model is a software development process combining elements of both design and prototyping-in-stages, in an effort to combine advantages of top-down and bottom-up concepts.Also known as the spiral lifestyle model (or spiral development), it is a systems development method (SAD) used in information technology (IT). This model of development combines the features of the prototyping and the waterfall model. The spiral model is intended for large, expensive and complicated projects. Figure 1. 0 6 Phases of Spiral Model The spiral model's divided into a number of frame work activities, also called task region. The figure 1. 0 illustrates spiral model containing 6 task regions: Customer Communication Task required to established effective communication between developer and customer.Planning Task required to define resources , timeliness ,and other project related info rmation . Risk Analysis Task required to asses both technical and management risk. Engineering Task required to build 1 or more representation of the application. Construction and release Task required to construct , test, install, and provide user support. Customer Evaluation Task required to obtained customer feedback based on evaluation of the software representation created during the engineering stage and environmental during the installation stage. 3. 0 Data Gathering, Procedures and OutputMany online information systems are operated manually by group of people. In such situations many people involved in the process of managing the catering such a way that inform the user regarding the information of the catering service, the decision support system of the catering, and help the customer to decide on how to choose their own affordable cater for their events. On the other hand keeping large amount of maintenance workers may cost a lot & it will not be efficient for a catering s ystem. Manual process in the transaction of the catering is not a reliable method.On the mint of view, in manual system the user can't find the suitable information for his or her events. We interview Mrs.. Beeline Apaches on how their catering services works and the required information in their business. We found out that their is a package in every events in their catering. For example, in wedding they have full package which cost IIOP,OHO up to IPPP,OHO. In that package they have a complete catering service with set-up, a place to have the venue, the amenities and miscellaneous, and other needs they can get by renting in other rental services (egg. Hairs and tables). We also visit their faceable account to gather some information to use in our proposed system . In their faceable account there are pictures of the events that in low resolution settings so we didn't use their own image as the picture of events in their catering services. There are also foods and beverages that have also low resolution so in order to improve the quality of the design of our proposed system we provide the detailed picture of Belle's Catering Online Information System.We decided that we will create two systems which is the back and front end. The front end is for the customer to vive the information about the services that Belle's Catering services offered. , while the back end is for the admit in controlling the data in the front end. In the process of our system, the customers will find the information in our system, their needs and suggestion will be provide by our Decision Support System (ADS), and other things that can be say to the caterer in the used of telephone/cellophane number or use as reference. The Existing System They have no existing system so that's why the proponents choose the Belle's Catering Services in order to make for them an existing online information system. . 1 Company Background Belle's Catering Services in Banana Mycenaean City, Vulcan is a public c atering service. The name Belle's Catering comes from the name of the owner Mrs.. Beeline Apaches. Maria Plainclothes started as an employee of a catering service. While her husband Leo Apaches is a set-up crew for the same catering service.When a friend suggest that they should start a small business in 2005. At first, they have a few 4. 2 Description of the System By using the present manual system, work is done manually. So, each and every transaction takes much time to complete. Whenever user requires any information, the decision and update process also takes more time and it is difficult to find particular information. As the transactions of the catering increases there is more information to be processed and stored.

Audrey Hepburn built her incredible acting talent out of her troubled upbringing Essay

Audrey Hepburn was born in 4th of May 1929 in Brussels, Belgium. She is an idol of elegance for all time. She spends her first years of school in London. However, because of the Nazi’s occupancy, she moved into Holland with her mother. She continued to conservatoire in Arnhem which is the city of Holland. After the war, Audrey started taking ballet classes. Her first show was in 1947 and its name is ‘High Buton Shoes.’ She became more famous with ‘Gigi’ movie. Also, she won Oscar with her ‘Roman Holiday’ movie. After a year, she acted in ‘Ondine with Mel Ferrer’. In this period, Hepburn and Ferrer started a relationship and they married in 1954. She gained Academy nomination with the ‘Sabrina’ movie in the same year. With the movie of ‘The Nun’s Story’, again she was nominated for the Academy award. In 1960, her first child Sean was born. She gained her fifth Academy nomination with the Ã¢â‚¬Ë œWait Until Dark’. However, in the same year, she got divorced. She made her second marriage with psychiatrist Andrea Dotti. They had a son which named as Luca. She acted in ‘Always’ in 1989. That is the last movie of her. After 1980 she started to work as a goodwill ambassador of Unicef. She died on 20 January 1993 in Swetland because of appendicular cancer. PsychologÄ ±cal Analysis Of Audrey Hepburn wÄ ±th the perspectÄ ±ve of Adler Audrey Hepburn was born in 4th of May 1929 in Brussels, Belgium. Her mother name is Baroness Ella van, Heemstra. As you can guess from ‘Barones’ title, she is from a noble family. From her first marriage, she has got two children, Ian and Alex. She made her second marriage with Joseph Victor Anthony Ruston, who is the father of Audrey. Audrey is the only child of this second marriage. Also, this marriage ended traumatically too because Audrey’s father left them in the 9th year of the marriage. When we look at the parental style of this famÄ ±ly, we can Ä ±nterpret Audrey as a neglected child. She lÄ ±ved wÄ ±th her father only for sÄ ±x years. When Audrey was sÄ ±x years old, Ruston left them. Audrey told that event as ‘I adored my father. When he left us, he commÄ ±ted us to lÄ ±fe-long Ä ±nsecurÄ ±ty’(15).However Ä ±t Ä ±s not the only reason to classÄ ±fÄ ±ed Audrey as a neglected chÄ ±ld. When we look at the these sÄ ±x years we see that Audrey and Ruston communÄ ±ctÄ ±on dÄ ±d not very wellà § Audrey was love her father very much and she was trying to show her talents to her father. Unfortunately, she could not get the results of thÄ ±s trÄ ±als. (12) AccordÄ ±ng to Adler’s theory the neglected chÄ ±ld can need to others Ä ±n the future to recognÄ ±tÄ ±on and nurturance (76). As we can guess thÄ ±s predÄ ±ctÄ ±on fÄ ±ts to Audrey because she was a famous actress and her need for recognÄ ±tÄ ±on can be satÄ ±sfÄ ±e d through her fans. Also, Audrey Ä ±nterpreted that she has a mÄ ±strust about compassÄ ±on and she always felt grateful to ones who showed compassÄ ±on to her. When we look at her mother Baroness Ella van Heemstra, we can observe the other characteristic of neglected chÄ ±ld: havÄ ±ng unsupportÄ ±ve parent. Her mother gÄ ±vÄ ±ng advÄ ±ce to her Ä ±n an dÄ ±fferent way whÄ ±ch Ä ±s: ‘ You should thÄ ±nk about always thÄ ±nk about others. You are not an Ä ±nterestÄ ±ng person. Other people are more Ä ±mportant than you.’ (12). In addÄ ±tÄ ±on to that, Audrey had an performance Ä ±n New York. At the end of the show, Ella van Heemstra congratulated her: ‘ You dÄ ±d a good job, especÄ ±ally when we consÄ ±der that you do not have any talent’. So when the whole world talks about Audrey show, Ella van Heemstra could not satÄ ±sfÄ ±ed wÄ ±th her daughter talent. When we contÄ ±nue to look at Audrey’s lÄ ±fe, Audrey started a boarding school in England.In the end of summer 1939, England started a war to Nazis. Audrey and her mother moved into Arnhem again. However, after a time Nazis occupied Arnhem too. Nazis try to provoke Holland against the England. To conceal herself, Audrey learned Dutch and change her name to ‘Edda van Heemstra’. At this time, they lose communication with Audrey’s brothers. After that Ella began to take part in the Holland resistance. Because of the occupy, Arnhem conservatoire open it’s door without a payment. Audrey started to take classes about music and dance in there. In 1944, an operation held to the Nazis. This operation failed and a request which is about leaving the city is asked from the civils. Audrey and her family left the city and they moved into Velp city.They had really very awful days in there. As we see, Audrey had terrÄ ±ble, traumatÄ ±c memorÄ ±es from the war days. So, how can she can stÄ ±ll contÄ ±nue and adapt to thÄ ±s lÄ ±fe? According to Adler, Individual Psychology understand and analyze the whole events from the perspective of soul’s goal.(Adler, 2017). For that period, when we look at the goal of Audrey, she stated: ‘My passion about dance suppressed the fear which is towards to Germans.’ So, we can say that her goal shaped her life and helped to cope with the problems. When we analyze more deeply, we can find some reasons about the choosing this goal.Audrey’s memories show that, when she was ten years old, she took part in her school performance. At the end of the show, everybody –including her mom- applauded her with enthusiasm. (18) . Audrey was very happy. Adler supports that, a child’s goal includes the desire of being protected and get into the society. (Adler, 2017). Also

All Human Beings are Born Free and Equal in Dignity essays

All Human Beings are Born Free and Equal in Dignity essays When we say that all human beings are born free and equal in dignity we mean that we are all the same and we all have the same rights according to every little detail in life. It means that every human being has to have the same opportunity in life, example: in getting a job, education, or attaining resources necesary for life. The problem is that it doesn't go that way, instead its the other way around. Society divides the world in classes in which the higher classes get all the benefits while verry few people really mind the poor or lower classes. This attitude has been there for a while since the early ages. Since ages people have been up to abusing the less fortunate for their benefit. This is a tactic that has lead the now huge powers (ie: United States) to be the economic giants they are now and that made the 3rd world countrys what they are now. There is basically no way to make everything just for everyone because the moment everything is equall for everyone (which is the basis of comunism) someone wants more and doesn't care whom he/she hurts when he/she does what they want to make their lives more comfortable than other's and not mattering what happens to others. Finally the only thing we can do to fix this problem is to start a hands-on approach to helping under-developed country's to have a fresh, debt-less, economically stable, and comercially developed start to help them make a great nation out of themselves. Panama is also inside this category because the economy is truly decadent and the amount of poverty is exeding the necessary values to mantain a balance in society. In all injustice could just be whjat keeps us alive and happy, or the other way around. So again we can't fix the problem... but we can ameliorate it the best we can. ...

Sociology of Everyday Life

Sociology of Everyday Life Sociologists and philosophers have developed a number of theories to explain everyday life and other related issues such as social relations, face to face interactions, the construction and conception of social realities among others. While some sociologists believe that every day life is a stream of disorganized events, others contradict this view and propose that daily events are deliberately contracted.Advertising We will write a custom essay sample on Sociology of Everyday Life specifically for you for only $16.05 $11/page Learn More This is among the many definitions of sociology of everyday life (Allan 53). The sociology of everyday life is important to the study of Sociology since it enables sociologist to understand the complexities of everyday life and the factors that determine social interactions. Harold Garfinkel and Erving Goffman are among major sociologists who have contributed to the study of sociology of every day life. Goffman and Garfinkel agree that there exist social rules which govern daily lives. By following these rules, people become actors. Furthermore, through daily interactions people express themselves. Therefore, Garfinkel’s and Goffman’s contributions are vital to the understanding the sociology of everyday life Garfinkel’s and Goffman’s ideologies on the sociology of daily life have been interpreted differently by critics. However, the two sociologists agree that through social interactions, societies are made (Allan 257). Garfinkel and Goffman further agree that there exist rules which govern how people interact. These rules are socially constructed and are the basis of establishing a well ordered society. Goffmanian school of thought postulates that social rules are useful in daily life interactions since they not only help in directing social interactions but also help people to make â€Å"social meaning and the definition of the self† (Maynard 278). In this regard, Goffmanian school of thought suggests that self identity is created through social interactions. To explain this concept, Goffman uses heterosexuals as examples and suggest that heterosexuals can determine how people perceive them by managing how they appear in public. According to Garfinkel daily interactions are governed by preexisting rules which cannot be easily changed (Allan 83). This implies that the society is made up of rigid rules, whose adherence determines how people fit into it. Garfinkel and Goffman acknowledge that societies cannot exist without rules. Furthermore, both Goffman and Garfinkel focus on the relationship between people and these rules. Both Garfinkel and Goffman postulate that people’s lives are governed by existing rules. This suggests that people are actors in every day life. Goffman suggest that rules enable people to conduct daily interactions. By asserting that rules are interactions enablers, Goffman elevates people above the rules.Advertisin g Looking for essay on social sciences? Let's see if we can help you! Get your first paper with 15% OFF Learn More This means that social rules exist to serve the complex and dynamic nature of human interactions needs. As such, the rules can change or be violated as human needs evolve. Goffman adds that violating the rules does not threaten social interactions but enables actors to derive new social meanings. As such, through social interactions, people portray their self-centeredness (Allan 56). Similarly, Garfinkel explains that social interactions occur within rigid social rules. However, Garfinkel contradicts Goffman and explains that social norms do not change within the course of interaction. As such people become actors since they follow predetermined social norms. This implies that, unlike Goffman, Garfinkel elevates social rules above the actor. As such, the rules do not exist to serve the actor but to govern the way the actors conduct daily interact ions (Maynard 278). Therefore, actors have to continuously learn what the society requires of them so as to maintain social order. Both Garfinkel and Goffman assert that daily interactions are a way of expressing the self. Garfinkelian school of thought postulates that a person is made up of two major components; personality and the self. These components don’t evolve but are constructed. The self is different from the personality. Sociology does not explain personality since the personality is not constructed socially. Rather, it is constructed psychologically. On the other hand, psychology cannot explain the self since the self is constructed socially. Therefore, self identity is constructed through the sociology of everyday life. Garfinkelian school of thought concludes that daily interactions not only help to construct but also to express the self (Allan 54). Similarly, Goffmanian school of thought stipulates that the self is expressed through social interactions. The sel f is covert and the only way it can be revealed is through face-to-face interactions. Through these interactions, people give social signal which reveal personal traits. These social signals help others form notions about us (Allan 157). As such, Garfinkel and Goffman suggest that social interactions not only help in forming self identity but also expressing it. Garfinkel and Goffman have made major contributions to sociology of everyday life, with significant effects on the wider field of sociology. The two sociologists have asserted that the society is a product of social interactions since people construct and derive meaning through face to face interactions. Within the process of daily interactions, there exist rules which govern how people interact. As such, people become actors. Social interactions are also significant since they not only enable people to express themselves but also in contracting self identity. Despite the fact that Garfinkel and Goffman differ on some aspect s, their theories have made significant contribution to sociology of everyday life.Advertising We will write a custom essay sample on Sociology of Everyday Life specifically for you for only $16.05 $11/page Learn More Allan, Kenneth. Contemporary Social and Sociological Theory: Visualizing Social ` Words. Thousands Oaks, CA: Pine Forge Press, 2010. Print. Maynard, Douglas. â€Å"Goffman, Garfinkel, and Games.† Sociological Theory 9.2 (1991): ` 277-279. Web.

In the film V for Vendetta V says that violence can be used for the Essay

In the film V for Vendetta V says that violence can be used for the good in the context of social justice. Do you agree Why or why not Use specific historical examples to support your argument - Essay Example According to the movie, V has tried to depict a different side to the aspect of violence altogether, by stating that it can be used for the good of social justice and this paper helps to provide an insight into the very aspect of the film through V’s actions and how they may be used for the good of society. V tries to make use of strategy rather that muscle power in order to come up with the best possible way to tear down the tyrannical rule that the society was bound by. The only emotion that motivates him is revenge and he is often seen being overshadowed by the demarcation between revenge and justice. He has a common goal to unite the people of dystopian Britain to overthrow the dictatorship that had been established by the use of force however he soon realises that his own will to seek vengeance gets caught up in the bigger picture. (Huck) He says, â€Å"Anarchy wears two faces, both creator and destroyer. Thus destroyers topple empires; make a canvas of clean rubble where creators can then build a better world.† In the quest for attaining freedom, V decides that he must overthrow the tyranny that existed in the form of the oppression that the people were facing. He was justified in bombing and attacking the place because the people that he ended up killing, namely, Adam J, Susan, Delia and Surridge were people who had committed heinous crimes in the past and had led to the destruction that persisted in the scenario at the time. In this case thus, violence has been justified to be done for a moral cause because someone had to make an attempt to overthrow the people who had been causing social chaos. Violence sometimes does allow for social change to enter because it is the only efficient tool that can be used to stop other forms of violence from happening. As seen in the past however, leaders in modern day reality, like Martin Luther King Jr and Mahatma Gandhi, preached the use of non violence to resist

JFK Assassination and Conspiracies Research Paper

JFK Assassination and Conspiracies - Research Paper Example This alleged attack caused serious wounding to Kennedy along with the injury of Connally himself. After approaching to the hospital, the death of Kennedy was announced thirty minutes later, by the hospital, named as Dallas Parkland. Kennedy was 46 at the time of his assassination. Vice president Lyndon Johnson was elected as the 36th president of United States on the same day. November, 25 was announced to be the day of Kennedy’s national mourning, in which hundreds of Americans lined up in the streets of Washington in the respect of Kennedy. JFK’s assassination has been backed by numerous theories up till now. The investigation of ten-months done by Warren Commission concluded that Lee Harvey Oswald was the murder of Kennedy. Lee Harvey has been investigated to act alone in the killing of Kennedy. The conclusion given by the Warren Commission was highly supported by the American public, with the percentage of 80, between 1966 and 2003. In 1998 the CBS polling resulted that, 76 percent of Americans believed JFK assassination, as a fact of conspiracy. Lee Harvey used to work in Marines, in 1936 and discharged from there in 1962 (Kurtz 56). He was originally from New Orleans. His return to the United States was in 1962, along with his wife and an infant child. It has been also investigated that, in early 1963 Oswald bought a .38 revolver along with a telescopic sight. He bought both of the equipment by mail order. In October 1963, Lee joined Texas School Book Depository building as an employee. The record of Lee had always been involved into some illegal activities, as a criminal. It is concluded to be Oswald, firing the bullets on Kennedy. He got arrested within half an hour after playing shots on the president Ruby, who was also connected to the criminal world. Lee Harvey Oswald was shot to death, by Jack Ruby. On the

Development and Evaluation of Participant-centered Biofeedback Essay

Development and Evaluation of Participant-centered Biofeedback Artworks - Essay Example Research Question: Is there biofeedback that is associated with rap and hip-hop visual art and which depicts different experiences and reactions among individuals? If there is or isn’t a reaction, how does it relate to the mind – body experience? ABSTRACT (your descriptive summary of what the research article is about – write last – and write as if this paragraph was to be included as part of a literature review for a research paper) The concept of physiopsychology is one which is now being approached in society as an essential component of experiences in art work. Specifically, it states that there is an association with art and everyday life, as well as how this relates to both the mind and the body, as well as associations with experience and how this changes specific influences (Khut 2006: 24). Examining the mind – body influence in different pieces of art work also creates a different understanding of the importance of art while questioning wha t types of effects it has on individuals and society. This paper examines the mind – body effect and experiences in rap and hip – hop visual art as a genre as well as how this affects the individual experiences, interactions and reactions within society. This examination will help to further designate the way in which this genre is associated with behaviors, characteristics and concepts that are associated with the physiopsychology of hip hop visual arts. OVERVIEW Detailed Content Summary Purpose The purpose of this study is to show how the mind and the body link together in the creation of artwork. It also shows how specific aesthetical techniques link to the mind – body relationships and create a sense of reflecting experiences through the use of aesthetics. This will be done specifically with the mind – body link to hip hop and African – American visual arts as a genre, specifically because it carries a specific type of interactions and messages to society that might work positively or negatively with the mind – body experience. References The references to be used will be based on others which have studied the mind – body relationship to various types of artwork. This will be combined with studies that have been given in relation to hip hop and rap visual art which have shown the mind – body relationship. There will also be references in terms of the overall ways in which the physiopsychology is linked to art work, specifically to define and show the relationship with art and everyday life, as well as how different components affect the mind and body. Theoretical Frameworks The first theory used will be based on biofeedback. This states that there is a direct relationship to the mind and body because of the aesthetics that are defined within a given art work (Khut, 2006: p. 18). There will also be reference to this same theory in terms of somaaesthetics, which states that there are influences within e xperiences and which shows that there are practical relationships which can be determined when interacting with various types of artwork (Khut, 2006: p. 29). Another set of theories will be based on the concepts of cultural identities. This forms the individual experiences, behaviors and attitudes which are created and also build a specific type o

Project Management Organizational Structures Paper Research

Project Management Organizational Structures - Research Paper Example Each form of organizational structure has its strengths and weaknesses, and is able to handle particular projects based on the context. Functional organizational structure involves divisions based on major functional areas such as marketing, finance, human resource, manufacturing, and so on (Meredith and Mantel, 2012). Functional organizational allows flexibility in staff planning and resource allocation because functional divisions can act as the administrative base for a project. Further the functional unit may be specialized to tackle the project thereby providing the technical expertise required to successfully complete the project. Additionally functional structure allows the technical expertise and know-how to be concentrated in the units and hence available to work on different projects. The staff can be shifted from one project to another while the functional division continues to provide a pool of experiences and specialized staff (Meredith and Mantel, 2012). The functional division acts as the center of specialists which ensures availability of specialized staff to work on different projects. The presence of experienced staff also enables the relevant expertise to be channeled into the project for successful execution and completion of the project. Lastly, the functional organizational structure organizes the specialists in a unit so that the arrangement not only helps in project execution but also in the advancement of the appropriate talent. A downside to functional organizational form is that it puts clients at the backseat. Often client interests are not the focus but functional units focus more on the work and how the expert staff is allocated to the projects (Meredith and Mantel, 2012). This sometimes leads to client interests to be ignored. The fact that the functional organizational form deals with functional areas means that the form is more inclined towards the activities involved in the project completion. It is

Criminal justice Essay Example | Topics and Well Written Essays - 250 words - 1

Criminal justice - Essay Example The jury’s successful conclusion means that they have successfully found the defendant guilty or not guilty based on the testimonies and evidences presented to them. It is important to note that the jury’s successful conclusion is, in the same manner, the judge’s successful conclusion, not only the judge intervenes in the verdict made by the jury. The victim and the defendant’s successful conclusion means that the verdict favors them. This is similar to the prosecutor and defense attorney’s successful conclusion, wherein, it collides. Of course, the successful conclusion of the victim is when the court rules in their favor and puts the defendant behind bars, or worse. And the successful conclusion of the defendant is when the court rules in their favor and sets them free. A successful conclusion in the courtroom depends on the position, the side and the role of the participant. The judge and the jury are the one that dictates the successful conclusi on because they give the decision. But the victim and the defendant may have different views whether it is successful or not depending on how their testimonies and evidences are accepted by the court.

Cuban Missile Essay Example | Topics and Well Written Essays - 500 words

Cuban Missile - Essay Example John F. Kennedy was the US president during this time of crisis. He therefore had to make swift moves to avoid going into war with the Soviet Union. As Robert Kennedy and Arthur Jr. Schlesinger portray in their book In Thirteen Days, they applaud John F. Kennedy for the way in which he handled the crisis.Kennedy’s team of Executive Committee of the National Security Council (ExComm) congregated and deliberated on different ways to deal with the crisis. As Robert puts it, they considered several options. The first one was invading Cuba, option two was ordering air strikes with the intention of taking out the missile areas, the other option was imposing a blockade around Cuba. This was aimed at keeping out the undelivered missiles. The fourth option they considered was presenting a private ultimatum to Nikita Khrushchev and in the event that the missiles were not removed, then a military action was to be taken. The fifth and the last option was to present some offer of trade for the missiles in Cuba and those in Turkey.The fifth option was fronted and therefore at the heart of the crisis Kennedy’s administration agreed to withdraw or remove the US missile s from the republic of Turkey and in exchange the Soviet Union was to also remove their nuclear forces from Cuba. The US central concession handled the matter in secret unlike the Soviet who came out in public. The US thought that the idea of withdrawing from the republic of Turkey would have seen the administration that was in place as weak.

Project Management Organizational Structures Paper Research

Project Management Organizational Structures - Research Paper Example Each form of organizational structure has its strengths and weaknesses, and is able to handle particular projects based on the context. Functional organizational structure involves divisions based on major functional areas such as marketing, finance, human resource, manufacturing, and so on (Meredith and Mantel, 2012). Functional organizational allows flexibility in staff planning and resource allocation because functional divisions can act as the administrative base for a project. Further the functional unit may be specialized to tackle the project thereby providing the technical expertise required to successfully complete the project. Additionally functional structure allows the technical expertise and know-how to be concentrated in the units and hence available to work on different projects. The staff can be shifted from one project to another while the functional division continues to provide a pool of experiences and specialized staff (Meredith and Mantel, 2012). The functional division acts as the center of specialists which ensures availability of specialized staff to work on different projects. The presence of experienced staff also enables the relevant expertise to be channeled into the project for successful execution and completion of the project. Lastly, the functional organizational structure organizes the specialists in a unit so that the arrangement not only helps in project execution but also in the advancement of the appropriate talent. A downside to functional organizational form is that it puts clients at the backseat. Often client interests are not the focus but functional units focus more on the work and how the expert staff is allocated to the projects (Meredith and Mantel, 2012). This sometimes leads to client interests to be ignored. The fact that the functional organizational form deals with functional areas means that the form is more inclined towards the activities involved in the project completion. It is

Cuban Missile Essay Example | Topics and Well Written Essays - 500 words

Cuban Missile - Essay Example John F. Kennedy was the US president during this time of crisis. He therefore had to make swift moves to avoid going into war with the Soviet Union. As Robert Kennedy and Arthur Jr. Schlesinger portray in their book In Thirteen Days, they applaud John F. Kennedy for the way in which he handled the crisis.Kennedy’s team of Executive Committee of the National Security Council (ExComm) congregated and deliberated on different ways to deal with the crisis. As Robert puts it, they considered several options. The first one was invading Cuba, option two was ordering air strikes with the intention of taking out the missile areas, the other option was imposing a blockade around Cuba. This was aimed at keeping out the undelivered missiles. The fourth option they considered was presenting a private ultimatum to Nikita Khrushchev and in the event that the missiles were not removed, then a military action was to be taken. The fifth and the last option was to present some offer of trade for the missiles in Cuba and those in Turkey.The fifth option was fronted and therefore at the heart of the crisis Kennedy’s administration agreed to withdraw or remove the US missile s from the republic of Turkey and in exchange the Soviet Union was to also remove their nuclear forces from Cuba. The US central concession handled the matter in secret unlike the Soviet who came out in public. The US thought that the idea of withdrawing from the republic of Turkey would have seen the administration that was in place as weak.

Design of Water-Based Fire Protection Systems Essay Example for Free

Design of Water-Based Fire Protection Systems Essay Water pressure is the energy that powers sprinkler system, so it is very important. Water flow creates pressure which generates energy that moves water through the pipes. Flow is the measurement of water required for the smooth flow of water to perform the required task. But the fire sprinkler requires much needed effort to provide improved fire protection against high challenge fire hazards. A sprinkler gives fast response with great supply water and increases the fire suppression capability. Installation of fire sprinkler system requires certain specific construction, performance installation and operation. For e. g. the discharge coefficient of sprinkler is nominally must be within the range of 13. 5-14. 5, where the discharge coefficient is calculated by dividing the flow of water in gallons per minute through the sprinkler by the square root of the pressure of water supplied to the sprinkler in per square inch gauge. Sprinklers were initially designed to control fire with thirty-foot ceilings In United States, water pressure is measured in per square inch and water flow is measured in gallons per minute. The maximum water supply is depend upon number of conditions such as length of pipe, the place mere fire catch up, the amount of water pressure. The method to measure the water supply depends upon the source of water. The measuring process differs in city water systems, water from tank. Sprinklers were initially designed to control fire with thirty-foot ceilings where flammable stock such as plastics such as plastics is kept 25-foot high in racks. Whereas in some cases available water supplies is not capable of creating that much pressure required for the control of fire, then a supplementary pump can be used to increase the content of water pressure before sprinklers. Therefore, water quantity needed for sprinkler system should be determined according to the suitable method so that waste should not be wasted or misused. REFRENCE Referred to sites: 1. http://www. patentstorm. us/patents/6336509-description. html Low pressure fast response bulb sprinklers 2. http://www. extremehowto. com/xh/article. asp? article_id=60335 Designing a Sprinkler System Jess Stryker Dated 3rd August 2007

Effectiveness Of Non Medical Nurse Prescribing Primary Care

Effectiveness Of Non Medical Nurse Prescribing Primary Care Nurse-led clinics have been increasing for some time and Marsden (1992) identified the benefits of using specialist nurses to compliment services already offered by doctors. Read (1999) defined nurse-led care as being the interface between nursing and medicine. Miles (2003) cited ten individual authors as saying that research shows that nurses are capable of carrying out procedures usually in the domain of doctors, often resulting in greater patient satisfaction. Patient satisfaction is an important quality indicator. Yellen (2002) felt that the measurement of patient satisfaction with nursing care was particularly important as it provided a good measure of overall satisfaction with services. Ford (1997) agreed with this principle but concentrated more on the competitive edge and financial survival being reflected in patient satisfaction. Cohen (1994) advocated the use of satisfaction questionnaires, but both Avis (1997) and Westbrook (1993) doubted their efficacy, questioning the validity of questionnaires and the way in which they are measured. Westbrook (1993) felt that questionnaires may be limiting and poorly evaluated, giving rise to a poor reputation for satisfaction questionnaires. Duffin (2002) commented that questionnaires with tick boxes appear to have limited use and may include leading questions where there is no scope for the patient to enlarge upon their answers. Both Robson (1993) and Wiles (1996) warned that the results of surveys can sometimes paint a falsely positive picture and may be difficult to translate into a course of action. However, Backhouse (2000) says that the power of a successful nurse-led user satisfaction survey lies in the immediacy and relevance of the results. This may have enormous potential to transform practice, especially if the staff are able to remain positive about any possible negative feedback. Backhouse (2000) commented that nurses may tend to take praise for granted, as a regular stream of cards and thanks is often the only feedback they receive. This may produce the belief that the service is satisfactory, but it has been found that although there is a great deal of satisfaction, there is also some dissatisfaction, particularly with respect to information (McColl (1996), Backhouse (2000), Byrne (2000), Duffin (2002)). As a Business Manager in General Practice in an affluent rural environment, the author has found that there are increasing frustrations and limitations with time and resources where a competent healthcare professional could manage a patients care more than adequately during one appointment. Additionally, continuity of care and health care management in a more patient centred, balanced way could benefit the patient. Discussion around the management of their medicines and general health education could aid to the patient taking responsibility for their own health care management. The Welsh Assembly Government (WAG) (WAG 2001, WAG 2005) has prioritised patient access to primary care services for the last few years which has impacted on patient expectation around the need for an urgent appointment. This has caused pressure on appointment systems, and subsequently changes have been made to deal with the demand. One way in which the practice would like to cope with these demands is by enabling the Senior Practice Nurse to give more holistic care, making the consultation seamless for the patient, thus reducing the need for additional appointments, having already consulted with an appropriate healthcare professional (WAG 2001, WAG 2005). This practice nurse is currently undertaking the Independent Nurse Prescribing (non-medical). When qualified, this will tie in with the nurse-led diabetes clinic and Minor Illness clinics for which she is qualified. The natural progression would be for her to prescribe appropriate medicine or dressings in relation to the competencies she has accumulated following evidence based practice in these disciplines. A nurse may spend a considerable amount of time dealing with the assessment and management of a patient, then waiting outside a GPs door for a prescription to be signed. This situation is far from ideal, and with the enhancement of the prescribing qualification, this could be done in a more appropriate way. This literature review looks at aspects of nurse prescribing in primary care, and how this can lead to patient satisfaction, autonomy and job satisfaction for nurse prescribers. Literature Search Strategy (Method: 10% c350 words) 582 LoBiondo-Wood (2002) describes a literature search as an efficient retrieval of scholarly literature related to the topic of interest, while Cormack (2000) describes a literature search as a review of previously written literature on a related topic in order to provide the researcher and the reader with knowledge of the field being researched. Research literature can originate from many sources. The volume of literature would be unmanageable if careful selection was not carried out (Cormack 2000, LoBiondo 2002). Polit (2004) recommends using electronic databases to locate relevant research information and points out the limitations of manual and internet sources as being time consuming and inconvenient, internet searching possibly not providing required results and bibliographic information. Polit (2004) likens locating all relevant information on the chosen subject to being like detective work. Primary research only was sought. CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature) with Full Text and MEDLINE were used to search for key words non-medical AND nurse prescib AND primary care with published dates between January 2004 to present, resulting in 209 hits. These were restricted to research, years 2004-2010 and English-only articles in order to reduce the number of articles to 29. Playle (2000) suggests that the title of a research article is extremely important and should cover focus as well as identifying the research approach used (McCaughan, 1999 Stevens et al, 1993). In the authors case, an informative abstract facilitates the choice of research article. The abstract or introduction, as Bailey (1991) suggests it should prepare the stage for the problem to be investigated, as well as being brief. As suggested by Playle (2000) a well written abstract identifies the main points of the study, although the main weakness can be the word restriction as suggested by Burns and Grove (2001). It should represent an accurate picture (Reid, 1993) of the study with concise methodology, sample subject, reported findings and conclusion. This would enable any reader to base a decision to read the article (Reid, 1993). The rationale for choosing the critique guidelines from Benton Cormack (2000) is based on the convenience and manageability of a well structured process that enables to author to appraise with ease. A literature review is an important element of a research question. Rees (2003 p. 17) indicates that a thorough review of the literature is essential to provide the theoretical and conceptual context for the study. Parahoo (1997) supports this stating a literature search provides the identification and locating up to date material, relevant to the topic under review. It involves the scanning along with critical reading of the literature chosen to assess usefulness to the question under discussion. The authors knowledge and prior reading of literature directed at change management in primary care dictated the final choice of research articles to Richards, L.A; Richards, A; Gilead, L; Stessman, J; blab la bla and Raz, I (1999) title of an article International Journal of Dermatology 38, 623-627 (appendix 1). Those chosen for review were three qualitiative and one quantitative research articles relating to the question under evaluation. AUTHORS All eleven authors have either the appropriate professional qualifications or academic qualifications, for example MD or PhDs. A further research on the authors names and using databases CINAHL and Medline xx to present showed that between them they have published xxx articles in various medical journals with different topics. Most have no bearing on the subject of maggots and wounds blab la bla, while most of them have some bearingà ¢Ã¢â€š ¬Ã‚ ¦. The review (50% c1750 words) 2168 THE REVIEW (PAULAs) LITERATURE REVIEW A good literature review draws on a wide range of sources (McCaughan, 1999) and will identify the need for research. Nevertheless, A poor literature does not invalidate the findings but a good one does enhance the status of the research (Stevens et al, 1993:135). HYPOTHESIS A hypothesis is not included and an explanation could be that the aim of this study is to provide new information by utilising a descriptive research method. Burns and Grove (2001) suggested that if there is very little or no research being conducted on a particular question, then researchers state objectives or questions and there is an objectiveà ¢Ã¢â€š ¬Ã‚ ¦. OPERATIONAL DEFINITIONS Quantitative research should have all terms explained or defined. Stevens et al (1993) refer to common error by researchers in the assumption that readers are knowledgeable about the jargon and terminologies employed. METHODOLOGY The research approach is not acknowledged within the article. Howedver, it can be assumed that the approach is quantitative, in that it involves manipulation of the independent variable.. On the other hand, to provide the strongest evidence with a greater degree of à ¢Ã¢â€š ¬Ã‚ ¦.. Also included are certain qualitative components such as à ¢Ã¢â€š ¬Ã‚ ¦.. that would indicated possible combination of the two approaches, qualitative and quantitative. Using this combination in approach to research may not appear to be very scientific, however Docherty (2000) suggests that this method may produce a more meaningful and richer data. Even so, there is strength and weakness to both approaches and neither have been stated within this study. On the other handà ¢Ã¢â€š ¬Ã‚ ¦ but backed up with à ¢Ã¢â€š ¬Ã‚ ¦. And the author agreed with this type of approach as it enables a reader to scrutinise the data, without having to be familiar with research methodology, data statistics or the terminology. SUBJECTS The subjects are identified as 43xx in five depts. Of xx hospital à ¢Ã¢â€š ¬Ã‚ ¦. Nevertheless, many potential or suitable candidates for this type of research may be unwilling to participate (burns Grove, 2001 and Reid Boore, 1987) due to the xxxx. SAMPLE SELECTION The approach to the sample selection is not clearly stated and a good research study should explain the sample selection method as suggested by Baxter (2001b). Howeverà ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ On the other hand, all the subjects are typically,à ¢Ã¢â€š ¬Ã‚ ¦. DATA COLLECTION Data collection procedures areà ¢Ã¢â€š ¬Ã‚ ¦.. not acknowledgedà ¢Ã¢â€š ¬Ã‚ ¦.. The validity and reliability are undefined within this study and McCaughan (1999) suggests that if the researcher has not mentioned testing for reliability and validity then it is unlikely that it has been done. ETHICAL CONSIDERATIONS Xxxxx ethical committee à ¢Ã¢â€š ¬Ã‚ ¦.. In the authors opinion, ethical consideration should have been an important part of this articleà ¢Ã¢â€š ¬Ã‚ ¦.. Nonetheless Appendix 3 shows/à ¢Ã¢â€š ¬Ã‚ ¦.. As suggested by Matthews Venables (1998) every published research report should include a description on how the informed consent is given. On the other hand, lack of acknowledgement of anonymity, confidentiality as well as the description of informed consent does not necessarily mean they have not been considered (Firby, 1995 McCaughan, 1999), merely that the researchers assumed that the results and method were more interesting to the reader. RESULTS The results are presented as xxxxx and backed up by xxx, which showed that xxx. However, quantitative data is limited wtug xxxx. In spite of this, there is sufficient detail that would enable a reader without any research experience to look at the results and understand what they signify and to judge with confidence the findings. DATA ANALYSIS The data analysis is appropriate to the type of data collected that is percentages and for the type of read that xxx was aiming for. In some ways the method employed is simple and easy to replicate. However, thereà ¢Ã¢â€š ¬Ã‚ ¦ Clarke (1999c) suggests that the data analysis relies heacily on the researchers skill and judgement to see that it is accurately exeuted, also not reported are values such as test values df and p. In addition, poor quality analysis will render the data anecdotal and unfocused, yet the analysis is focused, credible and to improve upon this, the author would suggest the inclusion of statistical tables. DISCUSSION The discussion is not really balanced, as it only mentions and draws upon xxxx However, what is discussed is very concise and knowledgeable. There is also no acknowledgement of the limitations or weakness of this particular stify and there is only one reference to disadvantages, THAT IS à ¢Ã¢â€š ¬Ã‚ ¦.. (Teresas) LITERATURE REVIEW The aim of the literature review was to find out what the nurses role is in primary care, in relation to providing xxxxx. To assist in the critiquing process, quantitative and qualitative papers were reviewed using the Benton and Cormack (2000) framework. Although the author finds this framework comprehensive and simplistic, it is noted Rees (2003) states qualitative and quantitative research are extremely different, and same method of critiquing cannot be used. This opinion is not upheld by Benton and Cormack (2000) as they promote the use of one framework for both. Within the articles reviewed the evident themes that emerged are xxx and xxxx. In order to guide the reader to continue reading a paper, the abstract should set the scene for the rest of the report. Playle (2000) states an abstract that is soundly written will list the main points of a study. It is noted three out of the four articles reviewed have concise detailed abstracts. Although, that by xxx (2006) lacked depth, understanding and did note cite up to date government papers to support the topic of xxxx. Burns and Grove (2001) highlight that a potential weakness noted wihin Gibbs et al (2004b) paper was the difficulty the reader encountered at determining whether the paper was quantitative or qualitative. Parahoo (1997) concedes this should have been obtained within the abstract, as this should briefly summarise the method, sampling and main findings within a study. Within the abstracts of the articles reviewed, the researchers have clearly portrayed and accurate image of all study methodologies, reported findings, sample subjects and conclusions. EDUCATION Gibbs et al (2004a) initial quantitative research paper tested one hundred and forty-one general practitioners and sixty-six practice nurse opinions relating to xxxx. Results favourably showed that ninety-seven percent of practice nurses raised xxxx but the article concluded xxxx within primary care and mainly relied upon xxxx. Leading on from this study, Gibbs et al (2004b) carried out a quantitative study involving eight general practices and one thousand five hundred and forty-nine kxdffdsdf. The article reports on xxxx. This quantitative paper involved structured interviews where questions were asked in a planned format. A structured interview involves set questions with no deviation from these (Parahoo 1997). A limitation of the study was the elevated drop-out rate but positively forty percent achieved a five percent or more weight loss at twelve months. It highlights whether the researcher has performed the study in a logical, systematic method, having paid attention to pointers that may influence the accuracy of the results (Rees 2003). Although Burns and Grove (2001) argue that a rigorous study should have exact measurement tools, a representative sample and a tightly controlled design. Audit was conducted in all practices prior to the study, where measurement tools such as weighing scales, height measure and large blood pressure cuffs were assessed. The provided consistency of the tools used at each centre along with evidence of their validity. Validity refers to whether an instrument measures what it stated to be measuring whilst reliability relies upon individuals using the tools and reporting accurate measurments obtained (Carter and Porter 2000). It was noted those practices participating in this study were self-selected, already having an interest in obesity management, thus possibly weakening representations. It was encouraging that a cross-section of those involved included large practices, rural, urban, single handed and those fro low deprivation areas. This appeared to provide a representative population with no evidence of bias selection. The xxxx project was ethically approved by xxxx. In contrast Moore et al (2003) in a cluster randomised control studyxxxxxxxx Cluster randomised trual means the sampling frame are geographically spread or the individual elements of the population are not know (Rees 2003). The advantage of this process is achievement of an accessible sample from an almost impossible total population (Rees 2003). Donnan (2000) states experimental research is the gold standard way of representing in a rigorous style that a treatment or intervention is effective. It concludes it si an essential tool for qualitative evaluation of a studys worth. Greenhalgh (2006) draws attention to the fact that publication of an article does not mean the evidence is robust. In conclusion as found in xxxx. Rees (2003) states bias is anything that distorts or affects a study, potentially altering or influencing the accuracy of the findings. Results noted that xxxx. They conclude more in=depth training of health professionals is needed xxxx. This would involve further implementation of training progrmmes and additional research. Ethical approval was granted by the xxxx ethics committee. The research paper by XX (2007) mixes quantitative and qualitative approaches and is known as triangulation,. Docherty (2000) suggests use of triangulation provides richer, more meaningful data. Holloway and Wheeler (2002) support this method stating it to be a way of obtaining rigour in qualitative research. Rees (2003 p. 235) lists this as being the use of more than one method of data collection within the same study in an attempt to produce more accurate information and understanding. This was a cross-sectional study with questionnaires being completed by forty General Practitioners and forty-seven practice nurses. A limitation to this study was no indication was made of the total number of initial questionnaires sent out in comparison to the response rate. A cross-sectional study is a survey that gazes at a situation at one point in time (Rees 2003). The qualitative results by xx (2005) were not shown within the report and rigour was disputed on reading the research paper as a full conclusion of the findings could not be made. It is realised word restriction could be the main reason for the results being omitted, but unfortunately it leaves the reading having to guess what they might have concluded. Ethical approval was supported by xxxx. In comparison with Gibbs et al (2004b) article the outcomes indicated mirror one another, with both papers coming to the conclusion that opportunties for xxxxxx in primary care are often missed or inadequate time given to education and support. Although the report by xx(2-3) shows xxxx, it was indicated this was in accordance with increasing responsibilities in implementation of chronic disease management. It is highlighted in the report that caution regarding results needs to take place. Also this article, although mainly quantitative, has a small sample size. Parahoo (1997) states quantitative research usually involves large numbers in probability samples. The importance of large numbers aims to lessen the chance of bias and correctly achieve statistical procedures (Rees 2003). A pilot study was not carried out prior to this research. Piloting of a questionnaire increases research validity and reliability as it highlights any anticipated problems accessing data, and ensures the method used to gather data works (Parahoo 1997). Research should be instigated because the researcher wants to extend knowledge base and understanding through rigorous collection of information, answering a question objectively and with accuracy (Rees 2003). SUPPORT Soanso (2009) article is a qualitative study and deals with support and perceptions of the patient who is obese. This is a primary study that reports research findings first hand (Greenhalgh 2006). Rees (2003) states to have involvement in qualitative research and understand a topic, individuals first have to see it through the eyes of those who experience it. This method aims to summarise perceptions, experiences, behaviour or interpretations. This process included a qualitative study with semi-structured interviews drawing on grounded theory methodology. Grounded theory aims to produce a concept or explanation that is grounded in the results and arises inductively by researchers understanding and analysis (Rees 2003). Polit et al (2001) strongly supports interviews stating they by far outweigh questionnaires. The response rate is higher, reaching a wider population than questionnaires, are less likely to mislead those reading the questions and provide wealthier data. Rees (2003) ag rees with the above adding, those involved can experience the belief of being in control and positively feeling more valued. It is noted there are disadvantages such as high cost, participants providing socially acceptable answers, affect of interviewer status and difficultly in expressing feelings (Rees 2003). Five general practices from differing socioeconomic backgrounds in Sheffield were involved with interviews conducted at their homes. This provided a varied population adding rigour to the study, and it could be generally assumed an individual would feel more comfortable being interviewed within their own surroundings. Although, it can be argued that interviewers have less power to control the interview within this environment as there is no assurance that the interviewee will maintain a safe place with no interruption, disturbance or being overheard (Pontin Webb 1995, Webb Pontin 1996). Kdfsdfsfhskdfhsd. Ethical approval was sought prior to this study from xxx Ethics Committee. Application to clinical practice (30% c 1050 words) 1086 APPLICATION TO PRACTICE At present within the authors practice setting issues of xxxx are raised xxxx. Since April 2006 the General Medical Service Contract (National Health Service 2006) awarded points for the xxxx. This critical review of the literature has aimed to answer the question: xxxxxxxxxxxxxxxxxxxxxxxxx? It is well documented that xxxx. Research that has been carried out in an ethical manner and is of robust design can benefit all involved and improve practice (Royal College of Nursing 2004). The document Best Research for Best Health (Department of Health 2006a) states research provides the support and evidence to tackle increasing challenges that disease and ill health have placed on society. This document supports a pilot study within primary care in England to improve evidence based practice of care by facilitating the conduct of clinical trial and other well designed studies. It would hardly be an exaggeration to say, pending successful results in 2014, the use of this structure within primary care in Wales could potentially benefit application of much needed research findings into practice. Findings of this review showed the counterweight project by Gibbs et al (2004a, 2004b) provided the best evidence of implementation within practice, showing xxxx. The Cochrane Library for Sytematic Reviews (2004) supports the Counterweight Project (2004b) stating The Counterweight Programme is an evidence-based weight managmentxxxx Brown Psarou (2007) in their literature review also supported this project stating it was rigorously conducted and soundly funded. Presentation of these research findings were undertaking xxxx. Banning (2005) suggests the management of obesity should focus on xxxx. The National Institue for Clinical Excellence (2001) states that primary care nurses are ideally placed to manage and assess obese individuals. This comprehensive package addresses issues and management of à ¢Ã¢â€š ¬Ã‚ ¦.. The material is simplistic with the alforithm providing an easy guide for the primary care nurse to follow, The à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ pathway opportunistically at routine appointments or reviews. To implement this in the clinical setting, xxxx. Successful implementation of this pathway into the practice setting would require change management issues to be addressed. Implementation of change following research can be a difficult process. Resistance, resentment and jealousy can all impede implementation of the change process (Cormack 2000). To overcome resistance to change the key factor is leadership, along with effective communication and a sound understanding of what motivates people (LaMonica 1994). Those involved in the change process must be kept informed and involved at each stage of change. Individuals like equilibrium and are keen to be involved once they know the process will not cause problems or a change of workload (Broome 1998). (Paulas) CONCLUSION A conclusion was included within the abstract, xxxx As suggested by McCaughan (1999) and Playle (2000), there is a restriction placed on researchers and authors by publications to condense from a much larger and more detailed research report. It can be assumed that this is the case with this research article. However, as suggested by Baxter (2001c) that in qualitative research to aid the flow and understandings, discussion and conclusion are kept together under one heading. In the authors opinion, the conclusion should have à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ RECOMMENDATIONS Stevens et al (1993) suggests the realistic researcher would draw conclusion from the data presented and then make further recommendations on what other research is required. However, there is no heading of recommendation or any indication that one was included. Alternatively, suggestions for further research studies and in the authors opinion threr should have been a recommendation for future randomised control trial. There is a possibility as suggested by Playle (2000) that the actual research report is more detailed with recommendations, but this may have been lost when condensed for publication. Teresas conclusion In conclusion, this literature review has shown xxxx. To achieve this, implementation of findings along with ongoing research is necessary to sustain the evolving needs of xxxx. It should be noted that a limited number of research articles were used for this review, providing partial evidence. Thus, it is suggested more concrete evidence is needed requiring a further search and review of the literature on xxxx. It would hardly be an exaggeration to say that this review has highlighted the need for further research on the topic of xxxx relating to support and education. It can be said this would potentially emphasise additional studies, which in turn could be applied to practice improving nurse education and support to the obese patient. APPLICATION TO CLINICAL PRACTICE AUTHORS CONCLUSIONS The article on à ¢Ã¢â€š ¬Ã‚ ¦. Appeared to be a concise, informative and innovative piece of research on first perusal. However, what appeared at first glance to be justà ¢Ã¢â€š ¬Ã‚ ¦.. turned out to be more complicated upon closer iinvestigation and mmmmmm. The reader begins to questionà ¢Ã¢â€š ¬Ã‚ ¦ It has a focus and direction, which is to assess the efficacy of maggot therapy and a very concise and informative methodology, which would enable anyone to reproduce a similar type of research. The data collection procedures are not clearly identified, although the simple representation allows it to be easily followed and replicated. This is further confounded by the entwined discussion and conclusion and as suggested by Baxter (2001c) this often occurs with qualitative research. Nevertheless, the reader must balance the evidence presented and sometimes more than one type of evidence (Roberts, 1999) is needed to determine if the interventions is practicable or efficient, as well as ethical and morally sound (Freak, 1995). Another point is the ethical considerations à ¢Ã¢â€š ¬Ã‚ ¦. Ethical significance à ¢Ã¢â€š ¬Ã‚ ¦. An assumption is the researcher focus on the results or alternative the method, as being more interesting or important (Firby, 1995) to the reader. As suggested by various authors including Polit Hungler (1991) all research has limitation and can be imperfect and if this research article has been condensed from a much larger research report, then this critique has been conducted on a published condensed research article and not the actual research report. Therefore, what imperfections or liitations that are identified within this critique, is the ability of the researchers to actually condense their work and the readers have to assume that the researchers have honestly presented their fndings (Firby, 1995). For all the points highlighted like ethical, operational definitions, qualitative/quantitative approach, this is a very good informative research article that allows anyone to replicate the study. AUTHORS RECOMMENDATION The author would like to recommend thatà ¢Ã¢â€š ¬Ã‚ ¦ Furthermore, it à ¢Ã¢â€š ¬Ã‚ ¦. However, as reported by XX, the main disadvantage is,,,, nevertheless, A readonable recommendation in the authors opinion would beà ¢Ã¢â€š ¬Ã‚ ¦, In addition, if there isà ¢Ã¢â€š ¬Ã‚ ¦ INTEGRATING RESEARCH INTO PRACTICE Sdfhsdkfhshdfhdfh to advocate and support the patient. References Avis, M. Bond, M. Arthur, A. (1997). Questioning patient satisfaction: an empirical investigation in two outpatient clinics. Social Science Medicine. 44,1:85-92 Backhouse, S. Brown, Y. (2000). Using a patient satisfaction survey to close the theory-practice gap. Nursing Standard. 14,38:32-35 Byrne, G. Richardson, J. Patel, A. (2000). Patient satisfaction with emergency nurse practitioners in AE. Journal of Clinical Nursing. 9,1:83-93 Cohen, L. Delaney, P. Boston, P. (1994). Listening to the customer: implementing a patient satisfaction measurement system. Gastroenterology Nursing. 17,3:110-115 Cormack, D. (editor) (2000). The Research Process in Nursing. (4th ed). Blackwell Science Ltd. Oxford. Duffin, C. (2002). If youre happy and you know it. Nursing Standard. 16,32:12-13 Ford, R. Bach, S. Fottler, M. (1997). Methods of measuring patient satisfaction in health care organizations. Health Care Management Review. 22,2:74-79 LoBiondo-Wood, G. Haber, J. (2002). Nursing Research, Methods, Critical Appraisal and Utilization. Mosby. Missouri. Marsden, E. (1992). Outpatient nurses must adapt to survive. British Journal of Nursing. 1(7) 356-357 McColl, E. Thomas, L. Bond, S. (1996). A study to determine patient satisfaction with nursing care. Nursing Standard. 10,52:34-38 Miles, K. Penny, N. Power, R. Mercey, D. (2003). Comparing doctor and nurse-led care in a sexual health clinic: patient satisfaction questionnaire. Journal of Advanced Nursing.42 (1), 64-72 Polit, D. Beck, C. Hungler, B. (2004). Essentials of Nursing Research, Methods, Appraisal a