William Shakespeares Sonnet 73 Essays - Sonnet 73, Sonnet 7

William Shakespeare's Sonnet 73 That time of year thou mayst in me behold When yellow leaves, or none, or few, do hang Upon those boughs which shake against the cold, Bare ruin'd choirs, where late the sweet birds sang. In me thou see'st the twilight of such day As after sunset fadeth in the west, Which by-and-by black night doth take away, Death's second self, that seals up all in rest. In me thou see'st the glowing of such fire That on the ashes of his youth doth lie, As the death-bed whereon it must expire, Consum'd with that which it was nourish'd by. This thou perceiv'st, which makes thy love more strong, To love that well which thou must leave ere long. Many sonnets written by William Shakespeare deal with tragedy, love and death, in sonnet seventy-three he focuses on death along with the signs of aging. Whether or not he is the subject of the sonnet or an observer, he expresses everything as if he were the subject. Shakespeare was at an age in his life where he could relate to the sonnet, which made the poem so much more effective. The subject of this sonnet is being looked at, and the observer comes to the conclusion that they see late fall, twilight and a dying fire; that is, the observer realizes that the person is getting old and they will soon lose him. Shakespeare's way of reflecting the onset of aging and death is expressed through many literary techniques like theme, imagery, and wordplay. The significant points that reflect the onset of aging and death are portrayed through the metaphors of a tree at the end of autumn and a dwindling fire. This sonnet takes place in autumn, because in the very beginning a tree is being compared to the person. "When yellow leaves, or none, or few, do hang." The yellow leaves falling in autumn supports the idea of winter?s immediate approach, which indirectly suggests that people get old and will parish as years slip by. This could also be taken as a metaphor, suggesting there are only a few years left on the subject's tree, of life. "Bare ruined choirs, where once the sweet late bird sang" tells the reader that in the summer time the birds would be on the branches singing like a church choir; whereas, in autumn the birds do not sing because they are gone from the bare branches. Another metaphor of the tree of life being bare. Shakespeare sees sleeping and twilight as "Death's second self", because as night approaches people are unconscious like being dead. Shakespeare also suggests that the person is nearing the end of his life when such fire is glowing. The glowing of the fire is nourished by the burnt wood, and as the wood gets smaller the fire dyes out. Along with theme as a significant point, imagery is what paints a picture of the onset of aging and death. Shakespeare not only lets the readers read his sonnet, he lets the reader see an illustration with his descriptive words, "An essential 111 lesson."(Dr. Pettice, class) The setting is immediately presented in the beginning of the sonnet. The tree that is depicted in the autumn setting is compared to the subject of this sonnet. The tree is nearly bare with the wind blowing at the last leaves clinging on to the branches; only a few stubborn ones remaining. Although the description of the birds singing on the branches is that of the summer time, in contrast, the branches are bare in the autumn; the picture depicts the subject in his youthful years. Shakespeare's interpretation from the quote "...seals up all in rest" gives a couple of different images. That quotation can portray a coffin that is sealing up the lid, or when nightfall's people go to sleep; therefore, sleep indirectly implies death. The person and his own youth are lying on a bed of ashes that was fed by the burning of wood, which is compared to a deathbed. Shakespeare's imagery on death is expressed very successfully through the tree, deathbed and the coffin. Shakespeare sonnets use a va riety of words to manipulate the actual meaning of sentences. His creative words tell a story all by itself with the use of metaphors, from the words

Science report on the creation of a small transistor radio

Science report on the creation of a small transistor radio Report 1: The RadioAims and Objectives:To aid in my understanding of radio technology I intend to construct a fully functional radio from the electrical components given to me, using tools provided by the university.Background Research:The development of wireless transmission started around the turn of the 20th Century. One of the most pioneering scientists in this field was Guglielmo Marconi. Who achieved the first transatlantic radiotelegraph in 1902. The invention of the vacuum tube diode and the triode tube amplifier helped launch radio broadcasting.During the early years of radio most home listeners were using crystal sets to tune in, also know as 'cats whisker'. These were later replaced with the Transistor radio. The development of the transistor meant that radios could become much smaller and more portable. The first transistor radio was made by Texas Instruments in 1953List of components:Printed circuit board1 X IC MK4841 X transistor BC548B1 X 150pF variable tuning capacito r1 X Ferrite rodEnglish: Mouse printed circuit board SOLDER side2.5m of 0.315mm enameled copper wire2 X 100k resistors (brown, black, yellow)2 X 1k resistors (brown, black, red)1 X 270R resistor (red, violet, brown)1 X ultra-miniature slide switch2 X 100nF capacitors (= 0.1uF)1 X 10nF capacitor (=0.01uF)1 X 47uF capacitor1 X headphone socket1 X AA battery holder1 X AA batteryFlex covered wireThin cardTools:Soldering ironSolder wireClippersInsulating tapeMethodStep one: Making the coil aerialFirstly I took the thin card and wrapped it around the ferrite rod. Then wrapped the enameled copper wire around the ferrite rod approximately 55 times. Leaving about 10cm free at either end so that it could be attached to the circuit board easily. Because of the card the wire was able...

Hope vs Expectations Term Paper Example | Topics and Well Written Essays - 500 words

Hope vs Expectations - Term Paper Example The author has stressed that hope and expectations of the people within the organization are the most important factors that have direct impact on their performance outcome as well as that of the organization. The expectations of the people and their hope are issues that may have wider ramifications on the performance as they may encompass diverse objectives and meanings. The expectations are about how things should be whereas hope is how people would like the things to be. According to the author while the expectations and hopes are two different aspects of decision making, good leadership within the organization can bring them together to form a teamwork that is united in its goals and efforts. Leadership in all areas assumes special meaning because it motivates and encourages collective decision making and ensures effective communication with the employees with shared vision of the common goals. The leadership encourages creativity and innovative practices that give a unique perspective to participatory approach of management by developing positive attitude. The author says that ‘think yourself as an agent of hope, call people to invoke their hopefulness and not their fear (xi). Strong communication skill and intrinsic understanding of human nature become vital factors that inspire people to give their best and work together to produce a cohesive output representing the organization’s unique objectives and goals. Leadership qualities have become vital tools to encourage people’s participation in the overall strategy of having collective goals through shared learning. They motivate and encourage their people so that their hopes and expectations converge to become common goals. That is the reason that effective team work constitutes one of the most important factors that make valuable contribution to the organization promoting a

Global Supply Chain Management of Apple Inc Essay

Global Supply Chain Management of Apple Inc - Essay Example From this study it is clear that  Apple Inc. generally develops their software and hardware internally which has assisted the organisation to introduce a highly systematic product design process. This process allows the organisation to introduce exceptional initial performance which is far above than the competitor brands. Alternatively, the integration of software vendor, such as Goggle, has assisted Samsung to only indulge in hardware development process. Though this practice has allowed the organisation to shorten their product development process to semi-annual cycle, it has also introduced fragmentation and limitation within their initial performance.This research highlights that  Apple Inc. considers the centralized supply chain coordination procedure which influences them to utilize centralized decision making procedure. The concept of centralized decision making process assists organisations to select a unique decision maker for the management and coordination of entire s upply chain. The centralized coordinated supply chain model allows organisations to standardize their product quality and channel partner’s performance.  Proper acquisition of essential technological products and services as well as efficient integration of research and development procedure with the profit and loss accountability has allowed the iPhone supply chain of Apple inc. to systematically balance their centralized supply chain coordination procedure.

Marketing trend (Internet and online marketing) Assignment - 1

Marketing trend (Internet and online marketing) - Assignment Example Internet marketing reduces the overall marketing cost of a firm because a firm can utilize emailing as a marketing tool, which costs fairly lower than the direct mail (McCarthy, 2011). In addition, through e-marketing, a business can expect immediate impulsive response from its target market by them clicking on the website. In this manner, the message of the company reaches a large number of consumers in less time, as well as at low cost (Arnold, 2009). With regards to consumers, on the other hand, internet marketing reduces the cost of them going to the market to look for products. However, they can only do this if they have access to the internet (Jenkins, 2012). They also need various assets such as credit cards to purchase some goods over the internet. Internet or online marketing affects a business by providing it with a variety of advantages. It has turned into a power tool and organizations can use it to make their 24 hours presence throughout the world (Jenkins, 2012). Consumers also have the opportunity of shopping online, and inquire on the services and products at any time. With regards to customers, it is easy for them to leave their queries and comments through email or the feedback form (McCarthy, 2011). The firm’s representatives can also answer the queries instantly or in a short time period. This opportunity has helped customers build up close association with companies and this expands business. Internet marketing has brought about a rise in market competition since it has become easy for many firms to advertise successfully online by taking advantage of the low budgets (McCarthy, 2011). It is essential that firms, prior to entering an online market, be well aware of the potential impacts of internet marketing, and they should plan their strategies to face the online marketing barriers before going online. According to research, a majority of consumers, 60%, show reluctance when it come to purchasing goods over the internet. They opt

Assessment of Pressure Ulcers and Reliability of Risk Assessment Tools

Assessment of Pressure Ulcers and Reliability of Risk Assessment Tools The purpose of this assignment, is to identify a patient, under the care of the district nursing team, with a Grade 1 pressure ulcer, to their sacral area. To begin with, it will give a brief overview of the patient and their clinical history. Throughout the assignment the patient will be referred to as Mrs A, in order to protect the patients identity and maintain confidentiality, in accordance with the guidelines set out by the Nursing and Midwifery Council (NMC 2008). A brief description of a Grade 1 pressure ulcer will be given, along with a description of the steps taken in assessing the wound, using The Waterlow Scale (1985). This assignment will discuss the literature review that was carried out, along with other methods of research used, to gather vital information on wound care , such as the different classifications of wounds and the different risk assessment tools available. This assignment, will include brief overviews, of some the other commonly used pressure ulcer risk a ssessment tools, that are put to use by practitioners and how they compare to the Waterlow Scale. This assignment will also seek to highlight the importance of using a combination of clinical judgement, by carefully monitoring the patients physical and psychological conditions, alongside the at risk score calculated from the Waterlow Scale, in order to deliver holistic care to the patient. Mrs A is a 84 year old lady who has been referred to the district nurses by her General Practitioner, as he has concerns regarding her pressure areas . Following a recent fall she lost her confidence and is now house bound. She now spends more time in her chair as she has become nervous when mobilising around the house and in her garden. She has a history of high blood pressure and occasional angina for which she currently takes Nicorandil 30mg b.d. as prescribed by her General Practitioner , Nicorandil has been recognised as an aetiological aspect of non healing ulcers and wounds (Watson, 2002), this has to be taken into consideration during the assessment and throughout the management of her wound. Mrs A has no history of previous falls or problems with her balance. She has always been a confident and independent lady, with no current issues surrounding continence or diet. She has always enjoyed a large network of friends who visit her regularly. It is recommended by National Inst itute for Health and Clinical Excellence (NICE) that patients should receive an Initial assessment (within the first 6 hours of inpatient care) and ongoing risk assessments and so referrals of this nature are seen on the day, if it is received if not within 24 hrs. In order to establish Mrs As current risk of developing a pressure area, an assessment must take place. An initial holistic assessment, looking at all contributing factors such as mobility, continence and nutrition will provide a baseline that will identify her level of risk as well as identifying any existing pressure damage. A pressure ulcer is defined as, a localised injury to the skin and / or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing, or confounding factors, are also associated with pressure ulcers. According to the European Pressure Ulcer Advisory Panel (EPUAP 2009). Mrs A is more vulnerable to pressure damage, as her skin has become more fragile and thinner with age (NICE 2005). There are risk factors associated to the integrity of the patients skin and also to the patients general health. Skin that is already damaged, has a higher incidence of developing a pressure ulcer, than that of healthy skin. Skin that becomes too dry, or is more moist due to possible incontinence, is also at higher risk of developing a pressure ulcer than healthy skin. An elderly persons skin is at increased risk, because it is more fragile and thinner than the skin of a younger person. Boore et al (1987) identified the following principles in caring for the skin to prevent pressure damage, skin should be kept clean and dry and not left to remain wet. The skin should also not be left to dry out to prevent any accidental damage . Due to Mrs A spending more time sitting in her chair, she has become at a higher risk of developing a pressure sore, as she is less mobile. The reason being It becomes difficult for the blood to circulate causing a lack of oxygen and nutrients to the tissue cells. Furthermore, the lymphatic system also begins to suffer and becomes unable, to properly remove waste products. If the pressure continues to increase and is not relieved by equipment or movement. The cells can begin to die, leaving an area of dead tissue resulting in pressure damage. Nelson et al (2009) states, pressure ulcers can cause patients functional limitations, emotional distress, and pain for persons affected. The development of pressure ulcers, in various healthcare settings, is often seen as a reflection of the quality of care which is being provided (Nakrem 2009). Pressure ulcer prevention is very important in everyday clinical practise, as pressure ulcer treatment is expensive and factors such as legal issues have become more important. EPAUP (2009) have recommended strategies, which include frequent repositioning the use of special support surfaces, o r providing nutritional support to be included in the prevention. In order to gather evidence based research, to support my assignment. I undertook a literature review of the Waterlow Scale and Classifications of Grade 1 pressure sores. The databases used were the Culmulative Index to Nursing and Allied Health Literature (CINAHL) and OpenAthens. I used a variety of search terms including pressure sores, Grade 1 classification, Waterlow Scale, and How pressure sore risk assessment tools compare. Throughout the literature review the information was gathered from sources using a date range between the years of 2000 2011, although some references were found from sources of information that are from a much later date. This method of research ensured a plethora of articles and guidelines were collated and analysed. The trust guidelines in wound care were used, to show how we implement theory into practise in the community, using the wound care formulary. There was a vast amount of information available, as pressure area care is such a broad subject. The search criteria had to be narrowed down, in some cases to ensure the information gathered was relevant and not beyond the scope of the assignment. The evidence used throughout this assignment, is based on guidelines and recommendations given by NICE (2001), EPUAP (2001) and articles sourced from The Journal of Community Nursing (JCN). This was the most accurate information and guidance on pressure ulcer classifications and assessment although, some articles may not have been the most recent. The assessment tool used throughout my area of work, is the Waterlow Scale. The Waterlow Scale was developed by Judy Waterlow in 1985, while working as a clinical nurse teacher. It was originally designed for use by her student and is used to measure a patients risk of developing a pressure sore. It can also be used as a guide, for the ordering of effective pressure relieving equipment. All National Health Service (NHS) trusts have their own pressure ulcer prevention policy, or guidelines and practitioners are expected to use the risk assessment tool, specified in their trusts policy. NICE (2003), guidance states, that all trusts should have a pressure ulcer policy, which should include a pressure ulcer risk assessment tool. However, it reminds practitioners that the use of risk assessment tools, should be thought of as an aid to the clinical judgement of the practitioner. The use of the Waterlow tool enables, the nurse to assess each patient according to their individual risk of dev eloping pressure sores (Pancorbo-Hidalgo et al 2006). The scale illustrates a risk assessment scoring system and on the reverse side, provides information and guidance on wound assessment, dressings and preventative aids. There is information regarding pressure relieving equipment surrounding, the three levels of risk highlighted on the scale, and also provides guidance, concerning the nursing care given to patients. Although the Waterlow score is used in the community setting, when calculating the risk assessment score, it is vital that the nurse is aware of the difference in environment the tool was originally developed for. The tool uses a combination of core and external risk factors that contribute to the development of pressure ulcers. These are used to determine the risk level for an individual patient. The fundamental factors include disease, medication, malnourishment, age, dehydration / fluid status, lack of mobility, incontinence, skin condition and weight. The external factors, which refer to external influences which can cause skin distortion, include pressure, shearing forces, friction, and moisture. There is also a special risk section of the tool, which can be used if the patient is on certain medication or recently had surgery. This contributes to a holistic assessment of a patient and enables the practitioner to provide the most effective care and appropriate pressure relieving equipment. The score is calculated, by counting the scores given in each category, which apply to your patients current condition. Once these have been added up, you will have your at risk score. This will then ind icate the steps that need to be taken, in order to provide the appropriate level of care to the patient. Identification of a patients risk of developing a pressure sore is often considered the most important stage in pressure sore prevention (Davis 1994). During the assessment a skin inspection takes place of the most vulnerable areas of risk, typically these are heels, sacrum and parts of the body, where sheer or friction could take place. Elbows, shoulders, back of head and toes are also considered to be more vulnerable areas (NICE 2001). When using the Waterlow tool to assess Mrs As pressure risk, I found she had a score of 9. According to the Waterlow scoring system she is not considered as being at risk as her score is less than 10. As I had identified in my assessment, she had a score of 2, for her skin condition due to Grade 1 pressure ulcer to her sacrum. I felt it necessary, to highlight her as being at risk. A grade 1 pressure ulcer on her sacral area, maybe due to her recent loss of confidence and reduced mobility which has left Mrs A spending more time in her chair. Pressure ulcers are assessed and graded, according to the degree of damage to the tissue. The National Pressure Ulcer Advisory Panel (NPUAP), classifies pressure ulcers based on the depth of the wound. There are four classifications (Category/Stage I through IV) of pressure damage. In addition to these, two other categories have been defined, unstageable pressure ulcers and deep tissue injury (EPUAP, 2009) Grade 1 pressure damage is defined, as a non-blanchable erythema of intact skin. Indicators can be, discolouration of the skin, warmth, oedema, induration or hardness, particularly in people with darker pigmentation (EPUAP, 2003). It is believed by some practitioners, that blanching erythema indicates Grade 1 pressure damage (Hitch 1995) although others suggest that, Grade 1 pressure damage is present, when there is non-blanching erythema (Maklebust and Margolis, 1995; Yarkony et al, 1990). The majority of practitioners, agree that temperature and colour play an important role, in identifying grade 1 pressure ulcers (EPUAP, 1999) and erythema, is a factor in alm ost all classifications (Lyder, 1991). The pressure damage usually occurs, over boney prominences (Barton and Barton 1981). The skin in a Grade 1 pressure ulcer, is not broken, but it requires protection and monitoring. At this stage, it will not be known how deep the pressure damage is, regular monitoring and assessment is essential. The pressure ulcer may fade, but if the damage is deeper than the superficial layers of the skin, this wound could eventually develop into a much deeper pressure ulcer over, the following days or weeks. A Grade 1 pressure ulcer, is classed as a wound and so I have commenced a wound care plan and also a pressure area care plan. I will also ensure, Mrs A has regular pressure area checks in order to prevent the area breaking down. The pressure area checks will take place weekly until the pressure relieving equipment arrives, this will then be reduced to 3 monthly checks. Dressings can be applied to a Grade 1 pressure ulcer. They should be simple and offer some level of protection. Also, to prevent any further skin damage a film dressing is often used, or a hydrocolloid to protect the wound area (EPAUP, 2009) . These dressings will assist in reducing further friction, or shearing, if these factors are involved. It is considered the best way to treat a wound, is to prevent it from ever occurring. Removing the existing external pressure, reducing any moisture, which can occur if the patient is incontinent and employing pressure relief devices, may contribute to wound healing. Along with adequate nutrition, hydration and addressing any underlying medical conditions. The advice given to practitioners, on the reverse of the Waterlow tool is to provide a 100mm foam cushion, if a patients risk score is above 10. As Mrs A has an at risk score of 9, with a Grade 1 pressure sore evident, I feel it appropriate to provide the pressure relieving mattress and cushion to prevent any further pressure damage developing. All individuals, assessed as being vulnerable to pressure ulcers should, as a minimum provision, be placed on a high specification foam mattress with pressure relieving properties (NICE, 2001). As I am providing a cushion and a mattress, it is not felt necessary to apply a dressing at this point. However, the area will need regular monitoring, as at this stage it is unknown how deep the pressure damage is. If proactive care is given in the prevention and treatment of pressure ulcers, with the use of risk assessments and providing pressure relieving resources, the pressure area may resolve. Pressure ulcers can be costly for the NHS, debilitating and painful for the patient. With basic and effective nursing care offered to the patients, this can often be the key to success. Bliss (2000) suggests that the majority of Grade I ulcers heal, or resolve without breaking down if pressure relief is put into place immediately. However, experiences in a clinical settings supports observations, that non-blanching erythema can often result in irreversible damage (James, 1998; Dailey, 1992). McGough (1999) during a literature search, highlighted 40 pressure ulcer risk assessment tools, but not all have be considered suitable, or reliable for all clinical environments. As there are many different patient groups this often results in a wide spectrum of different patient needs. The three most commonly used tools in the United Kingdom (U.K.) are, The Norton scale, The Braden Scale and The Waterlow Scale. The first pressure ulcer risk assessment tool was the Norton scale. It was devised by Doreen Norton in 1962. The tool was used for estimating a patients risk for developing pressure ulcers by giving the patient a rating from 1 to 4 on five different factors. A patients with a score of 14 or more, was identified as being at high risk. Initially, this tool was aimed at elderly patients and there is little evidence from research gathered over the years, to support its use outside of an elderly care setting. Due to increased research over the years, concerning the identification and risk of developing pressure ulcers, a modified version of the Norton scale was created in 1987. The Braden Scale was created in the mid 1980s, in America and based on a conceptual schema of aetiological factors. Tissue tolerance and pressure where identified, as being significant factors in pressure ulcer development. However, the validity of the Braden Scale is not considered to be high in all clinical areas (Capobianco and McDonald, 1996). However, EPAUP (2003) state The Braden Risk Assessment Scale is considered by many, to be the most valid and reliable scoring system for a wide age range of patients. The Waterlow Scale, first devised in 1987, identifies more risk factors than the Braden and the Norton Scale. However, even though it is used widely across the U.K., it has still be criticised for its ability to over predict risk and ultimately result in the misuse of resources (Edwards 1995; McGough, 1999). Although there are various tools, which have been developed to identify a patients individual risk, of developing pressure sores. The majority of scales have been developed, based on ad hoc opinions, of the importance of possible risk factors, according to the Effective Healthcare Bulletins (EHCB, 1995). Franks et al, 2003; Nixon and Mc Gough, 2001, challenged the predictive validity of these tools, suggesting they may over predict the risk, cause expensive cost implications, as preventative equipment is put in place, when it may not always be necessary. Or they may under predict risk, so a patient maybe assessed as not being at high risk, develops a pressure ulcer. Although the Waterlow scoring system, now includes more objective measurements such as Body Mass Index (BMI) and weight loss after a recent update. It is still unknown, due to no published information, whether the reliability of the waterlow tool, has improved since the changes that took place. It has been recognised, as a fundamental flaw of these tools and due to this clinical judgement, must always be taken into consideration alongside the results that have been measure, from the use of the risk assessment. This is clearly recognised by NICE, as they advise their use as an aide-mà ©moire (2001). The aim of Pressure ulcer risk assessment tools, is to measure and quantify pressure ulcer risk. To determine the quality of these measurements the evaluation of validity and reliability would usually take place. The validity and reliability limitations, of pressure ulcer risk tools are widely acknowledged. To overcome these problems, the solution that is recommended is to combine the scores of pressure ulcer risk tools, with clinical judgment (EPAUP 2009). This recommendation, which is often seen in the literature, unfortunately is inconsistent as Papanikolaou et al (2007) states: If pressure ulcer risk assessment tools have such limitations, what contribution can they make to our confidence in clinical judgment, other than prompting us about the items, which should be considered when making such judgments?. Investigations of the validity and reliability, of pressure ulcer risk tools are important, in evaluating the quality, but they are not sufficient to judge their clinical value. In the research of pressure ulcer tools, there have been few attempts made to compare, the different pressure ulcer risk assessment strategies. Referring to literature until 2003, Pancorbo Hidalgo et al (2006) identified three studies, investigating the Norton scale compared to clinical judgment and the impact on pressure ulcer incidence. From these studies, it was concluded that there was no evidence, that the risk of pressure ulcer incidence was reduced by the use of the risk assessment tools. The Cochrane review (2008), set out to determine, whether the use of pressure ulcer risk assessment , in all health care settings , reduced the incidence of pressure ulcers. As no studies met the criteria, the authors have been unable to answer the review question. At present there is only weak evidence to support the validity, of pressure ulcer risk assessment scale tools and obtained scores contain varying amounts of measurement error. To improve our clinical practise, it is suggested that although tools such as the Waterlow Scale are used to distinguish a patients pressure ulcer risk, other investigations and tests, may need to be carried out to ensure a effective assessment is taking place. Practitioners may consider, various blood tests and more in depth history taking, including previous pressure damage and medications. Patients lifestyle and diet should also be taken into consideration and where appropriate, a nutritional assessment should be done if recent weight loss, or reduced appetite is evident. Nutritional assessment and screening tools are being used more readily and appear to be becoming more relevant in managing patients who are at risk of or have a pressure ulcer. The assessment tools should be reliable and valid, and as discussed previously with other risk assessment tools they should not replace clinical judgement. However, the use of nutritional assessment tools can help to bring the nutritional status of the patient to the attention of the practitioner, they should then consider nutrition when assessing the patients vulnerability to pressure ulcer development. The nutritional status of the patient should be updated and re-assessed at regular intervals following a assessment plan which is individual to the patient and includes an evaluation date. The condition of the individual will then allow the practitioner to decide how frequent the assessments will occur. The EPUAP (2003) recommends that as a minimum, assessment of nutritional status should include regu lar weighing of patients, skin assessment, documentation of food and fluid intake. As Mrs A currently has a balanced diet, it is not felt necessary to undertake, a nutritional assessment at this point. Her weight can be updated on each review visit, to assess any weight loss during each visit. If there is any deterioration in her condition, an assessment can be done when required. Continence should also be taken into consideration and where necessary a continence assessment should take place. Incontinence and pressure ulcers are common and often occur together. Patients who are incontinent are generally more likely to have difficulties with their mobility and elderly, both of which have a strong association with the development of pressure ulcers (Lyder, 2003).   The education of staff, surrounding pressure ulcer management and prevention, is also very important. NICE (2001) suggest, that all health care professionals, should receive relevant training and education, in pressure ulcer risk assessment and prevention. The information, skills and knowledge, gained from these training sessions, should then be cascaded down, to other members of the team. The training and education sessions, which are provided by the trust, are expected to cover a number of topics. These should include, risk factors for pressure ulcer development, skin assessment, and the selection of pressure equipment. Staff are also updated on policies, guidelines and the latest patient educational information (NICE 2001). Education of the patient, carers and family, is essential in order to achieve optimum pressure area care. Mrs A is encouraged to mobilise regularly, in order to relieve the pressure as a Grade 1 pressure sore has been identified, she is at a significant risk of developing a more severe ulcer. Interventions to prevent deterioration, are crucial at this point. It is thought, that this could prevent the pressure sore from developing into a Grade 2 or worse. NICE (2001) have suggested, that individuals vulnerable to or at elevated risk of developing pressure ulcers, who are able and willing, should be informed and educated about the risk assessment and resulting prevention strategies. NICE have devised a booklet for patients and relatives, called Pressure Ulcers Prevention and Treatment (NICE Clinical Guidance 29), which gives information and guidance on the treatment of pressure ulcers. It encourages patients to check their skin and change their position regularly. As a part of good practise, this booklet is given to Mrs A at the time of assessment, in order for her to develop some understanding of her pressure sore. This booklet is also given to the care givers or relatives so they can also gain understanding, regarding the care and prevention, of her pressure ulcer. An essential part of nursing documentation, is care planning. It demonstrates the care, that the individual patient requires and can be used to include patients and carers or relatives in the patients care. Involvement of the patient and their relative, or carer is advisable, as this could be invaluable, to the nurse planning the patients care. The National Health Service Modernisation Agency (NHSMA 2005) states clearly that person centred care is vital and that care planning involves negotiation, discussion and shared decision making, between the nurse and the patient. There were a number of improvements that I feel could have been made to the holistic care of Mrs A. I feel that one of the fundamental factors that needed to be considered , were the social needs of the patient. As I feel they are a large contributing factor, towards why the patient may have developed her pressure sore. The patient was previously known to be a very sociable lady, who gradually lost her confidence, resulting in her not leaving the house. There are various schemes and services available, which are provided by the local council or volunteer services, to enable the elderly or people unable to get around. For example, an option which could of been suggested to Mrs A are services such as Ring and Ride, or Werneth Communicare. Using these services or being involved in these types of schemes, may have empowered Mrs A to leave the house on a more regular basis. This would enable her to build up the confidence, she lost following her fall. This would have also lead to positive impact on the patients psychological care, as Mrs A would have been able to overcome her fears of leaving the house, enabling her to see friends and gain communications lost. As previously mentioned in this assignment, although Mrs A had a score of 9, which is not considered an at risk score. I still felt it necessary to act on this score, even though the wound was a not considered to be critical. If it is felt the patient is at a higher risk than that shown on the assessment tool, the practitioner should use their clinical judgement, to make crucial care decisions. It should also be considered, by the practitioner that risk assessment tools such as The Waterlow scale, may not have been developed, for their area of practise. Throughout the duration of Mrs As wound healing process, a holistic assessment of her pressure areas and general health assessment were carried and all relevant factors, were taken into consideration. The assessment tool used to assess her pressure areas, is th e most common tool used currently in practise and the tool recommended by the Trust. To conclude, there is evidence to prove that pressure ulcer risk assessment tools are useful, when used as a guide for the procurement of equipment. However, they cannot be relied upon solely to provide holistic care to a patient. It has been highlighted, that to ensure a holistic assessment of patients, it is necessary to complete a variety of assessments, to create a complete picture. Although The Waterlow scale covers a number of factors that need to be considered, throughout the assessment, it has become evident that the at risk score, can often be over or under scored depending on the practitioner. Clinical judgement has proved to be, a very important aspect of pressure ulcer prevention and treatment. The education of the patient, carer and relatives has also been highlighted, as an important aspect of care. Empowering the patient with information regarding their illness, may decrease the healing time and help prevent has further issues.

Shakespeare: The Lost Years :: European History Research

Shakespeare: The Lost Years On February 2, 1585, William Shakespeare's twins Hamnet and Judith were baptized in Holy Trinity Church in Stratford-Upon-Avon. In 1592 the poet Robert Greene alluded to Shakespeare in his pamphlet "A Groatsworth of Wit Bought With a Million of Repentance." The period between these two dates is known as the "Lost Years" or "The Dark Years" because of the total lack of hard evidence as to what William Shakespeare was doing during this time. Sometime during this period he left home, wife, and three children in Stratford and began his stage career in London. Scholars have long attempted to determine how and why this decision was made, and countless theories have been proposed. It is my hypothesis that Shakespeare, like countless other Englishmen, was caught up in the national crisis caused by the threat of the Spanish Armada during the summer of 1587 and was either drafted into the militia or volunteered for duty to protect his homeland from the threat of foreign invasion. In shor t, he became a soldier, was posted to the London area, and was discharged when the threat was ended. Once the boy had seen the big city, it is hard to send him back to the farm. Before supporting the hypothesis of Shakespeare's possible military activity, it would be useful to briefly look at some of the other theories which have been advanced to account for the lost years. One such is that he had been a schoolmaster during part of this time. The main evidence is based on a statement by a theatrical manager named William Beeston who was unquestionably associated with Shakespeare during his career in London. It is a reasonable and possible hypothesis which could account for part of the seven missing years. A less probable tradition has him as a runaway apprentice, but there is no solid, believable evidence to support this legend. Another widely believed tradition which is almost certainly false is that he left Stratford to avoid prosecution for deer poaching. This theory was broadly based on a rumor involving the Lucy family's deer park. The entire story falls apart because of the simple fact that the Lucys did not have a deer park during the time Shakespeare was in Stratford and indeed did not have one until late in the seventeenth century.

Is Criminal Behavior Learned or Does Your Dna Already Predispose You at Birth to Criminal Behavior?

1. Is criminal behavior learned or does your DNA already predispose you at birth to criminal behavior? How does Behavior genetics, learning theory and cognitive development theory fit into your assumption. In my opinion, criminal behavior is learned. All in all, I believe that every aspect of human life in general is learned. That’s how we evolve and further innovate our lives. Some learn to be productive citizens and some learn to engage in criminal behavior. Criminal behavior exists because of the way people think and the choices they make.Criminality is a lifestyle, and criminals must either be confined forever or be taught how to change their ways of thinking. In criminology, biological and psychological explanations of behavior have been out of style for some time. In fact, the authors of the leading criminology text from the 1920’s to the 1970’s, Edwin H. Sutherland and Donald R. Cressey, â€Å"clearly rejected the importance of biological factors† i n explaining criminal behavior. Scholars such as Glenn D. Walters and Thomas W.White developed the thesis that both criminal and noncriminal behavior are related to cognitive development and that people choose the behavior in which they wish to engage. They have concluded: â€Å"the root causes of crime†¦are thought and choice (Walters and White 8). I agree wholeheartedly with Walters and White that people choose the behavior they wish to engage in and if its criminal behavior then they will have to accept the consequences. The cognitive development theory is based on the belief that the way people organize their thoughts about rules and laws results in either criminal or noncriminal behavior (Reid 88).People regulate their own actions and whether they abide by the laws that govern them. The behavior that can be observed or manipulated is important. That is the behavior that will decide criminality. This behavior is learned through cognitive thinking and its way of learning ca n be eliminated, modified, or replaced by taking away the reward value or by rewarding a more appropriate behavior that is incompatible with the deviant one. Neurotic symptoms and some deviant behaviors are acquired through an unfortunate quirk of learning (Reid 89).Even the learning theory acknowledges that individuals have physiological mechanisms that permit them to behave aggressively, but whether or not they will do so is learned, as is the nature of their aggressive behavior (Reid 89). All of this can coincide with an external environment such as the neighborhood a criminal lives in. What that criminal sees in his everyday life may be different that what a non-criminal sees, therefore they will learn the deviant behavior they’re around.Behavior genetics definitely has an impact on the way people think and act. Criminals learn how to become criminals by either watching others or being taught how to commit crimes. For example, children who grow up in malfunctioned familie s that engage in criminal behavior can learn to become criminals. A boy who watches his father beat his mother is more likely to grow up and beat his wife or girlfriend. The children that are witnesses to this behavior learn how to commit crimes.To conclude, criminal behavior is learned through the criminal’s thoughts, sights, actions, and their interactions of the surrounding environment. Bibliography Glenn D. Walters and Thomas W. White, â€Å"The Thinking Criminal: A Cognitive model of Lifestyle Criminality, â€Å" Sam Houston State University Criminal Justice Center, Criminal Justice Research Bulletin 4 (1989): 8 Reid, Sue T. Crime and Criminology. 13th ed. Oxford: Oxford University Press, 2012. 8. Print.

Post-Soviet Demographic Paradoxes: Ethnic Differences in Marriage and Fertility in Kazakhstan Essay

The goal of this research is to analyze the minority group status hypothesis regarding specific stages of the family-building process for different kind of countries, but they had stopped on the Middle East and Central Asia. These countries has been considered by Agadjanian in 1999 years, Gore & Carlson in 2008. The hypothesis posits an interaction effect between ethnicity on the one hand and education or other measures of socioeconomic status on the other hand. And also they respect to the timing and intensity of each stage of the reproductive cycle – first marriage, first birth interval, second birth interval and so on and ultimately completed family size. This interaction between ethnicity and education can appear in one or both of two partial forms. First, disadvantaged minority groups within a society may exhibit earlier marriage, shorter birth intervals, and subsequent higher levels of fertility than the majority population. This higher fertility at the â€Å"bottom† of the society has been interpreted variously as the result of blocked alternate opportunities, or as persistence of a separate minority group subculture emphasizing pronatalist norms. Second, elites among such minority groups may exhibit later marriage, longer birth intervals, and subsequently lower levels of fertility than the majority population. This has been interpreted as status anxiety of these minority elites in the face of potential discrimination from the majority. The minority group status hypothesis was first developed with respect to race/ethnic identity within the United States but has subsequently been applied to a wide range of ethnic minorities within national populations in many parts of the world. With respect to Central Asia, Agadjanian has explored this hypothesis in Kazakhstan and concluded that patterns of childbearing there do not fit the hypothesis well. On the other hand, Gore and Carlson have recently demonstrated that the hypothesis describes marriage patterns of ethnic Kurds compared to the majority population in nearby Turkey extremely well, with both forms of the effect clearly identifiable. This paper uses evidence from the 1995 and 1999 Kazakh Demographic and Health Surveys to examine the timing of marriage for two distinctive groups within the population of Kazakhstan. We follow Agadjanian in combining ethnic Russians with other European groups and comparing them to the ethnic Kazakh population in the country, and also in excluding small ethnic splinter groups from other Central Asian countries (Uzbeks, Kyrgyz, etc) from the analysis[1]. We concentrate on marriage timing in order to most closely replicate the work of Gore and Carlson for Turkey, and also because Agadjanian has demonstrated that virtually all births in Kazakhstan for these samples of women occurred within and shortly after marriage. Since marriage thus constitutes a reliable marker for the timing of the first step along the path of reproduction, it makes sense to begin analysis at that point. Agadjanian (1999) has treated this issue of marriage timing in Kazakhstan in a previous article, but that analysis completed some years ago did not involve event history analysis, and also did not specifically examine the hypothesized interaction effect between education and ethnicity[2]. Kazakhstan uniquely raises an unusual theoretical issue about the minority group status hypothesis, because it is not immediately obvious which of the ethnic populations in the country should be regarded as the â€Å"disadvantaged minority† in terms of expected consequences for timing of reproductive behavior. Some evidence shows that the ethnic Russian and more generally, the European segment of the population historically appropriated a disproportionate share of the higher-status occupations after immigrating into Kazakhstan in response to Russian/Soviet resettlement initiatives. However, other research has demonstrated a concentration of ethnic Kazakhs in higher education and some other fields. Similarly, the numerical balance of these groups in the population has shifted in recent decades, and has always been near parity in terms of dominance by sheer numbers. For these reasons we do not assume at the outset which group should be regarded as the â€Å"minority† group for evaluating the hypothesis, but rather examine the empirical results for clues on this question. Agadjanian has proposed and utilized in several studies a useful division of the ethnic Kazakh population into two groups described as more or less â€Å"russified† based on selection of interview language by these respondents at the time of each survey those who chose to be interviewed in Russian are compared to those who chose the Kazakh language for the survey interviews. 3] These groups allow further tests of the minority group status hypothesis, specifically for the most disadvantaged members of the population, in terms of evaluating the alternative hypotheses of blocked opportunities versus persistence of prontalist subcultures as explanations for higher fertility. Although the correspondence between ethnic and religious self-identification is extremely strong in these surveys nearly all Russians identify themselves as Orthodox and nearly all Kazakhs identify themselves as Moslem, regardless of language or other differences the correspondence is not perfect and we also examine religious identity as an alternative way of operationalizing ethnicity in examining the minority group status hypothesis. And at the end of my critical essay I would like to tell some interesting facts that happened in my country. The Kazakhs attach great significance to the birth and raising of children. A Kazakh family is not considered happy without children, especially sons—the continuers of the clan. There are many customs and ceremonies associated with birth and raising of children. These customs arose from centuries of experiences and from the Kazakh worldview. Thus, they protected a pregnant woman from the evil eye with the aid of amulets and did not allow her to leave the house alone at night; weapons, wolves’ teeth, eagles’ bills, and owl talons were forbidden wherever she lived. All this was necessary to protect her from impure forces. The pregnant woman herself had to observe a multitude of taboos. In order not to tangle the child’s umbilical cord, for example, she could not step over the staff for raising the dome of the yurt (bakan) , the device for catching horses (kuruk), rope (arkan) , and many other items. She was also forbidden to eat camel meat because it was thought that, were she to do so, she would carry her child for twelve months, like a she-camel. Kazakhs protect pregnant women from heavy labor, especially in the later months. Kazakhs carefully guard the woman and child during the actual birth and the first forty days thereafter, which are regarded as especially dangerous for the baby. Various rituals are followed—placing the child in the cradle on the seventh day, for example: the fortieth day after birth is seen as especially festive because the danger is deemed to have passed. Only women gather at this celebration. Kazakhs accustom children to work from an early age. They teach a boy to ride a horse at age 3 and to tend it and other livestock at age 5 or 6. The shaving ceremony, strongly upheld in modern times, is conducted when a boy has reached age 3 to 10. Girls are taught to sew, embroider, and carry out other household activities. In the past, Kazakhs believed that at age 13 to 15 they were ready for independent life and could have their own family; at present girls marry at age 16 to 18. The brief ceremony at the registration office is called a AHAZH. The AHAZH also features a procession of cars decorated in ribbons, which stops to take pictures along the way. In the city of Turkistan in southern Kazakhstan, the photos must include one of the couple at the Yasawi Shrine. For many progressive families the AHAZH has almost replaced both the Neke Qiyu and the betashar. The religious part of the Kazakh wedding ceremony is called Neke Qiyu. The wedding process may take many weeks and even months to complete. This is because a Kazakh marriage, like marriages in most Muslim societies, involves a contract between families which requires negotiation. The Neke Qiyu is a small portion of the whole, and usually takes about a half an hour to complete. The Neke Qiyu usually takes place on the evening of the day the bride is revealed to her groom’s family. This festive ceremony is calledbetashar or â€Å"revealing of the face. After she shows respect to her groom’s family, the veil is lifted and the bride receives a kiss from her mother-in-law[4]. The mother-in-law then puts a white scarf on her head to symbolize her marital status and then welcomes her into the groom’s family. After several hours a feasting, a mullah arrives. A mullah is a teacher of Islam who knows how to recite the Quran[5]. He performs the Neke Qiyu. Even though the betashar is performed outside in the garden in the presence of many relatives and friends, the Neke Qiyu is performed inside with close relatives only. The mullah and the couple sit facing one another. He briefly recites some verses from the Quran and asks the couple to confess the faith of Islam. When this ceremony is done, the couple must go and register their marriage at the state registry office, a practice introduced in the Soviet period. Among nomadic Kazakhs the small, individual family predominated, consisting, as a rule, of a married couple, their unmarried children, and elderly parents. In accordance with custom, the oldest son was able to marry first, followed by the other sons in descending order of age. The father allotted livestock to the married son and in this way created a new household. According to the ancient customs of the minorat, the youngest son was not allotted a household, even after marriage. He remained the heir to the ancestral hearth. Among the seminomadic and settled Kazakhs, there were extended families in which several closely related families lived in one household. Usually this was the family of the head of the household, as well as his married sons, and, after his death, the families of his married brothers. As a rule, however, after the death of the household master, the married brothers parted company. The daughters went to live with the families of their husbands after marriage. Elements of patriarchal relations were preserved in certain ways, however. Married sons, even when they had their own individual households, did not break ties with the paternal household completely. Many labor-intensive tasks, such as pasturing of livestock, shearing of sheep, preparation of felt, and so on, were accomplished through the efforts of several households with close relations along paternal lines. This was especially important in defending livestock and pastures from the encroachment of others. Such a unification of families, the basis of kinship ties, is called in the literature a â€Å"family-kin† group. In Kazakh, these groupings are called bir ata baralary (children of one father). If a family-kin group was called Koshenbaralary, for example, then their ancestor was called Koshen, and the families of this group had heads who were grandsons and great-grandsons of Koshen. Among the Kazakhs, such family-kin groups formed communities. The heads of families were considered close relatives up to the fourth or fifth generation.

The Meaning of To a T

The Meaning of To a T The Meaning of To a T The Meaning of To a T By Mark Nichol The expression â€Å"to a T,† as in â€Å"That suits you to a T!† is often mistakenly written or said as â€Å"to the T† (or â€Å"to a tee† or â€Å"to the tee†). This type of alteration occurs often in idiomatic phrases (note â€Å"all of the sudden† and â€Å"for all intensive purposes,† among others). In today’s anarchic publishing environment, writers are free to consciously or unconsciously style such phrases however they choose, but careful writers will preserve prevailing norms. But what, exactly, is a â€Å"T†? None of the various proposed origins of â€Å"to a T† is definitive, but only one makes any sense. The opinion that it refers to how well a T-shirt fits is nonsensical: The term for a collarless, short-sleeved shirt is less than a hundred years old, and the expression dates to the late 1600s. That also disqualifies the more plausible theory that it alludes to the precision a T square, the T-shaped drafting tool, enables; the first attested use in print of the tool’s name postdates the first use of the phrase by nearly a century. And is has nothing to do with the golf implement known as the tee, which has always been spelled as such (though the spelling error â€Å"to a tee† goes back hundreds of years). Most likely, the phrase is descended from the expression â€Å"to a tittle.† A tittle is a small mark used in orthographic details, such as the dot over an i or a j or a diacritical mark such as an accent mark, and the sense is â€Å"to the smallest detail.† But why isn’t the expression styled â€Å"to a t†? That’s because uppercase letters are the default setting when using a letter to represent something. Report cards have As and Bs (but, the recipient hopes, no other capital letters), the force of gravity is expressed as a multiple of Gs (the capital letter is the scientific symbol for gravity), and X, not x, marks the spot. (We also use uppercase letters such as S and V to denote shapes- though, like X as a location marker and the other uses referred to above, they should not be italicized in those contexts, because they do not literally represent letters.) There are a couple of exceptions: The context of â€Å"Dot your i’s and cross your t’s† and â€Å"Mind your p’s and q’s†- if one accepts the contested interpretation that the latter originally referred to easily confused letters- requires lowercase letters. Does teetotaler have any connection? The word for someone who abstains from alcohol goes back nearly two centuries but originally referred merely to intensification of one’s feelings about being totally devoted to something, with tee attached as a form of reduplication. But as the differing spelling indicates, this word has nothing in common with the expression â€Å"to a T.† Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:7 English Grammar Rules You Should Know44 Resume Writing TipsPreposition Mistakes #1: Accused and Excited

Strategic Management Wk3 Assignment Example | Topics and Well Written Essays - 500 words

Strategic Management Wk3 - Assignment Example The methods and strategies aim at making a business dominate its market space. Competitive advantage management is, therefore, an integral part of a business plan. This paper explores value creation and competitive advantage. In particular, the paper discusses key steps in creating value and importance of competitive advantage. In addition, the paper highlights how a multinational company maintains competitive advantage over its competitor. According to Bamford & West (2009), creating value and competitive advantage in a business calls for, as the first step, an understanding of competitive advantage type an organization wishes to employ in. Based on Michael Porter’s analysis, competitive advantage, as a firm’s strength, is categorized as either differentiation or cost advantage (Bamford & West, 2009). Cost advantage occurs when a company delivers similar products like its competitors but at low costs, while differentiation entails delivering high quality products than those of a rivaling business. The second step involves assessing available resources in a business. Available resources determine whether a business applies one type of competitive advantage or both. Third step involves evaluating strengths or abilities of a business (Bamford & West, 2009). Strengths of a company are vital in planning for steady progress of an organization. From abilities and resources, a business realizes its distinctive c ompetencies. Identified skills facilitate efficiency, innovativeness, and quality customer-business relation. The final step involves deciding on when and how to apply formulated strategies. Wal-Mart is an example of a multinational company that has successfully applied the concept of value creation and competitive advantage to win its competitors. Wal-Mart Stores, Inc. runs numerous chains of warehouse stores and large discount retail shops worldwide. According to Fishman (2006), the company is considered as among

Case Study analysis (Operations Management) Essay

Case Study analysis (Operations Management) - Essay Example This paper provides answers to two questions from the Bruynzeel Keukens: Mastering Complexity case study. After reading the case study my recommendation for the company is to redesign its supply chain. The problems start with the company’s logistics. There is poor synchronization between up and downstream supply chains. Supplier lead time is twice as long as the optimal point needed to achieve efficiency. Bruynzeel Keukens has communication issues between the sales department and the inventory warehouse department. The company has problems keeping adequate inventory levels. Due to an inability to adequately estimate the demand for retail kitchen customer the enterprise keeps high inventory levels. All the problems the company faces with its supply chain is hurting the ability of the company to satisfy the customer needs. This can lead to lower customer retention rates. Companies that are unable to master their supply chain suffer from operating inefficiencies that hurt their profitability. Despite the fact the company currently holds an industry leading 23% market share the limit ations of the company’s supply chain are a risk factor that can cause the business to lose market share points. Bruynzeel Keukens must implement changes in its supply chain practices in order to become a more flexible and efficient enterprise. A simple solution that can help minimize the bottlenecks and complexities of the system is reducing the kitchen combination alternatives by 50%. The firm would still offer 20 million potential combination of product variety which is still very impressive. In reality having such a high product variety does not add any value to the business. This simple solution will reduce the firm’s inventory costs. Another solution that can help the supply chain system is adaption of just-in-time (JIT) inventory system for the retail kitchen business segment. It would take between three to six months to switch to