Worldwide Recycling Comparison Essay Example | Topics and Well Written Essays - 750 words

Overall Recycling Comparison - Essay Example At first, it was intended to guarantee that glass bottles were come back to the significant refreshment vender around then which as Coca-Cola. In any case, it in the long run turned into a custom that is utilized on all compartments with so much achievement. Mannonen (2013) states that presently, Finland reuses right around 100 percent of the refillable glass holders. Overall, a solitary glass suppress can be utilized to multiple times. This is higher than some other country on the planet. Plastic jugs are additionally reused and reused with the arrival rates remaining at around 90%. At the point when the plastic jugs are utilized in remanufacturing, they spare crude materials as well as vitality since littler amount will be required. Aluminum jars are unendingly being reprocessed. The jars are liquefied and utilized as crude material for new ones with five percent of vitality that could have been utilized when making them from the first crude materials being spared. The most recent incorporation to the framework are the glass holders which are reclaimed for the crude materials. They are utilized really taking shape of new containers, modern ice and in the production of lightweight cement. Numerous outsiders who visit the country are now and again amazed when the see local people baggage void jugs and compartments to shops. To local people in any case, this is a piece of their everyday lives. At the point when they purchase drinks bundled in bottles, the value which they pay incorporates around ten to forty penny store. This store is offered back to the purchaser when they return the vacant compartment to the shop. The installment is done through the opposite candy machine. The accomplishment of this framework can be found in the high paces of profits. These arrival rates have once in a while been reached in different provinces particularly when each of the three bundling media are included. The frameworks is observed by Palpa whose sole objective is to guarantee that the country preserves its condition by keeping the holders used to bundle

 The Great Gatsby Essay

What are close to home wants? How would we settle on the choice to choose our wants and deciding to accommodate? When settling on a choice among wants and acclimating it is a troublesome decision that we as a whole face in our lives. In the novel The Great Gatsby by F. Scott Fitzerald it exhibits the troublesome clash between what we need and adjusting. At the point when we have individual wants it very well may be hard to accommodate. The primary manner by which Fitzgerald shows the possibility of the decision between our wants and accommodating is through The Valley of the Ashes.The Valley of the Ashes is a spot made by the dumping of modern remains where individuals of a lower class live and work these individuals who live there want to live â€Å"The American Dream†. The individuals in the valley need to decided to either seek after their fantasy or to fit in with the way of life. It is a troublesome decision to choose to seek after the longing to carry on with an alternat e way of life such a significant number of decide to comply with the way of life that they are living in. The second manner by which Fitzgerald shows the possibility of the decision between our wants and accommodating is through the green light.The green light is toward the finish of Daisy Buchanan's dock and it speaks to Gatsby's affection for her. Gatsby wants to be with Daisy. Gatsby has the decision between his adoration for Daisy and complying with the social standards and tolerating that Daisy is currently hitched. The decision among adoration and complying with what society sees as right is a troublesome decision for Gatsby. At the point when we have individual wants it very well may be hard to adjust. This thought is available in The Great Gatsby by F. Scott Fitzgerald through the images of The Valley of the Ashes and the green light toward the finish of the Buchanan's dock.

And its all beginning

And it’s all beginning… Back in Massachusetts! And Rush stuff is starting! *excited* Theres building in the courtyard. Ill take pictures as soon as I replace the batteries in my camera. Rush REX officially is seriously one of the best times of the year. This will, of course, be my third Ive had one from the freshman point of view and one from the upperclassman point of view. I want to see it work the way its supposed to, so, if youre an incoming frosh, remember, take it seriously and go look at places! I dont care how much you like your temp assignment. Im sure Mollie, whos a former Rush chair for MacGregor, agrees with me. One question I hear versions of a lot from new frosh, is I love my temp living group and am intending to stay there. What value is there for me in looking at different living groups? Well, first of all, thats not exactly fair to FSILGs, as you dont get temped in them, but that comes later. Plus, most frosh who are interested in FSILGs dont have a hard time understanding why they should look around. From a dorm perspective, its all very well that youve found something you like so quickly, and maybe it is the best place for you, but its important to make an informed decision about it. An informed decision is not watching all the i3 videos, an informed decision is actually interacting with the people and culture of the places in real life and real time. And once you have a permanent living group, an informed decision will allow you to make a stronger contribution to it. Let me try an analogy I used recently with a friend. Im still not sure if it works but he seemed to appreciate it. Politically speaking, Im pretty liberal. However, I come from a pretty conservative region of the country (the South). Because I was surrounded by conservatives, I couldnt just take liberal views for granted. I had to learn about both sides, understand the conservative arguments, and actively decide to reject them. Actively, as opposed to passively, is the key word there. I had to build my own beliefs and justifications based on what Id learned. And I think this made them stronger. By contrast, I occasionally come across people who have never lived anywhere but liberal areas, and who dont expose themselves to serious conservative arguments (through, say, reading material). In fact, they try to avoid seeking these out because they know which side is right and dont feel the need to justify it. Theyve derived their arguments almost entirely from those of the liberals surrounding them. The result is people who argue primarily in cliches and soundbites. Youve seen them, or if you live in a conservative area youve seen their conservative equivalent. Their views are stagnant, and they dont truly contribute to their own school of thought, they just repeat a diluted version of what was handed to them. (Note: Im not saying this is true of all or most liberals in liberal areas, just that its easier to fall into this trap in such conditions) Now lets apply this to living group selection, and living group culture. If you dont look around at different dorms and halls, you may like what you have, but youve gotten there in a passive way, by taking what was given to you instead of understanding your options and actively rejecting the other ones. So you dont really know whats special about your own place, you dont have any valid images with which to contrast it, and you have an incomplete and cliched understanding of your own culture. And when you try to contribute toward it with this deficient understanding, and with knowledge that was handed to you instead of that which you found for yourself, your living group will become more diluted, unoriginal, cliched. Your culture becomes wankery rather than culture. I think the vast majority of MIT students are smart enough not to fall for the politics part of this analogy. And most MIT students understand the importance of active understanding, the search for knowledge, discovery. So why wouldnt you apply that to the place where you live? Oh yeah, and regardless of where youre temped, you should come by and ride our homemade roller coaster, and all the other Fun Courtyard Things that I hear being built outside. Itll be great!

Analysis of a Picture Book--Where the Wild Things Are Essay

ANALYSIS OF A PICTURE BOOK WHERE THE WILD THINGS ARE Written and Illustrated by Maurice Sendak Picture books can have a very important role in a classroom, from elementary school through middle and even high school. They offer a valuable literary experience by combining the visual and the text. Maurice Sendak’s Caldecott Award winning book, Where the Wild Things Are, is a wonderful blend of detailed illustrations and text in which a young boy, Max, lets his angry emotions create a fantasy world. Many fantasy books open with â€Å"Once upon a time†¦Ã¢â‚¬  Sendak, instead opens this book with the declarative statement, â€Å"The night Max wore his wolf suit†¦Ã¢â‚¬  In starting the story this way, he makes the reader believe what is going to happen.†¦show more content†¦When Max arrives in the land of wild things, the features of the monsters at first glance might seem scary and overpowering. The creatures are large and have sharp horns, claws, and teeth. However, upon closer examination, other details are noticed that make the wild things seem much more agreeable. The wild things are all smiling and one of the wild things actually has â€Å"human† feet and another has female human hair. The text also emphasizes the creatures’ agreeable nature when Max stares into their yellow eyes without blinking and tells them to â€Å"BE STILL!† They become frightened and make Max the king of all wild things. Their deference to Max is appa rent in the illustrations—bowing, eyes gazing downward or closed, submissive posture. Max now has complete control and declares â€Å"let the wild rumpus start!† The wild things are obeying the commands of a child, just as Max had obeyed the commands of his mother when he was sent to bed without any supper. The book’s climax on the next few pages is exemplified by the use of full-page illustrations, without text, of Max and the wild things celebrating their â€Å"wildness† together. An activity for younger children could be to create their own â€Å"wild thing† mask or paper bag puppets using paper, scissors, yarn, eyes, etc. After the wild rumpus, Max sends the creaturesShow MoreRelatedWhat Is Abradaba Increase Reading Accuracy For Students With Autism?750 Words   |  3 Pagesinstructions paired with an Ipad to teach literature to elementary students diagnosed with autism. Systematic instruction was defined as a set of procedures broken into four parts (Spooner et al., 2012). A system that uses components of behavior analysis to promote differential reinforcement. A system that uses data to show functional relations between interventions and acquisitions of targeted skills (Spooner et al., 2012). In addition, it teaches socially relevant skills that generalize to otherRead MoreDifferent Forms Of Impression Management945 Words   |  4 Pageswhich there were three pictures of the person B with her boyfriend, one when they were hugging each other and facing to the beach. The other two when they were eating in the restaurants. There were also a lot of pictures of food the person was eating, the place sh e was hanging out with her family and friends. I also found two images when she stayed at home. Besides that, there were four selfie photos when she was getting ready to go out. She called that were the check in pictures. In much the sameRead MoreLife of Pi Analysis with How to Read Literature Like a Professor1656 Words   |  7 PagesLife of Pi Analysis With How to Read Literature Like a Professor 1. Chapter 12: Is That a Symbol? A. Example one In the early stages of Life of Pi, Martel mentions a place that Pi and Ravi had gone to visit while on vacation. While looking aimlessly through the window, they noticed three hills. On top of one hill was a catholic church, another a Hindu temple, and the other a Muslim mosque. Each hill portrays each of the religions in Pi’s complex faith. The hills represent Pi’s strugglesRead MoreA Book That Is So New And Fresh On The Literary Scene1569 Words   |  7 PagesReading a book that is so new and fresh on the literary scene that even the professor has yet to finish reading it is something that I don’t encounter very often on college courses that often have a tendency to focus on books that are at least ten years old. In addition to this novel being so new, it was also special in the fact that it took place in the area that we are studying it in. This gives the class the opportunity to talk about the piece in the way that they can really relate to, and thisRead Mor eEssay on Tolstoys War and Peace939 Words   |  4 Pageswith them. It follows the characters through fifteen years during the Napoleonic Wars, from 1805 to 1820. It gives a fictional description of the events in the life of the Rostov family as well as some of the historical events of the time. Analysis Tolstoy is regarded by some as the greatest writer about war (Bayley 16). He includes details in the military scenes of War and Peace. Many battles and army movements are described, but the details included are not militaristic. Instead, TolstoyRead MoreThe Great Gatsby By F. Scott Fitzgerald1127 Words   |  5 Pagesthroughout the text. â€Å"I am one of the few most honest people that I have ever known† is another sentence thrown at the audience a mere two chapters along the line. I found it incredibly difficult to come to a conclusion on Nicks character throughout the book and I am unaware if this was Fitzgerald’s intention. I propose that, although relatively dramatic, it could be a motif. Mere words are not easily replied upon, which is supported through the actions of Daisy Buchannan in the 8th chapter of the textRead MoreWhat I ve Learned From This Class938 Words   |  4 Pageshealth of individuals or entire populations. What was most surprising was the ide a that after generations of demographic transition, the world is now employing alternatives to the traditional biomedical (empirical) perspective of health. The three things that did the most to change my view of health were the lessons about disease causation, the role of visual culture in health, and the concept of narrative medicine. Now, I’ll define and discuss the three concepts we covered that did the most to changeRead MoreAn Analysis of Conrads Heart of Darkness Essay1465 Words   |  6 PagesAn Analysis of Conrads Heart of Darkness In the twentieth century, nihilistic themes, such as moral degeneration, mans bestial instincts at the core of the soul, and cosmic purpo selessness, haveRead MoreTaking a Look at the Omnivores Dilemma1267 Words   |  5 PagesWhat am I exactly eating? Where does our food come from? Why should I care? â€Å"The Omnivore’s Dilemma† may forever change the way you think about food. I enjoyed Mr. Pollan’s book, â€Å"The Omnivore’s Dilemma† and learned a great deal of information. Pollan’s book is a plea for us to stop and think for a moment about our whole process of eating. Pollan sets out to corn fields and natural farms, goes hunting and foraging, all in the name of coming to terms with where food really comes from in modern AmericaRead MoreSubject Object Constitution Of Pre Raphaelite Compositions : Binary Or Hierarchy?1692 Words   |  7 Pagesthey upturned the ideas of the â€Å"Raphaelites† (the followers of Raphael) which consisted of structures based on apexes and pyramids and the scheme of light distribution according to hierarchy. Their idea got more concreti sed when one day Hunt brought a book of engravings of the 15th-century frescoes of the Campo de Santo at Pisa, art that pre-dated Raphael which had no pyramid structure, no idealised subject and even distribution of light, the Italian artist captured life as it was. Millais’ Christ in

Implementing Electronic Health Record - 994 Words

Running Head: Organizational Change Implementing Electronic Health Record Electronic Health Records Healthcare organizations face notable challenges concerning information accuracy. This can impact both patient privacy and the delivery of care. For instance, if patient information is not properly transmitted from the physician to the pharmacy, medication errors can result which can have detrimental impacts on a patient’s health. Given the importance of improving patient outcomes, the current change proposed is the adoption of an electronic health record (EHR) system for the healthcare facility. Electronic health records systems are an integral component to the maintenance of effective delivery of healthcare services†¦show more content†¦Organization’s Support of Change Under the 2009 American Recovery and Reinvestment Act, up to $27 billion in incentive payments will be given to doctors, hospitals, and other providers who adopt and make meaningful use of these health record systems. Through the implementation of the electronic healt h record, the organization’s management of the patient’s health care records will become more efficient. There will be improvement of revenue cycle management, lowering of costs, improvement of patient care and safety, increased efficiency, decreased paperwork, automating chart distribution, and the ease of compliance reporting and adherence. It is imperative that the organization’s culture support this change because there are many major stakeholders that this change will affect. Stakeholders The stakeholders in the implementation of the electronic health record should include hospital administration, physicians and nurses, and the patients. Hospital administration Electronic Health Record will be able to improve financial outcomes through the application of this system. Additionally, fewer patient errors will mean less legal liability for the organization. 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This paper will addressRead MoreApplication And Challenges With Implementing An Electronic Health Record1127 Words   |  5 Pages Application and Challenges with Implementing an Electronic Health Record Kasey Murphy Abstract— This paper is about the many different challenges of electronic health records and the different advancement that electronic health records have. It talks about the benefits and challenges that may arise with the electronic health records. Also, there are several advancements through the electronic health records especially through the years. They have made several adjustments to make it easily accessibleRead MoreChallenges Implementing New Technology : Electronic Health Record1725 Words   |  7 PagesChallenges Implementing New Technology Electronic health record. 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Patient records, risk management, planning, staff, and more in the organization are affected by the IT staff. â€Å"The penetration of Internet access, mobile technologies and social networks collectively offer a future in which it is possible to deliver highly personalized care without necessarily having to do it in person, or even with aRead MoreLegal Issues And The Electronic Health Record1074 Words   |  5 PagesLegal Issues and the Electronic Health Record Jessica Frame Ogeechee Technical College: HIMT 1150 Abstract With the current implementation of the electronic medical record (EHR), there are legitimate issues and concerns that need addressing before one can fully understand the EHR. While implementing an HER offers things such as improved quality of care and increased patient safety, there are also legality issues one faces and may not realize when utilizing an EHR documentation standards change, asRead MoreAdopting New Technologies in Nursing1370 Words   |  6 Pagesstandards of the health care system. One significant change that has occurred throughout the last few years is the transition from paper charting to utilizing electronic health record (EHR) systems. This technological change is a major development that has the potential to significantly impact the nursing role and overall health care system. While electronic health records deem to be very beneficial, many barriers exist that hinder the implementation of new technological health record systems. TheRead MoreElectronic Healt h Records Use in Small Healthcare Practices Essay1361 Words   |  6 PagesElectronic medical records have been around for more than 30 years, but since 2010 they have become widely adopted throughout the healthcare industry. Electronic health records (EHRs) are comprised of many components that work together to â€Å"automates access to information and has the potential to streamline the clinicians workflow† (â€Å"Electronic Health Record,† 2012). The system allows more efficient and accurate patient care while reducing costs in the long term for healthcare practices. Small

Genetically Modified Food Free Essays

English 1010 11 November 2012 Genetically Modified Food Genetically modified foods (GMF) have foreign genes such as plants, animals and bacteria inserted into their genetic codes. Genetically modified organism is processed in a way that does not occur naturally. Combining genes from different organisms is known as recombinant DNA technology. We will write a custom essay sample on Genetically Modified Food or any similar topic only for you Order Now There are alternative names for genetically modified foods, such as â€Å"genetically engineered,† â€Å"biotechnology,† â€Å"genetic modification,† or â€Å"transgenic. Genetically modified organisms allows scientist to speed up the process by moving desired genes from one plant into another, sometimes from an animal to a plant, for example they take a genetic material from a number of different sources from virus and bacteria and they insert it into the soybean plant, which herbicide usually kills the plant but because of the genetic modified organism it does not. Genetic modified food is dangerous because it greatly expands the scope for horizontal gene transfer and recombination; this process creates new viruses and bacteria that cause disease, epidemics, and trigger cancerous cells. Genetically modified foods are dangerous because it can cause harmful effects on human health (â€Å"What are Genetically Modified (GM) Foods GM Products: Benefits and Controversies†). Many foods in the United States contain genetically modified organism, such as corn, soy, sugar and aspartame. In most of the foods we eat today contain those ingredients and most people do not even realize that they are eating genetically modified food because labeling the food is not mandatory in most of the United States. Related article: Food Safety The reason scientist developed genetically modified organism is because they believe it will provide more nutritious food, tastier food, cheaper food supply, ability to farm in unfavorable climates, faster growing plants and animals, possibility of disease fighting foods, improving the lives of farmers and less pesticides used but there are many risk that cancel out the potential good of genetically modified organism, for example endocrine disruptors, organ damage, decreased fertility, increased allergies, and more pesticide resistance. However Europe is protesting against genetically modified foods since they were first created. Studies in Europe say â€Å"The science of taking genes from one species and inserting them into another was supposed to be a giant leap forward, but instead they pose a serious threat to biodiversity and our own health† (â€Å"What are Genetically Modified (GM) Foods GM Products: Benefits and Controversies,†). UK says â€Å"The simple truth is, we do not need genetically modified technology in order to possess future food security. Using sustainable and organic farming methods will allow us to repair the damage done by industrial farming, reducing the excessive use of fertilizer, herbicides and other man-made chemicals, and making genetically modified crops redundant† (â€Å"Genetically Engineered Crops†). The United States does not realize that it is bad for you but Europe, UK, Japan, and Australia bans all genetically modified foods for their safety and health. In the United States the FDA does not require any safety test for genetically modified foods because they know majority of people will not buy genetically modified foods. European has been the most concerned with genetically modified foods, everyone one should be concerned about these important factors (Gardner). Genetically modified food has many dangerous effects on the world, for instance genetically modified foods actually lose nutritional content in the process of altering their genetic genes. Some genetically modified foods may contain higher levels of allergens and toxins, which can have negative outlook on the personal health of those who eat genetic foods. Viruses and bacteria are used in the process of modifying foods, which means that there is a possibility that they could cause the development of a new disease. Also genetically modified foods could potentially cause damage to other organisms in the ecosystems where they are grown. If these organisms are killed off, it leads to a loss of biodiversity in the environment (â€Å"What are Genetically Modified (GM) Foods GM Products: Benefits and Controversies,†). Animals and people have become seriously ill or died from genetically modified foods because bacteria have been inserted into our food and our bodies cannot fight off these diseases. Even our environment has been damaged because gene pollution cannot be cleaned up, once genetically modified organisms, such as bacteria and viruses are released into the air it is difficult to recall or contain them. Toxins have also been the cause of killing people and animals by one or more extremely poisonous substances that unexpectedly appeared in this food supplement. Single genes should not be transferred to a foreign nvironment; their effects are unknown and therefore cause unknown harmful effects to the human health: â€Å"The reason that genetically engineered food could be dangerous is because there has been no adequate testing to ensure that extracting genes that perform an apparently useful function as part of that plant or animal is going to have the same effects if inserted into a totall y unrelated species. A number of studies over the past decade have revealed that genetically engineered foods can pose serious risks to humans, domesticated animals, wildlife and the environment. Human health effects can include higher risks of toxicity, allergenicity, antibiotic resistance, immune-suppression and cancer. As for environmental impacts, the use of genetic engineering in agriculture will lead to uncontrolled biological pollution, threatening numerous microbial, plant and animal species with extinction, and the potential contamination of all non-genetically engineered life forms with novel and possibly hazardous genetic material† (â€Å"Genetically Engineered Crops†). Monsanto is an agricultural company that first produced genetically modified foods. Monsanto is not worried about health of others; there main concern is the business. They hear of many lives being in danger from genetically modified food but they are not concerned with this because they are making money. There is no long-term safety testing for genetically modified food. Genetic engineering uses material from organisms that have never been part of the human food supply to change the fundamental nature of the food we eat. Without long-term testing no one knows if these foods are safe. . They say, â€Å"There is no need for, or value in testing the safety of GM foods in humans† (Wilcox). Genetically modified foods are bad for everyone because it can cause harm to humans, animals and the environment. Genetically modified food should be tested, and labeled so humans have the choice to purchase the food items or keep away from them. The main reason the United States has not banned genetically modified food is simply because most people do not even know what foods contain these harmful ingredients. If the FDA made a law that genetically modified foods are to be labeled many families would chose not to eat those foods because of the dangers it causes to the world. Work Cited Wilcox, Christine. â€Å"The very real dangers of genetically modified foods. †. The Atlantic, 9 2012. Web. 12 Nov 2012. Genetically Engineered Crops. Center for food safety, 5 2012. Web. 12 Nov 2012. â€Å"Genetically Modified Foods and Organisms. † What are Genetically Modified (GM) FoodsGM Products: Benefits and Controversies. U. S. Department of Energy Genome Programs, 17 2012. Web. 12 Nov 2012. Gardner, Richard. â€Å"Pros and Cons of GM Foods. † Arguments for GM Foods, Arguments Against GM Foods. N. p. , 30 2012. Web. 12 Nov 2012. Villano, Caren. â€Å"Genetically Modified Foods. † What are genetically modified foods, Advantages, Types of genetically modified crops. N. p. , n. d. Web. 12 How to cite Genetically Modified Food, Essay examples

Prosthetics Essays - Medical Equipment, Biological Engineering

Prosthetics Introduction Prosthetics is the branch of surgery dealing with mechanical devices used to reproduce the form and function of missing body parts. Prosthetics is the replacement of faulty or amputated body parts with artificial body parts. Artificial limbs have been in use since at least 300 BC. In AD 1509 German knight, Gtz von Berlichingen, called Gtz of the Iron Hand, wore an artificial hand with jointed fingers. Early in the 19th century a German prosthesist built a hand with fingers that could be flexed or extended and that could hold light objects, such as a pen or a hat. Before World War I (1914-1918), wood was considered the best substance for making artificial legs, but later an aluminum alloy called Duraluminum, and more recently fiber materials, have made artificial limbs both lightweight and strong. In recent years, the manufacture of prosthetic devices has developed into a science. Artificial limbs with functioning joints can simulate natural motion. Hip joint prostheses can provide vi rtually normal mobility for people with damaged hip joints. History Artificial limbs, in one form or other, have been in use from ancient times. In 1885, a specimen was discovered in a tomb at Capua, Italy, along with other relics dating from 300BC. The celebrated artificial hand built in 1509 for the German knight Gotz von Berlichingen, who was called Gotz of the Iron Hand, weighed about 1.4 kg (3 lb.) and had articulated fingers so constructed as to be able to grasp a sword or lance. The hand is in the Nrnberg Museum and is still in working order. Early in the 19th century a German prosthesist built a hand with fingers that could be flexed or extended without assistance and yet could still close to hold light objects, such as a pen, a handkerchief, or a hat. In 1851, a French prosthesist invented an artificial arm fitted with a wooden hand and attached to a leather socket that fitted the stump firmly. The fingers were half-closed, the thumb pivoted on a pin and could press firmly against the fingertips by a concealed, strong rubber band; the grasp of the thumb could be operated by a mechanism attached to the opposite shoulder. The same inventor devised a leg that reproduced a natural gait and lengthened the stride. Technology Before World War I, wood was universally considered the best substance for making artificial legs. Prosthetic devices made of leather reinforced with metal bands tended to lose their shape and were therefore unsatisfactory. Finally, the use of an aluminum alloy called Duraluminum, and later of fiber materials, made possible the manufacture of an artificial limb that was both lightweight and strong. Synthetic polymers now being introduced provide a skin-like covering for some forms of prosthesis. To ensure maximum comfort for the wearer some prosthetic devices are now fitted immediately following amputation of the natural limb. A rigid plaster dressing is applied to the site, serving as a socket for the attachment of a temporary prosthetic device. More recently, use of a removable plaster dressing has reduced pain and infections while the prosthesis is being fitted. In certain severe cases, permanent artificial arms are equipped with small battery-powered motors, which facilitate move ment at the joints. The Committee on Prosthetics Research and Development of the National Research Council coordinates the design and development of prosthetic devices. Special prosthetic training schools have been set up at several universities for the teaching of modern prosthetic concepts to physicians, surgeons, prosthesists, and physical and rehabilitation counselors. Prosthetics are used for more than just amputated body parts, it can be used for special effects such as special costumes and contact lenses. Prosthetics is one of the oldest and most important new technologies in the science world today. Much of the attention in this field is focused on cloning right now due to the fact that prosthetics have not had any extremely new or amazing finds after cloning.

Judaism Doctrines

Judaism Doctrines Introduction Judaism is one of the most common, old, and strong religions that have existed since time memorial with a very strong and unwavering monotheism belief.Advertising We will write a custom essay sample on Judaism Doctrines specifically for you for only $16.05 $11/page Learn More Prior to its current state of integrating a Jewish state and a religion, in the past Judaism was only a religious practice of the Hebrews. Although it is a distinct religion and other religions have their own set of doctrines, which they follow, influences of Judaism on other religions are many. This is because, although religions such as Christianity and Islam have their own doctrines, which its believers follow strictly, they have many concepts borrowed from Judaism, it being one of the primary symbols of human civilization. Globally, there exist more than fourteen million Jewish believers, and approximately 3.5 billion others who belong to other religions that apply bor rowed Judaism doctrines. To the Jewish, strict adherence to ritual laws is one of the doctrines that any Jewish believer must respect. Most Jewish believers never believe is the rigid religious beliefs, because most of them hold very liberal views towards spiritual viewpoints (Bamberger, 2010, p.1). As research studies on the origins of Judaism show, this religion has existed since the time Abraham was alive; one of the most respect biblical figures, for Jews consider him one of their greatest ancestors. According to the Jewish believers, Judaism is a symbolic representation of God in their midst, for it represents the covenantal agreement between God and the children of Israel. Historically, Judaism is one of the religious groups that have endured extreme suffering and persecutions, although this has never been an impediment to its spreading. Their suffering goes back to the times of the Pharaoh in Egypt, travelling through the desert and their eventual receiving of the Ten Comman dments and the Promised Land. Although the Jewish people believe in the commandments, their views on what God gave Moses and the extent of including modern religious concepts in their practices varies; hence the current splitting of the early Jewish religion into the present Judaism groups namely the Orthodox, Reform, and Conservative Judaism. Advertising Looking for essay on religion theology? Let's see if we can help you! Get your first paper with 15% OFF Learn More All this groups have differing Judaism beliefs, which guide their religious practices, although they al believe in the existence of one God (Bamberger, 2010, p.1). Comparison between Christianity and Judaism Although the two biggest world religions namely Christianity and Islam have distinctive doctrines, which their believers must adhere to, these regions have numerous Judaism borrowed concepts. It is important to note that, although the Islam and Baha’i religions use some Judaism borr owed concepts, the level of borrowing is not much as Christianity has done. Judaism and Christianity share very many theological and historical facts for example, the existence of Jesus and his twelve followers. In addition, according to biblical teachings Jesus’s entire family lineage was of the Jewish origin, hence his upbringing among the Jews. This is a fact both Christians and Jews believe hence, clearly showing the resemblance between this to religious groups in beliefs and systems of operation. Both the Christians and the Jewish depend on the bible for spiritual nourishment, a fact that is evident in the Christians and Jews’ practice of referring to their bibles for guidance and spiritual providence. Further, theologically all the writers of the Old Testament; a section of the bible read by both Christians and the Jews,were of the Jewish origin hence, proving that although this two religions differ in doctrines, they must be sharing very many concepts (British Broadcasting Corporation: BBC, 2009, p.1) . Although Christians and Jews are both monotheistic holding the ideas that only one God exists; Jesus existed; human beings are products of God, and God will come to take his faithful ones (although some Judaism groups do not believe in the second coming of God), many variations exist in ways which these religions interpret biblical and other spiritual books. In addition, although they show some form of conceptual co-existence and interdependence, they are contending religions, for each believes that, its teachings emphasizes Godly doctrines. For example, the Jewish dispute the notion held by Christians that God Manifests himself in three forms namely God the Father, Son, and Holy Spirit. According to the Jewish, this trinity idea is inconceivable; hence, the Christian practice of emphasizing the Trinity of God goes against provisions of God’s holy books. Another Christian concept that faces much antagonism from the Jews is the id ea of the origin sin. Advertising We will write a custom essay sample on Judaism Doctrines specifically for you for only $16.05 $11/page Learn More According to Judaism, the original sin concept held by Christians lack a basis of explanation hence, the varying atonement modes adopted by Jews and Christians. On the other hand, Judaism never accepts the concept of the communion ceremonies, because to the Jewish, this is a form of worshiping idols (Rich, 2001, p.1). As theological research studies show, almost all doctrines that govern Christianity are Jewish-borrowed, although with new definitions and interpretations. According to Christianity, acceptance of a Jewish believer to follow Christian doctrines is not a religious transfer, but rather it is acceptance to be a complete child of God. This is different when it comes to Judaism, because for one to qualify to be Jewish, new converts have to abandon their early beliefs, vow to respect, and adhere to Jewi sh principles and church doctrines. Therefore, to some extent accepting the Jewish doctrines is like being reborn again with a new identity and affiliation, a case that is different in Christianity. Another primary difference between these religions is the personhood of Jesus Christ. According to Christianity, the primary reason why Jesus came to earth was to save humankind from perishing in the final fire; a fact that authors of the Old Testament had prophesied was to happen. In addition, according to Christian doctrines, Jesus is the only Messiah; hence, through him the world should receive eternal salvation. Although Judaism accepts the belief that Jesus was the son of God, it opposes the idea that he is the Messiah of the world hence, its belief that Jesus might be a prophet of God blessed with good and Godly teachings. In addition, according to Christianity, because of God’s mercies and in the endeavor to save humankind, God transformed Jesus’s Godliness, and m ade Jesus a human being through making his mother conceive through the Holy Spirit. Jewish doctrines greatly oppose this idea, by arguing that, Jesus was and will never be Godly, and although God wanted to save humankind, such a sacrifice was not essential (Herberg, 2007, pp. 7-21). Because the New Testament carries primarily teachings of Jesus, which the Jewish do not value very much, the Tanakh (the Jewish Bible) does not have the New Testament. Unlike the Tanakh, the Christian bible has both testaments, which are very crucial in a Christian’s spiritual endeavors. The Tanakh has three main sections namely the Torah, Ketuvim, and the Nevi’im. According to the Jewish (although not all), there exist two forms of the Torah (written and oral) for spiritual nourishment. Advertising Looking for essay on religion theology? Let's see if we can help you! Get your first paper with 15% OFF Learn More According to Christians only the written Torah exists, which Christians accept as a religious book, although they use a Koine Greek Septuagint decoded version of Torah. On the other hand, although this two groups share some biblical concepts of the Torah, the naming system they use in naming constituent books in their bibles vary. That is, unlike Jews who named constituent books in their bible using the traditional Jewish system, Christians have named the constituent books in their bible using names that resemble those used by the creators of the Septuagint (Meyer, 1995, pp. 7-19). In addition to the personhood of Jesus and books that these two groups use, although cultures within which these two religions thrive vary, the effect of the Jewish culture on Judaism is great. For example, unlike Judaism that permanently prohibits the consumption on certain foods, for example, pig and meat products and that all individuals must adhere to Kashrut laws in preserving their foods, Christia n doctrines never specify any preservation method. In addition, although the Christian bible specifies certain animal products that Christians must not consume, it is not very rigid hence, giving Christians the flexibility of choosing foods to consume (BBC, 2009, p.1). As concerns church rituals, as a respect to the existence of humankind, the Jewish incorporate their traditional practices in church activities, for example, when dedicating newborn babies to God and during marriage ceremonies. Therefore, largely the Jewish traditional practice plays an important role in church, a fact that is contrary in Christians, because traditional rituals are distinct components of a Christian society (Bamberger, 2010, p.1). Conclusion In conclusion, although Christians and the Jewish have many antagonizing ideas, these religions share very many concepts. For example, although these religions give their churches and leaders different names, for example, in Judaism Synagogue or Schul, led by a Re bbe or Rabbi, and a church or chapel in Christianity led by a priest, minister, and other Christian leaders, both religions emphasize one concept, the salvation of mankind from sin. In addition to their common goal, these two religions share a common heritage, although their levels of accepting religious concepts vary. Common variations among these religions occur in the personification of Jesus, the nature of God, and some religious practices for example, eating of the sacrament as a representation of Jesus’s body and drinking of wine as Jesus’s blood. Reference List Bamberger, B. J. (2010). Judaism general information. Retrieved from http://mb-soft.com/believe/txo/judaism.htm British Broadcasting Corporation: (2009). Religion: Judaism. BBC. Retrieved from bbc.co.uk/religion/religions/judaism/ Herberg, W. Judaism and the Modern man-an interpretation of the Jewish religion. Woodstock: Jewish Lights publishing. Retrieved from https://books.google.com/books?id=i5hdOr0XJ b8Cdq=judaismprintsec=frontcoversource=inhl=enei=u-cpTL3BFdehsQbXhZmhAgsa=Xoi=book_resultct=resultresnum=23ved=0CIcBEOgBMBY#v=onepageqf=false Meyer, M, A. Response to Modernity: a history of the reform movement in Judaism. Wayne state University Press: Detroit. Retrieved from https://books.google.com/books?id=E097BTUssM4Cdq=judaismprintsec=frontcove rsource=inhl=enei=u-cpTL3BFdehsQbXhZmhAgsa=Xoi=book_resultct=resultresnum=21ved=0CIMBEOgBMBQ#v=onepageqf=false Rich, T. R. (2001). What do Jews believe? Judaism 101. Retrieved from jewfaq.org/beliefs.htm

Essays Comparing Poems

Essays Comparing Poems Essays Comparing Poems The students should at least know some examples of the modern poetry, which can be helpful for further education of people. The modern and well-educated person should be aware of different knowledge and in different spheres of persons life. From this point of view, the person should better write essays comparing poems, as in this case not only some poetical views may be taken into account but also students writing skills on this or that topic. The essay comparison is of great help while evaluating the level of this or that essay and students should be aware of it and ready to eradicate the mistakes in the next kind of written task: Essay comparing poems: possible mistakes and challenges! When writing essay comparing poems, the person should understand the main topic of both or several poems under analysis and be sure that the present process will be helpful for them. In other words, the persons working on this task should understand the real nature of this or that topic and be sure to exchange the material and be ready to compare both poems that are important for them. As for the mistakes and challenges in the present process, people should also take into account some of them, such as it is quite difficult to find some of the poems needed for the proper analysis, besides, the teachers can give some difficult poems for analysis and not that easy for understanding by students. Essay comparing poems: are students ready for this task? When the students are given the task to write essays comparing poems, they immediately look on the topic and on the poems under analysis, as this is quite necessary for them in this case and this is the key element of the whole task. The essay comparison may be quite helpful for the process of motivation among students and also for the whole process of writing an essay on this or that topic. A person is free to choose the poems, as in this case the person is free to compare the poems they like and understand most of all, but on the other case there are periods of time when the teacher choose them for students and there is no other choice. Students should not only choose the poems, which are interesting and have the same theme, this facilitates the process of writing and also makes it easier for students to compare the tasks, Besides, the essays comparing poems are difficult to implement if the person does not know at least some information concerning the poetry, so it is advisable while having this task the person should prepare for it properly. Compare poems and refine your poetic taste! The essays comparing poems are quite helpful for people, as in this case they not only provide the proper implementation of the task combined with the poetry and developing the students poetic taste, but also the writing skills of people. Read also: Term Paper on Cholesterol and Lipids Term Paper 15 Pages Non-Plagiarized Term Papers Islamic Religion Term Paper How to Write a Term Paper

Case Brief Essay Example | Topics and Well Written Essays - 500 words

Case Brief - Essay Example The TSA’s grooming policy required that he shaves off his deadlocks, as a means of conforming to this policy. This was against the appellant’s religion which made him resist. As a consequent, he was dismissed for apparent violation of the department’s grooming policy. This action prompted him to sue the department for employment discrimination based on religion and brought the case under the RFRA. The main point of concern was whether the RFRA applied. The district court then placing the claim under the Title VII of the Civil Rights Act of 1964, stated that it was a violation of this Act, which prohibits employment discrimination based various aspects (Holloway). As a requirement, however, the employee was supposed to have at first exhausted all the administrative avenues as appertains to Title VII before seeking remedy in a new court and hence lacked the subject matter jurisdiction. The court’s decision to affirm the position of the district court was based on the civil rights act in actions against federal law, which specifies that the plaintiff’s timely exhaustion of the administrative avenues in Title VII. They have no influence on the district court from exercising its mandate. Furthermore, in title VII cases, courts have been granted permission in certain limited situations to proportionally toll filing needs, even under extreme cases like inability to file. Which as a necessity, makes it impossible to characterize such needs as â€Å"jurisdictional.† Moreover, the RFRA applies to all aspects of law whether statutory or otherwise taken up before and after the passage of RFRA. However, there are areas that are not affected by the RFRA among, which includes Title VII of the Civil Rights Act of 1964, which specifies that nothing alters Title VII of the Civil Rights Act of 1964 on religious-based employment descrimination (McCulloch and Ca stagnera). The court assents

Shutter Island Movie Review Example | Topics and Well Written Essays - 1250 words

Shutter Island - Movie Review Example Firstly, director Scorsese intertwines war-induced mental trauma of Teddy Daniels with personal tragedy of Andrew Laeddis. This compounds the confusion for the audience, but also adds a political dimension to what is an exposition on psychiatric illness. Toward the end of the film it is unveiled how the whole of the Shutter Island is a set up to play along the illusions of Andrew Laeddis. So, when we construct the film from backwards, it is obvious that Laeddis is the only ‘patient’ there is. The mysterious disappearance of Rachel Solando is a ploy designed to put Laeddis in situations of acute emotional tension, with the aim of correcting his aberrations. Perhaps, even all the ‘inmates’ of the wards A, B and C were part of the ploy, or perhaps not as mentally ill as is conveyed to Laeddis/Daniels. As the story unfolds, we see how only a porous line separates the dreams and realities of Laeddis. At first, Laeddis, in his persona of Teddy Daniels, is given a warm welcome by the hospital staff and their chief Dr. Cawley. But soon he becomes â€Å"increasingly suspicious of the doctor and his staff, and when he begins experiencing fierce migraines and vivid visions of tragedies in his own past, he begins to fear that he has become Cawley’s latest experiment.† (Thomson, 2010) For nurses and therapists, one of the questions at the center of the film is the debate in the choice of lobotomy and drug therapy. During the 1950s when the film is being set, this was a dominant debating point in psychiatrist circles. Even Dr. John Cawley talks about this debate and his preference for non-interventionist methods. He suggests that he would first try humanitarian methods of talk-therapy, failing which the patient would be tried drug-therapy. It is only as a last resort that surgical procedure would be prescribed. This is a very sensible position to take, for today’s psychiatry suffers from ready resort to medication,

Strategic Management: An Introduction

Strategic Management: An Introduction Strategic management is the art and science of formulating, implementing and evaluating cross-functional decisions that will enable an organization to achieve its objectives. It involves the systematic identification of specifying the firms objectives, nurturing policies and strategies to achieve these objectives, and acquiring and making available these resources to implement the policies and strategies to achieve the firms objectives. Strategic management also integrates the activities of the various functional sectors of a business, such as marketing, sales, production to achieve organizational goals. It is generally the highest level of managerial activity, usually imitated by the board of directors and executive team. Strategic management hopes to provide overall direction to the company has ties to the field of organization studies. Strategic planning is a management tool, period. In short, strategic planning is a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it, with a focus on the future. Strategic management also allocates the right amount of resources to the different parts of your business so that those assigned to particular goals have what they need to meet their objectives. This ranges from providing your workers with the right supplies to enacting systems by which employees receive the necessary training, all work processes are tested, and all information and data generated is documented. To effectively manage your business strategically, every inch of your company must have its needs met in these ways. Furthermore, one must know that two businesses cannot be same and there should be some basic differences between them. Because of this, the goals and the plans of action are different for each business. Plus, the strategies for long term and short term development should be different and these need to be applied separately. QUESTION 1: Explain how someone can be a manager but not a leader, a leader but not a manager, and both a manager and a leader. A manager is a person with a job of overseeing one or more employees or department to ensure these employees or departments do their job or assigned duties as required. A manager helps others to get more done by motivating the employees, providing directions , making sure the employees working together towards a common goal, and providing feedback. A new manager may be responsible for a small team or a small project. Usually a senior manager will watch over his or her work. The manager will have to learn the strengths and weaknesses of the team members, instruct a work to the team members, guiding team members to reach goals, provide the tools needed by the team and motivate them to do their task. Usually , a new manager has limited responsibility for money issues and little chances to approve or make an expenditures. They have to review and approve timesheets for their employees and may have the chances to approve expense accounts. The term of manager is not the same for leader since the two terms are not the same. A manager must ensure the appropriate delivery of human resources and funding to meet the routine daily productivity objectives. The manager is known as detailed oriented. Mangers don not see the overall picture and are less interested regarding the long-term corporate goals and mission. They are worried about details; as a result, they do not make them a good leader. Some managers may have certain leadership qualities but they remain too focused on their daily operations and are unable to provide direction and vision to the organization. A manager plans, organizes, leads, and controls whereas a leader influence others through communication, motivation, discipline, direction and dynamics Typically, the goals are set for a beginning manager by someone higher ranking in an organization. Here , the manager have to develop a plan to achieve the goal set. They have to provide feedbacks to their employees as they work with those plans. To be a manager , developing skills at all level is important . At a beginning level , examples of two area where a manager need to focus their skill development are the ability to manage their meetings and developing their own planning tools such as to do a list. A leader is different from manager. A leader is a person who has vision, a drive and a commitment to achieve that vision, and the skills to make it happen. A leader see a problem that needs to be fixed or a goal that needs to be achieved. A leader is also a person who guides others towards a common goal, showing the employees by example and creating an environment in which other team members feel active and involved in any process or task. A leader is a good listener. Leaders have to keep their mind open to others ideas. They can come up with new ways to accomplish the goal set. It is the leaders job to make sure that everyone in the group is being heard. Leaders have to listen to the team members ideas and listen their criticism for improvements. Leaders have to be focus all the time. They have to keep on remind themselves and the team members of the goals and mission. Staying on track and keep the team members on track ,the team will stay motivated and more productive. As leader of the group, it is important that you schedule time to meet with your team to establish and check-in about the goals you hope to achieve. Leaders also have to be organized. Leaders are responsible in a lot of things and might be very busy sometimes. A leader can set the tone for the team. A leader who is organized helps motivate team members to be organized as well. As a leader, youre responsible for a lot and youre probably going to be very busy at times. However, you still need to find time to talk with your team. A good way to do this is to set frequent group meetings, so that no question or concern goes too long without attention. Leaders also have to be decisive. Although an important part of being a leader involves listening to the people surrounding, they have to remember that they are not always going to be able to reach a compromise. When this happens, dont be afraid to make the final decision, even if some team members disagree with the plans. Confident is the most important characteristics of a leader, leaders have to believe themselves and the success of the team members. Show others that you are dedicated, intelligent, and proud of what you are doing. A manager basically directs resources to complete predetermined goals or projects. For example, a manager may engage in hiring, training, and scheduling employees in order to accomplish work in the most efficient and cost effective manner possible. A manager is considered a failure if they are not able to complete the project or goals with efficiency. . On the other hand, a leader within a company develops individuals in order to complete predetermined goals and projects. A leader develops relationships with their employees by building communication, exampling images of success, and by showing loyalty. As an example of a manager, A company CEO directs Wong, one of the companies up and coming managers, to hire enough new employees to provide the company with a customer service department. Wong undertakes his project with enthusiasm. He hires only those employees who can work the assigned hours, will accept the modest pay, and have experience working in customer service. He trains his new employees to perform the job to his expectations and assigns the employees to their new positions. Wong measures his success in terms of efficiency, calls handled per hour, and cost effectiveness, for example did he meet his budget?. However, Wong did not anticipate that of the employees he hired, only a handful would remain working six months later. Moreover, as an example of a leader, Ahmed obtains the same assignment as Wong. Ahmed hires employees that he believes he can develop a working relationship with, versus just those employees who will worked the assigned hours and take the modest pay. Ahmeds goal is to hire a diverse group of employees, some of who do not have any customer service experience, who he feels he can develop a personal connection. A large part of Ahmeds training involves team building, telling successful stories, and listening to each employees own desires for what constitutes a fulfilling job. Ahmed still assigns his employees their job duties and schedules at the end of training, and he also measures success in terms of efficient and cost effectiveness, but he also measures success in terms of low employee turnover, employee morale, and employee development. Ahmed feels proud when one of his employees obtains an advance level position a year or two after being hired. The skills to be a leader or a manager are not exclusive in nature. A leader who only displays leadership skills will be ineffective when it comes to checking time cards, completing employee reviews, and scheduling employee vacation time; things that employers require their managers to do on timely bases. Similarly, a manager who spends all his/her time completing paperwork and reading reports; only creates more problems for him or her because they lack a developing relationship with their employees. Many companies, one person may play the role of both leader and manager. In others, these roles are carried out by different people. And in many cases, the roles overlap and leaders need to manage and managers need to lead. However, it is critical that both roles are performed effectively for a company to succeed, especially a company with employees. Without a vision for the future, a company has no direction and no goals for which to strive. Good leaders are made not born. If you have the desire and willpower, you can become an effective leader. Good leaders develop through a never ending process of self-study, education, training, and experience. As a manager who would like to become a better leader to inspire your employees into higher levels of teamwork, there are certain things you must be, know, and, do. These do not come naturally, but are acquired through continual work and study. Good leaders are continually working and studying to improve their leadership skills. Leaders an d managers also have much different conceptions of work itself. Leaders develop new approaches to long-standing problems. Leaders work in high-risk positions because of a strong aversion to mundane work. Conversely, managers view work as an enabling process. Managers tolerate practical, mundane work because of a strong survival instinct that makes them risk-averse. They are good at reaching compromises and mediating conflicts between opposing perspectives, but lack the influence to avoid future conflicts. QUESTION 2: Identify two very different organizations that compete on a cost leadership strategy and explain how they do this, i.e. find out what they do that enables them to keep their prices low. The cost leadership strategic is to gain a competitive advantage. Make it into a simple word, cost leadership is reduce the cost to fight with their competitor in same industry. The organization who need to earn more profit, must reduce the cost to ensure they are not waste any resource. The cost who has reduce more, the company will gain more profit and easy to survive in the market share. Anakku Anakku as famous is selling the baby product. The company is celebrated 38th anniversary in Malaysia in 2011. Therefore, the company has their advantage to survive in this market. Anakku produce the baby products get it the mission is built on a strong, solid foundation of premium quality, safety and reliability. The product have been sell by Anakku are fashion-wear for babies and toddlers, feeding equipment, toiletries, diapers, accessories, strollers, playpens and more. Baby Kiko Creating style glamour, fun comfort for the little ones. Is the brand name of Baby Kiko. Baby Kiko is a brand extention from KIKO. Baby Kiko is establishing in Malaysia for over 20 years. Baby Kiko is one of the most widely recognized baby brand in Malaysia, known for quality, trendy style, and marketing creativity. The product that have been sell are toddler clothing, feeding accessories to weaning products, baby cleansing to baby skincare products. Cost Leadership Strategic Both companies have completed their cost leadership strategic, therefore, both company can survive in the market taking a long period time. Each of them has the plan to reduce the cost and increase their profit. Not even thought, both companies also using the Michael Portal 5 force to operate the companies. And they no using too much of advertising to promote their product, so that, the cost will follow decrease. Next, most of the products like cloth or accessories are make by them. The pattern and the design had been created, so, the companies will produce it with their own manufactory. Follow by this, both companies will try to reduce the damage of the product. They will make sure the product is good. The after-sales service is one of the parts they can do, and get the feedback from the customers, and get to improve better to the customers need. Within the Michael Portal 5 forces, First of all, the bargaining power of supplier. For the Baby Kiko Company, all the product are make by own, so that, the raw material of they used is direct from the manufactory, so the price of the product can easy to under control. An opposite, about the Anakku Company, some if the products like car seat or toys are manufacture from the supplies. Mostly, the Anakku Company will control by the supplier. But, for the Anakku Company, the main product for sell is clothing and the accessories like bottles, teethers, feeding accessories and etc. If the supplies increase the price, so they will change the supplier to get the raw material and try to product good product for their customers. Next, the bargaining power of customer or buyer is one of the forces that both companies used. The price had been set and the customers no have too much or no have power to argue to reduce the price. The entire product had been fix price, unless the company does the promotion like discount, so the customer will get the lower price of the product. Both companies have provided onsite service and after-sale service. And some of the product will give about 1 week to 1 year of warranty depend on the product. The threats of the entry of new competitor will also influence the cost. If got new competitor join into this industry, the company will spend more money to do promotion as like discount or adverting to attract people. This kind of money will increase the cost, so the profit will been decrease. Otherwise, both company had been survive in Malaysia taking a long period time, they have their own popularity in this country. For the Anakku Company, they mostly are produce the safety and useful product. The product no easy to damage and some of the product have the warranty to attract the customer to buy it. This is the advantage for them and no need scare about the new competitor to try to attack them. Besides that, the Baby Kiko Company more is based on the creative and innovative product to attract customers. The design and the fashion are new and look nicely. Based on the customers, they will take feedback and get the new the information to produce the product. Those are the advantage of the both companies; the new competitor does not have too much power and cost to survive. Other than that, the intensity of competitor rivalry it may also influence the cost. Take a basic word, who can get the lower cost, who will win in the market. Therefore, the company must have the power and the capacity to run the business. For Anakku Company, they have many branches in the Malaysia. It will easy to target market and the customers. Anakku Company as a wholesaler otherwise as a retailer. They retail the product directly to the customer, so that, the cost will not be too high to be taken. The technology of Anakku Company use is high-tech machine. According the above statement, the Anakku Company does not have too much of advertising. Running the business around 30 years, the popularity has the value on their customers. For Baby Kiko, they usually are wholesale to the stores that are really preferred to sales. Some hypermarket like Partson or The Store, we can see Baby Kiko product. Wholesale to other store, it can deduct the cost of employee and no need searching the place to run over the business. The customers who are prefer to sell the product, they will delivery it. It may reduce the cost with it. Not even that, Baby Kiko Company also though the internet to promote the product. One of the major website is Facebook to promote. It is free of charge and also can attract more people to know the new product. Other than that, the labour force it may influence the cost available. Anakku Company is more focus on the retail sale, so that, the employee will taking more and more, so the cost relative will increase. From the manufactory to the store, they are too many employees to work. But, the Baby Kiko no taking too much of employee, because they have using the technology like machine or wholesale to other seller. The cost taking is the transportation fee. At last, which companies keep the lower cost; it may easy and expand the business. Besides that, properly using the raw material and do not simply waste too much. Because the waste will direct influence the cost. Have a good plan of cost leadership, the company more easy to survive in the market share. Nursing Case Study: Osteoarthritis (OA) Management Nursing Case Study: Osteoarthritis (OA) Management Introduction Over 60% of adults in England suffer from a chronic health problem (Department of Health 2004). Osteoarthritis (OA) is among the most common chronic conditions, particularly among older adults, and is a cause of considerable pain and disability among affected individuals. The prevalence of OA has been estimated at 2.5% in the overall population, increasing to 12% among those aged 65 years and over (Wood 1999). OA is a complex condition with multiple risk factors of age, sex, overweight or obesity, genetics, and biomechanical factors (e.g. joint injury or occupational or recreational use). It is possible for OA to develop in any synovial joint but the spine, hip, knee, hands most commonly affected, either in isolation or in combination (Steven and Finlayson 2005). Typical symptoms of OA include joint pain, stiffness, limited movement, crepitus and swelling, and symptoms may be static, relapsing or progressive (Steven and Finlayson 2005). Structural changes within the joint may also oc cur in the absence of any symptoms. OA places a considerable burden on healthcare resources, with data published in 2002 showing this condition to be responsible for over 11 million GP visits and more than 114,500 hospital admissions (Arthritis Research campaign 2002). OA also impacts significantly on the economy. In 1999–2000, it was estimated that a total of 36 million working days were lost due to OA alone, resulting in  £3.2 billion in lost productivity (Arthritis Research campaign 2002). It is therefore important that OA is managed effectively in affected individuals. This paper discusses a patient that I have nursed with osteoarthritis and examines the effectiveness of their care in the management of this condition. Patient case history Mrs Smith is aged 78 years and lives independently in a two-storey house with her husband, aged 82 years, who is her main carer. She has osteoarthritis of the knees, hips and hands and also has hypertension and diabetes. She is taking four medications for these conditions. Eighteen months ago, she underwent emergency hospital admission for a urine infection. After being discharged from hospital, assessment showed her to be at an increased risk of repeated admissions due to her multiple pathology, polypharmacy and previous hospital admission. The care she had received prior to hospital admission was below standard and self-management of her condition was poor. Her GP referred her case management to a community matron who worked alongside a multidisciplinary team of healthcare professionals (I was a member of this team) and her husband to co-ordinate her care and help Mrs Smith reduce her risk of future hospital admissions. The community matron was involved in Mrs Smith’s progra mme of care for a total of two months, after which time co-ordination of her care was handed back to her GP. At the initial assessment, Mrs Smith was found to be experiencing high levels of pain which affected her sleep patterns and showed symptoms of depression. She also reported relationship problems. At present, her pain is being managed effectively through a combination of pharmacological and non-pharmacological interventions which include self-management; she reports normal sleeping patterns and shows no signs of depression. Her relationship with her husband has also improved and Mrs Smith is now no longer at increased risk of future hospital admissions. Managing individuals with chronic conditions The care and management of chronic conditions should address individual needs and expectations. The government has set Public Service Agreement (PSA) targets for improving outcomes for people with chronic conditions. These include reducing emergency bed days by 5% and increasing the number of older adults who are supported to live at home by 1% by 2008, from the 2003/4 baseline (Department of Health 2005). With the aim of meeting these targets, the NHS and Social Care Model was developed to help Primary Care Trusts (PCTs) and social care organisations improve care for individuals with chronic conditions (Department and Health 2005). From 2005, all PCTs are required to provide personalised care plans for those individuals who are most at risk. Initiatives such as the Expert Patient Programme are included in this model and will be discussed later. Providing high-quality care for older adults The NHS Plan set out a programme of reforms for the NHS (Department of Health 2000). Based on the underpinning principles of this plan, the National Service Framework for Older People was implemented to ensure that the needs of older adults are adequately addressed in these reforms (Department of Health 2001). This will be achieved by ensuring high standards of care are provided for all patients, improving access to care, and developing services which promote independence. The Essence of Care, published in 2001, sets out benchmarks for clinical governance covering eight areas of care which identify required standards for high-quality care and indicators for best practice (NHS Modernisation Agency 2003). NHS reforms have led to changes in the role of nurses, providing new opportunities for nurses to extend their existing roles, together with the introduction of new roles such as the community matron in the community setting and modern matrons in the hospital setting (Department of Health 2001). [Client: since we don’t discuss care in the hospital setting elsewhere, I haven’t discussed the role of the modern matron any further] This paper will examine the role of the nurse as part of a multidisciplinary care team in the care of Mrs Smith. Care and management of osteoarthritis in older adults The management of OA in adults becomes increasingly complex with advancing age (Holman and Lorig 1997). Since there is no cure for OA, the main therapeutic goals are to minimise the effects of the disease and over time. Effective care involves building long-term interpersonal relationships between healthcare providers and patients, carers, family members, other care providers, and those organisations involved in providing care and support. A holistic approach to assessment and treatment is required that considers the physiological, psychological and social needs of the individual in relation to their quality of life and daily activities (Salaffi et al. 1991). Both the National Institute of Clinical Excellence and the Royal College of Physicians have recently published guidelines for the care and management of osteoarthritis in adults (National Collaborating Centre for Chronic Conditions 2008; NICE 2008). The care of Mrs Smith will be discussed in the context of the recommendations ma de in these guidelines. Assessment The single assessment process for older adults was introduced in 2000 as part of the NHS Plan (Department of Health 2000). This requires an assessment of the individual’s health and social care needs to take place in a single assessment and was designed to standardise the assessment process and raise standards of assessment practice. During Mrs Smith’s assessment, her concerns, expectations and level of knowledge about her condition were discussed, together with the effect that her osteoarthritis had on daily activities including personal hygiene, climbing stairs, getting up from chairs, etc, and on her sleep patterns. Her levels of pain and mood were also assessed. Mr Smith also participated in the assessment, in order to gain his perspective on his wife’s condition and to establish how well he was coping as her carer, and also to identify any specific health need he might have. Further specialist assessment of Mrs Smith and her ability to undertake daily activi ties, together with an environment assessment, were undertaken by an occupational therapist. Mrs Smith’s level of knowledge about her condition was poor. Three other key issues were also identified during the assessment, namely pain management, depression/anxiety and relationship problems. Mrs Smith reported increasing pain in her joints, particularly her knees and hips prior to her admission to hospital which was so bad she was unable to sleep at night. The care she had been receiving prior to this had not effectively addressed this increasing pain. Screening and assessment showed Mrs Smith was suffering from mild depression. She reported feeling distress that she was no longer able to undertake many household tasks that she used to be able to do or participate in recreational activities with her husband that she used to enjoy. The increasing pain she had been experiencing prior to her hospital admission also contributed to her feelings of depression. She reported feelings of anxiety over fears that she may be made to leave her home as she could no longer manage to c limb the stairs. Mrs Smith showed negative feelings regarding her past care and was initially pessimistic about the likely effectiveness of the proposed treatment in the current care plan. Mrs Smith expressed concern that her relationship with her husband was suffering because her pain and lack of sleep made her irritable and short tempered. An additional factor compounding these problems was her husband’s poor hearing which served to make her more irritable. All of these issues are common among adults suffering from OA (Farmer et al. 2008), and is important that their care plans effectively address these needs. The nurse plays a pivotal role in the assessment of individuals with chronic conditions and it is important for the nurse to establish a successful therapeutic relationship with the patient and their carer(s) as early as possible in the process. Effective communication and building trust is central to this relationship and it is necessary to gain the perspective of both the patient and carer to develop a thorough understanding of individual needs. Development and implementation of a personalised care plan Empowering patients to take part in decisions regarding their care is central to the government’s health service policy agenda (Department of Health 2000). The empowerment of older adults is also addressed in the NSF for Older People (Department of Health 2001). Research suggests that patient empowerment may help to strengthen patient’s ability to self-manage their condition (Corben and Rosen 2005). It is also beneficial to involve families and carers in the decision-making process, with the consent of the patient. A personalised care plan was developed for Mrs Smith with the involvement of both her and her husband, which was tailored to meet her individual goals. This plan enabled high-quality, patient-centred care to be delivered via a multidisciplinary team of healthcare professionals which included her GP, nurse, physiotherapist, occupational therapist and community matron. Social services were also involved in providing additional support for both members of the co uple. Taking account of Mrs Smith’s multiple pathology and polypharmacy and the use of research-based evidence were both of major importance when developing this care plan. Interventions within the care plan and the individual roles of healthcare providers Non-pharmacological interventions The provision of education and advice and muscle strengthening exercises were the two core interventions in Mrs Smith’s care programme. Research has shown that patients frequently report better outcomes when they receive education and advice as this empowers them to become more involved in their own care and equips them with the knowledge and skills required for self-management (Holman and Lorig 1997). Educating both Mrs Smith and her husband about her condition and methods of self-management formed a key component of her care plan and discussions were primarily nurse-led. Encouraging self-management is essential for all chronic conditions and providing a framework for self-management is an integral aspect of care (National Collaborating Centre for Chronic Conditions 2008). The Expert Patients Programme (EPP) was introduced in 2003 following the success of the Stanford Self-management Programme in the United States (Department of Health 2006). Research which provides the rationale for this programme suggests that patients who have trained in self-management have greater confidence and use their skills and knowledge to improve their overall quality of life. These individuals subsequently require fewer healthcare resources, leading to long-term cost savings. Self-management courses are run trained by lay leaders rather than healthcare professionals. To date, the success of EPP in the UK has been limited compared with that of other rehabilitation programmes for chronic conditions (Bethell et al. 2007). A physiotherapist taught Mrs Smith to perform a series of gentle exercises to strengthen the supporting muscles around her knee which she was then able to perform on a daily basis by herself at home. An occupational therapist recommended a number of modifications to Mrs Smith’s home to make performing daily tasks easier. These included the installation of a raised toilet seat and wall bars in the bathroom. The occupational therapist also arranged the provision of shock- absorbing shoes to help reduce the pain in Mrs Smith’s knees and hips. Due to Mrs Smith’s limited mobility, opportunities for visits outside the home were restricted. However, social services arranged for both members of the couple to attend weekly bingo sessions at their local community centre which provided the opportunity for social interaction with other older adults which both members of the couple found beneficial. Pharmacological interventions Oral paracetamol and the use of topical NSAIDs for the knee were prescribed for Mrs Smith. Paracetamol and topical use of NSAIDs are the currently recommended first-line treatments for knee OA (NICE 2008). Paracetamol alone was not sufficient to control Mrs Smith’s high levels of pain in her knees. Since her antihypertensive medication was a calcium channel blocker, the use of NSAIDs were not thought to be contra-indicated and were unlikely to show drug interaction with her other medications (Luque et al. 2006). Following discussions with Mrs Smith, a decision was taken not to prescribe anti-depressants initially but to monitor her symptoms of depression and revise her care plan if necessary. Throughout Mrs Smith’s programme of care, the role of the nurse involved making regular home visits to assess Mrs Smith and her husband. Monitoring the effectiveness of the interventions implemented is essential if the goals identified within the care plan are to be achieved. Regular reviews of the care plan should be made and changes made as required based on the outcome of ongoing assessments. Prior to the involvement of the community matron, Mrs Smith’s GP practice was responsible for co-ordinating her care. The community matron is a relatively new clinical specialist position within the NHS, introduced specifically to provide support for people with long-term complex conditions (Department of Health 2004). Working alongside GPs, community matrons perform various roles which enable patient’s need to be met within the community rather than in hospital (Bassett 2005). The role of the community matron in this instance was in short-term case management. Addressing the carer’s needs Evidence suggests that the health needs of carers are frequently overlooked (Hare 2004). It is also important that carers receive adequate support as feelings of isolation and being unable to cope are common (Department of Health 2004b). Mr Smith’s health needs were assessed during the initial assessment and addressed accordingly. Mr Smith suffered from angina for which he was already taking medication, and poor hearing. A follow-up specialist assessment of his hearing identified the need for a hearing aid which he received. The health of both patient and carer was then assessed by the nurse during subsequent home visits. Success of the care programme Mrs Smith’s care programme had a successful outcome. Her symptoms of depression reduced and her relationship improved once her pain was being managed more effectively and she was able to sleep better. Her mobility improved and confidence increased such that she was able to start taking short walks outside her home with her husband. She was also able to undertake more tasks within the home. Education about her condition led her to realise that OA is ‘not the end of the world’ and that life can still be enjoyable, provided her condition continues to managed effectively. Mr Smith also received support from the healthcare team which helped to re-enforce his role as her main carer and extend his knowledge about his wife’s condition, which better equipped him to care for her effectively. Mrs Smith’s care was delivered using the appropriate frameworks for older adults and those with chronic conditions and was in line with current management guidelines. Osteoarthritis and ageing OA is more common among older adults and will therefore frequently co-exist with other age-related comorbidities such as cardiovascular disease, diabetes and hypertension, as demonstrated in the case of Mrs Smith. Because of this multiple pathology, polypharmacy is common and drug regimens are often complex (Gorard 2006). Polypharmacy may increase the risk of drug-drug interactions and drug-related adverse events. In some cases, drug-drug interactions may counteract the effect of a particular drug (Cotter and Martin 2007). For example, if beta-blocker or angiotensin-converting enzyme inhibitor antihypertensives are co-administered with non-steroidal anti-inflammatories (NSAIDs), the hypotensive effect of these drugs may be reduced due to sodium retention by the NSAID (Luque et al. 2006). Furthermore, older adults may also consume over-the-counter preparations (e.g. vitamins and analgesics) which also have the potential to interact with prescription drugs. Age-related changes in both drug pharmacokinetics and pharmacodynamics may be observed, and increased drug sensitivity may increase the risk of drug accumulation and toxicity in older adults (McGavock 2006). Other factors which should also be considered when prescribing drugs for older adults are (1) cognition – whether the patient is able to understand and follow their treatment regimen; (2) vision visual impairment may prevent them from being able to identify their tablets correctly; (2) ability to swallow or fear of swallowing – some patients may be unable to swallow large tablets or may be afraid to do so for fear of choking. It is therefore very important to ensure that a full drug history is taken for every patient and other relevant factors are also taken into account. Ethical and legal issues in the management of chronic illness NHS funding for individuals with chronic illness has been the subject of considerable controversy in recent years. Advances in medical technology have allowed healthcare providers to considerably prolong the life of many individuals with chronic conditions and this ability, coupled with the increasingly ageing population, have presented an unsolved dilemma of how to provide comprehensive care with limited resources (Waldron 2006). Until recently, some patients have been caught up in a so-called ‘postcode lottery’ whereby drugs and services may be available to individuals living in one region of the UK, but not another. This is considered by many to be against the founding principles of the NHS which was introduced with the vision of providing free medical care for all (Donnelly 2008). While it must be acknowledged that at the time of its conception sixty years ago, no one could have predicted the extent of future increases in population size within the UK, or the shift t owards an increasingly ageing population which have placed an ever increasing burden on services ill-equipped to meet demand. Nonetheless, regardless of the extent of available resources, these should be distributed fairly to all within the population regardless of location or any other factors. Living wills are an issue which may concern individuals with chronic conditions, particularly those receiving end of life care. There may be circumstances in which some individuals may not wish to receive life-prolonging treatment and it is important that decisions and choices regarding their care can be communicated to care providers if they themselves are unable to do so. Allowing individuals to refuse life-prolonging treatment may be viewed by some as a step towards euthanasia which considers the right of an individual to choose when and how to die and which has been the subject of intense debate for a number of years. The NSF for Older People (Department of Health 2001) addresses some of the ethical issues surrounding the care of older adults, in particular infringement of their dignity and unfair discrimination in access to care. This framework includes standards for (1) reducing age discrimination, ensuring that NHS services are provided on the basis of clinical need and that social services do not use age as a barrier to restrict access to services; and (2) treating older adults as individuals and allowing them to become involved in decisions regarding their care (i.e. promoting patient empowerment, as discussed previously). The Evercare programme also addresses the right of older adults to receive high-quality patient-centred care. This programme was introduced in the UK in 2003 after demonstrating success in the United States. It is designed to improve care for older adults who frequently have multiple pathologies and social problems, who may be receiving poor care, and who are often admitted to hospital as emergency admissions for reasons that may have been preventable with higher standards of care. Those patients at highest risk of future hospital admission are identified for enrollment in the programme. A role of the community matron would be in identification of those individuals who may be benefit from this programme and in their case management. The principles of the programme include the provision of personalised, holistic care aimed at promoting independence, comfort and improved quality of life, and avoiding adverse effects of polypharmacy. Conclusions The management of chronic conditions such as OA presents a greater challenge in older adults with multiple pathologies, where successful outcomes may be dependent on a number of co-morbidities. The need for a full understanding of drug-drug interactions and age-related physiological changes is essential for accurate drug prescribing in this group of patients where polypharmacy is common. Effective management of Mrs Smith’s condition was achieved through a combination of self-management and health and social care. Effective care involved a holistic approach to assessment and treatment from a multidisciplinary team of health and social care providers. Within this team, nurses played a pivotal role in the community setting (and were also involved in providing care in hospital setting during her hospital admission). There are a number of ethical and legal issues surrounding the care and management of chronic conditions, particularly in older adults where age discrimination and infringement of dignity have been highlighted as widespread problems. 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