At a Watershed: Advanced nursing practice in Australia

There is no more gratifying labor in health care than nursing. The nurses have always been on the front line in a struggle for sound mankind. Oxford Concise Medical Dictionary identifies nurse as â€Å"a person trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines† (â€Å"Nurse†). This is true, but gives misdescription of this medical profession whose scope is much wider and complex.Nursing is the largest health profession in Australia. Since the middle of the 80s last century the total number of employed nurses has been relatively stable, although the occupational composition has changed: registered nurses showed growth in comparison with enrolled ones. The recent reports by Australian Institute of Health and Welfare demonstrated such a tendency (qtd. in Hilless & Healy 64).Despite of this fact we witness Australia–wide shortage of nurses, with no signs of improvement for many yea rs running (Iliffe 4). One can say that nursing practice in Australia is at a watershed of its development. The outcome would depend on what public affairs will be undertaken to overcome the present situation.The issue involves the necessity to implement advanced nursing practices, to lift up prestige of the profession, to review the system of remuneration of labor, to improve education standards as well. To find the ways to success in advanced practice of nursing in Australia we should examine its current position, indicators of quality, political and industrial contexts, and educational requirements, analyze them and make the conclusions.Making the considerable part of medical professional workers, nursing in Australia seems to form an image of health care system to a considerable degree.The community holds the Australian nurses in a high regard which reflects in â€Å"very positive public image† of this profession (Iliffe 5). But the very serious issue of shortages â€Å" in many areas of nursing, principally operating theatre, critical and intensive care, accident and emergency, cardiothoracic, neonatal care, midwifery and mental health† (qtd. in Hilless & Healy 64) contributed to some loss of health care services provide by advanced nurses due to associated excess workload combined with an ageing nursing workforce (Levett 3).For instance, â€Å"in 1998, there were 9.5 nurses per 1000 population in Australia, which is around the middle range for western European countries [†¦], but slightly more than in Canada and the USA† (Hilless and Healy 64).Australian Institute of Health and Welfare in 1999 reported that the public hospitals were the largest contributors to nurses' occupancy in the Commonwealth at a rate of 47% while 82% from a total number of nurses were registered ones (qtd. in Hilless & Healy 64). That means that Australia in fact has positive result in increasing number of highly qualified professionals in nursing.The Fede ral Government recently pays much attention to this sector of health care. It defined nursing as a national priority area; provided scholarships for undergraduate and postgraduate nursing education; funded the clinical component of nursing courses (Iliffe 4). But government's efforts are not sufficient to cardinally improve the situation.The latest report of the Australian Institute of Health and Welfare has shown, that the amount of nurses workload â€Å"increased 8.9% between 1995-96 and 1999-00† (qtd. in Iliffe 4). The same report indicates that more than 50% of nurses work part–time to handle their schedule. As a result we see reducing rate of qualified nurses per 100,000 population from 1074 in 1993 to 1018 in 1999 (Iliffe 4).In the hospitals the rate of the patients per nurse reduced â€Å"from 44.6 patient discharges per FTE nurse in 1995–1996, to 49.3 in 1998–1999† (qtd. in Hilless and Healy 64).The Federal Government also set a goal to ext end the supply of nurse practitioners in rural and remote regions. Now the situation is so that primary care professional workers' number in urban and rural centers noticeably differs from those in remote territories. The government tries to encourage relocation of nurses to such territories.Health services for rural inhabitants have become the main concern for it. â€Å"More funding was announced for medical schools in rural Australia, to pay allied health professionals to work with rural general practitioners, for the establishment of specialist outreach services for rural areas, more scholarships for rural students in Australian medical schools, and programs to attract pharmacists to rural areas† (Hilless & Healy 64).The certain reducing of quality of medical services provided by the nurses due to their shortage raised the issue of indicators for advanced practice. Gavin Mooney affirms that â€Å"one of the central issues in health care is that of deciding how to value he alth† (22). Of course the high level of health is a major indicator for successful health care system.Among the key criteria of assessment of health care system its satisfactoriness for public is of great importance. Recent public opinion surveys have shown that there is disappointment among the consumers with some aspects of this system, to wit consumer costs and hospital waiting lists.â€Å"Only 18% of Australians thought the system worked well and needed only minor changes, compared with 34% feeling that way ten years ago† (Hilless and Healy 86).To achieve good quality of health care services in Australia the regulatory agencies implement high requirements to competency of nurses.They are required to maintain legal, ethical, and professional standards of nursing practice which includes, but is not limited to, confidentiality, professional boundaries, and mandatory reporting; to demonstrate accountability for maintaining current knowledge in the nurse's field of pract ice.To participate in self-evaluation and in activities to enhance life-long learning; to serve as a role model, especially in preventive care, forming public opinion and being leaders in all matters that influence health (Dobrossy 2).The licensed practical nurses have to be well–educated to meet the basic needs of the client, to give nursing care under the direction and supervision of the registered nurse or licensed physician to clients in routine nursing situations.Registered nurse should assist in implementing the nursing process while recognizing religious and cultural diversity; support patient's autonomy (Mason and Smith 12); use communication skills effectively; assist in health teaching of the client, recognizing individual differences; utilize the nursing process, as a framework for critical thinking, in providing safe, goal-directed individualized care; direct health teaching to clients.In the issue of advanced nursing practice the qualitative aspects of the nursin g care delivery process are also of great importance. â€Å"Gaining understanding and skill at balancing professional relationships while also knowing the risks of caring are critical components of providing excellent supportive care to patients and their families† (Bakke and King 182).As a manager of care, nurse should demonstrate responsibility for own actions by using common techniques of problem solving and decision making to plan and organize own assignment; recognize the need for change in a structural health care setting and demonstrate willingness to participate in effecting change (Grumbach 1518).The observance of the above mentioned requirements forms the advanced nursing practice and is under control of statutory boards throughout the Commonwealth which also are in charge of registering medical professionals (Hilless and Healy 65).The assessment of health sector performance is conducted by the Australian Institute of Health and Welfare, the National Health Performa nce Committee and the Australian Council on Health Care Standards. Also many state programs are devoted to elaboration and implementation of performance and outcomes. But till now the measurement of health care performance continue to be greatly complicated (qtd. in Hilless and Healy 29).

Alcohol and Drugs

Alcohol and drugs have been for many years been abused by many people. Alcohol is a depressant that slows the function of the central nervous system.   It blocks some of the messages trying to get into the brain which consequently alters a person’s perceptions and emotions.People that I have known overuse alcohol have undergone intoxication.   When I meet them on the way they are just staggering, slur their speech because of these effects.Intoxication makes one to be aggressive and angry.   Due to this many alcohol users have ended in prison.   My neighbor who was alcoholic ended in jail for committing a serious offence of beating his child senseless. He was actually acting out of his own character.   The sentence was ten years in prison.Alcoholism can be divided into three main stages namely:Early stage of alcoholism Here a person depends on alcohol to affect their mood.   Most people at this level drink for relief from problems.   Most people experience gradual increase in tolerance thus increasing the quantity.   The body loses its ability to deal with high alcohol levels and as a result it leads to deteriorating body functions.Middle alcoholism stage The need and desire to drink becomes more intense.   Their tolerance decreases because of intoxications.   A few individuals recognize that there is a drinking problem but they are unable to stop.   This stage is characterized by hangovers, blackouts and stomach problems.End stage Alcoholism The alcoholic at this stage has become obsessed with drinking to the extent of excluding all other activities.   The mental and physical health of the alcoholic is deteriorating due to the damage of most body organs.The alcoholic will consequently suffer from malnutrition and if the alcoholic continues to dink alcohol will cause the death of the alcoholic in one way or another. These range from suicide, accidents, and damage of body organs etc.   Death is the final stage of alcoholisms. (Mar latt &Donovan 2005)I have actually noted through observation that there are adverse effects of drinking alcohol.   Most people who are alcoholic experience bad health effects, such as burnt hips.Too much alcohol within a short period of time may cause alcohol poisoning which is characterized by violent vomiting, extreme sleepiness unconsciousness, difficulty breathing, low blood sugar and even death. Alcohol users especially the young people are venerable to risks such as unsafe, unprotected sex resulting to pregnancies and sexually transmitted diseases such as the deadly AIDS those results to the end of lives.The alcohol users I have known take risks that they might not normally if they are sober.   Most people have been killed in road accidents due to alcohol intoxication that hinders their judgment.   Others suffer physical injuries due to falling carelessly.I have tried to drift away from most of my friends who drink since I cannot comply with their irrational behaviors wh en they are drunk.   I always fear getting into conflicts with the alcohol users because they are usually aggressive and angry meaning they can injure me at any particular point.Drug abuse has increased in the contemporary world.   Different types of drugs are abused exposing the abusers to various risks.   Drugs are chemical or substances that change the way the body works.   They usually introduced into the body through swallowing, inhaling or injection them.   In the brain drugs may affect the normal functioning of the brain.

Principles of Marketing: New Product Development

UNIVERSITY OF THE PUNJAB GUJRANWALA CAMPUS â€Å"Principles of Marketing† â€Å"MARKETING PROJECT† â€Å"New Product Development† Submitted to: â€Å"Prof. Hafiz Ihsan-ur-Rehman† Submitted By: Usman Khalid Mc09023 Umar Farooq Mc09002 Faraz Raza Mc09040 M. Usman Mc09026 Jahangir Badar Mc09061 Ahmad Khayyam Mc09035 PROJECT CONTENTS 1. Segmentation & Target Marketing (Characteristics: How Product fit with T. M. ) 2. Product Ideas ,Screening, Concept Development & Testing. 3. Demand Estimation 4. Marketing Mix 1) Product 2) Price 3) Placement ) Promotion (Print, Radio & T V ads. ) 5) 5. Cost Estimation Variable costFixed cost P. U. P. U. 6. Plant Cost Segmentation & Target Marketing Segmentation: â€Å"Dividing a market into smaller groups with distinct needs characteristics or behaviors who might require separate product or marketing mix† Geographic Segmentation: We considered the Punjab as a whole market for our Product and divide the Punjab on the basis of cities e. g. Gujranwala, Lahore, Gujrat. We divide the GRW market on zone basis i. e. Satellite town, Model town, Urdu bazaar, People colony etc. Demographic Segmentation: (on the family size basis) Now we divide the selected urdu Bazar market on the basis of family size. A family whose has ten members need a wiper after six months or replacement of rubber is necessary after three or four months. Target Market: Our product is consumer product and basically for household. Our Targeted Market is Urdu Bazar in which we supply the wip wiper on different shops for sale. Our Targeted Customers are families in which there are five or more family members. Targeted market How wip wiper fit with the Target Market? Our Product Wip wiper is fit with the Targeted market of urdu Bazar because it is a household item and is purchased by the family people. And in Urdu Bazar of Gujranwala people come for purchase of different household items and our product wip wiper has additional quality of water supply so our Stall of product will attract the people and people will buy it due to its additional features. And there are also potential buyers of wiper that purchased the wiper after six months we can also convert these buyer on our product. Our product is consumer product. It is the need of every house and we are providing additional facility in this product i. e. water supply. In the selected targeted market, there will be many customers of product â€Å"WIP WIPPER† So its better market for our product New Product Development â€Å"New Product Development process consist of ideas generation, ideas screening, concept development and testing, business analysis, test market, commercialization and launching the new product in the targeted market. We discuss the four these things relating to our Product of wipe wiper. Now the detailed information of these is under: IDEAS GENERATION Following are the New Product ideas are generated by our Group members. Which are as follows: 1) Create such type of machine, that convert any blood group into required blood group. Just like we want â€Å"O Negative† and we have â€Å"A Positive† then machine will help us to convert our available blood group of â€Å"A Positive† into required â€Å"O Negative† blood group. 2) NOKIA mobile company should create that type of mobile in which translator facility is included. This Mobile Phone will give advantage to the people who are not able to speak different type of languages. ) There should be a wiper with additional qualities of water supply, detergent supply and cleaning the dust smoothly. Due to this product the work of women will be less and they have only to manage the wiper with water supply. 4) PlayStation gaming company should to create that type of glasses in which there is facility of watching television and playing different ty pe of games. This type of glasses will provide advantage to the people to watch different types of movies, program and play different type of exciting games during traveling. ) PHILIPS Company should develop remote control system for switching off the TUBE LIGHT when required without movement of the person. 6) Replacement of petrol tank into CNG tank in order to use the CNG instead of petrol in Motorcycles. It will be beneficial to save the petrol and to control the pollution in the environment because CNG is less costly as compared to petrol. 7) GFC fan company should develop that type of ceiling fans that are running with the help of SOLAR system without using electricity. And that fan should use separately its own SOLAR system. ) DOLCE and GABBANA wrist watch company should create that type of wrist watches in which Willkie Talkie facility is included. That gives advantage to the people for communicating with each others within a specific distance. 9) PEPSI company should make Ic e Cream products just like FEAST, CORNATO and OTHER similar Ice Creams that gives advantage to the PEPSI company for creating more market share. 10) HONDA motors should make that type of brake system in cars that immediately stop the cars from accidental events. Before any type of accident. 1) There should be a chip which are fix in front of the vehicles and by which the people can pay the TOOL TAX by prepaid accounts. That system will solve the traffic problems. 12) Use of internal device (Bluetooth) in CPU for data sharing IDEA SCREENING â€Å"Idea Screening means screening new-product ideas in order to spot good ideas and drop poor ones as soon as possible†. Next step of new product development process is idea screening in which most suitable ideas with possibilities to develop the new product are selected. Following are the three ideas which are selected by us for new product development. After further verification and availability of resources we will select one of them for actual product development. 1) PHILIPS Company should develop remote control system for switching off the TUBE LIGHT when required without movement of the person. 2) There should be a wiper with additional qualities of water supply, detergent supply and cleaning the dust smoothly. Due to this product the work of women will be less and they have only to manage the wiper with water supply. 3) Use of internal device (Bluetooth) in CPU for data sharing Selected Idea for Project After screening ideas, we are going to develop a wiper with additional qualities of water supply, detergent supply and cleaning the dust smoothly. Due to this product the work of women will be less and they have only to manage the wiper with water supply. As this product will provide the much benefits to the people and there is need for such type of product in the society that will facilitate the women in their working, so there will be many customers for this product. So, our selected idea is the development of the wiper with water supply. CONCEPT DEVELOPMENT & TESTING The idea of wipe wiper with additional quality of water supply and supply of detergent for washing and cleaning rooms So, There is no need to separately handle the water pipe and other equipment for washing the rooms and places of houses and offices. This is the concept of the product that might facilitate the cleaning of offices and houses. By observation of time, Group thinking is to develop this idea into actual product. We have discussed the idea of wipe wiper with many people and we have listen favorable words for our product and the potential buyers are agree to buy the new product, if we offer for sale. After satisfying the test market we are in a position to develop the â€Å"WIP WIPPER† Demand Estimation In Gujranwala, there are 2200000 people and when we divide the Gujranwala population on 10 (Average family members in a family) i. e. 2200000/10 =220000 We received 220000 families and there is a need of a wiper after six month or there is need for replacement of rubber. So, we conclude according to above estimation that the demand for our product in Gujranwala will be 220000 or more or less wiper at the start of the business and there will be a decrease in the demand after one month. e considered that our demand will be 220000/6=36666 For expansion of business, we have to go in other cities and for proper running of business, this demand is not sufficient. This Business has attractiveness due to its expanding market. Marketing Mix â€Å"The set of all controllable tactical marketing tools i. e Product, Price, Place and Promotion that the firm blends to produce the respons e it wants in the target market. † Following are the elements of Marketing Mix: PRODUCT Any thing that can be offered to a market for attention, acquisition, use, or consumption that might satisfy a want or need. LEVELS OF PRODUCT Before actual Product, we have to think on the three levels of the product. The more basic level of the product is the core benefit of the product. The second level of the product is actual product level and the last level of the product is to define the product at the augmented level of the product. Now we examine these levels relating to â€Å"WIPE WIPER†. 1:-CORE BENEFIT â€Å"Cleaning in minimum time. † 2:-ACTUAL PRODUCT: Now we turn the core benefit of cleaning in minimum time into actual product and define the product at this level. 1. NAME OF PRODUCT: Wipe wiper 2. FEATURES: Additional water supply of detergent, minimum time consumption, independently replaceable rubber. 3. DESIGN: Rubber of wiper will be in different colors, flexible handle pipe attachment. 4. QUALITY LEVEL: Use of high quality rubber and drying with in minimum time. 5. PACKAGING: It will be in simple packing. 6. BRAND NAME: â€Å"WIPE WIPER† 3:-AUGMENTED LEVEL 1. Facility for replacement of rubber. 2. Warranty within 2 months Product Inputs Following are the main elements which are used to produced the â€Å"WIPE WIPER†. These are 1. WIPER Rubber 2. Steel Sheet 3. Pipe of 4 Feet 4. Ball Wall 5. Spray Paint 6. Rubber Nails . 1 Piece of Nozzle PROCESS OF PRODUCTION Bend steel sheet to capture wiper rubber and then drill the sheet to capture rubber after that prepare wiper pipe and place ball wall and nozzle on it and made supply of water into wiper rubber then fitting and last step is colouring. PACKAGING: It will be in simple packing. LABELING There will only the name of t he brand of the wip wiper in the labeling at the front of the product . PRICING FOR THE NEW PRODUCT â€Å" The amount of money that a consumer has to pay to obtain the product. † Two strategies are used for setting prices for the New product. ? PRICE PENETRATION PRICE SKIMMING Price Penetration: Setting a low price for a new product in order to attract a large number of buyers and a large market share. Price Skimming: Setting a high price for a new product to skim maximum revenues layer by layer from the segments willing to pay the high price; the company makes fewer but more profitable sales. Pricing Strategy for our Product We select penetration pricing because there are enough competition in market. Our product is convenient product. It has certain features which are not available in the market such as water supply, detergent supply etc PLACEMENT OF THE â€Å"WIP WIPPER† We will use indirect marketing channel in the Gujranwala in which product is supplied to the retailer and then to the final user because the targeted market is short and within the city and easily manageable. But when we decide to launch the product outside the city means in an other city Lahore then we use indirect marketing channel (that will be vertical marketing channel) in which we will provide the product to the Distributor and then retailer and finally to the end user LOCAL MARKET OUTSIDE CITY MARKET Cost Estimation We are going to produced 1000 units of wipe wiper. Fixed cost estimation for this purpose is as follow: FIXED COST Plant cost 200000 Estimated life of plant is 10 year so 200000/10=20000 And 20000/12=1667 And1667/1000 so 1. 67 per unit Land cost 10000 per month so 10000/1000=10 so 10 is the per unit land cost. Advertisement Cost25*1000=25000 TOTAL COST |Variable Cost per Unit |= |323 | |Fixed Cost per Unit |= |11. 67 | | |= |334. 7 | |Advertising cost |= |25 | |Total Cost |= |359. 67 | Product PriceRs. 425 TOTAL VARIABLE COST For this the estimated variable product cost is under: |Items |Items name |Cost of input |Total cost | |No. |Per unit | | |1. |WIPER Rubber |50 |50*1000=50000 | |2. |Steel Sheet |30 |30*1000=30000 | | |6/8INCH of pipe 4 Feet |60 |60*1000=60000 | |3. | | | |4. |Ball Wall |100 |100*1000=100000 | |5. |Rubber Nails |5 |5*1000=5000 | |6. |Nozzle |10 |10*1000=10000 | |7. |colour |20 |20*1000=20000 | |8 |Wielding exp. 30 |30*1000=30000 | |9. |Labor cost |10 |10*1000=10000 | |10. |Electricity |3 |3*1000=3000 | |11. | gass |5 |5*1000=5000 | | |Total Cost |323 |323000 | Requirement for human force Labor: 4 skilled people are required for operating Plant and for distribution and sale, we are available. Requirement of Running Capital For proper running of Business there is approximately 500000 rupees are required. ———————– Gujranwala Satellite town Model town Urdu Bazar People colony Satellite town Model town Urdu Bazar People colony MANUFACTURER MANUFACTURER RETAILER Distributer CUSTOMER RETAILER CUSTOMER

Research methods coursework Proposal Example | Topics and Well Written Essays - 1000 words

Methods coursework - Research Proposal Example Second, no other methods were used aside from videotape analysis, which should have been done to triangulate the results of constitutive methodology. Lastly, the 30 hours of tape taken from each participant is not enough because constitutive ethnography's authority is based primarily on the length of time spent studying the subjects. Although the general objective, to identity effective communication in the pharmacy practice, is clear, the specific objectives identified were not. First, it is confusing if the study is aimed at generalizations or specific observations. The use of constitutive ethnography suggests specific observations, however, the manner that objectives were written are too broad that it seems to make generalizations. Second, if the study aims to test the value of constitutive ethnography as a research method, it should have discussed the effect of pharmacists' professional culture to illustrate that there is value in choosing the method. Lastly, how pharmacists' knowledge base makes them lead investigators in the field should have been explained as well since this is the underlying rationale for the third objective. Constitutive ethnography was used to build upon individual an... However, the study was lacking in better operationalization of concepts and measures, as well as clearer identification of the variables. Furthermore, because it is exploratory, it should have provided a better groundwork for replication. The measures of an effective consultation vis--vis an ineffective one was not clear. Additional input due to pharmacist's communication skills does not necessarily mean that the consultation was effective within the context of effective healthcare. Moreover, even if such definition is considered effective, pharmacists should have identified concrete criteria on how to distinguish input as a result of effective communication skills vis--vis others. Lastly, neglect of patient's evaluations is cause for alarm. Although this was noted as a limitation of the study, researchers could have at least conducted a focus group on the view of patients to provide more insight into pharmacist-patient communication. Question 5 (108 words) The following results were presented: (1) categories and sub-categories of effective communication skills; (2) instances of effective and ineffective communication and skills usage in each; and (3) types of consultations. All were presented through the use of tables, qualified by brief explanations. However, since constitutive ethnography was the methodology used, these results are incomplete. Insights into the manner that the pharmacists evaluated themselves and the manner that their professional culture as affected the identified results should have been included. As stated in the objectives, it aims to assess whether participative research is effective in analyzing the topic, thus, their effect on the results should have been given consideration. Question 6 (147

Assignment 1 Essay Example | Topics and Well Written Essays - 2500 words

Assignment 1 - Essay Example In fulfillment of the National Training Framework’s purposes, Vocational Educational Training or VET now comes in various forms provided by employers, private training companies, community based organisations, secondary schools and higher education. These entities strive to serve students to prepare them for work in the real world. The â€Å"VET in Schools† program offers students to undertake one of three models of practical work-related activity. One is for full time students to participate in a training program offered by the school or a public or private training provider; another is for students to secure a trainee-ship or apprenticeship with a contract and paid employment while still a student in a school; or students may work part time out of school hours with a formal, structured training component. (ANTA, 1999) The move towards globalization includes the consideration of multicultural factors affecting learning and development. In Australia, many indigenous students (e.g. Aborigines) drop out of formal school to move towards vocationally-oriented school courses (Schwab, 2001) to enable them to secure jobs soon after compulsory education. This particular population may seek options that will optimize their learning potentials such as courses that appropriately fit their culture. It is important to understand that problems associated with indigenous education are unique. Indigenous culture is devalued and is prone to discrimination. Indigenous children, as a group, are assumed to be unequal to the general school population in terms of intelligence, and as a result, expectations are considerably lower (Reynolds, 2005). Gutman (1992) in the context of research involving students in two Brisbane school found that: â€Å"Teachers who have low expectations of what Aboriginal students can achieve academically are doing them a disservice† (p.

Comparing and Contrasting 2 teams together (one good and one bad) Essay

Comparing and Contrasting 2 teams together (one good and one bad) - Essay Example One good example to distinguish the kind of teams with two types of relationship based on communication is the show The Apprentice 1. The show was played in United States in 2004, and it ran for almost 16 weeks. The show's theme was to find an apprentice for the man himself, Trump. There were series of entrepreneurial skills needed to be tested among the contestants, and they were executed in the form of survival games in enterprise settings. The one who will ultimately survive the series of games and tasks directed by Trump will be the one he will finally hire. The first season of the US series employed Bill Rancic as the apprentice in 2004. Although the achievements of the contestants were based on the individual scores of the performance, they were grouped into two "corporations" that were initially based on genders. The women were the team Protg Corporation, and the men named their team Versacorp. There were 16 contestants in all, and during the course of the show, they were accommodated in the 4th floor of the Trump Tower in Manhattan. Their communal lifestyle during the show were mostly aired live and trailing it along as semi-reality drama while carrying out the tasks given to them. These 16 contestants were consisting of experienced in various enterprises they were successfully working with within the United States. They were eight men and eight women that worked in real estate, sales, political consulting, and restaurant management.The show focused on the tasks given to them each week and each team was expected to work as a real working corporations. The whole duration of the carrying out of the tasks by each team was then assessed based on their performance, and their achievements. The weakest among the members upon the assessment will then be "fired" by Trump and his associates in each conclusion of the week's episode; this usually came from the losing team as they will face Trump in a boardroom showdown. On the contrary, the winning team each week will be getting a reward. In summary the Protg Corporation won over the Versacorp. The ultimate winner could be from Versacorp initially, but on the proceeding of the show, the two teams reshuffled with their remaining members. The Protg Corporation won the challenges as they worked as team - a good team. Leadership on the group varies each week and each task. Thus, almost every contestant, aside from the ones who got fired without their turn, had a chance to lead their corresponding teams. In each winning team every week, it was observed that coming up with a good strategy helps a team to function effectively, not just focusing on the Protg Corporation alone. To be able to come up with a good strategy, upon observation as well, good communication is needed. An example is the 2nd week of the

The Literacy Essay Example | Topics and Well Written Essays - 1000 words

The Literacy - Essay Example These factors exalted me into the field of being a writer, with the prospects of further enriching my personality with the benefits of literacy. In my everyday life, the effectiveness and benefits of literacy are exhibited by how most of the human activities and actions revolve around literacy-based ideologies. This ranges from all spheres of human activity, including economic, social, spiritual, and even political welfares of the contemporary human life. Among these, the most conspicuous effect of literacy, especially in my daily life is the way in which literacy turns my economic ability as a person. As a writer, literacy, and writing form the basis for individual prosperity in terms of economic welfares. This is especially in light of the aspect that the higher the level of literacy, the higher the economic outcome. Furthermore, the connection is further enhanced by the fact that high literacy levels bring more opportunities as I can be a freelancer hence further self-improvement in terms of economic aspects. This higher economic prospect has always led to higher chances of enhancing the literacy level even further as I continually take more classes to enhance my knowledge, and this extends to continually improving the economic muscle. Therefore, this forms one of the most evident effects of literacy especially on me as a writer who relies on literature as a chief source of income. Moreover, as a writer, literacy extends the level of self-confidence through the provision of knowledge.

Development Strategy Essay Example | Topics and Well Written Essays - 1500 words

Development Strategy - Essay Example and growth of specialized stores the competitive landscape became much more diversified. 'Boots operates in an extremely competitive environment where the pace of decision-making and speed of implementation is integral to success," said Boots' chief executive Richard Baker.' (WWD, Jan 23, 2004, p.13). In response to the changes of the environmental factors Boots Group has undertaken a number of measures. Among them are launch of the customer loyalty programmes, sale of non-core business branches, plans for merger etc. One of the examples is the loyalty programme that has been commenced early in the year. 'Customers earn four points for every 1 [pounds sterling] spent. They can buy goods with points, each point advantage card earned being worth a penny. Customers can also collect points on the Boots website, boots.com, but can't spend them on the site.' (Grocer, Feb 19, 2005 p45) The possibility to unite the efforts and capabilities with one more strong market player is for Boots Group another way of addressing the struggle for profits in a competitive environment. In October 2005 the company announced that 'it has been in talks for about six months regarding a merger with rival Alliance UniChem. The transaction was approved by both companies' respective executive boards and shareholders and is expected to be finalized in April, 2006.' (Hoovers 2005) The America's Intelligence Wire, Oct 3, 2005 noted that 'the merger comes after Boots. . .refused to reiterate profit guidance for the year amid slowing U.K. consumer spending and competition with Britain's top retailer, Tesco PLC'. Taken into account that the shareholders and potential investors are two more integral parts of the company's business environment, the rumours about possible merger that have been circulating for six months had significant influence on the stock performance. The ambiguity of the future outcome has partially caused the decline in the stock price earlier in the year followed by the increase after the announcement of merger has been made. (Reuters Quote 2005). The goal of the merger is to create 'an international, pharmacy-led company with a combined turnover of L13.0 billion ($23.11 billion), to operate under the name Alliance Boots. However, their proposal might yet be scuppered as several private-equity firms are reported to be looking at making a bid for Boots following the news that it is up for sale. Among these are KKR, Permira and Apax'. (Pharma Marketletter, Oct 10, 2005 p0) Another environmental aspect that becomes more and more important with the course of Boots expansion into the US market is the economic, social and political factors and the specifics of this market. The groups plan to gain strength in the US retail market in the upcoming few years: The firm is boosting its beauty product presence in U.S. retail partners CVS and Target, and by this fall, Boots beauty items will be offered in 130 stores, up from 32, which will give it entry into the key markets of Washington, D.C., San Francisco, Dallas, Minneapolis and suburban New York and Boston. This effort will also help the retailer gather data on how to successfully expand here nationwide in 2006 within these retailers. (Moore 2005, p.1) Organizational Audit The internal environment of the Boots Company is built upon a strong notion of

Rawlsian Civil Disobedience Speech or Presentation

Rawlsian Civil Disobedience - Speech or Presentation Example However, this kind of struggle is not the kind of struggle swamped with blood and precious life. It is the kind of resistance to injustice employing non-violent means, the kind of struggle wherein civil disobedience takes center stage. After all, I've always believed that violence breeds violence and that pure goals can never justify impure or violent actions. After World War 1, I began the Indian campaign for home rule and as a strong advocate of Satyagraha - "truth and firmness" -- I launched the movement ofnon-violent resistance to Great Britain. My protest against the Rowlatt Acts led to the slaughter of Indians at Amritsar by British soldiers; and in 1920, when the British government failed to make amends, I declared an organized campaign of non-cooperation. With this campaign, my fellow Indians in public office walked out from their jobs, government agencies were boycotted and Indian children were withdrawn from government schools. As a consequence, all throughout India, streets were blocked with crouching Indians who declined to rise even when beaten by police. True to expectations, I was again arrested. Economic independence for India, involving the absolute boycott of British goods, was an outcome of my Swaraj movement.

Explore the techniques used Essay Example for Free

Explore the techniques used Essay Explore the techniques used by Carol Ann Duffy to create contrasting voices by comparing two of the persona poems. In the poem Fraud, Duffy takes on the persona of an historical figure and creates a voice for it. She writes from the point of view of this character. In doing so, Duffy portrays the feelings and emotions of that character as she sees them. The character in Fraud is a Jewish man whose family were all killed in the Nazi holocaust. His name was Jon Ludwick Hoch, who later changes his name to Robert Maxwell. This was so that he could escape his past and what he left behind when he left Slovakia and to help him fit in when he moved to England. A way in which a voice is created in this poem is through use of the language, this marks it so you can tell it can only come from this specific character. The language is very direct and factual, giving no alternatives. What was my aim? To change from a bum a To a billionaire. The language exposes a lot about this persona. It shows that he was intelligent and cunning and knows what he is talking about. The character is not self pitying like that of the persona in Havisham,but condsending. The two characters through the use of different voices in each poem are portrayed as once being very vulnerable but now have become hardened by time. Povertys dumb. Take it from me Sunny Jim. This quote is from Fraud this shows how the voice is dominating and condescending. When looking at the poem you can immediately see that the line length is generally short, with no more than fourteen words per line and no less than two. This may be a method in which the personas thoughts are expressed, very rapid and direct thoughts. A lot of the lines end with M, for example scum, slum. This M sound is crude and suggests that the voice is similar to that of a whining and spoilt child. Which, in turn, when you research the real life character, says a lot about the person. He Lots of words in the poem are mono syables which gives a heavy beat to the end of the line. The character speaks in colloquial language, using a lot of slang words; this gives us an immediate opinion of the character. There is a frequent use of curse words this gives you the impression that the character is very direct not only in his conversations with people but with his whole out look to life. Words such as Mother fucker are swear words, but when used in this context in the play it gives a depth to the character. Through Duffys use of words we as readers can learn more about the character she is portraying/ A device that Duffy has used in this poem and with a lot of previous poems is the use of ellipsis. For example, the man speaks elliptically, his attitude towards things and he doesnt explain himself. This shows that his character is Shady , he elliptically refers to contemporary things. When he is talking about God, he talks elliptically about a lesbian sex show. Then theres Him- for whom I paid for a butch and femme To make him come. To create the contrasting voice in this poem, Duffy uses the above techniques. But what techniques are used in another of her persona poems Havisham? Havisham is a character taken from literature and given a voice by Duffy. The woman in question is the tragic Miss Havisham from Charles Dickenss novel Great Expectations. Some history to the character in Havisham is; she was jilted at the alter by her lover whom she was due to marry. She never really recovered from that day. Inside her house she kept the wedding feast as it was, at this point rotting and rat infested. She wore her once beautiful wedding dress, now reduced to blackened rags. The point is, she wanted to keep everything exactly the way it was the day of her wedding, in hope that her lover would come back to her. Clearly from the outset there is still bitterness for the love she lost unsuspectedly. The first literary device used in this poem, in the first line is an oxymoron when referring to her lover. This suggests what she once felt for him, and what she thinks of him now. An oxymoron is a contradiction, so it begs the question, how can he be both of these things? Beloved sweetheart bastard. As in Fraud, there is a use of elliptical language which leaves the reader asking themselves questions about the character and what she is referring to. Not a day since then I havent wished him dead . Prayed for it So hard I have dark green pebbles for eyes, Ropes on the back of my hand I could strangle with. Who is he? When was then? To make this more effective and dramatic, Duffy uses a metaphor to try and convey what it feels like. What it feels like when she is saying how much she has longed for him to be dead. Her eyes are compared to dark green pebbles. This has all sorts of connotations, what does a dark green pebble feel like? The first thing that comes to my mind is that it is referring to how she has become cold and almost unhuman. This is what he has reduced her to. Another metaphor is employed in the same stanza when she talks about the ropes on her hands. Of course, she does not literally have ropes on her hands; its connotations are that of veins. The veins on her hands are bulging, through the stress she has been put through. This poem is full of rage and anguish, unlike Fraud where the main tone was demeaning of others. The woman in this poem is extremely self pitying and is completely self absorbed over what this man did to her. She is lonely and lost, grieving for her lost love. This poem is not normally structured; it does not flow as most poems do. In the first two stanzas there are two or three words, then a full stop. This method is to give that line a more dramatic and edgy feel, to set off the enigmas in the poem. Spinster. I stink and remember. Beloved sweetheart bastard. Both of the personas in these poems are not happy or jubilant in any way, they are depressing figures that eventually come to their end. The point is that similar methods are used to create the two contrasting voices. The way in which you use them and the language used is what really determines the creation of a contrasting voice and persona.

Case Study of diagnosis and treatment of Gout

Case Study of diagnosis and treatment of Gout A 50 year-old male presented for an evaluation of rapid onset of pain and swelling in his right toe. The patient reported that he had two similar previous episodes with the same symptoms lasting four to five days and was treated by emergency physicians. The patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s past medical history is significant for hypertension and treated with Hydrochlorothiazide. The review of systems was negative for headache, fever, chills, rash, earache, sore throat, cough, rhinorrhea, vision changes, weight loss, or change in appetite or disposition. The patient was afebrile, and this blood pressure was slightly elevated. PHYSICAL EXAMINATION: General: The patient is a pleasant male who appears to be in no apparent distress. Vital Signs: blood pressure 123/48, heart rate 76, Temperature 38.3 and 98% on room air. HEENT: Extraocular muscles are intact. Pupils are equal, round, and reactive to light and accommodation. Neck: Supple. No jugular vein distention noted. No carotid bruits noted. Lungs: Clear to auscultation bilaterally. No wheezes, rubs or rhonchi. Heart: Regular rate and rhythm. Normal S1, S2. A 2/6 to 3/6 systolic ejection murmur at the right upper sternal border. PMI is nondisplaced. Abdomen: Notable for laparoscopy surgical wound. Positive bowel sounds. Extremities: MTP is red, hot and swollen. Neurologic: The patient is alert and oriented x3. No focal neurologic deficits noted. Pathophysiology Gout is an inflammatory disease characterized by the deposition of uric acid crystals in and around joints, subcutaneous tissues, and kidneys. Although men and women are equally affected by gout, men are six times more likely to have serum concentrations above 7 mg per dL. Gout typically occurs during middle age and is uncommon before the age 30 years old. Women rarely have gouty arthritis attacks before menopause 1. Clinical Presentation Gout attacks are usually associated with precipitated events. Patients usually present with rapid onset of severe pain, swelling, redness, and warmth in one or tow joints. This pain and inflammation are caused by inflammatory response. Acute attack untreated attacks usually last two to 21 days depending on cases. There are four clinical stages of gout according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The first stage is known as asymptomatic hyperurecemia. During this stage, the patients can have an elevation of uric acid in the blood but they do not have any symptoms yet. After more and more urate deposits around a joint and if any trauma triggers the release of crystal into the joint space, patients will suffer acute attacks of gout. This second stage is known as acute gouty arthritis. The third stage, known as interval or intercritical gout, involves the interval between acute flare gout attacks with persist crystals in the joints. When crystals deposits continue to accumulate, patients are likely to develop chronically stiff and swollen joints. This stage is called chronic tophceous gout. Some permanent damage to affected joints and sometimes to kidneys can be seen. This advanced stage is relatively uncommon if patients receive proper treatment. Differential Diagnosis Gout in the elderly is often polyarticular and involves upper extremity joints (especially proximal interphalangeal joints and distal interphalangeal joints). Women present 70% of the time with polyarticular disease rather than the classic monoarticular arthritis seen in men. Gout can be mistaken for rheumatoid arthritis because tophi may resemble rheumatoid nodules and rheumatoid factors often become weakly positive as people age. It may be difficult to differentiate cellulitis or septic arthritis from gout, particularly when a fever, leukocytosis, redness, or desquamation is present. The term pseudogout, for calcium pyrophosphate deposition disease, belies the difficulty in clinically differentiating it from gout. For definitive diagnosis, joint fluid must be aspirated for culture and a search for urate crystals. Diagnostic Test The gold standard diagnostic test for gout is an arthrocentesis. The American College of Rheumatology has established 12 clinical criteria, 6 of which a patient must have for diagnosis. * Maximum joint inflammation within 1 day * More than one attack over time * Monoarticular arthritis (although gout can be polyarticular) * Redness of joint * Great metatarsophalangeal pain or swelling * Unilateral great metatarsophalangeal involvement * Unilateral tarsal involvement * Suspected tophus * Hyperuricemia * Asymmetrical swelling within the joint on x-ray * Subcortical cysts without erosion on x-ray * Joint fluid culture negative for organisms during attack Treatment and Management The gold of treating gout is to minimize or eliminate the urate crystals from the joints and other structures associated with them. Several aspects must be taken into consideration and each treatment regiment is varied from patients to patients. The three main objectives that FNP take into consideration are treatment for the acute attacks, prophylaxis against recurrent attacks, and management of hyperurecemia. Asymptomatic hyperurecemia: urate-lowering drugs is not recommended to treat patients with asymptomatic hyperurecemia. If hyperurecemia is identified, underlying causes such as obesity, hypercholesterolemia, alcohol consumption, and hypertension should be addressed. Acute gout: NSAIDs are being used as first-line therapy. Indomethacin (Indocin), ibuprofen (Motrin), naproxen (Naprosyn), sulindac (Clinoril), piroxicam (Feldene) are also effective against gout. Corticosteroids: intra-articular, intravenous, intramuscular or oral corticosteroids are effective in acute gout. When one or two joints are involved, intra-articular injection of corticosteroid can be used. Intramuscular triamcinolone acetonide is as effective as indomethacin in relieving acute gouty arthritis. Triamcinolone acetonide is especially useful in patients with contraindication to NSAIDs. Oral prednisone: is an option when repeat dosing is anticipate. Prenisone, 0.5 mg per kg on day 1 and tapered by 5 mg each day is effective. Cochicine is also effective treatment for acute gout. However, majority of patients experience gastrointestinal side effects, including nausea, vomiting, and diarrhea. Patient Education If they are obese, they should be advised to begin a concerted program of supervised weight reduction (see Chapter 233), but to avoid starvation or very low calorie diets that may only exacerbate the risk of gout. Drinkers should be warned against binges. Maintenance of good hydration needs to be stressed to those at risk for nephrolithiasis. On the other hand, patients will find it comforting to know that severe dietary restrictions are unnecessary. Fasting should be avoided because it may precipitate an attack. The importance of treating an acute attack at the first sign of illness also needs to be stressed. For the patient with interval gout, a discussion of the risks and benefits of prophylactic therapy and the importance of compliance is indicated. Those taking allopurinol should be warned of the risk of a hypersensitivity reaction and advised to cease intake immediately and call the physician at the first sign of a rash, fever, or other manifestation. Pain management is the pri mary concern during acute phase of and attack. The patient should be advised to take analgesic medications as schedule. The joint should be rested as much as possible in a position of comfort. Ice, not heat, may help with reducing discomfort. Conclusion Gout is one of the most causes of acute monoarticular arthritis. Primary gout runs in families and follows multifactorial inheritance. The expanded use of agents that decrease uric acid excretion has significantly increased the incidence of secondary gout. The Fremingham Study suggested that almost half of new cases were associated with thiazide use. The FNP should be able to properly diagnose acute gout, treat it, prevent recurrence, and minimize the chances for the development of chronic gouty arthritis. Patients who present with asymptomatic hyperuricemia should be further investigated to prevent complications from this disorder.

Human trafficking and child sex trafficking

Human trafficking and child sex trafficking In recent years, there has been an increasing interest in the research of human trafficking, both in general and in child sex trafficking as a specific and crucial phenomenon. According to the U.S. Department of State (2007) trafficking is one of the fastest growing criminal enterprises with an approximate number of 800.000 victims each year trafficked over international borders. Anti-trafficking campaigns and NGOs have mushroomed and anti-trafficking policies have become important features of both international development agencies and governmental agendas (Piper 2005:203). Largely, scholars have concentrated their research on South East Asia; a region which is often described as the hub of trafficking in persons, particularly for the purpose of sexual exploitation. Since the UN Transitional Authority period child sex trafficking and child sex tourism have been identified as a specific problems and Cambodia has become the focus of many UN activities. Child sex trafficking is describ ed as relatively new phenomenon in Cambodia which did not exist before 1970 (Archivantitkul: 1998). The political and economic landscape of Cambodia as well as moral and social values have changed considerably in the last three decades since the Khmer Rouge regime. This fact makes Cambodia particularly vulnerable for people who seek to make a profit from the poverty of people who may be overwhelmed by the ongoing fast changing impacts which come to their country. South-East Asia has a large scale of undocumented labour migration. Those migrations flows are greatly facilitated by recruiters in destination and origin countries which can cause an exploitative situation. There is a fine line between the issues of migrant smuggling and trafficking and their distinctions are often blurred. Therefore, trafficking has to be seen as a part of migration flows (Piper 2005: 207). Most of human trafficking activities in South East Asia, particularly in the Mekong sub-region, take place domestically and so one can refer more to a regional or national problem than to an international one (ibid.:204). This part of the issue should be considered carefully as different patterns such as globalisation and the socio-economic conditions play an important role and could make trafficking in Cambodia again an international problem considering the causes ( ibid.:205). The definition of trafficking has changed considerably in the last number of decades and yet there is still no consensus about a universally valid definition (Laczko 2005: 10). The lack of a common definition together with the refusal of some states to recognise the existence of trafficking within their country makes it hard to combat this issue effectively on a global scale (Savona and Stefanizzi 2007: 2). In 2000, the UN General Assembly adopted the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons  [1]  , also known as the Palermo Protocol. The protocol offers for the first time a legally binding international definition of trafficking as the control of one person over another for the purpose of exploitation: Trafficking in persons shall mean the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs. Human trafficking and in particular child sex trafficking is considered by different scholars and studies (e.g. Williams and Masika 2002; Jana 2002; Asia Regional Cooperation to Prevent People Trafficking 2003) as a highly gendered topic. Despite the lack of research and accurate data on trafficking patterns, and it is clear that the majority of trafficking victims are women and girls (UNODC, 2006). Hence, one can say that trafficking is so often seen to be caused and facilitated by unequal gender relations and patriarchal values and systems (Williams and Masika 2002: 6). Undeniably, this creates of vulnerabilities and therefore human rights violations on women and children. Understanding the gender dimensions of this phenomenon is crucial to obtain a clear picture of the recruitment of trafficking victims up to the development of policy strategies and campaigns to combat these human rights violations. 1.1. The construction of the victim of child sex trafficking Existing research as well as political and criminal justice activity has the tendency to focus on the offender and their identification and punishment, rather than considering the victims of sex trafficking as equal players. This reflects a traditional criminology research approach which is often criticised by victimology discourse (Goody 2005: 239). Despite the large amount of literature and research which addresses child sex trafficking in Cambodia, there remains a gap about the conceptualisation of the victim of child sex trafficking. From a western perspective, victim conceptions are diverse which can be seen for instance in the ideal victim (Christie 1986) and in social constructivism views (e.g. Schà ¼tz 1962). Therefore it is also vital to consider the gender perspective of trafficking and the social role and construction of women and girls in the Cambodian society today in contrast to the past. For a better understanding of the origin of the construction perceptions it is interesting to take a closer look at constructivism theory. The concept of the victim underlies a construction of a certain reality within a culture, a society and in particular an institution. Those constructions of realities can be seen in the light of constructivism which means the construction of social realities. The theory of social constructivism has been contributed to by Schà ¼tz (1962), Berger and Luckmann (1966) and Gergen (1985, 1999). Regarding the construction of knowledge Schà ¼tz (1962: 5) argues that (a)ll our knowledge of the world, in common sense as well as in scientific thinking, involves constructs, i.e. a set of abstractions, generalizations, formalizations, idealizations, specific to the relevant level of thought organization. In terms of constructing the picture of a victim one can assume that the content of a perception is constructed in an active- constructive process of production rather than a passive- receptive process of representation (Flick 2004: 89). We find access to our world of experience which includes natural and social environment as well as certain conceptions by the construction of concepts and knowledge which are used to interpret experiences, understanding and attribution of meaning (ibid.: 90). It is crucial to regard the construction of knowledge and concepts in the context of social research and figure out the relevance for the present dissertation. Schà ¼tz (1962: 208ff) describes that social research uses pre-existing everyday constructs out of everyday knowledge and constructs with this another more formalised and generalised version of the world (Flick 2004: 91). Due to the lack of research about the conception of a victim in Cambodian society, my dissertation will focus on the social construct of a child sex trafficking victim and how it differs depending on the social environment or society the child is living in. This research seeks to identify the concept of a child sex trafficking victim which NGOs, International Organisation and the Cambodian government develop campaigns and policies to combat trafficking on. To get a clearer picture of the causes of child victim Piper (2005) claims that there is more research required into pre-trafficking situations (evidence of child abuse, family situation, and socio-economic pressure on family) and the challenges faced by trafficked victims who return to their countries and/ or regions of origin. Also the question arises of whether the victim can attain victim status after being returned to the family or whether stigmatisation causes him/her to be seen as an outcast. I would like to consider these issues for my qualitative interviews with NGOs and governmental representatives in Cambodia. 1.2. Additional literature review Apart from the literature referred to in the text above, essential texts for researching human trafficking and child sex trafficking in particular are e.g. Micollier (eds) (2004) who edited different essays which examine the social construction of sexuality, gender roles in the family, and gendered power relations in society in East Asia. The International Organization for Migration (IOM) also published various studies and books concerning human trafficking. The most contributive one for my research (IOM 2005), gathers a collection of essays that describe data collection and research of human trafficking from different countries. Relevant for the Mekong sub-region, Nicola Piper (2005) gives a review in this book about undertaken research on trafficking in South East Asia and Oceania. She highlights the gaps of knowledge in literature and research of trafficking issues. Savona and Stefanizzi (eds) (2007) and their contributors have a similar focus but offer a deeper analysis of migrat ion flows and trafficking and improving monitoring mechanisms for these complex criminal activities. An important study about human trafficking in Cambodia was undertaken by the Asia Regional Cooperation to Prevent People Trafficking (2003): Gender, Human Trafficking and the Criminal Justice System in Cambodia. Their research focus was on the gender perspective of trafficking and the underlying causes and contributing factors. Another study by the Asian Foundation (2006): A Review of a Decade of Research On Trafficking in Persons, Cambodia, aimed to provide a systematically review on trafficking related research about the consequences, scopes and patterns of trafficking. They review more trafficking in general and in its various patterns. Child sex trafficking is considered in a small but well researched paragraph. Summing up, these key readings and studies all critically asses human trafficking and offer a variety of valid perspectives on the phenomenon. 2. Research question and aim Research question As introduced to in the paragraph above, my research question arises out of a literature gap.: What type of conceptualisation of a victim do victim support centres, NGOs and the government in Cambodia have and how do those concepts influence their work, campaigns and policy strategies? Research aim The research aim is to identify the different existing constructions of a child sex trafficking victims in Cambodia provided and to explore if the social and cultural construction of a trafficked child differs depending on society and social environment like shelters or vocational training programme the child lives in or is involved in. Possible sub-questions that contribute to the research question are: How do children become victims of trafficking? What is the social construction of women and girls in Cambodia? Explore the historical development of the term child and juvenile in Cambodia in legal and cultural ways. Is there a changing meaning of those terms? How important is virginity for Cambodian men? 3. Research Method/ Design According to Flick (2006), the foundation of qualitative research is the reconstruction of social realities. Through the exploration of subjective perceptions, patterns of interpretation, structural characteristics and the latent meaning of action, a deeper understanding of a study field can be achieved. Thereby, no proband taming takes place by presetting of answering categories, but it creates a space for individual perspectives of the study field (Muckel 1996: 66). The general claim of qualitative research is to describe life worlds from the inside out, from the point of view of the people who participate (Flick et al: 3), to contribute to a better understanding of social realities. In comparison to quantitative social research where one examine already formulated hypothesis, the aim of qualitative research is to discover new ideas and to develop empirically justified theories (Flick 2006: 15). Though, the communication of the researches of the particular field, i.e. the subjectiv ity of the researcher and the researched, becomes an essential component of the research process and the finding (Flick 2006). Contrary to quantitative research controlling or excluding influence from the researched as interfering variables, in qualitative research the reflection of the researchers actions, his perceptions and observations as well as impressions and irritations are involved in the data evaluation process (ibid.: 16). The openness to the primary world of the researched and their different constructions of reality as well as according to the applied research methods are a basic characteristic of qualitative research (ibid.). My research interest focuses on the subjective views and conception of the victim of child sex trafficking in Cambodia. Therefore it is essential to apply qualitative research methods. In the following I will describe the chosen methods of collecting and evaluating data. 3.1. Method of data collection The dissertation seeks to asses NGOs, crisis centres and governmental agencies conceptions and views of the victim of child sex trafficking in Cambodia. The aim is to examine how their construction of a child victim influences their project, campaigns and policies. This interrelation is possible to depict verbally but not easily to detect throughout observation processes due to ethical considerations. The observation of the work with victims is ethically not justifiable in such a short research time frame as the identity with victims is strictly confidential and observation is not approved by the organisations or shelters if the researcher is not able to stay at least 2 month. Therefore the qualitative interview with the organisations and shelters was chosen as a research method. The main interest is to find out about particular perceptions and more complex argumentations. Therefore the questioning should be more active and probing (Hopf 2004: 204). Semi-structured Interview The semi-structured interview is an appropriate approach to explore the subjective perception and theories that stands behind my questionnaire. Scheele and Groeben (1988) introduced this approach to explore the construction and subjective theories behind everyday knowledge and the field of study (Flick 2006: 155). Their assumption was that interviewees are encouraged to express their perceptions and their reasoning behind certain topics in a natural manner if the interviewer provides a semi-structured question setting. Therefore one can reconstruct the subjective theories and views of the interviewee for the purpose of the study. The main elements of the semi-structured interview are open and confrontational questions. (see box 1) They offer the interviewee space to express their perception and knowledge. The confrontational question has a responsive function to the subjective theories offered by the interviewee and is asking a competing alternative to re-examine the opinions (ibid.: 156). An example for my research would be: (Text box 1) Another set of questions would be hypothesis-directed questions (see text box 2) which test scientific literature written about the research topic (ibid.). They give the interviewee the chance to become more explicit and help the interviewer to get the required information for the researched topic: (Text box 2) In specific: the Expert Interview The expert interview is a subcategory of the semi-structured interview. The approach of the dissertation questionnaire is to interview on the one hand service providers like victim support centre, crisis centres and NGOs that support the victim needs and rights. On the other hand it is an aim to speak to the Cambodian government which means in particular MP Mu Sochua of the Ministry of Womens and Veterans Affairs (MWVA). Here the interest is not so much the biographic background of the actual person but more the perception of the actual institution or the Cambodian Parliament about the research topic. The interviewees are seen as representatives for a certain group not as individuals (Flick 2006: 165). There are several research practical amenities for the expert interview. In an early exploration phase of a theoretical, less prestructured and informational less cross-linked research, the expert interview offers unrivalled dense data acquisition. This stands in contrast to the elaborate, cost and time-intensive accomplishment of participant observation, field study and systematic quantitative research (Bogner and Menz 2005: 7). It is recommended to choose expert interviews if a study field is hard or impossible to access especially when it comes to delicate issues like child sex trafficking and child prostitution. Beside the economic advantages and the chance to get information even about an awkward issue, another advantage is the facilitation of further field access when the expert refers to other colleagues and dialogue partners. It should also be noted out of a methodological view that a further benefit is that it is much easier to interview an expert as they usually have a higher linguistic competence which contributes directly to the analysis of the narrative. Hence, in an idealised conception, two academic socialised dialogue partners meet in this interview setting (ibid.: 8). To ensure validity of my research and to ascertain patterns of the construction of the victim of child sex trafficking, I intend to carry out 15-20 interviews with victim support centres, Human Rights NGOs who are concerned about child sex trafficking and government representatives (all in Phnom Penh). All institutions are contacted via email and telephone to arrange an appointment during my field trip in Cambodia and to offer them an outline of the research project which gives them the opportunity to prepare for the questions. I will use open-ended questions that give the interviewee space to present their perceptions and views. It also allows for the emergence of new topics that were not originally thought to be part of the interview. I will prepare 8 broad topics for the interviews that are formulated as broad questions and introduce them one after the other  [2]  . Depending on the interview course, I will specify the topics and ask in more detail to clarify vague formulations. 3.2. Limitations Whilst there are many advantages to this research design, there are also several limitations to the expert interview. Meuser and Nagel (2002:87) identify the expert might not always react as desired where their expertise may emerge as being limited and impede the interview process. Further, they identify the eventuality that the interviewee may not t participate in the question-answering game (Flick 2006:165) giving instead a speech to promote their knowledge and/or agenda. Whilst this can sometimes contribute to the research topic, it can also digress from the point and make it difficult to return to the original question. Another potential weakness of expert interviews is that the interviewee can change roles from being an expert to being a private person. Whereby, the interview looses objectiveness and private/ personal perceptions and bias may interfere with the representation of the institution or expert knowledge (ibid.). To ensure reliability for this method it is crucial that the interviewee, here the expert, understands the research context and the questions fully. Bulmer and Warwick (1983) identify the difficulties of conducting social research in developing countries which gives this research proposal an interesting angle. It is widely recognised that the availability of social data in developing countries is limited. Existing data is often of poor quality and therefore of little use due to limited administrative capacity, lack of manpower and infrastructure (ibid.: 4-5). The validity might be restricted and misleading if one relies only on administrative sources. The Cambodian law enforcement agencies and administration are perceived as the most corrupt sector. The Global Corruption Barometer also shows that 70% of the citizens are likely to pay bribes to the police (Anti- Corruption Resource Centre 2009) which proves the normality and explicitness of corruption within the population. When it comes to delicate issues such as human trafficking high ranking Cambodian law enforcement official are believed to accept bribes to facilitate human trafficking and child prostitution (US Department of State Human Rights Report 2006). A revealing example for corruption compliance within sex trafficking is the former Deputy Director of the Police Anti-Human Trafficking and Juvenile Department and two officials under his supervision were convicted and imprisoned for facilitating human trafficking (Anti- Corruption Resource Centre 2009). Due to the ubiquity of corr uption, corruption this must be recognised within my research and considered when seeking out NGOs, who can offer a different picture of the reality throughout their mandate, their reports and research. With this considering and an awareness of these potential difficulties and obstacles within the interview process, a valid data collection can be better guaranteed. If one does so, the expert interview can be a very useful and powerful source to generate valid data. After weighing up the variety of pro and cons, the expert interview is an appropriate interview method for this research to provide an interpretative account of the concept a child sex trafficking victim. 3.3. Alternative Method: Problem-centered Interview (PCI) Initially the problem-centered interview (Witzel 1982; 1985) was considered as an appropriate interview method for my research question about construction of a victim. The principles of the problem-centred interview are to gather objective evidence on human behaviour as well as on subjective perceptions and ways of processing social reality (Witzel 2000:1). In this sense, the basic concern is the exploration of subjective cognition, approaches, motivation for actions and situation al interpretations. In contrast, the narrative interview (Hopf 2004: 206) is considered in this context to be inadequate because it produces a lot of material which leads to a huge data amount. Further, there should be no intervention in the process where the role of the interviewer is an attentive listener. This would be inappropriate considering the specific research questionnaire in mind and the given time frame. The problem-centered interview to large extent draws upon Glasers and Strausss (1967) theory generating method of the Grounded Theory. The primary reason for excluding this research method is the fact that it is a biographic focused interview where the biography and personal experiences of the interviewee are integral to the data generated. The expert knowledge of a certain field or of a particular organisation and expertise which mirrors the ideology of that institution is of more use than the biography of the expert and their personal motivations and views. Nevertheless, the research interest is to ascertain and interpret why the concept of the victim is constructed as described by the organisation experts and why it might differ from Western views of the child as a victim of sex trafficking. Therefore cultural and social constructions of realities have to be included. 3.4. Data analysis The reliability of this study will be maximised by transcribing all interviews conducted and building categories based on an initial reading of the transcripts. This process is described as coding (e.g. Flick 2006: 295 and Seale 2004: 306ff) which is based in based in grounded theory as discussed earlier  [3]  . Seale identifies that the purpose of coding qualitative data is to reduce large amounts of data and to develop and test out theories (2004: 313). The main challenging task for the researcher is to filter out comparisons and identify similarities and differences in the interview material. For my research I will use open coding which means the process of breaking down, examining, comparing, conceptualising and categorizing data (Strauss and Corbin 1990: 61). The coding strategy enables me to analyse the concepts of the victim of child sex trafficking, group them into categories and subsequently discuss them in depth. The last step of coding is a list of terms together with an explanatory text (Bà ¶hm 2004: 271). 3.5. Ethics in qualitative research Multiple ethical considerations arise throughout the research process for this dissertation. Starting from the research design and the appropriateness of certain methods to collecting data and further on to the point of analysing the gathered data. More recently there has been a paradigm shift from the ethical concerns in social research concerned with the ways in which participants are affected by the research to a more post-structuralist approach which includes the social world and the knowable and objective truth is uncovered by researchers (Ali and Kelly 2004: 116). A crucial influence in social research ethics comes from feminist researchers who emphasise [à ¢Ã¢â€š ¬Ã‚ ¦] the role of power relations at all levels of knowledge production, from epistemology, through research relationships, to the dissemination of findings (ibid.). Research regarding child sex trafficking can be seen from the perspective of feminist research as it is a highly gendered topic. It is therefore crucia l to consider feminist research practices and its related ethical elements. A primary aim of feminist research is to contest and dispute the marginalised status of woman, and in this particular case vulnerable child, by representing their needs, perspectives and perceptions (Gillies and Alldred 2005: 39). There have been many controversies surrounding the role of the researcher in the production of knowledge about women and representing the Other (Wilkonson and Kitzinger 1996, in: Gillies and Alldred 2005: 39). The ethical concerns posed when carrying out research on trafficked children as such a vulnerable group are profound. I therefore consider it ethically unjustifiable to interview children about their experience with sexual exploitation within this short research period. Such an approach could potentially cause further distress to an already vulnerable and exploited subject group. As such, I have therefore decided against interviewing victims of trafficking and will conduct interviews exclusively with experts. Respect will be given to existing ethical precautions and regulations for social research whilst also acknowledging that an ethical practice will often comes down to the professional integrity of the individual researcher (Ali and Kelly 2004: 118). Translator difficulties A further challenge to potentially interviewing victims would be the requirement of a translator which can creates a multitude of problems: The dynamic can create a tense and unbalanced atmosphere for the victims to talk comfortably. There is a risk that the translator may not translate the verbatim accurately. Finally, interpretation of the language particulars of the victim is crucial to the data and therefore not understanding Khmer creates a large obstacle when reviewing the interview translations. This may be hard to overcome even with a translator. In consideration of this I decided to interview English speaking NGOs and government representatives. How generalisable will our results be to the sectors as a whole? 5. Timescale from 15th April to 2nd September Date 2010 Literature Review Contacts Questionnaire Design Fieldwork Cambodia Data Processing Data Analysis Write Report Submit Report April 15 * April 22 * April29 * * April 6 * * * May13 * * * May20 * * * May 27 * June 3 * * June 10 * June 17 * * June 24 * * July 1 * * July 8 * * July 15 * * July 22 * * July 29 * Aug 5 * * Aug 12 * * Aug 19 * Aug 26 * Sep 2 * Sep 9 * Sep 15 * (Bloch, A. (2010) Timescales for Research Project: The Professional Capacity of Nationals from the Somali Regions in the UK, Moodle City University, slides of lecture 6) 6. Bibliography Books and journal articles: Ali, S. and Kelly, M. (2004) Ethics and social research, in Seale, C. Researching Society and Culture. London [et al.]: Sage Publications. Archivantitkul, K. (1998) Trafficking in children for forced labour exploitation including child prostitution in the Mekong sub-region. Bangkok: ILO-IPEC. Asia Regional Cooperation to Prevent People Trafficking (2003) Gender, Human Trafficking and the Criminal Justice System in Cambodia http://wwww.humantrafficking.org/uploads/updates/gender_report_cambodia.pdf [accessed 7th April 2010]. Berger, P.L. and Luckmann, T. (1966) The Social Construction of Reality. Garden City, NY: Doubleday. Bloch, A. (2010) Timescales for Research Project: The Professional Capacity of Nationals from the Somali Regions in the UK, Moodle City University, slides of lecture 6. Bogner, A., Menz, W. (2005) Expertenwissen und Forschungspraxis: die modernisierungstheoretische und die methodische Debatte um die Experten., in Das Experteninterview: Theorie, Methode, Anwendung. Wiesbaden: VS Verlag FuÃÅ'ˆr Sozialwissenschaften. Bà ¶hm, A. (2004) Theoretical Coding: Text Analysis in Grounded Theory, in Flick et al A Companion to Qualitative Research. London[et al.]: Sage Publications. Bulmer, M., Warwick, D. (1983) Social Research in developing countries. Surveys and Censuses in the Third World. Chichester [West Sussex]: Wiley. Christie, N. (1986) The Ideal Victim, in Fattah, E.A. From Crime Policy to Victim Policy. Reorienting the justice system. Houndmills, Basingstoke, Hampshire: Macmillan. Flick, U., von Kardorff, E. and Steinke, I. (2004) A Companion to Qualitative Research. London [et al.]: Sage Publications. Flick, U. (2004) Constructivism, in Flick,U., von Kardorff, E. and Steinke, I. A Companion to Qualitative

sonnet 12 :: essays research papers

1. When I do count the clock that tells the time, 2. And see the brave day sunk in hideous night; 3. When I behold the violet past prime, 4. And sable curls, all silvered o'er with white; 5. When lofty trees I see barren of leaves, 6. Which erst from heat did canopy the herd, 7. And summer's green all girded up in sheaves, 8. Borne on the bier with white and bristly beard, 9. Then of thy beauty do I question make, 10. That thou among the wastes of time must go, 11. Since sweets and beauties do themselves forsake 12. And die as fast as they see others grow; 13. And nothing 'gainst Time's scythe can make defence 14. Save breed, to brave him when he takes thee hence. This sonnet is so famous that it almost makes commentary unessential. It will always be one of the best sonnets in the history of language. The lively and rapid passage of time, which brings every thing to an end, is described, not indeed in abundance, but with such noteworthy and overwhelming effect that humanity almost stares us in the face as we read it. The logic of the lines ends with the line itself is like the ticking of a clock or the unstoppable motion of a pendulum as it swings from side to side. The importance of the placing of this sonnet here (12) (I believe it’s because of the twelve hours of the day) as well as that of the 'minute' sonnet at (60) is hard to establish, but at the very least it points to an organized hand, which, like the clock itself, measures out the chain of important events as they occur. It is true, however, that it is not clear that we have Shakespeare’s order, so this is just my opinion. As for the forms of the sonnet, we are clear that it was definitely written by Shakespeare. A sonnet is a one-stanza poem of fourteen lines, written in iambic pentameter. One means to illustrate a verse line is to speak about how many stressed and unstressed syllables are in the line. A simple grouping of syllables, some stressed, some unstressed, is called a foot. The iambic foot is an unstressed syllable followed by a stressed syllable. Pentameter means there are five feet in the line. "Iambic Pentameter," subsequently, means a line of ten syllables, which interchanges unstressed and stressed syllables according to the iambic measure.

Crime :: essays research papers

Crime in the nineteeth century was rapid though out United States. But because of all of the poverty and sickness in the streets, crime was the only way to survive. Most of the crimes that took place in United States were crimes that involved stealing. Pickpocket gangs and street gamblers were a regular sight when walking down a major United States street. Prostitution was also a big money maker on the streets, done by both girls and boys. But crimes though out the middle class and rich were mostly property crimes and disputes, which made up 90% of all crimes committed by the upper-class. In the United tates today there a two categories which crimes fall under."Indictable" which is the same as our felony crimes that make up all of the major crimes. These crimes consist of: Murder, armed robbery, burglary, larceny, rape, and assaults on the police. The next called category is called " Summery " crimes which is equal to our misdemeanor crimes. Summery crimes were all minor crimes such as: Property crimes, Vagrancy, Drunkenness, Prostitution, Minor Larceny , and all other minor offenses. Probably the most famous criminal in the Victorian period was " Jack the Ripper ". Jack the Ripper was " the first modern sexual serial killer." Jack's trademark was the killing of female prostitutes. But not only did he kill them, he would surgically remove organs and intrails and place them near the dead body. "Jack the Ripper" wasn't his only nickname, he was also called "the Whitechaple murder " because the body's were found near the Whitechapel Road, and " The Leather Apron" because of a man that would come by and beat up the prostitutes for no reason. Jack the Ripper is credited for 9 killings, but police think that he might be responsible for more. All of the killing accrued with in one square mile. Jack is described as carrying a long knife in which he would cut open his victims, and a black Gladstone bag, the contents of which is unknown. Jack the Ripper's identity is unknown which is probably why this case is so famous. It is rumored that Jack the Ripper was a member of the royal family, and that people knew of his identity but wanted to keep it a secret. The London Metropolitan Police system was created in 1829, after the public need for security has been told to the government.

Apples and Oranges: a Comparative Essay

Apples and Oranges: A Comparative Essay Is the old adage â€Å"you can’t compare apples and oranges† correct? Besides being food, both of these produce items have much in common. They both are located under the Fruits and Vegetable category of the Canadian Food Guide; they are both spherical in shape, making them fit in the palm of your hand; and they both have a considerable amount of moisture under their skin. However, in both nutritional value and aesthetic appearance the orange far out weighs the lowly apple. Although, according to the Canadian Food Guide, a serving of apples and a serving of oranges are both considered one equal serving within the Fruits and Vegetables category, the nutritional value of oranges is far superior to that of apples. First, oranges have a higher concentration of vitamin C. This vitamin is essential in strengthening and maintaining a healthy immune system. Thus, the greater the vitamin C—within reason—the greater the functioning and resilience of our immune system. Furthermore, peeling an orange often requires extreme dexterity and excellent hand-eye coordination. Thus, when eating an orange one is not only receiving an excellent dose of vitamin C, one is also practicing hand-eye coordination and honing his/her dexterity. On the other hand, apples, although a good source of vitamin C lack the concentration that is obviously present in oranges. Thus, when eating an apple it seems that the apple’s nutritional value is simply calorie intake—fuel for the body. While this function is necessary, oranges ‘play double duty’. They provide us with calories at the same time as helping us to fight viruses and disease. Furthermore, eating an apple only requires a strong jaw and teeth. It does not help us to practice transferable skills such as dexterity. While the nutritional value of the fruits we consume is important, their aesthetic appearance is of greater concern. The appearance of an apple is pleasing; its symmetry, shine, and contours emulate marble sculptures. However, there is one essential flaw in the aesthetic of the apple. It lacks a strong and invigorating aroma. When an apple is bitten, it emits a deep musky smell, one that is unique but in no way mood-changing. Oranges, when peeled emit a heavy citrus scent which, studies have shown, help us to become re-energized. Perfumers have even attempted to capture this scent in their colognes, body washes, and au de toilets. But no synthetic concoction can truly mimetic the revitalizing effects of citrus. The very prestigious study of aromatherapy has verified the mood-changing effects of the citrus scent; â€Å"citrus is often used by psychologist to treat patients with depression with some promising results† (Fakes 2). Thus the orange combats both diseases of the body and diseases of the mind. Although there are many superficial similarities between apples and oranges, oranges are of greater nutritional and aesthetic value. Apples are valuable in their caloric value and their appearance, but they lack both the concentration of vitamin C as well as the revitalizing citrus effects. Therefore, perhaps the old adage is correct: â€Å"You can’t compare apples and oranges†.

How Do people make economic decisions Essay

The purpose of this paper is to evaluate how decision-making affects the economy and people. It is obvious that free markets perform much better than communist markets. The decision making principals, according to this there are four decision making principals. In the first principal people will trade off, they will give something up for another thing they want. Making decisions means people will have to trade one goal for another. The second decision is giving up something when they already had one thing. People make trade off according to the economy. People have wants and needs therefore they need to choose carefully how to spend their income and resources. Choosing and item will benefit and cost, it will also mean that the person will not have the benefit of the item he or she gave up. Third the margin is thought of in this step. When considering the margin people will take into consideration the marginal benefit and only then if it exceeds the marginal cost. Last, people will react to incentives. People will react to price and benefits associated with their decision. My example of purchasing my first home was based on marginal cost and marginal benefit. I was renting an apartment in California and rents seem to be going up because the economy going down. People were losing their homes due to foreclosure and had to live somewhere. House prices were going down and rents going up, there was no telling when they were going to stop. I did the math and figured my mortgage would be the same if not lower with some money down. The marginal cost would be greater up front in the form of cost associated with purchasing a home. However, my marginal benefit in the long term would be even greater. Therefore, if rent was cheaper now, I would have to pay more the longer I stay in that apartment. The marginal benefit to purchasing a home would be the same for the following 30 years. The only incentive that would have led me to make a different decision is if they guaranteed my rent for the next 30 years. The economics related to the decision making and the working of the economy can be demonstrated by me purchasing a tool for my job. When I purchase tools I get the benefit of making money based on my ability to fix the customers gas turbines. The economy benefits the store where I purchase the tool makes money. When I fix a gas turbine it allows the customer to pump and produce millions a dollars a day, and they sell the product and make money, in turn they sell the gas to customers which, get to work and make money. A market economy is a type of economic system in which the trading and exchange of goods, services and information takes place in a free market (Market Economy, 2010). These types of markets are governed by supply and demand. A centrally planned economy like Cuba and North Korea decision are made by the government. Mixed economies rely in the state and the private sector to make decisions on the market economy and economic system. In a free market people purchase and sell services and goods. In this type of market people are free to interact. In a communist economy, such as Cuba and North Korea the government decides what needs to be produced and where to work. Decision can be based on marginal cost or marginal benefit; there is no doubt that they are a huge part of the consumer’s decisions to purchase goods. Whether it is the cost of buying a home or just a simple meal people will always weigh the cost of goods.

The Epidemiology Of Tuberculosis Health And Social Care Essay

The intent of this paper is to inform and educate the reader of the mechanisms that make up the respiratory disease called TB. This paper addresses the history, the survey of the disease, and how it affects the wellness of the human population and its environmental public assistance. This survey ‘s purpose is to analyze and see the epidemiology three, symptoms, diagnostic trial, isolation, intervention, Koch ‘s Postulates, probe, surveillance, and obliteration associated with this respiratory infective disease. The Epidemiology of Tuberculosis Tuberculosis ( TB ) is a extremely contagious disease that if non treated, can be fatal. This infection is known for originating in the lungs, nevertheless it has the possible to impact any and all of the organic structure. The tubercle B or Mycobacterium TB is the bacterial micro-organism the causes TB ( Schiffman, 2010 ) . Scientist have traced TB every bit far as 2400 BC in spinal fragments of Egyptian mas and 750 BC in castanetss found in South American ( Medical News, 2010 ) . Throughout the old ages of find of this disease, there have been many names associated with Terbium: white pestilence, ingestion, awful disease, and the male monarch ‘s immorality. The nineteenth century, the generation of the industrial revolution conflicted with a deathly eruption of TB that killed one out of every seven persons infected with the bacterial infection in Europe. Finally this contagious unwellness spread to the United States as the big metropoliss became overpopulated ( Endreszi, 2009 ) . Present twenty-four hours, worldwide, there is more than 2 billion infected with TB. In 2007, there was â€Å" 1.77 million † TB related deceases ( World Health Organization [ WHO ] , 2009 ) . Our society has so many possible countries of increased hazard for the development of TB. The Center for Disease Control ( CDC ) reports that in 2009 there were â€Å" 11,540 TB ( TB ) instances reported in the United States † which is a lessening of 4.2 % in 2008 ( Center for Disease Control, 2010 ) . Hazard of continuance of TB involve HIV unwellnesss, in-migration of individuals from countries with high incidence of TB, and the transmittal of TB in high hazard environments, such as homeless shelters, infirmaries, and correctional installations. These same environments are now describing multi-drug immune TB ( MDR TB ) and extensively drug immune TB ( XDR-TB ) with an addition in decease rates. MDR TB histories for â€Å" 5 % † of the reported TB instances, † 27 sta tes † make up â€Å" 85 % of all MDR TB instances, † ( WHO, 2009 ) and 58 states have been confirmed to hold XDR-TB ( WHO, 2010 ) . The purpose of this survey is to analyze the epidemiology of TB, Koch ‘s posits, surveillance, control, and obliteration steps related to TB. Epidemiology Triad The â€Å" epidemiological three † is a tool that consists of an agent, host, and an environment used to explicate the spread of disease throughout a community, to place points of intercession to forestall transmittal, and to steer epidemiologic probes ( McMurray, 2007 ) . The agent in this survey is Mycobacterium TB ; an acid fast aerophilic rod that reproduces easy and is hypersensative to heat and ultraviolet visible radiation. TB chiefly effects the respiratory system, nevertheless, it can besides consequence the pericardium, lymph nodes, menges, kidneys, bowels, castanetss, articulations, and generative variety meats ( The Merk Manual, 2010 ) . Tuberculosis, a taking worldwide infective disease slayer, killed 1.7 million in 2009. However, â€Å" the TB decease rate has fallen by 35 % since 1990 † ( WHO, 2010 ) . The transmittal of the Mycobacterium TB is spread from individual to individual by airborne droplets with vehicles being coughing, sneeze, and speaking. The smaller the droplet, the longer it can linger in the air after the septic individual has left the country, leting incease probablity of inspiration by another individual. Passing Terbium from a household member or colleague is more likely than a alien in a shop or on the street ( Reichler, Reves, and Bur, 2002 ) . Mycobacterium TB ( infective disease agent ) is readily spreaded to susceptible worlds ( host ) through respiratory exposure in communal scenes or public assemblages ( environment ) . Persons with impaired unsusceptibilities, such as with diabetes mellitus, malignant neoplastic disease, corticosteroid therapy, and HIV/AIDs are at greatest hazard for geting the bacteria infection. In 2008, some Harvard Epimiology pupils conducted an analysis of 13 separate surveies in respects to diabetic patients and the possible elevat ed hazard for TB. Their analysis found that it is prevelant to concentrate on diabetics as high hazard with possible lessening in TB if diabetes can be controlled ( Jeon and Murray, 2008 ) . Although, peoples with healthy immune systems are susceptible if exposed for a long period of clip, for illustration health care workers. Healthcare staff are continuously exposed to illness in infirmary and extended life installations, which places these professionals at hazard for TB. Early sensing and intervention of the active septic individual is the key to bar of transmittal of TB in the health care puting ( Smeltzer, Bare, & A ; Hinkle, 2007 ) . External factors such as the environment can act upon the affects of the being. There are many environments factors that induce the susceptibleness of the organic structure for TB, such as: ethnic/racial minority, impoverished, homeless, overcrowded lodging, prison systems, and immigrants. The denisity of the bacteria in the air besides dictates t he possible hazard for aqcuiring TB ( Smeltzer, Bare, & A ; Hinkle, 2007 ) . Symptoms Latent TB refers to an person that has been exposed to the bacteria and can transport the being in the lungs without any symptoms of TB. This individual can hold a positive tegument trial, a normal thorax X ray, and a negative phlegm vilification. This person will non experience sick. A individual with active Terbium can hold any, all, or none of the undermentioned symptoms: feeling tired all the clip, weight loss, loss of appetency, chronic cough, febrility, haemoptysis, and or dark workout suits. This individual will hold amphoric breath sounds, the thorax may exhibit obtuseness on percussion, and increased tactile fremitus with cracklings can be aucultated after coughing. These persons frequently feel sick and can easy distribute TB to others. The skin trial on this individual will be positive, and they may hold an unnatural thorax X ray and or a positive phlegm vilification ( Center for Disease Control [ CDC ] , 2010 ) . Diagnostic Trial Several diagnostic surveies are available to be performed to find if Mycobacterium TB is present. First, the Mantoux tegument is performed by shooting 0.1ml of PPD agent subdermally doing a wale to guarantee an accurate reading. Errythema and tangible wale. 5mm is considered a positive reading. Of class, a positive skin trial does non ever intend the individual has active TB and the individual could hold been exposed in the yesteryear. Once a individual trials positive with the Mantoux trial, he or she should obtain other methods to find possible exposure. A new trial, Quantiferon TB gold blood trial is now being used in many infirmaries. This trial is reportedly for valid than the skin trial. A sputum sample is collected after a positive tegument trial to execute an acid-fast B ( AFB ) for civilization. This civilization will find if Mycoacterium is present in the giver of the sample. The 3rd survey requires a chest X ray to be completed. The X ray will be viewed for hempen multitud es and possible lesions or redness related to infection the the upper lobes. A medical rating for TB must include a complete history, chest X ray, and physical scrutiny ( Steadman ‘s Medical Dictionary, 2006 ) . Patients that are likely extended attention installation occupants much have these trials performed prior to arrangement. Anytime a patient has an active instance, that patient must be contained and specific intervention initiated to forestall an eruption of the disease. Isolation A confirmed TB or a susptected verification of the disease warrents isolation of the person to forestall farther transmittal to others. The following are several control methods to diminish the hazard of taint. The first is an inititiation of AFB safeguards instantly for all patients with confirmed or suspected of active TB and who may be infective. AFB suites are a individual private room with particular airing systems. Ultraviolet lamps or other methods may be used to supplement airing. The 2nd step is to put up a personal protective equipment ( PPE ) station outside the room. This station provides N95 disposable peculiar inhalators that each individual necessitating to come in room is required to wear prior to capture into room. These mask require a FIT trial to guarantee right size is used for each individual. The 3rd step, is isolation safeguards should be continued until there is a lessening in the beings on a phlegm vilification or clinical grounds of reduced infection. Fourth step, if any grounds of medicine opposition maintain AFB safeguards ongoing until there is a negative phlegm vilification. Particular safeguards should besides be initiated when bring oning a cough for smear sample ( Smeltzer, Bare, & A ; Hinkle, 2007 ) . Treatment Originating intervention without hold is the lone manner TB can be cured. Specialized intervention is based on whether TB is an active disease or merely an infections. Person who has been infected but does non hold the disease may necessitate preventative therapy merely. This preventative therapy is designed to kill the sources that have the possible to do injury. Preventive therapy is normally a prescription for a day-to-day dosage of INH, which is an cheap TB medicine. This preventative therapy last for nine months, with periodic medical examinations to guarantee the medicine is being taken right. Active Terbium instances require intervention with effectual drugs, such as: INH, Rifadin, pyrazinamide, and ethambutol ( WHO, 2009 ) . The intervention regiman entales an initial two month intervention stage followed by a continuance stage. The continuance stage is suggested to last four months for the bulk of patients but can be extended to seven for a sum of nine months. All TB medicin es should be taken together alternatively of divided doses ( Center for Disease Control, 2003 ) . Taking the medicines right is really of import due to if taken falsely patient can go ill and the TB will be more hard to bring around as it becomes drug immune. Multi-drug immune TB ( MDR TB ) is highly unsafe as the bacterium becomes immune to the medicine used to handle the TB, which makes the intervention uneffective. MDR TB is by and large due to the being going restistant to the INH or Rifadin, which are the two most of import anti-TB medicines. Directly oserved therapy ( DOT ) is utilised to guarantee that the patients adhere to the therapy set up for them. DOT is active when a designated individual watches the patient swallow each dosage of medicine. This is a recommend pattern for all patients due to unable to find who will be compliant and who will non ( WHO, 2008 ) . Koch ‘s Postulates â€Å" In 1890, the German doctor and bacteriologist, Robert Koch, released his famed standards for judgment † if a specific bacterium is the existent cause for a specific disease ( Medicine Internet, 2010 ) . Dr. Koch, over one hundred old ages ago, developed the unequivocal association of Mycobacterium TB and the existent TB disease. The cognition of the extended make up of the bacterium, their actions to the organic structure, their life rhythms, and their transmittal from individual to individual has been studied and observed by scientist over the last century. The tubercolusis bacterium was used by Koch in explicating â€Å" Koch ‘s posits, † the systematic series of stairss proved a specific being was so the cause of the specific disease ( Guyer, neodymium ) . Koch ‘s posits are as follows: The bacterium must be present in every instance of the disease. The bacterium must be isolated from the host with the disease and grown in pure civilization. The specific disease must be reproduced when a pure civilization of the bacterium is inoculated into a healthy susceptible host. The bacterium must be recovered from the by experimentation septic host. In order to happen â€Å" fulfillment † of Koch ‘s posits it is still a demand for tie ining an infective agent with a disease ( Medicine Internet, 2010 ) . Probe Every province is required to describe active TB instances and suspected instances to the wellness section by the clinician, infection control nurses, or by the pharmaceuticss when the TB medicines are dispensed. Labs are besides required to describe all positive TB vilifications and civilizations. Early coverage is critical to the control of TB and provides the clinicians entree to the resources of the wellness section for aid in instance direction and contact probe. Health sections routinely conduct contact probes for all instances of active pneumonic TB to place secondary instances of active TB and latent TB infection. This action will eleminate a TB epidemic by originating therapy as needed during these probes. Probes are categorized by the sum of exposure to TB the individual obtained. Health section staff notify exposed contacts so that the contact is scheduled for a PPD. A follow up trial is recommend three months from the initial trial or last exposure. All positive contacts are provided a thorax xray, every bit good as immature kids and immunocompromised contacts to find whether they have active TB ( Reichler, Reves, and Bur, 2002 ) . Surveillance Public wellness surveillance â€Å" is the on-going, systematic aggregation, analysis, reading, and airing of wellness informations † ( CDC, 2010 ) . As for any surveillance system, it is a tool for sweetening. This type of tool is to guarantee timely sensing of the exposure to TB. Nurses, by and large the first contact with the wellness attention system, may happen themselves tracking and alarming the proper governments and originating disease containment plans. The constructs of epidemiology, early sensing, and surveillance should be considered ( Veenema & A ; Toke, 2006 ) . World Health Organization 2008 guidelines to cut down TB transmittal: Everyday surveillance of reported instances and supervising results of interventions should be a first line of measuring epidemiology and control. All plans should be strong in the public presentation of the systems used for describing TB instances so the information reflects accurately the true incidence of TB and its tendencies. The rating procedure should be supported by appropriate operational research surveies. The analysis of disaggregated surveillance informations should be encouraged so as to pull out the maximal information of the TB epidemic and the impact of control steps. Appropriate computing machine package should be developed and implemented to better modus operandi recording and coverage. Execution of these specific guidelines prevents a TB eruption from happening. Trailing of septic persons requires uninterrupted supervising through clinics and other health care installations. Factors of import to supervising include the individual ‘s age, the country they reside, and other factors to enter and describe to community. Eradication In 2006, the World Health Organization ( WHO ) launched the new Stop TB Strategy, a planetary program to halt TB. More than 22 million patients have been treated under direct observation therapy-based services, since the initial launch. Over 500 groups and organisations have come together to accomplish this end. The scheme consists of programs to cut down TB prevalence by 50 per centum when compared to 1990 and entire obliteration by 2050 ( World Health Organization, 2006 ) . In the chase to eliminate TB, there are six constituents of the stop TB schemes implemented by the World Health Organization. These are the lineations listed below: Pursue high quality DOTS enlargement and sweetening. Address TB/HIV MDR/XDR- TB and other challenges. Contribute to wellness systems stregthening. Prosecute all health care suppliers. Empower people with T B and community. Enable and promote research. Presently, TB is non a campaigner for obliteration attempts: obliteration is defined as the accomplishment of a position whereby no farther instances of a disease occur anyplace and command steps are unneeded. Equally long as the epdicemic of untreated HIV infection exist and until a concerned attempt is made to command TB in all states, TB will increase despite optimum application of presently available TB control engineerings ( Mississippi Department of Health, 2010 ) . Decision Since 1953, when the first national study came out, TB instances have been on a diminution. â€Å" In entire, 13,779 Terbium instances were reported in the United States in 2006. This represents a 3.1 % diminution in the rate since 2005 † ( Center for Disease Control, 2007 ) . The TB infection rate for foreign born people was 9.5 times greater than U.S. born people. Screening foreign born individuals as they enter in the U.S. will let the individual to profit from curative and preventive steps and greatly cut down the hazard of distributing the infection to others. These steps will include identifying and wholly handling all individuals who have active TB, contact probe to measure all individuals in contact with TB patient to find TB infection or disease for appropriate intervention, and testing the populations at high hazard for TB to turn up individuals infected with TB to supply complete therapy in bar of the investion from come oning to active, infective disease ( Centers for Disease Control, 2010 ) . The CDC indicates that suppliers need developing so they will â€Å" believe TB † in the first topographic point and go more familiar with the advantages of join forcesing with the wellness section. Public wellness staff should happen more effectual schemes to guarantee that suppliers are current and remain current with new guidelines for the diagnosing and intervention of TB ( American Journal of Infection Control [ AJIC ] , 2007 ) .