Exposure Wilfred Owen

Exposure is a poem written by the one of the most famous poets of the World War 1, Wilfred Owen. The poem illustrates the conditions that the soldiers were exposed to while living in the trenches of the war zone. The poem is divided into two parts, with the first one being an introduction to the weather acting as more of the enemy to the British than the Germans were and comparing the war with the Germans less deadly than the war with the environmental conditions. In this essay, I will analyse how Owen uses imagery to evoke both past and present feelings in this poem.The first line of part tow of Exposure is, â€Å"Pale flakes with lingering stealth come feeling for our faces†. The personification of the flakes create tactile imagery that is felt by the reader as he describes how the snow sends the soldiers to a form of trance about their homes and the past, before the war. The phrase, â€Å"So we drowse, sun-dozed, littered with blossoms trickling where the blackbird fusses, † evokes the image of the soldiers lying in a garden perhaps at their home showing that the soldiers are indeed in a trance remembering about their lives before the war.These diction used to describe their state such as â€Å"snow-dazed† and â€Å"sun-dozed† all add to the idea of them drifting back into time and are also associated with bright light that is normally linked with death. The stanza ends with Owen asking the rhetorical question, â€Å"Is it that we are dying? † showing that it is as though their lives are flashing before their lives, which is correlated with their forthcoming deaths. The next stanza is an extension of the previous one as Owen continues to explore further on their past memories of home, which give off a warm tone to the reader.The phrase, â€Å"glimpsing the sunk fires glozed with crusted-red jewels,† has a lot of visual imagery reminding the reader of the sun, which is always related with positive feelings. The poet bl ends the words glow and glazed to create a new word, â€Å"glozed,† which strengthens the warmness of the imagery used to describe their memories. But as they are in the trance of remembering the past, they are brought back to reality by use of the phrases, â€Å"Shutters and doors all closed: on us the doors are closed†, and, â€Å"We turn back to our dying. The repetition of the closed doors shows the emphasis of their hopelessness and how they can’t go back to the past; they are forced to face the present, which is their death. The last stanza of the poem demonstrates the end of their dying. The phrase, â€Å"To-night, His frost will fasten on this mud and us, Shrivelling many hands and puckering foreheads crisp† shows the extent of what the exposure to the weather does to the soldiers. The first letter of the word, â€Å"His† is capitalized and this punctuation suggest that it is God’s frost that kills the soldiers.There is onomatopoeia in the word shrivelling, creating the image of the soldiers being reduced to nothing because of the frost. The last phrases explore the aftermath of this exposure to the weather, as the remaining soldiers bury the dead ones. There is some sibilance in the phrase; â€Å"picks and shovels in their shaking grasp,† which creates audio imagery that suggests the remaining soldiers are shivering from the cold. The effects of the exposure make the soldiers only half recognisable, supporting the severity of this weather.The phrase, â€Å"All their eyes are ice, But nothing happens† is the last of the poem showing the reader all that is left of the soldiers is a blank cold stare compared to with ice. The â€Å"but nothing happens† phrase is repeated several times in the poem proving that even after their death, everything remains the same, the war is still their. This gives the reader the idea of the soldiers dying in vain. In conclusion, part two of Exposure allows the reader to explore the feelings of the soldiers as they are going through this slow death.The effects of the weather cause the soldiers to go into a trance, remembering the past and all the warm memories that come with it. But the soldiers are then bounced back to their death where they face the intense conditions of the weather that is more deadly than the bullets of the war with the Germans. The poem concludes with the death of several soldiers caused by the exposure to the environment and how the remaining soldiers attempt to bury half recognisable men who died in vain.

Persevere of a Young Lady Essay

The start of the Holocaust began under the leadership Hitler. The Nazis blindsided by ideology started a war of hate against the Jewish People. The Germans at the beginning restricted human rights and bans transportation. Later in their rampage they began the onslaught of the Jewish people. Jews that managed not to escape the German stronghold were hunted down. People of Jewish decent had to abandon their lives and go in hiding. Hidden Jews had to live in the moment because they never know what is the future is ahead. In Anne Frank: The Diary of a Young Girl, Anne Frank shows the reader that the Holocaust did exist. The diary shows how a young girl was able to persevere in the cold settings. Frank described how important to lean on family but also believe in yourself. â€Å"Anne Frank’s ability to always improve herself enables her to resist oppression, determine for growth and a mind of direction†. Anne Frank’s was in a terrible situation where she had to remain hidden and stay with people who did not respect her. Under oppression, Frank felt the need to define herself. She longed for knowledge and enthusiasm to accompany her behind the walls. She was an able to reason the best approaches to address the situation. Frank shows her dedication in improving her condition: â€Å"Alone I had to face the difficult task of changing myself, to stop the everlasting reproaches, which were so oppressive and which reduced me to such terrible despondency† (170). At the time Anne was not strong to prevail against the compression of emotions in the house. Anne realized that she was becoming narcissistic; she started to enhance her view of situation differently. As the reader I felt that Anne at moments only felt that she was only individual going through these chaotic times. The way how Anne disrespected her mother was a developmental process. Anne comments were detrimental to her mother relationship. The sadness of her mother affected different parts of the family. I felt metaphorically Anne felt that group was like a wind chime, when you affect one part the other chimes respond. The need to improve herself is important for happiness in the Secret Annexe. Anne wanted to become something bigger then she. She was determined to become an Independent Woman. Being backed in the corner, Anne belief in improvement off sprang into knowledge of optimism. â€Å"The war goes on just the same, whether or not we choose to quarrel, or long for freedom and fresh air, and so we should try to make the best of our stay here. Now I’m preaching, but I also believe that if I stay here for very long I shall grow in to a dried up beanstalk. And I did so want to grow in to a real young woman†(138-139). Anne optimism in conflicts of her family and war was best kept to herself. Frank felt that the person who is able to control a situation is the one who can master oneself. This level of maturation was achieved by a bright girl. Anne intrigue in optimism of the moment was like the saying â€Å"the longest rope in the world has an end†. She had a good idea of how days were passing in the Secret Annexe. Anne remembered the days of having the freedom to go to school. Unlike girls her age going to school, Anne wanted become a woman. Anne not only wants to be a woman but to have a vision. Anne looked to the future for motivation. Despite all the troubles she was focused on improving her status. The motivation of this girl to pursue her goal shows no matter the situation it can always be manipulated. She did not worry of the past but focused on the future. Anne hard skin started to show: â€Å"Then I began trying to talk some courage into myself. I could only say: â€Å"I must, I must, I must†¦Ã¢â‚¬ ¦. Completely stiff from the unnatural position, I fell against the side of the bed and fought on, until I climbed into bed again just before half past ten. It was over! And now it’s all over. I must work, so as not to be a fool, to get on, to be a journalist, because that’s what I want! I know that I can write, a couple of my stories good, my descriptions of the â€Å"Secret Annexe† are humorous, there’s a lot in my diary that speaks, but – whether I have real talent remains to be seen. †(197). Anne showed a commitment to achieve her max potential. She will work hard to be remembered on this earth. Anne becomes very aware of her talent to write with beautiful description with clarity. I think that this moment indicated that Anne was showing Independence. She was not going to let hunger get in her way of success. Anne’s spirit of growth has enabled her to direct what in life she wanted to pursue. During the time of the Holocaust put a big strain on the individuals who were persecuted. Many lifeless acts by Germans had destroying many Jewish Famines but not their hearts. The Frank family never successfully managed to hide in Amsterdam. The Frank Family was transported to a Holocaust Camp where the Dad only managed to survive. The father of Ann Frank, Otto Frank took the need to publish Anne’s Diary. Anne’s Diary shows that the holocaust did exist and the life she has lived. This is important time in history where the most persecuted people in modern history was able to persevere.

Early Syncretism in India and China

There are two common traits reasons syncretism had not occurred in very early on in the Eastern Cultures of Indian and China. These have to do with the adaptability of religion and focus on discipline and work culture. Not all world religions are equally open to economic changes. The adaptability of a religious tradition may be measured by whether its sacred texts are open to translation and interpretation. This was not the case with Buddhism, Confucianism or Hinduism. There are various books and interpretations of Hinduism and Budhism. In India, Hinduism does not have any element of a structured religion; in fact it is loosely structured and that is why it has been resilient and tenacious enough to survive and expand. (Das, n.d) In China, it was established that Confucian tradition would continue to be the sources of value system, and modernization would continue for material gains. As there were various interpretations for one religious belief, no counter opposing philosophy existed. Buddhism and Hinduism focus on work culture as part of the religious paradigm. The concept Karma which literally means a person's actions, includes the notion, good work deserves good reward. In a free society it is the toughest to cultivate discipline in its people. Discipline is required one personal level to complete education as a student, or a jobs as a professional. With karma's discipline embedded at a grass-root level, far eastern cultures' workers possessed the skills and focus needed by workers to progress the economy. (Norbu, 1996). Thus implying that had syncretism integrated itself in the early encounters in the history of India and China, these two societies would have smaller communities that were deeply religious,resistant to work, averse to modernization and trade. Aversion to modernization and trade would've resulted in the colonization and dissolution of these societies. As a result India and China would not have existed as the emerging power houses of the world economy as we know it today.

Magic Realism and how it differs from surrealism Essay

Magic Realism and how it differs from surrealism - Essay Example The paper "Magic Realism and how it differs from surrealism" focuses on the realism and surrealism. This final unification is the supreme aim of surrealism: interior reality and exterior reality being, in the present form of society, in contradiction (and in this contradiction is the very cause of man’s unhappiness)†¦Ã¢â‚¬  From this definition, it is clear that surrealism delves into the conscious and subconscious of the human mind. Thus the element of reality is the social reality in which the character in the film is immersed in. The fantastic element is depicted in the subconscious state or dreams. Los Olvidados presents the stark reality of living in the slums of Mexico City. The film opens the eyes of the viewer to the exterior reality by letting him experience the cruelty and bullying. The viewer is bullied with the presentation of a boy charging directly at the camera and the throwing of an egg with the splashing of the yolk against the lens of the camera. The us e of monochrome or â€Å"black and white† film contributes to the theme of showing reality as it is without the trifles of color. The music used also matches the mood being depicted. It helps delineate the reality from the dream. The interior reality is introduced by the alteration in sound coupled with the technique of â€Å"slow motion† and â€Å"dream sequences† particularly in the dream of Pedro, wherein he sees Julian’s bloody dead body under the bed. His mother tried to sooth him by saying, â€Å"Listen, you’re not that bad.† ... His mother's words consoled him and justified his actions of keeping the same a secret out of fear of Jaibo. In the dream he offers to help support his mother but she refused and instead, walking in slow motion, offers him a rotting slab of diseased-looking meat in her hand. This was taken by a hand which emerged from under the bed to be later revealed as that of Jaibo. Even in his subconscious state his fear and impression of Jaibo persists- Jaibo who will take life and money without remorse as he did to Julian and which, he can also do to Pedro. The film was successful in depicting surrealisms end goal that the presentation of both forces leading to a level of understanding that would provide cause for the reasons for the individual character to move and make decisions as such. The film ends there. The viewer is left with nothing. There are no happy thoughts, no impressions of hope or sentimental feeling. There is just the note of understanding that "that is just the way it is." Ac cordingly to Surrealists, this is what liberates the mind.3 In contrast, a film using Magic Realism leaves the viewer feeling alive and appreciative of the world around him. Magic realism gives a "fresh presentation of the everyday world we live in. The artist may choose unusual points of view, mysterious juxtapositions or common objects presented in uncanny ways. However everything we see is within the realm of the possible, although sometimes unlikely."4 It is for this reason that there is an infusion of beliefs and superstitions of different cultural groups.5 "Magic Realism presupposes that the individual has a bond with traditions and the faith of the community, that s/he is historically constructed and connected."6 This is clearly seen in the film Like Water

Writer's choice Essay Example | Topics and Well Written Essays - 250 words - 20

Writer's choice - Essay Example These verses are so relevant to the believers today because they advocate for mercy, generosity, sharing and helping of the less fortunate people in the society. These are great values that modern Muslims should possess because of the existing inequalities which has resulted into the segregation of the society into the upper, middle and lower classes each of which has different capabilities. So, it is justified for these verses to encourage people to have the virtue of sharing. If no one cares for the other, then the disabled, sick and poor people will die of hunger. Apart from emphasizing on the role of sharing, these verses relate to the principle of brotherhood. By encouraging people to share with one another, it means that the verses are urging the believers not only to think about themselves, but to extend their concern, love and care for other people as well. By doing this, they will not be limiting their brotherhood to their biological relatives. Instead, they will extend it to everyone from all corners of the world. Once a person gets a conviction that brotherhood is a broader thing, they will consider all the human beings to be their neighbors. So, they will be obliged to share with them their resources, protect them and offer them all the necessary assistance that they might require. I think this will bring peace in the

Finance accounting solution Coursework Example | Topics and Well Written Essays - 250 words

Finance accounting solution - Coursework Example The student’s actions have consequences. If the store owner discovers the student’s mischievous actions, he can take legal action against her. Additionally, the business relationship of the two will be ruined, and the student may not be allowed to purchase from the store anymore. There are consequences to the store such as suffering losses because of the fraudulent returns by the student. Return fraud costs retail shops billions every year. Due to this, retailers are trying to come up with policies that curb the behavior, but still protect legitimate customers (Paul, 2012). There are ways through which retailers account for returned merchandise. First, the goods are examined, and their value is determined. If the goods are in good condition, they are restocked and sold again at new prices. However, if the merchandise is not in good condition and cannot be sold again, the retailer bears the loss of both the profit and the cost of acquiring the

Sport and media Essay Example | Topics and Well Written Essays - 250 words - 2

Sport and media - Essay Example article, the features associated with athletes and the tone used in sports coverage and reports varies according to the ethnicity and race of an athlete. The researchers were guided by four hypotheses that were developed using previous knowledge on ethnicity and racial minorities in the news. Media exposure using race-related messages can provide advantages in terms of identity to whites or majority consumers. They are offered intergroup messages, which support White positive distinctiveness and self-concept. The first hypothesis is that minority athletes are usually overrepresented as criminals when compared to Whites. The second hypothesis is that minority athletes are usually characterized unfavorably than White athletes in the coverage of crime related sports news. The third hypothesis is that crimes associated with minority athletes will be characterized with negative consequences. The fourth hypothesis is that the presentation of crime related sports news varies according to the race of an athlete (Mastro, Bleacha & Seate, 2011). These researchers show that the manner in which athletes are portrayed in crime related news varies according to race. In this case, minority athletes, particularly Black athletes were overly represented as criminals. The researchers used a social identify framework in order to analyze the content in the newspapers systematically. Mastro, D., Bleacha, E., & Seate, A. (2011). Characterization of Criminal Athletes: A Systematic Examination of Sports News Depictions of Race and Crime. Journal of Broadcasting and Electronic Media, 55, (4)

To what extent, Salford University lecturers & under graduate students Essay

To what extent, Salford University lecturers & under graduate students adopt the idea of social network communication - Essay Example The important key factors of communication are accuracy, time consuming and readable content. â€Å"Most impotent factors when transferring data from one computer to another or telephone call are time – consuming, quality and connection † (Jordon & Churhill 1987). Digital communication is defined according to the free dictionary by Farlex â€Å"electronic transmission of information that has been encoded digitally† (www.thefreedictionary.com). Education organisation uses communications to build a strong relation between lectures and students. Student can gain maximum level of knowledge, improving their skills and get the kind of support they need from their lectures using the gate of communication. In the UK, Salford University the main communicate between students and lectures are Salford University website (Black Board) or university email account. However, as individual effort some lectures at Salford University are recently trying to use social network to com municate with student. â€Å"Social network defined as a â€Å"users can send messages to public or particular group in different form as text, media etc. In this case social network can communicate with one or multi members† (Price at al, 2009). For the last three years studying at Salford University I found many students checking their social network first before they start their main work. Also in my first academic year in business school I learned from emerging technology lectures the use of social network for the benefits of education. This observation gives me an idea of the research topic. Some education staff at different level of education round the word use social network for the benefit of education with a limitation due to the risk and lack of awareness. In the other hand social network in not used in Salford University by all lectures this is my main reason for my research which I will try to cover to what extend Salford University will adopt the idea by student s and lectures. 2. Aims My intention is to find out to what extend Lectures and under graduate students at Salford University are interested in social network communication during their academic year. 3. Objective 3.1. Primary objective a) Discussing the topic with my supervisor. b) Finding previous research reports, article, and books. The research framework c) Develop and run questionnaire d) Get in contact with lecturers using social network within Salford University for more knowledge. e) Data analysis with the help of math scope at Salford University. f) Final report. 3.2. Secondary objective a) Finding and study the method of an education organisation adopting the idea. b) Get in touch with lecturers using social network outside Salford University and discuss the concept. 4. Literature Review How social net work is used? â€Å"Today there is a lot of thematic social networks that are trying to get the attention of new visitors and members every day†. â€Å" Education i s an evolutionary realm; it has been changing and including new practices since its beginnings in order to support changes in society, from the most recent technologies one of the most popular are society networks especially among youngsters† (A. Mora-Soto, 2009). Many people use social network for different purposes. Table 1 below shows how many people use social network spicily above the age of 15 years. In table 2 shows a statistic figure of important cities in UK like Manchester using social netw

Weighted-average cost of capital and capital structure Essay

Weighted-average cost of capital and capital structure - Essay Example These days the world community is fast coming to terms with the recessionary trends in almost all sectors. The corporate world is under severe pressure to cut costs and do justice with the existing workforce.On the one hand companies are trying to gain valuable support from the respective governments; while on the other hand, all efforts are being made to do away with undue expenditures, and making the capital structure optimal in efficiency. Weighted Average Cost of Capital (WACC) is a fundamental approach towards making the capital structure the most advantageous for the company. No doubt companies might have undertaken such exercise many a times in the past, but the manner in which the industry is experiencing the pressure in today's context, makes it all the more necessary for the companies to have a relook at some of the policies and procedures for calculating the WACC. Therefore, this study is an effort to analyze the procedures adopted for calculating the weighted average cost and how companies make use of such calculations in arriving at sound financial decisions for their investment plans.Managers are supposed to make strategic moves on the basis of both external and internal analysis. They have to control costs and manage money for the ongoing operations as well as for the futuristic investments. This could be in the form of preparing or reviewing budgets, expense reports, or travel authorizations. It may be cash management or sales management. For financial management, markets and environments are assessed. Internally, operating and financial capabilities of the company/ organization are analyzed by using the hard facts, i.e. the financial statements, budgets etc. Investment decisions happen to be quite crucial for a company and its business operations. Entrepreneurs often face the dilemma of adopting one type of capital structure as compared with alternatives available. There are a number of stakeholders involved in a business proposition. Besides the financial resources, the enterprise requires the support of human capital, intellectual capital, relationship capital etc. (Fletcher et al, 2003). While the efforts for optimizing other types of capital requires more of intellectual capital and internal control, the financial decisions for the company require a sound understanding of the fiscal position prevailing within the country/ region, the market position and the strategies being adopted by the competitive companies. The Weighted Average Cost of Capital therefore proves to be a handy tool in dealing with the financial decision and finding out the rate of returns that the company can expect in due course. The long term planning decisions ta ken with the help of WACC can also be reviewed during the course of operations, if it is found out that the actual figures are widely at variance with the expected rates of returns. The calculations of weighted average cost of capital involves according proportionate weight to each category of capital sources like, common stock, preferred stock, bonds and any other long-term debt1. Managerial economics demands analysis of current and actual costs. In the cost-benefit analysis opportunity cost also emphasizes the role of judgment. Computerized calculation can be done while analyzing the financial details of one's own company,

Discussion - of hypothesis testing results (dissertation) Essay

Discussion - of hypothesis testing results (dissertation) - Essay Example In this model, logistics regression was applied to test the probabilities that young people consider price, effect of brand image, design, trendiness of fast fashion cloths, and effect of advertising on their decision to make a purchase. Categorical variables were considered to show how various variables affect the predictability of the decision to purchase of not within the population. Based on gender, age, and education the logistic regression provides a platform of identifying fit within the model. The application of the Chi Square in this analysis is to identify the relationship or association of two cross-tabulated variables within a population (Kocherlakota, 2010). The null hypothesis in this case is considered to show that an association exists between the cross-tabulated variables of the population. The alternative hypothesis using the chi square analysis is used to refute the null and reinstate the hypothesis (Kocherlakota, 2010). In this case, the chi square method is applied to test the association between young people’s decisions of making a purchase with price, effect of brand image, effect of advertising, design, and/or trendiness of fast fashion cloths as influencing factors. The log likelihood statistics method was used in this analysis to show the fit between coefficient estimates and data (Kocherlakota, 2010). Since data is fixed, coefficients influence the likelihood that certain outcomes will take place. In the current case, the method was applied to show how different parameters influence the likelihood of young individuals to purchasing fast fashion or not. The parameters include price, design, brand image, trendiness, and advert effects on the decisions made. H1: As it mention in the literature by Jackson (2001), price is a major determinant of the decision to buy fast fashion. In addition, a conflicting factor is also identified. The cost of fast fashion cloths does not matter to young buyers

Credit card Essay Example | Topics and Well Written Essays - 15000 words

Credit card - Essay Example The various types of credit card fraud and the manner by which they are carried out are related, including the surrounding circumstances that enable or disable the commission of the crime. The various methods and techniques by which credit crime fraud is countermanded or mitigated are also presented, pursuant to the theory of situational crime prevention from the viewpoint of the individual, business firms, and the crime enforcement authorities. Other than the common typologies presented, seven case studies in particular are detailed with the intention of highlighting the special circumstances that set the case situations apart from the common types of card fraud. The unique situations may or may not easily lend themselves to situational crime prevention – the latter pertaining to terrorist activities in particular – but all of which crime enforcers are mandated to address and seek a solution to. The proposed research will examine one of a number of growing crimes that is perpetrated over the Internet via the World Wide Web (WWW). Specifically, it will look at credit card fraud. Although credit card fraud is not new, some form of fraud involving credit cards has existed for decades; the growth of commercial transactions over the WWW has made these crimes a major consideration for law enforcement agencies. This is because criminals are using new ways to steal technologies, merchandise from retail outlets, and cash from automated teller machines (ATMs). Credit Card Fraud is aspecies of payment card fraud, defined thus: "Payment card fraud is a generic term used to describe a range of offences involving theft and fraudulent use of payment card account data. Frequent types of payment card fraud include: lost or stolen card, account takeover, counterfeit card, application fraud and card not present." (Interpol, 2009) Incidents of payment card fraud became increasingly widespread following the technology boom in the

Citizenship; Civil Society And Civilization Essay Example for Free

Citizenship; Civil Society And Civilization Essay Citizenship as depicted by Weber has its root from Medieval European city, due to the political demands of the rising class, merchants, professionals and skilled workers to control the environment. (Ibid, 294) As earlier mentioned the spate of globalization and interconnectedness has generated a similarity in the construction and design of buildings, structures in the city. This was really not totally possible before with the variables of religion, culture playing a key perspective before. Religion to a greater extent determined the way things were done, for example, buildings in china where not built high , because in the belief that gods work on the earth, no hierarchical order like the Christians, temples built in the country which symbolises the belief system of the Chinese. The lack of citizenship or identity points to the fact that the system of governance does not allow for this, they had no citizens but subjects were present. (ibid 297). The Changan dynasty is a typical example of how the modern city developed ,with the regulation of the behaviour of the populace, already we can observe the existence of institutions which shows a little bit of modernity as we have today. Kaifeng is another city which is known for its trade and commerce potentials, the development of cities here is influenced by interaction with other players in the globe, just like the example of Kaifeng been unwalled,later on we can see that they also built a wall as the population was increasing, therefore we can conclude that population, external influence has a large part in moulding a city towards modernization or civilization. The educational sector also addresses the point of civilization, more educational empowerment; the more success can be achieved by a political system. The Hanghzou and Kaifeng,further stresses the point earlier submitted ,that the economy is a substructure on which the political interest of actors rest, the urbanization of the duo cities led to a change in the way of lie of different people, the migration of population further widened the chance of development. The aforementioned is further buttressed as a cogent point as Hangzhou by the end of the Song dynasty was the largest city in the globe. (Ibid, 302) The centrality of the progress of the City of Hangzhou ,therefore remains the economy, but the political system unlike the Ancient Athens state never gave in for a democratic rule, what was in operation was religious beliefs cum ancestral beliefs. The Islamic cities were not as progressive as compared to the Chinese; the political system was theocratic, with the sultan controlling the affairs of the cities. The distance between the ruled and ruler was a negating influence on the development of city or states in the Arab world, the level of freedom here also was restricted as you have the populace been more or less subjects ,unlike the only case in this paper i. e. the Athenians that demonstrated a major enshrinement of the democratic ethos. The lack of municipal authority in Islamic cities undermined the pace of evolution to civilization. The revival of cities in the West was prompted by a shift in history of class relations, this promoted freedom of association and other democratic ethos. The modern city however grew from the village level, down to the urban from which civilization got to the peak. (Ibid,310-316). The rights of citizens and not subjects were therefore in full force here, the Italian city of Pavias shows how the act of political representation was more in the polity, like the first ever in Athens, more representation meant more active participation by the civil society. The emergence of artist, professionals further paved way for civilization as evidenced by Artist and professionals from Florence and Siena. The emergence of institutions and democracy, however concluded the stage or phases of civilization with liberalism, Neo- liberalism playing a crucial part in the move towards civilization and Liberalism in the globe. CONCLUSION The paper has been able to find out the reasons for the civilization of cities or the evolution of cities in the current or contemporary globe, this was necessitated by religion ,systems of governance, interrelationships among empires ,trade and commerce to mention but a few. The Interesting part however remains the development of some continents at the expense of the other, this was briefly depicted as a result of religion and system of governance, the Islamic countries case is crucial here. However further scholarly submissions to the thesis is prevalent in the academia. REFERENCE Reilly, K, 1989, The West and the World A history of civilization. Second Edition volume 1

Developing A Five Star Hotel In Maldives Construction Essay

Developing A Five Star Hotel In Maldives Construction Essay Expedition Maldives Pvt. Ltd, this is leading construction company in Maldives, A Company is a expand hard with the ability to meet its clients building needs through wide range of contracting and company with a staffs of professionals skilled in architectural design and construction management, In every movement, the companys priority is helping its clients achieve their construction and developmental objectives. Our goal is to build the most expertly designed structure as economically as possible. During the past 07 years, Expedition Maldives Pvt. Ltd, a company, has successfully completed a wide range of construction projects for the private sector, hotels building, and government projects. Background Developing a five star hotel in Maldives. The project environment Mendhoo island is located in (BAA-Atoll) and this is an individual stand alone island. This is an investment of Blue line corporation, Netherland. The project commenced on 2011 February. The island is plan and design for 200 bed rooms with other necessary building in a five hotel. The first phase of the project is going to complete 100 bed rooms and required other buildings, such as restaurants, bars, sport centers and etc. The total investment of first phase is Eight million US$ (Eight million dollars), and the duration of the this phase is three years, after finishing the first phase the resort will be opened and connect the tourism industry. The remaining project phase of 100 bed room will start after analysis of performance. Project goals 1- To complete the project within the agreed timeframe of three years from January 2011 to January 2014, and handover to the owner of Mendhoo International 2- To complete the all the project works within agreed budget of US$ Eight Million (United State Dollars), that includes goods, materials, food, accommodation, transportation and labor cost. 3- To maintain the project quality according to the plan, without omitting any single part of project work and hand over the project after revising entire the project work, to make ensure the owner are satisfied with the project work. 4- To make sure the customer is satisfy, by finishing the project with the specification the customer provided and exactly the customer want. 5- To use the best methods and ways, to complete the project in a difficult situation such as strong weather it normally faced in the country like Maldives. Project objectives 1- To monitor the project works day-by-day and how the project team performance to avoid the problems that are facing on the project activities to complete project on time. 2- Adopt an effect monitoring system to handle goods, materials and other services which are used in the project to control the budget. 3- Supervise the all the project works, to ensure that the works are carryout according to the plan provided, to maintain the quality of the work. 4- Get the continuous feedback from owner or consultant that the owner has selected, to provide the product the customer actually wants. 5- Continuous monitoring of weather forecast, to organize the work schedules, suppliers transportation, to mitigate the obstacle facing on the project performance. Stakeholders Stakeholders of this project defined as all internal and external stakeholders. Internal stakeholders who involved in this project are Investors, investing for the project, Board of Directors, Managing director, Organizational staffs, Project manager, Project team members, Contractor and Suppliers. External stakeholders are government agencies, Architectures, Consultants, Competitors, Tourists and banks. Project Scope and Time Management Scope is building a five star hotel in Maldives, to provide higher quality accommodation for the customers and to deliver owners acceptable quality works within given budget and time frame and project time is managed buy according to the work breakdown structure (WBS) attached in this plan. Human resources management This looks on the process which required and how these people effectively involved in the project. This will includes all the stakeholders. In the organizational planning it was mentioned roles and responsibility of each member, whom they should report and provide the best resources to the staffs, that will include provide the best training which required for the project and good standard of food, accommodation, health and safety. Financial Management Required funding is provided by the investors for part payments from Blue Line Corporation, Netherland. They are paying in many different phases, according to the ongoing project works. Internally project will be audit; according to the audit management system will monitor and order the required good and materials for the project and made the payment for contractors and suppliers. Stakeholders Roles and responsibilities 1- The project investors will oversee the research of the business and finalized the budget for the project and investing on project. 2- Project board of directors will establishing the organization mission and vision, establish the plan and provide resources required for the project. 3- Managing director will develop the organization strategic plan in an effective manner and accountable for overall performance of organization. Managing day-to-day activities of the business, authority delegated from board and implementing board policies and strategy, allocating resources required to achieved the objectives. 4- Project Manager responsibility is completing the project on time, within the provided or given budget, and maintain the quality criteria provide training for the project staffs, maintain the project quality, identify the project procurement, develop and approve project charter, define the goals and objectives. 5- Project Teams members responsible are performing the project activities. They also help obtaining commitments to complete the project within schedule and limited budget. 6- Contractors will carry out the task handover according to the design and plan and contract they may be a construction or electrical. 7- A Supplier will supply good and material according to the contract, which are required for the project and should maintain the quality standard of the according to the contract. Project Management Information System PMIS Project Management Information System adopts for this project, collect, combine and distributes the information through electronically and manually. This used for upper management to communicate with lower management. It will provide the resources for planning, evaluating, monitoring, and controlling to a project through both formal and informal channels. Risks management In the risk identification of this project, all identified risks will be stored in a risk register and this list will be determine which risk is most danger to the project and will give more priority to attend the high risks first likewise resolving one after another. Tools and Techniques consider are Documentation Reviews, Information Gathering Techniques, Checklist, Assumption Analysis and Diagramming Techniques such as Cause and effect, and fishbone Ishikawa diagrams, Process flow charts, Influence diagram Risk treatment plan is a part of risk and also it is a part of risk management plan. This plan will show how the risk will be managed either that is high, medium or low. According to this project the first create risk management plan that will guide the team members and stakeholders, how they react on the risk. Communication Plan Maintain the communication among the stakeholders, according to the communication matrix given below. Communication type Project Objectives Medium Used Frequency Project Audience Project Owner Deliverable Methods Project Kick-off Introducing the project team and review objectives and management approach Face-to-Face Once Investor Board of Directors Stakeholders Project Team Project Manager Agenda Meeting Minutes Project Team Meetings Review project status within project team. Face-to-Face Call Conferencing Weekly Project Team Project Manager Agenda Meeting Minutes Technical Design Meetings Develop a technical design and solution for the project. Face-to-Face As needed Technical staff Technical Leader Agenda Meeting Minutes Status Meetings of Project Project status report to management Face-to-Face Call Conferencing Monthly PMO Project Manager Status Reports of Project Project status report of the activities, progress, costs and issues Email Monthly Investor Board of directors Project Team Stakeholders PMO Project Manager Status Report of Project Quality management To manage the quality of the project, the firm will adopt ISO 14000 for Environmental issues and ISO 12006 for Building construction issues. Both of these two families have many other series of standards that are included in this project. This is a five star hotel, so the quality management system of the project conduct according to the ISO approved standard. The firm staffs will be trained the standard of ISO approved level. The project is running with international standard, than these agencies provide required knowledge for particular issues, so adopting ISO standard is very important for this full project. The main reason of adopt ISO standard is to meet or exceed stakeholders needs and expectation. The project team will develop a good relationship with key stakeholders, specially the supporter and the recipient of the project, to understand what quality means to them. The project team will need to make adjustment to scope, schedule and budget to satisfy the recipient s needs and expectation. Procurement Management Procurement planning of this project, the firm will use annual procurement planning. This planning encourages the firm management to handle the available resources as well as deliveries according plans and strategies. 1- To identify the quantity of good and materials required for the project, according to the plan other requirements. 2- Always materials should be available for the project works. 3- Giving special attention to good, material and resources prices. 4- Minimize the procurement time, cost and increase the production. 5- Mitigating the level of risk associate with the project. 6- Equally perform the production and procurement plan. 7- A trusted understanding between business partners and suppliers. The firm management will consider on following stages of annual procurement planning. 1- Supporting service of delivering the products 2- Assessing company expenses on goods, materials and services 3- Improving the project procurement process 4- Improving the project performance of goals and events

Concepts Of Medicine Adherence And Its Economic Burden Nursing Essay

Concepts Of Medicine Adherence And Its Economic Burden Nursing Essay Even though 45% of all medications prescribed in the UK are for older people, it is postulated that up to 50% of older people are non-compliant with their medication (SCIE, 2005). The prescription of various medicines is central to medical care and the overall drug costs account to about 10 percent of NHS expenditures. Surveys carried out in literature enlighten us with the fact that approximately 30% to 50% of patients do not use of take their medications as recommended by their prescriber. (1). Statistics show that in 2007- 2008, the NHS in England spent  £8.1 billion on drugs if as many as 50% of the patients dont take their medications as recommended, this could mean that  £4 billion worth of medicines were incorrectly used (2) . Furthermore the additional cost of unused or unwanted medicines within NHS totals up to  £100 million each year. On top of that the estimated drug cost of unused or unwanted medicines in the NHS is around  £100 million annually (3). A Cochrane review Interventions for enhancing medication adherence concluded that improving medicines taking may have a far greater impact on clinical outcomes than an improvement in treatments (4). Therefore if the prescription is inappropriate in the first place it not only translates as a loss to patient but also involves the healthcare system and the society. The costs included here are both personal and economic. Concepts of Adherence and terminology There are three major terms which are commonly used in the literature to describe medication-taking behaviours i.e Compliance, Adherence and Concordance (5). According to Pound (6) initially, the term compliance was used to illustrate the medication taking behaviour, which was then replaced by the term concordance. The term compliance came into disfavour because it suggested that a person is passively following a doctors orders, rather than actively collaborating in the treatment process (3) Whereas concordance refers to the anticipated outcome of the consultation between doctors and patients about medicine taking It is viewed as successful prescribing and medication taking based on the partnership with the patient (6). However the most current, fashionable and accepted terminology is adherence, which is defined by McElnay (7) , as the extent to which a persons behaviour (in) in terms of taking medicines, following diets or executing lifestyle changes, coincides with advice given by health care professionals Adherence shifts the balance between professional and patient about the prescribers recommendations. Pound (6) states that the above mentioned three terminologies tend to be used interchangeably but are incorrectly applied. Adherence can be viewed as the central aim, concordance is the process used to apply the central aim compliance is the outcome of the process. The benefits of medication might be restricted thereby causing a further deterioration in health as a consequence of non-adherence. . On top of this the economic costs do not only translate to wasted medicines only but also include the knock on costs which arise from increased demands for healthcare if (on the whole) health deteriorates. It is hence due to this reason that non-adherence is a major issue and should not only be seen as the patients dilemma. A fundamental drawback is represented in the provision of the healthcare, which is often due to a failure in completely agreeing with the prescription in the first place or to recognise the appropriate support that the patients might require later on during the treatment. Hence addressing non-adherence is by no means about getting patients to take additional medicines. Therefore tackling the issue of non-adherence involves the initial understanding of patients opinion on the medicine and then the various reasons to as why they are/m ight be reluctant or unable to use them. Causes of non-adherence There are many causes of non-adherence however they fall into two main overlapping categories i.e intentional and unintentional. Both types relate to the lack of an established pattern of medication taking which led to the incidental omission of medicines and may be experienced concurrently (8). Purposeful or intentional non-adherence occurs when a patient makes a specific decision not to take the prescribed medication. The anticipation of drug-related side effects and general dislike of taking medicines are common causes of intentional non-adherence (9). While accidental or unintentional non-adherence occurs as a result of forgetting or misunderstanding instructions about the drug schedule .Unintentional non-adherence is proposed to be range from a random departure to medication omissions from a prescribed treatment regimen (10). Hence the main features of unintentional non-adherence focuses on altering medication contingent on self assessment or perceptions of mental health, stress or anxiety, forgetting to take medicines or simply altering the doses of medicines to fit in with daily chores. A research carried out by Svensson (10) Kippen (11) showed that older people adherent with their medication often link the administration of medication to specific lifestyle events, location, time, and patterns of daily activities. Below table 1.3.1 shows the common perceptions and characteristics of adherent and non adherent medication taking behaviors. Table 1: Shows common perceptions and characteristics of adherent and non adherent medication taking behaviours. Perceptions related to medication taking behavior Intentional Non-adherence Unintentional Non-adherence Feeling unnatural taking medicines Fears of prescribing errors/addiction Life style change/ Disruption to daily routine Adverse effects of medicines Lack of faith in the prescriber Drug related memory loss/ Forgetfulness Long term risks of medicines Failure to accept diagnosis Altering dosing regimen Past experience of medicines Dislike of taking medicines Being asymptomatic Lack of comprehension of the need to take medicines. Testing medicines against symptoms Period of illness Vulnerable group of people Of all the age groups, medication taking behaviour in older people is of the highest concern. This is due to multiple reasons as described by Huges (12). Firstly, older people are highly likely to suffer from multiple diseases. Secondly, older people frequently administer three or more medicines concurrently to manage these conditions and third as a result of poly pharmacy, they are increasingly likely to mismanage their medicines (13). Furthermore, research shows the following as different lay beliefs by older people on medicine taking The need to reduce the symptoms of hypertension, to feel physically better (14). Fear of complications and desire to control blood pressure (10). Positive confidence in the prescriber (15). Apart from the elderly, another age group, where non- adherence is becoming a significant problem is in the pediatric population. In one of the studies carried out by Bush (16) it has been shown that one-third of the children in grades 3 to 7 reported they had used one or more prescription or non prescription medications in a 48 hour period. Adherence plans for children often require innovative approaches to encourage active participation in caring for their own health and how to use their medications appropriately. Consequences of medication non-adherence No matter how much critical the conditions are a patient might stick to his medication regimen, thus reflecting a loss of the health care system with increased use of medical resources, such as GP visits, unnecessary additional treatments, emergency department visits and hospital admissions. One of the recent research shows that about 3-4% of UK hospital admissions are as a result of avoidable medicine related illness (17) between 11 and 30 % of these admissions result from patients who dont use their medicines as recommended by their prescriber (3). In a similar manner, in 2006-2007, figures show that that the NHS expenditures on hospital admissions (excluding critical care costs) was approximately about  £ 16.4 billion (18). And the estimated costs of admissions, within the same year i.e. 2006 2007, resulting from patients not taking their medicines as recommended was found to be between  £36 and  £196 million respectively (18). Hence a reduction in these admissions and associated costs would be expected as the overall medicines adherence increases. Factors affecting medication adherence In accordance to WHO some of the main common factors reported to have a significant effect on adherence include: poverty, low level of education, illiteracy, poor socioeconomic status, unemployment, unstable living conditions, lack of effective social support networks, long distance from treatment centre, high cost of medication, changing environmental situations, high cost of transport, family related issues and culture lay beliefs about illness and treatment. In accordance to WHO the common belief of patients being the sole responsible for taking their treatment is misleading and most often reflects a misunderstanding of how other factors affect peoples behaviour and the capacity to adhere to their treatment. Adherence, in short, is a multidimensional phenomenon which is determined by the interplay of five different sets of factors, each of which are termed as dimension by WHO (5) . Each of these dimensions are listed as under and shall be discussed in detail Social/ economic factors Provider-patient/ health care system factors Condition related factors Therapy-related factors Patient related factors Social and economic dimension It includes limited access to health care facilities, medication costs, low health literacy, limited English language proficiency, unstable living conditions (homelessness), lack of family/social support network, and cultural beliefs about illness and treatment. Among these factors few shall be discussed in detail as under English language proficiency Both low health literacy and limited English language proficiency are barriers to adherence that deserve special consideration. Health literacy can be defined as the ability to read, understand and act on health information so that appropriate health decisions can be made. The risk of unsafe use of prescription medicine, is high among people with low health literacy and limited proficiency in English language due to the complex nature of the printed information that is available and because these people often do not receive adequate verbal communication or sufficient time from health care providers. Older adults with low health literacy may have trouble reading health information materials, understanding basic medical instructions, following prevention recommendations and adhering to medication regimens. Social factors Medication adherence is positively associated with social support and the availability of help from family and friends. Better outcome to treatment is observed in people who have social support from their friends/family (who assist them with their medication regimens) Cultural beliefs and attitudes Adherence to therapy, may overall be affected as a consequence of different attitudes which the patient may have towards health and medicine. Addressing these issues by the health care professionals is of prime importance so that the patients can get the most out of their medicines without compromising their health In case of adults, different components of health and healing cannot be explained by no one list. Therefore each individual must be considered on individual basis. Two major key components are requisite i.e asking non-judgmental questions listening, when it comes down to understanding the process of gaining an insight into patients beliefs (regarding health and healing) Patients belonging from various ethnic minorities bring along their practices in the health care system. This sometimes puts the health care professionals at test, who have been professionally trained in the light of western philosophy and medicine. Although groups of people may have beliefs or practices in common, yet that doesnt mean that they all can be classified under the same category. Within groups , the major differentiating factors include health status, educational level, sexual orientation etc (5). Respect Taking care of elder patients who belong from such backgrounds where they receive a great amount of respect (e.g. British Asian community ) should involve the element of respect combined with kindness. If they are approached with an attitude that consists even a tiny fraction of scolding or telling off, they might show resentment towards the adherence of medicine even though it may put their lives at risk. Therefore to put such patients at relieve it is of prime importance to show respect towards them . Traditional therapies and cause of illness Literature shows that two components such as religion and spirituality can play a vital role in the overall understanding of illness in its broadest sense among older people (19). The will of God for an improper behaviour, exposure to cold wind, natural causes etc are all different factors which older patients believe are major culprits for causing illness (20). This consequently leads them in such a situation where they end up giving God a chance to heal them or alternatively they seek help from a folk healer, try home remedies or pray for the treatment of their illness. An excellent example of this can be viewed within the Chinese culture where health may be seen as finding norm between ying yang, which is much more like hot and cold (21). Now patients who follow Chinese health belief may try such approaches which targets at restoring the balance between ying and yang (using different varieties of food and herbs). Likewise, some Asian ethnic groups rely solely on traditional remed ies for the treatment of long term conditions (21). At this stage it is also important to mention that the patient may not be cooperative if he believes that the health care provider may disapprove information surrounding the use of non-traditional remedies. This may ultimately lead to different interactions with the prescribed medications. Medication For some patients the preference lies in the dosage form or the size or colour of the medication. For example some cultures in Latin America view injections as more potent in comparison to oral medications. Likewise it is believed that Western medications are too strong by Chinese older patients hence therefore they might choose to not take the full dose of medicine (22). Health care system dimensions It includes different factors such as provider-patient relationship, provider communication skills, patient information materials written at too high literacy level, restricted formularies (changing medications covered on formularies), poor access or missed appointments, long waiting time and lack of continuity of care (23). The quality of the HCP-patient relationship is one of the most important health care system-related factors impacting adherence. Adherence to medicines can be increased as a result of good relationship between the patient and the HCP (which features the element of reinforcement and encouragement from the HCP), however there are many factors which have negative effect (24). These include lack of training and knowledge for health care providers on managing chronic diseases, lack of incentives and feedback on performance, poor medication distribution systems, short consultations, overworked health care providers, weak capacity of the system to educate patients and provide follow up, lack of knowledge on adherence and of effective interventions for improving it. Condition related dimensions It includes Psychotic disorders, severity of symptoms, chronic conditions, depression, lack of symptoms, mental retardation (25). Among these factors few shall be discussed in detail as under Chronic conditions and lack of symptoms Information within literature supports the fact that adherence to such treatment options (often declines as the time progresses) where medications have to be taken on an unlimited basis for the management of a chronic ailment. Example of two perfect clinical conditions which would fit into this profile include high BP and osteoporosis (26) , in which the symptoms are totally invisible to the patient. Furthermore, in the absence of symptoms these ailments lack the cues which would motivate the patient to adhere towards his treatment regimen. Depression A study carried out by Krueger (28) showed significantly lower rates of medication adherence among people with chronic illnesses and who are depressed. It is therefore crucial for the HCPs to be aware of the devastating impact, depression has on adherence consequently on regular basis should assess older patients who are sad all the time or who report symptoms of sleeping disturbances to eliminate the possibility of clinical depression. The slow onset of the pharmacological actions posed by different classes of antidepressants is classified as one of the major factor that contributes towards decreased adherence among elder patients. Adding on to that if the patient begins to experience the side effects (before even the symptoms are relieved), might consequence discontinuation of the therapy at a very early stage. In a similar fashion, a research conducted by Kemyttenaere (29) shows that once the patients (suffering from depression) start feeling bette,r they might stop the antidepre ssant therapy midway. Psychotic disorders A patients experience with unpleasant side effects is mainly one of the key causes which drives them from continuing their antipsychotic therapy. Literature shows that interventions which focus mainly on the persons attitude and beliefs about medications 9rather than on the knowledge) helps improve adherence. The addition of two key ingredients i.e Behavioral techniques motivational interviewing within compliance therapies, have proven to be very effective in improving medicines adherence among patients who suffer from psychotic disorders (31). Therapy related factors/dimensions It can be sub-divided into other different factors such as duration of therapy, lack of immediate benefit of therapy, frequent changes in medication regimen, actual or perceived unpleasant side effects, medications with social stigma attached to use, treatment requires mastery of certain techniques, complexity of medication regimen and treatment interferes with lifestyle or requires significant behavioural changes. Research by Tabor (32) Krueger (27) showed that decreased adherence is associated with medications with a social stigma attached to its use and with medications which require following complex regimen ( e.g. duration of therapy, number of daily doses required, or therapies that interfere with a persons lifestyle. Adherence can also be affected by other factors e.g. if administration of a medication requires the mastery of specific techniques like injections (32). In a similar fashion, when medications such as antidepressants are slow to produce effects, the patients/older person may believe that the medication is not working and might stop taking it. Likewise the side effects of a medication too can lower adherence if the patients start believing that they cannot manage or control them (25). Patient related factors/dimensions They can be sub-divided into two major factors i.e psychological/behavioral factors and physical factors. Psychological factors include fear of dependence or possible adverse effects, knowledge about disease, motivation, perceived risk to disease benefit of treatment, understanding reason of medication need, confidence in ability to follow treatment, feeling stigmatized by the disease, frustration with health care providers , psychosocial stress, expectations towards treatment and substance (alcohol) abuse. Physical factors include issues like swallowing problems, hearing, visual cognitive impairments and impaired dexterity or mobility. Few of these physical and psychological factors can be discussed in detail as under: Psychological factors that influence adherence The WHO proposes a foundation model for medication adherence which is based on three major factors i.e. motivation, information and behavioural change. Behavioural change has been found to be influenced effectively by making interventions based on this model (33). In accordance to WHO, adherence and non-adherence are different behaviours. In order to change behaviour, information is a prerequisite, but in itself it is insufficient to achieve this change. Hence at this stage behavioural and motivational skills are critical determinants. Motivation and information work largely through the behavioural skills to produce an impact on the behaviour. However, when the behavioural skills are uncomplicated or are familiar, the two aspects i.e motivation and information can produce a direct effect on the behaviour (33). Physical Factors that influence adherence The risk for non-adherence among older patients is increased due to physical and cognitive limitations. Visual Impairment Decreased ability to perform activities of daily living and an increased risk for depression is associated with vision impairment (34), (35). Furthermore there are many other medication safety issues associated with vision loss. A persons ability to read patient information leaflets, prescription labels, determine the colour and markings distinguishing a medication is affected by low vision and blindness. Therefore consequently people who cannot read prescription labels or distinguish among different medications have to rely on their memory or depend on someone else for help and hence may not be able to take their medications correctly. Hearing Impairment Hearing loss is directly related with age. The natural aging process not only affects the ability to detect sounds at lower levels but also the capability to understand speech at a normal conversation level (36). This condition does gets worse with age and is progressive. It is therefore important to not assume when a deaf person nods his head in acknowledgement that he/she has understood, as he/she might be relying on a family member or a companion to explain later (36). Impaired Mobility Older patients with poor mobility may have difficulty in self administration of medicines or in obtaining medicines from the pharmacy (37). Cognitive Impairment Poor medication adherence is associated with Impaired cognition (25). Elderly patients with memory problems and cognitive impairment may have difficulty in understanding when to take, how to take or how much to take their medications. Others factors also include as swallowing difficulties and impaired dexterity. PREDICTORS OF medication non-adherence Predictors of medication non-adherence can be a useful tool in the improvement of medicine adherence among older adults. Few of the non-adherence warning signs (38) include failure to fill in a new prescription, failure to fill in prescription for choric medication or failure to obtain refills as often as expected for medications taken on chronic basis. Below are some of the more common predictors of medicines non-adherence (38): Forgetfulness Lower cognitive function or cognitive impairment. Lack of insight into illness Lack of belief in benefit of treatment. Belief that medications are not important or are harmful. Complexity of medication regimen Tied of taking medications. Inconvenience of medication regimen. Side effects or fear of medication side effects. Missed Appointments. Substance Abuse Limited English language proficiency. Role of NICE (National Institute of Clinical Excellence): The issue of non-adherence to medicine is a very important issue in its own essence. After assessing and understanding the impact of non adherence on the NHS the NICE (National Institute of Clinical Excellence ) came into action and published a guidance in January 2009 (Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence) to tackle and address this core issue (of non adherence). Before moving further it would be essential here to describe the role of NICE in terms of its function. NICE was established as a special health authority on 1st April, 1999 is an independent organisation that provides national guidance on promotion of good health and prevention and treatment of ill health in England and Wales (39). The institutes main purpose is to offer NHS health care professional advice on how to provide patients with the maximum attainable standards of care and to decrease the variation in the quality of care . Furthermore, NICE is not part of the European Medicines Evaluation Agency (which assess the efficacy and safety of drugs), only licensed drugs on the basis of their added value relative to existing practice in the NHS are assessed by NICE (40). It has four programmes that produce guidance which are mentioned as under (39): Public health guidance Clinical Guidelines Interventional procedures Health technology appraisals ( for surgical interventions, pharmaceuticals, medical devices, etc) Most programmes take into account both the elements of cost-effectiveness (how well an intervention works relative to its cost) and effectiveness (how well an intervention works) NICE has an annual budget of 33 million pounds annually with over 250 full-time staff members working at offices based in London Manchester. The processes NICE uses in the development of its guidance are highly consultative, evidence based and transparent. It also involves all relevant stakeholders, including policy makers, health professional managers, specialist, academics, representatives of health care industries, general public and patients (39). The guidance that NICE produced to address the issue of medicine adherence was CG76 Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence. This guideline was produced taking into account the patients views as to what they perceive as barriers to effective medicines adherence and thus encourages healthcare professionals to have a discussion with patients about their prescribed treatment especially for long term conditions. In addition to this the guidelines also open a pathway for dialogue and negotiation between the patient and the health care professional regarding their medication. A quick summary of the guidelines is as mentioned below Summary of the NICE guidelines Bullet-points below quote from summarise recommendations from the CG76 guidelines (41). The key recommendations from NICE guidelines are as under Table 1: Shows the key recommendations from NICE CG76 guidelines. Involving Patients: Improve communication with patients Increase patient involvement in the decision making process about their medicines. Understand the patients perspective on their condition and possible treatments. Provide information about their condition and possible treatments. Supporting Adherence: Assess adherence levels Identify adherence issues Address adherence issues Review medication and its effective use Improve communication between health care professionals in the care pathway. From www.nice.org.uk/pdf/CG76fullguidelines.pdp Significance of the Study Community Pharmacists are the health care professionals which are most readily accessible to the general public and therefore continue to be the first line of Healthcare. They are experts on medicines and represent an important link in the chain of the health care professional team. Thus the main objective of this research project will be to provide a new insight as to what the community pharmacists reflect/perceive about these NICE CG76 guidelines. Hence their views and opinions will be assessed and analysed with regards to these NICE recommendations (as this would help in the implementation process). Any differences in the views of the pharmacists or any disagreement on the effectiveness of the NICE guidelines would mean that further investigation could be required to improve or update these recommendations. Hypothesis: H0 = There will be no statistically significant relationship between the years of experience of the pharmacists and the awareness of NICE CG76 guidelines. H1 = There will be a statistically significant relationship between the years of experience of the pharmacists and the awareness of NICE CG76 guidelines. H0 = Majority of the community pharmacists will not agree (on to a large extent) that CG76 recommendations have been effective in the improvement of medicines adherence among their patients. H1 = Majority of the community pharmacists will agree (on to a large extent) that CG76 recommendations have been effective in the improvement of medicines adherence among their patients.

Brand Tracking Survey Essay -- Business and Management Studies

Brand Tracking Survey This is a brand tracking survey that Steinlager beer might use. You will see where you can insert your own product category and brand name. Notice how the questions go from broad to specific. Keep that format if you add your own questions. Keep all of these questions! Be aware that in some situations, brand tracking may be concerned with which products the brand reminds consumers of (when the brand is on multiple products), instead of which brands the product reminds people of (as we do here). Parts of this survey come from: Keller, Kevin Lane (1998), Strategic Brand Management: Building, Measuring, and Managing Brand Equity, New Jersey: Prentice Hall, p382-383. You would conduct this kind of survey by telephone or in person. The interviewer can complete the questionnaire[1]. Alternatively, give respondents a printed copy to complete, but save any pages that mention the target brand until they have completed the first part. Always begin with an introduction that tells who you are, what you are doing and what you will ask them to do. Use one like the one provided here. Introduction Information for Participants â€Å"I am conducting a short interview on consumer opinions about certain products. This is part of my study about brands at the Waikato Management School. I’m in Dr Carolyn Costley’s class on Brand Strategy. The questions will take about ten minutes. You do not have to answer them. If you do, I will combine your res...

Suicide :: essays research papers

Teen Suicide   Ã‚  Ã‚  Ã‚  Ã‚  Suicide is a major issue among teens. In 1990 alone we lost more than 13 out of 100,000 teens to suicide. This number increased by 15% less than one year later. When suicide is discussed in schools students take it very seriously because they know that at least two people in their class will attempt suicide.   Ã‚  Ã‚  Ã‚  Ã‚  When there are suicide prevention discussions most feel their is no hope. â€Å"Youth still see psychiatry as a pretty scary system,† says Lynn Chiarell, satellite program coordinator for Youth Net (Youth Net). â€Å"When you look at what happened at Columbine, it’s pretty obvious those kids had real problems but everyone just ignored it. We want to prevent that from happening here at Youth Net.† When suicidal teens see that there are people who care, they feel they have someone to talk to. Most teens that are thinking about suicide won’t talk about their feelings. This is why it is important that if someone brings the issue up you talk to them and ask them about their feelings and tell them you care. If we can get more people to at least consider suicide being an open issue it is a big step in teen suicide prevention.   Ã‚  Ã‚  Ã‚  Ã‚  Every teenager has mood swings and habit changes. But when a teen seems to be depressed for more than two weeks, serious depression could be setting in (APA Online). â€Å" Young people who have attempted suicide are at greater risk of future attempts. Listen for hints like, â€Å" I’d be better off dead† or â€Å" I won’t be a problem for you much longer† or â€Å" Nothing matters; It’s no use,† so you can tell if your teen is suicidal. Many suicide cases are by teens who abuse alcohol or drugs. Some teenagers â€Å"clean house† by giving away favorite possessions, cleaning their rooms or throwing things away before committing suicide. Some of the most dangerous times of a teen’s life is when he or she has suffered a loss or been publicly humiliated, Loss of self-esteem, the break up with a boyfriend or girlfriend. When this happens suicide is often a reoccurring thought. When you know that something like t his has happened you should talk to the teen about how they feel.   Ã‚  Ã‚  Ã‚  Ã‚  Young people in today’s society have it tough. They deal with divorce, death and illness. Teens have to deal with complex decisions and peer pressure every day.

Article Review Format Guide Essay

The article discusses whether the Sarbanes-Oxley Act and the subsequence laws were the correct solution for the problems that arose from the Enron and WorldCom bankruptcies. The article illustrates how the different rules and legislature affect different size business, and the ramifications that resulted for companies that must follow the Sarbanes-Oxley Act. The authors of the article also conducted a study on whether or not fraud of the financial statements was in direct correlation of businesses filing bankruptcy (Nogler & Inwon, 2011, p. 68) like in the cases of Enron and WorldCom. The results found that the larger the company that filed bankruptcy the more likely that securities fraud litigation and general overstatement of the revenue and assets of the company occurred (Nogler & Inwon, 2011). LEGAL ISSUE Legal issues were rampant in the article. For instance, with the issuance of the Sarbanes-Oxley Act of 2002, companies chose to â€Å"go dark† to â€Å"no longer trade publically,† (Nogler & Inwon, 2011, p. 67) in order to not have to comply fully with SOX. The article also address whether it is fair or just to make smaller companies follow the same exact rules and fines of such articles as Article 404 of the SOX Act. MANAGERIAL PERSPECTIVE Fraud is a real threat to the financial stability of a corporation and even the country. The legal issues presented in the article show how damaging fraud truly is. Of the over 1,200 companies that filed for bankruptcy in the study, 77.8% had some sort of fraud (Nogler & Inwon, 2011). These numbers show that laws like Sarbanes-Oxley are justified in trying to stop the illegal actions within the finances of a corporation by making people responsible for their actions and the actions of those around us. The creative reporting methods that people use in ponzi schemes and recording of financial information needs to be highly monitored to prevent losses for stakeholders. Realistic solutions include more laws for the betterment of the corporate world. Laws that protect individual employees like auditors and Certified Public Accountants, because as it stands now all liability falls to only a few people like the CFO or CEO, when in fact there are instances when they too need protection. Smal l businesses that wish to go public should have similar laws designed for their size and not just an umbrella law that might prevent the company from growth. Reference: Nogler, G., & Inwon, J. (2011, May/June). Sarbanes-Oxley Act: Was the ’one-size-fits-all’ approach justified? Journal of Corporate Accounting & Finance (Wiley), 22(4), 65-76. http://dx.doi.org/10.1002/jcaf.20691

Rebecca and the Short Story the Tell-Tale Heart Convey Gothic Themes Essay

The Gothic genre is a style of film and literature that expresses themes of madness, death, darkness, romance and obsession. Although Rebecca and The Tell- Tale Heart are fitted to the Gothic genre, the composers have conveyed similar themes in different ways. Obsession in Rebecca is that of Mrs Danvers, who is obsessed to the point it drives her mad. She would do anything to bring Rebecca back. Whereas in Poe’s short story the narrator is so obsessed with the eye of an old man he would do anything, including commit murder to get rid of it. Alfred Hitchcock’s film, Rebecca is a psychological thriller that uses cinematic techniques such as pathetic fallacy, characterization, motifs and lighting to convey gothic themes of madness and obsession. In contrast, Edgar Allen Poe’s short story The Tell- Tale Heart uses literary techniques such as narration and figurative language to successfully convey these same themes. While both composers convey Gothic themes of madness and obsession they communicate each with different techniques. Also the characters that they have created are portrayed as dealing with madness and obsession very differently. In the film Rebecca, the different characters Max and Mrs Danvers are used to explore the Gothic theme of madness. Hitchcock manipulates the frame in key scenes, by making Max’s body language suggest his nervousness, worry, anger and the need to ease himself. Max goes on to acknowledge, â€Å"Perhaps I am mad†. This declaration sums up the theory that something bothers Max, and that it is obviously taking a toll on him. Hitchcock depicts the sincere and loyal personality of Max as hiding something which changes his personality and domineering status. This is used to explore the gothic theme of madness and the effects that it has on Max. However, Mrs Danvers’ obsession leads her to commit acts of madness. Towards the end of the film Mrs Danvers burns down the mansion while she is still inside, inevitably killing herself in an attempt to bring justice to the long dead Rebecca. The final scene of the burning mansion and the screaming Mrs Danvers is symbolic of her madness, which was dangerous and not dissimilar from satanic worship. Poe’s The Tell- Tale Heart, also explores the gothic theme of madness. By writing in first person, Poe makes the story very narrow, as it fits only the narrator’s thoughts and reasoning. The narrator repeatedly claims he is not mad and that it is not madness that drives him, but instead it is the right thing to do. But he continues to question, â€Å"How then, am I mad? † Although there is only one point of view throughout the story, the narrator seems to talk to readers. He tries to persuade readers who are essentially his conscience that he is sane. Rather than convincing readers that he is sane, he verifies that he is indeed mad. By writing in first person, it is easy to understand what is going through the narrator’s mind. He emphasizes his madness and denial. Towards the end of the story the narrator behaves as if he is haunted and guilty, â€Å"I could bear those hypocritical smiles no longer†. He begins to imagine things that aren’t really there and reaches the point at which he can no longer hide his secret. Hence he is essentially confessing in the hope of freeing his conscience. Poe’s character is one who denies madness, whereas Hitchcock’s character embraces the idea. In addition, both Hitchcock and Poe successfully convey the Gothic theme of obsession. Hitchcock develops the menacing and lingering Mrs Danvers as a conniving character with an unnatural adoration for Rebecca. This is made apparent when Mrs De Winter catches Mrs Danvers in the room of Rebecca. The room has been kept to the precise orders of the late Rebecca. Mrs Danvers admiringly recounts all Rebecca had requested, â€Å"I kept her furs in here†¦ Put it against your face. It’s soft isn’t it? You can feel it can’t you? The scent is still fresh isn’t it? † The relationship between Mrs Danvers and the late Rebecca quickly escalates to become one that transgresses the normal. Mrs Danvers continues to hold onto the obsessive relationship and twisted love she shared with Rebecca. Mrs Danvers still longs for Rebecca who is no longer alive. The tone and language that Mrs Danvers uses when speaking to Mrs De Winter is short and proper. She seems to deliberately want to make Mrs De Winter feel uneasy with herself and incomparable to Rebecca. Even though Rebecca is dead, she is an increasingly large figure throughout the film. Her power is not drawn physically, but from the relationship she had with Mrs Danvers and the loyalty Mrs Danvers has for her. With the presence of Mrs Danvers, and the motif of her ‘R’ embroidery, there is a heavy feeling of Rebecca still being alive and never going away. The obsession that Mrs Danvers has for Rebecca may not be one of violence and hate, but it is still menacing, off-putting and frightening, right up to the end. The obsession in Poe’s short story and Hitchcock’s film both end similarly. The main character from The Tell- Tale Heart has an unhealthy obsession just like Mrs Danvers, â€Å"It haunted me day and night†¦ I think it was the eye! Yes it was this! † After ridding himself of the eye, a motif on the narrator’s obsession which is similar to the motif of Rebecca, his obsession has only shifted to concealing the crime he has committed. The narrator focuses all his power and attention to an eye, which causes him much annoyance, and an unbearable need to destroy it. His obsession with the eye and how it makes him feel, leads him to agree with himself in that it must be stopped. It is as if his obsession clouds his judgment of what is right and wrong. Even though Poe conveys the old man as how the narrator sees him, a reader can interpret the true nemesis as being the narrator. Poe conveys the narrator’s obsession by emphasizing every thought that has crossed his mind and how he spends much time and energy, taking care to deal with his obsession and fear. Eventually Poe’s character like Max also tries to conceal his crime but ends with a guilty confession. In conclusion, the key characters of Rebecca and The Tell- Tale Heart all portray the Gothic themes of madness and obsession. Each character plays a different role; Mrs Danvers is drawn up as a conniving madwoman who meets her deserved death. In contrast, Poe’s character is mad from the beginning as a result of an unhealthy obsession. He meets his own end voluntarily as he confesses his guilt.

Before The Law: A Psychological Approach Essay

There aren’t many descriptions of the setting discussed in the story, while in the process of reading it, the reader seems to only know that there is a gate, a doorkeeper, and a man trying to get in. It is not until the end of the story that it is realized that there may in fact not be a setting at all. Kafka wrote this parable with the intentions of that when the reader was beginning to read, they would assume that the gate the man is trying to get access into is guarding a building or some other place that humans could physically go to. While instead he was telling a story about the human mind. That last few sentences in the story being, â€Å"The doorkeeper recognizes that the man has reached his end, and to let his failing senses catch the words, roars in his ear: ‘No one else could ever be admitted here, since this gate was made only for you. I am now going to shut it. ’ â€Å" giving away Kafkas hidden message. The way that you look at the story, or possibly even the way you have lived your life thus far, can persuade how you take the message that Kafka is trying to give to the readers. The story is written in a third person narrative form, Kafka doesn’t give much detail as to the surroundings in the story but he does let you get into the mans head. He writes, â€Å"Yet in his darkness, he is now aware of a radiance that streams inextinguishably from the gateway of the Law. † Kafka is letting you in on how the man feels and how he views the gate. The way Kafka ends this story makes the reader have to think about their life almost involuntarily. The only difference in how each person thinks is: Where do you think the gate has access to? What do you think the law is? And why do you think the man wants to get in it? My answers to those previously stated questions may be different than many but I feel as if Kafka was trying to get the readers to understand that the law is every human beings own and personalized sanctuary. Society says that finding the job of your dreams, the lover of your dreams, and the house of your dreams is what makes you happy. I feel as if finding ones own inner peace is what truly makes you happy. The armed guards in this story represent the pathway and the battles that one has to take to get the their inner sanctuary. Each time you get past one guard, the next is harder to get through. The guards represent each level of growing into your own person and figuring out yourself and who you are. The story writes, â€Å" ‘Everyone strives to reach the Law,’ says the man, ‘so how does it happen that for all these many years no one but myself has ever begged for admittance? ’ â€Å" The man is doing what he thinks everyone else wants to do, he is not doing it out of pure satisfaction for himself, that is why he is not strong enough to even get past the first guard. At the end of the story it is then revealed that the gate was only meant for the man, but he didn’t try hard enough to get in before the light took him over. If only the man would have went to attempt to beat the guard would he have then realised that the path through the law would lead to his inner peace and serenity. He would have to fight harder and harder battles each time but he choose to not even try to get past the first guard. This story shows how the man has to fight to get what he wants and if he does not try to do so, he will die with nothing but an unanswered question and an unpeaceful mind. The setting could just possibly be within ones own mind, but it could also be everything in the physical world. Or both at the same time.

“Please Be Honest With Me Even If It Hurts Me” Poetry Essay

So many nights I sit all alone and and I think about you, wondering if you are ever thinking about me too. It is probably unrealistic to think that you might be thinking of me as much. In the silence of the night with the moonlight shining through my window the tears roll down my face because I care so much and in my heart I’m doubtful that you can feel the same. All I ever asked from you is that you give me honesty, even if hurts me. Oh so long ago our paths ran into each others online, we chatted from time to time and you became my friend. After a while I started to feel things in my heart that I have never felt before. I started to care about you more than I thought it was possible to care about someone . You never said that you cared for me, but sometimes I just do not know. Would you even care if I disappeared into nothing? The entire time that we were getting to know each other I’ve asked you time and time again to Please be honest with me even if it hurts me, I still need that from you. I know that you have your life there just as I have my life here, and our lives keep us busy with our daily responsibilities, but when days pass and I do not hear from you my heart begins to ache and my eyes begin to fill up with tears once again. Sometimes I check my email just to see if I hear from you. I know that there were no promises made to me but if you truly care about me lease remember that I need to be reminded often. Loving someone with some much to over come , between is never easy to begin with, insecurities can become even more intense without knowing or hearing that you care each day. I will never ask you to be anyone but yourself, you are the one I have grown to love, but I do ask you to be honest with me even if it hurts me. Once again I am getting ready to climb into my bed, just wishing and dreaming that you were here with me, even if it can only be a short while. Do you ever wish that also or am I living in a silly fantasy world? For now I will tuck my hopes and dreams in my heart for the night. If I knew for sure how you felt I would know if I should back off or get closer. Should I take my hopes and dreams and put them in a box where I know that they will be safe, or do I take a risk and keep telling you my feelings? Whatever you have to say to me say it honestly, even if it hurts me. For some reason fate has brought us together, I’m not sure of it’s plan, but I know there was a reason. I have put my trust into fate’s hands, where it wants me to be in your life, I will be, what it wants from you and I will be. I can hope and I can wish, but it can only work out the way I dream of, if that is want it wants it to be. There is only one thing I need to ask of you and that is â€Å"Please Be Honest With Me Even If It Hurts Me†

Information Technology Profession Essay

Information Technology plays an important role in today’s society. It plays the role of an enabler of social goals as well as business objectives of the organizations. IT professionals are involved in creating IT infrastructure and communication networks. Another set of IT professionals create applications that run on these IT infrastructure and network. These applications help to deliver with speed, the social programs of governments as well as enable business transactions to be conducted with accuracy, speed and ease. With the Internet access gaining popularity and the increasing volume and variety of information, the information technology has revolutionized the world with the IT professionals leading the change. IT as a profession has the primary responsibility of implementing projects and programs which can help in realizing the goals of an organization. Implementing IT requires a thorough understanding of business processes, knowledge of technologies available and working with a group of people who deliver as a team. At times, the technology bit is a small portion of the entire IT work, though a very important one. Technology roles in IT comprise of hardware and network professionals, programmers, database and storage professionals, software testers and project managers. A very important set of IT professionals are those who maintain and support the IT applications. These are people who ensure that the systems are always available for business use. Support professionals ensure the integrity and stability of the IT applications post implementation. IT requires a good educational background with some amount of proven analytical skills. IT professionals develop and mature in their careers over a period of time and so the people who are required in IT are essentially educated and intelligent people but they are not offered a fast paced career as they think they deserve. Data shows the level of declining interests in the field of computing research (Zweben, 2008). Also, the current negative perception of the job market is seen as the prime factor for the decline in the American students opting for IT as a career. There is a wide perception that the jobs in IT are endangered due to outsourcing (Murphy, 2008). This is not so. The US has the highest number of IT professionals and the only jobs outsourced are the ones which can be done by a lower level of skills. Most of the job portals offer a range of IT jobs and one should be able to gather information about various types of IT career options from job portals as well as IT organizations websites.

Challenges of gay people serving in the military Research Paper

Challenges of gay people serving in the military - Research Paper Example The USAF has worked over the years in alliance with many countries, building strategic partnership for acquiring and maintaining â€Å"access to foreign territories for operational purposes† (Moroney et al, 2010, p.xiii). The USAF has revised their Mission Statement during 2005 to conform to the needs of the time, and its present mission is to â€Å"fly, fight and win... in air, space and cyberspace† (Our Mission, 2012a). In order to achieve the objectives of their mission, the members of the Air Force uphold the vision of â€Å"Global Vigilance, Reach and Power,† which spans into the concept of â€Å"three core competencies: developing Airmen, technology to war fighting and integrating operations† (Our Mission, 2012a). USAF is an organization of high ethical values, and they function within the framework of three values that comprise the concepts of â€Å"Integrity First, Service before Self and Excellence in All We Do† (Our Values, 2012b). ... hip and members of this organization, while discharging their responsibilities, have to consider the interests of different stakeholders including the national government, the citizens, other friendly countries, and the overall interests of the international community in making this world a better place for humans to dwell on. Therefore, all personnel who serve the Air Force have to imbibe in them a high sense of integrity, moral, ethics, and other values that the organization upholds. Similarly, leadership, being the most crucial element in determining the right direction for organizations to achieve their goals, the role of leaders in upholding the tenets of USAF, becomes paramount. Thus, when the organization manifests even a slightest indication of any perceived deviation from its projected image in the public eye, the leadership will have to bear the brunt of criticism. Unfortunately, despite their elite status and the high degree of performance, leaders of the organization have come under the flakes of disapproval on allegations of discrimination against gays and lesbians. In this context, the sexual orientation of a person is his or her absolute right and no force on the Earth has any reason to question its validity. Similarly, there is no acceptable justification for discriminating people on the basis of their sexual preferences. Humans, in spite of their claims of being sophisticated, nurture certain notions, deriving from established norms, and categorize peculiar behaviors that do not fall into their definition of accepted way of life as taboos. Thus, they consider gay and lesbian individuals as deviant and outcast them from the mainstream society. When the society upholds the value of human rights to all, without any regard to the attributes of ethnicity,