Positive Effects Of Corporal Punishment - 1174 Words

Gershoff’s article talks only about a few positive effects of corporal punishment which include immediate compliance, prevention of future misbehavior, and moral internalization. Corporal punishment is often seen as ineffective and as having negative results in children’s development including developing of aggressive behaviors, harming parent-child relationships, and damaging mental health. Mediational processes are inevitable consequences of corporal punishment when administered to children; a few of them include emotional and sensory arousal, perception and acceptance of disciplinary message, and observational learning and social control. The effects of corporal punishment on moral development, according to Gershoffs article, are†¦show more content†¦In Development Through the Lifespan, Laura E. Berk talks about inductive discipline. This type of induction helps make the child aware of feelings by pointing out the effects of the child’s misbehavior on others† (p. 276). When children understand the consequences of their actions on others, they are then more likely to refrain from misbehaving and display prosocial behaviors. Finally, although it is very argued against in the article through the many studies discussed, corporal punishment also has a positive effect on moral internalization in children when it is applied in an instrumental way and not accompanied by strong parental emotion. In African-American families this form of punishment is quite common and highly encouraged. Because the children in those families are familiar with the punishment, the tend to â€Å"†¦ view it as an effort to encourage maturity†¦Ã¢â‚¬  (Berk, p. 270). Corporal punishment can help enhance children internalization when the children understand that it is aimed at guiding them to become responsible adults. Although, there are some positive constructs from corporal punishment there are even more negative constructs that outweigh the positive ones. Corporal punishment is often seen as ineffective and as having negative results in children’s development including developing of aggressive behaviors, harming parent-child relationships, and damagingShow MoreRelatedCorporal Punishment and the Effects of Its Usage757 Words   |  3 PagesCorporal Punishment and the effects of its usage Corporal punishment is the ability to make physical contact as a form of punishment for reprimanding ones behavior. Corporal punishment versus positive reinforcement while they both serve their purpose corporal punishment is known to be more effective. The most common form of disciplining has always been either a spanking, corporal punishment has been dated all the way back to biblical times. Now the corporal punishment that occurred during biblicalRead MoreEffects of Corporal Punishment on Children When Used in the Home1354 Words   |  6 PagesEffects of Corporal Punishment on Children When Used in the Home Discussion about corporal punishment is everywhere. It is in the news and in the home, and in education on what is punishment and what is abuse is beginning to rise. Corporal punishment has been used as a disciplinary tool for parents throughout all of Americas history (Gershoff, 2002, p. 1). However, the definition of what corporal punishment actually is, is still unclear to some people and parents. In Wendy Walshs essay, SpankerRead MoreEffects Of Positive Punishment On Children1562 Words   |  7 Pages This paper will explore effects of positive punishment on children from research conducted through an online database. The articles however vary in certain aspects and perspective of punishment. Lansford, Wagner, Bates, Pettit, Dodge (2012) discuss the controversy as to whether or not infrequent spanking is related to the higher levels of externalizing behavior. Fletcher (2012) discusses whether or not the use of punishment is effective on children. Straus (1999) suggested about 15 years ago thatRead MoreEffectiveness of Corporal Punishment1320 Words   |  5 Pagesof punishment is most efficient in eliciting avoidance behaviors. For a number of years the debate about the use and effectiveness of corporal punishment by teachers has divided educators, parents and ministry officials. As a result, researchers has tried their best to determine whether punishment or harm to a child does indeed thwart misbehavior and encourage students to follow the rules and regulations set forth by the schools. Although, Trinidad and Tobago has banned corporal punishment itRead MoreThe Effects Of Corporal Punishment On The Parent Child Relationship1634 Words   |  7 PagesTHE INFLUENCE OF CORPORAL PUNISHMENT ON THE PARENT-CHILD RELATIONSHIP. There are many different ways of disciplining a child. Corporal punishment is one of the main ones. The term corporal punishment means the intentional infliction of pain on the body for purposes of punishment and includes slapping, hitting with objects, pinching, shaking and forcing to stand for long periods of time. Family researchers define corporal punishment as the use of physical force aimed at causing childrenRead MoreCapital Punishment : A Controversial Topical1621 Words   |  7 PagesCapital punishment is a highly controversial topical. According to Benjet and Kazdin (2002), capital punishment can be defined as a child receiving a spank, an open-handed hit, on the buttocks that does not leave a lasting mark. The main theme of arguments in favor of capital punishment is in reference to its quick allowance of acceptance. On the other hand, the theme for arguments against capital punishment focuses on the long term effects of it. The stigma around spanking your child has changedRead MoreClassroom Discipline And Management Literature Review1363 Words   |  6 Pagesstrategies that are incorrect or rather unacceptable; whether this is done intentionally or under certain desperation to gain control and respect of the learners. It is prevalent across the globe. Although the South African system has used corporal punishment for many years to maintain discipline and management in the classroom; there have always been other alternative ways which are effective and better as opposed to the harsh way of discipline. The Constitution of South Africa specifically bannedRead MoreCorporal Punishment And Its Effect On Children1708 Words   |  7 Pagesviewpoint on corporal punishment; some of the reviews take a look at who is most affected by corporal punishment in terms of focusing their lens on race, socio-economic status, gender, culture etc. Some also take a critical look at the advantages and disadvantages of cor poral punishment. Some take a look at the widespread of corporal punishment in the US. Cases against corporal punishment and the effect of corporal punishment on children were also looked into. With all the different ways corporal punishmentRead MoreThe Case Against Spanking By Brendan L. Smith910 Words   |  4 Pagesresearchers has described that physical abuse and spanking can lead to some serious effects in children. Physical punishment can lead to aggression, antisocial behavior, and other negative effects physically and emotionally. The research and studies have found evidence of abuse to children in short-terms and long-terms. The physical discipline has been viewed as a violation of Children’s Human Rights. Physical punishment of children became a taboo in 30 countries this legal ban is used only as publicRead MoreIs Corporal Punishment A Common Parenting Approach?887 Words   |  4 Pagesas if corporal punishment is a common parenting approach, with over 70% of fam ilies participating. The speaker wants to introduce and convince families to a better parenting style. Holden presents a paradoxical argument that the way to empower children and parents is to disempower parents. He touches on the subject of corporal punishment and its unintended side effects. He transitions from speaking about a â€Å"traditional† parenting orientation, to what he considers a better option, â€Å"positive† parenting

Persuasive Essay Genetically Engineered Foods - 835 Words

Persuasive Research Essay: Genetically Engineered Foods Genetically engineered foods are products that are made out of genetically modified organism, or commonly known as GMO. The modification is inherited from generation to generation. These types of foods have deeply infiltrated the world’s food supply. Almost 90% of crops like corn, soybean, cotton, canola and sugar beets grown in the United States are now genetically modified. Genetic engineering promises increased crop yields, lower costs for farmers, and the reduced use of herbicides and pesticides. It is a completely different method from natural breeding. Because of the modification the nutritional content of the food will be altered. (Genetically Modified Organism (GMO)†). Genetically engineered foods should be banned everywhere in the world, because it is a huge danger to our health as well as to our environment and they increase herbicide and pesticide use. Since the modified product’s DNA is changed during the modification process, it can not only harm the environment, but humans as well. Many studies have shown that people get toxic and allergenic reactions from GMO food. The modified product is filled with chemicals. When people consume modified food, their immune system goes down and they tend to get sick. GMO food lacks in nutrients and has unknown side effects (Agricultural Biotechnology: The Promise and Prospects of Genetically Modified Crops). In 2010 the EuropeanShow MoreRelatedGenetically Modified Crops : Hope For Developing Countries?1543 Words   |  7 PagesLuis Herrera-Estrella and Ariel Alvarez-Morales, authors of â€Å"Genetically modified crops: hope for developing countries?†(2001) argues for genetically modified food to be grown in developing countries in an attempt to alleviate starvation and assist those countries in joining the developed world. The author supports this by immediately identifying and addressing prominent counter-arguments, displaying a localized need of the technology (soon to be globalized), and examining how harshly GMOs are criticizedRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 PagesPHILADELPHIA Temple University Press 1601 North Broad Street Philadelphia, Pennsylvania 19122 www.temple.edu/tempress Copyright  © 2010 by Temple University All rights reserved Published 2010 Library of Congress Cataloging-in-Publication Data Essays on twentieth century history / edited by Michael Peter Adas for the American Historical Association. p. cm.—(Critical perspectives on the past) Includes bibliographical references. ISBN 978-1-4399-0269-1 (cloth : alk. paper)—ISBN 978-1-4399-0270-7

Art a Bar at the Folies Bergere by Edourd Manet Free Essays

elly Turner A Bar at the Folies Bergere by Edourd Manet In the detailed work of art by the artist, Edourd Manet, the subject matter is depicting a barmaid who is alone working in a crowded bar shown in the mirror behind her but at a far distance away. The look on her face seems like she is distracted and overwhelmed with so many customers that she can’t handle taking everyone’s order. The subject matter comes from the artist who maybe is unhappy with his own work and maybe overwhelmed with all the pieces he needs to create for a certain event. We will write a custom essay sample on Art a Bar at the Folies Bergere by Edourd Manet or any similar topic only for you Order Now The media of this work is an oil painting. Oil paintings are used on a canvas. It is a slow drying process which gives the surface of the painting richness and depth of colors. To use oil paint you need good quality sable brushes, turpentine for cleaning and thinning brushes, a canvas, and paint. Points, lines, and shapes help create oil paintings. There are symmetrical forms of the barmaid depicting visual weights and counterweights in the piece, A Bar at the Folies Bergere, by Eduaor Manet. The shapes in this piece are geometric by the reflection of the mirror and also soft edged by the crowd in the background in the mirror almost faded out. The overall balance is destabilized. The masses in this painting are mostly focused on the bar tender then geometrically have the crowd smaller and faded away in the mirror depiction. The textures of this image are implied because there are x-ray photographs that reveal that Manet twice shifted the barmaid’s reflection further right. The color scheme is broken down with light and dark colors making it appear naturalistic. The space is created in two dimensional work with the barmaid’s image reflecting off of the mirror with the crowd portrayed in the background as pretty far away from her and also by balancing to lead our eyes around the work. Elements are arranged with the barmaid as the main element which is big and catches our eyes before we notice the smaller people in the mirror reflection. Unity is created by the mirror reflecting her back image talking to a man knowing that they are all one big room. There is variety n this piece because the barmaid is very finely painted yet the crowded area of people in the mirror is almost fuzzy and unrecognizable. The scale of this work is half life size half not with the women being painted as a normal size yet the other people are very tiny with just their upper bodies being painted. The woman is extremely emphasized in this picture and the man along with the bar top is emphasized as well but not as much as the woman. In the detailed work of art by the artist, Edourd Manet art can be described in many various ways to depict so many different aspects of the painting. How to cite Art a Bar at the Folies Bergere by Edourd Manet, Essay examples

Adaptation of nursing care - Free Samples - Myassignmenthelp.Com

Questions: 1. Pathophysiology of clinical manifestations of Type 1 diabetes. 2. Nursing considerations related to the administration of NovoRapid. 3. The potential impact of type 1 diabetes on Briana and her family. 4. Adaptation of nursing care to accommodate Toms intellectual disability. Answers: Answer 1: High blood glucose level: The high blood glucose level in type 1 diabetes is a consequence of the autoimmune destruction of -cells of the islets of Langerhans in the pancreas. Actively functioning -cells are able to sense the levels of glucose in the blood and release the required amounts of in cells is concomitant with a loss of control on blood glucose levels. The patient suffers from high blood glucose levels and is likely to suffer from secondary complications(Bluestone, Herold, Eisenbarth, 2010) Due to the absence of insulin the transport of glucose to the cells of the body is affected and glucose remains unutilized leading to a high blood glucose level (Pubmed). Glucose in the urine: Presence of glucose in the urine is an indication of diabetes and is termed as glucosuria. In the normal course glucose is reabsorbed into the blood by the kidneys. Glucose is detected in urine at high blood glucose concentrations of 10 mmols/L or more. Glomerular filtration of glucose is higher than the amount the renal tubules can reabsorb. More than 25 mg/dl in samples of fresh urine indicates either high plasma glucose level or insufficient renal resorption of glucose and often both (Restrepo, Pino, Zarate, Mora-Guzmanb, 2013 ). The urine testing for presence of glucose was used for monitoring glycemic control among diabetics in older times. It continues to be regarded as a non-invasive and inexpensive method even now. Increased urination: Increased urination or polyuria is one of the major symptoms of diabetes. Excessive and copious amounts of urine are passed. Among adults, the volume of urine may be more than three litres a day as compared to the normal output of one or two litres a day. Many times the diagnosis of diabetes occurs when a patient complains of polyuria. It can lead to dehydration and if the treatment for diabetes for control of blood sugar levels is not started soon, it can lead to affected kidney function. Once the kidneys fail to reabsorb sugar, the presence of sugar draws out more water and polyuria results (diabetes.co.uk). Increased thirst: The increase in thirst and higher intake of water occurs due to dehydration caused by polyuria. It is termed polydipsia and is usually accompanied by short term or long term dryness of the mouth. Several times high blood sugar is detected when a patient complains of thirst. In untreated diabetes the intake of water may be as high as five litres a day. Plolyuria, polyphagia and polydipsia account for the three major symptoms that are seen in diabetic patients at the time of diagnosis. Copious drinking of water may not alleviate the feeling of thirst in patients (diabetes.co.uk, polydipsia.html). Increased appetite: Increased appetite or polyphagia is a symptom observed among patients who suffer from hyperglycemia. Due to insulin resistance, the glucose in the blood fails to enter the cells leading to low energy. The body reacts by signalling hunger or increase in appetite. More intake of food raises the blood sugar further and the patient feels hungry all the time. Lowering blood glucose through exercise is often effective and reduces blood sugar levels and also stimulates production of insulin. This helps to alleviate the symptom of polyphagia. Ketones in the urine and blood: Ketones are detected in the blood at high levels when a person suffers from hyperglycemia. Less insulin secretion by pancreas impairs the transport of blood glucose into cells and this causes the liver to burn fatty acids to produce energy leading to the production of ketones. This happens when insulin levels are low but glucagon and epinephrine levels are normal. Small levels of ketones in the blood are normal but higher levels are often caused due to diabetes. (diabetes.co.uk, /diabetes-and-ketones.html). Weight loss: Weight loss among diabetes patients results when the body burns fat because enough energy cannot be generated as the glucose utilization is impaired due to lack of transport to cells. Ketoacidosis is usually accompanied by weight loss as the body begins to lose fat and muscle. A drop in weight from 5 to 10 kg that has not been preceded by exercise or diet regimen often points at diabetes. Answer2: Prior to administration Validate the medication order: Prior to the administration of insulin the nurse should ensure whether the insulin dose is written legibly on the prescription and choose a prefilled flexipen that contains the correct dose. It should be ensured that the patient has not received the injection scheduled for that time of the day. Have comprehensive knowledge of the medication It is important to know whether the insulin is slow acting or fast acting. Slow acting insulin is given at the same time everyday (Glargine-in Briana's case) while fast acting insulin (NovoRapid -TDS) should only be administered when the patient's blood glucose is 180mg/dl and it should be immediately followed with a meal. Prepare the medication safely The insulin bottle should be at room temperature. It should be rolled between the hands gently so that a uniform fluid can be seen. Air should be drawn into the syringe equal to the number of units of insulin to be administered. The insulin should be drawn into the syringe to draw the correct number of units. Assess the patient Briana's blood sugar level should be checked just before injecting insulin and patient should be watched for signs of hypoglycemia. Since she is a new patient, her blood pressure should be checked. Check whether the patient is feeling nausea, whether she will be able to hold the meal that will be consumed right after the insulin is administered. During administration Administer the medication safely Correct size of the needle should be chosen. Since Briana is a child and has lost weight recently, a 4mm or 6mm needle can be used. A subcutaneous injection should be given. The nurse should inject insulin into the subcutaneous fat and not into the muscle tissue by raising the skin and using a smaller needle. An 8mm needle is usually used unless specified by the doctor in some cases. The insulin pen should then be held in place to a count of ten to allow the insulin to disperse from the site where it is being injected (NHS, 2014). After administration Document nursing care It is important to make an entry in the chart about the details of the insulin injection. Date, time, site of injection, dosage given should be recorded in a clear and legible fashion. Ensure patient safety Patient should not show signs of allergy and a meal should be consumed immediately after the injection. Monitor the patient Patient's blood glucose should be monitored every hour until two consecutive readings are observed in the normal range. If any sign of hypoglycemia (blood glucose level is at or below 70 mg/dl) is observed patient should be given glucose orally. Answer 3 Emotional The emotional impact of Briana's diagnosis on the family is likely to be considerable due to her young age. The parents will be responsible for monitoring blood glucose levels, administration of medication and watching her food intake and physical exercise(Whittemore, Jaser, Chao, Jang, Grey, 2012). These tasks can prove to be daunting for her mother because of her father's intellectual disability and another infant to care for. The father has already shown signs of being overwhelmed at the time of diagnosis, more so because of his inability to comprehend the illness. Parents can suffer from distress and anxiety because there is disruption of routines. Post traumatic distress is common among parents soon after diagnosis. Physical A change in routine disrupts the family schedule and adds to the stress of the parents. It can be physically demanding to take care of the child's needs and the parents have to care of themselves and other children in the family. A constant watch over Briana's diet, exercise, medication and monitoring blood glucose levels can increase the demands on her parents' physically. Positive lifestyle changes in some cases can improve the adherence to healthy lifestyle of the family (Helgeson, Becker, Escobar, Siminerio, 2012). Answer 4. It is important to recognize the father's intellectual disability and the impediments that he may face when taking care of a young child with type 1 diabetes. Training and educating the father may need extra inputs, particularly with regard to administering insulin, monitoring blood sugar levels, recognising hypoglycemia and the strict regimen of diet and exercise that has to be followed. Awareness about complications that could occur if the medical team's advice is not adhered to has to be added as an extra layer of caution. Educating the parent who has difficulty in understanding, with the help of educational tools, remaining in touch with a social worker, periodic visits to the family during the initial days are important steps to be taken as a nurse. Monitoring the child's behaviour, pacifying the child in times of crises, maintaining a positive atmosphere that fosters the correct diet and exercise for the whole family need to be taught to the parent (Coren, Hutchfield, Thomae, Gustafsson, 2010). References Bluestone, J., Herold, K., Eisenbarth, G. (2010). Genetics, pathogenesis and clinical interventions in type 1 diabetes. Nature. 2010 Apr 29; 464(7293): 12931300., 464(7293): 12931300. Coren, E., Hutchfield, J., Thomae, M., Gustafsson, C. (2010). Parent training support for intellectually disabled parents. Cochrane Databae of Systematic Revi, (6):CD007987. diabetes.co.uk. (n.d.). /diabetes-and-ketones.html. Retrieved from https://www.diabetes.co.uk: https://www.diabetes.co.uk/diabetes-and-ketones.html diabetes.co.uk. (n.d.). polydipsia.html. Retrieved from https://www.diabetes.co.uk: https://www.diabetes.co.uk/symptoms/polydipsia.html diabetes.co.uk. (n.d.). polyuria.html. Retrieved from https://www.diabetes.co.uk: https://www.diabetes.co.uk/symptoms/polyuria.html Grissinger, M. (2011). Avoiding Problems With Insulin Pens In the Hospital. Pharmacy and Therapeutics, 36(10), 615616. Helgeson, V., Becker, D., Escobar, O., Siminerio, L. (2012). Families With Children With Diabetes: Implications of Parent Stress for Parent and Child Health. Journal of Pediatric Psychology, 37(4): 467478. NHS. (2014, May 20). 20May14.pdf. Retrieved from https://www.nhslanarkshire.org.uk: https://www.nhslanarkshire.org.uk/Services/Diabetes/Diabetes%20Clinical%20Guidelines/Documents/Guideline%20for%20the%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf Pubmed. (n.d.). /PMHT0024702/. Retrieved from https://www.ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024702/ Restrepo, B., Pino, P., Zarate, I., Mora-Guzmanb, F. (2013 ). Dipstick urinalysis for diabetes screening in TB patients. International Health, 5(2): 157159. Whittemore, R., Jaser, S., Chao, A., Jang, M., Grey, M. (2012). Psychological Experience of Parents of Children With Type 1 Diabetes. Diabetes Education, 38(4): 562579.

Poetry Feet Flashcard

Poetry Feet

Spanish Expressions Using the Verb Estar

Spanish Expressions Using the Verb Estar As one of the verbs meaning to be, estar is used constantly in Spanish to refer to peoples emotions as well as the status of things and persons. Although there are many times estar isnt translated as to be, usually its use is straightforward for English speakers. Estar also finds its way into numerous idiomatic expressions whose meaning may not be obvious at first. Following are some of the most common and/or useful of them, along with sample sentences taken from contemporary writing. Appropriate translations can vary, depending on the context. Spanish Expressions Using Estar dà ³nde estamos (an expression of amazement or disgust at what is being witnessed).  ¿Dà ³nde estamos?  ¡No lo puedo creer! Whats going on here? I cant believe it! estar a gusto (to be comfortable). Estoy a gusto en mi trabajo. I am comfortable with my job. estar al caer (to be on the verge of arriving). El Nexus 5 est al caer, y podrà ­a costar 399 dà ³lares. The Nexus 5 is almost here, and it could cost $399. estar al loro (to be on top of things). Puedes hablar de todo, porque ests al loro de lo que sucede diariamente. You can talk about everything, because youre on top of everything that happens daily. estar a oscuras (to be ignorant or in the dark). Estoy a oscuras en estos temas. I am in the dark about these subjects. estar a punto de (to be on the verge of). Estaba a punto de llamarte. I was just about to call you. estar al corriente (to be up to date or current). No estoy al corriente en mis pagos. Im not up to date with my payments. estar al dà ­a (to be informed). Quiero estar al dà ­a con todo lo que pueda con mi bebà ©. I want to know about everything that can happen with my baby. estar al là ­mite (to be at ones limit in patience). En estos momentos estoy al là ­mite, y me hace daà ±o ver como mi novio se autodestruye. These days I am at my limit, and it pains me to see how my boyfriend is self-destructing. estar de buen nimo (to be in a good mood). Mariano explicà ³ que ayer su padre estuvo de buen nimo. Mariano explained that yesterday his father was in a good mood. estar de ms (to be excessive). La seguridad nunca est de ms durante la presencia del presidente. There is never too much security during the presence of the president. estar mal de (un à ³rgano del cuerpo) (to have a bad body part). Roger estaba mal de la espalda y no podà ­a jugar con toda su capacidad. Roger had a bad back and couldnt play to full capacity. estar por ver (to remain to be seen). Y est por ver la respuesta del Gobierno de Espaà ±a. The response of the Spanish government remains to be seen. estar sin un cobre, estar sin un duro (to be broke). Recuerdo una à ©poca que yo estaba sin un duro. I remember a time when I was flat broke. estar visto (to be obvious). Estaba visto que no era particularmente una buena opcià ³n. It was obvious that it wasnt particularly a good option. llegar a estar (to become).  ¿Cà ³mo llegaste a estar delgada tan rpido? How did you become thin so quickly? Sources: Sample sentences have been adapted from online sources that include es.Gizmodo.com, Carlos Soriano Gà ³mez, Fobiasocial.net, Foro de Ayuda Psicolà ³gica, Correo del Orinoco, es.Yahoo.com, ComoHacerPara.com, ElBebe.com, ElDà ­a.es, BioBioChile, D. Vzquez Molini and Informe21.com.

Critically discuss the nursing paradigms that you consider have the Essay

Critically discuss the nursing paradigms that you consider have the most relevance to nursing and to your own clinical practice - Essay Example to develop a strong interpersonal relationship with the patient and give quality and compassionate care for optimum positivism for the patient in particular. According to Polit and Hungler (2006) paradigm is a "way of looking at natural phenomena that encompasses a set of philosophical assumptions and that guides ones approach to inquiry" (pg. 183). Nurses naturally use this type of thinking in their practice to assist them in determining what the best care methods are going to be for a patient. Of course this thought moves into the usage of metaparadigms in the field as well, with both interlacing together to form a unified pattern in professional nursing. A Metaparadigm differs from a nursing paradigm as, â€Å"it is known as a group of statements identifying a relevant phenomena† (Fawcett 1984, pg. 84). The Metaparadigm model has four known concepts that directly affect the clinical practice of any nurse, regardless of this is in theater or outside on the surgical ward, or even on a basic ward. These four known central concepts that directly affect the discipline of nursing are as follows: Carper’s Pattern of Knowing (1995) intertwines with this mental train of thought in nursing because it moves beyond the technical aspects of the field and goes more into personal knowledge and experiences. This is explicably true in the area of understanding the patient’s direct needs and the environment from which they came from before ending up in the medical environment (Sorrell & Sorrell 1995, pg. 2). It is also true that this type of philosophy, while bringing many nursing ideas into a more unified spectrum has also brought in a paramount shift in the profession itself. According to how Sorrell & Sorrell (1995) analyzed this concept in their research, they show how Carper believes that every knowledgeable pattern in nursing must be fully understood so that a perfect type of congruence between all of the theorizations and concepts will develop and not be

Executive summary for a project Case Study Example | Topics and Well Written Essays - 250 words

Executive summary for a project - Case Study Example tified that the core weakness within the replenishment process is delay time where delays at the bottleneck are longer: the time taken in completing the critical activities such as assembling of the required merchandise to be taken to the stores, or ordering of the required merchandise from the suppliers to fulfil market demand (longer lead time). In most instances a FIFO discipline most likely have higher delay time and lower outflow rates even in the best case scenario where there is regularity in processing of the merchandise. Such impact constrains the output rate at the bottleneck. The core solutions derived from the problem analysis to develop a â€Å"To-Be† replenishment process aimed at increasing operational excellence includes: Optimising lead time through adoption of just in time technique; the selection of a few strategic and trusted suppliers for whom a strategic partnership is made and the company’s replenishment process is integrated into such supplierâ⠂¬â„¢s systems; Vendor managed Inventory system which give control to the suppliers and ensures effective flow of accurate information on the level of merchandise required, which can be enhanced through incorporation of radio frequency Identification (RFID) system in the products; and cross docking where products are transported directly from the suppliers to the stores with the merchandise undergoing little to nil handling. Attaining operational excellence is critical for any business as organisations cannot afford to have quality issues, high cost operations or even long market cycles (Oracle 3). Notably, one of the core advantages that businesses often attain to achieve is effective inventory management to not only ensure high quality fresh products but also lower costs. Optimal inventory management is vital for any business organisation. The core benefits of having a much leaner inventory includes reduction in operation costs, higher customer satisfaction, and increased sales. In deed Lee (1)

Week 4 Individual Assignment Essay Example | Topics and Well Written Essays - 1250 words

Week 4 Individual Assignment - Essay Example Clear Hear manufactures phones at its own facilities. One of the goals of the managers of the company is to optimize production in order to take advantage of idle capacity. The company has an unused production capacity of 70,000 units. The firm has to decide whether or not to take an order of 100,000 units. The current bid is a price of $15 per unit. The firm has to consider the variable and fixed cost of producing the model. Clear Hear produces two types of phone models. The Alpha model is sold at $20. The profit margin on this model is 15% due to the fact that total cost equal $17 per unit. The Beta model is sold at $30 and it has a net market of 26.66%. Due to the fact that the production cost are higher than the price bid of the proposal the company cannot take the order under normal circumstances. To take the order the firm has to outsource the order to produce the phones at $14. The company would make a profit of $100,000 on the transaction. In order to increase revenues Clear Hear can utilize several strategies. The firm can invest money in marketing in order to attract new customers. Advertising campaigns can ignite the demand of the product. Another way to improve revenues is by motivating the sales staff. Increasing commission incentives is a way to motivate the salespeople to produce more. A firm can increase its production capacity by investing in technology such as new machinery for the production line. Increasing the production capacity of the firm can enabled the company to shift its supply curve to the right. Greater production would enable the company to increase its revenues. Another simply solution to increase the demand for the product is to decrease the price of the phones. Due to the thin margin on the Alpha model the company has to be careful with its price decreases because it may hurt profitability. It is important to pay attention to the laws of diminishing return.

Serum-hepatocyte Growth Factor (S-HGF) in Diagnosis of SPNs

Serum-hepatocyte Growth Factor (S-HGF) in Diagnosis of SPNs Value of hepatocyte growth factor in the differential diagnosis of solitary pulmonary nodules[F1] Haixin Yu, Yan Wang*, Wenduan Ma, Haixiang Yu, Shengtao Shang Abstract Purpose: To evaluate serum-hepatocyte growth factor (S-HGF) in the differentiation of solitary pulmonary nodules(SPNs)[F2].[F3] Methods: The study comprised 42 serum samples from SPN patients and 10 healthy samples as control. The HGF was measured by the commercially available immunoassay[F4].[F5] Serum levels of HGF of 42 patients with SPN was measured by ELISA kit, and compared with the control group of 10 normal subjects. The nodules were diagnosed by operation and pathology. Results: The median level of S-HGF was 180( range from 100 to 300) pg/ ml in the healthy control group, 165( range from 100 to 400) pg/ ml in benign SPNs group and while 395( range from 100 to 1550) pg/ ml in malignant SPNs group, The S-HGF mean level of malignant group was significantly higher than the with significant difference observed between the malignant group and control group(P. Moreover, the malignant group was also significantly higher than the , and between the malignant group and the benign group(Pwhile no significant difference between the benign , but not between the benign group and the control group(Pà ¯Ã‚ ¼Ã… ¾0.05). Furthermore, the S-HGF was also shown no statistically significant difference was observed(Pà ¯Ã‚ ¼Ã… ¾0.05) in different pathologic types of the limited number of lung cancer patients.In addition, when S-HGF in different pathologic types of the limited number of lung cancer patients were compared, no statistically significant difference was observed (Pà ¯Ã‚ ¼Ã… ¾0.05). Conclusion: S-HGF is valuable in the differential diagnosis of solitary pulmonary nodules. It was suggest that the patients with SPNs should consider an operation when the S-HGF level ≠¥250pg/ml, and malignant SPNs are highly suspected while S-HGF level ≠¥400pg/ml, surgical intervention should be taken immediately.S-HGF is valuable in the differential diagnosis of solitary pulmonary nodules. An elevated S-HGF level≠¥250pg/ml in patients with SPNs may strongly speak for malignant nodules and operation is suggested. If S-HGF level ≠¥400pg/ml, malignant SPNs are highly suspected, active surgical intervention should be taken. Key words: diagnosis, hepatocyte growth factor, solitary pulmonary nodule, NSCLClung cancer 1. Introduction The solitary pulmonary nodules (SPNs) is a single mass in the lung less than or equal to 3 cm in diameter, without concomitant pneumonia and atelectasis of involved lung segments and lobes [1]. In the general population, it’s reported that approximately 5% of SPN patients show lung cancer by radiology [2], which is considered one of the most common forms of cancer with a high death incidence ratio in the world [3]. Diagnoses of benign and malignant SPN has been concerned and become a challenge in these decades [4, 5]. Therefore, it is utmost important to improve the method in the characterization of SPNs[6].   With the development of modern medical science and technology, several detecting and monitoring method were used in screening the SPNs and lung cancer [2, 7, 8], Momen[9] et al. have compared three detection methods for identifying malignant SPNs for the sensitivity and specificity. The positron emission tomography (PET) imaging was consistently higher (80 to 100%) for its sensitivity, while was with lower specificity and larger variation (40 to 100%). Also, they found the similar results in dynamic CT with enhancement (sensitivity, 98 to 100%; specificity, 54 to 93%). In studies of CT-guided needle biopsy, sensitivity and specificity performed excellent, but nondiagnostic results were seen approximately 20%. Dalli[8] et al. also showed the similar result in 2013. While Carsten[10] et al. suggested that routine flexible bronchoscopy should be included in the pre-operative work-up of patients with SPNs in his study. Even so, it seems to find a better detection method of long cancer an d characterization of SPNs is still necessary. Serum-hepatocyte growth factor (S-HGF, Serum-HGF) is an important fibroblast-secreted protein that mediates development and progression of cancers[11]. Nagio et al. [12] gave the evidence that the S-HGF levels of patients with small cell lung cancer (SCLC) were significantly higher than those of patients with benign SPNs and healthy subjects. Ujiie et al[13] had proved that the levels of HGF in serum could be used as prognostic indicators of the patients with stage III non-small cell lung cancer (NSCLC) undergoing surgery and chemotherapy. Kasahara et al. [14] found that higher HGF levels were significantly associated with a shorter progression-free survival (PFS) and overall survival (OS) in patients with non-small cell lung adenocarcinoma. The expression level of S-HGF could be a sensitive indicator and an independent biomarker for evaluating the therapeutic effects and the prognosis in patients with lung cancer. Therefore, we give the hypothesis that S-HGF may be a potential targ et in diagnoses of benign and malignant SPNs associated with lung cancer. In our study, we used Enzyme linked immunospot assay (ELISA) method to detect the S-HGF levels between different serum samples from SPNs patients and healthy subjects. The solitary pulmonary nodule(SPN) is defined as a round opacity ≠¤3 cm in diameter surrounded by lung parenchyma[1].There should be no associated with hilar lymphadenopathy, atelectasis, pneumonia or chest wall pathologies. With more importance attached to physical examination and the development of medical imaging examination technology, the detection rate of SPN is on the increase. In the general population, approximately 5% of all SPNs shown by radiology are reported to be carcinomas[2]. In eight large trials of lung cancer screening, Momen et al[3] have compared the sensitivity and specificity in three detection methods for identifying malignant SPNs. The sensitivity of PET imaging was consistently high (80 to 100%), whereas specificity was lower and more variable (40 to 100%). They found similar results in dynamic CT with enhancement(sensitivity, 98 to 100%; specificity, 54 to 93%).In studies of CT-guided needle biopsy, sensitivity and specificity were excellent, but nondiagnostic results were seen approximately 20% of the time. Carsten et al[4], in a study of 225 patients with SPN of unknown origin, observed that the bronchoscopic biopsy results were positive in 84(46.5%) patients with lung cancer. The differential diagnosis between malignant and benign solitary pulmonary nodules (SPNs) is always a difficult point in clinical practice. In this study, we inv estigate the clinical significance of the serum level of hepatocyte growth factor(HGF) in patients with SPNs. 2. Methods 2.1. Patients According to the definition, inclusion criteria was setà ¯Ã‚ ¼Ã… ¡Ãƒ ¯Ã‚ ¼Ã‹â€ 1à ¯Ã‚ ¼Ã¢â‚¬ °On computed tomography (CT), SPN is a round opacity ≠¤3 cm in diameter surrounded by lung parenchyma.à ¯Ã‚ ¼Ã‹â€ 2à ¯Ã‚ ¼Ã¢â‚¬ °There should be no associated with hilar lymphadenopathy, atelectasis, pneumonia or chest wall pathologies.à ¯Ã‚ ¼Ã‹â€ 3à ¯Ã‚ ¼Ã¢â‚¬ °Regardless of age and gender. In consideration of some influences, exclusion criteria was setà ¯Ã‚ ¼Ã… ¡(1)Inflammation or infection within a month. (2)Surgery or trauma within 6 months. (3)Various liver diseases. (4)Chronic renal failure. (5)Arteriosclerosis. (6)Rheumatoid arthritis and osteoarthritis. (7)Diabetes mellitus. The case group included 42 patients with SPNs, mean age 60.7 years (range, 42 to 72). Besides, 10 healthy adult subjects were chosen as control. 2.2. Specimen collection The morning fasting venous blood of all subjects was collected in sterile polypropylene tubes, containing ethylenediamine tetraacetic acid (EDTA), and immediately centrifuged at 400rpm for 10min. Then, the plasma was stored at -70 °C until the assays were performed. 2.3. Assay for S-HGF We used Sandwich enzyme-linked immunosorbent assay(ELISA) to measure S-HGF. The HGF monoclonal antibody and standard substance for the assays were purchased from American RD systems. Goat-anti-human HGF polyclonal antibody as the primary antibody and donkey-anti-goat IgG polyclonal antibody labeled with horseradish peroxidase as the secondary antibody were both purchased from British biotech company Abcam. 2.4. Pathological diagnoses All the 42 patients with SPNs were pathological diagnosed postoperatively. 12 cases were benign nodules(4/12 were tuberculoma, 6/12 were inflammatory pseudotumor, 2/12 were hamartoma) and 30 cases were malignant nodules(17/30 were adenocarcinoma, 13/30 were squamous carcinoma). 2.5. Statistical methods All data were analyzed by SPSS 19.0. Because the measured data manifested as skewed distribution, geometrical mean Gà ¯Ã‚ ¼Ã‹â€ logG ±sà ¯Ã‚ ¼Ã¢â‚¬ °was calculated in each group after logarithmic transformation had been carried out on each datum. Then, Students t test was performed on both sides. Differences were considered statistically significant at Pà ¯Ã‚ ¼Ã…“0.05. 3. Result The S-HGF data measured of healthy control group, benign SPNs group and malignant SPNs group is shown in Table 1Table 1 are the measured S-HGF data of healthy control group, benign SPNs group and malignant SPNs group. All the data manifest as skewed distribution(All Pà ¯Ã‚ ¼Ã…“0.05). Geometrical mean Gà ¯Ã‚ ¼Ã‹â€ logG ±sà ¯Ã‚ ¼Ã¢â‚¬ °was calculated in each group after logarithmic transformation had been carried out on each datum(Table 2). TABLE 1 The S-HGF levelà ¯Ã‚ ¼Ã‹â€ pg/mlà ¯Ã‚ ¼Ã¢â‚¬ ° of healthy control group, benign SPNs group and malignant SPNs group. TABLE 2 The comparison of S-HGF level of each group after logarithmic transformation had been carried out on each datum. aBenign SPNs group vs healthy control group, Pà ¯Ã‚ ¼Ã… ¾0.05 bMalignant SPNs group vs healthy control group, Pà ¯Ã‚ ¼Ã…“0.05 cMalignant SPNs group vs benign SPNs group, Pà ¯Ã‚ ¼Ã…“0.05 The S-HGF level of benign SPNs group compared with the healthy control group, there were no significant differences (Pà ¯Ã‚ ¼Ã… ¾0.05). The S-HGF levels of malignant SPNs group were significantly higher than those of healthy control group(Psignificant differences (Pà ¯Ã‚ ¼Ã… ¾0.05, Table 3). TABLE 3 The comparison of S-HGF level of adenocarcinoma and squamous carcinoma aSquamous carcinoma vs adenocarcinoma, Pà ¯Ã‚ ¼Ã… ¾0.05 4. Discussion Hepatocyte growth factor/scatter factor (HGF/SF) from the serum of hepatectomized rats was first partially purified and described by Nakamura in 1984[15]. HGF receptor encoded by the c-met proto-oncogene is a member of the tyrosine kinase class of cell surface receptors. As a kind of cytokine, the hepatocyte growth factor(HGF) has widely biological activities, including regeneration, antifibrosis, cytoprotection, and differentiation[16]. Moreover, HGF is a predominant fibroblast-derived factor that stimulates mitogenesis, motogenesis, and the invasion and metastasis of human carcinoma cells [17]. The growth and metastasis of tumors depend on angiogenesis which is the result of the imbalance of promoters and inhibitors. The S-HGF levels in patients with acute hepatitis, chronic hepatitis and cirrhosis were found to be slightly higher than those in normal subjects[18]. So the patients with various liver and gall diseases were first excluded. So far, some studies showed the S-HGF levels were significantly increased in patients with Inflammation, infection, underwent surgery or trauma. Therefore, the patients with inflammation or infection within a month and the patients underwent surgery or trauma within 6 months were both excluded. Johanna et al. [19] had concluded that patients with chronic renal failure (CRF) have a systemic HGF profile reflecting a chronic inflammatory condition with high concentration, but low biological activity, of HGF. Therefore, the patient samples with CRF were also excluded. The S-HGF levels in patients with arteriosclerosis, rheumatoid arthritis, osteoarthritis, and diabetes mellitus were reported to be significantly higher than that in healthy population. So, the patients with these diseases were excluded as well. Tsao et al.[20] showed the HGF messenger RNA(mRNA) and protein were predominantly expressed by the tumor cells in a high percentage of primary NSCLC. Our study showed serum of the healthy control group contained trace amounts of S-HGF, the S-HGF levels of the patients with benign SPNs were nearly close to the healthy control group(PHGF levels of the patients with malignant SPNs were significantly higher than the healthy control group(Pà ¯Ã‚ ¼Ã… ¾0.05) and the benign SPNs group(Pà ¯Ã‚ ¼Ã… ¾0.05). It illustrated that the high level of S-HGF was associated with lung cancer. And it was further confirmed that S-HGF could be expressed by the carcinoma cells in NSCLC. The S-HGF levels of part of patients with squamous carcinoma in the malignant SPNs group were observed to be higher(à ¯Ã‚ ¼Ã… ¾700pg/ml) and the S-HGF statistical analysis by the statistical difference between the squamous carcinoma group and adenocarcinoma group, for the S-HGF, the median level of the squamous carcinoma group was 370(100-1500)pg/ml while the adenocarcinoma group was 420(100-1550)pg/ml, no statistically significant difference between the two groups(P>0.05). No further conclusions could be made, in case of the number limitation of the samples. The result confirmation should be amortized awaits further research. Further analysis of the 20 patients with high levels of S-HGF(≠¥250pg/ml), there are 3 patients(15%) with benign SPNs and 17 patients(85%) with malignant SPNs. Furthermore, for the 20 patients, the result shows that 1 patients (6.25%) with benign SPNs and 15 patients (93.75%) with malignant SPNs in the 16 patients with high levels of S-HGF(≠¥400pg/ml), It reveals that an elevated S-HGF level ≠¥250pg/ml in patients with SPNs are more likely to be malignant and when the S-HGF level ≠¥400pg/ml, malignant SPNs are highly suspected. Conclusion In conclusion, our study shows significant in the differential diagnosis between malignant and benign solitary pulmonary nodules (SPNs) for the S-FGF assay. The S-HGF levels of malignant SPNs group are significantly higher than the healthy control group(P SPNs group(Pà ¯Ã‚ ¼Ã…“0.05). The differences between benign SPNs group and healthy control group have no statistically significant(Pà ¯Ã‚ ¼Ã… ¾0.05). An elevated S-HGF level ≠¥250pg/ml in patients with SPNs are more likely to be malignant, surgical therapy should be considered. If S-HGF level ≠¥400pg/ml, malignant SPNs are highly suspected, surgical intervention is recommended without delay. Hepatocyte growth factor/scatter factor (HGF/SF) from the serum of hepatectomized rats was partially purified and described by Nakamura for the first time in 1984. HGF receptor encoded by the c-met proto-oncogene is a member of the tyrosine kinase class of cell surface receptors. As a kind of cytokine, the hepatocyte growth factor( HGF) has widely biological activities, including regeneration, antifibrosis, cytoprotection, and differentiation[5]. Moreover, HGF is a predominant fibroblast-derived factor that stimulates mitogenesis, motogenesis, and the invasion and metastasis of human carcinoma cells[6]. The growth and metastasis of tumors depend on angiogenesis which is the result of the imbalance of promoters and inhibitors. Sengupta et al[7] had demonstrated that HGF/SF could induce angiogenesis independently of VEGF, possibly through the direct activation of the Akt and ERKs. The S-HGF levels in patients with acute hepatitis, chronic hepatitis and cirrhosis were found to be slightly higher than those in normal subjects[8]. So the patients with various liver and gall diseases were first excluded. So far, some studies have found the S-HGF levels were significantly increased in patients with Inflammation or infection, or underwent surgery or trauma. Therefore, the patients with inflammation or infection within a month and the patients underwent surgery or trauma within 6 months were both excluded. Johanna et al[9] had concluded that patients with CRF have a systemic HGF profile reflecting a chronic inflammatory condition with high concentration, but low biological activity, of HGF. Therefore, the patients with CRF were also excluded. The S-HGF levels in patients with arteriosclerosis, rheumatoid arthritis, osteoarthritis, and diabetes mellitus were reported to be significantly higher than that in healthy population. So, the patients with these diseases were all excluded. Tsao et al[10] had showed that HGF messenger RNA(mRNA) and protein were predominantly expressed by the tumor cells in a high percentage of primary NSCLC. It indicated in our research that the serum of the healthy control group only contained trace amounts of S-HGF, the levels of S-HGF of the patients with benign SPNs were close to those of the healthy control group(Pà ¯Ã‚ ¼Ã… ¾0.05) and the benign SPNs group(Pà ¯Ã‚ ¼Ã… ¾0.05). It illustrated the fact that high level of S-HGF was associated with lung cancer. And, it was further confirmed that S-HGF could be expressed by the carcinoma cells in NSCLC. In addition, Nagio et al[11] had proved that the levels of S-HGF of patients with SCLC were significantly higher than those of patients with benign SPNs and healthy subjects. The levels of S-HGF of a portion of patients with squamous carcinoma in the malignant SPNs group were observed to be higher(à ¯Ã‚ ¼Ã… ¾700pg/ml) and statistical analysis was conducted to fond the statistical difference of S-HGF between the squamous carcinoma group and the adenocarcinoma group. The S-HGF median of the squamous carcinoma group was 370(100-1500)pg/ml and the adenocarcinoma group was 420(100-1550)pg/ml, no statistically significant difference was found between the two groups(P>0.05). No firm conclusions could be made, possibly due to the limited number of cases. It is of concern and remains to be further studied. Further analysis was taken in 20 patients with high levels of S-HGF(≠¥250pg/ml), 3 patients(15%) had benign SPNs and 17 patients(85%) had malignant SPNs. Further observation was made, among the 20 patients, there were 16 patients with high levels of S-HGF(≠¥400pg/ml), 1 patients(6.25%) had benign SPNs and 15 patients(93.75%) had malignant SPNs. It reveals that an elevated S-HGF level ≠¥250pg/ml in patients with SPNs are more likely to be malignant and if S-HGF level ≠¥400pg/ml, malignant SPNs are highly suspected. Ujiie et al[11] had proved that the levels of HGF in serum could be useful prognostic indicators of the survival of patients with stage III NSCLC undergoing surgery and chemotherapy. Kasahara et al[12] had shown that higher HGF levels were significantly associated with a shorter progression-free survival (PFS) and overall survival (OS) in patients with non-small cell lung adenocarcinoma. The expression level of S-HGF could be a sensitive indicator and an independent judgement standard for evaluating the therapeutic effects and the prognosis in patients with lung cancer. Furthermore, understanding the role of HGF in the tumor progression may help in designing new therapeutic strategies for lung cancer. In conclusion, the assay for S-HGF may be of some significance in the differential diagnosis between malignant and benign solitary pulmonary nodules(SPNs). The S-HGF levels of malignant SPNs group were significantly higher than those of healthy control group(Pà ¯Ã‚ ¼Ã…“0.05). The differences between benign SPNs group and healthy control group had no statistically significant(Pà ¯Ã‚ ¼Ã… ¾0.05). An elevated S-HGF level ≠¥250pg/ml in patients with SPNs are more likely to be malignant, surgical therapy should be suggested. If S-HGF level ≠¥400pg/ml, malignant SPNs are highly suspected, active surgical intervention should be taken. References 1.  Hansell, D.M., et al., Fleischner Society: glossary of terms for thoracic imaging. Radiology, 2008. 246(3): p. 697-722[à ¥Ã‚ ¼Ã‚  Ãƒ ¨Ã¢â‚¬ ¹Ã‚ ±Ãƒ ¥Ã‚ ½Ã‚ ª13]. 2.  Klein, J.S. and M.A. Zarka, Transthoracic needle biopsy: an overview. J Thorac Imaging, 1997. 12(4): p. 232-49. 3.  Siegel, R., D. Naishadham, and A. Jemal, Cancer statistics. CA Cancer J Clin, 2012. 62(1): p. 10-29. 4.  Cao, C., et al., A meta-analysis of unmatched and matched patients comparing video-assisted thoracoscopic lobectomy and conventional open lobectomy. Ann Cardiothorac Surg,2012. 1(1): p. 16-23. 5.  Zhan, P., Q. Qian, and L.K. Yu, Prognostic value of COX-2 expression in patients with non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2013. 5(1): p. 40-7. 6.  Tong, X., et al., [Clinical experience of the treatment of solitary pulmonary nodules with da vinci surgical system]. Zhongguo Fei Ai Za Zhi, 2014. 17(7): p. 541-4. 7.  Aberle, D.R., et al., Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med, 2013. 369(10): p. 920-31. 8.  Dalli, A., et al., Diagnostic value of PET/CT in differentiating benign from malignant solitary pulmonary nodules. J BUON, 2013. 18(4): p. 935-41. 9.  Wahidi, M.M., et al., Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007. 132(3 Suppl): p. 94S-107S. 10.  Schwarz, C., et al., Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules. Eur Respir J, 2012. 41(1): p. 177-82. 11.  Ma, D.C., et al., [Hepatocyte growth factor did not enhance the effects of bone marrow-derived mesenchymal stem cells transplantation on cardiac repair in a porcine acute myocardial infarction model]. Zhonghua Xin Xue Guan Bing Za Zhi, 2006. 34(2): p. 119-22. 12.  Takigawa, N., et al., Serum hepatocyte growth factor/scatter factor levels in small cell lung cancer patients. Lung Cancer, 1997. 17(2-3): p. 211-8. 13.  Ujiie, H., et al., Serum hepatocyte growth f

The Worst Jobs in the World :: essays research papers

The Worst Jobs in the World TURD DIVER - cleans the grate at the sewer treatment plant HOG SLAUGHTERHOUSE PROCESSOR - I work in a slaughterhouse where we process hogs. They come in by the truckload and sometimes I have to lead them to the killing pen and kill them with a bullet in the head. Usually this job means that the technician ends up covered with blood. The hog is then placed upon meat hooks by its hind legs. After the hog is lifted into position, its neck is slit so that blood can drain into a large vat. Sometimes it seems that gallons of blood pours out. One benefit, though, is cheap hams and bacon. We get to buy meat at very low cost. Too bad we don't make enough money to buy very much. $9.00 as processor. It's a living. BURNT POTATO CHIP PICKER - For minimum wage you get to watch cooked potato chips quickly fly by on a conveyor belt and you have to pick out the burnt ones. This is done in 90+ degree temperature, with a thick coating of oil in the air. With these three ingredients, it isn't long before motion sickness (watching the chips fly by) increases with the smell and temperature causing you to want to barf. And you know how it is having a minimum wage job, you don't get a break and have to keep your nose to the grindstone. Needless to say I turned down overtime. GAY BAR JANITOR - Think about it . . . Cleaning a bar is a bad enough thought. In a gay bar some of the things you see, hear and find can be very confusing and leave you not wanting to touch anything! Ever!!! ARMPIT SNIFFER in a deodorant factory. The World's Worst Jobs - Nuclear Warhead Sensitivity Technician - Circus Elephant Clean Up Specialist - Rotten Sardine Taste Detector - Assistant To The Boss's Nephew - Shark Baiter - Hurricane Photographer - Director Of Public Relations, Chernobyl Nuclear Facility - Prison Glee Club President - Road Kill Removal Crew Worst Jobs 1.Lumberjack 2.Fisherman 3.Cowboy 4.Ironworker 5.Seaman 6.Taxi driver 7.Construction worker 8.Farmer 9.Roofer 10.Stevedore World's Worst Jobs Do you think your job stinks? You could be a Flatus Odor Judge. That's just one of several of the Worst Jobs in Science according to the editors of "Popular Science" magazine, who just compiled the list for the latest issue. Topping the chart for worst jobs are the odor judges at a Minneapolis gastroenterologist -- they're are paid to smell people's farts to determine potentially critical medical symptoms.

Effects of Endosulfan

Pre-Induction Work. How To Ensure The Success Of Your Every Induction and Suggestion Before You Even Begin By William May Click Here To Become A Master Of Covert Hypnotic Influence In the study of hypnosis there are many elements that have been covered thoroughly. Certainly, any well informed student will be familiar with the need for a good pre-talk and the establishment of rapport, will have to be quite familiar with the process of inducing and deepening a trance, and, undoubtedly, with the deployment of the suggestions and commands that are, perhaps, the ultimate purpose for the creation of the trance state.Of course, the focus on the experience of trance itself, on creating, deepening, maintaining and utilizing that state, is the essence of our field, but to truly master this art, one must also understand far more about the creation of trance, and just how our interactions with a subject, even before any formal trance work begins. Our focus here, then, is on this initial phase of the hypnotic relationship. Now, clearly the pre-talk and rapport development fall into this stage, which we can call the pre-induction phase, but they are only one aspect of the work that can be done within this realm.Even before any mention of hypnosis is made, an informal preparation can begin. The subject can be conditioned towards responsiveness, while we can surreptitiously begin to calibrate to determine the style of hypnosis that will be most productive, and, of course, begin to establish the relationship that will allow this work to be done. Additionally, we might also utilize some basic covert hypnotic techniques to truly pre-induce the subject, such that by the time formal trance work begins, they are already in a light trance state and can easily be lead into a deep trance with minimal resistance.There are many possibilities that a competent hypnotist will utilize at this point in there interaction with a subject, and we cannot, certainly, discuss all of them here, but w e shall explore, and in so doing might raise new thoughts to lead us towards discovering further potentialities for just how the pre-induction phase might be utilized to enhance the hypnotic interaction for our subject, while making our job as hypnotist even easier.  © William May. www. masterhypnoticlanguage. com Let us begin with some minor points on what happens when a subject is first greeted and welcomed to our hypnotic arena.While my focus here is on therapeutic interactions, one can easily see how these same notions might translate to other contexts, whether it be on the street, in a theatre, or any other context. So, let us imagine that a client walks into the office for their first session. My preference is to meet them in the waiting room. This may seem, and indeed is, a minor point, but there is a reason for this. First, it does create a cordiality, as I can walk out, meet them with a warm smile and handshake, and then welcome them to come into my office.Additionally, I might find out a bit about the subject, whether they arrived alone, and if not, just who is with them; how they occupy their time whilst sitting in the waiting room, and their general demeanor. Many small details can be obtained through this simple gesture, whereas a subject might easily disguise some of their feelings upon entering the actual office, or, conversely, might feel an unease that they did not have as they waited. Such minor observations can be of extreme import. As an example, consider just how you might find it useful to know that your subject was reading a textbook on nursing versus a pulp novel.What might it say if they were, instead, playing a video game on there cell phone? These may be small details, but the awareness of such things can offer opportunities for metaphor(if your subject seems to be engrossed in a magazine on sports, for instance, you might weave a story that uses a sporting event as it’s focus), a point upon which to create rapport (â€Å"I couldn’t help but notice you are reading the new book by so-and-so, I’ve not read that, but I really enjoyed his XYZ, have you read that as well? †).Consider, also, the middle aged man who arrives at the office in company of his Mother, or the subject who sits alone in the corner of the office, not doing anything but purposefully avoiding interaction with anyone else in the waiting room. Another reason for stepping out of the office to meet the client is that it provides a small opportunity for getting the subject acclimated to following instructions. Even the simple gestures of asking subject to follow you into the office and of telling them to take a seat offer an opportunity to establish a pattern of compliance in an extremely non-threatening way.Again, these are minor points, but by creating a directive aspect in the relationship at this point, we are laying the groundwork for compliance that will be built upon as we move into hypnosis.  © William May. www . masterhypnoticlanguage. com At this point, of course, we have our initial interview with the subject, and the main point that I would make in this portion is to discover and accept the client’s frame. This is extremely Ericksonian, but accepting the frame, no matter its ridiculousness, is an extremely powerful stance to take as a hypnotist.To offer the most extreme example, let us suppose that a subject walks in and speaks immediately of how they have studied hypnosis, know that many hypnotists themselves acknowledge that the state does not exist, and are certain that they cannot be hypnotized. My response would be to say, â€Å"yes, you are quite right. Knowing as much as you do, you certainly are aware that some people have deficiencies that make it impossible for them to enter trance, and it is possible that you may be one of those people who just can’t relax enough to experience the wonderful possibilities of a hypnotic trance.Some people do have that problem, s adly, and it might just be so for you. Of course, until we do begin hypnosis, we won’t really know if you are one of those unfortunate people who just can’t experience this†¦Ã¢â‚¬  Thus, without arguing the point, we’ve established a viewpoint that not being able to enter trance is a deficiency, while creating the possibility that they might be wrong. At this point, we can immediately change the subject to some other matter, letting that idea sink in even deeper.In this work through the frame rather than against it, and the subject will want to disagree with our viewpoint that they can’t enter trance, since it has been connected to â€Å"deficiency† and â€Å"problems†, and will only be capable of resisting that suggestion through entering trance and changing the frame they entered with. At this point in the interaction, it can also be quite useful to begin using some minor suggestions, both to prime the subject for trance and, perhaps more importantly, to determine just how easily they respond.Simple comments can serve well to do this. For example, while gesturing towards a chair, you might comment, â€Å"that is a very comfortable seat, it’s easy to just sit back in it, take a nice deep breath, and relax. † The comment can be tossed out offhandedly, and you merely have to note whether the subject does respond or not. This is not intended to create the trance state (though with some subjects it is a good beginning), but it does allow us to begin noting how they respond.This can, for example, alert a savvy hypnotist to the potential for a polarity responder, when the subject responds in a way that is directly oppositional to the suggestion, or, conversely, to the suggestible and responsive subject who will easily respond by relaxing into that chair with a nice deep breath. Now, it should be noted that the suggestions can be far more subtle than this, but, as well, it’s important to recall  © William May. www. masterhypnoticlanguage. com hat the subject often is not aware enough of these techniques to notice even a somewhat overt comment of this sort. However, if you are wary of putting the subject on edge with a comment of this sort, one might use a suggestion that is not directed at relaxation, or by making an indirect suggestion by discussing how some of your other patients find it very easy to relax in that chair. The nature of the suggestion itself is not overly important here, the purpose is, as stated above, to establish a base line for responsiveness, as well as to develop that aspect of the interaction.This process of using small suggestions can be continued while progressing through the initial interview and pre-talk, allowing for calibration towards the type of suggestion that seems most effective. Some subjects will respond best to direct suggestions, while others seem more compliant when the suggestions are indirect. Learning this before hypnosis actually begins makes it possible for the savvy hypnotist to be far more effective and efficient.Instead of merely following a generic approach and tailoring it to the client during the hypnotic interaction itself, you already have much of the knowledge necessary for creating an impactful hypnotic pattern. Of course, this does not take the place of calibration during the actual hypnosis session, but it can allow the work to begin in a more practical and comfortable way for the subject. Additionally, one might, indeed, begin seeding useful suggestions at this point, a consideration that shall be discussed in more detail as we continue. At this point in the interaction, other forms of calibration can of course begin.For example, one might inquire about when a problem first emerged and make note of where the subject seems to look when referencing the past, and similarly asking questions about the present and future, can gain a notion of the overall timeline; one can determine, of course, submod al preferences, to best determine what type of imagery will be most impactful; indeed, depending upon the nature of your style and preferred techniques, it is possible to craft opportunities for noting various aspects of the clients behavior and perceptual maps which might be useful in cultivating a hypnotic response.In many cases all this requires is asking a question that accesses a certain process, and noting the client’s response. Additionally, we might find opportunities for creating anchors. The simple suggestion offered above, connecting relaxation to the client’s chair can serve, for instance, to connect the notion of relaxation with sitting in  © William May. www. masterhypnoticlanguage. com that position.Additionally, we might notice a certain response during questions about the client’s problem, a response that we feel could be useful to access again, and anchor this in whatever way seems appropriate so that we might recall it while the client is in trance. For instance, with a subject who suffers panic attacks, it might be that during the interview we share a small laugh, and might choose to anchor this, perhaps by leaning forward and touching the client’s knee.Later, during the trance process, we might fire that anchor while having the client recall a recent panic attack, triggering a response to the experience that can help to move them past the problem. Even anchoring the problem state, so that we can access it in conjunction with other resources can be quite useful. For example, we might anchor the panic response described above, and later build an anchor for peaceful relaxation, then collapse the two anchors to help move past the problem.Thus, we can utilize pre-induction experiences as opportunities for the development of potentially useful knowledge and resources that can easily lead towards success when we do foray into more overtly hypnotic processes. Now, moving towards some of the more direct tactics, letâ⠂¬â„¢s consider the pre-talk itself. The purposes of a pre-talk are many, and certainly we should all be familiar with the most basic of these, namely to inform our subject and to develop a level of comfort with the prospect of entering a hypnotic trance.Of course, the pre-talk, when handled properly, offers other opportunities, and can actually allow us to bridge into an initial hypnotic experience. What we are discussing here is a step beyond the generic use of various hypnotic tests, but instead a more directed approach designed to do precisely what the hypnotic pre-talk is intended for, by actually using the subjects own perceptions of hypnosis to create a light experience of trance. We are essentially going to ask just what the subject imagines trance will feel like, and what they will experience that will make them certain they are entranced.In asking these questions, however, we need to direct the subject’s answers so that they are most useful. Many times, a subject wi ll answer by imagining the responses they imagine they will experience, whether it be arm levitation or some other phenomenon they may have seen performed. This is not the type of answer we are seeking; instead the goal is to direct their imagination towards the sensory experience of what they imagine trance will be like.As you might already guess, this can easily transition into a full trance experience, simply by applying some revivification type techniques, amplifying that sensation that they have already imagined. Even more  © William May. www. masterhypnoticlanguage. com significantly, you are helping to establish a set of criteria that will make them certain that what they are experiencing really is trance. So many hypnotists forget at times that trance experiences are so normal to the uninitiated, so familiar to us all, that we can easily overlook them unless we have some type of deep hypnotic phenomenon.By using this type of technique, you establish a sense of what hypnosi s will feel like, so the subject will be setting up the criteria that guarantee they will recognize trance when it happens, and in so doing will begin to experience that feeling for the first time. At this point, you might just choose to let the subject go into a deeper trance directly, by merely amplifying the experience and allowing that sensation to build until it reaches the desired depth, or you can let them come back out, knowing that when you put them ack into trance it will be even deeper. They don’t even need to recognize that this first experience is a trance, and at times you might even let them stay in a minor level of trance as you continue. Thus, you have many options for how you continue your work. Indeed, if there is one thing that pre-induction work allows, it is the development of new options you might not have considered, and it is this aspect that is most important.So many times you’ll meet a hypnotist who has a way of dealing with this problem, and a tactic for that problem, but when you begin to really explore the possibilities in the way that you can before you ever use any type of formal hypnosis, you allow yourself to learn more about what will really help this individual person. Ultimately, the goal is to discover the structure of a problem, the frames and beliefs that shape it, so that as you approach the real issue, you can do so in a way that will truly impact this subject.To offer an entertaining example, a young man of my acquaintance and I had corresponded for some time online, but had not spoken directly. When we did have our first conversation, he noted all the patterns I use in my speech, and was certain that I was trying to hypnotize him. No amount of argument on my part, or on the part of others present would dissuade him. He was convinced that my using language patterns was proof that I was hypnotizing him, and that he needed to keep his guard up or he would drop into trance.Now, this was his frame, and whene ver I argued contrary to it, he found evidence supporting his belief. So, instead of disagreeing with him, I chose to accept his belief, and said â€Å"okay, since you insist that I am already doing so, I will hypnotize you now. †  © William May. www. masterhypnoticlanguage. com His response was that he could not be hypnotized as long as he kept his guard up. At this point, my response was again to accept his frame, but to add to it, saying â€Å"yes, you have your guard up, but at some point you will relax, and these suggestions are already waiting inside your mind. Thus, the subject was given the choice to accept the suggestions now, or to do so later, and chose to go into trance straight away. While this example does deal more directly with getting a subject into trance, it points out many aspects that can offer great insight in this process. First, it reinforced how much more can be done when we do accept a subject’s beliefs. If we argue with those beliefs, we d emonstrate a lack of understanding that can strain trust within the relationship.When we accept a frame, even a negative frame, we can work to move the subject out of it, or find a way, as in this example, to make that frame useful for moving forward. Thus, it is important, when doing your initial interview with the subject, to become aware of the beliefs they hold about the issue’s being dealt with, hypnosis, and various other factors you deem relevant to the creation of a successful experience for your client. Listen to your subject closely, noting presuppositions, as well as direct statements about belief.For example, if a person makes a comment â€Å"oh, even I can do that,† it clearly illustrates a limiting belief. Often it is not in the direct statements of beliefs that we uncover the frame from which the subject is operating, but in the implications of what they say that we truly get a glimpse at the client’s belief structure. Knowing a client’s re ality, it becomes much simpler to devise a therapeutic intervention that will have success. As mentioned above, my preference is to accept that frame and work within it to create change.Often we can add conditions to that frame, as with the client who has difficulty with giving up cigarettes who acknowledges that they will have difficulty with that process. We can acknowledge that this is true, while still adding stipulations that will make it easier: â€Å"Yes, a person can have difficulty with quitting cigarettes, until they are taught the right resources for that process. † Thus, we frame that our interaction will teach the subject resources to make that quitting process easier, without conflicting the knowledge the client has of their current experience.In the end, the real truth is that we need to view the work we do with a client before formal trance as having just as much complexity (and often, just as many hypnotic components) as in the more formal aspects of  © Wil liam May. www. masterhypnoticlanguage. com our work. By recognizing the client’s resources, apprehensions, beliefs, and goals, we are far better equipped to create a positive experience for them, while, as well, we can also take advantage of the pre-induction period to frame our interaction, build resources that we will later use, and even egin the use of suggestion. We can take this even further, by creating mild trance states through informal techniques, and continuing our work with the client already beginning to experience trance as an organic response. When you truly listen to the subject, and pay attention to all the things which occur before the induction, the options that are available expand in ways you might already imagine, and your accuracy in selecting the proper course of action will increase greatly with this new found information and the flexibility it promotes.

Individual Memo Essays

Individual Memo Essays Individual Memo Essay Individual Memo Essay It allows for virtually any format for the paper rivers as well as processing government compliant CHAPS variations of the surveys that are being implemented in healthcare organizations nation-wide. The new system will provide user-centered experience and intuitive design to allow every branch of the business to operate effectively and efficiently. QPS system provides company-wide synergy and interoperability between the segments of the process from outbound production, to inbound processing to analysis and presentation of results to our clients. In order for the success of the project it is required for every business manager to undergo at least 1 0 ours of training to use the new system and to get familiar with host of new compliance policies. Stakeholders Executive Sponsors CEO CIO Users Analysts Outbound Production Inbound Production Development Project Managers Developers Objectives and Outcomes The main objective of this project is to streamline the production, processing, and analysis of medical satisfaction surveys across the company wide continuum while adhering to the government standards, privacy laws, and new compliance policies. The outcomes of this project include a accompanied roll of the new Qualifies Survey Processing System and end- seer training in order to effectively and efficiently utilize the new system to its full potential. Success Measurement Since National Research Corporation has chosen a value based approach to this project it will be measured by its efficiency, effectiveness, and ease of use. The value this new system provides to the company is measured in reduced costs of production, increased speed and volume of production, increased speed of processing, increased efficiency of processing and analysis of data, as well as increase in speed of end result delivery to our clients. The reject is aiming at impacting operational area of the company. The new system will increase effectiveness and efficiency all across the process. The new system will be faster, more dynamic and easier to use. The new process will increase the productivity by about 1 5%, processing and analysis time by 19%, end-result presentation speed by 17%. All around these numbers will have a huge impact on quality and speed of our service. This in turn will allow to increase the production and provide the ability to attain a larger number of big clients than we currently can handle.

Summary of English Essay Source With thesis †English 200 Course

Summary of English Essay Source With thesis – English 200 Course Free Online Research Papers Summary of English Essay Source With thesis English 200 Course In his article â€Å"So That Nobody Has To Go To School,† Roger Sipher blames students that have no will to learn for the declining quality of American students and the education system. As a solution to this problem, he offers the notion of abolishing all mandatory-attendance laws in order to allow students to drop out if they feel like doing so. Also, teachers would be able to dismiss students with academic or behavioral problems, much like private school teachers. Once schools are rid of students that hamper the progress of classrooms, schools would be able to focus on maintaining high standards of education, instead of babysitting. In addition, he thinks that the money saved from not having to enforce mandatory-attendance laws could be used to help out the students who drop out of school. Analysis Sipher says that economists find no benefits of mandatory-attendance laws, and schools usually don’t have enough resources to enforce these laws anyway. He implies that school officials are trying to do something about students that don’t come to school or are a hindrance to classes, resulting in shoddy education. He continues to say that without mandatory-attendance laws, school officials can dismiss students much like private schools, or students can drop out if they want to. He says we have tried long enough to deal with these types of students, and tries to support his notions with the idiom â€Å"You can lead a horse to water, but you can’t make him drink.† Sipher includes six of what he calls â€Å"enormous dividends† that we can have if we abolish compulsory attendance laws. Essentially, he wants schools to educate, and educate only- not â€Å"trying to be all things to all people.† My point of view I disagree with Sipher on his general view, because I feel all American children should be in school, or at a chance to try to go to school. He does not show evidence for the decline in test scores, which I think is an important part of education, but it’s not everything. True, that the general quality of education will probably improve, but what about the quality of the general population? Without mandatory-attendance laws, I’m sure that a good part of the students will drop out of school. Sure, the students that stayed in school will have a better education, but the general population will become mostly illiterate. His idea for using the money saved from not having to enforce attendance laws also sounds a little weird. It’s almost like a welfare program for the less apt students, and is demeaning to them. I think it’s unethical, because it makes them outcasts. Remedial classes are a lot better than that. Research Papers on Summary of English Essay Source With thesis - English 200 CourseStandardized TestingHip-Hop is ArtPersonal Experience with Teen PregnancyComparison: Letter from Birmingham and CritoPETSTEL analysis of IndiaEffects of Television Violence on ChildrenResearch Process Part One19 Century Society: A Deeply Divided EraQuebec and CanadaInfluences of Socio-Economic Status of Married Males

Discussion 8 Assignment Example | Topics and Well Written Essays - 500 words

Discussion 8 - Assignment Example This can be accomplished through a variety of incentives as well as implementing new requirements for the landscaping of any new housing development. The outright legislation of what type of plants that an individual is allowed to plant in their own yard may seem a bit draconian, especially to those that have lived in the LA area for many years. As such, a good remedy to this would be to require that any new housing developments and or landscaping projects must adhere to some minimum drought hardy requirements. Simply having a green lawn is not reason for a fine; however, if water records can substantiate that the individual is wastefully using public resources solely for beautification purposes, that individual should be forced to pay a penalty for this luxury because the aforementioned individual is taking the resources of the entire public. It is a part of the American societal norm. We are constantly shown perfect, green, beautifully manicured lawns in movies, television, advertisements, and other forms of marketing. We are told that this is what we should all ascribe to and in so doing we will be able to further delineate ourselves from the rest of the neighborhood as the person who has the best grass – as if that really matters. In the first article that was assigned, it stated that the lawn business was a several hundred billion dollar a year money making machine; as such, the firms that benefit from this infusion of money will continue to lobby and advertise and market this form of â€Å"happiness† to an unwitting public. It depends on how severe the drought is or if the water system has reached or is near reaching absolute capacity. Going so far at this juncture as tearing out non-native plants would be a bit severe especially since such a broad ranging edict would have many negative effects on the local environment including

Human resource planning and recruitment strategies Research Paper

Human resource planning and recruitment strategies - Research Paper Example Also, the flexibility changes that have been made have also been discussed. Lastly, the recruitment decisions and the changes that are made have also been included. An attempt to provide examples for each of these situations has also been made to gain a better perspective of the situation and to understand how recession has impacted the companies. Human resource planning is the process of ensuring that the right person is at the right job at the right time. According to Vetter, 1967, ‘the process by which management determines how the organization should move from its current manpower position to its desired position. Through planning, management strives to have the right number and the right kinds of people, at the right places, at the right time, doing things which result in both the organization and the individual receiving maximum long-run benefits’ (Jackson & Schuler, 1990). There have been several businesses in the current economic environment who have made several changes in the human resources being used within the company to ensure that there is no wastage of resources and better levels of cost cutting as well. In the current economic condition with the level of recession increasing steadily, there are two main view points, a) viewpoint of the employees, and their salaries, and b) viewpoint of the employers and ‘loaded’ labour costs. Two of the companies that have used the recession as a basis for lay off include, Citigroup, which has laid off a total of 52,175 people, and General Motors which lay off a total of 75,658 people (Kneale & Turchioe, 2009). The companies did so due to the increasing expenses and need for cost cutting. However in the long term the companies do not consider how much of these lay offs could cost them. In the hustle bustle of reducing the costs, the companies, i.e. Citigroup and General Motors have also laid off several good employees who bring the company a high level of profit. In the long run this could prove to

What explains today's high degree of global financial integration Essay

What explains today's high degree of global financial integration - Essay Example lobal integration in the financial market has given the opportunities to the investors to diversify the risks and to access the financial products in a more easy way. (Agarwal, n.d.) The functionalities of the process of globalization has been motivated by heterogeneous factors, such as gradual increase of trade in goods and services, increase of free movement of capital across international borders, increase of international mobility of labor and increase of global technological transfers. The impact of international movement of capital and global financial integration on the developing countries experienced a dramatic change in the early 1990s with the enhancement of financial deregulation in many countries. (Wolf 2005) This is the period when the free capital movement from the developed and industrial nations to the developing nations had started to rise vividly which was seen through the increase in growth of the developing nations. However, during this era the globe has also seen a sequence of financial crises across many countries. In one hand many developed countries faced the financial crises, such as the 1992 and 1993 financial crises of the developed c ountries in the European Exchange Rate Mechanism (ERM). On the other hand the developing nations also faced such crises, like the Mexican Tequila crisis in 1995, 1997 and 1998 Asian crises, the Latin American and the Russian crises from 1998 to 2000 etc. All these crises that were seen throughout different part of the globe gradually proved that there lies an inherent risk of the international financial integration behind its benefit. The international financial integration through the opening of the cross border financial markets is a multifarious phenomenon that involves in unrestricting the movement of foreign direct investment (FDI) from the developed countries to the developing countries and pulling up the regulations from both the short term and long term financial instruments which are responsible

Social and Personal Related Factors Influencing Teenage Pregnancy Essay Example for Free

Social and Personal Related Factors Influencing Teenage Pregnancy Essay Introduction Teenage pregnancy or adolescent pregnancy is the early conception of female whose age ranges from 13 to 19. Just recently, adolescent has become an important issue in health in great number of countries, both developed and developing. However, pregnancy in adolescence is not an unusual phenomenon as it keeps on rising every now and then. There are lots of speculations about which factors triggers pregnancy the most. Some of these factors were deemed to be poverty, socioeconomic factors, educational attainment etc. Actually, a family with history of teenage birth is considered as one of the factor that influences teenage pregnancy. Teen female with family history of teenage births are significantly more likely to experience teenage pregnancy (East, et.al 2007). Childhood history of sexual abuse has also been taking in place as a factor of having early pregnancy. This factor increases the risk of teen women for subsequent adolescent pregnancy and that addressing conditions associated with childhood sexual abuse might impact the overall pregnancy rate (Noll, et.al. 2009). Somehow, even non expected factors such as childhood bullying were deemed to contribute for teen to have early pregnancy. Childhood bullying tends to have negative effect on the childhood of teen females. In fact, both bullies and victims had high risk of becoming teenage mothers regardless of the family-related risk factors. Reports of bullying and victimization from the girls themselves, their parents and their teacher were associated with becoming teenage mother independently of each other. Therefore, there is a predictive association between being a bully in childhood and becoming a mother in adolescence and it may be useful to target bullies for teenage pregnancy prevention (Lehti, et.al 2010). Conclusively, there are lots of factors which are deemed to influence teenage pregnancy and it is still a mystery that which factors we should consider above them all thus awareness could be given to those who will need it mostly. The aim of the study is to determine whether which of the social-related or personal-related factors greatly influences teenage pregnancy. Thus, when the study have determined and relay the results this could serve as a basis or guidelines for women to avoid early pregnancy. While for the parents of female teenager this will enable them to know of what aspect should they consider to avoid this teen pregnancy from happening and even for nurses, to conduct health teaching and public awareness that teenage pregnancy can always be prevented just as long as the action plan includes proven data and has the real factors that might lead teenagers to this unwanted and early pregnancy. Significance of the Study The study is deemed to be relevant in nursing profession and for the community in establishing a link between rendering care for the community both in Public and Private setting. The result aims to determine or to discover which among the following factors influences the teen women to be pregnant the most. The study is believed to benefit the following.

Cultural Competency of Nurses

Cultural Competency of Nurses 1.1 Cultural competency The commitment to equality in health care provision is ingrained within the core values of the health care profession and nurses are expected to fulfill these requirements. The Nursing and Midwifery Councils (NMC) Code of Professional Conduct clearly states that nurses must treat every patient as individual, respect their dignity and not to discriminate irrespective of age, ethnicity or cultural background (Husband and Torry 2004a). The NMC (2004) emphasises that culturally competent care is moral and legal requirement for nurses. Thus the requirement for the development of cultural competence is to be found within the NMC code of conduct. Josipovic (2000) points out that the delivery of individualised care, in consideration of religious and cultural requirements of Black and Ethnic Minorities (BME) patients can assist nurses to fulfill their obligations. However, there is no universal definition of cultural competence; Campinha-Bacote (2002) defines cultural competence as a process, which requires the health care professional to continuously attempt to gain the ability to work competently with the cultural context of the patient. Nevertheless Papadopoulas et. al. (1998) defines cultural competence as the ability to give effective care while taking into account patients specific cultural needs, behaviors and beliefs. Narayata definition Nonetheless, there has been significant discussion of different models of cultural competence in nursing literature (Gunaratnam, 2007). Campinha-Bacote (1998) model of cultural competence: the process of cultural competence in the delivery of health care service, identifies five essential constructor of cultural competence: Cultural awareness Cultural knowledge Cultural skill Culturally encounter Culturally desire Conversely the Papadopoulas et. al. (1998) model of developing cultural competence consists of four stages: Cultural awareness, Cultural knowledge, Cultural sensitivity and Cultural competent. Rosenjack Burchum (2002) identified the attributes of cultural competence as same as those of Papadopolos et al (1998) but adds cultural understanding, and cultural skill as essential attributes. Cultural competence is, according to Rosenjack Burchum (2002), the development of knowledge and skill manifested by the synthesis of the above attributes and their respective dimensions in human interaction. Although there is distinction in the models of cultural competence they all express common concern of three main components: cultural sensitivity, cultural knowledge and cultural skills (Gogwin et al. 2001). According to Garity (2000) cultural competence involves having understanding and sensitivity toward different cultural groups and factors that affect their lives such as immigration, discrimination and the possibility for these factors to improve or inhibit professional practice. Hence, for a nurse to become cultural competent s/he needs to develop an understanding of ones own cultural needs, views, beliefs, behavior and those of the patient while avoiding stereotyping and generalisation (http://www.culturediversity.org/cultcomp.htm). The aim is to ensure that the health care services and professionals are respectful and responsive to the health beliefs, practices, cultural and linguistic needs of diverse patients, which can help bring about positive health outcome (http://minori tyhealth.hhs.gov/templates/browse.aspx?lvl=2lvl). Cultural competency is a process that needs to be continuously developed in order to enhance ones ability to give affective health care (Papadopoulos 2006). All registered nurses have the responsibility to competently maintain professional knowledge and practice by ensuring up to date knowledge, skill and ability as well as safe and effective practice (NMC2008). Although the NMC clearly places the individual with the responsibility of developing cultural competence, it should be acknowledged that individuals alone cannot be held responsible for the delivery of culturally safe and competent health care service if insufficient resources are not made available (Husband and Torry, 2004a). Nonetheless, Dreher and MacNaughton (2002) described cultural competence as the same as nursing competence; the ability to deliver care individualised and therapeutic to each patient despite social context or cultural background, this being the signature of contemporary nursing. However, the basic principle of providing nursing care to culturally diverse populations is not an entirely new idea, as the need for such was recognised in the United States in the late 1800s (Davis, 1996) and was also recognized by Florence Nightingale when advising British nurses working in India (Wilkins, 1993). In the last century, most western countries saw significant changes in the make up of their populations due to increased trends in global migration that resulted in multiethnic and multi-religious societies. In the UK BME groups make up 7.9 % of the total population (Office for National Statistics, 2001). As the population becomes more diverse so does the complexity of the patients needs that the nurse must address (Black, 2008). Thus far, the need for the nurses to become culturally competent has become import (Black, 2008, Gunaratnam, 2007).The pertinent literature highlights that, in the last few decades, scholars and researchers have debated the issue relating to the delivery of appropriate nursing care to meet the needs of BME groups (refs). There is a growing body of evidence that show there are inadequacies in the nursing care provided to these groups (Vydelingum, 2006, Cortis, 2004) and concerns about ethnic disparities in health in the UK (Aspinall and Jacboson, 2004). Studi es on utilisation of hospital services by BME patients, in particular the elderly have consistently demonstrated level of dissatisfaction with the care provided from cultural and/or religious viewpoints (DoH, 2009; Clegg, 2003; Patel, 2001; Cortis, 2000, Vydelingum 2000) 1.2 BME Elders Nevertheless, the concept of the ageing population is one that has generated much discussion in the UK (Caldwell et al, 2008) as this age group is the main users of both health and social care services (Department of Health, 2001). While all older people have common needs and experiences of hospitals, the needs and experiences of the BME older people are shaped by their race and ethnicity (Ahmad, 1993; Blakemore and Boneham, 1994). Majority of todays BME elders are yesterdays young migrants from the commonwealth countries (Patel, 2001), who came to the UK during the 20th century as a result of government policy to fill labour shortage (Houston and Cowley, 2002). According to Evandrou, (2006) in 2001 4% of the BME population were over 65 and this number is rapidly rising, from approximately 60 000 in 1981 to about 360 000 in 2001-2002 (Butt and ONeil, 2004, Beaven, 2006) and is expected to increase in the next 15 years (Evandrou, 2000). These elderly groups have particularly been disadvantaged by the cumulative effect of age, race and inaccessibility to services (Norman, 1985). However, newly arrived migrants are likely to share similar concerns and experience in hospital care (Patel, 2001). The 2001 and earlier censuses show that health disparities exist in the UK and that levels of long term illness are higher in older BME groups than in the general population (From A Szczepura 2005).Older people from BME are report more chronic illnesses such as cardio-vascular disease, diabetes, hypertension and stroke when compared to the majority (Tilke, 1998; Ebrahim, 1999; Evandrou, 2000b). An appreciation of the health care needs of this group is vital in understanding the difficulties they face in accessing health care services (Toofany, 2007). One occurring theme connected with old age and ethnicity that has been repeatedly identified from the1980s until today is the lack of urgency over government action for the group (Norman, 1985, Patel, 1990, Lindesay, 1997, Patel, 2001). The Policy Research Institution on Aging and Ethnicity (PRIAE) highlights that these groups are not normally considered in old age research (Patel, 2003). Hoong Sin, (2003) points out that BME older people in the UK are disadvantaged by the lack of a reliable sampling frame. Although there are few national studies, most research projects are small and involve localised samples (Hoong Sin 2003). Therefore the infrastructure for doing research with such population groups is inadequately set up (Hoon Sin, 2003). In PRIAEs view we have had too much discussion, action is overdue (Patel, 2001). This information suggests that BME elderly groups have never been a priority on the agenda for research or policy makers in the health care services. Saleh (2009) su ggests that the introduction of the Race Relations (Amendment) Act 2000 increased pressure on health care organisations to adapt services to ensure equitable access for local all BME groups. On the other hand, Department of Health (DoH) ensures that reducing health disadvantage and social exclusion for BME elders is central to UK health and social policy (DoH, 2001b). The DoH made specific commitments, in the National Standards, Local Action, to improve quality of service for BME where they are disadvantaged in terms of health (refs). This approach according to Papadopoulos et al. (2006) is a sign that the NHS is undergoing modernization. Unfortunately, the last two National Patient Survey Programme reports (2008 2009) show the experiences of all BME groups (with the exception of those from the Irish community) are significantly less likely to be positive than those of the indigenous populations. From a nursing aspect this outcome questions the nurses competence in delivering culturally appropriate care. The literature available identifies cultural competency as one of the main factor that can help cease the inequalities in health care system (refs). According to Papadopoulos et al. (1999) although mention of the term cultural competence in DoH and National Health Services (NHS) documents has increased, there is no attention to what this actually means for patients or nurses and how it could be measured. Having and implementing clear, strong policies on race and equality is essential for health and social care organisations but this has to be supported with training and education (PRIAE, 2005). Consequently, Dreher and MacNaughton (2002) doubted whether cultural knowledge translated into culturally specific care would necessarily result in improved clinical outcomes or the reduction of health disparities. 2. The review Aim and Research Strategies 2.1 Aim Nurses are at the front line of care for BME older people in hospital therefore it is important that the care delivered is in line with what is viewed as appropriate by the patients to their needs. The Department of Health openly acknowledges that much remains to be done in terms of measuring older patients experiences of the process of care, respect, dignity, information and education (Shaw and Wilson, 2008). This review, therefore, intends to bring together the literature concerning nurses views of what is essential in delivering culturally appropriate care to BME older patients as well as this groups expectations and experiences of nursing care. The aim is to explore the cultural competency of nurses in caring for BME elderly patients in Hospital setting. 2.2 Search Strategy (Include: inclusion/exclusion criteria, databases searched, keywords, languages and inclusive dates of the literature searched.) Search Term Search was carried out using combination of keywords such as Nurses, Cultural Competence/Awareness/Sensitivity, Geriatric, Elderly/Older, Black and Minority Ethnic and Experiences/Views. Furthermore, concepts relevant to hospital care such as Dignity, Respect and Appropriate Care were searched in combination with the above key terms. Databases The electronic databases British Nursing Index, PsycINFO, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Assia and Cochrane Library were searched to identify peer-reviewed literature published in the English language between 1990 and 2010 that are UK based. The databases yielded XXX potential studies relevant to the topic under review. Further search was conducted in the World Wide Web using the same key words and it produced xxx studies. The websites of the Department of Health, Transcultural Nursing Society, Royal Collage of Nursing and relevant Third Sector Organisations such as Age Concern, and PRIAE were also accessed which yielded XXX literature. Further literature was gained from the reference and the bibliography of the gathered data as well as the library of the University. The titles and abstracts of the obtained literature were examined and studies focusing on care provided by nurses to BME elderly patients as well as studies examining the views/experiences of hospital care by this particular geriatric group were selected. For the purpose of the literature review an older person is defined as person older than 50 years. NSF considers an older person as a person who is over the age of 50 years. Yet, a limited numbers of studies (how many) about BME elders in hospital setting were identified. For this reason studies focusing on the topic that had a wide range of age sample group i.e. 30-80 were included as it would assist in identifying additional pertinent literature. In total, XX studies were identified to meet the inclusion criteria for the literature review. The literature selected were mainly primary empirical studies using qualitative approach. A qualitative research aims to understand the feelings, values, and perceptions that under lie and influence behavior (xxxx). Therefore the use of a qualitative methodology is seen to be appropriate as all the studies examine the experiences of the BME patients through their own eyes and those of the nurses (from internet). 2.3 Critical Appraisal of Three Qualitative Studies on the Experiences of Nurses in Caring for BME Patients and BME patients Experiences of Nursing Care Cortis (2004) Meeting the Needs of Minority Ethnic Patients Clegg (2003) Older South Asian patients and Care Perceptions of Culturally Sensitive Care In a Community Hospital Setting Hamilton and Essat (2008) Minority Ethnic Users Experiences and Expectations of Nursing Using Caldwells frameworks for critiquing health research, the three above stated studies will be analyzed systematically and supporting/contradicting evidence from other studies will be offered. WHY USE THIS FRAME WORK? Following the discussion of the review themes will be identified. Title Although the title of the study of Cortis is brief and conveys the nature of the study (Polit and Beck, 2010), it could be viewed as misleading as it gave the impression that the sample group was representative of different communities of BME groups. However, the study specifically focuses on the Pakistani ethnic community. Conversely, the titles of the researches by Clegg (2003) and Hamilton and Essat (2008) are short, accurate and clearly specifies what and who is being studied while reflecting the study content (Burns, 2000). The Researchers Academic and Professional Qualification The authors of the three researches have particular interest about the topic in question, which gives the assumption that they are familiar or have professional insights. The qualification (PhD, MsC) of the researchers is relevant as it indicates that they are competent and have creditability to carry out researches. Further evidence to support researchers knowledge and interest of the topic was demonstrated as they are all nurses with extensive experience; Cortis is a senior lecturer at the University of Leeds with Qualitative Research interest in ethnicity and BME issues. Clegg is a consultant in older peoples services and intermediate care at Leeds Teaching Hospital NHS Trust. Hamilton was a principal lecturer at De Montfort University with research interests in multi-ethnic care and Essat was research assistant at the same university working on a project exploring the educational preparation of student nurses to work in a culturally diverse way. Abstract and Rationale A qualitative study must offer an abstract containing summary of study aim/objectives, research approach, methods adapted and the result of the study including the clinical applications (Cormack, 1996). Bellow the abstract there should be key words related to the study offering the reader an overview of the research question. All studies have offered a comprehensive abstract with key words relevant to their topics. Clear rationale for undertaking the study was given by all researchers; Cortis rationale was the fact that there is little exploration of nurses experiences of caring for specific BME community while Cleggs rationale was that there is a lack of research defining the concept of cultural sensitive care from patient/care perspective. Lastly, the rationale provided by Hamilton and Asset is that, nationally, there is an evidence to suggest that care provided doesnt always meet the needs of BME patients. LR All three researchers did review pertinent literature (classics up to date), which was evident in the studies as well as the reference list. According to Doordan (1999) the literature offered should have discussed and critically reviewed related literature to find out what questions remains to be answered. Nevertheless, only Clegg (2003) provided a separate section for LR, which she must be praised for (Morse, 1994). In grounded theory studies, researchers start with data collection first and as the data is analysed and as the theory takes shape researchers then begin to search the literature in order to link it to the emerging theory (Polit and Beck, 2010), which was evident in Cleggs study. Aim The three studies clearly identify and justify their aims. Cortiss (2004) argues that in a number of studies BME are seen as homogeneous therefore the aim of his study is to investigate a specific communitys uniqueness: the experiences of nurses caring for Pakistani patients in north England. However, this aim is inconsistence with the title of study, which clearly treats BME as a homogeneously. WHAT DOES THIS MEAN? While the aim of the Clegg (2003), was to identify older south Asian patients and carers perception of culturally sensitive care. Lastly, the aim of the research by Hamilton and Asset (2008) was to give the minority ethnic groups the opportunity to voice their opinions on nursing care and to inform future nursing education. Ethical Issues Both Cortis and Clegg clearly highlight that permission to do the study was sought from the Local Research Ethics Committee (LREC), which is an imperative step before conducting any research. However, Hamilton and Essat (2008) omit to mention whether appropriate approval was gained from LRECs; who exist to examine proposed research projects in order to guard peoples rights and interests (Cormack, 2000). All the researchers have to be praised for specifying the process and purpose of the study was explained to the participants before the study in order to obtain informed consent. Cortis (2004) clearly specifies that assurance was given to maintain confidentiality and anonymity of the sample group, which is something Hamilton and Essat (2008) fail to address in their study. Both Cortis and Hamilton Asset dont comment on the associated ethical issues of autonomy, non-maleficience and beneficence, (Cormack, 20000). Nevertheless, Clegg considered the vulnerability of the participants (Gerrish and Lacey 2006, Speziale and Carpenter 2007) and therefore committed to the ethical principles of autonomy, non-maleficience and beneficence (RCN, 2004), but fails to mention how confidentiality and anonymity was maintained. Clegg showed sensitivity towards the participants by informing them the voluntary nature of the research with the option of being able to withdraw at any time. This implies a non-coerciveness approach which was important in this study as this was vulnerable group. Conversely, The three studies inform that permission was sought from the participant to audio-tape the interviews but omit to identify where data was stored and the disposal procedure used (Polit and Beck, 2008). This supports the premise that data used for a particular project should not be used for another without consent (Gerrish and Lacey, 2006). Methodological Both Cortis and Hamilton Essat (2008) fail to specify that the method used was phenomenological-exploratory, which is useful when studying individuals lived experiences (Crookes and Davies, 1998). The main methodological strength of using phenomenological in these studies is that it is an inductive and holistic approach that looks at what occurs within (Crookes and Davies, 1998). Both of the studies focus was on the unique experiences of providing care by nurses to BME patients and perception of BME older patient views/expectations of nursing care. The biggest methodological limitation for using phenomenological in these studies is that it is labour intensive and time consuming for the researchers in terms of data collection and analysis (Crookes and Davies, 1998). Clegg, on the other hand, identifies the methodology utilized as grounded theory, which is useful when studying individuals XXXX (GG). Methodological strength associated with the use of this approach in this study is xxxx x. Methodological weakness associated with the use of this approach in this study is The three studies clearly identify the major concepts of the design used and their concepts, which are what? Sampling Technique and method According to Polit and Beck, (2010) in qualitative research there is no rule for sample size as long as data saturation achieved. The sample number (n=30) used by Cortis was considered to be suitable for qualitative research (Cormack 1999) why? However, the sample number by Clegg was four patients and three relatives. Clegg states in her study that she is not sure if data saturation has been achieved. Morse (2000 in polit and beck book) suggests that number of participants required to reach saturation is a firmed by number of factors, such as the wider the research question the more participants necessary. This gives the impression that the sample size could have been too small for the scope of the research question hence why saturation was not reached (Morse 2000) possibly due to time or budget constraints (ref). Sampling number for Hamilton and Essat: six focus groups, member of which range from 8 to 15 (? large sample number for qualitative). All three researches state how many participants were recruited and from where; areas with high population of BME. Cortis participants were recruited from a large acute hospital in north England and Clegg recruited this sample from a two community Hospital inner city and Hamilton and Essat recruited their sample of 6 diverse BME communities groups. The researchers must be praised for providing a clear indication of inclusive/exclusive criteria, in the process of recruiting participants. In contrast the three studies fail to identify the sampling methods and techniques used but inferred from the research studies is that non-probability method of purposive sampling was employed (Cormack, 1996). The method of purposive/judgmental sampling relies on the belief that researcher have enough knowledge about the population to be able to pick sample members (Polit and Bechk, 2010). The main strength associated with the use of purposive sampling in these studies is that the researchers purposively choose the participants knowing they would give relevant information about the topic in question (Polit and Beck, 2008). However, one main limitation is that this technique relies upon the researchers knowledge of cultural competence of nurses (Polit and Beck, 2008). Method of Data Collection All researchers collected data by audio taping interview and transcription. Cortis, Clegg and Hamilton Assset adapted different types qualitative self-reporting technique, which is flexible in gathering self-reported information as it allows the participants to express their views in a naturalistic way (Polit and Beck, 2008). Data collection is described by Cortis as semi-structured interviews and supplementary questions to follow-up for clarification. Cortis informs that most interviews were done in the clinical area; implying that participant had choice of venue, which he must be commend for. However, he omits to state where the rest of the interviews were done. WHY IS VITAL TO GIVE PARTICIPANTS CHOICE OF VENUE? Nevertheless, Cleggs choice of data collection was unstructured interview that were done in the first language of the interviewee. Cross validation of the taped interviews was under taken by a second linguist. Both Cortis and Clegg fail to point out who/how many people performed the interview. Interview performed by one person provides uniformity and consistency (Denscombe, 2003). On the contrary, method of data collection used by Hamilton and Essat was focus group, which was sub-divided into 6 groups where each group had facilitator. The advantage with use of this method in this study is it can generate a lot of dialogue but the disadvantage is that not everyone is comfortable experiences their experiences/view in front of others (Polit and Beck, 2010). Overall, an advantage associated with the use of all interview technique utilized is that the interviewer can observe the participants non-verbal responses, which can provide valuable information (Burns 2000). Some of the main methodological limitation with the use of this method in these studies is that it was done in face to face, which could jeopardize the participants anonymity since they were identifiable for the interviewer (Cormack, 1996). Method of Data Analysis All the researches used thematic content analysis, which is creditable method of data collection (xxxx). Only Hamilton and Asset clearly stated the method used and who analysed the data: two members of the team. What does this mean for the research? Cortis transcribed the interviews himself to became personally immersed in the information. What does this mean for the research? Clegg points out that Micro-analysis of the data were used to identify categories but fail to say who analysed data. Having different people conducting the interview and the analysis of the texts can have an impact on the richness of the analysis performed (Strauss and Corbin, 1998). Nonetheless, steps were taken by all researchers to uphold the rigour of the interpretation by checking the transcript with the participants to ensure correctness, which gave the data conformability and credibility (Forchuk and Roberts, 1993). They also must be praised for indicating that the data was analysed systematically in several steps. However, they all fail to state the type of qualitative software used to categorise the information i.e. Ethnograph and if it was positive or negative to the analysis (Barnard, 1991). (Clegg: Triangulation was introduced into the process of data analysis, which was carried out by a colleague from India). The methodological strength linked to the utilisation of this thematic content analysis in these studies is that it is commonly used in qualitative research and is suitable the three study aims. Limitation would be this analysis includes gathering statements on the bases of similarity and frequency with the aim of making them to themes (Barnard, 1991). It could be argued that by doing so the researchers are using a quantities method of analysis for qualitative data as each data is not being treated uniquely (Barnard, 1991). Study Results The three studies identified themes based on the participants experience which implies themes were not based on presumption authors (Cormack, 1996). Each studies result relate to its aim, which they must be praised for. The finding of each study uses the participants precise statement from the interview, which demonstrates analytical points and allows the reader to hear the voices of the participants. This demonstrates conformability and credibility (Burns, 2000) and lets the reader to get in-depth understanding of topics in discussion (Morse1196). Hamilton and Essats results highlight the view held by BME groups regarding nursing communitys lack of knowledge of cultural and religious beliefs. Cortiss findings agree with this as majority of the nurse participants did not deem that the provision of care was affected by culture and spirituality/religion was viewed narrowly by identifying the need for patients to perform prayers with no lack of recognition of other religious requirements. Participants in Cleggs study described the fundamental importance of religion and its effect on health and hospitalization. Other references re culture and religion to be added. All three studies highlighted communicational problem between patients and nurses, which as an issue hinders the development of relationship. However, problems in this area have been covered in many other studies such as (add referennces)à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. And proposals and provisions to address them have been made by the DoH in order to reduce health inequalities (reference). Study Discussion All researchers offer a comprehensive discussion of their topics while comparing and contrasting their results relating to themes with other similar literature, which puts their finding in context making it more objective (Meltzoff, 1998). However, only Clegg specifies the study limitation which was the sample size- a larger sample size would have enhanced the probability of reaching saturation and increase the importance of the finding. Conclusion The three studies offer comprehensive conclusions which summarises the main results while suggesting area of further research or implementation. Cortis suggests that holism needs further conceptualization as his study highlighted nurses understanding of culture as part of holistic care was superficial, which presents a challenge for educators, nursing management, researchers and nursing practice in general. Clegg suggested further research needs to be carried out in order to define the nature of culturally sensitive services. She also points out that nurses understanding of culture and cultural sensitivity needs clarification. Hamilton and Asset suggests that nursing education must ensure that nurses initial training and post training education prepares them to become culturally understanding and sensitive. It could be argued that these three studies make useful recommendation for practice for nurses working with BME patients, which are based on education and research on cultural sensitivity. The three studies suggests that nurses are not culturally competent as required by professional bodies and the Government (English National Board for Nursing and Midwifery and Health Visiting 1997, DoH, 1997, United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1999, Quality Assurence Agency 2001). Cortis (2004) conducted a phenomenological study investigating the experiences of 30 registered nurses who had nursed Pakistani patients in a large acute hospital in north England within the last three months. Semi-structure interviews and supplementary questions to follow up were the main method of da