The Secret Life of Bees - Discussion Questions

Sue Monk Kidds debut novel, ​The Secret Life of Bees, is a coming-of-age story about feminine spirituality, racial tension, and maneuvering through love, loss, and change. The Secret Life of Bees is a great choice for womens book clubs and has the potential to promote lively discussions. Use these book club discussion questions to guide your group through Sue Monk Kidds touching tale. The Best Book Club Questions for  The Secret Life of Bees Spoiler Warning: These questions may reveal important details about The Secret Life of Bees. Finish the book before reading on. How would you describe Lilys feelings about her mother? Did they change throughout the novel? How did hearing that her mother left her to affect her perception of her mother?Do you believe T-Rays account of what happened when Lilys mother died?Did your opinion of T-Ray change when August told Lily about how much he used to love her mother? Does Deborahs abandonment explain or excuse T-Ray?Do you agree with Lily that people would rather die than forgive? Does she forgive her mother? T-Ray? Herself?What do the bees mean to the story? What is the secret life of bees?Do you think race was portrayed realistically in The Secret Life of Bees? What do you think Sue Monk Kidd was saying about race in this novel?Why did Rosaleen spit on the mens shoes? What are the ways the characters in the novel confront injustice? How do you think we should deal with injustice? Do these kinds of prejudices still exist today?What was your reaction to Lilys relationship with Zach? What do you think happened t o them in the future?Talk about the sisters. Who was your favorite? Do we all need a wailing wall, like May? Why do you think June was cold toward Lily? How would you describe August?What role did the Black Madonna play in their community? What do you think about the legend of the Black Madonna?Rate The Secret Life of Bees on a scale of 1 to 5.

Theme Of Sin In King Lear - 782 Words

â€Å"Sin is a matter of opinion. Sins are only sins if you are hurting other people.† (Corey Taylor). The seven deadly sins (Lust, Gluttony, Greed, Sloth, Wrath, Envy, Pride) are often examined by authors in attempt to inspect the nature of man. As we know â€Å"Man is a born sinner†, hence while considering Shakespeare’s King Lear play the characters were seen committing four sins i.e. greed which led to destruction, wrath which led to anger, pride led to disgrace and envy led to hatred. These four sins, when expressed, are the facilitators of devastation for characters in King Lear. Body1 greed To begin, first deadly sin is the sin of greed, that is evident in the character of Edmund, the rogue son, of the Duke of Gloucester. In fact, it is his†¦show more content†¦Thus, it becomes obvious that Edmund wanted not only the estate of his father, Gloucester, but wanted to gain control on both the estate of Cornwall and Albany, and had hopes of the entire kingdom itself. All of which he believed he was due even though he was nothing but a â€Å"bastard† and hence in his mind he knew that he was not entitled to the riches of his father (King Lear I.ii.10). PRIDE Secondly, the sin of pride is noticeable within this Shakespeare’s classic and is the stimulus to the characters eventual downfall. Once Regan and Goneril took complete authority over the kingdom, they stopped listening to their father’s orders and began to rule under no dominion. â€Å"Tis his own blame; hath put himself from rest, and must needs taste his folly† (King Lear 2.iv.287-288). This citation explains that the sisters believe that the King should get what he deserves for all the foolish actions he did. Their arrogance took over and they were inclined to break all family ties to be on top. In addition to that, the two sisters both pursued Edmund, even after knowing that the opposite sister also wanted to be with him. It became a rivalry that took a turn for the worst. As an outcome of the power trip and self-proclamation of pride, Goneril poisoned Regan and ended up committing suicide for all the complications she had caused and theShow MoreRelatedEssa y about The Theme of Justice in King Lear1682 Words   |  7 PagesThe Theme of Justice in King Lear      Ã‚  Ã‚  Ã‚   Many themes are evident in King Lear, but perhaps one of the most prevalent relates to the theme of justice.   Shakespeare has developed a tragedy that allows us to see mans decent into chaos.   Although Lear is perceived as a man more sinned against than sinning (p.62), the treatment of the main characters encourages the reader to reflect on the presence or lack of justice in this world.   The characters also vary in their inclinationRead MoreHuman Suffering in Inferno and King Lear Essay example1555 Words   |  7 PagesBoth Shakespeare’s King Lear and Dante’s Inferno explore the reasons for, and results of, human suffering. Each work postulates that human suffering comes as a result of choices that are made: A statement that is not only applicable to the characters in each of the works, but also to the readers. The Inferno and King Lear speak universal truths about the human condition: that suffering is inevitable and unavoidable. While both King Lear and the Inferno concentrate on admonitions and lamentationsRead MoreKing Lear: Themes Essay1613 Words   |  7 PagesKing Lear: Themes Many themes are evident in King Lear, but perhaps one of the most prevalent relates to the theme of justice. Shakespeare has developed a tragedy that allows us to see mans decent into chaos. Although Lear is perceived as a man more sinned against than sinning (p.62), the treatment of the main characters encourages the reader to reflect on the presence or lack of justice in this world. The characters also vary in their inclination to view the world from either a fatalisticRead MoreWilliam Shakespeare s King Lear1480 Words   |  6 PagesWilliam Shakespeare wrote the play of â€Å"King Lear† in 1986. This is a typical play of human coarseness and vengeance. The play challenges the audience through the contradiction of the goodness and primordial evil of a man. Many characters in this play demonstrate the tendencies of virtuous or vicious throughout the play. There are many themes in the play, but the most prevailing relates to the subject of justice. Shakespeare demonstrates this thematic deception of themes through instances of legal, divineRead MoreWilliam Shakespeares King Lear Essays1856 Words   |  8 PagesShakespeares King Lear A man more sinned against than sinning King Lear is one of Shakespeares more complex plays and within it many different themes are addressed and explored. King Lear is the somewhatRead MoreI Am a Man More Sinned Against Than Sinning. to What Extent Does the Character King Lear Suffer Out of All Proportions to His Initial Transgressions?1503 Words   |  7 Pagesextent does the character King Lear suffer out of all proportions to his initial transgressions? There would be two different opinions on whether or not King Lear deserved what had happened to him. First, I think I should mention the ways that King Lear suffered. There were evident levels of emotional and physical suffering. From an emotional perspective, Lear discovers that he is hated by his own daughters, which would be a terrible experience for a father. Not only is Lear hated by Goneril and ReganRead MoreA an More Sinned Against Than Sinning1811 Words   |  8 Pageswith this statement? King Lear is one of Shakespeares more complex plays and within it many different themes are addressed and explored. King Lear is the somewhat unfortunate vehicle that Shakespeare uses to explore many of these themes creating a complex character including the roles of a father, king, friend and adversary. As Lear is not a simple character he cannot simply be classed as all good or bad; it can be argued he is a bad father and king but does that make Lear a bad man? Does he deserveRead MoreLiterary Analysis Of William Shakespeare s Macbeth And King Lear1605 Words   |  7 Pagestragic parallels in two of his tragic plays, Macbeth and King Lear, which have both gone down as literary picassos. In both plays, themes of madness and injustice are clearly presented, along with containing parallel ideas about scheming, hypocrisy, and abuses of power. Likewise, female deception is also very apparent in both of the works plot, only adding to the idea of madness that both plays are trying to portray to their readers. In King Lear, his daughters Regan and Gonoril deceptively lie to himRead MoreThe Significance of Death and Sex to William Shakespeare1482 Words   |  6 PagesSignificance of Death and Sex to William Shakespeare In this essay, I will consider Death and Sin in Shakespearean drama and I would like to look at three of Shakespeares tragic plays: Hamlet, Othello and King Lear. Shakespeare uses many themes in all his play that attract audiences throughout history. The things he wrote about are as relevant now as they were in his time. Death and Sin were issues that are always around. In his plays, Shakespeare could comment on these things and makeRead MoreEssay on King Lear is a Christian Play About a Pagan World1184 Words   |  5 PagesKing Lear is a Christian Play About a Pagan World It is evident that King Lear contains references to both the Christian and Pagan doctrine. However, they seem to be expressed in entirely different styles. King Lear is purposefully set in a pre Christian era with numerous references to classical Gods but conversely there appears to be a striking resonance of Christian theology throughout the play. These echoes appear in various forms including the idea of Edgar being

Moral Reflection Free Essays

Everyday in our lives we are forced into making moral decisions about anything under the sun. There are situations that make such process difficult, and there are situations where the answer appears to be just right in front of our faces. I believe it would be difficult for anyone to decide on any ethical dilemma if he has no clear idea of morality. We will write a custom essay sample on Moral Reflection or any similar topic only for you Order Now Personally, I am aware that of at least two ethical principles that guide me in my everyday ethical decision-making. These are utilitarianism and Kantian moral philosophy. utilitarianism holds that a person’s action would be considered morally right if it tends to promote happiness for the greatest number of people. Thus, utilitarianism as a moral philosophy places emphasis on the consequences of human action, rather than on the motives behind such action (West). On the other hand, Kantian moral philosophy, or more popularly known as the categorical imperative, is based on notions of obligation, necessity and reason. Kant believed that morality consists in the choosing and doing proper conduct, and the proper action is dictated solely by rational considerations. Thus, Kant holds that subjective considerations, including emotions, should not be considered in moral decision-making (The Internet Encyclopedia of Philosophy). I believe in both these theories and I use them both when I decide everyday ethical dilemmas. There are times when. I believe purely rational considerations should prevail, but there are times that I also consider subjective factors like emotions. I believe that both theories guide my actions and decisions, and both allow me to weigh various considerations in my mind. Nevertheless, I believe that Kant’s method in determining the right conduct is a better decision-making process, because Kant provded clear criteria for choosing. Kant provided this rule, thus: â€Å"So act, that the rule on which thou actest would admit of being adopted as a law   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   by all rational beings. (Kant).† This rule is easier to follow since it does not fluctuate depending on my mood or subjective predilection, which could change in any day. It serves as a â€Å"true north,† which teaches all men how to think and decide moral dilemmas. One moral issue that deeply concerns me is euthanasia, or mercy killing. Euthanasia is defined as an act characterized by â€Å"the intentional ending of a patient’s life by a physician, usually by lethal injection (Religion Facts).†Ã‚   Euthanasia is always being raised as an option where a person is with a terminal illness and slim chances of recovering. It is an important issue for me because I could easily imagine myself in the position of the sick person’s family, and I could imagine subjective feelings that would dictate either euthanasia or maintaining life support. In these kinds of situations, utilitarianism could support either position, as the decision would depend on the consequences of an action. On the other hand, Kantian philosophy could provide a more definitive answer, but such answer would definitely not consider emotions, because these are subjective factors that are not based on reason. Works Cited Kant, I. The Metaphysics of Ethics. 1886. MacDonald, Chris. â€Å"Moral Decision Making — An Analysis.† 2002. 14 Feb. 2008.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   http://www.ethicsweb.ca/guide/moral-decision.html. Religion Facts. â€Å"Facts and Statistics on Euthanasia.† 14 Feb. 2008.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   ;http://www.religionfacts.com/euthanasia/stats.htm;. The Internet Encyclopedia of Philosophy. â€Å"The Categorical Imperative.† 2001. 14 Feb.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2008.;http://www.nd.edu/~rbarger/categorical-imperative.html;. West, Henry R. â€Å"Utilitarianism.† Encyclopà ¦dia Britannica. 14 Feb. 2008.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   ;http://www.utilitarianism.com/utilitarianism.html;. How to cite Moral Reflection, Essay examples

Ongoing Crisis Communication Planning Managing

Question: Discuss about the Ongoing Crisis Communication for Planning Managing. Answer: Introduction Communication is an essential activity for any business organization. Communication ensures that activities of the business organizations are successfully accomplished. This assignment highlights the importance of effective communication for the managers of an organization, along with the various challenges and issues that might be faced by them. For this assignment, the company NetSuite has been chosen. Moreover, the impact of ineffective as well as effective communication of the managers on the productivity of the business organization has also been mentioned in this assignment. Types of Communication Effective communication in any business organization ensures that the organizational activities are fulfilled successfully. In the company, the various types of communication include the formal as well as informal communication (Chaudhri 2016). The managers mostly engage in formal communication with the employees of the organization. The types of formal communication that the managers are engaged in includes up to down communication, down to up communication, horizontal communication as well as cross communication (Coombs 2014). For the managers of a company, cross communication is mainly practiced, since they engage in communication with various levels of employees. Another form of communication that the manager need to pay attention to is the non-verbal form of communication. This includes the body language and gestures that needs to be observed, in order to ensure clear understanding of the employees wish to communicate. The body language and gestures play an essential role in com munication. Thus, the manager needs to be competent enough understand and communicate effectively using verbal as well as non-verbal communication. The seven Cs of communication In order to ensure effective communication, the seven Cs of communication needs to be followed effectively. The seven Cs of communication are as follows: Clarity: It is essential for the managers that the clarity in communication is maintained. The lack of clarity in communication would result in misunderstandings and misinterpretation among the employees. This would result in decrease of productivity of the employees. Concise: The communication initiated by the managers has to be concise and to the point. Excessive and irrelevant information as well as clumsy communication might result in increased confusion among the employees (Cornelissen 2014). Concrete: The communication initiated by the mangers need to be concrete. The concreteness of the communication would assist the employees to understand the instructions given to them, without the overhead of additional information. Correct: It is important that the communication of the managers correct. Incorrect communication or information given to the employees, might prove to be detrimental for the business organization as well as the employees. Thus, the manager has an important responsibility to communicate the correct information (Goetsch and Davis 2014). Coherent: Logical and coherent communication plays an essential role and determines the efficiency of the manager. Completeness: Incomplete communication gives rise to unnecessary questions and confusion. Thus, it is the duty of the manager to ensure that communication is complete. Courteous: This is one of the most important qualities of a manger as well as effective communication. Courteous communication includes showing respect to the speaker as well as the listener. This includes respecting the individuality of each other, along with openness to accept each others ideas. Barriers to communication Though communication is an essential activity for the mangers, there are certain barriers of communication that hinders the effective communication in the business organization. These are: Emotional outburst: This barrier might cause the manager communicate inappropriately with the employees. Emotional outburst such as anger, stress, desperate behaviour, anxiety, might cause barrier in effective communication (Voinea et al. 2015). Conflicts: Conflicts of the manager with the employees might result in creation of a barrier in communication. Due to conflicts, the communication might not be concise and courteous, thus causing ineffective communication (Dozier et al. 2013). Misinterpretation: Misinterpretation among the employees and incorrect actions being taken results in ineffective communication. The manager might not be able to communicate effectively with the employees. Semantic or language barrier: The language barrier is a major communication barrier for the manager. The manager might not be competent enough in the specific language in which the employees communicate (Kurtz et al. 2016). Thus, the semantics and language barrier is a major barrier for the manager. Impact of ineffective communication Ineffective communication practiced by the mangers has a strong negative impact on the business organization. The negative impacts include misunderstandings among the employees, incorrect course of actions, deterioration of the productivity of the employees, lack of productivity among the employees (Grunig 2013). Moreover, lack of effective communication between the employees and the manager might result in employee dissatisfaction and deflection of the employees. Effective communication practiced by the manager results in increased productivity and diligent work among the employees. This is because, the employees receive a clear guide regarding what is expected from them (Hackman and Johnson 2013). Moreover, under an efficient leadership and guideline, the employees are happy to work. Thus, efficient and effective communication of the manager is essential. Effective communication is a special skill that the managers need to adopt and practice such that they are able to manage the employees successfully (Men 2014). Problem solving and conflict resolution skills are also essential skills that ensure effective communication in the business organization. Conclusion Communication plays an essential role in the business organization. The communication skills and efficiencies of the manager is important for the enhancement of the business. The employees find it easier to follow the instructions of the manager, if the clarity in communication is maintained, along with correct information being communicated. The various types of communication includes the formal and informal communication. However, the managers carry out formal communication and cross-cultural communication. The impact of effective communication as well as the negative impact of ineffective communication has been highlighted in this assignment. The positive impacts of effective communication of the manager include the enhancement of the productivity of the business organizations along with achievement of employee satisfaction and employee retention. However, the negative impacts of ineffective communication include dissatisfaction among the employees, along with failure to achieve o rganizational goals. Thus, it might be concluded that communication skills in the managers play an important role in enhancing the business, and achieving employee satisfaction. References Chaudhri, V., 2016. Corporate social responsibility and the communication imperative: Perspectives from CSR managers.International Journal of Business Communication,53(4), pp.419-442. Coombs, W.T., 2014.Ongoing crisis communication: Planning, managing, and responding. Sage Publications. Cornelissen, J., 2014.Corporate communication: A guide to theory and practice. Sage. Dozier, D.M., Grunig, L.A. and Grunig, J.E., 2013.Manager's guide to excellence in public relations and communication management. Routledge. Goetsch, D.L. and Davis, S.B., 2014.Quality management for organizational excellence. Upper Saddle River, NJ: pearson. Grunig, J.E., 2013.Excellence in public relations and communication management. Routledge. Hackman, M.Z. and Johnson, C.E., 2013.Leadership: A communication perspective. Waveland Press. Kurtz, S., Silverman, J. and Draper, J., 2016.Teaching and learning communication skills in medicine. CRC press. Men, L.R., 2014. Strategic internal communication: Transformational leadership, communication channels, and employee satisfaction.Management Communication Quarterly,28(2), pp.264-284. Voinea, D.V., Busu, O.V., Opran, E.R. and Vladutescu, S., 2015. Embarrassments in managerial communication.Polish Journal of Management Studies,11.

Hope for a Future free essay sample

In today’s society, Chicano Spanish speaking people are targeted to conform to the standard Spanish speaking language and culture. Gloria Anzaldua was exposed to this conformity at a young age when her teacher did not appreciate the way Anzaldua pronounced her Spanish name and said, â€Å"If you want to be American, speak ‘American. ’ If you don’t like it, go back to Mexico where you belong† (Anzaldua 374). Gloria Anzaldua who was a sixth generation Tejana and prolific writer wrote the essay â€Å"How to Tame a Wild Tongue† which is about her experiences dealing with being told to conform to the â€Å"right† language or culture throughout her life. Anzaldua gives the reader historic background of her rich culture which helps the reader understands why Anzaldua wishes to keep her cultural roots. Anzaldua uses rhetoric to make the reader feel what most Chicano Spanish speakers have felt in America. Chicano Spanish is not like standard Spanish, Anzaldua explains how it is a variation of languages and also how it was created when she states, â€Å"For a people who are neither Spanish nor live in a country in which Spanish is the first language; for a people who live in country in which English is the reigning tongue but who are not Anglo; for a people who cannot entirely identify with either standard (formal, Castilian) Spanish or standard English, what recourse is left to them but to create their own language? † (Anzaldua 375). We will write a custom essay sample on Hope for a Future or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page This quote shows how Chicano language isn’t the ‘right’ form of Spanish which makes people unsteady about the language; however it also shows how important this language is to the people that speak it because it gives them their own identity and ownership of their own culture. Anzaldua explains the history of the Chicano language and the differences it has with standard Spanish. She aims to show the reader how this evolved language is a mixture of other languages and how it all wraps together to create Chicano Spanish. Many people have believed that this language is a poor version of Spanish which is taking unfair cheap shots at this Chicano culture. These shots at Chicanos are making it harder and harder to keep the language alive because Chicanos are feeling uncomfortable speaking it because they expect to be judged by this â€Å"bastard language†. Anzaldua thinks that if this trend continues throughout the Spanish speaking culture, by the end of this century Chicano’s main language will be English and this culture will be extinct. Anzaldua gives hope that this culture will continue to thrive when she says, â€Å"I will no longer be made to feel ashamed of existing. I will have my voice: Indian, Spanish, white. I will have my serpent’s tongue-my woman’s voice, my sexual voice, my poet’s voice. I will overcome the tradition of silence† (Anzaldua 378). This rebellious statement shows that the Chicano culture has hope of keeping its existence because Anzaldua shows how big of an impact this language has on the identity of the Chicano people. In Anzaldua’s essay â€Å"How to Tame a Wild Tongue† she uses three main rhetorical components which are ethos, pathos, and word choice. Anzaldua’s word choice is very unique throughout her essay. She goes back and forth from English to Chicano Spanish; an example of this is when she says, â€Å"But Chicano Spanish is a border tongue which developed naturally. Change, evolucion, enriquecimiento de palabras nuevas por invencion o adopcion have created variants of Chicano Spanish, un nuevo lenguaje† (Anzaldua 375). This pattern of English to her language can confuse the reader while they are reading the passage especially if they don’t understand the language. Anzaldua uses this word alternation as an aid towards the Chicano language. She is very compassionate about keeping her language alive which is why she alternates the languages in her text to show the reader that the language is still thriving. Anzaldua makes it so that when you read her passage you read enough English to the point where you start to get comfortable then she throws a sentence completely in Spanish. This can also anger the reader with their ability to understand the text. Anzaldua had to go through many language improvement classes which were very stressful and tried to change her identity. Anzaldua might be trying to make the reader feel her pain through her speech classes by making them feel uncomfortable about their inability to read the text. Anzaldua is very emotional about her language throughout her essay which gives her essay pathos. Anzaldua makes the reader feel hopeless about the Chicano culture but then revives the reader with hope in her Chicano culture. Anzaldua gives the reader fear the extinction of the Chicano language when she says, â€Å"Chicanos feel uncomfortable talking in Spanish to Latinas, afraid of their censure. Their language was not outlawed in their countries. They had a whole lifetime of being immersed in their native tongue;† (Anzaldua 378). This fear of speaking their language make the reader feel like there is no hope that the language will continue and it will be lost due to the fear of the Chicano people. However Anzaldua picks the readers hopes up with her statement, â€Å"I will no longer be made to feel ashamed of existing. I will have my voice: Indian, Spanish, white. I will have my serpent’s tongue-my woman’s voice, my sexual voice, my poet’s voice. I will overcome the tradition of silence† (Anzaldua 378). This statement is a motivational speech that gives the readers goose bumps thinking about the hope that these Chicano people not only have in their language but in their culture and way of life. Anzaldua is very credible in her essay because she uses personal experiences regarding the Chicano culture in the Spanish society. Anzaldua states in her essay how people in society are disrespecting the language that she and her culture have spoken throughout history. Her claim is supported by her personal experiences in this discrimination towards her Chicano language. Her first experience with discrimination towards Chicanos happened in school when young Anzaldua pronounced her name with a Chicano accent, â€Å"If you want to be American, speak ‘American. ’ If you don’t like it, go back to Mexico where you belong† (Anzaldua 374). This is just one of many experiences that Anzaldua has had throughout her life with discriminatory situations regarding the Chicano language. These experiences make her creditable to use â€Å"unfair treatment towards Chicanos† as a claim in her essay because it shows the reader that she has been involved in the Chicano culture which makes her able to talk about it freely. The Chicano language is a mixture of Spanish speaking languages along with English to help give the people who use it an identity and often these people are seen as less of what they actually are; however this judgment is just unfair towards language because society has not seen something so different. Gloria Anzaldua leaves the reader with a sense of hope that the Chicano language will stay strong and thrive through all the hardships that they will experience when she says, â€Å"Stubborn, persevering, impenetrable as stone, yet possessing a malleability that renders us unbreakable, we, the mestizas and mestizos, will remain† (Anzaldua 382). Anzaldua is very proud of about her language and culture and shows her confidence that the Chicano culture will break the ongoing trend of small native languages going extinct because of the English language overpowering them. Anzaldua also gives the reader the first look of what to expect from a Chicano person giving us some characteristics. The reader could convey a Chicano person of being very hard working and very resilient after reading the last line of Anzaldua’s essay.

Give Thanks - Activities to Teach Your Students

Give Thanks - Activities to Teach Your Students Thanksgiving is the perfect time to teach students the importance of being grateful and giving thanks. Its very common for children to disregard the significance of the little things that go on in their daily life. For instance, being grateful for having food, because it keeps them alive, or being thankful for their house, because that means they have a roof over their head. Children tend to think of these things as everyday occurrences, and not realize the importance they have on their life. Take time this holiday season and require your students to think of every aspect of their lives and why they should be thankful. Provide them with the following activities to help them have a better understanding of why its important to be grateful, and how that can impact their life. A Simple Thank You Card Something as simple as making a homemade thank you card is a great way to teach students to be grateful for what they have received. Have students make a list of specific things that their parents do for them or things their parents make them do. For instance, I am thankful my parents go to work to make money so I can have food, clothes and all the basic necessities in life. or I am thankful my parents make me clean my room because they want me to live in a healthy environment and learn responsibility. After students have created their list of things they are thankful their parents do for them, have them choose a few phrases and write them in a thank you card. Brainstorming Ideas: I am thankful my parents make me do the dishes because that means we have food to survive.I am thankful my parents make me take care of my dog because that means my dog is happy.I am thankful my parents have a job because that means we have money to survive. Read a Story Sometimes reading your students a story can have a profound impact on how they view something. Choose any of the following books to show students the significance of being grateful. Books are a great way to open up the lines of communication and discuss this subject matter further. Book Ideas: The Firefighters Thanksgiving, by Maribeth BoeltsThanks for Thanksgiving, by Julie MarkesGiving Thanks, by Jake SwampGiving Thanks, by Sarah FischThanksgiving is for Giving Thanks, by Margaret SutherlandGrateful, by John Bucchino Write a Story A creative way to expand on one of the ideas listed above, is to write a story about why the students are thankful. Have students look over the list they created when they brainstormed for their thank you card, and choose one idea to expand into a story. For example, they can create a story centered around the idea that their parents work in order for them to survive. Encourage students to use their imagination and provide details from their real life, as well as ideas that they make up. Field Trip to a Shelter The best way for students to really be thankful for that they have in their life, is to show them what others do not have. A class field trip to a local food shelter will provide the students with the opportunity to see, that some people are thankful for just having food on their plate. After the field trip, discuss what they saw at the shelter, and make a chart about things students can do to help people in need. Discuss why they should be grateful for what they have, and how they can say thank you to the people that mean the most to them.

English has now become the lingua franca of the business world. What Essay - 1

English has now become the lingua franca of the business world. What are the implications of this for business and for native and non-native speakers of English - Essay Example For companies based in English-speaking societies, using English to coordinate and control business activities across the globe is less problematic. Yet, implementing a global language for the whole company is difficult for companies based in Asian or Latin Europe societies; however, even in these companies, requiring a language besides English as the international business lingua franca remains problematic (Garzone & Llie, 2007, p. 28). This essay discusses the implications of English as the lingua franca of the business world for the management, and native and non-native speakers of English. The chosen business genre is negotiation. Lingua franca is a language or expression that non-native speakers can use to effectively transfer information or exchange ideas with other non-native speakers. English as a lingua franca is defined by Firth (1996 as cited in Koester, 2010, p. 123) as: In order to explain business communications in the context of lingua franca, the concept of Business English as a Lingua Franca (BELF) was developed (Koester, 2010, p. 123). The increasing significance of English as Lingua Franca (EFL) is caused by a variety of occurrences. These involve the broader application of English as a global business language, English becoming a leading Internet language, the growing population of international students, and the continuous development of information and communication technologies (ICTs) (Bargiela-Chiappini, 2000, p. 311). Nowadays, EFL is the prevailing linguistic system that fulfils a need for communication. Even though workforce diversity is essential to businesses across the globe, international employees have to openly, clearly, and effectively communicate with one another. In order to cope with the intensifying global competition, an increasing number of European companies are implementing English as their official corporate

Effect of trampling on length of Cranesbill leaves Coursework

Effect of trampling on length of Cranesbill leaves - Coursework Example We make the assumption, for instance, that for a given distance along the transect, the soil and other relevant conditions are similar. Moreover, we can take it that if the data is any good, then standard deviations along any point of data collection along the transect (one meter intervals) should be small. This is to be expected too, given that for every measurement point along the transect there is only one reading for the soil compaction level, and several readings for the leaf length. Therefore, if soil compaction is correlated with the leaf length, then one can assume that the variations in length sizes along any measurement point in the transect should be small, or at least not significant enough to cause worry and doubt as to the validity of the data and of the alternative hypothesis being accepted (Statistics Canada 2011). Indeed, looking at the range of the standard deviation along the different measurement points in the transect, one sees that there is somewhat of a variati on along the measurement points, by a factor of 3 in some measurement points compared to others. There are several ways to interpret this. On the one hand, looking at the standard deviation figures, within the measurement points it is not conclusive that the standard deviation magnitudes are enough to cause worry as to the data validity. On the other hand, one can also investigate that maybe the wide variances in the sample data of leaf lengths within the measurement points may have something to do with the standard deviation being large or small. For example, looking at measurement point 8, or the measurement of leaf lengths at the point of eight meters from the start of the transect, one sees that the standard deviation is unusually large, in fact larger than any other standard deviation figure for the rest of the measurement points. Examining the data for this measurement point, one sees that compared to the other measurement points, there is a wider variation of measurement data for leaf lengths (1.5; 2.8; 2.8; 2.7; 2.3; 2.5). Looking at the measurements of leaf lengths at point 0, where the transect begins, one sees that the variation in measurements is somewhat smaller, or to put it another way, the leaf lengths are closer to each other, or varies less in comparison to measurement point 8 (1, 0.8; 0.8; 0.7; 0.7). This is borne out by the computed standard deviation for this measurement point, which is about a factor of three smaller than the standard deviation for point 8. The point is that within the measurement points, the standard deviation for the measurements vary in magnitude, and in some measurement points quite larger in comparison to the other measurement points. Judging by the standard deviation alone therefore, one comes to suspect whether the correlation between soil compaction and leaf length exists, and if the established correlation is valid. Of this, more will be said with regard to the inherent limitation of the study (Statistics Canada 2011; Wolfram Research 2012) Looking at ambient data, or data that is related to soil quality or pH, soil temperature, and the amount or intensity of the light present, this paper makes the assumption that more study needs to be done to either factor in or discount each of these variables as being correlated or associated with leaf length.

BAN SMOKING IN PUBLIC PLACES Essay Example | Topics and Well Written Essays - 3500 words

BAN SMOKING IN PUBLIC PLACES - Essay Example We claim to be Ð ° nation having freedom and equality, Ã'•Ð ¾ therefÐ ¾re, the point of view of Ã'•mÐ ¾kerÃ'• is explicit that not Ð °llÐ ¾wing them to Ã'•mÐ ¾ke in public is taking Ð °wÐ °y their freedom. Nevertheless, my point is that Cigarette Smoking Ã'•hÐ ¾uld be banned in public places because of the health risks, it impÐ ¾Ã'•eÃ'• on people who are expÐ ¾Ã'•ed to Ã'•ecÐ ¾ndhÐ °nd Ã'•mÐ ¾ke. Imagine going to the reÃ'•tÐ °urÐ °ntÃ'• or bars and unable to enjoy Ð ° nice meal or have Ð ° gÐ ¾Ã ¾d time because the place is Ð ¾verwhelmed with cigarette Ã'•mÐ ¾ke. Not only the smell of the Ã'•mÐ ¾ke is bad, it clings to clothing, hair, skin, and irritates eyes causing them to water and itch. How pleÐ °Ã'•Ð °nt is that? To many nÐ ¾n-Ã'•mÐ ¾kerÃ'• that is not very pleÐ °Ã'•Ð °nt, especially when it is harmful to their health. This eÃ'•Ã'•Ð °y will argue why Smoking Ã'•hÐ ¾uld be banned from clÐ ¾Ã'•ed-in public places. There are over Ð ° billion cigarette Ã'•mÐ ¾kerÃ'• Ð °crÐ ¾Ã'•Ã'• the world. Ð  large percentage of these Ã'•mÐ ¾kerÃ'• comes from America. For many years, people have been trying to put Ð °n end to cigarettes and their usage. Cigarette Ã'•mÐ ¾king is one of the top three preventable cÐ °uÃ'•eÃ'• of death Ð °mÐ ¾ng Ð mericÐ °nÃ'•. Not only are the people who Ã'•mÐ ¾ke affected by its dangers, but Ð °lÃ'•Ð ¾ the people who chÐ ¾Ã ¾Ã'•e not to Ã'•mÐ ¾ke. The effectÃ'• of cigarettes are increÐ °Ã'•ingly taking their toll. Banning cigarettes in public is Ð ° gÐ ¾Ã ¾d way to help prevent the dangers of cigarette Ã'•mÐ ¾king tÐ ¾wÐ °rdÃ'• thÐ ¾Ã'•e who are Ð °gÐ °inÃ'•t it. Johnsson and his co-authors report in their study that cigarettes Ã'•hÐ ¾uld be prohibited in public places because they are hÐ °zÐ °rdÐ ¾uÃ'• to the environment, they have Ð ° great influence on young children to Ã'•tÐ °rt smoking, and they are harmful to other people’s health (Johnsson et al, 2006). TÐ ¾bÐ °ccÐ ¾ Ã'•mÐ ¾ke cÐ ¾ntÐ °inÃ'• more than 4,000 chemicals in it. Forty of these chemicals are carcinogenic and eight of them Ð ° clÐ °Ã'•Ã'• Ð  carcinogenic,

Gender Economics in Turkey

Gender Economics in Turkey Elif Çolak Informal Economy; Under Participation Trap; Added Worker Effect This paper will look at the gender issues by focusing more on female side. Women in Informal Economy Worldwide, women’s involvement in the informal economy has increased since the early 1980s, as economic restructuring reduced job opportunities in the formal sector, increased the flexibility and casualness of labor markets, and increased the need for additional family income. There is a strong association between women’s employment and production for exports with the liberalization of the economy in Turkey. The number of women engaged in informal activities grown dramatically with the increasing influence of economic liberalization and flexible working conditions. Women’s work in exporting industries has been a center of major interest since the early 1980s women emerged as an important labor supply especially for the garment industry, but their integration into the production has remained informal and mostly made invisible through the utilization of familial relations in small-scale workshops. It also brings harsh working condition and low wages which allow the se sectors to become competitive. Unregistered economy refers to the legal economic activities which are not recorded officially to reduce production cost and aim tax evasion. Workplaces in unregistered economy are generally smaller in terms of scale; low wages are given to workers. There is an arbitrariness to recruit or fire workers. In rural area, TUÄ °K considers a category of unpaid family worker as employed and the majority of women, who are not registered to any social security institution, work as unpaid family worker. If we consider non-agriculture area, women mostly work as a regular employee and casual employee in unregistered economy. Self employment means that their payments depend on the profit of directly produced goods. They can make decision over operational activities. We can consider traditional handicraft activities under this category. Women who get specific order for dressmaking or handicraft works. They can decide about the finishing time of work and their payments after work. Other home- based work includes the piecework for subcontractor or another mediator. From 2004 to 2013, 5,19% of women on average work at the home. http://www.birlesikmetal.org/kitap/kitap_03/2003-1.pdf http://www.tuik.gov.tr/PreHaberBultenleri.do?id=13590 They arrive the conclusion that women are not willingly accept these jobs but they are forced to accept. Due to gender-related point of view, women workers are more prone to be abused by their employers. They work for below official minimum wage and face with harsh conditions at work. They feel helpless and despair due to the behaviors of employers and treatment in the working place. Under Participation Trap To define what the under participation trap means, we should look at the different factors which create this trap in relation to each other. Firstly, we consider the women with low levels of education. Most of them are likely to work in the informal sector with low wages that are lesser than the payment given to domestic workers to do housework or childcare. Labor supply turns into be very low considering these issues. With the belief that girls will not have a chance to participate in labor market with high wages, families may want to invest lesser for the educations of girls. At this point, it creates a cycle, known as the under participation trap, that girls education contributes to keeping wages low so that it will keep labor supply low. (World Bank Report 2009, 21) If we look at segmentation of labor market, we can see that formal sectors have higher productivity than informal sector and offer slightly above minimum wages. Returns to both education and experience are higher in formal sector again. However, the choice of working in informal sectors occurs due to exclusion of low educated women in formal sectors. Very low wages in informal sector lead to low levels of labor supply. There are also very little transaction of low educated women from informal sector to formal sector. Women who work in informal economy face with the lack of social security problem which force them to quit job. There are employment possibilities which offer limited range of work in textile industry, domestic service or retail activities for low educated women. When we look at TUIK data for the reasons of being out of labor force among women, the most important reason is that majority of them are busy with household works along the day. However, when we turn our interest to men, there is no percentage given to household works. The retirement or being students become the important reason for being out of labor force for men. Women are considered as housewives who have more time to dedicate for care giving and house works. This perception also brings some disadvantages to women such as dependence to men, lack of social security, or low self esteem. In the patriarchal family setting, men also see their household activity as an easy job with more spare time at home. Poorly educated women face with the cultural as well as economic barriers which prevent them to participate in the labor market. Former barrier includes the women’s role as care givers and family pressure. Latter barrier includes women’s participation in informal sector with low salaries and long working hours. Mothering and childcare are also other important determinants for female labor force participation. Mothers do not want to leave their kids alone so they need to stay at home to take care of them. In addition to this, they cannot afford to hire someone as a babysitter. â€Å"Participants mentioned they would need to pay at least 500 TL monthly to hire somebody to take care of their children. To afford this, they would need to find a job that would pay them more than 1,500 TL,†¦, was beyond what they could earn given their skills and education level.† (World Bank Report 2009, 20) Added Worker Effect Discouraged Worker Effect after Crisis Added worker effect means that if the unemployment of one spouse leads other spouse to increase his/her labor supply. We need to focus whether women have an incentive to participate in labor force when their husbands involuntarily lose their jobs. Due to the fact that my focus is on the crisis period, family members may also lose their hopes to find job which creates discouraged worker effect. The discouraged worker effects leads to hidden unemployment of the people who want to work but do not look for a job. Therefore, the actual unemployment rates can be underestimated with the dominance of this latter effect. (BaÃ…Å ¸levent and Onaran 2003, 441) To analyze how women react to crisis period in Turkey, Cem BaÃ…Å ¸levent and Ãâ€"zlem Onaran looked at the Turkish Household Survey data from October rounds of 1988 and 1994 period. In 1994, crisis period, Turkish lira was depreciated by more than 50 per cent and by the end of the year, Turkish economy is contracted approximately 6 per cent. (BaÃ…Å ¸levent and Onaran 2003, 441) They analyze difference between two years and compare outcomes according to the effect of economic crisis in 1994. They use the regression of female labor force participation (FLFP) on different groups’ unemployment rates and the other factors. They look at the variables such as education, number of children, and age of women to understand the relationship between these variables and dependent variable FLFP. The number of children has a significant negative effect on the FLFP although it has no significant effect on male labor force participation. Only exception for the effect on MLFP is that i f children’s ages are between 6 and 14, then employment rate of husbands increased due to the expenses of school age children. If married women have fewer children, they have a tendency to participate in labor force. Their conclusion is derived from the fact that while there is no significant correlation between 1988 data for added worker effect and discouraged worker affect, they find statistically significant result for added worker affect of the married women in currency crisis in 1994 which had negative correlation with discouraged worker effect. In other words, it can be concluded that the added worker effects dominates the discouraged worker effect by looking at 1994 crisis. Their expectation, not analyzed in their research, is that added worker effect could be more dominant than discouraged worker effect for women due to the positive influence of female employment trends as well as getting more accustomed to working life. Ä °pek Ä °lkkaracan and Serkan DeÄÅ ¸irmenci look at the years between 2004 and 2010. They also include single female into their analysis. They focus on the fact that added worker effect creates pressure on the labor market which has already contracted due to crisis. In addition to this, active labor market participants may give up looking and withdraw their labor force from labor market. They make emphasis on particular characteristics of the women such as their age, marital status, and education level. Household unemployment shock increases the participation of university graduates who are between 20 and 45 age group by up to 34 per cent while the percentage drops to 17% for high school graduates. (Ä °lkkaracan,and DeÄÅ ¸irmenci 2013,1) The effect of migration from rural to urban areas shifts the agricultural labor power of women from unpaid family workers to unpaid household workers while men shifts from agricultural worker to industrial or service work ers in the urban areas. With the financial liberation, which started in 1980s, women have encountered with harsh working conditions, long working hours with low wages under poor labor market demand. Therefore, expected returns from female labor force participation are lower and structural constraint such as lack of child or elderly service weakens the added worker affects. (Ä °lkkaracan and DeÄÅ ¸irmenci 2013, 31) They make a conclusion that added worker effect in Turkey appears as a coping strategy to deal with economic downturns but it again refers to smaller effects like 8-10 percent of working age female become labor force participant with job loss of their husbands. If we look at 2008 crisis, Turkey faced with productivity loss as well as economic instability which pave the way to unemployment. â€Å"According to the Institute of LaborLaw (2009), the Turkish unemployment rate in January 2009 was 15.1 percent, which roughly corresponded to 3,600,000 individuals being out of jobs. Based on the data of the Turkish Institute of Statistics (TURKSTAT) (2009), the labor unions declared that the highest rate of unemployment since the foundation of the Turkish Republic was during the period of the 2007–2008 economic crisis, when between 13.6–16.3 percent of all workers lost their jobs (Tes-Ä °Ãƒâ€¦Ã… ¸ 2009, 30). Almost nine million of these people now work without being covered by any social security insurance.†page98- unregisterd worker†¦. Policy Offers Lack of child care service for the pre-school age and elderly care services, which constitutes structural constraints, leads women to stay at home in order to provide the needs of these family members. The majority of women do not take more than secondary education so that they are offered by these poor employment opportunities. Without any public service, they have to use their labor power for domestic workload and if they start to work, they will face with harsh conditions without satisfactory payments in the workplace. In addition to this, women who are employed in the informal sector suffer from the poor access of maternity leave which affects the labor supply of women. We estimate the marginal effect of the unemployment shock on labor market transition probability for the overall sample as well as for different groups of women, and hence demonstrate that the effect varies widely depending on the particular characteristics of the woman—for example, her education level, age, urban/rural residence, and marital and parental status. Creating job opportunities for first time job seekers Affordable child care Sustaining investments on education In 2012, a cash transfer program targeted to give social security coverage for the poor widowed women because these women without men are seen as impoverished and vulnerable group to maintain living of their household by themselves. Distinction across welfare regimes is important to understand how social welfare is produced and allocated between state, market, and family. We should also take the criticism about welfare regime into account that this â€Å"welfare regime† approach is â€Å"gender blind† or in other words, there is gender bias toward women without men. (Ãâ€"zar and Yakut-Çakar 2013, 25) Women are not capable of continuing their working lives because they have drop-outs with marriages or child born. Care services cannot be affordable for those women so that they turn their home again. Women without men ( a male breadwinner) can less likely to find job in the formal sector due to lack of experience and considerable break between working time and staying at home. They will not face with job opportunities in the formal sector so that they need to accept uninsured and low-waged works in informal sector. Characteristics of unregistered jobs create unstable and volatile situation for women due to its duration and wage level. To maintain their daily livings, sometimes women take informal support from the relatives or neighborhoods but it turns out to be inadequate again.†By providing support to only widowed women, that is, those women falling outside family involuntarily upon the death of the spouse, the welfare regime in Turkey continues to assume women within the boundaries of family and punishes those that fall outside these boundaries.†32 spouse, the welfare regime in Turkey continues to assume women within the boundaries of family and punishes those that fall outside these boundaries REFERENCES BaÃ…Å ¸levent, L. and Onaran, O. 2003. â€Å"Are married women in Turkey more likely to become added or discouraged workers?† Labour, 17, 439–58. DeÄÅ ¸irmenci, S., Ilkkaracan, I. (2013). Economic Crises and the Added Worker Effect in the Turkish Labor Market. Levy Economics Institute of Bard College, 774, 1-47. Kà ¼mbetoÄÅ ¸lu, B., AkpÄ ±nar, A. (2010). Unregistered Women Workers in the Globalized Economy: A Qualitative Study in Turkey. Feminist Formations,22(3), 96-123. Unfolding the invisibility of women without men in the case of Turkey Ã…Å ¾ahin, M. (2011). KayÄ ±t DÄ ±Ãƒâ€¦Ã… ¸Ãƒâ€žÃ‚ ± Ä °stihdam ve Esnek ÃÅ"retim Sà ¼recinde KadÄ ±n EmeÄÅ ¸inin Durumu: Tà ¼rkiye’de Ev-Eksenli ÇalÄ ±Ãƒâ€¦Ã… ¸ma, UzmanlÄ ±k Tezi, T.C. BaÃ…Å ¸bakanlÄ ±k KadÄ ±nÄ ±n Statà ¼sà ¼ Genel Mà ¼dà ¼rlà ¼Ãƒâ€žÃ… ¸Ãƒ ¼, Ankara. TurkStat (Turkish Statistical Agency) (2012) Household labor force survey, Online. Available HTTP: http://www.tuik.gov.tr/VeriBilgi.do?alt_id=25> (accessed 23 May 2013). http://www.turkstat.gov.tr/PreHaberBultenleri.do?id=16005 World Bank Report 48508-TR (2009). â€Å"Female Labor Force Participation in Turkey: Trends Determinants and Policy Framework†. Human Development Sector Unit Europe and Central Asia Region. World Bank State Planning Organization (2009). Female labour force participation in Turkey: Trends, determinants and policy framework. Report No: 48508-TR. Washington: The World Bank. DÄ °SK BirleÃ…Å ¸ik Metal Ä °Ãƒâ€¦Ã… ¸Ãƒ §ileri SendikasÄ ± EV-EKSENLÄ ° ÇALIÃ…Å ¾ANLAR VE Ãâ€"RGÃÅ"TLENMELERÄ ° Bu kitapà §Ãƒâ€žÃ‚ ±k Ev-eksenli ÇalÄ ±Ãƒâ€¦Ã… ¸an KadÄ ±nlar ÇalÄ ±Ãƒâ€¦Ã… ¸ma Grubu’nun katkÄ ±sÄ ±yla hazÄ ±rlanmÄ ±Ãƒâ€¦Ã… ¸tÄ ±r. Ä °stanbul, Mart 2003 1

Bankruptcy Essay -- essays research papers fc

Over the years, the process of declaring bankruptcy has become incredibly simple. Because of this change, the number of people declaring bankruptcy is at an all time high. Today, bankruptcy is a common thing among companies and individuals alike. The American bankruptcy law allows people to avoid paying their debts by offering the debtors a discharge without a harsh consequence. By not having repercussions for their actions, bankruptcy filers often plan future bankruptcies, allowing them to steal even more money from creditors with no punishment. There are 13 different chapters in the bankruptcy system with the principal chapters being 7,11, and 13. You can only file for bankruptcy under these three chapters, the others are there to explain how the system works. Under Chapter 7, a person’s debts are wiped away while under chapters 11 and 13, debts are frozen while the debtor figures out a way to repay them. The people filing Chapter 7 are stealing money from creditors who are trying to help them. It is one’s moral duty to pay back his debts and one should be disgraced and embarrassed if they borrowed money they cannot pay back. Over 1,400,000 people filed for bankruptcy in 1998 under Chapter 7, Chapter 11, and Chapter 13. 75% of them were under Chapter 7, leaving â€Å"retailers, bankers, and credit-card companies† with $40 billion in unpaid debts (Kopecki 5) (Pomykala 16). The use of different reforms could cut down on the number of Chapter 7 filings and put responsibility back on the debtor. Declaring Chapter 7 bankruptcy is ethically and morally wrong and through different reforms this current â€Å"right† would be considered a crime. Bankruptcy was slowly transformed through history from being a crime committed by debtors into a social welfare program. In the past, bankruptcy offenders were severely punished. â€Å"Before the mid-19th century, bankruptcy was a crime† (Pomykala 16). There were many ways to punish those who committed this heinous act. The Pennsylvania Bankruptcy Act of 1785 allowed the flogging of these offenders while their ear was nailed to a post and afterwards the ear was cut off. Similar to Hester Prynne’s punishment of wearing a scarlet â€Å"A† on her chest for â€Å"adulteryâ€Å", people who committed the act of bankruptcy were â€Å"branded on the thumb with a â€Å"T† for â€Å"thief† (Pomykala 17). Various punishments like these served as a warning to future violators. B... ...uer, and Robin Leonard. How to File for CHAPTER 7 BANKRUPTCY. Berkeley: Nolo 1999. Feltman, Peter. â€Å"Bankruptcy Bill Closer to Enactment.† Bankruptcy Debate Continues 12 Dec. 2001. . Hanson, Randall K., â€Å"A new chapter in bankruptcy reform.† Journal of Accountancy Feb. 1999. Irons, John S., â€Å"Private Debt: Two Views on Debt.† About.com 12 Dec 2001 Jasper, Margaret C., Bankruptcy Law for the Individual Debtor. New York: Oceana 1997. Kopecki, Dawn, †More American Debtors Turn to Chapters 7 & 13. (bankruptcy law makes discharging debt easy).† Insight on the News 22 Mar. 1999. Pearce, John A. II, Samuel A. DiLullo, â€Å"When a strategic plan includes bankruptcy.† Business Horizons Sept.-Oct. 1998. Pomykala, Joseph S., â€Å"BANKRUPTCY LAWS: The Need for Reform.† USA Today Nov. 1999 Pomykala, Joseph. BANKRUPTCY REFORM: Principals and Guidelines (Revised Edition) Regulation Vol. 20, No. 4, 1997. Warner, David, † Bills seek to slow bankruptcy filings. (Congress introduces legislation to make bankruptcy laws more strict).† Nation's Business Mar. 1999

Interview: Pharmacist

Page R Smith Lean Visuals is the youngest and newest PhD pharmacist in our pharmacy, it is for this reason I choose to interview her. She is responsible for checking medications for drug interactions, correct data entry, counseling patients, maintaining a correct narcotic inventory, interacting with doctors' offices on behalf of patients to obtain new prescriptions or for medication therapy management.Some of her interpersonal Job duties include the management of technicians, and delegate work load within the pharmacy environment when needed due to increased need in an rear, and most importantly how to balance an regulate the corporate aspects and responsibilities of her positions while maintaining the integrity of the customers health care needs. The facility in we work in is a chain corporate retail pharmacy with front store attached. Our pharmacy currently services a growing community and fills approximately three thousand eight hundred prescriptions a week.This includes pharmacis t counseling patients, compounding medications, and vaccinations. Our technicians other responsibilities include filling prescriptions, maintenance of a script pro machine holding one hundred of our fasting moving drugs, billing of insurance companies, insurance over rides for lost prescriptions, mail order over rides, vacation supply over rides. Our pharmacy operates with three pharmacists on a rotating schedule, where two pharmacist work ten hour days in the pharmacy overlapping each other.In the state of Massachusetts a pharmacist can work with a ratio of two nationally certified and tow non-certified technicians under their license; or one nationally certified technician and one intern and two state level technicians. Counseling occurs mostly on new prescriptions and over the counter medications. Customers are concerned about when to take medications, how to take the medications; for example with or without food to buffer against stomach upset.When counseling is being sought for over the counter medications, the pharmacist must ask what the most prominent symptoms are and what other medications the patient may be on before making a recommendation. According to the interview with Lean the most important attributes for success as a retail pharmacist when giving advice to customers in regards to over the counter medications are the following. If you are questioning yourself in regards to an answer about a medication do not be afraid to let the patient know you need to reference the answer before giving it; you cannot remember everything.Also, there may not be a recommendation for every patient based upon symptoms and age. If you feel that there is no appropriate medicine that will assist the patient do not feel pressured into providing the patient with an answer simply tell them there is nothing that can help them with their particular issue. Customer base in a retail setting are local community members and people visiting needing to fill medications. The pha rmacy receives prescriptions through several different methods. We receive prescriptions hard copies brought in directly from providers.We acquire patients from other retails pharmacies in the area and even other sister stores with our chain. The majority of our patients fill maintenance prescriptions either monthly or every ninety days; which is a growing trend in pharmacy care. Other types of prescriptions filled include emergency room prescriptions for acute conditions and hospice prescriptions. Prescriptions in a pharmacy are classified into three different categories for filing purposes. They are class six which are drugs that are class six drugs, non-controlled substances.Controlled Substances which are for drugs classified XIII-C.V.. Finally, narcotics or prescriptions which are medications or drugs classified as Cell's. Medications are classified as controlled substances or narcotics based upon the levels for potential abuse or addiction properties. Leanness career in pharma cy began as a technician at the age of 16 in a pharmacy. She obtained her mandatory state license for technicians after working in the pharmacy for one thousand hours, and maintained his licenser while attending college and working in the pharmacy.She received her bachelor's degree from Worcester State University. Then applied and was accepted to the advanced program of Mass College of Pharmacy in Worcester. Where she graduated in from in 2010 and began working as a full time pharmacist with our company. During this entire time she worked either as a technician or intern for our company while attending school; the designation was dependent upon her level of schooling at the time. The educational requirements necessary to become a pharmacist is doctorate in Pharmacy.Upon obtain the educational requirements you must then pass your states respective law examination and the National Association of Pharmacists Exam to become a licensed Pharmacists. Then every year to maintain your licens e you must take fifteen continuing educational credits. These credits have some specific requirements two of them must be in the field of medical law based and five credits must be obtained at a live seminar. These credits must be submitted to the Board of Pharmacy each year before your license expires with the cost of renewal.When posed with question of whether or not pharmacy education prepares oh for being a pharmacist in a retail environment Lean felt divided over her answer. She felt that the level of schooling prepared new pharmacist adequately to answer medical questions in regards to medications and drug interactions. Where she felt school could not prepare you for in the field was how to deal with the interpersonal aspects of the Job. On the Job training of managing other team members was not a skill she learned until being hired as pharmacist as well.The dealing with customer's issues in a delicate but professional manner while adhering o corporate policies and maintaining your own personal integrity. When asked how you interact with other co-workers in your environment her response was, â€Å"sometimes it is difficult to draw the line between friend and supervisor†. She finds that due to her being a young pharmacist of twenty four. Having employees that are either your senior in age or in experience with the company time frame wise makes managing them difficult.They don't always feel your decisions are valid and may not agree or respect your choices, thus choosing to ignore them. Regardless of your underlings' age or rank within the company you must remember do what you feel is correct and encourage your staff to as well even if it involves disciplinary measures. Years and processing it and making your own decisions is still the best way to allow your staff a voice and be a fair supervisor.When asked to compare pharmacist positions in other organizations Lean referred to her husband who works as a pharmacist in a local hospital. The pharmacy setting deals with slightly different setup as they do not have to handle the public however they also must deal with a lit-level hospital full of nurses and doctors which provided similar demands. Their pharmacy also has the added demand of dealing with intravenous drug dispensing and making sure that the units and dilutions are correct. † As a pharmacist in a faced paced environment with numerous demands being thrust upon you at any given moment you need to take the time to check aspect of a prescription and reference your answers before you give them if necessary so that medications errors are not made The two most important attributes for success as a pharmacist in health care today are the ability to multicast and patience. When asked this question the example she provided was Mimi may be asked to check 3 waiters, perform 2 flu shots and give consultation too waiting patient all at once.You need to prioritize which to do first concentrate on what you are doing at that par ticular moment and maintain your composure throughout. This is an exemplary description of how many directions our pharmacists are pulled in on a daily basis. When asked about patience she stated that as a pharmacist you must have patience not only with customers but also with coworkers and the environment in general; hat it is necessary to not become overwhelmed unduly stressed. How do you see the field of retail pharmacist developing in the future?The greatest change in retail pharmacy this year was the pharmacist immunization program where nearly all staff pharmacist where mandated to become minimizing pharmacists. This was due to the severity of the flu season and the push by corporate entities for flu shots to be administered. Software developments keep adapting to attempt to meet the needs of the customer base, we now have acute prescriptions which moves antibiotics and main medications up in time frame knowing patients will be down sooner in need of them.These types of advanc ements are supposed to help the pharmacy and the pharmacists balance the patients' needs the actual health care or medicine and the basic needs of the corporate environment. Finding the point at which the medicine or health care aspect meets the needs of the patients and the corporate needs actually balance without one overwhelming the other or interfering with the needs of the other is the true challenge of retail pharmacist's Job. In conclusion pharmacists re everyday heroes performing at their peak every day for ten hours a day checking up to seven hundred prescriptions daily some days.Doing their best to ensure errors are not made for the sake of customer safety. Helping the community on a daily basis with recommendations and ensuring their patients safety from medical over dose and drug interactions that may have been missed by patients physicians; or due to the fact patients have multiple physicians. Generally looking out for the well-being of their clients and ensuring their best interests and being taken into consideration on a daily basis. References:

Monopolies - A Case Study Essays - Economic Systems, Free Essays

Monopolies - A Case Study Essays - Economic Systems, Free Essays Monopolies - A Case Study John Velimirovic Monopolization And Its Implication On A World Scale The monopolization of the capitalist system is at the base, a degradation, not only of the "free-competition" of the capitalistic (bourgeoises) socio-economic order, it is also, the degradation of the working class and, in fact, the respective systems imminent demise. During the Cold War competition between potential monopolist nations, USA, France, Germany, England and Canada was highly minimized and co-operation was (ironically) encouraged to counter the Soviet threat. Today, with the fall of the pseudo-socialist states in the Eastern block and the subsequent degeneration of such states in Asia, cooperation has been deemed unnecessary and a general neo-imperialistic takeover, a rat race if the reader will bear with me, has been instigated. However, it must be understood before the reader continues, the process unravelling before our eyes today, this disaster, is not a recent occurrence. Some economists and political analysts have dated its"birth" to the start of the Russo-Japanese war and the industrialization of the African colonies (imperialism). This being the case, though imperialism is primarily considered a political phenomenon by bourgeoises economists, socialists have cooked deeper into the matter and "unveiled" the economic character of imperialism and it's apparent contradictions (this will be dealt with later, as well as an overview of the historic contradictions, economic intricacies and ethical realities of imperialism. It should also be stated, that the term monopoly, "monopolization" will be dealt with from the left-wing point of view, as "imperialism"). The two prevalent schools of economic thought, the left wing (socialist) and the right wing (libertarian, "laissez fare" capitalists ...), have entirely different view on the matter of monopolization of capital. While the socialist, especially those of the Marxist persuasion (to which the author belongs), claim that the monopolization of capital is the most significant event in the history of capitalism since robotics, the bourgeoises economist refuse to recognize (foolishly), that a change in economic structure has even occurred! The contemporary bourgeoises media refers to the world market and it's expansion. This term is so overused and under analysed that these pseud-master, have managed to use it as a veil, as a euphemism to downplay the historical change, brought about by the fall of the eastern block and the subsequent degeneration of the Asian "peoples' republics". The "expanding world market"or the "world market",on its own, has always existed and expanded to new markets, so the above terms , when applied to the monopolization of the world market by the imperialist nations (see above), is an example of false terminology. The Domestic Consolidation of Capitalist Monopolies The international hegemony of the imperialist nation is impossible on such a grand scale, without the consolidation of the monopolization of capital, within the respective nation itself. The monopolization of capital in a single nation is, even though an important transformation, hardly baffling occurrence. It is, in essence, the domination of a single company (monopoly) or of many companies (oligarchies) over their respective competitions. At such a position, these companies wreck havoc on the market. They enter into special agreements (though they are in theory competitors) to artificially "jack-up" prices and inflate their profit margin at the expense of the consumer. An essential part of the functioning of what leftists term imperialism is the role of the banks without which the monopolization of capital is impossible and anachronistic. The principal role of banks is to serve as middlemen in the making of payments. By managing is such activities, they transform inactive money capital into profit yielding capital as well as placing numerous money revenues at the disposal of the capitalists. As a result, the banks grow, becoming monopolies themselves, obtaining at their disposal not only the profits of the capitalists, but the bulk of their capital as well. Through this process, the powerful banks "take after" the smaller ones and the market is left with a handful of superbanks having at their disposal the wealth of the whole nation. They enter into agreements to self interest rates and government policies basked on the way these banks function. This is incredibly detrimental because the general well being of the nation is confined and restricted to the demands of the money-making process. As a result over 95%of the population who does not control

Affirmative Action Essays (933 words) - Discrimination, Free Essays

Affirmative Action Essays (933 words) - Discrimination, Free Essays Affirmative Action AFFIRMATIVE ACTION I. We didnt land on Plymouth Rock, my brothers and sisters Plymouth Rock landed on us! Malcolm Xs observation is brought out by the facts of American History. Snatched from their native land, transported thousands of miles in a nightmare of disease and death and sold into slavery, blacks were reduced to the legal status of farm animals. Even after emancipation, blacks were segregated from whites in some states by law, and by social practice almost everywhere. American apartheid continued for another century. In 1954 the Supreme Court declared state-compelled segregation in schools unconstitutional, and it followed up that decision with others that struck down many forms of official segregation. Still, discrimination survived, and in most southern states blacks were either discouraged or prohibited from exercising their right to vote. Not until the 1960s was compulsory segregation finally and effectively challenged. Between 1964 and 1968 Congress passed the most sweeping civil rights legislation since the end of the Civil War. It banned discrimination in employment, public accommodations (hotels, motels, restaurants, etc.), and housing; it also guaranteed voting rights for blacks in areas suspected of disenfranchising blacks. Today, several agencies in the federal government exercise sweeping powers to enforce these civil rights measures. But is that enough? Equality of condition between blacks and whites seems as elusive as ever. The black unemployment rate is double that of whites, and the percentage of black families living in poverty is nearly four times that of whites. Only a small percentage of blacks ever make it into medical school or law schools. Advocates of affirmative action have focused upon these differences to support their argument that it is no longer enough just to stop discrimination. Liberal Democrats feel that the damage done by three centuries of racism now has to be remedied, they argue, and effective remediation requires a policy of affirmative action. At the heart of affirmative action is the use of numerical goals. Opponents call them racial quotas. Whatever the name, what they imply is the setting aside of a certain number of jobs or positions for blacks or other historically oppressed groups. Conservative Republicans charge that affirmative action really amounts to reverse discrimination, that it penalizes innocent people simply because they are white, that it often results in unqualified appointments, and that it ends up harming instead of helping blacks. The issue of preferences to address historical patterns of racial, ethnic, and gender discrimination has received a great deal of attention nationally. Whether in government contracts, private sector hiring, college admissions, or state hiring practices, opponents in the issue have engaged in often-heated debates. In Michigan, legislation to limit or eliminate affirmative action has been introduced this session. A good example of this legislation was proposed on March 18,1998 and it is called SJR N (S-2). This resolution proposed an amendment to the Michigan Constitution to prohibit discrimination based on sex or ethnicity and to prohibit the state and its political subdivisions from using religion, sex, color, ethnicity, or national origin as a basis for discriminating against or giving preferential treatment to any individual or group in employment, public education, or public contracting. The present system violates the fundamental principle of equal protection of the law against discrimination on the basis of immutable characteristics of race, sex, color, ethnicity, and national origin. SJR N (S-2) was intended to end this practice and return Michigan to the goal of a colorblind society. II. SJR N (S-2) is on the Conservative side of things, in that, the legislation is trying to stop reverse racism. There really is no moderate way to look at affirmative action; you can either be for it or against it. Sen. Bill Bullard Jr. was the chair and sponsor of this bill, but when he met with the other members of this committee it was stated in the minutes of the meeting that the issue will not be voted on today, nor does he (Bill Bullard) intend to press for a vote in the Legislature this year. There will be future opportunities for all who wish to contribute to this dialogue to have their views heard. The committee then had a long list of testimony from those who opposed SJR N (S-2).

Philosophy inquiry- A mini-version of a possible chapter 3 of a Assignment

Philosophy inquiry- A mini-version of a possible chapter 3 of a dissertation proposal - Assignment Example Aristotle refuses to imitate a theory that has been formulated without empirical estimation of regular and in-depth observation of the universal facts and realities (Thomas & Thomas, 1960). Turner opin...... The same is applied to social exchange theory, cognitive development perspective, deviance theories and others. The studies demonstrate various models and paradigms observed and followed by the researchers while developing an outline for conducting a qualitative research. Guba (1990) argues that a paradigm serves as an interpretative framework, which is guided by the set of beliefs and feelings about the world and how it should be understood and studied. In other words, a research paradigm determines and decides the epistemology, ontology and methodology to be applied on the basis of the topic selected for conducting the research work. Epistemology stands for describing the source of knowledge, which includes what is known, and what is going to be explored. The term epistemology has been derived from the Greek notion episteme, which stands for the philosophy of knowledge (Gall, Borg, & Gall, 1996). In simple words, epistemology aims to explore the source and origin of some specific k nowledge or information. Epistemology is the branch of philosophy that studies the nature of knowledge and the process by which knowledge is acquired and validated Epistemology poses the questions including: What is the relationship between the knower and what is known? How do we know what we know? What counts as knowledge? (Krauss, 2005:759). On the other hand, ontology is determined to unveil the realities of the concepts involved in the study. It also discovers the reality about the topic as well as the units of analysis selected for the research. For instance, while discovering the relationship between domestic violence and children’s alienation towards

Platos Form of Good and Justice Essay Example | Topics and Well Written Essays - 250 words

Platos Form of Good and Justice - Essay Example He was dissatisfied with the conditions that were prominent in Athens.The democracy here was failing and it was heading to ruins. He characterized his own concept of justice by bashing the notions that were held by the likes of Glaucon's and Adeimantus. This paper will look into the concept of the good of justice in and of itself as challenged. It will also focus on the Good of the Soul, its three form nature and immortality.Glaucon on justice presupposes that human good is made of a combination of power, wealth and pleasure and because these are limited, there have to be a competition among men for them. He says that it is natural for one to pursue what he sees as good.Socrates refutes the social contract and the bases of Glaucon’s argument by saying that the ultimate source of value is not found in nature and not in the human notion of social contract but it is a notion grasped by the intellect that is enlightened, which is the Form of Good. From his arguments he comes with the prospect of the good of the soul where he says that the soul is tripartite in nature and also that it is immortal and when one dies, their soul lives on. He used the three elements of the soul to explain how the society should be and the concept of Justice and Good is elaborated.This reasoning according to me it is very valid. It gives a reasoned version of what Good is and the concept of Justice coupled with Good. It gives the basis of what Plato was later to conceive as the Form of Good/Justice.

Mars Reconnaissance Orbits Essay Example | Topics and Well Written Essays - 500 words

Mars Reconnaissance Orbits - Essay Example Modeling of the MRO came after NASAs successful Mars Global Surveyor that was designed to conduct Mars surveillance from orbit. In its earlier specifications, the satellite design included a large camera for taking high resolution fascinating images of the Mars. This made Jim Garvin, a Mars exploration program scientist with NASA to predict that MRO would be like an orbit microscope. A visible-near-infrared spectrograph was also to be incorporated in the spacecraft. Five months later, after aero braking, the MRO entered began its major science phase after entering its final science orbit. In this way, it joined five other existing spacecrafts in the vicinity of Mars that were either on the planet surface or in orbit. These other active spacecrafts were: two Mars Exploration Rovers, Mars Global Surveyor, Mars Odyssey and Mars Express. MRO is equipped with a set of NASA’s most powerful scientific instruments used in the analysis of minerals, stratigraphy, ice of Mars and landforms. They include instruments such as radar, cameras and spectrometers. They are significantly used in monitoring of daily surface and atmospheric conditions of the Red Planet, and hosting of new MRO telecommunication systems for further future missions. It is probably remembered for discovery of ice and other startling discoveries on Mars such as dust devils going across the Mars surface and changing of sand dunes in real time as watched by its powerful cameras. The MRO has also helped to establish the cause for the damage of Phoenix spacecraft that went out of touch with the earth and it has generally helped in other spacecrafts to stay in touch with the Earth. The prime scientific mission of the MRO ended in December 2010, even though NASA still believes that the spacecraft can still do well until 2015. Many new things have been learned about the Red Planet courtesy of the spacecraft.

Activity Based Costing Essay Example for Free

Activity Based Costing Essay Activity based costing (ABC) is a relative new way to allocate costs to specific processes and services. This system assures that the costs are accurately distributed to the products or services that generated them. ABC illustrates costs more accurately, giving management insight to the cost associated with certain business activities. ABC extends the decision-making skills of management by expanding on traditional costing (job order costing/process order costing) techniques. However, since ABCs introduction in the 1980s, many corporations are not using ABC, despite gained managerial decision making capabilities. Even by the mid-1990s, ABCs use has not spread throughout the accounting industry and its use is not obvious (Selto Jasinski, 1996). The following article will discuss the pros and cons of the ABC method. ABC is an extension of traditional product costing techniques. These techniques are called job order costing and process order costing. A job order costing system arranges costs for each unit as it goes through a production process. A process cost system collects costs in work in progress account. The numbers of units worked are recorded for the accounting period. These systems alone do not accurately illustrate costs incurred. Instead, these two costing techniques generally lump costs into 3 main categories (cost centers). These three categories are direct materials, direct labor and overhead. Cost drivers are then assigned to represent the relationship between the cost and the process it is allocated to. ABC provides a better map of the costs of manufacturing products or distributing services. ABC uses a multitude of activity centers, which are the equivalent to the previously mentioned traditional cost centers. Each of these activity centers has its own cost driver and driver rate. ABC identifies many different costs to products by adjusting the cost driver and driver rates to specific activity centers. This process avoids across the board allocations of cost. For example, a product, which takes up .03% of space in the warehouse, would require .03% cost absorbed by product sales revenue. If the depreciation unit requires 5% cost to replace equipment at a latter date, 5% is the driver rate for that particular product. Unit, batch  and product level costs can be determined with ABC. The following steps can summarize the ABC process. The first step is to identify the activities that consume resources and allocate costs to those activities. For example, purchasing materials, record keeping, labor, materials, miles driven, machine hours and number of customers served are activities, which consume resources and needs costs to be assigned to them. The second step is to distinguish the cost drivers that are related to each activity. For example, if machine hours an activity used in the process, then the number of hours used in production of one unit would be the particular cost driver rate. The last step is to allocate costs to products by multiplying the cost driver rate by the number of cost driver units consumed by the process. There are many inherent strengths in the ABC model. The ABC model allows costs to be allocated to many different activity centers. Few corporations can focus on undifferentiated product lines and be successful. Having multiple product lines means the company has multiple cost drivers associated with each different product line. ABC is helpful in selecting which products are successful and which ones should be eliminated. Accurate cost information is key in determining the actual costs of frequent product changes. This cost is important because costs can be a good indicator of the justification or termination of varying product lines. Product lines have become more complex. Product lines of past were much simpler. For example, the Model T Ford came in one style and one color, black. Today, Ford cars have many different colors and styles. These different styles all have different cost drivers and activity centers. ABC illuminates hidden costs when high volume sales are not present and product differentiation is. This is advantageous because unprofitable lines can be replaced with lines that are profitable. Not many years ago, labor comprised 25 to 50 percent of a products cost. However, since the 1960s, labor is increasingly less involved in the  production process. For example, the textile industry replaced 100-year old shuttle looms for European air-jet looms, doubling output with less labor. In steel, the Nucor corporation used continuous casting machines to yield labor costs of $60/ton verses traditional steels $130/ton. Labor cost today is infrequently the driving force behind costs it was during the development period of cost accounting (1930s). Instead, indirect costs have replaced labor as the dominant portion of costs for some products (Kelly, 1991). To use labor as the major basis for allocating as job costing or process costing accounting does, may lead to inaccurate decisions by management. The accounting profession has largely overlooked ABC. Among reasons cited for low adoption were employee resistance and the organizational changes essential with the use of ABC (Ness Cucuzza, 1995). Some trace the source of hindered adoption of ABC to technical as well as cultural issues. Others feel that ABC would be more widespread in industry if it were marketed better by the accounts themselves (Brausch, 1992). There are several reasons for ABC low adoption rate. Complexity is an obstacle to implementing ABC. ABC requires detailed records of the costs associated with producing products and services as compared to traditional methods. This detailed record keeping requires more effort from the accountants and is more time consuming. The complexity of ABC can contribute to more errors. ABC can require more time to check and recheck to uncover errors. ABC generally requires more effort on the part of the accountant verses traditional methods and reduces the adoption rate of ABC. Another reason for not using ABC is the increased economies of scale. Many corporations are standardizing their products to reduce the costs to manufacture them. For example, Coca-Cola distributes its products in many different countries. The product varies very little in respect to packaging and manufacturing. Traditional methods of accounting can assign costs more easily, quickly and accurately for those products that have little or no product variation. ABC is a valuable tool in calculating the costs of producing varying product  lines. These differing product lines require more extensive accounting practices than traditional costing methods provide. The information obtained from ABC can help promote product lines that managers feel are profitable between those which should be eliminated. Labor is less frequently the major ingredient in the production process. ABC addresses this concern by examining and illustrating the overhead costs associated with particular activity centers. ABC describes these over head costs more accurately and is beneficial when increasingly more complex manufacturing processes are used. Adoption issues should be addressed to implement ABC method when costing decisions matter to managers. Bibliography: ReferencesBrausch, J.M. Selling ABC: New Cost Systems Can Flounder if They Are Not Marketed. Management Accounting, February 1992, pp. 42-46. Geishecker, M.L. New Technologies Support ABC. Management Accounting, March 1996, pp. 42-48. Kelly, K. A Bean-Counters Best Friend. Business Week, October 25, 1991, pp. 42-43. Ness, J.A. and T.G. Cucuzza. Tapping the Full Potential of ABC. Harvard Business Review, July/August 1995, pp. 130-131. Selto, F.H. and D.W. Jasinski. ABC and High Technology: A Story with a Moral. Management Accounting, March 1996, pp. 37-40. 17

Care for Post Elective Coronary Artery Bypass Graft Surgery

Care for Post Elective Coronary Artery Bypass Graft Surgery Assessment for the care of patient with respiratory problem  following Coronary Artery Bypass Graft 3 vessels disease and Mitral Valve Repair Introduction This essay examines a case study of a male patient with a complex history who has undergone elective coronary artery bypass graft surgery, and suffered a number of recovery complications. Coronary artery disease is a common pathology in the Western population, perhaps due to lifestyle and dietary factors, including lack of exercise and smoking. The case history will be examined in the light of nursing care and current theoretical knowledge, looking at the individual needs of the patient and the potential interventions which could be employed to address this patient’s emergent and ongoing condition. Nursing care at any stage, critical, acute or chronic, must be an holistic process which takes into account all of the social, physiological, psycholological, emotional and spiritual needs of the person. Given the critical state of this individual’s health, however, some needs can be identified as more urgent that others. The case history will demonstrate the predominant needs of this patient as those connected with his respiratory function and status, and therefore while all aspects of the case will be considered, considerable attention will be paid to his respiratory needs, treatments and potential outcomes. The focus is on nursing care, which must address the emergent clinical picture whilst considering long term, mid term and short term outcomes in a client-centred context. Discussion The patient, who shall be called Mr S to protect confidentiality, was admitted on June 6th for an elective coronary artery bypass graft procedure, plus a Mitral Valve Repair. According to UHC (2007) a coronary artery bypass graft (CAB or CABG) is a surgical procedure in which a healthy blood vessel is transplanted from another part of the body into the heart to replace or bypass a diseased vessel. In this case, it is the treatment of choice for the patient whose history of myocardial infarction and coronary artery disease made him a prime candidate for corrective surgery. Coronary artery disease is defined as the failure of the coronary arteries to deliver oxygen and fuels for myocardial work (Emery and Pearson, 1998). Coronary artery disease is a leading cause of myocardial infarction (Emery and Pearson, 1998). According to STS (2007), mitral valve repair is an open heart procedure which aims to treat stenosis or regurgitation of the mitral valve, which is the inflow valve for the left side of the heart. In normal physiology, blood flows from the lungs, where it picks up oxygen, and into the heart through the mitral valve (STS, 2007). When it opens, the mitral valve allows blood to flow into the left ventricle, which then closes to keep blood from leaking back into the lungs when the ventricle contracts to pump blood into the systemic circulation (STS, 2007). In this case, mitral regurgitation has been diagnosed, which is probably consequential to Mr S’s ischaemic heart disease (Emery and Pearson, 1998). The patient history includes the following: post lateral MI treated with thrombolysis; shortness of breath on exertion; treatment with GTN; hypertensive disease; raised cholesterol; smoker (80-100 cigarettes a day, stopped smoking in 2000); umbilical hernia repair; removal of a benign growth on the thyroid gland; left ankle oedema; distal varicosities to the left extremity. Mr S is allergic to penicillin, overweight at 115kg and has been treated for the health consequences of his lifestyle for some time. Mr S underwent the procedure as planned, with the standard postoperative care. On return to the ward from theatre he was initially on synchronized intermittent mandatory ventilation, which is a system that was developed as a method of partial ventilatory support to facilitate liberation from mechanical ventilation (CCM, 2007). In this system, a demand valve is located within the system through which patients can take spontaneous breaths, without having to breathe through the ventilator apparatus, allowing the patient to breathe spontaneously while also receiving mandatory breaths (CCM, 2007). As the patient’s respiratory function improves, the number of mandatory breaths is decreased, until the patient is breathing unassisted on continuous positive airways pressure (CCM, 2007). Non invasive forms of ventilatory support have been found to be associated with improved patient outcomes (Peter et al, 2002), in a range of acute respiratory conditions including acute respiratory fail ure. Mr S was extubated after ten hours, placed on high flow oxugen via face mask at 50%, but PA02 was only 7 with quiet lung bases on auscultation, leading to the introduction of WCPAP, with a PEEP of 7.5. He was coughing but not expectorating, and developed a number of other postoperative complications which are listed below. His CVP was on 24mmhg and stable within that range. Blood Pressure went down to 80/50 mmHg, treated with gelofusion with no response. noradrenaline was started 07mic/kg/min Frusemide 20mg /hr with good effect; on the second day urine outputtailed off to 60-70ml/hr so the frusemide was increased in 40mg/hr with good effect. Urine output increased to a ratoe of 120-150mls/hr. Mr S has has 3 chest drains: mediastinal, pleural and pericardial . Mr S is ventricularly paced at around 90 beats, with an underlying bradycardia of 44 beats /min. Blood results: urea was 4.4 on the first day, 8.3 day two post-op; creatinene was initially 102, then 164, and on the third day it was 280. Noradrenaline was used, followed by some attempt to wean MR S of this level of support, but the MAP was not stable and could not be kept at 70, and so noradrenaline recommenced. Plans for discharge were postponed due to the WCPAP, the renal complications and the blood pressure issues. Mr S was had an Epidural with plain levopuvicaine at 5mls per hourincreased to 8 mls because of pain on movement; in addition to this he had a PCA (which was being used minimally), and regular Cocodamol. As can be seen, Mr S’s condition is quite serious with a range of complications from the surgery related to his postoperative recovery. Given than cardiac surgery has been performed and there are issues with maintaining blood pressure and cardiac rhythm, the two appear to be connected. Low cardiac output due to arrythmias are of some concern, and so all observations should be closely monitored. The area of concern for this essay, however, is the area of the respiratory complications, but brief mention will be made of the nursing considerations of the other aspects of his condition Nursing care focusing on his pain relief should include regular pain management, assessment of pain scores and sedation levels, and hourly pump checks on the epidural infusion and the PCA. These should be documented contemporaneously and comprehensively, and this information should be used for ongoing care planning, evaluation and communication with colleagues. Monitoring of intravenous infusions should include checking the IV site and cannula for patency or any signs of inflammation, checking that all the infusion lines are connected, and the pumps are set at the correct rate. Fluid balance should be recorded on the appropriate chart at the appropriate hourly intervals. The colour and consistency of the urine should also be noted. Fluid management is important in respiratory disease because excess fluid intake is prone to leak through the capillary membranes into the lung tissues (Peters, 1998). Vital observations should be recorded as specified by the medical and cardiothoracic teams. Pressure area care should be carried out, nutritional status should be monitored, and responses to medications noted. All medications should be administered as charted. Further to this, the chest drains must be observed, insertion sites assessed for signs of infection, and temperature monitored for signs of systemic responses to infection. The drain contents must be included in the fluid balance measurements, and must also be reported to the doctors, and observed for signs of haemorrhage. The drains must be kept off the floor but below the level of insertion of the tubing, to prevent the contents tracking back up towards the body, which would increase the risk of infection. For this reason, if Mr S is moved at any time or repositioned, or during procedures such as bedmaking and attending to hygiene needs, the tubing of all three drains should be clamped for the duration of the activity and then unclamped again afterwards. In addition to this, Mr S appears to need considerable respiratory support. The literature shows that satisfactory oxygenation can generally be achieved in most patients by the use of continuous positive end expiratory pressure (PEEP) using a continuous positive airway pressure (CPAP) mask with a PEEP valve of 5-10 cm of water. However, it has become apparent that Mr S cannot be safely weaned from this as yet. One option to consider would be NPPV, which is a treatment which has evolved from CPAP (Peters, 1998). It has been found to be very effective in providing ventilatory support for patients with respiratory disorders, particularly long term and in the home setting (Peters, 1998). This might be one option which could support Mr S in being discharged from the intensive care facility. Positioning and physical support to maintain this are also important (Peters, 1998). Therefore, Mr S should be nursed upright or semi-upright, well supported by pillows, but giving due consideration to pressure area care. Thorens et al (1995) suggest that the quality of nursing seems to be a measurable and importantfactor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. While Mr S’s condition is not COPD, many aspects of his symptoms and, obviously, the environment in which he is being nursed, are similar to those described in this study by Thorens et al (1995). They suggest that below a threshold in the available workforce of ICU nurses, the weaning duration of patients from ventilation and other forms of mechanical ventilatory support increases dramatically (Thorens et al, 1995). Therefore, very close attention should be given to the education and number of ICU nurses (THorens et al, 1995), which in this instance could be vie wed from a managerial point of view, in ensuring that the appropriately skilled and experienced nurses are those allocated to the care of Mr S, and that his case should be seen as a priority. Addressing Mr S’s emotional and psychological needs are also important. While it is an extremely invasive and potentially life threatening procedure, coronary artery bypass graft surgery and mitral valve repair surgery are associated with positive patient outcomes(Moshkovitz et al, 1993). This was also an elective rather than an emergency procedure. This may mean that Mr S was not necessarily expecting such a problematic recovery period and so will need support adjusting to this. The same could be said for his family and carers, who would perhaps be somewhat shocked to find him still in a relatively serious condition. The support mechanisms available to him should be assessed, and it should be factored into the nursing care plan that time (often the most precious resource available to nurses) is allocated to him to ensure that he has amply opportunity to communicate with the staff. Communication difficulties may be associated with his condition, state of mind, level of conscio usness and the use of CPAP, and these must be taken into consideration. Wong et al (1999) discuss risk factors of delayed extubation and prolonged intensive care unit length of stay, which suggest that such occurrences are associated with higher levels of morbidity and longer periods of recovery. Whether this is due to the nature of the underlying condition, or the nature of the environment (or both), cannot be determined. However, it would appear that it is in Mr S’s best interests to be facilitated towards a level of wellness along the illness-wellness spectrum that is sufficient to warrant his discharge from the intensive care unit. It might be appropriate to consider different medication regimes, or to allow the physiological systems of his body more time to adjust to his postoperative recovering state. Another potential action might be to remove the epidural and encourage Mr S to use the PCA more appropriately, to support his pain control as a self-managed phenomenon, and to encourage a move towards increased independence, mobility and generally improved health. There is a degree of motor block evident from the epidural. Epidurals are also associated with low blood pressure, so this might be a factor in Mr S’s condition. The epidural would need to be removed under aseptic technique, and a small dressing placed over the site. The tip of the epidural catheter must be checked to make sure it is complete, and this noted in the patient’s records. Close monitoring of the patient’s blood pressure following this might allow the nurse to assess whether this has had a positive effect on Mr S’s blood pressure. Similarly, if Mr S is more mobile and able to move a little more independently, this might increase cardiac output and improve blood pressure. He is at considerable risk of post-operative thrombosis, in particular deep vein thrombosis and pulmonary embolism, and so mobilisation will be a key factor in his recovery and in preventing these complications. Hannan et al (2003) found that post-operative recovery from coronary artery bypass graft surgery can be adversely effected if the patient suffers from 6 or more comorbidities. Given his medical history, it is unsurprising that Mr S finds himself not recovering as quickly as potentially possible, and so it is important to maximise all opportunities to promote recovery and health. The use of low molecular weight heparin as a prophylaxis against deep venous thrombosis and pulmonary embolism is common in post-operative care, and is likely to be used here. However, there is a serious consequence of anti-coagulant therapy, which is the incre ased risk of haemorrhage, and so this again will need to be monitored for very carefully. Stanley et al (2002) suggest that neurocognitive decline is a continuing source of morbidity after cardiac surgery. This may be associated with cardiac arrythmias (Stanley et al, 2002). Mr S’s underlying bradycardia may then be a contributory factor in his long-term prognosis and this is why such intensive cardio-pulmonary support is warranted. Neurocognitive dysfunction is common after coronary artery bypass graft surgery (Stanley et a, 2002), and so assessments of this should form part of the ongoing care and monitoring of his condition. The pacemaker will also be monitored for functionality, and heart rhythm observed. Any changes will be assessed by the cardiothoracic team and any improvements towards normal rhythm noted. It is also important for nurses to consider multidisciplinary team input as a part of interprofessional working and client-centred care. For example, some research has demonstrated that a multidisciplinary approach to weaning from mechanical ventilation has been associated with greatly improved outcomes in the short and long term (Smyrnios et al, 2002). Mr S, given his condition, would be a prime candidate for pulmonary physiotherapy, which has been argued by some to be useful in the recovery process. Given the respiratory assessment findings, this may be used. However, the usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved(Pasquina et al, 2003). Therefore it would need to be a collaborative decision in conjunction with the consultant in charge of Mr S’s case. Conclusion This examination of Mr S’s case and history has demonstrated that he is suffering from a number of post operative complications associated with his surgical status, his past medical history and the range of comorbidities he is suffering. The diagnosis of his current condition must remain the area of responsibility of the doctors who are in chargeof his case. However, nursing interventions are a vital component of his care and potential for recovery. While doctors may diagnose and prescribe, it is the nursing staff who assess, monitor, administer therapies, and engage in the majority of prophylactic activities to support optimal return to wellness. This essay has also considered the need for an holistic approach to Mr S, viewing him as a person in the context of his own life rather than simply a set of conditions which much be treated and hopefully, resolved. However, the nature of his condition is serious, and until the cardiac and respiratory function issues are resolved, there is very little that can be done other than to support him and his body systems to continue to function, whilst engaging in nursing activities aimed at minimising further complications from his continued dependent and unwell state. There are a number of actions that can be taken, including pressure area care, fluid management, engagement with the multidisciplinary team, and pain management, all of which can contribute to supportive a positive prognosis for Mr S. However, he continues to require intensive nursing care until such time as he is able to be weaned off the CPAP and the noradrenaline which is helping to maintain the blood pressure. 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