Paper on The Collapse of the Soviet Union and Its Impact on Eurasia Essay

Paper on The Collapse of the Soviet Union and Its Impact on Eurasia - Essay Example The states themselves had likewise to wrestle with the real factors of being all alone, and sewing new partnerships with their neighbors and the remainder of the world. A large number of them saw interior insurgencies, while others were substance to let business as usual proceed for at some point. Today, a considerable lot of them have lively vote based systems and flourishing economies, however this can't be said of all. The Union of the Soviet Socialist Republics, or the USSR, was the world’s biggest communist state. At the point when it was made in 1922, it involved Russia, Ukraine and Belarus, just as Georgia, Armenia and Azerbaijan. By 1956, it contained Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. Russia was the most impressive of these, and the one that controlled the association. Before the association was broken up in 1991, it stretched out from the Arctic sea to the Afghan fringe with a populace of around 293 million. The Union of the Soviet Socialist Republics or the USSR included fifteen republics that were comprised of individuals of shifted ethnicities and disparate nationalities. On the 25th. December 1991, the Union of the Soviet Socialist Republics was officially broken down and the fifteen expresses that included the USSR got autonomous. This additionally denoted t he finish of the virus war. Despite the fact that by all accounts, the destruction of the Soviet Union looked unexpected, odd and frightening, some drawn out elements gave a moderate and slow decrease in its capacity, while other transient variables gave the trigger that encouraged its breakdown. By the 1980s the socialist philosophy was on the decrease, and the possibility of the state being the main and managing power of Soviet life the core of its political framework, of all state organs and open organs, (Lewin, 1991) was being addressed. Vladimir Lenin’s progressive vision of a framework

Some of the Trades Women Practiced in Early America on the Colonial Coursework

A portion of the Trades Women Practiced in Early America on the Colonial Williamsburg site - Coursework Example Ladies indicated that they had the option to deal with their families and do obligations like men. 1. Ladies worked during these circumstances for different reasons. Ladies were at home with their youngsters while the men were off at war. Ladies were left with bills and obligations that men once dealt with. The mechanical and assembling industry required laborers to help make things for war and shops immediately started topping off with ladies. 2. Working influenced the lives of ladies from numerous points of view. Ladies felt free and no longer depended on men. Ladies had the option to consider themselves to be laborers who could win cash and settle on choices all alone. Ladies immediately became use to the way that men were not required for endurance as once suspected previously. Ladies turned out to be extremely bustling attempting to shuffle work, family and family errands. A few ladies appreciated the entirety of the obligations while others became overpowered. Notwithstanding emotions felt, ladies of early America cleared a path for ladies of the

Mat 201 Module 1 Essay Example

Tangle 201 Module 1 Essay Example Tangle 201 Module 1 Essay Tangle 201 Module 1 Essay TUI THOMAS J. COBB MAT 201 Module 1 †Case Assignment Dr. Alfred Basta Mat 201 Module 1-Case Assignment Thomas J. Cobb 1. Assume you have 4 nickels, 6 dimes, and 4 quarters in your pocket. On the off chance that you draw a coin arbitrarily from your pocket, what is the likelihood that: a. You will draw a nickel? The likelihood of somebody drawing a dime would be 4/11 or 36%. b. You will draw a dime? The likelihood of some drawing a nickel would be 6/11 or 54% c. You will draw a quarter? The likelihood of somebody drawing a quarter would be 4/11 or 36% 2. You are rolling a couple of bones, one red and one green. What is the likelihood of the accompanying results: a. The aggregate of the two numbers you move from the bones is 11. There are 2 potential results. 5,6/6,5 b. The aggregate of the two numbers you roll is 6. There are 5 potential results. 1,5/5,1/3,3/4,2/2,4 c. The entirety of the two numbers you roll is 5. There are 4 potential results. ,4/4,1/3,2/2,3 3. A glass container contains 6 red, 5 green, 8 blue, and 3 yellow marbles. In the event that a solitary marble is picked indiscriminately from the container, what is the likelihood of picking a red marble? a green marble? a blue marble? a yellow marble? a. The red marble would have a 6/22 or 27% possibility of being drawn. b. The green marble would have a 5/22 or 23% possibility of being drawn. c. The blue marble would have a 8/22 or 36% possibility of being drawn. d. The yellow marble would have a 3/22 or 14 % possibility of being drawn.

Business Plan for Mobile Phone Recycling Essay Example | Topics and Well Written Essays - 3500 words

Strategy for Mobile Phone Recycling - Essay Example Expenses and Pricing Strategy 15 9. Money related Forecast 15 9.1 Sales and Cost Forecast 15 9.2 Cash Flow Forecast 17 9.3 Cost Table 17 9.4 Personnel Plan 18 Works refered to 19 Student Name: xxxxxx Subject: Management Topic: Business Plan for Mobile Phone Recycling 12 April, 2013 1. Official Summary ABC Recycle Company is a recently enrolled cell phones reusing association which means to dispatch its cell phone reusing tasks by setting up another plant in the region of London. The organization has the point of view to upgrade its regions of tasks in couple of other two urban areas in United Kingdom during next three years. Alongside money related points, the significant target of ABC Recycle is to furnish the clients with conservative options for the removal of their cell phone squander. The subsequent target is to keep the general public liberated from natural issues by arranging off misuse of cell phones. This showcasing plan has been set up in the wake of breaking down different issues with respect to the cell phone reusing industry in United Kingdom. ... Because of common sense, cell phones are available generally and now have become the main specialized device. Be that as it may, utilization of cell phone causes wellbeing risks because of the harmful synthetic compounds found on the cell phones and their extras. Utilization of cell phone likewise imperils distinctive creature species known to man. This is on the grounds that the components utilized in covering cell phones are perilous to creatures and their living spaces. The issue of wellbeing and jeopardized species is tended to internationally by reusing the a large number of cell phones found on the planet. The constant developing utilization of cell phones alongside the expanding insight of overall population with respect to their reusing has featured the need and noteworthiness of reusing industry and in this manner numerous producers are resulting in these present circumstances portion of the business. We will build up our new ABC Recycle Company in this division. 1.2 Busines s Aims The principle tasks of ABC Recycle Company will be to gather the utilized or unserviceable cell phones from the market and afterward in the wake of reusing process, making new item for reuse. Our reused mobile phones will meet the accompanying targets. (an) A reachable practical substitute to the clients for retailing their cell phones (b) To moderate the effects of misuse of cell phone on the earth 1.3 Financial Summary After the underlying phase of buying essential hardware and gear, ABC Recycling Company will start its reusing activities and ordinary deals in May. As indicated by our budgetary arrangement, the organization will contribute ?2,700,000 to buy one reusing line and one assembling line to set up the reusing plant and working capital. The three accomplices will additionally contribute ?1500,000 alongside ?800,000 long haul advances. We will likewise give

Fan, Ying : Branding the Nation: What Is Being Branded?

Fan, Ying : Branding the country: What is being marked? Diary of Vacation Marketing Volume 12 Number 1. 2005 p. 4-13 Abstract: The paper by Fan clarifies what country marking is. So first the contrast between Nation marking and Nation brand is clarified. Each Nation has a specific picture with or without Nation marking. It looks at the idea of country marking, concentrating particularly on the topic of what is being marked. The paper attempts to clarify what country marking is and attempts to clarify the contrasts between from one perspective country marking and item marking and then again country marking and item nation picture. Moreover it talks about dumbfounding issues of country marking and attempts to give a more extensive setting in which country marking can be applied. Be that as it may, to discover how country marking could help monetary advancement in a nation , more research is required. It is difficult to state how significant the job of country marking truly is. Watchwords: ation marking, nation marking, nation of-source impact, item nation picture, place promoting The writer: The paper is composed by Ying Fan a senior teacher at Brunel Business School, Brunel University in London. Dr Fan has held personnel positions at the colleges of Lincoln, Hertfordshire and Durham. His exploration advantages encompass marking and promoting interchanges, and multifaceted administration issues. Subject: Branding the country: What is being marked? The significant subject of the paper is the thing that country marking is and what the motivation behind country marking is. Research question : What is being marked? Is a country brand a different substance, or a component in the item brand? What is the bearing of the connection between's nations that have delivered solid brands and those that are solid brands themselves ? Strategy : The examination technique is a scholarly investigation Material and Structure of the paper: On the principal page of his paper contact informations, informations on the creator including a photograph of Fan are given. An Abstract summarizes the Keywords and gives an outline over the article. With everything taken into account the paper of Fan is 9 pages in length and is organized in the parts: Introduction What is Nation Branding? What is being marked? Country marking and item marking Nation brand picture and item nation picture Paradoxes The more extensive setting For a further understanding Fan gives 3 Tables: Terms utilized in the writing ; Examples of country marking where he gives 5 models and clarifies what is being marked and a table on Comparison between country marking and item marking . In his paper Fan makes backhanded references which are recorded in the references. Here the references are requested by appearance in the content not in order. The paper is anything but difficult to peruse and comprehend, it gives a decent review of the subject country marking. The structure is anything but difficult to follow. The paper is namelessly refereed. Finding of the article : The writer brings up that there is no single definition on country marking yet gives a working definition for the paper: ‘Nation marking concerns applying marking and showcasing interchanges strategies to advance a nation’s picture. Country marking can be utilized in various manners: utilizing the nation’s picture to advance deals and fares ; place marking which is a piece of the travel industry advertising ; political promoting for instance the articulation â€Å"axis of evil†; Nation marking in it's actual sense like Cool Britannia. The creator brings up that a country isn't an item in the ordinary sense . The Nation itself can barely be changed, the adva ntages are simply passionate, the Image is muddled and the proprietorship is indistinct. A country brand isn't fixated on a particular item, administration or cause that can be elevated legitimately to the client. Be that as it may, Nation marking concerns a nations entire picture, covering political, financial, authentic and social measurements. A Nation has not one but rather various pictures. What picture is recovered relies upon the crowd , the specific situation and the time. The creator discovers that negative national picture doesn't really influence the acquisition of items made by that nation, by giving the case of Japan and China. The creator attempts to discover the bearing of the connection between's nations that have delivered solid brands and those that are solid brands themselves . Country marking must be unmistakable and help the nation to situate itself against contenders . A trouble is that a universal crowd have an alternate level of information on a country and every nation has distinctive social qualities, accordingly disentangles the message in an unexpected way. Country marking regularly attempt to convey a solitary picture or message to various crowds in various nations . This renders for the creator the message insignificant, yet to attempt to be everything to all individuals will in the assessment of the creator unavoidably fall flat . What is the message a country needs to send, surrender an old however extraordinary picture for the new picture. This can bomb like for instance â€Å"Cool Britannia† did. Another trouble in country marking is that a national personality is extremely hard to characterize. Moreover in country marking, a comprehension of the customers’ existing impression of the country is significant. A specific picture is made after some time. Another significant part of country marking is the inward crowd. The creator brings up that Nation marking is only one piece of an advertising system which is a piece of the business methodology and that frequently country marking is overestimated regardless of whether it is a useful asset. It is for instance not adequate for the nation to elevate its picture energetically to different countries if the monetary reason for the country brand isn't there or the political circumstance is shaky. The picture issue of an area or country regularly results from political and financial difficulties which must be understood, country marking won't tackle a country’s issues however just fills in as the last touch .

Book References in Gilmore Girls A Year in the Life

Book References in Gilmore Girls A Year in the Life Ive been a fan of Gilmore Girls since the show began airing in October of 2000. Approximately six years ago, I began a blog where I documented my personal challenge to read all of the books referenced in all seven seasons of the series (full disclosure: Im still only on season two). I flew to Austin, Texas to attend the Gilmore Girls cast reunion at the ATX Festival. I began a podcast that is simply used as a vehicle to gush about how much my cohost Rob and I love the show. In October, I spent a weekend in Washington Depot, Connecticut (it helps that I live in Connecticut) with my friends as the town recreated a Stars Hollow experience. And did I mention that I named my daughter Lorelai? So it probably comes as no shock that the minute I heard about Netflix doing a revival consisting of four 90-minute movies, I immediately went out and purchased all of the Pop-Tarts, coffee, Mallomars, and pizza that a girl can physically eat without starting to resemble a Mallomar herself (but oh, that marshmallow-y filling)! Given the fact that I write for Book Riot, I knew that one of my self-appointed goals as I sat down to watch Gilmore Girls: A Year in the Life (besides trying not to cry too loudly at the scenes referencing Richard Gilmores death) would be to compile all of the literary references. So go visit Andrew at Stars Hollow Books and get to reading! WINTER The Adventures of Huckleberry Finn by Mark Twain Lorelai: I thought there’d be something fun in there. You know, like a treasure map. Or the prequel to Huckleberry Finn where Huck is a Klan leader and terrified of water Cyrano de Bergerac by Edmond Rostand Lorelai: Cyrano? On the Road by Jack Kerouac Lorelai: Yeah, but for now she’s Jack Kerouac. She’s On the Road-ing it. Pass the Peyote! [Fun fact: On the Road is actually the very first literary reference made in the original series.] John McPhee Rory discussing her upcoming book project: It’s not like I’m John McPhee Logan: Yet. The Life-Changing Magic of Tidying Up by Marie Kondo Emily explains that she has read The Life-Changing Magic of Tidying Up and is going through all of her possessions. Lorelai: He’s taking the dining room chairs. Emily: They don’t bring me joy. SPRING William Shakespeare   Naomi Shropshire: Come April, it’s like my face is one of Shakespeare’s first folios. Aeschylus Rory: And she kept coming back to it. Comparing the archetypes to characters in some play by Aeschylus. Oh, and you haven’t lived until you’ve heard a tipsy Brit try to pronounce Aeschylus. Logan: Hey, Aeschylus is hard even when you’re not tipsy. Death of a Salesman by Arthur Miller Rory: And trying to convince her that Willy Loman is not one of the characters in Aeschylus. That was a hoot. Edith Wharton Lorelai: I’m not Edith Wharton. I don’t write letters. Ralph Waldo Emerson Paris: I cannot remember the books I’ve read any more than the meals I have eaten. Even so, they have made me. Jane Eyre by Charlotte Bronte Written on the board in the literature class at Chilton:   Motifs of Jane Eyre The Art of War by Sun Tzu Paris: It’s killed or be killed. I’m not talking The Art of War. Oh no, that’s a tiptoe through the tulips compared with what you’re going to find beyond these walls. Dorothy Parker Paris: He loved telling people ‘it’s pre-war! Pre Civil-war!’ Like that wouldn’t make Dorothy Parker barf. [Worthy of note: Amy Sherman-Palladinos production company is called Dorothy Parker Drank Here] Consider the Lobster and Other Essays by David Foster Wallace Jim: I always like a spoonful of sugar. Denise: Consider the Lobster? It’s a serious subject but funny and truthful. Jim: Yeah, that’s the camp I’d put you in. I mean, no one’s David Foster Wallace. But there’s an erudition to your stuff and some whimsy which I like. Cloud Atlas by David Mitchell Robert Castellanos: And Miss Shropshire would like you to sign a letter waiving all rights to the Whale and Mouse idea. Rory: Fine.  Wasn’t exactly the next Cloud Atlas. Outlander by Diana Gabaldon Lorelai: Well, mom at 16 for starters. Hot in Outlander. But elsewhere… SUMMER Wild by Cheryl Strayed The book Lorelai is reading poolside [Wild becomes a major plot point in the Fall episode as well] Anna Karenina by Leo Tolstoy The book Rory is reading poolside Noam Chomsky April: I took some great linguistic courses too. I mean, it’s MIT. Noam Chomsky walks the halls. I met him. Chatted with him. Laughed with him. He’s my idol. Lorelai: Well, to Noam is to love him. Game of Thrones by George R.R. Martin Taylor:  That’s Nat sitting at the end of the first row. He’ll be directing as well. Let’s give him a nice hand. Rory: Whoa. Give him a crystal sword… he’s a white walker. [later scene in the same episode] Rory: I’m sleepy. I think I’ll nap, Brandon. Brandon: Yes, Khaleesi. Who’s Afraid of Virginia Woolf by Edward Albee Taylor: The opening scene is an excerpt from a play I wrote in college that happened to be blessed by my mentor, the great Edward Albee. You may know him as the author of a little something called Who’s Afraid of Virginia Woolf. Dave Eggers Rory: So you got Dave Eggers shaking in his boots? Jess: If Dave Eggers even knows we exist, I’d be happy. I Feel Bad About My Neck: And Other Thoughts on Being a Woman by Nora Ephron Rory: I don’t want to say you’ve been filing that piece of paper for a long time, but when you started, Nora Ephron felt good about her neck. Ode: Intimations of Immortality from Recollections of Early Childhood by William Wordsworth* On Richard Gilmores gravestone:  That there hath passd away a glory from the earth. *This quote was incorrectly attributed throughout the episodes to Longfellow on the gravestone and as its being discussed.  The correct author is Wordsworth. FALL Eat, Pray, Love by Elizabeth Gilbert Hiker: I almost did Eat, Pray, Love but my miles were blacked out. So here I am! Macbeth by William Shakespeare Life Death Brigade member: By the pricking of my thumb, something this way comes. Call of the Wild by Jack London Lorelai taping items to her pack: I have your call of the wild right here, pal The Portrait of Dorian Gray by Oscar Wilde Lorelai: You don’t move or change ever.   There’s a picture of you in the attic that Dorian Gray is consulting copyright lawyers about. David Mamet Lorelai: What’s the exact moment you became a Mamet play? Little House in the Big Woods by Laura Ingalls Wilder Sookie: Yeah, he’s been reading Little House in the Big Woods to Martha and he got to the part where Ma goes outside to check on… Lorelai: Oh, the horses! Because she thought the cow…. Sookie: had gotten out of the… Lorelai: barn. But it’s not and she smacks him on the nose and… Both:  it’s a bear! My Struggle by Karl Ove Knausgaard The book Jess is reading as he waits  in Luke and Lorelais living room.

Poetry 101 What Is Enjambment in Poetry

Poetry is a structured literary form, with patterns and rhythms that dictate the flow of verses. Lineation in poetry is how lines are divided and where they end in relation to a clause or thought. Having a line break at the end of a phrase or complete thought is a regular and expected pattern in poetry. Poets subvert this expectation by using a technique called enjambment. Enjambment breaks with our expectations of where a line should end, creating a different feel to a poem.

The Elementary And Secondary Education Act And The No...

The Every Student Succeeds Act (ESSA) was enacted into law on December 10, 2015 by former President Barack Obama. This law replaced the No Child Left Behind Act of 2001 that President George W. Bush passed into law during his presidency. The No Child Left Behind Act (NCLB) replaced the Elementary and Secondary Education Act of 1965 which was passed by Lyndon Johnson. The ESSA â€Å"reauthorizes the 50-year-old Elementary and Secondary Education Act (ESEA), the nation’s national education law and longstanding commitment to equal opportunity for all students† (Department of Education, 2016). The Elementary and Secondary Education Act of 1965 as introduced as part of President Johnson’s War of Poverty Social Welfare program. Between 1965 and†¦show more content†¦The law was scheduled for revision in 2007, and, over time, NCLB’s prescriptive requirements became increasingly unworkable for schools and educators. Recognizing this fact, in 2010, the Obama administration joined a call from educators and families to create a better law that focused on the clear goal of fully preparing all students for success in college and careers† (Department of Education, 2016). In 2007, NCLB act was due for review and reauthorization but due to lack of cooperation among representatives, the bill was not addressed then. During the Obama Administration, states were reviewed and it was discovered that though the NCLB was a good start many states were failing to meet the standards put forth by the act. The Obama administration thus issued waivers to states so that they could reach out to the schools that though were not meeting the standards they showed overall success and positive outcomes (Education Week,2016). These waivers were mention as a way to assist these at-risk schools with achieving the standards. To receive the waiver, many schools were forced to restructure their academic standards in conjuncture with standards such as the Common Core (Education Week, 2016). The Common Core has been a very controversial topic in schools and its effectiveness/credibility. The NCLB along with the ESSA were met with resistance from parents due to theseShow MoreRelatedElementary Secondary Education Act Of 1965 And Its Versions No Child Left Behind Act1488 Words   |  6 PagesEducation is valued as one of the most important aspects of socio-economic group mobilization and social elevation in the United States. Operating under a human capital ideology education in the U.S. is a means to provide education to individuals in an effort for continued economic advancement for our nation. However, as times change education fails to completely change with it. Secondary education is no longer seen as a means to earning financial stability. Primary education encompasses complexityRead MoreEducation Revolution: Why the No Child Left Behind Act Didnt Work1695 Words   |  7 PagesEducation is the foundation of American society. It empowers the youth of America to become the successful leaders this country needs for the future. Education has been one of Americaâ₠¬â„¢s top priorities since 1965, when the Elementary and Secondary Education Act was passed. Now, education is controlled by the No Child Left Behind Act, which was launched in January 8, 2002. This act was passed with intentions from the government to provide Americans with a more superior education system. HoweverRead MoreThe Importance of Improving Public Education Essay examples1453 Words   |  6 Pagesspecifically the â€Å"No Child Left Behind Act.† The No Child Left Behind Act was not the first law passed to affect the nation’s educational systems, nor will it be the last. There have been several problems laid out with the various educational systems put into place, and there are many things we could do today to better our educational systems in the future. Before President Bush’s No Child Left Behind Act went into place there was the â€Å"Elementary and Secondary Education Act of 1965.† However,Read MoreNo Child Left Behind1538 Words   |  7 PagesWe all have heard the key to success is education. However, in the United States, that key to success is far fetched. America as a whole needs many improvements. While America will never be a perfect society as I dream, America needs to take a step forward to improving the country for all. A better education system will be a step toward improving the United States. The education system in America continues to fail our children and falls behind compared to other countries. Children today are tomorrow’sRead MoreThe No Child Left Behind Act Of 20011403 Words   |  6 Pagesfair number of interesting topics in this Political Science 2 class session of the Fall 2016 semester. A few that stood out to me, personally, were the topics of laissez-faire economics, separate-but-equal issues, and the viewpoints of the No Child Left Behind Act of 2001. From the tenth edition of the course book We the People, Texas Ed. by Benjamin Ginsberg and Unit 2 of the lecture; a policy developed by the efforts of the late philosopher and economist, Adam Smith, laissez-faire economics essentiallyRead MoreEffectiveness Of The No Child Left Behind Act Of 2001 ( Nclb )1613 Words   |  7 Pagesthe No Child Left Behind Act of 2001 (NCLB). The NCLB Act of 2001 was a reauthorization of the Elementary and Secondary Education Act of 1965 (ESEA) (www.newamerica.org). The Elementary and Secondary Education Act of 1965 was a Great Society program that allocated federal funds for education and looked to hold schools accountable (www2.ed.gov). The NCLB Act of 2001 was passed through Congress in 2001 with bipartisan support and greatly increased the Federal Government’s role in the education systemRead MoreThe Reauthorization Of The Elementary And Secondary Education Act948 Words   |  4 Pages Every Student Succeeds Act was a new law that was signed into legislation in 2015 by President Barak Obama. ESSA is a biparty educational reform law was designed from several aspects of No Child Left Behind. The United States Department of Education (2015) stated that ESSA focuses on factors such as, advancing equity for the nations disadvantaged students by investing more in preschool programs, local innovations, reporting student progress on all high stakes assessmentsRead MoreNo Child Left Behind Act Essay1166 Words   |  5 Pages1. Definition of the Policy The No Child Left Behind Act of 2001 (NCLB) signed into law by President George W. Bush on January 8, 2002, is a comprehensive overhaul of the federal governments requirements of state and local education systems (www.nclb.gov). It reauthorizes the Elementary and Secondary Education Act of 1965 and replaces the 1994 Improving Americas Schools Act. 2. General Background Information President Bush has made education his number one domestic priority (www.ed.gov). OnRead MoreThe No Child Left Behind Act Of 2001 ( Nclb )1227 Words   |  5 PagesThe No Child Left Behind Act of 2001 (NCLB) is a United States Act of Congress that is a reauthorization of the Elementary and Secondary Education Act, which included Title I, the government s flagship aid program for disadvantaged students. No Child Left behind was enacted with the intent to become a government aid program for disadvantaged students, and eventually raise the general education standards for the United States. This act was created with the idea to â€Å"close the achievement gap withRead MoreEducation Is A Central Need Of All People Around Over The World1543 Words   |  7 PagesEducation considers as a central need of all people around over the world. All children have the whole right to learn. According to Aske, Connolly, Corman, (2012), â€Å"all children in the United States have the right to a pub licly supported education regardless of race, social class or religious beliefs is an American value.† The important point that we should take care of in the rights of education do not look at students’ social levels, race, and religions. Therefore, early reformers attempted and

The United States Healthcare System - 1736 Words

Unit 9 Assignment The United States’ healthcare system is not easy to define. It is a complex, decentralized, market-based system with multiple stakeholders. In this paper we will try our best to discuss the organization, financing, and delivery of the American healthcare system, as well as identify respective flaws. We will conclude this paper with a discussion on potential solutions to the flaws we have identified. Organization The American healthcare system is a complex, market-based system that operates in a non-integrated manner. As with any market-based healthcare system, products and services are offered to consumers for a set price, in accordance with state and/or federal laws (Sadeghi, Barzi, Mikhail, Shabot, 2013). Major†¦show more content†¦Ã¢â‚¬ ¢ Payers—As we have already stated, the American healthcare system is market-based. Therefore, the American healthcare system involves multiple payers from the public and private sectors, as well as the consumer themselves. Public sector payments are either covered by the public payers such as the federal, state, and local governments, such as Medicare and Medicaid, the Department of Veterans Affairs (VA), and the Department of Defense (DOD). Private payers are for-profit entities such as private insurers and businesses. Last, consumers not covered by public and private insurance pay for products and services out of pocket (Sadeghi, et al., 2013). †¢ Advocacy Organizations—Advocacy organizations in the health sector primarily consist of professional groups and organizations such as the American Public Health Association and American Medical Association, with a shared interests in influencing both public opinion and/or public policy (Sadeghi, et al., 2013). †¢ Providers—As the name implies, providers are individuals and organizations that provide a service to the consumer. These services include hospital care, surgery, medical imaging, laboratory tests, etc. †¢ Suppliers—Suppliers consist of for-profit entities such as pharmaceutical companies and medical equipment companies (Sadeghi, et al., 2013). †¢ Consumers—Consumers consist of individuals who utilize products and services

Precipitate Definition and Example in Chemistry

In chemistry, to precipitate is  to form an insoluble compound either by reacting two salts or by changing the temperature to affect the solubility of the compound. Also,​ the name given to the solid that is formed as a result of a precipitation reaction. Precipitation may indicate a chemical reaction has occurred, but it may also occur if solute concentration exceeds its solubility. Precipitation is preceded by an event called nucleation, which is when small insoluble particles aggregate with each other or else form an interface with a surface, such as the wall of a container or a seed crystal. Key Takeaways: Precipitate Definition in Chemistry In chemistry, precipitate is both a verb and a noun.To precipitate is to form an insoluble compound, either by decreasing the solubility of a compound or by reacting two salt solutions.The solid that forms via a precipitation reaction is called the precipitate.Precipitation reactions serve important functions. They are used for purification, removing or recovering salts, for making pigments, and to identify substances in qualitative analysis. Precipitate vs Precipitant The terminology can seem a bit confusing. Heres how it works: Forming a solid from a solution is called precipitation. A chemical that causes a solid to form in a liquid solution is called a precipitant. The solid is called the precipitate. If the particle size of the insoluble compound is very small or there is insufficient gravity to draw the solid to the bottom of the container, the precipitate may be evenly distributed throughout the liquid, forming a suspension. Sedimentation refers to any procedure that separates the precipitate from the liquid portion of the solution, which is called the supernate. A common sedimentation technique is centrifugation. Once the precipitate has been recovered, the resulting powder may ​be  called a flower. Precipitation Example Mixing silver nitrate and sodium chloride in water will cause silver chloride to precipitate out of solution as a solid. In this example, the precipitate is silver chloride. When writing a chemical reaction, the presence of a precipitate may be indicated by following the chemical formula with a down arrow: Ag Cl- → AgCl↓ Uses of Precipitates Precipitates may be used to identify the cation or anion in a salt as part of qualitative analysis. Transition metals, in particular, are known to form different colors of precipitates depending on their elemental identity and oxidation state. Precipitation reactions are used to remove salts from water, to isolate products, and to prepare pigments. Under controlled conditions, a precipitation reaction produces pure crystals of precipitate. In metallurgy, precipitation is used to strengthen alloys. How to Recover a Precipitate There are several methods used to recover a precipitate: Filtration: In filtration, the solution containing the precipitate is poured over a filter. Ideally, the precipitate remains on the filter, while the liquid passes through it. The container may be rinsed and poured onto the filter to aid recovery. There is always some loss, either through dissolution into the liquid, passing through the filter, or adhesion to the filter media. Centrifugation: In centrifugation, the solution is rapidly rotated. For the technique to work, the solid precipitate must be more dense than the liquid. The compacted precipitate, called the pellet, may be obtained by pouring off the liquid. There is typically less loss than with filtration. Centrifugation works well with small sample sizes. Decantation: In decantation, the liquid layer is poured or suctioned away from the precipitate. In some cases, an additional solvent is added to separate the solution from the precipitate. Decantation may be used with the entire solution or following centrifugation. Precipitate Aging A process called precipitate aging or digestion occurs when a fresh precipitate is allowed to remain in its solution. Typically the temperature of the solution is increased. Digestion can produce larger particles with a higher purity. The process that leads to this result is known as Ostwald ripening. Sources Adler, Alan D.; Longo, Frederick R.; Kampas, Frank; Kim, Jean (1970). On the preparation of metalloporphyrins. Journal of Inorganic and Nuclear Chemistry. 32 (7): 2443. doi:10.1016/0022-1902(70)80535-8Dhara, S. (2007). Formation, Dynamics, and Characterization of Nanostructures by Ion Beam Irradiation. Critical Reviews in Solid State and Materials Sciences. 32 (1): 1-50. doi:10.1080/10408430601187624Zumdahl, Steven S. (2005). Chemical Principles (5th ed.). New York: Houghton Mifflin. ISBN 0-618-37206-7.

Teenage Pregnancy During U.s. And U.k - 986 Words

Teenage Pregnancy in U.S. and U.K. Unplanned teenage pregnancy has been a problem in the U.S. and U.K. for many years. While both countries have taken measures to prevent this, it is still an issue. Gerard Lemos, author of Give Parents an Incentive, discusses how the U.K. government has been attempting to reduce the rates of teenage pregnancy. Lemos writes about the problems that teenagers face when they have children so young. One of the main issues brought up is the fact that young parents do not have an incentive to succeed. They are not being encouraged to beat the stereotype placed on teenage parents. He feels that the U.K. government and organizations need to do more to help those who are young parents. In Preventing Teen †¦show more content†¦If the providers are not aware of the changes, they will not be able to provide young adults all information. It is important to analyze the efforts being put into stopping this issue in both the U.S. and the U.K. to see what efforts are more effective. While both countries have resolved to lower the rates, both are still seeing rises. It is necessary to see if any measures seemed to have previously worked and if so, to see if either country is still practicing them. By comparing the rates of teen pregnancy in both countries, the preventative measures that need to be taken can be more clearly understood. Give Parents An Incentive. By Gerard Lemos provides important information about the issue of teenage pregnancy in the U.K. Lemos focuses on the important issue of educating young people about teenage pregnancy and giving them more reasons to want to do well. He says that many children do not fully understand the risks and the methods of preventing teenage pregnancy. The article also focuses greatly on the fact that more efforts need to go into helping young families. Since many people are still getting pregnant so young, there needs to be better support for them. While Lemos does propose different ideas of how to fix this issue, most of these ideas do not have any sources to support them. This could be a problem because it is not clear if these ideas are necessarily credible. Sarah Brown in Preventing Teen Unplanned Pregnancy

Monologue for Aunt Reed on her deathbed Free Essays

How dare she turn up? This is my house. My house! She just appears as though nothing had happened. Out of pity perhaps. We will write a custom essay sample on Monologue for Aunt Reed on her deathbed or any similar topic only for you Order Now Maybe out of guilt. The return to Gateshead Hall can only be out of pity. It is the only logical reason. Why else would she return to me? She is mocking me. I cannot stand for this. I must get rid of her. I cannot let Jane see me like this. I am weak and she is strong. Yet I am still the ruler of this house. I ought to send her to the Red Room. She has not contacted me for several years and turns up as I am lying on my deathbed. It is a mockery. She wants to see me die and suffer. I do not feel guilty for what I did to her when she was younger and why should I? I should only feel guilty for the death of my beloved son John. Maybe I should call for Eliza or Georgiana to remove my husband’s niece from the premises. I want nothing to do with Jane. And surely she is only here to confirm my death and try to stake a claim in the Gateshead Hall! Jane Eyre is a money grabber. She only wants the inheritance. But I will leave it all to Eliza and Georgiana. Jane Eyre is devious. She can barely remember my face and features. She wants to see a familiar figure but she is not welcome here. It is a happy feature that time quells the longings of vengeance and hushes the promptings of rage and aversion. She had left me in bitterness and hatred, and she came back to her now with no other emotion other than pity for her great sufferings, and a strong yearning to forget and forgive all injuries – to be reconciled and clasp hands in amity. My stern eyes can not be taken of that cunning woman, Jane Eyre. I closely watch her movements as she tries to engage in conversation with me. I want nothing to do with it. She must hate me after I used to lock her in the Red Room which she is terrified of. Then maybe she has come to pay her respects to me and just to see me one last time, before I have gone away to a better place, where we rich and religious people go. At least I can finally clear my conscience of Jane Eyre. I took my hand away, and, made my face turn rather from Jane; I made a remark that the night was warm. Again I went to regard Jane so icily, I felt at once that my opinion of Jane – my feeling towards her – were unchanged and unchangeable. I know by my stony eye – opaque to tenderness, indissoluble to tears – that I am resolved to consider Jane bad to the last; because to believe Jane good would give me no generous pleasure: only a sense of mortification. I had to think that Jane had a dreadful life away from Gateshead and that we are the best thing that has ever happened to her. Jane has only returned to see me swallow my pride and take a step back. She may have come to see Eliza and Georgiana but that is far from the truth. There is more to it. She is hiding something. She is not telling us what she wants. She has not told us where she has been these past several years but she only wants to know about us. I must keep Eliza and Georgiana away from Jane. Poison, she is. That rat has returned for herself. She is trying to keep her conscience clean, but is far from it. Her violent behaviour made her seem as though she is an animal. We do not tolerate animals in this household. She belongs under a rock. I have such a passionate hatred for Jane Eyre. Although this is now perhaps the time to forgive and forget as these are my last few moments with her. I shall engage in conversation with her for one last time before I leave this world and enter the next for I am surely going to Heaven as I have never sinned and am the model citizen. I opened my mouth. The dry crust around my mouth crumbled and dropped to the floor, my voice was crackly, my breathing thin and my mouth extremely dry for I could barely swallow my own saliva. My crackly voice came out, and there was a pin drop silence across Gateshead. Jane is trying to listen and etched closer towards me. Saliva crawled out of my mouth, almost as if it had more life than me. Jane screeched the chair across the wooden floor. I went to lash out at her, an uncontrollable fit. Eliza came into the room to control me. She pinned me down and forced water down my throat. Georgiana entered the room and stood on the side of my bed. She looked disgusted with me. Eliza had a firm look in her eye. She was upset with Georgiana. They began screaming at each other. They could not even look each other in the eye. How could I leave my family like this? They will be frowned upon by God and they will separate themselves from each other. My time is to surely be up within the next few days. If it is not the feud between my own daughters, Eliza and Georgiana, that killed me, it would be the fact that my husband’s favourite niece was sitting beside me, acting all innocent, not actually caring if I die or not. I had to get Eliza, Georgiana and Jane away from me. It is torture. The squabbling is driving me mad. The lamp faded as did the life within me. I am getting weaker. The flame is slowly dying out. I decided to drown out the sound of the women and began to think of John. Oh, if he is here right now, it would make me feel much better. He is the light in my life. The fabric of the family. And how this family has collapsed without him. I am now leaving this all behind. I shall meet my husband and begin my new life. How to cite Monologue for Aunt Reed on her deathbed, Papers

The Relationship Between the Experience of Directors and Company

Question: Discuss about the Relationship Between the Experience of Directors and Company. Answer: Introduction The topic of the paper is the relationship between the directors' experience and company profits. The literature review will attempt to find out what (if any) the existing literary sources say about the topic being investigated. However, as the literature review has been completed, it has been observed that there is no specific study which particularly explores the connection between the experience of directors and company profits (Gul Leung, 2004). As there is little literary information regarding this topic, the current literature review concentrates on finding out how the directors' experience influence the board of directors' activities, size, and composition affects the performance or profit of a company (Baysinger Butler, 1985). As all of these themes are associated with the director's experience and the subsequent company profits, it will help in establishing a solid base for the study. Literature Review The directors, as well as the managerial executives of a company, hold an imperative responsibility in current and modernized companies. The essential duty of the directors is to screen the administration for the investors' sake and in this manner, the directors exhort the administration and have the power to make choices or take decisions(Scherrer, 2003). This power incorporates setting the association's technique and official remuneration, designating the best administration and choosing new chiefs(Ferris, Jagannathan Pritchard, 2003). Since the governing body is vested with the duty of guaranteeing that the investors' cash is not squandered, investors should have a genuine enthusiasm for guaranteeing that the board is staffed with well taught and experienced executives(Keay, 2007).In this context, studies led by consultancy firms as often as possible suggest the hard and delicate individual profile variables of the directing executives to be essential for a company's productivity and subsequent profits. The individual factors incorporate work experience, the ability of critical thinking to manage problems, educational standard, respectability, efficiency as a leader or believability (Klynveld Peat Marwick Goerdeler, 2001). Comparable reports suggest that the significance of ability, for example, money related, industry-specific or experience have an immense influence on a company's performance and profits (Executive Insight, 2010). It has been demonstrated that the oversight of specific characteristics, for example, professional ability and experience, may lead to issues while surveying the inclination of different profiles regarding a particular post or for making some critical decisions in problematic situations(Epps Ismail, 2009). The professional variables, for example, the place where the directors have gained their education and the extent of their professional experience might be more applicable than statistic traits in clarifying the level of performance and company profits(Solomon, 2010). The activity of the directors might be determined as per the experience gained by them. An experienced director will potentially use the lessons learnt in the past in order to take critical decisions regarding various complex issues (Bai, 2013). In this context, it is also important to see how the activity of the directors impacts a company's level of performance and its profits too. Vafeas (1999) has demonstrated that organizations with less frequent gatherings or discussion sessions of the directors show the most elevated cost to add value to the company and ensure profitability. The fundamental reason behind such outcome is that an excessive number of gatherings or discussion sessions are a flag of less effective and merely experienced directors who might face several problems regarding correspondence among themselves (Vafeas, 1999). This might be due to their lack of knowledge and experience on how to properly communicate an issue with less complexity and how to decide the action s individually when needed. The outcomes of the study support the past results yielded by Yermack (1996) who described that higher experience levels and efficiency to provide effective leadership might potentially influence the performance and profits of a company. Furthermore, the aspect of the directors' experience is closely related to the size of the boards. The companies would want to appoint experienced and efficient executives in order to not only make sure that board size is small but also to ensure that it performs better than the large boards consisting of less experienced directors (Alnaif, 2014). Consequently, the size of the board will also have an impact on the company value and profits. As indicated by Jensen (1993), the organizations that have larger than average board sizes seem to turn out to be less efficient and this issue directly impacts the company profits. It is clear that the inclusion of excessive members in the boards or any advisory group may decrease their exertion and offer ascent to a certain level of free-riding leading to reduced performance and productivity of the companies. A decreased level of productivity will definitely influence the company profits in a negative manner (Patterson, Warr West, 2004). In a similar way, Yermack (1996) has discovered that, for sure, having fewer members in the board upgrades an organization's execution and impacts decidedly the behavioural approach of the investors as well as the organizational esteem. Thus, the overall value and performance of the company are also affected. However, Adams and Mehran (2008) neglect to locate a negatively constructed impact of the extent of the boards for the execution of the companies when they conducted a study on the banks in the USA. The outcomes recommend that there is a positively identified connection amongst the size of the boards and organizational execution or benefits. Further secondary sources from ICAEW (2017) guidance pages suggest the accounting or financial nature owned by the directors not only further imly the general duties and responsibilities but also the good practice which is minimum requirement in further defining the organizational performance (profits) from time to time. There are different industries that have viewed the relationship, firstly Tufani and Sevick (1997) and Dann et al. (2003) highlights the funds return dependence to focus on relationship between expense ratios and boards of independent directors. Also, Brickley and Horn (2000) believed to have estimated relationship between hospital performance and CEO turnover based on samples for non-profits and profits hospitals such as there is positive yet strong relationship between the two variables. Research Question The research question can be further defined through aim illustrating that directors experience and influence effects the profits of the organization. To further elaborate it is to study whether the directors' experience indeed influences (negatively or positively) the company profits and its further implications. To strengthen the respective research aim, board of directors contributes to the organization significantly because of their legally mandated responsibilities. Also, they intervene in the business through venturing the interest of the firms shareholders, providing advice to the top management followed by using control mechanism by monitoeing of company and managerial performance (Zahra Pearce, 1989) . In this regard, the study will try to find an answer to the following research question: What is the relationship between directors experience and company profits of top 20 ASX companies? Research Plan The proposed research will be quantitative in nature. It will focus on only the secondary sources. This means that the proposed research will not focus on gathering data primarily from participants through surveys or interviews. Rather, it will focus on the existing data related to the topic being studied. The secondary sources will be the company-related financial and organizational information of the top 20 ASX listed companies. The required data will be gathered from the Central Queensland University library databases. In order to collect the data, the researcher will appropriately use some specific search terms as per the names of the listed companies. It would be ensured that all the collected information are relevant and up-to-date. The financial information will help in assessing the trends of profit or loss experienced by the companies. The financial data will be based on the annual reports published by the companies. On the other hand, the organizational data will help in fi nding out the experience level of the directors and if their experience has impacted the company profits. However, it will be ensured that the researcher does not twist or manipulate the gathered information. It is highly recommended that a researcher uses the collected data in its original form in order to avoid any kind of personal bias and enhance the reliability of the outcomes(O'Gorman, 2001). Therefore, it will be ensured that the researcher does not incorporate any personal bias into the research so that highest reliability and validity can be maintained. After the collection of data, a statistical analysis will be conducted with two variables namely (a) Director's Experience and (b) Company Profits. In this regard the SPSS software will be used. There are several software programmes that are available for doing the statistical analysis but SPSS is considered to be the most efficient tool to perform a comprehensive evaluation (Arkkelin, 2014). Therefore, the validity of the d ata analysis will be ensured. The statistical outcomes will help to assess the relationship between directors' experience and company profits, and how the directors' experience might potentially impact the profits. Thereafter, the formulated outcomes will be comprehensively evaluated with regards to the evidence collected from the secondary sources (journals, books, and other relevant documents). In this manner, the study will address and answer the research question through generating statistically significant results and linking them to the existing knowledge. Proposed Method of Analysis The data analysis will be done through the use of SPSS software. All the collected data will be categorized and operationalized in order to make sure that they are ready to be inserted in SPSS. The two variables will be: (a) Directors' experience, and (b) Company profits. The data will be associated with the top 20 ASX listed companies and the sample size will consist of the 20 companies as per their company profits in the last 1 year. A simple linear regression test will be conducted in order to find out the relationship between the two variables and how the variables might impact each other. The coefficient values, standard error values, t-values, confidence intervals, and p-value will be thoroughly assessed and properly interpreted in order to find out any statistically significant relationship between the variables. The formulated outcomes will also help to identify the limitations of the study. One potential limitation is that as the study will be purely based on the data collec ted from Australian organizations, the outcomes might not be applied to other settings of different countries because the organizational structures and culture would vary from one nation to the other. However, the results would help in developing a comprehensive understanding of how the directors' experience and company profits are associated with each other and what the companies should do to improve that connection in order extends the business. Conclusion It has been observed that although the literature review could not find any particular research which specifically focuses on exploring the connection between directors' experience and company profits, it has discussed the findings of the research works which concentrate on some significant aspects intricately connected to the topic being studied. Moreover, the directors' experience seems to be intricately associated with various organizational aspects which subsequently influence company profits. The proposed research will be quantitative in nature and the data will be collected from the annual reports of the top 20 ASX listed companies. The simple linear regression test via SPSS software will help to find out the relationship between the two variables. Thus, the proposed research will help the professionals to focus on the aspects which might contribute to the enhancement of company profits and the academic experts will understand how the directors' experience and company profits a re connected within the organizational sphere so that broader studies can be conducted. References Adams, R. Mehran, H. (2008). Corporate performance, board structure, and their determinants in the banking industry. Retrieved from https://poseidon01.ssrn.com Bai, G. (2013). How do board size and occupational background of directors influence social performance in for-profit and non-profit organizations? Evidence from California hospitals.Journal of Business Ethics,118(1), 171-187. Baysinger, B. D., Butler, H. N. (1985). Corporate governance and the board of directors: Performance effects of changes in board composition.Journal of Law, Economics, Organization,1(1), 101-124. Brickley, J. A., Van Horn, R. L. (2000). Incentives in nonprofit organizations: Evidence from hospitals. Del Guercio, D., Dann, L. Y., Partch, M. M. (2003). Governance and boards of directors in closed-end investment companies.Journal of Financial Economics,69(1), 111-152. Epps, R., Ismail, T. (2009).Board of directors' governance challenges and earnings management.Journal Of Accounting Organizational Change,5(3), 390-416. Executive Insight. (2010).More Public Company CEO Succession Practice Data; Spencer Stuart Releases 2010 Board Index Study..Executive Insight. Retrieved from https://executiveinsight.typepad.com/executive_insight/2010/11/more-public-company- ceo-succession-practice-data-spencer-stuart-releases-2010-board-index-study-.html Ferris, S., Jagannathan, M., Pritchard, A. (2003). Too busy to mind the business?: Monitoring by directors with multiple board appointments.The Journal of Finance,58(3), 1087- 1111. Financial and accounting duties and responsibilities of directors | Members in business | ICAEW. (2017).ICAEW. Retrieved 18 September 2017, from https://www.icaew.com/en/membership/regulations-standards-and-guidance/membership/financial-and-accounting-duties-of-directors Gul, F. A., Leung, S. (2004). Board leadership, outside directors expertise and voluntary corporate disclosures.Journal of Accounting and public Policy,23(5), 351-379. Jensen, M. (1993).The modern industrial revolution, exit, and the failure of internal control systems. The Journal of Finance, 48(3), 831880. Keay, A. (2007).Company directors' responsibilities to creditors. Abingdon, OXF: Routledge-Cavendish. Klynveld Peat Marwick and Goerdeler. (2001). Corporate Governance in Switzerland: Board of Directors - Interim responsibility and liability. Zrich, ZRH: KPMG Fides Management AG. Nsubuga, Y. K. (2009).Analysis of Leadership Styles and School Performance of Secondary Schools in Uganda. (Published doctoral thesis). Nelson Mandela Metropolitan University, Port Elizabeth, Uganda. O'Gorman, A. (2001). From research design to execution: maintaining consistency and validity while responding to contingencies in the field.Addiction Research Theory,9(6), 575-585. Patterson, M., Warr, P., West, M. (2004). Organizational climate and company productivity: The role of employee affect and employee level.Journal of Occupational and Organizational Psychology,77(2), 193-216. Scherrer, P. (2003). Directors responsibilities and participation in the strategic decision making process.Corporate Governance: International Journal of Business in Society,3(1), 86-90. Solomon, J. (2010).Corporate governance and accountability. Chichester, SXW: Wiley. Tufano, P., Sevick, M. (1997). Board structure and fee-setting in the US mutual fund industry.Journal of Financial Economics,46(3), 321-355. Uppal, N., Mishra, S., Vohra, N. (2014). Prior related work experience and job performance: role of personality.International Journal of Selection and Assessment,22(1), 39-51. Vafeas, N. (1999). Board meeting frequency and firm performance. Journal of Financial Economics, 53(1), 113142. Van Vugt. M (2006).Evolutionary origins of leadership and followership. Personality Social Psychology Review, 10(4), 354371. Yermack, D. (1996). Higher market valuation of companies with a small board of directors. Journal of Financial Economics, 40(2), 185211. Zahra, S. A., Pearce, J. A. (1989). Boards of directors and corporate financial performance: A review and integrative model.Journal of management,15(2), 291-334.

Nursing for Pre Early Save Program- myassignmenthelp.com

Question: Discuss about theNursing for Pre Early Save Program. Answer: A large metropolitan hospital introduced EARLY SAVE program to reflect best practice in early recognition and response to clinical deterioration. Pre Early Save Program- Code Blue process for life threatening emergencies Early Save Program- Education for clinical staff, more formalized Medical Emergency Team (MET) process and the introduction of an observation and escalation chart To analyze the effectiveness of the EARLY SAVE program in improving early recognition and response to clinical deterioration, the data regarding the MET calls in the pre and post period needs to be analyzed. Firstly, 160 MET calls were made in the pre period and 360 in the post period. This means that the recognition and response process became wider after the EARLY SAVE program. The positive benefits of high rate of MET calls in the post program period are evident from the % of patients who remained in wards. Earlier 20% remained in the wards and after the EARLY SAVE program, the proportion of patients remaining in the ward increased to 50%. This is a remarkable improvement signifying that burden of ICU team and resuscitation team reduced. The positive benefits of the EARLY SAVE program is also understood from the difference in % of patients transferred to ICU and death in patients. In the pre period, the % of transfers to ICU was 35% and it reduced to 20% in the post program period. Secondly, number of deaths was 25% in the pre period and 10% in the post period. The MET calls in the both the pre and post period was mainly called for seizure, worsening respiratory infection, acute respiratory distress, suspected cardiac pain and alterations in vital signs indicating clinical deterioration. However, the impact of EARLY SAVE program was that % of people affected by different clinical deterioration reduced in the post period except worsening respiratory infection. The main reason for improvement in clinical outcome in majority of condition was that education was given to staffs regarding responding to clinical deterioration and use of observation and escalation chart enhanced the possibility of taking prompt response to d eteriorating condition of patients. The research by Massey et al. (2017) has also proved that education and environmental factors enables health staffs to recognize and respond to patient deterioration. Specific clinical education and skills training enables staffs to quickly recognize and respond to patient deterioration. The hospital can use the data in the pre and post EARLY SAVE program to report against NSQHS standard 9: Recognizing and responding to clinical deterioration in health care in the following ways: They can show the data regarding difference in results in the % of patients transferred to ICU and death in the pre and post program to prove the benefits of MET calls in early recognition and clinical response. They can defend no increase in HDU outcome post program by stating that with improvement in burden of ICU units, the need for escalation of care of moving to HDU was minimized. They can show the efficacy of formalized MET process by the increase in the number of patients remaining in the ward and not shifting to the ICU or HDU units. The advantage of a formalized MET process is that it has direct role in preventing cardiac arrest and this is evident in the case scenario as data revealed that only 60 Code Blue calls for cardiac or respiratory arrest were made in the post period compare to 140 in the pre period. The potential benefits of MET is appreciated by most hospitals and their staffs. Resuscitation is an emergency clinical procedure to support and maintain breathing in a patient experiencing respiratory arrest or cardiac arrest. The main purpose of cardiopulmonary resuscitation (CPR) is to restore normal breathing and circulation in critically ill patient and maintain normal blood flow and oxygen to the heart, brain and other vital organs. As it is an invasive procedure, the norm is to escort family members out of the room due to fear of immediate and long term negative consequences for family members (Hill and Fuhrman 2008). However, this essay mainly supports the fact that family members should be allowed during the resuscitation of their loved ones in acute care setting. The essay presents appropriate discussion to prove the benefits of family presence in terms of psychological outcomes and avoiding conflicts and violence in acute health care setting. The main rational to keep family members away during several attempts of resuscitation is that family member becomes exposed to high risk of emotional and physical sufferings during the procedure (Zavotsky et al. 2014). However, a contrasting evidence to support the presence of family members explains that they understand that the medical team took all possible steps to bring patients back to life and the complains regarding negligence in the event of death of their family members is reduced. In another way, it can be said that family members often have unrealistic expectations or suspicion about the behind the door resuscitation efforts and all doubts regarding the efforts put by the medical team may be made clear if family members are present during resuscitation efforts (Jabre et al. 2013). One barrier to allowing this new practice in resuscitation is that hospital staffs may not accept this new practice due to increase in emotional stress during the procedure. However, a study do ne to assess the attitude of heath care professional working in Yale New Haven revealed that majority of staffs favored the option of family presence if any staff accompanies the family member to control their action during the procedure (Lederman and Wacht 2014). Hence, if this new procedure needs to be fully implemented in acute care setting, there is a need to work on drafting and implementing a protocol to follow while allowing family presence during resuscitation. Another advantage of family presence during the resuscitation procedure is that patients relative can provide emotional support to patient and help them accept the reality of death. In case of death of patient, family members get the chance to be bid final goodbye to their loved ones and this can reduce suffering caused in the bereavement process. Pathological conditions like mourning or post-traumatic stress disorder (PTSD) can be minimized in family members by allowing them in the resuscitation. A randomized controlled trial with family members of patients undergoing cardiopulmonary resuscitation revealed that giving family members the option of witnessing resuscitation efforts significantly reduced the incidence of PTSD compared to standard procedure without family presence. Family members present were also associated with positive psychological outcome (Jabre et al. 2013). Family presence during resuscitation is a debatable topic in health care. However, many recent evidence has pointed out to positive psychological outcomes for family members. While Jabre et al. (2013) pointed out to the impact of family presence in CPR in improving clinical indicator of PTSD, Tazarourte et al. (2014) explained that it reduced complicated grieving in family members after the death of their loved ones during the procedure. One research evidence in particularly is of great importance to develop the argument as it aimed to explore the experiences of those people who were present during a family members resuscitation. It helped to get direct insights about subjective factors that play a role in influencing psychiatric morbidity in family members. The study finding summarized about the theme of being actively involved in the resuscitation process, communication between the family member and the emergency team, perception of the reality of death, experience and reaction of witnessing the the resuscitation. As this argument is mainly focused on the reaction of relative to witnessing resuscitation, the study revealed feeling of relief and being satisfied with the action of the medical team. However, some family members were also affected by the aggressive technique and had a negative memory of viewing the CPR (De Stefano et al. 2016). Therefore, the main conclusion from the study is that positive effect in grieving has been found by offering patients family the choice of witnessing the resuscitation procedure. The above evidence mainly paid attention to the view of family members and health care professionals in allowing patients relative to be present during the resuscitation process. However, one point that is missing is the perception of patients regarding the family presence during the invasive resuscitation procedure. Twibell et al. (2015) mainly paid attention to exploring adult inpatients view of family presence during resuscitation and it mainly revealed that maximum participants favored family presence, however the preference varied across patients according to the nature of family relationship and patients response. This research gave new insight that patients should be involved in deciding whether they would prefer family members presence during the procedure or not. Based on different arguments with support from peer-reviewed research articles, the main conclusion from the essay is that family presence should be allowed during resuscitation considering the positive effect in psychological outcomes, expectations and ethical conflict. To fully implement this option for patients, the future implication for health practice is to establish a full protocol for implementing family presence option in CPR and involving patients in decision making related to family presence. Reference De Stefano, C., Normand, D., Jabre, P., Azoulay, E., Kentish-Barnes, N., Lapostolle, F., Baubet, T., Reuter, P.G., Javaud, N., Borron, S.W. and Vicaut, E., 2016. Family presence during resuscitation: a qualitative analysis from a national multicenter randomized clinical trial.PloS one,11(6), p.e0156100. Hill Jr, R. and Fuhrman, C., 2008. Presence of family members during resuscitation.Annals of emergency medicine,52(3), pp.309-310. Jabre, P., Belpomme, V., Azoulay, E., Jacob, L., Bertrand, L., Lapostolle, F., Tazarourte, K., Bouilleau, G., Pinaud, V., Broche, C. and Normand, D., 2013. Family presence during cardiopulmonary resuscitation.New England Journal of Medicine,368(11), pp.1008-1018. Lederman, Z. and Wacht, O., 2014. Family presence during resuscitation: attitudes of Yale-New Haven hospital staff.The Yale journal of biology and medicine,87(1), p.63. Massey, D., Chaboyer, W. and Anderson, V., 2017. What factors influence ward nurses recognition of and response to patient deterioration? An integrative review of the literature.Nursing open,4(1), pp.6-23. Tazarourte, K., Jabre, P., Azoulay, E., Borron, S.W., Belpomme, V., Jacob, L., Bertrand, L., Lapostolle, F., Combes, X., Galinski, M. and Pinaud, V., 2014. Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment.Intensive care medicine,40(7), pp.981-987. Twibell, R.S., Craig, S., Siela, D., Simmonds, S. and Thomas, C., 2015. Being there: inpatients perceptions of family presence during resuscitation and invasive cardiac procedures.American Journal of Critical Care,24(6), pp.e108-e115. Zavotsky, K.E., McCoy, J., Bell, G., Haussman, K., Joiner, J., Marcoux, K.K., Magarelli, K., Mahoney, K., Maldonado, L., Mastro, K.A. and Milloria, A., 2014. Resuscitation team perceptions of family presence during CPR.Advanced emergency nursing journal,36(4), pp.325-334.

8 Persuasive Writing Techniques to Make the Story Appealing

Whether the story is fictional or not, there are less well-known persuasive writing techniques you can use to make it more appealing. Sometimes all it takes is a little reminding and boom, just like that new ideas come on like cerebral wildfire. In this article we’ll look at eight reliable methods you can use to compel your readers into deeper personal involvement. #1: Almighty Propaganda Not to get dark or anything, but look at how well certain governments and corporate bodies throughout modern history have used propaganda to persuade the masses do any number of oddball things. Are you adequately repeating the theme of the story in different ways? Are you creating characters that deepen the story by reinforcing your point, or pull it apart? If you need the reader to feel or imaginatively see something, then it bears repeating. Listen, the facts are in ladies and gentlemen: if you repeat a theme, a moral or even a marketing slogan to someone through a story about ten times over a short period you’ll imprint it within their minds. Say the same thing, show the same scene, or make the same impression in a series of different ways like creative and subtle propaganda. #2: Provide Reasons – Anything Will Do Give the readers good reason they should continue on with the next paragraph, buy the product, get involved with the character or even take you seriously as a writer. One of the most powerful words in your reason-arsenal is â€Å"because.† Why because? Who because? When because? What because? Everything needs to have because after it in one way or another for readers to buy into whatever story you’re selling. And here’s the key, your reasons don’t technically need to make sense. Of course in non-fiction this is situational, but for sales copy and fiction writing in general the reasons just need to be good enough to persuade, right? Since most human beings are persuaded emotionally, there’s a big grey area in the reasoning department. #3: Consistent Upward Climbs Rollercoasters are awesome, but they’re also mentally exhausting. If you want to drive readers nuts and have them begging for a CTA (call to action), then build your story with steady unchanging upwards momentum. Think about it from a psychological perspective. How much of human society is based on consistency? The power grid, entertainment, the work force etc. We’re mentally programmed not to come across as inconsistent. So, consistency needs to be woven into the fabric of your persuasive writing. #4: Lavish Readers with Social Proof Social proof is about tapping into another engrained trait – need for acceptance. Whether we want to admit it or not, we like to do what everyone else is doing. A simple example is, pretend you have a choice between two items of equal price and quality. One has customer testimonials extolling its virtues while the other does not. Which one do you think roughly 8 out of 10 people go with? Now, those testimonials could be completely false. It doesn’t occur to us to check their validity. Once you learn to recognize social proofing you begin to see it in all of the most powerful writing, regardless of genre. #5: Parables, Allegories, Metaphors Similes You could throw Myths in that list as well. This is the stuff that drives the human mind into frenzy. The trick, and the challenging part, is to make them original. How many creative, funny and ironic comparisons (simile) can you make between a mouse and a man? Metaphors get complex ideas across in a digestible way, through story. They make direct connections in indirect ways. Allegories are tough. Try making one of those up. Think about Plato’s timeless â€Å"Allegory of the Cave†. There is perhaps nothing more powerful than the proper and effective use of these tools. You can dramatically sweep minds right off their feet and into your arms (see what I just did there?). Study them and whenever you can, use them. #6: Appeal to the Human Animal Objectively, human beings are beings just like any others, at least in a physical sense. We’re governed to certain degrees, by instincts. These instincts go back hundreds of thousands of years. Jealousy, envy, acceptance into the tribe etc. When you really want to grab someone, grab them tribally. We all intimately understand the concept of â€Å"tribe.† Modern tribes are everywhere! #7: Unrestrained and yet Structured Insanity Go crazy. Do the unexpected and throw a few proverbial BIC lighters into the fire when no one’s looking. Upset the tribe. The key is to only allow true chaos to reign momentarily. If you sustain it too long the writing will thin out and all connection might be lost. Structure the insanity. #8: Get Psychological Last but not least, when your writing needs to evolve go psychological. It’s all psychological regardless really. Become the captain of that ship rather than the guy up in the crow’s nest. As the writer, you’re in control of the rudder of your story, not the audience. Use their minds as your persuasive sails. Have you created your own story? Do you have any tips for writing with persuasion?

Free Essays on Johnathan Davis

â€Å"Time has come, to realize what you are, what you’ve done tonight. Time has come, we’ll have something to talk about. I will too.† In the year of 1971, on January 18th, a baby boy by the name of Jonathan Houseman Davis was born to his mother and father, Mr. Rick Davis. Bakersfield, CA was the city and state to become home to such a talented young boy. Jonathan’s biological mother worked in a local theater. His father worked in a music industry, along with other jobs such as working at a local music store when Jon was a young boy. His early childhood was pretty good from birth to the age of 3. When he was 3 his parents divorced. While most children have problems getting used to a new parents Jonathan’s troubles went a deeper. â€Å" Little child, looking so pretty. Come out and play, I’ll be your daddy. Innocent child, looking so sweet. A rape in my eyes and on your flesh I’ll eat.† These lyrics are from the song â⠂¬Å"Daddy.† When he was 5 he took up drumming, and when he was 12 his father remarried, that’s when the troubles went deeper. â€Å"Looking back I was never ever right, you were my step mom who always wanted me out of your sight.† This is a song wrote when his father got remarried, â€Å"kill you† In high school he played piano, and bagpipes, which is one of the things to do when he has free time. He played in the highland high school band and also a bagpipe band. One song that comes to mind when I think about bagpipes would be â€Å"shoots and ladders†, which was one of his first songs that he plays the bagpipes in. It’s a bunch of nursery rhymes combined together for example, â€Å"Mary had a little lamb†, â€Å"blah blah black sheep†, â€Å"nick nack patty wack give a dong a bone.† All tied in together. In school the jock boys would make fun of him, and call him faggots because he wore eyeliner. With them by doing so he wrote the song â€Å"Fagget†. †Hit me ‘cuse I’m strange, hit me, A tatto... Free Essays on Johnathan Davis Free Essays on Johnathan Davis â€Å"Time has come, to realize what you are, what you’ve done tonight. Time has come, we’ll have something to talk about. I will too.† In the year of 1971, on January 18th, a baby boy by the name of Jonathan Houseman Davis was born to his mother and father, Mr. Rick Davis. Bakersfield, CA was the city and state to become home to such a talented young boy. Jonathan’s biological mother worked in a local theater. His father worked in a music industry, along with other jobs such as working at a local music store when Jon was a young boy. His early childhood was pretty good from birth to the age of 3. When he was 3 his parents divorced. While most children have problems getting used to a new parents Jonathan’s troubles went a deeper. â€Å" Little child, looking so pretty. Come out and play, I’ll be your daddy. Innocent child, looking so sweet. A rape in my eyes and on your flesh I’ll eat.† These lyrics are from the song â⠂¬Å"Daddy.† When he was 5 he took up drumming, and when he was 12 his father remarried, that’s when the troubles went deeper. â€Å"Looking back I was never ever right, you were my step mom who always wanted me out of your sight.† This is a song wrote when his father got remarried, â€Å"kill you† In high school he played piano, and bagpipes, which is one of the things to do when he has free time. He played in the highland high school band and also a bagpipe band. One song that comes to mind when I think about bagpipes would be â€Å"shoots and ladders†, which was one of his first songs that he plays the bagpipes in. It’s a bunch of nursery rhymes combined together for example, â€Å"Mary had a little lamb†, â€Å"blah blah black sheep†, â€Å"nick nack patty wack give a dong a bone.† All tied in together. In school the jock boys would make fun of him, and call him faggots because he wore eyeliner. With them by doing so he wrote the song â€Å"Fagget†. †Hit me ‘cuse I’m strange, hit me, A tatto...

Systems of governance and authority Essay Example | Topics and Well Written Essays - 750 words

Systems of governance and authority - Essay Example This resulted in significant losses among the European nations, both economically and politically, that had controlled resources in the Americas. The European countries ventured in Africa with a desire to maintain their wealth and political power. They promoted this new form of imperialism as a â€Å"moral obligation to civilize† the African communities (Louis, 2006). They also justified their entry and scramble for Africa with views such as seeking new markets and accessing resources for their newly formed industries. However, the main underlying reason for colonization of Africa was to seize the opportunity to demonstrate political and economic superiority over their rivals. Different countries used different approaches in exerting their influence on the African continent. The British used indirect rule while the French implemented the assimilation policy. The Belgians and Germans, on the other hand, used cruelty to maintain their control over African communities they ruled (Louis, 2006). Regardless of the tactics used, however, the hegemony over the African continent would only last a few generations before independ ence movements and revolutions emerged to help Africans regain control of their continent. Most of the communities in Africa reacted angrily to the control of the Europeans. Many of them rejected the colonial rule from the very onset. In Nigeria, for instance, the British Empire took over the region and exerted its control over the local communities. The Western African region the British took over was made up of different communities, some of which had their own leadership structures (Louis, 2006). Modern countries such as Nigeria, Benin, and Cameroun did not exist at the time the British gained control of the massive area in West Africa around River Niger. The British tried to bring the different communities together under one rule and one structure of governance. This move was met with great resistance,

Junk food Essay Example | Topics and Well Written Essays - 750 words

Junk food - Essay Example Most of the food in this category is oily food which is the easy way to suffer cholesterol. It is the most dangerous diseases even caused to a heart attack. Most of the junk foods are reached the market as ready to eat and it has an attractive smell and taste. Advertisement is the most important factor; children are attracted to this kind of food. â€Å"This term was coined in 1972 by advocates at the Centre for Science in the Public Interest who wanted to raise public attention about the issue of foods with a high caloric value and a low nutritional value. For manufacturers, producing such foods has great appeal, as they tend to be cheap to make and easy to handle. They also have an extended shelf life, making them easy for stores to stock and sell† (Affect of Junk Food, 2013). In present life the youngsters, especially even a small child very fond of food that we named as junk food. They never think about the consequences coming after this. In the name of balanced diet, peop le used this kind of food like potato chips, burger ect. As a result of these lifestyle people are very difficult to overcome the ill effects caused by it. Parents are playing a most important role in spoil the health of their growing child. Ones addicted for the junk food or fast food, people can’t show interest to eat nutritional food like fruits and vegetables. Junk food contains saturated fat which is not good for health. When trouble started, only then people began to stop eating junk food. Study about the junk food shoes that the bad facts are replaced the healthy fats in the brain. It is the most common condition of the conception of the junk food. Hydrogenated oils in fried foods are main cause of obesity. It increases the triglyceride levels in the body. In this condition it is very difficult to the flow of blood and leads to heart attack. A study published in the European Journal of Cancer Prevention revealed that consuming too much of fast foods that are high

Contact Lens Case Study Analysis

Contact Lens Case Study Analysis Contact lenses Contact lenses are a suitable substitute for correcting vision in a number of scenarios. There are hundreds of different contact lens types out there in today’s market with the figure growing extensively every year. With the advancement of research and technology, manufactures are always attempting to better their own product lines to suit a variety of needs a person may have, whilst also attempting to 1-up their competitors. The patient we are attempting to fit with lenses has never worn them before so as far as options go, we are open to explore different lens types and materials amounting to 100s of different combinations. She is a nurse who works long shifts in a hospital and desires fulltime CL wear of up to 12 hours a day, 7 days a week. To do this, we must assess each aspect of the test and result and cater lens choice to match intended wear time and to also correct her vision for both distance and near. The prescription that we have been presented with is a high myopic prescription so we need to compensate for the change in distance as the contact lens will sit on the cornea and not 12mm away. The compensated contact lens prescription equates to: Soft lenses come in many forms and for this patient, a silicone hydrogel (SiH) lens material would be the one to choose due to its high oxygen transmission (Dk/T) levels, much higher than hydrogel, like the SiH AirOptix Aqua, [Dk 138, 33% water, 8.6 base curve, 14.mm diameter, (AIR OPTIX ® AQUA Contact Lens, no date)] lens vs. the Frequency 55, [Dk 21, 55% water, (Frequency 55 aspheric | CooperVision UK, no date)] hydrogel lens. The Dk/T should be at a level where enough oxygen is passing through to the cornea, avoiding hypoxic conditions and preventing neovascularisation and oedema of the cornea which can lead to permanent corneal damage. SiH lenses however are not as comfortable as regular hydrogel materials due to the rubbery nature of the lens, and also the lenses hold less moisture compared to regular hydrogel. Silicone is not a wettable material so corneal hydration is an issue. (Sweeney, 2004, pp. 3 – 3). Manufacturers combat this by incorporating technology into the lens such as AquaGen found in Clarity 1 day toric [Dk 57, Water 56%, 8.6mm base curve, 14.3mm diameter (SAUFLON, no date)] .This allows the lens to stay hydrated and increase overall comfort wear-time, something extremely important for this nurse. Soft lenses drape over the cornea and range between 13.8mm-14.5mm sizes in order to cater for the patient’s measurements. A well fitted soft lens will ensure that the lens has corneal coverage in all directions of gaze. The lens should have movement of at least 1/4mm when blinking, not more because of the variable vision it will cause, or less as it will cause discomfort and should also allow adequate exchange of tears behind the lens to allow debris removal (Gasson and Morris, 2010, pp. 227-227). Rigid gas permeable (RGP) lenses are much more complex to fit than soft lenses They are tailor made to the patient’s prescription and measurements such as horizontal iris diameter (HVID) and pupil size. RGPs are smaller than soft lenses and smaller in diameter than the cornea itself, with diameters ranging from 8mm to 11mm. RGPs float on the tear film and can create a lens made out of tears. (Gasson and Morris, 2010, pp. 137 – 139) Practitioners need to take this tear lens into account as it can negate the need for toric lenses or require prescription adjustments through over-refraction (Gasson and Morris, 2010, pp. 137 – 139). RGPs offer superior clarity than their softer counterparts and are much more durable and longer lasting, however are mostly overlooked in modern times (outside of therapeutics) due to the patient’s impatience of adapting to the initial uncomfortable fitting. RGPs are also easier to lose as they can pop out of the eye much easier and are more difficult to completely cleanse, something important for this nurse considering her working environment. Assessing her slit-lamp examination results such as her tear break up time (TBUT) and tear prism, I would be looking at a lens that plentiful hydration to the cornea. This is because her TBUT of less than 10 seconds at 7 seconds and her tear prism of 0.2 mm indicate that she suffers from dry eyes (Dryeyesmedical, no date). Having dry eyes and not addressing the issue will result in significantly reduced wear time due to great increase in discomfort. High water content lenses; whilst more comfortable than most other lenses at first, deteriorate in comfort as the day progresses due to evaporation (Efron, 2012, pp. 87 – 87). These lenses then proceed to draw water from the next available source being the tear film through osmosis will cause discomfort for this nurse as she does suffer from dry eyes, reducing wear time considerably. Her TBUT and tear prism will influence the lens choice as she does intend full time lens wear, such as a SiH lens like the Acuvue Oasys toric lens [Dk 147, Water 38%, 8.4mm base curve, 14.3mm diameter, (JJvisioncare, no date)] or a RGP lens. The astigmatism present in her prescription will necessitate toric lenses which allow practitioners to correct astigmatism. Most popular toric lenses available on the market such as the Biofinity toric lens corrects astigmatism only up to a maximum of -2.25DC and the axis is only correctable to the nearest 10 ° meaning that contact lens practitioners must sometimes compromise the vision slightly when the prescription is unavailable in exact power and axis specifications such as this nurse (Ruben and editor., 1978, pp. 212 – 213), where an axis of 180 ° would need to be given for both lenses. An ideal lens for this nurse such as the Clarity 1day toric employs prism ballast which places 1-1.5Δ of base down prism at the base of the lens for stability. Stability of the lens reduces lens rotation and ensures toric lenses stay on axis. This does increase lens thickness and causes a reduction of Dk/T at the base of the lens, increasing risk of hypoxia at the zone (Efron, 2012, pp. 221 – 221). Acuvue Oasys toric lenses employ peri ballast aka accelerated stabilisation designs which have 4 stability zones. This design is claimed to provide more rapid settling on the cornea; within 1 minute, and achieve correct orientation within 5 ° of the anticipated position in 90% of cases (Gasson and Morris, 2010, pp. 266 – 266) Prism Peri ballast designs (Methods of Stabilisation | Optometry by Catherine Care, no date) RGP lenses would be a serious candidate due to her corneal astigmatism (K) readings gained from the keratometer. Her measurements gained were: RE: [emailprotected] [emailprotected] LE: [emailprotected] [emailprotected] Every 0.05 of difference between the 2 readings gained by each eye corresponds to 0.25DC, so comparing her corneal astigmatism to prescription, we can deduce that the difference equates to -0.75DC in her right eye and -1.25DC in her left eye. This means that when the lens is fitted on the flattest K, the difference between the K readings will create a negative powered tear lens that will correct the astigmatism completely in both eyes for his nurse, negating the need for toric lenses (Gasson and Morris, 2010, pp. 137 – 139). Multifocal contact lenses are an excellent way to correct presbyopia and exist both in soft and hard lens designs. Simultaneous designs such as concentric ring multifocals (MF) are fairly common such as the Oasys for presbyopia lens, [Dk 147, Water 38%, 8.4mm base curve, 14.3mm diameter, (JJvisioncare, no date)] which provides both distance and near vision in one lens. They do this based on pupil size and often are split up between centre distance (CD) lenses for the dominant eye in most cases and centre near (CN) lenses for the other eye. Depending on the level of illumination, a certain working distance will be favoured over the other as the concentric rings are positioned at intervals which the pupil size will coincide with. This MF design does increase the amount of glare experienced by the patient due to the rings and can also decrease contrast sensitivity due to superimposed retinal image sizes if CD and CN are given (Gasson and Morris, 2010, pp. 277 – 282). I would not recommend a MF soft lens for this patient as it will not correct her astigmatism. Daily MF toric lenses do not currently exist, however monthly soft MF toric lenses do exist with one lens type being the Proclear multifocal, a hydrogel lens with low Dk and high water content [Dk 42, 62% water content, (Coopervision, no date)] something definitely less than ideal for our patient’s desired wear schedule. Bifocal RGP lenses exist providing excellent distance and near vision and use the lenses movement on the cornea. The lens moves up as the eye rotates down, bringing the segment into the pupil’s path and allowing the patient to read. As the eye rotates back up, the lens moves down and the segment moves out of the pupils path and distance vision is restored. (Gasson and Morris, 2010, pp. 277 – 282) RGP bifocals such as the Boston Multivison lens would be an excellent choice for this patient if she were to adapt to them due to correcting astigmatism through the tear lens, allowing her to see distance and reading in one package and allowing plenty of oxygen to pass through the lens. Another successful form of CL correction for presbyopia is monovision (MV), in which one eye is optimally corrected for distance acuity and the other is corrected for near vision (Weissman, 2006, pp. 20 – 20). MV does not compromise lens fitting options and is a highly versatile option and is the least complicated method of dealing with. The distance prescription would be worn in the dominant eye and the reading prescription would be worn in the non-dominant eye, with the brain suppressing images from one eye depending on the working distance. The issue with MV however is that stereopsis is lost as binocular vision is not being utilised. This can be an issue for this nurse if she is required to carry out tasks that require accurate judgement of depth like administering an injection to a patient or driving. If the concept is thoroughly explained initially, there is a much higher chance of acceptance of MV and seeing that she hasn’t worn CLs before, she is very likely to adapt. (Gasson and Morris, 2010, pp. 277 – 282) The other alternative to this would be just to correct her distance prescription with contact lenses and to give her a separate pair of +1.75DS reading spectacles which although a viable solution, can be inconvenient for her and defeats the purpose of replacing glasses with full time CL wear. Some special advice for this patient would include managing her grade 1 blepharitis, which in its current state will not impact lens choice or length of wear if managed correctly. I would advise her to apply hot compresses to her lids and recommend a gel like Blephagel in order to accelerate debris clearance. I would advise her against using baby shampoo which is a surfactant, as it will break lipids in her tear film and will further detriment her dry eyes. I would advise her to administer artificial tears into her eyes which are CL compatible in order to maintain extended comfort all day. I would advise her to thoroughly clean her lenses daily if choosing a non daily lens by rubbing and rinsing in preservative free multipurpose solution, or alternatively recommend peroxide solution and let the lenses fully be cleansed without the need to rub and rinse. My overall recommendation after all things considered would be to fit this patient with the soft bi-monthly Acuvue Oasys toric lens with HydraClear technology to permanently lock a high volume of wetting agent inside the contact lens (JJvisioncare, no date). I would utilise monovision with distance dominance to correct for presbyopia, thoroughly explaining to her the mechanics of monovision and what to expect, as not to be overwhelmed by loss of stereopsis and to increase the overall likelihood of acceptance. I’d also tell her to take precaution if driving. My reasoning for this is heavily based off her wearing schedule in tandem with her dry eyes and her working environment. In order to achieve the wear schedule that she desires, it is extremely important that the lens has a high Dk/T lens in order to prevent hypoxic conditions and a high wettability in order to maintain corneal hydration, minimising discomfort and thus allowing said wear schedule taking into account her dry eyes. She is a nurse so automatically this puts her at a higher risk of infection, hence a lens more frequently replaced would be ideal to prevent deposit build up from affecting her too much and overall decrease the risk of infection. I would recommend her the peroxide solution to further clean the lenses and to decrease the risk of infection and to apply artificial tears for extra comfort. 2199 words Bibliography AIR OPTIX ® AQUA Contact Lens(no date) Available at: http://www.airoptix.com/contact-lenses/aqua.shtml (Accessed: 28 April 2015) CooperVision (no date)Proclear multifocal toric. Available at: http://coopervision.com/practitioner/our-products/proclear-family/proclear-multifocal-toric (Accessed: 25 April 2015) Efron, N. (2012) Contact lens complications. Third edn. Edinburgh: Saunders (W.B.) Co Frequency 55 aspheric | CooperVision UK(no date) Available at: http://coopervision.co.uk/contact-lenses/frequency-55-aspheric (Accessed: 28 April 2015) Gasson, A. and Morris, J. (2010) The contact lens manual: a practical guide to fitting. Edinburgh: Elsevier Health Sciences JJvisioncare (no date)ACUVUE ® OASYS ® for ASTIGMATISM. Available at: https://www.jnjvisioncare.co.uk/contact-lenses/all-acuvue-brand-contact-lenses/toric/acuvue-oasys-for-astigmatism (Accessed: 25 April 2015) JJvisioncare (no date)ACUVUE ® OASYS ® for PRESBYOPIA | Johnson and Johnson Vision Care. Available at: https://www.jnjvisioncare.co.uk/contact-lenses/all-acuvue-brand-contact-lenses/multifocal/acuvue-oasys-for-presbyopia (Accessed: 25 April 2015) MEDICAL, D. E. (no date) Diagnostic tests. Available at: http://www.dryeyesmedical.com/diagnosis/diagnostic-tests.html (Accessed: 25 April 2015) Methods of Stabilisation | Optometry by Catherine Care (no date) Available at: http://optometry.catherinecaregroup.com/method-of-stabilisation/ (Accessed: 29 April 2015) Ruben, M. and editor. (1978) Soft contact lenses: clinical and applied technology. New York: John Wiley SAUFLON (no date)Clariti ® 1day toric. Available at: http://www.sauflon.co.uk/eye-care-professionals/products/clariti-1day-toric (Accessed: 25 April 2015) Sweeney, D. F. (2004) Silicone hydrogels: continuous-wear contact lenses. Oxford: Butterworth-Heinemann Weissman, B. A. (2006) OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE CONTACT LENS PATIENT. 2nd edn. St. Louis, MO: American Optometric Association