Mine pro

There are 3 doctor and 5 nurse that have been worked in this organization. Usually the operation starts on game until pm. The special of this organization is, it is open every day. This organization has been built to easier the student to make a day with a healthy health. Not only give a free treatment for student, the organization give the service for all the candidate in Tim include the worker and lecture too. Purposely to short the time and help the student to get the faster treatment so the learning schedule will not been disturb.Not only give free treatment, this organization supply medicine for those that need it for free too. The medicine did came from various of supplier because f different disease that may influence. Not because that only the medicine that have been supply are based on budget that have be limited by government. 1. 2 Organizational Chart 1. 3 Current System Description The patient and the doctor usually have to fill down all the info as manually. They have to write it in a card that have prepare for them to refill like patient card, doctor card.Medicine supplier and many more works. All of this card will be save in one cabinet that special made for it. The patient will write down their personal detail and their first date receive service provide. The actor will receive patient detail, begin the treatment and suggest the solution or the medicine should take. After that the medical section will receive receipt from the doctor, prepare the medicine and give to patience. From the medicine section work, the workers need to do all the record manually about the process of in and out the medicine.About the stock, Who are the supplier and the quantity Of the medicine too. After that the worker need to make a monthly report, so they knew the quantity and the disease that mostly affected. 1. 4 Current System Problem The patient may have more than one patient card. Take time to find patient card. The doctor may have lost the past information about the patient health problem. May lost the record about the medicine. 2. Proposed Project Overview 2. 1 Proposed System Process The patient will fill in the information into the system when they first come.

Organizational Behavior in Multinational/Global Aviation Essay

Introduction Over the past few years the aviation industry has continued to face challenges on how well to manage the industry on both operational and management level in relation to interests of different stakeholders in the industry. Customers have increasingly demanded for better services while shareholders demand for more profits. With globalization of aviation industry, the market has become more competitive and demands the industry to be highly competitive to survive on the global market. This issue of global competition further complicates the achieving of customers, shareholders and other stakeholders needs by the industry. Thus, the industry needs to change its organization behavior and structure to overcome these new challenges. Studies show that industry performance is highly affected by its behavior. Dessler (2001) stresses this point when he points out that, organization behavior and structure determines the success of an industry. These new challenges has made the industry to rethink its business behavior, objective and aims coming up with strategies that has made the industry more successful than before. (Dessler, 2001) Globalization Globalization has had varied influences on policy making in the aviation industry, by influencing the making of key decisions in the industry. Globalization in this case has influenced economic policy making in aviation industry.   One of the effects or influence to economic policy making in aviation industry is that, it has made it more complex. According to top managers in aviation industry, globalization has made this policy making quite challenging due to the very many factors that are globally affecting it and the various needs of the different stakeholders that has to be fulfilled. Globalization has affected aviation industry in its decision making. This is because all the decisions made in this industry have to comply with international standards. This is so because globalization comes along with standards which all the industries have to adhere to. Decisions that are made in aviation industry also have to be according to international trade policies. Aviation industry faces big challenge in line with global competition and balancing of various stakeholders needs. (Dessler, 2001) Stakeholders Many times different stakeholders’ requirements do conflict, and at times the requirements of each group are not well understood. Balancing the requirement for the different groups in the industry becomes a challenge to the policy makers in the industry, many questions have to be asked before formulating a structure that can satisfy each individual group. Some of the questions asked when formulating policies are; How to balance the needs and know when trade-off can be applied How to analyze the needs to come up with a win-win resolution for all the concerned groups How do to conclude if the win-win- solution for each group is real possible Eventually economic and some other needs has to be included in the policy making process in relation to satisfying the various groups with a stake in the industry. Stakeholders and requirements The aviation industry like any other industry has nine basic or generic stakeholder groups with different class of people in each group. These groups are; (Cox, 2000) The government Board of directors Owners/ shareholders Management Executive Customer employees Suppliers Community We shall examine only four groups which are; owners, customers, employees, local environmental groups which are very important in the industry and how their individual needs are balanced. Shareholders Shareholders in an industry or a company are the owners of the industry; the capital invested in the industry comes from the shareholders who expect a reasonable return over the invested capital. Freiberg & Freiberg (1998) clearly states that, the objective of shareholders in an industry is mainly long term financial growth or short term financial gain in terms of dividends. The needs of shareholders may also include greater social enhancement, protecting the environment among other things. Shareholders basically put their financial capital in the business to have an opportunity of making money. (Freiberg & Freiberg, 1998) The executive management group in aviation industry is the one which is answerable to the shareholders in terms of results of the business, in a situation where the executive management to do produce positive results, the shareholders may replace the executive management or the shareholders may withdraw their money and invest it elsewhere. Any industry which is not well managed at the end it will have to collapse. The shareholders in the aviation industry basically expect the following from the industry; Long term financial returns (increase in relation to shareholders amount) Short term financial returns (dividends) Observance of social norms (environment and ethics) Freiberg, K., & Freiberg, J. (1998 Customers In any particular industry the most important group of stakeholders are the customers. Normally, customers demand high quality of services and a competitive price. (Legge, 2004) In order for the industry to realize profits it has to provide quality services at competitive pricing so that it attracts more customers to increase profitability of the industry. Supposing the level of profits falls and losses are made, the shareholders will complain. Thus, the challenge is to set prices and quality that can attract the customers and at the same time make profits that can sustain the industry. (Legge, 2004) Customer segment in this industry do not differ so much, customer will have different expectations from the industry and the executive managers will face different challenges in formulating ways to satisfy the varied requirements of the customer segment. One particular issue that has raised a lot of concern in the industry is the security issue. Ever since the September 11 terrorist attack in America, the concern of security in aviation industry has increased and all stakeholders and in particular the customers have demanded for high security and safety in the industry. (Legge, 2004) It is important that customers have to be listened to so that their needs are understood, in order to make improvements where possible, and where not possible customers be informed of the impossibility. Generally the industry is pursing customer requirements that are in line with the interests of other important stakeholders. Basically, customers’ demands in the aviation include; Improvement of the services the industry is providing especially in terms of security and safety Better competitive pricing A commitment of the industry to address their requirements (Legge, 2004) Employees This groups consists of all levels of employees who are down the executive management level, at times it may also include the upper middle level management, the middle level management, the supervisors and individual employees. The biggest concern of all employees in any industry is having good working condition, secure workplace and financial security. However, other requirements also exists that employees require. (Cox, 2000)   Basically employees require the following; Competitive salaries and benefits Job security Opportunities for career development and growth Safety Community The community though is a less formal stakeholder group in the industry, it is still important and it has a big influence on the industry. Yukl (2002) explains that, the community can either decide to support a business or not, depending on whether they concur with the way the business or industry is carrying out its activities. (Yukl, 2002) Yukl (2002) further explains that, the main interests of a community in any industry are safety of the environment, employment for the local community and cooperation from the industries in other community issues. Community members may become nuisance to the industry or be a support base for the industry depending on the relationships that exists between the industry and the community. The community has three main requirements which are; Environmental Economic Safety (Yukl, 2002) Balancing stakeholders needs The biggest issue thus is how to balance the various needs of the above mentioned stakeholders. It seems that there are three major issues or challenges that aviation industry faces in balancing the different requirement of the diverse stakeholders, this are underlined below; Identifying the specific main stakeholders in the industry in relation to different business situations Understanding the different needs and the main priorities that should be given to this needs Balancing the requirements which conflicts with each other (making trade-offs) (Cox, 2000) In order to solve the above challenges the industry has formulated a matrix formula, this has highly helped the industry in solving the challenges and in balancing requirements of each group of stakeholders. Generally using the matrix implies identifying the most important needs of each group of stakeholders. These are generally similar for each kind of stakeholders, for examples all customers will need better services and competitive prices, and all shareholders, whether ordinary of preferential will need high returns over their capital. To achieve this, the industry has undertaken different approaches to satisfy each group of stakeholders. (Cox, 2000) Balancing Shareholders needs The main aim of shareholders is to get good returns on their capital they have invested. To this end the industry has to attract more customers to achieve high profits so as to ensure high returns on the capital invested by the shareholders. This can be attained through prudent management and good policies and marketing to achieve high profits at the same time ensure that other stakeholders’ needs are taken care of. The industry has responded well by using new technologies in improving its services. The industry has utilized the use of online marketing and also incorporated the use of new technologies in production and operations activities which has resulted in significant increase in revenue and thus attained the shareholders goals. The industry generally has responded to globalization by redefining its services and expanding to new markets to increase its market share and hence profitability of the industry. (Larson, 1997) Balancing the needs of customers   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Industry has continued to provide better services and at the most cost effective prices which have increased the number of passengers over the years. Another aspect that the industry has undertaken in relation to customer is improving security in airports, in the aircrafts and even coming up with better designed aircrafts and air fields which put safety/security of the customer as a first priority. (Phegan, 2000) Customer satisfaction is vital for the success of Aviation industry. Phegan (2000) points out that, with ever increasing competition on the global market those industries that focus on customer orientation and customer satisfaction have chances of maintaining and even improving their customer base. Customers remain the most important group which ensures survival of any industry. Aviation industry has clearly balanced the goals of the customer (in relation to customer loyalty, satisfaction, profitability and sales) compared to other industry stakeholder needs. A significant consideration the industry has undertaken is an overall altitude of organizational commitment to customer objectives, without taking this commitment customer satisfaction will have a very limited impact. Aviation industry has made strategic market plans, which includes, how the company should divide the market and which segments of the market the industry should focus on basing on the Aviation industry capabilities and or industry competencies.   Aviation industry has to have a clear consideration of how the customer satisfaction will be ultimately balance with other needs of other stakeholders. (Phegan, 2000) Balancing employees needs Today, employees are no more human resource to be exhausted but employees have become human capital, thus an asset to an organization that need to be protected and developed. Globalization has opened up new opportunities and employees have become more difficult to retain in an industry that is not competitive enough. To this end aviation industry has to undertake motivation as the main aspect of getting well qualified professional who can achieve the goals of the organization and even surpass them. (Robbins, 2004 Motivational practices To be able to be successful in the current global and domestic markets, motivation, for any organization’s workforce is a solution in realizing competitive advantage. Aviation industry therefore, has the ultimate function of retaining good staff members who are the main drivers of the industry. It takes a considerable amount of time to train an employee in the industry to attain better standards for any specific duty. To lose such an employee at any stage of the production process is suicidal for the industry. Specific emphasis is therefore taken into account to make sure that such employees are kept for as long as they are required. (Robbins, 2004) Better conditions for service and financial rewards are examples of measures applied to motivate employees within the industry. In addition the industry is motivating the employees in terms of annual, leave, insurance or shorter working periods. Aviation industry has set good employee wages to attract human capital in the industry. Top managers in aviation industry have provided information that is useful in the making of decisions for the Aviation industry with regard to balancing the amount of wages to be paid to employees and the actual financial situations for the industry in relation to other stakeholders. It must be noted that, employees play the most important part in realizing the targets of the industry. The aviation industry currently is among industry with well paid employees, this has ensured that the employees are satisfied and thus they can drive the industry to new heights and help it achieve the other stakeholders’ needs. (Robbins, 2004) Balancing community needs The issue of community social responsibility has become an important issue in the recent years. Today, many customers want to be associated with companies that have good community social responsibility policies, and many industries are realizing that for them to succeed they have to operate within community social responsibility framework. Many industries all over the world are adopting and practicing community social responsibility. At the same time the local communities have become more aware of their environment and demand industries to protect it. Aviation industry has balanced this need of the community by becoming more environmental conscious by focusing on ways of reducing environmental degradation issues such as global warming and pollution. It is possible for the industry to achieve this at the same time satisfy other stakeholders. The aviation industry also gives the local community a say in issues concerning environment management and employment to ensure peaceful coexistence that can enable the industry to grow without friction with the community. (Handy, 1985) Conclusion Different stakeholders have different needs in any industry, customer, shareholders, employees and the community remains important to the success of an industry. The aviation industry has a challenge in balancing these needs. The industry has undertaken changes in its organization behavior and its marketing policies to balance these needs. Some of the changes that the industry has undertaken are prudent management to satisfy the needs of the shareholders, high quality services and secure industry to respond to the needs of the customers, good remunerations and better working conditions to satisfy the employees and being more environmental conscious and taking more social responsibility to respond to the needs of the community. However, in this global era the industry will still be faced with challenge on how best to formulate policy decisions which can satisfy all needs of the various stakeholders in the industry.       Reference: Bartol, K, et al. (2005): Management: a pacific focus, 4th edition McGraw-Hill Book Company. Cox, B. (2000):   Southwest Airlines attributes profitability to treating customers, workers well. Fort worth Star-Telegram Dessler, G (2001): Management, leading people and organizations in the 21st century, Prentice Hall Inc, New Jersey. Freiberg, K., & Freiberg, J. (1998):   Nuts! Southwest Airlines’ crazy recipe for business and personal success:   New York; Bantam Doubleday. Handy, C.B. (1985): Understanding Organizations, 3rd Edition, Harmond-sworth, Penguin Books, Larson, M. (1997):   Corporate culture is Southwest’s edge. Business Journal Serving Greater Sacramento, 13(43), 30 Legge, K (2004): Human Resource Management: Rhetoric and Realities. Anniversary Ed. Hampshire: Palgrave, Macmillan, Locke, E. A. (1976): The nature and causes of job satisfaction. In M. D. Dunnette (Ed.), Handbook of Industrial and Organizational Psychology, Chicago, IL: Rand McNally. Judge, T. A., & Watanabe, S. (1993): Another look at the job satisfaction-life satisfaction relationship. Journal of Applied Psychology, 78 Robbins, S. P. (2004): Organizational Behavior – Concepts, Controversies, Applications. 4th Ed. Prentice Hall Phegan, B. (2000): Developing Your Company Culture; a Handbook for Leaders and Managers, Context Press, Weick, K.E. (1979): The Social Psychology of Organizing 2nd Ed. McGraw Hill Yukl, G. (2002): Leadership in organizations (5th ed.); Prentice Hall.

African American-European American Iat Essay

The version of the IAT, that I chose to take is the African American – European American IAT. There were a few steps in order to complete the test; the first step was to fill out information about myself. The questions that I answered were related to my age my educational status, nationality, religious beliefs and my current state of employment. The next step of the test was to choose either ‘E,† or ‘I,† to indicate my choice of African American for a picture of a African American or European American for a picture of a European American. The next series of questions asked me to select either African American grouped with â€Å"bad,† or European American with â€Å"good’. Another series of questions was visually posed this time with, African American grouped with good and European American grouped with bad. The results show that data suggests a strong automatic preference for European American’s compared to African Americans. My automatic preference was toward European Americans. The results of this test aren’t very surprising to me. In class we were told how the test would go, so I already knew what to expect. There was a small bit of doubt whether or not the test would indicate a strong preference for one or the other at all though, because I am Hispanic. I would have speculate that based on the fact that I grew up primarily in white suburbia in a private school that almost exclusively consisted of all white students, that my preference is a subconscious choice. I am most familiar with European Americans therefore I chose them over African Americans. There is a distinction between implicit attitudes and explicit attitudes, that distinction is simple. Implicit attitudes are the attitudes that we don’t think about, they are automatic. Explicit attitudes are the attitudes that are consciously controlled. According to Gawronski and Bodenhausen, in the text, Social Psychology,†Our automatic implicit attitudes regarding someone or something often differ from our consciously controlled, explicit attitudes†(p.51). From the results of the IAT that I took, I would have to say that my implicit attitudes towards African Americans, do not match my explicit attitudes about African Americans. The reason that I believe that my implicit attitudes are different from my explicit attitudes is that I usually make a conscious decision to be friendly and welcoming to any person that I come in contact with regardless of gender, race, age, or sexual orientation. The results are mildly surprising, however, I believe that I am more accustomed to being in the company of European Americans, and therefore I show a distinct implicit attitude favoring them. Implicit attitudes are a dangerous thing; we should pay particular attention to how we label people explicitly, so that with time, we can manipulate our unconscious attitudes and impulse reactions to certain people. A good example of problems that people run into with their improper mind set comes to us from our text, Social Psychology. Age is the example Bugental and Hehman used in 2007, when they discovered that people treat the elderly differently than they do people whom are younger, they explain that â€Å"People’s perceptions of the elderly- as generally kind but frail, incompetent, and unproductive- predispose patronizing behavior†¦Ã¢â‚¬ (p. 308). It’s that attitude that people hold about the elderly that according to Bugental and Hehman, â€Å"predispose patronizing behavior, such as baby-talk speech that leads elderly people to feel less competent and act less capably’ (p. 308). It is important that we change our thinking, because if we continue to have the same biases, we not only do our selves a disservice in being implicitly and or explicitly inappropriate in our attitudes, but we also risk the chance of hurting others in our actions. Works Cited Myers, D. C. (2010). Social psychology (10th ed. ). New York: McGraw-Hill. Pages 51,308 Psych 312 Extra Credit 10pts 5-8-13 Eli J. Guymon Gender – Career IAT The second test that I took was the gender – career IAT. Before the test began, I was asked to report my beliefs about women versus men in the work force and women versus men in the home life. The second set of questions asked me to fill out information about myself. The questions that I answered were, what is my age, my educational status, nationality, religious beliefs and my current state of employment. Following those questions were questions about my family growing up, they wanted to know if I had a mother as a primary care giver, and if she worked outside of the home, specifying what she did for a living, and if there was a secondary caregiver, such as a father or step father, where they employed outside the home, and what their occupation was. The next step of the test was to choose either ‘E,† or ‘I,† to indicate my choice. The groupings in the first series of visual concepts to match were men’s names with the word men and women’s names with the word women. The next step was to match men with career minded words and women with household related words. Finally in the final sets of matching words the groupings were reversed so that men and household related items were a pair and women with career minded words belonged together. According to the results, data suggested little or no association between male and female with career and family. I did not have a automatic preference. My explicit and implicit attitudes match, I do not consciously nor do I subconscious place anyone in a group that favors either individual in the work place or family. I am not surprised by my results because I was raised in a home where my mother was a primary care giver but I also received care giving from my step father. Both my mother and my step father worked outside of the home. Both my mother and my step father shared responsibilities equally except where one person seemed to enjoy a task more than the other, that partner would assume say a specific domestic role that the other was happy to not have to do. For an example of a domestic role that both of my parents needed to be done but one seemed to favor it over the other, grilling outside, was my step fathers domestic role because my mother did not enjoy doing that work, and my step father rarely did his own laundry, because it was a task that my mother felt comfortable doing by herself.

Discussion about female vagina circumcision Research Paper

Discussion about female vagina circumcision - Research Paper Example These cultures do not do so to harm the woman but believe that it is a main definition between a girl and a mature woman (Momoh 56). It is usually performed on girls who are few days into their puberty stages and in certain regions it is a requirement for any girl who may wish to get married. The act is usually performed without any anesthesia by a traditional circumciser who uses a knife or a razor or sometimes even scissors to remove the female genitalia in question. Apart from being a part of some cultures, it is also a part of some religious beliefs such as some Islam communities based in these regions especially in African countries such as Somali which has a large population of staunch Muslims (Ehrenreich and Hochschild 87). It is mainly practiced in parts of Africa, the Middle East and a number of immigrant communities based in Europe, Australia and America. The practice has been existent for a large number of decades, and scientific discovery in the medical profession was the main force behind groups that have risen in an effort to bring an end to this tradition. Types of Female Circumcision The World Health Organization has classified types of female circumcision into four types that have been categorized according the procedure that takes place. These four types of circumcision are carried out by different cultures and communities and include: Type 1 – This involves the removal of the clitoral hood, or the partial or sometimes total removal of the clitoris itself. The medical term for this procedure is clitoridectomy (Amish, Aisha and Aldo 87). Type 2 – Involves the total or partial removal of the clitoris as well as the inner or outer labia. Different cultures practice different combinations of these procedures such as sole removal of the inner labia or the removal of the inner and/or the outer labia as well as part or all of the clitoral. This type is often referred to as excision (Amish, Aisha and Aldo 87). Type 3 – This type i nvolves the removal of all of the female genitalia. This is to say that both the inner and outer labia is removed and may or may not include the removal of all or part of the clitoris as well (Amish, Aisha and Aldo 89). Once this is done, the girl’s legs are then bound together for a number of days that can go over a month in order to allow the wound to heal. A twig or an object of similar proportions is inserted in the wound to create a small hole that will allow for the passage of urine as well as menstruation once the healing process is complete. This type is commonly referred to as pharaonic circumcision or infibulation. Type 4 – This type categorizes all the other procedures that have not been covered in the previous three (Amish, Aisha and Aldo 103). They may include processes involving scraping, incising, pricking, and cauterization among others. Complications Involving Female Circumcision There are a number of medical complications that women who have undergone female circumcision may experience as a result. Some of these complications may occur immediately while others may be experienced later on after a period of time has elapsed (Skaine 65). They include issues such as infections that may occur as a result of the tools that are used. Most

Development of A HRM Strategic Plan Assignment Example | Topics and Well Written Essays - 1500 words

Development of A HRM Strategic Plan - Assignment Example The basic functions of HRD are attracting best candidates, reducing employee turnover, and to enhance the productivity of the employees (Taylor, 2005, p.1). It is a critical factor that contributes highly towards gaining a competitive advantage in the marketplace. One of the most important aspects of an HRM strategy is to determine the type of candidate required in the organization carry out organizational tasks. Also organizations arrange various kinds of programs for the purpose of satisfying their employees, and the responsibility for arranging it also falls in the shoulders of the human resource department. HRM strategy also plays a crucial role in the overall organizational culture. Furthermore training and development is also one of the most important functions of the Human resource department. In the context of the project a property management company has been chosen where the new HR strategy will be developed. The HR strategy will focus on the different aspects of managing the human resource of the organization. It will also emphasize on the recruitment strategies of some other organizations in order to formulate a competitive strategy. In order formulate a sound HRM strategy of the organization and to add more value to it, the HRM strategy of 3 other companies have been analyzed. However the names of the companies have not been disclosed due to some privacy policies. In order to get insights about the strategies of the chosen companies an interview session was held. The sample questions that were asked to the HR managers of those companies are follows:- Regarding leave policy there are a small differences among the chosen companies. Company A allows 28 leaves in a calendar year, company B allows 25 leaves while Company C allows 30 leaves in a calendar year. Also these companies allow special leave on

Employment Law Research Paper Example | Topics and Well Written Essays - 2000 words

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The American Health Concerns Essay Example | Topics and Well Written Essays - 1000 words

The American Health Concerns - Essay Example It is the responsibility of the individual citizen to take care of the personal health. It is not the responsibility of the medical field, the government or the corporate American that shares the blame. It has been noted with serious concern that many Americans are physically inactive, spending many hours watching TV or with computers for leisure activities, doing school work, or working from the computer. Choosing to drive short distances instead of walking is another contributing factor. Modern technology, which minimizes physical demands, can also be a massive factor. The individual should carry the blame, although not in all health cases. There are other significant health issues that the government should take the blame. Quite a sizeable number of the United States citizens have complained the failure of the government, in ensuring proper and effective medical checkup. Some citizens have reported going to the hospital, for medical attention, only to go back home and attended mai nly due to insufficient medical personnel, or pure negligence from doctors. The government has also failed in public health initiative that is aimed at improving and protecting the general health. The public health initiative should be carried out through a promotion of improved healthy lifestyle, extensive research for diseases and prevention. A lot of unregulated food supplements have found their way in the market, and it is my observation that this is a failure by the government to protect public health.

Strategic Management and Leadership Assignment Example | Topics and Well Written Essays - 3500 words

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Current issues in financial reporting Essay Example | Topics and Well Written Essays - 1250 words - 1

Current issues in financial reporting - Essay Example 549-586). This paper explains the importance of financial reporting in organization, and gives the reasons for and against capitalising human resources in the financial statements of a company. Discussion Financial reporting entails communication of useful financial information for making credit, investment and other decisions in business. Reports to the stockholders on quarterly and annual basis, financial statement notes, prospectuses on issuance of security and common stock, and the external financial statements, like the income statements, stockholder’s equity statement, cash flow statements and the statements on stock equity. Financial reporting enhances delivery of information to the shareowners and lenders in business; it is usually component of the essential contract between them since they have the right to know the spending of their money and the returning profits (Ballweiser, 2004). In UK, big changes in financial reporting are under the Financial Services sector. T he Accounting Standards Board, ASB issued exposure drafts that detail the proposals for financial reporting in UK. ... The demand for more transparency ensures growth to the interests of an organization in order to meet such demand constructively. The organization will, therefore, have a strategic value in clarifying for the critical performance as well as internal management of the organization communication. This leads to effective allocation of capital in the organization, and critical in achieving a special attention within the accounting research. Reason for Capitalizing Human Resource in UK Human capital forms the main asset in service companies. The success of an organization can be rated depending on the  employees and customers they retain (Francis, Lafond, Olsson, & Schipper 2005, p. 295-327). Several studies on human resource measurement aim at providing the management of any organization with the traditional financial statements, as well as additional information. The intangible asset from many organizations is more critical than the tangible assets. Intangible assets comprise of the su ccess factors needed for maximization of profits and continual survival of the organization. Like human resource, while the intangible assets comprise of the fixed assets like property. The financial information from the financial statements is considered incomplete when they fail to cover and account the human resources. Financial measuring and reporting by businesses in UK enhance the management and evaluation of people’s performance. This ensures greater transparency on value creation through effective policies and practices that benefit stakeholders and the organization at large. The management of people by an organization impacts their performance. The feature of good managerial practices

Causes of Low Productivity and Policies to Raise Output in Essay

Causes of Low Productivity and Policies to Raise Output in Underdeveloped Countries - Essay Example According to Schultz (1998, p.329), economists find it difficult to understand the preferences and scarcity constraints that determine the choices that poor people make because they fail to understand is that poor people are no less than concerned about improving their lot and that of their children than rich people are. As poor people reside predominantly in low-income countries, they earn a pittance for their labor, half and more of their meager income is spent on food, and that most of them earn their livelihood in agriculture. Schultz also points out that economic history has also been neglected. Classical economics was developed during the time when most people in Western Europe were barely scratching out subsistence from the poor soils they tilled and were condemned to a short life span. As a result, early economists dealt with conditions similar to those prevailing in low-income countries today. Knowledge of the experience and achievements of the poor people over the ages can contribute much to an understanding of the problems and possibilities of underdeveloped countries today (1998, p.332). Accordin According to Emmerij (1987, p.9), the disappointing performance of agriculture in many low-income countries cannot be ascribed wholly to technical factors or agricultural conditions in that unsuitable economic policies can have the effect of reducing incentives to increase output and impending production. In connection to this, Schultz (1998, p.333) argues that differences in the soil productivity1 do not explain why people are poor in long-settled parts of the world, conversely, the state of agriculture in underdeveloped countries. Schultz narrates: "People in India have been poor for ages, both on the Deccan Plateau, where the productivity of the rainfed soils is low, and on the highly productive soils of South India. In Africa, people on the unproductive soils of the Southern fringes of the Sahara, on the somewhat more productive soils on the steep slopes of the Rift landform, and on the highly productive alluvial lands along and at the mouth of the Nile all have one thing in common: they are very poor" (Schultz 1998, p.331). Rather, Schultz cites that though land per se is not a critical factor in being poor, the human agent is. The expectations of human agents in agriculture - farm laborers who both work and allocate resources - are shaped by new opportunities by the incentives [in agriculture] to which they respond. These incentives, explicit in the prices farmers receive for their products and in the prices they pay for producer and consumer goods and services, are greatly distorted in many low income countries (1998, p.332). Governments tend to introduce distortions that discriminate against agriculture because internal politics generally favor urban at the expense of rural people, despite the much greater size of the rural population (Schultz, 1998). The effect of these government-induced distortions is to reduce the economic contribution that agriculture is capable of making (1998, p.332), despite the fact that

Mathlab Simulink Project Lab Report Example | Topics and Well Written Essays - 1000 words

Mathlab Simulink Project - Lab Report Example Communication toolbox is the boundary of matlab simulink is a graphical building block, diagramming tool, improved to resemble set of slab libraries. The matlab environment associates itself with the matlab and the engaging patterns of the two offers a tight and integrated move with the rest of the matlab environment. Additionally, this establishes matlab and can either be driven from the matlab itself or be scripted from it. Moreover, simulink, majorly used in control theory and error correction digital gesture dispensation of multidomain model and model-based plan helps in improving the performance and ability of matlab usage in determining error correction and coding methods. In conclusion, matlab simulink integrates its functions in order to have its performance at the best productive level for correcting errors and improving coding methods within a communication toolbox (Cassandras, 22). The reference signal operates from the coding methods. It moves in a graph line from 1 time offset all through frequencies as shown above in a upward and downward movements to give a graph of the above nature, therefore, confirming the principle of error correction and coding methods of up and down movements based on the wavelength of the signal and frequency. The control signal also operates almost in the same design but the movement and frequency of the graph is much more different as shown in the diagram below. The control signal has an upward steady movement with the wavelength up to 2, then a steady movement across the time offset meaning it’s the control signal that manipulates and confirms the idea of error correction and the coding methods of the communication tool box. It corrects the signal by allowing for steady flow of the signal within the communication toolbox. The developers and instructors of matlab have made an improving through the knowledge of the product developers and other stakeholders of the engineering field

Native American Religions Essay Example for Free

Native American Religions Essay Native American Religions happen to be one of the oldest and most enduring forms of religion. They comprise a large number of distinct tribes, states, and ethnic groups. Native Americans arrived on the North American Continent fifth-teen thousand to twenty thousand years ago. Native Americans have literally sources that exist from only the last four hundred years even though Native American life covers perhaps twenty thousand years. Over three hundred tribes have been recognized by the United States government. Native Americans are the only known ethnic group in the United States requiring a federal permit to practice their religion. In the state of Virginia, Native Americans face a unique problem. Virginia has no federally recognized tribes. Native American Religions have also been known as American Indians, Amerindians, Amerinds, Aboriginal, Indians, Indigenous, Original Americans, Red Indians, or Red Men. Native Americans religions are polytheistic. Native American Religions are remarkably free of priesthood. Native Americans are very personal in that they encourage Page 2 individuals to contact the spirit world alone. Native Americans believe that many levels of Gods and Spirits exist in the universe. They think of the High God or Great Spirits as a personal God. They believe in the Supreme Being in a manner found in many basic religions. Native religions have some of the qualities of monotheism, polytheism, and monism. Native American has been exposed to Christian eschatology for more than four hundred years. The influence of Christianity has been so strong that today most Native Americans are Christians. They are interested in the day-to-day life among the multiple spirits found in the world. Native Americans have a reverent attitude toward the land, trees, rivers, and mountains. Native Americans who practiced agriculture revere the soil, plants, and tree. Hunting was an important part of life within many Native American Cultures. The hunter would pray to the spirit of the animal before the hunt. Hunting was a religious pursuit in which the hunters saw the animal as a fellow creature, with a similar spirit. After all hunting’s one would ask the animal for forgiveness. They would basically perform a taboo. A religious action that enables people to avoid doing things that would offend the spirits of nature and the ancestors. This was one of the ways the Native American would protect themselves from possible danger from the spirit world. Another widely observed taboo is the avoidance of the dead. Taboo concerning about Page 3 the dead led Native Americans to be greatly concerned about their final resting places. There is no heaven for those who have been righteous and no hell for those who have been wicked. Native Americans often seek to control the forces of spirit world with ceremonies. The purpose of their ceremonies, rituals, songs, and dances is not necessarily worship. They are a mean of renewing the partnership between humans and the spirit world. Long hours of dancing in this atmosphere prepare the participants for contact with the spirit world. Holy week is also celebrated a song and dance. Native Americans often gain special powers by seeking visions that may place them in connection with the spirit world. Visions are sought by Native Americans at other times in life. The spirit may appear after a period of fasting and prayer, or sometimes without any preparation. The Sweat Lodge is probably the most important Native Ritual. The sweat lodge usually occurs before and after every other major ritual like the Sundance and Vision Quest. It is also a stand alone ritual meaning that it occurs whenever it is needed. Its original purpose was to cleanse or purify individuals. Mother sweat lodge essentially translates in to returning to the womb. The Sun Dance last from four to eight days starting at the sunset of the final day of preparation and ending at sunset. It showed continuity between life and death regeneration. It shows that there is no true end to life, but a cycle of symbolic and true deaths and rebirths. All of nature is intertwined and dependent on one another. This gives an equal ground to everything on the Earth. The sun dance was a significant part of the Crow Indian peoples Page 4 spirituality. It was a spiritual retreat in which a large number of participants would fast, pray and dance for a period of days. They asked for answers to events going on in their lives. Traditional Native Americans seem to believe in two souls, neither of which is considered immortal. One soul is the life, or the breath, that accompanies the body. The other soul is known as the free soul. One of the most common elements of Native American Religions is the use of tobacco and the sacred pipe in religious ceremonies. Tobacco was originally grown and used only for religious purposes by Native Americans. The tobacco used in religious ceremonies is stronger than the tobacco used in cigarettes. The ritual tobacco is occasionally smoked in rolled from corn husks. Most Native American tribes had traditional gender roles. Men hunted, traded and made war, while women gathered plants, cared for the young and the elderly. Women ever had the task of making weapons and tools, they took care of the roofs of their homes and often helped their men hunt buffalos. Many Native American people believed in the unusual power of a woman at these times in life. During a women menstruation she was kept away from ordinary society. Native Americans today have a special relationship with the United States of America. In conclusion, Native Americans can be found as nations, tribes, or bands of Native Americans who have sovereignty or independence from the government of the United Statesry society. Like other religions, Native American belief systems include many sacred Page 5 narratives. Such spiritual stories are deeply based in Nature and are rich with the symbolism of seasons, weather, plants, earth, water, sky and fire. The idea of an all powerful Great Spirit, a connection to the Earth, diverse creation narratives and collective memories of ancient ancestors are common. Traditional worship practices are often a part of tribal gatherings with dance, rhythm, songs and trance.

Biosynthesis, Metabolism, and Utilization

Biosynthesis, Metabolism, and Utilization Different ways glutathione acts to protect mammalian organisms from potentially toxic exogenous and endogenous compounds. Glutathione (GSH or gamma-glutamylcysteinylglycine) is a tripeptide and a sulfhydryl (thiol or -SH) antioxidant, enzyme cofactor and antitoxin that is made up of three amino acids namely L-glutamine, L-cysteine and glycine. The water solubility nature make it to be found in the cell cytosol and within aqueous phases of living system, although is constantly encountered in animals, plants and microorganisms (Kosower NS et al 1978 , Meister A et al 1976, Kidd PM et al 1991 and Lomaestro BM et al, 1995). Glutathione exists intracellularly in two forms in either reduced form or oxidized form which can be an antioxidant in reduced form (GSH) and sulphur-sulphur bond compound called glutathione disulphide (GSSG) in the oxidized form. Sensitive indicator of oxidative stress is the ratio of the reduced form (GSH)/ oxidized form (GSSG) which is also important in cell functioning in the organisms. Biosynthesis, Metabolism, and Utilization The homeostatical control status of glutathione by continuous self adjusting to equilibrate GSH production, its reprocessing from GSSG and its usage is a function of enzymes such as GSH synthetase, GSH reductase, peroxidises, transferases, transhydrogenases and transpeptidases. Cysteinyl moiety is the functional element of glutathione that provides the thiol reactive group which is liable for the sustenance of protein structure and functions through proteins disulfide linkages reduction, controlling of production and breakdown of protein, sustenance of immune function, defence against oxidative injury, removal of reactive chemicals. The metabolism and function of glutathione is directly decided by structural elements of glutathione which are ÃŽ ³-carboxyl peptide linkages of glutamate and C-terminal glycine presence. All mammalian cells produces GSH (Meister and Tate, 1976) and major site of biosynthesis is the liver ( Deleve and Kaplowitz, 1991). The production of GSH occurs in the cytosol of cell and its breakdown takes place outside the cell; production involves a two phase reaction catalyzed by GSH synthetase and ÃŽ ³-glutamylcysteine synthetase that uses two moles of adenosine triphosphate(ATP) per one mole of GSH while the breakdown are catalyzed by ÃŽ ³-glutamyl transpeptidase and dipeptidases present on the top surface of epithelial tissues. The first phase is under the influence negative feedback from its end product, GSH (Richman and Meister, 1975). The blockage of the regulatory site of the enzymes by excess glutamate can partially prevent feedback inhibition (Meister, 1984; Meister and Anderson, 1983; Richman and Meister, 1975). The limiting factor after the utilization of GSH and loss of feedback inhibition is the availability of cysteine. The breakdown products of GSH S-conjugates and GSH are the same (glutamate, glycine, and cysteine) and are also metabolized by same degradative enzymes which metabolized GSH and the products can be reabsorbed int o the cell for GSH production. Intracellular N-acetyltransferases can acetylate cysteine S-conjugates on the amino group of residue of cysteinyl to form mercapturic acids (N-acetylcysteine S-conjugates) which are released into the circulation or bile (Hinchman et al., 1991). ÃŽ ³-glutamyl cyclotransferase is responsible for the change of excess ÃŽ ³-glutamylcysteine accumulation, in the absence of its change to GSH which can result to 5-oxoproline and 5-oxoproline accumulation has harmful effect because of metabolic acidosis. REDOX AND CELLULAR REGULATORY ROLE OF GSH GSH Peroxidases and phospholipid hydroperoxide GSH peroxidases are antioxidant enzymes which uses glutathione has an important cofactor although GSH peroxidases exist in both selenium-dependent and non-dependent forms ( Zhang L., 1989). GSH peroxidases acts by reacting hydrogen peroxide and other peroxides with GSH in water phase to detoxify them while peroxides produced in cell membranes and lipophilic cell phase are detoxified by phospholipid hydroperoxide GSH peroxidases using GSH (Cathcart RF III., 1985). GSH can also be used by GSH transhydrogenases as a cofactor in the reconversion of dehydroascorbate to ascorbate, ribonucleotides to deoxyribonucleotides and interconversion occurring between disulphide and thiol group. GSH reducing power source is the nicotinamide adenine dinucleotide phosphate(NADPH) in reduced form which is from the pentose phosphate shunt that glutathione reductase uses as a source of electron in the reprocessing of GSSG to GSH (Cathcart RF III., 1985) and i ndicative of increased risk of oxidative injury in subjects unable to produce enough NADPH due to GSH insufficiency. Vitamin E and carotenoids which are lipid-phase antioxidant can be conserved by GSH reducing power ability (Meister A et al, 1994). There are two pools of GSH in liver which are the cytosolic GSH and mitochondrial GSH; the first has a half-life of 2-4 hours and the second half-life is about 30hours (Meister A et al, 1995). There are various disorders associated with two enzymes involved in the two phase synthesis of GSH which include peripheral neuropathy, haemolytic anaemia, aminoaciduria, CNS function defects, myopathy, spinocerebellar degeneration in inherited deficiency individuals (Meister A, Larsson A., 1995). Kosower NS. et al,. 1978 discovered the essential role of GSH in cellular homeostasis and various cellular functions; biological processes such as cell maturation, protein synthesis, transmembrane transport, intermediary metabolism, enzyme catalysis and re ceptor action. Ondarza RN. , 1989 also observed that redox uniqueness are essential to life process with many vital enzymes and about eight taking part in glucose metabolism being regulated by redox balance (2 thiol group and disulphide). Intracellular sulfhydryl (-SH) groups of proteins are mainly pro-homeostatically regulated by GSH (Crane FL. et al,. 1988). The whole range of biomolecules are protected by combination of the reducing power of glutathione with other antioxidants and ascorbate, which also helps in regulating their function, and to assist the survival and maximum functioning of the cell as a living unit. Metallothioneins are proteins which can bind with heavy metals and potential sulfhydryl poisons due to glutathiones reducing power and its -SH character that set the redox stage and also speed up their removal from the body later (Hidalgo J. et al,. 1990). The redox state of many cellular environments are fine- tune homeostatically by glutathione reducing power. GSH plays a central role in the antioxidant defense system that protects against various free radicals and oxidative stressors which its exposed to regularly (Cross CE, Halliwell B, Borish ET, et al. 1987). The exogenous oxidative insults tends to be more easily controlled by GSH. SYSTEMIC ANTITOXIN ROLE OF GSH Organs like lungs, intestines, kidneys and liver which are directly exposed to exogenous toxins are often important to GSH, although high concentration of GSH in lower section of lungs helps neutralize inhaled toxins (cigarette smoke) and free radicals made by activated lung phagocytes (Lomaestro BM et al, 1995; Cross CE, Halliwell B, Borish ET, et al, 1987). The detoxification of substances foreign to body is mainly by the liver and also carries GSH to other organs. The activity of GSH transferase enzymes (GSTs) drains GSH in normal functioning liver while malnutrition or starvation depletes liver GSH stores (Deleve LD, Kaplowitz N. 1990; Mandl J, et al,. 1995). The electron-donating co-factor of GSTs is GSH due to definite specificity its has for it, although GSTs have fairly wide specificity for their substrates. GSH plays a fair considerable role in liver P450 conjugation activity which is responsible for about 60% of liver metabolites present in bile but GSH conjugation is certa inly of full advantage to organism though it is not positive in every circumstance. There are different classes of xenobiotics that induce P450 enzymes which produce more toxic GSH conjugates than the parent xenobiotics ( Monks TJ, et al,. 1994). Depletion of liver pool of GSH can decrease conjugation and increase xenobiotics toxicity for example are Tylenol ® (experimental acetaminophen) and bromobenzene toxicity (Kidd PM. 1985). Glutathione and also glutathione S-transferase plays important role in the regulation of both acute and chronic chemical toxicity in the lung (west et al., 2003). Detoxification function of glutathione is dependent on the ability of its synthesis in the lungs and the cellular localization (plopper et al., 2001b, West et al., 2000). In human liver, the pulmonary glutathione S-transferase activity is about 30% while in the rodents liver, it is 5-15% (Buckpitt and Cruikshank, 1997). The distribution of isoforms of glutathione S-transferase varies in the lun gs. The result of polymorphisms expression in humans and potential for similarity of this with cancer of the lungs, particularly in smokers, makes glutathione transferase a focus point of acute interest. There are equilibrium systems working between enzymes, that is a decrease in one enzymes can cause an increase in another enzymes at the same time; the location and balance of all the enzymes determines toxicity. CONCLUSION Glutathione functions in the body are numerous which include neutralization of free radicals and reactive oxygen compounds, sustaining exogenous antioxidant in their reduced forms (Vitamins E and C). It also plays important role in diverse metabolic and biochemical reactions for example enzymes activation, DNA synthesis and repair, amino acid transport, protein synthesis, prostaglandin synthesis etc. In the immune system, glutathione manifest full potential by adjusting antigen being presented to lymphocytes which might influence formation of cytokine, resulting in formation of cellular or humoral responses, magnitude of responses are increased by promoting lymphocytes production, thereby causing promotion of killing activity of cytotoxic T cells and NK cells and regulating apoptosis; thus sustaining control of immune system. REFERENCES Buckpitt AR, Cruikshank MK: Biochemical function of the respiratory tract: Metabolism of Xenobiotics, in Sipes IG, Mc Queen CA, Gandolfi JA (eds.): Comprehensive Toxicology, Vol 8, Toxicology of the respiratory system. Oxford: Elsevier Science, 1997, pp 159-186. Plopper CG, Buckpitt A, Evans M, et al.: Factors modulating the epithelial response to toxicants in tracheobronchial airways.Toxicology. 160:173-80, 2001b. West JA, Van Winkle LS, Morin D, et al.: Repeated inhalation exposures of the bioactivated cytotoxicant naphthalene (NA) produce airway specific clara cell tolerance in mice. Toxicol sci 190:286-293, 2003. West JA, Chichester CH, Buckpitt AR, et al.: Heterogeneity of clara cell glutathione. A possible basis for differences in cellular responses to pulmonary cytotoxicants. Am J Respir cell Mol Biol 23:27-36, 2000. Kosower NS, Kosower EM. The glutathione status of cells. Intl Rev Cytology 1978;54:109-160. Meister A. Glutathione metabolism and transport. In: Nygaard OF. Simic MG, ed. Radioprotectors and Anticarcinogens. New York, NY: Academic Press: 1976. Kidd PM. Natural antioxidants-first line of defense. In: Kidd PM, Huber W. Living with the AIDS Virus: A Strategy for Long-Term Survival. Albany. California: PMK Biomedical-Nutritional Consulting: PMK Biomedical-Nutritional Consulting: 1991:115-142. Lomaestro BM, Malone M. Glutathione in health and disease: pharmacotherapeutic issues. Annals Pharmacother 1995:29:1263-73. Meister A. Minireview: Glutathione-ascorbic acid antioxidant system in animals. J Biol Chem 1994(April1);269(13):9397-9400. Meister A, Larsson A. Glutathione synthetase deficiency and other disorders of the gamma-glutamyl cycle. In: Scriver CR, et al eds. The Meatbolic and Molecular Bases of Inherited Disease (volume 1). New York: McGraw-Hill;1995;1461-1495 (chapter 43). Meister A. Glutathione, ascorbate, and cellular protection. Cancer Res (Suppl) 1994(Apr 1);54;1969S-1975S Meister A. Mitochondrial changes associated with glutathione deficiency. Biochim Biophys Acta 1995;1271:35-42. Meister A (1984) New aspects of glutathione biochemistry and transport-selective alteration of glutathione metabolism. Nutr Rev 42:397-410. Meister A and Anderson ME (1983) Glutathione. Annu Rev Biochem 52:711-760. Meister and Tate SS (1976) Glutathione and related gamma-glutamyl compounds: Biosynthesis and utilization. Annu Rev Biochem 45:559-604. Hinchman CA, Matsumoto H, Simmons Tw and Ballatori n (1991) Intrahepatic conversion of a glutathione conjugate to its mercapturic acid: Metabolism of 1-chloro-2,4-dinitrobenzene in isolated perfused rat and guinea pig livers. J Biol Chem 266:22179-22185. Richman PG and Meister A (1975) Regulation of gamma-glutamylcysteine synthetase by nonallosteric feedback inhibition by glutathione. J Biol Chem 250:1422-1426. Wei wang and Nazzareno Ballatori (1998) Endogenous glutathione conjugates: Occurrence and biological functions. Pharmacological reviews Vol. 50, No 3. Zhang L. Phospholipid hydroperoxide glutathione peroxidise: specific activity in rats of different ages. Biochim Biophys Acta 1989;1006:140-143. Cathcart RF III. Vitamin C: the nontoxic, nonrated-limited, antioxidant free radical scavenger. Med Hypotheses 1985;18:61-77. Crane FL. Morre DJ. Low H (eds). Plasma Membrane Oxidoreductases in Control of Animal and plant Growth. New York: Plenum Press; 1988. Ondarza RN. Enzymes regulation by biological disulfides. Bioscience Reps 1989:9:593-604. Hildalgo J. Garvey JS. Armario A. On the metallothionein. Glutathione and cysteine relationship in rat liver. J Pharmacol Exptl Ther 1990:225:554-564. Cross CE. Halliwell B. Borish ET. Et al. Oxygen radicals and human disease (proceedings of a conference). Ann Intern Med 1987:107:526-545. Kidd PM. Liver biotransformation of xenobiotics, foods, and drugs to free radicals oxidants. In: Levine SA. Kidd PM Antioxidant Adaptation- Its Role in Free Radical Pathology. San Leandro. CA: Biocurrents: 1985:222-281. Deleve LD, Kaplowitz N. Importance and regulation of hepatic glutathione. Seminars Liver Dis 1990;10:251-266. Mandl J, Banhegyi G, Kalapos MP, et al. Increased oxidation and decreased conjugation of drugs in the liver caused by starvation. Altered metabolism of certain aromatic compounds and acetone. Chem Biol Interact 1995;96:87-101. Monks TJ, Lau SS. Glutathione conjugation as a mechanism for the transport of reactive metabolites. Adv Pharmacol 1994;27:183-206. Kidd PM et al. (1997) Glutathione: systemic protectant against oxidative and free radicals damage. Alternative medicine review vol.2 No 3, pp 155-176. Stryer L. Biochemistry (3rd ed) New York NY: WH Freeman:1988. Hinchman CA and Ballatori N (1994) Glutathione conjugation and conversion to mercapturic acids can occur as an intrahepatic process. J Toxicol Environ Health 41:387-409.

Promoting A Healthy Environment For Children Education Essay

Promoting A Healthy Environment For Children Education Essay The proportion of children living in poverty grew from 1 in 10 in 1979 to 1 in 3 in 1998. 30% of children live in poverty in the UK The UK has one of the worse rates of child poverty in the industrialized world Source: www.endchildpoverty.org.uk June 2007 The majority of sleep experts advise parents to abruptly withdraw their attention at bedtime-with no mention of teaching a child self-soothing skills. But many parents are looking for help after having shared their bed or assisted their child to fall asleep for months or even years. When children are abruptly expected to fall asleep without any assistance it sets the scene for the all too familiar nightly bedtime battle. If parents consistently ignore their childrens anguished pleas for attention, after weeks of tears and tantrums, children will eventually begin to fall asleep on their own. But in the same amount of time, parents could have avoided the battles-by teaching their children to relax themselves to sleep while gradually and systematically decreasing their attention. Routine helps establish many aspects of healthy living good ways of life and good behaviour. Even the smallest structure is necessary in day-to-day life. Children want and even need routine and there are lots of ways to get them going byestablishing a schedule that works for al the family. There are so many positive side effects for starting to use strong routines for children. Children do not have a lot of control in their lives and it gives them a sense of organization, steadiness and comfort. This helps develop healthier behaviour and a sense of personal control. Doing things like bathing and brushing teeth as part of morning or nighttime routines can help establish good personal hygiene and health habits. Having built in chore time somewhere in the week or day, having them help pick up at the end of dinner or tidy up the house at the end of a day of playing establishes responsibility and work ethic. Mealtime When it is time to eat it is a perfect time to start good habits. Eating habits, particularly. Always eat breakfast, Lunch and tea, but at set times and with structure for children so there are no surprises and the length between eating isnt so great that hunger takes over the family. That can lead to irritability or impulse snacking and dinner wrecking. Set standards for when snacking can take place and what kinds of foods are eaten. Dont indulge or give in for food whenever a child wants something. The results should always be equal good eating and good eating habits. Mealtimes are a good time to instil family into the children. Always try to find some time to sit down together, preferably at a table, to talk and eat. Also, have children help get dinner started, set the table and clean up afterward to plant a bit of responsibility. A1 My role as an Early Years Practitioner would be to assist with the promotion of health and well-being of children and help maintain a healthy environment for children. I may be responsible for organising a room and making sure that policies and procedures are being followed and recorded. I would have to cater for their needs as young children; developmentally, physically and socially. This would be ensure that I am promoting and maintaining a healthy environment for all children. It is also important that you learn by experiencing and learning from the experiences of others. In my role I would have to plan and provide a caring and stimulating environment that is appropriate for individual children and enables children to reach their full potential and to work within the Children Act and local guidelines, legislation and standards and ensure that Child Protection policies and procedures are adhered to at all times. I would have to plan and prepare exciting play opportunities that meet the childrens developmental needs and stimulates their learning. I would also participate in supervision and staff development processes in support of promoting and maintaining a healthy lifestyle and environment and to undertake training as appropriate to meet any changes in standards or appropriate legal requirements as required. In reviewing and reflection of any issues is an important aspect of a practitioner and to review where, why, how, when, etc. The reflective cycle as developed by Gibbs allows you to think about what you have done, how well it went, get feedback from others and consider alternatives. The reflective cycle is broken down into 6 units 1. Description -what happened 2. Feelings 3. Evaluation Analysis conclusion and finally Action plan what will you do next time. The practitioner should also evaluate their own learning and performance. This can be done through Professional development and discussions with the line manager and other practitioners. For example: Share examples of your practice discuss Get ideas of other practices Visit other practices and observe, discuss. Make sure you keep up to date with current practices Articles in magazines, books, training, etc In house or external training Additional qualifications, etc Observe children / observe other practitioners Planning Childs next steps Try new things Trial and error is also an important reflection and to review how things happen. But in all cases, the safety of children is paramount. Experience is the most important issue and to understand that as an new trainee or new nursery nurse, you dont know everything. That you learn by experiencing and learning from the experiences of others. I would also have to keep in touch with new initiatives that are promoted and keep on top of new legislation.

Sir Thomas More the Martyr Essay -- essays research papers

The definition of a martyr is a person who willingly suffers death rather than renounce his or her religion. When Sir Thomas More died in July of 1535, he became a martyr. In the play A Man for All Seasons, author Robert Bolt shows us his views on how More came to his death . In this play, Thomas Cromwell, Richard Rich, King Henry VIII, and Sir Thomas More himself are responsible for his death. Although it could be argued that many more people in Sir Thomas More’s life had a part in contributing to his death, these four characters had the greatest part in eventually bringing him to his death. Some people may say that Cromwell and Rich were just pawns in the King’s plot, however they can’t possibly argue that they weren’t in control of their actions. Cromwell and Rich are essentially responsible for the final prosecution of More. Together, they are guilty of letting their inner want and need for power cloud their consciences, which led them to bring down a good man of Thomas More. More, being a smart man, could beat them in a court of law. Rather than fighting More with the law, Rich and Cromwell decided to break it. Rich lied under oath sending More to his deathbed, and he responded, â€Å"I am sorrier for your perjury than my peril†(156). Cromwell, in his quest for power, saw a doorway of opportunity where he could bring down More and in the process benefit his own social and economic status. As More stated, â€Å"Silence gives consent† (152) and Cromwell’s silence during Rich’s illegitimate testimony makes him an access ory to the crime and therefore just as guilty as Rich. Together, Rich and Cromwell are partners in the crime, whether they are accomplices to King Henry or for their own reasons. Either way, they are still responsibl... ...and, â€Å"I don’t believe this had to happen†(144). At least twice Sir Thomas More made poor choices and put himself into bad situations in the play, which ultimately took him closer and closer to his death. Sir Thomas More never had to die. He was the only person that really understood the implications that complying with the King’s desires would cause and yet he still ended up in the most undesirable position one could imagine. Many people caused the death of Sir Thomas More in A Man for All Seasons, however those that are most guilty are King Henry, Thomas Cromwell, Richard Rich, and Sir Thomas More. Who of these is most guilty is a matter of opinion, but that these people are truly and completely guilty of ending Sir Thomas More’s life is a fact. From King to commoner each of these people played a vital role in the destruction of one man’s honest and righteous life.

History Of Birth Control :: Contraceptives, Birth Control Essays

History of Birth Control Although birth control has been practiced since ancient times, the first organized efforts developed during the 19th century as population increased dramatically because of improved medical care, nutrition, and sanitation. However, birth control met with resistance. In 1873 the United States Congress enacted the Comstock Law, which prohibited the distribution of birth-control devices and information. During the early 1900s, American nurse Margaret Sanger led the birth-control movement in the United States. She and others opened clinics to provide women with information and devices. Although frequently jailed, she and her followers were instrumental in getting laws changed. In subsequent years, laws against birth control gradually weakened, and more effective methods were developed. Now a days there are several different methods of birth control. The first that I am going to talk about is called the rhythm method. As its synonym implies, this method is based on the assumption that, for each women, there is a rhythmic pattern of menstruation and ovulation that can be identified by keeping a careful record of the dates of menstruation. A second assumption is that ovulation occurs 14 days before the onset of the next menstruation. The rhythm method is the most commonly used of the natural methods. To be used successfully a record should be kept for at least six menstrual cycles. The fertile period is then defined by a set of rules for example: The length of the shortest cycle less 18 days marking the start of the fertile period and the length of the longest cycle less 11 days marking the end of the fertile period. This is the only birth control method that has received the Catholic Church’s seal of approval. The next natural way of avoiding the use of contraceptives is called the Basal body temperature method. In a normal, ovulatory cycle the temperature of the body measured on awakening, called the basal state, rises by 0.2C to 0.5C during two or three days following ovulation. This rise is defined as one in which three consecutive daily temperatures are at least 0.2C higher than the six daily temperatures preceding the shift. This rise reflect the secretion of progesterone from the corpus luteum. The unplanned pregnancy rate of this method is about 11.

Revenue Management and Pricing Essay

Springfield Nor’easters was a new Class A minor league baseball team, which would start the first season in June 2009. The marketing director, Larry Buckingham, had to design the price scheme for the new season. Springfield was the third largest city in Massachusetts with 55,338 residents and around 60% of the households were families with children below 18. However, Springfield offered few spectator opportunities for sports fans, the only way to attend a professional baseball game is to drive to other cities. Springfield Nor’easters, the first professional baseball team in the region, will compete in one of the 19 regional leagues under Minor League Baseball (MiLB). Each of the 30 teams in Major League Baseball (MLB) was affiliated with minor league teams and they funded players’ salaries as well as bat and ball expenses, while minor league teams were responsible for uniform expenses, league dues, office and travel expenses, etc. Nor’easters’ financial goal for the first year is break even and their income will come from tickets sales, concession sales and sponsors from local institutions and organizations. To design his tickets offers, Buckingham found that it’s important to both analyze the remaining data from a survey done in 2005 by League Sports Association and conduct a more detailed survey specific to the local market. Buckingham then figured out that his primary research objectives were to know how many people would come to the games and how much to charge them, and he made several observations while interviewing some counterparts of other minor league teams. First off, he needed to price seats on par with competition such as movies, bowling and other sporting events. Secondly, it’s important to have a well-designed mix of season tickets, group sales and individual tickets. Thirdly, he should consider promoting group sales with special promotions. Last but not least, concessions were critically important with at least a 39% profit margin. Buckingham kept three criteria in mind while designing the survey questions: maximum information yield for management decisions, question clarity for respondents, and ease of data analysis. He decided to conduct this survey by  mailing 10,000 postcards that would direct recipients to a website where they could complete a questionnaire and then get entered into a drawing. The online questionnaire was pretested three times and several questions were changed afterwards according to the feedback. The mailing list for the postcard was drawn from two sources. One half was taken from Springfield census tracts of households with income above the poverty level and the other was obtained from the mailing lists of four sports-related organizations in Springfield. Ultimately, 625 responses were tabulated. Luckily, Buckingham found that the sample respondent characteristics were fairly representative of the Springfield market. Buckingham knew that his real goal was to maximize not only ticket income but also concessions. He wanted to make sure the prices of different packages were set appropriately. Also, while calculating the concession sales, he was told to note that attendance would drop from around 100% (individual game) to 97% (5-game), 95% (20-game), 90% (38-game). With these things in mind, Buckingham started to analyze the survey data and calculated the optimal prices. We found that the actual pricing policy is much more complicated, there are a wide variety of seats, and more games (full season = 70 games). To have a more-close-to-situation price for comparison, we exclude the special and upscale tickets. Then average the rest’s ticket price (â€Å"Diamond Boxes†, â€Å"Field Boxes†, â€Å"Dugout Boxes†, and â€Å"General Admission†), and come up with a result of $9.25 per game. To sum up, our proposed price ($10/game) is slightly higher than the actual price, and the reasons are as followed. 　　First, in the actual stadium, there are some high-class club and seat that will compensate for other cheaper tickets. Second, there may be more advertisement, sponsorship, and special event revenue which haven’t been counted in the case. Third, the actual stadium may have more seats (ex. grass seating), so the ticket price can be lower ours. Lastly, however, global recession may be a cause, but we do not consider it to take a great part. Though the ticket price per NBA game actually increases through years, taking into account the improving but still sluggish economy in 2012 and the difference in popularity, it’s not likely that Springfield Cardinals is able to set price high.

Lady Macbeth, an honoured hostess and a fiend-like Queen Essay

The audience witness a total transformation of Lady Macbeth from a powerful, scheming woman to a sad and lonely wretch. By the end of this tragedy she has nothing to live for, is riddled with guilt and has lost all sanity. At the opening of the play the audience see how fervent her hunger for power and status is when she summons evil spirits; â€Å"Fill me from the crown to the toe top-full of the direst cruelty;† (Act One, Scene 5, lines 40-41). This statement displays Lady Macbeth’s character deeply nefarious, it would perturb the superstitions of the Christian spectators. The audience might also perceive her to be disturbed as in that same soliloquy she asks the spirits to, â€Å"Make thick my blood,† At the time that the play was written thick blood was associated with illness and derangement. It would have been most horrific for the audience to listen to the character persisting that she did not want to be womanly, especially for someone of her status is society. Pronouncing that she wished to be unsexed and that she wanted the spirits to â€Å"Come to my woman’s breasts, and take my milk for gall,† would outrage their perfervid Christian views as women were supposed to be maternal and loving whereas she uses the oxymoron to intensify her wish to become corrupt and inhuman. Immediately after she calls the spirits, Shakespeare returns Macbeth to the stage, scheduling his wife the ideal time to discuss her plan. Lady Macbeth begins to instruct him as she says, â€Å"Look like th’ innocent flower, but be the serpent under’t.† She uses this metaphor to reassure her husband and make known to him that others won’t realise he’d be doing anything wrong but at the same time urging him to commit the deed,ergo underlining the way in which it is her evil inventions which will destroy Duncan. The Shakespearean audience would be very disturbed to witness such wicked schemes emanating from a female character; women were particularly governed by society’s expectations and considered to be the fairer, gentler sex, leaving political machinations to their male counterparts. Along with manipulating Macbeth into executing all of her schemes, she also is competent to cover up after him when he is vulnerable to suspicion. Without her help and guidance, Macbeth would have not been able to consummate his feats. After Macbeth’s first act in which he commits regicide by killing his dear king Duncan, he is incapable of coming to terms with his actions and returning with the weapons to Duncan’s chamber. His ever-dutiful wife finishes the task. â€Å"Give me the daggers. The sleeping and the dead are but pictures.† Her control here reveals her power and determination. We see her draw a veil over Macbeth’s behaviour again after he has taken King Duncan’s life as Macbeth makes the mistake of killing the guards, when he knows that as a soldier himself he should interrogate suspects. After Macduff attempts to question Macbeth on his reasons, Lady Macbeth faints (Act 2 Scene 3 line 112). This shows her ability to extemporise when the situation requires it. Indeed there are several occasions when Lady Macbeth steps in to avoid her husband being put under suspicion. Her role in the banquet scene after Macbeth sees Banquo’s ghost has a reason. Macbeth shows signs of weakening before the spirit of Banquo. However, Lady Macbeth shows her authority over the proceedings. She instructs all but herself and Macbeth in Act 3 Scene 4 lines 118-9 to â€Å"Stand not upon the order of your going. But go at once,† thus managing to clear their estate of all the guests who had been visiting, which would have been a difficult feat especially for a woman yet her determination impels her capable. We sporadically notice that she is not such a nefarious character, as she would like to believe. An example of her vulnerability is when she needs a drink to give her courage in order to go through with the plan for the murder of Duncan, â€Å"That which hath made them drunk hath made me bold.† If she were truly a ‘fiend’ she would feel nothing. Similarly, when she is anxious and awaiting Macbeth’s return she utters that, â€Å"Had he not resembled my father as he slept, I had done’t.† Had she been entirely evil she would have distanced herself more and be unable to draw comparisons. The decisive moment however for Lady Macbeth is when she detects that she is no longer needed. Act 3 Scene 3 lines 6-7 describe this further when she asks Macbeth, â€Å"What’s to be done?† and he proves to her that he is no longer the mere student but the master as he replies, â€Å"Be the innocent of the knowledge, dearest chuck, till thou applaud the deed.† Macbeth’s use of ‘dearest chuck’ would have been supposed to be playful however in this context would have aggravated his wife and spurred on the doubts that would have been forming in her mind. The quotation is also analogous to what Lady Macbeth had said to him in Act 1 Scene 5 about looking innocent, thus extra proof of his imitation of his wife’s influence. Lady Macbeth’s return to the action in Act 5, scene 1 is dramatic in its irony. She is a mere shadow of her former self, unable to sleep and riddled with guilt she re-enacts the role she played in Duncan’s murder, and in so doing betrays her guilt to her waiting woman and, of course, the audience. The constant washing of her hands and utterances â€Å"Out damned spot†¦ Who’d have thought the old man to have so much blood†¦Ã¢â‚¬  serve to expose her crimes, her sentiments in Act Two â€Å"A little water cleans me of this deed† are shockingly highlighted in the closing Act with poignant irony. Delirious and disturbing outbursts: â€Å"Here’s the smell of blood still; all the perfumes of Arabia will not sweeten this hand. Oh, oh, oh!† (Line 44-6) and her use of metaphor amplifies her acute mental torture and pain, she is a woman so construed by guilt that she loses all sanity. Lady Macbeth’s downfall, like her husband’s, is a tragic one as she ultimately dies from her terrible crime. Like Macbeth, Lady Macbeth enjoyed reputation and status as the wife of the greatest Scottish warrior, much loved and honoured by king and county. However, she is as much Macbeth, guilty of ‘vaulting ambition’ and when she succumbs to that fatal flaw she can no longer function. Indeed, so consumed by guilt, Lady Macbeth commits suicide knowing that her crimes have involved interfering with the divine right of kings. Interestingly, however, the audience see many times throughout this drama when Lady Macbeth is not so cold as she is made out to be. We know that she is not a ‘fiend’ as we see on numerous occasions her inability to carry out acts herself, act 2 Scene 2, line 13-4, â€Å"Had he not resembled my father as he slept. I had done’t.† She is unable to distance herself from the stunt and even helping to carry out the act she finds difficult as she needs help to bring the courage she needs: â€Å"That which hath made them drunk hath made me bold;† illuminating further how she has some empathy for Duncan. The audience see just how terrible an effect all the events since the witches first met Macbeth have had on her mental state as they hear how she has taken her own life in Act 5 scene 5 from Malcolm. To conclude, it is clear that Lady Macbeth begins her role as ‘honoured’; she certainly enjoys the wifely role of Scotland’s hero. However, through greed and ambition, she forfeits her reputation and status. Certainly her actions are ‘fiend-like’ but she does betray some small shreds of conscience and is therefore well aware of her choices. A totally fiendish character would not experience guilt, but Lady Macbeth goes insane simply because she knows she has been immoral and sinful. Lady Macbeth, â€Å"an honoured hostess† and â€Å"a fiend-like Queen†.

Human effects on environments Essay

Human effects on environments is increasing during the past few years. Those trash and pollution made by people is becoming detrimental to local environment. There is a survey done in Xingqing park in Xian about human effects on natural environment. Water quality including turbidity and pH were tested, also the quality of soil was tested. In addition human effects were found in order to see how deep the damage is. Food web provides a view of creatures live in there in order to give an opinion on how much the pollution is. The result was that human activities does have negative effects on natural environment in various ways, so in conclusion people should care moe about loca environment instead of through trash. Introduction Human activities sometimes contaminates the nature, it can be seen in many parts of city such as parks and lakes. Here the environment of Xingqing park is damaged by people for many years. As a park, it locates in the center of the city which means the majority of people come there frequently. In order to find the damage, items such as pH, turbidity and others were tested to find out how much the negative effects are. Human activities like footprints and trashes are also counted in. The thesis is that human activities has detrimental damage on environment because of trash and lack of cleaning. Method In order to find out the quality of water, first we tested the water turbidity using Secchi disk, measured the length of the line to calculate the turbidity. Then the pH of water was tested using pH paper. Soil pH is a little different, we have to put soil and water in a ratio of 1 over 5, then wait until water and soil separated into layers, the clear part of the water will be tested by pH paper. For plants distribution and food chain we use a map to mark every time we see certain creatures. Human activities including foot prints and trash are marked in the map also. Then results will be analyzed to reach the conclusion. Findings Based on research, there are something in the park represents environmental damage. Walking around the lake there is died fish over the corner spreads smelly smell, it seems that the quality of water is not good enough to support such big creatures. Also there are not enough decomposers to break it down. In addition, there are several insects float on the water, also some trash such as plastic bags are around corner of the lake edge. The water turbidity is 33cm in Secchi disk measurement, another thing is seen commonly is massive of bacteria on the surface of water floating around,which is disgusting. On the ground there is a wild crab found in the bush, also there are wild sparrows and magpies found in the tree but not so many. For plans distribution, since it is an artificial lake, the plants are mostly planted by human, rings of tress surrounded the whole lake. But the grass cover is not in a high rate, hard soil is everywhere due to human walking, about 40%of land is covered by grass. Another thing need to consider is soil and water pH, however both the soil and lake have water in basic levels of 7 to 8, which is just ok for creatures to survive. Finally we noticed that there are a huge amount of ants, including big ants and small ants. Small ants stay together meanwhile big ants going around alone. As internet shown the air quality is not as bad, pm2.5 is in a level of 110 in general.

Chapter summaries for Better by Atule Gawande Essay

Mr. Gawande starts his literature on washing hands. He introduces two friends a microbiologist and an infectious disease specialist. Both work hard and diligently against the spread of diseases just like Semmelweis who is mentioned in the chapter. Something I learned, that not many realize, is that each year two million people acquire an infection while they are in the hospital. Mainly because the clinicians only wash their hands one-third to one-half as many times as they should. Semmelweis, mentioned earlier, concluded in 1847 that doctors themselves were to blame for childbed fever, which was the leading cause of maternal death in childbirth. The best solutions are apparently the sanitizing gels that have only recently caught on in the U.S. Then there was an initiative to make the sanitizing easier for all. The engineer Perreiah came up with solutions that gave the staff more time which was revolutionary in itself but the format worked only under his supervision. After he left it all went down the drain, so, Lloyd a surgeon who had helped Perreiah decided to do more research and was excited when he encountered the positive deviance idea, the idea of building on people’s capabilities instead of trying to change them. The idea worked and even got funding for ten more hospitals across the country. At the end of the chapter Dr.Gawande ponders upon the idea of how many he has infected because of his lack of cleansing. Chapter 2: The Mop-Up This chapter starts off with the difficulty of diligence. Yet there are some who have managed to deliver that expectation on an incredible scale. The task of distributing polio vaccines to millions of people, many in rural areas, was evidently a long and complicated task. The WHO had a team of only hundreds and had to teach the necessary vaccination procedures to the volunteers and local representatives, people who went door to door in all of these areas. Their target for the introduction of the vaccine was 90%.It was definitely complicated to try to keep the supplies in a constant outpour when there were only so many. For example, the vaccines needed to stay on ice to be effective. Something that seemed counterproductive and bothersome was the lack of information in some places. For example, some villagers didn’t even know the vaccines were coming that day so they had been missed and others blinded by their ignorance didn’t want to vaccine their children. One such case led to a woman who refused the vaccines for her child but later went on to regret it when her own daughter’s legs lay limply aside. Gawande traveled with a Pankaj who made rounds checking on the progress of the volunteers and making corrections as necessary. The diligence in reporting gave the WHO the necessary information to learn from that mop-up. The commitment to accumulating meaningful data and the commitment to studying and learning from that data is just as important as the actual process of vaccination itself. Chapter 3: Casualties of War Casualties of War, covers the efforts of battlefield surgeons in Iraq and Afghanistan to save as many wounded in the wars as possible. A Forward Surgical Team (FST) can set up all their equipment in the combat zones in less than 60 minutes. The travel time of a seriously wounded soldier from the frontlines back to the US averages 4 days; in Vietnam, it occurred in an average of 45 days, which as any doctor knows every second is crucial. The focus of the FSTs is â€Å"damage control, not definitive repair.† The wounded are then sent on to a temporary treatment facility immediately; if their injuries are serious they are then sent back to the US within a few days. The goal is for each level of treatment to give the patient the best chance for survival and then trust the next step in the chain to do its part to carry on the treatment. Gawande relates the incredible story of one individual with blast injuries who was opened up at the FST, received life-saving surgery and had arteries tied off, then he was cleaned out, packed with ice, and sent on an air evacuation; still left open from surgery with a note taped to him explaining what was done to the nearest combat hospital and a new surgical team. By analyzing the patterns of injuries and treatment, other basic life-saving measures were implemented. For example, soldiers coming into treatment were found to be without their Kevlar. When asked why? They would complain about the weight, the heat, and the discomfort. Orders were issued that Kevlar was to be taken seriously and the injuries became less frequent. Gawande’s point is that reporting is vital to diligence just as it was for the WHO supervisor fighting malaria; these doctors recorded the details and results of each case. They understand, as Gawande writes, that â€Å"vigilance over the details of their own performance offered the only chance to do better. Chapter 4: Naked The chapter is titled â€Å"Naked† and concerns the exam room etiquette that doctors and patients expect from one another and often uncomfortably tiptoe around. There is an allusion to a movie that has the female patient separated by a dark blanket like screen from the doctor. The doctor’s son who is about six years old is the communicator. Even though they are clearly audible to each other they wait until the boy speaks to them. This is the matter of decency. According to this literature some doctors feel uncomfortable with the whole process. There is really no established ground as to how to go about it. The author relates anecdotally that some patients and doctors find that having a â€Å"chaperone† present makes things worse. For example, when asking a female nurse to come in when a male doctor is examining a female patient makes the patient more nervous than before. The patient perhaps did not sense a cause for concern and is then put on the defensive. Most of all it’s about trust. The author relates occasions in which he felt aversion for the gowns but when the matters seemed to get to awkward or difficult he resulted to the exposing gowns. One out of every two hundred physicians is disciplined for sexual misconduct. Interns of both sexes on an average have had at least one incident of patient-initiated sexual behavior. So it is not uncommon for the situation to be more than just tricky. The chaperone helps both sides, the patient and the doctor, if any situation were to arise. Chapter 5: What Doctors Owe What Doctors Owe, the fifth chapter of Better continues the discussion of doing right and focuses on malpractice lawsuits. The main focus of this chapter is a doctor-turned-malpractice lawyer; he stands out because most doctors hate malpractice suits. Even the lawyer says he hated them as a doctor. He said he was sued three times and two were nuisance suits with no basis, but the third was a case in which he made a medical error which led to the harm of his patient. He appeared to feel legitimately bad about it. He argued that the system allows those who are harmed to come forward and receive some compensation which makes them better able to deal with their injury. Former Dr.Lang took up a case against Dr.Kenneth Reed for the Barbara Stanley trial. Reed had diagnosed melanoma on Barbara and insisted an extensive surgery was needed and she refused it because it seemed disfiguring to her. He got a ‘second opinion’ and the tests for melanoma came back negative. Two years later the growth reappeared. She died but not before telling Lang she wanted to sue Reed. Doctors strive to care for patients as best as possible, but of course there are instances where they make honest mistakes or are plain negligent, and that has to be addressed because it is the patient who pays. The downside of malpractice, as Gawande argues it, is that it is an essentially adversarial system which pits patients against doctors against insurance. He argues that it brings out the worst in all parties involved. Chapter 6: Piecework Piecework, is on doctors’ pay and its inevitable connection to the health insurance industry. According to this chapter every hospital has a Master Chart of prices for every imaginable health care procedure. Everything from a checkup to a surgery is listed with the price which is later charged to a patient, which inevitably is forwarded to an insurer. This raises an interesting question because it also sets limits on what doctors can make. If you are paying doctors via the Master Chart, then the more diagnosis they perform, the more they are getting paid. Either that or they can charge above the standard rate. One such doctor mentioned in this chapter did just that. He was considered an expert in a certain field and charged nearly ten times the standard rate. He also mandated payments in full by patients, none of this pay-through-insurance mess. He did great business and was paid more than most doctors while doing less work. Another potential solution was attempted by a doctor-run health care cooperative in Vermont. Several doctors with different specializations grouped together and charged patients a flat rate, while they took flat salaries. They were therefore able to manage the efficiency of their medical care. Their network grew, and eventually they added doctors of other specializations. Eventually the co-op became one of Vermont’s biggest insurers, ironic because they were trying to get away from the big insurance methods. Sure enough, size brought problems. The head and founder of the network left after a certain point, somewhat disappointed with the outcome. He cautions at the end of the article that at some point soon, the apparently untenable insurance and reimbursement system will need to be changed for the benefit of do ctors and patients. Chapter 7: The Doctors of the Death Chamber The Doctors of the Death Chamber. This sections starts off with the death of Michael Morales by lethal injection. Under the typical protocol the anesthesiologist administers the sodium thiopental which is expected to halt breathing within a minute of the administration. Then the paralytic agent is introduced, followed by a fatal dose of potassium chloride. Then later, the judge found that at least eight patients had not stopped breathing when the technicians gave the paralytic agent. The California Medical Association, the AMA, and the ASA immediately opposed such participation in a prisoner’s death as a clear violation of the medical ethic codes. The author was intrigued by how the Doctors and Nurses sorted between acting skillfully, acting lawfully, and acting ethically in such situations. Ever since the Gregg v. Georgia matter only two prisoners were executed by firing squad, three by hanging, and eleven by gas chamber. Pages 132 and 133 had details about the extent of each form of punishment. Some like the famous George Wallace were unlucky and had to endure physical pain for an extended amount of time. Many doctors, even though forbidden from participating, still take part in the execution. Some will help or just pronounce the prisoner dead, either way they can’t help feeling they are doing something wrong as reported by some of the interviewed doctors. They can’t help but feel they themselves are the executioners. Chapter 8: On Fighting This chapter is based on the â€Å"fight† so to say some patients have to deal with. The story of a high school history teacher is an example of someone who was willing to risk the complications of life just to be able to live it. He had a reappearing cancer in his left kidney. Through many setbacks he was last seen in a long-term care facility. Despite the great advancements in his health he seemed to be in worse shape physically than before and then he was confronted with the realization that he might not be able to walk ever again. Not only are they, the patients like Thomas, fighting but so are the doctors in charge. Another story about a young twelve year-old Callie had a similar reappearing tumor that came back just as big as before despite all the treatment. Although her family kept fighting, eventually her parents thought it was too cruel to keep Callie living such a difficult life. Many cases have been found that just by the doctors’ fight for a patient’s survival the odds get better for the patient. Many premature babies thought dead were brought back to life and were even able to live as a normal a life as possible. The topic of this chapter was: Never Stop Fighting, because even when the odds are against your favor there is always that one person we wished the doctors never stopped fighting for. Chapter 9: The Score The Score starts off with Rourke’s experiences as a doctor delivering babies. Then the moment comes when she herself has to give birth. She knew the process and wanted the procedure to go as smoothly as possible. The thing she was most afraid of was losing control of what was done to her. The chapter delves deeply into the process of giving birth. For example, the dilation of the cervix, etc. Needless to say it is a complicated process which in consequence led to many child and young women’s deaths earlier on in history. The most problematic is the exiting of the child’s head. There have been many methods that can be effective if used correctly, but deadly in other situations for liberating the child. The concept of the forceps when it first appeared had been kept secret for more than a century. The device was developed by Peter Chamblin. The score relates to the Apgar score that was created to ‘measure’ the child’s chance of survival rate. Th is helped some cases that looked frugal before that, look hopeful. Chapter 10: The Bell Curve This chapter deals with the outliers overall. Dr. Gawande relates a story about a child named Annie. Annie was diagnosed with cystic fibrosis. It is a recessive disorder therefore, despite ten million people carrying the gene; about a thousand American children are diagnosed with it per year. Her parents took her to Cincinnati Children’s and despite the hospitals effort they were negligent to say that they were not among the country’s top centers for children with cystic fibrosis. It used to be assumed that differences between doctors and facilities were insignificant. When plotting a graph of the results for each hospital it was expected to see a shark’s fin but instead what was seen was a bell curve. LeRoy Mathews was at the top of that bell curve. As other hospitals adapted to Mathew’s ideas his facility just kept improving at a tremendous rate. In 2001 CF tried a new approach with its patients. They were open. They were willing to speak about how other facilities were doing versus theirs. Berwick a former pediatrician was giving grants to hospitals that were willing to try his idea. Not a single family left the program. CF improved greatly after that. Warwick was another positive deviant. He was aggressive, and inventive. He came up with a cough to be able to get the more accumulated mucus out. The chapter sums up with the overall constant fight against settling for the average. Chapter 11: For Performance For Performance. This chapter sums the book up and is its own piece. It starts off with an introduction of a fellow doctor of his who has CF. Then we are led to a see how a certain Dr.Motewar in the Nanded hospital deals with the mass of people needing attention and care. The man was of ordinary appearance yet he saw at least 36 patients in three hours, most had serious complications. What was astounding to the author were the many skills developed by these doctors. He had lower expectations so to say. There was a man who died from a treatable lung collapse because of the lack of instruments. It is very common for patients to have to go out and buy their own medical instruments and medications for the procedures to be held. Dr.Motewar and his colleagues had developed a better procedure for ulcer removal despite the conditions and lack of equipment they have. Many techniques that seem almost crude and basic were actually life saving. The doctors from which the author observed in the chapter had their own methods which would not have ‘flown’ in the United States. This chapter’s topic was about the never-ending search for a better performance in any situation you have.