Gerontologic Considerations of Diabetes Mellitus - 1500 Words

Gerontologic Considerations of Diabetes Mellitus According to the Department of Health and Human Services (2011), 18.5 % of the United States population is over the age of 60 years. Of these, 10.9 million (26.9%) are diagnosed with diabetes mellitus (ADA, 2011.) In Lewis and associates’ text book on Medical- Surgical nursing, Lewis states that the incidence of diabetes mellitus (DM) increases with age (Lewis, Dirksen, Heitkemper, Bucher, and Camera, 2011.) The purpose of this paper is to explore the disease process of diabetes mellitus in the geriatric population. Pathology According to Lewis and associates, DM is a chronic disease that affects multiple body systems. For the purpose of this paper, only DM type 2 will be discussed based†¦show more content†¦The study was inconclusive on the factors involved, but the researchers suggest more studies need to be completed. (Salpeter, Khalaileh, Weinberg-Corem, Ziv, Glaser, and Dor, 2013) Another study suggests that diminished insulin sensitivity in the elderly is multifactoral as well. (Chen, Bergman, Pacini, Porte, Jr., 1985) Factors contributing to altered carbohydrate metabolism in aging include obesity and a progressive decline in physical activity. (Lewis et al., 2011) Lastly, the elderly also may take medications that treat comorbidities that effect insulin and glucose. Some of these include coreg, lipitor, corticosteroids, and lotensin. (Vallerand and Sanoski, 2013) Signs and Symptoms Typically, clinical manifestations of DM type 2 are nonspecific due to the fact that the onset is so gradual. Nevertheless, some may present with the classical signs of polydipsia, polyphasia, and polyuria. Common signs and symptoms associated with type 2 DM include fatigue, frequent infections, recurring yeast infections, dry skin, poor wound healing, and visual changes. (Lewis et al., 2011) According to the American Diabetes Association, seven million people are presumed to live undiagnosed with DM (ADA, 2011.) Many of these patients are overShow MoreRelatedEssay on Virginia Henderson, the Nursing Theorist1924 Words   |  8 Pagesapproach is going to be used to better understand concept and show how it is the foundation of the nursing process still used today. Case Study Mr. Jones is a 64 year old well nourished man with a history of long-standing non-insulin dependent diabetes mellitus (NIDDM). He had an open heart -surgery bypass graft 7 weeks ago. The graft site got infected and had to undergo an emergency surgery to improve circulation to his left lower limb. Mr. Jones is relieved that his leg was saved and he is now being

Analysis Of A Doll s House - 1180 Words

The role of being a husband in both A Doll’s House by Henrik Ibsen and Fences by August Wilson is failed to a certain extent due to the fact that they cannot meet the expectations of their wives. By failing to do so, they both damage their relationships. In Fences, we learn that Troy Maxon’s failure as a husband started when he cheated on his wife, Rose, with another woman, who soon became pregnant with his child. In A Doll’s House, Nora would do anything to save her husband, Torvald, but that that feeling wasn’t mutual, and in the end, Torvald shows Nora who he really is, someone she did not expect him to be. In Fences, we learn that, when Rose and Troy first met, Troy told Rose, â€Å"Baby, I don’t wanna marry, I just wanna be your man†Ã¢â‚¬ ¦show more content†¦Rose may have thought an affair was possible in the early years of their marriage, but after eighteen years, those expectations have changed. His excuse for this affair was that it got him â€Å"†¦away from the problems and pressures† in the house and that he could â€Å"†¦be a different man† (Wilson 180). â€Å"I can sit up in her house and laugh. Do you understand what I’m saying. I can laugh out loud†¦and it feels good,† said Troy (Wilson 180). Rose responded, â€Å"What the hell was I there for? That was my job, not somebody else’s† (Wilson 180). Troy doesn’t understand the role that he plays as a husband. He doesn’t understand that, just because he hit a bump in the road, it doesn’t mean he can do whatever pleases him. Rose explains to him that she’s had problems and pressures in her life as well, but she decided to be strong and hold on to Troy no matter what, because that is her responsibility as a wife. â€Å"†¦Don’t you think it ever crossed my mind to want to know other men? That I wanted to lay up somewhere and forget about my responsibilities? That I wanted someone to make me laugh so I could feel good? You not the only one who’s got wants and needs,† said Rose (Wilson 181). Even those Rose knew Troy wasn’t the finest man in the world, she stood by his side as a loyal and loving wife. Troy failed to meet the expectations of being a husband and keeping up with his responsibilities as one. Rose knew finally saw that after the announcing of his affair

Baldwin Norman Free Essays

The profundity of silence is a theme that plays a significant role in the works â€Å"Sonny’s Blues† by James Baldwin and â€Å" ’night, Mother† by Marsha Norman. The two tales represent confessions by family members that uncover the profound effect that each person’s communication method has had on the other. In particular, one identifies a lack of communication within both family relationships that demonstrates itself in an overabundance of silence. We will write a custom essay sample on Baldwin Norman or any similar topic only for you Order Now Baldwin’s tale recounts the woes of a certain brother who feels himself somehow responsible for the tragic events that have faced his younger sibling, and it portrays a relationship that lacks effective communication. Likewise, Norman portrays a family that has spent its usefulness in the avoidance of conversation. She eventually reveals the inadequacies of the mother who is at last unable to rescue her child from the pressures that cause her to contemplate death as the only acceptable option. The protagonists of each story find themselves in family relationships that fall short of the support necessary to prevent each from receding beyond the point of recovery. The tale rehashed in Marsha Norman’s play â€Å" ‘night, Mother† explores the hopelessness that leads to suicide, and in so doing, closely maps the psychological condition of the character Jessie (Whited 65). It takes the analysis of the situation into the realm of the family and considers that cocoon to be the engine that generates and exacerbates the problem Jessie faces. The â€Å"problem† is given its lineage in the relationships experienced by the members of the family. The relationships appear to be filled with action and devoid of communication. Of her own culpability, Mama says, â€Å"I didn’t tell you things or I married you off to the wrong man or I took you in and let your life get away from you or all of it put together† (lines 611-613). This circumstance points toward an overemphasizing of action and the downplaying of the type of conversation that allows true feelings to come to the fore. Jessie also recalls the silence of her father, and Norman hints that this silence has for the past decades stabilized or subdued the appearance of Jessie’s mental condition. Yet, this same silence has perhaps created the environment in which her mental or psychological illness has been allowed to germinate (Whited, 67). The idea that Jessie breaks her silence precisely at that hour in which her mental condition has become overwhelming and irreparable gives the idea that the lack of communication within her family setting may actually have been to her detriment. The exploration of the relationship between the narrator and his brother Sonny in James Baldwin’s â€Å"Sonny’s Blues† also represents a crisis of silence and suffocation within a family setting. This family in which Sonny resides also betrays a tendency toward continual action that precludes the kind of conversation which might have allowed the brothers to truly understand each other. Without understanding Sonny, the narrator (his brother) and their mother make plans to protect him for the rest of his life. They encourage him to live in situations that are not conducive to his spirited nature, such as his residence with Isabel while his brother goes off to war. Yet the silence Sonny endures, like that of Jessie, has the appearance of being his preferred mode of existence. The narrator says, â€Å"Sonny has never been talkative,† yet he goes on to say something more insightful that hints at the true desires that Sonny has always had. He continues, â€Å"So I don’t know why I was sure he’d be dying to talk to me when supper was over the first night† (Baldwin, 8). This hints at the underlying idea that though silence prevailed within the family, probing by his brother and mother might have dispelled both the silence and the dismal circumstances that later defined Sonny’s life. Literary analyst Tracey Sherard writes: â€Å"the narrator comes to understand his brother Sonny through the latter’s apparent struggle to strike out into the deep, unexplored waters of jazz improvisation† (691). Therefore, it is only through the music that Sonny’s brother is able to communicate with and understand him in the end. Comparisons between the two tragic characters of the stories, Sonny and Jessie, can be made in regard to their life choices. The two characters can be seen to choose silence during the early years of their lives, and this might be connected to another form of silence throughout the later stages of their lives. Sonny’s choice of life has led him to heroin, and this dangerous drug might be considered one that paves a path to death in a manner that is very similar to the suicide that Jessie contemplates. Both characters, therefore, choose suicide as the only means of silencing the worries and discontent of their lives. Jessie expresses a desire to sleep â€Å"whenever she wanted to, just by closing her eyes† (line 637), and this she has not been able to do since she was a â€Å"pink and fat† baby (639-40). This choice to commit suicide is therefore an extension of the idea of closing one’s eyes to problems of life. Sonny, in a similar way, chooses to close his eyes to his problems via his use of heroin. And likewise, the extension of this action (continued heroin use) is precisely concurrent with the death that Jessie so openly craves. Jessie’s mother, who desires not death, says â€Å"I’m not like you, Jessie. I hate the quiet and I don’t want to die† (lines 626-27) and this juxtaposition of death and quietness underscores the idea that the death desired by Jessie and Sonny can be seen also to be a form of silence. The motif of silence can be carried through even further within the analysis of the stories told by these authors. During the few short moments before her death, Jessie takes a break from her silence to explain the essence of it to her mother. Within this time she uncovers all the pain that her silence has embodied for the years preceding (Whited, 67). She also enumerates the problems that her ensuing death will hope to silence within her. This moment of conversation can be compared to (and in fact prefigures) the bullet that breaks for a split second the silence that has defined Jessie’s life. It also effects the reconstruction of that silence by guaranteeing its continuation in death. Death guarantees not only that the disappointments and fears in Jessie’s psyche will be quieted, but also that the events that have generated or exacerbated these problems will also cease to trouble her. The forms of silence to which Sonny subscribes are heroin (as has been uncovered above) and music. While heroin promises to lead him toward that final and inexorable death of the body, music provides a spiritual release for him that also provides an effective (if temporary) silence from his turmoil. Sonny’s escape to music as a means of silencing his demons can be compared to the way his brother describes their father as being â€Å"on the lookout for ‘something a little better. ’† Yet he goes on to say that his father â€Å"died before he found it† (Baldwin, 8). Sonny, too, looks to music as a form of escape—a means of quieting his dissatisfaction with his circumstances, a way of searching for something better. While as a youth he annoyed Isabel’s family with his constant piano playing, everyone was able to sense that â€Å"Sonny was at that piano playing for his life† (16). The piano’s music silenced not only the troubles that haunted his mind, but also the voices of hoodlums and vagrants on the street that would have called him into a life of crime and dissipation. It was, in fact, the eventual silencing of the piano by the screams of Isabel’s family that precipitated the demise that his music had been holding at bay. This re-establishes and supports the idea that music was a means of silencing the call of the inner city life and pressures that threatened to overtake Sonny in his youth. The lives and relationships explored within â€Å"’Night, Mother† and â€Å"Sonny’s Blues,† as told by Marsha Norman and James Baldwin respectively, speak loudly and portray vividly a distinct and almost impenetrable silence that enveloped the main characters. For Jessie, silence has been the defining characteristic of her relationship between her father during both his life and his death. During his life, he demonstrated his love with actions, and while Jessie appeared to be comfortable in that silence, the very essence of it provided the environment in which her psychological demise germinated and matured. Her mother, though disliking silence, has rarely been able penetrate Jessie’s, and this proves to facilitate the more permanent form of silence to which she graduates: that of death. Sonny too experiences silence within his relationships—a silence that becomes extended and embodies by the activities of his life. He refuses to speak to his family, silencing the discomfiture with music or heroin. Like Jessie, Sonny’s major life decisions place him on a path toward the ultimate silence: death. Works Cited Baldwin, James. â€Å"Sonny’s Blues. † Wright State University. 1957. Online Text. http://www. wright. edu/~alex. macleod/winter06/blues. pdf Norman, Marsha. â€Å"’Night, Mother. † Literature: Reading, Writing, Reacting. Laurie G. Kirzner Stephen Mandell (Eds). 4th Ed. New York: Harcourt College Publishers, 2001. 1708-1743. Sherard, Tracey. â€Å"Sonny’s Bebop: Baldwin’s ‘Blues Text’ as Intracultural Critique. † African American Review. Vol. 32, Issue 4. (Winter 1998): 691-705. Whited, Lana A. â€Å"Suicide in Beth Henley’s Crimes of the Heart and Marsha Norman’s ‘night, Mother. † Southern Quarterly 36 (Fall 1997): 65-74. How to cite Baldwin Norman, Papers

Business Corporations Law and Consultants

Question: Discuss about the Business Corporations Law and Consultants. Answer: Introduction The Corporations Act, 2001 lays down various duties which are to be followed by the directors, as well as, the officers of the companies. Such duties are assigned on the directors, as well as, on the officers of the company, as the companies are managed under or by the directors of the company, with the help of the officers. And the directors and the officers are in a position of trust; and their position can be easily used for personal benefits. The duties covered in the act relate to the duty of care, the use of information, and the like (Australian Institute of Company Directors, 2016). In the following segments, the case of Vines v ASIC has been discussed to evaluate the duties breached by the executive officers of the company. Vines v ASIC (2006) Geoffrey Vines was a former chief financial officer of the GIO Australia Holdings Limited and he had violated the duty of care regarding the forecasts of profits during the takeover bid (Jacobson, 2007). The ASIC, i.e., Australian Securities and Investments Commission, initially started the civil proceedings, in 2011, against Geoffrey William Vines, along with two other executives, Francis Timothy Robertson and Timothy John Henry Fox in relation to the Part B Statement which was published by the GIO when the takeover bid, in the late 1998, was being carried out (Piper Alderman, 2007). This Part B Statement contained a forecast of profit at $80 million, from the reinsurance division of the GIO. However, the reinsurance division of GIO was exposed to some major allegation due to Hurricane Georges, which struck in September 1998, at the Virgin Island and Puerto Rico. The predecessor of section 181(1) of the Corporations Act, 2001, i.e., section 232(4) of the Corporations Law was alleged to be breached by Vines and the two executives (Webster and Swan, 2007). The directors also failed to exercise the duty of care covered under section 180 of the Corporations Act, 2001. This matter was majorly related with the rationality of inclusion of the $80 million forecasted profit due to the allegations as a result of exposure to Hurricane Georges (Piper Alderman, 2007). Duties Breached Section 180 of the Corporations Act, 2001 contains the provisions regarding the duty of directors to act with care and diligence. As per 180(1) the directors have to discharge their duties and exercise their powers with a degree of care, as well as, diligence, which a prudent person in similar circumstances would do (Australasian Legal Information Institute, 2016a). As per section 181(1) of the Corporations Act, 2001, the directors, along with the officers of the company, have to act in good faith. As per this section, while discharging their duties and exercising their powers, a director has to do so in good faith, which is in the best interests of the company, and for a proper purpose (Australasian Legal Information Institute, 2016b). The contravention of both these sections attracts civil penalties stated under section 1317E; under which a declaration of contravention is made by the court. Decision of the Court The Court of Appeal affirmed that the standard of care contained in section 232(4) of the Corporations Law did not require a high order of negligence to established, in comparison to the duty stated under the general law. The court was of the view that the standard of care and diligence, that was applicable on Vines, did extend to the Part B Statements contents. Moreover, the information that was provided did fall in the structure of the due diligence procedure, which was designed to make certain the materially, as well as, adequately finalized disclosures to the shareholders of GIO as per the law, and in such a manner which would safeguard the involved individuals from liability in case a defect is established at a later stage (Webster and Swan, 2007). The Court of Appeal agreed with the earlier findings of Justice Austin regarding the contravention of directors duties by Vines on three instances: When Vines signed the management sign-off regarding the due diligence report, without even taking the requisite positive steps, which required the advise to the due diligence committee of GIO regarding the assumption of the forecasted profit of $80 million. When he did not inform the due diligence committee of GIO that he had no issues with the reliability of the profit forecast of GIO. And when he did not provide the proper attention to the fact, whether or not the reinsurance division of GIO could be attained in the estimated time subsequent to the issuance of the Part B Statement, and prior to the end of the takeover process (Webster and Swan, 2007). Though the contentions of the ASIC regarding some of the issues were overturned and the court held that Vines was not in violation of the duty of care: On November 9, 1998, when Vines made the unqualified statement of management confidence to the board within the reinsurance division of GIO regarding the profit forecast. When Vines did not provide the information pertaining to the basics on the forecast of profit calculations, in the email of November 22, 1998 sent to the due diligence committee and the report of November 17, 1998 which formed the base for the media release (Webster and Swan, 2007). Even though Vines was found to have acted with honesty, the seriousness of contraventions could not grant him relief. And it was held that Vines had to consider, whether or not the material information had to be disclosed, which he was aware about (Stephens Lawyers Consultants, 2007). Upon finding that the directors had indeed breached their director duties, in accordance with the draft of ASIC, the court made the declaration of contravention. And disqualification orders were made for Vines and Robertson for a period of three years, and for Fox, a disqualification order for a period of 12 years was made. The directors were also awarded pecuniary penalty order, as follows: Vines- $100,000; Robertson- $50,000; and Fox- $220,000. Along with this, a compensation order was also passed against Fox for AUS dollar which is equivalent to US$143,750 at the exchange rates of June 3, 1999. The ASIC costs to be paid by the three were Vines- 22%; Robertson- 28%; and Fox- 33% (Jade, 2016). Conclusion From the above case study of Vines v ASIC, it can be summarized that Vines, along with two other directors, i.e., Fox and Robertson had failed in their duties of care and diligence and to act in good faith, by being the executive officers of the company. The verdict of this cases helps in establishing the responsibilities of the executives of the company, especially while preparing the forecasts of profits during a takeover bid. References Australasian Legal Information Institute. (2016a) Corporations Act 2001 - Sect 180. [Online] Australasian Legal Information Institute. Available from: https://www.austlii.edu.au/au/legis/cth/consol_act/ca2001172/s180.html [Accessed on: 16/12/16] Australasian Legal Information Institute. (2016b) Corporations Act 2001 - Sect 181. [Online] Australasian Legal Information Institute. Available from: https://www.austlii.edu.au/au/legis/cth/consol_act/ca2001172/s181.html [Accessed on: 16/12/16] Australian Institute of Company Directors. (2016) What are the duties of directors?. [Online] Australian Institute of Company Directors. Available from: https://www.companydirectors.com.au/membership/the-informed-director/what-are-the-general-duties-of-directors [Accessed on: 16/12/16] Jacobson, D. (2007) ASIC v Vines Appeal Decided. [Online] Bright Law. Available from: https://www.brightlaw.com.au/asic-v-vines-appeal-decided/ [Accessed on: 16/12/16] Jade. (2016) ASIC v Vines [2006] NSWSC 760. [Online] Jade. Available from: https://jade.io/article/1022 [Accessed on: 16/12/16] Piper Alderman. (2007) Piper Alderman Legal Update. [Online] Piper Alderman. Available from: https://www.piperalderman.com.au/__files/f/4017/PA%20eBulletin%20June%202007.pdf [Accessed on: 16/12/16] Stephens Lawyers Consultants. (2007) Corporations Law Update: Recent Decisions About Directors' Duties And Liabilities. [Online] Stephens Lawyers Consultants. Available from: https://www.stephens.com.au/Sites/2196/Images%20Files/Newsletters/October%202007%20-%20Corporations%20Law%20Update.pdf [Accessed on: 16/12/16] Webster, J., and Swan, C. (2007) Focus: Implications Of Vines v ASIC. [Online] Allens. Available from: https://www.allens.com.au/pubs/ma/fomamay07.htm [Accessed on: 16/12/16]

Motivation in Learning and Teaching free essay sample

University teachers these days have to make themselves accountable in their teaching. Students are certainly a good source of feedback, for after all it is students that have first-hand experience of their teachers’ teaching. However, even ignoring the doubt whether all students are able to exercise impartial and objective judgement on their teachers’ performance, there are plainly aspects of teaching on which students are not in a position to pass professional judgement. Indeed, â€Å"student feedback questionnaires† tend to be rather limited in scope. Come to think of it, there are actually a number of sources in addition to student feedback, on which we as university teachers can depend for evaluating our teaching. First of all, we ourselves are sometimes the most reliable source of feedback a sort of â€Å"gut feeling† which we must be having right after teaching a class, a vague but genuine feeling about how well or how badly we have done! If only that feeling could be â€Å"externalised† and categorised or even quantified, how much more useful would that be for appraising our own performance. We will write a custom essay sample on Motivation in Learning and Teaching or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Another rich source of feedback is of course our colleagues, our peers. It is precisely in the context of evaluating our teaching performance that colleagues are able to play a significant role. Peer review/observation of teaching, if handled with care and carried out systematically, is capable of yielding extremely fruitful results, because our peers can be absolutely impartial, objective and are subject specialists. Furthermore, peer review/observation of teaching may over time form a substantial part of anyone’s â€Å"teaching portfolio† which may turn into an effective basis for contract renewal, ubstantiation or promotion. But then all this is easier said than done. We are of course well aware of the benefits of peer review/observation of our teaching. But the crucial question is: How should we go about it? One solution may be to happily marry a new form of micro-teaching to peer review/observation of teaching by using â€Å"state-of-the-art† video technolog y. Dr. Dwight Allen, who was one of the founders of traditional micro-teaching back in the sixties in Stanford University, 1 recently developed a new micro-teaching model which centres around the so-called â€Å"2 + 2† feedback. It works like this 1 Allen, Dwight W. Wang, Wai-ping (1996), Micro-teaching,Hsin Hua Publishers, Beijing The colleague whose teaching is being evaluated, teaches a five-minute lesson to a group of peers, usually four colleagues, focusing on one particular skill or technique, e. g. questioning skill, in the presence of a supervisor who is an expert’s in the colleague field. The entire session is videotaped, preferably using more than one camera, so that â€Å"split screen effects† can be achieved, capturing teacher and student action and reaction for playback viewing. Right after the â€Å"trial teach†, the supervisor will ask the teacher to self-critique his or her own performance. Then each peer will be asked to give feedback by following the â€Å"2 + 2† formula, which is actually making two positive comments and two suggestions for improvement. This way, if there are four peers present, a total of eight positive comments and eight different suggestions for improvement will be made available for the teacher’s consideration. All the time, videotaping is going on, so that every one will have a live record of what is happening. For the teacher such micro-teaching sessions would represent opportunities for safe practice and useful feedback. Colleagues may like to consider this suggestion, give it some thought and then try it out together with other colleagues. Colleagues may form â€Å"self-help groups† for micro-teaching/peer review purposes, whereby each colleague will take turns to be â€Å"observed and evaluated† and every time one colleague will act as â€Å"supervisor†. It should be emphasised that not only â€Å"generic† teaching kills such as getting students motivated and interested in the lesson, but even more importantly, particular skills that are specific to a given discipline or subject area should be trained and practised. Thanks to information technology (IT) facilities such as capturing video segments and footage, capturing sound and other media effects onto VCD’s and CD-ROM’s, colleagues these days can â€Å"store† their teaching endeavours and micro-teaching sessions reviewed by peers, in IT-based formats as well as in print format, making documentation of their teaching performances so much more versatile and variegated.

Vision of My Dream India Essays

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My India the country developed with no negative systems or ideas or beliefs. It is my dream also to see India as one of the most developed nati ons. 2020 is a good deadline * Save Essay * 0 pages * Words 51. The Former President Of India, Abdul Kalam for the New Millennium by A. P. J. Abdul Kalam, Y. S. Rajan; Penguin Books India, 2003. India-my-dream by A. P. J. Abdul Kalam; Excel Books, 2004. Envisioning * Save Essay * 12 pages * 2822 Words 52. Higher Education In India – Its Drawbacks And Suggestionsfor Reform Saturday, March 27, 2010 Higher Education in India Its drawbacks and suggestionsfor reform Today the world is of science, new inventions and competitions to excel * Save Essay * 4 pages * 778 Words 53. Leather Industry In Pakistan for the development of this industry. Pakistan faces its competition from countries like India and China who are now trying to compete with Pakistan both in terms * Premium * 67 pages * 16625 Words 4. 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Vodafone Marketing Issues Assignment Example | Topics and Well Written Essays - 1000 words

Vodafone Marketing Issues - Assignment Example Proposal: From the above annexure, it is observed that sales, as well as the market capitalization of the organization, has increased in the past year owing to the advertising efforts taken up by the company from past 2007 in the Hong Kong as well as the other units. Out of the total revenues generated by the advertising companies, a 9% increase is attributed to the Vodafone advertising campaigns (Eaton. M, 2007). With the increase in the ad spends, the company could boost its sales of mobiles and network services so much that even though the Average Revenue per User (ARPU) has been reduced to its rock-bottom prices, the increased customer base improved the profitability levels of the company. As already known, due to the recessionary pressures in this year, the sales targets were cut down twice already. The company is gearing up to face the turmoil by cost-cutting measures. In this exercise, reports suggest that severe cut in the ad spend would be taken up as one such measure along with the other measures of job cuts and logistics. (Thiel. S, 2009). As already emphasized, ad spend is directly related to the increase in sales and customer growth, a cut in that expenditure may cause negative repercussions for the organization. Instead, if increase in the ARPU is considered commensurate to the industry levels, given the existing large customer base of 289 million customers (Anon. 1, 2008), more revenue can be generated per customer which could be utilized for the required ad spend thereby giving a scope for the growth of the customer base in the future also. Research conducted by the Mc. Kinsey and London Business School suggests that firms which reduce their ad spend during the worst of the times tend to lose both in the short and the long terms.  

Kate Chopin Research Paper Example | Topics and Well Written Essays - 1750 words

Kate Chopin - Research Paper Example On the rare occasion when one 'woke up' from her enforced dullness, she was either reduced in social status, ruined forever, or killed by the restrictions keeping her from remaining fully awake. These are the issues Chopin explores in her work, reminding us, even now, of the need to protect women's rights and freedoms. Awakening the Female in Kate Chopin’s Works Perhaps the greatest single characteristic of the Victorian age was its nature as an era full of strong contradictions. These contradictions are often captured in the works of female writers working during this time period. As the greater world of farm and commerce changed around them, women as a gender began to question their expected roles in society and began demanding more opportunities available for personal fulfillment. This wasn't simply a selfish desire to follow their own dreams, although this was a factor. It was also a recognition of the fact that many women found it necessary to have more options open to th em for self-support and for the greater welfare of their families. Although women throughout time had found various ways to make it on their own, it was rarely possible for them to attain both material comfort and personal independence without the interference of a man. These are issues that figure prominently in women's writing of the time, such as in the work of Kate Chopin. Within her short stories and novels, Chopin reveals deep meaning and strong feminism embedded within the text due to her careful use of perspective and imagery. Her talent enables her to ‘paint a picture’ of life as it was experienced in that moment. Her stories gain their strength by focusing on key elements of the environment in which the characters move and through the special attention she gives to just how the story should be told. Her style enables the reader to experience the various constraining forces, both material and psychological, that were experienced by women of her time and illustr ates why they would want to escape from it. These ideas are easily discovered in a comparison among some of Chopin's short stories, such as â€Å"The Story of an Hour† and "The Storm," and her novel Awakening as the women experience an awakening to their own long-hidden inner nature. The possibility that one can actually awake to a hidden inner self is the primary action of many of Chopin's works and can be easily found in her short short story "The Story of an Hour." The story begins with the introduction of a frail woman later discovered to be named Louise. Louise is sitting in her home's living room being told by her sister and a close family friend of the sudden death of her husband during a railroad accident. â€Å"She wept at once, with sudden, wild abandonment, in her sister’s arms† (Chopin 199). Following her somewhat alarming outburst, Louise closes herself in her upstairs bedroom and sits in another chair looking out the window as she considers her new position as a widow. Her feelings toward her husband are revealed in this scene to have been strangely ambivalent: â€Å"And yet she had loved him – sometimes. Often she had not. What did it matter?† (Chopin 201). The horror of her emptiness as a married woman is clearly expressed in her nearly emotionless assessment of what she’s lost in conjunction with her dawning realization that she is finally free to follow her own idea of happiness: â€Å"

Post Colonial And World Literature In English Essay

Post Colonial And World Literature In English - Essay Example The abandonment of cultures and traditions by the colonized is one of the most significant aspects of post-colonial literature in the discourse on colonialism.The pacification of indigenous people in colonies was completed through the conversion of these individuals to Christianity because it was believed that it was the true religion and that the practices of these communities were satanic. The adoption of Christianity was considered by colonial administrators to be a means to not only pacifying the colonized but also as the first step of achieving their civilizing mission (Morrison 1984, p.327). This process was brought about through European missionary activities during the colonial period. colonialism developed mainly as a result of the diverse European powers seeking to ensure that they not only gained markets for their goods, but also for the purpose of prestige. The discussion above has shown that colonialism and racism are among the most important themes that are addressed in the post-colonial literature. Furthermore, colonialism developed mainly as a result of the diverse European powers seeking to ensure that they not only gained markets for their goods, but also for the purpose of prestige. In addition, the discussion has shown that forced labor is one of the aspects of colonialism that led to the development of resentment among indigenous people towards the colonists. Finally, the abandonment of cultures and traditions by the colonized is a significant aspect of post-colonial literature in the discourse on colonialism.

Balancing Productivity and Quality Patient Care

Balancing Productivity and Quality Patient Care Balancing Productivity and Quality Patient Care Abstract The purpose of this examination is to identify challenges balancing productivity and quality patient care as it stands from a supervisory position. Today’s supervisors must not only focus on their staff and patients, but also on the organizational business aspects such as increasing productivity and quality patient care. Supervisors are getting sandwiched between balancing productivity and quality care. In this somewhat daunting quandary the supervisors must strive to find ways to accomplish both missions. As I will propose this will require communication changes in organizational health care systems and a paradigm shift in current ideologies in the health care industry. Let’s start off in my own backyard so to speak, my organization is a Nursing and Rehabilitation hospital. The Mission statement is, â€Å"Come Here, Get Well, and Go Home†. This is a 213 bed facility. There are approximately 135 employees throughout the organization working on any given day. The organization specializes in sub-acute care, long-term care and has a rehabilitation unit. Also the organization has physical therapy, occupational therapy and speech therapy components to support patient’s recovery. All of these people in organization eventually may have some contact with a new patient at different times in the recovery process. It is obvious from a macro-perspective it would be difficult to realize any improvements in productivity or patient care without solid supervisory skills and knowledge. Nursing is my focus and professional occupation in which I will narrow the field to nursing for this examination. As a nursing supervisor one has to continually be knowledgeable to accomplish both goals of productivity and quality patient care. Their responsibilities include planning, organizing and overseeing staff. Nurse supervisors provided leadership two staffs under their charge. The nurse supervisor implements and interprets organizational policies and procedures maintaining nursing standards and regulations. They also continually evaluate patient care and ensuring their satisfaction. A nursing supervisor skills also include budgeting, prioritizing duties and delegating responsibilities. Some of the obstacles that impede the ability of nursing supervisors out of their control is rising healthcare expenditures have motivated spending reforms such as Medicares payment system. While such initiatives aim to limit wasteful healthcare expenses, they may inadvertently result in lower-quality care: providers may face an incentive to reduce the quality of their treatments to minimize costs and increase patient loads. (McDevitt, 2013) Unfortunately this is not the only pressure in which health care organizations have to do more with less. Supplies, operating costs, state and national legislation has placed a huge strain on the healthcare system at large. In the past nursing productivity has been the defined as the ratio of patient care per hour, per patient to salary and benefit costs paid out to staff by the organization. (Kohr, 2012) In the current economy this does not take into consideration the level of expertise in which nurses must process information to accomplish the goals of increased productivity and patient care. After all of that is said: Nursing productivity models of any kind should take into account patients’ needs, nursing competencies, the availability of material resources, and services provided. Nursing workload is a direct reflection of these variables and affects the delivery of patient care, patient safety, as well as satisfaction of nurses and of patients and their family members. Many investigators have linked nursing staff indicators and nurse staffing with patients’ outcomes (Kohr, 2012) The problems of balancing productivity with quality patients care are reducing costs and employee hours for the sake of protecting the bottom line is that really â€Å"protecting the patient?.† Yet that statement has clearly infiltrated and grayed the area between professional ethical, moral boundaries. In attempts at optimizing for efficiency are we as supervisors ultimately must manage both dichotomies. Managing these dichotomies is seemingly overwhelming at first glance. This is what I mean by the proverbial sandwich effect, the danger here is being so overwhelmed that you are paralyzed into doing nothing. I contend that productivity and quality patient care are not at odds with one another: they are both vital to the success of any healthcare organization. The essence of productivity vs. quality patient care dilemma is this: Productivity is visible, continuous, readily-understood and directly measured: a daily metric. On the other hand, quality patient care is invisible, boring, discontinuous, indirect, and its success is measured by the absence of negative outcomes. (Appel, 2012) Now that’s somewhat of a quandary. Almost in the same breath organizations are willing to state quality patient care is our core principle. The problem, however, is turning that vision into action: it is in the daily operations (Appel, 2012) and responsibility functions of the nurse supervisor, this is where the rubber meets the road. Nurse supervisors are critical to the surveillance and coordination that reduce such adverse outcomes. Much work remains to be done in evaluating the impact of nursing care on positive quality care indicators, such as appropriate self-care and other measures of improved health status. (Mitchell, 2008) Nurse supervisors must instill in the people that they manage to continually gather information that can be correlated into data to finding that balance between productivity and quality patient care. Whether it be quantitative or qualitative data all must be brought together to facilitate to make informed decision for possible change. Harnessing this information could unlock knowledge that may elicit innovations striking that balance between productivity and quality patient care. Leave no stone unturned, is the mantra of nurse supervisors in today’s tough economic and social times. How do we start? Communication, communication, communication is essential to establish any opportunity to balance a seemingly diametrically opposed processes. They can be integrated (productivity and quality patient care) to provide success for the organization and the patient. Tighter reins of communication and functions must be streamlined for optimal performance. Nurse supervisors can trigger a needs analysis of the situation informing the employees and organization that there is a performance gap between productivity and quality patient care. This brings in the team concept of the organization as a whole (everyone’s job) needs to be the spearhead, focal point for systematic change and concern with both issues of productivity and quality patient care. A decision-making structures is needed, a paradigm shift. What is a paradigm shift? Stephen Covey suggests that a paradigm shift is what we might call the AHA ! experience when someone finally sees the composite picture in another way or finally sees the light. (Covey, 2004) The health care industry has been moving â€Å"paradigm shift toward placing more value on quality and outcomes. This affect has changed in the way health care organizations do business. Higher quality can be the solution, said Dr. Michael Ogden, chief clinical integration officer with Cornerstone Health Care during the discussion at High Point University. In health care specifically, higher quality could actually lead to lower costs. (Covington, 2014) As a nurse supervisor myself this sounds good but how do we get there? Some employers and health plans are pushing for greater price transparency. They argue that if consumers realized that they could receive high-quality services from lower-cost providers, they would seek them out. This, in turn, could encourage competition among providers based on the value of care not just on reputation and market share. (Unknown, 2012) Another aspect would be to empower the patients to be active participants making decisions about their own care. Empowerment of the patient also means to include them as a part of the health care team which may stimulate opportunities and innovation. As a nurse supervisors some of these ideas are not new, I however assert that nurse supervisors must educate themselves to perform their managerial duties at high levels, not only will the organization benefit, but so too will the patients. Nurse supervisors will need considerable intestinal fortitude to sustain balancing productivity and quality patient care. A nurse supervisor of the future will have to be multi-dimensional with traits like leadership and persuasion skills. Nurse supervisors must show empathy, creating trust with coworkers and patients. They must also have analysis skills, to be able to make fact-based decisions. Last but not least, a nurse supervisor must have performance management and coaching skills to follow through on goals and objectives. Finally, I concludes this examination by making a statement that balancing productivity and quality patient care will always be challenging. References Appel, M. (2012, April 20). KevinMD. Retrieved from The problem of mixing productivity with patient safety: http://www.kevinmd.com/blog/2012/04/problem-mixing-productivity-patient-safety.html Covey, S. R. (2004). The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York : Free Press a division of Simon and Schuster. Covington, O. (2014, March 21st). Health care providers tout paradigm shift as path to reining in costs. Triad Business Journal. Kohr, L. M. (2012, November Volume 21, No 6). American Journal of Critical Care. Retrieved from Building a Nurse and Productivity Measure Based on this Energy Model: http://www.aacn.org/wd/Cetests/media/A1221063.pdf McDevitt, P. L. (2013, February). Productivity and Quality in Health Care:Evidence from the Dialysis Industry. Retrieved from http://www.econ.psu.edu/~plg15/gm_dialysis_Feb2013.pdf. Mitchell, P. H. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, Md: Agency for Health Care Research and Quality. Unknown. (2012, April/May). The Commonwealth fund. Retrieved from Quality Matters: http://www.commonwealthfund.org/Newsletters/Quality-Matters/2012/April-May/In-Focus.aspx

The Great Skater :: Personal Narrative Essay

The Great Skater Like any other sport, ice-skating is obliged to creative people who bring something new to it. These people are known to everyone as the inventors of particular jumps, splits, spins. They are given credit for their work and, sometimes, the skating moves they invented carry their names. For instance, the Lutz jump was invented by Alois Lutz before World War II; the Walley jump was attributed to Bruce Mapes who performed with the Ice Follies in the 1930s. With Mabel Fairbanks that was never the case. The spins she invented never have been officially admitted to be exclusively her creation. For me, it was a profound experience to be coached by her, as I was learning not only the art of skating, but also many things that one can learn from a wise person. I treasure her advice very much. Mabel Fairbanks was a brilliant and a hard working skater. The only problem she experienced over and over was the unwillingness of the skating world to admit that she was deeply talented. It was the second quarter of the 20th century, and she was not allowed to perform the major skating movements--the elements she found the most fun to perform. She was black, she was too good, and the other girls in the show wouldn't look as skillful having Mabel performing next to them. In fact, Sonja Heini once refused to allow Mabel to join Sonja's popular skating troupe because Mabel was too gifted. Mabel was restricted in her skating to the simple elements. But, Mabel wouldn't be Mabel if she didn't extricate herself from the restrictions. How? The solution was ingenious: "If they don't let me skate the conventional way, I'll invent something of my own. This way, nobody and nothing can prevent me from skating to my full abilities." Necessity turned out to be the mother of invention. In a short period of time, Mabel, the first black superstar skater in the history of the United States, came up with the new variations of basic spin. They were so gorgeous! She was the star of the shows at British West Indies with the famous Ice Follies, and in Mexico with the Ice Capades. The only sad thing is that the spins she invented have never been called anything more than just spin's variations. If it were for me, I'd call them Fairbanks spins.