Midterm paper free essay sample

When considering the moral issues of both cases of Roosevelt Dawson and the ten hour old baby, there are a few concerns that should be reflected upon. In Dawson’s case, he has lived for twenty-one years and the use of his limbs has been dramatically taken from him. His quality of life can be seen as a moral issue because he would have to relearn how to function without limbs. This could take place outside of the hospital setting and in an assisted living home, which would more than likely be frustrating. He would have to endure the stares and the stories of his paralyzed limbs. The moral issue of discharging Dawson from the hospital should be considered because he is suspected of leaving and committing assisted suicide due to his quadriplegic condition. In the case of the baby, the moral issue is also of quality of life. The mother has decided to not have the surgery performed and have nutrients taken away from her child. We will write a custom essay sample on Midterm paper or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The baby has lived for less than ten hours and obviously cannot yet make a decision for herself. If the surgery was to be performed and the baby fully recovered, the quality of life would still come into play. Because she does not know how it is to live with working limbs, she would be able to cope and learn how to function better than in Dawson’s case. Although she would be would most likely cope better without limbs, the question arises of ‘what would she be able to do on her own? ’ She would need someone to be with her at all times: to feed her, bath her, go to the restroom with her, dress her, and all other everyday tasks. Thus, the quality of life in this child should be considered when deciding if she should have the surgery to remove the anomalies or not. Previously, the Metropolitan Hospital board had agreed to refrain from providing breathing assistance and/or nourishment for people who have so stated their wishes. Thus, in this case of Roosevelt Dawson, he has previously met with both his mother and his social worker discussing his choices as to what his options were after he is discharged from the hospital. This can create a legal issue due to the fact that Dawson was originally going to be able to be discharged from the Metropolitan Hospital. If the Metropolitan Hospital were to refrain from discharging Dawson, then that could cause some disagreements with Dawson’s wishes and the wants of his social worker and his physicians. Dawson has also been found completely competent, which can provide stability to his life after his current stay at the hospital and thus strengthen his case to leave. Regarding the case of the baby girl, it has been stated, in our text, that contemporary ethical and legal norms hold that all human beings born alive should be treated equally, regardless of disability. This can call for a legal case because if this baby girl were to have been born with legs and arms, would the mother still not want surgery performed? And if she did not wish to have surgery, then that would call into her competence and if she were able to make a proper decision about the situation? If all human beings born alive should be treated equally, then why does the mother not want to have surgery performed on her baby girl? Thus, because the mother is not treating her child as if she were a baby without a disability, the hospital can be accused of following through with the wishes of an incompetent woman. According to the Child Abuse Amendments (CAA) of 1984, which ended the political controversy over the federal role in decisions to withhold treatment from handicapped newborns, legal issues could arise from the hospital not treating the baby. This amendment strongly protects the rights and interests of those with disabilities and leaves little room for non-treatment decisions to be based on expected low quality of life or the interests of parents. All children, whatever the extent of their disabilities, are to be granted medical treatment unless they met the narrowly defined exceptions. Also, in our text, at the very least, CAA could be perceived as setting the standard of care to which hospitals and doctors would be held, both by accrediting bodies and by courts hearing challenges to nontreatment decisions. The baby girl case has similarities with the case of Miller v.  HCA, in our text. In this Texas Supreme Court decision, while recognizing that parents ordinarily have the right to consent to or to refuse medical care for their children, the court also recognized that an exception to the parental consent requirement arises when an emergent condition exists and treatment must occur immediately to prevent the death of the child. Although, in Miller v. HCA, the court found that the doctor’s initial resuscitation in Miller was justified because the situation was an emergency and there was not enough time necessary to get consent form the parents or from a court. The court only found the doctor’s actions rationalized because the doctor did not have enough time to consult with the parents before making the life or death decision. In this case, the physician has time to get consent from the mother, which could then be argued, that if the neonatal team would have been taking action without the mother’s consent, and would not be justified. The two cases of Roosevelt Dawson and the baby girl have a several significant similar qualities to them: loss of limbs, the quality of their lives would be questionable, and both Dawson and the baby have other parties trying to make a life or death decision for them. In terms of quality of life, Dawson is a recent quadriplegic patient and the baby girl has been born without limbs. When calling into account the quality of their lives without limbs, should the baby have surgery and Dawson leave the hospital, could be considered of extremely difficult quality of life. Finally, Dawson’s social worker is pushing a court order for Dawson to stay in the hospital and not be discharged, while the baby’s neonatal staff is pushing a court order to disregard the mother’s decision on not having the baby undergo surgery and removing the nutrients currently being given. Although there are some similarities surrounding the cases of Dawson and the baby, there are positively some differences that cannot go unmentioned. Firstly in the case of Roosevelt Dawson, he is a twenty-one year old completely competent male, wishing to leave the hospital. But, according to his social worker, he is has the intentions of assisted suicide. In the case of the baby, she is a less than ten hour old female. She cannot take nourishment orally because she has anomalies of the mouth and throat, which can be surgically removed. Her mother is refusing to give the neonatal staff permission for surgery and has asked the hospital not to nourish her baby girl. Because the baby cannot make a decision for herself, her mother is her making judgments for her. Thus, there are some similarities of the two cases, but there are specific differences between them, how they should be handled, and how their physicians should interact with both them and their families. In order to relate to the patients in these cases, there are four types of physician-patient relationship models that should be considered. The first type of relationship representation is the paternalistic model. According to our text, this model ensures that the patients receive the interventions that best promote their health and well being. In other words, the physician is acting as a guardian to the patient strongly suggesting or telling the patient what the best option for him or her would be in that particular scenario. The second type of relationship model is called the informative model. Here, the objective of the physician-patient interaction is for the physician to provide the patient with all relevant information, and the patient selects the option they want, and the physician follows through with their wishes. A fairly to-the-point model: provide the information, make a decision, act accordingly. The third model is the interpretive model. The aim for this model is to illuminate the patient’s values and what he or she actually wants, and to help the patient select the available medical interventions that realize their values. This model is more interpretive, the physician tries to assess the patient’s core values and help them make a decision after considering them. Lastly, is the deliberative model with the goal of this model is to help the patient determine and choose the best health-related values that can be realized in the clinical setting. In this model, the physician would suggest the best option for the patient’s health, not considering any moral values, but only those that would be best clinical wise. Considering all the types of physician-patient relationships explained in the previous paragraph, the best relationship that should be established in the case of Roosevelt Dawson should be the interpretive model. This model would best fit Dawson’s case because he needs to know what he values. Because what he values (could be his life, family, friends, functioning limbs) could have him change his mind in wanting to be discharged. Because what would be best for his health and therefore his values, could be to have him stay in the hospital or at home with a physician assisting him and his family. Thus, if he were to realize that his moral values were to stay alive, then the best way to do that would be to listen to the physicians around him. The type of relationship that should be established in the baby girl’s case should be the paternalistic model. This is because in this model, the physician would act as the baby’s guardian and implement what is best for the baby’s life and has obligations, including that of placing the baby’s interest above his or her own and soliciting the views of the mother, who seems to lack adequate knowledge of the situation. This is the best model for this case because the physician would initially be the guardian for the baby, rather than the mother, and will thus make the best decision for the baby and disregard the views of the mother. To keep in mind moral autonomy when assessing the physician-patient relationships is vital. Moral autonomy is defined in our text as: to act freely, is to act autonomously; to act according to a law you give yourself and not according to the desires of nature or pleasure; and to respect each person’s liberty to self-determine their own idea of the good. For the case of Roosevelt Dawson, moral autonomy can be valuable when looking at various perspectives. Dawson’s choice to leave the hospital relates to his ability to act freely; if he does in fact wish to commit assisted suicide, it is to act according to a law he has given unto himself. Thus, to respect each person’s liberty to self-determine their own idea of the good is to respect Dawson’s idea that being discharged from the hospital is his best option. In regards to the case of the baby and her mother: the baby girl is unable to act according to a self-given law, therefore the mother should be able to make decisions based upon a self-given law in regards to her child; because the baby is unable to make a decision for others to respect, the mother has made the decision to not follow through with surgery that the neonatal staff is having trouble respecting; and because the baby girl needs someone to make decisions for her, it would be her mother and the mother should be able to act freely, thus her decision to not give her baby the surgery or not. Also keeping in mind, as described in our book, utilitarian is a form of consequentialism and the results of actions are the only relevant feature in assessing actions. Considerations of someone’s intentions, feelings or convictions are seen as irrelevant to the question of ‘what is the right thing to do? ’ Under the point of view of utilitarian, the right thing to do is to maximize utility; good is determined by the overall net happiness that can be achieved. A utilitarian considers his or her own happiness, but no more and no less than the happiness of others, they are committed to the value of equality; with this, the right thing to do is to maximize utility (utility being the balance of pleasure over pain; happiness over suffering). In the case of Roosevelt Dawson, the parties involved are Dawson and his family. Regarding a short duration of time, some considerations for a utilitarian would be that Dawson is suffering while he remains alive but would be happy during death; this would be opposite for his family, they would be generally happy while Dawson is alive and they would suffer for a period of time after his death. Thus, death gives happiness to Dawson, but the reverse to his family in short term. But looking at the long term circumstance, his family along with Dawson himself would suffer because his family would have to take care of him and Dawson would have to cope with being quadriplegic (assuming Dawson is not going to commit assisted suicide). When discussing the case of the baby girl, the mom, the baby herself, and the neonatal staff would be the participants when discussing the situation under utilitarian pretenses. In this case, if the surgery were to be performed, then the mom would suffer because she would be taking care of a baby without limbs and neonatal staff being happy that they saved a child’s life. If the surgery was not performed, then the mother would be pleased to not have to take care of a limb-less child and the neonatal staff would be depressed about not being able to save a child’s life. Considering both short term and long term paths, if the surgery were to be preformed, it would cause the mother to suffer because her child does not have limbs, and the baby girl would struggle, due to the fact that she does not have any limbs. If the surgery were to not be performed, it would make the mother happy because she would not have a burden child, and the neonatal staff would be unhappy because the baby would have died. Again to take into consideration is communitarianism. This according to our text is ethical truth that must be sought in the universal belief of rationality. Whether ethical norms are conceived in terms of enlightened self-interest, maximized utility, or the recognition of autonomy and human rights, they are viewed by this tradition as objective and universal, applicable to all times and places. Since different individuals will naturally have different values and conflicting visions of the good life, a truly liberal society will not adopt any particular conception of the good life to the exclusion or lessening of others. Unlike utilitarian beliefs which would pose the question of ‘what option would maximize utility? ’ the communitarian view would ask ‘which policies will promote the kind of community in which we want to live? ’ According to our text, in the case of Roosevelt Dawson, communitarians reject the desire for elevating the individual above the social group or community. Consequently, letting Dawson out of the hospital with the suspicion that he would commit assisted suicide, would not be what was best for the community because a member could potentially die. On the basis that there is a potential loss of life if Dawson were to be released from the hospital, would have a negative effect on the community and therefore be the unwanted plan of action. Similarly, in the case with the baby girl and her mother, not performing surgery and taking away nutrients from the child would also cause negative feelings around the community. Therefore, in order to keep the population happy, to follow through with the surgery so the baby would be able to eat orally, would be the communitarian desired option. Taking into thought, as discussed in lecture, vulnerable populations are those of group identities where there is historical evidence that a group has been treated unequally badly by medical professionals. In both cases, because Roosevelt Dawson is a twenty-one year old African American man and the child is a less than ten hour old female, there is more of an obligation to let a twenty-one year old man make his own decisions and have someone else make the decisions for the newborn child. Due to the fact that Dawson is a part of the group considered ‘adults’, he should be able to make his own verdict on whether to leave the hospital or not. At this age, a person should be able to make a decision about his or her own life without someone, even though may be in a ‘higher position’ than you. The fact that Dawson is African American should not be a factor in how the hospital should treat him, race should not be taken into play at all, the hospital should be treating Dawson as they would treat any other twenty-one year old that has been checked into the hospital. Rather than his race, the hospital should be obligated to take into account Dawson’s age when considering his wishes, and they have more of an obligation to grant his wishes because of his adult status. On the other hand, the baby should obviously not be making its own decisions, because she does not know anything about the situation. She is only less than ten hours old and has yet to make any decisions in her life at all. The obligations of the hospital to keep her alive should be no different than the obligation to keep any person alive, but because the baby cannot have an opinion or a decision in the matter, the mother’s decision should be considered. Although, because the mother is making the decision to withdrawal nutrients and not follow through with the surgery, her opinion and her thought process behind it should be taken into account. Taking consideration of the baby’s inability to make a decision of life or death on her own, the hospital is more obligated to keep her alive even if her mother is telling the neonatal staff to let her die. My recommendation for the case of Roosevelt Dawson is to let him leave the hospital and be free to make his own decisions. From our text, this is a rights-based approach; this advances the idea that simply, by being human, people have rights regardless of the legal system under which they live. My suggestion to let Dawson be discharged from the hospital is also because of the principle-based method. The principle of utility, or utilitarianism, would in this case ultimately maximize happiness. This response is formulated by the Doctrine of the Double Effect (DDE). According to our text, the DDE is in response to the recognition that an act may have both a good and a bad effect. The permissibility of the action depends on whether the bad effect is intended or for seen and permitted to happen. Therefore, the act of letting Dawson leave the hospital is not intrinsically wrong. The good effect is produced directly by discharging him and not by the speculation that he may or may not wish to commit assisted suicide. There is only speculation that Dawson wants to commit assisted suicide, not concrete evidence, thus letting him leave the hospital would be in the best interest for Dawson, his family, and this hospital. With the case of the ten hour old baby girl, my proposal is to follow through with the surgery to remove the anomalies in her throat and have her be able to consume nutrients orally. This recommendation is stemming from the hobbesian contractarianism. From our text, everyone is better off restricting his or her own liberty to injure others, so long as the others do likewise. Thus, harming the baby (not removing the anomalies and taking away her nutrients) is not inherently wrong in this way, but it is to our mutual advantage to accept conventions that define such harm as wrong. By removing nutrients, we would be harming the baby, which would be restricting the liberty and therefore wrong. Also, to maximize utility would be to follow through with the surgery and keep the baby alive. This would make the maximum amount of people happy, including the hospital, and thus would be maximizing utility.

Birth Order and its Effects essays

Birth Order and its Effects essays oldest children in birth order People in the birth order of oldest children are probably among the most over- studied sibling groups in the world. Researchers have shown great interest in oldest children for many years, and there is general agreement among them about the characteristics that are commom to most oldest children. "From ancient times, the oldest child has had a special significance in the family - and in the world. This special significance has meant everything from inheriting the kingdom to being offered as a sacrifice in religious rites, which is a good metaphor for the mixed blessings of the oldest" (Richardson 44). "The oldest child- the first child- is like a first love. The relationship between the first child and parents can never be duplicated. It is a replete with the awe and wonder of having brought into the world this little being, the focus of the parents' dreams and hopes" (Sulloway 55). "Even if later children become more favored by the parents, the relationship is usually not as intense as with the first "For the first few years. oldest children receive the full, undiluted force of their parent's love, fears, and expectations. The parents are usually very excited about the birth of the first child and look foward to it with eager anticipation mingled with fear" (Sulloway 56)."Even before the birth, the first pregnancy elicits more excitement and more anxiety than later pregnancies" (Wallace 28). "Prospective first parents usually worry at a minimum about the health of the mother and fetus, what to expect during delivery, whether the baby will be whole and normal at birth. And these concerns are not unfounded. The first is usually the most difficult labor, averaging 14 hours compared to 8 hours for later births, and there are more difficulties with delivery and more abnormalities in newborn firsts" (Richards...

Paradise Lost Essay Example | Topics and Well Written Essays - 1000 words

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Andy Warhol's Life Essay Example | Topics and Well Written Essays - 1500 words

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Public Health Disease Management of Tuberculosis

Public Health Disease Management of Tuberculosis This essay critically examines the effectiveness of policy frameworks and assessment tools in public health disease management of tuberculosis. The essay discusses the role of the community nurse and multidisciplinary teams in empowering individuals and populations in reducing health inequalities. The essay also explores the nursing and public health frameworks that assist in holistic assessment, planning implementation and the evaluation of care in the community, primary and public health sector. The essay also discusses how environmental, epidemiological and demographic data can influence policies and tackle the underlying social determinants of the health of populations. The essay also discusses strategies that enable the empowerment of individuals and groups, to make them responsible for their own health. The essay also identifies key issues emerging from the health and well-being of communities and discusses the impact that these will have on the role of the nurse and the multid isciplinary team. The main policy framework that has been put forward to combat tuberculosis is contained within the 2004 Department of Health document entitled Stopping tuberculosis in England: An Action Plan from the Chief Medical Officer, which outlines the goals of the programme, namely the long-term reduction and ultimately elimination of tuberculosis from England, with the immediate aims of reducing the risk of people being newly affected by tuberculosis, providing high quality treatment for all people living with tuberculosis and maintaining low levels of drug resistance to tuberculosis, through careful usage of antibiotics (DoH, 2004). This framework has dictated how health professionals treat cases of tuberculosis but has, in practical terms not stopped the drastic rise in tuberculosis in England: in 2002, for example, 6638 people were diagnosed with tuberculosis (DoH, 2004), whereas in 2005, the number of people infected by tuberculosis rose by 10.8% to 8113 (HPA, 2005; BBC, 2006), with the largest increases being in inner cities, particularly London (HPA, 2005; BBC, 2006). The public health management of tuberculosis includes: vaccinating uninfected at-risk groups; minimizing the chances of spreading the infection through minimizing contact of humans with cattle, for example; actively seeking infected individuals from within those groups most at risk; thoroughly investigating outbreaks of the disease when they occur; having appropriate measures in place to ensure that those with the disease do not infect health professionals; developing more rapid diagnostic techniques and creating an effective and easy-to-use national monitoring and surveillance system which functions within a legal framework (NICE, 2006). The spread of tuberculosis is not, seemingly, therefore being effectively managed as per the outlines in the policy framework in the 2004 Department of Health document entitled Stopping tuberculosis in England: An Action Plan from the Chief Medical Officer nor by the public health management schemes that are currently in place. Increases in tuberculosis are consistently most notable in the poorest sectors of the population (Bhatti et al., 1995), and for this reason, tuberculosis has been described, as it was historically, as a disease of the poor. There is, therefore, a massive socioeconomic influence over the spread of tuberculosis (Bhatti et al., 1995). Given this, then, it is important that the community nurses working in the ‘poorer’ sections of inner city areas are fully trained in how to diagnose, and how to best treat, tuberculosis, within the general framework as specified by the Department of Health (2004) policy document. In terms of the role of the community nurse and multidisciplinary teams in empowering individuals and populations in reducing health inequalities, as identified by Palacios et al. (2003), nurses play a key role in the management of tuberculosis cases in the community, with nurses being responsible for, amongst other things, identifying patients, evaluating patients prior to treatment starting, managing emergencies, educating patients and other health professionals, and providing coordination, for example overseeing other health workers and communicating between the members of a multidisciplinary team. Not only do the community nurse and the multidisciplinary teams they are involved with have a duty to identify and treat tuberculosis cases, but there is also an implicit obligation (built in to the framework for controlling tuberculosis as outlined by DoH (2004)) that health professionals should also educate individuals at risk as to how to minimize the risk that they would contract tu berculosis. Health inequalities, such as the greater likelihood of contracting tuberculosis if one comes from a poor background, need to be first recognized by health professionals and then treated, through treating the diseases as they manifest themselves, and through education programmes, which would aim to minimize the risks of contracting such diseases. Obviously this is approach does not treat the root causes of the inequalities, which is a political matter. In terms of exploring the nursing and public health frameworks that assist in holistic assessment, planning implementation and the evaluation of care in the community, primary and public health sector, there is a national framework for dealing with tuberculosis which offers guidelines as to how tuberculosis should be managed on the ground as it were (Singh et al., 2002). Tuberculosis care is generally undertaken on an out-patient basis with only emergency (usually previously undiagnosed) cases being dealt with on an in-patient basis (White et al., 2002). There is a system in place that ensures that any patients with suspected tuberculosis are seen by a tuberculosis team as soon as possible, following their first presentation to a health care professional, and that the presence of tuberculosis is noted on the national database and then managed according to national guidelines (i.e., those from the British Thoracic Society) (DoH, 2004). This national database of tuberculosis cases is p art of the Health Protection Agency’s surveillance scheme for tuberculosis, through the Statutory Notification of Infectious Diseases (NOIDs) scheme. The current best practice in terms of managing tuberculosis is the allocation of the patient with tuberculosis to a named case manager, who provides routinely supervised care to ensure that the medication is taken correctly and that the disease is being managed properly (DoH, 2004). In terms of how environmental, epidemiological and demographic data can influence policies and tackle the underlying social determinants of the health of populations. There are many organizations that collect data on various diseases that are present in the UK, and who then relate this data to socioeconomic factors. The Rowntree Foundation is one such organization, for example. Tuberculosis is a pertinent example of how environmental, epidemiological and demographic data can be used to effect changes to the political structures in place. As has been seen, it is known that socioeconomic variables can predict the presence of tuberculosis in the population, with those individuals from poorer areas more likely to suffer from a higher incidence of tuberculosis than those individuals from more affluent areas (Bhatti et al., 1995). The fact that there are still such diseases, with a strong socioeconomic aspect, present in the UK is cause for concern, and as many reports from the Joseph Rowntree Foundation have pointed out (for example, North et al., 2007; Dorling et al., 2007), the UK is facing higher levels of inequality than for four decades, which has major health implications for those living in the poorer sectors of society. These studies have been listened to, as the Government embarks on their social justice programme that aims to provide social equality for all members of society, in terms of health and education, for example. Thus, the use of environmental, epidemiological and demographic data can be responsible for directly influencing policies and tackling the underlying social determinants of the health of populations. If, for example, the poorer sectors of society were lifted out of this poverty, it is likely that ‘diseases of the poor’ such as tuberculosis would decline in frequency i n the UK. In terms of strategies that enable the empowerment of individuals and groups, to make them responsible for their own health, such strategies take many and varied forms, according to the disease under consideration. For tuberculosis, this entails, amongst other things, educating the patients as to why it is important to continue to take their medication even when they ‘feel’ better, to ensure that the disease does not recur and, more importantly, that antibiotic resistance is not developed. Most strategies for patient empowerment are based around patient education, in terms of bringing about changes in their immediate environment, or in their patterns of thinking, that will effect changes to their lifestyle and the ways in which they view their lives and, through this, will effect direct positive changes to their health; patient empowerment is generally a necessity for preventative medicine to be fully effective (Wensing, 2000). Empowering patients through education and t hrough better communication in the media, for example can lead to much higher levels of conformity with healthcare plans and to greater adherence to preventative medicine schedules (Wensing, 2000) which, in a disease like tuberculosis, which is notoriously difficult to treat if medicine schedules are not followed, is crucial to gaining control of the disease. In terms of the key issues emerging from the health and well-being of communities and the impact that these will have on the role of the nurse and the multidisciplinary team, it has been seen that tuberculosis is a disease of the poor, occurring most commonly in poorer areas in inner cities. Firstly, these health professionals have to recognize the socioeconomic aspect of such diseases, and to work within this context. For health professionals working in such situations, it is imperative that these health professionals are aware of all the current guidelines and policy frameworks with regards to such diseases, to ensure that they are aware of the necessity of conforming to these guidelines and frameworks. The impact that this has on the role of the nurse and the multidisciplinary team is to focus the health professionals attention to the diseases that are associated with poverty, and to focus their attention on treating these diseases in the optimum manner, and to empower their patie nts, in an attempt to manage, as effectively as possible, the incidence of such diseases. In conclusion, this essay has looked at the issue of tuberculosis in the UK, finding that whilst there is a policy framework in place aimed at reducing the incidence of tuberculosis, this is not wholly effective. The socioeconomic aspect of tuberculosis was discussed, as were the treatment options, the need for patient empowerment and the ways in which treating tuberculosis impacts health professionals. It is recognized that dealing with the root cause of diseases such as tuberculosis, which are generally known as ‘diseases of the poor’ is a political and not a health, matter, in terms of smoothing the inequalities that lead to the conditions where such diseases develop. References BBC (2006). Sharp rise in tuberculosis cases. 2nd November 2006. Available from http://news.bbc.co.uk/2/hi/health/6109228.stm [Accessed on 27th January 2008]. Bhatti, N. et al. (1995). Increasing incidence of tuberculosis in England and Wales: a study of the likely causes. BMJ 310, pp.967-969. DoH (2004). Stopping tuberculosis in England: An Action Plan from the Chief Medical Officer. Department of Health. Dorling, D. et al. (2007). Poverty, wealth and place in Britain, 1968 to 2005. Joseph Rowntree Foundation. Available from http://www.jrf.org.uk/bookshop/eBooks/2019-poverty-wealth-place.pdf [Accessed on 26th January 2008]. HPA (2005). Annual report on tuberculosis cases reported in England, Wales and Northern Ireland. Available from http://www.hpa.org.uk/infections/topics_az/tb/pdf/2003_Annual_Report.pdf [Accessed on 26th January 2008]. NICE (2006). Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Available from http://www.nice.org.uk/nicemedia/pdf/CG033niceguideline.pdf [Accessed on 26th January 2008]. North, D. et al. (2007). Interventions to tackle the economic needs of deprived areas: analysis of six policy case studies. Joseph Rowntree Foundation. Available from http://www.jrf.org.uk/bookshop/ebooks/2137-devolution-governance-deprivation.pdf [Accessed on 27th January 2008]. Palacios, E. et al. (2003). The role of the nurse in community-based treatment of multidrug-resistant tuberculosis. The International Journal of Tuberculosis and Lung Disease 7(4), pp.343-346. Singh, S. et al. (2002). Tuberculosis in primary care. British Journal of General Practice 52, pp.357-358. Wensing, M. (2000). Evidence-based patient empowerment. Quality in Healthcare 9, pp.200-201. White, V. et al. (2002). Management of tuberculosis in a British inner-city population. Journal of Public Health Medicine 24(1), pp.49-52.

Outsourcing Essay -- Economics Economy Consumerism Essays

Outsourcing Outsourcing has become a very popular issue, and it has reached an all-time climax. Firms are starting to do this a lot more than than in the previous decade. What is outsourcing? Outsourcing is defined as â€Å"The procuring of services or products, such as the parts used in manufacturing a motor vehicle, from an outside supplier or manufacturer in order to cut costs.† And it has become a big issue in our country. There are thousands of articles and books written on it, and you can attend numerous classes and speeches on the subject. The use of outsourcing is quite simple really†¦ Either pay an American worker $15 an hour, or pay someone in India to do the same job for $2 an hour. There are lots of other advantages and disadvantages to outsourcing but I will address those later in the essay. So what does an average American really know about outsourcing? Most people would say sending our jobs to another country in order to save money isn’t justified. It would cos t a lot of people jobs, which would send them into distress and possibly debt. But that’s not the whole story behind outsourcing. People hear about outsourcing and automatically decide that it is bad for our economy. What about the good things that outsourcing brings to our economy? We are sending jobs to India, their consumers will start making more money, and in return buy more of our goods and services. In this essay I will show you both points of the debate and you can decide for yourself whether or not outsourcing is bad for our country. A firm’s primary objectives are cutting un-necessary costs, reducing overhead, and cutting labor costs. America has one of the highest GDP’s, with the minimum wage law in the US being $5.15 an hour. Most people woul... ...l comes down to the American consumer, and how they view the topic. In the end†¦ the choice is yours. BIBLIOGRAPHY 1. Pew Research Center/Council on Foreign Relations survey conducted by Princeton Survey Research Associates International. July 8-18, 2004. N=1,003 adults nationwide. MoE  ± 3.5. Available at: http://www.pollingreport.com/trade.htm 2. Network Computing online, Online article, available at: http://www.nwc.com/shared/article/printFullArticle.jhtml?articleID=115201900 3. TechWeb online, â€Å"IT salaries are Rising†, online article, available at: http://www.techweb.com/wire/story/TWB20030402S0002 4. Information Week, â€Å"IT salaries Show Upward Trend, Outsourcing Overblown†, TechWeb article written by W. David Gardner, available at: http://www.informationweek.com/story/showArticle.jhtml?articleID=50500043

Does age matters in relationship? Essay

â€Å"Age is a Matter of Mind — if you don’t Mind, it doesn’t Matter.† but the The Bible says not to be â€Å"unequally yoked† (weird way to put it†¦ anyway) It is entirely your choice whether you decide to date someone considerably older or younger than yourself. To some age isn’t a significant factor in dating, while others have a strong opinion and will only date people the same age or within a few years of their age. It is a personal choice. There are no rules to say you shouldn’t date someone much older or younger than yourself, but be prepared for possible judgment from others if there is a considerable age gap. Of course, even if the age difference is there, you have to look at what you both enjoy. Do you have common interests and desires? If so, then an age difference of any size can potentially be overcome. There’s certainly no sense in throwing away a chance at happiness just because of a number. It’s just a good thing to be aware of, in case some difference should arise. But if two people are committed to making something work, it can, in spite of any obstacles that might come up. Both of you need to be sure that â€Å"Both are in Agreement and on the same Page?† But when there is a large age gap, this is when a relationship can face difficulties. With an age gap there is always going to be lifestyle differences. A younger person may enjoy nights out with their younger friends and have no interest in starting a serious relationship, whereas, their older partner might be at an age where they want to settle down and spend quiet time alone with them. However, if one person involved lies about what they want from the relationship then this can cause big problems further down the line. If you want a serious relationship, but the person you are dating only wants a casual one, then you need to think long and hard about whether they are worth sacrificing your dreams for. There are in fact many upsides to age differences in relationships that can have an extremely positive impact. The younger partner has the potential to extract energy and spark from the older partner. Equally as beneficial, an older lover can provide emotional stability and offer guidance with life choices. However social situations with family and friends can be challenging. Despite these potential problem areas, many relationships with an age gap are highly successful. The key is honesty and communication. Being open and truthful from the start about what you are looking for in a relationship, and even life, is the best way to ensure you are able to achieve this. If both partners are in agreement, then there is no issue. Like with any relationship, if you are happy, have a strong bond and are committed to making it work, then together you can cope with any complication life throws in your direction. Levels of Maturity – Immature individuals tend to be funnier and more exciting to be around, but when it comes to the important things – sometimes you can be left disappointed. Sometimes, different levels of maturity can be the deciding factor between your relationship making it or breaking under the pressure. Warning! If he’s still single/divorced after all these years, there must be a reason? Yes, he may not have found â€Å"the right one† yet, but seriously — why is he still single/divorced? Commitment-phobic? Emotionally stunted? Self Centered? You might want to check out his collection of baggage before you travel any further on this journey with him. Good Luck!

SAT Essay Scoring The Real Story

SAT Essay Scoring The Real Story SAT / ACT Prep Online Guides and Tips It's 17-19 days after your SAT test date, so you log into the CollegeBoard website, eager to see how you did. You look at your essay score and see...â€Å"9.† You check for more detail in your score report and see that Grader 1 gave you a 5, Grader 2 gave you a 4...and that's it. So how are SAT essays graded, and how can you use this information to your advantage? Read on to find out! feature image credit: Iffy explains it all by Quinn Dombrowski, used under CC BY-SA 2.0/Cropped and resized from original. A Quick Look Into SAT Essay Grading The first thing you do when you sit down to take the SAT is the 25-minute essay section. Once you write your essay (as well as the rest of the test), though, what happens to it? Your essay is scanned and uploaded to an essay grading interface and graders then grade it. SAT essays are currently graded on a scale of 1-6 by two graders, giving you a total essay score out of 12. This score out of 12, along with your raw score on the SAT Writing multiple-choice questions, is factored into your total SAT Writing score. If the two graders give you scores more than 1 point apart (i.e. if one grader gives your essay a 2 and another gives your essay a 4), a third essay grader will be brought in to resolve the issue. Your SAT essay scores are based on each essay grader’s impression of your essay as a whole, which is why the SAT essay is said to be graded "holistically." You don’t get a certain number of points taken off for grammar mistakes or for organizational issues, as you might on a normal school essay. In fact, graders are trained to ignore minor errors in grammar, sentence structure, and so on. Important note: In March 2016, the SAT essay will be changing in format and grading structure, so some of this information may not be accurate for that test. Check back for updates! SAT Essay Scoring: Official Policy How are graders supposed to grade? I've copied the official policy from the CollegeBoard below: â€Å"The SAT Scoring Guide expresses the criteria readers use to evaluate and score the student essays. The guide is structured on a six-point scale. Since the SAT essay is scored holistically, readers are trained to use the SAT Scoring Guide in conjunction with anchor papers, which have been scored by consensus as representative examples. The language of the Scoring Guide provides a consistent and coherent framework for differentiating between score points, without defining specific traits or types of essays that define each score point.† What's the SAT Scoring Guide? While I've written another article that goes into detail about the SAT essay grading rubric, I'll give a quick rundown of its main points here: Point of View, Logic, and Support You must: Have a clear opinion on the prompt (a thesis). Make sure you clearly answer the essay prompt, both in your introduction with a thesis statement and over the course of your essay. For example, take the essay prompt were "Are important discoveries the result of focusing on one subject?" Your thesis (and your essay) should clearly answer this question, preferably with a "yes" or "no" (SAT essays that try to answer "sort of yes, sort of no" tend to be weaker, since you only have 25 minutes to write your essay). You must: Use specific examples to support your point. You can't just say "my point of view is correct because it is" and be done. Instead, you need to use specific examples from history, literature, pop culture/current events, or your own life to support your thesis. You must: Explain these specific examples in a way that supports your thesis. It's also not enough to just write your thesis and then describe a specific example - you also need to explain why that example supports your thesis. Organization and Focus You must: Keep your essay organized. This means sticking to a clear essay structure (with an introduction, body paragraphs for each example, and a conclusion) as well as making sure your thoughts are organized within each paragraph. Vocabulary and Word Choice In order to score highly, you must: Use a wide variety of vocabulary correctly. It's good to use advanced vocabulary, but only if you're using the words correctly. You can get away with a few errors, but if your word choice starts to seriously affect the meaning of your sentences, your essay score may drop. Sentence Structure In order to score highly, you must: Use a variety of sentence structures. As I've said in other articles, this is the area that I struggle the most with under time pressure. As long as you don't start multiple sentences in a row with the same word (oops) or write sentences that all have the same underlying structure (e.g. "Gandhi was a great leader. India was in trouble. The world was watching."), however, you should be fine. Grammar, Etc. You must: Use standard written English grammar. Again, it's all right to make minor errors in grammar and punctuation in your essay - graders are trained to overlook minor issues. If your essay has consistent issues with grammar that make it difficult to understand your reasoning, however, this will affect your essay score. SAT Essay Grading in Practice Essay graders don’t grade based on how correct your statements are. This means that you can write things like "My friend was killed by a polar bear because he didn't go to the instructional course about how to deal with bear attacks" or "The Scopes Monkey Trial ended with Scopes being executed for his belief in evolution" and the graders will have to take it as true. My reaction when I first learned this: WHAT. How can that be true?! So I investigated further and found the reasons that lie behind this rule. Because SAT essay scorers don’t have time to fact check each and every fact in each and every essay, they must take everything you write in your essay as true. Plus, the stated purpose of the SAT essay assignment is to "show how effectively you can develop and express ideas" in 25 minutes. The CollegeBoard understands that under the time pressure of a 25-minute essay students will sometimes write things like "World War I took place in the early 1800s" (instead of "the early 1900s"). As long as your statements logically support your thesis, you're in the clear (although if you write things that don’t make sense that undermine your main point, your essay grade will suffer). Second, while there’s nothing in the publicly available official guidelines that say how long each grader has to grade, interviews with and articles by former SAT essay graders have provided further information about the grading process: if an essay scorer takes longer than 2-3 minutes to grade each essay, she has to be "retrained." This process is annoying, as the grader has to grade a series of pre-graded essays and make sure she's within a point of the grade before she can get back to grading actual student essays. Graders may also be forced to retrain if they run into a prescored essay that's been thrown in among the student essays and don't score it within one point of the score. To avoid all of this retraining, graders will sometimes score in the middle of a range to stay on the safe side. For example, if an essay is at least a 4, a grader might score it a 5 because that grade is within one point of a 6 OR a 4 (and might be right on target with a 5). Interior of a beet sugar factory showing centrifuges (CHS-2496) by Ashley Van Haeften, used under CC BY 2.0/Cropped from original. "These score results show the need for retraining. Let us return Grader 18927 to the vat." What Does This Mean for Your SAT Essay? Now that you know a little more about the official SAT essay grading policies and the reality of SAT essay grading, how can you use this information to write higher-scoring essays? Don’t hide your thesis. Graders spend 2-3 minutes per essay or else face a retraining penalty. They will not be happy if they have to hunt all over to find your point of view, so state your thesis clearly in your introduction. Be organized. Again, because the grader is spending a short amount of time on your essay, you want to make it easier for her to follow your logic. You can make a few mistakes. As long as errors in your grammar, punctuation, and spelling don’t significantly affect the readability of your essay, your essay's graders won’t penalize you for it. Similarly, as long as the facts you use in your essay logically support your thesis, it doesn't matter if they're actually true or not. For instance, you could completely change the plot of a novel like George Orwell's Animal Farm, and as long as the changes you've made make logical sense, the graders must not penalize you for it. What’s Next? Curious about what standards SAT essay scorers are using to grade your essay? Go into more detail on this topic with my article on the SAT Grading Rubric. Now that you know how your essay is scored, find out what's a good SAT essay score and compare it to the average SAT essay score. Get more insights on the SAT essay with our strategies for the SAT essay, based on stories of former SAT essay graders. Want to improve your SAT score by 160 points? Check out our best-in-class online SAT prep program. We guarantee your money back if you don't improve your ACT score by 4 points or more. Our program is entirely online, and it customizes what you study to your strengths and weaknesses. If you liked this SAT Essay lesson, you'll love our program.Along with more detailed lessons, you'll get your SAT essays hand-graded by a master instructor who will give you customized feedback on how you can improve. We'll also give you a step-by-step program to follow so you'll never be confused about what to study next. Check out our 5-day free trial:

Reed Surname Meaning and Origin

Reed Surname Meaning and Origin The Reed surname has a number of possible derivations: A descriptive name or nickname signifying a person with red hair or a ruddy complexion, deriving from the Old English read meaning red.A topographical surname for someone who lived in a clearing in woodland, deriving from the Olde English ried, ryd.A geographical name from any of the various places called Read or Reed. Reed is the 65th most popular surname in the United States. The REID spelling of the surname is extremely common in Scotland, where it is ranked #11. Surname Origin: EnglishAlternate Surname Spellings: REID, RIED, READ, READE, REEDEGenealogy Resources for the Surname REED: 100 Most Common U.S. Surnames Their MeaningsSmith, Johnson, Williams, Jones, Brown... Are you one of the millions of Americans sporting one of these top 100 common last names from the 2000 census? Reed Name Meaning Family History An overview of the Reed surname meaning, plus subscription-based access to genealogical records on Reed families around the world from Ancestry.com. REED Family Genealogy Forum: Search this popular genealogy forum for the Reed surname to find others who might be researching your ancestors, or post your own Reed query.FamilySearch - REED Genealogy: Find records, queries, and lineage-linked family trees posted for the Reed surname and its variations.REED Surname Family Mailing Lists: RootsWeb hosts several free mailing lists for researchers of the Reed surname.Cousin Connect - REED Genealogy Queries: Read or post genealogy queries for the surname Reed, and sign up for free notification when new Reed queries are added.DistantCousin.com - REED Genealogy Family History: Free databases and genealogy links for the last name REED. References: Surname Meanings Origins Cottle, Basil. Penguin Dictionary of Surnames. Baltimore, MD: Penguin Books, 1967.Menk, Lars. A Dictionary of German Jewish Surnames. Avotaynu, 2005.Beider, Alexander. A Dictionary of Jewish Surnames from Galicia. Avotaynu, 2004.Hanks, Patrick, and Flavia Hodges. A Dictionary of Surnames. Oxford University Press, 1989.Hanks, Patrick. Dictionary of American Family Names. Oxford University Press, 2003.Smith, Elsdon C. American Surnames. Genealogical Publishing Company, 1997.

Tesco Analysis Essay Example | Topics and Well Written Essays - 2750 words

Tesco Analysis - Essay Example At first an extensive background of the company is given, providing the data on the past of the corporation. Tesco walked through a considerable number of obstacles on its path with a single principle: price is the most considerable factor in retailing. While using 'pile it high, sell it cheap' strategy the firm has made its name on the three main notions: perfect use of online retailing, perfect meeting of customers' demands, and perfect pricing policy. More detail to these factors is given in the next part of the report. After that the report dwells on the market environment surrounding Tesco. Interestingly, another company that used strategy similar to Tesco is also a top retailer in its domestic market environment - it is Wal-Mart. The comparison between Tesco and Wal-Mart is drawn next. The report concludes with forecasting what strategic options Tesco will have in its nearest future. Tesco was founded in 1924. However, the real history of Tesco began in 1931 when the first store was opened. At first the company specialized only in food retailing, which already had some major players, e.g. Sainsbury - a leading company of that time. Despite many differences, such as family issues in controlling businesses both companies had similarities. Both Tesco and Sainsbury families were very influential, however unlike Sainsbury, where all the managerial control belonged to the family, Tesco always had non-family board of directors (Morelli 2004). At the same time, both Tesco and Sainsbury based their success on regional strategies placing their stores in highly concentrated South Western and South Eastern parts of England. In fact, this was one of the reasons of imperfect competition between these tow companies. Tesco became a public license company in 1949. The company has been noted for a rapid and effective use of its investors in compare with its competitors. While Sainsbury's growth was incremental through the use of retained earnings for investment in new stores (Williams 1994), Tesco has been known for the effective use of share floatation to gain the necessary capital for takeovers (Morelli 1996). Sainsbury became a public licensed company only 24 years later in 1973 - the unwillingness of the company to utilize leasing was one of the reasons why Tesco has become a new market-leading company. Meanwhile the industry of retailing was developing rapidly. Upcoming trends of those days were integrated supermarkets, allowing its customers to buy everything they need within one building and self-service, which granted lower expenditures on the retailing personnel. Later, "from the adoption of still larger superstores, computerisation, stock control systems and sub-contracting out of warehousing and distribution in the 1980s, the modem supermarket retailer has been prepared to rapidly develop new organizational approaches" (Morelli 2004, p. 771). Tesco began selling non food goods in 1964. Introducing innovative techniques, such as loyalty cards, banking services, one-stop shopping, etc. has also given Tesco some advantage, although all these methods were quickly imitated by other companies. Pricing was always one of the most important issues in retailing. Being similar among all the major players of the UK retailing industry, prices were hardly anyone's advantage. There were some ways to attract customers, though. For instance, one of

Discussion 1 Week 6 Corporate-level Strategies Assignment

Discussion 1 Week 6 Corporate-level Strategies - Assignment Example The merger could increase tendencies for dependencies between the corporate partners. As such, two examples which would illustrate the manner in which each company would avoid risks of dependency are as follows: (1) one company could replicate a successfully implemented business model in new market segments within the industry (Hill and Jones); and (2) the corporate partner could differentiate its products (or services) by focusing on core competencies which appeal to their clientele. For instance, offering exemplary customer service through acknowledging loyal clients by name recognition or provision of perks and freebies. 2. From e-Activity, determine the fundamental drawbacks associated with horizontal integration. Suggest another corporate-level strategy that could redefine the Southwest business model and thus allow the company to increase its competitive advantage within a changing industry environment. Provide a rationale to support your response. The fundamental drawbacks associated with horizontal integration include being exposed to coming into conflict with the Federal Trade Commission (FTC) for potential violations of anti-trust laws which undermine fair competition. In addition, customers’ interests and purchasing power could also be jeopardized if major companies within the industry engage in horizontal integration and control or dictate market prices. As such, another corporate-level strategy that could redefine the Southwest business model and allow the company to increase its competitive advantage within the changing airlines industry is the application of vertical integration. Southwest could look into improving scheduling (queuing of airline routes to facilitate speed in the number and volume of flights). The strategy would assist in minimizing costs, as well as improving customer satisfaction through speed within which services