Change and Emotions in The Things They Carried by Tim...

Albert Einstein once said, â€Å"The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.† This quote relates to Lieutenant Jimmy Cross from the short story â€Å"The Things They Carried,† by Tim O’Brien and the narrator from â€Å"Cathedral,† by Raymond Carver in that they both change. Lieutenant Cross gets distracted by Martha, a girl he is in love with, during the War and one of his man dies. The narrator from Carver’s short story gets jealous about a blind man his wife used to read to and is not happy that they are having him over their house. Even though the narrator is very similar to Lieutenant Cross in that they both have a connection with someone that makes them change, they are also very different in the emotions that they go through. These two characters share many similarities throughout the short stories. They both go through an event that makes them see things differently. Lieut enant Cross is in love with Martha even though he knows that she is probably not in love with him. He gets too distracted with Martha and does not really focus at his job as a lieutenant. One event that changed him was when Ted Lavender, one of his men, died. This made him realize that he was too distracted by Martha and did not cared enough for his men. He felt guilty and had to change his attitude towards his job. O’Brien states: â€Å"He would accept the blame for what had happened to Ted Lavender. He would be a man about it. He would look themShow MoreRelatedIn Literature, There Are Genres. Two Main Genres Are Fiction1350 Words   |  6 Pagesshort story is â€Å"Cathedral.† â€Å"Cathedral† shows a relationship that reality might portray sometimes, but deeper than the surfaced relationship, it a very unique relationship that Raymond Carver is portraying. â€Å"Cathedral† is a story that represents a broken marriage. The husband does not really love the wife. His emotions do not change throughout the story towards his wife. He is affectionately still towards her. She tried healing the marriage, but the husband does not try to change his ways to love

The World s Population No Matter - 1408 Words

There are a lot of places in today’s world about where to start talking in regards of inequality. What are the causes and affects it? Why does it in African societies today if we are no longer in slavery? Some people will argue that it is impossible to know why inequality exists and the same people would just accept that they are part of the losing end of the stick. They live their lives stuck with no progression. Although everything has a solution, people are not able to solve all problems and mankind can only know so much of what the other person is thinking. The world’s population no matter the race, gender or age is part of an ever-lasting experiment that we call Sociology. Sociology is a science guided by the basic understanding that the social matters: our lives are affected, not only by our individual characteristics, but also by our place in the social world. (Carl 2011:4) This paper will help better interpret what different inequalities exist in Africa. Seek to find how much of an impact it is to the rest of the world. Africa is known for its hot climate, beautiful attractions of nature and wild life. Africa is the world’s second largest continent. It remains today as the worlds poorest and undeveloped continent. Scientists believe that Africa is the birthplace of mankind. Africa was not where slavery began despite the many years of so many Africans as slaves. Africa has valuable natural resources such as gold, oil, diamonds, salt and petroleum. How can a countryShow MoreRelatedStrain On Earths Most Vital Resources1689 Words   |  7 Pageswater supply. In the words of the great Jacques Cousteau, â€Å"Water and air, the two essential fluids on which all life depends, have become global garbage cans.† In making this comment, Cousteau urges us to take a closer look at what we are doing to the world around us specifically our water and air. The pollution of Earth’s air can ensue from both human and natural actions, and can worsen multiple health problems such as asthma. Some of the natural things that pollute the air consist of volcanic eruptionsRead MoreHuman Neutering And Its Effects On Humans1224 Words   |  5 Pagescalled a Tubal ligation, this is where the flappoion tubes are pinched shut to prevent fertilization. In todays world these two surgeries are by choice and not mandatory, if these two surgeries were strictly enforced upon the human race at the age of twenty-five it could save the Earth from dying early. A decreased population could result in many positive outcomes for the planet. No matter the location when a person looks straight ahead of themselves to their left, right, or behind them there is mostRead MoreProbably The Greatest Ecological Problem Of Our Time Is1051 Words   |  5 Pagestime is the rapid growth of the human population. During most of the time humans have lived on Earth, its population has grown fairly steadily and slowly. For example, between the years 10 000 and 500 a. the global population passed from 5 million to 100 million. By the year 13000 of our era it reached 500 million, and by the beginning of the nineteenth century it had doubled to 1000 million. Since then there has been a real explosion of the human population, reaching more than 5000 million in 1987Read MoreCompulsory Voting Of Brazil : Compulsory The State Of The Country Is Not Ready For A Change1598 Words   |  7 Pagesnumber of abstentions. This is explained by the extremely low level of interest of the population in political matters as well as political immaturity. Co nsidering these facts, the obligation of voting in Brazil should be maintained, the country is not ready for a change. A significant portion of the population is not yet capable of electing their leaders for the sake of the collectivity. Actually, the population needs to be made fully aware that the vote is the greatest weapon that exists againstRead MoreIntro and historical context Spain is in southwestern Europe on the Iberian Peninsula and is1100 Words   |  5 Pagessomeone, and as usual the person through another tomato and a fight began. The next year on this festival the fight was recreated and continued for several more years. Spain was one of the most powerful world empires of the 16th and 17th century. Spain remained neutral during World War 1 and 2, but suffered a devastating civil war during 1936 and did not end until 1939. Although Spain went through a very brutal civil war, its end result was a peaceful transition into a democracy. This followedRead MoreEssay about The Effects of Population Increase on the Environment1150 Words   |  5 PagesThe Effects of Population Increase on the Environment As inevitable as death and taxes, the population of the world will continue to grow until the government intervenes. The gross increase in population will generally lead to adverse effects on the environment. In the anthology, A Forest of Voices, an entry titled ?Is It Too Late by Anthony Weston deals with the history of legislation for the protection of the environment and stories of it?s destruction that are all too real. Seemingly, asRead MoreA Great Matter Of Concern Today Or Just A Bust?1667 Words   |  7 Pages A Great Matter of Concern Today or Just a Bust? Marvin Patani Communications Essentials – COMM1016-41 Professor Mark Dorsey Wednesday, October 29, 2014 â€Æ' A Great Matter of Concern Today or Just a Bust? While India is on the verge of being the most populated country. While the third world countries are deprived of their resources rapidly. 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The Return Midnight Chapter 43 Free Essays

â€Å"Elena?†Stefan said quietly. â€Å"Could you ask me to come in? You have to invite me in if you want to – to talk – â€Å" Invite him in? He was already in – inside her heart. She had told the Guardians that everyone would have to accept Stefan as her boyfriend of almost a year. We will write a custom essay sample on The Return: Midnight Chapter 43 or any similar topic only for you Order Now It didn’t matter. In a low voice she said, â€Å"Come in, Stefan.† â€Å"The window’s locked from your side, Elena.† Numbly, Elena unlocked the window. The next moment she was encompassed by warm, strong arms in a desperate, fervent embrace. But the moment after that, the arms dropped, leaving her frozen and lonely. â€Å"Stefan? What’s wrong?†Her eyes had adapted and by the starlight through the window she could see him hesitating before her. â€Å"I can’t – It isn’t – It’s not me you want,†he said in a rush that sounded as if it came through a constricted throat. â€Å"But I wanted you to know that – that Meredith and Matt are holding Bonnie. Comforting her, I mean. They’re al okay and so is Mrs. Flowers. And I thought that you – â€Å" â€Å"They put me to sleep! They said they wouldn’t put me to sleep!† â€Å"You fel asleep, lo – Elena. While we were waiting for them to send us home. We al watched over you: Bonnie, Sage, and I.†He was Stillspeaking in that formal, unusual tone. â€Å"But I thought – Well, that you might want to talk tonight, too. Before I – I left.†He put a finger up to stop his lip from shaking. â€Å"You swore you wouldn’t leave me!†Elena cried. â€Å"You promised, not for any reason, not for any length of time, no matter how noble the cause!† â€Å"But – Elena – that was before I understood†¦Ã¢â‚¬  â€Å"You Stilldon’t understand! Do you know – â€Å" His hand flew to cover her mouth and he put his lips to her ear. â€Å"Lo – Elena. We’re in your house. Your aunt – â€Å" Elena felt her eyes widen, although of course subconsciously she had known this al along. The air of familiarity. This bed – it was her bed, and the spread was her beloved gold and white bedspread. The obstacles she’d known how to avoid in the dark – the tapping at her window†¦she was home. Like a climber who has negotiated an impossible-seeming section of rock, and almost fal en, Elena felt a tremendous rush of adrenaline. And it was this – or, perhaps, simply the power of the love that flooded through her – that achieved what she had been so clumsily trying to reach. She felt her soul expand and come out of her body. And meet Stefan’s. She was appal ed by the hastily swept-away desolation in his spirit, and humbled by the surge of love that flooded every part of him at the touch of her mind. Oh, Stefan. Just – say that – that you can forgive me, that’s all. If you forgive me I can live. Maybe you can even be happy with me again – if you just give it a little time. I’m already happy with you. But we have all the time in the world, Stefan reassured her. But she caught the shadow of a dark thought whisked quickly out of the way. He had al the time in the world. She, however†¦ Elena had to choke back a laugh but then clutched at Stefan suddenly. My backpack – did they take it? Where is it? Right beside your nightstand. I can reach it. Do you want it? He reached in the darkness and pul ed up something heavy and rough and none too pleasant-smel ing. Elena thrust one frantic hand inside it while Stillholding on to Stefan with the other. Yes! Oh, Stefan, it’s here! He was beginning to suspect – but he only knew when she drew out the bottle labeled Evian Water and held it to her cheek. It was icy cold, although the night was mild and humid. And as it effervesced violently, it glowed in a way that no ordinary water did. I didn’t mean to do it, she told Stefan, suddenly worried that he might not like to associate with a thief. At least – not at first. Sage said to get the water from the Fountain of Eternal Youth and Life into bottles. I dug up a big bottle and this little one, and somehow I stashed the smaller one in my backpack – I’d’ve put the big one in, too, but it didn’t fit. And I didn’t even think about the little one again until after they took away my Wings and my telepathy. And a good thing, Stefan thought. If they had caught you – oh, my lovely love! His arms squeezed the breath from Elena’s lungs. So that’s why you were suddenly so eager to leave! â€Å"They took almost everything else supernatural about me,†Elena whispered, placing her lips close to Stefan’s ear. â€Å"I have to live with that, and if they’d given me a chance I’d have agreed – for the sake of Fel ‘s Church – if I’d been logical – â€Å"She broke off as she suddenly realized that she had been literal y out of her mind. She’d been worse than a thief. She’d tried to use a lethal attack on a group of – mostly – innocent people. And the worst thing was that a part of her knew that Damon would have understood her madness, while she wasn’t sure Stefan ever could. â€Å"But you don’t have to change me into – you know,†she began whispering frenetical y again. â€Å"A sip or two of this and I can be with you forever. Forever and – for – forever – Stefan – â€Å"She stopped, trying to get her breath and her mental balance. His hand closed over hers on the cap. â€Å"Elena.† â€Å"I’m not crying. It’s because I’m happy. Forever and ever, Stefan. We can be together, just†¦just us two†¦forever.† â€Å"Elena, love.†His hand kept hers from twisting open the bottle. â€Å"It – isn’t what you want?† With his other arm, Stefan pul ed her tightly to him. Her head fel forward onto his shoulder and he rested his chin on her hair. â€Å"It’s what I want more than anything. I’m†¦dazed, I guess. I have been ever since – â€Å"He stopped and tried again. â€Å"If we have al the time in the world, we have tomorrow,†he said in a voice muffled by hair. â€Å"And tomorrow is time enough for you to start to think it through. There’s enough in that bottle for maybe four or five people. You’re the one who’s going to have to decide who drinks it, love. But not tonight. Tonight is for†¦Ã¢â‚¬  With a sudden rush of joy Elena understood. â€Å"You’re talking about – Damon.†Amazing how difficult it was to simply say his name. It almost seemed a violation, and yet†¦ When he could talk – like this – for a moment to me, he told me what he wanted, she sent. Stefan stirred a little in the darkness, but said nothing. Stefan, he only asked for one thing before he†¦went. It was not to be forgotten. That’s all. And we’re the ones who remember the most. Us and Bonnie. Aloud she added, â€Å"I wil never forget him. And I wil never let anyone else who knew him forget him – for as long as I live.† She knew she’d spoken too loudly, but Stefan didn’t try to quiet her. He gave one quick shudder and then held her tightly again, his face buried in her hair. I remember, he sent to her, when Katherine asked him to join her – when we three were in Honoria Fell’s crypt. I remember what he said to her. Do you? Elena felt their souls intertwine as they both saw the scene through the other’s eyes. Of course, I remember too. Stefan sighed, half-laughing. I remember trying to take care of him later in Florence. He wouldn’t behave, wouldn’t even Influence the girls he fed on. Another sigh. I think he wanted to get caught at that point. He couldn’t even look me in the face and talk about you. I made Bonnie send for you. I made sure she got both of you out here, Elena told him. Her tears had begun to flow again, but slowly – gently. Her eyes were shut and she felt a faint smile come to her lips. Do you know – Stefan’s mental voice was startled, astonished – I remember something else! From when I was very young, maybe three or four years old. My father had a terrible temper, especially right after my mother died. And back then, when I was little, and my father was furious and drunk, Damon would deliberately get in between us. He’d say something obnoxious and – well, my father would end up beating him instead of me. I don’t know how I could have forgotten about that. I do, Elena thought, remembering how frightened she had been of Damon when he’d first turned human – even though he’d put himself in between her and the vampires who wanted to Discipline her in the Dark Dimension. He had a gift for knowing exactly what to say – how to look – what to do – to get under anyone’s skin. She could feel Stefan chuckle faintly, wryly. A gift, was it? Well, I certainly couldn’t do it, and I can manage most people, Elena replied softly. Not him, though. Never him. Stefan added, But he was almost always kinder to weak people than to strong ones. He always did have that soft spot for Bonnie†¦ He broke off, as if frightened he’d ventured too near something sacred. But Elena had her bearings now. She was glad, so glad, that in the end Damon had died to save Bonnie. Elena herself needed no more proof of his feelings about her. She would always love Damon, and she would never al ow anything to diminish that love. And, somehow, it seemed fitting that she and Stefan should sit in her old bedroom and speak of what they remembered of Damon in hushed tones. She planned on taking the same thing up with the others tomorrow. When she final y fel asleep in Stefan’s arms, it was hours after midnight. How to cite The Return: Midnight Chapter 43, Essay examples

Continuous Improvement Plan E-procurement System

Question: Discuss about the Continuous Improvement Planfor E-procurement System. Answer: Introduction The Continuous Improvement plan plays a crucial role in assisting the functions and features of the project development of the smart operations (Almgren 2014). The role of Continuous Improvement plan is to form the accurate development skills in the development of functions of the project. The Continuous Improvement plan helps in forming the improvement of the existing system development for the project and implication of the system development. The major role of developing the Continuous Improvement plan had been for providing assistance in increasing the efficiency of each of the activities of the project. The development of project would help in forming appropriate development model for the inclusion of the existing system development in the organization. The following essay is being developed for developing a model for implication of the system based modification and development. The case study that would be used for implementing the continuous improvement plan is of Museum Victoria. The Museum Victoria had realized the need of specific E-procurement system that would be deployed for forming the correct and appropriate development of system integration. The use of Continuous Improvement plan would help the development of E-procurement system for Museum Victoria and it would also develop effective development model for integrating the activities of the museums. Continuous Improvement Plan in Museum Victoria The Continuous Improvement plan is a 4 phase cycle that is helpful for developing the smart implementation of the system module and integration of the smart functionality (Barrutia et al. 2014). The Continuous Improvement plan is developed for integrating the activities of the project and developing some improvement strategies for them. The nonstop administration arranges assumes a vital part for the operations of the venture improvement of the keen operations. The part of nonstop administration plan is for framing the exact advancement abilities for the operations of the venture. The nonstop administration plan is useful for shaping the change of the current framework advancement for the venture and ramifications of the framework improvement (Bell et al. 2015). The diagrammatical representation of the four phases of Continuous Improvement plan has been given in the appendix at the last part of the report. The Continuous Improvement plan consists of four phases namely Strategic Focus, Assessment, Implementation, and Continuous Improvement. The nonstop administration plan is a 4 stage cycle that is useful for building up the savvy usage of the framework module and coordination of the brilliant usefulness (Doss et al. 2017). The constant administration plan is created for incorporating the exercises of the venture and building up some change systems for them. The real parts of building up the persistent administration arrange had been for giving help with expanding the effectiveness of each of the exercises of the venture. The advancement of venture would help in shaping suitable improvement display for the consideration of the current framework improvement in the association. According to Cox et al. (2016), these phases have been developed for implementing improved performance of the project and development of smart functions for the project. The four phases of the Continuous Improvemen t plan have been explained below, Identify: The identification of plan is developed for implementing the improved functionalities of the project and development of smart project operations (Hornstein 2015). The identification plan would help in integrating the activities of the project operations. The use of specific standards and project objectives would help in developing the activities of the project. The identification plan is developed for developing the procurement for the project activities. The vital concentration is created for executing the enhanced functionalities of the venture and advancement of shrewd venture operations. The key concentration is produced for coordinating the exercises of the venture operations. As opined by Pearson, Macaluso and Hussain (2015), the utilization of particular guidelines and venture destinations would help in building up the exercises of the venture. The vital concentration is created for building up the acquisition for the venture exercises. Plan: The planning in Continuous Improvement plan is developed for forming the appropriate actions and activities for implementing Continuous Improvement plan (Kansara et al. 2015). The planning of the project would help in developing the accurate system integration. The identification of plan, risk planning, and treatment to endangered objectives is the primary function of implementation of the system. The appraisal in consistent administration plan is created for shaping the proper activities and exercises for actualizing persistent administration arrange. The recognizable proof of the venture would help in building up the exact framework combination (Cerda et al. 2016). The recognizable proof of plan, hazard evaluation, and treatment to imperilled destinations is the essential capacity of usage of the framework. Execute: The execution would be developed for integrating the development factors for the improvement of system modification (Kaplan and Atkinson 2015). The plan of action would be developed to integrate the system model and system operations. The completion would help in forming the supportive execution to the project activities (Patout et al. 2016). The usage would be produced for coordinating the advancement variables for the change of framework alteration. The arrangement of activity would be produced for framing the precise advancement of framework coordination (Nasution 2016). The consummation would help in shaping the steady execution to the venture exercises. Review: The review operation arrangement comprises of four stages in particular Strategic Focus, Assessment, Implementation, and Continuous Improvement (Li, He and Wang 2016). These stages have been created for actualizing enhanced execution of the venture and advancement of shrewd capacities for the venture. The review operation plan is created for incorporating the exercises of the venture and building up some change systems for them. Wells et al. (2016) have stated that the real parts of building up the persistent administration arrange had been for giving help with expanding the effectiveness of each of the exercises of the venture. The Continuous Improvement plan is formed for integrating the activities of the project and developing some improvement strategies for them (Kerzner 2013). The nonstop administration arranges assumes a vital part for the operations of the venture improvement of the keen operations. The part of nonstop administration plan is for framing the exact advancement abilities for the operations of the venture. The strategic focus is developed for integrating the activities of the project operations. The use of specific standards and project objectives would help in developing the activities of the project. The strategic focus is developed for developing the procurement for the project activities (Wienhold et al. 2016). The assessment in Continuous Improvement plan is developed for forming the appropriate actions and activities for implementing Continuous Improvement plan. The identification of the project would help in developing the accurate system integration. The identification of plan, ri sk assessment, and treatment to endangered objectives is the primary function of implementation of the system (Maniak et al. 2014). The implementation is being done to form the integration of the development factors for the improvement of system modification. The plan of action is formed for forming the accurate development of system integration (Goetsch and Davis 2014). The completion would help in forming the supportive implementation to the project activities. These stages have been created for actualizing enhanced execution of the venture and advancement of shrewd capacities for the venture (Olsson and Spjelkavik 2014.). The constant administration plan is created for incorporating the exercises of the venture and building up some change systems for them. Procedural Documents for continuous plan: the procurement documents is used to formulate the analysis of the Continuous Improvement plan and some of them are, Procurement Document for Continuous Improvement Plan Project Name E-procurement system for Museum Victoria Requirement for Continuous Improvement Plan: The Continuous Improvement plan is developed for integrating the activities of the project and developing some improvement strategies for them. The nonstop administration arranges assumes a vital part for the operations of the venture improvement of the keen operations. The part of nonstop administration plan is for framing the exact advancement abilities for the operations of the venture. Business Case Review: The case study that would be used for developing the continuous improvement plan is of Museum Victoria. The Museum Victoria had realized the need of specific E-procurement system that would be deployed for forming the correct and appropriate development of system integration. The use of Continuous Improvement plan would help the development of E-procurement system for Museum Victoria and it would also develop effective development model for integrating the activities of the museums. Scope Update: The use of specific standards and project objectives would help in developing the activities of the project. The strategic focus is developed for developing the procurement for the project activities. Testing Review: The appraisal in consistent administration plan is created for shaping the proper activities and exercises for actualizing persistent administration arrange. Major milestone events: Implementation of the project Continuous Improvement plan Change control process: The plan of action would be developed to integrate the system model and system operations. The completion would help in forming the supportive implementation to the project activities. The usage would be produced for coordinating the advancement variables for the change of framework alteration. Risk Evaluation: The usage would be produced for coordinating the advancement variables for the change of framework alteration. The arrangement of activity would be produced for framing the precise advancement of framework coordination. Implementation Plan: The Continuous Improvement plan can be implemented by the use of the PDCA cycle (Emrouznejad and Thanassoulis 2013). The project for implementing E-procurement system is realized for forming the development of the system integrations within the operations of the Museum Victoria. The E-procurement system is formed with the prior motive of integrating the operations and implementation of the project operations. As opined by Kaplan and Atkinson (2015), it is important for developing the accurate system implementation and occupational improvement of the operations. The implementation plan consists of the following steps, Step 1: Plan The first step to implement the Continuous Improvement plan is to plan the development of the activities in the project of developing E-procurement system for the Museum Victoria. The planning would be done sufficiently for developing the accurate system operations. Step 2: DO The second step in implementing the Continuous Improvement plan is actually deploying the planned activities for the project of E-procurement system for the Museum Victoria. It would help in developing the specific development procedures for the system integrations. Step 3: Check The third step in implementing the Continuous Improvement plan is to monitor and check the activities implemented in the project of E-procurement system for the Museum Victoria. The checking would be done by peer reviews or analysis of the activities. Step 4: Act The fourth step of the cycle would form the deployment of some changes after reviewing the ongoing activities of the Continuous Improvement plan for the E-procurement system for the Museum Victoria. Conclusion The Continuous Improvement plan assumes a vital part for the operations of the venture advancement of the shrewd operations. The part of ceaseless administration plan is for framing the exact advancement abilities for the operations of the venture. The nonstop administration plan is useful for shaping the change of the current framework improvement for the venture and ramifications of the framework advancement for Continuous Improvement plan. The real part of building up the nonstop administration arranges had been for giving help with expanding the proficiency of each of the exercises of the venture. The improvement of venture would help in framing proper advancement show for the consideration of the current framework advancement in the association. The accompanying paper had been created for framing the precise improvement demonstrate for ramifications of the framework based change and advancement. The contextual analysis that would be utilized for building up the constant change plan is of Museum Victoria. The Museum Victoria had understood the need of particular E-acquirement framework that would be conveyed for shaping the right and suitable improvement of framework incorporation. The utilization of consistent administration plan would help the improvement of E-obtainment framework for Museum Victoria and it would likewise create viable advancement display for incorporating the exercises of the historical centres. References Almgren, K., 2014. Information technology project management processes and practices: A comprehensive study for successful implementation of IT projects.International Journal of Business and Social Science,5(11). Barrutia, J., Landeta, J., Araujo, A. and Hoyos, J., 2014. Information Problems and Company Behaviour visvis Continuous Improvement Training.Human Factors and Ergonomics in Manufacturing Service Industries,24(6), pp.712-724. Bell, K.J., Smart, C.E., Steil, G.M., Brand-Miller, J.C., King, B. and Wolpert, H.A., 2015. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era.Diabetes Care,38(6), pp.1008-1015. Cerda, J., Baldwin, I., Honore, P.M., Villa, G., Kellum, J.A. and Ronco, C., 2016. Role of technology for the management of AKI in critically ill patients: from adoptive technology to precision continuous renal replacement therapy.Blood Purification,42(3), pp.248-265. Christoph Albrecht, J. and Spang, K., 2014. Linking the benefits of project management maturity to project complexity: Insights from a multiple case study.International Journal of Managing Projects in Business,7(2), pp.285-301. Cox, D.J., Taylor, A.G., Moncrief, M., Diamond, A., Yancy, W.S., Hegde, S. and McCall, A.L., 2016. Continuous Glucose Monitoring in the Self-management of Type 2 Diabetes: A Paradigm Shift.Diabetes care,39(5), pp.e71-e73. Doss, D.A., McElreath, D., Henley, R., Goza, R., Lusk, G. and Gokaraju, B., 2017. PROCESS IMPROVEMENT AND TOTAL QUALITY MANAGEMENT FOR JUSTICE SYSTEM ORGANIZATIONS.CONGRATULATIONS!, p.34. Emrouznejad, A. and Thanassoulis, E., 2013. Introduction to performance improvement management software (PIM-DEA).Handbook of Research on Strategic Performance Management and Measurement Using Data Envelopment Analysis, p.256. Goetsch, D.L. and Davis, S.B., 2014.Quality management for organizational excellence. Upper Saddle River, NJ: pearson. Hornstein, H.A., 2015. The integration of project management and organizational change management is now a necessity.International Journal of Project Management,33(2), pp.291-298. Kansara, P., Jackson, K., Dressler, R., Weiner, H., Kerzner, R., Weintraub, W.S. and Doorey, A., 2015. Potential of missing life-threatening arrhythmias after limiting the use of cardiac telemetry.JAMA internal medicine,175(8), pp.1416-1418. Kaplan, R.S. and Atkinson, A.A., 2015.Advanced management accounting. PHI Learning. Kaplan, R.S. and Atkinson, A.A., 2015.Advanced management accounting. PHI Learning. Kerzner, H., 2013.Project management: a systems approach to planning, scheduling, and controlling. John Wiley Sons. Li, Z.Y., He, J.S. and Wang, M.J., 2016. Improving Internationally Core Competences Based on the Capabilities of Precise and Accurate Project Management.Frontiers of Engineering Management,3(3), pp.231-238. Maniak, R., Midler, C., Lenfle, S. and Pellec?Dairon, M.L., 2014. Value management for exploration projects.Project Management Journal,45(4), pp.55-66. Nasution, M.N., 2016. A Deming Cycle as a Tool of Improving A Continuous Service Quality.The Indonesian Management Accounting Research (IMAR),5(1), pp.53-78. Olsson, N.O. and Spjelkavik, I., 2014. Assumption surfacing and monitoring as a tool in project risk management.International Journal of Project Organisation and Management,6(1-2), pp.179-196. Patout, M., Mylott, L., Kent, R., Arbane, G., Murphy, P.B. and Hart, N., 2016. Trial of Portable Continuous Positive Airway Pressure for the Management of Tracheobronchomalacia.American journal of respiratory and critical care medicine,193(10), pp.e57-e57. Pearson, S., Macaluso, A. and Hussain, S., 2015. High intensity interval training vs moderate intensity continuous training in the management of metabolic type disease.MOJ Anatomy Physiology,1(5), pp.27-33. Rwelamila, P.M.D., Rwelamila, P.M.D., Purushottam, N. and Purushottam, N., 2016. Strategic project management as an innovative approach for sustainable green campus buildings in Africa: The need for a paradigm shift.Smart and Sustainable Built Environment,5(3), pp.261-271. Sharbatoghlie, A. and Sepehri, M., 2015. An Integrated Continuous Auditing Project Management Model (CAPM). In4th International Project Management Conference. Wells, G.H., Mason, L.D., Foreman, E. and Chambers, J., 2016. Continuous subcutaneous levetiracetam in the management of seizures at the end of life: a case report.Age and ageing,45(2), pp.321-322. Wienhold, B.J., Schmer, M.R., Jin, V.L., Varvel, G.E. and Gollany, H., 2016. CQESTR simulated changes in soil organic carbon under residue management practices in continuous corn systems.BioEnergy Research,9(1), pp.23-30.

History of Facebook Transformation

Documentación para entrevista de visa americana

Documentacià ³n para entrevista de visa americana Los documentos que se llevan a la entrevista al consulado americano pueden ser muy importantes para ayudar al oficial consular a decidir si aprueba o niega la visa. Adems, la documentacià ³n es fundamental a la hora de luchar contra una decisià ³n de negacià ³n de visa que se considera es errà ³nea. Por lo tanto, si ests en el proceso de solicitar una  visa de no inmigrante  por primera vez o intentas obtener una aprobacià ³n despuà ©s de un rechazo de una peticià ³n anterior, te conviene informarte sobre quà © documentos llevar a la  entrevista en la embajada americana. Tanto  los obligatorios como los recomendados. En este artà ­culo puedes informarte sobre cules son las razones ms comunes para  de que nieguen una visa no inmigrante, como por ejemplo, la de turista, estudiante, trabajo o intercambio. Esto es importante porque hay que saber con anterioridad dà ³nde pueden estar los problemas y presentar documentacià ³n para mostrar evidencia que ayude a subsanarlos. Adems, segà ºn  el paà ­s en el que se aplica, quà © documentos llevar, cules son los tres  tipos de contestaciones que puede dar el oficial consular y quà © hacer si la visa es denegada. Recordar que la entrevista para todas las visas no inmigrantes se solicita como parte del trmite de la visa que se pide al llenar el formulario DS-160, que marca el inicio del mismo.  ¿Van a aprobar mi solicitud de visa americana no inmigrante? Esa es la pregunta que muchos solicitantes se hacen. pero no hay una respuesta que se pueda dar con absoluta certeza. Cada caso es un mundo con peculiaridades propias ya que ninguna persona es igual a otra. Lo que sà ­ se sabe es que en algunos paà ­ses los porcentajes de negacià ³n de las visas son ms altos que en otros. Sin embargo,  esto no debe de tomarse como una invitacià ³n a solicitar visas en consulados americanos distintos a los del paà ­s en el que se reside habitualmente, ya que para esto existen reglas especiales y, adems, puede no ser conveniente. Adems, existen situaciones que complican la peticià ³n de visa no inmigrante. Por ejemplo, cuando se est esperando por una visa inmigrante, es decir, por una tarjeta de residencia, tambià ©n conocida como green card. Las estadà ­sticas nos dicen como son las cosas y nos sirven para estar informados sobre quà © esperar. El gobierno de los Estados Unidos publica cada aà ±o fiscal cuntas visas se solicitan y cuntas son negadas. Adems, en cuntos casos se obtuvo finalmente una aprobacià ³n, a pesar de haber sido negada en un principio. En el 2017, el à ºltimo sobre el que hay datos, las embajadas y consulados de Estados Unidos aprobaron en todo el mundo un total de 9.681.913 visas no inmigrantes. Adems, no aprobaron un total de 3.516.581. Las causas principales de negacià ³n de la visa fueron, por el siguiente orden, las siguientes: En primer lugar, el solicitante no prueba suficientemente que no tiene intencià ³n de quedarse en Estados Unidos. Es la causa que se conoce como 214(b). En el FY2017, un total de 2.624.543 visas no inmigrantes fueron rechazadas por esta causa. En segundo lugar, la aplicacià ³n no cumple con los requisitos que exige la ley que se conoce como INA. Las causas ms frecuentes son la falta de documentos o informacià ³n o la necesidad de que otra agencia del gobierno revise la solicitud. En FY2017, un total de 811.238 solicitudes fueron rechazados por esta causa, que se conoce tà ©cnicamente como 221(g). En tercer lugar, por mentir para obtener  un beneficio, por escrito o hablando, en lo que se conoce en inglà ©s como misrepresentation y tà ©cnicamente como la causa 212(a)(6)(C)(i). En el à ºltimo aà ±o fiscal, 18.114 visas no inmigrantes fueron rechazadas por esta causa. En cuarto lugar, haber estado previamente de forma ilegal en Estados Unidos por ms de 365 dà ­as un total de 15.924 personas vieron sus peticiones de visa rechazadas.. Es la causa de negacià ³n de visa que se conoce como 212(a)(9)(B)(i)(II). En este punto hay que tener en cuenta que aplica el castigo de los tres y de los diez aà ±os. Y en quinto lugar, haber permanecido en Estados Unidos despuà ©s de haber cometido una violacià ³n migratoria. Esta causa, que se conoce como 212(a)(9)(c), afectà ³ a 9.551 solicitantes. Es muy importante tener en cuenta que durante ese mismo periodo de tiempo, un total de 744.003 solicitudes que en un principio fueron negadas fueron finalmente aprobadas porque se puedo demostrar con evidencias documentales que no aplicaba la causa de negacià ³n o porque puedo solicitar un waiver, tambià ©n conocido como perdà ³n, y à ©ste fue aprobado. Por lo tanto es evidente la importancia de la documentacià ³n para obtener la aprobacià ³n de la visa y, en el caso de ser negada, poder probar que la negacià ³n no corresponde. Documentos obligatorios para llevar a la entrevista para la visa americana Alguna papelerà ­a es comà ºn a todo tipo de visas no inmigrantes, por ejemplo: 1. Hoja de confirmacià ³n de la cita. 2. Pasaporte vlido y en buen estado. La fecha de expiracià ³n no puede ser inmediata. Las embajadas americanas imponen diferentes reglas a cada paà ­s en cuanto a quà © pasaporte esa vlido. Por favor verificar particularmente en aquellos paà ­ses en los que en los à ºltimos aà ±os ha habido cambios de modelos de pasaporte o existen diferentes modelos vlidos al mismo tiempo. Tambià ©n ver las reglas segà ºn el documento tenga incorporado chip o no. 3. Prueba de haber pagado el arancel o cuota de la visa. Hay que saber que este dinero nunca se recupera. Ni en los casos en los que la visa es rechazada ni cuando el solicitante cambia de idea y decide no ir a la entrevista porque ya no le interesa viajar a los Estados Unidos. Adems, en  algunos paà ­ses, como en el caso de Mà ©xico, es necesario acudir a un Centro de Atencià ³n antes de la entrevista por tema de  las fotos  y las huellas digitales. Pero cada paà ­s sigue sus propias reglas. Pero adems hay que seguir las reglas especà ­ficas de cada visa. Esto es asà ­ para casos como las de estudiante, intercambio, trabajo temporero, etc. Dos clases de problemas que pueden dar lugar al rechazo de la peticià ³n de visa Llegados a este punto hay que diferenciar entre dos posibles situaciones. Primero, si lo que se quiere es probar que no hay razones para negar la visa por ser inelegible. Y el segundo, cuando hay un problema que convierte al solicitante en inadmisible y desea pedir un perdà ³n, tambià ©n conocido como waiver o permiso. En otras palabras, la visa no inmigrante puede ser denegada porque se considera a una persona extranjera como inelegible para el visado que solicita o por ser inadmisible para ingresar a Estados Unidos. Documentos para que el oficial consular no considere al solicitante como inelegible Aunque hay varias causas, la ms comà ºn por la que se niega una visa no inmigrante como la de turista o la de estudiante es porque el cà ³nsul tiene sospechas de que el solicitante se puede quedar en Estados Unidos ms tiempo del permitido. En este punto es muy importante entender que dentro de las visas no inmigrantes hay dos que son consideradas de doble intencià ³n, las L y las H-1B. Esto quiere decir las personas con este tipo de visados pueden buscar activamente la green card en Estados Unidos. En otras palabras, no es importante para ellos probar que su intencià ³n no es quedarse en USA. Pero para el resto de las visas no inmigrantes, como la de turista, estudiante, intercambio y otras de trabajo temporal la causa ms comà ºn por la que no son aprobadas es precisamente porque el solicitante no es capaz convencer al oficial consular que su intencià ³n no es emigrar a Estados Unidos. En otras palabras, debe  probar lazos familiares y/o fuertes en su paà ­s de residencia.  Para eso se utilizan documentos adicionales, por ejemplo: Certificado o partida de nacimiento, original o copia certificada.Certificados de matrimonio, divorcio, relaciones de hecho, viudedad.Libros de familia en el que consten los hijos.Prueba de empleo, de ser propietario o socio de una empresa.Documento que acredite el estatus de estudiante.Cuentas bancarias tipo corriente y de ahorro con extractos que demuestren los movimientos en los à ºltimos seis meses.Inversiones, ahorros, propiedades de todo tipo.Hipotecas o contratos de arrendamiento de vivienda.Pensiones o rentas. Y adems  cualquier otra documentacià ³n que el solicitante crea que puede ayudarle a probar al oficial consular que su intencià ³n no es quedarse en Estados Unidos. No obstante, tener en cuenta que la persona de la oficina consular que lleva a cabo la entrevista no est obligada a examinar la documentacià ³n presentada. Es muy recomendable llevarla ordenada. Adems, para el caso concreto de solicitud de una visa de turista, paseo o placer puede ser conveniente contar con una carta de invitacià ³n redactada por un ciudadano americano, un residente permanente legal u otra persona que se encuentre legalmente en Estados Unidos. Pero no es necesario. Consecuencias de mentir  o presentar documentos falsos en la solicitud de visa Como se ha indicado previamente en este artà ­culo, la tercera causa ms comà ºn por la que se deniega una peticià ³n de visa no inmigrante es por mentir o presentar documentos falsos lo que, tà ©cnicamente, es un fraude de ley. Pueden darse mà ºltiples casos, como presentar documentos falsos de identidad, propiedades, trabajo o estudios acadà ©micos. Pero el fraude de ley incluye situaciones en la que se falta a la verdad en las contestaciones de que dan en el formulario de solicitud de  visa, por ejemplo, asegurando que no se tiene familiares que son ciudadanos americanos cuando lo cierto es que sà ­ se tienen. Una vez que las autoridades consulares o las de control migratorio se dan cuenta de que existe o puede existir un fraude de ley las consecuencias son inmediatas y graves. Por ejemplo, automticamente deniegan la peticià ³n de visa o, si à ©sta ya sido ya aprobada, la cancelan.   Aunque en casos muy concretos es posible levantar el castigo despuà ©s de haber cometido un fraude de ley mediante la peticià ³n de un waiver y, asà ­, obtener una visa, lo cierto es que es uno de los perdones ms difà ­ciles de obtener.   Quà © sucede despuà ©s de la entrevista en el consulado Pueden darse tres situaciones: 1. La visa es aprobada. En este caso el pasaporte debidamente estampado se recibir a los pocos dà ­as. Si este es el caso, los turistas deben tener especial cuidado y evitar estos 8 errores que pueden provocar que le cancelen la visa.   2. La visa entra en fase de procedimiento administrativo. No ha sido aprobada pero tampoco rechazada. Es lo que conoce como 221g. 3. La visa es denegada. Si una visa de turista o de estudiante, etc es negada porque no se ha podido demostrar lazos fuertes con el paà ­s de residencia, antes de pedirla de nuevo es conveniente realizar cambios que puedan convencer al consulado para aprobar una nueva solicitud. Si todo sigue igual, la respuesta va a ser la misma. Es decir: no. Por el contrario, si las razones para la negacià ³n fueron otras causas, es aconsejable consultar con un abogado para estudiar si procede solicitar un waiver, tambià ©n conocido como perdà ³n o permiso especial. Si se solicita un waiver, es importante contar con el asesoramiento de un abogado migratorio con experiencia en este tipo de casos ya que son complejos y conviene saber diferenciar entre todos los posibles perdones y cà ³mo argumentar y apoyar con documentacià ³n la peticià ³n de dicho waiver. Infà ³rmate con este  test de respuestas mà ºltiples Toma este quiz, trivial o test sobre visas para asegurarte de que sabes lo fundamental para obtener y conservar el visado. Este artà ­culo no debe considerarse como asesorà ­a legal. Tiene simplemente un carcter informativo.

(FAR) Quality Assurance Research Paper Example | Topics and Well Written Essays - 750 words

(FAR) Quality Assurance - Research Paper Example An implied warranty automatically protects the government upon the sale of an item, unless it is overridden by a disclaimer. An implied warranty of merchantability ensures government purchases items of good (average or above) quality and fit for an ordinary purpose intended for, while an implied warranty of fitness protects the government against unsuitable services or products for a specific purpose, known to the recommending seller of the item. Keywords: Defective Products, Items, Contract, Warranty, Acquisition, FAR, Disclaimer, Liability, Cost Determining Criteria to invoke a Warranty in FAR Contracting officers of the government have a crucial role to play, especially in considering commercial practices in handling contracts between the government and contractors, for a smooth exchange of the commercial items or services. Considering the various defects or gross mistakes that may arise in the provision of the commercial products, even though warranties are not compulsory in thes e contracts, such challenges push for the need of the warranty in specific acquisitions. According to the FAR part (46) section (703), contracting officers assess the nature and use of the services or suppliers, trade practices, administration and enforcement, cost, and reduced requirements to determine the appropriateness of a warranty for an acquisition in a contract. Warranties are an extension of the standing relationship between the contractors and the government, but also extend the liability cost to one of the parties based on the matters that may arise from the contract. Similarly, warranties support inspection and acceptance practices in quality assurance of the contracts. When an analysis of the above factors is conducted and the need for a warranty in a specific acquisition found, then in the best interest of the government, a warranty clause can be used. The government acquires the warranty when it is cost effective. In any case, the government would want to reduce the b urden in maintenance, use or operation, and additional costs that may arise due to potential undetected defects. That is why such factors like difficulty in detecting a fault prior to acceptance, assessing potential harm to the government in case of a defect, complexity and function of a an item or service, end use, degree of development, and state of the art under FAR 46.703 part (a) have to be evaluated. The arising costs coming from the deferred liability on the contractor’s side and warranty enforcement of the government’s side, extended trade practice in the cost of a warranted item to the government, the ability of an assured administrative system to report on discrepancies, and reduced government quality assurance requirement would necessitate the government to include a warranty. Through the procedure, the government would ensure that the non conformance is covered in the warranty clause of the contract. Protection against Defective Services Express Warranties They frequently characterize the majority of the government contracts. Some can be complex, but are often specific to service contracts. These warranties can be oral or written, but for official purposes to the government, a written form is often common as a claim for its existence and avoiding chances of contractor’

The Value of SWOT in General and Regarding Planning Case Study

The Value of SWOT in General and Regarding Planning - Case Study Example SWOT is essential in the planning stage of any management or marketing implement because it defines the internal and external environment of which the plan will be based. The efficacy of a plan depends on the accuracy of the assessment of the environment of which it will be applied as defined in the SWOT. SWOT provides a reality check in the execution stage of any management or marketing implement. It fine tunes the execution as SWOT considers the new realities in the internal and external factor of the organization. a) The extent to which the foregoing listed strengths, weaknesses, opportunities and threats are generic, ie. insofar as product and service providers are concerned? SWOT can be generic in terms of the internal assessment (strength and weakness) in terms of assessing the competency of its people. It is usually expressed in general terms such as â€Å"we have very talented people to execute the task†. In the weakness aspect, factors such as ailing equipment that ca n no longer perform the task adequately are expressed in general terms. With regard to external factors, competition is typically expressed in general terms in the threat aspect of SWOT. Assessment of opportunity in SWOT can be expressed in general in terms of growth of companies if they will be successful in the identified market. b)What SWOT considerations would you delete, change categorically, or add, if you were in the sports shoe industry and wished to be known as a socially responsible producer? The threat factor would be removed in the SWOT in order to be known as a socially responsible producer of shoes. It is because the competition must be ruled out in the consciousness of the business that compels it to compromise social responsibility in exchange for competitiveness.

Annual report for Intercontinental Hotels Group plc for the year ended Essay

Annual report for Intercontinental Hotels Group plc for the year ended 31 December 2011 - Essay Example $ in mn Revenue and Profits 2011 2010 % Inc. Sales 1768 1628 8.60 Operating profit 559 444 25.90 Exceptional items 35 15 133.33 Total operating profit 594 459 29.41 Profit before exceptional items 497 382 30.10 Tax -120 -98 22.45 Profit from continuing operations 377 284 32.75 Exceptional items 83 7 1085.71 Net profit including exceptional items 460 291 58.08 Financial position Good will and other intangible assets 400 358 11.73 Other non-current assets 1990 1952 1.95 Total non-current assets 2390 2310 3.46 Current assets 578 466 24.03 Total assets 2968 2776 6.92 Total current liabilities 860 921 -6.62 Total non-current liabilities 1553 1564 -0.70 Total liabilities 2413 2485 -2.90 Shareholders’ funds 555 291 90.72 Total capital employed 2968 2776 6.92 No. of shares 289472651 Shares issued during the year 1075438 Total number of shares 290548089 289472651 Financial Ratios Earnings per share (EPS) Profit from continuing operations/ 1.30 0.98 Number of shares outstanding ROCE Net income/Capital employed 12.70% 10.23% Operating profit margin (Excl. exceptional items) Operating profit /Capital employed 31.62% 27.27% Operating profit margin (Incl. exceptional items) Total Operating profit /Capital employed 33.60% 28.19% Net profit margin after tax (Excl. exceptional items) Net profit after tax excl. excep. items/Capital employed 21.32% 17.44% Net profit margin after tax (Incl. excep. items) Net profit after tax incl. excep. items/Capital employed 26.02% 17.87% Asset turnover Total sales/Total assets 0.60 0.59 Current ratio Current assets/Current liabilities 0.67 0.51 Acid test ratio Quick assets/Current liabilities 0.64 0.49 Receivables collection period Debtors (Trade and other receivables) 369.00 371.00 Total debtors/Sales x 365 76.18 83.18 Payables payment period Creditors (Trade and other payables) 707.00 722.00 Total purchases or cost of sales 771.00 753.00 Creditors/Cost of sales x 365 334.70 349.97 Gearing Total debt/Total equity 4.35 8.54 Interest cove r Interest charges (Interest) 64.00 64.00 Earnings before interest and tax (EBIT)/Interest 5.89 4.44 Price earnings ratio Share price as on 31 December ?11.57 ?12.43 Share price / EPS 8.92 12.67 Dividend cover Dividend paid to shareholders 148 121 Dividend paid/Net income 2.55 2.35 Revenue per available room Revenue per available room is up by 6.2% Revenue per room has been calculated by the company by dividing the total room revenue by the number of room nights available. Analysis of the financial performance and position InterContinental Hotels Group is a global hotel company, operating seven highly-respected brands internationally. Total number of rooms operating under IHG brands is 658,348 (4,480 hotels). IHG’s portfolio of brands includes Inter Continental Hotels & Resorts, Crowne Plaza Hotels & Resorts, Hotel Indigo, The Holiday Inn, Staybridge Suites and Candlewood Suites. The performance of the management should be viewed in relation to the industry for the purpose of meaningful evaluation. The revenue per availab

Stages of Child Development and Strategies Involving Them

Stages of Child Development and Strategies Involving Them Introduction: In this assignment I will give a definition of social and emotional development while also explaining each individually. I will give a brief account of physical, cognitive, language and creative development and how they holistically combine for good overall development. I give an account of the social and emotional development of children form the ages 3-5. Then I will outline the different stages proposed by at least two theorists. I will give examples of strategies used to promote social and emotional development. To finish up I will make reference to the environmental, social and other factors that may affect such development and learning. Correct Definition of social and emotional development: Social-emotional development includes the childs experience, expression, and management of emotions and the ability to establish positive and rewarding relationships with others (Cohen and others 2005). It encompasses both intra- and interpersonal processes. In my opinion social and emotional development starts from birth and is given to the chid by the child’s parents or primary care giver. It is essential that the care given at this age is positive and loving as this early age is where we as adults leave the imprint on the child that stays with them for life. Emotional development directly links to the child’s intrapersonal skills by where they learn a lot about themselves like how they feel and then how they use or control their emotions within certain situations. By taking turns, having manners, being aware of their own emotions and feelings and having patience which all contributes to good emotional development. Social development directly links to a child’s interpersonal skills where children interact with other people in a good and mannerly way by always trying to understand other people’s point of view, by discussing problems and coming to some sort of compromise to solve problems. Children develop good social skills through understanding a situation and voicing their opinion rather than letting their emotions take over. Describe how the development area relates to the holistic development: Physical, cognitive, language and creative development all interlink and become increasingly interdependent in the first few years of life to give the child a good holistic development. If one development stage is weak it generally leads to the child struggling on the other areas of development to. Lev Vygotsky says â€Å"Thought and language become increasingly interdependent in the first few years of life† (prezi.com 2015) Physical development A child who has good social and emotional development will be a very outgoing child whose great at playing and will have great confidence to take part in all activities that arise and may even take on the role of the leader in certain activities. On the other hand a child who lacks in good social and emotional development will shy away from such activities and therefore may be left out of activities due to the lack of confidence. Cognitive development Good social and emotional development within a child allows them to have confidence to ask questions about situations they may not understand, in asking these questions they will get the attention and answers they need which helps them understand and store the information they more accurately to a child that has no confidence to ask questions and therefore these children won’t want to draw attention to themselves therefore leaving them lacking within the cognitive development area. Language development A child who has good social and emotional development will have good speech and will have no problem in interacting or conversing with other people and will be more accurate with the use of their vocabulary. If a child has speech issues they will lack in confidence causing them to shy away from vocally interacting with other people and may also cause them to be a target to bullying and isolation. Creative development A child with good social and emotional development will be very self-assured and confident leading them to having a great imagination and imagination is the key to a child’s creativity. This child will not be afraid to make suggestions or make up little role plays in their head .A child who lacks in creative development will be shy and may need encouragement to help them to be creative and will always rely on other people for direction. Stages of social and emotional development correctly described for a preschool chid: â€Å"Quality afterschool programs provide safe, engaging and fun learning experiences to help children and youth develop their social, emotional, physical, cultural and academic skills.† Debbie Stabenow 3 Years Old: At this age children have developed both emotional and social skills which allow them to be more happy and content as they now don’t need a familiar face to feel secure as they have gained a certain amount of control through their actions, thoughts and the use of language. They are more aware of the situations around them leading them to share and take turns and to also show affection. 4 Years Old: At this age children tend to question a lot of things like their own actions and the actions of others and are constantly asking how things work it’s like they suddenly become aware of their surroundings. They are capable of socially making friends and interacting with their friends in large groups. At this age they also learn feelings and emotions like being hurt, let down or by having a fear and by then in turn turning to a parent for comfort or reassurance. Also at this age children are normally very confident and have a lot of self-belief. 5 Years Old: At the age of 5 children tend to be very socially outgoing which leads them to loving time away from their parents through school or through being involved in social activities e.g: Hurling, football, dancing or drama. They love to play with their friends and even enjoy a bit of competiveness especially if they win, in which case they will show signs of being proud and even show signs of boasting. They are very much in tune with their feelings and now know the feeling of happiness, sadness and even have the sense of shame and hurt. Stages of social and emotional development proposed and supported by at least two theorists: Trust vs mistrust occurs from birth up to 2 years of age by where a child even at his young age acknowledges the type of care that they are given. If the child is well looked after and loved this gives them a sense of trust and where a child is neglected gives them a sense of mistrust as suggested by theorist Eirk Erikson who says â€Å"if a child feels successful trust, he or she will feel safe and secure in the world†.(child development booklet) Erik Erikson also believes if you mistrust from this early age it will stay with you in your later years causing it very hard for you to trust anyone due to your previous experiences. Relationships occur in children from the age of five upwards where children are now socially aware of their environment and can now socially interact with their peers. At this age they are constantly looking for approval from adults as well as their peers. Children form a very strong bond with their parents as suggested by theorist Sigmund Freud. Shame is a big factor in children’s development especially in their first big occasion where they have to do something for themselves. One example where children experience their first sense of shame is through potty training. If children have a bad experience through potty training Erik Erikson believes this stays with them throughout their life and therefore when they don’t achieve their goals in later years it brings them back to their early years of failure and that sense of shame. Four strategies to promote social and emotional development listed and explained: Taking turns and responsibilities by putting on a play while getting the children to come up with and choose the roles and responsibilities encourages them to interact and discuss with each other through the organising of these roles. This also encourages them to take turn and share out the responsibilities along with using the skill of dressing themselves and also gets them to use their imagination through the creative play. Teamwork and relationships by organising a sports day for the children encourages and teaches them the value of good healthy competition and how to control their emotions if they lose at a certain activity or on the other hand show pride in the achievement in winning. Through certain activities children learn to compete individually and also as part of a team allowing them to encourage each other and form good relationships with each other. Emotions and imagination using square cards or paper and draw feelings on faces e.g: happy face, sad face, etc. Then in turn get the children to pick up a card and act out the feeling on the card through facial expressions. This helps the children understand feelings, emotions and empathy through a fun game. Language and vocabulary by doing circle time and letting the children share a story with the group promotes their self-esteem and confidence to talk within a group. It also promotes the use of their language, vocabulary and even imagination through the telling of their story. Reference to environmental, social or other factors that may affect the learning and development of a child: Environmental: One environmental factor that may affect a child’s learning and development would be where a child grows up. E.G: If there is a stigma to the estate where a child raised by where it’s known as a disadvantaged or poor area this can lead child to feel they will never amount to anything due to the amount of negativity surrounding that area. On the other hand this type of negativity really spurs some children on to achieve the goals they want and gives them inspiration to do better for themselves and map out a better life for themselves and for their potential future children. Cultural Factors: One big culture that raises a lot of questions is the Jehovah Witnesses due to their beliefs they don’t celebrate a lot of big calendar days that most religions do e.g: Christmas, birthdays, etc. Therefore when these occasions arise it often leads to isolation of the child and this can have many negative effects on a child themselves through their own feelings of been left out and can also lead to other children socially out casting the child because if their beliefs. Social Factors: Family is one of the biggest contributing factors from the social view of learning and development within a child. For instance if you were raised within a big family who had a good sense of family spirit it is believed that you may be more confident as you would have been surrounded with lots of people from the start and these people will have cheered you on, helped you when you fall and thought you all of your traits that you will carry for a lifetime. Conclusion: In this assignment I have given a definition of social and emotional development, described the development areas and how they work on a holistic level. I have outlined the stages of social and emotional development from the ages of 3-5. Proposed stages supported by two theorists. I have given four examples of strategies used to promote social and emotional development and have made a reference to environmental, social or other factors that may affect such development and learning. Bibliography others, c. a., 2005. www.cde.ca.gov/sp/cd/re/itf09socemodev.asp. [Online] Available at: www.cde.ca.gov/sp/cd/re/itf09socemodev.asp [Accessed 24 june 2015]. toys, p. h., 2015. playhivetoys.com.au. [Online] Available at: http://www.playhivetoys.com.au/ [Accessed 30 06 2015]. toys, p. h., 2015. www.playhivetoys.com.au. [Online] Available at: http://www.playhivetoys.com.au/ [Accessed 30 june 2015]. Training, C., 2015. child developmetn booklet. In: s.l.:Creative Training . Prezi.com(2015)lev vygotsky, avalibale online to view at www.prezi.com on 02/07/2015 www.brainyquote.com

Loneliness and Acceptance Essay -- First Person Narrative Examples

   I feel uncomfortable in my own world. Being alone unnerves me. I always have felt the need to share my world, my mind and my feelings with somebody. My feelings about myself seem less important than what others think of me. I'm scared of being lonely. And so are we all. We all seem to be on a continuous search for someone who will really love and understand us. Someone to provide us with a purpose for life. And yet I think we are all essentially alone. We are alone in our thoughts an emotions. The first time I really felt alone was when I was leaving Kentucky. We were at the airport saying our last good-byes. I was leaving everything and everyone that I loved, understood, cared for, to come and study in the Bay area. I was leaving familiar territory and moving into an unknown, unfamiliar world. I was saying good-bye to people who I had either grown up with or those who had seen me grow up. All my memories and emotions were attached to them. They were people who I thought really knew me and understood me. Yet every one of them had their own impression of how I should feel. Excitement, joy, fear, and sadness being the most popular. However nobody really knew what I was feeling. I felt all these emotions blended into an unique emotion of my own. One that I could not share with even my best friend. When I expressed my fears and anxiety about leaving Kentucky, no one seemed to really listen to what I was saying. They kept saying it would be alright. I was mature and almost an adult and the Western world with its great material temptations wouldn't corrupt me. But in my mind I felt isolated. I wanted them to sit and feel my anguish with me. But they wanted to pacify me, console me as though I were a baby. At that time I fel... ...e or friendship. We are taught that we don't have an identity if we are alone. Which is why we treat loneliness as a disease, one to be avoided at any cost. Loneliness is viewed as an inadequacy of our personalities. Though all of us are taught to be independent, our independence is superficial. We can cook, clean, and do our laundry but we can't seem to take care of our emotions independently. We are taught that we need to share all our emotions. And I believe that however hard we search we can never get the kind of understanding that we are looking for. We are taught to be uncomfortable in our own world. Society conditions us to believe that we are inadequately equipped to be alone and content. And that alone always means lonely.    Works Cited Macdonald, Elizabeth. "Odalisque" Encounters (Edt. Pat C. Hoy, Robert DiYanni) The Mc.Graw-Hill Companies, Inc.

Arguments on Rules and Justice

In my opinion, Socrates† analysis of human nature is very true as it ultimately brings us his definition of justice. I agree with his theory of human nature but not his social-political theory. In order to understand Plato†s theory of human nature and his social-political theory, we must examine each one of them closely. Plato believed that no one is self-sufficient enough to live individually. Human beings are not created equally; some of us are born wiser then the rest and some of us are just born stronger. For this reason, only the select few (which would be the guardians) among us are supposed to now what is best for the society and therefore becomes the ruler of everyone else. Our reasoning, spirit, and natural wants are all part of human nature. In book 1 of The Republic, Plato had several detailed discussions on the nature of justice with other speakers in a dialogue form. The process of discussion involves Socrates† questioning, arguing against various inadequate theories that attempts to define the true meaning of justice. From the rich old man Cephalus, we learned that justice involves telling the truth and repaying one†s debts. However, Socrates points out that this definition of justice is inadequate because it cannot account for the instances of certain circumstances. The simple example of returning a borrowed weapon to an insane friend who demands the return of his weapon, would be an instance of following the rule but would not seem to be just. Then Polemarchus, Cephalus†s son attempts to define justice by proposing that justice means † one should pay what is owed†. Not returning or refusing to return the borrowed weapon would clearly benefit one†s friend. Socrates said that harming our nemies is only likely to make them even more unjust than they already are and cause them to make more unjust choices. After that, Thrasymachus came up with his own definition of justice which is nothing more than the advantage of the stronger; those in positions of power use law to decide what is right. The kind of justice practiced anywhere depends on the type of government they have in power. Socrates does not disagree with this view if the facts about the society are as Thrasymachus says they are, however, he argues that sometimes rulers make mistakes. In that case obedience to the law maybe leads to its own disadvantage, therefore Thrasymachus†s definition is also inadequate. Furthermore, Socrates says that the best ruler must always know how to rule. They should rule for the art of ruling, but not their own interest alone. Later, Glaucon suggests that human beings, given an opportunity to do injustice without being caught and therefore without suffering any punishment or loss of good reputation, would naturally choose a life of injustice, in order to maximize their own interests. Glaucons efinition of justice is that it†s an equal contract, an approach between what is the best (doing injustice without paying the penalty) and the worse (suffering injustice without being able to avenge one self). Adieamantus narrows the discussion further by pointing out that to have a good reputation of justice is more important than justice is itself, whether or not that person really does have a good reputation of justice. In an attempt to provide an adequate, satisfying definition of justice, Socrates tries to make an analogy between the justice of individual human beings and of an entire society or city. Since the crucial elements of justice may be easier to observe on the larger scale like a city than on a smaller scale like an individual. Socrates focuses on the perfect city, because the city will represent the human soul. Socrates began with a detailed analysis of the formation, structure, and organization of this ideal city. He argues that since individual human beings are not self-sufficient; no one working alone can acquire all of the necessities of life by themselves. In order to resolve this difficulty, we gather together into society for the mutual achievement of our common goals. If each of us specializes in the practice of a specific art, we can work more efficiently. To make this ideal city healthy (opposite of a feverish city), Socrates states that the fundamental needs of human beings in the society are food, shelter, and clothes. From these fundamental needs, some additional requirements emerge that become necessary only because these needs are a part of the defense of the city against external attacks or internal disputes. Socrates proposed an additional class of citizens, the guardians which are responsible for guarding the city and keeping the city in order. In order to fulfill their proper functions, the guardian then must have a philosophy that gives them the ability to distinguish the true and false, friend and foes, and to avoid turning against their own kind due to external influences. I think Socrates† social-political theory does follow his theory of human nature, he believed that an ideal state, embodying the highest and best capabilities of human social life, could really be achieved, if the right people are put in charge. Since the key to the success of the whole is the wisdom of the rulers who make decisions for the entire city, Plato held hat the perfect society would occur only when kings become philosophers or philosophers are made kings. Guardians would need the virtue of courage to carry out their orders in the face of danger without regard for personal risk. The rest of the people in the city must follow its leaders instead of pursuing their private interests. Plato held that guardians should own no private property, should live and eat together at government expense, and should earn no salary greater than necessary to supply their most basic needs. Under this regime, no one will have any corrupt motive for seeking a osition of leadership, and those who are chosen to be guardians will govern solely from a concern to seek the welfare of the state and what is best for all of its citizens. Education in the city is needed to promote the achievement of a proper balance of society. Physical training and musical performance along with basic intellectual development and the ability to get rid of human natural desire would be needed to fill this position as a guardian. On Plato's view, it is vital for a society to exercise strict control over the content of everything that children read, see, or hear. By excluding all the poets and actors, there will be only one stimulation allowed in the city which is education. The highest goal in all of education, he believed, is knowledge of the â€Å"Good†; that is, not merely an awareness of particular benefits and pleasures, but acquaintance with the actual form of â€Å"good† itself. Glaucon and Adeimantus pose some of the arguments against the kind of life style Socrates promotes. They question Guardians† happiness when they are separated from the general public. Socrates said that the happiness of the guardian must be put aside for the sake of the city. However, he points out, the guardian class should be the happiest group under such a system. Socrates† definition of justice is when each of these classes performs its own role appropriately and does not try to take over the function of any other class, Plato believed that the entire city as a whole will operate smoothly, exhibiting the harmony that is justice. Then, a human being is only properly said to be just when the three souls perform their proper functions in harmony with each other, working in agreement for the good of the person as a whole. In onclusion, it was found that the education of the guardians was necessary to keep the city running and with their education you must devote their lives to persue the common goals and good of the city. Once the individual and the other individuals in the society or city were working in complete harmony only then would the circle be complete and everything would run smoothly. However, in order to achieve this the guardian had to be trained right and raised accordingly. The people must cooperate. Everyone would reap the benefits from a perfect society.

High-Profile Men of the American Civil War essays

High-Profile Men of the American Civil War essays No issue dominates the history of early eighteenth and nineteenth century America like the problem of slavery. It is amazing that even today, over 130 years after the Civil War started, there is still passionate debate regarding the "cause" of the Civil War. The curious thing is that although slavery was the moral issue of the nineteenth century that divided the political leaders of the land, the average American had very little interest in slaves or slavery. Most Southerners were small farmers that could not afford slaves. Most Northerners were small farmers or tradesmen that had never even seen a slave. But political leaders on both sides were very interested in slaves and slavery. Leaders from the south argued that the Southern plantation was a benevolent and paternal institution, where Southern slave-owners generally behaved with fatherly concern toward their slaves (southern gentlemen). Political leaders from the north believed that slavery was a profit-oriented system, a capita listic institution that was flourishing, not dying at the time of the Civil War. They saw slavery as a systematic method of controlling and exploiting labor. Whatever the case, the reasons a nation goes to war are usually varied and complicated, and the American Civil War is no exception. This essay will attempt to depict the differing views on what truly caused the Civil War, whether it was slavery, economic circumstances, or political issues. The following persons support the theory that slavery was the cause of the Civil War: A historian who has a respected opinion about the Southern Slave Powers, Russell B. Nye believes that this southern mentality should not be underestimated. These Slave Powers were soon to become important in the North, where it helped to build up several anti-slavery settlements. Many abolitionists believed that the Slave Powers were simply exercised by a few southern slave owners and in no way compared to the other millions o...

The Meaning of the Surname Pierce

The Meaning of the Surname Pierce The Pierce surname was adapted from the given name Piers,  a derivation of Peter, which means rock, from the Old French pierre  (Latin petra), meaning stone or rock. The name most commonly derived as a surname  meaning son or descendant of Piers or Peter. However, it may also have been bestowed or chosen as a topographic name for someone who lived in a rocky area, or as an occupational name for a quarryman or stone mason.   Famous People with the Pierce Surname Franklin Pierce  - 14th president of the United StatesWendell Pierce -  American award-winning actorBarbara Pierce Bush  -  wife of George H.W. Bush, 41st president of the United StatesGeorge Washington Pierce - Harvard professor of physics;  inventorNat Pierce  - American jazz pianistMarvin Pierce - American publisher; president of McCall Corporation Where the Pierce  Surname Is Most Common According to surname distribution from Forebears, the Pierce surname is most common in the United States, where it ranks among the top 200 surnames in the country. It is also somewhat common in Wales (ranks 350th) and Ireland (581st). Within Ireland, Pierce is most commonly found in Wexford, Carlow and Kerry. WorldNames PublicProfiler indicates a similar distribution, with the greatest percentage of individuals named Pierce found throughout the United States. The name is especially common in the southeast, including Mississippi, Arkansas, Tennessee, Texas, Alabama, North Carolina and Georgia. Genealogy Resources for the Surname Pierce Pierce  Family Crest - Its Not What You Think: Contrary to what you may hear, there is no such thing as a Pierce  family crest or coat of arms for the Pierce surname.  Coats of arms are granted to individuals, not families, and may rightfully be used only by the uninterrupted male line descendants of the person to whom the coat of arms was originally granted. The Pierce  DNA Project - Southern US: Individuals with the Pierce  surname, and variants such as Pearce, Peirce, Pearse, Pierse, and Percy, with ancestors from southern U.S. states  are invited to participate in this group DNA project in an attempt to learn more about southern Pierce family origins. The website includes information on the project, the research done to date, and instructions on how to participate. PIERCE  Family Genealogy Forum: This free message board is focused on descendants of Pierce  ancestors around the world. FamilySearch - Pierce Genealogy: Explore over 4  million results from digitized  historical records and lineage-linked family trees related to the Pierce surname on this free website hosted by the Church of Jesus Christ of Latter-day Saints. Pierce Surname Mailing List: Free mailing list for researchers of the Pierce  surname and its variations includes subscription details and a searchable archives of past messages. DistantCousin.com - Pierce Genealogy Family History: Explore free databases and genealogy links for the last name Pierce. GeneaNet - Pierce  Records: GeneaNet includes archival records, family trees, and other resources for individuals with the Pierce  surname, with a concentration on records and families from France and other European countries. The Pierce  Genealogy and Family Tree Page: Browse genealogy records and links to genealogical and historical records for individuals with the Pierce  surname from the website of Genealogy Today. References: Surname Meanings Origins Cottle, Basil.  Penguin Dictionary of Surnames. Baltimore, MD: Penguin Books, 1967. Dorward, David.  Scottish Surnames. Collins Celtic (Pocket edition), 1998. Fucilla, Joseph.  Our Italian Surnames. Genealogical Publishing Company, 2003. Hanks, Patrick and Flavia Hodges.  A Dictionary of Surnames. Oxford University Press, 1989. Hanks, Patrick.  Dictionary of American Family Names. Oxford University Press, 2003. Reaney, P.H.  A Dictionary of English Surnames. Oxford University Press, 1997. Smith, Elsdon C.  American Surnames. Genealogical Publishing Company, 1997.

Discussion 4 Assignment Example | Topics and Well Written Essays - 250 words - 3

Discussion 4 - Assignment Example nexpected medical costs hence saving you from bankruptcy and deep debts when you have to pay for your medical bills from the pocket (HealthCare.gov n.d.). . They not only will save you from the high costs of meeting medical expenses but can also help protect your children from diseases, as obesity, which is in the recent past, has been a major issue in America. For, instance it is assumed that if parents accessed healthcare insurance for their kids, they would be able to take them for regular check-ups hence the issue of obesity would be outdated because doctors would be able to observe any trends in the kid’s weight. Either it is believed that if all Americans had access to health coverage, all communicable diseases would be wiped out of America. Therefore, it is evident that health coverage is imperative for all Americans. To solve the issues crippling the healthcare system, all Americans should have access to healthcare insurance coverage. Because nobody wants to get hurt or sick, all Americans hence need care when faced with medical complications. To save all Americans from unexpected medical costs, healthcare insurance coverage should be made accessible to all. Innocent kids of America can thus be safe if insurance coverage should be made

Corporate Parent Role Essay Example | Topics and Well Written Essays - 250 words

Corporate Parent Role - Essay Example In addition, if the both the corporate parent and the business units belong to the same industry or involve in the same business, then the effect of their interaction is likely to be more fruitful. This is because there is a transfer of ideas and skills from the corporate parent to the business units. Although the corporate parent role may help improve performance, this may also affect the businesses negatively. For instance, when the corporate parent attempts to improve performance through central functions, this may affect the decision making of the business units. A simple decision that could be made within the business units might have to take a longer period, thereby affecting business. In addition, if not well handled, the parent managers and the unit’s managers may be in constant conflicts. This is likely when corporate parent attempts the stand-alone influence where the managers of the corporate parent control the business units. In general, the success or failure of the corporate parent influence is determined by the nature of interaction with the business

Supply Chain Management Essay Example | Topics and Well Written Essays - 1500 words - 4

Supply Chain Management - Essay Example Extensive research shows that a considerable percentage of the overall budget of any given company emanates from the costs of flow of materials, and it is upon which companies are rated (Maloni & Brown, 2006, 68). This paper delves into SCM by centering on some of the underpinnings associated with it to ascertain its prominent features that are involved in the improvement of flow of materials from producers as raw materials to end user as finished products, and its involvement in the reduction of costs associated with supply chain. Integrated supply chain In such a situation of Lauritzen Bulkers, a suitable supply chain will be that which identifies vividly the important information systems as well as material flows, and should be aimed at meeting the needs of the customers. This is because a customer play a significant role in the supply chain, and it is upon the management team to ensure they are satisfied with the products and services. This is why any disruptions that may occur i n one mode of transportation may have an effect on the supply and demand for goods world over. This is, in addition to, the globalization that is deep rooted in today’s world, where technology has managed to bring products, services, and people so close that businesses are happening far and wide with transactions made online (Arnseth, 2010, 27 ). This means that an incorporated supply chain should be in force to cater for the big fleet of ship as well as the people involved, for this will ensure the working together of everyone involved towards an appealing proposition of mutual benefit to all the parties concerned. Therefore, it is the relatedness of supply chain progression that offers an enhanced potential that can be seized to achieve a competitive advantage. This is, in addition to, its importance in holding onto that promise of ensuing success. Lauritzen Bulkers Company has achieved this through employment of youthful employees who are at prime performance of their life . This translates to increased productivity in an industry whose success depends on the energy and the flexibility of employees. Moreover, purchases of new vessels that are aiding in the effective transportation with no delay are significant. Therefore, what the company needs on top of these energetic employees as well as new vessels is s good management team that should strive to make the best use of the accessible resources, for the betterment of the company. This should, thus be evident at all the supply chains to ensure that there is no break in the communication flow, which however small it may seem, is capable of disastrous end results. Information systems and management across the chains It is factual that management of logistics and technology come out as a success when costs related to logistic operations are controlled as well as an alarm for information technology whose success relies on selection, exploitation and incorporation (Arnseth, 2010, 25). Therefore, the informa tion systems available are capable of granting a company to decide on what the right supply chain strategy and the mode of transportation of goods. If faced with the same responsibility, I would opt for an efficient delivery system that is home delivery to ensure that the right products land into the rightful owners with certification. Road transport is fine for it is cheap, fast and reliable for it can be found

Tuberculosis Undergraduate Essay Example for Free

Tuberculosis Undergraduate Essay Abstract Tuberculosis is a good example of the importance of the ecological balance between host and parasite in infectious disease. Hosts are not usually aware of pathogens that invade the body and are defeated. If defenses fail, however, hosts become very much aware of the resulting disease. Several factors may affect host resistance levels—the presence of other illness and physiological and environmental factors such as malnutrition, overcrowding, and stress. Tuberculosis is most commonly acquired by inhaling the tubercle bacillus. Only very fine particles containing one to three bacilli reach the lungs, where they are usually phagocytized by a macrophage in the alveoli. The macrophages of a healthy individual usually destroy the bacilli. I. Introduction Tuberculosis is or TB is an infectious disease that usually affects the lungs. The most common form is caused by Mycobacterium tuberculosis, a slender, rod-like bacterium commonly called the tubercle bacillus. The tubercle bacillus is very hardy, surviving when many other bacteria cannot. In addition to affecting the lungs, tuberculosis can affect almost all other organs of the body. Tuberculosis, which in the past called phthisis and consumption, has afflicted man for thousands of years. Evidence of the disease has been found in Egyptian mummies. Tuberculosis was once a leading cause of death in all age groups, but its severity has decreased with improved medical care and better living standards. Most persons have a natural resistance to the tubercle bacillus. Even though large numbers of persons, especially in cities, become infected by the bacillus early in life, only a small percentage actually develops the disease (Orrett Shurland, 2001). This paper intent to: (1) know the occurrence of tuberculosis and how it is being spread; (2) be aware of its symptoms and detection and; (3) figure out its treatment and control. II. Background Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, a slender rod and an obligate aerobe. The rods grow slowly (20-hour generation time), sometimes form filaments and tend to grow in clumps. On the surface liquid media, their growth appears moldlike, which suggested the genus name Mycobacterium, from the Greek mykes, meaning fungus. These bacteria are relatively resistant to normal staining procedures. When stained by the ZiehlNeelson or Kinyoun technique that stains the cell with carbolfuchsin dye, they cannot be decolorized with a mixture of acid and alcohol and are therefore classified as acid-fast. This characteristic reflects the unusual composition of the cell wall, which contains large amounts of lipid materials (American Thoracic Society, 2000). These lipids might also be responsible for the resistance of mycobacteria to environmental stresses, such as drying. In fact, these bacteria can survive for weeks in dried sputum and are very resistant to chemical antimicrobials used as antiseptics and disinfectants. Tuberculosis is a good example of the importance of the ecological balance between host and parasite in infectious disease. Hosts are not usually aware of pathogens that invade the body and are defeated. If defenses fail, however, hosts become very much aware of the resulting disease. Several factors may affect host resistance levels—the presence of other illness and physiological and environmental factors such as malnutrition, overcrowding, and stress (Weiss, 2000). Tuberculosis is most commonly acquired by inhaling the tubercle bacilli reach the lungs, where they are usually phagocytized by a macrophage in the alveoli. The macrophages of a healthy individual usually destroy the bacilli. If they do not, the macrophages actually protect the microbe from the chemical and immunological defenses of the body, and many of the bacilli survive and multiply within the macrophage (American Thoracic Society, 2000). These macrophages eventually lyse, releasing an increased number of pathogens. The tubercle bacilli released from dying macrophages form a lesion. A hypersensitivity reaction against these organisms causes formation of a tubercle, which effectively walls off the pathogen. These small lumps are characteristics of tuberculosis and give the disease its name. Tubercles are composed of packed masses of tissue cells and the disintegration products of bacilli and leukytes; they usually have a necrotic center. Few bacteria are present in the tubercle (Diehl, 2003). The tubercle bacillus does not produce any injurious toxins. Tissue damage is mostly from the hypersensitivity reaction. As the reaction continues, the tubercle undergoes necrosis and eventually forms a caseous lesion that has a cheeselike consistency. If the caseous lesions heal, they become are called Ghon complexes. If the disease is not arrested at this point, the caseous lesions progress to liquefaction. An air-filled tuberculous cavity is formed from the caseous lesion. Conditions within the cavity favor the proliferation of the tubercle bacillus, which then grows for the first time extracellularly. Bacilli soon reach very large members, and eventually the lesion ruptures, releasing the microorganisms into the blood and lymphatic system (American Thoracic Society and Centers for Disease Control and Prevention, 2000). This condition of rapidly spreading infection that overwhelms the body’s remaining defenses is called miliary tuberculosis (the name is derived from the numerous millet seed-sized tubercles formed in the infected tissues). This condition leads to a progressive disease characterized by loss of weight, coughing (often with a show of blood), and general loss of vigor. (At one time, tuberculosis was commonly was known as consumption.) Even when patients are considered cured, tubercle bacilli often remain in the lung, and the disease may be reactivated. Reactivation may be precipitated by old age, poor nutrition, or immunosuppression. III. Discussion A. Occurrence and Spread When a person with tuberculosis coughs or sneezes, tiny droplets containing thousands of tubercle bacilli are sprayed into the air. The disease is spread when non-infected persons inhale the bacilli thus released into the air. A person can also contract tuberculosis by drinking unpasteurized milk from cows having the disease. This form of tuberculosis is caused by the bacterium Mycobacterium bovis. Resistance to tuberculosis depends largely upon the general health of the individual. Persons who are undernourished or weakened by disease are more likely to develop tuberculosis. Outbreaks tend to occur in areas with crowded living conditions, such as nursing homes and prisons (Centers for Disease Control and Prevention, 2003). About 90 percent of tuberculosis infections occur first in the lungs. Tuberculosis of the lungs is called pulmonary tuberculosis. When tubercle bacilli are inhaled into the lungs, they are either destroyed by white blood cells or surrounded by special cells and fibers in the infected area of the lung, forming tiny nodules called tubercles. If the immune system is effective, the bacteria are kept from multiplying and an active case of tuberculosis does not develop. In some cases, however, the bacteria enter the bloodstream or lymphatic system and are carried to other parts of the body. The bacteria usually lodge in the brain, kidneys, bones, or heart (Murray, 2000). B. Symptoms and Detection Early pulmonary tuberculosis commonly gives no specific warning. Later, fatigue, weight loss, or a low fever may be the only symptoms. In advanced stages, severe coughing, hoarseness, chest pain and the appearance of blood in the sputum (a mixture of saliva and discharges from the respiratory passages) can occur. If the patient is untreated and his resistance is low, large areas of lung tissue can be destroyed and there is considerable weight loss. The best way of detecting infection by tubercle bacilli is by means of a tuberculin test. In a tuberculin test, tuberculin—a liquid containing substance obtained from tubercle bacilli—is injected between the layers of the skin. After 48 to 72 hours, the point of injection is examined for redness and swelling (Centers for Disease Control and Prevention, 2003). A tuberculin test will reveal whether a person has been infected by tubercle bacilli, but it will not indicate whether he has an active case of the disease. Diagnosis of active tuberculosis can usually be made by a chest X ray and other tests. Diseased areas of the lungs usually cast a characteristic shadow on the X-ray film. Another method of diagnosis involves a microscopic examination of the patient’s sputum for the presence of tubercle bacilli (Centers for Disease Control and Prevention, 2003). C. Treatment and Control Prior to 1945, practically the only methods for treating tuberculosis were prolonged bed rest and (in advanced cases) immobilization of the infected lung by collapsing it. Since the time, drugs have been produced that can stop the tubercle bacilli from multiplying, thus allowing the natural defenses of the body to be effective. The most important of these drugs are streptomycin (INH). In addition, improved surgical techniques permit the safe removal of areas of the lung where infection persists despite treatment with drugs (American Thoracic Society, 2000). Most important in tuberculosis control is early detection, so that persons with the disease can be treated and isolated from others. A vaccine known as BCG can create immunity to tuberculosis. However, in the United States this vaccine is recommended only in special circumstances. One reason is that vaccinated persons react positively to a tuberculin test and therefore cannot be differential from infected persons. D. Planning and Goals The major goals for the patient include maintenance of a patient airway, increased knowledge about the disease and treatment regimen and adherence to the medication regimen, increased activity tolerance, and absence of complications. E. Nursing Interventions a.) Promoting Airway Clearance Copious secretions obstruct the airways in many patients with TB and interfere with adequate gas exchange. Increasing fluid intake promotes systematic hydration and serves as an effective expectorant. The nurse instructs the patient about correct positioning to facilitate airway drainage (Diehl, 2003). b.) Advocating Adherence to Treatment Regimen The multiple- medication regimen that a patient must follow can be quite complex. Understanding the medications, schedule, and side effects is important. The patient must understand that TB is a communicable disease and that taking medications is the most effective means of preventing transmission. The major reason treatment fails is that patients do not take their medications regularly and for the prescribed duration. The nurse carefully instructs the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene (Diehl, 2003). c.) Promoting Activity and Adequate Nutrition Patients with TB are often deliberated from a prolonged chronic illness and impaired nutritional status. The nurse plans a progressive activity schedule that focuses on increasing activity tolerance and muscle strength. Anorexia, weight loss, and malnutrition are common in patients with TB. The patient’s willingness to eat may be altered by fatigue from excessive coughing, sputum production, chest pain, generalized debilitated state, or cost, if the person has few resources. A nutritional plan that allows for small, frequent meals may be required. Liquid nutritional supplements may assist in meeting basic caloric requirements (Centers for Disease Control and Prevention, 2003). F. Monitoring and Managing Potential Complications a.) Malnutrition This may be a consequence of the patient’s lifestyle, lack of knowledge about adequate nutrition and its role in health maintenance, lack of resources, fatigue, or lack of appetite because of coughing and mucus production. To counter the effects of these factors, the nurse collaborates with dietitian, physician, social worker, family, and patient to identify strategies to ensure an adequate nutritional intake and availability of nutritious food. Identifying facilities that provide meals in the patient’s neighborhood may increase the likelihood that the patient with limited resources and energy will have access to a more nutritious intake (Centers for Disease Control and Prevention, 2003). High-calorie nutritional supplements may be suggested as a strategy for increasing dietary intake using food products normally found in the home. Purchasing food supplements may be beyond the patient’s budget, but a dietitian can help develop recipes to increase calorie intake despite minimal resources. IV. Conclusion In conclusion, persons infected with tuberculosis develop cell-mediated immunity against the bacterium. This form of immune response, rather than humoral immunity, is because the pathogen is located mostly within macrophages. This immunity, involving sensitized T cells, is the basis for the tuberculin skin test. In this test, a purified protein derivative (PPD) of the tuberculosis bacterium, derived by precipitation from broth cultures, is injected continuously. If the injected person has been infected with tuberculosis in the past, sensitized T cells react with these proteins and a delayed hypersensitivity reactions appears in about 48 hours. This reaction appears as an induration (hardening) and reddening of the area around the injection site. Probably the most accurate tuberculin test is the Mantoux test, in which dilutions of 0.1 ml of antigen are injected and the reacting area of the skin is measured. A number of similar tests are also in common use. A positive tuberculin test in the very young is a probable indication of an active case of tuberculosis. In older persons, it might indicate only hypersensitivity resulting from a previous infection or vaccination, not a current active case. Nonetheless, it is an indication that further examination is needed, such as a chest X-ray for the detection of lung lesions and attempts to isolate the bacterium. References: 1. American Thoracic Society (2000). Diagnostic standards and classification of tuberculosis in adults and children. American Journal of Respiratory and Critical Care Medicine, 161 (4), 1376-1395. 2. American Thoracic Society and Centers for Disease Control and Prevention (2000). Targeted tuberculin testing and treatment of latent infection. American Journal of respiratory and Critical Care Medicine, 161 (4), S221-S247. 3. Centers for Disease Control and Prevention (2003). Essential components of a tuberculosis prevention and control program: recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Modibity and Mortality Weekly Report, 44 (RR-11), 1-16. 4. Diehl, H. S. (2003). The Health of College Students. American Council on Education. Washington, DC. 5. Murray, J. F. (2000). Intensive Care: A Doctors Journal. University of California Press. Berkeley, CA. 6. Orrett, Fitzroy A. Shurland, Simone M. (2001).Knowledge and Awareness of Tuberculosis among Pre-University Students in Trinidad Journal of Community Health, Vol. 26. 7. Weiss, R. â€Å"TB troubles.† Science News 133:92-93, 2000. Discusses reasons for the recent increase in tuberculosis in the United States.