The Man Who Was Almost A Man

Richard Wright’s â€Å"The Man Who Was Almost a Man† is a story of a 17-year-old teenaged boy, Dave, who wanted to be called a completely grown up man.He was though approaching adulthood but still was an adolescent and he was viewed as an adolescent and a kid by the adults. This was the most annoying factor for him. However, Dave possessed certain qualities that really represented childish behavior in him. Because of his childish attitude many people won’t believe in him as a grown up mature man.The story themes are centered on racial differences, poverty and sufferings of a black youth. He’s disgusted at being still too young. He wants to get old and rich and wanted to become a respectable citizen of the society. However, whatever actions the emotional and anxious kid takes are ridiculed and makes him younger in adult’s eyes. David Glover was from a poor family with not enough resources to develop a social status. He lacked economical influence and his social status was negligible because of poverty.In the story he acted in a way to acquire power but was rebuked and threatened by the adults for behaving childishly. He takes the gun to make and think of himself more powerful. â€Å"It was empty if anybody could shoot a gun, he could. He put the gun into his hip pocket and started across the fields. When he reached the top of a ridge he stood straight and proud in the moonlight, looking at Jim Hawkins’ big white house, feeling the gun sagging in his pocket.† (Wright)â€Å"  Ã¢â‚¬ËœWhut yuh do wid tha gun?’ his mother asked.†Ã¢â‚¬Å"’What wuz he doin wida gun?’ his father asked.†He was obsessed with the feelings of adulthood. He finally decides to get apart from a society that does not accept him as an adult. Dave is portrayed as an emotional kid who wants power, fame and high social status. He strives that the society should accept him as a noble man.â€Å"Dave turned and walked slowly. He heard people laughing. Dave glared~ his eyes welling with tears. Hot anger bubbled in him. Then he swallowed and stumbled on.† (Wright) Though people used to laugh on him he was still very serious regarding his actions and to be a man.†That night Dave did not sleep. He was glad that he had gotten out of killing the mule so easily, but he was hurt.† (Wright)He’s a kind of emotional, childish and lacked an understanding that why was he not accepted as a man.Richard Wright himself as a black narrates the difficulties he encounters as a black person while dealing with whites. He encountered whites during is professional career at jobs. He noticed violence and discrimination against blacks.Wright is a deliberate man who struggles through his life years. Other characters in the stories are also vibrant and well-drawn but Wright is shown as the most powerful and influential of all. As we go through the complete book we get more familiar with his charact er and how he’s being hurt. His pain is that why such dishonesty persist in this world.Most of the black characters are usually ridiculed for any of their set backs or made the point of humor. They’re shown as fat and whatever they do as funny. American culture is filled up with racial discrimination from school, education, and business to film, media, screen and shows. Color has become an integral part of our society and we don’t have much to talk about if we would no discriminate between colors and whites as inferiors and supers respectively.   

Different Opinions About Elearning Education Essay

Peoples have different sentiments about vitamin E acquisition. Some people think that e-learning is advanced and it reduces the clip and distance barriers of instruction while the other group thinks that e-learning leads to feelings of isolation and defeats ( Handzic & A ; Ho-hur, 2005 ) . â€Å" E-learning can be defined as utilizing web engineerings to make, foster, deliver and facilitate acquisition, anytime and anyplace † ( Liaw, 2008 cited in Duan et.al. , 2010 ) . Due to globalization corporations have to cover with more complex and unsure state of affairss today. To last and win in this environment the administrations have to maintain up with the gait and have to be more advanced and efficient ( Handzic & A ; Ho-hur, 2005 ) . It is of import to maintain the employees up-to-date non merely in the engineering but besides with the deductions which use the engineering and output for more efficient and effectual working ( Newton & A ; Doonga, 2007 ) . Corporate e-learning can be done in the signifier of e-training. Newton ( 2007 ) & A ; Doonga ( 2007 ) define Entraining as ‘an environment in which preparation or direction in a scope of accomplishments or techniques can be developed utilizing computing machine engineering ‘ . The intent of this paper is to place the benefits & A ; restrictions of corporate e-learning to administrations. Corporate E-learning is the hereafter of the concern universe. Corporate want to salvage more and more costs by holding more corporate e-learning instead than directing their employees to different locations for acquiring the needed preparation.A Literature reappraisal & A ; Secondary Data:The literature reappraisal will discourse the assorted advantages and restrict ions of e-learning. The literature reviewed considers both qualitative and quantitative analysis in their research. The intent of the literature reappraisal is to happen spreads in the survey that has been conducted on e-learning. This includes benefits, restrictions and intent of e-learning. Following are the benefits of e-learning: 1. Technological alterations increase the speed of work environment: A â€Å" Technology has changed the manner people live, work, believe, and learn † ( Urdan & A ; Weggen 2000 ) . The work force of today has to be on their toes to acquire a contract, to accomplish marks and all the challenges that come their manner. They have to understand a batch of information in a short span of clip. The rate at which new merchandises and services are introduced in the market is excess ordinary. â€Å" As production rhythms and life spans of merchandises continue to shorten, information and preparation rapidly become disused † ( Urdan & A ; Weggen 2000 ) . The preparation directors have to present the services more expeditiously and rapidly. Training directors feel the urgency to present cognition and accomplishments more quickly and expeditiously whenever and wheresoever needed. In the age of just-in-time production, just-in-time preparation becomes a critical component to organisational success ( Urdan & A ; Weggen 2000 ) . 2. Cost Savingss: Strother mentioning Newton & A ; Doonga ( 2007 ) assesses the â€Å" effectivity of e-learning in corporate preparation plans and gives some really impressive illustrations of i ¬?nancial benei ¬?ts of corporate e-learning. She quotes that IBM ‘s reported economy of $ 200 million in 1999 through transition of their preparation bringing methods to e-learning, Ernst and Young ‘s decrease of preparation costs by 35 % gained by replacing 80 % of schoolroom direction by utilizing e-training and Rockwell Collins decrease of developing outgo of 40 % by change overing 25 % of their traditional direction to e-training † ( Newton & A ; Doonga, 2007 ) . Corporate e-learning besides saves on the traveling of the trainers which can be used as optimal usage of their skills.A 3. Accessibility & A ; Flexibility of bringing: Schriver & A ; Giles 1999 prove that one of the benefits of e-learning us the handiness and flexibleness of bringing. It is cheaper to present the undertakings through decreased chance costs and decreased clip off from work. It besides helps to make the wider constituencies, besides to the most distant areas.A A 4. Globalization of concern is ensuing in multiplex challenges: Progresss in information engineering and falling trade barriers facilitate concern around the Earth. As boundary lines become less meaningful, planetary competition intensifies. International enlargement has led to larger and more complex corporations. Today ‘s concerns have more locations in different clip zones and employ larger Numberss of workers with diverse cultural backgrounds and educational degrees than of all time. Therefore, more information has to be delivered in progressively larger organisations, disputing internal planning, logistics, and distribution. Corporations worldwide are now seeking more advanced and efficient ways to present developing to their geographically-dispersed work force ( Urdan & A ; Weggen 2000 ) .A 5. Trainees learn at their ain gait: The trainees can take their ain clip in understanding the construct and do n't hold to hotfoot. E-learning besides helps them to hold the preparation stuff in their pant whenever required. Besides it can be referred whenever needed ( Elliot & A ; Clayton, 2007 ) .A Community edifice and Interactivity ( Handzic & A ; Ho-Hur, 2005 ) : E-learning aid in community edifice and increases a batch of interactivity between the trainer and the trainee between different parts of the universe. hypertext transfer protocol: //docs.google.com/a/kgsjain.com/File? id=dhcphsf9_1fzqchrkk_b Beginning: Urdan & A ; Weggen ( 2000 ) The above pie chart shows the instruction and developing market in the US in the twelvemonth 2000. A research was conducted in province of online acquisition in U.S. higher instruction. The survey was aimed at replying some of the cardinal inquiries about the nature and extent of on-line instruction based on responses from more than 2,500 colleges and universities. The below graph indicates the growing of pupils taking at least one on-line class. Exhibit 2: Addition in on-line registration signifier 2002 to 2006 Beginning: CIPD ( 2010 ) Pollss of 110 people were conducted and were asked different inquiries associating to e-learning. The undermentioned pie charts show that what people felt about the advancement of e-learning in UK. Exhibit 3 Exhibit 4 Exhibit 5 Exhibit 6 Exhibit 7 Beginning: Allen & A ; Seaman ( 2007 ) Exhibit 4,5,6 & A ; 7 represent the per centum of replies the replies provided by the users in respects the statements on the advancement of e-learning in UK organisations.. Restrictions of e-learning: â€Å" E-learning restrictions can be categorized as technological restrictions, personal issues and design restrictions † ( Wong, 2007 ) . Technological restrictions: Wong 2007 believes that for e-learning you need to hold a computing machine or a laptop to hold entree to e-learning. Rumble ( 2000 ) cited in Wong ( 2007 ) says that e-learning comes with benefits such as limitless entree 24 hours, 7 yearss a hebdomad, this privilege does non look to be executable for some people in rural countries due to the inability to entree Internet services. The Internet incursion rate in Malaysia is merely 31.8 % ( Phang, 2004 cited in Wong, 2007 ) . Good cyberspace velocities are the basic demand and these are merely available in few topographic points and non in all. Bose 2003 cited in Wong 2007 mentioned that, while it is executable to entree to high-speed bandwidth within the university campus, it becomes a job outside the campus, where Internet installations are less sophisticated.AHandzic & A ; Ho-hur ( 2007 ) say that a batch of research workers think that e-learning lead to feelings of isolation, defeat, anxiousness and confusion.A Personal issues ( Wong 2007 ) : Lack of personal technological accomplishments can be an issue in e-learning. The new people coming and fall ining e-learning might experience clueless as they do n't hold a instructor to steer them. A Elearners have to be techno understanding. Hamid ( 2002 ) cited in Wong ( 2007 ) stated that proficient accomplishments could do defeat to e-learning pupils due to the unconventional e-learning environment and isolation from others. Dringus ( 200 ) cited in Macpherson et Al. ( 2004 ) agrees Hamid stating that e-learners may be unable to prolong their impulse unless they have right accomplishments and they are self motivated. Design Restrictions: Poor design of the e-learning courseware is a major issue for scholars and e-learning suppliers Ivergard & A ; Hunt ( 2005 ) cited in Wong ( 2007 ) . The design should be easy to understand so that the scholar has the motive to larn. Courseware design should be tailored to the demands of the scholars: it should be easy to utilize and pupils should hold easy entree to guidance and information ( Howell, Williams & A ; Lindsay 2003 ; James-Gordon, Young & A ; Bal, 2003 cited in Wong 2007 ) . The undermentioned illustration explains how China adopted E-learning with the aid of 5 influential factors ( Duan et al. , 2010 ) . Figure I A the above figure explain the structural theoretical account cardinal theoretical accounts explicating factors of e-learning. A Another illustration of corporate e-learning is taken up by Japan. The Japan e-learning market reached 1350 billion hankerings in 2004, an addition of 41.3 % from 2003 ( Schnack, 2005 ) . Traditional acquisition: Traditional acquisition is sitting in the category physically and taking lessons. The traditional schoolroom puting adds value in footings of direction lucidity. Traditional acquisition is available about every portion of the universe where instruction is available. Students and the instructors are comfy with the schoolroom environment as they have been ever used to it. Teaching in this environment is more informal ( Chen & A ; Jones, 2007 ) . Traditional schoolroom learning gives an chance to the pupils to inquire self-generated inquiries in the category. The instructor can reply to the questions of the pupil ‘s right in the category. Traditional larning gives chance to pupils to interact with other pupils and have unrecorded treatments on subjects and have different sentiments on one construct. Interaction between pupils is an of import portion of single development. Teachers use state of affairss to explicate constructs to pupils which give them a pattern to believe on the t opographic point and come up with solutions in a speedy clip ( Lunce, 2006 ) . Surveies on e-learning have identified tonss of benefits like cost nest eggs, flexibleness and handiness of bringing and community edifice and interactivity ( Newton & A ; Doonga ) . Besides there is extended research on the restrictions of e-learning. The biggest difference between the two acquisition is the bringing methods so it is really of import to make a proper research in this affair to happen the differences. Important end of this survey was to be able to do meaningful comparings between two bringing methods ( Chen & A ; Jones, 2007 ) . Concept map: Untitleddrawing.jpgMind the spread:Surveies on e-learning have identified a batch of benefits and restrictions. There is non a batch of research done on the difference between traditional room larning andA e-learning. This research will give us an thought about what do people prefers? Though there are many benefits proven but it ‘s the people who will be utilizing e-learning in twenty-four hours to twenty-four hours life, so it is really of import to take their sentiment intoA consideration. In other words we will seek to happen the user friendly of e-learning in the sentiment of the people utilizing this. This research will besides give an thought to the people be aftering to take up e-learning in future. This research should be able to warrant the benefits and restrictions of e-learning in comparing to the traditional schoolroom acquisition. Research inquiry: What do people prefer, e-learning or traditional schoolroom acquisition and why?Research Design:Methods, Methodology & A ; Data Collection: Methods are the techniques that are used to roll up and analyze the information. Methodology determines whether the execution of peculiar methods is successful or non ( Veal. The method that can be used for this will be quantitative & A ; qualitative methods. The qualitative methods will assist garnering information in deepness and will be more subjective. The quantitative research will be more nonsubjective and will be analysed more statistically. Qualitative methods Samples / Focus groups: Peoples from different administrations who use e-learning, a sample will be from administration which does non utilize e-learning, a group of pupils who use acquisition and the last group who does non. Concentrate groups can be made and asked about the benefits of e-learning and traditional acquisition. This argument will give a good cognition about the ideas of people about both the constructs. The findings from the focal point groups will assist us to fix the questionnaire for the in depth interviews. Different questionnaires will be used for different groups. As the demographics of each group will be different the inquiries have to be prepared maintaining the intent of the research in head. Questions asked to the administrations utilizing e-learning will be largely based on the benefits, restrictions and the betterments to be made in e-learning, while on the other side the non user group will be educated first about e-learning and so asked whether they will be acute to travel to e-learning. The inquiries will be based on workplace e-learning. Same technique of two different questionnaire used for two groups will be used for the pupil groups but with different set of inquiries which will be more based on e-learning school instruction. In-depth interviews: The questionnaire made with the aid of the findings of the focal point groups will be explanatory. In-depth interviews will give an penetration of the thought of people sing these constructs. The in depth interviews inquiries will be connected to each other. Quantitative methods: Surveies: Surveies will be conducted in general to acquire statistics of the figure of people interested in e-learning or traditional acquisition. The questionnaire of the study will be a mix of unfastened ended and near complete inquiries. The inquiries in this study will be more general to acquire the Numberss merely, like how many people are interested in e-learning and how many in traditional schoolroom acquisition. Datas Analysis: Data Analysis will be divided into 3 different phases: Data Decrease: The irrelevant informations will be discarded and merely the information which is necessary and related to the research subject will be kept. Datas Display: The informations will be displayed with the aid of graphs and tabular arraies as ocular graphs can give a better apprehension of the informations. Decision: The findings and the of import material of the research will be entered in the signifier of a study. These decisions are stored so that they be used for future researches every bit good.Decision:As seen through the assorted diaries and beginnings related to e-learning, it is rather obvious that the narrative is instead double. There are surveies conducted to prove the worthiness of e-journal, whether people prefer to utilize this method, but as indicated earlier, there is n't much research on comparing the traditional schoolroom method of learning with the alleged hereafter of learning – e-learning. Where corporate are required to supply cognition through interdisciplinary countries of the organisation, e-learning tends to be a cost-saving method of cognition scattering. Though this might be true, there are a batch of people who prefer human interaction, instead the traditional method of larning. Based on this, I decided that future research can be conducted to happe n out what types of industries, entities or any such constitution, therefore an increased figure of studies throughout the workspace spectrum are highly of import to happen out the penchants of people in different parts of the Earth.

Managing and Reducing Cardiovascular Risk in Type 2 Diabetes Mellitus Essay

Diabetes mellitus is a metabolic disorder in which the body’s capacity to make use of glucose, fat and protein is disturbed due to insulin deficiency or insulin resistance. It is a hormone secreted from pancreas that helps glucose from food to enter the body’s cells where it is transformed into energy required by muscles and tissues to function. Diabetes is caused either because the pancreas does not secrete adequate insulin, or because cells do not react to the insulin that is produced. Due to this reason, an individual with diabetes does not take up glucose appropriately and glucose continues circulating in the blood (hyperglycaemia) harming tissues over time. This damage leads to acute health complications. The classic symptoms of diabetes mellitus are, Polyuria ,Polydipsia ,Polyphagia ,lethargy and weight loss. There are many causes for high blood glucose levels in the body and so a number of types of diabetes exist. Diabetes mellitus occur throughout the world. Based on the study conducted by IDF, the number of diabetics on earth stands at 365 million nearly 8. 5% of the global population. It is more widespread in the more developed countries. The greatest raise in incidence is, however, expected to happen in Africa and Asia, where majority of the diabetes patients will most likely be found by 2030. Diabetes mellitus is categorised into four broad groups: Type 1, Type 2, Gestational diabetes & â€Å"other specific types†. Scientists in US have found a Type 3 diabetes, it is still continuing further study. Type 1 diabetes is absolute insulin deficiency usually affects children and young adults. Type 2 Diabetes is an insidious progressive disease that is often diagnosed late when complication are present. Dunning (2004) described it as a long term complication with neuropathy, cardiovascular disease and retinopathy. It is a universal metabolic disorder affecting more than 2 million people in the United Kingdom and up to 750,000 more are expected to have it without knowing they do. Studies conducted show that 80% of population affected by diabetes live in developing and underdeveloped countries and the majority of people with diabetes is between 40 to 59 years of age. It is also estimated that 183 million people (50%) with diabetes are undiagnosed. It is noticed that Diabetes caused 4. million deaths in 2011 and caused sharp increase in medical expenditure. I am a staff nurse working in the cardiac ward and we often receive patients with cardiac problems as a long term complication of type 2 diabetes. Cardiovascular disease is a major cause of hospital admission and mortality in people with diabetes. Most of them are not diagnosed until they are admitted. During the course of this study the medical history and care and treatment provided to a patient named Mr M Davies who was admitted in my ward is chosen to learn about managing and reducing cardiovascular disease among patients with type 2 diabetes. In 1998 UKPDS pointed out the importance of reducing lipids blood pressure and blood Glucose to reduce the risk of cardiovascular disease. Hypertension leads to thicker, less elastic blood vessel walls and increase the strain on the heart. Studies indicated that there is a linear correlation between the diastolic blood pressure and the eventual outcome of type 2 diabetes. Standl & Schnell (2000) pointed out that as a result of ischemia-induced remodelling subtle changes occur in the heart and the effects of hyperglycaemia on the endothelium of large blood vessels that causes heart to failure. Mr M Davies (Mr.  MD) is a 61-year-old pensioner with a 4 years history of type 2 diabetes. He was diagnosed in 2008 and he had symptoms of hyperglycaemia for 2 years before diagnosis. His fasting blood glucose records indicated values of 6–7 mmol/L, which were explained to him as symptomatic of â€Å"borderline diabetes. † During the preliminary diagnosis, he was advised to reduce weight (â€Å"at least 10 lb. †), but no further action was taken. Other medical problems include obesity and hypertension. He was admitted in the ward with recurrent chest pain. (Appendix 1) This assignment is about managing and reducing cardiovascular risk in type 2 diabetes mellitus. Heart disease is well acknowledged as a chronic problem of diabetes, and is the major reason of morbidity and mortality in patients from middle-age onwards. Type 2 diabetes is associated at the onset with risk factors for heart disease such as hypertension and obesity, raising the question of whether diabetes is the independent risk factor for heart disease. In 2001 Morrish et al pointed out that the majority of cardiovascular deaths are specifically due to heart disease and this is supported by Fisher, Miles, (2008) commenting that heart disease is the major cause of morbidity and mortality at young as well as older ages. Butler (1997) said that increased life expectancy has led to an increase in the number of people over 65 years of in both the developed and developing worlds. Marso (2003) pointed out that due to the clear association between age and the development diabetes, this increase in the number of older individuals in the population will inevitably contribute to the increased prevalence of diabetes. Watkins (2008) mentioned that Type 2 diabetes is a disease of relative prosperity, prosperity leads to overweight and physical indolence. Insulin resistance, increasing with obesity, associated with progressive failure of insulin secretion in relation to ageing underlies the development of diabetes. It is anticipated that by 2025 the number of people with type 2 diabetes will be around 380 million and people with impaired glucose tolerance will be around 418 million. Diabetes is the foremost global cause of premature mortality that is broadly underestimated, because only a few among the diabetic patients die from reasons uniquely related to the condition. Nearly one half of type 2 diabetes patients die prematurely of a cardiovascular reason and approximately 10% die of renal failure. Diabetes is a condition that required to be managed every day. The management of Diabetes can refer to dealing with short term measures like high and low blood sugar to regulating it over the long term for instance by attaining to grips with knowing the condition. All patients with Type 2 diabetes require active dietary management throughout their disease. Watkins (2008) pointed out that weight loss in the obese is extremely valuable but is separate from dietary manipulations to control blood glucose. Treatment typically includes diet control, exercise, monitoring blood sugar at home, and in some cases, oral medication and/or taking insulin. Based on the type diabetes medicines are classified into different groups and each category of diabetes pills functions differently. Commonly used medicines to control diabetes are Sulfonylureas, Thiazolidinediones, Biguanides, Alpha-glucosidase inhibitors, Meglitinides and, Dipeptidyl peptidase IV. Sulfonylureas reduce blood sugar by stimulating the pancreas to produce more insulin. Sulfonylureas medicines like Glimeperide, Gliclazide,. Biguanides improve insulin’s capacity to transfer sugar into cells particularly into the muscle cells. They also stop the liver from releasing stored sugar. Biguanides are not advised to be used in people who have heart failure or kidney damage. Biguanides medicines such as Metformin. Thiazolidinediones like Pioglitazone and Rosiglitazone enhances effectiveness of insulin in muscle and in fat tissue. Alpha-glucosidase inhibitors, such as Precose (acarbose) and Glyset (miglitol) prevent enzymes that help digest starches, reducing the rise in blood sugar. These medicines may cause diarrhea or gas. They can decrease hemoglobin A1c by 0. 5%-1%. Meglitinides, like Prandin (repaglinide) and Starlix (nateglinide) reduces blood sugar level by stimulating the pancreas to secreate more insulin. Dipeptidyl peptidase IV (DPP-IV) inhibitors, such as Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) lowers blood sugar level in patients with type 2 diabetes by accelerating insulin secretion from the pancreas and lowering sugar production. The case history of Mr. MD indicated that he was advised to manage blood sugar level by diet control and regular exercise. It was also advised to take metformin 1000mg twice a day when diet and exercise are not enough to manage blood sugar level. The history showed that Mr. MD was non-compliance with any of these. On admission his random blood sugar was 20 mmol/L. As he was unable to tolerate oral intake due to nausea and chest pain, GKI was commenced for a day to control his blood sugar. On second day his blood sugar level was controlled and he started eating and drinking normally. Mr MD was referred to diabetic specialist nurse and dietician . Diabetic specialist nurse advised to stop GKI and advised to start OHA. Mr. MD commenced on metformin 1000mg three times a day (Learning outcome 1). Metformin has long been accepted as a appropriate first-line choice of oral medicine for Type 2 diabetes as it is the only oral hypoglycaemic agent related with no weight gain or even weight reduction. They decrease hepatic gluconeogenesis, boost peripheral glucose uptake and also lower the absorption of carbohydrate from the gut lumen. Because metformin functions on insulin sensitivity and with only endogenous glucose stimulated insulin secretion, it virtually never causes hypoglycaemia on its own and patients using it with diet and exercise do not need routinely to self-monitor blood glucose. The UK Prospective Diabetes Study (UKPDS, 2002) demonstrated a significant survival advantage for Type 2 patients started on metformin as first-line therapy, with less cardiovascular mortality, although it should be noted that they only used the drug in obese patients. Obesity is a worldwide problem. Barnett (2009) pointed out that obesity and overweight are independent risk factors for cardiovascular morbidity and mortality. Various studies reveal that obesity is a major cardiovascular disease risk factor across world’s populations. Risk of morbidity and mortality begins to increase at body mass index (BMI) >25 kg/m 2 and the risk raises sharply at BMI >30 kg/m 2. Each kilogram of weight put on from the age of 18 years was linked with 3. 1% higher risk of cardiovascular disease. In 1998 Gunnell observed that over weight in adolescence is a forecaster of these dangers in adulthood . These finding were supported by Must in 1992,who explained that this increased risk extends to overweight children and adolescents, who may be at risk of premature cardiovascular morbidity and death. The mechanism by which obesity causes increased cardiovascular morbidity and mortality is attributed to associated co-morbidities and risk factors such as hypertension, dyslipidaemia, type 2 diabetes and insulin resistance. The co-occurrence of some or all of these risk factors along with obesity is termed the cardiometabolic syndrome. On examination it was noticed that Mr.  MD has a high BMI (30. 9). West (2007). Suggested that addressing obesity is an essential aspect of managing diabetes, because type2 diabetes and many other health problems coexist. However it is important to consider the individual’s specific nutritional needs rather than just providing them with a ‘weight loss plan,’ ‘diabetic diet,’ a ‘standard meal plan or information about healthy eating. ’ Mr. MD was referred to the dietician. Dietician gave dietary advice and educated about importance of weight management by diet and regular exercise. He was advised to avoid take-away foods, reduce alcohol consumption and taking balanced food to prevent hypo and hyper glycaemia (Learning outcome 1).. Hypertension-Prevention & Management is very important in the management of metabolic diseases. In 1985 Modan et al pointed out that there is a strong relationship between high blood pressure and insulin resistance. This findings is supported by Reaven, (1999) . He said that the prevalence of insulin resistance in hypertension has been estimated at 50%. Scheen, (2004) proposed several possible mechanisms for this. Coutinho et al. (1999) said that impaired fasting blood glucose is related with high cardiovascular risk particularly if accompanied by hypertension. Henry et al. , (2002) said that in people with diabetes, cardiovascular disease risk is increased two to fourfold compared with those with normal glucose tolerance. This was supported by the study conducted by Heffner et al. , (1998) who said that diabetic people without past history of myocardial infarction may have as high a risk of myocardial infarction as non-diabetic patients with a history of previous myocardial infarction. Non-pharmacological interventions are cheap than pharmacological interventions and have no known dangerous effects. A range of lifestyle changes reduce blood pressure and the occurrence of hypertension. Non-pharmacological interventions such as weight loss in the overweight, exercise programmes, limiting alcohol intake and a diet with increased fruit and vegetables and limited saturated fat content, minimising dietary sodium consumption and increased dietary potassium intake. From the medical history of Mr MD it is noticed that he was taking Ramipril 5 mg/day and bisoprolol2. mg/daily. It is established that where non-pharmacological interventions are not enough to achieve the objectives then Pharmacological interventions are required. Several drug treatments are of proven value in minimising cardiovascular risk in people with diabetes and hypertension. Low-dose aspirin is suggested in diabetes whether or not there is evidence of large vessel disease. Williams et al. , (2004) noticed that the British Hypertension Society recommends 75 mg of aspirin for all with hypertension and diabetes, unless contraindicated. Antihypertensive therapy diminishes the risk of macrovascular complications by around 20%. Reducing blood pressure reduces progression of retinopathy, albuminuria and progression to nephropathy. Staessen et al. , (1997) observed that clinical trials with ACE inhibitors, beta-blockers, diuretics, angiotensin receptor blockers and calcium channel blockers have demonstrated benefit of treatment of hypertension in type 2 diabetes (Learning outcome 1).. On admission blood pressure level of Mr MD was very high. He was recommended treatment with antihypertensive drugs. Consultant prescribed Losartan 100 mg/day and increased ACE inhibitor (ramipril 10 mg/day) and beta-blocker (bisoprolol 5 mg/dayl). Studies show that treatment with ramipril in addition to standard therapy minimised combined myocardial infarction, stroke and cardiovascular death by about 25% and stroke by 33% compared with placebo plus conventional methods. This was supported by Sowers and Haffner, (2002) saying that almost all patients with hypertension and diabetes require combinations of blood pressure reducing drugs to attain the recommended blood pressure targets. During the treatment Mr. MD was advised non-pharmacological methods of blood pressure management and importance of diet control and referred to cardiac rehabilitation for regular exercise. Management of high cholesterol plays an important role in the management of diabetes. Lipid abnormalities are common in type 2 diabetes and can be broadly categorized into two groups: those that are common to the general population, for example elevated total and LDL cholesterol; and additional diabetes-related abnormalities, for example elevated triglycerides and reduced HDL cholesterol. Current US and European guidelines emphasize reducing LDL-C level to less than 100 mg/dL (2. 59 mmol/L). To reduce the cholesterol Mr. MD was undergone intensive lipid-lowering treatment with atorvastatin 80 mg/day. Dietary therapy was also a part of the treatment which was found effective to lower Lipids. Interventions to stabilize lipids in order to decrease the risk of CVD are warranted in people with type 2 diabetes. Both Fibrates and Statins improve lipid profiles in people with diabetes. Many studies have established the safety and effectiveness of the fibrates (gemfibrozil, bezofibrate, fenofibrate) in diabetes. Fibrates stimulate the peroxisome proliferator-activated receptor-a, changing the expression of a number of enzymes that regulate lipid metabolism, including lipoprotein lipase. Statins inhibit hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase, which is rate restrictive in cholesterol production. Another major strategy in the management diabetes is lifestyle interventions. Lifestyle interventions can progress lipid levels. Studies conducted on weight loss and lipids in type 2 diabetes have varied greatly as to the study diet, design and duration. A Meta-analysis of 89 studies and 1800 subjects with type 2 diabetes reported that a weight loss of 5% or greater reduced triglyceride levels by 10 ±40% and total cholesterol by 5 ±15%. These effects were greatest with very low-calorie diets, and the effects were seen in studies up to 6 months. A variety of diets can alter the lipid profile in people with type 2 diabetes. The organisation of diabetes care is very important in the long term management of diabetes care. Diabetes is the significant disease confronting the United Kingdom’s (UK) health care system. As a result, understanding how best to manage diabetes facilities is an important area if the health system is going to deal with the growth in both the demand for and cost of diabetes treatment. Care should be planed at reducing symptoms and minimizing the danger of long-term problems. It is pointed out that a proper balance of glucose and other cardiovascular risk factors such as smoking, hypertension, inactive lifestyle, dyslipidaemia and obesity is very crucial (UKPDS, 2002) in the organisation care of diabetes.

Leadership Is the Capacity to Translate Vision into Reality Essay

Leadership Is the Capacity to Translate Vision into Reality - Essay Example From this study it is clear that  many researchers had contributed in explaining the concept of leadership, certainly, applying differing perspectives, which makes it difficult to be defined in a comprehensive and all-inclusive manner using specific wordings. However based on the accumulation of the statement and researches conducted by theorists, leaders fundamentally imply to the capacity of persons to make a vision turn into reality in the accomplishment of a determined goal, which ideally requires a collaborative effort of many. This requires the leader to be a motivator, organiser and an implementer as well as a monitor of the entire process to ensure the overall success in accomplishing the set target. It has been due to this reason that the contemporary organisation has been heavily found inclining towards the demand of leaders.This paper highlights that  the concept of leadership signifies the power to release and engage individuals for or from any responsibility. Corresp ondingly, the quote indicates that leadership always performs within a framework of purpose, mission, and vision and shared values, being directed by a common cause. In addition, the characteristic of effective leaders can be identified as seeking others interest and challenging their limits to conquer the envisioned goal.  It is always not necessary for the leaders to create the vision, but the presence of vision must be there in the organisation and it must be shared among others who bind themselves in a common cause.... Correspondingly, the quote indicates that leadership always performs within a framework of purpose, mission, and vision and shared values, being directed by a common cause. In addition, the characteristic of effective leaders can be identified as seeking others interest and challenging their limits to conquer the envisioned goal. It is always not necessary for the leaders to create the vision, but the presence of vision must be there in the organisation and it must be shared among others who bind themselves in a common cause (Moore & Diamond, â€Å"Academic Leadership† 2). Conceptually, leaders are referred to individuals who are assigned with the responsibility of seeking that operations are coordinated and managed efficiently. Leaders are also responsible for motivating employees/subordinates to perform their activities in accordance with the mission and vision of the organisation, towards the achievement of the common goal (Avolio, Sosik, Dong and Yair, â€Å"Leadership Mo dels, Methods, and Applications†). In this context, it can be inferred that leaders need higher levels of skills to maintain the hierarchy of huge bureaucratic organizations as commonly witnessed in the modern day context. Hence, it can be argued that effective leaders are distinguishable on the basis of their hard work, intelligence, ambitions and political skills to deal with the emerging challenges and manage the resources well (Hogan & Kaiser, â€Å"What We Know about Leadership†). MEANING OF THE QUOTE Apparently, the quote given by Warren G. Bennis, â€Å"Leadership is the capacity to translate vision into reality†, signifies the importance of leaders in the formulation and completion of strategic tasks in the

Personnel Resourcing & Development Assignment Example | Topics and Well Written Essays - 1750 words

Personnel Resourcing & Development - Assignment Example This would help the company take into account the various aspects of the external environment that can impact the organization (Kay, 2010, p.23). In any organization human resources are the most valuable assets for any organization and the success of an organization is heavily dependent upon the management of these vital resources of the organization. The key components of Human Recourse Planning include the following: Proper planning of these vital aspects can help any firm take advantage of the opportunities and generate competitive advantage. In case of Advanced Technical Resourcing the proprieties would be to bring in a change management that would involve a change in all of the above elements so as to make it a preferred organization for prospective employees. Resourcing is one of the most crucial steps in the human resource management of an organization. Resourcing includes employee hiring as well as fitting an employee into the overall organization by ensuring a job fit that involves a matching of a person’s abilities with the requirements of an organization. In case of Advanced Technical Resourcing discussed in the case it is important to have specialised persons as otherwise it would result in employee dissatisfaction that could impact the overall productivity of the organization. Finding a good job matching is very critical to the success of the organization (Taylor, 2005, p.5-6). In order to induce motivation employees must be motivated about their jobs so that they view their tasks as responsibilities and not just activities. In order to do this it is necessary for business organizations to ensure career development as well as a reward mechanism to rightfully reward the deserving employees. In case of Advanced Technical Resourcing regard there should be a fair appraisal of the employees strictly based on performance. In the context of the

Monetary Policy, Fiscal Policy, Business Cycles, and Economic Growth Assignment

Monetary Policy, Fiscal Policy, Business Cycles, and Economic Growth - Assignment Example Owners of multinational companies in Malawi will receive reduced dividends. Some multinational corporations’ employees in Malawi will either be laid-off or receive lower salaries (Hansen, 2013). 6.b). If the president of Malawi imposes a mandatory minimum wage of $5.00 per hour, workers in multinational companies will receive better pay. Consequently, the level of poverty will reduce in the country. Multinational corporations will incur more cost especially salary expenses. Due to higher costs profits for the companies will reduce thus shareholders will receive lower dividends. Multinational corporations might lessen the number of employees to reduce the salaries expenses they incur (Hansen, 2013). 7. Western states like the United States and United Kingdom resort to deficit spending by borrowing money to stimulate economic growth or recovery in times of economic recessions. The main disadvantage with deficit spending is that it leads to interest rates. High-interest rates reduce the ability to borrow. High-interest rates discourage entrepreneurs to invest. Consequently, low investment rates mean that the production capacity of a country is reduced the general output of the country decreases hence. Reduction in the output of a country reduces the rate of economic growth in a country. Deficit spending means that the government spends more than the private sector. States tend to utilize resources inefficiently. So these actions might lead to wasted resources. Deficit spending and increased borrowing increases an economy’s inflation rate. Increasing inflation rate reduces the value of a currency and adversely affects its competitiveness with other currencies. Inflation wi ll also lessen the amount of savings (Hansen, 2013). 8. Listening to Laurence Kotlikoff of Boston University, I was interested in the argument he brought forward regarding the government’s concealment of its debt obligations. Kotlikoff pointed out that United

World war 2 through the 1970's Research Paper Example | Topics and Well Written Essays - 1250 words

World war 2 through the 1970's - Research Paper Example There were several turning points in America through the 1970s. These were the points of time when a significant change occurred. They were also moments of decision. At this time, there were many changes taking place around the world. Millions were dead, and the United States had become a super power (Finkelman, 2005). A sweeping historical turning point during the Second World War through the 1970s was the Watergate scandal. This political scandal took place in 1972, in the United States. There was a break in at the Democratic National Committee headquarters in Washington DC at the Watergate office complex. At the time, Richard Nixon was the president and his administration attempted to cover up its involvement in the break in. During the investigation into the scandal, many things got found out. It became discovered that president Nixon was taping all the conversations in the white House. It was this tapes that when later they got handed over government investigators implicated the president to have got involved in the cover up. Money that also got found on the burglars got connected to a slush fund used by fundraising group for the re-election of the president. Nixon’s vice president Agnew also admitted to tax evasion. The scandal was a crucial turning point because it led Americans to have key mistrust within their leaders and thus begin to question their leadership skills. It had a vital political impact on politics because political leaders and everyone else are fully aware that no one is above the law. This is because this scandal led to the resignation of a United States president. In America today, there is closer examination of the procedures of the executive office by the public. It served as a civic lesson to the public. People began to pay keen attention to their leaders and started to question leaders in local and state offices. This scandal also asserted the judiciary’s power to bring justice and equality of opportunity. Another key historical turning point that occurred during the World War II through the 1970s was the civil rights movement. This was a worldwide political movement for equality before the law. It took place between 1950 and 1980 (Finkelman, 2005). It took the form of civil resistance and campaigns aimed at bringing change. In some places, it became accompanied by armed rebellion and civil unrest. In America, the social rights movements aimed at outlawing racial discrimination and restoring voting rights to blacks. These movements not only gave equality to African American’s but also women. This had a significant impact on America today as it eventually led to the first black president and women in politics are reaching for the glass ceiling. This movement in America ensured that today certain groups of people got allowed to hold the basic rights that are guaranteed in the constitution. African Americans and women have an equal opportunity to be wealthy and lead a good life. No oneâ€⠄¢s rights get limited by law in America today as previously was the case. This movement ensured that today there is equality of rights and opportunities in America (Finkelman, 2005). America in the late 1930s wanted to stay out of the European conflict that became the World War II. This was because World War I had ended just 15 years earlier, and it was still a fresh wound to many Americans. World War I killed people, cost money, damaged property and affected everyone who encountered it. Most of them believed that the lives lost in World War I were so many and it was not worth it. A majority of American population was opposed to any policy that could involve the United States in another bloody conflict. In the years after the world war I Americans had reached the conclusion that it had been a disastrous mistake to

A current event in healthcare Assignment Example | Topics and Well Written Essays - 500 words

A current event in healthcare - Assignment Example 1990 carbon levels by 2020, due to the fact that the greenhouse emissions from the state’s woodlands was underestimated during the formulation of this target. The bill which was formulated in 2006 to have the state reduce its carbon emissions to 1990 levels by 2020 had previously assumed that no net carbon emissions would come from the wild lands (Gonzalez, Battles, Collins, Robards & Saah, 2015). Achieving the balance between the storage of carbon and its emissions to the atmosphere is normally a difficult challenge. This is because, through growing vegetation, carbon is removed from the atmosphere. This in turn serves to reduce any incidence of climate change naturally. On the other hand, burned or dead and decaying vegetation releases carbon to the atmosphere. This in turn increases the incidence of climate change (University of California, 2015). Therefore, the fact that the wild lands will always have decaying vegetation at any one particular time means that incidences of carbon emissions from the wild lands shall continue. Further, the dead and dried vegetation acts as fuel for wildfires, which when it burns the vegetation, releases a huge quantity of greenhouse gases to the atmosphere. Thus, the recent research seeking to quantify the amount of carbon gas emission that results from California’s wild land ecosystem has indicated that its forests has the potential of releasing a huge amount of greenhouse gases into the atmosphere. The forests acts as huge carbon reservoirs, and it was estimated that the quantity of carbon reservoir in the California’s forest is to the tune of 850 million tons (Gonzalez, Battles, Collins, Robards & Saah, 2015). Most especially, certain types of trees and vegetations were found to be the major reservoirs of carbon. For example, the redwood forests that is near California’s Redwood National Park was found to hold more carbon reservoirs on the ground per hectare, compared to any other ecosystem globally (Gonzalez,

Leadership and Communication Problems within Criminal Justice Term Paper

Leadership and Communication Problems within Criminal Justice Organizations - Term Paper Example Leadership is vital component of an organization, which influences it ability to conduct its objective. Communication enhances information delivery in organization. Criminal justice is a sensitive area, which requires proper leadership structures and effective communication for effective service delivery. The role of criminal justice organization influence social and human development. Sociologists believe that social growth depend on the effectiveness of the criminal justice organization. This paper identifies leadership and communication problems within criminal justice organizations. 2. Importance of Leadership & Communication Leadership refers to devising a vision of the future and influencing people through communication of the vision and motivating people to overcome the hurdles (Easton 266). From the above definition, it is evident that influencing depends on a range of processes and factors, which vary with the choice of applied leadership theory. Criminal justice organizatio n such police force face leadership challenges associated with management style. Hierarchical leadership style or bureaucratic leadership style influences service delivery in the police force. Police officers face the challenge of making moral judgment verses following orders of their bosses. Largely, this problem leads to ineffective service delivery in this department. Studies reveal that many police officers have limited authority to make moral judgment because of nature of leadership style that the organization has applied. a) Issues & Problems In hierarchal leadership style, chain of command dictates flow of information from top authority to the bottom authority. For instance, in police force, police boss passes information to the immediate junior officer who in turn does the same to his juniors. This leadership style often leads to many problems associated with criminal justice organizations. The informal relationship between criminal justice organizations and other organizati on pose leadership challenge to criminal justice organizations (Stojkovic.et. al. 192). Police chief gets a lot of pressure from partner authorities, which influence service delivery in the department. Largely, the society gauges the effectiveness of leadership structures through actions on the ground without considering factors that influence the outcome. For instance, police chief handling issues touching on political interest must employ different leadership tactics in handling the matter. The external influence is a serious problem that influences criminal justice leadership structures and service delivery. Officers working in courts usually get orders from their seniors to handle some court issues in a particular manner. Court leadership structures and police leadership structures are different. The difference in structure influence service delivery to the society. Leadership structures in court apply democratic leadership style, which promotes collective participation in organ ization decision. On the other hand, police department applies autocratic leadership style, which promotes decision making from the top management (Easton 284). Autocratic leadership style delivers good results in emergencies. On the contrary, police department conduct several activities, which do not call for emergency actions. For example, investigations require

Advanced Practice Nursing Role Essay Example for Free

Advanced Practice Nursing Role Essay Health professionals like nurses have a chance to go for autonomy in the nursing career which is beyond the practice of being a staff nurse. Various pathways for advanced specialization in nursing career have been established for the past few decades. This expansion of responsibilities and vision as a health professional helps nurses to fulfill growth as professional and as a person. Among the advanced practice nursing roles, the author deeply prefer Family Nurse Practitioner specialized in cardiology. This will help her utilize skills in nursing science and as a health care specialist with a twist on promotion of health of the cardiovascular system. Creative APN Role in Health Promotion The author has chosen the field of family nursing practitioner because of the challenges and roles that it holds. The current responsibilities of the family nurse practitioner posts promising personal as well as professional growth on the field of the health care industry. The advance practice nursing role of family nurse practitioner is composed of different skills which pertains to the areas of management skills of community health nursing, patient care, primary care, intervention on the desired population, and it also deals with community assessment and actions regarding the said assessment. It focuses on promotion of health and healthy living, avoidance of degenerative diseases, and the supervision of the illnesses in different ages, both chronic and acute. (UTA 2008) The author has chosen a specialized field in cardiology because in reference to the data given by the Centers for Diseases Control and Prevention for 2005 Death data table C, the leading cause of death in the United States is cardiovascular related. According to the statistics, 652, 091 deaths were related to heart problems (CDC 2008). The stated data poses a major concern that there is a very big problem related to cardiovascular disorders. In relation to this, the author envisions to help in solving this problem via the career chosen by the author. The family practice nursing with a specialization in cardiology will help the author contribute in building the foundations of a society with healthy cardio vascular systems. Among the probable setting that the author hopes to practice the stated advanced practice nursing role is in the Christ Hospital. It was established for more than 115 years and it was well known to be one of the leading hospitals which continue to promote, plan and innovate for the healthy future of the region. It was noted as one of the best medical institution in the United States for the last few decades consistently. The setting includes 555 beds with more than 1200 physicians and holds the most advanced and sophisticated technology for health care. It is a not-for-profit acute care facility which is supervised by the highly trained specialists that has great passion for health care. It focuses on the services for major surgery, orthopedics, cardiovascular care and other related fields (Christ Hospital 2008). The competencies required for this job ranges from clinical expertise to social relationship within the community. It requires expertise in retrieving records for the data regarding the health, medical history, psychosocial and family records. Ability to conduct physical examination, for the health problems related to the acute and episodic phases are required as well as the ability to interpret the laboratory findings. Provide health assessment to the visited areas or patients and to arrange referrals to other health professional. It is also required to have a knowledge on developing and implementing plans for the supervision of problems in the acute and episodic problems of the assessed in and out patients. In the competencies required to assess patients also include ability to enclose screening evaluation for the cardiovascular health and other relevant information regarding it, distinguishes between normal and abnormal change. Evaluate the pressure of the family or psychosocial factors on patient sickness, situations related to developmental delays and learning disabilities in all ages, reproductive health of both women and men, sexual health, pregnancy, and postpartum care, assess some problems like substance abuse like drugs. Performs and accurately documents appropriate comprehensive or symptom-focused physical assessment on patients of all ages. Recognize health and cardiovascular risk factors of patients of all ages and families in all stages of the family life cycle. Demonstrates proficiency in family assessment; show proficiency in functional assessment of family members. Assesses specific family health needs within the context of community assessment especially the ones that is related to the cardiovascular diseases. Identifies and plans interventions to promote health with families at risk of heart disease (NONPF 2002). Diagnosing of health status focused on the health of heart is also needed, the following competencies are required. Recognize signs and symptoms of acute physical heart disease across the life span. Recognize signs and symptoms of chronic cardiovascular disease across the life span. Evaluates and summarizes collected data for patients of all ages. Plans complete differential diagnoses, with relevance to the epidemiology, environmental and community characteristics, this also includes life stage development and the arrangement seen with increasing age, family, and heart risk factors (NONPF 2002). Upon diagnosis of the members with cardiovascular or heart related diseases. The planning caring and management of the treatment of the disease will proceed which requires a lot of competencies indicated below. It is required for the nurse to have abilities to provide health information for protection, health promotion, formulate strategies for the intervention and prevention of the cardiovascular diseases which aims in improving the cardiovascular system of the family, requires a knowledge on how to treat acute and chronic of cardiovascular diseases in all ages to minimize the risk of developing complications and increase quality of living, prescribe proper medication for the pharmacodynamics and pharmacokinetics, adapts care for to meet the needs of the at-risk patients, evaluate the effectiveness of the plan in relation to the plans made for the at-risk group. Assist the members of the family of the cardiovascular disorder patient, provide referrals to the health care professionals that can support the treatment of the heart disease, and apply the study regarding the idea that is family centered and can supply positive change in the health of the family. Family or Population Health Promotion Theories Models The family nurse practitioner specialized in the cardiology focuses on promoting health in relation to individual level and the family level. The health promotion theory that is suitable for the family nurse practitioner in the individual level is the Health Belief Model which focuses on the person’s perception of the possible risk and the evaluation of the actions that would prevent the problem from occurring again. In this case, the author’s future interaction with individuals who are at-risk to cardiovascular diseases will give her chance to use the said model in promoting the health information. Upon approaching, an at-risk patient, the author will be discussing the perceived susceptibility of the subject to cardiovascular diseases and the initial reaction of the patient will more likely to be curios. The next part is the explanation of the perceived severity and the possible consequences of the CVD in the patient; the next step is to discuss with the patient the possible benefits of positive action. In such case, the patient will soon realize the benefits of the perceived action. And will arrive eventually on the conclusion that the patient should consider on performing the perceived actions that could give benefits. The author also considers another theory of which the community level is involved. The community organization is theory which focuses the involvement of the members of the community in evaluating health problems. Upon interaction within community sites, the author will soon be empowering these families in relation to the participation in campaigns for heart related problems. The participation of the community and the relevance of the selected issue to the problem of the community like the cardiovascular diseases will greatly enhance the active development of the community. The most important activity that the author can do is the critical consciousness that she will be spreading in the community (HPA 2008). Agency and Financing of APN Practice The Christ Hospital will be the institution where the author hopes to apply in the mere future it was the medical establishment that was considered in this paper. It was established for more than 115 years and it was well known to be one of the leading hospitals which continue to promote, plan and innovate for the healthy future of the region. It was noted as one of the best medical institution in the United States for the last few decades consistently. The setting includes 555 beds with more than 1200 physicians and holds the most advanced and sophisticated technology for health care. It is a not-for-profit acute care facility which is supervised by the highly trained specialists that has great passion for health care. It focuses on the services for major surgery, orthopedics, cardiovascular care and other related fields (Christ Hospital 2008). The mission of the Christ Hospital is to lead the region in giving the excellent experience in health care especially the personalized one while forwarding clinical excellence, technology and education. The role that the author will be holding will help the institution in a way of providing personalized health care especially in the cardiology patients. The author’s expertise will also help the institution in advancing clinical excellence especially in the field of cardiology. The role will be financially supported by the hospital or allied services institutions relating to cardiology. In the specific case, the Christ Hospital will be responsible for the financial support of the role. The nurse practitioner in the said institution is included in the employee pay. Some stakeholders that can support the role are the health related institutions, hospitals, clinics, nurse organizations and cardiology specialty centers. The role of family practice nurse practitioner goes beyond the limits of a staff nurse which will promote personal and professional growth. The specialization in cardiology will greatly help in the regression of cardiovascular disease cases in the United States. Thus the APN role stated above will surely benefit not only the author but also the society at large.

Impacts of Music Piracy

Impacts of Music Piracy In the future, the only way musicians will make money is by playing live. New federal legislation says universities must agree to provide not just deterrents but also alternatives to peer-to-peer piracy, such as paying monthly subscription fees to the music industry for their students, on penalty of losing all financial aid for their students. When record companies appeared, services they were providing were necessary in order for people to listen to recorded music, making and selling records was a major undertaking. This was a starting point of development of recording techniques and record studios, at that time making recorded music available to masses required a significant capital and investments, which in turn required a legal structure that would provide stable profits and return on the required investment. Music industry used to provide people with tools that were essential to listen to recorder music and the difference between that time and our days is that record companies charge people for permission to use tools people already have that they did not provide, that in fact people paid someone else for, yet the legal structure that developed during the time when that services were useful remains. The legal structure says if you don’t pay you are breaking the law therefore you are criminal and the reason it h as not been changed is because of â€Å"STARS† the entire structure of the record industry is built around their interests. Records produce good money for the industry and almost nothing goes to the pocket of musician. This particular diagram is a good example of old model of music production chain, In our days there is no need of Publisher, Distributors and in most cases manufacturers, modern technology allows to burn CDs at home publish own records using internet distributing the material across the World Wide Web physically and digitally. In old days, musician had to pay to almost every person in Music Production chain to record, studios, engineers, managers, labels, publishers, legal departments, distribution networks etc. in fact all of the departments and services belong to the same corporation and the record companies are not actually record companies at all. â€Å"To begin with, we should note that the major â€Å"record companies† are not actually record companies at all but huge media conglomerates. Most â€Å"independent† labels are owned by a corporate label. Each â€Å"major† is in turn owned by an even bigger corporation, and so on up the food chain. At the top of the chain sit a tiny handful of media giants: Time Warner, Disney, Rupert Murdochs News Corporation, Bertelsmann of Germany, Viacom (formerly CBS) and General Electric. These corporations are among the world’s largest. All are listed in Fortune Magazine’s â€Å"Global 500† largest corporations in the world. They have integrated both horizontally (owning lots of record labels, lots of newspapers, and radio stations) and vertically (controlling newspapers, magazines, book publishing houses, and movie and TV production studios, as well as print distribution systems, cable and broadcast TV networks, radio stations, telephone lines, s atellite systems, web portals, billboards, and more).† In contemporary world there are very few recording projects that actually require use of the Cutting-edge technology studios. The Internet and World Wide Web have changed the character of music distribution with laptops and desktop PCs loaded with hardware and software necessary for high-quality sound recording. All the hardware and software applications are available for the average class people not mentioning internet piracy and â€Å"cracked† software that is available to download using peer-to-peer applications. The problem of piracy has been rising for the past 10 years, and the numbers of â€Å"pirates† are growing day by day. From my personal experience every person that is using computer came across piracy and became victims or even the pirates themselves and the reason for that is simple, easy and user friendly peer-to-peer software takes only couple of minutes to setup and another minute to become familiar with interface and all the features, in another 10 minutes it is possible to find your favorite artist and download your favorite album. That is in fact so convenient that it is becoming only the question of conscience whether it is a problem or an opportunity to become pirate. Realizing the problem of piracy Sony tried innovative approach to earn money on digital music, In 2000 Sony launched online music store â€Å"the Store† where the price for a track was $3.50 that turned off many early adopters of the service moreover, users were actually only renting the tracks for that $3.50 and after a certain point the files expired and could not be played again without repurchase, which was not a successful attempt and service failed quickly. Having that experience In 2003 Apple inc. run iTunes Store, with tremendous success with the Ipod sales which no doubts influences Music industry and the policy of digital music distribution. That is a breakthrough for digital music and especially for mp3 format. According to information by Apple CEO Steve Jobs at the end of the second week of January, 2008, the store has sold 4 billion songs, accounting for more than 70% of worldwide online digital music sales. There were many disputes on the World Wide Web and newspapers and other mass media sources about Ipod users and digital music in overall, where topics like â€Å"Ipod users are thieves† were headline. My own opinion is that it looks like a Dog chasing own tail, on the one hand technologies are growing very fast and there is nothing to put on the 200 GB HDD except tons of music and movies, the same with iPods it is highly improbable to have that amount of music in physical quantity, 40gb of Ipods capacity is approximately 5000 tracks which is around 200 albums†¦ In our days it is becoming more and more difficult for the music industry to ignore the basic economics, technology progress and the outdated legal structures of the industry such as unenforceable property rights (because it is impossible to sue everyone) and â€Å"zero† production costs (Peer-to-Peer and file sharing systems became way too popular). All the big labels such as SONY BMG, Warner and others have now given up on DRM (â€Å"Short for digital rights management, a system for protecting the copyrights of data circulated via the Internet or other digital media by enabling secure distribution and/or disabling illegal distribution of the data. Typically, a DRM system protects intellectual property by either encrypting the data so that it can only be accessed by authorized users or marking the content with a digital watermark or similar method so that the content can not be freely distributed.†) Music Companies still trying to charge for their music, but it’s becoming more and more clear that as long as there is a free alternative (Peer-to peer and other file sharing systems), the price of music and other media will have to fall. â€Å"LONDON — U.S. rock star Prince gave away his new album for free with a U.K. tabloid newspaper, weeks before its official launch, in a move that has caused dismay among music retailers.† Some artists already started to use the situation and instead of fighting with the â€Å"problems† started to look for the advantages and opportunities. Marginal production costs are zero and like in case with software applications, it doesn’t cost anything to produce another digital copy that would be as good as the original, as soon as the first copy exists anyone can create additional copies. Unless effective technical, legal or other artificial barriers to production can be created, simple economic theory dictates that zero marginal cost plus competition (The possibility that consumer will create and spread another copy) results in a zero price, unless government creates artificial barriers to a free market. â€Å"Sure, Radiohead is on a sustained run as the most interesting and innovative band in rock, but what makes In Rainbows important — easily the most important release in the recent history of the music business — are its record label and its retail price: there is none, and there is none.† In October 2007 Radiohead announced that their new album â€Å"In Rainbows† will be available to download free of charge, the fact is, the networks and peer to peed file sharing systems have grown into easy-to-use distribution methods for music even easier than what Radiohead has bee offering. According to Forbes website (www.forbes.com) about 240.000 users has been downloading album using Peer-to peer (BitTorrent) sources â€Å"according to Big Champagne, a Los-Angeles-based company that tracks illegal downloading on the Internet. Over the following days, the file was downloaded about 100,000 more times each day—adding up to more than 500,000 total illegal downloads.† Radiohead offered to download their album for free the only requirement was to set up an account on the website, but according to statistics that turned out to be not â€Å"cheap† enough! The recorded music industry †¦ has for too long been dependent on how many CDs can be sold, writes Guy Hands, EMIs chairman. The industry, rather than embracing digitalization and the opportunities it brings for promotion of product and distribution through multiple channels, has stuck its head in the sand. Radioheads actions are a wake-up call which we should all welcome and respond to with creativity and energy. Nokia made a step forward offering music downloads for free on their mobiles by signing contract with Sony BMG â€Å" Nokia will offer free 12-month access to music from artists of Sony BMG, the worlds second-biggest label, to buyers of its particular music phones, the worlds top cellphone maker said on Tuesday. Last December, Nokia unveiled a similar deal for its Comes With Music phones with the top record label Universal.Comes With Music is expected to launch in the second half of 2008 on a range of Nokia devices in selected markets, Nokia said in a statement.Nokia gave no financial details.Sony BMG, home to artists including Beyonce, Bruce Springsteen and Celine Dion, is jointly owned by Sony Corp and German media group Bertelsmann AG.The new music offering from Nokia the first cellphone maker to push heavily into content would differ from any other package on the market as users can keep all the music they have downloaded during the 12 months.† My personal opinion is whether you agree or disagree that the prices for the music will be zero or about zero but it is going to happen if the authorities would not take drastic measures to solve the issues as it appears that there is no â€Å"easy† solution†¦ The new era is coming, the era of free recorded music and my believe is that everything is going in a right way, recorded music will become one of the marketing tools to get people to pay for the live concerts, that will put emphasis on organizational skills and on new dimension of the performances and performance quality which will result in cultural socialization and stronger community. In countries like Brazil people already started to use situation as an advantage and opportunity, people doing huge amount of remixes which resulting in new styles and music cultures like Techno Brega â€Å"In the North of Brazil, you have the Techno Brega movement. [..] You have a music producer who has a recording studio. [..] Probably a small one with good equipment. They invite the artists to these studios to make the CDs. They deliver it to the street vendors, so that they can replicate them. The only people making a profit out of CD sales are the street vendors. The musicians dont expect any money from releasing the CDs.† People realized that CD sales model is not an effective way to earn money in our days it is outgrown to promotion side of business and what people are doing now is using CDs to record actual performances and then sell it to people who have attended the performance which is a good souvenir and memory of the event. Services and web resources are developing for the benefits of artist. Web resources such as www.myspace.com or www.sellaband.com could be of great benefits to artist. Sellaband is a very perspective web project which is aimed to promote artist but in slightly different way then www.myspace.com, Artist creates a profile, uploading all the necessary information and maximum of 3 demo songs and looking for â€Å"believers†, each believer have to invest at least 10$ in artist and as soon as the amount of believers will reach 5000 the artist will receive 50000$ to record the album, after the album has been produced the believers will receive limited edition CDs with all the bonuses, all services are absolutely free as for believers as for the artist, that is a very bright idea as the â€Å"believers† could be a very good source of money which is very important for the first album, the amount of believers could be less then 5000, the main concept is to rise 50000$ therefore, i n this case it is possible for artist to divide the source of money between believers and himself so that it could be 50% from artist and 50% from believers. In conclusion, record labels are going down and struggling to make profits from CD sales and it appears that digital music selling is more reliable for revenue then CD sales. Copyrights and intellectual property rights law have to be updated to cooperate with current issues of piracy and file sharing protocols. CD Sales model has to be reincarnated to CD promotional model in order to regain the value of physical product with the emphasis put on live performances which should result in quality and cultural aspect of performances.

The pathophysiology of a disease: COPD

The pathophysiology of a disease: COPD This assignment will discuss the pathophysiology of a disease process of chronic obstructive pulmonary disease (COPD). It will also show how biological, psychological and the social aspects of the disease that can have an affect on an individuals day to day life. COPD stands for chronic obstructive pulmonary disease. This is a term used for a number of conditions; including chronic bronchitis and emphysema. COPD leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out of the lungs. The word chronic means that the problem is long-term. COPD is a condition which mainly affects people over the age of 40, and COPD has a higher prevalence occurring among women than men (NHS-Choices, 2008). COPD is also a condition that is long term and incurable that can have a serious affects on health and quality of life, its not fully understood why COPD develops. (Marieb, 2003). The student will also incorporate local and national health and social policies, including frameworks that are in place in relation to the patients illness. The student identified a patient named Mrs J. She was admitted to hospital due to exacerbation of COPD. Her primary diagnosis is Osteoarthritis of the Hip but also had symptoms of emphysema. Mrs J is a 55 year old women and is married, Mrs J also has an older child whom she has become quite dependant on and felt lik e she had impacted on her childs life and had become a hindrances. Mrs J has become more breathless as her condition develops over time and more so while she was lying in bed unable to carry out her daily activities such as doing the housework, leisure activities, also looking after her appearance as she normally would have done at home. COPD is becoming one of the fastest leading causes of disability (NHS choices, 2008). According to British Lung Foundation, (2010) a recent survey, 83% of COPD patients said their COPD slows them down, 79% said they had to cut down their activities and 56% said their condition has a great affect on their families. COPD is the most common respiratory conditions in adults in the developed world and poses an enormous burden to society both in terms of direct cost to the healthcare services and indirect costs to society through loss of productivity. Recent analysis estimated that National Health Service (NHS) spends  £818 million annually in the Unite d Kingdom (UK). (British Thoracic Society, 2006). However 50% of the cost is accounted for by poorly managed exacerbations resulting in frequent re-admissions to hospital (Coakley Ruston, 2001). Mrs J condition would of been triggered by her heavy smoking, the toxins from her cigarettes has made her bronchioles (airway and lungs) become inflamed and narrowing the airway, this will lead to irreversible damage to the respiratory system by obstructing the bronchial airflow and hindering gaseous exchange within the alveoli (Munden, J, 2007). Mrs J suffers from many symptoms due to her smoking these include shortness of breath, a persistent cough, yellowish green sputum, signs of cyanosis to her lips, also Mrs J has continued to smoke as she thinks the damage has already been done so her condition. The vast majority of COPD patients are smokers. By stopping smoking patients can slow the rate of decline in lung function and thus improve the patients prospects in terms of symptoms and survival. The National Institute of Clinical Excellence guidance on COPD states that All patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity. These deliver a small dose of medicine to the lungs, causing the airway muscles to open up. Bronchodilators are also effective in preventing over-expansion of the lungs. Short-acting beta2-agonists are the most commonly used short acting bronchodilaors for COPD. Their effects last for about 4 hours. Short-acting antichloinergics are also used as bronchodilators. Long-acting beta2-agonists are similar to the short-acting agonists described above but their effect lasts for 12 hours. Lomg-acting anti-cholinergics need only be taken once a day. The NICE guidance recommends that short-acting bronchodilators should be used for the initial treatment for breathlessness and exercise limitation and goes on to say that, if this isnt having an effect then the treatment should be intensified using eith er a long-acting bronchodilator or a combined therapy with a short acting beta2-agonist and a short-acting anticholinergic The respiratory system is the major part for gases exchange to take place, it allows takes the air that enters are bodies when we inhale and travels through the respiratory system, exchanging oxygen for carbon dioxide and expels carbon dioxide when we exhale (munden, J, 2007). In the NHS there is a tool to calculate the smoking load and the packs in a year this tool is called smoking pack tool, this was used to see the damage that Mrs J had caused by smoking for so many years. This is because the seriousness of the disease depends on how much and how long the individual has smoked for. Mrs J has been smoking now for 45 years and on a average day having up to 40 cigarettes a day and is not prepared to quit as she feels the damage is already done. Mrs J smokes for comfort and feels that its all for her pleasure, she has become very isolated, her chronic bronchitis makes her breathless when doing actives and is not able to do her daily activities therefore is becoming depressed. Do this having a huge impact on her mental and social parts of her life. Patients with COPD have traditionally been divided into pink puffers and blue bloaters based on their physiological response to abnormal blood gases. The former work hard to maintain a normal pO2 which is why they puff away. They tend to have a barrel-shaped, hyperinflated chest and breath through pursed lips. The latter are blue because of hypoxia and polycythaemia. They are often obese and have water retention. This is why they are bloated. The blue bloaters are dependent upon hypoxia for their respiratory drive and to give oxygen and deprive them of this will lead to signficant hypercapnia and acid base imbalance. Although this concept is widely taught and acknowledged academically, in clinical practice patients tend not to be clearly in one or the other of these two categories (NICE Clinical Guideline (2004) Patients like Mrs J with airflow limitation clinically they have become known as pink puffers and blue bloaters (Kleinschmidt, 2008). Mrs J falls under the term blue bloaters as she linked to chronic bronchitis due to cyanosis which is a blue tinge to the lips, which occurs from poor gas exchange. pink puffers has been linked to emphysema as the patients may be showing signs of weight loss, using their accessory muscles with pursed lips giving them a reddish complexion, they may also adopt the tripod sitting position (Kleinschmidt, 2008). Although these conditions separate the patient may present with slight variations of them both, however they do differentiate through their underlying process, signs and symptoms (Bellamy Booker, 2004). Airways and air sacs within the lungs are manly elastic, with the air we breath the lungs change shape with inhalation they expand and return to the normal shape after they have been stretched with air. Mucociliary clearance is an important primary innate defense mechanism that protects the lungs from deleterious effects of inhaled pollutants, allergens, and pathogens. Mucociliary dysfunction is a common feature of chronic airway diseases in humans. The mucociliary apparatus consists of three functional compartments, that is, the cilia, a protective mucus layer, and an airway surface liquid (ASL) layer, which work in concert to remove inhaled particles from the lung. The nose and nasal cavity are composed of ciliated columnar epithelium cells which contain goblet cells and cilia, the goblet cells are responsible for secreting mucus which is able to trap the finer particles from inspired air and the cilia which are fine hairs that can trap larger particles. The cilia carrys the particles by a sweeping motion this is swept to the mouth or nose where it can then be swallowed, coughed or sneezed out of the body in order to prevent these particles from entering the lungs (Munden, J, 2007). The two major sources of mucus secretion in the respiratory tract are the surface epithelial goblet cells and mucous cells. In lungs, goblet cells are present in the large bronchi, becoming increasingly thin toward the bronchioles. The submucosal glands are restricted to the large airways with their density decreasing with airway calibre. In chronic respiratory diseases, such as COPD and asthma, submucosal glands increase in size (hypertrophy), and the number of goblet cells is increased (hyperplasia), becoming more dense in the peripheral airways, via a phenotypic conversion of nongoblet epithelial cells (metaplasia) (Rogers, 1994;Jackson, 2001). The increased of goblet cells density to ciliated cells in the bronchioles, under the conditions of hypersecretion, this impairs clearance of mucus. Lung histology from patients affected by COPD and asthma also shows the presence of edema, which can further reduce airway caliber and compromise lung function. A marked airway infiltration of macrophages and granulocytes is also present, principally neutrophils in COPD and eosinophils in asthma (Postma and Kerstjens, 1998). In clinical studies, these inflammatory parameters have been shown to correlate with a reduction in lung function (FEV1) and an exaggerated bronchoconstriction [airway hyperreactivity (AHR)] to nonspecific stimuli (Postma and Kerstjens, 1998). Smoking has many effects on the airways. Inhaled smoke destroys the cilia that are important for moving mucus to the throat for swallowing. As a result, mucus accumulates in the bronchioles and irritates the sensitive tissues there, causing a cough. Coughing is vital as it is the only way smokers can remove mucus from their lungs and keep the airways clean (Rubin, 2002). This is characterised by the smokers cough. Constant coughing to clear the sputum has an effect on the smooth muscle of the bronchioles which becomes hypertrophied (enlarged or overgrown). This in turn causes more mucus glands to develop. The goblet cells are replaced within the small airways (bronchi) with Clara cells they are another form of secreting cell these are important they form ciliated cells and to help regenerate the bronchiolar epithelium, they produce hypophase component and a protease inhibitor these help protect the lungs by mopping up debris (Stokley et al, 2006).To accomplish gas exchange the lung has two components; airways and the alveoli. The airways are two branching tubular passages that allow air to move in and out of the lungs, the wider segments of the airways are called the trachea and the two bronchi going to the right and left lung. The smaller segments are called the bronchioles and at the end of the bronchioles are the alveoli which are thin walled sacs like a bunch of grapes; small blood vessels (capillaries) run in the walls of the alveoli this is where gas exchange between air and blood takes place. (Matterporth Matfin, 2009). Rogers, 1994;Jackson, 2001 Chronic obstructive pulmonary disease, NICE Clinical Guideline (2004); Management of chronic obstructive pulmonary disease in adults in primary and secondary care COPD. BMJ Clinical Evidence. www.clinicalevidence.com, accessed 10 June 2009 Textbook of Medical Physiology (10th edition) Guyton, A.C. and Hall, J.E. (2000) W.B. Saunders, Philadelphia; London. Global Initiative for Chronic Obstructive Lung Disease; September 2005. Britton M; The burden of COPD in the U.K.: results from the Confronting COPD survey.; Respir Med.2003 Mar;97 Suppl C:S71-9. [abstract] Chronic obstructive pulmonary disease, NICE Clinical Guideline (2004); Management of chronic obstructive pulmonary disease in adults in primary and secondary care Lacasse Y, Goldstein R, Lasserson TJ, et al; Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD003793. [abstract] Barr RG, Bourbeau J, Camargo CA, et al; Inhaled tiotropium for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD002876

Hollywoods Attack On Religion :: essays research papers

Hollywood's Attack on Religion The section that I have chosen to analyze from the book Hollywood vs. America is "The Attack on Religion." In this part of the book, Michael Medved discusses the shift in attitude Hollywood has made toward religion, from acceptable to contemptible. He takes a look at the messages being sent in films, music and television in the last 15 to 20 years and analyzes their effects. In general, Hollywood depicts religion in an unfavorable manner, according to Medved. Moreover, Medved also argues that, not only has Hollywood taken a hostile stance toward religion, but it has paid the price, literally, for doing so. All of Medved's arguments are well supported and documented, making them seemingly futile to argue against. Yet, Hollywood, which includes films, music and television, continues to disregard the obvious facts that Medved has revealed. In the first chapter of this section, "A Declaration of War," Medved discusses the facts surrounding the protest which took place on August 11, 1988, in opposition to the release of the motion picture The Last Temptation of Christ. MCA/Universal, which funded the Martin Scorsese film, called the protesters a "know-nothing wacky pack" (38). However, as Medved points out, the protest was "the largest protest ever mounted against the release of a motion picture" (37) and included such groups as the National Council of Catholic Bishops, the Southern Baptist Convention, twenty members of the U.S. House of Representatives and prominent figures such as Mother Teresa of Calcutta and Ken Wales, former vice president at Disney studios. Even with such strong opposition from these respected groups and people, the studio refused to listen and stood behind its First Amendment rights. MCA/Universal was even supported by the Motion Picture Association of America, which stated that "The . . . MPAA support MCA/Universal in its absolute right to offer to the people whatever movie it chooses" (41). However, Medved rebukes this statement, arguing that "absolute right" wasn't the issue; the issue "concerned the movie company's choices, not its rights" (41). He supports this argument further by indicating that the MPAA would never support a film portraying Malcolm X as a paid agent of Hoover's FBI or portraying Anne Frank "as an out-of-control nymphomaniac" (41). By releasing The Last Temptation of Christ, the studio positions Jesus, God and Christianity below these prominent figures in history because it is portraying Jesus and other religious figures in uncharacteristic situations that would never be associated with these historical figures. This is supported by past experiences when movies were edited so as to not offend animal rights activists, gay advocacy groups, and ethnic

Free Nature vs. Nurture Essay :: Argumentative Persuasive Topics

Nature vs. Nurture There has always been a large controversy over whether inherited genes or the environment influences and effects our personality, development, behavior, intelligence and ability. This controversy is most often recognized as the nature verses nurture conflict. Some people believe that it is strictly genes that effect our ways of life, others believe that it is the environment that effects us, and some believe that both of these influence our behavior. Either way, social scientists have been struggling for centuries deciding whether our personalities are born or made. Tests are done often on identical twins that were separated to see how they are each influenced by their separate environments. In the past twenty years, it has been discovered that there is a genetic component to every human trait and behavior. However, genetic influence on traits and behavior is partial because genetics account on average for half of the variation of most traits. Urie Bronfrenbrenner, who studies genetics, said, "It is not nature vs. nurture, but the interaction of nature and nurture that drives development." Researchers are finding that the balance between genetic and environmental influences for certain traits change as people get older. Also, people may react to us in a certain way because of a genetically influenced personality and, we may choose certain experiences because they fit best with our instinctive preferences. This means that our experiences may be influenced by our genetic tendencies. One way researchers study the development of traits and behaviors is by measuring the influence of genetics through out ones life span, and it is found to be that the genetic influence on certain trait increase as people age. A research was done to see whether a trait would show up in a child if it was environmentally influenced or genetically influenced. A child was given more negative attention than another was, and it increased the chances of the child having depressive symptoms and anti-social behavior. But these symptoms disappeared when accounted for genetic influences and how parents treat their children. There are three types of gene/environment relations. The first one is called a passive correlation. It is to be explained as, for example, if a musical ability was genetic, and a child was passed a musical ability trait, than the child would most likely have musically inclined parents. Their parents then would provide them with the genes

Island of the Sequined Love Nun Chapter 27~28

27 Girl Talk Sepie washed the pilot's hair in a bowl with pounded coconut and brackish water. She had been taking care of the unconscious white man for two days and it was starting to get tedious. She was mispel of the bachelors' house, and washing and ministering to a sick and stinky white man was not in her job description. This was women's work. There are legends in the islands, and some of the old men swear they are true, that the women who service the bachelors' houses, the mispels, were taken to the secret island of Maluuk, known only to the high navigators, where they were trained in the art of pleasuring a man. After months of training, a mispel was required to pass a test before she was allowed to return to her home island to take over the duty of tending to the sexual needs of the men of the bachelors' house. The test? She was sent into the ocean with a ripe brown coconut clutched between her thighs, and there she floated, in heavy surf, for the entire circuit of the tides. Should the coconut pop loose or the mispel touch it with her hands, she failed the test (although there was some leeway in the event of shark attack). It is said that the inner thighs of the mispels of old were as strong as net cable. The second part of the test required the girl to find a delicate dragonfly orchid with a straight stem, and while her teachers looked on, she would lower herself over the flower until it disappeared inside of her, then rise again after a few minutes, leaving the stem unbent and the petals unbruised. The mispel held a position of honor, respected and revered among the is-landers. She was n ot required to do housekeeping, cooking, or weaving, and while the other women toiled in taro fields from the time they could walk, a mispel was allowed to nap in the shade, conserving her energy for her nocturnal duties. A mispel often ended her tour of duty by marrying a man of high status. No stigma followed her into married life, and she would be sought out to the end of her days by the other women for advice on handling men. Sepie, however, had not been chosen because of any special skill, nor had she passed through any vigorous concubinal boot camp. Sepie had been marked for mispel from the moment of her menses, when she emerged from the women's house with her lavalava tied a bit too high and showing a bit too much cappuccino thigh, her skin rubbed with copra until she glistened all over, and her breasts shining like polished wooden tea cups. She had painted her lips with the juice of crushed berries and peppered her long black hair with scores of sweet jasmine blossoms. She giggled coquettishly in the presence of all the men, danced dangerously close to the taboo of speaking to them in public, risked beatings by refusing to fall to her knees when her male cousins passed, and went about her chores with a wiggly energy that had caused more than one of the distracted village boys to fall out of a breadfruit tree during harvest. (She broke ankles as well as hearts.) Sepie was all titter and tease, a lazy g irl who excelled at leisure, a natural at invoking and denying desire, a wet dream deferred. At fifteen she took up residence in the bachelors' house and had lived there for four years. When Malink and the men brought the flyer and the man in the dress to her, she knew she was in for some trouble. â€Å"Take care of them,† Malink said. â€Å"Feed them. Help to make them strong.† Sepie kept her head bowed while Malink spoke, but when he finished she took his hand and led him into the bachelors' house, gesturing to the other men to lay the flyer and his friend on the ground outside. The men smiled among themselves, thinking that old Malink was going inside to receive a special favor from the mispel. What, in fact, he was receiving was an ass chewing. â€Å"Why don't you take them to your house, Malink? I don't want them here.† â€Å"It's a secret. If my wife and daughters find out they are here, then everyone will know.† â€Å"I'm the only one who can keep a secret in the bachelors' house. Take them to old Sarapul's house. No one goes there.† â€Å"He wants to eat them.† Malink couldn't remember ever having to argue with a woman and he wasn't at all prepared for it. â€Å"You're chief. Tell him not to. I will not cook for them. If I feed them, they will shit. I'm not going to clean it up.† â€Å"Sepie, what will you do when you marry and have children? You will have to do these things then. I am asking you as your chief to do these things.† â€Å"No,† Sepie said. Malink sighed. â€Å"I am asking you to do these things because these men have been sent to us by Vincent.† Sepie didn't know what to say. She had heard the Sky Priestess chastise Malink in front of the people, but she had been more concerned with losing coffee and sugar for a month than with the actual offense. â€Å"You will tell the men to cook for them?† â€Å"Yes.† â€Å"And they will carry them to the beach and wash them if they shit?† â€Å"I will tell them. Please, Sepie.† No man had ever said â€Å"please† to her before, let alone the chief. It was not a courtesy that women deserved. For the first time she realized how desperate Malink really was. â€Å"And you will tell Abo to wash his dick when it is his turn.† â€Å"What does that have to do with this?† â€Å"He is stinky.† â€Å"I will tell him.† â€Å"And you will tell Favo to quit making me put beads in his ass.† â€Å"Favo does that?† â€Å"He said he learned it from the Japanese.† â€Å"Really? Favo?† â€Å"Yes.† â€Å"But he's old, and he has a wife and many grandchildren.† â€Å"He says it makes his spear stronger.† â€Å"He does? I mean, does it work?† Malink had momentarily forgotten why he was here. â€Å"I don't like it. It is evil and unclean.† â€Å"You're talking about my old friend Favo, right? He's the one you're talking about?† â€Å"I told him only bachelors were suppose to stay here, but he says his wife doesn't understand him. His hands are like the skin of a shark.† â€Å"What kind of beads?† â€Å"Tell him,† Sepie said. â€Å"Okay,† Malink said in English. Then to himself he said: â€Å"Old Favo.† He shook his head as he walked out of the bachelors' house. â€Å"Beads.† Sepie watched him go, wishing that she had asked for more favors. Outside the men were grinning when Malink stepped into the moonlight. He hitched up his loincloth and averted his eyes from theirs. â€Å"Take them inside. You must cook and clean for them. Don't let the woman do it. It is too important for her.† As the men carried Tuck and Kimi into the bachelors' house, Favo ambled up to Malink. â€Å"How was it?† Malink looked at his old friend and noticed for the first time that Favo wore a long string of ivory beads around his neck. â€Å"I have to go home now,† Malink said. Sepie was, once again, swabbing up the wooden floor where the pilot had urinated on himself, when she heard the other one speak for the first time. The men had propped the Filipino up in the corner, where he had sat drinking the coconut milk and fish broth that she had been pouring into the pilot, but except for a few grunts when he made his way outside to urinate, the man in the dress had been quiet for two days. Sepie had learned to ignore him. He didn't smell as bad as the pilot, and she sort of liked his flowered dress. She'd said a prayer to Vincent for a dress just like it. â€Å"Where is Roberto?† the Filipino said. Sepie jumped. It didn't surprise her so much that he had spoken, but that he had spoken in her language. Although the words were clipped, the way someone from Iffallik or Satawan might speak. â€Å"He's right here,† she said. â€Å"Your friend stinks. You should take him outside and wash him in the sea.† â€Å"That's not Roberto. That's Tucker. Roberto is shorter.† Kimi crawled over to Tuck and laid his hand on the flyer's forehead. â€Å"He has bad fever. You have medicine?† â€Å"Aspirin,† Sepie said. Malink had given her a bottle of the tablets to crush into the flyer's broth, but after he gagged on the first dose she had stopped giving it to him. â€Å"He is more sick than aspirin. He needs a doctor. You have a doctor?† â€Å"We have the Sorcerer. He does our medicine. He was a doctor before the Sky Priestess came.† Kimi looked at her. â€Å"What island is this?† â€Å"Alualu.† â€Å"Ha! We have to get doctor for Tucker. He owes me five hundred dollars.† Sepie's eyes went wide. No wonder he wears such a fine dress. Five hundred dollars! She said, â€Å"The chief says I have to be secret about this man. Everyone knows he is here. The boys get drunk and talk. But I can't get the doctor.† â€Å"Why are you taking care of him? You are just a girl.† â€Å"I am not just a girl. I am mispel.† Kimi scoffed. â€Å"There are no mispels anymore.† Sepie threw down the rag she was using to wipe the floor. â€Å"What do you know? You are a man in a dress, and I don't believe you have five hundred dollars.† â€Å"It was a nice dress before the typhoon,† Kimi said. â€Å"Wash-and-wear. No dry cleaning.† Sepie nodded as if she knew what he was talking about. â€Å"It is a very pretty dress. I like it.† â€Å"You do?† Kimi picked at the crushed pleats around his legs. â€Å"It's just an old thing I picked up in Manila. It was on sale. You really like it?† Sepie didn't understand. Among her people, if you admired someone's else possession, manners bound them to give it to you. How could this silly man speak her language and still not know her customs. And he wasn't even looking at her that way all men looked at her. â€Å"What island do you come from?† â€Å"Satawan,† Kimi said. â€Å"I am a navigator.† Sepie scoffed. â€Å"There are no more navigators.† Just then the doorway darkened and they looked up to see Abo, the fierce one, entering the bachelors' house. He was lean and heavily muscled and he wore a permanent scowl on his face. The sides of his head were shaved and tattooed with images of hammerhead sharks. He wore his hair tied into a warrior's topknot that had gone out of fashion a hundred years ago. â€Å"Has the pilot awakened?† he growled. Sepie looked down and smiled coyly. Abo was the one boy in the bachelors' house who didn't seem to accept the communal nature of her position. He was always jealous, enraged, or brooding, but he brought her many presents, sometimes even copies of People that he stole from the men's drinking circle. Sepie thought she might marry him someday. â€Å"He is too sick for this,† Kimi said. â€Å"We need to take him to the doctor.† â€Å"Malink says he must stay here until he is well.† â€Å"He is dying.† Kimi said. Abo looked at Sepie for confirmation. â€Å"Well, he smells dead,† she said. The sooner they sent the pilot to the Sorcerer, the sooner she could get back to spending her days swimming and preening. â€Å"Malink will be angry if he dies,† she added for good measure. Abo nodded. â€Å"I will tell him.† He pointed to Kimi. â€Å"You come with me.† Kimi got up to leave, then turned back to Sepie when he reached the doorway. â€Å"If Roberto comes, tell him I'll be right back.† Sepie shrugged. â€Å"Who is Roberto?† â€Å"He's a fruit bat. From Guam. You can tell by his accent.† â€Å"Oh, him. I think Sarapul ate him,† Sepie said casually.† Kimi turned and ran screaming into the village. Malink looked up from his breakfast, a banana leaf full of fish and rice, to see Abo coming down the coral path toward his house. Malink's wife and daughters shuffled to the cookhouse at the sight of the fierce one. â€Å"Good morning, Chief,† Abo said. â€Å"Food?† Malink answered, gesturing with his breakfast. Abo had already eaten, but it would have been rude not to accept. â€Å"Yes.† Malink's wife poked her head out of the cookhouse and saw the chief nod. In a second she was giving her own breakfast to Abo, who neither thanked her or acknowledged her presence. â€Å"The pilot is sick,† Abo said. â€Å"Very bad fever. Sepie and the girl-man say that he will die soon without the Sorcerer's help.† Malink suddenly lost his appetite. He set his breakfast on the ground and one of his daughters appeared out of nowhere to take it to the cookhouse, where the women shared what was left. â€Å"And what do you think?† Malink asked. â€Å"I think he is dying. He smells of sickness. Like when Tamu was bitten by the shark and his leg turned black.† Malink rubbed his temples. How to handle this? The Sky Priestess was angry with him for even dreaming of the pilot. What would happen if he suddenly showed up with him? â€Å"What about the girl-man?† â€Å"He is not sick, but he has gone crazy. He runs around the village looking for Sarapul.† Malink nodded. â€Å"Catch him and tie him up. Make a litter and take the pilot to the betel nut trees by the runway. Leave him there.† â€Å"Leave him there?† â€Å"Yes, quickly. And bring the litter back with you. Make it look as if he walked to the runway. Send a boy to me when it is done. Go now.† Abo put down his food and ran off down the path. Malink went into his house and pulled the ammo box out of the rafters. Inside, next to the portable phone, he found the Zippo that Vincent had given him. He clicked it open, lit it, and sat it on the floor while it burned. â€Å"Vincent,† he said, â€Å"It's your friend Malink here. Please tell the Sky Priestess that this is not my fault. Tell her that you have sent the pilot. Please tell her for your friend Malink so she will not be angry. Amen.† His prayer finished, Malink snapped the lighter shut, put it away, then took the portable phone and went outside to wait for the boy to tell him everything was in place. 28 Choose Your Own Nightmare Tucker Case rolled through a fever dream where he was tossed in great elastic waves of bat-winged demons – crushed, smothered, bitten, and scratched – and there, amid the chaos, a pink fabric softener sheet passed by the corner of his eye, confirming that he had been stuffed into a dryer in the laundromat of Hell. He tumbled toward the pink, ascended out of the clawing mass, and awoke gasping, with no idea where he was. The pink was a dress on a heart-faced woman who said, â€Å"Good morning, Mr. Case. Welcome back to the world.† A man's voice: â€Å"After your message and the typhoon, we thought for sure you'd been lost at sea.† He was a white blur with a head, then a lab coat wrapped around a tall, smiling middle-aged man, gray and balding, a stethoscope around his neck. The doctor had his arm around the heart-faced woman. She too was smiling, with the aspect of an angel, the vessel of human kindness. Together they looked as if they had walked off of fifties television. The man said, â€Å"I'm Dr. Sebastian Curtis, Mr. Case. This is my wife, Beth.† Tuck tried to speak, but emitted only a rasping squeak. The woman lifted a plastic cup of water to his lips and he drank. He eyed the IV bag running into his arm. â€Å"Glucose and antibiotics,† the doctor said. â€Å"You've got some badly infected wounds. The islanders found you washed up on the reef.† Tucker did a quick inventory of his limbs by feel, then looked at them lest he had lost a leg that was still giving off phantom feel ing. He raised his head to look at his crotch, which was sending pulses of pain up through his abdomen. The woman gently pushed him down. â€Å"You're going to be fine. They found you in time, but you're going to need more rest. ‘Bastian can give you something for the pain if you need it.† She smiled beatifically at her husband, who patted Tuck's arm. â€Å"Don't be embarrassed, Mr. Case. Beth is a surgical nurse. I'm afraid the catheter will have to stay in for a few days.† â€Å"There was another guy with me,† Tuck said. â€Å"A Filipino. He was piloting the boat.† The doctor and his wife shot each other a glance and the â€Å"Ozzie and Harriet† calm shattered into panic, but only for a second, then they were back to their reassuring cooing. Tuck wasn't even sure he had seen the break. â€Å"I'm sorry, but the islanders didn't find anyone else. He must have been lost in the storm.† â€Å"But the tree. He was hung in the tree†¦Ã¢â‚¬  Beth Curtis put her finger gently on his lips. â€Å"I'm sorry you lost your friend, Mr. Case, but you need to get some rest. I'll bring you something to eat in a little while and we'll see if you can hold down some solid food.† She pulled her hand away and put her arm around her husband's waist as he pushed a syringe of fluid into Tuck's IV tube. â€Å"We'll check on you shortly,† the doctor said. Tucker watched them walk away and noticed that for all her â€Å"Little House on the Prairie† purity, Beth Curtis had a nice shape under that calico. Then he felt a little sleazy, as if he'd been caught horning on a friend's mom. Like the time, drunk and full of himself, he'd hit on Mary Jean Dobbins. To hell with solid food. Gin – in large quantities over a tall column of ice – that's the rub. Tonic to chase away the blues of bad dreams and men lost at sea. Tuck looked around the room. It was a small hospital ward. Only four beds, but amazingly clean considering where it was. And there was some pretty serious-looking equipment against the walls: technical stuff on casters, stuff you might use in complicated surgery or to set the timing on a Toyota. He was sure Jake Skye would know what it was. He thought about the Learjet, then felt himself starting to doze. Sleep came with the face of a cannibal, leg-jerk dreams, and finally settled in on the oiled breasts of a brown girl brushing against his face and smelling of coconut and flowers. There was a scratch and scuttle on the tin roof, followed by the bark of a fruit bat. Tuck didn't hear it. The pig thief had been caught and Jefferson Pardee had to find a new lead story. He sat at his desk pouring over the notes he'd written on a yellow legal pad, hoping that something would jump out at him. In fact, there wasn't a lot of jumping material there. The notes read: â€Å"They caught the pig thief. Now what?† You could run down the leads, pound the pavement, check all your facts with two sources, then structure your meticulously gathered information into the inverted pyramid form and what you got was: The pig's owner had gotten drunk and beat up his wife, so she sold his pig to someone on the outer islands and bought a used stun gun from an ensign with the Navy Cat team. The next time her husband got rough, a group of Japanese tourists found him by the side of the road, sizzling in the dirt like a strip of frying bacon. Mistaking him for a street performer, the tourists clapped joyously, took pictures of each other standing beside the electrocuted man, and gave his wife five dollars. The whole intrigue had been exposed when police found the pig-stealing wife in front of the Continental Hotel charging tourists a dollar apiece to watch her zap her husband's twitching supine body. The stun gun was confiscated, no charges were pressed, and the wife beater was pronounced unharmed by a Peace Co rps volunteer, although he did need to be reminded several times of his name, where he lived, and how many children he had. The mystery was solved and the Truk Star had no lead story. Jefferson Pardee was miserable. He was actually going to have to go out and find a story or, as he had done so many time before, make one up. The Micro Spirit was in port. Maybe he'd go down to the dock and see if he could stir up some news out of the crew. He slid his press card into the band of his Australian bush hat and waddled out the door and down the dusty street to the pier where rock-hard, rope-muscled islanders were loading fifty-five-gallon drums into cargo nets and hoisting them into the holds of the Micro Spirit. The Micro Spirit and the Micro Trader were sister ships: small freighters that cruised the Micronesian crescent carrying cargo and passengers to the outer islands. There were no cabins other than those of the captain and crew. Passengers traveled and slept on the deck. Pardee waved to the first mate, a heavily tattooed Tongan who stood at the rail chewing betel nut and spitting gooey red comets over the side. â€Å"Ahoy!† Pardee called. â€Å"Permission to come aboard.† The mate shook his head. â€Å"Not until we finish loading this jet fuel. I'll come down. How you doing, Scoop?† Pardee had convinced the crew of the Micro Spirit to call him â€Å"Scoop† one drunken night in the Yumi Bar. He watched the mate vault over the railing at the bow and monkey down a mooring line to the dock with no more effort than if he was walking down stairs. Watching him made Pardee sad that he was a fat man. The mate strolled up to Pardee and pumped his hand. â€Å"Good to see you.† â€Å"Likewise,† Pardee said. â€Å"Where you guys in from?† â€Å"We bring chiefs in from Wolei for a conference. Pick up some tuna and copra. Same, same.† Pardee looked back at the sailors loading the barrels. â€Å"Did you say jet fuel? I thought the Mobil tankers handled all the fuel for Continental.† Continental was the only major airline that flew Micronesia. â€Å"Mobil tankers won't go to Alualu. No lagoon, no harbor. We going to Ulithi, then take this fuel special order to the doctor on Alualu.† Pardee took a moment to digest the information. â€Å"I thought the Micro Trader did Yap and Palau States. What are you going all the way over there for?† â€Å"Like I say, special order. Moen has jet fuel, we here in Moen, doctor wants jet fuel soon, so we go. I like it. I never been Alualu and I know a girl on Ulithi.† Pardee couldn't help but smile. This was a story in itself. Not a big one, but when the Trader or the Spirit changed schedules it made the paper. But there was more of a story somewhere in those barrels of jet fuel, in the ru-mor of armed guards, and in the two pilots that had passed through Truk on the way to No One's Island. The question for Pardee was: Did he want to track it down? Could he track it down? â€Å"When do you sail?† he asked the mate. â€Å"Tomorrow morning. We get drunk together tonight Yumi Bar. My boys carry you home if you want. Hey?† The mate laughed. Pardee felt sick. That was what they knew him for, a fat, drunken white man who they could carry home and then tell stories about. â€Å"I can't drink tonight. I'm sailing with you in the morning. I've got to get ready.† The mate removed the betel nut cud from his cheek and tossed it into the sea, where tiny yellow fish rose to nip at it. He eyed Pardee suspiciously. â€Å"You going to leave Truk?† â€Å"It's not that big a deal. I've gone off-island before for a story.† â€Å"Not in ten years I sail the Spirit.† â€Å"Do you have room for another passenger or not?† â€Å"We always have room. You know you have to sleep on deck?† Pardee was beginning to get irritated. He needed a beer. â€Å"I've done this before.† The mate shook his head as if clearing his ears of water and laughed. â€Å"Okay, we sail six in morning. Be on dock at five.† â€Å"When do you come back this way?† â€Å"A month. You can fly from Yap if you don't want to come back with us.† â€Å"A month?† He'd have to get someone to run the paper while he was gone. Or maybe not. Would anyone even notice he was gone? Pardee said, â€Å"I'll see you in the morning. Don't get too drunk.† â€Å"You too,† the mate said. Pardee made his way down the dock, feeling every bit of his two hundred and sixty pounds. By the time he made it back to the street, he was soaked with sweat and yearning for a dark air-conditioned bar. He shook off the craving and headed for the Catholic high school to ask the nuns if they had any bright students who might keep the paper running in his absence. He was going to do it, dammit. He'd be on the dock at five if he had to stay up all night drinking to do it.