The Constitution of the United States Assignment

The Constitution of the United States - Assignment Example It has long been the tradition of rulers to have a constitution that is used to form the basis of governance. Since the earliest recorded history, constitutions were used to define who held the authority to tax or hold property. Constitutions had the additional responsibility of defining what the public's rights were and designing a structure of law enforcement. The wording and intent of a constitution define the nature that the government will have and the limits of its authority over individual freedom, free thought, free thought, and the ability of the people to make any necessary change. These traditions carried over to the US Constitution, which is a written document that defines the structure of government and its relationship to the people. As with the constitutions that preceded it, the document sets limits on power and provides a means to enact and enforce legislation. The US Constitution presents an agreed upon set of principles that are acknowledged to be universal and a system to implement these beliefs. The US Constitution spells out the rights that the people have and the legal recourse available when these rights are violated. The US constitution is based on the principle of separation of powers, which divides authority among the executive, legislative, and judicial branches. These basic principles were adopted from earlier European thinkers and constitutions, and form the foundation of the more eloquent expression that the legislative process is based on. In addition, the US constitution embodies the philosophical beliefs in equality and fairness that Americans have come to take for granted. While these principles were written into the original text, additional elaboration on individual rights and the need to accommodate a changing society have necessitated the addition of amendments.  

Converting Paper Records to a Computer Based Health Record Essay Example for Free

Converting Paper Records to a Computer Based Health Record Essay Traditional utilization of paper based medical records leads to the dispersion of clinical information as a result of the heterogeneous character of hospital systems. Due to this, the development of a clinical information system that can integrate hospital information as well as enable cooperation amongst legacy systems became a difficult task. System integration as well as the development of an efficient clinical information management system was thereby dependent upon the creation of conceptual and architectural tools that will enable such an integration. In line with this, many healthcare institutions are currently seeking to establish the integration of their workstations through the utilization of technological tools. Such tools are effective in the arrangement of clinical matters as well as in the arrangement of administrative and financial information. Clinical information systems are utilized by healthcare institutions in their integration of information. At this point, the utilization of electronic medical systems in healthcare delivery is evident in countries such as the United States, United Kingdom, Sweden, Hong Kong, Canada, as well as Australia. The current shift from a human memory based paradigm to a technological paradigm can be traced to the recent emphasis given on health care quality improvement and cost reduction. In lieu of this, policymakers started to adopt health information technology such as the Electronic Medical Record (EMR). According to Tim Scott in Implementing an Electronic Medical Record System, most information regarding the use of EMR systems are derived from the Regenstrief Institute, Brigham and Womens Hospital, the Department of Veterans Affairs, LDS Hospital, and Kaiser Permanente. The information derived from the following medical institutions shows the following. First, success is dependent upon the organizational tools rather than on the type of technology used. Second, minimal changes were noted in terms of increase of quality and efficiency as a result of the system’s adaptation. Such findings thereby led to the slow adoption and implementation of EMR systems since majority of medical institutions as well as healthcare systems required the high verifiability of the systems utility. True enough, researches within these institutions also showed that EMR systems increase the quality of patient care as it decreases medical errors, however, the economic aspect regarding its use has not been well documented leaving most medical institutions adamant regarding its implementation. In lieu of this, the paper is divided into three parts. The first part will present the rationale behind the formation of the technology based medical paradigm. It will be formulated within the parameters of Thomas Kuhn’s conception of scientific revolutions. The second part present a discussion of the various EMR components and the problems encountered in its implementation at Kaiser. The last part, on the other hand, will concentrate on presenting possible solutions to the problems evident in the utilization of the EMR systems within the Kaiser program while giving specific emphasis on the role of the agent in successful implementation. Thomas Kuhn, in his work entitled The Structure of Scientific Revolutions, discusses the very nature and necessity of what he calls scientific revolutions. In this particular work, Kuhn sees an apparent parallelism between political revolutions on the one hand, and scientific revolutions on the other. Kuhn writes: â€Å"scientific revolutions†¦ (are) those non-cumulative developmental episodes in which an older paradigm is replaced in whole or in part by an incompatible new one† (2000, p. 50). On a preliminary note, paradigms are frameworks in and through which we approach phenomena, in general. They are models, so to speak. Naturally enough, different models employ different methodologies, different methodologies in turn, generate different types of knowledge, which, consequently, have different criteria of proof or validity. Scientific development, as Kuhn contends, may appropriately be characterized by paradigm shifts and this he calls scientific revolutions. It is important to note that scientific developments do not occur in a vacuum. For the aforementioned reason, there is a felt need to situate scientific developments in the historical context within which they are conceived, proposed and ultimately, institutionalized and integrated as part of society’s shared knowledge. This is to say that scientific revolutions are also proper objects of historical analysis and discourse in as much as political revolutions are. Kuhn contends that there is a parallelism between political and scientific revolutions. As pointed out earlier, it is important to note that he characterizes scientific revolutions as â€Å"those non-cumulative developmental episodes in which an older paradigm is replaced in whole or in part by an incompatible new one. † Kuhn’s characterization emphasizes two important points. First, â€Å"that there is a replacement of an old paradigm by a new one†. Second, â€Å"that the new paradigm is not merely something new; it is also incompatible with the old paradigm†. This is to say that the incompatibility or the irreconcilability of the new paradigm with the old paradigm serves as warrant for the necessity of such a revolution. Although there are significant differences in both scientific and political developments, Kuhn argues that one may be justified in using the notion of revolution as a metaphor for understanding them. He writes: Political revolutions are inaugurated by a growing sense, often restricted to a segment of the political community, that existing institutions have ceased adequately to meet the problems posed by the environment that they have in part created. In much the same way, scientific revolutions are inaugurated by a growing sense, again often restricted to a narrow subdivision of the scientific community that an existing paradigm has ceased to function adequately in the exploration of an aspect of nature to which that paradigm itself had previously led the way. (2000, p. 150) Kuhn’s parallelism is thus, founded on the idea that in both cases, a sense of malfunction (in our institutions as for the case of the political, and in our paradigms as for the case of the scientific) necessitates for the occurrence of a revolution. In relation to this, the shift from a human memory based paradigm to the technological paradigm may be likened to a revolutionary development within the field of medical data acquisition and retention. The difference between the human memory based paradigm as opposed to the technological paradigm stems from the ascription of greater subjectivity in relation to human memory based data as opposed to technologically maintained data. As was stated in the first part of the paper, the heterogeneous characteristic of medical institutions stems from the existence of various separate holistic systems within it. As a result of this, deriving and correlating clinical information becomes tedious. The main reason for this stems from human memory based paradigms utilization of paper based records which has a high probability of non-viability and unreliability. Examples of this are evident in evidence-based medicines non-adherence to the traditional methods of training and practice. Second, paper based records fall short of their original expectations. The objective of the healthcare record is to identify problems and to understand the impact of the illness on the individual thereby enabling the amelioration of the problem to the patients satisfaction, within the bounds of medical capabilities and society’s resource limitations(Simpson and Robinson, 2002, p. 115). The main limitation of the paper bound records, therefore, stem from their inability of being multiply accessible to members of society. On the other hand, Scott related the reasons for the development of a technology based paradigm with the high verifiability of the positive results of technologically determined medical care processes. According to Scott, new technologies make it possible to evaluate and intervene to improve care in ways not heretofore possible (2002, p. 2). In line with this, members of both the public and private sector lobby for the accessibility of technological improvements. For the members of the private sector, this is due to the inclusion of the medical industry within the business sphere. For the members of the public sector, on the hand, demands for greater accountability for health care stems from the prevailing belief that technological advancements must be made accessible to the general public. According to the IOM, information technologys role in the substantial improvement of the redesign of the healthcare system is important since it ensures the formation of a strong infrastructure in supporting efforts to reengineer care processes oordinate patient care across clinicians and settings and overtime, support multidisciplinary team functioning, and facilitate performance and outcome measurement for improvement and accountability (qtd in Scott, 2002, p. 4). The results of the success of the EMR are traceable to the developments within the field of e-Health. According to Silber, EMR serves as the fundamental building block for the development of va rious applications such as the use of ICT by the Primary Health Care Team. Others involve the use of ERM for validation of research or as an instrument in Continuing Medical Education. Information necessary for the functions ascribed above, in relation to the personal health record, are possible since the health record’s functionality enables the inclusion of the following: practitioner order entry, electronic patient record, document management, clinical decision support, administrative data, integrated communication support, as well as access to knowledge and resources. According to Raymonds and Dolds, the functions of each component are as follows. The electronic patient record presents the patients history. Document management, on the other hand contains the actions undertaken in relation to the patients diagnosis. Clinical decision support as compared to the later contains the alerts based on current data from the electronic medical record, evidence based practical guidelines or more complex artificial intelligence systems for diagnostic support†. Access to administrative related information such as admission and discharge are contained within the section encompassing administrative data. Integrated communication support however provides the tools for the facilitation of effective and efficient communication amongst members of the patients health team. The last part enables access to other sources of information regarding the patients condition (Scott, 2007, p. 4). The Kaiser Permanente EMR implementation presented one of the main problems in relation to the utilization of the components of the technologically based paradigm. It was recognized that the problems arose due to several factors which range from the software’s lack of efficiency up to the non adherence of specific qualities of the program with the social conditions in the region as well as the team’s lack of background in relation to the efficiency the program necessitates with regards to the division of the work flow as well as its dependence upon all the players within the medical institutions that the program was implemented. Scott however stated that what should be given credence with regards to the above failed project is not so much as the failure of the program but the possibilities it opened in relation to the creation and implementation of new EMR programs in the future. Scott states, success and failure are socially negotiable judgments, not static categories† (2007, p. 43). Hence if such is the case it is thereby possible to conceive of the problems noted by Hartswood et al (2003) in relation to the user-led characteristic of EMR. The social negotiability of judgments thereby ensures the possibility of reversals in judgments as soon as occasions arise wherein a perceived failure may be reconnected with an overall success. In line with this, the continuous developments within the various EMR systems produced and implemented within the country ensures the viability and possibility of a near success and perfection within the system which in a sense also ensures the possibility of another scientific revolution in the near future whose scope may extend beyond that of the technological sphere.

Pearl Harbor Essay -- American History World War 2 WWII

"Yesterday, Dec. 7, 1941 - a date which will live in infamy - the United States of America was suddenly and deliberately attacked by naval and air forces of the Empire of Japan." Exactly as Franklin Delano Roosevelt proclaimed in his speech to Congress, December 7th would indeed live in infamy. Pearl Harbor was the most pivotal foreign affairs incident for the United States since the signing of the Declaration of Independence. Not only was it significant domestically, it had resounding consequences across the globe. It has lived on as one of the single most tragic events on United States soil. Early Warnings The United States had received many warnings stating there would be an attack on Pearl Harbor. In October, the Soviets top spy, Richard Sorge, informed Kermlin that Pearl Harbor would be attacked in sixty days. Moscow had then informed him that this had been passed on to the United States. The United States completely ignored all references to an attack on Pearl Harbor. On December 6th at 9:30pm, Roosevelt had read the first thirteen parts of the decoded declaration of war that the Japanese had sent to us. The document stated "This means war." This is when Roosevelt decided that it was time to proclaim war on Japan. Unfortunately, his decision did not reach Pearl Harbor in any helpful form before it was too late. Pearl Harbor has remained a controversial topic for these very same reasons. Franklin Delano Roosevelt has been blamed for not recognizing the seemingly obvious threats, but recently; a different take on the situation has surfaced. Historians have allowed for the possibility that Roosevelt was prevented from taking action by Congress. Some evidence to support this is an account by Harry Hopkins of the President'... ...concentration camps. These people were taken mainly from the west coast, apparently in case Japan invaded. Upon entering, they were searched, and stripped of any cameras or anything that might be construed as a weapon. Personal belongings were often taken, as well. Despite this, it is not often that you will hear a discussion of the American concentration camps during a history class in the United States. Conclusion Over the years, Pearl Harbor and all things surrounding it have been a controversial and sometimes tense subject. Some people would insist that FDR was a war-monger who could be held directly responsible for the loss of American lives. Others would say that he simply faced the facts. Both groups would be forced to agree that this country, indeed, this entire world, would be a much different place if the Japanese had not made their fateful sneak attack.

According to National Institute of Health

According to National Institute of Health (NIH) (2006), Acquired Immunodeficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus (HIV) by gradually destroying CD4+ T cells (also called â€Å"T-helper cells†), which play a significant role in the immune response system.In a healthy subject the CD4+ T cells range between 800 to 1,200 cells/mm3 but when this count falls below 200 cells/mm3, the individual is most vulnerable to â€Å"opportunistic infections† and cancers typical of AIDS.From the above it is evident that body has its own mechanism to prevent infections i.e., immune response system comprising of CD4+ T cells which are actually attacked by HIV systematically destroying the CD4+ T cells. These cells are active in fighting back infections attacking the body, thus once their count falls abnormally the body is vulnerable to the so called â€Å"opportunistic infections† which are typical of AIDS.Grant and Cock (2001) stated that general symptoms i n the early stages include loss of weight, fever, sweating during nights, diarrhea and frequent skin disorders especially of varicella zoster, fungal infections and pruriginous dermatitis leading to itchy rashes resulting into ulcerations and healing with pigmented macules.However the expanded definition of AIDS states that in addition to the above mentioned symptoms an individual is stated to be suffering from AIDS if the test for HIV antibody gives a positive result subject to one or more of the following conditions:à ¼Ã‚   Weight loss of more than 10%à ¼Ã‚   Cryptococcal meningitisà ¼Ã‚   Pulmonary or extra pulmonary tuberculosisà ¼Ã‚   Kaposi’s Sarcomaà ¼Ã‚   Neurological impairment sufficient to prevent independent daily activities.à ¼Ã‚   Candidiasis of the oesophagus and oral region accompanied by dysphagiaà ¼Ã‚   Recurrent episodes of pneumonia with or without aetiological confirmationà ¼Ã‚   Invasive cervical cancerCandidiasis of the oesophagus and oral regio n is caused to infection by fungus in immunocompromised patients such as those suffering from AIDS and gradually no medication may be effective in future course of time ultimately leading to loss of appetite and weight.Cryptococcal meningitis is infection of the brain and is due to spread of fungus from lungs to the brain through blood circulation. People who have defects in their cell-mediated immunity such those suffering from AIDS, are susceptible to disseminated cryptococcosis. Cryptococcal meningitis is fatal. The fungus infects the nervous system causing inflammation of the membranes covering the brain and spinal cord.The more frequent probable causes of HIV related diseases include cerebral toxoplasmosis and cryptococcal meningitis, â€Å"cerebral toxoplasmosis most often presents as a space occupying lesion of the brain, and cryptococcosis as chronic meningitis† thus brain gets effected in particular and nervous system in general.One of the important â€Å"opportunis tic infections† includes tuberculosis and may be detected at any stage in the course of immunodeficiency. Pulmonary tuberculosis is similar to non-HIV infected subjects in the initial stages of HIV infection, but the advanced stages of immunodeficiency exhibit â€Å"disseminated and multibacillary nature of tuberculosis† thus causing extensive damage to lungs in general and pulmonary system in particular.Pneumonia is an acute or chronic inflammation of lungs caused due to infection caused by a bacteria, virus or fungus. Patients suffering from AIDS easily get affected by opportunistic infections causing pneumocystis pneumonia or cytomegalovirus pneumonia.People suffering from AIDS are infected by various types of pneumonia affecting the lungs and respiratory system, thus respiratory system gets seriously affected along with the immune system.Kaposi’s Sarcoma is cancer of skin, mucous membranes and blood vessels. Kaposi’s Sarcoma is characterized by bleedin g at different sites on patient’s skin with the formation of round or elliptical lesions about quarter inch to one inch in size.

Research Methodology, Design and Process: Dementia Care

Abstract The ability to critically analyse literature is an important skill for evidence-based practice. This literature review aimed to critically analysed literature on dementia care. A search of literature was conducted on academic databases such as Pubmed and CINAHL. Three studies were finally retrieved for this literature review. Each of these studies was critiqued using the Critical Appraisal Skills Programme (CASP) tool for qualitative studies and the critiquing framework of Long et al. (2002). Findings of this literature review could be used to inform current and future community nursing practice. Specifically, this review revealed that music therapy could improve the mood of individuals with dementia and show evidence in improving memory function. While findings could not be applicable to a wider population, nurses could utilise findings and tailor these to the individual needs of their patients. Introduction Evidence-based practice (EBP) is heavily promoted in the NHS since this helps nurses and other healthcare practitioners apply findings of recently published literature to one’s current and future practice. The Nursing and Midwifery Council’s (NMC, 2008) code of conduct also emphasises that healthcare decisions should be evidence-based and supported by published literature and current guidelines. Developing the ability to critically analyse literature is essential when developing evidence-based care (Greenhalgh, 2010; Aveyard, 2014). There is a wealth of information from published literature and current guidelines. Determining the relevance and quality of these findings will help inform nurses whether findings are credible and valid before they are applied to current practice. As part of community nursing, I am interested in improving my current practice in order to deliver quality care to my patients. The recent policy on community care from the Department of Health (2013a) emphasises the importance of allowing patients with chronic conditions and their carers to self-manage their conditions, achieve self-efficacy and lessen admissions in hospital settings. This policy, â€Å"Care in Local Communities-District Nurse Vision and Model’ (Department of Health, 2013a) emphasises the role of nurses in supporting patients and their carers to improve their health outcomes. While it is acknowledged that patients with chronic illnesses may never recover from their condition, nurses have the responsibility to help patients or their carers manage signs and symptoms of the chronic illness. As a nurse in community setting, I have cared for patients with dementia. I saw how this condition impacts the patient’s quality of life and even increase the risk of depression amongst their carers (Talbot and Verrinder, 2009). I always had an interest in caring for patients with dementia. However, I noticed that most pharmacologic treatments have little effect in delaying the progression of cognitive impairments amongst these patients (Miller, 2009). These treatments are also costly and place a considerable burden on the family members and the NHS (Department of Health, 2013b). Hence, I thought that familiarising myself with non-pharmacologic interventions and their effects on cognition or memory of the patient would be important in my role as a community nurse. A number of non-pharmacologic interventions to preserve memory or delay cognitive decline have been developed in the last two decades. Studies (Spector et al., 2010; Hansen et al., 2006; Vink et al., 2004; Teri et al., 2003) show that these interventions range from motor stimulation, exercise programmes, sensory stimulation and cognitive training. Amongst these interventions, music therapy has been suggested to be least harmful and relatively effective. Some investigators (Fornazzari et al., 2006; Cuddy and Duffin, 2005) have shown that even in patients with severe dementia, music memory seemed to be preserved. However, some studies (Menard and Belleville, 2009; Baird and Samsom, 2009) suggest otherwise and explain that some patients with Alzheimer’s disease (AD) suffer from impaired music memory. One study (Baird and Samson, 2009) however, explained that procedural memory, specifically for musical stimuli are not affected in persons with dementia. With the acknowledgement tha t most pharmacologic interventions have limited ability to treat the symptoms associated with dementia, it is essential to consider how non-pharmacologic interventions, such as music therapy, alleviate symptoms of this condition. In order to enhance my current and future nursing practice and to increase my understanding on the relevance of music therapy to dementia care, I have decided to research this topic further. Literature Search A search of literature from academic databases such as the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Pubmed was done to retrieve relevant studies. CINAHL indexes more than 5,000 nursing and allied health sciences journals and contains almost 4 million citations. The depth of research articles indexed in this database makes it a database of choice for research on the effects of music therapy on patients suffering from dementia. Meanwhile, Pubmed was also used to search for academic literature. This database also contains millions of citations and indexes nursing and allied health journals. A quick search for ‘music therapy AND dementia’ was done in Pubmed since this database focuses on nursing and allied health journals. This search yielded 20 articles, most of which were available as full text journals. The same keywords were entered in the CINAHL database. The search yielded 14 articles, with almost all articles available as full text articles. A review of the abstracts of all articles was done to select only primary research studies conducted in the last five years. Polit et al. (2013) state that retrieving journal articles in the last five years will ensure that the most recent evidence is used to inform current and future nursing practice. Literature older than five years old may be outdated. However, this also increases the risk of excluding landmark studies (Aveyard, 2014). For the present review, the selection of studies was only restricted to the last five years to ensure that more recent evidence on music therapy were evaluated and critiqued. The re was also no restriction on the place where the studies were conducted since dementia affects people of different ethnicities. Learning from the experiences of other nurses or healthcare practitioners on the use of music therapy for dementia patients would also help improve nursing practice in the UK. The following articles were chosen for critique and evaluation: Simmons-Stern et al. (2012) ‘Music-based memory enhancement in Alzheimer’s disease: promise and limitations’ Sakamoto et al. (2013) ‘Comparing the effects of different individualized music interventions for elderly individuals with severe dementia’, Dermot et al. (2014) ‘The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists’ As previously stated, I am interested in how music therapy could help me assist my patients delay the progression of dementia and help them and their carers self-manage the signs and symptoms of dementia. Hence, all articles are relevant my work as a community nurse. To critique these studies, the Critical Appraisal Skills Programme (CASP, 2013) tool for critiquing qualitative studies was utilised. For the quantitative studies, Long et al. (2002) critiquing framework for quantitative studies was used. Both critiquing frameworks are easy to use and help researchers investigate the quality and rigour of research articles. Study 1: Simmons-Stern et al. (2012 A review of the title of the study shows that it reflected the main aim and objectives of the study. The title was concise and provided information to the readers that the study aimed to present the limitations of music-based memory enhancement as well as its possible application to nursing practice. Polit et al. (2013) emphasise the importance of creating a concise and clear title in order not to mislead readers and to inform stakeholders if the article is worth reading. A review was also done on the author’s background and shows that all had extensive background on dementia research and healthcare. This was essential since credibility of the authors’ background could increase the reliability of the findings of the study (Long et al., 2002). However, Hek and Moule (2011) emphasise that the authors’ background is not the sole criterion in assessing the credibility of the findings of the study. The abstract of the study failed to mention the type of study design used. While the abstract summarises the aims and main findings of the study, it did not follow the usual structure of an abstract in a journal article where the methodology or methods used are explicitly stated. Ellis (2010) reiterates that an abstract should provide a brief summary of the study’s background, aims and objectives, methodology, results and conclusion. Although it was difficult to determine why the researchers of this study failed to present the methodology in the abstract, readers of the study could have benefited from an abstract that states the methodology of the study. Reading of the body of the article would show that the quantitative study design was used. The study aimed to investigate the effects of music on the memory of patients suffering from Alzheimer’s disease, one of the diseases grouped under dementia. Simmons-Stern et al. (2012) made excellent use of literature and related findings from previous studies with the current study. Apart from the excellent use of literature, there was also a very good review of the previous studies and a gap in literature was clearly presented. Hence, the literature review of the study was well written and provided the readers with good background on why there is a need to carry out the present study. Polit et al. (2013) emphasise that a well-written review of literature should be able to provide context to the study’s aims and objectives and argue why there is a need to address the gaps in literature. Importantly, Simmons-Stern et al. (2012) avoided the use of jargon when writing the paper. Burns and Grove (2013) explain that the use of jargon should be avoided since this excludes readers of the article that have no nursing or medical background. A good paper is one that is written for a general audience and not only for a scientific community (Burns and Grove, 2013). A total of 12 participants who were diagnosed with Alzheimer’s disease and 17 healthy controls g ave their informed consents to participate in the study. Brown (2009) states the importance of obtaining the informed consent of participants before commencing the study. This would not only protect the rights of the participants but also ensure that the nurse researchers are observing the Nursing and Midwifery Council’s (NMC, 2008) code of conduct in protecting the patients or participants from harm. Part of obtaining an informed consent is the presentation of the study’s aims and objectives, possible side effects or benefits when participating in the study (Brown, 2009). An informed consent will also ensure that debriefing is provided to the participants to avoid any harm and psychological distress to the participants (Oermann, 2010). Apart from getting the informed consent, it was also crucial that an ethics committee has evaluated and approved the study protocol. An evaluation of the study reveals that this was observed and an ethics committee approved the study. On reflection, the study has a very small sample size (n=12 experimental group; n=17 control group). This would have taken a randomised controlled study design since a control group was used to compare the effects of music therapy on the patients with a healthy control. However, the investigators specifically state that this study was comparative. An inclusion and exclusion criteria were used when recruiting the patients, suggesting that participants were not randomly selected. Since the study was quantitative and employed the experimental study design, random sampling of the participants who have been more applicable (Crookes and Davies, 2004). It should be noted that it would also be difficult to randomise participants since this study was only conduc ted in one healthcare setting and it was crucial that participants have developed AD. While randomisation of participants was not observed, it is noteworthy that the investigators stated how many of the participants were excluded from the study and the reasons of their exclusion. This was essential since failure to explain why participants who gave their informed consents to participate in the study but were later excluded in the actual experiment would make the data collection process unclear (Moule and Goodman, 2009). Despite the small sample size, the demographic characteristics of the two groups were not significantly different when t-test was done. There were no significant differences in prior musical training, formal or informal, years of education and age between the participants of the two groups. This allowed the investigators to determine if there were differences after the study, this might have been due to the intervention employed. After informed consents were taken, the authors of the study declared that they paid the participants for the hours spent during the study. Compensating the participants for the time is considered as ethical since considerable time has been taken away from the subjects for their participation in the study (Hek and Moule, 2011). The interventions were clearly stated. This increased the rigour of the study since a clearly stated research method would help other investigators replicate the methods in future studies and verify whether similar findings are obtain ed (Hek and Moule, 2011). Simmons-Stern et al. (2012) also specifically outlined the lyrics used and where these were obtained and how music memory of the participants was tested. Results section of the study clearly presented the main findings of the study. Appropriate statistical tests were also utilised to test the hypotheses of the research. Polit et al. (2013) emphasise that statistical tests should be appropriate to the study’s aims and objectives and should rule out any biases in interpretation of the findings. Despite having a small sample size, the researchers were able to establish that music in patients with AD enhances memory in terms of familiarisation of sung lyrics but not in spoken stimuli. This suggests that in patients with AD, they can enhance their memory when familiarising with the lyrics or listening to music but not when they hear spoken language. There were also no significant differences in the healthy control and experimental groups in terms of memory after hearing the lyrics of a song compared to hearing the lyrics as a spoken stimuli. Since this study has a small sample size, the applicability of the findings to a larger and more heterogeneous population would be difficult (Burns and Grove, 2013). Although a control was used, it should be noted that participants in the experimental group are in the early stages of AD. This could have affected the findings of the study since it is unclear if patients with severe dementia would also yield similar reactions and results. At present, the findings are applicable to the sample population of the study and importantly, only on individuals in the early stages of dementia. While there were several limitations of the study, findings are noteworthy since these show that music therapy is promising as a non-pharmacologic intervention for enhancing memory in individuals with early stage dementia. The conclusion of the study was clearly presented and summarises the key points presented in the study. Although the discussion states future areas of study, there were no clear recommendations in the conclusion. Specific recommendations could have been made at the end to help future researchers identify areas of investigation. There were also no implications for future nursing and other healthcare practitioners’ practices. Despite the lack of clear recommendations, readers can still read through the study and identify areas that need further investigation. For example, there is a need to replicate the study in a larger and randomly selected sample population to strengthen the validity and reliability of the findings. There is also a need to compare findings with patients suffering from moderate to severe dementia to determine if music still has similar effects on the memory of those in advanced stages of the illness. There are a number of implications of the study in nursing practice. Nurses can use music to help enhance memory or prevent deterioration of memory amongst individuals with early stages of the disease. It is essential to consider the acceptability of music therapy in those suffering from dementia. As a whole, the study was of high quality and effort was made to reduce bias within the study. Although the investigators failed to blind assessors to the study, findings were presented objectively. It is also difficult to blind assessors because of the very small sample size (Burns and Grove, 2013). All investigators were familiar with the background of the participants and blinding them to the intervention was difficult since these investigators were also responsible in implementing the interventions. Finally, there were no conflicts of interest (Polit et al., 2013), ensuring the readers that bias in presentation of findings was avoided. Study 2: Sakamoto et al. (2013) An evaluation of the study’s title reveals that it was concise and clearly reflects the study’s aims and objectives. This was essential (Long et al., 2002) since this would present to the readers the main aim of the study. The type of study design chosen to answer the study’s aims was also appropriate. A quantitative study design would help investigators answer the research aims and objectives through experimentation, surveys or a randomised controlled trial (RCT) (Brown, 2009). In Sakamoto et al. (2013), the randomised controlled study design was used. Compared to other quantitative study designs, a RCT reduces risk of selection bias and bias in interpretation of findings (Moule and Goodman, 2009). Selection bias occurs when participants are not randomly selected and do no have equal chances of being assigned to a control or experimental groups (Crookes and Davies, 2004). This is avoided in RCT since all participants are randomly assigned to an experimental or c ontrol group. On the other hand, bias in interpretation of findings is lessened especially if investigators and assessors are blinded to the interventions and standard treatment (Oermann, 2010). A critical analysis of the study shows all participants in the study were randomly assigned to the treatment and standard care groups. However, a major limitation of this study was its relatively small sample size (n=39). It would be difficult to transfer findings to a larger and more heterogeneous group due to the representativeness of the sample population (Ellis, 2010). While it is difficult to transfer findings to other settings due to the relatively small sample size, community nurses may consider the applicability of the findings to their own practice. It is noteworthy that it would be difficult to recruit participants in the advanced stages of dementia since their ability to give their informed consent is severely limited (Department of Health, 2009). Further, their participation requires that their carers or immediate family members are aware of the study’s aims and objectives and should be able to assist the participants during the the study. While an ethics board app roved the study and informed consents were taken from the respondents or their representatives (Burns and Grove, 2013), involving individuals who suffer from severe cognitive impairment would be difficult. This also carries some ethical issues since their ability to understand the procedures of the study is compromised (Hek and Moule, 2011). Although the Mental Health Act in the UK acknowledges that carers can act in behalf of the individual with mental health condition, ethics regarding their participation in research studies remains debatable (Department of Health, 2009). Despite the possible ethical issues surrounding the study, investigators of this study used other means of evaluation to assess the participants’ responses to the interventions. For example, they used the Faces Scale (Sakamoto et al., 2013) to determine the emotions of the participants. A review of the study’s aims and objective shows that these were clearly presented in the beginning of the study. The introduction and review of literature also made excellent use of previous studies. It is also important to note the gaps in practice in recent studies were highlighted in the literature review section (Ellis, 2010). A good literature also argues why there is a need for the new study and how this could be applied to current healthcare practices (Ross, 2012). Methodology and methods used were also appropriate for the research question. Since the study aimed to determine the effectiveness of music therapy, it is appropriate that a RCT is used to compare music therapy with st andard care. Comparing music therapy with standard care is ethical (Ross, 2012) since all patients in the study received interventions. It would be unethical to withdraw treatment or assign participants to a control group that would receive no intervention (Crookes and Daives, 2004). The evaluation tools used to measure the responses of the patients were appropriate and have been previously validated and standardised. This was necessary to convey to the readers that validated measurement tools were used in the study (Moule and Goodman, 2009). A clear description of the research methods was presented. This would allow future researchers to replicate the present study (Oermann, 2010) and determine if similar findings could be observed. This also increases rigour of the study (Burns and Grove, 2013) since it is essential for other researchers to also test the hypothesis of the study and ensure that results are consistent across different healthcare settings. Results of the study were well presented and appropriate statistical tests were used. The discussion section of the study presented the strengths and limitations of the study. Polit et al. (2013) emphasise that presenting the limitations of a study will help inform other researchers on areas that need further improvement and presents areas for further research. Since weaknesses of the study were presented, readers and other healthcare practitioners can determine the extent in which the findings can be applied to current and future nursing practice (Burns and Grove, 2013) . The conclusion of the study succinctly captures the main points raised in the research study. This helped the researchers identify the main highlights of the study (Ellis, 2010). However, recommendations for other researchers and areas of improvement of the study were not cited. While the discussion section presented these limitations and areas for future studies, brief recommendations at the end of the study could have added rigour to the research study. Importantly, there were no conflicts of interest. This assured the readers that bias in reporting of data was reduced (Ellis, 2010). Findings of this study have important implications in nursing practice. All participants received either the passive or interactive music intervention while the control group received no music intervention. There was careful choice of music in the interactive group. For example, healthcare workers assigned to the interactive group helped investigators choose music for the patient participants. Music played during the intervention all had special meaning to the participants. All interventions were given individually for 30 minutes per session at once a week for 10 weeks. Those in the interactive group were allowed to clap, sing or interact with the music. Meanwhile, those in the passive group only listened to the music. The music chosen for the passive group also had special meaning to the participants. Those in the control group sat in silence for 30 minutes during the once a week session. Interestingly, findings show that music associated with special memories led to significant cha nges in the parasympathetic nervous system of the participants. Investigators note that music significantly increased relaxation of the individuals immediately after intervention when compared to baseline data. However, these were not noted in the control group. Significant changes were also seen on the emotional states of the participants in the interactive and passive music intervention groups. Music appeared to elicit pleasant emotional states. However, when passive and interactive groups were compared, the latter was significantly more relaxed following the music intervention. It should be noted that patients with severe dementia are more sensitive to environmental stimuli and may experience stress when placed in a new environment (Morris and Morris, 2010). Further, patients with cognitive impairments may express feelings of stress and fear through disruptive behaviour (Morris and Morris, 2010). The difficulty in verbalising their emotional needs could aggravate their responses to their surroundings (Department of Health, 2009). Hence, the st udy of Sakamoto et al. (2013) may have important implications in nursing care for patients in community settings. Nurses can encourage family members to play music that have special meaning to their loved ones suffering from dementia to illicit positive emotional states. The calming effect of music could be an advantage for patients cared in home or care settings since this would not only prevent stress but also allow patients to enjoy quality of life. Study 3: Dermot et al. (2014) A review of the study’s title shows that it also reflects the main aims and objectives of the study. Readers could easily understand that the study explored the experiences of individuals with dementia, their carers, staff and music therapists when music interventions are employed. The CASP (2013) tool for qualitative studies contains three screening questions that should be used to determine if a study is worth reviewing. The study of Dermot et al. (2014) suggests that music can help maintain the person’s interconnectedness and their quality of life. Findings have important implications in nursing practice since music intervention (Miller, 2009) is not costly and could yield positive results for patients suffering from early to advanced stages of dementia. Further review of the study shows that aims and objectives of the research were clearly stated. The main aim of the study was to explore the meaning of music in the lives of individuals suffering from dementia. Inves tigators of this study state that there is limited knowledge on why or how individuals find music beneficial to their wellbeing. Understanding the role of music according to the perceptions of the patients and their carers will help inform nursing practice on the relevance of music in the lives of people with dementia. A qualitative research methodology was appropriate for the study’s aims since the research aims to interpret the subjective experiences of individuals with dementia. Parahoo (2006) emphasises that a qualitative study allows researchers to explore the experiences and perceptions of individuals in more detail and depth. Since open-ended questions are used, investigators can use probing questions (Burns and Grove, 2013) to help participants articulate their experiences. One of the strengths of this study was the inclusion of participants’ family members, care home staff and music therapists. Individuals suffering from dementia were recruited from care homes and those living in the community. This allowed Dermot et al. (2014) to compare the perceptions of people with dementia living in care homes or in the community and determine if settings of the individuals impact their experiences with music therapy. Recruitment strategy employed was also appropriate for the research ai ms. There was also a clear explanation on the methods of data collection. Semi-structured interviews and focus group discussions were done. In the former, this would allow researchers to investigate perceptions of participants in more detail (Parahoo, 2006). However, this requires more time to complete especially if there are many participants in a study. A focus group discussion, on the other hand, requires little resources and could be completed in one setting (Polit et al., 2013). However, if a dominant member would be included in a focus group discussion, interactions would be limited (Burns and Grove, 2013). This could be avoided with a facilitator who knows how to redirect the discussion to all members of the focus group. A stregnth of the study of Dermot et al. (2014) is the presentation of a rationalisation on why they used a combination of focus groups and in-depth interviews. It should also be noted that participants with dementia might display cognitive impairments, depending on the stage of their illness. Hence, requiring these patients to explain their experiences in more depth might be challenging. However, the investigators tried to mitigate this challenge by including carers of the patients as part of the study participants. Inclusion of carers could provide researchers with more detailed information on how music impacts the wellbeing and quality of life of the patients since these carers are more acquainted with the individuals suffering from dementia (Miranda-Castillo et al., 2010). It is also noteworthy that music therapy was individualised to the patients in the study. Thi s suggests that comparison of music therapy received by the patients was not done. Instead, investigators focused on the impact of music therapy on the patients’ wellbeing. In addition, the study did not take into account the differences in music interventions and whether this shaped the individual’s reaction to music therapy. Despite the differences in music intervention, it was common for the music therapists to use songs that were well-known to the patients. They also supported active music therapy with exploratory improvisation. Dermot et al. (2014), however, failed to explain what is exploratory improvisation or how this was done during music therapy. There was also an explanation on the content of the guides used for the in-depth interviews and focus group discussions. This was essential to demonstrate the coverage of the interview guides and whether each guide reflects the aims and objectives of the study (Moule and Goodman, 2009). However, the relationship between the researchers and the participants was not thoroughly discussed. If the participants knew the investigators, this might lead to potential bias especially if the researchers hold positions of power (Oermann, 2010). Despite this limitation, Dermot et al. (2014) emphasise that only one facilitator guided the focus group discussions. There were changes in the methods used during data collection. For instance, where a focus group discussion was initially decided, this was then changed to individual interviews in the second group of patients and healthcare workers. Dermot et al. (2014) explain that the severity of dementia of the patients was considered in the choice of d ata collection. In-depth interviews were used when patients had severe dementia. There were also sufficient details on how participants were recruited and whether ethical standards were observed. Polit et al. (2013) state that ethics in research is crucial to ensure that the rights of the participants were observed and they were not subjected to undue stress or negative experiences during data collection. Confidentiality was also observed in the study and all participants remained anonymous. Approval was also sought from an ethics board in the community settings. Data analysis of qualitative data could be extensive and time consuming (Parahoo, 2006). Informing readers how data was analysed would help increase the rigour of a qualitative study. Dermot et al. (2014) provided an in-depth description of how data was analysed. Thematic analysis was also used to present the main findings of the study. There was also a clear description on how categories and themes emerged. For instance, the long-table approach was used during analysis of data. Verbatim transcripts wer e used to support the main themes. This ensures validity and credibility of the main themes generated in the study (Polit et al., 2013). Contradictory data were also taken into account. The researchers also critically examined their own roles in the research process and the potential bias that might arise during analysis of research data. While respondent was not done, validity and credibility of the data were observed through constant comparison of categories and themes. More than one researcher was involved in the analysis of data. Professors and doctoral students of the Doctoral Programme in Music Therapy were also consulted during thematic analysis and were involved in identifying categories. Importantly, findings were discussed with reference to the original research question. A discussion was also made on the relevance of the study to dementia care. Findings of this study suggest that music is a medium that is readily accessible to patients with dementia. Many of the patients, their carers and healthcare staff admitted that music promotes mental stimulation and is an emotionally meaningful experience. Almost all participants also remarked that song lyrics with personal meanings helped patients remember their personal history. It is also perceived to reinforce personal and cultural identity. Music is also perceiv ed to promote connectedness and building and sustaining of relationships. In addition, music has immediate effects on the mood of the patients. Most of the staff members who participated in the focus group discussions remarked that agitation of the patients decreased as a result of music therapy. It is also shown to promote a relaxing environment in the care homes. On the other hand, listening to music in the lounge area could be challenging since care home residents might have different music preferences. Hence, it would be a challenge for healthcare workers to address all the music preferences of the patients. Since the study was qualitative, transferability of the findings to a larger and more heterogeneous population is impossible (Polit et al., 2013). However, other healthcare practitioners could use findings to help build a peaceful environment for patients suffering from dementia. A further review of the study also shows that the conclusion summarises the main points raised in the study and provides recommendations for other researchers to consider in similar studies in the future. Implications of Findings in Nursing Practice Findings of this literature review could be used to improve nursing practice when caring for patients with dementia. All three studies (Simmons-Stern et al., 2012; Sakamoto et al., 2013; Dermot et al., 2014) included in this literature review demonstrate the impact of music therapy on patients with dementia. Music therapy could improve health outcomes and quality of life of the patients from early to advanced stages of the disease. In the latter, patients who have difficulty communicating their needs, react positively to music therapy. Many of the patients with severe dementia show less agitation when exposed to music that was once relevant to them before they suffered from dementia. This suggests that music therapy could even not only promote positive mood of the patients but might even reconnect them to ‘who they are’ (Dermot et al., 2014). This holds important implications in nursing practice in community settings. Music therapy could be introduced to families caring for a loved one with dementia and could be used to calm the patient, reconnect with their family members and create an environment that is less stressful for the individual with dementia. The type of music therapy, however, will be dependent on the preferences of the individual (Sakamoto et al., 2013). This is consistent with patient-centred care (Department of Health, 2009) where patient preferences are considered when creating a care plan or introducing healthcare interventions. It is suggested that interactive music therapy (Simmons-Stern et al., 2012; Sakamoto et al., 2013) might be more effective than passive music therapy in improving memory and mood of the patients with dementia. As a community nurse, I need to be aware of the different non-pharmacologic interventions for people with dementia. I can use findings of this review when caring for patients suffering from dementia. Music therapy is relatively easy to carry out and entails very little cost. Importantly, it has positive short and long-term impacts on patient’s mood, memory and quality of life. Hence, considering this type of intervention could also help ease the burden of carers who provide care to these patients on a daily basis. I could use information from this literature when conducting patient education. I can inform my patients and their family members of the benefits of music therapy and the sustainability of this type of therapy over time. I can also encourage family members to consider music therapy to help alleviate the mood of the patients and provide a calm environment. Conclusion This literature review has shown the feasibility and promise of music therapy in promoting wellbeing, improving memory and quality of life of patients with dementia. As a community nurse, music therapy could be employed with the help of a music therapist in community settings. Families and carers could be taught on how to use this type of therapy to improve the mood of the patient or to calm the individual when agitated. This type of therapy holds some promise in long-term care for people with dementia. As shown in the review, individuals with severe dementia still have the ability to respond positively to music therapy. However, consideration should still be made on the applicability of the findings of the three studies to a larger and more heterogeneous population. All studies recruited a relatively small sample size that might not be representative of the experiences of a wider group of people with dementia. Although this limits applicability, findings can be tailored to the needs of individual patients. Considerations should also be made on the preferences of the patients and their family members on whether music therapy is acceptable to them. Since there is a need to practice patient-centred care, nurses have to determine if patients or their family members are willing to employ music therapy. It should ne noted that this literature review is only limited to reviewing three studies. Literature on the acceptability of music therapy was not evaluated. Despite this gap in the present literature review, the positive responses generated after music therapy should help patients and their family members consider music therapy. References Aveyard, H. (2014) Doing a literature review in health & social care: A practical guide. 2nd ed. Berkshire: Open University Press. Baird, A. & Samson, S. (2009) Memory for music in Alzheimer’s disease: unforgettableNeuropsychology Review. 19(1), p. 85–101. Brown, S. (2009) Evidence-based nursing: the research-practice connection. Sudbury Mass: Jones & Bartlett Publishers. Burns, N. & Grove, S. (2013) The practice of Nursing Research: Conduct. critique and utilisation. 7th ed., St. Louis: Elsevier Saunders. Critical Appraisal Skills Programme (2013) 10 questions to help you make sense of qualitative research. England: CASP. Crookes, P. & Davies, S. (2004) Research into practice. Essential skills for reading and applying research in nursing and healthcare. 2nd ed. Edinburgh: Bailliere Tindall. Cuddy, L. & Duffin, J. (2005) Music, memory, and Alzheimer’s disease: is music recognition spared in dementia, and how can it be assessedMedical Hypotheses. 64(2), p. 229–235. Department of Health (2013a) Care in local communities: A new vision and model for district nursing. London: Department of Health. Department of Health (2013b) Improving care for people with dementia [Online]. Available from: https://www.gov.uk/government/policies/improving-care-for-people-with-dementia (Accessed: 5 December, 2014). Department of Health (2009) Living Well with dementia: A National Dementia Strategy. London: Department of Health. Ellis, P. (2010) Understanding research for nursing students. Exeter: Learning Matters. Fornazzari, L, Castle, T. & Nadkarni, S. (2006) Preservation of episodic musical memory in a pianist with Alzheimer disease. Neurology. 66(4), p. 610–611. Greenhalgh, T. (2010) How to read a paper: the basics of evidence-based medicine. West Sussex, UK: John Wiley and Sons. Hansen, V., Jorgensen, T. & Ortenblad, L. (2006) Massage and touch for dementia. Cochrane Database of Systematic Reviews. 4, p. CD004989. Hek, G. & Moule, P. (2011) Making sense of research. 4th ed. London: Sage. Long, A., Godfrey, M., Randall, T., Brettle, A. & Grant, M. (2002) Developing evidence based social care policy and practice. Part 3: Feasibility of undertaking systematic reviews in social care. Leeds: Nuffield Institute for Health. McDermot, O., Orrell, M. & Ridder, H. (2014) The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists. Aging & Mental Health. 18(6), p. 706-716. Menard, M. & Belleville, S. (2009) Musical and verbal memory in Alzheimer’s disease: a study of long-term and short-term memory. Brain and Cognition. 71(1), p. 38–45. Miller, C. (2009) Nursing for wellness in older adults. Philadelphia: Lippincott Williams and Wilkins. Miranda-Castillo, C., Woods, B., Galboda, K., Oomman, S., Olojugba, C. & Orrell, M. (2010) Unmet needs, quality of life and support networks of people with dementia living at home. Health and Quality of Life Outcomes. 8:132 doi: 10.1186/1477-7525-8-132. Morris, G. & Morris, J. (2010) The dementia care workbook. London: McGraw-Hill International. Moule, P & Goodman, M. (2009) Nursing Research: An Introduction, London: Sage Publishers. National Institute for Health and Clinical Excellence (NICE) (2009) Depression: The treatment and management of depression in adults. London: NICE. Nursing and Midwifery Council (NMC) (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Oermann, M. (2010) Writing for publication in nursing. 2nd ed., Philadelphia: Lippincott Williams & Wilkins. Parahoo, K. (2006) Nursing Research: Principles, Process and Issues. 2nd ed. New York: Palgrave Macmillan. Polit, D., Beck, C. & Hungler, B. (2013) Essentials of nursing research, methods, appraisal and utilization. 8th ed., Philadelphia: Lippincott Williams & Wilkins. Ross, T. (2012) A survival guide for health research methods. Maidenhead: OUP. Sakamoto, M., Ando, H. & Tsutou, A. (2013) Comparing the effects of different individualized music interventions for elderly indivduals with severe dementia. International Psychogeriatrics. 25(5), p. 775-784. Simmons-Stern, N., Deason, R., Brandler, B., Frustace, B., O’Connor, M., Ally, B. & Budson, A. (2012) Music-based memory enhancement in Alzheimer’s disease: promise and limitations. Neuropsychologia. 50(14), p. 3295-3303. Spector, A., Orrell, M. & Woods B. (2010) Cognitive Stimulation Therapy (CST): effects on different areas of cognitive function for people with dementia. International Journal of Geriatric Psychiatry. 25(12), p. 1253–1258. Talbot, L. & Verrinder, G. (2009) Promoting Health: The Primary Health Care Approach. Australia: Elsevier Australia. Teri, L., Gibbons, L., McCurry, S., Logsdon, R., Buchner, D., Barlow, W., Kukull, W., LaCroix, A. McCormick, W. & Larson, E. (2003) Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. Journal of the American Medical Association. 290(15), p. 2015–2022. Vink, A., Birks, J., Bruinsma, M. & Scholten, R (2004) Music therapy for people with dementia. Cochrane Database of Systematic Reviews. 4, p. CD003477.

One Flew Over the Cuckos Nest essays

One Flew Over the Cucko's Nest essays One One Flew Over The Cuckoos Nest In our study of this novel of rebellion, and protest. The ward in One Flew Over the Cuckoos Nest is microcosism of a much larger world, where power is too often misused and individuality is stifled for the sake of conformity.By using Chief Bromden as the Narrator Kesey pulls the reader right in to the middle of this by taking the only character that can shed light on all of the dominant themes present in the novel. Which are Keseys views on the feminist movement, civil rights, and the underlying idea of conformity. All of these issues are exposed in the "pool scene" in which the author, and director are constrained to different parameters, and must use different devices to convey the same message. The dominant theme in this novel is that of conformity. In the novel conformity is represented as a machine, or in Chief Bromden's mind a "combine" . To the Chief, the "combine' depicts the conformist society of America The Chief views the mental hospital as a big machine , which is run by " The Big Nurse" who controls everyone except McMurphy with "wires", and a "control panel"( which the Chief see quite clearly in his psychosis). In the Chiefs eyes McMurphy was missed by the "combine", and the Chief and the acutes were lured into it. Therefore McMurphy is an nonconformist and is free from the "wires" of "The Big Nurse" and so he is a threat to the "combine". This is very clear in the "pool scene". This excerpt from the book demonstrates R.Ps influence on the acutes to rebel, "Now that McMurphy was around to back them up, the guys started letting fly at everything that had ever happened on the ward they didnt like."(158) In the film you can actually see the acutes looking at McMurphy after they make their arguments to nurse Ratched, and he backs them up in the b ook by asking the doctor directly before the nurse had a chance to answer. This segment of the novel...

The Skimmers Guide to CoSchedule (Overview of the Best Features)

The Skimmers Guide to (Overview of the Best Features) Managing an entire marketing strategy†¦ well, it can feel like your head is spinning. Just as one campaign gets out the door†¦ Another thousand content requests come flying in (on way too short of notice) Your team members are frantically working on a million different things†¦ your social strategy is less-than-optimized your own to-do list is longer than should be legal And honestly†¦ You’ve come to the point where you need some HELP. As the #1 marketing project management, content organization AND social scheduling tool†¦ we’ve got the solutions you need to make your life a billion times  easier AND  get your entire marketing strategy back on track. ðŸ™Å' And since youre a busy marketer with *no* time to spare Ive put together  The Skimmers Guide To (so you can find the solutions you needfast). Table of Contents Project Management + Content Organization Custom Color Labels Projects Tasks, Task Templates, AND Task Approvals Saved Calendar Views Read-Only Views Tags Integrate With Your Favorite Tools Marketing Campaigns Team Performance Reports Social Media Scheduling Social Campaigns Social Helpers Bulk Social Upload ReQueue Best Time Scheduling Social Scheduling â€Å"On The Fly† For Mobile Social Engagement Report Social Campaign Report Social Network Reports (for Facebook, Twitter, LinkedIn, Instagram, and Pinterest) So let’s jump right into all the ways can stop your head from spinning and turn YOU into an ultra-organized, cool-as-a-cucumber (because you’ve got everything under control) marketing pro. Lets go! The Skimmers Guide to (Overview of the Best Features) Managing an entire marketing strategy†¦ well, it can feel like your head is spinning. Just as one campaign gets out the door†¦ Another thousand content requests come flying in (on way too short of notice) Your team members are frantically working on a million different things†¦ your social strategy is less-than-optimized your own to-do list is longer than should be legal And honestly†¦ You’ve come to the point where you need some HELP. As the #1 marketing project management, content organization AND social scheduling tool†¦ we’ve got the solutions you need to make your life a billion times  easier AND  get your entire marketing strategy back on track. ðŸ™Å' And since youre a busy marketer with *no* time to spare Ive put together  The Skimmers Guide To (so you can find the solutions you needfast). Table of Contents Project Management + Content Organization Custom Color Labels Projects Tasks, Task Templates, AND Task Approvals Saved Calendar Views Read-Only Views Tags Integrate With Your Favorite Tools Marketing Campaigns Team Performance Reports Social Media Scheduling Social Campaigns Social Helpers Bulk Social Upload ReQueue Best Time Scheduling Social Scheduling â€Å"On The Fly† For Mobile Social Engagement Report Social Campaign Report Social Network Reports (for Facebook, Twitter, LinkedIn, Instagram, and Pinterest) So let’s jump right into all the ways can stop your head from spinning and turn YOU into an ultra-organized, cool-as-a-cucumber (because you’ve got everything under control) marketing pro. Lets go!

Intrinsic Property Definition (Chemistry)

Intrinsic Property Definition (Chemistry) In chemistry, an intrinsic property is a property of a substance that is independent of the amount of the substance present. Such properties are inherent qualities of the type and form of matter, mainly dependent on chemical composition and structure. Key Takeaways: Intrinsic Property of Matter An intrinsic property is independent of the size of a sample or the amount of matter that is present.Examples of intrinsic properties include density and specific gravity. Intrinsic Versus Extrinsic Properties In contrast to intrinsic properties, extrinsic properties are not essential qualities of a material. Extrinsic properties are affected by external factors. Intrinsic and extrinsic properties are closely related to intensive and extensive properties of matter. Examples of Intrinsic and Extrinsic Properties Density is an intrinsic property, while weight is an extrinsic property. The density of a material is the same, regardless of the conditions. Weight depends on gravity, so it is not a property of matter, but depends on the gravitational field. The crystal structure of a sample of ice is an intrinsic property, while the color of the ice is an extrinsic property. A small sample of ice may appear clear, while a large sample would be blue. Source Lewis, David (1983). Extrinsic Properties. Philosophical Studies. Springer Netherlands. 44: 197–200. doi:10.1007/bf00354100

Partnership and limited liability partnership in the United States Essay

Partnership and limited liability partnership in the United States - Essay Example Humans have since time immemorial been considered social beings making partnership between individuals a common concept. Partnerships can as well exist between businesses, interest based organizations, schools, governments allowing for their nature and structure to be varied. Under this type of arrangement, partners agree to share their profits and losses and this mutual understanding is what allows them to operate efficiently (Wood 21). People engaging in partnerships often have varied reasons for their union. Some partner with others in order to increase their likelihood of achieving their goals when the situation calls for1. Others may partner simply to pool resources together in order to be able to participate effectively in the business world. While profits may be the driving force for some, strategic positioning is a major underlying reason for the formation of partnerships especially amongst those who are actively engaged in the business world. And because each member brings a long their own set of reasons for forming the alliance, partnerships have been marred with special challenges and issues. It is because of the dynamic nature of partnerships that the concept of civil law was introduced in their formation (Smith 16). An agreement is a symbolic tool of understanding between partners in any engagement. These agreements define each individual's goals, the company's overall goal, roles and responsibilities of each partner, lines of authority and succession, how achievements and shortcomings are to be classified, and most important, how resources are to be shared within the company. And because of the detailed nature of these agreements, they are required to be written down on paper and appropriately signed by all members in the partnership. This is done for future reference and each party often advised to keep a copy of the agreement. Articles of partnership are often drawn by the partners who are members of the partnership in order to make the document legally enforceable by law. (Smith 17). The roles of partners are often quite defining as to the nature with which they interact with the organization. In a general partnership, all partners manage the business and are personally liable for any expenses that are incurred during the management of the business. In the United States, there have been established limited liability partnerships which have got different features as compared to other forms of partnership2. A limited liability partnership accords its owners limited personal liability which is suitable for use in professional groups like accountants and lawyers3. The nature of Limited Liability Partnership These partnerships are often preferred because one partner does not wish to be liable for the problems or mistakes made by other partners within the organization. This is often the case is malpractice claims that may prove detrimental to the company even if they are fully enforceable by law4. In the case of malpractice clai ms, LLP protects each partner from any costs or expenses arising from any malpractice lawsuits that may be leveled against one partner5. Overall, LLP's have similar advantages as those realized in limited partnerships. One can still take part in the management of the business in an active manner, without exposing themselves to personal liability for the decisions and actions undertaken by the other partners beyond the value of their investment in the arrangement.

Women Suffrage Movements Term Paper Example | Topics and Well Written Essays - 1250 words

Women Suffrage Movements - Term Paper Example Participation of women in a countries decision-making process is a social issue that is experienced in the political field. This is because their participation depends on how they participate in making decisions at the domestic level. Their ability to make decision at the domestic level determines their chance of making decision at the national level through the voting process. At the beginning of the nineteenth century, the question of whether women have a chance to vote was a major question in European politics1. Women suffrage could not have achieved success if women did not fight for their rights. This essay will therefore analyze European women suffrage between the late nineteenth century and the dawn of the twentieth century. The essay will focus on major movements, key figure, and beliefs of women suffrage across Europe. The French revolution of 1789 is believed to have been the source of the notion of citizenship. This notion changed people view and attitude towards their cou ntries2. The notion of citizenship caused people to have interest and responsibility over their home countries. Voting in a national election comes as a responsibility as well as an obligation for every citizen. After the French revolution, women in most European countries started to consider themselves responsible for their country’s development and decision-making.... at took place during the upper half of the nineteenth century are considered to have paved way for major changes and revolutions across European societies. The ideology of nationalism during the dawn of twentieth century also contributed to the field. As an ideology, nationalism identified people according to their national boundary, ethnicity, political boundaries, history, and culture3. The rise of nationalism and French revolution are considered as the main factor that triggered women suffrage. Although the two movements seemed insignificant to women suffrage campaigns, they laid a foundation that other future movements could use to launch their campaigns for women rights in European societies. This indicates that establishing women’s rights in governance was a demanding issue. Different ideologies across Europe determined women’s suffrage across various European countries. The rise of ideology paved way for actual campaigns for women’s rights across Europe wi th their emphasis being the right to vote among women. Although women’s suffrage campaign had a common source, the campaigns were different across the different European countries. This is because each individual country had its own unique political system. Countries with hereditary monarch system of government such as Austria, Russia, Spain, and Hungary did not have voting rights for both their men and women4. Lack of national unity was also a common issue in some European countries such as Denmark, Germany, and Ireland. This implies that establishing women’s rights in such country was a complicated as well as a difficult issue. Lack of national unity and democracy in most European countries hindered women's suffrage movements. Absence of democracy and national unity in European countries also

The Ethics of Surveillance Cameras Essay Example | Topics and Well Written Essays - 2000 words

The Ethics of Surveillance Cameras - Essay Example From when you walk out of your house, in most cities, you are being watched (Parenti, 2003). This is because the cameras are now installed in major city streets, gas stations, retail shops and transport systems such as trains. The use of surveillance cameras doubled in the aftermath of the 9/11 terrorist attacks in New York City. These prompted frantic efforts, to curb terrorism, a major threat to security in this century. We are seeking to look at the ethics of surveillance cameras. Historically, the idea of watching the public by a select few, especially those who control us politically and economically can be traced to the Panoptical (Foucault, 1977). This was a kind of prison design, built in such a way that a single guard could watch the prisoners in a single gaze. This is a big way induces prisoners in a state of conscious and permanent knowledge that they are being watched. Foucault saw surveillance as productive machinery of continuous mind control, which is somehow what current surveillance cameras represent. Therefore, what we seek to argue here is that we need new ethics in the surveillance camera industry, because of the reasons below. This is because surveillance when done correctly and for the right reasons and people, then we can surrender apart of our civil liberty to privacy, for the sake of public security. Closed -circuit televisions when placed in public areas, give people a sense of security, reduce crime by up to five percent. Up to ninety percent of respondents saw no problem in having such surveillance in public areas. Surveillance done in the above manner, by the correct agencies, can be said to be ethical and legal. On the other hand, we can seek to look at the ethics of surveillance cameras, by looking at who does it and for what they will be  used to do, therefore the ethics of surveillance cameras. Ethics is defined by the BBC online, as a system of moral principles. This is what is good for the individual and society, therefore is responsible for holding the society together.  

Norman v Future Publishing Limited Essay Example | Topics and Well Written Essays - 1500 words

Norman v Future Publishing Limited - Essay Example The appellant’s original complaint went as stated in the originating Statement of Claim went on to allege that the publication of the words used had the result of placing the appellant into â€Å"ridicule, mockery and contempt.†Ã‚  Ã‚   It was also alleged that the words used in the publication had caused serious injury to the appellant’s â€Å"personal and professional reputation and in any event to her feelings.†   Lord Buckley, the judge at first instance struck out Norman’s Statement of Claim, essentially ruling that the words used, when taking together with the entire article could not be construed in the manner pleaded by Norman.   Norman then appealed to the Court of Appeal against the lower court’s decision under Order 82, Rule 3A of the Rules of Supreme Court, 1994 which provides that any party to a defamatory action may apply to a judge in chambers for an order â€Å"determining whether or not the words complained of are capabl e of bearing† certain meanings or the meanings complained on in the originating process.   The Order goes on to provide that if the judge upon hearing such an application agrees that the words complained of are not capable of â€Å"bearing the meaning† alleged in the pleadings he is at liberty to â€Å"dismiss the claim or make such other order as he deems just and fair.   The Court of Appeal went on to state that although appeals under this Order are typically discouraged,   when the result of the order is to dismiss the action altogether as it did in Norma’s case, or to take away from the jury the consideration.

Information Power Inside An Organization Research Paper

Information Power Inside An Organization - Research Paper Example If the information is used as a means of trade, it possesses a great power (Hersey et al., 2001). Information is necessary for shaping an organizational behavior because information is able to create a great influence on the people in an organization. Many organizations operate out of four major frameworks (Bresnahan et al., 2002). The frameworks include custodial, supportive, autocratic and collegial. Autocratic: the Autocratic model has a basis of power with managerial authority orientation (Anni-Kaisa Kà ¤hkà ¶nen, 2010). This model makes the employees to be oriented towards dependence and obedience on the boss (American Association of School Librarian, 1998). The subsistence need for the employee is met. The result of performance is thus minimal.Custodial: the Custodial model has a managerial money orientation and its basis is economic resources. The employees get an orientation towards benefits and security. The employees are also able to depend on the organization (Salancik, 1977). Passive cooperation is the performance result of this model and it meets the employee need of security. An organization that has this model is referred to as custodial organization (Anni-Kaisa Kà ¤hkà ¶nen, 2010). Supportive: the Supportive model is mainly concerned with the leadership.The managerial orientation of this model is support. The employee orientation is mainly concerned with the job participation and performance.The supportive model enables the employee need for recognition and status to be met.

The Most Important Contributors to Health Compromising Behaviors Essay

The Most Important Contributors to Health Compromising Behaviors - Essay Example One in five of all deaths every year in the United States have been credited to smoking, killing more than AIDS, suicide, alcohol, car accidents, homicide, and illegal drugs combined (American Cancer Society, 2004). Smoking is badly affecting the society. It is the most common addiction all around the world. In developing and countries where literacy rate is nil or less are more addicted to smoking and hence their behavior towards their relatives, education, society and future changes. With the adverse affect on health they face mental sickness. To decrease the rate of smoking many coutries are taking necessary steps as Bishop and Yoo (1985) declared that a surgeon's general report in 1964, regarding the knowledge of severe health affect of smoking, showed a diminution in cigarette sales. Before the provision of this report, taxes fixed on cigarettes were intended just to raise the revenue on the sale of cigarettes. However, after the provision of the Surgeon General's report, the ta xes fixed on cigarettes had an additional purpose of discouraging cigarette smoking (Meier & Licari, 1997). However, a great amount of people are addicted to alcoholic drinks, which are also a chief cause of ill-health nowadays. Drug abuse not only affects an individual but harm the whole society or community. The people who are addicted to alcohol consumption not only waste their money and precious time due to intoxication but also leave a bad impact on their young ones. Research explains that increased sales law enforcement can decrease the selling of alcohol to individuals. Plainly, setting up enforcement of lowest alcohol buying age laws is desired to make them more efficient (Grube, 1997). Drinking is harmful for the social and cultural values of a person. Intoxicated drivers do not just harm their own life but may also create risk for the other drivers and people around. Alcohol users being well aware of these problems do not quit it. Extreme drinking is really terrible for physical and mental conditions. Alcohol increases the risk of serious illness like heart disease, liver disease, reproductive problems and memory loss. It is declared in journal of the American medical association, the death rate of Alcoholic women is comparatively greater than Alcoholic men. This journal also declares that the danger of breast cancer rises with the regular use of alcohol. Although alcohol use is ordinary among a greater part of college undergraduates (Kuther & Timoshin, 2003; Ziemelis, Bucknam, & Elfessi, 2002), a division of students busy in a type of drinking behavior that occupies great levels of alcohol use which may put them at danger for communal, mental, emotional and physical troubles. This specific type of drinking behavior has been identified in the literature as binge drinking and includes the extreme use of alcohol in short periods (Murgraff, White, & Phillips, 1996). Current approximation discovers that about 44 percent of college students are resulted to be involved in binge drinking behavior (Torr J.D., 2002). Excessive drinking is a severe problem found in numerous colleges. To tackle this problem, study has swung towards knowing why college students use alcohol at height well over secure limits on sole drinking occasions (Murgraff et al.). More

Information Power Inside An Organization Research Paper

Information Power Inside An Organization - Research Paper Example If the information is used as a means of trade, it possesses a great power (Hersey et al., 2001). Information is necessary for shaping an organizational behavior because information is able to create a great influence on the people in an organization. Many organizations operate out of four major frameworks (Bresnahan et al., 2002). The frameworks include custodial, supportive, autocratic and collegial. Autocratic: the Autocratic model has a basis of power with managerial authority orientation (Anni-Kaisa Kà ¤hkà ¶nen, 2010). This model makes the employees to be oriented towards dependence and obedience on the boss (American Association of School Librarian, 1998). The subsistence need for the employee is met. The result of performance is thus minimal.Custodial: the Custodial model has a managerial money orientation and its basis is economic resources. The employees get an orientation towards benefits and security. The employees are also able to depend on the organization (Salancik, 1977). Passive cooperation is the performance result of this model and it meets the employee need of security. An organization that has this model is referred to as custodial organization (Anni-Kaisa Kà ¤hkà ¶nen, 2010). Supportive: the Supportive model is mainly concerned with the leadership.The managerial orientation of this model is support. The employee orientation is mainly concerned with the job participation and performance.The supportive model enables the employee need for recognition and status to be met.

Computer and Network Hardware Assignment Example | Topics and Well Written Essays - 250 words - 3

Computer and Network Hardware - Assignment Example Additionally, utilizing wireless network is simpler than utilizing cable network that has its own complexities. Hardwired systems have the tendency of backing up individuals in waiting to utilize computers. Consequently, this presents time limitations for individuals utilizing these systems. Fast Ethernet enable clients to receive augmented transmission speeds. The Ethernet protocol has implemented a novel standard that sustains 100 Mbps. Fast Ethernet necessitates utilization of dissimilar and expensive network hubs, in addition to network interface cards (Spurgeon, 2000). Furthermore, this category of Ethernet necessitates utilization of five twisted pair cable (Contreras, 2005). This category of Ethernet has considerable use in learning institutions to ensure that these institutions obtain reliable internet services, considering the huge populace that utilizes the internet. Bus and Star are the best topologies for library systems although the Star functions best in offering library services. Star topology requires easier maintenance relative to Bus topology. Additionally, it is easily installed and offers little difficulties during troubleshooting network-related problems (Bangia, 2005). Backbone entails huge transmissions that deliver information obtained from miniature lines that are linked to these transmission lines. These lines link LAN to WAN depending on the distance of

Importance of Conservation Essay Example for Free

Importance of Conservation Essay The term wildlife has been used to refer to species of wild plants and animals. Nature is a term which infers not only life forms but also the interactions between those life forms. Biodiversity is a comprehensive word for the degree of nature’s variety, including both the number and frequency of ecosystems, species and genes in a given assemblage. It is a word which embraces both species richness and genetic diversity, both of which are being threatened throughout the world. Species extinctions and a reduction in genetic variability is taking place at rate never before witnesses. These losses can be attributed to various factors including pollution, physical disturbance, exploitation for food and other uses, deliberate extirpation, and habitat loss and fragmentation; the last of these is undoubtedly the most serious threat. Symptomatic of the rapidly growing human population, pollution, extinctions and habitat loss are all contributing to a diminished quality of life for future generations (Spellerberg, 1992). Conservation of Botanical Diversity Plants are the basis for life on Earth and without their capacity to capture the sun’s energy through the process of photosynthesis there would be no life in our planet. Therefore the conservation of plants is vital to the continued existence of life. There are between 250 and 300 thousand species of flowering plants, an estimated 200 thousand species of ferns, conifers, mosses and liverworts, giving a total of over half a million plant species in the world. Each species has different habitat requirements, performs different ecological functions in different ecosystems and has different uses or potential uses for humankind. It is not then enough to preserve a few selected plant species. For the survival of a quality of life, and the maintenance of the physical processes such as climate patterns, atmosphere and soil, the majority of plant species are needed. It is, therefore, of utmost importance that conservation techniques for plants aim at preserving as many species as possible (Maxted, Ford-Lloyd, Hawkes, 1997). Nature Conservation and Landscape Ecology Nature conservation generally focuses on land and distinguishes between two main types of protected area: the national or international parks, and reserves. Like in the case of Konza Prairie Trail, aside from research purposes, the site is also being conserved to preserve the biodiversity in the area and save the animals that are living in the site (Mason, 2007). National/international parks are heterogeneous areas in which generally different biotopes are present and in which some processes are sufficiently conserved. Reserves are generally patchy and smaller, being surrounded by an agricultural or developed matrix. Nature conservation plans are generally achieved following three main approaches: Conservation of threatened plants and animal populations; Conservation of representative biotopes (a piece of land with a particular type of nature), including communities and ecological processes; Conservation of areas with high biological and/or ecological diversity Generally conservation policies tend to conserve structures rather than processes. Landscape ecology can be useful for nature conservation because it takes into consideration the spatial arrangement of habitats, and consequently considers structures and processes as perceived by the different species. This perception often does not coincide with human perception, creating difficulties when management action is required. A compromise should be found, since in the future wild, remote and large areas will be increasingly rare because of human intrusion (Farina, 1997).

Essays --

Annotated Bibliography Agars, M. D. (2004). Reconsidering the Impact of Gender Stereotypes on the Advancement of Women in Organizations. Psychology of Women Quarterly, 28(2), 103-111. doi:10.1111/j.1471-6402.2004.00127.x This article reveals the disparities in the workplace due to gender stereotypes favoring men over women in executive positions. Women have a much more difficult path to obtain executive positions, and maintain them. This article helps by showing the number of high-level women in fortune 500 companies. U.S. Department of Labor indicates that women occupy more positions in executive and managerial roles. However, with closer examination of Fortune 500 companies, only two women occupy the position of CEO opposed to their original statement of 45%. Gere, J., & Helwig, C. C. (2012). Young adults’ attitudes and reasoning about gender roles in The family context. Psychology of Women Quarterly, 36(3), 301313.doi:10.1177/0361684312444272 This study shows that even though the roles of men and women in society and the workplace have experienced a lot of change in the past few decades, there has been very little change in the family dynamic of men and women and the roles that society expects each to assume. The study wanted to examine the attitudes that women and men have about what their domestic responsibilities. When ask about supporting equal role divisions, women were more likely to base their reasoning on morality, and men were more likely to rely on what they believe to be socially accepted. In contrast, stereotypes regarding women’s roles, and social responsibility regarding men’s traditional roles were used to support the maintenance of traditional role divisions. Goswami, S., & Gupta, H. N. (2012). Percepti... ...ation over a five-year period to observe how minority ethnic women's workplace experiences differ from mainstream counterparts. The analysis results reveal the ongoing nature of multiple discriminations faced by minority ethnic women. Tachibana, C. (2012). Diversity: Promoting New Perspectives. Science, 337(6092), 367-370. doi:10.1126/science.opms.r1200120 The article looks at the importance of diversity in fields of science such as engineering, and mathematics careers as a way to activate innovation. We will use this article to help explain that it is important for the presence of women to be increase in male dominated fields. Also, the article urges the need for adequate child care for working mothers and the need to change some formal career requirements to accommodate female professionals who traditionally bear more of the responsibilities for child care.

Descriptive Essay - The Interesting Bus Ride Home -- Descriptive Essay,

The Interesting Bus Ride Home When most people think about an eventful or memorable place, they almost certainly would not picture a bus. As we all know, buses are not exactly attractive. The design scheme is the same in almost every bus: rows and rows of brown seats, a thin black aisle down the middle of the bus, hundreds of hazy windows, and the big, lemon-yellow exterior. Not many people, I am sure, would consider buses to be an important part of their lives. However, if a person were to think about it, they would realize that they probably have had at least one memorable experience in their life that took place on a bus. One of the most memorable bus experiences in my life happened when I was in fifth grade. The final bell at school had rung, so I sprinted out to the bus with a few of my friends to save seats since our bus was always crowded. After we flung our backpacks into the four back seats, we ran back inside the school to buy some Mountain Dew from the pop machine in the cafeteria. After jamming our quarters into the machine and snatching the cans out of the bin, we sprinted back outside to make sure we did not miss the bus. It was still there, in all its yellow glory, so we hurried through the doors and onto the bus. It had been wet and cloudy since that morning--a typical Oregon day--and as I made my way to the back of the bus, the faint smell of rain mingled with the rubbery-plastic smell of hundreds of little rain boots. When I finally got to my seat, I was rather unnerved to find that not only was someone sitting in my seat, but that that someone was none other than Nathaniel Larson, the most obnoxious kid in the 5th grade. I took a deep breath and said, in the kindest voice I could muster, "Nathan, you... ...int was chipped on the outside, and on the inside the chairs had holes and writing all over them. Oddly, though, this bus smelled slightly of paint, which was a huge contrast to its shabby condition. But to us, this dingy yellow vessel was beautiful; it was warm, and it would take us home. This old/new bus continued our route, and we all sat quietly, awaiting our stops. Everyone had a tired, almost forlorn look, as though they had been through much more than just switching buses. I did not have any concept of time as the bus chugged along, stopping occasionally to let people off, and all of a sudden I recognized that it was almost to my stop. I jerked out of the stupor I was in as the bus stopped in front of my apartment complex. As I gathered up my things to leave, I looked at my friends and said, "Well, this will make one interesting story at school tomorrow!"