Wednesday, July 31, 2019
Philip Kotler is widely acknowledged as the father of modern marketing and the worldÃ¢â¬â¢s foremost expert on strategic marketing. . His writing has defined marketing around the world for the past forty years. He is the S.C. Johnson & Son Distinguished Professor of International Marketing at ChicagoÃ¢â¬â¢s Northwestern University Kellogg School of Management. The Management Centre Europe has labeled him Ã¢â¬Å"the worldÃ¢â¬â¢s leading expert on the strategic practice of marketing.Ã¢â¬ Early Life Kotler was born in Chicago on May 27, 1931. Both KotlerÃ¢â¬â¢s parents emigrated in 1917 from Ukraine and settled in Chicago. Education He studied at DePaul University for two years and was accepted without a bachelorÃ¢â¬â¢s degree into the MasterÃ¢â¬â¢s program at the University of Chicago (1953) and his PhD at Massachusetts Institute of Technology-MIT (1956), both in economics. He studied under three Nobel winners in Economic Science: Milton Friedman, Paul Samuelson, and Robert Solow. He did a year of postdoctoral work in mathematics at Harvard University and in behavioral science at the University of Chicago. Professional Life Kotler started teaching marketing in 1962 at the Kellogg School of Management, Northwestern University. Kotler moved into marketing which he believed is an essential part of economics. He saw demand is influenced not only by price but also by advertising, sales promotions, sales force, direct mail, and various institutions (wholesalers, retailers, agents, etc.) operating as distribution channels. Kotler is the author and co-author of over 55 books and 150 published articles. His other textbooks include Principles of Marketing and Marketing: An Introduction. He has authored several books on all aspects of marketing, including the most widely used marketing textbook in graduate business schools worldwide, Marketing Management, (originally published in 1967 is the worldÃ¢â¬â¢s leading book inÃ marketing, and is translated into over 25 languages. It has educated millions of students. In 1996, it was judged to be one of the top 50 best business books of all times) now in its 14th edit ion. He has published more than 150 articles in leading journals, including the Harvard Business Review, Sloan Management Review, Journal of Marketing, Management Science and the Journal of Business Strategy. His first research in marketing was in mathematical modeling of marketing processes and impacts. In Journal of Marketing on January 1969, he extended the concept of Marketing. This article proposed the thesis that marketing concepts apply to non-commercial activities as well. Not-for-profit organizations can apply marketing analysis and concepts to advantage. He has consulted for IBM, General Electric, AT&T, Honeywell, Bank of America, Merck and others in the areas of marketing strategy and planning, marketing organization and international marketing. He has also advised governments on how to develop and position the skills and resources of their companies for global competition. He was voted the first Leader in Marketing Thought by the American Marketing Association and named The Founder of Modern Marketing Management in the Handbook of Management Thinking. Professor Kotler holds major awards including the American Marketing AssociationÃ¢â¬â¢s (AMA) Distinguished Marketing Educator Award and Distinguished Educator Award from The Academy of Marketing Science. The Sales and Marketing Executives International (SMEI) named him Marketer of the Year and the A merican Marketing Association described him as Ã¢â¬Å"the most influential marketer of all time.Ã¢â¬ (2008, Leaders in London Conference).
Tuesday, July 30, 2019
3 Ã¢â¬â 5 YEARS PHYSICAL DEVELOPMENT Buttons/unbuttons own clothing, cut out simple shapes, draw a person with head, trunk and legs, walk on a line, aim and throw ball, hop on one foot, form letters; write own name, colour in pictures, completes 20-piece jigsaw, skip with a rope, run quickly and able to avoid obstacles, throw large ball to a partner and catch it. Run, jump, begin to climb ladders; can start to ride tricycles; try anything; is very active. INTELLECTUAL DEVELOPMENTUnderstand concepts like grouping and matching, identify parts of a whole, draw, name, and briefly explain pictures, actively seek information. Tell their full name and age, show awareness of past and present, play with words, mimicking and creating sounds, and make rhymes, point to and name many colors, understand order and process, draw a person with detail, learn both by observing and listening to adults' explanations. Begins to notice differences in the way men and women act. Imitate adults. Continue t o learn through senses. Begin to see cause-and-effect relationships.Are curious and inquisitive. LANGUAGE DEVELOPMENT Retell a story (but may confuse facts) Combine thoughts into one sentence Ask Ã¢â¬Å"when? Ã¢â¬Å", Ã¢â¬Å"how? Ã¢â¬ and Ã¢â¬Å"why? Ã¢â¬ questions. Use words like Ã¢â¬Å"can,Ã¢â¬ Ã¢â¬Å"will,Ã¢â¬ Ã¢â¬Å"shall,Ã¢â¬ Ã¢â¬Å"should,Ã¢â¬ and Ã¢â¬Å"mightÃ¢â¬ . Combine thoughts into one sentence. Refer to causality by using Ã¢â¬Å"becauseÃ¢â¬ and Ã¢â¬Å"soÃ¢â¬ Follow three unrelated commands. Understand comparatives like loud, louder, loudest. Understand sequencing of events when clearly explained. Listen to a long story. EMOTIONAL DEVELOPMENT Seem sure of self. May not obey limits, tests rules, and often says no.Need freedom with limits. Self-assured, stable and well-adjusted. Like to be around mother and like to be at home. Like to follow rules. Like being given jobs to do. Can wait for their needs to be met, can feel secure when in a strange p lace away from their main carers, are less rebellious and use language rather then physical outbursts to express themselves. May have imaginary fears and anxieties. Project their own experiences onto dolls and toys. Show awareness of their own feelings and those of others, and talk about feeling. Similar essay: How Different Types of Transitions Can Affect Children
Principles of Gastronomy Topic: Discuss the means by which gastronomy can be understood as a tourism product. Introduction The emergence of gastronomic tourism is observed when a number of tourism organizations have incorporated gastronomy gastronomic elements into tourism as part of an marketing strategy, giving rise to the gastronomic tourism. (Hjalager and Richards, 2000). In first place, the essay is going to explain the respective concepts of gastronomy and tourism, following by description of gastronomic tourism with reference to the typology suggested by Hjalager AM (2002).Typical examples of tourism products with gastronomy focus range from food events, cooking class and workshops; food fairs featuring local products, visits to markets and producers, museums to souvenirs. In the later session there will be explanation on how gastronomy is understood as a tourism product, by fulfilling different motivations of tourists. Tourism and tourists motivation In a simple context, tour ism refers to traveling and visiting new destinations away from their usual place of residence.By definition, tourism product includes the total tourist experience that meet its expectations, including experience with housing, natural and cultural attractions, entertainment, transportation, catering. Tourists seek for travelling experience that fulfills their motivations. According to Fields (2002) and McIntosh RW, Goeldner CR & Ritchie, J. R. (1995) , , touristsÃ¢â¬â¢ motivation for traveling can be categorized into physical motivators, which include thrill seeking, escape from routine , sensory seeking, health concern.Also, there are cultural motivators, interpersonal motivators and status and prestige motivators. Gastronomy as a tourism product The study of gastronomy was first undertaken by Jean Anthelme Brillat-Savarin (1994). The word gastronomy is derived from Greek word gastros, meaning stomach, and gnomos, knowledge or law. According to Kivela J & Crotts JC, gastronomy is understood as the study of the relationship between food and culture. This includes the tasting, preparing, experiencing, experimenting and researching, discovering , understanding and even writing about food and wine .Embodying the idea of art of living, gastronomy has become an indispensable element in order to get to know the culture and lifestyle of a territory. Being regarded as a new trend in tourism, gastronomy can be understood as a tourism product by the means that it fulfill several touristsÃ¢â¬â¢ values and expectations: seeking knowledge and appreciation in food and beverage, understanding the culture and heritage of a place, searching for healthy lifestyle, experiencing authenticity or enjoying retreats from urban lifestyle, seeking for prestige and status, and lastly pursuing sustainability.Moreover, active promotions by marketers contribute to the understanding of gastronomy as a tourism product. The following sessions will explain the concepts in details. Gastrono my Ã¢â¬â enhancing knowledge and appreciation of food and beverage A formal dining experience in foreign countries is an example of gastronomy tourism product. Apart from the atmosphere and leisure experience enjoyed, formal meal experience provides tourists with the opportunity to learn local culture, such as exploring table manners and gain knowledge about local food.In particular, the differences in use of ingredients and methods of preparing, cooking, and preserving food between countries can be considered as authentic or traditional culture (Fields 2002). Therefore, displaying authentic, and local cultures is a way that gastronomy can be understood as a tourism product. Cooking classes in famous culinary destinations is another way in which tourists can explore deeper about the gastronomic world. Vacationing and cooking classes is increasing in popularity because tourists can learn to cook amazing food instead of merely tasting good food.Classic culinary destination includes Burgundy and Loire Valley in France . Furthermore, Biltmore Culinary Academy (2012) , at the Biltmore Hotel is a recreationalÃ cooking School that has a dedicated learning area and fully equipped professional kitchen offering a variety of classes, workshops, team-building events. Special foreign cooking techniques can be acquired through the learning process. Such tourism experience is far reaching and bringing long lasting benefits to travellers. Understanding culture and heritage by gastronomic tourism product Fields 2002) pointed out that local food and beverages can be included amongst cultural motivators because when tourists are experiencing new local cuisines, they are also experiencing a new culture. Tasting local food can be one of the ways to understand and experience local culture. According Leigh (2000), there is a strong relationship between types of food consumed and certain locations. Types of food consumed varies among different locations . For example . it is nor mal for French to eat eat frogs and snails, horse in their meals; Arabs eat camel meat and drink camel milk while?Australian eat Kangaroo and Emu. Different places have very distinctive food cultures. Such differences serve as uniqueness of each location and provide reasons for tourists to travel away from home. Moreover, regional gastronomic routes contribute to the understanding of local culture and enhance of agricultural knowledge (Munster 1994). In Benelux, there are seasonal routes that reflect links between agricultural cycles and local food production such as asparagus route, a mussel route, a hops route and a gin route.Seasonality of these routes coincides with the main tourist season to cater their needs. As these routes showcase specific products of a particular location in particular season, gastronomy can be understood as tourism product by its relevance to agricultural knowledge. Gastronomy in searching for healthy lifestyle as a tourism product Gastronomy can be under stood as a tourism product through the emphasis on health concerns (Richards G, 2002). Tourists from the developed countries are increasingly cautious about their health.For example, some health farms offer food products which have positive impacts on health and physical condition; The Ã¢â¬ËMediterranean DietÃ¢â¬â¢ in Greece and Italy, or the Ã¢â¬ËAtlantic DietÃ¢â¬â¢ in Portugal also emphasizes the health benefits of their food. Western tourists who are burdened by obesity or high cholesterol level are particularly attracted to pay a visit. Gastronomy can therefore be a tourism product by fulfilling tourists physical needs of improving health conditions.Experiencing authenticity or enjoying retreats from urban lifestyle In working farms, tourists can get a touch with simple and unsophisticated peasant food and beverage that is prepared with care and respect to tradition. The authentic experience is particularly treasurable for tourists who seek for retreats from tourists spo ts with extravagant decor and service. In a vineyard, tourists can participate in harvesting of grapes and fruits. These experience enable tourists, who are mainly city dwellers to try something new and enrich their personal experience.Gastronomy can be understood as a tourism product by allowing city dwellers to visit farmersÃ¢â¬â¢ market. Visitors can obtain country experience outside city and gain knowledge outside school textbooks. For example, interactive farm experiences offered in Collingwood ChildrenÃ¢â¬â¢s Farm (2012) include fun activities such as bottle-feeding lambs, milking the cow. Trained staff will teach visitors how to approach and handle farm animals correctly. The FarmersÃ¢â¬â¢ market also brings about real and fresh produce from over 70 farmers in the region.Products such as seasonal fruit, regional olive oil, smoked meat & fish, artisan cheeses, home made condiments, and artisan cheeses are examples. A wine tour experience in the relaxing suburb is also po pular gastronomic tourist activity. Wine tours typically include session of wine tasting, with adorable cheese or chocolate. Visitors can also walk through a heritage trail from the picturesque vineyards to the historic settlement; tourists can also meet the winemaker who will share their experience in winemaking process, and have a gourmet lunch experience paired with high quality wines ( Wyndham Estate 2012 ) .Gastronomy as a tourism product to express prestige and status One of the motivators for tourism is seeking of status and prestige. Gastronomy can be understood as a tourism product as it fulfills requirement in this aspect. According to Fields (2002) , eating nice food in a luxury place or attending special occasions can be regarded as a means to be distinguished from others. Moreover, tourist can express their prestige by tasting unique local food.Reynolds (2002) further pointed out that eating food in a nice restaurant and being seen to eat there can be considered as a to ol of drawing status distinctions. Gastronomy in form of souvenirs can also be tourism product that fulfills onesÃ¢â¬â¢ motivation of seeking prestige. Distinctive food and beverage products that is not available at home place are popular among tourist. Examples are authentic ingredients, designer glassware, porcelain, cutlery, and kitchen gadgets souvenirs, which can highlight the local culture of a place.Souvenirs can serve as a status symbol that allows tourists to share their prestigious and unique memories with family and friends. Large-scale events such as food and wine festivals are the most popular tourism product in gastronomy context. For example, the Food Network South Beach Wine & Food Festival presented by FOOD & WINE is a national, star-studded, four-day destination annual event showcasing the talents of the worldÃ¢â¬â¢s most renowned wine and spirits producers, chefs and culinary personalities (SOBEFEST 2012).Tourists can have a chance to meet the culinary celebri ties such as Bobby Flay, Emeril Lagasse, Rachel Ray and so on. Events such as tribute dinner are rare opportunity for tourists to have a touch with featured dishes of some of the worldÃ¢â¬â¢s most renowned chefs. Moreover, smartest designer cafes and restaurants that serve innovative menus and offer equally chic service are equally attractive to tourists who enjoy indulging themselves in trendy foods and wines. The Fat Duck restaurant in England is an excellent example.The restaurant is known for its menu of unusual dishes, created following the principles of molecular gastronomy including egg and bacon ice cream. Luxurious food and wine styles and cuisines with the extravagant uses of ingredients often form a part of their image and prestige Gastronomy as a tourism product by achieving sustainability With the emphasis on achieving sustainability, gastronomy can be understood as tourism products that boost the economies and reputation of a destination.For instance, as supported by FEHGRA, a gastronomic association in Argentina, a great diversity of high-end culinary offerings can be found throughout the country that use creative regional ingredients of the highest ancestral grains and tubers in the north and meat and dairy in the center. By using local ingredients, the place of origin and production of each ingredient are respected instead of travelling ingredients from a long way. TouristsÃ¢â¬â¢ destinations are also given a boost through their cuisine, as people travel to consume these excellent foods searching for balanced and healthy dishes with least possible wastage in heir preparation. * Marketing promotions to merge gastronomy with tourism product Apart from linking gastronomic experiences to tourist needs, active promotion and marketing strategies of tourism organizations is equally important. With more promotions tactics, gastronomy is much easier to be understood as a tourism product. According to the World Tourism Organization (2012), common ma rketing techniques used are organized events , and print brochures or websites. A sound illustration will be the Prove Portugal programme (2010) held in Portugal. It aims to communicate the national brand through the recognition of Portuguese cuisine.A website dedicated to Portuguese food and wine is established along with other communication tactics to further promote International culinary tours, books, training in the Schools of Hospitality and Tourism, and the fundamentals of Portuguese regional cuisine and chefs. Great efforts are put to make the place a strong- branded culinary destination for tourists. Conclusion In a nutshell, the rocketed development of gastronomy tourism proves that food is no longer a basic necessities for human, but a cultural element that associated with leisure and relaxation.Gastronomy can be understood as a tourism product in many ways such as food events, cooking class and workshops; food fairs featuring local products, visits to markets and produce rs, museums to souvenirs. Its vital role in tourism is further enhanced through the promotions and marketing efforts by tourism organizations. By fulfilling different motivations of tourists, namely in physical, cultural, experimental and prestigious level, gastronomy is understood as a tourism product. Reference: 1) Brillat JA ,1994). The physiology of taste (A. Drayton, Trans. ).Harmondsworth, UK: Penguin 2) Chaney, Stephen; Ryan, Chris Analyzing the evolution of Singapore's World Gourmet Summit: An example of gastronomic tourism International Journal of Hospitality Management , Volume 31 ,no 2 3) Collingwood ChildrenÃ¢â¬â¢s Farm, ; http://www. farm. org. au/; 4) FEHGRA ;http://www. fehgra. org. ar/; 5) Fields, K. (2002) Demand for the gastronomy tourism product: Motivational factors. In A. Hjalager and G. Richards (eds. ), Tourism and Gastronomy (pp. 37Ã¢â¬â50). London: Routledge. 6) G Richards, AM Hjalager, G Richards 2002 Greg Richards,Gastronomy: an essential ingredient i n tourism production and consumption, Tourism and gastronomy, 2002 London and New York 7) Hjalager, A. -M. (2002). A typology of gastronomy tourism. In A. -M. Hjalager ; G. Richards (Eds. ), Tourism and gastronomy (pp. 21-35). London: Routledge. 8) Jaksa Kivela and John C. Crotts 2006 Tourism and Gastronomy: Gastronomy's Influence on How Tourists Experience a Destination Journal of Hospitality & Tourism Research 30: 354 9) L James Leigh 2000, Implications of Universal and Parochial Behavior for Intercultural Communication, Journal of Intercultural Communication, No 4 10) Long, L.M. (Ed. ). (2004). Culinary tourism. Lexington: University Press of Kentucky. Mennel, S. , Murcott, A. , & van Otterloo, A. H. (1992). The sociology of food: Eating, diet and culture. London: Sage. 11) McIntosh RW, Goeldner CR & Ritchie, J. R. (1995). Tourism principles, Practices, philosophies, (7th ed. ), New York: Wiley. 12) Reynolds, G. (2002). Gastronomy: An essential ingredient in tourism production an d consumption? , In A. Hjalager & G. Richards (eds. ), Tourism and Gastronomy (pp. 3Ã¢â¬â20). London: Routledge. 3) The Food Network South Beach Wine & Food Festival 14) Stephen L. J. Smith ,1994 ,The tourism product, Annals of Tourism ResearchVolume 21, Issue 3, Pages 582Ã¢â¬â595 15) The Biltmore Culinary Academy 16) Wolf, E. (2002). Culinary tourism: A tasty economic proposition. Retrieved July 12, 17) 2004, from http://www. culinarytourism. org 18) Wyndham Estate 2012 19) World Tourism Organization (2012), Global Report on Food Tourism, UNWTO, Madrid
Monday, July 29, 2019
Nursing research - Essay Example In line with this, the process of change involved a number of principles as guided by LewinÃ¢â¬â¢s principles of process of planned change. The principle of unfreezing as advocated by Lewin improved the chances of success. In this case, Lewin advocated for proper and efficient planning of the change process in a detailed manner that clarifies and identifies the problem while suggesting the change process (Keele 236). In this case, this principle helped the facility change the thoughts, attitudes, and behavior of the nurses regarding the old and conventional method of bedside handovers. In effect, the new process of change was set to be effective since all nurses were aware of the new method of bedside handover. In addition, the principle of unfreezing, which involves encouraging people on the need for process of change was instrumental in ensuring that the change process was successful (Keele 236). In this case, unfreezing involved building relationships with the nurses who were to implement the planned
Sunday, July 28, 2019
Industry business model paper - Essay Example Some fifty million Americans gamble each year, betting anywhere from $30 billion to $100 billion, depending upon the estimate one chooses. The vast majority of this money is wagered illegally. Many states, however, are now stampeding to legalize lotteries, approve new racetracks and set up off-track betting! By early 1974, eight states were operating lotteries, with at least four others about to open for business. New York city began legalized Off-Track Betting (OTB) in 1971, and many other places, too, may soon do so. Also, New Jersey, Maryland and Hawaii are said to be considering joining Nevada in legalizing casino gambling. Yes, gambling is indeed a huge industry that is largely growing around the world today. For this particular reason, business organizations are actually becoming more interested in investing in gambling industries at present. For them, the said approach to business may indeed be risky, but the returns from the said challenging risks are all worth it. Among the business entities that were able to identify this particular truth behind the worldwide gambling industryÃ¢â¬â¢s progress towards the future is that of the Mandalay Business Corporation. The Mandalay Resort Group has invested a $1billion business entity to establish the Mandalay Bay Resort and Casino in Las Vegas. This particular investment has actually made a great impact in bringing in a tropical resort theme in the middle of the wild luxurious gambling industries. This particular resort holds at least 3,700 rooms within it vicinities and several huge function rooms within the area which are all made for gaming, dining and entertainment options that are considered as the main life of the said resort operations. Hotels are mainly establishment who accommodates people who needs housing due to traveling reason and those who are searching for temporary residence. Since they establishments are known for
Saturday, July 27, 2019
Outsourcing in Electronics Manufacturing - Does it Work - Research Paper Example In fact the majority of organizations (i.e. multinational or national) at the present contract or outsource their business services for instance call centerÃ services, electronic mail services andÃ payroll. In addition, these services are divided among different companies that are well experienced in providing services and facilities. However, these organizations are sometimes located out of the country (Thompson, 2011; Turban, Leidner, McLean, & Wetherbe, 2005). In this scenario, the outsource manufacturing expansion is as a great deal a return to essential competencies as it is an attempt to reduce operating expenditures. In addition, the enhancement of external knowledge has been particularly apparent in electronics manufacturing, which has basically turned into the shape of an outsource business model. Additionally, from circuit boards that present a wide variety of services and functionalities to wireless communications units to the insertion of micro electromechanical (MEM) sensors in a plethora of problem-solving and diagnostic devices, to a greater extent refined devices and electronic components are being contract manufactured. Hence, it allows electronics manufacturers to pay attention to what they do best at the same time as addressing the clinical needs of customers (Teng, 2012). In the past few years, there has been extensive progress in outsourcing in electronics manufacturing. We have seen that, a lot of original equipment manufacturers (OEMs) have adopted this modern trend in order to quickly and cost efficiently enter into new marketplaces. In addition, by teaming with a knowledgeable partner, an OEM could considerably reduce the time as well as operating expenses implicated in developing new services and products like that Microsoft did in its launch of the Xbox (Delattre, Hess, & Chieh, 2003; Teng, 2012). This paper presents a detailed analysis of some of the important aspects that are associated with outsourcing in electronics manufactur ing. The basic purpose of this research is to analyze how outsourcing in electronics manufacturing offers advantages and support for business cut down overall cost and enhance potential profitability of the business. This paper will present an overview of outsourcing with respect to the electronics industry and also present a critic, whether or not outsourcing in electronics manufacturing helps the business. Outsourcing within the Electronics Industry All through the world, businesses, manufacturing and industries outsourcing is not a new idea or trend for Original Equipment Manufacturers (OEMs). It is basically a Ã¢â¬Å"make v/s buyÃ¢â¬ assessments and decisions that have been around for businesses and manufacturing industries for a long time. In fact, it is not easy to find out a business that completely manufactures its own electronic items and products currently. However, it is also a fact that the outsourcing is relatively a new idea for electronics manufacturers industries (Delattre, Hess, & Chieh, 2003; Teng, 2012). In addition, an amazing flow in electronics manufacturing outsourcing actually started in the mid 90s and sustained throughout 2000s. All through this evolutionary period, a large number of huge technology original equipment manufacturers were getting their manufacturing policies to benefit from the wave of outsourcing substitutes that were easily accessible to them, to both improve the quality of their products and minimize asset and operating expenses. In
Friday, July 26, 2019
The European sovereign debt crisis dominated international financial markets during 2010-2012. Economies fell into recession and financial market volatility was high - Essay Example d not be contained as the problems only in the Greek region, given the economical and financial structure governing the European nations it was apparent that this crisis was a truly Ã¢â¬ËEuropeanÃ¢â¬â¢ crisis and couldnÃ¢â¬â¢t be handled in isolation with any one country. The Greek deficit was a direct result of the The European Nation came into being in 1992 through the signing of the Maastricht Treaty. The treaty established the euro as legal tender for all the participating nations, with the exclusive responsibility of forming the monetary policy for the euro zone falling on the European Central Bank. The treaty promised great benefits for the nations admitted to the euro zone. There were two major economic rewards firstly it increased the ease of borrowing for individual governments based on the average rating for the whole of euro zone; nations with high deficits and low GDP would enjoy the same average rating as a benefit from the high economic performance of stronger euro zone economies. Secondly, the uniform monetary policy meant that no nation could devalue its currency or lower interest rates etc to increase their competitive advantage. This leveled the playing field for all participants of the Euro zone. However, the mechanics behind these Ã¢â¬ËbenefitsÃ¢â¬â¢ were risky and the major criticism for the treaty. The countries were still held responsible for designing their fiscal policies in order to positively influence the economy, but without the control of monetary measures, they could not manage their sovereign debt problems through devaluation of currency or lowering the interest rates. Another concern, which would later prove to be true, was the idea that some economies might become Ã¢â¬Ëfree-ridersÃ¢â¬â¢ and depend on other participating nations in the euro zone to indulge in high debt to finance economic activities without the required increase in productivity. In order to put a check and balance on the system, a Ã¢â¬Å"convergence criteriaÃ¢â¬ was set upon for the
Thursday, July 25, 2019
Human Resource Management & Information Management (MBA) pro 6 - Essay Example Generally it is believed that PRP is a good tool to set a goal for the employees. It sets a criterion for the employees; and so to fulfill that out of their personal welfare, they indirectly help in gaining the objectives of company in a better, more focused and speedy way. PRP does not only act as a reward system, it also works as a silent warning or alarm system for the employees. When lazy or inefficient employees see their colleagues getting benefits, they are naturally alarmed by their situation. Thus inefficient people come to know through PRP that it is all about Ã¢â¬Å"survival of the fittestÃ¢â¬ thing and so they strive to work in a better way. PRP is a device that articulates the goals of the employers and the company in a better way. By setting criteria for getting performance related pay, employers clearly define what they want from their employees. This might be one of the reasons that PRP still holds importance for the employers. Thus it helps the employers to attain their focused goals in a better and faster way. Another reason for the prevalence of PRP in organizations is the notion that it targets and reward the deserving employees. Naturally some employees are more efficient and hard working than their colleagues, so this system rewards them for their special efforts and thus encourages them to keep up their good work. Finally I think PRP has an enduring interest for employers just because it is used everywhere. It has become an important phenomenon and is widely practiced so employers use it also because of the peer pressure in the corporate world. So PRP is here to stay although there is no solid proof about its motivational
Politeness Theory - Essay Example Primarily, the theory focuses on the sequential context of utterances, which is deemed critical for the comprehensive message interpretation; this is nevertheless examined alongside other conversational factors such as tone and volume. This theory can be applied to a diverse range of social and professional or academic situations including but not limited to classroom pedagogy and language teaching. This paper will critically examine the politeness theory by carrying out a critical analysis several journal articles dedicated to various aspects of the concept with particular attention to its application in a pedagogical context as well as an analysis of the various disputations that have been directed towards challenging it. Summary of the politeness Theory The fundamental notion behind Brown and Levinson politeness theory is the face, which they defined as the public self-image that each individual in a society desires to claim for him/herself. They created a binary framework in whic h the face was categorized as two divergent albeit related aspects namely the negative and positive face. The positive face is characterized with the self-image, which holds, and it encapsulates their inherent desire to gain approval and appreciation from other people. The negative face is characterized by oneÃ¢â¬â¢s not wanting to have their actions inhibited or constrained by or for the sake of others; in the context of this theory politeness refers to the steps that individuals take in the interests of preservation of both their face and that of their audience. The term has been explicitly defined as the redressive action through which individualÃ¢â¬â¢s counterbalance the effects of face threatening facts (FTAs) redressive is contextually applied in reference to actions that give or reinforce face to the audience of the message (Johnson, Roloff & Riffee, 2004). It is suggested that in communication, whether written, face-to-face of through other media, human beings perpetuall y attempt to maintain each otherÃ¢â¬â¢s face. This is manifested in the fact that they often try their outmost to avoid creating through discourse, embarrassing or humiliating situations for each other in order to preserve self-esteem. FTAs are defined as action that infringes on the need of the patient of the information to maintain their self-esteem; therefore, one can say that there are acts that intricacy poses a threat to face (Foley, 1997). According to the theory, orders, suggestions advises reminders, threats or warning and similar acts pose a threat to oneÃ¢â¬â¢s negative face, on the other hand, positive face is threatened when they incorporate elements of disapproval, ridicule contempt or accusations and insults. Under the positive strategy, politeness is inclined toward the positive self-perception of the speaker has for himself and the listener as well. This confirms that the speaker takes cognizance of the listeners need to be respected and this often happen among close friends or otherwise intimate people (Wilson et al., 1998). The negative politeness on the other hand is based on respect but in a different format as the speaker seeks to respect the negative face wants of the addressee by not interfering with their inherent autonomy of freedom. For example, one may start a request by saying Ã¢â¬Å"
Wednesday, July 24, 2019
Security Certificates in Law - Research Paper Example Deportation of suspected individuals protects the public from harm that would come through allowing suspected individuals to continue functioning freely. Very few people have ever been subjected to a certificate hearing implying that critical evidence is used to subject an individual to these hearings. In certain instances, the person subjected to certificate hearing has an opportunity to involve witnesses to petition their release. This is also a benefit. Due to the nature of the security certificates, it is hard to imagine that they would operate without violating some crucial laws. Specifically, it violates some sections of the Charter of Rights and Freedoms. These sections include denial of a fair trial, which is a major human right, civil rights with respect to international politics, and the inability to guarantee safe deportation. These are important laws that need to be observed. The Canadian Supreme Court allowed some Charter rights to be limited in the case of exceptional circumstances. These circumstances were not defined, and secrecy surrounds the cases that have been taken to certificate hearings. In addition, the Supreme Court had found that a framework of protecting classified information with immigration proceedings as consistent with the countryÃ¢â¬â¢s Charter of Rights and Freedoms. The Court allowed the limitation with the argument that terrorism ought to be dealt with in any way possible. Therefore, the safety of the Canadian citizens was the main concern that led to limiting some Charter rights.
Tuesday, July 23, 2019
Global Warming - Essay Example While scientists maintain that the impact of global warming will not be felt for years to come, its effect is visible in both changing average temperatures and the effect of these changes. In 2005, Moscow, one of the worldÃ¢â¬â¢s coldest cities, experienced one of the warmest winters in its history. Not only were temperatures high but these unusual temperatures were sustained for a lengthy period of time, with the consequence being a reversal of the normally consistent and unchanging laws of nature. Quite simply stated, Russian bears woke up fro their winter hibernation, in the midst of winter, as their body temperatures deluded their biological clocks into believing that spring, the season for waking up, had arrived (Stuff, 2006). This example, while seemingly inconsequential insofar as it has no embedded doomsday scenarios within it, is perfectly representative of what global warming is and what its effect on the environment can be. Indeed, just as Bongaart (1992) had warned seve ral years ago, global warming has the power to upset the laws of nature and, in so doing, threaten all forms of life on earth. Global warming, despite evidentiary support, is a source of controversy. One camp insists that it is an undeniable reality whose consequences, although impossible to accurately assess, are bound to be disasterous if corrective and preventative policy are not adopted by governments across the world (McCarty, 2001).
Monday, July 22, 2019
American English Essay Ebonics has been an issue in the field of sociolinguistics for quite a long time. It was previously labeled as Negro-standard English, Black English, Black English Vernacular, and African American English Vernacular. It is known to have historical influences from West African and Niger-Congo languages. Researches focused on its similarities and differences with that of the Standard American English to provide explanations to whether it is should be considered as a separate language or at least a dialect of standard American English (Blommeart, 1999). The term Ebonics was coined by Robert Williams in 1973. It referred to the unique variety of language used by African Americans. However, it was not widely used until the proposal of Oakland Schools in 1996. yet, up to this day, experts prefer the term African American to make it consistent with that of other varieties of English like British English, Southern English and among others (http://www. cal. org/topics/dialects/aae. html). One of the differences pointed by Collins (1999) are the phonological processes like consonant cluster simplification and word-final position. For example, words like cold, test, and desk are spelled as colÃ¢â¬â¢, tess, and deks in Ebonics. The habitual BE verb of Ebonics may also be confused if will be read as standard English. The debate mainly focused on the issue as whether Ebonics should be a separate language or at least a dialect. It was not a major issue until Ebonics was proposed as a medium for instruction. The sociolinguistic debate was replaced by a more encompassing issue of education, language, culture, and perhaps, politics too. The Ebonics Controversy In December 18, 1996, the Oakland School Board proposed to recognize Ebonics as Ã¢â¬Å"primary language of African American childrenÃ¢â¬ and be treated as a subject for Language Art apart from the standard American English (Rickford, 1999). More specifically, the proposal claimed, Ã¢â¬Å"Ebonics was a language that should be recognized, tolerated, and accounted for is instruction of the districtÃ¢â¬â¢s predominantly African-American student bodyÃ¢â¬ (Blommeart, 1999). It would have affected more than 52, 000 students in the district. The aim of this proposed project was improve the educational performance of the urban student body (Blommeart, 1999). The proposal started a debate not just among sociolinguists, but also among educators and politicians. Many of the critics of the proposal argued that the real cause of poor performance of the students was not a question of language but rather the Ã¢â¬Å"lack of effort, motivation, and commitment on the part of the students and their families. Ã¢â¬ (Blommeart, 1999).
Sunday, July 21, 2019
Social and Health Inequalities in New Zealand Assess and discuss the impact the following environmental and attitudinal determinants have on health in terms of planning, implementation, and the evaluation of health interventions: A. Demographic distribution of populations Before discussing the effect of Demographic distribution on population, let us first discuss what is population distribution. Population distributionmeans the pattern of where people live. World population distribution is uneven. Places which aresparsely populated contain few people. Places which aredenselypopulated contain many people. Sparsely populated places tend to be difficult places to live. These are usually places with hostile environments. Basically this determinant focuses on the importance of the number of people in a certain location. For example, if the location is dominated by the older age group, the government focuses their funding to the needs of the senior citizens. They focus more on that particular age group because they compose a great portion of the population. But the government should not disregard the other age group that has different needs also. (Population, 2014) B. Social The society that is present in New Zealand is very diverse. Same as the culture that is in this country. The Pacific people and the Maoris has a tendency to have a lower income job compare to the Pakehas. Therefore the Pakehas can afford better healthcare compared to the Maoris and the Pacific people. There are a lot of factors in the society that determines the health of the people. These factors may include strong family ties, pleasant environment, housing, and ways of living. These factors affect the health of the people in different manners. It may be negative or positive. If something goes wrong with these factors, social problems arise. For example, the poor housing may lead to poor hygiene and then it will eventually lead to sickness. In addition, hazardous environment at work or at home may endanger the health of the people. Looking at an individual perception, firm and good family ties and support enhances the health status of an individual. Strong social networks within a distinct geographical neighbourhood help to create healthier conditions in several ways, including: social control of illegal activity and of substance abuse socialisation of the young as participating members of the community providing first employment improving access to formal and informal health care (Wallace 1993). C. Cultural Here in New Zealand, the culture is very diverse since there are a lot of races that are present in this country. We have the Maoris, the Pakehas, the Indians, Asians and other races. Therefore the healthcare delivery system should also address to the needs of these people with different cultural background. Language is also one factor that we can look into. Many people from different parts of the world come here in New Zealand and letÃ¢â¬â¢s face it, not all of the foreigners are well versed in the English language. This creates a barrier in healthcare delivery. When explaining a treatment procedure to a patient who is not well versed in English, it is a challenge to make sure that you are explaining properly and giving the correct information to the patient. So, it is important to know and understand the patientÃ¢â¬â¢s background to be able to deliver appropriate care to them. It is very difficult for the Ministry Health of New Zealand to adopt to the different cultures present here but knowing the different cultures will help them understand and identify what measures to be implemented for the different cultures here in New Zealand. It may be a difficult task to do trying to understand each and every culture present here, but it will be beneficial and the Ministry of Health will be able to plan more strategic interventions for the people that compose New Zealand. Cultural diversity increases the challenge to the effectiveness of the healthcare delivery system in New Zealand (Durie, 2001) D. Political Politicians use healthcare to be one of their focus or goals if they are running for the election. Politicians promise to give the people a better healthcare delivery, healthcare benefits, facilities and other needs. This promises may be politically but if we look at it in a broader sense, it will benefit the people and their health if the promises that he politicians give will be carried out. E. Religious Beliefs New Zealand has become increasingly culturally diverse, there is also an increase in religious diversity. People that has a strong religious orientation and who are primarily motivated by religious belief are believed to have a greater health outcome. People have different religious coping style. This religious coping style is like the way people engage their religiosity to help them cope with their everyday life. Generally, religious belief and practices give a positive outcome to mental health. There is a strong link between religious belief and low incidents of depression. It also reduce the number of suicidal risks, anxiety attacks and sometimes psychotic disorders. Religious belief is important in helping people to recover from traumatic events. In addition, religious belief is believed to reduce practices that result to major health problems. These practices are alcohol abuse, drug abuse and cigarette smoking. Overall, religious belief should not be disregarded when it comes to health because it plays a major role in the life and health of the people. Healthcare personnel should respect the religious belief of the patients. F. Values Some people look at their health as a precious aspect in their life. They value it and take care of it very well. In a multicultural country like New Zealand, people here have different perspective of heath. As for the Pacific people and the Maoris they have a lesser value of health compared to the Pakehas. In order to know how to address the needs of the people, the health department should first identify their needs. Like if the Pacific people and the Maoris do not value their health, they should be given continuous health education to make them realize that they need to value their health. They should be also followed up so that there is continuity of care. G. Ethics Ethics are rules and principles that guide right and wrong. Ethic can be related to health if it is about making proper decisions regarding health. There are a lot of ethical dilemma in healthcare and treatments. It is acting well and making decision that is morally good. Let us take abortion for example. If a pregnant woman come in to the hospital and asks for the Doctor to abort the baby that she is carrying, the Doctor should decide if it is ethically correct to abort the baby or not. The healthcare team should know their morals. H. Traditions Traditions play a major role in healthcare. People are used to involving their traditions to their life and to their health. For the Maoris they value their family or whanau so much. Their tradition is that they want their family members or whanau to get involved in their care. Their family members has a say in making decisions regarding the health of the patient. Therefore, whatever decision the family or whanau has, it should be respected and taken into account by the healthcare team. Environmental Determinants The Public concepts of what health is Before discussing concepts of Health, let me first define what Health is. Health is the state of physical, mental and social well-being of one individual. Health is important because if one is in a Good Health condition, he/she can properly function (eg. For work, sports, etc) and it helps people do activities of daily living. Public concepts of health is important because if the public believes that they are healthy, then they can achieve almost anything and it makes them more productive in the community. The Public concepts of what illness is So what is illness? Illness is a disease or some sort of sickness that will or may affect an individual. It is usually a disease that affects the body of a living organism. There are different kinds of illnesses. For example, there are what you call Physical and Mental illnesses. Physical illness is any illness that affects the body which can be viral, bacterial, rash etc. Mental illness on the other hand, is a disorder characterized by dysregulation of mood, thought and/or behavior. The publicÃ¢â¬â¢s concept of what illness is important because if they perceive that they are ill or are sick, then they cannot function and work well. This affects their performance outside, whether at work, at play or even at home. They also cannot be easily accepted by society if they are believed to be carrying some sort of disease to prevent spreading. The importance the public put on health With regards to health, it is important that the public have an enhanced idea on how and which are healthy and unhealthy for them. Proper information dissemination and education should be done by different private and public sectors to inform the public. The public or the people on the other hand, should have an open-minded attitude towards learning. Compliance with these certain regimens can and will help the public have a healthy and happy lifestyle. Public attitudes towards health and medical professionals The public should be working together hand in hand with medical professionals into making and having a good and healthy life. Whether they be Caregivers, Nurses, GPÃ¢â¬â¢s, PhysioÃ¢â¬â¢s, or anyone working in the medical field, it is critical that they consider what they suggest. As suggested earlier, compliance is a big factor. All this knowledge that would be provided by all these professionals would go to waste If people are not willing to do or try. They must also have a positive attitude towards learning for them to further expand their knowledge, and at the same time be able to share Health teachings. REFERENCES Durie, M. (2001, November 22). CULTURAL COMPETENCE AND MEDICAL PRACTICE IN NEW ZEALAND. Retrieved February 25, 2014, from http://www.massey.ac.nz/: http://www.massey.ac.nz/massey/fms/Te Mata O Te Tau/Publications Mason/M Durie Cultural competence and medical practice in New Zealand.pdf Population. (2014). Retrieved from Internet Geography: http://www.geography.learnontheinternet.co.uk/topics/popn1.html Wallace R. 1993. Social disintegration and the spread of AIDS II: Meltdown of sociogeographic structure in urban minority neighbourhoods. Soc Sci Med 37: 887-96. Social and Health Inequalities in New Zealand Social and Health Inequalities in New Zealand INTRODUCTION Health care services in New Zealand are being delivered by various health organizations and people for the main goal to achieve optimum level of health among all. This assessment will give more insights about inequalities and disparities in healthcare system and services given to the consumers especially in the Maori context. As a healthcare provider, it is a must to study, understand, and adopt the healthcare system in New Zealand to render good quality nursing services to the consumers. Guided by the principles of the Treaty of Waitangi and Cultural Safety, health care providers have an in-depth realization of oneself and the people in New Zealand. This discussion highlights some inequalities and disparities in healthcare towards Maori and non-Maori population. This also provide some input on how the government is responding to this issues. This only limits to the Maori, non-Maori healthcare concerns within New Zealand. Some of the topics are related to political, social, housing, employment, and education inconsistencies of Maori and non-Maori individuals receiving healthcare in New Zealand. POLITICAL DISPARITIES AND INEQUALITIES According to Malcolm (2004), Maori receives only less than 50% of the governmentsÃ¢â¬â¢ expenditure or the primary healthcare services compared to the Europeans. This is believed to be partly economic issue but also of a cultural interests. But Primary Health Organization has been established to address this problem and this is the Access Funding. This provision is specially regulated for the benefits of the marginalized Maori population. But this policy is limited to the GPÃ¢â¬â¢s and Practical Nurse accessibility only, there are no provision for an improved funding of healthcare for Maori people. In this status, we can infer that because of lack of financial support, more Maori prefer not to seek healthcare consultation to specialist physician for proper treatment of health due to the limitation of the provision. Thus, more and more Maori are unhealthy and with high rates of disability and morbidity. Healthcare disparities between Maori and non-Maori marked as a colonial history of New Zealand. This racial problem has mixtures of components to be considered and until now it is still a debate. Loschmann Pearce (2006) said that, health inequalities will not be solve if there are no improvement in healthcare access. As evidenced, continues increased of variation of primary and secondary health care access between Maori and non-Maori. One survey showed that 38% of Maori adults reported problems in obtaining necessary care in their local area, as compared with 16% of non-Maoris. Maoris were almost twice as likely as non-Maoris (34% vs 18%) to have gone without health care in the past year because of the cost of such care. (Loschmann Pearce 2006) As primary health care services are the main place for health consultation and treatment in New Zealand, more Maori are going to seek healthcare to GPs clinic and medical centers. Access is not merely the entry to health care facility but it is also the provision of quality health services rendered. Since, most Maori go to primary health care clinics and centers, specific health concerns for Maori is not addressed because treatment for critical or complex case patient cannot be treated in a primary health care facility, specialize treatment is needed. Thus, unmet proper treatment. (The Health of New Zealand Adults 2011). SOCIAL DISPARITIES AND INEQUALITIES Social inequality issues are linked to ethnicity. Social disparity occur continuously in New Zealand. The impact of colonization to the Maori population marked to the very moment. There are issues in cultural identity as to which is more powerful and have the rights in the land and government. Discrimination and power imbalance still exist at present moment and its relation to healthcare is very significant. Social connectedness is the key determinant in gathering data related to social disparities among the two mentioned parties. According to Pollock, (2012) a healthy community has lower morality rate and higher expectancy rates. The data of life expectancy shows 83 years for non-Maori female and 79 years among non-Maori male, whereas, 75 years Maori women and 70 years in Maori men. Another determinant is the income of a particular person. Considering he/she can afford a high standard of living if he/she has a good and highly paid job. But in Maori context, they are marginalized, as shown in the data that median weekly earnings for Maori is $767 Ã ± 15.43 compared to $863 Ã ± 17.26 for non-Maori. This statistics views inequality among Maori and this has a big effect to their household income, thus their standard of living is low compared to the non-Maori people, based from Marriott Sim (2014). Unhealthy practices also associates with low income which eventually leads to unhealthy behavior. Smoking is high in many depressed areas and mostly Maori are living in this areas. There are studies linked that smoking plays important role in socio-economic and ethnic status of Maori and it is interrelated to lung cancer occurrence. Maoris in living in poor conditions were three times likely to use tobacco than those with high standard of living person. There is a rise in lung cancer usage and deaths in the deprived areas and 30% of Maori died because of lung cancer compared to the 17% of non-Maori death rates, Pollock, (2012). There are also studies that conflicting views regarding Healthcare Model in the work place. Maori still practiced their own context of health and healing and this understandings the viewpoints of conventional health services rendered. There are also medical practices that contradicting to their own cultural approach towards health. Marginalization is seen on staff insensitivity, judgmental, and disrespectful delivery of care, according to Elers (2014). The healthier a person is, the lower the mortality rates. Engaging in a healthy lifestyle activities will make a person fit. More Maori experienced sicknesses at a younger age and it happen often and die young. While non-Maori have higher life expectancy rate even if they lived unhealthy. Mortality and morbidity percentage is significantly higher among Maori population. Male with good work shows low death rate than male working as laborers and cleaners. There are also data shows that, the more deprived communities are, the higher percentage of death and illnesses. (Pollock, 2012) EMPLOYMENT DISPARITIES AND INEQUALITIES Employment status is one determinant in healthcare inequalities in New Zealand. According to Pearson (2012), among other ethnicity in New Zealand, Maori and Pacific population has the highest unemployment rate. It comprises of 17.8% compared to non-Maori which is 14.2% in the year 2006. Most of the jobs Maori landed are occupation in the land and fishing. Some of the Maoris are working as laborers with a rate of 30% compared to 15% of European laborers. While, 18.2% of Western people are managers and 10.6% for Maori society. Labour forces are mainly the occupation of Maori. This is in relation to their low educational attainment as Pearson (2012) said. Healthy status can be achieved in many ways, one good factor that leads to a good personal shape would be their status in life. The ability and capability to support basic needs and necessity like food and shelter. Insufficiency in lifeÃ¢â¬â¢sÃ¢â¬â¢ basic needs will eventually make a person unhealthy and easily get sick. As Blakely Simmers (2011) stated that, one of the leading disease of Maori is diabetes and it is mostly encountered in marginalized and low income individual and the predisposing factor would be obesity in the Maori race. How employment status affects the health of every individual is very important to discuss. Employment status is regarded as a main basis of health in a person. It has a direct and indirect effect on health and believed to have an increasing impacts over time. Another pointer to review is the funding of the government towards healthcare. Most Maoris seek health intervention in the primary health centers and GPs while the Europeans can afford to pay for specialist physician, thus, better health are achieved by the Western group. Another thing to consider is the discrimination views of Maori towards healthcare. Maori Health Review (2007), shows data that there are 76.3% Maori women wanted to receive transplant while 79.3% to non-Maori women and 80.7% for Maori men and 85.5% fo r non-Maori men respectively. This data indicates healthcare compliance to treatment and this a strong input for improvement of health. Thus, shows, Maoris have higher mortality rate. In addition to that, a person who are unemployed and have family will not able to sustain daily basic needs and health is our basic need. Thus, Maoris have more health vulnerabilities than compared to non-Maoris. HOUSING Family is the basic unit of society. It is the very foundation of social being in the community and it is also the most critical part in obtaining data regarding health and wellness of every individual more focus on children who are dependent of care from their parents or family members for physical and emotional development (Ministry of Health, 2009). In the middle of the 20th century, there is a significant increase in home ownership by the Maoris compared to the decreased percentage of non-Maori home ownership. This data is basically focus on the household proportion and not on the number of households, (Waldegrave, King, Walker, Fitzgerald, 2006). There are 47.0% of Maoris and Pacific people owned their homes as compared to 72.8% for Europeans. These varies with the quality of housing they had, Maoris lived commonly in two or more family sharing in bedrooms whereas, Europeans have enough space in the house and rarely shared bedrooms, as Pearson (2012) said. This pattern of living manifested a not well-designed standard of housing for Maoris, thus health risk is advantageous. Congestion and substandard housing may lead to poor health condition for Maori and most common are: colds, asthma, and post-natal depression. Pearson (2012) added that, there is a significant increase in obesity, smoking and alcohol drinking. There were 38.0% Maori alcoholic beverages drinkers whereas, 23.0% were reported for Europeans. Research shows that one of the leading cause of death for Maoris and non-Maoris are Ischaemic Heart Disease and the second leading cause is lung cancer for both Maori male and female, according to the Ministry of Health (2014). This is an evidence regarding the high number of Maoris who smoked as previously mentioned. The increased rates of respiratory diseases were due to the overcrowding of family members and contamination of molds in the home because of poor housing condition. These highly contagious diseases can be pass through droplet, personal cont act and airborne transmission. Thus, Maoris are susceptible to many easily spreadable diseases and many lifestyle related health problems, (Ministry of Health, 2014). EDUCATION Education is said to be the key factor to success. This is in connection with many advantages and helpful product like high paid jobs, better income, great occupational chances and have relations to positive health outcome, (Marriott Sim, 2014). Good education enables a person to be economically stable and high productivity in life which resulted in an improved standard of living. This also makes a person self-worthy, secured and a sense of belongingness. But there are some indicators to be considered to assess standard of living of every individual. This relates to the physical situations in which people lived, the availability of goods and services, and the accessibility of resources. These are the two pointers to considered, first is the income they get and second is the accommodation they have according to (Ministry of Social Development, 2010P). Maoris educational qualification has dropped enormously compared to non-Maori settlers. Pearson (2012), stated that there are 2 out 5 Maori have no school qualification compared to 1 out 8 Asians and a quarter of Europeans respectively. There are more Maoris who had no degree in education which is an evidence of many Maoris worked as laborers and cleaners. Data shows that many Maori school leavers who attended only the minimum level of education, NCEA level 2, 60.9 % of them completed level 2 compared to 82.1% for non-Maori in the year 2012, Marriott Sim, (2014) said. There are 18.6% Europeans who had bachelorÃ¢â¬â¢s degree, while there are only 9.1% of the Maori population finished bachelorÃ¢â¬â¢s degree. There is also a great difference in the aged-standardised tertiary participation rates in 2012 data, it shows 9.9% of Maoris compared to 8.0% in Europeans. Across years of observations, changes in educational attainment enhances improvement in Maoris life as to their way of living. The implication of these findings are relatively connected to the education background of individual to achieve optimum of heal th. All aspects are interrelated to each other. As little knowledge about health would lead to unhealthy way of living thus Maori are more unhealthy people compared to other ethnic groups. There is also a premise that education starts at home and this shows relevant to healthy lifestyle. Smoking at home is prevalence among Maoris, and according to their living conditions, overcrowding is a health treat especially to the young generation. Second-hand smoker comprised a high rates among Maori children. There are 2.6 times exposure to SHS among Maoris compared to non-Maori children and a significant high rates of 7.8 times of Maori children living in remote areas. Studies shows that almost 24% of the smokers were diagnosed with many mental health conditions like depression, bipolar, anxiety disorder, and alcohol and drug related disorder, according to the Ministry of Health, (2014). Conclusion Based from the given facts and data, I can confer that health disparities and inequalities among Maori and non-Maori are ambiguous to discuss. However, history plays a vast implication to healthcare services in New Zealand, it should be of greater good of the citizens not merely the matters behind the past. As a result of my review, majority of Maoris were unhealthy compared to the Europeans. This is based from the sources of information I gathered form many research and studies. Thus, health organizations and health providers must collaborate to promote, protect, and sustain health of New Zealanders. BIBLIOGRAPHY Maori Health Review. 2007. Patient preference and racial differences in access to renal transplantation. http://www.maorihealthreview.co.nz/pdf/NZMaoriHealthRR_005_02.pdf Ministry of Health. 2002. Reducing Inequalities in Health. https://www.health.govt.nz/system/files/documents/publications/reducineqal.pdf Lorna Dyall, Valery Feigin, Paul Brown, Mavis Roberts. 2008. Stroke: A picture of Health Disparities in New Zealand. https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj33/33-stroke-a-picture-of-health-disparities-in-new-zealand-p178-191.html Phoebe Elers. 2014. Maori Health: Issues Relating to Health Care Services. http://www.tekaharoa.com/index.php/tekaharoa/article/viewFile/170/128 Kerryn Pollock. Public health Social and ethnic inequalities, Te Ara the Encyclopedia of New Zealand, updated 13-Jul-12 URL: http://www.TeAra.govt.nz/en/public-health/page-6 Iann Culpitt. 1994. Bicultural Fragments: A Pakeha Perspective. https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj02/02-bicultural-fragments.html Laurence Malcolm. 2004. Are we proving fair access to our health services for Maori? www.pha.org.nz/documents/fairaccessforMaoritohealthservices.doc Lis Ellison-Loschmann and Neil Pearce. Improving Access to Health Care Among New ZealandÃ¢â¬â¢s Maori Population. American Journal of Public Health: April 2006, Vol. 96, No. 4, pp. 612-617. doi: 10.2105/AJPH.2005.070680 The Health of New Zealand Adults 2011/12: Key findings of the New Zealand Health Survey. Section 7: Barriers to Accessing Health Care. http://www.health.govt.nz/system/files/documents/publications/health-of-new-zealand-adults-2011-12-section7.pdf Ministry of Health. 2014.Tobacco Use 2012/13: New Zealand Health Survey. Wellington: Ministry of Health. David Pearson. Ethnic inequalities Occupation and education, Te Ara the Encyclopedia of New Zealand, updated 13-Jul-12 URL: http://www.TeAra.govt.nz/en/ethnic-inequalities/page-6 Lisa Marriott and Dalice Sim. 2014. Indicators of Inequality for Maori and Pacific People. http://www.victoria.ac.nz/sacl/centres-and-institutes/cpf/publications/pdfs/2015/WP09_2014_Indicators-of-Inequality.pdf Ministry of Health. 2014. Major causes of death (all ages) http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/maori-health-data-and-stats/tatau-kahukura-maori-health-chart-book/nga-mana-hauora-tutohu-health-status-indicators/major-causes-death-all-ages David Pearson. Ethnic inequalities Occupation and education, Te Ara the Encyclopedia of New Zealand, updated 13-Jul-12 URL: http://www.TeAra.govt.nz/en/ethnic-inequalities/page-6 David Pearson. Ethnic inequalities Housing, health and justice, Te Ara the Encyclopedia of New Zealand, updated 13-Jul-12 URL: http://www.TeAra.govt.nz/en/ethnic-inequalities/page-7 Ministry of Business, innovation Employment. 2009. Maori in the New Zealand Labour Market. http://www.dol.govt.nz/publications/lmr/maori/in-the-labour-market-2009/executive-summary.asp Prepared by Tony Blakely (UOW) and Don Simmers (NZMA), with input from many colleagues. June 2011. FACT AND ACTION SHEETS ON HEALTH INEQUITIES. http://www.pha.org.nz/documents/fact-action-health-inequalities.pdf Citation: Ministry of Health. 2009. A Focus on the Health of MÃâÃ ori and Pacific Children: Key findings of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health. Ministry of Health. Maori PH workforce development: the Aotearoa context. http://www.publichealthworkforce.org.nz/maori-health-development_66.aspx Charles Waldegrave, Peter King, Tangihaere Wlaker, Eljon Fitzgerald. 2006. Maori Housing Experiences: Emerging Trends and Issues. http://www.chranz.co.nz/pdfs/maori-housing-experiences.pdf
Physical Exercise Reduce Symptoms Depression Health And Social Care Essay The aim of this essay will be to discuss and apply selected evidence related to nursing practice within a chosen field. Evidence based practice is an approach used by clinicians to deliver the highest quality care to meet the needs of patients and their families. By finding appraising and using the best evidence, health professionals are able to achieve optimum outcomes for all. (Melnyk Finout-Overholt 2005). However, an alternative view suggests that evidence exists to inform and guide practice rather than dictate it. (McKenna et Al 1999). When clinicians apply an evidence based model, the best available evidence, modified by patient circumstances and preferences, is applied to improve the quality of clinical judgements. (McMaster Clinical Epidemiology Group 1997) A recognised framework will be used to identify a question and then a systematic literature search will be carried out to assist in answering this question. A copy of this search will be provided and search parameters will be applied to gain the most relevant literature. After applying these parameters the search will be narrowed down to the five most relevant pieces of research. A table will be provided to show the key findings from each piece of literature, and one piece of research will then be critiqued in depth using a recognised framework. The question identified in this essay is Can physical exercise or activity help to reduce the symptoms of depression in older adults, compared to other forms of treatment? Background and Formulation of Question The question was devised using the PICO framework. This framework often is used to formulate clinical questions (Craig Smyth 2002), and it identifies and defines the essential components of a good clinical question. PICO is an acronym for patient population of interest, intervention, comparison intervention and outcome (National Institute for Health and Clinical Excellence 2007). Patient population of interest shall be older persons diagnosed with depression, intervention shall be physical exercise or activity, the comparison intervention shall be other forms of treatment for depression and the outcome will be a reduction in the symptoms of depression. A well thought out and formulated question maximises the potential for finding relevant evidence for a patient population (Craig Smyth 2002) Depression in older adults refers to depressive syndromes defined in the American Psychiatric Associations Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that arise in people older than age 65 years. In old age, the symptoms of depression often affect people with chronic medical illnesses, cognitive impairment, or disability. (Alexopolous et al 2002). For a major depressive episode to be diagnosed, five of the following symptoms must be present: depressed mood, diminished interest, loss of pleasure in all or almost all activities, weight loss or gain (more than 5% of bodyweight), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling of worthlessness or inappropriate guilt, reduced ability to concentrate, recurrent thought of death or suicide. At least one of the symptoms must be either depressed mood or diminished interest or pleasure. The episode should last at least 2 weeks, lead to distress or functional impairment, and not be a direct effect of substance use, a medical condition, or bereavement. (Depression Today 2010). Two of the symptoms detailed above must be present for a minor depressive episode to be diagnosed. Between one and four percent of the general elderly population has major depression, and minor depression has a prevalence of between four and thirteen percent (Blazer 2003). Twice as many women as men are affected. Both the prevalence (Palsson et al 2001) and the incidence (Teresi et al 2001) of major depression double after age 70-85 years. Treatment for depression usually involves a combination of anti depressant drugs, talking therapies such as Cognitive Behaviour Therapy or Interpersonal Therapy and self help. (NHS Choices 2010). A recent review concluded that physical exercise programmes can obtain have a beneficial effect on depressive symptoms in older people. Although not appropriate for all older people exercise may improve mood in those undertaking it. (Blake et al 2009) Systematic Literature Search A systematic review of the literature was carried out using the CINAHL and PubMed databases and the search terms depression physical exercise and old* were used. CINAHL was found to be particularly useful as it possible to specify the age group required in the literature search. For the purposes of this search age 65+ was selected. PubMed is the public access version of Medline, a comprehensive database which indexes thousands of journals in the medical sciences field. (TVU 2010a). The Cumulative Index to Nursing and Allied Health Literature Indexes virtually all English language journals from 1983 onwards. This database covers midwifery, nursing and related disciplines (TVU 2010b). Initially the searches indicated a vast array of literature but by applying a systematic review this was reduced. By using a logical search strategy with Boolean techniques the number of documents was limited to thirty. These were then reviewed and five articles were then selected which addressed the ques tion of exercise as a form of treatment for older people diagnosed with depression. The search parameters were limited to studies written in the English language, the age and the subjects, and both sexes were to be included. Harvard (2007) suggests that by applying parameters such as these the most up to date and relevant literature can be sourced. A full record of this search history is attached in appendix 1 and 2. A summary of the findings in the five pieces of research selected is detailed in the table overleaf. This table follows a structure recommended by Timmins McCabe (2005). Author and Year Journal Type of Study Purpose Sample Design Data Collection Key Findings Blake et al 2009 Clinical Rehabilitation Qualitative To assess efficacy of physical exercise in 11 trials totalling 641 participants Varied Varied 1 Exercise not relevant 2009; 23: 873-887 systematic treating depression in older adults to all in group review 2 May improve mood 3 further research needed to establish medium to long term effects and cost effectiveness Mather et al 2002 British Journal of Quantitative To determine whether exercise is effective 86 participants split into RCT clinical 1 Modest improvement Psychiatry (2002) as an addition to anti depressants in reducing two groups interview in symptoms after 10 180:411-415 depressive symptoms in older adults weeks 2 older people should be encouraged to attend exercise classes Brenes et al 2007 Aging Mental Health Quantitative To test feasibility and efficacy of exercise and 37 participants, 32 completed RCT structured 1 Both exercise Jan 2007;11(1):61-68 anti depressants compared with usual the study clinical interview and medication were treatments for older adults with observed shown to be statistically minor depression self reporting more effective than current treatment 2 Exercise also aided physical functioning Kerse et al 2010 Annals of Family Quantitative To assess effectiveness of home based 193 participants, 187 completed RCT structured 1 exercise and social Medicine 8:214-223 (2010) physical exercise plan in treating older the study clinical interview visits showed similar adults with depressive symptoms compared effects in improving to social visits mood an quality of life 2 More research is required Blumenthal et al Archives of Internal Quantitative to assess effectiveness of exercise 156 participants RCT structured 1 after 16 weeks 1999 Medicine 159(19) (1999) compared to antidepressants for treatment clinical interview exercise equally effective of major depression in older as anti depressantsCritical Appraisal The following appraisal was structured by using an approved and recognised framework for completing such tasks. (Polit et al. 2001) The article selected for critical appraisal is Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. (Mather et al. 2002). A copy of the article is attached as appendix 2. The aim of the study was to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. This was clearly defined. In the introduction the authors stated that it is widely held that exercise is useful in depression, but that there were few studies on the potential effects that exercise may have as an addition to antidepressant therapies for older adults. The key finding of this study was that at ten weeks older people with poorly responsive depressive disorder showed a modest improvement in depressive symptoms and should therefore be encouraged to attend group exercise activities. The study conducted was a randomised controlled trial. Randomised controlled trials are the most rigorous way of determining whether a relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. (Sibbald Rowland 1998). Patients were randomly selected to attend either exercise classes or health education talks for ten weeks. Assessments were blind and were conducted at baseline, ten and thirty four weeks. The primary outcome was measured with the 17 item Hamilton Rating Scale for Depression (HRSD). HRSD is a multiple choice questionnaire used by clinicians to measure the severity of major depression in patients. (Hamilton 1960). The nature of both interventions is clearly described by the authors. All participants were outpatients recruited from primary care, psychiatric services and direct advertisement. 1885 patients were screened with a view to recruitment, and 86 were selected at random for the study. To be included patients were require d to have symptoms of depression, and to be older than fifty three years of age. In addition patients had to have been receiving antidepressant therapy for at least six weeks, without evidence of a sustained improvement in their condition. Patients were excluded if there was: alcohol or substance misuse, structured psychotherapy in place, or were already taking regular exercise. Patients with specific medical conditions preventing physical exercise were also excluded. Both groups were informed of the nature of the trial, and all patients gave written informed consent. The study was approved by a medical research ethics committee. There were two groups with 43 patients in each and were comparable in terms of age range and symptom presentation. There was however a heavy preponderance of women in the exercise group. The authors suggest that this may have introduced a bias into the results, and suggest a control group could be introduced in the future without either intervention. The outcomes for both groups were measured in the same way by the proportion of participants achieving a greater than thirty percent reduction in HRSD score from baseline. The results are shown in a statistical format and are recorded in a table. There are twenty four references in the report which support the evidence presented by the authors. The implications for the health service are that structured group exercise sessions can help to make a modest improvement in patients who are not responding to pharmacological treatment and that older people with depressive disorders should be encouraged to attend group exercise activities. It should be noted that one of the authors of the research is co-director of a company providing exercise classes for older people and whose profits support research into aging. Review of Literature This review of literature will show how the five main studies and all available literature assist in answering the set question. The first part of this review will concentrate on the five main studies and the second part will contain evidence from a wide range of sources and relate this combined information to government policy and guidelines. There will also be evidence of how all the information relates back to practice. It is well acknowledged that depression is widespread (Osborn et al 2003) and is the most prevalent mental health problem for older people (Age Concern 2007) The condition affects one in five people over 65 and rises to two in five in those over 85 (Mental Health Foundation 2008). The use of exercise to combat depression is well supported due to its effects on enhancing mood, improving cognitive function and reducing anxiety; it is also less expensive than medication (Louch 2008). A literature review was conducted to examine whether exercise could be an effective form of treatment for older adults with depressive symptoms. Article 1 (Blake, Mo, Malik and Thomas 2008) conducted a systematic review of eleven randomized control trials in order to establish whether physical activity interventions were successful in alleviating depressive symptoms in older people. Trials were included in the review when more than 80% of the participants were greater than sixty years old. In nine of the eleven studies short term positive outcomes were found, although the mode, intensity and duration of the exercise program differed across the studies. The medium to long term effects of exercise as an intervention were less clear. This outcome is backed up by Mead et al (2008) who concluded that exercise seems to improve depressive symptoms in people with a diagnosis of depression, but the effects are moderate and not statistically significant. However a randomized controlled trial conducted by Blumenthal et al (1999) (Article 2) had reached different conclusions. One hundred and fifty six men and women aged over fifty were split into groups randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride) or combined exercise and medication. After sixteen weeks of treatment the patients did not differ significantly statistically either on Hamilton Rating Scale for Depression or Beck Depression Inventory scores. The study concluded that antidepressant medication had the most rapid effect, but after sixteen weeks exercise was equally effective in reducing symptoms of major depressive disorder. Article 3 (Brenes et al 1999) conducted a pilot study designed as a randomized clinical trial to test the feasibility and efficacy of an exercise program and antidepressant treatment compared with usual care in improving emotional and physical functioning in older adults with minor depression. A total of thirty seven participants aged over sixty five were randomized to treatment: fourteen to exercise, eleven to sertraline and twelve to usual care. Patients who received either exercise or sertraline treatments demonstrated improvement both in clinician led and self reported measures of depressive symptoms. Those participants who received the usual package care experienced small or no improvement in mental state. There are some limitations to this study however. The sample size was small and thus the statistical power was weak. The diagnosis of minor depression was based on self diagnosis rather than clinical interview. It was also not stated in the report what the usual care was. Ther e were however significant trends to suggest that sertraline and exercise could be used as treatments for mild depression in older adults, and that a more in depth study should be undertaken. Article 4 (Kerse et al 2010) published a study comparing the effects of a home based exercise program with regular social contact in improving function, quality of life and mood in older people with depressive symptoms. A randomized controlled trial was conducted in which one hundred and ninety three people aged over seventy five with depressive symptoms received either an individualized physical activity program or social visits delivered over six months. The social visits were of the same time span as the exercise program. Outcome measures were obtained at three, six and twelve months. Both physical and mental well being was measured using a variety of techniques including a short function test, and the Nottingham Extended Activities of Daily Living Scale (Nouri Lincoln 1987). It was concluded that a structured activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. There was however no control group bein g measured that was receiving usual care. Article 5 (Mather et al 2002) set out to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. A randomized controlled trial was conducted in which eighty six participants aged between fifty three and ninety one already receiving anti depressant therapy were given either exercise classes or health education talks over a ten week period. Assessments were made blind at baseline, ten and thirty four weeks using the Hamilton Rating Scale for Depression as the primary outcome. At ten weeks a significantly higher proportion of the exercise group (55% compared with 33%) experienced a greater than 30% decline in depression. In an article in The British Journal of Psychiatry in 2002, Jagadheesan et al critiqued this study and stated that it could have been more meaningful if a control group had been added which received no additional treatment other than continuing antidepressants. (Jagadheesan et al 2002). The majority of research above suggests that physical exercise reduces depression and depressive symptoms in the short term in older adults, but additional well controlled studies are required to determine the long term efficacy. A systematic review carried out by Sjosten Kivela supports these findings (Sjosten Kivela 2002). Direct comparisons between studies is difficult as they differ greatly in characteristics, nature of control comparison group, age of the participants, type and intensity of exercise and outcome measures used to follow up. National Institute for Clinical Excellence guidelines are set out to assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The guidelines for depression suggest that for particularly for patients with mild or moderate depressive disorders, structured and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms. There is also evidence to suggest that individuals with low mood may also benefit from structured and supervised exercise. (NICE 2005). Conclusion Physical exercise is clinically beneficial in the short term for treatment of depressive symptoms in older people. Exercise, although not appropriate for all older persons with depression, may improve mood in this group. Evidence of the cost effectiveness of providing exercise interventions would be beneficial in helping decision making regarding service use and delivery. More well designed research studies are needed to examine the medium and long term benefits of exercise as a treatment for depressive symptoms in older adults, and to examine the types and duration of interventions that have the most positive effect. Word Count 3008 References Age Concern (2007) Mental Health Services Letting Down Older People. [On Line] Available at http://www.ageuk.org.uk/ [Accessed 12 May 2010] London: Age Concern. Alexopoulos, G.S., Buckwalter, K., Olin, J., Martinez, R., Wainscott, C., Krishnan, K.R. (2002) Comorbidity of late-life depression: an opportunity for research in mechanisms and treatment. Biol Psychiatry 2002; 52:543-58. Blake, H., Mo, P., Malik, S., Thomas, S. (2009) How Effective are Physical Activity Interventions for Alleviating Depressive Symptoms in Older People? A Systematic Review Clinical Rehabilitation 2009; 23: 873-887 Blazer, D.G. (2003) Depression in late life: review and commentary. J Gerontol Med Sci 2003; 56A: 249-65. Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, E., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Forman, L.M., Appelbaum, M., Doraiswamy, P.M., Krishnan, K.R., (1999) Effects of Exercise Training on Older patients with Major Depression Archives Of Internal Medicine Vol. 159 No.19, October 25, 1999 Brenes, G.A., Williamson, J.D., Messier, S.P., Rejeski, W.J., Pahor, M., Ip, E., Penninx, J.H. (2007) Treatment of Minor Depression in Older Adults: A Pilot Study Comparing Sertraline and Exercise Aging Mental Health, January 2007; 11(1): 61-68 Craig, J.V. (2002). How to ask the right question. In J.V. Craig R.L. Smyth (Eds.), Evidence-based practice manual for nurses (pp. 21-44). Philadelphia: Churchill Livingstone. Depression Today (2010) DSM IV [Online] Available at http://www.mental-health-today.com/dep/dsm.htm [Accessed 8 May 2010] Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry. 23: 56-62 Harvard, L. (2007) How to conduct an effective and valid literature search. Nursing Times 103, (45), 32-33 Jagadheesan, K., Chakraborty, S., Sinha, V.K., Nizamie, S.H. (2002) Effects of Exercise on Depression in Old Age The British Journal of Psychiatry (2002) 181: 532 Kerse, N., Hayman, K.J., Moyes, S.A., Peri, K., Robinson, E., Dowell, A., Kolt, G.S., Elley, C.R., Hatcher, S., Kiata, E., Wiles, J., Keeling, S., Parsons, J., Arroll B., (2010) Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE A Randomized Controlled Trial Annals of Family Medicine 8:214-223 (2010) Louch, P. (2008) Depression in Primary Care [On Line] Available at http://www.depression-primarycare.co.uk/ [Accessed 14 May 2010] Mather, A.S., Rodriguez, C., McMurdo, M.E.T. (2002) Effects of Exercise on Depressive Symptoms in Older Adults with Poorly Responsive Depressive Disorder The British Journal of Psychiatry (2002) 180: 411-415 McKenna, H., Cutliffe, J., McKenna, P., (1999) Evidence-based practice: demolishing some myths. Nursing Standard. 14, 16, 39-42. Date of acceptance: November 15 1999. McMaster Clinical Epidemiology Group (1997) Evidence Based Practice Resources [On Line] Available at http://hsl.mcmaster.ca/resources/topic/eb/nurse.html [Accessed 20 May 2010] Mead, G.E., Morley, W., Campbell, P., Greig, C.A., McMurdo, M., Lawlor, D.A. (2008) Exercise for depression. Cochrane Database of Systematic Reviews 2008. Issue 4. Art. No. CD004366.Ã Melnyk, B. M., Fineout-Overholt, E. (2005). Evidence-based practice in nursing healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams Wilkins. Mental Health Foundation (2007) Depression and Suicide in Later Life [On Line] Available at http://www.mentalhealth.org.uk/information/mental-health-a-z/depression-and-suicide-in-later-life/?locale=en [Accessed 12 May 2010] London: Mental Health Foundation National Institute for Health and Clinical Excellence (2005) Depression: Management of depression in primary and secondary care National Institute for Health and Clinical Excellence National Institute for Clinical Excellence (2007) Developing Clinical Questions [Online] Available at: http://www.nice.org.uk/niceMedia/pdf/GuidelinesManualChapter5.pdf [Accessed 8 May 2010] NHS Choices (2010) Treating Depression [On Line] Available at http://www.nhs.uk/conditions/depression/pages/treatment.aspx [Accessed 16 May 2010] Nouri, F.M. Lincoln, N.B. (1987) An Extended Activities of Daily Living Index for stroke patients. Clinical Rehabilitation 1987; 1:301-5. Osborn, P.J., Fletcher, A.E., Smeeth, L., Stirling, S., Bulpitt, C., Nunes, M., Breeze, E., Edmond, S.W.Ng., Jones, D., Tulloch, A. (2003) Performance of a single screening question for depression in a representative sample of 13,670 people aged 75 and over in the UK: Results from the MRC trial of assessment and management of older people in the community. Family Practice; 20: 6, 682-684 Palsson, S., Ostling, S., Skoog, I. (2001) The incidence of first onset depression in a population followed from the age of 70 to 85.Psychol Med 2001; 31: 1159-68. Polit, D.F., Beck, C.T., and Hungler, B.P. (2001) Essentials of nursing research methods, appraisal and utilisation. (5th Ed.) Philadelphia; Lippincott. Sibbald, B. Roland, M. (1998) Understanding controlled trials: Why are randomised controlled trials important? BMJ 1998; 316:201 (17Ã January) Sjosten, N., Kivela, S.L., (2006) The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int J Geriatr Psychiatry. 2006 May; 21(5):410-8 Teresi, J., Abrams, R., Holmes, D., Ramirez, M., Eimicke, J. (2001) Prevalence of depression and depression recognition in nursing homes. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 613-29. Thames Valley University (2010a) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Thames Valley University (2010b) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Timmins, F. McCabe, C. (2005) How to conduct an effective literature search Nursing Standard November 23: vol 20 no 11 Appendix 1 Copies of Search Strategies
Saturday, July 20, 2019
Agamemnon Agamemnon is the first book in the Orestiean Trilogy written by the famous Greek tragedy writer, Aeschylus. Agamemnon is a story of justice and revenge. The story takes place in a city called Argos. It starts with Agamemnon, the king of Argos, away at the Trojan War. The city is eagerly awaiting the news of their kingÃ¢â¬â¢s welfare and the outcome of the war. Watchmen are posted in the city, watching for the beacon that would report the capture of Troy and AgamemnonÃ¢â¬â¢s return. Beacons are set up from Troy to Argos; when one beacon is lit, the next one will be lit, until the last. The play starts when a palace watchman discovers the beacon and tells AgamemnonÃ¢â¬â¢s wife, Clytemnestra, the good news. The chorus enters relating the story of Agamemnon and his brother Menelaus. When MenelausÃ¢â¬â¢ wife, Helen, ran away to Troy with Paris, the prince of Troy, Menelaus gathered an army, led by Agamemnon, to attack Troy and retrieve Helen. Most important about the chorusÃ¢â¬â¢s speech is their mention of Agamemnon sacrificing his daughter, Iphigenia, in order to be able to wage war on Troy. They tell how she was sacrificed despite her cries, all for a wind that would take them to war. Clytemnestra then tells the chorus about the defeat of Troy and Agamemnon returning from his ten years away at war. After a few hours Agamemnon finally returns to his city. Along with him he brings Cassandra, a princess of Troy and captive to Agamemnon. She is known to be a prophetess who tells of tragedies. ...
Friday, July 19, 2019
<a href="http://www.geocities.com/vaksam/">Sam Vaknin's Psychology, Philosophy, Economics and Foreign Affairs Web Sites The debate between realism and anti-realism is, at least, a century old. Does Science describe the real world Ã¢â¬â or are its theories true only within a certain conceptual framework? Is science only instrumental or empirically adequate or is there more to it than that? Jose Ortega y Gasset said (in an unrelated exchange) that all ideas stem from pre-rational beliefs. William James concurred by saying that accepting a truth often requires an act of will which goes beyond facts and into the realm of feelings. Maybe so, but is there is little doubt today that beliefs are somehow involved in the formation of many scientific ideas, if not of the very endeavour of Science. After all, Science is a human activity and humans always believe that things exist (=are true) or could be true. A distinction is traditionally made between believing in somethingÃ¢â¬â¢s existence, truth, value of appropriateness (this is the way that it ought to be) Ã¢â¬â and believing that something. The latter is a propositional attitude: we think that something, we wish that something, we feel that something and we believe that something. Believing in A and believing that A - are different. It is reasonable to assume that belief is a limited affair. Few of us would tend to believe in contradictions and falsehoods. Catholic theologians talk about explicit belief (in something which is known to the believer to be true) versus implicit one (in the known consequences of something whose truth cannot be known). Truly, we believe in the probability of something (we, thus, express an opinion) Ã¢â¬â or in its certain existence (truth). All humans believe in the existence of connections or relationships between things. This is not something which can be proven or proven false (to use PopperÃ¢â¬â¢s test). That things consistently follow each other does not prove they are related in any objective, Ã¢â¬Å"realÃ¢â¬ , manner Ã¢â¬â except in our minds. This belief in some order (if we define order as permanent relations between separate physical or abstract entities) permeates both Science and Superstition. They both believe that there must be Ã¢â¬â and is Ã¢â¬â a connection between things out there. Science limits itself and believes that only certain entities inter-relate within well defined conceptual frames (called theories). Not everything has the potential to connect to everything else. Entities are discriminated, differentiated, classified and assimilated in worldviews in accordance with the types of connections that they forge with each other.