“Dude, Where’s My Country?” Book Review

â€Å"Dude, where is My Country† is a book composed by Michael Moore and distributed by Penguin Books in 2004. In this book, Moore provocatively and strongly talks about a few socio-political occasions in America. He takes on George W. Hedge, the Conservative unit and corporate wheeler sellers in America and offers wide extending cures which place the country’s reclamation decisively on the shoulders of the liberal powers. The creator analyzes America’s issues in themes running from tax reductions, the Iraqi war, among others and exhibits the disappointment of the country state to be an immediate result of moderate ethos. Moore first tries to expose what he calls the ‘Big Lie’, that America is characteristically and unavoidably traditionalist. He terms this conviction as an advocate lie, sustained by the privilege so as to put down the liberal masses. â€Å"†¦.. In this way, in the custom everything being equal, they lie. They make a contrary truth: AMERICA IS CONSERVATIVE. At that point they pound away with that bogus message so hard thus regularly that even their political adversaries come to accept that it's true,† Moore attests (Moore, 2003 page 2). To demonstrate that most Americans are without a doubt liberal, Moore gives realities which show greater part support for the Civil Rights development, premature birth, the Roe versus Wade administering, the Green development, weapon limitations, general human services (or associated medication as he puts it), network rather than prison administration for wrongdoers, gay and lesbian rights and unionization. He at that point asks why moderates hold the rein of initiative in the nation and continues to offer his ten pennies worth. Section one offers seven apparently logical conversation starters to Bush. Home of the Whopper† is the heading of Chapter two and it fills in as a symbolic herald of the issues introduced in this. Here, the creator talks about the untruths told by the Bush organization before portraying a tale including his incredible granddaughter who tries to discover from him the condition of the world when oil and plastics were accessible and looks to comprehend the purposes for the disappointment of arranging. It might be said, this part prosecutes the Bush organization for its remiss vitality approaches and appears to propose a hopeless future for America occasioned by these arrangements. Part four is named â€Å"The United States of Boo† and it appears as an exposition. In this part, Moore exhibits that passing through fear based oppression is factually unimaginable. As he so capably appears, there are different endless and conceivable courses through which Americans can bite the dust that fear based oppression dangers mean nothing. The ploy by the moderate war producers is a deception intended to remove Americans’ common freedoms. No place is this more concisely prove than in the Patriot’s Act, Moore induces. The following part depicts manners by which standard Americans can diminish demonstrations of psychological oppression. In resulting sections, Moore dispatches into an irate hostile rant against George W. Bramble that is bound with sour silliness. The Bush years are summed up as a bombed administration and different realities showed to help this case. The war against Iraq is introduced in incredible detail and utilized for instance to show Bush’s feeble administration. So also, the Enron catastrophe, the notorious Bush tax reductions and the breakdown of different firms are refered to as results of bombed financial arrangements. The creator exposes the relationship between Bush, Osama Bin Laden and Saudi Arabia. He proceeds to make stunning cases about supposed business associations between the Bushes and the Saudi Arabia aristocrats. As opposed to the desires of FBI and despite the way that solitary four of the 19 ruffians were non-Saudis, the Bush government protected the Saudi Arabians from examinations while different Arabs in America were secured simply like the Japanese were during the post world war II interment. Moore excuses the high endorsement evaluations delighted in by Bush in 2004 in this way: â€Å"the high appraisals for Bush are not an underwriting of his strategies. Or maybe, it is the reaction of a terrified nation that must choose the option to back the man accused of securing them. America has not begun to look all starry eyed at Bush-it's increasingly similar to â€Å"love the one you're (left) with. † (Moore, page 6). Railing against the â€Å"Christian Coalition†, Moore persuasively makes pitch for an administration worked around people who live and comprehend America for what it's worth. With respect to this, he presents the â€Å"Draft Oprah for President† development. Oprah, it appears, is the very portrayal of this individuals president that America so frantically needs. A clarion call for dissidents to reclaim their nation from the ‘undesired’ hands of the preservationists is sounded. Moore gravely expresses that Democrats ought not be left to â€Å"screw up† the [2004] political race and rather subtleties what he calls â€Å"Operation 10-Minute Oil Change† where everyone is called upon to accomplish something for ten minutes day by day with an end goal to drive out Bush and his oil associates. While the book is written in a straightforward language with powerful models, some hard realities and upsetting and profound inquiries that definitely work up intelligent idea, one can't help evade the inclination that it is horribly abstract and without genuine talk. Furthermore, ‘Dude, Where is My Country† appears to be a brazen support of General Wesley Clark and the Democrat company. I don't concur with Moore since his book is fragrant with various deceptions, falsities and errors. In page 69, he purposely distorts realities about American’s dealings with Iraq, advantageously destroying the arrangements of UN’s nourishment for oil program. He gives a not insignificant rundown of people as far as anyone knows bothered with the Patriot Act in page 111. Notwithstanding, as indicated by the sources he has given, the recorded people were never in any capacity influenced by the enactment. In a bold presentation of deceitfulness, Moore asserts that conclusion of schools in Oregon in 2003 was as an immediate consequence of the Bush tax breaks though they were in reality because of another law that decoupled the state’s personal expense framework from that of the focal government. There are numerous different cases which can't stand the test. They appear to have been purposefully wound with the goal that they can prop his cases. A portion of his attestations verge on the theoretical. A genuine case of this is the unconfirmed case that Saudi military acted in cahoots with Bush and the Saudi government to dispatch them. While a few cases are upheld by strong reality, numerous others are not verifiable and it is decisively this explanation that makes it difficult to concur with Moore lock, stock and barrel.

Same-Sex Marriages Should NOT Be Allowed Essay -- Legal Issues, Same S

Permitting same-sex relationships would change the essential meaning of marriage. Marriage is a significant duty of a man and a lady who add to human advancement. In this manner, the loss of commitments due to someone’s sexual direction ought not be compensated with a benefit, for example, marriage. Same-sex relationships influence numerous variables, for example, kids, the idea of marriage, and humankind. Nonetheless, it's anything but a crime to adore someone of a similar sex however it can thoroughly harm numerous parts of life. Likewise, same-sex relationships additionally can influence the individuals who are brought up by them as youngsters. It was uncovered that youngsters raised by gay couples did more regrettable than the posterity of hetero couples in nine of thirteen scholarly and social classes. At the point when youngsters are received they don't get a decision in whether their folks are gay or straight. Thus, their sexual direction might be misshaped because of the guardians they are embraced to. Youngsters brought up in families drove by same-sex guardians may decide to get gay or lesbian at a higher rate than thos...

Why I Chose To Spend My First Weekend Away From MIT

Why I Chose To Spend My First Weekend Away From MIT 1. I Kind Of Had To Things pick up pace real quick once the semester starts. At times, it feels like youre in a hamster ball, surrounded by due dates, responsibilities, meetings, applications. The grind never stops, and it comes at you from every direction. And so you walk all over your workload, checking off one thing after another. Until, they eventually travel a full circle to look right back at you in the eye. Thats one longwinded way of saying that Im back and Junior year has started. But along with the insane craziness that is my google calendar when Im at MIT, Ive returned with a new found drive to look at whats beyond the hamster ball. And so I found myself really actually relaxing in the mountains of New Hampshire. Now, if you know even the slightest bit of me, youd know that I really really really am not the type of person that would willingly spend the first weekend of the semester off campus. Rather Im definitely the type of person that would be spending that weekend color coding my calendars, creating assignment reminders and tackling whatever psets have already been released. But as you slowly but surely make your transition into being an upperclassmen, you begin to see things with a new perspective and your priorities begin to shift a little. So yes, I spent my first weekend a little bit up north of MIT, and heres why: 1. I Kind Of Had To The morning of retreat, my wonderful co-coordinator Sarah A. (21) and I literally woke up at 6:30 am, while all of campus was sleeping to make our way over to the nearest Restaurant Depot. The store had closed too early the night before and we hadt bought hamburger patties for our BBQ yet. After showing that kind of dedication, you cant not go to something youve spent months planning. So yeah, I kind of had to go. But also, I genuinely wanted to see how all of our hard work would pan out. The Muslim Students Associations Welcome Retreat was our summer baby. And we had to be there to witness it come to life. Heres a snapshot of what the weekend looked like: 2. Catching Up With Old Friends Is Nice Group chats and FaceTime calls do not do justice to actually being surrounded by some of your closest friends. And tbh, theres no better way to catch up with one another than being stuck in 2 hour car rides and finding yourself in an airbnb in the middle of nowhere New Hampshire. Youre kind of forced to be fully engaged in the moment. And even though I thought I new my friends well, theres always new surprises. 3. Who Doesnt Like Fostering New Connections Of the many community-building activities we had planned, we had one in particular that stuck out to most people: Spinning Yarn. So the idea here is that someone starts off by holding a ball of yarn. And they began to speak about themselves. Anything they want to say, from a quick recap of their ancestry to stories of sledding down the stata amphiteater. When someone else in the room relates to something theyve said, the barn of yarn is thrown over to them. It becomes their turn to tell us a little something about themselves or their lives. And so it goes on, until everyone is connected in a web of yarn: a pretty cool visualization of how people from all walks of life can become connected if they step forward: 4. Becoming B R A V E Theres not much to say here other than the fact that I went zip lining for the first time. And for someone who is absolutely terrified of roller coasters and things of the like, asking me to leap above a river with nothing but a harness to keep me from falling is kind of a lot. I might have dramatically screamed as I jumped, but I did it. And yeah, I feel like my bravery level rised just a tad bit. 5. Some Peace Is Kind Of Nice After a long day of zip lining, mountain biking and cave hiking, I found myself sitting in a Gondola on my way back down to the main ground. If there is any one moment that my heart feel so incredibly full in it was that moment. As we slowly descended from the top of Loon Mountain, all four of us that were in the gondola were just so awestruck by the beauty we were surrounded by that we sat in absolute silence, soaking in the surrounding views and giving each other the opportunity to spend some time within ourselves. Rarely do I ever feel comfortable to sit in silence for 15 minutes while being surrounded by others. But the silence came naturally with a feeling of pure peace. 5. Putting Things Into Perspective When your surrounded by all kinds of crazy views (or windows screen savers as some would call it), its not hard to realize that there is so much outside of the hamster ball. And while the hamster ball most certainly is my day to day reality, and is something that I look forward to exercising in, Ive realized how important it is to take a break, take a look outside, and maybe even occasionally go on a little adventure. Distance is good because it is a catalyst for reflection. And I can confidently say that my weekend away has not only fostered a better sense of connection with one of my key communities, but its also giving me a whole lot of beautiful photos to look back at and reminisce about.   But most importantly, those hamster legs of mine feel well rested and ready to tackle my next 3-month marathon.

Descriptive Essay - Original Writing - 1372 Words

â€Å"Yeah, Belich, is a bum,† Manny laughed. â€Å"I can’t stand that guy and his boring lectures. You would think history would be fun with all the wild stuff that happened before the volunteers, but Belich always finds a way to make it as dull and numbing as possible.† â€Å"Yeah, well, that’s all I really did over my recess,† Phillip admitted. â€Å"Kept it pretty low key, I guess. Hey, I’m going to grab an ice cream, can you guys watch my notepad computer.† â€Å"Yeah, whatever,† Manny dismissed. Lunch ended and Phillip then headed off to his next class, Introduction to Calculus. After having taken his usual seat in the back, he powered up his notepad computer so he could follow along with today’s lecture and take notes. But, even before the class†¦show more content†¦But, he told himself he was just being a baby and that he should get it over with and go see whoever this was and find out what they wanted. He had even thought it may be Russell behind the message. That he was playing some kind of trick on him for what happened down at the barber shop on Saturday. That he would be there at the playground in hiding with a bucket of something acrid and foul to throw at him, like rotten tomatoes perhaps. Phillip was determined to not let his brother get away with another one of machinations again, and he even began to give thought about what he could do to foil Russell’s plan. Having gotten himself a couple of stink bombs from Manny, Phillip was all set for his encounter with the stranger†¦ a stranger named Russell. And, he knew that if his brother wanted to play this game of cruelly picking on him, then his transport would be smelling like rotten eggs for the foreseeable future. With his smelly ammo secure in his pocket, Phillip ducked out one of the rear doors of the school just as soon as his final class had let out. He then made his way through the Southside parking lot, walked east along the runner’s track and baseball diamond, and ultimately came to the far side of the school district’s property where the playground and the backside of the elementary school stood. Looking around, it appeared to Phillip that he was alone. But he knew that wasn’t true. Russell was aroundShow MoreRelatedDescriptive Essay - Original Writing1110 Words   |  5 PagesI don’t know how I got to where I am, but I’m here now, and I have to win if I want to live. I am in a game, and in order to live, I have to escape . That’s the thing, though: I don’t know how to escape. I was running for my life around this old house that looked like it came straight out of a horror movie. I doubled over and held my head in pain as I saw the static, which meant it was coming. I was being chased by what looked like a person but in no way acted like one. Just as it was about to appearRead MoreDescriptive Essay - Original Writing1102 Words   |  5 PagesIt is on days like this when we stop to think about our life. Small drops of rain begin to dapple the cobblestone pavement as people whip out their umbrellas for cover. I continue sauntering down the busy street, relishing the feeling of a light shower. Moving with the mass of pedestrians, I stop at a crosswalk where I wait for the stoplight to turn green. A flower shop employee across the street scurries to bring in the numerous bouquets and close the doors as rain starts rolling down the displayRead MoreDescriptive Essay - Original Writing914 Wor ds   |  4 PagesDreamy I thought. Standing on the corner is a young guy with a smile. I see him here almost every day, so I linger for a while. He tells me his name, and I tell him mine. I m Ester, what s your name? I enquired. My names David .,He replied. We end up talking for a while and I asked him if he had ever left this city. He tells me of all these stories of the places where he s been, the distant lakes and mountains, and in valleys oh so green. I can see it in his eyes, he really has beenRead MoreDescriptive Essay - Original Writing974 Words   |  4 Pages I was used to moving round, having a mother who liked to travel more than making roots was something I had gotten used to. Still, I had never gotten used to the loneliness of an empty house when she was out exploring, or the feeling of leaving behind someone who could have meant something to me. Our most recent move was Oregon. It was pretty, and I didn’t mind it, but it was much different than Florida. Not only was it opposite sides of the country, it felt as if it were opposite worlds. InRead MoreDescriptive Essay - Original Writing1012 Words   |  5 Pageshave plenty of time in the next month to think about my feeling in regards to Kendrick. I needed to finish up the article and get it off to my editor. I should be able to get it done by tonight and send an email in the morning. I was thinking of writing my next article about the sea life around the Scottish coast. Since our salmon dinner last evening I thought I would do a piece about the commercial salmon farming that began in Scotland in 1969. In 2002 over 145,000 metric tons of farmed AtlanticRead MoreDescriptive Essay - Original Writing1561 Words   |  7 PagesThere’s something I need to say and what follows may not be something that you’d expect, it won’t be heartening or uplifting. If you remember today, I told you about going somewhere I wanted to go to†¦ I’m not sure if you believed and accepted what I now confess as untrue; it is partly. I needed to pull away emo tionally†¦ from you. You must have had fathomed that some degree of formality had seeped between us. Born of habit, formulaic greetings had become a routine. You presume that I’m a close friendRead MoreDescriptive Essay - Original Writing1387 Words   |  6 PagesI was wearing a beautiful blue dress with sapphire gems all around the chest area as I entered the ball with Ciel and Sebastian. I took a good look around here, the hallway was lined with gold. There was a servant ready to escort us to the ball room. Hello, come this way. He said, walking forward. Wow, this place is so fancy! I exclaimed, looking around. It s fake gold. Ciel bluntly replied, bringing my hopes down. I sighed. Ciel sounded like he wasn t in a very good mood. Ciel, lightenRead MoreDescriptive Essay - Original Writing1287 Words   |  6 Pages In the morning, Caireann woke me up. She stood above my bed, shaking my shoulder. I opened my eyes, looking at her. Then I looked across the room to her empty bed. Andy s empty bed sat in the corner. I swallowed, climbing out of bed. Sleep well? Caireann asked me, starting out the door. Yeah, I said, going over to our small dresser. I had the bottom two drawers. Andy had the middle two, and Caireann had the top. I pulled open the drawers, pulling on a colorful tank top and a grayRead MoreDescriptive Essay - Original Writing1345 Words   |  6 PagesLater that night, I was behind the wheel of my G-Wagon with Melissa in the passenger seat. She didn’t feel like driving since she was on the road all day and I understood so I didn’t mind when she asked me to. I had been tight-lipped. She kept eyeballing me as if she detected that something was bothering me but I just kept singing to my India Arie as if I was carefree. â€Å"So are you going to tell me what’s going on or no† Melissa said disrupting my own personal concert. I stopped singing and tookRead MoreDescriptive Essay - Original Writing1085 Words   |  5 PagesI WAS SITTING IN a taxi, wondering if I had overdressed for the evening, when I looked out the window and saw Mom rooting through a Dumpster. It was just after dark. A blustery March wind whipped the steam coming out of the manholes, and people hurried along the sidewalks with their collars turned up. I was stuck in traffic two blocks from the party where I was heading. Mom stood fifteen feet away. She had tied rags around her shoulders to keep out the spring chill and was picking through the trash

The Scarlet Letter, By Nathaniel Hawthorne - 1422 Words

The eighteenth-century author, Nathaniel Hawthorne was born on July 4, 1804 in Salem, Massachusetts. He was most famous for his writings The Scarlet Letter, â€Å"Young Goodman Brown,† â€Å"The Minister’s Black Veil† and an abundant array of other books and short stories. The stories that are mentioned contain a copious amount of symbolism throughout the entirety of each book. All the stories that he ever wrote have an underlying meaning and the symbolism was hidden within in the names, characters, places, and actions that happened in the books and helped the readers to have a greater understanding about the Puritan lifestyle and the Bible. The dictionary definition of symbolism is the use of symbols to represent ideas or qualities. A few†¦show more content†¦Pearl is the constant reminder of Hester’s sin; however, Pearl also brings Hester extraordinary joy. She is the cause of Hester’s determination to try and create a better life for Pe arl and herself. Pearl was also a boundless joy to her biological father, Revered Dimmesdale, in one scene, Pearl grabbed Dimmesdale by the hand and kissed it. This shocked Hester because this was one of the only times that Pearl showed affection to anyone, which brought immense joy to Dimmesdale (Lorcher, Trent). Dimmesdale is known to have committed the same crime as Hester when he clutches his chest constantly and is seen having the marking or the scarlet â€Å"A† engraved on his chest. Reverend Dimmesdale’s sin is more permanently proclaimed than Hester’s that is sewn on to her clothes, while his is a tattoo burned on his skin (Analysis: The Red Mark on Dimmesdale’s Chest). It is seen like an outward representation of the sin that is inside him that he is not fully open with (Lorcher, Trent). Pearl is always talking about the â€Å"Black Man† and she is referring to Satan and how Dimmesdale wrote his name in the Black Man’s book (Analys is: The Black Man). Hester’s husband, Roger Chillingworth is a symbol of evil and a sort of revenge for Hester (Lorcher, Trent). When Dimmesdale, Pearl and Hester meet on the scaffold one night a meteor streaks across the sky in the shape of a letter â€Å"A† and it seems to mean that God hasShow MoreRelatedThe Scarlet Letter By Nathaniel Hawthorne1242 Words   |  5 PagesLYS PAUL Modern Literature Ms. Gordon The Scarlet Letter The scarlet letter is book written by Nathaniel Hawthorne who is known as one the most studied writers because of his use of allegory and symbolism. He was born on July 4, 1804 in the family of Nathaniel, his father, and Elizabeth Clark Hathorne his mother. Nathaniel added â€Å"W† to his name to distance himself from the side of the family. His father Nathaniel, was a sea captain, and died in 1808 with a yellow fever while at sea. That was aRead MoreThe Scarlet Letter By Nathaniel Hawthorne960 Words   |  4 Pages3H 13 August 2014 The novel, The Scarlet Letter, was written by the author Nathaniel Hawthorne and was published in 1850 (1). It is a story about the Puritan settlers of the Massachusetts Bay Colony, set around 1650 (2). The story is written in the third person with the narrator being the author. The common thread that runs through this novel is Hawthorne’s apparent understanding of the beliefs and culture of the Puritans in America at that time. But Hawthorne is writing about events in a societyRead MoreThe Scarlet Letter, By Nathaniel Hawthorne919 Words   |  4 Pagessymbolism in Nathaniel Hawthorne’s â€Å"The Scarlet Letter†. Symbolism is when an object is used in place of a different object. Nathaniel Hawthorne is one of the most symbolic writers in all of American history. In â€Å"The Scarlet Letter†, the letter â€Å"A† is used to symbolize a variety of different concepts. The three major symbolistic ideas that the letter â€Å"A† represents in Nathaniel Hawthorne’s â€Å"The Scarlet Letter† are; shame, guilt, and ability. In Nathaniel Hawthorne’s â€Å"The Scarlet Letter†, the firstRead MoreThe Scarlet Letter By Nathaniel Hawthorne1397 Words   |  6 PagesFebruary 2016 The Scarlet Letter was written by Nathaniel Hawthorne in 1850 which is based on the time frame of the Puritans, a religious group who arrived in Massachusetts in the 1630’s. The Puritans were in a religious period that was known for the strict social norms in which lead to the intolerance of different lifestyles. Nathaniel Hawthorne uses the puritan’s strict lifestyles to relate to the universal issues among us. The time frame of the puritans resulted in Hawthorne eventually thinkingRead MoreThe Scarlet Letter By Nathaniel Hawthorne999 Words   |  4 Pages Nathaniel Hawthorne is the author of the prodigious book entitled The Scarlet Letter. In The Scarlet Letter, Hester Prynne commits adultery with Reverend Arthur Dimmesdale. Her husband, Roger Chillingworth, soon finds out about the incident after it becomes clear that she is pregnant. The whole town finds out and Hester is tried and punished. Meanwhile, Roger Chillingworth goes out then on a mission to get revenge by becoming a doctor and misprescribing Dimmesdale. He does this to torture DimmesdaleRead MoreThe Scarlet Letter, by Nathaniel Hawthorne1037 Words   |  5 Pagesthat human nature knows right from wrong, but is naturally evil and that no man is entirely â€Å"good†. Nathaniel Hawthorne, author of the classic novel The Scarlet Letter, believes that every man is innately good and Hawthorne shows that everyone has a natural good side by Hester’s complex character, Chillingworth’s actions and Dimmesdale’s selfless personality. At the beginning of the Scarlet Letter Hester Prynne is labeled as the â€Å"bad guy†. The townspeople demand the other adulterer’s name, butRead MoreThe Scarlet Letter By Nathaniel Hawthorne1517 Words   |  7 PagesNathaniel Hawthorne composes Pearl as a powerful character even though she is not the main one. Her actions not only represent what she is as a person, but what other characters are and what their actions are. Hawthorne makes Pearl the character that helps readers understand what the other characters are. She fits perfectly into every scene she is mentioned in because of the way her identity and personality is. Pearl grows throughout the book, which in the end, help the readers better understandRead MoreThe Scarlet Letter, By Nathaniel Hawthorne1488 Words   |  6 Pages In Nathaniel Hawthorne’s novel The Scarlet Letter, the main character, Hester Prynne, is a true contemporary of the modern era, being cast into 17th century Puritan Boston, Massachusetts. The Scarlet Letter is a revolutionary novel by Nathaniel Hawthorne examining the ugliness, complexity, and strength of the human spirit and character that shares new ideas about independence and the struggles women faced in 17th century America. Throughout the novel, Hester’s refusal to remove the scarlet letterRead MoreThe Scarlet Letter By Nathaniel Hawthorne1319 Words   |  6 PagesPrynne and Arthur Dimmesdale are subject to this very notion in Nathaniel Hawthorne s The Scarlet Letter. Hester simply accepted that what she had done was wrong, whereas Dimmesdale, being a man of high regard, did not want to accept the reality of what he did. Similar to Hester and Dimmesdale, Roger Chillingworth allows his emotions to influence his life; however, his influence came as the result of hi s anger. Throughout the book, Hawthorne documents how Dimmesdale and Hester s different ways of dealingRead MoreThe Scarlet Letter By Nathaniel Hawthorne1714 Words   |  7 PagesSome two hundred years following the course of events in the infamous and rigid Puritan Massachusetts Colony in the 1600s, Nathaniel Hawthorne, descendant of a Puritan magistrate, in the 19th century, published The Scarlet Letter. Wherein such work, Hawthorne offered a social critique against 17th Massachusetts through the use of complex and dynamic characters and literary Romanticism to shed light on said society’s inherent contradiction to natural order and natural law. In his conclusive statements

Victorianism Versus Modernism Free Essays

Matias Gutierrez Mrs. Smith World Literature 21 December 2012 OLD*******8 Victorianism in The Strange Case of Dr. Jekyll and Mr. We will write a custom essay sample on Victorianism Versus Modernism or any similar topic only for you Order Now Hyde and Modernism in The Metamorphosis Victorianism is about how the individual could improve the society. They believed that a good individual could make the society better as a whole and therefore improve life. Victorians focused on science and the desire for extremely realistic portrayal of life in both literature and art. Some aspects of Victorian thinking were retained while others were discarded in a new movement called Modernism. Modernists focus on the individual but have the view that humans are beings without free will and that they do not look for guidance within them, but instead are driven by factors outside of them. According to Modernist thinking, an individual is molded by the external factors that surround him. Therefore the way the society already is will affect the individual and Modernism tries to portray the effects of this. Each style captures something about the individual in the society. As mentioned above, Victorianism and Modernism both focus on the individual and the society. An example of this from a Victorian perspective is, The Strange Case of Dr. Jekyll and Mr. Hyde, written by Robert Louis Stevenson. This novel zooms in on the view of the morality in people and society, incorporating science as well. Both of these aspects were vital to Victorian thinking. Victorian period began during the reign of Queen Victoria, which lasted between 1837-1901. During this period the sciences went through a major revival. Both of these ideals are demonstrated in Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde. This novel accurately captures the ideals and behaviors occurring at the time with extreme detail and realism. â€Å"A certain sinister block of building thrust forward its gable on the street. It was two stories high; showed no window, nothing but a door†¦ The door, which was equipped with neither bell nor knocker, was blistered and distained† (2). Victorianism’s desire for the utmost detail on even the most routine things was demonstrated in most novels during the period. The extreme realism creates a better picture of society and how things are occurring during the lives of the individuals living then. The notion of morality and science were also in Robert Louis Stevenson’s novel The Strange Case of Dr. Jekyll and Mr. Hyde. This is a story of a respected doctor’s attempt to separate the two different aspects of human nature, good and bad. Dr. Jekyll who is depicted as a moral and decent gentleman, who participates in charity work and has the reputation of being a courteous doctor, personifies the good aspect. His experiment is to try to purify his good-natured self from his â€Å"wild and depraved† side. His experiment goes awry instead Jekyll liberates his primal, deprave and criminal side taking the name of Mr. Hyde. Hyde is a â€Å"troglodyte,† a primitive creature who asks on instinct instead of conscious and moral decisions. His reputation as an animal grows as he commits crime after crime. Hyde takes his immorality to the limit. He is the complete opposite of Jekyll. The scene when Hyde takes the potion to transform him backs to Jekyll, â€Å"He put the glass to his lips, and drank at one gulp. A cry followed; he reeled, staggered, clutched at the table and held on, staring with injected eyes, gasping with open mouth; and as I looked there came, I thought, a change—he seemed to swell—his face became suddenly black and the features seemed to melt and alter—and at the next moment †¦pale and shaken, and half fainting, and groping before him with his hands, like a man restored from death—there stood Henry  Jekyll! † (40). (Stevenson) This scene demonstrates that alchemy and science were heavily pursued during this time. Science was on the rise again during this period and Dr. Jekyll was testing everything that science could do for the society and through his testing and experimenting Jekyll changes to Hyde who is the bane of society. His scientific experiment helps show society that one bad individual could alter the â€Å"good life† of society. The Strange Case of Dr. Jekyll and Mr. Hyde showed people that being a good person is the best thing to do for society and for the individual. The reason Jekyll is a good example to show the Victorian qualities of science exploration and the effects the individual has on the world is explained by Masao, â€Å" In this society of respectables Dr. Jekyll stands out as â€Å"the very pink of the proprieties†(Chap. 1). Although his studies, like those of Faust and Frankenstein before him, tend toward â€Å"the mystic and the transcendental† (Ch. 10), he still manages to maintain a considerable scientific reputation. And yet, despite Jekyll’s social role-in fact, because of it-it is Jekyll who brings for Mr. Hyde. † (Masao 470-480) Masao explains why Jekyll underwent his transformation and how science heavily influenced his thinking to try this experiment. Masao also explains that science is possible through the well-mannered people of the time and their questioning of ways to improve society. The Modernism Period was about the individual and that the individual could not really change society. The Modernist literary period was marked by the reactions and sentiments towards global change and tragedy. The Modernist movement began around 1890 and lasted to 1945. Now during this time the World Wars wreaked havoc on the most culturally, technological, and industrialized parts of the world; which caused people to want to create order out chaos, or just to lose hope or alienate themselves which gave rise to Existentialism. With the creation of Modernism, came Magical Realism, Existentialism, and a break against the traditional styles of the past. One Modernist writer who accomplished all of the criteria for Modernism is Franz Kafka. Kafka, who was a very troubled man during his lifetime, clearly showed the affect his life had influenced him in his writing. Kafka was severely depressed at times and would express his feelings in certain stories of his such as In the Penal Colony and The Metamorphosis. Kafka would make his characters suffer his torment in a fantasy, magical realism way. He would invent new places and put no happiness or positive emotion in them. He would make his work reflect his depressive state of mind. Many writers would explore traumatic or negative situations because during this time period that’s all there was. War heavily influenced the Modernist movement. Another story of Kafka, Metamorphosis shows how constantly living in a depressive state or war torn area can affect the people in those areas. In Kafka’s Metamorphosis, he introduces the main character Gregor Samsa as, â€Å" a commercial traveler† (89). Samsa is also described to be a hard worker who works his shift to pay back the debt his parents incurred. Before Gregor is transfigured, he is the primary breadwinner for his family who just accepts his duty and will do his best to fulfill it. After his transfiguration, he again doesn’t even question why, how it happened, or how he can fix his predicament he has awoken to. He goes on trying to make life the best it can be. The opening line of Metamorphosis, â€Å"As Gregor Samsa awoke one morning from uneasy dreams he found himself transformed in his bed nto a gigantic insect† (89) (Kafka). Now as he realizes his alteration, he is totally unaffected by it. He continues thinking about how he will be able to make money for his family, even though there is no possible way he can help his family now. Kafka shows his sense of alienation and despair in reality through the lack of emotion in Gregor. It shows in the text that Kafka is deeply affected by his depression. Moderni sm is marked by the separation of morality or positive social criticism that was present in Victorian writing. However Modernism breaks from Victorian by showing that the individual is more important to think about because Kafka shows what happens when the individual disregards it when thinking how to provide for the society. Kafka’s illustration of the society recognizing how it can not help or change the society is shown also in the interpretation of Nina Straus, who writes that, â€Å"Kafka sought to escape by way of ambiguous writings and from which Gregor escapes through his transformation into an insect is Kafka’s image of an unequivocal, completely virile and powerful body. In contrast, we must imagine Kafka’s own body, a body with which he felt â€Å"nothing could be achieved† (29), and that body’s imagistic parallel in the â€Å"pitifully thin †¦ legs† of the insect Gregor, waving â€Å"helplessly† around a â€Å"bulk† that is â€Å"divided into stiff arched segments† (67). †¦Ã¢â‚¬ My body is too long for its weakness, it has no fat whatsoever for creating a beneficial warmth, for maintaining an inner fire, no fat from which the mind could someday nourish itself beyond its daily need without damaging the whole. How shall the weak heart †¦ manage to push the blood through the entire length of these legs? † The description shows how weak Kafka was during his life. He would rather try to improve himself than try to improve the flawed society that was being ravished by war, loss, despair and alienation. Victorianism and Modernism both focused on the individual and the society however they had very differing ideas about which was better to focus on. Victorians believed that helping the society was more important than focusing solely on the individual. A healthy and good person was extremely beneficial to the society and the way of life at the time. However introspection was not really praised but studying science was. Science was the way to improve society therefore Victorians were behind it completely. They wanted the best society possible even if that meant sacrificing some introspection and self-enlightenment, which Dr. Jekyll and Mr. Hyde demonstrates perfectly. Modernism, however, had given up on society. There was nothing the individual could do to improve his way of life. Their was set and nothing could change it. Modernists were particularly depressed with this thinking but it was heavily influenced by the World Wars. Kafka affected by this depression coped by creating Magical Realism as an escape from reality even though Metamorphosis still shows the flaws in society. Both of these styles have differing views on society and how society can make life better. Victorians were the first to believe that a healthy society meant good individuals but Modernists show that society will be flawed and there is nothing the individual can do to change this fact. Works Cited Masao, Miyoshi. â€Å"Dr. Jekyll and the Emergence of Mr. Hyde. †Ã‚  College English. 27. 6 (1966): 470-480. Print. ;http://www. jstor. org/stable/374021;. Straus, Nina. â€Å"Transforming Franz Kafka’s â€Å"Metamorphosis. †Ã‚  University of Chicago Press. 14. 3 (1989): 651-667. Print. http://www. jstor. org/stable/3174406. Stevenson, Robert Louis . The Strange Case of Dr. Jekyll and Mr. Hyde. Roslyn: Dover Thrift Editions, 1991. Print. Kafka, Franz. The Complete Stories. New York: Schocken Books Inc. , 1971. Print. How to cite Victorianism Versus Modernism, Essay examples

Ambition free essay sample

An ambition is an eager, and sometimes an excessive, desire for creation, honor, ascendancy, power, or the attainment of something. Every person is said to have his or her anomalous ambition. One might have dream to be rich, or having a villa. On the other side, one wants to become famous, a scientist or a doctor. Similarly, I have too my own ambition. I don’t want to become wealthy; I don’t want to get any fame. My aim of life is very simple and it is to serve poor people who are not getting enough to survive in this world with all of my heart. It’s said to be that person can be judged from what he wants to get in his life; and how he gets it; obviously it’s his ambition of life. There is one colloquia saying about ambition in life is that a person without any ambition in life is like a ship without a rudder who has no destination. I am really supporting this quote. We are never likely told to cross a bridge until and unless we come to a bridge, but this is the world in which ambition help us cross that bridge faster than other people. Some people think ambition and dreams is equal. But there is a thin wall between ambition and dreams. Ambition generally defined as somebody having a desire, a much stronger feeling than a dream. A dream is something that we can normally get without trying too much toward to achieve it. Ambition is the forces that keep us working and makes us go forward in our life. Its the super energy which energized me when I was facing a problem in the path of my goal. There is only one way to achieve any aim: simply moving forward with continuous improvement and passionate hard working and, obviously, with honesty nd dedication to achieve it. Having ambition is Just not enough. One must have to do continuous effort to achieve it. Maybe there is some obstacle, but it can be overcome only by self-esteem and a strong desire to achieve that ambition. If someone is only day dreaming and only planning instead of acting on that, its likely to get nothing but being at same place when where a person was once. Since I came to the U. S. from India at adolescence, Im enjoying helping others no matter who he/ she is. I have my opinion that if one will help others to achieve his life goal, he or she ill ultimately achieve their goal. I would like to state my personal example here. Once upon a time when I was in India, I had aimed to establish an Non-Government organization (NGO) that works to help slum childrens education as well as to oppose child labor who works at factories and Tea stalls. I started that by introducing my concept with my friend and family. And it was really appreciated by all of them as well as I got lots of suggestion from them. Then we planned to organize one event in which we had decided to go to a slum and poor people, we asked them their roblems, what is the reason for not sending their child to school and we tried to understand them at all levels. And by considering that all aspects we decided to admit some of the children in school with of our financial responsibility and provide them with basic necessities. We also introduced one scheme in which we had awarded the most three talented Children. And provided them scholarship for rest of his their higher education. We taced many problems during the starting phase as we had to work with illiterate people, complete formalities for their admission and in any surprising areas for which we didnt think to be happen. After all, we had overcome those entire difficulties with high spirits, moving forwarding by keeping vision in front of eye and definitely with the help of all NGO members. Now day, its working with full energy. There are many students getting benefit from this NGO and accomplishing their ambition which is one of my ambitions. It gives us more inspiration when students come to us and share their experiences of life. They are part of our NGO now and also working actively. One of best outside example I can tate is about Mahatma Gandhi. Mahatma Gandhi: Always aim at complete harmony of thought and word and deed. Always aim at purifying your thoughts and everything will be well (#2988 from Laura Moncurs Motivational Quotations). He had vision of free India. He was a bachelor of low graduate. He thought serve to country instead of become wealthy. Mahatma was smart enough to earn much more money by his qualification but he chose country over money. This is the most important thing which inspires to me toward achieving my ambition. He attained his goal by facing ots of difficulties in his way. Some situations were very typical to handle but he didnt compromise with situation. Instead of this, he understood that condition very well and faced that with great excellence, passion, self-confidence and proper planning. In William Shakespeares Macbeth, one can see how ambition can escort one to catastrophic effects if our destination is reached by swindling. Generally, focusing on a wrong aim seems to cause far too much guaranteed damage to relationships and to themselves. Macbeths ambition is to become king. In reality, he should have won this honor with honesty . But Instead of getting all the rights with respect; he has stolen it by cheating others. It may not accepted by any person and so it happened with Macbeth. He didnt get satisfaction but it may cause persecution, leading to more of the same. Once one is trapped into this unstoppable chain, the probability of getting out is with a lot of struggle. Macbeth: miet I do fear thy nature. It is too full the milk of human kindness. Thou wouldst be great, Art not without ambition, but The illness should attend it. (l. v. 16-20). Ambition is a strong desire to do or achieve something. Desire for success, wealth, fame. There is no any obstacle which can stop us from achieving what we have aimed to get in life. Our only obstacle is ourselves, and the extent of our ability to differentiate between a rewarding and devastating aim. If one can see it, one can achieve it. If you can dream it, you can become it. Dont steal an idea, but use your own, and no matter what road you take, you will end up where you wanted to be. Yes I can be! I can achieve any ambition in my life no matter how hard the situation will be!

Insider Trading Should It Be Abolished free essay sample

Insider trading is defined as â€Å" trading whilst in possession of non-public information and if known to the public, may lead to a substantial movement in a security’s price† . In Australia it is prohibited by insider trading regulation (IT regulations) in the Corporations Law (CL) 1991 , though it was initially established from recommendations made by the Rae committee in 1974 on the mining company scandals . The latest law changed one single section to 20 wide and complex sections, causing critique of Australia IT regulations . Henry G Manne argued that IT regulations should be abolished supported by three basic economic arguments. This essay will examine the pro and contra of each argument and shows that IT regulations have spoiled the notion of fairness at the expense of efficiency, despite the objective of any securities markets regulation to promote both aspects . 1. Insider trading could compensate corporate entrepreneurs . Pro and Contra This argument is supported by Carlton and Fischel who argued that the IT regulations are the same with setting government regulation of terms and conditions of employment; similar to restrict salary bonuses, stock options, vacation leave, and the others which can motivate management for their entrepreneurial skills . We will write a custom essay sample on Insider Trading: Should It Be Abolished? or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page However their assumptions ignore the difference between the volatile share price and a certain amount of normal compensation. As argued by Easterbrook, where there is a volatile share price, the management compensation argument reverts into a â€Å"lottery-ticket argument† . Because in the volatile share price, even informed traders will hardly predict the increase or decrease of share price in the future. The high fluctuation equalizes the possibility of losing their investment and getting profit, which as called ‘compensation’. From the two extremes, It can be concluded that compensation argument can be valid if the share price is relatively stable otherwise not all insiders can get their compensation through insider trading. Director’s fiduciary duty to Shareholder However, if IT regulation were only applied for a liquid market, what is the role of fiduciary duty? In Exicom’s case fiduciary argument was established where persons who are subject to a legal relationship of trust and confidence, arising from either a prior relationship with the securities issuer (typically directors, employees and corporate agents) or the other party to trade should not make a profit from that position or allow a conflict of interest to arise. Moore supports IT regulation on the basis of fiduciary duty. He reasons that directors have some fiduciary duty to their shareholder to fully disclose all information they could benefit from. His idea is supported by the fact that although there is no general principal that directors owe fiduciary duty to shareholders (in addition to the company), with the purpose to prevent directors when in the position of holding confidential information to spread the it to outsiders , such duty in recognized in Hooker’s case . Sub Conclusion Insider trading as a compensation for corporate executive is argued only happened in a stable market where they can use the information to predict the trend otherwise the profit compensation turn to be a lottery compensation. Here fiduciary duty of the insiders is questioned where in Hooker’s case it is possible that directors owe fiduciary duty to shareholder although there is no general principal on it. 2. Insider Trading Contributes to Market Efficiency Pro from Leland and Estrada Manne argued that ‘allowing an unfettered market in information will have salutary effects unheard of in connection with regulatory â€Å"disclosure†Ã¢â‚¬â„¢ . Recently, Leland and Estrada also stated similar idea that insider trading contributes to market efficiency through signaling where signal-trading by insiders pushed share price more quickly towards its equilibrium price. Pro from Empirical Measures Theory Moreover, empirical measure presents a theory; the more information gets into market, the lower transaction cost, the more liquid the market and the smaller volatility produced. Since investors get more helpful information to predict market trend, the transaction cost here is lower. Transaction cost is the cost to take the risk if the companies, which they invest in, somehow default. Thus lower transaction cost is equivalent to lower risk, which can encourage more investor to trade. As trading in the market occurs significantly in one flow (either buy or sell) based on the information they got, the volatility, which represented by the bid-ask (difference between the buy and sell quotes at any one time), decreases. Consequently liquidity increases. Evidence from Real Study In practice, Dodd and Officer found evidence that no significant abnormal returns (return of a security over its average or expected return) occurred on the day take over rumour was published, although some abnormal returns typically occurred prior to the publicity of rumour. This prior abnormal return must be because of insider trading, as the unpublished information they possess allow them to predict the trend up to takeover bid, thus, at the date of take over published, market already reached equilibrium price. Contra from Cox and Georgakopoulos and Response from Wyatt However, there are some disagreements on Manne argument. First, Cox claims that insider trading cannot make the price movement towards equilibrium price purely by their own actions . Also microstructure theory by Georgakopoulos, which states that whether support or against insider trading is depending on the market liquidity . A liquid market as discussed in the compensation arguments will give more benefit to insiders because the votality is lower and they can easily predict trend in stable price, hence, IT regulations in this case can be useful. On the other hand, illiquid market leads both insider and outsider traders away regardless the information they received since the votality is high and even unpublished information may just let them gamble on the security’s price, hence, in such market the presence of IT regulations has no effect to the market. The idea is that the uninformed traders is discourage to involve in market because of unfairness arise from the profit making activity by informed traders, hence, reducing the market effectiveness. For all that, both claims can be doubtful considering Wyatt suggestion that outsiders follow insiders action and further can encourage market liquidity . His suggestion is also supported by the fact that trader’s identity is kept confidential, thus, uninformed traders cannot be certain of the percentage of informed traders which make them discourage from trading. IT Regulation Distorts Market Efficiency Further issue is whether IT regulation increase market efficiency or it just increase the cost of compliance for companies and financial services firms? If IT regulation inhibits market efficiency then it should be revised. IT regulations in Australia reinforces continous disclosure (CD) regulations such in Crown Casino’s case where the chairman, who has no power on the company’s behalf, disclosed information to outsiders before the board disclosed it to the Exchange. The court emphasized on the breach of continous disclosure specifically on the abuse of the term ‘immediately’ . If IT regulation is just a flip-case of CD regulations, then it is obsolescent, as CD regulation already governs tardy disclosure . Sub Conclusion nsider trading contributes to market efficiency by moving the share price more quickly towards equilibrium price is supported by empirical measure which shows that insider trading increase market liquidity, and by Dodd and Officer finding on significance abnormal returns prior to take over rumour instead of on the date of publicity. Although Cox and Georgakopoulos go against the concept, Wyatt response that their arguments can be the contrary, that informed traders can be an opportunity for uninformed traders to get profit by following them instead of discourage them by unfairness. 3. Insider Trading and Long-term Investors Pro and Contra Finally, insider trading does no significant harm for long-term investors , â€Å"whose market decisions will be a function of time† . In detail, Manne asserts that the less frequent someone trades, the less significant effect of the unfair use of valuable information from insider trading they receive. Such investors just make investment on the basis that they are timely and not affected by the share price, which is affected by insider trading. However, this view is questioned by Schotland . He argued that even long-term investor needs cash and when they need it they will consider to ait for a right price to sell it. Further, Manne suggest that long term investor can ignore price to avoid being harmed by the effect of insider trading, expect for one, which is the lost of not having inside information in the range of the buying and selling price so that it is insignificant. Here Manne only refers to one investment. Yet, how about when the investors have more than one (in which the common condition to diversify)? They may need to watch a series of share price otherwise they will end up will sell it with no profit after putting so much faith waiting for it. Sub Conclusion Insider trading does no significant harm for long-term investors as they just invest on the basis of time instead of share price and only need to watch insignificant loss from the valuable information exploited by insider trading. The idea is fully objected by Schotland by arguing even long-term investors need cash and should consider the right price to sell the share. Also the insignificant loss only refers to one share, but in practice long-term investor such as retirees diversify shares by holding more than one. Conclusion In summary, the essay demonstrates a number of both pros and contras of whether insider trading should be abolished. Looking the above discussion, insider trading should be outlawed as it can cause significant harm to investors. It is also contradict with fiduciary argument. However, Insider trading is also evidenced contribute to market efficiency. Moreover, as in Crown Casino’s case, IT regulation is criticized to be a mere flip-case of CD regulation and the presence just increase the cost of compliance. Therefore, It would be better if IT regulations is revised in a way that promote both fairness and efficiency equally.

Risk management and the identification and analysis of risk The WritePass Journal

Risk management and the identification and analysis of risk INTRODUCTION Risk management and the identification and analysis of risk INTRODUCTIONImportance of risk managementCauses of pressure ulcerPressure ulcer gradingPrevalence and IncidenceCost of pressure ulcersIdentification and Assessment of riskNorton scaleStrengths and Limitations of Norton ScaleBraden scaleConclusionBibliographyRelated INTRODUCTION Risk management is the identification and analysis of risk. This leads to planning and implementation of control measures which may be physical, clinical, financial or cultural. The intended objective or aim being to eliminate, reduce or transfer risk. (Wilson.J. and Tingle.J. ed (1999)). Risk is defined as the possibility of incurring misfortune or loss and may be associated with patients, visitors and staff. It may also be associated with buildings and estate, equipment and consumables, systems and management. (Dobos C (1992)). Alaszewski et al (1998) a social scientist defines risk as the possibility that a given course of action will not achieve its desired and intended outcome and that some undesired and undesirable situation will develop instead. In the case of pressure ulcers, the nurses’ objective is to prevent them or stopping them from deteriorating any further. To do this there is need to identify the best assessment tool that can identify those that are at risk. With several assessment tools out there, there is need to identify a tool that is able to measure what it is supposed to measure and more accurately. (Dougherty et al 2008) Importance of risk management All organizations, public or private, large or small, do regularly face internal and external uncertainties that affect their ability to achieve their objectives. Effective implementation of risk management can help Organizations improve their chances of survival and success. Risk management encourages organizations to rely on proactive management to promote high quality care; deal effectively with opportunities and threats; comply with regulatory requirements. It also encourages them to improve on mandatory and voluntary reporting; improve on governance; encourage stakeholder confidence and trust; enhance strategic planning; minimize financial, environmental and safety losses; and improve on organizational resilience and performance. (Shortreed ,2010:p 8 ).There is little evidence though which testifies that   risk management reduces litigation, controls or reduces the incidence of adverse events or produces improvements in quality of care (Walshe and Deneen 1998.p 12-3). Risk management    is a fundamental element of the nurse’s role which is expected to lead to health and safety promotion of the members of the team and the patients with whom they come into contact. Pieces of legislation like the Health and Safety at Work Act 1974, The Management of Health and Safety at Work Regulations 1999 and Mental Health Act 1983. Also Human Rights Act 1998, Data protection Act 1998 and Mental Capacity Act 2005 do support the need for risk management. Patient safety in particular has been placed high on the Government’s agenda, the focus of guideline documents including ‘Organization with a memory’ (DH, 2000), ‘Building a safer NHS for patients’ (DH, 2001) and ‘Doing less harm’ (DOH and NPSA 2001). Also ‘Learning from Bristol’ (DOH 2002), ‘Design for Patient Safety’ DOH 2005, ‘Safety First’ (DH, 2006) and in ‘The operating framework for the NHS in England 2009/10à ¢â‚¬â„¢ (DH 2008), do give patient safety top priority. The NHS Plan reiterates the need for risk management by mentioning that all health organizations now have a statutory duty of quality and a responsibility to reduce the number of mistakes. (Department of Health, 2000). In the case of pressure ulcers it is the duty of the nurses to make sure that they are prevented and research shows that it is possible in 95% of the time (Waterlow 2005). Causes of pressure ulcer Pressure ulcers, are commonly referred to as pressure sores, bed sores, pressure damage, and pressure injuries. They are areas of localised damage to the skin, which can extend to underlying structures such as muscle and bone. Damage is believed to be caused by a combination of factors including pressure, shear forces, friction and moisture .EPUAP (2009) Pressure ulcers can develop in any area of the body. In adults damage usually occurs over bony prominences, such as the sacrum. (Dougherty et al 2008). People who are more prone to ulcers are those in most cases with the following intrinsic risk factors namely reduced mobility increasing age, incontinence, poor nutritional intake/dehydration, acute, terminal or chronic illness, neurological deficit, poor oxygen supply to the tissues, diabetes ,obesity/reduced body weight, sepsis/pyrexia, mental state/depression, medication .(NICE 2003). In community the changes in health environment and demographic set up have further compounded the problem of pressure ulcers as the health service changes have led to more patients being discharged earlier from acute care into the community. This, together with demographic changes, has given rise to increasing numbers of immobile elderly patients being cared for by the already short staffed community nursing staff. (Chaloner et al 1999.p 1142) Pressure ulcer grading EPUAP (2009) came up with four Category/Stages in grading pressure ulcers. Stage I pressure sore is a Non-blanchable erythema intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to the rest of the tissue. Category I may be difficult to detect in Individuals with dark skin tones. In risk management this category is usually a sign that the patient is at risk of pressure sores. Category/Stage 2 presents clinically as an abrasion or blister. It is a partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister. This category is sometimes confused with tape burns, incontinence associated dermatitis, maceration or excoriation. Category Stage 3 is superficial lesions.   Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunnelling. The depth of the pressure sore depends on the location of the ulcer. Category/Stage 4 results in full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar   Ã‚  may be present. Often includes undermining and tunneling. The depth of a Category/Stage 4 pressure ulcer just like stage three varies by anatomical location. They can extend into muscle and/or supporting structures. Bone and muscle is left exposed. Prevalence and Incidence It is estimated that approximate pressure ulcer prevalence is 6.7% of the UK patient population (DH 1992). Kaltenthaler, E et al (2001) reviewed sixty research papers that were written between 1980 and 1997 and a few before 1980. In the review they were able to establish that Prevalence reported for hospitals in the UK ranged from 5.1to 32.1%.The range for community settings was 4.4 to 6.8% and that for nursing homes was 4.6 to 7.5%.The highest reported prevalence was 37% for a palliative care unit. Incidence reported for hospitals in the UK ranged from 2.2% per annum to 29% over a maximum period of six weeks. Only one study, which included patients who were bedfast and chair fast, was reported for community settings giving an estimate of 20% over a maximum period of six weeks. No incidence studies were found for nursing homes. The highest reported incidence was for older patients with hip fractures which was 66% over an 18-month period. There were discrepancies   in measuring prev alence and incidence which can affect the findings, namely, substitution of incidence for prevalence in analysis,   use of different classification systems, under-reporting of pressure ulcers on transfer from different care facilities, overestimation of prevalence data by not taking case-mix into account, use of pressure ulcers as a measurement of quality, causing under-reporting, use of different study designs (prospective versus retrospective, observation versus chart review). (Sternberg, J. (1989.p 50). Moffatt, and Franks (1997:p.96-105) came to the conclusion that prevalence in community may be higher than stated since it is difficult to gain all information about patients in community. Cost of pressure ulcers The total cost of pressure ulcer care in the UK is said to be between  £1.4 billion– £2.1 billion which constitute four percent of total NHS expenditure. More than ninety percent of the cost of treatment is the cost of nurse time. (Bennett et al 2004). Modern dressings accounted for eighty million pounds worth of sales and traditional (dry, gauze based) dressings accounted for twenty one million pounds in the UK in 1999 (Russell, 2000). This can be divided into hospital (fourteen million pounds, six million pounds) and community (sixty four million pounds, fifteen million pounds for the modern and traditional respectively (Dealey, 1994). Patients in the UK are increasingly aware of their political clout and litigation against the NHS when it delivers below expectation is becoming a common occurrence (Walshe and Deneen 1998.p 9-10). The NHS receives around ten thousand new claims for clinical negligence annually, and this number is rising (National Audit Office 2001). The t otal annual charge to NHS accounts for settling claims has risen seven-fold since 1995–1996. Relatively few of the current claims relate to pressure damage and in the UK the mean value of settlements in these cases is relatively low compared to other countries like the United States of America (typically less than ten thousand pounds). (Tingle J. 1997.p 757-8). The emotional costs of living with a pressure ulcer are difficult to quantify. What is known is that patients experience pain, dependency, fear of the odor from the ulcer as well as feeling unclean. In a nutshell, negative effects on quality of life are real but impossible to quantify. (Bush 2002.p 34) (Reed et al 2001). All this according to Walshe and Dineen (1998.p 1-37) justifies the case for risk management. Identification and Assessment of risk Part of risk management requires that patients be screened on initial contact and if identified to be at risk of developing pressure ulcers should receive a full assessment of that risk. This is considered best practice. It is also best practice to use evidence based tools and scales in the process. (DH 2010). The rationale for trying to identify those that are at risk of pressure ulcers is that it is cost effective to prevent pressure ulcers than to cure them. This can be achieved considering that up to 95% of the pressure sores are said to be preventable (Waterlow 2005).   Also it is cost effective to catch them early than later ((Touche Ross, 1994). There are a number of tools and scales that have been devised over a long period of time. The most widely used are the Norton (Norton et al, 1962) and Waterlow (Waterlow, 1985.) scales in the UK and the Braden Scale (Braden and Bergstrom, 1988.) in the USA. Although precise figures on the use of these scales is unknown, it is acknowl edged that the Waterlow scale is the most frequently used risk assessment score in the UK ,especially in secondary care and some community setting. In community  Ã‚   in the UK ,The Walsall Community Risk Score Calculator   has been in use for   about twenty years but further research on validity of the tool is needed .(   Chaloner.D.M, and   Franks .P .J. (1999.p 11 42-1156)). The predictive validity of these assessment tools and scales in predicting which patients go on to develop pressure ulcers has   shown that there are clear variation in sensitivity, which means some tools are more effective in identifying and predicting those who are at elevated risk, and   thus may go on to develop a pressure ulcer. (NICE 2005.).Some researchers like Edwards (1996.) do doubt the rationale of applying measures of sensitivity and specificity to the scales when mathematical models were not used in designing them. There is an also ethical issue that arises in testing because it is not possible to have a sample of patients who are at risk who are not receiving intervention, which may have an effect on specificity (Deeks, 1996). Using the development of pressure ulcers as the only criteria for measuring the tools has its own weakness in that it misses those that were at risk but were rescued by good nursing and medical care .Waterlow (1996.)   argues that there is b ound to be statistical fallacy in the use of sensitivity and specificity because conditions never in most cases remain static especially in the face of good or bad   preventive nursing and medical interventions. Norton scale The Norton scale was the first tool used for pressure sore risk prediction, although it was originally intended for use as a research tool for studies in geriatric populations and not as a risk predictor (Norton et al, 1975). The scale contains assessments of general physical condition, mental status, activity, mobility and incontinence.   The Norton Scale is designed to identify the need for preventive pressure care in older hospital patients and aged care home residents.   Each of the five items is scored from 1 to 4, with a maximum total score of 20. Scores of 14 or less rate the patient as at risk of developing pressure sores, the lower the score, the greater the risk. The cut off point for at risk patients was later raised to 15 or 16 by Norton (Norton et al 1985). Strengths and Limitations of Norton Scale The tool has received wide spread criticism. Its simplicity which is supposed to be it strength has been identified as a weakness. The weakness identified is the assessor subjectivity (Dougherty et al 2008). It has been accused of both over predicting and under predicting   patients who are at risk of developing pressure ulcers   especially in patients undergoing surgery or recovering from myocardial infarction (Flanagan, M., 1993.),(Pritchard 1986). According to Bergstrom et al 1987 the Norton scale in his test over predicts by 64% while the Braden scale over predicts by 36%. This over and under predicting can have an effect on the resources that are to be utilized in dealing with the risk. The result may be wastage or use of less than adequate resources. The Norton is said to acknowledge that the tool was not intended as a universal tool, otherwise age and nutrition would have formed part of the criteria (Waterlow 2005). Deeks (1996.) used five separate studies to assess the predictive abilities of the Norton scale.   Three studies reported sensitivities of between 60% and 90% (Norton et al, 1975; Goldstone and Goldstone, 1982; Smith, 1989), one reported a sensitivity of less than 20% (Stotts, 1988), and one only had five patients developing pressure sores (Lincoln et al, 1986) and hence provided a very inaccurate zero estimate. The low sensitivity in this study may be attributed to the fact that it was based on patients who were admitted for an elective surgery and the Norton scores were taken on admission to predict pressure ulcers and the post operative data was not sufficient to come up with a sensible conclusion. On specificity the verdict was that it did vary a lot and variation was between 30% and 95%. All this shows massive inconsistence when it comes to sensitivity and specificity. Waterlow scale The waterlow scale is a popular scale in United Kingdom. It is seen as an improvement on the Norton scale (Heath (1995.p 625).Waterlow (1985) believed that many of the intrinsic factors, such as pain, nutrition, reduced cardiac output and anesthesia, had been omitted from the Norton scale   which had been developed for an elderly population. Consequently, the Waterlow risk-assessment scale was developed in 1984 (Waterlow, 1985) as a comprehensive tool to be used in conjunction with the nursing process. The tool was supposed to help nurses in the medical and surgical setting but not to replace clinical judgment. Unlike other tools which are based on an under taking of data collection, the aim of the tool is to provide guidelines on the selection of preventive aids and equipment as well as on management of established pressure sores. It is also to promote awareness of causes of pressure sores and provide a means to determine risk of pressure ulcer development. (Simpson et al (1997).T he waterlow has six main areas of risks namely build/weight, continence, skin type, mobility, sex/age and appetite. It also alerts the user to tissue malnutrition, neurological deficit, trauma and specific medication. The risk score threshold is 10, with 10-15 being ‘at risk’, 15-20 ‘high risk’, and above 20 being ‘very high risk’. (Dougherty 2008). Strength and limitations of the Waterlow On validity, Thompson (2005.p 455-459) cited Dealey (1989) comparative study of the Waterlow and Norton score. In the assessment of 175 elderly patients the waterlow had ninety eight percent sensitivity, and fourteen percent specificity. The Norton on the hand had had eighty eight percent sensitivity and twenty six percent specificity. The Waterlow was better on sensitivity but no so good on specificity. In another study by Wallard (2000), the waterlow scale was better than the Braden and Norton scale in terms of pressure sore predictive power in a study of 60 patients with spinal cord injuries. The Waterlow scored sixty four percent at high rate and thirty four percent at very high rate. Norton tool scored eighty six percent at no risk, eight percent at risk and two percent at high risk while the Braden scored four percent at no risk, twenty nine percent at low risk, forty six percent at moderate risk and twenty one percent at high risk. This shows that the Waterlow performs well in this group of patients. Although the waterlow scale is popular in UK, Edwards (1996) is skeptical on it’s inter reliability stating that Waterlow herself performed most of the observations during its development. Dealey (1989) in her research in which Student nurses from four wards assessed the same five patients using the Waterlow tool and the Norton tool. The results of that research showed 60% agreement on the Waterlow score and a 70% agreement using the Norton score .Despite this weakness on the part of the Waterlow it still is the most popular scale in UK. Edwards (1995) also assessed its inter-rater reliability using a cross-sectional observational survey of 40 community elderly patients with and without pressure ulcers. To minimize the risk of error, a research assistant with the same level of knowledge and experience participated with the researcher. 25% total agreement was reached and the specific low agreement categories were, mobility, build/weight for height and skin condition, suggesting that the tool is subjective. This means that patients may have received expensive equipment unnecessarily based on such unreliable scores. Waterlow (2005.) is the one to admit that it is a simplistic tool which needs the support of good clinical judgment and advice from the tissue viability nurses for it to be effective. This is true when choosing preventative aids. Also Waterlow (2005) is not confident that it will be effective in other areas other than in hospital and nursing homes were it was designed. This leaves the community and residential home settings with a tool that needs modification. Braden scale The Braden Scale was developed in the 1980s  Ã‚   in the USA for use  Ã‚   in medical and surgical acute units. It was developed following a prospective investigation of risk factors in the development of pressure sores (Moffatt, and Frank, (1997). The Braden scale has been widely utilized in United States of America. It does get backing from the Agency for Health and Research which recommended it for use in predicting pressure sore development in hospital and nursing homes in the United States of America. (Simpson et al (1996.)).Unlike the Norton and the Waterlow scales which assess risk it is a pressure ulcer predictor (Dougherty (2008.)).The Braden scale is a twenty three point instrument composed of six subscales namely sensory perception, moisture, activity, mobility, nutrition, friction, and shear (Heath (1995)) .They are scored from 1 to 4 depending on the severity of the condition except for friction and shear which is scored 1 to 3. The total score is then added up with a range which can go from 6 to 23.The lower the score, the higher the risk of developing a pressure ulcer. (Dougherty et al (2008). Strengths and limitations Unlike other tools the internal ratings of the six categories are supported by assessment guidelines. These guidelines seek to clearly describe the behavior and experience of the patient. The Braden Score has been validated in a number of patient populations (Bergstrom et al 1987 cited by Moffatt, and Frank, (1997)).For example, 99 medical and surgical patients assessed by registered nurses had an agreement between staff 88 per cent of the time. A sensitivity of 100 per cent, a specificity of 90 per cent and a negative predictive value of 100 per cent. A licensed practical nurses study had an agreement in only 19 per cent of 100 patients; sensitivity and negative predictive value were 100 per cent and a specificity of 64 per cent. These shows a poor inter rater reliability even though the prediction value is high. Bergstrom et al (1987) in a further study of 60 adults in intensive care showed a sensitivity of 83 per cent, a specificity of 64 per cent and a negative predictive value o f 85 percent. This shows that the Braden scale has very good sensitivity and reasonable specificity levels in patients in hospital if not better than all the above mentioned tools. In negative specificity it proved that it can identify those that will not end up with pressure sores in medical, surgical and intensive care. (Moffatt, and Frank, (1997).   It has been criticized for being difficult to use in a working environment and that it is still to prove itself in different settings in UK especially in community. (Dougherty (2008) (Simpson et al (1997). The Walsall score The Walsall Community Health Trust undertook to develop a tool for use in patients within the community .The development came about as a result of examining the existing risk scores and evaluating factors which they felt were likely to be important in the development of pressure sores. Each factor was then ascribed a score based on the influence it was felt it had on increasing the risk of pressure ulcer development. The development was based on clinical opinion and not epidemiological evidence to determine risk factors and scoring methods. (Chaloner.D.M and Frank’s .P .J. (1999) The Walsall tool looks at the following, predisposing disease, level of consciousness, mobility, skin condition, nutritional status ,bladder incontinence ,bowel incontinence .These are factors which other tools look at with one exception which makes it more relevant in community where the benefit of the 24 hour nursing care which is provided in hospital does not exist. The exception is the carer input which is particularly relevant to patients being treated in the community where care is intermittent, and often provided by informal carers who may be relatives or friends. Nursing intervention is expected in the following mobility, skin condition, nutritional status, bladder incontinence, bowel incontinence, and carer input categories. (Chaloner.D.M, and Franks .P .J. (1999).The â€Å"Total Risk Scores† determine the category as less than 4 (not at risk), 4 – 9 (low risk), 10 – 14 (medium risk), and 15 and over (high risk). Strengths and limitations All the mentioned tools were developed in hospital in some cases specifically for inpatients and the Walsall is meant specifically for patients in community and residential homes. To assess validity, a cross sectional study of 720 patients in Walsall, was under taken looking at the incidence of pressure damage, despite intervention, over a 12-week period. The study was in two phases. The first phase looked at nine categories which included pain and in the second phase they decided that pain was not relevant in determining pressure sores and left it out. Using ROC curve analysis highest sensitivity after adjustment was 80% with a corresponding specificity of 54%.The original weightings which included pain and predisposing diseases with an equivalent specificity could only achieve a sensitivity of 64 %.( Chaloner.D.M, and Frank’s .P .J. (1999). Although not better than other tools in terms of sensitivity and specificity, this modified tool is the first risk tool, developed specifically for the community environment to be scientifically tested.   It is also yet to be subjected to rigorous tests .Like all risk tools it is not supposed to replace clinical judgment.    Conclusion From the critical analysis of the above mentioned tools the only conclusion is that no single tool is considered reliable for universal use. Also some tools even in their intended areas of use do not always produce consistent result. The only way forward is for areas of care to produce their own hybrid risk assessment tool tailored to specific patient needs. This tool would be used as an ‘aide memoire’ to be used in conjunction with clinical judgment (RCN 2001).   The hybrid risk assessment tool creation to be effective should involve all health professionals, patients and carers. This makes sense because there is need to involve all the professionals and non professionals involved in the care of the patient in identifying risk. These professionals and non professionals should have the full knowledge that failure of one link in the chain of prevention will result in the development of a pressure ulcer. (Simpson et al 1997).    Bibliography Alaszewski A, Harrison L, Manthorpe J (1998) Risk, Health and Welfare: Policies, Strategies and Practice. Open University   Press, Buckingham Andersen KE, Jensen 0, Kvorning SA, Bach E (1982) Prevention of pressure sores by identifying patients at risk. Br MedJ284: 70-1 BENNETT,G.DEALEY,C, POSNETT,J.(2004).The cost of pressure ulcers in the UK. Age and Ageing 2004; 33: 230–235 Braden BJ, Bergstrom N (1988) Clinical utility of the Braden Scale for predicting tissue sore risk. Decubitus 2: 34–8 Braden BJ, Bergstrom N (1994) Predictive validity of the Braden scale for pressure sore risk in a nursing home population. Res Nurs Health 17: 45 9-70 Bush.C.(2002).Investigating the effects of living with a pressure ulcer.Nursing Times 3 september 2002. VOL: 98, ISSUE: 36, P: 34 Chaloner D (1996)   Pressure Damage Prevalence Study. (Report.) Walsall Community Health Trust, West Midlands (data on file; available from author) Chaloner.D.M, and   Franks .P .J.(1999). Validity of the Walsall Community Pressure Sore Risk Calculator. SKIN CARE MANAGEMENT. BRITISH JOURNAL OF NURSING, 1999, VOL 8, NO 17 Dealey C (1994)   The Care of Wounds. Blackwell Scientific, London Deeks. J. J.(1996)Pressure sore prevention: using and evaluating risk assessment tools. British Journal of Nursing  5(5): 313 320 (14 Mar 1996) Department of Health (2000)   The NHS Plan: A Plan for Investment, A Plan for Reform. Cm 4818-1. HMSO, London Department of Health (2007) ‘Best practice in managing risk: principles and guidance for best practice in the assessment and management of risk to staff and others in mental health services’Accessed electronically at dh.gov.uk/en/Publicationsandstatistics/ Publications/ PublicationsPolicyAndGuidance/DH_076511  on 18.04.2011 DoH (1992) The Health of the Nation. London: The Stationary Office Department of Health (2010) Essence of care 2010 : Benchmarks for the fundamental aspects of care. Leeds:The Stationary Office. Accessed at on 17/05/2011 Department of Health (2000) An organisation with a memory. London:   The   Stationery Office. Department of Health (2001) NationalService Framework for Older People.Department of Health: London accessed 16/02/2011. dh.gov.uk/prod_ consum_dh/ groups/dh _ digitalassets/@dh/ @en/ documents/digitalasset/dh_4071283.pdf Department of Health (1999) Saving Lives Our Healthier Nation.   London, The Stationery Office. Department of Health (2003) clinical governance reporting processes. www. doh. gov. uk/ clinicalgovernance/reportingprocesses.htm. Department of Health (2008) ‘The operating framework for the NHS in England 2009/10’ Accessed electronically at dh.gov.uk/en/Publicationsandstatistics/Publications/ Publications PolicyAndGuidance/DH_091445   on 15/03/2011 Department of Health (2006) ‘Safety first: a report for patients, clinicians and healthcare managers’ accesed at Error! Hyperlink reference not valid.   on 16/05/2011 Dobos C (1992) Defining risk from the perspective of nurses in clinical roles. J Adv Nurs 1(7): 1303–9 Dougherty,L., Lister,S.   ed (2008). THE ROYAL MARSDEN   HOSPITAL: Manual of Clinical Nursing Procedures. Student Edition .7th edition.West Sussex:Blackwell publishers. Edwards .M.(1996).Pressure sore risk calculators:Some methodological issues. Journal of Clinical Nursing 5(5):307-12 European Pressure Ulcer Advisory Panel (2009) Pressure Ulcer Treatment Guidelines European Pressure Ulcer Advisory Panel website at epuap.org/ gltreatmen t.html accessed 15/02/2011 Flanagan, M., 1993. Pressure sore risk assessment scales.Journal of Wound Care 2 (3), 162–167 Fox C (2002) Living with a pressure ulcer: a descriptive study of patients’ experiences. Br J Community Nurs 7(6;Suppl):S10–S22 Goldstone, AL., Goldstone, J., 1982. The Norton score: an early warning of pressure sores? Journal of Advanced Nursing 7, 419–426. Heath.H.B.M (1995).Porter and Perry’s Foundation in Nursing Theory and Practice. London :Mosby Halfens RJ,Van Achterberg T, Bal RM (2000) Validity and reliability of the Braden scale and the influence of other risk factors; a multicentre prospective study. Int J Nurs Stud 37(4): 313–19 Kaltenthaler,E. Withfield,M.D.. Walters, S.J .Akehurst, R.L.   Paisley  , S.(2001). UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare?  .Journal of Wound Care  10(1): 530 535 (Jan 2001) Leyshon  .S.(2005).Principles of risk management in community nursing.  British Journal of Community Nursing  10(7): 330 333 (Jul 2005 Moffatt,C. Frank,P(1997). Pressure sore risk: a challenge in the community  .British Journal of Community Nursing  2(2): 96 105 (Feb 1997) Moore .Z and Cowman .S (2010)Risk assessment tools for the prevention of pressure ulcers.(Review).Copyright  © 2010 The Cochrane Collaboration. Published by JohnWiley Sons, Ltd Morrison.M.J. ed (2001).The Prevention and Treatment of Pressure Ulcers.London:Harcourt Publishers Limited. National Audit Office (2001). Handling Clinical Negligence Claims in England. Report by the Comptroller and Auditor General, HC403 Session 2000–2001. London: Stationery Office, 2001. NICE (2005) The Management of Pressure Ulcers in Primary and Secondary Care. NICE, London .accessed on www.guidance.nice.org.uk/CG29/quickrefguide/pdf/English. Viewed on: 15/03/2011 Norton D, McLaren R, Exton-Smith AN (1962)   An Investigation of Geriatric Nursing Problems in Hospital. Churchill Livingstone, Edinburgh Norton, D., 1996. Calculating the risk: reflections on the Norton Scale. Advances in Wound Care 9 (6), 38–43. Reed.S. and Hambridge.K.(2001). Implementing best practice in pressure ulcer prevention. Nursing Times   14 June 2001. VOL: 97, ISSUE: 24, P: 69. Reid J, Morison M (1994) Towards a consensus classification of pressure sores.   J Wound Care 3(3):157–60 Russell L (2000) Understanding physiology of wound healing and how dressings help.   Br J Nurs 9(1): 10–21 RCN (2001) Pressure Ulcer Prevention.Royal College of Nursing.London. Accessed via NICE:www.nice.org.ukon15/04/2011 Shortreed,J. (2010) Enterprise risk management and ISO 31000. The Journal of Policy Engagement. Volume 2/Number 3 Simpson.A.,Bower. K.,Weir-Hughes.D. (1996)Pressure Sore Prevention. Whurr Publishers. London Sternberg, J.(1989) Prevalence of decubitus ulcers: issues of concern. Decubitus 1989; 2: 2, 50 Tingle J. (1997).Pressure sores: counting the legal cost of nursing neglect. Br J Nurs 1997; 6: 757–8. Thompson.D.(2005). An evaluation of the Waterlow pressure ulcer risk-assessment tool.   British Journal of Nursing  14(8): 455 459 (28 Apr 2005) Touche Ross (1994) Report on the cost of pressure sores to the health service. In: NHS Management Executive. Pressure Sores: A Key Quality Indicator.Department of Health Guidance EL (94)3. Health Publications Unit, Heywood, Lancs Vincent C ed (2001).CLINICAL RISK MANAGEMENT:Enhancing patient safety.2nd edition.London :BMJ Books. Walshe,K. and Dineen,M. (1998).Clinical risk management :making a difference ?. The NHS Confederation. Birmingham UK .Issue date 1998. Waterlow J (1985) Assessing the risk of pressure sores. Nurs Times 81: 48–55 Waterlow J (1996) Pressure sore assessments. Nurs Times 92(29): 53–8 Wilson.J. and Tingle.J. ed (1999).Clinical Risk Modification: A ROUTE TO CLINICAL GOVERNANCE?.Oxford:Butterworth Heinemann.

I don't have a topic but want something in the line of Essay

I don't have a topic but want something in the line of IT,telecommunication or netorking - Essay Example takes place regularly and firms that are able to keep pace, have experienced enhanced performance, reduced costs, shorter lead times and better service delivery. It also revealed that along with technology, people have to be trained to use the technology. Integration of technology has to be aligned with the business objectives and information flow is paramount to the success of IT implementation. Uncertainties and risk cannot be avoided in technology but can be minimized with the right application and training of personnel. This study would have managerial impact on the use of IT in supply chain management. The study has limitations as some technology could have been overlooked. This study has added to the existing knowledge because under one umbrella the latest technology and its impact have been reviewed across different industries which employ supply chain management for their operations. Information Technology (IT) is changing the world; it has become infused in life and it brings many challenges with it. Every aspect of management today requires information on which to build the organization. Nothing moves without information but mere information is not power. Information is no doubt the most vital asset that an organization possesses but the sheer volume of information that flows in an organization makes it essential for the managers to understand its importance. Strategic decisions are taken on the information and information changes by the minute. The right dissemination and application of information is power. The conversion of data from internal and external sources into information requires the use of information technology. It helps in enhancing the decision making process, enhances the operations, helps in overall growth of the company. It includes hardware, software, people, communication system, and the data itself. Information Technology can be used in a ny type of company be it manufacturing, retailing, or the service industry. While IT can be

The Third Sector and Public Policy Essay Example | Topics and Well Written Essays - 1500 words

The Third Sector and Public Policy - Essay Example 375). According to Kendall and Knapp (2000, p. 12), the term the Third Sector can also be defined as the range of institutions that occupy the space between the private sector and the government or State; they are neither private sector nor public sector. The third Sector includes registered charities, trusts, social co-operatives and enterprises, voluntary groups, and the local community among others. Even though the Third Sector organizations exist in varying dimensions and entities, there are three main characteristics that unite the Third Sector (Alcock, 2010, p. 7). The first characteristic is that these organizations are value- driven; that is, certain desires motivate them to achieve social, economic and political goals such as the environment well- being, public welfare improvement, and economic well- being. It is noteworthy that this characteristic rarely seeks to distribute profit but seeks to improve the overall welfare of the society. The second characteristic is that the se organizations usually reinvest any generated surpluses in order to facilitate the pursuit of their goals. That is why they are considered not- for profit organizations. The last main characteristic of these organizations is that they are independent from the government explaining why they are mostly referred as non- governmental organizations (Keane, 2001, p. 18-19). The Third Sector differs from the state and the market in a number of ways. Anheier, et al (2001, p. 24) note, their differences arise fundamentally from how Third Sector organizations are formed, their values, the scope of their activities, source of funding, and their objectives. To begin with, this essay will focus on what distinguishes the Third Sector from the State. The first distinction between the two entities is in regard to their range of provision; the state has a wide range of provisions while the Third Sector organizations have limited range of service provisions. For instance, whereas the state can offe r numerous public services, the Third Sector organizations can offer specific services such as social housing and personal social care. It should also be noted that in some cases, the services offered by the Third Sector organizations are usually outsourced to them by the state. The state seeks to provide more space to the Third Sector so as to increase the Sector’s capacity to provide services that were previously provided by the public sector (Kramer, 2000, p. 20). Towards this end, the Third Sector is seen to have potential in making contribution in the following areas; social and health care services, educational services, children services, and correctional services among others. The second distinguishing factor between the Third Sector and the state is the scale of funding. It is an undisputable fact that the state has far much funding for its services compared to the Third Sector. This can be attributed to the fact that the state collects revenues in form of taxes whic h is usually in large amounts which help it to fund its expenditure in regard to provision of services (Anheier et al, 2001, p. 13). This is totally different from the scale of funding that the Third Sector has; the Sector has small amount of financial resources to provide the required services. This problem is heightened by the fact that the Third Sector is not- for- profit organizations hence limiting their amount of revenues.

Health And Illness Across The Lifespan Health And Social Care Essay

Health And Illness Across The Lifespan Health And Social Care Essay The Royal College of Nursing defines nursing as the use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death (RCN, 2003). This essay will look at the role as a nurse, in supporting an individual, the family or carer living with a person suffering from Alzheimers disease. Walkers, (2002) definition of Alzheimers is that of a degenerative brain disease, manifesting itself in premature ageing, with speech disorder and was first discovered by a German neurologist, Dr Alois Alzheimer who, in 1906, examined the brain of a patient he cared for who subsequently died of an unusual mental illness (dementia) at age 51. Her symptoms included memory loss, language difficulties, and unpredictable behavioural manner. After her death, Dr Alois Alzheimer examined her brain and found a plague like structure and tangled fil ament in the nerve (neurons) of the patient brain (Stanton, 2001). The plaques represent a naturally occurring sticky protein and the tangled filament represents collapsed tau proteins. Though Krebs, et al (2012) theory agrees with this that plaque clumps (now called amyloid plaques) and tangled bundles of fibres (now called neurofibrillary tangles) accumulating in the brain triggers this disease, it has been called into question. Of today, Alzheimers is classified an unquantifiable science condition; which holds within its own right a large area of mental health. The definition of Walkers, (2002) degenerative refers to gradual deterioration; this means that this disease may be broken into gradual stages of early, middle and late. The early (onset) stage appears with symptoms such as memory loss, confusion, personality and behavioral changes, these normally occur between 2-4 years prior to and during diagnosis. The middle (progressive) stage has similar symptoms as the onset but with more obvious signs such as an increase of confusion, an increase of memory loss, difficulty in completing simple tasks, showing a decrease in communication skills and occasionally can at times appear to be delusional; this stage may be more distinct with language ability being decreased. This stage has a time frame of 2-10 years following diagnosis. The late (end) stage show symptoms that are more prominent than earlier stages, wi th the inability to care for oneself; with little or no communication ability, continence and inability to recognize loved ones, followed by death usually caused by infections. These symptoms may appear between 1-3 years after the disease has passed through its progressive stage as Gwythers (1985) cited by Gogia and Rastogi (2009). Though the cause of this disease is a common subject amongst scientist and physicians, it is believed that excessive intake of aluminium may be a key factor in acquiring this disease. In the 1960s and 1970s, research showed high aluminium levels in the brain tissues of some people who died with Alzheimers disease; this discovery spurred public concern that exposure to aluminium in our diet could be the cause of the disease (Rao and Rao 1995). Since then several scientific studies have examined the link between aluminium and Alzheimers, and none have found a clear association between them, Dean (2009). This contradicts Crapper et al (1976) that Aluminium h as been shown to be associated both, with plaques and tangles, in the brain of people with Alzheimers disease. There have been numerous studies among experts to resolve the issue in question, whether aluminium is in fact the cause of Alzheimers disease. This has been extremely difficult as this common disease is believed to have multiple causes, but while aluminium is widespread in our environment, there is no method that allows researchers to measure this individual burden or lifetime exposure to this element. Lliffe and Rusted, (2012) states that although no one single factor has been identified to be the cause of Alzheimers disease, it is likely that a combination of factors, including age, genetic inheritance, lifestyle and overall general health, are responsible. Even so, Alzheimers disease has a high impact on the aged population affecting around 496,000 people in the UK, with one in every fourteen people over the age of 65 and one in six over the age of 80, this shows that the greatest risk factor of Alzheimers is indeed old age. However, this disease is not restricted to the older generation; in the UK alone, there are over 17,000 people under the age of 65 living with the disease. (Ref) The Wife of United States former president Regan quoted: Alzheimer disease is a cruel disease that steals lives. Its hard to know what to expect. The years of exchanging memories of old age are gone. Its a long, long good-bye (Reagan, N. Cited in Brill, 2005). Burfoot, (2008) believes there are a minority that do not worry about getting Alzheimers disease; these include athletes which are at half the risk compared to that of the sedentary individual, studies have shown that they are showing lower risk for senile dementia and diseases like Alzheimers. Indeed, the chances of Alzheimers disease increases with each successive year of life after age 65. However, Alexander, (2009) believes that the disease is inevitable and is associated with the ageing population, particularly from the baby boom generation that came after the second world war and also due to the difference in medical care given by the National Health service (NHS) compared to health services that were available at this era, because of this people are living longer, and an increase in population means more people are making it to old age, but the reward for making it to old age is a gift of Alzheimers for 6 from every 100 people who gets past the age of 65, (Brody 2011). Though scientists have estimated that 496,000 people have Alzheimers disease in the United Kingdom alone and 22 million worldwide, the disease only affects about five percent of people ages 65 to 80 and nearly half the population of those 80 and older. Disturbingly, the disease is becoming even more common; statistics now show that the number of people with the disease doubles every five years among older people and failing to find a preventative or curative measure will be costly to society. Alzheimers disease not only affects the patient, but the society and family around them. Alzheimers disease slowly attacks the cognitive function, which is the higher thought processes. These individuals degenerate in such a way that they return to the stages of infantile dependents (Ref). While the lives of family members, especially those directly involved in the individuals care, are significantly impacted in many ways, caring for adults with a degenerative disease can be an extremely physically demanding task, Clark, (2001). For the primary caregiver involved in the day-to-day care, the disease can take its toll emotionally, physically, mentally and financially. The carer responsibility may even be extended for many years; of course this depends on what stage of Alzheimers the sufferer has been progressed to. The diagnosis of a parent or spouse with Alzheimers disease may also conjure up a number of mixed emotions; such as frustration, helplessness, or even guilt. The fact that it is a progressive and ultimately terminal illness can be difficult to grasp, Lu and Bludau (2011). To have a family member suffering from Alzheimers disease alters your life unavoidably, as the reversal of roles from being the child to the nurturing care provider can be unsettling and even overwhelming. The impact on the family can be quite difficult to witness, of watching a previously vibrant and independent parent decline over time to a former shadow of themselves and having to adjust to the increasing responsibilities as a caregiver can be psychologically demanding, as this role reversal usually occurs for spouses. For example a husband whose wife who has always managed the household may find himself having to take over this role, or vice versa. Children and grandchildren, nieces and nephew may find themselve s in this role. Whatever the make-up of the family, there is usually a role reversal, where someone to steps into the shoes of the caregiver, Lu and Bludau (2011). This is where a therapeutic relationship between the nurse, the family and patient has to be formed; this is a key component in the nursing profession that enables the best care possible is provided to an Alzheimers sufferer. However, before any treatment is given consent must be obtained (NMC, 2008) whether it may be from family members or clinicians caring for the patient on a day-to-day basis if the patient is unable. Making decisions for such person as long as its within their best interest and lacking the mental capacity to do so for themselves is acceptable, as the Mental Capacity Act (the Act) 2005 states any act done or decision made on behalf of an adult lacking capacity must be in their best interests. In the case of an Alzheimers sufferer, as their cognitive memory deteriorates, neglection and decision making for themselves becomes apparent, these patients becomes highly vulnerable, helpless and in a dependent position and looks to the nurse to uphold their dignity and res pect for their confidentiality, as stated by the Nursing and Midwifery Council (NMC), a person must be treated with respect, dignity and has the right to confidentiality, NMC (2008). As quality of care not only depends on good healthcare but also on respect for the person as an individual DH, (2001). Teamwork in this sense also has a vital role, without this, communication between different agencies such as social services, and the multidisciplinary team which may involve psysiotherapy, psychologist and nutritionist. These skills together will identify the support needed to make sure treatment is patient-centered and also promotes a collaborative partnership between the patient and health professionals (Silverman et al, 2005), only then effective treatment can be achieved that is needed for an Alzheimers sufferer. As a nurse, one should have excellent communication skills, whether through speaking, writing, observing or listening (Egan, 2002), this will enable them to be the ultimate patients advocate. To expand on this, nurses form the primary system of support; this could range from logistical issues, such as treatment in the accident and emergency department through to being admitted to the ward within the hospital. In the case of an Alzheimers patient where the patient may be within his or her own home for some time, regularly visiting the patient to assess the patients health condition, to provide emotional support to both frightened patient and family member. The nurse must be able to facilitate and identify any health promotions needed for his or her patient so that they are able to implement any strategy to best support the patient, family and carer neccessary. In an Alzheimers patient, onset of many chronic diseases, infection or illnesses will become inevitable and a reduction in a once bubbly individual will be a thing of the past, as their brain deteriorates. Alzheimers sufferer may forget simple task such as washing of themselves or eating the required amount of meals necessary for intake of nutritions needed, thus health promotions has to be tailored specifically for an Alzheimers patient unigue lifespan (Hubley and Copeman, 2008). Addressing issues such as smoking or cooking as well as living alone will enable any health concerns will allow you to make any changes before they become a danger to themselves or others. Alzheimer sufferer also needs to be protected from abuse; this is one of many important aspects of being a nurse. Abuse may come in many forms, being physical, psychological, financial, sexual, neglect or discriminated upon because of their culture or ethnicity and as the United Kingdom becomes a multicultural society, there are implications on how healthcare is delivered by nurses. Furthermore, a nurses action is guided by principles of moral and legal rights, this compliments excellent nursing care. Awareness of the legal codes helps them to control complicated situation that they may encounter and helps to direct the nurse as well as their multidisciplinary team in the best possible action answerable by law (Dimond, 2011). It is important that nurses are aware of this and that they are sensitive when treatment is being administered. Nurses need to familiarise themselves with what is acceptable behaviour and respond accordingly (Timby, 2005). An example being that in some cultures it may be unacceptable to make eye contact while in others it is not or it may also be unacceptable to touch certain parts of one body. In conclusion, whether or not aluminium or old age is infact the cause of Alzheimers disease, the nurse has to be the the patients representative in order to address underlying issues that exist between, the family, carer and society. Also, to amalgamate the multidisciplinary team and relevant agencies so that health promotions may be implemented by means of controling infections, which is the predisposing factor of an Alzheimers patient death. This relationship is complex and the nurses job has to be the forefront of it all, whether it may be to educate family and carer on how best to include hygiene and infection control as the disease worsen or to inform the multidisciplinary team about the patients health and wellbeing.