Tort Law Essay Example | Topics and Well Written Essays - 2000 words - 2

Tort Law - Essay Example This additional amount is known as punitive damages. Similarly, there may be situations whereby the plaintiff may file an injunction which prevents the defendant from injuring him or her or from invading one of his or her property. Tort laws are laws instituted to offer compensation to persons who have been harmed due to the irrational actions of a second or third party. The claims in tort generally involve state law, and are based on the postulation that individuals are at all times liable for their own actions, if it either directly or indirectly results in the injury of others. Tort law constitutes a branch of private law that is also characterized by contract law, property law and restitution. A tort law has a distinctive capability of transferring the problems of a victim plaintiff, to another person, the defendant2. In the tort law, the duty of care is that legal obligation that is imposed upon a person requiring that the individual stick to the standard of reasonable care in c ourse of executing any acts that can foreseeable harm other individuals. In order to establish whether there was an act of negligence in this case or not, there is need to first consider if the Healthy Organics Ltd, Maahir, Harry, the paramedics, Fred as well as the Surgeon who used a \ new non-invasive technique who can be regarded as defendants in this case, owed the plaintiffs (the affected individuals) a duty of care. In other words, are the five reasonably responsible for the injuries sustained by Syed, Maisy, Tom, Gerry, and Robert? As it is in this case, it is certain that there was a duty of care that is imposed by law that the defendants in this case breached and as provided by law such individuals are subject to liability. Exploration The article under analysis comprises of a number of cases that lie within the context of tort. The first is a scenario whereby a tort suit is applicable is in the case against Maahir, who is in possession of work man tools that aid him in eff ectively undertaking his work. As such, he is tasked with the obligation of ensuring the tools he uses are kept away safely, lest they inflict injury on any second or third party. Regrettably this is what unerringly materialized. Via a series of events made probable by laxity on the part of Maahir, Syed, an innocent child, is hurt. Explicitly, this set-up is characterized by elements of strict liability. Strict liability entails the plaintiff ascertaining, beyond a doubt, the defendant had an obligation to guarantee something was kept safe. Subsequently, the defendant failed to perform this duty, thus, leading to injury of the plaintiff. In this case, there was foreseeability as the random and careless placing of tools in an environment characterized by children was bound to eventuate in injury. In this occasion, Maahir had a liability on the injury sustained by Syed. When this case is looked into closely, there exists negligence on the part of Maahir. However, Syed must prove that he was a primary victim of negligence. In the ruling Alcock v Chief Constable of South Yorkshire3, it was ruled that primary victims only have to prove that the injury was foreseeable. Furthermore, there is no need to establish that psychiatric injury was indeed foreseeable4. As such, under this criterion then Maahir is liable for the injury sustai

Acts of Paul and Thecla Research Proposal Example | Topics and Well Written Essays - 500 words

Acts of Paul and Thecla - Research Proposal Example   Ã¢â‚¬Å"In the Acts of Thecla for example, Paul gives a speech in which he recasts the part of the bible that we call the beatitudes. Thats the "blessed are the so and so...." Pauls version of this is all about blessed are the bodies of virgins ... blessed are the chaste. Its all about sexual chastity. That those are the people who are blessed in this new recasting of the Christian message†. (Elizabeth Clark. pbs.org/wgbh/pages/frontline/shows/religion/first/roles.html) "The Acts of Paul and Thecla" tell us of how a woman was instrumental in spreading the gospel. It clearly pictures her as being a very string minded and sincere. This depiction of an independent woman was not very apt during that time period when women were subdued and always in the background. Moreover her life after she meets Paul is seemed to be filled with miracles where she miraculously survives an attempt to burn her alive, or her confrontation with wild beasts where she survives unscathed. Further she escapes from some men through a crack in the rock made by God which was then closed behind her. As for Thecla we see her as a strong willed and faithful disciple of the Lord. Her celibacy and strong character shows up where she baptizes, preaches and heals and stands up to her faith amidst all hurdles. The path she had chosen is very unlike the women of her period. In a way these story was apparently used by women who wanted to preach the gospel and looked for a legitimate status as ministers of Gods word. This story certainly reads and sounds like a myth due to the various miracles in one person’s life which we do not see or hear in any other even the prophets.

Reflective Log On Personal And Professional Development Skills Nursing Essay

Reflective Log On Personal And Professional Development Skills Nursing Essay Stress has always been a part of my life. I have experienced it during exam revision, my Duke of Edinburgh expedition, being the captain of a tennis team and performing in a play. My reason for choosing this SSC was to help me to identify and manage my stress, plan my goals and improve my time management so that excessive stress can be avoided in the future. We began the course by studying the graph of performance versus arousal, illustrating the human response to stress. Performance initially increased with stress. I have always perceived stress as a negative thing and something that should be avoided at all costs. I soon learned that some stress is good for you; some stressors keep you motivated and working at the optimum rate; without them, I would become bored and feel like I was underachieving. When stress is excessive, however, the graph starts plateauing and then going down. The body starts suffering and displaying signs of being overstressed leading to lowered productivity and finally breakdown and illness. When I am very stressed, I find myself experiencing a combination of symptoms. Anxiety, procrastination, increased heart rate, diarrhoea, sensitivity to criticism, negative self-critical thoughts and occasional emotional outbursts are not uncommon to me. Being on such a demanding course as Medicine, it is important to manage stress efficiently to keep productivity at optimum levels. Knowing about the manifestations of stress is useful both when directly administering healthcare and to inform professional conduct. The understanding of the manifesting symptoms of stress will allow me to identify it in myself and others: I can later use this either to prescribe the right course of action to the patient, or to manage underlying problems at work. The two types of stress are acute and chronic. The General Adaptation Syndrome proposed by Seyle explains the stages the body goes through when faced with stress: Alarm, Resistance and Exhaustion1. The alarm stage involves the fight or flight mechanism as well as activation of the Hypothalamic Pituitary Adrenal axis, leading to down-regulation of the immune system. In the resistance phase, the body tries to cope with the increased stress. In the exhaustion phase, sustained stress has depleted the body of resources and we suffer from diseases of adaptation. I experience acute stress on a frequent basis, for example when I get a minor injury or am trying to meet an essay deadline, leading to alarm and resistance. Chronic stress is more long term, such as occupational stress, commonly leading to the exhaustion phase of the General Adaptation Syndrome. This occurs when I am stressed for a longer period of time, such as when struggling to catch up with work or preparing for exams. Extended periods of high stress situations can lead to burnout, which is characterised by emotional exhaustion and depersonalisation, leading to low productivity and feelings of low achievement. I have experienced similar feelings when, after pushing myself too hard, I feel negative, run down and as though my work is barely progressing. The extreme demands of a medical career can easily drive a doctor to burnout. I was glad that this SSC gave us space to consider burnout, as it brought my attention to aspects of my own conduct when under pressure. With an awareness of my personal difficulties in mind, I often try to use action and emotionally orientated skills to manage my stress levels. I plan ahead in terms of work and other commitments, and prefer to work steadily over time and not get emotionally worked up about it. However, acceptance-orientated stress management comes into play when stressors seem more imminent. With the associated stress of an oncoming exam, for instance, I accept it and work, trying to avoid further stress by reminding myself that I am doing my best. I was surprised to learn about the extent to which personal stress effects those who surround us. Stress is infectious and in a clinical scenario it is important to seem calm to the patient to build a rapport and gain their trust. A visibly stressed doctor will result in stressed patients, or even cause stress in other members of staff leading to poor patient care, often due to non-verbal communication such as body language. With the understanding that interactions with patients, and teamwork situations will feature a lot in my career, knowing about the infectious nature of stress has reinforced my belief that I must manage my stress and be cautious of how (or what) I communicate. To improve my stress management, it is important to become aware of my stressors, and how I react physically and emotionally to them, while bearing in mind the three main variables of stress: intensity, duration and number of stressors present. This will allow me to evaluate what I can change and to moderate my physical and emotional responses. Keeping fit by going to the gym and playing sports, as well as socialising allows me to unwind and feel good about myself. I find these very effective in stress management as they allow build-up of physical and emotional reserves. However, I need to improve my prioritising mechanisms, as sometimes prioritising is my downfall: for example I often find myself persuaded to go out with friends before an important deadline. Doing work when it is important rather than urgent will also leave me room to do the things I enjoy, without the avoidable pressure of time constraints and outstanding work: thus by starting assignments sooner rather than later, and studying lectures and tutorials after having them I will reduce my exposure to the stressors, and the intensity and duration of the stress With those plans in mind, I found learning about the methods of stress manipulation halting, interrupting and coping useful and insightful. In the past I have used halting and coping as my primary methods of manipulating stress. However, I now feel that these are not best in all situations; indeed, they can result in more when work accumulates and must be completed later. I am now putting into place interruption, which involves reducing the stress rather than stopping it altogether by preventing it from building up; this works well when it incorporates the management of variables of stress. I found it a surprise that such a thing as eustress existed; once again challenging my perceptions that stress is almost always a negative thing. I then recalled when I had experienced this in the past, for example when exams are over and I have almost unlimited time to do whatever I want. Learning how to identify stressors, as well as enhancing relevant communication skills, was useful. As a doctor, using the interrogative words Who, What, When, Where and How when interviewing patients will help me to take good patient histories: they will allow me to direct the patients answers in a way which will help identify the stressors efficiently. The areas which cause stress are occupation, personal relationships, environment and non-work time. Using the aforementioned words will create open yet specific questions, prompting the patient to open up and provide a better history. However, the interrogator why should not be used as it is too vague and not productive enough when trying to determine the causes of stress. Thought awareness refers to negative thinking. I have experienced this myself, when the approach of exams causes me to doubt my knowledge and anticipate failure. However, I have addressed this by making sure I prepare in enough time and by using my time efficiently. I am now able to think more clearly, remain calmer and make informed decisions in more stressful situations. I recognise the importance of being optimistic, and believe that even when things do not go according to plan, I must see the experience as positive and an opportunity to learn. As well as that, I am quite a confident person and apply myself to most situations with a confident mind-set even if they are in uncharted territory. This allows me to push my boundaries, and this boosts my confidence when I am pleasantly surprised to discover a new skill. On my Duke of Edinburgh expedition, I was leading my team. Unfortunately due to torrential rain and wind, a part of our route was impassable; this meant I was responsible to plan a new route within a short period of time as it was getting very late and dark. I successfully managed to get the team to the camp with very little delay to our original plan. The final step in stress management is rest, relaxation and sleep. In my experience, all three have suffered during stressful times, especially rest and relaxation. I play badminton, tennis and go to the gym as forms of recreation, and enjoy music and television to distract me from the stress. I sometimes stop doing these during intense times in order to make time for work. I now realise that it is important not to halt these activities. However the biggest change I will be making is implementing the self-hypnosis techniques learnt in the classes. I think that the hypnosis allows me to be more awake and refreshed than by taking a quick nap, which often leaves me feeling worse when I wake up which I learnt was due to me interrupting a sleep cycle. To be someone who works productively, efficiently and in a professional manner, I must set realistic goals and then achieve them, borrowing some aspects of the tycoon mentality. Namely, it is necessary firstly to know what I want; the best way of going about this is to maintain focussed on it by not bothering too much about what I dont want. To remain focussed on achieving my goals, it is important that I constantly visualise them to keep myself striving towards them. This means clearing your mind of any clutter such as goals that are now unattainable and past events. I often find myself thinking of what has happened in the past and replaying them in my mind and thinking about what I could have done differently, for example I once said something rash to a friend in the heat of the moment which I later regretted; I kept thinking about all the time and got really stressed. I now realise that this is merely a waste of time and I could use this time to make more use of the present to cre ate a better future. Tycoons realise the importance of compartmentalising, that is, not carrying emotional baggage from one thing to another. As a doctor for me this will be imperative: I must not carry any sentiments about one patient to another when dealing with another case. I already compartmentalise in day to day life, and for instance when I get upset about one thing, I do not allow the associated emotions to interfere with other aspects of my life. I have also set myself some clear cut and realistic goals which I am working towards and know how to get there. In some ways I do have tycoon mentality, which is valuable as a medical student and future doctor. Although the importance of hard work is undeniable, anticipating success will help me to achieve it, as the ensuing excitement which in turn motivates me to strive towards my ambition. Anticipation also allows me to change my goal if my current goal no longer seems to be the right one for me. Past experiences have shown me that whatever seems like a huge effort will only become habitual in time, usually a period of three weeks according to Maltzs Psychocybernetics2. For example, when I promised myself to visit the gym to improve my fitness, it initially seemed a huge effort to make time for it, but after some time I stopped seeing it as an effort. It became a part of my schedule, and I am able to fit other activities around it: this is goal maintenance I have a goal in my career of becoming a liver surgeon, it is a definitive long term goal and I am determined to achieve it. I will need to achieve several goals such as passing my exams and attending surgical society meetings to achieve the long term goal. By having a time frame to achieve my goal, I will always endeavour to achieve the goals I set myself. It is not just enough to have a goal; you need to make it a reality. I am good at operating on my own initiative and try to take the necessary steps to climb up the ladder towards my goals. Desire results in sustained effort: For instance, I will not let progress made towards my ambition deter me from trying harder. I am currently searching for placements with surgeons and gaining career advice to set me apart when I apply for a job. Loss of desire can mean you can get side tracked from your goals and result in you not achieving them; I am always trying to keep a focus on my goals in order to prevent this from happening. In order to gain satisfaction from achieving my goals, I need to make sure that I keep doing my on-going activities such as gym, tennis and badminton. Otherwise, I would have lost this aspect of my life as well as it being detrimental to my fitness. I am often guilty of stopping these activities when Im busy with other work, but from now on will incorporate them into my goals. Goals are something you want to achieve; dreams go beyond goals and are on the horizon beyond the path to your goal. This made me think whether some of my goals are actually goals or whether they are dreams. I then realised that my goal of becoming a well renowned surgeon is actually a dream, I will need to hit all my goals and go beyond before I can make my dream a reality. I also realise that no one is going to create my success; only I am solely responsible for creating my success. I have set SMART goals (Specific, Measurable, Achievable, Realistic and within a Time frame) and I am now forming a personalised goal portfolio so that I can hit my targets; to supplement this, I am also going to make lists of tasks that I need to do. Though I have never used lists in the past, I feel that making lists facilitates organisation and aids the memory, thus increasing chances of success. I feel that this SSC has equipped me with a platform of skills which will be useful in my career as a doctor. Mainly these fall under the categories of stress management, motivation techniques, time management and relaxation. Surprisingly, though, the course has shed light on the importance of communication and body language with regards to stress management, and familiarised me with concepts I did not previously know about, such as eustress and the positive influence of stress for productivity. Nevertheless I feel that the most important things I learned were the skill of identifying that I was stressed, and the knowledge that sometimes I need to relax. Above all, though, I feel that this SSC has been one of the most influential aspects of my medical education, as it has taught me to recognise that stress is not merely a black and white issue: it resides neither in the situation or the person, it depends on a transaction between the two.3

elderly abuse :: essays research papers

? The National Elder Abuse Incidence Study ? Executive Summary ? Introduction and Background America's burgeoning elder population has affected every segment of the social, political, and economic landscape. Public debate of the issues surrounding the special needs of the approximately 44 million persons in this country age 60 years and over has heightened national awareness and concern. As a result, public policies relating to issues such as retirement security, affordable long-term care, and quality of life are changing to meet the unique needs of the aging population. Yet, as the public looks toward improving the lives of the elderly, abuse and neglect of elders living in their own homes have gone largely unidentified and unnoticed. The National Elder Abuse Incidence Study has shed new light on this significant problem with the finding that approximately 450,000 elderly persons in domestic settings were abused and/or neglected during 1996. When elderly persons who experienced self-neglect are added, the number increases to approximately 551,000 in 1996. Additionally, thro ugh this study we have learned that: Â · Female elders are abused at a higher rate than males, after accounting for their larger proportion in the aging population. Â · Our oldest elders (80 years and over) are abused and neglected at two to three times their proportion of the elderly population. Â · In almost 90 percent of the elder abuse and neglect incidents with a known perpetrator, the perpetrator is a family member, and two-thirds of the perpetrators are adult children or spouses. Â · Victims of self-neglect are usually depressed, confused, or extremely frail. The National Elder Abuse Incidence Study (NEAIS) was conducted by the National Center on Elder Abuse at the American Public Human Services Association (formally known as the American Public Welfare Association) and the Maryland-based social science and survey research firm, Westat. The Administration for Children and Families (ACF) and the Administration on Aging (AoA) in the U.S. Department of Health and Human Services jointly funded this research. The study asked the fundamental question: What is the incidence of domestic elder abuse and neglect in the United States today? In public health and social research, the term "incidence" means the number of new cases occurring over a specific time period. The NEAIS used a rigorous methodology to collect national incidence data on what has been a largely undocumented phenomenon, and it provides the basis to estimate the incidence of domestic elder abuse and neglect among those aged 60 and above in 1996.

How does haddon create sympathy for ed boone? Essay

How does Haddon create sympathy for Ed Boone? In the novel, The Curious Incident of the Dog in the Night Time, I shall be exploring how Haddon creates sympathy for protagonist, Ed Boone. I have many aspects to protect my point of view. Firstly, our first impressions for the character of Ed Boone were that he was a caring and loving father that knew how to handle his even through his difficulties. We know he understands his son and can always sympathize with Christopher, because instead of shouting at or hugging Christopher when he got arrested, he â€Å"spread his fingers in a fan† as a â€Å"sign of love† for Christopher. We sympathize with Ed because he was currently facing the hardships of being a single parent upbringing an autistic teenager. Haddon makes us sympathize with Ed Boone from the beginning of the novel and carries on throughout exceptionally. In addition, Haddon heightens out sympathy for Ed Boone when successfully writing a pathetic fallacy for Ed. This happened when Ed had a loving son, wife, home and job, but then we began to sympathize with him because his wife left him for his next door neighbour and he was left alone. So, he started a new relationship with Mrs Shears and soon split up and Ed was left vulnerable on his own, yet again. The impact on Haddon using this technique will help the reader sympathize with Ed from the start of the novel and successfully turns him into a victim in the novel. Furthermore, we as readers can now sympathize with Ed far easier and when Ed â€Å"hides things to protect† Christopher, we can infer and deduce he knew Christopher won’t be able to take it all in and it would affect him dearly. So, Ed did what he thought was best and protected Christopher from â€Å"knowing the details† about his mother and Wellington. We can understand that it’s difficult and Ch ristopher will not be able to handle it, therefore Ed hid certain information from Christopher out of love and the understanding he has for his son. Moreover, our sympathy was given yet again to Ed when he came back from work and found his son missing. However, Ed being the responsible parent that he is phoned the police and â€Å"worried himself sick.† We can infer and deduce that Ed obviously loves Christopher and the thought of him away from his father worries him. We feel sorry for Ed because we don’t whether he will see his son again and neither does Ed. We can put ourselves in his shoes and know he must be feeling alone, guilty and full of regret and remorse, because of this, we feel sorry for the character of Ed Boone thanks to Haddon’s  incredible techniques and powerful plot that guarantees sympathy given to the written character, Ed Boone. Finally, the last point I have in which Haddon makes the reader give an endless amount of sympathy and love to Ed, is where Haddon written out the situation of a single working parent of an autistic teenager who has many special needs. In which, in able to look after teenager, Christopher, you have to understand his needs and wants. To do this you will need a lot of patience and it can be very difficult at times because Christopher can last several days without eating or communicating. Also, he won’t eat any two foods touching, in result of them being thrown away and he doesn’t eat or touch anything that is the colour brown or yellow. Christopher has many other needs and Ed has to understand Christopher’s mind frame and know what to do in able to cope with his son. To be able to live with Christopher and have such a close relationship between the two of them, takes a great amount of patience and love, and is even harder to do when on your own. Haddon enable the reader to understand that life is challenging for Ed and makes us come to a realization that we will not be able to do what Ed is doing, so we naturally give our sympathy to Ed because of what he has to cope with in his day to day life. To conclude this essay, I strongly believe that Haddon creates many circumstances where the reader can sympathize with protagonist, Ed Boone. Because of Haddon’s phenomenal writing skills, we give nothing but sympathy and understanding to Ed as he faces many challenges, and because we can’t help him, we comfort Ed and sympathize with him. Sympathy given to Ed from the reader was one of Haddon’s expectations from this novel, and I can truly say he exceeded in this and brought true emotions for protagonist, Ed Boone.

Analysis chinese banking industry systems, processes and products Essay

China’s rapidly developing economy is dependent on a banking industry which is controlled by the state. The four public banks of China and the People’s Bank of China have a strong hold over the country’s financial system. The advent of China in WTO in 2001 and globalization has led to a felt need for transformation in the Chinese economy to integrate it with the global economy. The financial sector will need to support this change. An assessment of the state of the Chinese banking industry at present and its future growth is therefore essential. Ideally this can be achieved by benchmarking a Chinese bank and a European Bank, for which purpose a case study of Bank of China and HSBC, London has been carried out. The aim of the research is therefore to undertake an analysis of the Chinese banking systems, processes and products through a case study of the above mentioned banks while the objectives of the research indicate assessment of the overall state of the Chinese banking industry, evaluate implementation of various processes and systems and highlight the areas for growth. A deductive – inductive approach with emphasis on case study has been adopted for the research. Apart from extensive secondary research through literature survey, a detailed questionnaire has been administered to 40 clients across a wide cross section of personal and corporate customers of Bank of China and HSBC, London which has formed the key primary resource for the research. A review of the research sources and questionnaires has revealed that Bank of China has been able to quickly adapt itself to the changing requirements of a globalised financial environment and is providing both personal as well as business banking services to meet its customer’s requirements. HSBC which considers itself as the World’s local bank is providing a complete package of services to the corporate as well as personal client and has been successful in implementing the same throughout the World. Its initial forays into China have also underlined the success story. The quality of service in both the banks was seen to be similar, however HSBC provided better follow up and also more services on the internet than Bank of China. The growth trajectory of both the banks indicates that, while HSBC is attempting to grow throughout the World; Bank of China is growing primarily within the Chinese banking system. There are a number of areas for improvement identified in the research which could well be undertaken by Bank of China to include greater efficiency and better customer service, improvement in technology and customer follow up and exploitation of niche areas such as credit cards. The entry of foreign banks will see greater competition in the Chinese banking sector. The need for Chinese banks to adopt global practices is also underlined and it is anticipated that the entry of more global banks as HSBC in China will provide the impetus to this growth. ANALYSIS CHINESE BANKING INDUSTRY SYSTEMS, PROCESSES AND PRODUCTS: A CASE STUDY BANK OF CHINA AND HSBC, LONDON Chapter 1 – Introduction China is a rapidly growing economy which is considered as a model for emerging countries all over the World. The dynamism of an economy lies in an efficient and effective financial system led by the banking sector. The impact of the banking sector on economic growth in China and its contribution to public life has been a matter of debate over the years. China has a banking system which is controlled by the State and thus has a very large influence on the economy. Exclusively controlled by the central government, the four state banks and People’s Bank of China have a very strong hold over the financial system both internally and externally. (China’s Economic System, 2004). However the rapid growth of China towards a socialist market economy has been affecting the banking sector in various ways and Chinese banks have undertaken measures to enhance their efficiency and contribute effectively to the economy. China’s entry into the WTO in 2001 has also necessitated adoption of liberalized norms in line with the global banking and financial industry. To what extent China has been able to adapt these new practices and how these are affecting or likely to affect the growth of the Chinese economy is an issue of great relevance. As China’s economy gets increasingly integrated with the global economy, its financial markets will have to support this union. It is therefore essential to assess the state of the Chinese banking industry at present and its trajectory of growth in the future. A case study approach to this issue is considered relevant for which Bank of China and HSBC, London are selected for review of the systems, processes and products to provide an insight of the financial needs and their fulfillment today and tomorrow. Bank of China is one of the principal banks in the country; it is one of the four banks which are owned by the State in China. (About Bank of China,. 2006). It has been a key central bank of China which has carried out international exchange as well as provided funds and been a point for foreign trade in the country over a period. It conducts a wide variety of services including commercial banking, insurance as well as investment banking. It is one of the largest banks in Asia and has been placed at the 18th position by the Banker Magazine in 2005. (About Bank of China,. 2006). It also has a large overseas presence in 27 countries. The systems, processes and practices followed by the Bank of China would be a good indicator of the state of the Chinese banking industry in both its internal and external dimensions. HSBC is an epitome of a modern bank. Based in London, the Bank had its origins in provision of finance for trading with China in the 19th Century. After China adopted a nationalist communist economy and banking system, HSBC’s presence in the country was limited. However the bank has now retuned with a vigor and strives to make inroads in the highly competitive financial sector where banks with a state monopoly are said to enjoy unprecedented advantage. The Bank is also taking benefit of its old legacy and is already earning profits to the tune of $ 161 million for the first half of 2005. (Schuman, 2006). HSBC in some ways can be seen to be a competitor to the Bank of China, though its reach within China is limited to only 20 branches. (Schuman, 2006). The investments made by HSBC in Chinese financial sector are reported to be $ 4 billion and include almost one fifth stake in China’s fifth largest bank, Bank of Communications and its second largest insurance company, Ping An Insurance with which the Bank of China too has many contracts. A comparative analysis of BOC and HSBC would thus provide us an effective understanding of the state of the banking industry in China in all its operational facets. The dynamic nature of the research will entail application of a deductive-inductive approach which in practice is adopted by a number of similar research projects keeping in view the importance of both qualitative and quantitative findings.

Hawk Roosting Essay Example

Hawk Roosting Essay Example Hawk Roosting Essay Hawk Roosting Essay Essay Topic: poem Power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men. Lord Acton. This is often true, especially when some of the most powerful rulers such as Hitler and Mussolini were bloodthirsty and merciless dictators. To many, Stalin was the epitome of a sadistic, power-hungry tyrant, in complete control. As it is often the powerless who want freedom, the world gets divided into the ones in power, the ones trying to gain power, and the ones rebelling against absolute power. Ted Hughes is a poet who uses animals to portray human emotions, such as greed and ambition. He personifies inanimate objects and emotions to bring across his message. In his poem Hawk Roosting, Hughes speaks in first person, the hawk as the speaker. His personal views, on many occasions clash with those of the hawk, which in my opinion is affective as it shows how the poet differs from his subject. In the first stanza, the poet very quickly takes us into the poem, by giving us an image of the hawk. It seems as though the speaker, the hawk, is indifferent about the readers presence as hes asleep. The hawk appears to be in control, as hes higher than anyone and anything else, I sit in the top of the wood. Also, he shows he feels hes invulnerable, and immortal, as if nothing can hurt him, with my eyes closed. The first stanza introduces the reader to the hawks attitude to life, explaining that he feels hes living his dream, and that his reality is as good as anybodys dream, inaction, no falsifying dream. : There is also a clear description of the physical appearance of the hawk, streamlined and sleek. The fact that the poet mentions the hawks head and feet, between my hooked head and my hooked feet, shows that the speaker, the hawk, sees himself as streamlined from the top to the bottom, and mentions the basic animal hunting tools, the claws and the beak. This suggests that although the hawk appears to have human emotions, the hawk itself, is merely an animal built for survival through hunting. The air of arrogance and control is already apparent, as the hawk, instead of sleeping like a ordinary animal, plans and perfects his kills; controlling sleep, therefore controlling nature, in sleep rehearsing perfect kills and eat. The fact that he refers to kills in plural, and eat in singular is unusual and suggests that he kills not only to survive, but sees it as an art; a skill to perfect and develop. In the second stanza, the reader is given an image of the hawks surroundings and environment. The poet highlights that the hawk is in control, through the description of the surroundings. Rather than describing what is there, Hughes describes the way the speaker, the hawk, sees everything, through the eyes of the hawk. By describing the advantages of the situation first, the poet starts off the stanza by putting the hawk in complete control of his surroundings, as if hes in harmony with nature, almost controlling it to his advantage, the convenience of the high trees! The fact that the hawk is on top of everything shows hes got an advantage above everything else, and also seems like hes looking down on everything as his property and belongings. This is also shown through the way he describes the elements; as if they were put there just for him, to his advantage, made the way he wants. Those advantages also help him hunt and survive, such as the airs buoyancy and the suns ray, the air helping him fly, and the sun blinding his victims. This feeling of possession is shown through the personification of the earth, the earths face upward for my inspection, as if the earths face, is staring up at it, in awe and inferiority; as if it is there for him to judge. After making the point about being on top of the wood in the first stanza, the poet then refers to how the hawk is sitting. As being on top of the wood is linked with being on top of the world, by saying that the hawk has his feet locked on the tree, the hawk is almost saying that he has his feet locked around the whole world My feet are locked upon the rough bark. This highlights how the hawk imagines himself to be in complete control of everything, the entire world. The next line accentuates the hawks perception of the world as being his, when he turns the tables, almost, on Mother Nature. It seems to the reader, as if in the hawks mind everything was pointless up until the moment in time when he was created. It appears as though, to the hawk, he is the perfect being, and has the right to control everything because it is all his and he were made to be in charge of everything. It took the whole of Creation/ to produce my foot, my each feather: / now I hold Creation in my foot. This sentence also gives the reader the impression that, in the hawks mind, the whole of creation exists because of him, and for him, and also as it apparently took so long for him to be made, he is perfect. The poet now begins to show how contradictory his own personal views are to the hawk. As we, the readers, by now have a clear image in our head of the power-corrupt hawk in our minds; Hughes now begins to subtly show us the hypocrisy in the hawks words. When the hawk is flying around what he thinks he owns, he seems to be judging it, which the reader might see as slightly futile, as even if he saw a flaw in his perfect world, he would not have the power to change it in reality, despite what he may think. Therefore the element of disillusion is already introduced through this line, as well as denial, as the hawk appears to be happy with everything, so as not to look powerless against Mother Nature Or I fly up, and revolve it all slowly. The hypocrisy is shown through the way the hawk gives the reader the impression that he needs no excuse to kill as he was born with the right, yet is appearing to be explaining why he chooses to kill what he wants I kill where I please it is all mine. This shows that although the hawk appears to be completely comfortable with his reasoning on the fact that he kills and needs no excuse, he gives us a reason anyway. If he saw no grains of truth in that maybe he does need a reason, he wouldnt have excused himself. Also, by giving us a reason for his way of life, he has completely undermined his whole basis for doing things the way he wants, as he is now telling us why he does things. The hawk then shows even more hypercriticism, as right after saying why he kills, hes saying that he needs no reason to kill, as if to cover up in case the reader feels the reason given is somehow unsatisfactory There is no sophistry in my body. It feels as though the hawk is trying to give us the impression that he kills just for the fun of it, and although to some extent this is probably true, it seems as though he slightly exaggerates this. This is shown through the way he appears to need no reason for pointless killings, but then gives us one, and then to say that he only kills simply to kill, My manners are tearing off heads, which would have been obvious without him pointing this out. The fact that he feels the need to point it out shows that to some extent he only acts this way to appear superior and all-powerful.

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buy custom Albuterol in Asthma essay Asthma is one of the most common pulmonary illnesses that affect more than fourteen million people in the United States (CDC, 2008). The prevalence of asthma is increasing in most countries, and estimates show that the numbers are likely to rise by 100 million by 2025 (Bateman et al., 2008). Asthma is characterized by reversible airway obstruction following exposure to environmental allergens or irritants or respiratory viral infection (CDC, 2008). Asthma is also characterized by impediment and irritation that occurs in many patients. Treatment of asthma has always been medications that are aimed at controlling the inflammation as well as the medications for general relief of the severe symptoms. However, the recommended management is the clinical assessment of the symptoms and the lung function assessment of an individual. These are viewed as the measures of the outcomes that result from this condition. Most asthma exacerbations are dealt with in various outpatient systems. However, more severe conditions require hospitalization. These hospitalizations are responsible for the foremost healthcare expenditures by patients. In the United States, these hospitalizations lead to over 400,000 cases of asthma hospitalizations annually. This eventually leads to very high expenditures for asthma related conditions (Bharmal Kamble, 2009). Asthma in both children and adults is associated with an increase in direct expenses, which eventually brings the expenditure to a very high level according to healthcare costs. The main therapy in the treatment of asthma is the administration of 2-receptor agonists which reverse the acute airway obstruction as well as other conditions such as cough. According to Ameredes (2009), levalbuterol and albuterol are the most common short acting 2-receptor agonists in the treatment of asthma. Racemic albuterol is a mixture of two stereo isomers R-albuterol and S-albuterol. Clinical studies have distinguished the two isomers in terms of their affinity. Studies upon isolation of the two isomers have revealed that R-albuterol is responsible for the bronchodilator activity. However, S-albuterol does not possess bronchodilator characteristics, but it acts in association with various pharmacological activities to neutralize the therapeutic effects of R-albuterol (Handley, 2000). Levalbuterol, also referred to as levosalbuterol is an alternative treatment for asthma and other pulmonary illnesses such as Chronic Obstructive Pulmonary Disorder (COPD). It blocks the beta-2-receptor to prevent the constriction of the airways in these conditions, and is therefore called a bronchodilator. Cells in the airways contain receptors that are called beta-2 receptors. Levalbuterol binds and activates the beta-2 receptors and is hence referred to as a beta agonist. This initiates signaling within the cells which results to the relaxation and opening of airways. However, the safety of albuterol and Levalbuterol is generally different. The S-isomer in albuterol has been believed to be inert in nature and its presence in the drug of no consequence. But it is now thought to foreshorten the duration of R-albuterol by compressing its potency (Handley, 2000). The main purpose of this study is to provide a comparative view of asthma related therapies, as well as the outcomes of tre atment after the maintenance treatment of asthma using levalbuterol and albuterol. Literature Review Studies in patient preferences on the type of medication provide crucial information on the evaluation of asthma symptoms as well as the effects of medication on the wellbeing of the patients and the levels of functional activities (Bateman et al., 2008). These studies have been insufficient in evaluating the effectiveness of albuterol in treating asthma. Albuterol has been in use for a long time but is said to be associated with various side effects such as tachycardia and jitters. The introduction of levalbuterol in 1999 has brought an opportunity to assess patient predilections between albuterol and levalbuterol. A stepwise approach to disease management is necessary for the assessment and eventual treatment of asthma. One of the main goals of asthma treatment is to uphold the wellbeing of people as one of the main humanistic upshot measures (Reed, 1985). Today, clinicians use many other measures to manage diseases with a need to control the effects of asthma as well as the wellbeing of the patients. These measures include patient satisfaction as well as other health related measures that are centered on the quality of life. Studies have revealed that patients preferences have a great impact on medication side effects, as well as patients quality of life. Patients compliance with the medication is also necessary for successful control of asthma (Bharmal Kamble, 2009). Disease control measures are also very crucial in reinforcing the positive perceptions of the treatment of asthma. When levalbuterol was approved in 2005, studies suggested that its use resulted in better respiratory parameters as well as fewer hospitalizations that brought about very little, if any, side effects and though it is priced much higher than albuterol since it has a higher duration of action (5-8 hours) as compared to albuterol (4-6 hours), its use led to generally lower treatment costs in terms of hospitalization and subsequent treatments (Carl, 2003). Studies comparing levalbuterol to albuterol revealed that levalbuterol yielded bronchodilation with few side effects. However, these results are not universal and some studies suggest no significant differences in clinical endpoints. The baseline distinctiveness for the two groups of patients (those who were administered with albuterol and those who were administered with Levalbuterol) was very distinctive (Ameredes, 2009). In the medical field, albuterol has been in use for a long time, one of the factors that make it preferable. Due to the mixture of the two isomers (R)-albuterol and (S)-albuterol that are considered inert, albuterol is considered somewhat classical in the medical field. However, the single-isomer formulation that has been manufactured recently is used therapeutically when the other component is deemed to be undesirable. Pharmacology Levalbuterol and albuterol are 2-receptor agonists and they reverse the acute airway obstruction as well as other conditions such as cough. The two drugs serve to reduce the resistance in the airway as they are known to enlarge the diameter of the bronchi or the air passages (Ozminkowsk et al., 2007). These drugs, therefore, help to enhance the overall flow of air both into the lungs and out. The drugs work on the beta-2 receptors resulting in the relaxation of the pulmonary smooth muscles (Perrin-Fayolle et al., 1996). Studies conducted with regard to the metabolism of levalbuterol in the human tissues indicate a 5-11 fold better sulfoconjugation within various human tissues than albuterol. A single dose of the albuterol dosage, whether taken orally or inhaled, results in a higher blood level within the body than levalbuterol (Perrin-Fayolle et al., 1996). Perhaps, this indicates a predominance of the (s)-albuterol, an inactive product, after repeated dosing of the active albuterol. It is estimated that up to 8 % of patients who receive nebulized racemic albuterol develop paradoxical bronchospasm, a condition which is life threatening. This decline in efficacy could be attributed to the composition of racemic albuterol. Levalbuterol is the therapeutically active bronchodilator in racemic albuterol, also referred to as (R)-albuterol. Evidence indicate that (S)-albuterol does not possess any bronchodilatory activity, in fact, it increases the level of calcium in the smooth muscle cells in vitro, which favors contraction and opposes bronchodilation. This also leads to increased in vitro bronchial reactivity of human airway smooth muscles. Clinically, the isomer promoted increased hypersensitivity and increased bronchospasm that is methacholine induced in patients with moderately severe asthma. On the contrary, levalbuterol, when administered as a single isomer, eliminates all the detrimental effects of (S)-albuterol (Bateman et al., 2008) Research has also shown that racemic albuterol and Levalbuterol are important since they produce effects that can be used as prescriptions for cancer treatment. The treatments include corticosteroid strengthening and the diminution of inflammatory mediators. However, on the other hand, (S)-albuterol produces contradictory effects. Studies indicate that the adverse effects associated with albuterol, such as jitters, tychardia and bronchospasms, are less frequent with levalbuterol (Gawchik, 2007). Symptom relief was also perceived to be higher, leading to a greater overall satisfaction with Levalbuterol treatment. However, it is important to bear in mind that while levalbuterol and albuterol help in relaxing the smooth muscles and increasing the flow of air within the airways, they do not actually reduce the speed of the progression of the primary disease (Ozminkowsk et al., 2007). They only help in minimizing the signs and symptoms of exercise and wheeze limitations along with the sho rtness of breath, leading to a better life for the people living with COPD. Improved outcomes Many investigators in their publications from studies have revealed that the use of levalbuterol yields better symptom relief and less frequency of the adverse effects as compared to albuterol. However, their pattern of outcomes cannot be applied universally because other studies propose that there is not a clear difference in clinical endpoints. Ozminkowski Wang (2007), state that the various publications that have resulted from various studies are difficult for doctors to follow. Most of these data highlight the effects of albuterol and levalbuterol in efficiency and safety. This was done by comparing the relief of symptoms and the exhibited side effects of each form of treatment. However, this clinical research provides no superiority of levalbuterol over albuterol. The effects of levalbuterol may be greatest to patients with moderate to severe asthma, especially in cases of racemic albuteol overuse (Ameredes, 2009). When a patient inhales racemic albuterol, he or she has a persistent effect that is caused by (S)-albuterol. This is in comparison to levalbuterol. This suggests potential contradictory outcomes from clinical experiments. One study carried out on children under the age of twelve years evaluated the treatment of asthma in children by caregivers who used either albuterol or levalbuterol. Various interviews were scheduled for caregivers, and the main questions were the satisfaction level of their children with bronchospasms. The caregivers were supposed to report contentment or discontent. The patients were administered with albuterol and levalbuterol for four consecutive weeks. After the first dose, levalbuterol created a greater relief of symptoms compared to doses of albuterol in nearly all patients including those with relentless asthma (Carl, 2003). Ameredes (2009), carried out a research study to find out the distinctive difference between albuterol and Levalbuterol. The objective of this study was to find out whether levalbuterol reduced the costs of treating asthma as compared to albuterol and to find out the various ways that levalbuterol and albuterol were different. He used a correlational research design that brought forward thirty seven patients who were diagnosed with acute asthma. The patients in his sample were children between the ages of 6-18. The results of this study indicate that Levalbuterols potency is 2-fold than racemic albuterol and 90 to 100 fold more than S- albuterol. Ameredes (2009) suggests that there have been highly heterogenous results from various studies that compare the clear differences between albuterol and levalbuterol. In one study, levalbuterol was more effective in suppressing bronchospasm than (R) albuterol and (S) albuterol. However, subsequent research studies revealed that there are equivalences between albuterol and levalbuterol. Some indicated that the effect of 1.25 mg levalbuterol was similar to that of 2.5 mg racemic albuterol, with (S) albuterol showing little measurable effect. The above studies were shot-term, and thus a short-time approach would be used to evaluate the two drugs. This approach, however, did not measure the difference that existed between albuterol and its isomers, if used chronically. Nelson (1998), conducted a clinical trial that would compare albuterol to levalbuterol. The study was based on both children and adults that were diagnosed with acute asthma in the United States. In his study, the patients were selected randomly and assigned levalbuterol or racemic albuterol. This trial was aimed at checking the equivalences of equal amounts of the two drugs. The study was correlational and involved fifteen patients from a local hospital. The study resulted in greater improvements in force expiratory volume in one second in the levalbuterol group as compared to the dose-equivalent of racemic albuterol group. This implied that an equimolar dose of levalbuterol produced better results than albuterol. The dose that produced numerically equivalent bronchodilation as recemic albuterol, 2.5 mg, was 0.63 mg levalbuterol, not 1.25 mg which is the mass equivalent dose. The interpretation of this data shows a particularly damaging effect of S-albuterol (Nelson, 1998). Clinical studies have been carried out in pediatric patients with asthma. According to Gawchik (2007), a randomized placebo-controlled trial was necessary to compare the two drugs. In his study, he discovered that no differences existed in bronchodilation with levalbuterol and albuterol. This was because there was no dose-related correlation in children with moderate asthma. However, the dose-related correlation was found in children with severe asthma. In another study of acutely asthmatic patients between the ages of 6-18 years, there was a conclusion that the more expensive levalbuterol did not reduce the amount of return visits to the hospital for further asthma management as compared to racemic albuterol (PerrinFayolle, 1996). The treatment also did not shorten the length of stay at the emergency department, improve expiratory flow (PEF), neither did it reduce the number of nebulized treatments when compared to racemic albuterol. On the other hand, contrary to this, Gawchik (2007), writes about the new form of albuterol inhalers that are in use in the market since 2009 in a bid to compare albuterol to levalbuterol. He notes that due to the recent changes, the new form is adjusted and better in terms of the security of use due to the fact that they are both human and environmentally friendly. The chloroflouroalkane found in rescue inhalers both in levalbuterol and albuterol have been found to harm the environment. Therefore, the inclusion of hydroflouroalkane has been important as a propellant. This is actually a positive step in the study of the effects of the two types of drugs. Ozminkowski Wang (2007), conducted another age-stratified randomized study with hospital admission rate of the patients presented to the emergency department as the outcome. The study was aimed at finding out the frequency of admission of patients to the emergency section and the return rate after discharge. The objectives of this study were to find out the patient-return rate after treatment in the emergency section and find out the role played by levalbuterol in assisting the quick recovery of patients in the emergency section. The admission rate was lower in the levalbuterol group as compared to the albuterol group (Ozminkowski Wang, 2007). The risk of the admitted group was greater in the albutrerol groups than the levalbuterol group. However, the length of hospital stay in the levalbuterol group was not significantly shorter than the albuterol group and there were no adverse effects in both groups. In this study, the conclusion was that substituting the administration of albuterol with levalbuterol would reduce the number of hospitalizations (Carl et al., 2003). This was supported by another study by Nowark et. al. that showed that levalbutereol was preferrable to albuterol in the treatment of acute asthma. Administration of the same dose showed that improvement was greater in levalbuterol as compared to racemic albuterol. The study also indicated that patients with higher plasma levels of (S) albuterol show slower improvement and have a higher likelihood of hospital admission In the same research, the investigator notes several factors. First and foremost, he acknowlegdes the fact that abuterol is the most commonly prescribed inhaler with beta-2 agonist. In addition, he notes that it is also considered the best drug when it comes to reversal of acute bronchospasm. Due to the equal mixture of (S) and (R)-albuterols, there is little effect of broncholdilating activities. On the contrary, the (R)- albuterol has a better binding effect to beta-2 receptors as compared to the (S)-albuterol (Tripp, 2008). According to the investigator, the creation of levalbuterol was needed for several reasons including fewer incidences of transcient tachycardia; the chance of better tolerability as compared to albuterol; and a higher efficacy than albuterol. A further examination of the research, showed that patients benefit more from levalbuterol. Additionally, the outcomes of the study revealed that levalbuterol was better than albuterol in a sense that patients treated with levalbuterol required less medication after recovery and that they had shorter lengths of hospital stay. A regression analysis revealed that levalbuterol was allied with duration of stay savings. Another study conducted by Truitt, Witko, Halpern (2003), showed similar improvements in FEV and mean heart rate decreased with levalbuterol. This study that was carried out in comparison to albuterol. However, the researchers note that the magnitude of the difference is minute. Therefore, it is important to study these differences together in order to detrmine the most reliable results. Nonetheless, the investigators note that results may be helpful to patients who are affected with arrhythmias, cardiac conditions and structural heart diseases. This is because if the differences are not considered, it may worsen the heart condition. Therefore, the investigators note that the transcient tachycardia that is evident in cardiac patients may be a key indicator of the dose dependancy that is formed with time by patients who use levalbuterol and albuterol (Truit, Witko Halpern, 2003). In another study, Nowak (2008) and his colleagues compared the effects that are brought forth by nebulized levalbuterol. This was in comparison to the ones that are brought forth by racemic albuterol. The subjects were 627 adults who suffered from acute asthma. The subjects were radnomly given the opportunity to use either 1.25 mg of levalbuterol or 2.5 mg of albuterol. This was after twenty minutes of emergency admission and 40 minutes later all the patients received 40 mg of prednisone. The level of expiratory volume was forcefully increased by 40 percent when the patients were administered with levalbuterol, this is in comparison to racemic albuterol. The investigators also discovered that this coresponded to a fourty percent reduction in the subjects who required hospitalization (Nowak, 2008). The effects of levalbuterol were evident in patients who had severe asthma. The high levels of (S)-albuterol in the circulating plasma are thought to be the main cause of overuse of racemic albuterol. The number of relapses in the two groups after a period of thirty days, however, did not differ. In another randomized clinical trial, Carl et al. compared the use levalbuterol with racemic albuterol in over 500 pediatric patients reporting to a hospitals ED. Hospital admission rates were reduced among those receiving levalbuterol in comparison with those receiving racemic albuterol treatments. The study was also seeking to establish the hospital conversion where levalbuterol racemic albuterol was replaced with levalbuterol 1.25 mg every 8 hours or levalbuterol 0.63 mg every 6 hours. Despite that the frequency of levalbuterol was less, the patients required fewer rescue treatments to reduce the symptoms than did those treated with racemmic albuterol. This means that the less frequently scheduled treatments with levalbuterol will lead to reduced workload and reduced number of missed treatments because of unavailability of therapists. This is also supported by Truit et al, who reported that treatment with levalbuterol required one day less of admission, significantly fewer treatments and a 67 % decrease in readmissions within 30 days of discharge after treatment with the 2-agonist compared with racemic albuterol. Other studies reported similar results, indicating that treatment with levalbuterol reported decreased numbers of daily treatments, reductions of staffing and fewer as-needed treatments when compared to racemic albuterol as the acting 2-agonist. Nowak (2008) conducted another study of patients who suffered from acute asthma and another group suffering from chronic obstructive pulmonary disease (COPD). There was a comparison of treatment of levalbuterol and albuterol that were administred in a period of 6 to 8 hours in 1.25 and 2.5 miligrams repectively. There were fewer nebulizations that were requiredwhen it came to the case of levalbuterol. On the other hand, there was an increased need for rescue aerosols in the period of 14 days hospitalization. However, most of the other outcomes were similar in the two groups. This is including the costs and study of the pulmonary functions. In the study by Truitt et. al. (2003), the retrospective chart review on hospitalized patients who had asthma and COPD showed that the results were more or less the same. This therefore led to the conclusion that the benefit of levalbuterol over albuterol is usually greatest in patients who have moderate as compared to severe asthma, particularly t hose with an overuse of albuterol. Side Effects Vitro and animal studies have shown significant outcomes that can be used as a basis of comparison. Many research studies reveal that albuterol is associated with severe effects that raise concerns, such as chest pain and high blood pressure. This could be because of the fact that inhalation of racemic albuterol leads to pushiness in circulating S-albuterol twelve times more than levalbuterol (Ameredes, 2009). Levalbuterol has been acclaimed to be a safer form of albuterol but it comes at increased costs. It costs five times more than racemic albuterol. According to Gawchick (2007), albuterol is purely used for the treatment of symptoms that are occasional but an overdose of the drug can be fatal. One of the precautionary measures that should be taken when using albuterol is that the use should be discontinued in cases of adverse side effects, including hypersensitivity; abnormal heart rhythms; diabetes; epilepsy this is coupled with seizure disorder; and heart diseases. The researcher also notes wheezing, pounding heart, tight chest, nervousness, blood pressure, and chest pains side effect may be a sign of hypersensitvity. Evidence from preclinical and clinical studies suggest that the worsening of asthma symptoms in some patients with continued use of albuterol or its overuse could be contributed by the racemic mixtures of albuterol isomers, which may result from the presence of the (S)-albuterol. The slow phamarcokinetic profile is one significant characteristic of (S)-albuterol. It is metabolized 12 times slower than levalbuterol. This is because it does not have sulfation and elimination enzymes preferrentially specific to levalbuterol. This leads to the differences in circulating levels of the isomers after administration of racemic albuterol. After administering a dose of inhalable racemic albuterol, it has been shown that the circulating levels of levalbuterol are undetectable wheras the levels of (S)-albuterol persisit for as long as 12 hours and may be preferentially retained in the lungs (PerrinFayolle, 1996). Therefore, it is important to consider the physiologic and pharmacologic effects of each isomer within the racemate mixture separately. According to Truit, Witko Halpern (2003), the issue of tolerance is still a bit controversial. There are some researchers that have noted that the overuse of racemic albuterol may lead to some factors that include hypokalemia and even increased mortality. Therefore, due to the lack of bronchodilator activities in (S)-albuterol, there may arise the situation of worsening air activity or rather pro-inflammatory effects. This is because it is metabolized 10-fold slower than levalbuterol (Truit, Witko Halpern, 2003). This could additionally result in the accumulation of (S)-isomer over (R)-albuterol leading to paradoxic bronchospasm. In addition, patients who suffer from asthma or COPD and other cardiac diseases have a likelihood of worsening the situation when they experience tachycardia and this therefore means that they are safer when using levalbuterol as compared to albuterol (Lovtall, Palmqvist, Maloney, Vantresca and Ward 2004). Studies have also discovered poor adherence to med ication by patients who suffer from tachycardia The other main factor that was noted when comparing the two agents is cost. Before the year 2009, the metered-dose inhaler (MDI) that had generic formulations was widely available. There were also versions of albuterol that were much cheaper. They included proventil and ventolin. This fact also applied to levalbuterol. On the contrary, many of the MDI formulations contained a lot of chloroflourocarbon and therefore, this meant that they had to be banned by the FDA (Food and Drug Administration). This was particularly due to environmental reasons. Therefore, the unavailabilty of the MDI has led to the leveling in price of the two agents (Truitt et. al., 2003). However, there are variations in the cost of levalbuterol nebulization as compared to albuterol nebulization. The use of levalbuterol faces various limitations including higher costs, small sample size in terms of testing, inadequate manpower and lack of support by many researchers This however, does not mean that albuterol should be preffered over levalbuterol since there are instances when levalbuteral tends to be widely accepted. First and foremost, there is a need by patients who have severe chronic asthma to get the doses of beta-2 agonist. This happens in spite of the use of controller therapies. A study by Tripp (2008) showed that levalbuterol resulted in Forced Expiratory Values (FEV) that were equivalent to or better than those that were observable in albuterol. The -mediated effects were lower for a single dose of levalbuterol as compared to racemic albuterol. In this studies, treatment of asthma using levalbuterol was cheaper due to the little numbers of hospital admissions (Tripp, 2008). In this particular study, levalbuterol treatment in the emergency department was cost effective because it led to a situation of patients recovering faster and thus reducing the cost of healthcare. Although the (R) -albuterol and (S) albuterol isomers are similar in their molecular weight and their physiochemical properties, their 3-dimensional structure makes them super imposable. This conformational stereochemistry makes their properties distinct and for each isomer which results to them being considered different compounds (Nelson, 1998) As a result, regulatory authorities have demanded that the potential risks associated with the mixtures that make up racemic albuterol be quantified. Levalbuterol was developed to minimize the side effects associated with (S)-albuterol and maximize therapeutic effects. The findings of this study demonstrate that the use of levalbuterol significantly reduces hospital admission rates in patients presenting to the ED with acute asthma when compared to racemic albuterol. The study suggests that levalbuterol has clinical benefits over racemic albuterol in critical care settings, and these benefits are evident in both pediatric and adult patients administered with levalbuterol. The above studies were conducted in geographically distinct ED settings, with varying patient populations, physicians, and socioeconomic conditions demonstrating that substituting racemic albuterol with levalbuterol improves patient outcomes by reducing hospital admissions. Different studies have suggested that levalbuterol produces greater bronchodilation than racemic albuterol and improves discharge rates and health resource use (Ozminkowski Wang 2007). A post-hoc analysis on the patients found that their (S)-albuterol plasma levels negatively impacted their baseline forced expiratory volume in 1 second as well as pulmonary function an hour after ED treatment was commenced. Despite the higher cost of levalbuterol in the treatment of asthma, when the total costs are considered, the differences in the costs are insignificant. The overall costs were similar in the levalbuterol group and the racemic albuterol group. The cost reductions were reported with increasing severity of asthma. This results from reduced hospital admissions and less frequent dosing, making the treatment more cost effective despite its high cost (Nowak, 2006) The clinical and preclinical benefits of levalbuterol observed in the literature cited in this investigation occur due to the difference between the two agents which is the presence of (S)-isomer in the racemic mixture. Despite previous studies suggesting that it is inert, the (S) isomer may instead have some proinflammatory effects. The bronchoprotective efficacy of racemic albuterol progressively declines with regular use, leading to reduced interval between dose and decreased bronchodilation (Nelson, 1998). The above findings indicate that levalbuterol, when used in place of albuterol reduces the number of hospital admissions, and is cost effective in the treatment of acute asthma in the ED setting. This makes the observations provocative and interesting since the only difference between the two agents is the presence of the (S)-isomer in the racemic mixture. The mainstay of therapy for reactive airway diseases has been rapid-onset 2-agonist agents such as racemic albuterol. However, the recent isolation of (R)-isomer levalbuterol has provided a new option for the treatment of asthma and COPD. The use of levalbuterol therapy produces both clinical and economical advantages when compared to albuterol therapy. Buy custom Albuterol in Asthma essay

Background and Management at Palmas Bank

The local currency in this chapter explains the background and management of Palmas Bank. The Palmas Bank is located in the outskirts of Fortaleza in the northeastern part of Brazil. As an example of developed countries, there are Community Banks and Community Organizations in Ceala, the capital of Fortaleza. The local currency of the Palmas Bank contributes to the residents of the poor and the regional economy, creating a sense of unity in the use and investment of alternative funds between residents and regional companies. The history of Palmas community organization and facilities has enabled local residents to establish living and living resources for community organizations and facilities. The most powerful point of Covesting is its team with a very economic background in the areas of investment banking, trading, and private management. Covesting team is headed by founder and CEO Dmitrij Pruglo. Dmitrij is a financial and investment banking expert (former Saks Bank manager) with more than 12 years experience in the field of foreign exchange trading, stock markets and derivatives. Chief Operating Officer and Co-Founder Tim Voronin is an experienced stock and derivatives trader. Tim started trading career as a prop trader of Argo Traders in 2008. There, as one of the most unstable times in the history of the market, we traded with the London Stock Exchange on XETRA. Another co-founder of this project is Dinis Guarda. This is one of the most influential 20 people in financial technology and block chains (Richtopia). His role at Covesting is to support the Board of Directors in establishing industry leading transactions and P2P asset management platforms in the field of encryption. Giovanni's career is traditional financial and international business, banking risk and trading system. He is a member of Hedge's co-founding team and is an external consultant of Adbank and Lucyd. His skills range from symbolic, conceptual, implementation, networking and business d evelopment to commercialization and monetization of conceptual and financial technology related products. Giovanni graduated from the top 100 business school of the University of Western Australia and has a business degree in international business, banking and economics. He also got bank risk certification and applied agile work methods. He is the value chain of Block Chain Technology Communicator and its value-added use case. Oh, of course! I am a financial, business development and marketing consultant with a background in technology, design, business, and banking. I have a masters degree in business administration from St. Andrews University and a bachelor's degree in computer science from Newcastle University. Last year I participated in several ICOs. UTRUST, Opu, Safein - I am crazy! I have experience in marketing, management and consulting of other projects so I think I can bring some useful insights into the TV-TWO table.

SUNY Empire State College Case Study Example | Topics and Well Written Essays - 2000 words

SUNY Empire State College - Case Study Example According to the law in Texas, in order to establish an insanity defence, the accused should show that they could not differentiate between bad and good while committing the crime. Did the State prove their case? This case provides explanation with regard to the psychological research in the court’s ruling and supports the court ruling in accordance to the evidence of the psychological research. This paper will show the positive and negative sides of the use of psychological research and testimony within the case of Texas vs Andrea Yates. In the Texas vs. Andrea Yates case, some material and key issues surfaced within the management of the case. The performance of mental illness to the juries or judges, along with, information & evaluation of the impact of mental illness as it relates to criminal conduct and responsibility (Wang, Chen, Chin & Lee, 2005). There are contemporary concerns on the potential impact of mental illnesses within the fairness of the court procedures in c apital cases. Additionally, the American Psychological Association indicates that severe mental disorders can significantly reduce a person’s capacities to reason rationally and to suppress conduct that violates the law. The American Psychological Association strongly supports the insanity defence because it offers the criminal justice system a method for recognizing unfair penalty to the mentally ill person. We should not assume that the defendant Andrea is evil. The National Alliance for the "mentally ill" is a grassroots advocacy organization for citizens with severe mental illnesses. Today there is psychosocial treatment, medications, and support that work to improve the most intense symptoms of these illnesses. Did Dr. Dietz decide to ignore various symptoms pointing to the appellant's continued use of medication? It is believed by many that, he should have been more thorough in his detail of her medical follow up. Considering the appellant, there was a time when her men tal status appeared unstable and in need of the necessary medical and/or therapeutic interventions to reduce her depression. The court provided information regarding Andrea’s suffering from mental illness and that she had wanted to commit suicide (Godfrey, 2005). On June 18, 1999, the appellant suffered severe depression, which led her to trying to commit suicide through an overdose. The appellant’s mother, while at the appellant’s home noticed that Andrea Yates was almost catatonic, slow to respond to dialogue or no response at all. Some of the factors noted that led to the Andrea Yate’s decline were five pregnancies, home schooling her children, and living in a bus. Dr. Dietz should have noticed that the appellant was not taking her medicines and testified with a lack of support to the medical advice suggested. Mrs. Yates began to withdraw, was not eating well, and had trouble sleeping and established thoughts of being a terrible mother. Dr. Dietz had n o knowledge of post-partum disorders. He stopped treating patients in 1981 or 1982 with post-partum depression. He testified that Andrea Yates was sane. She knew she had done something wrong and expressed that â€Å"it was the work of the devil†. He told the jurors that she did not have hallucinations but that her mother indicated that she had observed them (Wang, Chen, Chin & Lee, 2005). Andrea Yates had a history of mental illness that included hospitalization and medication. This led to her admission under suicide watch. April 13, 2001, she began an outpatient program at Devereux and May 4, 2001 was readmitted to Devereux and discharged on May 14, 2001. She was prescribed Haldol medication. The degree of stress does not change. What transforms is the ways in

The aftermath of earthquakes in Haiti, like the hurricane in New Essay

The aftermath of earthquakes in Haiti, like the hurricane in New Orleans a few years ago, reveals both humanitarian aid and looting and violence - Essay Example The aftermath of earthquakes in Haiti has much to do with the prevailing conditions there, before the earthquake. The effectiveness of the relief operations depends upon not only with the organizations involved in relief work, , but also with the adaptability of the people to make the best use of the relief supplies. What are the ground realities in Haiti? Joseph Francis Bentivegna writes, â€Å" Institutional corruption siphons off foreign aid, so the needy are never helped. High export taxes discourage peasants from growing popular crops while politically influential families make huge profits because they are exempt from paying taxes.† (Introduction....) This being the mentality of the ruling class(bureaucrats and politicians) the chances of people getting a fair share of the relief materials are dim. The after-effects of the magnitude 7.00 earthquake are staggering. The damage is massive. Logistical challenges hamper the relief efforts. Rescue teams from all over the world have arrived and co-coordinating their work is itself a gigantic task. According to Red Cross estimates, 50,000 deaths have occurred and morgues have no place for the bodies. Bodies are strewn in the streets like rotten vegetables. Utter confusion prevails. Day by day, the situation is going from bad to worse. Food is in short supply, security is sparse, medical supplies are in great demand

Classic airline and marketing Essay Example | Topics and Well Written Essays - 500 words - 1

Classic airline and marketing - Essay Example After insignificant loss in this sector, many of the airline companies utilized this chance and have emerged as the top players in the airline business. The financial crisis also contributed to aggravate the situation and paved the way for the decline of this airline company. However, they have recorded earnings of over eight billion dollars and this has given scope for revival. These profits are not insignificant if one considers the crunch in travel sector due to global financial crisis. But, problems including the failure in the marketing have again caused this airline to show poor performance. They found a decrease of 10% relating to the shareholders. Again, due to the global economic crisis, the board of directors of Classic Airlines has been forced to decrease the rates by 15%. They has also been a little hesitant to improve their marketing technologies. These made them to pay badly and struggled to withstand in the current competition. The company has also failed to provide su itable offers to attract customers to their services. Most of the other companies came up with numerous offers on hands to attract new customers and retain the old ones. Thus, the previous loyal customers and some of the frequent flyers started to migrate to other airlines that offered them higher value in their services and are also ready to travel for low prices. When Classic Airlines has sensed this idea, they were not able to implement a marketing plan to retain their loyal customers because of the rate problems. They were not able to run their operation on a cost that the other companies offer. Thus, the marketing tactics to retain the reputation of the company among the passengers did not bear any fruits. Currently, Classic Airlines are not able to find an alternative to escape from their dilemma. They are not ready to reduce the cost from what they have decided in their budget. They are now trying to

Evaluation of dietary advice given to patients receiving external beam Essay

Evaluation of dietary advice given to patients receiving external beam radiotherapy to the prostate with recommendations to curr - Essay Example However, due to inadequate instructions and disagreements to such treatment and dose instructions, conflicting results have been obtained in relation to the appropriate practices for prostate cancer patients and their diet, bladder, and rectal volumes. Comparison between previous studies and application of findings into standard clinical practice have become a challenge that should be effectively addressed to ensure optimal health among prostate cancer patients who have been undergoing radiation therapy (Smitsman et al. 2008). Treatment for prostate cancer requires patients to obtain adequate nutrition through a well-balanced diet, although greater difficulty can be experienced due to the fact that the body is exerting effort in fighting the cancer. Moreover, it is also working ultimately for the repair of healthy cells which radiation therapy may have damaged. At the same time, radiation therapy can bring about adverse side effects which considerably reduce the patient’s stre ngth and debilitate his appetite. As radiation therapy damages the healthy cells in one’s body along with the prostate cancer cells, this can cause irritation to the intestines. The intestines play a fundamental role in the intake of food and fluids into the body; thus, the irritation that can be experienced by the intestines due to radiation therapy will reduce its ability to process food and water, causing abdominal pain as well (Heemsbergen, Hoogeman, and Witte 2007). Intestinal irritation can be experienced during and after the radiation therapy with which its adverse side effects can be experienced for an estimate of 6 to 18 months after the duration of the therapy. As such, being provided with the most effective and suitable dietary advice is of paramount importance. On the whole, an increase in vegetable, fruit, and healthy grain intake has been suggested along with the reduction or complete avoidance of fatty foods, dairy products, high levels of sugar intake, and har mful beverages (Chan, Ghan, and Giovannucci 2005). Aside from dietary changes, certain medications are also provided to prostate cancer patients to alleviate the intestinal irritation symptoms attributed to radiation treatment, including loose bowel movements, nausea, vomiting, and abdominal cramps. An enzyme in the body that is significantly affected by radiation therapy is lactose, which assists the body in digesting milk and other dairy products (Agarwal et al. 2008). Doctors or registered dietitians tend to recommend a diet that is low in lactose intake after the patient has undergone radiation treatment as it makes lactose difficult to be digested for a period of time. Compared to while milk, fermented milk products, such as yogurt and sour cream, can be more easily digested by cancer patients; cheese, puddings, ice cream, and other food products that contain high levels of lactose should be avoided. Because commercial foods can be incorporated with lactose, such as instant cof fee, it is important that food labels are carefully checked. Foods that contain high levels of fiber, including whole grain and bran products, should be avoided as well as these can accelerate the digestion process and exacerbate bowel movements. A low-fiber diet can, thus, help in the

Analyze a news paper Essay Example | Topics and Well Written Essays - 750 words

Analyze a news paper - Essay Example t consider the nature of the audience by asking who the articles are targeted for, what type of information are they offering based on the types of language being used. By examining an issue of a newspaper such as The Chronicle for evidence of the process, the motive and the audience, one can get a better idea of the newspaper’s quality. The process of a newspaper refers to the types of information the issue contains and what this reveals about the paper’s persuasion. A look through the titles of the articles suggests the paper carries a pro-institution persuasion as the main thrust of the issue explores the concept of for-profit college systems as the new wave for the future. Information offered in the most current issue of the newspaper includes titles such as â€Å"For-Profit Colleges Change Higher Education’s Landscape†, â€Å"Private Giving to Colleges Dropped Sharply in 2009†, â€Å"In a Booming California Suburb, Fertile Ground for For-Profit Colleges† and â€Å"In Cutting Programs, Universities Try to Swing the Ax Gently.† In these titles, there is enthusiasm for the for-profit concept and discouraging news for the non-profit sector. The Chronicle of Higher Education makes no attempt to disguise its affiliation with the institutions, however, so this persuasion is no t surprising. In the case of the article about cutting programs, for example, a great deal of information is provided regarding the extreme difficulties college boards are having in trying to tighten the budget while retaining as many programs as possible. This begins to introduce the question of the motive. Why would a newspaper have such a persuasion in their reporting? What are they hoping to achieve in reporting on these issues? Because the newspaper is strongly affiliated with the higher education institutions, it stands to reason that they would take a stance strongly supportive of the institutional viewpoint. Sympathetic to the difficulties being experienced by universities

Classic airline and marketing Essay Example | Topics and Well Written Essays - 500 words - 1

Classic airline and marketing - Essay Example After insignificant loss in this sector, many of the airline companies utilized this chance and have emerged as the top players in the airline business. The financial crisis also contributed to aggravate the situation and paved the way for the decline of this airline company. However, they have recorded earnings of over eight billion dollars and this has given scope for revival. These profits are not insignificant if one considers the crunch in travel sector due to global financial crisis. But, problems including the failure in the marketing have again caused this airline to show poor performance. They found a decrease of 10% relating to the shareholders. Again, due to the global economic crisis, the board of directors of Classic Airlines has been forced to decrease the rates by 15%. They has also been a little hesitant to improve their marketing technologies. These made them to pay badly and struggled to withstand in the current competition. The company has also failed to provide su itable offers to attract customers to their services. Most of the other companies came up with numerous offers on hands to attract new customers and retain the old ones. Thus, the previous loyal customers and some of the frequent flyers started to migrate to other airlines that offered them higher value in their services and are also ready to travel for low prices. When Classic Airlines has sensed this idea, they were not able to implement a marketing plan to retain their loyal customers because of the rate problems. They were not able to run their operation on a cost that the other companies offer. Thus, the marketing tactics to retain the reputation of the company among the passengers did not bear any fruits. Currently, Classic Airlines are not able to find an alternative to escape from their dilemma. They are not ready to reduce the cost from what they have decided in their budget. They are now trying to

Analyze a news paper Essay Example | Topics and Well Written Essays - 750 words

Analyze a news paper - Essay Example t consider the nature of the audience by asking who the articles are targeted for, what type of information are they offering based on the types of language being used. By examining an issue of a newspaper such as The Chronicle for evidence of the process, the motive and the audience, one can get a better idea of the newspaper’s quality. The process of a newspaper refers to the types of information the issue contains and what this reveals about the paper’s persuasion. A look through the titles of the articles suggests the paper carries a pro-institution persuasion as the main thrust of the issue explores the concept of for-profit college systems as the new wave for the future. Information offered in the most current issue of the newspaper includes titles such as â€Å"For-Profit Colleges Change Higher Education’s Landscape†, â€Å"Private Giving to Colleges Dropped Sharply in 2009†, â€Å"In a Booming California Suburb, Fertile Ground for For-Profit Colleges† and â€Å"In Cutting Programs, Universities Try to Swing the Ax Gently.† In these titles, there is enthusiasm for the for-profit concept and discouraging news for the non-profit sector. The Chronicle of Higher Education makes no attempt to disguise its affiliation with the institutions, however, so this persuasion is no t surprising. In the case of the article about cutting programs, for example, a great deal of information is provided regarding the extreme difficulties college boards are having in trying to tighten the budget while retaining as many programs as possible. This begins to introduce the question of the motive. Why would a newspaper have such a persuasion in their reporting? What are they hoping to achieve in reporting on these issues? Because the newspaper is strongly affiliated with the higher education institutions, it stands to reason that they would take a stance strongly supportive of the institutional viewpoint. Sympathetic to the difficulties being experienced by universities

A comparison of the women in the Hardy Tales Essay Example for Free

A comparison of the women in the Hardy Tales Essay Rhoda in the tale The Withered Arm and Phyllis in the story The Melancholy Hussar of the German Legion are both very lonely women. Both of these women and have been mistreated by men, but none of them ever speak out for themselves to tell the men that their behaviour is unacceptable. Women who were treated by men were just expected by their fathers (if the husband is rich) to just keep quiet and be happy that they are financially supported. Rhoda is a social reject. She has been isolated to a small, dilapidated cottage in the middle of a lonely field. Rhoda is of the poor working class. She has received no education and is illiterate. Her son wears worn out shoes that rub his feet. Farmer Lodge, the sons biological father takes no responsibility for his son and does not support Rhoda financially. This shows that Farmer Lodge is irresponsible and dismisses his responsibilities. When the story is told Rhoda is thirty to forty years of age, thin from starvation, dark eyed, poor and a single mother. She is a milkmaid and earns very little, no where near enough to feed her and her son properly. Rhoda was once very pretty and was in a relationship with Farmer Lodge. Farmer Lodge is a very shallow fickle man who is only attracted to the looks of a woman rather than her personality. Unfortunately, because he is rich many women fall for him although he never truly loves them. When Farmer Lodges new wife arrives Rhoda is very bitter about her and strives to find a way in which she is better than Farmer Lodges new wife, Gertrude. Although Rhoda seems like quite an independent character that fends for herself, she has been mistreated by Farmer Lodge for quite sometime. Another woman who is severely mistreated by men is Phyllis in the tale The Melancholy Hussar of the German Legion. Phyllis is mistreated by her father who grows selfish and withdraws her from the town where she was happy with her friends. When Rhoda visits conjuror Trendle she sees that is was herself who caused the abrasion on Gertrudes arm she feels quite guilty. She would not care if it were someone else who caused it, but she feels bad because Rhoda knows it was her. At the end of the story, Rhoda has gained nothing and lost everything. Her son who she greatly loved and was the nest thing in her life has been hanged for arson. At this time hanging for arson was common. Rhodas son was made an example of for other arsonists. I blame Rhoda for her situation because it was social suicide for Farmer Lodge to be in a relationship with a poor milkmaid let alone have a child together. Rhoda must have known this. If Rhoda had never have started a relationship with Farmer Lodge none of the following events would have occurred. It may have just been a coincidence that Gertrudes arm became deformed, but it drove Gertrude mad and eventually ended up killing her.

Positive Working Environments for Children

Positive Working Environments for Children Introduction â€Å"To be included is to experience belonging.† Lancashire County Council (2010) The aim of this assignment is to explain and examine how the staff within a setting ensures a positive working environment for the child. The practitioner will demonstrate an up to date and working knowledge of principles, policies and practices of inclusion. The practitioner will also discuss how parents and multi-agency team’s maybe involved in meeting the particular learning needs and care needs of a child through the implementation of a case study. And also review how new legislation such as Marriage (Same Sex Couples) Act 2013 and The Children and Families Act 2014 have resulted from the term ‘inclusion’. According to Lancashire County Council (2010), children are included when they attend a mainstream setting and have complete access to its social and academic life. In becoming more inclusive, schools should meet a greater diversity of needs. Some children may have an identified Special Educational Needs (SEN), whilst others maybe gifted, a child who has English as an additional language or a child with behavioural difficulties. All these children will experience barriers when it comes to learning; therefore we describe such children as having additional needs. All settings should make arrangements to meet the individual needs of all their children, before considering whether some children need arrangements that are additional to or different from their usual practice. All settings should be following good practice guidelines and be providing a differentiated approach for all children. â€Å"Differentiation â€Å"means altering and adapting the way activities are presented to children to enable them to access them and make progress. Settings should offer a range of resources to match different levels of ability, use staff flexibility to give children one to one or small group activities or individual attention and ensure that members of staff has time to plan and prepare activities. Staff should also look at how their setting is organised, are children expected to sit and listen for longer than is appropriate for their age and stage of development? Do children know the structure of the session? , does the setting have clearly defined area s for activities? All these issues can be addressed by adding visual cues for the defined areas and structure of the session. this can make such a difference to the children with speech and language development and for children with English as an additional language as these visual prompts will help the child to learn what is coming next and what is happening in that specific area. â€Å"Every child deserves the best possible start in life, and support to fulfil their potential† DFES (2008) According to the DFES (2008) a child’s experience in the early years has a major impact on their future life chances. Practitioners should focus on each child’s individual learning. All Early years providers must have and implement an effective policy for ensuring equality of opportunities and for supporting children with additional needs, learning difficulties and disabilities. Working effectively in partnership with parents is a crucial part of the early years work. Parents frequently feel that their parenting skills will be judged according to how their child is getting on. Even the most confident and assertive parents can feel very vulnerable and ignorant when it comes to inclusion. â€Å"Parents are the children’s first and most enduring educators. When parents and practitioners work together in early year’s settings, the results have positive impact on the child’s development and learning. Therefore, each setting should seek to develop an effective partnership with parents.† (QCA 2000 page 19) When a parent is told that their child might have an additional need the parents might endure a number of feelings for example, guilt – what have they done wrong? Denial- his brother was just the same and he’s fine now, Anger- who do they think they are giving me this information? Worry- I don’t want my child being treated differently from any other children. Recognizing and accepting that their child is experiencing difficulties can take time but as a practitioner it is important to support this process by taking the time and effort to build up a good relationship with the parents, have an honest and open approach, avoid using language that the parent might not understand or find distressing. It is important to remember that a parent has a lot of valuable information about a child and as a practitioner there aim should be to build a trusting relationship with the parent/carer and to keep the parent fully informed and included in any processes following the initi al discussion. In March 2011, the government published the SEN and disability green paper which proposed a new approach to special educational needs and disability .they intended to develop a radically different system that will support better life outcomes for young people. Any legislation changes were to be taken forward from May 2012. The green paper offered a visual representation of the main themes of the recommendations put forward by the government in the form of a ‘word cloud’.in the illustration below, the larger the word ,the more heavily it featured in the green paper. Although the modern SEN started in the early 1980s, the current framework emerged in the 1990s with the education act 1993/1996 and the issue of the SEN code of practise (as revised in 2001). The code of practice as become the bible of SEN for anyone involved for anyone involved with children with an SEN. The new SEN code of practice 0-25 years (2014) has evolved from many criticisms of the older publications. Parliaments own education and skills committee said in 2006 that the system was â€Å"not fit for purpose†, and many people felt that getting children and young people the correct provision had become a â€Å"fight† between parents and the local authorities, with schools and nurseries often caught in the middle. Parents also perceived that local authorities had a conflict of interest as they both assessed need and made provision. There was also a criticism of the SEN system and particularly of statements in an Ofsted report in 2010 entitled a† a statement is not enough† Five separate inquiries conducted about SEN/disability issued between 2006 and 2010 made other criticisms. After a change of government in 2010 a call for views of the SEN Green paper in 2011 promised the biggest reform in SEN in 30 years. A subsequent SEN Green paper has become The Children and Families Act 2014 and a completely new SEN code of practice has now been issued coming into law in September 2014. Main body Child A is 35 months old; he lives with his mum and dad and is an only child. His mum and dad both work full time so child A spends a lot of time with his grandparents. He lives on a local council estate 3 miles away from the setting and this is his first setting that he has attended which he started in September 2014.Child A has an identified speech and language difficulty which has been identified through observations and assessments by the practitioner and the settings SENCO. The child’s parents have also identified the speech and language difficulty and have a scheduled meeting with the settings SENCO. DFES (2008) suggests that the development and use of speech, language and communication are very imperative in young children’s learning. Much teaching is delivered verbally; and children need good communication skills to make friends. Children’s future achievements are reliant on their capability to communicate effectively. It is essential for us, practitioners to ensure that we do everything we can to support child A in becoming a skilful and capable communicator. As well as making use of spoken language effective communication is also non-verbal. Eye contact, body posture, gesture, facial expressions displaying interest/surprise/boredom can be just as expressive as words. If children arrive in the classroom without the ability to communicate effectively, then they will be disadvantaged from the outset. A number of reasons are given for the decline in early communication skills, forward facing buggies may hinder a childs speech development as it is difficult to push and talk to a child whilst the child is facing away from you , it is impossible to have any eye contact and engage in running commentary of sights, sounds and smells. New technology is also another factor in a child’s speech delay, mobile phones and listening to music with headphones isolate a parent in their own world , leaving a child to become isolated in theirs..Tallent et al(2011). It is my job as child A’s key person is to identify these key issues and educate the child and the parents on opportunities for communication .ways in which I can do this is describe the stage child A’s speech and language and communication development has reached, track their progress (as shown in appendices 1) and identify issues as they arise. I encourage and interact with child A and also plan and implement activities that meet the level of his language development (as shown in appendices 2). I have the responsibility as child A’s key person to provide additional support for child A and to give the child my full attention when child A is talking and to ask open ended questions to encourage the child’s speech development. Skinner the behaviourist therapist suggested that children learn language through reinforcement. In other words, when we show enthusiasm for something that the child is trying to say, this should encourage child A to repeat the utteran ce. It is also essential that i provide the correct support for the child by adapting activities such as adding visual aids, adding visual aids around the room in the defined areas and offering the child visual aids in form of choices, and provide the child with prompts to indicate a response or request. This will help the child communicate effectively and give the child the same opportunities. I identified that child A had a speech and language difficulty whilst tracking his progress child A was at the developmental age of 16-26 months I observed and assessed the child over the next few months in accordance with the graduated approach outlined in the SEN code of practice 2014 and when no progress was being made I took the evidence to the settings SENCO as outlined in the graduated approach shown in the illustration below. In my settings inclusion policy reviewed in 2014(as shown in appendices 3) it states that the setting will encourage children to thrive and to recognise and appreciate their differences and so fulfil their unique potential. It also states that the settings objective is to help parents with children and their families to take part in the nursery and their community and will do this by working with partner agencies and the local community to eliminate the causes of social inclusion and make our services available to all. This includes facilitating, assisting, supporting and valuing each child in pursuit of this aim. As a practitioner following the above graduated response will help the child to reach their full potential. And allow the families access to the partner agencies such as a speech and language therapist. According to DFES (2008) parents need to work in partnership with the setting and support their communication within the home, with their family and in the wider world. These situations are very different from those provided by the setting. For that reason I as child A’s key person must work with the parents in partnership. I should plan regular opportunities to discuss child A’s level of development with his parents. Information should be relayed between me and the parents such as rhymes that child A likes in the setting so these can be repeated at home. The settings single equality policy is derived from The Equality Act which first came into force in October 2010. The equality act states that, public organisations including schools have to take action to make things equal for the people who work for them and use their services. This is called the Single Public Sector Equality Duty. My setting is committed to taking positive action based on the equality act and to make sure staffs are aware of the law and how to put it in to practice. My setting has a professional and dedicated, multi skilled, highly qualified and diverse team of staff who have lots of experience of working in a diverse setting within a diverse community. All these professionals such as practitioners, family support , the setting SENCO and other outside professionals such as health visitors and speech and language therapists will work together to ensure that child A will get the support that he needs. This support will come in the form of regular reviews and meetings with the setting SENCO and key person and additional support in the form of family support services and speech and language referrals may also be offered to child A’s parents..