The 10 Best Italian to English Dictionaries of 2019

Playing Video Games Is Not Only For Kids Anymore - 1720 Words

Training up to 50 hours every week with your team in order to make it to the big leagues, competing against other teams for fame, glory, money, and a chance to join one of the professional teams. Does not sound like an especially rare scenario, but what if I told you I was talking about video game players? That is right. Playing video games is not only for kids anymore. During the last decade eSports (professional online gaming) have grown to an unexpected extent. Professional players go through intense non-stop training every week to keep up with other teams. Call of Duty, Dota2, League of Legends, these are only a few examples of the most popular games. Being a professional player is very time consuming and requires a lot of dedication.†¦show more content†¦I have been gaming for years and tried to go professional in more than one occasion. However, I lacked the support to achieve so: my family never saw it as a career path that I could follow in order to have what they co nsidered a successful life, and school was a big impediment that did not provide me with any help either. I know how it feels to try to go professional but not being able to only because I didn’t have the resources to even try. First, let’s talk about how professional gamers spend their day. â€Å"The players on Team Liquid, a professional League of Legends team, practice for a minimum of 40 hours per week and most play the game far more,† (Jacobs) stated Harrison Jacobs in his article â€Å"Here s the insane training schedule of a 20-something professional gamer.† Harrison followed one of the most popular League of Legends teams through 2015’s tournament season. They do not have breaks. Even â€Å"free days† involve playing and discussing strategies. Practicing is a constant effort to avoid falling behind the other teams and master the changes the game offers every couple of weeks. It is not simply playing games, it is about mastering something you love. This requires

Strategic Management Multi Perspective Approach

Question: Discuss about the Strategic Management for Multi Perspective Approach. Answer: Introduction This study deals with analyzing the concept of management accounting in recent era of accounting field (Webster, 2016). In this particular assignment, emphasis has been given on the accounting operations handled by a company named as Parker Limited. In the recent accounting scenario, it has been observed that most of the accounting researchers had differentiated the accounting standards in unique accounting systems based on the use of accounting methods. The current segment elucidates usage of accounting method by applying accounting systems (Senthilkumar, Maruthamuthu and Kannaiah, 2014). This act provides help to the potential users for ascertaining the cost of any given product. This will be even used for making the computation of profits and getting accurate results at the same time. In this study, analysis has been done for the company named as Parker Limited who manufactures as well as sell pen and pencil sets (Kamala et al. 2015). This company received positive feedback from t he customers and decided in selling their products in the foreign markets. The main purpose of the report is bringing out the actual potentially of the offers and plans of Parker Limited. This can be done by calculating cost and profit by way of using cost accounting techniques (Kaplan and Atkinson, 2015). Computation of Current Net Monthly Profit Calculation of Monthly Profit Particulars Unit Cost per Unit Total Amount Monthly Sales Revenue 10000 $7.50 $75,000 Manufacturing Costs: Direct Material 10000 $1.00 $10,000 Direct Labor 10000 $1.20 $12,000 Variable Overhead 10000 $0.80 $8,000 Fixed Overhead 10000 $1.00 $10,000 Total Manufacturing Costs 10000 $4.00 $40,000 Marketing Costs: Variable Marketing Costs 10000 $1.50 $15,000 Fixed Marketing Costs 10000 $1.50 $15,000 Total Marketing Costs 10000 $3.00 $30,000 Total Cost of Goods Sold 10000 $7.00 $70,000 Monthly Net Profit 10000 $0.50 $5,000 Table: Computation of Net Monthly Profit (Source: Created by Author) From the above table, calculation is made for understanding net monthly profit for Parker Limited (Groot and Selto, 2013). Addition to that, it helps in ascertaining the current cost structure as well as net monthly profit for augmenting the other offers. Therefore, current production cost of Parker Limited has been calculated for estimating their net monthly profit for a given financial year (Drury, 2013). Recommended Offers from Educational Institutions Calculation of Monthly Profit Particulars Unit Cost per Unit Total Amount Normal Monthly Sales 10000 7.5 75000 Order from Educational Institution 2000 5.5 11000 Monthly Sales Revenue 12000 $7.17 86000 Manufacturing Costs: Direct Material 12000 $1.00 $12,000 Direct Labor 12000 $1.20 $14,400 Variable Overhead 12000 $0.80 $9,600 Cost of Logo Inscribtion 2000 $0.60 $1,200 Fixed Overhead 12000 $0.83 $10,000 Total Manufacturing Costs 12000 $3.93 $47,200 Marketing Costs: Variable Marketing Costs 12000 $1.50 $18,000 Fixed Marketing Costs 12000 $1.25 $15,000 Total Marketing Costs 12000 $2.75 $33,000 Total Cost of Goods Sold 12000 $6.68 $80,200 Monthly Net Profit 12000 $0.48 $5,800 Table: Calculation of Monthly Profit (Source: Created by Author) The above table indicates calculated done for the monthly set and offers taken from educational institutions (Balakrishnan, Labro and Soderstrom, 2014). Addition to that, it has been explained if Parker Limited will be accepting the offer from educational institutions for making the supply of 2000 sets at the rate of $ 5.5 per set for calculating monthly set (Ambrosini, Jenkins and Mowbray, 2015). In case the offer gets accepted, then the total monthly net profit will fall by $ 0.02 per set (Ambrosini, Jenkins and Mowbray, 2015). By this, it is recommended that Parker Limited should not accept the offer based on profitability aspect. Profitability aspects are not the sole aspect that needs to be evaluated at the time of undertaking business decisions. It is for this reason why Parker Limited should take into consideration other essential factors like cash inflows as well as production cost per set (Balakrishnan, Labro and Soderstrom, 2014). All the major aspects need to be taken into consideration that will guide company at the time of making financial decisions in the near future. At the time of accepting the offer, it is recommended that Parker Limited should reduce the cost of goods sold per set (Senthilkumar, Maruthamuthu and Kannaiah, 2014). Addition to that, this will help Parker Limited in generating high amount of cash inflow by way of gaining higher net profit in the upcoming financial year. Therefore, it is essential for considering the other factors that the company will identify while accepting the offer (Balakrishnan, Labro and Soderstrom, 2014). Each of the factor should be taken into consideration if the company required accepting the offer for given period of time. Profitability of Long-term Government Calculation of Monthly Profit Particulars Unit Cost per Unit Total Amount Normal Monthly Sales 10000 $7.50 75000 Order from Educational Institution 5000 $4.00 20000 Monthly Sales Revenue 15000 $6.33 95000 Manufacturing Costs: Direct Material 15000 $1.00 $15,000 Direct Labor 15000 $1.20 $18,000 Variable Overhead 15000 $0.80 $12,000 Fixed Overhead 15000 $0.67 $10,000 Total Manufacturing Costs 15000 $3.67 $55,000 Marketing Costs: Variable Marketing Costs 15000 $1.50 $22,500 Fixed Marketing Costs 15000 $1.00 $15,000 Total Marketing Costs 15000 $2.50 $37,500 Total Cost of Goods Sold 15000 $6.17 $92,500 Monthly Net Profit 15000 $0.17 $2,500 Table: Calculation of Monthly Profit (Source: Created by Author) The above table shows the calculation of net monthly profit. It happen in a situation when Parker Limited will be accepting the long-term government contract for rendering 5000 sets at the rate of $ 4.00 per set (Balakrishnan, Labro and Soderstrom, 2014). Certain aspects should be taken into consideration that will enable understanding the aspect of long-term government contract with particular price structure. It is thereby important for the company in making innovative ways for generating revenues for a given financial year. Parker Limited will earn only $ 2500 as total profit as well as profit per set of $ 0.17 (Balakrishnan, Labro and Soderstrom, 2014). Addition to that, Parker Limited will be generating very low amount of profit by way of accepting an offer. This is based upon total profit volume as well as profit per set. Therefore, Parker Limited will get $ 4000 in advance for every month. These particular aspects will be helpful for Parker Limited as they have issue with shortage of cash. Parker Limited is not suffering to any of the above-mentioned issues, so it is advisable to the company in rejecting the offer (Ambrosini, Jenkins and Mowbray, 2015). Rejecting the offer will help the company because it will make the company suffer with many potential issues that should be avoided as far as possible. Lower pricing for the new foreign market Calculation of Monthly Profit Particulars Unit Cost per Unit Total Amount Manufacturing Costs: Direct Material 20000 $1.00 $20,000 Direct Labor 20000 $1.20 $24,000 Variable Overhead 20000 $0.80 $16,000 Fixed Overhead 20000 $0.50 $10,000 Total Manufacturing Costs 20000 $3.50 $70,000 Marketing Costs: Variable Marketing Costs 20000 $1.50 $30,000 Fixed Marketing Costs 20000 $0.75 $15,000 Total Marketing Costs 20000 $2.25 $45,000 Total Cost of Goods Sold 20000 $5.75 $115,000 Less: Sale in Domestic Market 10000 $7.50 $75,000 Sale in Foreign Market 10000 $4 $40,000 Table: Calculation of Monthly Profit (Source: Created by Author) From the above table, calculation is done for gaining understanding of the minimum prices in the new market (Balakrishnan, Labro and Soderstrom, 2014). This means new market penetration will take into consideration on how Parker Limited should offer the sets at lower process to the newly targeted customers. It is advisable to Parker Limited in lowering the price at such a range whereby it can generate zero profit as well as does incur any loss at the same time (Senthilkumar, Maruthamuthu and Kannaiah, 2014). It is important to consider the fact that fixed expenses are constant in nature for shorter time based on certain product volume (Ambrosini, Jenkins and Mowbray, 2015). This will be helpful in the long run whereby the offer will be changing at the same level of production. Addition to that, it becomes impossible in computing the minimum price for longer period of time. This is for the reason why fixed assets will not be same at any point of time. It is recommended to Parker Limited in changing the minimum range of price based on fixed expenses. Therefore, new selling price will be adopted by Parker as it will help in long run. This will be considered only if the price can help company in gaining zero profit and zero loss (Balakrishnan, Labro and Soderstrom, 2014). The above analysis help in gaining understanding on the application of minimum sale price in a given production process Profitability of the offer from outside supplier Calculation of Monthly Profit for Order from Outside Supplier:- Particulars Unit Cost per Unit Total Amount Sale to Outside Supplier 10000 $7.50 $75,000 Monthly Sales Revenue 10000 $7.50 $75,000 Costs of Purchase: Purchase from Outside Supplier 10000 $4.20 $42,000 Fixed Overhead 10000 $0.70 $7,000 Total Manufacturing Costs 10000 $4.90 $49,000 Marketing Costs: Variable Marketing Costs 10000 $1.10 $11,000 Fixed Marketing Costs 10000 $1.50 $15,000 Total Marketing Costs 10000 $2.60 $26,000 Total Cost of Goods Sold 10000 $7.50 $75,000 Monthly Net Profit 10000 $0.00 $0 Table: Calculation of Monthly Net Profit (Source: Created by Author) From the above table, it is easy to understand the expected profit or loss at the time of generating an offer from outside supplier (Balakrishnan, Labro and Soderstrom, 2014). In other words, the table exhibits that Parker Limited will generate no profit at the time of accepting the offer at the same time. It can be clearly understood from the above calculation that Parker Limited can reduce the total assets at the time of accepting the offer. It will incur zero profit because of higher cost of goods sold per unit. Therefore, it is recommended that Parker Limited should not accept this offer given by outside supplier (Senthilkumar, Maruthamuthu and Kannaiah, 2014). Profitability of the Offer from Outside Supplier with the Rental Plan Calculation of Monthly Profit for Order from Outside Supplier Rent:- Particulars Unit Cost per Unit Total Amount Sale to Outside Supplier 10000 $7.50 $75,000 Rent from Building Car Parking $5,500 Monthly Sales Revenue 10000 $8.05 $80,500 Costs of Purchase: Purchase from Outside Supplier 10000 $4.20 $42,000 Fixed Overhead 10000 $0.70 $7,000 Total Manufacturing Costs 10000 $4.90 $49,000 Marketing Costs: Variable Marketing Costs 10000 $1.10 $11,000 Fixed Marketing Costs 10000 $1.50 $15,000 Total Marketing Costs 10000 $2.60 $26,000 Total Cost of Goods Sold 10000 $7.50 $75,000 Monthly Net Profit 10000 $0.55 $5,500 Table: Calculation of Monthly Net Profit (Source: Created by Author) From the above table, calculation is done for understanding monthly net profit or loss for rendering properties for rent (Balakrishnan, Labro and Soderstrom, 2014). This particular attributes aligns with the offer gained from the outside suppliers. This reveals the fact that Parker Limited will be generating total profit of $ 5500 at the time of taking business decisions. This will help company to evaluate the offer from outside supplier, which cann be accepted within the provision of rental income (Senthilkumar, Maruthamuthu and Kannaiah, 2014). Conclusion At the end of the study, it is concluded that it is essential for making comparisons as well as reviewing the current net profit as well as cost of the profit structures. This has been indulged by after making marketing offers as well as plans where marketing strategy prevails and aims at generating higher profit per set. Addition to that, it is necessary to carry on with the current marketing policy of Parker Limited. This is for the reason as this company should accept the offer from the educational institution as discussed in the above calculation. This will happen at the time of accepting the offer for the company that aims at accumulating funds for generating high amount of profit. It has been analyzed that Parker Limited will be sacrificing its profit for short-term purpose based on penetrating activities. On the other hand, it should not even continue for longer period as it will be increasing prices as obtained from a favorable amount of market shares especially in the intern ational market in the most appropriate way. Moreover, it can also consider the offer from outside supplier only if it can utilize its assets to generate rental income of $5500 or more. Reference List Ambrosini, V., Jenkins, M. and Mowbray, N., 2015. Advanced strategic management: A multi-perspective approach. Palgrave Macmillan. Balakrishnan, R., Labro, E. and Soderstrom, N.S., 2014. Cost structure and sticky costs. Journal of Management Accounting Research, 26(2), pp.91-116. Drury, C.M., 2013. Management and cost accounting. Springer. Groot, T. and Selto, F.,2013. Advanced management accounting. Pearson Higher Ed. Kamala, P., Struwig, J., Bornman, M., Boersman, R., Vermaak, M., McGill, M. and Taylor, P.,2015. Principles of Cost Accounting. Oxford University Press Kaplan, R. S. and Atkinson, A. A., 2015. Advanced management accounting. PHI Learning. Senthilkumar, K., Maruthamuthu, K. and Kannaiah, D., 2014. Advanced Cost Accounting. Vikas Publishing House Webster, W. H., 2016. Accounting for managers. PHI Learning.

The Ambivalence Of Abortion Essay Research Paper free essay sample

The Ambivalence Of Abortion Essay, Research Paper The Ambivalence of Abortion Whether or non abortion is morally right or incorrect, the fact remains that a adult female has the right to do her ain determinations. If a adult female decides to hold an abortion it is her right to make as she pleases with her organic structure. It is apprehensible that many may differ with abortion being legal, but that is no ground non to let others to hold a different sentiment. Nevertheless, the inquiry of whether abortion is morally right should be left up the scruples of the adult female whom is doing the determination and non through judging eyes non traveling through the same state of affairs. There are more pros than cons to holding an abortion. For case, a adult female with a household of four who are hardly lasting discovers she is pregnant. She decides to hold an abortion because she cant afford the babe. We will write a custom essay sample on The Ambivalence Of Abortion Essay Research Paper or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page That might have saved the universe of another sad narrative of a female parent abusing and pretermiting her unwanted kid. Unfortunately, sometimes a female parent can run the hazard of decease if they go through with the gestation. Would it be just to allow the female parent of two immature kids die because SOME PEOPLE don # 8217 ; t believe in abortion? On the other manus, it may be true that immature adult females are taki ng advantage of the fact that they can easy hold an abortion. Some say they are replacing birth control with abortion. Nevertheless, no one of all time said we can # 8217 ; t topographic point limitations on abortion but we can # 8217 ; t allow one bad apple spoil the whole clump. The fact remains that although some might take advantage of the state of affairs, it is unconstitutional to deny the chance to person who REALLY has no other option but abortion. Every adult female ( and individual ) has the right to do their ain determinations. No 1 has the right to deny another of their ain sentiment. Some may non believe in or hold with abortion and that # 8217 ; s absolutely all right but it does non give them the right to deny others of the option. Finally, a adult female has the right to make up ones mind whether or non to hold an abortion and whether or non to experience guilty about it. Although abortion is legal, it doesnt mean you have to wish it, hold with it, or have one. It merely means that there are others who do hold with it and have the constitutional right to do their ain determinations. In decision, every adult female has the right to hold abortion as an option. Ambivalence: The province of holding conflicting attitudes or feelings, as love and hatred, about the same thing at the same clip.

Critical Lens Essay

Critical Lens Essay A critical lens essay is a type of essay where students ability to think critically and express their ideas in the written form is estimated. Generally, it requires three major skills: reading, critical thinking, and writing. Critical Lens essay generally follows a fixed essay format: introduction, three body paragraphs, and conclusion. What Is a Critical Lens Essay A critical lens essay is a type of essay where students ability to think critically and express their ideas in the written form is estimated. Generally, it requires three major skills: reading, critical thinking, and writing. Careful preparation for essay writing is no less important than writing itself. ESSAY WRITING TIPS AND TRICKS This type of essay (see all types of essay) is often used during written examinations when the assignment is given in the form of a statement or a phrase, and students are asked to relate it to one or two pieces of literature. Critical Lens Essay Structure Critical Lens essay generally follows a fixed essay format. In the essay, a student has to discuss two literature pieces and 3 literary terms. In addition, a student needs to know capitalization rules and write them correctly. All titles are capitalized. Book titles are underlined and short stories are put in quotes. Generally, an essay consists of the following elements: Introduction The first sentence introduces the quote itself. Next sentence one should give the students interpretation of the quote to show how the student understands its meaning. Next, outline whether you agree or disagree with this quote, mention the books you are going to talk about in your essay and explain how your quote relates to them. Remember to spell, capitalize and punctuate all titles correctly. It is advisable not to use personal pronouns like: â€Å"I, you, we, me, my†; in contrast, it is better to substitute them with third person pronouns or alternative words like ‘they’, ‘readers’, ‘people’ etc. Three Body Paragraphs Paragraph  1. In the first body paragraph,  restate the quote in your interpretation. Paragraph 2. In the second body paragraph, mention the titles of the first literature piece you are going to analyze and briefly mention how it relates to the selected quote. Paragraph 3.  In the third body paragraph, speak about the second literary piece and explain how you think it relates to the quote you have selected. In order to back up your quote, you will need to use specific examples from each novel. Another thing: dont forget to connect the book back to the interpretation of your quote. Conclusion Your conclusion sums up the main thoughts of the essay. It is strongly recommended not to repeat your introduction verbatim. Don’t forget to end your essay with the quote that opened it. CRITICAL ESSAY FROM A TO Z Steps on How to Write a Critical Lens Essay STEP 1. Read the quote attentively. STEP 2. Try to rewrite the quote in your own words. STEP 3. Analyze the quote. STEP 4. Decide whether you agree or disagree. STEP 5. Name the two literary pieces that support your position. STEP 6. Think of a short summary of the two texts and express how they support/don’t support the quote. STEP 7. Try to use literary elements into your argument, but dont overdo it. Use it in the introduction and the first body paragraph. STEP 8. In the  first paragraph, focus on the book you have read and explain how the text supports your understanding of the quote. STEP 9. If one paragraph appears to be too long, you may break it up into two smaller ones. STEP 10. In the second paragraph, you should use the same order but now write about the other text. STEP 11. Make a short summary of what youve written – that’s your conclusion. STEP 12. Restate your thesis and explain how the texts you selected  to support it. CRITICAL ANALYSIS Necessary Literary Elements Keeping the structure in mind, you should not forget to use the following literary elements: Figurative Language: use the simile, metaphor, alliteration, personification and hyperbole correctly. Flashback: be able to describe the past event at present. Foreshadowing: use name hints or clues that suggest some events that may happen next. Plot: follow the correct sequence of events which took place in the literary piece. The point of view: give your own point of view. Setting: show your knowledge of the time and place of the action in literary work. Theme: show your understanding of the central idea of the literary work. Tone: use your specific attitude towards the audience or subject. Be able to add to your interpretation of the quote the details from the books you read.  If you follow all the tips you will create an intelligent critical lens essay and will easily convince the reader that you are aware of your topic to the smallest detail. The main thing you need to keep in mind while creating your critical lens essay is to persuade readers to accept your viewpoint. Place an order and our professional academic writers will help you find the right reasoning to do that!

Seguro médico de viaje internacional para EE.UU.

Seguro mà ©dico de viaje internacional para EE.UU. Los turistas extranjeros no estn obligados por ley a comprar seguro mà ©dico internacional para viajar a Estados Unidos. Sin embargo, carecer de cobertura mà ©dica en ese paà ­s puede causar consecuencias econà ³micas y migratorias muy graves. Puntos Clave: seguro mà ©dico de viaje para EE.UU. Costo medio visita a Emergencias: $2.168 dà ³lares americanosCosto seguro mà ©dico de viaje: a partir de $1.50Cà ³mo elegir el mejor seguro: Travel Insurance Center, SquaremouthProblemas migratorios: Cancelacià ³n de visa de turista o ESTA. Problema cada vez ms frecuente. Costo de gastos mà ©dicos en EE.UU. No cabe duda de que en Estados Unidos hay mà ©dicos y hospitales que son los mejores en su especialidad a nivel mundial como, por ejemplo, en el tratamiento de cncer. Pero tambià ©n es la sanidad ms cara del mundo. Segà ºn datos del National Institute for Health, el costo promedio de una factura por asistencia mà ©dica en Urgencias de un hospital (ER, por sus siglas en inglà ©s), es de $2.168. Adems, hay que tener en cuenta que el costo puede variar enormemente no sà ³lo segà ºn la naturaleza del problema de salud, sino que tambià ©n depende del tratamiento, de los anlisis practicados y del lugar en el que se reciben los cuidados mà ©dicos. Por ejemplo y segà ºn datos de International Insurance Travel Group, los gastos facturados pueden ser los siguientes: Dolor de cabeza: de $15 a $17.797Infeccià ³n de orina: de $50 a $73.002Piedra en rià ±Ãƒ ³n: de $128 a $39.408Consulta mà ©dica tà ­pica: de $150 a $200Anlisis de sangre: pueden llegar a costar $1.200 Recientemente varios medios de comunicacià ³n se han hecho eco de dos casos en los que una mujer recibià ³ una factura de $2.229.11 por tres puntos de sutura y un hombre de ms de $3.500 por cinco puntos, a pesar de que el costo promedio est entre $150 y $350. En esas cifras queda claro que los costes son altà ­simos y que dependen en gran medida del lugar dà ³nde se recibe el cuidado mà ©dico. El problema es tan grande que, de hecho, los costos mà ©dicos son la principal causa de bancarrota familiar en el paà ­s ya que tan solo en 2016 se solicitaron 770.846 segà ºn el National Bankkrupcy Forum. Los turistas internacionales visitando los Estados Unidos deberà ­an comprar un seguro mà ©dico antes de salir de sus paà ­ses para evitar tener que pagar ese tipo de gastos mà ©dicos por problemas que puedan surgir durante la visita.  ¿Cul es el mejor seguro mà ©dico de viaje para EE.UU. y quà © est excluido? Un buen nà ºmero de aseguradoras que venden seguros de viaje internacionales excluyen a Estados Unidos de sus pà ³lizas por el alto costo de los servicios mà ©dicos en este paà ­s. Por ello es fundamental asegurarse de que el seguro que se quiere cubre Estados Unidos. Adems, es altamente recomendable preguntar cun grande es la red de mà ©dicos y hospitales en el paà ­s de la aseguradora, si est incluido un servicio de traduccià ³n si no se habla inglà ©s y tambià ©n de evacuacià ³n mà ©dica, ambulancia y repatriacià ³n. Una vez que esos puntos se han clarificado, lo que es el mejor seguro depende de las necesidades de la persona que lo contrata, de su salud e incluso de su edad. Tambià ©n de si prefiere pagar una cantidad alta y no hacer co-pagos o prefiere abonar una pequeà ±a y, si hay un accidente o enfermedad, realizar un pago junto con el seguro. Cabe destacar que en la mayorà ­a de los seguros para turistas que viajan a EE.UU. estn excluidos todas ls enfermedades y condiciones pre-existentes entre los que se encuentran la diabetes, el cncer, problemas de corazà ³n, etc. Adems, con carcter general no estn incluidos en estas pà ³lizas los gastos ocasionados por un embarazo, el parto, consultas genà ©ricas de cualquier clase, vacunas, exmenes oculares o dentales y procedimientos cosmà ©ticos.  ¿Cà ³mo comprar un seguro mà ©dico de viaje para EE.UU? Se puede comprar cualquier seguro mà ©dico internacional que expresamente incluya Estados Unidos. A la hora de comprar es recomendable consultar con precios y condiciones de varias aseguradoras. Adems, el seguro mà ©dico de viaje se puede comprar online en la pgina web de Travel Insurance Center, que est afiliada con USA Tourist.com y ofrece una gran variedad de seguros. Tambià ©n es recomendable verificar con Squaremouth y comparar entre cientos de seguros para ver cul es el ms conveniente para cada caso. Tanto Travel Insurance Center como Squaremouth estn recomendadas por embajadas y consulados americanos.  ¿Cul es el costo de un seguro mà ©dico de viaje para EE.UU.? Hay una gran variedad de precios dependiendo de, entre otras cosas, quà © cantidad de cobertura mà ©dica se compra. Es prctica frecuente asegurar entre $50.000 y $100.000 para viajes inferiores a tres meses y de $100,000 a $500,000 para estancias previstas superiores a un trimestre. Obviamente, se puede asegurar ms cantidad o, incluso, sin tope mximo. Adems de la cantidad asegurada influye en el precio del seguro mà ©dico el tipo de beneficios que se incluye y quà © se excluye, si hay co-pago cada vez que se utiliza el seguro, si hay deducible y la cantidad de à ©ste. El deducible –deductible en inglà ©s – es la cantidad de dinero que el asegurado debe pagar por un gasto mà ©dico cubierto por la pà ³liza antes de que empiece a pagar el seguro. Por ejemplo, si hay un deducible de $2.000 eso quiere decir que el asegurado debe gastar esa cantidad en recibir servicios y cuidados mà ©dicos antes de que el seguro comience a pagar. El deducible es diferente al costo del seguro, que se conoce en inglà ©s como premium, y debe pagarse en el momento en que se contrata el seguro. Teniendo en cuenta todo lo dicho en los prrafos anteriores, el seguro mà ©dico puede costar entre $1.50 por dà ­a a ms de $10 por dà ­a, dependiendo de lo que se asegure. Es muy recomendable guardar facturas siempre si se acude a un mà ©dico o a un hospital. Adems, en el caso de las medicinas la mayorà ­a de las aseguradoras siguen la polà ­tica de que el turista debe pagar por ellas y ms tarde le regresa el gasto, pero debe recibir factura que le debe enviar el asegurado.  ¿Dà ³nde recibir tratamiento mà ©dico barato en EE.UU.? Los tratamientos mà ©dicos en Estados Unidos pueden ser muy caros aà ºn estando asegurados porque, por lo general, la mayorà ­a de los asegurados deben pagar parte de la consulta o procedimiento. Por esta razà ³n es muy comà ºn que, salvo casos de emergencia, se acuda a centros econà ³micos y nunca a Salas de Emergencia de hospitales para asuntos como dolor de garganta, resfriados, infeccià ³n de orina, dolores de cabeza, etc. En Estados Unidos prestan estos servicios un abanico de centros, entre los que destacan las Clà ­nicas de Salud Comunitarias, las Clà ­nicas de Cuidado Urgente y las clà ­nicas Walk-in. Se puede consultar sus ubicaciones y cul es la ms cercana en la pgina de la Asociacià ³n Nacional de Clà ­nicas Gratuitas y Caritativas (National Association of Free and Charitable Clinics, en inglà ©s. Por à ºltimo, cabe destacar que en cadenas como CVS, Walgreens o Walmart es habitual que brinden un servicio para rutinas mà ©dicas a cargo de enfermeros y asistentes mà ©dicos.  ¿Por quà © cuando un turista no paga una factura mà ©dica puede tener consecuencias graves? Los turistas, tanto los que viajan con visa como los que pueden hacerlo con ESTA, pueden sufrir la revocacià ³n de esos documentos y la prohibicià ³n de ingresar a Estados Unidos por no pagar un gasto mà ©dico. La razà ³n est en la Ley de Tratamiento Mà ©dico de Emergencia (EMTALA, por sus siglas en inglà ©s) que dice que los hospitales y mà ©dicos tienen la obligacià ³n de atender las emergencias de todas las personas que lo necesiten. Emergencia en EE.UU. significa, entre otras cosas, que no se haya ingresado al paà ­s para recibir ese tipo de tratamiento y que de no recibir el cuidado mà ©dico urgente la persona enferma o accidentada puede morir o sufrir un fallo de un à ³rgano o parte de su cuerpo. Adems, para ser emergencia el problema debe haber surgido de repente, es decir, no puede ser el resultado de una condicià ³n previa debilitante. Como ejemplos de emergencias pueden citarse los partos, la amputacià ³n de una pierna o brazo, un ataque de apendicitis, etc. En estos casos de emergencia que el hospital debe atender si el enfermo o accidentado no paga o/y no tiene seguro mà ©dico el que acaba pagando es Medicaid, que est financiado con dinero de impuestos de los estadounidenses a travà ©s de aportaciones de los estados y de dinero del gobierno federal. Precisamente esto à ºltimo es lo que puede causar problemas migratorios de anulacià ³n de visa o ESTA y de no poder conseguir visas inmigrantes o no inmigrantes a partir de ese momento porque se puede considerar a la persona que no pagà ³ como una carga pà ºblica y, por lo tanto, inadmisible para ingresar a EE.UU. Puede tomar esa decisià ³n un agente consular o cualquier miembro de la CBP (Patrulla Pronteriza). Asà ­, puede darse casos como, por ejemplo, que una seà ±ora dà © a luz en EE.UU. como turista y a partir de ese dà ­a ingrese al paà ­s en varias ocasiones sin ningà ºn tipo de problema. Y de repente un dà ­a en el puesto de control migratorio se le niegue la entrada al paà ­s y se le revoque la visa o la ESTA por decisià ³n de la persona encargada en ese momento de checar los papeles. En la actualidad, à ©ste es un problema cada vez ms frecuente que afecta a unas personas pero no a todos, ya que depende de la decisià ³n personal de agente de la CBP o del consulado. En estos momentos no es posible saber con certeza ni quià ©n se va a quedar sin visa por esta causa ni cundo pero sà ­ que es una situacià ³n cada vez ms comà ºn. La CBP no ha notificado pà ºblicamente cà ³mo se entera de que una persona no pagà ³ una emergencia mà ©dica pero en algà ºn momento durante la emergencia mà ©dica se obtiene el pasaporte del turista, se escanea y se envà ­a a las autoridades en todos los controles migratorios en las aduanas. Adems, en el caso de haber dado a luz a un nià ±o en EE.UU. los datos de ambos padres se obtienen fcilmente al solicitar el pasaporte estadounidense para el menor. Cada vez son ms frecuentes los casos en los que en ese momento se anula las visas de los dos progenitores. Adems, destacar que à ©stos no tienen derechos migratorios mientras el hijo es menor de 21 aà ±os. Por à ºltimo, cabe destacar que ningà ºn hospital o mà ©dico atiende a turistas sin seguro o sin pago previo exceptuando ese caso de emergencia explicado en los prrafos anteriores por lo que es altamente recomendable comprar un seguro mà ©dico de viaje antes de ingresar a EE.UU. Este es un artà ­culo informativo. No es consejo legal para ningà ºn caso en particular.

Valuing People in Financial Statements Essay Example | Topics and Well Written Essays - 1000 words

Valuing People in Financial Statements - Essay Example This is because their respective annual financial reports do not reflect the financial position of the customers to their business. This paper will discuss whether companies should have a financial value for their employees with reference to Mark Spencer’s annual report. Most businesses consider their customer base to be their most valuable asset. This is a myopic consideration since behind every satisfied customer there is a hard working staff who contributed to their satisfaction. This indicates that employees should be beyond the customers of the company since they are responsible for successful products and satisfied customers (Hart, 1995, p. 56). Therefore, the value of employees can be measured from the quality of the products that they are responsible for and, the level of customer’s satisfaction resulting from their efforts. Being of financial significance indicates that workers are assets to the company and the company has the responsibility to account for them . Companies consider their workers as expenses due to the salaries that they receive at the end of the month or the end of a given trading period. In this case, workers would appear in the right hand side of their balance sheet. However, this is not a valid reasoning since salaries or wages is a return or compensation for labor (Vygotsky, 1978). Labor has economic value to a business. This indicates that workers or the source of the labor also has economic value to the business. Indeed, workers are assets of a company due to the economic value of their efforts to the company. However, shareholders and other stakeholders of a company fail to consider the financial value of workers when evaluating a company. This evaluation does not give the actual position of the company since workers too have a financial significance to a company. According to Paul Herman the CEO of HIP investments, most companies fail to consider their workers as their assets. Layoffs are the main reason that quali fies workers to be expenses of a company. A company can increase its profit through various ways. The main method that companies use to increase their profit is reducing their cost of operation. Cost of operation includes fixed costs and expenses. In this case, fixed costs are costs that are incurred during the production process, and are invariable. On the other hand, expenses are cost incurred by the company due to factors that facilitate production or distribution of finished products. Layoff is considered as a method of increasing profits since it enable companies to cut down their expenses and hence their cost of operation. Laying-off workers has positive returns in the short term since economic downturns are not permanent (Kalb, 1993, p. 198). Economic downturns are followed by economic recoveries that force the companies to hire more employees to compensate for laid-off workers. In this process, the company spend money in hiring and training of new workers to compensate for t he laid off workers. Hiring new workers is critical to a company’s success. The abilities of a company to outsource for the best workers in a particular field determine the competence of its products in a given market (Ellen, 2009). This process has financial significance to the company since it is a form of investment. In addition, the company needs to train its employees in order to achieve

Madonna of the Meadows and Madonna of the Long Neck Essay

Madonna of the Meadows and Madonna of the Long Neck - Essay Example Raphael’s painting shows the Madonna as a softly rounded woman with soft blonde hair gathered into a soft bun out of the viewer’s angle of vision. She is delicately bent over her son who is depicted as a plump and somewhat strangely proportioned infant just on the verge of walking. He is reaching out for a wooden pole suggestive of a cross held by a slightly older St. John. This entire scene is seen over the backdrop of a very green landscape that stretches far back into the distance with a large lake and mountains visible far into the horizon. Parmigianino’s painting also depicts the Madonna tenderly holding the infant baby Jesus. She is tall and columnar as she looks down on an elongated infant who seems on the verge of falling out of her lap. She perches on a pedestal backed on one side by a rich red velvet curtain while a large grouping of angels gathers around her on this side to look adoringly at the baby. One of these angels is carrying a vase or urn that has a mirrorlike finish to it. It is positioned in such a way that it would throw a reflection back at the baby Jesus and may be the reason the baby was startled as the vase also has an etched cross on its surface. On the other side of the Madonna is a kind of landscape scene that is mostly a cloudscape. The visible sky is full of storm clouds with just a hint of blue on the horizon. There is also a tall Roman style column and the figure of St. Jerome. There are a number of ways that the two paintings are similar. They are both concerned with the relationship between Jesus’ birth and his eventual death as well as the presence of his mother in both of these events.

The Underlying Truth Behind the Disasters of the Families Essay Example for Free

The Underlying Truth Behind the Disasters of the Families Essay People today are facing the most devastating effects of both advancement and social progress. Gone are the days when the families are noted as the hiding place for the afflicted. Most of the time, reports that are passed on in television, in the radio, in papers and now in the Internet are sourced out from the ones who are maltreated, those who are abused by people in their own homes. Yes, the problem is rising and the victims are increasing every year. The issue on individual abuse becomes one of the menaces in the society that appears to be much hard to deal with. How then are these victims cared for? How are they protected and how are they later on treated for them to be able to move on with their lives? These questions and other more information shall be the basis of the study that follows herein. Through the researches that have been further collected by the author and the online interview and survey method that shall be utilized as well by the author, the needed data for this particular study would be collected in order to arrive in a much more valid and practical conclusion. -i- Domestic Abuse: The Underlying Truth Behind the Disasters of the Families Chapter 1: Introduction â€Å"Abuse† is a term that is believed to be an overloaded description of the actual situation that is happening in the society right now. It could be observed that through the years, the number of individuals being victimized by the said dilemma are undeniably increasing making the word â€Å"abuse† not just a word but one among the many things that people within the human society fear most. Significance of the Study There is an important factor that defines studying social dilemma as one of the most important issues that need to be dealt with by the experts who are concerned of primarily assisting the human society in recovering from the said factors of distress. Concerning the fact that cases of abuse affect the whole human community in many ways, it is indeed necessary to understand why and how abusive acts actually develop. The reasons behind the developments of the said situation and the effects that it leaves towards its victims would actually help in identifying which type of treatment actually fits the situation best. The victims are the main reasons why there exist some certain support groups and NGO’s that are devoted to focusing themselves in helping the people understand why and how they could help those who are primarily afflicted by the said social malady. It is the expectation of the researcher of this study to help the people understand the roots of the major advancing process by which abusive acts increase every year. More than simply understanding the roots of the problem, this research also aims to make possibilities by which the said situation could be treated well by the authorities who are supposed to be involved within the treatment of the said social issue. To understand the objectives further, the following list shall enlighten the vision of the readers with regards the said purposes of the commencement of this particular study.

Mind-body Distinction :: essays research papers

â€Å"Mind-Body distinction† We usually view the mind as the brain and body as something physical. The mind may be better known and understood when one is thinking. When thinking, the mind is made up purely of thoughts and the body is an extension. The mind is telling the body what to do. The mind is a mental entity and the brain itself is the physical body. Although one can not have a mind with out a brain, the mind and brain differ in which one is mental and the other physical. Together the mind and body are like a foundation. Empirically we know that the mind needs a brain to exist, but the mind is not a physical substance. Moreover, a brain sits useless unless it has a mind. Substances with shape, mass, and other physical properties characterize the physical. In contrast, substances without any size, shape, mass often characterize the mental. One of the first things about our bodies is that they have limitations that we may think are not there. Our bodies seem to be what they are no matter what we think about them. Although you can change your body by changing your body image, you can never become the ideal person you think you can be. Thus, our bodies seem to exist and be what they are independently from what any mind thinks they are. Are bodies are physical and can not be changed because we can see them change in our mind. The body can be controlled by the mind to do certain things but the mind can not change our physical appearance. The main characteristic of the mind is the ability to think. A mind does more than take in information from the world and react to it. The mind has hopes, feelings, and beliefs. It is aware of the world and has feelings and thoughts about the information that it takes in from the world. Minds are non-physical and the thoughts it produces do not have anything in common with the physical. We can see, touch, or hear our thoughts. An idea can exist, but only in the mind. An idea has no physical properties to it. Physical objects can be perceived in the mind but objects in the mind are immaterial.

Elderly Interview with Mrs. G Essay

Mrs. G was chosen for a formal interview, the purpose of this interview was explained before she signed the consent form. The meaning of OT and the role of OT in wellness was discussed with her. The interview was scheduled at her son’s home in the living room for approximately one hour. She was seen at 5pm in the afternoon. According to the Quality of Life Index for Adults 1997, Mrs. G is experiencing some difficulty within the domain of physical health and pain. Mrs. G stated that she was unable to do some activities such as climbing more than one flight of stairs and walking several blocks. Mrs. G stated that her pain level is moderately and that it slightly interferes with her daily activities. According to the Montreal Cognitive Assessment, Mrs. G is experiencing some cognitive deficits, she scored 3 point below the normal range. Mrs. G is a 68 year old African American female born in Independence, Louisiana in 1946. She is currently living in her own single floor home with her husband. She has two children but both live out of the area, even though her children aren’t in the area, she has a very good family and friend support network. She attended Merritt College for nursing and worked as a nurse for 30 years. Mrs. G is now a retired nurse and her husband a retired air traffic controller. Mrs. G enjoys shopping, attending church, traveling and cooking for friends and family. She states that she loves to dance salsa but she hasn’t gotten around to go dancing because she hasn’t found the time. Mrs. G is currently in good health and is able to carry out functional task without assistance. Her history of illness include thymus, high blood pressure, high cholesterol, hysterectomy, appendicitis and diabetes. Mrs. G is currently taking daily medications for her cholesterol, blood pressure, insulin and on occasion pain meds for her Arthritis on the neck and C4-5 herniated disc. Mrs. G states that she may skip a day of medication because she forgets some days. Mrs. G’s living conditions are good, she has a spacious 3 bedroom home and is able to maintain her home. Mrs. G states that she has good community resources at Keiser, which they provided classes to help manage her diabetes. Mrs. G’s typical day goes as followed; she wakes up and usually begins her day by reading the Bible, after she prepares breakfast for herself and her husband. Then she sits to relax or to watch TV, she watches the news, the chew and MSNBC with her husband and in between she talks on the telephone to friends and family. She attends the food bank twice a week, Monday’s she has choir rehearsal and Tuesday bible class. When she returns home she cooks dinner, does laundry, and cleans her home if needed. Then she sit watches scandal and the evening show and speak on the telephone again. She reads her Bible and goes to sleep around 11 pm. According to Erik Erikson’s Theory of Human Development, Mrs. G is within the stage of ego integrity. Ego integrity is the ability to see life as meaningful and the abilities to accept both the positive and negative part of aging without feeling intimidated. Mrs. G has a very positive outlook on her life she is charismatic, funny and you feel welcomed around her. Problem List Diet: Mrs. G suffers from diabetes, high blood pressure and high cholesterol due to this it is recommended that Mrs. G lowers her sodium intake and increase her intake of fruits and vegetables limit fried food. Medication Management: Mrs. G is on insulin due to her diabetes and on various medications for high blood pressure and high cholesterol, Mrs. G states that sometimes she misses days because she forgets. Exercise: Mrs. G is currently over weight and she need to keep an exercise routine to improve health. Joint conversation: Mrs. G has arthritis of her neck and hands also a herniated disc at the level of C4-5 Concentrate: Mrs. G sates that during reading and some conversations she tends to lose concentration. Long Term Goals Within discharge client will attend salsa class once a week to facilitate wellness. Within discharge, client will be taught joint conservation technique to facilitate wellness. Within D/C, client will be educated on a low-fat/low-carb diet to facilitate wellness. Within discharge, client will maintain concentration 10 minutes during reading activity to facilitate  wellness. Within D/C, client construct a medication management schedule to facilitate wellness. Activities Enroll in salsa classes once a week at her local community gym. Games such as dominoes, checkers, chess, card games, scrabble, and bingo. Types of puzzles Jigsaw puzzles, Crossword, Word search, Sudoku, Crypto quotes. Craft such as drawing, painting, knitting, playing music, scrapbooking, and woodworking, mosaics using tiles or colored paper, and photography. Cooking activity that contain planning and selecting recipe, shopping for materials/ingredients. Educational materials Exercise Diabetics should try to avoid exercising in weather that is too hot or too cold. Exercises such as yoga, tai-chi, swimming and rowing are recommended to develop core power, strengthening and lengthening muscles, and managing stress (Mark Daily Apple, 2014). Nutritional Recommendation A healthy diet for a diabetic is essential, foods that increase blood sugar should be monitored here are some steps to have a heathy dinner plate that will aid in managing your diabetes. Try these six simple steps to get started: 1. Using your dinner plate, put a line down the middle of the plate. Then on one side, cut it again so you will have three sections on your plate. 2. Fill the largest section with non-starchy vegetables such as: spinach, carrots, lettuce, greens, cabbage, bok choy green beans, broccoli, cauliflower, tomatoes, vegetable juice, salsa, onion, cucumber, beets, okra, mushrooms, peppers, turnips 3. Now in one of the small sections, put grains and starchy foods such as: whole grain breads, such as whole wheat or rye whole grain, high-fiber cereal cooked cereal such as oatmeal, grits, hominy or cream of wheat rice, pasta, dal, tortillas cooked beans and peas, such as pinto beans or black-eyed peas potatoes, green peas, corn, lima beans, sweet potatoes, winter squash low-fat crackers, snack chips, pretzels and light popcorn 4. And then in the other small section, put your protein such as: chicken or turkey without the skin fish such as tuna, salmon, cod or catfish other seafood such as shrimp, clams, oysters, crab or mussels lean cuts of beef and pork such as sirloin or pork loin tofu, eggs, low-fat cheese 5. Add a serving of fruit, a serving of dairy, or both as your meal plan allows. 6. To complete your meal, add a low-calorie drink like water, unsweetened tea, or coffee (diabetes.org, 2014). – References See more at: http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/?loc=ff-slabnav#sthash.csyt8odq.dpuf – See more at: http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html?loc=ff-slabnav#sthash.PZeyq2ta.dpuf http://www.marksdailyapple.com/10-exercises-for-seniors/#axzz36jgoG2ib http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/?loc=ff-slabnav

Superstition Speech

Superstitions To inform my audience about commonly practiced superstitions, their meaning, origins, and what affects they have on our lives and commonly practiced traditions. Hi! My name is Sarah & today I am going to talk to you about superstitions. According to blah blah superstition is defined as blah blah blah. How many of you have ever crossed your fingers for good luck, or got a little nervous about something bad happening on Friday the 13th? I would bet that all of you have said or have heard someone say â€Å"God Bless You† after a sneeze.Have any of you ever wondered where the traditions of Halloween came from? Or maybe why it is thought to be bad luck for the groom to see the bride before the wedding ceremony? Today I am going to enlighten you with the answer to these questions and much more. I. For the most part superstitions can be placed into 2 categories, good or bad luck, many of them also have deeply religious meaning and use symbolism. A. Good Luck 1. You must knock on wood 3 times after mentioning good fortune or the evil spirits will ruin things for you. )The tradition traces back to an ancient pagan belief that spirits resided in trees and that by knocking on the wood, you were paying a small tribute to them by acknowledging them, and could call on them for protection against ill-fortune. Also, you were thanking them for their continued blessings and good luck. 2. Crossing two fingers (the middle and pointing fingers) on one hand as a sign of hopefulness or desire for a particular outcome. a)This is probably the superstition that is most widely used today. By making the sign of the Christian faith with our fingers, evil spirits would be prevented from destroying our chances of good fortune.It is also used as an expression: â€Å"Cross your fingers† is often told to someone hoping for good luck or a particular outcome. Sometimes, when someone tells a lie, they will cross their fingers (usually behind their back). This somehow ab solves them from the consequences or makes the lie not count. See a penny pick it up, all day long you will have good luck. b)Finding a penny and picking it up is believed to bring a day of good luck. Finding a penny with heads up is considered luckier. It is believed that this penny should not be spent; keeping it safe can bring you fortune.Any metal was considered God's gift to mankind 3. Saying â€Å"God Bless You† when someone sneezes. (1)†The blessing of those who sneeze started when the great plague took hold of Europe. Sufferers began sneezing violently, and as such, were bound to die. The Pope passed a law requiring people to bless the sneezer. At the same time, it was expected that anybody sneezing would cover their mouth with a cloth or their hand. This was obviously to stop the spreading of the disease, but many believed that it was to keep the soul intact.Sneezing ‘into the air' would allow the soul to escape and death would be imminent. Humankind has long been equating the soul with breath. It was thought that when one sneezed, the soul briefly flew out of the body, and this might allow an evil spirit to take up residence within. On the other hand, it is also said that blessing someone who sneezes is necessary because their heart skips a beat when they sneeze; it is wishing them continued good health B. Bad Luck 1. Breaking a mirror will bring seven years of bad luck. a)Romans tagged the broken mirror a sign of bad luck.The length of the prescribed misfortune, 7 years, came from the Roman belief that man's body was physically rejuvenated every 7 years, and he became, in effect, a new man. One's reflection in a mirror is thought to be the representation of his or her soul or spiritual state. Breaking the mirror, and therefore the person's reflection, would bring damage to their soul and spiritual hardship. Taking the pieces outside and burying them in the moonlight could avoid this. 2. Open an umbrella indoors and bad luck will à ¢â‚¬Å"rain† on you. a)Origin can be traced back to when umbrellas were used as sun protection.Opening one indoors supposedly was offensive to the sun (or sun god) and would bring his wrath down upon the offender 3. Walking under a ladder will bring bad luck. a)Excluding the obvious – that something might fall on you from above – the belief that walking under a ladder will bring bad luck seems to stem from the ladder forming a triangle with the wall and the ground. This represents the â€Å"Holy Trinity†, and if you violate this by entering the space, it puts you in league with the devil, and you're likely to incur God's wrath. 4. Friday the 13thThe belief that thirteen brings bad luck is an extremely pervasive belief throughout many societies, and is strong enough that many major hotels and high rises traditionally either build only twelve floors, or, if they want to go higher, skip labeling the 13th floor entirely! Many people refuse to stay on the 13th f loor, or in room 13. People stay home from work, for fear of something bad happening. Most airports don't have a thirteenth gate. There are many theories as to why this belief is held. One is that Judas, known as â€Å"the Betrayer of Jesus†, was the 13th member present at the Last Supper.Paraskevidekatriaphobia is the official term for the fear of Friday the Thirteenth. Jesus was said to have been crucified on Friday and the number of guests at the party of the Last Supper was 13, with the 13th guest being Judas, the traitor. II. Superstition plays a role in several of our nationally celebrated Holidays and traditions. A. Halloween blah blah blah 1. Costumes- The people of Ireland at that time were pagans and spirits were a part of their religion. Their beliefs involved good and evil spirits and would strive to live in harmony with both.This is where the custom of dressing up in costumes came in. On All Hallows Eve the spirits of the dead, good and evil, were believed to wal k the streets until sunrise so anyone out might run into an evil spirit and become possessed. To keep from becoming possessed, the villagers would dress in animal skins and paint their faces to scare away the bad spirits. 2. Trick or treat- it began in Ireland as part of their end-of-summer festival. October 31st is the last day of the Celtic calendar and November 1st begins the new year.On this last day of the year it what a widely-held belief that on this one night the spirits of the dead could visit the living. Family members would leave a plate of food and a place set at the table to welcome their spiritual guests. People would also leave gifts of food out to keep from angering the evil spirits and causing them to do mischief. It was a preventative measure. The saying â€Å"trick or treat† was a question, because if you left no treat you may wake up the next morning to find you had been victim of a trick or some form of mischief B. Thanksgiving blah blah During Thanksgivi ng, it is traditional to roast a turkey.When it is served, it's also traditional for two people to take the wishbone (the bird's clavicle) each making a wish, they pull apart the bone to break it. The person ending up with the larger piece will supposedly get his or her wish. Although Thanksgiving is an American holiday, the wishbone custom was brought over to the new world by the Pilgrims from England, where it had long been in practice. The ritual of breaking apart the wishbone can be traced back to the ancient Romans, Etymologists claim that the expression ‘get a lucky break' initially applied to the person winning the larger half in a wishbone tug-of-war. III. There are many wedding traditions that may seem a little silly and far fetched, and even though most of us don’t know their origin or meaning, we still include them in our wedding day rituals. A. It’s bad luck for the groom to see the bride in her wedding dress before the ceremony. 1. During the time wh en arranged marriages were custom, the couple wasn’t allowed to see each other before the wedding at all. The wedding symbolized a business deal between two families and a father would have been pleased for his daughter to marry a man from a rich family.But he also feared that if the groom met the bride before the wedding and thought she wasn’t attractive, he’d call off the wedding, casting shame onto the bride and her family. Therefore, it became tradition that the bride and groom were only allowed to meet at the wedding ceremony so that the groom did not have the opportunity to change his mind. And that veil the bride wears? Its original purpose was also to keep the groom from finding out what the bride looked like until the last possible minute, when it was too late to back out of the transactionB. Ringer Finger 1. C. The person who catches the bride’s bouquet or garter when she tosses it over her head will be the next to get married. 1. The story behi nd this tradition is downright dirty. In medieval times, it was considered lucky to get a fragment of the bride’s clothing, so hordes of guests would follow the newlywed couple into their wedding chamber after the ceremony and stand around the bed, trying to rip pieces of the bride’s gown right off her body.Because dresses were often torn apart, brides searched for alternatives to preserve their gowns and began throwing their bouquets to distract guests while they made their getaway. When the bride and groom made it safely into their wedding chamber, the groom would then crack open the door and toss the bride’s garter to the throngs of people waiting outside as a way of saying that he was about to â€Å"seal the deal. † D.The groom must carry his new wife across the threshold of their new home to prevent bad luck. 1. In ancient cultures, the threshold of the home was considered to be a hotbed of lurking, unattached evil spirits, and since a new bride was particularly vulnerable to spirit intrusion, especially through the soles of her feet, the groom ensured that his wife would not bring any bad spirits into the house by carrying her inside. Conclusion

Free Essays on The Professors House

that Willa Cather lived by. In the novel, The Professor’s House, Cather’s life is directly parallel to the life of the main character, Professor Godfrey St. Peter. Through St. Peter, the reader is able to observe the struggles as well as triumphs that occurred at that point in Willa Cather’s life. Her struggle with materialism versus idealism, discovery of religion, and her own mid-life crisis are all shown through the character of Godfrey St. Peter. In 1922, Cather became â€Å" increasingly distressed with the growing mechanization and mass-produced quality of American society† (Norton). This was the time her writing took a new direction and became more concerned with finding alternative values to the materialistic life she increasingly felt around her. This is shown through St. Peter’s character in many instances. St. Peter was extremely idealistic and generally avoided anything that even remotely seemed materialistic. In Book 3 of The Professor’s House, St. Peter reflects on Tom Outland’s untimely death. He describes how the only way to remain idealistic in today’s society is to die. â€Å"A hand like that, had he lived, must have been put to other uses, His fellow scientists, his wife, the town and State, would have required many duties of it†¦.he had escaped all that. He had made something new in the world-and the rewards, the meaningless conventional gestures, he had left to others† (237). St. Peter believes that Tom was only able to retain his idealism through his death, leaving all the materialistic matters behind for others to handle. One of the more subtle ways that St. Peter demonstrates his idealism is through his new house. â€Å"He couldn’t make himself believe that he was ever going to live in the new house again. He didn’t belong t... Free Essays on The Professor's House Free Essays on The Professor's House The Professor’s House: The Life of Willa Cather as Compared to the Life of Godfrey St. Peter Write what you know. These are words that Willa Cather lived by. In the novel, The Professor’s House, Cather’s life is directly parallel to the life of the main character, Professor Godfrey St. Peter. Through St. Peter, the reader is able to observe the struggles as well as triumphs that occurred at that point in Willa Cather’s life. Her struggle with materialism versus idealism, discovery of religion, and her own mid-life crisis are all shown through the character of Godfrey St. Peter. In 1922, Cather became â€Å" increasingly distressed with the growing mechanization and mass-produced quality of American society† (Norton). This was the time her writing took a new direction and became more concerned with finding alternative values to the materialistic life she increasingly felt around her. This is shown through St. Peter’s character in many instances. St. Peter was extremely idealistic and generally avoided anything that even remotely seemed materialistic. In Book 3 of The Professor’s House, St. Peter reflects on Tom Outland’s untimely death. He describes how the only way to remain idealistic in today’s society is to die. â€Å"A hand like that, had he lived, must have been put to other uses, His fellow scientists, his wife, the town and State, would have required many duties of it†¦.he had escaped all that. He had made something new in the world-and the rewards, the meaningless conventional gestures, he had left to others† (237). St. Peter believes that Tom was only able to retain his idealism through his death, leaving all the materialistic matters behind for others to handle. One of the more subtle ways that St. Peter demonstrates his idealism is through his new house. â€Å"He couldn’t make himself believe that he was ever going to live in the new house again. He didn’t belong t...

Hurray for Slew!

Hurray for Slew! Hurray for Slew! Hurray for Slew! By Maeve Maddox I saw a headline in my morning newspaper (Yes, I still read print!) that renewed my hope that one of my favorite irregular verb forms, slew, is going to survive after all. U.S. says raid slew leader of terror cell Ever since Buffy the Vampire Slayer ruled the television waves, the regularized form slayed has been gaining ground. The traditional simple past form, slew, was slipping away, but between headline writers and writers of fantasy, it may have a new lease on life. Slew has fewer letters than slayed and in writing headlines, short words trump long words. I like slew because it sounds more deadly, serious, and final. Buffy slew the vampire. David slew Goliath. Saint George slew the dragon. If youre going to opt for slew for the simple past, youll want to use the past participle form slain: Buffy has slain the vampire. On the other hand, I can think of at least one context in which it would be more suitable to use the -ed form. A common figurative expression to describe the effect of a funny comedian is to say, He slays me. Ex. That Jerry Seinfeld just slays me! Translation: Jerry Seinfeld makes me laugh. It would sound odd even to me to put it in the past as The other night at the club, Jerry Seinfeld just slew me. When it comes to killing unusual creatures, however, or writing tight headlines, you can go with the irregular forms of slay/slew/slain. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:35 Synonyms for â€Å"Look†Ten Yiddish Expressions You Should Know15 Names and Descriptions of Effects

Patient verification Research Paper Example | Topics and Well Written Essays - 750 words

Patient verification - Research Paper Example Alternatively, the patient can physically present a document of identification like a driver’s license or social security card. These credentials or documents locate a stored biometric template usually linked to it from a previous enrollment. After provision of the credential or document, the patient scans his or her biometric. The captured template gets compared against the stored template which has been located with the documents. After this, what follows is the confirmation or denial of the patient’s claimed identity by the biometric scan which gets supported by verbal confirmation to an identification name. The main area where patient misidentification may occur is during blood transfusions, surgical interventions and drug administration. Patient verification occurs when a healthcare worker can confirm that the identity documents given by the patient match those on the patient’s identity documents. Statistics Recent statistics show that there have been forty percent cases of patient misidentification. In the entire healthcare industry, lack of proper patient verification results in the wrong person procedures, discharge of infants to the wrong families, medication errors, testing errors and also blood transfusion errors. According to the United States Patient Safety Agency, there were more than 100 cases of patient misidentification between 2000 and 2003. ... This can be attributed to new technologies like bar coding that have improved the process of patient verification. Such interventions have proved to be quite cost effective in the healthcare industry. Implications Since patient misidentification has been noted to be the cause of many root errors, various measures have been taken to control the problem. The Joint Commission of the United States made improvement of patient identification accuracy its focus in the National Patient Safety Goals introduced in 2003 (Marie, 2009). This still continues to be a requirement for accreditation. The National Priorities Partnership and National database of nursing quality indicators show that patient misidentification poses as one of the most serious risks to the safety of patients. It cuts across the entire healthcare practice and, therefore, is an issue of major concern. The implication of patient misidentification is that thousands of people get injured by the health system the seek help. This increases the need for limiting working hours for health care members whereby an increased number of workers care for each patient (WHO, 2007). The National Patient Safety Agency decided to incorporate the NHS number in order to reduce and possibly mitigate the risks of patient misidentification. Enhancing quality There are various ways that enhance quality concerning patient verification. This can get done by ensuring that all aspects of the management of patient verification comply with the existing recommendations from the National Safety Agency. There must be clear procedures and standards for healthcare workers involved in patient verification (Medscape, 2013). These standards provide a framework for the required work ethics and, therefore, mitigate the risk of

Discussion Board 4-1 Assignment Example | Topics and Well Written Essays - 250 words - 4

Discussion Board 4-1 - Assignment Example Working with a client suffering from learned helplessness can prove to be very challenging and unworkable (Ungar, 2011). Special techniques and approaches have to the present and innovated to help tackle the complex counseling environment usually presented by learned helplessness. One of challenges working with a client suffering from learned helplessness is that they are also reluctant to take advice and counseling. This makes it difficult for counselors to succeed in engaging the clients in negotiation and navigation. Dully, a counselor fails to understand or know about the problems of clients. Another common challenge encountered when working with clients suffering from learned helpless relates to the difficulty to accept changes (Ungar, 2011). Victims of learned helplessness tend to be contented with the little they usually have as well as their contemporary conditions that, however, suffocates them. Counselors may struggle and apply many strategies, but fail to persuade individuals with the condition to adopt normal lifestyle. At sometimes, a counselor may consider transferring a client from one region where abuse erupts to a calm place designated for recovery alone (Ungar, 2011). The clients set to gain such favors may resist and insist on staying in th e same condition for a longer time. Some battered women have refused attempts by law enforcing officers and counselors intending provide them with alternative shelter, or arrest batterers after long time of enduring

Bias or the Predisposition an Issue Assignment Example | Topics and Well Written Essays - 500 words

Bias or the Predisposition an Issue - Assignment Example The title itself gives away the author’s leaning against Karadzic using the word â€Å"mock† – a word that has harsh implications such as to treat somebody with scorn. Though according to the article the former Bosnian President has â€Å"demanded another nine months to prepare his defence† (Charter, 2009, para. 2) and â€Å"mock† can literally mean to prevent something, the choice of words connotes Karadzic’s actions to cause frustration or humiliation- a far too great accusation that becomes personal in relation to the judges present at the court. Other words used to describe Karadzic include â€Å"a psychiatrist who hoodwinked many with his disguise† (Charter, 2009, para. 3) and â€Å"wraithlike shadow† (Charter, 2009, para. 4). The first description already insinuates that the former Bosnian Serb leader is indeed already guilty of tricking his whole nation even before the trial has started. The writer here forgets that the t rial is ongoing in the first place to assess whether Karadzic is guilty or not. The second description, on the other hand, is plainly a figure of speech- a rhetorical device that appeals to the imagination of readers to suggest how evil Karadzic is. Upon further inspection of the way the article is written, the tone of the writer becomes apparent: he is the one who is, in fact, mocking Radovan Karadzic as he mimics the actions of the defendant by putting them into words in a demeaning way: It seems that his exasperation subsided when Karadzic â€Å"finally graced the UN war crimes court† (Charter, 2009, para. 1) – his tone condescending in even being patient for Karadzic’s arrival. The placement of certain facts and the pertaining to the defendant can put emphasis on ideas and also give away the inclination of the writer: The placement of â€Å"a psychiatrist who hoodwinked many with his disguise on the run as a New Age healer and who prides himself as a master of mind game†Ã‚  (Charter, 2009, para. 3) between dashes is sure to stick to the reader’s mind as the whole story of the life of Radovan Karadzic, not to mention the reference to Karadzic being a â€Å"master of mind games† (Char ter, 2009, para. 3) will surely make readers think twice before sympathizing with him.

Health Essays Myocardial Infarction Mortality

Health Essays Myocardial Infarction Mortality Myocardial Infarction Mortality 1.0 Introduction In the UK, about 838,000 men and 394,000 women have had a myocardial infarction (MI) at some point in their lives, (NICE clinical guideline 48, 2007). The latest statistics from the British Heart Foundation state that approximately 227,000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess the prognosis of patients below the glucose cut off threshold for DIGAMI treatment and whether or not this borderline category falls in to the highest risk group in terms of mortality and morbidity. To determine if there is both a clinical and analytical case to use fluoride oxalate tubes for plasma glucose and HbA1c collection and analysis in East Lancashire. To ascertain the effect of a previous DIGAMI audit conducted in 2006 by the Clinical Audit Team and reflect on any improvements of conformance to the protocol two years later. If there is a significant relationship between HbA1c and prognosis then a risk stratification chart and a more clinically and analytically robust inclusion criteria on to the intensive treatment protocol (DIGAMI Regime) can be determined. This could lead to a better prognosis for a group of patients that fall into a borderline category that are not currently treated under the current protocol who potentially should be depending on the results of this study. 1.3 Cardiovascular Disease 1.3.1 Incidence of CHD The incidence of CHD follows different trends across the UK depending on various factors including regional, socio-economic and ethnic differences. There is a definite North-South gradient, and mortality rates are at the highest in Scotland and the North of England. Social class inequalities in mortality rates show that male manual workers are 58% more likely to suffer premature death from CHD than non-manual workers. Statistics also show that South Asians (Indians, Pakistanis, Bangladeshis and Sri Lankans), are more likely to suffer premature death with figures of 46% for men and 51% for women. This ethnic grouping the highest risk (Figure 1.). The East Lancashire NHS Trust provides a service for over half a million people offering care across four hospital sites. The population of East Lancashire falls into one of the higher risk areas in the UK with local authority statistics for reflecting this fact. Age-standardised death rates per 100.000 in Blackburn with Darwen, Burnley, Rossendale, Nelson and Pendle show that these areas fall into the upper fifth quintile for men and upper fourth and fifth quintile for women (Coronary Heart Disease Statistics 2005). In the Lancashire NUTS-2 area, which includes Blackburn with Darwen Unitary Authorities 93.4% of the 1.41 million residents classified their ethnic group as white British, Irish or other white background. A further 5.3% gave their ethnic group as Asian or British Asian. This figure is 1.3% above the national average. Even more pronounced is when the East Lancashire population is singled out, where the percentage rises to 10.8%. (Appendix ). The sub region of East Lancashire contains the highest proportion of ethnic minorities which is a contributing factor to the high incidence of CHD in addition to the socio-economic differences compared with other regions. Myocardial Infarction 1.4.3 Risk Factors Pathophysiology 1.4.2 Morbidity and Mortality 1.4 Diabetes Although there have been significant advances in the care of many of the extrapancreatic manifestations of diabetes, acute myocardial infarction continues to be a major cause of morbidity and mortality in diabetic patients. Factors unique to diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Autonomic neuropathy may predispose to infarction and result in atypical presenting symptoms in the diabetic patient, making diagnosis difficult and delaying treatment. The clinical course of myocardial infarction is frequently complicated and carries a higher mortality rate in the diabetic than in the nondiabetic patient. Although the course and pathophysiology of myocardial infarction differ to some degree in diabetic patients from those in patients without diabetes, much more remains to be known to formulate more effective treatment strategies in this high risk subgroup. J Am Coll Cardiol, 1992; 20:736-744 Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis RM Jacoby and RW Nesto Myocardial function is further impaired in diabetic patients by the metabolic changes that occur in the early stages of myocardial infarction: insulin resistance and hyperglycaemia are induced by release of catecholamines, cortisol, glucagon, and growth hormone.10 At the same time, secretion of insulin by the pancreatic islets is reduced,11 which impairs the ability to compensate for this state of insulin resistance. The combination of low insulin concentrations and elevated catecholamine concentrations increases release of non-esterified fatty acids, which augment myocardial oxygen requirements and depress mechanical performance. 12 BMJ 1996;313:639-640 (14  September) Editorials Insulin infusion in diabetic patients with acute myocardial infarction 1.4.1 Pathophysiology Mention stress hyperglycaemia 1.5 Glycated Haemoglobin Glycation is a nonenzymatic process of adding a sugar residue to amino groups of proteins. Normal adult haemoglobin usually consists of Hb A (97%), Hb A2 (2.5%), and HB F (0.5%). HbA1c is one of a group of a minor haemoglobins separated from the major constituent Hb A. It has become the dominant measure of glycated haemoglobin because of improved analytical techniques and ease of routine separation and quantification. HbA1c is formed by the condensation of glucose with the N-terminal valine residue of the haemoglobin ÃŽ ²-chain to form an unstable Schiff base followed by dissociation or a Amadori rearrangement to form the stable ketoamine (Figure ). The glycation of haemoglobin is essentially irreversible and its level depends on the lifespan of a patient’s red blood cell and the blood glucose concentration. Tietz p791 HbA1c is primarily used as an indicator of glycaemic control and used in diabetic monitoring. The feasibility study of the DCCT trial (diabetes control and complications) published in 1993 provided evidence for the much hypothesised opinion that better glycaemic control would decrease long term complications of diabetes mellitus and that the HbA1c test can be used as a measure of this. The UKPDS (U.K. Prospective Diabetes Study) followed on from these findings and conducted the largest clinical research study of diabetes focussing on reducing life-threatening complications by appropriate treatment including maintaining a HbA1c result of 7.0% or below (see section 1.5.1). 1.4.1 Utility of HbA1c Type 2 diabetes can be diagnosed using two different criteria, the fasting plasma glucose (FPG) and the 2 hour glucose value of the oral glucose tolerance test (OGTT) which is the ‘gold standard’. The FDG cut-off value of 7.0 mmol/L has been calculated to roughly correlate to the OGTT 2 hour diagnostic value of 11.1 mmol/L and provides greater reproducibility. A major disadvantage to the patient is the requirement to fast prior to both of these protocols. Glycated haemoglobin concentration is an indicator of the average blood glucose level over approximately 90 days. Though the lifespan of a red blood cell is normally 120 days, the contribution of the plasma glucose concentration to glycated haemoglobin differs depending on the time interval, with the largest influence on the HbA1c value being the most recent. It provides a retrospective index of integrated plasma glucose levels and has been suggested to have a role to play in the screening and diagnosis of diabetes in addition to its primary role of monitoring diabetic control. The debate of whether an HbA1c result could be used for diagnosis continues despite the generally accepted argument that the test as a single entity is not sensitive enough to provide definitive cut-off values and determine reference ranges because the values of the two populations; non-diabetics and diabetes overlap. An HbA1c result above the upper reference limit however is specific for glucose intolerance. Another concern is the limitations of the HbA1c result in individuals with abnormal haemoglobinopathies and anaemias, especially when the latter is secondary to haemolysis or iron deficiency (Kilpatrick, 2005). Glycation depends on the lifespan of a patient’s erythrocyte and the blood glucose concentration so in these groups the results will not be accurately representative of metabolic control in comparison to reference ranges based on the general population. 1.4.2 Reason for the Study It is highly unlikely that the HbA1c test will replace routine glucose testing for the diagnosis of type 2 diabetes but it may still have an invaluable role in this area. HbA1c levels may be less influenced by acute stress induced by an ischemic event compared with plasma glucose and therefore could be useful as a tool for differentiating patients with diabetes, and identifying undiagnosed cases in the inpatient setting. Although the increased risk of CHD with type 2 diabetes is universally accepted, a study conducted by Khaw et al. of the general population showed that medically diagnosed diabetes only accounted for 20% of all CVD fatalities. The majority of fatal events came from apparently healthy individuals with a glycated haemoglobin > 6% in the absence of diabetes and this relationship was independent of other risk factors (Khaw et al., 2002). Minor glycometabolic dysregulation may be associated with an increased risk yet this route of research has been poorly explored. If a strong correlation exists then HbA1c could be used as a routine test in the primary prevention of CHD, and patients with suspected acute coronary syndromes can be diagnosed with dysglycemia. In this identified group of individuals, intensive treatment could improve the long term prognosis of the patient. 1.5 Previous Studies DIGAMI 1 and 2 DCCT VA Cooperative Study UKPDS 1.6 Current Situation at the RBH East Lancashire Hospitals NHS Trust provides a range of health care and acute services to the Boroughs of Blackburn, Burnley, Hyndburn, Pendle, Ribble Valley and Rossendale with a population of approximately 515,000 falling into its catchment area. The primary purpose of the Pathology Department at Blackburn Royal Infirmary is to provide a high quality testing service for the diagnostic, screening and monitoring of patient samples. Recent drivers for change revolve around The Pathology Modernisation Programme which was launched in 1999. This aims at improving the quality and efficiency of NHS pathology services and encourages the introduction of new technologies and practices to deliver high quality patient care and matching capacity with increased demand. England’s National Health Service has embarked on an ambitious program of system reform. The Labour Government has committed to increase NHS spending to implement changes of streamlining services and improving quality of service. One of East Lancashire Hospitals NHS Trusts Key Objectives is to streamline diagnostic services and to reduce overheads as part of a Trust wide cost improvement programme. The aim is to work ‘smarter’ rather than ‘harder’ to balance activity with demand. However, current capacity to meet demand is almost at saturation point and we have reached the inevitable point in which processes have to change. 1.6.1 Post MI Management DIGAMI 1.6.2 Laboratory Service to Users The decision of treatment for some patients with a suspected MI can rely on the venous glucose result. It is therefore paramount that the result validated is accurate and precise. 1.6.2.1 Glucose Stability The MI patients treated as per DIGAMI protocol are diabetic patients or non-diabetics with a glucose of >11.1mmol/L. An area of contention is the fact that for inpatients, serum glucose is collected in Startedt S-Monovette ® gel tubes containing no preservative and analysed on the VITROS 5,1 FS chemistry system. The manufacturers’ guidelines state the stability of glucose decreases by approximately 8% for every half an hour prior to separation of the serum from the cells (VITROS datasheet ). Though samples from A+E are dealt with urgently this is a short timeframe from collection to result. Some bloods are taken via a paramedic collection on route to the accident and emergency department and therefore are delayed even longer prior to analysis. The stability of serum glucose is a well known problem hindering the accuracy of results this is the reason that samples arriving from GP surgeries are processed routinely on the Thermo Konelab analyzer using blood collected in tubes containing a fluoride oxalate preservative. It has been discussed to also use such tubes for ward samples, with all glucoses being run on the VITROS analyzer. Up to now the stability issue of hospital samples has not been thought of as a clinical hindrance because they are prioritised and processed sooner than the GP samples and therefore there has been a ‘medically allowed tolerance’ The importance of the admission blood glucose result has come to light as it can be a deciding factor for the inclusion of MI patients on to the intensive DIGAMI treatment protocol, and as a direct consequence, will have a clinical impact on the prognosis of a patient. Due to the glucose being metabolised by the cells and giving a falsely lower result, a group of borderline patients may not meet the inclusion criterion for DIGAMI as a result and have a worse prognosis than they should have. Therefore this is an issue of great clinical importance. This project should indicate to what extent the stability is a problem and approximately how many patients it affects. If the HbA1c result could be utilised as a complimentary test to be used in conjunction with known diabetic status and admission plasma glucose then the inclusion criteria would be both more clinically and analytically reliable. Historically HbA1c analysis is performed by the haematology department on EDTA blood samples for logistical reasons. If analytical stability and comparison studies show that fluoride oxalate tubes can be used accurately and precisely for glucose and HbA1c analysis then one biochemistry tube would be sufficient for both tests. Laboratory practice for diabetic diagnosis and monitoring could then be a leaner process for cascade HbA1c testing in terms of archiving, retrieval and storage of samples. 1.7 Clinical Audit Clinical audit is a quality improvement process which is a component of clinical governance within the NHS introduced to improve patient care through a systematic review against explicit criteria and the implementation of change. Participation is recognized by the General Medical Council as an integral part of good practice and the results should be used to improve the quality of care. The Myocardial Infarction National Audit Project (MINAP) is funded by the National Institute of Clinical Excellence (NICE) and is carried out by the Royal College of Physicians (RCP). It was established in 1999 as a method of clinical audit to examine the quality of management of myocardial infarction and shows how hospitals in England and Wales are performing against targets in the NSF for CHD. 1.7.1 Summary of 2006 DIGAMI Audit In 2006, the clinical audit team conducted an audit with one of its’ main objectives being to assess whether the DIGAMI protocol was being adhered to. This was a retrospective study in which the casenotes of 46 patients were viewed and information extracted. These patients were either known diabetics or had a plasma glucose of >11.1mmol, and had presented with cardiac pain. A summary of the baseline characteristics was that over half of the patients were of Asian descent, there was a slight female prevalence and the majority included were known diabetics. They also concluded that the DIGAMI regime was only initiated in 24% of the cases, whereas all 46 patients should have been treated as per current protocol. Another non-conformance to the protocol was the fact that approximately 50% of the patients did not have a venous blood glucose checked by the biochemistry laboratory (Bharucha et al., 2006). The results of this audit will be re-addressed in this study to ascertain the effectiveness of the recommendations and the impact of the results two years on. Reasons for undertaking this project According to estimates there are as many as a third of undiagnosed diabetics (as cited in Greci et al., 2003). The DIGAMI regime is an intensive treatment protocol for the management of myocardial infarction in patients known to have diabetes mellitus or in patients with hyperglycaemia on admission. At East Lancashire NHS Trust, intensive treatment with intravenous dextrose and insulin reduce and control blood glucose levels to between 4-9 mmol/L. Currently, there is a standardised inclusion criterion and treatment protocol rather than a treatment programme which is graded in intensity, and tailored to individual glycometabolic status. Hospital glucoses are analysed using serum collected in Starsedt Monovet 4.2 ml gel tubes. The manufacturers’ guidelines state the stability of glucose could decrease by 7% every half an hour prior to separation of the serum from the cells. Although samples from A+E are dealt with urgently this is a short timeframe. Paramedic collection of samples on route mean even longer time delays before separation.

Eye Ball :: Literary Analysis, Spiegelman

What would you expect to be the mindset of a misfit kid who isn’t really that popular who is playing baseball with the other kids because he wants to fit in with them instead of being himself? There is such a boy in a first person short story that was written by a worldly-renowned author. In â€Å"Eye Ball,† Spiegelman uses characterization to develop the theme of be yourself and don’t try to fit in with others at the expense of showing your true self. Spiegelman’s use of the little misfit boy as a round character reflects the theme because he realizes that he doesn’t fit in so well with all the other boys. Being a kid with Amblyopia, or â€Å"lazy eye†, he already knew that he was at a disadvantage and he points out his condition when he is saying â€Å"since I’m virtually blind in my left eye† and when he said â€Å"Amblyopia, a â€Å"lazy eye,† made my whole world 2D† (130). He still tries to play baseball with the other boys, but he quickly finds out that he isn’t that good at it. Identification can be made with the out-of-place feeling that the little boy most have felt. Now he is most likely feeling down because he did poorly when he was up at bat. Most out of place people â€Å"must escape into fantasy and/or develop a rarefied sense of humor to survive† (130). The usual â€Å"boy in 1950s America, baseball was not optional and to be inept assured a place in the social hierarchy even lower than a girl’s† (130). This shows that there was a current stereotype of how little boys should be and he tried to be stereotypical with all of the other little boys. Spiegelman’s use of the little misfit boy as a dynamic character reflects the theme because he learns to be himself and not try to be something that he isn’t. He realizes that he is out of place when the boys placed him and he â€Å"was inevitably relegated to right field, far out of harm’s way† (130). While in the outfield he thought that his boredom took out his â€Å"anxiety that a ball might come† (130). He already knew before he went with the boys, that playing baseball with them wasn’t going to go smooth so he â€Å"often kept some comic book handy† (130). While he is thinking, he finally realizes that his true comfort is in comics and not sports.