Response to Text Carlitos Way

Response to Text: Carlitos Way The film Carlito’s Way directed by Brian De Palma uses visual and verbal techniques to show the idea of world of crime. The main aspects of world of crime are loyalty, betrayal and can’t escape your past are all shown in the film. Together visual and verbal techniques are used to show the main idea of the film which is world of crime. An important idea in the film Carlito’s Way is the idea of loyalty. Loyalty is shown throughout the film by Carlito to his friends. Carlito played by Al Pacino shows loyalty to his friend Dave played by Sean Penn when he is going on the boat to help get Tony T out of Prison.The verbal technique dialogue is used to show the idea of loyalty. When Carlito is on the boat with Frank Tony T’s son Frank asks Carlito, â€Å"is this guy a friend of yours,† and Carlito replies ,â€Å"Yea, He’s a friend of mine,† this shows that Carlito is loyal to Dave even though they are in a situat ion where Carlito could go back to Prison, or worse he could die. Brian De Palma has used dialogue to show that in the world of crime loyalty is a big idea and when people are loyal to their friends then they will do anything for them even if it is a danger to their life.This show the Audience that Carlito is loyal to Dave for getting him out prison and feels that he owes Dave and he will pay him back in any way. This also shows in the world of crime you must also pay people back when you owe them. I’ve learnt from this that in the World of Crime I should be loyal to my Friends no matter what situation I am in. Another important idea in Carlito’s Way is the idea, can’t escape your past. The idea of can’t escape your past is shown by Carlito when he has just hit Benny Blanco down the stairs and is shown through the visual technique and verbal technique of lighting and voiceover.When Carlito is standing at the top of the stairs about to hit Benny Blanco the lighting on his face is red which shows Carlito’s dark and bloody past, he then hits Benny and there is a voiceover of Carlito saying â€Å"Dumb move, man. Dumb move. But it's like them old reflexes coming' back. † this reinforces the idea of can’t escape your past because that is what Carlito used to do in his past. Brian De Palma uses these to show that when you have got into the World of Crime you can’t escape even when you want to.This shows the Audience that you can’t escape the world of crime even if you want to start fresh as it will always drag you back in. I have learnt from this that you shouldn’t get in to the world of crime in the first place as you will never be able to get out of it once you are in, even if you try to get out. Another important idea in Carlito’s Way is the Idea of betrayal. This idea is the most important as it would be the most common in the world of crime. It doesn’t matter who is going to betr ay you, it could be your best friend or a family member they can still betray you if they think it’s going to benefit them.The idea of betrayal is shown by Pachanga when he betrays Carlito to Benny Blanco and is shown through the verbal feature Dialogue. When Carlito is at the train station and about to board the train Benny Blanco shows up and shoots him, Pachanga then comes and says ,â€Å"Hey no hard feelings Carlito. But I got to think about my future, too. You know, it is that way sometimes, papi. Come on, let's go,† Benny then says, â€Å"No you stay here,† and then kills Pachanga because he is no more use to Benny.Brian De Palma uses this feature to show that in the world of crime Carlito can be betrayed by anybody even one of his closest friends. This also shows that in the World of Crime someone can betray you just because they need to make some money and that it doesn’t matter if you have been friends your whole life. This shows the audience tha t betrayal is very common in the world of crime and can come from anywhere even your closest friends. I have learnt from this that in the world of crime you should trust no one as you don’t know who could betray you.In conclusion the visual and verbal features such as dialogue, lighting and voice over are all used to show the ideas of can’t escape your past, betrayal and loyalty which are all in the World of Crime. All the techniques together can show the viewer the ideas about betrayal and how anyone can betray you in the world of crime, the idea of loyalty and how you should be loyal to your friends in the World of Crime no matter what situation you are in and the idea of you can’t escape your past and when you get into the World of Crime you can’t get out even if you want to.Brian De Palma used these visual and verbal features to show the audience the world of crime and how it affects you in life. I have also learnt from this film that you should be lo yal to your friends but also be wary because betrayal could come from any direction whether it is friend or family and eventually your past can catch up with you.

Hesi Topics

Potential Community Health HESI Topic Areas These are some additional areas you may want to considering being familiar with: Ancathosis nigricans A skin condition characterized by dark, thick, velvety skin in body folds and creases. Most often, acanthosis nigricans affects your armpits, groin and neck. There's no specific treatment for acanthosis nigricans † but treating any underlying conditions, such as diabetes and obesity, may cause the changes in your skin changes to fade Characteristics of acanthosis nigricans include: Skin changes. Skin changes are the only signs of acanthosis nigricans.You'll notice dark, thick, velvety skin in body folds and creases † typically in your armpits, groin and neck. Sometimes the lips, palms or soles of the feet are affected as well. Slow progression. The skin changes appear slowly, sometimes over months or years. Possible itching. Rarely, the affected areas may itch. Acanthosis nigricans is often associated with conditions that increa se your insulin level, such as type 2 diabetes or being overweight. If your insulin level is too high, the extra insulin may trigger activity in your skin cells. This may cause the characteristic skin changes.Question pertained to nurse checking for lice and noticing dark patch of skin on neck. Advisor role Antepartum – risk factors Anthrax incubation and exposure Assess trends and patterns Assessing income Assessment – validation Assignments – home care; Make sure students know how to prioritize home health clients (i. e. which ones to see/call back first. ) When given the choice between a patient with COPD who is short of breath, a terminally ill pt who refuses to eat or drink, or a pt with congestive heart failure who has gained 3 lbs, choose the last one.Asthma triage Battering-communication If the question pertains to a nurse suspecting a female patient has been abused and the woman has her child in the room with her, the nurse should ask the child to leave the room and question the woman about the abuse. The question does not pe rtain to the child being abused. Breast cancer-risk (who is at greatest risk) Calculate rate – population COBRA-cost (client still has to pay for expenses) When the question asks what would be a concern for a person who has lost their Job but has COBRA, the answer is paying for health care/expenses.Communicable disease (pertussis) Community – assessment Community Assessment – TB Community data source Community education – evaluate Community resource – elderly Community resources-population age Community resources – rural Community strategies – mental deficiencies Cultural competence Cultural -lactose intolerant Cultural – Native American (Native Americans are at high risk for diabetes – have the highest rates, so the nurse needs to screen for and educate about this).Culturally sensitive teaching CV disease – African American Diabetes AIC If a nurse is working in a community with high rates of diabetes and implements a program, at the end of 1 year (or whatever evaluation period is stated) the nurse will ant to evaluate hemoglobin A1 C levels to determine effectiveness of program.Disaster – Cholera (Priority for treating those with cholera: fluid and electrolytes) Disaster- Professional Disaster – red tag triage Disaster planning Disaster Preparedness – START Disaster triage – color system Elder abuse-Home setting Elder health – assessment Employee health Epidemiological triad host Epidemiological triad agent Fall in home Family assistance – ophthalmic meds Family ecomap Flu vaccine-priority Gatekeeper Genetic risk – assessment Geriatrics – home nutrition Geriatric syndrome – home health GTD-hCG valuesHealth Promotion Program – Planning Heart healthy diet – limit Heat stroke If an adolescent is playing sports at school and goes to the school n urse with red, dry skin and other symptoms of heat stroke, the first thing the nurse should do is call for emergency personnel (not assess). Hepatitis A – risk Main route is through fecal-oral Hep B vaccine – pregnancy Hepatovax B allergy Home care referral Home Health – Management Home health – PT Home safety – post arthroplasty Hypertension-BP measure Immunize – 3rd world country Immunization rates Increase vaccination rates Infant mortality rateInfluenza -prophylactic Relenza Lillian Wald – Henry Street (she established the Henry Street Settlement) Focused on cleanliness, staff was educated, and ventilation Lipid screening Long-term care-infection Long-term car – fall prevention Meals-on-wheels Medicare Menomune vaccine Migrant worker risks Morbidity data – gather Morbidity data-glaucoma If a nurse is working with an elderly population and most of them are choosing to get a surgery that will CURE glaucoma, then the nu rse will be concerned with assessing prevalence of glaucoma (not morbidity). Needs assessment Neighborhood safe housesNeuman model – line of defense Obese children-parent involvement Occupational health – smoking Occupational nurse practitioner role Oral contraceptives – smokers Osteoporosis – prevention Outcome evaluation Polypharmacy – GERI Post vaccination teaching Primary prevention – adolescents Primary prevention – WIC Priority – HF lab results Program goal setting Quality Care – nursing home Quality Care – public clinic management Quality health – bicycle safety Rash with fever – PEDI (chicken pox) Ritalin evaluation – adolescent Assessing intervention with ADHD in an adolescent: get their feedback on mprovement, as their self-esteem is priority School age screen (obesity) School nurse role If an adolescent comes to a school nurse and tells her she is pregnant, the nurse will want to im plement measures to ensure the teen and her baby are healthy. These things include referral to prenatal care, encouraging prenatal vitamins, etc. The nurse will NOT tell the parents and things like arranging childcare or teaching breastfeeding are not something the school nurse will be involved in. screening – DM – PEDI Screening priority Question regarding hypothyroidism and the nurse recognizes that mental ysfunction is a long-term consequence. What is screening priority? Answers included screening for T3 in preschoolers or children (? ), iodine screening in people over 60, TSH in women over 45, and T4 in newborns. The answer is T4 in newborns.Seat belt safety-adolescents Secondary prevention – tobacco Secondary prevention – children Sensitivity of tests Social organization Stakeholder If a community health nurse is going into a community to try to develop or implement an intervention, remember one of the key things he/she must do is form a relationship with someone who would be identified as the stakeholder. Stakeholders will be someone who is invested in the health of the community and will be invested in the program to be implemented. They will be vital in the nurse gaining access into the community, the success of the program, and ensuring the sustainability of the program. STD-Reporting If an adolescent goes to the health dept and is diagnosed with chlamydia, the nurse must report this. It is a reportable disease that is monitored by the state and the CDC, and the disease intervention specialist must be informed to do contact tracing.

A Seperate Piece Essay Research Paper A

A Seperate Piece Essay, Research Paper A Separate Peace In his book A Separate Peace John Knowles communicates what war truly is. He uses a figure of complex characters in a really complicated secret plan in order to convey the harsh, sad, barbarous, destructive forces of war. The Characters Gene and Finny are used as opposing forces in a battle between that cold world of war-that is World War II in this story-and a separate peace. A peace off from the existent war and all of the awful things that come with it. Through their relationship, that is a battle on both sides form the beginning, Knowles establishes the world of war in all of its kernel. Gene Forrester is established as the force of world which is the war. This thought is established clearly in a drawn-out address Gene gives as the storyteller of the narrative in Chapter Three: Everyone has a minute in history which belongs peculiarly to him. It is the minute when his emotions achieve their most powerful sway over him, and subsequently when you say to this individual # 8220 ; the universe today # 8221 ; or # 8220 ; life # 8221 ; or # 8220 ; world # 8221 ; he will presume that you mean this minute, even if it is 50 old ages by. The universe, through his unleashed emotions, imprinted itself upon him, and he carries the cast of that passing minute everlastingly. ( 32 ) This statement explains that Gene must hold something that is his # 8220 ; stamp. # 8221 ; This cast appears to specify an individual-exemplifying what he stands for. It is found that this is true in the following paragraph where Gene continues, # 8220 ; For me, this moment-four old ages is a minute in history-war the war. The war was and is world for me. I still live and think in its ambiance # 8221 ; ( 32 ) . Later in the same paragraph he goes on to state: America is non, neer has been, and neer will be what the vocals and poems call it, a land of plentifulness. Nylon, meat, gasolene, and steel are rare. There are excessively many occupations and non adequate workers. Money is really easy to gain but instead difficult to pass, because there isn # 8217 ; T really much to purchase. . .The war will ever be fought really far off from America and it will neer terminal. Nothing in America bases still for really long, including the people, who are ever either go forthing or on leave. ( 32 ) This is what Gene stands for in the narrative of A Separate Peace. Gene appears to omnisciently understand the world of war and how it effects people. Throughout the full narrative Gene is used to convey in the destructive world of war into the mundane life at Devon High School where there is an effort to make, and exist in, a separate peace. There is nevertheless rather an resistance to this reality-known by Gene-that is headed by Gene # 8217 ; s best friend Finny. Finny has his ain # 8220 ; reality. # 8221 ; Finny displays this world throughout the whole book merely as Gene acts throughout the whole book. From the position of the storyteller, Gene, Finny # 8217 ; s universe is one where there are a batch of things that Finny does to seek and replace for the existent war. This universe or # 8220 ; world # 8221 ; that Finny creates and exists in is the separate peace spoken of earlier. Finny foremost begins to make this separate peace with games. Because Finny can # 8217 ; T face the world of the existent war these games are representative of the war. Finny makes the regulations so that he can be in these games as a force that is never-say-die. The first game Finny invents is # 8220 ; The Super Suicide Society of the Summer Session. # 8221 ; This game consists of jumping of the limb of a tree into the river by Devon High School. As the game is invented both Finny and Gene agree to acquire it started they must leap out of the tree and in to the river foremost. Finny allows Gene to leap foremost. This is where there is a foreshadow of the autumn from the separate peace: We were standing on a limb, I a little farther out than Finny. I turned to state something else, some procrastinating comment, something to detain even a few seconds more, and so I realized that in turning I had begun to lose my balance. There was a minute of entire, impersonal terror, and so Finny # 8217 ; s manus shot out and catch my arm, and with my balance restored, the terror instantly disappeared. ( 24 ) In this case Finny is able to salvage Gene from falling out of his universe into Gene # 8217 ; s # 8220 ; reality. # 8221 ; The thought of Gene understanding that this is truly Finny # 8217 ; s universe comes at the beginning of Chapter Three, # 8220 ; Yes, he had practically saved my life. He had besides practically lost it for me. I wouldn # 8217 ; Ts have been on that darn limb except for him. # 8221 ; Here Gene knows that his traveling into Finny # 8217 ; s world could hold wholly taken his world or life off. This game appears to be a replacement for the existent war more and more as Chapter Three advancements. Gene goes on to explicate how he and Finny signed up # 8220 ; trainees # 8221 ; on the topographic point and how they initiated them every dark ( 25 ) . This clearly resembles the basic preparation and initiating of existent soldiers in the war. Finny besides creates another game that substitutes for the existent war: Blitzball. It is known that this game is related to the war because a boy nowadays during the innovation of the game, Bobby Zane, remarks, # 8220 ; Let # 8217 ; s make it hold something to make with the war. # 8221 ; Finny likes this thought and goes with it. He goes on to do up all sorts of regulations. After all of the parts of the game are invented Gene realizes that, # 8220 ; He had unconsciously invented a game which brought his ain athletic gifts to their highest pitch. # 8221 ; What may be even a more of import statement is what Gene says following the last statement # 8221 ; The odds were enormously against the ball bearer, so that Phineas was driven to exceed himself practically every twenty-four hours when he carried the ball. To get away the wolf battalion which all the other participants became he created contraries and misrepresentations and Acts of the Apostless of sheer mass mesmerism which were so extraordinary that they surprised even him. ( 31 ) Finny made up this athletics and he made it so that he could be in control. This is merely like Finny # 8217 ; s universe of separate peace. Finny continues to touch Gene # 8217 ; s world that is the existent war in much the same manner he does in the games he invents. He continues with this subject by truly neer acquiring in problem. He ever has come capturing manner to do up his ain regulations that he can stay by while disobeying the existent regulations. In making this no 1 seems to keep Finny responsible-they neer truly do him abide by the existent regulations. In Chapter Two Finny wears a pink shirt which he explains is an emblem for the bombardment of Central Europe ( 18 ) . He explains that because he has no flag to wing for them-or anything else related-he will have on the pink shirt. Finny avoids holding to conform to the existent regulations in school that twenty-four hours when Mr. Patch-Withers asks Finny about it-surly because he usually disapproves of such rebellious behaviour. Finny once more explains what he explained to Gene and avoids any problem. Gene remarks, # 8220 ; It was mesmerism. I was get downing to see that Phineas could acquire away with anything. # 8221 ; Further grounds of Finny # 8217 ; s ability to do his world-or separate peace-comes on the undermentioned page. Mr. Patch-Withers offers the # 8220 ; traditional term tea to the Upper Middle Class # 8221 ; ( 18 ) . While at this event Finny explains all of his ideas about the bombardment of cardinal Europe. While making so he poses a inquiry to others, # 8220 ; I think we ought to bomb the daytimes out of them, every bit long as we Don # 8217 ; t hit any adult females or kids or old people, don # 8217 ; t you? # 8221 ; He continues, # 8220 ; Or infirmaries. . .And Naturally no schools. Or churches. # 8221 ; An statement over whether such a effort could be accomplished on the physical degree ensues, but what is truly of import is that Finny says this when it truly is non really plausible-and remains rather implausible up until the late 1980s. Finny doesn # 8217 ; t to the full understand the impact of war on people-he doesn # 8217 ; t understand that war kills people physically and mentally and he doesn # 8217 ; t understand that it effects everyone that has a close relationship with the it ( non including himself ) . It effects adult females, kids, old people, infirmaries, churches and schools. Finny has created a false world here and it is emphasized even more on the following page when he says he believes that, # 8220 ; the school is involved in everything that happens in the war, it # 8217 ; s all the same was and the same universe # 8221 ; ( 20 ) . The truth is that the war is partly involved in the war, but non the manner Finny believes it is. Finny has created a separate peace at Devon that he substitutes for the existent war. Meanwhile, Gene understands that the land that the war is being fought on is, # 8220 ; All foreign lands. . .inaccessible except to military mans ; they are obscure, distant, and sealed off as though behind a drape of plastic. # 8221 ; This transition shows us that although Gene may non hold fought in the war and had first manus experiences of the awful devastation of it, he lt ;< p>has perchance the best apprehension he can without being in the war and he appreciates the war for what it is. This is unlike Finny who creates his ain war within Devon-which is truly a separate peace because of its deficiency of the existent features of the existent war. There is turning point in the book at which all of this creative activity of a separate peace that is non the existent war Michigans and the world that Gene knows-the one that is real-begins to go more clear. A really of import event occurs in Chapter Four. One eventide as Gene is analyzing for an test, Finny announces that Leper is traveling to take his first spring from the tree. This requires the attending of Gene. When the male childs get to the tree to leap Finny suggests that he and Gene jump side by side. This is the first clip that we get to see the symbolism of puting Gene # 8217 ; s world next to Finny # 8217 ; s world to compare the two. While on the limb, someway, Gene # 8220 ; jounced the limb # 8221 ; ( 52 ) . Finny fell to the difficult shore violently and # 8220 ; shattered # 8221 ; on of his legs while Gene jumps # 8220 ; with unthinking sureness. # 8221 ; Here we see that when the two worlds are compared side by side Finny # 8217 ; s falls and shatters. Subsequently in that same chapter Gene puts on Finny # 8217 ; s apparels and looks in the mirror to see that he appears to be merely like Finny ( 54 ) . In making this he understands how each of them are fighting to recognize the right world. Finny sees his world and Gene sees his ain but together they are still really similar even though their thoughts about world are different. The chapter continues with Dr. Stanpole uncovering to Gene that, # 8220 ; athleticss are finished # 8221 ; for Finny. This takes off Finny # 8217 ; s manner to make his separate peace. Finny is non present for the beginning of the autumn session at Devon and as a consequence Chapter Six begins with the statement, # 8220 ; Peace had deserted Devon # 8221 ; ( 64 ) . This indicates the deficiency of peace, the peace that the school had come to cognize when Finny was present-a separate peace. With the deficiency of this peace the door is unfastened for the world that is war to enter. Throughout Chapter Six we begin to see more and more of the existent war to ooze into Devon. We find that, # 8220 ; Five of the younger instructors were losing, gone into the war. Mr. Expressway had come in his Naval ensign # 8217 ; s uniform. . . # 8221 ; With all of this go oning Finny is non traveling to give up his world without a battle. Finny finds out that Gene had signed up as an helper to a squad and informs Gene that # 8220 ; if I can # 8217 ; t play athleticss, you # 8217 ; re traveling to play them for me # 8221 ; ( 77 ) . Gene doesn # 8217 ; T put up any statement to this thought because of his deep friendly relationship with Finny. The fact that he has hurt Finny a batch late likely besides has something to make with his deficiency of statement. After all Finny still is his best friend and aching a best friend is difficult to make even when you know that, to uncover the truth, sometimes you have to. His old exchange is forgotten for a piece as school Begins. When it begins to snow two hundred male childs are recruited to assist shovel snow off of the railway paces in a near by town as portion of # 8220 ; the war attempt # 8221 ; ( 88 ) . This is merely the beginning of the war # 8217 ; s ooze into life at Devon. Later in that same chapter we find the war is set uping the male childs even more where Brinker announces, # 8220 ; I # 8217 ; m giving it up, I # 8217 ; m traveling to enlist. Tomorrow. # 8221 ; In that same chapter Finny returns to Devon to Gene # 8217 ; s surprise. During their conversation in their room Finny finds out that there are no amahs this semester because of the war. Gene remarks on this, # 8220 ; After all, there is a war on # 8221 ; ( 96 ) . Finny # 8217 ; s intuiting response is, # 8220 ; Is there? # 8221 ; It is difficult to state if Finny is being sarcastic or intending something different than what is sounds like with this remark. One can, nevertheless, know that the fact that he said this is of import because it is in the book at all. With this in head it would do sense that this is a remark on Finny # 8217 ; s deficiency of understanding for the existent war that is happening. Later we find that Gene is believing approximately enlisted to function in the war but he decides no to because he doesn # 8217 ; t want to abandon his friend who he has hurt plenty already. With this in head Gene remarks, as the storyteller, # 8220 ; peace had come back to Devon. # 8221 ; This indicates that Finny # 8217 ; s thoughts of the separate peace had returned and Finny attempts to set up them once more after being off so long. The beginning of Finny # 8217 ; s try to regenerate his separate peace takes topographic point when he tells Gene, # 8220 ; You # 8217 ; re traveling to be the large star now. # 8221 ; Gene is hesitating to take this on and goes on to explicate that athleticss didn # 8217 ; t seem as of import to him with the war on. Finny responds to this, # 8220 ; Have you swallowed all that war material. . . there isn # 8217 ; t any war. # 8221 ; This is the point at which Gene comes to recognize that Finny doesn # 8217 ; t believe there is a existent war traveling on. Finny goes on to do Gene make what he can no longer make: vie physically. He does this in order to maintain the thought of the separate peace alive. The thought of Finny non understanding the war is emphasized more when Finny tells Gene that he is traveling to develop him for the Olympics in 1944. Gene responds by stating Finny # 8220 ; there isn # 8217 ; t traveling to be any Olympic gamess in # 8216 ; 44. That # 8217 ; s merely a twosome old ages off. The war- # 8221 ; Finny # 8217 ; s response is, # 8220 ; Leave your fantasy life out of this. We # 8217 ; re preparing you for the Olympics, buddy, in 1944. # 8221 ; Finny openly defies the thought that there is a war traveling on and that it is set uping people around the universe. The 1944 Olympics do non happen. This is the beginning of the terminal for Finny # 8217 ; s separate peace and the events that follow conveying out the undeniable world of the war. It becomes of all time more evident as Leper enlists and the senior male childs are solicited during the winter months by members of the armed forces recruitment squads. Finny continues his deficiency of belief by acquiring involved with the Winter Carnival. Finny does this in an effort to show everyone the peace that he believes is existent. The terminal of Finny # 8217 ; s separate peace continues though when, during the Winter Carnival, he receives a wire. Gene takes the wire from Finny and reads it, it reads: I HAVE ESCAPED AND NEED HELP. I AM AT CHRISTMAS LOCATION. YOU UNDERSTAND. NO NEED TO RISK ADDRESS HERE. MY SAFETY DEPENDS ON YOU COMING AT ONCE. ( signed ) YOUR BEST Friend, ELWIN LEPER LEPELLIER. Gene goes to see Leper and finds he has changed. The first thing he notices is Leper # 8217 ; s left side of his lip raising involuntarily. Gene comes to happen that Gene abandoned the Army after recognizing that he was traveling to have a Section Eight any ways ( a Section Eight is a discharge because of a deficiency of psychological control ) . It is found that Leper does look to hold mental unwellness and has turned into a violent individual who is really angry-something that Leper decidedly wasn # 8217 ; T before he was in the war. Gene brings the intelligence of Leper # 8217 ; s state of affairs back to the school to put out the undeniable verification of the war. Leper has proven to us that there is a war and that it can kill the organic structure and spirit-it is destructive. The male childs finally come to keep a test with Gene to happen out the truth about the autumn that Finny took from the tree. We neer truly happen out if Gene jounced the limb on intent or if he believes he did-all of this is really equivocal. The most of import event during the meeting is Finny # 8217 ; s realisation though. As the male childs are reasoning to seek and happen the truth Finny says, # 8220 ; I merely wear # 8217 ; t attention. Never head # 8221 ; ( 169 ) . Brinker cries to Finny as he runs off, # 8220 ; Wait a minute! We haven # 8217 ; t heard everything yet. We haven # 8217 ; t got all the facts. # 8221 ; Gene narrates, # 8220 ; The words shocked Phineas into consciousness # 8221 ; ( 169 ) . Finny has become cognizant of the existent truth and runs to the stepss in the hallway and Gene narrates, # 8220 ; Then these separate sounds collided into the general uproar of his organic structure falling clumsily down the white marble steps # 8221 ; ( 169 ) . Finny # 8217 ; s separate peace has fallen-literally and figuratively. The operation that Finny must undergo is purportedly simple. The operation is simple but a complication occurs and Finny dies. With Finny dies his separate peace. With the force of Finny # 8217 ; s separate peace on Devon the war comes fully fledged into Devon in the individual of military personnels from Parachute Riggers # 8217 ; school, who take over the Far Common. Gene recognize this as he walks down the halls to hear the P.T. teachers voice shouting, # 8220 ; Hut! Hew! Hee! Hore! # 8221 ; Indeed Gene # 8217 ; s world is the truth: the war is really existent and really destructive. John Knowles communicates what war truly is. He uses complex characters in a really complicated secret plan in order to convey the harsh, sad, barbarous, destructive forces of war. Gene and Finny # 8217 ; s relationship that includes the resistance illustrates this fact. Their relationship is used by Knowles to set up the awful world of war in all of its kernel.

Tracing Dimensions of Changing Culture Essay Example | Topics and Well Written Essays - 1750 words

Tracing Dimensions of Changing Culture - Essay Example The book is a collection of seven short stories beginning with â€Å"Girl with Lizard†, which tells about a boy and his obsession and desire for a mysterious painting he inherited from his parents, which drove him to unconsciously ruin his relationships with women while discovering his parent’s dark past. â€Å"A Little Fling†, a story about a husband’s political betrayal of his wife for her sake, a wife’s betrayal of her husband to spite him, the narrator’s betrayal of his friend as a result of his own naivety, and the revelation, which destroyed the intimate relationship they all shared. â€Å"The Other Man†, a story, which recounts a man’s discovery of his late wife’s affair and his realization about the truth of his marriage. The middle story, â€Å"Sugar Peas†, tells about a narcissistic man balancing his relationships with three women. â€Å"The Circumcision†, which tells of the relationship between a German man and a Jewish girl in New York, is a foray into the sensitive topic of the division caused by their culture and religion. â€Å"The Son†, on the other hand, tells of filial love, described in a dramatic fashion. The book then ends with â€Å"Woman at the Gas Station†; which narrates of a man and his decision to leave his wife. All these stories are bound by the themes of betrayal brought about by obsession, desperation, and historical circumstance – all because of and in spite of love. The themes, embodied in Flights of Love are best exemplified in his opening story â€Å"Girl with Lizard†.

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Business Plan Essay Example | Topics and Well Written Essays - 4500 words - 1

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Sustainability issues in providing Healthcare Services at Nicaragua Research Paper - 1

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Capital Structure of CNG Travel Group PLC Case Study

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Emotional Abuse Awareness Research Paper Example | Topics and Well Written Essays - 1000 words

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Proposal - Reclassifying Department of Child Services Investigators as Assignment

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Kaiser Permanente Risk Management Executive Summary Essay Example for Free

Kaiser Permanente Risk Management Executive Summary Essay Organization Description Kaiser Permanente (KP) is the nation’s largest integrated health care delivery system. KP serves nine states and over nine million members, with an annual operating revenue in 2013 of 53.1 billion. KP is a leader in quality improvement efforts in the health care industry through participation in studies performed by the National Committee on Quality Assurance (NCQA), The Joint Commission (TJC) accreditations, and the implementation of a state of the art electronic health records system, which focuses on integration and quality of care standardization. The focus of this summary is on KP hospitals in the northern California region and will include topics such as the purpose of risk and quality management, risk identification and management, current risks, quality outcomes, organizational goals, and the relationship between risk and quality management. Risk and Quality Management Purpose General The purpose of risk management in health care is simply the process of protecting the assets and minimizing financial losses to the organization (Singh Habeeb Ghatala, 2012). A comprehensive risk management strategy within a health care organization will include focus on continuous quality improvement (CQI). The purpose of CQI in health care, according to Sollecito and Johnson (2013), is to offer a â€Å"structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations† (p. 4). Through linking the processes of risk management and quality improvement the success of both processes is more likely to be realized. Kaiser Permanente The key concepts for risk and quality management at KP are commitment to quality, patient safety, privacy protection, and fraud prevention. KP risk management and quality management programs are central to their mission, values, and culture. Methods currently utilized to support these concepts  within KP are consumer surveys, the use of an integrated EHR with evidence based guidelines and clinical decision-making functionality, stringent patient privacy regulations and processes, continuous clinical and administrative staff training programs, and participation in studies focused on standardizing national quality measures (Kaiser Permanente, 2012). Risk Identification and Management Steps While KP is a leader in health care risk and quality management there are specific steps this consultant is recommending on a continual basis that will improve risk identification and management within the organization. 1. Identify and analyze loss and exposure While there are many methods utilized within the health care industry in the identification and analysis of loss and exposure, the recommended methods for KP are as follows: a) Incident-reporting analysis b) Improvement on the current performance management process for employees to bring focus on risk mitigation and quality improvement. c) Quantitative analysis of patient complaints and satisfaction surveys. d) Review of the organizations past professional liability and workers compensation reports. e) Review of surveys completed by TJC and NCQA on other hospitals in order to identify risk areas that KP should focus on. (McCaffrey Hagg-Rickert, 2009) 2. Research and propose alternative risk techniques To mitigate risks that are unavoidable at KP, a combination of alternative risk techniques will help reduce situations that might negatively affect the organization. A financial analysis and risk analysis should be performed in order to ascertain the likelihood of utilizing the exposure avoidance technique. This is not a likely option as the financial impact of eliminating services may out weigh the risks involved with continuing them. A loss reduction approach is more likely to be the technique chosen for this organization. The core prevention activities that must be present in the loss reduction technique are as follows: a.) Ongoing staff education b.) Current policy and procedure review and revision c.) Updates to the organizations current EHR system to ensure the data present in the clinical decision-making and evidence-based clinical guidelines technology is the most current data available. According to Chen, et al (2009), â€Å"a growing body of literature confirms the value of electronic health records (EHRs) in improving patient safety, improving coordination of care, enhancing documentation, and facilitating clinical decision making and adherence to evidence-based clinical guidelines† (p. 323). 3. Risk management technique selection This two-part process of risk management technique selection is accomplished through forecasting and application of an ongoing measurement process, which will allow KP to analyze the risk management technique with regard to outcome and cost effectiveness. Included in the measurement process both risk treatment and risk-financing techniques should be measured (McCaffrey Hagg-Rickert 2009). 4. Implement the selected techniques Implementation of the chosen risk management techniques may include decisions on insurance coverage and policy changes, overall department workflow changes to ensure compliance with state and federally mandated regulations and guidelines, and elimination of processes that impede or hinder patient safety. 5. Monitor and improve upon the implemented risk management program In order to continue improving upon the newly implemented risk management program a comprehensive monitoring strategy should be employed. In fact, McCaffrey and Hagg-Rickert, (2009) stated, â€Å"a multidisciplinary approach to evaluating the risk management program ensures that the impact of additional opportunities to improve the risk management function are fully explored† (p. 21). a.) Prepare an annual risk management report b.) Compare the new annual report against prior years risk management data (McCaffrey Hagg-Rickert 2009) Current Risks Three risks that KP should take special care to avoid are rejection of newly implemented risk management and CQI procedures by employees, statute and regulatory changes, and health care associated infections (HAIs). 1. Rejection Change implementation is never an easy task and without special care taken the rate of rejection to change by clinical and administrative employees is high. In order to achieve successful CQI changes the following guidelines and recommendations are presented. a.) Minimize employee rejection through easily implemented and followed CQI procedures. b.) Engage employees in planning to increase acceptance. c.) Ensure lateral linkages within the organization across specialty departments to improve communication (Sollecito and Johnson, 2013). 2. Statute and regulatory changes With the ever-changing landscape in state and federal statutes and regulations surrounding the health care industry, special attention to this risk area must be taken. In fact, Cohen (2009) stated that â€Å"health care is one of the most heavily regulated of all sectors of commerce† (p. 328). Failure to comply with state and federal statutes and regulations can bring about negative financial affects at KP, including but not limited to; fines, loss of accreditation and credentialing, and an increase in malpractice lawsuits, not to mention a decrease in quality of care. a.) Risk management and quality improvement officers stay current and involved in statute and regulation changes. b.) Mandate educational goals for risk management and quality management officers with regard to state and federal regulations. c.) Implement a monthly employee newsletter within which the risk management officer and quality improvement officer outline regulation changes. Include processes that emplo yees should expect to see implemented to maintain compliance. Include a signature page with those editions that include changes to policy and ensure all employees sign and return to the human resources department. d.) Ongoing training for clinical and administrative employees with regards to statute and regulation. The risk management and quality improvement officers will be responsible to work with the organizations education department to implement new workshops as needed. e.) Include these responsibilities in the performance monitoring strategy for the risk management and quality improvement officers. 3. HAIs Health care associated infections are a serious risk in hospitals, as noted by Sydnor and Perl (2011), in their statement â€Å"HAIs are the most common complication seen in hospitalized patients† (para. 20). Improper prevention can lead to increased costs, lengthier hospital stays, and even patient death. Additionally, a Condition of Participation (CoP) (42 CFR 482.42) by CMS mandates hospital infection control programs to adhere to specific requirements. Recommendations are as follows. a.) Implement a house-keeping checklist to ensure proper sanitization of patient rooms. b.) Implement a sanitization checklist for clinical staff that will enforce hand washing before and after patient contact. c.) Develop a committee to review and revise the KP infection prevention and control program. Revisions should focus on compliance with TJC and the Center for Disease Control (CDC) regulations. Quality Outcomes Internal and external Three internal and external factors that influence quality outcomes are organization management of interpersonal relationships between physicians and patients, patient compliance, and continuity of care. Without proper management of interpersonal relationships between physicians and patients, the organization will face degradation in trust and openness. Patients should be involved in all treatment decisions, through proper education on their diagnosis and treatment options. This will bring about patient engagement in this decision making process. While KP cannot force their patients to comply with treatment guidelines, the external influence of patient compliance is crucial to quality outcomes. Programs focused on thorough training and education of patients and family members will improve the rate of compliance, thus improving the probability of positive quality outcomes for patients. Lack of patient compliance will hinder the treatment process and lower the level of quality outcomes standards at KP. Continuity of care is another internal influence that can affect quality outcomes. Regular follow up with patients will also increase patient compliance. Without improving continuity of care, the KP organization will see a reduction in positive quality outcomes and an increased in undesired outcomes (DeHarnais, 2013, chp 5). Goals Short-Term 1. Design new regulatory and statute training programs for all clinical and administrative employees. 2. Review and revise the KP infection prevention and control program 3. Revise the performance management system to include CQI measurements and risk management procedures as performance metrics. Long-Term 1. Increase adherence to state and federal regulations and statutes throughout the KP organization. 2. Reduce HAIs by 10% throughout KP hospitals in the northern California region. 3. Improve CQI measurement and risk management policy adherence throughout the northern California region by 20% among clinical employees. Risk and Quality Management Recommendations Risk management policies 1. Quarterly peer review The Health Care Quality Improvement Act (HCQIA) of 1986 â€Å"encourages hospitals, state licensing boards, and professional societies to identify and discipline physicians, dentists, and other health care providers who, after adequate, nondiscriminatory peer review, were found to have engaged in negligent or unprofessional conduct† (Cohen, 2013 p. 333). Through ongoing screening of new and current clinicians, KP will take responsibility for offering their patients that highest quality of care and reducing the risk of employing negligent clinical employees. 2. Zero tolerance adherence policy for all employees with regard to infection control procedures Part of the CMS CoP (42 CFR 482.42) regulation is the â€Å"designation of an infection control officer and development of relevant policies that address the identification and control of infections and communicable diseases. Without full compliance with all CoPs, KP could face the loss of their Medicare provider agreement. 3. Vulnerability analysis chart and emergency plan policy. According to Rawson and Hammond (2009) â€Å"by evaluating vulnerabilities and taking appropriate preventive action, loss can be minimized in an emergency†Ã‚  (p. 506). Health care facilities should include prevention measures in their emergency plans that include the risk of terrorist attacks. While terrorist attack risk cannot be completely mitigated, it is the responsibility of the health care facility to be prepared for such an emergency. Obtain additional information on including risk of terrorist attacks from the National Institute for Occupational Safety and Health (NIOSH). Quality management policies 1. Adherence to evidence-based clinical guidelines While it has been shown that â€Å"clinicians have customarily enjoyed a great deal of autonomy in their practices† (Argawal, 2010, para 3), it is imperative that clinicians follow evidence-based clinical guidelines. If exceptions should be made the details of, the patient diagnosis and variations should be presented for peer review prior to altering treatment plans. 2. Minimum score of 88% on customer satisfaction surveys Clinicians must maintain an average score of no less than 88% on customer satisfaction surveys quarterly. In today’s health care market, measurements of quality include consumer satisfaction. In fact, Bernard and Savitz (2009) state that in todays â€Å"competitive health care environment, consumers want and expect better health care services and hospital systems are concerned about maintaining their overall image† (p. 185). Relationship between risk and quality management In the past, risk management officers and quality improvement managers worked autonomously from one another, in fact they most often reported to different superiors. However, today healthcare organizations are realizing that in order to reach quality of care goals and maintain effective risk management programs these disciplines must work together closely. An example of how risk management efforts and quality improvement efforts complement one another is seen in the reduction of medical errors. The risk management plan must consider ways to reduce medical errors, while the quality improvement plan will offer solid steps toward minimizing medical errors (Sollecito and Johnson, 2013). Conclusion This summary focused on topics such as the purpose of risk and quality management, risk identification and management, current risks, quality outcomes, organizational goals, and the relationship between risk and quality management. While KP is the nation’s largest integrated health care delivery systems and leader in CQI standardization, there is always room for improvements. This consultant understands the importance of improvement at KP, thus humbly presents this summary and recommendations to the board of directors. References Agarwal, R. (2010, May). A Guideline for Quality Accreditation in Hospitals. Quality Digest, (), 1-4. Retrieved from http://www.qualitydigest.com/inside/twitter-ed/guideline-quality-accreditation-hospitals.html Chen, C., Garrido, T., Chock, D., Okawa, G., Liang, L. (2009). The Kaiser Permanente electronic health record: Transforming and streamlining modalities of care. Health Affairs, 28(2), 323-33. Retrieved from http://search.proquest.com/docview/204522974?accountid=458 Cohen, M. (2009). Statutes, Standards, and Regulations (chp 10) in McCaffrey, J. J., Hagg-Rickert, S. (2009) Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass. DesHarnais, S. I. (2013). The outcome model of quality (chp 5) in Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluznys Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers. Emily R. M. Sydnor, Trish M. Perl (2011, January). Clin Microbiol, 24(1): 141–173. Retrieved from http://www.ncbi .nlm.nih.gov/pmc/articles/PMC3021207/ Kaiser Permanente. (2014). Kaiser Permanente, Retrieved from http://share.kaiserpermanente.org/article/history-of-kaiser-permanente/ McCaffrey, J. J., Hagg-Rickert, S. (2009, Chp 1) Developing of a Risk Management Program in Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass. Rawson, M. L. and Hammond, H. Y,. (2009) Emergency Management in McCaffrey, J. J., Hagg-Rickert, S. (2009, Chp 7) Developing of a Risk Management Program in Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass. Singh, B., Habeeb Ghatala, M. (2012, August). Risk Management in Hospitals. International Journal of Innovation, Management and Technology, 3(4). Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluznys Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers.

Nurse Staffing: Job Satisfaction and Retention

Nurse Staffing: Job Satisfaction and Retention Elizabeth Campins Overview of Quantitative Article The study conducted by (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014), entitled Nurse Staffing and the Relationship to Job Satisfaction and retention, will be the object of the article analysis for this assignment. We are going to evaluate the research question of the study, the study design, representativeness, and the result of the data analysis including strengths and weakness of the study. Research Question The problem that has been addressed in the study is if the nurse-patient ratios affect job satisfaction and retention. The research questions for this article are the following: Has the number of patients assigned to the nurse resulted in job satisfaction? Has the actual economic situation influenced nurse decision to stay in the current position? (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014) The above research questions contain variables referred as predictors that can be measure. Those predictors are the staffing size of registered nurses, and number of the patients assigned to nurses. For the second research question the predictor is the actual economic situation which includes the numbers of layoffs and/or hiring, and costs-services reduction. The outcome of this study is nurse retention and job satisfaction. One we have the problem clear, the population of interest identifies, the interventions considered feasible, and the standard and future comparison established we are in the path to find the best evidence (Adams, 2012, p. 73). Study Design Nurse Staffing and the Relationship to Job Satisfaction and retention by (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014) is a quantitative design study. It is valuable for explaining relationship, nursing measurement and quantification that conduct to conclusive results (Peters, 2012, p. 161). The specific design of this study is non-experimental. It describes the relationship between nurse staffing, job satisfaction, and nurse retention in an acute care environment. More specifically this article is a correlational design study because establish relationship among variables or better to say among predictors and outcomes (Peters, 2012, p. 176). The type of predictive correlational designs for this study is model-testing. For this model type it is probable that researchers hypothesize which variables can conduct to better outcomes. Sample Size and Representativeness The type of sample for this study is a non-probability sampling method. It is used when the sampling frame cannot be calculated. As a result, the threat of selection bias is increased and is less representative of the selected population (White, 2012, p.257). Among non-probability sampling, this article is a convenience or consecutive type where the participants are recruited as they become available (White, 2012, p.257). There were seventy subjects selected as they become available. The majority were female with ages between thirty three and forty five years old. In addition, data collection last over thirty days. The strategy for choosing the subjects were stablished before the selection. It requires RN licensed, with six months experience at bedside in an acute care institution. The level of education at the time of the collection, age, gender, was also required. In addition was asked if the subjects were employed in a Magnet hospital. Results of data analysis Procedures Quantitative method takes in consideration data analysis after the data collection is finished. The study used statistical analysis. The tool was IBM Statistical Package for Social Science (SPSS), version 20. For demographic and subscale variable was used descriptive statistics to determine if the predictive variable, that we mention at the beginning of the paper were related to the outcome nurse retention and job satisfaction. The following survey tools NWI-R (Nursing Work Index Revision) and COP (control over practice) subscales, which was taken from the NWI-R, were used to measure job satisfaction. A weak positive relationship between control over practice and nursing staff indicates that there is a relationship between workload and job satisfaction. One more retention variable was analyzed with frequency and percentage to get results about the actual economic situation affecting the decision to keep the current position. A moderately strong negative correlation shows that a nurse will consider leaving their actual position if the dissatisfaction increases. It Level (p) means a statistical parameter of the analysis. It was set at alpha equal to 0.05. The theme identified was nurse-patient high ratios work-load. It concluded that incrementing responsibilities during the shift put at risk satisfactory patient care, and raise nursing dissatisfaction and turnover. A common strategy mentioned for the participants to retain them in bedside nursing care was improving nursing-ratios. This strategy will decrease the cost of hiring and training new staff nurses, and it will retain experienced nurses. Improving the nurse to patient ratio is highly valuable to increase job satisfaction and retention. Summary of the Strengths and weakness The study major strengths were in data collection. The method of collection corresponds directly with the research question. It contains a variety of age groups and level of experience of the participants. An additional strength of the study is the use of control over practice subscale (COP) as an important survey mechanism to measure job determine the levels of job satisfaction and its impact on the nurse environment (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014). The main weakness in the study was a sample size with only seventy participants as they become available during a thirty days period. For this reason is complicated to determine the generalizability of this research to the larger population (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014). The study demonstrates that exist relationship between predictors and outcomes. This relationship does not show relevant threats in bias, history, maturation, testing or instrumentation. We are confident that the study has a relevant internal validity. On the other hand, it is not possible to conclude that the study can be generalized to other subjects or settings because of the limitations of the sample size (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014). This study is not generalized to larger population, as a result, has a weak external validity. Summary of the Major Points of the Paper From Nurse Staffing and the Relationship to Job Satisfaction and retention by (Hairr, Salisbury, Jonansson, Redfern-Vance, 2014) we considered two important research questions for a quantitative study. It was reviewed the sample size and its representativeness of the population. After analyzing the data and procedures results we summarize the strengths and weakness of this study supporting our conclusion with (Peters, 2012, p. 150). Overview of a Qualitative Article The study conducted by (Lavoie-Tremblay et al., 2014), entitled Transforming care at the Bedside: Managers’ and Health Care Providers’ Perception of their Change Capabilities will be the focus of the article analysis for this assignment. We are going to evaluate the research question of the study, the study design, representativeness, and the result of the data analysis including strengths and weakness of the study. Research Question The problem that has been addressed in this study is the perceptions of managers and others healthcare providers about their change capabilities. The research questions are the following: Are the new strategies, that nurses are implementing, working to create better results in a way that make communication and teamwork easier and more efficient? Does the new project reduce wasteful work? (Lavoie-Tremblay et al., 2014). In the above research questions the research has interest in specific information from the person point of view and their inside about the subject studied (Mauk, 2012, p. 189). Participants that are knowledgeable on the researching theme are called key informants for the purpose of qualitative research. Study Design Transforming care at the Bedside: Managers’ and Health Care Providers’ Perception of their Change Capabilities by (Lavoie-Tremblay et al., 2014), is a qualitative design study. Among of the four types of qualitative research, our study is categorized as grounded theory where the main review of literature is examined when the research has being completed to compare the theory with other reviews, and create theories for other processes (Mauk, 2012, p. 199). There is not set of sample size at the beginning of the data collection. The researcher gets data until they are saturated with the information needed (Mauk, 2012, p. 200). The strategy used in our study is focus groups. The study involved three focus groups: pediatric medicine unit, an adult acute respiratory care unit, and an adult neurologic unit. Also was considered three individual interviews. The study was conducted for nine months (Lavoie-Tremblay et al., 2014). Sample Size and Representativeness As stated before, sample size in grounded theory is known at the end of the collection data. It relied on focus groups where the key informants where selected from managers and healthcare providers included in the transforming care at the bedside (TCAB) teams. It also includes recruited patient’s representation from the hospital’s committees whose members had been patients or had family members who were patient. The sample included sixteen women and three men for a total of nineteen participants. The demographic information (gender, age, education, job title) was collected to allow for an external assessment of the generalizability of the findings to a different setting (Polit Beck, 2012, p. 518). Results of data analysis Procedures Interviews were audio-recorded and transcribed using NVivo data analysis. This procedure facilitates a rigorous analysis of unstructured data (Miles, Huberman, Saldaà ±a, 2013). Data analysis was examined in three ways: Condensing the data or coding the transcripts, presenting the data for discussion with the research team, and verifying the data with an audit trail to keep a record of the data collection details throughout the study. Two outside researchers coded the transcripts to reduce the chances of biased interpretation. Some of the themes identified were: Learning skills, sharing leadership capabilities with other staff members, impact of the changes for the institution and personally, the perception of the team approach to lead change, among others. Summary of the Strengths and weakness The strengths of the research article were sustained in the fact that the motivation to work as a team develops change capabilities in participants. The study gave the tools and resources necessary to identify, implement and evaluate changes. The study was successful in developing most of the target elements to change. Participants mentioned how their unit’s mode of functioning went from working alone to teamwork style. Also, they mentioned that the TCAB project helped them develop new skills and capacities for change. This study has credibility (Mauk, 2012, p. 200). It has being confirmed through members check after researchers sharing the results with participants to make sure the finding reflected what they say during the interviews. The study limits the generalizability of the results because was only conducted in three units. Summary of the Main Points of the Paper Transforming care at the Bedside: Managers’ and Health Care Providers’ Perception of their Change Capabilities by (Lavoie-Tremblay et al., 2014) we considered two important research questions for a qualitative study. It was reviewed the sample size and its representativeness of the population. After analyzing the data and procedures results we summarize the strengths and weakness of this study supporting our conclusion with (Mauk, 2012, p. 194). References Adams, S. (2012). Identifying research questions. In N. A. Schmidt, J. M. Brown (Eds.), Evidence-based practice for nurses: Appraisal and application of research (2nd ed., pp. 67-87). Sudbury, MA: Jones Bartlett Learning. Hairr, D. C., Salisbury, H., Jonansson, M., Redfern-Vance, N. (2014, May/June). Nurse staffing and the relationship to job satisfaction and retention. Nursing Economic$, 32. Retrieved from http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=3[emailprotected]hid=4212 Lavoie-Tremblay, M., O’Connor, P., Lavigne, G. L., Biron, A., Ringer, J., Baillageon, S., Briand, A. (2014, Nov). Transforming care at the bedside: Managers’ and health care providers’ perceptions of their change capacities. The Journal of Continuing Education in Nursing, 45(11), 514-520. http://dx.doi.org/10.3928/00220124-20141023-02 Mauk, K. L. (2012). Qualitative design: using words to provide evidence. In N. A. Schmidt, J. M. Brown (Eds.), Evidence-based practice for nurses: Appraisal and application of research (2nd ed., pp. 187-215). Sudbury, MA: Jones Bartlett Learning. Miles, M. B., Huberman, A. M., Saldaà ±a, J. (2013). Qualitative data analysis: A method sourcebook (3rd ed.). Retrieved from https://books.google.com/books?id=3CNrUbTu6CsCprintsec=frontcoverdq=Qualitative+data+analysis:+A+method+sourceboockhl=ensa=Xei=NZzOVMT_L6fPsQStvIDYDAved=0CDQQ6AEwAA#v=onepageq=Qualitative data analysis: A method sourceboockf=false Peters, R. M. (2012). Quantitative design: Using numbers to provide evidence. In N. A. Schmidt, J. M. Brown (Eds.), Evidence-based practice for nurses: Appraisal and application of research (2nd ed., pp. 165-185). Sudbury, MA: Jones Bartlett Learning. Polit, D. F., Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippicott Williams Wilkins. White, A. H. (2012). Using samples to provide evidence. In N. A. Schmidt, J. M. Brown (Eds.), Evidence-based practice for nurses: Appraisal and application of research (2nd ed., pp. 247-271). Sudbury, MA: Jones Bartlett Learning.

Yeast Culture Lab: Background Information

Yeast Culture Lab: Background Information In the laboratory, yeasts are stored, maintained cultivated with the help of few elementary methods. Yeasts, being a group of unicellular organisms taken care of similar to those of most bacteria except that their nutritional environmental requirements vary. Yeast: These  are microorganisms  having cells with membrane-bound nuclei .Yeasts are unicellular and its size may vary greatly depending on the species. Yeasts have asexual and sexual reproductive cycles and most of them reproduce asexually by budding. Yeast culture: Yeast culture composes yeast in the form of dry product over a media dried over in order to safeguard the fermenting activity of the yeast. The process of fermentation creates metabolites, which is in fact an advantage of yeast culture. The bacterial activity gets stimulated resulting in an increase in digestion of feeds by the bacteria as their number grew. This increase in numbers can result in more nutrients from the feed being available acting as a source of energy. Reproduction: The natural process supports life as it produces new progeny individual  organisms from their parents. Each individual organism exists due to this biological process. The process involves two methods of the following types:  sexual  and  asexual. Sexual reproduction requires two individuals of opposite sex to involve during the sexual course. However, the asexual reproduction do not any requires involvement of another individual as it can reproduce with the division of a bacterial cell into two daughter cells. Consumption: It is simply the process of taking food into the body through the mouth. However, reproduction is a function of consumption. When an organism goes under reproduction, its consumption must be adequate to provide the supplementary nutritional support because this biological process needs additional resources for future survival. Death in Population: The processes that change the size of populations are birth, death and movement into and out of that population. The science of ecology is not just about understanding nature but often also about predicting or controlling it. In the life history of the unitary organism, as time passes and the post reproductive phase arrives death happens due to senescence which is the organic process of growing older. The individual of different ages do contribute to births in population. As per the static life table, we assume the rates of birth and death to be constant. However, the fecundity of individuals also changes with their age contribute to births in the population as per age-specific fecundity schedules. Further, understanding the cohort life table for annuals tracks a single cohort from the first birth to the death of last survivor. Aim of the Experiment: Let us understand the process of manufacturing Bakers Yeast by implying fed-batch culture in order to reduce the contamination. Procedure: The production of Bakers yeast involves a series of aerobic stages for the development of inoculums. The process involves eight stages. The first three stages are aseptic as the pure culture for initial inoculums are used. However, open vessels are used to carry rest of the stages. Pumping of yeast from one stage to the other as well as the seed cultures being centrifuge and washed before transfer reduces the level of contamination. During the later stages, which involves fed-batch systems, ensures better yield. The development of inoculums for the commercial production of Bakers yeast involves PC 1, 2, 3 as pure culture batch fermentations. F 1 2 is non-aseptic batch fermentations. F 3 4 is fed-batch fermentation F5 is final fed-batch fermentation leading to yield of Bakers yeast with minimal contamination. Purpose: The purpose of this experiment is to understand the process of producing Bakers yeast with the removal of contamination to its minimalism. It involved the fed-batch culture to describe batch cultures fed with a medium without the elimination of culture fluid. Materials and Methods: Molasses, Chemicals like sulfuric acid Ammonium Sulphate, Ammonium Phosphate, Ammonia, Sodium Chloride, Antifoaming, Potato Starch, Emulsifying agent and Sodium Hydroxide etc. Profile on productions of Bakers Yeast Retrieved from http://www.southinvest.gov.et/Publications/SSNPR%20draft%20Profile/B/%20Bakers%20Yeast.pdf The fed-batch fermentation system follows as shown in the figure below. The Vitaminpros website, diagram retrieved from (http://www.vitaminpros.com/beta-1-3-d-glucan.htm) Discussion: The diagrams of different population dynamics inclusive of: Phases of population growth after disaster Limitations of environmental carrying capacity (while it is high) Limitations of environmental carrying capacity (while it is low) Habitable site dominated by population decay We could easily figure out that factors, which regulate the size of a population, may not determine its size for most of the time instead; responses may change over changing levels of resources. Population  growth  cycle: As we have studied, the density-dependent birth mortality rates lead to the regulation of popular size. When both are density dependent or either of them, then, the two curves cross. The density at which they do is carrying capacity. The population graph involves four phases: Lag Phase: Here, the yeast settles in the environment. Logarithmic Phase: Until this phase, they wait for the favorable conditions to grow, consume reproduce. As they find the proper consequences, they grow exponentially. Stationary Phase: This phase is only temporary as reproduction begins to cause their environment to deteriorate to where the death rate begins to overtake the birth rate. Death Phase: During this phase, the environment becomes very toxic with their excrement results in their death. Carrying Capacity: its effect Carrying capacity is the population level of an organism that persists given the quantity of life supporting infrastructure available to it. In a situation where numbers of an organism are below the carrying capacity of its environment, its birth rate will amplify. If the population exceeds the carrying capacity, the death rate will increase until the population numbers are stable. Carrying capacity increased by the discovery and exploitation of new resources (such as metals, oil or fertile uninhabited land) and decreased by resource exhaustion and waste buildup, for example declining soil fertility and  water  pollution. The ecological concept of carrying capacity helps to determine a sustainable population level. The Energy flow in Biogeochemical Cycle: We must understand the pattern of energy flow for forest, grassland, plankton community in sea small ponds. It helps us to understand relative roles of live consumer and decomposer systems. We will observe that the decomposer system is responsible for majority of secondary production and the live consumers have greater role in open-water aquatic communities. If we discuss the flux of energy matter through ecosystems, we will come across various cycles: The phosphorus cycle The nitrogen cycle The sulfur cycle The carbon cycle They act as global pathways of nutrients between the abiotic reservoirs of atmosphere, hydrosphere lithosphere and the biotic reservoirs consist of terrestrial aquatic communities. In general, the snapshot of the entire process goes like this. The figure Retrieved from http://www.britannica.com/EBchecked/topic/65875/biogeochemical-cycle Conclusion: The natural processes works in harmony and any effect or changes in the functionality or behavior of one process will have a direct or indirect influence on other natural phenomenon. The Hypothesis accepted as per the successful completion of the experiment mentioned above, as the amount of contamination in the Bakers yeast produced was minimal. References Coleman, B. (1996). Additives for Horse Feeds. Retrieved from Website: http://www1.agric.gov.ab.ca    Townsend, C.R. (2008). Essentials of Ecology (3rd Edition), Individuals, Populations, Communities Ecosystems Retrieved from (Chap. 5, pp. 145-153) Townsend, C.R. (2008). Essentials of Ecology (3rd Edition), Individuals, Populations, Communities Ecosystems Retrieved from (Chap. 5, pp. 145-163) Townsend, C.R. (2008). Essentials of Ecology (3rd Edition), Individuals, Populations, Communities Ecosystems Retrieved from (Chap. 5, pp. 145-163) Stanbury, P.F.,Whitaker,A.(1995).Principles of fermentation technology,2nd edition Retrieved from (chapter 6, figure 6.2) Townsend, C.R. (2008). Essentials of Ecology (3rd Edition), Individuals, Retrieved from Populations, Communities Ecosystems (Chap. 9, pp. 288) Townsend, C.R. (2008). Essentials of Ecology (3rd Edition) Retrieved from Individuals, Populations, Communities Ecosystems, (Chap. 5, pp. 170, fig. 5.21) Townsend, C.R. (2008). Essentials of Ecology (3rd Edition) Retrieved from Individuals, Populations, Communities Ecosystems, (Chap. 11, pp. 368, fig. 11.7) Townsend, C.R. (2008). Essentials of Ecology (3rd Edition) Retrieved from Individuals, Populations, Communities Ecosystems, (Chap. 11, pp. 381, fig. 11.16)

Essay --

pH is usually referred to test out or find the measure of a concentration of hydrogen ions. pH is used to measure whether the solution if it is a base or an acid. The term pH stands for power of hydrogen. Usually there is a scale for measuring pH, Solution with a 7 or below is consider an acidic solution, but an pH greater than 7 is consider a base solution, and 7 is a neutral solution. The pH scale is a set of solution standards whose pH is established by the international system. Most of the times pH can be measured through concentration cells which measure the differences between hydrogen electrodes. Finding the pH for solution can be done in various ways such as a pH meter or glass electrode. White vinegar can also be some sort of fluid composed mainly involving acetic p in addition to drinking water. The actual acetic p will be made because of the fermentation involving booze simply by acetic p germs. White vinegar will be currently mainly utilized as a change involving express element, although in the past, on account of this primarily basically on the market delicate p, it acquired a considerable model of manufacturing, health-related, in addition to household uses, selection of that location unit even now endorsed these days. Small business white vinegar will be made possibly simply by rapid as well as slow fermentation functions. In general, slow ways that they location unit in combination with old vinegars in addition to fermentation matter gradually over weeks or possibly a season. The actual extended fermentation amount permits for your buildup of the nontoxic slime made up of acetic p germs. rapid ways that they add mother involving white vinegar on the availabi lity fluid just before adding atmosphere utilizing a en... ...inging about hyperbolic runoff. That runoff drinking water makes this succeeding blend extra acidic. Regarding 50 percent the acidity inside the atmosphere falls to earth through dry deposit. Some kinds can accept acidic waters more than others. polluting of the environment impacts many species ultimately impacts additional through the entire organic phenomenon combined with non-aquatic kinds like parrots. The penalties of smog, combined together with different ecological stressors, depart trees in addition to plants unripe to be able to confront to be able to cold conditions, insects, in addition to illness. The pollutants could on top of that inhibit trees ability to breed. Some soil square gauge higher capable of neutralize acids than others. In areas the spot that the soil streaming capability will be low, this harmful outcomes of smog square gauge plenty added.

Existentialists: I Am Me, And You Are You :: essays research papers

Existentialists: I Am Me, and You Are You   Ã‚  Ã‚  Ã‚  Ã‚  Existentialists view mankind as individuals whose unique past experiences establish personal characteristics that set all of us apart. This idea can be best expressed in an intuitive statement by a celebrated individualist, Tarzan. â€Å"Me Tarzan, you Jane† is at the nucleus of the beliefs of the existential atom. This seemingly simplistic statement relates to existentialism by leading us to the idea of man's individualism, guiding us to belief of existence before essence and ushering us to the notion of freedom of choice. These three beliefs can then be related to the characters in the existential writer Jean-Paul Sartre's â€Å"No Exit.†   Ã‚  Ã‚  Ã‚  Ã‚  At first reading of this statement, one notices Tarzan's word choice. â€Å" Me Tarzan, you Jane† implies that Tarzan and Jane are not one and the same. Instead, they are two different people who lead very different lives. Tarzan, the Ape Man, is by nature different than his newfound lady friend. Existentialists would further this train of thought to say that since people are always different, they can never be the same. They would then argue that every person is an individual, not a copy from a predetermined mold. Jean-Paul Sartre also portrays his characters as individuals, not carbon copies of each other. Garcin, a soldier who went AWOL, certainly lived a different life than the baby- killer Estelle.   Ã‚  Ã‚  Ã‚  Ã‚  These individualistic qualities lead to us by Tarzan's statement, now guide us to the existential belief of existence before essence. This idea consists of the belief that people are formed from their own unique past experiences. Tarzan, a lonely boy who was raised by a pack of gorillas, has not experienced the touch of mankind. His isolation from the world is completely opposite from that of Jane's past. Jane, a women raised in the indulgence of the modern day, has experienced many unique events that have made her what she is. Jane can never know what is like to be Tarzan because she can never experience what he has gone through. Likewise, Tarzan, the Ape Man, can never experience what it is like to be Jane because he can never live through the unique events of Jane's past. Sartre also gives us characters with very unique backgrounds. Garcin can never experience the troubled past that Inez had and Inez in turn can never understand why Garcin needs to be told he is not a coward.   Ã‚  Ã‚  Ã‚  Ã‚  After now understanding that existentialists view people as individuals who have unique past experiences that make them who they are, existentialists would now usher us to the notion of each character's freedom of choice. Existentialists: I Am Me, And You Are You :: essays research papers Existentialists: I Am Me, and You Are You   Ã‚  Ã‚  Ã‚  Ã‚  Existentialists view mankind as individuals whose unique past experiences establish personal characteristics that set all of us apart. This idea can be best expressed in an intuitive statement by a celebrated individualist, Tarzan. â€Å"Me Tarzan, you Jane† is at the nucleus of the beliefs of the existential atom. This seemingly simplistic statement relates to existentialism by leading us to the idea of man's individualism, guiding us to belief of existence before essence and ushering us to the notion of freedom of choice. These three beliefs can then be related to the characters in the existential writer Jean-Paul Sartre's â€Å"No Exit.†   Ã‚  Ã‚  Ã‚  Ã‚  At first reading of this statement, one notices Tarzan's word choice. â€Å" Me Tarzan, you Jane† implies that Tarzan and Jane are not one and the same. Instead, they are two different people who lead very different lives. Tarzan, the Ape Man, is by nature different than his newfound lady friend. Existentialists would further this train of thought to say that since people are always different, they can never be the same. They would then argue that every person is an individual, not a copy from a predetermined mold. Jean-Paul Sartre also portrays his characters as individuals, not carbon copies of each other. Garcin, a soldier who went AWOL, certainly lived a different life than the baby- killer Estelle.   Ã‚  Ã‚  Ã‚  Ã‚  These individualistic qualities lead to us by Tarzan's statement, now guide us to the existential belief of existence before essence. This idea consists of the belief that people are formed from their own unique past experiences. Tarzan, a lonely boy who was raised by a pack of gorillas, has not experienced the touch of mankind. His isolation from the world is completely opposite from that of Jane's past. Jane, a women raised in the indulgence of the modern day, has experienced many unique events that have made her what she is. Jane can never know what is like to be Tarzan because she can never experience what he has gone through. Likewise, Tarzan, the Ape Man, can never experience what it is like to be Jane because he can never live through the unique events of Jane's past. Sartre also gives us characters with very unique backgrounds. Garcin can never experience the troubled past that Inez had and Inez in turn can never understand why Garcin needs to be told he is not a coward.   Ã‚  Ã‚  Ã‚  Ã‚  After now understanding that existentialists view people as individuals who have unique past experiences that make them who they are, existentialists would now usher us to the notion of each character's freedom of choice.

A Clean, Well-Lighted Place Essay example -- Literary Analysis, Ernest

â€Å" A Clean, Well-Lighted Place† by Ernest Hemingway is a simplistic short story in which he narrates a scene in a Cafe, where the main characters are two waiters and an old man. In the story, Hemingway hardly created a background for his characters, but this was part of his minimalist writing style. He wanted to create a story that was straightforward to the reader, and in which the reader could easily understand his attitude. His purpose for writing the story was to expose his feelings on society, politics, and the individual at the time. These feelings could be characterized by three main words: desperation, disillusionment, and loneliness. Through all of the characters in his story, the reader was able to obtain one of these feelings. However, when I read the story I wanted to know more about the characters to be able to establish a connection with them. I wanted to know how and why did each of them acquired those feelings? Therefore, I decided to change the point of vi ew of the story from third- person- limited to first- person. Unlike Hemingway, I included more personal details about one of the main characters, in this case the old man, whom I consider to be the most mysterious character of the three. This way, I could make the reader relate more to the emotions conveyed by the story. Consequently, by showing the reader the old man's background, I made Hemingway's attitude of his original story stronger, and also establish a connection between the reader and the character(s). However, I also had to modify some of the plot, and language to make my scene coherent and relevant to my point of view. The most drastic change I made to Hemingway’s short story was the change of point of view from third- person- limited to first -per... ... When I first read â€Å"A Clean, Well-Lighted Place† by Ernest Hemingway, I thought that I lacked a connection to the story. I did not feel like I knew the characters, which left me with no connection to them and intrigued me as well, especially the old man. Why did Hemingway leave out backgrounds to his characters? This motivated me to write my scene through the old man's point of view. I felt that with the change of point of view to first- person, the reader would feel more attracted to the story, and at the same time I could keep Hemingway’s attitude of despair and disillusionment intact, maybe even make it stronger. With my part of the puzzle, I felt more at peace with his original story, and I was able to establish a relationship between Hemingway (as a writer) and me (as a reader). I was able to experience his motivation for writing â€Å"A Clean, Well-Lighted Place†.

Air France essay

Describe how you would assess how a row (keyword-engine pair) is performing and how to manage it To figure out how a row (keyword-engine pair) is performing, we need to do cost-benefit analysis first. In other words, since company’s goal is to sell tickets and create value, it would be useful to assess by measuring dollar amount earned from a dollar of cost (= Amount/Total cost). However, the row is already in ascending order of dollar amount relative to total cost. Also, there are only 368 data out of more than 4,000 data overall. Therefore, looking at the sales figure only is not the best way to assess keyword-engine pair performance.I took out all the numbers that have no conversion rate. That means, it did not generate any sales and these will not be helpful in assessing the performance. Then, among those numbers with conversion rates, I only looked at the numbers of which the amount is bigger than the cost. Otherwise, company is losing money whenever it pays advertising. Then, I multiplied average position with click through rate and conversion rate so that to calculate how people relatively choose to pick up Air France and buy tickets via website. This will tell how its keyword performs with search engine to generate sales over cost.However, to manage well, we also have to consider Ad rank. QS is determined by click thru rate and bid strategy is actually average CPC. If we multiply together, we can get Ad rank. To perform well, we need have higher click thru rate rather than higher CPC. Therefore, we also need to look at relative CPC assuming same position. That’s why I looked at other numbers without conversions rate too. Apply your performance metrics to each of the keyword-engine pairs (i. e to each of the rows) and identify the â€Å"top 10† keyword-engine pairs to pursue   Below are the top 10 results based on performance metrics that I mentioned above.However, we can see that most keywords already contain france . I believe pe ople who typed france will look at Air France site automatically, so the company should not focus highly on the word. I confirmed this logic by looking at numbers without conversion rate. See below. And also, the first one should be an outlier, since only one click generated 900% of sales. So, I calculated again filtering these two words out. Below is the result. As we can see from above, both â€Å"cheap†and â€Å"paris† are a good match with â€Å"Google†.