Baseball Is America s Sport - 1505 Words

Baseball has been around for centuries and is a sport that has been one of america’s most popular sport for a very long time. Filled with excitement,happiness and fans that absolutely love the game baseball can Arguably be america’s sport. Created in 1846 and having many changes that have bettered and the game more exciting. Some will say that it is boring and lost its cool but baseball is far from losing its cool. The beauty of baseball is that it has no clock just straight nine straight innings of baseball. People will say it has no action, , but in baseball, there are home runs, amazing catches, diving stops, amazing feats and much more. The atmosphere is incredible, the fans are great and there is no better place to eat a hotdog and†¦show more content†¦As the pitcher was getting set to throw the next pitch , the batter pointed to right side of the outfield calling his shot. Setting backup he set his feet the pitch was on the way the batter swung and hit a homerun to the right side of the field where he had called his shot. This man went by many but mostly known as the Babe â€Å"The Great Bambino† Ruth. The history of baseball is what makes the game of baseball so great looking at it from where it has been to where it is now a big change in the sport. Baseball can and is arguably be America s sport for so many reasons. Some people look at this sport as â€Å"it s the highest paid sport I want to play it† as for others their love and passion for the game is more than anything. If anything Baseball s getting cooler new rules new styles of playing the game new uniforms everything is just making the sport better. Some kids don t look at the game at because of the sports they look at the people who play it and look at the style the swagger they bring to it. Every baseball fan has their favorite team their favorite player and their favorite stadium Is not just the game of baseball it’s everything to it. To the home run s the diving catches all the great plays that went down in MLB history are what makes baseball a great sport. Baseball will always and forever be America s sport. Everyone has their opinions on everything just like everybody has a favoriteShow MoreRelatedBaseball Is America s Past Time Sport1588 Words   |  7 Pages Baseball is well known as America s Past-Time sport. It has been played the same for many years, and now all of a sudden some fans and the commissioner of baseball want to make such abrupt rule changes just to speed up the game itself. Those rule changes include possibly eliminating managers, introducing a time limit on mound visits, a pitching clock, also there has been talk about starting every inning with a runner on second base, and finally one of the most drastic changes is cuttingRead MoreThe Sport Of Baseball : America s Favorite Pastime1093 Words   |  5 PagesThe sport of baseball, otherwise known as â€Å"America’s favorite pastime†, h as reportedly been around since the 17th century. It has had its ups and downs like every other sport, but the crazy history of how it came about is quite extensive. Having to find new players that no one would think of to play and eventually having the first ever World Series; the sport has changed throughout time. The beginning of baseball can be accredited to Thomas Wilson who was a conformist leader in England. WilsonRead MoreBaseball : America s Pastime Of The Past1255 Words   |  6 PagesBaseball: America’s Pastime of the Past A pastime is a hobby that is performed in someone’s spare time. The term America’s pastime is something that the entire nation enjoys and participates in. Since its creation, baseball has taken the top spot as the nation’s favorite recreation. For generations it filled the homes of Americans whether it be via television, conversation, or participation. Families would travel together to their local baseball stadium and root for the home team. KidsRead MoreBaseball is the National Pastime1051 Words   |  5 PagesFor most sports fans there is nothing like opening day and a baseball field. In recent years I have over heard several people say Baseball is not the National Pastime or National Game any longer. When I query these people the typical response is Football is our new National pastime/game. Frank Deford (Nov 7, 2012) a writer for Sports Illustrated said, Baseball is what we used to be. Football is what we have become. I refuse to believe this based on my knowledge of both games. In this paperRead MoreBaseball Is America s National Pastime976 Words   |  4 PagesThe argument over which sport is originally Americas national past time is as enduring and intense as American sports themselves. Each and every week millions of people tune in to watch their favorite sports being played. Over the years baseball has traditionally been known as the national pastime among all sports, but the rich tradition and history behind baseball is still around and noticed, with that being said, baseball is still referred to as America’s national pastime. This can be attributedRead MoreJackie Robinson s Influence On Baseball And America1392 Words   |  6 PagesRobinson’s Influence in Baseball and America Baseball has been known as America’s great sport since the 1920’s. Many people love to watch the games and create their own fantasy teams because they look up to the wide, diverse players on each team. Every team consists of males of different races and this helps bring culture into the great game. Having such a big diversity in one sport makes it easier for more people to enjoy because there is something in it for every person. However, baseball has not alwaysRead More316 (4-5). Ms. Matthews . English Iv. 24 April 2017 . How1096 Words   |  5 Pages2017 How Baseball Changed Over Time Baseball changed over time when African Americans were able to join the game of baseball in the early 1840s when the game of baseball started. Only African American were able to play the game of baseball due to segregation. Most people did not even want African Americans to play baseball in the MLB they could have their own league but,not with whites because no blacks were allowed to communicate with them. Alexander Cartwright invented the game of baseball and theRead MoreHow did Jackie Robinson Overcome Racial Discrimination in Sports1119 Words   |  5 Pagesbeen protested and demonstrated against? Jackie Robinson felt the outcry of America during his baseball career. Fighting not only for his future, but also for the overall well-being of his sport, Robinson received death threats for his efforts. On a daily basis, this disciplined African man fought the pressures of hatred toward his entire race. As a segregated country, America saw major league baseball as a white man’s sport. Robinson was the outlier in an otherwise American â€Å"tradition.† Society observedRead MoreAthletes and Steroid Use Essay1265 Words   |  6 Pages  Ã‚  Ã‚  Ã‚  Ã‚  In recent history American culture has become more and more dominated by sports. Out of all of these sports baseball is considered to be Americas pastime. Over the last couple years Americas pastime has come under scrutiny about some of its players using anabolic steroids and other performance enhancing drugs. In an interview with Sports Illustrated, Major League Baseball commissioner Bud Selig said,  ¡Ã‚ §... hopefully we can figure out ways to solve this problem. It needs to be solved. ThereRead MoreWhy Jackie Robinson Was The First Pro Ball Player844 Words   |  4 Pageswere being built sports and the development of it broke them down or found new ways for the different genders and races to find ways to use sports as an outlet. Women were constantly fighting for their right to be involved in sp orts and pushing the limits as to what social norm deemed acceptable for them to be allowed to play. Working class women started to compete professionally in rowing competitions; they played crocket and played lawn tennis. The American pastime of baseball was well on its

Reduce stress Free Essays

There have various way to reduce stress such as listen to music , exercises regularly and have a good relationship with other people. Topic sentence 1 : Firstly, listen to music can reduce stress. Supporting details 1 : different person have different favorite music genre, but the most effective in other to reduce stress is listen to slow and classic music. We will write a custom essay sample on Reduce stress or any similar topic only for you Order Now Supporting details 2 : furthermore, music can lowering blood pressure, and decreasing the levels of stress hormones. Supporting details 3 : Listening to music can relieve depression and increase self-esteem ratings in elderly people. Topic sentence 2 : secondly, exercises regularly can reduce stress Supporting details 1 : in other to reduce stress need to have exercises at lease 3 days a week, when done exercises, sweats release with negative energy from our body and keep our mind in balance. Supporting details 2 : Otherwise, exercises can keep our body healthy and away from diseased. Supporting details 3 : to avoid feel boring with the same activity we can change our regular exercise from gimnasium to swimming, dancing, cycling, playing badminton or other extreme sports like wall climbing, and jugle tracking. Topic sentence 3 : finally, have a good relationship with other people Supporting details 1 : get to know about our friends and be socialized. Supporting details 2 : have a good sense of humor and sometimes make jokes with friends in office. Supporting details 3 : must have at least one best friend that can express any problems, always make parents as the best person to find any problem solve because they always know the best for us. How to cite Reduce stress, Papers

Mental Health Illness Among the Maori

Question: Write about theMental Health Illness Among the Maori. Answer: The Maori refers to the indigenous people of New Zealand. However, increased contact with the European community has either misplaced or diffused the culture of these people due to increased urbanizations and social cultural interactions. The indigenous Maori people are conservative, polytheistic and lovers of art and drama which has also been compromised by use of television, film and theatre technology. The Maori people have been suffering from various acute conditions and mental illnesses. These have been influenced by various factors such as access to quality health care, social economic challenges and risk factors such as drug abuse and other dietary cultural factors. This paper explores mental health conditions among the Maori people and how the indigenous model guides action to address mental health issues among the Maori people. Bradley, et al (2015) explains that with increased study on the factors influencing health, causes, signs and symptoms of disease and not withholding an inquiry into the various methods of disease transfer, preventive and curative mechanisms, mental health disorders have been observed in many Maori people as opposed to the other populations living in New Zealand. As stated earlier, high prevalence of these conditions can be blamed on the amount of wealth and the social status of the people, physical activity the people engage in and the general lifestyle they lead, how well they observe nutritional practices and the body sizes of these people. Leckie and Hughes, (2017) have also proven that the mental health conditions have been mostly influenced by the culture and the political factors of the people. This serves to assert the fact that the conditions are mostly prevalent on the indigenous Maori people as opposed to other immigrant cultures. The traditional beliefs, behaviors, practices and attitudes of the Maori people and their political history of oppression especially with the onset of the Europeans, cultural competition and other factors have worsened the state of health of the Maori people. Newton?Howes and Boden, (2015) have however arguably reasoned that the economic weakness of the Maori people is the main cause of poor mental conditions. Poor economic abilities restrict the people to a poor diet even when they have enough information of the dietary requirements. Illiteracy is also a factor that can be attributed to economic incapability of being able to fully educate the community on sound health patterns such as lifestyle and drug use challenges. Poverty as suggests Gurung, (2013) has also made the government to be unable to cater effectively for the health needs of the people and this has mostly affected the Maori since they are deeply rooted in tradition and intuition beliefs. The available information about mental illness and mental disorders in the Maori community state that there have been increased suicide rates among the Maori people and hospitalizations as the people have finally adopted western medication. There are however still very shocking statistics which explain that 30% of all adult Maori people are at risk of getting a mental health challenge. Having several mental disorders have also become a common phenomenon identified among indigenous Maori people. These disorders commonly range from anxiety, moods and drug related mental health conditions (Shoemaker, et al 2015). Cunningham (2015) explains how the traditional beliefs about mental health illnesses have varied among the Maori people. These beliefs have ranged from bizarre and mystical beliefs to biological and psychological views. As a matter of fact, among the pre-colonial populations, it was almost impossible to distinguish between the different types of conditions such as insanity and intellectual incapability. However, people generally realized that mental health illness was associated with the economic status of the people in the society. Mental health illnesses do not readily express themselves in the face of the Maori people. Psychiatric expert is required in order to detect and be able to treat these conditions. The best approach thereof is to try and develop a therapeutic relationship between the patient and the clinical officer (Wurtzburg and Rocchio, 2014). The relationship enhances sound communication and helps the patient to give all the relevant information to the health care provider. A process known as verbal screening is also a very important intervention as it tries to figure out the period the illness has been a challenge, some of the interventions that the patient has employed and other predisposing factors such as abuse that may contribute to overall mental disorders in people. Collier and Friedman, (2016) argues that in treatment of these disorders, it is necessary to recognize the cultural influences of the Maori people. People who did not traditionally recognize medicine as treatment may view medicine as an addition to other approaches and rather not as the primary treatment course. Solitary and individual counseling and therapeutic interventions may not work much for the Maori people since their culture do not focus on individuality but is rather concerned with the development of large relationships. Brunton and McGeorge, (2017) argues that Partnering with Kaupapa Maori service providers provides a better ground for health officers in order to be effective in their work. The understanding of mental illnesses has influenced the cultural responses among contemporary Maori people (Ward, 2014, June). The prevalence rates are notably higher with people with a low social-economic status, youths and middle-aged adults and equally higher with ladies as opposed to men. This has influenced the people to categorize mental health disorders as cultural related and this has prevented many people from seeking medical advice. This has led people to seek for treatment from specialists and also perform various rituals in a bid to cleanse the people from the mental illnesses. According to Saul and Simon, (2016) the government of New Zealand, having identified the challenge has come up with various resolutions of rooting out the mental health disorders among these people. Some of these interventions include the implementation and reorganization of various initiatives that respond to these mental conditions such as stress and depression. The government has also made plans to effectively deliver relevant cultural care that does not conflict with the beliefs of the people. This has been observed as very effective in the sense that it induces compliance among the very people and provides collaborative efforts which yield more. The government has also developed effective partnerships between primary care providers and recognized mental health care providers in a bid to improve the services that are offered to the people and in turn improve the overall health of the people. An inquiry into the overall risk factors has also prompted the government to try to address these factors as opposed to the illnesses in order to prevent occurrence of more of these illnesses. Efforts to raise the social-economic status of the Maori people have also been one of the primary focuses of the government since it remains one of the major predisposing factors to these conditions (Gureje, et al 2015). In conclusion, mental health can be said to be a threat that has not extensively been addressed among the Maori people. Alongside other acute infections and food disorders due to drug use and the lifestyle conditions, mental health still remains to be a major threat to people living in New Zealand especially those of the Maori descent. Relationships, cultural assessment, beliefs and customs however remains one of the most important virtues that the Maori uphold that to some extent can be said to have some little influence in their mental conditions. References Collier, S., Friedman, S. H. (2016). Mental illness among women referred for psychiatric services in a New Zealand women's prison.Behavioral sciences the law,34(4), 539-550. Newton?Howes, G., Boden, J. M. (2015). Relation between age of first drinking and mental health and alcohol and drug disorders in adulthood: evidence from a 35?year cohort study.Addiction. Bradley, P., Dunn, S., Lowell, A., Nagel, T. (2015). Acute mental health service delivery to Indigenous women: What is known?.International journal of mental health nursing,24(6), 471-477. Gureje, O., Nortje, G., Makanjuola, V., Oladeji, B. D., Seedat, S., Jenkins, R. (2015). The role of global traditional and complementary systems of medicine in the treatment of mental health disorders.The Lancet Psychiatry,2(2), 168-177. Shoemaker, E. Z., Tully, L. M., Niendam, T. A., Peterson, B. S. (2015). The next big thing in child and adolescent psychiatry: interventions to prevent and intervene early in psychiatric illnesses.Psychiatric Clinics of North America,38(3), 475-494. Ward, T. (2014, June). The theory and practice of critical pedagogy in bicultural community development. Part 1: Theory. Capitalism and community health: An indigenous perspective. InIV INTERNATIONAL CONFERENCE ON CRITICAL EDUCATION Critical Education in the Era of Crisis(p. 833). Saul, J., Simon, W. (2016). Building resilience in families, communities, and organizations: A training program in global mental health and psychosocial support.Family process,55(4), 689-699. Leckie, J., Hughes, F. (2017). Mental Health in the Smaller Pacific States. InMental Health in Asia and the Pacific(pp. 253-272). Springer US. Brunton, W., McGeorge, P. (2017). Grafting and Crafting New Zealands Mental Health Policy. InMental Health in Asia and the Pacific(pp. 273-287). Springer US. Gurung, R. A. (2013).Health psychology: A cultural approach. Cengage Learning. Wurtzburg, S. J., Rocchio, C. C. (2014). Mental Illness and Culture.The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. Cunningham, C. (2015). Psychosocial factors in healthcare for Maori.Psychosocial Dimensions of Medicine, 208.

Tim Burton Cinematic Techniques free essay sample

Tim Burton is a successful film maker and has inspired many to get into the movie making business due to his cinematic techniques. In many of his films, Tim Burton uses lighting successfully to show happiness or sadness. He is known for having very low key beginning credits. Low key lighting can be used to show a sad, mysterious or scary environment. For example, the beginning credits of the movies Charlie and the Chocolate Factory and Edward Scissorhands are very dark cloudy scenes. They both have a solid black background and obscure objects appearing. Also, Burton used lighting perfectly in Charlie and the Chocolate Factory when the lucky children who obtain the golden tickets enter the huge room where the chocolate was made. It is a bright and colorful room filled with tasty goods. High key lighting is used to create a happy, exciting, or fun atmosphere. The lighting on the kids faces as they walk in the factory was very high key because they were bright and full of joy. We will write a custom essay sample on Tim Burton Cinematic Techniques or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Burton also uses a high key effect on the town in Edward Scissorhands; it is filled with brightly painted houses with beautifully cut bushes. Also the clothes that people wear in Edward Scissorhands are very brightly colored because people would wear a single colored outfit of much color. As a result, lighting is used effectively throughout his movies to show different effects. Camera angles were very important in the films Edward Scissorhands and Charlie and the Chocolate Factory. In the movie, Charlie and the Chocolate Factory the scene of Willy Wonka walking in the jungle is a great example of camera angles. As the big bug zeroes in on Wonka, a low angle camera is used to show the bug is big and strong. Then, it cut to Wonka with a high angle shot showing he is helpless and small. After Wonka successfully kills the bug, it gives him a low angle shot showing he is the victor and that he is more powerful. In Edward Scissorhands, low angle shots are used many times while Edward is cutting things. For example, while Edward is constructing his first ice sculpture in Kims lawn the camera is low angle and makes him look very powerful while he sculpts the big angel. It makes him seem as if he is on top of the world and can do anything. There are also low angle shots while he cuts all of the housewives hair. There is a very effective long shot in the beginning of the movie while Peg strolls into Edwards house, when she finally gets into Edwards room there is a long shot which shows how big the house actually is by making Peg look very short due to the height of the ceiling. As a result, Tim Burton uses low angle, high angle, and long shots to represent strength, weakness, and to show a large scene and many things occurring at once. Tim Burton is a very skilled film maker who uses many cinematic techniques to make his movies enjoyable to watch. He efficiently uses lighting and camera angles in two of his major pieces, Edward Scissorhands and Charlie and the Chocolate Factory. He uses these two techniques very well and a handful of others that make his movies very well known and watched by many people. In conclusion, Tim Burton is able to use cinematic techniques an important part of his movies by using lighting and camera angles.

Shouldice Hospital Essay Example

Shouldice Hospital Essay Example Shouldice Hospital Essay Shouldice Hospital Essay Q1: How does shouldice compete? In other words why do patients come to shouldice hospital? Two main reasons drive customers into choosing Shouldice over other competitors/hospitals. The first is quality, and the other is cost. talking about quality of the Shouldice â€Å"product† includes both, quality of the operation, and quality of post operation activities and overall services offered by Shouldice. The Shouldice method is a focused, specified operation that deals with Hernias, with a reputation that has been built throughout the years and is still growing; the hospital doesn’t even use advertisement to attract patients, the â€Å"word of mouth† way of advertisement has been doing very well for them so far. The superior quality offered by the Shouldice method, gives the patients a motive to operate at Shouldice for what it gives regarding peace of mind, low risk and low recurrence rates. Away from the in-operation excellence in quality, the services that Shouldice hospital offers are more tempting than other hospitals. Patients do not feel that they are in a hospital; they consider it more like a recovery vacation with an excused absence from work without feeling any guilt in that. How do you count for its performance ? The Shouldice Method * Specializes in external hernias only. * Is a 45 minute procedure for first time repairs, * And a 90 minute procedure for recurrences of hernias previously repaired elsewhere. * Involves separation of muscle layers and six rows of sutures in an overlapping fashion resulting in a reinforced muscular wall. * Typically, only requires use of a sleeping pill, a pain killer, and a local anesthetic allowing for immediate post-op ambulation rapid recovery. The Patient Experience * Appointments are driven by patient referrals. * Patients are encouraged to self-diagnose to avoid a visit. * The experience requires only one or two visits. * A typical length of stay is about 3 days. * All rooms are semiprivate, and patients are grouped with someone of like interest. * Patients nearing discharge help orient new patients arriving. * Surgery occurs on day 2. * Patients walk from the operating table to the post-op room (with some help from surgeons), * For psychological and physiological reasons * And are encouraged to exercise regularly, explore the premises and make new friends. * Patients were so fond of their experience that they sometimes asked if they could stay an extra day. * The most common after-effect in summer is sunburn! The Nurse Experience * Shouldice employs 34 full-time equivalent (FTE) nurses on staff. * The ratio of nurses to patients is 1:15, compared to 1:4 in Canadian acute-care hospitals. * Nurses spend an unusually large amount of time providing counseling services to patients. * Due to low nurse turnover, there is a waiting list of nurses wanting to work at Shouldice. * Competition is constantly short-staffed. The Doctor Experience * 10 full time surgeons, * 8 part-time assistants, * 2 anesthetists on site, * 30-36 operations per day. * Each surgeon performs 3-4 surgeries per day. * Salary is $144k + bonus (15% over competition). * Surgeon’s typically work 7:30 – 4:00 M-F. * On call 1 weekday night in 10, 1 weekend in 10 * Better quality of life than most surgeon schedules * Consequently, turnover is low. The Facility * The facility is designed so patients have to walk in order to do things they need or want to do. * Rooms are not equipped with phone or TV. * Patients must travel to make a phone call, watch TV, socialize, eat, etc. * Small rise stairways make it easier on patients who have just completed surgery. * Carpeting makes it feel warm and comfortable. * Patients and staff eat together in the cafeteria. * Food all fresh ingredients and prepared from scratch. The Administration * No one is fired! Turnover is low. * Staff is non-union. * Pay scale is higher than the competition. * Profit sharing plans are in place for doctors and staff. * Cross-training teamwork are strong. * Managing director stays late one night per week to interact with patients and staff. The Market * 1 million hernia operations in the US in 2000. * Most commonly performed on males. * Shouldice has a backlog of 2400 growing. * Relies entirely on word-of-mouth advertising. * Rates are reasonable. * Annual checkups are provided for alumni free of charge. * Annual reunion of patients draws about 1000. What actions to take to expand the hospitals capacity ? Consider becoming a teaching hospital to provide a new revenue stream and spread the Shouldice technique around the world. Consider performing surgeries on weekends. Provide training for leadership staff, to overcome the concerns about compromised quality control of operations with expansion. Develop resilience skills of all staff and leadership skills for administration. Hire new staff with the understanding of the new operating hours. It is highly recommended to adopt Saturday working option with some minor modifications. The existing procedure needs to be synchronized with the various activities and to be well planned. How would you implement the changes you propose ? * Admission of patients to be made on Sundays with the available administrative staff. * During the peak period of operations, use the 14 hostel rooms available in the third floor for accommodating the patients. * Incentives to doctors, nurses and other staff for the Saturday working days to be paid twice that of normal days. * Successor for Dr. Obney from the existing experienced doctors to be done within six months. * A general meeting is going to be scheduled to discuss the expansion. * Feedback and suggestions would be gathered from the overall staff. * Employees would be allowd to work flexibly.

Here is How to Make Edible Glitter

Here is How to Make Edible Glitter Make your own edible glitter. Its easy and inexpensive and much safer for kids or to put on your face. Edible Glitter Ingredients 1/4 cup sugar1/2 teaspoon liquid food coloring You can use granulated white sugar or any of the crystalline sugars. Avoid brown sugar (too moist) and powdered sugar (not sparkly). Use liquid food coloring because paste coloring is more difficult to mix and may discolor when baked. Mix together the sugar and food coloring.Bake the colored sugar in a 350 F oven for 10 minutes.Store the sugar glitter in a sealed container, to protect it from moisture. Non-Toxic Glitter Recipe 1/4 cup salt1/2 teaspoon liquid food coloring Mix together the salt and food coloring.Bake the colored salt on a baking sheet at 350 F for 10 minutes.Allow the glitter to cool. Store the glitter in a sealed bag or container. You can mix either type of glitter with corn syrup or non-toxic glue for craft projects or stick it to your skin. It also sticks fairly well onto petroleum jelly for use on your lips. Because petroleum jelly is oil-based, it wont dissolve the sugar.

Cultural Competence in Nursing Essay Example | Topics and Well Written Essays - 1250 words

Cultural Competence in Nursing - Essay Example Such perceptions are very common in the United States because a bigger percent of the citizens are Christians who believe in God or a higher power. This concept applies to the chronically ill and the families who at most times may strongly belief that their chronic illness could e a sort of test and that through God’s intervention the illness will eventually be treatable. This means that this chronically ill patient focuses on inner strength and health care givers should fully apply their cultural competence by supporting the patient and its family’s cultural beliefs. More so, nurses and health care givers can obtain focused information about client’s presenting illness and his perception of causes of illness and beliefs about cultural treatment modalities (Jeffreys, 2010). This concept usually applies to patients or families of the chronically ill patients who believe in non-biomedical healing tradition. These individuals strongly believe that traditional medici ne could be more effective to biomedical medication. A competent health giver or nurse should understand this cultural concept by understanding the chronically ill patient or his family’s wish. Ideally, culturally competence approach would put up ways to communicate with chronically ill patients about their perception of their conditions, concerns and fears about a particular medication. Hence, physicians and caregivers could play a crucial timely role in addressing social cultural barriers to care by following culturally competent approaches to decision support (Jeffreys, 2010). Cultural competence can also assist patients to manage their own illnesses by providing educational information... This essay stresses that effective communication and interaction between health care givers and their chronically ill patients is essential because it delivers high-quality care. Statistics from the National Adult Literacy Survey claims that approximately ninety million U.S. adults have trouble in reading written text. More statistics claim that patients with chronic illness and limited health literacy have less knowledge of managing diseases, compared to those with higher literacy level. Such situations are commonly evident in the current society. For instance, a patient suffering from chronic illness like diabetes may tend to think that since diabetes is hereditary, there is no means of controlling it since other family members suffered from the disease and eventually died and so is his fate. In this respect, proper education through effective communication from the caregivers will be of crucial help to inform the chronically patient that insulin injection will greatly assist in co ntrolling diabetes. This paper makes a conclusion that chronic illnesses are terminal illnesses that needs accurate acceptance by the patients and their families. This means that the health care givers have a hard task of building a strong relationship with the patients in order to understand their likes and innermost views and likes. The outcome from the chronically ill patients lays the platform for the caregivers to deliver the best and efficient services as well as help in eradicating health disparities starting from individual levels.

Vermeers The Music Lesson and Rubens The Three Graces Essay

Vermeers The Music Lesson and Rubens The Three Graces - Essay Example The essay "Vermeer’s The Music Lesson and Ruben’s The Three Graces" discovers Baroque Painting in Relationship to Renaissance Aesthetics. The focus is on the Vermeer’s The Music Lesson and Ruben’s The Three Graces. The way in which light and colour were used emphasized the drama that was sought after during this time. In comparing the work of the Baroque period to the work of the Renaissance, one can see a heavier and richer use of colour, while sharper uses of light and shadow combine to emphasize a climactic point of drama. In order to examine the differences between the works that was done in the Renaissance in comparison to the work done in the Baroque period, pieces with the same theme allow for clear contrasts. The Three Graces by Peter Paul Rubens reveals that the fascination with mythological subjects that was observed during the Renaissance still provided subject matter for the painters of the Baroque period. Rubens’ work allows one to obse rve that there is an emphasis on the curves of the body, the heaviness of the form accentuated with more extreme chiaroscuro. The light and dark of the painting creates a more dramatic look to the work. As well, the tones that are used provide a higher level of drama to the moment of the embrace between the three deities. When you compare the work of Rubens to the earlier works of Botticelliand Raphael, there is a distinct difference in the tension within the composition. In the works of Botticelli and Raphael, the figures are light.... Botticelli, Primavera (1485-1487) interaction creates a higher level of drama in the Rubens work from the Baroque period than in the paintings from the Renaissance period. The Baroque period provided for a more painterly approach to the artwork that was generated. The dynamism of the work was created through a less controlled performance of the act of painting, while the Renaissance had work that was done in a more linear format. According to Beardsley, the linear work of the Renaissance in comparison to the more painterly work of the Baroque â€Å"is comparable to the shift of emphasis from rhythm to harmony† (218). Where linear painting is defined by carefully rendered images that are three dimensional due to the use of carefully controlled perspective, painterly work has an element of randomness that is Figure 3. Raphael, The Three Graces (1504-1505) created through the emotions of the act of painting. According to Staiger, â€Å"Linear perspective uses the artist’s viewpoint to figure out angles of things that recede into the distance† (104). In painterly work, however, the brush strokes are applied where they feel right, rather than through a perspective that is relevant to the position of the artist. The paint strokes are more visible and have a textural effect that is not present in a more linear work of art. Johannes Vermeer did work that embraced the aesthetics of light and shadow in combination with rich toned hues. He was greatly influenced by the changes that were being made away from the aesthetics of the Renaissance period. According to Gowing, â€Å"The baroque provided the example which dominated Vermeer’s beginnings. And while other Dutch painters could carry its rhythm as a

Torah or the Law Essay Example for Free

Torah or the Law Essay Torah or the Law is the substance of Gods covenant and is not merely the moral code delivered by Moses through the Ten Commandments in Mt. Sinai but also the prescriptive elements the Mosaic Law functioned primarily as the constitution of the nation as basis in determining civil and criminal cases. It also serves a guide to worship, good family and social relationships, most of all Israels guide to relationship with God. 1. Discuss the expression of `righteousness` in the Torah, prior to the giving of the righteousness AND ten commandments, with special examples. Exodus 19 suggests that the God of judgment is also the God of the law, his judgments express his concern for righteousness (Deut 6:25) because He is also righteous (Jos 10;1). The righteousness becomes a command to win the favor of God in response to his glorious act of blessings including the possession of land (Deut 9:4). To note, The Ten Commandments is a perfect expression of Gods revealed will of righteousness (Deut 9:5). God in the law established a requirement for his people in the highest possible standard. (Exo.13:8-10, Exo.20:3-17, Deut.4:5,9,10; Deut.5 :6-21, Deut.6:4-9, Deut.11:18-21, Deut.32:46-47). But it is not by the deed that they gain God’s favor. Deut 9:5-6 states that by nature, men are wicked so they offer sacrifices (Deut 33:19) to gain the righteousness that God requires but only by Gods faithfulness and favor that they become righteous. 2. Discuss the definition of `covenant,` and its expression in specific examples in the Torah. Merriam-Websters definition of covenant is a written agreement or promise usually under seal between two or more parties especially for the performance of some action. For the Israelites, covenant happened at Sinai through the Ten Commandments (Ex 19-24,Ex 34:28; Dt 5:2-3; 9:9) where the following were revealed (Zondervan Reference Library Software): 1. Everyones person is to be secure (Ex 20:13; 21:16-21, 26-31; Lev 19:14; Dt 5:17; 24:7; 27:18). 2. Everyone is to be secure against slander and false accusation (Ex 20:16; 23:1-3; Lev 19:16; Dt 5:20; 19:15-21). 3. No woman is to be taken advantage of within her subordinate status in society (Ex 21:7-11, 20, 26-32; 22:16-17; Dt 21:10-14; 22:13-30; 24:1-5). 4. Punishment for wrongdoing shall not be excessive so that the culprit is dehumanized (Dt 25:1-5). 5. Every Israelites dignity and right to be Gods freedman and servant are to be honored and safeguarded (Ex 21:2, 5-6; Lev 25; Dt 15:12-18). 6. Every Israelites inheritance in the promised land is to be secure (Lev 25; Nu 27:5-7; 36:1-9; Dt 25:5-10). 7. Everyones property is to be secure (Ex 20:15; 21:33-36; 22:1-15; 23:4-5; Lev 19:35-36; Dt 5:19; 22:1-4; 25:13-15). 8. Everyone is to receive the fruit of his labors (Lev 19:13; Dt 24:14; 25:4). 9. Everyone is to share the fruit of the ground (Ex 23:10-11; Lev 19:9-10; 23:22; 25:3-55; Dt 14:28-29; 24:19-21). 10. Everyone, down to the humblest servant and the resident alien, is to share in the weekly rest of Gods Sabbath (Ex 20:8-11; 23:12; Dt 5:12-15). 11. The marriage relationship is to be kept inviolate (Ex 20:14; Dt 5:18; see also Lev 18:6-23; 20:10-21; Dt 22:13-30). 12. No one, however disabled, impoverished or powerless, is to be oppressed or exploited (Ex 22:21-27; Lev 19:14, 33-34; 25:35-36; Dt 23:19; 24:6, 12-15, 17; 27:18). 13. Everyone is to have free access to the courts and is to be afforded a fair trial (Ex 23:6, 8; Lev 19:15; Dt 1:17; 10:17-18; 16:18-20; 17:8-13; 19:15-21). 14. Every persons God-given place in the social order is to be honored (Ex 20:12; 21:15, 17; 22:28; Lev 19:3, 32; 20:9; Dt 5:16; 17:8-13; 21:15-21; 27:16). 15. No one shall be above the law, not even the king (Dt 17:18-20). 16. Concern for the welfare of other creatures is to be extended to the animal world (Ex 23:5, 11; Lev 25:7; Dt 22:4, 6-7; 25:4). 3. Discuss the way in which the Torah uses `family` as a narrative perspective. The Israelites in Moses’ time lived in a patriarchal culture and the law expressed an emphasis on the responsibility of the fathers as head of the family. Their families were confronted with immorality so the Law (Torah) gave light and direction to preserve the family relations from corruption. As such, marriage was mentioned several times in the Law (Exod 21-22, 34; Lev 18, 21; Num 5, 25; Deut 7, 21-22, 24-25, 27). Within the family, children were to honor and obey their parents (Exod 20:12; Deut 5:16; 21:18-21; 27:16). And since the family circle might include servants, slaves, and strangers also referred to them as family (Exod 12, 21-22; Lev 19, 22, 24-25; Num 9, 15, 35; Deut 1, 12, 14-16, 23-24, 27). Family purity and respect were strictly guarded against sex (Lev 20:1-21; Deut 22:20:21) The law mentioned a perfect relationship between husband and wife, fathers to daughters, sons to mothers, fathers wife, sibling relationships, mother and fathers son or daughters, to own sons and daughters, father and mothers close relative, in-laws and close relative relationships and even with the neighbors (Lev.18). Deuteronomy 4:40 states a commandment to the Israelites to keep his decrees and commandments to teach and pass to their children and their childrens children with God’s promise of long life in the land. 4. Discuss the examples of readings from Genesis and Exodus that deal with issues of gender, race, ethnicity, or social class. Issues in Genesis and Exodus started in the birth of the Jewish race and the descendants of Abraham, the Patriarchs. The Patriarchal era socially classified the authority of the male and the female and family role. The family is composed of husband, wife, children, grandparents, uncles, aunts, cousins, servants, concubines, friends, and visiting guests and followed some of the marriage practices of the surrounding nations and had more than one wife, a practice known as polygamy. One issue was when Abraham had a son with Hagar, Sarahs slave girl who became a surrogate mother for her mistress. A wife was like a property of his master but she had the highest position in the household. Moreover, birthright and sibling rivalry issue also arose when Isaac, son of Abraham from Sarah inherited everything Abraham owned (Gen 25:5) though Ishmael, son from Hagar was the eldest. Sons of concubines did not normally share equally with the sons of a mans wife (or wives) and the oldest son was entitled to the birthright, normally a double-share of the inheritance (Wolf, Herbert. An Introduction to the Old Testament Pentateuch, Moody Press, 1991). Same thing happened when Esau sold his birthright to Jacob sons of Isaac. Inheritance issue was also involved between Jacobs wives Rachel and Leah against their father Laban who did not give them the portion of the bride payment usually transferred to the daughters as dowry (Gen. 32). From the wives of Jacob and to his twelve sons the rivalry passed on when the other ten sons envied Joseph and sold him to be a slave of Egyptians but later put him in a better social and political status as Egyptian official.

Genetically Engineered Organisms Essay -- seeds, monsanto, food

Genetically Engineered Organisms Without vigorous experimentation or public consent genetically modified foods have been introduced into our daily kitchens without much notice from the general public. Widespread use of genetically modified (GM) seeds began in 1996 and since then has spread to cover 167 million acres around the world; two-thirds of that quantity being in America (Figure 1). Figure 1 Monsanto is the main developer of these seeds and controls over 90% of the American market, alerting a possible crisis in the democratic system. (Cummins and lilliston, 2004). Alarmingly, some of the largest biotechnological companies have also introduced toxic pesticides into our environments, including but not limiting to: Agent Orange, DDT, and PCB’s, causing much worry worldwide. This report will cover the basics of genetic engineering, genetically engineered seeds, possible effects on human health and affects on the environment. The four most common genetically engineered (GE) crops grown on a commercial scale are soybeans, corn, cotton and canola. Among these, two main traits have been added: herbicide resistance (75 percent of all GE crops), pesticide resistance (17 percent) or both (8 percent), (Genetically Engineered Food, Page xiv). The first steps in genetically modifying organisms is identifying the trait you want the plant to have, and finding another organism that has it. Then, the gene can be inserted into the plant using a 22-caliber charge that fires a metal particle coated with DNA, called a â€Å"gene gun†. Another method of inserting the desired gene includes heating the seed and placing it under stress causing it to be susceptible to a bug called Agrobacterium tumefaciens. This bacterium tricks the organism into b... ...wever possibly inaccurate, allow us to speculate on new technologies which could help feed the growing population of humans on earth. Works Cited Wolfenbarger, Laressa L., and Paul R. Phifer. "The ecological risks and benefits of genetically engineered plants." Science 290.5499 (2000): 2088-2093. Jesse, Laura C. Hansen, and John J. Obrycki. "Field deposition of Bt transgenic corn pollen: lethal effects on the monarch butterfly." Oecologia 125.2 (2000): 241-248. Anal Bioanal Chem. Oct 2008; 392(3): 333–340. Seralini GE, Cellier D, Spiroux de Vendomois J. New analysis of a rat feeding study with a genetically modified maize reveals signs of hepatorenal toxicity. Arch Environ Contam Toxicol. 2007;52:596–602. The Ecological Risks and Benefits of Genetically Engineered Plants L. L. Wolfenbarger, et al. Science 290, 2088 (2000); DOI: 10.1126/science.290.5499.2088

Ethical Scrapbook Essay

The ethical scrapbook part two coincides with further evaluations in regard to 12 contemporary examples of different situations, and circumstances. With these 12 contemporary examples, in which further discusses each team member’s evaluation, and opinions of each example. These examples include: Police Acts of Kindness, People reaching out after hurricane Sandy, Daughter display of Kindness, Acts of Vigilantism, Community Revenge, Diana, the Hunter of Bus Drivers, Women Demand Respect, Salt March, Flying Pickets, and Sit-ins. In addition, these examples also include Poll tax Non-Payment, Professionals committing crimes, in which Kenneth Lay, along with Stuart Greenberg, and James Traficant who represents individuals who has the role of professionals committing such crimes. With these 12 contemporary examples, each team member’s goal is to decide if the particular individual makes the best decision given the circumstances and can one see himself or herself acting similar ly in theses similar circumstances. With comparing one’s individual response as a team, these responses will permit answers pertaining to examples that generate an agreement between each team member. These examples will generate disagreement, along with the reflection of each disagreement in terms of an individual’s personal values. With further detail, one will also answer the following: laws for acting as a Good Samaritan. In addition, Vigilantism becoming a part of the criminal justice system when it fails, along with the circumstances of which one may violate the law in regard to enforcing the law. One’s opinion on civil disobedience becoming effective with changes to the law, along with certain laws to become in agreement when considering violating to change, and determining conditions that exist within a profession, excluding that of criminal justice professions, in which contributes to unethical behaviors. In  addition, deciding if the American society has become predisposed to ethical or unethical behaviors. Finalizing the summary is to identify the ethical considerations for both the future of the criminal justice system, and reducing ethical violations. With the 12 contemporary examples for each solution, team members will provide the best resolution of one’s opinion for every scenario. Police Acts of Kindness Review  The best decision of an individual in regard to Police Acts of Kindness, one answers that the police officers went out of his or her jurisdiction to assist children who are at a high-risk of involving themselves among other youth of troubling paths. These officers also assist with providing positive outcomes for the youth, instead of involvement in gang activity, and drug involvement. With this particular example, one may find themselves acting in the similar circumstances of the police officers. These circumstances involve the opportunity to help individuals, and believe one is making a difference in another person’s life. As a result, the experience becomes rewarding, and to have the personal knowledge that another individual’s goals have become meant. Hurricane Sandy Review The best decision of an individual in regard to hurricane Sandy, one may answer the outcome in giving freely. These acts of kindness and giving freely include free medical care to those who cannot afford medicine. In addition, an individual provides home electricity to charge cellphones of individuals to reach out to family and friends. If one could act similarly, individuals will not pay for medical care, and other non-perishable supplies. Daughter displays Kindness Review The best possible decision of an individual in regard to a daughter displaying kindness, one may also answer to have the assurance of the community is an amazing accomplishment, in which helps both the sister and aunt readjust to life circumstances. If one could act similarly, making a negative situation in turn for something good is a self-fulfilling accomplishment. Community Revenge Review The best possible decision of an individual in regard to community revenge, an arrest is the best resolution for this particular situation because of the involvement of the community, in which results with a positive outcome. If one could act similarly with this situation, one will become the target of vengeance for oneself, and other women. Diana-the Hunter of Bus Drivers Review The best possible decision of an individual in regard to the hunter of bus drivers, law enforcement officials fail to provide justice for these women. As a result, these women begin to seek vengeance. If one could act similarly, one may also seek vengeance because of the traumatic experience these women endures. Women Demand Respect Review The best possible decision of an individual in regard to women demanding respect, one may answer that the suffering of sexual harassment by men results in acts of Vigilante. With the acts of Vigilante, women have the best possible decision by hauling these men to law enforcement officials personally. Salt March Review The best possible decision of an individual in regard to the Salt March, Gandhi makes the best possible decision by defying the empire over the salt monopoly. If one could act similarly, one will become in agreement to achieving the best outcome for everyone and not what is best for the government. Flying Pickets and Sit-ins Review The best possible decision of an individual in regard to flying pickets and sit-ins because individuals believe to have better work situations for themselves, and coworkers. If one could act similarly, one will permit him or herself to better working conditions. Poll Tax Non-Payment Review The best possible decision of an individual in regard to poll tax non-payment is the exposure of the leader, in which becomes an effective tax collection process. If one could act similarly, these actions are helping the government and not hurting people one will permit his or her approval. Kenneth Lay Review The best possible decision Kenneth Lay demonstrates is his ability of obtaining financial gain within a company. As a result, Kenneth Lay did not fully demonstrate accuracy of the business and mishandles a large number of people’s money, in which causes he or she to commit suicide because they lost everything in the process. This individual did not make the best possible decision. If one could act similarly, one will not permit these types of actions by hurting those who has any involvement with the company. Stuart Greenberg Review Stuart Greenberg did not make the best possible decision because he did not remain truthful with his cases, in which discredits his professionalism. If one could act similarly, one will not become in agreement to act as such because one’s employment will become in jeopardy. James Traficant Review James Traficant did not make the best possible decision in regard to his staff. If one could act similarly, one will choose not to take advantage of innocent individuals. Reflection of Both Agreements and Disagreements The examples generating the most agreement between each team member include: (1) Daughter displays kindness, (2) People reach out after hurricane Sandy, (3) Police Acts of Kindness, (4) Women demand respect, along with (5) Flying Pickets, and sit-ins examples. The most least favorable example by each team member is the Diana, the hunter of bus drivers, Kenneth Lay, along with Stuart Greenberg. These examples reflect an individual’s personal value systems by the way, each situation displays unethical behaviors. Good Samaritan Law People have a natural tendency to help someone in distress, he or she believes the moral obligation to help, and serve other people but there are a few that would rather watch a person suffer in agony rather than assisting him or her. Jurisdictions should have a Good Samaritan law requiring an individual to help another individual if he or she becomes able, this can help provide the necessary assistance to the person until the proper authority arrives. In today’s day of frivolous lawsuits many people become  scarce to lend a hand and help a person in need. Individuals may choose to not become responsible for any damages one may create in regard to assisting another individual. Individuals may become more comfortable by recording events on his or her cell phone along uploading on YouTube. If there were laws requiring an individual to help another individual people in need can get the necessary assistance in a timely manner, and punish those that refuse to help someone in need . Permanence of Vigilantism, and One’s opinion of violating the Law The Criminal Justice System no longer displays strong management skills as new laws become into existence. These management skills will permit defense attorneys to finding loop holes in regard to protecting his or her clients. Many believe he or she requires the fulfillment of taking matters into his or her hands. Vigilantism should not become a part of any function if the criminal justice fails. In addition, just like the victim, the defendant has rights, and if he or she becomes innocent, the community must accept the judgment of the courts. There are many factors that influence the decision of the courts, in which most of the community becomes unaware of viable information. The one circumstance, in which the community obligates themselves with violating the law is to enforce the law in regard to the criminal justice system failing. In Detroit the community decides to take the law into his or her hands when the local authorities delays a rape investigation of a 15- year old girl, and the suspect becomes set free (Garcia, 2013). Civil Disobedience Becoming Effective in Changing the Law In one’s opinion, one may agree with civil disobedience becoming effective in regard to changing the law. Civil disobedience in one’s opinion, ushers the equality for minorities, along with the civil rights movement stemming from the 1960s continues to develop changes in the law. These changes also include the antiwar sentiments of the 1970s has become a change into the present, yet not as a benefit for those who want to do away with wars. The tea party has a change with the way politicians approach certain circumstances. The change one disagrees with is the gun ownership, and property rights. Gun ownership permits for more violence, and individuals do not fully understand the rules and regulations of gun laws. Individuals who  pose these guns find themselves on the other side of the law because of lack of knowledge in protecting themselves, including his or her property. An individual cannot protect him or herself from an intruder entering his or her property because certain laws exist that prohibits this type of gun use. Existing Conditions within a Profession Conditions that exist in a profession, in which excludes the criminal justice profession that contributes to unethical behavior include the role of leadership, and employees within his or her workplace are two examples of displaying unethical behaviors. The unethical behavior of leaders most often has consequences for him or her, along with followers, and his or her respective organizations (Chandler, 2009). Examples of these unethical behaviors by leaders in corporate businesses, religion, and government include individuals such as Kenneth Lay, Jeffrey Skilling of Enron, and former The United States Senator John Edwards from North Carolina. As a result of each of these individuals actions were one of pure humiliation. American Society, Ethical or Unethical American society can become a society of ethical or unethical individuals. Individuals who display ethical or unethical behaviors become an adaption at an early age. These behaviors establish the learning skills, and influences by adult peers. With the choice of becoming an ethical or unethical individual is the choice of the individual him or herself will permit to make. Ethical Considerations An ethical consideration becomes the rules, and regulations within any organization as well as the criminal justice system. One ethical consideration is to control the use of force by law enforcement officials. This ethical consideration requires a more strict, and ethical code of conduct for law enforcement officials. To reduce unethical violations within the criminal justice field, one must upgrade the punishment levels for individuals who violate the law. One may also believe in the efforts of a better policing practice, one must go through a series of training on a regular basis, in regard to keeping his or her skills up-to-date throughout his or her career of law enforcement. Conclusion A person can take any 12 examples of different situations and circumstances and not everyone will agree and as a criminal justice major one will become willing to see things from another individual’s point of view. Not everyone will agree with everything throughout life and acquiring a difference of opinion gives person ideas, and by obtaining different ideas one may work together as a team. If a person does not agree with someone’s way of thinking he or she may assume a person’s ideas or thoughts are already correct. For most people he or she will become accustom to another individual’s point of view, or by determining one’s theory may become of the truth. Throughout this assignment there have been ideas agreed and disagreed about and by talking and listen an agreement was met. References Garcia, A. (2013, August 12). Vigilante detroit residents attack suspected rapist after police fail to act. Retrieved from http://www.rawstory.com/rs/2013/08/12/vigilante-detroit-residents-attack-suspected-rapist-after-police-fail-to-act/ Chandler, D.J. (2009). The Perfect Storm of Leaders’ Unethical Behavior: A Conceptual Framework. International Journal of Leadership Studies, Vol.51 Iss. 1, 2009. Retrieved from http://www.regent.edu.acad/†¦/ijls/IJLS/Vol51s1-chandler%2012.pdf.

Franz Schubert

It was Franz Peter Schubert, who said to a friend â€Å"I have come into the world for no other purpose but to compose†. For someone to be so certain, focused and dedicated at such a young age with extraordinary talent and promise, finding out more about Schubert’s life and astonishing music was a must for me. Franz Peter Schubert was bone in Vienna, on January 31, 1797 to his father, Franz Theodor Schubert and his mother, Elisabeth Vietz.Because Schubert father was a schoolmaster, he began receiving lessons from his father at an early age, as early as age five. A year later Schubert was enrolled in his farther school and taking lessons not only from his farther but also piano lessons from his brother Ignaz. Schubert was very talented and gifted, there were times when his instructor would try to teach him new things which he already had knowledge of. It was at age eleven when Schubert became a choirboy in the court chapel and won a scholarship to the Imperial Seminary.I t was at the Imperial Seminary that Schubert was introduced to the symphonies of Mozart and visits to the opera that strengthen his musical knowledge. At an early age Schubert played the viola and also wrote many of his early string quartets in the family string quartet, with his brothers Ferdinan and Ignaz on violin and his father on the cello. Schubert composed many masterpieces in his late teens while teaching at his father’s school. While teaching Schubert also continued private lessons in composition from Salieri which had a huge impact on Schubert’s musical training than any of his other teachers.By the time Schubert was eighteen he composed 143 songs including The Erlking, which grabbed my attention. The Erlking is rich with emotions and has a physically powerful dialogue. When listening to The Erlking you can visualize the movement and passion so well that it gives you chills. Schubert’s Erlking is one of the earliest and finest examples of musical roman ticism. In Schubert’s Erlking, there is the narrator, father, son, and the Erlking, which is all song by one person. Because the Erlking s done by one person, that one singer is to deliver each character in its fitting tone. The frighten child is song in a high register in minor, while the father is sung in a low register that distinguishes with the high pitched of the son cries, and the Erlking has modest melodies in major keys. The Goethe’s ballad tells a story of a father riding on a horseback through a storm with his ailing child in his arms, as the child is being followed by the Erlking which denotes death.At the very beginning of the Erlking, the piano begins with rapid octaves. It is said that the triplet rhythm unifies the occurrence of the song and suggests that it represent the horse’s dash. The narrator then paints the perfect picture so that you are able to perceive this wild late ride as the farther holds his unwell son so tight and closely to him. As the Goethe ballad continues the son cries out to his father, my father in a forte tone to inform him of the Erlking and his presents.The father, who uses a lower register tone, try to consol the boy and keep him calm by suggesting that the Erlking is a streak of mist and the whispering promises from the Erlking was only wind rustling in the dead leaves. After the son cried out for the last time to his father even louder than before, â€Å"My father, my father, now he is taking hold of me! The Erlking has hurt me! † The piano stops and the father reach the courtyard weary and anxious with his child dead in his arms. It was on You Tube where I first had the pleasure of seeing and not only hearing the performance of The Erlking.Jessye Mae Norman the soprano Opera singer performed The Erlking. Jessye Norman was born in Augusta, Georgia on September 15, 1945 to Silas Norman an insurance salesman, and Janie King Norman. Norman is one of the most admired contemporary opera singer s and recitalists, and is one of the highest paid performers in classical music. Jessye Norman is also known for the direct and emotionally expressive qualities of her singing and for her formidable intellectual understanding of the music and its style.During the performance of The Erlking, Jessye Norman gave great passion thought the recital with her body movement and facial expressions. The distinctions between the narrator, son and father were very obvious and the tones were delivered well. In a New York Times article, Norman explained to John Gruen, â€Å"As for my voice, it cannot be categorized and I like it that way, because I sing things that would be considered in the dramatic, mezzo or spinto range. I like so many different kinds of music that I’ve never allowed myself the limitations of one particular range. Although Norman decides not to label her voice, there are some vocal critics that feel that she is not a dramatic soprano, but deem her to be more of a rare s oprano voice type known as a Falcon. The Falcon voice is an intermediate voice types between the soprano and the mezzo soprano that is similar to the dramatic soprano but with a darker color. Norman, nevertheless, refuses to position any label on her voice. Although Franz Schubert died at such a young age he was able to write over 600 songs, he composed symphonies, string quartets, operas, art song and piano pieces as well.Schubert was recognized to be more than a great song composer only after forty years after his death when the Unfinished Symphony was performed. It was in 1828 when Franz Schubert die, he was only thirty one years old. The cause of his death was said to be typhoid fever, which is a worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person that contains the bacterium salmonella enterica. Later it was said that Schubert’s cause of death was syphilis.To recognize Schubert a memorial was built in Viennaâ €™s Stadtpartk to honor and always remember his greatness. Schubert’s grave was move to Zentralfriedhof the largest and most famous cemetery in Vienna, where it is now near Beethoven whom he admired deeply.REFERENCEhttp://www. charlierose. com/view/interview/10121http://www. classicalarchives. com/composer/3308. htmlhttp://www. youtube. com/watch? v=Iz5TV8LWbrohttp://www. bach-cantatas. com/Bio/Norman-Jessye. htm Franz Schubert Franz Schubert (1797-1828), the earliest master of the romantic art song, was unlike any great composer before him: he never held an official musical position and was neither a conductor nor a virtuoso; his income came entirely form composition. â€Å"I have come into the world for no other purpose than to compose,† he said. The full measure of his genius was recognized only years after his tragically early death. Schubert was born in Vienna, the son of a schoolmaster. Even as a child he had astounding musical gifts. If I wanted to instruct him in anything new,† recalled his amazed teacher, â€Å"he knew it already. † At eleven, he became a choirboy in the court chapel and won a scholarship to the Imperial Seminary. Schubert managed to compose an extraordinary number of masterpieces in his late teens while teaching at this father's school, a job he hated. His love of poetry led him to the art song; he composed his first great song Gretchen am Spinnrade (Gretchen a t the Spinning Wheel), when he was seventeen, and the next year he composed 143 songs , including The Erlking.When he was nineteen, Schubert's productivity rose to a peak; he composed 179 works, including two symphonies, an opera, and a mass. At twenty-one, he gave up teaching school to devote himself to music. He associated with a group of Viennese poets and artist who led a bohemian existence; often, he lived with friends because he had no money to rent a room of his own. Working incredibly fast, from seven in the morning until early afternoon, he turned out one piece after another.He spent his afternoons in cafes and many of his evenings at â€Å"Schubertiads,† parties where performances in the homes of Vienna's cultivated middle class; unlike Beethoven, he did not mingle with the aristocracy. The publication and performance of his songs brought him some recognition, but his two most important symphonies–the Unfinished and the Great C Major–were not performed in public during his lifetime. Schubert died in 1828, age thirty-one. His reputation was mainly that of a fine song composer, until the Unfinished Symphony was performed nearly forty ears later and the world could recognize his comprehensive greatness. Schubert's Music Along with over 600 songs, Schubert composed symphonies, string quartets and other chamber music, sonatas and short pieces for the piano, masses, and operas. The songs embrace an enormous variety of moods and types; their melodies range from simple, folk like tunes to complex lines that suggest impassioned speech, and their piano accompaniments are equally rich and evocative. Schubert's imaginative harmonies and dissonances provide some of the most poetic moments in music.The spirit of song pervades his instrumental music, too, and his longer works often include variation movements based on his own songs; his famous Trout Quintet in A Major (1819) is an example. Many of the symphonies and chamber works have long, lyr ical melodies, and a number of them–especially the Unfinished Symphony (1822) and the Great C Major symphony (1825-1826)–are comparable in power and emotional intensity to Beethoven's. The Unfinished was written six years before Schubert's death; no one knows why it has only two (rather than four) movements. The Great C Major was discovered ten years after his death by Robert Schumann.

Definition of Lecompton Constitution

Definition of Lecompton Constitution The Lecompton Constitution was a controversial and disputed legal document of the Kansas Territory that became the focus of a great national crisis as the United States split over the issue of slavery in the decade before the Civil War. Though it is not widely remembered today, just the mention of Lecompton stirred deep emotions among Americans in the late 1850s. The controversy arose because a proposed state constitution, which had been drafted in the territorial capital of Lecompton, would have made slavery legal in the new state of Kansas. And, in the decades before the Civil War, the issue of whether slavery would be legal in new states was perhaps the most intensely debated issue in America. The controversy over the Lecompton Constitution eventually reached the White House of James Buchanan and was also heatedly debated on Capitol Hill. The issue of Lecompton, which came to define whether Kansas would be a free state or a slave state, also influenced the political careers of Stephen Douglas and Abraham Lincoln. The Lecompton crisis played a role in the Lincoln-Douglas Debates of 1858. And the political fallout over Lecompton split the Democratic Party in ways that made Lincolns victory in the election of 1860 possible. It became a significant event on the nations path toward Civil War. And so that national controversy over Lecompton, though generally forgotten today, came to be a major issue on the nations road toward Civil War. Background of the Lecompton Constitution States entering the Union must draw up a constitution, and the Kansas territory had particular problems doing so when it moved to become a state in the late 1850s. A constitutional convention held at Topeka came up with an constitution that did not allow for slavery. However, pro-slavery Kansans held a convention in the territorial capital of Lecompton and created a state constitution that made slavery legal. It fell to the federal government to determine which state constitution would go into effect. President James Buchanan, who was known as a dough face, a northern politician with southern sympathies, endorsed the Lecompton Constitution. Significance of the Dispute Over Lecompton As it was generally assumed that the pro-slavery constitution had been voted upon in an election in which many Kansans refused to vote, Buchanans decision was controversial. And the Lecompton Constitution split the Democratic party, putting the powerful Illinois senator Stephen Douglas in opposition to many other Democrats. The Lecompton Constitution, although a seemingly obscure issue, actually became a subject of intense national debate. For example, in 1858 stories about the Lecompton issue appeared regularly on the front page of the New York Times. And the split within the Democratic Party persisted through the election of 1860, which would be won by the Republican candidate, Abraham Lincoln. The U.S. House of Representatives refused to honor the Lecompton Constitution, and the voters in Kansas also rejected it. When Kansas eventually entered the Union in early 1861 it was as a free state.

A Project Report On Marketing Fundamentals Tesla

Market research is one of the vital components adopted by companies to understand the needs, beliefs and desires of the customers. Primary and secondary are the major types of research that includes market information, market segmentation, market trends, SWOT analysis and other tools that help to gain an insight of the market conditions (Elliott, Thiele and Waller, 2014). Tesla is an American based automobile company that has very well positioned itself through its planned and extensive market research (Tesla, 2017). The company performed a strategic market research by using different tools such as PESTEL analysis, surveys and questionnaires and other methods to gather information from the market. Tesla used PESTEL analysis to assess the political, economic, social, legal, environmental and technological factors of the market to construe that the governments are promoting the production of environmental cars because of rising prices of fuel. The customers, on the other hand, have also begun to prefer the cars that protect the environment and do not pollute it due to which there was a demand for electric cars in the market (Forbes, 2016). Further, Tesla also conducted interviews with groups of moms and women of different ages to take their opinion about electric cars (Forbes, 2016). Thus, from the research, the company developed its marketing strategies and launched the product Model X especially for women (Forbes, 2016). The model was designed by considering the core selling points including safety, large space for kids and a third row. The engineers of the company incorporated all of this into the car design and manufacturing process. Another feature that was inferred from the research was that the female generally prefer to have a beautiful car along with ease for their children (Forbes, 2016). Thus, the company strategically used market research data to develop an effective product for the female.    Competition in a market arises when there are several players offering similar product or services to a large number of consumers. The players compete with each other in order to acquire a larger market share of the market and increase their sales revenue (Economics Online, 2017). The players could compete on the basis of prices, marketing, strategies and attributes of products to attract a greater share of target audience (Lin, 2016). Coca Cola is one of the largest producers of cold drinks with its huge network of sales and distribution around the world. The company has established its unique brand identity through its quality products and strong global recognition. Coca cola has its huge fan following that is a result of its customer loyalty (Lin, 2016). The main competitor of Coca Cola is Pepsi that is a thorn in the flesh for the company. Coca cola would have become the leading soft drink company around the world without Pepsi. The presence of Pepsi has brought significant changes in the marketing strategies of Coca Cola company. When Pepsi reduced its prices in the market of Australia, Coca cola also reduced the prices in order to maintain its position in the supermarket’s shelf. Coca cola has to incur a huge loss in order to carry out this campaign and retain its market position (Lin, 2016). The advertisements launched by Pepsi also influence the marketing strategies of Coca cola (Lin, 2016). Coca cola responds with complete maturity to the ads of the Pepsi in order to retain its position in the minds of the consumers. Thus, Coca Cola has to invest a huge amount of money to compete with Pepsi through huge advertising and marketing strategies. Coca cola has increased its advertising budget amount in order to stay in competition with the Pepsi (Lin, 2016). PESTEL analysis helps to determine the political, economic, social, technological, environmental and legal aspects of a country that would facilitate the growth of the product and the company. Samsung introduced its latest product Galaxy S8 after an extensive PESTEL analysis of the market in order to acquire maximum returns from the market. The political factors include stable political conditions, country relations and the support of government. Overall Samsung has received favorable response from the market of US, Australia, Europe and developing nations of Asia (Walters, 2017). The company faced some issues due to volatility of Latin American countries that affect the operations of the company. Samsung Galaxy S8 has captured the market in a short span of time in the developing nations but faced some issues in developed nations due to low purchasing power of the customers. Korea’s strong currency also affected the revenue of the product. The market has witnessed rising popularity of electronic and mobile devices among the consumers because of changing and emerging technology. The main challenge that the company faces is the frequent changes in the demands of the consumers. Samsung has very well tailored its product to suit the needs of almost every consumer around the world (Walters, 2017). Samsung is one of the most innovative companies that stays ahead of its competitors and makes optimum use of technology to offer the latest products to the customers. Samsung has produced amazing software and applications by effectively blending the market demand and technology in a single product Galaxy S8 (Walters, 2017). Samsung has to face numerous issues regarding Copyrights and patents. The company also faced challenges regarding wireless communication regulations and had to adhere to the laws and regulations pertaining to electronic device safety around the globe. Samsung has always considered the laws and regulations of the environment and has deployed processes that do not pollute the environment. SWOT analysis is used by the companies to determine their strengths, weaknesses, opportunities and threats to develop a marketing plan (Lamb, Hair and McDaniel, 2008). Woolworths is one of the Australian retail based firm that consistently enhance its strategies in order to retain its market position. Woolworths occupies the largest market share of Australia and is the pioneer firm to introduce the concept of retail chain (Greenblat, 2017). The retail chain has established its brand name and unique identity through its quality products and services. Woolworths is one of the oldest retail companies but does not have a global presence when compared to its competitors. The retail chain also has not been successfully able to develop a sustainable unique selling proposition that questions its credibility and market positioning (Berry, 2016). The company delayed to enter online market due to which it has to face tough competition. Woolworths could expand its business by exploring new markets and establish its global presence. It could deploy franchise model and joint venture strategy in the beginning in order to penetrate deeper in the market. The cost of food material and other products has witnessed an increase that could affect the profitability of the firm. The ongoing recession has also influenced the activities of the organization. There is an intense pressure in the market from Aldi and Coles that is again affecting the market share of the company (Berry, 2016).    From the SWOT analysis, the company has explored its opportunities by entering the international market of UK through marketing mix element. Product: Woolworths introduced its quality services that ensure freshness of food and high product quality (The Conversation, 2017). Price: Woolworths has deployed economical pricing strategy in order to capture the market (The Conversation, 2017). Promotion: Woolworths offered discount offers to attract large number of audience. Place: Woolworths opened its stores in the main market area in order to attract the audience. Segmentation is the process of dividing the entire market into smaller segments to determine segment for the company (Lamb, Hair and McDaniel, 2008). Segmentation could be done on the basis of demographics, geography, lifestyle and psychology of the customers.   The different segments could include youngsters, executives, professionals, adults, female, housewives, unemployed and college students (Elliott, Thiele and Waller, 2014). After segmenting, a particular group of people called target market is targeted by the industry through strategic marketing and advertising. Positioning is influencing the minds of consumers through effective marketing strategies (Elliott, Thiele and Waller, 2014). Retail industry is one of the largest industries of Australia that targets a large group of segment. Around 70%-90% of the consumers prefer to shop their groceries and other household material from the retail chains because of the availability of a wide range of products (Greenblat, 2017). The target customers of retail industry include housewives, females, adults and middle aged people. The customers are attracted towards the retail chains because of low priced products and quality services (Greenblat, 2017). Thus, the retail industry has very well identified its target group from which it can increase its sales revenue and profitability. Further, the strategic positioning involves offering low priced product along with quality services, discounts and special offers during festive season also excite the customers to shop from retail stores. The customers are also promised fresh food products and customized services such as home delivery, app based shopping and other unique services (Greenblat, 2017). The consumers feel elated and experience a unique shopping experience with the retail stores that compels them to shop for next time and become a loyal customer. Thus, the industry has strategically positioned itself as a low cost brand that offers quality services along with a unique experience to its consumers. Brand management is one of the most crucial elements of marketing that has occupied the top most concern for the leaders of the companies. A brand has to consistently evolve itself in order maintain its sustainability by meeting the customer demands. Apple is one of the examples of successful brand management around the world. The brand has very well utilized and internalized the concept of perceived value due to which the consumers always assess the benefits of its products of much higher value as compared to their prices. The brand has built itself by connecting with the consumers through their emotions that they experience while using the Apple’s products (Bajarin, 2016). The customers never forget a brand with which they have had a great experience and Apple has very well internalize this process through its highly innovative and technologically advanced products. Another major reason for Apple’s success is its risk taking ability and targeting the emerging market through which it became a pioneer and leader in the electronics market (Scheidies, 2017). Nokia is a Finnish multinational corporation that demonstrates the example of failed brand. Nokia might have evolved as successful brand but failed miserably because of its ineffective marketing strategies. The major reason for Nokia’a failure was Nokia did not deploy appropriate marketing strategies and projected itself more like an engineering company in the market (Huy, 2016). The company could not touch the chord of the consumers through its products and services. The company was rather more focused to build hardware devices instead of satisfying the needs of the consumers. Nokia always underestimated the significance of software in a mobile set due to which it was unable to adapt itself with the transitioning business environment (Surowiecki, 2016). Nokia never adapted the latest operating system and insisted on its hardware design. Another blunder of Nokia was its inability to analyze its competition that it faced from Apple and Samsung. Elliott, G., Thiele, S.R., and Waller, D. (2014). Marketing. Australia: John Wiley & Sons. Forbes. (2016). Tesla's Unique Position In The Car Market Is One Of Its Biggest Strengths. Forbes. Available at: https://www.forbes.com/sites/greatspeculations/2015/07/02/teslas-unique-position-in-the-car-market-is-one-of-its-biggest-strengths/#427a537e3ad7 [Accessed Online 4 May 2017]. Huy, Q. (2016). Who Killed Nokia? Nokia Did. Insead Knowledge. Available at: https://knowledge.insead.edu/strategy/who-killed-nokia-nokia-did-4268 [Accessed Online 4 May 2017]. Lamb, C.W., Hair, J.F., and McDaniel, C. (2008). Essential of Marketing. Cengage Learning. Surowiecki, J. (2016). Where Nokia Went Wrong. New Yorker. Available at: https://www.newyorker.com/business/currency/where-nokia-went-wrong [Accessed Online 4 May 2017].

An Evolutionary View of the Style of Pablo Picasso Research Paper

An Evolutionary View of the Style of Pablo Picasso - Research Paper Example The essay "An Evolutionary View of the Style of Pablo Picasso" investigates the influential artist Pablo Picasso. Unlike many artists both before and after his time, Picasso differentiated his works into a series of periods which exhibited a number of unique thematic elements and worked to exploit common beliefs and motives. One such period was what art critiques have categorized Picasso’s â€Å"Blue Period†. As the name implies, during this time, Picasso painted a host of paintings which relied almost exclusively on varying monochromatic tones and shades of blue and blue-green. Although more than just a reliance on a particular type of paint, this period was also defined by the thematic sterility and coldness that it portrayed. In this way, Picasso used the medium of the paint to transform images that might typically be understood another way into images that bore a somber, cold, and realistically touching reality. Accordingly, this brief analysis will seek to apprecia te and understand Picasso’s â€Å"Blue Period† for the thematic elements, personal influences, and times in which this particular artwork was created. Picassso’s â€Å"Blue Period† is interesting beyond merely the thematic elements or the type of paints used to express these due to the fact that the â€Å"Blue Period† began when Picasso himself sank into what many scholars term a â€Å"deep depression". As a result of many of the life experiences that Picasso shared during the turn of the century to include his more complete grasp of his own mortality. ... Picasso struggled to sell them to an audience that was put off by their innately melancholy and cheerless subject matter. Many art critics have inferred incorrectly that Picasso’s incorporation of the underprivileged in society during this period was due to the fact that he himself was poor during this time and sought a way to reflect on the plight and situations associated with his fellow man. This however is not the case as it was the subject matter and the means in which Picasso approached it that sealed his fate with regards to the demand for his paintings and the subject matter with which he dealt during the â€Å"Blue Period†. Although many paintings of this period focus on the melancholy and sadness that Picasso felt as a result of his lost friend, Casagemas, another recurring theme throughout these paintings is in regards to the blindness and loss of sight that many of the characters exhibit within his works. It is the understanding of this author as well as a h ost of more talented art critics that this fixation with loss of sight and blindness helps to depict the depression and lack of vision that Picasso was experiencing during this time. Additionally, rather than choosing to focus his energies on typifying the plight of the extraordinary man/woman, Picasso chose for his subject matter the drunk, the prostitute, the nobody, and the everyman. In this way, the resounding emptiness that afflicts a faceless humanity is aptly expressed to the viewer in a way that a focus on a recognizable societal group or individual would not be. As the years progressed, Picasso, himself somewhat famous within the art community in Paris prior to 1901 began to fade into a type of

Informal Assessment Essay Example | Topics and Well Written Essays - 500 words

Informal Assessment - Essay Example It so turns out that, critical reasoning, is in itself difficult a task. It is a skill, and like any skill, it is expected that it can be acquired and sustained with practice. As majority of individuals seeking to learn as well as explore different sectors in the market, with the main aim of making it in life, it is necessary to also learn that, the first step comes from ones individual effort itself. It can be argued that, with reference to the goals that majority of the students aspire to achieve, it can be narrowed down to, success as the bottom-line (Daniels, 2009). The fact that, opinion in terms of career preferences is concerned plays a major role in the case study. Opinion tends to vary from one individual to another, thus broadening the scope of learning involved. It is thus only necessary that each individual receive fair and necessary knowledge as expected. Nothing less of which is considered reasonable. Ambition too falls into question, as it is this, which draws the separating line between the success levels expected. Individuals may follow this particular course, in pursuit for bigger dream realization. In a separate scenario, the issue of an individual’s background may also facilitate what facilitates the coming together of random people, as in topic. It is only fair that boundaries limited to background issues are kept, to ascertain that equality is widespread amongst everyone. It is thus acceptable, to come up with strategies within reason, that aim at delivering to all the random individuals in a more or less equal manner. In a move to deliver every single detail as elaborated, use of emotional appeals would play a huge role in this. These are also referred to as the appeals to pathos. They are powerful tools for influence what individuals think, as well as believe. Everyone, especially at such a critical moment, makes decisions. Some of these decisions are of huge importance, some being based on ones

Theory of Knowledge Essay Example | Topics and Well Written Essays - 1500 words - 1

Theory of Knowledge - Essay Example Some areas of knowledge do require reason in order to functions, like mathematics and the natural sciences, while some others, like art and history, do not, because they are based on humans, which are, by nature, partly irrational. This inability to apply reason to all aspects of knowledge means that in order to get a better understanding of these areas, we must use different ways of knowing. (Wok). There are four Ways of Knowing (WoK) perception, emotion, reason, and language. One is supposed to use the Ways of Knowing and the Areas of Knowledge to acquire, perceive, and apply knowledge. To understand the world and to achieve knowledge, people have developed a number of ways of knowing. These are well known as perception, emotion, language as well as reason. The question "each and every other way of knowing are controlled by means of language" is a statement that needs more investigation as well as reflection. Knowledge can be said to be information that the brain has received that meets a certain set of criteria. When someone states that they know something they must also believe that, that something is so. A word is a unit of language that carries meaning and consists of one or more morphemes which are linked more or less tightly together, and has a phonetical value. In general a word will have a root or stem and zero or extra affixes. Words can be joint to make phrases, clauses, and well structured sentences. A word that consists of two or more stems combined together is known as a compound.

Role of the nurse in management of COPD

Role of the nurse in management of COPD Chronic Obstructive Pulmonary Disease (COPD) is a treatable condition that is defined as being a disease characterised by airflow limitation that is not fully reversible. This airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases (Fabbri, 2003). One in every four acute admissions to hospital is due to respiratory difficulties, and 50 per-cent of these are caused by the complications of COPD (Roberts, et al., 2001). In the United Kingdom, it is the third most common cause of overall adult morbidity and mortality, especially among smokers, (Barnes, 1999), and it is a significant burden to the NHS. In recent years, nurse-led primary care interventions have become more widespread. Although there has so far been insufficient evidence to support their implementation, there appears to be no difference in quality of care between doctor-led and nurse-led COPD programmes (Pye, 2008), and they may offer a cost effective and holistic solution to both the NHS and patients respectively. This essay will use a case based discussion to illustrate the role of the Nurse Practitioner (NP), and nurse prescribing issues for a patient with COPD. Case study The patient is a 62-year-old married Caucasian female who attended for a routine primary care nurse-led COPD evaluation during 2010. The patient had no other past medical history, apart from moderate COPD. This was diagnosed three years ago, following recurrent respiratory infections, two of which had necessitated hospitalisation. The NP had not seen this patient before and after familiarising herself with the notes and establishing a rapport with the patient took a medical history asking important questions about the history of the presenting complaint, the COPD, the patients past medical and surgical history, medication lists, allergies to medications, social history and smoking habits. The NP used a template questionnaire that was part of the COPD care pathway to identify how the COPD impacted on the patients quality of life. She herself had introduced this questionnaire herself as a result of her own reflective learning and had based it on one from a paper by Vandevoorde, et al., (2007) that included aspects about patient symptoms that patients do not always volunteer to medical professionals, such as side effects from medication and qualitative measures of fatigue and mental well-being (Vandevoorde, et al., 2007). Three months earlier, the patient had one exacerbation, which resulted in admission to the local hospitals medical assessment unit, and she recovered well. She occasionally had moments of shortness of breath, but these were typically on exertion and doing other strenuous activities. During this visit, she reported that her condition was stable. Her sputum production was approximately  ¼  ½ a cup/ day, and she needed to use 2.5l of oxygen at night. The patient continued to smoke six cigarettes/ day, and being a much heavier smoker previously she had a history of 60 pack years. She was compliant with her regular inhalers and had no problems with side effects, apart from a bad almost metallic taste in her mouth that she had occasionally recently started if she had forgotten to wash her mouth after using her inhalers. She had also been started on a Corticosteroid inhaler by the hospital respiratory team following her last exacerbation, but she mentioned that she had not noticed any difference in her COPD symptoms in using this. On direct questioning, she remembered that she also did have an unpleasantly sore mouth and voice was becoming hoarser since she had commenced using this steroid inhaler, but she didnt know if this was the effect of the steroid inhaler, the drying effects on mucous membranes of using oxygen therapy, or something else. She had noticed these symptoms for at least three weeks, and two weeks ago she had noticed white patches on her tongue. Apart from oxygen, and the newly introduced Corticosteroid inhaler that she was using; in terms of her other medication, she was taking the long acting beta 2-agonist Salmeterol twice a day, and the anti-cholinergic bronchodilator, Ipratropium Bromide. She had been using both Salmeterol and Ipratropium Bromide for several years, and she had no side effects with either of these medications. Antibiotics had been stopped for some time since her last exacerbation, and she had finished her Prednisolone some time ago. Overall, from a medical perspective she felt well in herself apart from the mouth problem. On examination, the patient spoke in short sentences, and occasionally her wording was stifled by shortness of breathe, but she did not appear to be in distress, and she was alert. Her skin was pink in colour and she appeared to be breathing with pursed lips, which is a characteristic feature of being a pink puffer and having the diagnosis of emphysema (Flenley, 1990). The NP then examined the patients vital signs, checking her pulse, which was 96 beats/ min and regular. Blood pressure, was 140/ 78 mmHg, and she was apyrexial. The NP then looked for signs of peripheral and central cyanosis by checking the colour of the patients hands and asking the patient to show the underside of her tongue. There were none, but the patient appeared to have oral candidiasis. The patients hands had a fine tremor, a side effect of her taking the long acting beta 2-agonists (Rossi, et al., 2008), but when questioned, she reported that it was not a problem as she was still able to write housework instructions to her husband. The patients respiratory rate was slightly higher than normal at 18/ min, but this was satisfactory. The NP listened to the patients chest and bilateral breath sounds were equal, but with a few polyphonic wheezes. There were no crackles and no crepitations were present. Heart sounds were normal. Spirometry was done, after explaination to the patient how to do the test in detail beforehand, giving the opportunity to ask questions. The patient had done the test many times beforehand, but expressed appreciation. The results showed airway obstruction and ventilatory impairment, consistent with the diagnosis of moderate COPD. A blood gas analysis was not taken, but the oxygen saturation on air was 96%. Inhaler technique was checked and this w as satisfactory. She lived with her husband, although she mentioned he had recently had to stop work due to him having ill health, and this was causing her a lot of anxiety from both the worry over his health and also the potential impact of the loss of income to their household. He had previously worked in a factory that stored and distributed flour products, and he had over several years started to develop breathing problems himself, despite him being a lifetime non-smoker. He was under investigation by the respiratory physicians, and this was causing a significant amount of tension to both of them. She reported that when she had her last exacerbation, he had become ill at that time, and she had to help him with personal care at home for a period of time, and the increased workload caused her shortness of breath to increase. She felt that her energy levels had been depleted for several weeks in the run up to her last admission to hospital, and that she did not even have time to smoke. Despite her COPD being relatively stable on this visit, the patient appeared depressed. When asked if she was depressed, she answered that she was and she was also having difficulty sleeping at night with financial issues caused by the ill-health retirement of her husband being the biggest stressor. The NP explained to the patient that she had identified several areas that needed action and further discussion with the GP. One was on the appropriate use of the steroid inhaler, the second was the oral thrush perhaps caused by the use of steroid inhaler (Ellepola, et al., 2001), the NP explained that there are treatments available for this that might be appropriate for her. Furthermore, she told the patient that the issue of depression needed further assessment by the GP. The patients medical records were updated with the findings of the assessment, as per good note keeping practice (NMC, 2009), and the patient was left in the room while the GP was consulted. The NP presented the case to the patients GP and mentioned her concerns about both the depression, and also the appropriateness of using the Corticosteroid inhaler and the oral candida. The NP recalled a lecture she had received during her course on nurse prescribing for COPD and discussed this with the GP. The GP took the opportunity to do an informal teaching session and agreed with the NP reminding her about the findings from a paper in 2000, by Barnes, which suggested that inhaled corticosteroids are not indicated for the treatment of COPD anymore. Unlike in asthma, where inhaled Corticosteroids are the mainstay of treatment, they have been found to have a limited role in the maintenance of function in patients with COPD. It was observed that only 1 in 10 patients with COPD will show a significant improvement in lung function following treatment with inhaled corticosteroids (Barnes, 2000) and the reason is thought to be that different inflammatory mediators are accountable for th e airway hyper reactivity that is present in asthma and COPD, and those that are responsible for COPD are less responsive to inhaled steroids (Barnes, 2000). Respiratory physicians will still use them, but usually only in cases where symptoms are not optimally controlled with bronchodilators alone (Fabbri, 2004), hence explaining why they were introduced when this patient had her last exacerbation. It was thought very likely that the oral candida as well as the metallic taste and hoarse voice could be due to her use of the steroid inhaler. The NP showed to the GP that the patients pulmonary function, as demonstrated by the Spirometry taken that day, was no worse than on her previous visit, prior to the Corticosteroid inhaler being started. Since a significant clinical response had not been objectively observed, both the GP and the NP decided together that the steroids should be discontinued from the point of view of risk v benefit and also evidence-based best practice. Both the GP and the NP then explained to the patient about the likelihood of the steroid inhaler not offering her that much benefit, instead causing her new symptoms. Her mouth was examined and it was confirmed that the patient had oral thrush, which is a known side effect of using steroid inhalers (Ellepola, et al., 2001). It was decided to wean off the Corticosteroid inhaler over a couple of weeks before stopping completely, and see how things go. She was also advised by the GP to rinse her mouth thoroughly after using the steroid inhaler, as well as the others. If the situation became worse, with regards her breathing she was advised to call the surgery for an urgent appointment to review her medication. The NP then suggested that the patient was started on an antifungal medication for the Candida albicans infection, such as Fluconazole, a decision that had been made following consideration and reflection, in line with the steps of the prescribing pyramid (National Prescribing Centre, 1999). The NP had already consulted the British National Formulary online (BNF, 2010a) to check for contraindications. The patient had none and also there were no history of liver problems or cardiac arrhythmia where caution should be exercised. The decision was made to commence treatment using a course of oral Fluconaz ole. The patient was advised about this, and also she was told of the possible side effects such as headache, dizziness, nausea, vomiting, abdominal pain, diarrhoea and the small possibility of liver problems (BNF, 2010a). She understood the information given and found the decision acceptable and so agreed to commence treatment, and to report any side effects that she noticed. With regards the patients depression this was assessed by the GP, after taking a psychiatric history and risk assessment. Both the patient and GP together decided to try a short course of antidepressant medication, which would be kept under close review. She was also encouraged to pursue social service channels with regards to disability living allowance if she was finding it difficult to care for her husband, especially because she was also infirm. The NP provided her with relevant paperwork for local social services and offered to make some enquiries on her behalf to arrange a home assessment. Before the patient left the room, both the GP and the nurse reinforced the importance of smoking cessation on her COPD and the possibility of nicotine replacement. The patient smiled and said she will give it some thought. Influenza vaccination was also mentioned as a reminder for later in the year. A follow up telephone consultation had been arranged for two-weeks time with the NP. The notes were then completed by both the GP and nurse with regards this part of the consultation. Two weeks the telephone consultation took place and the patient reported that she felt much better about her quality of life, her oral symptoms were almost back to normal and since taking the antidepressants, she had noticed a higher ability to perform day to day activities, and overall she seemed to have a more positive and bright outlook on life. The patient mentioned that she had also finally decided to stop smoking and wanted assistance with this in the form of nicotine patches that the nurse had previously mentioned. The NP arranged for the patient to attend a smoking cessation clinic, during which she made a mental note to apply the prescribing pyramid to this particular issue of nicotine replacement, and offered her congratulations on the patients progress. A further review appointment was also made with the GP to monitor the antidepressant treatment. Discussion This case illustrates the role of the COPD NP in primary care, and discusses prescribing issues. The nurse had taken a complete history and identified several medical, psychosocial issues and prescribing issues and taken appropriate action. From a medical and functional viewpoint, the examination and spirometry showed the patient had stable, moderate COPD, however holistic assessment revealed that she was taking steroid inhalers that were ineffective in her condition and were also causing her to develop an oral thrush infection. The NP also identified that the patient was depressed and there were social problems at home, caused by the patients husband being unwell. The COPD NP correctly identified several issues that needed referral to her GP colleague, and she had worked through a prescribing pyramid to identify that both the steroid inhaler may not be needed anymore, and that the patient would benefit from using an antifungal medication for her thrush. The prescribing pyramid The prescribing pyramid (National Prescribing Centre, 1999) is a stepwise approach that has involves seven stages (1-7), and each stage should be considered carefully before climbing to the next: Consider the patient. Which strategy should be used? Consider a choice of product Negotiate a contract Review the patient Record keeping Reflection With regard the oral thrush infection, the patient had a full history taken and clinical examination. A holistic viewpoint that took into account the fact that the patient was experiencing unpleasant side effects led the nurse to conclude that GP referral was necessary to confirm the diagnosis and also to tackle the concurrent issue of the steroid inhalers and depression. When considering step four, the NP had reviewed the British National Formulary online (BNF, 2010a) and had decided that Fluconazole was the most effective product for this patient as the patient also had a dry mouth because of her oxygen therapy. Nystatin, another antifungal can be used for oral thrush, but it is less suitable for patients who have dry mouths (BNF, 2010b). The patient also had no contra-indications to Fluconazole, and she was not taking and other drugs that had known drug-drug interactions with this new agent. The patient was informed of all the possible side effects in a form that she could underst and. This patient had a central role in the decision making process in this consultation in line with stage four of the prescribing pyramid (National Prescribing Centre, 1999). Effective communication skills are an important part of good nursing practice, as originally outlined by the UKCC in 1996 (UKCC, 1996). In the context of nurse prescribing, this includes explaining what the prescription in for; how to take the medication; how long it takes to work and what the possible side effects may be. The nurse also referred to the BNF as reference when making this decision, which is an example of good, evidence-based reflective practice. In accordance with step five, a review of the patient was organised to establish whether the treatment was effective, safe and acceptable. The patient was also advised to make contact if there were any problems, which is in line with guidance (National Prescribing Centre, 1999). For step six, the nurse practitioner made detailed notes in the medical records immediately after the consultation as per recommendations by the NMC (2009). The NP reflected on her own practice in this situation and asked the GP to give her constructive feedback, which was useful for improving her own learning and practice. Her need for continuing professional development was acknowledged in the original planning of the service within that practice and as a specialist member of the team, having a good working relationship with all the GPs she had the clinical support to hand and was able to obtain medical advice, supervision and guidance when required. The department also had regular visits from pharmaceutical companies and teaching on local formulary practices. The NPs own educational programme included critical appraisal training to enable her to be aware of the influences on prescribing. Conclusion Nurse-led COPD primary care assessment services where specialist NPs are responsible for performing assessment, investigation and are able to act as liaison officers for patients are becoming more widely implemented in the UK as an integrated medical-social and holistic approach to COPD management. Such nurses prescribe full treatment packages for patients and provide them with a point of contact for specialist advice should the patients have an exacerbation at home, as well as forming the link to the tertiary respiratory units should the need arise. Keeping the majority of COPD care in the community should offer better patient centred care as well as cost savings for the NHS. NPs have a crucial role in the management of COPD, and must be aware of prescribing issues reflective learning to give their patients the best possible care.