The art of the impressionists Essay Example | Topics and Well Written Essays - 500 words

The art of the impressionists - Essay Example The light and color effects can also be noticed in Camille Pissarro's works wherein the lights and colors vary depending on the specific time of the day. In "The Stage Coach at Louveciennes," the artist painted the scene in dark lighting conditions possessing complementary colors of reds and greens generously used by the artist while in "Le verger (The Orchard)," the noticeable brightness of the day light and the complementing colors of violet with shades of yellow and the blue sky in contrast to the hint of orange shade of the soil. In the "Village Path," the red lighting of the painting can be clearly seen which in turn complements the dominantly green color of the scenery. In addition to the attribute of light and color effects of the impressionist style, impressionistic paintings are also characterized by concentration on the general impression produced by a scene or object and the use of unmixed primary colors, as explained with the examples previously mentioned, and small strokes to simulate actual reflected light (Pioch).

The Influence of Words During Times of War Essay

The Influence of Words During Times of War - Essay Example The Power of Words in Wartime by Robin Lakoff (2005) is an article describing just how powerful words can be a weapon. The article centers around the history of words used in wartime, focusing on the descriptive words that are typically used to describe 'the enemy'; barbarians, infidels, Japs, Yankees, Frogs. The article suggests that these words help to bring one side closer together by grouping the enemy as something negative, something outside of themselves. It gives a sense of supremacy to one side, often focusing on physical or cultural differences between the enemy and the home side. Killing another person is murder, but killing a 'target' or a 'Hun' in the event of war is something different, and just shows how powerful words can be in changing the normal morals of an individual. Churchill's Powerful Words. As previously mentioned, Churchill and his powerful speeches have been considered one of the most important elements in the Allied win of the Second World War (Brekle, 1989 ). "Give us the tools and we will finish the job† (Churchill, 2003) are the famous words of Churchill to Franklin D. Roosevelt, allowing the nation to see the confidence of Churchill, bringing faith, courage and hope to the nation. It suggests that Churchill himself had a great amount of faith in the Allied forces, and it is sometimes this type of faith that is needed to give confidence to an army, confidence being something that is perhaps more important than technology in winning a war (Oliver, 1987).... Churchill's Powerful Words As previously mentioned, Churchill and his powerful speeches have been considered one of the most important elements in the Allied win of the Second World War (Brekle, 1989). "Give us the tools and we will finish the job† (Churchill, 2003) are the famous words of Churchill to Franklin D. Roosevelt, allowing the nation to see the confidence of Churchill, bringing faith, courage and hope to the nation. It suggests that Churchill himself had a great amount of faith in the Allied forces, and it is sometimes this type of faith that is needed to give confidence to an army, confidence being something that is perhaps more important than technology in winning a war (Oliver, 1987). Churcill is also famous for saying "Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning† (Churchill, 2003). This again was a powerful quote at the time, stirring the forces and the nation into believing that there is so me hope that the tragedies of war would begin to end. In this quote, Churchill acknowledges the past, present and future struggles of the war, but does so in such a confident manner. There are numerous more quotes that can be used to show Churchill's rhetoric and how instrumental it was in instilling hope, but these serve to give evidence of his skill and its power during wartime. The Rhetoric of Roosevelt Roosevelt was also known for his skill in rhetoric. Whilst Churchill seemed more focused on giving the forces confidence on the battlefield, Roosevelt is possibly more associated with letting the nation know that the cause they were fighting for was the right cause. This is an important tool in persuading soldiers to sign up to fight; no-one wants to fight for

Reflective Summary On Prescribing Practice Learning Nursing Essay

Reflective Summary On Prescribing Practice Learning Nursing Essay The author, a nurse practitioner based in an Emergency Department (ED), from here on in will be referred to as the practitioner. The practitioner is currently employed in a development role with the view, following training, of becoming an acute care practitioner. This will entail working autonomously: taking accurate clinical histories, physical examination, gain differential and working diagnosis and organise a plan of care. This plan of care could well include a number of prescribed medications. Hence it is in the practitioners job description (as it is increasingly in many specialist/autonomous nursing roles) to become a Nurse Independent and Supplementary Prescriber (NISP). The Cumberlege Report (1986) suggested that nurses should be able to prescribe independently and highlighted that patient care could be improved and resources used more effectively by doing so. It identified that nurses were wasting their time requesting prescriptions from Doctors. Since the publication of this seminal piece of work, non-medical prescribing has been analysed, reflected upon, researched at great lengths and changes in practice made (DoH 1989, 1999, 2006 2008; Luker et al 1994; Latter et al 2011) and is still under constant review. The aim of this portfolio is to: Reflect on practice as a means of on-going personal and professional development. Demonstrate a capability of integrating learning into practice. Submit a range of material mapped against the module learning outcomes, NMC 2006 prescribing standards, domains of practice and core competencies. Establish an evidence-based approach to practice competence as a safe independent supplementary prescriber. This prescribing practice portfolio will be a reflective portfolio using Rolfe et al (2001) model of reflection to aid learning from experience and close the gap between theory and practice. This model has been chosen as it is something the practitioner is familiar with and has used before. The portfolio will conclude with a reflective summary on prescribing practice learning which will draw together the evidence used to support achievement of the competences identified. After discussing with colleagues who have already completed the NISP course, the practitioner is aware of the complex nature and volume of work that is required over the duration of it. There is a feeling of nervousness due to this but also a feeling excitement over what will be learnt. If successful the practitioner believes her practice will be enhanced significantly as she will have the ability to give patients seamless care. References Department of Health. (1986) Neighbourhood Nursing: A Focus for Care. (Cumberlege Report). London: HMSO Department of Health. (1989) Report of the Advisory Group on Nurse Prescribing. The Crown Report). London: HMSO Department of Health. (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report Two) London: HMSO. Department of Health. (2006) Medicines Matters. London: HMSO Department of Health. (2008) Making Connections: Using Healthcare Professionals to Deliver Organisational Improvements. London: HMSO Latter, S. Blenkinsopp, A. Smith, A. Chapman, S. Tinelli, M. Gerard, K. Little, P. Celino, N. Granby, T. Nicholls, P. Dorer, G. (2011) Evaluation of nurse and pharmacist independent prescribing. Faculty of Health Sciences, University of Southampton; School of Pharmacy, Keele University on behalf of Department of Health [Online] Available at http://eprints.soton.ac.uk/184777/ [Accessed 15th Sept 2012] Luker, K. Austin, L. Hogg, C. Ferguson, B. Smith, K. (1998) Nurse-Patient Relationships: The context of Nurse Prescribing. Journal of Advanced Nursing. (28) 2: 235-242 Rolfe, G. Freshwater, D. Jasper, M. (2001) Critical Reflection in Nursing and the Helping Professions: a Users Guide. Basingstoke: Palgrave Macmillan. Consultation Holistic Assessment Case Study In this case study the consultation, diagnosis, prescribing options and decisions of a 35 year old female seen in the ED will be discussed. This case study will aim to improve the practitioners knowledge of conducting a consultation and its relationship with making a diagnosis and treatment options. To maintain confidentiality, in line with the code of professional conduct, the patient will be referred to as Mrs A (Nursing and Midwifery Council (NMC), 2008). Consultation Examining the holistic needs of the patient is the first of seven principles of good prescribing (National Prescribing Centre (NPC), 1999) and must be undertaken before making a decision to prescribe (NMC Practice Standard 3, 2006). Holistic assessment takes into consideration the mind, body and spirit of the patient (Jarvis, 2008). Traditionally consultation and making a diagnosis has been completed by Doctors. However, nurse diagnosis would appear to have been formally acknowledged since The Crown Two Report (DoH, 1999) as part of the independent prescriber role. Horrocks et al, (2002), found greater patient satisfaction with nurse consultations than with GP consultations. Jennings et al, (2009) and Wilson Shifaza, (2008) also found this to be true of nurse practitioners working in emergency departments. Importantly, they also found no significant variation in other health outcomes. Most of these studies found that consultations with nurses were to some extent longer, they offered more advice on self-care and self-management and that nurses gave more information to patients. Although there are various consultation models that have been described (Byrne Long, 1976; Pendleton et al, 1984; Neighbour, 2005; Kurtz et al, 2003; Stott Davis, 1979), these are based upon observation of doctor, not nurse consultations. Nevertheless, the consultation models and skills described in the medical literature are relevant to all practitioners (Baird, 2004). Consultation models help the practitioner centre the consultation around successful information exchange and try to provide a theoretical structure. Consultation models can also be used to help make maximum use of the time available at each consultation (Simon, 2009). Traditionally the medical model is used to assess patients however; it does not take into account the social, psychological, and other external factors of the patient. The model also overlooks that the diagnosis (that will affect treatment of the patient) is a result of negotiation between doctor and patient (Frankel et al, 2003) In this case study, the practitioner has used Roger Neighbours model of consultation. This was found by the practitioner to be simple and easy to remember, whilst covering all areas needed to make an effective consultation and assessment. He describes a 5 stage model which he refers to as a journey with checkpoints along the way: Connecting establishing a relationship and rapport with the patient. Summarising taking a history from the patient including their ideas, expectations, concerns and summarising back to the patient to ensure there are no misunderstandings. Handing over negotiating between the practitioners and patients agenda and agreeing on a management plan. Safety netting the consideration of what if? and what the practitioner might do in each case. Housekeeping reflecting on the consultation. (Neighbour, 2005) Connecting Mrs A was called through to the Rapid Assessment and Treatment area in the ED. It was apparent from Mrs As facial expression and limp that walking caused her pain. Silverman Kinnersley, (2010) state that non-verbal communication is extremely important and can often provide clues to underlying concerns or emotions. The practitioner had never met the patient before so had no previous relationship with her but was aware that she may have pre-conceived ideas about the ED which may have caused her anxiety. The practitioner introduced herself to Mrs A, explained her job role, the process that was about to be undertook and consent obtained. During this time eye contact was maintained and the practitioner also asked Mrs A how she would like to be addressed. This was done to try and build up a rapport with Mrs A, to help her feel at ease and reassure her. Simon, (2009) and Moulton, (2007) agree and state that rapport is essential to effective communication and consultation. Mrs A was also of fered a trolley to sit on to make herself comfortable and the curtains pulled around for privacy and dignity. On reflection the practitioner was aware that the environment was a busy and noisy assessment area and this can have a negative impact on the consultation (Silverman et al, 2005). Identifying this with Mrs A and apologising may have re-assured her further and gained trust and respect. Summarising The practitioner began with an open ended question and did not interrupt the patients response. Neighbour, (2005) and Moulton, (2007) advise this to open the consultation. Gask Usherwood, (2002) found that if a practitioner interrupts, patients then rarely disclose new information, which could lead to not finding out the real reason for the consultation. Mrs A revealed that she received an insect bite to her right lower leg 5 days ago, since then the surrounding skin had become swollen, increasingly red, painful and hot to touch. She explained that the redness was spreading up her leg and the pain was getting worse. Mrs A explained that she was concerned that it was not going to get better and was very worried that it had got worse during the last 3 days. Upon questioning Mrs A also complained of malaise and that she had been feeling very hot and cold and at times. She had been managing to eat and drink as normal. Mrs A lived with her husband, was a non smoker and drank alcohol occasionally. She had no past medical history and took no prescribed or over the counter (otc) medications. It was also elicited that she was allergic to Penicillin which she had an anaphylaxis reaction to. Taking a medical, social, medication and allergy history is important as it can be relevant to the presenting complaint, makes sure key information has not been overlooked and is essential in preventing prescribing errors (Bickley, 2008; Young et al, 2009). The practitioner actively listened to what Mrs A was saying by maintaining eye contact, using open questions and by summarising the history back to clarify points and to make sure nothing was missed. On reflection the practitioner feels this also gave the opportunity for Mrs A to add any further information not disclosed so far. Closed questions were then used to gain specific information related to the initial information given, this is advised by Young et al, (2009) and Moulton, (2007). Effective communication is important as Epstein et al, (2008) explains that a precise history can supply at least 80% of the information necessary for a diagnosis. Upon examination there was obvious erythema. Light palpation revealed that the area was very warm and tender. Neurovascular assessment was performed and was unremarkable. Mrs As chest was clear, heart sounds normal and her abdomen was soft, non tender. Physical examination is important as it is used to detect physical signs that the patient may not be aware of and can be used to confirm or disprove a possible diagnosis. It also suggests to the patient that their illness is being taken seriously. (Bickley, 2008, Charlton, 2006). Observations were taken including blood pressure, heart rate, temperature, respiratory rate and oxygen saturations. All were within normal parameters except her temperature which was 38.2 degrees Celsius. Venous blood was taken to check haematological, biochemical and coagulation status. Mrs A white cell count (WCC) and C-reactive protein (CRP) levels were raised, all other blood results were normal. Handing Over Before making a final diagnosis, it is important that differential diagnoses are excluded (Nazarko, 2012). The practitioners differential diagnoses were deep vein thrombosis (DVT) or venous eczema. However, Mrs A had a straightforward history (insect bite) that together with her observations (raised temperature), examination findings (redness, heat, swelling and pain) and blood results (raised WCC and CRP) indicated an alternative diagnosis, so DVT and venous eczema were ruled out. The practitioners working diagnosis was cellulitis. This was discussed with Mrs A and she appeared reassured that a diagnosis had been made. The practitioner explained that she would like to discuss this with a senior Doctor to help decide on a treatment plan. The practitioner presented the patient to an ED Registrar who agreed with the diagnosis. Diagnosis, treatment and prescribing options were then discussed to aid the practitioners learning. Cellulitis is a bacterial infection of the skin and subcutaneous tissue which is potentially serious (Epstein et al, 2008). It is caused by one or more types of bacteria, most commonly streptococci and staphylococcus aureus (Nazarko, 2012). Cellulitis usually occurs on the lower legs, arms and face but can arise anywhere on the body (Bickley, 2008). Patients with cellulitis present with signs of inflammation, distinctively heat, redness, swelling and pain (Nazarko, 2012). Inflammation is localised initially but increases as the infection progresses. Patients can be systemically unwell (pyrexial, tachycardic, hypotensive) and white cell count and C-reactive protein levels will be markedly raised (Beldon, 2011, Wingfield, 2009, Nazarko, 2012). It appears there is a general lack of evidence based literature surrounding the treatment of patients with cellulitis. The practitioner could only find one national guideline on the management of cellulitis in adults, which was published in 2005 by the Clinical Resource Efficiency Support Team (CREST, 2005). However, to the practitioners knowledge, these have not been validated by a clinical study. Morris, (2008) found in his systematic review that antibiotics cure 50-100% of cases of cellulitis but did not find out which antibiotic regime was most successful. Kilburn et al, (2010) also could not find any definitive conclusions in their Cochrane review on the optimal antibiotics, duration or route of administration. Eron, (2000) devised a classification system for cellulitis and its treatment which CREST used in their guidelines. This system divides people with cellulitis into four classes and can serve as a useful guide to admission and treatment decisions. However Koerner Johnson, (2011) found in their retrospective study, comparing the treatment received with the CREST guidelines, that patients at the mildest end of the spectrum were over treated and at the more severe end undertreated. They also found a significant variation in antibiotic regimes prescribed for patients with cellulitis. Marwick et al, (2011) questioned whether classes I and II could actually be merged to improve treatment. The practitioners trust has antibiotic guidelines (updated yearly) which also include a classification system. This aids the prescriber in choosing the correct antibiotic, dose, route and duration for certain conditions, cellulitis being one of them. After discussion with the Registrar it was determined that Mrs A was in Class I or non-severe which meant she could be managed with oral antibiotics on an outpatient basis. The practitioners trust and CREST, (2005) guidelines advise first line treatment for non-severe or class I cellulitis as oral Flucloxacillin 500mg, three times a day. Flucloxacillin is a moderately narrow-spectrum antibiotic licensed for the treatment of cellulitis. However, Flucloxacillin was contra-indicated for Mrs A as she had a severe penicillin allergy (British National Formulary, (BNF) 2012). Clarithromycin is a macrolide which has an antibacterial spectrum that is similar but not identical to that of penicillin; they are thus an alternative in penicillin-allergic patients (BNF, 2012). Clarithromycin is licensed and recommended by CREST, (2005), and by the practitioners trust, as an alternative to Flucloxacillin in cellulitis for patients with a Penicillin allergy. It is indicated in the BNF, (2012) for the treatment of mild to moderate skin and soft-tissue infections. It demonstrates suitable pharmacokinetics, with good distribution into skin and soft tissues, and is effective against the large majority of staphylococcal and streptococcal bacteria that cause cellulitis (Accord Healthcare Limited, 2012), (See drug monologue page 21-28). There were no contraindications in prescribing Clarithromycin for Mrs A. The option of not having any medication was discussed with Mrs A however, she wanted treatment so the benefits and side effects of Clarithromycin was explained, and consent obtained from Mrs A to prescribe the antibiotics and to be discharged, (NMC Practice Standard 5, 2006). Dose and duration were then also clarified and the importance of taking the antibiotics as prescribed and to complete the full course. On reflection, by discussing and deciding on the best treatment together this would hopefully promote concordance. Negotiating with patients and agreeing on a management plan is very important aspect of reaching patient centred care (Neighbour, 2005). Using an FP10 Clarithromycin tablets 500mg twice a day was prescribed by the Registrar (as the practitioner was not a licensed prescriber, NMC Practice Standard 1, 2006), as per trust guidelines, for 7 days. Paracetamol tablets 1g four times a day was also prescribed for its analgesic and anti-pyretic properties (BNF, 2012). A stat dose of both were prescribed and the practitioner asked the nurse to administer the first dose (NMC Practice Standard 9 14, 2006), and was aware that by delegating this task the prescriber remained accountable. The FP10 was given to the patient to take to the pharmacy of her choice for them to dispense (NMC Practice Standard 10, 2006), (See mock prescription page 29). The practitioner did not initially contemplate cost effectiveness but on reflection it has been recognised that this needs to be taken into consideration when prescribing (NPC, 1999). Intravenous antibiotics may have been prescribed, which may have meant an admission into hospital or administration by nurses on an outpatient basis; thus would have increased the cost of treatment significantly. Admission to hospital can also be overwhelming and can put the patient at risk of hospital acquired infections and increased risk of antibiotic resistance (Wingfield, 2008). Safety Netting The erythematous border was marked, with the patients consent, with permanent pen to monitor for any improvement or additional spread of infection (CREST, 2005, Beldon, 2011). The practitioner advised Mrs A that she should return or see her GP if she had worsening symptoms or if by the completion of the course of antibiotics symptoms had failed to resolve. Mrs A was also advised that, if a similar incident occurred, she should seek medical assistance early so that treatment could begin as soon as possible to reduce the risk of severe and long-term complications. In addition it was recommended that she should drink plenty of fluids to prevent dehydration, elevate the leg for comfort and to help reduce the swelling (CREST, 2005, Beldon, 2011). Mrs A was warned that there could be an increase in erythema in the first 24-48 hours of treatment (CREST, 2005). This advice and information empowered Mrs A and made sure that her discharge was as safe as possible. The practitioner brought the consultation to a close by asking Mrs A if she had any questions or if there was anything else she would like to discuss. This gave Mrs A the opportunity of clarifying any information given by the practitioner and the opportunity to divulge any information or concerns not previously mentioned. This re-assured the practitioner that she had addressed her problem appropriately. Housekeeping The practitioner made sure there was clear concise documentation of the consultation and choice of prescription in Mrs A notes (NMC Practice Standard 7, 2006). A discharge letter was also produced to send to her GP NMC Practice Standard 6, 2006). Once the prescription was ready, Mrs A was discharged. This case study has shown the practitioner the importance of effective communication in consultation. By following Neighbours consultation checkpoints it gave structure to the consultation and will be used by the practitioner in future practice. It has also helped the practitioner to gain an understanding of different prescribing options and how to explore these further. For example, the practitioner did find when reading around the subject that there has been some research on the use of corticosteroids in cellulitis to increase resolution, however, to the practitioners knowledge, this is not currently advised in any guidelines and further research is needed. The practitioner would also like to be involved in the development of a cellulitis pathway at her place of work. This could include an algorithm to aid practitioners to differential diagnosis so patients can receive appropriate treatment and reduce the incorrect prescribing of antibiotics. As there are no National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment and management of cellulitis, treatment of patients is not standardised and consequently quality of care could be affected. The optimal choice for antimicrobial therapy requires review and definitive study in clinical trials. References Accord Healthcare Limited (2012) Summary of Product Characteristics for Clarithromycin Capsules 500mg. [online]. Electronic Medicines Compendium. Datapharm Communications Ltd. Available from: http://www.medicines.org.uk/EMC/medicine/25914/SPC/Clarithromycin+500mg+Tablets/ [Accessed 21ST September 2012] Byrne, P. Long, B. (1976) Doctors Talking to Patients. London, HMSO. Baird, A. (2004) The Consultation. Nurse Prescriber. (1) 3: 1-4 British National Formulary: No. 64 (2012) London: BMJ Group and Pharmaceutical Press. Bickley, L. (2008) Bates Guide to Physical Examination and History Taking. 6th Ed. London: Lippincott, Williams and Wilkins. Beldon, P. (2011) The Assessment, Diagnosis and Treatment of Cellulitis. Wound Essentials. (6): 60-68. Clinical Research Efficiency Support Team (2005) Guidelines on the Management of Cellulitis in Adults. Belfast: Clinical Research Efficiency Support Team. Charlton, R. (2006) Learning to Consult. Abingdon: Radcliffe. Department of Health (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report) London: HMSO. Epstein, O. Perkin, G. Cookson, J. De Bono, D. (2008) Clinical Examination. 4th Ed. London: Mosby. Eron, L. (2000) Infections of Skin and Soft Tissues: Outcome of A Classification Scheme. Clinical Infectious Diseases. (31) 287 Frankel, R. Quill, T. McDaniel, S. (2003) The Biopsychosocial Approach: Past, Present, and Future. Rochester: University Of Rochester Press. Gask L, Usherwood, T. (2002) ABC of Psychological Medicine: The Consultation. British Medical Journal (324) 7353: 1567-1569. Horrocks, S. Anderson, E. Salisbury, C. (2002) Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors. British Medical Journal. (324) 7341: 819-823. Jarvis, C. (2008) Physical Examination and Health Assessment. 5th Ed. Missouri: Saunders Elsevier. Jennings, N., Lee, G., Chao, K., Keating, S. (2009) A Survey of Patient Satisfaction in a Metropolitan Emergency Department: Comparing Nurse Practitioners to Emergency Physicians. International Journal of Nursing Practice (15) 213-218. Kilburn, S., Featherstone, P., Higgins, B., Brindle, R. Interventions for Cellulitis and Erysipelas. Cochrane Database Systematic Reviews. 2010 Issue 6, Art. No. CD004299. DOI:  10.1002/14651858. Koerner, R. Johnson, A. (2011) Changes in the classification and management of Skin and Soft Tissue Infections. Journal of Antimicrobial Chemotherapy. (66) 232-234. Kurtz S, Silverman J, Benson J, Draper J. (2003) Marrying Content and Process in Clinical Method Teaching; Enhancing the Calgary-Cambridge Guides. Academic Medicine (78) 8: 802-809. Marwick, C. Broomhall, J. McCoowan, C. Phillips, G. Gonzalez-McQuire, S. Akhras, K. Merchant, S. Nathwani. Davey, P. (2011) Severity Assessment of Skin and Soft Tissue Infections: Cohort Study of Management and Outcomes for Hospitalised patients. Journal of Antimicrobial Chemotherapy. (66): 387-397 Morris, A. (2008) Cellulitis and Erysipelas. Clinical Evidence. [online] BMJ Publishing Group Ltd. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907977/ [Accessed 10th September 2012] Moulton L. (2007) The Naked Consultation: A practical Guide to Primary Care Consultation skills. Abingdon: Radcliffe. National Prescribing Centre. (1999) Signposts for Prescribing Nurses General Principles of Good Prescribing. Prescribing Nurse Bulletin. (1): 1-4. Nazarko, L. (2012) An Evidence-Based Approach to Diagnosis and Management of Cellulitis. British Journal of Community Nursing. (17) 1: 6-12. Neighbour, R. (2005) The Inner Consultation. How to Develop an Effective and Intuitive Consulting Style. 2nd Ed. Oxford: Oxford-Radcliffe. Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife prescribers. London: Nursing and Midwifery Council. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: Nursing and Midwifery Council. Pendleton, D. Schofield, T. Tate, P. Havelock, P. (1984) The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press. Silverman, J. Kurtz, S. Draper, J. (2005) Skills for Communicating with Patients. 2ND Ed. Oxford: Radcliffe. Silverman, J. Kinnersley, P. (2010) Doctors Non-Verbal Behaviour in Consultations: Look at the Patient Before You Look at The Computer. British Journal of General Practice. (60): 76-8. Simon, C. (2009) The Consultation. InnovAiT (2) 2: 113-121. [online] Available at http://rcgp-innovait.oxfordjournals.org/content/2/2/113.full. [Accessed 13th September 2012] Stott, N. Davis, R. (1979) The Exceptional Potential in Each Primary Care Consultation. Journal of the Royal College of General Practitioners. (29): 201-5. Wingfield, C. (2009) Lower Limb Cellulitis: A Dermatological Perspective. Wounds UK. (5) 2: 26-36. Wingfield, C. (2008) Cellulitis: Reduction of Associated Hospital Admissions. Dermatological Nurse 7(2): 44-50. Wilson, A. Shifaza, F. (2008) An Evaluation of the Effectiveness and Acceptability of Nurse Practitioners in an Adult Emergency Department. International Journal of Nursing Practice. (14): 149-156. Young, K. Duggan, L. Franklin, P. (2009) Effective Consulting and History-Taking Skills for Prescribing Practice. British Journal of Nursing. (18) 17: 1056-1061. Drug Monologue. Name of Drug Clarithromycin Drug Classification Macrolide Therapeutic Uses(s) Clarithromycin film-coated tablets are indicated in adults and adolescents 12 years and older for the treatment of the following bacterial infections, when caused by clarithromycin-susceptible bacteria. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial exacerbation of chronic bronchitis à ¢Ã¢â€š ¬Ã‚ ¢ Mild to moderate community acquired pneumonia. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial sinusitis à ¢Ã¢â€š ¬Ã‚ ¢ Bacterial pharyngitis. à ¢Ã¢â€š ¬Ã‚ ¢ Skin infections and soft tissue infections of mild to moderate severity, such as folliculitis, cellulitis and erysipelas Clarithromycin film-coated tablets can also be used in appropriate combination with antibacterial therapeutic regimens and an appropriate ulcer healing agent for the eradication of Helicobacter pylori in patients with Helicobacter pylori associated ulcers Dose range and route(s) of administration Adults and adolescents (12 years and older) à ¢Ã¢â€š ¬Ã‚ ¢ Standard dosage: The usual dose is 250 mg twice daily. à ¢Ã¢â€š ¬Ã‚ ¢ High dosage treatment (severe infections): The usual dose may be increased to 500 mg twice daily in severe infections. Children younger than 12 years: Use of Clarithromycin film-coated tablets is not recommended for children younger than 12 years. Use Clarithromycin paediatric suspensions. Clinical trials have been conducted using clarithromycin pediatric suspension in children 6 months to 12 years of age. Elderly: As for adults Dosage in renal functional impairment: The maximum recommended dosages should be reduced proportionately to renal impairment. In patients with renal impairment with creatinine clearance less than 30 mL/min, the dosage of clarithromycin should be reduced by one-half, i.e. 250 mg once daily, or 250 mg twice daily in more severe infections. Treatment should not be continued beyond 14 days in these patients. Patients with hepatic impairment: Caution should be exercised when administrating clarithromycin in patients with hepatic impairment Administered orally. Pharmacodynamics Mode of Action Clarithromycin is a semi-synthetic derivative of erythromycin A. It exerts its antibacterial action by binding to the 50s ribosomal sub-unit of susceptible bacteria and suppresses protein synthesis. It is highly potent against a wide variety of aerobic and anaerobic gram-positive and gram-negative organisms. The 14-hydroxy metabolite of clarithromycin also has antimicrobial activity. The MICs of this metabolite are equal or two-fold higher than the MICs of the parent compound, except for H. influenzae where the 14-hydroxy metabolite is two-fold more active than the parent compound. Side Effects Dyspepsia, tooth and tongue discoloration, smell and taste disturbances, stomatitis, glossitis, and headache; less commonly: arthralgia and myalgia; rarely: tinnitus; very rarely: dizziness, insomnia, nightmares, anxiety, confusion, psychosis, paraesthesia, convulsions, hypoglycemia, renal failure, interstitial nephritis, leucopenia, and thrombocytopenia Interactions Aprepitant Clarithromycin possibly increases plasma concentration of aprepitant Atazanavir Plasma concentration of both drugs increased when Clarithromycin given with atazanavir. Atorvastatin Clarithromycin increases plasma concentration of atorvastatin. Cabazitaxel Avoidance of clarithromycin advised by manufacturer of cabazitaxel. Calcium-channel Blockers Clarithromycin possibly inhibits metabolism of calcium-channel blockers (increased risk of side-effects). Carbamazepine Clarithromycin increases plasma concentration of carbamazepine. Ciclosporin Clarithromycin inhibits metabolism of ciclosporin (increased plasma concentration). Colchicine Clarithromycin possibly increases risk of colchicine toxicity-suspend or reduce dose of colchicine (avoid concomitant use in hepatic or renal impairment). Coumarins Clarithromycin enhances anticoagulant effect of coumarins. Disopyramide Clarithromycin possibly increases plasma concentration of disopyramide (increased risk of toxicity). Dronedarone Avoidance of clarithromycin advised by manufacturer of dronedarone (risk of ventricular arrhythmias). Efavirenz Increased risk

Outsourcing Essay -- Economics Economy Consumerism Essays

Outsourcing Outsourcing has become a very popular issue, and it has reached an all-time climax. Firms are starting to do this a lot more than than in the previous decade. What is outsourcing? Outsourcing is defined as â€Å"The procuring of services or products, such as the parts used in manufacturing a motor vehicle, from an outside supplier or manufacturer in order to cut costs.† And it has become a big issue in our country. There are thousands of articles and books written on it, and you can attend numerous classes and speeches on the subject. The use of outsourcing is quite simple really†¦ Either pay an American worker $15 an hour, or pay someone in India to do the same job for $2 an hour. There are lots of other advantages and disadvantages to outsourcing but I will address those later in the essay. So what does an average American really know about outsourcing? Most people would say sending our jobs to another country in order to save money isn’t justified. It would cos t a lot of people jobs, which would send them into distress and possibly debt. But that’s not the whole story behind outsourcing. People hear about outsourcing and automatically decide that it is bad for our economy. What about the good things that outsourcing brings to our economy? We are sending jobs to India, their consumers will start making more money, and in return buy more of our goods and services. In this essay I will show you both points of the debate and you can decide for yourself whether or not outsourcing is bad for our country. A firm’s primary objectives are cutting un-necessary costs, reducing overhead, and cutting labor costs. America has one of the highest GDP’s, with the minimum wage law in the US being $5.15 an hour. Most people woul... ...l comes down to the American consumer, and how they view the topic. In the end†¦ the choice is yours. BIBLIOGRAPHY 1. Pew Research Center/Council on Foreign Relations survey conducted by Princeton Survey Research Associates International. July 8-18, 2004. N=1,003 adults nationwide. MoE  ± 3.5. Available at: http://www.pollingreport.com/trade.htm 2. Network Computing online, Online article, available at: http://www.nwc.com/shared/article/printFullArticle.jhtml?articleID=115201900 3. TechWeb online, â€Å"IT salaries are Rising†, online article, available at: http://www.techweb.com/wire/story/TWB20030402S0002 4. Information Week, â€Å"IT salaries Show Upward Trend, Outsourcing Overblown†, TechWeb article written by W. David Gardner, available at: http://www.informationweek.com/story/showArticle.jhtml?articleID=50500043

Vote For Snowball: The Kosher Porker

Tulip Serbin Plansinis Vote For Snowball: The Kosher Porker At a time when food and spirits were low, a certain candidate stepped up to the hay mound to lift up such grief and depression. In his actions and improvements to better the farm, he made the harvest more productive, and led victory through a tough battle. No one would be a greater leader than Snowball. He supported animals’ rights, a continued revolution, and productivity. Shortly after the rebellion of Mr. Jones, to signify this exciting new change to the society of human kind, Manor Farm was quickly changed to Animal Farm.By Snowball changing the name of the farm, it now indicated that this farm was run and operated by animals. Not only did this show farmers the strength of the animals, but also the effecting power they could have. Snowball’s dream was to have every farm run and operated by animals. Snowball was very persuasive. Snowball persuaded the animals with the simple sentence, which said, â€Å"Sure ly, comrades, surely there is no one among you who wants to see Jones come back† (Orwell 52)?To put his plan of a continued revolution in action, he then sent pigeons to all the neighboring farms to spread the word of the rebellion, hoping to get other animals thinking of the same idea. Also, the Beats of England song was being highly recognized and sung by animals and humans alike. Snowball was definitely a highly determined pig, and knew how to popularize his farm and its effecting power. Nothing could be more superior in a leader, than being â€Å"for the people†.Snowball was for the Animals’ Rights, and showed it prominent ways. During Old major’s speech, he came up with the idea of Animalism, where animals are highly acknowledged, and humans are shunned from the animal world. Snowball was the first pig to take any action in improving upon Animalism. Old Major had a long list of rules and regulations for the animals if a rebellion was to take place. Sn owball elaborated the long set into The 7 Commandments. The commandments were then written on the barn so that all the animals could see them.By doing this, all the animals knew what they could and couldn’t do. Every person (or animal) likes to patriotic to their cause or country, and snowball helped them raise their patriotism by making a flag. An organization or town or anything that has a leader†¦ could not be a professional name until a flag is made. By making this flag, it published and popularized again the power the farm had. Snowball also came up with very good ideas. The most important idea was the idea for the building of the windmill.In the story he said, â€Å"I do not deny that to build this would be a difficult business, but you would decrease your working time, and it would provide luxury to all animals† (Orwell 65). Snowball also liked to get involved. One example is he fought himself in the Battle of the Cowshed. By using Julius Caesar’s ta ctics he led his farm to victory. He knew how to lead animals very well. In the text he said, â€Å"War is War. The only good human being is a dead one† (Orwell 59). Snowball showed immense courage and definitely earned the animals’ respect for it.Snowball knew how to listen and treat the animals to their own wants and needs. Snowball knew how to get the â€Å"hay† rolling. Snowball was very productive. In order for the animals to have some say in the matter, he made up the idea of The Committees, which included The Egg Production Committee for the chickens, The Clean Tail Committee for the cows, and Whiter Wool Committee for the Sheep, plus many more. Although, the committees didn’t go very far, showing the animals that he (a pig) was letting the animals in the â€Å"in crowd† , showing something no other pig was able to do.Also, Snowball made the harvest successful. In the story he said, â€Å"Now, Comrades, let us make it a point of honor to ge t in the harvest more quickly than Jones and his men did† (Orwell 43)! Snowball was determined to make it a point that the animals could accomplish far more than Jones could do. By saying that quote, he got the animals excited to participate in the â€Å"challenge† of â€Å"Beat Jones in the Harvest†. Snowball also taught the animals education.Although some animals couldn’t get passed the 4th letter in the alphabet, every animal on the farm was literate. Indeed, they did beat Jones in the harvest thanks to Snowball’s supervision and Boxer’s hard work. Snowball supported animals’ rights, a continued revolution, and productivity. He also was involved in getting work done, such as fighting in the Battle of the Cowshed. He also knew how to get the work accomplished, but in a way that benefited everyone. Snowball in the end knew how to win the â€Å"popular vote† by â€Å"being for the animals†.

Rhetorical Analysis Essay

Thesis: Technology, such as texting, while driving is unsafe and can be a hazard to teen drivers and others. In the Knox News opinion column, there was an article found titled â€Å"Twits texting, tweeting behind the wheel.† The author of this article, Ina Hughs, is arguing that texting, MP3 players, and other electronic devices are unsafe to use when behind the wheel. She is writing to inform teenagers and other drivers about the dangers of driving while texting. Even though Hughes makes some excellent points in her column, she may not be the most qualified person to be writing about the dangers of texting and how tempting it may be. Hughes indeed has a cell phone, but she had the texting enabled on her phone so she does not text with it. The only information that she gets that makes her qualified to write this article would be the fact that her eleven-year-old grandson just got a cell phone. Even with this information, it still does not qualify her since her grandson cannot drive. She did though get facts from reliable magazines and researchers to back her up. Hughs’ format of her article shows a lot about whom she is and her qualifications. Just about every paragraph she either has some sort of statistical evidence or an example of why texting and driving is bad. She does not have any real connection to the audience she is trying to address. The author uses logos a lot in this text to support her many claims as to driving while texting. One thing she mentions is, â€Å"according to the New York Times, one in five drivers admits to texting while driving on a somewhat regular basis, and they say they won’t stop because they are ‘literally addicted.’† This claim reinforces her purpose of texting while driving by giving statistical evidence of why it is so dangerous. So many people do it. â€Å"According to research, every time you get a text, tweet, instant message, or call, ‘your brain squirts out a little dopamine- the pleasure chemical- and left to our own devices, we spin out of control.

Slipping into Newspeak

Slipping into Newspeak Slipping into Newspeak Slipping into Newspeak By Maeve Maddox One of the scariest things Ive read lately is this comment in a language forum: America is based on the tradition of divergent thinking There was a time when nuances were important; larger vocabularies were needed.   These vocabularies will soon be superfluous as we move into an age where communications are devised and sent in the most efficient manner available.  (Emphasis added.) Anyone who has read George Orwells 1984 will hear in this comment an echo of the character Symes conversation with Winston about the shrinking size of the Newspeak dictionary: Were getting the language into its final shape Were destroying words scores of them, hundreds of them, every day. Were cutting the language down to the bone. The Eleventh Edition [of the Newspeak dictionary] wont contain a single word that will become obsolete before the year 2050. Rules of grammar that contribute to precision of thought are already breaking down. Nuances that used to be observed in newspaper writing are disappearing, for example, such pairs as smell/fragrance, peal/toll, famous/notorious: Wedding Bells are Tolling Less in Milwaukee Stories about historys most famous murders at the Crime Library Such a Tiny Flower But What a Beautiful Smell The character Symes explains to Winston that paring English to the bare bones of communication is in the public interest: Dont you see that the whole aim of Newspeak is to narrow the range of thought? In the end we shall make thoughtcrime literally impossible, because there will be no words in which to express it. Every concept that can ever be needed, will be expressed by exactly one word, with its meaning rigidly defined and all its subsidiary meanings rubbed out and forgotten. In Orwells novel, the emasculation of the language is undertaken by the government as a means of controlling and extinguishing dissident thought. In reality, thanks to the neglect of language instruction in the public schools, over-simplified writing in the media, and the popular attitude that standard English is elitist and undemocratic, government intervention has not been necessary. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:20 Types and Forms of Humor5 Lessons for Mixing Past and Present TenseCharles's Pen and Jesus' Name

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Top 8 Free Online Style Guides in English

Top 8 Free Online Style Guides in English Sensible is probably the highest praise that can be given to a style guide. Neither a comprehensive documentation manual (such as the MLA or APA guides) nor a self-improvement book (along the lines of Strunk and Whites The Elements of Style), a publishers style guide should provide practical and consistent advice about matters ranging from abbreviations and preferred spellings to punctuation standards and acceptable terminology. If youre not already committed to one particular code of conventions- such as The Associated Press Stylebook, the journalists bible- consider befriending one of these free online style guides. Each has its eccentricities and limitations, and no two of them agree on every fine point of usage. But theyre all sensible and reasonably consistent.   American Styles National Geographic Style Manual  Online since 1995 and frequently updated by a team of editors, this is an alphabetically arranged guide to preferred National Geographic Society style and usage.​The Tameri Guide for Writers: Generalized Stylebook  Maintained by Susan D. Schnelbach and Christopher Scott Wyatt, the Tameri Stylebook is based on the Associated Press Stylebook, which is the primary style guide for reporters and editors at daily newspapers and many periodicals.​Wikipedia: Manual of Style  This style guide for all Wikipedia articles is intended to help editors write articles with consistent, clear, and precise language, layout, and formatting. British Styles The BBC News Styleguide (pdf) Written by John Allen, a BBC reporter and editor for the past 40 years, this popular manual is not a do and dont list but a guide that invites you to explore some of the complexities of modern English usage.​Economist.com Style Guide  John Grimonds online guide is based on the stylebook followed by journalists at The Economist magazine. The 11th edition of the paperback version of the guide will be published in 2015.​The Guardian and Observer Style Guide  Edited by David Marsh and Amelia Hodsdon, this is the online version of Guardian Style. The third edition of this witty handbook was published in December 2010.​Telegraph Style Book  Augmented by monthly style notes from associate editor Simon Heffer, this is the official guide to house style for The Daily Telegraph, The Sunday Telegraph, and Telegraph.co.uk. Canadian Styles The Canadian Style  Compiled by the Canadian governments Translation Bureau, Canadian Style includes useful advice for drafting letters, memos, reports, indexes and bibliographies along with concise answers to questions concerning written English in the Canadian context.

Access to Insurance Versus Access to Care Research Paper

Access to Insurance Versus Access to Care - Research Paper Example They have limited access to health care compared to legal immigrants and native citizens. Overtime, undocumented immigrants are restricted from accessing Medicare and obtaining Medicaid, which are the main insurance programs. Fear of deportation, job restrictions and language barriers are the vital factors limiting undocumented immigrants to accessing health care (Bond & Bond, 1994). In order to provide unlimited health care to United States citizens, there should be an amendment on health care system policies. Policies for improvement include universal health care, increasing competition and accountability in health care, and making health care system accessible and affordable. Implementing these policies would ensure that all inhabitants of United States access affordable health care. Policy makers should implement a single health insurance system policy for realization of health care accessibility. In this policy, all citizens are entitled to medical care in spite of age, job or race according to Medicare system. In addition, the government should design strategies of providing medical insurance and not just delivering health care to strengthen Medicare policy. Furthermore, implemented policies should encourage non-profit and private health care resource providers. Implementation of health and Medicare policies would ensure accessibility to quality and affordable care to all citizens irrespective of income or employment status. Though there is availability of health care access, high prices of insurance policies hinder it. To enhance affordability and access of health care, provision of medical care should be through auto insurance system. An auto insurance system would widen choice for insurance cover and lessen government bureaucracy in health care sector. Increasing choice of health care would present different health care choices for citizens. Besides, competition amongst health care providers would increase which will consequently decrease

Website evaluation for a destination Essay Example | Topics and Well Written Essays - 3000 words

Website evaluation for a destination - Essay Example The font size and color combination was not so good. Here we can have a same theme of heading. Each heading in the webpage has different color that gives the feeing of distraction to the users. 14 Acceding to most of the questionnaire respondents the website navigation is good. In this web site we have a clear view of our presence in the website. Here we have proper and functional hyperlinks that offer us the capability to navigate through the whole website in an effective way. 14 Web based information platforms are aimed at offering the people valuable information about the relevant area or subject. The human computer based analysis offers the capability to weigh up and assess these systems working and performance regarding their interaction to users. This research and analysis based report will also offer deep and comprehensive overview of the website evaluation through the human computer interaction rules. This website is an E-Tourism website that belongs to Bangladesh. It is an official website of Bangladesh Government for tourism and its online address is: www.bangladeshtourism.gov.bd. The main intention of this research is to evaluate this website regarding its design, content, usability and interactivity for the better and effective system development that can effectively interact with its audience. The subject of Human–computer interaction deals with the analysis of the interaction among people and computer. In this paradigm we analyze how we can build a system (web site) that is able to offer better support and facility during the usage of system. This subject investigates the user psychology, behaviors and develops the system or designs the web site that is capable to meet the user expectations regarding system working. Website evaluation for better design, content, usability and interactivity is main area that developer needs to address while developing a web site for the user. Human computer interaction rules based evaluation process is

Persuasive Thesis- Convince the adult reader to agree with your Essay

Persuasive Thesis- Convince the adult reader to agree with your position on an issue you've recently debated. Work with your own ideas and experiences add no ou - Essay Example This enthusiasm is not shared by those of the religious right or the current presidential administration. This faction is opposed to embryonic stem cell research which they claim as immoral and characterize as devaluing human life, much the same as does abortion, drawing a link between the two. I suggest those who support federal funding of stem cell research are positioned on higher moral ground. Stem cells are basically the building block cells of a human being which are capable of becoming different types of tissue. The main objective for pursuing stem cell research is curing incapacitating ailments such as Parkinson’s, Alzheimer’s, spinal cord injuries, strokes and other various diseases. Embryonic stem cells possess the ability to restore defective or damaged tissues which would heal or regenerate organs which have been adversely affected by a degenerative disease. The moral dilemma that surrounds the prohibition of aborted fetuses is the idea of abortion itself. The Bush administration has made it very clear that it is opposed to legal abortions, in at least most circumstances, and has transferred this ideology to its prohibition of embryonic stem cell research. The concept of scientific study of the next stage of development, the fetus, which resulted from an abortion, is unthinkable. This ideology of the administration reflects the minority opinion which opposes abortion and also reflects the majority opinion that is opposed to aborted fetuses of consenting parents being used for experimentation. This reality has no basis in reason. Why would those who claim to be ‘pro-choice’ want to waste the aborted tissue? For that matter, why would pro-lifers want to witness what they believe is a living being tossed away in vain? At least its ‘life’ could have meant something to humanity in a very real way. Whatever moral or political position, the fact is, all these fetuses could have served

Develop Alternative energy supply system Research Paper

Develop Alternative energy supply system - Research Paper Example Under the proposition, solar panels and wind turbines have been proposed. These energy supply projects have arisen after the evaluation of the area that the Bambui community is located. Considering that, the proposed energy project incorporate the use of alternative energy sources obtained from natural sources, it is important to determine the advantages of these energy sources. One is that they are infinite, unlike the hydroelectric power source whereby water can dry out [2]. For example wind, can wind die out? It cannot. The sources of alternative energy sources are free. However, they are society and location particulate, which is the case in Bambui. Weather conditions have to be considered, the source, and geographical location. In addition, there is minimal risk of exposure to hazards and little harm to the environment [3]. The objective of this paper is to develop and suggest an alternative energy supply system for the Bambui community considering all pros and cons of the

Individual 4 Criminal Justice Essay Example | Topics and Well Written Essays - 1000 words

Individual 4 Criminal Justice - Essay Example This report will deal with the economical issue associated with the decision. It will also address with any constitution issue related to it. Moreover it will discuss about the names in prison privatization and how they have impacted corrections. The Department of Corrections plays an important part in the criminal justice process. DOC is often the final stop. By the time a person is sent to prison to serve a sentence, he or she has had contact with at least four (and sometimes more) different agencies and public officials. The criminal justice process creates checks and balances to make sure the administration of justice is fair and equitable. The focus of Department of Correction is on the social well being of the society. Being able to increase the effectiveness of the department will give a definite change in crime and will increase public safety. The main question is how it makes an economic sense. In the survey of the study area as a whole, the most frequently mentioned anticipated effect of the prison is that it will be good for the local economy. The most frequently mentioned anticipated positive effects are that it will: Be good for the local economy/improve the standard of living, Increase population, Create employment opportunities (directly), and/or while building (indirectly). Economic development experts throughout the state consider correctional facilities to be positive contributors to local economies, providing good-paying jobs and benefits in communities where employment is scarce. When proposed prisons are on the table, local newspapers are filled with articles reporting grand claims for economic salvation and flyers flood into local coffee shops, general stores and mini-marts. The purported benefits are described by a California Department of Corrections official who states "Prisons not only stabilize a local economy but can in fact rejuvenate it. There are no seasonal fluctuations, it is a non-polluting industry, and in many circumstances it is virtually invisible... You've got people that are working there and spending their money there, so now these communities are able to have a Little League and all the kinds of activities that people want." [1]. As a result of such claims, the competition for prison "development projects" has become fierce and political. Constitutional Issues: The existence of constitutional rights for any individual is dependent upon mechanisms to uphold these rights and protect them from violation or denial. The Department of Corrections have supervisory and protective care, custody, and control of the inmates, buildings, grounds, property, and all other matters pertaining to the following facilities and programs for the imprisonment, correction, and rehabilitation of adult offenders. In establishing, operating, and utilizing these facilities, the department shall attempt, whenever possible, to avoid the placement of non-dangerous offenders who have potential for rehabilitation with repeat offenders or dangerous offenders. Medical, mental, and psychological problems shall be diagnosed and

The play, Everyman Research Paper Example | Topics and Well Written Essays - 1500 words

The play, Everyman - Research Paper Example Considering the reality of death, the author has portrayed death as someone who calls Everyman, the protagonist of the play to meet God and reply for his deeds. The protagonist asks Death that he wants some time to get some friends to accompany him in his journey to his destination to meet God. He gets some time, but he realizes that the friends who were dear to him are not ready to accompany him. The author perceives and treats death as a call from God to enable people realize what is good for them in life. Everyman as the name suggests represents every man on earth. The play as a whole is a play that portrays Christian values and can be understood as an allegorical or morality play. The play starts with God’s call to Death where he claims that human beings in the world are not following his commandments and are committing sins (Lester, 1981). He asks the Death to bring Everyman to answer for his committed deeds. Death works as God’s messenger who brings God’s m essage to Everyman that he should appear before God to answer for his deeds. God sends for Everyman as he says, â€Å"...Go thou to Everyman, And show him, in my name, A pilgrimage he must on him take, Which he in no wise may escape; And that he bring with him a sure reckoning Without delay or tarrying...† (Everyman, 1987, 65-71) Death is asked to tell Everyman to conduct a pilgrimage in order to reach God. The sending of Death ensures that Everyman has to leave the world and its belongings in order to reach the court of God. Death also represents the abolition of life and reaches Everyman to inform him of his ending to reach his final destination before God. The representation of death in Everyman is not fearsome, but educative as the figure when comes forth Everyman, he is not frightened at seeing him. However, when he is told that he is going to come before God, he is frightened considering himself alone and secluded. He thinks that he will gain someone’s sympathy i n his journeying towards God and this sympathy will lead him to have Heaven (Spinrad, 1987). Death comes and informs Everyman, â€Å"Death: In great haste I am sent to thee From God out of his Majesty. Everyman: What, sent to me?† (Everyman, 1987, 90-92) At hearing a call from God with Death as God’s messenger, Everyman gets disturbed considering him incapable to appear before God in his present condition. He calls Death â€Å"gentle† And asks him for some time, in which, he can arrange for some friends to accompany him in his pilgrimage. Everyman says, â€Å"O wretched caitiff! whither shall I flee That I might 'scape endless sorrow? Now , gentle Death, spare me till tomorrow, That I may amend me With good advisement.† (Everyman, 1987, 171-75) He sees no place to escape and seeks mercy from Death. He regards himself extremely sorrowful and distressed not because of appearance of Death, but because of being called by God when he is not ready to appear. As mentioned earlier on, death is portrayed not as fearsome and horrible as it was supposed to appear at that time when the play was written. In medieval times and middle ages, death was portrayed with skeletons or someone with frightening appearance that at once made the observer to tremble (Cawley, 1970). Death in Everyman was portrayed as a messenger of God who was so merciful that he gave some time to Everyman to search for his companions for the journey. Death let everyman to ponder over the differences between right and wrong that assign him the title of

Individual 4 Criminal Justice Essay Example | Topics and Well Written Essays - 1000 words

Individual 4 Criminal Justice - Essay Example This report will deal with the economical issue associated with the decision. It will also address with any constitution issue related to it. Moreover it will discuss about the names in prison privatization and how they have impacted corrections. The Department of Corrections plays an important part in the criminal justice process. DOC is often the final stop. By the time a person is sent to prison to serve a sentence, he or she has had contact with at least four (and sometimes more) different agencies and public officials. The criminal justice process creates checks and balances to make sure the administration of justice is fair and equitable. The focus of Department of Correction is on the social well being of the society. Being able to increase the effectiveness of the department will give a definite change in crime and will increase public safety. The main question is how it makes an economic sense. In the survey of the study area as a whole, the most frequently mentioned anticipated effect of the prison is that it will be good for the local economy. The most frequently mentioned anticipated positive effects are that it will: Be good for the local economy/improve the standard of living, Increase population, Create employment opportunities (directly), and/or while building (indirectly). Economic development experts throughout the state consider correctional facilities to be positive contributors to local economies, providing good-paying jobs and benefits in communities where employment is scarce. When proposed prisons are on the table, local newspapers are filled with articles reporting grand claims for economic salvation and flyers flood into local coffee shops, general stores and mini-marts. The purported benefits are described by a California Department of Corrections official who states "Prisons not only stabilize a local economy but can in fact rejuvenate it. There are no seasonal fluctuations, it is a non-polluting industry, and in many circumstances it is virtually invisible... You've got people that are working there and spending their money there, so now these communities are able to have a Little League and all the kinds of activities that people want." [1]. As a result of such claims, the competition for prison "development projects" has become fierce and political. Constitutional Issues: The existence of constitutional rights for any individual is dependent upon mechanisms to uphold these rights and protect them from violation or denial. The Department of Corrections have supervisory and protective care, custody, and control of the inmates, buildings, grounds, property, and all other matters pertaining to the following facilities and programs for the imprisonment, correction, and rehabilitation of adult offenders. In establishing, operating, and utilizing these facilities, the department shall attempt, whenever possible, to avoid the placement of non-dangerous offenders who have potential for rehabilitation with repeat offenders or dangerous offenders. Medical, mental, and psychological problems shall be diagnosed and

Reading Response to a Poem Essay Example for Free

Reading Response to a Poem Essay The poem â€Å"Wild Geese† by Mary Oliver was a very inspirational poem. Oliver creatively uses imaginative language, emotion, symbolism, and romanticism which led to a very positive and upbeat tone in her poem. Throughout this poem, the one thing that I focused on was the positive and upbeat tones that this poem contained. By her use of symbolic and imaginative language in â€Å"Wild Geese†, the reader is opened to Mary Oliver’s underlying meaning behind her literary prose. Furthermore, the calm romantic tone of this thought provoking poem, raises positive emotions to rise up out of the moment, and invites us to further take a look at ourselves. Mary Oliver immediately engages the reader into considering the true meaning behind her choice of words. In lines one through five, the reader can envision being in a very noble place where rules are always followed. Mary Oliver (1986) noted that, â€Å"You do not have to be good. You do not have to walk on your knees for a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves† I believe that she is saying that you do not have to follow the rules of society by bowing down to others or to repent for being who you are. Oliver used the symbol of an animal, you should do what you love to do and not worry about having to say you are sorry. With that being said, animals never have to apologize for being who God or the Creator made them to be. In lines six and seven, she again uses emotion and romanticism to bring out the feeling of her readers. Oliver (1986) noted that, â€Å"Tell me about despair, yours, and I will tell you mine. Meanwhile the world goes on†. She cleverly shows that we all have problems and yet the world will still go on. God or the Creator never promised us an easy life. In lines eight through eleven, Oliver uses the symbols of nature once again to show us that life is still going on no matter what problems we face. Oliver (1986) noted that, Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees,   the mountains and the rivers. She uses the emotional state of the reader along with the quiet romantic tones to show that although you will go through trying times in life, it will not last forever. She uses the symbolism of the wild geese, in lines twelve and thirteen, to show that we will always be guided to our destinations. All we have to do is allow our natural instincts to guide us just as the wild geese are guided home by natural instinct. In lines fourteen through fifteen, Oliver uses emotion and imaginative language to let the reader know that no matter who you are, or how lonely you feel, the world is for you to design it. The reader needs to use his/ her imagination. If you can dream it, you can achieve it. She again uses the symbolic nature of the wild geese to illustrate this concept. Last but not least, in lines sixteen through eighteen, she again uses imaginative language to challenge the reader to not conform to the world. The reader can use their imagination to break free from their conventional life styles and to join their place in the family of nature. In nature, there are no rules, but the ones that you create, where you are free to be as the â€Å"Wild Geese†. In conclusion, I found the poem â€Å"Wild Geese† by Mary Oliver extremely inspirational. She creatively uses imaginative language, emotion, symbolism, and romanticism to convey a very positive and upbeat tone in her poem. Throughout this poem, the one thing that I continuously focused on was the positive and upbeat tones that this poem contains. This is a very inspirational and uplifting poem. It encourages us to go beyond the plan that is laid out for us by society and lends us permission to be who we were destined to be. Throughout this entire poem, we are given permission to shake off all of life’s discretions, throw caution to the wind, and be as wild and free as nature intended us to be. References Clugston, W. R. (2010). Journey into literature. San Diego, CA: Bridgepoint Education, Inc.

The tourism system model

The tourism system model The Tourism System In early tourism research, it was argued that by analysing disaggregated components of tourism, it is possible that an understanding of tourism as a whole could be achieved (Pearce, 1989). However, these reductionist claims often result in a failure to explain the different complex relationships, interactions, interdependencies and impacts within the tourism system (Carlsen, 1999). For example, traditional tourism models such as Leiper (1979) tourism system model assumes that tourism players function in a coordinated manner, suggesting that tourism could be controlled in a top-down approach (McKercher, 1999). However, tourism displays all the characteristics of complexity. Failing to acknowledge the elements of uncertainty, chaos, dynamics and non-linearity in tourist systems, these simplistic traditional approaches to tourism seems to become irrelevant and invalid. Tourism is an activity in which people freely engage in, for personal satisfaction or pleasure, where their behaviour is voluntary and discretionary proceeding from ones own free choice (de Freitas, 2002). Thus, tourists participation is expected to decrease as discomfort and dissatisfaction increase. â€Å"Should climate change, so will be the tourism demand† (De Freitas, 2005, 35). Over the years, more sophisticated models have been developed in attempting to explain what tourism is, its composition and the relationships and interactions that exist within it. From the tourist personality type models (Plog 1974; Pearce 1990), Maslows hierarchy of needs (Maslow, 1954), expectancy theory based on Vrooms theory of work motivation by Witt and Wright (1992) to the Mieczkowski Tourism Climate Index (1985) and the push-pull tourism framework (Dann, 1977; Crompton 1979; Iso-Ahola, 1982, 1989; Klenosky, 2002), these approaches provide different but valuable insights for examining the motivations underlying tourist and visitation behaviour. These models have also been useful for the study of the importance of climate to tourism as well as the research on climate change and tourism, providing an understanding and agreement of the varieties and kinds of activities and stakeholders involved. Climate, a Tourism Resource Climate exists outside of any tourism project. However, it becomes a resource when incorporated within a good or service. This is illustrated by the high demand of North Europeans travelling to the Mediterranean resorts, seeing it as a land of paradise. In addition, climate is often said to delimit optimal zones for tourism at a global and regional scale, as illustrated by the warm tropical zone, considered optimum for sun and beach tourism (Burton 1991). In this way, climate, a natural resource becomes part of the tourism product. All of respondents of the survey agreed that climate is important to tourism with 89% ranking it as â€Å"very important†. With the aim of accessing how climate fares in relation to other important considerations in tourism demand, Table 2.1 illustrates the ranks respondents give to each of the factors relevant to their visit to a country for tourism. Attractions in the destination were viewed as the most important factor followed closely by climate. Of considerable importance to this study which may have been omitted in many studies focusing on the temperate regions, 95% of respondents believed that escaping from their countrys winter cold is at least of some importance in their decision for travel. This shows how weather and climate are intrinsic components of the vacation experience and can act as a central motivator in an individuals selection of holiday destination, the timing of holiday travel as well as a salient factor in tourism spending and holiday satisfaction. This study measures up to many other researches such as that done by Hu and Ritchie (1993). Measuring the importance of destination characteristics, they reviewed several destination image studies from the 1970s and found that â€Å"natural beauty and climate† were of universal importance in defining destinations attractiveness. Using a representative survey, Hamilton and Lau (2005) confirmed that climate is at least the third most popular attribute in tourists decision making. Climate can directly affect tourism. There seems to be a clear connection between weather, climate, and human sensitivity. Atmospheric weather conditions may impact tourist demand, participation, experiences and satisfaction (de Freitas, 2003; Yu et al, 2009). People usually dislike very cold or hot climates and possibly very humid ones probably for good reasons founded in evolutionary biology (Heal and Kristrom, 2002). Survey result of this study proves similar conclusion where 74% of respondents indicate that they were more likely to travel during their countrys winter and 19% during summer. None of the respondents chose autumn and spring as the season they would want to travel out of their country. A warm climate seems to be a huge attraction for many of the mid-latitude tourists with 100% citing a â€Å"hot and sunny† weather condition as the preferred choice in the country they visit, even for those who want to escape the summer heat in their country. This proves Maddison and Bigano (2000) findings that the ideal temperature at the most popular tourist destinations are those offering warmer temperatures of around 31oC. In Context: Sentosa Climate has been argued to be one important component which shapes a destinations image and in some regions of the world, constitutes the resource on which the tourism sector is predicated (Lohmann and Kaim 1999). For example, marketed as â€Å"The Island for All Seasons†, the Mediterranean climate which Cyprus, Greece has been blessed with, has identified as the fundamental attribute attracting tourists to the destination. Mather et al contends that â€Å"the climate is a dominant factor in much of the travel that takes place from northern Europe to the Mediterranean () Not only is the purpose of this mass movement of people primarily leisure-based, visiting a sunny beach destination is the intrinsic reason for travel† (2005, 70). Being a tropical country, Singapore and in particular Sentosa has the perfect conditions for the creation of the ideal tourist coast all-year sunshine, warm water, white sandy carbonate beaches and coral reefs -popularised in the three â€Å"Ss†: sun, sea and sand (Wong, 2003). Sentosa is Singapores premier island resort getaway and Asias leading leisure destination. It receives over 6 million visitors yearly, making it the most visited paid-access attraction in Singapore. According to partial break-down of visitor arrivals to all the paid attractions in Singapore as seen in Figure 2a, it show consistency with Sentosa being the most visited paid-access attraction among all groups of tourists. Thus, it makes a good case study for studying climate as a resource for beach tourism in Singapore. Findings in this study shows that although the warm tropical climate of Singapore appeals to the mid-latitude tourists, inducing them to visit the Island of Sentosa as well as their beaches, weather did not prove to be the ultimate choice affecting tourists decision to Sentosa. In fact, although weather ranks second after attraction/activities, given only a choice, only about one quarter, specifically, 27% of the tourists chose weather to be the most important. One reason for this may be because climate invokes the concept of weather which is what tourists anticipate experiencing at a specific destination and is a key factor of consideration for tourists, consciously or implicitly during travel planning (de Freitas, 2002; Gomez Martin, 2005). Thus, having already considered Singapores hot and humid climate before the trip, factoring in possible weather conditions that might be experienced, attractions and activities that can be found in Singapore is determined to be more important at the expense of weather. This result corresponds to the activities that respondents carry out in Sentosa illustrated in Table 2.2, with â€Å"visiting attractions† being the most carried activities by all tourists during their day in Sentosa. The preference of tourists for certain climatic and weather conditions highlights the relationship between tourism and climate. Naturally, different tourism types and activities require different climatic conditions. Thus, climate is one important variable that influences among other factors, what and when particular kind of tourism activities can be done carried out. For example, climate has been identified as the fundamental attribute attracting tourists to the Mediterranean area (Mather et al, 2005; Amelung and Moreno, 2009). Seeking and enjoying the sun is one of the main reasons why many tourists go away on holiday, evident in 70%-80% of UK holidaymakers citing better climate abroad as the primary reason for their trip (Perry, 1993). Similarly, winter sports depend directly on climatic resources. Without snow or low temperatures for the artificial production of snow, the development of ski resorts would not have been possible (Gomez Martin, 2005). In this study on Sentosa, the activities that can be carried out by tourists (Table 2.2) could be sub-divided into two categories: weather dependent and weather independent. Swimming/sun tanning, picnicking and water sports/playing volleyball is to a large extent dependent on weather, especially to the presence of sunshine and rainfall. Although a large percentage of 59% tourists came to Sentosa specifically for sun tanning and swimming, respondents seems to participate largely also in non weather specific activities such as visiting attractions, shopping and dining in an indoor eatery. This result points to an important fact that although Sentosa depends largely on its beaches as well as some outdoor attractions, they provide a diversified range of activities which tourists are also attracted in but do not solely tap on the appeal of the weather. Climate versus Weather Climate invokes the concept of weather in that it is defined as the accumulation of daily and seasonal weather events over a long period of time whereas, weather is the condition of the atmosphere at any particular time and place (de Freitas, 2002). In a study of this nature, McEvoy (2008: 103) reminds that it is important to differentiate between visitor responses to climate versus weather conditions. Decision-making relating to tourism such as the destination and period of travel has been found to be based largely on climate information. On the other hand, the vacation period is much more weather-dependent and reliant on short term forecasts where actual weather information is more important than climate information (Matzarakis, 2007). The nature of the relationship between the atmospheric environment and the enjoyable pursuit of outdoor recreational activity may be seen to be a function of facets of on-site atmospheric conditions, the weather. Pleasant weather increases tourist satisfaction, whereas severe weather conditions such as rain and strong winds disrupt outdoor activities. In southern Alaska, for example, tour operators noted a marked difference between the sunny, dry summer of 2004 and wet summer of 2006. Although this study fully acknowledges the importance of climate to tourism, with weather being an important factor, survey results show the possibility that destinations may also be chosen in spite of the likely bad weather. Figure 1 illustrates the findings. The result suggests that even if it rains on the day that tourist decides to go to Sentosa, 49% of the respondents would not alter their original plan to visit the island. The reasons cited were more or less similar in that they would â€Å"choose to visit other attractions within Sentosa† and â€Å"stay in indoor venues†. All of the 28% tourists who states that there will be changes to their plans to Sentosa were at Sentosa beach specifically for the purpose of outdoor beach activities such as swimming, sun tanning and picnicking. Therefore, with some tourist activities more sensitive to weather than others, metrological conditions may affect or disrupt the construction of the planned days event. On the other hand, Sentosa Island with many indoor attractions, allows for contingency plans to be made which enables tourists to be independent of weather conditions. With â€Å"visiting attractions† being the most carried out activity for respondents (Table 2.2), as well as â€Å"attraction/activities† cited as the most important factor affecting their decision to visit Sentosa, it suggests why majority of tourists may not change their plans to visit Sentosa even under unforeseen weather events. Therefore, although climate and weather is one of the many factors that may influence tourist decisions, good weather may not be the primary reason for selecting destinations. Weather Forecast Mark Twains famous quote of â€Å"Everybody talks about the weather but no one does anything about it† is often held up as a truism but Twain himself have said this â€Å"aint necessarily so†. Along the same line of argument, Dewar (2005) contends that humans may not be able to alter the day-to-day weather but they do alter their behaviours to either avoid or take advantage of these weather conditions. To some extent as discussed previously, a majority of respondents seems to have predicted that they would alter their behaviours, by visiting indoor attractions to avoid unfavourable rainfall events. Weather forecasting is a useful way to alter ones behaviour or plan activities to suit prevailing weather conditions on the day of event. Favourable climate and weather conditions are essential advantages which influences the degree of satisfaction, allowing tourists to enjoy their holiday activities safely and comfortably, helping them fulfil the desires that originally brought them to the destination (de Freitas 1990, 2003; Blazejczyk, 2001; Gomez-Martin, 2005). However, it is surprising that although 59% of respondents engaged in a pre-planned weather dependent activity of sun tanning and swimming as well as 10% for picnicking, only a small percentage of 13% admitted to have checked the weather forecast before coming to Sentosa.

Chaucer and Religion Essay -- essays papers

Chaucer and Religion It is very rare that a book is written without the opinions of the author being clearly expressed somewhere within that book. Geoffrey Chaucer’s The Canterbury Tales is one such book. In the General Prologue alone, by viewing Chaucer’s description of the Knight, the Prioress, and the Friar, the reader is able to pick up on Chaucer’s satirical humor toward the church of the 14th century. The first male traveler mentioned is the chivalrous Knight. It is interesting that Chaucer chooses to introduce The Knight as the first character. He possibly does this because during the era, Knights were strong, truthful and were to fight the good fight. This tactic would fit in to Chaucer’s goal of relaying the overall message that nothing of the time was as enchanting as it were to appear. Chaucer describes his Knight as a man so honored due to his loyalty in battle. He states, â€Å"And evere honoured for his worthyness †¦ No Cristen man so ofte of his degree (2).† This whole statement is hypocritical because the Knight is being viewed as Christian when he kills men and p...

My Educational Goals and Philosophy Statement Essay -- Philosophy Teac

My Educational Goals and Philosophy Statement 'The most important function of education at any level is to develop the personality of the individual and the significance of his life to himself and to others' -Grayson Kirk. The teaching philosophy of progressivism focuses on developing the whole child. This philosophy not only teaches the core subject material, but it also allows the teacher to help develop the person the child is going to be. John Dewey, founder of progressivism, denounced the scholarly and classical school of curriculum. Dewey thought children should not be taught what to think but how to think through a 'continuous reconstruction of experience.' This implies that children learn best when they do hands on activities, therefore, they are learning by doing. These hands on activities will also incorporate several of the multiple intelligences. The kinesthetic learners will be able to actually do the activity, visual learners get to see the activity being performed, and auditory learners get to hear the directions and steps as the teacher explains them. As a teacher, I intend to present many different activities to the classroom. I feel that is so important to incorporate as many learning styles as possible into each lesson. From my observation in my field experiences, a student that favors one learning style will perform better when that learning style is available for an activity. Hands-on activities also allow for the students to learn by relating what they are studying to the knowledge they have previously acquired. This perspective, know as constructivism, was based mostly on research performed by Swiss psychologist Jean Piaget. Children are not just em... ...g else out there that teachers can learn. New technology, for one, is something that develops each and every day. I feel that the addition of a special education classes as a requirement will further educate and prepare future educators who will continually be in contact with the special education students. As for me, I plan to take on any opportunity to excel in my teaching profession. I want to continue on in my Bachelor?s degree with a specialization in Math and move on to get my Master?s in administration. Education is a wonderful gift that is available to everyone who wants to take part. It is not only about the books and the teaching of the basics. Education is about developing the whole child. It will be my job to develop the child as a person, not just as a student. When I begin my teaching career, I will strive to develop every aspect of the child.

Plastic Money Essay

The study assesses the impact of outsourcing on organisational performance and it is done in Century Bottling Company Limited. It focuses on the benefits and challenges companies face in outsourcing their non-core activities. The study uses the objective of assessing the impact of outsourcing on organisational performance to get data presented in the findings. These show that companies benefit from outsourcing though they face some challenges in their bid to outsource their non-core activities to outside providers. Organisations always prefer letting specialists in different fields accomplish certain tasks in their companies and this means that organisations can benefit from outsourcing as shown in the Literature Review The Data was collected and then analysed to fit the purpose of the study though with several limitations ranging from financial constraints to time constraints. see more:types of plastic money The findings show that companies outsource to access special expertise, speed up delivery of services, reduce costs and get  enough time to concentrate on their core activities. In the long run companies have benefited from outsourcing in several ways like reduction in costs and company staff getting enough time to concentrate on their core activities to promote the company`s competitiveness in the market. In conclusion, companies should outsource some of their services so as to reduce costs and concentrate on core activities. This therefore shows how important outsourcing is and other companies should adopt it just like Century Bottling Company has done and get good quality services from experts as well as more time for core activities. CHAPTER ONE 1.0 INRODUCTION. This chapter looks at the background, problem statement, objective, research questions and significance of the study. 1.1Background The rationale to outsource was rooted in the cost constraints facing asset managers as they struggled to survive the bear market. Traditionally, the outsourcing market focused on infrastructure, data operation and cost takeout as primary drivers but in addition enterprises are looking at outsourcing business areas to achieve greater flexibility and gain greater ability to respond easily as outsourcing is evolving into a strategic tool for change. Lysons 2000, says outsourcing developed as a reaction to the over diversification that took place in the 1970’s and early 1980’s and has led many enterprises to review their core and concentrate on them. In Uganda, business processes that were kept inside the firm such as cleaning and transport are increasingly being outsourced to places where costs are cheaper and back-off operations can be provided like in Century Bottling Company Limited, cleaning, security and part of transport have been outsourced to outside providers. Century Bottling Company Limited located at Namanve and it deals in production of soft drinks like sodas in different brand names say, Sprite, Coke, Fanta, Novida, Stoney, Datsan and Minute maid among others. It has a range of activities some of which are core 1  and not outsourced. Those that are considered non-core are outsourced to different service providers. It gets a list of service providers, looks at their terms, kind and quality of services provided and the costs involved. It is from this list that it selects the most favourable to outsource to. For instance, Century Bottling Company outsources activities like part of its transport is given private vendors who have trucks in good mechanical conditions, negotiate the price and terms of service. These pick the products from the company premises and deliver them to the agreed destinations like depots and various customers. Cleaning is also done by A&A for all departments in the company and this gives the employees a good working environment and more time to perform their duties. However, despite outsourcing these activities are still having weaknesses like late deliveries due car mechanical breakdowns and unsatisfactory cleaning which is at times due to personal character of the cleaners and poor supervision. Looking at outsourcing as a way of reducing on the work load of the company staff and giving core activities more time for companies to perform to their best, Century Bottling Company also outsources its non-core activities so as to concentrate on the core activities to improve its performance in important areas like the production department since the quality of a company’s products is very crucial for its performance in the market. In its bid to outsource, Century Bottling Company has not forgotten what outsourcing is all about. This gives a relationship between what outsourcing is and what Century Bottling Company is doing. 1.2 Problem statement Outsourcing is a very crucial function in an organisation because it directly affects the firm’s operational activities. Following the identified problems such as late delivery, poor cleaning, high transportation costs in Century Bottling Company, steps have been taken to solve the problem by bringing trusted and better qualified people to provide the services. Despite the steps taken, the contribution of outsourcing to organisational performance is still low. Therefore, the study is to establish the impact of outsourcing on organisational performance with a  case study of Century Bottling Company. 1.3 Objective of the study. The study aims at assessing the impact of outsourcing on organisational performance. 1.4 Research questions (i) Which activities are out sourced and which are not? (ii) How is outsourcing beneficial to an organisation? (iii)What are the challenges encountered in carrying out outsourcing? 1.5 Scope of the study The study focuses on the procurement department of Century Bottling Company Limited. It establishes the impact of outsourcing on organisational performance and the study covers the procurement staff, user department and providers of different services. The study looks at the outsourced activities, benefits of outsourcing and the challenges in connection with the organisational performance. 1.6 Significance of the study (i) The study will help business managers to minimise losses through minimising costs and creating value for money. (ii) The research CHAPTER TWO LITERATURE REVIEW. 2.0 Introduction This chapter looks at a review of issues and factors that have been explored and studied in the existing literature on outsourcing and examine the existing gaps. 2.1 The concept of outsourcing. Baily, 1998, many organisations today are turning to external procurement, where we even find that functions such as transport, accounts, computer services, even purchasing can be outsourced. This gives the company employees time to perform their duties to the company’s satisfaction and this improves the organisational performance which is every company’s objective to achieve competitive advantage. Eyaa, 2006, defined outsourcing as a decision by firms to have an external supplier to take over an activity that would have otherwise been performed in-house by organisation employees. Usually organisations look for the best service providers to whom to outsource their  work, this gives them a chance to get their work done by experts which means good quality work leading to a good company name. Lysons and Gillingham, 2003, states that outsourcing is the strategic use of resources to perform activities traditionally handled by internal staff and their resources. It is a management strategy by which an organisation outsources major non-core functions to specialised and efficient service providers to help the organisations perform best where it is best capable. Axelsson and Wynstra, 2000 defines outsourcing as a decision and subsequent transfer process by which activities that constitute a function that earlier have been carried out by a company are instead purchased from an external supplier. Usually companies that provide outsourced services choose what they can do better, this means training their workers to perform to the best of the clients expectations. This means specialisation with all its benefits to organisations. Different Authors like, Bendor, Bona and Lysons suggest that the following activities should not be outsourced or if done it should be done with great management consideration; management of strategic planning, management of finance, management of consultancy, control of supplies Quality and environmental management. The ranges of services that are outsourced are timeless and these include; Waste disposal, research and development, transmission service, estate management, customer brokage, catering, Asset repair and control library and cleaning. Although various organisations have tried to look at what the different Authors have written and put it in consideration in their bid to outsource, they have not fully met their intentions like cost reduction, efficient and effective service provision from the service providers to whom they outsource their activities. This is partly due to the ever increasing prices of products which also mean increase in prices of services being outsourced. 2.2 Cost reductions. Sabiti, 2003, says that, the organisation that outsources is cutting administration cost of maintaining or doing the activity in house, the overriding factor in outsourcing decision is cost cutting, but where as this may make business sense in the beginning, in some cases it 6  could bring complications and put the whole exercise at a high risk if all concerns are not adequately assessed. This means that the outsourcing organisation should not only look at the costs being low but also consider the outcomes of process of outsourcing at the end of everything to the organisation. Manzi, 2004, states that the most common economic factor that influences the decision is the need to reduce costs. Where the benefits analysis has been carried out and has been established that it is most economic to outsource rather than continue to operate a given function looks forward to making profits in business. Kulumba, 2005, states that, outsourcing is a popular phenomenon with managers because they believe that outsourcing vendors are inherently more efficient due to economies of scale. The outsourcing organisation benefits from getting the services from the provider at a reduced cost since it is provided on a large scale and usually for a reasonable time if it is good work. Antonuccci 1998, advised that, if the vendor is efficient than the prospective client, organisations could reduce its own costs through function consideration and resource optimization. Due to experience in the field and knowledgeable experts, it leads to proper and efficient use of resources yet with good quality work. 2.3 Key factors necessary for outsourcing 2.3.1Competence Bourassa 1988, says that organisations should focus on core activities and leave the noncore activities to outside providers who have the skills to do them better. The providers who have all the required competence, skills, and service providers should be of desired level to be able to meet the company requirement. K Farrington, 2006, also shows how important competence is, it is the core activities of the company that tell or manifest the performance of the organisation. These activities need much more time so as to come out at their best and give the company competitive advantage over others. This can be achieved through outsourcing non-core activities and concentrate on its core competence. 2.3.2 Management support Peter Jeans 2008, suggests that when it comes to outsourcing, it should be supported by all departments of the organisation so as to get the best of the benefits of outsourcing in the  organisation. To achieve success, we always have to stand together to share ideas for better organisational performance. Garry Petty, says that any activity in the company done without management consent and support is a manifestation of failure in that activity. This shows how much important management support and involvement is in all company activities outsourcing inclusive. 2.4 Drivers of outsourcing 2.4.1 Quality actual capacity Lysons and Gillingham 2006, state that, it is temporarily insufficient to comply with demand; the quality motive can be subdivided into three aspects, that is to say; Increased quality demand, shortage of qualified personnel and outsourcing as a transitional period. Therefore companies have various reasons for outsourcing their non-core activitie s. 2.4.2 Finance Frankwood and Sangster, according to them, the company has a limited investment budget. The funds must be used for investments in the core activities which are long term decisions and leave non-core activities to outside providers to do them on behalf of the organisation. 2.4.3 Core business Erick Bartz, shows that, Core business is a primary activity that enables an organisation to generate revenues to concentrate on core business activities. All subsequent activities are supportive and should be outsourced to give enough time to the core activities. 2.4.4 Benefits of outsourcing Outsourcing is beneficial in the following ways; 2.6.1 Cost saving This is the lowering of the overall cost of the service to the business. This involves the score defining quality levels, repulsing, renegotiations, cost restructuring, access to lower cost economies through off showing cold labour arbitrage 2.6.2 Specialisation Lysons and Gillingham, say that, Outsourcing allows an organisation to concentrate on areas of business that derive competitive advantage and outsource non core activities to specialist with better skills and expertise. 2.6.3 Access to innovation There are opportunities to have access to capabilities of suppliers into the products and services of the customer organisation rather than attempt to replicate the capabilities of a supply network (www.pwc.com) 9 2.6 Challenges of outsourcing Like any restructuring exercise and management decision making in business, there are risks associated with outsourcing that procurement managers or top management need to consider carefully (Procurement News December,17th,23rd 2003) and these may be; The possibility of over depending on or leveraged by suppliers which make switching costs to other suppliers in future prohibitively expensive. Over a long time, a supplier of outsourced service may become complacent or change ownership and also a risk of a fall in employ morale for fear of being made redundant, confidentiality links of company matters and in some instances loss of intellectual property rights. Eyaa, 2006, says that, high prices being imposed on suppliers due to increasing trends in outsourcing, the demand for suppliers is so high and has pushed the rates being charged by the suppliers to be high. This later increases the costs yet outsourcing is all about helping firms cut costs. Too much expectancy from suppliers as Company employees tend to expect too much from supplier firms as far as service provision is concerned because they are specialists yet things can go wrong once in awhile. Such issues should not be ignored. Manzi, 2005, according to him, there is a possibility that vital company information may be at a risk of being linked to the company’s competitors which is dangerous since some suppliers may be spies to the company. Conclusion. Organisations always want to let specialists in a particular area accomplish a certain task for them. This implies that business can benefit from the practice of outsourcing. 10 Outsourcing is growing at an exponential rate and could deliver desired benefits if proper choices are made at the inception of the arrangement. When companies choose to outsource, they should give themselves room to monitor performance, renegotiation, or terminate the arrangement with the service providers. The outsourcing client must also ensure that their employees are informed about the progress of discussions regarding outsourcing their department and properly treated when the arrangements come into effect. CHAPTER THREE METHODOLOGY 3.0 Introduction This chapter provides an over view of the methods used to collect and process data. It gives the research design the sample selection methods, size, and data processing. 3.1 Research Design The study uses both qualitative and descriptive study designs. Both methods are used to help carry out self report data collection from the interested sample and allowing a thorough and easy analysis of the respondents’ opinion. Both survey designs adequately lead to collection of reliable information by description of the impact of outsourcing on organisational performance in the study area. 3.2 Data Collection Methods Data is collected from interviews conducted in Century Bottling Company as well as responses from the questionnaires. Some of it is from secondary sources such as magazines, text books, internet and Newspapers and this is quoted where necessary and used to draw deductions as per the study. 3.3 Data processing and analysis The information is assessed, edited to eliminate the errors, the data is then coded and grouped according to the study to ease analysis, it is then analysed using SPSS. The findings are interpreted in light of the research objective and reviewed in order to attach meaning to the Data collected. 3.4 Limitations of the study i. Financial constraints Relatively a lot of money is required in this study. This involves photocopying of articles, making phone calls, word processing, binding, transport. These increase the cost of the study. ii. Language barrier Questionnaires written in English are only limited to respondents who only know English. This is quite a problem while extracting information from the illiterate respondents. iii. Lack of adequate cooperation Some respondents are busy and others suspicious of the study thereby not willing to fully cooperate. Officials in the procurement department are busy attending to their normal schedules and meetings and had no time to answer some of the questions. This affected the quality and quantity of data collection. iv. There is a threat of time limit and deadlines that need attention considering the fact that the study is carried out alongside other activities like course works, lectures and tests as well. CHAPTER FOUR PRESENTATION, INTERPRETATION AND DISCUSSION OF THE FINDINGS 4.0 Introduction. This chapter presents findings from literature review, primary data from the interview and questionnaires filled by Century Bottling Company staff. The study is guided by the objective of assessing the impact of outsourcing on organisational performance. 4.1 Relevance of outsourcing. To Century Bottling Company, outsourcing is relevant in different ways, say, it easies the working process, it is cost saving and provides more time to the employees to concentrate on the core activities. This helps the company to keep in business with competitors in the industry as lack of concentration may have a very big impact on the company’s performance and customers may be taken. Century Bottling Company outsources its non core activities leaving the core activities to their staff. In Century Bottling Company, all core activities such as the, production of all their products, the cooler department, the ware house, managerial staff recruitment, among others have not been outsourced for reasons like protecting the quality of the company’s product, protect company secrets and records. However, non core activities have been outsourced to outside providers who have more expertise and these include the following; Medical services to staff are provided by International Medical Centre which renders medical services to the staff whenever they need it. Cleaning services in all departments of the company is done by A&A cleaning services Motor vehicle repair and servicing is done by City Tyres Company Limited to the company cars. Security services are provided by Saraceen security services limited. Part of the transport of the company’s products is done by individuals with trucks that are in conditions good enough to deliver company products to the various destinations. Catering services are  provided by Sunset Hotel where staff is able to get their meals in time and get back to their duties in time. The other findings indicate that outsourcing is a manifestation of hurdles that are associated with the functionality of internal departments. This is because some senior organisation executives have a feeling that there is no return on expenditure, in sourcing does not meet the needs of the business and forecasted games in productivity that are used to justify that never materializes. As a result of this perception, top executives find outsourcing more relevant as a means of cost saving and focusing on their core business activities. 4.2 Nature of organisational performance Century Bottling Company considers outsourcing of non core activities as the best option. It looks at identifying potential providers, establishing both short term and long term relationship with the service providers without compromising the objectives of the organisation as a way of having good organisational performance through outsourcing. 15 This is because the services that have been outsourced are also important to the organisation as well as its performance in the long run. 4.3 Whether outsourcing improves organisational performance It is seen that the impact of outsourcing on the performance of an organization depends on which stake holder is making the analysis. In Century Bottling Company, many of the non core activities are outsourced in order to give the organisation ample time to concentrate on core activities such as production and the cooler department. Looking at the way activities were done before outsourcing, for instance, in the transport department, it was at times hard to deliver company products to the customers in time more especially the ones in the remote areas, but with the idea of outsourcing part of transportation to capable individuals, such customers have been catered for as they are now able to get what they need in time. This promotes customer loyalty and creates a good company image leading to competitive advantage. This indicates an improvement in organisational performance through the transport department. Source: primary data. Table 1 above indicates that, majority of the people are degree holders. This implies that the company is in position of making good decisions about outsourcing. 4.4 Conclusion Century Bottling Company carries out outsourcing to gain access to special expertise, to speed up delivery of services, reduce costs, focus on core activities and improve technology among others. Since the inception of the concept of outsourcing, organisations find outsourcing as the preferred method of procuring non core services and enjoy benefits of outsourcing by concentrating on core activities thus improved management performance CHAPTER FIVE SUMMARY, CONCLUSION AND RECOMMENDATION 5.0 Introduction. This chapter looks at the summary of the findings, conclusions and recommendations drawn from the study. 5.1 Summary Basing on the case study of Century Bottling Company and other literature by various authors, it is believed that organisations outsource services that are noncore to the organisation. It is established that outsourcing has a long term as well as short term bearing on the organisation. The study establishes why organizations outsource many of their non core activities. This is seen by analyzing and discussing the literature review and the interview conducted in Century Bottling Company 5.2 Conclusions Basing on the study above, it is clear that outsourcing positively increases on the performance of organisations, that is to say, it reduces on costs, increase access to new technology, new expertise, core competence concentration, speed up delivery and increase revenue / profits. Therefore, the rate of organisational performance as a result of outsourcing is high in both short and long- term and many business executives are committed to attach their success to the outsourcing process. In the previous chapter, we find that to a greater extent, outsourcing is very relevant Century Bottling Company, however, it is not in order to judge outsourcing as trouble free since it is associated with some calamitous results and firms need time to apply clear outsourcing methodolo gies in order to realize its full usefulness. 5.3 Recommendations Organisations should outsource their noncore business to outside providers that can bring great competitiveness. This is because outsourcing gives company staff more time to concentrate on core competences to produce better quality products and outcompete their competitors in the market hence a competitive advantage. Organisations should establish a partnership with the service providers to establish tools to measure the performance where organisational requirements should be matched with the implementation process through identifying new skills, abilities and knowledge for each project, thus, encourage organisations to obtain front-edge outsourcing. The choices are many for service outsourcing as well as their providers, therefore, this puts organisation on attention to strategically assess their partners. Organisations should not only consider cost reduction and base on low prices and big players to fill their requirements, but should also emphasize the type of relationship and the trend of behaviour between the outsourcing organization and the service providers. Organisations should come up with clear acknowledgement on whether the provider will be able to respond reasonably to the expectations and frequent changes in business and technology requirements to ensure continuity in service provision. For organisations to measure outsourcing effectiveness as regards performance, they should put in place a standard format of measuring performance such as performance evaluation, performance ratios and performance appraisal such that the success from outsourcing g management point of view is the same as what clients deem to be success. 5.4 Areas for further research Opportunities for further research still exist in this area. The study examines outsourcing and its impact on the performance of