Media Hype, Racial Profiling, and Good Science Essay

Summary: Gold begins his essay right away, without any sort of formality. The essay begins with Gold laying a foundation for the requirements of â€Å"good science. † After which Gold spells out the requirements of articles to sell large volumes of newspapers. This latter generates the term anecdotes. The term anecdote is analyzed, scrutinized and concluded as unacceptable due to the evidence relying more on beliefs than facts. Thus creating a vicious circle. Gold than highlights the fact that there exists large numbers or web pages, lawsuits, publications and presentations specifically directed at the issue. Varying levels of government in the United States has passed legislation about the issue. Individuals known as experts of have been successful writing books and employed as expert witnesses or consultants on the matter. Departments of been created to address the issue and conferences devoted to the topic. The American experience has been deemed applicable in Canada. Gold delves into the high social costs involved in the existence and beliefs of the racial profiling anecdotes. The solution is more important than the conception. Gold offers that communication, building trust, transparency and any inappropriate behavior dealt with seriously by the government are requirements to the solution. Gold then goes on to say that the community must also realize that the guilty may use any method to escape punishment. Gold comments that racial profiling is a phenomenon that is supposed to exist in Policing. The Toronto Star claims to have proved this phenomenon by evidence. This evidence needs to be examined by science. Gold then begins to explore the definition of racial profiling. Sometimes the term is used when a handful of officers are bigots. Sometimes it is applied when it seems that the police service promotes racism through its training materials. There is no evidence that American policing material is connected to Toronto Police. Profiling is the activity and racial a subspecies of profiling. Criminal law literature hosts a variety of profiles. As well, police profilers generate ad hoc profiles. Profiling is a â€Å"junk science† involving vague and non-specific characteristics that can be manipulated. There is no scientific merit to profiling. Racial profiling is one-dimensional profiling where the race replaces all other characteristics. Profiling implies to tell us something about an unknown suspect by identifying characteristics. Racial profiling claims to predict the race of a suspect. Claims should recognize the difference between reactive and proactive policing. Reactive policing is when police seek out a specific gender and race because witnesses described the culprit as such. Reactive policing is irrelevant to profiling. Proactive police activity should be the only data used. Statistics on police-minority interactions need to take into consideration the demographics of a given area. Also, are police targeting specific activity due to community concerns in a certain area? It may surprise people to know how much police activity is reactive and how little is proactive. The Toronto Star fails to recognize such issues. The data collected by the Toronto Star also fails to make the distinction. Gold then moves into to the claims and conclusions aspect of the essay. Stating that data collected needs something to be compared to or measured against, some sort of baseline. The Toronto Star used general population figures from the last available census. Apparently, using uses such as a baseline in unacceptable in the expert statistical analysis. Gold attempts to illustrate that fact that the Toronto Star blundered their way from the statistical analysis without using any accepted criteria. After which Gold suggests that data collection needs to be done under comparable conditions. Gold then moves onto another publication â€Å"Wortley and Tanner,† and the definition used by them. The term greater levels are brought up, and Gold asks â€Å"compared to what? † Wortley and Tanner utilized surveys to collect their data, which results in an opinions and claims survey. Gold calls such data collection, â€Å"Anecdotes in bulk. † After this, Gold goes on for some time about assumptions and making the leap from report to reality based on anecdotal evidence. Gold implies that the Toronto Star failed to take into consideration population distribution and population concentration of identifiable groups. The Toronto Star assumes that all groups are even distributed amongst throughout the general population. The Toronto Star compares data of an ethnic population to number of arrests for violent crimes in higher. Violent crimes will be a reactive policing perspective with witnesses identifying physical traits of the culprits. Such data cannot be used for profiling. This was mentioned earlier on in Gold’s essay. Gold then gives an example of a specific case in the United States where profiling failed the Police investigation. Constant failure to identify criminals using a profile would become apparent with an increase in unsuccessful outcomes. For the conclusion, Gold regurgitates the term â€Å"junk science† and how it is unsuccessful. Then applauds Wortley and Tanner for their cautionary note to have such figures scrutinized by experts and peers before releasing results to the public and that quality control needs to be applied to media discussions on the topic. Strengths: Gold does a good job comparing â€Å"good science† with â€Å"junk science,† and how inaccurate the use of â€Å"junk science† will be. Gold quickly defines terms that he continually uses throughout the rest of his essay to assist the reader in following his train of thought. At the beginning of the essay Gold lays the groundwork for what he will discuss throughout the essay. He, quickly lays down his assumption of what racial profiling is and how unlikely that it is used by police. Gold lies out his essay with sections with subtle conclusions being drawn by the end of each. This helps to keep the reader on track as he attempts to dispel the phenomenon known as racial profiling. Hold spends most of his time attacking the foundation of each group or agencies bases for profiling. He uses references and his knowledge of statistical analysis to debunk each idea. Also, Gold uses various examples of how ineffective the outcome would be given each scenario. Gold illustrates how some groups confuse proactive and reactive policing as the same thing, when in fact they are not. He does his best bring that idea several time throughout the essay. Gold is forthcoming with the fact that he was retained by Toronto Police to make submissions on this same very topic. That mention shows that Gold is trying to be honest with the reader. Also, I believe that it aids the read into recognizing that Gold would have had to do a far amount of research to make such submissions. The fact that Gold is privately employed and not a government employee may make the reader feel that he is less-biased on this particular topic. Weaknesses: At some points during the essay Gold seem to gone off on a tangent. At one point he offers solutions to bridge the gap between government agencies and communities. This is done more than once, and was not relevant to the topic being discussed in the essay. There are a few points where Gold appears to be talking in circles with verbal jargon. I didn’t feel those points in his essay resulted in any valid point to validate his argument. It was almost as though Gold digressed or lost focus for a moment. There are points within the essay where Gold appears to put his personal thoughts in brackets, thereby taking away from his credibility. For most of the essay Gold is trying to prove that the Toronto Star wrote an article without merit or proper research. Near the end of the essay he brings up another writer â€Å"Wortley and Tanner. † I believe that it would have been more effective he had integrated both writings earlier on in the essay. It appears as though â€Å"Wortley and Tanner,† are almost an afterthought. Conclusion: I think Gold effectively made his point with this essay. He is credible and knowledgeable, proving his point with examples, scenarios and data. He shows an appreciation for other points of view and illustrates how they may be incorrect based on their data collection. He affectively dissects the definition of the issue and how come groups confuse racism with racial profiling. As well his recognizes the differences between proactive and reactive policing. Gold shows how reactive policing gets generalized by most groups when in fact the investigation is driven by information from independent sources. I believe the weak points in Gold’s essay are overshadowed by his strong points, resulting in a fair and reasonable conclusion to his argument.

Corporate Parenting Essay

Children’s homes operate under the directorate of â€Å"Corporate Parenting† meaning that when a child is placed in the children’s home on an interim or full care order or even if the child is voluntary placed by the trust ( once they become looked after), the staff within the home have responsibilities which include safeguarding the young persons welfare when their needs are being considered by the courts and also taking into consideration when making decisions the views of the child, parent and any other person involved with the young person. As a corporate parent the child’s religious identity, racial origin, cultural and linguistic background all need to be considered, also your role includes preparing the young person for life when they will no longer be â€Å"looked after† by the trust. Staff in residential care have a legal responsibility to each young person as directed by the â€Å"Children’s Order (NI) 1995. Under the directorate of corporate parenting social care staff with in children’s homes are obliged to look after and treat any young person as any other good parent would look after their own child. Social workers in residential care strive to involve the child’s parent in the decision making process of the child’s life; and work in partnership with parents, however there can be occasions where a parent does not act in the best interests of their child and the trust as a corporate parent can limit a decision made by the parent. Professional Carer Professional Carers can be employed within the statutory, voluntary and private sector, again professional carers (i.e) foster parents/ fee paid carers or emergency foster carers have a responsibility to provide a duty of care to safeguard and protect the welfare and well being of each child placed with them. Professional carers are also governed by policies and procedures and legislation which are a requirement by law.

Religion: And How it Has Changed My Life Essay

After thinking about it, I thought Wicca hasn’t really changed my life that much, at least not in concrete ways. I’ve always loved the Earth and thought of it as being beautiful and precious. I’ve always been fascinated at the beauty and mystery of the Moon and the starry sky. I’ve always found Nature to be healing in an all inclusive way that encompasses the physical, mental and spiritual realms. I’ve always believed that our minds have the power to accomplish amazing things. I’ve always thought that there is much more to this Universe than what we can see with our eyes and grasp with our minds. I rejected my family’s religion, Christianity, because despite many claims of it being filled with peace and love, I found their holy book to be filled with persecution and cruelty. I was certain that no single culture had a direct-line to the Divine, that there was no â€Å"One Truth†. I became interested in natural remedies. I celebrated the seasons in my own simple manner. In many ways, I am as I always was, and yet discovering Paganism has brought major changes to my life. When I realized that there was an actual religion whose beliefs so closely matched my own, I was filled with happiness and enthusiasm. I literally spent about a year and a half utterly consumed in learning all I could get my hands on: the lore, mythology, magick and ritual. It was fascinating, and all my spare time was devoted to gathering knowledge and attempting to incorporate what seemed true into my life. I know that I will always be learning and growing in my chosen philosophy, but it is more subtle now. I know the â€Å"basics† at a basic level. I am branching out, studying mythology to an even greater depth, using meditation and divination to know myself with ever greater understanding. I am certain that each individual’s path will be unique, but I consider Wicca to be a path more concerned with who I truly am and how I connect with this Universe. These are wonderful concepts to ponder, but how has Wicca actually affected my daily life? As I thought about the question I realized that it has affected me in subtle but myriad ways. It has become a deeply intertwined part of my life. I think it affects every aspect of my day to day existence. The small rituals, that are such a part of my daily routine now, enhance my life and make it more more meaningful and fulfilling. When I wake in the morning I step outside and greet the Sun. I feel a moment of thanks for its warmth and life-giving rays. I read a poem or a meditation about a Goddess/God. My evening routine is similar. I go out and welcome the Night, the Moon and the Stars. I acknowledge the mystery and magic that I find intrinsic in their beauty. I try to spend as much time as possible out in Nature because I realize that such time is necessary for me. I light candles and whisper heartfelt thanks and love to my Goddess and God. But these actions, while important and meaningful to me, are things I’ve added to my life as a form of worship. How has Paganism changed my everyday, mundane existence? As I mentioned earlier, I did not have much respect for Christianity when I was younger. Learning about many different religions has helped me to realize that Christianity can be a satisfying and fulfilling path for many people. It is only in the hands of extremists that it can become a path of hatred–just as with any other religion. Wicca has helped me to be tolerant of other people’s spirituality as long as they aren’t spewing prejudice and hatred for any other religion besides their own. This didn’t happen overnight. At first I was indignant about Christianity’s attempt to destroy Paganism, the cruelty of the â€Å"Burning Times† and the intolerance that some modern day Christians show toward other spiritual paths. As I read and learned and pondered the issues, I realized that even Christianity, with its horrible history and its modern day fanatics, is a valid and rewarding path for most of its adherents. For most it is a path of love and peace. I never was too concerned about keeping my room â€Å"spotless†. I’m a bit of a pack rat, and things tend to pile up. I’m also a procrastinator, it’s easy for me to put things off until I’m in the mood to do them. Now I try to keep it less cluttered and more organized. This is a direct result of Wicca, because I don’t want negativity to gain a foothold in my home. I realize that messiness can affect the feeling of my home if only in subtle ways. I’m far from perfect, but much better than I used to be and improving with time. I often had a terrible time making decisions, especially important ones, sometimes agonizing for days or even weeks over which choice to make. Now I’ve learned several different types of divination. These help me to know my own mind and make the best decision I can without second guessing myself or wondering if I should have chosen a different route. I hardly ever prayed before becoming Wiccan. I connected it with Christianity. Now prayer has become an important part of my life. This was something I didn’t plan. It just developed naturally. Prayer gives me peace of mind at times, gives me an instantaneous response to stressors and lets me have a spontaneous and intimate relationship with Divinity. I have always written poetry. I have become more prolific. Even if my words are only beautiful and meaningful to me, poetry adds a glorious dimension to my life. It is an amazing experience to begin writing and have the words flow onto the paper without any struggle, to realize that, in some very special moments, it is as if you are a conduit to Divinity and the words are a direct connection with God/Goddess. While I don’t believe anyone can know for certain what happens after death, I have accepted reincarnation as my personal philosophy. It just makes sense to me, and it gives me comfort and peace when I am faced with the death of others or my own mortality. I have become more calm and serene. I don’t let things bother me as much as I used to. I live more in the moment now than in worrying about the past or the future. I feel an even greater sense of gratitude for my life, the blessings that I have and the beauty and wonder of this amazing Universe. Meditation has given me much benefit, but the whole philosophy of life, that I’ve embraced in the past few years, gives my existence a deeper meaning and makes sense of things that I couldn’t understand before. I have learned spellcraft and use it to improve my life. I believe that much, of the changes that magick makes, is within ones self. It gives me a confidence and a surety that affects my whole life. I believe that to make outward changes, a person must first change their inner self. That is what magick is to me, the ability to change myself for the better, to live in harmony with those that I love and the natural world around me. It also lets me communicate my desires to the Universe, and if it be for the greater good, I know my wishes will be granted. Perhaps in a way I hadn’t anticipated, but granted nonetheless. Of course I realize I must do the mundane work, and I never ask for more than I truly need. I am not as shy as I used to be. I love writing, but just about 5 years ago, I would have been too reticent to submit my thoughts in this essay or any other something that other eyes might see. I’m in the process of created my own website, I have been for about 2 years. This was a gigantic step for me, but I felt an almost overwhelming urge to honor my Goddess and God in this way. I joined a Pagan message board about two years ago. That was another huge step for me. It took me several months of â€Å"lurking† to get up enough courage to join, but I wanted to be a part of a community of like minded people and join in on those discussions that I found so interesting. This would have been impossible for me without all the small steps I’ve taken in the last few years. You could say that most of these things would have developed anyway as I gain the experience and wisdom that comes from living more than seventeen years. That may be true, but then again it might not. I know others my age who are torn by angst, whose lives seem filled with a steady stream of problems, who are anxious and unhappy and ever searching for what will bring them contentment and fulfillment. Perhaps it’s a matter of personality or temperament. I really don’t know, but I do know that Wicca has been a catalyst for changes that have greatly improved my personal life. My spirituality gives me a satisfaction that I searched for and couldn’t find for a long time. Wicca is an intrinsic part of me now. It affects my every waking moment perhaps not consciously, but at a deeper, more profound level. Wicca answers an abiding need deep within the very core of my being. Because I have accepted and embraced its philosophy, my entire life has been affected. I am a totally different person than I was 7 or 8 years ago, yet I am the same in many ways. I know that’s a contradiction, but I know that it’s true also. We all change subtly with the passing of time. Hopefully we change for the better. Wicca has changed my life in both great and small ways. I believe I am a better person for it.

Article Review Example | Topics and Well Written Essays - 250 words - 4

Review - Article Example belief and understanding that if only the next biggest competitor could be eliminated that business could somehow get better, the fact of the matter is that the competition that these two firms provide to each other as well as the ideas that are ultimately â€Å"borrowed†/stolen between the two are yet another reason why the firms continue to operate with such a high premium placed on innovation, design, and development. This tense competition is further interesting due to the fact that the article raises the specter of Internet Explorer and Netscape as well as the resurrection that Apple experienced as a result of the iPad under Steve Jobs ultimate direction. What these cases help to bring to the mind of the reader is the fact that as soon as a single firm gains market dominance and somewhat eliminates a rival, the ability of the dominant firm to continue to efficiently innovate and design quality products necessarily decreases. In this way, the reader can appreciate the way in which the firms in question are currently locked in competition; meaning that this ultimate translates to increased quality to the end user. Gupta, Poornima. "Insight: Apple and Samsung, frenemies for life| Reuters." Business & Financial News, Breaking US & International News | Reuters.com. Reuters, 10  Feb.  2013. Web. 24  Feb.  2013.

Euthanasia in the United States Essay Example | Topics and Well Written Essays - 1500 words

Euthanasia in the United States - Essay Example It is vital that the health professionals understand the cultural, legal, and ethical climate that may allow, forbid, or dictate the use of what is commonly called euthanasia. For the purposes of this discussion, euthanasia is in context with patients that are terminally ill, have a poor prognosis, a very limited life span, in palliative care, and are suffering due to a low quality of life or intense pain. While euthanasia is a generic term often used by the public, it requires further definition. Voluntary euthanasia is done at the patient's request, while non-voluntary is committed when the patient may be incompetent to make the decision or in a comatose state and the decision is made by a surrogate (Cohen et al. 1099). Withholding treatment that could sustain life is a form of euthanasia, and may come at the request of a patient, a surrogate, a physician, or a medical review board (Cohen et al 1099). Terminal sedation is, "the practice of sedating a terminally ill competent patient to the point of unconsciousness, then allowing the patient to die of her disease, starvation, or dehydration" (Braddock and Tonelli). Physician assisted suicide (PSA) is the prescribing of a lethal dose of drugs with the knowledge that the patient intends to commit suicide (Cohen et al. 1099). Each form of euthanasia carries its own legal ramifications and is governed by its own set of ethical considerations. While Belgium and the Netherlands in the European Union have enacted laws that permit euthanasia in a well-regulated setting, in the United States it is generally forbidden. From a legal standpoint, voluntary euthanasia (suicide) is allowed in only four states due to "neither statutory nor common law prohibitions against suicide" (Darr Part II 33-34). Non-voluntary euthanasia is outlawed in all fifty states and would fall under the statutes that prohibit murder (Cohen et al. 1099). While these forms of euthanasia are against the law in most US jurisdictions, other forms may be permitted in special situations. Physician assisted suicide (PAS) is a topic that has gained wider discussion in recent years as medical treatments may prolong a person's life, but are unable to add to the quality of life. PAS came to the public's attention when Dr. Kervorkian admitted to assisting suicide in as many as 130 separate cases (Darr Part II 32). According to Darr Part II, "All his assisted suicides occurred in Michigan, which initially had no law banning it" (31). Michigan subsequently passed a law, but Dr Kervorkian continued the practice. He was eventually sentenced for murder and after exhausting his appeals the US Supreme Court denied his writ for certiorari in 2002 (Darr Part II 32). However, these actions opened the door for states to create legislation that would permit PAS. Currently only Oregon has a law that permits PAS. In Texas, PAS is governed under section 22.08 of the state penal code that states if, "the actor's conduct causes suicide or attempted suicide that results in serious bodily in jury" it is considered a jail felony (Chapter 22). The argument over PAS has been, and continues to be, controversial. Kervorkian's argument was predicated upon Roe v. Wade on the basis of individual autonomy and the right

DISASTER PREPARATION Research Paper Example | Topics and Well Written Essays - 750 words

DISASTER PREPARATION - Research Paper Example If there are risk factors that could result into their own illness, that of their family members as well as those that they come into contact with. In the event of violence, they are encouraged to think about the available security services that are available at the scene of the disaster and this ensures their own safety and that of their patients. RNs have the responsibility to act ethically if the victims that they are helping out are members of their family or friends (American Nurses Association, 2010). However, RNs are advised to put their patients’ needs first at all times and this ensures that they act ethically at all times. Nurses have the duty to act according to the code of conduct governing the practice and this facilitates efficiency while handling disasters. Volunteering in a community wide disaster can be challenging for RNs in various ways. This is caused by various aspects that are present in a community-wide setting. First, volunteers are called upon to ensure the safety of their patients first. This means that they are forced to put their lives at risk. In relation to this point, volunteers put their lives at risk, those of their family members and those that they touch or talk to. This is owing to the fact that they might get an infection while volunteering and are in a position where they can transmit it to other members of the society. Secondly, ethical issues arise when helping out in community-wide disasters because these volunteers are likely to come into contact with friends and family (American Nurses Association, 2010). They may be tempted to help out their family first and this goes against the code of conduct governing their practice. This explains the reason as to why volunteers should be highly cautious in this situati on. The other challenge that I will be likely to face in community-wide disasters is the likelihood to face legal problems. This is because some of the members of the community recognize me and therefore

The Australian Government and Reserve Bank Assignment

The Australian Government and Reserve Bank - Assignment Example The main purpose behind the development of such type of an economy is to ensure the availability of opportunities for every Australian citizen for their future success (Key Achievements, n.d). The Reserve Bank of Australia started operating as the central bank of Australia on 14th January 1960. The main purpose of the Australian Reserve Bank is to â€Å"conduct monetary policy,† maintaining a strong economic system and issuing currency of the nation (Reserve Bank of Australia, 2011). The paper seeks to examine the performance of the Australian government and Reserve Bank of Australia in the past two with emphasis on their macroeconomic policies. How successful have the Australian Government and the Reserve Bank of Australia has been in running the Australian economy over the last two years? The time when most of the major powers like UK and USA were suffering due to the recession, the Australian economy was growing at a rate of 0.4pc in the first quarter of 2009 according to t he Australian Board of Statistics. There was even a rise in its GDP. Source: Keep Australian Government The only thing that might put the Australian economy at the backseat was the growing rate of unemployment and it needed immediate attention (Malkin, 2009). Thus when the Labor Party came into power it was expected from them to design their policies in such a way so as to bring more improvements for the economy and also reduce the rate of unemployment. In the department of health, the Gillard Government had signed a number of health reforms with all the States and Territories in order to secure the health of the Australians in the future. This agreement will be a boon for the economy as it will provide the funds required for the public hospitals, one can expect greater levels of â€Å"transparency and accountability† and less waiting for the patients. As a result of the above health reforms one can see that hospital funding has increased by over 50 percent. Around $ 1.5 bill ion have been injected in the emergency departments. Plans for the aged section of the population have increased by 10,000. In order to ensure availability of medical facilities in the rural areas incentives and bonuses are being given to the doctors (Health Reform, n.d). Though the health reforms were meant for the whole economy yet it lacked a â€Å"common architecture binding policy† attitude. Increasing health care costs have proved to be a factor responsible for lack of health care facilities among the indigenous Australians. Apart from that there has been the problem of lack coordination and content (Gillespie, 2011). The Gillard government has made efforts to make every school a great school because they believe that proper education is very important for increasing a person’s potential and also for increasing the wealth of the nation in future. Accordingly policies were designed in such a way so as to ensure uninterrupted flow of quality education. Funding for education continued, existing Education Tax Rebate was expanded; $3.1 million was to be spent in the next two years in order to establish National Trade Cadetships and many more (Schools Policy Analysis, 2010). As global warming as become an important issue all over the world, the Gillard Government has taken steps to ensure a safer environment for the Australians. The government’s Clean Energy Future Package is considered to be an important economic

Newspaper article analysis Essay Example | Topics and Well Written Essays - 1000 words

Newspaper article analysis - Essay Example The main contributor to this piece is Jim Rogers, the CEO of Duke Energy, a company which has traditionally made its earnings through the burning of coal power but now is aiming to implement clean energy solutions in China. Is China ignoring its environmental obligations, as some American politicians will have us believe, or is China investing in alternative sources of energy to combat the environmental problems that it presently faces? Yes, contrary to popular opinion, "China leads the world with its massive investment in energy efficiency and renewable power" (Rogers, Lash, Sung, 2009). Despite these changes, the authors readily admit that rapid Chinese economic growth was devastating to the environment. Accordingly, these authors controversially assert that China may be in fact ahead of the United States in certain environmentally-friendly business concepts. China has a centralized bureaucratic state which is capable of implementing changes from above much more effectively. These authors argue that cooperation between these two nations must exist as China and the United States are â€Å"worlds two largest emitters of greenhouse gases† (Rogers, Lash, Sung, 2009). Accordingly, China and the United States must work together in order to solve the pollution problem afflicting this planet. In what context was this article written? Far from being impartial, this article was spearheaded by the CEO of Duke Energy, a company with vested business interests in China with respect to their renewable energy efforts. It is important to note that CNN gave the article a caveat from the outset altering the reader of Mr. Rogers’ status as a businessman with a vested interest in making China look good. What is interesting to note is the title, â€Å"Coal-burning CEO: U.S., China must fight pollution† which bears little resemblance to the actual content of the article. In fact, it appears to discredit Mr. Rogers. This is an

Health promotion theroy Coursework Example | Topics and Well Written Essays - 250 words

Health promotion theroy - Coursework Example This theory is normally based on the fact that the readiness of an individual to act depends on his or her own perceptions. These perceptions include severity of the consequences, the potential benefits, and cost of taking that particular action as well as the susceptibility. The main advantage of this theory is that subsequent interventions can be planned and made on the basis of the response of an individual towards these concepts. This theory was purposely developed to respond to the issue of the failure of the free TB health screening plan. This model can be used to look into a number of both short-term and long-term health behaviors which include the transmission of HIV/AIDS and other sexual risk behaviors (Glanz & Lewis, 2002). This theory argues that a person will normally take a health-related act such as using a condom if he feels that HIV can be avoided, expects a positive result by using protection and if he believes that he can effectively take an optional health action. This theory is very useful when planning for the community health program. You will be in a position to predict the proper plan of action to take after taking these studies in the community. However, it is worth noting that the theory does not look into other aspects of the individual such as the environment in which they live (John,

View of Human Nature in The True Believer Essay

View of Human Nature in The True Believer - Essay Example Human nature is naturally attracted to fanaticism, because people are empty inside. Hoffer (1959) says: â€Å"A man is likely to mind his own business when it is worth minding. When it is not, he takes his mind off his own meaningless affairs by minding other people's business† (14). Since people find meaninglessness in their existence, they need something larger than themselves to continue â€Å"wanting† to exist. This belief is value-rich, because Hoffer is saying that people need meaning in life, in order to â€Å"live.† Mass movements, furthermore, make them believe that they can do something valuable, which can help them reap benefits in the future. Hoffer stresses that fanaticism is the rejection of the present and the preference for the future, because the â€Å"future† (1959, 182) can given them vital rewards, such as 100% certainty to heaven, as some religious zealots believe. This is the great paradox of mass movements. It might seem that fanatic s are doing something for their organizations, or even their gods, but in reality, when they sacrifice themselves and other people, they are seeking for ultimate selfish gains. Humans are inherently violent, and they do so because they have self-interests. ... feeds something empty inside people, and it helps give an ironic sense of peace to fanatics, because they can express themselves through violent means. The more they can hurt others or themselves or both, the more they feel alive. Mass movements embrace uniformity, because this responds to the need for new meanings. People attracted to mass movements find no meaning inside themselves, and so they have to search for it in external mass movements. Hoffer argues: â€Å"When we lose our individual independence in the incorporateness of a mass movement, we find a new freedom—freedom to hate, bully, lie, torture, murder and betray without shame and remorse† (1959, 100). These newfound freedoms give a sense of meaning, a way to fill the internal void. These meanings make life worth living for in drastically new ways with others who believe in it too. Hoffer offers fine, chilling points on what constitute mass movements. His viewpoints on mass movements underlie his beliefs in human nature. Human beings are selfish, and selfishness and meaninglessness are important ingredients to mass movements. When people are both selfish and find no meaning in their lives, they are moths to the fires of fanaticism, violence, and uniformity. They will brazenly fly to these fires, because by â€Å"dying,† they are â€Å"living.† Self-Interest in â€Å"Why Not Socialism?† G.A. Cohen (2009) believes that people should consider the merits of socialism, because it is morally superior to capitalism. In his book, â€Å"Why Not Socialism?† Cohen examines and defends the advantages of socialism compared to capitalism. His measuring stick is the value and meaning he places on the notion of â€Å"community.† He defines a â€Å"community† as that phenomenon, where â€Å"people care about, and, where necessary

Change Theory Assignment Example | Topics and Well Written Essays - 500 words

Change Theory - Assignment Example Some of those steps include; unfreezing, refreezing and changing. Based on the nature of change that needs implementation, I believe it is an ideal theory, which can enable the changes to be effectively implemented. Thus, to ensure that the new technique of reporting is effectively implemented with positive results, I settled for a participative leadership style to steer the team to embrace the change in question efficiently. The reason why this leadership style stood out from the rest in ensuring the said changes are implemented is because it is involves the whole team thus denoting a democratic notion whereby each member feels his/her opinions are respected. This style requires all the team members to participate actively in decision making by airing out their views, before the final decision is communicate by the participative leader (Burke, 2010). Therefore, this will tend to boost the morale of the team members in ensuring the new changes are successfully fully implemented since they will be part of the decision-making body. In addition, the participants will develop a sense of contentment since they will view the democratic nature of this leadership style being ideal as each and every opinion that they propose will be considered hence forming a portion of the final decision that will be implemented. That notwithstanding the participative leadership style will ensure a positive response to changes by the team members as they will not reject those changes since they are part of the team that came up with the decisions thus it will be their obligation to embrace them since it is their own making. Thus, this having been said it is prudent to say that the changes will be positively implemented successfully since it will be a common initiative of the whole team rather than an individual’s making (Burke, 2010). The Kurt Lewin theory of change is ideal in implementing this

Kodak Essay Example for Free

Kodak Essay The purpose of this report is to perform an extensive analysis of the Eastman Kodak digital photography brand, and ultimately, to provide a sound marketing strategy to their board based on our findings. We do so by examining both a macro view of the digital camera industry as well as analyzing the brand’s history, positioning, success factors, and current challenges. We discovered that Eastman Kodak, while once the unquestionable leader in the film industry, failed to adapt to changing technological market trends and was left behind the digital revolution. Kodak’s unsuccessful response to a major technological discontinuity has resulted in a profound loss of market share and profitability. We have developed a market plan for the dire state Kodak currently finds itself in, one that will attempt to reinvigorate Kodak’s brand as a premium name in digital photography by returning to its traditional values and competencies. While the company currently operates through three distinct segments: Digital Film Imaging, Health Group, and Graphic Communications, we have narrowed our scope to focus primarily on the digital film segment as we felt that this area has the most potential for improvement in the near future. The Digital Film Industry Origins of the Market The evolution of the digital camera market mirrors the evolution of the technology and innovations surrounding photography itself. Throughout the nineteenth century the motivations behind innovations and discoveries in photography surrounded the speed and affordability of creating an exposure. Some of the earliest photographs took up to eight hours of exposure to complete, and were often contained on flimsy and expensive materials, that did not lend themselves to being easily shared. It is evident that the desire to quickly create and share still images existed more than a century before modern digital cameras were ever created. Early attempts at digitizing images for storage remained largely in the video imaging segment, and very little focus was put on the technology for still images. The progress that was made was characterized by poor picture quality and very difficult storage procedures. As a result, professional photographers and hobbyists clung to the old processes of developing film well into the 1990’s. In reality it was the increasingly competitive nature of the news media, particularly in the newspaper industry that led to some of the more workable innovations in digital still imaging technology. It was seen as a competitive advantage for a media outlet to take, store, and send images through digital transmission, rather than wait for a slow development process before a picture could even be viewed. It is no coincidence that the first commercially available digital cameras were incredibly expensive and used almost exclusively by photo journalists. As was the case with the market, for still cameras relying on 35mm film for picture development, it was technological breakthroughs that spurred the growth of the digital camera market. With the development of JPEG file formats in the late 1980’s digital images could be taken and stored on the same device using battery power. Although there are many competitive claims as to who entered the market first, Kodak was arguably the first entrant in 1991 with the DCS-100. The Growth of Digital Photography The transformation from conventional to digital photography was a total shift of technology that not only completely changed the way companies of this industry operate, but also the products and services they offered. Advancement in the information and communication technologies also significantly contributed in shaping digital photography, as well as the digital camera itself. Computers were being used to store and edit photographs, while internet offered an easy way to share and distribute multiple copies of the image to different people at the same time. Furthermore, the concept of a photograph being original was eliminated as duplicate, unidentifiable copies of the image were possible. The key growth stages of the digital photography can be summarized as follows. Steven Sasson (of Kodak) invented the digital camera in 1985 in Kodak research laboratories. The low operating cost, easy storage and distribution were the major attractive features of this new product. Instead of using film like traditional analog cameras they were able to store the image on internal storage or on rewritable memory cards. In 1986, many electronic cameras were released by different manufacturers, e.g., Canon released first still video electronic camera, Kodak: 1.4 million pixel CCD, Nikon: SVC, electronic camera with a 2/3-inch CCD of 300 000 pixels, Sony: Mavica A7AF still video camera, (CCD) of 380,000 pixels which records images onto a 2-inch floppy disks. The world’s first fully digital consumer digital camera was released by Fuji, with the feature that images could be digitally recorded on a removable memory cards. Since then the improvement in camera manufacturing has continued over the years, as new players joined the race with the discovery of new dimensions of digital technology and its applications, and the need for new accessories. Hewlett-Pakard’s ink jet printers became consumer items. Sanyo, Samsung, Olympus also released new digital cameras, and Toshiba manufactured memory cards. Joint Photographic Experts Group (JPEG) created compression file format to easily transfer digital image electronically. The products were further improved with the better understanding of digital technology as continued research and costs were considerably reduced in 1998, leading to exponential rise in sales of digital cameras over the next years. (See Exhibit 1 to see how digital camera sales have skyrocketed since the turn of the century). New professions emerged covering various available features of the digital cameras, and cameras were developed for the specific segments and niches, such as amateur photography, advertizing photography, editorial photography, documentary photography and scientific photography. Digital photography is still far from maturity, as products are continuously introduced or improved though constant innovation. The need to develop specifications (sizes, dimensional tolerance for imaging media, and formats for all major users) and written standards for digital imaging are realized, developed by American National Standards Institute and International Standards Organization. Ultimately, the arrival of digital photography, combined with the ever-improving capabilities of computers to store and display photographs, and the Internet to share them helped revolutionize the major customer processes associated with photography. Photographs could now be taken by consumers at virtually no cost, who could then choose to save or delete their photos with the push of a button, and decide to print them on a PC printer or via email. It is clear then that the industry is almost completely driven by both social and technological change. Competitors Overall, the digital film industry is a highly competitive one. An analysis of the forces that determine the long-run profit attractiveness of this particular segment would reveal that the industry has: high threat of segment rivalry (existence of several large competing companies); high threat of new entrants (abundance of digital photography technology on mobile devices); extremely high threat of substitute devices (countless ways to put an image into digital format); high threat of buyer power (low differentiation level of most digital cameras); and finally, high threat of supplier power (cost of switching suppliers for a large digital camera company would be astronomical). Kodak manufactures and distributes a large number of different products, primarily focused around photography. The sale of each line of products comes with its own competitors. However, for the purposes of this report, the focus of the competitor analysis will be on cameras, both digital and non digital varieties. The camera industry had worldwide sales of $35.5 billion in 2010. Given the large value of this industry, it is important to know what share of the market Kodak’s competitors’ control. A look at the market for digital SLR cameras, disposable cameras and film follows. The world market for digital SLR cameras is dominated by Canon and Nikon, who held world market shares of 37% and 33% respectively in 2010. The remaining 30% market share is held primarily by Sony and Olympus/Panasonic. Sony sold 12% of the world’s digital SLR cameras in 2010, and Olympus/Panasonic had 11% of the market in that same period. Kodak was only one of the several competitors who comprise the remaining 7% of worldwide digital SLR camera sales. Low cost digital SLR cameras have come on to the market and are competing in the same space as digital compact cameras. A look at Kodak’s website showed only one brand of digital SLR camera is being offered by Kodak. Since Kodak is primarily competing in the digital camera space through compact cameras, the shift in digital SLR cameras to a lower price point does not bode well for Kodak since it increases competition. Disposable camera sales in 2009 were comprised primarily of cameras under the Kodak and Fuji brands. Kodak enjoyed a 52.9% market share in this period, while Fuji held 18.1% of the world market. The majority of the remaining 29% of the worldwide market of disposable cameras came from private label brands, who sold 28.4% of disposable cameras worldwide. Disposable cameras like any other cameras come in two varieties, analogue and digital. The market for analogue cameras has been decreasing over the years. For instance, the sales of analogue cameras decreased from US$1,335.5 million in the United States in 2004 to only US$9.5 million in 2009. This is a decrease in sales of over 99% in only 6 years. Although Kodak has kept a leading position in the analogue market, the dissolution of the market for analogue cameras limits the value of Kodak’s leading position in this segment. Kodak has also kept a leading position in the sale of camera film. However, this market segment has seen a similar fall in sales as the decrease in the disposable camera market. In this segment, Fuji is once again Kodak’s largest competitor. Kodak’s tagline â€Å"Kodak Moments† helps it maintain its leadership position in film, but the sharp decline in the sale of film and a strong competitor in Fuji once again limits the value of this leading position. The market for cameras has seen a rise in the competitiveness of one particular alternative product that may limit the growth potential of the camera industry in the future. Mobile phones with cameras built in now form the main substitute to cameras. Since these devices have many features such as video, audio, and internet browsing, and are relatively inexpensive, they represent a real threat to the camera industry. 80% of the world demand for the imaging devices and optical modules that comprise the cameras in mo bile phones is handled by Panasonic, Sony, Sharp and Konica Minolta. Kodak does not compete in this market. Other substitutes that Kodak will need to compete with are counterfeit items. Not only are these items likely to be sold at lower prices, they are also generally inferior in quality and could harm the brand of the companies whose products are being counterfeit. From this analysis of the current competitive landscape, we can see that Kodak’s most important competitors in digital cameras are Canon, Nikon, Sony, Panasonic and Fuji. (See Exhibit 2 for a look at Kodak compared to its traditional competitor, Fuji). Customers The digital film industry targets a large number of consumers spanning different segments and demographics. The following will illustrate who these main consumers are and which kinds of individuals digital photography appeals to. Segments Digital photography is targeted to two major segments; professional and non-professional consumers. As expected, the needs of these two target segments are quite different, and organizations in the digital camera industry market their product to appeal to these distinct expectations and needs. Digital camera companies, therefore, market their product to these diverse groups and consequently identify further submarkets and niche markets. Demographics In the world of photography demographic segmentation plays very vital role in marketing the product. In this method of segmentation, demographics is important because customers’ wants, desires, preferences, and usages are strongly associated with demographic variables. Interest in photography generally starts at early age, usually early teenagers. Consumers are not especially conscious about the brand but want to fulfill their purpose. However, this is the phase where a perception of the brand starts taking position in the minds and get stronger and stronger with the time. After this phase consumers of age 20 to 50 are divided into different groups. Some people adopt photography as profession, some use it for their extensive tourism habits, and finally some take it as fun and leisure activity and some use it as their need. This use depends on their nature, living style and job requirement. Professionals, who adopt photography as occupation or as their hobby, are always more conscious about the quality and success results. They don’t want to see that there is no photo in their camera after any event coverage or after returning from an adventure. They need more reliable equipment with guarantee of better results because this is their earning source. If someone is pursuing photography just for fun and don’t have passions for the hobby then they will typically not pay as close attention to the bells and whistles of the product. In terms of gender, photography appeals to both men and women alike. Marketing does not generally target men or women, although recent manufacturing of point and shoot cameras includes the product in a variety of colours for the consumer to choose from. Lastly, demographics in the digital film industry relies on the consumer’s income. The major manufacturers of digital cameras have realized this, and typically offer product ranging from budget quality, to expensive professional equipment. Psychographics Psychology is also a strong variable to understand consumers. People are different based on their personality traits, psychology, life style and values. Psychographic profile could be completely different within same demographic group of consumers. For example, two individuals of same age group have same range of income like photography as a fun but they have different psychology. One is more caring about quality with regard to details captured in the pictures and the other more focus on the originality of the colours of the pictures. For this reason, camera manufacturers have produced cameras with a plethora of adjustable features, which can be modified to suit the user’s preferences. Important Trends The broad industry of photo imaging and cameras has gone through some profound changes over the past several decades. As expected, technological advancements over the past century are the prime drivers of the various trends this industry has witnessed. Perhaps the greatest transformation this industry has seen has been the relatively recent rise of the digital camera phenomenon. Although the prototype for the digital film industry began with the development of Sony’s analog-type â€Å"Mavica† electronic camera, this product did not gain immediate acceptance in the marketplace due to its high price and the lack of suitable peripherals (i.e personal computers). The larger trend towards digital cameras then was truly popularized in the late 1990s and early 2000s with digital â€Å"point and shoot† cameras, of which Kodak participated in at a much later stage than its competitors. With the release of these user friendly devices, digital camera sales increased by 75% per year by 1997 where film cameras increased by 3%. At first, the absence of an LCD screen for formatting, shooting, and reviewing purposes proved to be a hindrance to the popularization of digital cameras. Once the LCD screen was introduced, the trend was ignited. Photos could now be viewed immediately, and kept or discarded as the consumer desired. Today, most major camera manufacturers have made the exodus from film to digital. Canon as well as Nikon surprised the world when they agreed to stop production of most film cameras, setting another trend that has continued to this day. Another major shift in the world of digital photography was the gradual emergence of cameras on mobile phones. As technology improved, so did the quality of cameras included with virtually every mobile device. As expected, this had an impact on the sale of cheap digital cameras, as the phenomenon was now available to anyone who had a mobile device. This trend continues to this day, with both iphones and Blackberries including high quality cameras with their mobile devices. Currently, there has been a revival of DSLR cameras, with Canon and Nikon holding the majority of market share. Although it is difficult to predict future trends in the camera industry, many market researchers, trend watchers, and technology prognosticators agree that digital is here to stay. Easy access to necessary peripherals such as personal computers and even printers has garnered quick acceptance of the digital camera by consumers. The move to digital will remain; however, the relative maturation of the Japanese, North American and European digital camera markets may result in repeat buyers, as well as marketing cameras to for late adopters. This could all culminate in lower profit margins for some of the worlds leading camera manufacturers.

Factors that Influence Communication

Factors that Influence Communication There are many ways of communicating and the way we communicate is key factor of what we really are trying to put across. Factors that may influence our communication are; eye contact, body language (i.e. posture), tone of voice, gesture, and facial expression. Here are examples of how each of those would influence the way we communicate. Eye contact allows us to guess another persons thought and feelings by just look at their eyes. For example if I was talking to someone and they were looking away Id get the feeling that they are bored and not interested. Also if I was talking to someone and during the conversation I raised my eye it suggest that I am listening and excited or either shocked depending on the topic. Body Language. Posture is part of our body language. For example if I was talking to a boy I liked Id be facing towards him and chatting, however if my body was not facing towards hom this suggest that I am not really interested. Also if when sitting down chatting to a person if they are leaning back this can send the message that they are either relaxed or bored, however if they are leaning forward this implies that they are interested. Tone of voice Our tone of voice is really important when conversing. For example if you talk really fast and loud this may suggest that you are angry. However if you talk in a slow calm voice then this shows that you are rather being friendly. Gesture Gesture is the movement of the arm, hand and head used to help us understand what a person is trying to say. For example when trying to communicate but speech is not possible people use hand gestures. The common hand gestures are the peace sign (the index and middle finger raised and apart), okay gesture (closed fist held with the thumb extended upward) and the not okay (closed fist held with the thumb extended downward). Face Expressions Our face usually shows our emotional state. Our facial expression shows whether we are sad, angry, happy ,surprised scared etc. For instance, if someones facial expression was a big smile and wide eyes this may suggest that they are happy. P4: Explain strategies used in health and social care environments to overcome barriers to effective communication and interpersonal interactions. M2: Review strategies used in health and social care environments to overcome barriers to effective communication and interpersonal interactions. P4: There are many communication barriers. The message the sender is sending may not be understood by the receiver in the correct way and for that reason there is a communication breakdown. There are the communication barriers; Deafness Blindness Dumb/Muteness Language Slang Environment M2: I will also review the strengthens and weaknesses of the strategies used in health and social care environments to overcome barriers to effective communication and interpersonal interactions. Blindness Blindness is the loss of sight/vision. To overcome the barrier of blindness, braille and speech can be used to communicate. Braille is a writing system used by blind people to be able to read, Braille characters are small rectangular blocks called cells that contain tiny palpable bumps called raised dots. For example in a care home, the lunch menu can be written in braille for a person who cant see the menu. Also another way to overcome this barrier is by either having a big print menu or spectacles for the client so that its clearer. In addition using language to describe things is a very useful way to communicate to a blind person for example when meeting a blind person it is effective to make them aware that you are there and who you are and also what you may look like? The advantages of using braille is that braille allows the visually impaired to understand quicker and get things done easily and faster as well as allowing them to be more independent . The disadvantages are the not all visually impaired people know how to use braille also not all peoples fingers are sensitive enough to use it. I believe that braille is effective as it makes the visually impaired very independent and makes life a lot easier. I believe that braille could be more effective if it had been taught in schools to everyone not just the mainstream students. This will not only benefit the visually impaired but someone who is not visually impaired because in life if they do come across a blind person they will be able to still communicate with them. Deafness Deafness is the loss of sound. To overcome the barrier of deafness sign language can be used to communicate. Sign language is using gesture and signs to communicate to a deaf person for example at a hospital a deaf patient can communicate with their doctor using sign language .Another way to overcome the barrier of hearing disability are by using clear speech so that the person can lip-read, this will involve using a lot of eye contact because you would need to make your face visible for the person trying to lip-read. Also using technological aids to communicate is also very effective, these are facilities to help with communication for example hearing aids are small devices that goes behind ones ear which strengthen a persons hearing. The advantage of using sign language is The disadvantage of using sign language is that light is always need, people cannot communicate with each other in the dark also not all hearing impaired people know sign language Dumb/muteness Dumb/Muteness is the inability of speech and is often associated or linked with deafness. However, the technological aid of text-to-speech can overcome this barrier .Text-to-speech is computerised equipment that allows a muted person to type what they want to say and then it will translate into speech form. Also makatons can be used to overcome this barrier. Makaton is a language programme for developing language using speech, signs and symbols. For example in a childcare centre Makaton is used a lot with pre-speech babies and toddlers like picture cards and gestures. Environment: (Space. Noise. Location. ) Space- The space between people is very important when communicating because little space between two can make a person uncomfortable .For example if à ¢Ã¢â€š ¬Ã‚ ¦.wanted to talk to..and the space between them was 1 finger away from each other and its someone you arent close to then the person may feel very uncomfortable and may not be listening probably or is not giving the right responses back or even too much of a distance can lead to misunderstanding. Noise- If there is a lot of background noise it will be harder for people to hear each other when communicating and mixed messages may be received. Language: Language can become a barrier as the person you may be trying to communicate with may not be able to speak the same language so therefore the communication is received but not understood. However, to overcome this barrier interpreters/translator are people who will translate and forward your message to the person who you are trying to communicate with by talking to them in their language. For example if the doctor only spoke English but his patient would only be able to speak Turkish a Turkish interpreter would translate to her what the doctor is saying to her or if the doctor does know how to speak Turkish he should use his patients preferred language. Slang Slang is an informal way of speaking which consists of words and phrases that may not be found in the standard dictionary. Slang is mostly used by the younger generation within specific social groups and communities. It consists of words shortened as well as words such as piff which would mean good looking or sick which means cool/awesome. Jargon is quite similar but it is not informal, it is technical terminology words and phrases used by particular professions. For example a doctor uses the scientific terminology for DNA which is deoxyribonucleic acid rather than DNA. To overcome this barrier it is best to avoid using slang and use the formal standardized English.

The child sex tourism industry in india

The child sex tourism industry in india Introduction The commercial sexual exploitation of children is a fundamental violation of childrens rights. The child is treated as a sexual object and as a commercial object. The commercial sexual exploitation of children constitutes a form of coercion and violence against children, and amounts to forced labor and a contemporary form of slavery.1 Child Sex Tourism is part of the global phenomenon of commercial sexual exploitation of children. It involves the sexual abuse exploitation of both male and female children, usually but not always, in tourism destinations. Several studies have attempted to understand the extent and severity of the phenomenon, emphasizing different aspects thereof: be it travel trade, psychological, socioeconomic facets. The factors that push children into sexual exploitation are numerous for example: family disintegration, inequitable socio-economic structure, harmful and religious practices which undermines fulfilment of the basic need of the children. By treating the child as a commodity which can be purchased, hired sold or thrown away is no longer a question of poverty, but rather one of values, in particular the values of consumerism. According to NHRC Report on Trafficking in Women and Children, in India the population of women and children in sex work in India is stated to be between70, 000 and 1 million of these, 30% are 20 years of age. Nearly 15% began sex work when they were below 15 and 25% entered between 15 and 18 years (Mukherjee Das 1996). In public view child sex tourism is not considered a major social issue in India, partly because of the perception that the problem is not as acute as in some countries of South East Asia and partly because the problem is largely associated only with poverty. Every hour, four women and girls in India enter prostitution, three of them against their will. Here when a women or a children are forced for such things then Are these not a concern related to ethics? This paper will discuss the causes of the problem of child prostitution for sexual needs in India. Sex tourism refers to an organized tour whose primary purpose is the commercial-sexual relationship with an individual from the country that he or she is visiting. There are three major categories of sexual exploitations that occur within sex tourism. These are prostitution, pornography and trafficking for sexual purpose. Recently, the trend of sex tourism is to provide sex tourists a wider number of children as opposed to older and more mature women. In fact, the commercial sexual exploitation of minors by international tourists today is considered as a human tragedy occurring in a grand scale with virtually no consequences for those who practice this. The World Tourism Organization, a specialized agency of the United Nations, defines sex tourism as trips organized from within the tourism sector, or from outside this sector but using its structures and networks, with the primary purpose of effecting a commercial sexual relationship by the tourist with residents at the destination. But it also refers to business people, transport industry workers or military personnel. Attractions for sex tourists can include reduced costs for services in the destination country, along with either legal prostitution or weak law enforcement and access to child prostitution. More than 2.4 million tourists visit India every year and growth of the tourism industry in the country has contributed to an increase in the sexual exploitation of children by tourists. Child sex tourism is prevalent in Goa, North Karnataka, Kerala, Tamil Nadu, Orissa, West Bengal and in Rajasthan. Mumbai is believed to be the biggest centre for pedophilic commerce in India. Child sex tourism involves hotels, travel agencies and tour operators and some companies openly advertise availability of child prostitutes. They have contacts with adult sex workers, rickshaw pullers; petty traders who make contact with street or other vulnerable children and bring them to tourist hotels and lodges. Children are often promised better jobs and then forced into sex and in many cases moneylenders force parents to sell their children to repay debts. A traveler may not intend to engage in sex with children while he is away from home, but he does so because a child is made easily available to him. Op portunistic exploitation, then, along with organized child sex tourism, is a critical factor compounding the complex socio-economic factors that push children into local prostitution industries. Here are some of the prominent  facts about child sex tourism in India: India has the largest number of children (375 million) in the world, nearly 40% of its population 69% of Indian children are victims of physical, emotional, or sexual abuse (or read it as every 2 out of  3) New Delhi, the nations capital, has an abuse rate of over  83% 89% of the crimes are perpetrated by family members Boys face more abuse (>72%) than girls  (65%) More than 70% of cases go unreported and unshared even with parents/family There are many factors that make children vulnerable to sex tourism. They may also be called as a Push factor for them in child sex. Let us discuss some of them. Organised prostitution: It is known that child prostitution is the sexual exploitation of the child for remuneration in cash or in kind, usually but not always organized by an intermediary (parents, family members, procurers, etc.). Many children, particularly girls, are abused within brothels that are frequented by both, local, regional and foreign child abusers. Some research suggests that girls enter the sex industry as a direct result of coercion or an unspoken expectation by other family members, including sisters or mothers already in the industry. Many of the girls are from the States of Karnataka, Andhra Pradesh and Maharashtra and often the daughters of migrant women involved in the sex industry. Poverty and economic insecurity: The majority of the children, both migrant and local, come from poor backgrounds and have little or no access to education. The parents are unskilled workers from neighbouring States who need to migrate to various regions in search of employment. As a result, many of the children are also compelled to work and can be found around beach and resorts areas, often working as vendors. The nature of their work requires them to be friendly to tourists and therefore leaves them open to offers by sex tourists. Weak family structure: Family breakdown is seen as an important aspect leading to children being exposed to abuse. Many children have run away from home and live on the streets due to problems at home ranging from drug abuse, alcoholism or physical or mental illness. Like all children who suffer from violence and abuse, they may be physically, mentally injured. They are at high risk of: long-lasting physical, social, and psychological damage, disease (including HIV) or unwanted pregnancy and forced abortions. Lack of parental supervision: Many of the abused are migrant workers children who are unsupervised and alone on the streets while their parents take up casual or daily wage work in Goa. These children often end up wandering on the streets and are vulnerable to the lures of sex tourists. Trafficking: Trafficking of children is a worldwide phenomenon affecting large numbers of boys and girls every day. Children and their families are often lured by the promise of better employment and a more prosperous life far from their homes. Others are kidnapped and sold. Trafficking violates a childs right to grow up in a family environment and exposes him or her to a range of dangers, including violence and sexual abuse. There is also some evidence to suggest that children are being trafficked to Goa from other parts of the country or even from other countries for purposes of sexual exploitation. Children are also sold by poor families from different regions and then forced into working in the sex industry or other labour around coastal areas where they are at risk from sex offenders. It appears that some families sexually exploit their own children by either selling them to traffickers or by forcing them into prostitution. Such families prize material benefits at the cost of an y abuse to their child. Pornography: Pornography is like a media in sex tourism. Child prostitution is somehow connected with child pornography. It refers to the visual or audio depiction of the child for the sexual gratification of the use, and involves the production, distribution and or use of such material. Pornographic images of children are often copied multiple times and may remain in circulation for many years; the victim continues to be subjected to humiliation long after the image has been made. Discrimination: Many prostitutes in India are victims of the Devadasis (temple prostitute) system and have been dedicated to the Goddess Yellamma (around 10,000 girls in India are dedicated annually). Goa is no different and many of the girls in its red light districts are victims of this system. After knowing all the factors which push children into such vulnerable situation, one thing which comes instantly into mind is that all contrary to the principles of Integrity and Fairness. It is always questionable that Are these children not a human being? How a parent can do such pitiful things with their own child?Every child has its own integrity and has the right to live a life of respectful human being. The exploitation of human beings dehumanizes the individuals who are trafficked, rewards the inhumanity of the traffickers, and weakens the moral and social fabric of society at large. Restoring dignity to persons who have been exploited is not easy, and the danger of paternalizing trafficked victims in the name of aiding them must be kept in view. Traffickers and parents who expose their children need to be stopped and held accountable, but they also need those who will help them to a transformation of heart and mind. Sex tourism is the dark side of the global phenomenon of tourism. Every day we read about the benefits of tourism, its income and employment potential, its ability to bridge the gap between the rich and the poor, its potential to overcome uneven development in backward regions of the world Asks why sex tourism is being condoned and wonders why more voices are not raised in protest against its continuance. It often raises a concern for the Indian society but why only India society, child sex tourism is the part of every country whether in Asia or Europe or America. Do societies and Government need not to show Concern and Respect towards these children. Children are the future and some even call them Gift of God. Travellers who travel to some less developed country think that they have all the rights to use people as they want. The methods that sex offenders use to lure children into abusive situations range from offering them money or gifts, convincing parents that the child will enjoy a better life and providing children with shelter and employment. Such grooming methods are the hallmark of the preferential sex offender whereas the opportunistic ones exploit the children they meet on the street or are offered by pimps. The justifications that sex tourists offer for their abuse of children include the perception that they are helping the children monetarily and also giving children the love that they appear to crave. Many travel agencies, hotels and others are all involved in this whole process. These people think that it is part of their job and they are rendering their services to these travellers. But are their not any Code of Ethics in tourism industry. Develop an ethical policy regarding trafficking and commercial sexual exploitation of children. Providing information to tourists on CST and request them to help dealing with the problem by informing if they see any doubtful behaviour of tourists who accompany children. To provide information to travellers by means of catalogues, brochures, in-flight films, ticket-slips, home pages, etc. The study calls for specific national, regional and local actions to safeguard children who are being sexually exploited, or are at-risk of sexual exploitation. Recommendations include the Ministry of Tourism creating a National Plan of Action to Counter Child Abuse in Tourism and for businesses in the tourism industry to shoulder more responsibility for this problem by, for example, joining the Code of Conduct (www.thecode.org). It was recommended that state and central tourism departments report annually on the status of child abuse cases, set up mechanisms along with other bodies for the protection of children, and to demonstrate a clear stand against any form of child sex abuse. The Ministry of Women and Child Development (MWCD) are also called on to create a comprehensive Act that imposes severe punishment of offenders, including extradition laws (through the Ministry of Home Affairs). The report also calls for child sex tourism cases to be treated as non-bailable offences. Trai ning on child rights laws and how to handle child abuse cases for Police was also recommended, along with sensitization training and mandatory reporting of child abuse (including adults traveling with children under suspicious circumstances) both by Police and by airport and railway authorities. More in-depth study on the commercial sexual exploitation of children is also necessary to inform policy, protection mechanisms and campaigns. What can we do? Here are my thoughts: Educate our children about sex. If you are not parents yourselves, but know and care about other families of friends and relatives, open up this topic for discussion and encourage the parents to do what is  right. If you think talking about sex is difficult for you, dont just be embarrassed,  shrug  it  off, and give it up. Many parents dont know their children are victims, and live in a fantasy world of nothing like that would ever happen to my child. Talk to your parents in order to understand what diffi culties they had to face culturally when bringing you up. That may give clues to how to overcome cultural taboos. Finally, spread the word. Spread the awareness. We owe it to the next generation. With the knowledge that our children know the basic facts to safeguard themselves, we can at least hope to hold our heads high once  again. With the economic growth more tourism increased salaries limited family lifeà ¢Ã¢â€š ¬Ã‚ ¦ more luxury lifeà ¢Ã¢â€š ¬Ã‚ ¦ money being spent for temporary pleasure going highà ¢Ã¢â€š ¬Ã‚ ¦ all kind of un-social activities will be going high. It is the real form of terrorism. Let the policy maker and the party in power and the opposition party see that this is the new form of suicide bomb. After centuries of being shoved under the carpet, the truth is out. And we, as Indians, should stop, hold our breath, drop our heads in shame, and introspect. In the fight against trafficking government organizations, non-governmental organizations, civil society, pressure groups, international bodies, all have to play an important role. Law cannot be the only instrument to take care of all problems. Notes A statement from The Declaration and the Agenda for Action from the First World Congress against the Commercial Sexual Exploitation of Children, held in Stockholm, 1996

The relationship between Rhoda and Gertrude in The Withered Arm Essay

Discuss the relationship between Rhoda and Gertrude in The Withered Arm. The Withered Arm is a pre-20th century book by Thomas Hardy; the plot of the story is in and around the writers' imaginary village of Holmstoke and town of Casterbridge. One of the main themes of The Withered Arm was Jealousy it was portrayed through Rhoda Brook, 'a thin fading woman of thirty' 'that had once been handsome', who had an affair with Farmer Lodge and bore him a son. Farmer Lodge left Rhoda to bring up their son on her own and later married a new wife, who was 'years younger than him', called Gertrude. In this essay I am going to discuss the relationship between Rhoda and Gertrude in The Withered Arm. The relationship between Rhoda and Gertrude is a triangular one. It is between Rhoda, her ex-partner Farmer Lodge and his wife Gertrude. Rhoda heard about the coming of Farmer Lodge's new wife Gertrude through her fellow 'milkers' who were gossiping while at work. She then sent her son several times to go and 'give her a look'; she was mainly interested in the appearance of the new wife. She specifically asked her son to see "if she's dark or fair show marks of the lady' and to 'notice if her hand be white or are like a milkers hands like' hers. It was obvious that Rhoda wanted to compare herself with Gertrude but was disappointed when her son came back with news of the new wife being 'A lady complete', 'and her face as comely as a doll's' as she kept on asking her son questions like 'Her eyes not dark like mine?' and 'Is she tall?' 'as tall as I'. All the answers Rhoda got about Gertrude were so positive that when she heard that Gertrude was 'rather short' she said to her son 'with satisfaction', 'that's al... ...onduct. In fear of loosing Farmer Lodges love, Gertrude resorts to most despicable cure, which led to her death. In The Withered Arm Thomas Hardy used Rhoda's son to start a good relationship between Rhoda Brook and Gertrude. The quirk of fate in the situation is that Rhoda's son, the ill fated boy's life mutually brought Gertrude and Rhoda together in the beginning of the story and his death made them meet again, this time the last, not as friends but as enemies. The boy's carving of the chair instead of helping his mother cook and his poaching, which eventually led to his death were suggestions of his early and tragic death. It seems that as long as the two women were alive their link kept their relationship going whether good or bad, and it was only after Gertrude's death that the relationship between her and Rhoda brook finally came to an end.

Flute Acoustics Essay -- acoustic sound

A flute blows a rapid jet of air across the embouchure hole. The pressure inside the players mouth is above atmospheric (usually 1kpa: just enough to support a 10cm height difference in a water manometer). (http://newt.phys.unsw.edu.au/music/) The work done to accelerate the air in this jet is the source of power input to instrument. Sound requires an oscillating motion or air flow. In the flute, the air jet, and the resonance in the air in instrument produces an oscillating component of the flow. As the air starts to vibrate some of the energy (sound ) is radiated out the ends and through any open holes. Most of the energy is lost as a sort of friction (viscous loss) with the walls. The pitch or note can be altered very slightly by breath and lip adjustment, but if changed completely the length of the air must change. This is why the holes in the flute are used to remove the constriction of the air at that particular point. The resonance of the air column in the flute mostly determines the playing frequency which is the pitch. (http://newt.phys.unsw.edu.au/music/) Since the...

Diabetes Mellitus Study Guide

DIABETES MELLITUS * Chronic multisystem dz , abnormal insulin production / impaired utilization * Disorder of glucose metabolism related to absent/ insuff insulin supply or poor utilization of inslin that’s available * 7th leading cause of death * leading cause of blindness, ESRD, lower limb amputation * contributing factor for heart dz/ stroke risk 2-4 x higher than without DM * INSULIN – hormone produced by cells in islets of Langerhans of pancreas.Normal – continously into bloodstream ( basal rate), or increased w/ meals (bolus) * Normal glucose range 70-120 mg/dL, average insulin secreted daily 40-50 U 0. 6 U/kg * Glucagon, epinephrine, GH, cortisol oppose effects of insulin counterregulatory hormones they blood glucose lebels, stimulate glucose production by liver, movement of glucose into cells. Insulin released from cells – as precursor / proinsulin thru liver enzymes form insulin & C-peptide ( C-peptide in serum & urine indicator of cell function) * in plasma insulin after meal storage of glucose as glycogen in liver/ muscle, inhibits gluconeogenesis, fat deposition, protein synthesis * Nl overnight fasting release of stored g;ucose from liver, protein from muscle, fat from adipose tissue * Skeletal muscle & adipose tissue receptors for insulin insulin-dependent tissues Type I Diabetes Juvenile onset, insulin-dependent, s/s abrupt but dz process present for several yrs, 5-10%, absent or minimal insulin production, virus/toxins, under 40, 40% before 20 yr * s/s thirst( polydipsia), polyuria, polyphagia ( hunger), fatigue, wt loss, Kussmaul respirations * immune mediated dz; T-cells attack & destroy cells * genetic predisposition & exposure to virus * Idiopathic diabetes – not atoimmune, strongly inherited, in small # pt w/ type I DM , African/Asian * Predisposition HLAs human leukocyte ntigens when exposed to viral infection cells destroyed * Long preclinical period, s/s develop when pancreas can no longer produce suffi cient insulin to maintain nl glucose levels * Req. insulin from outside source exogenous insulin eg. injection * No insulin diabetic ketoacidosis (DKA) life threatening, results in metabolic acidosis * â€Å"honeymoon period† – newely diagnosed pts, tx initiated pt experience remissions req little insulin because cells produce suff amount of insulin lasts 3-12 mths then req permanent insulin Prediabetes * risk for developing diabetes glucose levels high but not high enough for diabetes diagnosis * impaired fasting glucose IGF 100-125 mg/dL * 2 hr oral glucose tolerance test OGTT 140-199 mg/dL * HgB A1C – 5. 7%-6. 4% risk for diabetes * Increased risk for developing DM type II – if no preventive measures develop DM in 10 yrs * Long term damage to body heart, blood vessels occur in prediabetes * Usually no symptoms * Maintain healthy weight, exercise regularly, healthy diet risk of developing diabetes Type II Diabetes * Adult onset, non-insulin dependent, 9 0% * > 35, overweight, tendency to run n families * African Am, Asian, Hispanics, Amerian Indians Some insulin is produced but either insufficient for body needs / poorly utilized * Gradual onset, many yrs undetected hyperglycemia, 500-1000mg/dL * Early usu. asymptomatic; high risk pt screen annually * Fatigue, recurrent inf, vaginal yeast inf, candida inf, prolonged wound healing, visual changes * Risk factor obesity ( abdominal/ visceral ) * 4 major metabolic abnormalities * insulin resistance > tissue no response to insulin / unresp receptors – receptors are located on skeletal muscles, fat & liver * ability of pancreas to produce insulin – fatigued from compensatory prod of insulin, ell mass lost * inappropriate glucose by liver – too much glucose for body needs – type II * altered prod. of hormones & cytokines by adipose tissue ( adipokines) role in glucose & fat metabolism – type II. Two adipokines ( adiponectin & leptin ) affect insulin sens itivity altered mechanism in type I & I * Metabolic syndrome > risk for type II & cardio dz, cluster of abnormalities, insulin resistance, insulin levels, triglycerides, HDLs, LDLs, HTN * Risk factors for metabolic syndrome central obesity, sedentary lifestyle, urbanization, westernization Gestational Diabetes During pregnancy, 7% of pregnancies * High risk – severe obesity, prior hx of gestational DM, glycosuria, polycystic ovary syndrome, family hx of DM II screened at 1st prenatal visit * Average risk OGTT at 24-28 wks of gestation * Higher risk of cesarean delivery, perinatal death, neonatal complications * Will have nl glucose levels within 6 wks postpartum but risk of DM II in 5-10 yrs * Nutritional therapy – 1st line , if doesn’t work insulin therapy Other specific types of diabetes * Due to other medical condition or treatment causes abn blood glucose levels * Damage , injury, destruction of cell function Cushing’s, hyperthyroidism, pancreatitis, cystic fibrosis, hemochromatosis, TPN * Meds > corticosteroid (prednisone), thiazides, phenytoin(Dilantin), antipsychotics – clozapine * Tx underlying condition, stop meds Diagnostic studies * A1C > 6. 5 % ; greater convenience, no fasting req, less day to day alterations during stress/ illness * FPG >126 – no caloric intake for 8 hrs prior testing ; confirmed by repeated testing another day; if has s/s and FPG>126 further testing OGTT not req * 2 hr OGTT >200, glucose load 75g accuracy depends on pt preparation, and factors that influence results.False negative > impaired GI absorption, falsely elevated> severe restrictions of carbs, acute illness, meds corticosteroids, contraceptives, bed rest * IFG impaired fasting glucose & IGT > prediabetes, 100-125 mg/dL, IGT 2 hr > 140-199 * Glycosylated HgB – HgB A1C > amount of glucose attached to HgB molecules over lifespan ( RBC 90-120 days ) DM pts should check it regularly, done to monitor success of tx / make chang es to tx < 6. % – risk of retinopathy, nephropathy, neuropathy dz affecting RBCs – can affect A1C results Treatment * Goals > s/s, promote well being, prevent acute complications, prevent/ delay onset/ progression; met when pt maintain glucose level as near to nl, daily decisions about food intake, blood glucose testing meds, exercise * Rapid acting insulin – lispro (Humalog), aspart (NovoLog) – onset 0-15 min, peak 60-90 min, dur. -4 hrs , clear, give 15 min before meals ; bolus * Short acting – Regular (Humulin R, Novolin R) onste ? -1 hr, peak 2-3hr, dur 3-6 hrs, injected 30-45 min before meals; bolus * Intermediate acting – NPH, basal insulin, onset 2-4hrs, peak 4-10hrs can result in hypoglycemia, dur. 10-16 hrs, can be mixed w/ short & rapid, cloudy, must be agitated before adm. Long acting – glargine (Lantus), detemir ( Levemir) addition to mealtime insulin, type I, to control glucose between meals & overnight, without it risk of developing DKA, no peak – risk of hypoglycemia , not diluted or mixed, clear; onset 1-2 hrs, dur. 24hrs +, basal * Combination > pt don’t want 2 separate injections, 2 type of insulin mixed together, not same control of glucose levels as with basal-bolus; ahort/rapid mixed w/ ntermediate provide both mealtime & basal coverage * Storage > vials room temperature 4 wks, heat & freezing alter insulin, between 32-86 F; avoid direct exp to sunlight, extra insulin in fridge/ traveling-thermos, Prefilled syringes – sight impaired, manual dexterity; syringes w/ c;udy solution in vertical position needle up to avoid clumping of suspension, rolled gently, warm before injection. * Injection > abdomen fastest absorption arm, thigh, buttock, rotate within 1 particular site; never into site that’s about to be exercised (heat = absorption & onset), vial 1ml=100U, SQ 90 degrees * Needles ? 5/16 inch (short – children, thin adults); gauges 28,29,30,31 – hi gher gauge = smaller diameter = more comfortable injection * Recapping done only by person using syringe, never recap syringe used by pt; alcohol swabs in health care facility before inj to HAI, at home soap & water * Insulin pump – continuous subq insulin infusion 24 hr/d basal rate , loaded w/ rapid acting insulin via plastic tubing to catheter in subq tissue.At meal time – bolus . (+) tight glucose control, similar to nl physiologic pattern, nl lifestyle, more flexibility (-) infection at site, risk of DKA, cost Problems w/ insulin therapy * Hypoglycemia * Allergic rxn – itching, erythema, burning around inj. site, may improve w/ low dose antihistamine ; rxns to Zinc, protamine, latex , rubber stoppers on vials * Lipodystrophy – atrophy of subq tissue if same inj site used Somogyi effect – rebound effect, overdose of insulin induces undetected hypoglycemia in hrs of sleep, produces glucose decline in response to too much insulin s/s headaches, n ight sweats, nightmares ; if in morning glucose – adcised to check glucose levels at 2-4am if hypoglycemia present at that time.If it is insulin dosage in affecting morning blood glucose is reduced TX : less insulin * Dawn phenomenon – hyperglycemia on awakening in the morning due to release counterregulatory hormones in predawn hrs ( possibly GH/cortisol) adolescence/ young; TX: adjustment in timing of insulin adm. or in insulin. Predawn fasting glucose levels insulin production from pancreas , s. ff > wt gain, hypoglycemia * Meglitinides repaglinide(Prandin) insulin prod, less likely cause hypoglycemia because more rapidly absorbed/eliminated, cause wt gain, take 30 min before meal, not if skipped * Biguanides – Metformin > glucose lowering, first choice DM II/prediabetes, obese & â€Å"starch blockers† slow down carbs absorption, taken with â€Å"first bite†, effectiveness> check 2 hr postprandial glucose levels * Thiazolidinediones – Ava ndia > â€Å"insulin sensitizers†, for pts w/ insulin resistance, don’t insulin Production, not cause hypoglycemia; risk of MI, stroke , not for pt w/ HF * DPP4 inhibitor – Januvia > new class, slow inactivation of incretin hormones; DDP4 inh are glucose dependent = risk of hypoglycemia, no wt gain * Incretin mimetics – exenatide (Byetta) > stimulate incretin horm which are in DM II, stim. of insulin, Suppress glucagon, satiety = caloric intake, slows gastric emptying; prefilled pen * Amylin analog > Amylin hormone secreted by cells, co secreted w/ insulin Pramlintide (Symlin) is Synthetic , type I & II when glucose level not achieved w/ insulin at mealtimes , subq thigh or abdomen NOT arm , not mixed w/ insulin – cause severe hypoglycemia ! * blockers — masks s/s of hypoglycemia, prolong hypoglycemic effects of insulin * Thiazide / loop diuretic — hyperglycemia, K Nutrition Type I > meal planning, exercise, developed w/ pt’s e ating habits & activity pattern in mind, day to day consistency in timing & amount of food eaten * Type II > wt loss = improved insulin resistance, total fats & simple sugars = calorie & carbs intake; Spacing meals , wt loss 5-7% = glycemic control, regular exercise * Carbohydrates > sugar, starches, fiber whole grains, fruits, veggies, low fat milk included min 130g/d * Glycemic index GI > describe blood glucose levels 2 hrs after carb meal , GI of 100 = 50g glucose * Fiber intake 14g/1000 kcal * Fats 7% of total calories , < 200mg/d cholesterol & trans fats * Protein same for diabetes / normal renal function / gen. population, high proein diet not recommended * Alcohol > inhibits gluconeogenesis ( breakdown of glycogenglucose) by liver; severe hypoglycemia in pt on insulin / oral hypoglycemic dx.Moderate alcohol consumption < 2 drinks men, track carbs w/ each meal & daily, set limit for max amount ( depends on age, wt, activity level) usu. 45-60g /meal ; also My Pyramid & plate me thod ( ? nonstarchy veggies, ? starch, ? protein, nonfat milk & fruit * Exercise > 150 min/wk moderate intensity aerobic; DM II resistance training 3 x wk, most adults should 30 min moderate intensity activity 5 x most days * Exercise > insulin resistance, blood glucose, wt loss which insulin resistance ( may need less meds), triglycerides, LDL, HDL, BP, circulation * Start slowly w/ progression. Insulin, sulfonylureas, meglitinides >risk of hypoglycemia with increase physical activity esp if exercise at peak of dx or no food intake.Effect may last 48 hrs post exercise Exercise 1 hr after meal, have 10-15g carb snack every 30 min. during exercise (prevent hypoglycemia). Before exercise glucose immediate info about glucose levels – can make adjustments diet, activity, meds * Recomm. for all insulin-treated pts * Multiple insulin injections – 3 or more x day, done before meals, before & after exercise esp in type I, whenever hypoglycemia suspected, when ill (stress), 2 h rs after start of meal – if effective Pancreas transplantation * For pt w/ ESRD, plan to have kidney transplant * Pancreas transplanted following kidney transplant, pancreas alone –rare * Pancreas alone only if hx of severe metabolic complications, emotional roblems w/ exogenous insulin, failure of insulin-based management * Improve quality of life, no exogenous insulin need, no dietary restrictions * Only partially able to reverse renal & neurologic complications * Need lifelong immunosuppression to prevent rejection * Pancreatic islet cell transplantation in experimental stage, islets from deceased pancreas via catheter into abdomen portal vein Nursing management * Pt active participant in management of diabetes regimen * Few/no episodes of acute hyper/hypoglycemic episodes, maintain glucose level near nl * Prevent/ delay chronic complications * Adjust lifestyle to accommodate DM regimen w/ min. stress Nursing assessment Past hx mumps, rubella, viral inf, recent trau ma, stress, pregnancy, infant>9lbs, Cushing, acromegaly, family hx of DM * Meds > compliance w/ insulin, OA; corticosteroids, phenytoin, diuretics * Eyes > sunken eyeballs, vitreal hemorrhages, cataract * Skin > dry, warm, inelastic, pigmented lesions on legs, ulcers(feet), loss of hair on toes * Respiratory > Kussmaul – rapid, deep * Cardio > hypotension, weak rapid pulse * GI > dry mouth, vomiting, fruity breath * Neuro > altered reflexes, restlessness, confusion, coma * MS > muscle wasting * Also electrolyte abnormalities, fasting glucose level >126, tolerance test> 200, leukocytosis, BUN, creatinine, triglycerides, cholesterol, LDL, HDL, A1C 45yrs without risk factors for diabetes Acute intervention * Hypoglycemia, DKA, HHS – hypersmolar hyperglycemic syndrome * Stress f acute illness/ surgery > counterregulatory hormones > hyperglycemia ( even minor upper resp infection or flu can cause this) * Continue regular diet, noncaloric fluids (broth, water, diet gelatin, decaffeinated), take OA/insulin as prescribed, monitor glucose Q4H * Acutely ill DM I , glucose>240 test urine for ketones Q3-4H , medium/large report to MD * Ill > eat than normal > continue OA meds/ insulin as prescribed + carbohydrate containing fluids (soup, juices, decaffeinated) * Unable to keep fluids/ food down MD * Don’t stop insulin when ill counterregulatory mechanisms will glucose level * Food intake important body needs extra energy to deal w/ stress Extra insulin may be needed to meet this demand, prevent DKA in DM I * Intraoperative > IV fluids & insulin before, during, after sx when there’s no oral intake In DM II w/ OA – explain it’s temporary measure, doesn’t mean worsening of DM * If contrast medium (w/iodine) > Metformin discontinued 1-2 days before sx, resumed 48 hrs after sx risk of acute renal failure.Resume after kidney function nl ( creatinine checked & is nl) * Insulin adm > teach proper administration, adjustments, side e ffects, assess response to insulin tx, if new to insulin assess ability to manage tx safely, cognitive status, ability to recognize/ tx hypoglycemia, if cognitive skill another responsible person must be assigned; diff to self inject/ afraid of needles * Follow ups > inspect injection sites ( lipodystrophy ) * Short term memory deficit > OA or short acting OA cuz doesn’t cause hypoglycemia * OA w/ diet & activity, not take extra pill when overeating * Diligent skin care & dental > aily brushing/ flossing, inform dentist about DM * Foot care !!! scrapes, burns treated promptly & monitored > nonirritating antiseptic ointment > dry sterile pad> not start to heal in 24 hrs or infection > MD * Regular eye exams * Travel – sedentary > walk Q2H to prevent DVT & prevent glucose , carry snacks, extra insulin COMPLICATIONS Diabetic Ketoacidosis DKA * Diabetic coma Profound deficiency of insulin > hyperglycemia, ketosis, acidosis, dehydration * Most likely in DM I pts, but someti mes in DM II ( severe illness/ stress) * Causes > illness, infection, undiagnosed DM I, inadeq insulin dosage, poor self management, neglect * Insulin – glucose cant be properly used for energy fat broken for fuel ketones (by product) serious when excessive in blood alter pH, cause metabolic acidosis ketonuria (in urine) & electrolyes depleted; impaired protein synthesis, nitrogen lost from tissues * Untreated depletion of Na, K, Cl, Mg, phosphate hypovolemiarenal failure/ retention of ketones & glucose shockcoma (result of dehydration, lytes & acidosis)death * s/s > dehydration, poor turgor, dry mm, HR, orthostatic hypotension, Kussmaul , abdominal pain, sunken eyeballs, acetone fruity odor, early s/s > lethargy,weakness * blood glucose >250, arterial blood pH IV access begin fluid/ electrolyte replacement NaCL 0. 45% or 0. 9% to restore urine output 30-60 ml/hr & BP * glucose level approach 250 5% dextrose added * Incorrect fluid repl > sudden Na & cerebral edema * Obtain K level before insulin started – insulin > further K * Insulin withheld until fluid resuscitation & K>3. 5 * Too rapid IV fluids & rapid lowering of glucose cerebral edema Hypersmolar hyperglycemic syndrome HHS * Life threatening, able to produce insulin to prevent DKA but not enough to prevent severe hyperglycemia, osmotic diuresis, ECF depletion * Less common than DKA * Often > 60, in DM II Causes > UTI, pneumonia, sepsis, acute illness, new DM II * Asymptomatic in early stages > so glucose can rise very high >600mg/dL * The higher glucose > in serum osm > neurologic manifestations somnolence, coma, seizures, hemiparesis, aphasia * Resemble CVA (stroke) determine glucose level for correct dx * Ketones absent in urine * Tx similar to DKA * First IV 0. 45% or 0. 9% NS, regular insulin given after fluid replacement * Glucose fall to 250 – add glucose 5% dextrose * Hypokalemia not as significant as in DKA * HHs require greater fluid replacement * Assess VS, I&O, turgor, l abs, cardiac / renal monitoring related to hydration & electrolyte levels, mental status, serum osm Hypoglycemia Low blood glucose glucagon & epinephrine > defense against hypoglycemia * s/s of epinephrine > shaking, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor * brain req constant supply of glucose > when > affect mental functioning > LOC, diff speaking, visual disturbances, confusion, coma, death * Hypoglycemis unawareness > no warning signs until glucose reach critical point > incoherent, combative, LOC > often elderly w/ beta blocker meds * When very high glucose level falls too rapidly, too vigorous management of hyperglycemia * Mismatch in timing of food intake & peak of isulin/ OA * Can be quickly reversed Check glucose levels, if contain fat that glucose absorption; check glucose in 15 min * Still 70 eat regular meal/snack low peanut butter, bread, cheese, crackers, check glucose in 45 min * No significant imptovement after 2-3 doses of 15g carb MD * Pt no t alert to swallow 1mg glucagon IM in deltoid muscle ( nausea, vomiting rebound hypoglycemia) * Hospital setting > 20-50ml of 50% dextrose IV push * CHRONIC COMPLICATIONS OF DM Angiopathy * end organ dz from damage to blood vessels (angiopathy) 2nd to chronic hyperglycemia * leading cause of diabetes-related deaths, 68% deaths due to cardio, 16% strokes * causes: accumul.Of glucose metabolism by products (sorbitol) damage to nerve cells, abnormal glucose molecules in basement membrane of small blood vessels (eye,kidney), derangement in RBCs – oxygenation to tissues * DM I > keep blood glucose levels near to normal – retinopathy & nephropathy (complications of microvascular complications) Macrovascular complications * Dz of large, medium size blood vessels , earlier onset in pt w/ diabetes * W > 4-6x risk of cardiovascular dz, M > 2-3 x * risk factors > obesity, smoking, HTN, fat intake & sedentary lifestyle * Smoking injurious to pt w/DM, risk for blood vessel dz, CV d z, stroke, lower extremity amputations * Maintain BP control – prevention of CV / renal dz Microvascular complication * Thickening of vessel membranes in capillaries/ arterioles in response to chronic hyperglycemia * Are specific to diabetes Eyes ( retinopathy ), kidneys ( nephropathy ), skin (dermopathy ) * Some changes present w/DM II at time of dx, but s/s not appear until 10-20 yrs after onset of DM * Diabetic retinopathy – microvascular damage to retina, most common cause of blindness 20-74 yrs old. Nonproliferative> most common, partial occlusion of small blood vesselin retina microaneurysms, Proloferative> most severe, involves retina & vitreous neovasculization ( form new blood vessels to compensate) if macula involved vision is lost * DM II > dilated eye exam at time of diagnosis & annually, DM I within 5 yrs after DM onset * Laser photocoagulation * Virectomy * Glaucoma Nephropathy – microvascular complication, damage to small blood vessels that supply glomeruli / kidney.Leading cause of ESRD in US; same risk for DM I & II > HTN, smoking, genetic predisposition, chronic hyperglycemia * Screen for nephropathy annually w/ measurement albumin / creatinine ratio * If micro/macroalbuminuria > ACE inh ( lisinopril ) or angiotensin II rec antagonist ( Cozaar ) tx HTN & delay progression of nephropathy * Aggressive BP management & tight glucose control Neuropathy Sensory neuropathy (PNS)– loss of protective sensation in lower extremities amputations * Hyperglycemia > sorbitol & fructose accumulate in nerves damage * Distal symmetric polyneuropathy > hand/ feet bilaterally * Loss of sensation – to touch/ temperature * Pain > burning, cramping, crushing, tearing , at night * Paresthesias > tingling , burning, itching * At times skin too sensitive (hyperesthesia) * Foot injury & ulcerations without having pain TX : blood glucose control, topical creams capsaicin ( Zostrix ) 3-4 X/d pain in 2-3 wks, selective serotonin, norepin ephrine reuptake inh ( Cymbalta ), pregabali ( Lyrica ), gabapentin Autonomic neuropathy – can affect all body systems & lead to hypoglycemic unawareness, bowel incontinence, diarrhea, urinary retention Complications : * Delayed gastric emptying ( gastroparesis ) anorexia, n/v, reflux, fullness, can trigger hypoglycemia by delaying food absorption * Cardiovascular abnormalities , postural hypotension assess change from lying, sitting, standing, painless MI, resting tachycardia HR * Risk for falls * Sexual dysfunction > ED in diabetic men > 1st s/s of autonomic failure * Neurogenic bladder > urinary retention, diff. voiding, weak stream empty bladder Q3H in sitting position, Crede maneuver ( massage lower abdomen) * Cholinergic agonists > benthanechol Feet & lower extremities Risk for foot ulcerations & lower extremity amputations * Sensory neuropathy > major rosk for amputations due to loss of protective sensations LOPS * Unaware of foot injury, improper footwear, stepping on objects w/ bare feet * Screening using microfilament > insensitivity to 10g Semmes-Weinstein > risk for ulcers * Proper footwear, avoid injuries, diligent skin care, inspect feet daily * PAD risk for amputations due to blood flow to lower extremities * PAD s/s > intermittent claudication, pain at rest, cold feet, loss of hair, cap refill, dependent rubor ( redness when extr in dependent position ) * DX : ankle brachial index ABI & angiography * Casting to redistribute weight on plantar surface * Wound control > debridement, dressings, vacuum, skin grafting etc. Charcot’s foot > ankle & foot changes joint deformity need fitted footwear * Acanthosis nigricans – dark, coarse, thickened skin in flexures & neck * Necrobiosis lipoidica diabeticorum – DM I, red-yellow lesions w/ atrophic skin , shiny & transparent revealing blood vessels under the surface – young women * Granuloma annulare – DM I, autoimmune, partial rings of papules, dorsal surface of h ands/ feet Infection Candida albicans, boils, furuncles, bladder infections (glycosuria) antibiotics Gerentologic * reduction in cells, insulin sensitivity, altered carbohydrate metabolism * 20 % > 65 YO * # of conditions treated w/ meds that impair insulin action (