Evaluating Teachers Assignment Essay Example | Topics and Well Written Essays - 1750 words

Evaluating Teachers Assignment - Essay Example Bearing in mind that Miss Paulson had received adequate points in her previous evaluation despite having some difficulty in managing classes goes to point out some issues in the evaluation that have to be addressed within the shortest time possible to avid the recurrence of some incidents as the one she was involved in. The officers responsible for evaluation have shown clearly that they are too lenient during their evaluation sessions. Secondly, there has been a poor teacher supervision structure, which led me to find Miss Paulson attending to individual students leaving the rest of the class unattended, which was also not reported. In this case, the state requires that teachers should be evaluated annually although tenured teachers can even be evaluated once in three years or a twice in a decade, in Ms Paulson’s case, evaluation was done within the stipulated timeframe by the law. In this case, a formal investigation is not necessary as such, incident has never been reported in the school; however, some form of internal (within the school) investigation must take place. Steps to be taken in investigating the incident Wednesday morning constitute an investigating panel Wednesday afternoon the panel to identify the students and staff to be interviewed Thursday morning interviewing of the students Thursday afternoon interviewing of staff members Friday morning Investigating panel meets to draw conclusion and finalise on the investigations. Friday afternoon the principal receives the finding of the Investigations and hands them over to the superintendent. Monday morning official communication from the school is received by the parent of Jessica Robertson The students and staff to be interviewed will be selected depending on their probability of having some information relating to the incident. Among those to be interviewed will be Jessica Robertson since she is the complainant and will provide insight on the incident, which involve the pornographic picture s in class. In addition, the class monitor will be interviewed as he is in charge of the class when the teacher is not around. Those on the front row of the class will also have to be among those to be interviewed since they may have seen who interfered with Miss Paulson’s computer. Miss Paulson will also be interviewed to give her side of the story and what happened on the material day and time; any other staff member who was responsible in setting up of the projector will also have to be interviewed to get the clear picture of all that happened. The interviews will be oral to enable the panel read the body language and will be conducted with utmost confidentiality to ensure the respondents open up on the incident. The panel will have to undergo an oath of secrecy before the district attorney to ensure confidentiality of all the information. Miss Paulson will continue to teach other classes and will not be subjected to any discrimination until investigations are complete Sin ce the investigation will be done internally, any correspondence with the media and community will be done by the principal so as to avoid any form of miscommunication or misstatement. 2.) Evaluation of the conduct of professionals needs to be understood from the activities in which they engage themselves and the manner in which they carry themselves out in performing their duties. This means that any activity of a professional has to be

Situational Analysis of Starbucks Essay Example for Free

Situational Analysis of Starbucks Essay We start off with the organizational analysis’s corporate mission, products and services, leadership Organizational Culture, and Strategy. Next we analyze the firms resources by means of tangible intangible resources, capabilities and core competencies. Then we move into the financials analysis which divides into subcategories such as valuation, growth, profitability, financial strength and management efficiency. The final aspect of the internal analysis is the SWOT analysis which clarifies Starbuck’s Strengths, Weaknesses, Opportunities and Threats. The final closure of the Strategic Analysis is the recommendations for both internal and external analysis along with a conclusion. 2. 0. 0History The history of Starbucks starts in Seattle in 1971. (George, 2010) Three friends; Jerry Baldwin, Zev Sigel, and Gordon Bowker, who all had a passion for fresh coffee, opened a small shop and began selling fresh-roasted, gourmet, coffee beans and brewing and roasting accessories. (George, 2010) The company did well, but things began to change in the 80’s. (George, 2010) McDonald’s has no issue with the generating locations and hitting targeted demographics. Primarily because, McDonald’s is the oldest business in the food service industry. The most common demographic in the American trends are the tweens to teens segment. Here, the up and coming teenagers, or teenagers dive into a new hangout place in order to gain the â€Å"feel† and â€Å"experience† the coffee industry offers. Starbucks offers an influence in the youth of America into employment roles or simply influential leisure hangouts for teenagers. Adam Smith’s â€Å"The Wealth of Nations† best defined competition amongst the market as Lassiez Faire â€Å"A philosophy or practice characterized by a usually deliberate abstention from direction or interference especially with individual freedom of choice and action. † However, no single firm, or group of firms, must ultimately have complete power over any industry because that firm would have the power to regulate prices of that particular commodity. (Dept. of Labor, 2011) This would be known as a monopoly. Should a firm be in recognition of monopolistic power, they would be violating the Sherman Anti-Trust Act in practicing in unfair business practices. (Dept. of Labor, 2011) One example that led to unfair business practices is known as price fixing. (Dept. of Labor, 2011) Price fixing is defined as an agreement between business competitors selling the same product or service regarding its pricing. (Dept. of Labor, 2011) Other pieces of Government regulation is OSHA (Occupational Safety Health Administration). (Dept. f Labor, 2011) Here these laws are backed by the federal governing body of the United States Department of Labor. (Dept. of Labor, 2011) Simple laws here give the employee factions laws to simply abide by in case of any unfair management practices such as quid-pro-quo. All firms must abide by both means of competition and OSHA’s regulator laws. The only real factor in the government/political segment that affects the industry is the EBIT (Earnings Before Interest i n Taxes), because it defines the net worth after gross income a firm can accumulate in the coffee industry.

Management Of Acute Coronary Syndrome

Management Of Acute Coronary Syndrome Acute coronary syndrome encompasses a collection of three acute processes related to myocardial ischemia. These include: unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI). Myocardial ischemia is caused by inadequate perfusion within the myocardial tissue due to oxygen demand exceeding oxygen supply. In a healthy person the amount of oxygen required by the myocardium (O2 demand) is determined by heart rate, myocardial contractility, myocardial wall stress, and afterload. As explained by Antman, et al (2012), oxygen supply to the myocardium requires a satisfactory level of oxygen-carrying capacity of the blood (determined by the inspired level of oxygen, pulmonary function, and hemoglobin concentration and function) and an adequate level of coronary blood flow. The coronary vessels have the ability to adjust their level of resistance to adapt to the increased oxygen demand required by the myocardium during certain times (such as during physical exertion). Ischemic heart disease is typically caused by atherosclerosis, which is a buildup of plaque inside the lumen of the coronary vessels. The emergence of atherosclerosis in the vessels does not occur overnight. Antman, et al. (2012) found that atherogenesis in humans typically occurs over a period of many years, usually many decades and that growth of atherosclerotic plaques probably does not occur in a smooth, linear fashion but discontinuously, with periods of relative quiescence punctuated by periods of rapid evolution. The process of atherosclerosis begins with an abundance of lipoproteins in the blood stream. These lipoproteins bind to the walls of vessels and are eventually deposited within the intima of the arteries. To counteract this process, phagocytes are sent into the vessel to attack these foreign particles (Antman et al., 2012). Once the phagocytes are within the intima, they mature into macrophages and become lipid-laden foam cells (Antman et al., 2012). As these plaques advance calcification occurs. This process is thought to be a key step in the formation of atherosclerotic plaques (Antman et al., 2012). Normally this narrowing of the vessel lumen does not cause chest pain or discomfort. Eventually, however, these plaques may rupture. At this point platelet activation occurs, which eventually leads to clot formation at the sight of the plaque. This clot, or thrombus, may break off and lodge in a coronary vessel. These two processes are a common pathogenic finding with acute coronary syndrome (Lincoff, Califf, Anderson, Weisman, Aguirre, Kleiman, Harrington Topol, 1997). A partial occlusion of the coronary vessels due to a ruptured plaque/platelet complex causes unstable angina or a NSTEMI. In this case, the oxygen demands of the heart cannot be met. A complete occlusion causes a STEMI (Anderson, Adams, Antman, Bridges, Califf, Casey Jr, Chavey II Wright, 2011), which eventually leads to myocardial cell death. Discussion/Analysis The emergency department providers are often the first line of defense in the management of patients with chest pain. The ability to quickly evaluate whether or not the cause of chest pain is potentially fatal is of great importance. Critical chest pain can be broken down in to non-cardiac and cardiac causes. Non-cardiac causes include: pneumothorax, pulmonary embolism, and Boerhaaves syndrome. Acute coronary syndrome is among several cardiac causes of emergent chest pain. An accurate diagnosis of the cause of chest pain requires several key components. These include: patient history (including risk factors), physical examination, diagnostics, and labs. History History is instrumental during the evaluation of a patient with chest pain. Ischemic chest pain is often described as a severe pressure or squeezing and is classically described as the feeling of an elephant sitting on my chest. Typically this pain is described as substernal chest pain which radiates to the neck, jaw, or down the left arm. Additional details regarding the onset of chest pain can also serve as important clues. For example, pain on exertion that resolves with rest suggests stable angina, whereas new onset chest pain or chest pain at rest suggests unstable angina. A good method to differentiate cardiac from non-cardiac chest pain is whether the pain improves after administration of nitroglycerin (NTG). If the pain is relieved by NTG it is considered to be likely due to cardiac causes. Additional details suggesting cardiac origin are shortness of breath, nausea +/- vomiting, diaphoresis, and the presence of syncopal/near-syncopal episodes. It is important to note that a patient with chest pain often have a silent or atypical presentation. This is especially true in elderly men (Woon Lim, 2003) and diabetics (Tabibiazar Edelman, 2003). A patient with an atypical presentation may present with shortness of breath but lack the classical symptom of angina pectoris which radiates to the jaw or left arm. Commonly these patients complain of a feeling of indigestion or epigastric discomfort. Thus it is very important to consider ACS in these patients. The presence of risk factors plays an important role in the evaluation of chest pain, especially in a patient with known disease. The landmark Framingham Heart Study showed that cardiac risk can be influenced by diet, lifestyle, and familial risk factors (Oppenheimer, 2005). The more risk factors that a person carries, the greater their risk of developing ischemic heart disease. These risk factors are generally grouped into two categories: those that are modifiable and those that are not. Risk factors amendable are as follows: Tobacco smoke (American Heart Association, 2012) High blood cholesterol (AHA, 2012) High blood pressure (AHA, 2012) Physical inactivity (AHA, 2012) Obesity and overweight (AHA, 2012) Diabetes mellitus (AHA, 2012) Risk factors that cannot be changed include: Age- 82% of people who die of coronary heart disease are >65 (AHA, 2012) Male sex (AHA, 2012) Heredity- this includes both family history and race (AHA, 2012) Risk is higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans (AHA, 2012) Patients presenting with unstable angina or NSTEMI have variable levels of risk of cardiac death and ischemic cardiac events (Antman, Cohen, Bernink, McCabe, Horacek, Papuchis, Mautner Braunwald, 2000). The trial conducted by Antman et al. (2000) set out to develop a simple risk score that has broad applicability, is easily calculated at patient presentation, does not require a computer, and identifies patients with different responses to treatments for UA/NSTEMI. In doing so, the TIMI risk score was created. The scores are calculated using a score of 1 for each risk factor (7 total categories) assigned to a given patient. According to Antman, et al (2000) the score determines the patients risk of death, myocardial infarction, or severe ischemia. Antman, et al. (2000) found 7 prognostic variables that increase a patients risk. These are: Age 65 years or older At least 3 risk factors for coronary artery disease (male, dyslipidemia, smoking, hypertension, diabetes mellitus, obesity family history) Prior coronary stenosis of 50% or more ST-segment deviation on ECG at presentation At least 2 anginal events in prior 24 hours Use of aspirin in prior 7 days Elevated serum cardiac markers In TIMI 11B/ESSENCE, event rates increase significantly as the TIMI-score increases (Antman et al., 2000). A score of 0/1 showed a 4.7% event rate; 8.3% for 2; 13.2% for 3; 19.9% for 4; 26.2% for 5; and 40.9% for 6/7. This landmark pair of trials allows practitioners a quick assessment of a patients risk of suffering a serious cardiac event. Physical Exam Physical exam is also a key component in the evaluation of a patient with chest pain, as many clues can suggest acute coronary syndrome. Unstable vital signs can be an important hint that the patient has suffered an MI. A general examination may reveal a patient who is diaphoretic and/or using accessory respiratory muscles. The cardiovascular exam could reveal a new murmur, S3/S4 gallop, or JVD. Finally, during the pulmonary exam rales may be heard upon auscultation. Diagnostics Diagnostic testing is an essential part of the evaluation of a patient presenting with chest pain. Several important diagnostic tools were introduced to the emergency department in the latter half of the 20th century that greatly improved the diagnosis and care of acute coronary syndrome. Electrocardiogram The introduction of coronary care units in the 1960s allows physicians to utilize the electrocardiogram (ECG) to monitor potential fatal arrhythmias in patients with acute myocardial infarction (Julian, 1987). Shortly thereafter the portable electrocardiogram became commonplace within the emergency department to assist in diagnosing complications of acute coronary syndrome (Drew, et al, 2004). A patient presenting with myocardial ischemia will typically have symmetrically-inverted T waves in leads V2-V6 (Dubin, 2000). As the name suggests, a STEMI is an ST-segment elevation myocardial infarction, though ST-segment elevation can occur with Prinzmetals angina in absence of an infarction (Dubin, 2000). Additionally, the ECG allows us to evaluate necrosis of the heart in the form of the presence of Q-waves. Q-waves are the first downward deflection of the QRS complex (Dubin, 2000). As Dubin (2000) explains, a positive Q-wave MI must: Lack a preceding spike in the QRS complex Be at least 1 mm wide or Have an amplitude of 1/3 the QRS complex An additional benefit of the ECG is that it allows the practitioner to identify the location of an acute event. Each lead corresponds to a particular location of the heart. For example, leads II, III, and AvF are the inferior leads and reflect the inferior portion of the heart. Due to the relatively high specificity but low sensitivity of the 12 lead ECG in diagnosis of acute coronary syndrome, a group of researchers in Canada recently set out to enhance ischemia detection by conducted a trial which added a new criteria using a three vessel specific leads derived from the traditional 12 lead ECG (Horacek, Mirmoghisi, Warren, Wagner Wang, 2008). This trial showed a statistically significant improvement in the ability of the vessel specific lead protocol to detect ischemia (Horacek et al., 2008). Horacek et al. (2008) found the following sensitivity and specificity for conventional STEMI criteria versus that of the vessel specific leads (VSL): Vessel Sensitivity Specificity Left Anterior Descending 74% conventional, 91% VSL 97% conventional, 97% VSL Right Coronary Artery 60% conventional, 70% VSL 94% conventional, 94% VSL Left Circumflex Artery 36% conventional, 71% VSL 100% conventional, 100% VSL Totals Set 60% conventional, 76% VSL 96% conventional, 96% VSL Based on these results, Horacek et al. (2008) concluded that using vessel specific leads can identify acute ischemia better than existing STEMI criteria. While a STEMI criteria using vessel specific leads has yet to become a mainstay within the standard emergency room protocol, this study provides exciting new improvements in the detection and management of patients with ACS. Serum Biomarkers The use of biochemical markers to detect cardiac cell death significantly evolved in the 1980s and 1990s. Initially, nonspecific markers such as aspartate transaminase and total creatinine kinase were used to detect myocardial necrosis (Lewandrowski, Chen Januzzi, 2002). During the mid-1990s the more cardiac specific enzymes CK-MB became the gold standard for detection of myocardial injury (Lewandrowski et al., 2002). CK-MB, which commonly rises 4-9 hours after the onset of angina, was not without its shortcomings. CK-MB may be falsely elevated due to several different causes, including recent strenuous exercise or skeletal muscle damage, or renal failure (Vivekanandan Swaminathan, 2010). In the late 1990s a more predictable biomarker, troponin I, was introduced for more accurate detection of acute coronary syndrome (Heeschen, Goldmann, Moeller Hamm, 1998). According to Heeschen et al. (1998), Troponin I can be evaluated at the bedside in the emergency room and has a higher diagno stic sensitivity for the detection of acute myocardial infarction (60% vs 48%) when compared to CK-MB. The reason for this improvement in accuracy is that troponin I is not found in skeletal muscle tissue or renal failure (Heeschen et al., 1998). As Heeschen et al. (1998) demonstrated in a head to head study that cTnI test systems produced no positive results in patients with end-stage renal failure and acute or chronic skeletal muscle injury, whereas 30% and 71% of the patients, respectively, had increased CK-MB mass concentrations. One disadvantage of troponin I, however, is that it has a lower sensitivity for the detection of acute myocardial infarction compared to that of CK-MB (Heeschen et al., 1998). This is due to an increased level of cTnI in patients with unstable angina (Heeschen et al., 1998). For this reason, a typical workup for a patient with chest pain in the emergency room includes both cTnI and CK-MB assays, which are drawn at presentation and every 3-6 hours therea fter (Ross, Bever, Uddin Hockman, 2000). Imaging A common component of a chest pain protocol is a chest x-ray. This is normally either a standard AP/lateral series or a portable chest x-ray if the patient is unable to get out of bed. The chest x-ray is useful to eliminate other possible causes of chest pain, such as an aortic aneurism or a pneumothorax. Contrast-enhanced computed tomographic angiography, or CTA, has become an integral part of the management of acute coronary syndrome due to its high sensitivity and specificity (Hoffman, Truong, Schoenfeld, Chou, Woodard, Nagurney, Pope Udelson, 2012). According to the ROMICAT-I study performed by Hoffman et al., (2012), CTA is an effective way to rule out myocardial infarction or ischemia as well as major cardiovascular events over the next 2 years from presentation. The data presented in ROMICAT-I showed that patients undergoing CTA decreased their hospital stay by 7.6 hours compared to standard therapy (Hoffman et al., 2012). Additionally, 50% of CTA patients were discharged from the hospital within 8.6 hours of presentation versus only 10% of patients undergoing standard therapy (Hoffman et al., 2012). Finally, the mean time to diagnosis was significantly decreased with the CT group versus the standard group (Hoffman et al., 2012). Overall, CTA was shown to reduce time spent in the hospital and time to diagnosis when compared to standard therapy for acute coronary syndrome. This is important to note considering the importance of quick coronary reperfusion of STEMI patients (Trost Lange, 2011). An additional observation was that these benefits were achieved without an increase in the cost of care (Hoffman et al., 2012). There was no overall difference between the groups in incidence of myocardial infarction 30 days after initial presentation (Hoffman et al., 2012). It is important to note that a patient undergoing a CTA is exposed to increased radiation. Additionally, patients undergoing CTA were more likely to undergo invasive coronary procedures when compared to standard evaluation. Based on this data, a question arises as to whether every patient presenting with possible acute coronary syndrome should undergo a CTA. The population studied in ROMICAT-I consisted of low to intermediate risk patients. Overall, CTA was shown to decrease the time to diagnosis and hospital stay for patients with possible ACS. In contrast, CTA increases a patients exposure to radiation and increases the likelihood that these patients will undergo an increase in invasive coronary procedures. These factors should all be considered when evaluating a patient presenting with chest pain. Treatment Pharmacologic Aspirin: Early aggressive aspirin (ASA) therapy (162-325mg followed by 81-162mg daily) is currently recommended for all patients with acute coronary syndrome, unless contraindicated (Kirk, Kontos Diercks, 2011). Plavix (Clopidogrel): According to the CURE trial Clopidogrel has been shown to provide a 20% reduction in cardiovascular death, MI, or stroke for NSTEMI patients with positive biomarkers or ischemic ECG changes (Kirk et al., 2011). It is important to note that the significant anti-platelet benefits of Clopidogrel administration should also be weighed against the increased risk of bleeding events if the patient may be a candidate for coronary artery bypass surgery. Antianginal Agents: Nitroglycerin (NTG): NTG is commonly administered by EMS respondents but can also be ordered once the patient arrives in the emergency department, typically sublingually or in the form of Nitropaste. Nitroglycerin dilates the coronary arteries, which reduces myocardial oxygen demand (Trost Lange, 2011). For this reason, it is important to evaluate the patients baseline blood pressure. If SBP is less than 100, caution should be used. Morphine: Intravenous morphine may be given in the event that chest pain is not relieved by NTG administration. Morphine reduces ventricular preload, thereby decreasing myocardial O2 demand (Trost Lange, 2011). Beta-Andrenergic Blockers: Beta-blockers decrease demand on the heart by decreasing heart rate, blood pressure, and myocardial contractility (Trost Lange, 2011). In a patient presenting with ACS, IV Lopressor is typically the agent of choice. These are especially effective agents in patients with elevated blood pressure or tachycardia. It is important to evaluate relevant contraindications to beta-blocker therapy, such as: HR Calcium-Channel Blockers: Diltiazem and Verapamil improve cardiac O2 supply by vasodilation of the coronary vessels, reduce O2 demand by reducing afterload, and reduce heart rate and contractility (Trost Lange, 2011). Calcium-channel blockers are 2nd line treatments for ACS and are typically reserved for patients who are unable to take a beta-blocker (Trost Lange, 2011). Contraindications include: sick sinus syndrome, 2Â ° or 3Â ° AV heart block, hypotension, acute MI with pulmonary congestion, atrial fibrillation or flutter with accessory bypass tract, and ventricular tachycardia, severe left ventricular dysfunction, and cardiogenic shock (Epocrates, 2012). Antithrombotic therapy: Antithrombotic therapy is recommended in a patient with suspected ACS, unless contraindicated (Trost Lange, 2011). Unfractionated heparin is easy to administer (IV) and is rapidly reversible with protamine in the event of bleeding. (Trost Lange, 2011). As with any antithrombotic, there is a risk of bleeding so these patients require close monitoring. Low molecular weight heparin is more predictable, has a lower incidence of thrombocytopenia, and does not require monitoring (Trost Lange, 2011). LMWH is the preferred agent for a more conservative, ischemia-guided strategy to prevent in hospital death or myocardial infarction (Trost Lange, 2011). Bivalirudin is an antithrombotic agent that does not cause thrombocytopenia (Trost Lange, 2011). It has been shown to be equally as effective as unfractionated heparin or LMWH but with a significantly lower rate of bleeding (Trost Lange, 2011). Oxygen administration should be administered for patients who are short of breath, showing signs of shock, or O2 saturation Next Step for NSTEMI or Unstable Angina Patients If a patient is considered to be high risk, such as a patient is at risk of future ischemia or infarction, an early invasive strategy is recommended (Trost Lange, 2011). For these patients, cardiac catheterization should be performed within 24-48 hours of admission (Trost Lange, 2011). In a low risk patient, a more conservative treatment is typically recommended. For these patients, catheterization is only recommended if recurrent or provocable ischemia occurs (Trost Lange, 2011). TIMI scores are a valuable tool to assess the patients risk and to guide the practitioner on the appropriate next step. Next Step for STEMI Patients Prompt coronary reperfusion is paramount in patients presenting with STEMI (Trost Lange, 2011). A door-to-balloon time of less than 90 minutes is considered to be the goal (Trost Lange, 2011). If the patient presents to a facility without a percutaneous coronary intervention facility the patient should be either: Treated with fibrinolytic therapy if not contraindicated (Trost Lange, 2011) Or Transferred to a nearby PCI facility (Trost Lange, 2011). Conclusion Acute coronary syndrome is spectrum of diseases typically caused by atherosclerotic disease. Emergency department practitioners must be able to rapidly diagnose and manage ACS patients in order to potentially preserve precious heart muscle. While treatments for ACS have improved dramatically over the past 30 years, several recent innovations have brought upon exciting new possibilities for the care of these patients. These include new vessel specific ECG leads, cardiac specific biomarkers, and the use of computed-tomographic angiography to assess patients with possible ACS. One component of the management algorithm that has not changed is the need for a strong history and physical examination to aid in diagnosis. Urgency in obtaining diagnosis cannot be stressed enough, and patients presenting with STEMI should be rapidly sent for PCI or transferred to a facility with PCI capabilities.

Creative Management Essays -- essays research papers

Creative Management gives creative ideas of how a manger should present himself and how to approach different situations. Creative Management written by Shiegru Kobanashi, focuses mainly on the importance of teamwork, and on group management. How can we transform our present methods of production, under which we become slaves to machines, and regulations for the temporary increase in productivity, into one in which we are the masters of our work? How can we establish a system, which will make people work voluntarily and feel good about doing it. The book starts with waking up make sure you have proper hygiene. Wear simple clothes. Not close that stand out. A fussy dresser doesn’t impress people, but it gives a false impression of the person wearing the clothes you should wear clean, pleasing clothes that match your personality. A manager should always meet someone with a smile. It will lighten the mood and there is no better way to show your personality them by your smile. â€Å"Face every day with a smile, and you will lead a pleasant life everyday.†(Page 86) It expresses the importance of saying the simple words good morning and good night. When talking to employees you should speaking sincerely and low toned which will make others understand your thinking or feeling. Speaking forcefully and loud with raw emotion can affect other people as well as yourself. The book also emphasizes the importance of a manager to use empathy when dealing with fellow employees. Always put yourself in other people’s position. If you base all decisions and give information to workers solely on how you feel chances are the advice you give will not be what the person coming to you needed. Everyone is different and everyone’s lives are different. A good manager should get to know his employees as best as possible. Giving the manager a little incite into each of their lives. The more you know about your fellow workers the easier it will be to put yourself in there shoes and give the correct advice. .  Ã‚  Ã‚  Ã‚  Ã‚  The world is filled with all types of temptations, and sometimes a manager is put into a situation where he has the opportunity to make some extra cash or maybe get something from some one for doing a not so legal favor. When these situations occur you should stop think things through. You have a mind and are used to doing your own thinking, but you a... ...wth are discussed. This type of meeting takes place every six months. Each department manager or team leader becomes familiar with other functions and groups, learns from hearing their work revised, and participates in policymaking. They learn the significance of his department’s activities in relation to the whole company. They discuss policy making ideas, review appraisals, and set goals. Teams don’t function on order from above, rather it functions on it’s own ideas. The same thing can be said about the individuals who make team, and revise goals that are also handled by team. In other words they work as a unit. A manager should hold himself as a person of power who is still an equal of his work force. The job of the manager is not to order people around and push his ideas. A manager's job is to keep the work force unified and keep it working as a team. Most people in today’s society are power hungry and are only in it for them selves. They don’t realize that if everyone is successful you will be successful they will be to. So remember . there is no â€Å"I† in team. Working to getter and putting minds together is much more efficient then one person how thinks they know everything

My Thoughts About Science

â€Å"Thoughts About Science† by Robert Sager, write a one-half to one page (no longer) reflective essay on your thoughts about science and environmental science. Reading â€Å"Thoughts About Science† intrigued my research towards what science really is. Whether or not someone may believe that the earth started out with a great boom, the amount of research we have today about why we can survive living on this planet explains other theories.The scientific method shows how we can take thoughts and turn them into facts with a reasonable ay of doing so. I think the scientific method is great to use as humans because it involves tons Of research and not just a thought we claim is true. Questioning our mind and putting it into actions such as testing if the thought may be true or not shows we can explain our reason here on earth.Although there are many other contradictions, such as religious and cultural beliefs, I think as humans we have to accept scientific facts in our liv es because it makes up our development of humankind. Without science, we could be living in a world where all humans die because we don't know how to survive n terms of what to do if we get a fever, what to do to nourish our bodies and so forth. Science, in my opinion, is all about testing hypothesis so that we can better ourselves.Some scientists may go back to a hypothesis or theory that was proven a long time ago, yet touch back on it to see if we can improve a certain formula / truth. Think science helps our environment because the environment has so many factors that we need in order to survive (animals, plants, heat, etc). Knowing that we need these through the help of science will better ourselves even if we go through negative times where a thought may not be able to be proven.

The History of License Plates in the U.S.

The History of License Plates in the U.S. License plates, also known as vehicle registration plates, are required for every car in the United States these days, but when automobiles first started to appear on the road, there was no such thing! So who created license plates? What did the first one look like? Why and when were they first introduced? For these answers, look no further than the turn of the 20th century in the Northeastern United States.   The Very First License Plate Although New York was the first state to require automobiles have license plates in 1901, these plates were made by individual owners (with the owners initials) rather than being issued by state agencies as they are in modern times. The very first license plates were typically handcrafted on leather or metal (iron) and were meant to denote ownership via the initials.   It wasnt until two years later, in 1903, that the first state-issued license plates were distributed in Massachusetts. The very first plate, featuring the number 1, was issued to Frederick Tudor. (One of his relatives still holds an active registration on the plate.)   What Did the First License Plates Look Like? These early Massachusetts license plates were made of iron and covered in porcelain enamel. The background was colored a cobalt blue and the number was in white. Along the top of the plate, also in white, were the words: MASS. AUTOMOBILE REGISTER. The size of the plate was not constant; it grew wider as the plate number reached into the tens, hundreds, and thousands. Massachusetts was the first to issue license plates, but other states soon followed. As automobiles began to crowd the roads, it was necessary for all states to find ways to start regulating cars, drivers, and traffic. By 1918, all states in the United States had begun issuing their own vehicle registration plates.   Who Issues License Plates Now? In the U.S., vehicle registration plates are issued solely by the states Departments of Motor Vehicles. The only time a federal government agency issues these plates are for their federal vehicle fleet or for cars owned by foreign diplomats. Notably, some Native American tribes also issue their own registrations to members, but many states now offer a special registration for Native Americans.   When Did It Become a Requirement to Annually Update License Plate Registrations? Although the first license plates were meant to be semi-permanent, by the 1920s, states had begun mandating renewal for personal vehicle registration. At this time, individual states began experimenting with different methods for creating the plates. The front would typically contain registration numbers in large, centered digits while smaller lettering on one side dictated the abbreviated state name and a two- or four-digit year the registration was valid during. By 1920, citizens were required to obtain new plates from the state each year. Oftentimes these would vary in color year to year to make it easier for police to identify expired registrations.

Setting Up and Validating Radio Buttons

Setting Up and Validating Radio Buttons The setup and validation of radio buttons appears to be the form field that gives many webmasters the most difficulty in setting up. In actual fact the setup of these fields is the most simple of all form fields to validate as radio buttons set one value that only needs to be tested when the form is submitted. The difficulty with radio buttons is that there are at least two and usually more fields that need to be placed on the form,  related together and tested as one group. Provided that you use the correct naming conventions and layout for your buttons, you will not have any trouble. Setup the Radio Button Group The first thing that to look at when using radio buttons on our form is how the buttons need to be coded in order for them to function properly as radio buttons. The desired behavior we want is to have only one button selected at a time; when one button is selected then any previously selected button will be automatically deselected. The solution here is to give all of the radio buttons within the group the same name but different values. Here is the code used for the  radio button themselves. input typeradio namegroup1 idr1 value1 /input typeradio namegroup1 idr2 value2 /input typeradio namegroup1 idr3 value3 / The creation of multiple groups of radio buttons for the one form is also straightforward. All you need to do is to provide the second group of radio buttons with a different name to that used for the first group. The name field determines which group that a particular button belongs to. The value that will be passed for a specific group when the form is submitted will be the value of the button within the group that is selected at the time that the form is submitted. Describe Each Button In order for the person filling out the form to understand  what each radio button in our group does, we need to provide descriptions for each button. The simplest way to do this is to provide a description as text immediately following the button. There are a couple of problems  with just using plain text, however: The text may be visually associated with the radio button, but it may not be clear to some who use screen readers, for example.  In most user interfaces using radio buttons, the text associated with the button is clickable and able to select its associated radio button. In our case here, the text will not work in this way unless the text is specifically associated with the button. Associating Text with a Radio Button To associate  the text with its corresponding radio button so that clicking on the text will select that button, we need to make a further addition to the code for each button by surrounding the entire button and its associated text within a label. Here is what the complete HTML for one of the buttons would look like: input typeradio namegroup1 idr1 value1 /label forr1 button one/label As the radio button with the id name referred to in the for parameter of the label tag is actually contained within the tag itself, the for and id parameters are redundant in some browsers. Their  browsers, however, are often not smart enough to recognize the nesting, so it is worth putting them in to maximize the number of browsers in which the  code will function. That completes the coding of the radio buttons themselves. The final step is to set up the radio button validation using JavaScript. Setup Radio Button Validation Validation of groups of radio buttons may not be obvious, but it is straightforward once you know how. The following function will validate that one of the radio buttons in a group has been selected: // Radio Button Validation// copyright Stephen Chapman, 15th Nov 2004,14th Sep 2005// you may copy this function but please keep the copyright notice with itfunction valButton(btn) {    var cnt -1;    for (var ibtn.length-1; i -1; i) {          if (btn[i].checked) {cnt i; i -1;}    }    if (cnt -1) return btn[cnt].value;    else return null;} To use the above function, call it from within your form validation routine and pass it the radio button group name.  It will return the value of the button within the group that is selected, or return a null value if no button in the group is selected. For example, here is  the code that will perform the radio button validation: var btn valButton(form.group1);if (btn null) alert(No radio button selected);else alert(Button value btn selected); This code was included into the function called by an onClick event attached to the validate (or submit) button on the form. A reference to the whole form was passed as a parameter into the function, which uses the form argument to refer to the complete form. To validate the radio button group with the name group1 we, therefore, pass form.group1 to the valButton function. All of the radio button groups that you will ever need can be handled using the steps covered above.

Critic On Huckleberry Finn Essays - Adventures Of Huckleberry Finn

Critic On Huckleberry Finn Essays - Adventures Of Huckleberry Finn Critic On Huckleberry Finn I felt that this novel, The Adventures of Huckleberry Finn, by Mark Twain is appropriate and necessary to illustrate the attitudes of pre-Civil war Americans. To me, this book just shows the life of two runaway people and their life along the Mississippi River. The first time I read this book, I really did not realize that Mark Twain was discriminating blacks. I think that the NCAAP is too worried about literature. Mark Twain probably wrote this book and used terms such as the N- word to show realism in his book. The way Mark Twain puts the book together combined with his way of speech makes the book sound so real that you could confuse it with a autobiography of a little child named Huck. The book Huckleberry Finn was written about a time between 1835s-50s. This meant that during Huck's time, slavery was still around and most whites during this time do not like blacks. The N- word just literally show us what white people think of blacks at that time. They use this wor! d to verbally express their feelings. However, I am not trying to say that Huck calls Jim a N- because he does not like him. He probably picked it up from other people (adults). Besides this "vulgarity" as An Lew has put it, this book in my eyes is a perfectly good reading book for young people. It is exciting, adventurous, and realistic. Most of the N- words are used by Huck and as you see of their relationship together, you know that Huck does not mean it in a bad way. Since this word was used and passed around for quite some time, Huck must have picked it up from someone and is using it sort of as a slang for African Americans. They are messing with one of the greatest and most famous writers around. I don't think this book is very prejudice at all. . . it is just very expressionable.

Strategic management (structural industry analysis) Essay

Strategic management (structural industry analysis) - Essay Example 1). Using a model such as Porter's Five Forces goes well beyond simply searching for trends within an industry in that it can help one to develop marketing strategies that are quite effective. "In the Five Forces Model, Porter explains that in any industry there are five forces that influence what happens within the industry: 1. Existing companies, 2. potential new companies, 3. substitutes for products offered, 4. the suppliers, and 5. the customers" (Website Marketing Plan, 2007, p. 1). The overall business environment is constructed from the combination of these five forces. Improvement's to a company's marketing strategies can be made when management studies these five forces and how they relate to each other within their particular industry or even a specific niche within their industry (Website Marketing Plan 2007). One example of a company who may utilize this model includes EBay, which lies within the online auction industry. Their competitive force would include competitors such as UBid and WeBidz, as they offer the same services as EBay. There are a wide variety of potential new entrants, but they hold a great deal of market share due to their vast popularity, so it would take quite a sharp company to overtake EBay in this particular market. EBay's customers would include those who visit the website, whether they partake in auctioning and, therefore, pay fees or merely contribute to the income of EBay through visiting its sponsors' advertisement banners. The supplier's in this market are unique in that they are actually other consumers, as it is a consumer-to-consumer environment. Substitutes for EBay could include things such as variety and thrift stores, yard sales, discount stores, and classified ads. Another popular company that can analyze its marketing strategies using Porter's Five Forces Model would be Wal-Mart, whose main competitors include companies such as Target and Kmart. Their competitors can exist either on ground or online, such as Target.com. Potential new entrants to the market include up-and-coming discount stores of other varieties that carry a wide range of products at low prices. Customers include those who visit Wal-Mart's physical stores, as well as those who visit their website. Wal-Mart has a wide array of suppliers. Whereas they used to proudly sell products that were made in America, marketplace pressures pushed them to find cheaper suppliers, such as companies located in China. Due to recent conflict with imports from China, this could be a large problem for them in the future if they do not adjust that particular strategy to suit the desires of their customers. People can visit a variety of other stores to obtain the same types of products that they cou ld obtain from Wal-Mart, such as mom and pop stores, but the downside would be that they may have to visit several of these types of stores to get what they could get in one trip to Wal-Mart. Competitiveness, Generic Strategy, Effectiveness, and Profit Consumers have many choices today when they go to

Can men be victims of rape Consider this question in relation to Essay

Can men be victims of rape Consider this question in relation to legislative changes and the evolution of the policing response - Essay Example Although many people may view this assertion as vague, there are some different and varying deliberations on how men undergo difficult times as victims of rape. The worst of it has been on the revelations of how the society would view this issue given that in the wider society, culture has it that men are not allowed to discuss such matters in public. In fact, in some instances, men fear reporting instances of rape with the consequence of being turned against and being the offender instead of being the victims. Some of the common instances of men’s rape are between men and men. This is evidenced by the increased instances of homosexuality. Nevertheless, deliberations have been on how to define men rape in the context of events that may have transpired during the incidence. However, just like in women, men’s rape is characterized by assault and use of force and being forced to perform the sexual act without ones consent. When this happens, a man, just like a woman feels diminished and less a man (Lea, Lanvers, & Shaw, 2003). In fact, to some extent, when men undergo rape, they have a feeling of fear that they end up being gay. There are also concerns that this act may affect their sexual orientation in future. In addition, the worst thing comes in when a man feels that the connection between him and women has been eroded. They get scared even to approach women. In another dimension, for those men that become victims of rape, they have problems having sexual intimacy with their wives. This greatly affects their marriage and may end up breaking up. This becomes worse when men victims stomach these deeds instead of sharing with their spouses. In addition, there have been instances of men’s victim developing avoidance emotions. They tend to kind of develop some psychological problems that keep them away from other people. Some have developed some assault traits that make them aggressive even to their own relatives and friends. In this regard,

Utilizing Online Social Networking Sites Paper Essay

Utilizing Online Social Networking Sites Paper - Essay Example The registered members of the group can talk about camera and accessories to improve their photographs and also talk about their professional knowledge which helps them to learn about the latest provisions in the field. The groups also provide continuing education opportunities in the field of professional photography and these groups provide various educational opportunities and education credits to licensed professionals. The groups also provide qualified referrals and it helps the members to stay connected with the professional community. It helps to further business opportunities in the field of photography in the following ways - There are many LinkedIn applications which can be added to personal profiles and homepages to promote and to stay connected with other human service professionals. Social networking sites provide a platform to individuals who have nowhere to turn for help. Human service is also designed as the professional services for those in need (Alle-Corliss, 1998). As per Maslow’s hierarchy of needs - The scheme of need includes self actualization, esteem needs, belongingness & love needs, safety and psychological needs. It is found that people who are deprived of meaningful social contacts suffer from medical problems (Cassel, 1990). Firms believe that good work spread through spontaneous referrals and referral works because of transferred trust. Employment patterns are related to groups and time (Calvo-Armgengol and Jackson, 2004) and the information spreads fast across social networks. Quality referrals to your client can be generated through awareness, colleagues, service providers, seminars or conference. With the evolution in IT, internet based social networking sites can generate quality referrals. There are other ways to generate quality referrals such as articles, blogs, news, exhibitions, emails, books, case studies, online advertisements, SEO etc.

Any to pic Essay Example | Topics and Well Written Essays - 500 words

Any to pic - Essay Example The cases of failure among health care institutions that have been publicized, though a minority, their overwhelming blow cannot be condoned. These failures have been associated with inadequate compassion, inadequate respect, and lack of dignity. The media has gone further to highlight the consequences of such shortcomings. The most adverse effect is that such failure results to death of many individuals, who would, otherwise have been saved. The interest of some health care organizations has masked the avoidable harm that patients experience across various parts of the world (Reid, 2012). It is essential to note that for a positive movement to be made, the most essential task is shifting the mindset of all health care professionals at all levels. For instance, it is essential that normalizing the nonstandard should be stopped as well as acceptance of the unacceptable. Moreover, there should be a collective as well as individual practice and promotion of professional cores and values that increase the safety of patients and property ownership. Nevertheless, improvements should be made in surgeries, with increases in effectiveness and commitment among the professionals. Health care professionals touch people’s lives at times of primary human need, when compassion and care are what they need most. It is, therefore, significantly essential that individuals, boards, and teams explore what compassion, dignity, respect, and care signify and their manner of demonstration (Reid, 2012). Building united mental representations of care requires nurses to express professional values and describe their expectations. As much as there has been reported failures and poor performance in health care institutions, it is, however, essential that their efforts be recognized. It is arguable that with the absence of nurse leaders to engage others in work, a health environment is unachievable. Professionals have argued that it is only qualified nurses who can determine whether

History of Programming and the Ancient Origin Assignment

History of Programming and the Ancient Origin - Assignment Example The aim of this product of research is to identify those valuable programming languages aside from knowing their history and to find out why they are valuable. Parts of programming are definitely traceable to ancient times. Around 1790 BC, Babylonians left evidence of mathematical records shown in tablets. The archaeologists named it Plimpton 322. And in 780-895 BC, Mohammed Al-Khorzmi wrote the beginning of Algebra, originally written as Kita al-jabr wa’l muqabala which got translated in Latin and then used in Europe, and the book Algorithm originally called in Latin Algorithmic de numero Indorum.1 The ancient numbers were in Base 60 and later Base 10. Without numbers, programming in order to command a machine to do something on its own even with verbal instructions that are written would be inconceivable. Konrad Zuse, an inventor of the first mechanical computer, utilized binary numbers and punched tapes. The same is true with words and languages. Both also have ancient origins. However, it took over 2000 years before civilization saw the connection between numbers, words, and machines. During the Age of Industrial Revolution, 1804, Joseph Marie-Jacquard programmed the â€Å"Jacquard Mechanical Loom† to mass produce textile materials with designs. He did it by using a punched card. Each row of holes corresponded to a design. Those holes controlled the looming operations to a certain extent in the way manufacturers wanted textiles to look like. By just replacing the card with a different combination of holes, they were able to change the design.2 Terence Parr summarizes the evolution of programming as one that was machine-based at the start to high-end abstractions that could be adjusted from one machine to another. The programming language before was tied to the computing machine itself. It could not be adjusted to make another machine work. 3    There was only a machine-dependent programming language. Codes were a binary number  combinations using zeros (0) and 1.  

CONFLICT OF LAWS IN BUSINESS & COMMERCE Essay Example | Topics and Well Written Essays - 5000 words

CONFLICT OF LAWS IN BUSINESS & COMMERCE - Essay Example This report will first provide a brief explanation of basic issues that arise in reference to the enforcement of foreign judgments in England and then apply them in the context of the four different instances where damages have been levied on Pulman Technics by foreign courts. A dispute over a foreign judgment may involve one of three elements (a) whether the Court which issued the judgment has the necessary jurisdiction (b) choice of law applicable in those judgments and (c) recognition and enforcement of judgments (Clarkson and Hill, 2007:131). Foreign judgments are recognized and given effect to by courts in other countries, because the recognition of foreign judgments is one of the essential elements of private international law on the basis of res judicata provisions. Through the application of the full faith and credit doctrine, courts do recognize the judgments delivered by other courts functioning within a competent jurisdiction. The Theory of obligation rests on the premise that if the original court’s assumption of jurisdiction was in order, then it should prima facie be recognizable in England.(Clarkson and Hill, 2007: 133) In the case of judgments that have been passed within countries that are a part of the Brussels Convention, such judgments would be enforceable in England, provided they are not repugnant to the principles of morality and fairness advocated under English law.In the case of foreign judgments passed in countries that are not a part of the Brussels Convention and where no reciprocal enforcement treaties exist, the action to enforce the judgment must be brought under common law rules. The matter of consent will be established if there is a contractual clause allowing jurisdiction to the foreign court, or if there is a voluntary appearance by the judgment-debtor. (Clarkson and Hill, 2007:136). A defendant must have been present in the foreign country where action is being brought against him or her and in the event,

Any to pic Essay Example | Topics and Well Written Essays - 500 words

Any to pic - Essay Example The cases of failure among health care institutions that have been publicized, though a minority, their overwhelming blow cannot be condoned. These failures have been associated with inadequate compassion, inadequate respect, and lack of dignity. The media has gone further to highlight the consequences of such shortcomings. The most adverse effect is that such failure results to death of many individuals, who would, otherwise have been saved. The interest of some health care organizations has masked the avoidable harm that patients experience across various parts of the world (Reid, 2012). It is essential to note that for a positive movement to be made, the most essential task is shifting the mindset of all health care professionals at all levels. For instance, it is essential that normalizing the nonstandard should be stopped as well as acceptance of the unacceptable. Moreover, there should be a collective as well as individual practice and promotion of professional cores and values that increase the safety of patients and property ownership. Nevertheless, improvements should be made in surgeries, with increases in effectiveness and commitment among the professionals. Health care professionals touch people’s lives at times of primary human need, when compassion and care are what they need most. It is, therefore, significantly essential that individuals, boards, and teams explore what compassion, dignity, respect, and care signify and their manner of demonstration (Reid, 2012). Building united mental representations of care requires nurses to express professional values and describe their expectations. As much as there has been reported failures and poor performance in health care institutions, it is, however, essential that their efforts be recognized. It is arguable that with the absence of nurse leaders to engage others in work, a health environment is unachievable. Professionals have argued that it is only qualified nurses who can determine whether

CONFLICT OF LAWS IN BUSINESS & COMMERCE Essay Example | Topics and Well Written Essays - 5000 words

CONFLICT OF LAWS IN BUSINESS & COMMERCE - Essay Example This report will first provide a brief explanation of basic issues that arise in reference to the enforcement of foreign judgments in England and then apply them in the context of the four different instances where damages have been levied on Pulman Technics by foreign courts. A dispute over a foreign judgment may involve one of three elements (a) whether the Court which issued the judgment has the necessary jurisdiction (b) choice of law applicable in those judgments and (c) recognition and enforcement of judgments (Clarkson and Hill, 2007:131). Foreign judgments are recognized and given effect to by courts in other countries, because the recognition of foreign judgments is one of the essential elements of private international law on the basis of res judicata provisions. Through the application of the full faith and credit doctrine, courts do recognize the judgments delivered by other courts functioning within a competent jurisdiction. The Theory of obligation rests on the premise that if the original court’s assumption of jurisdiction was in order, then it should prima facie be recognizable in England.(Clarkson and Hill, 2007: 133) In the case of judgments that have been passed within countries that are a part of the Brussels Convention, such judgments would be enforceable in England, provided they are not repugnant to the principles of morality and fairness advocated under English law.In the case of foreign judgments passed in countries that are not a part of the Brussels Convention and where no reciprocal enforcement treaties exist, the action to enforce the judgment must be brought under common law rules. The matter of consent will be established if there is a contractual clause allowing jurisdiction to the foreign court, or if there is a voluntary appearance by the judgment-debtor. (Clarkson and Hill, 2007:136). A defendant must have been present in the foreign country where action is being brought against him or her and in the event,

Nutrition and Body Essay Example for Free

Nutrition and Body Essay All macromolecules are essential to the body. One has to have the right amount of all of the macromolecules in order to be healthy. It is believed that high protein diets with carbohydrate restriction causes weight loss. However as a result of high protein diet, one damages his/her kidney which is responsible for filtering proteins from blood. In the article, Janine says, â€Å"If you eat too much proteins and not enough carbs you can ruin your kidneys forever.† I agree with Janine, one has to have enough carbohydrates. Carbohydrates are important in the body as they provide energy for short term storage. However if one does not have enough carbohydrates in his/her diet, it affects the brain. Glucose from carbs is the fuel that brain uses to produce energy that moves and motivates one therefore one has to have glucose in the body. Mitchell has this misunderstanding about carbs and fat. Mitchell thinks that if one cuts down on carbs, he/she is actually training the body to burn fat instead. Fats and carbohydrates are two different things. If one is gaining weight, that’s because of calories. The amount of calories one takes causes obesity. Obesity is linked with poor body image. A positive body image is maintained by eating foods that contain fewer calories in it. A person’s weight is affected by genetic inheritance, nutrition and physical activity. Perceived body size is affected by media, puberty, and peer groups. All these factors affect body weight and perceived body size. Metabolism refers to all chemical processes that go on continuously inside the body. The amount of kilojoules your body burns at any given time is affected by your metabolism. Thyroid gland located below the larynx produces thyroid hormone which controls metabolism, growth, body temperature, muscle strength and appetite. Homeostasis is the process used by the body to maintain a stable internal environment. Hormonal regulation of metabolism such as when blood sugar levels rise in the body, insulin is secreted by the pancreas to covert glucose into glycogen, and when sugar levels in blood fall, glucagon is secreted by the pancreas to convert glycogen into glucose. If people have high blood sugar, they get diabetes. If people have low blood sugars, they get headaches, hunger, pale skin etc. Maintaining a normal blood sugar level is very important in the body. In the article, Mitchell says, â€Å"I get pretty hungry and I was getting headaches.† I think it’s because of having low blood sugar level. Mitchell has high  insulin and less glucagon hormone in the body. The advice I would give to Mitchell is to stop dieting and eat healthy foods that contain fewer calories. Mitchell needs to have physical exercises, healthy foods and self-concept.

Hydration Management in Acute Stroke Patients

Hydration Management in Acute Stroke Patients Introduction Stroke is a global public health concern with many sufferers presenting with varying levels of confusion (Oh and Seo 2007). Management of hydration in acute stroke patients is not standardised and variations in practice can be very wide between different continents. The sheer number of possible comorbidities and the relative ease with which hydration can trigger concomitant problems can lead to increasing incidence and prevalence of long-term patient care resulting from inadequate hydration management. Optimum hydration assessment and management are key clinical activities; however, inadequate hydration controls by health professionals persist (Oh and Seo 2007). Research shows that to guide fluid management to desired levels, a regular assessment of the volume status has to be made Scope This literature review is based on works that are found on Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health literature (CINAHL), Cochrane, Department of Health (DoH), National Institute of Clinical Excellence (NICE), National Medical Council (NMC), World Health Organisation (WHO), Wiley Interscience and CKS databases that relate to hydration in stroke patients and nursing awareness of hydration in stroke patients. There is wide literature on different aspects of stroke and many authors have studied the effects of hydration in stroke patients. This review looks at literature that discusses management of hydration and/or the impacts of variations in hydration management on acute stroke patients outcomes like method of feeding, time- compliance in taking readings or measurements, legal issues and ethical issues. Relevance to clinical practice This literature review looks at relevant studies by experts that are found on credible databases. The purposes of the expert studies are reviewed and analysed to inform better understanding of current nursing practice in hydrating acute stroke patients. Several studies on hydration highlight specific difficulties relating to the assessment and management of hydration in acute stroke patients. There are differences between the management and the assessment of hydration in different hospitals and these complicate improving awareness of managing hydration for nurses in practice. If optimum hydration is directly linked to improved outcomes in acute stroke patients, research will be required to identify and overcome barriers to effective hydration management, including the development of specific tools (and knowledge base) to facilitate interventions that promote optimum hydration in seeking improved outcomes in acute stroke patients. Methods of search and documentation n on-line literature search of MEDLINE, CINAHL, COCHRANE, DOH, NICE, NMC, WHO and CKS from 1999 to May 2009 failed to identify enough relevant articles on hydration in stroke patients. Other sources were then reviewed for available literature on medical journals including the BMJ and American Family Physician. For the on-line computer-based literature searches, the following keywords were used: stroke, fluid balance, hydration, cerebrovascular accident (CVA), dehydration, stroke outcome, cerebrovascular disorders, medical management, artificial nutrition and hydration, dysphagia, dysphasia, pyrexia, acute brain infarction, enteral tube feeding, fluid and electrolyte balance, neurology, withholding treatment, pathophysiology and nurses and hydration Hydration and hydration management in acute stroke patients This literature review looks at one of the issues encountered globally in the treatment of acute stroke patients optimum hydration. It takes a particular look at the nursing awareness, measurement, assessment, methods of intervention and the legal issues associated with hydration in acute stroke patients. Stroke is a debilitating condition and can be caused by an ischaemic event or a subarachnoid/intracerebral bleeding. Stroke patients usually present in hospital with co-morbidities (Oh and Seo 2007). Variations exist in stroke fatalities across geographical regions even within the same continent. Studies by Bhalla et al (2003) across four European centres (London, Dijon, Erlangen and Warsaw) have shown significant variation (after adjusting for case mix) in stroke case fatality, in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity. There were also significant intervention differences between centres in intravenous fluid use, enteral feedin g, initiation of new antihypertensive therapy and insulin therapy, with the London centre having the lowest uptake of interventions. In another European BIOMED Programme, significant variations in case fatality for stroke between European centres (after adjustment for stroke severity) were observed, with the United Kingdom (UK) centres having the highest case fatality and the lowest levels of independence (Wolfe et al., 1999). There were lower intervention rates in the UK centre to correct abnormal physiological parameters in the acute phase which may reflect a difference in philosophy of acute medical supportive care compared with other European countries (Wolfe et al., 2001). Awareness of optimal hydration balance and assessment of the patients hydration condition (in the care of acute stroke patients) is a fundamental part of critical care nursing and optimising the hemodynamic situation can be seen as a team-effort. One of the important factors determining quality of the circula tion is the amount of circulating blood (Hoff et al 2008). Following a stroke, patients may have swallowing impairment and other changes of the gastro-intestinal (GI) tract that could affect nutritional and hydration status and that lead to aspiration pneumonia (Schaller et al 2006). Such changes affect the ability of the acute stroke patient to lead a normal nutritional life. Although the Schaller et al (2006) work did not show a direct link between hydration and other comorbidities, they agree that impaired hydrational status is associated with reduced functional improvement, increased complication rates, and prolonged hospital stays. Hydration and hydration status Hydration balance is a measure of the bodys ability to manage fluids and electrolytes. In order to identify the urgency of interventions, nursing staff should characterize an individuals fluid and electrolyte imbalance as mild, moderate, or severe based on pertinent information including lab tests and other relevant criteria. It is important to recognize that the main electrolyte in extracellular fluid (ECF) is sodium and that of intracellular fluid (ICF) is potassium (Edwards, 2001). Toto (1998) pointed out that large increases or decreases in fluid volume can cause infarct, coma and confusion. This knowledge becomes significant in maintaining cerebral blood flow and in preventing secondary brain insult after an acute stroke. In a complication, respiratory or metabolic acidosis will promote the movement of potassium from the ICF and give rise to high serum potassium levels, which may affect cardiac function (Edwards, 2001). This phenomenon can be seen in many traumatic insults to th e brain. A basic knowledge of this physiology in addition to the homeostatic mechanisms for fluid and electrolyte balance is a vital foundation for nursing practice, and essential to the nurses role in hydration management. Cook et al (2005) highlighted the significance of fluids and hydration in the neuroscience patient and in Cook et al (2004) they highlighted that an understanding of the physiological mechanisms that surround stroke is important for nurses to monitor and treat such patients. Kelly et al (2004) in their study of dehydration and venous thromboembolism (VTE) after acute stroke believed dehydration after acute ischaemic stroke (AIS) is strongly independently associated with VTE, reinforcing the importance of maintaining adequate hydration in these patients. Their study of hydration over a 9-day period showed indication that dehydration was largely hospital acquired and that the association was causal. Although the possibility that VTE was already present at entry to hospital cannot be discounted, tests have shown that VTE is rarely present before the second day post stroke, and then it becomes increasingly prevalent over the next few days. This could be for one of many reasons including poor communication between patient and hospital staff, change of environment for the patient and the physiological impacts of stroke Hydration balance and nutritional/electrolyte balance The differences in how hydration is assessed in different hospitals have been subject of study for some time. The significance of fluid electrolyte homeostasis becomes very relevant in trauma and shock situations such as subarachnoid haemorrhage where an inflammatory response is triggered which causes a significant change in capillary membrane permeability in a short period of time. In such situations, water, electrolytes and albumin move into the interstitial space to permit the site of injury to receive the required factors (third space shift) (Edwards, 2001). A number of physiological mechanisms are required to maintain homeostasis of hydration status, all of which inform proactive nursing assessment, intervention and evaluation. Those with trauma to the nervous system are vulnerable to disruption to the homeostasis of fluid and electrolyte balance (Cook 2005). Older adults may have a poorer capacity to adapt to shifts in acute fluid balance, leading to the possibility of cardiac and renal functions being impaired and, as a result, a lower glomerular filtration rate (Sheppard, 2001). Managing the fluid balance of the stroke patient by intake and output measures needs to be exercised cautiously because even though the patients fluid volume may not have changed, his/her circulatory volume may be significantly lower in instances of major trauma (Edwards, 2001) Good hydration has been shown to reduce the risk of urolithiasis (category Ib evidence) (see Appendix 2), constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence), and is associated with a reduction in urinary tract infections (UTIs), hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct Complications of measurement/control Naso-gastric v PEG, enteral v parentera Patient history taking on presenting in the hospital differs from hospital to hospital. History taking should include assessment of fluid intake and loss, baseline hydrational status, skin turgor, heart rate, blood pressure and urinary output. Normal fluid intake for the average adult is approximately 2-2.5 litres, obtained from food, fluids or metabolic by-products (Edwards, 2001). Methods of measurement are not standardised across hospital settings with Wise et al (2000) showing that faecal fluid losses are often neglected in daily fluid balance charts with the possibility of inaccurate hydration assessment. Fluid assessment must include estimating, as accurately as possible, the quantity of fluid taken in. It must take into consideration the entire processes by which water, potassium and sodium are obtained. Measurements are often mainly focused on the extremes of hydration (optimal hydration and extreme dehydration) and this should not be the case. Assessment of hydrational statu s and need is continuous and begins somewhere along a continuum of severe hypovolaemia/ dehydration to severe hypervolaemia/ overhydration. In looking at dehydration, not only extreme dehydration should be noted. Manz and Wentz (2005) highlight that there is increasing evidence mild dehydration may also account for many morbidities and play a role in various other morbidities. The way in which stroke is managed acutely, such as measures maintaining physiological homeostasis may also vary between different populations (Bhalla et al 2003). The physiological indicators of acute deficits in fluid balance may be masked in individuals where compensatory mechanisms are intact. A history of acute events, mainly from baseline documentation and history taking, may enable better identification of such imbalances (Sheppard, 2001). Fluid and electrolyte homeostasis is brought about by the interaction between the renal, pulmonary, neuroendocrine, integumentary and gastrointestinal systems (Edward s, 2001). According to (Cook 2005), fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Artificial feeding and fluids are the options for a patient who has an advanced, life-threatening illness and is dying. The patient, family members and doctor can talk about these options and the benefits and risks (Ackermann 2000). Hydration and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. Edwards (1998, 2001) highlighted that homeostasis is maintained by a constant movement of water, sodium and potassium between intra- and extracellular compartments. While the movement of water and electrolytes between the cellular compartments is highly significant, it is important to recognize that in acute and chronic illness intracellular fluid (ICF) is reduced and extracellular fluid (ECF) increased almost to the extreme (Edwards, 2001). This is highly relevant for cerebral metabolism, because transport of oxyge n, glucose, proteins and other products for cellular metabolism—and their by-products—may be severely impaired. Stroke may affect ones level of alertness, perception of thirst, ability to access liquids, and ability to swallow them when offered. Stroke victims with such impairments may be at increased risk for diuretic-induced dehydration (Churchill et al 2004). Managing hydration balance is of crucial importance and the mechanisms for the adequate monitoring and controls need to be in place. Nursing management questions in the assessment of hydration in acute stroke patients should include whether use of intravenous fluids during the first week of stroke was recorded. Questions should also include whether the patient was fed orally, by nasogastric tube, through percutaneous gastrostomy tube, by intravenous methods or not at all? The fact that these questions can be raised enforces the need for adequate documentation and recording of acute stroke patient records. Bhall a et al (2002) says that the use of artificial ventilatory support with intubation or nasal intermittent positive pressure ventilation should be documented as well as the use of supplemental oxygen given through nasal catheters or masks. Enteral tube feeding is a vital means of feeding and balancing hydration levels in patients with stroke. There are no set standards for hospitals in the UK and hospitals have recorded much variation between them in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used (Ebrahim and Redfern 1999). Some clinicians delay tube feeding for 2 weeks or more, and although early nutrition is unlikely to be harmful, whether any nutritional benefits offset the difficulties and complications of initiating and maintaining early enteral tube feeding is unclear. If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers o f patients are being denied best treatment. Whether enteral tube feeding via PEG rather than nastrogastric tube or early initiation of enteral tube feeding improve outcomes was tested in the FOOD trials and no evidence of significant benefit from PEG rather than nasogastric tube feeding was found. Neither was any hazard from early tube feeding found (The FOOD collaboration 2003). The explanation for any difference between PEG and nasogastric groups is not clear, but one factor might be the effect of a long-term PEG tube on dependency since more patients in the PEG group were still receiving such tube feeding than in the nasogastric group at follow-up (The FOOD collaboration 2003). The survivors in the PEG group were also more likely to be living in institutions and had lower quality of life. Another intriguing finding was the excess of pressure sores in the PEG group, raising the possibility that those with such tubes might move less or be nursed differently. Weaknesses in this test results include insufficient statistical power to exclude more modest differences between groups; no information about the proportion of eligible patients enrolled in each centre; our use of an informal (although reliable and highly predictive) assessment of nutritional status; absence of precise monitoring of patients daily intake of nutrients (rather than fluids); absence of on-site source data verification or collection of information on changing nutritional status (e.g. in-hospital weights); possible bias due to masking of secondary outcome measures. Although compliance was not 100%, this fact results from the inevitable difficulties of adhering to rigid schedules when patients conditions change. Difficulties with nasogastric feeding in stroke patients (who are often confused and uncooperative) have led to increasing use of PEG tubes at an early stage. Enthusiasm for this method has been encouraged by the results of a trial that reported much lower case fatality rates in patien ts fed via PEG (13%) rather than nasogastric tube (57%) (The FOOD trial collaboration 2003). Due to significant alterations in fluid balance after enteral tube-feeding in patients, close attention to the recording of fluid balance such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage (Oh and Seo 2007). One explanation for the varying and inconsistent readings in fluid hydration between enteral and PEG might b Stroke patients and the impacts of stroke on life Difficulty with swallowing is a common problem in acute stroke patients, and can lead to aspiration pneumonia, dehydration, and exacerbation of any existing malnutrition (Finestone and Greene-Finestone 2003). In Oh and Seo (2007) the authors set out to examine the fluid and electrolyte complications after enteral tube feeding in acute brain infarction patients. The background is that inconsistencies in the results of the water and electrolyte complications associated with enteral tube feeding are partly because of uncontrolled disease-related variables. The implication is that these variables were not adequately managed. Stroke patients very often present with dysphagia and this is very commonly dehydration associated with undernutrition (The Food Trial 2005). Up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods (Mann et al 1999). Although a 50% prevalence can be considered to be high, th e nutritional/fluid status of a stroke patient can rapidly deteriorate in hospital. The difficulty in feeding stroke patients with dysphagia coupled with the discomfort associated with stroke can exacerbate undernutrition and/or dehydration. Studies show that undernutrition shortly after admission is independently associated with increased case fatality and poor functional status at 6 months (The FOOD trial collaboration 2003). The current financial burden of efficiency savings and reduced budgets in the NHS hospitals results in reduced staff numbers so that patients can not be attended to on a one-on-one basis so that ensuring appropriate hydration levels is done by periodic but regular monitoring of charts. An option for the future in this area may be to involve the patients family members in hydration monitoring and provide them with appropriate training if evidence can show that being around loved ones improves outcomes and early warnings. In acute stroke, artificial nutrition t hrough an enteral route is needed because of dysphagia and since oral feeding is unsafe in some dysphagic patients, enteral nutrition is often administered as nasogastric or percutaneous endoscopic gastrostomy (PEG) tube feeding (Finestone and Greene-Finestone 2003). Naso-gastric tube feeding (a prevalent enteral method) has been reported to improve clinical outcomes more than the parenteral route in brain-injured patients (Rhoney et al 2002). Oh and Seo (2007) in their study used 85 subjects, but their work was limited by the fact that it was performed retrospectively and some of the subjects records were incomplete. Also, because the patients in the study were from one hospital it is not conclusively known whether the results can be generalised to the whole population./p> Legal and other aspects Japanese physicians attitudes towards artificial nutrition and hydration (ANH) as a life-sustaining treatment (LST) were examined to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. The study findings show that the informants held different views towards LST because most doctors considered ANH to be indispensable and ANH is automatically provided to patients (Aita and Kai 2006). With the advancement of medical technology, decisions to withhold or withdraw LST are among the most difficult to make for health professionals (British Medical Association 2001). Physicians caring for stroke patients often encounter comatose or semi-comatose patients with severe stroke for whom it is difficult to determine whether or not to continue care (Asplund and Britton, 1989). By administering LST, some patients in this patients group, whose bodily functions other than brain function could remain stable, could pot entially survive for months or years without achieving awareness or being able to interact with others (Aita et al 2008). Certain Japanese physicians have criticized the current efforts regarding life prolonging as Aita et al (2008) states: Prolonging the process of dying like this constitutes the violation of dignity and human rights. The life-prolongation only serves hospital operators who want to make profits by keeping hospital beds occupied. They also said this practice impacted the carers and that some nurses also feel emptiness toward the manipulative life-prolongation when taking care of these elderly patients. In the West, some countries have worked out nation-wide guidelines related to withholding or withdrawing LST that say stroke-caused profound impairment with no hope for recovery is a potential reason to withhold or withdraw LST (British Medical Association, 2001). Ackermann (2000) believes withholding and withdrawing therapy challenge family physicians to be excellent communicators with patients and families and recommends that family physicians should continue to be strong advocates for dying patients. Sprung et al (2003) highlighted differences between withholding and withdrawing therapy showing that withdrawal of therapy is followed by a nearer and more rapid death than withholding therapy, and that physicians and nurses were more inclined towards withholding rather than withdrawing therapy. Food and water are considered symbols of caring (Ackermann, 2000), therefore, it may be natural for physicians to give a special status to ANH as food and water. Whether to withdraw ANH from a patient in persistent vegetative state has also drawn substantial media attention in the U.S. (Casarett et al., 2005; Ganzini, 2006). The findings of the study also suggest that the physicians double standard is partly based on their subjective judgment whether the treatment is ordinary or extraordinary. However, the standard of ordinary/extraordinary care has long been criticized as too vague to guide decision-makers in the U.S. (Beauchamp and Childress, 2001). It is believed the current legal framework has also inappropriately led some physicians to simply continue care regardless of the patients conditions, thus resulting in putting an unnecessary burden on patients. The physicians subjective interpretation of the current legal framework may lead to decisions not to initiate mechanical ventilation in some older adults for fear of facing a situation in which physicians cannot withdraw it at a later stage Conclusion Hypovolemia and hypervolemia occurred frequently after acute stroke but were often not recognized as such by nurses. The nurses predictions of current volume status do not seem sufficiently reliable to serve as a basis for therapeutic decisions. More advanced techniques for bedside assessment of volume status may be indicated for optimizing volume status in patients with acute stroke (Hoff et al 2004). Whereas studies have looked at the optimal method of improving hydration, whether correcting dehydration in stroke improves outcome is not very clear. Given the complexity of the cell death cascade following brain ischemia, novel approaches and combination therapy are inevitable for victims of stroke (Fisher and Brott 2003). The review indicates that standards vary from country to country in the legal framework for withdrawing and withholding hydration and nutrition during end stage care.

Binswangers Disease :: Biology Essays Research Papers

Binswanger's Disease Even though I knew my grandmother for 17 years before she died my mother told me that I had never met her. According to her my grandmother had not been "herself" for years because the affects of her advanced age had basically destroyed the person she once was and turner her into a living zombie. Although humans live an average of 85 years, things such as memory loss and lack of motor control can completely change a person and in a way kill her years before she dies. Vascular Dementia has the same general symptoms as "old age" only it typically occurs in younger people. Binswanger's Disease is a specific type of vascular dementia, probably the most common form, which affects people at approximately age 60. Most people diagnosed with this disease do not live past five years of its onset(1). Currently, not much is known about Binswanger's Disease; in many ways it resembles various other neurological disorders making it difficult to diagnose. The trademark of this disease is damage to th e blood vessels in the deep white matter of the brain(1),(4),(5). The pons, basal ganglia, and thalamus are typical sites for these lesions(5),(7). A Magnetic Resonance Imaging scan is one of the most reliable ways to see this damage(5),(6). However, with outward symptoms such as depression, strokes, and disease of heart valves(1),(2),(3),(5) an MRI is not typically one of the first diagnostic tool used and the disease proceeds unchecked. My original thought surrounding Binswanger's Disease related to my mother's opinion of my grandmother; the people with the disease became different people due to the changes in their brains. In other words, one of the physical changes that takes place in the brain must somehow affect the victim's I-function effectually transforming him or her into a different individual. From the point of view that brain equals behavior and there is nothing else this analysis made logical sense. However, it seemed like a very simplistic summary of the disease's effects, and after deeper investigation into the course of the disease I realized that the answer would not be so easy. One of the facts I uncovered is that occasionally victims will partially recover and stabilize for a period of time, thus reverting to their pre-Binswanger's Disease selves(1),(5). So the I-function cannot, most probably, be destroyed in these instances since the victims return to their original behavior, even though their br ains have undergone alterations. Binswanger's Disease :: Biology Essays Research Papers Binswanger's Disease Even though I knew my grandmother for 17 years before she died my mother told me that I had never met her. According to her my grandmother had not been "herself" for years because the affects of her advanced age had basically destroyed the person she once was and turner her into a living zombie. Although humans live an average of 85 years, things such as memory loss and lack of motor control can completely change a person and in a way kill her years before she dies. Vascular Dementia has the same general symptoms as "old age" only it typically occurs in younger people. Binswanger's Disease is a specific type of vascular dementia, probably the most common form, which affects people at approximately age 60. Most people diagnosed with this disease do not live past five years of its onset(1). Currently, not much is known about Binswanger's Disease; in many ways it resembles various other neurological disorders making it difficult to diagnose. The trademark of this disease is damage to th e blood vessels in the deep white matter of the brain(1),(4),(5). The pons, basal ganglia, and thalamus are typical sites for these lesions(5),(7). A Magnetic Resonance Imaging scan is one of the most reliable ways to see this damage(5),(6). However, with outward symptoms such as depression, strokes, and disease of heart valves(1),(2),(3),(5) an MRI is not typically one of the first diagnostic tool used and the disease proceeds unchecked. My original thought surrounding Binswanger's Disease related to my mother's opinion of my grandmother; the people with the disease became different people due to the changes in their brains. In other words, one of the physical changes that takes place in the brain must somehow affect the victim's I-function effectually transforming him or her into a different individual. From the point of view that brain equals behavior and there is nothing else this analysis made logical sense. However, it seemed like a very simplistic summary of the disease's effects, and after deeper investigation into the course of the disease I realized that the answer would not be so easy. One of the facts I uncovered is that occasionally victims will partially recover and stabilize for a period of time, thus reverting to their pre-Binswanger's Disease selves(1),(5). So the I-function cannot, most probably, be destroyed in these instances since the victims return to their original behavior, even though their br ains have undergone alterations.

The High School Gymnasium :: Observation Essays, Descriptive Essays

My alarm clock blares into my silent room. It’s time to spend the early hours of my Saturday morning at the same place I spent the late hours of my Friday night. Groggily I get dressed and leave without breakfast. When I arrive, it is dark, empty and cold. The lonely feeling replaces what was bright, full and warm just hours ago. This place is the gymnasium at my high school. For four years, I have exerted sweat, tears, and even blood in this place. On this stage, four years of my growing up and maturing were played out for anyone willing to pay two dollars. I have been everywhere in this gym, from standing high on the bleachers with a bird’s eye view, to lying on the ground debating whether to rise only to get knocked down again. Those who have left a part of themselves in this place can breathe deeply and inhale experiences. Experiences of glorious victories and experiences of embarrassing defeats; both experiences I have left in that gym. Friendships were made and lost on that court, and other ones strengthened when my friends from outside came with their support and encouragement. It is here I learned perseverance, hard work, determination and loyalty. It is not here that I found who I was, but more who I was not. It is here I had to not settle for mediocrity, but strive for excellence. When I think back to the long hours I spent in this gymnasium, the most prominent memory will be my final game there. It was a night of emotions. I was surrounded by encouraging teammates, supportive family and friends, and finally I received my reward for the energy I had spent there for four years: I made the game winning shot. While my name will soon be taken down from the wall, and another person will wear number thirty-three in that gym, I have left a piece of me there, which is the beauty of the place.

Attraction, Gender Roles, and Homosexuality: an Analysis of Brokeback Mountain

In this paper, I will identify examples from the film Brokeback Mountain that exemplify concepts of human sexuality – specifically, attraction; gender roles and socialization; and sexual orientation – in attempts to discuss the accurate portrayal of the concept within the scene, in concordance with known research findings regarding the aforementioned topics. In Brokeback Mountain, Ennis Del Mar and Jack Twist are two young men living a pastoral life as cowboys/ranch hands; they meet each other for the first time in 1963 in Wyoming, to undertake a sheep herding job for the summer. Their employer’s one rule for them while up on Brokeback Mountain is that one of them has to stay with the sheep out in the fields overnight, and the other can stay at camp. After spending several weeks together enduring the job’s hardships, and with only each other for company, they slowly begin to build a relationship. While at first their relationship is platonic, it eventually evolves into a romantic one; Brokeback Mountain depicts in depth the struggles and complications – both internal and external – Jack and Ennis must deal with throughout the entirety of their relationship. Attraction Because Ennis lives the stereotypical cowboy lifestyle, he frequently tends to keep to himself; he has experienced many hardships throughout his lifetime, and is not prone to be particularly conversational. Jack, on the other hand, is easy-going and carefree; his ambitions in life to become a rodeo cowboy have helped him to develop into a loquacious individual – these personality characteristics are illustrated through Jack and Ennis’s first interactions with each other while up on Brokeback Mountain. While at first Jack and Ennis seem like polar opposites, by spending so much time together while herding sheep, it allows them to open up to and identify with each other, and to see that they both feel isolated from society – just to ifferent extents. According to the mere-exposure effect (Saegert et al. , 1973; cited in Hyde & Delamater, 2008), Jack and Ennis’s repeated exposure to one another â€Å"[lead] to greater liking for [each other]† (Bornstein, 1989; cited in Hyde & Delamater, 2008, p. 283). This consistently repeated exposure led to Jack and Ennis being able to build rapport amongst themselves, and help them realize that they are alike in many respects. Homophily, the inclination to be surrounded by and to have contact with people who are similar to ourselves in social status (Hyde & Delamater, 2008), also lends itself well to Jack and Ennis’s relationship, in that, we tend to like people who are similar to ourselves, because they help to positively reaffirm our self-image (Hudson and Levinger, 1978; cited in Hyde & Delamater, 2008). Although Jack and Ennis would consistently butt heads about how to do things, they eventually grew to like each other – albeit, platonically at first – because they felt as if they grew to know and understand one another. Gender Roles and Socialization Socialization, a method in which a society expresses accepted norms and expectations of an individual (Hyde & Delamater, 2008), is very important in that, it provides an avenue for individuals come to know about gender roles and stereotypes. Via socialization, both Jack and Ennis learned of their expected gender roles, or â€Å"a set of†¦ culturally defined expectations, that define how people of one gender ought to behave† (Hyde & Delamater, 2008, pg. 314). For example, Ennis has been socialized to believe that men are supposed to be masculine, stoic, and composed; however, developing homoerotic feelings for, and engaging in homosexual relations with Jack, are contrary to Ennis’s culturally-defined gender role of a man. After their sheep-herding job is done, and the protagonists part ways, Ennis, unable to adequately comprehend and deal with everything that has happened to him while up on Brokeback Mountain, breaks down in self-disgust, because these events have caused him to question his masculinity, a key part of his identity. Ennis, attempting to reassert his masculinity, tries to preserve it by waiting until he has privacy (running into a deserted alley way) to act out – because socialization has taught him that men do not act on or display their emotions; upon discovering that he is being observed by another, he defensively (and instinctually) lashes out in rage, like any heterosexual man would be expected to do. Sexual Orientation Throughout the film, various situations arise in which both Jack and Ennis attempt to define their sexual orientation. Initially, we are lead to assume that both Jack and Ennis identify as heterosexual – Ennis is engaged and is due to be married once he finishes the herding job on Brokeback Mountain, and we also assume that Jack is heterosexual, the reason for this being that straight is the sexuality that is most commonly associated with his chosen profession (although there are some moments in which we may question this assumption about Jack; for example, when he and Ennis first meet, Jack continuously checks Ennis out, attempting to do so discreetly while shaving). While up on Brokeback Mountain, however, we get more in-depth insight about both Jack and Ennis’s sexuality. After becoming extremely intoxicated one evening, Ennis decides to sleep at camp (instead of with the sheep); Jack convinces Ennis to sleep in the tent with him to avoid the cold, and Jack reaches over and uses Ennis’s hand to stimulate himself. Ennis, still intoxicated and sleep-drunk, is confused about what is happening – once Jack clearly asserts what he’s trying to do, Ennis initially resists him, but eventually succumbs, and Ennis engages in his first homosexual experience. Ennis realizes something about his relations with Jack are â€Å"right†, and continue – although hesitantly at first – to engage in them. Jack, who initiated the homosexual relations, could be placed in one of two categories regarding his sexuality: as bisexual, in that his gender orientation is geared towards both genders, or conversely as a situational homosexual. Situational homosexuality also helps to explain the late-immergence and occurrence of homosexuality in Ennis; in situational homosexuality – or deprivation homosexuality – a person who identifies as heterosexual may engage in homosexuality activity, due to fact that they are in situations in which they are deprived of their regular heterosexual activity (Hyde & Delamater, 2008, p. 361) [1]; while being away from other individuals for months at a time while on herding jobs, Jack may have turned to heterosexual activity, in order to satiate his need for sexual activity. Conclusion Throughout this paper, I have provided examples in which three specific concepts of human sexuality – attraction, gender roles and socialization, and sexual orientation – are portrayed in the film Brokeback Mountain. Although media tends to dramatize individuals’ experiences regarding human sexuality, through this film, we get glimpses into the interpersonal journeys of Jack Twist and Ennis Del Mar, two men who struggle not only with coming to terms with their own sexual identity, but who also struggle with the development and maintenance of their relationship and love for one another, spanning throughout their adulthood years. Although Jack and Ennis’s relationship is not â€Å"stereotypical† (for both men and women, heterosexual and homosexual alike), from it, we can take away from their relationship that, regardless of one’s sexual orientation and/or preference, we all experience the same struggles regarding human sexuality, to some degree or aspect. [1] It is later revealed throughout the film, that Jack is, indeed, most likely bisexual. For example, some time after Jack and Ennis have parted ways after the herding job on Brokeback Mountain, he meets Lureen Newsome. Both highly attracted to each other, they engage in sexual intercourse, which consequently results in Lureen’s pregnancy, and Lureen and Jack’s marriage. However, throughout the year, Jack still maintains his relationship with Ennis, and admits that he has been to Mexico, to engage in homosexual relations.