Beggar Mafia Research Paper Example | Topics and Well Written Essays - 1500 words

Beggar Mafia - Research Paper Example However, their has developed a business of begging that has spawned a series of crimes that defy the belief of the Western world. Children are being mutilated and maimed in order to be used by gang leaders for proceeds from begging through a form of organized crime referred to as a beggar mafia. In this research project I plan to show how there is a lack of awareness from which global social pressure could evolve in order to force countries in which there exists these organizations so that strict law enforcement actions can be put into place to stop the beggar mafias from operating. One of the horrors of life that face many parents in third world countries is the abduction of their children in order to force them into a profession of begging, centralized by leaders who expect them to bring home a certain amount of money per day. In India, one of the countries where this practice is predominant, there are more than 44,000 children who disappear each year, most of which are trafficked into illegal professions such as prostitution. A good portion of them are used within syndicated systems of beggars, maimed and mutilated to make them seem more sympathetic, and then their earnings taken from them in order to support the leaders of this heinous activity. The beggar mafia can exist because local law enforcement and politicians are benefiting from payoffs from the leaders of the gangs. Because of the different cultural concepts of individual value and law, third world countries are often susceptible to the existence of such organized crime within their cities. The prime targets of such trafficking and abuse are the poor as their poverty is easily manipulated through a lack of resources with which to combat the assault of circumstances that can be a part of the taking of their children, the use of their need, and the neglect of their overall well-being. In addition, there is the horror of doctors who are

Abundant Living Essay Example for Free

Abundant Living Essay Abundant Living is an Adult Family Home located in Stanwood Washington. It â€Å"offers assisted living services for seniors who need help with daily living activities such as bathing, dressing, mobility, and medication assistance. † Their staff are â€Å" specially trained to care for residents with Alzheimers and other forms of dementia† (Abundant Living Adult Family Home Care Corporation, 2013). It currently has only one house supporting six full time residents and has a meager online presence consisting of only a website. The owners have recently bought another house with the goal of creating an additional adult family home and will soon be in need of six residents and at least four employees. Their current marketing strategies consist mainly of word of mouth and printed ads in local newspapers. This business could greatly bene? t from growing its online presence especially during this vulnerable time of expansion. There are currently over 73,000 residents in Snohomish County over the age of 65 (United States Census Bureau, 2013). Online marketing would make it much easier and more economical to reach a growing customer base whose online focus and technological prowess continues to increase. The real customer is not the elderly person themselves. It is usually their children, often in their ? fties and sixties, who are in need of a safe environment for their parents or loved ones to live where they can be assured that a high level of personal care and medical attention will be available. The idea of expanding online would be to market the business to a larger number of target customers than current marketing techniques are able to. An expanding customer base would allow the business to choose it’s residents based on level of care needed, matching personality characteristics with current residents, and those who can afford private pay instead of State pay. State pay residents often pay thousands of dollars less a month than those who can afford private pay; $4000-$1900 (M. Raymond, 2013). This combination of factors is important in choosing a resident as it maximizes the income that can be generated from the twelve rooms that are available to residents. The pgraded website would allow potential customers to see where they or their parents would be living, who they would be living with, and who would be taking care of them. It would increase awareness of the business’s new house and reach a much larger target audience. The website would be an online welcome mat for customers and advertise the business strengths such as a higher level of personal care, lower employee to resident ratios, increased ind ependence, and a more stable atmosphere for residents with Alzheimer’s or dementia. Also, a tab could be created on the website that would be a place for prospective employees to look for openings and determine if they would be a good ? t. Additionally, linking such social media sites as Facebook, Instagram, Google Plus, and Twitter it would better allow residents and their children or friends to keep in touch through photos and descriptions of recent resident special activities, events, business news, and daily occurrences. By creating social media pro? les for the business and linking it to the business website it would also greatly increase word of mouth advertising potential. Customers would be encouraged to like or follow the business on a variety of social media outlets allowing their friends to be exposed to the business and create free online word of mouth marketing. Increasing the online presence of the business would also has the possibility to increase the number of applicants for new employee positions. Abundant living’s direct competitors include Josephine Sunset Home in Stanwood and A Holistic Adult Family Home, LLC in Marysville. Josephine is a combination Nursing Home facility and Assisted Living. It is a much larger facility with a larger staff and a greater number of residents. Its major advantage is its availability to customers. With a larger facility and attainment by the state of Washington of a Skilled Nursing License Josephine is able to accept and care for a larger number of residents who also might require more intensive medical care. Its website is much more comprehensive, easier to use, and is more informative than Abundant Living’s. It also has a tab for employees. Josephine does have some key weaknesses though. The Skilled Nursing area is quite a bit more expensive than both Abundant Living and A Holistic Adult Family Home. Their rates vary from $237 a day to $263 a day. (J. Aungst, 2013). These rates are nearly double that of Abundant living. Also the level of care residents experience is not of the same quality of an Adult Family Home. Employees of Josephine have many more residents to care for than employees of Adult Family Homes that are limited to only six per house. In fact, at times Josephine employees may be responsible for as many as 20 residents. (W. Flaherty, 2013). This larger ratio of residents to employees leads to a less personal interaction with residents and a lower overall quality of life. A Holistic Adult Family Home is more similar in comparison to Abundant Living in that it is an Adult Family home with a Custodial Care license that is legally limited to six residents per house. Rates are similar to Abundant Living but still higher; $5100 a month versus $4000 a month. (E. Moody, 2013). Holistic already has two houses up and running doubling the capacity of Abundant Living. With all of these things in mind the marketing strategies that Abundant living should use are people, price, and product. Abundant Living’s ? e employees are one of its most valuable resources and can be extremely helpful in the marketing effort. They should be encouraged to spread awareness about the new house that will be opening soon and that every interaction should be treated as an interaction with a potential customer. Employees should be encouraged to embrace the business’s brand values of compassion, empathy, and professionalism. These employees could also be potential custome rs as they have parents of their own who are only getting older. Steps should be taken to increase employee morale as having happy and satis? ed employees increases the likelihood of having happy and satis? ed customers. Abundant Living’s main advantage over the competition is that they offer a level of care for their residents that is equal to or better than the competition for substantially less cost. With a waiting list of 25 customers in line for an availability the business should employ the market skimming strategy. The business should charge slightly higher price than they are now, around $4500 a month, for the ? rst residents to ? l the new house to recoup the costs of expansion and then reassess once those costs have been recouped. This will increase the return on investment while still maintaining competitive rates. The ? nal marketing strategy that could be used focuses on the actual product. Online marketing should concentrate on Abundant Living’s high level of care, low employee to resident ratio, and their success at the current house. Marketing efforts should focus on the augmented product of increased independence, a proven track record, and the creation of a stable environment for those with Alzheimer’s and ementia, helping to set the business apart from the competition This marketing can be accomplished by posting positive consumer reviews on the business website as well as comparing the business’s strengths to the competition’s weaknesses. By expanding online marketing techniques, focusing on the business’s product, price, and people, and setting itself apart from the competition Abundant Living will be poised to experience a very successful expansion and increase in market share.

Psychological Impact of Newly Diagnosed Lung Cancer

Psychological Impact of Newly Diagnosed Lung Cancer CHAPTER ONE Introduction The concern addressed in this dissertation is to explore the psychological impact on a newly diagnosed lung cancer patient. Patients with lung cancer normally experience variety of distress symptoms, many of which begin prior to diagnosis and continue throughout the course of the disease and the treatment, which adversely affects the functional status and quality of life (Julkunen et al, 2009). The experience of lung cancer is not limited to only the victims but may equally have wide-range impact on families physical and emotional well-being. Therefore it is essential to critically assess the extent of this psychological impact of lung cancer on the patient. This topic is properly examined in context of a critical literature review approach. The approach has adopted the traditional method which is considered appropriate for the purpose of this piece of work. This method involves a critique, summary and synthesis of a body of literature after which a conclusions is drawn, (Coughlan,et al. 2008). According to Crombie (1996), the purpose of writing a literature review is to convey to readers the knowledge and ideas which have been established on the chosen topic, and explore the strength and weaknesses. This helps to identify gaps and inconsistencies in the literature. Gomm et al, (2000) stated that the purpose of a review is to analyse critically a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles. A further consideration for the literature review will not merely be a descriptive list of materials obtained, or a summary of relevant resource s, but rather to provide the framework of the research investigation and summarise the literature studied in order to develop the research study (Brink and Wood, 2001). A brief description of the anatomy and physiology of the lungs will be discussed to enhance proper understanding of the topic. Pathophysiology, aetiology and epidemiology of lung cancer will be outlined. The methodology will be described including a brief description of the models and strategies adopted in conducting the review. The review of 10 peer review papers are presented in chapters using critical appraisal tools to evaluate the strengths and limitations of the research papers. Both qualitative and quantitative primary research papers will also be used. Limitations of the literature and the process of the review will be identified. The dissertation will be structure in the following way: Chapter 2 will explore the background information about lung cancer by examining the pathophysiology, aetiology, and epidemiology, pathogenesis, treatment and evaluation of the disease. It also considers the rationale behind the chosen topic. Chapter 3, Research Methodology, outlining the various strategies employed to gather and analyse the sources of data. Chapter 4, Psychological distress: anxiety, depression, desire for hastened death, feeling of guilt and hopelessness. Chapter 5, Discusses the impact psychological distress has on quality of life of newly diagnosed lung cancer patients. Chapter 6, Summary of findings of the literature reviewed. Chapter 7, Limitations of the literature reviewed. Chapter 8, Limitations of the whole literature reviewing process. Chapter 9, Conclusion and Recommendations, distils the key points and relates them to proper management of lung cancer. It also proposes a number of recommendations to tackle the problems identified above. CHPTER 2 Lung cancer 2.1 Introduction The study is to identify the psychological impact of newly diagnosed lung cancer on the patient. Lung Cancer is a disease that begins in the tissue of the lungs. To better understand lung cancer, it is vital to understand the anatomy and physiology of the lungs. 2.2 Anatomy and physiology of the lungs The lungs are two cone-shaped structures positioned on either side of the heart. In the mediastinum. They are sponge-like organs that are part of the respiratory system. During breathing, air enters the mouth or nasal cavity and travels down the trachea. The trachea, divides into two smaller tubes: the right bronchus and the left bronchus. The right bronchus enters the right lung and the left bronchus enters the left lung. The right and left bronchus branch into bronchioles. These bronchioles end in tiny balloon-like air sacs called alveoli. The alveoli are where oxygen, carbon dioxide, and other substances are exchanged between the lungs and the blood stream. (Gould, 2006). Pathophysiology, aetiology and epidemiology of lung cancer Lung cancer is a term, which covers a collection of several different forms of malignant tumour arising in the lungs and in the major airways (The Royal College of Physicians, 2005). There are two major types of lung cancer, non-small cell and small cell. Non-small cell lung cancer (NSCLC) arises from epithelial cells which is the most common type of lung cancer. Small cell lung cancer begins in the nerve cells or hormone-producing cells of the lung. The term small cell refers to the size and shape of the cancer cells when seen under a microscope. According to (McCance and Heuther 2005) the non-small cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. There are different types of NSCLC, these are: Squamous cell carcinoma (also called epidermoid carcinoma). This is the most common type of NSCLC. It forms in the lining of the bronchial tubes and is the most common type of lung cancer in men. Adenocarcinoma. This is found in the glands of the lungs that produce mucus. This is the most common type of lung cancer in women and also among people who have not smoked. Bronchioalveolar carcinoma. This is a rare subset of adenocarcinoma. It forms near the lungs air sacs. Recent clinical research by Scullion and Henry (1998) has shown that this type of cancer responds more effectively to the newer targeted therapies Large-cell undifferentiated carcinoma. This cancer forms near the surface, or outer edges, of the lungs. It can grow rapidly. The small cell lung cancer (SCLC) as (MacCance and Huether, 2005) puts it, accounts for about 20% of all lung cancers. Although the cells are small, they multiply quickly and form large tumors that can spread throughout the body. Smoking is almost always the cause of SCLC. Lung cancer begins when cells in the lungs grow out of control and form a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). A cancerous tumor is a collection of a large number of cancer cells that have the ability to spread to other parts of the body. A lung tumor can begin anywhere in the lungs (Muers et al, 2001). According to Hughes and Pride (1999), once a cancerous lung tumor begins to grow, it may or may not shed cancer cells. These cells can be carried away in blood or float away in the natural fluid called lymph, which surrounds lung tissue. Lymph flows through the lymphatic vessels that drain into lymph nodes. Cancer cells metastasise when it leaves its site of origin and moves into a lymph node or to a far away part of the body through the bloodstream. The location and size of the initial lung tumor, and whether it has spread to lymph nodes or more distant sites, determines the stage of lung cancer. The type of lung cancer and stage of the disease determine what type of treatment is needed. The staging system describes the extent of the disease at the time and therefore provides a basis for treatment and prognosis. The staging systems as described by McCances and Huether, (2006) are based on the following: The size of the primary tumour (T); The extent of regional lymph nodes (N); and The spread of the tumor (M). Lung cancer is the most common form of cancer in the UK, resulting in 36,000 deaths each year (DOH, 2007). Lung cancer is the leading cause of cancer motality in the UK: In every 15 minutes, a new diagnosis is made with approximately 40,000 fresh cases every year (NICE, 2009). It remains the most frequent of all malignant diseases and the one with the poorest prognosis. 80 percent of effected people die within a year (DOH, 2007). Lung cancer continues to rise and is now very high in women as well as men (Hamer et al, 2008). Many epidemiological studies have assessed the extent and nature of problem in the UK, (Blackler et al, 2007) report that lung cancer occurs in people who smoke. This is supported by further research from the United States of America, including other comprehensive study conducted by Scullion and Henry (1998) that the risk of lung cancer is higher in persons who begin smoking early, continue for many years, and are considered heavy smokers. However (Gould, 2006) posited that people who dont smoke can also develop lung cancer, although this is much rarer. This confirms (McCance and Huethers, 2005) statement that people who have been in prolonged or close contact with asbestos have a higher risk of lung cancer, especially if they smoke. Lung cancer is rarely diagnosed in people younger than 40 most cases occur in people over the age of 60. 2.3 Pathogenesis, Treatment and Evaluation The treatment of lung cancer is based on the size and location of the tumor, whether the cancer has spread, and also the persons overall health. There are four basic ways to treat lung cancer: surgery, radiation therapy, chemotherapy, and targeted therapy (NICE, 2005). Treatment options differ for each individual and may depend on other factors such as age, physical condition, and other medical problems. The goal of Surgery is to remove the part of the lung where the tumor is isolated. Chemotherapy is to kill rapidly dividing cells in the body, including cancer cells using drugs. It is the main treatment for people with small cell lung cancer. In many people, chemotherapy will enable them to live for longer, with better control of symptoms. (NICE 2009) Chemotherapy may be given on its own, or before radiotherapy. Sometimes chemotherapy and radiotherapy are given at the same time; this is known as chemoradiation. Targeted therapy is a treatments designed to target cancer cells in more specific ways, usually involving the mechanisms that cause cancer cells to grow or divide (DOH, 2007). The diagnosis of lung cancer becomes a crisis in victims life when experienced, confronting them with changes in identity, role, and social interactions and presenting them with an uncertain future (Waller and caroline, 1996). Kemp (1999) posited, the psychosocial distress can interfere with the patients healthcare and diminish his or her health and functioning. Many patients who face cancer diagnosis that require physical effects of treatment appear to experience emotional difficulties, including anxiety and depression. Equally, patients with untreated depression or anxiety may be less likely to take their cancer medication and maintain their health. Moreover they may withdraw from family or other social support services which may affect the treatment outcome. 2.4 Rationale The rationale for the choice of topic was based on a desire to understand the psychological impact of lung cancer on the patient. Often the physical effects of the cancer disease and treatment are focused more on the curative effort. Therefore, it is important for the health-care team to address psychological effects, that cancer patients normally encounter that can greatly affect their sense of well-being. Nursing is expected to deliver high quality care that is effective in promoting health and well being (LoBiondo-Wood and Haber, 2006). Evidence-based practice is a key strategy in the development of modern health services and crucial to the development of nursing practice (Parahoo, 1997). Evidence-based care as Brink and Wood (2001) suggest and supported by (Carnwell 1997), is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. The successful completion of the review will investigate primary r esearch. In doing so this may act as an additional information source for healthcare professionals and as a basis for further enquiry. Chapter 3 METHODOLOGY 3.1 Aims and research questions Against the background of the foregoing explanation, it is desirable to identify the psychological distress associated with lung cancer and how it affects the patient. The questions the review seeks to address/answer are 1. What are the psychological reactions of newly diagnosed lung cancer patients? 2. How do these psychological reactions affect physical and psychological wellbeing of theses patients? 3. What interventions can be used to address these psychological reactions of newly diagnosed lung cancer and manage them effectively? 3.2 Parameters for the literature search The chosen method is a systematic literature review of both qualitative and quantitative research in the study area. A systematic literature review as defined by (Parahoo, 1997) is a summary of research that uses explicit approach to perform a thorough literature search and critical appraisal of existing body of published knowledge to identify the valid and applicable evidence. It is a means of managing very large volumes of information to identify evidence on which recommendations can be made (Holloway and Wheeler, 2002). Studies were used if they included adults (age 45 +) who have been newly diagnosed of lung cancer. 3.3 Inclusion Criteria This review included literature published from the year 1999 onwards All papers published in English Language only. Primary research directly related to the topic and Published research articles only. 3.4 Exclusion criteria Primary research not directly related to the topic Unpublished research articles Articles published before the year 1999 Other people were involved also, people from the specialist cancer services and the librarians whose help was invaluable in developing a search strategy and in sourcing and retrieving papers. 3.5 Literature searching strategies The search was completed using electronic databases. These were the Cochrane Library, CINAHL, British Nursing Index, Northampton Full Text [emailprotected], Proquest, Medline, and PsycInfo. The Cochrane Library was searched initially to see if a similar study had been done. The other data based were then searched from 1999-2009. Medline is a nursing and medical database. It is known to be incomplete (Markinson, 2002) however (Tagney and Haines, 2009) demonstrated that a search on MEDLINE is likely to produce most of the appropriate papers because it publishes articles from a worldwide source. The hospital library service was used to find studies which were not available in full text form on the internet or locally held journals. Not all could be located; however this potentially could be a source of bias. In discussing the problems and importance of incomplete retrieval of papers, (Chalmers and Altman, 1995) argue that trials that are difficult to locate tend to be smaller and lower methodological quality than trials that are easily accessible. The key words used to search the database were LUNG CANCER, DIAGNOSIS, DEPRESSION, CANCERS, PSYCHOLOGY, PSYCHOLOGICAL INTERVENTION, MEN, ANXIETY, ANGER, SADNESS, FEELING OF GUILT OR REGRET and PATIENTS FEELINGS. The nature of the study necessitated the use of very general terms such as lung cancer, and psychology. Sensitivity was chosen rather than specificity in the selection process and this meant that the search initially uncovered a large number of papers unrelated to the study. The result of the search was initially screened by reading the abstract online and retrieving the relevant ones using the inclusion and exclusion criteria. The studies which were retrieved were screened again to make sure they fulfil all the criteria required to be used for the review. To avoid bias, this study used methods outlined by Aveyard (2008). The methods were simplified for people who are new to or have little experience in doing a literature review. As suggested by (Cutcliffe and Ward, 2003) met hods used in systematic reviews reduce the potential bias of the review. 3.6 Method of Evaluation The literature is evaluated using Greenhalg T (1997) structure for evaluating qualitative research. (See appendix 2) This model was selected because most of the research was qualitative due to the nature of the selected topic. Anxiety and depression are difficult to measure because its an emotional response and therefore immeasurable. 3,7 Method of Analysis The research is analysed using a summing up approach as described by (Aveyard, 2008) which is adopted from the approaches given by Paterson et al (2001). This model was chosen because it facilitates the extraction of themes from research literature of a diverse nature. Again is suitable for people who are new to the literature review process. The themes generated are: Psychological distress: Anxiety, depression, feeling of hopelessness and the desire for hastened death. Effect of psychological distress on quality of life of people with newly diagnosed lung cancer. 3.8 Data handling method The data was stored and subsequently analysed using data storage system described by (Cormack, 2000) this system has two commonly methods of storing data: storage in original form, and storage using computer. The printed research papers were stored in a ring binder file and a memory stick was used to store computerised data. The purpose of data storage as LoBiondo-Wood and Haber (2006) puts it has three basic related purposes: to make sure that no data are lost; to ensure that information are obtained in a way which makes it reasonably accessible; and to ensure that the researcher is able to analyse the data. A separate note book was used to store references. 3.9 Resources required and sources identified Resources required are computers, various libraries, search engines, text books, stationary, supervisor, and librarian. Sources identified are internet and printed journals. CHAPTER FOUR THEME 1 Psychological distress: Anxiety, depression, desire for hastened death, feeling of guilt and hopelessness. Following exploration of the available and chosen research for this literature review, various themes have been identified. This chapter aims to discuss and explore the reviewed literature regarding the psychological distress of newly diagnosed lung cancer patients. It will discuss anxiety, depression, feeling of guilt and hopelessness which influence the disease-related factors on the desire for hastened death which have emerged from the data. Five studies (Akechi et al (2006), Turner et al, (2006), Wilson et al, (2007), (Rodin, et al 2009) and Mystakidou et al, (2008) will be examined using the methodology, discussions and analysis of the research to evaluate their findings. (See appendix 3 for research articles) In order for this to be achieved, the chapter has been divided into three sub-themes these are: Psychological distress. Anxiety and depression. Feeling of guilt/hopelessness and the desire for hastened death. There will be a small summary to conclude the chapter. 4.1 Psychological distress A cancer diagnosis can be viewed as a very stressful event for patients as they must adapt to the shock and uncertainty that such a diagnosis presents Fox et al (2006). As a result of life-threatening nature of cancer, psychological distress in cancer patients has been widely studied. Previous studies have indicated that 10-40% of cancer patients suffer from psychological distress (Skarstein, 1999). Vos et al, (2008) reported that 19% of lung cancer patients experienced depression between the time of diagnosis and initial treatment and 35% of them continued to experience the same disorder 6 months after. It is therefore vital to investigate the exact predictive factors of the psychological factors experienced by newly diagnosed lung cancer patients. The first research paper identified was conducted by Akechi et al (2006). The purpose of the study was to investigate longitudinal changes and predictive factors for psychological distress among newly diagnosed lung cancer patients. The study was conducted among 85 newly diagnosed advanced non-small cell lung cancer patients. Data were obtained in structured interview and validated self-report questionnaires. Psychological distress was evaluated using the Profile of Mood State (POMS) scale. This scale was developed by McNair et al., 1977. The POMS scale according to Akechi et al (2006) is a self-rating scale measuring six emotional sates (tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue, and confusion) and total mood disturbance. It was hypothesized that a lower fighting spirit and a higher helplessness/hopelessness were significant predictors of total mood disturbances. Therefore initial psychological response after lung cancer diagnosis was the most relevant p redictor of subsequent psychological distress. Their findings indicate that initial mood disturbance after the disclosure of a diagnosis of cancer (shock and uncertainty) is the most relevant predictor for subsequent psychological distress and that early intervention beginning immediately after a diagnosis is one way of preventing and/or reducing subsequent psychological distress in lung cancer patients. Initial psychological response after cancer diagnosis seems to continue the subsequent illness trajectory for at least several months, although several dimensions of psychological response, including anxiety and depression, may decrease. In their words, the overall psychological distress does not decrease naturally in the usual clinical care setting. Their study has several methodological advantages as compared with other studies because the method used for collection and analysis of the data were clearly described in the study which confirms that the qualitative method used was appropriate for the study (Greenhalg, 2001). However it has several limitations and cautions must be used when interpreting its findings. First, it was stated in the methodology that the researchers were not able to obtain longitudinal data on approximately 40% of the potentially eligible subject at the time of the investigation (Akechi et al, 2006). This introduces the possibility of a selection bias (Crombie 1996). The absence of this longitudinal data mentioned demonstrate that individual level change over time could not be studied on 40% of the sample therefore the researchers could not obtain the longitudinal course of psychological distress of those people(Akechi et al, 2006). This indicate that the findings may be distorted by the bias, even though it seems to be very common and one of the most difficult issues that cannot be completely overcome in the studies focusing on advanced cancer patients. Secondly, of all, this study included up to 6 months follow-up after cancer diagnosis, the longitudinal course of patients psychological status thereafter is unclear. Six months after diagnosis may not be enough long time to evaluate the longitudinal course of distress experienced by advanced lung cancer patients. For example, a recent study, examining the course of psychological distress in metastatic breast cancer patients demonstrated that distress remained constant or declined during the illness trajectory; however distress significantly increased proximal to death (Hill et al, 2002). Considering the prognosis of advanced non-small cell lung cancer patients, it seems plausible that many dimensions of psychological distress, including anxiety and depression, may increase as death approaches. The convenience sampling method used also poses threat to the generalisation of the findings, because the study subjects consisted entirely of newly diagnosed advanced non-small cell lung cancer (NSCL) patients who visited one Thoracic Oncology Division in Japan. Since patients with other lung cancer types at other sites were not examined in the study, it remains unclear whether the results can be extrapolated to patients with other lung cancer types at other sites. Lastly, psychological distress after cancer diagnosis was the only significant predictive factor of subsequent psychological distress after cancer diagnosis. To the best of our knowledge, very few studies have addressed the predictive factors for psychological distress in lung cancer patients while several studies have investigated predictors for subsequent psychological distress in other types of cancers (REF). Edward and Clarke (2004) demonstrated that family functioning and patients illness characteristics were associated with anxiety and depression in newly diagnosed lung cancer patients. Consequently, because the follow-up period in this study was short and the sampling method used caution must be taken when interpreting the findings. 4.2 Anxiety and Depression Depression refers to an emotional disturbance marked by the cardinal symptoms of persistent and pervasive low mood and the loss of interest or pleasure in normal activities (Skarstein et al, 2000). McPherson (2004) defined anxiety as a feeling of apprehension and fear characterized by physical symptoms such as palpitations sweating, and feelings of stress. Depression and anxiety disorders are thought to be common in palliative cancer care ( Strutkowski et al, 2008). The first study identified was conducted by Turner et al, (2006). It was a prospective observational cohort study of patients undergoing palliative radiotherapy for lung cancer. The aim was to measure psychological distress and concerns before and after treatment using the Hospital Anxiety and Depression (HADS) and a concern checklist. Participants were selected randomly from radiotherapy clinics in various hospitals. Data were obtained from a group of 83 elderly patients (aged 75 and above) being treated with palliative radiotherapy for lung cancer, with a comparison group of 49 younger patients (aged 65 and under). They completed the HADS (Hospital Anxiety and Depression Scale) and a concerns checklist before and after treatment. The HADS according to Skarstein, (1999) is an instrument which rates anxiety and depression in patients with physical illness. It has two sub-scales, one assessing anxiety, and another evaluating depression. Anxiety and depression subscales of the HADS were scored using a score of 0-7 = normal, 8-10 = borderline, and 11-21 = probable case (i.e. likely to have the diagnosis of anxiety or depression confirmed after formal psychiatric assessment). The concerns checklist data were examined to provide median numbers of concerns identified by each patient group before and after treatment and, the changes over time were compared statistically. They hypothesized that majority of newly diagnosed lung cancer patients experience severe level of depression and anxiety. The result of the study shows that the 60% of young group and 40% of elderly group had anxiety. And 30% of young group and 60% of the elderly group had depression. The young group consistently ranked the illness, the future relating to the illness, family and their energy level as their major concern and the elderly group also ranked family and breathlessness as their major concern. This findings suggested that people of all ages have similar concerns and level of anxiety and depression whiles receiving palliative radiotherapy for lung cancer. A year after a similar study was conducted by Wilson et al, (2007). It examined depression and anxiety disorders in 381 patients who were receiving palliative cancer care. The study group consisted of 212 women and 169 men (age 26-93). Data was obtained through the development of a structured interview of symptoms and concerns. Depression and anxiety disorders were assessed with a modified version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) clinician evaluation guide. The PRIME-ED according to Fox, (2006) provides a quick screening method for a wide range of mental health disorders. The findings of the study suggested that physical symptoms (such as pain and breathlessness) as well as issues about the illness itself and its treatment were more likely to have been addressed. Anxiety and depression were the frequent individual diagnosis. But there was no association between these disorders and the time to death. However it makes it more difficult to treat their physic al symptoms. The findings from these two studies suggest that depression and anxiety disorders are common in newly diagnosed lung cancer patients. However Turner et al (2006) suggested that people of all ages have similar concerns and levels of anxiety and depression while receiving palliative radiotherapy for lung cancer. Turner et als (2006) findings supported Wilson et al, (2007) because it also established that issues about the illness itself and its treatment outcome were the major concerns of the participants which influence anxiety and depression. However the two studies are limited to the method used. Turner et al (2006) clearly identified the data collection method used in the methodology. Patients completed the Hospital Anxiety and Depression Scale and the Concerns Check List. The questionnaire was completed by patients during their first visit for radiotherapy using touch-screen technology to record their responses. This method has been validated against paper questionnaire (Holloway and Wheeler, 2002). Some patients also used the paper version of the questionnaire. Data obtained from these two methods were compared in the analysis. Follow up was made during the next visit of patients to their outpatient appointment. Lung cancer specialist nurses were used for the collection of follow-up data. Where this was not possible, questionnaire, along side paid envelopes were sent directly to the participants. Those who returned completed questionnaires were sent a letter of thanks. On the other hand, Wilson et al, (2007) used a di agnostic interview which was a modification of a protocol that has been developed for the rapid screening of mental disorders in primary rather than palliative care. Although it has been used in previous studies in oncology settings, admittedly there is not enough strong body of validating research to support it use (Skarskein, 2000). Moreover Turner et als (2006) study was conducted in the United Kingdom while Wilson et al, (2007) was conducted in Canada. This could affect the interpretation of the findings because of the existing cultural differences and healthcare systems among these two countries. Conversely, in both papers the researchers achieved excellent sample sizes and responses (LoBiondo-Wood, 2006). Greenhalg (2001) stated that when examining studies it is important to distinguish whether the sampling strategy is appropriate for the design of the study and level of evidence provided by the design. Turner et al, (2006) selected a sample size of 191 patients undergoing palliative radiotherapy in radiotherapy centres in various hospitals. From this, 132 were recruited into the study, 83 elderly and 49 younger patients. Wilson et al, (2007) selected an eligible sample of 381 lung cancer patients receiving palliative care in eight sites across Canada. In both studies the researchers achieved excellent sample size and response rate. The sample sizes were large enough to give an accurate picture of what is going on (Greenhalg, 2001). Crombie (2008) stated that studies which use too small sample size often fail to detect clinically important effects. Moreover both studies used random sampling to recruit participants for the studie

Business Analysis of Sport Obermeyer Essay -- Papers Business Manageme

Business Analysis of Sport Obermeyer Sport Obermeyer is a high-end fashion skiwear design and merchandising company headquartered in Aspen, Colorado. Over the years, Sports Obermeyer has developed into a dominant competitor. Sports Obermeyer's estimated sales in 1992 were $32.8 million. The company holds 45% share of children's skiwear and 11% of adult Skiwear market. Sport Obermeyer produces merchandise ranging from: parkas, vests, ski suits, shells, ski pants, turtlenecks, and accessories. These products are sold throughout U.S. department stores in urban areas and ski shops. With increasing demands and rising competition, Sport Obermeyer needs to have an edge on the market. Starting in 1985 with a joint venture in Hong Kong called Obersport, the company began to increase productivity to meet their new demands. Recently, a number of contractual ventures were added and a new complex in Lo Village Guangdong China have enhance production but increase the level of difficulty on the planning and production stages. The Sp ort Obermeyer case describes the forecasting, planning and production processes of a global skiwear supply channel. The case provides an in-depth description of the planning and production processes Sport Obermeyer and its supply channel partners undergo each year to develop and deliver Obermeyer's product line. The case will emphasis on the nature of the information that flows among the members of the supply chain and the timing of key decisions and events in order to have a successful inventory line. Sport Obermeyer, was founded in 1947 by Klaus Obermeyer. Klaus Obermeyer, a German immigrant began teaching at the Aspen Ski School in 1947. During his time teaching, he observed his students being unprotect... ...training and increasing the amount of workers would far exceed Obermeyers input cost. The backbone of Obermeyer's sales is the parkas. It would be in their best interest to produce all the parkas in China were profit would be maximized. The Hong Kong factories should be used to produce the different styles of Obermeyer Ltd. In conclusion, Obermeyer must strategize an effective method of calculating production decisions. Obermeyers initial issues have been due to scant information about how the market would react to the line. There is no indication of how consumers reacted to 1992-93 line of their skiwear. Obermeyer must comply sample data from the buying committee's forecast and correlate it with Obermeyer's top selling products. This would alleviate the amount of risk and loss executed every year due to inaccurate information of the market's reaction.

Outline the Operations Processes Relevant to Transformations

Outline the operations processes relevant to transformations. Describe and explain the impact of the 4? s on the transformation processes. Operations refers to those ongoing cyclic activities involved in the running of a business for the purpose of producing value for the stakeholders. Operations includes the conversion of inputs (resources) into outputs (goods and services). This conversion is known as transformation. Thus, operations processes are those processes involved directly with transformation. †¢ Operations processes entails different processes relevant to transformations.Sequencing and Scheduling are two essential aspects that assist with structuring and ordering the transformation processes. Sequencing refers to the order in which activities in the operations process occur. Scheduling refers to the length of time activities take within the operations process. The two main scheduling tools are Gantt charts and Critical Path Analysis (CPA). An understanding of both seq uencing and scheduling is necessary for operations managers. †¢ As well as operations, technology is another aspect of the operations process which is relevant to transformations.Business technology involves the use of machinery and systems that enable businesses to undertake the transformation process more effectively and ef? ciently. Business technology may include a computer, keyboard and mouse, mobile telephones, printers etc. Manufacturing technology includes robotics, computer-aided designs (CAD) and computer-aided manufacturing (CAM). †¢ Task Design is relevant to transformations as it involves classifying job activities in ways that make it easy for an employee to successfully perform and complete a task. It overlaps the employment relations function of job analysis, job description and person speci? ation. †¢ A plant layout is the arrangement of equipment, machinery and staff within the facility (either a factory or of? ce). The plant layout have an impact on the ef? ciency of the operations function. Plant layouts ensure enough physical space for production, effective use of equipment, the use of appropriate technology, and a good work environment, to name a few. †¢ All operations processes should be monitored for their effectiveness. Monitoring is the process of measuring actual performance against planned performance. As well as monitoring, the main transformational process should be subject to control.Control occurs when KPIs are assessed against predetermined targets and corrective action is taken if required. This requires effective monitoring and focus on continuous improvement. Monitoring and control lead to improvements when there is a focus on quality and standards. Improvement refers to systematic reduction of inef? ciencies and wastage, poor work processes and the elimination of any bottlenecks. Monitoring, control and improv Transformation processes are in? uenced by volume, variety, variation and visibility. That is, the four V? – how much of a product is made, the range of products made, the amount of a product desired by consumers and the nature and amount of customer contact. The in? uence of volume has a strong impact on the transformation process. Volume refers to how much of a product is made. Volume ? exibility depends on the increase or decrease on the demand of a product. An example of a business which used volume as an in? uence for the transformation process is the manufacturers of Leapfrog Leapster Explorer. In 2010, the console became available for sale. However, there were more far more games than actual consoles.This meant that retailers had a shortage of consoles in comparison to games. This is a prime example of a situation caused by a supplier with an incorrect perception of volume. The in? uence of variety is the second ? V? that impacts strongly on the transformation process. Variety is the mix of products made, or services delivered through the transformation process. It is sometimes referred to as mix ? exibility. Mix ? exibility is known by customers as product range or variety of change. The in? uence of variety on transformation processes is the greater the variety made, the more the operations process needs to allow for variation.An example of a business that considers variety is Electrolux. Electrolux make Simpson, Chef, Dishlex and Westinghouse brands. These brands are attached to a range of whitegoods such as fridges, washing machines, ovens, dishwashers and dryers. In this way, the company can sell a variety of products made with largely similar production processes. A variation in demand can impact signi? cantly on transformation resources. Increases in demand will require increased inputs from suppliers, increased human resources, increased energy use and increased use of machinery and technology.The fourth and ? nal V that impacts the transformation process is the in? uence of visibility. Visibility is important in the transformation as it is the nature and amount of customer contact (feedback). Direct customer contact may include customer feedback given through surveys, interviews, letters, blogs and verbal contact. Indirect customer contact comes from a review of sales data that is an analysis of customer preferences. As businesses seek to maximize sales, customer contact is essential and ultimately shapes the transformation process.

A Masters in Education for a Young Teacher Essay Example

A Masters in Education for a Young Teacher Essay Example A Masters in Education for a Young Teacher Essay A Masters in Education for a Young Teacher Essay Teachers who have, in essence, just begun their careers often jump on the first job they can find after college. After all, it’s difficult to get into particular school districts and sometimes there are no options when it comes to choosing exactly what grade you want to teach. It’s best to simply get your foot in the door and make changes from the inside as more opportunity becomes available. The need or desire to get a job right out of the gate is one of the reasons that many who have received their undergraduate degree in education bypass the choice to go straight on to earning their Master’s Degree. It may be that their expenses are such that they can no longer afford going to school full time and must get a job in order to support further schooling, or they may find themselves with a career opportunity that they simply cannot pass up, especially in this economy. But now immersed in that job and getting comfortable with the school and the classroom, that new teacher may still not want to lose the momentum she had gained through her undergraduate work; momentum, she has been told, that is difficult to recapture when you let too much time go by between earning an undergraduate degree and continuing on in a Master’s program. The option, of course, is to look at online learning where the ability to pursue degree programs in everything from Nonprofit Management to a Masters in Education is possible. This type of learning is fast becoming the most popular choice for those who are interested in continuing school in a non-traditional manner; something that supports their schedule and allows them the flexibility and control that they need to manage a multitude of responsibilities including family and a full time job.

The Challenger essays

The Challenger essays As the 1980's approached, the launch of a space shuttle was almost as routine as a trip on an airliner. Space travel had been successful on 24 missions. Most people thought the danger of space travel was nearly eliminated. On January 28, 1986, they were proven wrong. The orbital Challenger was preparing to make it's tenth flight. Everyone in America watched as the seven crew members prepared for Mission 51-L. One of the seven crew members was Sharon Christa McAuliffe, the first teacher and civilian, to fly in space. This fact made this particular launch very famous. The commander of the Challenger was Francis (Dick) Scobee. Scobee was married with two children. He obtained his B.S. Degree in Aerospace from the University of Arizona in 1965. Soon after graduation he entered the Air Force pilot training program. After obtaining his pilot's wings he began his assignments, including a tour in Vietnam. Scobee gained more then 6500 hours of flight time as an Air Force test pilot. He entered NASA's astronaut corps in 1978. Scobee was the pilot of mission STS-41-C, the fifth orbital flight of the Challenger. This mission proved that shuttles could repair satellites in orbit. Michael Smith was the shuttle pilot on board the Challenger and the father of three children. He earned a M.S. Degree in Aeronautical Engineering from the Naval Postgraduate School. He also worked as a test pilot for the US Navy, receiving more than 4300 hours of flying time. In May 1980, Smith was selected to become a NASA astronaut and a year later he received his first assignment as a space shuttle pilot. He was to be pilot of the Challenger. This was Smith's first space flight. There were three mission specialists on the Challenger. Judith Resnik was one of them. Resnik earned a B.S. Degree in electrical engineering from Carnegie-Mellon University, and later received a Ph.D. in the same field. She was selected as a NASA astronaut in 1...

Merriam-Websters 2018 Words of the Year

Merriam-Websters 2018 Words of the Year Merriam-Webster’s 2018 Words of the Year Merriam-Webster’s 2018 Words of the Year By Mark Nichol Toward the end of every calendar year, Merriam-Webster, like other major dictionaries, shares a list of the words most frequently searched for on its website. As usual, this search traffic is largely driven by public discourse, as people look up words they see and hear in the media and in conversations, seeking to learn definitions of unfamiliar words or to clarify for themselves the meanings of words they know (or think they know). This post discusses Merriam-Webster’s Word of the Year for 2018 and ten runners-up. The Word of the Year, justice, was newsworthy in several contexts. The primary sense is that of administration or maintenance of fairness and lawfulness, and increasing concern about social justice has brought the concept, and the term that represents it, to the forefront in our society. But justice is a job title as well as a concept, referring to a judge on a national or state supreme court or similar body, and the controversy over confirmation of Brett Kavanaugh as an associate justice of the US Supreme Court also led people to check the definition. (The senior member of a supreme court is often titled â€Å"chief justice,† while the others are designated â€Å"associate justices.†) Finally, on a more trivial note, the Justice League is a team of superheroes created for DC Comics and appearing in various media, including a film released late last year. The runners-up include nationalism, which has figured prominently in the media as the concept gains traction throughout the world, including in the United States, where President Donald Trump recently unabashedly identified himself as a nationalist. However, he, like many people, appears to be unclear on the concept: Nationalism is often conflated with patriotism. However, while the latter term refers to pride in one’s country, nationalism denotes loyalty to a nation at the expense of international (and intranational) harmony. Nationalism is closely associated with fascism, a political philosophy that incorporates dictatorial control and centralization of authority and brutal suppression of individuals and groups deemed undesirable or resistant to fascists’ goals. In summary, to be called a nationalist is decidedly not a compliment, and to call oneself a nationalist does not invite compliments. Pansexual, incorporating a Greek prefix meaning â€Å"all,† refers to a conception of gender identity and sexual orientation as something that occurs along a spectrum, rejecting the idea of binary categorization. Lodestar, originally denoting Polaris, the North Pole Star, which for millennia has served as a navigational aid, now refers more broadly to a guide, inspiration, or model. (Lode is a Middle English word meaning â€Å"course† or â€Å"way; it’s seen also in the context of mining: A lode is a deposit of ore.) The term had a vogue this year after it was used in an anonymous op-ed in the New York Times purportedly written by a senior Trump administration official. Because Vice President Mike Pence is known to use the fairly obscure term, some people suspected him of being the author. An epiphany is an appearance or manifestation, but the term is most commonly employed to refer to a realization or revelation. Its popularity as a search term early this year likely resulted from the Christian holiday by that name, which on January 6 commemorates the visit of the Magi, or Three Wise Men, to where the infant Jesus lay; it derives from the Greek verb epiphainein, meaning â€Å"manifest.† Feckless, used by a television commentator to criticize Ivanka Trump for, in her role as adviser to her father, failing to criticize the Trump administration’s immigration policies, employs the root feck, of Scottish origin, meaning â€Å"value† or â€Å"worth.† Essentially, it is a rare synonym for worthless. Laurel, the word for a tree whose foliage was used to crown victors in athletic events in ancient Greece, became a hot search term when a debate erupted online about which of two words was being enunciated in an online dictionary’s pronunciation sound file. By extension of its original definition, the term came to apply to the celebratory object itself and to figurative honors; one idiom based on the term is â€Å"rest on (one’s) laurels,† which alludes to someone who, upon achieving an honor, refrains from attempting feats that bring further recognition. (Usage generally pertains to one who does not rest on one’s laurels, meaning that person does seek other honors.) Pissant was frequently looked up after a radio personality described a famous football player’s daughter with the word, which is a derogatory dialectal term formed from piss and ant. (This word is not to be confused with puissant, a rare term meaning â€Å"powerful† and etymologically related to power and potent. All three words derive from the Latin term posse, meaning â€Å"able,† which survives in English as the term for a group deputized to pursue a fugitive or, more loosely, to denote one’s entourage.) The death this year of Aretha Franklin, best known for her rousing rendition of the song â€Å"Respect,† prompted look-ups of that word, which literally means â€Å"look back.† (The second syllable of that word, meaning â€Å"look,† is also the root of spectacle, spectator, inspect, suspect, and so on.) Maverick is a term often applied to the late John McCain, a US senator and presidential aspirant, for his frequent opposition to party-line politics. The word, describing someone who often acts without regard for group or party loyalty, derives from the surname of a gentleman who, after taking a small herd of cattle as payment for a debt, neglected to brand them, rendering them vulnerable to appropriation by other ranchers, who rounded them up on the open range and applied their own brands to the livestock. Since then, the word has been a synonym for independent, though â€Å"stolen from a careless owner† would be a more appropriate association. The death of Marvel Comics mogul Stan Lee this year resulted in references to excelsior, the word with which Lee typically signed off in the columns he wrote for his company’s comic books. Though the primary meaning of the word is mundane- it was a trademark for a brand of wood shavings used as protective packing material and later a generic term- its origin is the Latin word meaning â€Å"higher†; excel, excellent, and so on are related. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:What Is Irony? (With Examples)Precedent vs. PrecedenceQuiet or Quite?

Shakespeare Essay Example | Topics and Well Written Essays - 250 words

Shakespeare - Essay Example The desire of Helena becomes true, irrespective of her low social position. The success of Helena in turning the king of France has caused for a turning point that helped her a great deal in attaining her dreams. Bertram’s attempt to seduce Diana was well abolished by Helena and trickily she makes union with him in the bed scene and conceives his child. Moreover, she had asked Diana to get the family ring of Bertram. Helena in the play achieves both conditions of Bertram to become his wife in a tricky way. At the end, when Bertram sees his wife’s great attempts to win over, makes him attached towards Helena and thus the play ends well as with the title. The play is not much attached to the unities like the unity of place and the unity of time as Aristotle propounded. But it has made some achievements with the unity of action. It can be seen that the Aristotelian logic of the action, as rebuilt by Frye is well established in the play. According to Aristotle it should hav e â€Å"proper beginning, middle, and end† (Kitano). In ‘All Well that Ends Well’ Frye finds the â€Å"material cause â€Å"of the comedy in the young man’s sexual desire and the â€Å"final cause† in â€Å"the audience, which is expected by its applause to take part in the comic resolution† (Haley 19). All Well that Ends Well has gone through these levels as according to the Aristotle’s theory.

Controversial Behavioral Management Techniques for ADHD Research Paper

Controversial Behavioral Management Techniques for ADHD - Research Paper Example This essay stresses that there are those who think that it is merely a label that justifies the unruly behavior of students who need more rigorous discipline. Within the educational perspective, teachers keep on looking for correct knowledge about ADHD that will help them create classroom management techniques that are effective for students with this condition. Most of ADHD diagnoses come from teachers’ observations, and several of the symptoms of the condition oblige teachers to give a diagnosis, such as â€Å"the child often fails to give close attention to details or make careless mistakes in schoolwork, work, or other activities†. This paper makes a conclusion that when children with ADHD go to school, they are affected by the teachers’ method or techniques, as well as the school’s viewpoint about behavioral management. It is widely recognized that ADHD seldom arises alone; it is frequently complemented by comorbid disorders, like learning disabilities or oppositional defiant disorder. Sooner or later, this behavior could result in deviant behavioral patterns. In numerous instances, the delinquent behavior is simply bothersome or possibly makes the teacher annoyed. The initial idea could be â€Å"I’ve got to punish this behavior to stop it†. This is where controversial behavioral management techniques for ADHD come in. The first is corporal punishment or physical punishment. This technique does lead to inhibition of a problematic behavior, but it does not eliminate it. ... When children with ADHD go to school, they are affected by the teachers’ method or techniques, as well as the school’s viewpoint about behavioral management. It is widely recognized that ADHD seldom arises alone; it is frequently complemented by comorbid disorders, like learning disabilities or oppositional defiant disorder. Sooner or later, this behavior could result in deviant behavioral patterns (Hornby et al., 2013). In numerous instances, the delinquent behavior is simply bothersome or possibly makes the teacher annoyed. The initial idea could be â€Å"I’ve got to punish this behavior to stop it† (Flick, 2010, 101). This is where controversial behavioral management techniques for ADHD come in. The first is corporal punishment or physical punishment. This technique does lead to inhibition of a problematic behavior, but it does not eliminate it. The student discontinues the behavior but relapses to it eventually. The punishing teacher actually embodies the behavior s/he wants to get rid of. The student gets the message that physical punishment is an effective way of coping with problems such as this (Flick, 2010). It is also necessary to mention that corporal punishment is normally used long after the student shows the problematic behavior. The main point is it is unwise to exercise corporal punishment in school. Simply put, it is completely unsuccessful in managing behavior issues, and it is useless with ADHD. Studies report detrimental consequences of exercising physical punishment (Southall, 2007). A particular type of punishment less harsh than corporal punishment is the verbal scolding. This implies that the student is verbally reprimanded for showing improper

Tthe First Bank of the United States Essay Example | Topics and Well Written Essays - 2000 words

Tthe First Bank of the United States - Essay Example They needed to shore up their own fiscal policy and standardize a currency that could be adopted nationwide and begin to get the country off on the right financial footing. The First Bank of the United States was an effort to do this, and its charger came into effecting 1791. While certainly far from perfect, nor even ideal in the eyes of many, it was a solid first effort by the founding fathers of the nation to set the country on the right path to financial security and freedom, in addition to their newfound global independence. They also wanted to show the world that the nation was capable of not only paying back its debt, but also in handling its own internal needs moving forward. This was seen as a necessary first step towards establishing domination throughout the region and keeping potential invaders from arriving on the shores of the young country. To understand this First Bank, one needs to discuss the background of Hamilton’s Plan, the economic policy associated with the Bank, and its eventual implementation. While the First Bank of the United States was all about creating fiscal policy for the new country, it is still important to remember that it was also an actual physical building. The bank itself was built in Philadelphia, which at that time of the capital of the country. Alexander Hamilton was the brainchild behind the concept of the bank, and his desire was to implement a mechanism by which the United States, and each individual state within the union, could begin to tack its monumental debt as a result of the Revolutionary War. Prior to the creation of the bank and the implementation of its charter, coins and paper currency were actually issued by state banks, and these individual currencies combined to form the national currency. For obvious reasons, if the Union was going to succeed, they had to nationalize its monetary

Film paper Movie Review Example | Topics and Well Written Essays - 1500 words

Film paper - Movie Review Example The modern audience might be amused of how Godard suddenly breaks the 4th wall this way. They can perceive the breaking as a form of interpersonal connection, a way to get into the mind of the audience to make them think about filmmaking too, not just the film. A 1959 audience might be a bit shocked, as if their spectatorship has been violated. They might also seem confused of what Michel means. The influence of the technique up to now may not have the same power as before because it might seem too contrived, depending on how it is executed. Or it might just seem like an overused technique for some of the modern audience who have seen it many times. Done before or within the context of avant garde films, breaking the 4th wall can attain the impact of changing how people see the film and the social context of the film. It can highlight the insight that film is about making impressions and images, a contrived way of affecting the audience through the right placing and combination of fi lm elements. 2. One of the scenes that features several jump cuts is the transition between the long bedroom scene between Patrician and Michel and their kiss. Before the jump cut, Patricia starts a game where she will stop staring at Michel once he stops staring at her. After he does his usual rubbing of his lips mannerism, Patricia is in shallow focus and she rolls the poster to look at Michel through its hole. The poster serves as a double frame. She looks into him and the camera zooms, as if she is going deeper into his personality, trying to figure out why she is attracted to him. Michel keeps on staring at her, in this case, he also stares at the audience, and the shot zooms to a close up, making his necklace and cigarette appear closer and closer. The impact is that the audience sees only the physical and the material of his identity. He hides himself inside his carefree attitude to life. After that is the jump cut which is disorienting. All of a sudden,

Human Rights Act 1998 6(3)(b) Essay Example | Topics and Well Written Essays - 1000 words

Human Rights Act 1998 6(3)(b) - Essay Example This pigeonholing of information meant for the common people of a democratic country only serve to increase ambiguity about the nature and extent of their existence and most importantly the essential function they possess to help the citizen of the state. Statutory interpretation of Section 6 of the Act makes the understanding of two types of "public authority" seemingly quite clear-cut within the sphere of judicial classification. Obvious public authorities, private authorities that act publicly and as per section 6 (3)(a), those bodies who may be part of any court or tribunal2. Thus Public Authority stands precariously at a very sharp contrast to the given fundamental rights under the British Constitution Law. Briefly, the 6(3)(b) may be seen as one of those restrictive clauses that seek to curb those given rights under imposing specifications that though clarify their function of being exhaustive to their cause, is nonetheless oppressive to universal ideology of the Human Rights. Thus the actual impacts of exercise of such rights are important to the present condition, which shall indicate where our future is headed. Hermeneutics of law is an important step towards grasping the closest interpretation of an evolving constitution that exist side by side to so many case law challenges. To accommodate international or rather European Convention of Rights' incorporating Human Rights law nationally the British Constitution must also revise its fundamental problems of laws full of gaps. The Leonard Cheshire3 case successfully brought forth new interpretation and classification of bodies of 'pure' public authorities. These fell outside the scope and target of the Act since the court had narrowed the whole idea of the 'public authority' for the specific category of section 6(3)(b). The case centered on a home care foundation called the Leonard Cheshire Foundation was unable to fight for the fundamental rights called voicing out. They were thus met with a lot of resistance when they tried to fight against the decision that directed closure of the home thereby leaving the residents free to go wherever they will. This act of closure was problematic to the residents since under the Human Rights Act 1998 the home was being subjected to disrespect by them and the major issue got tied up with finding an apt definition for Leonard Cheshire, which ultimately was declared a non public authority and thus it changed the way human rights act was applicable in its context anymore. The event is familiar to all, but the act requires us to think a step further about the case of fundamental rights being held at variable contexts and thereby being subject to being called null and void when it acted in favor of the residents by helping them find placements too. Similar was the case of Johnson v. London Borough of Havering in 2007 when the Court of Appeal made decision of another care home being governed by the local authority. The transfer from them to another private sector was proposed which brought alarming issues of human rights act and its legitimacy or applicability under the private sector. Hum an rights act enjoyed under the governmental concern would invariably lead to a confusing turn of being loosened and ultimately becoming in effective in the future. Thus under the private sector the public and the private would not be a separate domain at all and be under the constant threat of being violated without any fixed line drawn legally to act in favor of its citizens.

Management Philosophy Final Paper Essay Example | Topics and Well Written Essays - 1000 words

Management Philosophy Final Paper - Essay Example The management model used by the management is also a determinant of the relationship that will be created with the employees. Competency is also required of the employees as it plays an essential role in ensuring that the mangers are able to carry out their duties effectively. The paper is thus a management philosophy regarding best management practices. As a manager, I prefer an organization that is flexible and the leadership is democratic. According to the participative theory of leadership, the leader should always take into account the input of the others and also ensure that the other people are encouraged to participate and make their own contributions. The use of such models encourages flexibility and teamwork which is essential in enhancing the success of an organization. On the other hand, I would like to work where the organizational culture promotes flexibility and teamwork. This is because a good relationship among the employees can be attained through teamwork and close working relationship among the team members. As a manager and employee, I also prefer working in an organization that has effective communication. Effective communication is an important tool that enables the employees to understand the issues that are taking place in the organization (Hatten, 8). I believe that ethics at the workplace is important and should be considered before making any managerial and business decision. On the other hand, it is also important to note that the brand image of an organization is dependant on how ethical it is. The confidence of the clients is usually enhanced by the presence of high ethical standards. Any form of unethical behavior has negative impacts on the image of the organization. I therefore believe that the concepts of ethics should also be incorporated in an organizational culture of an organization. As a manager and employee, I would not work in any organization that is engaged in unethical

Film paper Movie Review Example | Topics and Well Written Essays - 1500 words

Film paper - Movie Review Example The modern audience might be amused of how Godard suddenly breaks the 4th wall this way. They can perceive the breaking as a form of interpersonal connection, a way to get into the mind of the audience to make them think about filmmaking too, not just the film. A 1959 audience might be a bit shocked, as if their spectatorship has been violated. They might also seem confused of what Michel means. The influence of the technique up to now may not have the same power as before because it might seem too contrived, depending on how it is executed. Or it might just seem like an overused technique for some of the modern audience who have seen it many times. Done before or within the context of avant garde films, breaking the 4th wall can attain the impact of changing how people see the film and the social context of the film. It can highlight the insight that film is about making impressions and images, a contrived way of affecting the audience through the right placing and combination of fi lm elements. 2. One of the scenes that features several jump cuts is the transition between the long bedroom scene between Patrician and Michel and their kiss. Before the jump cut, Patricia starts a game where she will stop staring at Michel once he stops staring at her. After he does his usual rubbing of his lips mannerism, Patricia is in shallow focus and she rolls the poster to look at Michel through its hole. The poster serves as a double frame. She looks into him and the camera zooms, as if she is going deeper into his personality, trying to figure out why she is attracted to him. Michel keeps on staring at her, in this case, he also stares at the audience, and the shot zooms to a close up, making his necklace and cigarette appear closer and closer. The impact is that the audience sees only the physical and the material of his identity. He hides himself inside his carefree attitude to life. After that is the jump cut which is disorienting. All of a sudden,

Management Philosophy Final Paper Essay Example | Topics and Well Written Essays - 1000 words

Management Philosophy Final Paper - Essay Example The management model used by the management is also a determinant of the relationship that will be created with the employees. Competency is also required of the employees as it plays an essential role in ensuring that the mangers are able to carry out their duties effectively. The paper is thus a management philosophy regarding best management practices. As a manager, I prefer an organization that is flexible and the leadership is democratic. According to the participative theory of leadership, the leader should always take into account the input of the others and also ensure that the other people are encouraged to participate and make their own contributions. The use of such models encourages flexibility and teamwork which is essential in enhancing the success of an organization. On the other hand, I would like to work where the organizational culture promotes flexibility and teamwork. This is because a good relationship among the employees can be attained through teamwork and close working relationship among the team members. As a manager and employee, I also prefer working in an organization that has effective communication. Effective communication is an important tool that enables the employees to understand the issues that are taking place in the organization (Hatten, 8). I believe that ethics at the workplace is important and should be considered before making any managerial and business decision. On the other hand, it is also important to note that the brand image of an organization is dependant on how ethical it is. The confidence of the clients is usually enhanced by the presence of high ethical standards. Any form of unethical behavior has negative impacts on the image of the organization. I therefore believe that the concepts of ethics should also be incorporated in an organizational culture of an organization. As a manager and employee, I would not work in any organization that is engaged in unethical

Work Experience Essay Example for Free

Work Experience Essay Thursday, a new day, I was actually looking forward to seeing what today had to bring. I was right to wonder as today we were doing the normal lessons of Maths, P. E, English and History, which we do Thursdays, but today we were also going to do painting. The children were excited, and so was I. After our fun last lesson of the day of painting it was time to pack up and go home. I, on the otherhand had to stay and clean up, which I did not mind as I had seen how much the children enjoyed painting and just the smiles on their faces gave me motivation and me smile too. Friday, the day I had at first been looking forward to but was now dreading all week had come. I was upset at the thought of leaving the children that had made me feel so welcome and had made me smile not stop for the past two weeks. The day was all right. It started the same way and was pretty much the same, apart from the gut feeling I had. As the day went on I tried my hardest to explain to the children that I was going back to my own school, to do my work. They did not understand, no matter how much I explained. After two weeks it was over, it was the end of the day on Friday and I was going to have to say goodbye. All of sudden two children missing and five minutes later they returned with a big card for me. I was very emotional at this point as I held back my tears. In the card they had all signed it and had drawn pictures of themselves. I also had six pictures that Ross, Daryl, Chloe, Steph and Katie had drawn for me. As the children left they all hugged me and took a handful of marshmallows, which I had brought in for them. I remember saying goodbye to all of them and holding back my tears. There was of course two favourites, isnt there always but these two were special to me as they had me feel so comfortable around them and had always been grabbing my hand at every chance. These two children were Chloe and Daryl. Although me and Daryl did have our moments, like when he decided that he had just about enough of me and he stuck his finger up at me, which to be honest was quite funny and when Chloe gave me a photo of herself and her granddad which I of course returned to her tray without her knowing. I then picked up my bag and walked out of Ruislip Gardens Primary School one last time. I left and caught my bus home feeling sad and shedding a tear or two. From work experience I feel that I have matured a lot and that I definitely know that this is definitely the line of work I am interested in. I have below written my own poem of my experience of work experience. The moment that I first saw it I was terrified, but little did I no the children were going to be right by my side. The children they were lovely and the staff they were too, Things did not turn out how I had expected and all the things I had imagined they were not at all true. I am glad that I had gone there to work and act mature, But I am definite I am eager to start the real World of work and this I am sure. Now there is one thing I would want to say and I want everyone at Ruislip Gardens to know too, I would like to say this and I mean it, THANK-YOU.

Globalization And Intercultural Communication Cultural Studies Essay

Globalization And Intercultural Communication Cultural Studies Essay What is Globalization? Globalization is a process of interaction and integration among the people, companies, and governments of different nations, a process driven by international trade and investment and aided by information technology. This process has effects on the environment, on culture, on political systems, on economic development and prosperity, and on human physical well-being in societies around the world. What is intercultural communication? Intercultural communication, more precisely then, is defined as the study of communication between people whose cultural perception and symbol system are distinct enough to alter their communication e.g. In China, KFCs Finger licking good was translated as Eat your fingers off. Chevrolet attempted unsuccessfully to market its Nova compact car in Latin America countries. In Spanish no va means does not go or it does not run. In todays global scenario governments, organizations and companies are getting involved more and more. And because of globalization there has been fundamental change in who, where and why we do business and it is not constrained by borders or distance. More and more people from the remote locations in overseas location or from different cultural backgrounds are chosen to run the organization. To secure success in todays globalised workplace there is a need for effective and clear intercultural communication. How people communicate, manage, work together, approach deadlines, negotiate, meet, greet and build relationships are important aspects of intercultural communication within the context of globalised business or organization. It is becoming much more related on two fronts 1. Businesses with a mix of cultures working together and 2.Businesses wanting to trade successfully abroad. It leads to bad presentation and lost deals if people are unaware of how to get along and get business done. For achieving business goals and higher profitability it is necessary to understand intercultural communication differences, manners, etiquette, protocol and communication styles. To achieve competitive edge it is necessary to know intercultural communication. It is necessary for people to get it right and get it right at the first time. Intercultural communication plays an important role whenever an organization looks for a new supplier, giving a presentation or negotiating a contract. In conclusion, the need for intercultural communication skill is obvious we are all working in an interconnected global economy and it is important to build good relationships with people from other cultures. Globalised world economy is having a positive effect on individuals and companies. People extend their inter personal skills, flex their creative muscle and learn new ways of doing things when they are forced to think outside the box. It is necessary to build a good relationship with people in todays interconnected global economy which tells us the need for intercultural communication is important. This leads to better business. Key aspects of intercultural communication: Perception: The internal process by which we select, organise and intercept information from the outside world is known as Perception. In other words, what we tend to notice, reflect upon and respond to in our surroundings is our perception and it is significant to us. Because of which no two person can have same perception of our surroundings. It is especially in the case if we interact with people who come from very different cultures different from our own. The way in which each one of us perceives the world is learned and is part of our own cultural experience. Certain kind of food or the responses like we have to going to see the doctor is the judgement we make and we all react to these different events in the way our culture has taught. Our perceptions are culturally determined and in turn influence the way we communicate. Beliefs: The judgements which we make about what is true or wrong is known as Beliefs. It is usually linked to objects or events that pose certain characteristics that we believe to be true with or without proof. E.g. we have beliefs about religion (God), events (meeting was successful), other people (she is friendly) or even about ourselves (I am hard working). Most of our beliefs are ideas about how things work, why things are the way they are, and where things come from. Many of our beliefs are concerned with providing an explanation for things which would otherwise be unpredictable or inexplicable, such as weather, death and romance. Values: Values are defined as an enduring set of beliefs that serve to guide or direct our behaviour. It represents the norms of the culture and specify, for instance, what is good or bad, right or wrong, rude or polite, appropriate or inappropriate. In other words they provide us with a set of rules for behaving , making choices and reducing uncertainty. Like our perceptions and beliefs, values are learned and hence subject to interpretation. When we interpret behaviour, an object, or an event, we are applying value judgements, which reflect our particular culture. Culture and Pragmatics and Interactional Norms Whenever there is any effect on cultural on communication, text structure are more affected then in the case of inter culture communication. The meaning of equivalent units in terms of contexts of use, and the sorts of interactional trajectories are established by the effect of culture. The culturally based nature of meaning in language use is seen in example, which features an exchange in English between an Australian child and his French mother. Thank you Son: Hi Mum thanks for picking me up. Mother: Thanks for picking you up! Did you think? I wasnt going to come? But Im your Mum; of course I was going to come. Its dark and youre little. Of course I was going to pick you up. In the example a child thanks his mother and the mother reacts negatively. The meaning of thanks for picking up leads to the contention of the issue. Thanking is a mark of appreciation in Australian cultural framework, which means appreciating for something thats has been done for ones benefit. It shows gratitude for the mothers action. But the mothers response in this frame does not make any sense: expressions of appreciation do not typically occasion expressions of anger within this framework. The meaning of thank you is different in the French framework. In the French framework, especially between intimates, thanking is not an automatic acknowledgement for something which is done by another for ones benefit. Rather in close relationships thanking is reserved for unusual or unexpected actions things which are additional to the normal relationships between people. The sons thanking is hearable as a sign that picking me up is not an anticipated act, but rather something extraordinary or strange something this child had not anticipated of the mother. The mothers reaction was towards the construction of the act that is being appreciated and concurrently of the other as the sort of person who would not pick up her son at night and not towards the thanking. An implied criticism is hearable in thanking of the mother. The conflict here is motivated by perceptions of what counts as an appreciable act. For the son, any beneficial act is appreciable but for the mother this is not the case. The translation of the following sentence is similar but it has different meaning in the Australian English and Polish sentences. Why dont you close the window? Dlaczego nie zamkniesz okna? The English version forms a polite request framed indirectly as a idea, while the other sentence imply stubborn and unreasonable behavior on the part of the addressee. The word to word translation may be same but it is different in the cultural context. Another example would be as follows, Pass me the book. Passe-moi le livre. The sentence in English enacts a relatively low level of politeness in terms of the social relationships, but the French example could be used in a considerably wider range of contexts. In fact, the form passe, which is the tu-form of the verb, encodes a close social relationship which would make example a more natural formulation of the request. In comparison with the following examples, Could you pass me the book? Pourrais-tu me passer le livre? After reading the example a feeling arise as the words in English sounds polite to the ears in the discussion between the family members over the wide range of topics. In the French example it implies where there is a close interpersonal relationship (tu) and it crucially involving more politeness. This type of constraints will be used, where the non-family members uses their interpersonal relationship (tu) to bring harmony among the group which is involving an effort of the addressee or it can be rejected legally. The construction of the words in passing of the book is a challenging task and there is the confusion between the structure and situation. In the communication between people, culture plays an important role and it influences the speaker to choose words in a particular language. This simple example proves, as in a social interaction in English, How are you is the most frequently used greeting words. The first question which comes in my mind is what is Globalisation? Globalization refers to the growing interconnectedness of different parts of the world, a process which gives rise to complex forms of interaction and interdependency. (Thompson 1995) Globalisation as a concept refers to both to the compression of the world and the intensification of consciousness of the world as a whole. (Robertson 1992) Globalisation refers to all those processes by which the peoples of the world are incorporated into a single world society, global society. (Albrow 1990) The second question comes in my mind is what is Intercultural Communication? Communication between two people from different cultures is said to be intercultural communication. It comes in to existence when a person from one culture tries to communicate with the person from another culture, a communication is understood. The potential for misunderstanding and disagreement is great whenever there is a cultural difference in these kinds of contacts. It is to be said that there is a relationship between culture and language. In other words, language is a guide to culture. Other scholars argue that language merely reflects, rather than shapes, our thinking, beliefs, and attitudes. Despite these differences in approaches, all scholars still agree that a close relationship exists between language and culture. Language plays very important role in both globalisation and intercultural communication. Whenever an organisation wants to start a new business it is important for them to know the local language of the host country. If an organisation does not have any idea about the local language, it will be very difficult for them to conduct business in that country and also it will be difficult for them to sell their product in the local market. Now days every organisation around the world is trying to recruit some local employees so that it will be easy for them to communicate with the local customers. It is also necessary for an organisation to the business etiquette of the host country. When I talk about etiquette it means dress, clothing, body language, gestures, dining, gift-giving, meetings, customs, protocol, negotiations, and general behaviour. Another important factor which affects globalisation is culture. It plays an important role for any organisation. If an organisation fails to understand the culture of the host country they could face the following cultural effects, Consumer behaviour Local demand Buying decisions Brand image. Knowledge of Native culture is useful when dealing with home markets but it has little value when dealing in foreign markets. Culture acts as a hidden entry barrier, but it can be overcome with cultural sensitivity, hard work quality. Culture influences managerial styles and management decisions. It also affects the nature of business negotiations. The example for the effect of culture on an organisation is as follows: McDonalds in India. When McDonalds entered the Indian market, it introduced itself as the American style fast food outlet. They priced their product according to the Indian customers attitude, thinking etc. They were one of the first international fast food outlets which were successful in India. The only mistake McDonalds made was they did not read the Indian culture properly. In India beef or cow is to be considered as God in many religions. And McDonalds use beef oil to cook their food. When the Indian consumer came to know about this fact, they started avoiding eating food at McDonalds. Because of this mistake, the brand image of the McDonalds was affected. The education system in India is totally different from Australian education system. In India, teaching style is very different when you compare it to the Australian style. In India, Prof. is the one who speaks in the class for the majority of time and its more of theoretical knowledge then practical knowledge. But when you see the Australian style of teaching, the student are given chance to speak in the class and ask questions whenever they have a doubt. And in Australia, there is a mixture of both practical and theoretical knowledge. So for any Indian student coming to Australia, its difficult for them to adapt to the Australian education system very quickly. It is also necessary to know the gesture or greeting in different country or different culture. For e.g. in India people normally greet by saying Namaste which means Hello in English. They would normally join their hands and say Namaste. But in Australia, people greet in different way i.e. they would normally hug and say hello or shake hands and say Hello. But in India people try to avoid the body contact with the other people when they are greeting them.

moralhf Huckleberry Finn Essays †Moral :: Adventures Huckleberry Huck Finn Essays

Huckleberry Finn – Moral The Adventures of Huckleberry Finn by Mark Twain tell the story of how a young boy learns how to overcome the idea that colored folks are less equal then white folk. Regardless of the positive lessons portrayed throughout this book, it has been miss represented even from the very day that it was published. In fact, it has been said that this "book has been controversial since it was published it 1885" in a Los Angeles Times article written by Henry Weinstein in 1998. The Adventures of Huckleberry Finn is a classical story which was written for enjoyment and future education. This book was not written to encourage any derogatory slurs to any ethnic groups. Even though Jim, the colored friend of Huckleberry Finn, felt that every white person though of color people as less equal, his friendship with Huck should be an inspiration to everyone to overcome differences. America has become a country that has given every one of its citizens an awesome privilege to be equal. Along w ith this privilege to be equal, America citizens have the opportunity to learn and become educated. The schools that provide this education should had the right to teach people how this country has evolved into a great nation. This right should include an ability to examine both the good and the bad and it should include a proper response to both. The Adventures of Huckleberry Finn provides an excellence chance for teachers to explain to young people how America has now treats everyone equal. Many times in the friendship of Huck and Jim, Jim's idea that all white people treat colored people as less equal then white people show up. Jim, who is a run-a-way slave, was always trying to avoid any contact with white people of town. One specific example of how Jim thought about white people was when he stumbled across a dead man on the river in a house. Jim did not what to tell anyone, not even Huck. He thought that if anyone found out they would blame him for murdering the fellow. Jim was always in hiding. He thought that if a white person saw him, he would be sent back to his owner and punished.

Large Amounts of Glutamine as the Cause of Disease Essay -- Biology Al

Neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease are caused by the aggregation of abnormal proteins in neurons. An essential component of cellular function is the correct assimilation of proteins in the cell. Proteins fold into specific structures and then carry out cellular functions. However, when this folding process runs amuck, abnormal proteins are introduced into the cell. In neurodegenerative diseases, these protein aggregates are characterized by having genes which contain too many CAG trinucleotides repeats that encode for polyglutamine (polyQ). Having too much polyQ leads to the gene products being converted to a proteotoxic state. All in all, disruptions in protein folding lead to an overabundance of CAG repeats which results in an overproduction of polyQ which raises the toxicity of the cell to levels that effect the cell's functions. Through experimentation, this paper attempted to find the threshold for the number of CAG repeats that determines whether cellular function will be disrupted by the protein aggregates. Molecular genetic studies have already established than normal chromosomes (and genes) contain fewer than 30-34 CAG repeats. This paper attempted to prove that 35-40 CAG repeats results in cellular toxicity levels that severely disrupt cellular function. To address the connection between the CAG threshold (thus, the polyQ aggregation) and cellular toxicity, a species of worm, Caenorhabditis elegans, was used during experimentation. (C. elegans are good model organisms to study human neurodegenerative disease not only because C. elegans' neurons resemble vertebrate neurons at cellular and molecular levels, but also because many genes are conserved between worms and h... ... aggregation causes cell toxicity, or if the aggregates are a benign product of some other, yet unknown process that causes the detrimental effects. If future research reveals that glutamine aggregates promote cell toxicity, we can direct research on how to inhibit these aggregations to slow down or possibly reverse the course of the disease. 2.) How aging in the infected organism influences the progression of Huntington's disease: Experiments with C. elegans expressing the age-1 genetic mutation not only had an extended the lifespan, but also had a delayed onset of Huntington's disease. This suggests that a substance produced as an organism ages can catalyzes the toxicity of Huntington's disease. With this in mind, further research could hunt for what this aging-related catalyst is. Blocking this substance may slow down or halt the progression of the disease.