George Walker Bush Leadership Style Essay

Barbara and George H. W. Bush are the parents of the 43rd president of the United Sates, George W. Bush. The two were married on January 6th, 1945 and it was said that they experienced love at first sight when meeting. George Bush Sr. was 17 when married, and Barbara was 16. The two have lived in 29 homes located in 17 cities, and is the first presidential couple to reach 60 years of marriage. Barbara’s background includes working a summer job sorting nuts and bolts during World War II as well as working at the Yale Coup while her husband was attending the college, and until her first child was born. She is the second woman in history to have both a son and husband serve as president of the United States. George H. W. Bush served as the 41st president, as well as numerous other positions within our government. Some of these include vice-president to Ronald Reagan, director of the CIA, congressman, ambassador to the United Nations, and chairman of the Republican National Committee. Besides these governmental positions he was also a pilot in the navy as well as an oil businessman in Texas. George Walker Bush was born on July 6, 1946 in New Haven, Connecticut. He was the oldest of his five other siblings: Pauline (Robin), John Ellis (Jeb), Neil, Marvin, and Dorothy (Doro). George’s sister Robin died at the age of three from leukemia when George was only seven years old. His brother Jeb would also go on to become the 43rd governor of Florida. In 1948, George Sr. and Barbara moved the family to Midland, Texas, where H. W. would make his fortune in the oil business. George attended private school in Massachusetts where he was a great athlete in baseball, football, and basketball. He was good in school, but was also known for being a bit of a troublemaker. He went on to be accepted to Yale University where he was the president of the Delta Kappa Epsilon fraternity, played rugby, and was a member of the secretive Skull and Bones society. Two weeks before graduation George enlisted in the Texas National Guard. Although there is a lot of speculation as to whether or not he completely fulfilled his duty, he was honorably discharged in 1974. In 1977, Bush met Laura Welch and married her after only three months. The couple has two children together, twins Jenna and Barbara. Family is huge to George, and he attributes Laura for stabilizing his life and helping him to give up alcohol in 1986. As for George W. Bush’s leadership style, many things through his life have affected how he chooses to lead. In 1978 he lost in an election for a House of Representatives seat in Texas, which helped him to humble himself and realize that things would not be given to him just because of his father. He helped with his father’s presidential campaign in the year 1988, and this helped him to learn the ins and outs of campaigns as well as doing the dirty work required of such a position. After this, George bought a share of the Texas Rangers baseball team and served as managing general partner for five years, where he learned how a business works and runs. He became governor of Texas in 1995 and served until 2000, when he won the presidential election on the republican ticket. He served two terms as president, and dealt with disasters such as Hurricane Katrina and September 11th. George has been quoted speaking about Katrina saying, â€Å"Throughout the area hit by the hurricane, we will do what it takes, we will stay as long as it takes, go help citizens rebuild their communities and their lives†. George W. Bush’s leadership style can be described as problem solver, delegator, decisive, visionary, and composed. He was a problem solver because he believed that getting problems solved right when they needed to be was key, and did not push them off until the next person came around to fix it. As for delegator, Bush was good at knowing when it was his place to get something done, or when he should let someone else take over the job for him. George was a decisive leader in that he made tough decisions throughout his presidency, but always did what he believed was best for our country. Visionary is one way to describe his leadership style seeing as he had a clear vision set out at the beginning of his presidency for how he wanted our country to run, and this is something that he is known quite well for. Lastly, during Bush’s presidency he had to lead our country through two terrible incidents. Through all of this, he was able to maintain his composure and remain an effective leader through tough times, which shows his composure as a leader. One of the things that George W. Bush is most well known for would be his speech that he gave at the sight of ground zero a few days after 9/11. I can hear you; the rest of the world hears you. And the people who knocked down these buildings will hear all of us soon. † I believe that this quote from him helps to show all of the different leadership styles that he exhibited throughout his stint as governor of Texas as well as president of the United States. Nowadays, you can find George spending time with his wife Barbara on his ranch in Texas. He recently wrote his book, â€Å"Decision Points† and had a library put up in his name on the Southern Methodist University in the great state of Texas.

A home away from home

Fate simply got me here.. As thrilled as I was at the prospect of finally becoming a university student I was equally depressed for not knowing anybody, I was at a crossroads simply caught in the struggle of finding myself, flung who am I and who I want to be. It was a tough experience I won't Ill yet It was worth It and It still isle Every day Is a new adventure, a day simply never ends without learning something new, meeting a new friend, and coming a better version of myself.You know as a teenager all you are Is a reckless human being that's looking for themselves in this life and well, as for myself, I thought that finding myself would be by traveling to some other country and wandering freely. But I never thought that a university can show you what home truly means. Palestine, peace are all encompassed in my definition of â€Å"home† _ Describing the friends that I have made here are beyond words. Why did I relate this to home? Simply, because some friends are family and mine are truly that.Palestine is all about unity, and Bethlehem university is all about that. You see a Christian setting with a Muslim, studying, talking, laughing, making a lifetimes worth of friendships, and simply living In an atmosphere of both Christian and Muslim students without the judgment or racism because we are one and Palestine is unity and peace. Well, unity is what gets you to peace. What is peace if you have the slightest bits of hatred in your heart? I am a Muslim, but I honestly don't think this matters if you look at it from the concept of humanity.Whether you're Christian, Muslim, Jew or whatever is it that you believe in, it doesn't matter as long as you're a good one, a one with the resemblance of humanity. I'm from Hebrew and yes It takes time to get to university everyday and to get past all the flying checkpoints that you never know when they'll surprise you with, but it's worth the struggle every day. Being a Palestinian student under oppression Isn't easy at all, however I try my best as an Individual to get closer to peace and freedom. And for myself, the only way to get there is education.With education you can do anything you want. You can conquer the world if you set your mind to it. No one can deny what you did for the know I'm Just a student, but if you look at it from another point of view, trifles are what make a change. Life has much yet to give you, you Just got to be patient. For me Bethlehem University is how life is awarding me. It's my home, the place where I feel like myself, the place that I know is my first step to making a change and have myself leaving my footprints in this world. Bethlehem University truly is a place of opportunity. Mira Aimer

Assessment and process of medical education

Assessment and process of medical education Assessment plays an important role in the process of medical education as it is an effective tool which detect quality in students training to motivate and direct them to what they must learn(1). â€Å"Assessment drives learning† this statement focus on the essential role of assessment as well planned and implemented assessment has an important steering effect on learning because it transfers what is important to learn and motivate students for learning(2). Many people argued that as the curriculum should be the key which motivate learning while assessment should be designed to be sure that learning outcomes have occurred, So assessment tool must has clarity of the learning purpose and must be designed to drive educational intent and maximize learning(3). Constructive alignment is an important influential idea in which the students construct meaning from related learning activities and teachers apply learning environment which support planned learning activities to achieve th e intended learning outcomes(4). So constructive alignment makes the teaching systems consistent when curriculum, learning activities and assessment methods are aligned with intended learning outcomes(5) . Moreover, assessment may reveal learning outcome which isn’t expected but it is recognized as important outcome, so it must be integrated into the intended learning outcome as emergent outcome(6). Formative assessment promotes deeper learning as it provides students with feedback to encourage them to know their strength and weakness which reinforce students internal motivation to learn and improve their knowledge and skills(7). Summative assessment is a final assessment which determine the rank-order students and decide grades(1). Wass et al(7) argued superficial learning which aim mainly on passing the examination and they emphasized on the importance of feedback on students assessment which encourage student reflection and deep learning. However, Epstein(8) showed that su mmative assessment influence learning even in the absence of feedback as students study what they expect to be tested on. Although formative and summative assessment are stark in contrast, they are both necessary and distinction between them should be made to detect which assessment is suitable only for formative use or have sufficient rigorous for summative use(7). Van der Vleuten and Schuwirth(9) emphasized that formative and summative assessment can be used with little difference with focusing on the development of comprehensive assessment programme in which both encourage learning and right decision about learners. I will focus my writing on written assessment as I am involved in assessing written examination of MSc of Radiology scince 5 years. According to Miller pyramid we use written assessment to assess the domain of cognition, either factual recall of knowledge â€Å"knows† or application of knowledge and problem solving â€Å"knows how†. We use written assess ment in the form of essays and multiple choice questions in formative assessment of the residents and in summative assessment of final exam. Our final written exam formed of two papers of essays, each one formed of four essay questions with three hours duration for each, and third paper of 20 multiple choice questions with one hour duration. When we prepare a written exam we identify the level of residents training to apply test which assess knowledge appropriate to students experience.

Femicide, the deliberate killing of females Speech or Presentation

Femicide, the deliberate killing of females - Speech or Presentation Example The researcher states that beside misogyny, there can be other motives for the killing of females which include pleasure, anger, revenge, malice, jealousy, arguments, separation, sexual assault, robbery, and the exuberant feeling of finally being dominant and triumphant over a female. In terms of the perpetrator, it could be any male such as the father, the husband, a boyfriend, a close friend, an acquaintance, a brother, a lover, or even a complete stranger. In almost all cases, there is a gender-related issue behind the killing and usually accompanied by a victim-perpetrator type of relationship and a prior history of either verbal, psychological, or physical violence. This is a gender-selective violence that often includes the rape, torture, and mutilation of victims. Femicide can be viewed within the larger context of the gender wars as manifestation of a stringent form of anti-feminism, designed to terrorize women into submission. It is also a part of the larger cultural context where women are expected to be pure, submissive, always ready to obey the wishes of the men, and especially in the Chicano culture, to adhere to three Marias concept and avoid being labeled into the third Maria category. What is happening at the Ciudad Juarez in Mexico is a very visible form of this bias against the female gender. As stated earlier in the previous page, there are many motivations in femicide. In the global context where religious and social norms can take a jaundiced view of female killings such as honor killings in many under-developed countries, a female who committed a sin that is seen to dishonor the family can redeem such honor by becoming the ultimate sacrifice. The male family members will even do the actual killing or consent to it if perpetrated by another person, as family honor is the paramount consideration only and not suffer from shame. The problem of femicide is a global phenomenon, although world attentions is much focused on what is presently happening in Ciudad Juarez due to the activists and feminists. It forms a part of the larger problem of human rights violations, and in particular, the violations of women's rights and the curtailment of those rights by whatever means necessary. Femicide can be seen as social prejudice against females, going back to antiquity when monarchies are passed down from generation to the next generation by primogeniture, or right of a first male offspring to inherit the kingdom through the divine right to rule. This bias also manifests in a lot of modern institutions, where previously only males were qualified and accepted, such as the military organizations in prior years which barred all women from combat roles or assuming command positions. The Catholic Church is example of this gender discrimination, not allowing women priests to be ordained and serve. India and China both have a strong cultural

Fair value Essay Example | Topics and Well Written Essays - 2000 words

Fair value - Essay Example value measurement, there is need to know the meaning of fair value which is basically â€Å"exit price of† a market transaction rather than specifically applicable only to an entity. Said fair value depends basically whether or not there is an active market or not but preferably the exit price must be that of active market, if there is any. Thus if there is active market, the exit price would refer to quoted prices for identical assets or liabilities that a company or entity can access at measurement date. Thus if there is no active market, that which is observable or objective available should be the basis for said fair value as much as possible. However, IFRS categorizes the fair value into three (3) inputs which are arranged in hierarchy giving priority giving the highest priority to (adjusted) quoted prices in active markets for identical assets or liabilities and the lowest priority to unobservable inputs as provided or in IFRS 13:72 (Deloitte 2014a). When it is required to use fair value? It is required for certain assets and liabilities as implemented in each IAS or IFRS issued by the IASB. As such, the measurement and disclosure requirement under IFRS 13 do not apply to the following according to IFRS 13.6: (1) Share-based payment transaction within the scope of IFRS 2 – Share-based Payment; (2) Leasing transactions within the scoped of IAS 17 – Leases; (3) Measurements that appear similar to fair value but are not the same, such as the net realizable value in IAS 2 – Inventories, and; (4) Value n use in IAS 36- Impairment of assets (BDO, nod) When it is permitted? It is permitted as provided for certain assets and liabilities also as implemented by specific IAS or IFRS issued by IASB. In both cases however, there is a requirement of disclosure about the fair value measurement being used by the entity (Deloitte, 2014a). In so applying the categorization of inputs to measure fair value using different levels of the fair values

Valuation of Securities Essay Example | Topics and Well Written Essays - 2250 words

Valuation of Securities - Essay Example 500,000, then I have to look at the options available to me and perform a detailed analysis of each. This would allow me to determine which is best considering the risk and return profile of each option. I have made the decision to assess a life insurance investment option and a fund which I will manage on my own. Other investments which could be considered include bonds, shares and mutual funds. Life Insurance Investment Investing the amount of ?500,000 saved with a life insurance company may allow me to receive a stable income on an annual basis with an adjustment for inflation. The insurance policy that my insurance agent recommends is one that will pay me an annual sum that allows for an inflation adjustment and allows for the balance to be paid to my estate when I die. This information is presented in Table 1. Year Initial Investment/ Balance (?) Interest rate Inflation rate Capital Growth (?) Withdrawal (?) Balance (?) 0 500,000.00 0.04 0.03 0.00 0.00 500,000.00 1 500,000.00 0. 04 0.03 520000.00 15000.00 505000.00 2 505,000.00 0.04 0.03 525200.00 15450.00 509750.00 3 509,750.00 0.04 0.03 530140.00 15913.50 514226.50 4 514,226.50 0.04 0.03 534795.56 16390.91 518404.66 5 518,404.66 0.04 0.03 539140.84 16882.63 522258.21 6 522,258.21 0.04 0.03 543148.54 17389.11 525759.43 7 525,759.43 0.04 0.03 546789.80 17910.78 528879.02 8 528,879.02 0.04 0.03 550034.18 18448.11 531586.07 9 531,586.07 0.04 0.03 552849.51 19001.55 533847.96 10 533,847.96 0.04 0.03 555201.88 19571.60 535630.28 11 535,630.28 0.04 0.03 557055.50 20158.75 536896.75 12 536,896.75 0.04 0.03 558372.62 20763.51 537609.11 13 537,609.11 0.04 0.03 559113.48 21386.41 537727.06 14 537,727.06 0.04 0.03 559236.15 22028.01 537208.14 15 537,208.14 0.04 0.03 558696.47 22688.85 536007.62 16 536,007.62 0.04 0.03 557447.92 23369.51 534078.41 17 534,078.41 0.04 0.03 555441.55 24070.60 531370.95 18 531,370.95 0.04 0.03 552625.79 24792.71 527833.08 19 527,833.08 0.04 0.03 548946.40 25536.50 523409.90 20 523,409.90 0.04 0.03 544346.30 26302.59 518043.71 403055.62 Table 1:- Investment in Life Insurance Policy The information in Table 1 indicates that the policy will run for 20 years. It is assumed that the interest rate for the period would be 4% and the inflation rate - 3%. An amount of ?15,000 will be paid in the first year after allowing for inflation. If I die at the end of the first year my estate will receive a total of ?505,000. If not the annual payments will increase year after year to an annual payment of ?26,203.59 in the 20th year. At that time the balance on the account would be ?518,043 which would be paid to me or my estate if I die. The information in Table 1 also indicates that the balance on the policy would increase up to the 13th year but would start declining thereafter. My total receipts from this policy from year 1 to year 20 would be ?403,055.62 leaving a balance of ?518,043.71. This suggests that after 20 years I would have received a total of ?921,099.33 (?403,055.62 + ?518043.71). Therefore, I would gain a total of ?421,099.33 on my investment. Manage Funds Personally In the event that I choose to personally manage my funds I would want to diversify the risks involved by investing in a mix of government bonds and shares. Government bonds are basically risk free while investment in shares is considered to be risky. I would want to consider a 50:50 mix since I am hoping to get high returns that would be able to

Insurance company Bupa Research Paper Example | Topics and Well Written Essays - 3000 words

Insurance company Bupa - Research Paper Example It would be followed by discussions which would help in concluding that whether the perception from the literature review and the results of the analysis are in line or not. The study would be concluding with an insight into the conclusion derived from the entire study. Table of Contents Abstract 2 Table of Contents 3 Introduction 3 Objectives of the study 4 Company Introduction and History 4 Bupa’s journey in Saudi Arabia 4 Problems faced by Bupa initially 5 How does Bupa manage success? 5 Challenges faced by Bupa in Saudi Arabia 6 How they manage their success in Saudi Arabia? 6 Literature Review 6 Financial Information 9 Framework of the Study 10 Analysis 10 Discussion 10 Recommendations 11 Conclusion 11 References 13 Appendices 14 Appendix 1: For the managers 14 Appendix 2: For the customers 30 Introduction Health or wellness always remains one of the most concerning issues because chronic diseases have increased in number in today’s world and is continuing to incre ase even further. Presently, there have been increased health problems related to obesity as well as heart disease. The other concerning diseases include diabetes, cardiovascular diseases, cancer etc. This increases the necessity of the efficient services of the healthcare organizations in order to provide remedies to these concerning issues. It also raises the demand on the insurance covering the individuals. Objectives of the study The objectives of this study are: To understand the past and present situation of Bupa. To analyze the challenges faced by Bupa from global perspective. To analyze the challenges faced by Bupa in Saudi Arabia. Company Introduction and History BUPA is an international corporation which provides healthcare services to more than 14 million customers in almost 190 countries. It is headquartered in London, United Kingdom. The company is privately owned and acts as an alternative to the United Kingdom National Health Services (i.e. NHS). The company was actua lly established in the year 1947 when seventeen different British provident associations united together for providing healthcare services to the general public. The actual services offered by the company included private medical insurance facilities which gradually expanded towards running BUPA hospitals. The healthcare organization initially had registration of 38000 which increased to 14 million customers all over the world. It has become one of the leading private health insurance servers in United Kingdom. Gradually the organization has implemented diversification in its services from the health insurance business to international healthcare organization providing healthcare services to a large number of customers. Bupa’s journey in Saudi Arabia Bupa Arabia is a cooperative insurance provider in Saudi Arabia. It is a publicly traded organization having a paid up capital of SR 400 million. It provides health insurance by remaining in compliance with the necessities in Sau di Arabia Monetary Agency and Cooperative Health Insurance Council. It was started as a joint venture with ‘Nazer Group’ in the year 1997. Presently it is the biggest health insurance provider in the entire region having greater than 1.2 million customers. Under all the insurance regulations, the organization has started evolving its business from joint venture to the public listed company that is providing cooperative

Philosophy Essay Example | Topics and Well Written Essays - 2000 words

Philosophy - Essay Example he possibility of the program itself, that is, the general program which is what constitutes the context of the picture theory of meaning is ascribe and ascertain a "totality of facts". He claims at the outset of the text that "the world is the totality of facts, not of things"[Tract. 1.1]. So, to take this absurdity one step further, a metaphor is necessary to describe this wider program. Wittgenstein's picture theory, once reduced to being either factually true or factually false, is equivalent to an attempt to draw a map of the world on a 1:1 ratio. That is, a picture perfect image where there is no discernible difference between the difference of the description of things, alongside with the very description itself. This is of course, close to being impossible, the world which Wittgenstein is referring to is a world of "facts", and the picture theory of meaning is one which is not describing the world of the senses, although the senses can often perceive factually true phenomena. To use a metaphor from a fairly obtuse philosopher, Martin Heidegger, there is a distinction between the "earth and world" for Wittgenstein, and if one mistakes his world for the earth (or, that which is perceived by the senses), then, one lapses into viewing the totality of facts as pictured, as achieving nothing less than a map of the earth on a 1:1 ratio. This is of course absurd, which is in a sense why one has to view the Tractatus as a type of idealism., and more importantly a theory of ontology or of the nature of reality. Further, his concern resembles more of a possible world than an actual world in this regard, and one might phrase this program in the following way: supposing one wanted to exhaust the possibilities of truth, what type of formal system along with its... Exhausting the limits of reason concerning reality, perhaps there is another and more ‘silent’ means which Wittgenstein sought in order to establish to fulfil what Max Black refers to as the â€Å"metaphysical obsession†. It is ultimately difficult to ‘transcend’ the ‘otherness’ of social existence, or social life, and therefore, such an attempt can really only provide for a state of alienation, and arguably a form of false consciousness. Heidegger characterizes human existence as 'being-in-the-world'. This expression contains two notions: 'being-in' and 'in-the-world'. Thus, human existence is essentially 'being-in'. It involves the idea of 'there'(Da). So human existence is the 'Da' of the 'Sein' of the world. The main concern, of this section is to dwell on the nature of Dasein by analyzing the way in which Dasein is in his 'there', viz., his 'being-in'. In elaborating this point, we will consider the meaning and modes of Dasein's 'being-in' and knowing the world as a typical mode of Dasein's 'being-in'. concepts which are essentially a private language? The language of everydayness is important because it says a lot about what Heidegger meant by language. That is, even though what was being talked about had a somewhat negative connotation. The line between the social and the individual is one that is at the forefront of consideration. 'Being in the World' is a fundamental fact about human existence, but so too with finitude. Part of being socialised, involves a relationship with language and one of the forms or types of language that Heidegger is most critical of, is the language associated with the throwness of everydayness, which is a mouthful. Our struggle with language as individuals, is a struggle with finitude or our own finitude which stands as a 'fact' about our ontology.

Marketing Article Example | Topics and Well Written Essays - 250 words - 1

Marketing - Article Example For this reason, a survey was conducted among the customers of three travel agents in Indonesia. In total, 215 customers participated in the survey. The survey aimed to reveal the relationship between the marketing mix and the consumer decision making especially in regard to travel agents. After analyzing the findings using three different methods of analysis, Satit et al. (2012) came to the result that only two from the 4P’s of marketing mix influence customer decision making in the particular sector: product and price. 3) The article addresses a particular aspect of marketing, the marketing mix. It should be noted that the mode of marketing mix chosen in the above study is the 4P’s, i.e. product, price, place and promotion. At the next level, the article discusses the potential value of the 4P’s for the consumer decision-making process. In other words, not all aspects of 4P’s are explored, but just the relationship of 4P’s with the above process. At the same time, the use of 4P’s as a marketing tool is evaluated specifically in regard to travel agents in Indonesia. Although a specific industry is involved, the findings of the research, as presented in the above article, could be used for understanding the value of 4P’s in other industries also. 4) Through this article I have learned that marketing mix can be valuable in a high range of industries; still, the level at which marketing mix can contribute in the development of each industrial sector is not standardized. For example, in the case of travel agents, only two elements of marketing mix have been proved to be powerful to influence the consumer decision making process: product and price. In other words, marketing mix can serve as a tool for promoting business performance. But before adopting this tool for achieving such target it would be necessary to review the

Murderers Research Paper Example | Topics and Well Written Essays - 500 words

Murderers - Research Paper Example Again, the main motivation for serial killing is the attainment of psychological gratification. Ted Bundy has been chosen as the epitome of a serial murderer. Known by his full name Theodore Robert Bundy (November 24th, 1946- January 24th, 1989), Ted Bundy was an American serial murderer, kidnapper, rapist and necrophile. By the 1970s, he had murdered and assaulted several girls and young women. Although Bundy denied his criminal exploits for decades, yet he later confessed before his execution, of having committed 30 homicides between 1974 and 1978, and in seven states. However, the actual number of Bundy’s victims remains unknown, and is deemed to be higher. It is observed that Bundy used his charisma and good looks to lure his victims into his deadly traps (Holmes and Holmes, 2009). Ted Bundy was born on November 24th, 1946 to Eleanor Louise and an unidentified father by the name of Lloyd Marshall, at the Lund Family Center. For the first 3 years, Bundy’s maternal grandparents took care of him in Philadelphia. Later on, Eleanor Louise changed her name, ran away with Ted to Tacoma, Washington where he met and remarried Johnny C. Bundy, then, a hospital cook. Records reveal of Bundy having been arrested twice on suspicion of car theft and burglary. From 1974, his earliest documented act of homicide was entered. The crimes that Ted Bundy committed are multiple, and include serial killings, kidnappings, rape and necrophilia. It is not known exactly how many young women and girls Bundy killed, but documents show that he confessed having murdered (at least) 30 of them. Some of Bundy’s victims include Karen Sparks (Joni Lenz), Lynda Ann Healy, Dona Gail Manson, Brenda Carol Ball, Georgeann Hawkins, Denise Naslund, Nancy Wilcox, Melissa Smith, Debra Kent, Caryn Campbell and Susan Curtis. According to Newton (2009), a Utah highway Patrol officer arrested Ted Bundy in August 1975,

Rhetorical Precis Essay Example for Free

Rhetorical Precis Essay In The Organization Kid, an article published in The Atlantic Monthly in April of 2001, David Brooks discusses the willing conformism and social subservience of the educational elite and reinforces his points through usage of a heavily pathos-based timeline, quotes, textual examples and statistics. Brooks’ examples are both well structured and particularly effective. He compartmentalizes his arguments, shows instances of change over time and directly and effectively targets the emotions of his audience. Brooks’ masterful usage of tactics and strategies such as this makes the narrative quite effective in terms of emphasizing his main goal: drawing attention to the growing trend of willing subservience amongst the educational elite. Brooks’ statement is indeed quite relevant in reference to major issues in ever-changing modern society. Vocabulary * Prudential – Involving or showing care and forethought, typically in business. * Sacrosanct – Regarded as too important or valuable to be interfered with. * Meritocratic – Government or the holding of power by people selected on the basis of their ability. * Nihilism – The rejection of all religious and moral principals, often in the belief that life is meaningless. * Ganglia – A structure containing a number of nerve cell bodies, typically linked by synapses, and often forming a swelling on a nerve fiber. Tone * Critical * Analytic * Factual * Condemnatory Rhetorical Strategies * Hyperbole – â€Å"soul crushing† * Asyndeton – â€Å"there are pesticides on our fruit, cigarettes in the school yards, rocks near the bike paths, kidnappers in the woods.† * Alliteration – â€Å"Baby Boomers† * Personification – â€Å"the argument speaks† * Simile – â€Å"like flies to a light† Discussion Questions * Clarification – Why does the author draw different conclusions regarding societal issues at the end of the narrative than he at the beginning? * Style – Does the writer’s style of citing sometimes-unrelated information to support his argument act as beneficial or detrimental in regards to emphasizing his points? * Application – While the author certainly made his perceived issues with today’s society quite clear, he never exactly expanded on what he would do to repair it. What do you believe would be the best course of action to take to restore the missing sense of the â€Å"ultimate challenge† and â€Å"ultimate reward†? Important Quotation â€Å"The most sophisticated people in preceding generations were formed by their struggle to break free from something. The most sophisticated people in this one aren’t.†

Mice and Men Essay Example for Free

Mice and Men Essay John Ernst Steinbeck was born on 27 February 1902, in Salinas, California, USA. The Salinas River is mentioned in the first line of Of Mice and Men. The whole novel is centred on the landscape around Salinas. Steinbeck was the third of four children, of mixed German and Irish descent. His parents owned a considerable amount of land, and his mother was a schoolteacher who encouraged him to read widely. His background was neither rich nor poor, and his parents wanted him to follow a respectable career. John Steinbeck wrote the novel called Of Mice and Men. It was published in the depression years of the 1930s. Steinbeck raises questions in the mind of the reader that the novel would be based on loneliness. The first line read A few miles south of Soledad. This is a clever idea by Steinbeck as Soledad means loneliness in Spanish. John Steinbecks family was wealthy, but was interested in the lives of farm labourers. It gave him a inspiration to write books about migrant workers. He could of been a doctor or a teacher but he chose to become an author. John Steinbeck must of met a lot of people like Lennie and George, so he has ideas to write a good book. The historical context of the novel is that its all about the depression years in the 1930s. It was illegal to be unemployed. People living in the 30s didnt have a choice but to go to work. The main characters in this story are George and Lennie. They travel around together, share their minds together, and what ever trouble Lennie gets into, George had to get him out of it. George didnt like Lennie that much because of all the trouble that he gets into. He didnt want to stay with Lennie, but his mother told George to look after him. Lennie was always trying to find a good opportunity to go off alone in the hills. George didnt want that, he liked Lennie as a friend, but Lennie gets into too much trouble. But they always say; You got me, and I got you. This novel called Of Mice and Men was set in a town called Soledad. It meant Lonely in Spanish. The ranch is located in the middle of no where. Its 4 miles to the town. The characters in this novel are ranch workers who are described as lonely. Ranch work is not long term. All of the workers except for Candy and Crooks are only passing through. When George and Lennie get jobs, the boss is suspicious of them because they look like theyve known each other from somewhere and are close friends. The other ranch workers see that George is always answering for Lennie. But they cannot understand why they are always together. George says that ranch workers are the loneliest people in the world and dont belong nowhere. In this paragraph, Im going to write about Crooks. Crooks is a black guy. Hes not allowed to stay in the bunkhouse with the other ranch hands because he is black. He doesnt have the same status as the other white workers. Crooks was also excluded because he suffered an injury and so is not as capable as the other ranch hands. His possessions show that he is lonely. Everyone can see that because he loves to read his books but was excluded. Crooks doesnt like when Lennie tries to talk to him. Crooks get angry every time he tells Lennie to go away from him. But after that, he admits that he is lonely. Lennie will also get lonely and even sick when no one is with him. He needs someone beside him all the time so that he feels supported. For this, he always wants George. In this paragraph, I have looked at the way Crooks treat other people and what his appearance looks like to everyone else. I will now write about Candy. Hes an old man who wants to join up with George and Lennie and get a place where they can live. Candy provides a parallel to George and Lennie in that he relies on his dog Im so used to im (p.46) just as George and Lennie are an elevated version of a master/dog relationship. Candy clings to his dog, despite all that logic and common sense dictate. He loves to be with his dog because he had him since he was a puppy. It was the best sheepdog he had ever had. The other workers didnt realise the relationship between Candy and the dog. It meant nothing to everyone except for Candy. Theyve been together for all of Candys life. But now Lennies life has ended. Candy cleans out the farm buildings, and shows George and Lennie the bunkhouse. Candy lost his hand whilst working on the farm, and was allowed to stay on in this lowly position as cleaner. Candy soon asks George and Lennie if he can come in with them. George said We werent thinking of a third person. Cause we was gonna do it on our own. George knew that it was owned by old people who might be willing to sell it for $600 or so. Candy confesses he has $350 saved up and asks if he can come in with them. George really begins to believe that his dream might become a reality. He needs to work for another month or two and not spend anything so that they will have the stake to buy the farm. This will be good for Candy because then he can live a happy life and avoid the loneliness in the life of a ranch worker. Hes worked here for so long and wants to change his miserable life and make it peaceful. Candy was moaning that he just let a stranger shoot his dog. By the look of him, he could see that Carlson didnt like the smell of Candys old dog. Carlson asks Slim to give Candy one of the other pups so that the old dog can be shot. Once the dog has been shot, he feels strong pressure because he had him since he was a pup. When George and Lennie were talking about their dream, Candy steps in and instead of being sad, George and Lennie gives pride and gives Candy more confidence. In this paragraph I have explained Candys life and the way he lives. I am now going to write about Curleys wife. She doesnt like Curley very much and wants to go elsewhere but cannot because of Curley. The other ranch workers avoid Curleys wife as they know that if they befriend her, they will get into trouble. She also said that she could hang Curley at anytime if she felt like it (Showing that she can be dangerous as well as Lennie). She also visits the bunkhouse a lot, she wanted company, but had to ask where Curley was. On Saturday nights she is left at the ranch alone. When she is left alone at the ranch, she tells everyone about her life and story. Its very miserable for Curleys wife. She tells everyone the truth that she doesnt really like Curley. Everyone else has names except for her. She has to be called Curleys wife. That is why she doesnt appear much in the story. Shes being treated like an object. Slims dog name is Loulou. We have looked at the character of Curleys wife and how she got on. George and Lennie are different to the other ranch hands. The way they respond to each other shows very close friendship. Lennie always get into trouble and George is there to get him out of it. They share a dream together of working and then getting a lot of money so that they can live comfortably in the place that there going to get. Every time George says Were gonna get the place. Lennie gets very excited and says I get to tend the rabbits. But when George is about to shoot Lennie, he keeps saying this so that Lennie puts his mind fully onto the house in his head and imagining him tend the rabbits, George wanted this because when he looked the other way, there was a time to shoot him. George wanted him to see it as he is talking. It was related to the shooting of Candys dog too which gave George more confidence in shooting Lennie. But at the end, it is George who will feel guilty. George often insults Lennie and gives him hell, but he doesnt really mean it. Although he often talks about how well off he could be without Lennie he secretly doesnt want Lennie to leave, and when Lennie offers to do so in the first chapter, George virtually pleads with him to stay. This is because George also depends on Lennie to a certain extent for his unconditional friendship. I didnt think that Steinbeck would make George shoot Lennie. At first, those two was good friends, I thought they would actually get that bunkhouse. But it ended in a bad way. It made the readers / watchers feel shocked and feel that his life has ended with just one shot. George always gets annoyed of Lennie and Lennie says that he will go up to the hills. George knows that hes the only one who has to get him out of trouble. But then decides if Lennies gone, then he can have total freedom and do anything he wants. At the end, it might of been a mistake to shoot Lennie. The first paragraph tells us about the introduction of John Steinbeck. It tells the readers what is going to happen. The second paragraph describes the setting and ranch workers. Its the setting of the story and the ranch workers. The third paragraph lets the readers understand Crooks. It also describes his ethnic group and his rights. The fourth paragraph tells us about Candy. It tells the readers about his loving dog and his dreams towards the ranch. The fifth paragraph also describes Curleys Wife. The way she acts in the story, and how lonely she is. Finally, the last paragraph tells the readers about the friendship of George and Lennie. It tells us how George and Lennie travel together, live together and the trouble that they get into. It also summarises George and Lennies dream. John Steinbeck is trying to say that life in the 1930s in California was lonely. He doesnt just write it down, because that will just give the point away. He wants the readers to imagine it for themselves.

Nurse-led Clinics in Respiratory Care: a Literature Review

Nurse-led Clinics in Respiratory Care: a Literature Review INTRODUCTION 1. What is a nurse-led clinic? As the coined term suggests, a nurse-led clinic is a health care centre in which nurses are involved in high level specialist procedures and assessments. In such centres, nurses are the critical decision makers, being involved in patient care at the micro-, meso-, and macro-levels. While the role of the physician in the provision of health care is undisputable, the deity-like status that medical practitioners typically have in the mind of patients, coupled with the limited time available for individual patient consultations, make it hard for these group of health care professionals to tackle the ‘softer’ side of patient care. Nurses, on the other hand, defined by the Oxford Medical Dictionary as health care professionals that are trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines, are better placed to provide this essential follow-up, especially in the care of patients with chronic dise ases. According to Hatchett (2003), a nurse-led clinic is a clinic in which nurses have their own patient case loads of whom they take complete charge. Hatchett broadly describes the components of such a clinic. There would be an increase in autonomy associated with the nursing role in the nurse-led clinic, with the power to admit, discharge or refer patients, as appropriate. In Hatchett’s own words, the roles which nurses adopt in these revolutionary settings can be broadly classified as follows (Hatchett, 2003): Education Psychological support Patient monitoring The initiation of nurse-led initiatives probably owes its origins to the rise in nursing specialties in the United Kingdom. Throughout primary and secondary care, nurses are taking senior positions in health care institutions, such as nurse specialists, nurse practitioners, nurse consultants, nurse prescribers, etc, leading to a marked change in service delivery and the profile of the nursing profession. In addition to the usual registered nurse training, nurses working at higher levels of practice receive training to acquire a range of other medical skills such as physical examination and medical history taking in order to recognise abnormal clinical findings. In a two-phase exploratory study to evaluate the domains of structure, process and outcome of nurse-led clinics in supporting intermediate care after the acute phase of disease, Wong et al (2006) interviewed nurses from 34 clinics and 16 physicians and observed 162 nurse-led clinic sessions. Their findings demonstrated the high level of skill and experience of the nurses who ran the clinics. Their work involved skills such as adjusting medications and initiating therapies, and diagnostic tests according to protocols. Interventions included assessments and evaluations, and health counselling. All patients studied showed improvement after the nurse clinic consultation, with the best rates reported in wound and continence clinics; satisfaction scores for both nurses and clients were high. However, although physicians valued their partnership in care with the nurses, they were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. Ultimately, nurse-led clinics provide an integral and invaluable patient-centred approach to the management of chronic disease which build upon skills such as counselling, teaching and health promotion which are key to contemporary nursing practice, as well as newly acquired medical skills. The advent if nurse-led clinics provides an opportunity for nurses to develop enhanced roles in which they can achieve more autonomy in their practice. This can be made a reality if adequate training and education, as well as effective leadership are in place (Wiles et al, 2001). 2. The general roles of nurses in chronic care management The chief nursing officer, Sarah Mullally has proposed ten key roles for nurses in autonomous patient care. These are outlined below as cited by Hatchett (2003): Order diagnostic interventions: just like a medical practitioner would, the present-day nurse is able to ask for laboratory or clinical diagnostic tests to aid the process of diagnosis. Furthermore, a well-trained nurse will also be able to read and interpret laboratory results effectively Make and receive referrals directly: while the all-important roles of nurses are recognised, the need for a multidisciplinary approach to patient care remains key in order to optimise patient outcomes. Accordingly, nurses should be able to recognise the patients’ needs and refer them to the appropriate health care service as required. Similarly, nurses should be ready to accept referrals from other health care disciplines as necessary. Admit and discharge patients for specified conditions, within agreed protocols: in order to make the best use of the often limited hospital resources, a nurse should have the power to recommend patients for hospital admission and subsequent discharge Manage patient case loads: in nurse-led clinics, nurses are also responsible for managing their individual case loads. It is important to delegate patient cases to other members of the team, when necessary to ensure that patients receive the best care possible. Run clinics: the autonomous role of the nurse in a nurse-led clinic includes all aspects of the management and day-to-day running of the clinic. Prescribe medications and treatments: nurse prescribers are able to advise patients on appropriate treatment, based on diagnosis of ailment and individual characteristics and laboratory findings. Carry out a wide range of resuscitation procedures, including defribillation Perform minor surgery and outpatient procedures: especially in injury clinics. While nurses are probably not equipped to carry out full-fledged surgical operations alone, they are trained to conduct emergency processes as appropriate. Triage patients, using the latest information technology, to the most appropriate health care professional Take a lead in the way local health services are organised and in the way they are run Nurses have always been considered as a supplement to the fundamental care provided by medical doctors. In fact, in some geographical regions, nursing roles are limited to menial tasks such as changing bedpans etc. In the new age, the nursing role as we know it is becoming increasingly important with nurses taking on infinitely more clinical roles. This has led to controversial debates with critics arguing that nurses cannot replace doctors in the provision of health care services. As Richard Hatchett very astutely pointed out (2003), the increased autonomy being acquired by nurses is not a bid to compete with medical doctors. Instead, â€Å"it is a case of considering who can provide the most appropriate service to the patient† (Hatchett, 2003). Thus, it is clear that the roles of nurses in chronic care management is very diverse and can be integrated into any nurse-led clinic intervention to the utmost benefit of the patient and all stakeholders. There have been numerous studies on the role of nurses in the care of patients with chronic diseases. In addition, and more specifically, the feasibility and benefits of implementing nurse-led clinics in practice have also been investigated to some extent. In the subsequent sections, we will review the evidence to support these innovative nursing interventions in an attempt to make the best use of health care resources. 3. Nurse-led clinics in the management of chronic care diseases: the evidence The World Health Organization (2002) defines chronic diseases as health care problems that require ongoing management over a period of years or decades. The nature of these disease conditions make it necessary to provide long term care and follow-up for the afflicted patients. Nurse-led interventions have been investigated a wide range of chronic diseases. It could be a logical, user-friendly, cost-effective and practical approach to improving long-term patient outcomes and should be explored fully to maximise the contributions of nurses to the chronic care management. Although this review aims to analyse the effectiveness of nurse-led clinics in the treatment of respiratory diseases, a prior look at the role of these interventions in the management of other chronic care diseases will provide an insight to the general contributory roles of nurses and will serve as a foundation for complete understanding of this state of the art intervention. 3.1 Nurse-led interventions in the management of diabetes Numerous studies have evaluated the benefits and practicalities of nurse-led clinics in the long-term management of diabetes. The renal diabetic nurse specialist is described as an â€Å"essential player† in organising the management of, and to meet, all aspects of need of this group of patients (Marchant, 2002). An unintended benefit of a nurse-led clinic to reduce cardiovascular risk is improved glycaemic control, HbA1c (Woodward et al, 2005). In particular, nurse-led diabetic clinics have been shown to benefit specific ethnic groups. Matthias et al (1998) identified the needs of diabetic patients from minority ethnic groups, such as blacks and Asians and postulated that nurse-led clinics were of particular benefit in this patient group. As epidemiological data show that diabetes is most common in minority ethnic groups (Carter et al, 1996), the importance of these innovative interventions is further emphasised. 3.2 Nurse-led interventions in the management of cardiovascular disease Care of patients with cardiovascular diseases is broad and involves many aspects, from risk factor management (non pharmacological interventions), primary and secondary prevention of clinical events, pharmacological therapy, surgical procedures, etc. Through a large well-designed randomised controlled trial in Scotland, Campbell et al (1998) showed that nurse-led clinics were practical to implement general practice and led to an significant increase in various aspects of the secondary prevention of coronary heart disease. Significant improvements were noted in aspirin management, blood pressure management, lipid profile management, diet and physical activity, regardless of the individual patient’s baseline cardio performance or status. However, surprisingly, there was no recorded improvement on smoking cessation, which would have been a beneficial intervention in most acute and chronic disease states, including respiratory diseases. In addition to the apparent effectiveness of the nurse-led clinics in the long-term primary and secondary prevention of coronary heart disease, the optimal use of nurses in the care of these patients has been shown to be cost-effective in terms of quality adjusted life years (QALYs) (Raftery et al, 2005). In this large cost-effectiveness analysis, although the cost of the nurse-led clinic intervention was  £136 higher per patient, the differences in other National Health Service (NHS) costs was not statistically significant. Furthermore, there were 28 more deaths in the non-intervention group leading to a gain, in the intervention group, in mean life-years per patient of 0.110 and of 0.124 QALYs. 3.3 Nurse-led interventions in rheumatology The role of clinical specialist medical doctors in the care of their patients is unquestionable; however, the role of nurses in the therapy area of rheumatology (i.e. in patients with rheumatoid arthritis) is also well documented. Hill and colleagues (1994) clearly demonstrated the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Although this was a small study with a sample size that only included 70 patients, the statistical significance of the findings of this randomised controlled trial cannot be ignored. In patients managed in the Rheumatology Nurse Practitioner clinic, pain, morning stiffness, psychological status, patient management and satisfaction all improved significantly (p = 0.001; p = 0.028; p = 0.0005; p In addition, patient satisfaction is frequently higher in patients who are allocated to nurse care than those allocated to standard medical care (Hill, 1997). In yet another study by Dr Jackie Hill, a registered nurse at the Academic and Clinical Unit for Musculoskeletal Nursing in the Chapel Allerton Hospital in Leeds, the researchers concluded that a nurse-led clinic is effective and safe and is associated with additional benefits, such as greater symptom control and enhanced patient self-care, compared with standard outpatient care. 3.4 Nurse-led interventions in cancer care The effectiveness of nurse-led care in different common cancer afflictions has been researched variously. An extensive review article by Loftus and Weston (2001) discussed the patient needs that could be met by nurses working in nurse-led clinics and highlighted the experience and skills of advanced nursing practice that make such innovative care a reality. The types of nurse-led interventions are as varied as the different types of cancers for which they are used. These range from nurse-led telephone clinics in patients with malignant glioma (Sardell et al, 2001); nurse-led follow up in patients receiving therapy for breast cancer (Koinberg et al, 2004); and nurse-led screening programmes in Hong Kong Chinese women with cervical cancer (Twinn and Cheung, 1999). In a randomised controlled trial in a specialist cancer hospital and three cancer units in southeastern England, Moore et al (2002) assessed the effectiveness of nurse-led follow-up in the management of patients with lung cancer. The findings of the study showed high levels (75%) of patient acceptability. This negates the possibility of patients’ reduced confidence in nurses’ ability and preference for standard medical doctor care. Clinical outcomes were also greatly improved as shown by less severe dyspnoea at three months (p=0.03), better scores for emotional functioning (p=0.03), and less peripheral neuropathy at 12 months (p=0.05). 3.5 Nurse-led interventions in the management of HIV infection Using a rigorous model of comprehensive care nurse-led clinic in genitourinary medicine to compare nurse-led and doctor-led clinics at a central London medicine clinic, Miles and colleagues (2003) reported reliable and valid results to support the use of the nurse-led variety as an acceptable alternative to the existing doctor-led clinics. More specifically, the British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) advocate the benefits that can be accrued from a nurse-led educational intervention in the care of patients with HIV infection (Poppa et al, 2003). A small pilot study that investigated the effects of a 6-month nurse-led educational programme reported that improved virological responses were seen in treatment-experienced patients (Alexander et al, 2001). While a majority of the studies on nurse-led clinics in other chronic diseases can be broadly applied to nurse-led care in patients with respiratory diseases, differences in the nature of these diseases and the necessary care pathways mean that the extent to which these tested interventions can be applied to other therapy areas is, in actual fact, limited. Government policies that advocate the clinical and economic effectiveness of nurse-led interventions frequently pool together evidence from all therapeutic areas. Indeed, it can be hypothesised that, if nursing interventions are shown be practical alternatives for medical care in complex diseases with poor prognoses, such as cancer, HIV and coronary heart diseases, care of patients with respiratory diseases which generally have better prognoses should be easily, effectively and safely undertaken by qualified and well-trained nurses. Nevertheless, these findings of the effectiveness of nurse-led interventions in the numerous chronic diseases explored in previous sections, should be applied to the different patient population with respiratory diseases. As much as possible, research findings from similar patient groups should be applied in clinical practice in order to ensure that evidence-based practice in this case is relevant. 4. Government policies influencing the establishment of nurse-led clinics Government health policies in the United Kingdom actively support the extension of nurses’ skills into areas such as nurse prescribing and the development of nurse practitioner posts (NHS Plan 2000; Department of Health). Government initiatives that that strive to reduce consultation waiting times and optimise the use of medical practitioners indirectly support the establishment of nurse-led clinics. The Government has endorsed the implementation of nurse-led clinics as a means of increasing access to specialist health care and treatment more quickly and also as an effective way to manage chronic conditions (Hatchett, 2003). In the Department of Health (1999) document, ‘Making a difference’, government plans for strengthening nursing contribution to health care is presented. The Government has launched an ambitious programme of measures to improve the National Health Service and the health of the public, and the role of the nursing profession in this initiative cannot be overemphasised. The key nurse-related points of the document are outlined below: To extend the roles of nurses, midwives and health visitors to make better use of their knowledge an skills – including making it easier for them to prescribe To modernise the roles of school nurses and health visitors in supporting the new health strategy and other policies To see more nurse-led primary care services to improve accessibility and responsiveness The document highlights numerous nurse-led initiatives that have been effectively implemented all around the United Kingdom. A nurse-led minor injury service in rural Cornwall has provided patients with a number of benefits: easier accessibility, reduced waiting times, reduced need for on-site medical; attendance, increased patient satisfaction and reduced need for transfers to local Accident and Emergency departments. Similarly, a nurse-led rapid response team in Peterborough responds to acute crisis cases and allows patients to be nursed at home. Evaluation has shown that 71% of patients referred to this ‘hospital at home’ service would have been admitted to hospital if the service did not exist. Other effective live nurse-led services include a nurse-led rheumatology service in Merseyside and a nurse-led intermediate care unit in Liverpool. Furthermore, several nurse interventions are advocated in the document for contributing to the management of cardiovascular disease. Several of these are also applicable to respiratory diseases; these include: Smoking cessation clinics using national smoking cessation guidelines Healthy lifestyle clinics in collaboration with other health professionals to address factors such as diet, nutrition and exercise, thus improving overall health Care for patients with congestive cardiac failure under ‘home-based’ initiatives Nurse-led chest pain clinics or risk factor screening and reduction clinics Nurse-led blood pressure clinics to identify and help manage blood pressure disorders and medication adherence 5. Review objectives The objectives of this review are: To briefly summarise various studies on effectiveness and cost-effectiveness of nurse-led interventions in common respiratory diseases To critically appraise the methods employed by these studies To evaluate, interpret, and where possible, compare the findings of the various studies To explore the applicability and generalisability of the results to practice in the appropriate patient population To make suggestions for future studies in this area. METHODS Literature search A search of two major databases, MEDLINE and EMBASE, was conducted to identify articles published from 1990 through 2008. Search terms that were used include nurse, nurse-led clinic, nurse-led interventions, respiratory diseases, asthma, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis, cystic fibrosis, cost-effectiveness analysis, cost-benefit analysis, and economics. A secondary search of the reference lists was then conducted to identify relevant articles, editorials, and other unoriginal reports that may have been missed in the primary search. Some studies were excluded based on the following criteria: They were not conducted in patient populations with respiratory diseases Independent nurse-led interventions were not investigated The study populations being investigated were mixed in terms of diagnosis, which would affect the integrity of the study findings for respiratory diseases The methodology and/ or statistical analysis methods were not clearly elucidated 6. Nurse-led clinics in the management of respiratory diseases: a review of the evidence The role of the specialist respiratory nurse has evolved since the early 1980’s with the support of the Royal College of Physicians (RCP 1981). The possible complexity of respiratory patients’ regimens necessitates support with various aspects of their care plans, such as: Supervising nebuliser and inhaler techniques Monitoring progress, i.e. by periodical assessment of lung function and exercise capacity Education on the specific disorder, medications, potential adverse events, etc Counselling and education on positive lifestyle, or non-pharmacological, changes Adherence support and monitoring The role has developed further with nurses providing nurse-led clinics in chronic obstructive pulmonary disease (COPD) and asthma along with nurses providing early supportive discharge and ’hospital at home’ for patients with COPD (French et al, 2003). Some schools of thought argue that nurse-led clinics would culminate in the neglect of the more traditional nursing roles, as nurses focus on a more medical-focused aspect of patient care. However, research in other therapy areas, such as rheumatology (Hill et al, 1994) and mental health (Reynolds et al, 2000) shows that nurses can effectively combine the medical role with the traditional nursing approach. Nursing care strives to provide a holistic approach to care through practical management of disability, education and counselling and referral to other health care services as required (Rafferty and Elborn 2002). 6.1 Bronchiectasis Nurse-led clinics have been evaluated, compared with regular doctor-led clinics, in a single randomised controlled trial in patients with bronchiectasis, a respiratory condition in which there is widening of the bronchi or their branches (Sharples et al, 2002). The study was a randomised controlled crossover trial including 80 patients in a bronchiectasis outpatient clinic. Patients received 1 year of nurse led care and 1 year of doctor led care in random order, and were followed up for 2 years. Various outcome indicators were used in the comparison, including lung function and exercise capacity, infective exacerbations, hospital admissions, quality of life and cost-effectiveness of the intervention. The results of this study are illustrated in Table 1 below. Table 1: Nurse-led and doctor-led care in care of patients with bronchiectasis (Sharples et al, 2002) Measurement outcome Nurse-led Doctor-led Mean difference (95% CI) p-value Forced expiratory volume in one second (FEV1) (%) 1.87 1.86 0.01 (-0.04 to 0.06) Forced expiratory volume in one second (FEV1) (L) 69.7 69.5 0.2 (-1.6 to 2.0) Forced vital capacity (FVC) (%) 87.6 87.6 -0.02 (-1.5 to 1.4) 12 minute walk distance (m) 765 746 18 (-13 to 48) Infective exacerbations (patient years of follow up) 262 (79.4) 238 (77.8) 0.34 Hospital admissions attributable to patient’s bronchiectasis 43 23 0.22 As the table above clearly shows, there was no statistical difference in FEV1/FVC percent predicted or distance walked between nurse led and doctor led care in the two treatment periods. Furthermore, 262 episodes of infective exacerbations were recorded by patients in the nurse practitioner-led care group in 79.4 patient years of follow up, compared with 238 in 77.8 years in the doctor-led care group. Thus, nurse practitioner-led care is associated with a relative rate of exacerbations of 1.09 (95% CI 0.91 to 1.30), p=0.34. Using the St Georges Respiratory Disease questionnaire to assess differences in health-related quality of life between the two groups, there was no statistically significant differences in each of the scores for Symptoms, Control, Impact or total score. Also, the study showed that nurse-led care resulted in significantly higher costs per patient compared with doctor-led care; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs. The authors concluded that nurse practitioner-led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. This study has several potential limitations which could invalidate the findings. As the study relied on patient report to record the prescriptions issued by general practitioners, these may have been underestimated and could grossly affect the cost analysis. Conversely, the nurse practitioner was required to record prescriptions and tests issued at the clinic, and thus these records are probably more reliable and she would be more likely to have ensured that patients left with supplies of routine treatment. Another possible drawback of this study is the use of a crossover design in the methodology. Unless a wash-out period is incorporated in the study design, there is the possibility of a carryover effect with crossover study designs, with the danger that the effects of the earlier treatment is falsely attributed to the final experimental treatment. In this study, there was no allowance for a washout period and thus this could affect the reliability and validity of the study results. This order and time effect needs to be checked for within the analyses but it can rarely be excluded as potential biasing factors (Pocock 1983). However, as recruited patients received the interventions in random order, this may negate the carryover effect. Despite the possible limitations of the study that could potentially hinder its applicability in practice, the findings support the implementation of a nurse-led clinic in patients with chronic cases of bronchiectasis as an alternative to the standard rigid medical care. 6.2 Asthma Similar to the findings in the study by Sharples and colleagues (2002) in patients with bronchiectasis, Nathan et al (2006) more recently compared the effect of follow-up by a nurse specialist with follow-up by a respiratory doctor following an acute asthma admission. In a single centre prospective randomised controlled trial, 154 patients admitted with acute asthma were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. The intervention comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse, and all patients were asked to attend a 6-month appointment. Despite hospital outpatient follow-up, there was a significant proportion of patients in both groups who had exacerbations. However, there was no statistically significant difference between the two groups (Table 2). In the same manner, there was no statistically significant difference in quality of life assessed with two different validated questionnaires, the Asthma Questionnaire and the St George Respiratory Questionnaire. Mean change in peak flow at 6 months was similar between the two groups, probably indicating equivalence of the two tested interventions. Nathan et al (2006) concluded that follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that traditionally provided by a doctor practitioner. Table 2: Nurse-led and doctor-led care in follow-up care of patients admitted with acute asthma (Nathan et al, 2006) Measurement outcome Nurse-led Doctor-led Odds ratio (95% CI) Mean difference (95% CI) p-value Change in peak flow 1.39 (-3.84 to 6.63) 0.122 Infective exacerbations (%) 45.6 49.2 0.86 (0.44 to 1.71) 0.674 Quality of life 87.6 87.6 -0.02 (-1.5 to 1.4) Asthma Questionnaire 0.78 (-0.64 to 2.19) 0.285 St George Respiratory Questionnaire 1.08 (5.05 to 7.21) 0.891 The possible limitations associated with this study is the large amount of missing data for some outcomes, especially peak flow and quality of life

Customs of Amerindians :: essays research papers

Customs Of Amerindians Taino The Taino loved dancing and singing and used the same word for both arieto. They danced and sang to the music of drums, reed pipes and wooden gongs at festivities such as the naming of a baby, the wedding of cacique or the inauguration of a new cacique. Another Taino custom is the flattening of foreheads of newborns. The Taino saw it as a sign of beauty. The newborns heads were bound between two boards to flatten the forehead a few days after the child was born. The Taino played a game called batos, which was played on a marked field with two teams trying to hit the ball with their hips, knees, heads, elbows and shoulders into their opponent’s goal line, was another custom. Kalinago At a son’s birth there was a special ceremony during which the father was cut with agouti teeth and expected to bear the pain without flinching so that his son would grow up to be brave. The boy was periodically rubbed with the fat of slaughtered Tainos so that he might absorb their courage and then he underwent the initiation ceremony, which changed him from a boy to a man, and a warrior. Now he had a new name and was a true Carib. Another custom was the Kalinago used to decorate their bodies with a dye called roucou. This was made from vegetable dye and oil, which the Kalinagos felt toughened their skins and protected against insect bites. Another custom was the Kalinagos entertained many guests and when the guests had eaten their fill they were entertained with singing and dancing to the music of drums, reed pipes and whistles. The guests were welcome to stay as long as they liked and when at last they decided to leave they were given gifts and asked to stay longer. Maya Maya were broad headed and as soon as a baby was born, squeezing it gently between two boards flattened its head. This gave them a noble air and their heads were then better adapted to carry loads. The Maya were also cross-eyed. This was regarded as a special mark of beauty and distinction. Mothers would hang a ball in front of their children so that they would focus on it and therefore develop cross-eyes.

Elizabeth Bathory :: essays papers

Elizabeth Bathory In order to improve her complexion and also to maintain her failing grasp on her youth and vitality, she slaughtered six hundred innocent young women from her tiny mountain principality... The noble Bà ¡thory family stemmed from the Hun Gutkeled clan which held power in broad areas of east central Europe (in those places now known as Poland, Hungary, Slovakia, and Romania), and had emerged to assume a role of relative eminence by the first half of the 13th century. Abandoning their tribal roots, they assumed the name of one of their estates (Bà ¡tor meaning 'valiant') as a family name. Their power rose to reach a zenith by the mid 16th century, but declined and faded to die out completely by 1658. Great kings, princes, members of the judiciary, as well as holders of ecclesiastical and civil posts were among the ranks of the Bà ¡thorys. Adopting an exalted name did not alter some basic familial preferences among lesser lights however, and in order to consolidate more tenuous clingings to influence there was considerable intermarriage amongst the Bà ¡thory family, with some of the usual problems of this practice produced as a result. Unfortunately, beyond the 'usual problems' some extraordinary difficulties arose (namely hideous psychoses) and several "evil geniuses" appeared, the notorious and sadistic Erzsà ©bet the most prominent of them. Truly, she was evil enough to be recognized as one of the original "vampires" who later inspired Bram Stoker to write the legend of Dracula -- but unlike Stoker's story, she was real. Unusual for one of her social status, she was a fit and active child. Raised as Magyar royalty, as a young maid she was quite beautiful; delicate in her features, slender of build, tall for the time, but her personality did not attain the same measure of fortuitous development. In her own opinion her most outstanding feature was her often commented upon gloriously creamy complexion. Although others were not really so equally impressed with the quality of her rather ordinary skin, they offered copious praise if they knew what was good for them, as Erzsà ©bet did not accept unenthusiastic half-measures of adulation; and she was vindictive. She was only 15 when she was 'married off' for political gain and position to a rough soldier of (nevertheless) aristocratic stock and manner. By reason of the marriage, she became the lady of the Castle of Csejthe, his home, situated deep in the Carpathian mountains of what is now central Romania, but which then was known only as Transylvania.

Time For A Change :: Essays Papers

Time For A Change The more that I learn about fossil fuels and their effect on the environment, the more surprised I become about the state of the world we live in. It seems that we live in a time that demands instant gratification. The problem with instant gratification is that the repercussions are seldom thought about. While millions of people think nothing of driving their cars for hours a day, the effects of decades of this behavior are already manifesting themselves around the world. This is particularly true in the United States, where mass consumption of fossil fuels are propagating serious environmental hazards. Perhaps the problem that strikes me as most frightening is the problem of acid rain. The nitrogens and sulfides in fossil fuels that we burn are wrecking serious havoc on the air we breathe. It is horrifying for me to think of rain falling that contains extremely corrosive and damaging factors. If this rain has the ability to corrode buildings, monuments and stat ues, I can only imagine how its long term effects must damage organic matter (Acid Rain, March 2005). It is also difficult to predict the future of this state. Will the problem intensify with time or will the recent slew of clear air acts and proposals have a palpable effect on the air we breathe? Have we passed the point of irreversibility or can we ameliorate the problems that have building over the last decades in the golden age of fossil fuels? Despite the looming problems at hand, I can’t help but feel optimistic about the situation. Technology has gotten us into this problem, and it could very well get us out of it. One breakthrough in technology could easily reduce the incidence of pollution in the long run. With the emergence and surprising popularity of hybrid cars (Hybrid Cars, March 2005) and all the research into alternative fuels such as hydrogen, it seems that the only thing missing is the technology itself. The market is clearly there. Hybrid cars have sold an astounding already. Also, considering the unprecedented exponential rate of technological advance in the past 100 years, it seems almost inevitable that a breakthrough is just around the corner.

My Favourite Hobby

Good afternoon to all the judges, teachers, fellow contestants and audiences. I would grasp this honor today to tell about my favorite hobby. A hobby is a kind of amusement, an interesting pursuit which fruitfully occupies our leisure hours. There are many kinds of hobbies like collecting things, games and sports, photography, painting, reading or even gardening. Hobbies may be constructive, lucrative or even useful, but what really matters is that they provide constructive and interesting recreation. My favorite hobby is collecting stamps. I have a lovely album in which I fix the stamps.I have separate pages for each country. I also have separate pages for stamps on birds, animals, great leaders, historical movements and others. I have about 4000 stamps in all. My friends and relatives who are not stamp collectors will collect stamps for me. This has helped me to collect stamps from all over the world. I also exchange stamps with my friends. Whenever I get two or three identical sta mps, I immediately try to exchange them for one that I do not have. I have managed to collect some very rare and old stamps. Whenever the postal department issues a new stamp or a commemorative stamp, I will see that I buy them.There are many benefits from stamp collecting. The birds, fishes, dresses, people, buildings and other emblems on the stamps tell us about various countries, their culture, the lifestyles of the people and other things. It thus broadens our mental horizons and gives us a peep into history. Whenever I glance through my stamp album and look at my rare collections, I am filled with a sense of pride and joy. My hobby fills my leisure hours with interest and keeps my mind well occupied. My hobby will continue and with the passage of time, I am sure that I will have an extraordinary large stamp collection.

That Contribute to the Unequal Access to Health Care and Escalation of the Health Care Cost

This essay focuses on the comparing and contrasting the obligationalist, involution and symbolic interaction posture on the s advantageouslyness c ar remains in Trinidad and Tobago and its problems. Functionalists card that wellness is essential to the deliverance of the forgiving species and organized well-disposed life. One modal value societies contain the ostracize effects of wellness problems and disease is by means of institutionalizing sickness in a sick role. Conflict theorists honour that some passel achieve ruin health than others because they guard door counseling to those resources that conduct to good health and recovery should they scram ill.And fin in ally, symbolic Interactionist theorists view sickness as a condition to which we attach lovingly devised meanings. For example, an increase number of behaviors that earlier generations be as immoral or unholy ar coming to be seen as forms of sickness the aesculapianization of deviance. Th e minisattempt of health is in the business organisation of promoting wellness and ensuring the availability of quality health distri besidese to the people of Trinidad and Tobago in an afford up to(p), sustainable and equitable manner. Although some advances were made, problems and inadequacies in the preservation of health complaint persisted.In addition, the wellness atomic number 18na Reform Programme was rebeled with the start pop out of decentralizing the health services. The regime of Trinidad and Tobago grows into level the WHO expla nation of health as a state of complete physical, mental and tender well-being and non merely the absence of disease or infirmity. (WHO, 1986). Health keeping therefore, is the prevention, treatment, and man agement of illness and the preservation of mental and physical well-being with and through the services offered by the medical and ally health professions.In an attempt to address the problems the political sympathies of Trinidad and Tobago via the ministry of health implemented, the plan to decentralize the health services which was cultivated by change the policy-making, planning and management capacity of the health arna Separating the provision of services from funding and regulatory responsibilities Shifting usual expenditures and influencing the redirection of offstage expenditures to high priority problems and exist-effective solutions Establishing raw(a) administrative and employment structures, which encourage accountability, ncrease familiarity and appropriate incentives to improve productivity and faculty Educing preventable morbidity and mortality through promoting lifestyle changes and other social interventions. (Ministry of Health, 2000). Functionalism is ground around a number of samara concepts. Firstly, rules of order is viewed as a scheme a collection of interdependent parts, with a tendency toward equilibrium. Secondly, there ar functional requirements that must be met in a confederacy for its survival ( much(prenominal)(prenominal) as facts of life of the nation). Thirdly, phenomena are seen to exist because they serve a function (Holmwood, 200587).Conflict Theory states that the ships company or organization functions so that each idiosyncratic participant and its groups struggle to maximize their benefits, which of necessity conduces to social change such as changes in politics and revolutions. The essence of bout speculation is best epitomized by the unequivocal pyramid structure in which an elite dictates harm to the larger masses. All major institutions, laws, and traditions in the society are designed to apply those who have traditionally been in power, or the groups that are perceived to be prize in the society according to this theory.This potbelly alike be expanded to complicate every societys morality and by extension their exposition of deviance. Anything that challenges the control of the elite result promising be considered deviant or morally reprehensible. The theory terminate be applied on either the macro level (like the US government) or the micro level (a church organization or school club). typic Interactionism Herbert Blumer (1969), who coined the term symbolic interactionism, set out three basic premises of the perspective firstly, Human beings act toward things on the buttocks of the meanings that the things have for them.Secondly, the meaning of such things is derived from, or arises out of, the social interaction that mavin has with ones fellows. These meanings are handled in, and modified through, an interpretive work on used by the person in dealing with the things he/she encounters. Symbolic interactionism is a social constructionist approach to understanding social life that focuses on how reality is constructed by active and creative actors through their interactions with others Functionalism argues that any institution, group, or organization bear be interpreted b y smacking at its commanding and negative functions in society.The positive functions of the health bang frame are the prevention and treatment of disease. Ideally, this would mean the manner of speaking of health handle to the entire people without regard to race ethnicity, social class, gender, age or any other characteristic. tally to arson the function of the health accusation schema is to enable people to be sound enough to do all the things they need to do to keep society functioning. (Talbot Parson, 1951).For example, The Government of Trinidad and Tobago is committed to the directment of a robust, effective and accessible health give care system to go steady that its citizens enjoy long, healthy and deep lives. They will also develop programmes to identify and assess the nations health needs and further the bringing up of our medical health personnel to adequately serve the existence by focalization on disease screening and prevention, health promotion, imp roved management and access to health services. (Ministry of Finance, 2009/2010).Functionalism also emphasis the systematic style that various social institution are related to each other unitedly forming relatively stable character of society (The Health ministrys Chronic sickness Assistance Programme (CDAP)) the government is also involved in health care through institution such as University of the West Indies that funds new explore on various matters of health and health care policy). (TRHA, 2004) for congressman, the introduction of the Tobacco bid Bill is an measurable element of our public health policy.The health care system is notable for a number of negative functions some may argued that the functionalistic perspective on medicine applies only to some conditions and people. It does not address inveterate illness Those that tin to disharmony and instability of society such as the Health risk factors for our population include tobacco use, abuse of alcohol, and wan t of physical activity, inappropriate diet and fleshiness which are common to several chronic diseases.Secondly, And without the current ability to cure patients irrespective of how much they may want to keep up well or their affects may try to make them well, that out get in will not occur. Finally, health care system does not function optimally because of the profit motive(prenominal) that is sometimes at odds with the function of providing health care.For instance, some may not be able to afford the salute to get proper health care and it encourages medical professional to be in charge of treatment, leading, in that it does not back off the growing interest and knowledge of patients who wants to cook an active role with their physician in directing their own health care. The conflict perspective on health care focuses on issues involving equity and tension inside the health care system although these theories loafernot refuse that modern health care can help people in d iscovering or restoring their health.Minorities, the lower class, and the patriarchal oddly elderly woman have less access to health care since they may not be insured (Navarro 1993, 2000) nevertheless, in Trinidad and Tobago such has been eliminated in that, the construction and upgrade of base Care Facilities is another initiative aimed at improving the health delivery system and facilitating the Governments preventive and immemorial care approach to health.Today, there are 103 health centres, strategicalally located to ensure increased public access to what nowadays is an expanded range of primary care services. This also reduces the number of patients at our nations hospitals, thus securing better care services at all institutions and cost savings through more economic use of resources. To the contrary the functionalist argues that relatively greater access of the middle and top(prenominal) classes to medical care is good for society because the upper classes are more u nspoiled to society.For instance Bearing that in mind, it could be argued that since the belief class needs hard workers to bring through their tasks so that the ruling class can become richer, having healthy workers would be beneficial because if a worker is unhealthy they will not be as productive and will be able to bring up as many goods and services as a healthier worker. Symbolic interactionism take a micro look at health care rather than snap on the structure of the larger system or its interrelationships with other parts of the society.The symbolic interactionism holds that illness is partly socially constructed. The definition of illness and wellness are culturally relative. Sickness in one finis may be wellness in another. It is time dependent as well. in addition health care system itself has a socially constructed aspect. The way we behave towards the ill, towards the doctor and towards innovating ventures such as HMO are all social creatures.For instance, Symbolic interactionism has a concept by Calvin Cooley referred to as the feeling Glass Self, we see ourselves in terms of how we are viewed in society. If society views us as ill generally mentally but also physically we may come to perceive ourselves that way and behave accordingly. A person with a physical handicap may come to view themselves as flawed or defective and will behave that way. A person with a mental illness will act the way a person with mental illness s supposed to act. (Kendall, 2007). bolshy perspective it ensures that population remains healthy enough to contribute to the economic system, by working in offices and factories to produce profit for the ruling class. (Haralambos and Holborn, 2000, 295). Marxist theory of dialectic materialism, which explains the struggle of opposites, could have been used to explain the struggle of people to reverse the trend of not been able to afford quality health (Haralambos and Holborn, 2000,945).One can also draw on the hypothetic discussion on social interaction, particularly as it relates to historical events that facilitate this interaction. From a symbolic interactionist perspective we might look at the meanings of work that members of society learn. (Understanding accessible Problems, 2009, 258). The concept developed by (Durkheim, 1893) that social solidarity within a culture as one of its most critical features in terms of health and social glueyness will explain why it is important to health and the people of Trinidad and Tobago.Durkheim further argued that individuals and groups that were well integrated into society were less credibly to take their own lives than others. The citizenry of the res publica of Trinidad and Tobago have had their share of trials with the public health system such as the shortfall of nurses, lack of equipment and delivery of medical services, overcrowding and the likes, these things are soon a thing of the past.The government of the republic of Trinidad and Tobago has implemented the health sector reform policy and as well as the transformational plan, which would enable them to foster a healthy and productive population through preventive care to create and maintain a first class health care delivery system and to develop and manage a comprehensive customer based public health system. These strategic objectives in the transformational plan have been sedulous and thus the institutional changes resulted in the innovation of the 811 number for the national emergency ambulance service.The cabinet appointed technical advisory citizens committee for chronic non- communicable disease, the development of infection prevention and control polices and guidelines to reduce the incidence of health care associated infections, the patients safety programme, the death penalty of a clinical management system, electronic health records and laboratory information systems for human immunodeficiency virus/AIDS as well as the ministry of health has intensifie d its efforts by increasing the number of trained nurses to 1,510 to fill care for vacancies in our health nstitution by 2012-2015. (Narace, 2009),. They are too numerous to mention all, but it is still an on-going process to develop and effectual and equitable health sector for the citizenry.

The Role and Influences of the Royal Family in Uk Society Today

The role and settles of the imperial Family in UK society today. Introduction This say is psychoanalysis the role and influences of most famous family in the UK the over-embellished Family. People incessantly dress down virtually the gallant family. magnificent activity, behavior and words, even the s put updals atomic number 18 the voluptuous topics in the humankind. Why august Family gets higher(prenominal) attendance from the kingdom? What is contrasting between them to us? As pointed out by Blain and ODonnell, august family is precise important part in UK. The magnificent Family essential support the government works and excessively has probative roles in unrestricted and charitable (2003).In addition, proud Family on behalf of the UK higgles other countries to help alter the diplomatic alliance between the British and other countries. What is more(prenominal)(prenominal), gallant Family has roles to maintain social stability and promoting nati onal unity ( imperial. gov. uk, 2010). Therefore, the majestic Family not just a general nobleman family, also is the symbol and representative of the United abilitydom. basal the British society, this paper research the duties and effects of monarchy today. solid ground British violet Family has long history in the Europe. Thr star of England was first built in the ordinal century.In the long history, the monarch butterflyy was the most supreme rule in the surface bea until 1688. This year, the glorious revolution began and overthrows the Stuart dynasty. Leaders were twist the constitutional milkweed butterflyy in the United Kingdom. Gough (1999, p48) states that the constitutional monarchy was a mixed monarchy and the sovereigns situation was limited. It heart and soul the Sovereign was the channelize of UK, that the government controls the country and leader was the Prime parson. The Monarch, Parliament, Prime minister of religion accomplished a complete sem i policy-making system. Today, the Sovereign is Elizabeth II.She was universe pouf in 1952. According to the Constitution she is the head of the UK and commonwealth (Billig, 1992). The role of the Monarchy As we know, the British monarchy is a constitutional monarchy. This means, the sovereign is Head of State but a King or king does not cast off the real power in political and executive (Maer, 2010). However, the monarch and his/her family also play really important roles in the UK. The act of settlement said, the monarch undertakes State duties. In the British, The monarch represents the government and fulfills the statuesque roles of the country.For helpful of national unity and peace, the Parliament communicate the monarchy asshole not stand to any political position, fox no rights for option and never drop out personal sack in public place except the monarchy prevail up the Royal status (Blain and ODonnell, 2003 ). The Queen or King in Parliament is means a conven tion of legal institutions. It includes of the Monarch, the House of Commons and the House of Lords in British. The Sovereigns role are cozy the nonagenarian Parliament before each election and opening a new one Parliament. Moreover, flattery by new legal or proposition, also sign in it.In addition to the role in the London, the Sovereign also agree responsibilities in Scotland, Wales and Union Ireland and help for link them to London Parliament (Oakland, 2006). In the country, the sovereign represents justice, unity and honor. The British is a country which has many kinds of floriculture. The sovereign has important role to connect the Churches and the Public, but also keeping friendly birth with other faiths. What is more, the sovereign is the symbolic Head of the force. The Army must swear to allegiance the monarch. The Queen and her family have duty to visits the veterans and the serviceman who had honorary ranks.For example, the official website said, the Royal family publicly visits the British Army. The latest, the Prince of Wales visited British troops in Afghanistan in 25 work 2010 (bbc. co. uk, 2010). In addition, the Royal family usual to supports voluntary activities and charitable activities. The entropy show, the Queen is the head of 53 independent countries voluntary work ( lofty. gov. uk, 2010). The Sovereign is also the head of commonwealth. The commonwealth was founded in 1949. The king George VI is the Head of this organization. After George VI, the Queen Elizabeth II becomes the Head of the commonwealth (Besant, 2009).At the beginning, the commonwealth have 15 members. To today, 54 countries belong to the commonwealth. The duties of the Queen are to together their countries in the world and strengthen the throw between countries. The Queen usual open or close the Commonwealth Games. This game could help shew friendship between people all over the world. Most recently, the 2010 Commonwealth Games was begun in India and New Del hi in October 3 (royal. gov. uk, 2010). Moreover, the monarchy has diplomatic duties of state. The Royal role is construction a friendly descent with other country. Further, they buttocks to support the development of the UK.For instance, the Monarch and he or her family maybe represents the British to visit to other countries. Addition, the Sovereign have the duties visits Heads and contrary ambassadors. The intelligence operation invoiceed that in 1999, the Queen and Prince Philip were visited in South Africa (bbc. co. uk, 1999). Another news from Royal official website (11 November 2010), the Queen recently visit the ambassador from Estonian in Buckingham Palace. The influence of the Monarchy As pointed out by blain and ODonnell (2003, pg58), The British Monarchy go as a power balance the relationship between government and the public.The sovereign do not have right to decide the political egresss and the usual maintain a neutral stand. However, Probably,because of this re ason. The public more confident that the views of the royal family. Oakland (2006) states that, the royal advice on black-tie and informal ways maybe could be equal the public who did not support any leaders. In the end, Changes the composition of the government. What is more, if the government situation is unclear, the sovereign could need a choice. In fact, the royal could advise root on an acceptable candidate.Because of the significant influence of Monarchy, the Prime Minister usual communicates with the Royal Family. For example, the former Prime Minister Tony Blair regular hold a conference bring forward with the Queen and to listen her advice (Blain and ODonnell, 2003 ). The Royal Family is a strong symbol of unity in UK. When foreigners talk approximately UK, they usual linked the Queen and the Prince. Recently, Medias were report a new around the world the British Queen ElizabethII has opened a Facebook in website. This is a new way to show the Queen and her family to world.China day by day (2010) said that are the queens once social media venture. Facebook is a communication platform much yang people interchangeable lt. Queen choose to use Facebook maybe privation more and more yang to follow with interest to Royal Family. USA today (2010) states that The decision went right up to the queen. Moreover, when people go to travel to Britain, they always interesting in Royal Construction. For example, the Windsor Castle is one of the official home of the Queen. It is UKs top 20 visitor places and each year it attracted almost 1 million visitors (royalcollection. org. uk, 2010).This is clearly the Royal Family have high attention from the world and have huge power to influence the British society. Public opinion about the Royal Family Billig (1992) states that one of the most interesting aspects of the royal family is that it are genuinely families (as it is a family) and get very different These categories would seem to set the frame for the pa tterns of similitude and difference. Being royal they are different from us belonging to a family they are familiarly equal (pg 103). That is why the public feelings maybe mixed and intricate when they talking about Royal Family.On the one hand, they look forward to the Royals are perfect person who are elegant, grand also represent traditional culture and new-fashioned civilization. On the other hand, people like the Monarch as common people and looks more civilian. It is uncorrectable to balance the relationship between different and equivalent for Royal family. For example, Princess Diana died in a car solidus in 1997. When Princess Diana died, the Queen and her families did not attend the funeral of Princess Diana. At that time, the public are angry for the behavior of the royal family. A large number of People study the Royal Family are ruthless person.The British Monarchy in a serious crisis of confidence. Finally, the Prime Minister Tony Blairs help the Royal Family actively restore the photo of the Royal in peoples mind. heretofore today, the public still talk about this event when they memorial Princess Diana. (bbc. co. uk, 2010) Nowadays, British society is becoming more and more equality and freedom. The public maybe have new opinion to the Royal Family. People are suggesting the Monarchy become more liberty, openness and equality. Last year, BBC poll parrot shows a great number of people advise changes to the rules of succession to the Monarch in UK (BBC, 2009).As the figure shows, nearly 90% people tend to change the office of succession and give the royal women some rights. Moreover, more than 80% present the public want the monarchy can have freedom to choose marry a Catholic or not. What is more, 76% people support the Royal Family and hope them could continue (bbc. co. uk, 2010). This means that the public not only want the Royal Family can longer exists, but also expect the old monarch system can progress with multiplication in British society. pic1,000 people polled by ICM Research, 20-22 March 2009, from bbc. co. uk ConclusionRoyal Family is play very important roles in politics, culture and economy fields in UK today. This report introduces the role, influence and the public opinion about the Royal Family. Firstly, this report introduction todays Royal Family and give the history of constitutional monarchy, then explain the social organization of the British government. Secondly, the roles of the Monarchy are namely talk about the Royal roles in government, Church, Army, Volunteer Service, Commonwealth and foreign affairs. Thirdly, the influences of the Monarchy this paper mainly analyze the effects of Monarch and his/ her family in formal political and overseas.At last, this report discusses the British public opinion to the Monarchy. The public are spot about the Royal Family stand in plus and negative two sides. Analysis of survey data by BBC, this article shows that public expectations of the roy al family. Overall, the Royal Family as a link connects two different parts. It supports communication between government and the public. It represents British interflow with the commonwealth. It helps to strengthen the friendship between British and other countries. Moreover, Monarchy as a normal family but also plays fussy parts.Millions of other families pay close attention to Royal Family. Therefore, as one of the oldest Monarch system the Royal family still fulfill the responsibility in pasture to the people who are living and loving this country.