Alternative Medicines For Complementary And Integrative...

In the United States alone, the Nation Alliance on Mental Illness stated that 16 million adults deal with depression each year (â€Å"Mental†). Depression is a common mental health disorder that people can acquire in today’s society. There are many forms of depression that exist ranging from mild to very severe. Some of those forms include major depression, seasonal affective disorder, postpartum depression, psychotic depression, dysthymia, and bipolar disorder. Many individuals with depression try to treat their illness by relying on antidepressants. Antidepressants are a popular form of treatment of depression because they can be easily obtained and require little effort from the person using them. However, there are many other natural,†¦show more content†¦However, complementary medicines may work alongside traditional medications. Some examples of CAM are acupuncture, diet, yoga, meditation, and physical activities such as sports, hiking, and running. Comp lementary and alternative medicine is increasing in popularity because it can be more beneficial for the patient and their health. Also, using CAM as a way to treat certain illnesses can be much less expensive than investing in antidepressants or other forms of medication. Overall, CAM is a healthy and beneficial method to help alleviate depression and other similar health conditions. Physical activities such as yoga, exercise, sports, and nature and outdoors activities affect victims of depression in a positive way and can improve their mental health. To begin, yoga is a highly recommended activity to help reduce depression. Yoga is a mixture of meditation, stretching, and breathing techniques that helps to clear the mind and focuses on positive energy within an individual. In the journal, Issues in Mental Health Nursing, Lila Louie, a nurse from the University of California, stated, â€Å"In recent years, increasing numbers of people are turning to complementary and alternative medicine for relief from depression and other mental health problems. One form of CAM is yoga†(Louie). This is because antidepressants and doctor prescribed medicines can become expensive over time. Yoga has become

The New Jim Crow Mass Incarceration Essay - 1797 Words

Jim Crow laws are regarded as part of the racial caste system that operated in the Southern and Border States in the years between 1877 and the mid-1960s. Under the series of the anti-black laws, African Americans were treated as inferior and second class citizens. The laws have been argued to have represented the legitimization of the anti-black racism in the US. The book The New Jim Crow Mass Incarceration in the Age of Colorblindness is written by Michelle Alexander and originally published by The New Press in 2010. The present paper reviews the above book with the intention of identifying the author’s main argument and the essence of the writer’s message to the readers. The Book’s Main Argument The author, Michael Alexander an advocate, a legal scholar and a renowned civil rights lawyer has dedicated her career fighting racial injustice, especially in the American Criminal Justice system. The main argument of her book is therefore based on the fact that the racism infects every stage of the criminal prosecution system in a bid to influence the understanding of the public regarding the war on drugs and its effect on the entire nation. The book thus argues that the war on drugs and mass incarcerations are a representation of the previous racialized social control forms such as Jim Crow and slavery. The author thus claimed that there more blacks under the control of the criminal justice system currently than the number of African Americans who were enslaved in 1860. TheShow MoreRelatedThe New Jim Crow : Mass Incarceration1370 Words   |  6 Pagesunrecognizable ways that fit into the fabric of the American society to render it nearly invisible to the majority of Americans. Mi chelle Alexander, in her book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness shatters this dominantly held belief. The New Jim Crow makes a reader profoundly question whether the high rates of incarceration in the United States is an attempt to maintain blacks as an underclass. Michelle Alexander makes the assertion that â€Å"[w]e have not ended racial caste in America;Read MoreThe New Jim Crow : Mass Incarceration1361 Words   |  6 PagesBook Review Michelle Alexander, The New Jim Crow: Mass Incarceration in the Age of Colorblindness The premise of the ‘The New Jim Crow: Mass Incarceration in the Age of Colorblindness’ by Michelle Alexander, is to refute claims that racism is dead and argue that the War on Drugs and the federal drug policy unfairly targets communities of color, keeping a large majority of black men of varying ages in a cycle of poverty and behind bars. The author proves that racism thrives by highlighting theRead MoreThe New Jim Crow : Mass Incarceration1477 Words   |  6 PagesThe New Jim Crow: Mass Incarceration in the Age of Color Blindness, by Michelle Alexander. The New Press, 2010. 290 pages. Reviewed by Ashlei G Cameron. Michelle alexander is a highly acclaimed civil rights lawyer, advocate and legal scholar. As an associate professor of law at Standford law school, she directed the Civil Rights Clinic and pursued a research agenda focused on the intersection of race and criminal justice. In 2005. Alexander won a Soros Justice Fellowship that supported the writingRead MoreThe New Jim Crow : Mass Incarceration1199 Words   |  5 Pagesthose who did read her book The New Jim Crow: Mass Incarceration In The Age of Colorblindness. Michelle Alexander stated that The most despised in America is not gays, transgenders, nor even illegal immigrants - it is criminals. That was an important quote since the stereotypical criminal in our racially divided America in most cases are those of color also known as blacks. This is why the criminal justice system in the United States promotes the mass incarceration of blacks that can be seen throughRead MoreThe New Jim Crow : Mass Incarceration1081 Words   |  5 Page s Michelle Alexander’s The New Jim Crow: Mass Incarceration in the Age of Colorblindness outlines how the criminal justice system has systematically designed new methods of discriminating against African Americans. The book advocates for racial justice, specifically, for African Americans and contends they [African Americans] were targeted and subsequently incarcerated, by white voters and public officials, through the War on Drugs campaign. President Reagan and his Administration exploited racialRead MoreThe New Jim Crow : Mass Incarceration1347 Words   |  6 PagesHunter Silver Dr. Kendall Smith English 103-4120 10 November 2015 High Incarceration Rates Due to Racism Racism effects the the high incarceration rates according to Michelle Alexander, the author of â€Å"The New Jim Crow: Mass Incarceration in the Age of Colorblindness. This scholar writes about how the civil rights movement has been taken back by the mass incarceration of black Americans in the war on drugs. Alexander also explains how the severe consequences that these black men carry on afterRead MoreThe New Jim Crow : Mass Incarceration Essay1401 Words   |  6 Pages Michelle Alexander’s book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, examines mass incarceration in the United States, why the criminal justice system works the way it does towards minorities, the detriments associated with mass incarceration as it relates to offenders, and much more. In the introduction of her book, Alexander immediately paints the harsh reality of mass incarceration with the story of Jarvious Cotton who is denied the right to vote among other rights becauseRead MoreThe New Jim Crow : Mass Incarceration Essay1096 Words   |  5 PagesAlexander, Michelle. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: The New Press, 2010. Study Questions for â€Å"The New Jim Crow†: 1) What is the relationship between the War on Drugs and the spread of crack cocaine through inner city neighborhoods in the 1980s? President Ronald Reagan officially announced the current drug war in 1982, before crack became an issue in the media or a crisis in poor black neighborhoods. A few years after the drug war was declared, crackRead MoreThe New Jim Crow : Mass Incarceration1239 Words   |  5 PagesIn 2013, Michelle Alexander published her book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, hoping it served as a call to action. Immediately this book received a huge amount of attention because of the controversial topics presented. This book opened a lot of people’s eyes to the term colorblindness, a sociological perspective referring to the disregard of racial characteristics. There is no racial data or profiling, no classifications, and no categorizations or distinctionsRead MoreThe New Jim Crow : Mass Incarceration1547 Words   |  7 PagesSSP101 Final Michelle Alexander is a noble civil rights advocate and writer. She is best known for her 2010 book The New Jim Crow: Mass Incarceration in the age of colorblindness. Michelle Alexander writes that the many gains of the civil rights movement have been undermined by the mass incarceration of black Americans in the war on drugs. She says that although Jim Crow laws are now off the books, millions of blacks arrested for minor crimes remain marginalized and disfranchised, trapped by

Disaster Recovery Plan

Question: Describe about the Disaster Recovery Plan? Answer: Since the beginning of the civilization, among the various crucial factor which greatly influences the essential activity of the human being as well as regulate the quality of life, health is most significant. As per the given instruction this assessment will be focusing on the various aspect of the recovery plan relating to the various potential disasters in the perspective of the safety of various relevant medical documents as well as clinical data of numerous patients (Croskerry, 2010). The whole concept of various recovery plan from disaster as well as work flow relating to this systematic plan is belong to a systematically, powerful body, that is ministry of health care. Various potential disaster as well as various security related issues, can be major problem for the proper management of patient related data and in the way of overall performance of the health care system as well as the activity of the health care provider. In order to develop a effective management plan to cou nteract the disaster as well as keep the various medical document safe, relating to the various patient, various approaches is there, like Business community base planning, Information system for disaster, coordinator for disaster recovery, etc It is very important to understand the various significant purposes of the therapy recovery plan as well as its multipurpose way of planning, before the detailed evolution of various type of research design or specific type of recovery plan (Denham, 2010). In order to choose a specific disaster management oriented research design, clarification of the about the proper concept of the management plan is very much essential. Then the various aspects and the specific field of the disaster should be taken into the consideration and also need to know in what format the recovery plan fits. It included the development of a relevant system of keeping the various essential medical data safe and it also arise the recovery oriented research topic or question to moderate stage of the research process like the collecting of the data, evaluation of the collected data in order to synthesizing the evidence based practices as well as reporting the data (Donaldson, 2010). In order to systematically evaluate the various aspects of the research design as well as its various classification, philosophical as well as theoretical assumption, always play a significant role. Before the detailed interpretation of the philosophical assumption in the context of the qualitative research, it is essentially suggested by various researchers after the numerous clinical study, that there is no such confirm or predetermined way or systematic process for the successful development of the qualitative hypovolemic therapy(Jordan 2012). In spite of some conventional way of processing or developing, the systematic structure or progressing of the qualitative therapy, depending upon some significant factors like epistemological factor or ontological factor or research goal oriented factor. In the perspective of qualitative health care and effective recovery plan, it may be explained as the naturalistic as well as interpretative approach, which should be carried out with the responsibility of exploring various potential phenomena from the internal context. It also includes the perspective of the research oriented subjects and relevant information (Marie, 2010). The concept of the various disaster management plan also focusing on the perspective of the interpretive as well as materialistic practice which may resolve explain various unresolved issue of the modern world. It also emphasize on the various significant factors, which can greatly influence the structure of the research design like some fundamental search strategy, identify the main idea of a research project, relevant literature search as well as comprehensive understanding of the rationale, recognition of the significant unknown along with the research question. After that main part of the research design is came into the scenario like aim as well as objectives of the disaster recovery plan.The next step is the, develop the hypothesis as well as testing of the hypothesis, determined the main deliverables, identify the main resources (New Zealand - Ministry of Health to offer support service for former sawmill workers exposed to PCP. 2010). Another significant criterion, which grea tly regulating the total research design of the main hypothesis, is the proper timeframe for the specific research. So, determine the proper time-frame of the research design is the fundamental consideration, in order to develop a systematic research process. After the development of the timeframe, the next significant step of the research design is the, development of a appropriate workflow model, depend upon which the whole research strategy will be on progress. Another associated significant issue of the recovery plan relating to the various potential disaster, is the various risk factor and the potential adverse effect of the risk, which may occur during numerous application of the hypothesis. References Croskerry, P., Abbass, A., Wu, A. (2010). Emotional Influences in Patient Safety. Journal Of Patient Safety, 6(4), 199-205. doi:10.1097/pts.0b013e3181f6c01a Denham, C. (2010). Greenlight Issues for the CFO. Journal Of Patient Safety, 6(1), 52-56. doi:10.1097/pts.0b013e3181c72c9e Donaldson, L., Noble, D. (2010). The Need for Risk Profiling in Patient Safety. Journal Of Patient Safety, 6(3), 125-127. doi:10.1097/pts.0b013e3181ed73a3 Jordan - Ministry to evaluate integration of mental health services. (2012). International J Health Care QA, 25(2). doi:10.1108/ijhcqa.2012.06225baa.011 Marie, M. (2010). Do You Have a Disaster Recovery Plan?. Information Security Journal: A Global Perspective, 19(1), 1-3. doi:10.1080/19393550903317088 New Zealand - Ministry of Health to offer support service for former sawmill workers exposed to PCP. (2010). International J Health Care QA, 23(8). doi:10.1108/ijhcqa.2010.06223hab.007

Advantages and Disadvantages of large Sample Size Free Samples

Questions: 1. Discuss the advantages and disadvantages of having a sample of this size. What factors should be considered in decision on sample size? 2.What are the advantages and disadvantages of the current Sampling Method? 3.What are your suggestions to improve the Sampling Methods? 4.Discuss some of the problems in the process of data collection and how to address them in future study 5.What secondary Dataset can be used to check the representativeness of the sample and how can it be used? Answers: 1.In our case being that the population size was sixty nine thousand, a sample size of fifteen thousand represented by over twenty percent covers over one fifth of the population. This sample therefore has a bigger sample size than expected. i.e. 383 bank workers were to make the sample size for this population size (69,000) with confidence level of 95 percent and margin of error of 5 percent. Large sample sizes are therefore associated with advantages and disadvantages. Advantages of large sample size Large sample sizes ensure for the reliability of the sample mean as the estimator of the population parameter. For a sample to fully reflect the correct population mean, larger sample size is always contemplated of. The quantity need to be pinned down. Standard error (Se) of the mean is therefore used to quantify the reflection of population mean. This standard error is essential for all calculated sample means. This is taken as an advantage of the large sample sizes due their wide coverage of the population. Working with large samples is important since it helps in sweeping out the outliers in the sample. Small samples are perceived prone to outliers which may misrepresent the data in the sample. Bigger samples capture greater odds of outliers in the sample. However, in most of the cases, outliers tend to complicate analysis of statistical data but accounting for them help in giving realistic picture and the characteristics of the population. Another advantage of large sample sizes is that they help in obtaining a quality and precise mean. This is so because the mean will have covered many elements of the population. Determination of the mean is important for it help the researchers to do away with the outliers from their data. Outliers in the dataset are important to be dealt with because they totally differ from the mean greatly and may give a deceitful image about the sample or population. Disadvantages of large sample size Since large sample size is suitable due to its large and wider coverage of the population of study, it is in the same way time consuming and expensive to work with. For instance, sampling 15,000 workers who work in the Belgian bank will require a lot of time and also the expense that will be involved will be high. A lot of time is required since the larger sample size is spread in the manner that the population is spread and thus collecting data from the entire sample will involve much time compared to smaller sample sizes. Due to its wider coverage, the expense that is involved in data collection process is also higher compared to expense that could be incurred in a small sample size. Overrepresentation of population data in a population involves large sample size. Collection of data from this sample size in a well distributive way will require high financial involvement for the success of the process as planned Factors to consider when choosing sample size Decision on what sample size to use will depend on the population size i.e. 69,000 bank workers and cost that will be involved in data collection. If the researcher wants to incur low cost in the process, smaller sample size will be preferred. In that case, it will also help in determining how precise we should be with our data. Sampling whole lot of 15,000 Belgian bank workers will mean high cost incurred in the data collection process. Prior information concerning the subject of study will help in determining the sample size for use in the study. This prior information can be considered in deciding whether to reduce the sample size or not. The key elements that will be considered from prior information is the prior mean and variance estimates, this is according to (Moher et al, 1994). Practicality is another factor to be considered when choosing for the sample size. The sample size chosen for use must make sense and practical in real life situation. Margin of error also forms another key factor for it will be relied on in determining how reliable and perfect a sample is. It will be showing the width or interval at which the calculated mean will lie and also help in construction of the confidence interval level. 2.The bank workers who were to be involved in the study were given equal chances of being selected by employing probability sampling methods. The chances will be made in such a way that they are greater than zero; this helps in reducing human biasness that may arise through their judgments thus making the process free and fair for inclusion of all banks and the bank workers in the process (Bacchetti, 2002). Probability sampling method used by the research institutions was stratified sampling method. The research institutions first randomly identified the banks which formed the strata then in the identified banks; they randomly selected the workers for fairness in their selection. Advantages Compared to other probability sampling methods like the simple random sampling, stratified sampling method gives more precision of the same sample size. Precision is important in the estimation process of the population parameter, each stratums statistic will be calculated and their closeness compared to one another. The process is found to be cost effective as it only involves random selection of different baking institutions and workers over the entire population which makes it half completed because of its precision. It is also flexible in that any number of participants can be selected with ease and efficiency. Also, this process tends to be more effective as it results to accuracy in selection of data since it involves lesser degree of judgment of the researcher. It as well forms easier way of sampling as compared to other sampling methods since it does not involve long and complicated processes. Moreover, probability sampling method does not require any technicality therefore a ny person can carry it out even non-technical persons. Since it only require random assignment of numbers over the specified strata. Disadvantages This method (stratified probability sampling method) of selecting the sample results to the selection of only specific class of samples. This sampling method is as well time consuming as the researcher is required to follow all due procedure such as first identifying strata and also going down to the strata to do the selection of individuals that will now participate in the process. The process result to monotony as the researcher or the surveyor will be repetitively assigning numbers in order to obtain the required information through this method; this may have further effects such as reducing the efficiency of the surveyor. 3.The chosen sampling method will have influence on the outcome data for use in the analysis. For instance, if the method that was used in sampling the banks was found to be biased, this will affect the results and the conclusions that will be drawn from this sample study (Mann, 2003). So to eradicate such short comings, the researcher is supposed to ensure that they reduce biasness as much as possible to save on the results and their dependability. This can be done through randomization. This ensures that all the possible samples are given equal chances of being selected for the sample of study. This so far is the effective technique that can be applied by the researcher in ensuring for equality of all possible samples when using simple random sampling. To reduce and improve stratified sampling technique, the groups are divided into groups referred to as strata that must be showing relationship that is meaningful in the study. In some cases, responses from the strata may be different from one another in a survey. Stratification is done in response to help in reflecting the population and ensuring that each stratums opinion is represented and reflected in the sample. In most of the cases, stratification is done by gender in order to take care of the divergent opinions and have all of them represented. Because each sampling method is concerned with precision in the analysis thereafter, testes methods are supposed to be conducted. This is done with the aim of ensuring that each sampling method chosen for use to satisfy research goals. The level of precision and the cost associated will be important to determine for each potential method. In this case, since standard error will be used, it will help in measuring the level of precision w hereas the smaller the standard error, the greater the precision of our sample. 4.More often, questionnaires have been widely used in the collection of data from the respondents. In as much it has been preferred method for data collection, it is always associated with some problems (disadvantages). Dishonesty has been a big problem rocking the use of questionnaires in data collection. This arises as a result of the respondents abscond the truth from the researcher when answering the questions. In our case since the questionnaires were sent to the respondents, this may result to lack of clarity of questions for easy understanding by the respondents (Zaza et al, 2000). The matter of dishonesty may be as a result of hiding what they consider private for the fear of disclosure and desirability bias. Though this kind of problem can be dealt with by ensuring them (the respondents) about their privacy and also that their identifications will be hidden. Also, conscientiousness of the responses provided by the respondents can be missed since some of the respondents do not carefully think when responding to the questions. In some cases, they preselect the answers before they go through the whole question to know the requirement of the question. Validity of the data is affected when the respondents try to split the questions and even go further ahead to skip some of the questions thus missing out potential answers. The research institutions involved in this study can collect the most accurate data through structuring simple questions that are easy to read and understand by the respondents. If the questions are not presented to the respondent face-to-face like in this scenario, the respondents may have difficulty with understanding the questions and interpreting them since the researcher is not around to give clarity of what the questions need and offer guidelines. This will lead to a variation in interpretation of the questions thus resulting to different responses which some may not even be meaningful and related in any way with the subject of discussion (Zaza et al, 2000). Skewed results from this can be combated by well structuring the questions and making them easy to read, understand and interpret. Questionnaires should always be made accessible. The choice of which data collection tool to be used should be made by considering the respondents. For instance, people with other forms of physical disability such as visual impairment or hearing impairment, survey should not be used with them to collect data. Problems of this sort are eliminated or dealt with by making appropriate choice of which data collection tool to use. At sometimes, some respondents do have their own hidden agenda and this may lead them to provide biased information. Interest of the participants may steer them towards either the product or services. Questionnaires that only make use of open-ended questions are difficult to analyze by the respondents. Answers obtained through these types of questions are individualized opinions hence they cannot be quantified by the analysts since they vary across all the individual groups. Structuring a questionnaire with many open ended questions will result to more data to be analyzed. So it can be dealt with by reducing the number of open-ended questions and using the closed ended questions instead. Some of the questions remaining unanswered are other problems that are being encountered by the researchers when using questionnaires especially when the questions are optional. This risk can be avoided by making the questionnaires online and terming all the fields required. In the same way, the questions are supposed to be precise and easy to respond to. 5.The dataset that will be used to check for the representativeness of the sample will be obtained from the National Bank of Belgium in conjunction with Employment industry in Belgium. They will be used as the checking point for collected data for study. They will also be used to obtain data that are termed relevant from other sources like from the previous study. Additionally, secondary data provide descriptive information that is used to support the study that is currently being carried out thus helping in the development of the study with facts. Variables used in the study are in most of the cases tested if at all there is a relationship that exist between variables thus helping in building up the model. Secondary data are as well used in data mining where computer technology is used in studying the trend for the previous research by visiting large volumes of data. Among other uses of the secondary data, they are as well used in the identification of relevant sources in order to d o away with plagiarism. References Moher, D., Dulberg, C. S., Wells, G. A. (1994). Statistical power, sample size, and their reporting in randomized controlled trials.Jama,272(2), 122-124. Bacchetti, P. (2002). Peer review of statistics in medical research: the other problem.British Medical Journal,324(7348), 1271. Mann, C. J. (2003). Observational research methods. Research design II: cohort, cross sectional, and case-control studies.Emergency medicine journal,20(1), 54-60. Zaza, S., Wright-De Agero, L. K., Briss, P. A., Truman, B. I., Hopkins, D. P., Hennessy, M. H., ... Pappaioanou, M. (2000). Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services.American journal of preventive medicine,18(1), 44-74.

Consequences of the WW Essay Example

Consequences of the WW Essay What are the consequences of The Second World War? What are the most important results of the Second World War?What vital lessons can be derived from its history? The utter defeat of fascist Germany and militarist Japan in which the Soviet Union took the decisive role, was the result of joint efforts by the international front of national liberation, democratic and otherprogressive forces. The reasons for Victorys impact on world history are to be found in the course and character of the war itself. This is obvious because the Second World War affected the whole system of international relations and, together with these, the interests of all nations and countries far more than the First World War. Its origins, course and consequences are a reflection of the essence and contradictions of the epoch. The main source of wars, as before, is imperialism whose inherent contradictions have become exacerbated in the ever-deepening general crisis of capitalism. War is rooted in the lengthy struggle between rival imperialist blocs, on the one hand, and in their common striving to destroy the Soviet Union and all forces of socialism and progress, on the other. The fomenters of the Second World War were the German imperialists, with the tacit approval of the ruling circles of Britain, France and the United States, who banked on exploiting the armed might of fascist Germany, and her partners in the fight against the USSR, the communist and working-class movement. History has shown that a policy of appeasement is pernicious to its pursuers. The Soviet Union and the other peace loving forces failed in their efforts to prevent war. It began in 1939 with a conflict within the capitalist system. When fascist Germany treacherously attacked this country in the summer of 1941, Britain, France and a number of other countries depended for their very existence on the Soviet Unions capacity to breast the tide and win the war. That is the expre

Biography of Fukuzawa Yukichi †History Essay

Biography of Fukuzawa Yukichi – History Essay Free Online Research Papers Biography of Fukuzawa Yukichi History Essay This paper will be on the life and works of Fukuzawa Yukichi, the man who spread foreign studies throughout Japan, opening schools and founding one of Japan’s major universities today. I chose this topic, because the name Fukuzawa Yukichi sounded familiar and therefore I did some brief research on him. From there I found out that he had been the founder of Keio University, which got me interested in him. Fukuzawa Yukichi is a very important figure in Japanese education, for he spread foreign studies and rangaku amongst the Japanese society.My research question of this paper will be: How was Fukuzawa’s knowledge in foreign studies and â€Å"rangaku† advantageous when trying to spread foreign studies? My hypothesis is that his knowledge helped him to gain support and respect from the bakufu as well as the citizens, and helped him to open schools throughout Japan and travel abroad to study. Fukuzawa’s Background â€Å" Fukuzawa Yukichi was born on January 10th, 1835 in the city of Osaka.†1 His father was a low-ranking samurai of the Okudaira clan of Nakatsu. However, a year and a half after Fukuzawas birth, his father passed away leaving the family in poverty. Due to this Fukuzawa was unable to go to school until he was fourteen, when he finally had enough money to go to a school of Dutch studies. â€Å"When his brother sent a letter to the chancellor of the lord of his clan, it was returned to him for the address didn’t contain honorifics appropriate to the chancellor’s status. Due to this Fukuzawa developed a great hatred for the feudal system.†2 Fukuzawa waited for a chance to change the ways of the feudal system. In February, 1854 at the age of nineteen he traveled to Nagasaki to study Dutch language and gunnery in order to become an expert in western gunnery. â€Å"After one year, he decided to head for Edo to work for a family friend who was a physician, under the pretext of visiting his mother.†3 He traveled up to Osaka where his brother greeted him. â€Å"His brother then stopped him from continuing on to Edo and told him to stay in Osaka. And so Fukuzawa remained in Osaka and studied western medicine and Dutch language at the Tekijuku school run by the physician Ogata Koan.†4 At the age of twenty-three, he was ordered by his clan to travel to Edo and teach Dutch at the clan headquarters. Once he arrived in Edo, he was provided with a small apartment in Teppozu. Before long his pupils started coming to learn Dutch and pretty soon his apartment had become a small school. Putting ideas into action The following year, in 1859, Fukuzawa visited Yokohama which had just been opened to foreign trade. To his dismay, his knowledge in Dutch language was completely useless, for the language in use was English, not Dutch. Fukuzawa then decided to teach himself English with a conversation book and an English-Dutch dictionary. â€Å"Fukuzawa heard that the shogunate was sending a Japanese ship, the â€Å"Kanrin Maru† to escort an American warship with Japanese envoys to San Francisco.†5 He was determined to sail on thin voyage and sent a letter to Captain Kimura, the highest-ranking member of the Japanese Navy. â€Å"He also visited the Captain at his home and asked the Captain to take him along as a personal servant, which he agreed to immediately.†6 During his stay of four months, Fukuzawa was overwhelmed by the new ideas which greeted him. â€Å"The men and women dancing together, ice cubes in drinks, horse-drawn carriages were all so new to him and amazed him.†7 Before his journey back, he bought a copy of the â€Å"Webster’s Dictionary,† which is said to be the introduction of Webster’s to Japan. Upon his return Fukuzawa became an official translator for the bakufu, while continuing to study English. Fukuzawa Yukichi in 1860 Traveling abroad and gaining respect â€Å"In 1861 Fukuzawa married a seventeen-year-old girl with whom he had nine children. A year later, he was sent to Europe as a highly-paid member of a diplomatic mission.†8 During this time he visited Egypt, France, England, Holland, Prussia, Russia, Portugal and various ports in Southeast Asia, taking notes wherever he went. He then published a book which consisted of his research and experiences abroad, titled â€Å"Seiyo Jijo.† (Western Things) This book became an immediate best seller. It included descriptions of schools, hospitals, railways etc. In January, 1867 Fukuzawa traveled to the United States once again. â€Å"This time he had gone as an interpreter for a delegation sent to purchase an American warship and to obtain rifles for the shogun’s army.†9 Upon his return, Fukuzawa wrote another book, â€Å"Seiyo Tabi Annai ( A Guide to Travel in the Western World) also became a best seller. â€Å"This was followed by his third book, (Seiyo Ishokuju (Western Clothing, Food and Houses).†10 He also set up his own school in Shinsenza, and named in Keio Gijuku. The number of students grew rapidly to 100 students. â€Å"On the 4th of July, 1868 sounds of gunfire from a battle a few kilometers from Keio-Gijuku could be heard during one of Fukuzawa’s lectures.†11 But he went on teaching about political economy. He told his students â€Å"whatever happens in the country, whatever warfare harasses our land we will never relinquish our hold on Western learning. As long as this school of ours stands, Japan remains a civilized nation of the World.†12 During these years Fukuzawa was offered several positions in the Meiji government, but refused them as well as renouncing his samurai status and becoming a commoner. â€Å"This showed his true devotion to Foreign studies and connecting with the commoners. Two years later, he suffered a severe attack of typhoid fever and as a result moved to Mita, where it was less damp and had a view of the ocean.†13 In the years that followed, he devoted himself exclusively either to teaching at Keio or helping initiate modern schools elsewhere. â€Å"He also translated and/or wrote pamphlets about the West and elementary textbooks on a surprisingly wide variety of subjects such as physics, geography, military arts, the British Parliament and international relations.†14 He bitterly criticized the traditional Japanese school curriculum, emphasizing ancient texts and the enjoyment and writing of poetry, as providing impractical pursuits. He argued that Western education was necessary and urged boys and girls who had just learned kana letters to consult translated textbooks and, at a more advanced stage, to read a Western language. Public Speaking â€Å"In 1873, Koizumi Nobukichi, a member of the Keio staff showed Fukuzawa a bookled entitled â€Å"American Debation.† This interested Fukuzawa who immediately started to translate this booklet on speech and debation.†15 He renamed in the â€Å"Kaigiben†(How to hold a conference.) Fukuzawa formed the â€Å"Mita Enzetsukai† which was the Mita Oratorical Society which studied speaking in public, debating, and giving conferences. This Oratorical Society rented a room in Fukuzawa’s former home and held their first official meeting on June 27th, 1874. Their meetings continued on until 1875. By this time the membership had increased to over twenty. â€Å"By this time, Fukuzawa and his colleagues had gained enough skill in speaking to have the confidence needed to display their art before the public.†16 However, there was no such place available in Japan at the time. Therefore, he decided that he would build one on the Keio campus. â€Å"He asked his friend, Tomita Tetsunosuke who was visiting the United States at the time, to send some plans of various American assembly halls. Once they arrived, he carefully drew up a blue print for his speech hall. On April 7th, 1875 the Mita Enzetsukan was completed.†17 Saturday, May 1st, 1875. This was the memorable date of the first speech given in the speech hall. Nearly four hundred guests arrived and assembled at the Speech Hall. â€Å"The Mita Enzetsukai’s speeches were a great success and people both young and old flooded into the speech hall.†18 Sometimes, more people arrived than could fit the Hall. This popularity continued on until the 1923 earthquake, when the hall waws moved to the top of Inari hill to escape damage. The number of students at Keio-gijuku, which had climbed back to more than 300 between 1871and 1876, again began to decline, in part because of the unsettled domestic scene. â€Å"As most of thestudents were samurai, a decision by the government in 1871 to abolish domains and reduce the hereditary privileges and stipends of the lords and vassals also affected the amount of money that could be spent on education. In five years, this process of confiscation was completed.†19 During this period, Fukuzawa’s students, most of whom were samurai, had been obliged to leave the school because of their lost privileges, the war and worsening poverty due to inflation. Those who came from Satsuma returned to join the rebellion there and were either killed or wounded. In dire financial straits, Fukuzawa supplemented the school’s budget with his personal income and also asked for loans from the government and private sources. No one, however, was willing to lend the Keio-gijuku any money and some suggested that it should be dissolved. His fellow teachers responded by voluntarily accepting a reduction of their salary by two-thirds. â€Å"Subsequently, the number of students gradually recovered from a low of 200 in 1878 to as many as 500 in 1881. Fukuzawa subsequently created Keio University to teach what Japanese schools were unable to teach, and by 1890 had imported a sizable foreign faculty. â€Å"20 The Economic and literary side As a measure to reduce expenditure, the government decided to sell factories and enterprises. When it was announced that these properties had been sold off at incredibly low prices, civil rights leaders criticized the government severely. â€Å"A rumor appeared in the press that Fukuzawa, with the financial help of Iwasaki Yataro of the Mitsubishi Corporation, was urging a coup d’à ©tat by Okuma. In return, Ito Hirobumi kicked out Okuma from the cabinet.†21 The real reason for this political drama was a struggle for control over input on legislation for the future constitution. Several Keio graduates who had worked under Okuma had suggested a constitutional monarchy on the British model, while the Ito group preferred the Prussian type. â€Å"This group was responding to, and afraid of, Fukuzawa and the Keio school, since Fukuzawa himself often expressed active support for Okuma’s policies.†22 After his political victory, Ito suspended the constitution and the opening of the Diet for ten years, canceling the sale of government properties. â€Å"Before their split, Ito, Okuma and other members of the government had arranged with Fukuzawa to start a newspaper to help promote the early opening of the Diet, but this was easily given up on. Fukuzawa decided to proceed alone and launched â€Å"Jiji-shimpo† on March 1st, 1882.†23 He declared that this quality newspaper would remain impartial and independent. From that time onward most of Fukuzawa’s writings appeared in â€Å"Jiji-shimpo,† not only serious articles but also satire. â€Å"He addressed all contemporary issues such as politics, domestic and international issues, political economy, education and educational policy, the moral code, particularly women’s rights, and so forth.†24 These articles and parodies fill nearly half of the twenty two volumes of his â€Å"Learningsâ⠂¬ . His book â€Å"Gakumon no susume† was one of the first books written in the modern form of Japanese, with both kanji and kana: Fukuzawa wanted to bring education to the masses, and part of that idea was bringing language and the written word to the masses. The â€Å"jiji-shimpo† was his only literary outlet left, and he continued to write in it until his death in 1901.25 . Comparison Natsume Soseki is one of Japan’s most influential authors. Natsume was born towards the later years of Fukuzawas life. The two great historical figures share similarities and differences. Natsume and Fukuzawa both excelled in languages: Natsume Chinese and English, Fukuzawa Dutch and English. They also both traveled abroad. Fukuzawa traveled to Europe and the United States, and Natsume traveled to England. But whilst Fukuzawa’s travels were all quite successful, Natsume did not benefit much from his visit to England. In fact, he went under depression. Both Fukuzawa and Natsume were teachers. However, Natsume decided to quit teaching at an early age and concentrated on writing novels. On the other hand, Fukuzawa continued to teach as well as writing books, speaking publicly, participating in human rights and the economy as well. Fukuzawa was much more active and worked in many different aspects. Natsume concentrated mainly on novels, which I think is why his novels are so famous and still studied today. One more similarity is that both men were on the Japanese yen notes. Natsume was on the  ¥1,000 note whilst Fukuzawa was and still is on the  ¥10,000 note. Conclusion My research question can finally be answered now. Fukuzawa’s knowledge in foreign studies and rangaku were quite advantageous when trying to spread foreign studies. He was able to gain respect from the bakufu with his knowledge of English. However, his knowledge in†rangaku† was not of much use, since Perry’s arrival had consisted of English, not Dutch. But because of his knowledge in so many different languages he was able to have three successful journeys abroad and to open up schools and gain respect from his pupils. Also, by learning â€Å"rangaku†, Fukuzawa was able to learn English easily, as well as being able to relate with the Europeans and the Americans. Overall His knowledge in foreign studies was extremely advantageous From writing this research paper, I learned that there was more to Fukuzawa Yukichi than just finding Keio University. He worked extremely hard to learn â€Å"rangaku† and English, convinced people to send him abroad and devoted his life to foreign studies and speeches. He published many books and gave numerous influential speeches which affected the Japanese society. He gave up his status as a samurai which was an extremely hard gesture at the time, and spent his life on education and spreading it to the population. He has affected and in a way created the Japanese education which we use today. Not only did he change educational aspects of Japan, but also the politics and women’s rights. Research Papers on Biography of Fukuzawa Yukichi - History EssayPersonal Experience with Teen PregnancyStandardized TestingEffects of Television Violence on ChildrenAssess the importance of Nationalism 1815-1850 Europe19 Century Society: A Deeply Divided EraArguments for Physician-Assisted Suicide (PAS)Quebec and CanadaHip-Hop is ArtHarry Potter and the Deathly Hallows EssayAnalysis of Ebay Expanding into Asia

Darwin Assignment Essay Example | Topics and Well Written Essays - 500 words

Darwin Assignment - Essay Example Evolution is more an educated guess work where we try to find evidences and answers for questions that are related to what could have taken place. The drawback in the evolutionary theories is that it is not able to provide the evidence of how the organisms were formed or how the different species came into being. Scientists till date find it impossible to generate the amino acids which make up the proteins needed in the cells to be formed. Even if a certain theory comes close it falls short in relation to the time period. There are plenty of flaws in evolutionary theories which does not answer or give a solution in entirety. Moreover it has been proved that the entire system must be there for making a start. This has been very clearly explained in Michael Behe’s book Darwin’s Black Box, where he with examples he proves that just one cell cannot reproduce without the components that are required for its growth. When all these interpreted theories are studied it seems absurd. The only answer that settles all debates is a Creator. Schools must encourage the students to analyze on their own and do some critical thinking by providing information for and against evolution. This would certainly encourage both teachers and students to collect, analyze and interpret data. This would make them understand better that science is still in the process of finding an answer to evolution. Putting forward every aspect can in fact be a better option in helping the children come to their own conclusion. Education is to stimulate mental growth and not force down thoughts. This open minded approach would be the intelligent design which zeroes in on a creator of an intelligent nature. â€Å"The intelligent design (ID) movement claims that life as we know it could not have developed through random natural processes -- which only the guidance of an intelligent power can explain

Supermarket Buyers Using Suppliers as Cannon Fodder Supply Management Assignment

Supermarket Buyers Using Suppliers as Cannon Fodder Supply Management - Assignment Example Supermarkets are engaging to exploit all the possible opportunities and they are doing so, by aggressive purchasing from multiple suppliers (Jennings, 2014). Purchasing from large number of manufacturers gives them power to bargain on price and quantity and due to this power they are generating more profits, whereas food manufacturers are suffering. This price war has raised many questions among marketers and economics, and they are seeing this war as an unfair tactic of retailers which is creating negative impact on the overall supply chain.Supermarkets are engaging to exploit all the possible opportunities and they are doing so, by aggressive purchasing from multiple suppliers (Jennings, 2014). Purchasing from large number of manufacturers gives them power to bargain on price and quantity and due to this power they are generating more profits, whereas food manufacturers are suffering. This price war has raised many questions among marketers and economics, and they are seeing this w ar as an unfair tactic of retailers which is creating negative impact on the overall supply chain. In today’s dynamic world, companies are not competing with each other in fact their whole supply chains are competing and retailers are creating trouble for the supply chains of different manufacturers (Bolton, Shankar, & Montoya, 2010). Additionally, many economists believe that a supply chain is as strong as its weakest link and retailers are weakening the supply chains of manufacturers by demanding heavy contribution from them and by aggressive purchasing.

Partnership - Assignment Paper Essay Example | Topics and Well Written Essays - 750 words

Partnership - Assignment Paper - Essay Example A partnership is different from a company on the grounds that it is not incorporated and thus cannot be called a separate legal entity. However, a firm may be sued, or sue other partners if it is registered. Every partner is an agent representing the partnership firm and this function begins as soon as the partners agree to form a partnership with each other, irrespective of the fact that they began trading or not. Thus, each partner will be liable to his full extent for the debts of the firm. A partnership agreement arises out of a contract among the various partners which may be either expressed or implied in nature. There are various kinds of partners, dormant and active, in some cases, an individual might hold himself a partner only to the outside world and thus becomes liable for any debts that the firm must manage in due course. Various articles of partnership including a Memorandum of Association, Articles of Association etc must be laid down as part of the contractual agreeme nts which contain relevant information including the names of the partners, extent of capital provided, nature of the firm’s business, the ratio of sharing profits and losses, as well as the regulations for admission and retirement of partners. The main difference between a partnership and a company is that a company is a type of a corporation and is a separate legal entity except for cases where the company has been proved to be illegal in which case the corporate veil may be lifted. However, Limited Liability Partnerships are corporate bodies having a separate legal personality from their members. A partnership is a mere unity of ownership and control and may be dissolved however a company goes on even after the death of the directors. Each partner in a partnership firms has a certain liability to pay the debts because of his position within the firm if he retires, dies, or is a new partner altogether, just as he is equipped to receive the profits too. In a company however, each director or member who has subscribed is entitled to a small dividend as per the subscription. The audits of a partnership are not available for the scrutiny of the rest of the society whereas a company’s audits and shares are part of the public proceedings as well and thus open to all. When a company is formed as a subsidiary of another company, then the questions are raised whether the company which is the subsidiary of the other company works as an individual entity or on the basis of its parent’s company. In the case of Solomon vs Solomon the question raised was whether a company is an original entity in itself, and the decision mentioned that the company is indeed an individual entity in itself and operates on its own accord. Any company which is formed has the power and the ability to work on its feasibility without the interference from another company. However, nowadays the concept of veil has overshadowed the Solomon case where there is a common understa nding that a subsidiary often is run by its parent company. A partnership can be terminated in many ways. One of the most common ways of terminating the partnership is when the partnership goes bankrupt and

Substance Abuse And Mental Disorders Social Work Essay

Substance Abuse And Mental Disorders Social Work Essay Dual diagnosis between drug abuse and mental illness is very common. The two problems affect and interact with each other. The number of people diagnosed with a mental illness and substance went from 210,000 to 800,000 between the years of 1998-2003. (Druss MD, Bornemann, Fry-Johnson MD, McCombs PhD, Politzer, Rust MD, 2006) Substance abuse is the most common and clinically important dual disorder among adults with severe mental illness. Studies show that fifty percent of people with mental illness also have a substance abuse problem. (Saisan, Smith, Segal, 2010) And more than half the persons with a substance abuse diagnosis also have a diagnosable mental illness. (Saisan, Smith, Segal, 2010) Clinicians believe that mental illness and substance abuse are biologically and physiologically based. Although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other. (Saisan, Smith, Segal, 2010) Both conditions can mirror each. PROBLEM STATEMENT: More and more people are suffering from a combination of substance abuse and mental health problems. Alcohol and/or drugs are often used to relieve the symptoms of a mental illness, side effects from their medications or just to cure symptoms they are having at the time. Alcohol and drug abuse can increase original risk for mental disorders and can make symptoms of a mental health problem worse. Substance abuse and mental illness commonly co-occur due to genetic factors, environmental factors, a brain disorder and/or a development disorders. Co-occurring disorders, two disorders or illnesses occur simultaneously in the same person, they are called dual diagnosis or co morbidity. (Topics in Brief, 2007) Treatment for this dual diagnosis has not been well designed. Clients have to go a treatment facility for mental health treatment and a different facility for substance abuse treatment. This kind of treat is not successful because this leaves the client trying to cope/manger a disorder on their own. It is almost impossible for them to manger the other disorder because if they could quit on their own they would not need treatment. It can be hard to diagnose a person with a dual diagnosis of mental illness and substance abuse. One of the things that makes diagnose hard is denial by the patient. Substance abuse and mental disorders commonly co-occur because of overlapping genetic vulnerabilities, overlapping environmental triggers like stress, involvement of similar brain regions, and drug abuse and mental illness are developmental disorders. (Topics in Brief, 2007) Having a dual diagnosis put a person at greater risk for relapse. Violence and suicide attempts are also more prevalent among the dually diagnosed population. BACKGROUND: The problem of dual diagnosis became clinically clear in the early 1980s. (Drake R. P., 2001) Substance abuse and mental illness hinders your ability to function, handle life and have a healthy social life. Mental illnesses are mental conditions that disrupt a persons thinking, feeling, mood, ability to relate to others and daily functioning. The World Health Organization has reported that four of the 10 leading causes of disability in the US are mental disorders. (National Alliance on Mental Illness, 2010) Some of the major and the most common mental illness that occur with substance abuse are manic depression, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, generalize anxiety disorder and antisocial personality disorder. It is reported that about 57.7 million Americans experience a mental health disorder in a given year. (National Alliance on Mental Illness, 2010) Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not need to sustain life or to make it better. One in four US deaths can be attributed to alcohol, tobacco, or illicit drug use. (Innovatory Combating Substance Abuse, 2010) The commonly abused drugs by people with a mental illness are alcohol, cocaine and/or marijuana. Substance abuse complicates some aspect of care for a person with a mental disorder. It provides challenges for the counselor to engage the individual in treatment. About 50% of individuals with severe mental disorders are affected by substance abuse. (Saisan, Smith, Segal, 2010) Thirty-seven percent of alcohol abusers and 53% of drug abusers also have at least on serious mental illness. (Saisan, Smith, Segal, 2010) See the chart below. The risk of developing a drug abuse problem while having a disorder goes as high as 15.5% for antisocial personality disorder and as low as 02.1% for phobias. The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder. (Saisan, Smith, Segal, 2010) When a person has a dual diagnosis of substance abuse and mental illness the clinician has to determine what are the symptoms/signs of the substance abuse and what are the symptoms/signs are from the mental illness. Disorders with Increased Risk of Drug Abuse Disorder Risk Antisocial personality disorder 15.5% Manic episode 14.5% Schizophrenia 10.1% Panic disorder 04. 3% Major depressive episode 04.1% Obsessive-compulsive disorder 03.4% Phobias 02.1% Source: National Institute of Mental Health. (Drug Abuse and Mental Illness Fast Facts, 2006) At least 60% of people fighting substance abuse or mental illness are fighting both at the same time. (Bouchex, 2007) Patients with mood, anxiety or drug disorders are about twice as likely to be diagnosed with the other as well. Figure 1 (Topics in Brief, 2007) The prevalence of these dual diagnoses does not mean that one condition caused the other, even if one appeared first. The high rates show the need for better treatment and treatment centers able to deal with both at the same time. WORKING DIAGNOSIS: Substance abuse can cause mental disorders due to the fact that, drug abuse can cause a mental illness, mental illness can lead to drug abuse, drug abuse and mental disorders are both caused by other common risk factors all three can contribute to the establishment of specific dual diagnosis of mental disorders and addiction. (Topics in Brief, 2007) FRAMEWORK/METHOD OF ANALYSIS: I began my search using Google and searched using the terms Substance abuse and Mental Illness. This resulted in nine articles that were relevant to my topic all of which I used as references. I then went to the Pub Med Central database and searched using the term substance abuse and mental illness and found many articles. I used four of those articles as references. The other references were found on website such as National Institute on Drug Abuse and the National Drug Intelligence Center. ADDITIONAL INFORMATION (LITERATURE REVIEW): This review looks at progress made in understanding the relation between drug abuse and mental illness. Volkow found that the relationship between substance abuse and mental illness is likely to reflect common contributing factors and brain substrates. (Volkow, 2001) One of the main factors substance abuse and mental illness have in common is stress. A question that still remains is the role that drug abuse has on causing psychosis in individuals with no previous psychiatric histories. Stimulant drugs induce psychosis because they increase extracellular dopamine concentration in the brain. However it does not explain why psychosis can continue after the stimulant drug is no longer present in the brain. Regier, et al, broke his study down into specific mental disorders. This review found that of people with schizophrenia forty-seven percent has some form of substance abuse problem. People diagnosed with schizophrenia have a 4 times as likely then people who do not have schizophrenia to have a substance abuse problem. (Regier, et al., 1990) The odds for people diagnosed with anxiety disorders to have a substance abuse proplem were more than fourteen percent. It is believe that substance abuse may trigger mental illness in vulnerable individuals. Evidence show a complex explanation in which well-known risk factors- such as poor cognitive function, anxiety, deficient interpersonal skills, social isolation, poverty, and lack of structured activities combined to render people with mental illnesses particularly vulnerable to alcohol and drug abuse. (Drake, 2009) People that already have a mental disorder probably appear to be extremely sensitive to the effects of alcohol and other drugs, due to having a form of brain disorder. Drake, et al, explains the term dual diagnosis as misleading because people with a dual diagnosis are diverse and tend to have multiple illnesses rather than just two illnesses. Drake discusses how researchers have established some identical finding. First, co-occurrence is common. Second, dual diagnosis is associated with a variety of negative outcomes, including higher rates of relapse, hospitalization, violence, incarceration, homeless and serious infections such as HIV and hepatitis. (Drake R. P., 2001) Third, the mental health and substance abuse treatment system delivers fragmented and ineffective care. RESTATEMENT OF WORKING DIAGNOSIS (Hypothesis): There is evidence that substance abuse can lead to a mental disorder but also a mental disorder can also lead to a substance abuse, it is not known which comes first. Like the saying which comes first the chicken or the egg. It is said that having one of the diagnosis makes you vulnerable to the other. MANAGERIAL/POLICY RECOMMENDATIONS: Why people who are having a mental disorder are so prone to drug abuse raises a lot of questions due to the limited research done on the topic. The research so far is inconsistent and has failed to address a number of issues. There is a need for more research as well as more treatment center that are equipped to deal with dual diagnosis. The patient has two brain diseases that influence one another, and which both need treatment, at the same time. This is when dual diagnosis treatment is need. It is an approach used by clinicians to treat individuals affected by two co-occurring or coexisting conditions simultaneously. Dual diagnosis affects a person physically, mentally, spiritually, emotionally and socially. There is a need for an all-inclusive approach that identifies both disorders, evaluates both disorders, and at the same time treats both disorders. Many treatment centers now only treat one or the other. Substance abuse treatment are not recommended or designed to handle a ment al illness and vice versa. Awareness about the problem needs to be made public, so that people know the signs to look for and how to approach the person about their disorder correctly. Patients also need to be aware of the help that is available to them and support groups like Dual recovery Anonymous. There also needs to be better training for the counselors and physicians so that they will be able to better and accurately diagnosis patients. For recovery to be successful you must treats a clients addiction and mental health problem.

Speech Recognition and Speech Synthesis :: Essays Papers

Speech Recognition and Speech Synthesis Speech Recognition. Speech Recognition is the process by which a computer maps an acoustic speech signal to text. It is different that speech understanding which is the process by which a computer maps an acoustic speech signal to some form of abstract meaning of the speech. This process depends on the speaker, and how he speaks the language. There are three different systems for the speaker. * Speaker dependent system. * Speaker independent system. * Speaker adaptive system. Speaker Dependent System. A speaker dependent system is developed to operate for a single speaker. These systems are usually easier to develop, cheaper to buy and more accurate, but not as flexible as speaker adaptive or speaker independent systems. Speaker Independent System. A speaker independent system is developed to operate for any speaker of a particular type like American English, or any other kind of English Language. These systems are the most difficult to develop, most expensive and accuracy is lower than speaker dependent systems. However, they are more flexible. Speaker Adaptive System. A speaker adaptive system is developed to adapt its operation to the characteristics of new speakers. It's difficulty lies somewhere between speaker independent and speaker dependent systems. There are many things that effects the speaker systems. For example The size of vocabulary of a speech recognition system affects the complexity, processing requirements and the accuracy of the system. Some applications only require a few words like numbers, others require very large dictionaries (e.g. dictation machines). There are no established definitions for the size of vocabulary. To make it easy to understand we can say that :- small vocabulary - tens of words medium vocabulary - hundreds of words large vocabulary - thousands of words very-large vocabulary - tens of thousands of words. As well as the size of vocabulary effects the speaker system, the way on speaking this words effects too. There are two different ways of speech. continuous speech or isolated-word speech. Isolated-word Speech:- An isolated-word system operates on single words at a time - requiring a pause between saying each word. This is the simplest form of recognition to perform because the end points are easier to find and the pronunciation of a word tends not affect others. Thus, because the occurrences of words are more consistent they are easier to recognize. Continuous Speech:- A continuous speech system operates on speech in which words are connected together, i.e. not separated by pauses.

Costs and Manufacturing Overhead

1. How much overhead cost would be saved by outsourcing production of muffler-exhaust systems and oil pans if a. Overhead costs were entirely fixed costs?$0 would be saved because fixed costs do not affected by reduced number of labor caused by outsourcing. b. Overhead costs were entirely variable costs? (How is volume of activity measured at Bridgeton? Why is volume not measured by simply counting units produced?) All of them would be saved. If using numbers in 1988 for estimate, (5,766,000+6,532,000)*434% = $53,373,320 would be saved.Bridgeton accumulates all manufacturing overhead costs into one cost pool, and use direct labor dollar cost as the allocation measure to apportion the overhead costs in the cost pool.Unlike direct labor and direct material costs that can be traced to specific products, overhead costs could be administrative and manufacturing related so that not all of them are involved in ACF’s production. Therefore, there isn’t a high degree of correlati on between the units produced and the amount of manufacturing overhead used.2. How much overhead cost do you think Bridgeton and the consultants implicitly assumed would be saved by outsourcing muffler-exhaust systems and oil pans? They expect all overhead specific to product line of Muffler – Exhaust systems and oil pans would be saved, which is ($5,766,000+6,532,000)*434% = $533,733,20 (using 1988 data for estimate).3. Calculate the overhead allocation rate for each of the model years 1988 through 1990. Are the changes since 1987 in overhead allocation rates significant? Why have these changes occurred? a) divide total overhead ($) by total direct labor ($) showed in Exh.2 to get overhead rate. | 1987| 1988| 1989| 1990|Overhead Rate| 437% = 107,954/24,682| 434% = 109,890/25,294| 577% = 78,157/13,537| 563% = 79,393/14,102| Costs and Manufacturing Overhead Bridgeton Industries Case Assignment Questions1. How much overhead cost would be saved by outsourcing production of muffler-exhaust systems and oil pans if a. Overhead costs were entirely fixed costs?$0 would be saved because fixed costs do not affected by reduced number of labor caused by outsourcing. b. Overhead costs were entirely variable costs? (How is volume of activity measured at Bridgeton?Why is volume not measured by simply counting units produced?) All of them would be saved. If using numbers in 1988 for estimate, (5,766,000+6,532,000)*434% = $53,373,320 would be saved.Bridgeton accumulates all manufacturing overhead costs into one cost pool, and use direct labor dollar cost as the allocation measure to apportion the overhead costs in the cost pool.Unlike direct labor and direct material costs that can be traced to specific products, overhead costs could be administrative and manufacturing related so that not all of them are involved in ACF’s production. Therefore, there isn’t a high degree of correlation between the units produced and the amount of manufacturing overhead used.2. How much overhead cost do you think Bridgeton and the consultants implicitly assumed would be saved by outsourcing muffler-exhaust systems and oil pans? They expect all overhead specific to product line of Muffler – Exhaust systems and oil pans would be saved, which is ($5,766,000+6,532,000)*434% = $533,733,20 (using 1988 data for estimate).3. Calculate the overhead allocation rate for each of the model years 1988 through 1990. Are the changes since 1987 in overhead allocation rates significant? Why have these changes occurred? a) divide total overhead ($) by total direct labor ($) showed in Exh.2 to get overhead rate. | 1987| 1988| 1989| 1990|Overhead Rate| 437% = 107,954/24,682| 434% = 109,890/25,294| 577% = 78,157/13,537| 563% = 79,393/14,102|

of mice and men1 essays

of mice and men1 essays In John Steinbecks novel, OF MICE AND MEN, his theme of following your dreams and not being selfish was very clear. By opening the story with two dominant characters, George and Lennie, talking about their dreams to by a piece of land and build there dream place he showed us a great relationship between two friends. As the story continues they begin to carry out their plan. George and Lennie are going to a farm to look for work. During the interview the boss notices that George is answering all of Lennies questions, and this makes the boss suspicious. George explains that Lennie is not to bright. When the two friends are back in their bunk they meet Curley and his wife. Throughout the entire story Geprge and Lennie are continually discussing their dream plans; they have already begun to save money. Because Lennie likes to pet soft things Slim gives Lennie a puppy. Lennie is extremely large compared to the small puppy and George makes Lennie put the puppy down for fear that he might hurt it. Carlson Finally convinces Candy to kill his old blind dog. While Candy is waiting for this to happen George and Lennie then begin to once again discuss their dream. Curley decides to get in on the action. Curley later hits Lennie for laughing at him. Lennie is must bigger than Curly and ends up crushing Curleys hand. The group decides to say that Curley hurt his hand in a machine so that no one will get fired. Lennie later goes and visits Crook, a black man who normally does not associate will white men. Crook eventually invites Lennie into his shed and Lennie shares his dream plan with Crook, who decides he wants in on the plan but only because he will become lonely. Curleys wife then enters the scene and threatens Candy, which causes Crook to become scared and decide to not be part of the dream plan. After Lennie went home Curleys wife came to visit him and disco ...

Summary In Praise of the F Word Essays

Summary In Praise of the F Word Essays Summary In Praise of the F Word Paper Summary In Praise of the F Word Paper Summary: â€Å"In Praise of the ‘F’ Word† In this article, â€Å"In praise of the ‘F’ word†, Marry Sherry makes the point that in order to help kids do their school work and get their education; they must be threatened with failing. Before she started teaching her class, she would blame the poor academic skills our kids have today on drugs, divorce and other impediments to concentration necessary for doing well in school. She had an experience with her sons grade 12 English teacher. The teacher told Marry that because her son was talking in class, she wasn’t going to move him since he was a senior but was going to flunk him. At first she was a little put off by the fact that the teacher was going to take sure a drastic measure, but after a moment of thinking she realized that the teacher was making a reasonable decision. Marry goes on to talk about passing students who haven’t mastered school work cheat themselves, as well as their future employers who expect them to have those basic skills from high school. Their excuse for not having those skills is that kids can’t learn if they come from bad environments, but really the reason is that kids don’t put the right amount of school work into their lives as they should. Students that attend night classes are more determined to get their education and they make it their number one priority. Marry really believes in using flunking to help motivate kids to work harder because passing kids who aren’t actually doing the work are just going to suffer in the long run. Sherry, Marry â€Å"In Praise of the ‘F’ Word† Developing Reading Versatility. 2003: Page 200-201

Compare and contrast the tradional marker and new marker of liver Essay

Compare and contrast the tradional marker and new marker of liver fibrosis - Essay Example But is is fraught with several disadvantages and recent novel methods claim to overcome the disadvantages associated with liver biopsy. In this research article, both traditional and novel methods of liver biopsy evaluation are discussed. Novel assessment strategies include serological assays, imaging methods and genetic studies. There are 2 types of biochemical markers and they are direct and indirect. Direct markers evaluate for fibrolysis and fibrogenesis. There is evidence to show that there does exists a good correlation between different biochemical markers, suggesting the fact that they investigate similar process. While the role of biochemical markers are studied and many researchers have opined that they are better than liver biopsy, currently liver biopsy still enjoys the first line investigation method for diagnosis and staging of liver fibrosis. Imaging studies and genetic studies are also considered useful, but in research stage. Excessive accumulation of various extrace llular matrix proteins like collagen is known as liver fibrosis. The condition arises because of chronic damage to the liver due to one or more causes like chronic hepatitis C infection, non-alcoholic steatohepatitis and alcohol abuse. It has the potential to progress to advanced liver conditions like liver failure, cirrhosis and portal hypertension, requiring liver transplantation (Bataller and Brenner, 2005). As of now, there is no standard treatment for liver fibrosis. Though some treatments have been found effective among rodents, they have not been practical to apply on humans because of the difficulties associated with performing serial biopsies to evaluate and ascertain the changes associated with treatment accurately and also because of the fact that humans are much less sensitive towards antifibrotic treatments when compared to rodents (Bataller and Brenner, 2005). Currently, the most effective treatment for liver biopsy appears to be removal of the offending agent and the only curative approach for those with cirrhosis and complications is liver transplantation which improves not only the quality of life, but also the survival (Bataller and Brenner, 2005). Management of liver fibrosis is mainly based on the accuracy of the degree of liver fibrosis. Those with chronic liver disease need to be frequently evaluated for detection of liver fibrosis in early stages. Traditionally, liver biopsy was considered to be the "gold standard" test for ascertaining and evaluation liver biopsy. However, this test is fraught with several limitations and risks because of the invasive nature of the procedure. Recent investigations like biochemical tests, liver magnetic resonance imaging and genetic evaluation are non-invasive and overcome the disadvantages of liver biopsy. However, some experts continue to employ liver biopsy for evaluation of liver biopsy arguing that it is a more accurate assessment strategy. In this research article, both traditional and modern metho ds of liver fibrosis evaluation will be compared and discussed through review of suitable literature. A brief overview of the pathogenesis of the disease will be

Health implications related to the personal health and wellbeing of Essay

Health implications related to the personal health and wellbeing of individual patients in hospital and domestic settings - Essay Example My immediate guess was that both chemotherapy and laser therapy had affected his body metabolism to a certain extent. He was a patient very concerned about his appearance. Being just 27 years of age and unmarried, he wanted to look smart all the time. He recalled the fact that he had a very stylish hair style prior to undergoing chemotherapy. He lamented stroking the few remaining strands of hair remaining in his otherwise bald head. The patient said he used to look in the mirror often and was very proud of his neatly combed hair earlier, but now he was devastated by the figure looking back at him when looking in the mirror. According to him his hair style enhanced his personality and every one used to comment on it. I knew that he was visibly shaken by his hair loss and this was affecting him psychologically. He asked me whether his hair would grow again. Due to his hair loss he told me that his confidence was shattered and did not know how to face society once he was discharged from hospital. Chemotherapy treatment often causes hair loss basically because the cells in the hair follicles grow fast (Baker, 1996). Hair loss would not be a permanent issue and the hair will grow back once the patient's treatment has ended. In fact chemotherapy damages fast growing cells, however all drugs will not cause hair loss and in some scenarios it just cause thinning and others cause dramatic hair loss including the body hair and eye brows (Bandura, 1998). Moreover, different people have different tolerances to the drugs and occasionally, some people lose their hair when it is not expected and sometimes in other cases no hair loss occurs when it is expected. The patient did not understand how certain drugs produced negative side effects in the long run, when I told him that certain chemical combinations coming from different drugs would have caused his hair roots to destabilize he thought that I was talking about some alien disease. When I explained this to him and said that his hair loss was temporarily he was much relieved and satisfied. Finally a smile appeared on his hitherto gloomy face. He thanked me a lot for enlightening him about his hair loss. I was much satisfied when a smile finally appeared on his face. Entry two This week I had an encounter with a patient who complained of a swelling in the neck and in the groin and the legs. But he was experiencing no pain. He also complained of an early feeling of fullness of the stomach and recurrent abdominal pain. He was sixteen years of age and had been an active member of the school soccer team and other sports sometime back. But now he was thin and frail and has been under medication for some time. He lamented that he was unable to go to school and take part in soccer practices which he loved so much. He had been a boy of robust build but of late has lost a lot of weight and said he was having a feeling of 'lack of energy'. This apart he experienced chills, fevers and night sweats on a regular basis. Being the only child in the family, he was the apple in the eye of his parents. He wanted to do all that he can to make his parents proud. Though not a very bright student in his studies, he was very keen on sports and said that his ambition was to

The Art of Balancing Assignment Example | Topics and Well Written Essays - 750 words

The Art of Balancing - Assignment Example The examples of such scenarios are rampant around the world, where a few people have decided that there exists a need for change and have gone about it the wrong way resulting in utter failure which has had dire consequences for their cause. This essay discusses the works and leadership tactics of one of the greatest change leaders of our times, Nelson Rolihlahla Mandela, who lead his nation out of the darkness of the Apartheid and into the burgeoning future, and who has been called one of the most instrumental and inspirational politicians of this century. One of Mandela’s most striking aptitude had been the ability to stay calm under intense pressure and to keep his fear under check so that those who followed him could go. According to Stengel (2008), it was not Mandela’s absence of fear, rather his ability to move beyond it, that managed to make him such an inspirational role model for his people. Researchers such as Groves (2006), note that emotional expressivity is one of the most important skills that a visionary leader has and that it directly affects the level of influence that leader has on the actions of his followers. Hence a leader and his ability to express his emotions a certain way under varying circumstances have a direct impact on the way his followers will react to that same situations. The great leader claims himself that there were many times during his imprisonment in the Robben Island jail, that he was afraid for his life and for the life of the revolutionary change that he wanted to create, but it was his ability to focus beyond the fear which allowed him to maintain and keep strong the faith of those who looked up to him as their leader. As the leader of the African National Congress, and has led an armed struggle against the government, it was to his fellows a great shock when Mandela began negotiations with the government during his imprisonment.  

Sinusitis Care Plan Essay Example for Free

Sinusitis Care Plan Essay This therapeutic care plan will utilized the â€Å"I can treat and prescribe framework† to ensure that appropriate patient treatments are selected using a step by step approach, including assessment integration, drug and/or disease related problems, therapeutic goals, therapeutic alternatives and indications, plan of care and evaluation (OPHCNPP, 2012). By going through each step of this framework, and including or excluding treatment options based on individual patient factors and strong clinical evidence, this clinician will arrive at the most suitable treatment plan for the patient. H.K (32 year old male) presented with persistent facial pain for 7 days. He reported having a headache (6/10 on a pain scale) upon bending forward and awakening, occasional tooth pain, no nasal drainage, and no cough. H.K denied fever or chills but admitted to feeling â€Å"run-down†. His past medical history included varicella zoster at age 5 years, seasonal allergic rhinitis (pollen), viral respiratory tract symptoms 2 weeks ago (now resolved), and no recent antibiotic use over the past 3 months. He is married with two children who are not in daycare (ages 8 and 9). H.K is a supermarket manager, non-smoker, and denied substance abuse. The patient reported having private prescription drug coverage but was only taking Advil cold and sinus (2 tablets orally every 6 hours as required) with good effect. H.K’s vitals were taken (temp. 37.5 °C tympanic, HR 74 reg., R 12 reg. and equal). His head and neck examination revealed that his sclera were clear and his pupils were r ound, reactive to light with accommodation. There was tenderness to palpation of the frontal and maxillary sinuses. Transillumination of the right and left maxillary sinuses revealed an opaque surface. His nares were erythematous and edematous with no obvious discharge. There was cobblestoning of the pharynx with slight erythema. His tonsils were two plus in size with no exudates. His neck examination revealed the absence of lymphadenopathy, the thyroid was non-palpable, and his chest examination revealed clear lung fields. The diagnosis of acute sinusitis was made based on H.K’s presenting signs and symptoms. The two most common predisposing events for acute bacterial sinusitis are acute viral upper respiratory infections and allergic inflammation (80% and 20% of bacterial infections, respectively) (Desrosiers et al., 2011). Complications of sinusitis are very rare and are estimated to occur in 1 in 1,000 cases (Hwang, 2009). In complicated sinusitis, the orbit of the eye is the most common structure involved and is usually caused by ethmoid sinusitis (Hwang, 2009). Patients who present with visual symptoms (diplopia, decreased visual acuity, disconjugate gaze, difficulty opening the eye), severe headache, somnolence or high fever should be evaluated with emergent care suspected (H.K had none of these symptoms) (Hwang, 2009). Most adult patients diagnosed with acute sinusitis become well or nearly well after 7 to 10 days, but 25% are still symptomatic after 14 days (Worrall, 2011). H.K had no untreated medical conditions contributing to his acute sinusitis (not pollen season). A primary health care nurse practitioner can effectively diagnose, treat and manage adults who have symptoms like H.K according to the Nurse Practitioner Practice Standard of Ontario (CNO, 2011). His condition was not life threatening and did not necessitate a referral to a physician, specialist or transfer of care. H.K was taking Advil cold and sinus, a drug that was appropriately dosed (1-2 tablets orally every 6 hours as required to a maximum of 6 tablets in 24 hours), which is clinically indicated for sinus pain in adults and is not too complex (CPA, 2013). This drug was deemed safe for him after a review of contraindications, including hypersensitivity to the agent, nonsteroidal anti-inflammatory drug-induced (NSAID) asthma or urticartia, aspirin triad, pre-operative coronary bypass surgery, coronary artery disease, monoamine oxidase inhibitor use within 14 days, uncontrolled or severe hypertension, and urinary retention (Epocrates, 2013). For H.K, the oral route of medication administration was most appropriate, the least invasive and the easiest way for an adult to take drugs (Brophy et al, 2011). Advil cold and sinus is not a cytochrome P450 system inhibitor, which is the main (or partial) cause for large differences in the pharmacokinetics of other drugs (Rx Files, 2012, Epocrates, 2013). The patient was not taking borrowed prescriptions, using drugs from previous occurrences of the condition, or experiencing any adverse drug events/reactions to Advil cold and sinus. Also, he was not being double dosed or experiencing therapeutic duplication of drugs belonging to the same pharmaceutical class. H.K had no untreated medical conditions (other than his new acute sinusitis), was not taking drugs prescribed by other clinicians and there were no other factors (communication errors, non-adherence, financial restrictions) influencing his ability to receive medication. Antibiotic therapy should be reserved for patients with acute bacterial sinusitis as defined by a complete history and physical examination (AMA, 2008). A â€Å"wait and see† approach has been suggested in recent Canadian guidelines as a means of differentiating bacterial sinusitis from a viral respiratory tract infection (Desrosiers et al., 2011). Initiation of treatment should take place 7 to 10 days after persistent symptoms or when signs compatible with acute sinusitis occur (Desrosiers et al., 2011). Since H.K’s facial pain had lasted for 7 days, the decision was made with the patient to treat. Goals of care were established (with the patient) including maximizing symptom relief (especially drainage of congested sinuses), eradication of infection, and prevention of re-occurrence and complications (Fryters Blondel-Hill, 2011). Five drug choices were selected and scrutinized as potential treatment options for H.K, including first and second line therapies (appendix 1) (ARP, 2012). The primary bacterial pathogens involved in the development of acute sinusitis for adults are Streptococcus pneumonia and Haemophilus influenzae (AMA, 2008). Canadian antimicrobial resistance data of S. pneumoniae describes that penicillin resistance rates range from 14% to16% in Central Canada (Powis et al., 2004). Amoxicillin is a first line drug therapy that remains active against S. pneumoniae with the rate of resistance under 2% (Brook et al, 2006) and also retains the best coverage of oral beta-lactam agents against S. pneumoniae (AMA, 2008). It is available in a capsule, chewable tablet or powder for oral suspension (H.K had no dysphagia and preferred to take capsules) (CPA, 2013). Amoxicillin should not be prescribed to a patient more than once in a 3-month period (H.K had not taken it in the last 3 months) (ARP, 2012). This drug is acid resistant, rapidly absorbed after oral administration, and is stable in the presence of gastric acid allowing for adequate systemic concentr ations (H.K was not taking drugs that affect gastric acid production) (CPA, 2013). Pertinent adverse affects of the drug are diarrhea, nausea, headache, vomiting, abdominal pain, anaphylaxis, anemia, AST/ALT elevation, mucocutaneous candidiasis, rash and pseudomembranous colitis (Medscape Reference, 2013). Amoxicillin is contraindicated with anaphylaxis reaction to penicillins or cephalosporins (Epocrates, 2013). Several cautions to consider when prescribing amoxicillin to H.K include him having clostridium difficile infection, infectious mononucleosis (result is skin rash), bacterial/fungal superinfections, allergy to cephalosporins, and carbapenems, (Medscape Reference, 2013). Also, serious drug interactions include bcg/typhoid vaccine live, doxycycline, minocycline, probenecid and tetracycline (Epocrates, 2013). H.K did not have any of the contraindications, cautions, or potential medication interactions relevant to taking amoxicillin, so it was deemed safe for him to take. Amoxicillin was selected as a treatment option for H.K (appendix 1). The three times a day (500 mg) option was selected to ensure simplicity, when compared to the 875 mg twice a day option that would require H.K to take two possibility identical capsules (a 500 mg and a 250 mg), increasing the likelihood of medication error (Epocrates, 2013). A primary concern for individuals infected with H. influenzae is ampicillin resistance, mediated by the production of a beta-lactamase, which is produced by approximately 19% of the bacteria (Zhanel et al, 2003). H. influenzae remains predictably susceptible to amoxicillin-clavulanate (a second line therapy) which possesses the added benefit of stability against beta-lactamases and cephalosporins (Tristam et al, 2007). Amoxicillin-clavulanate is also effective against most penicillin-resistant S. pneumoniae (MacGowan et al., 2004). It has enhanced gram positive activity and should be used in patients where risk of bacterial resistance is high, consequences of failure of therapy are greatest, or for patients not responding to first-line therapy (DeRosiers, et al, 2011). Common side effects of this drug are nausea, vomiting, diarrhea, rash and uticartia (Poole-Arcangelo Peterson, 2013; Rx Files, 2013). Higher rates of diarrhea and other gastrointestinal side effects occur with amoxicillin-clavulanate than with amoxicillin alone (Burns et al., 2009). It is also considered a more costly sinusitis treatment (ARP, 2012; Rx Files, 2012). Amoxicillin-clavulanate was added as a treatment option for H.K (see appendix 1). The clinician selected the two times a day option (875 mg) because the clavulanic acid daily dose is less, resulting in a decreased likelihood of the patient experiencing adverse effects co mpared with a more frequent dosing schedule option such as every 8 hours (Rx Files, 2012). As a result of activity against beta-lactamase–producing H. influenza and S. pneumonae (Zhanel Lynch, 2009), cefprozil and cefuroxime axetil have a second line treatment role in acute sinusitis (ARP, 2012). With the expanded spectrum of activity, ability to achieve adequate concentrations in tissues, suitability for twice-daily dosing, favorable toxicity profile, and proven tolerability of cephalsporins, they are a safe alternative for treatment (Poole-Arcangelo Peterson, 2013). However, they have a broader range of activity and are more costly than amoxicillin (Rx Files, 2012; ARP, 2012). Second line drugs cefuroxime axetil and cefprozil were added as treatment options for H.K (see appendix 1). The 250 mg dose was selected for both drugs due to ease of use (smaller pills, easier to swallow), patient related factors (H.K was not immunocompromised) and disease related factors (H.K’s sinusitis had no complications). In beta-lactam-allergic patients, a second line therapy such as trimethoprim-sulfamethoxazole (TMP- SMX) may be substituted for penicillin (ARP, 2012). The TMP-SMX resistance reported from Canadian laboratories is approximately 14% (Desrosiers et al., 2011). Increased pnuemoncoccal and H. influenza resistance rates make TMP-SMX a less desirable agent, however it is one of the most cost-effective options for patients with financial constraints (not an issue with H.K) (ARP, 2012). The most common side effects of this drug are rash, fever and gastrointestinal symptoms (Poole-Arcangelo Peterson, 2013; Rx Files, 2012). Drugs containing sulfa (such as TMP-SMX) potentiate the effects of warfarin, phenotoin, hypoglycemic agents and methotrexate (Poole-Arcangelo Peterson, 2013). Since H.K is not taking these drugs, TMP-SMX was selected as a treatment option (see appendix 1). One double strength tablet was selected over two single strength tablets for simplicity of administration. The general approach to the non-pharmacological management of acute sinusitis requires utilizing adjunctive therapies. Decongestants, intranasal corticosteroids (INCS), antihistamines, mucoltylics and analgesics are treatment options. A decongestant may be used to reduce mucosal edema and facilitate aeration and drainage (Desrosiers et al., 2011). Oral decongestants have been shown to improve nasal congestion and can be used until symptoms resolve. (Desrosiers et al., 2011). Topical decongestants are controversial and should not be used for longer than 72 hours due to the potential for rebound congestion (ARP, 2013). INCS reduce inflammation and edema of the nasal mucosa, nasal turbinates, and sinus ostia (Desrosiers et al., 2011). INCS are minimally absorbed and have a low incidence of systemic adverse effects (Desrosiers et al., 2011). Adverse effects include transient nasal irritation, epistaxis, pharyngitis, rhinitis, headache, and changes to taste, smell and voice (Rx Files, 201 2). A Cochrane review evaluating three INCS drugs for acute sinusitis found limited but positive evidence for INCS as an adjuvant to antibiotics (Zalmanovici Yaphe, 2009). Antihistamines are often used to relieve symptoms because of their drying effect, however there are no studies to support their use in the treatment of acute sinusitis (Desrosiers et al., 2011). Guaifenesin is a mucolytic that has been used to thin mucus and improve nasal drainage, however because it has not been evaluated in clinical trials, it was not recommended as an adjunct treatment for sinusitis (Rosenfeld et al, 2007). Selection of analgesics should be based on the severity of pain. Tylenol or an NSAID given alone or in combination with an opioid is appropriate for mild to moderate pain associated with sinusitis (Rosenfeld et al, 2007). Recent Canadian guidelines suggest that limited evidence exists supporting the beneficial effects of saline irrigation in patients with acute sinusitis (Desrosiers et al., 2011). Despite limited evidence, saline therapy, either as a spray or high-volume irrigation, has seen widespread use as adjunct therapy (Desrosiers et al., 2011). Although the utility of saline sprays remains unclear, the use of saline irrigation as ancillary therapy is based on evidence of moderate symptomatic benefit and favourable tolerability (Desrosiers et al., 2011). Some additional comfort measures for patients with symptoms of acute sinusitis include maintenance of adequate hydration and application of warm facial packs. No high quality trials have demonstrated that these comfort measures are effective (Worrall, 2011). As viral infections predispose individuals to acute sinusitis, strategies (such as handwashing) that focus on patient education of reducing viral transmission help to reduce the incidence of bacterial sinusitis (Desrosiers et al., 2011). Educating patients about common predisposing bacterial sinusitis factors may be considered as a preventative strategy (Desrosiers et al., 2011). Prophylactic antibiotics are not effective in preventing viral episodes or the development of subsequent bacterial sinusitis, and are not recommended (Desrosiers et al., 2011). Also, there is no evidence that influenza or pneumococcus vaccinations reduce the risk of contracting acute sinusitis (Rosenfeld et al, 2007). Recent reviews have found limited evidence for alternative and complementary medicine (Scheid Hamm, 2004). Alternative practices that have failed to show efficacy include acupuncture, chiropractic, naturopathy, aromatherapy, massage and therapeutic touch (Desrosiers et al., 2011). Vitamin C preparations and zinc lozenges are also felt to be controversial (Scheid Hamm, 2004). Studies of zinc lozenges for the common cold have produced mixed results (Desrosiers et al., 2011). One recent meta-analysis of echinacea preparations has shown some positive effects in reducing duration of respiratory tract symptoms (Barrett et al, 1999). However, the widespread use of echnichea in the treatment of acute sinusitis is not well supported (Desrosiers et al., 2011). A recent Cochrane review found that when antibiotics were given to patients, they increased recovery time from sinusitis symptoms (Ahovuo-Saloranta, 2008). The choice of first-line treatment is based on the anticipated clinical respons e of a patient, as well as the microbiologic flora likely to be present. Also, when selecting an antibiotic regimen for H.K, the clinician considered the medication cost, medication safety profile, adverse effects, and local patterns of bacterial resistance in order to maximize therapy (Hickner et al., 2001). The recommended antibiotic regimen is specific for H.K, who did not have any intracranial/orbital complications or a compromised immune function, and has normal renal function. In the absence of drug allergies and presence of resistant organisms, amoxicillin was selected for H.K as it is a first line therapy, is generally effective against susceptible and intermediate resistant pneumococci (Brophy et al, 2011), low cost (ARP, 2012), high patient tolerability, and relatively narrow antimicrobial spectrum (Aring Chan, 2011). Factors suggesting greater risk of penicillin resistant streptococci include antibiotic use within the past 3 months, chronic symptoms present for longer than 4 weeks, and parents of children in daycare (H.K had none of these risk factors). When antibiotics are prescribed by the clinician, the duration of treatment should be 5 to10 days as recommended by product monographs (Desrosiers et al., 2011). For H.K, the clinician utilized product monographs and other evidence based guidelines for determining the appropriate duration of treatment (CPA, 2013; ARP, 2013). Based on the information and discussion presented in this paper, amoxicillin 500 mg three times a day for 10 days (CPA, 2013) was selected as the most appropriate treatment for H.K (see appendix 2). H.K was instructed by the clinician to take his medication until finished, not share it, and to store at room temperature away from moisture, heat and light (Epocrates, 2013). He was taught about the drug’s side effects and that overdose symptoms may include confusion, behavior changes, severe rash, decreased urination, or seizure (Epocrates, 2013). He was provided health teachings by the clinician, including seeking emergency medical help if exhibiting any signs of an allergic reaction (hives, difficulty breathing, swelling of the face, etc.) or experiencing serious side effects (white patches/sores inside his mouth/lips, fever, swollen glands, rash, itching, joint pain, pale/yellowed skin or eyes, dark colored urine, fever, confusion/weakness, severe tingling, numbness, pain, muscle weakness, easy bruising, unusual bleeding, purple/red pinpoint spots under his skin) (Epocrates, 2013). H.K was provided health teachings regarding reducing the risk of contracting viral infections through hand washing techniques. Complementary therapies, alternative medicines, comfort measures, saline prophylactic antibiotic usage and vaccines were not recommended to H.K. He was also instructed about the role these treatments play in acute sinusitis treatment. Only evidenced-based adjunctive therapies as described in this paper have been selected for H.K, including INCS therapy (see appendix 3), analgesics (Advil cold and sinus) and oral decongestants (Advil cold and sinus). H.K agreed to this treatment plan. Based on H.K’s history and physical exam findings, a follow-up examination would be required if no improvement is seen within 72 hours of antibiotic administration, as this could indicate treatment failure (Derosier et al, 2011). The patient was advised to return in 72 hours if there were no improvements in symptoms. He did not return to the clinic for follow-up. If H.K had deteriorated at any time, the clinician would have reassessed for acute complications, other diagnoses and adherence to treatments (Derosier et al, 2011). If H.K experienced a type 1 hypersensitivity reaction to amoxicillin at any time, other pharmacological options would have been considered. A phone call was placed one week after H.K’s medical visit to conduct a post-visit evaluation, and he reported that his symptoms were nearly resolved (pharmacological and non-pharmacological therapy evaluation). Since H.K demonstrated signs of clinical improvement, a follow-up visit or possible referral to an otolaryngologist was not required (Fryters Blondel-Hill, 2012). The original goals of care for H.K were met. He stated that he was able to manage his symptoms with the treatment plan, was grateful that no complications were experienced, and was more knowledgeable about the prescribed drugs and future prevention strategies. H.K was satisfied with his healthcare experience (self-report) and was able to verbalize non-pharmacological therapies and apply them to his situation. When faced with a similar patient in the future, the clinician will ensure that the â€Å"I treat and prescribe framework† is utilized, as it is a valuable tool for ensuring patient specific treatment. Professional feedback from the course instructor/preceptor will also be integrated into future treatment plans.