Construction Management for Bill of Quantities †MyAssignmenthelp.com

Question: Examine about the Construction Management for Bill of Quantities. Answer: Presentation The report depends on Bill of Quantities (BOQ) for another two story block working with concrete tiled rooftop comprises of two lofts. The area of the development of the structure is at 52 box street, East Hills. The sort of agreement is fundamentally founded on Australian General Conditions of Contract. BOQ comprises of offer procedure of whole venture included estimation of cost, offering, opening of delicate for the undertaking just as grant of agreement (Cunningham 2016). Legitimate cost estimation assists with deciding attainability investigation of given undertaking and office for obtainment method of the task work. It assists with arranging the accounts required for effective venture finish. From the point of view of the contractual workers, legitimate cost estimation assists with setting up an offer for work and encourage asset courses of action for assessment just as execution of the work. This specific report sums up the significance of distinguishing proof and estimating of cost noteworthy fundamentals so as to build odds of winning the delicate of the East Hills venture. It likewise investigates the evaluated fundamentals bill for the cost noteworthy starters things for the gave venture. From the offering survey, significances of the depiction of BOQ and notwithstanding its belongings are featured all through the task model. Venture starters costs Significance of precisely distinguishing and valuing cost-huge fundamentals to expand odds of winning a delicate Jayaraman and Jayaraman (2016) expressed that the business are chosen the temporary worker dependent on most minimal offer measures. A most minimal offering cost is a key noteworthy approach to win a delicate. Seymour (2017) dissected that determination of most reduced offer isn't required to reflect genuine expense of the venture work. Delicate evaluating is a significant part to get ready of BOQ. In the given venture, cost estimation is accomplished for experienced laborers, for example, sub-temporary worker those are specific into building development. The evaluating cost noteworthy starters are never really cost data dependent on collaboration with the providers (Cunningham 2015). Delicate cost is taking value data all through citation for the providers just as sub contractual workers. This specific task is an administration venture which gives higher caliber and practices into sort of development they go for citations (Fichtner and Michel 2016). The achievement of contractual wo rker for getting of agreement depends on nature of the citations got for the materials and things to subcontract. It is additionally required to have serious costs at an opportunity to set up the estimation of cost. Standard methods are being built up to the duties of the individual those are to complete the offered capacities just as arrangements that rose (Abas 2017). The rundown of the things for which there is prerequisite of citations is being set up with complete appraisal of the contracted reports. The temporary worker presents a delicate for the task which sets out understanding of the association to embrace the structure development venture, their proposed approach and estimation of cost to attempt the undertaking (Larson and Gray 2013). So as to win an agreement, a legitimate delicate documentation is required for the undertaking. Into the development condition, the temporary workers are offered low for the components like starters just as earthworks to win of the agreements. Be that as it may, forecast of low offer is a troublesome undertaking for the given task. Into the task, lower offer is granted the agreement, at that point it is proposed that forecasts of lower offer is legitimate for winning the delicate. Peng, Ding and Yu (2016) referenced that offering execution is examined by structure estimators. The nature of counsel offered to the customer is improved if the specialist can see the plan cost from the offering results. At that point, the contractual worker can re ady to relate its capacity so as to win the agreements (Abas et al. 2017). The contractual workers are submitted lower costs for the undertaking components so as to win agreements of the delicate. Undertaking overhead estimation is required to improve the precision of the delicate valuing. Endeavors are given to improve the strategies to assess the roundabout expense. The temporary worker increases a serious edge by modifying the fundamentals, for example, venture overhead. Goh and Hall (2013) sent the venture situation and presumed that citations are acquired among the provider and subcontractor. In this way, appropriate venture evaluating for the task overheads are required to get accomplishment into the undertaking offer (Wang and Wei 2014). Into the development business, fundamentals are abstract just as the greater part of the occasions it is hard to value the framework work. The primary area of work is bill of amounts which comprise of the monetary issues those are identified with the agreement (Azam, Sabrina and Mohyin 2016).The contractual worker has duty to value the fundamentals things into the delicate dependent on venture prerequisites. Anifowose et al. (2013) clarified that fundamentals area of the bill of amounts contains of two unmistakable kinds of things. The things those are not explicit but rather have recognizable cost considered to delicate, for example, authoritative need for protections, site capacity for the business just as installment towards the neighborhood authority (Kang et al. 2013). Things those are fixed just as related cost which gets from the contractual workers unsurprising strategy to draw out the venture work. The works are related to bring of plant from the site and gave that of impermanent works (Jayaraman and Jayaraman 2016). The time related development is accommodated the primers things which permit the givers to cost the things exclusively. The giver has the capacity to extend the time related cost things to furnish specific techniques for building development. The accomplishment of temporary worker for picking up of agreement depends on prevalence of the citations set up for the mate rials notwithstanding things to contract out (Brook 2016). Subsequently, valuing the primers things are altogether required to boost odds of winning the delicate for the task. Evaluated fundamentals bill for the recognized cost-critical starters things for the given venture Starters Bill Thing Portrayal Sum ($) Valuing approach with legitimization 1 Foundation of the site 1.1 Site freedom for development of new two story block building 14,000 The territory of the site comprises of 400m2 for an expense of $35 per m2, thusly the site freedom cost is (400*35) = $14,000. 1.2 Platform, plant and types of gear, lifts just as cranes 20,000 The aggregate of room is 500m2 for cost of $40 per m2, consequently the expense is (500*40) = $ 20,000. 1.3 Testing of the dirt 20,000 The absolute region for building the two stories is 400m2, where the expense for testing the dirt is $50; thus the expense is $20000. 1.4 Authority charges 840 Authority charges $30 for the undertaking with working day of all out 28 days. 2 Foundation 2.1 Filling to the nursery beds 740 The nursery bed is developed to 100 profound with region of 37m2, the assessed cost is $20; subsequently the all out expense is (37*20) = $740. The top soil blend of the nursery beds include three sections with imported topsoil and one section is manure. 2.2 Natural manure 2590 The natural manure is being indicated applied at pace of 3kg per 10m2, incorporates of development to profundity of 200 and positions to surface level with nearby surfaces. The region is 37m2 with cost of $70; henceforth the expense is (37*70) = $2590. 2.3 Planting and relationship of exhuming just as filling of the work 300 There is flexibly of 140 dia pots and plant into the beds are determined as ceria turbinate with complete number of 10, and cost of $30; thus the all out expense is (10*30) = $300. 2.4 Removal and beds for the ways 208 There is removal of the materials business of 16m3 at diminished level not surpass 1.0m of all out profundity of strip footings. It expenses of $13 per m3, consequently the all out expense is (16*13) = $208. 2.5 Unearthing for the electrical and waste administrations 6800 4*25mm2 PVC links into channels (least 600m spread) just as it are brought into courses. It incorporates for removal, support appearances of uncovering, refilling, notice tape with removal of surplus ruin. The complete region is 34m with cost of $200; thus the expense is $6800. 2.6 Removal from downpour and permeating water by method of siphoning out 200 15 measurement pipe works into pursues in brickwork is 10m, with cost of $20; henceforth the expense is $200. 2.7 Upkeep countenances to side of unearthing not to surpass 1.0m absolute profundity for the strip footings 2120 The territory of the exhuming for the strip footings is 53m3 with cost of $40 per m3; consequently the cost is $2120. 3 Windows and entryways 3.1 Aluminum surrounded window 3000 There are two anodised aluminum surrounded sliding window units comprehensive of industrial facility coating, fixings, furniture just as trims. It suits of opening 1210 wide* 1029 high with incorporates of working into block depression divider. Every one of the windows is cost of $1500. Consequently, the expenses of the windows are (2*1500) = $3000. 3.2 Metal door jambs 6000 There are six metal door jambs to suit 2040*820*35 thick single leaf entryways, complete with pair of steel butt hingers, hook continue, striking plate incorporates for the structure 110 thick block parcel dividers. Every one of the windows is cost of $1000. Along these lines, the expenses of the windows are (6*1000) = $6000. 3.3 Outer wood entryways

Dodge vs Chevy free essay sample

You’re setting off to the vendor to purchase another diesel truck however you don’t realize what brand to get. You’ve been considering it, doing a little research and you’ve go to a â€Å"brick wall†. You can’t conclude whether to get the Dodge 2500 Cummins or the Chevrolet 2500 Duramax. Well my recommendation is get them both, on the grounds that they are both GREAT trucks. Every one of them is going to keep going you quite a while and give you near no issues. But†¦Ã¢â‚¬ ¦. Since you will most likely be unable to manage the cost of both or have any utilization for the two vehicles, you have to pick one. This paper will ideally help decide. The Dodge 2500 diesel is the quickest selling truck available, basically as a result of its Cummins B-arrangement motor. The Cummins B-arrangement motor was acquainted with Dodge in 1989. It denoted the first run through a real medium-obligation diesel motor had been utilized in a light-obligation truck as the 2500 Ram. We will compose a custom paper test on Evade versus Chevy or on the other hand any comparative point explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page Without a doubt, different pickups had diesels, yet none of them had a motor with a gross vehicle weight rating anyplace close to the Cummins B-arrangement 66,000 pound limit. Despite the fact that it has an incredible motor, the body is known to be made less expensive than Ford or Chevy. Many individuals have issues with the scramble splitting down the center, paint blurring and chipping simpler, and while getting in wrecks, the casing breaking when it ought to have even more a springy trademark. Likewise Dodge utilizes modest axils, which are the substantial iron bars going from the casing to the wheels. Since Dodge utilizes modest axils, the front-wheel arrangement gets unaligned simpler and can cause, what a few people call â€Å"the Death Wobble†. The Death wobble is the point at which you are driving at speeds over 60 miles an hour and out of nowhere the arrangement leaves line and both front wheels begin shaking to and fro in some cases making you lose control of the vehicle. In spite of the fact that its blemishes may sound awful, the Cummins motor over gau ges the cons by far. It has all the more towing power, strength, its manufactured harder, and is known to outlive the vehicle itself. 200,000 miles on a vehicle may seem like a great deal yet it’s nothing with regards to a Cummins whenever utilized appropriately. The Chevrolet 2500 diesel likewise has a decent motor yet many individuals don’t like them because of the way that they are made by Isuzu in Japan so getting parts for them is somewhat costly, additionally there are not a mess of individuals/mechanics that realize how to chip away at the Duramx motor so discovering somebody who can take a shot at it is somewhat troublesome. Another con about the Duramax motor is that, at around 200,000 miles, they are known to begin having issues like injector disappointment, mass wind current sensors going out, and so on, dissimilar to the Cummins motor that can go more than 300,000 miles without having any issues. In spite of the fact that the Chevrolet might not have the best Motor, numerous individuals would state that is has the BEST transmission. In the event that you don’t recognize what the activity of the transmission is, they are a cone-formed part about the size of three tires put one next to the other that are associated from the motor to the drive shaft. The motor twists the drive shaft while the transmission changes gears when to motors gets fired up to shield the motor from overheating. Transmissions are not something you would need to be turning sour all the time. It is over the top expensive with regards to getting them supplanted. Transmissions are not handily fixed. When something turns out badly, Most of the time the main choice is to get a fresh out of the box new one. Transmissions, for a diesel truck, can cost you anyplace between 2,000 dollars to 8,000 dollars. Chevrolet utilizes the Allison-Chalmers transmission. Each part within this transmission is made to top quality. Numerous trucks need another transmission after around 200,000 miles yet tests have demonstrated that the Allison-Chalmers transmission can go 300,000 miles, in any event, when pulling overwhelming burdens on an ordinary premise. Another genius for the Chevrolet is the inside and paint. Chevrolet places somewhat more cash into the materials used to fabricate their not at all like Dodge, generally at any rate. They utilize better paint that doesn’t blur or chip as effectively as evade and they utilize thicker and heavier iron for their axils to dodge the steady requirement for re-arrangement. Be that as it may, similar to Dodge, the inside isn't constantly considered â€Å"the best†. They have had issues with paint stripping off runs and entryway boards and a few people say that the material utilized on the seats are un-current.

2014 February Freshman Admits - UGA Undergraduate Admissions

2014 February Freshman Admits - UGA Undergraduate Admissions 2014 February Freshman Admits This afternoon, UGA offered admission to a group of freshman applicants. In the past, this group has been approximately 2,000 or so admits, and while I do not have an exact number, it is fairly close to this average. Our office is too busy reviewing files for me to run any mid-range academic averages at this time, but the academic information should be very similar to the Early Action admitted students (it will not be exactly the same, as we had a large number of EA admits who were applying for our to scholarships which slightly skews EA stats a little higher). These admitted freshman, made up of mostly Regular Decision applicants, met the stringent academic criteria of Early Action admission that we had used with our much larger wave of December admission offers. Do not panic if you were not admitted with this February group. We are still very much in the midst of carefully reviewing documents and data on a great many more files, and there are still lots of decisions to make. Admitted students will see their decision on myStatus, while applicants who do not yet have a decision will see the same myStatus message as before. The final wave of freshman application decisions will be made by the end of March, after we have completed our holistic file reading process. Thank you for your patience as we finish our reviews over the next month. Go Dawgs!

2014 February Freshman Admits - UGA Undergraduate Admissions

2014 February Freshman Admits - UGA Undergraduate Admissions 2014 February Freshman Admits This afternoon, UGA offered admission to a group of freshman applicants. In the past, this group has been approximately 2,000 or so admits, and while I do not have an exact number, it is fairly close to this average. Our office is too busy reviewing files for me to run any mid-range academic averages at this time, but the academic information should be very similar to the Early Action admitted students (it will not be exactly the same, as we had a large number of EA admits who were applying for our to scholarships which slightly skews EA stats a little higher). These admitted freshman, made up of mostly Regular Decision applicants, met the stringent academic criteria of Early Action admission that we had used with our much larger wave of December admission offers. Do not panic if you were not admitted with this February group. We are still very much in the midst of carefully reviewing documents and data on a great many more files, and there are still lots of decisions to make. Admitted students will see their decision on myStatus, while applicants who do not yet have a decision will see the same myStatus message as before. The final wave of freshman application decisions will be made by the end of March, after we have completed our holistic file reading process. Thank you for your patience as we finish our reviews over the next month. Go Dawgs!

Historical Significance Of The War Of 1812 - 1436 Words

1. Identify state the historical significance of the following: a. Lewis Cass- a veteran of the War of 1812. His views on the extension of slavery were well known because he was the reputed father of â€Å"popular sovereignty.’’ b. Stephen A. Douglas- Thirty-seven-year-old Senator of Illinois. He tried to break the North-South deadlock over westward expansion; proposed the Territory of Nebraska to be sliced into two territories, Kansas and Nebraska.Their status on slavery would be decided by popular sovereignty. Kansas would be presumed to be a slave state, while Nebraska would be a free state. c. Franklin Pierce- from the hills of New Hampshire is the second â€Å"dark-horse’’ candidate in American history. In the Democratic Convention of 1852 in Baltimore, the Democrats chose Franklin Pierce as their candidate for president and won the election of 1852. He supported the Compromise of 1850, the Fugitive Slave Law, and the Kansas-Nebraska Bill. d. Zachary Taylor- Chosen as Whig’s candidate for presidency and won election of 1848 (12th President). A Virginia-born, slave owning planter from Louisiana who was a war hero for his participation as a general in the Mexican-American war. President Zachary Taylor opposed slavery and seemed ready to veto any compromise between the North and South that went through Congress. In 1850, President Taylor died suddenly in office and Vice President Fillmore took over. e. John C. Calhoun- part of the â€Å"immortal trio† and known as the GreatShow MoreRelatedhis part 8 Essay1005 Words   |  5 Pageswithout resorting to violence or bloodshed. The federalists let go office with anxiety but peacefully. The election proved that parties would not rip apart a democratic system. Instead, they served as a vehicle for peaceful discussion and change without war. c. Looking at the record of Jeffersons presidency, in what respects did his policies represent a significant change from Federalist policies? 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Confine your answer to the years from 1861 to 1870. 2008 DBQ (Form A) Analyze the ways in which the Vietnam War heightened social, political, and economic tensions in the United States. Focus your answer on the period 1964 to 1975. (Form B) For the years 1880 to 1925, analyze both the tensions surrounding

Ethical and Socially Responsive Business Ruby Tuesdays...

Ruby Tuesday’s vision is to provide great value to their guests and a great working environment for their team members by reflecting their core values of Quality, Passion, and Pride in everything the company does. The company adopted a Code of Business Conduct and Ethics to confirm its commitment to conduct business with the highest integrity. Compliance with Laws, Rules, and Regulations is, to me, the most important area in a company’s code of conduct. Complying with laws, rules, and regulations includes preventing harassment and discrimination, improper payments, and environmental compliance. When companies are in compliance they are not putting themselves at risk of huge fines, lawsuits, and negativity towards their company.†¦show more content†¦Ruby Tuesday Inc.’s code of conduct prohibits all fraudulent activity that involves; dishonest acts, embezzlement of the company’s funds, forgery or alterations on checks or drafts, conversion of funds for personal use, unauthorized handling or reporting transactions, and falsification of the company’s financial statements or records. This is significant because again it could result in unwanted fines, lawsuits, and negativity towards the company. If companies are not properly funding their organizations or if employees are embezzling money f or personal uses, it is not going to look positive for the company. This could ruin their business in a whole because customers will not want to do business with people that are unethical. Confidentiality is also an important aspect in a company’s code of conduct. Ruby Tuesday Inc.’s code of conduct states that the protection and proper use of confidential information or trade secrets in its possession are fundamental to its ability to conduct the company’s business. This is significant to business because if workers go around telling people about their secrets and confidential information, they are then telling people how the company runs business, giving the competitors when they need to compete. Some key steps that Ruby Tuesday’s should use to ensure that employees are following the code of conduct are training and continued training,

A Note On The Value Of Physical Contact - 910 Words

Humans are oriented around touch. Babies crave nurturing and nearness to their mother from the minute they exit the womb. Something as simple as a warm embrace can wipe sorrow and stress away. This need for physical contact is the reason why letters carry so much more value than an email or text message. Letters are tangible: they’re a piece of paper that can be stored in a drawer or tacked up on a wall. They require time and attention to write, so they are able to convey such an emotional closeness people who are far away. There is such a stark contrast between dialogue and text: people are often more willing to honestly write down their feelings to express them aloud. That is why Mark Dunn held true to the passions of his hyper-literate Nollopians by deciding write his debut novel entirely in letters; they mean something to people, especially those who are in love. Mittie is a prime example of this concept seeing as she keeps a box of all the letters she had received from Amos- dating back long before the alphabet began to fall apart. Reading these letters her mother had treasured actually gave Ella a sense of comfort when she was almost entirely alone on Nollop: â€Å"I miss ewe all teeplee. I reat letters- teer, sweet letters ewe wrote to Pop- warm, engaging letters Pop wrote to eww†¦I reat tem to gain neeted inspiration† (Dunn 187). Letters, such as the ones written by Mittie and Amos, have a way of revealing the author’s personality, their voice to put it in English terms.Show MoreRelatedMagical Thinking Case Study1469 Words   |  6 Pagesthis definition; we need to first explore the ideas of magical similarity and magical contagion. Two things are essential to the idea of magical contagion: that some sort of physical contact occurs, and that there is an â€Å"essence† transmitted . The â€Å"essence† that gets transmitted via physical contact is what makes an object of note pure or impure. Essence is the idea that an object has properties that are not immediately visible . For example: if a sandwich were to be dropped on the floor, and someoneRead MoreQuestion Answers1603 Words   |  7 Pagesvulnerable to abuse and what a learner must do if abuse is suspected or | |alleged | |Credit value-3 | |Level 2 Read MoreIntentional Torts And False Punishment950 Words   |  4 Pagesintends to â€Å"cause a harmful or offensive contact with the person of the other or a third person, or an imminent apprehension of such a contact, and (b) the other is thereby put in imminent apprehension.† (Glannon 24) My experience on the train meets the definition of an assault. Battery Some may think of battery as a beating or violent act, but Restatement (Second) of Torts clarifies â€Å"bodily harm as physical impairment of the condition of another’s body, or physical pain or illness.† (Glannon 7) OurRead MoreImportance Of Communication In Nursing854 Words   |  4 Pagesprocess and can result in either quality effective care or ineffective care caused by lack of information. Written communication between the doctors, nurses, patients, and patient families can occur in a number of forms whether handwritten nursing notes or electronic medical records. Both forms are permanent legally binding documentations. The major key to all successful written communication is that it stays clear and accurate. 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Understand why communication is important in the work setting 1.1 People communicate by many ways including non-verbal highlighting facial expression, eye contact, body language, physical gestures such as touch, dress and behavior, along with verbal including tone and pitch of voice. The age and knowledge of a person one is communicating with, also dictates somewhat the amount of vocabulary i.e words and terms used tooRead MoreEffects of a Hypoglycaemic Comapred to a Hyperglycaemic Diet895 Words   |  4 Pagesenergy sources being used throughout the test were the aerobic glycolytic and the aerobic lipolysis systems. To determine which energy system was predominately being used we can use RER. If RER is a value of .7 the energy system being predominantly used is the aerobic lipolysis system, where as a value closer to 1 predominate system being used is the aerobic glycolytic system. This ration being used is calculated by the whole volume of CO2 expired and the volume of oxygen intake per minute (VCO2/VO2)Read MoreThe Implementation Of Anti B ullying Initiatives976 Words   |  4 Pageschange in school practices requires time and a consistent whole-school approach, especially in the area of bullying preventative strategies. The goals of anti-bullying initiatives also align with the teaching in schools of indispensable socio-moral values such as respect, care, cooperation, acceptance of differences and inclusion. In summary, there are significant moral, social, emotional and educational advantages to addressing the issue of bullying in schools. According to researchers, bullying sinceRead MoreWhen I First Arrived At Robertson Electrical And Mechanical1033 Words   |  5 Pagesvarious questions to Mr. Butcher while we were in his office. I asked my salesman the importance of selling value, and then Mr. Butcher explained the value formula to me. The value formula is a very detailed explanation of how value is perceived in the mind of the buyer. In class, we learned the importance of selling value and the components that create a products value. In the value formula, value perceived by the customer is calculated by quality perceived (Qp) multiplied by service perceived (Sp),Read MorePurpose And Goals Of Counseling1273 Words   |  6 Pagestogether to decide the frequency of sessions and number of sessions that may be required. Risks and Benefits of Proposed Counseling Services The benefits from counseling may be an improved ability to relate with others; a clearer understanding of self, values, goals, increased productivity, and an ability to deal with everyday stress. You should be aware that while counseling interventions offer potential benefits, they also present possible risks such as uncovering painful, or uncomfortable feelings of

Definitely Maybe free essay sample

Instead of spending that twelve bucks on a CD of worn out alternative songs, why not make an investment in the future of alternative music? These days, the alternative market is slowly integrating pop into even the hardest rock. This pop crossbreeding is unavoidable, so why not listen to the British quintet Oasis, a band that knows how to blend the two correctly. Combining playful pop and good old rock and roll, this band packs power into their energized debut. This album has already given us the raw yet friendly single Supersonic, now playing on area rock stations. If it is not, request it immediately. Hey, it beats listening to that Nirvana unplugged song again. One of the best things about Definitely Maybe is that there are no filler songs to skip over. Listen to the whole album, and you will soon find out that Oasis has not booked a ticket to One-Hit-Wonderland. We will write a custom essay sample on Definitely Maybe or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Definitely Maybe has been a bestseller in England since its initial release in late summer. The competition in England is fierce, and Oasis has fended off established musical giants from America and Europe. They have been compared to The Beatles many times and even look like the Fab Four. Oasis has sent five singles to the British top ten, which goes to show that the album is so hot and so jam-packed with hits that b-sides are now challenging for number one. So, is Oasis a wise way to invest your allowance? Definitely. Are they 1995s contribution to rock immortality? Maybe

Authorpreneurs and VC Publishers

Authorpreneurs and VC Publishers Authorpreneurs and VC Publishers The WannabesI was listening to Joanna Penn talk at an Apple event in Covent Garden a few days ago, and I was surprised that the sentence she repeated the most was: â€Å"Writing is hard! It’s extremely hard. If it was easy, everyone would be doing it.†I immediately drew a parallel to starting a company. Everyone knows it’s hard, but keeps forgetting it. Why? Because, technically, anyone can do it. You sit down and write. You fill out a form and incorporate your company. No special skills required.What does that mean? Well, you end up with thousands of â€Å"wannabes†. The I’ll-write-someday-you’ll-see-ers, the I’ve-had-this-great-startup-idea-for-awhile-and-I’m-working-on-it-ers. I don’t have the numbers, but I guess less than 10% of these â€Å"wannabes† become authors, or entrepreneurs.The AuthorpreneursThis took me back to an article by the same Joanna Penn that I read a few weeks ago: The Arc Of The Indie Autho r Journey. From First Book To CEO Of Your Global Media Empire. Penn writes: â€Å"You don’t have to know everything now. You can learn on the job. We all have to. None of us are born with the knowledge of how to do these things – we just find out along the way.† That’s what I do every day at Reedsy. I learn along the way.Indie authors are entrepreneurs in addition to being authors. This is what makes independent authorship particularly difficult, and definitely thrilling for some. â€Å"Taking control† is a dream for many; some are even incredibly good at it. But success takes a lot of self-discipline, a business mentality, boldness and a natural (or very well-trained) ability to promote yourself.Oh, and money. Editing and cover art, if done well, are not cheap (nor should they be). So either you keep your day job for a while, or you try your luck on Kickstarter (the former is highly recommended).That’s a lot of requirements. The good thing is, if you’re committed, you â€Å"learn along the way†. But what if you’re not? What if you just want to write?The Future of traditional publishingIf you don’t have an entrepreneurial mentality, you don’t start your company and you don’t self-publish. It’s as simple as that. Many people don’t want to take control, don’t want to have to choose their editor, cover designer, publicist, etc. They excel at writing, and at that only.In my opinion, that’s what publishers are (or should be?) for. Not to pin down those who want to fly with their own wings, but to help those who can’t.If we keep the parallel to entrepreneurship, we can consider that a few decades ago, it was impossible to start your own company without a lot of money. You shopped your idea around until you found a partner to finance your operation and in return you gave up a hefty majority of your company’s equity. Only as technology has adva nced, most startups are able to prove their concept with almost $0. You can raise millions in the early stages of your company without giving massive chunks of equity away.The emergence of self-publishing is a very similar phenomenon. Technology has lowered the barrier to entry, and authors are able to â€Å"show traction† (i.e., sell thousands of books) without support from publishers.You can only ask 80% of a company when the company has no choice. Today, startups and authors have a choice.But let’s be honest. These successful â€Å"indies† would sell ten times more if they had a publisher backing them and opening bookstores to them. Hugh Howey and the whole self-publishing community know it. Publishers are slow to realize it.Some are starting to offer print-only deals. Some others offer 50% net royalties instead of 25%. â€Å"Exceptions†, some might say. Well, the future is made of today’s exceptions.We’re also on Twitter!   Follow  R icardo  and  Reedsy!

Flame by jackson pollack essays

Flame by jackson pollack essays My experience with art is somewhat novice at best, but one particular piece caught my eye. It is a painting by Jackson Pollack entitled "Flame." This piece, which is, to say the least, is abstract. Although it is abstract, it still conveys an environment and setting. At first glance, it seems to be just a pattern of colors, but after comparing the placment of the colors and shapes, it seems to me to be a certain place in time or space. Ascending from what appears to be the ground, are bright red "flames," or shapes similar to it. The shades of red, yellow, and black look dark, and aggressively gothic, giving the total look of the piece fairly angry or suffering. It seems as though the black, red, and yellow colors are reaching out and around the light colored objects, almost smothering them. The few light colored shapes show to possibly be people, distorted and reaching for something. The overall appearance looks like a place between hell and purgatory. Most of the colors are red, yellow and black, and they are all very rich. The reds are mostly the same shade, which i can only describe as fire engine red (being a firefighting major). The black background doesn't stray from the original darkness, although intertwining between the reds and yellows. The few yellows in this oil painting are mere remnants of the red flames throughout the scene. As for the "human" objects, they feel vivid, but are pale in color, maybe because the rest of the painting is so dark. The only shapes in the piece that seem to be lighted at all are the people and the ground in front of them. All the rest of the shapes look simply pushed back. The irregularity of the shapes in this piece all have the same flow, either rising up like flames, or being suppressed such as the people. There are no definitive shapes, sharp cornes, or straight lines in this work. They seem to easily flow together, allowing the shading be the seperation as opposed...

Ethical Considerations on the End of Life Research Paper

Ethical Considerations on the End of Life - Research Paper Example In other cases, the person to be given euthanasia does not have the power to make a decision. This may happen, for example, if he/she is in a state of a comma, or else, he/she is conscious but is fully paralyzed and can do nothing more than fed artificially. According to (Cavan and Dolan 12), euthanasia can be defined as, â€Å"the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy.† As this definition indicates, all possible measures are exercised in euthanasia to ensure that it takes the victim minimum pain and labor to die. It is obvious that the victim is given euthanasia by another person.   Issues like euthanasia should be dealt with extreme care and delicacy particularly in the present age when people have grown much conscious about health and safety issues and ethics is considered a priority in every act an individual indulges in. â€Å"All forms of euthanasia, voluntary or involuntary, should be condemned until death is chosen for an individual by law because of his/her criminality.† It is useful to discuss certain types of euthanasia before making an in-depth analysis of the ethical consideration of this dilemma because people tend to argue for or against euthanasia without distinguishing between the various conventional forms of euthanasia. There are two fundamental types of euthanasia depending upon the presence or absence of the will of the person being given euthanasia. These two types of euthanasia are called as the voluntary and non-voluntary euthanasia (Dyck). It may seem surprising that there are people who tend to have euthanasia willingly, though it is true and there may be many reasons for that. Euthanasia which is given after seeking due permission from the victim is termed as the â€Å"assisted euthanasia†.

Strategic Management Essay Example | Topics and Well Written Essays - 750 words - 4

Strategic Management - Essay Example Due to this, the company has restructured its hard lines and homes divisions to team related categories (Freshman 2006, 24-27). Wal-Mart uses the cost leadership strategy in which it fights to be the lowest cost producer in the industry but marinating the greatest quality o its products. In this strategy, Wal-Mart sets its prices quite lower than the average industry prices in order to win greater market share. The firm makes all efforts to improve process efficiencies. Since it is a multinational corporation, it targets the broad market to cover its costs. This cost leadership strategy is very effective at the global level of operations. Wal-Mart re-engineering and E-engineering Wal-Mart strives to be ahead of its competitors by incorporating satellite communication between cash register, distribution centers, and stores. This is something that makes it easy for customers in different areas purchase products from stores in different regions meeting the customers’ needs at the immediate point of demand. ... The general strategy that Wal-Mart has been employing in its operations is the low-cost, high volume strategy that targets its businesses at the global level. Because Wal-Mart has numerous stores in many countries, it therefore successfully undertakes this strategy of lowering its prices and producing in bulk to cover the costs by a considerable amount. It does this to increase its market share. It also manages this because it has lower operating expenses as compared to industry level (Lampel 2002, 51-52). This control strategy aims at ensuring reduced costs, high volume production, and improved quality. It is apparently clear that part of Wal-Mart’s strategy to remain competitive in its operations is to make products that prove to have less negative effects to the environment. In this regard, Wal-Mart regulates what products to sell in their stores. It has also come up with a sustainable waste management strategies aimed at reducing pollutants and ensuring a clean environment . For instance, it takes up proper waste management by implementing strategies to recycle paper products. This is seen through its efforts in the Go Green initiative. Apart from environmental friendliness, it seeks for ways to lower its costs in operations and instead use the saved monies in technological advancement (Massengil 2003, 66). Wal-Mart Reciprocal interdependence and Information sharing Wal-Mart reciprocal interdependence encourages communication from one department to the other whereby an input in one department becomes the input of the other. This means Wal-Mart communication is at highest level of communication or interaction. Reciprocal

Natural resources Curse or blessings

Natural resources Curse or blessings Abstract: The resource curse refers to a complex phenomenon that resource rich countries fail to take the advantages from their natural resources. According to this term countries with abundance of natural wealth are unable to gain the benefits of having the resources that they are supposed to get in comparison to the countries with fewer natural resources. This paper describes the existence of resource curse, how to deal with this curse and its implication to development of Middle East. Introduction Even though a country with plenty of natural resources should progress in terms of GDP and economic growth at far more pace as compared to countries with far less resources or with no resources at all as compared to them, studies and experiments do tend to suggest otherwise. True, natural resources reserves do help a country raise individual living standards, economic growth, nevertheless, unless made full use of it can result in a negative GDP too. Experiments after being carried out in this regard has shown that in some countries despite resources being available in plenty their progression was not in line with it. On the contrary, countries which should have struggled to make their way through, as they had little resources or none at all, in reality have out-performed countries with abundant resources through the help of their service and manufacturing industries. While on the other hand some natural-resources rich countries have done exceptionally well as they utilized their wealth with perfection. To sum up, it can neither be said having less natural resources will mean a country can not progress nor can it be said that having enough of it will prevent a country from moving further forward. The whole thing has got to do more with whether proper utilization of it was made or not. Is there a resource curse? If a closer look is taken at some countries in the Middle Mast, for example, Saudi Arabia, Kuwait, Iran and Iraq, it can be seen that they all share some things in common. These countries have more oil reserves than any other countries in the world; they are governed by Islamic laws, the fate of the people lies at the hand of their leaders, and where democracy is not present at all. General people have nothing to say as to how the country would be run and armed forces are often used as a weapon by the leaders to ensure that power does not come out of their hands. Despite having natural wealth, these countries have not performed as per expectation. Still they have slow population growth and poor life expectancy than average, low quality education and health care, low market diversification, poor socio-political development indices. There are some other natural resource-rich countries, where natural resources could not bring blessings. In some African countries civil war occurred over the control of the resources which may lead to separatism. People from natural resource areas want to keep control over their resources. Thus they get engaged in conflict with their Government. The Governments abilities to perform go down badly. For instance, in Angola and Sierra Leone, some rebel groups in the area where natural recourses like diamond, gold etc are located, are engaged in different forms of crimes like extortion, drug dealing, kidnapping foreign executives of multinational companies for ransom. The revenues from natural resources can go up and down. When the prices of the natural resource rise the economy of the countries dominated by natural resources booms and again if the price falls down the economy also plummets. For instance, the price of crude oil shot up from $10 per barrel in 1998/1999 to $140 per barrel in the middle of 2008. Again in December 2008 the price plunges to $40 per barrel. On 29th of December 2009 the price was $76.19 per barrel. The wild fluctuation of the price of natural resource can have a great impact in the Governments annual development budget if the economy depends absolutely or mostly on natural resources. In the resource rentier countries, the Government does not tax the citizens because they have fixed sources of income from resource rent. They do not have to explain about their policies, rules, and laws to the public. People also do not or can not complain about their living standard, health, Government policies etc even though they are poorly served by the Government. As a result, the relationship between the rulers and public collapses. In the Middle East people can not protest against any Government policy. In fact the rulers, dependent on natural resource rent, tend to be repressive, corrupt and poorly managed. In the resource abundant countries human resources are often ignored. Instead of investing in the development of education, health and research, Government make huge expenditure on buying luxurious products, military, police from which the only rulers or elite societies get benefited. The countries which have natural resource, the giant multinational companies gather there. They want to get control over the resource to mine it by paying a token money. They try to get the control either by bribing money or other forms of gifts to the rulers of that country, or by creating pressure from their own country to the resource owner country. If the Government is not accountable to its citizens, it is very tough to avoid such pressure or the greed of bribe. Thus the multinational companies are spreading corruption in the poor, but with natural resource, countries. For example, Niko, a Canadian company is in charge of gas exploration in Bangladesh. In 2005 because of the incompetence, technical fault of Niko, two huge blowouts of gas occurred. Bangladesh faced a loss of tk7.4650 billion in local currency ($1=tk70 approximately) including gas and environmental damages. But instead of paying the compensation they gave a luxurious car which cost 10 million in local currency to the state minister for energy as a bribe to avoid compensation. There are many countries with little or no natural resources at all, which have been able to develop. Resource-rich countries like Middle East could not perform well in terms of economic growth. Even the growth of some countries with ample natural resources was negative. On the other hand countries with low natural resources performed extremely well. Most of the resource poor countries like Singapore, Korea, Taiwan, and Hong Kong grew rapidly during the period. They achieved rapid economic growth from export industries based on manufactured products. Lack of natural resources could not be an impediment in their development. Some countries with affluent natural resources used this wealth effectively and thus they became developed. USA for example, was a resource rich country. But unlike others it used its mineral resources as a ladder of progression. Natural resources played an important role in the technological and industrial development. US made a huge investment in exploration, geological knowledge, transportation and the technologies of mining, refining and utilization. US excelled other countries in the world in mineral sector. Mineral sector contributed a lot to enhance the knowledge and technological capabilities. In the way to leadership in manufacturing, the mineral sector of the USA was an important issue. According to Wright (2004) resource extraction in the United States was more fundamentally associated with ongoing processes of learning, investment, technological progress, and cost reduction, generating a manifold expansion rather than depletion of the nations resource base. It had a great effect in the progress of education. By the nineteenth century, the education system of the US in mining engineering and metallurgy came out as the world leader. Columbia School of Mines which was opened in 1864 became the leader. Later University of California at Berkeley developed into worlds largest mining college. Wright (2004) wrote in his journal that The most famous American mining engineer, Herbert Hooverà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬an early graduate of Cals cross-bay arch rival, Stanfordà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬maintained that the increasing assignment of trained engineers to positions of combined financial and managerial, as well as technical, responsibility was a distinctive contributing factor to U.S. leadership in this sector. In 1917 a survey was conducted which found there were 7500 mining engineers in the USA. Thus natural resources contributed in the progress of law, investment and education which led to overall development in America. Considering all the evidences, it can be said that natural resource is neither a vital element of development nor a curse. Development depends on lots of factors like Government policies, accountabilities, human resource development, education, fiscal policy, manufacturing industries etc. When a Government can not rule the country properly, it becomes authoritarian and repressive. It uses the rent from natural resource to dominate the public and avoid accountability, transparency. At that time resource becomes a curse. But for this natural resource can not be blamed rather the mismanagement can be blamed. If the natural resource is utilized appropriately, it can be blessing. How can a state overcome the resource curse? Some evidences suggest that there is a negative relationship between natural resources and growth. So resources were called a curse by many researchers. But it is not always true. A country can get rid of this curse by taking some steps. The guaranteed income from natural wealth can be used as a source of investment rather than a source of public disbursement. The transformation of natural assets into manufacturing capital can lead to break the curse. The country can use the resource rent to develop the infrastructure. The country can invest the rent in different sectors like manufacturing, health, education, development of law and order, human rights. If the country can manufacture goods in a large volume, it can export them. Income from exports will reduce the dependence on natural resource. The government can launch a comfortable taxation system. It will establish the relationship between the ruler and the public. Whenever government will take money from the citizens, it will have to explain the incomes and expenses of the country. It will provide accountability and transparency. The Government can share the revenue with the local people. When the local community was given the power to handle resources of the country, it not only motivates long-term investment but also takes the pressure off the shoulder from central government, and also helps to alleviate poverty. Through the proper management of natural resources, a government can sustain the welfare of the country; can raise the life standards of the people living below the poverty line and thus make the natural resources as a blessing. The Middle East will not develop until its oil reserves run out. Discuss. Most countries in Middle East, if not all, have some things in common such as monarchy system, oil reserves, no accountability and transparency, absence of democracy, repressive. Economy of these countries relies on their oil income. As they do not rely on tax from its people, they can avoid accountability and other responsibilities to the people. Because of oil being present there in plenty and the income the government extracts from selling them to other parts of the world being more than enough for them to run their country, the government do not feel it important to build manufacturing industries in their country. But at some point down the line this oil reserve will come to an end. Then these countries will be forced to find other sources of income and only then they will really start thinking to build other service and manufacturing industries. This may open the doors for private sector. When the private sectors thrive, it will bring investments from different places which will also in turn create plenty of job opportunities. Government will have to invest for the development of human resource to cope with demand for skilled people. As a result there will be a literate society. The rulers will loose legislation blocks to investment, private employment, exorbitant regulatory barriers, poor enforcement of commercial contracts and dispute resolution, taxation barriers. The multinational companies (other than Oil companies) will be attracted to these countries to expand their businesses. Huge investment will come that will contribute to the development of the countries. Another thing, when rulers will tax the citizens, they will have to explain their policies, incomes and expenses. As a result accountability and transparency will grow up. It can lead to democracy. When the rulers will start thinking of the welfare of the public, it will help to sustain the democracy and development of the country. The example of UAE can be taken. It is expected that the oil reserve of UAE will run out in twenty years. The rulers realised this. So they are trying to move to other sectors, for example tourism. Now Dubai is one of the most lucrative tourist places. Every year millions of tourists from all over the world visit Dubai. Government are earning a substantial amount of revenue from tourism sector. Dubai is attracting the business companies from the western world. Currently Dubai is one of the best places for business. Almost all of the international companies have branches in Dubai. Thus the Government of UAE is reducing dependence from oil. Another example is Kuwait. They are utilizing the rent from oil for off-shore investment. This way they are trying to stabilize the economy. As long as the countries of Middle East will get revenue from oil, they will remain averse to make changes. They will stay in vicious circle until the oil reserve will be depleted. The sooner they realize that oil reserves are not unlimited, they will move to the way to development. Conclusion: Though some of the evidences identify natural resources as a curse, but the resources themselves are not a curse. Mismanagement of the resources makes them a curse. But there is no short term option to get out of the curse. Oil in the Middle East is a sensitive issue. When the Government will decide to use the resource for the development of the living standards of citizens, they will transform into a good government from authoritarian rulers. International pressure and internal pressure can shake the rulers. But because of having a large oil reserve, the rulers can avoid all forms of pressure. This paper has illustrated all the facts related to natural resources. According to Kirk Hamilton and Giovanni Ruta, (2006) Whatever the level of government, good management is a precondition for good performance. Natural resources are governance-intensive. Sound management of these natural resources can support and sustain the welfare of poor countries, and poor people in poor countries, as they move up the development ladder. Bibliography: Class Lecture Journals Moore, M. (2004) International Political Science Review. Revenues, State Formation, and the Quality of Governance in Developing Countries, 25(3), pp. 297-319 Sachs Jeffrey D. and Warner Andrew M. (2001) European Economic Review. Natural Resources and Economic Development The curse of natural resources, 45, pp. 827-838 Wright, G. and Czelusta, J. (2004) WHY ECONOMIES SLOW. The Myth of the Resource Curse, 47(2), pp.6-38 Online Resources Bannon, I. and Collier, P. (2003) HUMAN SECURITY IN CONFLICT SITUATIONS. Natural resources and violent conflict: options and actions [Online]. Pp.242-245. Available from [Accessed 2nd January 2010] Hamilton K. and Ruta, G. (2006) Environment Matters. From Curse to Blessing Natural Resources and Institutional Quality [Online]. pp. 24-27. Available from [Accessed 2nd January 2010]. Humphreys, M., Sachs Jeffery D. and Stiglitz Joseph E. (2007) Escaping the Resource Curse. USA: Columbia University Press. [Online] Available from [Accessed 2nd January 2010]. Sachs Jeffrey D. and Warner Andrew M. (2001) European Economic Review. Natural Resources and Economic Development The curse of natural resources, 45, p. 829

Essay --

Hello everyone! I am thrilled to announce that I will once again be miniaturized along with my submarine and take you on another Fantastic Voyage inside the human body. In case you have forgotten the details of our last journey, my sub and I will be shrunken down to be 8 microns long. This time I will be swallowed by Fred, a 55 year old man, while he enjoys a hamburger, French fries, and root beer. As I pilot my way through his body, I will be describing the process of digestion and what major structures I see and come across. Can you imagine being part of someone’s meal? Neither can I, yet here I am being chewed and mixed with a juicy burger by Fred’s teeth. As Fred enjoys his meal, the first part of digestion is happening in his oral cavity. Fred’s burger is a mixture of carbohydrates, lipids, and proteins. As he chews and moves his food around with the help of his tongue, I can see his saliva coming from different angles and mixing with his food. There are three pairs of salivary glands, the parotids, submandibulars, and sublinguals. They secrete most (about 1L) of the saliva produced each day in an adult. (Thibodeau & Patton, 2008, pg397) Saliva contains mucus and a digestive enzyme called salivary amylase. As you can see here, the process of chewing combined with this mucus is allowing the food to break down into a small bolus. After this process I am now mixed up with the bolus and with the help of Fred’s tongue, I have began moving down into the pharynx and then down t o this muscular tube called the esophagus. The esophagus is a stretchy pipe, about 25 centimeters that carries food and liquids from the throat to the stomach for digestion after it has been chewed and chemically softened in the mouth. (InnerBody, 2013) ... ...nce: Thibodeau, G., Patton, K. (2008). Structure and Function of the Body (13th ed.). St. Louis, MO: Mosby Elsevier Publishing. InnerBody, Digestive System. (2013). Retrieved from http://www.innerbody.com/image/digeov.html KidsHealth (1995). Your Digestive System, On the way down. Retrieved from http://kidshealth.org/kid/htbw/digestive_system.html# Inner Body, Superior Mesenteric Artery. (1999). Retrieved from http://www.innerbody.com/image_dige08/card25.html Coffman, M. A. (n.d.). The Absorption of Food by the Human Body | Healthy Eating | SF Gate. Retrieved from http://healthyeating.sfgate.com/absorption-food-human-body-4100.html Oza, N., & Cooper, D. (2011, May 18). How Does the Human Body Maintain Homeostasis? How Chemicals and Organs Work Together to Keep the Body in Balance. Retrieved from http://www.brighthub.com/science/medical/articles/111342.aspx

Evidence-based Interventions for a Patient Suffering from Dementia

Introduction Evidence-based practice has been promoted in all healthcare levels in the NHS (Department of Health, 2012). This is done to ensure that interventions are supported by current evidence in healthcare and have been found to be effective for most patients (Pearson et al., 2009). The use of evidence-based practice is rooted in the belief that patients should only receive quality care (Pearson et al., 2009). The same approach is used when caring for patients with mental health conditions. In the policy, No Health without Mental Health (Department of Health, 2012), the NHS has emphasised that patients suffering from mental health conditions should receive quality and evidence-based care. This brief aims to critically discuss the case of an 80-year old woman who is suffering from dementia and the different forms of interventions that could be applied to the case. Consistent with the Nursing and Midwifery Council’s (NMC, 2008) code of conduct, a pseudonym will be used to hide the identity of the patient. This brief discusses the purpose of evidence-based practice in managing patients with a progressive condition such as dementia. An investigation on the different forms of evidence-based interventions and their potential impact for promoting inclusion would also be presented. A discussion on interventions as means to develop a shared understanding of the patient’s needs would also be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process. Using Evidence-based Interventions for Patients with Dementia The Nursing and Midwifery Council’s (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised that the past model of evidence-based intervention relies only on current evidence from literature to support clinical decisions. Current studies that are of high quality are often used to inform current practices. Fitzpatrick (2007b; 2007c) exmphasised that nurses and other healthcare professionals should have the skills to critically assess the quality of a study and determine whether the findings are applicable to one’s current and future practice. Evaluating the strength of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has included best practices, personal experiences of healthcare professional on providi ng care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a; 2007b, 2007c; Greenhalgh, 2010). This new definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care. Communicating evidence from published literature is also essential in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthened first. Kizer (2002) observe that, â€Å"this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient† (p. 117). In the UK, The National Institute for Health and Clinical Excellence (NICE, 2006) and the National Collaborating Centre for Mental Health (2007) have provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues’ experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patient’s name is Laura (not her real name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, aggressive behaviour and agitation (Department of Health, 2009). A psychiatric consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and psychiatrist are discussing alternative drugs to reduce her anxiety level and regulate her sleeping patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. While she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion. Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the Mental Health Act 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patient’s immediate family members or appointed guardian (Depart ment for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patient’s case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will include the patient’s carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise. Evidence-based Interventions and Potential Impact for Promoting Inclusion A number of studies (Casartelli et al., 2013; Monaghan et al., 2012; Ewen et al., 2012) have shown that exercise could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patient’s mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise intervention to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking e xercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012; Hopper et al., 2013) has also been shown to be effective in reducing anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis. It should be noted that the psychiatrist and the GP in the healthcare team are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side effects on the cognition of patients (Porsteinsson et al., 2013; Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Laura’s case, she is pro gressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura. Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Laura’s case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patient’s case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. Similar to animal-assisted therapy, there is also strong evidence on the e ffectiveness of music therapy in managing anxiety, depression and aggression amongst patients with dementia (Sakamoto et al., 2013; Wall and Duffy, 2010). Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patient’s end-of-life care. All these realisations could influence the carer’s own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013). The patient in my care is also suffering from type 2 diabetes. Pharmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in hospitals, the new environment and lack of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital stay could be influenced by changes in her behaviour. It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have sufficient diet. This is seen as a challenge in Laura’s case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Laura’s type 2 diabetes through proper feeding would be an added challenge to her care. Legal, Ethical and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary admission to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. Apart from the legal aspects that influence the delivery of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and ot her healthcare practitioners should ensure that the interventions would be beneficial to the patient (Beauchamp and Childress, 2001). In Laura’s case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patient’s behaviour. In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Laura’s case, her autonomy would be respected. Allowing patients to participate in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. Justice will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patient’s background, religion, race, gender, ethnicity, she should receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Laura’s healthcare needs. While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive sufficient funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007). Role of the Nurse in the Intervention Process On reflection of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMC’s (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Laura’s family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful stage in the patient’s disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient is experiencing. Since nursing is a continuing process, I have to inform the family members that the patie nt will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage. Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her dignity would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will attend courses on how to conduct end-of-life care for patients with dementia. Through Laura, I realised that a patient’s dignity should always be observed. It is recommended that in my future and present practice, I will continue to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patient’s experiences on how to choose and deliver interventions. Conclusion Evidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patient’s rights, act as her advocate and ensure her safety during the trajectory of the condition. For future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patient’s preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions. References Baillie, L. & Gallagher, A. (2011). ‘Respecting dignity in care in diverse care settings: Strategies of UK nurses’. International Journal of Nursing Practice, 17, pp. 336-341. Beauchamp, T. & Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. Casartelli, N., Item-Glatthorn, J., Bizzini, ., Leunig, M. & Maffiuletti, N. (2013). ‘Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-moth postoperative comparison’. BMC Musculoskeletal Disorder, 14:176 doi: 10.1186/1471-2474-14-176. Croker, J., Swancut, D., Roberts, M., Abel, G., Roland, M. & Campbell, J. (2013) ‘Factors affecting patients’ trust and confidence in GPs: evidence from the national GP patient survey’, BMJ Open, 3(5). Pii: e002762. Doi: 10.1136/bmjopen-2013-002762. Department of Health (2012). No Health Without Mental Health. London: Department of Health. Department of Health (2009). Living Well with dementia: A National Dementia Strategy. London: Department of Health. Department for Constitutional Affairs (2007). Mental Capacity Act 2005 Code of Practice. Norwich: The Stationery Office. Ewen, A., Stewart, S., St Clair Gibson, A., Kashyap, S. & Caplan, N. (2012). ‘Post-operative gait analysis in total hip replacement patients- a review of current literature and meta-analysis’. Gait Posture, 36(1), pp. 1-6. Filan, S. & Llewellyn-Jones, R. (2006). ‘An animal-assisted therapy for dementia: a review of the literature’. International Psychogeriatrics, 18(4), pp. 597-611. Fitzpatrick, J. (2007a). ‘Finding the research for evidence-based practice: Part one- The development of EBP’. Nursing Times, 103(17), pp. 32-33. Fitzpatrick, J. (2007b). ‘Finding the research for evidence-based practice: Part two-selecting credible evidence’. Nursing Times, 103(18), pp. 32-33. Fitzpatrick, J. (2007c). ‘How to turn research into evidence-based practice: Part three- Making a case’. Nursing Times, 103(19), pp. 32-33. Greenhalgh, T. (2010). How to read a paper: the basics of evidence-based medicine. West Sussex, UK: John Wiley and Sons. Hopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. & Schooling, T. (2013). ‘An evidence-based systematic review on cognitive interventions for individuals with dementia’. American Journal of Speech and Language Pathology, 22(1), pp. 126-145. Kizer, K. (2002). ‘Patient centred care: essential but probably not sufficient’. Quality and Safety in Health Care, 11, pp. 117-118. Kurz, A., Thone-Otto, A., Cramer, B., Egert, S., Frolich, L., Gertz, H., Kehl, V., Wagenpfeil, S. & Werheid, K. (2012). ‘CORDIAL: Cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: a multicenter, randomized, controlled trial’. Alzheimer Disease and Associated Disorders, 26(3), pp. 246-253. Monaghan, B., Grant, T., Hing, W. & Cusack, T. (2012). ‘Functional exercise after total hip replacement (FEATHER): a randomised control trial’, BMC Musculoskeletal Disorder. 13:237 doi: 10.1186/1471-2474-13-237. Moncrieff, J. & Cohen, D. (2009). ‘How do psychiatric drugs work?’. British Medical Journal: 338 [Online]. Available from: http://www.bmj.com/content/338/bmj.b1963#alternate. Morrissey, J. & Callgahan, P. (2011). Communication skills for mental health nurses. Maidenhead: Open University Press. National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell and Social Care Institute for Excellence and NICE. National Institute for Health and Clinical Excellence (NICE) (2013). Falls: assessment and prevention of falls in older people: NICE clinical guideline 161. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2008). Type 2 Diabetes: The Management of type 2 diabetes. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2006). Dementia: Supporting people with dementia and their carers in health and social care. London: NICE. Nursing and Midwifery Council (NMC) (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Pearson, A., Field, J., Jordan, Z. (2009). Evidence-Based Clinical Practice in Nursing and health Care. Assimilating Research, Experience and Expertise. Oxford. Blackwell Publishing. Polit, D. & Beck, C. (2010). Essentials of nursing research: appraising evidence for nursing practice. 7th ed. London: Lippincott Williams and Wilkins. Popp, J. & Arlt, S. (2011). ‘Pharmacological treatment of dementia and mild cognitive impairment due to Alzheimer’s disease’. Current Opinion in Psychiatry, 24(6), pp. 556-561. Porsteinsson, A., Drye, L., Pollock, B., Devanand, D., Frangakis, C. Ismail, Z., Marano, C., Meinert, C., Mintzer, J., Munro, C., Pelton, G., Rabins, P., Rosenberg, P., Schneider, L., Shade, D., Weintraub, D., yesavage, J. & Lyketsos, C. (2013). ‘Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial’. JAMA, 311(7), pp. 682-691. Repper, J. & Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. London: Balliere Tindall. Sakamoto, M., Ando, H. & Tsutou, A. (2013). ‘Comparing the effects of different individualized music interventions for elderly individuals with severe dementia’, International Psychogeriatrics. 25(5), pp. 775-784. Smith, G., Greogry, K. & Higgs, A. (2007). An integrated approach to family work for psychosis. London: Jessica Kingsley Publishers. UK Legislation (2007) Mental Health Act 2007 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2007/12/contents (Accessed: 13th May, 2014). Wall, M. & Duffy, A. (2010). ‘The effects of music therapy for older people with dementia’. British Journal of Nursing, 19(2), pp. 108-113. Wright, N. & Stickley, T. (2013). Concepts of social inclusion, exclusion and mental health: A review of the international literature. London: SAGE. Wright, J., Turkington, D., Kingdon, D. & Basco, M. (2009). Cognitive-behaviour therapy for severe mental illness: An illustrated guide. USA: American Psychiatric Publishing Inc.

Birth Control Movement Margaret Sanger - 1980 Words

The birth control movement was created in early 20th century by Progressive and Socialist reformers like Margaret Sanger. She and other birth control activists would fight for women’s access to birth control through the 20th century which has gone on to affect American women today. In order to analyze the affect that birth control has had on America, it is necessary to look at the works of Margaret Sanger and the birth control movement of the progressive era. A good primary source with information that assesses the birth control movement is the collection of anonymous letters sent to Margaret Sanger entitled Motherhood in Bondage, published in 1928. A secondary source used is the book Margaret Sanger And the Birth Control Movement In America, written by Ellen Chesler in 1992. Lastly, a tertiary source is the PBS website, http://www.pbs.org/wg1}bh/amex/pill/timeline/ that discusses the timeline of birth control in America. If it were not for the progressive thinking and radical changes promoted by the socialist party, birth control would have never been able to make its mark on American history First to promote the Birth Control movement was radical political activist, Margaret Sanger. At nineteen years old, Margaret watched her mother of only fifty years old die from tuberculosis. Out of anger she immediately blamed her father for putting the strain of eleven childbirths and seven miscarriages on her mother (PBS). This would begin her career for helping women. SangerShow MoreRelatedMargaret Sanger And The Birth Control Movement Highlighted1187 Words   |  5 PagesMargaret Sanger and the Birth Control Movement highlighted a variety of important issues. 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Sanger, as described by biography.com, was â€Å"†¦ an early feminist and women’s rights activist who coined the term ‘birth control’ and worked towards its legalization† (â€Å"Margaret Sanger†). Margret was also responsible for the creation of the first planned parenthood center, and later was a founding member of theRead MoreEugenics and Planned Parenthood Essay1405 Words   |  6 Pagesways. Likewise, Margaret Sanger’s feminist, contraceptive movement was not originally founded with this purpose. It was marketed as a way to control the population and be merciful to those yet to be born, again determined also by race and intelligence. The similarities in purpose actually brought the two organizations together to form a â€Å"liberating movement† to â€Å"aid women† known today as Planned Parentho od (Schweikart and Allen 529-532). 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