Human Resources in the Healthcare Sector

My medical practice area is that of a privately owned clinic. This clinic will be located in the State of Florida in the United States. The customer type for my clinic will be patients and those people who need medical consultation.Advertising We will write a custom report sample on Human Resources in the Healthcare Sector specifically for you for only $16.05 $11/page Learn More My stakeholders will be the local government, the ministry of public health, other clinicians and my customers or clients. My strategic partners will include the major hospitals, labor unions and pharmaceuticals. The mission of my clinic will be to heal where others try while the vision will be to become the most reliable and trusted clinic in the State of Florida. The corporate status of my clinic will be a profit based organization. The core values of the organization will be honesty, professionalism, diligence, hard work, respect of human dignity and conservation of our enviro nment. Human resources are arguably the most important of all resources in an organization, be it a public or private sector organization. Human resources comprise of people, who are trained or have acquired certain skills, knowledge and expertise in various fields. Some people may have one type of skill while others may have multiple skills. Human resources are what drive organizations in the sense that they operationalize organizations. Human resources may include staff, employees, technicians and various specialists. Human resource management is therefore the art of managing people in order for them to be productive (Savage Fottler, 2010).Advertising Looking for report on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More In the healthcare sector, human resources comprise of doctors, nurses, administrators and various specialists like dentists, gynecologists among others. The management of human resources in the healthca re sector plays a very crucial role in ensuring that the sector meets the expectations of the public. The role of the healthcare sector is to prevent diseases and cure or treat people while the role of the people is to give the nurses and doctors the necessary support. However, the relationship between the healthcare providers and the public is not of much importance. This is because it is determined by the manner in which the human resources are managed within the sector. If properly managed, the sector relationship with the public would be excellent while if poorly managed, it would be very poor. In the healthcare sector, management of human resources may comprise various things. One of them is the motivation of healthcare staff. This may comprise improvement of the work environment, proper remuneration of staff, and the on-the-job training of staff for them to enhance their knowledge in their respective fields. In order for the healthcare staff to function optimally, there is nee d to provide them with the proper equipments and materials. They need to have enough drugs as well as other materials for their work. They also need to be housed properly as well as be provided with regular leaves so as to avoid instances of being overworked. This is because many healthcare organizations, both public and private are usually understaffed (McConnell Fallon, 2007).Advertising We will write a custom report sample on Human Resources in the Healthcare Sector specifically for you for only $16.05 $11/page Learn More Also worth mentioning is the issue of workforce migration. Many healthcare researchers do agree that there is need to look into the issue of migration of healthcare providers to various countries where there are greener pastures characterized by attractive pay packages and better working environment. Migration of workforce leads to a crisis because those who are left are usually overworked and thus poorly motivated, which leads to poor service delivery. All efforts should therefore be made by any government to ensure that the healthcare sector is well funded to prevent such migration (Niles, 2013). One of the effects of human resource management in the healthcare sector in service delivery is that proper human resource management is directly proportional to service delivery. As explained above, if the human resources, in this case doctors, nurses and other staff in the healthcare sector are properly motivated and provided with what they need in their work, then the service delivery to the public would always be good. The reverse is also true. Another effect on the future service delivery in the healthcare sector is that proper human resource management may help curb the problem of workforce migration thus improving on service delivery (Pynes Lombardi, 2011). One aspect of quality and best practice in human resource management in the healthcare sector is the observation of best practices in the healthcare sec tor. The healthcare providers, through proper management should uphold best practices such as observing the code of conduct as well as respecting the ethics of the medical profession. Above all, they should put the interest of the patients first irrespective of the circumstances.Advertising Looking for report on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More They should be seen to act for the best interest of their clients and handle them with dignity. Other forms of best practice are to observe professionalism in their work so as to make the patients have confidence in them, which enhances healing. References McConnell, C.R., Fallon, L.F. (2007).Human resource management in healthcare principles and practice. Sudbury, Mass: Jones and Bartlett Publishers. Niles, N.J. (2013).Basic concepts of health care human resource management. Burlington, Mass: Jones Bartlett Learning. Pynes, J., Lombardi, D.N. (2011). Strategic management of HR in healthcare is important in delivering high-quality patient care. (1st Ed). San Francisco: Jossey-Bass. SavageG.T., Fottler, M.D. (2010). Advances in Health Care Management. Bradford : Emerald Group Publishers. This report on Human Resources in the Healthcare Sector was written and submitted by user Blake Velasquez to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Books for Boys Recommended by Librarians

Books for Boys Recommended by Librarians If you are looking for books for boys, from young children to tweens and teens, youll be interested in these reading lists recommended by librarians. The books on these reading lists include childrens books and young adult (YA) books that will appeal to a wide range of ages and interests. Even boys who complain they can never find anything good to read and, as a result, are reluctant readers, should be able to find books they enjoy on some of these lists. 8 Reading Lists For Boys Young Adult Books with Guy AppealTeen librarian Jennifer Kendall recommends 10 books that have proven to be very popular with teen boys. Science fiction, fantasy, action, and adventure continue to be genres that teen boys particularly like.Great Books for BoysThis article and list of books recommended for boys come  from The National Childrens Book and Literacy Alliance. It includes a list of books recommended by The Horn Book in these categories: Picture Books, Middle-Grade Fiction, Young Adult Fiction, Non-fiction Middle School/High School and Poetry.Adventures in History for BoysThis brief reading list from the Central Rappahannock Regional Library in Virginia includes cover art and a brief summary for under a dozen books of historical fiction recommended for older boys.Especially for BoysThis annotated reading list of recommended books for boys is from the St. Charles Public Library in Illinois. It includes cover art and a brief summary of 160 books recommended for boys, from p reschool age through eighth grade. To narrow your search, you can search by grade range, which is very helpful. Recommended books include Richard Pecks A Season of Gifts and several by Sharon Creech. Good Books for GuysThe Multnomah County Library in Oregon provides five reading lists, divided by grade levels: Small Fries: Pre-K, Young Guys: 1-3, Middle Guys: 4-6, Large Fries: 7-8, Older Guys: 9-12. While not annotated, the lists include cover art. Among the series recommended for boys in grades 4-6 are Percy Jackson and the Olympians.Chapter Books for BoysThis annotated reading list from the Salt Lake City Public Library in Utah includes three dozen books. The list includes Dear Mr. Henshaw by Beverly Cleary and My Side of the Mountain by Jean Craighead George.Picture Books for BoysThe annotated reading list of 20 picture books includes  Where the Wild Things Are  by  Maurice Sendak. This is an annotated list from the Salt Lake City Public Library in Utah. Click on â€Å"check availability† to see the cover art. For General Information on Encouraging Reading Because the article covers a wide age range, all of the tips may not apply to your child. But some of the best tips include making sure your children see you reading on a regular basis, fully utilizing your public library, taking the time to help your child find books that match his interests and reading level and sharing books by reading them aloud and discussing them with your children.

Portfolio of documents and exercises 04101 Essay

Portfolio of documents and exercises 04101 - Essay Example Include organising, leading or group activities. Those requiring initiative, creativity or giving intellectual development are also of interest. The following questions are designed to encourage you to provide specific abilities. Your examples can be taken from your education, work experience, placements or spare-time or other voluntary activities but do not write solely about course-work. Describe a challenging project, activity or event which you have planned and taken through to a conclusion. Include your objective, what you did, any changes you made to your plan and state how you measured your success. ï‚ · To analyze the extent of change in customer satisfaction due to either a change in customer expectations over Mobile Number Portability services before and after availing it or a change in the services provided by the mobile network operators to its customers which further lead them to avail MNP. ï‚ · Thus to suggest strategic and tactical actions for slowing down the rate of customer loss, increase customer satisfaction and attracting customers who are unhappy with their existing service contributor. Describe how you achieved a goal through influencing the actions or opinions of others (perhaps in a team context). What were the circumstances? What did you do to make a difference? How do you know the result was satisfactory? During the second year of my studies, I had a group assignment which required all the group members to prepare a presentation on one of our course modules. I myself chose to lead the team precisely because I could understand that other individuals in the team were reluctant to lead the way. The first major circumstance that came in front of me was that my team was formed of people belonging from different culture. This was mainly due to the fact that the five individuals within the group came from different countries. Therefore, it was important for me to understand the acceptance, tolerance and

Trucks Load Indicator also known by Electronic load indicator or Axle Research Paper

Trucks Load Indicator also known by Electronic load indicator or Axle load Indicator - Research Paper Example In addition, it is for this reason that several truck companies like Volvo, have embraced the use of axle load indicators in the trucks manufactured by their companies. Those who have been exposed to trucks will attest to the fact that they have axles. The number of the axles, however, varies depending on the truck with some of them having two axles whereas some have close to twelve axles. Overtime various stakeholders realized that there were several instances where the axles installed within the trucks were overloaded, and this always acted as a disadvantage for the truck (Butcher, 2005). To control the problem of weights, the stakeholders, came up with the axle load indicator and since then the original version has been altered with the aim of improving it. It is to this effect that several companies that produce axle load indicators like Airtec Corporation produce axle load indicators with optic switches. Some of the companies also produce axle load indicators, which contain rheostats instead of the normal electric switches. History, however, does not mention the exact individual who came up with the axle load indicator. Therefore, there is the need to appreciate the person because his invention has made handling the trailers much simple. For the axle load indicator to be operational, it has to be installed. It is far reaching to recognize the fact that the production companies have designed the axle load indicators in such a way that any able operator can do the installation (ARO, 2011). For surety reasons, however, there are dealers who deal specifically with the installation of the axle load indicators. The companies that do the production can as well avail their engineers to do the installation though at a cost. The installation, however, can be done through connecting the axle load indicator to the light circuit of the truck. Operationally, the truckload indicator registers some calibrations

Why Has the UN Security Council Been So Unsuccessful in Its Attempts Essay

Why Has the UN Security Council Been So Unsuccessful in Its Attempts at Managing World Order - Essay Example To achieve the United Nation’s objective, significant effort has been evident. Nevertheless, in most cases, the results have fallen far short from the goals. In order to meet its goals, the UN has regularly held global conferences to address the security issues. Several factors have contributed to the UNSC’s unsuccessful management global order. One of the factors is the lack of transparency of the council. There have been conflicts regarding the restructuring of the council (Council of Europe: Parliamentary Assembly, 2005). The members cannot agree on whether to expand the council or let it remain the same. Additionally, lack of democracy in the council has made some states to have a negative attitude towards it. Some of these states do not trust it, and this makes it difficult for it to maintain peace among the conflicting states. The UNSC cannot settle the dispute among the sates that fail to trust it because they will not give it permission to do it. Lack of impleme ntation of resolutions According to Council of Europe: Parliamentary Assembly (2005), in recent years, the United Nations Security Council has adopted resolutions, but relevant persons fail to implement them basing on their ignorant nature. For this reason, violation of international laws has been evident; hence, conflicts worsening (Council of Europe: Parliamentary Assembly, 2005). ... Therefore, people do not believe that the UN can bring them peace. Craving for power According to Karen (2011), The UN has not achieved much as far as peace is concerned because of the craving for power. Craving for power has made the governing class in all countries to be hostile to the inadequacy of the nationwide autonomy. The powerful minorities influence the masses, and many of them already have an objective for destructions (Council of Europe: Parliamentary Assembly, 2005). This has hindered the United Nation Security Council from achieving it goal of maintaining the world order. UK and US war against Iraq According to Karen (2011), The United Nations suffered a great setback when UK and US announced war against Iraq. They declared war against Iraq claiming that it posses huge quantities of mass-destructive arms. The US defined its actions as ‘pre-emptive’ measure, but until now, no WMD existent and they US still carry out its activities in Iraq. The third world co unties are opposing the US’s actions against the Iraq, and are blaming the United Nations Security Council for failing to prevent this. Hence, this has lowered the relevance of the UN Security Council globally. The individuals who believe in the collective response to global security issues could see the difficulties that the UN underwent because of the Iraq war. This is because the war made the confidence in the multilateral system to be undermined. Disagreements in reformation According to Knight (2001), the UN General Assembly has been debating for many years regarding the council reformation but has never reached an agreement. The G4 proposed to be the permanent members of the Security Council. Their permanent membership would augment the Council members. This proposal was opposed by

Abdominal Aortic Aneurysm Ultrasound Screening Programme

Abdominal Aortic Aneurysm Ultrasound Screening Programme Susmi Suresh Role of the National Abdominal Aortic Aneurysm Ultrasound Screening Programme in Improving Health Outcomes: a systematic review Abstract Background: Abdominal Aortic Aneurysm (AAA) is one of the common conditions that affect men aged 65 and older. Described as a ticking bomb(1), rupture of such an aneurysm results in fatal bleeding and death. Early detection allows appropriate treatment to be given to patients as an effort to reduce mortality rates. The National Abdominal Aortic Aneurysm Screening programme, an initiative of Public Health England, offers screening to men in the prevalence group by following its objective of reducing mortality rates of preventable illnesses(2). Ultrasonography is the chosen imaging modality due to its high sensitivity and specificity(3). The aim of this study is to examine current literature on AAA and to understand whether screening programmes are effective enough to reduce mortality rates of AAA. Quality of life (QoL) as a health outcome will also be examined and evidence analysed, to see whether screening programmes affect patients quality of life. Method: A thorough search of prominent databases was carried out and the search-results underwent application of inclusion and exclusion criteria developed for this review. Four major randomised controlled trials were identified. Following data extraction, quality assessment was carried out using the CASP tool. Risk of bias was checked using the Cochranes tool for assessing risk of bias. All of these ensured a valid conclusion to be drawn.   Results: The four chosen RCTs were the MASS trial, the Chichester trial, the Viborg trial and the WA trial. The Mass and Chichester trials were conducted in the UK whereas the Viborg and WA trials were carried out in Denmark and Australia, respectively. The data pool of 125595 people added to the reliability of the findings of this review. A significant reduction in mortality rates of AAA was found in the intervention groups following an ultrasound screening of the abdominal aorta(4-7). QoL was looked at as the secondary outcome in the MASS trial which concluded that there was no adverse effect on QoL(4). Conclusion: The review showed evidence on reduced AAA mortality rates in men aged 65 and older following ultrasound screening. No adverse effect in patients QoL was found. The NAAASP is a commendable initiative of Public Health England and it is suggested that similar screening programmes be introduced through an evidence-based healthcare. Introduction       An aneurysm forms when a section of a weakened arterial wall dilates permanently. The walls of an artery can weaken and dilate due to cardiovascular diseases like arteriosclerosis, inflammation of the arterial wall or trauma. When this dilation occurs in the abdominal aorta, which runs from T12 to L5, it is considered to be an Abdominal Aortic Aneurysm (AAA)(8). Several studies have found smoking, hypertension and alcohol consumption to be the major risk factors of AAA(9). A family history of AAA is also considered to be a risk factor(10). AAA is age and sex-dependent as concluded by a retrospective prevalence study that looked at a cohort of 100,000 men and women each. The prevalence among men was found to increase rapidly after the age of 55 and that among women increases after the age of 70(11). Therefore, women are considered to be at low risk of developing AAA and hence screening programmes focus on a male population of 65 years or older(12). Patients are mostly asymptomatic and where symptoms do present, these could be abdominal pain, flank pain, back pain, groin pain, or syncope. A palpable pulsating abdominal mass could also be found during examination. An aneurysm once formed, grows in size until it bursts, leading to fatal bleeding. Only 2 in 10 people with a ruptured aneurysm survive if not treated with emergency AAA repair surgery(13). The survival rate among those who receive surgery is 94%(14). AAAs are detected using an ultrasound scan (US), which is considered to be the most effective screening modality with high sensitivity (98%) and specificity (99%) rates(15). The US is safe, cheap, quick, and non-invasive, and provides results immediately. It is widely accepted as a valid screening method and the aorta can be visualised in 99% of patients(15). Compared to CT scans which can sometimes overestimate the diameter of aneurysms in the oblique plane(15), ultrasound continues to be the choice of screening modality. In 2014, around 2000 men died from ruptured AAA, accounting for around 1% of all registered deaths in men aged 65 and over(16). Past records show a reduction in mortality in England from 7.5% in 2009 to 1.6% in 2012(17). This sheds light on the National AAA Screening Programme (NAAASP) offered by the NHS. Early detection via screening of a large aneurysm of above 5.5cm, means that patients are given the choice of repair surgery thereby increasing their survival rate by 69%(8, 18). Surveillance is offered to patients with a small or medium aneurysm of 3-4.4cm and 4.5-5.4cm, respectively(19, 20). This is through an ultrasound scan every twelve or three months for small and medium aneurysms, respectively. Screening aims to reduce the risk of developing a disease in a healthy population who have no signs of illness with respect to the condition being screened. The NAAASP is based on the policies recommended by the UK National Screening Committee in 2005 following the results of the largest randomised controlled trial about AAA, the Multicentre Aneurysm Screening Study (MASS), which showed that screening reduces mortality by 40% after 10 years(21). Implemented in 2009, the programme achieved a nationwide coverage by the end of 2013. The programme aims to reduce AAA mortality by providing a systematic population-based screening programme for the male population during their 65th year and on request, for men over 65(22). This falls under Domain 2 and 4 of the Public Health Outcomes Framework provided by the Department of Health, with the objectives to help people to live healthy lifestyles and, to reduce the number of people living with preventable ill health and people dying prematurely(22), respectively. NAAASP Annual Data 2014/15 shows that a total of 280,520 men were screened and 83.2% had a conclusive screen(23). During the screening year 2013/14, this was 82% out of a total of 287,126 men(24). Depending on the size of the aneurysm, either surveillance or surgery was offered. Overall, the programme aims to achieve the health outcome of reduced mortality. Quality of life is also reported as a health outcome as shown by several retrospective, observational and cohort studies conducted on patients(25-27). Knowledge on the success of screening programmes like NAAASP remains limited. The aim of this review, therefore, is to examine current evidence on whether a screening programme improves health outcomes, namely reduced mortality and improved quality of life, by critically and systematically reviewing literature using the quality assessment tools of the critical appraisal skills programme (CASP). This will be achieved through the following objectives: Develop inclusion and exclusion criteria based on PICOS relating to AAA and ultrasound scanning Carry out a systematic search of databases- Medline, Web of Science, the Cochrane Database, OneSearch and the ISRCTN Registry (BioMed Central). Filter the search using the inclusion and exclusion criteria and carry out data-extraction using the Cochrane Data Collection form Carry out quality assessment using the CASP tool and use the Cochrane tool to assess risk of bias Conduct an analysis, focusing on mortality and quality of life as the health outcomes Methods Although evidence exists on the accuracy of using ultrasonography for detecting abdominal aortic aneurysms(3) and the validity of the scan results is widely accepted due to its high sensitivity and specificity(3), the process of abdominal aortic scanning was decided to be reviewed first(Appendix A). Prior to conducting the search, inclusion and exclusion criteria were set (Table 1)(28). Following this, databases were chosen for the search-topic Abdominal Aortic Aneurysm. These included PubMed/MEDLINE, ISRCTN Registry, Web of Science, Lancaster University/OneSearch and the Cochrane Database. Search strategies were developed for each source and search filters were decided (Table 3-7). Medical Subject Heading (MeSH) terms were used to further refine the results (Table 2). Overall, seventy-four articles were found and after removing duplicates, forty-nine remained. These were subjected to the inclusion and exclusion criteria, thus narrowing down the results to seventeen relevant articles. The reference lists of the retrieved articles were further reviewed for any relevant cited papers. This process was repeated until no relevant articles were found. Four major randomised clinical trials were identified from these. These were reviewed after undergoing data extraction and quality assessment. Data extraction was carried out using Cochranes data extraction tool and this allowed for a full-text screening that removed any ineligible studies. Moreover, the use of a standardised form increased the validity and reliability of this review whilst also reducing any risk of bias(28). Finally, the trials were critically appraised using the CASP tool. This enabled identifying risk of bias within the trials, particularly selection bias, performance bias and reporting bias. Table 1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Inclusion Criteria Exclusion Criteria Population General population of males aged 65 years or older Patients who are asymptomatic and symptomatic who were involved in AAA screening Patients from all ethnicities Patients of all socioeconomic status Trials that include females, younger children and males younger than 65 years since AAA is age and sex specific Intervention Ultrasound Screening for AAA Any other imaging modalities like CT, MRI or radiography Comparison Non-screened population Aneurysm Aortic Aneurysm Thoracic Aneurysm Outcome (s) Mortality Quality of Life Study Design Randomised Controlled Trials (RCTs) Trials that look at AAA detection using Ultrasonography Articles in the English language Articles from the time period starting from approximately 20 years before the NAAASP programme came into effect, i.e., 1985 to present Full articles All other types of studies such as qualitative studies, observational studies, cohort or case-series studies. Articles in foreign languages Studies conducted outside this time period Articles that are not fully available Table 2  Ã‚  Ã‚   Medical Search Headings (MeSH) Abdominal Aortic Aneurysm Mass Screening Ultrasonography Rupture Table 3 PubMed Search Strategy/Method Results Abdominal Aortic Aneurysm 23,807 Mass Screening 128,434 Ultrasonography 386,798 Rupture 109,121 AAA + MS 599 AAA + MS + US 300 AAA + MS +US + Rupture 102 AAA + MS +US + RCTs 23 AAA + MS +US + Rupture + RCTs 11 Table 4 Web of Science Search Strategy/Method Results Abdominal Aortic Aneurysm 18,625 Mass Screening 43,081 Ultrasonography 80,257 Rupture 119,830 AAA + MS 131 AAA + MS + US 23 AAA + MS +US + Rupture 12 Limit English 11 Table 5 Cochrane Library (RCTs only) Search Strategy/Method Results Abdominal Aortic Aneurysm 702 Mass Screening 3827 Ultrasonography 11,318 Rupture 3097 AAA + MS 46 AAA + MS + US 23 AAA + MS +US + Rupture 10 Table 6 OneSearch Search Strategy/Method Results Abdominal Aortic Aneurysm 27,819 Mass Screening 73,090 Ultrasonography 122,460 Rupture 94738 AAA + MS 604 AAA + MS + US 123 AAA + MS +US + Rupture 42 Limit Articles 39 Table 7 ISRCTN Registry/BioMed Central Search Strategy/Method Results Abdominal Aortic Aneurysm 37 Mass Screening 328 Ultrasonography 88 Rupture 176 AAA + MS 3 Results Four dominant randomised controlled trials (RCTs) were identified- the Multicentre Aneurysm Screening Study(4) (MASS) conducted between 1997 to 1999; the Chichester Study(5), 1988 to 1991; the Viborg County Trial(6), 1994 to 1998 and; the Western Australia (WA) Trial(7), 1996. These collectively showed that AAA mortality rate can be significantly reduced in the population following an ultrasound scan of the abdominal aorta (Table 8). The Mass and Chichester trials were carried out in the UK and had a participant number of 67,770 men aged 65 to 74 years and 6040 men aged 65-80 years, respectively. The Viborg Country trial was conducted in the Viborg county of Denmark with a participant number of   12,639 men aged 65-73 years; the WA trial, carried out   in the province of Western Australia included 41,000 men aged 65-79. All these trials used ultrasound screening of the abdomen to detect AAA and measured AAA-mortality as the primary outcome(4-7). The secondary outcomes of all trials were all-cause mortality. However the Mass trial also measured quality of life and cost-effectiveness as the secondary outcomes. Cost-effectiveness was also measured by the Viborg trial as the secondary outcome. Participants were randomly selected and randomisation was computer-generated(4-7). Mass and Chichester trials recruited participants via GP registers based on gender and date of birth. In the Mass trial, some were excluded if the GP considered them to terminally ill, had other health problems or had undergone AAA repair(4). In the Viborg trial, recruitment was through the countys health department and WA participants were selected from the electoral roll(6, 7). The WA trial excluded those men who were too far from the screening location; the Viborg trial had no such exclusions. MASS Trial The intervention group composed of 33839 men and the control group, 1333 men. Attendance was 80% and the median follow-up was ten years(4). 65 men died in the intervention group and 113 died in the control group, due to AAA. Mortality data was taken from death registry provided by the Office of National Statistics (ONS). The study concluded that AAA mortality rate can be significantly reduced by up to half, following ultrasound screening. There was a 42% reduction in the intervention group, hazard ratio (HR) 0.58 95% CI (0.42-0.78)(4). The study also measured mood and health status outcomes such as state anxiety, depression, and health-status measures such as mental and physical health, and self-rated health(4, 13). These were calculated at intervals of six weeks after screening and, 3 and 12 months after detection of aneurysm or surgery. There were no significant changes in anxiety and depression and these remained within the recommendations(4). However, those screened negative and undergoing surveillance scored higher in health-status measures. This trend continued until 3 months after screening(4). However at 12 months, those who had undergone surgery scored higher than those in surveillance. They also self-rated higher, similar to those screened negative(4). Despite these results, the authors refrained from making a conclusive statement on quality of life. In the intervention group, there was an increase in the number of elective surgeries, odds ratio (OR)- 2.45 95% CI (2.02-2.97)(4). Nevertheless, there was no significant difference in the overall 30-day mortality after elective surgery in the intervention and control groups; this remained at 6%. However, unnecessary surgery and the risk of overdiagnosis are seen as factors reducing the overall quality of life(29). So even though this increase in elective surgery in the intervention group and its effects could be used as a measure of quality of life, the authors did not make such a link. Chichester Trial The intervention group composed of 2995 men and the control group, 3045 men. The median follow-up was fifteen years and the attendance rate, 74%, decreased with age. About 33.8% of men in the age range of 76-80 years declined compared to 19.5% in the age group of 65 years(5). 10 men died in the intervention group and 17 died in the control group, due to AAA-related causes. Like the Mass trial, mortality data was taken from the ONS Death Registry. The study found no differences in mortality rates in the two groups up to four years from screening. However, over 15 years, mortality was found to be reduced in the intervention group by 11%. This was not considered as a significant reduction, HR 0.89 95% CI (0.60-1.32) (5). Viborg Trial The intervention group composed of 6339 men and the control group, 6319 men. Attendance was 76% and the maximum follow-up was fourteen years(6). 6 men died in the intervention group, compared to 19 in the control group. Mortality data was taken from the national registry. There was a significant reduction in AAA-related hospital mortality, OR-0.31 95% CI (0.13-0.79)(6). The study recommends screening men aged 65 years to reduce AAA-mortality. However since the study only noted deaths from AAA in a hospital setting in the county of Viborg, this finding cannot be expanded to other countries. Western Australia Trial The intervention and control groups composed of 19352 men each. Attendance rate was 70% and the maximum follow-up was 43-months(7). 18 men died in the intervention group and 25 died in the control group. Mortality data was taken from the national death registry and the hospital registry. The study found that there was no significant reduction in mortality following ultrasound scanning in the intervention group of men aged 65-83 years in Western Australia, OR- 0.72 95% CI (0.39-1.32)(7). However the study noted that in the subgroup of men aged 65-75 years, mortality was found to be reduced(7). Table 8 AAA mortality: raw data Trial Deaths in Screened Deaths in Unscreened Odds Ratio (95% CI) MASS 65/33,839 113/33,961 0.58 (0.42 to 0.78) Chichester 10/3205 17/3228 0.59 (0.27 to 1.29) Viborg 6/6339 19/6319 0.31 (0.13 to 1.79) Western Australia (WA) 18/19352 25/19352 0.72 (0.39 to 1.32) Total* 93/56,396 155/56,541 0.60 (0.46 to 0.78) *Data from the Viborg trial is not included since the study noted deaths only in a hospital setting. Hence, results cannot be compared to the other studies(30) Discussion The pooled data of 125595 participants shows that AAA mortality rate can be significantly reduced in the population following an ultrasound scan of the abdominal aorta. Data from the four RCTs show that the Absolute Risk Reduction (ARR) for the Mass trial, Chichester, Viborg and WA are 0.14%, 0.21%, 0.21% and 0.04%, respectively (See Table 9 for the full data processed by the review author). Although these may appear insignificant, when applied over a population, the ARR is 140.7, 214.6, 206.0 and 36.2 per 100,000 respectively. Hence, the Numbers Needed to Screen (NNS) are 711, 466, 485 and 2765 respectively. On an average, this is an ARR of 149.4 out of every 100,000 people for an NNS of 1107. This NNS is lower than other screening programmes like breast cancer screening which has an NNS of 1339(31).   This confirms the benefits of a population-based screening programme such as the NAAASP. The Mass trial, which looked at the effects of ultrasound screening on the quality of life found its measures to be within normal standards. Since the NAAASP is based on the results of this trial, it can be said that ultrasound screening has no adverse effects on the quality of life of the screened population. However, a   limitation acts on the trial- quality of life was measured only up to twelve months after scan; no data is available for the period after that. If quality of life was continued to be measured during follow-ups or even separately via postal questionnaires or GP appointments, a more valid inference could have been drawn. It would also have provided a fuller picture on the long-term effects on quality of life. One other limitation acting on this review is the possibility of selection bias as a result of excluding some articles in foreign languages. Despite this, the findings of this review remain unaffected and can be considered valid since an exhaustive search of the major databases was carried out systematically. Although the inclusion criteria of free-articles was applied after this search, Lancaster Universitys subscription service ensured access to all available articles and a complete retrieval of the selected search was possible. The pooled study population consisted of 125,595 men and the MASS trial alone had a sample of 67800 people. So, conclusions on quality of life and AAA mortality can be considered reliable. However, there are inconsistencies present in the four RCTs due to the different methods used. For example, the Viborg trial noted mortality only in a hospital setting. This makes its results incomparable to the other trials. Also, the source of mortality data varies in the four studies. All the trials looked at the national death registries but the Chichester and WA trials also looked at other sources(5, 7). This may have resulted in possible over-estimation or duplication of data. Similarly, the cause of death was re-checked by a clinician and two random vascular surgeons in the Chichester and WA trials, respectively. Whilst expert opinion regarding the cause of death could lead to precise and accurate mortality data, there could also be false-positives when opinions are formed on complex cases with multiple causes of mortality. This subject of human error was also noted whilst carrying out the preparatory ultrasound screening (Appendix A). Individual measurements of the same abdominal aortic diameter were varied. Although this points to the possibility of human error that may adversely affect the accuracy the diagnosis, the NAAASP identifies staff training as a significant aspect of the programme to overcome this. Staffs are well-trained in the use of ultrasonography for AAA screening and in the overall delivery of the programme(8). Also, the programme itself has several failsafe procedures incorporated within all phases of the programme so that the performance thresholds are constantly maintained(8). The result of this review can be applied to patient care in the UK. The NAAASP is successfully running its seventh year. Since its implementation in 2009, one million men have been screened(32). Accumulating evidence shows it is feasible to reduce AAA-mortality by ultrasound screening, thereby making it possible to achieve the programmes aim. Public Health England could implement similar screening interventions in other disease areas. There is currently a long of list of conditions like atrial fibrillation, thyroid disease and lung cancer where a population-based screening is not offered (but privately available) due to the absence of enough evidence to inform a screening programme'(33). Evidence-based healthcare could be further expanded to diseases like these. It is not just new and untreatable diseases that prove to be a challenge to 21st century medicine; it is the phenomenon of the disease-iceberg that proves most challenging. By detecting and treating early onset of illnesses, people live a longer and healthier life. Table 9 Data processed by the review author using the results from the four RCTs Trial Experimental Event Rate (EER) Control Event Rate (CER) Absolute Risk Reduction Relative Risk Reduction Number(s) Needed to Screen (NNS) Odds Ratio/Relative Risk MASS 0.00192086 0.00332735 0.00140649 0.422705 710.992 1.73222 Chichester 0.00312012 0.00526642 0.00214629 0.407543 465.919 1.68789 Viborg 0.000946522 0.00300680 0.00206028 0.685207 485.370 3.17669 Western Australia 0.000930136 0.00129186 0.000361720 0.280000 2764.57 1.38889 Overall 0.00157807 0.00276806 0.00118999 0.429901 840.344 1.75408 Overall* 0.00164905 0.00274137 0.00109232 0.398457 915.482 1.66239 *Data from the Viborg trial is not included since the study noted deaths only in a hospital setting. Hence, results cannot be compared to the other studies(30) Conclusion Following critical appraisal of the current available evidence provided by four major RCTs, it was found that mortality from AAA can be significantly reduced in males aged 65 years and older, through a population-based screening programme. Ultrasonography continues to be the chosen imaging modality due to its accuracy and ease-of-use.   It was also found that such a screen

Free Grapes of Wrath Essays: The Joads Journey :: Grapes Wrath essays

The Joad's Journey in The Grapes of Wrath Throughout history man has made many journeys, both far and wide. Moses’ great march through the Red Sea and Columbus's traversing the Atlantic are examples of only a couple of men’s great voyages. Even today, great journeys are being made. Terry Fox's run across Canada while fighting cancer is one of these such journeys. In every one of these instances people have had to rise above themselves and overcome immense odds, similar to a salmon swimming upstream to full fill it's life line. Intense drive and extreme fortitude are qualities they needed to posses during their travels. In The Grapes of Wrath, Steinbeck illustrates the Joad’s endurance by his use of extended metaphors in intercalary chapters. Steinbeck uses intercalary chapters to provide background for the various themes in the novel. He effectively foreshadows upcoming events by telling of the general state of the local population in the intercalary chapters. He then narrows it down to how it effects the main characters of the novel, which are the Joads. Setting the tone of the novel in the reader’s mind is another function of Steinbeck's intercalary chapters. In chapter three, Steinbeck immaculately describes the long, tedious journey of a land turtle across a desolate highway. From the onset of his journey, the turtle encounters many setbacks. Along the way ants, hills, and oak seeds hinder him under his shell. The turtle’s determination to reach his destination is most apparent when a truck driven by a young man swerves to hit the turtle. The turtle's shell is clipped and he goes flying off the highway, but the turtle does not stop. He struggles back to his belly and keeps driving toward his goal, just as the Joads keep driving toward their goal. Much like the turtle from chapter three, the Joads had to face many great hardships in their travels. The planes of Oklahoma, with their harsh summer weather, were the Joads desolated highways. The truck driver represented the Californians, who Buried food and killed livestock to keep the Joads and others like them away from their dream. And their ants and hills were sickness. Even through all of this, the Joads persevered. They were driven by two great motivating powers, poverty and hunger. Just as the turtle searched for food, the Joads were searching for paradise, "The Garden of Eden.

College Worth? Essay

College is a place for higher education. Many people go there for further study every year. Meanwhile, plenty of people skip college or drop out of college. Sort of people believe college is not worth because it cost too much. Most people think college is worth because you will able to get a good job when you holding a degree. Yes, because being a college graduate can help you gain more than the money you spent to pay for college. College is worth it because you will have a better job and pay then you can support yourself and your family. College student debt grows year by year, which means many students are unable to pay back their loan because they drop out of college or unable to find a job that can help they pay for their loan. However, it is just an excuse for those who did not finish college. In fact, according the article â€Å"The (Non-Monetary) Value of a College Degree†, Elia Powers writes â€Å"In 2005, a person with a professional degree could expect to make $100,000 a year, compared with less than $32,000 for a high school graduate and $51,000 for a graduate of a four-year college† this means college graduate can make much more money than high school graduate. Also, in the article â€Å"College Student Debt Grows. Is It Worth It?† NPR Staff state â€Å"For students graduating this year, Kantrowitz estimates that their debt will be about $27,000† this means people mostly borrow about $27,000 for college. Assume you graduate from college and earn $51,000 every year. You can pay $500 monthly. Then your debt will be clear with 5 years. Of course if you are only high school graduate and earning $32,000 per year. You are not able to pay back the loan because the money is only support for your own life expenses. Although finishing college requires much effort and time, college is worth it because college can lead you to become a healthier person. Finishing college can help you to make healthier decisions. When you are in college, you are considering about yourself and your future. You will able to determine what is good for you and what is bad. As the article â€Å"The (Non-Monetary) Value of a College Degree†, Elia Powers mentions â€Å"Of those 25 or above, roughly 25 percent of people whose educations stopped at high school smoke, compared with 10 percent of those who earned a bachelor’s degree or higher,† this means people who are college graduate most likely quit smoking or do not smoke. As we know smoking is a bad habit that will damage human health. So they made a healthy choice which is to stay away from smoking. Also at the same article above, Elia Powers said â€Å"for instance, more than 60 percent who were in the 25-34 age range said they exercised â€Å"vigorously† at least once a week. That’s compared with 31 percent of high school graduates who said the same.† This means 60 percent of college graduate exercise frequently so they can keep their body in health shape. We all know living in a healthy way is important because no one wants to get sick. Healthy is precious now because people realize health is our wealth. Although some factors may bother you going to college, college is still worth it because you will become a responsible citizen who can return to our society. The most important thing for a country is its citizen. The government needs money to run so we pay taxes and we can chose the best person to lead and improve our country. Then we can have a better life. In the article â€Å"The (Non-Monetary) Value of a College Degree†, Elia Powers states â€Å"Forty-three percent of those surveyed with at least a bachelor’s degree said they volunteered in 2006, and they reported doing so for a median of 55 hours.† This means college graduate people will more likely to serve for our society. This can make our environment better. Also, as â€Å"The (Non-Monetary) Value of a College Degree† Elia Powers mentions â€Å"In every age category, college graduates cast ballots at a higher rate than those who didn’t receive a diploma. The trend is particularly pronounce d for the 25- to 44-year-old group, in which 76 percent of college graduates voted, compared with 49 percent of high school graduates.† This means college graduate are also more willing to vote too. They want to be involved in the election. This is good for the democracy of the country. We all deserve the right to enjoy the facility of our country; however, we have the duty to serve our country too. College can make you become a good citizen who can improve our society. College is worth it also because it will build your personality and grow intellectually. Some people think college is a risky investment because if you are taking more debt, and unable to pay back afterword, you will be in big trouble. However, if you think more deeply about what else college can bring to you; you will see college can actually bring you more rewarding assets. In the online article â€Å"Is College worth it?† from PewResearchCenter, the Pew Social Trends Staff said â€Å"Among survey respondents who graduated from a four-year college, 74% say their college education was very useful in helping them grow intellectually; 69% say it was very useful in helping them grow and mature as a person; and 55% say it was very useful in helping them prepare for a job or career.† This means the things you experience and expect in college is different and difficult to train in the reality. While you became a smarter person, is there any cost you can trade in to become a knowledgeable man? Getting a degree is hard but the most important is the stuff you gained when you graduated from college. In this situation, we should try to encourage more people to get into college. People think college does not worth probably are not finished college. To persuade them is to get them into college and let them experience the changes leaded by college. I think government should lower the interest rates for college student loan so people can less consider the most common factors. Also the government can set up an alternative way to finish college like offer other type of degree which is easier to complete and government approved. Lets have people to realize that having a college education is important because this will improve the quality of our life and country.

7 Active Reading Strategies for Students

7 Active Reading Strategies for Students Active reading techniques can help you stay focused and retain more information, but its a skill that takes time and effort to develop. Here are some strategies to help you get started right away. 1. Identify New Words Most of us develop a bad habit of glossing over words that are vaguely familiar to us, often not even realizing we are doing so. When you  read a difficult passage or book for an assignment, take a few moments to really observe challenging words. You will likely find that there are many words that you think you know- but that you can’t really define. Practice by underlining every noun or verb that you cannot replace with a synonym. Once you have a list of words, write the words and definitions in a logbook. Revisit this log several times and quiz yourself on the words. 2. Find the Main Idea or Thesis As your reading level increases, the complexity of your material will likely increase as well. The thesis or main idea may no longer be provided in the first sentence; it may instead be located in the second paragraph or even the second page. Finding the thesis is crucial to comprehension. You’ll need to practice finding the thesis of the text or article each time youre reading. 3. Create a Preliminary Outline Before you dive into reading the text of a difficult book or chapter, take some time to scan the pages for subtitles and other indications of the structure. If you don’t see subtitles or chapters, look for transition words between paragraphs. Using this information, you can craft a preliminary outline of the text. Think of this as the reverse of creating an outline for your essays and research papers. Going backward in this way helps you absorb the information you are reading. Your mind will, therefore, be better able to â€Å"plug† the information into the mental framework. 4. Read With a Pencil Highlighters can be overrated. Some students commit highlighter overkill and end up with a sloppy multi-colored mess. Sometimes it’s more effective to use a pencil and sticky notes when you write. Use the pencil to underline, circle, and define words in the margins, or (if you’re using a library book) use sticky notes to mark a page and a pencil to write specific notes to yourself. 5. Draw and Sketch No matter what type of information you’re reading, visual learners can always create a mind map, a Venn diagram, a sketch, or a timeline to represent the information. Start by taking a clean sheet of paper and creating a visual representation of the book or chapter you’re reading. Youll be amazed by the difference this will make for retaining information and remembering details. 6. Make a Shrinking Outline A shrinking outline is another useful tool for reinforcing the information that you read in a text or in your class notes. To make a shrinking outline, you need to re-write material you see in your text (or in your notes). While it is a time-consuming exercise to write out your notes, it is also a very effective one. Writing is a necessary part of active reading. Once you have written out a few paragraphs of material, read it over and think of one keyword that represents an entire paragraph’s message. Write that keyword in the margin. Once you have written several keywords for a long text, go down the line of keywords and see if each word will prompt you to remember the full concept of the paragraph it represents. If not, re-read the paragraph and choose a more accurate keyword. Once every paragraph can be recalled by a keyword, you can begin to create clumps of keywords. If necessary (e.g. if you have a lot of material to memorize) you can reduce the material again so that one word or acronym helps you remember the clumps of keywords. 7. Read Again and Again Science tells us that we all retain more when we repeat a reading. It’s good practice to read once for a basic understanding of the material, and read at least one more time to grasp the information more thoroughly.

Free Essays on I Wandered Lonely As A Cloud

worth uses various natural phenomena, such as clouds, daffodils and waves, as devices to characterize his speaker’s different stages of emotion and feeling. The first few lines of the poem portrays the speaker’s initial emotion. â€Å"I wandered lonely as a cloud, that floats on high o’er vales and hills,† the speaker is described as a â€Å"cloud,† lonely, aimless, and cruising quickly and lightly through â€Å"vales† and â€Å"hills.† A vision of the daffodils moved him to a state of being connected to something, as the poet wrote, â€Å"When all at once I saw a crowd, a host, of golden daffodils.† The concord and harmony of the â€Å"dancing daffodils† replaced his feeling of loneliness; he is no longer a â€Å"lonely cloud.† As the twinkling stars in the milky way, and the sparkling dancing waves appeared in the second stanza, they danced along with the â€Å"ten thousand† daffodils, a new state emerged for the speaker, he started to realize the world of interconnection and relationship. He sees the universe as a harmonious whole, in which every subject reflects a nd echoes the other. The daffodils became the speaker’s companions in the third stanza, and they were describing as â€Å"the jocund company† by the poet. He enjoys the company of the dancing daffodils, which brings him happiness and joy. As the poem goes on, the second emotion from the speaker occurs in the last stanza: the state of â€Å"solitude.† â€Å"For oft, when on my couch I lie, in vacant or in pensive mood, they flash upon t... Free Essays on I Wandered Lonely As A Cloud Free Essays on I Wandered Lonely As A Cloud â€Å"I Wandered Lonely as a Cloud† by William Wordsworth, a poem that discloses the relationship between nature and human beings: how nature can affect one’s emotion and behavior with its motion and sound. The words the author adopted in this poem are interconnected and related to each other. They are simple yet profound, letting us understand how much William Wordsworth related his works to nature and the universe. In the poem, William Wordsworth uses various natural phenomena, such as clouds, daffodils and waves, as devices to characterize his speaker’s different stages of emotion and feeling. The first few lines of the poem portrays the speaker’s initial emotion. â€Å"I wandered lonely as a cloud, that floats on high o’er vales and hills,† the speaker is described as a â€Å"cloud,† lonely, aimless, and cruising quickly and lightly through â€Å"vales† and â€Å"hills.† A vision of the daffodils moved him to a state of being connected to something, as the poet wrote, â€Å"When all at once I saw a crowd, a host, of golden daffodils.† The concord and harmony of the â€Å"dancing daffodils† replaced his feeling of loneliness; he is no longer a â€Å"lonely cloud.† As the twinkling stars in the milky way, and the sparkling dancing waves appeared in the second stanza, they danced along with the â€Å"ten thousand† daffodils, a new state emerged for the speaker, he started to realize the world of interconnection and relationship. He sees the universe as a harmonious whole, in which every subject reflects a nd echoes the other. The daffodils became the speaker’s companions in the third stanza, and they were describing as â€Å"the jocund company† by the poet. He enjoys the company of the dancing daffodils, which brings him happiness and joy. As the poem goes on, the second emotion from the speaker occurs in the last stanza: the state of â€Å"solitude.† â€Å"For oft, when on my couch I lie, in vacant or in pensive mood, they flash upon t...

U.S. History 1945 to 1992 Essay Example | Topics and Well Written Essays - 750 words

U.S. History 1945 to 1992 - Essay Example Divisions emerged in Poland and Germany, there was formation of COMECON and NATO, and America utilized economic and military intervention to defeat Communist forces in Turkey and Greece. America wanted the European and Asian countries to adopt capitalism while the Soviet Union wanted to expand Communism. The Cold War had begun by 1949, as America and the Soviet Union confronted each other economically and politically without engaging in war. The Marshal Plan saw the United States affirm its economic dominance by providing financial aid to countries in Europe that decided to adopt capitalism. It would also mean that the United States would trade with these countries. In the 1950s, the United States was sending monetary aid to China and Korea to help fight communism. Back at home, American politics were totally against communism and the government’s political wing created a loyalty program that ensured that the Americans drove out all communists even in Hollywood. The American citizens were against communism and it was considered a great evil for one to be a communist. America recovered from the great depression, many jobs were created, and prosperity was experienced in the American society because people had the money to spend. This demonstrated that America’s capitalism doctrine was superior to communism. During the John F Kennedy era, the government put a lot of emphasis on foreign policy, as it planned t o quell communist expansion around the world. However, the Cuban Missile Crisis and the struggle for African American to gain equal rights with the White people, characterized the Kennedy era. It was unfortunate that America believed in free people and it was trying to free other countries while the country was plagued by racial inequality. The Cold War was significant in the fight against racial segregation and bringing change for the black people and other minority groups. After President

Nature or nurture Essay Example | Topics and Well Written Essays - 1500 words

Nature or nurture - Essay Example This at least seem possible conclusions that may be drawn from the work of Michael Kimmel, a sociologist, teaching at the University of New York at Stony Brook. Apart from having written on gender in general and men in particular, he has also produced numerous books and journal articles that deal specifically with the issues of masculinity, particularly that of teenage boys and young men under the age of 30. In a recent book (2008), Kimmel discusses the ‘code of masculinity’ these young men are socialized into, usually from an age earlier than even puberty, and the fear that is created by enforcement tactics used by others around them to ensure that the socialization process is successful. It is not only Kimmel but also others like Kindlon and Thompson (qtd. In Kimmel 2008) who point out that young men are not comfortable with the denial of personal needs and with living in emotional isolation. The cruel treatment they suffer at the hands of their peers leaves them beref t and is the reason for many teenage suicides. The fact that so many young boys and men appear to be extremely ill at ease with ‘wearing the mask of masculinity’ (Pollack qtd. ... nowledges the recent pre-occupation with biology in the area of human identity, and the apparent demise of theories of gender as a social construct, she also points to the fact that the difficulties so-called ‘transgender’ children experience, appear to have been exacerbated by parental indulgence. These children take on role-playing at a very early age – usually the role of the opposite sex – and persist with it, without a sign of change in sight. In A Boy’s Life (November 2008) Rosin maps the options that are open to these children and how their parents agonize over choices they are ill equipped to make. Both Rosin and Kimmel offer a disturbing view of the motivation of peers, parents, communities and professionals, those involved in the negotiation of gender and identity, and how a mix of fear of rejection, a need for normalcy and peer approval, parental weakness and professional ambition can lead to a single-minded homing in on only those solutio ns that serve these purposes. As Kimmel points out, it is not surprising that a system that is held together by fear and constant peer affirmation should selectively look to nature and nurture to justify itself. Like many other ambiguous intellectual constructs, it uses contradictory justifications. Thus, masculinity is described to be the result of evolutionary and chemical processes – biologically determined, unalterable and unassailable (614). It would appear that men come into the world, fully ‘wired’ for masculinity. This is indeed biology at work. Yet, curiously, it is vulnerable. It must be re-enforced by toughening up or it is in danger of lapsing. As Kimmel points out, if it is indeed hard-wired, nothing whatsoever would need to be done to preserve it. But that is clearly not the case, otherwise men