Economics Assignment Example | Topics and Well Written Essays - 2500 words - 1

Economics - Assignment Example Instead of closing out contracts with cash settlements, a common procedure on the commodities market, the Hunts took delivery on silver. They then stockpiled this silver and used their large cash reserves to buy up even more futures. The billions in demand triggered the rise of silver to more than $50 per ounce.† (Beattie, 2010) If speculation can have this much of an impact on the price of a fixed commodity – and the silver price plummeted when the Hunt brothers’ market corner was toppled – then the market cannot be totally reliable for an egalitarian distribution of resources. In this instance, a small minority with excess capital reserves could easily create massive market movements in price. It is the same with any commodity if a large capital interest takes hold in the sector and accumulates not from the need of supply, but based on speculation, then the aspects of banking and finance can come to determine even the price of coffee and tea. A free market based upon supply and demand and a free market fueled by speculation may not function in the same manner in determining market prices. If one reviews the ability of a group of brothers like the Hunts to move prices in silver, what could a nation-state, for example, accomplish if it were to try to monopolize a sector of commodities, or accumulate from a perception of scarcity. One example of this would be the Chinese State-owned and financed oil companies or loans being given to businesses by State-sponsored banks to buy commodities like copper, driving up the price. Q.2 - In free market economics, government interference and influence in the economy is rejected, in favor of the pure dynamics of supply and demand being determinant in driving prices, investment, capital flows, and other aspects of trade, manufacturing, and business activity. In this theory, the market operates naturally and

Brand sense Essay Example for Free

Brand sense Essay In measuring the Brand Experience of the target segment, companies focus on the response and understanding of their customers and their reactions on the part of the particular five senses while handling the brand in question. Further, this array of experiences of the customer reveals the perception of the user extending the issue to question the self; about the identity or for using a certain brand, what image the customer gets about the self. Speaking strictly, who am I? This is a kind question that seeks the image or the perceived image of the person; thus, the personality. Relating the perceived image of the user and the brand in use; Brand Personality of the brand can be derived. In this entire process the essence of a brand can be identified by using different senses for different kinds of brand with need and experience of different customers, the employees involved with the brand and the particular target segments. To make a cross-section of this marketing idea; the unique presentation of the senses and the allied questions to the brand, can be observed in the brand sensory wheel that segregates the divisions of the total composition of the senses (Brand Sense, 2001). Source: Harvest Consulting Group LLC. The discovery of the sensory approach has enabled companies to unfold the essence of the current service and the possibilities of the future avenues. Author has logisised this that it will enrich the brand loyalty and makes the existing relationship deeper. Behind this happening, the five senses can play a crucial role. To know the fate of a brand conducting the sensory audit is a vital step to forecast the brand’s multiplication power on its sensory touch point. Ascertaining the brand’s stimuli, enhancement, and bonding capabilities, decides the execution of the above knowledge. The essence of this approach is the simple fundamental of including more senses to make the brand base stronger. We also follow this while evaluating the brand and its surroundings too. To explain, a visual encounter of Starbucks retail follows the suite bellow: Sight: Brand logo on building, cups, and bags Sight/Sound: Uniform and customer approach Sight/Sound/Touch: Interior aesthetics (sofa, colors, wall paper, music) Smell/Taste: Distinct aroma of freshly ground coffee This process also unveils the concept of smashability factor, which measures the strength of an individual sense for a brand and hoe much impact it can give. A real-time example of the application of the auditory sense reflects from the recent transformation of the Cadillac brand. For the hard penetration of the European and Japanese car makers into the American luxury car segment, Cadillac Source: brand papers. had to bear the burn of declining sales figure during late 80s and early 90s. To retrieve the brand from the grip of the downward graph, the same has been assessed, disassembled, reassembled, and re-positioned by late 90s. To do so, the brand invested in molecule analysis to create a new meaning to its design and market preference. This entire process has remodelled the brand from its â€Å"grandpa drove into a fast, sexy, and desirable product† concept to the recent Caddy commercial with Led Zeppelin playing â€Å"been a long time† that blaring out from the speaker (Brand papers, 2009). the innovation of the sensory branding has opened a plethora of concepts to associate the brand with the target group and it has no end to create feel factors. This is because, the central theme of this process is entirely depending on the nature, which again is the adobe of the man kind. Reference Brand Sense.(2001). Building Brands with Sensory Experiences. New York: Harvest Consulting Group LLC. Brand papers. (2009). Sensory Approach. Retrieved March 14, 2009, from http://images. google. com/imgres? imgurl=http://www. brandchannel. com/images/papers/272_gm_flagship_cl. gifimgrefurl=http://www. brandchannel. com/papers_review. asp%3Fsp_id%3D680usg=__eiohIvWqTVwC7vNmelzj2n_t4JQ=h=315w=400sz=52hl=enstart=14um=1tbnid=Ny3PU6pNRmcVVM:tbnh=98tbnw=124prev=/images%3Fq%3Dbrand%2Bsense%252BMartin%2BLindstrom%26ndsp%3D20%26hl%3Den%26sa%3DG%26um%3D1 Lindstrom, M. (2005). Brand Sense: Build Powerful Brands through Touch, Taste, Smell, Sight, and Sound. New York: Simon Schuster Adult Publishing Group. Additional Reading Johnson, L. and Learned, A. (2004). Dont think pink: what really makes women buyand how to increase your share of this crucial market. AMACOM Div American Mgmt Assn. Ornbo, J. ; Sneppen, C. and Wurtz, P. F. (2008). Experience-Based Communication (illustrated). Springer.

Attachment And Associated Disorders In A Classroom Education Essay

Attachment And Associated Disorders In A Classroom Education Essay EE and JE are two brothers, age eleven and eight respectively, who attend the same mainstream primary. Both children were identified as having difficulties considered consistent within Autistic Spectrum Disorders (ASD) and therefore each was issued with a Special Educational Needs (SEN) Statement. Both children have recently started to experience social, emotional and behavioural difficulties (SEBD) at an intensity which is of great concern for those professionals working with them. A more detailed description of these difficulties will be outlined in the following section. The school they attend opened an ASD Resource Base (RB) in September 2009. The siblings have been timetabled in the Base according to their language and cognitive developmental levels. They were mapped for this wave 3 intervention with the view of increasing their successful inclusion in the mainstream educational offer. For EE, initial assessment lead professionals to allocate 60% of his school time in the RB, along with eight other students of different ages but similar educational needs. All nine children have been assessed within P Scale levels (QCA, 2005). JEs learning difficulties are of a moderate nature and therefore he was grouped in a different ability group with other three students. All children in this group were assessed to be working at National Curriculum level 1. JEs group was scheduled four weekly sessions in the Base with the view to provide additional support in the development of the childrens Literacy, Numeracy and Social/Emotional skills. All teachers involved in their education are developing a shared understanding of the use of Provision Maps (PMs), personalised documents that provide an overview of the childrens allocated wave 2 and wave 3 interventions, as well as their long and short term educational targets. PMs are used to inform teachers planning, both in the mainstream classroom and in the RB. In addition, they provide staff with a shared understanding of each childs educational needs (Gross, 2008). PMs also contribute to the schools inclusive ethos, supporting Riesers (1995) proposal that SEN should be part of the schools equal opportunities policy rather than being considered as a separate issue (cited in Cowne, 2000). Any child on role at this primary can access to the provision that is additional to or different from the mainstream offer at any time their needs indicate so, whether they present with SEN or not. The purpose of this essay is not necessarily to challenge the subjects ASD diagnoses but to analyse the nature of the behaviours they are currently manifesting, which may provide some relevant explanations and result in useful interventions once and if attachment disorders are considered. Johnson (1992) and Williams, OCallaghan and Cowie (1994), authors cited in Geddes (2006), maintain that childrens attachment experiences have implications for those seeking to support them in their learning process. It is the authors assumption that the two boys in this study are using behaviour as a way to communicate their emotional needs. This essay will attempt to give meaning to their current behaviour using Geddes Learning Triangle Theory (2006) and apply this analysis to inform future practice. Recent behavioural changes in both siblings if considered jointly may contribute to critically identifying possible parenting issues, which could prove significant as both children are currently being assessed as potentional candidates for the Child Protection Register. Identifying Problem Behaviours: an outline of background information and recent behavioural observations. EE is the eldest of the siblings and will be moving to secondary education in September 2010. He was diagnosed with ASD when he was almost 3 years old. EE presents with severe difficulties in the three areas of development which constitute the triad of impairments at the core of the autistic spectrum: social and emotional understanding; all aspects of communication; and flexibility of thought and behaviour (Jordan, 2005). During his primary education, EE has been known as a compliant boy, very quiet and tranquil. He tends to keep to himself but responds well to adult lead activities. He finds it hard to stay focused on activities that are not of his own choosing but understands boundaries and responds well to positive behavioural management approaches used with individuals with ASD, such as making connections with key adults, clear expectations, and verbal praise (Kluth, 2003). Over the past two months, EE has shown increasing signs of anxiety in response to other children suddenly b ecoming upset. On one occasion, a little girl in his RB group accidentally hurt herself and began to cry inconsolably. The change in his muscle tone was very apparent to those working with him. He became very rigid and placed his hands on his stomach. After a minute or two, and once the girl had calmed down, EE asked to go to the toilet, which he never had done before during lesson times. While it is reported that EE has been receptive to criticism in the past, he is currently very sensitive to any sign of disapproval, getting easily upset if he feels he is in trouble and often denying any wrongdoing. If another child hurts him/herself and a graze is apparent, EE tries to communicate the incident to an adult. He has begun relating these incidents to his own experiences, intentionally expressing these connections to the adults working at the RB and consequently disclosing events of concern. He has pointed at scars on his body while naming his brother. When asked what happened, EE usu ally responds mummy slaps JE. EEs language difficulties are a barrier to him expressing his needs and historically he has not initiated a conversation with another person. The contexts in which EE feels the need to share his own thoughts are related to others or himself being in physical pain. Recently EEs appetite has also worsened and he is reluctant to join in at snack time, having to be regularly encouraged to eat. It would then seem reasonable to consider EEs behaviours, such as the changes in his appetite, noticeable anxiety and withdrawal, as symptoms possibly associated with a specific emotional disorder, such as depression or anxiety (DfEE, 2001). JE is a year 4 student and the second child of what is about to become a family of four siblings. JE also was diagnosed with ASD at the age of four. He has always had a very loud and active nature. His language impairment is more apparent in his expressive skills, especially when involved in some kind of conflict with his peers. JE is known for his tendency to be non-compliant. When contradicted or challenged, he initially would protest verbally, but would comply with key adults like his teacher or LSA. He had not shown any physical aggression until two months ago. JE regularly appears in a heightened state of anxiety and he has become increasingly negatively fixated on one particular child, with whom he has experienced difficulty interacting with throughout his schooling. His sensitivity to criticism has accentuated recently and his difficulties in initiating and maintaining positive and trusting relationships with both peers and adults are escalating. JEs most challenging behaviour is his determination to always be in control at whatever the cost, both in class and at playtimes. He appears increasingly restless and has expressed lack of sleep. The nature of JEs SEBD is gradually proving more challenging to those working with him, to the extreme of being at risk of permanent exclusion. He is developing a pattern of flight and fight (Geddes, 2006), demonstrating an increasing violence against school property and/or adults. Physical restrain is met with spitting, kicking, punching, and even with the shouting of false accusations. Sometimes the trigger to his outburst can be peers succeeding in tasks or behaviours which he has declined to attempt himself. At other times, the outburst occurs when he has been denied permission to go to the toilet or to access to a preferred activity. His ability to remain on task is deteriorating. When a member of the mainstream staff referred to calling his father to report his behaviour, JE begged for it not to happen, alegating that his father would hit him with the belt. Despite knowing of his tendency to lie, the leadership considered all recent developments involving both siblings, and the schools child protection officer referred their case to Children Services. Circular 9/94 (DfEE, 1994) defines (S)EBD as difficulties presented in a continuum between behaviour which challenges teachers but which can be considered within normal developmental bounds and that which is indicative of serious mental illness. In EEs case, the behaviours he is presenting could be considered typical within the autistic spectrum, yet it is the sudden change parallel to those observed in his younger brother that has alerted professionals working with him, triggering a multidisciplinary analysis of the possible causes underlying these behaviours. JEs disruptive and disturbing behaviours, the deterioration of his social skills and his escalating distress, have lead the author of this paper to consider a possible overlap between his SEBD and mental health difficulties (SEBDA, 2006). It would appear that his current case scenario fits within the DfES (2001) definition of conduct/anti-social disorders: Conduct disorder is a term used by mental health specialists to describe a syndrome or core symptoms, which à ¢Ã¢â€š ¬Ã‚ ¦ involve three overlapping domains of behaviour: defiance of the will of someone in authority; aggressiveness; and anti-social behaviour that violates other peoples rights, property or person. (DfES, 2001 p.24) A referral to Children and Adolescence Mental Health Services (CAMHS) followed this hypothesis, but in the interim that assessment is undertaken by the designated professionals, staff involved with JEs education relates to Geddes (2006) assertion of the practitioners need to reflect upon the effect that he is having on those working with him. Professionals agree that the severity of JEs behaviour at times of crisis appears to be negatively affecting professionals ability to think and respond using best practice, thus the system is becoming reactive with an increase in punitive responses and fixed term exclusions. JE is gradually becoming more rejected and unpopular amongst his peers and the adults around him, which is having a detrimental effect on his self-esteem and consequently his academic performance is decaying hastily. Difficulties in interpersonal relationship skills correlate highly with self-esteem, affect school performance and other psychosocial domains (Dana, 2009). JEs emotional and social difficulties seem to be spiraling within Danas assertion. Greenhalgh (1994) emphasizes that for those children affected with emotional and behavioural difficulties, their ability to learn is strongly linked to the childrens ability to relate to others. His assertion could be then considered in connection with the pioneer work of Bowlby (1969; cited in Bowlby, 1988) on Attachment Theory. Bowlby explains attachment behaviour as a set of behaviour patterns meant to develop during the childs early months of life. He adopts an ethological approach to the understanding of parenting and identifies the need for protection as the reason for the development of attachment between infant and caregiver. Attachment can be explained as the emotional bond that develops between the two, providing the infant with emotional security (Peardy, 1998). Cooper, Smith and Upton (1994) considered that behaviour problems in schools could be caused by the emotional difficulties emerging as a consequence of difficult family backgrounds or physical/sexual abuse. Ainsworths experiment called The Strange Situation (1978; cited in Geddes, 2006 and Pearce, 2009) contributed to the identification of the essential input of the mothers sensitivity to her infant in the development of attachment patterns. It is reported that JEs social and emotional difficulties, specially his inability of developing trusting and long lasting relationships, have always been present during his schooling, but has taken a more anti-social direction in recent times. Prior to critically analysing the attachment patterns observed in the teaching and learning environment of the RB thus the individuals SEBD can be analysed under the Attachment Theory framework -, it appears relevant to first consider the Attachment Theory in relation to children diagnosed with autistic disorders. Attachment patterns in children with ASD. Parenting children with ASD can be highly stressful (Koegel et al. 1992 and Dum et al. 2001; cited in Rutgers et al. 2007). Rutgers et al. (2007) explain how a number of researchers maintain that impairments in social interaction may have their impact on parental interactive behaviour, suggesting that parenting is particularly affected by the childs lack of adaptability, his/her demandingness and the parents acceptability of the childs disability. Despite this fact, Rutgers et al. (2007) conclude that children with ASD are able to show secure attachment behaviours to their parents regardless of their impairments in social interactions. The results of their study, also indicate that children with ASD who present with attachment disorders, follow a disorganised/disoriented pattern. Pearce (2009) describes this pattern as that defined by the childrens bizarre and contradictory behaviours towards the caregiver, exhibiting incomplete movements and poor affective displays. Rutgers et al. ( 2007) attribute the cause of these differences to the detrimental impact that the childrens social and language impairments can have on their parents interactive behaviour, especially when the children have severe difficulties in conventionally displaying their emotions. These authors maintain that with children with ASD, more sensitive parenting is not necessarily associated with more attachment security, whereas for children without ASD, more sensitive parenting is associated with more attachment security. These findings could be significant when identifying differences in the possible underlying causes of the siblings current SEBD. As outlined in the introduction of this essay, the aim of this present analysis is to underpin possible connections between the subjects SEBD and what Ainsworth et al. (1978, cited in Geddes, 2006; Rutgers et al. 2007; and Pearce, 2009) referred to as insecure patterns of attachment. Before considering possible attachment disorders as possible causes of the childrens SEBD, the siblings language difficulties have been taken into consideration. Teaching staff consulted the RB Speech and Language Therapist (SALT) in relation to a possible link between the childrens recent change in behaviour, their communication disorders, and their self-awareness. Law and Garrett (2004) cited the work done by Baker and Cantwell (1985) in order to determine the exact nature of the relationship between behavioural disorders and communication disorders. These authors concluded that early communication difficulties and behavioural problems are integrally linked in a common developmental trail that may beco me stronger as the child grows older. Both children have been receiving language therapy at school and since the opening of the RB, the hours of direct contact with the therapist have increased. During the first weeks of the school year, both children shown better than expected progress in all academic areas and SALT reported considerable improvement in their language and communication skills. Both children are demonstrating a strong need to communicate. Whether this need is to point at what is upsetting them or to link their present experiences to other environments is unknown. In consultation with the SALT, and in terms of their language development, it was agreed that both children are making good progress. It was then assumed that answers to the subjects change in behaviour needed to be found elsewhere. Understanding the nature of early experience and its disorders in the classroom could help staff understand the meaning of the childrens behaviour in school and indicate what kind of response and intervention may be effective (Geddes, 2006). Attachment patterns observed in the classroom: differences between the two siblings. Clements (2005) asserts that behaviour is driven by interactions between the individual and the environment, adopting an ecosystemic approach when understanding behaviour in children with ASD. Attachment Theory is yet another ecosystemic framework within which professionals have the opportunity to view pupils and their social and emotional difficulties holistically (Geddes and Hanko, 2006; Gross, 1987). Consequently, staffs understanding of the impact early experiences can have on the childrens behaviour at school could contribute to the emotional heath and well-being of all pupils (Geddes, 2006). Dowling and Osborne (1985; cited in Geddes, 2006) stress that children develop an understanding of relationships based on their experiences with parents and siblings, friends and extended family. Through these primary experiences, Dowling et al. explain how children will develop an understanding of rivalry for parental affection, sharing and ownership. Stern (1985) maintains that experience s of being in the company of an other are to be seen as active acts of integration, rather than as passive and unsuccessful intends of differentiation of their self. Both siblings seem to have recently suffered deterioration in their emotional well-being, yet they appear to be expressing these difficulties in very different ways: while EE is approaching adults for comfort, JE is attacking them. These differences, explains Bee (1997), could find an explanation in the biological argument explaining temperament and personality. The biological perspective considers that each individual is born with characteristic patterns determined genetically, which then establish the individuals responses to the environment and to other people (Ayers, Clarke and Murray, 1999; Bee, 1997). Goleman (1996) supports this statement and adds that each individual inherits a series of pre-set emotional features, which determine his/her temperament. It would seem, however, as if by adopting a biological perspe ctive to explain the differences in the siblings behaviours, the birth order of the children would then not be accounted for, nor any environmental factors. This would then contradict the advice of a number of researchers who advocate for the need to adopt an eclectic approach to the analysis of SEBD (Cooper et al., 1994; Cooper, 1999; Jones, 1999; Visser, 2002; Visser, 2005). JE is the second of three siblings and the family is currently expecting a fourth baby. EE was diagnosed with ASD soon after JE was born. Sterns (1998) assumption that experiencing the self in the company of another is to be seen as an experience towards integration might not have been such for JE. Links between Attachment Disorders and Mental Health Problems can be found in Greenhalghs (1994) work when he refers to Kleins (1946) concept of the paranoid-schizoid position, which is characterised by the individuals strong need for omnipotence, or in another words, the need to have things ones own way. They relat e omnipotence to the fear that allowing others to get their ways will stop the individual from preserving the experience of things being good. When identifying the problem behaviours in previous sections of this essay, it was mentioned JEs need to dictate his own way (e.g. he is to go to the toilet any time he wants to, not when he is scheduled to; he finds it very difficult to cope with the adults authority, often challenging it and reacting violently when feeling contradicted). Geddes (2006) applies the principles of the attachment patterns originally determined by Ainsworth et al. (1978; cited in Geddes, 2006; Rutgers et al. 2007; and Pearce, 2009) to the classrooms teaching and learning dynamics. She does so with what she names The Learning Triangle, established between the child, the teacher and the task. Rutgers et al. (2007) reached the conclusion that children with ASD tend to be less secure and more disorganised in their attachment pattern. This assertion could provide a th eoretical basis to critically consider JEs SEBD difficulties as being caused by a disorganised /disorientated attachment. When describing pupils whose attachment pattern is of this type, Geddes (2006) identifies the following responses to their schooling and learning: à ¢Ã¢â€š ¬Ã‚ ¦ the pupil is likely to: appear in a heightened state of anxiety; be highly vigilant and notice any slight distraction; have an absence of trust in the authority of adults; be insensitive to others feelings; place considerable importance on objects rather than relationships; may bully others perceived as vulnerable/reminders of their vulnerability; get into trouble a lot in relatively unsupervised settings such as the playground; experience overwhelming affect (feeling) which has no apparent meaning; sudden react to unseen triggers; be extremely sensitive to criticism and implied humiliation; have little development of the capacity to reflect à ¢Ã¢â€š ¬Ã‚ ¦ and sadly appear to enjoy very little. (Geddes, 2006; pp. 108) JEs problem behaviours seem to be consistent with most of the patterns described above. When JE joins a lesson in the RB, he is asked about his mood. All pupils in his group are invited to register themselves according to six basic emotions. JE has only managed to identify two of the choices, excitement and anger. Over the past month, JE has regularly indicated feeling angry but he cannot express the reason behind his emotion. Research on the origins of anger and rage link aggression and violence to weak bonding in infancy and weak parenting (APA Commission on Violence, 1993; cited in Geddes, 2006). Geddes (2006) also quotes Holmes (2001) definition of outbursts of rage as a form of displacement activity resulting of an individuals dilemma between fear and need. She also classifies the learning profile of disorganised students as that of being omnipotent and controlling when approaching the classroom, reaching to the same consideration as other authors previously refer to (e.g. Klein , 1946 in Stern, 1998). On the other hand, EE is responding well to a nurturing approach to his emotional needs, which Clements (2005) identifies as one successful strategy for those individuals with ASD who like EE are sensitive or anxious and ready to avoid situations. When considering Geddes Learning Triangle to critically analyse EEs SEBD, the evidence compiled with the SALT; the fact that he is approaching the adults in the RB when feeling upset and/or distress; his growing ability to work independently with the support of visual aids; and his good response to the nurturing approach staff is adopting, could contribute sufficient evidence to consider EE as a securely attached pupil who over the last two months has been experiencing some external strain. His condition of first-born and his kind and gentle manner would appear to have contributed to his development of a secure attachment with his mother. Over the years, he has demonstrated a capacity to adapt to school and to respond to the demands of the academic and social setting in which learning takes place, which Geddes (2006) identifies as features characteristic of secure attachment, a social and emotional skill that children with ASD are capable of achieving (Rutgers et al. 2007). Geddes goes to describe the secure attached pupil as a child who presents with high scores of ego-resilience and self-esteem, less dependency on the teacher with the past of time, but with a growing affect for him/her. The securely attached pupil can increase the intentionality in his/her interactions with others and s/he is generally more co-operative. This would seem consistent with the recent improvement in EEs expressive skills assessed by the SALT as well as his ability to allow a key adult to help him focus back on task after an incident that may have upset him. Conclusions and advice for further practice It would seem that EEs emotional distress needs to be further assessed within the work of a multi-disciplinary team in order to bring some light to his family situation. His anxiety could be rooted to home events that are yet to be clarified. From an educational point of view, staff needs to advocate for his emotional well-being and continue offering a nurturing approach to his current needs (Clements, 2005). The conclusion reached in this discussion regarding the possible implications of an identified attachment disorder for JE, along with the nature of his behaviours, imply that the educational priority for the immediate future is to provide JE with safety, reliability and predictability (Geddes, 2006). Visual cues, such as visual timetables, are already being used. Clear expectations and behavioural boundaries are common and consistent practice amongst the staff of the RB and, in few occasions, JE has shown some positive responses to the authority of one of the teachers. It appears necessary that these same boundaries are consistently used in the mainstream provision. In order to guarantee that, the teacher with whom he seems to be developing a positive relationship could be allocated as his key worker for a period of time. For children identified as having a disorganised/disoriented attachment pattern, Geddes (2006) also recommends the use of a physical container as a possible therape utic strategy. She advocates that this resource can be interpreted as a secure base. This approach needs to be further explored, but taking into account that JE is very fond of comic characters, providing him with a toy that he can place in and out of a box during the school day as required by his emotions could facilitate him with a tool with which to explore and regain interest in the world around him. JE shows interest in playing with his peers and it is often his lack of skills to initiate positive interactions at playtimes that causes him trouble. JE could benefit from adult support at playtimes to facilitate good role models and assertive approaches to conflict, social skills strategies recognised as useful in helping individuals to improve their self-concept and achieve optimal levels of self-esteem (Roffey, Tarrant and Majors, 1994). EE and JE have both been displaying abnormal behaviour patterns and despite very similar diagnoses of ASD, they have been exhibiting markedly different responses to what is assumed as external factors possibly stressed within the home. Through this examination of attachment and associated disorders, it has been hypothesized that the variation in the boys response could possibly be due to JE suffering from an attachment disorder in addition to his original diagnoses of ASD. For this supposition to be validated it is acknowledged that there is need for an extensive multidisciplinary investigation in the home dynamics and further analysis of JEs mental health. The value of investigating attachment and associated disorders when analysing possible causes of individuals SEBD is that it can inform staff to look further than the original ASD diagnoses. If the supposition of JE presenting with an attachment disorder of a disorganized/disorientated pattern is correct, working on developing JEs attachment to and trust of staff, as well as maintaining the specialised ASD provision within the RB, can only be of benefit to him. Unlike EE, JE is not responding to the strategies advised as best practice for children with ASD.

Actors and Actresses of the 50s: Vivien Leigh, Audrey Hepburn, Marlon B

In the 50s, several things happened to shock and awe the entertainment business; such as the invention of the teleprompter, TV’s first soap opera, â€Å"The Little Rascals† TV show, and the â€Å"I Love Lucy† TV show. But the most important thing about the entertainment in the 50s was the actors and actresses. Through out the 50s there were hundreds of actors and actresses. To name a few Vivien Leigh, Audrey Hepburn, Marlon Brando ,Grace Kelly, Bette Davis, Katharine Hepburn, Burt Lancaster, Bing Crosby, Dorothy Dandridge, Judy Garland, Elizabeth Taylor, and Doris Day. Each of these performers have received Oscars nods for their played roles. Audrey Hepburn was born on May 4, 1929 in Belgium. Hepburn was a cosmopolitan from birth as her father was an English banker and her mother a Dutch baroness. In the movies she appeared as a delicate adolescent, a look which remained until her last movie Always (1989) directed by Steven Spielberg. Her career as actress began in the English cinema and after having been selected for the Broadway musical "Gigi" she debuted in Hollywood in 1953. With Roman Holiday (1953) she won an oscar; her favorite genres were the comedies like Sabrina (1954) or Love in the Afternoon (1957). At the end of the sixties she retired from Hollywood but appeared from time on the set for a few films. From 1988 on she worked also for UNICEF. Born Marlon Brando, Jr. on April 3, 1924 in Omaha, Nebraska to a calcium carbonate salesman and his artistically inclined wife Dorothy, "Bud" Brando was one of three children. An enigmatic superstar widely regarded as America's greatest actor, Marlon Brando has been a Hollywood icon since the early 1950s. Brando was by all accounts "difficult" even as a youngster, having been expelled from sev eral schools, including a military academy. Upon being prodded by his father to find some direction for himself, he chose to follow his muse to New York. Brando made his debut on the boards of Broadway. Brando was invited by talent scouts to screen test for the studios they represented, but it came to naught as he refused to be bound by the then-standard seven-year contract. Brando made his screen debut in The Men (1950), studying for his part as an embittered paraplegic by lying in bed for a month at a veterans' hospital. The following year Brando reprised his characterization for the adapt... ...ied eight times. Taylor is considered one of the last, if not the last major star, to have come out of the old Hollywood studio system. And not just any studio, the top of the heap: MGM. Her early movies, as a child in the early 1940s, starred such Hollywood luminaries as Orson Welles and Spencer Tracy. She quickly grew up, however, and by 1950 was, if not starring in, assuming major responsibilities for the success of motion pictures she appeared in. Then with major roles onscreen, came worldwide attention off-screen, most notably due to a succession of famous and/or rich husbands and a series of health crises throughout her life. To put it simply, Elizabeth Taylor has lived a life far more exciting and dramatic than any movie she's ever appeared in and probably most any other movie you could name. She's known internationally for her beauty, especially for those violet eyes, with which she captured audiences early on in her youth and has kept the world hooked on ever since. She's won the Oscar twice and she's earned her place in and out of the sun. These actors and actresses are just a few of the many remembered and celebrated talents in the entertainment business of the 50s.

Hitting a Baseball

It has been a proven fact that hitting a baseball is one of the toughest things to accomplish in sports. In the major leagues if you fail 7 out of 10 times you are still considered to be an incredibly good hitter. That statistic shows how challenging it is even for Athletes at the professional level to produce a perfect swing. In order to achieve this perfect swing there is a series of adjustments that must be made. In this essay I will show how hitting a baseball develops through 3 different stages of learning. When someone is first starting off usually around the ages of 7 to 9 , they do not understand that the way a bat is held effects the outcome of the swing. In the beginning process many tend to place the bat in their palm and grip it extremely tight, without aligning their knuckles. They do not realize that holding the bat this way will reduce the range of motion in the swing, causing slower bat speed. Another key component to hitting a baseball is the hitter’s stance. In the beginning stage many crowd the plate, with their toes pretty much touching the corner of the tip of the plate. The legs are extremely bent and the toes are pointing in two different directions. The hands are then placed right next to the ear with both elbows facing up. The hitters back is usually arched at the top, with their shoulders kinds of pushing in to the neck. As the ball is pitched the hitter does not take a step towards the pitch, instead they keep their feet planted on their heels. When the ball is getting closer they begin their swing by dropping the back elbow and lifting the front one up. As the bat begins to cross the plate the head begins to turn away from the ball, because they are using no hip action. The bat is stopped in front of their body, creating no follow through. There may be little or no contact at this point. As a hitter progresses around the middle school stage, one thing they begin to change is the way they grip the bat. Now that they are a little more informed they begin to align the knuckles and place the bat on the fingers instead of on the palm. The hitter now has more flexion in the wrist along them to better their chances of hitting the ball. The stance of the batter is now gradually changing as well. The batter is now able to get in a position to where they can feel a little more comfortable. The knees are just are just slightly bent still allowing them to have some mobility. The toes are both facing in the same direction but are still planted on their heels. The elbows are now facing down instead of up, and the hands are up just above the shoulders and away from the ears. The back is no longer arched and the hitter is now at a stance where they are not as stiff as they once were. As the pitch comes the hitter now takes a step forward to generate some force, and prepare for his swing to begin. As the pitch is coming the hitter now keeps his eyes on the ball as it is coming in and extends hit arms out toward the baseball but slightly drops the barrel of the bat because of this, the hitter might have a tendency to pop the ball up instead of hitting a solid line drive. At this point the swing has now gotten better but still it has not generated bat speed to its full potential. Once the collegiate level is reached the batter now understands all the key fundamentals to hitting a baseball. With many years of practice and execution the hitter’s swing is now at its perfect state making it much easier to create contact and power. At this point the hitter no longer has any difficulty with the grip of the bat, or stance. Their feet are at shoulder width length allowing them to be at their most powerful position. The hitter is on the balls of his or her feet and is no longer on the heels. As the pitch is coming the hitter shifts his weight from the front leg to the back leg. The hitter is creating negative force by taking a step back, then going forward once again. At this point, weight should be about 70 percent on the back leg, 30 percent on the front leg. This allows the hitter to stay on the back leg to generate the most amount of power possible as they are swinging. While this is happening the hitter must also shift his hand back to generate more power in the upper body as well. The next step is the key essential where many beginners go wrong when trying to hit a baseball. Many believe that the hands trigger the swing, but this is untrue. It is the explosion of the hip that creates the swing. The hips start to open and allow the hands to explode through the hitting zone at a much higher rate of speed than if the hands triggered first and were still inhibited by the body. This has been proven by some of the most respected hitting authorities in the world by using high speed motion detection software to analyze a hitter's swing. Once the hips have started to open, the hands shoot through the zone. The hitter drives the nob of the bat to the ball, and keeps the bat through the zone as long as possible. This makes it easier to hit the pitch no matter where it is thrown. Once the bat has made contact the hips naturally finish their rotation as the hands leave the hitting zone and follow through. The weight shifts forward into contact, and all of the steps come together into a fluid, quick swing. Now the batter can produce hard linedrives or homeruns instead of soft grounders or pop ups.

7 Reasons You Didnt Get the Job

7 Reasons You Didnt Get the Job If you’re  searching for a new job, you want to be  sure you don’t  make any obvious mistakes that might keep you  from finding work- especially after spending a lot of time on job search sites. Although most people know it is a bad idea to cancel at the last moment or wear a running suit to an interview, smaller mistakes can also keep you from being considered. 1. You didn’t  proofread your resumeWith just one glance, a resume can tell a recruiter a lot about a job applicant. A resume that’s messy and contains bad grammar or typos is not likely to be taken seriously. You can fix problems with your resume by using an online grammar checker and rereading it carefully to look for mistakes. If you have a friend who is a whiz  at grammar and punctuation, ask him or her to look it over for you. Whatever it takes, make your resume as perfect as you can.2. Your resume is unfocusedDid you  write your  resume a year ago and are now just recycling it to apply for jobs? The days of using a general resume are over. Because hiring managers are busy people, they want to interview the best candidates for the job and not waste time on applicants whose qualifications aren’t a good fit. Rewriting your resume to include your qualifications that fit perfectly with the job description can get you that interview.3. You didn’t write a cover letterHiring managers go to the cover letter first before looking at an applicant’s resume. Even when applying for a position by sending your resume via email, you really need to include a cover letter. Many hiring managers won’t consider an application without one. Remember to include the reason you want the job in your cover letter, and don’t make it a mini copy of your resume.4. You went into the interview coldLet’s say you’ve been invited for a job interview. You’re feeling pretty confident at this point. But, overconfidence and lack of preparat ion has cost countless people a job offer. Do your homework. Job interviews normally consist of knowing about the company where you are applying, asking questions that are relevant, telling the recruiter why you are qualified and how you can be an asset in the job, and doing a follow up afterward.5. You cast  your net too wideOne mistake some job seekers make is not focusing on the type of job itself. Think about opportunities, not one particular job, and you can find yourself employed faster. Maybe you have your heart set on a job with the Widget Company, but you would have to start at the bottom and work your way up because there are no openings for someone with your qualifications. Focus clearly on the position you want to fill, and expend your efforts in that direction.6. You weren’t on timeTime matters when it comes to hiring managers. Showing up late for an interview reflects badly, as does showing up too early because it can make you appear anxious and make the inter viewer feel pressured. Do leave early to get to your interview about 10 minutes before it is scheduled, but find a spot to relax if you arrive before that.7. You got too personalMaking a personal connection with a hiring manager can be a good idea, such as sharing an interest in a ball team or certain things about the city. However, going overboard and supplying too many details about your personal life takes up the hiring manager’s time and may not reflect well on you. Rambling on, whether in a resume or during an interview, can leave a bad impression. If you do relate personal information, keep it in context with the job.After spending time searching classified job ads and sending in a resume, common mistakes made by a job applicant can cost that person a job. Just as knowing how to be a successful job applicant and sail through an interview is valuable information, knowing how to conduct a job search in a practical way is also. Instead of looking at countless job ads in di fferent locations, TheJobSearch does the work for you by sending you email alerts when jobs fitting your qualifications become available. Fill out your job interests and qualifications, sign up with TheJobNetwork, and that is all it takes.

Liberalism essays

Liberalism essays how does the American concept of classical liberalism differ from the concept of liberalism that evolved in Europe after the french revolution? before answering the question i will, in my own words, give the defention of liberalism. When first hearing the term liberalism i imediatly think of freedom. if i were to give a one word deffinition fo liberalism it would most likely be freedom. i think that freedom sums up liberalism pretty good, in a one word way. threw this paper i will further get into depth of liberalsim, classical liberalism, and the differences between the such. so now that there is a basic undertanding of the term liberalism, im going to go into the deffenition of classical liberalism. classical liberalism asserts the natural rights of an individual, with carful attention to the rights of minorieties. The right of property is highly covered along with the controling governments obligation to protect that property. the right of an individuals to advance in the social atmosphears, and also in the economical world. some of the ideas of classical liberalism have been around for centuries, but it wasnt untill the late 17th century that john locke was able to bring these ideas together an present them to the masses. "john locke serves as the founding father of classical liberalism by tying these principles together in a difinitive matter, providing a thorough foundation upon which later minds could build. he, in short offered these around which the classical liberal dialogue revolves" (www.belmont.edu/lockesmith/essay.html) that right there is my deffenition of classical liberalsim, based on the knowledge i obtained through out a few short readings. in this paper i will better explain the deffenition with cited sources and comparisons to the ideas of american classical liberalism. ...

Discuss The Meaning And Significance Of The Paraclete Religion Essay Essay Example

Discuss The Meaning And Significance Of The Paraclete Religion Essay Essay Example Discuss The Meaning And Significance Of The Paraclete Religion Essay Essay Discuss The Meaning And Significance Of The Paraclete Religion Essay Essay In replying this inquiry I need to discourse the significance and significance of the Paraclete expressions in John 14-15. The first thing, I need to make is to look at the contents of the word as it is utilizing by Jesus in mention to the Holy Spirit. In John 14:16 the Paraclete is promised as the 1 who is to obtain the place of Jesus. Jesus affirmed it ( John 16: 7 ) that it is to your advantage that I go off, for if I do nt travel off, the soothing Counselor will non come to you ( John 16:7 ) . Gill writes Is the Paraclete, so, the replacement or the replacement for Christ as He is sometimes called? The reply is that He is both. He is the replacement of Christ historically, but non in the sense that Christ ceases to move in the church. He is the replacement for Christ s physical presence, but merely in order that He may do critical and existent Christ s religious presence.[ 1 ] In John 14:18, we have seen the pledge that Jesus gave I will come to you : this has a similar overtone as the old pledge of the Paraclete. Sympathizer i? ¶ To learn them all things Harmonizing to Jamieson in his authorship says The word translated Comforter is used in the New Testament five times. In four cases it is applied to the Holy Spirit John 14:16 ; 26 ; 15:26 ; 16:7. In the other case it is applied to the Lord Jesus in 1 John 2:1: We have an advocator ( Paraclete-Comforter ) with the Father, Jesus Christ the righteous. [ 2 ] In John 14: 25, 26. Jesus says the Father will direct the Paraclete as his representative and he will learn them everything and will remind them of everything he himself have told them. And as the Son came in the Father s name, consequently, the Father will direct the Holy Spirit in Jesus name, with great power and ability to reproduce in the trusters souls what Christ taught them, ( John 14:17 ) . In the Gospel these are some of the looks that are applied to the Paraclete that is important to His Godhead personality, teaching14:26, reminding 16:4, testifying 15:26, coming 14:18, convincing 16:8, abiding 15:4, speaking 14:10, guiding 16:13a, prophesying 16:13b, and praying 14:16 He shall learn the trusters all things, and he besides shall take them into all truth ( John 16:13 ) . Jamieson says Here it might be really appropriately inquired ; whether any of all time, besides the apostles themselves, were taught all things, or led into all truth. [ 3 ]It is the duty of every truster to be led into all truth that is necessary for their ain contentment merely as it was the duty of the apostles to be led into all truth necessary non merely for them but besides for the whole church. His intent is to soothe the adherents, to be with them in Jesus absence and to give them his peace, and this is justly expressed by the word, Comforter. His aim is to learn them, and remind them of fact and this expressed by the word proctor or instructor, ( John 14:26 ; 15:26, 27 ) i? ¶ He shall laud me Furthermore, the Spirit of God glorifies Christ in the life of the trusters through righteousness, peace, and forgiveness, for grace, and for day-to-day supplies of it, for penetration and power for commissariats and remainder, for being and pleasance and by leting them to be by religion on Jesus. He has encouraged them to perpetrate their all to him and to laud him, for he is their wisdom, virtue consecration and rescue and by giving him glorification for redemption in Christ of the Holy Spirit, and by doing changeless petition to him for his way and by tilting on him, and anticipating every good thing from him every bit for clip and sempiternity ( John 16:14 ) . For he shall have of mine, and shall demo it unto you Gill writes which is to be understood non of gifts Christ received from his Father, and which he gives to work forces by his Spirit ; nor of internal grace, as religion, love which the Spirit from Christ plants in the Black Marias of work forces ; but either of the philosophies of the Gospel, the deep things of God and Christ, which the Spirit hunts, and reveals in the relief of the word. The Gospel is a kind of a Kabala , though of a different sort from the unwritten jurisprudence of the Jews. Christ received it from the Father, the Spirit received it from Christ, and the apostles received it from the Spirit and the churches of Jesus from them in wining coevalss. [ 4 ] i? ¶ To brood in trusters That he may stay with you forever, here he did nt state he will be with them merely for a few old ages, Jesus told the apostles that he will be with them everlastingly, he will be with them while they are a unrecorded, besides he will be with everyone that shall win them in the work of the ministry, and every true truster unto the terminal of the universe. ( John 14: 16, 17 ) . Make our residence Johnson in his composing reference on The conditions on which Christ will be present in each psyche, seen, and enjoyed, are here given: ( 1 ) One must love Christ ; ( 2 ) so love him that he will obey from the bosom his commandments ; ( 3 ) this loving, obedient psyche will be loved of the Father ; ( 4 ) Jesus will love him ; ( 5 ) both the Father and the Son will attest themselves to him ; ( 6 ) this manifestation is by their approaching and staying in him through the Helper. [ 5 ] Ye are the temple of God ; ( 1 Corinthians 3:16 ) , Your organic structure is the temple of the Holy Ghost ; ( 2 Corinthians 6:16a ) Ye are the temple of the life God. ( 2 Corinthians 6:16b ) This does non intend that there is any personal brotherhood between Christians and God that there is any curious indwelling of the kernel of God in us. However this gave the trusters hope to joy in the presence of God. For God is fundamentally present everyplace, Advocate and Intercessor i? ¶ Paraclete is applied to Christ In 1 John 2: 1, 2, NLT, reads: But if you do sin, there is person to plead for you before the Father. He is Jesus Christ, the 1 who pleases God wholly. He takes off non merely our wickednesss but the wickednesss of the full universe. At this point the significance is comparatively obvious and precise that Jesus Christ, the blameless, is typifying as the trusters Advocate and Intercessor with God the Father. His righteousness is set over against our wickedness. Here the Paraclete, Christ, is He who, because of His propitiatory offering for the wickednesss of work forces, intercedes for them with God and therefore averts from them penal effects of their evildoings. The sense in which Paraclete is here applied to Christ is found nowhere in the transitions we have cited from the Gospel. The Holy Spirits as Paraclete is Intercessor or Advocate, but non in the sense here showed. The Spirit as Paraclete convicts the universe of wickedness, of righteousness and judgement. Jesus Christ as Paraclete vindicates trusters before God. [ 6 ] And I will inquire the Father and he will give you, 14:16a We know doubtless in Romans 8:34 ; Hebrews 4:14 ; 15 ; 7:25 that he makes intercession in Eden for the trusters, and we besides know that as a consequence of his intercession in Eden for us, that we get all our approvals, and it is because of him that our supplications are offered and are effectual before God. Another soothing Counselor likes me, the Spirit of Truth, to be with you forever, 14: 16b Jesus had been to his adherents a counsellor, a leader, a brother, and a manager while he was them, he had harmonizing to McGarvey Borne with their biass and ignorance, and had administered solace to them in the times of despondence. But he was about to go forth them now to travel entirely into an unfriendly universe. The other Comforter was to be given as a compensation for his absence, or to execute the offices toward them which he would hold done if he had remained personally with them. [ 7 ] To the apostles it was chiefly to animate them with the cognition of truth of the Father. As good, he came to convert work forces of wickedness. It was appropriate for such a representative to be sent into the universe ( John 16:14 John 14:26 ; 15:26 John 16:8-11 ) . Jesus told his adherents that their earthly family with him was about to stop, but he will be with you forever. Therefore the Holy Spirit would come, with whom families would non disrupt. Helper and Teacher i? ¶ To demo them the things of Jesus And I will pray the Father, and he shall give you another Comforter. The word Comforter does non to the full interpret the Grecian word Paraklete no English word does. The word Advocate may be used, and Helper is every bit good if non better than Comforter. We should detect that by the word another Jesus show that he himself had been and would be a Paraklete . [ 8 ] However, when the Spirit of Truth comes, that is the Holy Spirit, he will steer you into all the truth ; for he will non talk on his ain enterprise but will state merely what he hears from the Father and the Son. He will besides denote to you the events of the hereafter ( John 16:13 CJB ) . That says to us the Holy Spirit was neer to convey, perfectly, any new direction since he was non talking for himself. Here the Son of God alleges for himself all that the Holy Spirit taught even to the statement of things to come. He will convey me glory by uncovering to you whatever he receives from me ( 16:14 ) Therefore, the Spirit would transport to the apostles mind all the words which Jesus had spoken, although, at the nowadays he said, Oh, there is so much more I want to state you, but you ca nt bear it now ( 16:12 ) . i? ¶ To bear informant to Christ When the Counselor comes, whom I will direct you from the Father the Spirit of Truth, who keeps traveling out from the Father he will attest on my behalf. ( 15: 26 ) And you testify excessively, because you have been with me from the beginning ( 15:27 ) Believers should be cognizant that our finally aim in this universe is to be a informant for our King of male monarchs. To be an effectual informant, we need the aid of the Paraklete without him our informant will be uneffective. God s program is for adult male to work in partnership him. Everything the Holy Spirit does is consistent with the testimony of the nature of Jesus. His occupation is to state us, and to demo us, who Jesus is. If religious phenomenon occurs that are non consistent with the nature of Jesus, it is nt the Holy Spirit making it. He is the One who wills testify of Jesus in all that He does. [ 9 ] He shall attest of me From the beginning of Jesus ministry, there were a group of work forces selected and chosen by God for this map, to bear informant of the Son of God, of his deity, boy ship, embodiment, and of him being the Messiah,[ 10 ] of his agonies and decease, Resurrection, Ascension, ecstasy at the right manus of God, and of his ordination to be the Judge of the speedy and dead. All of which they can attest to, and by the gifts he imparted on them, and his grace that was on them all, by the marks, admirations, and diverse phenomenon, and by their influence authorization and accomplishment with the sermon of the Good News everyplace. ( John 15:27 ) . i? ¶ To inmate of wickedness, of righteousness and judgement But it is really best for you that I go off, because I do nt, the Counselor wo nt come. If I do travel off, he will come because I will direct him to you ( 16:7 ) . Why the Spirit could non come until the Lord had departed, is found in the poetries which follow, they provide us with an first-class and equal footing, for in these poetries they demonstrated that the Paraclete s occupation had to make with the strong belief of adult male s bosom through the sermon of a completed Gospel, of Christ s return to heaven, in his glorification seated at the right manus of his Father, these form a critical portion of the completed Gospel. And when he comes, he will convert the universe of its wickedness, and of God s righteousness, and of the coming judgement ( 16:8 ) . And he, when he is come, will convict the universe ( 16:8 ) It is the working of the Holy Spirit to take the truths associating to Christ, and, so utilizing the apostles as mouthpieces ( Acts 2:1-37 ) . To convert the universe as to these truths In regard of wickedness, and of righteousness, and of judgement, this convincing work was wholly comparative to Christ, the wickedness of discrediting him, the righteousness revealed in him, and the power of judgement conferred on him. [ 11 ] Of wickedness, because they believe non on me ( 16:9 ) . The Spirit convinces the universe that does non believe in Christ, for those that belief in him receives forgiveness, and to those who do non believe there is no forgiveness. The universe is converting that all have sinned and fall short of God s glorification ( Romans 3:23 ) , and it is the Spirit that convicts the disbeliever of wickedness which comes from unbelief. Therefore in order to pulverize sinin the bosom of adult male, it must be penetrated with the Holy Spirit. Of righteousness, because I go to my Father, and ye lay eyes on me no more ( 16:10 ) . Without uncertainty, Christianity teaches that righteousness is a demand to grok the presence of God. Without being righteous we can neer see him, nor can we of all time expect standing before him. Because Jesus returned to the Father, and is staying with the Father, hence, the Holy Spirit convinces the people of the universe that those who are trusters in Christ, and holding his righteousness, shall besides accomplish the presence of the Father. ( Philippians 3:3-14 ) . Of judgement, because the prince of this universe hath been judged ( 16:11 ) . Finally, the Spirit convinces the people of the universe that Jesus is commissioned as its adjudicator. Because of the Resurrection of our Lord which offers to us the warrant of this fact ( Acts 17:31 ) . The Resurrection of Jesus gave us such a warrant as it is proofing of the judgement and denouncement of that old snake , Satan, the main leader in evil turbulence against God, Jamieson writes and he that hath power to judge the caput thereby shows he had, power to judge the organic structure. Satan held the power of decease over humanity, but Jesus judged him and brought him to naught by taking off this power ( Hebrews 2:14,15 ) . The cross of Christ as the beginning of life asserted his high quality over all other powers ( Colossians 2:14,15 ) , which implies an ability to judge them. [ 12 ] Decision The Paraclete is promised as the 1 who is to obtain the place of Jesus. Jesus affirmed that it is to your advantage that I go off, and he will direct us the Comforter, and he will: To learn us all things To brood in the trusters To inmate of wickedness, of righteousness and judgement Helper and Teacher, to demo them the things of Jesus To bear informant to Christ, and He will attest of Him To remind the trusters To steer the trusters He may stay with the trusters for of all time

Breaker Failure Detection Algorithms Research Paper

Breaker Failure Detection Algorithms - Research Paper Example The second part addresses issues worth consideration when applying Breaker Failure Protection and lastly, advances towards breaker Failure Protection. Using algorithms significantly enhance the numerical BF protection. Introduction Contingency analysis remains to be one of the great tasks that face protection engineers. The reason to this is due to the fact that a Protection Engineer has to focus on Murphy’s Law and Ohms Law concurrently. The design for PRS plays a key role in detecting any fault that happens on the power system and the possibilities of eruption of any fault in the protection system of the power system. When the protective relay system is order, the designers of the power system understand it but the condition changes when a failure is detected. Deriving solutions towards this failure is what makes a protection engineer proficient. The protection engineer can only succeed by understanding how operations of the system. The best approach that the engineer can ha ve is to have a proper understanding of each component of the system as well as their interaction and overlaps needed. The need for Breaker Failure Protection To successfully analyze this topic, the differences between fault detection devices and fault interruption devices should be understood. Any disturbances like faults are detected by protective relays. The protective relays works in either way, interfere with the fault current system or cuts off any connection to the power system. Systems that lack breaker failure detection fail to analyze detection and interruption failures. This is not the case for breaker failure detection. The redundant relay systems play the role of detecting fault in case of failure (IEEE 8). What to consider for Breaker Failure Protection Before considerations necessary for breaker failure detection, aspects of back up protection need to be focused. The aspects include speed, sensitivity and user friendliness together with maintenance required. Sensitivi ty The question considered under this aspect is on the reliability of remote relays in detecting faults in the power system. A difficulty arises when analyzing the conditions that lead to system failure. The hindering factor is the load encroachment. The radial system has limitations in the fault current and the circuit load. The source acts as a controlling factor thereby making this system simple. Complications arise for networked systems. The possibilities of the relays detecting failure past the remote bus is limited because of the in feed. To solve this issue, a remote backup through distance relays with applications in the adjacent zones seems appropriate. This leads to change in the reach setting of the in feed to long ones. Complexities arise when the zone three relays are relied on as a backup protection. When breaker failure protection and a normal back up are applied, the problem is solved (Daume, Jon 20). Speed Speed of the system in clearing faults that arise due to fai lure of the primary protection is vital. Over tripping of the system is prevented by the time taken by the relays in overlapping zones. The outcome to this process is for a remote back up to be set up after a reasonable delay. When breaker failure protection is used, tripping of back up circuit breakers is quickened. The set up speed of the system is guided by damage that is likely to be incurred on equipment, quality of power and its impact on its environs and stability. Incase

Research assignment Paper Example | Topics and Well Written Essays - 1250 words

Assignment - Research Paper Example Apart from being some of the most favorable career choices in New York and the US at large, these career options suit skills that I have accrued over time, and also require the personal traits and character strengths that I possess which include spirituality, love, gratitude, kindness, and humor. From this research, I aim at collecting sufficient information both from secondary sources and interviews that would guide me in making a wise and directed career choice. The structure of the research paper will involve three segments: a total of eight Q&A on each of the two occupations, with two questions extracted from each of the four parts of information in the Career Database, and a conclusion. Occupation One: Registered nurse Q.1: What kind of work is done in this field (types of tasks, responsibilities, assignments, projects, etc.)? A: The work of a registered nurse entails a lot of tasks and responsibilities that draw their descriptions from the many environments that registered nurs es work: nursing care facilities, hospitals, correctional facilities, schools, military, doctor’s offices, and different types of camps. ... The work of registered nurses is not only limited to these, but Kate, a registered nurse in an Albany hospital, emphasizes on a lot of sacrifice of nurses in being able to step out of their working description and do many other tasks whenever it is needed, especially in a critical situation involving life. Q.2: How flexible are the hours? Does the work involve long hours, shift work, overtime, or working on weekends? A.: Most working environments for registered nurses have duty rosters that allocate each employee fair working hours. These rosters are usually supplied beforehand, ensuring each registered nurse has flexibility in planning other personal activities. The average working hours for nurses is approximately 10 hours. The work involves shifts that provide alternations by various workers. However, in cases of emergencies like catastrophes, there is an expectation and obligation of nurses to sacrifice and work overtime, even with an exception of compensation, for the sake of hu manity. Q.3: What education is required for someone who is entering this field (associate’s, bachelors, master’s, or other advanced degrees)? A: At entry level, an Associate’s degree is the requirement for someone with an interest in pursuing a career as a registered nurse. However, a Bachelor’s degree would be a better bet as research has shown that most people in this career have attained this level of education (Labor Statistics). Q.4: What kinds of people tend to do well in this field? What skills and qualities are important (e.g., attention to detail, ability to work under pressure, or ability to negotiate)? A. Being a registered nurse requires a number of skillsets and qualities that only a few have in a combinative form. These include patience, altruism,

Analysing case Essay Example | Topics and Well Written Essays - 250 words

Analysing case - Essay Example However, there are individual and organizational level factors that if taken into account would increase the likelihood for an employee to change in response to feedback. Individual precursors (IPs) There are five individual-level precursors that, when present, increase the likelihood that an employee will change in response to feedback. The five IPs are: 1) Awareness; 2) Sense of Necessity; 3) Confronting Change; 4) Willingness for feedback; and 5) Development Orientation. The central IP is awareness. Awareness is what makes an individual acknowledge that a problem exists and that it calls for change. Sense of necessity is the recognition that a change in behavior is important and that it has to be followed through. Confronting change is an extension to awareness but with a greater understanding of the steps needed to change. Willingness for feedback indicates emotional readiness for feedback and openness to frank opinions from others. Development orientation involves believing in s eeking development through trying new things and seeking learning opportunities (Silverman, Pogson, and Cober 141). Works cited Silverman, Stanley B, Corrie E Pogson, and Alana B Cober.

Contract Law Essay Example | Topics and Well Written Essays - 2000 words - 2

Contract Law - Essay Example The industrial revolution was characterized by the rise of many businesses and enterprises to offer employment opportunities and consequently boost peoples’ living standards. With such an active population, it was expected that some people could make use of others’ resources and time by carrying out fraud business practices. This led to the formation of laws that sought to govern both the workers and the employers and protect them from any uncouth business practices that either could carry on the other. The law not only served the employees and employers but also observed that the business practices carried out by different business entities were legal . There are other scholars that claim that contract law came to rise as a sub-branch of civil law. History of contract law with relation to civil law is rather precise. This is from the fact that contract law is widespread from the fact that different contracts have different rules depending with the type of business acti vities to be carried out by the parties. This thus does not require a particular set law to govern it and makes it rather flexible and diverse. This is related to civil law in that civil law has core principles summed up and put into a referable structure and rules are made depending on the most appropriate system. This inspired present day contract law and thus the various developments witnessed .The Lex mercatoria is also said to have been a powerful force in the formation of contract law. The Lex mercatoria acted as a system through which merchants.... This is from the fact that contract law is widespread from the fact that different contracts have different rules depending with the type of business activities to be carried out by the parties. This thus does not require a particular set law to govern it and makes it rather flexible and diverse. This is related to civil law in that civil law has core principles summed up and put into a referable structure and rules are made depending on the most appropriate system. This inspired present day contract law and thus the various developments witnessed3. The Lex mercatoria is also said to have been a powerful force in the formation of contract law. The Lex mercatoria acted as a system through which merchants and other business people used in Europe in the medieval era to ensure that there was the upholding of healthy business practices4. As it evolved, it gained principles that leaned more towards the common law setting. This is when a set of business people and law makers convened and so ught to create a system that would support merchants of all types regardless of the types of business they carried out unlike the common law that had a particular set system. This led to the formation and rise of contract law. Shifting focus to Classical Law, it is important to understand that it is one of the oldest forms of law in existence. Classical law has its roots in Rome and thus has the synonym Roman law. The form of law receives credit as one of the oldest law systems from the fact that it comprises laws that were written in Stone tablets. Roman law has ensured that these laws are observed by the subjects it governs and amendments are rarely done on it. Classical law can relate to contract law in that the

Honesty Research Paper Example | Topics and Well Written Essays - 1250 words

Honesty - Research Paper Example In developing the concept of honesty, one finds that by going from the initial definition of the word honest to the cultural differences expressed in one different language, the true concept, of honesty requires the existence of human relations. The purpose of this paper is to prove the thesis that Honesty in the dictionary sense is not the best policy. The online dictionary definition of honesty implies "fairness and straightforwardness of conduct". The second definition is keeping to the facts: sincere. (Merriam-Webster) Fairness and sincerity are a contradiction. If an older child beat up his brother because his brother broke one of his games, the parent would admonish the violent reaction of the older brother over the younger brother's breaking the toy. Our society does not adhere to violence. The broken toy could have been an accident or a deliberate act. If his parents were sincere, they would ascertain as to why he broke the toy. If both boys were at fault, fairness would dictate that both would be punished. It is rarely the case as the punishment is different for each child and culturally given to the older of the twoIn reality, honesty is governed by a set of rules which go beyond our comprehension of the word. Most of us think that honesty exist. It exist if the rules are followed. In the second source, Mr Dougherty analys es Cringe comedians. He entitles his article Honesty is the best policy. (Dougherty ) People no longer want to spend time thinking through the significance of thought provoking jokes. We are in the "now" society. If it is not attained within 30 seconds, it is not worth it. Cringe comedians come up with one line jokes attacking the truths of life. They twitter their way thru the commentary of life's problems. Life can be split into two twits: alleviating the fears of life by throwing freezing water to chill the problem. A comedian who basis all his one line cringes on self deprecation makes at least one person in the audience feel that there is one person who is better off than the comedian . or the comedian has mastered the art of persona and gives members of the audience what they want to hear as each one has a different concept of honesty. The first comedian uses self deprecation to alleviate fear and the second comedian uses self deprecation to share honest aspects of the "person a". There are people in the audience who can relate to both sorts of tweets. The word tweet is used in a derogatory fashion to show the rapidity in which cringe comedians respond to humor. The concept of honesty is used as the dictionary describes as "straightforwardness" . This limits the point that there is a set of rules to the concept of honesty. As the previous source is somewhat weak, the following source is from a journal. The concept of honesty can be broken down into mathematical equations. A fundamental principal of man is that all human relations are based on the concept of honesty. As this is a rather grandiose principal, the writer has broken it down into equations. The concept of Honesty:

Human Resources Administration Assignment Example | Topics and Well Written Essays - 500 words

Human Resources Administration - Assignment Example The team is also responsible for addressing to the employee grievances, suggestions and administrative challenges. In order for the department to minimize employee strikes and demonstrations, the department needs to open proper channels of communication between the management and employees. The law requires that all employees are entitled to benefits to benefits which include health insurance covers, leave and reasonable salaries. Health insurance covers are particularly important in any job because the employees are exposed to risks. Food servers, for example, may get burnt while carrying the food to the customers incase of spillages. The food Servers deal with different kinds of customers, some may have ill motives causing disturbances in the restaurant resulting to injuries among the employees. Fire outbreaks are common in many restaurants, which normally cause significant loss and damage in terms of property and to the staff. Health covers help the employees gain easy access to medical attention as well as save money. Employers must ensure that they pay their employees well failure to which they face the law. If the employees are not appreciated well through attractive salary package, they will not have the motivation and morale to undertake their duties well. Food servers most of whom leave away from the working station should receive commuter allowance so that they can be at work on time; the organization might not perform well if its employees never report at work on time. The government labor laws require that every employee whether working in government institutions or private companies be awarded leave days. Human resources department should develop a structure which all its staff get off days without interfering with the normal functioning of the organization.

Contract Law Essay Example | Topics and Well Written Essays - 2000 words - 2

Contract Law - Essay Example The industrial revolution was characterized by the rise of many businesses and enterprises to offer employment opportunities and consequently boost peoples’ living standards. With such an active population, it was expected that some people could make use of others’ resources and time by carrying out fraud business practices. This led to the formation of laws that sought to govern both the workers and the employers and protect them from any uncouth business practices that either could carry on the other. The law not only served the employees and employers but also observed that the business practices carried out by different business entities were legal . There are other scholars that claim that contract law came to rise as a sub-branch of civil law. History of contract law with relation to civil law is rather precise. This is from the fact that contract law is widespread from the fact that different contracts have different rules depending with the type of business acti vities to be carried out by the parties. This thus does not require a particular set law to govern it and makes it rather flexible and diverse. This is related to civil law in that civil law has core principles summed up and put into a referable structure and rules are made depending on the most appropriate system. This inspired present day contract law and thus the various developments witnessed .The Lex mercatoria is also said to have been a powerful force in the formation of contract law. The Lex mercatoria acted as a system through which merchants.... This is from the fact that contract law is widespread from the fact that different contracts have different rules depending with the type of business activities to be carried out by the parties. This thus does not require a particular set law to govern it and makes it rather flexible and diverse. This is related to civil law in that civil law has core principles summed up and put into a referable structure and rules are made depending on the most appropriate system. This inspired present day contract law and thus the various developments witnessed3. The Lex mercatoria is also said to have been a powerful force in the formation of contract law. The Lex mercatoria acted as a system through which merchants and other business people used in Europe in the medieval era to ensure that there was the upholding of healthy business practices4. As it evolved, it gained principles that leaned more towards the common law setting. This is when a set of business people and law makers convened and so ught to create a system that would support merchants of all types regardless of the types of business they carried out unlike the common law that had a particular set system. This led to the formation and rise of contract law. Shifting focus to Classical Law, it is important to understand that it is one of the oldest forms of law in existence. Classical law has its roots in Rome and thus has the synonym Roman law. The form of law receives credit as one of the oldest law systems from the fact that it comprises laws that were written in Stone tablets. Roman law has ensured that these laws are observed by the subjects it governs and amendments are rarely done on it. Classical law can relate to contract law in that the

Human Resources Administration Assignment Example | Topics and Well Written Essays - 500 words

Human Resources Administration - Assignment Example The team is also responsible for addressing to the employee grievances, suggestions and administrative challenges. In order for the department to minimize employee strikes and demonstrations, the department needs to open proper channels of communication between the management and employees. The law requires that all employees are entitled to benefits to benefits which include health insurance covers, leave and reasonable salaries. Health insurance covers are particularly important in any job because the employees are exposed to risks. Food servers, for example, may get burnt while carrying the food to the customers incase of spillages. The food Servers deal with different kinds of customers, some may have ill motives causing disturbances in the restaurant resulting to injuries among the employees. Fire outbreaks are common in many restaurants, which normally cause significant loss and damage in terms of property and to the staff. Health covers help the employees gain easy access to medical attention as well as save money. Employers must ensure that they pay their employees well failure to which they face the law. If the employees are not appreciated well through attractive salary package, they will not have the motivation and morale to undertake their duties well. Food servers most of whom leave away from the working station should receive commuter allowance so that they can be at work on time; the organization might not perform well if its employees never report at work on time. The government labor laws require that every employee whether working in government institutions or private companies be awarded leave days. Human resources department should develop a structure which all its staff get off days without interfering with the normal functioning of the organization.

About My Childhood Essay Example for Free

About My Childhood Essay My name is Rouda Mohammed Al-Suaidi. I started kindergarten at the age of 4 in one of the finest schools in Abu Dhabi, which is Al-Worood Private School. I felt so scared on my first day of school and I didn’t go to school alone. My mother used to stay with me in class which made some of my classmates laugh at me. I remember they used to call me â€Å"A baby† and â€Å"Mommy’s little girl†. I used to cry a lot when they call me this. I spent my whole childhood there from kindergarten until High School. Throughout my childhood, I faced several successes and challenges. One of my successes in my childhood is being a famous basketball player in school. It first started at home, where I used to have a small basketball hall to practice and play with my family and friends especially in the weekends. At first, I didn’t have any idea on how to play this sport, but with the help of my precious father and uncle, they taught me all the ways and techniques to be an excellent basketball player. After being taught by my father and uncle, I started implementing the techniques and ways in mini basketball competitions, which were just amongst the students from grade 6-12. Although I was a fat, chubby young basketball player in school, my P.E teacher wanted me to compete with other international schools in Dubai and Sharjah. In the beginning, I was anxious and worried to compete with the schools in Dubai and Sharjah. Moreover, I was terrified because I had an image in my mind that the students their will make fun of me and laugh because I was fat. See more: Social process essay My P.E teacher motivated me and started training me after school time. After a lot of training and support from both my P.E teacher and family, I competed with the other schools and our school was ranked the 2nd best school in playing basketball. I was so happy about it but I wished to be ranked the first, but it never de-motivated me in practicing more and more. My father always told me: â€Å"be optimistic and never be pessimistic† and since then, I’ve been following my father’s quote until my recent life. Another success in my life was helping my cousin in raising two of her only children, a boy (Ali) and a girl (Sarah). At that time, Ali was just 18 months and Sarah was only 3 months. Ali and Sarah were everything to me. They were staying with me most of the time from the afternoon after I directly come back home from school till the evening around 10. However, in the weekends, they used to sleepover in our house. When I come back home, I used to eat lunch quickly and finish my school work quickly just to spend time with them. After I finished all my studies, I used to play with them, feed them lunch and dinner, bathe them at night before they leave in the weekdays and create a time for their naps during the day. The reason behind me helping my cousin in doing the mother duties is because my cousin was going through a process of having a divorce. After the divorce, my cousin went through depression and when I saw her like that, I offered to help her in her duties towards her children. So, she showed me how to do several things like: changing their diapers, play gently with them and taking turns while playing, share toys with each other, how to make them sleep, feed them and many other things. Although it is a very hard job raising a child, it didn’t prevent me from learning to be a successful mother in the future when I have my own children. Also, it didn’t stop my studies in sch ool. Moreover, it made me more focused in class and become a better student. Being a make-up artist is my third success through my childhood. In order to reach that success, I had to watch a lot of people putting make-up, ask them to teach me the techniques on how to put make-up and arrange the colors of the make-up when drawing the eyes, understanding and knowing the differences of all skin types for the make-up. Also, I used to watch people putting make up through T.V programs, watch the whole program and write down my questions on a piece of paper and send them an email in order to ask my questions and wait for their reply. Being a make-up artist was my childhood dream and after learning the basics and imitating it on the people, I became more confident and would want to expand my dream into opening my new make-up beauty center in the short term time. Although there were some successes in my childhood, I also faced many challenges. One of my greatest challenges was feeling embarrassed and lonely. During my childhood, I was always embarrassed of myself because I was very fat. The students in school used to make fun of me and call me different names: like â€Å"you look like pumba†, â€Å"you look like an old cow†, and many other names. I used to cry a lot to my mother when I go back home. Because I stood quiet and listen to students for years making fun of me, I turned to be a lonely person in my childhood. I used to be alone in the music lessons, art lessons and in the break times. I used to like walking alone, not playing with other children like all other normal children do. The reason behind this was my worry of the children making more fun of me because I was fat. This issue affected me a lot as a child but as I grew up, I started to be more sociable with the people. Another challenge is to know and understand the quality of time. As a child, I always wanted to play and have fun. I never organized my time and never valued the quality of time. I always wanted to lose time when I was assigned for any job for my mother or finish my school work very quickly and not caring about my work at all. All I wanted is time for playing only. As I grew older, I had many commitments to do in life like studying to become an excellent student and get high grades that would allow me to enroll in one of the best universities in Abu Dhabi, being with my family by visiting them, living my personal and social life and others. Unfortunately, I realized that I couldn’t mange my time at all and I was eager for help. My family was very supportive. They got me books on time management and I started reading those books, learning the techniques on how to organize your time. After a period of time, I started organizing my time, appreciate and value the quality of time. Finally, meeting my family’s expectation was also one of my challenges in life. The reason behind it is that parents expect a lot from their children. They expect to be successful, talented, hard working, enthusiastic and many other things. You wouldn’t want to embarrass yourself in front of your parents, because they always think that they’ve raised a perfect child whereas no one is perfect and everyone has negative and positive side effects. In my childhood, my parents expectations to me was being an excellent students, getting high grades in my exams and quizzes. I felt overwhelmed, pressured and exhausted because I didn’t want embarrass myself with my parents and I didn’t want them to get angry and mad at me for not at least trying to reach their expectation. I was trying very hard to meet their expectations in any of the issues and expectations and eventually I did.

Reflective Summary On Prescribing Practice Learning Nursing Essay

Reflective Summary On Prescribing Practice Learning Nursing Essay The author, a nurse practitioner based in an Emergency Department (ED), from here on in will be referred to as the practitioner. The practitioner is currently employed in a development role with the view, following training, of becoming an acute care practitioner. This will entail working autonomously: taking accurate clinical histories, physical examination, gain differential and working diagnosis and organise a plan of care. This plan of care could well include a number of prescribed medications. Hence it is in the practitioners job description (as it is increasingly in many specialist/autonomous nursing roles) to become a Nurse Independent and Supplementary Prescriber (NISP). The Cumberlege Report (1986) suggested that nurses should be able to prescribe independently and highlighted that patient care could be improved and resources used more effectively by doing so. It identified that nurses were wasting their time requesting prescriptions from Doctors. Since the publication of this seminal piece of work, non-medical prescribing has been analysed, reflected upon, researched at great lengths and changes in practice made (DoH 1989, 1999, 2006 2008; Luker et al 1994; Latter et al 2011) and is still under constant review. The aim of this portfolio is to: Reflect on practice as a means of on-going personal and professional development. Demonstrate a capability of integrating learning into practice. Submit a range of material mapped against the module learning outcomes, NMC 2006 prescribing standards, domains of practice and core competencies. Establish an evidence-based approach to practice competence as a safe independent supplementary prescriber. This prescribing practice portfolio will be a reflective portfolio using Rolfe et al (2001) model of reflection to aid learning from experience and close the gap between theory and practice. This model has been chosen as it is something the practitioner is familiar with and has used before. The portfolio will conclude with a reflective summary on prescribing practice learning which will draw together the evidence used to support achievement of the competences identified. After discussing with colleagues who have already completed the NISP course, the practitioner is aware of the complex nature and volume of work that is required over the duration of it. There is a feeling of nervousness due to this but also a feeling excitement over what will be learnt. If successful the practitioner believes her practice will be enhanced significantly as she will have the ability to give patients seamless care. References Department of Health. (1986) Neighbourhood Nursing: A Focus for Care. (Cumberlege Report). London: HMSO Department of Health. (1989) Report of the Advisory Group on Nurse Prescribing. The Crown Report). London: HMSO Department of Health. (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report Two) London: HMSO. Department of Health. (2006) Medicines Matters. London: HMSO Department of Health. (2008) Making Connections: Using Healthcare Professionals to Deliver Organisational Improvements. London: HMSO Latter, S. Blenkinsopp, A. Smith, A. Chapman, S. Tinelli, M. Gerard, K. Little, P. Celino, N. Granby, T. Nicholls, P. Dorer, G. (2011) Evaluation of nurse and pharmacist independent prescribing. Faculty of Health Sciences, University of Southampton; School of Pharmacy, Keele University on behalf of Department of Health [Online] Available at http://eprints.soton.ac.uk/184777/ [Accessed 15th Sept 2012] Luker, K. Austin, L. Hogg, C. Ferguson, B. Smith, K. (1998) Nurse-Patient Relationships: The context of Nurse Prescribing. Journal of Advanced Nursing. (28) 2: 235-242 Rolfe, G. Freshwater, D. Jasper, M. (2001) Critical Reflection in Nursing and the Helping Professions: a Users Guide. Basingstoke: Palgrave Macmillan. Consultation Holistic Assessment Case Study In this case study the consultation, diagnosis, prescribing options and decisions of a 35 year old female seen in the ED will be discussed. This case study will aim to improve the practitioners knowledge of conducting a consultation and its relationship with making a diagnosis and treatment options. To maintain confidentiality, in line with the code of professional conduct, the patient will be referred to as Mrs A (Nursing and Midwifery Council (NMC), 2008). Consultation Examining the holistic needs of the patient is the first of seven principles of good prescribing (National Prescribing Centre (NPC), 1999) and must be undertaken before making a decision to prescribe (NMC Practice Standard 3, 2006). Holistic assessment takes into consideration the mind, body and spirit of the patient (Jarvis, 2008). Traditionally consultation and making a diagnosis has been completed by Doctors. However, nurse diagnosis would appear to have been formally acknowledged since The Crown Two Report (DoH, 1999) as part of the independent prescriber role. Horrocks et al, (2002), found greater patient satisfaction with nurse consultations than with GP consultations. Jennings et al, (2009) and Wilson Shifaza, (2008) also found this to be true of nurse practitioners working in emergency departments. Importantly, they also found no significant variation in other health outcomes. Most of these studies found that consultations with nurses were to some extent longer, they offered more advice on self-care and self-management and that nurses gave more information to patients. Although there are various consultation models that have been described (Byrne Long, 1976; Pendleton et al, 1984; Neighbour, 2005; Kurtz et al, 2003; Stott Davis, 1979), these are based upon observation of doctor, not nurse consultations. Nevertheless, the consultation models and skills described in the medical literature are relevant to all practitioners (Baird, 2004). Consultation models help the practitioner centre the consultation around successful information exchange and try to provide a theoretical structure. Consultation models can also be used to help make maximum use of the time available at each consultation (Simon, 2009). Traditionally the medical model is used to assess patients however; it does not take into account the social, psychological, and other external factors of the patient. The model also overlooks that the diagnosis (that will affect treatment of the patient) is a result of negotiation between doctor and patient (Frankel et al, 2003) In this case study, the practitioner has used Roger Neighbours model of consultation. This was found by the practitioner to be simple and easy to remember, whilst covering all areas needed to make an effective consultation and assessment. He describes a 5 stage model which he refers to as a journey with checkpoints along the way: Connecting establishing a relationship and rapport with the patient. Summarising taking a history from the patient including their ideas, expectations, concerns and summarising back to the patient to ensure there are no misunderstandings. Handing over negotiating between the practitioners and patients agenda and agreeing on a management plan. Safety netting the consideration of what if? and what the practitioner might do in each case. Housekeeping reflecting on the consultation. (Neighbour, 2005) Connecting Mrs A was called through to the Rapid Assessment and Treatment area in the ED. It was apparent from Mrs As facial expression and limp that walking caused her pain. Silverman Kinnersley, (2010) state that non-verbal communication is extremely important and can often provide clues to underlying concerns or emotions. The practitioner had never met the patient before so had no previous relationship with her but was aware that she may have pre-conceived ideas about the ED which may have caused her anxiety. The practitioner introduced herself to Mrs A, explained her job role, the process that was about to be undertook and consent obtained. During this time eye contact was maintained and the practitioner also asked Mrs A how she would like to be addressed. This was done to try and build up a rapport with Mrs A, to help her feel at ease and reassure her. Simon, (2009) and Moulton, (2007) agree and state that rapport is essential to effective communication and consultation. Mrs A was also of fered a trolley to sit on to make herself comfortable and the curtains pulled around for privacy and dignity. On reflection the practitioner was aware that the environment was a busy and noisy assessment area and this can have a negative impact on the consultation (Silverman et al, 2005). Identifying this with Mrs A and apologising may have re-assured her further and gained trust and respect. Summarising The practitioner began with an open ended question and did not interrupt the patients response. Neighbour, (2005) and Moulton, (2007) advise this to open the consultation. Gask Usherwood, (2002) found that if a practitioner interrupts, patients then rarely disclose new information, which could lead to not finding out the real reason for the consultation. Mrs A revealed that she received an insect bite to her right lower leg 5 days ago, since then the surrounding skin had become swollen, increasingly red, painful and hot to touch. She explained that the redness was spreading up her leg and the pain was getting worse. Mrs A explained that she was concerned that it was not going to get better and was very worried that it had got worse during the last 3 days. Upon questioning Mrs A also complained of malaise and that she had been feeling very hot and cold and at times. She had been managing to eat and drink as normal. Mrs A lived with her husband, was a non smoker and drank alcohol occasionally. She had no past medical history and took no prescribed or over the counter (otc) medications. It was also elicited that she was allergic to Penicillin which she had an anaphylaxis reaction to. Taking a medical, social, medication and allergy history is important as it can be relevant to the presenting complaint, makes sure key information has not been overlooked and is essential in preventing prescribing errors (Bickley, 2008; Young et al, 2009). The practitioner actively listened to what Mrs A was saying by maintaining eye contact, using open questions and by summarising the history back to clarify points and to make sure nothing was missed. On reflection the practitioner feels this also gave the opportunity for Mrs A to add any further information not disclosed so far. Closed questions were then used to gain specific information related to the initial information given, this is advised by Young et al, (2009) and Moulton, (2007). Effective communication is important as Epstein et al, (2008) explains that a precise history can supply at least 80% of the information necessary for a diagnosis. Upon examination there was obvious erythema. Light palpation revealed that the area was very warm and tender. Neurovascular assessment was performed and was unremarkable. Mrs As chest was clear, heart sounds normal and her abdomen was soft, non tender. Physical examination is important as it is used to detect physical signs that the patient may not be aware of and can be used to confirm or disprove a possible diagnosis. It also suggests to the patient that their illness is being taken seriously. (Bickley, 2008, Charlton, 2006). Observations were taken including blood pressure, heart rate, temperature, respiratory rate and oxygen saturations. All were within normal parameters except her temperature which was 38.2 degrees Celsius. Venous blood was taken to check haematological, biochemical and coagulation status. Mrs A white cell count (WCC) and C-reactive protein (CRP) levels were raised, all other blood results were normal. Handing Over Before making a final diagnosis, it is important that differential diagnoses are excluded (Nazarko, 2012). The practitioners differential diagnoses were deep vein thrombosis (DVT) or venous eczema. However, Mrs A had a straightforward history (insect bite) that together with her observations (raised temperature), examination findings (redness, heat, swelling and pain) and blood results (raised WCC and CRP) indicated an alternative diagnosis, so DVT and venous eczema were ruled out. The practitioners working diagnosis was cellulitis. This was discussed with Mrs A and she appeared reassured that a diagnosis had been made. The practitioner explained that she would like to discuss this with a senior Doctor to help decide on a treatment plan. The practitioner presented the patient to an ED Registrar who agreed with the diagnosis. Diagnosis, treatment and prescribing options were then discussed to aid the practitioners learning. Cellulitis is a bacterial infection of the skin and subcutaneous tissue which is potentially serious (Epstein et al, 2008). It is caused by one or more types of bacteria, most commonly streptococci and staphylococcus aureus (Nazarko, 2012). Cellulitis usually occurs on the lower legs, arms and face but can arise anywhere on the body (Bickley, 2008). Patients with cellulitis present with signs of inflammation, distinctively heat, redness, swelling and pain (Nazarko, 2012). Inflammation is localised initially but increases as the infection progresses. Patients can be systemically unwell (pyrexial, tachycardic, hypotensive) and white cell count and C-reactive protein levels will be markedly raised (Beldon, 2011, Wingfield, 2009, Nazarko, 2012). It appears there is a general lack of evidence based literature surrounding the treatment of patients with cellulitis. The practitioner could only find one national guideline on the management of cellulitis in adults, which was published in 2005 by the Clinical Resource Efficiency Support Team (CREST, 2005). However, to the practitioners knowledge, these have not been validated by a clinical study. Morris, (2008) found in his systematic review that antibiotics cure 50-100% of cases of cellulitis but did not find out which antibiotic regime was most successful. Kilburn et al, (2010) also could not find any definitive conclusions in their Cochrane review on the optimal antibiotics, duration or route of administration. Eron, (2000) devised a classification system for cellulitis and its treatment which CREST used in their guidelines. This system divides people with cellulitis into four classes and can serve as a useful guide to admission and treatment decisions. However Koerner Johnson, (2011) found in their retrospective study, comparing the treatment received with the CREST guidelines, that patients at the mildest end of the spectrum were over treated and at the more severe end undertreated. They also found a significant variation in antibiotic regimes prescribed for patients with cellulitis. Marwick et al, (2011) questioned whether classes I and II could actually be merged to improve treatment. The practitioners trust has antibiotic guidelines (updated yearly) which also include a classification system. This aids the prescriber in choosing the correct antibiotic, dose, route and duration for certain conditions, cellulitis being one of them. After discussion with the Registrar it was determined that Mrs A was in Class I or non-severe which meant she could be managed with oral antibiotics on an outpatient basis. The practitioners trust and CREST, (2005) guidelines advise first line treatment for non-severe or class I cellulitis as oral Flucloxacillin 500mg, three times a day. Flucloxacillin is a moderately narrow-spectrum antibiotic licensed for the treatment of cellulitis. However, Flucloxacillin was contra-indicated for Mrs A as she had a severe penicillin allergy (British National Formulary, (BNF) 2012). Clarithromycin is a macrolide which has an antibacterial spectrum that is similar but not identical to that of penicillin; they are thus an alternative in penicillin-allergic patients (BNF, 2012). Clarithromycin is licensed and recommended by CREST, (2005), and by the practitioners trust, as an alternative to Flucloxacillin in cellulitis for patients with a Penicillin allergy. It is indicated in the BNF, (2012) for the treatment of mild to moderate skin and soft-tissue infections. It demonstrates suitable pharmacokinetics, with good distribution into skin and soft tissues, and is effective against the large majority of staphylococcal and streptococcal bacteria that cause cellulitis (Accord Healthcare Limited, 2012), (See drug monologue page 21-28). There were no contraindications in prescribing Clarithromycin for Mrs A. The option of not having any medication was discussed with Mrs A however, she wanted treatment so the benefits and side effects of Clarithromycin was explained, and consent obtained from Mrs A to prescribe the antibiotics and to be discharged, (NMC Practice Standard 5, 2006). Dose and duration were then also clarified and the importance of taking the antibiotics as prescribed and to complete the full course. On reflection, by discussing and deciding on the best treatment together this would hopefully promote concordance. Negotiating with patients and agreeing on a management plan is very important aspect of reaching patient centred care (Neighbour, 2005). Using an FP10 Clarithromycin tablets 500mg twice a day was prescribed by the Registrar (as the practitioner was not a licensed prescriber, NMC Practice Standard 1, 2006), as per trust guidelines, for 7 days. Paracetamol tablets 1g four times a day was also prescribed for its analgesic and anti-pyretic properties (BNF, 2012). A stat dose of both were prescribed and the practitioner asked the nurse to administer the first dose (NMC Practice Standard 9 14, 2006), and was aware that by delegating this task the prescriber remained accountable. The FP10 was given to the patient to take to the pharmacy of her choice for them to dispense (NMC Practice Standard 10, 2006), (See mock prescription page 29). The practitioner did not initially contemplate cost effectiveness but on reflection it has been recognised that this needs to be taken into consideration when prescribing (NPC, 1999). Intravenous antibiotics may have been prescribed, which may have meant an admission into hospital or administration by nurses on an outpatient basis; thus would have increased the cost of treatment significantly. Admission to hospital can also be overwhelming and can put the patient at risk of hospital acquired infections and increased risk of antibiotic resistance (Wingfield, 2008). Safety Netting The erythematous border was marked, with the patients consent, with permanent pen to monitor for any improvement or additional spread of infection (CREST, 2005, Beldon, 2011). The practitioner advised Mrs A that she should return or see her GP if she had worsening symptoms or if by the completion of the course of antibiotics symptoms had failed to resolve. Mrs A was also advised that, if a similar incident occurred, she should seek medical assistance early so that treatment could begin as soon as possible to reduce the risk of severe and long-term complications. In addition it was recommended that she should drink plenty of fluids to prevent dehydration, elevate the leg for comfort and to help reduce the swelling (CREST, 2005, Beldon, 2011). Mrs A was warned that there could be an increase in erythema in the first 24-48 hours of treatment (CREST, 2005). This advice and information empowered Mrs A and made sure that her discharge was as safe as possible. The practitioner brought the consultation to a close by asking Mrs A if she had any questions or if there was anything else she would like to discuss. This gave Mrs A the opportunity of clarifying any information given by the practitioner and the opportunity to divulge any information or concerns not previously mentioned. This re-assured the practitioner that she had addressed her problem appropriately. Housekeeping The practitioner made sure there was clear concise documentation of the consultation and choice of prescription in Mrs A notes (NMC Practice Standard 7, 2006). A discharge letter was also produced to send to her GP NMC Practice Standard 6, 2006). Once the prescription was ready, Mrs A was discharged. This case study has shown the practitioner the importance of effective communication in consultation. By following Neighbours consultation checkpoints it gave structure to the consultation and will be used by the practitioner in future practice. It has also helped the practitioner to gain an understanding of different prescribing options and how to explore these further. For example, the practitioner did find when reading around the subject that there has been some research on the use of corticosteroids in cellulitis to increase resolution, however, to the practitioners knowledge, this is not currently advised in any guidelines and further research is needed. The practitioner would also like to be involved in the development of a cellulitis pathway at her place of work. This could include an algorithm to aid practitioners to differential diagnosis so patients can receive appropriate treatment and reduce the incorrect prescribing of antibiotics. As there are no National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment and management of cellulitis, treatment of patients is not standardised and consequently quality of care could be affected. The optimal choice for antimicrobial therapy requires review and definitive study in clinical trials. 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Name of Drug Clarithromycin Drug Classification Macrolide Therapeutic Uses(s) Clarithromycin film-coated tablets are indicated in adults and adolescents 12 years and older for the treatment of the following bacterial infections, when caused by clarithromycin-susceptible bacteria. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial exacerbation of chronic bronchitis à ¢Ã¢â€š ¬Ã‚ ¢ Mild to moderate community acquired pneumonia. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial sinusitis à ¢Ã¢â€š ¬Ã‚ ¢ Bacterial pharyngitis. à ¢Ã¢â€š ¬Ã‚ ¢ Skin infections and soft tissue infections of mild to moderate severity, such as folliculitis, cellulitis and erysipelas Clarithromycin film-coated tablets can also be used in appropriate combination with antibacterial therapeutic regimens and an appropriate ulcer healing agent for the eradication of Helicobacter pylori in patients with Helicobacter pylori associated ulcers Dose range and route(s) of administration Adults and adolescents (12 years and older) à ¢Ã¢â€š ¬Ã‚ ¢ Standard dosage: The usual dose is 250 mg twice daily. à ¢Ã¢â€š ¬Ã‚ ¢ High dosage treatment (severe infections): The usual dose may be increased to 500 mg twice daily in severe infections. Children younger than 12 years: Use of Clarithromycin film-coated tablets is not recommended for children younger than 12 years. Use Clarithromycin paediatric suspensions. Clinical trials have been conducted using clarithromycin pediatric suspension in children 6 months to 12 years of age. Elderly: As for adults Dosage in renal functional impairment: The maximum recommended dosages should be reduced proportionately to renal impairment. In patients with renal impairment with creatinine clearance less than 30 mL/min, the dosage of clarithromycin should be reduced by one-half, i.e. 250 mg once daily, or 250 mg twice daily in more severe infections. Treatment should not be continued beyond 14 days in these patients. Patients with hepatic impairment: Caution should be exercised when administrating clarithromycin in patients with hepatic impairment Administered orally. Pharmacodynamics Mode of Action Clarithromycin is a semi-synthetic derivative of erythromycin A. It exerts its antibacterial action by binding to the 50s ribosomal sub-unit of susceptible bacteria and suppresses protein synthesis. It is highly potent against a wide variety of aerobic and anaerobic gram-positive and gram-negative organisms. The 14-hydroxy metabolite of clarithromycin also has antimicrobial activity. The MICs of this metabolite are equal or two-fold higher than the MICs of the parent compound, except for H. influenzae where the 14-hydroxy metabolite is two-fold more active than the parent compound. Side Effects Dyspepsia, tooth and tongue discoloration, smell and taste disturbances, stomatitis, glossitis, and headache; less commonly: arthralgia and myalgia; rarely: tinnitus; very rarely: dizziness, insomnia, nightmares, anxiety, confusion, psychosis, paraesthesia, convulsions, hypoglycemia, renal failure, interstitial nephritis, leucopenia, and thrombocytopenia Interactions Aprepitant Clarithromycin possibly increases plasma concentration of aprepitant Atazanavir Plasma concentration of both drugs increased when Clarithromycin given with atazanavir. Atorvastatin Clarithromycin increases plasma concentration of atorvastatin. Cabazitaxel Avoidance of clarithromycin advised by manufacturer of cabazitaxel. Calcium-channel Blockers Clarithromycin possibly inhibits metabolism of calcium-channel blockers (increased risk of side-effects). Carbamazepine Clarithromycin increases plasma concentration of carbamazepine. Ciclosporin Clarithromycin inhibits metabolism of ciclosporin (increased plasma concentration). Colchicine Clarithromycin possibly increases risk of colchicine toxicity-suspend or reduce dose of colchicine (avoid concomitant use in hepatic or renal impairment). Coumarins Clarithromycin enhances anticoagulant effect of coumarins. Disopyramide Clarithromycin possibly increases plasma concentration of disopyramide (increased risk of toxicity). Dronedarone Avoidance of clarithromycin advised by manufacturer of dronedarone (risk of ventricular arrhythmias). Efavirenz Increased risk