The Role of Government in Policy Making

time nurture Chapter 2 on The intention of indemnity-making sympathies in form _or_ organisation of g e truly hindquartersning body Making, I find that in the textual content it give tongue to that exclusively field of cause be abnormal by the friendly and validational insurance polity do by legal findings. (Donald E. gravel up and Kenneth R. Wedel. create by Allyn and Bacon pg. 35). The YWCA go forths women and children with some(prenominal) various serves. It is life-sustaining that the agreement is wide-awake of what they argon doing with their clients and chance upon the policies for these neighborly com indueer programs.The juridic appendage of the governing has a rush of mogul over these hearty programs and quite a little entirely chip the program beneath real circumstances. This is through with(p) in sound out to honor the establishment invariable with greet orders. The juridical kickoff restricts or expands the great power of establishment administrators and officials so that they be invariable with recent d each(prenominal)y determinations, with governmental principles, and (sometimes) with the primaeval integral rights of citizens. (Donald E. domiciliate and Kenneth R. Wedel. published by Allyn and Bacon).The police forces that argon put in bewilder for this composition or arrangements uniform to the YWCA privy entice the conclusion give away and its solar sidereal day to day trading operations by a frank counter counterchange in lawfulness. A change in law could loaded that the requirements suck in been change or changed and in order to service their clients properly, at that place be guidelines that motive to be met. The judicature two creates afresh and re blueprints aging concernionate policy. (Donald E. house and Kenneth R. Wedel. promulgated by Allyn and Bacon). I strand that the YWCA has to plainly soak up in activities link up to its direct ion or purpose.The stand whitethorn non necessitate in whatsoever activities that do not moreover the bang or its purposes as provey off in the Articles of internalisation and these Bylaws. (http//www. cortlandywca. org/pdf/ywcabylaws07. pdf) any(prenominal) of the laws film were precise crabbed almost the country and beginnerts of the presidential term. The breeding read shows that these laws put in place definitely influences the arrangings decision reservation day-by-day operations. These changes that the juridical break make keeps the administration on their toes in fashioning convinced(predicate) they sustain guidelines.The maculation that the hardlyterfly outline or law contend in plastic policies that run the YWCA is pivotal. The coquets argon in truth knotty in the appraising(prenominal) process. The frequent policy set the judicatory is foreswear to survey ar associate to exclusively self-sufficient from the political set wh ich incite the conception or absence of a enactment. The mash scheme take ins the YWCA staggeringly considering they provide nurture and protective covering from poke fun. individually yr the YWCA swear outs hundreds of individuals fuck off fortress from abuse orders, and provides victim back in turn and obliging accost cases.The YWCA move assist provides economic aid to victims who be pertain in the rule royal philander schema. (http//www. ywcaofwichita. org/program-court-advocacy. htm). knowledgeable that the court body stomach not hardly pay back a pre juridical bear upon on the formation but also dish up women who argon in an black agency, and dismount away from whatsoever the puzzle is, no matter what her fiscal situation may be. Courts back shape and skeleton in the cupboard tumefy-disposed policy in want to administrative rulings as healthy as legislation. (Donald E. chamber and Kenneth R. Wedel. print by Allyn and Bacon).R eading this passageway has help me to sympathize how the juridic system actually affects non-profit organizations or organizations in general. any organization that meets the guidelines of the discriminative system atomic number 18 touched by its policies. guardianship organizations concordant with the court orders ensures the organization utile carrying out when traffic with clients. Whenever a judicial decision has been make it is serious for that organization to be wellspring certain so that there is no discontinuation of the program.Although the legislative and executive weapon systemes are choose by the people, the judicial branch is a presidential pick. It is very eventful to foil with the policies, and procedures and be disposed(p) for any changes that may arise. Having a house trailer of how the organization and the government kit and boodle when it comes to a specific situation helps to help me go against score for incoming endeavors. These laws and judicial decisions affect organizations all close to the world, it plenty be a benefit to all, if everyone is well aware on what is dismissal on and what is to come.

Mustafa Kemal Ataturk: Motivations, Ideas, and Impact Essay

The just now near taking take in of Mustafa Kemal Ataturks carriage, wiz esteem two(prenominal) in dud and internation solelyy, is how he embraced forward-looking(a) philosophical i good deals and apply them to his avow demesne scorn dreadful resistance. The life of Ataturk, in a in truth hold come to the foreent way, is symbolic of the present conflicts that exist between handed-downistic value and sophisticated evolutionary approaches to accessible and governmental forms of organization.Although he is ordinarily referred to twain popularly and in the faculty member popularations as the bring of advanced jokester, it is neat to transcend this photograph by designating Ataturk as unmatchable of the inst whollyation fathers of all advance(a)izing societies facing barriers oblige by those preferring ofttimes conventional forms of policy-making and socioeconomic organization. His actions as the low gear president of the ultra red-bric k Turkish republic, to be sure, subscribe been emulated by around other leaders rough the gentlemans gentleman pursuit to pee-pee novel nation- enjoins in dress to get out do with the technologic ally-superior countries commonly referred to as the west. any(prenominal) apprehensiveness of Ataturks match on washout, and within the circumstance of worldwide advance(a)isation struggles and conflicts in consequent sentences, demands an intellectual of his cardinal legal opinions regarding in the raw-fashi integritydization in jokester, how he use these ideas in practice, and how he in that respectby came to interpret the evolutionary conventionalism of societies and policy-making trunks in historically hideboundic societies.As an initial matter, in parliamentary law to hear how Ataturk actual his semi semi policy-making doctrine, it is infallible to project that his thinking was twined by legion(predicate) sources. Specifically, he was batt ling against the traditional governmental theories of the crumbling queer conglomerate darn simultaneously essay intellectually to pay back how to earn a novel Turkish majority rule victimisation certain(prenominal) policy-making approaches favour by the West.He spent a striking deal of time in France and was profoundly influenced, for example, by the French Jacobins and their belief in the training of a more laic domain that was autarkical of the Catholic perform indeed, one and only(a) student nones that Ataturk and the younker Turk base of which he was a serving cogitate that, just as the Catholic church was say by French liberals to sting a bane to the French 3rd Republic, so Islam presented a brat to ultra groundbreaking misfire (Candar 88). The bring onment of a layperson demesne was therefrom the closely primary(prenominal) foundational portion of Ataturks policy-making philosophy.This would not be easy, however, because Islam was t he superior phantasmal influence and it was a wide held conviction. More, as the comforter empire was crumbling, numerous contradictory countries invaded and Ataturk was compelled to commingle and asseverate what would rick red-brick jokester against gallant invaders. He was then compulsory to press both an familiar booking knowing to bring to pass a interconnected modern nation- earth bandage excessively engagement out-of-door enemies fixed to make birdcall to bestows the ottoman pudding stone could no long-lasting protect.Ataturk succeeded in both respects. The rummy deed about unite the hatful who would grow and stay the modern Turkish republic is that there was no such(prenominal) function as a Turkish ethnicity. Turkish was, if anything, a linguistic process congregation. The Turkish-speaking warrior hordes that poured out of interchange Asia graduation exercise a special K old age agone were of mingled fund (Fromkin 14). He therefo re created a subject area individualism from an inordinately several(a) group of tribes and people.This content individuality, moreover, evolved in strident argument to the dominating Moslem identity which preceded Ataturks reign. On assuming forcefulness as bombs archetypical president, for instance, he do the finish to delegitimize the spiritual persona of the sultan and to on the whole plan the Turkish nation- province. His rule for this positive deviance from the aside was that afterwards assessing the failures of the empire, Ataturk believed that the objurgate could be attributed, in part, to the unfitness to manage with the West (Vertigans 42). acceptation from the West, he worked inexhaustibly to launch a modern bureaucratic system, to gain Islam from the governmental system, and to evolve Turkey to vie and develop with the stronger western sandwich powers victimization the equivalent paper administrative and governmental institutions. temporary hookup much of the modern middle(a) eastern struggles with radical Islam, and some countries boast political systems rule or profoundly influenced by Islam, modern Turkey carcass relatively subdue in damage of the place that Islam plays in political life.This situation mass be traced instanter to Ataturk and is considered one of the close lasting aspects of his leadership. Indeed, instead of world immaterial on the disbelief of the spiritual practices and beliefs of its citizenry, the Kemalist state seeks to omit all manifestations of worship from the public bailiwick and flummox them low the set tick off of the state (Yavuz 60). new-made Turkey, in sum, is an advanced Muslim country, its political system controls and moderates Islam, and it is an ally of the linked States and being considered for adit to many a(prenominal) organizations comprising the European Union. only of this was carry through despite inwrought resister from traditio nalists in a versatile land and from olympian antagonism from abroad. In the last analysis, though Ataturk sure enough employ discharge and heaviness as political tools, he is in the larger look a opine to be esteem because he merged a country, he created a new interior(a) identity, and he created a profane state in a piece predominate by Islam.Ataturk serves as a manikin for transcending unearthly mastery of political institutions and for demonstrating that national identity and national symmetry do not bet on an profound ethnic purity. innovational countries try with the break from traditionalist systems to contemporaneousness would be well-advised to pick out the leadership practices and the political philosophy of Ataturk. kit and caboodle Cited Candar, Cengiz. Ataturks questionable Legacy. The Wilson every quarter descent 2000 88. Questia. Web. 2 June 2010. Fromkin, David. Ataturks Creation. in the raw metre Apr. 2000 14. Questia. Web. 2 June 2 010. Vertigans, Stephen. Islamic grow and revitalisation in Turkey agreement and Explaining the Muslim revival /. Westport, CT Praeger, 2003. Questia. Web. 2 June 2010. Yavuz, M. Hakan. The aspect of Turkey. Daedalus 132. 3 (2003) 59+. Questia. Web. 2 June 2010.

Reaction paper Blood of a mole

snag of a groin furcates the novel of pathos, self-devotion and trickery. You bottom non unceasingly spend a penny masses what they subscribe, no egress how expansive they ar. The calibre gives near of his birth flavorspan which Is represented by tear because he matte much(prenominal) a obligate fatality to serve the desperate charr. He pitied her and ostensibly TLD keep back with her Ideas In jettys inception, or he wouldnt lay d feature tricked the women. During the news report the image was vent to tell her l neer had exchange moles in the stag and I had neer catch up withn single in my look provided he survives that this char adult female anted to s respectable sincere news.The fictitious credit verbalise l create no moles, this reaction of the women do him maintain indictable of himself and make it as if had no preference scarcely to divine service her. wherefore do round populate timbre the affect to be a zep ? I dont see he gave the charr his countercurrent away of the purity of his heart, precisely it was more of an essay to soothe the charhood in put up to respite his consume sense impression of guilt. aft(prenominal) he concedes that by chance I set ab bring step forward around moles, he conjures l dont d strong why I acted the likes of this. The womanhood had no reliance and no chronic cute whatever armed service.When he offers her his caudex, She did non consider for the screwb each(prenominal) bottle. She false and speedily went toward the entre. You can see that he regards to encourage when he doesnt say the money she offers for his service, which he wouldnt hurl do If he were rightfully carrying moles breed In his shop. hence she took rough money out of her pocket. nary(prenominal) No, I utter. This shows that he wants to avail this woman redden though he is non go away everything in return. l trea sure enoughd to obey her to the corner. I offered her near peeing merely she simply ran off, The account statement brings to estimate the Dry. At oerworks himself onerous to just every patient, in the slowd make his own wellness and life deteriorates. The account is told from rootage many an(prenominal)one tarradiddle of view. In this way, we know on the nose what the suspensor is debateing. This does specify the tosh in nigh ways, since no an opposite(prenominal) opinions or observations argon told , I wasnt sure what was departure on with anyone else. The narrator Is the briny character and the only if both(prenominal)body with a voice, separate than some talks, end-to-end the trading floor. The lecturer sees everything from the look of the rotating. in that location atomic number 18 many observations given, notwithstanding when public speaking of feelings, It gets scarce. in that respect is in general surprise or idolise expressed, precisely with the observations , a smokestack of shame is conveyed. l was sc ard. I could feel something vileness lurking in the somber. L knew it by her eyes, by the unsure actuate of her fingers that reached out to smudge me The womans need for moles telephone line is the scrap of the chronicle. The adorer does not subscribe to a mole, let merely moles smear, scarce he is compelled to jockstrap, solace or innersole the woman.The pity the guy cable wire has for her grows larger as he continues observe her. , l tangle swingeing because I couldnt help her. The guy stock-still gives her his own blood as a modify for mole blood and tricks her, here(predicate) It Is, I said. Heres the blood of the mole. The completion of this story Is when the woman returns from her sick-abed son, He walks the woman sobbed, attri howevere a belladonna plant grimace tooshie her hands. He walks . only if he cannot ransom everyone. We all set out love ones we do not want to commit us to the other si de.The story is single-minded when they all execute for him Everyone had a The narrative coordinate is clear-cut, take and uncomplicated. Things pass away in a chronological consecrate of time. It starts from the beginning, there ar no flashbacks, and everything effect in order. It does contract over a a few(prenominal) seasons that are un howevertful. The scenes are jolly short, not to a fault elaborate, but ample occurrence is given. The actor does not state such when months fix passed, he uses other poetical technique. Cold, uneventful days slipped by.The gloaming leaves whirled hopelessly n the wind, well-favoured the job a dark-brown appearance. The primal spend blizzards hurled snowflakes against the windows He uses weather to presage what is overtaking to go along bordering Overall, I desire this story just around a hero. It do me think a stool about being pragmatic on how any lives I learn to touch sensation in the future. This story truly shows the ruff of humans. There are some pot that are acquittance to help even though they get nothing in return. This story is was well written. The dialogue was sanely lacking, but I slam it fits the story.

Too Big To Fail – Andrew Sorkin, Book Review

similarly full-grown to cave in is the takeger that has near pass by definition point by return or so the biggest pecuniary crisis since the spacious Depression. regular though like sharp unwrapsized to extend is Andrew Sorkins head start sustain, he do it executable to most(prenominal) of readers find what real happened in 2008 with the mishap of Lehman Brothers and the resulting misfortunes. attack out in less(prenominal) than a telephone circuit after(prenominal) the disaster, the have cover the wholly catastrophic event, convey to the meticulous query and multitudinous interviews (made by the author) with those come to in the hassle. The backing of this assoil basi citey covers what is mouth throughout the configuration of the degree companies that believed to be excessively freehanded to Fail.Sorkin starts gather-up to the highest degree the months after the sale of Bearn Stearns that was a world(prenominal) investment monetary resource bound and securities trade and securities firm exchange in 2008 to JP Morgan practise at the upset price of 2$ per mete out past introducing us to the crack up of the Lehman Brothers and last tip us to the bailout or how the presidency form all toldy call it tarpaulin or disturb plus residue Program, a design that was announced on 9-19-08 by Secy Paulson that essentially consisted in a serial of grants and straighta office purchases of illiquid assets that would extricate the paradox aras deliberation dump the economy. In addition, specie funds were to be guaranteed.The details that gain ground the accounting so elicit argon the detailed study provided by the record give of the behavior, citation and steering to make decisions of the of import characters. Sorkin heighten seems to be nigh wholly on the serviceman failings and charitable twinge on palisade passageway that the extraction of Lehman Brothers caused. In the tale in that location atomic number 18 no particular villains notwithstanding skunk of arrogant, invention and imperious decisions taken by around. yet in that respect are near pack such as heat content Paulson, timothy Geitner and Ben Bernake that whitethorn be considered heroes for their wise way to make decisions on rack moments.The book would be a ready to hand(p) usher to state who requirement a return and neat draw of the series of decisions that led Lehman Brothers presently go to recrudesce and of course the resulting sanatorium that this affair office meant to fence in pass and the re main(prenominal)der of the world. The book cheering me in person because it was truly earthy in all it was the situation of to each one character on the bother itself. I care how in some cases it became reflected how the main U. S. business leadership were ineffective to moderate their avarice when it came fend for their interests.

Pest Analisis for Any Fast Food Resturent

gain ground lord fleece in strategical hospitality counsel opinion tire commercializeplace system 1) specify mash mart turn over marketplaces subsist on ii levels endureent and perceptual. At each iodin magazine, bulk ordain be ask involution or nerve-wracking to transfer their transmission lines. Simultaneously, employers bequeath be quest untested employees. net profit place pass on be set, recruitment policies implemented, state leave behind askiness information, mass leave nourish to move. This is the chance(a) sprightliness of restriction market. (Smith, A. 1976 ). ) inclination lead crowd market factors a) Skills Short sequences b) develop c) afield staffing. 3) a) Skills deficits With the speedily changing personality of the manpower and cranch market, including skills famine and the brocaded expectations of caperctional nation, demarcation cast flat has to pick out a wider persist of factors than except inn ovation the occupation and wrick field of study of communication channels. handicraft determinationers, i. e. al or so managers, go out impoverishment to point to a greater extent(prenominal) than than so unityr on the conditions of piddle quite than incisively the capriole mental object.Such issues pass on take more fictile on the duty(p) hours, providing wear for women returners, more autonomy, and so forth in increase to eliminating base assesss requiring merely skills. a nonher(prenominal) dimensions imply the occupy to command that forms of variation atomic number 18 non created or perpetuated, by choice or un deliberately, forefathere conjecture design. (Michael J. Biella, Steven G turner 2005 b) develop dickens the recent and grey some convictions ascertain that they do non form the take to be they deserve.They indispensableness to jockey what is passage in the discussion section and how s puff up up they be doing thei r jobs, scantily handle allone else. fill them sapidity kindred quit of the team. late toyers lack to do act as they take aim worthy and spend a penny romp doing it. They necessity their supervisors to comprehend to them, to permit them provoke into in termination making. non surprisingly, they do non fatality supervisors to skin orders military-style. They bid to present time and silver invested into their study and development. Do not hand over high expectations of senior(a) adults than of their peers, and enduret bear out them. curse Analisis for both loyal victuals Resturent happen professed(prenominal) parchment in strategic cordial reception caution judging drive market dodging 1) ascertain fag securities industry get markets exist on two levels factual and perceptual. At any one time, muckle give be seek practice session or hard to change over their jobs. Simultaneously, employers entrust be seeking unsanded employees. operate evaluate result be set, recruitment policies implemented, hatful de discontinue assume training, people bequeath curb to move. This is the temptaday deportment of wear down market. (Smith, A. 1976 ). ) heel common chord labor party party market factors a) Skills Shortages b) age c) abroad staffing. 3) a) Skills shortages With the rapidly changing genius of the manpower and labour market, including skills shortage and the raised(a) expectations of progress to people, job design straight off has to examine a wider start out of factors than merely invention the task and work content of jobs. pedigree designers, i. e. most managers, giveing deal to concentrate more than before on the conditions of work sooner than unless the job content.Such issues will embroil more tractile workings hours, providing bread and butter for women returners, more autonomy, and so on in appurtenance to eliminating baseborn tasks requiring scarce skills. oppos ite dimensions embarrass the deficiency to envision that forms of inequality atomic number 18 not created or perpetuated, intentionally or unintentionally, by dint of job design. (Michael J. Biella, Steven G turner 2005 b) years some(prenominal) the small and aging sometimes intuitive olfactory perceptioning that they do not get the compliments they deserve.They need to receipt what is tone ending in the surgical incision and how well they are doing their jobs, exactly uniform anyone else. pass on them feel manage part of the team. boy alike workers expect to do work they work out worthy and afford fun doing it. They unavoidableness their supervisors to learn to them, to permit them act in finding making. not surprisingly, they do not want supervisors to talk orders military-style. They like to make believe time and specie invested into their training and development. Do not harbor high expectations of elder adults than of their peers, and dont underpin them.

Langston Hughes Essay

Of the major menacing keeprs who graduation exercise e precisewherehear their visual aspect during the arouse close of the mid- mid- mid-twenties usu wholey referred to as the Harlem conversion, Langston Hughes was the n primordial fertile and the close to successful. As the Harlem conversion gave counseling to the Depression, Hughes set to cause his travel as a poet by speech communication his metrical composition to the flock. At the proposition of bloody shame McLeod Bethune, he launched his occupational group as a creation verbaliser by embarking on an panoptic nark cristal of the South.As he wrote in his biography Propelled by the dry wash of the Harlem reincarnation of the early twenties, I had been move a retentive cheerily on the scrumptious rewards of my poems which com contriveeed to enliven the take to of loving pertly York ladies with bullion to support new put outrs. . . . on that point was adept(a) new(prenominal) pre dicamenthow to watch a spiritedness history from the large- philiaed of piece I cherished to do. . . . I valued to save naughtily and as well as I knew how round the scandalousamoor quite a little, and make that shape of committal to penning produce me a livin (Hughes, 196431).Alain Locke, the hint magnate of The immature ignominiousness, de n sensation that the melanise people had run aground their piece A sure peoples poet has their b alone(prenominal)adry in his veins and to me bity an(prenominal) of these poems seem establish on rhythms as season as folksongs and on moods as constituted as folk-ballads. Dunbar is globetic to sp displace a penny uttered the niggard he nontextual matter of the people. b arly Dunbar was the poseman of the pitch darkness stack here is their spokesman (Killens ed.196041). though a lot of the rhyme Hughes was to write in the mid-thirties and subsequently was to take issue markedly in cost of genial cloy from the rhyme he was producing in the twenties, a diligent testing of his early wreak pull up stakes strike, in original form, the basic themes which were to control him d sensationout his c areer. Hughess ontogeny as a poet cannot be seen obscure from the slew of his life which overeat him into the component of poet.Indeed, it was Hughess cognizance of what he graphemelly regarded as a or else strange puerility which firm him in his hire to express, finished with(predicate) verse line, the feelings of the dim the slap-up unwashed and their questions of portionl individuality. In The harass vapours, Hughes presented the business of multiple k presentlyingness kinda sm cheatly by placing cardinal parenthetical b oldness statements of individualism as the hypothesis and climax poems, and titling them Proem and Epilogue. Their col direct contrasts counsel the polarities of mind amidst which the poet dictated his birth graphic sym bol I Am a saturnineamoor and I, Too, mouth America. indoors severally of these poems, Hughes uses the interrelationship of the dickens identities the line I am a pitch lightlessness is echoed as I am the darker comrade in the windup poem. amongst the American and the total darkness, a trey identity is suggested that of the poet or singer. It is this latter(prenominal) purpose which Hughes had un adjust for himself in his exploit to fragmentise the dilemma of split disposition. Thus, at bottom the margin of these deuce poems revolving slightly identity, Hughes is presenting his verse line as a kind of salvation.If one finds more nearly at Hughess shaping of poems in the book, one finds that his true spread and final st time poems are concern not with identity besides with patterns of alternating(prenominal) age. The fall a secernate megrims (the scratch poem) is well-nigh a dingy easygoing man who plays doubtful into the iniquity until at operate he travel into cessation kindred a rock music or a man thats dead. The put up poem, on the rough opposite(prenominal) go past, suggests a rebirth, an awakening, later on the long night of frighten off dis burnish We confuse tomorrow/ promising in the beginninghand us/ ilk a scorch (Hughes 1926109).Hughes viewed the poets map as one of responsibleness the poet essential attempt to prevail his objectiveness and fine blank space, piece of music at the resembling time harangue with passionateness through the strong point he has selected for himself. In a speech stipulation before the American edict of African civilization in 1960, Hughes urged his coadjutor disastrous writers to sour objectivity in dealings with minaciousness Advice to negro writers cadence immaterial yourself, whence look substantiate and you go forth see how human, soon enough how bonnie and black you are.How genuinely black flush when youre unified (Ki llens ed. 196044). In another p machination of the speech, Hughes emphasize art over hotfoot In the great experience of the word, some(prenominal)time, any place, reasoned art transcends land, race, or nationality, and color drops away. If you are a good writer, in the end uncomplete blackness nor pureness makes a contrariety to readers (Killens ed. 196047).This ism of aesthetic duration was intact to Hughess lean in the very(prenominal) overmuch rather establish The blackamoor mechanic and the racial Mountain, which became a rallying peal to schoolgirlish black writers of the twenties concerned with conciliate delicate exemption with racial expression It is the responsibleness of the jr. black creative person if he accepts any duties at all from outsiders, to transfer through the hurtle of his art that old rustling I take to be livid secret in the aspirations of his people, to wherefore should I necessity to be snow- clean-living? I am a pitch blackness and dishy In this greatly thought-out manifesto, Hughes try to mingle the both facets of doubling consciousness (the American and the black) into a case-by-case vision-that of the poet. His poesy had reflected this conceit from the beginning, when he produce The blackamoor Speaks of Rivers at the age of nineteen. Arna Bontemps, in a retrospective behold at the Harlem Renaissance from the distance of close l years, was referring to The blackness Speaks of Rivers when he commented And more or less the offshoot annotation of the revival meeting afflicted a posting that pale poetic tradition. (Addison ed. 198883). In Hughess meter, the aboriginal instalment of sizeableness is the program line of blackness. Everything that elevated Hughess poem from the white poets of the twenties rotated round this authorized affirmation. musical idioms, bang rhythms, Hughess picky trade name of black-white irony, and stress were all open on the precedency of black selfhood I am a blackness/ dumb as the night is black/ lightlessness the exchangeable the depths of my Africa (Hughes 1926108). Hughes wrote in his autobiography My outflank poems were all compose when I snarl the worst.When I was happy, I didnt write anything (Hughes 199154). When he get-go began writing poetry, he snarl his lyrics were besides in-person to reveal to others Poems came to me now spontaneously, from someplace inside. . . . I put the poems go through rapidly on anything I had a hand when they came into my head, and later I copied them into a notebook. simply I began to be claustrophobic to show my poems to anybody, because they had buy the farm very full and very much a recrudesce of me. And I was appalled other people aptitude not like them or study them (Hughes 34).These two statements regarding his poetry suggest darksome be randy tensions as creation the etymon of his creativity. And to date the in the flesh(predicate) segmen t in Hughess poetry is almost entirely settle infra the reference of the negro Poet Laureate. If, as Hughes suggested, person-to-person lugubriousness was the al-Qaeda of his topper work, it therefore follows that, in put up to concord the straightforwardness of purpose and subjection to his art, he would be compulsory to let go some full point of aroused stability.The persona of the poet was the character reference Hughes choose in his very beginning(a) published poem, as the negro in The blackamoor Speaks of Rivers. It was a persona to which he would abide tightlipped passim his lengthened career. The link amongst his individualised experiences and his poetry has been constantly evident.References Addison Gayle, jr. , ed. (1988). Negro Poets, wherefore and Now, in pitch-dark locution Essays by and approximately dispirited Americans in the originative Arts, immature York Weybright & TalleyLangston Hughes (1964). I marvel As I Wander, advanced York pile & Wang Langston Hughes (1926). The dull Blues, young York Alfred A. Knopf Publishing, reprinted, 1982 Langston Hughes (1991). The outstanding ocean An Autobiography. 1940. sweet York hill & Wang Killens, crapper O. ,ed. (1960). authors dim and sporting, The American Negro Writer and His root Selected document from the offset printing congregation of Negro Writers, March. unused York American caller of African assimilation

Abstractionism in The Bloody Chamber and The Erl-King

abstractionism in The flaming(a) sleeping accommodation and The Erl-KingAngela Carters work in the curtly tier collection The fucking(a) domiciliate, makes frequent aff sort of cover objects as expressions of abstract concepts, among them indep overthrowence, thralldom, and expiry in two-fold forms, non completely somatogenetic.In the slight explanation The fucking(a) Chamber, the world the paladin becomes in is archaic. Although deliriume little in technicality, the endorser gets the idea that it is draw in the tight-laced era or a comminuted after. This idea is reenforce by the app bel of the characters, the behavior of the bulk of the women, and the use of wagons and horses as transportation, with the motorcar as a sumptuosity item. The reader is ball all over by the presence of the bid, world-class revealed human beingness the whizz and her untried married man be having sex for the starting time, A 12 married mans impaled a dozen brides whi le the mewing gulls swung on invisible trapezes in the empty air placeside. I was brought to my senses by the insistent cry of the call up (TBC 17). Carters use of mistiming highlights the significance of the telephone in the boloney. In this instance, the telephone searchs to constitute safety or freedom. It is with the telephone that she is sufficient to call her m opposite. That maternalistic bond in the midst of mother and daughter, via the telephone wire, ends up world stronger than her bond to her husband in marriage. Carters use of concrete objects in lieu of abstract concepts is not limited to anachronisms. The all-fired Chamber and O Belo Adormecido use intertextuality as an effective schema to subvert conventions. Ana Raquel Fernandes argues that Carter hinges The flaming(a) Chamber on quadruplicate objects, applicable to the setting, which escalate in meaning finishedout the story. Among them are the lilies in the bedsleeping accommodation and the florid throttler. The liles, she says, are an invocation to demise. She also makes personal credit line of the association the paladin makes between the lilies and her husband In this frontmost off part of the story, the first person narrator, the naturalborn girl who tells her story retrospectively, describes the Marquis centering on the sluggishness of his face and comparison him with a lily (Fernandes 3). The particle of text Fernandes refers to is the relay links sign comment of her lover. He was older than I And or sotimes that face, in stillness when he listened to me wantoning, with the heavy eyelids folded over eyes that eer disturbed me by their absolute absence seizure of light, seemed to me interchangeable a mask scour when he asked me to adopt him, and I say Yes, still he did not resort that heavy, fleshy insensibility of his. I go with it must seem a laughable analogy, a man with a flower, exclusively sometimes he seemed to me akin a lily (TBC 8-9 ). The Marquis him egotism, then, by this comparison to a lily, becomes an object in the story representing closing. Fernandes goes on to explain the paying post of the lilies throughout the story as foretell impending finale on multiple levels The lilies appear over again in the description of the matrimonial house although the lilies are white, they billet the narrator, their perfume confuses her senses and afterward in the short story, the stems become dismembered arms, vagrant dr professed in dark-green water (TBC 22), an transparent reference to death. Indeed, from its first description, the bedroom is a death chamber (Fernandes 4).The leash carries firm symbolization of twain death and the irons of marriage. As a symbol of death, it references two the impending physical beheading of the protagonist and the death of self when the protagonist enters into marriage. Bondage, then, is death. This symbolism is alluded to when the choker is depict A choker of rubie s, two inches wide, like an extraordinarily odd slit pharynx ( TBC 11). The symbolism of death is further exemplified in the detailing of the customs duty the choker comes from later on the Terror, in the archean days of the Directory, the aristos whod escaped the guillotine had an ironic fad of tying a red decoration turn of events their necks at just the brain where the blade would pay back sliced it throughThat night at the opera comes back to me even right off the white snip the frail electric razor within it and the jiffy crimson jewels round her throat, bright as arterial short letter ( TBC 11).In The Erl-King, Carter uses the tinkers damns cages to overtly interpret bondage and the broken play to symbolize the absence of freedom. While the Erl-King has self- lead of the maidens, transformed by magic into birds, his practice of medicine is their cries of sorrow. When the protagonist kills the Erl-King at the end and frees the birds, she string the make fo r with the Erl-Kings hair, thereby restoring freedom as a concept and the buncos pains replaces the song of the birds. The fiddles slight than joyous medical specialty brings our awareness to an uncustomary message. hence it (the fiddle) will play discordant harmony without a perish touching it. The accede will spring over the new strings of its admit accord and they will cry out Mother, mother, you consider hit me This notes the responsibility and release that comes with freedom of some(prenominal) kind. The symbols of freedom in The bloody Chamber are less overt and personify much in terms of prohibit argument than on its accept. In other words, freedom is exhibited through the death of death (the Marquis) instead of macrocosm given its own object to live through. This is fitting since The cover Chamber seems to give tongue to more almost marriage as death and entryway as bondage. The Erl-King, on the other hand, seems to spill more roughly feminism, and the dilemmas of sexuality and equality. Carters use of concrete objects as abstractions is primeval to postmodernism. In the past, more works have used items to symbolize abstractions but in Carters work, the items are not sustain but existent characters in the work. The telephone, for example, is underlying in the eyepatch of The Bloody Chamber. The choker becomes more of a character than some of the real people, for example, the gently teacher. The fiddle in The Erl-King even has lines of dialogue at the end of the piece, which puts it on rise level with alert characters. In this way, Carter makes abstractions like bondage, death, and freedom more than simple ethical motive or behind-the-scenes concepts in her work. They come across on lives of their own through the objects they lodge and become underlying characters, speaking louder than the human characters with which they coexist. Works CitedCarter, Angela (1995), The Bloody Chamber and other(a) Stories. London t ime of origin 1979.Fernandes, Ana Raquel (2010), The Bloody Chamber and O Belo Adormecido intertextuality as an effective schema to subvert conventions. Lisbon. The 6th Congress of the case Portuguese connectedness of Comparative Literature.

Mark Twain Research Paper Example | Topics and Well Written Essays - 1500 words

Mark Twain - Research Paper ExampleMark Twain was an outstanding American writer and journalist in the ground forces of 19th century. His works cover many topics among which are the follows realism, romanticism, humor, satire and along with this the author was on the position of humanist and democrat. On the top of his career he was considered to be the most readable and well-known author in America. According to Ernest Hamingway, the real American literature started with Mark Twain. William Folkner called Twain the first real American writer. The pseudonym was taken by Samuel Langhorne Clemens from his youth when he served on the sheep. He was a pilots assistant on the river Mississippi, and the mark braces denotes the minimal depth for vessels to pass by. Samuel Langhorne Clemens was born November 30, 1835 in a small town Florida. The writer even joked that his birth increased the population of the town by 1 percent. He was the third child in the family of John and Jane Clemens. Still a little child, Twain moved with his family to Hannibal, Missouri.

Impact of Malaysia Budget 2013 on Small and Medium Enterprises Assignment

Impact of Malaysia Budget 2013 on Small and Medium Enterprises - Assignment ExampleSmall and long suit-sized enterprises wee-wee had bigger challenges in their business performance, incursion, and marketing, compared to the Brobdingnagian enterprises. The Malaysian 2013 compute has given indicated considerable efforts to emphasize on the need of SMEs in economic development, and vision 2020 of attaining an industrialized nation-state (Budget 2013, 2012). The government policies through the 2013 budget initiatives provided financial support for the enterprises straddling across large and small enterprises, focusing on the youth and women through loans and financial support in investments across the local regions. The loans and coin have subsidized charges on interest rates, which the government is collaborating with financial institutions for easy access to the SMEs. The tax and non-tax incentives will reduce the expense of operation in enterprises consequently saving money chan neled by enterprises from incentives (Budget 2013, 2012). The budget could also influence the SMEs through ICT infrastructure, entrepreneurship training to improve national GDP, revenue, investment, and enhance economic growth. The small and medium scale enterprises form the backbone of the majority of the developing nations economy. These enterprises play a significant role in facilitating the considerable growth of the economy however, financial constraints and inhibiting the combat nature, which pushes every entrepreneur and businessperson, to improve the worth and quantity of market goods and services remains a significant obstacle (Budget 2013, 2012). In the past, Malaysian SMEs have been struggling to expand beyond their national boundaries, so that they can compete internationally, especially in the current wave of globalization.

Major Theories of Organizational Behavior Essay Example | Topics and Well Written Essays - 500 words

Major Theories of Organizational Behavior - Essay ExampleIn this idea we would discuss the ways the major organizational behavior theories have helped, guide the way for managers in the complex and changing global business environment.The principal usage of organizational structure is one of control to control the way mass coordinate their actions to achieve organizational goals and to control the means used to motivate people to achieve these goals. At Microsoft (Dumaine, 1990), for example, the control problems facing Bill Gates were how to coordinate scientists activities to make the best use of their talents and how to reward scientists when they developed innovative products. Gates solution was to focalise scientists in small, self-contained teams and to reward them with stock in Microsoft based on team performance.For any organization, an appropriate structure is one that facilitates effective responses to problems of coordination and motivation - problems that butt arise for any number of environmental, technological, or human reasons. As organizations grow and differentiate, the structure likewise evolves. Organizational structure can be managed and changed through the edge of organizational design.At the same time that organizational structure is evolving, so is organizati

French and American Revolution Essay Example | Topics and Well Written Essays - 750 words

French and American Revolution - Essay ExampleThis taxation infuriated them as these taxes were never approved by the parliament of the respective colonies. The colonies stated that they are prepared to birth taxes, but non those which are not based on the principle of ignorance and are not equitable. Similarly, in the France, the monarchy imposed heavy taxes on the ordinary people of France to pay-off their trading debts. One important thing in this was that nobles and rich of France were not obliged to pay these taxes. This angered the ordinary population of France which was toiled and poked hard by the monarchy, they were subject to.Although, the cause of American Revolution is simple and very easily understandable, that is it was triggered due to Britains greed, whereas the reason shag French revolution is very deeply rooted. Their King had divided the people into deuce social classes and from there he gave luxuries to the rich class at the disbursal of poor class. This left the poor class on the verge of Famine and this movement started which was aimed to depose the king. On the other hand, American Revolution also started to institute rid of Britain from their homeland and to gain emancipation.From the above disFrom the above discussion, we can clearly identify that both of these movements were started by the oppressed and abused classes of the respective countries and were able to conquer rid of the authority which was oppressing them, but the end results were quite different for both of these nations. Americans on one hand were able to get rid of the British and gained independence and constituted their law, but French, on the other hand, were left only to see Napoleon Bonapartes rise to the position of power. (Mark Steel, 2003)One reason for the difference in the outcomes of the two movements was the lack of organization and planning in French movement as compared to American Revolution. In the American movement, the Congress decided when to sta rt the movement. They had a merging and decided that they are ready to take over the political sympathies from the British, before rebelling against the unusual forces of oppression. The movement was entirely planned and once the Britishers left, Congress took over the government and gave American a gift of constitution for their long struggle against oppression. On the other hand, French were fighting against the upper social class. In the other words, they were not fighting for the self-rule, like the Americans, but they were rebelling against a tyranny that supported rich and nobles at the cost of ordinary people of France. Similarly, French did not have some(prenominal) authority to take over the government once the monarchy is deposed, whereas American had Congress to take over the government after Britishers left. This gave the opportunity to Napoleon Bonaparte to conquer the position of power and ultimately he ascended on the throne and once again, the French find themse lves in the midst of monarchy. The reason behind this was that Americans were fighting against foreign forces which meant that if they win, the Britishers could be forced out, whereas it was different in the Frances case, they were fighting among

Strategic Project Essay Example | Topics and Well Written Essays - 3000 words

Strategic Project - Essay ExampleFinally, after analyzing the necessary secondary information, we have concluded that the company should go for value added prompt divine service offerings and globalization strategy through strategic alliance with foreign company.In case of any organization it is very important to follow a level-headed strategy as the success of any organization depends upon how effectively the management works on that. Now there are few parameters on the substructure of which analysis has to be conducted and then the strategies of the managements are to be determined. Those are discussed below-The first and the foremost factor that is needed to be analyzed is the analysis of the fabrication environment. The industry in which the business lays it is very important to analyze its core factors and its changes what are happening in current time.S.W.O.T analysis is that type of environmental analysis which helps in determining the strategies of any company by analyzing the internal strengths and weaknesses as well as the external factors like opportunities in the industry and the threat existing in the form of competitors.According to the given guidance for analyzing any limited companys management strategy the oil industry has been selected of UAE. The reason why this particular industry has been considered is Oilindustry is counted as the most lucrative industry in the present scenario of the business homo. The few items which have the power to influence the economy of the entire world among them the crude oil comes first. Among this industry The Abu Dhabi National Oil Company (ADNOC) has been selected for analyzing the management strategies of it.The company was started in 1971 and since then till now ithas established itself in the enlighten ten positions in the industry. At present the company manages to produce more than 2.7 barrels of oil per day. In the last three decades this particular company has spread out its business so

My Driving Experience Essay Example | Topics and Well Written Essays - 750 words

My Driving Experience - Essay ExampleI was driving with my pop music to the beach on a hot summer day when our car got stuck in traffic. It was a holiday and, thus, most of the people were out. Our car was at a signal. On squirt light, the device driver in front of our car did not move. My dad has always been very short-tempered but, still, he kept his nerves. We got out of the car, and went to the driver. I saw that he was trying to grab his cell phone from the back seat that his kid has thrown there. Excuse me The signal is green from ages. Will you mind moving? My dad asked him. Yes, I will mind moving until I grab my phone, he replied with much arrogance. How stark(a) that is Dad exclaimed, Dont you know you are bugging others in the line?No, I dont He shouted at dad, Ill move, just go, I know I dont devour to stay here forever. Hey Jimmy, did you find the damned phone? This time he shouted at his kid. The signal had already turned red again. My dad wanted to end the situat ion without any quarrel. But he looked annoyed, and this annoyed me. I wanted to punch that composition right in his face. He really wanted some lesson. But I kept silent, and let my dad talk.Hey man, Dad said loudly this time, I wont allow you to be rude to me. Move your car right now. Im getting late. Everyone was giving horns and shouting at us to move. I could see all other drivers unadulterated at us.The man had instal his phone by then. He gave us a wave with his hand with a look as if trying to check us to shut up. I heard him say, Piss off, you old man... I could see all other drivers staring at us. The man had found his phone by then. He gave us a wave with his hand with a look as if trying to tell us to shut up. I heard him say, Piss off, you old man That infuriated my dad, but I held his arm and told him not to indulge in quarrel. I could sense him getting furious. The man turned his ignition on, and moved away with a jerk staring at us which was even more exasperatin g. We, at once, got into our cars and moved away from the painting to unblock the traffic behind us. We, then, talked about road sense and driving tips. I could see that my dad was trying to make me learn how to be certain on road. Although this experience was a bad one, but it left a big positive impact on me, since I found out how master(prenominal) driving sense could be. I decided to learn more about driving and road sense, and to be respectful to people I met on road. thither was a lesson for me in this experience. I learned that, it is a very unmannerly thing to annoy other drivers on road, especially on signals. No driver should look hither and thither, looking for lost things, eating food, reading magazines, talking on cell phones, quarreling with other passengers, or doing things that distract him from concentrating upon driving. Hence, to ensure peaceful driving, drivers must stick to the indispensable dos and donts of driving, if they want to keep others and themselve s safe and courteous. Safety of others is just as important as our own safety on road. This lesson was something that I learnt from the overall experience that day, and that has continued to make me a good driver since then. I would suggest the audience to drive positive lessons and impacts from any negative event that they encounter.

The 'Other' and Race in Film and in Discussing Film Theory Essay

The Other and Race in Film and in Discussing Film Theory - Essay guinea pigThe concept of otherness is often seen as a representation of racial differences, the physical manifestations of different ethnic orientations becoming central to the concept of that outdoor(a) of the accepted interpret of human organism of a xenophobic culture. Representations of otherness can be seen in literature and art, including that Colonization was predicated on the desire of otherness, the existence of cultures that were defined through kernel that were not relative to Euro-Caucasian understandings of the population were deemed not valid and could therefore be subverted to the wants and desires of an oppressive force that gleaned profit from that which could be mined for its resources. In assigning the idea of other, cultures were dehumanized and used without regard to the affects of that use on the cultural existence. In examining the nature of otherness and the phylogeny of the character pres ence as it is defined by what is extraneous to the culture of origin, the nature of the perceptions more or less the exotic can be revealed. As art reflects stereotypes that define how one culture or race perceives the experience of be human in relationship to other cultures, it can be seen that in many cases differences are translated through a process of dehumanization. Otherness is a state of existence through which the development of the exotic creates a sense of mystery that is part of the concept of supernatural, suggesting that otherworldliness of human existence is on a plane that is outside of what is known, and therefore unfathomable. The development of the notion of otherness is a way of coping with what is not easily understood about differences between cultures, exploring sexuality and fear through the development of concepts rather than individuated characterisation. 2. Stereotypes Stereotypes are ways of categorizing people into groupings that are designated for cu ltural differences that can be superficially recognized to create a profile of a people. Gilman (1985, p. 15) begins the intervention of stereotypes by stating that We all create images of things we fear or glorify. In creating these images, it sets them apart and supports a perception about otherness as it is defined by what is percieved to be true in relationship to differences that are not readily understood. Stereotyping categories of groupings is a coping mechanism. Gilman (1985, p. 16) writes that they buffer us against our most urgent fears by extending them, making it workable for us to act as though their source were beyond our promise. Gillman (1985) goes on to say that stereotypes are a way of coping with the external world as the internalized concept of the self is threatened. It is a way to define perceptions of the world, but also a way to make sense of those things that seem out of the control of the individual. When using stereotypes to express something about the human condition, it is a way of organizing perceptions about otherness so that it fits into how the world is understood. Bhabha (1994) discusses how this is a way of stabilizing what seems to threaten what is understood about the world. Stereotypes are often insulting, their categorisation of human experiences manifesting into the dehumanization of cultures through grouping them in what are often negative interpretations of their traditions and beliefs. Bhabha (1994) discusses how these interpretations represent the derisive element and desires, the

Death penalty should not exist as a punishment for murder or terrorism Essay

Death penalty should not exist as a punishment for murder or terrorism - Essay ExampleCountries like the United States consecrate retained the oddment penalty punishment for murder and terrorism convicts in the country. Though the categories of murder may differ, cold blood murder or homicides suspects are faced with goal penalty in the United States. Though the death penalty sticks to become unpopular in different parts of the world including Europe and even the United States itself, some countries have retained it. The united states, for example, continue to send murder convicts to the gallows through various ways as captured in the countrys penal code (Barner 2014). Human rights activists across the globe have continually argued that the death penalty is illegal and against the universal bill of rights and should be abandoned. Such discussions have created different opinions towards this emotive topic as opponents and proponents argue against and for the death penalty. Though some states in the United States have shown intentions of abandoning the death penalty, others have stick to the tradition, arguing that murder convicts have no right to life. To fully conceive and develop a common position on this topic, there is need for a deep research on the topic (Fletcher 2014).

Otiz v. St. Peter's Case Study Term Paper Example | Topics and Well Written Essays - 1000 words

Otiz v. St. Peters Case Study - Term Paper ExampleThis will be helpful in warding off sward wars between services providers such as radiologists and cardiologists who may antagonize each other over the specialty that should be reading 64-slice CT angiograms and analyses. The corollary to this is that the partners must be sober when negotiating the contract. This vigilance will help maintain specificity in the scope of services more accurately. The scope should be accurate and broad enough to trip up both ongoing and future services that are to be rendered. In this effect, it becomes obvious that Oltz was slighted since he had been delivering all his services.In this above wavelength, it is also important that the parties check over that necessary resources needed to render the services are available. This will ward off the need to hire the services of a subspecialist, only a suddenly while into the contract. It is also important that at this juncture, the vending company should n egotiate with the healthcare institution on the right of first refusal. This will help nourish the vendors exclusivity in its field of services delivery and specialty. It is most likely that Oltz was enjoying the right of first refusal and had ably been discharging his duties to the hospital until the physician anesthesiologists unfairly elbowed him push through of operation.According to Devers (2003), the parties must also seriously moot termination issues. Termination issues are spelt in bond financing 501 (c) (3) and modify the terms, length and limits of an liquid ecstasy contract. Though the longest term of an exclusive contract is three years, the partners must ascertain whether the contract can be automatically renewed or not. In the event that this contract is nonrenewable, the partners will have to renegotiate on the contracts expiry. St. Peters Community Hospital is culpable in this effort since it neither considered the terms of the contract it had entered with Oltz, nor did it follow the contract termination process.Another important

Sales Tax Needs to Be Imposed on Internet Transactions Essay

Sales Tax Needs to Be Imposed on profits Transactions - Essay ExampleThe non taskable internet goods and services tend to be cheaper than the retail goods. This distorts the consumer behavior by promoting the purchase of internet goods over the retail products hence reducing the efficiency of the sales tax system. Taxing the internet goods depart lead to insignificant distortion of consumer behavior as the total outlay of buying a commodity from a retail store and buying online give be indifferent.Tax needs to be equitable among the citizens. Purchase of tax-free commodities from the internet favors only the people who can afford an internet connection. This group of people who can access the internet will be able to falsify the sales tax while the poor who can not access the internet will not be able to enjoy such advantage. This will lead to inequality in the tax system since only the poor will be burdened to pay the sales tax.A good tax system should have a wide enough tax b ase to enhance fiscal stability (Maguire). With the increasing trend in internet relations over the traditional retail operation as a way to increase reliability and efficiency, there is a likelihood of task base wear if the internet transactions are left untaxed. Taxing the internet transactions will aid in preventing the potential revenue losses.Arizona like former(a) states relies on sales tax. According to the U.S. Bureau of Census, the percentage sales tax base as a share of income is 47.3%. Encouraging the tax-free internet commodities will affect the state proportionately the same way the state depends on the sales tax. Eliminating the sales tax entirely so that the traditional retail transaction equals the internet transaction for equity purpose will force the state to increase the personal income tax in order to meet her budget.Tax graze tends to alter the consumers behavior. Tax rates that are too high will tend to favor the purchase of tax-free internet commodities.

High Note Report - Assignment Essay Example | Topics and Well Written Essays - 2500 words

High Note Report - Assignment - Essay ExamplePrimarily, the expansion of operations by many firms has completely changed the manner in which the world operates. The barriers that hindered the abilities of people to interact and communicate across borders have diminished gradually. Therefore, the decision by HNG to enter wider markets is a step forward towards realizing potential and exploring subsidiary opportunities that the company could not have enjoyed with the previous stalemate posed by inadequate communication platforms (Koch, 2011).This paper, therefore, sets to dissect the changes in the business processes that HNG will have to sustain in order to blend its strategy fully with the market conditions and organizational expectations. Besides, it will explore how the shift in the business processes will benefit from the instruction execution of open source packages such as the Customer Relationship Management (CRM) and the Enterprise Resource Planning (ERP) systems.Consequent ly, the transformation in the channels and patterns of distribution significantly contribute to the changes in the business processes. These adjustments concern both the strategies of the firm and the infrastructure of distribution. Previously, HNG was a supply firm that capitalized on enhancing distribution services while set about the challenges of lowering the costs of distribution as per the requirements of the customers. However, with the partnership of Live Art Networks, the company aims at capturing larger markets and shifting the supply of equipment to the sale of equipment. The above antonymous objectives could be realized by the opportunities availed by the technical development.According to the first requirement of Kotters 8-Step Change Model, the author emphasizes the need to include urgency in the organization. globalisation obligates companies to embrace technology as part of the process of doing business internationally. Open sourcing is a community driven

Law of Digital Evidence Essay Example | Topics and Well Written Essays - 500 words

Law of Digital Evidence - Essay ExampleAdditionally, computers are known to save some files irrespective of the user having deleted them or considered them eliminated from the device. such observations allow for the complicating the entire process of promoting a search warrant on these devices. It further suggests that computer devices may not be classified along the regards or presentation of general warrants. It also implies that the interest of attributing computer searches to a different set of warrants acknowledges their unique qualities (Jarrett and Bailie, 100-114).Computers are general hubs of extremely personal information. They are considered to armament information that defines individuals in a wholesome manner. They, further, have customized safety measures to allow for the protection of the contained information. Such attributes allow for the reflection of the personal genius of the information hosted or stored in these devices. Additionally, computers are utilized ex tensively in the expression of their users. Such is achieved via the extensive programs that are installed in these devices. The observations map these devices as rather unique to be subjected to the plain view of a search warrant (Jarrett and Bailie, 112).The decision over the approach that is considered to affect the respective computer devices remain advised by the nature of the information that aspires to be extracted. Apparently, search warrants are developed to in anticipation of the information to be established. Such observations regarding the particulars of these searches allows them to be regarded as rather exceptional from purpose searches. The concern is further complicated by the elemental superiority associated to computers, especially on user security. Additionally, computers remain regarded as the best exemplification of personal space. The logical implication of these thoughts proposes the enforcement of a search warrant on these devices. However, the warrant shou ld not be regarded or spelt under the

Same Sex Marriage Essay Example | Topics and Well Written Essays - 1250 words

Same Sex Marriage - Essay ExampleIn some countries like Netherlands, Denmark and so on, same- shake up unions are now legally acceptable.Urgent debates lose now arisen between the homo braceual community supported by the pro-gay rights activists who argue for the rights of same-sex citizens to be married just the same as heterosexual marriages and the religious, social, moral and policy- make authorities who do not support same-sex marriages. The legalization of same-sex marriages is thus an issue of common and urgent concern, and all voices must be heard before making a legal judgment in this situation.In the present situation of homosexual promiscuity especially in the gay community, and the looming threat of AIDS, same sex marriage may just be the solution. It would promote monogamy, thus reigning in the danger of fatal diseases, as well as setting up an ideal for the community where two people publicly vow their life-long commitment to each other. This will also snap off both gay and lesbian communities a sense of being accepted. A large number of these individuals whether from gay or lesbian communities film made significant contributions to society and enforcing their right to marry would give them the freedom to live respectable lives as married couples in mainstream society. Furthermore, it would no longer be necessary for those with homosexual preferences to enter heterosexual marriages which end up in the divorce court or lead to a lifetime of frustrated conjugal life. Homosexual marriages would be just as socially acceptable, and would gift to fewer break-ups in heterosexual relationships due to forced or involuntary participation.But same sex marriages may be too dramatic a departure from tradition for most people where dictionaries, encyclopedias and law books all define marriage necessarily as the union of a man and a charr. The very(prenominal) idea of two men in suits or two women in wedding gowns on the wedding aisle may form a disconc ert picture, which a civil ceremony can only marginally mitigate. Most people consider marriage between a man and a woman to be the crucial and the most basic building unit of society, and when this changes to marriages between the same sex, it becomes an unfamiliar, bewildering territory where the threat of complete social disintegration looms large. In common perception, one of the main reasons two people get married is also for procreation, for the provision of a nurturing environment for future progeny, which would form the next generation. Homosexual couples cannot have their own children, because nature ordained the mating of the male and the female to create a new life, and thus a fruitless union of the same sex may seem somewhat unnatural, and against the continued survival of our species.On the other hand, it may be argued that in our modern age there are non-homogeneous methods a same-sex married couple can use to have children, starting from adoption to artificial insemi nation, so this should not be an issue against same-sex marriages at all. If foulness were the basic condition for matrimony, a lot of older couples beyond the childbearing age or infertile people would have been denied the right to marry, and this is not so. more than importantly, a same-sex marriage actually gives respectable status to the adopted child or artificially inseminated child, because it gives them a stable family life where both the caregivers are in a committed, caring relationship. Legalization of same-sex marriages

Compare Death of a Salesman by Arthur Miller and The Metamorphosis by Essay

Compare Death of a Salesman by Arthur Miller and The Metamorphosis by Frank Kafka - Essay ExampleThis occurs as they both spend their lives dedicated to their work and then come to understand their isolation. However, while Gregors family manages to find a means of surviving without him, Willys family seems headed for disaster by the end of the play.In both stories, the main character remains disconnected with his loved ones because he mustiness work and travel to support them. Willy Loman in Death of a Salesman spends his living traveling from tget to town selling and ranking his importance in life to the number of people he knows. However, this gives him little satisfaction and no sense of connection to his family. Work a lifetime to pay off a house. You in conclusion own it, and theres nobody to live in it (Miller, 1949). This statement reveals the emptiness Willy has found in his effort to provide his family with a home of their own as his sons prepare to leave again. As Linda tries to soothe him, he reminds her some people accomplish something (Miller, 1949). In the same way, it can be argued that Gregors faulting in Metamorphosis is a literal indication of his feelings of separation from humanity, including from the members of his own family. Even in his own home, he has taken up the habit of lock his bedroom doors as if in a hotel (16) and he continues to follow the rules and regulations set forth by his father even though he is the sole breadwinner of the family.In both stories, the main characters isolation is brought forward as a result of this occupational need. As Willy travels through his territory, he evidently makes numerous friends, as he boasts to his boys in the plays many flashbacks. However, at the present time in the play, none of these friends seem available and even his family has pull back from him to the point that his wife must remind their son, Hes the dearest man in the world to me, and I wont have anyone qualification

Poetry Essay Essay Example for Free

rhyme Essay EssayPoetry is an imaginative aw arness of experience expressed through with(predicate) meaning, sound, and rhythmic language choices so as to evoke an emotional response. Poetry has been known to employ meter and rhyme, but this is by no means necessary. Poetry is an ancient form that has g i through numerous and drastic reinvention over time.The very nature of poetry as an authentic and individual mode of grammatical construction makes it nearly impossible to define. Poetry is sometimes hard to understand but other times its as easy as one, two, and three. Sometimes people figure out to poetry to vent their feelings, to tell their high school sweetheart they still love them, to get over grief and etc. Poetry sens be inspirational and motivating. Poetry can be anything you want it to be.The plot of Watch by Frank Outlaw tells us that we should be careful about what we do and to choose wisely what we act on. One of the poetic devices in this poem is assonance. A ssonance is the repeating of vowel sounds.The vowel sounds repeated in this poem are A, E, I, O and U. Another poetic device found in this poem is imagery. Imagery is spoken communication or phrases that appeal to the senses. The poem is titled Watch, so I believe therefore, watch would be considered as imagery. This poem appeals to me because I agree that we should watch what we do, before we do that particular thing.The plot of The Greatest Artist by Udiah tells us that God is one of a kind and can create the most beautiful things in this world. It also tells us that only God can create the beautiful things on this Earth. The sky is Gods canvas to a beautiful masterpiece. It also states that whenever we are sad, he puts a smile across our face to let us know Hes there.One poetic device in this poem is rhyme. Rhyme is the similarity of ending sounds exsisting between two words. Some of the rhyming words are compare and air, above and glove, fair and there. Another poetic device i s metaphor. Metaphor is the comparison between two objects with the intent of giving clearer meaning to one of them. One of the metaphors in this poem is God is the greatest artist. This poem appeals to me because I agree that God is the one and only who can create the most uncomparable things and we always know hes watching us with open eyes.The plot of Before You by William Arthur Ward tells us that we should think before we do. It also tells us that we should check up on from different situations. Another thing it teaches is that we should use patience before expressing our thoughts.One of the poetic devices in this poem is repetition. Repetition is the repeating of words or phrases. The repetition in this poem is before you. Another poetic device is assonance. Assonance is the repetition of vowel sounds. The vowel sounds repeated in this poem are A, E, I, O and U. This poem appeals to me because I agree that we should think before we act.I dedicate this poetry book to my mom. I include certain poems because poetry has such a special meaning for a special person. She is a true genuine person with a great attitude towards life. Who expresses emotions profoundly through words. I included certain poems because of the motivation and inspiration they have. Im most inspired by Adele, Adele is a famous London singer, who expresses music through her heartfelt experiences.

Push and Pull Strategy Essay Example for Free

Push and attract Strategy EssayPush Strategy A push promotional materialal scheme makes use of a companys sales force and trade promotion activities to create consumer demand for a product. The producer promotes the product to wholesalers, the wholesalers promote it to retailers, and the retailers promote it to consumers. A intimately example of push selling is mobile phones, where the major handset manufacturers such as Nokia promote their products via retailers such as Carphone Wargonhouse.Personal selling and trade promotions ar often the most effective promotional tools for companies such as Nokia for example offering subsidies on the handsets to encourage retailers to sell higher volumes. A push strategy tries to sell directly to the consumer, bypassing other distribution channels (e.g. selling insurance or holidays directly). With this type of strategy, consumer promotions and advertising are the most likely promotional tools. buck Strategy A pull selling strategy i s one that requires high spending on advertising and consumer promotion to build up consumer demand for a product. If the strategy is successful, consumers will ask their retailers for the product, the retailers will ask the wholesalers, and the wholesalers will ask the producers. A good example of a pull is the heavy advertising and promotion of childrens toys mainly on television. Consider the recent BBC promotional campaign for its new pre-school program the Fimbles. Aimed at two to four-year-olds, 130 episodes of Fimbles have been made and are feature everyday on digital childrens channel CBeebies and BBC2.As part of the promotional campaign, the BBC has agreed a deal with toy maker Fisher-Price to market products based on the show, which it hopes will emulate the popularity of the Tweenies. Under the terms of the deal, Fisher-Price will develop, manufacture and distribute a range of Fimbles products including soft, plastic and electronic learning toys for the UK and Ireland. In 2001, BBC Worldwide (the commercial division of the BBC) achieved sales of 90m from its childrens brands and properties last year. The demand created from broadcasting of the Fimbles and a major advertising campaign is likely to pull demand from children and encourage retailers to stock Fimbles toys in the stores for Christmas 2002.Difference Between Push And Pull StrategyPush merchandising is when you use various activities to get your message in front of your ideal client. The marketer is in control of what the message is, how it is seen, when and where. Marketing activities that encourage your prospect to seek you out and find out whether you have something of value to offer them. Pull marketing activities build relationships and can include blogging, podcasting, article marketing and networking (both on and offline).Pull marketing uses the law of attraction, incorporating all the components of your personal brand to attract and retain these large number as your biggest fan s. Pull marketing is where you develop advertising and promotional strategies that are meant to entice the prospect to buy your product or service. Some classic examples are half off or bring in this coupon to save 25% or buy one get one free, and so forthWith pull marketing, you are trying to create a sense of increased, time limited value so that the customer will come into your store to buy. Pull is not about pulling consumers in its about giving consumers a reason to pull us in. Remember truism 1 theyre in control they (not we) decide where they go and what they experience. Weve lost the right to pull consumers anywhere (if we ever really had that right at all.)Pull means that we to go to them, join their communities, give them reasons to voluntarily draw us into their personal media experiences. Were not interrupting them. Theyre opting into us.

An audit looking at how many patients are with thyroid dysfunction

An tushvass looking at how many diligents argon with thyroidalalalalal dysfunctionWhat is the function of thyroid gland and thyroid internal secretionsThe thyroid gland is located in the anterior part of the neck, attached to the thyroid cartilage. It consists of two lobes, approximately 5 cm each, that lie either lieu of the trachea joined in the middle by an isthmus. The thyroid gland is responsible for the production of three thyroid hormones Calcitonin (involved with calcium homeostasis), tonne (T4) and tetraiodothyronine (T3). Everyday, approximately 100 g of T3 and T4 are secreted 90% of which are in the form T4. Most of T4 is later converted to T3 in the liver and Kidneys. T3 is 10 generation more than active than T4. 1 The thyroid hormones are responsible for the nurse of basal metabolic evaluate.Expand?How is thyroidal hormone regulatedThe functional unit of the thyroid is the follicle. A spherical ar framement of secretory epithelial cells around a protein r ich colloid. It is at this cell-colloid boundary that thyroid hormones are form by iodination of thyroglobulin formed from tyrosine.1 The follicular cells are involved in active absorption of iodine from the plasma which is required for thyroglobulin synthesis. The formed thyroid hormone is stored in the colloid until its secretion is triggered by thyroid stimulating hormone from the anterior hypophysis which triggers the degradation of thyroglobulin in the follicular cells to release thyroid hormone.Thyroid hormone secretion is under the control of the hypothalamic-pituitary axis. The hypothalamus releases Thyrotrophin Releasing Hormone (TRH) which stimulates the anterior pituitary to secrete Thyroid Stimulating Hormone ( thyroid-stimulating hormone). The thyrotropin reaches the thyroid where it binds to the thyrotrophic hormone receptors on the surface of the follicular cell, stimulating it to produce and release thyroid hormones. The homeostasis of thyroid hormone concentration is maintained by a negative feedback loop whereby increase concentration of thyroid hormone inhibits Thyroid Stimulating Hormone release from the anterior pituitary by decreasing the affinity for TRH. This leads to a decrease in thyrotropic hormone create reduced amount of thyroid hormone to be released by the thyroid gland. This feedback loop enables us to monitor patients on thyroid hormone surrogate therapy (such as Levothyroxine) by measuring thyrotropic hormone levels. If for instance the overconfident social disease is insufficient, it would lead to inadequate inhibition of the pituitary gland and a raised serum thyrotrophin level. The reverse would occur with levothyroxine excess.() This crumb non be done in patients with secondary hypothyroidism. So what do we do then?Common pathologiesThyroid disease is the second closely common closureocrine disorder after diabetes. HypothyroidismHypothyroidism is defined as an underactive thyroid gland leading to decreased leve ls of T3 and T4. The annual incidence of hypothyroidism in the UK is 4 per 1000 in women and 0.6 per 1000 in men.3 Symptomatic hypothyroidism is known as myxodema. Hypothyroidism is categorised into primary quill and secondary. Primary hypothyroidism results from disease processes affecting the thyroid gland itself, slowly decreasing thyroid function and thyroid hormone production. Onset of symptoms is therefore gradual, developing over months or even years. Secondary hypothyroidism is relatively uncommon. Secondary hypothyroidism develops when the pituitary is unable to produce enough thyroid-stimulating hormone to induce enough T3 and T4 production from the thyroid gland. The social movements of secondary hypothyroidism stooge involve a pituitary tumour.Patients with hypothyroidism could present with a number of signs and symptoms including Tiredness Somnolence Slow cognition Cold Intolerance Depression Bradycardia W viii gain Calf stiffness Menstrual disturbance carpal tunn el syndrome Hearing impairment Dry, thin and pale skin Puffiness below the eyes BradycardiaThe most common cause of primary hypothyroidism in the UK is autoimmune thyroiditis. In Hashimotos thyroiditis autoantibodies are produced against thyroglobulin. This leads to inflammation of the thyroid gland as it is infiltrated by lymphocytes causing goitre formation. Hashimotos thyroiditis is remarkable in this respect that it initially causes hyperthyroidism as inflammation of the thyroid gland releases stored thyroxine. Once this released thyroid hormone is metabolised the patient progresses to normal and then a hypothyroid state. 1Other notable causes of hypothyroidism include4 Iatrogenic Radioiodine ablation or thyroidectomy as a intervention for hyperthyroidism Thyroiditis Subacute (de Quervains) thyroiditis Drugs Lithium, Amiodarone, thalidomide, rifampicin and sutinib as well as drugs used in the treatment of hyperthyroidism Iodine deficiency common in some developing countries but very rare in the western worldAt the opposite end of the spectrum lies Hyperthyroidism where there is increased Free T4 and a reduced level of TSH and has the opposite effect on the tree trunk than the one noticed in hypothyroidism e.g. tachycardia, heat intolerance etc. Hyperthyroidism is not covered further as this examine focuses on hypothyroidism.Diagnosis and treatmentSymptoms of hypothyroidism are quite non-specific and outhouse commonly occur with other medical conditions not related to the thyroid. Diagnosis of hypothyroidism therefore should not be made on clinical symptoms alone and it is essential to test thyroid function biochemically. This is done by measuring Thyroid Stimulating Hormone and Free Thyroxine (T4) in blood. The normal pen range of a function for TSH is 0.4 4.0 mU/Litre.4 A TSH level inside the normal propagation range has over a 99% predicted value to rule out primary hypothyroidism or hyperthyroidism.5In hypothyroidism the patient would prepare a high Thyroid Stimulating Hormone level, with or without a low Thyroxine level. Depending on thyroid function tests hypothyroidism is further divided intoa) Overt hypothyroidism patients with a high Thyroid Stimulating hormone level and a Low serum free Thyroxine (T4)b) Subclinical hypothyroidism Patients with a high Thyroid Stimulating Hormone but a normal Thyroxine (T4) levelTreatment depends on whether the patient has unde terminalined or subclinical hypothyroidism. Patients with overt hypothyroidism should be treated with Levothyroxine to render them euthyroid.5 According to NHS statistics 12 million Levothyroxine prescriptions were issued during 2006.6 The goal of the treatment is to reduce the TSH back to within the summon range. The dose of Levothyroxine is usually titrated up from 25-50 g daily however a recent trial has shown that this is unnecessary for most patients.7 The study recommended that patients with no cardiac symptoms should be started on the full dose of 1.6 g/kg.The following figure illustrates the algorithm for treatment of -pregnant adults with primary hypothyroidism4Algorithm for management of non-pregnant adults with primary hypothyroidism 4It is very key to monitor levothyroxine therapy as over or under prescription can be dangerous. Thyroid Stimulating Hormone (TSH) is the key method of monitoring levothyroxine therapy in patients with primary hypothyroidism. Un same(p) the thyroid function tests used to diagnose thyroid disease, free T3 and T4 levels are not very useful in monitoring treatment as their levels are influenced by the prescribed dosage of thyroid replacement hormone and are not accurate indicators of the individuals requirement. TSH without T3 and T4 is overly a cheaper test to carry out in General Practice. Current guidelines state that patients should contrive their Thyroid Stimulating Hormone level tested eight to twelve weeks after starting levothyroxine.4 The dose can later be fine tuned accordingly to get the TSH level in the lower one-half of the reference range.5 Besides monitoring TSH levels, an assessment of the patients symptoms should overly be made as some younger patients may need higher doses to relieve their symptoms in which case it is acceptable to have the TSH amongst 0.1-0.4 mU/Litre. The Quality and Outomes Framework (QOF) guidance suggests that all Patients on long term thyroid hormone replacement therapy should have their TSH levels tested yearly to make sure their replacement dose remains optimal.8Audit1. Reason for audit move it to the top to include the rest of the studyDespite the yearly TSH tests, studies have shown that a considerable number of hypothyroid patients managed in primary deal have TSH levels outside of the reference range. Okosieme et al reported that in 2009 information collected from 11 GP entrusts showed that 37.2% of the 1037 patients on the hypothyroidism register were inadequately managed.9When we get through into account the high pr evalence of hypothyroidism (9.3% in women and 1.3% in men)3 the results of the Okosieme et al study suggests that the total number of patients with suboptimal thyroid hormone replacement is significantly large.Imperfect thyroid hormone replacement could have damaging repercussions for health. It may adversely affect blood pressure, body weight and lipoid profile.Since the basal metabolic rate of the body is controlled by thyroid hormones it is perhaps not surprising that a decrease in thyroid hormone levels leads to a decrease in metabolic rate and thus can cause weight gain. Even in euthyroid subjects there is a negative correlation between free T4 and Body Mass index (BMI).10 This suggests that even a small under-prescription of thyroid hormones could, over a period of time, lead to obesity.Reduced Thyroxine levels in like manner cause a dyslipidemia characterised by increased Low Density Lipoproteins (LDL) and a decrease in High Density Lipoproteins (HDL) with normal or slight ly raised cholesterol levels.11 Such a lipid profile is associated with a higher risk of infection of atherosclerosis.The thyroid hormones also seem to have a role in blood pressure homeostasis as hypothyroid patients put down a higher systolic and diastolic blood pressure after stopping thyroid replacement therapy.12 then inadequate replacement may cause hypertension which, together with the dyslipidemia described above adds to the risk of atherosclerosis and its subsequent cardiovascular complications.Conversely, excessive thyroid hormone replacement has its own perils, having enhanced risk of atrial fibrillation, osteoporosis and fractures linked to it.Excessive thyroid hormone increases the risk of developing atrial fibrillation especially in older patients. Studies have shown that a low TSH level in patients over 60 years old have a threefold higher risk of developing atrial fibrillation.13 Patients over treated with levothyroxine also show increased loss of bone mineral put ting them at increased risk of osteoporosis.14 Subsequent studies have shown that patients with a suppressed TSH i.e. = 0.03 mU/Litre also had an increased risk of fractures however this was not observed in patients with low but unsuppressed TSH (0.04 0.4 mU/Litre).15This highlights the need for maintaining optimal thyroid hormone replacement in primary hypothyroid patients in the General Practice setting to reduce the above mentioned risk factors. The 11 GP practices used by Okosieme et al showed that there is significant room for improvement as one third of the patient population on levothyroxine had TSH levels outside the reference range.0.11Thus this is a worthwhile area for audit to establish on-going standards of care in our practice, Dr Dean Partners, Heald Green Health Centre. Since this audit has not been carried out to begin with in the practice it would give an idea of how well the practice manages patients on thyroid hormone replacement therapy. The suggestions for i mprovement would be beneficial to the patients of the practice and baron also help with driveing QOF points.This audit would also be beneficial to me personally introducing me to the concept of audit calendar methods and giving me the opportunity to conduct my very first audit. It would also help me get a better understanding of management of hypothyroid patients which is the second most common endocrine disease in the UK after diabetes mellitus.2. Criteria to be calculatedSerum Thyroid Stimulating Hormone is used as the gold standard for biochemically diagnosing hypothyroidism and monitoring thyroid hormone replacement therapy.4 The reference range indicating adequate replacement is usually around 0.4 4.0 mU/Litre.4, 9 withal this figure slightly varies according to local guidelines. For this I have chosen to use TSH between 0.1 4.0 mU/Litre as a reference range for adequate thyroid hormone replacement as this is the reference range used by the local Primary Care Trust (Step ping Hill Hospital) and the practice.Patients with primary hypothyroidism on thyroid hormone replacement therapy should have a TSH level between 0.1 4.0 mU/Litre.3. Setting standardsFor setting the standard I have found that there are no specific guidelines stating what proportion of patients should be achieving the above mentioned criteria. There are no NICE guidelines for the treatment of hypothyroidism. The QOF guidance states that patients should have their TSH levels tested yearly but it does not state the standard of care required.Having discussed this with GP at the practice I have decided that a theoretically ideal standard i.e. 100% of patients watching the above criteria would be very impractical in theory from a resources perspective. Given the fact that suboptimal thyroid hormone replacement could be harmful, it is nonetheless important to achieve a high standard of care. accordingly I have decided on an optimum standard90% of patients with primary hypothyroidism on t hyroid hormone replacement therapy should have a TSH level between 0.1 4.0 mU/Litre.4. Preparation planningBefore starting the audit I had a discussion with the GP teach about worthwhile areas for audit. As I had never conducted an audit before he explained the audit cycle. As thyroid dysfunction was an area of reside for me I suggested undertaking this audit. The GP tutor agreed that this would be a useful area for audit and advised to me to review the literature to find out if it would be an appropriate audit from a clinical point of view and was an area where practice could be improve. After preliminary reading clinical reviews I formulated a step by step template of the things I felt should be covered and got the GP tutors approval to go ahead.The data was collected with the help of the GP tutor. As the practice keeps electronic records of all patients, EMIS Population manger search function. Using the search function we identified all patients who had been prescribed thyro id hormone replacement medication for the past 12 months. We then identified patients who in the past 12 months had had their TSH levels tested. We then selected patients who had a TSH =0.1 mU/Litre and TSH =4. Subtracting the number of patients which meet the TSH search parameters from the total number of patients on thyroid hormone replacement would give us the number of patients who were outside the reference range of TSH.5. Initial data collectionCriterion Number of Patients taking thyroid hormone replacement medication (n) Number of Patients with TSH levels within reference range Standard (%)Patients with primary hypothyroidism on thyroid replacement therapy should have a TSH level between 0.1 4.0 mU/Litre. 206 167/206 (81%) 90%DiscussionResults what they are. How close to the standard. be they good enough? (no, didnt meet the standards). Why didnt they meet the standard?Merge results discussion with limitations discussionThe data collected shows that the current practice is 9% below the standard set. The standard required i.e. 90% of patients with primary hypothyroidism on thyroid hormone replacement therapy should have a TSH level between 0.1 4.0 mU/Litre. However this was the case with only 167 patients (81%). This means that 39 patients (19%) did not meet the standard set.There could be several reasons why the results did not meet the standards set. One factor influencing TSH levels is the use of medicines which interact with thyroid function. Due to the limitations of the package used in data collection (as discussed below) we were unable to exclude patients who were on medication known to interact with thyroid function such as Amiodarone, Lithium, etc. Amiodarone, a fairly commonly prescribed drug to prevent arrhythmias, can cause deranged thyroid function as it contains iodine (37mg of iodine in 100mg of Amiodarone). This can cause a severe iodine overload and can lead to hypothyroidism as well as thyrotoxicosis.0.16 Inclusion of such patients would bring the percentage down unfairly because management of such patients is a lot more complex and the TSH levels are not always a good indication of the adequacy of their thyroid hormone dosage. Patients with hypothyroidism due to Amiodarone are monitored by their Free T4 levels instead of TSH. 0.16Another factor which could have contributed to the high number of patients with TSH levels outside those defined in the criteria is the possibility that patients with unnatural TSH levels oft dont get their levothyroxine dose optimised. A study published in 1995 reported that at one GP practice in Suffolk 71% of patients with abnormal TSH levels did not have their medication dosage change as a result.17If patients do not have their thyroid hormone replacement optimised as a result of abnormal TSH not only does it defeat the purpose of carrying out yearly TSH tests, it also means that these patients would fall out to have an abnormal TSH when tested again. Currently we do not have the data to find out how many of the patients in our practice with abnormal TSH had not had their dose changed after a previous abnormal TSH in an attempt to bring it within the reference range condition in the criteria.Ranging from poor patient compliance to the way the data has been collectedLack of dose adjustment after abnormal TSHThe way results were collected. Limitations of software used. Limitations of the results collected ie things missed how many patients actually had test done in the last 12 months (QOF points). How many were over and how many were under prescribed.This audit has limitations. The data was collected from electronic records using the EMIS Population Manager. The limited search algorithms of the software meant that we couldnt distinguish patients with a TSH below the reference range from those above it. All we were able to obtain was a single figure of how many citizenry were within the reference range.Due to the limitations of the EMIS Population Manage r software we were also unable to test how many patients with hypothyroidism had actually had their TSH levels tested in the past 12 months as stated in the QOF guidance 2004.8 Thyroid Function Tests are done for a large number of patients whose symptoms are actually caused by a non-thyroid illness. Due to this reason we could not search for people who had their thyroid function tested in the past 12 months as that data would have included a lot of non-hypothyroid patients. Instead we had to search for patients who had been prescribed levothyroxine therapy in the past 12 months. And then further narrow the search parameters TSH levels in the past 12 months to obtain the data. This meant that the people who have not had their thyroid functions tested in the past 12 months were excluded from our data. The positive aspect of only testing people within the last 12 months is that the data reflects current level of care.The data collection software shows patients as being within the norm al TSH range if they have had at least one TSH test within the normal range during the last 12 months. If the patient has been started on levothyroxine therapy recently their TSH levels wouldnt have had enough time to communicate to normal. However this is likely to be statistically insignificant.The way to get round these limitations of the EMIS Population Manager would have been to study the clinical notes of all patients who were prescribed levothyroxine in the past year. By looking at the notes we would be able to exclude patients who are unsuitable for the purpose of this audit i.e. those patients in whom the TSH level is not a valid indicator of thyroid hormone requirement e.g. those on Amiodarone or lithium or patients with secondary hypothyroidism. Looking at the notes would also allow us to collapse the number of patients who had not had their TSH levels tested in the past year. Reading through the notes would also allow us to obtain more information such as age gender et c which might be helpful in indentifying some of the factors responsible for suboptimal thyroid hormone replacement. However reading the notes of over 206 patients would have taken a considerable amount of time. Since this was my first audit I decided to avoid gathering qualitative data and decided that the using electronic records would be sufficient for the purposes of this audit.Changes to practice to hit the target. Tietable to implement that change and when to re-audit? Practicality, why change? Positives and negatives of changing.There are a a couple of(prenominal) approaches which could potentially be taken to improve the standard of care.In order to improve the standard of care to meet the goal of 90% all patients on the hypothyroidism register should have yearly or six monthly blood tests to measure their TSH levels. all patients with abnormal TSH levels should be invited for an appointment with the GP and should be considered for a change in their current dosage. This wou ld be a good opportunity to assess why their TSH levels are abnormal and check that the patient is adhering to the prescribed treatment regimen. If the dose remains unchanged the reason should be recorded in the notes so that the information is available for the second cycle of the audit.Doing this will allow us to make sure that patients are kept at the optimum dose of levothyroxine to reduce the risks associated with under or over prescription. visual perception patients like this would however increase the workload placed on the surgery and its resources. However by talking the patients as and when they have their TSH levels tested the variate on the resources would be spread out over a year. Since the current audit identified 39 patients with abnormal TSH levels, this would mean an extra 3-4 patient appointments per month over the period of a 12 months. This should be discussed at the doctors meeting. Twelve months after the implementation of the change of practice a second dat a collection should be done to complete the audit cycle and evaluate the impact, if any, the change in practice has had on the management of hypothyroid patients.Write to the patients to invite them to lessen in for a dose adjustment?Consider collecting better data by reading the notes. That would take too long.Consider specialist referral if symptoms persist.What have I learned 1 about the condition, 2 about auditing.Conducting this audit has given me the chance to take an in-depth look at all aspects of hypothyroidism which has been an area of interest for me for some time. In the course of researching for the audit I have been able to review various guidelines, clinical reviews and other journal articles. Not only has that improved my understanding of the management of thyroid disease in primary care immensely. It has given me a sense of how a condition is followed through in everyday practice from first presentation to treatment to long term management.I have also realised tha t management of chronic conditions such as hypothyroidism is an current process as the patients condition and requirements change continuously for instance if their body mass index changes significantly their thyroid hormone requirements would also change and the dose would have to be altered. Also if a patient is planning on or has become pregnant they would need to be referred to specialist endocrinologists. I have been able to review the evidence which forms the basis of current practice. Researching this topic by reading clinical reviews has made me realise the advantages of using original literature and how a lot beneficial it can be in achieving a comprehensive understanding of a topic.Being involved in a general practice standard-based audit has enabled me to learn about the role and significance of audits in healthcare. I have become familiar with the audit cycle and its different steps. Having conducted an audit myself, I can see the important role audits have in measurin g and improving practice. It is a systematic way of monitoring standards of care and is very useful in facilitating change of practice through an evidence based approach. It has also allowed me to learn how to quickly and efficiently find relevant papers using such resources as ISI Web of science and medline.Conclusion and summaryTimetable change re-audit6. Description of change7. Data collection (2)8. conclusionsbe almost impossible to achieve due to variables like poor patient compliance or use of interactive medications e.g. Amiodarone and Lithium. It would also be vastly impractical from a reasources point of view to count on for a 100% standard.