Human Resource Learning and Development(Reflective Learning Critique ) Essay

Human Resource Learning and Development(Reflective Learning Critique ) - Essay Example 217) Socio - Psychology depicts human beings as social animals, seeking and learning from experience, through observation, cognition and reflective processing of mankind. In theory, it enhances the human thinking and inculcates the notion that we; the social animals, adapt to changes in society and learn as the society evolves. The learning experience is one which is a never ending process, one that defines our very existence (Hassan, 2007). According, to the Swiss Biologist, Jean Piaget, when human beings are born, they know nothing; they have no mental or verbal skills. However, with experience they learn and adjust themselves in the very society they live in. According to the literature, one uses each experience either positively or negatively; completely ignoring it would not make it an experience (Jarvis, 2003). A constructivist learning environment is a place where people can draw upon resources to make sense out of things and construct meaningful solutions to problems. It emphasizes the importance of meaningful, authentic activities that help the learner to construct understanding and develop skills relevant to solving problems. The literature and theories that we have analyzed and fathomed have given a more profound understanding to the learning process that one takes for granted but which leaves a strong impact on our persona and psyche. The models we studied provided a valuable insight into analyzing my experience and use it as constructively I can. My experience is one which is holistically simple but taken in a reductionist perspective, one can see how, I have learned from it (Mathis & Jackson, 2004). The transition from a high school, to a university is a crucial experience in a student’s life, I was no exception. In school we are used to being given structured lectures, supervised assignments, or study at the end of the term. In

A Discussion of Obamacare Essay Example for Free

A Discussion of Obamacare Essay Over the course of my paper I shall discuss the piece of legislation known as the Patient Protection and Affordable Care Act, more informally known as Obamacare. The issue currently debated with this piece of legislature focuses on its constitutionality, its purpose as a tax hike, and whether or not it should be passed. Is the Patient Protection and Affordable Care Act unconstitutional? From what I have studied in the article â€Å"Is Obamacare unconstitutional? †, at debatetopics. net, and from what I know of the act, I would say that it is certainly unconstitutional. Does the act serve as a tax hike? According to â€Å"Voters consider ObamaCare a tax hike, poll shows† at foxnews. com, it does. Should the Patient Protection and Affordable Care act be passed? From everything I have learned of the act and from what knowledge I have gained from â€Å"Patterson: State leaders should refuse to allow Obamacare to localize† at masnbc. com, I personally would not allow the act to pass. The act is unconstitutional as it was passed under a false premise. It was upheld as constitutional by justifying the individual mandate as a tax. However, it would never have been passed if it had been upfront in regards to creating a new personal tax. The means used to justify the act as constitutional are inconsistent with the original wording of the bill and therefore unconstitutional. The act is also passed under a false premise as it creates a new tax and is therefore a tax bill. Those living in the country illegally are exempt from buying health insurance and get it for free. Those individuals who are currently considered â€Å"entitled† and receive government aid are also exempt. These illegal immigrants and entitled persons will receive free healthcare and the rest of the country will have to pay for it. The act is also unconstitutional in regards to the individual mandate itself. It is not up to the government to make its citizens purchase health insurance, nor should they pay for the health insurance of others. It is up to no other person to give a given individual anything. There should never a case in which one group of people is forced to care for others because those others refuse to do anything with themselves and their lives. The act is clearly unconstitutional as it forces the average United States citizen to purchase a service from a private firm or be penalized for not doing so. The fine attached to not purchasing health insurance is also only considered constitutional under Congress power to tax. A main way of denying Obamacare is to refuse to establish state-level health exchanges. Exchanges are basically government sanctioned cartels where only a few government approved insurers can sell government approved health insurance, including all subsidies, exemptions and mandates that they apply. When agreeing to establish an exchange, a given state agrees to operate a massive government program which would be run according to federal rules and mandates. The federal government would control the doctors and providers allowed, the health insurance plans and benefits, the subsidies and exemptions. The state would do the work of the federal government and bear the cost of the program and would also act as an IRS enforcer as it would be required to give the names and taxpayer identification numbers of people who have changed employers and lost coverage as well as those who have terminated their coverage or simply choose not to purchase insurance. On top of all of this, the state would be responsible for enforcing the individual mandate. Overall, the Patient Protection and affordable care act is unconstitutional, serves a tax hike and should not be passed under any circumstance. Bibliography: â€Å"Is Obamacare Unconstitutional? †,2012, â€Å"Voters consider ObamaCare a tax hike, poll shows†,2012, â€Å" Patterson: State leaders should refuse to allow Obamacare to localize†,2012,

The Police Exception And The Domestic Abuse Law Essay -- essays resear

The Police Exception and the Domestic Abuse Law Beating a spouse is wrong. Fighting is wrong. Domestic Abuse is wrong. This is a very simple concept and lawmakers, police officers, and citizens of our country for years have been in majority agreeance with these concepts. One of the punishments our government has come up with for convicted domestic abusers is revoking the privilege to carry weapons in public. This prevents convicted abusive citizens from having the ability to tote a potentially murderous weapon around, at any time ready to be assistance to their destructive and unstable personalities' wishes. Police amendended. Officers have recently been added to the list of people who are not allowed to carry guns in public if they have been convicted of Domestic Abuse. Some precincts are outraged, however this seems to be the proper law and should stay as it is Law officers are human, and just like everyone else, they make mistakes. An up- and-coming officer could get in a skirmish at the local bar and be charged with Domestic Abuse. This same officer could become one of the most effective law enforcers in the country. With this law, this officer would not be allowed to continue his services for his county and his fellow police officers. Many people feel that this officer is being done a great injustice and should be allowed to continue his otherwise flawless career as an officer of the law. Interesting. One simple conviction could ruin the lives of every cop in the cou...

A Paper on Listening Skills

In today’s life we find it a bit difficult to make important decisions or to perform the tasks in a shorter span of time because we are used to taking our time in analyzing and understand the situation and then acting on it.But on the other hand, the need to be agile and alert is very important these days; and it depends on us how to manage our time and activities. The paper would talk about the skills of listening in detail by first introducing it, then the need of active listening, barriers to active listening, and tips for active listening.There is a significant difference between hearing and listening; hearing is natural process where as listening is a skill. We hear everything ranging from traffic noise to our friend’s voice over telephone, but listening deals with the hearing where we actually understand it and make sense out of it. We might be hearing but we might not be listening. Now let’s discuss the importance of active listening skills.Importance of L istening SkillsWhether it is our daily routine life or our working life, active listening has become so much important for us to remember the facts and things because information is bombarded to us from various sources.Talking about the working environment, active listening can make employees more productive and effective in their work; not only this, there are several other reasons that emphasize the importance of active listening. Employees would be able to understand the assignments in a better way; build up good relationships or rapport with the supervisors, customers, or with other co-workers; perform better when working in teams or groups; resolve problems or complex tasks effectively; manage time efficiently; and answer the questions to others at a later stage when required.Barriers to Listening and Ways to improve itMany students and employees forget the information imparted in the lecture or any meeting because they make certain mistakes while listening; however, they try t o listen actively but some mistakes while listening can put all their effort in vain.First of all, listeners must be neutral and put aside all their biases, prejudices, or emotions attached to a particular matter being discussed. Such biases keep the listener from understanding the gist of the topic being discussed under a certain situation or cause.Secondly, listeners must try focusing on the speaker’s words and not his way of speaking, dressing, color, physique, or accent. Many listeners often trust the speaker who speaks confidently and is well-dressed, even if he or is not accurate or true in his speech.

Essay on Charge of the Light Brigade

How is inner and outer conflict represented in ‘Romeo and Juliet’ and ‘the charge of the light Brigade’? Whereas ‘Romeo and Juliet’ contains a lot of inner conflict as well as outer conflict, Lord Tennyson’s ‘Charge of the light Brigade’ contains many techniques to enhance the conflict as well as glamorise the ‘light Brigade’ in various ways. Tennyson presents the cavalry men of the Crimean war (1854- 1856) as great victors and a powerful army. This glorious army is bragged about in the form of a poem by Tennyson.Imagery is one of the techniques which Tennyson uses to build the conflict up as a picture to let the audience visualise the conflict on the battlefield. He talks about the dangers the light brigade are up against as well as enemies, ‘cannon to the right of them, cannon to the left of them, cannon in front of them’ the light brigade are in a perilous position, the repetition of the phrase â €˜cannon’ nearly creates a picture in the audience’s mind of the cannons and dangers the light brigade are up against.This is a sense of outer conflict due to the fact that they are cavalry men with spears up against guns and cannons. In addition to this construction of imagery in the audience’s mind Tennyson uses metaphors to describe the walk of the light brigade into their deaths. ‘Into the valley of Death rode the six hundred’, The phrase valley of death indicates that the army is going to die, how ever the inner confliction here is that the army knows they are going to die, they almost walk into valley of death.The valley of death is probably a monument or a place where many others have fallen or a place of bereavement or a great genocide, this line is repeated at the end of every stanza but is varied eventually towards the end of the poem. Rhythm is also a technique which Tennyson expresses through out most of the poem for effects on the au dience. Repetition is also present in this poem on top of the regular fast-paced rhythm to poem. This regular fast paced rhythm is created by regular number of syllables in the lines, end rhymes (rhyming couplets), repetition of line structures and words along with repetition of variation of last line.For example the last line of the first couple of paragraphs is ‘Rode the six hundred’ which continuously repeats itself through out the poem however as soon as the audience approaches Stanza 4 they will all realise that it says ‘ they rode back, but not the six hundred’ this is almost the climax of the poem when the audience will start to realise that the light brigade are slowly diminishing in number, they are starting to be defeated in battle. This variation of the last line of stanza 4 tells the audience that the Light brigade are perishing in battle and are not the heroes they were at the beginning of the poem.So rhythm plays a huge part in the understandi ng of the poem, as well as enhancing the poem. As well as rhythm, Onomatopoeia also enhances the poem, to glamorise each stanza and increase the heroism of the light brigade and enliven the dangers and enemies the light brigade come across, ‘Volley'd ; thunder'd; Storm'd at with shot and shell’ the light brigade are being shot at and they are on the battlefield, the Phrases ‘volley’d’ and ‘Thundered’ emphasise the situation of the stanza and more or less make it easier for the audience to imagine the battlefield and the situation of the stanza.The conflict is shown through the Onomatopoeia and the way they emphasise the understanding the stanza and help with the imagination of the enemies. Sound also plays a huge part in the enhancement of the understanding and imagery of the poem, for instance ‘Shatter'd & sunder'd’ tell us how they were attacking or what their surrounding sounded like, this physical conflict is emphasised by the sounds and the words that describe the action and scenery.In total there are 6 stanzas (amazing fact), but did you know that each stanza has its own theme, for example the theme of Stanza 1 is ‘A league of their own’ or the theme of stanza 4 is ‘the fall’, the transition from stanza 1 to stanza 4 is almost a whole journey, the audience would have seen the heroism and then the fall of the brave soldiers. The themes help to build up the poem and the climax, this plan is a general base for the audience to know what to expect in each of these stanzas. The conflict is built up slowly over each stanza and then finally publicized.Duty and obeying in ‘Romeo and Juliet’ is one of the similarities as of ‘The charge of the light brigade’, in this case Juliet must obey her parents orders but most of all her fathers, for during those times it was a patriarchal society, so when her father asked her hand in the marriage of her and paris, s he had to obey, but she could not, due to her strong love for Romeo, this conflict against the order of the ‘boss’ of the house, this failure to follow orders will result in a loss, in Juliet’s case she will lose the love of her father and presumab y her mothers as well, her father will disown. Juliet will live but this is not the case for the light brigade, they must follow the orders of their commander, and if they refuse to follow orders, then it is a possibly different case, they would probably be Court Marshalled, this procedure will most probably end their lives. This commander made decisions and gave orders with out realising the dangers up ahead.This conflict, Either physical or inner, is shown through the Enhancers of the poem as well as the actions of the characters, these are represented in the most common of ways, Duty and obligation are common but not the consequences, both the poem and the play contain inner conflict, the inner conflict in ‘Ro meo and Juliet’ is shown through the words of Romeo and his inner confusion if this is his true love, and ‘the Light brigade’ must follow orders even if they wish other wise.Conflict overall is easier to identify in the light Brigade and is mostly outer and physical conflict which is emphasised by the techniques which glamorise the ‘light Brigade’ this glamorisation is the factor to which makes the Soldiers look like heroes. Essay word count: 1096

Questioning the Madness of Hamlet Essays

Questioning the Madness of Hamlet Essays Questioning the Madness of Hamlet Essay Questioning the Madness of Hamlet Essay Essay Topic: Hamlet Questioning The Madness of Hamlet In the Shakespeare play, Hamlet, there is the question concerning the madness of the main character, Hamlet. There is no real answer to the question, â€Å"Is Hamlet mad†? It is merely based on ones own opinion and interpretation of the play. Although, Hamlet might display qualities of someone mad, is there enough proof to make the statement factual? First, we should look at the definition of what mad really means; According to Dictonary. com, Mad means to be mentally disturbed, deranged, insane, or demented. Considering there is evidence that it is possible Hamlet could actually be mentally disturbed, there is definitely proof that he is just pretending. Hamlet openly admits that he pretends to be deranged, but why is he pretending? There also is proof that he is still logical and reasonable with his decisions, which doesn’t fit the description of the word mad. There are many characters in the play who seem to have evidence that Hamlet is mad, that is just his master plan working. Losing your father and learning that your new father, your uncle, is a murderer would definitely make one lose their reasoning to stay sane. Hamlet had a game plan to seek revenge for his father and it started with having society fooled by making them believe he was a mad man. Starting from the beginning, Hamlet showed anger towards the events that had taken place. Hamlets first solilioquy is where he expresses his feelings and thoughts for the first time about the events. As Hamlet says, O that this too too sullied flesh would melt,/ Thaw, and resolve Itself into a dew,/Or that the Everlasting had not fixed/ His Canon ‘gainst self- slaughter (1. 2. 129-132). Clearly his thoughts here are unlike normal thoughts, but that does not mean he is mad. He talks of suicide and wanting to disappear, but looking at what is happening in the play, anyone of a sane mind wouldn’t want to be around to witness such events. When someone is angry they vent and say stuff that they don’t mean, and that is just what Hamlet is doing. If he wanted to commit suicide, that is just what he would have done. Throughout the play, a presence of a ghost keeps appearing. Does seeing this ghost make Hamlet a mad man? As Horatio says, Two nights together had these gentlemen,/ Marcellus and Barnardo, on Their watch/ In the dead waste and middle of the night/ Been thus Encountered. A figure like your father,/ Armed at point exactly, Cap-a-pie,/ Appears before them and with solemn march/ Goes slow and stately by them (1. 2. 196-202). Well considering that Horatio, Reynaldo, Barnardo, Francisco and Marcellus all saw the ghost along with Hamlet, they would all have to be mad men as well. This is not valid proof that Hamlet is a mad man. It wasn’t a figment of his imagination, the ghost had to be seen in order for all the men to witness the same thing. After seeing the ghost he fills Hamlet in with all the details of his death, Hamlet begins to lay out his plan with steps. He warns his friends of his antic disposition. Hamlet says, â€Å"As I perchance hereafter shall think meet / To put an antic disposition on† (1. 5. 174-175). â€Å"Antic† actually means clown, which means he’s going to put on a show from now on and pretend is he insane. Why would Hamlet pretend to be insane one might want to ask? Well Hamlet wants to show weakness to King Claudius so that he won’t take him as a threat. Hamlet wants to distract the people of Denmark from his real intentions and that is to seek revenge for his father. If it weren’t for Hamlet pretending his madness, King Claudius would have known that something was wrong with his nephew, and surely he would have him killed. If Hamlet didn’t act the way he was, then the King would have seen it in Hamlets eyes that he knew the truth about his father’s death. If you really think about it, today if someone claims they are crazy, the majority will get away with it. If you are believed to be mad, than you can pretty much get away with anything. It was a well thought out plan that only a genius could have thought of. His plan seems to work as he has convinced Polonius that he is a mad man. A conversation between Hamlet and Polonius starts and he ask Hamlet if he knew him. Hamlet responds with, â€Å"Excellent Well. You are a fishmonger† (2. 2. 174). Considering that Polonius is the Kings pet spy, he pretends he doesn’t know who Polonius is. At the same time, he almost makes fun of him. A â€Å"fishmonger† is slang for pimp, which is just what Polonius is to his daughter, Ophelia. Readers may assume that Hamlet is mad, because it is not obvious that Hamlet is pretending, because he does not remind us of his plan of antic disposition The scene of the play where Hamlet shows a perfect example that he still makes logical and reasonable decisions is when he sets up a play to catch the King red handed. In a conversation with Horatio, he tells him to watch the Kings expressions. There is a play tonight before the king. / One scene of it comes near the circumstance / Which I have told thee, of my father’s death. / I Prithee, when thou seest that act afoot, / Even with the very comment of thy soul / Observe my uncle. If his occulted guilt / Do not itself unkennel in one speech,/ It is a damned ghost that we have seen, / And my imaginations are as foul / As Vulcan’s stithy. Give him heedful note, / For I mine eyes will rivet to his face, /And after e will both our judgments join / In censure of his seeming. He simply made a scene in the play that is the exact way his father was killed. From doing this, he hopes to see some sort of reaction out of the King. If he does that, what the ghost had told him is true. Hamlet had great ideas to catch the King. Anyone who is mentally unstable, insane, or demented couldn’t have came up with such a logical way to catch the King red handed. There is just too much evidence in the play that Hamlet is pretending his madness. He simply states his plan of â€Å"antic disposition† and his plan works. So much so that even the readers that know the dramatic irony of his plan still believe that there is a possibility that he is mad. Such events that happened through out the story can definitely leave someone with their reasons, but not Hamlet. He holds to his plan, making sure the King truly indeed did do it and making everyone believe his â€Å"antic disposition. † Even though the killing of the King was not the type that Hamlet probably wished for, revenge was seeked. Work Cited Shakespeare, William. Hamlet. Penguin Group (USA) Inc: Penguin Group. 2001 mad. Dictionary. com Unabridged. Random House, Inc. 12 Sep. 2012. .

Free Essays on Response To Revolution

Response to Revolution Response to Revolution, by Richard E. Welch Jr., is an honest and unbiased look at America’s policy towards Cuba during the Cuban Revolution. It covers the general history of and preconceived notions about the revolution in depth and gives ample attention to both sides of the relationship between the U.S. and Cuba. In addition to this Welch analyzes the reactions of America’s various factions during the early years of the revolution. Upon taking this into a change of the status quo, and of one that only played the international game of politics on its own terms. The general idea underlying Response to Revolution is the evolution of the U.S.’s opinion of the Cuban revolution from good to bad. Yet to understand this, the author shows that it is first important to understand the events and attitudes that took place between the U.S. and Cuba in the years between 1958-1961. At the onset of the Cuban revolution we find that the U.S. government supported the Batista regime and that while it was technically a democracy it reinforced bitter class differences. Eventually various factions united under Castro and the Batista government was overthrown. While the United States for the most part stayed out of this war and even cut off arm sales to Batista before his overthrow, Welch shows that by then it was to late for the U.S. to ever create a good relationship with Cuba. The reason for this is that the years of and U.S. dominated Cuban economy, combined with the troublesome Platt Amendment, fueled the fire of class differences and created in Castro’s mind a distrust of U.S. involvement in Cuba. However, while Castro’s anti-American stance no doubt hindered relations with the U.S., it was more the fault of the Eisenhower and Kennedy presidencies reluctance to offer aid outright to Castro and accept change in Cuba. This unwillingness of Castro to adhere to the U.S. standard or democracy in turn led to u... Free Essays on Response To Revolution Free Essays on Response To Revolution Response to Revolution Response to Revolution, by Richard E. Welch Jr., is an honest and unbiased look at America’s policy towards Cuba during the Cuban Revolution. It covers the general history of and preconceived notions about the revolution in depth and gives ample attention to both sides of the relationship between the U.S. and Cuba. In addition to this Welch analyzes the reactions of America’s various factions during the early years of the revolution. Upon taking this into a change of the status quo, and of one that only played the international game of politics on its own terms. The general idea underlying Response to Revolution is the evolution of the U.S.’s opinion of the Cuban revolution from good to bad. Yet to understand this, the author shows that it is first important to understand the events and attitudes that took place between the U.S. and Cuba in the years between 1958-1961. At the onset of the Cuban revolution we find that the U.S. government supported the Batista regime and that while it was technically a democracy it reinforced bitter class differences. Eventually various factions united under Castro and the Batista government was overthrown. While the United States for the most part stayed out of this war and even cut off arm sales to Batista before his overthrow, Welch shows that by then it was to late for the U.S. to ever create a good relationship with Cuba. The reason for this is that the years of and U.S. dominated Cuban economy, combined with the troublesome Platt Amendment, fueled the fire of class differences and created in Castro’s mind a distrust of U.S. involvement in Cuba. However, while Castro’s anti-American stance no doubt hindered relations with the U.S., it was more the fault of the Eisenhower and Kennedy presidencies reluctance to offer aid outright to Castro and accept change in Cuba. This unwillingness of Castro to adhere to the U.S. standard or democracy in turn led to u...

Why the Illinois v. Wardlow Case Still Matters Today

Why the Illinois v. Wardlow Case Still Matters Today Illinois v. Wardlow is not a Supreme Court case that most Americans know well enough to cite by name, but the ruling has made a serious impact on policing. It gave authorities in high-crime neighborhoods the green light to stop people for behaving suspiciously. The high court’s decision has not only been linked to a rising number of stop-and-frisks but to high-profile police killings as well. It has also been held responsible for creating more inequities in the criminal justice system. Does the 2000 Supreme Court decision deserve the blame? With this review of Illinois v. Wardlow, get the facts about  the case and its consequences today. Fast Facts: Illinois v. Wardlow Case Argued: November 2, 1999Decision Issued:  January 12, 2000Petitioner: State of IllinoisRespondent: Sam WardlowKey Questions: Does a suspect’s sudden and unprovoked flight from identifiable police officers patrolling a known high-crime area justify the officers stopping that person, or does it violate the Fourth Amendment?Majority Decision: Justices Rehnquist, OConnor, Kennedy, Scalia, and ThomasDissenting: Justices Stevens, Souter, Ginsberg, and BreyerRuling: The officer was justified in suspecting that the accused was involved in criminal activity and, therefore, in investigating further. There was no violation of the Fourth Amendment. Should Police Have Stopped Sam Wardlow? On Sept. 9, 1995, two Chicago police officers were driving through a Westside neighborhood known for drug trafficking when they spotted William â€Å"Sam† Wardlow. He stood beside a building with  a bag in hand. But when Wardlow noticed the police driving through, he broke into a sprint. After a brief chase, the officers cornered Wardlow and frisked him. During the search, they found a loaded .38-caliber handgun. They then arrested Wardlow, who argued in court that the gun shouldn’t have been entered into evidence because the police lacked a reason to stop him. An Illinois trial court disagreed, convicting him of â€Å"unlawful use of a weapon by a felon.† The Illinois Appellate Court reversed the lower court’s decision, asserting that the arresting officer didn’t have cause to stop and frisk Wardlow. The Illinois Supreme Court ruled along similar lines, arguing that Wardlow’s stop violated the Fourth Amendment. Unfortunately for Wardlow, the U.S. Supreme Court, in a 5-4 decision, reached a different conclusion. It found: â€Å"It was not merely respondent’s presence in an area of heavy narcotics trafficking that aroused the officers’ suspicion but his unprovoked flight upon noticing the police. Our cases have also recognized that nervous, evasive behavior is a pertinent factor in determining reasonable suspicion. ...Headlong flight- wherever it occurs- is the consummate act of evasion: it is not necessarily indicative of wrongdoing, but it is certainly suggestive of such.† According to the court, the arresting officer hadn’t misstepped by detaining Wardlow because officers must make commonsense judgments to decide if someone is behaving suspiciously. The court said that its interpretation of the law did not contradict other rulings giving people the right to ignore police  officers and go about their business when approached by them. But Wardlow, the court said, had done the opposite of going about his business by running away. Not everyone in the legal community agrees with this take. Criticism of Wardlow U.S. Supreme Court Justice John Paul Stevens, now retired, wrote the dissent in Illinois v. Wardlow. He broke down the possible reasons people might run when encountering police officers. â€Å"Among some citizens, particularly minorities and those residing in high crime areas, there is also the possibility that the fleeing person is entirely innocent, but, with or without justification, believes that contact with the police can itself be dangerous, apart from any criminal activity associated with the officer’s sudden presence.† African Americans, in particular, have discussed their distrust and fear of law enforcement for years. Some would even go so far to say that they have developed PTSD-like symptoms because of their experiences with police. For these individuals, running from the authorities is likely instinct rather than a signal that they’ve committed a crime. Additionally, former police chief and government official Chuck Drago pointed out to Business Insider how Illinois v. Wardlow affects the public differently based on income level. â€Å"If the police are driving down a middle-class neighborhood, and the officer sees someone turn and run into their house, that’s not enough to follow them,† he said. â€Å"If he’s in a high-crime area though, there may be enough for reasonable suspicion. It’s the area he’s in, and those areas tend to be to impoverished and African American and Hispanic.† Poor black and Latino neighborhoods already have a greater police presence than white suburban areas. Authorizing police to detain anyone who runs from them in these areas increases the odds that residents will be racially profiled and arrested. Those familiar with Freddie Gray, the Baltimore man who died in police custody in 2015 after a â€Å"rough ride,† argue that Wardlow played a role in his death. Officers apprehended Gray only after he â€Å"fled unprovoked upon noticing police presence.† They found a switchblade on him and arrested him. However,  if the authorities had been prohibited from pursuing Gray simply because he fled from them in a high-crime neighborhood, he may very well still be alive today, his advocates argue. News of his death sparked protests across the country and unrest in Baltimore. The year after Gray’s death, the Supreme Court decided 5-3 in Utah v. Strieff to let police use the evidence they’ve collected during unlawful stops in some circumstances. Justice Sonia Sotomayor expressed her dismay at the decision, arguing that the high court has already given the authorities ample opportunity to stop members of the public for little to no reason. She cited Wardlow and several other cases in her dissent. â€Å"Although many Americans have been stopped for speeding or jaywalking, few may realize how degrading a stop can be when the officer is looking for more. This Court has allowed an officer to stop you for whatever reason he wants- so long as he can point to a pretextual justification after the fact.â€Å"That justification must provide specific reasons why the officer suspected you were breaking the law, but it may factor in your ethnicity, where you live, what you were wearing and how you behaved (Illinois v. Wardlow). The officer does not even need to know which law you might have broken so long as he can later point to any possible infraction- even one that is minor, unrelated, or ambiguous.† Sotomayor went on to argue that these questionable stops by police can easily escalate to officers looking through a person’s belongings, frisking the individual for weapons and performing an intimate bodily search. She argued unlawful police stops make the justice system unfair, endanger lives and corrode civil liberties. While young black men like Freddie Gray have been stopped by police lawfully under Wardlow, their detainment and subsequent arrests cost them their lives. The Effects of Wardlow A 2015 report by the American Civil Liberties Union found that in the city of Chicago, where Wardlow was stopped for fleeing, police disproportionately stop and frisk young men of color. African Americans constituted 72 percent of people stopped. Also, police stops overwhelmingly took place in majority-minority neighborhoods. Even in areas where blacks make up a small percentage of residents, such as Near North, where they make up only 9 percent of the population, African Americans comprised 60 percent of people stopped. These stops don’t make communities safer, the ACLU argued. They deepen the divides between the police and the communities they’re supposed to serve.

Financing the Mozal Project Essay Example | Topics and Well Written Essays - 1250 words

Financing the Mozal Project - Essay Example Along with the great benefits of the project there are also risks factors associated with its implementation. Some of the risk factors that must be considered in the business plan of a project are recurring revenue, economic uncertainty, and liquidity (Bizkanal). Mozambique is a high risk country due to a variety of factors. Among 20 African nations the country ranks last in road infrastructure, completion of secondary school, and legal effectiveness. It also ranks second to last in openness to trade and time spent to obtain permits. These factors make the country a difficult sell to foreign investors. Another major risk in the region is the political factor. The country is recovering from the effects of a civil war that lasted 17 years. There are still political tensions and bitterness between the Frelimo and Renamo parties. A risk that can inhibit the profitability and success of the project is a decline in the market price of aluminum in the future. The price of electricity is a d eterminant of the plant’s competitive position. Some of the key partners of the Mozal project are Alusaf, the government of Mozambique, Eskom, Electricidade de Mucambique (EdM), trustee responsible for the administrative duties, lenders, and the International Monetary Fund (IMF). Alusaf is the company that will own and administer the project. The company is a subsidiary of the Gencor Group. In 1996 Alusaf generated net income of $41.7 million. The company has the vision of expanding the firm through the Mozal project. The risk of acquiring its primary raw material, alumina, will be naturally hedged by fixing the prices based on LME. Eskom and Electricidade de Mucambique will supply the project with all the electricity it needs for production. The government of Mozambique is an important partner that must invest in improving the infrastructure of the country as well as honor the economic incentives and tariff exemptions available in the Industrial Free Zones. These factors wil l provide the company with a competitive advantage. The risk of the government bailing out and breaking the agreements is low because the government desperately needs the income and jobs the project generates. The trustee will be responsible of collecting sales proceeds, paying debt, remitting expenses, and paying dividends. The International Monetary Fund is a key partner because it has the capacity to provide large funds of money. Getting its approval would help the company obtain more financing from the private sector. The risk of the IMF are minimized by performing a throughout evaluation of projects to ensure its sustainability and that it provides an economic benefit for the community. There are several key factors to the success of the Mozal project. One of those factors is the ability of the company to develop and manage its human resources adequately. The management of human resources starts in the construction phase of the project. The company plans to bring experienced ma nagers and skilled workers from South America during the initial phases of the project. It is imperative to properly manage the construction phase of the project. The firm is responsible for the work performance of a construction crew composed of 5,000 workers. The timeliness and the ability of the firm of completing the project within budget are highly dependent on being able to motivate the workers to perform at a high level. A second factor

Sociology, Annotated Bibliography Example | Topics and Well Written Essays - 1000 words

Sociology, - Annotated Bibliography Example 2. Gozdziak, E.M., (2004) Training Refugee Mental Health Providers: Ethnography as a bridge to multicultural practice- Human Organization. Journal of the society for applied anthropology, vol. 63 (2) 203-210. 2004. Gozdziak in this paper discusses a psychological problem of refugees which is becoming serious. With the passage of time the number of refuges in the world is increasing, and this is resulting in increased mental complexities of these refuges. This article focuses on the importance of training programs to train psychologists to deal with the diverse pool of refugees for providing them mental support. Anthropology is also discussed in the article as a contributing factor n this regard. Menjivar has paid attention towards social networks with all their complexities amongst the Salvadoran immigrants. The book talks about scarcity of resources and the importance and need of sharing those with family and friends. Immigration is never easy, and this is what Menjivar is trying to establish here. From sociological analysis point of view the book is really good. It is highly informative. 4. Menjivar, C. (2006). Family reorganization in a context of legal uncertainty: Guatemalan and Salvadoran Immigrants in the United States.International Journal of Sociology of the Family vol 32(20) 223-245. Menjivar has discussed the issues of Immigrants in the Uni... Due importance has been given to the painstaking breaking and remaking of family ties and reorganizations. Legal issues faced by the immigrants, how the law can come between family members and how socially problematic lives immigrants may lead afterwards is the focus of this book. 5. Menjivar, C. (2004). Teen Life in El Salvador. Edited by Tompkins, C. and Sternberg, K. Westford, Conn: Greenwood Publishing Group Co. Pp. 155-171 With her extensive research and writing experience in the field of psychological issues and sociology, Menjivar has brought forward the true picture of life as a teenager in El Salvador. The issues of teens are highlighted in the book. Relationship between teen unresolved issues and crime rate is mentioned while the issues and their solutions are also discussed. 6. Menjvar, C. and Marsiglia, F. F. 2004. Nicaraguan and Salvadoran Children and Families. Edited by Fong, R. New York: Guilford Publications. Pp. 253-273 Menjvar and Marsiglia discuss the social issues faced by Nicaraguans as well as Salvadoran Families and Children. As immigrants these people face a lot of problem which sometimes creates very complex situations. To avoid those situations, the practices with these families should be acceptable for them culturally. This is the focus of this book. 7. Menjvar, C. and Rodrguez, N. 2005. New Responses to State Terror. Austin: University of Texas Press. Pp. 335-346 Menjvar and Rodrguez talk about the carelessness of states due to the loopholes in welfare policies or legal issues. The book focuses on the responsibility of the states as a supporter and provider and it criticizes the loose rules which sometimes practically kill families, social life or psychologically normal behavior. 8. Menjvar, C. 2006. Global

The Best Vacation I Ever Had Essay Example | Topics and Well Written Essays - 1000 words - 1

The Best Vacation I Ever Had - Essay Example I was so relieved when I finally heard my captain's announcement that the plane would be touching down at my designated country's Changi International Airport in a few minutes. The weather was fine on that Sunday morning when I finally arrived at my destination. I was so happy to be able to synchronize my watch and try to adapt to the local time. My biological clock took some time getting used to the current time zone I was in. I was in a high, exuberant mood and could not wait to get to my hotel. I wanted to start sight-seeing straightaway because I was that excited. I cleared customs and immigration in just under half an hour. I looked around for the directional signs and located the taxi-stand where I took a cab to my hotel, the Raffles Hotel. I loved the city the minute I got into my short cab ride to my hotel. It was bustling with life. There were hundreds and thousands of people everywhere. It looked as though the whole city was like a giant hive teeming with people. People just poured out from buildings and they were on the move all the time. I got an eyeful of what the city was like before I arrived at my hotel. I had my currency converted back home in L.A. so I counted out the correct amount and got back my change. I was glad I did not have to pay a tip to the driver. The Raffles Hotel was totally grand. ... He looked magnificent in his livery. The front desk's reception staff were very polite, courteous and helpful. I got settled into my hotel room in a few minutes. I hit the shower and was so glad to have my first real shower about twenty-fours after my last one in my own home. I changed into fresh clothing and packed a daytime carry bag with my personal essential valuables and camera. I was ready to go for my first day tour of Singapore. I enquired at the information desk on the best tourist location to visit. I was told to see Sentosa. It was an island resort with all the beautiful tourist spots to entertain, educate and engage any visitor.As I was not hungry for breakfast, I opted to get aboard the island of Sentosa and have my late breakfast there. I boarded the hotel's bus to get to the cable car station. There was an orderly queue to buy tickets for the cable car. I bought my ticket and had the luxury of having the entire cable car to myself for the duration of the ride. It was b eautiful up there, being suspended in a moving cable car and transported driverless along a long wire. I looked down and saw that the transportation on the roads were as small as ants. I was lucky to have no fear of vertigo. The scenery was breathtaking. I took pictures through the glass window. My cable car was pulled along soundlessly over the sea. I looked down and saw all sizes of sea transport cruising through the waterways. It was like traveling in a low flying aircraft. Pretty soon, my cable car ride came to an end. I had reached the long end of the electric cable line. The first person who greeted me when I stepped out of my vehicle was a photographer. He was touting snaps against an enlarged scenery photograph backdrop. I thought it was expensive at USD 15 per shot so

Ernest Rutherford and Nuclear Physics contributions Research Paper

Ernest Rutherford and Nuclear Physics contributions - Research Paper Example His father was a wheelwright, his mother a schoolteacher (Campbell). He moved once or twice, though staying in New Zealand the entire time, and attending different schools when he moved (Campbell). Though Ernest as a boy liked tinkering with clocks, and loved to make models of the wheels that were used in the mills, he did not show any real passion for science during childhood (Mahanti, 2011). Most of his education came through the winning of scholarships, first to Nelson College in 1889, then on to Canterbury College at the University of New Zealand, where he first developed an interest in electrical science, running experiments that would determine whether or not iron was magnetic at a high magnetizing frequency (Campbell). After failing in three attempts to secure a teaching position after university, and briefly considering medicine, he took odd jobs tutoring students to help make ends meet while continuing to experiment in electrical science. In 1895 he won a scholarship to Camb ridge University to work with instructor J.J. Thomson (Campbell). Thomson, who was quick to realize Rutherford’s exceptional ability as a researcher as he had already designed several original experiments involving high-frequency, alternating currents, invited him to become a member of the team to study of the electrical conduction of gases. The pair soon became not only researcher and student but also good friends, and Rutherford was able to take Thomson’s theories and improve on them, breaking the ground to make a lasting impression on nuclear physics today. Rutherford developed several ingenious techniques to study the mechanism Thomson was using, whereby normally insulating gases became electrical conductors. In studying this matter, Rutherford commented that when a high voltage is applied across them, a clear view was given of the mechanism of the transport of electricity through the gases by the means of charged ions (Rutherford 1904). He also worked jointly with Thomson on the behavior of the ions observed in gases that had been treated with X-rays (a recent discovery), as well as the mobility of ions in relation to the strength of the electric field. It did not hurt in any way that Thomson was the one to discover that the â€Å"atom†, then known as the smallest unit of matter, was not in fact the smallest, but made up of even smaller particles, giving yet another area of interest for Rutherford to experiment with (Mahanti, 2011). When the Macdonald Chair of Physics at McGill University in Montreal became vacant in 1898, Rutherford left for Canada to take up the post. He promptly made a name for himself by discovering the element of radon, a chemically inactive but extremely radioactive gas (Campbell). While at McGill, he also did the work that gained him the 1908 Nobel Prize in Chemistry by demonstrating that radioactivity was the spontaneous disintegration of atoms. With the help of a young chemist, Frederick Soddy, he began to un ravel the mysteries of radioactivity and contributed directly to nuclear physics as we know it today by proving that some heavier radioactive elements spontaneously decay into slightly lighter atoms (Mahanti, 2011). In this, Rutherford noticed that in a sample of radioactive material, it invariably took the same amount of time for half the sample to decay - its â€Å"

How to Increase the market share in organic product market A Case Essay

How to Increase the market share in organic product market A Case Study of PARKnSHOP in Hong Kong - Essay Example To get a feel of what marketing strategies would work for PARKnSHOP, 300 regular shoppers are surveyed at 30 of the 40 superstores controlled by PARKnSHOP all over Hong Kong. Simple analytic tools are employed to analyze their responses. And appropriate recommendations for marketing strategies are provided, based on the findings from the survey. Established in 1973, PARKnSHOP is Hong Kong’s leading supermarket chain. With its perpetual commitment to innovation, quality, service and value, PARKnSHOP is well regarded in the industry and broader community through many quality awards. PARKnSHOP started its first superstore in 1996 and giving customers a modern one-stop stopping solution. The store sells over 20,000 product categories ranging from snacks to electronics household appliances. PARKnSHOP is also linked with three other supermarkets by the names of GREAT, TSTE and GOURMET. These three high-end supermarkets cater mostly to the expatriates and more affluent clientele in Hong Kong. These stores also sell a wide variety of organic products as in some Agri-foods like instant and canned soup and noodles; plain noodles and dried pasta; processed food and seafood products; ready-made meals and drinks (PARKnSHOP, 2010). However, as the number of customers that go for ready-made organic food increases, many superstores are jostling to control a larger share of the organic product market. This study investigates the appropriate steps PARKnSHOP management should take in arriving at a good conclusion about the most effective marketing strategies to adopt in capturing a greater share of the dynamic market for organic products. As a former colony and a trading outpost of the British Empire, Hong Kong has developed itself into a formidable economic wonder, turning into a global financial center where most financial institutions, banks, credit facilities and others have decided to establish their branches (Schenk, 2001).

The Christian Paradox Essay Example | Topics and Well Written Essays - 750 words

The Christian Paradox - Essay Example At the same time, three quarters of American believe that one of the teachings of the Bible is: "God helps those who help themselves". An anti-Christian statement said by Benjamin Franklin. What Jesus actually said was "Love your neighbor as yourself". This is one of the most important principles of the Bible's teachings. How could something as clear as this ideal of selfless love and care for the others, become the opposite at the core of people's beliefs While we are among the richest nations in the earth, we rank among the last countries in giving aid to the poor countries. We provide 15 cents each per day to the official development assistance to poor countries. Yet the point is, as McKibben says, not that America ranks bad in these categories; "it's that the overwhelmingly Christian American nation trails badly in all these categories, categories to which Jesus paid particular attention". What Jesus Christ meant by loving our neighbors was to help the poor, the sick, the naked and hungry; not our suburban fellows. This wisdom didn't apparently became very popular at the suburban mega-churches, where you can buy lattes and listen to self-centered sermons such as "how to discipline your children, how to reach your professional goals, how to invest your money, how to reduce your debt" (McKibben, 2005). When did faith become a marketing product for consumers Chris... Let's forget about Jesus focus on others, and make best-sellers filled with self-improvement, self-esteem, self-obsessed advice. Bill McKibben is an environmental writer. He is surprised to see yet another example of the Christian paradox in our environmental policies. Countries where religion is not so important, such as Norway and Sweden, actually are more concerned about a healthy atmosphere than us. In these places they have taken much more measures to protect their environment; like cutting back on their carbon emissions, using public transport, living in smaller places, etc. Instead, the U.S.A., one of the countries that produces the most carbon emissions1, is not signed up at the Kyoto Protocol. Would it be better if we abandoned our so-called Christianity The author wonders if in the "absence of the magical answers of religion, people might just get around to solving their problems and strengthening their communities in more straightforward ways". Yet, it seems like this nation will stay a "Christian nation, but what kind of Christian nation"(McKibben, 2005). Examples like Alabama's governor's failed attempt to change the tax rate or the Colorado jury who condemned someone to death based on the "eye for an eye" philosophy, illustrate once more, the abyss that exists between Jesus' will and the actual politics. In the words of McKibben: "they undercut Jesus, muffle his hard words, deaden his call, and in the end silence him. In fact, the soft-focus consumer gospel of the suburban megachurches is a perfect match for emergent conservative economic notions about personal responsibility instead of collective action".(McKibben, 2005). Can we really blame only the religious leaders for our counter-biblical behavior We are

How to Increase the market share in organic product market A Case Essay

How to Increase the market share in organic product market A Case Study of PARKnSHOP in Hong Kong - Essay Example To get a feel of what marketing strategies would work for PARKnSHOP, 300 regular shoppers are surveyed at 30 of the 40 superstores controlled by PARKnSHOP all over Hong Kong. Simple analytic tools are employed to analyze their responses. And appropriate recommendations for marketing strategies are provided, based on the findings from the survey. Established in 1973, PARKnSHOP is Hong Kong’s leading supermarket chain. With its perpetual commitment to innovation, quality, service and value, PARKnSHOP is well regarded in the industry and broader community through many quality awards. PARKnSHOP started its first superstore in 1996 and giving customers a modern one-stop stopping solution. The store sells over 20,000 product categories ranging from snacks to electronics household appliances. PARKnSHOP is also linked with three other supermarkets by the names of GREAT, TSTE and GOURMET. These three high-end supermarkets cater mostly to the expatriates and more affluent clientele in Hong Kong. These stores also sell a wide variety of organic products as in some Agri-foods like instant and canned soup and noodles; plain noodles and dried pasta; processed food and seafood products; ready-made meals and drinks (PARKnSHOP, 2010). However, as the number of customers that go for ready-made organic food increases, many superstores are jostling to control a larger share of the organic product market. This study investigates the appropriate steps PARKnSHOP management should take in arriving at a good conclusion about the most effective marketing strategies to adopt in capturing a greater share of the dynamic market for organic products. As a former colony and a trading outpost of the British Empire, Hong Kong has developed itself into a formidable economic wonder, turning into a global financial center where most financial institutions, banks, credit facilities and others have decided to establish their branches (Schenk, 2001).

Physician Billing research paper Example | Topics and Well Written Essays - 750 words

Physician Billing - Research Paper Example A more specific term comes out of medical billing is the physician billing which has eight potholes: previsit process, patient check-in process, charge capture and entry process, claim process, payment posting process, account follow-up process, denial management process, and patient collections process (Walker, Larch, and Woodcock, 2004). Each pothole must be avoided at all cost to ensure the smoothness and speed of the billing process. Physician Billing In all types of businesses and professional practices, transactions are inevitable and the one giving the service will get to earn from his efforts while satisfying the needs of the clients. Nobody can deny that money is a need to be able to facilitate exchange and to allow anyone to purchase his needs and wants. In the process of transactions, billing is a primary concern. According to Business Dictionary (n.d.), billing is the â€Å"process of generating an invoice to recover sales price from the customer and is also called Invoi cing.† In the process, the business earns revenue wherein profits are made and the expenses of the business for the service are also covered. In other words, invoicing is important that the organization facilitates the process of getting paid after the service or product is delivered to the client which includes having billing accounts. In that way, invoices are matched with the orders, efforts, and transaction records and for tracking the payments (Silverston, 2001). In the medical field, business is inevitable as hospitals and healthcare providers need to earn revenue to cover their operating expenses. For physicians, they need to earn profit from their expertise by assisting people with their physical ailments. For that reason, medical billing comes to life. Medical billing involves coding as the process is made to assist the physicians in processing insurance and medical claims effectively. The process involves handling patient invoices and taking care of reimbursements. T he reimbursement process contains the medical procedures and services rendered by medical doctors. As the processing of the billing becomes a career, a number code system had been created to assist the encoders in inputting the data with ease as numbers represent certain disease or injury. A software assists the medical billing representatives in recording the procedures and let the insurance software interpret the code flawlessly. In that process, reimbursement is quick and physicians get their professional fee promptly. As medical billers do the job, they must understand the technicalities in the medical field like terminology, disease, anatomy and many more. They must be dependable in terms of knowledge, skills, and job habits and must have the knowhow when it comes to technicalities in invoicing (McGarry, 2003, p. 82). For those who plan to become a medical biller or choose medical billing as a career, they need to understand the basics and not just the definition of the work. F or some, medical billing is considered as business since they do the stuff at home and online. They are not employees that need to go to work in hospitals or offices everyday with scheduled fix time. Since technology has been advancing rapidly in the past years, internet becomes a powerful tool to start a business or career without leaving the house. The trend nowadays is the electronic medical billing that requires a personal computer to perform the tasks. It is

Microbial Analysis of Soil Essay Example for Free

Microbial Analysis of Soil Essay Abstract: soil samples were collected fortnightly from area near Dahisar River, A river in suburb of Mumbai. laboratory analysis started from July 2010 to September 2010. Total bacterial and fungal count were estimated by standard spread plate isolation. Isolated bacteria were subject to colony characterization and were estimated by their morphological and biochemical characters. As being a monsoon the occurrence of variation of different species were high. The microorganisms isolated from the soil were of staphylococcus strain and were gram positive, aerobic, coccus shaped bacteria. The fungal species were also identified, of which Aspergillus and Penicillium were dominant, followed by mucur, as sub dominant .This project aims to find out the water and soil quality of River and as it is flowing through an industrial area, to find out if it is getting affected by the Industrial pollutants. Introduction: Soil is the region on the earth’s crust where geology and biology meet, the land surface that provides a home to plant animal and microbial life (Pelczar et al., 1993). Soil teems with microscopic life (bacteria, fungi, algae, protozoa and viruses) as well as macroscopic life such as earthworms, nematodes, mites, and insects, and also the root systems of plants. The numbers and kinds of micro- organisms present in soil depend on many environmental factors: amount and type of nutrients available, available moisture, degree of aeration, pH, temperature etc (Prescott et al., 1999). Soil bacteria and fungi play pivotal roles in various biochemical cycles and are responsible for the recycling of organic compounds (Wall and Virginia, 1999). Soil microorganisms also influence above- ground ecosystems by contributing to plant nutrition, plant health, soil structure and soil fertility (O’Donnell et al., 2001). Soil is generally a favorable habitat for the proliferation of microorganisms, with micro colonies, developing around soil particles. Numbers of micro organism . In soil habitats normally are much higher than those in fresh water or marine habitats (Atals and Bartha, 1998). Bacteria make up the most abundant group of micro- organisms in the soil (3.0 x 106 – 5.0 x 108) per gram of soil, followed by the actinomycetes (1.0 x 106 – 2.0 x 107), fungi (5.0 x 103 – 9.0 x 106), yeast (I.0 x 103 – 1.0 x 106), algae and protozoa (1.0 x 103- 5.0 x 105) and nematodes (50 – 200) counts per gram of soil are wide differences in the relative proportions of individual bacteria genera found in particular soils (Atals and Bartha, 1998). Soil fungi may occur as free-living organisms or in mycorrhizal association with plant roots. Fungi are found primarily in the top 10 cm of the soil and are rarely found below 30 cm. They are most abundant in well-aerated and acidic soils (Domsch et al., 1980). Most fungi in soil are opportunistic (zymogenous). They grow and carry out active metabolism when conditions are favorable which implies adequate moisture, adequate aeration and relatively high concentrations of utilizable substrates (Postage, 1994; Miyanoto et al., 2002). In this research we isolate culturable heterotrophic bacteria and fungi from different top soil samples MATERIALS AND METHODS Laboratory analysis Preparation of materials The materials needed for this experiment include; glass wares (conical flasks, bijou bottles, pipettes, petri-dishes) and they were washed with detergents. These glass wares were rinsed thoroughly with clean distilled portable water and left to air dry before sterilizing them in the autoclave at 15ââ€" ¦C for 1 hour. Also, the laboratory cabinets on which the work would be carried out was swabbed with cotton wool soaked in methylated spirit to sterilize it before any microbiological analysis was carried out to avoid the growth and isolation of other organisms not present in the samples. After sterilization, the plates were allowed to cool to about 45 degrees before they were used. Microbiological evaluation Ten (10) grams of the soil sample for microbiological evaluation was weighed into 9ml of sterile water. Preparation of serial dilution goes thus: 1ml of the original stocks solution was poured into 9ml sterile distilled water and mixed thoroughly to give 10-2 of the original sample and this was done for each sample and the bottles labeled according to date of collection Isolation and Enumeration of Micro-organisms. 1gram of the samples was homogenized in 9mls of distilled water to obtain a ratio of 1:9 and the second diluted of each sample was plated using the pour plate technique. Sterile molten nutrient agar (NA), potato dextrose agar (PDA), macconky’s agar,(MA) manitol salt agar (MSA) and deoxycholate astrate agar (DCA) were used{the potato dextrose agar (PDA) was acidified). These agars were then added and left to solidify undisturbed. These plates were incubated 37oC for 24hours (incubation was aerobic) and the procedure was repeated using 10-2 finally the number of colonies per plates were counted and recorded. The acidified PDA was incubated at 25C for 3-7 days for microbial growth. Total Bacterial counts (Cfu/g) The total bacteria count for each sample was determined with the pour plate techniques using nutrient agar. The plates were incubated between 24hours at 370C and all colonies appearing on the end of the incubation period were counted using digital unlimited colony counter and the counts were expressed in colony forming unit per gram {CFU/g} of the sample. Colonies of bacteria developing on the plates were observed, isolated and reisolated on a fresh media until pure culture was obtained. Preparation of Pure Culture It is necessary to isolate organisms in pure culture before studying and identifying them because a pure culture originates from one cell. Characteristics colonies from the original culture on the plates were picked with a sterile wire loop (using surface streaking method) and this loop was used to make streak of the colony on the surface of newly prepared sterile agar plates of NA,MA MSA. These streak will space out the inoculants and discrete colony of a particular specie of organism and then incubated at 35-37oC for 24hours to enhance microbial growth. Distinct colonies were re-inoculated on another fresh agar plates in order to obtain a pure culture. The isolates were picked with sterile loop and streaked into prepared agar slants, labeled and incubated for growth after which they were kept in the refrigerator for future use and identification. Identification of Isolates These isolated bacteria were identified using both morphological culture characteristics (i.e. the color, shape, elevation, capacity, consistency, edge) and biochemical test (i.e. citrate, oxidase, indole, sugar fermentation, test etc.)and the bacteria were identified based on the results obtained from the above mentioned biochemical characterization results and the procedures include. Grams Staining Techniques A drop of distilled water was placed on a clean glass slide. The inoculating wire loop was sterilized by flaming until it was red hot (this is to prevent the invasion of unwanted micro- organisms that might be inhabiting the wire loop) in the blue flame of a Bunsen burner. The loop was allowed to cool and the small portion of each colony of microorganisms to be gram stained was picked and smeared in the drop of water (distilled) on the glass slide and then spread into a thin smear along the slide. The smear was air dried and passed through the blue flame. The smear was stained with 1%crystal violet and left for 1minutes (60secs) and then washed with running distilled water it was then stained again with Lugols iodine for another 60secs and also washed with running distilled water. The slide was decolorized rapidly with 75% alcohol in order to present the organism from having the color of the primary reagent and it was washed immediately with distilled water. The slide finally was flooded with a counter stain safranine (a secondary stain) for 60secons and also washed off with distilled water and allow to air dry. The slide was covered with a cover slide and observed under the microscope using oil immersion x 100 objective lens with immersion oil. The gram reaction of the isolated arrangement and the shape of the cell were observed and recorded. Gram positive (+ve) bacterial were characterized by a purple color (i.e. the primary stain) while the gram negative (-ve) bacteria were characterized by red color (i.e. the secondary stain) .This procedure is actually used to ascertain the component of each organisms cell wall. Motility Motility was determined by hanging drop techniques. Using loop, a little part of the colony of the organisms were grown in peptone water for 18hours and then placed in the grease free slide and covered with a Vaseline bound cover slip and then observed under x100 objective lens. A motile organism is then seen moving in the drop of liquid. Identification Of Mold Isolates Mold isolated was identified using cultural and morphological characteristics and according to (Fawole and Oso, 2001), microscopic observation was carried out using lacto phenol blue stain. Procedure for Mold Staining A drop of lacto phenol blue stain was dropped on a clean grease free sterilized glass slide and after this a sterile inoculating wire loop was used to pick the mycelium unto the glass slide from the mold culture .The mycelium was spread evenly on the slide. Teasing was carried out to separate the mycelium in order to get a homogenous mixture and the mixture was then covered with cover slips gently and then allowed to stay for some seconds before observing under x40 under the microscope. The microscope examination of actively growing mold was on the basis of structures bearing spores, presence or absence of septate. BIOCHEMICAL TESTS Catalase Test Catalase test demonstrates the presence of catalase enzyme by aerobic microorganisms. Catalase is an enzyme that catalysis the release of oxygen from hydrogen peroxide (H2O2). To test for catalase, a drop of 3% hydrogen peroxide solution was added to a slide and the organism to be tested for catalase production is brought in contact with the hydrogen peroxide. The production of gas bubbles however indicates a positive reaction and this shows that catalase enzyme is produced.(FawoleOso, 2001) Oxidase test This was carried out by placing a clean filter paper on the working bench or petri dishes and 2-3 drops of freshly prepared oxidase reagent was added to the isolate using a sterile inoculating wire loop. After this, a few quantity of oxidase reagent was added and a purple coloration was observed within 10-15minutes which indicated that the organisms is oxidase positive and according to Olutiola et al, 1991, a positive reaction is dependent on the presence of cytochrome. This test is also useful for the separation of Neisseria in mixed culture and in differentiating Pseudomonas from enteric bacteria. Indole test Olutiola et al, 1991, describes the test as one which is important in the differentiation of colonies and it depends on the production of indole from tryptophan by the organism. An inoculating loop was used to inoculate the organism into a test tube containing decarboxylase medium becomes violet. An uninoculated test tube serves as a control (i.e. remained yellow) Sugar fermentation test The ability of the isolates to utilize certain sugar as energy source was tested. If the organism does ferment a particular sugar, acid will be produced and gas may be produced or not. Acid production is indicated by color change of the medium from red to yellow and acid presence could also be detectable with a ph. indicator in the medium while the production of gas is indicated by a void produced in a Durham tube. The fermentation medium was prepared by 0.1g of sodium chloride and 0.1g of fermentable sugar (glucose) in 10ml of distilled water. An amount of 9ml of the medium was pipette into a test tube containing Durham’s tubes in replicates. 5ml of phenol red indicator was immediately discharged into the test tubes. The test tubes containing medium were sterilized in an autoclave at 121 o for 15minutes.After sterilization, each isolate were incubated in glucose Medium. An uninoculated test tube was also incubated for glucose to serve as a control. The test was also carried out using maltose, lactose, galactose, manitol, sucrose, fructose and mannose.(Olutiolaet al., 1991) Discussion: The abundance of bacteria and fungi in this study were typical of environment with high species richness and functional diversity. Despite the fact that it is possible that a number of bacteria and fungi may be missed in this study, the isolates could be readily assigned dominant (e.g. Bacillus sp, Aspergillus sp) or transient/succession roles in the isolation of organisms form different seasons, which form the basis of this study. In additions to the implications of the determination of the number of microorganisms during soil sampling, one should consider the qualitative aspect of the preservation of important species and groups of microorganisms and of the changes in these biochemical characteristics resulting from the variations in these counts. Although the results of this study would not be considered to be exhaustive, as it was done within the limits of facilities available in the laboratory, an insight into the population dynamics and distribution of culturable aerobic bacteria and fungi diversity has been elucidated. This is without prejudice to the possible influence which a substantial proportion of bacteria and fungi that are not culturable in vitro could have on the overall picture of event. It would require more modern technology (nuclei acid probes) to obtain such detailed overview of microbial diversity. This should be a subject of extension of this investigation in future. Conclusion Through this project, if emphasis is made on public health, the observation and findings show striking predominance of Salmonella typhi. And E.coli. E.coli being an enterobacter cause dysentery and S.typhi poses a great risk of typhoid. Health inspector and municipal authorities should look into this matter for further investigation and if possible improvement Acknowledgement Investigators are grateful to the Principal Management of S.V.K.M’s Mithibai College for constant encouragement support. And head of department of zoology Prof. V.V. Dalvie for providing me opportunities and Prof. Radhika D’souza, under whose guidance the project was successfully completed References 1 .Atals RM, Bartha R (1998). Microbial Ecology: Fundamentals and Applications. 4th Edition. Benjamin Cummings Publishing Company Inc. Addison Wesley Longman Inc. pp. 300 – 350. 2. Miyanoto T, Igaraslic T, Takahashi K (2002). Lignin–degradation ability of litter decomposing basidomycetes from picea forest of Hokkaida Myco.sci. (41): 105 – 110. 3. Domsch KH, Gaws W, Anderson TH (1980). Compendium of soil fungi 4. O’ Donnell AG, Seasman M, Macrae A, Waite I, Davies JT (2001). Plants and Fertilizers as drivers of change in microbial community structure and function in soil. Plant Soil (232): 135 – 145. 5. Pelczar MJ, Chan ECS, krieg NR (1993). Microbiology: Concept and Application International edition McGraw-Hill, USA. Pp 281-324. 6. Wall DH, Virginia RA (1999). Controls on soil biodiversity insights from extreme environments. Appl. Soil Ecol. (13): 137–150. 7. Fawole and Oso, 2001

Study on the use of reflection in nursing

Study on the use of reflection in nursing In recent years, reflection has undoubtedly become an important concept in nursing, stimulating debate and influencing nursing practice and education around the world. Much has been written about the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the process of reflecting has been described as a transferable skill which may be incorporated into clinical practice, enabling practitioners to better understand themselves and others, and solve problems (Mantzoukas Jasper 2004). Indeed, the capability to reflect consciously upon ones professional practice is generally considered important for the development of education and, hence, for clinical expertise (Mamede Schmidt 2004). Reid (1993) defines reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993, p. 305). The nursing profession seems to advocate the need for nurses to be educated and practice in ways that develop their critical thinking, autonomy and sensitivity to others (Reed Ground 1997). Bulman (2004) contends that reflective practice may provide a means of achieving this. Within an intensive care setting, some evidence exists to suggest a strong relationship between lived experience and learning, with most critical care practitioners learning from previous experience (Hendricks et al 1996). More recently, reflection has been closely associated with the concepts of critical thinking and deconstruction. It is argued that a combination of these principles create a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to reason the origins of situations, and to consider what has gone before and what may happen yet (Rolfe 2005). In order to be effective in practice there is a requirement to be purposeful and goal directed. It is suggested therefore that reflection cannot just be concerned with understanding, but must also focus on locating practice within its social structures, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which can aid and facilitate the practitioner in reflection, promoting a process of continuous development (Bulman 2004). Reflection is seen as a dynamic process and not a static one (Duke 2004), and thus the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. One such framework is Gibbs (1988) Reflective Cycle, which is adapted form a framework of experiential learning, and uses a series of questions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) highlights 6 important areas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be done differently in the future. The 6 components of the Reflective Cycle are outlined below: Description What happened? Feelings What were you thinking and feeling? Evaluation What was good and bad about the situation? Analysis What sense can you make of the situation? Conclusion What else could you have done? Action Plan If the situation arose again, what would you do? It is clear that the idea of reflective practice has come to have a considerable impact on the nursing profession. This paper will focus on 2 clinical scenarios occurring within an intensive care setting. The issues raised will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured reflective process, and to identify ways in which clinical practice may be improved in the future. Scenario 1 Description The first scenario concerns the care of an elderly, critically ill patient, who was being treated in a surgical intensive care unit. At the time of this scenario the patient had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The patient had many other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite source of sepsis had been identified. The above patient was being cared for by the author on a 12 hour day shift and at the morning ward round it was noted that the patients condition had deteriorated significantly over the previous 2 days, with increased inotrope dependence and worsening renal function. With few treatment options left to try, the consultant anaesthetist decided that the patient should have a CT scan to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of any kind would not be appropriate, despite potential positive findings on CT. Knowing that a CT scan had been carried out 1 week previously with no significant findings, the author raised concerns about the benefit of such a procedure, and suggested that at the very least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. Withdrawal of treatment had been mentioned as a possibility in the event of no improvement in the patients condition. The son however was not informed about the scan which went ahead the same day. Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer resulting in a need for increased inotropes due to further hypotension caused by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to take the patients weight. Again the author voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan. The patient remained unstable throughout the transfer, requiring a further increase in inotropes on arrival at scan. Whilst on the CT table, the patient became dangerously hypotensive and bradycardic, and it seemed that cardiac arrest was imminent. Adrenaline boluses were administered, and large fluid boluses of gelofusine were also given. In view of this, the CT scan was abandoned midway, and the patient was quickly transferred back to ICU. Further adrenaline boluses were needed during transfer. On arrival back to ICU, the author was met by the patients son, who was not aware that the patient was being scanned. He was made aware of the patients poor condition. Back in ICU it was decided that further resuscitation was not appropriate. The son was present when the patient died a few minutes later. Feelings On the day these events took place, the predominant thoughts and feelings of the author were ones of guilt and inadequacy. Having considered the multiple health problems faced by the patient at this time, the author felt that the process of transferring the patient to CT scan and carrying out the scan itself may cause the patient stress, discomfort and potential danger, and ultimately be of little or no benefit. During the transfer and scanning process, the author became increasingly anxious about the immediate safety of the patient, and the potential for deterioration in the patients condition. When the patient became dangerously bradycardic and hypotensive, the authors thoughts were concentrated on trying to prevent cardiac arrest. On returning to ICU and meeting the patients son, it seemed that neither the dignity of the patient or the concerns of the family had been respected. The author felt an inadequacy and felt that the interests of the patient had not been properly advocated. The patient passed away in a distressing and undignified manner, and the son did not have the opportunity to spend personal time with the patient prior to this happening. The author felt guilty, as it seemed that the CT scan should not have happened and that the undignified circumstances surrounding the patients death need not have occurred. Evaluation Looking back on the events of scenario 1, it seems that there were both positive and negative aspects to the experience. During transfer to CT scan and the emergency situation which followed, the author felt that there was good teamwork between the different professionals involved in the care of the patient. Because of this, prompt action was taken, preventing cardiac arrest. However, it seems that this situation may have been avoided, which in turn raises many questions relating to the care of the patient. Ethically, one must question how appropriate it was to scan a severely septic, unstable patient, especially when corrective treatments would have been inappropriate in the event of an abnormality being discovered. Should the author have advocated the interests of the patient and family more forcefully? Was there a lack of communication and consensus between the critical care team? The events of this incident culminated in a clinical emergency situation which led to the patients death. Thus, the author feels that the patients clinical condition and the ethical issues and dilemmas surrounding the patients care must be examined and discussed, in the hope that lessons can be learned through the reflective process. Analysis Sepsis Most illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. Indeed, sepsis affects 18 million people worldwide each year (Slade et al 2003), with severe sepsis remaining the highest cause of death in patients admitted to non-coronary intensive care units (Edbrooke et al 1999). Sepsis is a complex condition that results from an infectious process, and is the bodys response to infection. It involves systemic inflammatory and cellular events that result in altered circulation and coagulation, endothelial dysfunction, and impaired tissue perfusion (Kleinpell 2004). Dellinger et al (2004) define sepsis as the systemic response to infection manifested by 2 or more of the following: High or low temperature (>38 °C or Heart rate > 90 beats per minute Respiratory rate > 20 breaths per minute or PaCO2 High or low white blood cell count (> 12,000 or In severe sepsis impaired tissue perfusion along with micro vascular coagulation can lead to multiple organ system dysfunction, which is a major cause of sepsis-related mortality (Robson Newell 2005). While all organs are prone to failure in sepsis, pulmonary, cardiovascular, and renal dysfunction occur most commonly (Hotchkiss Karl 2003). When multiple organ system dysfunction occurs, Dolan (2003) promotes evidence-based sepsis treatment whereby patients should receive targeted organ support. This includes mechanical ventilation, renal replacement therapy, fluids, vasopressor or inotropic administration, and blood product administration, to maximize perfusion and oxygenation. In recent years new therapies have emerged which have been shown, in some cases, to increase the chance of survival from severe sepsis. Recombinant human activated protein C has been shown to have anti-inflammatory, anti-thrombotic and pro-fibrinolytic properties (Dolan 2003). In a randomised controlled trial, Bernard et al (2001) found a significant reduction in the mortality of septic patients who had been treated with activated protein C. The National Institute for clinical excellence (2004) now recommends this treatment for adult patients who have severe sepsis resulting in multiple organ failure, and who are being provided with optimal ICU support. Steroids, the use of which in ICU has long been debated, have also been shown, in low doses, to reduce the risk of death in some patients in septic shock (Annane 2000). Despite the development of specific treatments to interrupt or control the inflammatory and procoagulant process associated with sepsis, its management remains a major challenge in healthcare (Kleinpell 2004). The patient in scenario 1 was clearly in a state of severe sepsis, with respiratory, cardiac and renal failure, and receiving some of the supportive treatments mentioned above. Indeed it seems that the severity of this condition should not have been underestimated. In view of this, the ethical issues surrounding the decision to take this patient to CT scan must now be considered. Ethical Dilemmas and Consensus Ethical issues have emerged in recent years as a major component of health care for critically ill patients (Friedman 2001). Thus, caring for these patients in an intensive care setting necessitates that difficult ethical problems must be faced and resolved (Fisher 2004). Traditionally, much of the literature in biomedical ethics comes from theoretical perspectives that include principled ethics, caring ethics and virtue ethics (Bunch 2002). Although these perspectives provide an ethical awareness, which can be helpful, they do not of necessity give much direction for clinical practice. Melia (2001) supports this notion, suggesting that many discussions of ethical issues in health care are presented from a moral philosophical viewpoint, which as a consequence leaves out the clinical and social context in which decisions are taken and carried through. Beauchamp Childress (1994) identify 5 principles pertinent to decision making in intensive care. These are: salvageability, life preservation, non-maleficence, beneficence, and justice. Ethical dilemmas occur when two or more of the above principles come into conflict. The principles of beneficence (doing good), non-maleficence (doing no harm) and justice (fair treatment) are well established within the field of bioethics. Within a critical care context however, the dilemma between salvageability and life preservation becomes an important focus for health care professionals. Indeed, Prien Van Aken (1999) raise the question of whether all medical means to preserve life have to be employed under all circumstances, or are there situations in which we should not do everything that it is possible to do. This question becomes particularly relevant when a patients condition does not improve but rather deteriorates progressively. Curtin (2005) suggests that at some point in the course of t reatment, the line between treating a curable disease and protracting an unpreventable death can be crossed. In such incidences Prien Van Aken (1999) identify a transitional zone between the attempt to treat the patient, and the prolongation of dying, in which a conflict between the principles of life preservation and non-maleficence develops. These concepts seem particularly relevant to scenario 1 where the interests of the patient may have been neglected in favour of further attempts to treat the patients condition. This, in turn created a conflict between the principles of salvageability and life preservation. The decision to perform a CT scan on a patient with such cardiovascular instability and a very poor prognosis, meant that the patient was subjected to dangers and harms when there were few, if any benefits to justify this. Hence, the conflict between the ethical principles was not resolved, and the professional duty of non-maleficence toward the patient was not respected. Such conflicts and dilemmas in intensive care can be made all the harder by the availability of advanced technologies. Callahan (2003) writes that one of the most seductive powers of medical technology is to confuse the use of technology with a respect for the sanctity of life. In addition, Fisher (2004) contends that it has become all too easy to think that if one respects the value of life, and technology has the power to extend life, then a failure to use it is a failure to respect that value. This is particularly true of diagnostic technologies (such as CT scanning) which must be used with caution, especially in cases where the diagnostic information will make little or no difference to the treatment of the patient, but can create or heighten anxiety and discomfort for the patient (Callahan 2003). Medical technology is a two-edged sword, capable of saving and improving life but also of ending and harming life (Curtin 2005). Good critical care medicine carries the responsibility o f preserving life, on the one hand, and making possible a peaceful death, on the other. Callahan (2003) concludes by warning that any automatic bias in favour of using technology will threaten that latter possibility. Consensus between members of the intensive care team is also highlighted as an important issue in ethical decision making. Effective communication and collaboration among medical and nursing staff are essential for high quality health care (Woodrow 2000). Collaboration can be seen as working together, sharing responsibility for solving problems, and making decisions to formulate and execute plans for patient care (Gedney 2000 p.41). In intensive care units where ethical problems are faced frequently, care has to be a team effort (Fisher 2004). In a qualitative study, Melia (2001) found that there was a strong desire within the intensive care team that ethical and moral consensus should be achieved in the interests of good patient care, even though it was recognised that there is no legal requirement for nurses to agree with ICU decisions. Cobaoglu Algier (2004) however, found that the same ethical dilemma was perceived differently by medics and nurses with the differences being related to the hospitals hierarchical structure and the traditional distinctions between the two professions. Similarly, it has been observed that differences between doctors and nurses in ethical dilemmas were a function of the professional role played by each, rather than differences in ethical reasoning or moral motivation (Oberle Hughes 2001). It seems therefore that while the medical and nursing professions share the same aims for patient outcomes, the ideas surrounding how these outcomes should be achieved may differ (Fisher 2004). These differences have contributed to the development of the concept of the nurse as patient advocate, which sees advocacy as a fundamental and integral role in the caring relationship, and not simply as a single component of care (Snowball 1996). The role of the nurse advocate should be that of mediator and facilitator, negotiating between the different health and illness perspectives of patient, doctor, and other health care professionals on the patients behalf (Mallik 1998). Empirical evidence is sparse and philosophical arguments seem to predominate in the field of patient advocacy. There is some evidence to suggest that nurse advocacy has had beneficial outcomes for the patient and family in critical care areas (Washington 2001). Hewitt (2002) however found that humanistic arguments that promote advocacy as a moral imperative are compelling. Benner (1984) writes of advocacy within the context of being with a patient in such a way that acknowledges your shared humanity, which is the base of nursing as a caring practice (Benner 1984, p. 28). It has been argued that advocacy, at least in a philosophical sense, is the foundation of nursing itself and as such should be regarded as an issue of great importance by all practitioners (Snowball 1996). Conclusion It can be concluded that sepsis in a critical care environment is a complex condition with a high mortality rate, requiring highly specialised treatments. As such, the ethical issues and dilemmas faced by health care staff caring for a septic patient can be both complex and far reaching. It must be noted, that there can be no general solutions for such ethical conflicts; each clinical case must be evaluated individually with all its associated circumstances. A study of ethical principles would suggest that it is important that the benefits of a specific treatment or procedure are established prior to implementation, and that these benefits outweigh any potential harms or risks to the patient. The ultimate decision maker in the scenario under discussion was the consultant anaesthetist, who should have provided a clearer rationale for performing a CT scan on such an unstable patient. As the nurse caring for the patient, the author recognises that the final decision regarding treatment rested with the anaesthetist. However, the author could have challenged the anaesthetists decision further, advocating the patients interests, with the aim of reaching a moral consensus within the team. Perhaps then the outcome would have been more favourable for all concerned. Action Plan By reflecting on this scenario, the author has gained an understanding of sepsis and the potential ethical problems which may be encountered when caring for a septic or critically ill patient. As a result, the author feels more confident to challenge those decisions made relating to treatment, which do not seem to be in the best interest of the patient, or which have the potential to cause more harm than good. The author now has a greater understanding of the professional responsibility to advocate on a patients behalf, with the aim of safeguarding against possible dangers. It is hoped that this will result in improved outcomes for patients in the authors care. Scenario 2 Description This incident occurred in a surgical intensive care unit while the author was looking after a ventilated patient who had undergone a laparotomy and right sided hemi-colectomy 2 days previously. Around 10.30am the patient was reviewed by medical staff and was found to be awake and alert with good arterial blood gases, and requiring minimal ventilatory support. In view of this, it was decided that the patients support should be reduced further, and providing this reduction was tolerated, that the patient should be extubated later in the morning. In the intensive care unit in which the author works an intensive insulin infusion protocol is used (see Appendix A). This is a research based protocol which aims to normalize blood glucose levels and thus improve clinical outcomes for critically ill patients. All patients on this protocol require either to be absorbing enteral feed at à ¢Ã¢â‚¬ °Ã‚ ¥30ml/hr, on TPN or on 5% dextrose at 100ml/hr (Appendix A, note 2). The patient involved in this incident was receiving enteral feed via a naso-gastric tube, and was on an insulin infusion which was running at 4 U/hr. When it was decided that the patient was to be extubated, the author stopped the enteral feed as a precaution, to prevent possible aspiration during or after extubation. The author however did not stop the insulin infusion which breached the protocol guidelines. About 12 noon the patients blood gases showed that the reduction in support had been tolerated, and so the patient was extubated. Shortly after this the author was asked to go for lunch break and so passed on to a colleague that the patient had recently been extubated but was managing well on face mask oxygen. Returning from lunch 45 minutes later, the author found the patient to be disorientated and slightly confused. With good oxygen saturations, the author doubted that the confusion had resulted from hypoxia or worsening blood gases. The author then realised that the insulin infusion had not been stopped with the enteral feed earlier. A check of the patients blood glucose level showed that it was 1.2mmol/L. The author immediately stopped the insulin infusion, administered 20mls of 50% dextrose intravenously, as per protocol, and recommenced the enteral feed. Twenty minutes later, the patients blood glucose level had risen to 3.7mmol/L. The patient continued on the insulin protocol maintaining blood glucose levels within an adequate range. There were no lasting adverse effects resulting from the hypoglycaemic episode. Feelings When it was realised that the insulin infusion had not been stopped, the author felt a sense of panic, anticipating correctly that the patients blood glucose level would be dangerously low. Thoughts then became concentrated on raising the blood glucose level, to ensure that no further harm would come to the patient as a result of the authors mistake. Following the incident, when the patients glucose levels had risen, feelings of guilt were prominent. At this point the author realised how much worse the outcome could have been for the patient. The author felt incompetent, knowing that the patient could have been much more severely affected, or could even have died as the result of such a simple mistake. Evaluation The events of scenario 2 highlight the fact that clinical errors, while easily made, can have potentially disastrous consequences. This is especially true of those errors which involve the administration of drugs intravenously. In the interest of patient safety, it is important that all such errors are avoided. The clinical error outlined above could easily have been avoided. It seems that there was not sufficient awareness, on the authors part, of the insulin infusion protocol and the guidelines concerning the administration of insulin. As a result, the insulin protocol was not adhered to. The following analysis therefore will focus on the importance of insulin therapy in critical care areas, and will consider the safety issues surrounding intravenous drug administration. Analysis Blood Glucose Control in Intensive Care It is well documented that critically ill patients who require prolonged intensive care treatment are at high risk of multiple organ failure and death (Diringer 2005). Extensive research over the last decade has focused on strategies to prevent or reverse multiple organ failure, only a few of which have revealed positive results. One of these strategies is tight blood glucose control with insulin (Khoury et al 2004). It is well known that any type of acute illness or injury results in insulin resistance, glucose intolerance and hyperglycaemia, a constellation which has been termed the diabetes of stress (McCowen et al 2001). In critically ill patients, the severity of this condition has been shown to reflect the risk of death (Laird et al 2004). Much has been learned recently about the negative prognostic effects of hyperglycemia in critically ill patients. Hyperglycaemia adversely affects fluid balance, predisposition to infection, morbidity following acute cardiovascular events, and can increase the risk of renal failure, neuropathy and mortality in ICU patients (DiNardo et al 2004). Research suggests that there are distinct benefits of insulin therapy in improving clinical outcomes. Such benefits have been seen in patients following acute myocardial infarction, and in the healing of sternal wounds in patients who have had cardiac surgery (Malmberg 1997; Furnary et al 1999). More recently Van den Berghe et al (2001) conducted a large, randomized, controlled study involving adults admitted to a surgical intensive care unit who were receiving mechanical ventilation. The study demonstrated that normalisation of blood glucose levels using an intensive insulin infusion protocol improved clinical outcomes in critically ill patients. In particular, intensive insulin therapy was shown to reduce ICU mortality by 42%, and significantly reduce the incidences of septicaemia, acute renal failure, prolonged ventilatory support, and critical illness polyneuropathy. The length of stay in intensive care was also significantly shorter for patients on the protocol. It is unclear as to why improved glycaemic control has been associated with improved outcomes in several clinical settings. Coursin and Murray (2003) have summarized several leading hypotheses including maintenance of macrophage and neutrophil function, enhancement of erythropoiesis, and the direct anabolic effect of insulin on respiratory muscles. The potential anti-inflammatory effects of insulin have also been evaluated (Das 2001). There is also uncertainty over whether it is the actual insulin dose received per se, or the degree of normoglycaemia achieved that is responsible for the beneficial effects of intensive glycaemic management. Van den Berghe (2003) analysed the data derived from their 2001 study and have concluded that the degree of glycaemic control, rather the quantity of insulin administered was associated with the decrease in mortality and organ system dysfunction. In a follow up to Van den Berghe et als 2001 study, Langouche et al (2005) found that a significant part of the improved patient outcomes were explained by the effects of intensive insulin on vascular endothelium. The vascular endothelium controls vasomotor tone and micro-vascular flow, and regulates trafficking of nutrients and several biologically active molecules (Aird 2003). Langouche et al (2005) conclude that maintaining normoglycaemia with intensive insulin therapy during critical illness protects the vascular endothelium and thereby contributes to the prevention of organ failure and death. Whatever the reasons for improved patient outcomes, the study by Van den Burghe et al (2001) has prompted much research in this field, all of which has yielded similar results. In a similar study, Krinsley (2004) found that the use of an insulin protocol resulted in significantly improved glycaemic control and was associated with decreased mortality, organ dysfunction, and length of stay in the ICU in a heterogeneous population of critically ill adult patients. Thus it seems that with the strength of the emerging data in support of a more intensive approach to glycaemic management, insulin infusions are being utilised with increasing frequency, and are considered by many to be the standard of care for critically ill patients (DiNardo et al 2004). It is important to note that a well recognised risk of intensive glucose management is hypoglycaemia. Indeed Goldberg et al (2004) emphasise that in the ICU setting where patients often cannot report or respond to symptoms, the potential for hypoglycaemia is of particular concern. The events of scenario 2 highlight the authors error in the administration of insulin resulting in hypoglycaemia. For this reason some issues surrounding intravenous drug therapy will now be discussed. Intravenous Drug Therapy There is an increasing recognition that medication errors are causing a substantial global public health problem. Many of these errors result in harm to patients and increased costs to health providers (Wheeler Wheeler 2005). In the intensive care unit, patients commonly receive multiple drug therapies that are prescribed either for prophylactic indications or for treatment of established disease (Dougherty 2002). Practitioners caring for these patients find themselves in the challenging position of having to monitor these therapies, with the goal of maximizing a beneficial therapeutic response, as well as minimizing the occurrence of any adverse drug-related outcome (Cuddy 2000). The Nursing and Midwifery Council (NMC) (2004) identifies the preparation and administration of medicines as an important aspect of professional practice, stressing that it is not merely a mechanistic task performed in strict compliance with a written prescription, but rather a task that requires thought and professional judgement. Heatlie (2003) found that the introduction of new insulin protocols and regimes could give rise to problems, espe