Cinderella Man Film Essay

Cinderella Man is a film about The Great Depression. How is this period in history depicted in the film? The film Cinderella Man is based on a true story about a boxer James J Braddock, during the Great Depression in the 1930’s. Braddock, his wife Mae and his three kids were very well off, due to the fact that Braddock was doing very well with his boxing and winning lots of fights, which resulted in lots of money. This all changed very suddenly when Braddock’s career was turned upside down when the Great Depression hit. The first scene in the film which shows that times were starting to get tough is when there is a transition scene from 1928-1932, where there is a slow left pan fade starting from their dresser with lots of accessories such as jewellery, a photo in a nice frame, a watch and a stack of money which Braddock earned from winning a fight that night, and the pan ends with a shot of their dresser during the great depression which is clearly much less accessorised with very little jewellery, a razor, a false tooth and the same photo but without the frame. As Braddock and his family were very well off before the great depression this scene really illustrated how tough the times were and there were many people much worse off than Braddock’s family. Another scene in the film that portrayed the period of the Great Depression was the scene when Braddock went to the Docks to work. Each day unemployed men would wait at the gate and hope to get picked to work on the docks that day. This scene gives you as a viewer a sense of truth about the movie and when the men are stretching out their arms through the bars it demonstrates how desperate people are getting. After it shows the men begging to get picked to work it switches to a close up shot of a newspaper getting dropped on the ground with the title â€Å"unemployed hits record 15 million†. The close up shot of the newspaper really emphasises that the film is during the great depression, and nearly everyone is unemployed; and this shot works perfectly in depicting this point in time. The next scene which indicates the film is during the great depression I personally think is the most effective. Jim and Mae are so low on money that they can’t afford to keep their three c hildren, one who is sick at home and Mae sends them off without telling Jim and this leads to them fighting. After this is changes to a high angle close up on the EMERGENCY RELIEF ADMINISTRATION OF NEW JERSEY and hundreds of people filling out welfare application forms. The camera then pans to Braddock when it is his turn and the woman at the counter says to Braddock- â€Å"I never thought I’d see you here Jim†. When the woman at the counter says this to Braddock it makes me as a viewer think that if Braddock is associated with wealth and he has lost everything, then what does the average person have left? As many other scenes in the film, this one really proves that the film is during the great depression and thousands and thousands of people are hardly surviving. The last scene I am going to talk about which represents the time of the great depression is probably the most effective in getting the message across that the film is during the great depression, and this scene is in Hooverville which is a place where lots of little shanty’s were built by homeless people dur ing the great depression. This scene in the film is very loud and gruesome, with sounds such as police sirens, breaking glass, people yelling and people vomiting. The camera shows lots of people running around, bodies on the ground and small fires everywhere. This scene uses a hand held camera to emphasise the franticness of the people, and shows the occasional close up of individual’s faces to show that they are scared. Immediately after it shows a close up of Mike’s face when he says ‘tell Sarah I’ll be late.’ it flashes straight to a close up of a coffin with a number on it and then another close up on Mae’s grief stricken face. Because mikes coffin only has a number on it, it shows that NO one could afford a personalised coffin and all these people to the government were simply just numbers. At a glance this film is just about boxing, but as you watch it you learn that there is a deeper meaning to the film, and shows the story of one man, who went from having everything to nothing, and then struggled his way through the great depression, and in Braddock’s words he ‘was fighting for milk.’

No Child Left Behind and English Language Learners

No Child Left Behind ( NCLB ) was intended to be instruction ‘s reply to â€Å" divide but equal. † Between 1979 and 2007, the figure of school age kids who spoke a linguistic communication other than English at place increased from 3.8 to 10.8 million ( NCES, 2009 ) . This represents an addition from 9 per centum to 20 per centum for this clip period. Spanish is the first linguistic communication of about 12 per centum of all pupils in public schools. More than 400 different linguistic communications are spoken by the 5.5 English Language Learners ( ELL ) in the United States. 49 per centum of Hispanic 4th graders were classified as proficient in basic reading compared to 77 per centum proficient white pupils on the same trial. In math, 69 per centum of Hispanic 4th graders were adept compared to 91 per centum for white pupils ( NCES, 2009 ) . Merely 4 per centum of 8th class ELLs and 20 per centum of pupils classified as â€Å" once ELL † scored at the proficient or advanced degrees on the reading part of the 2005 National Assessment for Educational Progress ( NCES, 2009 ) . ELLs have some of the highest drop-out rates. They besides are more disposed to be placed in lesser accomplishment groups. Since NCLB was implemented in 2001, there appears to be an addition in the figure of high school ELLs non having a sheepskin because they failed high-stakes trials even though satisfactorily finishing all other graduation demands. The United States is going more and more diverse both ethnically and linguistically. The per centum of ELLs in schools is on the rise more fleetly than the existent Numberss. While the figure of pupils with restricted ability in English has grown exponentially across the United States, their degree of academic accomplishment has lagged radically behind their linguistic communication bulk equals. ELLs academic public presentation degrees are significantly below those of their equals in about every step of accomplishment. In the 2005 National Assessment of Educational Progress, merely 29 per centum of ELLs scored at or above the basic degree in reading, compared to 75 per centum of non-ELLs ( NCES, 2009 ) . The Good The NCLB Act has drawn a good trade of coveted consciousness to the achievement spread of ELL pupils. Under NCLB, the academic advancement of every kid, including those larning English, will be assessed in reading, math and finally scientific discipline and societal surveies. This will supply parents and instructors with information as to how good the pupils are executing and provinces will be held accountable for consequences ( NCLB, 2001 ) . The jurisprudence has generated some benefits for ELLs by pulling attending to these pupils, and doing their public presentation count. NCLB requires that pupils are to be tracked as a subgroup and instructors and decision makers are more concerned about what is working and what is non working. They besides are more aware of looking for what could work with ELLS. Most provinces now have criterions for kids larning English as a 2nd linguistic communication. Annual appraisals based on those criterions and marks are to guarantee more pupils are come oning and making English linguistic communication proficiency over clip ( NCLB, 2001 ) . NCLB requires that all kids, including ELLs range high criterions in English linguistic communication humanistic disciplines and mathematics. In add-on, Title III of NCLB requires ELLs to make proficiency in English in several countries including reading, composing, hearing, and speech production and that their advancement be assessed yearly ( Abedi, 2004 ) . Schools and territories must assist ELLs, among other subgroups ; do changeless betterment toward this aim as measured by public presentation on province trials, or hazard austere effects. States and territories must guarantee that there are extremely qualified instructors in all schoolrooms, including those with ELLs. NCLB does non order a peculiar method of direction for larning English and other academic topics. Districts and schools have the privilege to take the methods of direction that best meets the demands of pupils, including methods of teaching in another linguistic communication or in English ( NCLB, 2001 ) . The jurisprudence is flawed but it does concentrate on English linguistic communication scholars and makes their achievement count. The Bad Ells are the fastest turning population in our public schools and many of them are really born in the United States, the kids of immigrants ( NCES, 2009 ) . The challenges for ELLs are hard. This population continues to swell quickly in volume, with mostly surging concentrations in a little figure of provinces. Accurate ELL designation remains a challenge. As presently implemented, ELLS are to be assessed under the same conditions in testable topics as adept English talkers. Many provinces and school territories are non tracking high school graduation rates for ELLs ; the fastest turning population of pupils ( Zehr, 2009 ) . NCLB was supposed to rectify this. Merely eleven provinces met their answerability ends for ELLs under NCLB in the 2007-2008 school twelvemonth ( Zehr, 2009 ) . NCLB intended to do teacher quality betterment by holding instructors attain â€Å" extremely qualified † position. But â€Å" extremely qualified † does non intend the instructor of ELLs is extremely qualified to learn ELLs ( Harper & A ; de Jong, 2009 ) . High bets proving is coercing direction to alter from enquiry, lifelong larning to learning to the trial by utilizing a method called â€Å" drill and putting to death † . Teaching to the trial is extinguishing the chance for instructors to learn pupils higher order believing accomplishments ( Ravitch, 2010 ) . This reduces clip that instructors are able to learn creativeness, self guided enquiry, and motivational subjects for all pupils. Ells are being taught trial taking schemes alternatively of content related aims. The usage of trial homework worksheets and â€Å" bore and kill † exercisings does non turn to the demand for direction in academic English. To do equal annual advancement ( AYP ) , each territory and school is required to demo that every subgroup has met the province proficiency end in reading and math. Accurately measuring these pupils in English, which is compulsory by jurisprudence, is really demanding, dearly-won, and clip consuming. The cogency of AYP is in hazard when schools inconsistently label English proficient pupils ( Abedi, 2004 ) . NCLB gives provinces authorization to categorise ELLs. Different provinces and even school territories within a province usage different ELL categorization standards. Besides, the ELL subgroup stableness remains inconsistent when ELL pupils reach proficiency degree and are moved out of this group. This straight affects the truth of AYP coverage ( Adebi, 2004 ) . States with high ELL pupil populations in their school territories face greater challenges when learning ELLs and doing AYP as compared to provinces with sparse ELL pupil populations ( Abedi, 2004 ) . ELLs need clip and readying to larn academic English. Unfortunately, in many ways, NCLB is increasing the accomplishment spread by puting greater demands on instructors to supply trial tonss that will lend to the school doing AYP. Possibly, the most toxic defect in NCLB is its legislative bid that all pupils in every school must be adept in reading and mathematics by 2014, including pupils with particular demands, pupils whose native linguistic communication is non English, pupils who are stateless and missing in social advantage, and pupils who have every social advantage but are non interested in school assignment ( Ravitch, 2010 ) . If they are non, so their schools and instructors will endure the effects. What Can Be Done? Teachers must concentrate on learning reading. Abedi ( 2004 ) states that ELL pupils who are better readers perform better. Reading is the key to all academic topics and without adept reading accomplishments, all pupils, including ELLs will make ill on all trials ( Abedi, 2004 ) . Teachers should be learning and non worrying about ways to do certain that they make the tonss needed in order to maintain instruction. Focus on ELLs public presentation, both for persons and groups to place forms of betterment or deficiency of betterment, ideally utilizing multiple steps ( Adebi, 2004 ) . The ELL subgroups must stay stable over clip. When a pupil ‘s degree of English proficiency has improved to a degree considered proficient, that pupil is moved out and non counted in that subgroup ( Abedi, 2004 ) . Testing must be just for all pupils particularly ELLs. Academic accomplishment trials are constructed for native English talkers. Modifying linguistic communication on trial inquiries to decrease the degree of gratuitous lingual and cultural prejudice could increase public presentation of ELLs ( Abedi, 2004 ) . Lack of academic English accomplishments topographic point ELLs at a greater disadvantage for understanding what is being assessed. Testing should be fair for all pupils. NCLB has placed undue trial public presentation force per unit area on schools with big Numberss of ELL pupils. This is particularly unrealistic when schools may still fight with the same limited school resources as earlier. We must hold a clear vision of what is considered a good instruction ( Ravitch, 2010 ) . Goals should be meaningful and come-at-able and non based on a apparently unapproachable ideal. As a state of immigrants, it is perfectly indispensable that we meet the demands of those pupils larning English as a 2nd linguistic communication. It has long been a challenge within the schoolroom to at the same time learn English alongside the other mandated topics such as mathematics, composing, scientific discipline, and societal surveies. Along with this, best pattern learning modes must be identified and used and instructors must be given appropriate preparation to implement these best patterns. Along with this, support must be provided to adequately implement these learning best patterns. Teachers must hold preparation in order to transport out these aims. Last, lawgivers must look at NCLB and find its achievability. Is the authorization for each pupil to be adept in English linguistic communication humanistic disciplines and mathematics by the twelvemonth 2014 idealistic or realistic?

Buddha was a religious innovator Essay Example for Free

Buddha was a religious innovator Essay In my opinion, Buddha was a religious innovator- since he went against all other prominent religious beliefs of the time in declaring that there was no soul- no permanent self (anatta). I will be discussing whether Buddha was indeed a religious innovator, the ideas he has taken from other religions and entirely original, new concepts he created. He disagreed with many other popular religious practices, for example sacrifices- around which the Vedic religion (which was popular around Buddha’s time) revolved. He did so for many reasons, the main being Buddhists don’t believe in a God- no God would mean sacrificing an animal would be wasteful and pointless. Another reason he disagreed with this would be that hurting the animal would be against the eightfold path since harming the animal unnecessarily would not be a ‘right action’ it would also be an example of not showing the ‘right mindfulness’ since if we were aware of the animal’s pain and suffering then we wouldn’t be sacrificing the animal. Many Buddhists choose to be vegetarian as hurting animals creates bad karma due to the above. Buddha’s main difference in opinion to ideas of the time would be that the Buddhist Dharma (or teaching) says that we have no soul or ‘no permanent self,’ this is called Anatta. Buddhists believe that because we are made up of five Skandhas- (Form, sensations, perceptions, mental formation and consciousness) that are constantly changing, we have no permanent self. Buddhism was the first religion to say that we have no soul. The Jains and Shramanas (both prominent religions of Buddha’s time) both taught that the atman (or soul) is reincarnated time after time until Moksha, where the soul returns to God (or ‘Brahmin’ in some cases.) In Buddhism, Buddha taught that it is not our atman that is reborn, but our karma. For example- a candle lighting another candle, it is the heat from the first candle that lights the second- no part of the first candle is passed along to the second. Buddhists believe this, but with karma instead of heat- that is, they believe it is our karma that causes rebirth time after time. Buddha also made it clear that equality was an important part of Buddhism since we could be reborn as anything- poor man or a king- we are all the same. This was innovative since in Eastern Europe there was great emphasis on the social division called the caste system, which was present in the Vedic religion and very rigid. This meant that many of the lower classes and poorer people could not take part and so were cut off from the religion. However, Buddha did take ideas from the ideas of karma, but changed them slightly. For example, the Jains believed that karma was a sticky substance which floated above their heads preventing them from escaping rebirth, whereas Buddhists might perceive karma as a force which governs balance- for example if you’re a bad, mean, rich person in this life, you might come back as a poor beggar who lives a miserable life. Another Jain idea that Buddha imitated was that of ‘Ahisma’ or non-violence. Buddhists believe violence is wrong because of parts of the eightfold path, such as ‘right action’. This was the Jains main teaching- they were the first to become vegetarians- many Buddhists choose to become vegetarians too. Having considered both points of view, I still believe that Buddha was a great religious innovator simply due to the fact that most of his teachings and ideas had not been heard before. Buddha was a religious innovator. (2017, Sep 11).

Occupational Health and Safety Essay Example | Topics and Well Written Essays - 750 words

Occupational Health and Safety - Essay Example Consequently, this may lead to injuries caused by human error. Once a person is exhausted, he or she requires time to rest in order for the mind to focus on the tasks at hand. The fatigue is often as a result of an employee overworking in order to get the favor of the management which pushes them to work beyond their limits (CCH Australia Limited., 2009). This results to overworking and hence getting tired. The other reason for occupational accidents is a tight working schedule which may force employees to work beyond their capacities just because the management has established tight deadlines. An overworking employee has often end up getting fatigued because their bodies work under tight pressure. A perfect example is whereby an employee working at a steel company is given a time duration of more than eight hours for the completion of a task. This is like using humans like robots. This will reduce his attention at his or her duties in the end he may accidentally place his hand in th e smelted steel thus causing body harm. The other cause of injuries at work place is stress which comes as a result of a poor working environment or problems at home (Burke, Clarke & Cooper, 2012). Stress at the workplace may be as a result of lack of payment or even delayed payment. For instance, a worker who was supposed to be paid within a week has had her payment delayed and has been anticipating it for over two weeks when management decides to make a lower amount of pay or even fails to do so without placing reasons. Obviously, the employee will experience stress because there are bills to be covered with little or no money. Stress may lead to less concentration during working hours and this may lead to workplace injuries in form of accidents from improper use of machines or even missed quality issues. Collision is the other cause of accidents in workplaces. The collision between people and machines or objects at the workplace may result in injuries. Such accidents may result f rom poor set up within the working environment which limits movement of people as well as machines. Equipment may be placed in positions that may cause collisions during movement. For instance, someone carrying a box while ascending the stairs may hit the roof because it is very low resulting in a fall (Burke, Clarke & Cooper, 2012). Statistics show that conflicts do occur at work place in that employee may fight at the long run this may lead to body arm to the affected parties. This makes work related fights as the other cause of injury in workplaces. If they are not stopped in the right manner it may attract more groups hence people getting involve. The other cause of injuries in is slips due to slippery ground they may result due to the companies’ structures. The other cause is the most famous ignorance; this may be as a result to ignorance of safety rules. The workers may find themselves being injured due to their ignorance. Measures should be taken in order to deal with the accidents (Burke, Clarke & Cooper, 2012). First the setting up the workplace in away that collusions and slips are minimized. The high of the roof should be high to avoid knocks. Second safety measures should be but in place in that protective clothing and gloves are worn to prevent spillage of chemicals that may corrode ones body. Also counseling should be done to deal with stress and depression by the employees. Lastly the company should adopt a culture

Gender differences and oral health behavior Research Paper

Gender differences and oral health behavior - Research Paper Example With increasing research indicating that one’s periodontal health may be related to overall health, never has it been more important to ensure the health of your teeth and gums. You cannot be healthy unless you are periodontally healthy† (Clem cited in perio.org, 2012). However, there is sufficient research to demonstrate a difference in the behaviors and attitudes of men and women towards dental hygiene and care, with the former generally considered to be not quite as particular about maintaining dental hygiene and care as the latter. A vast majority of the research works conducted so far have found a greater tendency in the girls to take care of their dental hygiene and adopt positive attitudes and behaviors towards dental care as compared to boys while studies many studies conducted upon older men and women have found similar trends of dental care and behaviors and attitudes towards it. This suggests that age might be an important depicter of the behavior and attitude an individual adopts for the dental hygiene and care. This imparts the need to study the correlation between age, gender, and attitudes and behaviors towards dental hygiene and care. Identification of gender differences and oral health behavior of adults is fundamental to the development of ways in which both men and women can be convinced to change their behaviors towards the dental hygiene for the better. This research will provide a more holistic view of the attitudes and behaviors of females and males towards the dental hygiene and care as the research will be conducted upon adult men and women. Results of this research will contribute towards the knowledge of effect of both age and gender upon an individual’s tendency to adopt positive attitude and behavior towards the dental hygiene and care. Fukai, Takaesu, and Maki (1999) studied the link between general health habits and oral health behavior in both men and women and found a direct

Diary of a medical mission Term Paper Example | Topics and Well Written Essays - 250 words

Diary of a medical mission - Term Paper Example There should also be no crowding at the shelter and patients should be educated on the first signs of deadly diseases so as to contain earlier. The secondary intervention would include measures such as carrying out thorough screening on people showing signs and symptoms of diseases such as high blood pressure, parasitic infections, Tb and other diseases. This is carried out so as to treat the diseases and contain its outbreak. Tertiary prevention would include slowing down the pain related to fracture sand other deadly diseases like TB. It would also include preventing these diseases from causing other complications. These involve better surgeries and requesting for new medications. Stroke patient should also be given both occupational and physical therapy. The interventions measures highlighted above would be carried out as early as the 1st phase, and throughout 5th phase. This is because mitigation preparedness response and recovery map the all three levels and each of them is encountered at every phase. I would like working with local based agencies and cooperation and also incorporate local nurses because they have a better understanding of their people and environment. They can also easily notice symptoms of some diseases in their

Opera house branding Assignment Example | Topics and Well Written Essays - 250 words

Opera house branding - Assignment Example Opera house aims at enhancing student values through plays, and thus its messages through plays will be mostly student-oriented (Griffin). Opera house aims at bringing the young audience mostly the students. The company will, therefore, be providing features that aim at incorporating such audience. In addition, the opera house will provide the students shows as well as arranging several classes and activities to attract the people and bring them closer to the company. The main message the company is passing to the audience is unity and self-reliance. The main idea of bringing the people close to the company is for the people to take the opera house as a community business that they are part of it (Galbi). The people should feel that they own the business. The public should feel it is their responsibility to make it progress to new heights and compete with other opera houses that offer the company stiff competition. The company is looking forward to enhancing this mutual relationship with the target audience so that its longevity can be

Summary Essay Example | Topics and Well Written Essays - 500 words - 97

Summary - Essay Example The Home, which was located in the heart of Victoria, was regarded as the safe haven for Chinese prostitutes and other Chinese females who were thought to be at risk of falling into prostitution but later open door for Japanese women and children. This was intended to protect Asian women from being transformed by the by the missionaries. The white women largely influenced the behaviors and attitude of the Asian women especially in areas of marriage and domesticity. There were several issues that triggered the transformation and the white domesticity especially through the enactment of racial and gendered performances. The article also explains a high profile kidnapping that involved a cross racial encounters as well as policing and gendered boundaries in an unsanctioned cross-racial contact. It is apparent that discourses of domesticity and Christian related marriage largely contributed to the kidnapping. The police and other responsible institution did not do proper investigation concerning the issue of kidnapping and this became a major scandal that affected the Home. The Home enabled careful management and intimate cross-cultural contact that triggered racial constructions of the period in British Columbia. Menzie who was a suspect in the kidnapping saga contaminated the white community. The state of marriage and the intermixing Chinese and European populations were greatly affected by the incidences between the two groups. It is therefore worth noting that the Victoria’s Chinese Rescue Home acted as a domestic space and the women’s moral authority was used to allow the various practices that took place. Marriage, for instance, was considered significant and acted as part of women’s domain as far as Christianity is concerned. People who ran the Home greatly contributed to various racial discourses and the article shows how moral entrepreneurs operated in difficult ways. The entrepreneurs

Ethnographic Perspectives on the Everyday Assignment

Ethnographic Perspectives on the Everyday - Assignment Example Effective communication can be lost as the worker tries to explain the problem and the manager is only hearing excuses as to why expectations cannot be met. Failures in communications can result in strained relationships between managers and workers as information is not given or processed correctly. The way in which workers and managers communicate with one another is often defined by the management style that a manager will adopt. The type of leadership that is established will have an effect on how a worker responds and is able to communicate to the manager. As well, the way in which an individual has experienced speaking with leadership will also have an effect on how they can communicate to a manager. Communications styles develop long before an individual enters the workforce, but they can be trained in order to provide for more effective communications (Young, 2009). Often times it is a lack of communications training that will position a worker so that are unable to give information to an employer. There are four basic types of management that will affect the way in which communication develops between a manager and an employee. The four types are autocratic, paternalistic, democratic, and laissez-faire. In an autocratic type of management, information is proprietary and all decisions are made by the manager. A paternalistic manager will make decisions upon the basis of what is best for the employees. Through good relationships with employees, this type of manager acts as a guardian for their interests. In a democratic style of management the manager will allow employees a voice in the decision making process with discussions and a fairly free flow of information allowing for some equality within the groups and teams of the organization. In the laissez-faire form of management, the manager avoids his responsibilities and the employees end up picking up duties

The Fall (of man) in Genesis Research Paper Example | Topics and Well Written Essays - 2500 words

The Fall (of man) in Genesis - Research Paper Example iew it, it is the â€Å"conflict of conflicts† that swayed the peace of man as he entered a new era where peace between him and fellow man, him and Gods creation was eroded. The conflict between Man and God and its solution is much similar to the conflict that exists in the contemporary society between people, countries and even leaders. As the ebb of peace is enjoyed between each tide of war, man (and countries alike) assesses previous battles, losses and gains, so as to strengthen itself for future conflicts. Seldom do men realize the very origin of conflict may be traced to the Old Testament book of Genesis. It should be understood that not every fall ends up in a war, but the source of all conflict is the result of one fall in particular. The fall of man as depicted in Genesis begins the greatest conflicts known: the conflict of man verses God; the conflict of man verses man; and the conflict of man verse creation. In the book of Genesis, Man was the most privileged work of God’s creation. God created man as the last creature after He had created the earth, a conducive environment for man. As opposed to other beings that were created out of nothingness, man was created from soil, a symbol that he was a special creation on Earth1. Much more, he was created in the image and likeness of God, to signify the close relationship that God established between man and Himself as the most privileged work of creation. This special treatment is also manifested in the nature of the responsibilities that the Lord gave to man as regards the entire work of creation. The Lord asked man to take responsibility of the land, the animals and the environment as he fends for his existence in this work of creation. In principle, man was placed as the overall in the work of creation, a superior being than no other in the Garden of Aden. When God noted that Adam was lonely, he created Eve from his own rib so that she would keep him company and wipe away his loneliness2. The love of God

Organizational Performance Management Essay Example for Free

Organizational Performance Management Essay Healthcare organizations have differences and similarities across the board. Some healthcare institutions are faith based and will not allow for some procedures. Others provide small procedures and vaccinations. Some healthcare facilities are for profit and others are non-profit. While other health care providers only take certain types of insurances, either government funded or privately funded insurances. The Mayo Clinic is large not for profit operating healthcare provider and healthcare research entity. They provide a vast array of services in the United States from diabetes to cancer treatment and research. The Mayo Clinic has a worldwide reputation and standard that continues to receive accolade and awards. The Mayo clinic has received the Joint Commission’s Gold Seal of Approval. This award is given to organizations that demonstrate the highest dedication to improving and providing patients with best quality of care. The Mayo Clinic takes pride in being able to provide the highest level of care and to also maintain it. The Mayo Clinic has established a department to manage any infraction that may hinder its goal of achieving this standard it has set forth (Mayo Clinic For Patients, 2013). The Mayo clinic has to maintain a standard that is consistent with the reputation that they have established for themselves through risk and quality management. The Mayo Clinic has a compliance and integrity program established to reinforce safety. This program is put into place to monitor the overall business practices and to ensure they are being conducted with integrity. The program puts a ll policies and procedures under one chain of command so that they can be monitored and used as a means of communication for employees. The compliance office oversees the directing and receiving of reports, questions, and concerns about the care provided. The Compliance Office works with all department heads and stakeholders to ensure regulations and requirements are met (Integrity and Compliance Program, 2011). They also establish furthering education so that employees are up to date on current rules and regulations. The compliance office is open to receive any and all violations reports. The violations are investigated thoroughly. This program ensures that the company is able to provide statements in relation to its business practices, current and forthcoming law changes, and to protect itself and staff from any civil or legal issues. The integrity and compliance program applies to all individuals who work in any capacity at the mayo clinic from main stakeholder to students and volunteers. Workers are expected to report any violations that are suspected or otherwise known (Integrity and Compliance Program, 2011). The compliance program offers an open door policy and protects its employees from retaliation. The purpose for this office is to identify violations that are against company policy and the company and its employees to be civilly liable, and criminally liable. Each Mayo facility has a compliance officer on staff to ensure its compliance an d integrity program is being fulfilled. Compliance officers are responsible for investigating suspected violations. Each employee is required to take a compliance-training course to ensure that they know what is expected of them when they witness, suspect, or commit a violation. The compliance program further educates new employees on the standard in which Mayo conducts business. The current state of providing healthcare is ever changing and the Mayo Clinic has to stay one step ahead and ensure that their employees are properly educated in all aspects of healthcare laws (Integrity and Compliance Program, 2011). Abrazo recognized as 2011 as Best in Arizona by U.S. News and World Report, One of the Best in Phoenix, ranked #12 for the Arrowhead Hospital are a few of its great recognition as an great health care organization. The Joint Commission name Maryvale Hospital for heart attack, heart failure, pneumonia and surgical care as â€Å"top Performer†. The American Heart Association and American Stroke Association awarded The Sliver Plus Achievement Award for 2012 and 2011 to Phoenix Baptist Hospital and the Arizona Quality Alliance awarded Arrowhead Hospital in 2012 for Excellence. Abrazo Health Hospital has done and continues to contribute the best qua lity care in the valley for its community. Maintaining a fact sheet that include Medical Group, Health Institute, School-Based Health Centers, an Emergency Center in North Peoria, and providing health plans for those who need help in these areas. Abrazo has also contributed to many charitable organizations in the Valley. Like the American Heart Association, Susan G. Komen, YMCA, Leadership Council, and many high schools. They continue to provide information to the community and continue huge amount of support to the American Heart Association, Community Education and Outreach, Fire Service Leadership Conference, Keogh Foundation, School-Based Health Centers, Susan G. Komen, Race for Cure, The Legacy Backpack Buddies, and the Valley of the Sun United Way. Abrazo Health is part of the Nashville-based Vanguard Health System who embraces non-profit health care systems and serves as a bridge for these non-profit organizations to connect, serve as a business partner to for-profit corporation. The Vanguard Health System and Abrazo Health continue to provide top quality care in affiliation with board certified physicians, nursing professionals and well-trained staff, all who were recognized by national organization that share the same values in patient care. Showing Distinguished Awards from American Heart Association, Arizona Quality Alliance, The Joint commission, and named â€Å"Best in Phoenix† by U.S. New and World Report, Abrazo leads in the healthcare industry with a fantastic reputation. Another organization’s risk and quality management that finds themselves in a unique situation between providing the best resources possible to the community and regulation is the Southwest Autism Research Resource Center. The Southwest Autism Research Resource Center, also known as SARRC, is a non-profit, community-based organization that conducts research and distributes information, as well as supports individuals with autism and their families. In 2009, SARRC conducted 250 training and orientations, as well as offered information and services to students and staff in 90 Arizona schools. All of the services they offer are of highest quality and evidence based (Sarrc, n.d.). Autism touches on a broad spectrum of conditions and behaviors. In order to provide support for this spectrum, SARRC performs and receives research from many doctors as well as developmental psychologists. Performance is monitored by how the varying levels of success the therapies have on developmental delays such as feeding, speech, and social skills. Autism touches on a broad spectrum of conditions and behaviors. In order to provide support for this spectrum, SARRC performs and receives research from many doctors as well as de velopmental psychologists. Performance ismonitored by how the varying levels of success those therapies have on developmental delays such as feeding, speech, and social skills. For SARRC, the main regulatory body that effects accreditation on research and treatment is the Arizona Board of Psychologist Examiners. By following the guidelines set by the Arizona Board of Psychologist examiners, SARRC will be in compliance and be able to perform at expectations above the high standards set by the board. They also have to make sure that they are following regulations set forth by the U.S. Food and Drug Administration. Some of these regulations include the use of electronic records, protection of human subjects, informed consent, and specific safeguards for children. By continuing partnerships with doctors and researchers and following the guidelines set by the regulatory board, SARRC can focus on becoming the center of choice for those seeking assistance Autism spectrum disorders. This will help improve overall organizational performance. The most important part of an organization is to make sure everyone at all levels is working toward a unified goal. Some levels of the organization may have other compartmentalized goals, but overall the message should be clear. Leadership should set the expectations of all incoming employees, but all employees should have a way of giving feedback to leadership on how they feel the organization is progressing to its goal. Staff needs to know that without compliance and accreditation guidelines the organization cannot survive, much less thrive on the assistance it provides to the community. The goal is to have a majority of the staff believe in the direction of the organization and for the organization to listen to its employees. Compliance and regulation set the tone for risk and quality management systems in an organization. Certain aspects may help or hinder performance depending on the particular regulations set by the state. With the guidelines in place, quality management can gauge whether exceeding these standards would help the organization. Besides the level of service provided in quality management, risk management dictate that these actions are responsible from a fiduciary standpoint. Nonprofit organizations aren’t in it to make the big bucks per se, but they still are a business that needs to run and pay employees, facilities, and other services provided. Abrazo Health offers a broad range of medical services, internal medicine, general surgery, cardiology, orthopedics, mother and infant care, diagnostic imaging, and emergency service. Mayo clinic offers cardiology, diabetes, and neurology surgery. SARCC focuses primarily on autism research. Abrazo departments are strictly viewed by the board members to ensure safe and quality care is being provided. Abrazo has over 5,000 employees, 600 volunteers and 2,000 affiliated physicians, and are located all over the Phoenix Valley. The Mayo Clinic is somewhat nationwide with its main facilities in Minnesota, Florida, and Arizona. The Mayo Clinic staffs and employs around 61,000 employees. The mayo clinic also has a research department and an accredited medical school established to train medical professionals and student medical doctors (Mayo Clinic facts – 2012, 2013). Abrazo Health Hospital has five acute who are all accredited by The Joint Commission (TJC) who have accredited hospit al for more than 50 years. Arrowhead Hospital, Maryvale Hospital, Phoenix Baptist Hospital and West Valley Hospital are recognized as a certified Primary Stroke Center and are a part of the Abrazo Health Hospital. All three of these organizations are not for profit. Each facility has its own purpose and mission statement. Not all healthcare facilities are the same as they provide care in their own way established from their own standards and levels of care. Each has a common goal in providing the highest level of care in any treatment they provide. Each has the tough task of always having to update their quality and risk management goals to meet the demands of the public and reimbursement agencies along with maintaining their accreditations. Quality and risk management have to be proactive and stopping incidents before they start. Incidents cost organizations financially and in the long run take away from the level of care that they are trying to provide. References Abrazo Health. (2013). Retrieved from http://www.abrazohealth.com/home.aspx Integrity and Compliance Program. (2011). Retrieved from http://www.mayoclinic.org/mcitems/mc2500-mc2599/mc2570.pdf Mayo Clinic Facts — 2012. (2001-2013). Retrieved from http://www.mayoclinic.org/about/facts.html Mayo Clinic For Patients. (2013). Retrieved from http://health.usnews.com/besthospitals/area/mn/mayo-clinic-661MAYO/for-patients SARRC. (n.d.). Retrieved from http://autismcenter.org/about_sarrc.aspx - University of Phoenix Material Organizational Performance Management Table After you have completed your individual research on your chosen type of health care organization, collaborate with your Learning Team to complete this table. Then, refer to this table as you collaborate to write your paper. Include this table as an appendix to your paper. Fill in the necessary information in each cell, but be as succinct as possible. 1. Provide names of or links to specific organizations. Summarize key products or services provided by each type of organization and identify the primary customers they serve. Organization One| Organization Two| Organization Three| MAYO Clinichttp://www.mayoclinic.com/The Mayo Clinic is a non-for-profit worldwide organization that is dedicated to medical care and research. They employee Doctors from all practices and utilize their expertise to work together for the better of the patients. The Mayo Clinic also has school for furthering education for medical professionals. They treat over a million people a year. Their mission is to provide care and let people care for themselves. They provide up to date information and methods for their patients and website | Abrazo HealthCarehttp://www.abrazohealth.com/home.aspx Abrazo Health offers a broad range of medial services, internal medicine, general surgery, cardiology, orthopedics, mother and infant care, diagnostic imaging, and emergency service. Providing new standard care and over 5,000 employees, 600 volunteers and 2,000 affiliated physicians. They are located all over the Phoenix Valley. | Southwest Autism Research Resource Center (SARRC)http://autismcenter.org/default.aspxSARRC is a non-profit, community-based organizations that conducts research and distributes information, as well as support for individuals with autism and their families. In 2009, SARRC conducted 250 trainings and presentations, as well as offered information and services to students and staff in 90 Arizona schools. All of the services they offer are of highest-quality and evidence-based. | 2. Outline the overall content of the major regulations, accreditation requirements, and other standards that affect each organization. Provide the title, section, parts, or subparts or the numbering system and so on of the specific regulations or accreditation requirements. For example: Use of electronic signatures in electronic medical records is equivalent to handwritten signatures on paper; FDA regulation; Title 21 CFR Part 11, Subpart C,  § 11.200 Electronic Signature: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?cfrpart=11 Organization One| Organization Two| Organization Three| Mayo Clinic and its website are accredited through the Joint Commission. The Joint Commission overseas hospitals that receive Medicaid reimbursements. The Joint Commission has also accredited the Mayo Clinic in its Advanced Stroke Center. Commission on Accreditation of Rehabilitation Facilities (CARF) has accredited Mayo Clinic for their inpatient rehabilitation programs.CEO Cancer Gold Standard Accreditation.Breast Clinic has received the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons.-Educational Accreditations Mayo Clinic’s College of Medicine, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) which provides continuing medical education for physicians. Mayo Clinic College of Medicine designates these educational activities for category 1 credits toward the American Medical Association (AMA) Physicians Recognition Award.College of Medicine, Mayo Clinic, has achieved Accreditation with Commendation – which is the highest level of recognition offered by ACCME.| Abrazo Health Hospital and the five acute are all accredited by The Joint Commission (TJC). The Joint Commision have been accredited hospital for more than 50 years. Arrowhead Hospital, Maryvale Hospital, Phoenix Baptist Hospital and West Valley Hospital are recognized as a cerified Pimary Stroke Center and are apart of the Abrazo Health Hospital. Also recognized as 2011 Best in Arizona. U.S. News and World Report, One of the Best in Phoenix, ranked #12- Arrowhead Hospital.TJC top Performer- Marvale Hospital for heart attack, heart failure, pneumonia and surgical care. American Heart Association and American Stroke Association- The Sliver Plus Achievement Award for 2012 and 2011 to Phoenix Baptist Hospital.Arizon a Quality Alliance- Award for Excellence to Arrowhead Hospital in 2012. Abrazo Health Hospital have done and continue to contribute the best quality care in the valley for years. | Use of electronic records and electronic cignatures Title 21 CFR Part 11 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=11 Protection of Human Subjects Title 21 CFR Part 50 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=50 Informed ConsentTitle 21 CFR Part 50.25 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=50.25 Safeguards for ChildrenTitle 21 CFR Part 50.55 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=50.55 | 3. Highlight the effect of each organization’s regulations, accreditation requirements, and other standards on the risk- and quality-management functions and activities. Organization One| Organization Two| Organization Three| Mayo Clinic has a standard of practice, therefore they need the highest of accreditations. They have to maintain their level year round to not only their patients but also their employees. Risk management has to assess any and all possible issues that could cost the company money and loss of productivity due to fines, and employment turn over. Quality management has to ensure that all employees are up to date on education and changes in regulations and procedures. The accreditations aloow the Mayo Clinic to conduct certain researches and also certain procedures such as brain and cardio surgical procedures. Without the accreditation they would not be able to perform said procedure and therefore lose money. | Abrazo Health has 5 acute hospitals in the state of Arizona. Arrowhead, Maryvale, Paradise Valley, Phoenix, and in West Phoenix. Each providing a broad range of medial needs and working with the Arizona Heart Hospital and leading a great reputation in the cardiovascular department. Abrazo has been rewards on numerous occasions which has lead the organization to continue to provide great quality care all over the metropolitan area of Phoenix Arizona. Abrazo Health maintain a fact sheet which include Medical Group, Health Instutute, School-Based Health Centers, an Emerg ency Center in North Peoria, and providing health plans. Abrazo has also contributed to many charitable organizations in the Valley. Like the American Heart Association, Susan G. Komwn, YMCA, Leadershio Council, and many high schools., they continue to provide information to the community and continue huge amount of support to the American Heart Assoication, Community Education and Outreach, Fire Service Leadership Conference, Keogh Foundation, School-Based Health Centers, Susan G. Komen, Race for Cure, The Legacy Backpack Buddies, and the Valley of the Sun United Way.| Since SARRC is a non profit research organization located in Arizona, not only do they have to comply with non-profit laws but also the regulation of the Arizona Board of Psychologist Examiners. This board of examiners regulates how employees of SARRC are licensed to perform work with children and the education they need to keep licenses up to date. From a risk standpoint the board ensures that SARRC employees are li censed to give psychological treatment to children and to use safe methods. This also helps SARRC maintain high quality as the research techniques used exceed the Board of examiners qualifications as per SARRC programs (http://autismcenter.org/programs.aspx)| 4. Specify components of performance-management systems—policies and procedures, self-audits, benchmarking, complaint management, corrective or preventive action, education and training, communication, and other mechanisms—to be used by each organization. Organization One| Organization Two| Organization Three| Mayo Clinic has a compliance department and employs compliance officers that ensure policies and procedures are being followed accordingly. Compliance officers investigate all forms of complaints and work with department directors and managers to manage investigations and look for ways to stop these issues before they start. Education is developed through past incident along with present and future policy and law changes.| Abrazo part of the Nashville-based Vanguard Health System who Abrzo providing top quality care in affiliated with board certified physicians, nursing professionals and well-trained staff who have been recognized by national organization who share the same value in patient care. Showing Distinguished Awards from American Heart Association, Arizona Quality Alliance, The Joint commission, and named â€Å"Best in Phoenix† by U.S. New and World Report, Abrzon leads in the healthcare industry with a fantastic reputation. | SARRC research led by Christopher Smith, Ph. D an experimental psychologist, uses collaboration between different methods and scientists to find the possible causes of autism. Since autism is such a broad spectrum and there is no pinpointed contributing factor, most of the research and progress in the field is experimental. Most patients go in with the understanding that Autism may not be something that is curable. Performance is measured by the proven research methods which are demonstrated to work the most effectively for the child which varies per child for the broad spectrum disorder.| 5. Provide links to any relevant sources that will be useful as your Learning Team completes the paper. Organization One| Organization Two| Organization Three| http://www.mayoclinic.org/mcitems/mc2500-mc2599/mc2570.pdfhttp://health.usnews.com/best-hospitals/area/mn/mayo-clinic-661MAYO/for-patientshttp://www.mayoclinic.org/about/facts.html| | |

Effects of Zinc Deficiency

Effects of Zinc Deficiency INTRODUCTION Zinc is a trace mineral that plays an indispensable role for human health because of its critical structure in multiple enzymes that are involved in gene expression, cell development and replication (International Zinc Nutrition Consultative Group [IZiNCG], 2007). Aside from its unique and extensive role in biological processes, zinc is essential for physiological processes including growth and development, and brain and immune function (Ackland and Michalczyk, 2006). More than 85% of total body zinc is found in skeletal muscle and bone (National Health and Medical Research Council [NHMRC], 2006) as well as in the brain that plays a central role in the production of enzymes essential for RNA and DNA synthesis (Black, 1998). Zinc deficiency affects, on average, one-third of the world’s population ranging from 4 to 73% in different countries (Hotz and Brown, 2004). It has been estimated that zinc deficiency is responsible for deaths of nearly 450,000 children under age 5 years old annually (Black et al, 2008). Similarly, zinc deficiency is accounted for 16% lower respiratory tract infections, 18% of malaria and 10% of diarrheal disease and more than 28 million aggregates to loss of disability-adjusted life years (DALYs). In total, 1.4% (0.8 million) of deaths worldwide were attributable to zinc deficiency: 1.4% in males and 1.5% in females (WHO, 2012). Zinc deficiency is defined by short stature, hypogonadism, impaired immune function, skin disorders, cognitive dysfunction and anorexia (Prasad, 1991). Zinc deficiency is uncommon but a widespread problem across the globe (Ackland and Michalczyk, 2006). It has far-reaching consequences, playing a contributory role to stunted growth in children (Brown et al., 2001) and causing abnormal cerebellar function and damage of behavioural and emotional responses (Henkin, 1975) in addition to morbidity from diarrhea, pneumonia and malaria (Shankar, 2000). Therefore, zinc deficiency compromises the development of children worldwide and is a veritable public health concern (Gibson, 2005). Background of the Study Micronutrients have been scientifically and technically discovered to improve the overall well-being of an individual and that deficiencies can cause a range of health and developmental problem. Zinc is one of the micronutrients that promote immunity, resistance to infection as well as growth and development of the nervous system. Zinc deficiency can lead to more frequent infections, reduce children’s ability to fight and survive disease, and impair mental capacity. These risks remain serious as children grow and develop because they cannot learn as well, and lose school days due to illness. Later in adulthood, it negatively affects physical energy and, therefore, productivity. Reduced intellectual capacity undermines investments in education and perpetuates cycles of poverty, which is a significant barrier to achieve economic growth and improved standards of living. In addition, intellectual ability is affected by iron which affects work capacity, physical and cognitive performance (Global Report, 2009). Zinc has the primary focus of scientific investigations related to linear growth which is intimately connected to nutrition. As a manifestation of chronic undernutrition, stunting has been linked to multiple adverse health outcomes that extend beyond childhood into adult life (Souganidis, 2012). Recent evidences also suggest that zinc deficiency may be associated with deficits in activity, attention, and motor development that commonly occur in nutritionally deficient children (Souganidis, 2012) because it contributes to the structure and function of the brain (Black, 1998). According to the World Bank (2012), the Philippines ranks 48th out of 136 countries in terms of the prevalence of stunting and 32% of Filipinos are at risk for insufficient zinc intake. Generally, zinc status is of high magnitude (>20%) among infants and preschool children (6 months to 5 years), female adolescents (13 to 19 years), older persons (20 to Statement of the Problem Zinc deficiency has been a major micronutrient problem in the Philippines. It has been associated with linear growth and cognitive development. Zinc has also been related to iron due to their inhibitory factor with one another. The effect of zinc on physical growth occurs during the first 2 years of life with association to high rates of infection, inadequate nutrition and cognitive deficits. The following questions were highlighted in the study to examine the association of zinc status to nutritional status, iron status and cognitive development as well as possible risk factors of zinc deficiency in 2 to 3 year old children in Laguna, Philippines. What are the socio-economic and demographic characteristics, water and sanitation practices, health services, child care and feeding practices of mothers? What are the food intake and nutrient adequacy of children? What is the nutritional status, zinc status and iron status of children? What is the level of cognitive development of children? What is the degree of association between zinc status and the following variables: water and sanitation practices, and health services; child care and feeding practices, and food intake; nutritional status; iron status; and cognitive development? Hypothesis of the Study The following were the research hypothesis that guided the study: Water and sanitation practices are associated with nutritional status. Health services are associated with nutritional status. Infection is associated with nutritional status and cognitive development. Food intake is associated with nutritional status and cognitive development. Weight-for-age, height-for-age and weight-for-height are associated with zinc status, iron status and cognitive development. Zinc status is associated with iron status and cognitive development Iron status is associated with cognitive development. Objectives of the Study Generally, this study aimed to determine the Zinc status and its relationship to physical growth and cognitive development of 2 to 3 year old children in Laguna, Philippines. It specifically sought to: describe the socio-economic and demographic characteristics; water and sanitation practices; health services; and child care and feeding practices of mothers; evaluate the food intake and nutrient adequacy; assess the nutritional status, zinc status and iron status; determine the level of cognitive development; and examine the association of zinc status with each of the following variables: water and sanitation practices; health services; child care and feeding practices, and food intake; nutritional status; iron status; and cognitive development. Significance of the Study The province of Laguna has been consistent in the implementation of nutrition programs. The nutrition sector has been conducting nutritional assessment to address the magnitude and severity of malnutrition particularly, of under and overnutrition in the province. However, zinc deficiency, as one of the public health concerns, and its multifactorial causes have not yet been given attention. With limited researches, the assessment of zinc status provided a deep understanding of the consequences of stunting and iron status as well as its contributory effect to cognitive development of 2 to 3 year old children. The results of the study shall provide local government units, program planners and policy makers with significant inputs for relevant programs; suggested and recommended effective nutrition strategies to local nutrition and health workers; and imparted to nutrition and nutrition-related professionals knowledge and awareness on micronutrient deficiencies, particularly of zinc. Scope and Limitations of the Study The study focused on the assessment of physical growth, zinc status, iron status and cognitive development of 2 to 3 year old children in the province of Laguna. Factors affecting child nutritional status included were to socio-economic and demographic characteristics, health, water and sanitation practices, child care and feeding practices and dietary intake. Contributory factor to nutritional status such as infection was also included. The criteria in selecting the study area and the profile of the province were limited to the availability of secondary data. The sample size was based from the 2013 Operation Timbang (OPT) list which may not include all children with ages 24 to 35 months old. Data on child morbidity was limited to personal interview of mother-respondents. Likewise, dietary assessment was limited to a non-consecutive 2-day food recall which may not indicate foods that are highly seasonal. Determination of cognitive development was also limited to the adapted items of the Early Childhood Care and Development (ECCD) program, Metro Manila Developmental Screening Test (MMDST), and Child Development Index (CDI). The sample size may not be able to reflect the entire population of 2 to 3 year old Filipino children. However, the sample size was sufficient to test the statistical significance of the study. The conclusions were made from the results of the study. Hence, it was limited to the conditions inherent to the selected children.

Are All Religions Basically The Same?

Are All Religions Basically The Same? Imagine that three people are all touching a part of an elephant. The first is touching the elephants leg and says that the elephant is like the truck of a tree. The second is touching the elephants trunk and disagrees with the first. They think that the trunk is more like a large snake. The third person thinks that the elephant is more like a great wall because they are toughing the side. Each person is convinced that they are right and the others are wrong because of what they know and have experienced. What they dont realize is that they are all technically right because they are each describing a different aspect of the elephant. The same analogy can be applied to the major religions of the world. In 1973, John Hick discussed the idea for a paradigm shift in thinking about different religions in his book God and the Universe of Faiths. Hicks idea is that the different religions could be viewed as different human responses to one divine reality In a later book, Hick presented a theory that attempted to explain all the religions. Hick refers to this theory as a pluralistic hypothesis and defines it as that all religions can be described as culturally conditioned responses to the same ultimate reality. This theory faces one major difficulty though, the contradicting claims that each different religions makes. How can it be possible that all major religions are responses of the same ultimate reality if they contradict one another? For a pluralistic view to be plausible, the hypothesis has to sufficiently explain how religions can make incompatible claims while at the same time be responses of the same ultimate reality. To overcome this difficulty, Hick attempts to explain four critical factors: (1) people are inherently religious; (2) the substantial diversity of the content of religious beliefs; (3) that religious beliefs are not an illusion; and (4) that basically every religion positively changes its followers lives. Hick doesnt spend much time on the first two factors because they are self-evident to most. To argue the third factor Hick examines naturalism and absolutism. Naturalism is the belief that only natural laws and forces operate in the world and that nothing exists beyond the natural world. Hick believes that the universe can be understood when looking at it from this perspective. What he does not find plausible with the claim is that all religious beliefs are delusional. Absolutism, in contrast to naturalism, generally accepts a realist view of religious phenomena. Absolutism is also setup so that only one system of religious beliefs is exactly true and all other religions which disagree with it are false. Hick rejects this attitude because although absolutism may seem plausible when looking at only one religion, application to the real world leaves it highly implausible. Also if absolutism were true, empirical evidence would exist to confirm it. It is obvious that different religions hold conflicting beliefs on several aspects. It seems obvious enough also that almost every religion has positive moral change on its believers. So it implausible to believe that only one religion is true and it is the people who believe this that Hicks hypothesis has the most appeal to because it provides the framework for the claim that any religion which positively affects its believers lives is valid. However, for the hypothesis to be plausible it must sufficiently cover the conflicting truth-claims problem. A difficulty Hicks pluralistic hypothesis faces is the conflicting belief systems of various religions. In Hicks book An Interpretation of Religion, Hick claims that all religions authentically experience what he defines as the Real. Yet each religion has beliefs that are different and often contradict other religions. The question then is if different belief systems and conflicting truth-claims leaves Hicks pluralistic theory implausible. Hick does not believe that conflicting truth-claims disproves his theory but they do present a difficulty. Hick devotes an entire chapter in An Interpretation of Religion to discussing them, covering three separate points on which religions tend to disagree on. First are matters of historical fact, then matters of trans-historical fact and differing conceptions of the Real. Hick believes that these disagreements can be resolved by applying the historical method but it proves to be difficult. One reason is because many historical claims of religions have no other historical support outside the religion that makes them. Hick reasons that historical differences just must be accepted, because many are not over central articles of faith. Hicks basic argument is that most historical disagreements cannot be resolved and since the disagreements are not related to the essence of any religion, resolving them is not critical to the argument and therefore the disagreements do not create a problem for his hypothesis. Later in is his book, Hick considers conflicting trans-historical truth-claims. He defines them as having to do with questions to which there is, in principle, a true answer but which cannot be established by historical or other empirical evidence. Two examples he gives are the nature of the universe and the fate at death of human beings. The nature of the universe has been a main dispute between theistic and non-theistic religions. In applying Hicks definition, this is a dispute to which there is, in principle, only one valid answer. Nevertheless, the question cannot currently be answered, even by modern science because current scientific cosmologies can be companionable with either perspective. The fate at death of human beings is another example of conflicting trans-historical truth claims. This conflict mainly arises between eastern and western religions. Eastern religions emphasize multiple reincarnations or rebirths after death. Western theistic religions claim though that a person lives a single life that is followed by judgment at death to determine their eternal fate. These points are important to Hicks pluralistic hypothesis. In Hicks examination of various religions, he does not directly address different religions different beliefs of what happens at death because despite the differing beliefs, Hick reasons that every faith helps its people develop morally which he believes is an essential result of the switch from self-centeredness to Reality-centeredness. On this basis, he argues that these differences do not hamper salvation/liberation and therefore do not present any problems for his hypothesis. In his book, Hick also examines conflicting beliefs about the ultimate Reality. Hicks hypothesis asserts that all religions are correct interpretations of the Real. However, one obvious problem of this is the drastically different notion of the Real that each religion holds. As Hick previously claims, each religions deity is a correct, yet different face of the Real and since no concepts, categories, or distinctions can be applied to the Real, this prevents any potential contradiction between religions. So the differences between the basic concepts and practices of different religions, the different (and often) conflicting historical and trans-historical beliefs and the varied belief systems on which all of them are formed, are harmonious with Hicks pluralistic hypothesis. Compatible in that the multiple world religions constitute different conceptions and perceptions of, and responses to, the Real from within the different cultural ways of being human. However, Hicks hypothesis does not offer a satisfactory explanation of the problem of the conflicting truth-claims of the different religions. In order for Hicks hypothesis to be probable it has to be free from internal contradictions and accurately explain religious phenomena. It cannot sufficiently meet either of these conditions. This paper began with the scenario of three people each touching a different part of an elephant. This metaphor is basically a simplified version of Hicks hypothesis. Each religion is like a man who is unable to see the elephant as the whole it really is. But how do we know that the people are all describing the same elephant? Perhaps the first was actually holding the truck of a tree and the second was actually holding a fire hose and the third was touching the side of a building. This scenario has a critical flaw, it assumes the same thing it allegedly proves, that all three were touching an elephant. Furthermore, the scenario described does not really describe the worlds religions. None of the descriptions were conflicting, just different. What if each of the statements made about the elephant contradicted the statements of the others? Would it still be possible to assume that everyone is describing the same elephant? How much contradiction is required before it becomes clear that its not the same elephant everyone is describing? This same question can be applied to Hicks hypothesis. With the conflicting truth-claims of various religions, is it really reasonable to accept Hicks claim that all religions are just different interpretations of the same reality? Hick addresses the credibility of the possibility that every religion worships the same God and just refers to him by different names in Disputed Questions, entitled Jews, Christians, Muslims: Do We All Worship the Same God? He concludes that the trouble of this claim is that the various descriptions have to be compatible. The same criticism Hick applied against that position can be applied to Hicks own hypothesis. The differences between religions are far too great for his hypothesis to be plausible. Sensitivity Analysis: Applications and Issues Sensitivity Analysis: Applications and Issues For a given linear programming model, finding the optimal solution is of major importance. But it is not the only information available. There is a very good amount of sensitivity information. It is basically the information that accounts for what happens when data values are changed. Sensitivity analysis basically talks about how the uncertainity in the output of a model can be attributed to different sources of uncertainity in the input model. Uncertainity analysis is a related practice which quantifies the uncertainity in the output of a model. In an ideal situation, uncertainity and sensitivity analysis must run in tandem. If a study is carried out which involves some form of statistical modelling (forming mathematical equations involving variables), sensitivity analysis is used in order to investigate exactly how robust the study is. It is also used for a wide range of other purposes including decision making, error checking in models, understanding the relationship between input and output variables and enhancing communication between the people who make the decisions and the people involved in constructing the models. For example, we know that there are some variables which are always uncertain in a budgeting process. Operating expenses, future tax rates, interest rates etc. Are some of the variables which may not be known with a great amount of accuracy. In this regard sensitivity analysis basically helps us in understanding that if these variables deviate from their expected values, then how will the business, model or system that is being analyzed will be affected. An assumption called certainty assumption needs to be invoked in order to formulate a problem as a linear program. The assumption involved knowing what value the data took on, and decisions are made based on that data. However, this assumption is somewhat doubtful: the data might be unknown, or guessed at, or otherwise inaccurate. Thus, determining the effect on the optimal decisions if the values are changed is clearly not feasible because some numbers in the data are more important than others. Can we find the important numbers? Can we determine the effect of misestimation? In order to address these questions, linear programming is very handy. Data changes are showed up in the optimal table. A case study using involving sensitivity analysis is worked upon using solver in the later part of the report. 1.2. TABLEAU SENSITIVITY ANALYSIS Assume that we solve a linear program by ourselves which ends up with an optimal table (or tableau to use a more technical term).We know what an optimal table looks like: It has all the non-negative values in the row 0 (which we also refer to as the cost row), all non-negative right-hand-side values, and an identity matrix embedded. If we have to determine the effect of a change in the data, we will have to try and determine how that change affected the final tableau and thus, try and reform the final tableau accordingly. 1.2.1. COST CHANGES The first change that we will consider is changing the cost value by some delta in the original problem. The original problem and the optimal table are already given. If the same exact calculations are done with the modified problem, we would have the same final optimal table except that the corresponding cost entry would be lower by delta (this happens because the only operations which we do with the first row are add or subtract scalar multiples of it through m to other rows: we never add or subtract the scalar multiples of row 0 to the other rows). For example,let us take the problem Max 3x+2y Subject to x+y = 0 1 + delta >= 0 which holds for -1 = 5.4 11 NZ DISTILLATE: DAN + DJN + DUN >= 8.7 12 US DISTILLATE: DUP + DUN

Womens Liberation Movement as Seen In Shiloh and The Astronomers Wife :: essays research papers

The days of the barefoot woman forced to stay in the kitchen and bedroom are over. Women’s liberation has gained voice in the last century and has emancipated many women, bringing them into the realization that they are not subservient to men. As this thought process becomes more widely spread, more and more women are seeing the truth of it. In the short stories Shiloh and The Astronomer’s Wife this theme of realization and liberation is dominant.   Ã‚  Ã‚  Ã‚  Ã‚  In the story Shiloh by Bobbie Ann Mason we are introduced to Norma Jean. She is a wife to an injured trucker named Leroy. Our first glimpse at Norma Jean is of her working out. â€Å"Leroy Moffitt’s wife, Norma Jean, is working on her pectorals. She lifts three-pound dumbbells to warm up, then progresses to a twenty-pound barbell. Standing with legs apart, she reminds Leroy of Wonder Woman.† (Pg. 68) This shows a bit about her strong, self-improving personality. Another look at this trait are seen in her attempts at learning. â€Å"Norma Jean is going to night school. She has graduated from her six-week body-building course and now she is taking an adult-education course in composition at Paducah Community College. She spends her evenings outlining paragraphs.† (Pg. 74) Not only is Norma Jean improving her body but her intellect as well. I believe this self-improving aspect points to an independence in her.   Ã‚  Ã‚  Ã‚  Ã‚  In The Astronomer’s Wife independent woman is the farthest description of Mrs. Ames. â€Å"She was a youngish woman, but this was forgotten. The mystery and silence of her husband’s mind lay like a chiding finger on her lips. Her eyes were gray, for the light had been extinguished from them.† (Pg. 63) She had at one time been a bright beautiful woman but now she is stifled and has forgotten her beauty. She is very soft spoken. Every time she talks it mentions the soft tone or the hushed voice. This shows that she is a gentle and rather timid woman.   Ã‚  Ã‚  Ã‚  Ã‚  Norma Jean starts having problems in her marriage with Leroy when he gets disabled in a truck accident and is anything but gentle and timid about it.. He has been on the road for fifteen years as a trucker. Now he is home for good and adaptation is necessary. He is all for settling down in the marriage but he senses her discomfort. â€Å"Since he has been home, he has felt unusually tender about his wife and guilty over his long absences.

meditation Essay -- essays research papers

Meditation is defined as a mind-body technique, which practices awareness, and induces tranquility in order to connect the mind and the body. It is also described as â€Å"mental fasting,† implying clearing and cleansing of the mind by the absence of distractions and negative emotions (Leikin, 2003). It has shown to benefit its users psychologically, physically, as well as spiritually. Meditation works by bringing about a relaxed and healthy state by physiologically and biochemically altering the body. It is characterized as a state of rest, while allowing the body to become more alert. This is accomplished through a dramatic decrease in metabolism, in turn, relaxing breathing patterns, and thus slowing activity within the nervous system. Upon completion of meditation one is more likely to show faster reactions to certain stimuli, a greater level of creativity, and a more conscious understanding and comprehension (ICBS Inc., 2004). Vast health and spiritual benefits can be ob served, as well. This paper will describe and discuss how meditation came about, the context in which it was used in the past, reasons for its use as compared to modern uses, as well as, ways in which meditating can heal the body and soul. It will also compare different forms of meditation, including; what each method entails, examples of postures to achieve each method, and results that can be achieved. Meditation was originally practiced spirituality in many ancient religions, including Hinduism, Judaism, Christianity, and most commonly, Buddhism. The founder of Buddhism, Siddharta Gotama became the master of the art of meditation and went on to teach it to his followers. He became known as â€Å"Buddha,† (â€Å"Enlightened or Awakened One.†) (Saunders, 2000). Buddhism is one of the world’s oldest and largest religions, starting over 2500 years ago. With Buddha as their leader (not as their God), followers learn the Four Noble Truths; First, â€Å"all existence is suffering,† secondly, â€Å"there is a cause for this suffering,† third, â€Å"the cause may be brought to an end,† and fourth, â€Å"the discipline necessary to bring it to an end is enlightenment (also known as, Buddhism)† (Saunders, 2000). Buddhists basic beliefs entail interconnectedness with everyone and everything, there is no beginning and no end (which involves the concept of reincarnation), and the law of â€Å"cause and effect,† or kharma. (Saunders, 200... ...ing From Within. New York: Alfred A. Knopf, Inc. 1980 Leikin, Jerrold B. American Medical Association Complete Medical Encyclopedia: Meditation. New York: Random House Reference. 2003. Leikin, Jerrold B. American Medical Association Complete Medical Encyclopedia: Transcendental Meditation. New York: Random House Reference. 2003 Lukoff, David. History of Meditation as a Clinical Intervention. 2002. www.virtualcs.com Saunders, E. Dale. Encyclopedia Americana International Edition: Buddha and Buddhism. Volume 4. Connecticut: Grolier Inc. 2000. Smith, Dr. Joseph F. Medical Library: Meditation. October 13, 2004. www.chclibrary.org/micromed/00056320 The Institute for Applied Meditation, Inc. Heart Rhythm Practice. 2004. www.appliedmeditation.org/Heart_Rhythm_Practice.shtml Trivieri, Jr., Larry. The American Holistic Medical Association Guide To Holistic Health: Healing Therapies For Optimal Wellness. New York: John Wiley & Sons, Inc. 2001.   Ã‚  Ã‚  Ã‚  Ã‚   White, Charles S. J. Encyclopedia Americana International Edition: Mantra. Volume 18. Connecticut: Grolier Inc. 2000. Zen Mind International. Meditation. 2004. www.zenmind.com/meditation.html

The Impact of Classical Literature on Machiavellianism Essay -- Litera

In offering his own world view and knowledge to the Medici family, Machiavelli draws a considerable amount of his resources from classical figures and ideology. While Machiavelli is writing for a prince, whose goal would be to gain in territory, power, and control; his philosophy ties simply into less vital victories in the lives of common people. In this paper I will explain the points where he differs and conforms from/to the classical ideology in the generalized context of a leader. He uses these in one of two ways, by agreeing with and reinforcing them, or by refuting them. While Machiavelli keeps the need for a leader to have independence, seriousness, loyalty, and intellect; he rejects the necessity of generosity, mercy, and honesty, in favor of the outward appearance of these virtues. While Machiavelli’s viewpoint differs from the common ideology of his time and of classical antiquity, he does not disagree with all of the virtues. One such virtue is independence. Machiavelli spends the beginning of his treatise discussing principalities and defending them. A wise and successful leader, he says, should not use auxiliaries or mercenaries, as they will always lack unity and their true loyalty is always uncertain. For auxiliary troops, their loyalty is always to a rival, whom may betray the leader at any time. Wise leaders also do not consider a victory with outside help to be a true victory. (The Prince, Chapter 13, pg.49) For mercenaries, their loyalty is to whoever can offer them the most. (The Prince, Chapter 12, pg.43) Machiavelli reinforces this key idea with two examples. The first is in the Old Testament when Saul offered David his weapons and armor, which he rejected as he would be unable to fight well w... ...re the leaders that maintain a faà §ade of honesty, while being skillful in deceiving rivals and enemies. He advises that a leader cannot and should not keep his word when it would harm him. He goes on to say that men are so naà ¯ve and focused on the present that any skillful deceiver would have little difficulty finding people to deceive. (The Prince, Chapter 18, pg.61-62) Despite some of Machiavelli’s more provocative and shocking statements in The Prince, upon a close reading, his values are not very different from those of the classical period. Although he rejects the genuine need for generosity, mercy, and honesty in return for the appearance thereof; he keeps the more significant remaining values the way they are. The changes that he makes in explaining his view of the world are based on his examination of humans as inherently corrupt and self-serving.

Conflict Identification and Resolution

Conflict Identification and Resolution BUS 610: Organizational Behavior Currently I am employed at Bank of America, they [Bank of America] established a new department called the Enterprise Estate Unit where deceased customers accounts are handled. When we the employees were notified that the Enterprise Estate Unit was being established everyone was excited because it was a chance to move into a different line of business.Bank of America associates are not allowed to â€Å"post out† or apply for different positions until they have been at their current position for at leas a year, however when associates were notified about the new department the advice given by human resources was all associates could apply with approval of their manager. With that new information associates (new hires and tenured associates) apply to be in the new department. The conflict arose when new hires were being hired to move to the new department over the tenured associates and the tenured associate s did not think that was fair.After complaints were issued to the site leader about new hires being picked over the tenured associates, the site leader had to investigate why new hires were being allowed to post out to different positions. After investigation the site leader found out the information given by the human resource department was incorrect, only associates that had been with the company for a year or more were allowed to apply for the position. Recruiters that interviewed associates for the position also knew that only associates that had been with the company for a year or more could apply for different positions.Poor communication was the cause of this conflict. There was a lack of external communication, the communication between â€Å"the company’s staff and clients, suppliers, and vendors (Kondrat, 2009). † Applications were sent to a third-party recruiting company that did not know the policy of only posting to positions after being with a company fo r a year. Because employees did not receive clear direction, the rule is that associates could only apply for positions after a year of being with the company, however the posting stated that with supervisor approval, anyone could post for the position.Consequently, employees self managed and created their own rules and priorities, which differed from the organization. Poor communication is a big problem that causes conflict in an organization. Chris Joseph said in his article that in a workplace setting lack of communication leads to conflict, which can harm an organization, and poor communication creates conflict in a number of ways, the types of conflict that could arise due to the lack of communication or the lack of communication are: creating uncertainty, lack of loyalty, and rumors and gossip, (Joseph, 2012).In the situation previously described the two biggest conflicts that arose because of the lack of and poor communication was the lack of loyalty and rumors and gossip, wi th rumors and gossip being the biggest problem. â€Å"If employees don’t know the intent of their co-workers or the company, they may resort to speculation. Whether rumors develop regarding a company merger or about favoritism toward a single employee, gossip creates a hostile work environment (Baldwin, 2012). Distributing correct information would reduce gossip and also ease employees mind and make them feel like they are valued. In an organization effective communication is an essential element, especially in a successful organization. Effective communication is needed to process and send information, ideas, thoughts and ideas between members of the organization. Lack of loyalty is also a result of lack of communication. A sense of employee identification fosters company loyalty [†¦] With a lack of communication, your employees may identify less with your organization. They may look elsewhere for a job in which they feel a vested interest (Baldwin, 2012). † The feeling of a lack of loyalty is another conflict that arose due to the lack of communication. Many of the associates that were looked over for the position left Bank of America and found positions with other companies because they felt the time that they invested with the company was not valued.Unfortunately the site leader had to play the role of the â€Å"Devils Advocate† but, the conflict was resolved and certain measures were taken to make sure that a situation like this would not happen again. The site leader did not revoke the position from the new hires that were offered the position in the Enterprise Estate Unit, however the new hires that had interviews scheduled for the position were unable to interview, and the tenured associates that did not get interviews offered to them because the interview quota was filled were able to get interviews and if qualified they were hired.The site leader gathered all of the associates together and made sure associates understood tha t no matter what postings say that if you [associates] had not been with the company at least a year they were not allowed to apply for positions. Also a new rule was applied, and that rule is that all applications are not allowed to go straight through to the recruiters; they had to go through human resources to make sure the employees are qualified. References Baldwin, A. (2012).Lack of communication as a weakness in organizations. Retrieved from http://www. ehow. com/info_8773766_lack-communication-weakness-organizations. html Joseph, C. (2012). How does a lack of communication cause conflict in the workplace?. Retrieved from http://smallbusiness. chron. com/lack-communication-cause-conflict-workplace-10470. html Kondrat, A. (2009, February 12). Effective communication in the workplace. Retrieved from http://suite101. com/article/effective-communication-at-workplace-a95815

What are Robots and how are they being used now days?

Introduction:Robots are becoming the most reliable and used man-made tools in many aspects of human life (Peter, H. 2013). Robots are mechanically self operated tools that can help us in manufacturing and in difficult surgeries such as fixing something really small that cannot be held or seen by humans. This article will explain the importance of robots and its role in making human life easier. However, we must understand that Robots will never replace humans in all aspect of live.Helpful Things that Robots do:The Robot is a tool that can do different and difficult types of jobs such as in hospitals and manufacturing. Some people feel like its more safe to let the robot do a surgery because it is very accurate. Robot can also build tiny things in manufacturing because they are faster and more accurate than humans. In some countries Robots are being used to replace house animals like dogs, cats, rabbits, rats, guinea pigs and others. These Robot Pets are machines rather than living th ings and can give their owners plenty of fun and they can also teach us about real animal (Parker, S. 2010). Some robots are great fun and many people like to play with them because they are more challenging and fun to play with. For example, when you play Chess against a Robot it can defeat you very easily because it can think ahead of every move it can make to win the game.Disadvantage of Robots:Robots have also many drawbacks such as it uses a lot of power to function properly. Also, if the power is out, the robot will not function. Another drawback is that the robot cost a lot of money to be built for a specific job. However, in the coming years as technology is improving, Robots will become more and more part of our day-to-day life and cheaper to have. As Robots become more reliable, it will take over many tasks that are currently only being handled by humans. This is one of the main reasons for the increased of unemployment now a days and more will be expected in the future as the technology continue to improve.Conclusion:Now days Robots are very helpful and widely used in many aspects of our day-to-day life. They are considered smart tools that can be programmed to perform certain tasks that are normally handled by humans in a faster and more accurate way. However, we must understand that Robots will never replace humans in all aspects of life. At the end of the day they are only machines that are created by humans!

Legal/Ethical Issues and the Solutions of a DNR

Do-not-resuscitate (DNR) orders are those given by a physician indication that in the event of a cardiac or respiratory arrest â€Å"no† resuscitative measures should be used to revive the patient (Pozgar, 2013, p. 153).Difficulties and confusion about do not resuscitate orders still exist, despite efforts to help patients, families, and surrogate decision-makers make informed choices. In this paper, issues will be addressed about the legal and ethical dilemmas about a DNR, how a DNR can affect while being used in a school system, the history of the issues of DNR, and how potential effects can be addressed to the issues for the future.Additionally, I will discuss the legal rights of the DNR to individuals as they interact with healthcare services, the implications of the patient’s bill of rights as it reflects to a DNR, and analyze selected ethical and legal case studies that have promulgated precedent-setting decisions. The majority of patients who die in hospital have a â€Å"Do Not Resuscitate† (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don’t, and how they view discussions of resuscitation status.Some issues addressed with a study are the patients and families understanding the considerations of a typical request of full code (FC) or DNR orders. DNR patients reported a much greater familiarity with resuscitation discussions than FC patients. This was typically due to previous conversations with health care professionals, experiences with relatives, or self-realization prompted by other experiences. FC patients, on the other hand, typically reported no previous experience with this discussion, although a few had discussed it previously on admission to hospital.FC and DNR patients had very different understandings of resuscitation and DNR orders, and there were few common themes identified in their answers. DNR patients described resusc itation as violent or traumatic event, associated with â€Å"tubes† or â€Å"machines,† painful, and generally futile. FC patients, on the other hand, often described resuscitation in a more abstract way, the â€Å"restoration† of life. Finally, a small number admitted frankly that they had no clear idea of what resuscitation actually were (Downar, Luk, Sibbald, Santini, Mikhael, Berman, and Hawryluck, 2011).Although most patients are pleased with their physician’s approach to the conversation, many reported a negative emotional response overall. Both FC and DENR patients often reported being shocked or upset by the conversation, either because of the timing or the content, or simply being confronted with their own mortality. Advance Care Planning may help reduce this negative response; by normalizing the subject and raising it before an acute illness, physicians may help reduce anxiety and shock when it is raised during deterioration.Both FC and DNR pati ents emphasized the importance of honesty, clarity, and sensitivity when discussing this issue (Downar, Luk, Sibbald, Santini, Mikhael, Berman, and Hawryluck, 2011). Mr. H is an 81-year old veteran with a history of chronic obstructive pulmonary disease (COPD) and depression. His daughters went to visit their father at 10 am and found him awake, but unable to communicate or follow commands. Empty morphine bottles were strewn around the room where he was found. Mr. H’s daughters called an ambulance and had their father transported to the emergency department of the local VA hospital.In the emergency department, there was concern for either an accidental or intentional opioid overdose, and the toxicology screen was positive for opioids. Narcan was administered with some modest and brief improvement in mental status, but Mr. H never obtained a level of consciousness that would enable him to express his treatment preferences. Progress notes written during the weeks before the inc ident indicated that Mr. H had threatened to commit suicide if his respiratory disease progressed to the point that he could not breathe.Mr. H was admitted to the medical intensive care unit, where an arterial  blood gas showed him to have respiratory acidosis. Several hours after arrival in the MICU, Mr. H became hypotensive and bradycardic. The intensive care resident on duty advised the daughters of her concern that the patient would develop respiratory failure that was likely to lead to a cardiac arrest, requiring CPR. The daughters indicated their father’s longstanding wish to be DNR. A durable power of attorney for health care (DPOA) executed five years before, although not documenting any treatment preferences, did appoint the two daughters as health care agents.The intensive care resident explained to the daughters that it was standard clinical practice to utilize CPR, even if patients had clearly expressed wishes to be DNR, if the arrest of respiratory compromise w as secondary to a suicide attempt. The daughters informed the resident that they had had several extended conversations with their father over the last year, occasioned by his failing health, in which he had communicated to them his wish not to have any aggressive care when his quality of life declined.The daughters both professed to be devout Christians, but said their father had been an inveterate atheist, whose philosophy of life was that when an individual could no longer function at an acceptable level, he had the right to refuse all life-sustaining interventions. The resident and the intensive care attending, which had now arrived, did not feel they could ethically or legally enter a DNR order, precluding the use of a life-saving intervention that could potentially reverse Mr. H’s respiratory failure, because it was secondary to a suicide attempt.At this juncture, the MICU physicians requested an urgent ethics consultation to resolve the conflict. The decision to overri de the DNR request of an individual who has attempted suicide is often framed as a clear and classical conflict between the principles of autonomy and beneficence or nonmaleficence. The other situation occurs when an individual, having authorized an EMS DNR order, attempts suicide and is discovered before the attempt becomes successful; Both circumstances provoke the classic dilemma, where the ethical wishes of rescuers to act for the good of their patient i. e., beneficence, run counter to the individual’s autonomous wishes expressed in the EMS DNR order.The rescuer cannot satisfy both of these conflicting ethical principles (Geppert, 2010). A 2010, reviewed of the clinical, ethical, and legal dilemmas related to DNR orders in suicidal patients presents a case report of a patient hospitalized for severe depression, who overdoses on the psychiatric unit and is found unresponsive with a recently obtained DNR order in her hands, The review argues that contemporary law and polic y related to DNR orders are not formulated to encompass the situation of an individual with serious mental illness.They recommend that patients be screened for suicidal ideation before a DNR order is entered, and that states and institutions clarify their response to DNR status in the context of attempted suicide. â€Å"Passive assistance† occurs when a health care provider does nothing to prevent a patient’s suicide. In the health care context, however, passive assistance has been an ethical practice for many years. For example, DNR orders have been instrumental in forming the current awareness of rights and responsibilities in the area of death and dying.A physician who refrains from attempting CPR on a patient who has made a rational choice to commit suicide is within the acceptable guidelines of the practice of medicine. If there is disagreement, every reasonable effort should be made to communicate with the patient or family. In many cases, this will lead to resol ution of the conflict. In difficult cases, an ethics consultation can prove helpful. Nevertheless, CPR should generally be provided to such patients, even if judged futile.In some cases, the decision about CPR occurs at a time when the patient is unable to participate in decision making, and hence cannot voice a preference. There are two general approaches to this dilemma: Advance Directives and surrogate decision makers (University of Washington School of Medicine, 2008). Do Not Resuscitate Orders in Schools In recent years, legal trends have expanded educational opportunities, including access to adaptive, for children and adults with wide variety of disabilities or handicaps.The American Academy of Pediatrics (AAP) has previously addressed the ethical and legal issues involved in decisions to either limit or withdraw life-sustaining medical treatment. Parents, who, after consultation with their pediatrician and other advisors, decide to forego CPR of their child, may want this de cision respected by school system personnel. These decisions challenge all persons involved in a situation in which SPR may be given to balance personal beliefs, strong feelings, legal concerns (especially those having to do with liability), educational considerations, and other issues (Pediatrics, 2000).In contrast, the school officials may be worried that a DNR order could be misinterpreted by medically untrained staff, resulting in harm to a child, or they may worry that personnel would feel bound not to respond to an easily reversible condition, such as a mucous plug in a child with a tracheotomy. Administrators have concerns about their personnel responding to circumstances not anticipated by a DNR order, such as when a child chokes on food or is injured. School officials may be rightfully concerned about the effect of a death in school on other students.The parents of healthy children may not want their children exposed to death in a classroom or other school setting (Pediatri cs, 2000). The AAP recommends that pediatricians and parents of children at increased risk of dying in school who desire a DNR order meet with school officials – including nursing personnel, teachers, administrators, and EMS personnel, and, when appropriate, the child. Individuals involved ideally will reach an agreement about the goals of in-school medical interventions and the best means to implement those goals. Concerted efforts to accommodate all points of view will help avoid confrontation and possible litigation.Pediatricians need to assist parents and schools to review, as needed when warranted by a change in the child’s condition, but at least every six months, plans for in-school care. Pediatricians need to review the plan with the board of education and its legal counsel. Pediatricians and their chapter and district members should work with local and state authorities responsible for EMS policies affecting out-of-hospital DNR orders to develop rational proce dures and legal understanding about what can be done that respects the rights and interests of dying children (Pediatrics, 2000).History of issues with a DNR The development of CPR in the early 1960s precipitated the need for DNR orders. However, it soon became evident that the routine application of resuscitation efforts to any patient who suffered a cardiopulmonary arrest led to new problems. Thus, even in the earliest stages of its development, resuscitative measures presented a basic ethical quandary that still underpins much of the controversy over DNR orders today: the potential conflict between prolongation of life itself and the quality of the life preserved. DNR orders arose out of the need to address such suffering.In 1974, the American Medical Association noted that â€Å"CPR is not indicated in certain situations, such as in cases of terminal irreversible illness where death is not unexpected. † DNR orders developed out of the general bioethics milieu of the last quarter of the twentieth century, concomitant to â€Å"the promotion of patient autonomy: (Goldberg, 2007, p. 60). While DNR orders have, by the present day, become a familiar if not regularly encountered phenomenon, â€Å"there is less legal certainty for providers regarding DNR orders for incompetent patients† (Goldberg, 2007, p. 60).The patient Self-Determination Act of 1990, the 1983 report of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, and the ruling in Cruzan, Quinlan and other landmark cases established the right of competent patients, through both advance directives and their surrogates, to refuse life-sustaining treatments, providing the ethical and legal basis of DNR orders. Currently, the Joint Commission standards require all health care institutions to have policies and procedures regarding advance directives and DNR orders.All 50 states have statutory requirements that uphold the autono my of competent patients to make health care decisions, including those regarding CPR, and to exercise this self-determination through authorized surrogates should they lose decision-making capacity (Geppert, 2010). A Patient’s Bill of Rights Reflected in a DNR DNR comfort care orders permit comfort care only, both before and during a cardiac or respiratory arrest. This kind of order is generally appropriate for a patient with a terminal illness, short life expectancy, or little chance of surviving CPR.DNR comfort care arrest orders permit the use of all resuscitative therapies before an arrest, but not during or after an arrest. A cardiac arrest is defined as an absence of palpable pulse. A respiratory arrest is defined as no spontaneous respirations or the presence of agonal breathing. Once an arrest is confirmed, all resuscitative efforts should be stopped and comfort care alone initiated. DNR specified orders allow the physician to â€Å"tailor† the DNR order to th e specific circumstances and wishes of the patient.For example, under this option the physician could specify â€Å"pharmacological code only,† or â€Å"no defibrillation,† or â€Å"do not intubate† (Department of Bioethics, n. d. ). If the patients’ preferences regarding resuscitation are clear, they should be respected. Patient preferences to refuse resuscitative efforts can be communicated directly by the patient, or by an advance directive, a valid Do Not Attempt Resuscitation (DNAR) order, or by the patient’s legal representative. Unofficial documentation may be considered when determining patient preferences (ACEP, 2008).It is appropriate for out-of-hospital providers to honor valid DNAR orders or out-of-hospital advance directives. Standardized guidelines and protocols should be developed to direct out-of-hospital personnel’s resuscitative efforts. When resuscitative efforts are not indicated, emergency physicians should provide appro priate medical and psychosocial care during the dying process. This may include the provision of comfort measures and psychosocial support for the patient and family.Recommendations to better DNRsFirst, to the extent permissible under individual state laws, propose that U. S. hospitals and journals begin to consider the term â€Å"do not resuscitate order† and the abbreviation â€Å"DNR† to be obsolete. These terms carry the implicit message that when interventions such as chest compressions and bag-mask ventilation are undertaken, resuscitation of the patient will result. Suggestion to use the phrase â€Å"do not attempt resuscitation† and the abbreviation â€Å"DNAR,† making clear that CPR is really only an attempt at resuscitation.Find that DNAR retains clarity about the interventions being discussed while reminding both patients and practitioners of the uncertainty of the outcome of resuscitative efforts. Second, to remind medical learners and practit ioners of the questions that must be answered at the time of admission to the hospital. Placing â€Å"attempt resuscitation† status immediately after diagnosis reminds the practitioner that the diagnosis of the patient should play a major role in determining whether resuscitation should be attempted.This modification in the admission orders also makes the specification of â€Å"attempt resuscitation† and â€Å"do not attempt resuscitation† explicit. While some policies will at first continue to presume consent for CPR, practitioners will be reminded that there is a decision to be made. Third, as a routine part of a discussion the physician should provide an explanation of how the patient’s prognosis would change should the patient experience cardiopulmonary arrest. A cardiopulmonary arrest is not a neutral event.It is thus not only indicative of the severity of illness, but also an indicator that the prognosis is worse than if the cardiopulmonary arrest h ad not happened. A discussion of these features can be of particular value to families of patients for whom an event of cardiopulmonary arrest would indicate a worsening of the underlying disease or result in irreversible damage. Fourth, physicians should help clarify prognosis by proposing a course of action to the family. In some instances, that will mean deferring to patient decision, where the medical evidence and judgment is not conclusive.In other situations, it will mean recommending that CPR not be attempted. Consistent with safeguards ensuring physician accountability and where individual state laws would permit broad physician discretion, it might even mean that some cases will necessitate reclassifying CPR as a pseudo-option that does not even warrant a mention. However, a failure to make a recommendation is more likely to cause families additional anxiety than it is to be perceived as coercion.In addition, making a proposal for a course of action can help a physician com municate the significance of a cardiopulmonary arrest given the patient’s underlying condition (Bishop, Brothers, Perry, and Ahmad, 2010, pp. 65-66). In conclusion, when patients’ and physicians’ understanding of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making.A conventional formulation would contend that the origin of the respiratory depression from a suicide attempt was the ethically determinative factor. This perspective would logically have led to the recommendation to override the surrogates’ request for a DNR order. Yet this attribution gives more ethical weight to a choice the patient appeared to have made impulsively and proximately, with questionable decisional capacity, rather than the distal and deliberate preference of an individual with intact capacity to refuse life-su staining treatments (Geppert, 2010).The four recommendations are only the first steps along a process of a DNR change. The ultimate goal will be to reach a more balanced place where discussions about decisions can be made jointly, but with the acknowledgement that all decisions are laden with moral values inherent in the practice of medicine and life in a pluralistic society and that all judgments are themselves fallible.