Graduation Speech -- Graduation Speech, Commencement Address

(Love you mother and father in Romanian) many individuals here today most likely didn't comprehend what I just said in light of the fact that I am Romanian, yet in the event that you investigate my folks face they realize I love them. I am Romanian and my folks went to the U.S. also, could have picked any state however they picked Washington. For all the individuals who don't acknowledge Washington as much as me let me set out certain vibes. After I went to Arizona and California and some different states I came to understand that everything here is so a lot greener. Washington has the best-tasting faucet water and truly, there is a distinction in taste of water. Did you realize Washington has a wonderful kelp backwoods? Individuals from all around the globe come here to make a plunge our sea to see our kelp woods. On the off chance that you need some speculation tips put resources into kelp cause there will be a major blast in that industry. The city of Seattle is one of the best. I t is so aesthetic and everybody here is so pleasant. I just felt I should call attention to that we have perhaps the best state in the United States. The magnificence of doing a graduation discourse is you get the opportunity to state what ever you need. I felt that would have been simple however, as I think back through the four years of secondary school the main time I composed something was the point at which I was relegated it. So you would think such a youthful flourishing psyche would exploit this and hold nothing back out. So I composed and composed and well, I continued wasting time. I viewed other initiation speakers from the HBN chronicle talk about our future and understood that they had some truly extravagant expressions of exhortation. Presently I realize I can't offer you guidance on the future since I don't have the experience. What I will give you individuals here today is some evaluation An information about a spot that you all may not of ev... ...iday collection. That is the excellence of The Simpsons, it doesn't make a difference how stupid you are everybody has their place in the city. They keep consistent with them selves and in the long run there snapshot of popularity will come. Everybody, know your Simpsons! Presently I need to leave as much as all you individuals, it just appears as if the most recent day will never end. So I simply need to state regard one another and never abandon any you had always wanted in light of the fact that you get one life and you should make it a great one. So as we leave I need all of you to realize that I have the all the best for every one of you and if any of you see my comic book, Stickmen Revolution, available to be purchased feel free to get me out a piece. I leave you with a joke, (Romanian Joke) I know some of you may experience considerable difficulties getting that however on the off chance that you investigate my folks' faces that was, that was an extremely amusing joke. For The Revolution!

Bless Me Ultima Ultima Is a Witch Essay

In the book Bless Me, Ultima, Ultima is an elderly person who was welcome to remain at our hero house, Antonio, to live the rest of her existence with the Marez family. Yet, there is a contention to who is Ultima, a witch or curandera? Ultima considers herself a curandera, somebody who utilizes herbs and old traditions to recuperate another person, however a few people in the book consider her a bruja, which is Spanish for witch. Ultima is known as a witch ordinarily in the novel yet neither denies nor acknowledges the allegation. The Author of the book, Anaya Rudolfo leaves us with the topic of who truly was Ultima, a witch or curandera? As I would see it I accept that Ultima is a witch. All through the novel Ultima shows numerous attributes of being a witch and in this paper I will give you how Ultima is a witch. First is the connection among Ultima and the owl. In the book when Ultima moves in with the Marez family, an owl follows. The owl can be an image of witch and is even said so in the novel, â€Å"In numerous cuentos I had heard the owl was one of the camouflages a bruja took†¦Ã¢â‚¬  (pg13). Ultima has an exceptionally solid association with the owl and is even said that the owl was Ultima’s soul or life power. A case of Ultima and the owl being a similar individual is toward the finish of the novel when Antonio covers the owl, â€Å"†¦ and after mass we would take her body [Ultima] to the function in las Pasturas for internment. In any case, that would just be recommended by custom. Ultima was truly covered here. Tonight† (pg262). That citation implies that when Antonio covered the owl he was likewise covering Ultima since they shared spirits. In the event that Ultima has the spirit of witch, at that point she herself must be abhorrent. Another underhanded association among Ultima and the owl is when in page 134 of the book Ultima’s owl tears out Tenorio’s eye. On the off chance that Ultima was actually a curandera would she truly harmed a man, when her obligation of a curandera was to help and help individuals? Next are the demonstrations of Ultima. Ultima shows many witch like character when she was relieving Lucas. First was that she had dolls of the three witches and she had utilized them like voodoo dolls, â€Å"†¦and when he inhaled on them they appeared to wriggle in her grasp. I shivered to see those earth dolls take life. At that point she took pins†¦she stuck a pin into each doll† (pg101). Here Ultima seems to do some malicious voodoo custom. A curandera depends on herbs and nature to mend individuals and not insidious voodoo. Second is the way that she reviled somebody, â€Å"†¦ and what you looked to do will fix you† (pg101). Here is the place Ultima was evacuating the revile that was put on Lucas, Antonio’s uncle. Ultima doesn't just expel the revile yet sends it back to witches that reviled Lucas. On the off chance that she was a curandera shouldn’t she have the aims to just mend Lucas rather than likewise reviling the witches as well? Last is the statement â€Å"You must comprehend that when anyone, bruja or curandera, cleric r miscreant, alters the destiny of a man that occasionally a chain of occasions is sent into movement over which nobody will have extreme control. † This occurs and it prompts passing of Tenorio’s girl, angering him, to execute Narciso. Ultima knew this and it wound up murdering a man. Could this have been a malicious plot by Ultima? Last is the wellspring of Ultima’s powers. The possibility of Ultima’s powers are raised in page 93, â€Å"Toma, Tenorio yelled. He crossed his fingers and held the indication of the cross before Ultima’s face. She didn't budge†¦Either she was not a bruja, or their perspective, she had powers that had a place with the fiend himself. † It is workable for Ultima to have the forces of the fallen angel on the grounds that off all the past reasons recorded. She has done malevolence for the reasons appear previously and now since she can take the cross you can see that she has powers more grounded than a witch, or even powers â€Å"from the fallen angel himself†. To additional confirmation of her fallen angel skilled forces you can see from this statement, â€Å"Would the enchantment of Ultima be more grounded than all the forces of the holy people and the blessed mother church†¦Ã¢â‚¬  (pg97). Here you can see that Ultima’s powers are not of the congregation and are more grounded. Last is a definitive test that was made in the book. Ultima was given the test to stroll through an entryway that had the characteristic of a cross made by two favored needles. She effectively experiences the entryway however with a special case. Everybody returns home reasoning she isn't a witch, yet Antonio finds the needles on the ground. In the event that the needles were on the ground, at that point Ultima could have strolled through the entryway easily. Ultima could have disrupted the needles when the possibility of the test was first welcomed on. Her thumping down the needles can demonstrate her dread of God and everything sacred, saying she is a witch. Taking everything into account you can see that Ultima is a witch. She has a profound association with a creature that is supposed to be a witch, which is her owl. Ultima additionally has the spirit of a witch. Ultima has drilled voodoo in the book alongside reviling others. At long last her forces are from the villain himself. Due to all the reasons expressed I accept that Ultima is a witch in the story Bless Me, Ultima.

Phenibut Withdrawal Symptoms, Timeline & Treatment

Phenibut Withdrawal Symptoms, Timeline & Treatment Addiction Coping and Recovery Overcoming Addiction Print How Long Does Withdrawal From Phenibut Last? By Corinne O’Keefe Osborn linkedin Corinne Osborn is an award-winning health and wellness journalist with a background in substance abuse, sexual health, and psychology. Learn about our editorial policy Corinne O’Keefe Osborn Updated on August 07, 2019 Verywell / Gary Ferster More in Addiction Coping and Recovery Overcoming Addiction Methods and Support Personal Stories Alcohol Use Addictive Behaviors Drug Use Nicotine Use In This Article Table of Contents Expand Overview Signs & Symptoms Coping & Relief Warnings Long-Term Treatment Resources View All Back To Top Phenibut (ß-phenyl-?-aminobutyric acid) is a psychoactive medication developed in Russia during the nineteen-sixties. It was, and remains, approved there to treat a variety of disorders, including insomnia, anxiety, and depression. Because phenibut was never approved by the FDA, it remains unavailable here as a prescription medication. Although it is still unknown to most Americans, phenibut use has grown in recent years due to its widespread availability on the internet. Phenibut can now be easily purchased online as a “dietary supplement.” Phenibut is used and abused for a variety of purposes. As a central nervous system depressant, it can relieve anxiety and induce euphoria. This makes it an appealing alternative to people struggling with alcohol or opioid dependence. It is less sedating than some other anti-anxiety medications because it also contains stimulating and nootropic properties. Nootropics, also known as smart drugs, help to increase focus. Due to these combined effects, phenibut is often used to reduce social anxiety, become more sociable, and get work or studying done. Unfortunately, phenibut tolerance can develop within weeks of occasional use. This leads people to take higher and higher doses, increasing the likelihood of a difficult withdrawal experience.   Overview Phenibut is a synthetic, designer drug, but its chemical structure is very similar to that of a naturally occurring amino acid known as GABA. Because GABA and other amino acids are proteins, according to the FDA, GABA is technically a “food” and not a drug. It is through this loophole that phenibut, a GABA lookalike, can be legally bought and sold in the U.S.?? People often assume that legal nutritional supplements are safer than illegal drugs, even when taken daily in large doses. Unfortunately, this is not the case. There are many risks to taking unregulated nutritional supplements like phenibut, and chief among them is the potential for dependence and withdrawal. Reports have begun surfacing of phenibut withdrawal symptoms so severe that people require hospitalization.?? These symptoms are usually both physical and psychological. Symptoms can include severe anxiety and agitation along with tremors, nausea, and vomiting. There have been reports of serious psychotic symptoms such as auditory and visual hallucinations, delusions, and paranoia.?? Withdrawal symptoms may appear anywhere from several hours to several days after your last dose. Symptoms may be combined with an intense desire to use more phenibut. If you experience intense cravings, then your phenibut abuse may have evolved into an addiction.   Signs Symptoms Phenibut withdrawal is different for everyone. Some people take large daily doses for a year but don’t experience withdrawal, or see only mild effects. Other people take moderate doses two to three times a week for a few months and end up suffering severe symptoms when they try to stop. Still, others take high doses for only a few consecutive days and end up in the hospital. Doctors and researchers in this part of the world have little understanding of phenibut withdrawal. It is not easily recognized in clinical settings and there are no standard treatment protocols. What little we do know about phenibut withdrawal syndrome comes from case reports published in medical journals and self-reported descriptions in online forums. Phenibut withdrawal can begin in as little as three to four hours after your last dose. Acute symptoms can last for several days and are sometimes followed by a period of protracted withdrawal lasting weeks or months.?? The physical symptoms can be very distressing, but it is usually the psychological symptoms that drive people to seek medical attention. Psychological hallucinations delusions dissociation suicidal thoughts anxiety depression panic attacks Physical tremors muscle rigidity sweating nausea vomiting fast heart rate seizures fatigue There have been several reported cases of extreme psychotic symptoms stemming from phenibut intoxication and withdrawal. People have come to the emergency room after experiencing visual and auditory hallucinations.?? One person described seeing dragons, flashes of color, and disturbing sexual images.?? Others have described a sense of dissociation or a feeling of unreality. Delusions, psychosis, and suicidal thoughts or acts have also been reported.?? Many people experience extreme agitation and anxiety. In several of the reported cases of intoxication and withdrawal, both physical and chemical restraints were necessary for the safety of both the patient and medical staff. Three patients required IV sedation so intense that they needed breathing tubes.?? While these examples are worst-case scenario, milder psychological symptoms are not uncommon. In online message boards, many people describe feeling like they are “going insane” or “stuck in hell.” People describe panic attacks, depression, suicidal thoughts, and severe insomnia. Physical symptoms like tremors, muscle rigidity, and sweating all contribute to intense insomnia. Some people even experience “brain zaps” when they try to sleep.  Depression and fatigue cause problems for many people, who find it difficult to fulfill their normal responsibility at home, work, or school. Depression and rebound anxiety may continue for several weeks after the acute symptoms of withdrawal resolve.   How Do You Know If Youre Having Hallucinations? Coping Relief First of all, if you experience hallucinations, suicidal thoughts, or extreme agitation, seek emergency medical attention right away. Phenibut withdrawal can be severe, so many people opt for medication-assisted detox. While there is no standard treatment protocol, there are several medications that can help treat your acute symptoms and increase your chances of quitting phenibut successfully. Trying to treat your withdrawal symptoms at home with prescription drugs or supplements is not a good idea. Treating phenibut withdrawal is difficult and people respond differently to the medications available. Medications that work for some people may make your symptoms worse. Inpatient treatment at your local emergency room or detox clinic ensures access to a variety of prescription medications. Medications that have been used to treat severe acute symptoms of phenibut withdrawal in inpatient settings include the following sedatives and anti-psychotics:?? Dexmedetomidine PhenobarbitalPropofolHaloperidolBenzodiazepines   For people without severe psychological symptoms like hallucinations, delirium, or agitation, the following prescription medications may be taken at home. It is important to work with a doctor to gradually taper these medications. BaclofenGabapentinBenzodiazepines (diazepam, lorazepam, others)ClonidinePregabalinPhenobarbitalZolpidem, Benadryl, or other sleep medsAnti-depressants In anecdotal reports, most people respond to either a baclofen or gabapentin taper. These two medications are structurally similar to phenibut, so they act as a substitute to prevent withdrawal. However, you may need to reduce your phenibut dose before you make the switch.     In one case study of an individual taking high doses of phenibut, doctors found that 8 to 10mg of baclofen could be substituted for one gram of phenibut.?? Their treatment protocol involved reducing daily phenibut intake by about 0.5 to 3g each week. For example, 8g daily during week one, 5g daily during week three, and down to 1g by week six. During this taper, doctors simultaneously prescribed gradually larger doses of baclofen, peaking at 60mg during week six, then tapering down.?? This was one of the only reported case studies that included a phenibut taper, but according to anecdotal reports, a gradual taper is one of the most common self-directed withdrawal treatments. The members of the subreddit r/quittingphenibut recommend reducing your dose by about 10-100mg per day. During your taper, the short-term use of benzodiazepines and sleep meds can help you manage acute anxiety and insomnia. Go to a primary care doctor or psychiatrist for help. They can help you develop a plan.   Discussions in online forums also include a variety of supplements that may help ease withdrawal in some people. Frequently mentioned supplements include: L-theanineMagnesiumKavaAshwagandha Warnings Phenibut withdrawal can be very dangerous. More dangerous than most other withdrawal syndromes. Attempting to quit cold turkey very bad idea and could increase your risk of seizures, insomnia, and psychosis.  Your best bet is to make a plan to quit phenibut. Inpatient detox is hands down the safest way to quit. At an inpatient detox facility, hospital, or addiction clinic, you will be met with a team of specialists who can help get you through withdrawal with the least amount of discomfort possible. Many insurance plans cover detox and addiction treatment. If you can’t or won’t do inpatient treatment, then at least see a doctor before you quit. That way you are prepared with a tapering plan and prescription medications to treat your symptoms. Arrange to take the first three or four days off of work. Make sure you have someone to help monitor you for signs of danger and assist with at-home responsibilities like childcare.   Be prepared to meet with some resistance at the hospital or doctor’s office. Most doctors in the U.S. have very little experience with phenibut dependence and withdrawal. Even addiction specialists may be unaware of the severity of phenibut withdrawal. You may need to educate your doctor about phenibut, so make sure to have an article or case report keyed up on your phone. Even better, print one out. Long-Term Treatment Many people with phenibut dependence require a long-term treatment plan. Long-term addiction treatment focuses on preventing relapse. Relapses are common among phenibut users who may go months without the drug then decide they are “ready” to handle it again in small doses, or for occasional use only. This type of thinking typically leads straight back to dependence and addiction. Your long-term treatment plan will need to address any current or prior dependence on other drugs or alcohol. If you started using phenibut to help you quit drinking, then quitting phenibut increases your risk of relapsing with alcohol. Research shows that people addicted to drugs require at least three months of treatment to quit successfully. If you have a co-occurring alcohol use disorder, treatment will be an ongoing process that you will have to deal with for many years to come, especially during times of high stress.?? There is another group of people who may require more specialized care. If you began using phenibut to treat anxiety, depression, or post-traumatic stress disorder, these symptoms are likely to reemerge after withdrawal. It is imperative that you seek treatment for these underlying disorders. Otherwise, you are at risk of relapsing with phenibut or other non-therapeutic drugs.   Evidence-based treatments for single or multi-substance abuse include varying combinations of behavioral therapy and medications.?? The same is true for people with co-occurring substance abuse and mental health issues. Behavioral therapy can take several forms. You may work with a therapist, psychologist, or a prescribing psychiatrist. Many people benefit from residential treatment programs, which provide an opportunity to stay in a healing environment for several weeks after your withdrawal. Other people prefer to seek treatment on an outpatient basis. Often supplementing behavioral therapy with peer-based support groups like Narcotics Anonymous or Alcoholics Anonymous. Resources Phenibut dependence is not widely understood or recognized, but that doesn’t mean it isn’t real. Check out this message board full of people going through the same thing as you: r/quittingphenibut. When you are ready to get serious about quitting, start by making an appointment with your primary care doctor, psychiatrist, or local health clinic. Your doctor can help refer you to the best place for treatment. Look for someplace that accepts your insurance. To find a doctor who specializes in addiction treatment, use this searchable directory from the Substance Abuse and Mental Health Services Administration (SAMHSA). You can also call SAMHSA’s national helpline at 1-800-662-HELP (4357).   A Word From Verywell When you first sought out phenibut, you were not looking to pick up another addiction. Maybe you used to help you get off alcohol, kratom, or benzos. Maybe you have severe anxiety. Whatever your reasons, expect those issues to arise again during and after your phenibut withdrawal. It is going to be hard, and symptoms may linger for weeks, but you will get through it. Once the brain fog is lifted, and the vicious withdrawal cycles are over, you will be free to live your life. How Long Should You Expect Withdrawal Symptoms to Last?

Using Animals Symbolically by Using Poetic Devices Essay

Using Animals Symbolically by Using Poetic Devices I will be discussing the ways in which the poets use animals symbolically by using poetic devices. The three poems that I have chosen are â€Å"The Tyger† by William Blake, â€Å"The Eagle† by Alfred, Lord Tennyson. Lastly, Pied Beauty by Gerard Manley Hopkins. Alfred Lord Tennyson has used an image of an eagle to give the reader an image of a man standing on a cliff top waiting for his world to fall around him. He is in a desolate area; there is no society near him â€Å"ringed with the azure world. He stands†. He watches the sea pass lower than him his world collapses beneath him n he falls. â€Å"And like a thunderbolt he falls† The sun has symbolized God. And his closeness to the eagle.†¦show more content†¦However, the poem is trying to tell us that the eagle is standing â€Å"close to the sun in lonely lands† and that the enormous sea is beneath him. These are the ways that the poet has used the eagle symbolically and to illustrate his strength and power standing high in the sky. â€Å"Tyger! Tyger! Burning bright† This is an example from â€Å"The Tyger† Metaphors of fire and blazing are emphasize by duplication of the â€Å"B† sound. The â€Å"B† sound makes it stronger and powerful to use. My second choice is â€Å"Pied Beauty†. Gerard Manley Hopkins who was born in 1844 wrote this poem. The poem is tells us about all the different creatures that God has shaped. Explaining how for many belongings in nature there is a contradictory. He is also telling the reader that we should be thankful towards it and the entire God gifted. In the poem, there are uses of some oxymoron’s by using them it shows the different extremes that exist within nature. This is similar to the Tyger. In addition, that shows the readers that to keep the balance on the planet God has created an opposite. â€Å"Adazzle, dim†. â€Å"With swift, slow; sweet, sour† He uses animals as one of God’s gift for our nature and used them symbolically for the exquisiteness of the planet. My third choice of poem is â€Å"The Tyger† written by William Blake. This poem shows the evilness of theShow MoreRelatedHow Does Randall Jarrell Use the Imagery in Durer‚Äà ´s Engraving of the Knight, the Devil and Death to Symbolically Convey a Philosophy of Life Using Powerful Poetic Devices?1131 Words   |  5 PagesHow does Randall Jarrell use the imagery in Durer’s engraving of the knight, the devil and death to symbolically convey a philosophy of life using powerful poetic devices? ‘The knight, Death and the Devil’ poem written by Randall Jarrell, based on the engraving by German artist ‘Albert Durer’ depicting a valiant knight, on horseback treading along the path of life. 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The Uncertainty Of Minority Identity In Claude Mckays...

The Uncertainty of Minority Identity in Claude McKay s America Claude McKay was simultaneously a central and a peripheral figure in the Harlem Renaissance. McKay s name is inextricably linked with this poetic movement; his work was included in Alain Locke s seminal anthology The New Negro: An Interpretation (1925), cementing not only his success as a contemporary poet but also his significance as a black poet in America. However, McKay is an unusual case in that, unlike other notable Harlem poets like Langston Hughes or Gwendolyn Bennett, he was not born in America. McKay moved from his native Jamaica to America when he was 22, he was already a grown man and an established poet by the time he experienced life in a racially divided†¦show more content†¦McKay inserts himself into the canonical literary history of the sonnet, exploiting this mainstream, traditional form to discuss the issue of unstable identities experienced by marginalised groups in America. Robert Smith argues that the sonnet form s rise and fall seemed quite the thing for the thought [McKay] wished to convey to his readers (Smith 273). The oscillation of sonnets between contradictory ideas allows McKay to riddle America with contesting descriptions of America, all of which destabilise the speaker s feelings towards this country, as the love which he explicitly claims to feel is undercut by consistent qualifications and mitigations. The unconventionality of McKay s type of rise and fall (Smith 273) lies in the continual nature of this oscillation; there is not just one turning point in America, it is perpetually twisting and turning as it navigates the experience of the speaker as a member of an oppressed group. Although the poem starts with ostensibly negative images of a feminised America feeding the speaker bread of bitterness (2) as she sinks into my throat her tiger s tooth (2). The plosives in the tight-knit phrase bread of bitterness create forceful, heavy sounds , sitting on the tongue uncomfortably, just like the unpalatable bread itself. The inversion of syntax in the following line is also awkward, foregrounding the act of violence being

Smb Company Free Essays

Comb’s are not high margin companies individually, and the internet is a great way to cut down on the sales cost and time to close for deals. As mentioned above, SAP offers two â€Å"solutions† for Comb’s: SAP Business One ND mynas All-in-One. SAP even discloses that 60% of their implementations fit into the SMB category (a large number considering it was earlier stated that 15% of revenue comes from such clients). We will write a custom essay sample on Smb Company or any similar topic only for you Order Now The category is defined in a related article sponsored by SAP done by DC (a global market intelligence and advisory firm) the SMB category is made up of businesses with fewer than 1,000 employees. SAP Business One SAP Business One is targeted at companies from 10 to several hundred employees. It includes the basic CRM, manufacturing and finance components of the ERP software, the so-called â€Å"critical† functions. It is billed as an ass to implement, understand and upgrade solution that integrates with Microsoft Office applications. It’s repeatedly referred to as an affordable solution which solves the problems of multiple systems for multiple uses (what ERP does for any business). The following is an outline of the capabilities of SAP Business One, which is implemented through business partners. Most companies have some form of application or software system that handles financial, inventory and customer data, intelligence and reporting. 9 www. Sap. Com Looking through the demos available through SAP’s website, the interfaces appear to e straightforward and robust, but not an open-the-box solution such as Microsoft Office. There would still need to be some kind of training to get an organization up to speed on the software. Case in Point: Annexation Federal One organization that successfully used this approach is Annexation Federal, a systems integrator to U. S. Federal government agencies. The company, which designs, sources, and installs voice and data telecommunications systems, struggled with a variety of legacy systems from prior mergers. The company needed a single, integrated solution that could handle the omelet demands of managing high-end telecommunications projects while providing greater flexibility, better reporting, and enhanced data visibility throughout the organization. Annexation Federal saw a demonstration of the product, which proved to its financial team that SAP Business One could support the company’s current and future accounting and financial systems needs. The organization recognized that the SAP Business One features were precisely what was needed to help manage the order- to- cash process accurately tracking order and sales from multiple vendors, billing contracts in a timely manner, monitoring work in progress, ND accurately calculating contract profitability. Implementing SAP Business One in less than six weeks, the company was able to create a seamless path from initial quote to purchase order through 7 invoices. With SAP Business One, we were able to streamline multiple solutions down to Just one and simultaneously achieve much wider functionality than we had previously, says Duane Taylor, vice president of finance for Annexation Federal. Today, the company is able to more effectively get the information it needs from its system, creating dramatic benefits. For example, the reconciliation of financial data at he end of each fiscal period once took as much as three weeks with employees working overtime. With SAP Business One, the company generates the needed department were redirected, saving more than $300,000 annually. Accounts receivable collections improved as a result of the availability of information, saving $1. 5 million. In addition, soft benefits such as improved communications, better visibility, and enhanced customer responsiveness have also been noted. The net result: Annexation Federal received payback on its investment in Just four months. (from SAP. Com) mynas All-in-One mynas All-in-One consists of solutions which are re-packaged and industry specific. They are versions of the mynas Business Suite engineered for turn-key application. These solutions are created to enable companies in the SMB range to purchase the capabilities of SAP software without any of the implementation issues associated with modifying the system. These are implemented through business partners such as Barrington and MM. In addition to these solutions, SAP also describes on their website the success stories through press releases, news articles, examples and case studies for particular industries. Qualified mynas All-in-One solutions are under development worldwide. And several of these vertical and cross- industry solutions are currently available in North America. Examples include industries such as high tech manufacturing, semiconductor manufacturing, ISP businesses, pharmaceuticals, and beverages. A recent press release outlined the partnership with SAP and Citric: 8 Both software vendors traditionally have focused on the enterprise market but now have Joined forces to make inroads into the SMB market. The solution will allow small and midsized customers to securely access their ERP applications from the road or from their home offices, the companies said. Citric will adopt SAP’s licensing model ND has priced the Material solution at $139 per named user. Business One costs $3,700 per named user. 10 10 Rooney, Paula. Citric, SAP Join Forces To Target SMB Market Joint solution to be Material Presentation Server For Business One. CRY. January 17, 2005 9 SMB ERP oracle protect it. Headquartered in Redwood Shores California, Oracle has operated for over three decades and is currently the world’s largest enterprise software company with over ten billion dollars in annual revenue. The company has grown in part through organic growth and in part through acquisitions, including Peoples/JDK Edwards 2004), Retake (2005), and Entrance (2002). Oracle currently offers SMB solutions through both its Oracle and Peoples/JDK Edwards brand names with a vision to merge the solutions into a central ‘Fusion’ platform. 11 Their company vision places an emphasis on three principles of the Inoperativeness Enterprise; to simplify, standardize, and automate. Oracle has integrated these principles into their own operations and focuses to incorporate them into the design of their software to better serve businesses worldwide. In June 2004, Oracle concluded that the enterprise segment was highly penetrated and the mid-market segments are large ND growing. In FYI 02/03 over 50% of application new license revenue came from companies under $1 billion. Oracle’s market assessment concluded that they would move to target the US mid-market segment as they believe it to hold the greatest potential for incremental growth. 12 Their mid-market messaging will surround the idea of ‘simply business. ‘ More specifically, Oracle looks to emphasize their affordability, simplicity, competitive, and growth aspects. 11 Presentation by Hide Kindle of Oracle in Seattle on Thursday, May 12 and www. Oracle. Com/solutions/mid/index. HTML 12 Oracle Presentation, June 2004 – Mid Market Special Edition Campaign Plan: HI IFFY SMB ERP oracle E-justness suite ‘special Edition’ The current Oracle solution emphasizes their E-Business Suite. The suite specifically focuses on core business applications to streamline key business processes (financial, purchasing, inventory management, order management, manufacturing, and sales forc e automation). 13 To target businesses less than $100 million, Oracle offers a ‘Special Edition’ package which is basically a scaled down version of their full- business suite. It claims to be affordable, easy to install, and simple to implement for a rapid and measurable return on investment. Oracle has chosen to sell this package through regional partners rather than directly through their sales representatives. 14 The differentiating factor that Oracle focuses on is that they are the only package with comprehensive, built-in business intelligence. What this meaner to SMB is that they will be able to manage, access, and analyze their business data very rapidly. This ability to synchronize information can give a company the ability to quickly Enterprise The current Peoples/JDK Edwards SMB solution is targeted at companies that have begun to outgrow their current systems. It is positioned as footwear to meet a company’s current needs with the flexibility and adaptability to also meet needs in the future. The product line is branded under JDK Edwards (Enterprise Solutions, Rapid Start, and World Express). Emphasis is placed on the comprehensive industry-specific functionality, affordability of the package, and flexibility to fit into a current and changing business. 314 Conversation with Keith Gosling of Hitachi Consulting in Seattle on Monday, May 16 Presentation by Hide Kindle of Oracle in Seattle on Thursday, May 12 The package is a pre-integrated set of modular applications with built-in, underspecified functionality. At this point the JDK Edwards sales force continues to sell the JDK Edwards product. They continue to promote the pr oduct but at some point in the next 2-3 years I predict that the sales forces of JDK Edwards and Oracle will converge in anticipation of the Fusion release. Oracle Fusion Hide Kindle, Oracle SMB Manager, noted that there are three primary ‘hot topics’ currently facing Oracle. 1 5 These include business intelligence (81), corporate governance (SOX), and budgeting/planning. Over the next several years Oracle aspires to focus on these hot topics in conjunction with taking the best pieces of each of their three primary footwear packages (Oracle, Peoples, JDK Edwards) to integrate into a complete ‘Fusion’ package. Oracle plans to roll-out individual fusion applications by 2007 and a complete Fusion Application Suite by 2008. Oracle’s primary sales point surrounds this idea of ‘how you package’ the product. They see the advantages of Oracle Fusion in four general categories. The first is scalability. Here they argue that with the package you will be able to implement the package and it will have the ability to grow alongside your business. Price is the second advantage. Oracle plans to package the cost of software, services, and licensing to make the option an attractive and affordable one. A third advantage is functionality. By taking the best pieces of the current software packages, Oracle argues that functionality will be a distinct advantage. By using partners on a regional level, Oracle sees the ease and effectiveness of implementation as a fourth advantage of Fusion. 15 This rapid transition from stand-alone products to an integrated suite does not come without issues. Two primary disadvantages of Oracle’s Fusion Suite are integration and support. More specifically, Oracle is going to face some major challenges over hose next few years as they look to roll-out a new package while supporting current customers. 3 SMB ERP Microsoft Microsoft Business Solutions offers a variety of ERP solutions for medium sized business entities. These solutions cover most industries and can be scaled down to any size business. Several of the software solutions are a complete ERP solution. All of the solutions offer an accounting and finance core. Many of the solutions integrate with Microsoft Office software so it is easy for new users to manage and leverage the data. In addition, Microsoft offers several solutions for certain aspects of business footwear solutions. 6 These additional solutions include: Business Network which allows streamlining collaboration through the use of XML templates, CRM to support marketing and customer service, Enterprise Reporting or Small Business Financial which are accounting applications, Retail Management System for point of sale and retail applications, Small Business Products for e-business, and Business Contact Manager for managing customer data. Microsoft Kappa Microsoft Kappa is an ERP solution with a price range from $kick to $kick. Currently, about 4,500 firms are using this software. Microsoft provides local partners to assist with implementation of this software and ongoing support. The benefits of Kappa is its unique design – one database, one toolbox, one business logic, one source code – meaner customizations and upgrades are easy to make. In addition, maintenance costs are low. 17 1617 www. Microsoft. Com/Boisterousness’s/Default. Asps www. Software re. Com 14 Nucleus Research, a global provider of research focused on IT return on investment conducted a study on Microsoft Kappa. 8 It found the following: 75 percent of customers had achieved a positive ROI from their Microsoft Kappa deployment with n average payback period of 23 months. 56 percent of Microsoft Kappa customers were able to reduce staffing costs as a result of their Microsoft Kappa deployment. 44 percent of Microsoft Kappa customers were able to reduce IT costs as a result of their Microsoft Kappa deployment. 75 percent of Microsoft Kappa customers reported improved operations and visibility as a result of their Microsoft Kappa deployment. Kappa is a multi-language, multi-currency ERP solution with core strengths in manufacturing and e-business together with strong functionality for the wholesale distribution and business services industries. By providing integrated, adaptable functionality within one open, scalable platform, Microsoft Kappa helps mid-market and companies across the globe seize opportunity and gain competitive advantage Extra is designed to help scale your business by providing internet functionality. This internet functionality can be used to collaborate with customers, partners, suppliers, and employees. Microsoft Kappa supports the entire business with functionality spanning manufacturing, distribution, supply chain management, reject management, financial management, customer relationship management, human resource management and business analysis. It also tailors itself to local legal and accounting requirements while supporting multiple languages and currencies. 18 www. Microsoft. Com/Boisterousness’s/Kappa/kappa_ROI_report. SSP Microsoft Kappa Case Study:19 The vision of North Atlantic Industries (ANA) is to become the preeminent global supplier of innovative military and commercial off- the-shelf (COTS) solutions that fulfill the requirements of companies in the aerospace, industrial, and defense markets. ANA achieved a positive return on its investment in Microsoft Boisterousness’s Kappa software by reducing inventory costs, realizing direct savings in perso nnel costs, and increasing the productivity of employees through reduced downtime. Annual return on investment (ROI) 128% Payback period (years) 0. 60 Net present value (NP) 499,888 Average yearly cost of ownership 146,626 Microsoft Great Plains Microsoft Great Plains is an ERP solution with a price range from $ask to $kick. With a lower price range than Kappa, Great Plains is positioned to support lower midwicket firms. It provides functionality for How to cite Smb Company, Papers

Critical Incident Pressure Area Near Miss free essay sample

Some key information missing in introduction conclusion. 3-5 Detailed and focused introduction conclusion. 6-8 Well developed introduction conclusion. 9-10 Very well developed comprehensive introduction conclusion. BODY0-2 Description of event lacked some major detail. 3-5 Descriptions of event mostly clear, but some detail lacking. -8 Clear description of event. 9-10 Very clear and succinct description of event. 0-4 Relevant legal and/ or ethical issues only briefly / not described. Critical analyses of issues poorly / not attempted. Arguments not/ inadequately supported by appropriate literature. 6-10 Relevant legal and/ or ethical issues described. Critical analyses of issues attempted. Arguments supported by appropriate literature. 12-16 Relevant legal and/ or ethical issues well described. Sound critical analyses of issues evident. Arguments well supported by appropriate literature. 18-20 Relevant legal and/ or ethical issues comprehensively described. In-depth critical analyses of issues evident Arguments well developed and thoroughly supported strengthened by appropriate literature. 0-4 Relevant ANMC or ACORN Competencies or standards only briefly / not described. Critical analyses poorly / not attempted. Arguments not/ inadequately supported by appropriate literature. 6-10 Relevant ANMC or ACORN Competencies or standards described. Critical analyses attempted. Arguments supported by appropriate literature. 12-16 Relevant ANMC or ACORN Competencies or standards well described. Sound critical analyses evident. Arguments well supported by appropriate literature. 18-20 Relevant ANMC or ACORN Competencies or standards comprehensively described. In-depth critical analyses evident. Arguments well developed and thoroughly supported strengthened by appropriate literature. 0-4 Recommendations not included/ only briefly described/not supported. 6-10 Recommendations included however more support or description needed. 12-16 Sound, relevant recommendations described. 18-20 Very clear description well argued support of relevant recommendations. Some (5-6) grammatical spelling errors. 6-8 Followed academic presentation requirements. Few (2-4) grammatical spelling errors. 9-10 Good structure and adherence of academic presentation requirements. No grammatical or spelling errors. Total: /100 /30% INTRODUCTION. In this assignment on critical analysis I will present a clinical incident and discuss and analyse a critical incident in detail utilising a critical incident tool (CIT). This incident I have chosen occurred during an operative procedure. I will discuss the incident as I proceed through the steps outlined in the critical analysis tool. I will present a brief overview of the incident before commencing my analysis. I will discuss the importance of a critical analysis and why they are important to nursing practice. I will also discuss the incident in terms of standards, guidelines and legislation. I will outline 4 recommendations for improvement to my practice. I will finish with a conclusion and a look forward to the future of pressure injury care in Australia. Incident The patient was a 12 year old male child undergoing and emergency open reduction and internal fixation of a right wrist fracture. The child was positioned in the supine position. The procedure was a difficult fixation and done by a registrar so was somewhat longer that the usual time taken to undertake this procedure. No names will be used to protect patient confidentiality. Due to the positioning the patient sustained a near miss pressure injury. The near miss and resultant tissue injury was not discovered until the procedure was completed. I will discuss this incident in full as I proceed through the critical analysis. Critical Analysis The purpose of undertaking this assignment is to look at this incident in more detail, and delve into the nursing obligations and duties owed to our patients. It has encouraged me to think more globally and think the issue through in depth. I have found I have had to consider the foundations that underpin my nursing practice. Critical analysis utilises a framework or a methodology to formally process and incident or significant event. The event does not have to be â€Å"critical† or even have a significant adverse outcome to be viewed as a critical incident. I have included the following definitions in relation to performing a critical analysis and what it hopes to achieve for the practitioner. Schluter, 2007), â€Å"The CIT is a practical methodology that allows researchers to understand complexities of the nursing role and function, and the interactions between nurses and other clinicians. † (p113). This is expanded in definition by (McClure ND) who defined reflective practice learning experience as follows, â€Å"To maximise learning through critical reflection we need to contextually locate ourselves within the experienc e and explore available theory, knowledge and experience to understand the experience in different ways. † (para 7). A critical incident is an event that is usually remembered by the participant as important or used as a learning tool for the purpose of reflection. (Daly, Speedman, Jackson,. 2010). The Australia Nursing Midwifery Council (ANMC) states the following about critical thinking and analysis, â€Å"This relates to self – appraisal, professional development, and the value of evidence and research for practice. Reflecting on practice, feelings and beliefs and the consequences of these for individuals/groups is an important professional benchmark. † (p. 2). Also under the ANMC competencies nurses have a duty of care to their patients to that complies within the current legislation governing nursing practice. I am using the following incident analysis from (Services, 2009) which is heavily based on work by Crisp, Green Lister and Dutton (2005) . 1. Account of the incident The incident I am going to discuss did not get discovered until we were taking down the drapes and getting ready to transfer the patient onto the bed. During the procedure I was the scout nurse in the theatre. Once the drapes were removed, I noticed the child’s left foot was crossed on top of his right foot. This resulted in the calcaneal part of his heel came to rest on the top part of the bony section of his right foot. I could immediately see a round red area on the top of his right foot that resulted from pressure from his heel. This was a direct result of the pressure of his foot over the duration of the procedure. The procedure was a difficult fixation and done by a registrar so was somewhat longer that the usual time taken to undertake this procedure. Once I discovered the incident my focus was to assess the injury and treat it appropriately. I pressed the skin involved and the red area from the pressure was blanchable, but slow to respond. I think had the pressure from his upper foot had been applied any longer this would have developed into a stage one pressure area. I rubbed the affected area to help restore circulation and checked the heel of the foot that was resting on the top of the right foot. I gave the patient a warm blanket to help achieve normothermia, reported and documented the injury. I also completed a prime incident report. 2. Initial responses to the incident When I discovered the incident, I felt a sense of failure that I had not noticed the crossed leg under the drape. I felt I had let our patient down whilst caring for him in the operating room. I also felt my colleague was unmindful of the ramifications of what a pressure injury that develops into a stage one pressure ulcer would involve for this patient. I felt we owed a duty of care to the patient to administer appropriate treatment, timely intervention and report the injury to the surgeons. I had assumed everyone would be of the same mind in relation to this incident. 3. Issues and dilemmas highlighted by this incident Under the ANMC competencies there is an ethical nursing framework that exists to govern ethical nursing practice. One area of ethical consideration during this incident was when I pointed out the scrub nurse this injury to the patient. She stated to me that the positioning was correct at the beginning of the case, so there was nothing that we could do about the injury occurring. Under the ANMC framework to â€Å"maintain an effective process of care when confronted by differing values, beliefs and biases. † I myself did not witness the patient position prior the draping, so I can’t say I noted the patient’s position. The staff member was very senior to me and have a forceful personality. I felt quite uncomfortable during the time that we discussed the patient injury. I felt the person who was with me felt as if there was blame being allocated, which for me was not the case at all. I wanted to notify her of the patient’s injury as I would like to be if I were in the same position. I also felt she was being dismissive of the patient’s injury. I notified the surgeon and documented this in the nursing notes. I also communicated the injury with the recovery staff. Under civil legislation we owe the client a duty of care in all aspects of the care we provide. 4. Outcome The patient was very fortunate not to develop a stage one pressure injury. Due to the state of the tissues when I found them I have no doubt that another 20 minutes or less would have resulted in a pressure injury for this patient. This is why I have used it as a critical incident. It was such a close call for a patient who was so young with no other co morbidities. Had he not been well nourished and in good health, I am certain this would have resulted in a pressure injury. Due to this incident I have changed how I practice in the surgical setting in regard to monitoring and correcting patients positioning. I feel I am more vigilant in regard to positioning. As I have processed this incident through critical analysis and reflective practice I think I have come to terms with the incident a little better. I have gained a better understanding of my role in this incident, and have developed as a practitioner to help other patients so they are better positioned to decrease the likelihood of developing a pressure injury. I have also increased my knowledge base about pressure injuries significantly, and continue to learn about them in the peri-operative environment. I think this incident served as an excellent learning experience to help prevent similar injuries in others. 5. Learning A recent survey has been collected and published by AORN, (Steelman, Grayling Perkhounkova 2013) found during a survey of peri-operative nurses that preventing pressure injuries was the 5th most important priority safety issue they were concerned about. When they divided it into settings, hospital based nurses rated it as the third most important safety issue. They also found there was no purpose built valid tool to conduct risk assessments on patients in the peri-operative environment. They also found limited resources to help nurses prevent pressure injuries. (Mahan, P. 2006) defines a pressure ulcer (now known as pressure injury) as â€Å"any lesion caused by unrelieved pressure resulting in damage of underlying tissue. Pressure ulcers are usually located over bony prominences and are graded or staged to classify the degree of tissue damage observed. † (p. . ). (Mahan, P 2006) stated in relation to pressure injuries, that â€Å"prompt and effective treatment can minimise the deleterious effects and speed recovery. † (p. 6) (Baron McFarlane 2009) identified that staff felt that pressure injuries were uncommon in the operative setting. However due to surgical techniques improving and becoming increasingly complex, op erating times were lengthening. They found that injuries could occur in a one to four hour time frame dependent of the patient’s condition. They also found due to specific environmental reasons the operative environment contributed to this risk. This was due to general anaesthesia, anaesthetic agents that decreased perfusional status and body temperature. When relaying incidents and other issues found postoperatively I will continue to maintain a calm, non judgmental response. I will be more forward when a staff members seems to find this confronting and discuss the issue with them at and appropriate time and find out why they reacted the way they did. I have found 4 recommendations for improvement that I can undertake to help prevent pressure injuries. 1)Educate staff on what a pressure injury is and how to prevent them. This would also highlight patient risk factors, important co morbidities and the importance of patient positioning. There are two online options for this education. These had the added benefit of accruing CDE points, and all staff can undertake the education when they are able. https://members. nursingquality. org/NDNQIPressureUlcerTraining/https://members. nursingquality. org/NDNQIPressureUlcerTraining/ http://www. health. vic. gov. au/pressureulcers/education. htm 2) Use a patient positioning time out prior to draping involving all team members. This does not have to be formal, and is a quick and easy check prior to draping to ensure the patient is correctly positioned prior to draping. It is important to involve other staff members from all disciplines as pressure injuries occurs both in the anesthetic and surgical arena. This also incorporates all elements of the ACORN standard on peri-operative positioning. Advocate for the use of pressure relieving devices on all patients, regardless of age, co morbidities or skin condition. Even young well people are at risk of pressure injures. Conduct and document a baseline skin assessment, and continue to monitor the status of the patients skin, documenting any issues. The Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury suggest a number of tools for the use in children, and there is good evidence to support the use of three of the tools 3)Ensure patient is warm and all warming devices are used appropriately. Pressure injuries can result from heavy blankets. So I would ensure the patient has one warm blanket and a forced air warmer insitu. There is good evidence to link pressure injury prevention and normothermia. If the patient is normothermic the risk of pressure injury is decreased. (Fred, Ford, Wagner VanBrackle, 2012) As a result of this incident I am more aware of the Australian College of Operating Room Nurses Standard (ACORN) on Patient Positioning. (ACORN 2012-2013) states, â€Å"Safe positioning for, and during, surgery and in the immediate postoperative period minimizes the risk and prevents unnecessary surgical complications. † and also â€Å"The positioning shall not compromise the patients respiratory and cardiovascular function, or cause damage to the nervous, muscular and integumentary systems. Future learning needs. I believe I need to educate myself on patient positioning for all types of surgery. I also need to maintain currency in the latest evidence based practice on pressure injuries and pressure relieving devices. Due to the governments policy on pressure injuries and the financial penalties health care facilities face, I think all nursed will need to make this a priority learning goal. I also need to learn more about anaesthetic agents in greater detail. It was not until I undertook this assignment that I realised the uge impact they have on a patient and there risk of a pressure injury. (Walton-Greer, P. 2009) discusses the impact anaesthesia has on the patient in relation to pressure injury. Due to pain receptors being blocked, depression of the autonomic nervous system and the vasodilatory effect of the anaesthetic agents the all have a cumulative affect on the risk of developing a pressure injury. She also found that patients having a spinal or epidural anaesthetic were more at risk. I am also going to complete the pressure injury education components as per recommendation one in this assignment. As a department we need to explore a risk assessment tool for use in the theatre for patients who do not have one already completed. The health care facility uses the Waterlow scoring system. It is part of the ACORN standard S12 criteria 1. 3. This standard also states that nurses â€Å"demonstrate a competent knowledge of the aetiology of pressure sores’ and (ACORN) statement 3, states that nurses â€Å"appropriately use a risk assessment tool and preventive screening positioning techniques based on evidenced based research† (p. 3). CONCLUSION In conclusion I think that pressure injuries are a priority area for nursing care and active preventative measure should be instituted in all surgical patients. Nursing staff should work as a team to ensure the patient is positioned well, and given appropriate follow up care. It should become standard practice to conduct a skin assessment on admission to a hospital facility, and if one has not been done, it should be conducted if practicable by the theatre nurse. At the end of my conclusion I will include a look forward for what in will mean to hospitals if patients acquire a pressure injury in their care. I personally will conduct a patient positioning time out prior to draping to ensure the patient is correctly positioned and had the correct pressure relieving devices in place. I will also explore my future learning needs as outlined in my assignment. All issues surrounding patients need to be communicated clearly and in a calm and non judgmental way, they also need to be documented as per hospital policy. Looking Forward. The Australian government has instituted a policy where Health Care Facilities will be fined under a punitive system on each pressure injury that occurs in a facility. This money will be taken from the operative budget of the ward/ unit in which the pressure injury occurred. I personally think this will have a detrimental affect on health care. There are other models in which you a financially rewarded for preventing pressure injuries. Injuries need to be documented within 6 hours of admission or otherwise a financial penalty will result whether the injury occurred within the facility or not. This will be important to theatre nursing staff who are treating trauma patients and critically ill patients who are admitted to their unit after presentation to the hospital.

Movie Evaluation free essay sample

At this point he doesn’t really know what is actually happening. He continues in his routine grabbing a snack from the fridge and then pressing the play button on the answering machine. In this scene He listens to the first of six messages his father left as the events unfolded. He then turns on the television as the messages continue to play and witnesses what has happened and realizes his father is in the building. Just as the news camera captures the first tower falling Oscar falls to his knees, the pudding he got from the fridge spews everywhere and he begins to sob. This movie is categorized as a drama. Certain aspects should be within a drama and relating criteria should be established this includes first and foremost emotion, second would be a powerful message, also if the movie is based from real events, such as this one, realistic scenarios should take place and last but not least quality acting and effective casting, which go hand in hand. We will write a custom essay sample on Movie Evaluation or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page In a beginning scene from the movie when Oscars mother Linda Schell (Sandra Bullock) gets a phone call from her husband Thomas Schell while she is at work. You can hear the sheer panic in his voice and the chaos of distraught people in the background. Linda Schell now understands how dyer the situation is because he is in the building. She panics and tries to talk him into staying on the phone with her, they get disconnected. The viewer can easily relate to Linda’s fear and helplessness. Throughout the entire movie you can feel Oscars pain of losing his father. After â€Å"the worst day† Oscar refused to step foot in his father’s closet until one day he gathers the courage to do so. He is sorting through his father’s things when he knocks a vase off of a shelf. The vase shatters and he finds a key and believes it was a last â€Å"reconicense mission† his father created for him. He deems it necessary to continue the game they played that consisted of Oscar going on â€Å"reconicense quests† that his father would develop for him so that he would face his fears of being out in society. Loud noises, lots of people and being out in public put Oscar on edge as he has Autism and he has much trouble trying to make sense out of the simplest things in life and understanding why he can’t make sense of them, but his focus of understanding turned to his father’s untimely death. This movie does have a powerful message of how an unexpected tragedy can change lives forever. We may not have answers as to why or no complete understanding of what truly happens, but we must find a way to move on. As far as depicting real scenarios I believe this movie is right on point with one exception, Oscar was released from school as things started to take place. Before these attacks happened no one felt there was a real threat to humanity, but in a real situation such as this one, school districts, in my opinion, would not have released the children off on their own. Even if no one quite knew what was happening. It is the facilities responsibility to protect and care for those children while they are under their care. This was the only scenario I didn’t agree with. It almost gives a misconception of how schools would react, I think. Last but not least a drama should have quality acting which would foresee effective casting. Someone might seem right for the part but cannot portray the character effectively, which doesn’t make it believable or relatable. If the wrong people are casted, who aren’t quality actors, it would create a different atmosphere for the movie. It may not do so well if the characters aren’t portrayed effectively. I look for actors/actresses who have been awarded for their work and those I’m familiar with because there is a good chance the movie will be worthwhile. Overall Extremely Loud and Incredibly Close is a captivating, emotional and heartfelt movie about a boy with autism whom has just lost his father and learning to cope. With its quality acting and effective casting, powerful message and real life scenarios this movie is a must see.

The Life and Works of David Ricardo - a Biography

The Life and Works of David Ricardo - a Biography David Ricardo - His Life David Ricardo was born in 1772. He was the third of seventeen children. His family was descended from Iberian Jews who had fled to Holland in the early18th Century. Ricardo’s father, a stockbroker, emigrated to England shortly before David was born. Ricardo began working full-time for his father at the London Stock Exchange when he was fourteen. When he was 21 his family disinherited him when he married a Quaker. Luckily he already had an excellent reputation in finance and he set up his own business as a dealer in government securities. He quickly became very rich. David Ricardo retired from business in 1814 and was elected to the British parliament in 1819 as an independent representing a borough in Ireland, which he served up to his death in 1823. In parliament, his main interests were in the currency and commercial questions of the day. When he died, his estate was worth over $100 million in todays dollars. David Ricardo - His Work Ricardo read Adam Smiths Wealth of Nations (1776) when he was in his late twenties. This sparked an interest in economics that lasted his whole life. In 1809 Ricardo began to write down his own ideas in economics for newspaper articles. In his Essay on the Influence of a Low Price of Corn on the Profits of Stock (1815), Ricardo articulated what came to be known as the law of diminishing returns. (This principle was also discovered simultaneously and independently by Malthus, Robert Torrens, and Edward West). In 1817 David Ricardo published Principles of Political Economy and Taxation. In this text, Ricardo integrated a theory of value into his theory of distribution. David Ricardo’s attempts to answer important economic issues took economics to an unprecedented degree of theoretical sophistication. He outlined the Classical system more clearly and consistently than anyone before had done. His ideas became known as the Classical or Ricardian School. While his ideas were followed they slowly were replaced. However, even today the Neo-Ricardian research program exists.

BORDER SECURITY ISSUES RESEARCH PROJECT # 2 Essay

BORDER SECURITY ISSUES RESEARCH PROJECT # 2 - Essay Example The CPJ report shows that Iraq has held this position since 2008, when there was another survey (Witchel, 2014). In 2012, when there was a U.S invasion, journalists were not killed because of their relation to their work. However, because of increasing terrorists groups in the country, there were 10 journalists killings of which nine were unresolved murders. In total, the report shows that there 166 journalist murder cases since year 1992, with 103 of these cases murdered with impunity. The second country ranked as the worst is Somalia, where there were four new murders last year. According to the report, there are elusive armed insurgent gangs who terrorize the media to the point that the law agencies do not follow-up the cases (Witchel, 2014). There were 53 journalists’ deaths since 1992. Out of these deaths, 35 journalists were murdered with impunity. In Philippines, there are 51 murders of journalists that are still unresolved. The country has remained number 3 after Iraq and Somalia since year 2010 (Witchel, 2014). According to the CPJ report, there are 53 journalists killed since 1992 and 35 of these journalists were murdered with impunity. In Sri Lanka, there was no progress made in the unresolved cases of journalist murders. However, CPJ notes that it did not record any of the murders from year 2009 to 2013. CPJ notes that out of 19 journalists killed since 1992m 10 of these journalists are murdered with impunity and go unreported in Sri Lanka. Colombia falls in the fifth category with 45 cases of journalists killed since 1992. 36 of the 45 cases were murdered with impunity. Nonetheless, it records so many cases of death threats of journalists in different states of Columbia. In Afghanistan, journalists who are also from other states are usually jailed for many years such as the Pakistani reporter who was sentenced to 4 years in prison in July, this year. In total, Afghanistan records 26 cases of journalists murdered since 1992, with

Judicial restraint and judicial activism Essay Example | Topics and Well Written Essays - 250 words

Judicial restraint and judicial activism - Essay Example On the other hand, the doctrine of judicial restraint holds the assumption that the courts are supposed to submit to the decisions made by the executive and legislative branches. This is because the people elect the president and the members of the Congress and the federal judiciary members are not. The courts are also supposed to submit to the agency decisions and rules. In other words, under this doctrine, the courts are not supposed to hinder the implementation of agency rules and legislative acts unless they are precisely unconstitutional. For instance, many states before the case of Roe v. Wade held that abortion was illegal, regulated sodomy, made homosexual sodomy and adultery a crime (Bardes, Schmidt, and Shelley 459). Judicial activism approach is appropriate because the courts are able to act in an independent manner. In other words, the courts can make their decisions without the influence of the executive and the legislature. These two branches of the government (executive and legislature) at times make decisions that only serve their interests and not that of the people (Bardes, Schmidt, and Shelley 459). For instance, the in Griswold v. CT case of 1965, the court suggested that the rights to privacy existed and thus, the case overturned the Connecticut law that regulated birth

Land Art Movement and Artists

Land Art Movement and Artists Land Art was mainly developed during the late 1960s. It is also known as Earthworks. Land art was the revolutionary side of the artists, which were trying to escape from the traditional painting and sculpture, as well as their ecological concerns. According to Robert Smithson, this revolutionary approach, was also an attempt to escape from galleries and museums; this led to environmental consciousness and objection. †¦The ecologist tends to see the landscape in terms of the past, while most industrialists dont see anything at all. The artist must come out of the isolation of galleries and museums and provide a concrete consciousness for the present as it really exists, and not simply present abstractions or utopias†¦[1] This had as a result, for artists to create their art directly into the landscape. The work was made mostly with huge scale ‘sculptures directly in nature, using natural materials. Land art is about ‘real life and embodies the direct and instinctive relations with the landscape, the nature and the environment. It covers the approach of the location and the experience of the observer attaching special importance to the landscape. Land art works were mainly exhibited with written or photographic documentations. [2] Land art also provides the social and cultural conditions of that time. During 1968 there was a fundamental change of revolution in both continents, United States and Europe. In United States there was a pacifist and human rights expression, mainly caused by the Cold War and the American attachment in Vietnam. In Europe, one factor for that revolutionary change was the rebellious activities of the ‘Situationist Internanionale (Guy Debord) in France. Also the warning of danger caused by the nuclear war (global extinction), had a result to emphasize the importance of ecological issues. The first images from space, published the same year, changed the way we perceive our world. Land art reveals the clash positions of that period, in the direction of land and the environment. It desires a radical change and the recovery of the ecological disaster on land caused by the industrialisation. Through Land art we can reconsider our relationship with the landscape and with nature. The massive unexploited land of America played a major role in the development of Land art in the United States during that period. Many American artists performed their works, using those unexplored deserts of the American landscape. Those deserts embodied a mainly American approach towards landscape. They also proposed the success of American culture and technology over nature. They rejected the historic fine art traditions of Europe and they started to reference towards the significant national American idioms.[3] One main American artist is Robert Smithson, which he considers being the most important theoretical artist among all land artists. Many of his activities were located in the geological and culturally rich of Western America in desert locations. Smithson was interested in natural history from an early age. The year 1964 was a crucial year for his career as he began to develop his themes and interests. Blood, decay, geological strata and theories about time and history, were some of the artists interests that were developed through the paintings that he made on that period. In the same year he created a series of ‘crystalline sculptures, like The Eliminator 1964. He also developed a friendly relationship with a number of artists, which were associated with Minimalism. One of them was Donald Judd. When he exhibited those sculptures, they were perceived as Minimalist. This was mainly because he was known for his connection with those artists and due to the fact that for this work he used industrial materials. But Smithsons work deals and represents the multipart conceptual ideas. This multipart conceptual ideas include crystalline growth, decompose and the dilemma of perspective. He rejects clarity, unlike Minimalism, in which objects are standing themselves and are symbolising the external. [4] Smithson, as well as other artists, played their part in transforming the perception of nature. He has seen landscape as a place in continuous transformation, revealing entropy. He is associated with a natural landscape and he emphasizes the relationship between man and natural powers. Smithson also provides a powerful image for the contemporary position. In Smithosns writings the concept that emphasizes much on his work is the principle of energy loss-entropy. In 1968 he started to think about the scale and how artworks can be positioned and viewed in the landscape. He explored these ideas in a series of works called Site and Nonsite. Smithson described this work as ‘an indoor earthwork. In 1969 he started to produce his work directly into landscape, as he was interested in making art outdoors, away from galleries. He produced photographic work using mirrors. [5] In 1970 he made his major work on the landscape called Spiral Jetty, (1) which was made at Rozel Point on Great Salt Lake, in Utah. Spiral Jetty was made from rocks, mud and precipitated salt crystals. Smithson documented the creation of the sculpture. He learned that Great Salt Lake in Utah carried micro bacteria that coloured the water red and he developed an interest in the symbolic possibility of a red saline lake. He created the spiral form, as he was inspired with the location, the natural characteristics and the historical contexts. Smithson linked the red salt water with blood. Through Smithsons own writings, Spiral Jetty is presented as a particular clear example of his association between artwork and location and he is emphasizing its entropic qualities.[6] Michael Heizer was an American artist who was considered being very important to the development of land art. He felt that a sculpture needed to express the character and the scale of the great Western American landscape. He believed that artworks were valued as products and he provided the differences between those works of the urban marketplace and the works in the landscape. He stated that: ‘†¦the position of art as malleable barter-exchange items falters as the cumulative economic structure gluts. The museums and collections are stuffed, the floors are sagging but the real space exists†¦'[7] Heizer used the desert spaces as a laboratory. His first landscape work began in 1967, and it was called North and South. Through out this work we can perceive his interest in void and negative spaces. He rejected European traditions, as he wanted to make art that was ‘American. Heizer most famous and most debatable work is Double Negative (2), built in 1969. It is located at the Mormon Mesa, near Overton, Nevada. This work was made at the edge of the sandstone cliff and it is composed of two deep cuts creating a huge channel. Double Negative is composed of space itself. Heizer said that: In Double Negative, there is the implication of an object or form that is actually not there†¦ [8] Heizer believes that the work is not about the landscape but it is about the sculpture. He also believes that the importance of his work in not in what ‘it rejected but in what ‘it offered instead. Heizer through his work kept his primary purposes for his art in the landscape. In England the Land art started to develop as well in the late 1960s. England presented fewer opportunities for impressive gestures than United States. One main British artist was Richard Long. Long mostly gave emphasis to the simplicity on his work, giving the attention to his common skills and the materials he used. Walking was the principal form of Long. [9] But beneath this simplicity we can perceive the conceptual and the imaginative aspects that highlight Longs art. He explored ideas about time, space and experience. From an early age he started also to explore the traditional subject of landscape. In 1969 he aimed to ‘create an open and exploratory environment during his studies on the ‘Advanced Sculpture Course at St Martins School of Art in London. Other artists shared the same interest with Long about landscape as a subject for contemporary art. During his studies he developed a very different way of reaching the landscape, as through his work, he involved space and scale. His achievement on that period was the work titled with: A Line Made by Walking, 1967. (3) He simply walked along a line, across a field, in order to create a visible path in the grass. The path was photographed. We can split the work into two parts. Part one is the making of the work and part two is the documentation. After this work he continued to explore this conceptual aspect by creating two more works, Bicycle Sculpture 1967 and A Ten Mile Walk, England 1968. Because this kind of works couldnt exhibit into a gallery, Long started to use documentary materials such as texts, maps and photographs. We can separate Longs sculptures into two categories. Sculptures that were made by walking in the landscape, and the documentation of it, and sculptures which were made in the gallery as a reaction to space and locality. This separation on Longs works (the work made in the landscape and the work made for the gallery space), can be compared with Robert Smithsons works Site and Nonesite . We can find many similarities and differences between artists in the two continents. Longs work is considered being practical opposing to the work of Smithson, which is considered being theorised. Both artists used natural materials in order to accomplish their motivations. Long was using in his work, forms such as lines and circles expanding the modernist development. On the other hand, Smithson, had the obsession with ‘ destruction, decay, decomposition and dissolution. Both artists shared the same interest in order to find the place (landscape) to construct their works. Mapping was also a significant concern for Long, as well as for Smithson, not only for the documentation of their work but also to find a specific location. Equally through their works, they demonstrated cultural and artistic concerns. [10] Land art emphasizes the importance between nature and culture. Through Land Art, artists provided that the landscape is one of the original places of cultural expression, like social and environmental are clearly marked. Bibliography: Land Art: A Cultural Ecology handbook, ed. by Max Andrews, London: RSA, 2006. Beardsley, J. Earthworks and beyond: contemporary art in the landscape, 3rd edn. New York: Abbeville, 1998. Malpas, W. Land art, earthworks, installations, environments, sculptures, Kidderminster: Crescent Moon, 1998. Tufnell, B. Land Art, London: Tate Gallery Publications, 2006. [1] Land Art: A Cultural Ecology handbook, ed. by Max Andrews.p.22 [2] Tufnell, B. Land Art, London: Tate Gallery Publications, 2006, pp.12-19 [3] Tufnell, B. Land Art, pp.12-19 [4] Tufnell, B. Land Art, pp 35-42 [5] Beardsley, J. Earthworks and beyond: contemporary art in the landscape, 3rd edn. New York: Abbeville, 1998, pp. 19-23 [6] Tufnell, B. Land Art, pp 43-45 [7] Beardsley, J. Earthworks and beyond: contemporary art in the landscape, p.13 [8] Tufnell, B. Land Art p.51 [9] Beardsley, J. Earthworks and beyond: contemporary art in the landscape, pp.41-46 [10] Tufnell, B. Land Art, pp 32-35

Italian Culture and Work Ethics Essay

History teaches us that it is through the family that new generations are equipped with ethics and values regarding work. The advent of bourgeois society, with its characteristic openness towards other social classes, appears to have relegated the promotion of working values by families to the background. This study sets out to test the hypothesis according to which the family continues to maintain an important role in the transmission of working values. Based on data from the Work Importance Study (Super and Sverko, 1995: Life Roles, Values, a n d Careers, San Francisco, Jossey-Bass), two subgroups were compared (working adults, and high school and university students), considered as representing two different generations (youths vs adults). Some results from cluster anatysis show how substantial similarity exists between adults and youths in terms of ideal values, expressing ‘what would be important in an ideal world’. The difference between the subgroups lies in expectations (termed ‘expected values’) relating to ‘what would be important in my actual work environment’. Here, relatively more important values for young people are relatively less important for working adults. Another result presented concerns the relationship existing betiveen value typobgies (classed into six categories) and personal character associated with birth order. What emerges is that the only children are prevalently the ‘tough type’, while the first bom, considered by some to be custodians of family traditions, tum out to be more independent than the second or third bom, identified above all by their calm and sociable characters. Introduction: the work ethic and the family ethic This study presents the results of a survey conducted nationaUy in 1995 on a sample of 1523 subjects (represendng the three main geo-cultural areas of Italy: North, Centre and South—see BeUotto, 1997). The objecdve of the survey was to determine values associated with work. For this a quesdonnaire, a values scale (VS) was used, devised by an intemadonal team pardcipadng in a world-wide survey called the Work Importance Study—WIS (Super and Sverko 1995). With the data coUected, a profile of the value judgements of Italian families was formulated. The importance of working values within the family context has been little explored from a psychological point of view. Yet the family is characterized by the ethical nature of the reladonships it contains, hence its values (Boszormeny-Nagy and Spark, 1973; Cigoli, 1992). The family is rightly placed in that class of insdtudons that Hegel indicated as the ethical horizon of human society. ‘ There are very few Italian studies on the processes of value transmission within families, not to mendon the handing down of working values. While one of the principal funcdons recognized as typical of families is the socializadon of the individual, studies regarding the socializadon by families with regard to work are rarely encountered. 1351-1610/99/040583-13 Â © 1999 Interdisciplinary Centre for Comparative Research in the Social Sciences 584 Massimo Bellotto and Alberto ^atti The lack of research in this field can be partly explained by the relatively recent history of the concept of the ‘family’ as a scientific subject for study in social psychology. At least until the end of the 1940s, families were considered as a group typology (Lewin, 1951). Successively, interest focused on the pathology of family relationships (Bateson et al. , 1956; Epstein et al. , 1982; Bamhill, 1979; Watzlawick et al. , 1967). It was only in die 1970s that the so-called ‘normal’ family was considered worthy of psychological investigation as a scientific subject (Scabini, 1985). In recent years, however, the theme of values and the ethical importance of families has emerged strongly in a variety of fields, from individual and family psychotherapy to organizational psychology. In this article we would like to propose that a terminological distinction be made between ethics and morality. Ethics are, as the etymology of the word suggests, the study of the ‘customs’ (ethos), the social habits, the relational practices of a people or social grouping. Morality relates more to the theme of how much certain behaviour corresponds to a reference model. In this sense, it is important to distinguish between ethics and morality when studying the customs and habits, in a word, the ethics of families (and not their morality). This is to avoid the pitfalls associated with referring to a particular set of values held by the family being analysed. What exacdy are the working values held by families? What relationship exists between these values and family needs? What are the motivations that stir the family organization? And which family values can be linked, even indirecdy, with work? Let us seek some answers to these important questions. Families in history have also been units of production. The peasant family, craft guilds, the factory worker families of the first and second industrial revolutions (Manoukian, 1976) are the most emblematic examples. In medieval society the chances of changing one’s profession from the one inherited from the family were rather hmited. Children continued the working traditions of the family without having much choice in the matter. The transmission of working values within family groups, historically speaking, seemed to go without saying. However, it would be worthwhile to pose the question of how families educate their members today with regard to work. Families in Westem society have changed profoundly. The social mobility intrinsic to the very idea of bourgeois society (Weber, 1904) has led to the privatization of family relationships (Aries, 1960) and to the specialization of family practices to the sentimental sphere. The educational role of families is becoming more and more marginal, being delegated to collective institutions such as schools. Moreover, from the viewpoint of economic history, families have become increasingly characterized as units of consumption, losing in part their role as units of production. From a macrosocial perspective, a fundamental problem emerges in Italy: the percentage of youth unemployment is one of the highest in Europe, especially in the South. Working Values and the Italian Family 585 majority of young people between the ages of 15 and 24 live at home: 82. 4% of males and 72. 5% of females. In the next age bracket, 25-34, many more young men sdU live at home with their parents (33. 6%) compared with young women of the same age (22. 9%). According to some demographic projecdons to the year 2000, these percentages wiU touch 36. 3% for young males and 34. 2% for young females. There are cultural and ideological reasons for this phenomenon, such as the idea that marriage is the only proper route towards adult independence (8 males out of 10 and 9 women out of 10 leave the family only foUowing marriage). However, social factors also make a contribudon, in particular, high youth unemployment and a shortage of rental accommodadon. The result is that families coundng a young adult as a member are a socially significant category. Psychological factors and value systems also play an important role. The working values tradidonaUy handed down in Italian families place heavy emphasis on permanent and full-dme employment. The definidve departure from the family is often condidonal on minimizing the risks of independence. Among others, for these two factors (permanent fuU-dme employment and minimum risk of independence), life-dme employment in government and union employment policies have come to be considered as a necessary and sufficient prerequisite for the attainment of adulthood. The quest for so-caUed ‘guaranteed employment’ has led Italian society to one of the most cridcal paradoxes in its history: the creadon of a barrier to occupadonal access for youth. Thus, the one prerequisite considered a vital and sufficient condidon for the evoludon of Italian families, life-dme employment, has become one of the major obstacles to the same end. By disallowing generational change in employment, it has become impossible for young generadons to enter the workforce, and hence to reach independence. ‘* Following on these consideradons, we decided to use the results of a study on working values (WIS 1995) to shed some light on value differences between young students and adult workers. As mendoned above, very few studies have been carried out in Italy on the transmission of values within families. While the WIS study was not designed for this purpose, we believed that it could give some indicadons regarding the generadon gap (youths vs adults) and differences in social status (students vs workers). The underlying hypothesis to tjiis study is therefore that working adult values can be considered as being similar to those of parents; likewise, those held by young students can be considered as being similar to those of offspring. The WIS survey.

Dupage County Needs Assessment

Dupage County needs assessment U OM LTH C A E TUS ENT H A T ESM S S AS ITY N DUPAGE COUNT Y HEALTH DEPARTMENT Everyone, Everywhere, Everyday Community Health Status Assessment DuPage County Health Department 2010 Prepared By Mary Lally, RN, MPH Crystal Reingardt, MPH Peggy Iverson, BS Stacey Hoferka Jensen, MPH, MSIS Elizabeth Barajas, MPH Table of Contents Section 1 Leading Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Top Ten Leading Causes of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Crude Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Top Ten Leading Causes of Death by Gender . . . . . . . . . . . . . . . . . . . . Top Five Leading Causes of Death by Age Group . . . . . . . . . . . . . . . . . Years of Potential Life Lost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Demographic and Socioeconomic Characteristics . . . . . . . . . . . . . DuPage County Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Birth Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Statistics. Mortality Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Immigrant Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unemployment. Unemployment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 1-1 1-2 1-3 1-4 1-5 2-1 2-1 2-7 2-8 2-9 2-1 0 2-11 2-12 2-13 2-13 3-1 3-7 3-8 3-22 3-23 3-24 3-25 3-25 3-28 3-29 4-1 4-1 4-7 4-8 4-12 4-13 4-14 5-1 5-1 5-4 5-7 5-7 5-10 6-1 6-1 6-2 6-3 6-6 Section 2 Section 3 Chronic Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diseases of the Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cancer. Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stroke. Stroke. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chronic Lower Respiratory Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arthritis. Arthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Osteoporosis. Osteoporosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetes. Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Asthma. Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EndDisease. End-Stage Renal Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Infecti Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VaccineVaccine-Preventable Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rabies . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section 4 Section 5 Maternal and Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Infant Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Factors. Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Low Birth Weight and Very Low Birth Weight . . . . . . . . . . . . . . . . . . . . . . Adolescent Pregnancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Activity Nutrition, Physical Activity and Obesity. . . . . . . . . . . . . . . . . . . . . . . . Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Activity. Physical Activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Obesity. Overweight and Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FORWARD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section 6 Section 7 Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outdoor Air Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Water Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Waste. Toxics and Waste. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Communities. Healthy Homes and Healthy Communities. . . . . . . . . . . . . . . . . . . . . . . Infrastructure and Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Foodborne Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mental Health Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ment al Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alzheimer ’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Illicit Drug Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Injury and Violence Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unintentional Unintentional Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accidents. Motor Vehicle Accidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drowning. Drowning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Deaths. Firearm Related Injuries / Deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Child Abuse and Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Domestic Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1 7-1 7-3 7-4 7-6 7-6 7-8 8-1 8-1 8-3 8-5 8-6 8-7 8-10 8-12 9-1 9-1 9-2 9-3 9-4 9-5 9-6 9-7 9-9 1010-1 1010-1 1010-2 1010-2 1010-4 1010-5 10-5 101010-8 1111-1 11-1 111111-2 1111-4 1111-5 1111-6 1111-6 Section Section 8 Section 9 10 Section 10 Minority Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DuPage County Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DuPage County Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ethnicity. Cause Specific Deaths by Race and Ethnicity. . . . . . . . . . . . . . . . . . . . . Top Five Leading Causes of Death by Race and YPLL . . . . . . . . . . . . . Motor Vehicle Accidents, Homicides, and Suicides . . . . . . . . . . . . . . . . Maternal and Infant Health Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Infectious Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Access to Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preven tive Clinical Preventive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ongoing Sources of Primary Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inadequate Prenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sentinel Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Section 11 Introduction In order to meet State requirements for health department re-certification, Illinois Administrative Code requires that every five years, each Local Health Department must assess the health needs of its community through a systematic process known as the Illinois Project for Local Assessment of Needs (IPLAN). IPLAN is grounded in the core functions of public health and ddresses public health practice standards. One of the required documents of the IPLAN process is a Community Health Status Assessment. The Community Health Status Assessment is intended to answer th e question, â€Å"What is the health status of the residents of DuPage County? † The results of this assessment will provide the IPLAN Steering Committee with an understanding of the community’s health status and ensure that the IPLAN priorities include specific health status issues. The Community Health Status Assessment is developed through the systematic analysis of health status data from primary and secondary sources.The following DuPage County Health Department Community Health Status Assessment is a compilation of data from these sources. The Institute of Medicine defines a community health profile as a set of health, demographic and socioeconomic indicators which are relevant to most communities. It is intended to provide a broad strategic view of the population’s health status, and the factors that influence health in the community. The IPLAN Steering Committee will use this document to identify and support approximately ten health status issues. Method ologyThe DuPage County Health Department has created this Community Health Status Assessment to identify specific health needs as part of the IPLAN process. Our intent is to develop an accurate, comprehensive picture of health status of DuPage County residents. Content areas covered focus on physical, mental and environmental health. This assessment will follow a structure similar to the U. S. Healthy People 2010 (HP 2010) document, providing the most current data available, and indicating how DuPage County compares to the HP 2010 target whenever possible.Incidence, prevalence and trends are shown when available. Objectives without HP 2010 targets have been included where appropriate based on public health impact. Direct HP 2010 comparisons were not always available. Finding current, comparative data on specific health objectives consistently remains a challenge. Many data sources have been used in an attempt to provide accurate data for analysis. Data reliability must always be con sidered, as in some instances, occurrence of morbidity or mortality may be so low that a valid rate or percent cannot be calculated or, if calculated, would be meaningless.These occurrences are noted throughout the document. Data derived in the Community Health Profile is a compilation of many sources. Frequently when discussing national health statistics or trends, direct HP 2010 text was quoted. The IPLAN Data System was a primary source for Illinois and DuPage County specific indicators, as this system contains a wealth of data on births, mortality and chronic illnesses. Illinois Department of Public Health birth and death files were frequently used as a data source, along with sources from specific DuPage County Health Department service areas.Other data and information sources include Access DuPage, American Cancer Society, American Heart Association, American Psychiatric Association, Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention, DuPage County Environmental Committee, DuPage County Sheriff’s Office, DuPage Federation on Human Services Reform, Family Shelter Services, Illinois Attorney General, Illinois Council Against Handgun Violence, Illinois Department of Children and Family Services, Illinois Department of Employment Security, Illinois Department of Public Health, Illinois Department of Transportation, Illinois Environmental Protection Agency, Illinois State Board of Education, Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, National Adolescent Health Information Center, National Alliance on Mental Illness, National Cancer Institute, National Diabetes Information Clearinghouse, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institutes of Health, National Osteoporosis Foundation, National Safety Council, National Stroke Association, Nationally Highway Traffic Safety Administration, Safe Kids USA, SEER*Stat (Surveillance, Epidemiology an d End Results statistical software), Substance Abuse and Mental Health Services Administration, Suicide Prevention Resource Center, The Alan Guttmacher Institute, The Joint Commission on Accreditation of Healthcare Organizations, U. S Census Bureau, U. S.Centers for Disease Control and Prevention, U. S. Department of Commerce, U. S. Department of Health and Human Services, U. S. Department of Housing and Urban Development, U. S. Department of Justice, U. S. Environmental Protection Agency, and World Health Organization. Section 1: Leading Causes of Death and Mortality in DuPage County A good place to begin our study of the health status of the population is by reviewing the leading causes of death in DuPage County residents. Presenting, ranking, and comparing leading causes of death data is a common method of showing mortality statistics, and is useful for illustrating the relative burden of disease-specific mortality.The DuPage County death data presented in this section were obtai ned from death files provided by the Illinois Department of Public Health. In 2006, there were 5,703 deaths in DuPage County and 102,122 deaths in Illinois (1). Ninety-four percent of DuPage deaths were White, three percent were Asian, and two and one half percent were Black. Three percent of DuPage deaths were Hispanic. Minority Health will be addressed in Section 10 of this Community Health Profile. See Table 1. 1 for a comparison of the 2006 Top Ten Leading Causes of Death in DuPage County and Illinois (2)(3). See Table 1. 2 for the 2004 and 2005 Top Ten Leading Causes of Death in DuPage County (2). Table 1. Top Ten Leading Causes of Death in DuPage County with Illinois Comparison, 2006 DuPage County Rank Cause of Death All Causes 1 2 3 4 5 6 7 8 9 10 1 Illinois Number of Deaths 102,122 27,002 24,052 5,974 4,725 4,401 2,792 1 Number of Deaths 5,703 1,419 1,384 347 260 192 183 158 109 107 93 Percent of Deaths 100. 0 24. 9 24. 3 6. 1 4. 6 3. 4 3. 2 2. 8 1. 9 1. 8 1. 6 Percent of De aths 100. 0 26 24 6 5 4 3 1 Diseases of the Heart Cancer Cerebrovascular Disease Chronic Lower Respiratory Disease Accidents Alzheimer’s Disease Pneumonia Diabetes Mellitus Nephritis and Nephrosis Septicemia 2,794 2,501 2,001 3 2 2 Pneumonia is not in the top ten leading causes of death in Illinois Source: Illinois Department of Public Health (2) (3) 1-1 Table 1. Top Ten Leading Causes of Death, DuPage County, 2004-2005 2004 Percent of 2005 DuPage Total DuPage Deaths Deaths Deaths All Causes 5,444 100. 0 5,761 Diseases of the Heart 1,326 24. 4 1,455 Cancer 1,395 25. 6 1,440 Cerebrovascular Disease 385 7. 1 388 Chronic Lower Respiratory 252 4. 6 274 Disease Accidents 208 3. 8 181 Pneumonia 137 2. 5 177 Alzheimer’s Disease 166 3. 0 179 Nephritis and Nephrosis 116 2. 1 138 Diabetes Mellitus 119 2. 2 116 Septicemia 102 1. 9 89 Source: Illinois Department of Public Health (2) Percent of Total Deaths 100. 0 25. 3 25. 0 6. 7 4. 8 3. 1 3. 1 3. 1 2. 4 2. 0 1. 5 Since 1908, Dise ases of the Heart has been the first or second leading cause of death in the United States (4).Since 1921, Diseases of the Heart has remained the number one cause of death (4). While DuPage County historical mortality data dating back to 1921 is unavailable, one can extrapolate national patterns to County mortality. The increase in 2004 total Cancer can be seen as an anomaly. The transposition between Diseases of the Heart and Cancer in 2004 should be monitored. Crude Mortality Rate Table 1. 3 Crude Mortality Rate, DuPage County and Illinois, 2000-2006 Year DuPage County Illinois 2000 617. 1 855. 8 2001 620. 6 840. 1 2002 616. 1 842. 9 2003 615. 6 829. 2 2004 586. 3 805. 0 2005 618. 0 812. 1 2006 611. 3 795. 8 Source: Illinois Department of Public Health (2) 1-2Crude Mortality Rate in DuPage County and Illinois 2000 – 2006 Rate per 100,000 Population 1,000 800 600 400 200 0 2000 2001 2002 2003 2004 Illinois 2005 2006 Year DuPage County Graph 1. 1 Source: Illinois Department o f Public Health (2) As can be seen from Graph 1. 1, between 2000 and 2006 the DuPage County and Illinois mortality rates remained relatively stable. The DuPage County crude death rate ranges from 586 deaths per 100,000 population to 620 deaths per 100,000 population. The Illinois mortality rate is higher and has a greater range than DuPage County. It ranges from 796 deaths per 100,000 population to 843 deaths per 100,000 population (2). Top Ten Leading Causes of Death by Gender Table 1. DuPage County Leading Causes of Death, All Ages by Gender, 2006 Male Female Rank Cause Number Rank Cause 1 Cancer 681 1 Heart Disease 2 Heart Disease 661 2 Cancer 3 Accidents 130 3 Cerebrovascular Disease (CVD) 4 Cerebrovascular Disease 128 4 Chronic Obstructive (CVD) Pulmonary Disease (COPD) 5 Chronic Obstructive 99 5 Alzheimer Pulmonary Disease (COPD) 6 Pneumonitis 81 6 Pneumonitis 7 Diabetes 51 7 Accidents 8 Nephritis 47 8 Nephritis 9 Alzheimer 44 9 Diabetes 10 Septicemia 43 10 Septicemia Source: Illinois Department of Public Health (2) Number 758 703 219 161 139 77 62 60 58 50 1-3 Gender Differences The 2006 top ten leading causes of death are the same for oth males and females, though the ranking of causes varies by gender. The first and second cause of death for males is Cancer, followed by Heart Disease. This order is reversed for females. Accidents (Unintentional Injuries) are the third leading cause of death for males, but the seventh leading cause for women. This category includes motor vehicle accidents and any other unintentional injury death that occurs as a result of a fall, drowning, firearm or other accidental cause. In DuPage County, the number of male Accident deaths is more than twice the number of female Accident deaths, which is attributed primarily to higher numbers of male motor vehicle deaths.This discrepancy between male and female accident deaths is a trend that is also seen nationally (5). CVD and COPD are the fourth and fifth leading causes for males , but the third and fourth causes for women. Alzheimer’s disease is the fifth leading cause for women, but the ninth cause for men. Pneumonitis is the sixth leading cause of death for both males and females. Diabetes was the ninth leading cause of death for females and the seventh in males. Nephritis was the eighth leading cause of death in both females and males and Septicemia was the tenth leading cause of death for both genders. Top Five Leading Causes of Death by Age Groups Table 1. 5 Five Leading Causes of Death by Age Group in DuPage County, 2006 Rank