The Betrayal of Anne Frank Essay Example for Free

The Betrayal of Anne Frank Essay For decades, historians around the world have been reviewing facts about the betrayal of Anne Frank. On August 4th, 1944, the Gestapo captured Anne Frank and the other residents of the ‘Secret Annex’. Months of torture were ahead of them in three different concentration camps. The camps got the best of seven out of eight people from the ‘Annex’. Otto Frank, Anne’s father, was the only survivor of the Holocaust. The betrayer of Anne Frank and her family needs to be found, they all deserve it. Until now, no one has known who made the fatal phone call to the Secret Police. Anton Tony Ahlers is the infamous betrayer of Anne Frank. Tony Ahlers son said, â€Å"Your suspicions of my dad possibly betraying the Franks is wrong. He DID betray them.† Ahlers was also a known betrayer. Lana Hartog told one of the Frank family helpers that she knew Jews were hiding and could not just sit back and let it continue. Although investigated after the war, she was not found guilty. This proves Lana’s innocence; therefore, she is not guilty. Ahlers is a clear suspect who hated Jews, and Otto and his family were Jews. Ahlers was a worker for the DNP (Dutch National Party- Nazis) and had a hand in dozens of betrayals. Ahlers half sister, Margaret Block, says that Tony bragged about turning in the Franks; however, because everyone in their family was terrified of him and what he could do to them, they never turned him in. If Ahlers had betrayed many other Jews and had turned them in, what would stop him from doing it again? That question leaves historians at a stop sign, at which they are paused momentarily. Tony Ahlers was the only person in the investigation of the betrayal of the Frank family that had a motive; he desperately needed money. With his business bankrupt, he truly had nothing else to lose. Otto was of no use to him any longer in the aspect of business. Otto Frank did business with the German Army, and Ahlers found a letter stating Otto believed the Germans would lose the war. Ahlers used the letter to blackmail Otto. Tony desperately needed money, and his last resort was Otto Frank. Tony Ahlers is still the #1 suspect in the betrayal of Anne Frank. The events of Annes betrayal and the Holocaust happened many decades ago. Certain things are fresh in the minds of historians everywhere; after all, Tony Ahlers has always been the prime suspect of the infamous betrayal. His sons confession, his job, and the only one with a motive, the arrow points right to him. His name needs to be brought to the table, so the Annexs residents can rest in peace. â€Å"In Spite Of Everything, I Believe That People Are Good At Heart.†

Inter-Professional Education in the Healthcare Sector

Inter-Professional Education in the Healthcare Sector Chapter 1 Introduction Health carers working in Malta are expected to work towards a patient-centred care and to communicate and collaborate in multidisciplinary teams even if they lack sufficient basic knowledge on the role of every team member. Sacco (2008) stated that there has to be effective team-working, communication and collaboration between professions for patients and their allied care to improve. He also stated that I.P.E. between the different professions is a way of attaining this team-work. Much has been written over the past few years on inter-professional education (I.P.E.) and its effect on the health care system. A lot of research and promotion have been conducted. However, Lumague et al. (2006) still believes that professional programs are still not giving the appropriate importance of I.P.E. in their curricula. According to Sacco (2008), I.P.E. was never used by any of the professions related to medicine in Malta, as a way of learning. Buttigieg stated (as cited in The Times of Malta, 2008) that â€Å"we still have a long way to go to be able to claim with confidence that interdisciplinary collaboration in teaching and research at our University is bearing the fruit that is becoming increasingly necessary in the world of today. Although the exercise was found to be very exhausting by the researcher, it was also an enriching experience and an introduction to the world of research. Provided that this was the authors first attempt to research, the study has helped her develop a better understanding of the research process. Chapter 2 Literature Review 2.1 The Current Healthcare System and the Present Situation at the FHS Sacco (2008) stated that in the present healthcare system, patients are looked after by Multidisciplinary Teams comprising an extensive range of healthcare and other professionals. Apparently, the FHS board is not fully aware of the benefits of I.P.E. and although a lot of lip service is presented to working as a Multidisciplinary Team (MDT), not much is truly done to promote it throughout the actual education (Sacco, 2008). Sacco (2008) argues that in Malta, although the medical profession is part of the MDT, little or no integration is happening throughout the undergraduate years. Furthermore, there has to be a clear distinction between ‘Common Core Learning and I.P.E. The terms should not be used interchangeably since they do not have the same meaning. Currently in Common Core study-units students are being taught together with other students from other divisions of the FHS, or other faculties within the University, which is the same as ‘multi-professional education as this involves learning the same content together side by side, which in turn should not be mistaken with I.P.E. (Sacco, 2008). The latter does not only comprise the subject matter, but it also involves the different roles of different professions and how professionals can work together towards a shared goal (Sacco, 2008). Health education was somewhat inward-looking, however, owing to the altering health services, has changed from being ‘mono-professional to ‘multi-professional, and then becoming ‘inter-professional (Sacco, 2008). 2.2 Background on I.P.E. The need for immediate improvement of human resources was recently emphasized by the World Health Report 2006 produced by the World Health Organisation, according to which, the world is short of 4.3 million doctors, midwives, nurses and support workers. This crisis was also recognized by the 59th World Health Assembly (2006), who demanded upgrading of the health personnel production through various methods which included ‘‘innovative approaches to teaching in industrialised and developing countries.   Furthermore, Gilbert (2005) pointed out that shortage of healthcarers in Canada were already reported in the Curtis Report, back in 1969, and the latter approved of : considerations for replacing the training program with a more advanced one, empathetic patient care, and increased collaboration and management in delivering healthcare. In addition to this, the requirement of numerous necessities of particular groups of facility users, the diversity of necessary service responses to these and the necessity for effective information exchange and discussion with regards to care planning and delivery, lead to the demand for cooperation between the health care professions and the social care professions, and health and welfare/ social care agencies (Towards Unity for Health, n.d.). Robson and Kitchen, (2007), also emphasised the importance of an effective interprofessional collaboration in order to provide the best healthcare possible. The necessity of health and social care professions working together more was already highlighted for a number of years (Department of Health, 1989, 1998, 2000).  Ã‚   The complexity of patient care is on the rise, thus effective cooperation between health and social care professionals is needed. However, evidence proposes that the latter two are not cooperating well with each other (Cochrane Review, 2002). Collaboration still poses several problems especially with interprofessional coordination and communication. In a study carried out by Robson and Kitchen, (2007), students thought that communication and interprofessional relationships are the key factors affecting collaboration. I.P.E. has long been supported to be a solution to the challenges which collaboration presents (WHO, 1988; Department of Health, 2000). However, although it is evident that I.P.E. initiatives within universities have many beneficits, there were doubts to how successful the development of such initiatives could be (Oxley Glover, 2002). The following are several problem issues that were identified by Brian ONeill (as cited in Oxley Glover, 2002): Finding placements, particularly for team experiences Differences amongst students with respect to knowledge they bring to the course, motivations for taking the course, and preferred learning styles Evaluation of outcomes Transferability of knowledge and skills to practice, and impact of interprofessional learning to practice. 2.3 Challenges to the Implementation of I.P.E. Research suggests that it is very important for the professionals to have knowledge on how to work, communicate and collaborate effectively and cross boundaries between professions for a better health care system. According to the Council for the Professions Complementary to Medicine (2006), â€Å"Physiotherapists should communicate effectively with registered medical practitioners, other health professionals and relevant outside agencies to provide effective and efficient service to the patient† (p. 2). Salvatori, Berry, and Eva (2007), reported that although barriers to implementing I.P.E. exist, the need to overcome them is critical if we are to keep pace with the changing healthcare system and better prepare health professional students for collaborative practice. A preliminary survey of I.P.E. found that, there is a wide variability when the term ‘interprofessional is interpreted and that there are many barriers to I.P.E. some of which are overloaded curricula in schools of health professions, faculty and administrations lack of support and also financial limitations (Rafter et al., 2006). Not all of the above had been successful where endeavored. Oxley and Glover (2002) stated that in their own research some participants felt that they had not benefited from inter-disciplinary work as the course were â€Å"too theoretical. On the other hand, most of the respondents felt that this work was successful owing to the inclusion of for example practical experience, work placements, and inter-professional projects. 2.4 What is the Best Time to Introduce I.P.E.? The best time to introduce interprofessional learning in higher education still remains debated (Horsburgh, Lamdin, Williamson, 2001). On the other hand, Yan, Gilbert, Hoffman (2007) stated that it is the time to take a step forward to an I.P.E. and collaborative practice.   Students themselves were found to be in favour of I.P.E. as early as possible that is in their first year of their course prior to the development of professional prejudice (Parsell, Spalding, Bligh, 1998; Horsburgh, et al., 2001; Rudland Mires, 2005) and stereotyping of other healthcare groups which may in turn have a negative impact on attitudes when it comes to collaborating interprofessionally (Hojat et al., 1997; Tunstall-Pedoe, Rink, Hilton, 2003; Rudland Mires, 2005). On the other hand, introducing I.P.E. early in the course may sometimes be useless when labeling has already been formed in the minds of those who are about to start the course. Rudland and Mires, (2005), reported that medical students start the course already knowing the main differences between the nurses and the doctors characteristics and backgrounds. For example medical students perception of the nurses is that they are more caring, have less social status, less competent and academically weaker than doc tors. According to Khalili Orchard (2008) currently the way healthcare students are learning and socialized is via a uni-disciplinary model, which in turn may lead to in-group and out-group behavior (The Social Contact Theory).   Learning about the roles and responsibilities of just ones profession leads to professional socialization which in turn might lead to professionals distrusting other professionals and forming myths of perceptions about them, thus professional socialization and lack of effective collaboration. Sacco (2008) stated that professional socialisation is more the training of medical students into developing as doctors and physiotherapy students into developing as physiotherapists, rather than preparing them to be able to become team members. Shared interprofessional learning may be a solution to this problem as professions come to appreciate roles and responsibilities of other professions. Thus, I.P.E. may be the key to more effective collaboration in the actual workpl ace. Furthermore, it would be ideal if knowledge, skills and attitudes would be passed on from the I.P.E. into the actual workplace, something that still has to be accomplished within Maltas health services (Sacco, 2008). Multiprofessional learning and education (now looked at as interprofessional) have been given great importance by the World Health Organisation (as being an important factor in primary health care) since 1978 in the Alma-Ata 1978 Primary Health Care Report and it was emphasized later in 1988, in their statement ‘Learning Together to Work Together for Health.   This initiative was also supported in many countries by other legislative and policy requirements such as ‘Learning together to work together (Department of Health, 2000) in the UK and the Inter-professional Education for Collaborative Patient Centred Practice Initiative, supported by Health Canada (Herbert, 2005). 2.5 Evidence Available to Support I.P.E. Hammick, Freeth, Koppel, Reeves, Barr (2007) states that there is limited evidence to support the proposal that learning together will aid practitioners and agencies to work better together. The effect of I.P.E. on the healthcarers work still needs to be re-examined since â€Å"there is no published evidence that I.P.E. promotes interprofessional collaboration or improves client relevant outcomes† (Zwarenstein et al., 2005). Campbell (2003) reported that most studies that he selected for his systematic review were deficient in their methodologic rigor. The review concluded that there was no convincing impact of I.P.E. in improving collaborative practice and/or health/well-being. On the other hand, evidence that suggests that interprofessional learning improves interprofessional collaboration is also available (Atwal Caldwell, 2002). Oxley and Glover (2002), maintain that there are benefits to I.P.E. for different stakeholders including employers, universities and students. For example the recruitment of a higher standard of graduate by employers will in turn have a positive reflection on the institute and its operators. According to the Commission on the Future of Health Care in Canada (2002), â€Å"If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.† Barr, et al. (2000) succinctly summarises the four main benefits I.P.E. can provide: Enhances motivation to collaborate Changes attitudes and perceptions Cultivates interpersonal, group and organisational relations Establishes common value and knowledge bases Hammick et al. (2007) found that I.P.E. is generally liked, allowing knowledge and skills needed for to work in collaboration to be learnt. Furthermore, staff development is the main impact on the effectiveness of I.P.E. and can help learners bring out the unique values about themselves and others (Hammick et al., 2007). When it comes to initiatives with regard to quality improvement, I.P.E. is effective in improving practice and services (Hammick et al., 2007). On the other hand, according to Zwarenstein et al. (2005), â€Å"there is no published evidence that I.P.E. promotes interprofessional collaboration or improves client relevant outcomes†. Thus, the need for more research on I.P.E. is needed. 2.6 Attitudes towards the Inter-Professional Teamwork and Education   There was an amount of studies carried out to gain more information regarding attitudes of healthcare students towards interprofessional teamwork and education. Such students tend to show positive attitudes towards I.P.E. (Tunstall-Pedoe, et al., 2003; Pollard, Miers, Gilchrist, 2004; Curran, Sharpe, Forristall Flynn, 2008). In a research study conducted by Lumagae et al. (2006), when it comes to patient care, interprofessional teamwork was approved by all the participants who all agreed that opportunities comprising their development of skills, attitudes and behaviours required for interprofessional collaboration should be involved in their healthcare education. Salvatori et al. (2007) also stated that â€Å"It is clear that students enjoyed their experience and perceived new respect and understanding of other professional roles and the potential for interprofessional collaboration in caring for patients† (p. 80). Most of such studies stated that there is a tendency that medical students and also postgraduate medical residents have significantly less positive attitudes towards interprofessional teamwork when compared to students from other healthcare professions (Hojat et al. 1997; Leipzig et al., 2002; Pollard et al. 2004; Tanaka Yokode, 2005). Attitudes of medical and nursing students towards interprofessional teamwork were studied and no significant difference was found between them two (Curran, et al., 2008). However, Curran et al. (2008) also found out that these two groups of students report significantly less positive attitudes towards interprofessional teams when compared to pharmacy and social work students. Curran et al. (2008) also reported that medical students significantly showed less positive attitudes towards I.P.E. when compared to nursing, pharmacy and social work students. Being a female and/or a senior undergraduate also showed more positive attitudes towards interprofessional teamwork and education (the latter being more significant especially with prior experience with I.P.E.). In this study, profession, gender and year also seemed to play a role in determining positive attitudes towards both interprofessional teamwork and education. On the other hand, Pollard et al. (2004) found that there were students who had viewed interprofessional collaboration negatively and they included mature students and those that had experience at university or of working in a health or social care settings. Curran et al. (2008), argues that although having previous experience in I.P.E. activities may not improve attitudes to it, participating in it may have more positive attitudes towards interprofessional teamwork. 2.7 Attitudes towards the Roles of their Own other Professional Groups Research has also tried to give answers with regard to students attitudes towards the roles of their own other professions. Tunstall-Pedoe, Rink, and Hilton (2003), argue that the overall attitude of students studying medicine towards students from other professions was less positive. In a study carried out by Hojat et al. (1997), medical students were found to have different attitudes from nursing students with regard to areas of authorities and power, including professional dominance and medical responsibilities in serving patients needs. Furthermore, Spence and Weston, (1995) maintains that nurses were more clear in their perceptions of competencies essential for medicine, than medical students were about competencies important for nursing.  Ã‚  Ã‚   It should be noted that literature review with regard to I.P.E. at the FHS was scarce and difficult to find.   Chapter 3 Materials Methodology 1 Introduction This chapter describes the planning and development of the research study. It also explains the underlying rationale for deciding on the studys structure. 3.2 Objectives of the Study It is not really known whether students of the Faculty of Health Sciences (FHS) and the Faculty of Medicine and Surgery (FMS) agree to the implementation of a new I.P.E. system at the FHS. The overall objective of the study was to understand whether students at the FHS and at the FMS know what I.P.E. is and to explore their opinions regarding the implementation or not of I.P.E. in the common curriculum at the FHS. The goals of the study were to: Explore the students understanding of the term I.P.E. Identify whether the students agree or disagree to the implementation of I.P.E. and I.P.E. study-units at the FHS, and if they agree, the study-units or areas of study they would like to see becoming inter-professional and at what stage of their course to implement it. Find out the students attitudes towards I.P.E. with regard to its benefits and challenges if any. Discover the students attitudes towards I.P.E. teams Discover the students attitudes towards other healthcare professions 3.3 Operational Definition of Terms Table 1 Illustrating the operational definition of terms. 3.4 The Research Design For the aims and objectives of the study to be addressed, the latter had to be descriptive, qualitative and thus, a non-experimental and explorative research design was considered to be the most suitable approach. One-to-one interviews were preferred to group interviews since in the former more personal information about the participant could be elicited (Carter, Lubinsky, Domholdt, 2011), the patient may feel more comfortable to speak in front of a person rather than in front of a group and thus giving more honest information especially when it comes to expressing his/her attitudes towards others. The interviews were carried out in-person, with the advantage of providing the best opportunity for building rapports and for observing the interviewees nonverbal cues (Carter, et al., 2011). 3.5 The Research Setting This study was conducted in Malta with the permission of the University of Malta. The University has a number of Faculties two of which being the FHS and the FMS, from which students were chosen to participate. The courses which fall under these faculties and which were included in the study can be found in Appendix F, wherein the numbers of students present in each division is also given. The participants had a say in the choice of the research setting, and preferred meeting at places most familiar and within reach to them including University of Malta areas, Mater Dei Hospital and at certain pharmacies, which were also within reach by the researcher. Carter, Lubinsky, and Domholdt (2011), suggest that the setting in which the research is carried out contributes greatly to an interviews success. The interviewer made sure to choose a setting which is familiar and comfortable to the interviewee, with special attention given to the environmental setting such as quietness to avoid interruptions, adequate lighting, room temperature, and comfortable and appropriate set-up of chairs to avoid building psychological barriers. Carter, Lubinsky, and Domholdt (2011), emphasized the importance of an appropriate introduction to an interview as this sets up the tone, affecting the rest of the interview. Furthermore, the researcher was aware of the body language at all times, keeping the appropriate distance, maintaining eye contact in line with cultural norms, showing interest and full awareness in what the interviewee was saying (by for example leaning forwards to him/her, nodding, smiling to funny comments that the subjects passed) and speaking clearly and at an adequate volume level. Attention was also given to choosing the appropriate type of clothing as in an interview the attire plays an important role. At the end of each interview, the interviewer made sure to thank the participant for his/her contribution to the research study in order to show appreciation and to indirectly help promote and encourage participation in future research. 3.6 Target Population In this study, the target population which is described as ‘the entire population in which a researcher is interested and to which he or she would like to generalize the study result (Polit and Beck, 2008, p. 767), included students from all the different divisions of the FHS and from the divisions of Pharmacy and Medical students which both fall under the FMS. When the researcher interviewed these students, the latter had already started their next scholastic year. The researcher staggered the interviews so as to gain more knowledge whilst completing the literature review and to be able to give the participants appropriate cues during the interviews. This helped the researcher to achieve better results because the cues given targeted the research question. A literature search of electronic databases including Ebsco, Cinahl and Pubmed was conducted between January 2009 and May 2011. The inclusion criteria for this study were: All the students whose course fell under the FHS or the FMS. Male or female Willingness to participate in the study. English speaking Students over 18 years of age. The study will be using undergraduate students opinions rather than post-graduate healthcarers opinions, as there is a lack of similar studies on the issue. The exclusion criteria for this study were as follows: Students who never had any clinical experience. Students who did not fell under University of Malta Those who did not want to participate. 3.7 Sampling Size and Methods Used to Choose the Sample Owing to time constraints, a method of convenience sampling was used to select a sample for the study, choosing easily accessible people who are in proximity to the researcher or who are willing to take part in the study (Castillo, 2009). This method is also the cheapest, simplest sampling form available and does not entail planning (Ellison, Barwick, Farrant, 2010). This type of sampling offers a fast attainment of preliminary information with regard to the research question being studied and is also inexpensive (Berg, 2004; Castillo, 2009). Students who satisfied the criteria were recognized and 31 people were chosen including 12 males and 19 females whose ages ranged from 19 to 46. The following is a proportion showing the total number of medical students, is to the total number of pharmacy students is to the total number of students from the FHS, respectively: 426: 196: 823. One student per 90 students for each FHS division was interviewed in order to have a representable sample . The researcher was aware that the selected subjects could not represent the entire population as to test the whole population it entails to interview an enormous amount of people and that would have taken an infinite amount of time to complete the study. The sampling was unrepresentative and did not offer statistical advantages (Ellison, et al., 2010). The sampling size was mostly determined by the available time and resources. The researcher tried to find a balance between depth and breadth of the interviews. The in-depth information obtained from the research population provided rich and valuable data. The researcher contacted subjects who satisfied the inclusion criteria of the study via e-mails or face-to-face, in order to set appointments for the interviews, and had to find a compromise between both her and the subjects availabilities. The researcher made sure that she would not disturb them. The researcher used stratified sampling to make sure that a particular sample, from the known population under study, is denoted in the sample (Berg, 2004). Furthermore, the use of stratified sampling also helped the researcher to access small subgroups within the population, allowing the researcher to examine the extremes of the population (Castillo, 2009). This known population was divided into strata, chosen according to literature support, from which samples were selected. The researcher had information on the population and was able to divide it into strata, for which a sampling fraction had to be applied, which represent proportions of the whole population (Berg, 2004). Qualitative research makes sure that informants are not manipulated in a certain way as would probably be typical in studies which are quantitative experimental, but, instead tries to access the informants viewpoints (Carter, et al., 2011).   3.8 The Research Instrument The interview guide had two parts, one of which included demographic data and the other part included fifteen open-ended questions. The latter produced the qualitative data. The intention of establishing a rapport with the interviewees was to make them feel more comfortable. Friendly light conversations, the use of sense of humour, and common conventions for example talking about weather conditions and about the surrounding environment helped to ease any tension built by the research situation and to start building a warm rapport. Furthermore, the researcher made sure that the interviewees had a say in the setting of the interview by asking them their preferred place, to augment comfort of the participant (Carter, et al., 2011). Moreover, the researcher made sure that the location chosen offered the least interruptions not to prevent limitations in conducting the interviews.   A self-preparatory semi-structured interview was the tool of the study (Appendix I). The clearest purpose of an interview is to collect information (Carter, et al., 2011). Questions were pre-designed prior to the interview and based on literature, yet, the format used in semi-structured interviews allows the researcher to elicit more information from the participant and to make questions more clear (Carter, et al., 2011). Berg (2004), characterized semi-structured interviews as being relatively structured, as being flexible both in wording and order of the questions, as being able to allow adjustments in the language level, as allowing the interviewer to give answers to questions and to make some clarifications if needs be, and as allowing the interviewer to add/remove probes (according to subjects). Carter, Lubinsky, and Domholdt (2011), pointed out that observation and interviewing skills were actually qualitative research methods seen regularly in clinical practice. As a physiotherapy student, the researcher was taught how to observe and assess patients thoroughly. This was an advantage to the researcher as she had already been gaining skills in observing and interviewing people prior to beginning the research study, thus, eliciting better and more reliable data. For example, being able to give relevant cues at the appropriate time during the interviews kept the interviews flowing. Carter, Lubinsky, and Domholdt (2011), stated that developing skills in interviewing when one is a student or a healthcare professional will transfer to a research study. The researcher made sure to try to elicit as much information as possible from the interviewees without putting them in an uncomfortable position. The latter was avoided by not asking too much of the participants, by selecting the right probing and cues, by showing an attitude of healthy curiosity and care, and by not judging them and keeping in mind that others have their values and opinions too. Any non-verbal communication noted was written as fieldnotes during the interviews and added to the transcripts. During the interviews the researcher followed a copy of the interview schedule in order to keep the interviewee on track and used probes to make it easier to elicit complete data from the interviewees (Berg, 2004). Probes were also used when the subjects used monosyllabic answers such as ‘yes or ‘no. ‘Uncomfortable silence was also used as a sign that the researcher expected to obtain more information. The interviewer also kept in mind to sound as natural as possible when asking questions and to remain neutral on the subject so as not to bias the participant by sharing personal judgments. Choosing facilitative techniques like providing utterances (for example ‘uh-huh), using ‘reflection by repeating some words of the interviewees utterance, ‘confrontation to point out certain physical evidence as the interviewee spoke (for example â€Å"I noticed you smiled when you told me that), ‘interpretation (for example ‘It sounds to me like youre not happy about that situation) were used to encourage the interviewees to continue (Carter, et al., 2011). Goffman (as cited in Berg, 2004) noted that people do not only learn to send or receive messages during their growth but also they learn how to avoid particular types of them. Goffman called this avoidance ‘evasion tactics. Berg, (2004) made it clear that although this has to be surmounted when conducting interviews, one has to be caref

Prevention of Chronic Obstructive Pulmonary disease (COPD)

Prevention of Chronic Obstructive Pulmonary disease (COPD) Title: Discuss the nurse led intervention in relation to secondary prevention for COPD Chronic Obstructive Pulmonary disease (COPD) is a growing health concern today all over the world. The World health Organization predicts that by 2020 COPD will rise from it’s current ranking of 12th most prevalent disease worldwide to 5th and from 6th most common cause of death to 3rd.(Murry 1997) Another study by WHO(2002) states that COPD is the third largest cause of respiratory death and account for 20% of respiratory mortality. According to research conducted in UK, around 900000 patients are suffering from COPD in England and Wales currently (NICE 2004). Numbers of patients affected by COPD are increasing in UK and it has taken over the place of heart diseases as one of the major killer diseases leading to 30000 deaths per year. (Gibson 2003). Reason for dramatic increase in COPD includes reduced mortality from other diseases like heart diseases in industrialization countries and infectious diseases in developing countries with marked increase in cigarettes smoking and environmental pollution all over world. COPD is a chronic progressive disorder characterized airway obstruction with little or no reversibility. COPD affects bronchi, bronchioles and lung parenchyma with predominance on distal airways. It involves two clinical condition- chronic bronchitis and emphysema. Most patients with COPD have both pathological condition but relative extent of emphysema and chronic bronchitis is variable in individual patient. Chronic Bronchitis and Emphysema Chronic bronchitis is defined as a cough productive of sputum on most days for 3 months for successive 2 years. Cough is due to hyper secretion of mucus not necessarily accompanied by air flow obstruction. Chronic bronchitis is characterized by enlargement and multiplication of mucus glands, resulting increased airway mucus production. Evidence suggests that apart from quantity, quality in the form of composition of mucus is also altered becoming more viscous. Mucus is one of the important component in pathophysiology of COPD. Increased secretion of mucus is the result of goblet cell hypertrophy on exposure to various noxious stimuli. This mucus affects pulmonary function in various ways. Increased secretion for prolong period leads to decrease in FEV1 which is promotional to degree of hyper secretion .Excess mucus causes airway obstruction by accumulation in peripheral airways and increased airway resistance. Additionally, there is thickening of airway wall and infiltration with lymphocytes, neutrophils and macrophages leading to fibrosis. In contract to asthma, infiltration of lymphocytes and neutrophils are found in greater number in airway lumen. In the event of exaggeration of COPD, Eosiniphils are also observed in airway lumen. Inflammatory process in COPD is powered by interaction of proteolytic enzymes and several chemokines, as sputum of patients with COPD shows increased amount of Leucotriene B4, interleukin- 8 and tumor necrosis factor. Emphysema is defined as enlargement of airspaces distal to terminal bronchioles with destruction of alveolar wall resulting loss of elasticity of lung and closure of small airways. Elastic recoil of alveolar attachment helps to maintain the patency of airway lumen especially during expiration. With destruction of connective tissue matrix of alveolar walls by proteolytic enzymes called proteases, released by inflammatory cells in the alveolar wall causing destruction of elastin, affects structural integrity of alveolar wall. Pathological changes in emphysema are related to proteolytic activity of these enzymes. In peripheral airways of patients with COPD, there is airflow limitation due to loss of alveolar attachments, inflammatory obstruction of airways and luminal obstruction with mucus. The airway narrowing in COPD is the end result of combination of structured inflammatory narrowing, loss of elastic recoil and loss of alveolar attachments. One of the important effects of risk factors of COPD is abnormality in ciliary function. Airway wall is lined by cilia which act as a force to propel mucus or foreign body towards trachea for coughing it out. Mucociliary function is affected by thick and tenacious mucus. It also increases the risk of infection due to accumulation in airway causing recurrent infection in lungs and further lung damage. Mucus plugging and pulmonary infection contributes to V/Q mismatch and hypoxia eventually. Acute hypoxia caused dyspnoea affecting other systems of the body. Chronic hypoxia leads to pulmonary hypertension and right sided failure. Other pathophysiological consequences of COPD include abnormalities in pulmonary function, the mechanism of gas exchange. Risk factors for COPD There are several factors responsible for development of COPD called risk factors. Smoking cigarettes, both active and passive, is considered the major causative factor in development of COPD. More than 80% of COPD patients are or were smokers (Gibson 2003). Air pollution, industrial smoke and chemicals used in industry are responsible for development of COPD. Exposure to industrial dust is a causative factor in diseases like asbestoses, mesothelioma and black lung disease. Infection especially in early childhood and frequent exposure to allergens leading to changes in airway are contributing factors in development of COPD. People with Alfa -1 antitrypsin deficiency are more likely to develop COPD due to genetic defect in production of enzyme alfa-1 antitrypsin. It is believed that patients having periodontal diseases are more likely to develop COPD as the bacteria casing periodontal diseases travel to lung and cause infection and inflammation. Babies with low birth weigh have shown increase incidence of COPD and poor nutrition during fetal development leading to small dysfunctional lung is considered the responsible factor for development of COPD. COPD in more common in men, over sixty years of age. At this age it is at its highest level of development, which started in young age. Out of all the risk factors discussed smoking cigarettes is most important factor in causing COPD. Effects of smoking cigarettes on human body are due to nicotine present in a cigarette. Nicotine molecule was produced over 60 million years ago by tobacco plant to overcome insect herbivores. Tobacco introduced in Europe in 1492 when Christopher Columbus sailed to America and its cultivation then spread to many parts of world (Corti 1931). Today tobacco is widely prevalent in society in the form of cigarette smoking. Typical cigarette contain 9 mg of nicotine of which 1 mg is absorbed by smoker. Burning tobacco produce a complex mixture of compounds divided in gas and particulate phase components. In gas phase component, carbon monoxide (4%) forms the significant amount in concentration in addition to nitrogen, oxygen and carbon dioxide. The particulate phase component is consisting of aerosol of tar. Tar is the sticky, brown, residual substance left after removal of nicotine and moisture. Both gas and particulate phase are responsible for COPD Delivery of smoke compound is variable according to type of tobacco used in cigarette, addition of filter and the vigor with which an individual smokes cigarette. Smoking affects lung at the level of bronchi, bronchiole and lung parenchyma. Tobacco smoke affects structure and function of bronchial mucous gland. Number and size of mucus secreting glands increase due to smoking leading to more production and deposition of mucus in airway. Tobacco smoke also produces structural changes in airway cilia. These changes are related to dose and duration of smoke exposure. It also affects the function of cilia with abnormal clearance of secretion. Additionally, it also cases narrowing of small airways with inflammation and fibrosis. Apart from this, smoking has some short term effects like increase in carboxyhaemoglobin, decreased appetite and emotional dependence on nicotine. COPD is treated with elimination of risk factors, bronchodilators such as beta-agonists and anti-cholinergic, corticosteroids, low concentration of oxygen and mucus thinner like guaifenesic. The cost of COPD is enormous as economic burden on health care system, society, patients and their family is significant. An audit of 1400 patients admitted in a hospital revealed that 34% patients readmitted and 14% had died within 3months. (Roberts 2002) It is imperative to act upon risk factors responsible for COPD. Smoking is major risk factor for development of COPD and it is never too late to stop smoking and benefits starts immediately. (Price 2004).Usually smoking starts in teen age and continues for long time, but those who have never smoked remain non-smoker for many years. Study indicated decline in number of male smokers in UK from 70% in 1950 to 28% in 1998 (Macfadyen 2001).More positively, men are giving up smoking in increasing number. These changes in behavior of people in society towards smoking are the result of implementation of health promotion strategies in communities. Health promotion is the science and art of helping people changing life style to move towards the state of optimum health. Optimum health is defined as a balance of physical, emotional, social, spiritual and intellectual health (Irwin 2005) Health promotion is directing the plan to foster communities’ abilities to take effective actions at local level. It covers the methods to map and mobilize local resources, to activate citizens, government for management of positive changes, and transform institutions into health promoting environment. It involves the actions to improve ability of health care system for primary and secondary prevention and assist citizens in taking control and improve their own health by behavior and lifestyle changes. Life style changes can be facilitated with combination of enhanced awareness and creating environment that support good health practice. Health promotion is that element of public health that focus on social conditions for maintenance and development of better health for productive society. Evaluation of health education programmes reveled that change in knowledge did not result in action and improved health. Knowledge alone is not sufficient but people need the confidence that they can change their lives. Hubley (2002) explained that health empowerment has two components self efficacy and health literacy. Self efficacy implies feeling of power and control and confidence of taking action. Health literacy is related to ability to communicate health related issues. .Health literacy is achieved only by means of health education leading to understanding of health issues and application of it in decision making. Many traditional health education methods rather disempower person by creating more dependency on health professionals. Important element in health promotion is to provide cognitive input through educational process which will not undermine community confidence. Health education using participatory learning methods creates a way forward for heath literacy and self efficacy. Nurses in health care set up facilitate these components of health promotion by helping smoking cessation in society and directing health care for secondary prevention of COPD. Nurses as health care professionals act by providing information and support to smokers either by telephone contact or nurse led clinic to obtain objective of reducing smoking in communities. There are clear objectives for nurses in smoking cessation programmes of advocating positive social and environment changes for health promotion and organizing supporting activities that leads to secondary prevention of health related morbidity and mortality. It is important for nurses to educate the people to influence the positive behavior changes in health related issues. Apart from providing information, it is important for nurses to use the information to bring change by communicating and convincing smokers and organizing individual action. Government says that smokers are four times more likely to quit smoking using NRT with local NHS stop smoking programme than if they only rely on their will power. (DH 2004) Smoking is seen in three phases: initiation, maintenance and cessation. Initiation occurs in early teens and begins with experimentation with cigarettes. There is evidence that adolescent of more rebelling or risk taking, out going nature are more likely to take up cigarettes. Individuals of more neurotic personality are also more prone to take up cigarettes. Some degree of genetic predisposing has also been observed, which not particularly specific to nicotine but also for alcohol and caffeine. High status individuals in media also have great influence in initiation of smoking. Maintenance of smoking is promoted by direct and indirect effect of nicotine releasing central dopamine, noradrenalin and opiate peptides. It helps in coping with stress and also improves performance due to its tranquillizing effect, in a variety of tasks but it eventually leads to dependence, addiction and withdrawal symptoms. On initial contact with patient, nurse establishes that the person is a smoker and obtains informed consent from person. Nurse gives a questionnaire to patient to know smoking history of patient in the form of numbers of cigarettes smoked in a day by a person. It also includes disclosure of information about duration and pattern of smoking. Nurses then assess the willingness of the person to stop smoking. By asking smoker to rate the importance of quitting on a scale one to ten, with one number having least importance. Smokers are also asked to rate their confidence in their ability to quit. This gives an idea to nurse about the readiness of a smoker for quitting. Nurse also assess level of breathlessness in patient with COPD, which is graded as follows (Gibson 2003). Not troubled by breathlessness on strenuous exercise. Breathlessness when walking uphill Walks slower than counterpart on the level because of breathlessness Stops to take a breath after 100m or a few min on the level Too breathless leave the home or breathless on dressing. After initial assessment, nurse counsel patient to educate and prepare him/ her to take action to quit smoking. Nurse explains the benefits of smoking cessations with emphasis on the explanation that a person starts getting benefits immediately after stopping and set a quit day with explanation of problem they may come across. In clinic, most patients say they would like to give up and also tried to stay away from cigarette (Percival 2004).A study indicates that long term success of smoking cessation depends on several factors like low daily cigarettes and delayed first cigarette of day; low consumption of alcohol or caffeine, high socioeconomic class; non smoking spouse and less neurotic or depressive personality. Some evidence also suggests that women find it difficult to give up. It is important for the nurses to now the degree of self confidence from the outset that the goal will be achieved and absence of stressful episodes during the therapy as contributing factors for long term abstinence from smoking. Study suggests that, persons usually give up smoking after five to six trial and error sequences. (Gibson 2003) The duration of therapy is usually six weeks. Nurses lead session either in a group or one to one and manage for regular follow up. After initial contact, nurses remain in contact with person by telephone or in clinic at 2 days, one week, three weeks and three months interval. Patients are given booklet about COPD and disadvantages of smoking. Booklet also contains the benefit s of quitting smoking. It also explains the patient about how to quit smoking, how to cope with withdrawal symptoms like need to smoke, depression, irritability, insomnia, difficulty in concentration, restlessness and increased appetite Patients with strong withdrawal urge are explained about NRT. At the end of six weeks patients have consultation with nurses. Those who continued smoking or relapsed are offered additional support. Anti smoking public health campaign helps smokers by drawing attention more frequently and pushing them to take action. It also helps nurse in facilitating their advice. Self reported motivation of smokers, wish to avoid further health problem and in some cases actual ill health are important factors in giving up smoking. For example, a pregnant lady is inclined to give up smoking to avoid harm to her baby. Smokers receiving advice from hospital physician specially after admission for myocardial infarction had quit rate of 50%, compared to success rate for advice by physician in general practice of around 5% in unselected patients.(Pety 2000 ) Concern of passive smoking and many times social pressure by family and friends also contributes in moving forward for help in smoking cessation clinic. Rising price of cigarettes and ban or restriction of smoking in public places also tend to discourage smokers. Socioeconomic model suggest that for every one percentage rise in cigarette price leads to 0.5 % drop in consumption (NICE 2004).Smoking advertisements and perceived status of smoking from them are significant factors in encouraging people to become smoker. Nurse encourages person in finding alternate source of enjoyment and different coping strategies in the event of stress leads to successful outcome on long term. Nurse also takes help of specialist in search for other ways of mastering concentration during sustained task. Nurse also asks spouse to quit smoking to create the environment for behavior change. Many smokers have poor central control system for arousal reward and punishment, and then alternative strategies may involve physical sports, mental relaxation, assertiveness techniques and different scheduling for work activities. Nurses help smokers understanding and reducing the image smoking as’ something exciting and sophisticated’. Most smokers give up with the help of their own efforts but those who cannot manage themselves nurses propose specific methods with the social support. For those , who will not give up in immediate future some damage limitation can be achieved by production of safe cigarettes; transfer to pipe or cigar or chewing tobacco; other formulation of tobacco like nicotine gum, nasal spray, transdermal patch inhalable aerosol- called nicotine replacement therapy (NRT). Before starting medication nurse rules out contraindication for medication like severe cardiovascular diseases, recent MI, severe cardiac arrhythmia, recent CVA, transient ischemic attack, pregnancy and breast feeding. Variety of other drugs apart from medications used for NRT are also used in practice which counteract unpleasant aspects of nicotine withdrawal, includes amphetamine, benzodiazepines, ACTH, vasopressin, clonidine, fluoxetine, bupropion and naloxone. Mecamylamine (nicotinic antagonist) is another important medicat ion used in smoking cessation. Nicotine replacement therapy in the form of nicotine gum or patch is better than smoking and decrease health risk. NRT and bupropion are prescribed to those who have set a date as a target to stop smoking. Transfer to pipe decrease the risk of lung damage, but can not protect upper oesophageal tract. With nicotine nasal spray, absorption from mucosa is much faster than gum and the blood level achieved are comparable with cigarette smoking. Nicotine aerosol has irritant sensation in nose but it is still the attractive option in switching from cigarettes. Nicotine patches application on skin promotes slow absorption of nicotine from the skin .It is devoid of sufficient sensory stimulation involved in smoking. It has limitation in alleviating withdrawal symptoms during smoking cessation therapy. Practically more useful are nicotine gum, transdermal nicotine patch, nasal spray and antidepressant bupropion. They are equally effective and safe, doubling quitting rate. Study indicates less than 5% drop out rate due to adverse effects if these drugs, but combination is superior in effects compared to single drug (Gibson 2003).Combining medication with counseling by nurse boost the quit rate. Nurse explains side effects of NRT like headache, nausea, dizziness, palpitation, dyspepsia, hiccups, insomnia, myalgia, anxiety, and irritability to patients before starting it. For many novice ex-smokers major difficulties emerge after initial euphoria of successfully having overcome the first week of withdrawal symptoms. The more complex task then begins to manage and overcome withdrawal symptoms for longer term for successful outcome. NRT forms the mainstay of management of withdrawal symptoms. There are differences in response from various types of NRT .In case of heavy smokers( more than 20 cigarettes a day) 4mg nicotine gum is more effective than 2mg. In medium to heavy smokers standard patch of 21 mg is more effective than lower dose patch. Treatment with NRT is continued for 10 to12 weeks with gradual withdrawal. If person is unsuccessful in quitting after 3 months, the treatment is again reviewed. (West 2000) Addition to anti-smoking measures, nurse should check effectiveness of inhaled drug, it’s technique and if they are symptomatic despite short acting bronchodilators. Nurse also takes care of nutrition and vaccination in COPD case. Nurse led clinic for smoking cessation is a part of pulmonary rehabilitation program which involves exercise and education over 6to 8 weeks to anyone who feels that COPD is affecting quality of his or her life. It is closely related to health promotion by creating an environment and providing education for improving personal and community health. Educating people to change behavior and empowering them to take actions leading to smoking cessation are essential elements of smoking cessation clinics. References Corti C., (1931). A history of smoking. London: George G. Harrap Department of health, Office of National statistics, (1997). General household survey. London: HMSO Gibson g., Duncan G., costabel U., Sterk P., Corrin B.,( 2003). Respiratory medicine, 3rd edi, vol. 1 p 645. London: Elsevier Hubley J (2002). Health empowerment, health literacy and health promotion putting it all together. http://www.hubley.co.uk/1hlthempow.htm (Accessed on May 14, 2005) Irwin J (2005). Health promotion theory in practice: an analysis of Co-Active Coaching. International Journal of Evidence Based Coaching and Mentoring ,vol-3, no-1.http://www.brookes.ac.uk/schools/education/ijebcm/vol3-1-a-morrowirwin.html! (Accessed on May 14, 2005) Macfadyen L., Hastings G., Mackintosh A., ( 2001). Cross sectional study of young people-awareness and involvement with tobacco markets. BMJ. 322, pp 512-517. Murry C., Lopez A., (1997). Alternative projections of morbidity and disability by cause, 1990-2020: Global burden of diseases study. Lancet: 349. 1498-1504 NICE guidelines (2004). Management, treatment and cure of COPD. British journal of nursing ,vol.13, no18, pp1100-1103 NICE; (2004). Guidelines to improve patients with COPD. London : NICE Percival J. (2004).Make use of all resources to quit smoking. http://www.professionalnurse.net/nav?page=pronurse.articleresource=1454302fixture_article=1454302category=RESPIRATORY_CARE. (Accessed on May 14 , 2005) Pety R., Darby S., Deo H., (2000). Smoking, smoking cessation and lung concern in UK since 1956.Combination of national statistics with two cases control studies. BMJ, 321, pp 323-324 Price D., Foster J., Scullion J., Freeman D., (2004). Asthma and COPD. London: Elsevier Roberts M., Lowe D., Bucknell C., (2002). Clinical audit indicator of outcome following admission to hospital with acute exacerbation of COPD. Thorax, 57, pp 137-141 West R., McNeill a., Raw a., (2000) .Smoking cessation guidelines for health professionals: an update. Thorax, 55, pp 987-999 WHO, (2002), reducing risks, promoting healthy life. Geneva : WHO Legally Binding Undertaking I, Paulatsya Joshi, undertake that in line with my contractual obligations this work is completely original, and has not been copied from any website or any other source, either in whole or in part. By submitting this work I understand that if my work is found to be plagiarised that I will not only forfeit my fee but also be subject to legal proceedings in order to recover damages for loss of profit and damage to business reputation. Moreover, I understand that I may be subject to legal proceedings from any third parties, such as the end clients and copyright holders of the original work who may have had their rights infringed or suffered loss as a result of my actions. I also understand that in addition I will be liable to a  £100/$200 administration charge and that I may be liable for legal costs. I understand that this e-mail and the work I am submitting may be used as evidence against me if I breach this undertaking. Please take this to constitute my electronic signature Paulatsya Joshi

Gertrude and Helen: Wantonness in the Trojan War and Shakespeares Hamlet :: Shakespeare Hamlet

Gertrude and Helen: Wantonness in the Trojan War and Hamlet      Ã‚  Ã‚   Hamlet is the melancholy Dane; Claudius, the smiling villain. Polonius is the oily courtier; Horatio, the loyal friend. Most of the characters in Hamlet are well defined and unambiguous; the character of Gertrude, however, presents us with many ambiguities and difficulties. Some critics see her as "well-meaning but shallow and feminine, in the pejorative sense of the word: incapable of any sustained rational process, superficial and flighty" (Heilbrun 10), while others see her as a stronger character, cool and calculating. The play presents many aspects of Gertrude's character ambiguously. Janet Adelman writes,    Given her centrality in the play, it is striking how little we know about Gertrude; even the extent of her involvement in the murder of her first husband is left unclear....The ghost accuses her at least indirectly of adultery and incest...but he never accuses her of nor exonerates her from the murder. For the ghost, as for Hamlet, her chief crime is her uncontrolled sexuality; that is the object of their moral revulsion, a revulsion as intense as anything directed toward the murderer Claudius. But the Gertrude we see is not quite the Gertrude they see. And when we see her in herself, apart from their characterizations of her, we tend to see a woman more muddled than actively wicked; even her famous sensuality is less apparent than her conflicted solicitude both for her new husband and for her son....Even her death is not quite her own to define. Is it a suicide designed to keep Hamlet from danger by dying in his place?...Muddled, fallible, fully human, she seems ultimately to make t he choice that Hamlet would have her make. But even here she does not speak clearly; her character remains relatively closed to us (Adelman 15-16).    In spite of the many ambiguities of Gertrude's character, one of her chief characteristics is wantonness, and like Helen of Troy, Gertrude's wantonness led to tragedy. Wantonness-a word that is little in use nowadays-suggests three characteristics: luxuriously rank extravagance, lack of discipline, and lustfulness. The treatment of Gertrude's character in Hamlet supports the argument that her chief fault is wantonness, for these three characteristics can be seen in her character.    The first characteristic, luxuriousness or extravagance, is not directly stated in the play but can be inferred from the actions of Gertrude. One possible reason for her remarriage after King Hamlet's death is a desire to maintain her position as queen, with all its luxury and comfort.

Software Piracy in Lebanon :: Software Piracy Expository Essays

Software Piracy in Lebanon Abstract What is it about copying software that is desirable? Simply because it is free. In the United States, one might think twice before copying a Microsoft product. Copyright issues are all over the media --remember Napster? For a period of a year, we read countless stories of students all over the US and the world that were arrested for copying and trading MP3s. However, travel across the Atlantic to the chaotic world of Lebanon and one would not even think twice about copying a version of Microsoft Office 2000. What is the likelihood of getting caught? Pretty much a 0% chance. With political chaos surrounding Lebanon since its independence in 1943, the lack of law enforcement allows a variety of of crimes to occur -- one of the biggest ones being software piracy. About 89% of the software in Lebanon is illegally obtained. Section I gives a brief overview of how the origins of Lebanon. Section II describes the politics of Lebanon. The objective of Section I and Section II is to demonstrate to the reader how the lack of a stable government and any true law enforcement allows for so much piracy. Section III discusses in greater detail software piracy and Intellectual Property protection in Lebanon. Section IV gives the author’s point of view. Sources and endnotes can be found in Section V and Section VI respectively. Section I: Introduction Establishing Lebanon2 The history of the Middle East is rich with an eclectic mix of ethnicities and culture. Before World War I, the region that we now call the Middle East was ruled by the Ottoman Empire. After the end of World War I, the Ottoman Empire diminished. Turkey emerged through the works of the Allies. Mesopotamia, an area filled with tradition and profitable goods, was split between Britain and France. With the support of the French, the Maronites, a sect of the Roman Catholic Church, established a strong political status in what is now modern day Beirut, Tripoli, and most of the Lebanon coast. Starting in the early 1900s, the Maronites had pressed for the expansion of this small Lebanese territory to what they argued was its natural and historical boundaries. Their argument was that the area had always had a unique social and historical character, different from its surroundings, which made it mandatory for the French to grant it as an independent state.

San Francisco Bay Consulting

San Francisco Bay Consulting (SF Bay Consulting), as described in the Harvard Business School case by Baker and Monsler (1995), is a leading business consultancy and litigation support group following the goal of providing â€Å"practical application of economic theory to business problems† (p. 1). In order to manipulate and analyze data, high-end software and computers are used to serve clients’ needs.The company faces serious internal problems regarding the relationship between their consultants and the computer services (CS) staff because of disagreements concerning the transfer pricing system, which is applied to alleviate the procurement and payment of computer resources. The major challenges for this system are the heavy price drops for computer hardware and the broadness of the researchers demands.The management of SF Bay Consulting forbids their employees to purchase their own computer hardware and software which leads to frustration among the consultants, espec ially in the case when the CS department refuses to buy and supply certain hardware and software requested by the consultants. The worst scenario occurred when transfer prices produced charges to clients’ bills that exceeded the current market price for the computer as it has happened with the SUN workstation.Donald Learner, Chief Financial Officer of SF Bay Consulting, now sees himself in charge to find a solution to the current problems that is able to satisfy both, the consultants as well as the CS employees. For this purpose, he has identified three options: a) Stick to the current system, b) make CS a profit center, or c) run CS as an expense center. Due to the fact that the current situation at SF Bay Consulting is going to escalade if it is further made use of, option a) is not recommendable and a different solution has to be found.Otherwise the working environment will be seriously affected in the long run and thus efficiency of the company might decrease to an undesi rable level. Option b), to make CS a profit center, would lead to the situation that consultants themselves are allowed to purchase any hardware or software they like and thus focus on problems, others as they are supposed to do. However, this option would lead to the freedom for researchers to purchase the equipment they would like to work with and might free them of their frustrations.Since IT specialists are running the CS department their core competency is not to focus on earning a profit within a competitive environment. While focusing on equipment procurement would distract researchers, the argument of distraction also holds true for the computer experts, which have to refocus and be in charge not only for maintenance but also running a business in a competitive manner. On the other hand this could lead to a more competitive price management that could cause lower costs for the two internal groups.Notwithstanding, Learner and Alex Whalen (founder, president, & CEO of SF Bay C onsulting) both agree that computer purchasing decisions should stay within CS to secure a certain level of compatibility among hardware and software and to avoid maintenance problems. Lastly, option three, to run CS as an expense center, would eliminate internal billing and lead to group profit generated from client charges greater than the CS overhead costs.Even though, there is a possibility of researchers ignoring the costs they provoke with a great deal of requests for CS, this problem might be minor due to the fact that they are not as frustrated as before and thereby reaching a higher level of overall satisfaction. In order to make all employees more sensitive for working efficiently an elaborated group-profit-related bonus system could be introduced at SF Bay Consulting.However, the impact of the bonus system for CS employees has to secure a balance between profit orientation and reasonable investments into hardware and software. Moreover, if all employees generate one overa ll profit together, there will not be any internal competition but a jointed overall goal. In conclusion, choosing option c), to run CS as an expense center is the right recommendation for SF Bay Consulting in order to solve its internal problems.

Сhaucer’s Use Of Biblical Material In ‘The Miller’s Tale’

The biblical references and implications in ‘The Miller's Tale' mockingly inter-relate the tale's sexual and vulgar content and its religious elements. It is a parody on and critique of the Church, mocking all sacred: the stories from the Bible, the saints, even the Holy Family. The ‘dronken' miller commences his tale in ‘Pilates voys', implying that the story will be condemning Christianity, since Pilates, according to the Bible, has condemned Jesus with his words. As the scholar clerk Nicholas and parish clerk Absolon represent St. Nicholas and Absalom, Son of David, miller sinfully compares two saints with two lustful and immoral men, who are concerned more with secular than the spiritual matters. Since carpenter John metaphorically represents Joseph and Noah, and his young wife Alison therefore represents Virgin Mary and Noah's wife, the miller this time immorally correlates Joseph/Noah and Virgin Mary/Noah's wife with a madman and a promiscuous, sly wife, when the Church forbids promiscuous behavior and implies that mad behavior is associated with the Satan. Further religious mocking is portrayed by the actions of Nicholas in the tale, as he does exact the opposite of what St. Nicholas did. While St. Nicholas was very zealous in his efforts to maintain ecclesiastical discipline and honor, especially in relation to the marriage laws, Nicholas the clerk has no concern for honor and respect toward marriage, as he is successfully pursuing a married woman. When one Countess left her husband for a paramour, St. Nicholas commanded that she should be excommunicated unless she returned to her husband. Nicholas in ‘The Miller's Tale', however, is even using religion to break the sanctity of marriage and influencing Alison to commit adultery, a sin. Nicholas, the clerk, invokes and manipulates the biblical story of Noah and the flood to convince the ignorant carpenter John of the impending flood, and further advance his own plan to sleep with Alison. By using his knowledge and religious references to invoke authority, Nicholas is successful in his deception, since the carpenter does not doubt the teaching of the Church. Furthermore, Nicholas hypocritically tells John that he and Alison must abstain from sleeping together because they will be awaiting God's grace. John believes everything Nicholas says; even that Nicholas is so knowledgeable that he knows God's business. John's knowledge, on the other hand, is limited, as he does not know there was no mention of Second Flood in the Bible, or that Noah built only one boat, not an additional one for his wife, nor does he know much about Noah's Arc, as his confusion of ‘Noees flood' and ‘Noweles flood' (line 710) shows. Carpenter John then agrees to make three boats, so that his wife Alison, Nicholas and John himself can be saved from the flood. Although Nicholas presents the story of Noah's flood as very similar to the story in the Bible, frequently calling upon ‘Goddes privetee' and ‘Goddess grace' to validate his reasoning, the story he tells contrasts greatly the story in the Bible. The original story helps to explain the power and compassion of God, since God sent Noah the flood because man had become corrupt and lecherous. These same sins are causing this fake ‘flood', thus strengthening Satan, and this time the plan is Nicholas'. In this way, Nicholas uses the sacredness of religion to pursue his private erotic-aesthetic sensual pleasures, with no sacredness attached; therefore he almost embodies Satan. Bible is degraded, in this way, being portrayed as only a tale book, one of many texts which can be played with and rewritten. Although the carpenter shows genuine fear of the flood and says it's not men's business to know about God's secret affairs, suggesting he respects and fears the power of God, by placing his complete trust in Nicholas, embodiment of Satan, he destroys his own piety. Like a joke on God, Nicholas does know God's secret affairs and what the future will bring. Nicholas further states that his plan will work because a clerk can fool a carpenter any day – a class distinction and condescension in contrast with the teachings of the Church. The entire scene encompasses several sins. First, the whole story is a lie and thus a sin. Lust, another sin, serves as the driving force behind this lie. Finally, Nicholas and Alison's intercourse out-of-wedlock for pleasure serves as the sinful result of the story. The miller therefore contorts the most holy image of Noah into a dreadful satanic scene of the tale. The fact that a man such as Nicholas sings ‘Angelus ad Virgenum' is itself mocking of the Church. Carpenter John's wife Alison portrays promiscuous behavior almost continuously throughout the tale; from the sinful encounter with Nicholas, agreement to deceit her husband to her indulge in adultery. When Nicholas tells her to sleep with him immediately, or he will ‘spille' (l. 170) so ‘God [him] save', it is another pun on religion as this ‘spille' could perhaps mean ‘waste the seed', God forbid, as opposed to depositing it with Alison's ‘mercy' (180). Right after she and Nicholas made a plan how to arrange their next adulterous encounter, Alison goes to church, juxtaposing the profane and the sacred in the same way. She is further sarcastically characterized by her name, as in Old English and German it means ‘honest', ‘noble' and most, or least, of all ‘holy'. After her husband tells her of the evacuation plan, Alison tells John she is his faithful wife – something he accepts and believes as a word of God, and John follows Nicholas' instructions just as Noah obeyed God even though everyone laughed at him. While John sleeps in the boat, Alison and Nicholas are in the bedroom until the morning church bells ring. The reference to the couple's intercourse in the same breath as the church bells is meant to perhaps show that man's plans sometimes unintentionally mirror God's order, or that their time in the bedroom ‘is up'. Their ‘doings' in the bedroom are even compared to ‘revel and melodye', music in God's praise, further mocking the Church. Absolon, who represents Absalom, Son of David, is a parish clerk who spends much time in taverns and looking at and flirting with other women, especially Alison. The miller suggests that this irreverent priest only performs his duties to engage in other secular, sinful practices. As a religious pun, Absolon in the tale has a ‘natural attraction' to women and all things secular, while Absalom, Son of David, was known for his ‘unnatural revolt'. By pursuing Alison, Absolon clearly shows that he has no intention of keeping his vow of chastity. It is emphasized that Absolon is combing his hair before going out, which is an added joke to confirm whom he represents, since Absalom, the Son of David, was also famous for his luxurious hair. Absolon knows that Alison has a husband, for she wears a head covering typical of married women, but he ignores this fact and lusts after her anyway, making his pursuit even more sinful. The head-coverings of the married women were designed to protect their hair, which St. Paul had deemed as holy. However, even this holy image is twisted into that of Satan later on in the tale. Absolon them goes to Alison's house, believing she is alone, and performs a parody of a morning prayer, asking for Alison's grace and mercy instead of God's. When he asks for her kiss, he kisses ‘beard' and realizes it was her pubic hair. In this way, Alison's pubic hair corrupts the holy hair image, because she uses it to conduct a dirty, sexual joke to combat the lustful longings of Absolon. Her ‘beard' is also perpetrated against, so it presents another pun on the holy hair image. Having vowed revenge, Absolon comes back to Alison's house with a hot ‘colter' (plowshare), which is a backward use of the Biblical adage turning swords into plowshares. Nicholas gets his punishment, and as he screams, word ‘water' triggers the double action of John cutting the rope that suspends his tub as he thinks the flood came, and Nicholas acting to soothe his pain. While the Church (Catholic Church, Jewish synagogue, etc. ) teaches respect for authority, ultimately invested in God, the Father, to whom the Jesus, the Son, submits, it regards adultery as a mortal sin, and teaches prudence and severe restraint in sexual matters. ‘The Miller's Tale' is the opposite, as the father figure, John, is overthrown by youth, Nicholas, and ironically, by the invocation of God's authority. From a pious point of view, this story laughs at the belief that Jesus was conceived by the Holy Spirit. Perhaps the miller is insinuating that Jesus was conceived by Mary's unfaithfulness to Joseph, not by any Holy Spirit. As an added pun, if Absolon also symbolizes the worshippers, as he worships Alison, then the wind Nicholas passes in Absolon's face is the award for any pilgrim, worshipping ‘true' beliefs in the Holy Tale of Conception and Sanctity. The miller further implies that Church's preaching against greed, blasphemy, gluttony, adultery and all things related to the Satan is hypocritical, as he parodies the sacred discipline and Church by showing characters representing the Church, behaving in all the forbidden and blasphemous manners.