What Is a Linear Programming Problem

Linear Programming is a mathematical technique useful for allocation of scarce or limited resources to several competing activities on the basis of given criterion of optimality. The usefulness of linear programming as a tool for optimal decision-making on resource allocation, is based on its applicability to many diversified decision problems. The effective use and application requires, as on its applicability to many diversified decision problems. The effective use and application requires, as a first step, the mathematical formulation of an LP model, when the problem is presented in words.Steps of linear programming model formulation are summarized as follows : STEP 1 : Identify the Decision Variables a) Express each constraint in words. For this you should first see whether the constraint is of the form >/ (at least as large as), of the form < (no larger than) or of the form = (exactly equal to) b) You should then verbally express the objective function c) Steps (a) and (b) should then allow you to verbally identify the decision variablesIf there are several decision alternatives available , then in order to identify the decision variables you need to ask yourself the question – what decisions must be made in order to optimize the objective function ? Having accomplished step 1(a) through (c) decide the symbolic notation for the decision variables and specify units of measurement. Such specification of units of measurement would help in interpreting the final solution of the LP problem . STEP 2 : Identify the Problem Data For solving a problem, we need to identify the problem data so as to provide the actual values for the decision variables. For this,†¦

Admission to University of Texas Health Science Center at Houston

Right from a very young age I had always enjoyed helping people. As I grew up my involvement with helping people waxed tremendously. The consequence of this predilection was the development of a passionate desire to help the sick and ailing. I was extremely fortunate to realize my true calling in life at a very young age.At present I am in my senior year at the University of Houston. I will become a graduate in the spring of the year 2008. Subsequently, it is my heartfelt desire to be admitted to the University of Texas Health Science Center at Houston. Furthermore, I am working as a treasurer for the Cougars Volunteer Association.Moreover, my main volunteer work is with respect to the work that I do at the Ben Taub General Hospital. Houston is home to a number of hospitals that are some of the best in the world. The Texas Medical Centre is a telling example of this fact. The Ben Taub General Hospital is an elite Level 1 Trauma Centre, with a very large intake of adults and children for treatment.My volunteer services require me to visit each patient, in order to ascertain that they obtain what they need. I had been awarded a pharmacy technician certificate and I had been working at a pharmacy as a pharmacy technician, prior to my current volunteer service at the Ben Taub General Hospital.  I am ecstatic at helping and working with patients, especially the old, the infirm and children. This has dictated my choice to become a nurse. I have learned to treat challenges as stepping stones and not stopping stones to success. One such major challenge that arose was consequent to my having to work while studying as a full – time student.This challenge caused me a great deal of difficulty, nevertheless, I was able to overcome it and in the process I became that much more experienced in handling a combination of hard work, stress and paucity of time. This particular challenge gave me the confidence to attain any goal that I set my sights on.In the year 1972 The University of Texas School of Nursing at Houston was established. At present it is one of the best schools for learning the art and science of nursing. The Texas Medical Center is home to the School of Nursing campus. It provides all the benefits and expertise of a world class Health Science Center.The University Of Texas Houston School Of Nursing provides a wide choice of course work, which culminates in the BSN, MSN, PhD or DNP degree. The methodology of imparting knowledge at this school is flexible and students can learn, work on research projects and participate in clinical practice in multifarious ways (School of Nursing at Houston, 2007).In addition, this school has assimilated the latest developments in technology. Accordingly, facilities like teleconferencing and satellite communications are widely used to enable contact with distant locations. Moreover, this technology has made it possible for classes to be conducted simultaneously at Houston and other sites.The Universit y Of Texas School Of Nursing at Houston provides a number of highly innovative programs and one such program that is offered in collaboration with the UTMB is a baccalaureate nursing program, which is spread over three semesters.This program caters to the need of students who possess a degree and who are desirous of joining the nursing profession. Instructions are provided online. Moreover, there are eleven masters programs, which hone the specialty care skills of nurses and ensure their professional advancement. The faculty is excellent and consists of some of the greatest nursing professionals (School of Nursing at Houston, 2007).Nursing is not only an art but also a science and concentrates on enabling families, people and society to achieve, recover and maintain the best possible health. Modern nursing aims at engendering improving the quality of life by ensuring the best of mental and physical health. Nursing has been extremely successful in achieving this great objective.The a ct of rendering relief to a sick person provides immense satisfaction. This extremely noble profession has been succinctly described by the American Nurses Association as â€Å"Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.†This is very much in consonance with my objectives in life.Therefore, I am exceedingly keen to study at this venerable school of nursing. It is my life’s passion to succor the sick, infirm, old and children and to this end the best profession is that of nursing. As such, any person who whole – heartedly participates in the academic programs of this school is certain to become a very good nurse.ReferencesSchool of Nursing at Houston. (2007, June 11). Retrieved November 6, 2007, from The University of Texas: http:// son.uth.tmc.edu/School of Nursing at Houston. (2007, June 11). Retrieved November 6, 2007, from The University of Texas: http://son.uth.tmc.edu/education/

Alcoholic Beverage and Personal Communication Essay

Introduction The use of a range of drug types, including alcohol, are part of the traditions of many, if not all, communities in Fiji. The Fijian and Indo-Fijian communities have long traditions of psycho-active drug use in the context of ritual and ceremony. 1,2 It has been noted that seafarers, together with indentured labourers, brought cannabis or Indian hemp traditions to Fiji, with the sugar cane plantations providing fertile ground for cultivation. 2,3 Meanwhile, kava was widely cultivated and consumed by ethnic Fijians. The Indo-Fijian community slowly adopted kava drinking rituals and gradually others began to increase their consumption. In addition, marijuana use emerged and spread with increasing popularity amongst youth, especially males. 2-5 This literature review explores the current licit and illicit drug situation in Fiji. It considers peer-reviewed articles identi? ed using Pub Med, Health Internet Work Access to Research Initiative (HINARI) searches and ‘grey’ literature, including published and unpublished reports, and web based resources (e.g. UNDOC, WHO). The review found that there is limited data available to assist in understanding the current situation and associated harms in Fiji, but notes more studies and reports have examined alcohol consumption patterns and associated social problems when compared with studies on illicit drug use. 1, 5-15 Alcohol use in Fiji According to the WHO Global Status Report on Alcohol, data from the 1993 National Nutrition Survey indicate that consumption of alcoholic home brew use is widespread in Fiji, as in other Paci? c nations. These beverages usually contain up to three times the alcohol content of commercially produced beer and are mostly drunk by younger men. 16 After 1995, unrecorded alcohol consumption in Fiji was estimated to be 1. 0 litre of pure alcohol per capita for the population older than 15 years (estimated by a group of key alcohol experts). 17 Although there are no recently published statistics on the number of drinkers and abstainers, the same survey found daily drinkers to be 1. 4% among males and 0. 8% among females aged 12 years and over. 18 Estimates from alcohol experts show that the proportion of adult males and females who had been abstaining (in the year prior to the survey) was 74% (males) and 98% (females). 17 Research shows that single drinking sessions with a high rate of alcohol intake (common practice among Fijian youth) can cause abrupt mood swings resulting in violence, accidents and ? ghts, exaggerated emotions, uncharacteristic behaviour, memory loss, impaired judgement, communication problems, sleepiness, coma, stupor and death (at very high intake) and suicide attempts. Binge drinking has also been implicated in schizophrenic and other psychiatric episodes. 19 165 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 While there is limited current information on the rate and consumption patterns of alcohol, cannabis and kava among young people,1,6,9 several studies2,3,8,11 were conducted to analyse the extent of tobacco and alcohol use among young people in Fiji in the 1990s and early 2000s. One of the studies4 found that alcohol is widely consumed in one form or another among young people, with about 2 in 5 of the young people surveyed having tasted it. The percentage of young people classi? ed as current drinkers ranged from a high of 26% among males to 9% among females. 4 Of concern was the high proportion of binge drinkers: about 3 in 5 young people reported having had 5 or more alcoholic drinks in one session. The study4 indicated that the high prevalence among 13-15 year olds poses a serious concern, and highlights the need for law enforcement and intervention programs to create an environment that promotes responsible drinking. Interestingly, the study found that when compared to smoking, alcohol and kava use, the proportion of young people using cannabis was relatively low. 4 A follow up survey of 2147 students in 2004 by the National Substance Abuse Advisory Council (NSAAC) found a general increase in substance use among secondary students (see table 1). Table 1: Youth Substance Use in Fiji (Comparison of the results for Fiji in the 1999 Global Youth Tobacco Survey by UNICEF and WHO and 2004 follow up survey by NSAAC). Substance Tobacco Alcohol Kava Marijuana GYT Survey (1999) 32. 3 40. 3 51. 9 12. 8 NSAAC (2004) 43 51 61 13 Signi? cant variations exist in the drinking habits of males and females in Fiji; there are many more male drinkers than there are female drinkers. 11 Ordinarily males consume the bulk of the alcohol in the company of other males, usually during drinking sessions with no special occasion, while most women drink alcohol during social functions or in night club settings in the company of men and other women. While women occasionally participate in drinking sessions, typically it is an exclusively male activity. 11,13 It is at these drinking parties where the most copious amounts of alcohol are reportedly consumed. Thus, when males drink, they tend to drink larger amounts of alcohol in one sitting than women do. Illicit drug use in Fiji Border Security and Drug Control Limited data exist to aid in understanding illicit drug use and the associated harms across the Paci? c. In addition, there are no surveillance systems. 20 However, Fiji by virtue of its geographical position is faced with the twin problems of illicit drug traf? cking and increasing use. 21,22 These are further aggravated by the rapid transitional and social changes arising from urbanization. These developments create an atmosphere which exposes entire communities to greater risk associated with drug use (Personal communication – Fiji Police Department, 2008). Minimal use of drugs such as heroin, morphine, cocaine and hallucinogens occur, but this review found that Fiji is considered a transit area for smuggling. [20-23]. Drugs such as heroin, methamphetamines and 166 PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 REVIEW cocaine are not commonly used due to their high cost when compared to the average income. Raw cocaine has reportedly been found in Fiji and three Chinese men and a Fijian security guard were murdered in what was thought to be an organized crime execution linked to drugs. 22 National enforcement agencies have responded to curb traf? cking as is re? ected by the large seizures of illicit drugs. 24,25 In spite of this response, a drug laboratory found in Fiji in 200625 supports the view that organized crime groups could escalate their activities in the Paci? c islands. 21,25 A raid at an industrial estate in Suva, involving police from Australia and New Zealand and Fijian Customs Of? cer followed a major heroin seizure in 2000. 21,25] The lab identi? cation also suggests a transition of Fiji (and possibly other Paci? c Nations) from a transhipment point to a production base. According to the New Zealand Police, to succeed in future operations similar to the Suva bust, interested agencies need to work towards having â€Å"robust communication systems† across organisations to keep them connected and informed on crime in the region. 21 It is reported that there are about 5000 vessels transiting in the Paci? c on any given day. 21,24 Large shipments may be unloaded from a mother ship to smaller vessels, and can subsequently go in hiding at the many small, uninhibited islets and atolls, waiting for the next step. 21 Fiji has recently established a Transnational Crime Unit (TCU) with the Fiji Islands Revenue and Customs Authority (FIRCA) as one of the key law enforcement agencies involved. This unit has been vigilant in promoting the cooperation between border organizations in order to assist the TCU in controlling the borders. 24 The Unit also compiles data for intelligence risk assessments throughout the year. It supports a Case Management Intelligence System (CMIS), whereby relevant information from the Police Department, Immigration Department, Local Government Authorities, Financial Intelligence Unit, and other Law Enforcement Agencies24 are automatically linked in the system. A number of cases which the TCU have been investigating include a Tongan syndicate smuggling drugs from Fiji to Tonga. In a recent example of program cooperation a number of TCU surveillance targets were arrested during a Police roadblock in Sigatoka (personal communication, FIRCA, 2008). Domestic Issues Cannabis is by far the most common and widespread illicit drug used in Fiji. 11 Like many other countries in the region, anecdotal evidence suggests there has been a considerable increase in drug use among young people4 despite the relatively small increase suggested by the 2004 NSAAC study (see table 1). However, it is not clear if the two studies they reported were directly comparable. Data collected by the St Giles Hospital and the Fijian Police Department support the view there has been an increase in use. Admissions data for St Giles Hospital reports on cannabis induced psychosis and other disorders. In 1987, ? ve young men were admitted to St Giles Hospital with cannabis related mental disorders. In 1988, the number rose to ? fteen with many more unreported cases. 26 The 2005 hospital data revealed that a total of 612 patients were seen at outpatients department diagnosed with a substance abuse disorder. These included 386 (63%) patients for marijuana, 59 (10%) alcohol, 99 (16%) kava and 99 (16%) tobacco use issues. In 2006, 272 admissions to St Giles Hospital were reported as drug related, consisting of 66% Fijians, 20% Indo-Fijian and 14% belong to other ethnic groups. It is probable that the political troubles in 2006 impacted on the number of admissions, but no data were available to con? rm or reject this view. Police arrest data report possession (see Table 2). 8,13,26 Statistics provided by Fiji Police showed 259 drugrelated crimes were committed in 2008. There was a 21 per cent drop from 2007 which had 329 drug-related 167 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 crimes. 27 There are also reports of increasing cannabis cultivation as a form of inter-seasonal cash crop substitution among farmers. It is estimated that Fiji has between 500 to 1000 cannabis producers, some of them citing the country’s worsening economy as the motivator for production (personal communication, Police Drug Unit, November 2008). For generations, the villagers of Navosa have travelled for hours across rugged terrain to reach a road to the market to sell their produce with no guarantee their produce will be sold. Facing the same hardships as their ancestors, many of these villagers report having no choice but to resort to marijuana growing because â€Å"The product is lighter, it has a steady market and is economically viable† (Personal communication with growers, December, 2008). Production is predominantly for local consumption. Table 2: Recent Crime Data ( Drug offences recorded by the Fiji Police Forces from 2000 to 2006). Year Drug offences 2001 433 2002 417 2003 417 2004 312 2005 312 2006 333 The Save the Children Fund in Fiji reports that the continuing political and economic instability in the country has also led to a lot more children working as drug traf? ckers or prostitutes. [28] Concern over the increasing number of children involved in drug traf? cking was sparked by the recent arrest of three school children caught selling drugs in an amusement centre in Labasa. The Fiji Women’s Crisis Centre reported an increase in young Indo-Fijian girls working as prostitutes in urban centres. Furthermore, the National Manager for Save the Children Fund in Fiji, says there is a growing trend among poor families to send their children out onto the streets. 28 Drug and alcohol legislation and policy According to the literature, there is no regional-based illicit drug policy for the Paci? c and few treatment programs. 20,29 Information from the Paci? c Island Forum Secretariat (PIFS) indicates that Fiji’s Illicit Drugs Control Act is an adaptation of the Regional Model Law on the Control of Illicit Drugs which was developed by the Secretariat. There was no formal committee, but it was endorsed by a Cabinet sub-Committee on legislation which was chaired by the then Attorney-General. Both the Fijian Government and PIFS are advocating for a regional legislative framework to respond to the increase in illicit drugs in the region (personal communication, PIFS, 2008). Amphetamines are a key drug of concern with the region’s geographical vulnerability highlighted as a key factor in the rationale for this approach. At the time of writing, Kiribati and Fiji are the only two PIFS member countries to have adapted and enacted the model law. Furthermore, a Code of Practice has been developed by PIFS to assist stakeholders such as law enforcement agencies and pharmacies to classify, register and dispose of illicit drugs (personal communication, PIFS, 2008). It may be adapted by Forum member countries with modi? cations to suit national legal and administrative arrangements. Legislative control on the consumption and sale of alcohol to minors has not been widely and effectively implemented. While minors are legally barred from consuming alcohol, the sale of alcohol beverages to under-age drinkers is common throughout the country. 11 For the minor who is unable to gain access to commercial alcohol beverages, homebrew is an easily obtained alternative. Anecdotal evidence suggests that minors make up a large and undetected percentage of consumers of alcohol beverages. 168 PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 REVIEW Sexually Transmitted Infections Sexually Transmitted Infections, including HIV, are emerging public health problems in Fiji. 13 A recent WHO report indicated that the rise in the number of HIV cases, in addition to increasing number of patients accessing STI clinics, in an ongoing concern. In 2006, MOH statistics indicated30 that Fijians comprised 83% of con? rmed HIV diagnoses, Indo-Fijian 13% and ‘others’ 4%. Since 2004, Fijian males had replaced females as having the highest number of cases. Overall, males comprised 59% and heterosexual transmission accounted for 85% of all cases. By the end of 2004 a total of 182 HIV infections had been reported in Fiji13 and the number of new cases reported each year has increased for the last ? ve years. In Fiji, reported cases of syphilis and gonorrhea have ? uctuated between 1998 and 2004. In 2004 there were 852 reports of syphilis and 1182 gonorrhea. The number of cases reported for 2008 were 1004 for syphilis, 1064 gonorrhea and 283 HIV cases. 27 Recent statistics from Fiji’s Health Ministry on Sexually Transmitted Infections are a cause for concern with the high rate of STIs among people aged 20 to 29 increasing the risk for HIV infection. 31,32 Fiji’s Director of Public Health notes that statistics gathered over the past eight years by the Ministry show that gonorrhoea and syphilis are the most frequently reported STIs in the country, which â€Å"highlights the underlying concern of unsafe sexual behaviour among young people† and the â€Å"same high-risk behaviour for the transmission of HIV. † He also said that â€Å"sex is serious business† and that â€Å"anyone, especially young people, who participates does so at their risk, in view of the sad consequences of infection from so many STIs including HIV, pelvic in? ammatory disease and infertility. †32 Risk/Protective Factors Some religious groups in Fiji, such as Islam, strictly forbid the use of alcohol. Christian denominations such as the Assemblies of God, Jehovah’s Witnesses and the Seventh Day Adventist Mission also prohibit the consumption of alcohol. Individual members of these religious groups vary in the degree to which they adhere to these principles. Any negative effects of combining tobacco or alcohol with kava use are currently conjecture, with relatively little work done to explore the nature of the relationship between these substances in the Paci? c. 1,6,9,26,33 However, anecdotal evidence suggests an inter-relationship exists with social and health consequences. 1, 4-6, 9, 13, 26, 33, 34 Reports of kava drinking followed by a beer chaser, known as ‘washdown’, are not uncommon and suggests the need for further exploration of potentially harmful consumption patterns. Excessive drinking, drinking too frequently and too much, often re? ects the drinking pro? le of the majority of young people in countries like Fiji. 5, 11, 14 Excessive drinking is reported as a signi? cant contributor to motor vehicle accidents, violence and aggressive behaviour, unwanted pregnancy, sexually transmitted infections, and criminal activities. 3, 14, 15, 18, 26 It has been suggested that the alcohol consumption pattern of young Indigenous Fijian males follows the traditional kava ritual of drinking until there is nothing left in the kava bowl. In many instances, young people often end their kava drinking session by consuming alcohol (‘wash down’). [3, 5] It is reported that most youths drink excessively to manage their problems, but it may result in new problems like unsafe sex, crime and violence and even suicide. 5, 14, 15, 34, 35 A study in Fiji10, 11 revealed that alcohol was a factor in 58% of all homicide between 1982 and 1992 and approximately 80% of the crime in the country is alcohol-related. 10, 18 169 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 Furthermore, the effects of alcohol on the physical, mental and social health of Fiji’s citizens have in recent years been the subject of considerable concern amongst health-care professionals and social scientists, as well as the ordinary citizens. 2, 3, 8, 10, 11, 23, 26, 33 At present there is suf? cient evidence from a variety of research ? ndings1, 6, 10, 11, 34 to suggest that the heavy consumption of alcohol contributes other health problems in Fiji, such as diabetes, heart problems, obesity and hypertension. Among the social consequences of excessive alcohol consumption in the country,10, 11 violent crime, domestic violence, and road fatalities have been identi? ed as the most serious. 8, 23, 34 While alcohol and home brew drinking are more common, marijuana cultivation, sales and distribution has become pervasive in some Paci? c Island countries. It has been seen as a good source of income. A further emerging substance abuse issue is glue snif? ng among school age children, mostly in their early teens. In addition, unemployment in youths is a major problem in the Paci? c. In Fiji it has been estimated that out of nearly 10,000 youths seeking employment, only 1500 can be employed. 2, 3, 13 Studies and observations in some urban areas of Paci? c countries point to an increasing numbers of people between the ages of 15-19 engaging in commercial sex worker with some aged even younger. 2, 3, 11, 15, 35, 36 Conclusions There is a range of evidence and data suggesting the potential for increased risk of HIV infection associated with substance use in Fiji, but there is a need to explore this issue further with social behavioural and qualitative research. While harmful substance use patterns and sexual health risk factors are increasingly reported, there is little current analysis regarding the interaction of the two. Of particular concern is the current environment of rapidly changing substance use patterns with little in the way of structural responses to protect the people of Fiji from the range of social and health-related harms. In addition, dif? cult economic conditions and the tangible bene? ts of cannabis growing and distribution (and potential for amphetamine production) lend urgency to the need to investigate these issues further and to develop viable interventions that are informed by robust data and research information. References 1. Goundar R, Kava consumption and its health effects. Journal of Community Health and Clinical Medicine for the Paci? c 2006. 13(3): p. 131-5. 2. Plange, N. K. , Social Aspects of Drug and Alcohol Abuse: An overview of the situation in Fiji. Fiji Medical Journal, 1991. 17(3): p. 5-12. 3. Plange, N. K. , Alcoholism and Crime among Urban Youth in Fiji. 1991, University of the South Paci? c. 4. UNICEF. , Substance use among adolescents in Fiji: A surveillance Report from the Fiji Global Tobacco Survey. 1999. 5. Rokosawa, M. Alcohol problems in Fiji. 1986 [cited. 6. Moulds RFW, M. J. , Kava: herbal panacea or liver poison? [For Debate]. Medical Journal of Australia, 2003(178): p. 451-3. 7. Morrison F, H. F. , Gaylord J, Leigh B, Rainey D. , Adolescent drinking and sex: ? ndings from a daily diary study. Perspective on Sexual Reproductive Health, 2003. 35(4): p. 162-8. 8. Adinkrah, M. , Homicide-Suicides in Fiji: Offence patterns, situational factors & socio-cultural contexts. Suicide and Life Threatening Behavior, 2003. 33: p. 65-73. 170 PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 REVIEW 9. Kava, R. , The adverse effects of Kava. Paci? c Health Dialog, 2001. 8: p. 115-18. 10. Adinkrah, M., Violent encounters: A study of homicide patterns in Fiji society. 1996, Fiji Council of Social Services. : Suva, Fiji. 11. Adinkrah, M. , Crime, deviance & delinquency in Fiji. 1995, Suva, Fiji: Fiji Council of Social Services. 12. Plange, N. K. , Social aspects of drug and alcohol abuse: An overview of the situation in Fiji. Fiji Medical Journal, 1991. 17(3): p. 4-12. 13. WHO, National Workshop on Alcohol Related Problems in Fiji. 1986. 14. Naiveli, B. , Alcohol and Crime. 1986, Royal Fiji Police. p. 34,35 15. Kippax, D. D. , The Genesis of Alcohol -Related Problems. 1986, Fiji School of Medicine. p. 24-28. 16. Na tabili kavoro: The place of alcohol in the lives of Fijian people living in Aotearoa New Zealand. ALAC Research Monograph series: No. 4. Wellington, Sector Analysis, Ministry of Health for the Alcohol Advisory Council of New Zealand, 1997. 17. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001. 7(3): p. 155-157. 18. http://www. who. int/substance_abuse/publications/en/? ji. pdf, WHO Global Status Report on Alcohol 2004: Geneva. 19. Recommendations for policy to support health promotion. A report to the Minister of Health., N. C. f. H. Promotion, Editor. March 1998. 20. Devanney M, R. G. , Baldwin S, Crofts N, Power, R, Illicit drug use and responses in six Paci? c Island countries. Drug and Alcohol Review, 2006. 25: p. 387-900. 21. Drug Enforcement Administration – Intelligence Division, Drugs Intelligence Brief: the paci? c islands region, v. Alexandra, Editor. 2004, Drug Enforcement Administration. 22. United States Of? ce on Drugs & Crime, Paci? c Islands: UNODC – Regional Centre for East Asia and the Paci? c. 2003. 23. Ratinisiva M, Drug Traf? cking, Prevention and Control in Fiji. Fiji Medical Journal, 1991. 17(3): p. 5-12. 24. Fiji Islands Revenue and Customs Authority, Annual Report. 2006. p. 17. 25. Louisa, C. , Paci? c ripe for drug ring boom, in NZ Herald. 2004: Auckland. 26. Abusah, P. Y. , The Drug Scene in Fiji. Fiji Medical Journal, 1991. 17(3): p. 21-25. 27. http://www. stats? ji. gov. fj/Key%20Stats/Miscellaneous/15. 7%20crime%20cases%20recorded. pdf. 2008. 28. http://tvnz. co. nz/view/page/425822/37544, More Fijian youth in drugs, prostitution 2001. 29. Illicit Drugs Control Bill Draft. Fiji: Paci? c Islands Forum Secretariat. 2002. 30. Ministry of Health, Annual Report – Shaping Fiji’s Health.2007. 31. http://www. health. gov. fj/index. html. 2008. 32. http://www. stats? ji. gov. fj/Social/health_cdeath. htm. 2008 [cited. 33. Council out to Fight Drug Abuse, in The Fiji Times. 34. Caswell, S. , Alcohol in Oceania. 1986, Alcohol Research Unit, Dept of Community Health and General Practice, School of Medicine, University of Auckland, New Zealand. p. 25. 35. Kippax D, O. M. J. , Alcohol-Related Problems in Fiji. 1986, Suva: Suva. 36. Ali, S. , Family Life Education. 1986, Ministry of Education. p. 36-39. 171 REVIEW PACIFIC HEALTH DIALOG MARCH 201 1, VOL. 17, NO. 1 172.

Online library Essay Example | Topics and Well Written Essays - 250 words

Online library - Essay Example My experience with it has been impressive. I did try searching some topics using the Summon engine, and learnt a few critical issues when it comes to utilizing the engine. First, I did search a broad topic, which unleashed over one million results. However, on using parenthesis, the results were reduced to ones that are more relevant. Other steps involved were refining the topics, and specifying the research content material to utilize. Narrowing down the topic did grant an opportunity to fine-tune results granting access to relevant resources (Majumdar, 2012). In essence, the Summon does provide an easy model to filter out the search content. One can be in a position in the search for multiple formats and content at a go. One can filter out books, articles, journals, videos, and other databases. Most significantly, University of Hull Summon Tutorial provides a simple and fast search engine from the library databases. It delivers contents from intensive disciplines. The Summon is easy to use, while the screen results are easy to understand. From the utilization and utility of the system, two lessons were clearly valid: it is important to filter out the information using the keywords to acquire relevant information. Secondly, utilization of simple language is critical to get back authentic information (Insinna,

Research of Barclays Essay Example | Topics and Well Written Essays - 1000 words

Research of Barclays - Essay Example It also sponsored many big and major events also. This list of sponsorships may include Premier League, certain sports events e.g. tennis, golf and foot ball tournaments, the Churchill cup etc. Barclays is the second largest bank in the United States (Salz, 2013). There are also certain controversies which are associated with the name of Barclays as it is very usual matter that every banking institution is usually supposed to be involved in the money corruption cases. Same is the case with Barclays, most of the competitors tried to create a bad word of mouth regarding the Barclays bank but it was not successful and the popularity of the Barclays bank is still in the minds of its potential customers (Skinner, 2011). Need for Marketing Research: Due to difference in the customer needs and choices the Barclays bank is also trying to serve them at every level. That is the reason of having different banking products and services so that customers of different segments can be targeted easi ly (the Beans Group, 2012). When any company has such a versatile kind of target market and customers then there is a need of market research so that new and prevailing trends in the market can be analyzed efficiently. The promotional tools of the banking products and services would also be different for different customers. While doing market research the company should be capable of covering costs and also sell the product at a profit. They should also be able to handle the expected problems of the new segment (FAO Corporate document Repository). Marketing Research at Barclays: There is so much competition in the banking industry that every bank has to be vigilant about the opportunities arising in the customer market so that it can be grabbed at once and then have a first mover advantage in offering new services to its potential customers. To achieve this vigilance by the company the marketing research should be very much active and effective also. Marketing research actually mea ns to collect the customer related data from the market segments and thus analyzing it in comparison with the company’s resources and also the cost involved. This marketing research also helps to devise future plans for the company. Barclays have analyzed the potential in the students target market and thus do a market research to find out whether this would be a profitable decision to launch any product regarding this segment (Havard Business School, 2013). Barclays have considered the students as the major segment to be invested in. They did a marketing research in order to analyze the potential of this specific market segment (Elizabeth, 2012). Barclays has a competitive advantage over other companies due to the geographic area it has covered (Barclays PLC Bank Annual Report, 2012). On the basis of this advantage Barclays can compete over them in the future also by serving more and more segments. The research and development department of the Barclays is very effective. Th e research team provides actionable ideas that are based on the consumer preferences (Barclays PLC Bank Annual Report, 2012). At first the company which is going for market research should focus on its own image created in the customer’s eye (Gerber). In this way it can be easily analyzed that how the population of that segment will perceive that company’s product. The research and development department at Barclays efficiently try to cover all the possible segments of the consumer market and even also made valuations and other

Interpersonal Theory Essay Example | Topics and Well Written Essays - 500 words

Interpersonal Theory - Essay Example During this stage, Freud believed, the Oedipus complex occurs in which the child desires the parent of the other sex and feels rivalry with the same-sex parent. When the Oedipus complex is resolved, the child identifies with the same-sex parent, but females retain a lingering sense of inferiority and "penis envy"—a notion contested by female psychoanalysts like Clara Thompson and Karen Horney (Wade & Travis, 1993). Carl Jung believed that people share a collective unconscious that contains universal memories and images, or archetypes. Personality, in this view, includes many archetypes, such as the shadow (evil) and the anima and animus. The object-relations school emphasizes the importance of the first two years of life, rather than the Oedipal phase; the infant’s relationships to important figures, especially the mother, rather than sexual needs and drives; and the problem in male development of breaking away from the mother (Guntrip, 1961). Thus individuals who are at various stages of development can experiences problems in having a well adjusted personality as well as having positive relationships with other people who are around them. Most of us have come in contact with people who seem to successfully irritate or frighten people away with their clinginess, significant lack of self esteem, and even anger and threatening behavior. Psychodynamic theories suggest that these individuals adapted this personality style by going through a childhood which was filled with anxiety (Guntrip, 1961). While this manner of dealing with others may have been beneficial in their youth, as adults it serves to almost guarantee their needs will not be met. There are three identified ways of dealing with the world that are formed by an upbringing in a neurotic family: Moving Toward People, Moving Against People, and Moving Away From People (Guntrip, 1961). Psychodynamic approaches have been criticized for

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

Communist Revolution - Essay Example It can be stated that a series of political upheavals took place in China between 1911 and 1949. These activities significantly helped to establish the People’s Republic of China. These activities were guided by Communist party Rule. Guomindang is the political party established in the year 1911. The major objective of this political party was to gain supreme political power. This political party governed China under the guidance of Chiang Kai Shek from 1928 to 1949. After this the Communist party took power. Subsequently since 1949, the Communist Party was the authorized party which ruled Taiwan. The Guomindang faced several problems at the initial stages of revolution. Problem of authority restoring of the Central government and growing activities of communist movement affected Guomindang. After 1930, Jiang introduced a series of attack. It helped to encircle the individuals of Communist party. This attack led to a specific attempt by Chu Teh to explore the movement and acti vities. Chu Teh was the army commander of Communist Party at that point of time. The communist Party initiated a Long March from the South East China to North West China. The duration of this movement was one year. This Long March resulted from October 1934 to October 1935. In the year 1935, almost 100,000 marched through the army of KMT in South Jiangxi. This troop trekked near about 6,000 miles through a specific roundabout route. Finally, this troop succeeded to reach to Shaanxi’s North West Province. Due to this Long March the number of armies of Communist party was reduced to 8,000. During this Long March a power resist developed between Jiang Guo and Mao Zedong. This unfavorable conflict between the two led to split of the force eventually. Mao’s revolution group finally based themselves in Yanan. This establishment remained throughout the revolution and in war with the Japanese. It formed a critical uneasy alliance with the group of nationalists. The major motiv e of this war is to expel the intruders. In the year 1936, the government of Japan offered a secret demand to the Chiang Kai Shek’s government. This proposal was disguised as the pitch for the war between the communists. The Chiang Kai Shek’s government’s acceptance would have meant the domination of Japan over the Chinese. The results of this war were dramatic. The Communist party controlled almost 19 base areas (Zarrow, 2005). There was a population of 100 million under these base areas. Most importantly, this Communist party himself had the population of one million. Therefore, Communist party was ready to test their strength with the KMT. The Japanese surrendered under United States after atomic bombing of Hiroshima and Nagasaki incident in the year 1945 during the Second World War. General George Marshall was sent to President Mr. Harry Truman as a special diplomat to China in the year 1945. The major responsibility or task of General George Marshall was to mediate an agreement between the KMT and Communist Party. At that point of time, the government of United States helped Chiang by providing air fighting troop to the Northern China. Officially this plan was successfully executed as the Japanese were regimented to surrender to the American Troops or KMT. This activity favored Chiang. Finally, the war broke out in the year 1946. It renewed the civil war against the group of Nationalists in the year 1946. During the Second W

Macroeconomics Essay Example | Topics and Well Written Essays - 500 words

Macroeconomics - Essay Example According to Hayek, â€Å"the price mechanism of the free market serves to convey information about supply and demand that is dispersed among many consumers and producers and which cannot be assembled or coordinated efficiently in any other way†. And seriously â€Å"doubts whether a socialist economy is capable of solving the problems of rational allocation of its resources (Hayek, 1982)†. Keynes on the other hand favored government intervention through its fiscal and monetary policy to assuage the impact of recession and depression or financial crisis like the one United States recently had in 2009. Keynes believe that it is not only the market that can make an economy work at a maximum efficiency but such can also be raised to the that level by the intervention of the government. In contrast to Hayek, Keynes advocated collectivism through international coordination of fiscal and monetary stimulus to deflect and mitigate any downturn in economic cycle. He is also the s ponsor of deficit spending to lift an economy from depression in contrast to Hayek’s proposal that it solely market the (free) market that can achieve utmost efficiency in an economy.

The Industrial Revolution and its Impact on the United States Research Paper - 1

The Industrial Revolution and its Impact on the United States - Research Paper Example On the technology front, the biggest advancements were in steam power. New fuels such as coal and petroleum, were incorporated into new steam engines. This revolutionized many industries including textiles and manufacturing. Also, a new communication medium was invented called the telegraph. This made communicating across the ocean much faster . The invention of steam power gave momentum to the development of rail transport in America. Moreover, petroleum and diesel engine engines were also discovered followed by the steam engine. All these discoveries contributed heavily to the development of transportation facilities and infrastructure. Before the introduction of these engines, Americans were using other means of transport which were comparatively slower that that with automobiles. In other words, the distance between different places appeared to be more than what it is today, before the introduction of of engines and the subsequent discoveries of automobiles. Along with the discovery of automobiles, industrial revolution brought another major breakthrough in communication in the form of the discovery of telegraph. Telegraph and automobiles contributed heavily to the development of communication and transportation which in turn gave momentum to the development of manufacturing units or industries and businesses across Amer ica. The full impact of the Industrial Revolution would not begin to be realized until about 100 years later in the 1800s, when the use of machines to replace human labor spread throughout Europe and North America .

Johnson & Johnson Essay Example | Topics and Well Written Essays - 750 words

Johnson & Johnson - Essay Example The company’s target market is the health care sector. J&J aims to provide medical facilities, nursing homes and mothers with the supplies they need to operate. With its diagnostics and treatment products, J&J’s products have become household names in the health care sector, beauty parlours and homes. According to Delo and Neff (2013, p.8), J&J capitalizes on its 92 consumer product brands to maintain an enormous presence in the current competitive market.  To achieve this, J&J spends a significant part of their revenues to market its numerous brands in various media including electronic media, print media, outdoor ads, blogs and social media- products that include; baby items, medical products and devices, skin care products, hair beauty products, and health products for women, and dietary products (Cameron 2007, p.65). As Chwallek (2013, p.16) has indicated, J&J relies on its strong brands as the key cog in its marketing initiatives. Owing to the success of the company in marketing its brand, today J&J customers and prospects would rather pick on its products than settle for other products provided by its market rivals. As a result, the company’s consumers normally prefer to pay more for the brands, a development that has earned J&J more profit edge over its market rivals that sell fairly cheaper products. J&J’s leading role among the world’s top companies whose presence trace to the late 19th century is one of its major strengths (Chwallek 2013, p.16). The company boasts of high level of customer satisfaction and effective research and development programs that have resulted in its continued existence, 128 years since its inception. The long period of existence has enabled the company to build on its corporate image, customer base, and product image to its advantage. With its strong presence across the world made possible

Behavioral risk factors Essay Example | Topics and Well Written Essays - 250 words

Behavioral risk factors - Essay Example Academy of Sciences cites some specific behaviors that influence health such as tobacco and alcohol consumption, physical exercise and food intake, sexual practices, and disease diagnosis. Despite the availability of data on the direct effects of these behaviors on a person’s health and his contraction of potentially chronic diseases, they remain at a staggering level. Primary prevention with early screening and detection, together with an overall change in attitude are important to address illnesses prevention and obviate disease transmission (2001). The importance of community engagement in wholesome activities cannot be stressed enough. In this regard, the companies together with local health personnel should work together in implementing activities that promote a healthy lifestyle. Sports activities that initiate larger group participation are ideal and convenient. Information drives through a wider audience employing the mass media will also be vital to update people of the most recent health hazards and various studies. In addition, the different companies should encourage their employees to avail of provided for medical consults at the onset of their health concerns to ensure early

Industrial Development and Western Expansion’s Effect on US Farmers Essay Example for Free

Industrial Development and Western Expansion’s Effect on US Farmers Essay True, the United States of America’s surge in industrial development and western expansion were indeed crucial factors that led to protests by farmers. This is evidenced by many different events that occurred during the time when industrialization was most in focus in the United States. This onset of industrial boom occurred some time between the 18th century and the 20th century. The fist thing that should be tackled here in order for one to understand the truth behind the initial statement of this essay is the Western United States. This refers to the westward expansion of the United States. Because of the demand for more land, the rich prairie lands of the west proved to be a lucrative source for larger areas of development. Many chose to pursue a life in the west and resided there. America’s expansion towards its west allowed more than 400 million acres of free land to be utilized for whatever purposes could be thought of by its new owners. This had numerous implications for the American citizen, most especially to the American farmer. Land became available in bulk over night. However, despite this availability, farmers and farm labor decreased by at least 30% during this stage. This decrease in production may have been due to the increase in individuals who could provide satisfaction to the market’s demand for agricultural products. Thus greater production also led to lower costs for the said products on the agricultural market. Farmers found themselves unable to compete with this change. The industrial development which had already begun at that time also contributed to this. Farmers found themselves unable to deal with industrialization. The industrialization of the agricultural industry meant new innovations, new machines. Some of these innovations included railroads which allowed the harvested agricultural products to reach the market more quickly. Other innovations such as the refrigerator allowed for preservation of the produce. Farm yields now reached more distant places but could also now be processed in factories to last longer. This meant that the farmers were up against a major competitor in the food industry, markets and globalization. Local family farms found themselves unable to keep up with the tide of new instruments. Although machines were available for them to work more efficiently such as the reaper, the steal plow, and the harvester, these were not enough for the greater capabilities of factories and national manufacturers. The marginalization of the individual farmer in the face of westward expansion and industrial development brought much distress and discontent. Protests were held and many voiced their frustration at the economical change that seemed to have happened over night. Farmer organizations such as The Grange and Farmers Alliance were established. These worked to demand regulations, protective tariffs, trade policies, conservative monetary policies and the like. It is clear from the evidence given that westward expansion and industrial development truly were factors in the protests of farmers. Whether these two issues proved to have good results in the long run is a different matter. It is sufficient to say that these caused much discontent in farmers at the time enough so that they rose in protest. References Cowan, Ruth Schwartz (1997) A Social History of American Technology, New York: Oxford University Press Hindle, B. Lubar, S. (1986) Engines of change: the American industrial revolution, Washington: Smithsonian Institution Press Meyer, D. (1989). Midwestern industrialization and the american manufacturing belt in the ineteenth century. The Journal of Economic History, 49(4), 921-937 Shannon, F. (1950). The status of the midwestern farmer in 1900. The Mississippi Valley Historical Review, 37(3), 491-510

Issues of Nurse Prescribing in the UK

Issues of Nurse Prescribing in the UK Introduction The changing face of the NHS is a topic of controversy and debate from the perspectives of professionals and policy makers. The last three decades have seen a transformation in nursing in the United Kingdom, and in the ways that nurses envisage themselves (McCartney et al, 1999). This transformation is only one symptom of a raft of policy changes which have affected the NHS. Evolution of nursing as a profession has seen them moving from being a group labelled the doctors’ handmaidens to a professional group with its own staunchly defended identity (McCartney et al, 1999). This new professionalism has also led to diverse developments and advancements in the role and functions of nurses, with increased autonomy and extended roles which could be viewed as encroachment on medical roles or as ideal management of an already skilled and knowledgeable workforce. As far back as 1986, the Cumberledge report raised the possibility of allowing community nurses to prescribe independently, and several years later the necessary legislation was initiated (McCartney et a, 1999). In 1997, the government established a review of prescribing, supply and administration of medicines, chaired by Dr June Crown (Stephenson, 2000). This became known as the crown report (DH, 1998). It was chiefly concerned with the supply and administration of medicines by group protocols (S tephenson, 2000). A group protocol could be described as a specific written instruction, drawn up locally by doctors and pharmacists, for the supply or administration of named medicines by other health professionals in an identified clinical situation (Stephenson, 2000). A number of authors supported this move and in particular, the ability for nurses to be able to prescribe medications for clients in certain circumstances. However, the implementation of this policy change has been neither uniform or timely. This paper will explore the policy context of the implementation of nurse prescribing, utilising a theoretical framework to examine the laggard nature of the change and the reasons why nurse prescribing remains unfinished business in the professional and policy arena. The theoretical framework used will be the Diffusion of Innovation theory, as defined by Rogers (1962, 1976). Diffusion of Innovation Rogers (1962, 1976) defines the diffusion process as the spread of a new idea from its source of invention or creation to its ultimate users or adopters. This could be considered the macro level of change assimilation or even awareness. However, the notion of diffusion of innovation is more than a macro concept, and Rogers (1962, 1976) further differentiates what he describes as the adoption process from the diffusion process in that the diffusion process occurs within society, as a group process; whereas, the adoption process is individual. In Rogers’ (1962, 1976) opinion, the adoption process is the mental process through which an individual passes from first hearing about an innovation to final adoption. The theoretical construct of chief concern here is that of macro level diffusion of a professional innovation. There are five stages in the Innovation-Decision Process as described by Rogers (1962, 1976) and these will be mapped against the literature below. First knowledge of innovation (Rogers, 1962, 1976). First knowledge of innovation could be pinpointed to the Cumberledge report in 1986, which was a report into community nursing, after which the issue was debated and discussed and entered into the theoretical arena in the healthcare professions and healthcare policy and governance in general. However, Jones (2004) cites the case of nurses who began to make a case for prescriptive authority in 1978. There is varying evidence of how diffuse this knowledge became at a societal and policy level and there is some evidence of widespread resistance in the medical and pharmaceutical professions (Jones, 2004). It is important to remember that for some critics, nurse prescribing does not necessarily constitute something entirely innovative. Nurses already perform a number of roles which require full knowledge of medications, but there may be issues about education and skill levels across nurses educated in different places (King, 2004). If there are questions already about nurses’ knowledge and ability around medications, then the preliminary debate about this issue (which extended over two decades) is understandable. Forming an attitude toward the innovation (Rogers, 1962, 1976) A number of attitudes towards this innovation are apparent in the literature. For example, Jones (2004) suggests that implementation of this innovation would be characterized by political machination, the need to construct an effective case, and deft manoeuvring within the corridors of power. This raises issues to do with the context within which the innovation takes place, as already discussed. Jones (2004) also alludes to the district nurses who presented a case in the 1970s, and the RCN who continued to press that case further. This also relates to Rogers’ (1962, 1976) description of some of the factors or prior conditions that affect the innovation-decision process, such as previous practice (which may influence the decision makers in a positive or a negative way), and the norms of the social systems in which the innovation is taking place. The firmly entrenched hierarchical norms of the NHS and healthcare systems in general could be viewed as the biggest hindrance to nurs e prescribing, and so forming an attitude towards the innovation, for all the key players within the system. A decision to adopt or reject (Rogers, 1962, 1976) The decision to adopt the innovation occurred piecemeal and somewhat sequentially in time. Jones (2004) states that it was after much initial scepticism and a good deal of negotiation that a tacit agreement between nursing, medicine and pharmacy was reached in 1988. Subsequently, the RCN wree able to cause the government to initiate the Crown report in 1989. However, there were limitations to this decision, in that it was restricted to health visitors and district nurses who would be able to prescribe by virtue of them having post registration qualifications that marked them as competent in this advanced field (Jones, 2004). Implementation of the new idea (Rogers, 1962, 1976). It is this stage which is the most problematic in relation to nurse prescribing, perhaps due to the nature of adoption across the wider NHS context. Nurse prescribing is sanctioned, but remains a locally differentiated policy with apparent piecemeal implementation. This could raise issues of quality and also the ability to evaluate the effects and impact of nurse prescribing at the macro level. Despite the adoption of the principle, there was a distinct lack of action in moving the agenda forward, and it was some time before the bill was passed through Parliament in 1992 (Jones, 2004). The literature shows that the legislation passed in 1992, and in 1994 nurse prescribing began in eight demonstration sites (Bates, 2002). Following this pilot, a national roll out of nurse prescribing began in 1998 (Bates, 2002). This, however, applied only to nurses with district nurse of health visitor qualifications working in the community and employed by an NHS Trust or GP (Bates, 2002). Confirmation of the decision. Confirmation of the decision can also be seen within the literature, in that in 1999 there was a review of prescribing, which then recommended that prescribing rights be extended to include other groups of nurses and other health professionals (Bates, 2002). Subsequent to this, the NHS Plan (2002) clearly supported the recommendations and it was posited that by 2004, nurses should be able to prescribe independently, or supply medicines in Patient Group directions in four areas: minor illness, minor injury, health promotion and palliative care, within the aegis of a Nurse Prescribing formulary (Bates, 2004). Bates (2004) stated that there were approximately 22000 nurse prescribers in the UK, 3000 of which were in Scotland (at the time of her article). This suggests that there is widespread confirmation of the decision through demonstrable changes in practice. It is also notable that nurse prescribing has further progressed towards supplementary nurse prescribing, which allows nurses a nd other health professionals to prescribe for a patient who has been through an initial assessment by a doctor, in accordance with a clinical management plan (NHS Scotland, 2002). It should be noted that prior conditions affect the innovation-decision process. Prior conditions include previous practice, felt needs/problems, innovativeness, and norms of the social systems (Rogers, 1962, 1976). Consequences of Innovations (Rogers, 1962, 1976). Any discussion of the innovation-decision process, must also consider the consequences or changes that can occur to a social system as a result of the adoption of an innovation. Rogers (1962, 1976) identifies three consequences or changes. Desirable versus undesirable consequences The primary purpose of nurse prescribing is to give maximum benefit to patients and the NHS, whilst also supporting quicker and more efficient access to healthcare while promoting a more flexible use of the skills of the existing workforce (Bates, 2002). This however could be a somewhat idealistic view of general nurse prescribing. While for many nurses it may enhance their ability to provide care, others may consider that it simply adds to their already onerous workload. There may also be ethical issues, perhaps through conflicts between personal, official and legal senses of duty for nurses, which could result in cognitive dissonance between their conceptual model of their nursing role and the new directives to extend this role in to a traditionally medical area of responsibility. Nolan et al (2001) in a study of mental health nurses’ perceptions of nurse prescribing found that most of their respondents felt that this would significantly improve clients’ access to medication, improve compliance, prevent relapse, and prove cost effective. However, the same respondents also felt that they may not have sufficient knowledge and skills to assume responsibility for prescribing (Nolan et al, 2001). In this case, as elsewhere, nurse prescribing is a double-edged sword, but it seem from this research that the nurses felt that the benefits outweighed their concerns, and their concerns were, after all, possible to overcome through additional training. Direct versus indirect consequences. Some of the indirect consequences may be easier to appreciate than the direct consequences, while some of the direct consequences may be less popular, in a sense, because they benefit members of the institutional system in ways less acceptable to some of the professionally defined or client-defined groups within the system. For example, if the direct consequence of nurse prescribing is a reduction in doctors’ workloads, this will benefit doctors, and may indirectly benefit patients by providing more or better quality doctor-patient contact, and patient outcomes. But there is no evidence so suggest that this rather optimistic viewpoint could be true. A reduction in doctors’ workloads may demonstrate no improvement in patient care, but an increase in nurses’ workloads could be viewed as having more potential indirect consequences for the patient experience. Deontological debates also raise this issue, and the question is where does the duty of the nurse truly lie? Another indirect consequence of the innovation might be the burden placed on nurses to conform to this professional development and to adhere to the directive. Nurses who do not wish this level of responsibility and autonomy may suffer personally and professionally, finding themselves non-conformists through no fault of their own. However, if another consequence is an enhancement in the status (and pay) of nurses, nurses who prefer not to prescribe could be viewed as holding the profession back. Anticipated versus unanticipated consequences. It is difficult to evaluate the anticipated consequences against the unanticipated ones, given that there is little literature discussing these. Some anticipated consequences might relate to improvements in medication education by nurses (Rycroft-Malone et al, 2000), whereby the nurses will be more knowledgeable, competent and perhaps confident in this activity. This is an important issue in the modern healthcare service where consumerism has become one of the most powerful driving and defining forces (Rycroft-Malone et al, 2001). It is this kind of consumer power which contributes to future policy direction, after all, although the current rhetoric, with its implicit assumption that greater consumer involvement in health care is both desirable and beneficial (Rycroft-Malone, 2001), could be challenged by those who believe that the conferred authority of medicine (and nursing) should take the lead. This author can only project certain consequences, some of which may relate to consume r power and the negotiation of power dynamics between different groups. However, it is debateable if these could be considered anticipated or foreseeable consequences. Another anticipated consequence of this innovation is the close evaluation of the innovation, with inevitable close scrutiny of the nursing profession and its actions in response to the new powers and responsibilities. Latter and Courtenay (2004) in a review of evaluations of nurse prescribing found that the initiative had been largely successful. However, they also identify areas for much further scrutiny and consideration, such as gaps in the knowledge base about prescribing, the nature of the evidence about nurse prescribing, and the need to evaluate the extension of prescribing powers to nurses working outside the initially defined settings (Latter and Courtenay, 2004). It would appear that the nurse-patient relationship may be a positive dimension of patients’ perceptions of nurse prescribing, but there is a need to further evaluate the more intermittent contacts that patients may experience with nurses in certain settings (Latter and Courtenay, 2004). McKenna and Keeney (2004) found that there is still a lack of understanding of the roles of, in particular, community and specialist nurses, but that there is public support for nurse prescribing. Questions still remain about nurses’ ability to be effective in working outside their standard professional area (McKenna and Keeney, 2004). This raises questions about the consequences for nurses in how they interact with their clients, and suggests that nurse prescribing may contribute to changing the professional ‘face’ of nursing. Conclusion The modernisation of the NHS, with its emphasis on timely and effective delivery of services, has been a key factor in the implementation of nurse prescribing and its development into independent prescribing, even into the hospital setting (Clegg et al, 2006). The history of nurse prescribing demonstrates the drive for professional growth in certain areas, sanctioned by changes in the context of service delivery, but hampered by traditional roles and concepts of professional domain. Debates also consider the challenges of training, legal issues, professional issues, budgetary and practical issues surrounding nurse prescribing (Clegg et al, 2004). What is most apparent from this examination of the literature, however, is that while the embryonic stage of nurse prescribing is long gone, the innovation is still undergoing a process of growth and maturation, which is persistently emergent and therefore leaving the status of the profession in relation to this issue largely unformed. This examination of nurse prescribing has shown that change spreads by a process of diffusion, which could be viewed in retrospect as a piecemeal process driven from different directions and according to the perhaps hidden agendas of different agencies, such as nurses, the government, and the consumer. More research is required to examine the ongoing growth and consequences of this innovation, for the professions and the clients, now that it has become an established part of healthcare practice in the UK. 2,500 Words References Bates, C. (2002) Independent nurse prescribing. RCM Midwives Journal 5 (2) 63. Berry, D., Courtenay, M. and Versellini, E. (2006) Attitudes towards, and information needs in relation to, supplementary nurse prescribing in the UK: an empirical study. Journal of Clinical Nursing. 15 22-28. Crown, J. (2003) Bringing practice up to date: progress with nurse prescribing. Nurse Prescribing 1 (2) 56-58. Gooch, S. and Bennett, G. (1999) Extending prescribing: nurse prescribing and the Crown Review. Hospital Medicine 60 (10) 718-721. Jones, M. (2004) Case Report. Nurse prescribing: a case study in policy influence. Journal of Nursing Management 12 266-272. King, R.L. (2004) Nurses’ perceptions of their pharmacology educational needs. Journal of Advanced Nursing 45 (4) 392-400. Laresen, D. (2004) Issues affecting the growth of independent prescribing. Nursing Standard 22 (19) 33-39. Latter, S. and Courtenay, M. (2004) Effectiveness of nurse prescribing: a review of the literature. Journal of Clinical Nursing 13 26-32. McCartney, W., Tyrer, S., Bracier, M. and Prayle, D. (1999) Nurse prescribing: radicalism or tokenism? Journal of Advanced Nursing 29 (2) 348-354. McKenna, H. and Keeney, S. (2004) Community nursing: health professional and public perceptions. Journal of Advanced Nursing 48 (1) 17-25. NHS Scotland (2002) Extending Independent Nurse Prescribing within NHS Scotland http://www.scotland.gov.uk/Publications/2002/09/15042/8426. Nolan, P., Hage, S., Badger, F. et al (2001) Mental health nurses’ perceptions of nurse prescribing. Journal of Advanced Nursing 36 (4) 527-534. Rogers, E. M. New Product Adoption and Diffusion. Journal of Consumer Research. Volume 2 March 1976 pp. 290 -301. Rogers, E. M. (1962). Diffusion of Innovations. The Free Press. New York. Rycroft-Malone, J., Latter, S., Yerrell, P. and Shaw, D. (2001) Consumerism in health care: thecase of medication education. Journal of Nursing Management. 9 2221-230. Rycroft-Malone, J., Latter, S., Yerrell, P. and Shaw, D. (2000) Nursing and medication education. Nursing Standard 35-39. Stephenson, T. (2000) Implications of the Crown Report and nurse prescribing. Archives of Disease in Childhood. 83 (3) 199-202.

Service Provisions for the Elderly

Service Provisions for the Elderly ANSWER: Have you ever wondered why people say it is rude to ask a girl for her age? Do you know why most adults cringe every time they celebrate their birthdays? Truth be told, most of us fear aging because we associate it the gradual loss of our physical and mental abilities which in turn affects our emotional state. Bernard Nash asks, â€Å"Does it not strike you that we all want to live longer but none of us wants to grow old?†[1] Tangelder, J. (2014). He believes that aging, to most of us, is like a paradox. We enjoy life enough for us to choose to live longer yet we fear the effects of aging because it links towards the inevitable end. Most of us view aging as a loss of the benefits of our youth and the gain of multiple drawbacks of aging like diseases and illnesses such as dementia and hypertension. Physically speaking, it is a known fact that we lose a lot of control when we age. We lose the ability to walk properly, pee at will, see clearly, hear accurately, and so on. Also, aging introduces things that we do not have control of like arthritis, diabetes, sleep disorder, and many more. Aging even affects most of us emotionally. People get depressed from losing all the control that they once has. All these negative ideas leaves most of us with the fear of growing old. However, people need to understand that there are multiple ways to â€Å"age gracefully† and cope with these changes through the advent of medical advancements and growing concerns of aging. We can now cope to the point where we can enjoy the transition from being young to becoming elderly. All people need is a little support as we go through all these changes of being an elderly. One of the most important kind of support that people need is emotional support. We can get these support from our own families and friends. Some people also find comfort by going to their church community or marae based community. Also, here in New Zealand, there are a lot of support groups that can help people who get depressed from not being able to do what we were so accustomed to do. In Auckland alone, there are multiple organisations such as GROW, Balance NZ, Emotions Anonymous, Franklin Depression Support Group, Raeburn House, Men’s Change Support Group, and many more. All of which aims to help those undergoing change and depression. There even is a Depression Helpline. All these networks for us to use so that we can learn a thing or two about battling our demons of aging. Furthermore, there are multiple support organisations that help with common geriatric issues. One for which is Health and Disability Advocacy Service. Advocates help those who think their rights are being violated. In this case, one’s rights to health and disability service. Advocates side with the service-user. They generally listen to one’s concerns, explain your rights, suggest different courses of action, and support the actions that one takes. In New Zealand, this is a free service. This service is very important because it is always nice to have someone behind your back. If things go south, at least you know there is a group willing to listen and help with your health and disability problems. As we all know, Alzheimer’s disease is the most common form of dementia. â€Å"Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks.†[2] (â€Å"Alzheimer’s Disease†, 2011, p. 1). Because of this, I believe that Alzheimer’s New Zealand is another support organization that assists the elderly to cope with this particular disease. They are a non-profit organisation that support people with this disease by giving information and education programmes to aid in better understanding of the disease. They also assist people by giving them useful information on how to provide financial support in availing of further assistance from other supportive organisations. HealthEd is another support organisation that helps with the aging process. Basically, HealthEd provides a list of free health catalogue resources conveyed by the Ministry of Health and Health Promotion Agency. Though they do not provide free services, what they offer is free information. People in New Zealand will be able to access unlimited information about certain health diseases or issues such as arthritis, Alzheimer’s, stroke, and many more. For me, information is very vital because it helps people understand what they have, what they are going through, and how they can cope. There may be information on how to contain the disease, maintain good health, or eliminate the disease all together. Age Concern is also an important organisation here in New Zealand. Their primary focus is to promote the dignity, respect, rights, and wellbeing of older people. Similar to HealthEd, they have many useful articles in their own website about aging. They help the elderly in New Zealand by providing information and support. They want to have a society in which the elderly are included rather than excluded. They want to establish a place where the elderly plays a valued role in the community. Age Concern also helps with social isolation, loneliness, and elder abuse. Finally, the SuperGold Card is one way of showing how much New Zealand appreciates and values the contributions of the elderly. Basically, by having this card, the elderly can enjoy discounts and offers from different establishments. There is no actual retirement age in New Zealand but once elderly can no longer work, they generally have limited funds. Having these discounts will help them enjoy the finer things in life. After all, they do deserve it. Besides the different support organisations, New Zealand also has different service provisions that the elderly can choose to avail. One example is the hospital. Here in New Zealand, there are many private hospital establishments that specialize in elderly care. People who choose to avail this service are those who require hospital level of care. Whoever avails of this service can be assured that qualified clinical staff will be with them for the duration of their stay. Doctors, nurses, therapists, pharmacists, and other medical staff will be present in these establishments. Hospices are another service provision present in New Zealand. Hospice New Zealand (2014) explains that hospice care has a unique whole person approach – which means physical, spiritual, emotional and social needs are equally important – a multidisciplinary team provides care for the person who is dying and their families and friends, both before and after a death.[3] Hospices tailor-fits an elder’s treatment plan based on what he or she thinks is important. If an elderly service user believes that being a part of the community is essential to growing old, then the hospice sees to it that the service user remains part of the community. Based on my current experience, this is done by taking them out of the house and having them do things they like such as bowling or doing the groceries. Residential Care is also a service provision in which the elderly can avail. This is a long-term care given in a rest home which includes rest home care, continuing hospital care, and dementia care. Residents of New Zealand get a Residential Care subsidy through government funding. This is very important because this helps geriatric people financially. Even if the government does not pay all the cost of this service, it is a very big help compared to other countries where they need to spend money from their own pockets. Nursing Homes is similar to Residential Care. The biggest difference is the level of care offered by these homes. Residential Care is more on the activities of daily living while Nursing Homes involves the medical aspect such as giving of medication and providing basic first aid when needed. According to Jenni Wiltz (2013), nursing care facilities provide room, board and care for patients who aren’t able to live on their own or in an assisted living facility due to serious debilitation or a medical condition.[4] Another service provision that is out there is Independent Living services. Adolf Ratzka (2003) defines Independent Living as a philosophy and a movement of people with disabilities who work for self-determination, equal opportunities and self-respect.[5] Independent Living does not mean that the service user does not need any help at all. Independent Living is being able to have the same rights and choices that other non-disabled people have. Even if we grow old, that does not mean we lose the control we have in making choices for ourselves. I also consider Day Care a crucial service provision that can assists the elderly. Before we get old, we enjoy doing different things like swimming, horseback riding, or going to the beach. When we get old, it does not mean we stop liking these things. Day Care is a programme where the elderly can continue to enjoy the things they used to do. In the place I work, we see to it that our service users do things they enjoy. We take them swimming, bowling, laughter yoga, and many more. All these support organisations and service provisions are there for a reason. As an employee of Kindly Residential Care and Rest Home, I believe that the above mentioned organisations and services should be accessed so that our service users can enjoy the finer things in life. By introducing them and their families to these options, our service users will have the dignity to age gracefully. They might even consider this stage in their lives to be the best among the rest and, possibly, look forward to what awaits them in the not so distant future. ANSWER: SOCIAL ISOLATION OF THE INDIVIDUAL AND THEIR FAMILY When people grow old, it is a known fact that they gradually lose the different abilities and skills they once had. This muddles one’s emotions to a point of them losing their own self-confidence thereby choosing to isolate themselves from their families, friends and others. But social isolation isn’t only a result of one’s own doing, society tends to isolate the elderly thinking they are too fragile to do anything. Kindly Residential Care Rest Home understands the importance of being part of a bigger whole. We have partnered with different organizations to ensure that our service users remain part of society. We also have a series of activities and programs that our service user can choose to be a part of such as: Day care Swimming 10 pin bowling Fishing Horseback riding Group recreational activities like coloring, drawing, and painting. Music therapy Laughter yoga Others ASSUMPTION OF AUTOMATIC LOSS OF INDEPENDENCE Society has this concept that the older people get, the more they would need our assistance. Though this is somewhat true, it does not mean these people automatically lose all sense of independence. They may not be able to do the things they used to do but they still have right to independence and choice. In Kindly Residential Care Rest Home, we make sure that our service users are given the dignity to remain as independent as possible through various ways such as: Giving them a chance to choose. They can choose what to wear, what to eat, or what chores they want to do. Encourage and empowering them to do things. Assigning of tasks will make them feel like they are part of a bigger picture. Supporting them as needed. We do not do things for them but we assists them whenever there is a need. Being patient and letting them do things at their own pace. As long as the job is done, it does not really matter how long it takes. Educating the service users, their families, and society. Everyone should know what the service user is going through so that everyone will be on the same page when it comes to caring for the service user. UNABLE TO MAKE DECISIONS ABOUT OWN CARE People often have this misconception about the elderly not being able to make sound decisions about many things especially their own care. Most elderly people retain the ability to make decisions but there are a few that require aid and support. We, at Kindly Residential Care Rest Home, believe in supporting our service users in whatever decisions they make as long as no harm will come to them. By partnering with other organizations, we can assure our service users that they can make the best educated decision regarding their health. Our partners are: Health and Disability Advocacy Service Age Concern Grey Power Carers New Zealand HealthEd Alzheimer’s New Zealand SeniorLine Others DISSATISFYING INTERACTIONS WITH THE MEDICAL COMMUNITY People often write off the elderly because they assume that the elderly have no clue as to what they are doing or as to what is currently going on around them. We live in a fast-paced world and people think that the elderly take too long to catch up. People think the elderly cannot learn new things. Especially in the medical community, medical staff tends to do things for the service user to speed up the process. Instead of giving the elderly a chance to accomplish something, most staff ignores this. This results in both parties having the wrong conception towards each other. Most medical communities feel like the elderly are always unsatisfied with their help while the elderly feel like they are being taken for granted. Kindly Residential Care Rest Home sees to it that every service user is given full attention especially when it comes to their medical status. This can be achieved through: Prioritizing the service user Practicing active listening Personalizing the type of care towards the needs of the service user Quarterly review to check what is working, what needs to be done, and what to improve on. Proper training of staff if needed UNCERTAINTY OF SUPPORT SERVICES AND TREATMENTS People usually fear the unknown. The elderly never had the same access to internet as we do. Knowing and getting specific information about the different support services and treatments out there was very hard to come by. And once they do come by a specific support service or treatment they have not heard of, they will be very skeptical and hesitant to try it. Unlike today’s generation, we can easily read people’s comments and testimonials about a certain support service or treatment. Through those, we can make a sound decision whether to go through with the program or not. Kindly Residential Care Rest Home fully understands this dilemma most service users have and we have dedicated ourselves to helping our service user find the right support service or treatment that best suits them. Because of our vast knowledge and partnership with support organizations, we make sure each service user knows about their options by: Explaining about the program Telling them about the advantages and disadvantages of the support service or treatment Giving recommendations Enrolling them for a trial period if possible Making follow-ups to see if the service user is satisfied with the service BIBLIOGRAPHY http://www.mentalhealth.org.nz/resourcefinder/listings/resource/73/support-groups/ http://advocacy.hdc.org.nz/ http://www.alzheimers.org.nz/about-us http://www.ageconcern.org.nz/ http://www.caughey-preston.org.nz/services/hospital-care/ REFERENCES Tangelder, J. (2014). Aaaaagh! I’m Getting Old. Power to Change: Experience his Power. Retrieved from http://powertochange.com/experience/life/gettingold/ Alzheimer’s Disease: Fact Sheet. (2011). National Institute of Aging, No. 11-6423, Pg. 1. Hospice New Zealand. (2014). What is Hospice? Retrieved from http://www.hospice.org.nz/ Ratzka, A. (2003). What is Independent Living – A Personal Definition. Journal of Independent Living Institute. Retrieved from http://www.independentliving.org/def.html [1] Tangelder, J. (2014). Aaaaagh! I’m Getting Old. Power to Change: Experience his Power. Retrieved from http://powertochange.com/experience/life/gettingold/ [2] Alzheimer’s Disease: Fact Sheet. (2011). National Institute of Aging, No. 11-6423, Pg. 1. [3] Hospice New Zealand. (2014). What is Hospice? Retrieved from http://www.hospice.org.nz/ [4] Wiltz, J. (2013). Residential Care VS Nursing Home. Journal of Livestrong.com. Retrieved from http://www.livestrong.com/article/164027-residential-care-vs-nursing-home/ [5] Ratzka, A. (2003). What is Independent Living – A Personal Definition. Journal of Independent Living Institute. Retrieved from http://www.independentliving.org/def.html

Gravity :: essays research papers fc

Gravity has many benefits to humanity. It holds us to the earth so we do not fall off the earth and die in space. It holds the planets in orbit around the sun, and moons in orbit around their planets. It also holds stars in orbit around the center of the universe. (Gibben, page 14) Sir Isaac Newton thought that God created a perfect universe. He thought our universe was so perfectly designed that if God left the universe could run by itself. This view was extremely different early pagan scientist and offered new views about gravity. (Lindley page 34 and 35). Some two-hundred years later Einstein developed the General theory of Relativity. In this theory he stated that matter disturbs space-time. he said that the universe is like a giant rubber sheet and objects such as stars bend space-time. (Gibben, page 49.) One of a gravity's most complicated features are black holes. Black holes are objects that have as strong or stronger pull of gravity as stars such as the sun compacted into a extremely small space. It is so strong that light can not escape a black hole. It has been proven that black holes leak. The smaller the black hole is the more it leaks. (Gibben, page 46) If a object is put in the path of a black hole the process of spegetification begins. This process begins when an object falls under gravity it stretches and stretches into a long thin object. the only way to get out is by traveling faster than the speed of light. (Gibben, page 63) According to Newton, if the sun was to disappear, the sun's gravity would immediately disappear with it. This would cause the gravitational attraction of the sun and earth to immediately leave into outer space. Then the earth along with all the other planets, moons, and asteroids would fling into space.

Essay --

The Evolution of a Global Economy and Its Effects Relating to Wal-Mart Introduction The whole has been filled with many business challenges and market opportunities. As a result, there have been many changes in the overall turnover of the organization. This paper will focus on financial resources, operating, financial and equity return of the organization. International finance has been a major boost for businesses world over to grow and dominate their sectors. Those businesses that utilize this facility end up being a major success internationally. The use of international finance means that the businesses have more investments, cash flows and capital growth; this increases their chances of growth through investing in global markets. World financial institutions such as; world banks, world trade organizations, commercial banks have been responsible for funding business that have changed over to big businesses making volumes of sales throughout the world. I would like to make my discussion by using Wal-Mart as an example of what is happening in our world. For example, Thomas Friedman, in his book â€Å"The World is Flat†, says that if Wal-Mart were an individual business, it would rank as China’s eighth-biggest trading partner, ahead of Russia, Australia, and Canada. Wal-Mart is a perfect example of a business that has used world finance to retain sustained growth and development. This paper also focuses on world finance and how it has enabled Wal-Mart to grow beyond borders while still a gross profit, it also answers the question how government bodies affect financial decision-making. This paper studies Wal-Mart external business market and its influence on its strategic business contingency plan. Economically, Wal-Mart has enjoyed... ...art has joint ventures in China and several majority-owned subsidiaries. Wal-Mart’s majority-owned subsidiary in Mexico is Walmex. In Japan, Wal-Mart owns 100 percent of Seiyu as of 2008 (walmartstores.com) Wal-Mart also owns 51 percent of the Central American Retail Holding Company, more than 360 supermarkets and other stores in Guatemala, El Salvador, Honduras, Nicaragua, and Costa Rica. Global Impact In 1993, President Bill Clinton signed The North America Free Trade Agreement into law. The trade agreement eliminated all non-tariff barriers to agricultural trade and tariff rate quotas allowing Wal-Mart to import products and export jobs. This had a great financial impact on America. However after seeing the affects this agreement would have on our country, Congress expanded the North America Free Trade Agreement to include over thirty-one additional countries. Essay -- The Evolution of a Global Economy and Its Effects Relating to Wal-Mart Introduction The whole has been filled with many business challenges and market opportunities. As a result, there have been many changes in the overall turnover of the organization. This paper will focus on financial resources, operating, financial and equity return of the organization. International finance has been a major boost for businesses world over to grow and dominate their sectors. Those businesses that utilize this facility end up being a major success internationally. The use of international finance means that the businesses have more investments, cash flows and capital growth; this increases their chances of growth through investing in global markets. World financial institutions such as; world banks, world trade organizations, commercial banks have been responsible for funding business that have changed over to big businesses making volumes of sales throughout the world. I would like to make my discussion by using Wal-Mart as an example of what is happening in our world. For example, Thomas Friedman, in his book â€Å"The World is Flat†, says that if Wal-Mart were an individual business, it would rank as China’s eighth-biggest trading partner, ahead of Russia, Australia, and Canada. Wal-Mart is a perfect example of a business that has used world finance to retain sustained growth and development. This paper also focuses on world finance and how it has enabled Wal-Mart to grow beyond borders while still a gross profit, it also answers the question how government bodies affect financial decision-making. This paper studies Wal-Mart external business market and its influence on its strategic business contingency plan. Economically, Wal-Mart has enjoyed... ...art has joint ventures in China and several majority-owned subsidiaries. Wal-Mart’s majority-owned subsidiary in Mexico is Walmex. In Japan, Wal-Mart owns 100 percent of Seiyu as of 2008 (walmartstores.com) Wal-Mart also owns 51 percent of the Central American Retail Holding Company, more than 360 supermarkets and other stores in Guatemala, El Salvador, Honduras, Nicaragua, and Costa Rica. Global Impact In 1993, President Bill Clinton signed The North America Free Trade Agreement into law. The trade agreement eliminated all non-tariff barriers to agricultural trade and tariff rate quotas allowing Wal-Mart to import products and export jobs. This had a great financial impact on America. However after seeing the affects this agreement would have on our country, Congress expanded the North America Free Trade Agreement to include over thirty-one additional countries.

The Predatory Organism: Bdellovibrio

Identifying the genes and the proteins to be expressed by this organism during pore formation in the host cell will be of significance to bacteriology. The possible use of this information can be seen in the study done by Kadouri and O’toole. It was established in this report that B. bacteriovorus can be used as a control agent against certain biofilm communities. It was observed that biofilm populations of Escherichia coli and Pseudomonas fluorescens were significantly reduced when exposed to B. bacteriovorus.Since biofilm formation is unnecessary and damaging in some instances, inhibition of its formation can be done through natural elimination of the biofilm organisms, and that is through the inoculation of B. bacteriovorus. Another possible application of this predatory organism is through its use as an anti-microbial therapeutic agent. It had been suggested by Hobley et al. that the introduction of this organism to a microbial-infected wound can lead to the reduction of p athogenic organisms in the site of inoculation.In this way, the use of antibiotics can be avoided and possible resistance of disease-causing organisms to the applied drug can be avoided. If the genes responsible for pore formation in the host cell will be identified, the organism can be manipulated to increase the genes’ expression. These can then be enhanced and controlled in accordance to the desired amount and time of expression. II. Aims This paper aims to propose a method on how to determine the necessary and significant enzymes involved in pore formation of the host cell by Bdellovibrio bacteriovorus H100.The specific aims are as follows: 1. Identify the genes of B. bacteriovorus H100 specifically expressed during pore formation in the host cell during the predatory life cycle phase of the organism using time course Microarray analysis. 2. Identify specific hydrolytic enzymes expressed by the identified genes of B. bacteriovorus H100 involved in pore formation on host c ell membrane. III. Background The discovery of Bdellovibrio by Stolp and Starr in 1962 opened the scientific world to the dawn of a new organism- a bacterium which preys on its own kind (12).This bacterium is a curved rod, Gram negative organism classified under the group of delta-proteobacteria. It is a motile bacterium; monotrichously flagellated; obligately aerobic; small in size (0. 3 ? m in width and 1-2 ? m in length); and is obligately predatory. Its genome consists of 3. 85 mega base pairs. Most of these genes encode for enzymes involved in hydrolysis and flagella involved in host sensing (3). The best known species of Bdellovibrio is B. bacteriovorus, observed to prey on other Gram negative organisms such as Salmonella, Escherichia coli, Sphaerotilus natans and Pseudomonas fluorescens (1).The distribution of Bdellovibrio bacteriovorus is observed in diverse environments; therefore, it is considered to be an ubiquitous bacterium. It was associated in dry environment such as the soil; in wet locations such as brackish water, sewage, fresh water, pooled reservoirs and sea water; and in unique microbial niches such as biofilms (3). The life cycle of this bacterium consists of two stages. The first stage is the so-called free-swimming attack phase and the second stage is known as the intraperiplasmic replication phase. Figure 2 shows a graphical representation of these two stages.The life cycle of B. bacteriovorus takes about three hours to complete. For the initiation of the attack, the monotrichous flagellum is an important facet to consider. Movement is essential in finding the suitable host in the environment. The predatory organism moves towards a region with a high prey concentration. This process is meditated by chemotaxis. It can be seen from the illustration that a critical stage in the predation of B. bacteriovorus is the ability of the organism to penetrate its host bacterium. Upon contact with another Gram negative, B.bacteriovorus then forms a pore in the cell membrane of its host. Initial entrance of B. bacteriovorus is followed by the organism’s penetration of the periplasm. Bdellovibrio bacteriovorus then occupies the periplasmic space of the host cell (3). Without this phase, the other steps in the whole life cycle of the organism cannot be ensured to occur. Figure 3 and 4 shows an electronmicrograph of B. bacteriovorus attaching to a host cell. A specific strain of the bacterium, B. bacteriovorus HD100, was studied by Rendulic, et al. This strain of Bdellovibrio was found to have an unusually large genome.Though this bacterium preys on other Gram negative organisms, its genetic make-up did not comprise of any gene from its host. Furthermore, it was elucidated that the genes present in B. bacteriovorus HD100 are made up of gene families coding for enzymes such as hydrolases and transporters, important in the penetration and killing of the host. These genes also code for enzymes needed for uptake of complex mol ecules (6). One hurdle in studying the molecular characteristics of this organism is its host dependent nature. Without a suitable host, growth cannot be ensured, thus, elucidation of its genetic make-up may be difficult to achieve.Further studies using this bacterium revealed that Bdellovibrio can generate mutant cells that do not require host cells for growth and are therefore known as host independent (HI) strains. Despite this, they were able to retain the ability to grow on prey and hence are termed as facultative predators. For gene manipulation techniques, HI strains are usually used (8). Despite the fact that the complete genome of the organism was already sequenced, the specific genes coding for the needed enzymes to form pores in the host cell were still unidentified.With this lack of information, this study is formulated and designed. IV. Research Design and Methodology Culturing of B. bacteriovorus HD100 on prey dependent and prey independent set-ups: Predatory (HD) cult ures of B. bacteriovorus HD100 will be grown on E. coli in Ca2_-HEPES buffer at 30Â °C, with shaking at 200 rpm (8). Escherichia coli ML35 and E. coli W7-M5 (10) will be used as the prey throughout the experiments. Escherichia coli ML35 will be cultured in nutrient broth (Difco Laboratories), and E. coli W7-M5, a lysine and DAP auxotroph, will be cultured in nutrient broth supplemented with 0.2 mM lysine and 0. 1 mM DAP at 37Â °C with shaking at 200 rpm. Prey-independent HI strains will be plated on rich peptone-yeast extract (PY) medium (8). Synchronous cultures: Synchronous cultures will be used for performing various experiments as described below. Briefly, fresh bdellovibrios will be added to prey cells in HM buffer (3 mM N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid (HEPES)-1 mM CaCl. LQ. One mM of MgCl2 will be adjusted to pH 7. 6 using NaOH (10). The organisms will be grown until a final concentration of 1010 bdellovibrios per ml and 5 x 109 E.coli per ml is reached. For proper aeration, volumes will be kept to ? 20% of the flask’s volume and incubated at 30Â °C with shaking at 400 rpm. Synchronous cultures will be examined at intervals for attachment and penetration with a Nikon model L-Ke microscope (Nippon Kogaku Inc. ) equipped with phase-contrast optics and a Nikon model AF camera. Time course Microarray analysis. Time course Microarray analysis will be performed to identify the genes to be expressed during the entry phase, specifically during pore formation on the host cell membrane of B.bacterovorus H100. Microarray slides of B. bacteriovorus H100 will be ordered from Advanced Throughput, Inc Services. Total cellular RNA will be extracted from B. bacteriovorus H100 cells at entry phase using the RNeasy mid kit (Qiagen). The RNA of the organism will also be extracted during the other stages of infection. This will serve as a reference for comparison of the genes expressed and not expressed at the desired stage. Complementary DNA sy nthesis, fragmentation, labeling, hybridization, staining and washing will be performed according to the Affymetrix B.bacteriovorus H100 GeneChip array expression analysis protocol (Affymetrix). Briefly, cDNA will be synthesized from RNA using Superscript II (Invitrogen) according to the manufacturer’s instructions. RNA will be removed by alkaline treatment and subsequent neutralization. Complementary DNA will be purified with QIAquick PCR purification columns (Qiagen). Purified cDNA will be fragmented by DNase I (Amersham) at 37Â °C for 10 min followed by end labeling with biotinddUTP, using an Enzo BioArray terminal labeling kit (Affymetrix), at 37Â °C for 60 min.Hybridization will be performed in an Affymetrix GeneChip hybridization Oven 640. Washing and staining will be performed using an Affymetrix Fluidics Station 400. Arrays will be scanned with an Agilent GeneArray Scanner G2500A. GeneChip scans will be initially analyzed using the Affymetrix Microarray Suite 5. 1 s oftware, from which PivotData tables will be exported. Raw data from the PivotData Tables will be analyzed in GeneSpring software version 6 (Silicon Genetics), using the parameters suggested by Silicon Genetics for analysis of Affymetrix Microarrays. Real-time PCR:Real-time PCR using the Applied Biosystems 7500 Real-time PCR system will be performed to confirm microarray results. RNA will be extracted from B. bacteriovorus H100 at initial phases of predatory life cycle up to entry phase as described above. RNA will be reverse transcribed into cDNA and simultaneously labelled using the iScript One-step RT-PCR kit with SYBR Green (Biorad). RT-PCR reactions will also be performed to amplify cDNA of housekeeping genes (identified from micro array studies) for normalization of fluorescence values. Identifying the specific hydrolytic enzymes of B.bacteriovorus which are involved in pore formation on host cell membrane. Many experiments showed that B. bacteriovorus H100 releases hydrolytic enzymes during predatory life cycle. According to Thomashow and Ritterberg, glycanases and lipopolysaccharideases are required for pore formation in the prey’s peptidoglycan and LPS layers respectively. The glycanase and/or peptidase could be responsible for weakening the peptidoglycan layer of the prey and thereby responsible for permitting conversion of the substrate cell to a spherical shape (10).Tudor et al. proposed another model for penetration. According to them peptidase is responsible for pore formation but not glycanase (11). Specific enzymes involved in pore formation are not known. The genes identified from the time course micro array technique will be mutated as described previously using suicide vector pSSK10. Resulting mutants will be complemented by using vector pMMB206 (8). Mutants will be analysed for the specific enzymes (using 2D-gel electrophoresis) and their actions on host cell i.e, as a glycanase, LPSase or peptidase will be observed by radio labellin g experiments (10). Wild-type B. bacteriovorus H100 and complemented strains will be used as controls. Radio labeling experiments: Escherichia. coli W7-M5, auxotroph for lysine and DAP and cannot metabolize glucosamine, will be radiolabelled as described previously (9,10). Peptide portion of E. coli W7-M5 peptidoglycan will be labelled with [3H] DAP and the lipopolysaccharides and glycan portions of the peptidoglycan will be labeled with [3H]glucosamine.Various mutants and wild-type strains will be tested for predation using this radiolabelled strain. Solubilisation of glucosamine and DAP from labelled prey peptidoglycan will be measured as described previously (11). Briefly, samples taken at intervals will be precipitated with an equal volume of cold 10% trichloroacetic acid for 30 min followed by centrifugation. Resulting supernatants will be assayed for soluble radioactivity in a scintillation counter (Rackbeta II). Two-dimensional gel electrophoresis: The hydrolytic enzymes rele ased by B.bacteriovorus H100 during its predatory life cycle will be analyzed by performing two-dimensional gel electrophoresis. Sample preparation for 2D-gel electrophoresis: Escherichia coli ML35 cells will be challenged with B. bacteriovorus H100 wild-type as well as the mutant strain. Culture fluid will be drawn from synchronous cultures during attachment and entry phases of B. bacteriovorus H100. Culture fluid will be centrifuged to discard any cell debris. Proteins in the supernatant will be precipitated using cold acetone. The precipitated proteins will be separated by centrifugation.The precipitated pellet will be air dried and will be dissolved in rehydration solution (8M urea, 2% CHAPS {3-[3-cholamidopropyl)-dimethylammonio]-1-propanesulfonate}, 18 mM DTT, 0. 5% IPG buffer pH range 4-7; Amersham Biosciences), plus a trace of bromophenol blue. Sample protein concentrations will be determined using the BCA protein assay (Pierce). Resulting protein pellet will be subjected to 2D-gel electrophoresis. 2D-gel electrophoresis: Two-dimensional (2-D) gel electrophoresis will be performed according to the method of O’Farrell.Proteins present in the pellet will be resolved on two-dimensional gels using the products and protocols of Amersham Pharmacia Biotech. In the first-dimension, proteins will be resolved by isoelectric focusing on a precast Immobiline DryStrip with a linear pH gradient. This will be followed by electrophoresis using sodium dodecyl sulfate polyacrylamide gel on 12. 5% acrylamide gel. For analytical 2-D gel electrophoresis, 100 ? g of sample protein will be applied to the gels and the proteins will be stained with Pharmacia Biotech silver stain kit.For preparative two-dimensional protein gel electrophoresis, 500 ? g of the sample protein will be loaded on the gels and proteins will be visualized using Coomassie blue R-350 (Phast Gel BlueR; Amersham Pharmacia Biotech). Spot analysis will be carried out using PDQuest Image Analysis softw are (BioRad). Spots absent from the mutant sample gel will be manually excised from the wild-type B. bacteriovorus H100 sample gel for identification. Mass spectrometry and protein identification: Excised protein spots of interest will be destained, reduced, carboxymethylated, and digested with trypsin in situ.This will be done overnight with a temperature of 37Â °C as described (8). Gel digests will be centrifuged, and an aliquot of the supernatant will be taken for analysis using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Lists of peptide masses will be generated and searched against the NCBInr database using the Mascot protein identification system (Matrix Science; http://www. matrixscience. com). Sequences of proteins identified by Mascot will be analyzed for a predicted signal sequence using SignalP 3. 0 (http://www. cbs. dtu.dk/services/SignalP/). V. Conclusion The identification of genes responsible for the expression of hydr olytic enzymes of Bdellovibrio bacteriovorus is of significant importance. Since the organism preys on other bacteria, its special attributes must be thoroughly studied and appreciated for possible useful applications. As mentioned earlier, this predatory organism can be used as a control agent against biofilm, as well as pathogenic organisms. Through the use of natural agents to control destructive and disease-causing bacteria, the use of chemicals and antibiotics can be lessened or avoided.Since the rapid evolution of organisms towards resistance and tolerance to anti-microbial substances is becoming more widespread, an alternative approach to these problems can be useful in the world of bacteriology. Thus, the identification of these genes and hydrolytic enzymes is of utmost importance. The elucidation of this information can be used as a primary defence against harmful microbes if this knowledge will be taken advantage. A more effective predatory role can be performed by Bdellov ibrio bacteriovorus if the genes and the hydrolytic enzymes of the organism will be expressed efficiently and constitutively.