Mobility in stroke rehabilitation Essay Example

Mobility in stroke rehabilitation Essay Mobility in stroke rehabilitation BY Itsas0101289 Mobility in Stroke Rehabilitation The purpose of this assignment is to identify the nursing role in the mobility rehabilitation of a patient who had a lacunar ischaemic stroke affecting the right corona radiata. The nursing care and the interdisciplinary management of the impairment will be critically evaluated as well as the patient progress during the stay in the hospital. The patient that will be discussed in this assignment was given the pseudonym of Martha. Martha is a 76 year old female who had a lacunar ischaemic stroke of the ight corona radiata. She has relevant past medical history of hypertension. on admission, Martha was presented with weakness on her left side in both her leg and arm with sensation preserved and no cognitive impairments. The corona radiata is a white matter that contains both descending and ascending axons that carry information from and to the brain cells that make up the cerebral cortex, an area of the brain that is responsible for the processing of conscious information and where the orders to initiate voluntary movements (walking, tapping your foot) first originate (Similima, 2011). These areas of the nervous system activate muscles all over the body to move. Therefore if the corona radiata is affected by a stroke, movement will be interrupted. The type of stroke that affects the corona radiata is called Pure motor stroke and is the most common type of lacunar strokes, accounting for more than 50% of all cases (Similima, 2011). Pure motor strokes cause partial or complete weakness in the face, arm and leg on one side of the body. It can occur in any of these areas, alone or in combination with either of the other two. We will write a custom essay sample on Mobility in stroke rehabilitation specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Mobility in stroke rehabilitation specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Mobility in stroke rehabilitation specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Most commonly, pure motor strokes cause either a combination of arm and leg eakness, sparing the face (this is the case of Martha), or a combination of arm, leg and face weakness. By definition, there is no loss of sensation anywhere in the body, no visual or speech symptoms or higher cognitive impairment (Wityk and Llinas, 2007). The hemiplegia is one of the most common neurological impairments following stroke and it needs to be managed by every member of the medical team all patients have the benefit of the range of expert advice needed for high quality care (NHS, 2010). Multidisciplinary teams (MDT) need to bring together staff with the ecessary knowledge, skills and experience to ensure high quality diagnosis, treatment and care. The MDT meeting is about considering the patients individual case not Just about treating a stroke. To support this, an MDT should take account of the patients views, preferences and circumstances wherever possible when consulting on the care that is most appropriate for the patients condition. MDTs should be alerted if there are significant changes to their recommendations and the reason for this is so they have the opportunity to review and build upon each case The aim of the Multidisciplinary approach to a patient who suffers from a motor impairment is to maximise functional ability by providing time, space for activities, aids and equipment, preventing injury and promoting safety (Woodward and Mestecky, 2011). When caring for a patient it is of the utmost importance to ensure there is no further injury, therefore the communication within the team is crucial. Every member of the team should know what the patient is able to do and how they should be cared for to gain the best rehabilitation. Marthas case was approached this way and her status was discussed twice daily in the handover. Also during the day it is the nurses duty to speak the physiotherapist and get her recommendations. When possible, I found very helpful going with the physiotherapist and doing the daily exercises together enabling me to get a better understanding of Marthas condition and Martha seemed to like the added support. This also gave Martha more confidence around me when doing transfers as sometimes it can be very scary for a patient trying to mobilise when suffering from hemiplegia. Along this the Multidisciplinary meetings were done twice a week with the consultant, the hysiotherapist, the occupational therapist, the ward sister and myself or the nurse who was on duty looking after Martha. Correct positioning and early mobilisation of a patient following stroke is important in preventing potential complications arising from impaired movement which can develope changes in muscle tone such as spasticity. Around 19% of patients suffer spasticity following a stroke associated with pain and which interferes with rehabilitation interventions (Woodward and Mestecky, 2011). On admission the physiotherapist performed the Modified Ashworth Scale and Martha scored 1 which eans that there was slight increase in muscle tone. This was manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension (Bohannon and Smith, 1987) (Woodward and Mestecky, 2011). From the beginning Martha used to hate being in bed and after being assessed by the physiotherapist making sure she was safe to do so she used to spent most of the time sitting in the chair provided. She was educated to sit well back and in the centre of the chair placing the affected arm well forward n a pillow with the feet flat on floor and knees directly above the feet. She was very comfortable in that position and she always had the nursing bell close to her and used to call us if the pillow fell down or when similar issues arose. However, there were times that Martha was feeling tired and she had to spent longer periods resting. While in bed she usually prefer lying on her affected side so she could be more independent. She liked having two pillows for the head and the affected shoulder was moved well forward placing the good leg forward on a pillow and another pillow placed behind her back. Although her preference was lying on the affected side, after being educated of the complications of immobility she didnt have any problem to lie on the non affected side, especially during the night. The affected shoulder was placed forward with arm on pillow and the affected leg backward on a pillow. Plus an extra pillow was also placed behind her back. Another action taken postulated to be secondary to promotion of anti-gravity muscle activity in the trunk and lower limbs, maintenance or improvement in soft tissue and Joint flexibility, modulation of the neural component of spasticity through prolonged stretch and ltered sensory input, reduction of lower limb spasms and positive psychological effect (Stevenson VL, 2010). At the beginning this was Just carried out by the physiotherapist with the nurses help for safety reasons. Active movements were also performed to increase strength, re-educate movement patterns and improve cardiovascular fitness. Active movements should be encouraged because the effects are greater than those seen with passive exercise alone. These benefits have been seen in studies of people suffering from a stroke (Stevenson VL, 2010). Marthas rogress was incredible and when she left the hospital she was able to walk with a walking stick and the supervision of her daughter or with a zimmer frame and the Modified Ashworth Scale score was O. This was an achievement as when she came she wasnt able to mobilise at all. Another complication that can occur as a consequence of having a mobility reduction is the damage of the skin integrity therefore several tools were done to assess this risk. Within the first 6 hours of admission every patient needs to be assessed using the waterlow assessment and the MUST nutritional screening, also the skin needs to be inspected. Martha got a waterlow score of 17 on admission which placed her at high risk of developing a pressure sore, she was continent of faeces and urine and no pressure sore was found on admission. The taken actions according to NICE guidelines 2005 were to provide her an air mattress, to place her in a position chart ensuring that the prolonged pressure on bony prominences was minimised and ensuring the correct usage of manual handling devices in order to minimise shear and friction damage. Two sliding sheets were provided and the bony prominences were kept from direct contact from one another by using pillows in between them. At the beginning Martha found very difficult to get used to sleep on an air mattress because of the noise but the benefits of using it were explained and she agreed to use it. By talking to her I discovered that she loved listening to music when she was going to sleep and the following day when her family came to visit her, the difficulty of sleeping because of this device was discussed and they brought Marthas iPod with her favourite music which helped her to sleep peacefully through the night. Having a good night sleep is very important for any patient, specially for those who re having rehabilitation as they require a lot energy and strength. Additionally skin inspections were done regularly and Martha, as she wasnt mentally impaired was taught how to inspect her skin. She was shown what the high risk areas were (heels, sacrum, ischial tuberosities, elbows, temporal region of skull, shoulders, back of head and toes) and early signs of skin integrity deterioration (persistent erythema, non- blanching erythema, blisters, discolouration, localised heat, localised oedema and localised induration) (NDNQI, 2013). Regarding general hygiene, Martha required assistance due to her mobility impairment. Such care was provided regularly according to the RCN guidelines that recommends that skin cleansing should be done with mild detergents using warm water to minimise irritation and drying and particularly over bony prominences should be avoided (RCN, 2009). Martha was always very helpful and used to do as much as she could by herself, at the beginning she required more assistance but by the end of her time at the hospital we Just needed to supervise her when going to the shower and she used to do everything by herself. She usually liked to have her shower after the physiotherapist session and his preference was respected as much as possible. Also she didnt like to use the hospital clothes which according to her made her look less sick so the family brought her own clothes. The MUST score obtained was 1 on admission. Adequate nutrition is required by the body for maintaining tissue integrity and preventing tissue breakdown (NPUAP,2009) Due to this score Martha was put on food chart which helped us monitoring her food intake along with daily weight measurements and she was also referred to the dietician on the day of admission who put her on food supplements and which were discontinued when Martha started having a etter food intake. The family was made aware of the importance of having a good food intake and they brought Martha her favourite cakes and homemade food. At the beginning Martha needed assistance with feeding herself as she wasnt able to cut her food, opening leads etc. Assistance was given regularly and the kitchen staff was made aware about her requirements, therefore before serving her food they always used to come and talk to us first as it can be very frustrating not being able to feed yourself and have the food in front of you. Martha had a good progression during her tage in the hospital and she put on 3kg, her food intake was appropriate and she didnt develop any pressure ulcer. When the mobility of a patient is reduced the risk of VTE (Venous Thromboembolism) increases and therefore in a patient who suffers from hemiplegia after stroke should be assessed for this risk and preventive measurements should take place. According to The National Institute for Clinical Excellence (NICE, 2010), recommendations are that all patients should be assessed for risk of developing thrombosis (blood clots) on a regular basis. Martha was assessed on admission scoring 8 using the adapted tool rom Autar 2003 (Version 2PT 5/12) She was assessed again 24 hours after admission and when her mobility was better she was reassessed scoring 5. Because of the risk of developing a WE Martha was put on Enoxaparin and all the effects and risks were explained. Current NICE guidance suggests LMWH (Low Molecular Weight Heparin) prophylaxis for acute medical patients at WE risk unless there is a high bleeding risk (NHS, 2012). Stockings were not put on her because according to the Clots in Legs or Stockings after Stroke (CLOTS) trial 1 GECS (can even present a greater risk to patients f skin breaks, blisters, ulcers and skin necrosis (CLOTS Trial Collaboration, 2009). Early mobilisation is fundamental to prevent WE along with more risks and that is why this patient was mobilised as soon as possible with the physiotherapist support (NICE, 2010). A very weak arm due to its considerable hanging weight, is at risk of stretching the shoulder Joint structures and developing a partial dislocation or subluxation (Turner- Stokes and Jackson, 2002). Shoulder subluxation is considered a problem because it Many studies have suggested that trauma to the shoulder Joint can be prevented by roper positioning and handling. The shoulder should be protracted, the arm forward, the wrist in neutral or slight supination and the fingers extended. Another important aspect that needs to be considered is not to pull from limbs when doing transfers, especially from the affected one. Therefore Martha and family were educated not to do so. An arm sling was provided to her to support the affected arm. However,the sling was only used while doing transfer. When she was sitting on the chair a lap tray was provided positioning the arm away from the body, discouraging dduction and internal rotation and allowing bilateral upper limb activities (Turner and Jackson, 2002). Martha didnt develop a shoulder subluxation during her stage in the hospital. This was confirmed by an X-Ray that was taken to ensure there was no underlying problems. However she had pain on the shoulder and that is why this X- Ray was performed initially. Hemiplegic shoulder pain, or post stroke shoulder pain, occurs in at least 30 percent of patients although another estimate placed it at 70 percent . Post stroke shoulder pain can adversely affect both length of in patient ehabilitation and overall functional outcome (Woodward and Mestecky, 2011). Martha was on regular paracetamol but she wasnt put on NSAlDs from the beginning. When she started to feel this pain the consultant was informed who requested an X-Ray, the physiotherapist and the rest of the team were also made aware of the troubles. The consultant also put the patient on PRN Ibuprofen which was very effective in reducing the pain levels. I consider that the approach to this risk wasnt the most effective one as Martha suffered from shoulder pain and it can be an area to improve for future patients. However the communication within the team was very successful and the problem was solved in a short period of time. Another recommendation for the future supported by evidence based documentation could be the practice of passive movements which improve the spasticity (Lynch, et al. 005). After suffering a stroke the person can suffer an alteration on the body image understanding as such as the beliefs and feelings about how our bodies look and function. This is influenced by what we think we should look like, and how we think our bodies should perform. In Marthas case the main issue for her was the loss of unctionality of half of her body. Martha went from being able to perform all the activities of the daily life by h erself to require assistance for most of them. Successful adjustment and adaptation to this new situation depend on how well the acquirement of the new knowledge is and skills needed in order to get on with her life. (Woodward and Mestecky, 2011). The rehabilitation team role was crucial here because we needed to teach her new skills and this was achieved by good coordination and communication within the team. It was very important to proceed in the same way and reinforce the knowledge. As supportive measures a board was used to remind Martha the steps she had to follow and also it was very helpful for her family as they knew which was the appropriate way to help her mother. Also setting realistic goals was very positive for her as every day she had a new challenge to achieve and that kept her motivated. Motivation also plays a vital role in with the way in which a patient evaluates their chances of successful rehabilitation and that this is influenced by social or external factors (Woodward and Mestecky, 2011). Martha as already mentioned was always motivated to improve her skills and his had a very positive impact on her evolution. Also she had a very good support from her family who was always there to help her and a good support from the health team. After 5 weeks of rehabilitation Martha was discharged being able to perform the activities of the daily life by herself, walking with a walking stick and assistance from her daughter or with a zimmer frame. She went to a nursing home for a couple of weeks while they were adjusting her house for her (she lived with her daughter). After she was seen by the team (consultant, physiotherapist) as an outpatient and she also came to visit the team to the ward. Reference list Bader ,M and Littlejohns, L (2004) AANN Core Curriculum for Neuroscience nursing. th edition. Missouri. Saunders Bohannon, R. and Smith, M. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy 67(2): 206. Jun Hao Pan, Xin Yuan Song,; Sik Yum Lee, Timothy Kwok, (2008) Longitudinal Analysis of Quality of Life for Stroke Survivors Using Latent Curve Models. Stroke. Lynch, D; Ferraro, M; Krol, j; Trudell, C M; Christos, P and volpe, B T . (2005) Continuous passive motion improv es shoulder Joint integrity following stroke Clinical rehabilitation. Available at: http://cre. agepub. com/content/19/6/594. full. pdf *html (Accessed 9 March 2013) National Institute of Clinical Excellence (2010) Venous thromboembolism reducing the risk: full guideline. Available at: http:// www. nice. org. uk/nicemedia/live/12695/47200/47200. pdf (Accessed 8 March 2013) National Institute of Clinical Excellence (2001) Clinical practise guidelines, Pressure ulcer risk assessment and prevention, recommendations 2001. Available at: http:// www. nice. org. uk/nicemedia/pdf/clinicalguidelinepressuresoreguidancercn. pdf. Accessed: 6 March 2013) National Pressure Ulcer Advisory Panel (NPUAP) (2009) The Role of Nutrition in Pressure Ulcer Prevention and Treatment. Available at: http:// www. npuap. org/wp-content/uploads/2012/03/Nutrition-White-Paper-Website- Version. pdf (Accessed: 25 March 2013) NDNQI (2013) Pressure ulcers training. Available at: https://www. nursingquality. org/NDNQlPressureUlcerTraining/Module1/ Default. aspx (Accessed: 25 March 2013) NHS (2010) CLOTS trial 2: Thigh length versus below knee stockings for DW prophylaxis post stroke. Available at: http:// www. nelm. nhs. /en/NeLM-Area/News/2010September/21 /CLOTS-trial-2-Thigh- length-versus-below-knee-stockings-for-DVT-prophylaxis-post-stroke/ (Accessed: 6 April 2013) NHS (2010) The Characteristics of an Effective Multidisciplinary Team (MDT). Available at: http://ncat. nhs. uk/sites/default/files/ evidence. Available at: http://www. evidence. nhs. uk/documents/]-nhs-evidence-comms-publications-eyes-on- evidence-eyes-on-evidence-sle ep-apnoea-thromboprophylaxis-contraception-stroke- diabetes-and-more. pdf (Accessed: 6 April 2013) Royal College of Nursing (2009) RCN Masterclass (2009): Continence, Pressure Ulcers and Nursing Metrics. Available at: http://www. rcn. org. uk/_data/assets/pdf_file/0004/280777/Dettorri_M_Collier_ppt. pdf. (Accessed: 25 March 2013) Royal College of Nursing (2013) Preventing VTE. Available at http://www. rcn. org. uk/ development/practice/cpd_online_learning/ nice_care_preventing_venousthromboembolism/preventing_vte (Accessed 7 March 2013) Stevenson VL. (2010) Rehabilitation in practice: Spasticity management, Clin Rehabil 2010 24: 293. Available at http://cre. sagepub. com/content/24/4/293. full. pdf *html (Accessed: 7 March 2013) Similima (2011) Corona radiata. Available at: http:// www. similima. m/physiology-biochemistry (Accessed : 6 March 2013) Thompson H and Ryan A (2008) A review of the psychosocial consequences of stroke and their impact on spousal relationships. British Journal of Neuroscience Nursing Vol 4 No 4 pp 177- 184 Turner-Stokes L, Jackson D. Shoulder Pain After Stroke: A Review of the Evidence Base to Inform the Development of an Integrated Care Pathway. Clinical Reh abilitation, 2002: 16:276-298. Wityk, R and Litnas, R. (2007) stroke. Philadelphia : American College of Physicians Woodward, S. and Mestecky, AM. (2011) Neuroscience Nursing Evidence-Based Practice. Chichester:Blackwell Publishing Ltd.

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The Career Criminal Essays - Criminology, Criminal Law, Crime The career criminal The career criminal, or, more pointedly, those individuals who participate in criminal acts on a regular basis for both a central and constant source of income has, generally, a specific set of identifying factors which, while conclusive in laymen's terms, fail to meet the criteria necessary for scientific inquiry. While definitions exist as to what a career criminal is, the research methods employed in determining these definitions are a large point of contention for criminal justice theorists, especially due to their potential and virtually imminent inclusion to modern hypothesis on the subject. These research methods include longitudinal data collection and compilation, cross-sectional data collection and compilation, and, as at least one group of theorists argue, the most efficient method, informative interviewing. The longitudinal research method employs a data collection technique which focuses on the duration of a particular actin this case, the so-called criminal careerbased not upon specific incidents, but the length of time measured between such acts (Blumstein, Cohen, and Farrington, 1988). That is, an individual's propensity for criminal conduct in a so-called career mode would be measured first by the original act as an origin, then with the succeeding acts, until a final point became evident. Therefore, such a research method would logically conclude that an individual who performed or participated in criminal conduct on two occasions several years apart would be considered a career criminal. It is for this reason, that criminal justice theorists differ as to the applicability and relevance of the longitudinal research method (Blumstein, Cohen, and Farrington, 1988). Since the longitudinal research method could construe two independentor even two interdependantcriminal acts as the foundational make-up of a career criminal, theorists may hypothesize incorrectly as to the actuality of an individual having a career based in criminal behavior. Because it is widely believed by opponents of the longitudinal research method that the mere occurrence of two criminal acts spaced out over an individual's lifetime or testing window is not indicative of the so-called career criminal modus operandi, the research method has increasingly lost its popularity and application in such studies, unless, of course, it is supported or otherwise confirmed by other utilized research procedures (Blumstein, Cohen, and Farrington, 1988). One of these alternative testing and research methods is the cross-sectional data collection and compilation model. The cross-sectional data collection and compilation model, when applied to the criminal career hypothezation, measures the probability of occurrence of a particular act of criminal conduct or other so-called criminal behavior. The cross-sectional model allows for a glimpse into each individual criminal act which may be thought to, when compiled, comprise a framework which indicates that individual is a career criminal. For this reason, the cross-sectional model is infinitely more applicable and accurate in determining, or at least providing indicators which would lead to a determination, of conduct constituting that of a career criminal. While such assistance is immeasurable for a determination of whether or not an individual is a career criminal, it still falls short of a definite model for such identification. For this reason, many criminal justice theorists feel that the individual application of the cross-sectional model is inappropriate for its unsupported inclusion into relevant scientific hypothesis. Once again, however, when such data is adequately supported or otherwise confirmed by other information, inclusion is proper. Criminal justice theorists have relied on either one, or both models since the inception of investigation into all areas of criminal behavior. Such data, however, comes under fire if, and when, other theories surface which either provide additional information, or information which is more in-depth and in deference to that data already obtained and reported upon (Gottfredson and Hirschi, 1988). The dilemma, of course, is that regardless of how detailed and in-depth even the most comprehensive of testing techniques are, there is always one method which is the most detailed, as it originates from the primary source. This data is called informative interviewing (Gottfredson and Hirschi, 1988). Informative interviewing is a method through which criminal justice theorists acquire information from the primary source (Gottfredson and Hirschi, 1988). In the case of the present issue, deliberating over the question of what behavior is indicative of a career criminal, information would most probably be

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Analysis of India and Stagflation Literature review

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4P Marketing Essay hese are the basic elements of the MARKETING PLAN for any business. PRODUCTThe business has to produce a product that people want to buy. They have to decide which market segment they are aiming at age, income, geographical location etc. They then have to differentiate their product so that it is slightly different from what is on offer at present so that people can be persuaded to give them a try. PROMOTIONCustomers have to be made aware of the product. The two main considerations are target market and cost. A new business will not be able to afford to advertise on national television, for instance and would not wish to because its market will be local to start with. Leaflets, billboards, advertisements in local newspapers, Yellow Pages and word of mouth would be more appropriate. PRICEThe price must be high enough to cover costs and make a profit but low enough to attract customers. There are a number of possible pricing strategies. The most commonly used are PENETRATION PRICING charging a low price, possibly not quite covering costs, to gain a position in the market. This is quite popular with new businesses trying to get a toehold. CREAMING the opposite to penetration pricing, this involves charging a deliberately high price to persuade people that the product is of high quality. Luxury car makers often use this strategy COST PLUS PRICING this is the most common form of pricing. Costs are totalled and a margin is added on for profit to make the total price. PLACEThe business must have a location that it can afford, and that is convenient and suitable for customers and any supplier. The Marketing mix is a set of four decisions which need to be taken before launching any new product. These variables are also known as the 4 Ps of marketing. These four variables help the firm in making strategic decisions necessary for the smooth running of any product / organization.These variables are Product

Leadership Essay -- Interpersonal Trustworthiness

The problem to be investigated is how the gap of trust between leaders and followers, weakens employees’ commitment, harms wealth creation, and produces augmented transaction expenses in organizations all over the world (Caldwell, Hayes & Long, 2010). Scandals involving large corporations in recent years have led to calls for more attention being given to ethical behavior within companies, particularly among company leaders. A research area of interest is how ethical behavior among leaders impacts the environment of an organization and the behavior of its staff, including employees’ organizational dedication (Organizational Behavior Application Guide, 2011). Trust between leaders and a follower is essential for a company to be successful. If the followers don’t feel as if they can trust the leaders then there will not be open lines of communication within the company and without those nothing can get accomplished. Leaders today’s face the challenge of earning the trust and commitment of staff members if they want to steer their companies to success in a highly aggressive international framework. Interpersonal trustworthiness is a personal evaluation of the probability that another person can be trusted to respect responsibilities intrinsic within an apparent social contract. The connection amid leader behavior and leader trustworthiness becomes a function of each person’s theoretical thinking as followers infer the understood and explicit elements of the social contract and the values that social contracts include. More and more, scholars have recognized the leader–follower connection as a chain of psychological contracts that increase to the level of a covenantal association (Caldwell, Hayes & Long, 2010). Leaders e... ...ched and that no matter what they do, right or wrong, someone always knows about it. Unethical behavior is something that is not easily overlooked or forgiven in the business arena and once a breach has been identified it takes a big toll on the company and reputation for a long time to come. Organizational behavior is always in the spotlight and should be carried out in the most ethical way possible. The opportunities and benefits that are lost in the end from leaders who are not ethical are tremendous to most companies. Many times the damage that is done is beyond repair and sometimes costs the company its existence in the end. It is very important that organizations make sure that they have good ethical policies in place to guide leaders in the decisions that they make since they not only affect them personally but affect the company as a whole.

Symbolism in The Glass Menagerie

The Glass Menagerie, by Tennessee Williams is a short drama that uses a big assortment of symbolisation throughout to depict the emotional, physical and societal province of each of its characters. Laura is a really delicate immature adult female that lives in a lower category, moth-eaten flat with her older brother Tom, and her bizarre female parent Amanda. Laura feels as though she is an castaway in contrast to the remainder of the universe. Among the many perennial subjects of this drama the breakability is shown in a small unicorn that safely exists within a glass menagerie. There are other less outstanding symbols such as the colourss of a rainbow, bluish roses, and the issue, and entryway to the flat. Laura ‘s glass menagerie is an of import symbol. Laura does non desire to be involved with the universe outside this â€Å"dark, grim† flat that she lives in with her female parent, a â€Å"proud, vibrant adult female, Amanda, † and her brother â€Å"Tom, an aspiring poet, and shoe warehouseman.† ( ebscohost.com ) . She prefers the comfort of her â€Å"transparent glass animals† ( 478 ) . Laura would instead pass clip with her bantam glass Equus caballuss and unicorn statuette, listening to her old records. She would prefer to make this all twenty-four hours instead than holding any contact with other people. One of the clearest symbolic utilizations of the glass figurines happens at a point in the narrative when Laura and Jim are left by themselves. Laura makes the statement â€Å"You should ever take good attention of your glass.† ( 510 ) Again, we see the symbolism of the glass unicorn and the breakability of Laura. Laura is really diffident and guiltless, really much like the glass figurines she cleans throughout the twenty-four hours. All though it is really delicate, much like Laura herself, the glass radiances and glitters, amplifying many colourss of the rainbow in the visible radiation. The glass unicorn is evidently the most symbolic of Laura! Reading between the lines as Jim and Laura are speaking, it is easy to see that the unicorn represents Laura ‘s remarkably different, delicate, and uncomfortablenss in the normal universe. Jim makes the statement. â€Å"Poor small chap, he must experience kind of lonesome† . It is obvious that Laura has felt only most of her life, and Laura replies â€Å"the unicorn sits on a shelf with some normal Equus caballuss that do non hold any horns, and they all seem to acquire along nicely together.† ( p512 ) During Jim and Laura ‘s short romantic brush, for a minute, Laura is experiencing more assurance. It ‘s as if she is get downing to experience a small normal like her Equus caballuss. When Jim accidently knocks the glass unicorn to the floor, and breaks the horn off. â€Å"The unicorn has lost its horn. It does n't truly count. It may be a approval in disguise.† Laura provinces, and â€Å"I will merely conceive of that it has had some sort of operation.† And â€Å"with the horn removed he may experience less capricious! Now he might experience more like he is one of the Equus caballuss, the 1s without any horns† . ( p513 ) For a minute Laura is happy and uplifted. She begins to smile and experience the tenseness of uniqueness raising from her. Jim sees this and starts dancing about with her, and finally kisses her. All of this gives us the little feeling that Laura may eventually be get awaying the illusory universe in which she has lived for most of her life. Laura is for a minute, get downing to experience more recognized, particularly from Jim. For a minute she is experiencing less witting about her physical disablements. She starts to open up merely a small spot. It ‘s non long after all of this that Jim tells Laura of his battle to another adult female. Laura is broken. She is broken indoors, and no longer feels the same singularity that she one time felt with the glass unicorn. She looks at Jim, and tells him to take the unicorn. It ‘s as if she has let travel of something indoors. Past dream like memories of a love that she one time had for Jim, have now been lost in the world of Jims words. Laura has spent many old ages smoothing, and taking attention of her glass menagerie, and maintaining her unicorn safe from the outside universe. But, now it has been exposed, and in bend it has been broken, merely as Laura has been broken. The dream of possibly, some twenty-four hours holding love from a adult male, and being normal has now been replaced with a broken bosom, and a withdrawn unhappiness. As the introspective and diffident Laura is lost even further in to herself. We begin to see a glance of the symbolisms in the usage of the rainbow and its colourss. But it is less obvious than that of the glass unicorn. The rainbow signifies that there may be some hope in the hereafter. Tom gives Laura a glance of hope, â€Å"Laura is overwhelmed with emotions when Tom pulls out the rainbow-colored scarf and tells the narrative of how a prestidigitator changed a bowl of small fish into Canary Islandss. Towards the terminal of the drama, Tom reflects on Laura as he gazes at some broken colored glass, and imagines his tattered sister Laura and her broken spirit†. ( ebscohost.com ) . Tom wishes in the symbolic sense that he could blow out the tapers of his sister ‘s desperation. He besides reflects on how Laura would pass hours smoothing her glass animate beings, maintaining them safe from the remainder of the universe. There is sad sarcasm in Tennessee Williams drama when you think about the symbolism of the rainbow. Although rainbows seem to be positive, bright, and hopeful marks that a new twenty-four hours is coming shortly, there is normally much hurting that must be endured before that clip, if it of all time comes. There is rather an array of symbolism that helps to organize the character of Laura. Tennessee Williams uses the colour of blue in Jim ‘s moniker for Laura. Like the rose, Laura is delicate, and like the colour blue, she is diffident, guiltless, and really sad. Plants Cited Fambrough, Preston. â€Å" William ‘s The Glass Menagerie. † Explicator 63.2 ( Winter 2005 ) : 100-102. Academic Search Complete. EBSCO. Northwestern State U, Watson Lib, Leesville, LA. 17 Mar. 2008 & A ; lt ; hypertext transfer protocol: //search.ebscohost.com & A ; gt ; . Reese, Jennifer. â€Å" The Glass Menagerie. † Entertainment Weekly ( 28 Apr. 2006 ) : 143-143. Academic Search Complete. EBSCO. Northwestern State U, Watson Lib. , Leesville, LA. 17 Mar. 2008 & A ; lt ; hypertext transfer protocol: //search.ebscohost.com & A ; gt ; . Williams, Tennessee. â€Å"The Glass Menagerie† Literature for Composition: Writing Arguments about Essays, Fiction, Poetry, and Drama erectile dysfunction. by Sylvia Barnet, William Burto and William E. Cain†¦8ThursdayEd New York. 2007: 499-519.

Buddhism, Legitimation, and Conflict: The Political Functions of Urban Thai Buddhism Essay

Ideally, Buddhism is a religion with a huge following whereby the believers in the religion follow and interact socially with the Dharma doctrine which is basically what the Buddha taught or his way of living. Dharma is the path to attain such enlightenment and the teachings of Buddha and through the following of Buddhists traditions shows the variances in attaining Dharma and reaching enlightenment. The Buddha way of teaching is only considered helpful to individuals if it is practiced with discipline what the Buddha’s themselves called the VinayaCITATION Jac07 p 44 l 1033 (Jackson 44). The understanding of Buddhism is expressed by the acts of those who abide unwillingly to the apparition of Dharma-Vinaya and preach its beliefs to the masses. Like many other religions, Buddhists have multiple sects and traditions. In essence, the ultimate goal for all Buddhists is to attain enlightenment. Theraveda Buddhism accounts for nearly ninety five percent of the population in Thailand and this shows just how much Buddhism more than any other religion is influential in Thailand. In the long history of the existence of Thailand, the citizens seem to have been predominantly Buddhist by religion at least from the moment they were acquainted with it. Current historical records show that all the previous kings of Thailand were adherents of Buddhism. Most notable is the fact that the Thai constitution clearly states that a Thai King must be a Buddhist and as a result, must be the ultimate upholder of Buddhism. Theravada School of Buddhism has been one of the three major forces that have influence in the country. Despite the existence of substantial regional and local variations, the major themes of Buddhism in Thailand are provided by the Theravada schoolCITATION Mac07 p 87 l 1033 (Mackenzie 87). Traditionally, Pali is the language of religion in Thailand as evidenced by the fact that the scriptures are recorded in Pali through the older Tham and Khom scripts or the modern Thai script. As the primary religious Thai text, Pali is also used in religious rite despite the little number of Thai citizens who understand it. Hindu beliefs from Cambodia also serves are a significant influence on Buddhism in Thailand especially during the Sukothai period. The Thai kingship institution was largely influenced by Vedic Hinduism just as it did in Cambodia which as a result exerted influence in the creation of law and order in the society and religion of Thailand. There are certain rituals that are still practiced in modern Thailand by monks or specialists in Hindu rituals that can clearly be related to Hind practices or of Hindu origin. Essentially, Hindu influence can still be seen within Buddhist ceremonies and institutions in Thailand despite the fact that the visibility of Hinduism within Thai society has diminished significantly during the Chakri DynastyCITATION Suk10 p 34 l 1033 (Suksamran 34). Folk religion is the third major influence on Thai Buddhism as seen in the Buddhist rituals and precepts that are used in trying to appease the local spirits. Although the Thais who have received Western education often tend to define the line between practices of folk religion and Thai Buddhism, this is quite a gray area given the practices of the rural locales. An in-depth analysis of these three influences can clearly be traced through the current development and practices within the political system of Thailand. One of the most striking things that one notices upon arrival in Thailand is the magnificent Buddhist temple with its exquisite architecture coupled with the sight of monks and novices in yellow clad especially in the wee hours of the day. This sight serves as an inevitable reminder to both residents and foreigners of the dominance of Buddhism in the Thai nation Despite the fact that Thailand currently exists as a constitutional monarchy, its political system is quite a reflection of the string Southeast Asian tradition of Buddhist supremacy nature that link the legitimacy of the government to its support and protection for Buddhist institutions. This link has progressed into the modern era as seen in cases where Buddhist clergy and institutions are given special treatment by the Thai government as well as being subjected to a special government oversightCITATION Jac07 p 90 l 1033 (Jackson 90). Besides the cleric leadership of the Sangha, Buddhist temples and monks in Thailand are supervised by a profane government ministry. Good examples of these occurrences have been seen in the legal state of reform movements and Buddhist sects. For example , the case of Santi Asoke received legal prohibition from referring to itself as a Buddhist denomination and in the prosecution of monks who have been persecuted in the case of ordaining women by trying to revive lineage of the Theravada bhikkhuni and in so doing tried to impersonate clergy members hence their demiseCITATION Mac07 p 111 l 1033 (Mackenzie 111). A further examination of the Buddhist ways reveals certain themes and guidelines in the religious teachings of Buddha. The Srakakayana literally translates as the disciples. This is important to the Thai faith because as Buddhists listen to the teachings of Buddha and practice the teachings therefore becoming disciples. They thus listen to the text and scriptures then they can f ind their way to salvation. Generally, this concentration allows them to realize Dharma through listening and practicing. For a monk in Thailand to obtain a passport in order to travel abroad, one must have a Buddhist monk identification card, an official letter granting the permission to travel outside Thailand from the Sangha Supreme Council, any initial Thai passport or a certified equivalent thereof and a copy of House Registration. Beside these insurmountable acts of state recognition and support from the Thai state like the official gifts to monasteries from officials within the royal family and the government , Buddhist monks have quite a number of special rights bestowed upon them. Buddhist monks have access to free public transportation in airports and train stations where they often have special seating allocations. There is no law that directly forbids members of Buddhist institutions like monks and nuns from being candidates in the enrollment for recruitment as government officers. However, both the Sangha Supreme Council which serves as the supervising agency for Thai Buddhist communities a nd the Council of Ministers have placed such prohibition in cases of appropriateness in accordance with the Memorandum of the Administrative Department of the CabinetCITATION Suk10 p 127 l 1033 (Suksamran 127) . On the contrary, it is a crime for ordained monastic to stand for office or vote in elections. No member of the Buddhist community or other religious communities is entitled to either elect or be elected for any government position. The Thai constitution disfranchises a monk, novice, clergy member or priest of Buddhist religion from holding any government post. In addition, any member who is elected as a representative will lose membership upon becoming a Buddhist monk, nun or clergy. This illustrates a clear fact that Buddhist members are not in any way appropriate for Thai politics. The existence of Buddhists members like monks and nuns highly depends on the respect of the public and as a result, society expects them to behave in a way that calls for respect for the entire public and not a specific affiliate communityCITATION Jac07 p 221 l 1033 (Jackson 221). Any involvement by a Buddhist member either in support or participation of an election is considered a breach of the unusual conduct of the law and the Buddhist member is considered to have disgraced his religion, community as well as himself. Thus failure of monk or nun to uphold these stipulated rules is ground enough for them to condemned, disrespected and balked at in various ways. Since 2007 there have been several calls by Thai Buddhists to acquire recognition within the new constitution of Thailand as a state religion. Initially, this suggestion received rejection from the committee that was responsible for drafting the new constitution which consequently triggered quite a number of protests from those who supported the initiative such as a hunger strike by twelve of the Buddhist monk and various protest marches within the capital of ThailandCITATION Mac07 p 210 l 1033 (Mackenzie 210). Opponents of the plan, including Sulak Sivaraksa who is a renowned Thai social critic and scholar, did so based on claims that political gain is the driving force behind the call to declare Buddhism as a national religion and that it may have manipulated by the Thai supported Thaksin Sinawatra who had just been ousted as the country’s Prime Minister. As expected the Committee drafting the constitution later on failed to vote in support of the special status of Buddhism and in so doing provoked intense reaction from religious groups which criticized the committee for being impartial to religious affiliates. The issue also caught the attention of the Queen of Thailand who raised concerns over the matter and on her birthday, she delivered a speech through which she highlighted the notion that Buddhism goes way beyond politics. The reclusive politics of Thailand is in complete upheaval. The Sangha can no longer be dismissed as political force and simply perceived as a legitimacy fount for the country and for the monarchy. The role played by hundreds of monks in ProThaksin redshirts between March and May of 2010 are a clear proof of the growing apprehension within Buddhism. However, beyond these intense displays of complete lack of satisfaction, an important fact is the Buddhism and in this case the Sangha, faces quite a number of serious challenges. From a Buddhist perspective, the solution of Thailand’s approach to Buddhism is twofold. First and foremost, there should be a link between Buddhist base communities in Thailand to create a relatively decentralized society that can thereafter serve as a model for religion. The second solution lays in the attainment of a society that is more just on a national level through fighting for political reforms steered by Buddhist thinkers. The newly established Thai constitution that includes a democratic process that is reformed with a balance of power and structural check serves as a stepping stone towards structural change within Thailand’s political system. References Jackson , Peter A. Buddhism, Legitimation, and Conflict: The Political Functions of Urban Thai Buddhism. Bangkok: Institute of Southeast Asian Studies, 2007. Mackenzie, Rory . New Buddhist Movements in Thailand: Towards an Understanding of Wat Phra Dhammakaya and Santi Asoke. New York: Routledge, 2007. Suksamran, Somboon . Buddhism and Politics in Thailand: A Study of Socio-political Change and Political Activism of the Thai Sangha. Bangkok: Institute of Southeast Asian Studies, 2010. Source document

Italian Future Indicative Tense

Italian Future Indicative Tense The future shows a simple fact that has yet to occur or come to fruition: Arriverà ² domani.Terminerà ² il lavoro entro una settimana. The future can take value imperative: Farete esattamente come vi ho detto.Imparerai questa poesia a memoria. BRANDIRE GUSTARE RIDURRE VINIFICARE io brandir guster ridurr vinificer tu brandirai gusterai ridurrai vinificerai lui, lei, Lei brandir guster ridurr vinificer noi brandiremo gusteremo ridurremo vinificeremo voi brandirete gusterete ridurrete vinificerete loro, Loro brandiranno gusteranno ridurranno vinificeranno CONJUGATING ITALIAN VERBS IN THE PRETERITE PERFECT INDICATIVE TENSE Word formation in Italian is the linguistic process (think vocabulary building) in which terms can be transformed from base words to suffissati (suffixed words)- orologio  Ã‚ »Ã‚  orologiaio, prefissati (prefixed words)- campionato  Ã‚ »Ã‚  precampionato, and composti (compounds)- fermare carte  Ã‚ »Ã‚  fermacarte. The formation of words enriches the Italian language from within. In fact, it produces new vocabulary- as in orologiaio (watchmaker), precampionato (preseason), fermacarte (paperweight)- starting with vocabulary that already exists- in this case, orologio (watch), campionato (season), fermare (to hold, detain, secure), and carte (paper). The suffisso (suffix) is the particle that appears at the end of the suffixed, for example -aio in orologiaio. The prefisso (prefix) is instead the particle that appears at the beginning of the prefixed, for example pre- in precampionato. Together, the suffixes and prefixes are known as affixes; the suffix -aio in orologiaio and the prefix pre- in precampionato are, therefore, two affixes. Composti (compounds) are formed by the merger into a single word of at least two words; this is the case of fermare and carte in the compound word fermacarte. All Italian speakers can construct, starting from certain basi (bases) and making the necessary modifications, a whole series of new words (the technical term is defined as neoformazione- a compound or derivative recently introduced to the language). So, for example, orologiaio, precampionato, and fermacarte are new words derived from orologio, campionato, fermare, and carte. To go from the base to the new term there are certain rules of transformation. Word Formation Is Not Simple AdditionThe formation of words does not consist in the mere addition of elements: base suffix suffixed; prefix base prefixed; word word compound word. This, in fact, it is only the appearance of the phenomenon. The formation of words instead assumes that the speaker has is fully aware of the meaning of the relationship linking the new word to its base. For example, everyone (or at least native Italian speakers) will recognize in words such as scaffalature and librone a connection to scaffale and libro, but nobody will think that struttura and mattone are linked to strutto and matto. Only in the first case can an equivalence be formulated: insieme di scaffali has the same meaning as scaffalatura (shelf unit)grosso libro has the same meaning as librone (big book, tome) While in the second case: insieme di strutto (lard as a whole) has a different meaning than struttura (structure)grosso matto (big madman) has a different meaning than mattone (brick) As shown, the formation of words in Italian cannot be explained only by taking into consideration the formal relationship that links a base with an affix (-ura, -one, and others); it is also necessary to consider the relationship between the meanings. The formation of words can be divided into three categories: suffissazione (suffixation), prefissazione (prefixation), and composizione (composition).

EXAM QUESTION Coursework Example | Topics and Well Written Essays - 500 words

EXAM QUESTION - Coursework Example The expected cash outflows depend on the bulge of various cost elements, working capital and venture requirement. Particularly the inaccuracy of subjective forecasts and manager tendency to overestimate or underestimate the value of particular actions and its proving useful for evaluating alternatives marketing strategies (Bunn, 2009). It has three components namely value, brand and relationship equity. Value equity refers to customers’ company product assessment based on the offer, price and convenience. McDonalds is an example of a fast food company with a fair pricing policy, and this has raised customer equity and thus had a competition advantage over the competitors in marketing. The customer equity estimate from archived customer’s data enables managers to identify the financial impact of alternative marketing value drivers of the customer’s equity. The areas covered are brand advertising, quality or service improvements, loyalty programs. Through computation, it is possible to determine the economic return for prospective marketing initiative. Estimation of each customer’s lifetime value roots on the data about the frequency of their purchases in a category, the average quantity purchased and historical brand-switching patterns, combined with business’s contribution margin. The necessary purchase data is obtainable from the business’s sales records while brand-switching patterns estimates from either longitudinal panel data or survey data similar to those collected in customer satisfaction studies (Yu-Jia, 2011). It is a term used for an aspect essential for a business or project to achieve its set goals and mission. It is a small number of elements that tend to detach the winners from the losers. It is critical to alter the marketing strategies due to the ever-changing markets in order to meet and satisfy the customer’s needs. An example is in the retailing industry, where location is a fundamental factor. The industry

Discuss the proposition that in choosing to outsource a function Essay

Discuss the proposition that in choosing to outsource a function managers commonly underestimate the potential hazards and costs - Essay Example ..........................................................................................5 Cost cutting...........................................................................................................5 Strategic advantage..............................................................................................5 Underestimated risks and hazards of outsourcing to the outsourcer................................6 Cultural ...............................................................................................................6 Regulatory ...........................................................................................................7 Informational ......................................................................................................9 Organizational ...................................................................................................11 Why and how such limitations and underestimations happen? .................................... .13 Lack of a proper procedure and framework .....................................................13 Unreal perception of the core business and competencies...............................13 Putting wrong person on the job.......................................................................14 Conclusion....................................................................................................................14 References........ ons now try to focus on their core competencies and get external service providers for their supplementary functions to gain instant access to their expertise, service levels and synergistic benefits from the partnership of the two. This has been termed as ‘outsourcing’ in the business jargon and lately assumed much of significance in business scenario (Winkler 2009:22). Caught in the dilemmatic ‘make-or-buy’ decision, organizations and more importantly the managers often underestimate the risks, possible hazards and hidden costs of their outsourcing decision. Superficially, outsourcing seems to provide cheap labour supply, external expertise, synergies in competencies and perfection of all activities but in-depth analysis of outsourcing decision and related factors reveal serious consequences related to labour enforcements, cultural asymmetries, lack of control and governance over the vendor operations, threat of information leakage and many more which have a direct bearing on the financial, organizational and social viability of the outsourcer’s business. This paper seeks to address this emerging situation with a critical knack. Commencing from an introduction and historical overview of outsourcing and reasons why managers outsource, the main body of the paper comprises major risks and potential hazards encountered in effective management of outsourcing decisions. Discussion of underestimated costs in such happenings and why they happen is also included with a checklist to better the proposition. Examples of insurance, shipping and IT industry have been inserted at appropriate places to anchor the understanding of the concept and provide a practical meaning to the underlying aspects. Historical overview of outsourcing The advent of outsourcing dates back to