Wednesday, September 2, 2020
AMRICAN Jewish Striggle Essay Example | Topics and Well Written Essays - 500 words
AMRICAN Jewish Striggle - Essay Example Simultaneously, those from Germany called themselves Ashkenazi Jews (Rosove 50). With the American Independence, the country conceded its residents opportunity which stretched out to religion. Thusly, Jews needed to battle against individuals from their locale contradicting from their Judaic religion to join among different strict tendencies, Christianity, Atheism and common lifestyles. Jews needed to withstand preferences advanced by the opportunity of love in the United States. Beginning from the 1840, American Jews battled against boundless reception of American models in their places of worship which undermined their since quite a while ago held conventions. For instance, rabbis started to consolidate parts of their religion with Orthodox and Protestant American divisions as others looked to embrace the Reform Judaism (Rosove 52). At the point when the American Civil War started, Jews additionally ended up split into Southern ace bondage and Northern abolitionist subjugation Jews. The resulting pressures got hostile to Semitic assumptions America to the front. In the militaries, Jews battled to have their own pastors until the law was altered to permit this (ordinarily, just Christian appointed clergymen involved this job). In 1872, General Order No.1; an enemy of Jewish request required the removal of Jews from General Ulysses Grantââ¬â¢s armed force regiment. Fights by Jews made President Abraham Lincoln invert the request (Sarna and Golden). Governmental issues, especially before and after World War II has introduced a difficult presence for American Jews. The oppression of Jews by the Stalinist system in Russia, the Nazi system in Germany and the Holocaust show appearances of Jewish battles that represent noteworthy migration to the U.S (Charters 24). After 1948, American Jews have battled with loyalty and political character issues around the feeling of having a place with the Zionist country of Israel and the U.S. The Palestinian and Arab World test on the
Saturday, August 22, 2020
The Life and Works of Krzysztof Kieslowski essays
The Life and Works of Krzysztof Kieslowski articles Notable chief Krzysztof Kieslowski, has expressed that he despises making films yet acknowledges the existence they've permitted him to live. Kieslowski was conceived in Warsaw, Poland, on June 27, 1941. His dad was sick for the vast majority of his life and when he was 16, his dad kicked the bucket at 47 years old. Right now, Kieslowski had no clue about what he needed to do with his life so he chose to have a go at being a fire fighter. Notwithstanding, the control that position required sometimes fell short for him, so he dropped out. Kieslowski's uncle informed him regarding The College for Theater Technicians in Warsaw, and Kieslowski selected, having no other bearing for his life. Once in school, he became hopelessly enamored with theater and chose to turn into a chief. So as to enter the program, he originally needed to finish concentrates in another field, so he picked movie coordinating on the grounds that he figured it would relate well to theater work. Kieslowski bombed his placement tests to Ldz Film School two progressive years. At the point when orders for him to sign on for administration in WWII came his direction, he deliberately starved himself and faked mental precariousness so as to keep away from military assistance. He maintained a strategic distance from the draft and upheld his family through different occupations, from office positions to showy fitting (where he met numerous on-screen characters who might later work for him), and fiddled with verse and drawing. His initial proficient film work comprised of a progression of one-act films intended to be appeared in theaters as supporting material for highlights films. All through the rest of his profession, open agreement of the chief stayed split - numerous in Poland appreciated his work, while others thought of him as a shark. They likewise trusted him to be a swindler to himself and his nation. In spite of being notable in Poland, he wasnt globally known until his set of three of movies Three Colors. All through his profession he turned increasingly more toward show, in any case, Kieslowski demanded that his work stayed consistent with the pr... <!
Friday, August 21, 2020
Customer Relationship Management Systems Free Essays
string(215) the framework likewise encourages the showcasing group of an association to develop and configuration explicitly focused on and successful advertising efforts which may help increment the productivity of a firm (Bose, 2002). Theoretical: Client relationship the executives frameworks are utilized in the contemporary business condition to encourage relationship advertising and different practices, which assist firms with upgrading connections between themselves, their clients, providers, representatives, and different accomplices in their business forms. CRM frameworks furnish all gatherings with fundamental data which helps make tasks progressively productive and upgrades benefit. Be that as it may, CRM frameworks likewise have disadvantages. We will compose a custom paper test on Client Relationship Management Systems or on the other hand any comparable point just for you Request Now This paper talks about the focal points and weaknesses of CRM frameworks and outlines the referenced ideas through a contextual analysis upon Dell. Presentation: A couple of decades back, clients would by and by go to general stores or different stores where they had recently bought items or profited a help so as to either enlist grievances, to ask about different items and administrations, or so as to buy the item or book the administration once more. In like manner, organizations would endeavor to watch and physically record which things left their racks sooner and which things were less famous with clients among other information, for example, marketing projections, ordinary buying examples of clients, and what number of clients were fulfilled/disappointed with an item/administration (Reinartz, Kraft, Hoyer, 2004). While it recently took weeks or months for organizations to endeavor to accumulate this data, such data is presently accessible to organizations in practically no time. Nonetheless, the advantage of comfort isn't just constrained to organizations as clients likewise appreciate the office of housing grumblings, posing inquiries, putting orders, and getting a completely customized client assistance dependent on their inclinations and inclinations. While a few clients appreciate the way that organizations know about every little thing about them remembering their birthday celebrations and the quantity of individuals for their family, a few clients are not as eager about this circle of client relationship the executives programming frameworks. In like manner, client relationship the board programming frameworks have their individual points of interest and weaknesses (Chen Popovich, 2003). This paper will talk about the way in which client relationship the executives frameworks have changed e-strategic policies and coordinated individuals, procedures, and innovation both inside and across hierarchical settings followed by a conversation of the prescribed procedures of firms utilizing client relationship the board frameworks. The paper will at that point keep on talking about the difficulties presented by the client relationship the board framework and the social ramifications of its utilization with explicit accentuation upon protection issues. A contextual analysis of Dell will be given further in the paper so as to outline the material ideas referenced. The paper will finish up with a synopsis of the central matters underlined in the paper and suggestions for enhancements in the utilization of client relationship the board frameworks. Client Relationship Management Systems and Their Effect on E-business: ââ¬Å"E-business is a general procedure which empowers the correct administration of business capacities including time cycle, speed, globalization, improved profitability, arriving at new clients and sharing information across establishments for serious advantageâ⬠says Lou Gerstner, CEO IBM (Lecture 2). Beforehand, organizations were not appropriately mindful of what their clients required and endeavored to satisfy those necessities and needs through mystery or by asking a couple of clients what they favored over what they didn't want in an item. Along these lines, administrators recorded client objections in registers and endeavored to determine them inevitably, while this procedure regularly brought about deferrals over months. In any case, the usage of e-business frameworks and the far reaching utilization of web based business have empowered the presentation of client relationship the board frameworks, which incorporate the ââ¬Å"methodologies, programming, and correspon dence abilities, that help associations to structure and deal with their client connections and communications with the target to expand consumer loyalty with the organisationââ¬â¢s items or servicesâ⬠(Lecture 3). Consequently, clients are currently ready to get to solid, precise, and fundamental data in regards to the items and administrations that they have utilized with the snap of a mouse (Bose, 2002). Client relationship the executives frameworks have profited firms by incorporating individuals, procedures, and innovation to expand the degree of productivity in associations and empowering firms to utilize client data to further their potential benefit. The framework empowers the creation of a client database recording all client subtleties and making a client profile, which gives the organization insights about the customerââ¬â¢s needs and regular buys. While beforehand organizations would endeavor to offer a similar item to each client in a similar way, client relationship the board frameworks permit the data with respect to client inclinations to be utilized to separate and explicitly focus on the firmââ¬â¢s items to a client (Payne Frow, 2005). Client relationship the board frameworks are not just used to stay in correspondence with clients, however are utilized as a device to interface a firmââ¬â¢s clients, dispersion channel individuals, providers, and other comparative gatherings inside a similar stage and boosting these connections to build benefit in the business. This is done through the different highlights of the client relationship the board frameworks which give crucial data to the entirety of the gatherings engaged with the business, therefore making the conduction of business progressively advantageous, data effectively open, and activities proficient and savvy (Payne Frow, 2005). For instance, the business power mechanization capacity of client relationship the executives frameworks gives data on clients, past arrangements, and contenders to help the business power of the group. In this way, the framework enables the deals to power of the firm play out their activity all the more viably and furthermore gives the providers of the business data in regards to client inclinations and the items most popular among various objective gatherings. Different elements of the framework incorporate client care and emotionally supportive networks, which empower clients to follow their requests, screen their solicitations, and empowers supervisors to answer to client inquiries instantly in this way helping both client assistance work force and clients to satisfy their capacities easily. Field administration is a capacity that permits remote staff to rapidly and adequately speak with the client assistance work force to address singular issues. Accordingly, the client relationship the executives framework gives data to remote staff with respect to client needs so as to empower them to meet them all the more enough (Jayachandran et al, 2005). The showcasing computerization capacity of the framework permits forward-thinking data on customersââ¬â¢ purchasing propensities to empower the development of po werful advertising efforts. As needs be, the framework likewise encourages the showcasing group of an association to develop and configuration explicitly focused on and viable advertising efforts which may help increment the gainfulness of a firm (Bose, 2002). You read Client Relationship Management Systems in class Paper models In this manner, the client relationship the board framework gives data to a few gatherings engaged with the business procedure and along these lines coordinates the utilization of innovation with individuals so as to improve and upgrade business forms. This is one of the principle reasons that client relationship the executives frameworks are getting profoundly well known among firms. The utilization of the framework empowers a firm to develop income, give better client support, present repeatable and steady deals forms, make new worth and increment client dependability (Campbell, 2003). It likewise permits firms to actualize the three periods of client relationship the board frameworks, which empowers the obtaining of new clients, upgrade of the benefit of existing clients, and the maintenance of productive clients forever. It empowers the execution of center client relationship the board forms including strategically pitching and up-selling, direct promoting, client assistance, and deals power mechanization. In this manner, the utilization of these procedures gets generous enhancements showcasing efforts, item advancement, deals, and field administration (Lin, Chen, Chiu, 2010). The utilization of client relationship the executives frameworks has empowered firms to impart inside their association, with clients, and over their association to different firms, who might be individuals from the appropriation channel or the firmââ¬â¢s providers, by sharing and assembling fundamental data in regards to clients and preparing this data to make it valuable in the business procedure. The accepted procedures of client relationship the board frameworks incorporate well-foundation of authoritative needs, great between departmental correspondence, the mix of front-end and back-office information mining techniques, and the foundation of an exceptional focal distribution center of information (Oztaysi, Sezgin, Ozok, 2011). Numerous organizations at present apply client relationship the board procedures through the usage of social client relationship the executives and the utilization of web based life to convey the desired information to clients viably. Stages, for example, Facebook, Twitter, and LinkedIn, are utilized so as to speak with clients and publicize items/administrations to them (Bose, 2003). Notwithstanding, while the utilization of client relationship the executives
Thursday, May 28, 2020
10 SAT Writing and Language Tips to Improve Your SAT Essay
The SAT Essay section is an optional part of the exam. However, many students decide to write the essay because they know itââ¬â¢s an admission requirement for some colleges. If youââ¬â¢re looking for tips on how to boost your performance on the SAT essay, there are many to be found. Use these 10 tips to improve your own SAT essay on test day: 1) Make an Outline. As a high school student, you know that the basic outline of an essay includes an introduction, body, and conclusion. One way to start out on the right foot with your SAT essay is to make an outline that lays out all of the points, details, and other elements you want to include. You can refer to your outline throughout the writing process to ensure that your essay is organized and complete. Though it takes some time to create an outline, it can reduce the amount of revisions you have to make. 2) Analyze the Writing Prompt. Some students skim over the essay prompt and dive right into the writing. This is a mistake. The prompt lays out exactly what you need to look for and evaluate in the authorââ¬â¢s piece. 3) Focus on a Few Significant Points of the Argument. This is one of the most helpful SAT writing and language tips. When you focus on just a few significant points, youââ¬â¢re displaying your ability to recognize the most persuasive elements in the essay. Also, discussing a few points in a thorough way is a lot more effective than trying to touch on every persuasive element employed by the author. 4) Expand Your Vocabulary. An SAT essay-grader evaluates your command of the English language. Consequently, one way to boost your performance on the essay is to learn some new vocabulary words. Science, news, and literary magazines are great resources for new words. Once you have a dozen or more, use them in everyday conversation or on school assignments. Quizzing yourself with an online vocabulary game is a fun way to ensure that you retain new words. Ideally, you want to use words that lend to the clarity and succinctness of your SAT essay. 5) Strive for Quantity and Quality in Your Essay. As you practice your essay-writing skills, keep in mind that you are aiming for quantity as well as quality. As a rule, it takes about one to two written pages to fully explain how an author supports their claims. 6) Include a Strong Thesis Statement in Your Introduction. In your thesis statement, you should reveal the authorââ¬â¢s argument and the persuasive elements they use. This sets the stage for you to begin pointing out specific examples of the authorââ¬â¢s persuasive devices. When you create a strong, clear thesis statement, youââ¬â¢re showing essay-graders that you understand the authorââ¬â¢s argument and recognize the persuasive elements. 7) Brush Up on Your Grammar, Spelling, and Punctuation Skills. This is one of the simplest SAT essay tips to follow. When you use proper grammar as well as correct spelling and punctuation, it adds to the quality of your essay. Keep in mind that these sorts of errors can detract from even the most convincing SAT essay. 8) Write With Objectivity. Chances are good that youââ¬â¢ll have an opinion on the topic discussed in the authorââ¬â¢s essay. But your job is to evaluate the authorââ¬â¢s persuasive argument, not state your opinion on the given topic. Writing an objective essay shows essay-graders that you read and are adhering to the prompt. 9) Highlight Specific Details. All of the material you need for your essay can be found in the authorââ¬â¢s piece. When you point out specific details, youââ¬â¢re displaying your ability to effectively analyze an argument. 10) Take Care With Your Handwriting. The quality of your handwriting may not enter your mind as you prep for the SAT essay, but if graders have too difficult of a time deciphering a studentââ¬â¢s handwriting, they arenââ¬â¢t likely to give the personââ¬â¢s essay much consideration. If you donââ¬â¢t feel comfortable with cursive, write the essay in print. Donââ¬â¢t let messy handwriting prevent you from highlighting your impressive essay-writing skills! Our professional SAT instructors scored in the 99th percentile on the test, so when you take our courses, youââ¬â¢re getting SAT essay tips from individuals who conquered all parts of the exam. We teach you strategies designed to improve the quality of your writing. Sign up for SAT tutoring services at Veritas Prep and get access to many other SAT writing and language tips. Make the call today!
Saturday, May 16, 2020
The Vision For Vital Connect Programs Essay - 1217 Words
4. RESOLUTION The vision for vital connect program is to create a model for coordinated, collaborative and coordinated patient care system. This model can be implemented by creating a well structured and connected province-wide health information technology solution. This HIT solution will consist of following: â⬠¢ Provincial clinical information system â⬠¢ E-referral system â⬠¢ Personal health portal 4.1 Provincial clinical information system EHR is defined in the Health Information Act (HIA)[4] as ââ¬Å" the interconnected electronic health information which is developed to be shared across authorized users in a secure environment .ââ¬Å" By creating a vast network of interconnected repositories, EHR will provide a easy access to health information about individual patients to care, providers.To create a province-wide clinical information system, the first challenge is to connect individual Electronic Medical Records (EMR) that may be concise to a particular healthcare facility. Currently, more than 1200 standalone EMR systems exist within Alberta Health Services (AHS), with very few of them interconnected and most of them outdated. The vision to create a province-wide fully connected clinical information system can be fulfilled if all these stand-alone systems are updated and attached to each other to facilitate seamless flow of information and instructions. There are various advantages to using provincial CIS: â⬠¢ Better Patient Care â⬠¢ Increased efficiency â⬠¢ Better quality of care â⬠¢Show MoreRelatedHasbro Case Study - Ethical Behavior1287 Words à |à 6 PagesIn the aftermath of Tycoââ¬â¢s executive scandal in the early 2000ââ¬â¢s, Ed Breen and Tycoââ¬â¢s newly elected management team were vital elements to the repair of Tycoââ¬â¢s corporate social responsibility and company image. During this time, Tyco International began focusing on the repair of internal weaknesses and devised several initiatives to improve their image and reform their values. During Tycoââ¬â¢s reform period they focused on multiple goals and company-wide achievements. Governance, customers, growthRead MoreBusiness Analysis : Corporate Website Analysis Essay1468 Words à |à 6 Pagesto be top most vital sector for the economy. The websites of two Australian banking companies: Common Wealth Bank of Australia and Beyond Bank priding themselves for providing integrated financial services and leading in the Australian financial services industry is evaluated on the image in terms of the corporate identity and culture as aligned with the organisationââ¬â¢s vision and values. VISION AND VALUES Vision statement takes mission and adds an element of human values. CBAââ¬â¢s vision is stated asRead MoreHealth St. Joseph s Hospital And Medical Services Essay1271 Words à |à 6 Pageschosen hospitalââ¬â¢s mission, vision, and/or value statement to services provided to the community. Dignity Health and their sponsoring congregationââ¬â¢s mission is committed to further the healing ministry of Jesus. They dedicate their resources to delivering compassionate, high-quality, affordable health services; Serving and advocating for our sisters and brothers who are poor and disenfranchised; and Partnering with others in the community to improve the quality of life. Vision: People from around theRead MoreMission and Vision Statement of Rim1628 Words à |à 7 PagesMotion (RIM) organization, it showed that the organization itself does not provide vision and mission statement to their employees as well as the public. According to Thompson and Strickland (2010), a strategic vision delineates managementââ¬â¢s aspirations for the business, providing a panoramic view of ââ¬Å"where are we going.â⬠It lay out the companyââ¬â¢s strategic course in preparing for the future. A clear strategic vision communicates the managementââ¬â¢s aspirations to stakeholders. It also helps steer theRead MoreHrm595Proposal Plan, Part Iv1081 Words à |à 5 Pagesenvironment. Walgreens is a successful business looking to progress overall presentation and place the company for potential expansion. In order for this to follow through, a total rewards program needs to be created. The incentives and compensation plan must connect with the goals of the organi zation. A solid rewards program will build motivation in the work place. As the text states, ââ¬Å"The notions that rewards are means to motivate employees assuming that the rewards are distributed fairly. Rewards seemRead MoreAdministrative Interview Of Stephanie Thompson Essay885 Words à |à 4 Pagesis the Executive Principal of Farragut High School. When she first started at Farragut High School, she the parents and community stated that they never knew what was going on in the school. Mrs. Thompsonââ¬â¢s first priority was to establish ways to connect with the school community. She started by welcoming staff, students and parents every morning not only at the doorway but in the parking lot as well by directing traffic. Some days Stephanie would ask the students about their family or have shortRead MoreHealth Issues Of The Medical Field1650 Words à |à 7 Pages82 years old lady, who has developed health problems which make her feel isolated and lonely. The following ess ay highlights Mollyââ¬â¢s leg ulcer, primary health care, wellness, health professionals and how these have been used to create a learning program for Molly. It also describes the pathophysiology of diabetes, Type II Diabetes and resources/ support services for the clientââ¬â¢s spouse who is experiencing grief after the client died. Lunnay McIntyre (2014) describes Primary Health Care (PHC) asRead MoreThe Keep Indianapolis Beautiful : A Great Appreciation For Art, Nature And Sense Of Community1023 Words à |à 5 PagesIndianapolis went from a trashy, neglected city to a place of beauty, pride and opportunities. Throughout this profile, I will identify how KIBââ¬â¢s legacy was created, its contibution to social capital through ââ¬Å"private action for public goodâ⬠, and why KIB is vital for not only Indianapolis, but the world in its entirety. In 1947, John Gunther, an American journalist, was responsible for the negative perspective on the city of Indianapolis. In the 1960ââ¬â¢s and 70ââ¬â¢s, around the time women demanded to be heardRead MoreArticle Review on ââ¬Å"How PG Tripled Its Innovation Success Rateâ⬠1073 Words à |à 5 Pagesrate of their innovations. The article began by mentioning how innovation was the ââ¬Å"backbone of PGââ¬â¢s growthâ⬠, but at the start of the 2000ââ¬â¢s, only 15% of PGââ¬â¢s innovations actually met expectations (Brown Anthony, 2011). PG created the ââ¬Å"Connect and Developâ⬠program which allowed people from outside the company to give their own ideas to the company, but the first major step in creating successful innovations was to hire two PG veterans to build a ââ¬Å"growth factoryâ⬠(Brown Anthony, 2011). The twoRead MoreSchool Counseling : A Unique Ethical Code872 Words à |à 4 PagesContinuing education can include conferences, webinars, or workshops which allow people from the field to network with peers and earn continuing education units (ASCA, 2016). Furthermore, the ASCA website lists the vision, mission, goals, and objectives to outline professional identity. The vision includes advocacy, leadership, collaboration, and systemic change. Empowering school counselors with knowledge, skills, and resources to foster student success. The mission is that school counselors will be professional
Wednesday, May 6, 2020
Corporate Lobbying Detention Watch Network - 1869 Words
Figure 1, A 10 Years Record of Corporate Lobbying: Detention Watch Network Another strategy is a system known as occupancy requirement. Such is a case in which a private company requires a state to keep prisons the company is building or taking over filled to a minimum percentage. This policy is made to stand no matter how crime in the state may fluctuate. Occupancy requirements are common practice within the private prison industry. The In the Public Interest group reviewed 62 contracts for private prisons operating around the country at the local and state level. The group found that 41 of those contracts included occupancy requirements that demand local or state government keep those facilities between 80 to 100 percent full. Thisâ⬠¦show more contentâ⬠¦Unlike all of the above mentioned problems either caused by or support private prisons, the flaws in the legal system that results in imprisonment of innocent people or the over sentence of small crimes is an issue of itââ¬â¢s own. It has many motivated, social and legal aspects outside the pri son industry. Yet it is also supported by and benefits companies that have invested on prisons. ââ¬Å"Ninety-seven percent of 125,000 federal inmates have been convicted of nonviolent crimes.â⬠(Pelaez, 2014). It is believed that more than half of the 623,000 inmates in municipal or county jails are innocent while two-thirds of one million state prisoners have committed nonviolent offenses. The three strikes, life imprisonment after being convicted of three felonies, law is one of the legal system that cause the overpopulation of prisons. ââ¬Å"Private prison companies have supported and helped write three-strike and truth-in-sentencing laws that drive up prison populations.â⬠(Dupp, 2013). The three strike law was ruled unconstitutional by the US Supreme Court in 2015. Some individuals arrested under it have been realised. However, during its existence, it had made the building of 20 new federal prisons necessary. Another law that benefits private prisons is mandatory minimum sentences. This is law that ensures a minimal number of years is sentenced for a certain crime, as
Tuesday, May 5, 2020
Christina Harwood Essay Example For Students
Christina Harwood Essay February 4, 1999LA 345 P. SouvorinClose CallLate one evening a young woman, in tears, steps into her bathroom torn apart with emotional pain and anguish. She raises her head to look in the mirror. A terror stricken face shines back at her with the coloring of a Scarlet Macaws red breast and a pasty complexion on her face. Her high, delicate cheekbones are waterfall ledges from the tears that she sheds. As she stands before the mirror, she is clad in a long, flowing nightgown the color of the full moon. She turns away from the mirror and her small, dainty feet are heard as she ever so slowly turns towards her bathtub. Its seems like an eternity for her to go just two steps from the mirror and her image. She begins to look at a small, sharp object in the back corner of her tub. Curious she picks this up and begins to trifle with it. All the while her sobs become deeper and would pierce any bystanders soul with the gut wrenching sound they brand to the ears. Her whole body is numb from her anguish and she senses her soul becoming lost in a void of nothingness. Looking at the object through clouded blue eyes, she lowers it towards her right wrist of soft, peachy flesh.Slowly she closes her eyes and in one swift motion her skin starts to ooze her lifes essence, blood. Eyes tightened and biting on her lower lip, she whimpers from the pain that has now become physical. Her sobs are quelled as her pain is freed from her wrist as she sits propped against her toilet. Thinking begins to become sluggish as her time nears. She lays the flowing fountain of release in her lap. Her nightgown becomes a blood-moon, stained forever with her spirit in the liquid that ran from her. Her breathing enters upon a preparation for her ceasing to exist; thoughts are now in oblivion with her soul. For, she has done that most of heinous of deeds a person could execute die at their own hand. Now her spirit is slumped over her once lively shell that held her soul, she is lifted towards the heavens to her final resting. A mixture of fragrances at the spot where her body lies that of sweet, wild roses and a salty pungency which was wrought from the deep red liquid. A shattering scream tears the young from her sleep sitting straight up in a cold sweat. She begins to frantically check that she is fine finally, assured that it was nothing but a mere dream. Slays her head back down onto her soft, downy pillow drifting back to sleep with her cat at her feet and cuddling close to Honey, her teddy bear.
Friday, April 17, 2020
Stargirl Character Analysis Essay Example
Stargirl Character Analysis Paper Stargirl is a very eccentric character. We see that she acts very different compared to the other students. We see this at the basket ball match when she cheers the both teams. Even if the opponents score she cheers for them too. All the students conform and are not used to someone standing out of the crowd. People do not appreciate her for who she is. Her differences do not gain her any favors but make her life worse as others dont understand. She also act weirdly and this also makes her a target. Leo mentions that Stargirl cheered whenever the ball went into the basket, regardless which team shot it. He also mentions that she cheered anyone, anywhere, anytime. This shows how eccentric Stargirl is. She is very different and others dont appreciate her kind thoughts. She act like this because of her different background. Stargirls eccentric ways are looked down upon because everyone conforms. They do not see eccentric people as their own and thus she has a rough time alone. Stargirl is very extraordinary. We see this when she comes to mica high school or the first time. She wears different clothes that seem out of fashion, she sings happy birthday to everyone, Stargirl also has a pet rat named Cinnamon, she also plays the ukulele. People see her unusual behavior as a bad thing. She stands out from the crowd and is a constant target. Leo mentions that she wore and off white dress white ruffles and looked like it could have belong to Her grandmother. He also saysshe began to strum her uke, it was happy birthday. This shows her extraordinary side. She is different is nearly every aspect and is understood only by Leo who is the only one that appreciates her Different ways. Stargirl has extraordinary hobbies, fashion, actions and personality. Many people do not appreciate this but she enjoys being special. We will write a custom essay sample on Stargirl Character Analysis specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Stargirl Character Analysis specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Stargirl Character Analysis specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Stargirl is very empathetic. She cares for everyone and is very kind. She is very emotional and doesnt like anyone being
Friday, March 13, 2020
Padre Pio Is Perhaps The Most Well Known Religion Essay Essays
Padre Pio Is Perhaps The Most Well Known Religion Essay Essays Padre Pio Is Perhaps The Most Well Known Religion Essay Essay Padre Pio Is Perhaps The Most Well Known Religion Essay Essay Francesco Forgione was born May 25, 1887 in Pietrelcina, Italy. His parents were Grazio and Maria. He lived with his parents, an older brother Michele, and three younger sisters, Felicita, Pellegrina, and Grazia. Three other kids died in babyhood, including Francesco, for whom Padre Pio was named. The Forgiones were a really spiritual household, and in his place as a immature male child, his religion was nurtured. In his childhood, Francesco s great religion was apparent. He loved to sing anthem and play church in his younger old ages, and consecrated himself to Jesus when he was five. As an grownup, Pio commented that Jesus, Mary, and his guardian angel appeared to him. He besides claimed to hold suffered onslaughts by the Satan. In 1897, Francesco s parents foremost learned of his desire to be a priest. A Capuchin monastic was going to acquire contributions, and Francesco was drawn to the adult male, and told his parents that he wanted to be a mendicant. The Forgiones went to Morcone to inquire if the Capuchins would take their boy. They were interested, but Francesco did non hold the needed instruction, merely holding three old ages of public schooling ( EWTN ) . In order to pay the private coach needed for Francesco, his male parent went to America to work, and during this clip he was confirmed. He completed the instruction demands for the Capuchin order, and at 15 he became a minor Capuchin, and took the name Pio, after the frequenter saint of Pietrelcina, Saint Pius V. He was called Fra, intending brother, until he became a priest. Then on August 10, 1910, the 23 twelvemonth old Fra Pio was ordained a priest by Archbishop Paolo Schinosi. On August 14, he celebrated his first mass. On September 7, 1910, as Padre Pio was praying in the Piana Romana, Jesus and Mary appeared to him and gave him the lesions of Christ, the stigmata. He prayed for God to take away the lesions visibly, but for the agony to remain. God answered his supplications and took the lesions off, until old ages subsequently, when Pope Benedict XV urged all Christians to pray for an terminal to the war. On July 27, Padre Pio offered himself as a victim for the terminal of th e war. Between August 5 -7, he had a vision in which Christ appeared and pierced his side. The experience has been identified as a transverberation or piercing of the bosom bespeaking a brotherhood with God. A few hebdomads subsequently, the same being who appeared to him on August 5 appeared once more. It was the hurt Christ. Padre Pio received the seeable stigmata, the five lesions of Christ, which would remain with him for the balance of his life. The intelligence of the stigmata spread around the universe by early 1919, and legion physicists examined his lesions, though he was non interested. Pio accepted the lesions as a gift from God, but would hold preferred to endure the hurting of Jesus without the universe knowing ( EWTN ) . As said by the Eternal Word Television Network, in the mid-1960s, Padre Pio s wellness began to deteriorate, but he continued to state Mass and receive confessions. On the 50th day of remembrance of the stigmata Padre Pio celebrated Mass, and the following twenty-four hours, he was excessively tired to state Mass or hear confessions. On September 22, he managed to state Mass and people had to fight to hear him. Merely after midnight on September 23, Padre Pio called his higher-up and renewed his vows, and at 2:30a.m. , Padre Pio died a natural decease. On his deathbed, he held the rosary beads, but was excessively weak to state the prayer beads. Harmonizing to Leo s Design, he repeated the names Jesus, Maria until he died, when he opened his eyes really broad and said, I see two female parents! ( Leo s Design ) He is believed to hold meant Mary and his ain female parent. With his last breath, he whispered Maria! so the great mysterious, priest, and saint, Padre Pio, laid his capu t down to rest for the concluding clip, after a life full of enduring and hapless wellness, physical lesions, and marvelous religious lesions. As he had predicted, he lived ill but died healthy, with the stigmata healed and his organic structure in all right status, although cryptically drained of all blood harmonizing to physicians. His feast twenty-four hours is the twenty-four hours of his decease, September 23. Saint Padre Pio was canonized on June 16, 2002, by Pope John Paul I at the terminal of a long procedure that lasted 33 old ages, seven months, and twelve yearss. The canonisation procedure started on November 4, 1968. He was attributed with miracles of mending many people, including immature chidren, being in two topographic points at one clip or going to topographic points in seconds, and his most celebrated Markss, the stigmata ( Discover Catholic Miracles ) . On September 26, 1968, over a 100 thousand people gathered at San Giovanni Rotondo to pay their respects to this holy adult male. He was buried in the crypt prepared for him in the Church of Our Lady of Grace. ( EWTN ) . In his life-time, the great Padre Pio took portion in 100s of multitudes, and did things no other adult male could make. He came from a little state town, and became a really celebrated and well-known priest and saint. He was 81 old ages old when he died.
Wednesday, February 26, 2020
Media Creates Political and Ideological Controversies Essay
Media Creates Political and Ideological Controversies - Essay Example Audiences are seen to be susceptible to any message or information that is presented by the media. As per Lowery and DeFleurââ¬â¢s theory media has an immense impact on its viewers. This theory endorses great power and influence on the media. Although later research disproved this theory, it was evident through the findings (Hyman & Sheatsley 1947) that audiences were not brainless recipients of information and formed their own opinions of mediaââ¬â¢s projections of news and events. But fact remains that even though media coverage may not be able to completely form a publicââ¬â¢s opinion on just one front, it is responsible for how they view the world. This is where the agenda-setting theory of mass communication comes in. while the media may not be able to tell us exactly how we should think, it does specify what we should think about. ââ¬Å"The agenda-setting theory was originally developed to explain the influence of the mass media in determining which political issues become important in elections. Adroit committee members and politicians claim that if you can control the agenda you can control the meeting.â⬠(Sutherland & Sylvester 2000). Basically, the most crucial function of media is to act as a gateway between the public and the government. Itââ¬â¢s the media who provide information regarding political matters and matters regarding policy and governance. Newspapers aim to cover politics and issues related to politics follow the guidelines that journalists must remain ââ¬Å"politically correctâ⬠and neutral and ââ¬Å"presentâ⬠covering all sides of the argument (Sloan & Mackay 2007) Research has shown that most media slant is focused on coverage related to political and election campaigns, where media needs to influence the general public. But very few researches have been done to check why the media slant is involved in suchà specific issues such as ââ¬Å"immigrationâ⬠and why is it covered by ââ¬Å"negativelyâ⬠slanted media coverage.
Sunday, February 9, 2020
Power and Privilege Homogeneous Choice Essay Example | Topics and Well Written Essays - 1000 words
Power and Privilege Homogeneous Choice - Essay Example Additionally, we all have a natural desire to preserve those parts of us that are unique or particularly cherished, and pass them on to our progeny. While racism and prejudice are always an unacceptable approach to our differences, there should also be an allowance for individuals to interact positively with one another while preserving their own culture, traditions, and values. I believe that it is possible to truly respect the differences between individuals and cultures, while retaining the natural comfort level found in individual association with those of similar background and world view. I call this homogeneous choice. As an individual, I am naturally aware of the differences between myself and others. Whether those variations are cultural or behavioral, I know that I can face a personal dilemma as I react to those differences; I can choose to accept them or oppose them in some way. In his article on the subject of diversity, David Brooks points out that it is in my nature to be around others like myself, and that I have the power to organize my life so that my contact with people radically different from me is limited (Brooks 31). That does not make me, however, an opponent of integration or a racist; it doesn't even mean that my personal choices are necessarily intentional. Things like personal comfort tend to occur absent specific and directed analysis, and my respectful reaction to others of different cultures can similarly be natural and uncomplicated. If I like a particular individual, regardless of cultural background, I simply like them. I don't sit around trying to analyze why I like them or what it is about them that makes them likeable; I just know that I am comfortable with them. Similarly, there are people for whom I don't especially care and that discomfort has nothing to do with race, creed, color, or any of the other common prejudicial points of view. I can respect the individual, even though I am not comfortable being around them every day, without being driven by prejudice against their culture; and that is the point. The nexus of these ideas can be articulated one word: Respect. If my responses to the differences in people I meet, and their unique way of perceiving the world, are respectful of their point of view, I can avoid a negative perspective that includes prejudice or racism. Different isn't bad, it is just different. Neither do I have to embrace all of the differences I encounter, or even like them, and include them in my choices for frequent association. I can respect my own perspective as a valid point of view, and extend that same consideration to the people I meet. The guiding principle for me, as for most other people, is personal comfort. I am naturally more comfortable with certain cultures than others, especially my own. As Brooks points out, people are "finding places where [they] are comfortable and where [they] feel [they] can flourish" (30). While he goes on to lament the lack of diversity in American culture, I don't think that it is appropriate to force people out of their personal comfort zones to accomplish a specific diversity goal. In America, the freedom of association is a constitutional right, and for good reason. Individual freedom is about flourishing within a chosen environment and I should be allowed to make those choices that promote my
Thursday, January 30, 2020
Auto World Inc Essay Example for Free
Auto World Inc Essay Auto World Inc. (AWI) is a leading automotive retail and service chain. They have many operating segments comprised of two different centers 10 miles apart from each other. Pit Stop Centers (PSC) offer service labor, installed merchandise, and tires while their Auto Boyz Centers (ABC) sells automotive merchandise. AWI has a plan to close their operating segment PSC to change their current operating structure to improve and efficiently deliver retail products and automotive services by providing their customers with a ââ¬Ëone stopââ¬â¢ shopping for ââ¬Ëdo-it-yourselfââ¬â¢ retail customers and ââ¬Ëdo-it-for-meââ¬â¢ customersâ⬠(PSC Case). AWI expects this change to enhance their ability to increase market share, improve sales, and company earnings. This change in restructuring will have an effect on current earnings and will need to be reported properly in their 2007 Income Statement. AWI must report this continuing activity properly under US Generally Accepted Accounting Principles (GAAP). The FASB Accounting Standards Codification (ASC), commonly known as GAAP has specific standards that must be followed in order to classify the disposal of an entity as discontinued or continues operation of a component of an entity. Under the guidance of numerous ASCââ¬â¢s, AWI does not meet the two conditions to report their PSC closures as discontinued operations. The criteria used, assessment period, presentation, and disclosure for this retail company will be explained in detail when applying proper GAAP. A component of an entity comprises operations and cash flows that can be clearly distinguished, operationally and for financial reporting purposes, from the rest of the entity; it may be a reportable segment or an operating segment, a reporting unit, a subsidiary, or an asset group in which Auto World determined correctly under the first requirement that the PSC met the definition of a ââ¬Å"component of an entityâ⬠(ASC 205-20-20). The two conditions for reporting the disposed transaction as discontinued operations are: The results of operations of a component of an entity that either has been disposed of or is classified as held for sale under the requirements of paragraph 360-10-45-9, shall be reported in discontinued operations in accordance with paragraph 205-20-45-3 if both of the following conditions are met: 1. The operations and cash flows of the component have been (or will be) eliminated from the ongoing operations of the entity as a result of the disposal transaction. 2. The entity will not have any significant continuing involvement in the operations of the component after the disposal transaction (ASC 205-20-45-1). Several steps below will be used to explain why the disposal of the PSC stores should be considered a continuation of operations rather than discontinue of operations (ASC 205-20-55-3). These three steps along with their respective answers are also depicted in a flow chart (see Appendix A). Step one asks are continuing cash flows expected to be generated by the ongoing entity? Yes, the continuing cash flows are being generated by ABC from transactions with customers from PSC. Step two asks if the continuing cash flows result from a migration or continuation of activities. The continuing cash flows are the result of a migration from the closed PSCââ¬â¢s to the ââ¬Å"one stopâ⬠ABC. ABC sells products similar to those sold in the closed retail stores. After the closure of the Pit Stop Centers, Auto World estimates that there will be continuing cash flows from the sale of automotive services and tires by the ongoing ABCââ¬â¢s of approximately $600 million. Auto World estimates that the Pit Stop Centers would have generated approximately $700 million of sales absent the disposal transaction (PSC Case). Step three asks if the continuing cash flows are significant. Yes, the ongoing ABC estimates the continuing cash inflows will approximate 86 percent (see Appendix B) of that would have been generated by PSCââ¬â¢s absent the disposal transaction. AWI is expecting these actions to generate significant cash flow in 2007 and to increase free cash flow in 2008. AWI is also expecting to yield improvements in operating earnings of approximately $58 million in 2008 to be significant leading to the classification as a discontinued operation to be inappropriate (ASC 205-20-55-70). Since stakeholders rely on financial statements to base their decisions and to project future cash flows, current information presented must be accurate under GAAP Under the second requirement, one issue I have identified is the intentions of managementââ¬â¢s decisions to improve their companyââ¬â¢s net earnings. The professional literature I relied on are these two statements, ââ¬Å"the actions we are announcing today will further enhance our ability to increase market share and improve sales and earnings at our companyâ⬠and ââ¬Å"in this regard, we remain committed to the automotive business and we expect to deliver significant additional profitable growthâ⬠were made by Mr. Bobby, chairman and chief executive officer. When considering the use and disclosure of restructuring charges, depending on the industry, there should not be re-occurring ââ¬Å"restructuring costâ⬠line item on the Income Statement year after year. Closing the PSC stores as of the second quarter in June 2007 is an event taking place in 2007 which can happen only once. If management continues to show this type of special/unusual charge in future periods, the question of integrity should be raised. Management does not want to give off the impression of possibly smoothing earnings by using restructuring charges. ââ¬Å"Once a decision to restructure is made, GAAP requires companies to estimate the future costs they expect to incur to carry out the restructuring for such things as plant closings (AWI currently estimates it will incur restructuring and other charges totaling $52 million pre-tax). These estimated restructuring costs are then charged to an expense account with an offsetting credit to a liability account (Restructuring reserve) in the current periodâ⬠(Revsine, pg 155). In developing my recommendation and conclusion for resolving this issue, management should make a foot note explaining these changes which will allow stakeholders to make better decisions. The new re-structured ABC will continue to sell automotive parts that were previously sold through the PSCââ¬â¢s, and under the ASC, PSC store closures are not considered and cannot be reported as a discontinued operation in AWIââ¬â¢s second quarter financial statements. The continuing cash flows are being generated by ABC from transactions with customers from PSC, given by the level of significance of 86 percent for this continuing cash flow subsequent to the disposal transaction.
Wednesday, January 22, 2020
The North American Continent :: History
The North American Continent There is tremendous difference in the way the native Indians used to live off the land and the way American Settlers are destroying the land even as we speak for the purpose of profit. The author of this story is trying to convey the damage and destruction wrought on by the Europeans in the relatively few years of habitation of the lands of America. The difference is not only cultural but also spiritual. While Native Indians viewed the land on which they lived as sacred, the European settlers arrived with the aim of exploitation, not only of the land but also of the native people. When you think about the creation the continents, beginning with Pangaea, how the landscape must have been very beautiful in its most natural setting. Imagine the great mountain ranges and the incredible forests and natural hillsides and plains and prairies that make up the countryside. It must have been breathtaking to be able to see the landscape of present day America in its natural state. As the water table began to recede, the first humans began to cross the Bering Straight to inhabit North America and South America. Travel to South America was made possible thought the Isthmus of Panama. Only now are we beginning to appreciate what the Native Indians were trying to convey to us. Native Indians have been living off the land and had not desire for industry or great wealth. They did not have a significant impact on the landscape. Europeans consumed the land away from the Indians starting with gold and silver. Vegetables such as potatoes and squash and tomatoes found their way back to Europe as did plants for medicines. Some of the more impressive aspects of the native Indians were the creation of many languages and many cultures. They expressed their creativity in their poetry and dance and rituals and ceremonies. Some rituals could last for days. The first Europeans had to be amazed to witness the exotic rituals that had never been seen before. Some Indians had tried diplomatic approaches to the intruding Europeans. One had formally spoken to the United States senate and another had negotiated with the French and the British. The significance is that the Indians lived off the land where there is no industry, no air pollution, no water pollution, and no deforestation. On the contrary, the Europeans came to establish colonies for the purpose of exploiting the land and people too.
Tuesday, January 14, 2020
6 steps decision making Essay
In addition to time pressures that we encounter when searching for evidence to support care decisions for individual patients, it may be difficult for clinicians to apply the evidence that we find. The rate limiting step may not be doing the search, but the steps needed in ââ¬Å"setting evidence-based medicine (EBM) in motion.â⬠We present an example of a search for evidence by a Physician Assistant (PA) student that highlights this challenge. PAs receive accelerated training in the medical model and work in teamsà under physician supervision. Approximately 40 000 PAs currently work in theà US in a wide range of settings and specialties.à Practising EBM has become an important component of training for PAs.à During an internal medicine rotation, a PA student encountered a common clinical practice unsupported by currentà evidenceââ¬âadministration of nebulised albuterol in patients with community acquired pneumonia (CAP). While this practice mayà be justified in patients with underlying chronic obstructive pulmonary disease (COPD) who also present with CAP, this studentà questioned the grounds for its use in patients with CAP who do not have COPD. Clinical scenario A 68 year old man presented to the emergency department with fever, chills, and a non-productive cough of 1 weekââ¬â¢s duration. He had fatigue, headache, rhinorrhoea, and mild nausea, butà denied dyspnoea. He had no history of smoking or COPD. Heà had atrial fibrillation and was taking warfarin for stroke prevention. On admission, his temperature was 38.4 à °C, heart rate wasà 108 beats/minute, respiratory rate was 24 breaths/minute,à blood pressure was 156/88 mm Hg, and oxygen saturation wasà 86% by pulse oximetry on room air. Rales were heard in bothà lung bases and in the right middle lobe. Chest radiographyà showed a diffuse infiltrate in the right middle and lower lobes. Complete blood count showed a white blood cell count ofà 22 000 cells/ml with a left shift, and arterial blood gases showed mild respiratory acidosis.à One dose of ceftriaxone was administered parenterally, and a course of azithromycin was started. Albuterol, 5% solution,à delivered by n ebuliser 3 times daily was also ordered, in addition to a combination of inhaled ipratropium and albuterol,à delivered by metered dose inhaler every 4 hours as needed.à During the hospital stay, his pneumonia resolved, but his heart rate increased to 150 beats/minute and his blood pressure rose from 156/88 to 200/110 mm Hg. Clinical question Although there was no institutional protocol for use ofà nebulised albuterol for treatment of CAP, the house staff often ordered it.à The PA student queried: In a 68 year old man with CAP and no underlying COPD, does use of nebulised 2 agonists improve symptoms? What is the risk of harm in thisà patient? Search strategy Firstly, a treatment guideline was sought to clarify recommendations regarding use of nebulised albuterol for treatment of CAP.à The American Thoracic Society guidelines for management ofà CAP1 were rapidly retrieved through PubMed, UpToDate, andà MD Consult. The British Thoracic Society (BTS) guidelines for the management of CAP in adults2 were also found in PubMed.à Both sets of guidelines were relevant to our patient, but neither guideline discussed the use of nebulised albuterol in theà treatment of CAP. The BTS guidelines had a section on general management, which discussed the use of adjunctive therapiesà for CAP, but nebulised albuterol was not mentioned. Evidence from controlled clinical trials was mentioned in the guideline for ââ¬Å"bottle blowing,â⬠3 but not for physiotherapy.à Having not fully answered our question with a review ofà relevant guidelines (and having not attracted the attention of anyone who could change the patientââ¬â¢s treatment p lan), weà searched PubMed again, this time specifically for studies on the use of albuterol in patients with CAP. No relevant trials were found on the use of nebulisers for CAP.à To identify evidence about harm with the use of albuterol,à PubMed was searched using the terms nebulised albuterol, cardiac arrhythmias, and randomised or controlled clinical trials.à No trials were found. When just the content terms wereà searched, 9 articles, not directly relevant to our patient, were found. One prospective, open label study on the effect ofà nebulised albuterol (for treatment of asthma) on cardiac rhythm was found.4 10 patients were studied, and although no adverse effect on cardiac rhythm or blood pressure was found, the study did not convince the team that no potential for harm existed in this, or other patients, especially when thereà was no clear indication for use of albuterol. Recognising that searching and appraising the literature are not the only important aspects of practicing EBM, we consulted an experienced pulmonologist, who practises and teaches using the EBM model. In addition to reviewing treatment plans forà multiple cases of CAP requiring hospital admission with theà Nurse Practitioner/Physician Assistant service, he recommended review of the Centre for Evidence-Based Medicineà website at Mount Sinai Hospital in Toronto, Ontario, Canadaà (www.cebm.utoronto.ca/), which suggested bubble blowing as a method for helping clear secretions.2ââ¬â3 This served as anà excellent, rapid approach to finding good information on treatment of CAP, and confirmed the evidence previously found inà the literature search.à Application of the evidence to this, and futureà patientsà The treatment plan for this patient was not altered by theà studentââ¬â¢s rapid search for evidence. Changes in usual care for a common illness required a compr ehensive search and discussion among all clinicians in our institution caring for patientsà with CAP. The clinical team reviewed the results of the search and because no evidence was found to support use of albuterol in patients like ours, changes were made to future practice. As a result of this process, which took a few hours and evolved over several weeks, orders for bronchodilators for patients with CAP are now made on an individual basis, depending on theà presence of patient comorbid illnesses, such as COPD. 164 Volume 8 November/December 2003 EBM www.evidence-basedmedicine.com EBM notebook Downloaded from ebm.bmj.com on 10 August 2009 Conclusion The need for a rapid search for evidence is sometimes, but not always, important to the care of an individual patient. In this case, the speed of the search did not affect the ability of the PA student to apply theà evidence to the patient. Setting the evidence in motion may require communication of search results to other members of the clinical team and may affect the care of future patients. Although the catalyst for setting EBM in motion was a student, the evidence, including the results of further research, along with the judgment of the experienced pulmonologist,à convinced the clinical team to make changes to usual care and to base future treatment of this common condition on the best available evidence. The basic concept of evidence-based medicine proposes toà make health related decisions based on a synthesis of internal and external evidence. Internal evidence is composed of knowledge acquired through formal education and training, generalà experience accumulated from daily practice, and specificà experience gained from an individual clinician-patient relationship. External evidence is accessible information from research.à It is the explicit use of valid external evidence (eg, randomised controlled trials) combined with the prevailing internal evidence that defines a clinical decision as ââ¬Å"evidence-based.â⬠To realise this concept in day to day clinical practice, the Evidence- Based Medicine Working Group proposed a 5 step strategy,à corresponding to step 1 and steps 3 to 6 shown in the left hand column of the table. In teaching this 5 step approach, we encountered several difficulties. We noticed a growing hesitance to accept this strategyà as students advanced in their medical training. In the presence of well established methods of treatment or diagnosis, thisà resistance rises even more, regardless of the level of training.We assume that this barrier is associated with the process of socialisation into the health professions. Throughout medicalà education students are virtually ââ¬Å"trainedâ⬠to make decisions under the condition of uncertainty. Advanced students and to a greater extent clinicians lose some of their ability to differentiate between scientific evidence and what seems to be evident. If we intend to implement evidence-based medicine more efficiently, we need to modify the way students and clinicians learn to make decisions. Therefore, an additional step was introduced in our evidencebased medicine teaching programme (step 2 in the table).à Students were to provide answers to their clinical questions based on their current knowledge (internal evidence) beforeà continuing with the remaining steps of the evidence-basedà process.2 Our collective experience concerning this additional step was extremely positive. The students using this new step were satisfied that their pre-existing knowledge had beenà integrated into the evidence-based approach. By explicitlyà documenting their internal evidence, students used the remaining steps of the process to evaluate not only the best evidence in making a clinical decision but also to assess the accuracy of their internal evidence, the grounds upon which their preconcep- The 6 steps of evidence-based decision making Step Action Explanationà 1 Transformation of the clinical problem into 3 or 4 part question (a) relevant patient characteristics and problem(s), (b) leading intervention, (c) alternative intervention, (d) clinical outcomes or goals. 2 Additional step: answer to the question based on ââ¬Å"internal evidenceâ⬠only Internal evidence: acquired knowledge through professional training and experience (in general and applied to the patient). Should be documented before proceeding to step 3. 3 Finding ââ¬Å"external evidenceâ⬠to answer the question External evidence: obtained from textbooks, journals, databases, experts. The value of the external evidence will be highly variable, see step 4. 4 Critical appraisal of the external evidence Should answer 3 questions: (1) Are the results valid? (2) Are the results clinically important? (3) Do the results apply to my patient? (or is my patient so different from those in the study that the results do not apply?) 5 Integrating external and internal evidence The 2 sources of information (external and internal) may be supportive, non-supportive, or conflicting. How the decision is made when non-supportive or conflicting will depend on multiple factors. 6 Evaluation of decision making process Once the decision has been made, the process and the outcome are considered and opportunities for improvement are identified. The health authority of Alto Adige in northern Italy initiated and supported a project, the ââ¬Å"Bressanone Model,â⬠in which the effects of implementing evidence-based medicine on the quality of health care were to be shown. In this model we used the six step approach, which proved to be successful in the studentà project to teach experienced clinicians.3 The participants were asked to name problems of their day to day practice that lacked either an effective or an efficient solution. The evidence-based medicine support group helped participants to phrase the 3 or 4 part questions. Subsequently, the physicians were asked to submit their individual answers to the questions before continuing with steps 3 to 6. Agreement between internal and external evidence varies. Completing the full process could result in finding evidence that confirms the internal evidence, validating and strengthening the clinicianââ¬â¢s or studentââ¬â¢s confidence in the decision. The process could also reveal that little evidence exists to support the decision or that the available evidence is equivocal. In such cases, other factors such as cost or inconvenience to the patient may need to be given greater consideration. Possibly, the best external evidence found is not in agreement with the internal evidence. This represents a particularly valuable experience for the clinician or student because it may avoid an ill advised decision. It also shows the fallibility of making decisions onà uncertain ground based on internal evidence alone. This in turn will hopefully promote the routine assimilation of external evidence in clinical decision making. The documentation andà comparison of steps 2 and 5, used as a research tool or quality assurance outcome measure, coul d provide valid informationà on the effects of evidence-based medicine on clinical decision making. In case of conflicting internal and external evidence, clinicians have several options. They may change their mind and align it with the external evidence. They may determine that the external evidence is not sufficiently convincing and remain with theà original decision. Or, they may choose to discuss with theà patient the conflict between the internal and external evidence in a manner that enables the patient to take part in the decision making process. This last approach is recommended becauseà patient preference is considered an essential part of theà evidence-based decision making process1 and decisions oftenà need to be made in the absence of clear research findings.
Monday, January 6, 2020
Chinese Vocabulary Banking
You may need to do some banking when visiting a Mandarin-speaking country, no matter whether you are traveling for pleasure or for business. For instance, you may need to exchange money, withdraw funds, or even open an account.à Banks in larger cities may have English-speaking staff, but dont count on it. This list of common banking terms will help. Click on the links in the Pinyin column to hear the audio. Practical Tips You can always bring a Mandarin-speaking friend or colleague to act as translator. For many transactions, you will need to present some identification. Always bring your passport (è ·Ã§â¦ § / 护ç⦠§, hà ¹ zhà o) or ID card (è º «Ã¤ » ½Ã¨ â° / è º «Ã¤ » ½Ã¨ ¯ , shÃân fà ¨n zhà ¨ng) to the bank. Vocabulary List Vocabulary Pin Yin Traditional Simplified bank yn hng counter gu ti window chung ku teller ch n yun manager jng l account zhng h open an account ki h deposit (into an account) cn kun withdraw money t kun cash a check du xin exchange money hun qin exchange rate hu l cash xin jn check zh pio cashiers check du hun zh pio travelers check l xng zh pio credit card xn yng k passport h zho ID card shn fn zhng visa qin zhng
Subscribe to:
Comments (Atom)