Wednesday, October 30, 2019

Research &Evaluation of a service Initiative Essay

Research &Evaluation of a service Initiative - Essay Example en has become a serious concern and needs to be studied at primary healthcare setting, using wider platform of service initiatives (O’Hara et al., 1984; Whitton, Warner & Appleby, 1996). The study would be making efforts to identify the needs of the mothers and critically evaluate the support and proactive participation of peer support groups for women with PND in St. Albans. I am a student healthcare visitors and the student would greatly facilitate in exploring the various facets of timely interventions to reduce pnd. There is considerable evidence to show that PND has a substantial impact on the mother, her partner and baby (Linnet et al, 2003; Brown, Bacigalupo, 2006; Hall & Elliman, 2008). Evidence suggests that mothers’ psychosocial and mental health can have a significant effect on the mother and baby relationship and that PND can result in both emotional and cognitive disorders in the infant (Bee & Boyd, 2008; Stein et al.,1991; Murray & Cooper, 1991). All of which have significant health impacts on individuals and society, signifying a major public health issue (Hearn et al., 1998; Briscoe, 1986). Motherhood is one of the most important and challenging role of women. It becomes a lifelong learning process and is hugely facilitated by emotional support of the family (Scrandis, 2005). But often, the changing role of single women into mother is accompanied by socio psychological adjustments which are hugely facilitated by the husband, support family and peer groups (Rodrigues et al., 2000; Oats et al., 2004). The social expectations become highly stressful because of the various factors like lack of knowledge, conflicting views and differences about childcare between the expectant mothers and peer group. Very often this adversely impacts the self confidence and promotes doubts about one’s competency level of being a good mother thereby creating stress and pnd amongst the women (Dressel & Clark, 1990; Beck, 2002). Thus, encouraging family support

Monday, October 28, 2019

Committing suicide Essay Example for Free

Committing suicide Essay By the end Sybil denies all to do with Eva committing suicide. The audience has never liked her and this makes things worse.  Mrs Birling is selfish, ignorant and up tight, just like Mr Birling. He starts the same way as his wife when the inspector shows up. Mr Birling is the man of the house and is involved in most of the play. He describes himself as a hard-headed man of business and tells Eric that he should look after himself and his family, he wants Eric to be a hard-headed man of business so he can take over eventually. He likes Gerald and would prefer him as a son rather than Eric because they both think the same way. When Sheila calls off the engagement Gerald understands but Mr Birlings plans are in ruins. He had planned co-operation between Crofts limited and his own company. I dont understand why you should come here, Inspector.  Arthur doesnt like the Inspectors attitude and makes this clear. He is probably the most disliked character in this play. What he did to Eva was considered a very minor thing but she was only asking for a small raise. He dismisses what Sheila and Sybil did. At the end he too looks for ways out. Mr Birling predicts the future occasionally and every time he is wrong. We can look back on what has already happened and we know that he is wrong. The Germans dont want war. Nobody wants war  - the Titanic-she sails next week-forty six thousand eight hundred tons- forty six thousand eight hundred tons- New York in five days-and every luxury-and unsinkable  In both cases he is wrong and the next case he will probably be wrong:  theres a very good chance of a knighthood-so long as we behave ourselves  This leads to scandal, which there is a lot of in this play. This also attracts the audiences as people enjoy things to gossip about especially when there are respectable or rich people involved. Geralds affair, Eric making Eva pregnant and Alderman Meggartys nasty private life. But she became your mistress.  Yes.  And you made love again?  Yes.  Hes notorious womaniser. About Alderman Meggarty.  Mr Birling was never liked and through the course of the play the audience likes him less and less.  I personally never thought about liking or not liking the Inspector, he is just there, putting the questions to the Birlings. He is the most assertive on the scene and the stage directions show he makes his presence felt even though Mr Birling repeats his past achievements. By the time Gerald returns from his walk he is too late to confront Mr Goole, his timing is perfect. Then Gerald tells us:  That man wasnt a police officer.  There is an element of shock and surprise but some of the audience may have guessed this. Who is he then?  That is one of many questions left open and unanswered. Most of them are about the Inspector. His name suggests something supernatural. Goole sounds like Ghoul this means, a person unnaturally interested in death. This is exactly what the Inspector is but it seems he can change the future. But just remember this. One Eva Smith is gone-but here are millions and millions and millions Eva Smiths and John Smiths still left with us, with their lives, their hopes and fears, with their suffering and their chance of happiness, all intertwined with our lives, and what we say and do. We dont live alone. We are members of the body. We are responsible for each other. And I tell you that the time will soon come when, if men will soon learn, then they will be taught it in fire and blood and anguish. Good night. The end is about the wars so he knows about the future and ends up changing it. He knows too much to be human. He already knows what has happened and is just there to make the truth come out and teach the Birlings a lesson, or else. As mentioned before he seems to be able to change the future because of what happens at the end.  The end of the play is not really the end, it is the middle because things are just getting interesting again. The biggest unanswered question is what will happen now, J.B Priestly has left this to us to think about and try to finish. The ending leaves everything wide open and open to debate and argument. It is the talking point of the whole play.  Yes? Mr Birling speaking What? -here-  That was the police. A girl has just died- on her way to the Infirmary- after swallowing some disinfectant. And a police inspector is on his way here- to ask some- questions-

Saturday, October 26, 2019

Canterbury Tales :: Essays Papers

Canterbury Tales With the presidential election at its boiling point, many try to provide their own joke every now and then. Late night comedians such as David Letterman and Jay Leno try to spit out a new joke during their ten-minute spiel, and sometimes one can assume that they are getting even with the election process. Throughout the one-hour show, the comedians do their best to trick both the viewers and all those involved with the election process by having people act out scenes, or imitate one of the presidents. Also, as just about every other comedian tries to achieve, he or she throws in a dirty joke about the president or his family to tie it all up right at the end of their spiel. These three aspects of comedy—revenge, trickery, and infidelity—can all be found in The Miller’s Tale. The Miller’s Tale encompasses a dark and infernal level of comedy, similar to that of comedy today. In The Miller’s Tale, Nicholas, a clerk, is a student of astronomy and of young women, who represents the dark and infernal level of comedy where â€Å"love cannot dwell in such society; everyone is fundamentally along, though hypocrisy and self-serving may give the appearance of friendship† (Cowan, 11). Nicholas lives with a wealthy carpenter named John, who’s an old man who protects his beautiful wife, Alison, as if it were flies on scat. In the infernal state â€Å"the pretty girl†¦ is either absent or, if she does enter the boundaries of this dark region, victimized† (11). Alison is caught between three disrespectful men. Her husband, John, won’t let his eye off his young and zealous wife; Nicholas always becomes as sly as a snake, wanting to make love to her, and trying to outwit his friend, John; the carpenters wife, fancied by Absalom, a parish clerk who has none of Nicholas’ attractiveness, but an eye for the ladies of the to wn. Although marriage is very rare in the infernal state, â€Å"old husbands tyrannize young wives, spouses are unfaithful, maidens are linked by opportunism to unsuitable mates†¦Ã¢â‚¬  (12). The old husband, John, tyrannizes his wife day after day with his over-protective personality,while she is unfaithful to him by making love and flirting with other men. Trickery is a key part in The Miller’s Tale, and found in the infernal state: â€Å"deception and disguise, characterizing marks of comedy, are used in infernal society for the purpose of gaining advantage, usually to the harm of others† (12).

Thursday, October 24, 2019

AIDS and Needles Essay

Becton Dickinson, one of the largest manufacturers of medical supplies, dominates the US market in disposable syringes and needles. In 2005, a nurse, Maryann Rockwood (a fictional name), used a Becton Dickinson 5cc syringe and needle to draw blood from a patient known to be infected with HIV (Human immunodeficiency virus). Ms. Rockwood worked in a clinic that served AIDS patients, and she drew blood from these patients several times a day. After drawing the blood on this particular day, she transferred the HIV-contaminated blood to a sterile test tube by sticking the needle through the rubber stopper of the test tube, which she was holding with her other hand. She accidentally pricked her finger with the contaminated needle. She is now HIV positive. A few years earlier, in 2000, Becton Dickinson had acquired exclusive rights to a patent for a new syringe that had a moveable protective sleeve around it. The plastic tube around the syringe could slide down to safely cover the needle. The Becton Dickinson 5cc syringe used by Maryann Rockwood in 2005, however, did not yet have such a protective guard built into it. The AIDS epidemic has posed peculiarly acute dilemmas for health workers, including doctors and nurses. Doctors performing surgery on AIDS patients can easily prick their fingers with a scalpel, needle, sharp instrument, or even bone fragment and can become infected with the virus. The greatest risk is to nurses, who, after routinely removing an intravenous system, drawing blood, or delivering an injection to an AIDS patient, can easily stick themselves with the needle they were using. Needlestick injuries occur frequently in large hospitals and account for about 80 percent of reported occupational exposures to HIV among health care workers. It was conservatively estimated in 2005 that about 64 health care workers were then being infected with HIV each year as a result of needlestick injuries. Although the fear of HIV had heightened concerns over needlestick injuries, HIV was not the only risk posed by needlestick injuries. Hepatitis B can also be contracted through an accidental needlestick. In 2000, the Centre for Disease Control (CDC) estimated, on the basis of hospital reports, that each year at least 12,000 health care workers are exposed to blood contaminated with the Hepatitis B virus, and of these 250 die as a  consequence. Due to underreporting, however, the actual numbers may be higher. In addition to Hepatitis B, needlestick injuries can also transmit numerous other viral, bacterial, fungal, and parasitic infections, as well as toxic drugs or other agents that are delivered through a syringe and needle. The total statistics on needlestick injuries in 2005 are disturbing, although the exact incidence of contamination is unclear. It was estimated that each year, in the United States alone, between 800,000 and 1 million needlestick injuries occurred in hospitals – of these, between 60,000 and 300,000 resulted in Hepatitis B infection. By one estimate, the risk of contracting HIV from a known contaminated needle could be as high as 1 in 1000, and the risk of contracting Hepatitis B, a serious and often life-threatening condition, could be as high as 1 in 6. These estimates would imply that as many as 600 to 1000 health care workers were at risk of contracting HIV and as many as 100,000 were at risk of contracting Hepatitis B. Several agencies stepped in to set guidelines for nurses, including the American Nursing Association, the CDC, the Environmental Protection Agency (EPA), and the Food and Drug Administration (FAD), who all developed such guidelines. The most comprehensive guidelines were issued by the Occupational Safety and Health Administration (OSHA), who on December 6, 2001, required hospitals and other employers of health workers to (a) make sharps containers (safe needle containers) accessible to workers, (b) prohibit the practice of recapping needles by holding the cap in one hand and inserting the needle with   the other, and (c) provide information and training on needlestick prevention to employees.  The usefulness of these guidelines was controversial. Nurses work in high-stress emergency situations requiring quick action, and they are often pressed for time both because of the large number of patients they must care for and the highly variable needs and demands of these patients. In s uch workplace environments, it is difficult to adhere to the guidelines recommended by the agencies. For example, a high-risk source of needle sticks is the technique of replacing the cap on a needle (after it has been  used) by holding the cap in one hand and inserting the needle into the cap with the other hand. OSHA guidelines specifically warned against this two-handed technique of recapping and instead required that the cap be placed on a stable surface and the nurse use a one-handed spearing technique to replace the cap. (Note that recapping the needles in this more time consuming way presented no risk of needlestick injury to the user). As noted above however, nurses are often pressed for time (and are keenly aware of the added danger of walking around with an uncapped needles) and tend to take the ‘two-handed recapping shortcut’ when no suitable surface is readily available for the safer one-handed capping technique. This fact is known to Hospital administrators, who regularly warn against such practices, and offer ongoing training and retraining opportunities to their nursing staff. Several analysts suggested that the peculiar features of the nurse’s work environment made it unlikely that needlesticks would be prevented through mere guidelines alone: The problem was not the worker, but the design of the needle and syringe. Experts on needlestick injuries argued that, rather than trying to teach health care workers to use a hazardous device safely, the focus should be on the hazardous product design and that a whole new array of devices in which safety is an integral part of the design was required. Regulators also urged manufacturers to provide the health care worker with devices in which safety was built into the design. The risks of contracting life-threatening diseases by the use of needles and syringes in health care settings had been well documented since the early 1980s. Well over half of all the needles and syringes used by U.S. health care workers since 1980 were being manufactured by Becton Dickinson. Despite the emerging crisis, however, Becton Dickinson decided not to modify its syringes, although it did include in each box of needled syringes an insert warning of the danger of needlesticks and of the dangers of two-handed recapping. On December 23, 2000, the U.S. Patent office issued patent number 4,631,057 to Charles B. Mitchell for a syringe with a tube surrounding the body of the syringe that could be pulled down to cover and protect the needle on the syringe. At the time, at least four other patents for needle-shielding devices existed. As Mitchell noted in his patent application, those devices all suffered from serious drawbacks. One of them  would not lock the protective cover over the exposed needle, one was extremely complex, another was much longer than a standard syringe and difficult to use, and a fourth was designed primarily for use on animals. It was Mitchell’s assessment that his invention was the only effective, easily usable, and easily manufactured device capable of protecting users from needlesticks, particularly in emergency periods or other times of high stress. Unlike other syringe designs, Mitchell’s was shaped and sized like a standard syringe so nurses already familiar with standard syringe design would have no difficulty adapting to it. Shortly after Mitchell patented his syringe, Becton Dickinson purchased from him an exclusive license to manufacture it. A few months later, Becton Dickinson began field tests of early models of the syringe using a 3cc model. Nurses and hospital personnel were enthusiastic when shown the product. However, they warned that if the company priced the product too high, hospitals, with pressures on their budgets rising, could not buy the safety syringes. With concerns about HIV rising fast, the company decided to market the product. In 2001, with the field tests completed, Becton Dickinson had to decide which syringes would be marketed with the protective sleeves. Sleeves could be put on all of the major syringe sizes, including 1cc, 3cc, 5cc, and 10cc syringes. However, the company decided to market only a 3cc version of the protective sleeve. The 3cc syringes account for about half of all syringes used, although the larger sizes-5cc and 10cc syringes-are preferred by nurses when drawing blood. This 3cc syringe was marketed in 2002 under the trademarked name Safety-Lok Syringe. It was promoted as a device that â€Å"virtually eliminates needlesticks.† The 3cc safety syringe with the protective sleeve was sold in 2001 to hospitals and doctors’ offices for between 50 and 75 cents. By 2003, the company had dropped the price to 26 cents per unit. At the time, a regular syringe without any protective device was priced at 8 cents per unit and cost 4 cents to make. Information about the cost of manufactu ring the new safety syringe is unavailable but is estimated at between 13 and 20 cents each. The difference between the price  of a standard syringe and the price of the safety syringe was an obstacle for customers. To switch to the new safety syringe would increase the hospital’s costs for 3cc syringes by a factor of three. An equally important impediment to adoption was the fact that the syringe was available in only one 3cc size, and it was perceived to be of limited application. Hospitals are reluctant to adopt and adapt to a product that is not available for the whole range of applications the hospital must confront. In particular, hospitals often needed the larger 5cc and 10cc sizes to draw blood, and Becton Dickinson had not made these available with a sleeve. For 5 years, Becton Dickinson manufactured only 3cc safety syringes. During that period, Becton Dickinson did not license its new safety syringe technology to another manufacturer that might have produced a full range of syringe sizes. Most hospitals and clinics, including the medical facility where Maryann Rockwood worked at drawing blood from many patients with Hepatitis B or HIV, did not stock the Becton Dickinson safety syringe. Most nurses in the United States continued to use unprotected syringes. Maryann Rockwood sued Becton Dickinson, alleging that, because it alone had an exclusive right to Mitchell’s patented design, the company had a duty to provide the safety syringe in all its sizes, and that by withholding other sizes from the market it had contributed to her injury. The case was settled out of court.

Wednesday, October 23, 2019

Has the Time Come to Legalize Drugs? Essay

Legalization of drugs — long an issue championed mainly by fringe groups — is rapidly moving to the mainstream in Latin America. Last week’s surprise statement by former Mexican President Vicente Fox in support of â€Å"legalizing production, sales and distribution† of drugs made big headlines around the world. Fox, a former close U.S. ally who belongs to the same center-right political party as President Felipe Calderà ¯Ã‚ ¿Ã‚ ½n, rocked the boat at home by indirectly criticizing the very premise of Calderon’s all-out military offensive against Mexico’s drug cartels, which has cost 28,000 lives since 2006. Calderon immediately responded that he opposes legalization of drugs, although he has opened a dialogue with political parties about the future of his country’s anti-drug policies. The left-of-center Party of the Democratic Revolution announced that it supports â€Å"de facto legalization† of drugs. Fox’s statement, first published Saturday in his blog, went far beyond a 2009 joint declaration by former Presidents Fernando Henrique Cardoso of Brazil, Ernesto Zedillo of Mexico and Cesar Gaviria of Colombia. In that statement, the three former leaders questioned the effectiveness of the U.S. war on drugs and proposed de-criminalizing possession of marijuana for personal use. While the three centrist former presidents’ proposal amounted to not prosecuting people for consuming marijuana, Fox’s proposal calls for legalization of all major drugs — the whole enchilada. In an extended interview, Fox told me that he is making his proposal because drug-related violence in Mexico has reached intolerable levels, and because the experience of other countries such as the Netherlands has shown that allowing drug sales has not significantly driven up drug consumption. â€Å"Prohibitionist policies have hardly worked anywhere,† Fox told me. â€Å"Prohibition of alcohol in the United States [in the 1920’s] never worked, and it only helped trigger violence and crime.† Since possession of small amounts of marijuana has already been decriminalized in Mexico, what’s needed now are bolder steps, such as legalizing drug production and using the taxes it generates to fund anti-drug education programs, he said. â€Å"What I’m proposing is that, instead of allowing this business to continue being run by criminals, by cartels, that it be run by law-abiding business people who are registered with the Finance Ministry, pay taxes and create jobs,† Fox said. Fox called for a reversal of Calderà ¯Ã‚ ¿Ã‚ ½n’s decision to send the army into the streets to fight the drug cartels because â€Å"the army is not prepared to do police work, and we are seeing day to day how the army’s image is losing ground in Mexico† as a result of this war. Why didn’t you come out with this proposal when you were president? I asked. Fox responded that legalization was often discussed in Cabinet meetings during his presidency, but that the urgency of such a measure has increased since â€Å"because of the extraordinary cost we are paying in a drop in tourism, a drop in investments and a lack of attention to education and health.† In a separate interview, White House drug czar R. Gil Kerlikowske told me that drug legalization is a â€Å"non-starter† in the Obama administration. Kerlikowske disputed the idea that alcohol prohibition drove up crime in the United States in the 1920s, arguing that there were no reliable crime statistics at the time. And he rejected the notion that there has been no major increase in drug consumption in the Netherlands. â€Å"In the Netherlands, consumption did go up. In fact, the Netherlands has been in the process of closing down hundreds of the marijuana cafes that had been in existence because of the problems that are occurring,† he said. My opinion: I’m not convinced that a blanket legalization of drugs would work because government regulation of the cocaine and heroin businesses in countries that already have high corruption rates would result in greater official corruption. On the other hand, it’s clear that after four years of Calderà ¯Ã‚ ¿Ã‚ ½n’s U.S.-backed war on drugs, the cartels are smuggling more drugs, killing more people and becoming richer. Perhaps the time has come to take a step-by-step approach and start a serious debate about passing laws that would regulate legal production of marijuana, alongside massive education campaigns to discourage people from using it. Then, we could see who is right and consider what to do next. (c) Miami Herald. Miami Herald content is the intellectual property of Miami Herald. Any copying, republication or redistribution of Miami Herald content is expressly prohibited by federal law. Miami Herald shall not be liable for any errors or delays in content, or for any actions taken in reliance thereon. Source: http://www.miamiherald.com/2010/08/12/1772336/has-the-time-come-to-legalize.html Commentary Number 1 The question raised in this article is a complex one. Mexican President Felipe Calderà ¯Ã‚ ¿Ã‚ ½n’s hesitancy at enforcing drug-legalization policies is understandable, as the legalization of drugs in a drug-war-torn country such as Mexico can be beneficial or adverse from an economic point of view. One might argue that such measures would bring about a series of negative externalities on the public such as harmful health effects. A majority believes that the legalization of drugs will increase crime rates; most people under the influence of narcotics are prone to violent crimes. However, the reasons ex-President Vicente Fox has for de-criminalizing drugs appear to outweigh the adverse effects. The law of demand states that as price falls, the quantity demanded rises, and as prices rise, quantity demanded falls. This illustrates that legalization of drugs will reduce the profit criminals make. Every time the government takes hold of a drug dealer and the products he is selling, supply of the drug to the illegal drug market is reduced. If there is a reduced supply, there is an increase in price of the good. Drug-addicts are helpless, and thus they will buy the drug for the higher price, giving the criminal dealer more profit. Every time the government thinks it is winning its drug war, it is actually losing; the illegal state of these drugs aids the dealers, harming the government. Figure 2 Price elasticity of demand of a good is a measure of the extent to which the quantity demanded of a good changes when its price changes. As is illustrated on Figures 1 and 2, due to the fact that drugs are a necessity to drug-addicts, they are willing to buy pretty much the same quantity of the drug at any price, thus making the price elasticity of demand of drugs inelastic (when the quantity demanded remains similar as the price changes). If drugs are legalized, the government can benefit from its demand price inelasticity by taxing on drugs, and thus making more profit that can be allocated accordingly. Drug consumers will not care whether they are paying more than they should be and will buy the legal drug at the price it is sold legally. Other people will notice why the drug is inelastic, and will avoid them due to its addictive dangers. Thus, the absence of undercover drug dealing will show people the dangers of drugs and lead to consumers and producers providing less of the drug once the government starts taxing, thus leading to a smaller population using them. The most beneficial aspect of drug legalization in Mexico would be taxing on the drug. As demand for drugs is inelastic, the tax revenue raised will be large. Additionally, the deadweight loss (fall in total surplus consumers and producers make) will be smaller as the consumers will not consume less at first even though producers will produce at a less quantity. These are shown on Figure 3. The consumers will pay more taxes as they desperately need to buy the drug, and eventually will try and consume less when they become financially diminished. They will seek rehabilitation, and thus shrink the market for drugs. If the government correctly uses the revenues raised by taxing on drugs to promote healthcare and drug rehabilitation, the Mexican economy can cause a decline in overall drug sale and use. Figure 3 In conclusion, Mexico’s ex-President Vicente Fox should proceed with convincing the government to legalize drugs, as this measure will not only reduce consumption and production of these harmful products, but also promote society and the economy by raising revenue to enhance health and other aspects of the economy that need betterment.