Contemporary Healthcare Specific Management and Leadership Practice Essay

If there is one word which describes the American health care environment during the last decade, that word is change. Professionals joining the health care industry during the 1990s will find little resemblance to the work environment their predecessors found a mere 10 years earlier. Physical therapy practice during the 1960s and 1970s was largely limited to three settings: the hospital, private practice and extended care institutions. Private practice followed the medical practice model and served primarily ambulatory outpatients. Hospital-based practice accounted for the majority of practice opportunities. Along with some limitations on professional autonomy, employment in hospital-based practice generally offered the greatest opportunities for variety in clinical practice. Literature Review Change is constant and usually affects an entire organization. Change sometimes can cause chaos and stress, but which must be acknowledged and dealt with in order to make an organization effective. Improving high-quality patient care is the most important issue for everyone in a physical health institution, and this improvement needs to remain a central focus of and the main reason for the change. Discussions with hospital executives reveal: There is a need for an action plan to meet the needs of a more culturally diversed population. Adverse patient care incidents are under-reported because there are different interpretations about what should be reported. The hospital has not been able to invest in training hospital staff on reporting requirements. There are no systematic report mechanisms in place. Further study on the case reveals that the peer review processes of the hospital are weak if not minimally compliant. The number of patient complaints about hospital care has been rising. Complaints are often complex, and may involve the hospital’s other health care facilities, and health professionals, as well. Medication errors have been a major concern for the hospital this lately. Though deficiencies were cited, the potential for patient harm was not clearly identified. Still, it has important influences on the quality of care for the medical facility. Faith also noted that their premium cost are decreasing, and is becoming a significant concern for the hospital. The lack of clear and concise ethics guidelines for medical personnel, especially on issues requiring ethical decisions. Each group of stakeholders has somewhat different concerns. That is, each cares more about some aspects of an organization’s activities and less about others. Customers. Many organizations say that they put the concerns of their customers or clients first. For U.S. companies, that often means improving the quality of the service while keeping costs in check. Interviews with the customers reveal that the health care organization’s Teamwork Competency account illustrates that using teams to improve quality is one approach that organizations can use to address the concerns of customers. Employees. Many of the concerns that employees have today reflect changes in the structure of organizations and the fact that work is a major activity in their lives. How a company treats employees during times of change is a key issue raised by this company. Pay is another area of concern to employees. The desire to receive equal pay for equal work is among the most important of workplace issues, according to a national survey of 40,000 women. Owners and Shareholders. For many organizations, the concerns of owners—that is, taxpayers and contributors—often are essentially those of society at large. But for privately owned companies, and those whose shares are publicly traded, the concerns of owners—that is, shareholders—may be quite different from those of society in general. Most shareholders invest their money in companies for financial reasons. At a minimum, they want to preserve their capital for later use. Because the job of institutional investors is to make money by choosing which companies to put their investment in, their perspective on corporate issues is to make profit generation the firm’s top priority. As professional investors, these shareholders have considerable power to influence management’s decisions. Physical therapy health care service product is a bundle of tangible and intangible benefits that satisfy patient’s needs. Factors as job design, role clarity, and autonomy affect employee attitudes, which in turn affect patient experience in the institution. These observations emphasize the need to look beyond the immediate and obvious aspects of satisfaction and to consider other aspects, which affect patient perception of their experience. In dealing with the hospital’s problems with respect to organizational processes, ethics and communication issues, it must be considered from three perspectives: structure, process and outcome. To assure that the hospital services are being appropriately provided, each dimension of hospital care provision must be considered. Quality of Life has different meanings as compared to the other health-related subject matters. It is used to describe a patient’s health status, a description of how he perceives himself and his point of view about his life.   But Quality of Life Concept encompasses more than the health status or one’s perception about self and life.   This concept analysis nursing paper serves to provide the most comprehensive definition about this concept and how it is used in medical terms at present. Quality of Life Concept has become an â€Å"impressive ‘explosive’ trend† talked about by medical field professionals, published in journals, books and various quality life articles for the last 10 years now.   Within this period, its concept continues to evolve and has reached three phases. In the first phase, there is the formal assessment made and classified as ‘physician’s judgment of the patient’s health’. In the second phase, the points of view of the patients were given focus and the tools used in the study were those applied from psycho-social fields. In the third phase, multi-dimensional questionnaires were adopted and the concept of Quality of Life and health status begin to have different meanings (Apolone and Mosconi, p.66, 1998). Today, the trend continues to evolve as patient-oriented measures are applied and studied from functional disability scales to spiritual quality of life and economic measures. It is also a lot of other possible factors that have effects on a patient’s perception about what quality of life is in relation to his health.   The patient’s point of view in quality and effectiveness is taken into consideration and is treated as a more comprehensive humanistic approach that determines what to him is quality of life (Apolone and Mosconi, p. 68, 1998). Definition of Quality of Life When we speak about quality of life in layman’s terms, it literally pertains to a number of definitions. It connotes with standard of living, available resources or conditions that tell about either the comforts or discomforts of life and such other identifiable meaning and perception about an ideal life.   There are many indicators about what quality of life a patient can perceive and most of these indicators depend variably on one’s cultural values. Defining Quality of Life for the purpose of this nursing concept paper is variable because it pertains to a â€Å"subjective experience†. Hence, it can not be measured with â€Å"object indicators.†Ã‚   Being the case, according to Skevington, studies show that the â€Å"best person to assess quality of life is arguably the individual himself† (Skevington, par. 4, 1999). When questions are asked to a patient and he, in turn, answers the questions, the medical professional likely gets a limited clinical success in the study of the patient’s history because of limited information.   He is unable to get the necessary data that may be of help in assessing the health condition of the patient.   Hence, there is a need to come up with a good quality-of-life measure that will enable health and interventions to be properly evaluated. The World Health Organization (WHO), Geneva, in collaboration with the WHOQOL Group, designed an instrument called WHOQOL-100 that is used in â€Å"multinational clinical trials for the evaluation of quality-of-life outcomes during all types of health care interventions like surgery, counseling and medication.† (Skevington, par.1, 1999).  Ã‚   It is useful also for making cross-cultural function about perceived quality of life relating to health and at a one-to-one level, in improving communications between doctors and their patients in the consulting room (Skevington, par. 1, 1999). The WHOQOL has up come with such instrument and made it as comprehensive as possible to reach out to various global dimensions that are workable internationally. Moreover, it is intended for use by persons with chronic diseases, informal caregivers and people living in highly stressful situations. WHO defines health as a â€Å"state of complete physical, mental and social well-being, not merely the absence of disease or infirmity†.   On the other hand, the WHOQOL Group defines Quality of Life as â€Å"an individual’s perception of their position in life, in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns (Sousa).   It is so broad a concept that it affects the patient’s physical health, psychological state, level of independence, and social relationships with his environment in a very complex way.   In addition to this definition, WHOQOL Group has added the sixth domain to the list, which is â€Å"spirituality, religion, and personal beliefs.† (Skevington, par 5, 1999). Furthermore, the WHOQOL 100 is an instrument that is applied to heterogeneous cross-section of sick and well people in order to examine its internal consistency reliability, construct validity , and discriminant power (Skevington, par. 1999).. Concept of Quality of Life in Health Care The Quality of Life came about when the disciplines of sociology and psychology became an issue related to health care. It has emerged into a larger issue when technological advances were aimed at increasing life span. Quality of Life has become a means to guide a patient in deciding on whether to pursue a treatment or not for his or her ailment.   According to clinicians, Health-related Quality of Life is an appropriate focus for a patient who has a disease or who is ill, and whose aspects in life become health-related (Haas, p. 730, 1999). A)  Ã‚  Ã‚   Defining Attributes of Quality of Life. The Walker and Avant’s 1995 method of concept analysis of Quality of Life took note of the various characteristics or critical attributes recurring in the process of their studies and they are grouped according to four recurring themes.   The first theme is the â€Å"multi-dimensional and dynamic nature of the QOL.   Authors have stressed that QOL is a multi-dimensional concept considering that it is â€Å"based on values; is dynamic, ever changing and depends largely on the context in which it is measured† (Haas, p. 733, 1999). The second theme is that QOL includes an assessment.   In this case, the authors include words such as response, appraisal, measure, experience and assessment in defining and using QOL (Haas, p. 733, 1999).   The third theme is centered on the subjective nature of QOL. Grouped within this theme are words like perception, well-being, and satisfaction. (Haas, p. 733, 1999). The fourth and final theme recognizes the objective nature of QOL, with authors using â€Å"behavior, functioning, and environment as measures of QOL.† (Haas, p. 733, 1999). These defining attributes were sourced from the definitions and use of QOL. It mainly shows that QOL is indeed an individual’s current life circumstance. It further shows that it is multi-dimensional in nature and in being so, is based on values and is dynamic. It is also composed of both subjective and/or objective indicators. Finally QOL is subjectively measured by persons capable of self-evaluation.   (Haas, p. 733, 1999) (B) Congruence of the Concept with the Assumptions and Other Concepts within the Model/Theory. The QOL Model was formulated to provide a measure that takes into consideration both the components and determinants of health and well being that are consistent with the concept of Quality of Life. The QOL Model or Profile emphasizes on the person’s physical, psychological and spiritual functioning and his connections with his environments as well as opportunities for maintaining and enhancing skills (The Quality of Life Model, par 3, 2005). The Conceptual framework of the Quality of Life has three life domains which are aimed at providing a person to enjoy the more essential potentials of his life. (The Quality of Life Model, par 4, 2005) Each of the three domains has three sub-domains and they are as follows: (a)  Ã‚  Ã‚   Being pertains to who one is.   Its three sub-domains are: (1) Physical Being, which relates to a person’s or patient’s physical health, personal hygiene, nutrition, exercise, grooming and clothing, and general physical appearance; (2) Psychological Being, which relates to his psychological health adjustment, cognitions, feelings, self-esteem, self-concept and self-control; (3) Spiritual Being, which relates to his personal values, personal standards of conduct and spiritual beliefs. (The Quality of Life Model, par. 5, 2005) (b)  Ã‚   Belonging pertains to the person’s connections with his environment. Its three sub-domains are: (1) Physical Belonging, which relates to his connections with his home, work place/school, neighborhood and community; (2) Social Belonging, which relates to his connections with his intimate others, family, friends, co-workers, neighborhood and community; (3) Community Belonging, which relates to his connections with matters pertaining to adequate income, health and social services, employment, educational programs, recreational programs or community events and activities. (The Quality of Life Model, par 5. 2005) (c)  Ã‚  Ã‚   Becoming pertains to achieving personal goals, hopes and aspirations. Its three sub-domains are: (1) Practical Becoming, which relates to achieving personal goals in domestic activities, in work, in school or volunteer activities or seeing to health and social needs; (2) Leisure Becoming, relates to activities that promote relaxation and stress reduction; (3) Growth Becoming, relates to activities that promote the maintenance or improvement of knowledge and skill and adapting to change. (The Quality of Life Model, par. 5, 2005) Ferrans Conceptual Model of Quality of Life. Ferrans has developed a model based on the adoption of the individualistic ideology, which recognizes that quality of life depends on the unique experience of individuals. He maintains that the individual person is the only accurate judge of his quality of life because people differ in their perceptions and values. (Ferrans, par. 1, 1996)   This model uses qualitative methodology and has identified four domains of quality of life: health and functioning as psychological/spiritual, social and economic, and family. (Ferrans, par 1, 1996)   Patient data are analyzed in relation to these domains of quality of life. Researchers, physicians, policy makers adopt the Quality of Life concept as an instrument that tests the validity, reliability and effectiveness of different and relevant sub-domains for the purpose of evaluating the impact of medical interventions on the population (Apolone and Mosconi, p. 68, 1998). Since the concept is considered non-medical determinant, it is treated as confounder, a complementary way for effectiveness of care to a patient. This is because medicine still plays the major role in determining the final health outcome of a patient. (Apolone and Mosconi, p. 68, 1998) Since patients are the proper judge of their quality of life, there are ways to enhance the well-being of patients who may have a poor quality of life.   Studies show that the presence of positive feelings in patients is the most important feature of the kind of quality of life he has. Patients, with positive feelings most likely enjoy a pleasant quality of life than those who are in-patients and sick. A person has control of his emotions which can generally affect his state of mental being.   It is a matter of developing the positive attitude and containing oneself into thinking of a positive outlook in life.

Great Expectations Essay

How does Charles Dickens introduce his characters, setting and themes at the beginning of his novel, Great Expectations? The world that Charles Dickens creates at the beginning of his novel Great Expectations is one of isolation, loneliness and sorrow. This is because he portrays the world in this novel through Pip, whose childhood is spent in loneliness because he was deprived of his parentage and the comfort of his siblings at an early age. His sister Mrs Joe Gargery brings him up and is extremely aggressive and abusive towards him. She pushes him to the extent that he isolates himself from the world, and spends part of his childhood grieving over the death of his parents in the graveyard. The atmosphere at the beginning is shown as being really distant and sorrowful, when describing the atmosphere where Pip is first introduced as, â€Å"the small bundle of shivers growing afraid of it all and beginning to cry was Pip.† Dickens has chosen to use a variety of linguistic devices to help the reader visualise what the landscape looks like. For example he uses a series of adjectives to describe Pip’s immediate surroundings: ‘Dark, flat wilderness.’ In particular he uses metaphors to compare the different aspects of the environment; â€Å"the distant savage lair from which the wind was rushing, was the sea.† This presents the sea in such a way that the readers are given the impression that the sea is aggressive and hostile. This relates back to the way Pip’s sister behaves towards him, always aggressive towards Pip and takes every opportunity to abuse him both mentally and physically. â€Å"Bleak place overgrown with nettles.† This describes Pip’s surroundings as being overcrowded with nettles. The link that is significant between the nettles and Pip, is that the place is hazardous seeing that the nettles often sting and hurt when one comes into contact with them, signifying pain and distress. This relates to how the convict (later known as Abel Magwitch) treats Pip, when he comes in to contact with him at the graveyard. He handles Pip in an intimidating and aggressive way; he is very insulting to him partially because he wants Pip to help him. The picture that Dickens creates of Magwitch, contrasts with the church, especially because the church is a religious symbol where you can seek sanctuary from the rest of the world and its problems. â€Å"The river wound, twenty miles of the sea.† This gives us the impression that the river is alive and is unwinding. Also the image of the long river comes in to mind. â€Å"The marshes were just a long black horizontal line then.† A marsh is a great expanse of wetland, mostly useless because you can’t build anything on it. â€Å"The river was just another horizontal line, not nearly so broad nor yet so black; and the sky was just a row of long angry red lines and dense black lines intermixed.† This represents the environments as being a place of isolation, deserted because of a loss of inhabitants. People would not normally want to be in such an area. In the beginning of the novel, it reveals that Pip is found at this place. He is lonely and secluded from everyone, trying to find support and refuge amongst the dead; some of them being his parents and his brothers. The adjective in this quote shows how the graveyard has a livid atmosphere, generally to signify the connection between the dead and the unfortunate circumstances that they died in. The character of Pip in Great Expectations is portrayed as being very tolerant and silent when compared to the rest of the characters in his surroundings. He is always very diminutive when confronted by other people. Throughout the novel he is seen as being serene and distinctive, possibly because of his parentage and his social background. â€Å"I never saw my father or my mother, and never saw any likeness of either of them.† Pip had not seen his parents since he was born, as both of them had been deceased when Pip had been very small; however he was brought up by his only living relative; his sister. â€Å"My sister – Mrs. Joe Gargery, who married the blacksmith.† As Pip had never experienced the love and care of his parents he used to spend most of his time in the graveyard, trying to comfort himself with the presence of his family. â€Å"The shape of the letters on my father’s, gave me an odd idea that he was a square, stout, dark man, with curly black hair. From the character and turn of the inscription, â€Å"Also Georgiana Wife of the Above,† I drew a childish conclusion that my mother was freckled and sickly.† Although Pip didn’t know how his parents appeared, he tried to change that by observing their graves stones to visualize what they looked like. The isolation that is felt at the beginning is apparent in the fact that he tries to imagine what his parents looked like from the shape of the letters on their tombstones. Pip’s brothers also died at a young age, which deprives Pip of having any companions to play or spend his time with. â€Å"Of five little brothers of mine – who gave up trying to get a living, exceedingly early in that universal struggle.† This leaves Pip being more isolated and alone than he would have been if they had been alive. The only thing that he knew about his brothers was their names; â€Å"Alexander, Bartholomew, Abraham, Tobias, and Roger, infant children of the aforesaid, were also dead and buried; and that the dark flat wilderness beyond the churchyard†¦Ã¢â‚¬  The dark flat wilderness reflects the emotional feelings of Pip and the harshness of the atmosphere. This is important because it explains his isolation and surroundings, and how he seeks shelter in this dark deserted environment. The phrase â€Å"memorable raw afternoon,† directly relates to how cold, uncomfortable, rough and painful life is for Pip. There is also some importance in this extract taken from the novel. â€Å"The low leaden line beyond, was the river; and that the distant savage lair from which the wind was rushing, was the sea;† These phrases describe the surroundings that Pip grew up in. The metaphors in this are given a lot of importance as they relate to the severity and loneliness in Pip’s life. The role of Abel Magwitch in the opening of the novel is considerable, although we do not see much of him other than in the opening and final passages, he is arguably one of the most influential characters in Pip’s life. Charles Dickens depicts Magwitch as extremely aggressive and impertinent; this presents him as a fearful and a cautious man. â€Å"A fearful man, all in course grey, with a great iron on his leg.† This is a really menacing image of him, as when he threatens Pip for food and drink Pip immediately responds to him by agreeing to steal the food. There have been many incidents in the opening extracts of the novel where Pip has been threatened by the convict. â€Å"Keep still you little devil or I’ll cut your throat.† This gives the audience the impression that Magwitch is violent and aggressive. He treats Pip with the same violence and aggression when he asks Pip to get things for him, not at all considering how old or small Pip is. This shows us how Pip is abused and insulted by Magwitch, for his own personal gain. â€Å"You get me a file.† He tilted me again. â€Å"And you get me wittles.† He tilted me again. â€Å"You bring ’em both to me.† He tilted me again. â€Å"Or I’ll have your heart and liver out.† He tilted me again.† The way Magwitch speaks is so different to the Standard English that Pip uses, this is because he uses colloquial language. This citation also proves that Magwitch is selfish and passionate, as he is so desperate to get what he desires that he will do anything to make sure he gets it, no matter how much turmoil and trouble it could cause. Furthermore, it shows that he is very dangerous and the influence he has over Pip can lead Pip to carry out a criminal act. The instant image that is created of Magwitch is of danger and neglect, because of all the exploitation and torment that he furnishes on Pip. â€Å"A fearful man, (†¦). A man with no hat, and with broken shoes, and with an old rag tied round his head†¦ who limped, and shivered, and glared and growled; and whose teeth chattered in his head as he seized me by the chin.† You can tell that that Pip is petrified of Magwitch due to his appearance and the way he conducts himself. This has an immense amount of impact on Pip as he still has nightmares regarding the convict, which frightens him. However this image of Magwitch is shown in a different light as we advance in to the novel. Pip is courteous and kind to him, as a result he decides to make Pip a ‘gentleman of great expectations.’ It is possible that because of the pain that was inflicted on to him in his past, he treats Pip in that way. Nevertheless, when Pip is being questioned about the theft of the food, Magwitch takes the blame on to himself, it is a possibility that he felt guilty about all the pain he caused Pip and also because Pip had been prepared to do so much for him. Another reason for Magwitch to make Pip a ‘gentleman of great expectations’- is because, although he was intimidating and traumatizing to Pip, Pip showed lots of respect and politeness towards him, in addition to bringing him what he requested. â€Å"Yes sir.† This shows that even though he is being physically abused, he is being respectful; this may be because Pip is vulnerable and is in a sense of helplessness and danger. Abel Magwitch becomes Pip benefactor as he perceives Pip as being trustworthy and well mannered. It is shown later on in the text that Magwitch had a daughter. Therefore bearing in mind that Pip had lost his parents at an early age, Magwitch felt concerned about Pip and sought to replace the parental love that Pip was deprived. The theme of abuse is also present through out a variety of chapters. There’ve been many incidents in this novel in which Pip has suffered from abusive behaviour, physically and mentally, from numerous characters. Those of which includes; Pip’s sister – Mrs Joe Gargery, Estella and Ms Havisham. The type of abusive behaviour that he endures from his sister is revealed during the opening scenes of the novel. His sister is revealed as being very stern and intolerant towards Pip. She beats him severely and also attacks his mental state of mind. Her way of speaking to him is really harsh and her actions provide the audience with the assumption that Mrs Joe Gargery loathes Pip. â€Å"Knowing her to have a hard and heavy hand, and to be much in the habit of laying it upon her husband as well as upon me.† This implies that she used to hit Pip. The way that his sister used to punish him, would be unacceptable in today’s society as it would be seen as child abuse. â€Å"And what’s worse, she’s got ‘tickler’ with her.† What is meant by the term tickler is that it is â€Å"a wax-ended piece of cane, worn smooth by collision with my tickled frame.† Mrs Joe Gargery used canes to beat Pip. The audience can imagine how much pain must have been inflicted on to Pip at such a young age. Not only does she use canes to beat Pip she also hits him with her hand. â€Å"She concluded by throwing me.† In the opening passage Mrs Joe Gargery also insults Pip and attacks his mental state of mind by making him feel unwelcome and unwanted. â€Å"If it warn’t for me you’d have been to the churchyard long ago, and stayed there.† She keeps reminding Pip that she is the only person left for him, and if it wasn’t for her he would have been abandoned and left to die. â€Å"It’s bad enough to be a blacksmith’s wife (and him a Gargery) without being your mother.† This quote is also saying that Mrs Joe Gargery has unwillingly had to look after him and replace his mother, and she is to some extent ashamed and unhappy of being Joe the blacksmiths wife and their relationship together is not what it should be of a loving husband and wife. The novel illustrates that Pip also receives abuse and neglect from Ms Havisham and Estella together. Although they may not be as violent as Pip’s sister, they do mentally abuse him and make him feel extremely small and neglected. â€Å"Sometimes, she would coldly tolerate me; sometimes, she would condescend to me; sometimes, she would be quite familiar with me; sometimes, she would tell me energetically that she hated me.† This shows that Estella enjoys playing with Pips feelings and thrives on playing with his heart and emotions. Estella has acknowledged that Pip has taken a liking to her and she entertains herself when Pip tries to engage with her. Ms Havisham builds up the love in Pip’s heart for Estella. She fuels the fire in which Pip burns for Estella. â€Å"Does she grow prettier and prettier, Pip?† She is also seen to have a lot of influence over Estella and it seems that it is under her directives that Estella strives to break Pip’s heart. â€Å"Miss Havisham would embrace her with lavish fondness, murmuring something in her ear [that sounded like] â€Å"Break their hearts my pride and hope, break their hearts and have no mercy!† Ms Havisham has brought up Estella and it is under her instruction that Estella is directed to play with his emotions and gradually break Pip’s heart. The reason that Dickens had to write this story was that it reflected some of his own experiences; he presented Great expectations in such a way that some of it included some aspects of his own autobiography. â€Å"Great Expectations does draw on my own experiences. Like Pip, I grew up in the marshy country around Chatham and Rochester; like him I raised myself up in status in society. Pip discovers his secret benefactor, a kind of father to the orphan boy, is actually a criminal; my own father spent time in prison for debt.† In addition to this, there were many events in his life that had an immense impact on him as a writer. â€Å"The greatest was my experience as a young boy when I was taken from school and sent to do low and demeaning work in a Blacking Factory, pasting labels onto bottles of boot-blacking. I felt miserable and abandoned, and even at my most successful as an adult the horror of that time returned to me. It gave me a peculiar accuracy and empathy for childhood and the children’s point of view; and for the downtrodden and abandoned in general.† The relation that this states between Charles Dickens and Great Expectations is that in some stage in his life he felt abandoned and isolated. This being the reason that Dickens had empathy for children and had experienced as a child on what their feelings and thoughts were. My personal view of Great Expectations and why it is still such an important book is it reflects the organization of today’s society and why there is such a huge status gap between the rich and the poor. It also relates to how Pip has to struggle in life as a child, and how much torment and abuse he has to face all through his life. This reflects the life of many children today who face abuse and neglect from their families and relatives, or that when a child is kidnapped, they are physically and mentally harmed whilst being abandoned, away from the rest of the world alone and isolated My reaction to this novel was that it was extremely emotional and had a powerful story to it, which had the readers engaged in every moment of the novel. I found that the story which was based on Pip had a huge impact on me, and I got involved and anxious to know what happened next. The emotions and the way that Pip was treated, had been emphasised in the novel to a great extent, so that the audience felt truly apprehensive and sympathetic towards Pip. I think that this novel has been very successful in attaining the support of the audience. Charles Dickens’s novel Great Expectations represents the heart breaking accounts and feelings of many unfortunate children. All the more reason for the work of Charles Dickens to be appreciated and praised through out society.

Strategic bussiness Essay Example | Topics and Well Written Essays - 5000 words

Strategic bussiness - Essay Example The critical attributes of specifying task objectives are determined by various factors. In the first place, an organisation embarks on undertaking a specific project or task as a result of the need to fulfill certain objectives anticipated from the successful completion of the desired task. Indeed, there is need to keep in mind the main reason why an organisation has decided to undertake that task. During the contemporary period, organisations are in existence for various reasons and they seek to fulfill different objectives. As a result of the fact that organisations operate in a dynamic environment, they often find themselves confronted by situations which require them to change their usual way of conducting business. Against this background, the attributes of specifying the organisation’s attributes are mainly influenced by its core business and core competences. It follows from the argument that an organisation can only embark on initiating change when there are possible or foreseen benefits that can be enjoyed after the successful completion of the project. It is therefore very important for the organisation to consider its core competencies and the likely benefits which can be brought by the envisaged change. Another attribute includes the need to determine if the task is attainable. In some cases organisations may decide to embark on specific tasks as a way of trying to waiver negative impacts that may affect their operations but this may be suicidal if the set goals are difficult to attain. Whilst it may sound easy to embark on a particular project, it is also very important to ensure that the organisation has the requisite resources to achieve the objectives set. Broadly speaking, the resources range from human resources, financial resources as well as time. Failure to take this into consideration may negatively impact on the envisaged task. Resource management is primarily concerned with mapping out the allocation of the resources, identifying

Art 1A Essay Example | Topics and Well Written Essays - 1000 words

Art 1A - Essay Example Small bronze statues were commonly found in every sanctuary in Greece. The Statuette of a Horse is one among these small sculptures. It is made out of bronze which measures 3 1/8† x 1 3/8† & 2 3/16†. It is typically molded as shown by its form. Minute details on the surface, however, were less apparent as the artifact was aged as observed by its surface texture. The artist showed both abstract style and naturalistic approach in this particular work. The artist was not so particular with the details of the artwork. The abstract characteristics of the statuette are shown by the long head, the small body and other features. Several works were found in Greece that showed similar approaches and style including the use of the horse as a subject which was evidence of naturalist idea. Although, less emphasis were given on naturalistic rendering but rather on details of some specific parts of the body as shown by the long legs which may have represented some characteristics the sculpture was made to symbolize. The artist might have petitioned agility and speed. It could be an offering to appease the Gods. Or it could be for something else. The maker of the artwork is unknown but the perforated base suggests that it was made in Southern Greece where this style was mostly observed based on literatures. The style was most common during the Geometric Period (8th century BCE) and the early archaic era which began in the early seventh century BC. Particularly, this sculpture was believed to be crafted during 750-700 BCE based on the Getty Museum record. During the Archaic period artists preferred the use of bronze (an alloy of copper and tin) against pure copper because of its ability to be molded easily. It is a known fact that bronze would stay liquid longer than pure copper when melted. This characteristic is considered advantageous to the delicate artist of those

Pakistan Research Paper Example | Topics and Well Written Essays - 1250 words

Pakistan - Research Paper Example Historically, Pakistan came under the rule of different rulers like the Mauryan Empire, which ruled for two hundred years before Christ (B.C). After this, Pakistan was conquered by the Kushan Empire. The area that is now Pakistan and India was always merged into one polity under all this different rulers who saw it as the best way to govern the Indian subcontinent (Kaplan 2). The area was characterized by two rivers; the Ganges River and the Indus River and their tributaries. The Indus River and its tributaries fall on the Pakistan side and the Indus with its tributaries fall on the Indian side, with the watershed running almost perfectly matching the border demarcation that separates the two countries. Earlier rulers, like the Kushans, never tried to demarcate the region into two separate entities unlike the British, Mughals and the Mauryans, who saw the need to group them under such entities (Kaplan 3). The source of Pakistan’s troubles could be attributed to the Muslim expe rience that Pakistan got under different Islamic warriors. Every successive conquest saw the area named as Pakistan today; being at the center of these conquered territories (Kaplan 1). One of the major capitals of the Mauryan Empire was Peshawar, which is a major city in today’s Pakistan. This further indicates that this region and Pakistan, as a whole, have had a long running history with Muslim influence (Kaplan 2). This does not imply that religion is the problem, in Pakistan, but an avenue used, by wrong elements, to act as a vessel for their objectives. Hurdles facing Pakistan can be linked to its history of being a frontier territory because it acted as a transition point for many cultures, religions and governments even in the medieval ages. There was the influence of religion and cultural diversity, from the Arab world and central Asia, on one side, and change of governments from the eastern frontier. It was made up of different socio-cultural elements, and with the dawn of the 20Th century, Pakistan did not inherit any form stable institutions that citizens believed in as was the case with neighboring India after Colonial rule (Kaplan 2). When Pakistan came into being, the majority of the country’s wealth existed in the Indus valley, which encompasses the Punjab state. It has the best irrigation fields and the river basin provided numerous resources business opportunities. The area was also on the trade routes used to trade with other neighboring regions like Afghanistan, China and Russia (New York Times 34). It has the best schools and the majority of females are educated unlike other parts of Pakistan like the Sindhi, Baluchistan and Pashtun states. This caused discontent to develop between the privileged state of Punjab and the rest of the country (Kaplan 3). This led to the development of strong ethnic authorities at the expense of government institutions that were lacking or were inefficient. Their different linguistic varieties st rengthened the animosity between different warring factions. This has left the country with Islamic idealism as the only attempt at unification which has fuelled Islamic extremism (Kaplan 4). The inhabitants of the Indus River valley complain that they are discriminated against as the only working portion of the population (Kaplan 4). Failed or failing state institutions are the

King Abdulaziz Essay Example | Topics and Well Written Essays - 1250 words

King Abdulaziz - Essay Example This person was the founder of the present day Saudi Arabia, named as King Abdul Aziz Ibn Al Saud. King Abdul Aziz was born in the city of Riyadh, to the family of King Abdul Rehman. He was brought up under the strict and inflexible vision of his father. His father was so concerned about the teaching of Islam to his son a group of contemporary religious scholars came to teach him the fundamentals of Islam. With the passage of time, he started to show his great array of amazing talents and qualities, which included courage, horsemanship, leadership qualities and perceptiveness. He showed his interest in the situation and atmosphere around him, and also the historical events of great significance. When King Abdul Aziz was barely 12 years old, he traveled to the country of Kuwait along with his father in the year 1891. He spent a long duration of 10 years, and it was there where he acquired great abilities such as that of leadership and statesmanship. So, as a result of the qualities an d understanding that he had gathered from his elders and teachers, he resolved to restore the rule of his forefathers, no matter what problems come in the way. A start of new era could be witnessed as King Abdul Aziz left Kuwait and went to his hometown Riyadh, leading an army of 60 soldiers. In the future, this small force of army consequently turned out to be the one that overpowered the big force by the will of Allah. King Abdul Aziz Ibn Abd al-Rehman in true words wrote the history and fate of the Saudia Arabia. He used to the powers that no one could think of, as the powers that King Abdul Aziz Ibn Abd al-Rehman used were not worldly materials. These powers included the unifying and awakening of the religious faith among his fellow Muslims, deft, comprehensive politics, and the best of all a courageous and inspiring character for everyone to look at, at the time of sorrow and despair. King Abdul Aziz Ibn Abd al-Rehman brought back and restored the rule of his forefathers from a situation that was virtually considered to be completely destroyed and a situation of political extinction in the country. He did this be re-introducing the real image of Islam and inspiring the people by the teachings of the Great Religion. He started to build to Saudi state and he did that in three major stages. These stages include the recapturing of Najd in 1905, invading over the Shammar clan at Hail in the year 1921, and finally the conquering of Hijaz fours year later in 1924. During the era of birth of King Abdul Aziz Ibn Abd al-Rehman, the area of Central Arabia had been victimized to the issues of complete political disaster and disintegration, and the King Al Saud was forced to fight for his rule with the governers of the land of Havil, known as the al-Rashids. That fight and long lasting conflicts between the two ruling groups led King Al-Saud to evacuate and move his family from the city of Riyadh in the year 1891. The capture of the city of Najd by the Rashids was of quite pain and grief for King Abdul Aziz Ibn Abd al-Rehman along with his parents equally. Najd had great significance in the history of Saudi state as it had been the capital of the earlier as well as the second Saudi state. And thus its capture by the al-Rashids was really a matter of concern for King Abdul Aziz Ibn Abd al-Rehman and his father and this inspired him work for the restatement of his patrimony, and to recover the rule of

Final Essay Example | Topics and Well Written Essays - 500 words - 1

Final - Essay Example (Plunkett 67) . On Feb 2005, Verizon approved to acquire MCI Company. The acquisition was to benefit it in terms of economics of scale and access to a wider base of customers. By the year 2006, MCI was already integrated into Verizon thus adopting the name verizon business. It then became the largest telecommunication company in the U.S In terms of its sales i.e. 75.11 billion; assets added up to 168.13 US dollars and the company had a profit of 9.4 billion US dollars. Later with the mergers of Bell South and AT and TINC, It became the largest telecommunications company based on its profits and assets in the world. (Plunkett 68) The company principality operates in the US with its headquarters in New York. It offers wireless and wireline services such as voice, network access, data services, broadband video and global internet protocol networks. Verizon communications Inc operates in more than 150 nations worldwide. Verizon voice messaging services is offered for both businesses and residences. Verizon’s Cell co partnership operates the second largest wireless telecomm network in the US In terms of the number of subscribers and revenue. It is also one of the major US carriers to utilize the CDMA technology and uses 8 billion US dollar annually in its maintenance and expansion. It offers both voice and 3G data services for example, text and picture messaging, over the air downloadable applications and wireless broadband based on EV-DO Rev A. It also carries various mobile services and phones eg LG, Motorola and Samsung. (Lutz 138) Verizon’s video services was launched in September , 2005 and uses optical fibre network to distribute more than 330 channels, 180 digital videos and music channels and 1800 video on demand titles. DSL internet services are offered to the same areas where phone services are provided. It is known to have the largest number of spammers of all networks globally. Verizon’s

Managment methodologies of the military sector compared to the Research Paper

Managment methodologies of the military sector compared to the civilian sector - Research Paper Example There are certain principles of management which must be applied both in the military and the civilian sectors in order to enhance management. In the same way, considering the different cultures realized in these two sectors, it is fundamental to note that certain principles applied in the military sector cannot really work in the civilian sector. While discipline and chain of command is highly required in the military sector, it is not really a major concern in the civilian sector. The primary focus of management in all the sectors is basically to create a balance between efficiency and effectiveness. Principles In the civilian sector, the focus is to ensure that the customers are well serviced and satisfied. In this case, the employees must be managed effectively in order to realize this goal. If employees are not satisfied, it is evident that they will not really offer the best services to the customers and this limits efficiency and effectiveness. In the military, the officers mu st keenly weigh the aspects of effectiveness and efficiency considering that military missions call for high efficiency in operations (Christiansen, 2010). The inverse relationship between effectiveness and efficiency must be understood by the managers in all the sectors. There are four principles of management that cut across both the military and the civilian sectors and should therefore be a focus. Planning Planning is essentially a continual process and includes both short term and long term plans. Goals and objectives are normally set to be achieved within a given timeframe. For instance, the preparation of the budget is a planned process and cuts across both the military and the civilian sectors. Organizations usually have their short term and long term plans which are usually formulated well in advance. In the same way, such plans are common in the military sector. For instance, the Department of Defense has a document called the Five Year Defense Plan (FYDP) which it continu ously revises (Higbee, 2010). Organizing A business or a military agency should organize itself into units or departments that are meant to address different concerns within the organization. These divisions are mostly done on the basis of functions, geographical areas, products or customers. It is highly important to ensure that everything is organized in the most effective manner in order to enhance efficiency. Leading The concept of management is essentially a process of conducting roles and duties through people. In this case, a good manager should have the ability to lead people effectively by putting the employees through the best motivational programs and ensuring they give their maximum to the organization. In the military sector, discipline is highly regarded but motivation and managerial effectiveness must always take center stage. The nature of military activities creates the need for the officers to be well motivated. Such motivations are realized through promotions, pay benefits and other forms of recognition. Controlling The aspect of controlling does not actually relate to people. Rather, it is a way of ensuring that the organization actually meets its goals and objectives as set forth in its plans. In this case, progress has to be measured in order to provide information on how any inefficiency can be addressed. In case the goals are not met, then it is important for different approaches to be applied or the goals

The Development of American Colonies Essay Example for Free

The Development of American Colonies Essay Since the discovery of the New World by European powers, the newly established European settlements on American soil varied from region to region. Two such regions were The Chesapeake and The New England regions. Although both were settled vastly by the English people the societies they formed were different. These differences were due to a few factors. The factors include motivation for migration, geography, social, political and economical structures of the settlements. These factors are what contributed to the variations seen in the societies formed by settlers of distinct regions. In the 1600s life in Great Britain was no too pleasant for certain groups of people. The farming population of England was pushed off their land by landlords who began enclosing areas for pasture of animals such as sheep needed to maintain the increasing woolen industry of England. The landless farmers swarmed into cities such as London and Bristol. The cities became overpopulated and unemployment rates soared. People were desperate for jobs. In the 1600s a system called primogeniture was practiced in England. The system ensured that all inheritance went to the oldest son in the family. Younger sons of aristocratic families were left without inheritance where eager to find prosperity of their own. Such people looking for profit decided to try their luck in the New World. The motivation of these people was mostly personal profit. For those of elite origin escaping primogeniture was also a motivation. Another motive which stimulated these courageous people was finding a better route to the Indies which a few competing European powers were also seeking. The leadership was provided by a popular monarch Queen Elizabeth, and the financing by Virginia Joint Stock Company. In 1607 a group of Englishmen set out and settled James Town which became a colony in the Chesapeake region. The first band of settlers was all males, although later shipments of people did include a small fraction of women. This trend could be seen in Document C which contains a list of passengers headed for Virginia in 1635.The passage to the New World was rough and people died in its pursuit. The geography in the Chesapeake region was different from that in England. The hot climate provided for diseases such as malaria to which the English people were not immune. These diseases  killed off many of the colonists. The soil was fertile; the woods full of game and fish was present in the ocean. Yet many of the emigrating men were gentlemen who were not accustomed to work and therefore did not know how to take advantage of these resources. Other colonists spent time searching for gold instead of focusing on survival and the starving time came into being. The colonists died in large numbers of malnutrition and starvation and disease. The colony survived due to the leadership provided by Capitan John Smith. His theory of Those who shall not work shall not eat caused some discipline within the men. As stated in Document F by Captain John Smith the colonists faced hard times. They died of cold and hunger. Captain Smith explained in the document that getting colonists to work was troublesome. Those who hunted gold got others involved and the men wasted time instead of gathering food. Capitan Smith realizing such starvation sent out a ship to summon supplies for the next year. The two councilor that were present in the colony to maintain law and order made friends with the sailors and wanted to sail back to England thus causing Smith trouble to prevent such from happening. Such unruly colonists owed a large part of their survival to Capitan Smith. He made relation with the local Indians and their leader Powhatans aided the colonists in obtaining food. When another shipment of people arrived amongst them was leader Lord de la Warr. He held a harsh military rule and made trouble with the local Indians whom the colonists raided for food. A war was started yet peace came to be when colonists by the name of John Rolfe married the Powhatan princess named Pocahontas. The economy of the colonies improved when John Rolfe perfected tobacco growing. Tobacco was a profitable crop yet it required labor and vast areas of land to grow it upon. Tobacco exhausted soil and the English were forced to press upon Indian Territory to find more land for Tobacco growing. These actions caused Indians to rebel. Another series of Anglo- Powhatans wars was launched and a large number of colonists killed including John Rolfe.  Yet the English won and the peace settlement required the Indians to be uprooted and moved away form the white settlements. These were the origins of reservation systems which later came into being. Tobacco being a profitable crop, plantation system was developed for its growth. Such plantations required labor and the use of the Headright came into being. The system included the use of people called indentured servants. Indentured servants singed contracts and volunteered their labor as slaves for a set number of years in return for passage fair to the New World provided by their master. They were further promised their freedom dues which included a small piece of land, clothing, and a few barrels of corn upon the termination of their indenture. The indentured servants were promised much yet the promises were not always kept. The land they were given was on Indian Territory and caused Indian attacks. Further the land was second rate and not much crops could be grown on such land. The indentures thus faced poverty at the end of their indenture. These conditions caused the indentures to rebel. Bacons rebellion occurred in 1653 and consisted of angry indentures rebelling against the rich land owners who were backed by Governor Berkley or the area. Ideas of the rebellion are vividly described in Document H which explains how wealth was unjustly and unevenly distributed among the landowning population leaving the others including freed indentures to poverty. Another colony in the Chesapeake region was Maryland founded by Lord Baltimore as a haven for Catholics. The economy of the colony also largely depended on the growth and exportation of tobacco and thus also needed labor The Chesapeake region which had connections to the Caribbean saw the black slavery that occurred there and adopted it for the work on plantation. African servants were easier to maintain and control with the use of the Adopted Barbados slave codes. Virginia colony set up a form of government called the House of Burgesses which was a small parliament which governed the colony. Yet the southern colonies were surrounded by enemies of other nations such as the Dutch and  the Spanish in Florida. Government was not always able to defend the colony form such invaders. As Stated in Document G where Governor Berkley explained the colonial inability to defend itself form the Dutch which whom they were forced to share the continent. These attacks of foreigners had to be curbed and controlled by Virginias government. Societies were hard to form in the Chesapeake colonies. The areas were spread out and the establishment of schools and churches was difficult. There was still a shortage of females present in the region. Thus a large number of men could not find a wife and start a family. The few unstable families reproduced slowly compared with the New England Colonies. High mortality rate of men enabled women to have power and inherit their husbands property to support themselves and their children upon becoming a widow. Such were the factors that formed the societies in the Chesapeake colonies. English puritan separatist who believed the Anglican Church was corrupt suffered much prejudice for their religious beliefs. They moved to Holland where they became increasingly aware of the Dutchification of their children, their loss of English language and customs and adoption of Dutch culture. These people wanted a place where they could freely practice their religion while remaining fully English in speech and culture and traditions. Puritans secured a charter form the Virginia Joint Stock company and were supposed to land in James town, yet they sailed off coast and landed in Plymouth. The motivation of these people included mostly religious purposes and the worry of the Dutchification of their children. They thus came in families to settle and stay. These puritans strongly believed in hard work and survival. Only one person died on their passage over. As the list of passengers bound for New England is examined in Document B a trend of women men and children coming as families could be seen. Among the religious motives of the Puritans was the idea of building a perfect holy society that would be an example to all others. Jonathan Winthrop, the founder of the Massachusetts Bay colony. Expressed his desire to build a holy city on a hill blessed by god in Document A. Geography was another factor which influenced the development of the  colonies. New England soil was rocky therefore the families did small subsistence farming in contrast to the export economy sustained in the south. The New England region had access to the ocean therefore fishing and whaling was pursued. The woody region contributed to, much of the lumber used in shipbuilding. The local Indians of the region seemed to be previously wiped out by an epidemic leaving shelters and cleared fields for European settlements. The Wampanoag tribe in the settlement helped the puritans survive by introducing corn and other to them. The colony thus celebrated their first Thanksgiving Day with the Harvest brought about in the fall. The Governmental structure of the colonies was set up before the puritans left the ship to settle New England. The Mayflower Compact was drawn on the ship and was an agreement signed by the male passengers to form a self governing body ruled by majority in the settlements which they were about to established. As could be seen in Document D the Mayflower compact was the first form of the colonies agreement toward the common goal of survival. The government later set up in the colonies was a theocracy. The church was supported by a state tax yet the clergy officials were not able to hold office. Town meetings were administered in which decisions were made by a vote of majority. An assembly called the General Court was elected by free adult puritan males. The General Court made the decisions such as tax and wage regulations in the colonies. In Document E could be examined to see how the General Court assembly controlled prices and wages. Document E is a good example how theocratic even the General Court was often referring to god to prove their point or justify a cause. Outcasts were removed by the government such as minister Roger Williams. Roger Williams was and extreme puritan separatist believed that the puritan church established in the new world further needed reform. He thought that He believed that the Indians of the region were mistreated and deserved better land. Roger Williams was expelled from Massachusetts Bay colony and went further to est. the Rhode Island colony which offered complete religious freedom, no tax supported church and sheltered outcasts such as Anne Hutchinson. Anne Hutchinson also went to defy the puritan theology  claiming that there was no predestination a belief cherished by the puritans. She was exiled and sent to the Rhode Island colony. The economy of the colonies rested largely upon shipbuilding for the British army. Production of products such as tar and rosin were valued by the English navy and were paid well for. Bostons geographical location on a seaport made it a center of trade and commerce, which was a profitable position. Colonies like Rhode Island which often half slave auctions profited from such occurrences. Fishing and export of codfish also sustained the economics of the colonies. Finally the social structure of the New England colonies was different from the southern Chesapeake colonies. The New Englanders formed towns and communities. Education was important many of the colonists had to be literate in order to read the bible. Institutions such as Harvard University were established to train young men for clergy. The families in New England were stable and fertile. They reproduced well and the population grew. As the population grew other colonies such as Connecticut Valley and New Haven colonies were added to the New England region. These colonies were similar expect for Rhode Island colony and later established Quaker Pennsylvania. The Massachusetts colonies even formed a confederation called the New England Confederation with the Connecticut colonies whose purpose was to protect the colonies and was ruled by a voting majority of representatives. In conclusion the variations in geographical, economical, social, political, and motivational factors contributed to the diverse societies formed by people of common English origin. These factors affected the largely the mentality and the way of life of the people residing in these New England and the Chesapeake regions. The differences in the aspects of society mentioned above are what gave the colonies of different regions their distinct characteristics. Bibliography: Bailey, Thomas, and David Kennedy. The American Pageant. 10th. Lexington Massachusetts: D.C. Health and company, 1994.

Personal Discovery Essay Overview Essay Example for Free

ï » ¿Personal Discovery Essay Overview Essay This essay is intended to guide the student from identifying a problem or situation, taking some action in regard to the situation, and writing about the experience while supporting/developing their evaluation/analysis with two primary sources. A General Overview: First, you will be given a professionally-generated article that addresses a particular topic. This semester, the topic will involve health risks. Second, you must decide upon an activity after reading the article. For instance, since the article you will be given is on health risks, you will will need to identify two activities you can perform that will effect the consequences of your chosen health risk. Third, you will write a first draft of an essay of about 750 words (three pages) in which you discuss the activities and what motivated you to choose those activities, followed by your reactions and responses (such as â€Å"What did I learn?† And â€Å"Why could it be valuable to me?†) Fourth, find an article in the Three Rivers Rutland Library data base which provides additional information or that either refutes or corroborates what your rough draft says. Ideally, this one will help you determine the best practices for avoiding or managing the health risks. Incorporate information in the form of direct quotation and paraphrasing according to MLA style into the final draft. Finally, prepare a final draft of the paper in which you analyze the experience and the article, then synthesize all of the information into a cohesive essay. This essay will be the final assignment of the semester, so it is important to do your very best work. The final essay shuold be of 750 1,000 words, not including the correct MLA-style Works Cited page. Short Writing Assignment #7 Instructions: Read and study the information from the following web page: http://www.myhealthnewsdaily.com/839-top-10-leading-causes-of-death.html Download the Article Close Reading template (located in the Assignments: Unit 5 folder) Complete the template through a close reading of the article. Minimum Requirements: Completed Article Close Reading document for Top 10 Leading Causes of Death by Rachael Rettner. Since you have used this template before, take into account any suggestions or comments I provided you with to make sure you make the fullest use of the template possible. DOWNLOAD TEMPLATE Attached Files: Article Close Reading Document.docx (15.785 KB) Short Writing Assignment #8 Instructions: Choose two activities which you can do over a period of a few consecutive days which may prevent your death or the health-related consequences for you from the chosen malady. Make sure you think about the activities you choose to give before you decide. They should be planned, not spontaneous events. Once you perform your activities, notice the immediate effects and think about their long-term value. How did you feel when performing your activities? Were your activities difficult? How did you feel after the experience? Sit down and write about the experience while it is still fresh in your mind. Minimum Requirements: Compose a 200 300 word reflection on your activities. Make sure you clearly identify your chosen health malady and the activities you performed in the context of your reflection. Personal Discovery Essay First Draft Instructions: Using the following outline, compose a rough draft of your Personal Discover Essay. . INTRODUCTION:Mention the article and author. Give the briefest summary of the main points that relate to your paper. As you agree or disagree with the ideas, a thesis should develop. PERSONAL:Why did you choose to do these particular malady and activities? Were they the most convenient, the most inconvenient, or did they involve activities that had been on your mind, for example? How did you feel when you anticipated the activities, before you actually performed them? ENVIRONMENT:Identify your activities. What exactly did you have to do? Give some detail about this so the reader can imagine how much (or how little) was done. REACTION:What was your  reaction? How did you feel, both physically and mentally, after performing your activity? Did this surprise you? Have you had other experiences where you’ve changed your actions, or added activities, based on your health decisions? If so, how did this reaction compare to that experience? INTERPRETATION:Consider this experience in light of Rettners article. How do you think her numbers would change if everyone took these activities seriously? Do you think there is a significant chance others will follow your lead? Will you continue to perform these activities in the future? Do you think others are likely to do so? Why or why not? CONCLUSION:Tie the essay together, reiterating your thesis, perhaps mentioning Rettners article one more time. Make a statement about health activities, predict what would happen if more of us were required to try to improve our health, or discuss how we would be affected if we expected more healthy living activities of ourselves. Try for a fresh and original ending to this essay. Minimum Requirements: Write the first draft of an essay of about 750 words in which you discuss what you did and what motivated you. Part of the essay should discuss the article and your feelings about it, while it should also include your reactions and responses Personal Discover Essay Instructions: Find an article in Three Rivers’ Rutland Library database that provides additional information or that either refutes or corroborates what you said in your first draft. The article may discuss public service, student character, or any other aspect of your essay. Incorporate the information from your new article into the final draft of the Personal Discovery Essay. The final draft should demonstrate your ability to analyze the experience and what was read and then synthesize the information into a cohesive essay. Minimum Requirements: A final draft of the Personal Discovery Essay which syntheses of the genesis article, first hand information gathered in real time, and a supporting document located in the database into a single essay of 750-1000 words. In addition the the essay, you should include a correct MLA-style Works Cited  page containing citations for the Rettner article, as well as the database article. Apply the scientific and healthcare professionals’ advice and expertise to craft an essay of Personal Discovery which uses both your day-to-day altered habits and the science that backs them up in an essay which incorporates the best practices of our three major essays this semester

Bedside Index for Severity in Acute Pancreatitis (BISAP)

Bedside Index for Severity in Acute Pancreatitis (BISAP) Abstract Objectives The aim of this study was to evaluate the diagnostic performance of Bedside Index for Severity in Acute Pancreatitis (BISAP) score for predicting severe acute pancreatitis (SAP) in the early phase. Method The PubMed, Cochrane library and EMBASE databases were searched until May 2014. The strict selection criteria and exclusion criteria were determined, and we applied hierarchic summary receiver operating characteristic (HSROC) model and bivariate random effects models to assess thediagnosibility of the BISAP score for predicting SAP. We obtained pooled summary statistics for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and calculated the area under the HSROC curve (AUC). The 95% confidence intervals (CI) for each diagnostic test measure were also calculated. Publication bias was assessed using Deek’s funnel plot asymmetry test. Statistical analyses were performed using the STATA12.0 software. Results The pooled sensitivity, specificity, PLR, NLR, and DOR were 64.82%, 83.62%, 3.96, 0.42 and 9.41, respectively. The AUC was 0.77 and the HSROC curve for individual studies was generated and analyzed to explore the influence of threshold effects. Conclusion We confirmed that BISAP score is an accurate means to predict SAP in the early phase. Keywords: BISAP, HSROC curve, severe acute pancreatitis, acute pancreatitis Introduction Acute pancreatitis (AP) is an inflammatory condition of the pancreas with a clinical course that varies from mild to severe and characterized by activation of pancreatic enzymes to cause self-digestion of the pancreas 1. Generally, AP is mild, self-limiting, and requires no special treatment and ranges about 80-90% of patients with only minimal or transitional systemic manifestations, but about 20%-30% of patients develop a severe disease that can progress to systemic inflammation and cause pancreatic necrosis, multi-organ failure, and potentially death 1-4. So it is important to have an early, quick, and accurate risk stratification of AP patients, which would permit evidence-based early initiation of intensive care therapy for patients with severe AP (SAP) to prevent adverse outcomes and allow treatment of mild AP (MAP) on the common ward. Early identification of patients with SAP would allow the clinician to consider more aggressive interventions within a time frame that could pre vent possible complications. Currently, there are a variety of score systems developed for the early detection of SAP, such as Ranson’s score 5, acute physiology and chronic health examination (APACHE) II 6, 7 and computed tomography severity index (CTSI) 8. Also there are many inflammation markers such as C-reactive protein (CRP), interleukin-6 (IL-6) and others 9, 10. Several studies show that cytokines play an important role in the cascading inflammatory responses 11 and it may act as mediators of distant organ complications in SAP. So the levels of cytokine in serum may also reflect the degree of the inflammatory response 12. In 2008, Wu et al. 13 proposed a new prognostic scoring system, the bedside index of severity in acute pancreatitis (BISAP), is a simple and accurateà ¢Ã¢â€š ¬Ã¢â‚¬Å¾ method that can predict the clinical severity of AP within 24 h of presentation. BISAP incorporates five parameters: blood urea nitrogen > 25 mg/dL, impaired mental status, systemic inflammatory response syndrome ( SIRS), age > 60 years, and detection of pleural effusion by imaging 14. Unfortunately there has been no systematic or meta-analytic review of cross-sectional studies of this scoring system. The purpose of this study was to aggregate the reported data across the different studies and to assess the ability of the BISAP score to predict SAP. Materials and methods 2.1 Literature search The search was performed on three databases: PubMed, Cochrane library and EMBASE. These databases were searched from the first date available in each database up to May 2014, using the search terms ‘acute pancreatitis’ AND (‘BISAP’ OR ‘bedside index of severity in acute pancreatitis’). Once articles had been collected, bibliographies were then hand-searched for additional references. 2.2 Inclusion and Exclusion Criteria To be included in this meta-analysis, studies must meet the following criteria: (1) studies evaluate the BISAP score for predicting SAP; (2) the subjects were diagnosed with AP; (3) prospective study; (4) the absolute numbers of true positive (TP), false negative (FN), false positive (FP), and true negative (TN) test results were available or derivable from the article; (5) the clinical result of patients was indicated as SAP. Studies were excluded if one of the following existed: (1) the numbers of TP, FN, FP, and TN test results were not derivable from the article; (2) cross-sectional study; (3) non-original articles, such as review, meeting abstract, case report and comment; (4) duplicate of previous publications and data description is not clear. 2.3 Data extraction and quality assessment All data were extracted independently by two authors according to the inclusion criteria listed above. Disagreements were resolved by discussion or solved by consultation of a third reviewer. The following characteristics were collected from each study: the first author, year of publication, source, experiment design, sample size, the reference standard (gold standard), the numbers of TP, FN, FP, and TN and others. The QADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria were used to assess the quality of diagnostic accuracy studies included in this meta-analysis 15. Statistical analyses Hierarchical summary receiver operating characteristic (HSROC) modeland bivariate random effects model were performed in STATA 12.0 (StataCorp, College Station, TX, USA) software using the program ‘metandi’ to generate pooled accuracy estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and calculated the area under the HSROC curve (AUC) 16. The HSROC curve for individual studies was generated and analyzed to explore the influence of threshold effects. The 95% confidence intervals (CI) for each diagnostic test measure were also calculated. Publication bias was assessed using Deek’s funnel plot asymmetry test 17. Results 3.1 Eligible Studies The process of selecting studies for the meta-analysis was shown in Fig. 1. There were 32 studies potentially eligible studies identified. Of these, 14 studies were excluded after screening based on abstracts or titles to avoid obvious irrelevance. Finally, 9 studies 14, 18-25 met the inclusion criteria and were included in the meta-analysis. The data collected from the related studies was summarized in Table 1. Among these studies, kim et al. 20 reported the results of the meta-analysis with the cutoff values set at 2and 3, respectively. All patients were recruited within 24 h from the time of admission or transfer and used for the calculation of the BISAP scores. All included citations were prospective cohort studies. The absolute numbers of TP, FN, FP, and TN were calculated by sample size and the degree of sensitivity and specific. A summary of the quality of the studies was displayed in table 2. The included studies were not descript the tenth quality indicator (were the index test results interpreted without knowledge of the results of the reference?) and the eleventh quality indicator (were the reference standard results interpreted without knowledge of the results of the index test?) 15. At the same time, there are some studies not described in detail for eliminate and exit objects. 3.2 Meta-analysis The results of the HSROC model were show in Table 3. The pooled sensitivity of BISAP testing for the diagnosis of SAP was 64.82% (95% CI: 54.47%-73.74%), and the specificity was 83.62% (95%CI: 70.03%-91.77%). The pooled DOR was 9.41 (95%CI: 5.38-16.45), the PLR was 3.96 (95%CI: 2.27-6.89), and the NLR was 0.42 (95%CI: 0.34-0.52). The AUC of the HSROC was 0.77 (95%CI: 0.73-0.80) (Fig. 2). The I2 index of heterogeneity was 95% (95% CI, 91%-99%). 3.3 Subgroup Analyses There was a negative correlation between the logits of sensitivity and specificity (Spearman correlation coefficient, 20.09), indicating the present of an importanteffect of the diagnostic threshold (cutoff level) on the performance of BISAP score. The following cutoffs were selected for subgroups analysis (Table 4). Analysis of studies that set the BISAP cutoff point at 2, the pooled sensitivity, specificity, PLR, NLR, and DOR were 67.30% (95%CI: 60.53%-73.42%), 78.28% (95%CI: 68.86%-85.46%), 3.10 (95%CI: 2.12-4.52), 0.42 (95%CI: 0.34-0.51) and 7.42 (95%CI: 4.39-12.54), respectively. The AUC of the HSROC was 0.70(95%CI: 0.66-0.74). Analysis of studies that set the BISAP cutoff point at 3, the pooled sensitivity, specificity, PLR, NLR, and DOR were 61.18% (95%CI: 41.20%-78.00%), 88.64% (95%CI: 88%-97.18%), 5.39 (95%CI: 1.80-16.12), 0.44 (95%CI: 0.30-0.64), and (95%CI: 4.44-34.03), respectively. The AUC of the HSROC was 0.78 (95%CI: 0.75-0.82). 3.4 Publication Bias Deeks’ Funnel Plot Asymmetry Test for the overall analysis showed that no significant publication bias was found (P = 0.359, Fig. 3). Discussion Generally, Ranson, APACHE II, and CTSI scoring systems have been used to evaluate the severity of AP 22, 23. However, these techniques all have their inherent strengths and weaknesses. For example, the Ranson’s score 5 is relatively accurate at classifying the severity of AP, but the evaluation cannot be completed until 48 h, which will miss the potential for early treatment and increase mortality. The APACHE II system 6, 7 allows the determination of disease on the first day of admission and is more accurate than Ranson’s score, but complexity is its major drawback. CTSI 26, 27 is calculated based on CT findings of some local complications and cannot reflect the systemic inflammatory response. Recently, the BISAP score has been proposed as an accurate method for early identification of patients at risk for in hospital mortality 13. Several studies showed that BISAP score is a reliable and accurate means for predicting the severity of AP in the early phase 18, 22, 23. B ut these studies are not systematic, so we collect the reported data across the different studies and apply HSROC model and bivariate random effects model to assess the ability of the BISAP score to predict SAP. The pooled sensitivity, specificity, PLR, NLR, and DOR were 64.82%, 83.62%, 3.96, 0.42 and 9.41, respectively. The AUC of the HSROC was 0.77. Our meta-analysis indicated that BISAP score is a reliable and accurate means to predict SAP. This meta-analysis assessed the diagnostic performance of BISAP in 1972 individuals from 9 research studies 14, 18-25. The results show that the performance of BISAP to predict the severity of AP has a good specificity, but moderate sensitivity in predicting SAP. In addition, compared with other scoring systems in predicting SAP, BISAP has a higher specificity but a lower sensitivity 21-23, 28. The low sensitivity may be caused by these factors. First, the characteristics of study participants are differences (cultural and geographical differences), such as lifestyle, race, and genetic basis. Second, etiologic distribution may also explain the noted differences. Third, the different definitions of SAP may also be a reason for these variations. The HSROC curve presents a global summary of test performance and shows the tradeoff between sensitivity and specificity. The summary DOR and the AUC of the HSROC were 9.41 and 0.77, respectively.The predictive accuracy of BISAP scoring system was measured by AUC. An AUC of 1.0 represents a perfect test, whereas an AUC of 0.5 represents a test that performs no better than chance 29. The result revealed that the discrimination of disease severity was good in our study, which is similar to other reports. DOR is a single indicator of test accuracy that combines the sensitivity and specificity data into a single number. The DOR of a test is the ratio of the odds of positive test results in the patient with disease relative to the odds of positive test results in the patient without disease. The value of a DOR ranges from 0 to infinity, with higher values indicating better discriminatory test performance (higher accuracy).A DOR of 1.0 indicates that a test does not discriminate between pa tients with the disorder and those without it 30. In the present meta-analysis, we found that the pooled DOR was 9.41, also indicated a high level of overall accuracy. Since the HSROC curve and theDOR are not easy to interpret or use in clinical practice, and likelihood ratios are considered to be more clinically meaningful, we also presented both PLR and NLR as our measures of diagnostic accuracy. Likelihood ratios of > 10 or 31. The PLR and NLR value were 3.96 and 0.42, respectively. This result performed similar to traditional scoring systems in predicting SAP and suggested that the accuracy of still need to improve. But BISAP is relatively simple and had greater accuracy than other scoring systems, making it a promising method of predicting SAP 14, 19, 21, 28. Furthermore,it may be combined in medical decision-making at the extreme of the prediction range, such as enrollment criteria for clinical trials, and as triaging intensive care unit admission 32, 33. We also explored systematically the issue of heterogeneity by use of subgroup analysis. In our analysis, the diagnostic threshold presented an important effect on the performance of BISAP score. The results demonstrated that a BISAP score of 3 had greater accuracy and high predictive value than a score of 2 for predicting SAP. Our meta-analysis had several limitations. First, when the BISAP scoring system converts continuous variables into binary values of equal weight, it fails to capture synergistic or multiplicative effects based on the interactions of interdependent systems 21. Future research could focus on comprehensive reassessment of the pathologic mechanisms of AP with attention to the effects of preexisting risk factors (e.g. age, obesity, genetic) and well-defined end points, identification of accurate biomarkers to assess activity on these pathways, and mathematical models that have strong predictive accuracy. Second, the exclusion of conference abstracts, letters to the editor, and non-English-language studies might have led to publication bias, which was not found in the present review. However, a review of these abstracts and letters suggested that the overall results were similar to the results in the English language studies included. Third, there is a risk for publication bias in which positive results or results with ‘expected’ findings are more likely to be published. We made every possible effort to minimize this type of bias by contacting investigators in the field of BISAP. If editors were more likely to publish manuscripts showing the ‘expected’ results of a good diagnostic performance for BISAP, then our results may be overestimating the real diagnostic performance of BISAP. In conclusion, we confirmed that BISAP score is an accurate means to predict SAP in the early phase. Due to simplicity and easily obtained parameters, BISAP score should gain broad acceptance in routine use not by replacing clinical assessment, but rather by complementing and objectifying it.

Richard Wrights Black Boy: The Meaning of American Hunger :: Wright Black Boy Essays

Black Boy: The Meaning of American Hunger When a person thinks about hunger, food comes to mind. We never think of hunger as anything else. In Richard Wright's book titled "Black Boy (American Hunger)", a young boy faces many different types of hunger. He refers to the phrase "American Hunger" throughout his book. I feel that the "American Hunger" which he is referring to is the hunger to be considered an American and be treated as an equal. Throughout his life he was treated as if he were from another planet. He was always considered to be different, an outcast and a loser. He felt the need to be a part of the so-called American Culture. He wanted to be able to do what the white children did. He wanted to be able to go to school, to learn, to read, have friends, have a job; but because he was an African American he could not. This is what I will be discussing in this paper his intellectual hunger. Richard was so eager to learn that he kept constantly asking questions, and if his questions were left unanswered he would let his imagination take over.. He would try to find work in which he would be able to read some of the books. His family and relatives refused to let him learn. There is one incident in which his schoolteacher read to him. His grandmother got angry and said that reading was devils work. Through out his childhood he heard many terms and phrases. He never understood what they meant but once they were said he knew if they were good or bad. For example, when Richard was taking a bath and his grandmother came in to scrub his backside, Richard replied with, "When you get through, kiss back there." This is just one of the many phrases he said in which he did not know the meaning. Through his eagerness to learn he began to understand himself, other blacks, and whites better. He continues to learn and to play dumb for his own survival. His self education began when a co- worker lent Richard his library card to read Mencken's essays. He feels that his dreams and his stories in which he reads are an escape for him. He wants to fit in with others and be able to be apart of America.

Nationalists :: essays papers

Nationalists The extent to which Nationalists should pursue their goals is a complex issue. The possible changes as well as the losses must be weighed. There is a myriad of complex issues surrounding the situation. Without Nationalists making changes, Italy would not be unified, Apartheid would still exist in South Africa, and many other changes would not have occurred on this planet. I believe that Nationalists should try to solve their problems and get what they want without using violence as a tool. Guseppe Mazzini was a major factor in the unification of Italy. He started his fight for unity with non-violent means. He tried wearing black clothing to mourn the persecuted, and he attempted to educate the people about the dangers of foreign rule in Italy. Gradually however he escalated to more violent means of getting his way. He stirred feelings of Nationalism, brotherhood and religion. In 1848 he started a revolution in Rome. The Pope was forced to flee the city, and Mazzini established a Roman Republic. The entire republic was built upon the one-time rage of the masses. Mazzini simply stirred the emotions of the people, but they didn't really feel that strongly about it. The population of Rome didn't care enough to fight for the retention of the city. The French were easily able to re-take the city, and return it to the Pope. Mahatma Gandhi represents the other side of the spectrum, throughout his life he used only non-violent means to get what he wanted. His main goal was to get Moslems and Hindus to live peacefully together. He was quoted as saying "All religions are almost as dear to me as my Hinduism". One instance of his attempts to use non-violent means to accomplish his goal was his two hundred and thirty-kilometer march to the ocean in order to extract salt illegally. This was in protest of Britain's salt monopoly in India. Other non-violent acts that he used as tools to persuade the government to listen to his goals were his six to twenty-one day fasts. At one time Gandhi used a fast to force his release from prison. The prison would have been held responsible for his death and would have major pressure put on it to close down. Gandhi had become such a hero to the population that, if the government allowed

Ethical Analysis of the Shawshank Redemption Essay

It has been suggested that a person can learn a great deal about a society; its customs, values, ethical beliefs, etc†¦, through its cultural works (art, film, literature, etc†¦). In the case of the 1994 film, The Shawshank Redemption, a story of one man’s wrongful imprisonment and subsequent freedom, the viewer can gain a great insight into two ethical principles that help to govern society. The Shawshank Redemption provides the viewer with a backdrop against which to consider the ethical principles of justice and power and the implications that the way in which those principles are dealt with in the film can have for society. Ethical Principles Ethics can be defined as, â€Å"a social, religious, or civil code of behavior considered correct, especially that of a particular group, profession, or individual† (Ethics). While the individual principles that make-up such â€Å"correct behavior† can be debated from group to group and society to society, there are certain ones that seem to transcend culture and societal boundaries. One of these is â€Å"justice.† Justice can be defined as â€Å"the quality of being fair and reasonable/conformity to moral rightness and attitude† (Justice). It is a sense that a person is being treated in a manner that is in accordance with a reasonable and fair application of both written and unwritten â€Å"laws† that are considered to be righteous and is an almost universal ethical principle. One can see the ethical principle of justice in The Shawshank Redemption from the very beginning of the film. The foundation of the movie is the unjust imprisonment of the ma in character, Andy Dufresne, and the subsequent injustices that are done to him while there. These injustices take the form of sexual assault by other prisoners, a refusal on the part of the warden to acknowledge evidence of his innocence, and a resulting two-month assignment to solitary confinement when he tries to argue the point. The other characters are not free from the effects of injustice either. From the new prisoner who is beaten to death for crying to Red, who his continually rejected for parole despite obviously being â€Å"rehabilitated,† the characters continually face situations in which they are treated in a manner that both they and the audience would view as unjust. The second main ethical principle in the film is that of power. Power exists any time one person exerts some advantage over another. It can take the form of intellect, money, strength, etc†¦ and with it comes an inevitable ethical dilemma of how to use the power. As was discussed with justice, there appears to be a universal belief that power should be used in a judicious manner, but that does not always happen. Johnson (2012) suggests that, â€Å"†¦we recognize that power has a corrosive effect on those who possess it,† (p. 9) and that kind of behavior is evident in the film. Warden Samuel Norton abuses his legitimate power, or power of his position, along with both reward (delivering something of value) and coercive (penalties or punishments) power to use and abuse prisoners for his own personal gain, even going so far as to have one shot in order to protect his financial and personal interest (Johnson, 2012, pp. 7-8). Head guard Byron Hadley abuses his power through coercive measures, beating and killing prisoners and running the prison through fear and intimidation. Even the other guards, though they do not abuse the prisoners physically, take advantage of their position to get free financial work from Dufresn. The use and abuse of power extends to the prisoners, as well. Red uses his influence with the guards to get all of his friends on the same work detail. At the same time, Boggs and The Sisters use their physical power to force Andy into unwanted sexual acts. Even Andy uses his power, exercising the expert power of his financial abilities in illegal ways and, in doing so, gaining privileges for both the other prisoners and himself (Johnson, 2012, p. 8). While the audience may ultimately view these actions more favorably in light of the injustices faced by the prisoners, they nonetheless represent actions that, in and of themselves, would be examples of abuse of power. Character Reactions The ethical principles of justice and power play-out in the film through the reactions of the different characters to the environment of injustice and abused power that is present in the prison. It is the prison establishment, represented by the Warden, Hadley and the other guards, that provides the catalyst that drives the character interplay. The Warden and Hadley are the main abusers, but even the other guards, who show fairness and justice to the prisoners when left on their own, fall victim to the pressures of the Warden and Hadley’s evil â€Å"shadow† (Johnson, 2012) and join-in to some degree. It is this situation that causes the prisoners to have to choose how they will react. In the face of the unfair treatment and abuse of power, the prisoners choose to react in different ways. Boggs and /The Sisters become part of the abuse through the use of physical strength, beating and sexually assaulting Dufresn and others at will. Red and the rest of Dufresn’s group are able to maintain a semblance of ethical normalcy but become numb to the things going on around them and begin to take them as a matter of course. It is Dufresn who refuses to give-in to the injustice and abuse. He fights the Sisters, even though he does not always win, plots behind the scenes to escape, makes use of his position as â€Å"financial advisor† to help the other prisoners and, through it all, he maintains his inner strength, hope, and ethical outlook. This interplay between the prison establishment and the prisoner, as well as the differing ways that the prisoners choose to react to the situation helps to bring to light some ethical implications suggested by the film. Ethical Implications While there are several suppositions and implications that can be made from the movie about society and its beliefs, two seem to stand-out. The first ethical implication of the movie is the idea that society takes a utilitarian view of ethics. Under a utilitarian approach, decisions are based on their consequences (Johnson, 2012, p. 154) and the â€Å"ends justify the means.† There is a sense that while certain actions, in and of themselves, can be considered unethical, society is willing to view them more favorably within a certain context. For example, there seems to be an inate need for people to feel that justice has been done, and certain unethical behaviors may be acceptable in achieving that end. This can be seen throughout the movie. Boggs, the leader of the Sisters, is beaten until he is paralyzed for hurting Dufresn. Dufresn escapes from prison and takes $370,000 of ill-gotten, laundered money in the process. Either of these might be considered unethical in and of th emselves, but the audience is willing to applaud both in the interest of justice being served. We see this same utilitarian view in the use of power in the movie. The Warden and the guards abuse their power to differing degrees and the audience is meant to frown and look askance. However, when Dufresn exploits his financial capabilities in an illegal activity and escape or Red engages in smuggling items into the prison, the audience applauds. In a vacuum, all of the acts are unethical. However, the actions of Dufresn and Red seem to serve, in the eyes if the audience, to balance-out some of the abuses of power and advance the cause of justice. As a result, they are looked at as being ethical in as much as they helped meet the ethical principle of justice despite being unethical themselves. The second implication is the power of ethical leadership. This can be seen in the reaction of the two main groups, the governing power of the Warden and the guards and Dufresn’s group, to their respective leaders. In the case of the guards, we see the influence that the leadership of the Warden and Hadley has over them. As was mentioned earlier, the guards are motivated to act in harsh ways towards the prisoners when around the Warden and Hadley, but we see more ethical and humane interactions when the guards are alone with the prisoners. Even Hadley changes once the â€Å"spell† of the Warden’s leadership is broken, crying like a baby when he is arrested. Thus, one sees the length and power of the shadow that the Warden casts. In contrast to the guards, one sees the positive influence that Dufresn has on Red and the other prisoners in their group. When he arrives, they are practical and pragmatic, resigned to the way things are. However, Dufresn shows them that ethical behavior and rightness can still exist. This begins with their first meeting, when he asks for the name of a prisoner who was beaten to death. This seems inconsequential to the others but serves as a symbol of Dufresn bringing the ethics of the outside world with him into the prison. Despite all that occurs during his stay, he never loses those ethics. He never loses hope. And, in the process, he raises the ethical level and level of hope for all members of the group. Both men lead their respective groups through their actions and decision-making. One’s actions lead in an unethical manner and the other in a more ethical one. Through this, it is evident just how influential the ethical decisions of a leader and the â€Å"shadow or light† they cast can be (Johnson, 2012). Thus, against the backdrop of the microcosmic subculture of Shawshank Prison, one sees the importance of justice and fair use of power to American society. The adage that, â€Å"Power corrupts and absolute power corrupts absolutely,† (Johnson, 2012, p. 11) becomes a reality within the prison walls and the characters are left to make sense of it. Ultimately and ironically, it is the seemingly unethical deeds of Dufresn and Red (who breaks his parole to go to Mexico) that restore the balance of justice and power that the audience is seeking and, in doing so, reveal the important role that these ethical principles play in society. References Ethics. In The Free Dictionary by Farlex. Retrieved from http://www.thefreedictionary.com/ethics Glotzer, L., Lester, D.. & Marvin, N. (Producers) and Darabont, F. (Director). (1994). The Shawshank Redemption [Motion Picture]. United States: Castle Rock Entertainment. Johnson, C.E. (2012). Meeting the Ethical Challenges of Leadership: Casting Light or Shadow, fourth edition. Thousand Oaks, California: Sage Publications Ltd. Justice. In The Free Dictionary by Farlex. Retrieved from http://www.thefreedictionary.com/ethics