Dult learning Essay

Knowles adult learning theory is an attempt to develop adult learning in which he emphasizes that adults are mature people responsible for making sound decisions. There are certain assumptions about the design for learning by Knowles in his theory (Brookfield Stephen, 1994). First, it is assumed that adults need to know the reasons for learning something. Second, adults should learn through experience. Third, adults approach learning as a way of problem solving. Finally, adults learn best whereby the topic is of immediate value. These assumptions are important because they reflect the significance of Knowles adult learning theory. In health care organizations, Knowles theory is of paramount importance because it helps them to handle any form of health problem as a way of maintaining safety at work place. Experience and responsibility is of paramount importance and teaching adults on how to handle health issues at work place controls occurrence of health hazards. There are certain barriers to education or learning which include first, inability of adults to focus on topics. This is a major barrier because the adults have many things to attend to such as family, work and assignments. Second, weak study or critical thinking skills which do not allow the learners to concentrate in class are a major barrier. It is barrier to learning process because the tutor has to commit a lot of his or time trying to explain a simple concept to old adults (Taylor Edward, 1999). Third, unlearning old knowledge and low self-esteem is a major barrier to learning process because of old age which makes adult learners to have low esteem. Fourth, adults have very tight schedule during the day and this means that they have a challenge of time constraints and commitments. References Brookfield Stephen, 1994, Understanding and Facilitating Adult Learning: A Comprehensive Analysis of Analysis of Principles and Effective Practices, Open University Press. Taylor Edward, 1999, Adult Education Philosophy Informs Practice, Adult Learning.

Community Health Practice Essay

Community Description and Data Interpretation Pueblo, Colorado, also known as â€Å"The Home of the Heroes†, was given this proclamation in 1993 by the United States Congress, due to Pueblo having as many as four recipients of the â€Å"Medal of Honor† living here in the community. Pueblo dates back as far as 1842, and was known as â€Å"Fort Pueblo† (History of Pueblo). Over the years, Pueblo became the â€Å"backbone† of Southern Colorado due to the ore mines and is also the largest steel producing city in the United States, thus also being referred to as the â€Å"Steel City†. Pueblo has had a long and colorful history and has had five different countries and territories that â€Å"held dominion† over the area. These five areas are as follows: France, Mexico, Texas, Spain, and of course, the United States of America. (History of Pueblo) Pueblo County is 2,398 square mile area and is located approximately 112 miles south of the state capital of Denver, Colorado and approximately 100 miles north of the New Mexico border. Pueblo is geographically located at the intersection of the Arkansas River and Fountain Creek and is approximately 4600 feet above sea level. Although surrounded by lots of mountains such as the Wet Mountains, the Sangre de Cristo Mountains, Green Horn Mountains and Pikes Peak Mountain, Pueblo is very much desert land with annual precipitation being only approximately 12 inches. (Pueblo, Colorado, 2014). Pueblo County has a land area of 2389 square feet and 9.0 square miles of water. (City-Data Pueblo County, CO , 2012) Population/Economic Assesssment Pueblo’s population according to 2012’s census is 159,063 which is a growth rate of 3.56% since 2000, and which rank it 246th for the most populated city in the nation. Pueblo is comprised of a very diverse mix of people with the majority being white non-Hispanics at 56.2% and the Hispanics or â€Å"Latinos† comprising 39.2% of the population. The remaining population is comprised of African Americans 2.4%, Native Americans 2.9%, Asian 1% and the remaining 2.4% of the population are those that are of two or more races  (American Fact Finder). The average age of Pueblo’s population is approximately 39 years old. The total population percentages of those 18 years and younger is 24.5% and with those 65 years and older comprising 15.3%. (United Stated Census Bureau, 2010) `As mentioned before, Pueblo is one of the nation’s top leaders in steel production, but the huge â€Å"steel-market† crash of 1982 left Pueblo with a fairly weak economy sinc e that time. According to the 2010 census, the average annual household income in Pueblo is approximately $38,780, which has Pueblo County’s income ranking far below Colorado’s average income of $47,510. With such a difference in the average annual income, Pueblo has a high percentage of the population that is living below the Federal Poverty Level, making Pueblo’s overall poverty rate is the 2nd highest in the state of Colorado. The average household size is 2.47 people. According to statistics from the American Fact Finder, Pueblo County has 18.1% total population below the Federal Poverty Level. Of that population, there are 26.3% that are children 18 years and younger, those 18 years to 64 years old is 17% and those over the age of 65 are 9.6% below the Federal Poverty Level (America Fact Finder, 2012). With almost 20% of Pueblo County’s population being below the Federal Poverty Level, it would stand to reason the increase in the number of people in Pueblo that qualify for food stamps and other public assistance. According to the 2012 American Community Survey, there were an estimated total of 11,976 households in Pueblo County that received food stamps. Of the households that received food stamps 45.7% of them had children 18 years or younger and 23.4% had at least one person in the household that was 60 years or older. (United Stated Census Bureau, 2010) The unemployment rate in Pueblo County is 9.6% approximately 1% higher than the U.S. average; however, there has been a recent job growth of 1.38% in Pueblo. Even with the more than average unemployment rate and high population below the Federal Poverty Level, Pueblo County has a very low cost of living compared to the rest of the nation. The cost of living in Pueblo, CO is approximately 15.3% lower than the U.S. average with the median housing cost of $96,700. Even with the lower cost of living in Pueblo County, there are still about 175 individuals that are homeless that are living on the streets. With large international companies such as  Vestas pewag, and Rocla Concrete Tie choosing Pueblo, Colorado as new sites for their companies, unemployment rates will lower and this can only boost the economy and increase the population. (Community Health Status Report, 2011) Before the inception of the current Affordable Care Act, Pueblo County had approximately 30,312 individuals that were on Medicaid. This number has drastically increased since January 1, 2014 since Colorado was a state that chose â€Å"Medicaid Expansion† to assist with aiding the health care costs and compliance of the Affordable Health Care Act. According to Colorado Health Institute, Pueblo County has done an amazing job getting the â€Å"uninsured† children in public insurance programs. Pueblo County recorded that 95.7% of children eligible for Medicaid/CHP+ is enrolled. Access to health care is largely affected by available and affordable health insurance. Pueblo County was noted to have a total of 13.6% of the population in 2010 that were uninsured. The amount of money that Pueblo County spent per capita on public health funding took a significant drop in 3 years from 2009 to 2011 of over $2.00 per person. Pueblo County also has a large percentage (18.8%) of individuals that not only are on Medicaid but are dually covered by Medicare. Dual coverage is based on income, health and disability; these individuals are usually in very poor health with chronic, complicated health problems and/or mental issues. Even with the public health funding, Pueblo County still has 17% of the population that have unmet health needs because of financial limitations. Hopefully with the new law of the Affordable Care Act the percentage of â€Å"unmet† health needs will completely diminish or at least significantly decrease. Cultural Assessment Pueblo, Colorado is a multi-cultural community with the majority of the population of Hispanics, Italians and Slovenians that have occupied Pueblo for generations. The Hispanic culture is the most prominent in Pueblo, which can be seen in the architecture, art, festivals and museums which pays great tribute to their Hispanic heritage. One of the largest pieces of the Hispanic culture that is enjoyed by all in Pueblo is the food. Pueblo holds annual festivals and celebrations that display the unique cuisines of the Hispanic culture, the most prominent cuisine being the â€Å"Pueblo Green Chili†. Food of the Hispanic culture and the health risks may contribute to the high number of adults that are overweight or obese. According to findings in the Pueblo Community Health Status Report of 2011, 23% adults over the age of 18 are overweight. With such a large Hispanic population comes a high percentage of the population that have genetic disposition for Diabetes Mellitus Type 2. (County Health Rankings and Road Maps, 2013) A large family unit which includes generations of â€Å"extended† family is a huge part of the Hispanic culture in Pueblo. The Hispanic population in Pueblo really holds the matriarchs and/or patriarchs to a high respect. Although not nearly as prominent in Pueblo, the Italian culture is a large part of Pueblo’s culture as well. Italian culture is seen predominantly in the culinary influences that paved the way for the unique â€Å"Pueboloan† dishes, such as the Italian Sausage sandwich that you can find at one of Pueblo’s oldest tra ditions, Pass Key Restaurant. (Pueblo, Colorado, 2013). The Slovenian culture is another influential part of Pueblo’s culture. The Slovenians migrated to Pueblo and settled here working in the steel industry. They introduced cultural and culinary traditions that are still very highly practiced and part of Pueblo’s culture even today. For example, Potica is one of the most popular culinary treats that is extremely popular around the holiday season, but can be found and enjoyed all year around. The Slovenian folk music and theatre can also be seen throughout Pueblo. (History of Pueblo) Catholicism is the predominant religion in Pueblo and is a huge part of the culture. Approximately 68% of Pueblo proclaims they are Catholic. In Pueblo’s culture, women are the largest majority of this population, although â€Å"Holy Orders† are the role of the men. (Pueblo, Colorado, 2014) Genogram Interpretation From my observation of data, statistics and information gathered for Pueblo County’s Community assessment, I have found that Pueblo County overall is a fairly healthy community. The community is predominately white, non-Hispanic population with an increase of the Hispanic population in the past two years. The Median household income is $38,780 and 16.9% household at or below poverty level. The unemployment rate at 9.6% which is 1% higher that the U.S. average. With such financial difficulties there were approximately 13,760 individuals that receive food assistance, Pueblo is a multi-Cultural community consisting of Hispanic, Italian & Slovinian. All cultures brought together with food served at festivals and at restaurants. Pueblo is predominately Catholic religion at 68% with women playing a large part in Catholic & Hispanic Culture. Large Hispanic population diagnosed with diabetes type II and obesity. The crime rate is higher than the national average. In 2006, Pueblo County had approximately 2.4 liquor stores per 10,000 people. Underage rates of drinking increased with age. Methamphetamine use in youth (less than 10 percent), but showed signs of increase between 2005 and 2007. The health factors and morbidity and mortality rates of Pueblo County are higher than the national benchmarks. Pueblo has 95% of days with good air quality and drinking water safety at 1%. Pueblo County has a disaster/ emergency management preparedness plan as well as a chemical stockpile emergency preparedness program for the Pueblo Chemical Depot. Pueblo operates in an all-hazards disaster plan with Pueblo Health Department being the lead in the Emergency support function of Public Health. Pueblo County, Colorado is overall a healthy community. Nevertheless, the areas where improvements need to be made are determining a way to attend to each individual’s reaction to negative life events. These events are causing a rise in binge drinking and the use of methamphetamine abuse. Creating and implementing a plan to decrease the poverty level and being able to inform and address access and functional needs. Neighborhood/Community Safety Assessment As sad as it is to say, violence in Pueblo County is a huge â€Å"health† problem. Pueblo’s overall crime index as reported in 2006 was 6945 crimes which was higher than the national average and encompasses â€Å"violent† and â€Å"property† crimes. Violent crimes consist of murder, rape and aggravated assaults. Property crimes include burglary, larceny, theft , motor vehicle theft , arson, and vandalism. In 2006, Pueblo had a reported total of 628 violent crimes with breakdown as follows: Murders – 6; Rapes 49; Robberies – 170; Aggravated assaults – 403. Pueblo’s reported â€Å"property crimes are as  follows: Burglary – 6317; Larceny/Thefts – 4409; Motor Vehicle Thefts – 455 and Arsen – 55. (Pueblo Colorado Crime statistics and Data Resources, 2014) . Along with the high crime rates that fill Pueblo’s neighborhoods that have an effect on the safety and health of the county are the large nu mber of liquor stores that fill them. In 2006, Pueblo County had approximately 2.4 liquor stores per 10,000 people. (Community Health Status Report, 2011) With such a high density of liquor stores and access to alcohol, it can also contribute or be a large relation to the economic and social crumbling of the community and overall rate of crime. There are studies that report that the â€Å"over-concentration of liquor stores increases the perceived lack of safety and limits walkability in the community†. (Community Health Status Report, 2011). The excessive consumption of alcohol also leads to major health problems, such as, cirrhosis of the liver, cardiovascular disease, cancer, anemia as well as the effects due to injuries sustained in car accidents secondary to driving under the influence. Substance abuse, including alcohol, is another public health concern in the Pueblo community. One of the biggest concerns of alcohol abuse is that of â€Å"binge† drinking among individuals. Binge drinking is a major indicator of substance abuse and is defined as â€Å"Consuming five or more alcoholic drinks in one occasion in the pa st month†. From 2007-2009, there were 14.5% of adults in Pueblo that reported binge drinking, a rate that was well below the Healthy People 2020 objective. (Community Health Status Report, 2011). According to the website, Teen Drug Abuse, 90% of alcohol consumption by those that are underage is in the form of â€Å"binge† drinking. (Teens and Addiction, 2014). In Pueblo County, underage rates of drinking increased with age, indicating that teenagers are more likely to experiment or try alcohol around the ages of 16 or 17. (Community Health Status Report, 2011). In Pueblo County, methamphetamine use in youth ages 15-18 years was low (less than 10 percent), but showed signs of increase between 2005 and 2007 for the â€Å"15 or younger† category. Following national trends, results from 2009 indicate decreasing methamphetamine usage across the board for all age groups. This may be in part to successful prevention interventions, education campaigns about methamphetamine use, or inconsistent self-reporting (Community Health Status Report, 2011) Housing, water quality, and air quality are factors that can be classified as the environmental quality/safety of Pueblo,  County. â€Å"Homes† represent to most a place of safety, security and shelter and because these factors are so important they have the potential to help or harm the h ealth of the community. The United Way Pueblo County evaluation in 2009 reported that Pueblo County had a large shortage of â€Å"low income† rental housing. The estimated rental housing in Pueblo County reported in 2009 was 32% and home ownership was reported at 68%. (America Fact Finder, 2012). Sewage is another factor that can potentially be a huge source of water contamination. Waste water treatment plants in higher populated areas of Pueblo County are used to treat sewage before being released back into the environment; however, not all areas of Pueblo County are served by a treatment plant. Pueblo County has approximately 16,000 homes that have septic systems and are not serviced by a waste water treatment plant. Water wells can become contaminated due to improper septic system treatment. In Pueblo County, the majority of its population the drinking water comes from surface water. In some cases, the drinking water may come from shallow surface sources or underground wells. (Community Health Sta tus Report, 2011). The air quality in Pueblo is for the very good with the particle matter (PM2.5) being very low. Particle matter is defined by the EPA as the tiny particles directly emitted into the air and particles formed in the air by chemical transformation of gaseous pollutants. (United Stated Census Bureau, 2010). According to the Pueblo City-County Health Department’s Environmental Health Division, there were over 830 complaints in 2010 with the majority of complaints which were 41% of the total complaints were about the housing. (City-Data Pueblo County, CO , 2012). All in all the environmental Quality of Pueblo County is above average. The health factors and morbidity and mortality rates of Pueblo County are in lot of cases higher than the national benchmarks. Premature infant deaths in Pueblo County in 2009 were 8,767. Malignant neoplasms rank first in Pueblo County for the leading casue of death with heart disease being second leading cause of death in Pueblo County. (Community Health Status Report, 2011) Morbidity reporting of poor or fair health was 17% Health factors in Pueblo County such as smoking was 23% compared to the National benchmark of 13%, teen birth rate was 63% compared to National benchmark of 21%, sexually transmitted diseases reported in Pueblo County was approximately 352 with the national benchmark of 92. (County Health Rankings and Road  Maps, 2013). Disaster Assessment Pueblo has a Disaster Management Program which includes several support functions based on the emergency which includes the following: transportation, fires, wildfires, victim care, search and rescue, long-term recovery, hazmat, damage assessment, floods, mass fatality, terrorism, tornadoes and winter storms. The program’s goal is to prevent or decrease the impact of natural or human caused disasters. There are also additional support systems such as behavioral health response and an animal health response plan. The department staff and fire fighters are specially trained and ready to respond to any major disasters that may occur. The command staff members assist in the coordination of the disaster and emergency management training exercises in the local region. There are monthly meetings with the members and the Pueblo County Emergency Response Team (PERT) and with other local emergency reponse and support agencies. (Pueblo, Colorado, 2014). Pueblo also operates and â€Å"All Hazards† disaster plan that is designed to address the needs of the Pueblo Fire Department and the people of Pueblo in and efficient and effective manner if a disaster occurs. It is also serves as a supplement to the Pueblo County Emergency Operations Plan. (Pueblo, Colorado, 2014). The Pueblo Chemical Depot, a chemical weapons storage site is located in Pueblo County. Mustard agents HD and HT are stored at the Pueblo Chemical Depot. The chemical stockpile emergency preparedness program is the federally funded program administered by the Department of Defense and the Federal Emergency Management Agency (FEMA). The program was placed to prepare the local authorities for a possible chemical weapons incident. If such an incident occurs, Pueblo Chemical Depot will notify the Pueblo County Sheriff’s Communication Center in accordance between the agreement between Pueblo County and Pueblo Chemical Depot. (Emergency Services Bureau, 2013) Due to the hot dry summers, a fire or wildfire frequently occurs and there is an emergency support system that is in place. The following agencies included are the Pueblo County Sheriff’s Office Emergency Services Bureau, Public Works, the Colorado State Patrol, the Colorado State Forest Service, US Forest Service, Colorado State Parks, American Medical Response, both local hospitals –  Parkview Medical Center and St Mary Corwin Hospital. The Emergency Support Function and Wildland Fire Incident Annex is there to guarantee a correct response from the numerous agencies involved for containing and extinguishing fires. This is an effective system that was established to manage the various resources and agencies involved to fight structural and wild land fires in Pueblo County. (Emergency Services Bureau, 2013). The Pueblo Activation Sequence establishes procedures for the activation and operation of the Pueblo County Emergency Operations Center (EOC). The EOC is activated to an anticipated or actual response that involves more than one area or jurisdiction and/or multiple response agencies. This includes agencies that respond to HazMat accidents, severe weather, flooding, earthquakes, civil disturbances or terrorism. (Emergency Services Bureau, 2013) The Pueblo County Health Department leads the emergency support functions for Public Health and Medical Services. Their supporting agencies are as follows: Local Hospitals, EMS, Behavioral Health Services, Emergency Service Bureau, Coroner, Agriculture, Education, Human Services, Law Enforcement Agencies, Military and Veteran Affairs, Public Safety, Regulatory Agencies, Transportation, Pueblo Community Health Center, American Red Cross, Salvation Army and COVOAD. This program provides a response and recovery action related to the lifesaving tra nsport, evacuation, treatment of the injured, controlling of the spread contamination, prevention of contamination of water and food supplies and the disposition of any dead. (Emergency Services Bureau, 2013) As you can see, Pueblo County is very well prepared with any type of natural, chemical, or human caused disaster. Summary From my observation of data, statistics and information gathered for Pueblo County’s Community assessment, I have found that Pueblo County overall is a fairly healthy community. The community is predominately white, non-Hispanic population with an increase of the Hispanic population in the past two years. The air pollution in Pueblo County is below the national average with 95% of days with good air quality and only 5% with moderate air quality. An area that could use improvement would be to find a way to attend to the individuals that make negative responses to traumatic or  negative life events. These responses and events may play a huge factor in the rise of homicides that are taking place in Pueblo County. The education of the public community about the emergency and disaster preparedness programs through community outreach will help to inform and develop functional needs for Pueblo. Works Cited (2013). Retrieved February 07, 2014, from Pueblo, Colorado: http://pueblo.org/history America Fact Finder. (2012). Retrieved 02 08, 2014, from U.S. Census Bureau: http://quickfacts.census.gov/qfd/states/08/0862000.html City-Data Pueblo County, CO . (2012). Retrieved February 5, 2014, from http://www.city.data.com/county/Pueblo_County-CO.html Community Health Status Report. (2011). Retrieved February 2, 2014, from Pueblo.org: http://county.pueblo.org/sites/default/files/documents/Status%20Report%202011%20Final.pdf County Health Rankings and Road Maps. (2013). Retrieved February 8, 2014, from http://www.countyhealthrankings.org/aIntpp/#/colorado/2013/pueblo/county/outcomes/overall/additional/by-rank Emergency Services Bureau. (2013). Retrieved February 9, 2014, from Pueblo County Sheriff’s Office: http://www.sheriff.co.pueblo.co.us/esb/oem.html History of Pueblo. (n.d.). Retrieved 02 08, 2014, from Pueblo, CO – Official Website : http://www.pueblo.us/index.aspx?nid=119 Pa rticle Matter. (2013, March 18). Retrieved February 5, 2014, from EPA United Stated Environment Protection Agency: http://www.epa.gov/pm/ Pueblo Colorado Crime statistics and Data Resources. (2014). Retrieved February 2, 2014, from Area Connect: http://pueblo.areaconnect.com/crime1.htm Pueblo, Colorado. (2014, January 31). Retrieved February 08, 2014, from Wikipedia: http://en.wikipedia.org/wiki/Pueblo,_Colorado Teens and Addiction. (2014, February). Retrieved February 9, 2014, from Teen Driug Abuse: http://www.teen-drug-abuse.org/ United Stated Census Bureau. (2010). Retrieved February 2, 2014, from Current Population Survey: http://www.census.gov/hhes/www/cpstables.htm

Analysis chinese banking industry systems, processes and products Essay

China’s rapidly developing economy is dependent on a banking industry which is controlled by the state. The four public banks of China and the People’s Bank of China have a strong hold over the country’s financial system. The advent of China in WTO in 2001 and globalization has led to a felt need for transformation in the Chinese economy to integrate it with the global economy. The financial sector will need to support this change. An assessment of the state of the Chinese banking industry at present and its future growth is therefore essential. Ideally this can be achieved by benchmarking a Chinese bank and a European Bank, for which purpose a case study of Bank of China and HSBC, London has been carried out. The aim of the research is therefore to undertake an analysis of the Chinese banking systems, processes and products through a case study of the above mentioned banks while the objectives of the research indicate assessment of the overall state of the Chinese banking industry, evaluate implementation of various processes and systems and highlight the areas for growth. A deductive – inductive approach with emphasis on case study has been adopted for the research. Apart from extensive secondary research through literature survey, a detailed questionnaire has been administered to 40 clients across a wide cross section of personal and corporate customers of Bank of China and HSBC, London which has formed the key primary resource for the research. A review of the research sources and questionnaires has revealed that Bank of China has been able to quickly adapt itself to the changing requirements of a globalised financial environment and is providing both personal as well as business banking services to meet its customer’s requirements. HSBC which considers itself as the World’s local bank is providing a complete package of services to the corporate as well as personal client and has been successful in implementing the same throughout the World. Its initial forays into China have also underlined the success story. The quality of service in both the banks was seen to be similar, however HSBC provided better follow up and also more services on the internet than Bank of China. The growth trajectory of both the banks indicates that, while HSBC is attempting to grow throughout the World; Bank of China is growing primarily within the Chinese banking system. There are a number of areas for improvement identified in the research which could well be undertaken by Bank of China to include greater efficiency and better customer service, improvement in technology and customer follow up and exploitation of niche areas such as credit cards. The entry of foreign banks will see greater competition in the Chinese banking sector. The need for Chinese banks to adopt global practices is also underlined and it is anticipated that the entry of more global banks as HSBC in China will provide the impetus to this growth. ANALYSIS CHINESE BANKING INDUSTRY SYSTEMS, PROCESSES AND PRODUCTS: A CASE STUDY BANK OF CHINA AND HSBC, LONDON Chapter 1 – Introduction China is a rapidly growing economy which is considered as a model for emerging countries all over the World. The dynamism of an economy lies in an efficient and effective financial system led by the banking sector. The impact of the banking sector on economic growth in China and its contribution to public life has been a matter of debate over the years. China has a banking system which is controlled by the State and thus has a very large influence on the economy. Exclusively controlled by the central government, the four state banks and People’s Bank of China have a very strong hold over the financial system both internally and externally. (China’s Economic System, 2004). However the rapid growth of China towards a socialist market economy has been affecting the banking sector in various ways and Chinese banks have undertaken measures to enhance their efficiency and contribute effectively to the economy. China’s entry into the WTO in 2001 has also necessitated adoption of liberalized norms in line with the global banking and financial industry. To what extent China has been able to adapt these new practices and how these are affecting or likely to affect the growth of the Chinese economy is an issue of great relevance. As China’s economy gets increasingly integrated with the global economy, its financial markets will have to support this union. It is therefore essential to assess the state of the Chinese banking industry at present and its trajectory of growth in the future. A case study approach to this issue is considered relevant for which Bank of China and HSBC, London are selected for review of the systems, processes and products to provide an insight of the financial needs and their fulfillment today and tomorrow. Bank of China is one of the principal banks in the country; it is one of the four banks which are owned by the State in China. (About Bank of China,. 2006). It has been a key central bank of China which has carried out international exchange as well as provided funds and been a point for foreign trade in the country over a period. It conducts a wide variety of services including commercial banking, insurance as well as investment banking. It is one of the largest banks in Asia and has been placed at the 18th position by the Banker Magazine in 2005. (About Bank of China,. 2006). It also has a large overseas presence in 27 countries. The systems, processes and practices followed by the Bank of China would be a good indicator of the state of the Chinese banking industry in both its internal and external dimensions. HSBC is an epitome of a modern bank. Based in London, the Bank had its origins in provision of finance for trading with China in the 19th Century. After China adopted a nationalist communist economy and banking system, HSBC’s presence in the country was limited. However the bank has now retuned with a vigor and strives to make inroads in the highly competitive financial sector where banks with a state monopoly are said to enjoy unprecedented advantage. The Bank is also taking benefit of its old legacy and is already earning profits to the tune of $ 161 million for the first half of 2005. (Schuman, 2006). HSBC in some ways can be seen to be a competitor to the Bank of China, though its reach within China is limited to only 20 branches. (Schuman, 2006). The investments made by HSBC in Chinese financial sector are reported to be $ 4 billion and include almost one fifth stake in China’s fifth largest bank, Bank of Communications and its second largest insurance company, Ping An Insurance with which the Bank of China too has many contracts. A comparative analysis of BOC and HSBC would thus provide us an effective understanding of the state of the banking industry in China in all its operational facets. The dynamic nature of the research will entail application of a deductive-inductive approach which in practice is adopted by a number of similar research projects keeping in view the importance of both qualitative and quantitative findings.

Research paper Assignment Example | Topics and Well Written Essays - 1500 words

Research paper - Assignment Example The greatest happiness is fulfilled when acts that produce maximum happiness for those affected-the best results-are considered morally good acts. In utilitarianism, ethical behavior implies acting in the interests of the larger group, even if one must sacrifice one’s own interests to do so. The welfare of the group matters not the individual. Higher pleasures are logical or intellectual while lower pleasures are concerned with the physical needs. The role of pleasure is to provide happiness. Showing compassion for the society helps an individual care for the community in which he or she lives. Compassion is very significant to an individual in that it makes them realize the meaning and purpose of life, which is to be happy. This is because since every person wants to be happy, they will do anything to avoid misery and suffering. Virtues are important because they help human beings to derive pleasure in their actions, have uniformity in the way they act, and act promptly which in turn will result to peaceful co-existence, thus everybody will be happy about the life they live. Posner is following the principle of act utilitarianism in that he desires to die so that he does not cause financial constrain to his family. In the early 1960s, Ford’s market position was being heavily eroded by competition from domestic and foreign manufactures of subcompacts. Lee Iacocca, then President of Ford, was determined to regain Ford’s share of the market by having a new subcompact, the Pinto, in production by 1970. Then Ford engineers crash tested an early model of the Pinto. They found that when the automobile was struck from the rear at 20 miles per hour, the gas tank regularly ruptured. Stray sparks could then ignite the spraying gasoline, engulf the car in flames, and possibly burn the trapped occupants. Nonetheless, Ford management decided for several reasons to go ahead with production of the Pinto as designed. First, the design met all applicable fe deral laws and standards then in effect. Secondly, the Pinto was comparable in safety to other cars being produced by the auto industry. Third, an internal Ford study indicated that the social costs of improving the design outweighed the social benefits. According to the study, it was estimated that a maximum of 180 deaths might result if the Pinto design were not changed. For purposes of cost/benefit analysis, the Federal government at that time put a value of $200,000 on a human life. Consequently, the study reasoned, saving 180 lives was worth about a total of $36 million to society. On the other hand, improving the 11 million Pintos then being planned would cost about $11 per car for a total investment of $121 million. Since the social cost of $121 million outweighed the social benefit of $36 million, the study concluded that improving the Pinto design would not be cost-effective from a societal point of view. 1. Identify the relevant issues for decision-making In early 1960s, F ord’s market position was wearing down due to high competitions from domestic and international manufactures of subcompacts. Therefore, the Ford Motor Company, endorsed by the vice-president Lee Iacocca, came to a decision of manufacturing a new subcompact car called Pinto that was to be produced domestically at an affordable price. The decision of manufacturing Pinto was also aimed at gaining large market share for the company, the designing and development of Pinto car was therefore accelerated in order to

Health policy Essay Example | Topics and Well Written Essays - 750 words

Health policy - Essay Example Decisions on the clear-cut balance to be employed will rely on an array of issues including the perspective of stakeholders, specifically service users and mental health experts. Community based health care services could be a solution to the dire problems of mental health care in Australia, particularly in New South Wales. Large hospitals located in the urban areas often have the best facilities and equipment for mental treatment whereas clinics in the communities are left behind because of over-emphasis on the needs and demands of the health care sector in the cities. Community based mental health services could lessen the problem of overcrowding in city hospitals which usually causes poor quality mental health care, could improve the medical knowledge and expertise of medical practitioners assigned in the rural areas and most probably it could eliminate the negative attitude of â€Å"blaming the victim†. The Medical Journal of Australia released a report in the mid-1970s which showed the result of the investigation on community psychiatry in the locale. The decision to allow psychiatric hospitals to consign patients in the community had produced confusion on professionals, on whether they were gaining independence or just being coldheartedly disregarded. The New South Wales Mental Health Act in 1958 revised the mental health guidelines. It abolished the 1898 Lunacy Act which prohibited certification and committal on the singular basis of psychiatric infirmity. This move then gave community workers and mental welfare officers an opportunity to visit patients on vacation at home. Community-based services were then further reinforced by the introduction of new psychotropic drugs in the 1950s which were able to lessen acute symptoms of significant conditions and made possible the placing of mental health patients in the community (Lewis 2003, p. 109). Moreover, beginning from the 1960s, mental health professionals were instructed in community principles

Executive Compensation in Investment Banks Essay

Executive Compensation in Investment Banks - Essay Example Initially it was the investing public that was greatly affected, but as the crisis grew and the state had to intervene, it was the common man who stands out as most hurt, not only in the US, but across Europe and the world. Apart from bearing the full force of the crisis in terms of recession, unemployment, it is his money that is being used to bailout companies from the mess created for which he is in no way responsible. The media, the public and the politicians are busy naming the culprits for the crisis. The state regulators are trying hard to exonerate themselves by saying it did everything to prevent it and academicians are busy trying to analyse and suggest solutions. The analysts and executives who are being seen as the immediate malefactors are facing the media and public ire for the alleged role they played in the process. The important thing about this crisis is that it is not something that happened by a set of circumstances which developed overnight. There have been two similar occurrences, though of lesser magnitude in the last decade, the stock market bubble in the mid nineties and the crisis following the dot.com bubble burst in the earlier part of the century. At both times the reactions of the media, public and regulators have been similar, but apparently whatever remedial action taken by the regulators and the industry does not seem to have prevented the recurrence of the present crisis. Questions are still being asked on how this has happened Can these be prevented Are these inherent risks in a capitalist and market economy and therefore these are unavoidable If so, how should they be mitigated What and who is responsible for the present crisis What has been the role of the state and regulators The questions being attempted to be answered in these area are more specific namely if the executive compensation in investment banks are flawed and whether disclosures made in Reports and Accounts have given information to shareholders about long term prospects of the company to justify such high compensation and how these have affected shareholders wealth erosion in the present crisis. There is a universal agreement across academicians, industry, regulators and media that executive payments in investment banks are indeed very high. "Firms make lots of money, and use about half of it to overpay their employees."(Brown, 6) CFA UK's analysis of pay structure of employees of investment banks (Annexure A) and concedes that they are very high compared to other business sectors. Even if we concede for the moment that the remuneration and incentives paid to employees and CEOs of investment bank is disproportionate to what they really deserve, and this had a bearing on the crisis, this cannot be the reason for the crisis. Three articles have been chosen from three different sources-the media, academic research and industry association to see how much they agree with the statement. These have been taken from three different periods of time, one immediately after the previous crisis of 2002, one midway between the last two crises (2007) and one not more than a month ago after the full impact of the crisis was beginning to unfold (2008). The first one is written by Gretchen C. Morgenson et al. (2002) appeared in May 2002 in the Money and Business/ Financial section of

Older Adulthood Essay Example | Topics and Well Written Essays - 250 words

Older Adulthood - Essay Example This means that some diseases and health defects associated with old age can be prevented or at least reduced if proper care is taken. I will advocate for routine medical checkup for me and my friends so that these many complications are avoided in future. For example, it has come to my attention that avoiding exposure to environmental toxins and other hazards and also getting faster access to healthcare can avoid these complications. For a successful transition into old age, I will from now henceforth advice those with old age to accept the change, be sociable and also employ spiritual faith. Older adults require religious support and spiritual nourishment to enable them cope as I have just realized. Another way of coping is by keeping old and retired people busy by volunteering. This enable them overcome depression associated with old age, widowhood or caring for a sick partner. Having family members visit the old is refreshing to them (Kail and Cavanaugh 519). Old people are sometimes neglected or abused. This is not good as they require as minimum stress as possible. I have a changed opinion about old age, and will from now on emphasize on love and care for the old people. From this class, I have learnt of better ways of caring for and helping the older people. I have also gained an insight that can enable me advice old people into successful transition to old age. Plus, it has changed my view on old age. Old is

Creole linguistics Essay Example | Topics and Well Written Essays - 500 words - 5

Creole linguistics - Essay Example Although there are still many debatable aspects their inclusion into the linguistic arena has motivated scholars to have closer inspections. Unlike languages such as Slavic and Germanic languages Creole languages are different because they have no common ancestor (Baptista 5). All the creole languages put together can never be traced to a particular language or group of languages but what is evident is that there are traces of many different languages within the creoles of different regions. One of the observable features of creole is the use of the double negative or the subject as well as the verb in the negative. This double negative could be influenced by the Romance languages such as Spanish since this is grammatically incorrect in English. The Spanish, â€Å"Yo no voy a ninguna parte,† to Jamaican Creole, â€Å"mi na go no wey,† to the English, â€Å"I am not going anywhere,† is an example of this feature. This is used by the creole speaker to show emphasis and assertiveness. A creole is a restrictive language. Scholars point out that they were developed for communication means. They therefore lack many of the linguistic structures found in other languages. One of the features that point to this restriction is with regard to questions. The structure of the sentence is usually the same as when one makes a statement. The only difference is in the intonation. This could be due to the absence of a written code for the language. A language that is only perpetuated orally will have reduced structures different from those languages that are written. For example, Guyanese Creole â€Å"he gone,† can both mean â€Å"he is gone,† or â€Å"has he gone?† One is just left to the mercy of the speaker’s intonation before being able to decode the message. Apart from questioning there are other areas of creole languages that involves the intonation and emotional involvement

Finance research project Paper Example | Topics and Well Written Essays - 2500 words

Finance project - Research Paper Example To do the analysis about the current situation of the company a ratio analysis has been performed over the 3 years financial data of the companies. The various ratios that have been calculated are Profitability Ratios, Asset utilization Ratios, Liquidity (Solvency) Ratios, Debt Utilization Ratios and Market Value Ratios. We shall now discuss the various ratios in detail. These are the ratios which show the ability of a firm to earn profits (Profitability Ratios, 2010). It helps to calculate the profit earning capability of a company with respect to the sales, assets and other such expenses. The various ratios under this are: This calculates the amount of earnings for a company from every dollar of sales (Peaveler, 2010). This is calculated as net profit divided by the revenue or sales (Profitability Ratios, 2010). The higher the profit margin the better the company and its operations (Profitability Ratios, 2010). This ratio basically calculates the efficiency with which a firm uses its fixed assets to generate profits (Peaveler, 2010). This can be calculated by dividing the net profit by the total amount of fixed assets (Peaveler, 2010). The higher the ROA the better the company and its management are (Profitability Ratios, 2010). This ratio calculates the profit that a company is earning over the investment of shareholders (Peaveler, 2010). This can be calculated by dividing the net profit by the total shareholders equity of the firm (Peaveler, 2010). The higher the ROE the better the company is (Profitability Ratios, 2010). These ratios tell the management how well they have been using their assets to generate sales (NIMS, 2010). They give valuable insight about the internal operations of the firm and thus the management could take the required steps to improve the same. The various ratios have been discussed hereunder: This ratio indicates as

Review and Insights Essay Example | Topics and Well Written Essays - 500 words

Review and Insights - Essay Example Additionally, both sides must be contrasted, or shown what is different about each position, in the essay. Argumentative essays are another subject altogether. When you revise your argumentative essay, Kirszner (1999) recommends that you should keep at least some of the following questions in mind: The same could be applied to persuasive essays. It is of utmost significance in a persuasive essay, above all, to make a well-formed and logical argument. The writer’s position does not necessarily matter so much, as much as does the attitude of the writer and the evidence that the writer has to support his or her assertions. A passionate persuasive argument is part of the persuasive essay, but the essay will not reach its intended purpose without the proper evidentiary support. In that regard, it is much like the argumentative essay, but slightly different in that the attitude of the writer must convince the reader based largely on an emotional appeal as well. A well-written case study is one in which the writer is in the position to analyze and manage an imaginary real-life situation. The case study’s purpose is to give the analyst experience in how he or she would approach a particular problem and solve it in a potential actual setting. The exemplar case study is one which: first, gives the details and background about the case; second, provides scenarios as to what is the desired outcome or potential outcomes of the case study; and thirdly, discusses why the solution(s) given to the problem is/are the best, and why one recommendation was chosen over the other for the problem. There are certain tips that can be followed in order to ensure success in writing quality research papers and essays. James Foley (2001) mentions a few useful things he had his students do in order to get involved in the process of researching papers; adequate preparation for completing research required a

Short Stories Essay Lamb to the Slaughter Essay Example for Free

Short Stories Essay Lamb to the Slaughter Essay Most murder mysteries often have a motive to prompt an investigation, and most classic murder mysteries include a detective to solve the case. Murder mysteries obviously also include a murder, may it be spectacular, cold blooded or accidental. There is also a murderer and a victim and a weapon of some description.. However, not all murder mysteries involve an alibi which in my opinion, adds to the suspense of the story. The main focus of a murder mystery is the location of the story or where it is set. There may be many different locations in a murder story, however there must be one main location for the story to be effective. Lamb to the Slaughter was written by Roald Dahl who is infamous for his enthralling stories, most of which are directed at a younger audience. It was first published in 1954. In Lamb to the Slaughter, the use of modern language automatically gives the impression that it is written in the present day. Roald Dahl is much more famous for his stories which are directed at a younger audience, however Lamb to the Slaughter is directed at an older audience ranging from GCSE students to adults. In his style of writing, Roald Dahl always writes about ordinary people who get involved in difficult situations to make his stories more suspenseful. The other short story, which I will be investigating, is The Speckled Band. The Speckled Band was written by Sir Arthur Conan Doyle and it was first published in 1892. Sir Arthur Conan Doyle is infamous for writing The Sherlock Holmes Adventures and The Speckled Band is just one story of many and The Speckled Band is written in speech of the time when it was first published much like Lamb to the Slaughter. Much more formal English language was used when compared to Lamb to the Slaughter. The main characters in The Speckled Band are Holmes and Watson and you could tell that they were well educated just by analysing how they spoke. Sir Arthur Conan Doyles creation has had worldwide success and has also been made into a Television series. The stories prove so popular because of the way Sir Arthur Conan Doyle wrote the stories. He was very descriptive and gave the reader a real atmosphere of what it must be like to be in Sherlock Holmes Land. The setting also enhances the suspense and the atmosphere of the stories which is also another successful formula, which proves the Sherlock Holmes Stories to be  so popular. Sherlock Holmes is probably thee most famous detective in the world now and it is all thanks to the creation of Sir Arthur Conan Doyle. Lamb to the Slaughter and The Speckled Band are both murder stories however they both deal with different types of murders. However in both stories there is a focus on animals that being the snake in The Speckled Band and the Leg Of Lamb in Lamb to the Slaughter. The Speckled Band is the longer, more sophisticated story of the pair and deals with exotic animals. This may be a personal theme of Sir Arthur Conan Doyle. While the Lamb to the Slaughter murder is brutally simple, but in this case the murder is so good the murderess gets off. In the Speckled Band we want the detective to solve the murder to tell us how it was done, while in the Lamb to the Slaughter we know how the murder was committed, and we read on to see if she gets away with it. We also have two different styles as one of them was written in the 19th Century and the other in the 20th Century. The Speckled Band starts with the reader being introduced to how many cases Dr Holmes and Watson have solved and also what sort of cases these were. These cases were not ordinary cases, they were all difficult; strange, but none-commonplace, so any normal cases were shunned. The first sentence is also very long; taking up eight lines, so the reader can get background all in one go, without having to refer back to anywhere. The story is retrospect, as the plot of the story has already been started. We are introduced to the case and Dr Holmes; by Dr Watson, the faithful companion to Holmes. The entire first paragraph is devoted to describing the case of Dr Grimesby Roylott of Stoke Moran The first mention we get of Holmes is when at the beginning of the second paragraph he wakes Watson up, which we find unusual as, we are told he is a late riser. At the bottom of the next page we get our first archaism of the story. These are old style words or phrases that are now no longer in use, the one we get here is intimate friend, in this sentence he is referring to Dr Watson, and now most people no longer say male friends are intimate. We also get the feeling that Holmes has collected a considerable amount of money for his efforts on the seventy odd cases he has solved. This is shown by the fact he is only a bachelor; but he still manages to have a maid, and  he also drinks coffee which is an expensive drink; as in 1883 coffee was a recent import and so only for the upper classes. He is also respectful and a gentlemen and cares a lot for people, You must not fear, he said leaning forward and patting her arm. We then come across defray which is another archaism and means to make good or repay. We also find that Holmes finds his work rewarding, as when Miss Stoner says she cant pay yet, Holmes lets her pay when she can. The narrative then told by Miss Stoner goes on to say she was a step daughter to one of the oldest Saxon families in England, this family has fallen apart as has the Saxons. Being old as well would mean they were honourable. The estate had stretched to Berkshire and Hampshire, which are both rich a reas. The Dr Grimesby Roylott went to Calcutta, which was the jewel in the crown, of the British Empire, and soon got a prison sentence for beating a native butler to death, but as he was white, he did not get a death sentence. This shows us that he had a huge temper and was strong enough to kill someone with a beating. While in the Indies he married Mrs Stoner who had ?1000 a year, which would be given to him while her daughters resided with him. So when she died shortly after they returned to England near Crewe in a railway accident, they moved in with Dr Grimesby Roylott back to his roots at Stoke Moran. While they lived with him the ?1000 a year saw to all their needs. Until Doctor Grimesby Roylott changed and started throwing fits of anger, and as he was a man of immense strength he often got into brawls. It was said to be part hereditary and part from living in the tropics for so long. He had even thrown the local blacksmith over a bridge, so if he could do that to a blacksmith, normal people had no chance. He also allowed gypsies onto his land, and would disappear off with them for weeks at a time. He also had a cheetah and a baboon roaming his land, showing that he could not leave India behind. Her sister met a half-pay Major of Marines at her aunts house, and if she were to marry him Dr Grimesby Roylott would have to pay ?250 a year of his ?1000. A half pay soldier is a private soldier who already has enough money to live, and doesnt need paying; he is an amateur soldier. On the day of the murder the weather had been bad and full of forbidding, offering perhaps some pathetic fallacy of the awful deed done that night. Then from the story being quiet and conversational it very quickly turns into a scene of action and murder. The last words of her sister were very confusing, and so puzzled everyone;  which added mystery and cynicism. The next main event was when Percy Armitage asks for her hand in marriage. When this happens she is told to move to the room where her sister had died. From this point onwards the reader is very neutral, as they talk of what to do, and in a classic Sherlock Holmes way he talks of what to do and when to do it, but it will all happen because of logic. The next page is just Dr Holmes summing up and analysing all that he has been told. Dr Grimesby Roylott then burst through the door and starts shouting and threatening Holmes, he is never phased by any of this and responds quietly and politely to the raging shouts directed at him. We then see the great detective start on his quest; he shows he is also well aquatinted with firearms as he tells Watson to get an Eleys No2. So they then set off on the journey to Stoke Moran, when reached the story tells of the darkness surrounding Stoke Moran, and the Great House and its owner. During this part of the story, Watson asks Holmes questions on behalf of the reader, and so the reader gets all the information that Watson gets. Sherlock Holmes then goes through the whole process of trying to solve the mystery of how the murderer got into the house room, but it is without success, so it is still a mystery to Watson, the reader and probably Holmes. It is obvious though over the next few pages that Holmes begins to understand how the murder was committed. It is also shown that he begins to dislike Dr Grimesby Roylott increasingly, as he understands more about the murder and how it was committed. We then get the plan of Sherlock Holmes to show us how the murder was committed. The plan works perfectly, but with one fatal part for Dr Grimesby Roylott. The doctor is bitten by the murder weapon, the evil doctor dies dressed even in death in an eastern style. After this we are brought up to date by Dr Watson as he finishes writing the narrative. The start of the Lamb to the Slaughter differs from the Speckled Band because it is in the pas-tense. It builds up a picture. It also shows that it is in the 20th century as it has a Thermos bucket. We are then introduced straight away with no description a character who is Mary Maloney, who is six months with a child; and so an unlikely murderer. Where as in the Speckled Band we are introduced to Holmes after a page of description of his background; and  he is the story. The story style is more immediate and straightforward, and in the Speckled Band we have Dr Watson as a filter to help us. We get description of movement over the next paragraphs. This helps us to assess the mood in the house, and the tension between the two people. We also get to know the characters, and their routines, where as in the Speckled band we know who the main characters are and what they do, while out of no where we are told that Mr Maloney is a policeman with no build up to it all. We are also told that the couple have a conversation that lasts only about four or five minutes. We are not told what happened in this conversation, so we are forced to make our own opinion, of what he said to her, while in the Speckled Band we are given every detail. We are then made to make up our own mind about this and the next part of the story, when she walks across the room, she couldnt even feel her feet touching the floor. This shows she is walking on an autopilot, she may have pre-meditated the murder. She then goes downstairs to get the leg of lamb. We are told all this in the Lamb to the slaughter, but in the Speckled Band we dont know what the murder weapon is, but we do know that it is pre-meditated. We are then told that Mrs Maloney goes out to the shops to get an alibi, that she was happy and chirpy and not looking or acting like someone who had just committed murder, she puts on the face of a expectant mother and a very happy wife. She does this perfectly and gets th e alibi needed for later in the story. So when she gets back to the house she does not need to act to cry or feel sorrow at the death of her husband because she really loved him, and was probably sorry for killing him. The stories do also differ as, one person calls all the moves of the investigation, and the other has a team of people working all working together to try and solve the murder, when the single investigator solves the crime and the group of detectives fail. We then get a long drawn out conversation between the policemen, which is all-ironic. As they talk about the murder weapon, they are describing the joint that they are eating. Towards the end Mary gets referred less and less as a person and more as an object; this shows her identity as a murderer is disappearing. Both of the murders are perfectly planned and carried out, but the one has a detective, which we need to solve the case, and the other is a case of will the murderer be caught?

Sport Utility Vehicle and Mercedes Essay Example for Free

Sport Utility Vehicle and Mercedes Essay 1. What is the decision facing Mercedes? Mercedes must determine how to market the BlueHybrid and the so-called mild hybrid the ML450 to the United States market, while competing with Toyota and Honda. Mercedes also needs to be concerned with making sure that they keep their existing customers, while transitioning into the green marketplace. 2. What factors are most important in understanding this decision situation? Consumers are attracted to Mercedes-Benz for the vehicles’ luxury, design, safety, and powerful engines that have excellent handling and acceleration. The performance that Mercedes is known for must not be lost in a hybrid or of a mild hybrid. The marketers need to ensure that all the reasons that consumers are attracted to Mercedes stay the same and maybe even add a bit of â€Å"green† to it. However, customers are not going to want to pay $80,000 to $90,000 for a hybrid SUV that shutters when transitioning from gas to electric. 3. What are the alternatives? Mercedes must determine how it is going to represent its brand. Is it the well known for fast well built cars with little concern for family vehicles and gas mileage or will they blend the two and use their â€Å"brand† to bring new people and existing customers to a green vehicle with the newly developed lithium-ion battery? 4. What are the decisions you recommend? I think that the challenge of Mercedes is that they are so well know for crafting excellent vehicles that when considering branching out into new technology with a new market potential, with expansion of American facilities, there creeps in the decline of the brand. What if the hybrids and mild-hybrid fail? What will it do to the brand? I recommend that Mercedes enter into the SUV marketing with this hybrid technology on a low-scale, marketing to the environmentally green customer and see what the response is, as well as the performance of the vehicles. 5. What are some of the ways to implement your recommendations? Mercedes has to ensure that the market research shows the consumer desire to match in order to introduce a hybrid luxury SUV to the United States market. Marketers must target the most viable customer base that will be thought to purchase the luxury SUVs. Mercedes will need to use its branding in commercials, television shows and the standard billboards around town to get the vehicles into the public’s awareness. Bibliography Michael Levens (2012). Marketing: Defined, Explained, Applied, Second Edition (text and case book).

Hydration Management in Acute Stroke Patients

Hydration Management in Acute Stroke Patients Introduction Stroke is a global public health concern with many sufferers presenting with varying levels of confusion (Oh and Seo 2007). Management of hydration in acute stroke patients is not standardised and variations in practice can be very wide between different continents. The sheer number of possible comorbidities and the relative ease with which hydration can trigger concomitant problems can lead to increasing incidence and prevalence of long-term patient care resulting from inadequate hydration management. Optimum hydration assessment and management are key clinical activities; however, inadequate hydration controls by health professionals persist (Oh and Seo 2007). Research shows that to guide fluid management to desired levels, a regular assessment of the volume status has to be made Scope This literature review is based on works that are found on Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health literature (CINAHL), Cochrane, Department of Health (DoH), National Institute of Clinical Excellence (NICE), National Medical Council (NMC), World Health Organisation (WHO), Wiley Interscience and CKS databases that relate to hydration in stroke patients and nursing awareness of hydration in stroke patients. There is wide literature on different aspects of stroke and many authors have studied the effects of hydration in stroke patients. This review looks at literature that discusses management of hydration and/or the impacts of variations in hydration management on acute stroke patients outcomes like method of feeding, time- compliance in taking readings or measurements, legal issues and ethical issues. Relevance to clinical practice This literature review looks at relevant studies by experts that are found on credible databases. The purposes of the expert studies are reviewed and analysed to inform better understanding of current nursing practice in hydrating acute stroke patients. Several studies on hydration highlight specific difficulties relating to the assessment and management of hydration in acute stroke patients. There are differences between the management and the assessment of hydration in different hospitals and these complicate improving awareness of managing hydration for nurses in practice. If optimum hydration is directly linked to improved outcomes in acute stroke patients, research will be required to identify and overcome barriers to effective hydration management, including the development of specific tools (and knowledge base) to facilitate interventions that promote optimum hydration in seeking improved outcomes in acute stroke patients. Methods of search and documentation n on-line literature search of MEDLINE, CINAHL, COCHRANE, DOH, NICE, NMC, WHO and CKS from 1999 to May 2009 failed to identify enough relevant articles on hydration in stroke patients. Other sources were then reviewed for available literature on medical journals including the BMJ and American Family Physician. For the on-line computer-based literature searches, the following keywords were used: stroke, fluid balance, hydration, cerebrovascular accident (CVA), dehydration, stroke outcome, cerebrovascular disorders, medical management, artificial nutrition and hydration, dysphagia, dysphasia, pyrexia, acute brain infarction, enteral tube feeding, fluid and electrolyte balance, neurology, withholding treatment, pathophysiology and nurses and hydration Hydration and hydration management in acute stroke patients This literature review looks at one of the issues encountered globally in the treatment of acute stroke patients optimum hydration. It takes a particular look at the nursing awareness, measurement, assessment, methods of intervention and the legal issues associated with hydration in acute stroke patients. Stroke is a debilitating condition and can be caused by an ischaemic event or a subarachnoid/intracerebral bleeding. Stroke patients usually present in hospital with co-morbidities (Oh and Seo 2007). Variations exist in stroke fatalities across geographical regions even within the same continent. Studies by Bhalla et al (2003) across four European centres (London, Dijon, Erlangen and Warsaw) have shown significant variation (after adjusting for case mix) in stroke case fatality, in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity. There were also significant intervention differences between centres in intravenous fluid use, enteral feedin g, initiation of new antihypertensive therapy and insulin therapy, with the London centre having the lowest uptake of interventions. In another European BIOMED Programme, significant variations in case fatality for stroke between European centres (after adjustment for stroke severity) were observed, with the United Kingdom (UK) centres having the highest case fatality and the lowest levels of independence (Wolfe et al., 1999). There were lower intervention rates in the UK centre to correct abnormal physiological parameters in the acute phase which may reflect a difference in philosophy of acute medical supportive care compared with other European countries (Wolfe et al., 2001). Awareness of optimal hydration balance and assessment of the patients hydration condition (in the care of acute stroke patients) is a fundamental part of critical care nursing and optimising the hemodynamic situation can be seen as a team-effort. One of the important factors determining quality of the circula tion is the amount of circulating blood (Hoff et al 2008). Following a stroke, patients may have swallowing impairment and other changes of the gastro-intestinal (GI) tract that could affect nutritional and hydration status and that lead to aspiration pneumonia (Schaller et al 2006). Such changes affect the ability of the acute stroke patient to lead a normal nutritional life. Although the Schaller et al (2006) work did not show a direct link between hydration and other comorbidities, they agree that impaired hydrational status is associated with reduced functional improvement, increased complication rates, and prolonged hospital stays. Hydration and hydration status Hydration balance is a measure of the bodys ability to manage fluids and electrolytes. In order to identify the urgency of interventions, nursing staff should characterize an individuals fluid and electrolyte imbalance as mild, moderate, or severe based on pertinent information including lab tests and other relevant criteria. It is important to recognize that the main electrolyte in extracellular fluid (ECF) is sodium and that of intracellular fluid (ICF) is potassium (Edwards, 2001). Toto (1998) pointed out that large increases or decreases in fluid volume can cause infarct, coma and confusion. This knowledge becomes significant in maintaining cerebral blood flow and in preventing secondary brain insult after an acute stroke. In a complication, respiratory or metabolic acidosis will promote the movement of potassium from the ICF and give rise to high serum potassium levels, which may affect cardiac function (Edwards, 2001). This phenomenon can be seen in many traumatic insults to th e brain. A basic knowledge of this physiology in addition to the homeostatic mechanisms for fluid and electrolyte balance is a vital foundation for nursing practice, and essential to the nurses role in hydration management. Cook et al (2005) highlighted the significance of fluids and hydration in the neuroscience patient and in Cook et al (2004) they highlighted that an understanding of the physiological mechanisms that surround stroke is important for nurses to monitor and treat such patients. Kelly et al (2004) in their study of dehydration and venous thromboembolism (VTE) after acute stroke believed dehydration after acute ischaemic stroke (AIS) is strongly independently associated with VTE, reinforcing the importance of maintaining adequate hydration in these patients. Their study of hydration over a 9-day period showed indication that dehydration was largely hospital acquired and that the association was causal. Although the possibility that VTE was already present at entry to hospital cannot be discounted, tests have shown that VTE is rarely present before the second day post stroke, and then it becomes increasingly prevalent over the next few days. This could be for one of many reasons including poor communication between patient and hospital staff, change of environment for the patient and the physiological impacts of stroke Hydration balance and nutritional/electrolyte balance The differences in how hydration is assessed in different hospitals have been subject of study for some time. The significance of fluid electrolyte homeostasis becomes very relevant in trauma and shock situations such as subarachnoid haemorrhage where an inflammatory response is triggered which causes a significant change in capillary membrane permeability in a short period of time. In such situations, water, electrolytes and albumin move into the interstitial space to permit the site of injury to receive the required factors (third space shift) (Edwards, 2001). A number of physiological mechanisms are required to maintain homeostasis of hydration status, all of which inform proactive nursing assessment, intervention and evaluation. Those with trauma to the nervous system are vulnerable to disruption to the homeostasis of fluid and electrolyte balance (Cook 2005). Older adults may have a poorer capacity to adapt to shifts in acute fluid balance, leading to the possibility of cardiac and renal functions being impaired and, as a result, a lower glomerular filtration rate (Sheppard, 2001). Managing the fluid balance of the stroke patient by intake and output measures needs to be exercised cautiously because even though the patients fluid volume may not have changed, his/her circulatory volume may be significantly lower in instances of major trauma (Edwards, 2001) Good hydration has been shown to reduce the risk of urolithiasis (category Ib evidence) (see Appendix 2), constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence), and is associated with a reduction in urinary tract infections (UTIs), hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct Complications of measurement/control Naso-gastric v PEG, enteral v parentera Patient history taking on presenting in the hospital differs from hospital to hospital. History taking should include assessment of fluid intake and loss, baseline hydrational status, skin turgor, heart rate, blood pressure and urinary output. Normal fluid intake for the average adult is approximately 2-2.5 litres, obtained from food, fluids or metabolic by-products (Edwards, 2001). Methods of measurement are not standardised across hospital settings with Wise et al (2000) showing that faecal fluid losses are often neglected in daily fluid balance charts with the possibility of inaccurate hydration assessment. Fluid assessment must include estimating, as accurately as possible, the quantity of fluid taken in. It must take into consideration the entire processes by which water, potassium and sodium are obtained. Measurements are often mainly focused on the extremes of hydration (optimal hydration and extreme dehydration) and this should not be the case. Assessment of hydrational statu s and need is continuous and begins somewhere along a continuum of severe hypovolaemia/ dehydration to severe hypervolaemia/ overhydration. In looking at dehydration, not only extreme dehydration should be noted. Manz and Wentz (2005) highlight that there is increasing evidence mild dehydration may also account for many morbidities and play a role in various other morbidities. The way in which stroke is managed acutely, such as measures maintaining physiological homeostasis may also vary between different populations (Bhalla et al 2003). The physiological indicators of acute deficits in fluid balance may be masked in individuals where compensatory mechanisms are intact. A history of acute events, mainly from baseline documentation and history taking, may enable better identification of such imbalances (Sheppard, 2001). Fluid and electrolyte homeostasis is brought about by the interaction between the renal, pulmonary, neuroendocrine, integumentary and gastrointestinal systems (Edward s, 2001). According to (Cook 2005), fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Artificial feeding and fluids are the options for a patient who has an advanced, life-threatening illness and is dying. The patient, family members and doctor can talk about these options and the benefits and risks (Ackermann 2000). Hydration and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. Edwards (1998, 2001) highlighted that homeostasis is maintained by a constant movement of water, sodium and potassium between intra- and extracellular compartments. While the movement of water and electrolytes between the cellular compartments is highly significant, it is important to recognize that in acute and chronic illness intracellular fluid (ICF) is reduced and extracellular fluid (ECF) increased almost to the extreme (Edwards, 2001). This is highly relevant for cerebral metabolism, because transport of oxyge n, glucose, proteins and other products for cellular metabolism—and their by-products—may be severely impaired. Stroke may affect ones level of alertness, perception of thirst, ability to access liquids, and ability to swallow them when offered. Stroke victims with such impairments may be at increased risk for diuretic-induced dehydration (Churchill et al 2004). Managing hydration balance is of crucial importance and the mechanisms for the adequate monitoring and controls need to be in place. Nursing management questions in the assessment of hydration in acute stroke patients should include whether use of intravenous fluids during the first week of stroke was recorded. Questions should also include whether the patient was fed orally, by nasogastric tube, through percutaneous gastrostomy tube, by intravenous methods or not at all? The fact that these questions can be raised enforces the need for adequate documentation and recording of acute stroke patient records. Bhall a et al (2002) says that the use of artificial ventilatory support with intubation or nasal intermittent positive pressure ventilation should be documented as well as the use of supplemental oxygen given through nasal catheters or masks. Enteral tube feeding is a vital means of feeding and balancing hydration levels in patients with stroke. There are no set standards for hospitals in the UK and hospitals have recorded much variation between them in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used (Ebrahim and Redfern 1999). Some clinicians delay tube feeding for 2 weeks or more, and although early nutrition is unlikely to be harmful, whether any nutritional benefits offset the difficulties and complications of initiating and maintaining early enteral tube feeding is unclear. If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers o f patients are being denied best treatment. Whether enteral tube feeding via PEG rather than nastrogastric tube or early initiation of enteral tube feeding improve outcomes was tested in the FOOD trials and no evidence of significant benefit from PEG rather than nasogastric tube feeding was found. Neither was any hazard from early tube feeding found (The FOOD collaboration 2003). The explanation for any difference between PEG and nasogastric groups is not clear, but one factor might be the effect of a long-term PEG tube on dependency since more patients in the PEG group were still receiving such tube feeding than in the nasogastric group at follow-up (The FOOD collaboration 2003). The survivors in the PEG group were also more likely to be living in institutions and had lower quality of life. Another intriguing finding was the excess of pressure sores in the PEG group, raising the possibility that those with such tubes might move less or be nursed differently. Weaknesses in this test results include insufficient statistical power to exclude more modest differences between groups; no information about the proportion of eligible patients enrolled in each centre; our use of an informal (although reliable and highly predictive) assessment of nutritional status; absence of precise monitoring of patients daily intake of nutrients (rather than fluids); absence of on-site source data verification or collection of information on changing nutritional status (e.g. in-hospital weights); possible bias due to masking of secondary outcome measures. Although compliance was not 100%, this fact results from the inevitable difficulties of adhering to rigid schedules when patients conditions change. Difficulties with nasogastric feeding in stroke patients (who are often confused and uncooperative) have led to increasing use of PEG tubes at an early stage. Enthusiasm for this method has been encouraged by the results of a trial that reported much lower case fatality rates in patien ts fed via PEG (13%) rather than nasogastric tube (57%) (The FOOD trial collaboration 2003). Due to significant alterations in fluid balance after enteral tube-feeding in patients, close attention to the recording of fluid balance such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage (Oh and Seo 2007). One explanation for the varying and inconsistent readings in fluid hydration between enteral and PEG might b Stroke patients and the impacts of stroke on life Difficulty with swallowing is a common problem in acute stroke patients, and can lead to aspiration pneumonia, dehydration, and exacerbation of any existing malnutrition (Finestone and Greene-Finestone 2003). In Oh and Seo (2007) the authors set out to examine the fluid and electrolyte complications after enteral tube feeding in acute brain infarction patients. The background is that inconsistencies in the results of the water and electrolyte complications associated with enteral tube feeding are partly because of uncontrolled disease-related variables. The implication is that these variables were not adequately managed. Stroke patients very often present with dysphagia and this is very commonly dehydration associated with undernutrition (The Food Trial 2005). Up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods (Mann et al 1999). Although a 50% prevalence can be considered to be high, th e nutritional/fluid status of a stroke patient can rapidly deteriorate in hospital. The difficulty in feeding stroke patients with dysphagia coupled with the discomfort associated with stroke can exacerbate undernutrition and/or dehydration. Studies show that undernutrition shortly after admission is independently associated with increased case fatality and poor functional status at 6 months (The FOOD trial collaboration 2003). The current financial burden of efficiency savings and reduced budgets in the NHS hospitals results in reduced staff numbers so that patients can not be attended to on a one-on-one basis so that ensuring appropriate hydration levels is done by periodic but regular monitoring of charts. An option for the future in this area may be to involve the patients family members in hydration monitoring and provide them with appropriate training if evidence can show that being around loved ones improves outcomes and early warnings. In acute stroke, artificial nutrition t hrough an enteral route is needed because of dysphagia and since oral feeding is unsafe in some dysphagic patients, enteral nutrition is often administered as nasogastric or percutaneous endoscopic gastrostomy (PEG) tube feeding (Finestone and Greene-Finestone 2003). Naso-gastric tube feeding (a prevalent enteral method) has been reported to improve clinical outcomes more than the parenteral route in brain-injured patients (Rhoney et al 2002). Oh and Seo (2007) in their study used 85 subjects, but their work was limited by the fact that it was performed retrospectively and some of the subjects records were incomplete. Also, because the patients in the study were from one hospital it is not conclusively known whether the results can be generalised to the whole population./p> Legal and other aspects Japanese physicians attitudes towards artificial nutrition and hydration (ANH) as a life-sustaining treatment (LST) were examined to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. The study findings show that the informants held different views towards LST because most doctors considered ANH to be indispensable and ANH is automatically provided to patients (Aita and Kai 2006). With the advancement of medical technology, decisions to withhold or withdraw LST are among the most difficult to make for health professionals (British Medical Association 2001). Physicians caring for stroke patients often encounter comatose or semi-comatose patients with severe stroke for whom it is difficult to determine whether or not to continue care (Asplund and Britton, 1989). By administering LST, some patients in this patients group, whose bodily functions other than brain function could remain stable, could pot entially survive for months or years without achieving awareness or being able to interact with others (Aita et al 2008). Certain Japanese physicians have criticized the current efforts regarding life prolonging as Aita et al (2008) states: Prolonging the process of dying like this constitutes the violation of dignity and human rights. The life-prolongation only serves hospital operators who want to make profits by keeping hospital beds occupied. They also said this practice impacted the carers and that some nurses also feel emptiness toward the manipulative life-prolongation when taking care of these elderly patients. In the West, some countries have worked out nation-wide guidelines related to withholding or withdrawing LST that say stroke-caused profound impairment with no hope for recovery is a potential reason to withhold or withdraw LST (British Medical Association, 2001). Ackermann (2000) believes withholding and withdrawing therapy challenge family physicians to be excellent communicators with patients and families and recommends that family physicians should continue to be strong advocates for dying patients. Sprung et al (2003) highlighted differences between withholding and withdrawing therapy showing that withdrawal of therapy is followed by a nearer and more rapid death than withholding therapy, and that physicians and nurses were more inclined towards withholding rather than withdrawing therapy. Food and water are considered symbols of caring (Ackermann, 2000), therefore, it may be natural for physicians to give a special status to ANH as food and water. Whether to withdraw ANH from a patient in persistent vegetative state has also drawn substantial media attention in the U.S. (Casarett et al., 2005; Ganzini, 2006). The findings of the study also suggest that the physicians double standard is partly based on their subjective judgment whether the treatment is ordinary or extraordinary. However, the standard of ordinary/extraordinary care has long been criticized as too vague to guide decision-makers in the U.S. (Beauchamp and Childress, 2001). It is believed the current legal framework has also inappropriately led some physicians to simply continue care regardless of the patients conditions, thus resulting in putting an unnecessary burden on patients. The physicians subjective interpretation of the current legal framework may lead to decisions not to initiate mechanical ventilation in some older adults for fear of facing a situation in which physicians cannot withdraw it at a later stage Conclusion Hypovolemia and hypervolemia occurred frequently after acute stroke but were often not recognized as such by nurses. The nurses predictions of current volume status do not seem sufficiently reliable to serve as a basis for therapeutic decisions. More advanced techniques for bedside assessment of volume status may be indicated for optimizing volume status in patients with acute stroke (Hoff et al 2004). Whereas studies have looked at the optimal method of improving hydration, whether correcting dehydration in stroke improves outcome is not very clear. Given the complexity of the cell death cascade following brain ischemia, novel approaches and combination therapy are inevitable for victims of stroke (Fisher and Brott 2003). The review indicates that standards vary from country to country in the legal framework for withdrawing and withholding hydration and nutrition during end stage care.

A Comparison of Hawthornes Works :: essays papers

A Comparison of Hawthornes Works A Comparison of Hawthorne's Works In both of Hawthorne's short stories and The Scarlet Letter, the author uses distinct symbolisms that have more than one meaning. In The Scarlet Letter, the red rose bush and the weeds located at the entrance of the prison symbolize both good and evil. Throughout the novel, the rose bush represents Pearl, and how good things can come out of bad experiences. Hawthorne suggests the red rose as being "some sweet moral blossom", and represents Hester's relationship as a love both good and bad. Also in The Scarlet Letter, the letter "A" symbolizes more than one thing. The first and clearest form of the letter is that of "Adultery". It is apparent that Hester is guilty of cheating on her husband when she surfaces from the prison with a three-month-old-child in her arms, while her husband has been away for two years. The second form that it takes is "Angel." When Governor Winthrop passes away, a giant "A" appears in the sky. People from the church feel that, "For as our good Govern or Winthrop was made an angel this past night, it was doubtless held fit that there should be some notice thereof!" The final form that the scarlet letter take is "Able." Hester helped the people of the town so unselfishly that Hawthorne wrote that because such helpfulness was found in her, "The people refused to interpret the scarlet "A" by its original significance". They said that it meant Able; "So strong was Hester Prynne, with a woman's strength." While the letter "A" is a most complex and misunderstood symbol, Pearl is even more so. Throughout the story, she develops into a dynamic symbol - one that is always changing. God's treatment of Hester for her sin was quite different than just a physical token: He gave Hester the punishment of bearing a very unique child which she named Pearl. This punishment handed down from God was a constant mental and physical reminder to Hester of what she had done wrong, and she could not escape it. In this aspect, Pearl symbolized God's way of punishing Hester for adultery. In Hawthorne's short stories, The Minister's Black Veil, in particular, the black veil worn by the minister suggests more than one meaning. It shows sin, darkness, concealment, and death all in one.

Dropping The Bomb :: essays research papers

Dropping â€Å"The Bomb†   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Towards the end of WWII America was faced with a dilemma. The Japanese had bombed Pearl Harbor using Kamikaze pilots and were showing no signs of regret for it or any signs of not continuing these kinds of attacks. Through these actions they were also showing the world that they had no fear or respect for the American people. With both the devastating effects of Pearl Harbor, the largest most deadliest attack ever on American soil, and the Japanese’s blatant disrespect for the U.S. on our hands president Harry Truman had no other choice but to drop an atomic bomb on Japan.   Ã‚  Ã‚  Ã‚  Ã‚  Dropping the atomic bomb on Japan did not just come out of the blue. We had tried to warn Japan numerous times before about the type of weapons we were capable of using and even tried to show them what the atomic bomb could do. Even after attempted peace talks with Japan they still refused to pull back. We also had tried other war tactics such as bombing them with regular bombs and even sending in ground troops to fight. Time after time Japan refused to cease fighting. If we had not chosen to drop the bomb on them then there is a good chance that we would have suffered a greater amount of loss of soldiers in continuing to fight.   Ã‚  Ã‚  Ã‚  Ã‚  As it was stated before, Japan knew the basic extent of our power and they still decided to attack us, so they knew what would come of them doing this. It just became evident that they really were not prepared to â€Å"mess† with us until after the atomic bomb had been dropped. So in a way you could say that â€Å"they got what was coming to them.† We also got the response we were looking for, after the bomb was dropped, by Japan surrendering to the U.S.   Ã‚  Ã‚  Ã‚  Ã‚  Some may argue that the overall effects of the atomic bomb were to devastating and that there were other means of retaliation we could have used to get our point across and to get Japan to surrender.

Crises during the presidency of andrew jackson Essay -- essays papers

Crises during the presidency of andrew jackson Andrew Jackson was a very influential man during the 1800's. Events that took place during his two-term tenure as President called upon his expertise on the Constitution. These events had a major impact on the country at that time. He had to face obstacles that presidents before him had not faced, but there was also one that was an old issue that was being reopened. This was the controversy over the constitutionality of the Bank of the United States. The other major obstacles were the nullification controversy and the treatment of the Cherokee Nation. The nullification controversy started before Jackson came into office. In the year before Jackson had taken office, Congress had passed a tariff for the declared purpose of protecting northern manufacturers and businessmen. Southerners thought that the industrialization of the north would lead to the downfall of the southern agrarian economy. They named the tariff the "Tariff of Abominations"(Coit 11). Vice-President John C. Calhoun of South Carolina led the movement of people who thought that "a combined geographical interest should not be able to disregard the general welfare and turn an important local interest to its own profit"(Coit 12). Calhoun was not for the secession of South Carolina so he tried to think of a substitute. He borrowed an idea evolved by Thomas Jefferson and James Madison in the Kentucky and Virginia Resolutions of 1798 and 1799. The idea was nullification. Nullification, as Calhoun viewed it, the right of a "single state to veto, within its own borders, a federal law that it deemed unconstitutional-subject to the later approval of at least one fourth of the states. If such approval was not forthcoming, the state should, if it wished, be allowed to secede from the Union"(Coit 12). The South knew that nowhere in the Constitution was Congress given the express right to impose a tariff whose purpose was simply to protect industry. Up to that point, President Jackson's view was unknown. But that all changed at a Jefferson Birthday dinner. Most of the toasts had been printed up beforehand and were nullificationist. So Jackson rose, looked at Calhoun and stated, "Our Union. It must be preserved"(Coit 16). Calhoun knew he had to think of a retort so he stood and said, "The Union-next to our liberty most dear"(Coit 1... ...s to the fullest limit. Everything he did he thought was in the white people's best interests. When he vetoed more bills than any other president before him, he did it for the public. When he needed support in politics, and he couldn't get much from his colleagues, he would turn to the Constitution and he would manipulate it so the law was seemingly on his side. Of course it also helped to be infallible in the public's eyes. His policy of persecuting the Indians was horrible, his destruction of the Bank of the United States ultimately hurt the citizens, his avoidance of secession was the only thing that was good for the country. But the people believed him and the Constitution, so to these he could do no wrong. BIBLIOGRAPHY Coit, Margaret. Volume 4: 1829-1849 The sweep westward: The LIFE history of the United States. Ed. Editors of TIME-LIFE BOOKS. New York: TIME-LIFE BOOKS, 1963 Commager, Henry Steele, ed. Documents of american history. New York: Appleton-Century- Crofts, 1949 Pessen, Edward. Jacksonian America: society, personality, and politics. Homewood: The Dorsey Press, 1969 Remini, Robert. Andrew Jackson. New York: Twayne Publishers, Inc., 1966

Benefits of leadership

The Benefits of the Leadership Course Responsibility O A responsible person Is one who is able to act without guidance or supervision, because he or she Is accountable and answerable for his or her behavior. C) You will be prepared for both the risks and the opportunities that accompany new roles. C) Your responsibility will grow, giving you an edge on others O A person who does as promised deed can be considered as reliable. C) How does being responsible pay?C) A person who has a reputation of being responsible is trusted to do things on his or her own, without supervision. Leads to self esteem, promotions, Develops Leadership Qualities O Questions How do you handle yourself in unexpected or uncomfortable situations? An effective leader will adapt to new surroundings and situations adjust. O You can develop Important qualities Having these qualities Improves your self-esteem and Job situations Major qualities include open-mindedness, enthusiasm. Inconsistency, courage, and confidenc e C) You will be prepared to deal with real life situations Example is getting a job O Gain feedback on your existing strengths – and weaknesses – as a leader Service Opportunities O it makes you get involved O colleges see the amount of service hours O by volunteering and helping others, you get to learn and see more about your community C) colleges want to see you being more productive and caring to others and not just yourself.C) It gets you familiar with the environment of the working class and the business roll O questions do you volunteer at any organization? What does your organization do to help your community? Have you learned anything by doing this service? Develops Leadership Ability in Extracurricular Activities (D gives you ability to lead in your club/sport's team C) gives you extra edge over other students/athletes C) enables you to hold a leadership position on a sport's team In school or In a club (D gives you opportunity to hold office in student coun cil