Holistic care approaches used in healthcare Essay

The objective of this assignment is to evaluate Holistic care approaches used in healthcare within the acute care setting specifically relating to the role of Assistant Practitioners. Holistic care takes into consideration an individual’s psychological, sociological and mental health needs. Using a holistic approach to care enhances the experience for my patients and families (Erickson 2007). The Nursing and Midwifery Council (2010) defines holistic medicine as a system of comprehensive or total patient care that considers the physical, emotional, social, economic and spiritual needs of the person, taking into consideration a person as a whole. Over the past few decades the focus of medical care has shifted from treatment of a disease and or injury to treatment of a patient (Henning, 2013). Holism has a long history derived from a Greek-indo -European root holos or hale, meaning whole, healthy, healing, holy and the act of caring (Auyang,1999). The first published literature in relation to holistic care was produced by Florence Nightingale in her book Notes on Nursing, which described the work of nurses as putting patients in the best condition for nature to act upon them (Nightingale, F 1969). However the concept of holism was first defined by polymath Jan Smuts in 1927, as the tendency in nature to form wholes that are greater than the sum of the parts through creative evolution (Smuts. 1927). Different theories on holism have been widely supported and promoted in healthcare since the 1960’s, when Florence Nightingale first identified the importance of treating patients individually, as opposed to solely treating the illness (Dossey & Keegan 2009). However this concept is new in Emergency medicine, and has been derived from the recent conflict in Afghanistan. The Army pain management task force published best practice based on a holistic, multidisciplinary, integrative approach to care (Schoolmaker, 2009). The Nursing Midwifery council (2008) states that all nurses must practice in a holistic, non-judgemental, caring and sensitive manner. Throughout this assignment the names of patients, and family members have  been substituted to comply with the Data Protection Act (1998) in order to safeguard their identities and ensure confidentiality is maintained as per NHS Policy (2012). Mr. T attended the Emergency Department (ED) after taking a poly-pharmaceutical overdose and collapsing sustaining superficial lacerations to his arms and face. Mr. T was an unkempt gentleman of middle age who was wearing soiled clothes and looked malnourished. Mr. T was known to have some minor learning difficulties and was a frequent attendee to the ED, due to his long extensive history of alcohol and illicit drug abuse. Regular attendees to the ED often suffer from alcohol and or substance misuse, where homeless and socially disengaged (Cherpitel C 1995). Little & Watson (1996) found that frequent attendees to the ED where at risk of bias care, because they often did not adhere to medical advice or except support resulting in frustration amongst staff during busy times. Pirmohamed et.al. (2000) published figures stating that the majority of alcohol-related ED patients are 18–60 years of age, and about 20% of these involve a serious health problem due to long-term alcohol and drug misuse. Blenkiron et.al. (2000) identified that 15-25% of suicides and deliberate self-harm is associated with prolonged alcohol misuse, a battle Mr. T had been fighting against for several years. Mr. T had been using cannabis from a young age which studies have indicated an increased risk of self-harm and suicide attempts, (Beautrais, et.al 1999). Cannabis has also been well documented to contribute to psychiatric and depressive disorders (Andereasson, et al 2002) & (Moore, et.al. 2007). Abraham Maslow (1908-1970) was a humanistic psychologist who developed his theory, ‘the hierarchy of needs’ (1943) a five stage model of motivational needs often depicted as a pyramid. The five stages are divided into; Psychological, safety, social, esteem and self-actualization. He believed that the lower levels of the pyramid have to be satisfied before a person could move up. Each stage was further defined stating the lowest level was what every human required to survive such as food, shelter, water, sex, air, clothing, to the top being the pinnacle of each person’s potential in life who is able to pursue inner talent, creativity and fulfillment (McLeod, 2007). At this point Mr. T was barley functioning at the lowest level as he  was unable to meet his basic nutritional needs and lacked warm clean clothing or shelter. Lack of food can affect a person’s mood, behavior and brain function, (Pessoa, 2008). I provided Mr. T with food and clean warm clothing , in order to assist with some of Mr. T’s basic humanistic psychological needs, as advocated by Maslow (1943) alongside his medical treatment, demonstrating a comprehensive holistic approach to care. Rutledge (2011) another psychologist disagreed with Maslow’s theory and developed her own theory Maslow Rewired, stating none of these needs starting with basic survival on up, are possible without social connection and collaboration, and that humans require community, Love and the feeling of belonging before harvesting the ability to survive, although this is very much more associated with the 21st century. However substantive evidence has accumulated over the past few decades showing that social ties and social support are positively and casually related to mental health, physical health and longevity (Berkman, 1995). However Mr. T had no relatives other than his brother, who was estranged due to Mr. T’s extensive alcohol abuse. He was disengaged from services, refused social support and often did not adhere to medical advice. The tablets and quantities Mr. T had taken did not require any immediate treatment likewise the lacerations to his arms and face required minimal intervention, however Holistic nursing as advocated by Dossey & Keegan (2009) treats the entire patient. Therefore as a holistic practitioner I investigated Mr. T’s Psychological issues through gentle discussion whilst a colleague dressed his wounds and administered medication to reduce the effects of alcohol withdrawal, thus assisting with Mr. T’s Physical effects which in turn will assist with his psychological needs. Alcohol is a drug with complex behavioural effects that can be pleasurable when consumed in moderation but can be unpleasant when misused, (Swift, 1999). Mr. T was initially withdrawn and reluctant to discuss his mental health problems, however through gentle questioning whilst undertaking basic tasks, a skill often used by nurses as indicted by Berg et al (2007). Mr. T started to disclose information in relation to his psychological behaviour. Whilst  discussing such issues with Mr. T it is important to maintain good eye contact and engage in a moderate amount of social touch, as this is perceived by patients as a more empathetic clinician (Montague 2013). A similar approach is advocated by, McCann & McKenna (1993) whilst Bamford – Wade & Kimble (2013) promote compassionate listening in addition to touch when dealing with patients in crisis. Therefore it was essential to speak slowly and use appropriate body and facial language to demonstrate empathy and understanding to the patient. Throughout the discussion non-verbal listening skills are respectfully used. Egan (1994) offers the acronym ‘SOLER’, an approach u sed in counselling which stands for; S – Sit square O – Open Posture L – Lean slightly forward E – Eye contact R – Relax However according to Stickley (2011) the school of nursing and midwifery has introduced a new model to student nurses, the Acronym SURETY, which stands for; S – Sit at an angle U – Uncross legs R – Relax E – Eye contact T – Touch Y – Your intuition This approach subsequently adds in ‘touch’ as advocated by McCann & McKenna (1993) along with your intuition. A nurse’s intuition is not a new concept and studies have been carried out since 1978, (Gerrity 1987) however it is a skill widely associated with experience (Hams 2000). Intuition has been acknowledged by clinicians and scholars as a vital component of clinical judgment and decision making (Rew 2007). Mr. T responded well to this approach of communication. Carl Rogers (1961), another humanistic psychologist developed the theory Core conditions which is the basic attitudes that councillors should display in order to show acceptance of the client and valuing them as a human being, and include Congruence, empathy and respect. Like Rutledge’s (2011)  approach, Rogers (1959) believed everyone needs to feel loved, valued and unconditional regard, to achieve Maslow’s findings that all humans aim to ‘self-actualize’ and fulfill their potential (1961). During the assessment it is essential to communicate effectively, minimise barriers such as using medical terminology in discussion as advocated by, Minardi & Riley (2007). Physicians frequently use medical words during consultations leading to ‘jargon’ that is potentially misunderstood thus impairing effective communication (Blackman & Sahebjalal 2014) Good communication skills allow patients and relatives alike to express their concerns and needs, subsequently building trust between them and the healthcare professional, demonstrating a two way circle of communication, identified as the most effective method by Schramm (1954). The Johari Window is a model created by Luft & Ingham (1995) and used by healthcare professionals whilst communicating with patients, that encourages self-awareness and understanding of others, ensuring practitioners are aware of their own beliefs, principles, attitudes and strengths in order to help their patients. There are some barriers to providing effective communication, as the ED is a very busy loud environment which can hinder effective communication and possibly result in communication overload Woloshynowych et al (2007). However by simply taking a patient or relative away from these areas and into a quiet room, communication barriers can be minimised. Mr. T responded well to the approaches used, and had not spoken of his feelings or depression for a long time. Mr. T explained that he had lived with his mother up to the age of twelve when she passed away following a lifetime of alcohol abuse and that this was the only life he knew. Psychologist Albert Bandura believed children imitate behaviors witnessed as they grow up which was illustrated in the experiment ‘The Bobo Doll’, (McCleod 2007). Since becoming reliant on drugs and alcohol Mr. T’s mental state had significantly deteriorated thus exacerbating his addiction and leading to unemployment and subsequently homelessness. Due to the fact Mr. T was disengaged from services and had no family support he was feeling  increasingly isolated and unloved thus amplifying Rogers. C (1961) theory OF â€Å"Core Conditions† however Mr. T was reluctant to change. DiClemente & Prochaska (1998) developed the â€Å"Transtheoretical Model of Change† which is primarily associated with addiction and the willingness to change. The five stages of this are; 1. Precontemplation – Unwillingness to change 2. Contemplation – Consideration of change 3. Preparation – Commitment to change 4. Action – modification of behaviour takes place 5. Maintenance – lifelong avoidance of relapse Mr. T was currently at the precontemplation phase and unwilling to make changes to his current circumstances. Due to increasing pressure from NHS targets, Emergency practitioners have a very limited amount of time to address such varied and extensive issues due to all patients needing to be transferred or discharged within four hours of arrival. As strong advocates of holistic practice the department strives to ensure all patients are treated holistically and provided with the relevant knowledge and support required to address and manage their problems. Mr. T was referred to the mental health team for further assessment of his psychological needs assisted with housing, and referred to the Alcohol and Drug Misuse Team in order to address his addictions. These services work in both the interests of staff and patients providing support to patients with complex alcohol and drug dependence in order to reduce the number of attendances to the ED and help to reduce care costs. The home office published data relating to alcoholism which showed the cost to the NHS is in excess of  £3.5 billion annually (Government’s Alcohol Strategy 2012). Layard (2005) concurs with these statistics stating that ‘Mental Health’ is our biggest social problem. In conclusion a Holistic approach to care considers the physical, emotional, social, economic and spiritual needs of a patient taking in to account a person as a whole not only treating the physical and medical needs of a patient. It is evident that treating patients as a whole and not the presenting complaint alone is key to providing effective healthcare for the patient and can result in fewer admissions and reduce pressure on resources. The evidence provided in this assignment has shown that the emergency  department uses all resources available, working as a multi-disciplinary team to assess and treat patients with complex mental health needs and drug and alcohol dependencies fairly without passing judgement. Effective communication plays a vital part in effective treatment of a patient although there is potential for communication to be hindered. The communicative approaches used proved favourable with Mr. T and enabled the practitioner to gain the relevant information required. The psychological approaches used with Mr. T proved effective and by treating Mr. T in a holistic manner contributed to the effective management of his care. Based on the research and evidence published holistic care significantly improves patient outcomes leading to greater patient satisfaction and contribute to reducing healthcare costs which will subsequently assist in providing a longer sustainable national health service.

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UNIVERSITY OF CAMBRIDGE INTERNATIONAL EXAMINATIONS GCE Advanced Subsidiary and Advanced Level MARK SCHEME for the November 2005 question paper 9708 ECONOMICS 9708/04 Paper 4, maximum raw mark 70 This mark scheme is published as an aid to teachers and students, to indicate the requirements of the examination. It shows the basis on which Examiners were initially instructed to award marks. It does not indicate the details of the discussions that took place at an Examiners’ meeting before marking began. Any substantial changes to the mark scheme that arose from these discussions will be recorded in the published Report on the Examination. All Examiners are instructed that alternative correct answers and unexpected approaches in candidates’ scripts must be given marks that fairly reflect the relevant knowledge and skills demonstrated. Mark schemes must be read in conjunction with the question papers and the Report on the Examination. The minimum marks in these components needed for various grades were previously published with these mark schemes, but are now instead included in the Report on the Examination for this session. †¢ CIE will not enter into discussion or correspondence in connection with these mark schemes. CIE is publishing the mark schemes for the November 2005 question papers for most IGCSE and GCE Advanced Level and Advanced Subsidiary Level syllabuses and some Ordinary Level syllabuses. Page 1 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 Section A 1 (a) What evidence is there in the article that the UK mobile phone companies operate in an imperfect market structure? Only four companies, can fix price, have product differentiation in the handsets, no perfect knowledge. (b) Explain the statement ‘one result will be that cross-subsidisation will disappear and the price of a new handset will go up considerably. Explanation of meaning of subsidising one product or service by the profits on another which itself may be overpriced. The removal of the subsidy will result in the price of the subsidised product increasing if profit levels are to be maintained. Often the subsidised product makes a loss but is produced because it is supplementary to other profit making products or services. (c) The article says the decision of the High Court will cost the companies ? 1. 5 billion to ? 2 billion. Explain how the phone companies might react in order to retain their profit levels. Could try to reduce labour costs, implement some redundancies, could stop research and development, could generally try to reduce costs or could try to increase revenue by promoting products through advertising. (d) Explain with the aid of a diagram how the existence of termination charges would affect consumer surplus. Termination charges are placed above the market level. Diagram should show a price above market clearing which will result in reduction in consumer surplus. 1 mark for D/S diagram correctly labelled; 1 for showing the reduced area of consumer surplus; 1 for explanation. e) Does the information lead you to agree with the spokesperson when he said that consumers should not necessarily regard the decision as a good thing? In consumers’ interest: they would save ? 700 but over next three years, price reduction would be on all calls. Against consumers’ interest: cost of telephone handset would rise; there is a fear of increased calls for text messages; possib ility of phone company finding some other way to keep profits high. [6] [4] [4] [3] [4]  © University of Cambridge International Examinations 2005 Page 2 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 General comments for Section B The essay questions carry a maximum mark of 25. Try not to ‘bunch' marks, but use the whole mark range. If there is any doubt in your mind, give the benefit of doubt to the candidate. The difference in grades should be assessed on the ability of the candidate to demonstrate the various objectives of the examination listed in the syllabus and not purely on the ability to itemise further facts from the content of the syllabus. Marks should be awarded for the ability to demonstrate that aim (b) of the syllabus has been achieved as well as aim (a) – which refers to content knowledge. It is the objective of the examination, as listed in the syllabus, to assess both these aims. An overall guide for marks for individual questions is given below; these are from a total of 25. They may be applied proportionally of course to parts of questions where the total is less than 25: Mark 1 – 9 (Linked to level one in individual question notes). 1-5 where the answer is mostly irrelevant and only contains a few valid points made incidentally in an irrelevant context. There will also be substantial omissions of analysis. here the answer shows some knowledge but does not indicate that the meaning of the question has been properly grasped. Basic errors of theory or an inadequate development of analysis may be evident. 6–9 Mark 10 – 13 (Linked to level two in individual question notes). 10 –11 where there is evidence of an ability to identify facts or some ability at graphs and/or a fair ability to apply known laws to new situations. There should be an a ccurate although undeveloped explanation of the facts relating to the question together with an explanation of the theory, and evidence of some bility to discriminate and form elementary judgements. Do not expect a clear logical presentation. There will not be much evidence of the ability to recognise unstated assumptions, nor to examine the implications of a hypothesis, nor of the ability to organise ideas into a new unity. 12 – 13 where the answer has a more thorough relevance to the question but where the theory is incompletely explained.  © University of Cambridge International Examinations 2005 Page 3 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 14 – 17 (Linked to level 3 in individual question notes). 4 –15 where there is a good knowledge of the facts and theory of the question, clear evidence of the ability to use the facts and theory with accurate reference to the question that may have presented the candidate with a novel ap plication. There should also be evidence, where appropriate, of the ability to examine the implications of the question and an attempt to distinguish between facts and value judgements. Clear statements, supported by reasoned arguments should be given and there should be some attempt at a conclusion to the question. There should be a reasoned structure to the whole answer. Do not expect too many extra Illustrative points which are not explicitly referred to in the question, do not expect too much critical comment on unstated assumptions 16 – 17 for an answer showing a well reasoned understanding of the question's requirements and of the relevant theory: the analysis should be sound though the illustration and development may not be very full. 18 – 25 (Linked to level 4 in individual question notes). 18 –20 where there is a thorough knowledge of the facts and theory with an excellent ability to describe, explain or analyse this in a precise, logical, reasoned manner. There should be an ability to query some of the assumptions in the question and clear evidence of an ability to distinguish between fact and value judgements and to draw some conclusions on the matter being discussed. Conclusions should be formed and expressed within a sound structured answer so that the whole is well presented. New illustrations and apposite examples should be introduced as further evidence of an ability to recognise the principles of the question and their application to relevant current situations. 1 – 25 for an answer which, given the time constraint, could not be improved significantly: it will have clear analysis, ample illustration and a good attempt at considered evaluation. Be positive in your marking, awarding marks for what is there without being too much influenced by omissions. Marks should not be deleted for inaccuracies. Corresponding marks for sub-sections. Total Mark 10 Total Mark 12 Total Mark 13 Total Mark 15 1 1-3 1-4 1-4+ 1-5 2 4-5 5-6 5-6 + 6-8 3 6-7 7-8 7-8+ 9-11 4 8-10 9-12 9-13 12-15  © University of Cambridge International Examinations 2005 Page 4 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 Section B 2 (a) Explain what is meant by efficient resource allocation in a free market. L4 L3 L2 L1 (b) For a sound explanation with clear understanding of the principles involved in the analysis. [8 – 10] For a competent explanation but with limited development of the analysis. [6 – 7] For a correct explanation of a free market but undeveloped explanation of allocative efficiency. [4 – 5] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. 1 – 3] [10] Would you agree that in some circumstances it is best to accept the decision such as that of the French government and abandon the search for economic efficiency through the free market? [15] Discussion of the reason for market failure. Monopolies, merit goods, public goods. Consideration of whether this might apply in the case of the large engineeri ng company. L4 L3 L2 L1 For a reasoned discussion of causes of market failure and clearly structured answer. [12 – 15]. For a fair explanation of market failure but lack of development and reasoned conclusion. 9 – 11] For a limited but acceptable attempt to consider some market failures. [6 – 8] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 5] 3 (a) Explain how trade unions can be incorporated into the economic analysis of wage determination. [12] Candidates are asked to comment on trade unions so the economic theory of wages that they should use is that for an imperfect market. This theory should be explained using marginal revenue productivity. Trade unions can have an effect on the supply curve which is now no longer solely determined by market forces. Where the actual wage will be determined depends upon the relative strengths of the employer and the trade union. L4 L3 L2 L1 For a sound discussion with good explanation of the analysis and a clear understanding of the principles involved. [9 – 12] [7 – 8 D and S approach] For a competent comment but with limited elaboration of the analysis. [7 – 8] [5-6 D and S approach] For a correct explanation of part of the analysis. Candidates might explain either the government or the unions. 5 – 6] [3+ – 4 D and S approach] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 4] [1 –3 D and S approach]  © University of Cambridge International Examinations 2005 Page 5 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 (b) Discuss the possible effects that trade unions might have on the economy of a country. [13] Trade unions could affect the supply of labour and working practices. They could cause production to decrease with consequent downward effects on income, spending and national income. Candidates could explain this using the multiplier concept. Union could, however, through negotiation prevent disruption of production, or could monitor the implementation of safety procedures which might involve extra spending by the employer. This might well have an upward effect on national income. L4 L3 L2 L1 For a reasoned and clear explanation with accurate development of theory contrasting possible outcomes. [9 – 13] For a clear but undeveloped explanation which concentrates on change of income in one direction only. 7 – 8] For a limited attempt to consider the theory and with a greater concentration on the descriptive elements. [5 – 6] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis are substantial. [1 – 4] 4 (a) With the help of diagrams distinguish between normal profit and abnormal profit. [10] Diagrams to show normal and abnormal profit with accompanying explanation of the c urves used in the diagram. Candidates can distinguish between perfect and imperfect markets. L4 L3 L2 L1 For a sound explanation, good diagrams correctly labelled, with clear understanding of the principles involved in the analysis. [8 – 10] For a competent explanation but with limited development of the analysis. Diagrams clear but not fully labelled. [6 – 7] For a correct explanation of terms but some poor diagrams. [4 – 5] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 3] (b) Discuss whether firms always want to maximise profits and are able to do so in the way suggested by economic theory. 15] Discussion of the theory of profit maximisation. Candidates should consider not only whether it is possible to calculate marginal revenue and marginal cost to achieve profit maximisation but also whether the firm might have alternative aims. Sales maximisation, behavioural, managerial, satisficing, market share aims might be mentioned. L4 L3 L2 L1 For a reas oned discussion and clearly structured answer. [12 – 15] For a fair discussion but undeveloped answer mentioning either only one part of the question or both parts but only scant mention of alternative aims. 9 – 11] For a limited but acceptable attempt to consider the question with very limited development of either part. [6 – 8] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 5]  © University of Cambridge International Examinations 2005 Page 6 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 5 How far do you agree that low interest rates and low inflation are the most important aims of government policy in maximising economic welfare? 25] Discussion of the general macro aims of government policy with a comment on whether the two mentioned should be regarded as the most crucial. The effect of low interest rates and low inflation and po ssible links between them can be developed. Reasons should be given for either choosing or not choosing these aims as the most important. L4 L3 L2 L1 For a thorough explanation of the aims, a clear analysis of the link between them, a discussion of the possible outcome of a choosing either those aims or alternatives with a reasoned conclusion. 18 – 25] For a competent explanation of the aims but where there is only limited attempt to consider the significance of the importance of the aims. There will be some discussion but the evaluation will not be fully developed or extensive. [14 – 17] For an accurate though undeveloped explanation with some attempt at analysis but only limited evaluation. [10 – 13] For an answer which shows some knowledge but does not indicate that the question has been fully grasped. The answer will have some correct facts but include irrelevancies. Errors of theory or omissions of analysis will be substantial. 1 – 9] 6 With the appr oval of the Malaysian government, the Swedish company IKEA, the world’s largest retailer of home furnishings, has invested $106 million in Malaysia in the past three years. It plans to open another large store in the country, employing 450 people with expected sales of approximately $50 million in the first year. (Herald Tribune Aug 15 03 p 12) (a) Use the multiplier analysis to explain what effect this investment might have on the Malaysian national income. [10] Discussion of the effect of increasing investment in terms of employment, income, spending, saving. Multiplier analysis. Usually this question is asked with reference to government spending and investment but this is a large investment and it also will have multiplier effects. L4 L3 L2 L1 For a sound explanation of the analysis and a clear understanding of the principles involved. [8 – 10] For a competent comment but with limited elaboration of the analysis. [6 – 7] For a correct explanation of part of the analysis. Candidates might explain how investment might increase income but might not deal with further increases in as they do not discuss what leakages occur at each ‘round’. 4 – 5] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 3]  © University of Cambridge International Examinations 2005 Page 7 Mark Scheme GCE AS/A LEVEL – NOVEMBER 2005 Syllabus 9708 Paper 4 (b) Discuss whether the activities of multi-national companies are always beneficial. Candidates should discuss the effects of large companies. They could consider whether a large company is beneficial for the shareholders, the workforce and the consumer. These groups may be in different countries. They should comment on the effect in host country where wages/incomes/employment might increase and on the possible benefits for directors (and shareholders) who may be in the home country. The multi-national might have chosen to operate in the host country because of reduced costs or cheaper inputs so a comment on the possible benefits of comparative advantage would be pertinent. L4 L3 L2 L1 For a sound discussion with good explanation of the analysis and a clear understanding of the principles involved. Reasoned evaluative comments should be given. 12 – 15] For a competent comment but with only limited evaluation of the effects. [9 – 11] For a correct discussion of the analysis but with only very brief, or no evaluation. [6 – 8] For an answer which has some basic correct facts but includes irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 5] [15] 7 ‘There are so many difficulties in measuring living standards that w e can never be sure that people in one country are better off than those in another country. ’ Comment upon this statement. [25] Candidates should consider each part of the statement. They should discuss whether there are many difficulties in measuring living standards and give reasons for their conclusion on this part of the question. They should then consider whether it is possible to compare one country with another and discuss what use national income statistics might be. They should form an overall conclusion. L4 L3 L2 L1 For a thorough explanation of the difficulties of measuring living standards, and a clear conclusion to the assertion followed by a consideration of the usefulness of using the statistics to make comparisons. [18 – 25] For a competent explanation of the difficulties but with a limited conclusion. There will be some consideration of comparison between countries but this will not be fully developed or extensive. [14 – 17] For an accurate though undeveloped explanation with some attempt at analysis but only limited evaluation. The conclusion will be weak. [10 – 13] For an answer which shows some knowledge but does not indicate that the question has been fully grasped. The answer will have some correct facts but include irrelevancies. Errors of theory or omissions of analysis will be substantial. [1 – 9]  © University of Cambridge International Examinations 2005

orld Trade Organization Essay

On November 30, 1999, major governments met at a World Trade Organization (WTO), ministerial meeting at the Washington State Convention and Trade Center in Seattle, Washington. During this meeting an enormous public protest took place in the streets of Seattle. The protestors were representing human rights groups, students, environmental groups, religious leaders, labor rights activists and members of numerous other groups. The groups were not only from the United States, but had come from all over the world. All of these people were peacefully protesting the practices of the WTO in the name of free trade. The protestors stated that the WTO upheld trade practices that allowed child labor, low wages and environmental destruction. The WTO justified these practices in the name of free trade. Tens of thousands of people were in Seattle to protest peacefully, and the protests did start peacefully, but they did not end that way. A small number of anarchist groups were in Seattle to cause civil disobedience and acts of vandalism and property damage. These groups conducted deliberate acts of vandalism on corporate offices in Seattle. The Seattle Police Department did not have the number of officers, even with help from other departments, to handle the number of protestors. The officers used pepper spray, tear gas, stun grenades and eventually rubber bullets to try to unblock congested city streets. Some of the anarchists fought back by breaking windows and vandalizing storefronts. Dumpsters were pushed out into intersections and they were lit on fire and tires on police cars were deflated. The National Guard was finally called in, but did not get to Seattle until the next morning. Once the WTO packed up and went home, the protestors packed up and went on their way. When the meeting finished, businesses had suffered millions of dollars in damage and lost sales, over 500 people were arrested. No deaths were attributed to the protest and no one was seriously injured. There was controversy over city response and the Seattle police chief resigned. The anarchist protestors felt the protest was a success. Before the Seattle Protest, there was almost no mention of anti-globalization in the U. S. media but the protest had forced the media to report on why anyone would oppose the WTO. Good or bad, the message of the protestors was broadcast to the world.

Legal Assignment for Architecture Case Study Example | Topics and Well Written Essays - 1500 words

Legal Assignment for Architecture - Case Study Example A covenant is an agreement written under seal commonly used with reference to sales or leases of land. Covenants are privately negotiated and agreed not necessarily obligating both parties involved, but a promise to perform or give something to the other party. The legal document is part of the deed of ownership and represents a binding contract between two parties: the covenantor (the person bound to perform the promise or stipulation) and the covenantee (the person on whose favour it is made). In this instance, Robert is the covenantor, one doing the favour, and John is the covenantee, for whom the favour is intended. Favour at this instance is the retaining wall in Robert's property. Covenants are subdivided into numerous classes. Restrictive covenant is a covenant which restricts the use of land, which is binding not only upon the current owner, but also upon the future owners of the land. A covenant real runs with the land and descends to the heir and is also transferred to a purchaser. If the original owner of Robert's land covenanted to maintain the wall, then the nature of the covenant is a restrictive covenant. Robert is obliged by the restrictive covenant to maintain the retaining wall that already exists. Trying to get a covenant enforced is risky and can be expensive and time consuming. If a covenant is breached, John should check if enforcement is possible by going through the courts. He would need to prove if his rights are affected. If Robert fails to maintain the retaining wall on his property and risks to damage or cause detriment to John's property, John must show that the disrepair of the retaining wall amounts to liability on Robert's part. 2. Does John have a right of support from the wall What is the nature and effect of such a right John has a right of lateral support from the wall. Since John's property or soil had not been altered and it was in its natural state, thereby allowing for the right of lateral support. Lateral support is the right of a landowner expected from the neighbouring property against any slippage, cave-in, landslide, flood, etc. In the case of the two owners, in addition to separating lands, the retaining wall serves to retain the earth. Although John's land is at a much lower level than Robert's, he still has the right of lateral support since the right signifies maintaining the land in its natural position. Since Robert owns the retaining wall, it is his obligation to maintain the wall to prevent soil from slippage upon the adjoining property and that the damage or impending damage is due to the natural state of his property, at this instance, the growing roots of a tree in his property. This impending damage on another's natural state of property requires Robert to give due John's right of lateral support. In this instance where John's property is in danger of land slippage from Robert's property due to a caving or damaged retaining wall that has been covenanted by Robert, caused by the growing trees in Robert's property, John may seek lateral support. 3. Can the tree be chopped down if it is subject to a tree preservation order John needs to request from

Communication Tool and Report Essay Example | Topics and Well Written Essays - 500 words

Communication Tool and Report - Essay Example I chose to create the communication message board because patients who cannot talk often find it very difficult to be understood. The nursing staffs often find it challenging to understand what the patients who cannot talk really want. Therefore, the communication message board â€Å"talk† for the people who cannot talk (b-independent, 2014). This method of communication is relevant to the nursing field because communication with the patients is a vital component of the profession. The nurse and patient can create mutual understanding through communication. However, some people may not verbally communicate due to illnesses like stroke, neurodegenerative diseases or tubes inserted in their throats to clear passageways. These people can still communicate using non verbal communication such as communication boards. The communication tool designed is accessible inwards particularly those comprised of people who are experiencing difficulties in talking. The nurse on duty can easily get it from a specific position within the ward. This communication tool is necessary because it helps to make the job of the nurse quite easy as well as to help the patient who cannot talk express themselves. Signs are very important in such a scenario since the nurse and the patients can be in a position to mutually understand each other. The nurse can be in a position to understand the needs of the patients which helps to reduce negative impacts such as frustration on their behalf when dealing with restless patients. If I were to re do the task, I think I would try to device an electronic gadget that is comprised of all letters of the alphabet such that the patient can type what he or she wants. Based on the presumption that many people can read and write, I would try to create a device that makes it possible for the patients to create sentences about what they may require at a particular time. The advantage of this is related to precision. The

The Economics of the Just Price Essay Example | Topics and Well Written Essays - 250 words

The Economics of the Just Price - Essay Example The aspect of determining price fairness has raised questions since the concept was conceived and has been an element of discussion. An economic solution was developed to determine the constituents of fair prices in accordance to some conditions that must be satisfied. These factors are the clear definition of production factors. The presence of perfect competition within the market and the absence of market failures as a result of economies of scale. When these parameters are considered the prices of commodities with only be affected by eh production costs and profits desired; and hence will be fair to both consumer and producer. This determination of the conditions that define fair prices has aided in the understanding of the elements that can be used to determine a fair price. In the ancient times, there were various factors that caused difficulties in determining a fair price and they were summed by the element of capitalism which was characterised by a lack of proper prices for labour, widespread aversion to payment of loans, and failure to incorporate interest payments into production costs.

Business management Essay Example | Topics and Well Written Essays - 4000 words

Business management - Essay Example China is one country which escaped from the current global financial crisis without much damage. As per economic gurus, China’s economy will surpass that of the US’s within 20 years of time. Earlier, China was reluctant in opening their economy, but at present their economy is more transparent than even Japan’s economy. Moreover, China’s trade in 2004 was equal to 70% of its GDP, while that of Japan was 24%. China received $60.6 billion of foreign direct investment in 2004, while Japan, received only $20.1 billion (Overholt, 2005, p.5). China has adopted an economic policy in which they were ready to open the unimportant sectors for the FDI whereas the critical sectors were kept under government control only. They have encouraged privatization in many small scale industries and less important industry sectors and that also in bulk. Xinhua, Chinese daily, has quoted the opinion of the World Bank chief economist, Deepak Bhattasalithe recently. He has told to the Chinese daily that, not only the Chinese Governments effective policies on taxation, but its long-term investment in infrastructure construction also contributed to a more pleasant investment climate (Xinhua, 2004). There is no second opinion about the immense economic developments happening in China. Economic growth of a nation is controlled by many parameters like, political stability, lack of agitations in the society or industrial sectors and also the country’s ability to mobilize the internal resources along with attracting foreign direct investments (FDI) in the country. The people’s living standards, unemployment problems, educational levels, infrastructure developments, overall domestic peace levels and also the relationships with the neighboring countries, all will reflect the economic growth of a nation. China has all the above qualities and hence corporate can think about investing in China. China is the number one country in the world as

Remote Sensing Assignment Example | Topics and Well Written Essays - 250 words

Remote Sensing - Assignment Example The assignment "Remote Sensing" talks about the topography maps and what colours are used to describe different areas on this kind of maps. The bright color of the area A on a map shows an area on the earth surface without vegetative cover. Featured area A is possibly a snow-capped area in the landscape. Featured area A may also represent a well that has liquids such as natural gas or body of water. The feature A is visible around mountain areas in a streaming shape that shows the flow in the direction towards low altitude areas. Featured area A reflects light to produce a different color from the area B and C. Assuming Landsat scale resolution of 1800 by 1200, the length of the feature at A is 3 miles. The Bright dots beside B show areas of that do not have vegetation cover. Exposed areas appear brown in the satellite image compared to areas at B that have vegetation cover. Although the bright spots do not appear very similar to feature A, they depict relations. Bright dots are a small representation of feature A. The white color suggests C is an area at the mountaintop; the bright color is because of sunlight reflection. The area at the tip of the mountain has no vegetation. The region consists of bare rocks that reflect back sunlight. The topography of the area is mountainous the altitude rises towards C with region C suggestively mountain top with no vegetation characterized by the bright colors. Towards regions A and B, the altitude falls with regions B representing a flat base of the low altitude region.

Industrial Revolution in Britain Essay Example | Topics and Well Written Essays - 3000 words

Industrial Revolution in Britain - Essay Example England, having a profuse supply of laborers to mine coal and iron, meaning a good supply of industrial fuel, possessing colonies that serve as her sources of raw materials and as her markets, achieved a head start over its European equals in the phenomenon of Industrial Revolution. Most importantly, England's isolation kept her from wars bombarding other European countries, and allowed her to continue industrializing without disruption (Rempel). Industrial Revolution induced the widespread use of machineries for manufacturing. England went through the phenomenon beginning in18th Century. Soon, more things could be done quicker and labor costs became cheaper. The process changed England from an agrarian, handicraft economy into a machine-dominated manufacturing industry. This bought for England greater economic potentialities and urbanization. Urbanization as an effect of industrializing made England evidenced an increase in population, as well as the emergence of several new social classes (Rempel). An advent of factories in places where palpable resources of coal and other essential materials could be found was set up in the process of rapid industrializing and urbanizing. Concentration of work forces in these locations was then called for. Eventually, these areas were developed to great cities with established political centers. The problem was that these so called "factory" and "mining" towns became so crowded and swamped that no good living conditions were experienced. Sanitary provisions are found lacking, and diseases spread across these swamped areas. "The dreadful living conditions in these new towns can be attributed to lack of good bricks, absences of building codes, and the lack of machinery for public sanitation. Yet the more tenable cause was the fact that factory owners offered little regard to the laborers as they treat them as commodities and not as actually human beings with important needs" (Rempel). These towns then sprouted new categories of British social classes. Factory owners became the new bourgeoisie and the men, women and children became categorized as the new working class. The more alarming incident here was that women and child labor emerged prominently in this period. Yet, more and more people moved to these cities in search of the higher profits that was seem guaranteed in working for these industries. Unfortunately, the industry workers were not to become well-off despite having jobs. This is so because they play second fiddle to the sophisticated machines, and were often degraded to routine process laborers, working long hours yet receiving low compensations under quite inauspicious conditions (Rempel). Longer hours meant reduced leisure time even though their material consumption did not increased. It was apparent that the workers become concentrated on factories and mines, and less on agriculture, where half of the population was in a century earlier. Employment in agriculture as a percentage of the population declined rapidly. By 1850, only one in four British could be said to be working the land and as had been said, employment growth at this point in time took place mostly in traditional manufacturing service industries (Voth, 2003). Therefore, wage increases that would have been expected from

Gender studies and sex Essay Example | Topics and Well Written Essays - 500 words

Gender studies and sex - Essay Example Homophobia defines this situation as the ability to be unmasked and be rendered unworthy to be a real man in front of other men. Fear is also one way of identifying a real man. If you are so shameful and fearful, you may not be identified as a real man. Homophobia is almost interwoven with sexism and racism. The fear of being identified as homosexual has proved to control mens behaviors. Homosexuality was not in the American norm thus rendering them unmanly. So men tend to avoid women especially in public to avoid others from judging them. Slaves for example, were identified as dependable men thus unable to defend their women and children. Native American were also believed not to be real men. Manhood is equal to power. This is seen in various jobs in the government. Men have more jobs than women. In various institutions, men have it all. So the feminine have been left powerless. Women in various instances are complaining publicly. They have been rendered powerless by men. It seems men have really framed it wrongly since life expectancy has been lower in men than women. Males have higher mortality than females. This could be based on their psychological, social and behavioral factors. Behavioral factors include, smoking, excessive consumption of alcohol, poor diet and risk taking. There are a number of causes leading to improper health options for men. It is believed that true masculinity can be seen through mens body and therefore it could be based on provision of health. Biological determinism sees the gender distinctions as biologically based thus natural, unavoidable and unchangeable; it therefore perpetuates males power. Mans power is well enhanced and privileged through artificial understanding of masculinity and power. Traditionally, various traits of masculinity is evident and are seen to be correct and natural that men find supremacy as a demand. Hegemonic masculinity is replicated through

Philosophy Essay Example | Topics and Well Written Essays - 500 words - 3

Philosophy - Essay Example I would ask journalists to interview me. I would begin organizing a protest movement. We would begin to apply pressure on the decision-makers. If no results were forthcoming, I would take more drastic, and perhaps illegal, action. I would blockade government buildings. I would try to shut down the government through peaceful means as protestors recently tried to do in Wisconsin. I would help lead the students on a strike march to Sacramento. Throughout this whole process I would feel justified to take these actions because I would see the government's policies as illegitimate and undemocratic. The only response to those kind of policies is to protest and cause maximum disruption. Part 2 Socrates makes a number of very intelligent points to Euthyphro. In my situation, I have said that the policies of the government are not just. This injustice is what motivates me to take actions against the government. I have a definition of justice in this context which would be something like this: in a financial crisis, the burden of cuts should be shared somewhat equally across society; it is unfair to pass all of the costs on to students who have very little money to begin with. I understand that not everyone would agree with this idea.

The Stages of Development That Led to the Final Form of the Five Books of the Pentateuch Essay Example for Free

The Stages of Development That Led to the Final Form of the Five Books of the Pentateuch Essay The ‘Documentary Hypothesis’ states that the Pentateuch is a series of parallel narrative documents that have been composed and edited together by various people over different centuries in time. Some scholars believe that the composition of the Pentateuch was complex with numerous changes and later additions. The stages of development that led to the final form of the five books of the Pentateuch , i. e. the oral, written and editing stages, was interpreted by various people over a period of centuries. Prior to any written documentation, it is assumed that stories and traditions would have been retold orally. Even during the time from Abraham onwards (1750 B. C. E) when writing was in existence, it was only used by professionals in the service of rulers and temples, as the majority of the population could not read or write. This meant the stories of the Hebrews were still relayed orally through stories, poems and songs. This gave rise to embellishment and certain inaccuracies as the stories passed from one person to another and between generations. Many of the stories were told as a means of entertainment to larger gatherings and by parents to children. Over a long period of time these oral stories or traditions were brought together as collections and, in time, became the source for written material. The Pentateuch was probably contributed to by four sources commencing in the latter half of the tenth century B. C. E. They were the Yahwistic source (J), in the ninth century Elohistic source (E), the seventh century B.  C. E Deuteronomist source (D), and the Priestly source (P) in the late sixth century B. C. E. As is evident, bringing the oral traditions into a written form was a complex and lengthy process spanning several centuries and calling upon different traditions, stories, narratives and laws, each with their own particular perspectives. Nevertheless, they did eventually all come together to form the Pentateuch which would have been edited by redactors in several stages over time. Given the lengthy process in reducing the oral traditions to written form, it is clear that there were various versions of stories which underwent continued augmentation or shortening. The process was therefore far from scientific thus giving rise to a significant amount of poetic license on the part of the editor. This led to inconsistencies and contradictions. It was indeed not until the Hebrew Bible was canonised in the first century A. D that a select version of each book was formally adopted and standardised.

Overview: Working with Pediatric Patients

Overview: Working with Pediatric Patients OBJECTIVES The main purpose in learning how to work with pediatric patients is to have a clear idea of the potential challenges a medical assistant may encounter when dealing with this patient population. There are many topics to cover, including but not limited to: Understanding correctly the language used within the different pediatric age groups, learning how to effectively communicate with toddlers, adolescents and parents along with finding best practices to proper document basic and vital pediatric information like: height, weight, circumference measurements, pulse, respiratory rates, blood type screening, as well as body motor developing, sensory and language milestones throughout the patient growth. Other important skills to learn are immunization guidelines along with the proper time in which vaccinations have to be administered. At the same time, describing appropriately and effectively different signs and changes during puberty, including secondary sex characteristics. Last, but no least, providing parents with education guidelines for safety along with discussing social issues that are affecting our youth’ health today. Pediatric age classifications and proper communication Although often we may perceive the word â€Å"pediatric† as babies or toddlers, this conception is wrong. In reality, when we refer to pediatric we are covering from new born through 18 years of age. The medical assistant must be knowledgeable in all stages and must be able to handle the challenges these bring forth. The following terms are critical to understand and it is imperative to learn how they are related to one another in communication skills, patient/parents education and documentation. The age ranges are classified as follows: Newborn.- It is the initial period following birth Neonate.- It is the first month of life Infant.- It is the first year of life Toddler.- From the first year of life to preschool age Child.- It often starts with school attendance into the middle childhood Adolescent.- Puberty starts here, reproduction is possible and development of secondary sex characteristics It is highly recommended to practice appropriate communication based in the patient’s age and the patient’s family. Speaking down to or over the head of an individual often creates barriers in the patient responses. It is very important to speak the language that both, the patient and his/her parents understand. When talking to a parent is vital to remain professional and call by their name, in the other hand, when talking with small children who often have not developed verbal interactions, it may be appropriate to communicate through expressions or motions. When speaking with older children or adolescent, communication barriers may come up. Never assume a meaning or intention. Always attempt to clarify what a patient is communicating; it is valid to consider that the patient may be testing the caregiver’s reactions to words or phrases. Communication, if appropriately used, can be a major tool for great evaluations and examinations. It can increase the patient confidence to the healthcare provider and as result; enable high quality health care to the patient. Infant/Toddler Measurements Infants and toddlers grow at an impressive velocity, therefore accurate and consistent measurements are highly necessary to evaluate normal or abnormal development patterns. This practice is helpful in identifying any potential health issues in which early detection will be the key to prompt prevention procedures Height and weight measurements in children at young age can be a clear indicator of potential health issues. Therefore, the medical assistant must be proficient in obtaining and recording this vital information. Being accurate is essential, especially during the early years. Indicators of questionable health may be determined based not only on initial size, but on growth pattern or trends. The National Center for Health Statistics provides charts for height, weight and head circumference. These charts use percentiles, which compare the child’s measurements with an average range of growth for children in the United States. Many factors come to play when assessing measures, one of them is familial stature, gestational age at birth, and chronic disease. When measuring the height of an infant is recommended to get another person to help, when possible, children under 2 years of age are measured in a horizontal position with the body fully extended, although a â€Å"caliper† (an instrument used to measure the distance between two points) is used by most practitioners, some clinics still use a tape measure to complete this task. Children with two years of age or more can be measured while standing. This procedure should be done by removing the patient’s shoes and having the patient’s heels, back and head in the same plane, it is a good practice having the patient standing against the wall. The same can be obtained with the use of an upright physician’s scale. Weight measurement gives another way of asses the pediatric patient’s growth and development, as with height, accurate measurement documentation is used based in the statistics chart provided by the NCHS (National Center of Health Statistics). Young infants are weighed directly on an infant scale, ideally they should be weighed naked or in a diaper. Any item on the scale, aside of the child should be considered to add or subtract when taking measurements. As children get older, techniques must adapted to the patient’s comfort, young children can be weighed in their underwear and using a standing scale. As they go into school age, a gown can be worn for more comfortable and accurate evaluation. The weight of the gowns and/or underwear do not have to determine at this age because of the constant fluctuation of ounces in these children would not be significant as they would for an infant. In the other hand, the use of accurate equipment is much more important and vital. Head circumference and chest circumference is another source of health evaluation. Knowing the traceability of the cranium and the brain is critical in the kid’s health. Abnormally large or small head size must be monitored. Patient’s may encounter macrocephaly which is an abnormally growth of the head circumference larger than 97th. Percentile. Before jumping to conclusions, familial or generic trends need to be considered. In the other hand, microcephaly, the abnormally small head may also indicate a pathologic condition, such as chromosomal disorder. When the head is measured, it is important to always measure the same area at all times; it is recommended to it just above the eyebrows. The information can document in either inches or centimeters according to office protocol. The chest measurement may or may not be done due to various locations being measured. This procedure is an additional calculation that is used to identify low birth weights in preterm babies and may also be used when there is a suspicion of lung or heart disease Pediatric Vital Signs Obtaining vital signs can be challenging at times, bold pressures are usually not taken until the age of two. Cuffs are used to measure blood pressure and they come in a variety of size and themes to make this task as pleasant as possible for the patient, although the use of new or unfamiliar equipment is often traumatic for a young child, many offices acquire equipment that is appealing to children. A good practice is to allow the child to safely touch and test the sphygmomanometer and stethoscope as well as mock with either a doll, stuffed animal or to a parent. The pulse in the young child varies with age and growth. The young infant or toddler may be very active, thereby increase the pulse rate. The primary location for measuring pulse in infants and young children are different than the location in adults. The radial artery is normally used to check on older kids and adults, at the same time, for infants and young children, the femoral or brachial arteries are the choices for patients of this age group. Another way of measuring pulse is through auscultation which is listening to the heart with stethoscope Respirations in the infant and toddler can be measured with the pulse. The rates will vary, depending on the level of activity or illness. Let’s keep in mind that a fever can elevate the respiratory and pulse rates. Obtaining an accurate body temperature is another skill that is essential for medical assistant. Fevers are very common in pediatric patients and they are more frequent compare to adults. There various methods to measure body temperature. In children and adolescents, auditory or aural readings are quick and relatively comfortable. Infants with two months of age or less are best evaluated with a temporal thermometer. Another option is obtaining rectal temperature reading. Pediatrics measurements and vital signs are key evaluation tools for identification of any potential disorders Pediatric Development Aside of the measurements discussed earlier, other areas of growth and development include motor, sensory and language development. There are different milestones that indicate acceptable growth and development patterns. These milestones are used a guidelines to determine the normal growth in children, especially during the first two years of age, it is important to keep in mind that some children reach these sooner or later compared to others, however this is completely normal. Motor development usually includes three areas of growth: reflexes, gross motor and fine motor skills, Reflexes refer to automatic responses to any stimulation. The following are the most common reflexes: Breathing, sucking, rooting, swimming, grasping and moro. Gross motor skills include motions such as rolling, scooting, crawling and walking. Fine motor skills develop utilizing smaller movements, these include touching, grabbing, poking, pulling, and pinching. Sensory Development are related to vision and hearing senses along with the deep perception and motion assessment. Any single area that exhibits impairments will affect the growth in other areas of development. Visual development involves increasing distances in sight as brain matures. Color perception also develops as the child grows. In the other hand, hearing improves in normal development as the child matures Language Development from infancy forward, the child begins with noises that elicit response. These become words, phrases and finally sentences. The timing in which these occur may be different due to educational and environmental circumstances Visual and Auditory screenings are conducted as way of measurement the sensory development and to avoid potential problems that can be treated and corrected. Prior to school age some visual milestones are evaluated: blinking, fixation on objects, coordination of eye movements, and reaching for objects, shaking ere movements and wandering eyes. Hearing screening in the newborn and infant begins. Lack of hearing is often interpreted as intellectual delay. Clues include responses to loud noises, facial expressions and turning head toward noises. As the child matures, more formal testing of hearing can be completed. Audiometric equipment can be used for this purpose. Vaccinations or immunizations have been recommended by the World Health Organization in a constant effort to prevent the spread identified diseases. History shows that infectious diseases have led to worldwide epidemics and studies show that the infant fatality rate decrease due to the use of vaccinations, UNICEF studies show that these include smallpox, whooping cough, polio, diphtheria, tetanus, HIB, hepatitis B, measles, mumps and rubella Pediatric visits include schedules of specifics vaccinations from the country in which the patient lives. The medical assistant is usually responsible for administration of these vaccinations, either orally, topically, or by injection. It is the job of the medical assistant to educate patient regarding the risks and side effects of each individual vaccine. As well as direct them to websites in which they can learn more about this topic. Documentation of the vaccine given must be through, the type, the lot number, the method of administration, and location of injections is placed in the patient record or immunization log. It is an important job of the medical assistant performing pediatric injections. Proper skills need to be developing for the comfort and safety of the patient to avoid physical or emotional trauma. Most pediatric injections are given intramuscularly. An important part of the medical assistant job is to calm the patient before and after the injection. Blood screenings are done to all infants through their capillaries and they may occur within the first seven days of life. Some blood screening is done if symptoms are present or it the presence of family disease. These could be â€Å"sickle cell anemia†, â€Å"IRT†, â€Å"Hypothyroidism†, â€Å"Homocystinuria†, â€Å"Ketonuria†, â€Å"and Galactosemia†. Circumcision or removal of foreskin of the penis is very common on newborn infants while they are still in the hospital; however there are occasions in which due to unforeseen circumstances this procedure is done in the pediatrics’ office which could turn in complications. Adolescent Care could be very challenging for the medical assistant. This is when the secondary sex characteristics become more obvious. At this age in when youths could show manners of independency and even exploration of new avenues such as drugs, alcohol and other substances. Communication could also be challenging with care giver. The communication could persuade embarrassment and nonprofessional. It is important to remain nonjudgmental and at the same time show empathy and professional company. Adolescent can present hug concerns for their height and weight due the influence of society and media with unrealistic and unhealthy standards, therefore the importance of being sensitive when discussing with young people about normal height and weights Puberty brings sexual changes and reproduction becomes a possibility. During this time estrogen and progesterone hormones are increasing in girls. In the other hand, boys will have the increase in the production of testosterone. Secondary sex characteristics are the visual changes seen when boys and girls as they grow to become adults. These are features that are not necessarily related to reproduction, these are voice changes, breasts, shoulder widening and facial hair. Behavioral and Mental Health Issues such as depression, eating disorders, abuse, suicide are thought to be primarily for adults, however they can also occur in the pediatric patients. The health professional must be aware of these signs and symptom in order to provide diagnosis and treatment to these problems

The sanctity of life

The sanctity of life The Christian response to abortion in our western culture has been a matter of preserving the sanctity of life. Although it would seem to be cut and dry to a Christian that abortion violates that sanctity of life, it continues to face constitutional evolvement, differing worldviews, the scrutiny of the medical profession, and with respect to school text books. All of these concerns illustrate a wayward compass, lacking the ability to find true north. Society continues to weigh the simple yet complex definitions of personhood. Abortion is purported to be morally justified by pro-choice advocates in the postmodern culture. The question of what is right or wrong is argued within both sides of the issue. For instance the religious community cannot reach agreement cites Rothstein and Williams, (1983) what a person consists of or when a person begins life. This paper will contend that the postmodern attitude towards abortion has been characterized as ambivalent, and in a postmodern theistic society which has been exposed to liberal schools of thought changing Christian and family values to err on the side of science and convenience. Further, decision makers on the pro-choice side have used their agenda to further their secular beliefs through education, giving rise to sexual promiscuity. Additionally, there have been declines in moral thresholds, in theological literacy, and in respect for the importance of gender roles, resulting in societys ambivalence and a reduction in regard for the sanctity of life. Disputes over abortion are usually very heated due to the involvement of conflicting world views. Abortion is going to have difficulty attempting to reside within a Christian worldview, based purely on their opposing logic. Furthermore, abortion cannot maintain itself within the worldview of liberal postmodernism. Challengers of abortion are aware they are supporting unborn babies; although they may not be cognizant they are also supporting the Christian worldview. Also supporters of legal abortions identify that they are securing a womans right to choose even though they may not be completely aware of their support to the postmodern worldview. A worldview adds perspective and helps us identify with the world around us, and how we deduce and appraise not only what we see, but how we compare ourselves to our understanding of life. Religion has the ability to hone a persons worldview, which starts to develop and institute a moral awareness which tends to give form and shape our moral perspectives. (Durkheim 1954), Religion serves as a main source for determining right and wrong, good and bad, just and unjust.(p. 43). In order to have a suitable understanding of the postmodern view of abortion, both opposing worldviews must be examined in order to balance our understanding as to why a person in a theistic society embraces a pro-abortion stance. This comparison will also show why there is difficulty in finding a common ground, and why a postmodern worldview conversion or construction is not practical at this point, leading to the rise in secular decision making. Comparative analysis of two opposing worldviews: Man is a created being and has a composition pre-determined by an intelligent and purposeful design, as opposed to mans indiscriminate evolvement and has no fixed nature or design. Man is an immortal spirit being which indwells a mortal body, and in contrast, man is wholly a physical animal and or machine. Moral law governs universally through marriage, sexual activity, and family, and in contrast morality is culturally and or individually determined. (Luker, 1984) Argues that pro-choice activist women share almost no common premises and very little common language with antiabortion activist women; in particular, the worldviews and conceptions of motherhood held by the two different groups of women are antithetical. (p.2). The culture war on abortion has many fronts, and those who adhere to liberal postmodernism or answer to liberal postmodern ideology are likely to frame lawful abortion as a set of rights or privileges. Professor Stanley Hauerwas author of Theologically Understood goes on to say that Christians in America are tempted to think of issues like abortion primarily in legal terms such as rights. He explains rights as an agreement between members in a society, who have nothing in common. Professor Hauerwas states that within a liberal society such as ours, the law functions as a mediator of such agreements. He gives an example of our system of law by saying lawyers are to America what priests were to the medieval world. In other words according to professor Hauerwas, Is abortion right or wrong? Or is this abortion right or wrong? rather, the first question is, Why do Christians call abortion, abortion and with the first question goes a second, Why do Christians think that abortion is a morally problematic term? (p. 5). Professor Hauerwas demystifies years of elusions by calling abortion, abortion which is already an achievement based on principles. Lets call a spade a spade, pro-choice is really pro-abortion isnt it, or what about termination of pregnancy, and with the use of this terminology the postmodernist have reduced the churchs involvement, and reallocated the moral responsibility onto the medical profession. (Emerson, 1996) For most of the twentieth century, abortion was removed from public scrutiny by defining it as a question of medical judgment. (p. 44). Well by circumventing the church we can easily foretell any future decision making within a postmodern society towards abortion by defining that mistake as take God out of anything and it dies as pointed out here by Friedrich Nietzsche, parable of a madman Do we smell anything yet of Gods decomposition? Isnt this the crux of postmodern wisdom which is inserting Gods insignificance into the minds of our youth like a Botox injection giving off the same expression of emotion? As pointed out by (Sire, 2004) A culture cannot lose its philosophic center without the most serious of consequences, not just to the philosophy on which it was based but to the whole superstructure of culture and even each persons notion of who he or she is. When God dies, both the substance and the value of everything else die too. (p. 211). This leads me to my next point on Postmodernisms thinking on the sanctity of life, which has created a pro-abortion crisis in America. In the United States alone the abortion rates had increased, in 1974 898,000 to 1,533,000 in 1980. These figures tell us that on an average day in Washington D.C., our nations capital 4,257 abortions are outnumbering live births. Twenty-five percent of all pregnancies are terminated in this manner and forty percent among teenagers, and approximately twenty percent of all women in the United States have had a legal abortion. Sixty percent were under twenty five years of age, and eighty two percent were unmarried at the time of their abortions, and sixty nine percent of these individuals were white. This is the latest available information provided to us by researchers at the (Henshaw, Koonin Smith institute, 1991). The above information shows the influential state and the wide acceptance of abortion and its use as a solution rather than as a last resort. Another way we see secular conditioning, is through what we read, which raises the question are we neglecting to effectively teach any alternatives to abortions such as adoption? For a number of generations we have been stealth fully preconditioning society by removing God from public education. Here for example a member of the Texas board of education is reported saying (Castro, 2010)There seems to be a misinformed view of religion in American history, that America is somehow founded on Christianity, Mize said. We just ask that things be historically accurate.(Â ¶7). The following message certainly points to a valid concern held by many Christians, and alludes to a valid misrepresentation on prolife options within our school textbooks. The following independent study is brought to us by (Kathy Shepherd Elaine Hall, 1994) from 1988 through 1993 sampling 27 textbooks representing 16 publishers covering a period of 6 years.(p. 267). They referenced topics such as, abortion and legal cases such as Roe v. Wade, pro-life, birth control, teen pregnancy, and reproduction. Citations for abortion were indexed more than 60 times and adoption citations were indexed under 13 headings. Also with this study acknowledgement to abortion was tendered 4 times more page space than adoption. That study certainly lessens the burden of understanding a postmodern view towards the ultimate decision to dismiss life, since a form of preconditioning has shown a dismissive slide of pen towards alternatives methods of abortion. (Geersten, 1977) The textbook often provides the central focus and organizing framework for courses, and students, in turn rely on textbooks as their most readily available source of information about the course topics. (p. 102). Postmodern theists are also finding difficulty with the abortion issue when it comes to their education as pointed out here, (Schmalzbauer, 1993) contends that Evangelicals for the most part tend to adhere to their education group rather than their religion with regards to their abortion attitudes. (p. 6). Education will no doubt reconstruct the minds of our youth as pointed out by (Evans, 2002) when he commented on Wuthnow, 1988 education is a more powerful opinion structuring force than religious discourse itself, and most studies find that the more education a respondent has, the more liberal his or her abortion attitudes. (p. 418). This adds to why a postmodern theistic society raises and nurtures its most influential citizens into embracing such secular ideas as Humanism, Naturalism, and Theistic Existentialism? (Bruce Steve, 1996) Postmodernism is here to stay and to evolve. It is a major paradigm shift that has vast and deep impact on the world. When modernity hits hard on Christianity, many sociologists predict the inevitable demise and even eradication of Christianity by secularism. (p. Â ¶5). Also having the wrong personalities controlling how textbooks are studied can only point to the trickling down effect of God within the hearts of man. (Strickler and Danigelis, 1999) Point out that education is shaping the very future of Christendom. By the mid-1990s abortion had been legal for two decades, the population had become more educated and more secular, and other sociodemographic trends found abortion increasingly acceptable. (p. 188). Another reason our postmodern society leans towards abortion as a first consideration rather than as a last resort rests within their understanding of God. The postmodern cultures knowledge of the bible clearly illustrates the ease of which abortion decisions are made. According to the attitudes in society, the concept of God has not changed, and Americans declare their attitudes outline their public disposition. Timothy Renick, (2007) mentions a vast many Americans purport their own religious institutions take part in public strategy issues, and the majority of Congress members consult their individual religious values when voting on legislation. He further notes that America is still very Christian minded, more so than Israel is Jewish or Utah is Mormon. (Timothy Renick, 2007) Yet surveys show that the majority of [postmodern] Americans cannot name even one of the four Gospels, only one-third know that it was Jesus who delivered the Sermon on the Mount, and 10 percent think that Joan of Arc was Noahs wife. (Hey, at least they know that Noah was associated with an ark-or is that Arc?) (p. 26). (Timothy Renick, 2007) continues to paint a solemn picture of postmodern Christianitys understanding of the bible by saying, Many high school seniors think that Sodom and Gomorrah were husband and wife. Renick also claims that devout Christians are, on average, at least as ignorant about the facts of Christianity as are other Americans. Sixty percent of evangelicals think Jesus was born in Jerusalem; only 51 percent of the Jews surveyed made the same mistake. And things are not getting any better. (p. 26-27). (Renick, quotes Prothero, 2007) comments on America which has become a nation deeply religious and profoundly ignorant about religion.(26). References Schmalzbauer, John 1993 Evangelicals in the new class: Class versus subculture predictors of Ideology. Journal for the Scientific Study of Religion 32(4):330-342. Wuthnow, Robert 1988 the Restructuring of American Religion. Princeton, NJ: Princeton University Press. Geersten, R. (1977). The textbook: An ACIDS test. Teaching Sociology, 5, 101-120. Henshaw, S. K., Koonin, L. M., Smith, J. C. (1991). Characteristics of U.S. women having Abortions. Family Planning Perspectives, 23, 75-81. Bruce, (1996). Religion in the Modern World. Oxford. Oxford University Press. Emerson M. (1996). Through Tinted Glasses: Religion, Worldviews, and Abortion Attitudes. Journal for the Scientific Study of Religion, 1996, vol. 35, No. 1. P. 41-55. April Castro, (2010) Texas Ed Board Set to Take 1st Vote since Primary. http://abcnews.go.com/US/wirestory?id=10058603page=1. Retrieved on April 9, 2010. Lokensgard, K. (AP 2009). Religious literacy, the First Amendment, and public education. Council of Societies for the Study of Religion Bulletin. 38(2), 41-45. Renick, T. M. (S 4 2007). Dumbed down: what Americans dont know about religion. Christian Century. 124(18), 26-29. Once again here we are asking how a Christian in a postmodern society can consider abortion as a viable solution to a complex moral issue. The abortion debate has polarized Americans like no other national problem since 9/11 or Watergate. The abortion issue has created a vast partitioning across Americas cultural, and religious lines, which is also evident at the individual, political, and ecclesiastical levels. (New International Version, 1984) You may say I am allowed to do anything. But I reply, Not everything is good for you. And even through I am allowed to do anything, I must not become a slave to anythingBut our bodies were not made for sexual immorality. They were made for the Lord, and the Lord cares about our bodies. (1 Cor. 6:12-13). Thomas Jefferson is regularly addressed as one of the finest proponents of religious freedom in the nineteenth century. In a letter dated 1816 he writes about moral decisions which he acknowledges the individual is heir to his own decision and no one else, (Lokensgard, 2009) But I have ever thought religion a concern purely between our God and our consciences, for which we were accountable to Him, and not to the priests (p. 43).

Html and How it Works :: Essays Papers

Html and How it Works There are almost 300,000 Aborigines in Australia. About 34,500 live in Sydney. There is debate about when Aborigines migrated to Australia from Papua New Guinea and the Indonesian archipelago. There is evidence of occupation about 50,000 to 60,000 years ago. The earliest archaeological evidence of Aboriginal occupation of the Sydney area is 15,000 years ago at Emu Plains in Sydney's west. Captain Cook guessed that the population of Aborigines for all of Australia would have been about 150,000. Recent estimates are that the Aboriginal population was about 750,000 in 1788. Governor Phillip guessed that there were no more that 1500 Aborigines living in the Sydney area. The first official census of Aborigines did not take place until 1971. Aboriginal people throughout the Sydney area identified themselves more strongly as members of smaller clans or bands. There were an estimated 29 different bands liming in the Sydney area, and between seven and eleven based near the shares of Sydney Harbour and the nearby coast. Each band had approximately fifty members. The general collection of beliefs is known as the Dreaming. The Dreaming not only explains the past and how the present came to be, but also prescribes codes of conduct for important events. When Arthur Phillip was given his instructions from the British government before the First Fleet sailed, he was not instructed to negotiate or enter into treaties with the Aborigines for the use of purchase of land. To Europeans, possession or title to land depended on working or cultivating it. Cook had observed on his journey on the Endeavour that Aborigines did not work or improve the land, so that it was terra nullius, and therefore able to be claimed by the British government. The official instructions from the King, however, ordered Phillip to treat the Aborigines in a conciliatory fashion and that any wrongdoing towards them was to be punished. The critical difference between European and Aboriginal notions of land possession and ownership was that, for the Aborigines, there was no conception of the right of an individual to hold property to the exclusion of everyone else. For the colonists, there was no conception of anything else. Aborigines were closely connected to the land, but in a wider and more collective sense, not in the personal legalistic manner land was possessed in European society. From the outset, the stage was set for a fundamental and irreconcilable clash between cultures, which would soon impoverish the lives of Australia's indigenous people.

The Clinic :: essays research papers

The Clinic The Clinic is one of a series of Alex Delaware novels written by Jonathan Kellerman. Alex Delaware is a psychology doctor who is often employed by the Los Angeles Police Department (LAPD) to provide psychological profiles of both victims and killers. The book is 465 pages long. In this novel Dr. Delaware has been asked to provide a psychological profile of the victim of a particularly gruesome murder. The victim is Professor Hope Devane, who was found murdered under a large elm tree in front of her home. She was stabbed three times; once in the heart; once in the groin; and once in the back. The only clue was a bicycle track left at the scene. The murder had occurred three months ago and the case had been turned over to a different detective, Milo Sturgis, due to the lack of progress in solving the case. Milo Sturgis is a personal friend of Dr. Alex Delaware and requested his assistance. Very little was known about Professor Hope Devane and Detective Sturgis asked Dr. Delaware to compile a psychological profile of her. Professor Devane had written a male-bashing book entitled â€Å"Wolves and Sheep.† The book had created quite a controversy and Professor Devane had appeared on numerous talk shows. Dr. Delaware discovered that Professor Devane had set up a committee at the university where she was employed. This committee was established to assist students who claimed to have been sexually harassed by other students. There were only three cases handled by the committee before the head of the university dissolved it. Detective Sturgis and Dr. Delaware decide that it would be a good idea for Dr. Delaware to locate and interview both the members of the committee and the individuals involved in the three cases. There were only three members of the committee. The members were Professor Hope Devane, another professor at the university, and a student named Casey Locking. The professor who served on the committee told Dr. Delaware that she only sat in on two of the cases and then dropped out because she felt the committee was too radical. She also said that Professor Devane exhibited signs of someone who might have been abused herself. Dr. Delaware interviewed the students involved in the three cases, with the exception of one young woman who seemed terrified. This girl claimed to have been raped by a fellow student who was a drama major. The Clinic :: essays research papers The Clinic The Clinic is one of a series of Alex Delaware novels written by Jonathan Kellerman. Alex Delaware is a psychology doctor who is often employed by the Los Angeles Police Department (LAPD) to provide psychological profiles of both victims and killers. The book is 465 pages long. In this novel Dr. Delaware has been asked to provide a psychological profile of the victim of a particularly gruesome murder. The victim is Professor Hope Devane, who was found murdered under a large elm tree in front of her home. She was stabbed three times; once in the heart; once in the groin; and once in the back. The only clue was a bicycle track left at the scene. The murder had occurred three months ago and the case had been turned over to a different detective, Milo Sturgis, due to the lack of progress in solving the case. Milo Sturgis is a personal friend of Dr. Alex Delaware and requested his assistance. Very little was known about Professor Hope Devane and Detective Sturgis asked Dr. Delaware to compile a psychological profile of her. Professor Devane had written a male-bashing book entitled â€Å"Wolves and Sheep.† The book had created quite a controversy and Professor Devane had appeared on numerous talk shows. Dr. Delaware discovered that Professor Devane had set up a committee at the university where she was employed. This committee was established to assist students who claimed to have been sexually harassed by other students. There were only three cases handled by the committee before the head of the university dissolved it. Detective Sturgis and Dr. Delaware decide that it would be a good idea for Dr. Delaware to locate and interview both the members of the committee and the individuals involved in the three cases. There were only three members of the committee. The members were Professor Hope Devane, another professor at the university, and a student named Casey Locking. The professor who served on the committee told Dr. Delaware that she only sat in on two of the cases and then dropped out because she felt the committee was too radical. She also said that Professor Devane exhibited signs of someone who might have been abused herself. Dr. Delaware interviewed the students involved in the three cases, with the exception of one young woman who seemed terrified. This girl claimed to have been raped by a fellow student who was a drama major.

Anti Mining Essay

I. Exordium (opening) â€Å"Where you stand on this issue is determined by the question: do you love this country? If you do, you’ll fight for it..† â€Å"Mining is a search-and-destroy mission.† II. Salutation: Member of the Board of Judges, my worthy opponents, ladies and gentlemen, Good afternoon. III. Definition: According to Meriam-Webster’s Dictionary, mining is the excavation of materials from the Earth’s crust, including those of organic origin, such as coal and petroleum. Modern mining is costly and complicated. First, a mineral vein that can likely produce enough of the desired substance to justify the cost of extraction must be located. Then the size of the vein or deposit is determined, and mining engineers decide the best way to mine it. Most of the world’s yearly mineral production is extracted by surface mining, which includes open-pit mining, strip mining, and quarrying. For ore bodies that lie a considerable distance below the surface, underground mining must be considered. In both techniques, excavating and extracting mineral substances involve costly combinations of drilling, blasting, hoisting, and hauling, as well as measures for health and safety and reduction of environmental impact. IV. Team Split I shall discuss the Necessity aspect while my team mate, 2nd speaker shall discuss the Beneficiality and the 3rd speaker shall discuss the Practicability aspect of the proposition. V. Argument I VI. Argument II VII. Argument III VIII. Closing/Conclusion Haribon Foundation features women in the book â€Å"STORIES from the MINES of struggle, sisterhood and solidarity† released by Alyansa Tigil Mina (ATM); these are the women â€Å"who continue to campaign for human dignity, biodiversity conservation and sustainable communities†. Natividad Nagutom or Naty, 61, is a resident of Barangay Magapua, Mogpog in Marinduque. She is married to Julio Nagutom and a mother of eight children. She is a member of Marinduque Council for Environmental Concern (MACEC) for over 13 years. Now, she is the chairman of MACEC chapter in their barangay. Her involvement in MACEC had developed her to become a tough advocate of human rights and a safe and peaceful community. Like most members of MACEC, Naty has her own share of struggles with the impact of mining in their town. In 1993, the Maguila-guila Siltation Dam of Marcopper Mining Corporation collapsed and caused a flash flood that gushed to the Mogpog River. The heavy surge of water and mine spill had shaken their house and almost drowned them to death. Naty and her husband tied themselves with their eight children, so that they can support each other and avoid drowning. That traumatic experience drove her to be involved in the campaign against mining in their community and the entire province. She actively participated in many seminars, trainings, and mobilizations in and out of the province which are usually sponsored by MACEC. With support from MACEC and other organization, she took the lead in filing the case against Marcopper Mining Corporation. In 2005, she attended a Mining Conference in Baguio City organized by Legal Rights and Natural Resources Center. In the conference, she shared her experience during the 1993 flash flood and her contributions to the anti-mining actions. The participants felt her struggle; almost all of them cried after realizing that they were not alone in the fight for justice. That experience made her an even stronger advocate. Her integrity was challenged by the attempts of mining company to buy off her stand and discontinue. But she never thought of withdrawing the case even though sometimes it frustrates her to think that it is moving slow. But they cherish victories and milestones in their campaign—the 50-year mining moratorium in the province is one. To Naty, mining is a destructive industry that causes people to live in fear and exposes them to so much threat. For her, mining has no place now in Mogpog and in the entire province of Marinduque. THE IMPACTS OF MINING IN THE PHILIPPINES The problem of the issue is the negative environmental and health impact of mining.   Statement of Catholic Bishops of the Philippines, 1998. Mining poses tremendous risks to life and limb, not only to miners but to the community as well. Countless accidents have happened and have affected thousands of miners in our country, directly or indirectly caused by hazardous mining operations. There is a very high social cost of mining and the impact on the society is immeasurable. Occupational health hazards posed by mining to workers are exposure to intense heat, poor ventilation, vibration, dust, fumes, repetitive stress injury (RSI), intense noise, manual handling (e.g. lifting) of heavy machinery and biological and chemical hazards. Due to the nature of underground mining, miners are constantly exposed to intense heat while hydration is very limited. Miners usually have fluid and salt deficiency due to constant sweating, increased stress on the heart, heat stroke, opacity of the lens and reduced fertility due to high heat. Poor ventilation robs the body of needed oxygen causing the brain to malfunction and leads to many deaths especially in underground operations. Vibration on the other hand can cause permanent damage to bones and vibration syndrome or â€Å"dead finger† syndrome can lead to gangrene in the hands and fingers. It can also cause digestive problems due to constant shaking of the internal organs, heart problems and disruption of the nervous system. Mines exposes workers to different types of airborne particulates, making them vulnerable to systemic toxic effects due to the absorption of lead, manganese, cadmium, zinc and other toxic material. Fumes are emitted by chemicals being used or by the machines being employed during mining operations. Coupled with poor ventilation, this can trigger accidents and cause death to workers. RSI being a soft-tissue disorder is caused by overloading of particular muscle group from repetitive use or maintenance of constrained postures. Miners who suffer from RSI complain of weakness of the affected muscles, heaviness, â€Å"pins and needles† sensation and numbness. Noise or irritating and hazardous sound can cause hearing impairment and/or disrupt body functions like blood circulation and hormone imbalance. Deafness and hearing loss can become irreversible and other non-auditory effects are increased blood pressure and peptic ulcer due to increased gastrointestinal motility. Manual lifting of materials causes back troubles leading to acute pain. A large percentage of the workers suffer sooner or later from this disorder caused by their type of work. Because most mines in the Philippines extract gold, the use of sodium cyanide for leaching gold from finely ground ore is frequent. The use of liquid mercury to create gold-amalgam is also wide-spread. Cyanide blocks the transfer of oxygen from the blood to the body tissues. Signs of acute poisoning include rapid breathing, gasping, tremors, convulsions and death. Effects of sub lethal poisoning include headache, dizziness and thyroid enlargement. A Fact-Finding Team composed of human rights and environmental experts from the United Kingdom which looked into the impact of mining on the environment and peoples’ livelihoods in the Philippines highlighted the occurrence of mining-related human rights abuses affecting local communities especially indigenous people; extrajudicial killings of persons protesting against mining; corruption in the mining sector; political pressure on the judiciary resulting in pro-mining decisions; and environmental impacts. The team observed that the record of mining companies with regard to environmental protection, disasters and post-mining clean-up in the Philippines is widely acknowledged, even with the government, to be very poor. As of 2003, there had been at least 16 serious tailing dam failures in the preceding 20 years and about 800 abandoned mine sites have not been cleaned up. Clean-up costs are estimated in billions of dollars and damage will never be fully reversed. It warned that water contamination from mining poses one of the top three ecological security threats in the world. Many mining applications in the Philippines are in water catchment areas close to the sea, and pose major threat to valuable marine resources. The severe pollution of the Taft river system in Eastern Samar as a result of the mining activities in Bagacay is a vivid example. The report also emphasized the very high geo-hazard risks in the Philippines. In the Philippines, over half of the active mining concessions and two-thirds of exploratory concessions are located in areas of high seismic risk where earthquakes are likely. The Philippines is considered as the hottest hotspot in the world in terms of threats to its mega diverse biodiversity. Thus there is an urgent need to properly manage its natural resources. It is estimated that 37% of Philippine forests may be exposed to new mining. We have to be concern with the past experiences where human rights were disregarded in pursuit of the mining operations. Likewise, our country is facing with the diminishing and restricted natural resources. Our government may be in need of revenue, but sacrificing the environmental management, such as the agricultural land, water and forests, which are more essential, sustainable and economically practicable. The exploration, development and utilization of mineral resources contend with the present day realities of global warming, pollution, and food shortages. One thing to consider is the dangers posed by earthquakes, typhoons and volcanic eruptions. Protecting the environment is avoiding risk and disaster; hence the acts of provincial board members are laudable. The bill in Congress banning all mining exploration and operation in Carigara Bay shows how Leyte 2nd district Representative (Rep.) Sergio Apostol, principal authored, with Leyte 3rd district Rep. Andres Salvacion and Biliran lone district Rep. Rogelio Espina, co-authors, seriously are concerned with the lives of the people and to protect the environment. Sangguniang Panlalawigan action on mining ventures in the province show they are not sleeping on their jobs. Their concern on the effect of mining is a great service to humanity, especially for Leyteà ±os. A negative impact on the environment, not only during its operations, but will continue even after long years of its cessation. Thus, the vital action of the government either from the national or local authorities imposing regulations to moderate the negative effect of mining in a locality is necessary. Our country has extremely poor mining reputation compared from other parts of the world. Abandoned mines and even those still operating have affected the livelihoods of thousands of lesser fortunate Filipinos. Mining has a negative effect for Filipino source of livelihood. In the case of the farmers in MacArthur wherein Leyte 2nd district Board Member Anlie Apostol is alarmed, because the Nicua Mining Corporation’s mining award may be against the spirit of the Agrarian Reform Law. Some 40 hectares were bought with option for the farmers to buy back the land may have violated the provision that the farmer-beneficiary could not sell the land within 25 years. Unless the land is no longer productive and approved by the Department of Agrarian Reform in accordance with the rules in conversion or exemption. At present we have some 800 abandoned mines in the country that have caused immense environmental damage. Some of which have records of human rights abuses. Abandoned mines have left the affected residents to undergo economic difficulties. How long will Nicua operates the mining? It is worthy to note that some mining companies have failed to comply with national law and international standards, according to Clare Short, a member of parliament from Birmingham, United Kingdom. As the stand taken by the Catholic Bishops’ Conference of the Philippines (CBCP) when they publicly opposed the 1995 Mining Act. Leyte 1st district Board Member Roque Tiu is correct in his contention that the Mines and Geosciences Bureau (MGB), and the Provincial Government of Leyte are not in contradiction over the Mining Act and the Local Government Code (LGC). It is true that licenses for mining operation is issued by the national government, however, the LGC provides: â€Å"Section 27. – Prior Consultations Required. – No project or program shall be implemented by government authorities unless the consultations mentioned in Section 2 (c) and 26 hereof are complied with, and prior approval of the Sanggunian concerned is obtained. Provided that occupants in areas where such projects are to be implemented shall not be evicted unless appropriate relocation sites have been provided, in accordance with the provisions of the Constitution. â€Å"Section 26. Duty of National Government Agencies in the Maintenance of /Ecological Balance.- It shall be the duty of every national agency or government-owned or controlled corporation authorizing of involved in the planning and implementation of any project or program that may cause pollution, climatic change, depletion of non-renewable resources, loss of cropland, rangeland, or forest cover, and extinction of animal or plant species, to consult with the local government units, nongovernmental organizations, and other sectors concerned and explain the goals and objectives of the project or program, its impact upon the people and the community in terms of environmental or ecological balance, and the measures that will be undertaken to prevent or minimize the adverse effects thereof.† In one of the rulings of the Supreme Court, it states: â€Å"Congress introduced Sections 26 and 27 in the Local Government Code to emphasize the legislative concern â€Å"for the maintenance of a sound ecology and clean environment.† These provisions require every national government agency or government-owned and controlled corporation to hold prior consultations with the local government unit concerned and to secure the prior approval of its sanggunian before implementing â€Å"any project or program that may cause pollution, climatic change, depletion of non-renewable resources, loss of cropland, rangeland, or forest cover and extinction of animal or plant species.†