Clinical Director At Community Partners - 1050 Words

For the purpose of this assignment, we interviewed Jodi Greenblatt, the Clinical Director at Community Partners (CP) and Hilary Jacques an LCSW Outpatient Therapist. I was thoroughly impressed and refreshed by the interview with Jodi. While interviewing Jodi, I felt that she had a wealth of knowledge and was very knowledgeable about the theoretical framework that Community Partners employs. Jodi explained to us that the agency does not specify any treatment modality, but the agency does have commonly used treatment modalities that include, but are not limited to, CBT, EMDR, TF-CBT, Play Therapy, Motivational Interviewing and Triple P Parenting Skills. She explained that the theoretical underpinnings of the commonly used treatment modalities are CBT and the trauma based focus of the treatment modalities. Said another way, what Jodi was describing was that the commonly used treatment modalities employed by the agency have a trauma-focused orientation and are grounded in theories of cha nge. Afterwards, Jodi explained that a significant portion of Community Partner’s clients are DCF referred and a majority of the agency’s client populations consist of children and families that are affected by trauma, so trauma geared interventions such as CBT and others with CBT elements, such as EMDR, have been proven to help clients suffering from trauma to recover. Also, the treatment modalities that Jodi discussed are well align with the agency’s mission statement of improving the odds theShow MoreRelatedProgram Mission And Community Resources1469 Words   |  6 PagesProgram Mission and Community Resources The program for the course project’s titled Time-Out and it will look to provide prevention and solution-based services to African American male high school athletes located in the community of Hampton, Virginia who are at-risk or have engaged in criminal activities, truancy, poor academic performance, or weak support systems. This paper will provide readers the program’s mission statement and rationale as to how the program’s culture will be created to supportRead MoreBenefits Of Direct Care Staff1024 Words   |  5 Pagesserve as the point of contact for school personnel, and the intake of referrals. 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Symptoms And Symptoms Of Schizophrenia - 1677 Words

According to the DSM IV-TR. Symptoms of schizophrenia, include meeting three criteria: need to have two or more characteristics symptoms such as delusions, hallucinations, disorganized speech, grossly disorganized behavior/catatonic behavior or negative symptoms such as blunted affect, alogia, or alovitian which was evident in this film.. In addition to these symptoms, the individual must also display a social or occupational dysfunction, such as a disturbance in functioning in his work, interpersonal relationship or self-care. The third criterion is having all of these symptoms continue for more than six months which John Nash showed throughout his graduate school. Criterion A for schizophrenia is met because the hallucinations†¦show more content†¦There was a point in the movie where Nash hallucinates that Harris planted a device in his arm that allows him to see a code using ultra violet rays. Supposedly this device leads him to open a secret place, where he secretly cracks codes to help the government. However, this is all a creation of Nash’s imagination. Criterion B for schizophernia negative symptoms was also met throughout the film because it seemed that John Nash was always occupied by being an over achiever and afraid of failure. Criterion C was also met because his delusions and hallucinations were portrayed and carried on throughout the whole film from beginning to end. Mood disorders, substance abuse and history of previous medical conditions can all be ruled out because none of these were shown. Along with all this Nash fell under the Paranoid subtype throughout the movie because he always seemed to be occupied with his duty as a government spy and having to fulfill his duty. This was shown through Nash by always putting his duty as a government spy before his wife, his job as a professor at Princeton, having his office cluttered/ disorganized and filled with magazine cut outs that he believed were helping him crack codes for the government as to where the Russians had the bombs hidden. Under Axis II I diagnosed him with Narcissistic Personality Disorder but put it as provisional

Black House Chapter Twenty-nine Free Essays

29 â€Å"YOU GUYS READY?† Dale asks. â€Å"Aw, man, I don’t know,† Doc says. This isn’t the fifth time he’s said it, maybe not even the fifteenth. We will write a custom essay sample on Black House Chapter Twenty-nine or any similar topic only for you Order Now He’s pale, almost hyperventilating. The four of them are in a Winnebago kind of a rolling green room that has been set up on the edge of La Follette Park. Nearby is the podium on which they’ll stand (always assuming Doc can keep his legs under him) and deliver their carefully crafted answers. On the slope running down to the broad river are gathered nearly four hundred newspeople, plus camera crews from six American networks and God knows how many foreign stations. The gentlemen of the press aren’t in the world’s best mood, because the prime space in front of the podium has been reserved for a representative sampling (drawn by lottery) of French Landing’s residents. This was Dale’s one ironclad demand for the press conference. The idea for the press conference itself came from Jack Sawyer. â€Å"Mellow out, Doc,† Beezer says. He looks bigger than ever in his gray linen slacks and open-collared white shirt almost like a bear in a tuxedo. He has even made an effort to comb his acres of hair. â€Å"And if you really think you’re going to do one of the Three P’s piss, puke, or pass out stay here.† â€Å"Nah,† Doc says miserably. â€Å"In for a penny, in for a fuckin’ pound. If we’re gonna give it a try, let’s give it a try.† Dale, resplendent in his dress uniform, looks at Jack. The latter is if anything more resplendent in his gray summerweight suit and dark blue silk tie. A matching blue handkerchief pokes from the breast pocket of his coat. â€Å"You sure this is the right thing?† Jack is completely sure. It’s not a matter of refusing to allow Sarah Gilbertson’s Color Posse to steal the limelight; it’s a matter of making certain that his old friend is in an unassailable position. He can do this by telling a very simple story, which the three other men will back up. Ty will do the same, Jack is confident. The story is this: Jack’s other old friend, the late Henry Leyden, figured out the Fisherman’s identity from the 911 tape. This tape was supplied by Dale, his nephew. The Fisherman killed Henry, but not before the heroic Mr. Leyden had mortally wounded him and passed his name to the police. ( Jack’s other interest in this press conference, understood perfectly and supported completely by Dale, is to make sure Henry gets the credit he deserves.) An examination of French Landing property records and plats uncovered the fact that Charles Burnside owned a house on Highway 35, not far out of town. Dale deputized Jack and tw o widebodies who just happened to be in the vicinity (that would be Messrs. Amberson and St. Pierre), and they went on out there. â€Å"From that point on,† Jack told his friends repeatedly in the days leading up to the press conference, â€Å"it’s vital that you remember the three little words that lead to most acquittals in criminal trials. And what are those words?† † ? ®I can’t remember,’ † Dale said. Jack nodded. â€Å"Right. If you don’t have a story to remember, the bastards can never trip you up. There was something in the air inside that place â€Å" â€Å"No lie,† Beezer rumbled, and grimaced. † and it messed us up. What we do remember is this:Ty Marshall was in the backyard, handcuffed to the clothesline whirligig.† Before Beezer St. Pierre and Jack Sawyer slipped through the police barricades and vaporized Black House with plastic explosive, one reporter got out there and took numerous pictures. We know which reporter it was, of course; Wendell Green has finally realized his dreams of fame and fortune. â€Å"And Burnside was dead at his feet,† Beezer said. â€Å"Right. With the key to the handcuffs in his pocket. Dale, you found that and released the boy. There were a few other kids in the backyard, but as to how many â€Å" â€Å"We don’t remember,† Doc said. â€Å"As to their sexes â€Å" â€Å"A few boys, a few girls,† Dale said. â€Å"We don’t remember exactly how many of each.† â€Å"And as for Ty, how he was taken, what happened to him â€Å" â€Å"He said he didn’t remember,† Dale said, smiling. â€Å"We left. We think we called to the other kids â€Å" â€Å"But don’t exactly remember † the Beez chips in. â€Å"Right, and in any case they seemed safe enough where they were for the time being. It was when we were putting Ty into the cruiser that we saw them all streaming out.† â€Å"And called the Wisconsin State Police for backup,† Dale said. â€Å"I do remember that.† â€Å"Of course you do,† Jack said benevolently. â€Å"But we have no idea how that darn place got blasted all to hell, and we don’t know who did it.† â€Å"Some people,† Jack said, â€Å"are all too eager to take justice into their own hands.† â€Å"Lucky they didn’t blow their heads clean off,† said Dale. â€Å"All right,† Jack tells them now. They’re standing at the door. Doc has produced half a joint, and four quick, deep tokes have calmed him visibly. â€Å"Just remember why we’re doing this. The message is that we were there first, we found Ty, we saw only a few other children, we deemed their situation secure due to the death of Charles Burnside, also known as Carl Bierstone, the South Side Monster, and the Fisherman. The message is that Dale behaved properly that we all did and he then handed the investigation off to the FBI and WSP, who are now holding the baby. Babies, I guess in this case. The message is that French Landing is okay again. Last but far from least, the message is that Henry Leyden’s the real star. The heroic blind man who I.D.’d Charles Burnside and broke the Fisherman case, mortally wounding the monster and losing his own life in the process.† â€Å"Amen,† Dale says. â€Å"Sweet old Uncle Henry.† Beyond the door of the Winnebago, he can hear the surflike rumble of hundreds of people. Maybe even a thousand. He thinks, This is what rock acts hear before they hit the stage. A lump suddenly rises in his throat and he does his best to gulp it back down. He reckons that if he keeps thinking of Uncle Henry he will be okay. â€Å"Anything else,† Jack says, â€Å"questions that get too specific â€Å" â€Å"We can’t remember,† Beezer says. â€Å"Because the air was bad,† Doc agrees. â€Å"Smelled like ether or chloro or something like that.† Jack surveys them, nods, smiles. This will be a happy occasion, on the whole, he thinks. A love feast. Certainly the idea that he might be dying in a few minutes has not occurred to him. â€Å"Okay,† he says, â€Å"let’s go out there and do it. We’re politicians this afternoon, politicians at a press conference, and it’s the politicians who stay on message who get elected.† He opens the RV’s door. The rumble of the crowd deepens in anticipation. They cross to the jury-rigged platform this way: Beezer, Dale, Jack, and the good Doctor. They move in a warm white nova glare of exploding flashbulbs and 10-k TV lights. Jack has no idea why they need such things the day is bright and warm, a Coulee Country charmer but it seems they do. That they always do. Voices cry, â€Å"Over here!† repeatedly. There are also thrown questions, which they ignore. When it comes time to answer questions they will as best they can but for now they are simply stunned by the crowd. The noise begins with the two hundred or so French Landing residents sitting on folding chairs in a roped-off area directly in front of the podium. They rise to their feet, some clapping, others waving clenched fists in the air like winning boxers. The press picks it up from them, and as our four friends mount the steps to the podium, the roar becomes a thunder. We are with them, up on the platform with them, and God, we see so many faces we know looking up at us. There’s Morris Rosen, who slipped Henry the Dirtysperm CD on our first day in town. Behind him is a contingent from the now defunct Maxton Elder Care: the lovely Alice Weathers is surrounded by Elmer Jesperson, Ada Meyerhoff (in a wheelchair), Flora Flostad, and the Boettcher brothers, Hermie and Tom Tom. Tansy Freneau, looking a bit spaced out but no longer outright insane, is standing next to Lester Moon, who has his arm around her. Arnold â€Å"Flashlight† Hrabowski, Tom Lund, Bobby Dulac, and the other mem bers of Dale’s department are up on their feet, dancing around and cheering crazily. Look, over there that’s Enid Purvis, the neighbor who called Fred at work on the day Judy finally high-sided it. There’s Rebecca Vilas, looking almost nunnish in a high-collared dress (but cry no tears for her, Argentina; Becky has stashed away quite a nice bundle, thank you very much). Butch Yerxa is with her. At the back of the crowd, lurking shamefully but unable to stay away from the triumph of their friends, are William Strassner and Hubert Cantinaro, better known to us as Kaiser Bill and Sonny. Look there! Herb Roeper, who cuts Jack’s hair, standing beside Buck Evitz, who delivers his mail. So many others we know, and to whom we must say good-bye under less than happy circumstances. In the front row, Wendell Green is hopping around like a hen on a hot griddle (God knows how he got into the roped-off area, being from La Riviere instead of French Landing, but he†™s there), taking pictures. Twice he bumps into Elvena Morton, Henry’s housekeeper. The third time he does it, she bats him a damned good one on top of the head. Wendell hardly seems to notice. His head has taken worse shots during the course of the Fisherman investigation. And off to one side, we see someone else we may or may not recognize. An elderly, dark-skinned gentleman wearing shades. He looks a little bit like an old blues singer. He also looks a little bit like a movie actor named Woody Strode. The applause thunders and thunders. Folks cheer. Hats are thrown in the air and sail on the summer breeze. Their welcome becomes a kind of miracle in itself, an affirmation, perhaps even an acceptance of the children, who are widely supposed to have been held in some bizarre sexual bondage linked to the Internet. (Isn’t all that weird stuff somehow linked to the Internet?) And of course they applaud because the nightmare is over. The boogeyman died in his own backyard, died at the foot of a prosaic, now vaporized aluminum clothes whirligig, and they are safe again. Oh how the cheers ring in these few last moments of Jack Sawyer’s life on planet Earth! Birds are startled up from the bank of the river and go squawking and veering into the sky, seeking quieter environs. On the river itself, a freighter responds to the cheers or perhaps joins in by blasting its air horn over and over. Other boats get the idea and add to the cacophony. Without thinking about what he’s doing, Jack takes Doc’s right hand in his left, Dale’s left hand in his right. Dale takes Beezer’s hand, and the Sawyer Gang raises their arms together, facing the crowd. Which, of course, goes nuts. If not for what is going to happen next, it would be the picture of the decade, perhaps of the century. They stand there in triumph, living symbols of victory with their linked hands in the sky, the crowd cheering, the videocams rolling, the Nikons flashing, and that is when the woman in the third row begins to make her move. This is someone else we know, but it takes us a second or two to recognize her, because she has had nothing at all to do with the case we have been following. She’s just been . . . sort of lurking around. The two hundred seats up front have been awarded by random drawing from the French Landing voter rolls, the lucky lottery winners notified by Debbi Anderson, Pam Stevens, and Dit Jesperson. This woman was No. 199. Several people shrink from her as she passes them, although in their happy frenzy they are hardly aware of doing it; this pale woman with clumps of straw-colored hair sticking to her cheeks smells of sweat and sleep lessness and vodka. She’s got a little purse. The little purse is open. She’s reaching into it. And we who have lived through the second half of the twentieth century and have through the miracle of TV witnessed a dozen assassinations and near assassinations know exactly what she is reaching for. We want to scream a warning to the four men standing with their linked hands raised to the sky, but all we can do is watch. Only the black man with the sunglasses sees what’s happening. He turns and starts to move, aware that she has probably beaten him, that he is probably going to be too late. No, Speedy Parker thinks. It can’t end like this, it can’t. â€Å"Jack, get down!† he shouts, but no one hears him over the clapping, the cheering, the wild hurrahs. The crowd seems to block him on purpose, surging back and forth in front of him no matter which way he moves. For a moment Wendell Green, still bobbing around like a man in the throes of an epileptic seizure, is in the assassin’s path. Then she heaves him aside with the strength of a madwoman. Why not? She is a madwoman. â€Å"Folks † Dale’s got his mouth practically on the microphone, and the P.A. horns mounted to the nearby trees whine with feedback. He’s still holding up Jack’s hand on his left and Beezer’s on his right. There’s a small, dazed smile on his face. â€Å"Thank you, folks, we sure do appreciate the support, but if you could just quiet down . . .† That’s when Jack sees her. It’s been a long time, years, but he recognizes her at once. He should; she spat in his face one day as he left the Los Angeles courthouse. Spat at him and called him a railroading bastard. She’s lost fifty pounds since then, Jack thinks. Maybe more. Then he sees the hand in the purse, and even before it comes back out, he knows what’s happening here. The worst is that he can do nothing about it. Doc and Dale have his hands in a death grip. He drags in a deep breath and shouts as he has been taught to do in just such a situation as this â€Å"Gun!† and Dale Gilbertson nods as if to say, Yes it is, it is fun. Behind her, pushing through the clapping, cheering crowd, he sees Speedy Parker, but unless Speedy’s got a particularly good magic trick up his sleeve He doesn’t. Speedy Parker, known in the Territories as Parkus, is just fighting his way into the aisle when the woman standing below the platform brings out her gun. It’s an ugly little thing, a bulldog .32 with its handle wrapped in black kitchen tape, and Jack has just half a second to think that maybe it will blow up in her hand. â€Å"Gun!† Jack shouts again, and it’s Doc Amberson who hears him and sees the snarling woman crouched just below them. â€Å"Ohfuck,† Doc says. â€Å"Wanda, no!† Jack cries. Doc has let go of his left hand (Dale has still got his right one hoisted high in the summer air) and Jack holds it out to her like a traffic cop. Wanda Kinderling’s first bullet goes right through the palm, mushrooms slightly, begins to tumble, and punches into the hollow of Jack’s left shoulder. Wanda speaks to him. There’s too much noise for Jack to hear her, but he knows what she’s saying, just the same: Here you go, you railroading son of a bitch Thorny says hello. She empties the remaining five bullets into Jack Sawyer’s chest and throat. No one hears the insignificant popping sounds made by Wanda’s bulldog .32, not over all that clapping and cheering, but Wendell Green has got his camera tilted up, and when the detective jerks backward, our favorite reporter’s finger punches the Nikon’s shutter-release button in simple reflex. It snaps off eight shots. The third is the picture, the one that will eventually become as well known as the photo of the Marines raising the flag on Iwo Jima and that of Lee Harvey Oswald clutching his belly in the parking garage of the Dallas police station. In Wendell’s photo, Jack Sawyer looks calmly down toward the shooter (who is just a blur at the very bottom of the frame). The expression on his face might be one of forgiveness. Daylight is clearly visible through the hole in the palm of his outstretched hand. Droplets of blood, as red as rubies, hang frozen in the air beside his throat, which has been torn open. The cheering and the applause stop as if amputated. There is a moment of awful, uncomprehending silence. Jack Sawyer, shot twice in the lungs and once in the heart, as well as in the hand and the throat, stands where he is, gazing at the hole below his spread fingers and above his wrist. Wanda Kinderling peers up at him with her dingy teeth bared. Speedy Parker is looking at Jack with an expression of naked horror that his wraparound sunglasses cannot conceal. To his left, up on one of four media towers surrounding the platform, a young cameraman faints and falls to the ground. Then, suddenly, the freeze-frame that Wendell has captured without even knowing it bursts open and everything is in motion. Wanda Kinderling screams â€Å"See you in hell, Hollywood† several people will later verify this and then puts the muzzle of her .32 to her temple. Her look of vicious satisfaction gives way to a more typical one of dazed incomprehension when the twitch of her finger produces nothing but a dry click. The bulldog .32 is empty. A moment later she is pretty much obliterated broken neck, broken left shoulder, four broken ribs as Doc stage-dives onto her and drives her to the ground. His left shoe strikes the side of Wendell Green’s head, but this time Wendell sustains no more than a bloody ear. Well, he was due to catch a break, wasn’t he? On the platform, Jack Sawyer looks unbelievingly at Dale, tries to speak, and cannot. He staggers, remains upright a moment longer, then collapses. Dale’s face has gone from bemused delight to utter shock and dismay in a heartbeat. He seizes the microphone and screams, â€Å"HE’S SHOT! WE NEED A DOCTOR!† The P.A. horns shriek with more feedback. No doctor comes forward. Many in the crowd panic and begin to run. The panic spreads. Beezer is down on one knee, turning Jack over. Jack looks up at him, still trying to speak. Blood pours from the corners of his mouth. â€Å"Ah fuck, it’s bad, Dale, it’s really bad,† Beezer cries, and then he is knocked sprawling. One wouldn’t expect that the scrawny old black man who’s vaulted up onto the stage could knock around a bruiser like Beezer, but this is no ordinary old man. As we well know. There is a thin but perfectly visible envelope of white light surrounding him. Beezer sees it. His eyes widen. The crowd, meanwhile, flees to the four points of the compass. Panic infects some of the ladies and gentlemen of the press, as well. Not Wen-dell Green; he holds his ground like a hero, snapping pictures until his Nikon is as empty as Wanda Kinderling’s gun. He snaps the black man as he stands with Jack Sawyer in his arms; snaps Dale Gilbertson putting a hand on the black man’s shoulder; snaps the black man turning and speaking to Dale. When Wendell later asks French Landing’s chief of police what the old fellow said, Dale tells him he doesn’t remember besides, in all that pandemonium, he could hardly make it out, anyway. All bullshit, of course, but we may be sure that if Jack Sawyer had heard Dale’s response, he would have been proud. When in doubt, tell ’em you can’t remember. Wendell’s last picture shows Dale and Beezer watching with identical dazed expressions as the old fellow mounts the steps to the Winnebago with Jack Sawyer still in his arms. Wendell has no idea how such an old party can carry such a big man Sawyer is six-two and must go a hundred and ninety at least but he supposes it’s the same sort of deal that allows a distraught mother to lift up the car or truck beneath which her kid is pinned. And it doesn’t matter. It’s small beans compared to what happens next. Because when a group of men led by Dale, Beez, and Doc burst into the Winnebago (Wendell is at the rear of this group), they find nothing but a single overturned chair and several splashes of Jack Sawyer’s blood in the kitchenette where Jack gave his little gang their final instructions. The trail of blood leads toward the rear, where there’s a foldout bed and a toilet cubicle. And there the drops and splashes simply stop. Jack and the old man who carried him in here have vanished. Doc and Beezer are babbling, almost in hysterics. They bounce between questions of where Jack might have gone to distraught recollections of the final few moments on the platform before the shooting started. They can’t seem to let that go, and Dale has an idea it will be quite a while before he can let go of it himself. He realizes now that Jack saw the woman coming, that he was trying to get his hand free of Dale’s so he could respond. Dale thinks it may be time to quite the chief’s job after all, find some other line of work. Not right now, though. Right now he wants to get Beezer and Doc away from the Color Posse, get them calmed down. He has something to tell them that may help with that. Tom Lund and Bobby Dulac join him, and the three of them escort Beez and Doc away from the Winnebago, where Special Agent Redding and WSP Detective Black are already establishing a CIP (crime investigation perimeter). Once they’re behind the platform, Dale looks into the stunned faces of the two burly bikers. â€Å"Listen to me,† Dale says. â€Å"I should have stepped in front of him,† Doc says. â€Å"I saw her coming, why didn’t I step in front â€Å" â€Å"Shut up and listen!† Doc shuts up. Tom and Bobby are also listening, their eyes wide. â€Å"That black man said something to me.† â€Å"What?† Beezer asks. â€Å"He said, ? ®Let me take him there may still be a chance.’ â€Å" Doc, who has treated his share of gunshot wounds, gives a forlorn little chuckle. â€Å"And you believed him?† â€Å"Not then, not exactly,† Dale says. â€Å"But when we went in there and the place was empty â€Å" â€Å"No back door, either,† Beezer adds. Doc’s skepticism has faded a little. â€Å"You really think . . . ?† â€Å"I do,† Dale Gilbertson says, and wipes his eyes. â€Å"I have to hope. And you guys have to help me.† â€Å"All right,† Beezer says. â€Å"Then we will.† And we think that here we must leave them for good, standing under a blue summer sky close to the Father of Waters, standing beside a platform with blood on the boards. Soon life will catch them up again and pull them back into its furious current, but for a few moments they are together, joined in hope for our mutual friend. Let us leave them so, shall we? Let us leave them hoping. ONCE UPON A TIME IN THE TERRITORIES . . . ONCE UPON A TIME (as all the best old stories used to begin when we all lived in the forest and nobody lived anywhere else), a scarred Captain of the Outer Guards named Farren led a frightened little boy named Jack Sawyer through the Queen’s Pavilion. That small boy did not see the Queen’s court, however; no, he was taken through a maze of corridors behind the scenes, secret and seldom-visited places where spiders spun in the high corners and the warm drafts were heavy with the smells of cooking from the kitchen. Finally, Farren placed his hands in the boy’s armpits and lifted him up. There’s a panel in front of you now, he whispered do you remember? I think you were there. I think we both were, although we were younger then, weren’t we? Slide it to the left. Jack did as he was bidden, and found himself peeking into the Queen’s chamber; the room in which almost everyone expected her to die . . . just as Jack expected his mother to die in her room at the Alhambra Inn and Gardens in New Hampshire. It was a bright, airy room filled with bustling nurses who had assumed a busy and purposeful manner because they had no real idea of how to help their patient. The boy looked through the peephole into this room, at a woman he at first thought was his own mother somehow magically transported to this place, and we looked with him, none of us guessing that years later, grown to a man, Jack Sawyer would be lying in the same bed where he first saw his mother’s Twinner. Parkus, who has brought him from French Landing to the Inner Baronies, now stands at the panel through which Jack, hoisted by Captain Farren, once looked. Beside him is Sophie of Canna, now known in the Territories as both the Young Queen and Sophie the Good. There are no nurses in the sleeping chamber today; Jack lies silent beneath a slowly turning fan. Where he is not wrapped in bandages, his skin is pale. His closed eyelids are hazed with a delicate purple bruise-blush. The rise and fall of the fine linen sheet drawn up to his chin can hardly be seen . . . but it’s there. He breathes. For now, at least, he lives. Speaking quietly, Sophie says, â€Å"If he’d never touched the Talisman â€Å" â€Å"If he’d never touched the Talisman, actually held it in his arms, he would have been dead there on that platform before I could even get close to him,† Parkus says. â€Å"But of course, if not for the Talisman, he never would have been there in the first place.† â€Å"What chance has he?† She looks at him. Somewhere, in another world, Judy Marshall has already begun to subside back into her ordinary suburban life. There will be no such life for her Twinner, however hard times have come again in this part of the universe and her eyes gleam with an imperious, regal light. â€Å"Tell me the truth, sir; I would not have a lie.† â€Å"Nor would I give you one, my lady,† he tells her. â€Å"I believe that, thanks to the residual protection of the Talisman, he will recover. You’ll be sitting next to him one morning or evening and his eyes will open. Not today, and probably not this week, but soon.† â€Å"And as for returning to his world? The world of his friends?† Parkus has brought her to this place because the spirit of the boy Jack was still lingers, ghostly and child-sweet. He was here before the road of trials opened ahead of him, and in some ways hardened him. He was here with his innocence still intact. What has surprised him about Jack as a grown man and touched him in a way Parkus never expected to be touched again is how much of that innocence still remained in the man the boy has become. That too is the Talisman’s doing, of course. â€Å"Parkus? Your mind wanders.† â€Å"Not far, my lady; not far. You ask if he may return to his world after being mortally wounded three, perhaps even four times after being heart-pierced, in fact. I brought him here because all the magic that has touched and changed his life is stronger here; for good or ill, the Territories have been Jack Sawyer’s wellspring since he was a child. And it worked. He lives. But he will wake different. He’ll be like . . .† Parkus pauses, thinking hard. Sophie waits quietly beside him. Distantly, from the kitchen, comes the bellow of a cook lacing into one of the ‘prentices. â€Å"There are animals that live in the sea, breathing with gills,† Parkus says at last. â€Å"And over time’s long course, some of them develop lungs. Such creatures can live both under the water and on the land. Yes?† â€Å"So I was taught as a girl,† Sophie agrees patiently. â€Å"But some of these latter creatures lose their gills and can live only on the land. Jack Sawyer is that sort of creature now, I think. You or I could dive into the water and swim beneath the surface for a little while, and he may be able to go back and visit his own world for short periods . . . in time, of course. But if either you or I were to try living beneath the water â€Å" â€Å"We’d drown.† â€Å"Indeed we would. And if Jack were to try living in his own world again, returning to his little house in Norway Valley, for instance, his wounds would return in a space of days or weeks. Perhaps in different forms his death certificate might specify heart failure, for instance but it would be Wanda Kinderling’s bullet that killed him, all the same. Wanda Kinderling’s heart shot.† Parkus bares his teeth. â€Å"Hateful woman! I believe the abbalah was aware of her no more than I was, but look at the damage she’s caused!† Sophie ignores this. She is looking at the silent, sleeping man in the other room. â€Å"Condemned to live in such a pleasant land as this . . .† She turns to him. â€Å"It is a pleasant land, isn’t it, sirrah? Still a pleasant land, in spite of all?† Parkus smiles and bows. Around his neck, a shark’s tooth swings at the end of a fine gold necklace. â€Å"Indeed it is.† She nods briskly. â€Å"So living here might not be so terrible.† He says nothing. After a moment or two, her assumed briskness departs, and her shoulders sag. â€Å"I’d hate it,† she says in a small voice. â€Å"To be barred from my own world except for occasional brief visits . . . paroles . . . to have to leave at the first cough or twinge in my chest . . . I’d hate it.† Parkus shrugs. â€Å"He’ll have to accept what is. Like it or not, his gills are gone. He’s a creature of the Territories now. And God the Carpenter knows there’s work for him over here. The business of the Tower is moving toward its climax. I believe Jack Sawyer may have a part to play in that, although I can’t say for sure. In any case, when he heals, he won’t want for work. He’s a coppiceman, and there’s always work for such.† She looks through the slit in the wall, her lovely face troubled. â€Å"You must help him, dear,† Parkus says. â€Å"I love him,† she says, speaking very low. â€Å"And he loves you. But what’s coming will be difficult.† â€Å"Why must that be, Parkus? Why must life always demand so much and give so little?† He draws her into his arms and she goes willingly, her face pressed against his chest. In the dark behind the chamber in which Jack Sawyer sleeps, Parkus answers her question with a single word: Ka. Epilogue SHE SITS BY his bed on the first night of Full-Earth Moon, ten days after her conversation with Parkus in the secret passageway. Outside the pavilion, she can hear children singing â€Å"The Green Corn A-Dayo.† On her lap is a scrap of embroidery. It is summer, still summer, and the air is sweet with summer’s mystery. And in this billowing room where his mother’s Twinner once lay, Jack Sawyer opens his eyes. Sophie lays aside her embroidery, leans forward, and puts her lips soft against the shell of his ear. â€Å"Welcome back,† she says. â€Å"My heart, my life, and my love: welcome back.† April 14, 2001 How to cite Black House Chapter Twenty-nine, Essay examples

Character Analysis Lady Macbeth free essay sample

Set in 1603, Shakespeare’s play, Macbeth, follows the life of what started out to be a normal married couple. When the couple, Macbeth and Lady Macbeth, discover from a prophecy that Macbeth would one day rule the land of Scotland, the two did everything in power to make sure this would come true. The couple devised a plan to murder Duncan, the current king of Scotland; Macbeth carried out this plan. With this newfound immense amount of royal power, Macbeth and Lady Macbeth go through several challenges in their relationship. Throughout Shakespeare’s play, Macbeth, there are significant changes in the way the audience perceives Lady Macbeth when considering her power, brutality, and physical characteristics. Comparing the beginning to the end of the play, it is apparent that Lady Macbeth is very different when considering her power. In the beginning, it appears as if Lady Macbeth was the superior in her relationship with Macbeth. At this period of time, man being inferior to woman was found to be very unusual. In a sense, Lady Macbeth was the â€Å"man† of the relationship. While debating whether or not Macbeth should kill Duncan, Lady Macbeth says, â€Å"When you durst do it, then you were a man; and to be more than what you were, you would be so much more the man† (Shakespeare 43). This line expresses Lady Macbeth’s opinion that Macbeth will only be a true man if he follows through with the murder; until then, Lady Macbeth would question his manhood. By using this line, Lady Macbeth has total control over her husband and can basically get him to do whatever she may ask. On the other hand, Macbeth seemed to turn around and take steps toward being the â€Å"bigger man† in their relationship as the play unfolded. With his immense amount of power, Lady Macbeth had no choice but to go with his superiority. An example of Lady Macbeth’s weakness was when she was conversing with the doctor and said, â€Å"Out, damned spot, out I say! One. Two† (Shakespeare 163). This quote explains how Lady Macbeth was obsessive over washing her hands, in other words, she was trying to get rid of the guilt of Duncan’s Murder. This section of the play shows Lady Macbeth’s significant change of weakness. As a weak woman, she succumbs herself to Macbeth’s power. In sum, Lady Macbeth went from being a powerful wife to a meaningless woman within the play. Another change the audience sees in the play is Lady Macbeth’s brutality. At the beginning of the play, she was the mastermind of Macbeth’s violent endeavors (Duncan’s Murder). When the two were plotting Duncan’s murder, it was Lady Macbeth who conveyed Macbeth to follow through; he was about to back out of the plan, as he did not want to commit such crime. When Macbeth was pondering the idea of failure, Lady Macbeth was quick to respond, â€Å"We fail? But screw your courage to the sticking place and we’ll not fail† (Shakespeare 43). This quote shows that Lady Macbeth was the one with confidence in their situation at hand. Towards the end of the play, it was Macbeth who was the mastermind behind his devious plans. Macbeth develops a sense of anxiety over Banquo, as he was the only one who suspected Macbeth had anything to do with Duncan’s Murder. Macbeth makes plans to kill Banquo, â€Å"Our fears in Banquo stick deep, and in his royalty of nature reigns that which would be feared† (Shakespeare 85). Macbeth was making these plans with two murders that he hired; not lady Macbeth. With the guilt of Duncan’s murder, it is doubtful that Lady Macbeth would offer support to Macbeth’s plan, given the opportunity, but Macbeth had purposely left her out of his plans. Now that he was king, he no longer needed assistance from his â€Å"housewife†. This just goes to show that Lady Macbeth went from being a brutal organizer of murder to a wife that has no part of her Husband’s secret life. Throughout Macbeth there are several observable changes in the physical being of Lady Macbeth. Though she may appear the same when focusing on her physical appearance, there are several physical changes in her mental health. At the beginning of the play, Lady Macbeth seemed to be a typical put together woman. At the end of the play, she virtually became a psychiatric patient who was in desperate need of mental healthcare. A doctor was consulted, but even the doctor knew there was nothing that could be done to save Lady Macbeth. While the doctor observed Lady Macbeth in her sleep, Lady Macbeth exclaimed â€Å"Here’s the smell of the blood still. All the perfumes of Arabia will not sweeten this little hand†¦Wash your hands† (Shakespeare 163-5). The doctor responds to the gentlewoman, â€Å"This disease is beyond my practice†¦So, good night. My mind she has mated, and amazed my sight. I think but dare not speak† (Shakespeare 165). This line shows the astonishment the doctor faces while observing Lady Macbeth. Her illness had reached a level of severity that a doctor could not even fix. Therefore, Lady Macbeth experiences many changes in her physical health throughout Macbeth. Macbeth is a very dense read with a lot of information and different characters. However, the changes in Lady Macbeth were very significant. Though the story concluded with her tragic death, Macbeth put his wife through countless situations that no woman should have to live through. She went from being the brains behind a murder to observing her husband committing several ruthless crimes. She also went from being a strong healthy woman to a woman with severe mental health issues. Throughout Shakespeare’s play, Macbeth, there are significant changes in the way the audience perceives Lady Macbeth when considering her power, brutality, and physical characteristics. Works Cited Shakespeare, William. Macbeth. N. p. : Folger Shakespeare Library, 1992. Print.

Social Media HIPAA Essay Example

Social Media HIPAA Essay Social Media HAIFA Jacqueline Ford Healthcare Compliance Increasing privacy violations is more evident than ever. Usage of Social Media to network between friends, colleagues, and family is at an all-time high. Cellophanes or smartness are used not only to communicate socially, but also professionally. More innovative are cellophanes and portable tablets with high megalith cameras built-in, to instantly share a real-time event(s). For example: a loved one delivering a baby; a witness to an accident; injuries and/or wounds, Just to name a few. This is occurring daily not only with civilians, but healthcare workers; especially those who witness graphic or invasive procedures not normally seen to the average Joe. Unfortunately, some healthcare workers have no medical conscious; and for those who disclose patient information online can find themselves in violation of patient privacy laws like the Health Insurance Portability and Accountability Act, also known as HAIFA. We will write a custom essay sample on Social Media HIPAA specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Social Media HIPAA specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Social Media HIPAA specifically for you FOR ONLY $16.38 $13.9/page Hire Writer If caught, this can result in not only getting disciplined or fired, but being subject to fines of up to $250,000 and even a prison sentence. Another potential active consequence is an investigation and discipline by the professionals state board. But that threat hasnt stopped some medical professionals from posting confidential patient information online without permission. Some recent examples of social networking HAIFA breeches include these violations in Healthcare: A nurse who posted a patients picture and chart on his Faceable page because he thought it was funny and since it was only Faceable, there was no real harm in it A doctor who treated a patient over Twitter Emergency room personnel who posted pictures on the Internet of a man being rated for fatal knife wounds A doctor who asked a patient on a date after seeing her profile on a dating website A Rhode Island doctor was fired from the hospital and reprimanded by the Medical Board after she posted on her Faceable page about a long day at work. She never referred to the patients name but gave out enough details about the injuries to allow others to guess who it was. Although these are extreme examples of social networking gone wrong, even seemingly innocuous behaviors like writing about work on a blob, befriending a patient n a social networking site or taking a photo with a cellophane can lead to HAIFA Phoenix, on December 19, 2007; Dry. Adam Hansen, chief resident of general surgery at Mayo Clinic Hospital, admitted that he took a picture of a patients penis prior to surgery. Strip club owner Sean Dubious has a tattoo on the top of his penis that reads: Hot Rod. Hansen had admitted to Dubious that he took the picture with his cell phone while the patient was unconscious being prepped for gallbladder surgery. One of the primary purposes of the Health Insurance Portability and Accountability Act is to make it an actual federal offense for anybody to release any information about any patient without their written consent. Yet violations of HAIFA are only misdemeanors. Hansen is presently practicing as a Thoracic Surgeon at United Hospital Center in West Virginia. In order to address the growing problem of HAIFA violations by medical professionals, a company that develops mobile solutions is creating technology that will monitor social media sites to find HAIFA violations and evaluate the severity of the privacy breeches, which will help a medical facility take appropriate action. Some medical schools are also doing their part to help solve the problem by giving future doctors tips on how to conduct themselves professionally online, as well as examples of people in the profession who have made serious mistakes on social networking sites. According to a one professional In the current health care environment, we do not need to look any further than our nightly news program or daily paper to understand that health care costs have risen precipitously over the past decade and are on a similar path for the coming years unless we do something drastic to reverse he trend (p. 33). Mr.. Sullivan statement does bring a vital point, what drastic measures can be taken to keep patient privacy, private? With the ease and magnitude of the misuse of our social network technology; only a clear, well-defined and widely disseminated social networking policy that emphasizes compliance responsibilities during both work and non-work hours, and in using both company computer systems and any other devices with access to the Internet, is an employers most effective weapon against liability for employee misuse of social networking sites. From a reflections standpoint, operating social media to enhance your health organization can be accomplished in a compliant way.

How to Conjugate Remettre (to Put Back, Replace)

How to Conjugate Remettre (to Put Back, Replace) The French verb remettre means to put back or to replace. It is an irregular verb. How to Conjugate the Verb Remettre While remettre does not follow the conjugation pattern of a regular verb, it is conjugated the same way as all French verbs ending in -mettre.  The following charts will help you memorize the simple conjugations for remettre. Present Future Imperfect Present participle je remets remettrai remettais remettant tu remets remettras remettais il remet remettra remettait nous remettons remettrons remettions vous remettez remettrez remettiez ils remettent remettront remettaient Subjunctive Conditional Pass simple Imperfect subjunctive je remette remettrais remis remisse tu remettes remettrais remis remisses il remette remettrait remit remt nous remettions remettrions remmes remissions vous remettiez remettriez remtes remissiez ils remettent remettraient remirent remissent Imperative (tu) - remets (nous) - remettons (vous) - remettez How to Use Remettre in the Past Tense The most common way to put something in the past tense in French is to use the passà © composà ©. It is a compound tense requiring an auxiliary verb and a past participle. For remettre, the auxiliary verb is avoir and the past participle is remis. For example: Elle a remis le jus dorange.She replaced the orange juice. Ils ont remis les livres.They put back the books.

Compare & Contrast Edgar Allen Poe's The Tell Tale Heart and The Fall Essay

Compare & Contrast Edgar Allen Poe's The Tell Tale Heart and The Fall of the House of Usher - Essay Example â€Å"†¦found myself, as the shades of the evening drew on, within view of the melancholy House of Usher. I know not how it was - but, with the first glimpse of the building, a sense of insufferable gloom pervaded my spirit. †¦I looked upon the scene before me - upon the mere house, and the simple landscape features of the domain - upon the bleak walls - upon the vacant eye-like windows - upon a few rank sedges - and upon a few white trunks of decayed trees†¦Ã¢â‚¬  (Baym/Poe, 1553) Against this gloomy background we are introduced to the narrator who remains nameless as is the narrator in The Tell-Tale Heart. In typical Gothic fashion The Fall of the House of Usher’s narrator introduces a striking contrast. He is about to enter the gloomy house with a view to bringing some cheer to his friend, Roderick Usher’s melancholic mood. (Byam/Poe, 1553) True to Gothic form Poe has succeeded in introducing us to a subliminal element. This is a subliminal element in that the reader will not hesitate to latch onto as a false sense of security, expecting brightness and a cure to the malady afflicting Roderick Usher. This is a typical technique of Gothic writers. (Punter, 116) The Gothic element of fear is set up in a different way in The Tell-Tale Heart. The narrator first introduces us to fear that has been instilled in him as a result of the physical condition of an old man’s eye which he described as: â€Å"One of his eyes resembled that of a vulture -- a pale blue eye with a film over it. Whenever it fell upon me my blood ran cold, and so by degrees, very gradually, I made up my mind to take the life of the old man, and thus rid myself of the eye for ever.†(Baym/Poe, 1589) Both tales describe madness in a similar nature. Although in The Fall of the House of Usher, madness is viewed as a malady to be cured while in The Tell-Tale Heart madness is viewed with optimism. Usher who is a hypochondriac complains of having an over sensitivity to sight and sound

Spotless Laundry Essay Example | Topics and Well Written Essays - 5000 words

Spotless Laundry - Essay Example This implies that new customers can be created. These new customers would be people previously doing their own laundry or using services of conventional laundry shops. The capital employed would come from personal equity and a very small portion will consist of loans. This is because in the initial stages of operations, it’s almost impossible to get financing from financial intermediaries. Our mission is to provide high quality, fast and reliable laundry and pressing services that would give the customer the value of their time and money. We will strive for the complete satisfaction of our clients and work on building long-lasting relationships with them. The Laundry and Cleaning industry in Dubai, UAE is more prices focused and gives importance to quality and service than was some years back. The current laundry industry in UAE has the potential of about 0.5 billion USD per year1. New projects are coming up in the next two years, i.e. 2010 and 2011, with better technologically advanced equipment. The hotels in Dubai have mostly outsourced their laundry services to small companies specializing in this. Laundry industry costs have risen over the years due to high labor and utilities (water, fuel, power) costs. Hence, efficient machinery is crucial for laundry companies so they can reduce these recurring costs and charge low prices to customers. Based on the descriptors in Annexure 1- Industry Maturity Guide, the Laundry and Cleaning Industry can be analyzed as to which stage in the Industry Maturity Cycle it belongs to. As per our analysis, it falls in between the late growth and very early maturity stage (Annexure 2 –Industry Maturity Cycle). Strengths: The start-up firm’s fast, door-step service with a polite and well mannered ‘way’ of giving the service is what will be the differentiating point for Spotless Laundry. The vans of the

Difference between men and women in the workplace Essay

Difference between men and women in the workplace - Essay Example (Wirth, N.D.). It is thus increasingly found that a handful of women tend to occupy the managerial positions on a global scale in comparison to men. In this context the paper makes an inference into the causes, which has led to the emergence of gender disparity in the managerial positions. One of the key reasons behind the under representation of women at managerial positions of big corporations is the age factor. It is often seen that the women employees competing for managerial positions tend to be quite young which act as an obstacle in letting them occupy senior positions. The male managers quite old and experienced are found to have a steady access to such positions. It is seen in a global context that women tend to occupy a mere 20 percent of the total global workforce. It is also found that the gender gap widens proportionately to the increase in job responsibility. (Wirth, N.D.). In recent times the society has developed itself from the past in letting women gain access to better education and in revision of social customs like early marriages promoting development of the women race. This in turn has made women capable of applying to managerial positions. Yet, women who become married find it much harder to reach the managerial pinnacle in spite of having the required capabilities. The reason behind such a pitfall is their need to address both the family and their career simultaneously. Need to rear their children coupled with other family needs act as an obstacle in the path of progress. (Wirth, N.D.). In other cases, the organizations are constituted in a manner as to provide a male image to the senior positions of the company. To fulfill the above criteria the interview board takes conscious decisions to impart a picture of gender bias while selecting personnel for the senior post. (Broughton & Miller, March, 2009).

Decrease Ventilator Associated Pneumonia

Decrease Ventilator Associated Pneumonia Patients on ventilator support are very prone to respiratory infections. These patients have no means or control over what enters their lungs or what does not. One prevalent infectious process that can occur in these patients is ventilator associated pneumonia (VAP), and affects many patients every year who require ventilator support. Ventilator associated pneumonia is a form of pneumonia, a lung infection, which occurs in mechanically ventilated patients. It develops at least 48 hours or more after the ventilator is utilized (Powers, 2006). Ventilator associated pneumonia is caused by bacterial organisms entering the patients lower respiratory tract usually by aspiration of oral pharyngeal secretions. The bacteria colonize within the lungs causing immune response or infection to occur (Powers, 2006). The development of this infection can lead to a decline in the patients outcome and increased healthcare cost to the patient as well as the health care facility (Mori, 2006). With all t hese problems VAP can produce it is important to the patient as well as healthcare providers to be able to find ways to reduce the development of VAP cases in patients. The purpose of this paper is to determine if routine oral care can decrease the incidence of ventilator associated pneumonia in mechanically ventilated patients. The picot question guiding this paper is what effect does routine oral care have on the incidence of ventilator associated pneumonia rates in mechanically ventilated patients. Background and Significance Ventilator associated pneumonia is a serious infection affecting both the patient, healthcare facility, and staff. It is the second most common healthcare-acquired infection (Koening, 2006). Incidence of VAP is estimated as high as 65% and it occurs in up to 28% of patients who have been on the ventilator 48 hours or longer (Powers, 2006). The mortality rate associated with VAP ranges from 12-50% (Sona et al, 2009). Studies on the mortality rates of VAP also show that patients who develop VAP have a 2.2 to 4.3 times higher risk of death compared to other mechanically ventilated patients who do not have pneumonia (Powers, 2006). A couple affects that VAP has upon the patient and healthcare facility are time of hospitalization and healthcare costs. Ventilator associated pneumonia causes the length of a hospital stay to increase significantly. It can increase the hospitalization time anywhere from four to nineteen days longer (Powers, 2006). This extra hospitalization can cause additional stress for the patient and their health. As the incidence of VAP causes longer hospitalizations to occur, patient and health care facility costs climb also. It is estimated that the average increase in hospital costs is around $57,000 per VAP occurrence (Powers, 2006). There are also increases to the hospital that occur due to increases in supplies used, staff that is utilized, and more medications used. Since VAP has such a negative impact upon patients and healthcare facilities many interventions have been tried to prevent the incidence of VAP. One intervention utilized is keeping the head of the patients bed raised to at least thirty degrees to prevent aspiration of bacteria in secretions. Another is sedation vacations which consists of interrupting the patients sedation medication until patient shows signs of alertness, to assess if patients can be weaned off the ventilator more quickly. Other notable interventions that have been utilized in the past and some in todays practice as well include: suctioning secretions, good aseptic techniques such as hand washing, and oral care (Pruitt Jacobs, 2006). Patients are continually developing VAP and having complications from the infection. If it is found that routine oral care, defined as teeth brushing with the use of an oral antimicrobial within this paper, can reduce the incidence of VAP in mechanically ventilated patients it could decrease length of hospital stay, keep costs due to incidence of VAP down for both patient and healthcare institution, as well as decrease mortality rates in these patients. Clinical Question Ventilator associated pneumonia occurs way too often in the hospital setting. It causes significant stress on the patients already problematic health status. The writer of this paper has observed many nurses who are vigilant in providing oral care to ventilated patients, but has also observed other nurses who forego oral care as if it not important and has no affects upon the patients health. This made the writer question what the actual effectiveness of oral care has upon reducing the incidence of ventilator associated pneumonia in mechanically ventilated patients. This issue is very relevant to nursing because the ultimate goal of a nurse is to help the patient have the best possible outcome. Trying to achieve the best possible outcome for the patient makes infection control is a very high priority for nurses. Patients who have infections are more prone to get other infections and require more nursing care and more time to recover from their illnesses. Although VAP will continue to occur in patients, and oral care is not a cure for ventilator associated pneumonia, there is valuable information included in research studies included within this paper that shows the incidence of VAP can be reduced in mechanically ventilated patients by implementing routine oral care. Empirical Review 1 The purpose of the first study, conducted by Sona et al, 2005 was to determine the effect of a routine oral care protocol upon incidence of ventilator-associated pneumonia. The research design was a quantitative, experiment, quasi-experimental study which utilized a non-equivalent control group before and after the design. The study had no conceptual framework stated by the researchers. Within the study, the variables of significance to the clinical question being looked at were the routine oral care protocol and the ventilator-associated pneumonia rates. The independent variable of new oral care protocol was defined as the mechanical cleansing of the teeth or gums to remove plaque with a tooth brush and the application of an oral antimicrobial. The study went on to further discuss the protocol as brushing the teeth for one to two minutes with a regular toothbrush and then applying .12% chlorahexidine to all oral surfaces every twelve hours. The dependent variable was the ventilator associated pneumonia rates. It was defined as a common hospital acquired infection and is the leading cause of death in ICU patients who are ventilator dependent. Ventilator associated pneumonia rates were measured using the National Nosocomial Infections Surveillance System (NNIS) criteria.The reliability nor the validity of this instrument was addressed within the study. Another variable that was studied was length of stay. This was just measured by the number of days that the patient spent within the ICU after a ventilator associated pneumonia infection occurred (Sona et al., 2009). This study took place at Barnes Jewish Hospital on a 24 bed intensive care unit (Sona et al., 2009). The study focused particularly on patients that were admitted to the surgical intensive care unit (SICU) whom required mechanical ventilation. The subjects consisted of all patients who had mechanical ventilation between June 1, 2003 and May 31, 2005. Subjects were chosen using non-probability convenience sampling. The pre-intervention was implemented for patients that were admitted between June 1, 2003 and May 31, 2005. The size of this sample was 777 patients. The pre-intervention phase consisted of standard care the nurse provided to the patients, no changes were provided during this time; only observation took place. One month before the end of the pre-intervention phase all nursing staff working on the SICU were debriefed and educated on the aims of the study as well as the new routine oral care protocol by two clinical nurse specialists and a nurse educator. This was to help pre vent discrepancies in the intervention. During the post intervention phase of the study which took place between June 2004 until May 2005 the sample size consisted of 871 patients who were all nil per os (NPO) (Sona et al., 2009) On June 1, 2004 the new routine oral care protocol was implemented (Sona et al., 2009). The intervention/protocol consisted of the nurse brushing the teeth of the patient for one to two minutes with a regular toothbrush, rinsing the mouth with water and suctioning it out, and then using 15 mL of .12% chlorahexidine to cleanse the mouth. The intervention was repeated every 12 hours by the registered nursing staff. Compliance of the protocol was estimated to be around 90% and the implementation was carried out for 12 months before results were analyzed(Sona et al., 2009). For this study the level of significance was expressed using p-values. A p value of less than .05 was considered significant (Sona et al., 2009). For the data analysis, two statistical tests were used: The Mantel-Haesnel Chi Squared . After the analysis of data, it was determined that p=.04 showing that the routine oral care protocol did cause a significant reduction in the ventilator-associated pneumonia rates within the subjects studied. The pre-intervention rate for VAP was 5.2 infection per 1000 ventilator days while post-intervention rate for VAP showed 2.4 infections per 1000 ventilator days (Sona et al., 2009). Other statistics for the study showed the patients number of days the patient was on ventilator was decreased(Sona et al., 2009). From the statistical analysis within the study, the researchers derived certain findings and conclusions (Sona et al., 2009). One of the findings was that the post intervention group had trends toward shorter time on the ventilator, as well as length of hospital stay. The main finding within the study found that when the routine oral care protocol was being utilized, the rates of ventilator-associated pneumonia were significantly decreased. The researcher makes it a point to state that although the finding suggests that the implementation of the protocol reduces rate of VAP this cannot be proven (Sona et al., 2009). This study is a nonrandomized controlled trial. The quality of this evidence was convincing and significant. It was a consistent study and it is considered to be of Level II quality. Certain extraneous variables that could have had an effect upon the outcome of the study, as identified by the student, could have been the condition the patient was in before the ICU admission, any pre-existing conditions that could alter health and increase the risk of infection, and the nurses attitude toward performing oral care. Although the study was a strong and consistent one, it did have both strengths and weaknesses. There were no strengths identified by the researchers. However, the student did identify some strengths within this study. One of the first strengths was the education that was given to the nursing staff prior to the implementation of the protocol. This helped the study to be more valid by increasing the continuity of the care and way the nurses performed the protocol. The other strength of the study was the design being a quasi-experimental. This is because quasi-experimental studies usually can be generalized to the population that is being studied. Weaknesses that were addressed within the study by the researchers was that the researchers themselves did not evaluate the teeth brushing portion of the intervention to make sure that the nurses were being consistent in the way they did it, and if the nurses performed it for the correct amount of time (Sona et al., 2009). This resulted in the lack of control over nursing techniques. Another weakness of the study recognized by the researcher was the study did not take into account the change in the patient population over the duration of the study (Sona et al., 2009). Some weaknesses the student identified within this study was that the study was very susceptible to bias because no blinding or masking was used within this study. Everyone knew what was occurring and this could have had the researchers looking as if the intervention helped more than it actually did. Within the study the researcher did not address if the study could be generalized. However, the writer of the paper believes that this study can be generalized. The intervention is a very simple one. Most cultures have no problems with utilizing oral care. Also, most hospitals have intensive care units and/or ventilator dependent patients which were the population within the study. This intervention within the study does not have a lot of risks. The only risks mentioned were possible tooth staining from the antimicrobial and poor taste (Sona et al., 2009). Also, this intervention is very feasible. To implement oral care there is no special training needed, although education should be provided. The oral care routine is a relatively quick intervention that takes no more than 5 minutes to implement, which would allow nurses with busy schedules to still be able to perform the intervention. Also, this intervention is very low cost compared to the cost of ventilator associated pneumonia c ases. Therefore, the cost-benefit ratio would be a great benefit to health-care facilities. This study suggests that oral care can be very effective in decreasing the incidence of ventilator-associated pneumonia rates. Although a very valid study, one study is not enough evidence to implement a new protocol into a nurses practice. One must look for more studies and literature to support the finding in order to attempt to implement it into practice. The next study that was appraised by the writer of this paper seems to support the findings that were found in this study. Empirical Review 2 The next study examined by the writer of this paper was a research study conducted by Mori et al.,2005. The purpose of the study was to determine if oral care of mechanically ventilated patients contributed to the prevention and reduction of the incidence of ventilator associated pneumonia (Mori et al., 2005). The research design utilized for this study was a quantitative, experimental, quasi-experimental which used a non-equivalent before and after approach. Within the study the researcher did not state any theoretical framework to guide the study. The study was not randomized, and used a non-probability convenience sample method (Mori et al., 2005). The research study took place on a medical/surgical intensive care unit in an urban university hospital which was not named by the researcher (Mori et al., 2005). The population of interest was ventilator dependent patients with tracheal intubation. Since subjects were chosen by convenience sampling, they were chosen as they became available on the unit. Inclusion criteria for subjects were that they must have been receiving mechanical ventilation and have tracheal intubation. Exclusion criteria for the study were patients whose conditions contraindicated oral care, patients with severe bleeding tendencies, or patients with iodine allergies. The sample for the oral care group was patients admitted to the intensive care unit between January 1997 and December 2002, and consisted of 1,248 patients. The sample for the non-oral care group, or the control, was patients admitted during January of 1995 until December of 1996; this sample size was 414 subjects (Mori et al., 2005) For this study, the independent variable was the oral care being delivered (Mori et al., 2005). This variable was defined as cleansing of the oral cavity three times a day by nursing employees following the specified new protocol. The protocol was that the nurse would check the patients vital signs and then do oral suctioning, followed by positioning the patients head to the side to prevent asphyxiation and determine the condition of the oral mucosa. After this the nurse would clean the mouth with a 20-fold diluted solution of providone-iodine gargle (antimicrobial). Then the use of a standard toothbrush was used to brush the teeth; the patients mouth was rinsed with water. Directly following the brushing and rinsing, the providone-iodine was utilized again by swabbing the mouth and teeth. Finally, oral suctioning was done one final time. The dependent variable in the study was the incidence of ventilator associated pneumonia. This variable was defined as a hospital-acquired pneumoni a that becomes present after 48 hours of the patient being mechanically ventilated. Ventilator associated pneumonia was suspected if patch infiltrates were present upon the patients chest x-ray and two of the following were present: a temperature of 100.4 degrees Fahrenheit, white blood cell count of 10,000 m3 or higher, or purulent respiratory secretions were observed. A definite diagnosis of ventilator associated pneumonia, which was used for evidence of the incidence in this study, was determined by trancheobronchial secretion cultures showing a result of 1+ or more. Other variables were duration of hospitalization defined as length of stay measured by the number of days and the causative agent of the pneumonia identified by bacterial cultures (Mori et al., 2005). Reliability and Validity of the cultures and radiography used to measure if ventilator associated pneumonia was present and causative agent were not addressed within the study by the researcher, so the validity is unkno wn.

The Silence of the Lambs by Thomas Harris Essay example -- Thomas Harr

The Silence of the Lambs by Thomas Harris The novel The Silence of the Lambs by Thomas Harris is said to fall under the genre of psychological horror. The stories that fall under the genre of horror include a few essential elements: a villain or one seen as evil to create an initial story line. The foil is the next element; a foil is a person who tries to stop the villain from going through with the evil plan or plot. These two elements naturally lead to conflict between the two persons or groups and then from this conflict -- suspense, the last element is added. Suspense is important to keep the reader interested and to keep the story line going. When psychology is added to a story, the definition of horror is changed completely. There are still those few essential elements above but there is also a few more added. The story now has something to do with the mind and how it works, and there is really no definition for that. The mind and it's workings are a mystery to us and that mystery of the mind adds to the suspense and t herefore the idea of psychology and horror are able to go together and become one. This essay will prove that The Silence of the Lambs is indeed a psychological horror according to the five criteria above along with other sources. The first element to a psychological horror is a villain, and the villain is The Silence of the Lambs is Mr. Jame Gumb. He is a white male in his mid thirties, 'most serial killers are white male, unemployed, intelligent and experience financial difficulty.';(Bonata, 3) Gumb is all of these things, he is unemployed but a very skilled seamstress, and using these skills is making himself a second skin out of women who he is able to take control of and render them powerless. He is also very intelligent but is anable to interact with other people and therefore remains unemployed. He experienced financial difficulties until he was the recipient of a large sum of money from an inheritance. 'The unconscious fear of women goads some men with a compulsive urge to c onquer, humiliate, hurt, or render powerless some available sample of womanhood.'; (Menninger, 183) Gumb was deeply disturbed and unable to overcome the death of his mother and he wanted to be like her and resented any woman because he feels that he should have been born a woman instead of the man that he is. He is sewing a skin of women to try to beco... .... The closing of the case did not come without suspense however. Through the entire book there was some sort of suspense weather it concerned Buffalo Bill, the actions of Hannibal Lecter, or the situation that Clarice Starling was in. The last seven chapters are the most suspenseful chapters of the story. They deal with the capture and killing of Jame Gumb, the rescuing of the prisoner that he held hostage and finally the freeing of Clarice Starling from the 'screaming of the lambs';. Clarice starling murders Jame Gumb and his prisoner is set free with a few minor injuries. Clarice Starling finally finds peace within her and is able to enjoy life to the fullest and she owes it all the Dr. Hannibal Lecter. The location of Lecter is left unknown which leave the reader without a final closing further adding to the suspense of the novel. Novels in the genre of psychological horror are said to have the elements listed above. This essay has proven that the elements are indeed in the novel The Silence of the Lambs and therefore the novel is a psychological horror. The elements listed above are found through out the novel and are just a few of the many instances in which they occur. The Silence of the Lambs by Thomas Harris Essay example -- Thomas Harr The Silence of the Lambs by Thomas Harris The novel The Silence of the Lambs by Thomas Harris is said to fall under the genre of psychological horror. The stories that fall under the genre of horror include a few essential elements: a villain or one seen as evil to create an initial story line. The foil is the next element; a foil is a person who tries to stop the villain from going through with the evil plan or plot. These two elements naturally lead to conflict between the two persons or groups and then from this conflict -- suspense, the last element is added. Suspense is important to keep the reader interested and to keep the story line going. When psychology is added to a story, the definition of horror is changed completely. There are still those few essential elements above but there is also a few more added. The story now has something to do with the mind and how it works, and there is really no definition for that. The mind and it's workings are a mystery to us and that mystery of the mind adds to the suspense and t herefore the idea of psychology and horror are able to go together and become one. This essay will prove that The Silence of the Lambs is indeed a psychological horror according to the five criteria above along with other sources. The first element to a psychological horror is a villain, and the villain is The Silence of the Lambs is Mr. Jame Gumb. He is a white male in his mid thirties, 'most serial killers are white male, unemployed, intelligent and experience financial difficulty.';(Bonata, 3) Gumb is all of these things, he is unemployed but a very skilled seamstress, and using these skills is making himself a second skin out of women who he is able to take control of and render them powerless. He is also very intelligent but is anable to interact with other people and therefore remains unemployed. He experienced financial difficulties until he was the recipient of a large sum of money from an inheritance. 'The unconscious fear of women goads some men with a compulsive urge to c onquer, humiliate, hurt, or render powerless some available sample of womanhood.'; (Menninger, 183) Gumb was deeply disturbed and unable to overcome the death of his mother and he wanted to be like her and resented any woman because he feels that he should have been born a woman instead of the man that he is. He is sewing a skin of women to try to beco... .... The closing of the case did not come without suspense however. Through the entire book there was some sort of suspense weather it concerned Buffalo Bill, the actions of Hannibal Lecter, or the situation that Clarice Starling was in. The last seven chapters are the most suspenseful chapters of the story. They deal with the capture and killing of Jame Gumb, the rescuing of the prisoner that he held hostage and finally the freeing of Clarice Starling from the 'screaming of the lambs';. Clarice starling murders Jame Gumb and his prisoner is set free with a few minor injuries. Clarice Starling finally finds peace within her and is able to enjoy life to the fullest and she owes it all the Dr. Hannibal Lecter. The location of Lecter is left unknown which leave the reader without a final closing further adding to the suspense of the novel. Novels in the genre of psychological horror are said to have the elements listed above. This essay has proven that the elements are indeed in the novel The Silence of the Lambs and therefore the novel is a psychological horror. The elements listed above are found through out the novel and are just a few of the many instances in which they occur.

Frq Apush Farmers vs Industrialization Essay

The Gilded Age, a time of industrious growth and a surge of new immigrants. Americans had witnessed the death of rural life dominated by farmers and the birth of an urban and industrial America dominated by bankers, industrialists, and city dwellers. Overproduction led farmers into debt leaving them just an overflow of crops due to the repressed prices. Tariff Policies forced farmers to buy manufactured goods for survival. Farmers lost their status and power due to industrialization. Let’s just say farmers felt betrayed by their government and not letting them have voice. Overproduction was the most vexing problem during this time. The American farmer produced too much for their own good. As levels rise, the use of farm machinery increased it allowed the farmer to grow even more, new farming techniques, and the spread of railroads l made markets full of produce. As more and more crops were in the markets, it made the prices fall for the produce. Farmers were growing more and making less money. Of all the problems a farmer faced, overproduction was the gravest. Not making enough to recoup expenses because of depressed crop values, farmers attempted to compensate by producing more. This made the problem worse. The lack of income drove farmers into ever-deepening debt. Farmers fell victim to a tariff policy of the U.S. during the Gilded Age. It forced them to buy all the manufacture goods they needed for survival on a market protected by tariff legislation at high prices while selling what they produced on an unprotected market at reduced prices because of oversupply and foreign competitors. The government put a tax on the manufactured goods being imported into the U.S. by other manufactures. They hoped to make them more expensive than the American goods. For consumers would buy American goods. During this process it made American rapidly industrialized. Famers felt doubly discriminated against because they felt the tariffs were applied primarily to manufactured goods while their interests were left to fend for themselves. One of the hardest impacts due to industrialization for farmers was that they had to deal with the recognition that rural and agricultural America was given way to an urban and industrialized American. Dominated by the interests of big business, and government. Famers found the major political parties during the time unresponsive to their demands that government deal with their problems. Farmers no longer controlled the social, economic, or political systems. Which was a constant struggle for them to be heard, and did not feel appreciated. Farmers were impacted by industrialization in many ways causing many problems. Making a huge amount of them very unhappy during the Gilded Age.

Descartes Meditations essays

Descartes Meditations essays Descartes meditations are based on the epistemological theory of rationalism: that is if someone truly knows something then they could not possibly be mistaken. He provides solid arguments for what his meditations stand for, and how he obtained a clear and distinct perception of "innate" ideas. In his Meditations he comes to terms with three certainties: the existence of the mind as the thing that thinks, the body as an extension, and God as the Supreme Being. Descartes is interested in the certainty of his existence and the existence of other people and things. Descartes argues that knowledge is acquired through awareness and experience. Using this approach, Descartes moves through doubt to certainty of his existence. He asks himself various questions about the certainty of his existence and solves them through clear thought and logic. Using this method Descartes establishes doubts to be truths, and he establishes that he does indeed exist. In this paper, I will show how Descartes moves through doubt to certainty. I will explain how Descartes uses the cogito, proves the existence of God and what that means to his existence. I will also discuss the general rules of truth that Descartes establishes. In the First Meditation Descartes begins to examine what is certain and what is doubtful. Descartes wants to establish that his knowledge is certain and not doubtful. He states, I had accepted many false opinions as being true, and that what I had based on such insecure principles could only be most doubtful and uncertain; so that I had to undertake seriously once in my life to rid myself of all opinions I had adopted up to then, and to begin, and to begin afresh from the foundations, if I wished to establish something firm and constant in the sciences. By this Descartes means that he wishes to establish a foundation for his knowledge based on certainty instead of doubt. Descartes first looks at the senses. This is important ...

My Identity Inheritance essays

My Identity Inheritance essays I have determined myself to be a star-bellied sneetch. I am a white, heterosexual male. Even though I do not follow a particular religion, I am still considered to be part of a dominant group. Ive grown up in a middle class environment, which has given me opportunities that subordinate group members usually do not receive. Although I am not tall, classically good looking, or in top physical shape, my identity will continue to provide me an edge at a good life. My father, who is of mainly Irish descent, doesnt like talking about his family for personal reasons. For my family tree, I decided to interview my mother instead. She has more knowledge about her mothers side than her fathers, so that is what Ill be writing about today. The Oelholf's immigrated to the United State from Germany near the end of the 19th century. The German family brought their young son, Fred, who is my great great grandfather. Farming was their trade. They settled in the small rural community of Spencerville, Ohio. There they grew corn and soybeans while also raising livestock. The Oelholf family made a good living in agriculture. They got along well with neighbors because of their strong work ethic and Protestant beliefs. Fred took over the farm as his father grew too old to work. He married and raised four children, and to each he left a section of the farm. One of those children, William, is my great grandfather. William worked hard while growing up on the farm. When his number was called, he went overseas and fought in World War I. Luckily, he came home alive. He continued the family business of farming, and thrived. William married Nondis, a woman of English descent, who bore six children. While being a homemaker, Nondis also made arts and crafts which she sold to the community. Nondis and Williams first child was John, or as he was better known, Johnny. I dont have a lot of details about...

Marketing 2 Assignment Example | Topics and Well Written Essays - 500 words - 1

Marketing 2 - Assignment Example g undertaken also they designed teaser campaign for the firm’s rebranding process also a graphic was released which showed the repealing of old and evolution of a new identity on ’01.01.01’ (date of launch)(Rebranding and Repositioning a global brand. 29 legal firms all around the world were coming up with marketing strategies and advertisements which repeatedly captured the rebranding of Andersen Consultancy and the idea that firm was evolving into a bigger and better place. Through this extensive research and massive marketing the firm transferred its brand equity from Andersen to Accenture which itself was derived from two words ‘assent’ and ‘future’, the idea of providing more and broader services than ever before. (Accenture) (Accenture, 2002) A. The shift in the Brand name as mentioned previously was a result of a legal decision which if not handled properly might have resulted in the collapse of a giant of that time. This rebranding was not a result of an innovation or anything. Criteria to evaluate the new brand name revolved around the question, that what innovation was the firm offering after this huge makeover. Business reengineering, Business Integration, Specialist in Technology, More and broader services, Masters in the field and Leaders of Future were the six agenda’s set by the firm at the time of rebranding. In the light of these criteria Accenture is the perfect fit for the company since its name in itself speaks of future and is innovative in nature too. The conversion was no less then reengineering and transforming the firm into a whole new platform, for people to look up to with a guarantee of receiving the best at their footsteps. (Accenture, 2002) A. Accenture used this opportunity of renaming itself to reposition the brand in a whole new dimension. While this process of repositioning was undertaken the company and its legal and marketing advisors kept this fact in mind that the services of consulting being performed by the

The Confession of Saint Patrick Essay Example | Topics and Well Written Essays - 1000 words

The Confession of Saint Patrick - Essay Example He narrates the story of his life from his childhood through to adulthood and right up to the time before his death. This account by St. Patrick gives us an insight into the background of the prevailing times and also lending focus to the legends and the myths that shrouded his personality. This biographical account is edited by Whitely Stokes and was compiled by Beatrix Fà ¤rber and Benjamin Hazard. The language used by the author was Latin. His father was Calpornius, who was a deacon in an era much before celibacy became the rule for priests. He was a Romanized Briton. Patrick’s mother came from an upper-class Gaulish family of Martin of Tours, though Patrick does not pride himself for the fact. As time gradually rolled by, Patrick’s enslavement had a great impact on him and strengthened his faith in the Christian religion. At the very impressionable age of sixteen, he admitted in his ‘Confessions’ that he was captured and brought to Ireland to serve as a slave to a Druidic chieftan named Milchu in Dalriada, at the County Antrim. But at the age of twenty two he escaped from there and once again reunited with his parents at Britain where later he became ‘one of the first Christian clergymen in Ireland, being preceded by men such as Pallidius (c.380-457/61). His first convert was his patron Dichu, who gifted him a huge barn (sabhal) where a church was constructed and the site still retains the name of Sabhal that is pronounced as â€Å"Saul.† In Ireland, Patrick was not the first Christian missionary, because much before him were missionaries like Secundus and Pallidius who continued their active work in the south of the island. But even so, Patrick is given a lot of credence as one of the best missionaries because his teachings had a great impact especially in provinces like Ulster and Connaught where there were no Christians before. He came across as a man who possessed a deep love for God and courageous enough to face

Global Network Strategies (Geography of Transport Systems) Essay

Global Network Strategies (Geography of Transport Systems) - Essay Example However, this does not mean that regional and national centers will cease to exist. Some products still require a three-tier distributing that consists of regional, national as well as international centers. Network structure is adapted in order to meet the requirements of IFT demand. This can adapt numerous forms operating at various scales. There are various strategies employed in distribution networks. The choice of one strategy over the other mainly depends on the nature of the cargo and the environment it is operated from. They include point to point distribution, corridor structures of distribution, hub and spoke networks, fixed routing networks and Flexible Routing networks. This is usually used when there is need for satisfaction of specialized and specific one time orders. This often leads to the creation of empty return problems and less than full load. This structure requires minimal logistics but the efficiency is compromised. A good example of point to point network is the point to point transportation system. This system transports containers from one location to a second address. It consists of a transport channel, propeller, operator, numerous containers and an operative communication. The controller is configured to receive instructions for transport between the locations. The controller instructs the operator, who then communicates with the propeller. The propeller moves the cargo to move from the first location to the second. It is important to have a way to between two addresses by use of a channel type system with containers moving rapidly and directly between start points and finish points. It is also important to have a way of monitoring the movement of the cargo in the system and rerouting cargo should there be any delays arise in any section of the system as well as any other complications. Moreover, it is vital to have a system which can allow various container sizes. This is what point to point distribution network offers. The size of the containers can be selected. This helps in meeting traffic and cargo constraints. A system to transport cargo within various containers from the first address to the second consists of various tracks between these addresses to engage and support plurality of the containers. The invention of point to point transportation enabled cargo transportation by the use of containers. Corridor structures of distribution These usually help in linking services, like land bridge that connect container trains to seaboards, with high density agglomerations. Loading and unloading of traffic along the corridors can be done at local and regional distribution centers that act as sub hubs in the distribution system. This is especially applicable in large transport and logistics companies (Rodrigue et al, 2006). Hub and spoke networks These have come with high throughput distribution centers and the emergence of air freight distribution. These are in great favor of parcel services. This structure is only possible if the hub is capable of handling big amounts of consignments where time is important. It requires logistics that are extensive since efficiency comes from the terminal of the hub. A main distribution cente