Trash Summary

Trash Summary Trash is an epic novel about three ordinary dumpsite boys that sort through trash for a living. One day they find a key that leads them to a train station locker. From there they start the journey of their lives. Throughout the book many characteristics are shown both good and bad. I have chosen to talk about the themes trust and resilience. I chose these topics because I think both of these were shown many times in the book and they are to things that you need in every day life. Trust is the reliance that you have on one another, the belief that someone will come through for you in a time of need.This was shown many times in the book my favourite example was when Rat, (or Jun-Jun) was there for Raphael and Gardo at the beginning of the book they needed a place to hide the wallet. At any give time he could have gone straight to the police and turned in Raphael and Gardo.. Sister Oliver’s trust, pity and innocence led her to believing the three boys lie, this ende d up putting her at great risk. Later on in the novel Gardo went back to the prison with the 20,000 pesos to give the guard for the bible.The guard tried to catch Gardo but he escaped just in time. I think this was a case where they were forced to trust the guard whether they wanted to or not, they had no option to get the bible or not. Resilience is the ability to bounce back and put up with severe amount of stress. That’s exactly what these boys put up with for the whole book, between being chased by corrupt police and breaking into a grave these boys had amazing mental strength. The best example of this is when Raphael got taken to the police station; he was tortured, beaten and almost killed.It took lots of resilience is just there will to see there adventure all the way through to the end. At any given time they could have quite gone to the police turned the other two in and made 20,000 peso. â€Å" We will fish for ever and live happy lives. That is our plan and nothin g will stop us. † This quote said by Jun-Jun shows that the three boys trust each other to the end of the world. They would die for each other happily. They have been through so much mentally and physically that they could put up with anything. I honestly do think nothing will stop them.

Making Sex Offenders Names Public

Amanda McCloskey â€Å"Making sex offenders names public. † Making sex offenders names public does have there ups and downs but i am totally for it. Sex offenders can be men or women it does not matter about what gender the sex offenders are because either way the adult is the one who is taking the innocents of a child. In most cases the child can know there sex offender.The reasons why i think that sex offenders name should be public are, the protection of both genders and children in the area, for the sex offenders names to be out there so they have to live with what they did, so that the people from the community can prevent it from happening again. Sex offenders are very dangerous and we really don't know when they are going to do it again. The first reason why i think sex offenders names should be public is for the protection of both genders and children in the area.Men and women can both sexually abuse someone. Sometimes when your walking by someone you never really thin k to yourself that the person you just walked by can actually be a sex offender. Sex offenders names are already public but the reason i am for it is because then people actually can try to prevent it by taking there time and looking through the list of sex offenders and what the person did, who is actually by them and live close to them. Both genders can still be harmful, or even harmed.This whole topic and situation is just scary to picture and talk about but personally it needs to be out there, and the sex offenders website for your state needs to be always updated. When your a child you never think that someone can actually do something that harmful for you and it is just sad. Any person has a right to know so that they actually have a chance to protect themselves. Thats one of the reasons why i think that sex offenders name should be public. The second reason why i think a sex offenders name should be public is so sex offenders name to be out there for everyone to see and so th ey have to live with what they did.Also because they won't be able to hide if someone ask them about it, for instants trying to get a job and lying about it. The thought of being sexually offended is scary and i personally don't think anyone would want to go through that. People who are sexually offending shouldn't be afraid to tell on the person, because a lot of the people who don't tell often who did to them might do it to someone else, and if they talk they can prevent it from happening again. I don't understand how an adult can take avenge of a person knowing that it is wrong.

A Report Into Consumer Behavioural Theory

Understanding consumer behaviour allows us to engage more effectively with our target market and increase sales * It is vital we understand the needs of our target market and their motivation for purchasing Benecol or alternative products. * Giving Value to a product after we understand our consumers’ needs and motivation for purchase can increase positive interaction with our market. * When marketing a product, it is advised that the advertisement attaches itself best to the needs and value of consumers with relevant and engaging information. Creating a psychological struggle for customers as well as curing it can be vital to increase market share and customer satisfaction. * Overcoming pre-purchase alternatives to Benecol is a great challenge due to the highly saturated market the brand finds itself in, although this is not impossible as promotion of the products health benefits can lift it. * Consumers can be conditioned to relate to Benecol both consciously and unconsciously through various marketing and production techniques. Marketing strategies can be put in place which are directly or indirectly linked to the purchase or use of the product that gain short or long term boosts in sales or customer satisfaction such as sales promotions or school giveaways to promote health in children which improves brand reputation. * Taking advantage of every point of interaction between the product and the consumer can greatly increase the likelihood that a customer will become loyal to the brand and perhaps even aid the increase of market share. Introduction Consumer behavioural theory gives marketing departments the opportunity to gain a more effective understanding of the customers they have or wish to attain. The theories attached to this subject emotional, cognitive and psychological reaction to marketing and brand management. The following is a report on consumer behaviour related to the Benecol brand with the intention to gain a better organisational understanding of marketing theories and methods relevant to the specific brand. Due to the market segmentation of Benecol, the report largely aims to focus on consumer behaviour closely linked to health and food products, as well as applying more general consumer behavioural theory where relevant. As the relevant theories to consumer behaviour in the case of Benecol are outlined, recommendations will be made in order to aid the company in customer acquisition, retention and satisfaction. Motivation and Need Recognition In assembling this report it was understood that many theories of behavioural aspects of marketing are derived from an organisation’s awareness and understand of its target markets’ needs and desires and those who utilise this most effectively are often the most successful brands. For instance, Coca-Cola has no health benefits, therefore it is marketed as hedonistic product and the more its target market become increasingly health-conscious the more Coke will play on its slogan ‘enjoy’, whilst also increasing its market share in other ways, i. e. hrough the purchase of shares in drinks companies that promote health (Macalister & Teather, 2010). The need or desire that is recognised by Benecol’s products is clearly the reduction of cholesterol, the motivation for this is increased health as well as Benecol’s ease of use. The motivation for buying a product that increases the health of the consumer is self-evident in many ways. Value Theory Many researchers have suggested that consumers are ‘value driven’ and find that the enjoyment of a product is balanced between what is given and what is received (Torben, 2005). In short, this theory argues the following factors are counted when a future purchase is considered: From this, it could be argued that Benecol’s price and quality are subjective to the customer as the benefits from use of said product are only noticeable long-term and the economic cost of the range are noticeably, although not unreasonably, higher than alternatives. However, the value the product gives to the consumer from a marketing perspective will be discussed in greater details through other behavioural theories as the above chart is too rudimentary to give explicit argument to Benecol’s potential without more exploration. Information Processing Something highly intrinsic to the product value of Benecol is the emphasis on being ‘the only range of foods to contain Plant Stanol Ester, a unique cholesterol lowering ingredient. ’ (Rasio Plc. , 2011). Getting this information to the public through advertising happens through the brand website, but on television the advertising is focused on basic prompts that will motivate the audience into believing in the benefits of using the product. One example is the latest UK advert which places stress on the convenience of the product with a line in fairly small print about the plant stanol ester underneath the visual of how easy it can be to help lower cholesterol. The information of stanols is considered secondary in marketing the convenience product and therefore is only likely absorbed by those already interested in the product or the advertising. Dissonance This theory is based on a consumer’s cognitive struggle where two beliefs that are reasoned to be true are not consistent. This process of a cognitive clash brings about a motivation to come to a positive conclusion where a psychological compromise can occur to bring an end to the inconsistency, therefore ending the dissonance (Torben, 2005). By advertising the negative effects rival products can have on a consumer’s health, Benecol creates a struggle within the consumer’s mind that whilst they enjoy their regular food and dairy products, they are damaging to their health by creating large amounts of cholesterol. Benecol is then introduced as an alternative to health-damaging products that bridges the psychological inconsistencies in the consumer’s mind by offering a products that helps prevent cholesterol whilst not taking enjoyment away from eating. By offering advertisement reinforced with clinically proven information, the customer is also limited in averting the dissonance caused by Benecol’s initial information about rival product. Benecol therefore markets by initiating dissonance and then promoting a solution to end the consumer’s self-conflict. Balance Theory and Modelling This motivational theory argues that ‘people desire cognitive consistency in their drive to achieve psychological balance in their thoughts, feelings and social relationships’ (Dacko, 2008). In relation to marketing, consumer can be attracted or put off of a product due to a linked influencer even if it is not directly linked to the product, also known as modelling. For example, a woman could be attracted to an anti-wrinkle cream if she sees it endorsed by Dame Helen Mirren because she is a fan of the actress’ work and beauty. Similarly, if an organisation were thinking of using Accenture, a deal could have been negatively affected due to the unrelated infidelities of Tiger Woods, had the latter not ceased to sponsor him when they did. The theory promoted by Benecol is the trifecta of a person balancing convenience, taste and health. Ergo, Benecol is promoted as a product that does not impede on the consumer’s convenience from daily routine in preparing food, manages to taste as good as unhealthy products whilst being a product that promotes good health. Although it has done in the past with Carol Vorderman, Benecol currently does not market its product using celebrity endorsement, something that its rivals, Activia and Actimel do in the UK. Although these products are not exactly the same as Benecol, they produce many products in the same market advertising similar benefits, such as yoghurts and mini-drinks that aid well-being. Pre-purchase Alternative Evaluation This theory bases its argument on the focus that a customer makes a cognitive and emotional decision on the alternatives to the product in question before a purchase is made. Through judging the price, quality and branding of the products in question cognitively, a consumer will then make their decision based on the positive or negative effects that the previous factors will have on their life. As Benecol is marketed as an alternative to unhealthy dairy staples such as yoghurts and spreads, it is undeniable that the market that Benecol is placed in is highly competitive. Benecol spread is nearly twice as expensive as similar products including own brand olive spreads that cost under half the price for twice the weight of product (Ocado, 2011). The following is a statement from international brand analysts Datamonitor in a report for the UK dairy industry: ‘From the consumer's point of view, dairy products may be used directly as food or beverages, or ingredients for other home-made foods. There are a wide range of foods and drinks that can be used in similar ways to dairy products, so if dairy prices raise too high, it is easy for consumers to replace them with alternatives. This reduces the pricing freedom of retailers and market players. Some of the alternatives may have advantages for retailers, such as cheaper storage or higher margins. The threat of substitutes is assessed here as strong, although dairy products are important parts of most peoples' diet and are unlikely to be completely replaced’ (Datamonitor, 2008). From this we see that Benecol has the challenge to promote the positive effects it can have on a consumer’s life rather than any economic benefits it may possess, unless it was marketed in a way that suggested it could save customers money in the long-term as a prevention of high spending due to ill-health. This however is playing on consumer fear and would not be recommended as a means of increasing customer acquisition, retention or satisfaction. Classical Conditioning This theory refers to an argument that consumers can be programmed into acting without being conscious of their conditioning. Through classical conditioning it is argued that by stimulating different emotional states in a consumer through the use of marketing, product placement, packaging or use, the consumer’s approach to the product becomes altered to act immediately with a certain approach to a product that is involuntary (East, Wright, & Vanhuele, 2008). With Benecol, it could be argued that consumers are conditioned into both positive and negative emotional reactions through our marketing. The deep mint green logo surrounded by a heart blended with soft, sky blue backgrounds in our packaging and advertising is warming and few products in the same or similar markets share the same colour scheme so not only are we unique in our packaging so when customers do see similar colours, they are quickly linked back to Benecol which aids them to buy more. As mentioned in relation to other theories of consumer behaviour, fear plays a large part in motivating one to purchase an item which promotes health. Although as a company it would not be ethical to play on fear to boost sales, there is no denying the very real possibility that consumers are motivated to purchase goods when they are conditioned to understand that not doing so could lead them to health problems down the line.

Buddhism Essay Example | Topics and Well Written Essays - 750 words - 3

Buddhism - Essay Example From the holy book, chapters 16–20 are devoted to nirvana and the path to enlightenment (Buddharakkhita 6–23). According to the teachings, the events that a person is subjected to are an outcome of the thoughts he or she has formed. Hatred should not lead to hatred, for it never causes hatred to cease but only by love. It is important to control one’s senses, and not only seek controlled pleasures or be immoderate in one’s food since such behavior will only cause Mara the Tempter to overthrow such person. Whether one is a monk or a householder, it is important to remove evil and sinful thoughts. Ethics seems to be a strong point in the teachings and drive home the benefits of good and sinless living, as compared to sinful living where one only has evil thoughts. The evil doer always thinks of the evil he has done, and these thoughts continue to haunt him even in his sleep, and deprive him of the simple pleasures in life since he is always thinking about ev il, retribution, and the acts that others would take on him. A person who is free from such thoughts would be free from evil intentions and subsequently be free from hatred, desire, and evil (Buddharakkhita 30–63). According to Lord Buddha, a wise man does not pass arbitrary judgements but reaches them after deep thought. To be called an elder and not just a vain old man, one must show truthfulness, restraint, self-mastery, virtue, and inoffensive behaviour, and should be free from defilements (Buddharakkhita 64–65). Lord Buddha also says that a person must be watchful in using his speech, control his mind and not commit evil. Lust, affection, and desire are bondages that tie a man to sin and wrongdoing, so they must be cut off. The evil embodiments are defined by craving, or the mother, self-conceit that is the father of evil desire, eternalism and nihilism that are the two warrior kings, and sense organs and objects that are the country. Once these evils are destroye d, the person is ready to be on the road to salvation. Disciples of Gotama are those who happy and non-violent, who practice mindfulness of the body, who have the qualities of the sangha, dhamma and Buddha, and those who constantly meditate (Buddharakkhita 66–75). A wise man must come to realize that by renouncing a lesser happiness, one can achieve a greater happiness. One should avoid being entangled by bonds of hate since cancers of the mind only increase for people who are arrogant and heedless. It is important that one always be on guard since opportunity can slip by, and it is better to walk alone if the company that one finds is not made of virtuous people. The current of craving flows everywhere and includes sensual pleasure, annihilation, and continued existence. It is essential that one free himself from these cravings (Buddharakkhita 78–87). How Do Moral Expectations of a Buddhist Monk Differ from the Morality of a Lay Buddhist? The Buddhist monk is one who has given up all worldly pleasures and seeks nirvana, or the path of salvation. The laity, or the lay Buddhist, is one who still has a family and looks after his household. While the rules for the monk are strict and need stringent self-restraint, those for the laity are more of behavioral nature. Differences are given as below. A monk must practice restraint and show extreme control in his actions and attitude. Accordingly, the monk should restrain oneself in the eye,

Public law Essay Example | Topics and Well Written Essays - 1500 words - 1

Public law - Essay Example According to Dicey, â€Å"The principle of Parliamentary Sovereignty means neither more nor less than this, namely that Parliament thus defined [i.e., as the ‘King in Parliament’] has, under the English constitution, the right to make or unmake any law whatever; and, further, that no person or body is recognised by the law of England as having a right to override or set aside the legislation of Parliament† (as cited in Eleftheriadis, 2009). Hence, one can say that parliament alone has the power to make laws. It also has the immunity in that none can change the laws made by it. In Jackson v Attorney-General [2005] UK HL 56, Lord Steyns approved an argument put forward in 1935. He said that the monarch and the two Houses (Lords and Commons) must consent to legislate. Parliament can spread legislative powers in various ways. This was redefining parliament for a specific purpose and could not be ignored (Carroll, 2013. P. 105). In Pickin v British Railways Board [1974 ] AC 765, it was noted that though parliament had not followed procedure, it could not be compelled to investigate the allegation. (ibid, p. 102). 1. The EU Referendum Bill and Parliamentary Sovereignty of UK â€Å"The constitutional referendum is often conceptualised as the ultimate institutional expression of popular sovereignty’’  (Daly, 2013). ... If no party receives an absolute majority, the future of the referendum could be in jeopardy. Only if the orders are passed through parliamentary assent can the referendum be conducted at the stipulated time. In the past, many amendments were proposed to EU Treaty bills. This resulted in the demand for referendum for such amendments. The Conservatives were of the opinion that the EU was intruding into various aspects of life. Hence, they supported a ‘referendum lock’ which would validate future EU association by the citizens (European Union Referendum Bill, 2013). The EU provided its members an ‘opt-out option’. However, this was cast in an all or nothing terms. This was to discourage UK and such members who took the matter lightly. The Treaty demands that opt-out decision should be taken at least six months prior to the end of the transition period allowed. The Tory Eurosceptics were in favour of no opting back. They were of the opinion that co-operation wi th other European countries could be possible through international arrangements on a case-by-case basis (Craig, 2013, p. 172). Sovereignty is closely related to state power. The state maintains sovereignty in that it has the power and authority to enact laws by which it can serve the national interest. Member states desired international co-operation in foreign & security policy, justice & home affairs. In such sensitive matters, they prefer inter-governmentalism, hence retaining control in their own hands. Nevertheless, EU needs to involve itself since crime and terrorism have a cross-border nature. Hence, state autonomy will have to be sacrificed in such matters as the price for resolving serious issues of global concern. The European Arrest Warrant (EAW) is a case in point. EAW

Macro Essay Example | Topics and Well Written Essays - 500 words - 2

Macro - Essay Example Normally the PPF does not shift inward. Theoretically PPF can shift inward if there is a decline in the factor endowment or a decline in technology or both. But in reality it is possible in the abnormal situations such as disaster or war when the endowment declines. The above statement can be explained by using an example. We consider a country having two sector agriculture and industry. Here we consider that the maximum of the industries are small scale and cottage industries. If the country engages itself in free trade then it would certainly be an exporter of agricultural product. The producers of agricultural product would enjoy better price in the global market. On the other hand the foreign industries are more cost efficient so they can supply industrial products at a lower price. The consumers of the domestic economy would be benefitted and the income of the country would also rise. But the small scale and the cottage industries would face foreign competition. That would hamper the interest of the owners of such industries. Hence the economy would face welfare gain while the owners of industry would be worse off. Absolute Advantage: Let us consider that in country i the amount of labor required to produce 1 unit of j is given as Lij. For all i=A,B and j=X,Y. Now if we find LAX LBY we can say that country A enjoys absolute advantage in production of X and B in Y. If the countries are subject to perfect competition, full employment and perfect mobility of factors within the domestic boundary A should specialize completely in production of X and Bin Y. Free trade would be mutually beneficial. Comparative Advantage: Theory of comparative advantage emerged to answer the question â€Å"If one of the two countries enjoys absolute advantage over the other in both lies of production should there be any chance of mutually

The Fold Theory Essay Example | Topics and Well Written Essays - 2000 words

The Fold Theory - Essay Example Deleuze finds the existence of the soul in the body; however, since there is no way for the exiting of the same, he justifies the statements made by his predecessor philosophers’ opinions regarding the place of the soul in the upper dark chamber of the body, diversified by folds, i.e. the mind. Deleuze also cites Focillon, where he submits to state that the latter viewed Baroque Gothic as the birth of the mystical experience, which is actually the long voyage of the soul within various parts of the vast and endless universe. Hence, the body remains confined to one specific zone or area, where it is actually present, while soul seeks no limits and boundaries for traveling and can reach everywhere it wants to move. On the contrary, the body remains silent to some extent and requires permissions and efforts in order to change its place. Deleuze declares Leibniz as the first philosopher to define and elucidate the mystical and mathematical dimensions in his work. He also states th at the world is made up of monads and divergent series, which can be compared to the folds. Consequently, it can be examined by keeping in view the infinity of pleats and creases of unified and dispersed matter. Deleuze has also discussed plastic forces in an analytical manner by presenting the examples of organism or living matter, where artificial is always inferior to the real one. It is because of the very fact that plastic cannot perform altogether in such a way as the living matter, though it is more machinelike than mechanical.

Paper Assignment Essay Example | Topics and Well Written Essays - 1500 words

Paper Assignment - Essay Example (e) Presidential vote closely reflects voters’ party loyalties and is not influenced by whether an incumbent is running in a district or how much money the local candidates spend. (+) Districts that voted at least 10 percentage points more Democratic than the nation were classified as safe Democratic; districts that voted at least 10 percentage points more Republican than the nation were classified as safe Republican; districts that were within 5 percentage points of the nation were classified as competitive. (a) House district have become less competitive, but not because of redistricting. Most of the change has occurred between redistricting cycles. For the same reasons that states and counties have become less competitive- Americans are increasingly voting for candidates who reflect those values. (e) on the county level-number of counties dominated by one party and the proportion of voters living in such counties have increased dramatically over the several past decades. Also, growing ideological polarization at the elite level has made it easier for voters to choose a party identification on the basis of their ideological preferences. (+) Polarization=sorting, as voters bring their policy and partisan preferences into alignment (a)Growing financial advantage enjoyed by incumbents also contributes to the low level of competition in recent congressional elections. (e) It now costs over a million dollars to wage a competitive campaign for a U.S. House seat. (+) Most incumbents can raise that kind of money easily, but very few challengers can (they lack the financial resources needed to wage competitive campaigns). The most vulnerable- those in districts that were more supportive of the opposing party’s presidential candidate than the nation. Claims that redistricting does have an effect on the number of competitive congressional districts and, as a case study of redistricting institutions in Arizona illustrates, the choice of redistricting

Role of government Essay Example | Topics and Well Written Essays - 500 words

Role of government - Essay Example In the 19th century, the government had little concern about the economy of the country. The government only ensured that its people had sufficient food and basic necessities (Zeckhauser and Leebaert 84). However, current governments are concerned with the improvement of the economy. The government takes the responsibility of funding projects that will benefit the citizens an also generate income to the nation. Unlike the olden governments, the current government also invests in other nations so that the country has a larger income. The government facilitates international trade that has an economic benefit for the nation. The changes have come as a result of the economic competition between countries and the desire for development. The government protects the rights of all people regardless of their race or gender. Current governments are focused on gender and race equalities and hence the laws that are developed and enforced have a lot of respect for gender and race equality. This has come up as a result of modernization and evolvement of cultures. The government plays a vital role in enforcing rights and freedoms of its citizens. The governments of the 19th century favored the natives, but the situation has long changed due to the pressures for equality. The modern governments are very helpful in preparation for disasters and offer a lot of help when natural disasters hit (Zeckhauser and Leebaert 171). The current governments have implemented programs and set up departments that deal with natural disasters. Through such departments, the government is able to help its people during disasters. The situation was different during the 19 century since technology levels were low, and the government roles were not well defined. Programs such as the FEMA have been developed specifically to ply for the needs of the citizens during disasters. The government has made an improvement in its role in the medical and education sectors. In the past, the role

Should the middle east countries depend on the oil for their economy Essay

Should the middle east countries depend on the oil for their economy - Essay Example As the vast oil reserves were discovered, the economy or group of economies experienced significant changes in various macro-economic aspects (TÃ ©treault). From business point of view, oil is not only a fuel but also an object for trade. Many authors and academicians agreed that it a very important source of foreign exchange and contributor to economic development. Middle East’s aggregate oil reserves are accountable for approximately 66% of total oil supply in the world. Monopoly in oil industry has resulted in wealth creation at a rapid pace in majority of countries in the region. Apart from the vast reserves, another reason behind oil monopoly of Middle Eastern (ME) countries is that these countries have been a great support to the world economy during major oil and energy crisis in 1979-81 and 1985-86. However, the oil industry is also a reason of economic misery in the ME region, it has resulted in power intervention, political corruption and militarization (TÃ ©treault; Toft 7265-7274). Oil is considered as a resource of paramount importance in domestic as well as international economic and political environment from importers’ as well as exporters’ point of view. While oil is the main source of economic development and global recognition for ME countries, the ME economy does suffer from various disturbances as a cost of owning the largest reserve of the lucrative resource. It was observed during the study that the oil wealth has created national economic distortion and imbalance in power and wealth distribution. Keeping in view the disadvantages of oil as a source of economic development, the paper presents arguments against the heavy dependence of ME economy on oil as a source of economic sustenance. The primary reason behind tremendous importance of oil in the Middle East is its role in the world economy. Oil is a source of national importance not only to small developing economies but also to major developed economies such as

Product Cost and Budgetary Control Methodologies and Systems Essay

Product Cost and Budgetary Control Methodologies and Systems - Essay Example The budgetary control systems controls costs through the preparation of budgets, comparing actual performance with the budget. This allows the managers to act upon the budget and results in order to attain maximum profitability (FAO, 2010). Over the last two decades the computer world is changing how companies operate and report. The need to incorporate computerized systems in every business aspects is still ongoing research. Budget information systems and product cost systems are analysed in this report, their benefits and challenges they pose. The product cost and budgetary control methodologies and systems There are two budget control methodologies i.e. the budgets and the budgetary control. The budget is the formal statement that represents the projected financial resources that are needed to undertake business activities. Budgetary control on the other hand is a technique and a tool that is used by management to compare the budget with the actual performance. Any discrepancies a re then acted upon either by revising the budget or exercise control action. The budget information system (BIS) BIS has been in use for the last 25 years having been used for budgetary needs in schools, cities and even countries. BIS integrates all the budget functions into one single application. These functions are capital budgets, human resources, operations, performance measures, reports and producing final budget documents. The system provides all the necessary features for maximizing the efficiency of the budget process. BIS is software that interfaces with the finance, personnel and payroll departments. It then condenses the historical data into database structures. This enhances performance in strategic planning, reporting, document processing, capital planning and improvements. Benefits of BIS The system improves overall performance by enhancing planning process. The system reduces errors hence planning is made easier and effective. The use of BIS accelerates the speed wit h which comparison of data is undertaken. It enables accurate tracking of costs in the system. The system quickens the budget preparation process hence few hours are spent in this process. Use of the BIS lowers the number of personnel needed for database management. To implement BIS in an organisation, there is need for training the involved staff. This is enhanced through videos materials, online sites, documents that come with the softwares and use of experts. The system can be customized to meet the individualized needs of a company i.e. application process, reports format and document processing. Different computer softwares are used for the BIS depending on the manufacturing company. However aspects of budgeting can be incorporated in one single software or broken down into budget softwares separately, control aspects, comparison parts etc. It is highly recommended for the company to incorporate the single application software of BIS. It may be expensive and complicated but wit h enough training and customer support from the producing company, the system is easy to use. The product cost is defined as the cost of direct labour, direct materials and direct overheads utilized in the production process. These costs are incorporated in the budget process and actual results compare for any variances. The product cost system sets out the process for accounting for the organisation’s product costs for the purpose of producing information

PharmaCARE Essay Example for Free

PharmaCARE Essay PharmaCARE (We CARE about YOUR health ®) is one of the world’s most successful pharmaceutical companies, enjoying a reputation as a caring, ethical and well-run company that produced high-quality products that saved millions of lives and enhanced the quality of life for millions of others. The company offers free and discounted drugs to low-income consumers, has a foundation that sponsors healthcare educational programs and scholarships, and its CEO serves on the PhRMA board. PharmaCARE recently launched a new initiative, We CARE about YOUR world ®, pledging its commitment to the environment through recycling, packaging changes and other green initiatives, despite the fact that the company’s lobbying efforts and PAC have successfully defeated environmental laws and regulations, including extension of the Superfund tax, which was created by Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Based in New Jersey, PharmaCARE maintains a large manufacturing facility in the African nation of Colberia, where the company has found several â€Å"healers† eager to freely share information about indigenous cures and an abundance of Colberians willing to work for $1.00 a day, harvesting plants by walking five (5) miles into and out of the jungle carrying baskets that, when full, weigh up to fifty (50) pounds. Due to the low standard of living in Colberia, much of the population lives in primitive huts with no electricity or running water. PharmaCARE’s executives, however, live in a luxury compound, complete with a swimming pool, tennis courts, and a golf course. PharmaCARE’s extensive activities in Colberia have destroyed habitat and endangered native species. Two (2) years ago, after PharmaCARE’s research indicated that one of its top-selling diabetes drugs might slow the progression of Alzheimer’s disease, its pharmacists began reformulating th at drug to maximize the effect. In order to avoid FDA scrutiny, PharmaCARE established a wholly-owned subsidiary, CompCARE, to operate as a compounding pharmacy to sell the new formulation to individuals on a prescription basis. CompCARE set up shop in a suburban office park near its parent’s headquarters, and to conserve money and time, did a quick, low-cost renovation and designated Allen Jones to run the operation’s â€Å"clean room.† CompCARE benefited from PharmaCARE’s reputation, databases, networks, and sales and marketing expertise, and within six (6) months had the medical community buzzing about AD23. Demand soared, particularly among Medicare,  Medicaid, and VA patients. Seeing the opportunity to realize even more profit, CompCARE began advertising its services and the availability of AD23 to consumers and marketing the drug directly to hospitals, clinics, and physician offices, even though compounding pharmacies are not supposed to sell drugs in bulk for general use. To get around this technicality, CompCARE encouraged doctors to fax in lists of bogus patient names. As production increased and hours were extended, one of Allen’s techs pointed out what appeared to be mold around the air vents. Allen immediately contacted the facilities’ supervisor, who came over to inspect the lab. As time went on, workers began coughing, sneezing, and getting headaches at work, and one employee, Donna, who had a perfect attendance record, got so sick she could no longer come to work due to chronic bronchial problems. Eventually, she filed for worker’s compensation. Allen’s best supervisor, Tom, threatened to complain to OSHA about the air quality in the lab, and one of the techs, Ayesha, filed an EEOC complaint alleging she had not been promoted to supervisor because she was a Muslim; in fact, although Ayesha was a very good worker, Allen did not believe she had the management or people skills necessary to be a good supervisor. Allen discussed these issues with his boss, the Director of Operations, who told Allen that if he wants to keep his job and receive his promised bonus, he needs to fire Donna, Tom, and Ayesha, and keep his own mouth shut about the mold and the bogus prescriptions. As CompCARE and its parent company enjoyed record profits and PharmaCARE’s stock price approached $300 per share, reports started filtering in that people who received AD23 seemed to be suffering heart attacks at an alarming rate. The company ignored this data and continued filling large orders and paid huge bonuses to all the executives and managers, including Allen, who, after being named â€Å"Employee of the Year,† was beginning to miss production schedules due not only to his staff’s increasing use of sick leave, but also his own health issues. PharmaCARE sold CompCARE to WellCo, a large drugstore chain, just weeks before AD23 was publicly linked to over 200 cardiac deaths. Both PharmaCARE and WellCo saw their stock price plummet.

Nurse Strategies to Prevent Elderly Suicide Attempts

Nurse Strategies to Prevent Elderly Suicide Attempts Investigation into nurse strategies to prevent or minimise attempted suicide in patients aged 65 and over. Abstract This dissertation considers the rationale for positive nurse-based intervention in consideration of issues relating to suicide in the elderly. The introduction sets the context, including the historical context, of the issues and discusses the negative effects of ageism on issues relating to suicide in the elderly. The literature review considers selected texts which have been chosen for their specific relevance to the issue and particularly those that espouse the view that ageism is counter productive to a satisfactory quality of life outcome for the elderly person. Conclusions are drawn and discussed with specific emphasis on those measures that are of particular relevance to the nursing profession whether it is in a secondary care facility, a residential home setting or in the primary healthcare team and the community. We can observe, from a recent paper (O’Connell H et al. 2004), the comments that, although there is no doubt that the elderly present a higher risk of completed suicide than any other age group, this fact receives comparatively little attention with factors such as media interest, medical research and public health measures being disproportionately focused on the younger age groups (Uncapher H et al. 2000). Perhaps we should not be surprised at the fact that both suicidal feelings and thoughts of hopelessness have been considered part of the social context of growing old and becoming progressively less capable. This is not a phenomenon that is just confined to our society. We know that the Ancient Greeks tolerated these feelings in their society and actively condoned the option of assisted suicide if the person involved had come to the conclusion that they had no more useful role to play in society (Carrick P 2000). Society largely took the view that once an individual had reached old age they no longer had a purpose in life and would be better off dead. In a more modern context, we note the writings of Sigmund Freud who observed (while he was suffering from an incurable malignancy of the palate: It may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear. (cited in McClain et al. 2003) We would suggest that one of the explanations of this apparent phenomenon of comparative indifference to the plight of the elderly in this regard is due to the fact that the social burden of suicide is often refered to in purely economic terms, specifically relating to loss of social contribution and loss of productivity. (Brechin A et al. 2000). This purely economic assessment would have to observe that the young are much more likely to be in employment and less likely to be a burden on the economic status of the country whereas with the elderly exactly the converse is likely to be true. This results in economic prominence being give to the death of a younger person in many reviews. (Alcock P, 2003). There is also the fact that, despite the fact that we have already highlighted the increase in relative frequency of suicide in the elderly, because of the demographic distributions of the population in the UK, the absolute numbers of both attempted suicides and actual suicides are greater in the younger age ranges and therefore more readily apparent and obvious. The elderly are a particularly vulnerable group from the risk of suicide. In the industrialised world males over the age of 75 represent the single largest demographic group in terms of suicide attempts. Interestingly (and for reasons that we shall shortly discuss) although there is a general trend of increasing suicide rate with age the excess rates associated with the elderly are slowly declining in the recent past (Cattell 2000). We can quantify this statement by considering the statistics. If we consider the period 1983 to 1995 in the UK then we can show that: The suicide rates for men reduced by between 30% and 40% in the age groups 55–64, 65–74 and 75–84 The rates for the most elderly men (males over 85 years) remained fairly static, this group still having the highest rates of any group By way of contrast, the 25- to 34-year-old male group exhibited a 30% increase in suicide rate during the same period, this group are becoming the group with the second highest rate, while the 15- to 24-year-old male group demonstrated a 55% increase in suicide rates. (WHO 2001) Female suicide rates have shown a similar overall decrease, reducing by between 45 and 60% in the 45–84 age group. Elderly women, however, retain the highest rates throughout the life span (Cattell 2000) The ratio of male to female elderly suicide deaths remains approximately 3:1 (Fischer L R et al. 2003) We can suggest that these trends in reduction of suicide, particularly in the elderly are likely to be due, amongst other things, to: The improved detection of those at risk together with the advent of aggressive treatment policies relating to mental illness in the elderly. (Waern M et al. 2003) One of the main reasons, we would suggest, for this obviously changing pattern and the discrepancies in the suicide rates between the age ranges, is the fact that, in direct consideration of the context of our topic, the elderly are more likely to be both amenable to professional help and also, by virtue that a higher proportion are likely to be in direct contact with healthcare professionals either through failing health or nursing homes and hospitals, (Suominen K et al. 2003), have the warning signs of impending suicide recognised and acted upon more promptly than the younger, arguably more independent age group. In specific consideration of the elderly group we should also note that attempted suicide is more likely to be a failed suicide attempt rather than a parasuicide. (Rubenowitz E et al. 2001). There is considerable evidence that the incidence of depression is increased in the presence of a concurrent physical illness (Conwell Y et al. 2002) and clearly this is going to be more likely in the elderly age group. Some sources have cited association rates of between 60-70% of major depression with physical illness in the over 70yr olds. (Conwell Y et al. 2000). Another significant factor is that it is commonly accepted that an attempted suicide is a strong independent risk factor in the aetiology of further suicide attempts. (Conwell Y et al. 1996) This trend is much more marked in the elderly group with a ratio of about 4:1 which compares very badly with the ratios in the younger age groups of between 8:1 and 200:1 (depending on age range, definition and study). (Hepple J et al. 1997) In this dissertation it is intended to gain evidence based knowledge of the scope and significance of the phenomenon of attempted suicide in the elderly. In addition it is intended to gain evidence based knowledge in the use of strategies to ameliorate attempted suicide in the elderly to highlight gaps in the literature available and to suggest recommendations for change in nursing practice It is hoped to be able to suggest areas for research into the phenomenon of attempted suicide in the elderly. The initial strategy was to undertake a library search at the local post graduate library and the local university library (Client: you might like to personalise this) on the key words â€Å"suicide, elderly, prevention strategies, industrialised societies†. This presented a great many papers. About 40 were selected and read to provide an overview of the literature in this area. During this phase, references were noted and followed up and key literary works were assimilated. The bulk of the papers accessed and read were published within the last decade, however a number of significant older references were also accessed if they had a specific bearing on a particular issue. The most significant references were accessed and digested. The dissertation was written referencing a selected sub-set of these works. To increase nurses knowledge and understanding of attempted suicide in the older age group and to highlight through the literature review, evidence based strategies that an be employed to ameliorate attempted suicide amongst the elderly. Literature review Before commencing the literature review, it is acknowledged that the literature on this subject is huge. The parameters of the initial search have been defined above. In addition it should be noted that there is a considerable literature on the subject of assisted suicide which has been specifically excluded from these considerations The literature base for suicide in the elderly is quite extensive and provides a good evidence base for understanding, appropriate action and treatment. (Berwick D 2005) One of the landmark papers in this area is by Hepple and Quinton (Hepple J et al. 1997) which provided a benchmark, not only on the aetiology of the subject, but also in the long term outcomes, which, in terms of potential nursing care input, is extremely important. The paper points to the fact that there is a good understanding of the absolute risk factors for suicide in the elderly but a comparative lack of good quality follow up studies in the area. It set out to identify 100 cases of attempted suicide in the elderly and then follow them up over a period of years. The study was a retrospective examination of 100 consecutive cases of attempted suicide that were referred to the psychiatric services over a four year period. The authors were able to make a detailed investigation (including an interview of many of the survivors), about four years later. Their findings have been widely quoted in the literature. Of particular relevance to our considerations here we note that they found that of the 100 cases identified, 42 were dead at the time of follow up. Of these, 12 were suspected suicides and five more had died as a result of complications of their initial attempt. There were 17 further attempts at suicide in the remaining group. Significantly, the twelve women in the group all made non-lethal attempts whereas all five of the men made successful attempts. The authors were able to establish that the risk of further attempts at suicide (having made one attempt) was in excess of 5% per year and the â€Å"success† rate was 1.5% per year in this group. From this study we can also conclude that the risk of successful repeat attempted suicide is very much greater if the subject is male. The authors were also able to establish that, because of their initial attempt, those at risk of self harm were likely to be in contact with the Psychiatric services and also suffering from persistent se vere depression. We can examine the paper by Dennis (M et al. 2005) for a further insight into the risk factors that are identifiable in the at risk groups. This paper is not so detailed as the Hepple paper, but it differs in its construction as it is a control matched study which specifically considered the non-fatal self harm scenario. The study compared two groups of age matched elderly people both groups had a history of depression but the active study group had, in addition, a history of self harm. The significant differences highlighted by this study were that those in the self harm group were characterised by a poorly integrated social network and had a significantly more hopeless ideation. This clearly has implications for intervention as, in the context of a care home or warden assisted setting, there is scope for improving the social integration of the isolated elderly, and in the domestic setting community support can provide a number of options to remove factors that mitigate towards soci al isolation. This would appear to be a positive step towards reducing the risk of further self harm. The O’Connell paper (O’Connell et al. 2004) is effectively a tour de force on the pertinent issues. It is a review paper that cherry-picks the important information from other, quite disparate, studies and combines them into a coherent whole. It is extremely well written, very detailed, quite long and extremely informative. While it is not appropriate to consider the paper in its entirety, there are a number of factors that are directly relevant to our considerations here and we shall restrict our comments to this aspect of the paper. In terms of the identification of the risk factors associated with attempted suicide in the elderly, it highlights psychiatric illnesses, most notably depression, and certain personality traits, together with physical factors which include neurological illnesses and malignancies. The social risk factors identified in the Dennis paper are expanded to include â€Å"social isolation, being divorced, widowed, or long term single†. The authors point to the fact that many of the papers refered to tend to treat the fact of suicide in reductionist terms, analysing it to its basic fundamentals. They suggest that the actual burden of suicide should also be considered in more human terms with consideration of the consequences for the family and community being understood and assessed. (Mason T et al. 2003) In terms of nursing intervention for suicide prevention, we note that the authors express the hypothesis that suicidality exists along a continuum from suicidal ideation, through attempted suicide, to completed suicide. It follows from this that a nurse, picking up the possibility of suicidal ideation, should consider and act on this as a significant warning sign of possible impending action on the part of the patient. The authors point to the fact that the estimation of the actual significance of the various prevalences of suicide varies depending on the study (and therefore the definition) (Kirby M et al. 1997). In this context we should note that the findings do not support the ageist assumptions expounded earlier, on the grounds that the prevalence of either hopelessness or suicidal ideation in the elderly is reported as up to 17% (Kirby M et al. 1997), and there was a universal association with psychiatric illness, especially depressive illness. If we consider the prevalence of suicidal feelings in those elderly people who have no evidence of mental disorder, then it is as low as 4%. It therefore seems clear that hopelessness and suicidality are not the natural and understandable consequences of the ageing process as Freud and others would have us believe. This has obvious repercussions as far as nursing (and other healthcare) professionals are concerned, as it appears to be clearly inappropriate to assume that suicidality is, in most cases, anything other than one of many manifestations of a mental illness. It also follows from this, and this again has distinct nursing implications, that suicidal ideation and intent is only the tip of the iceberg when one considers the weight of psychological, physical and social health problems for the older person. (Waern M et al. 2002) If one considers evidence from studies that involve psychological autopsies, there is further evidence that psychopathology is involved. Depressive disorders were found in 95% in one study. (Duberstein P R et al. 1994) Psychotic disorders and anxiety states were found to be poorly correlated with suicidal completion. Further evidence for this viewpoint comes from the only study to date which is a prospective cohort study in which completed suicide was the outcome measure. (Ross R K et al. 1990). This shows that the most reliable predictor of suicide was the self-rated severity of depressive symptoms. This particular study showed that those clients with the highest ratings were 23 times more likely to die as the result of suicide than those with the lowest ratings. It also noted that other independent risk factors (although not as strong), were drinking more than 3 units of alcohol per day and sleeping more than 9 hours a night. One further relevant point that comes from the O’Connell paper is the fact that expression of suicidal intent should never be taken lightly in the older age group. The authors cite evidence to show that this has a completely different pattern in the elderly when compared to the younger age groups. (Beautrais A L 2002). The figures quoted show that if an elderly person undertakes a suicide attempt they are very much more likely to be successful than a younger one. The ratio of parasuicides to completed suicides in the adolescent age range is 200:1, in the general population it is between 8:1 and 33:1 and in the elderly it is about 4:1. (Waern M et al. 2003). It follows that suicidal behaviour in the elderly carries a much higher degree of intent. This finding correlates with other findings of preferential methods of suicide in the elderly that have a much higher degree of lethality such as firearms and the use of hanging. (Jorm A F et al. 1995). The paper by Cornwell (Y et al. 2001) considers preventative measures that can be put in place and suggests that independent risk factors commonly associated with suicide in the elderly can be expanded to include psychiatric and physical illnesses, functional impairment, personality traits of neuroticism and low openness to experience, and social isolation. And of these, t is affective illness that has the strongest correlation with suicide attempts. We have discussed (elsewhere) the correlation between impending suicide and contact with the primary care providers. Cornwell cites the fact that 70% of elderly suicides have seen a member of the primary healthcare team within 30 days of their death and therefore proposes that the primary healthcare setting is an important venue for screening and intervention. It is suggested that mood disorders are commonplace in primary healthcare practice but, because they are comparatively common, are underdiagnosed and often inadequately treated (ag eism again). The authors suggest that this fact alone points to the fact that one of the suicide prevention strategies that can be adopted by the primary healthcare team. they suggest that clinicians, whether they are medically qualified or nursing qualified, should be trained to identify this group and mobilise appropriate intervention accordingly. Obviously the community nurses can help in this regard as they are ideally placed to maximise their contact with vulnerable and high risk groups. We have identified the role of a major depressive illness in the aetiology of suicide in the elderly. Bruce (M L et al. 2002) considered the role of both reactive and idiopathic major depression in the population of the elderly in a nursing home setting. This has particular relevance to our considerations as firstly, on an intuitive level, one can possibly empathise with the reactive depressive elements of the elderly person finding themselves without independence in a residential or nursing home and secondly, this is perhaps the prime setting where the nurse is optimally placed to monitor the mood and other risk factors of the patient and continual close quarters. The salient facts that we can take from this study are that there was a substantial burden of major depressive symptomatology in this study group (13.5%). The majority (84%) were experiencing their first major depressive episode and therefore were at greatest risk of suicide. The depression was associated with comorbidity in the majority of cases including â€Å"medical morbidity, instrumental activities of daily living disability, reported pain, and a past history of depression but not with cognitive function or sociodemographic factors.† All of these positive associations which could have been recognised as significant risk factors of suicide in the elderly. Significantly, in this study, only 22% of all of the seriously depressed patients were receiving antidepressant therapy and none were receiving any sort of psychotherapy. In addition to this the authors point to the fact that 31% of the patients who were put on antidepressants were taking a subtherapeutic dose (18% because they were purposely not complying with the dosage instructions). The conclusions that the authors were able to draw from this study were that major depression in the elderly was twice as common in the residential setting as opposed to those elderly patients still in the community. The majority of these depressed patients were effectively left untreated and therefore at significant risk of suicide. There was the obvious conclusion that a great deal more could be done for this study population in terms of relieving their social isolation and depressive illnesses. And, by extrapolation, for their risk of suicide. Ethical considerations. In consideration of the issue of suicide in the elderly we note that there are a number of ethical considerations but these are primarily in the field of assisted suicide which we have specifically excluded from this study. (Pabst Battin, M 1996) Having established the evidence base in the literature that defines the risk factors that are known to be particularly associated with suicide in the elderly, we take it as read that this will form part of the knowledge base for the nurse to be alert to, and to identify those patients who are at particular risk of suicide. It is equally important to be aware of those factors that appear to confer a degree of protection against suicide. This will clearly also help to inform strategies of intervention for the nurse. Studies such as that by Gunnell (D et al. 1994) point to the fact that religiosity and life satisfaction were independent protective factors against suicidal ideation, and this factor was particularly noted in another study involving the terminally ill elderly where the authors noted that higher degrees of spiritual well-being and life satisfaction scores both independently predicted lower suicidal feelings. (McClain et al. 2003). The presence of a spouse or significant friend is a major protective factor against suicide. Although clearly it may not be an appropriate intervention for nursing care to facilitate the presence of a spouse (!) it may well be appropriate, particularly in residential settings, to facilitate social interactions and the setting up of possible friendships within that setting (Bertolote J M et al. 2003) This Dissertation has considered the rationale behind the evidence base for nursing intervention and strategies to prevent or minimise suicide attempts in the elderly age group. We have outlined the literature which is directed at identification of the greatest â€Å"at risk† groups and this highlights the importance of the detection and treatment of both psychiatric disorders (especially major depression), and physical disorders (especially Diabetes Mellitus and gastric ulceration). (Thomas A J et al. 2004) Although we have been at pains to point out the relatively high and disproportionate incidence of suicide in the elderly, we should not loose sight of the fact that it is not a common event. One should not take the comments and evidence presented in this dissertation as being of sufficient severity to merit screening the entire elderly population. (Erlangsen A et al. 2003) The thrust of the findings in this dissertation are that the screening should be entirely opportunistic. The evidence base that we have defined should be utilised to identify those who are in high risk groups, for example, those with overt depressive illnesses, significant psychological and social factors, especially those who have a history of previous attempted suicide. The healthcare professional should not necessarily expect the elderly person to volunteer such information and if the person concerned is naturally withdrawn or reserved, minor degrees of depressive symptoms may not be immediately obvious. (Callah an C M et al. 1996). In terms of direct nursing intervention, this must translate into the need to be aware of such eventualities and the need to enquire directly about them. The nurse should also be aware that the presence of suicidal feelings in a patient with any degree of depression is associated with a lower response rate to treatment and also an increase in the need for augmentation strategies. The nurse should also be aware of the fact that these factors may indicate the need for secondary referral. (Gunnell D et al. 1994). If we accept the findings of Conwell (Y et al. 1991), then the estimated population at risk from significant mood disorder and therefore the possibility of attempted suicide in the elderly, is 74%. This can be extrapolated to suggest that if mood disorders were eliminated from the population then 74% of suicides would be prevented in the elderly age group. Clearly this is a theoretical viewpoint and has to be weighed against the facts that firstly â€Å"elimination† of mood disorders (even if it were possible), would only be achieved by treatment of all existing cases as well as prevention of new cases, and the secondary prevention of sub-clinical cases. We know, from other work, that the detection and treatment of depression in all age ranges is low, and even so only 52% of cases that reach medical attention make a significant response to treatment (Bertolote J M et al. 2003). These statistics reflect findings from the whole population and the detection rates and response rates are likely to lower in the elderly. (Wei F et al. 2003). It follows that although treatment of depressive illness is still the mainstay of treatment intervention as far as suicide prevention is concerned, preventative measures and vigilance at an individual level are also essential. Nursing interventions can include measures aimed at improving physical and emotional health together with improved social integration. Sometimes modification of lifestyle can also promote successful ageing and lead to an overall decrease in the likelihood of suicidal feelings. (Fischer L R et al. 2003) On a population level, public health measures designed to promote social contact, support where necessary, and integration into the community are likely to help reduce the incidence of suicide in the elderly, particularly if we consider the study by Cornwell (Y et al. 1991) which estimated the independent risk factor for low levels of social contact in the elderly population as being 27%. Some communities have provided telephone lines and this has been associated with a significant reduction in the completed suicide in the elderly (Fischer L R et al. 2003) To return to specific nursing interventions, one can also suggest measures aimed at reducing access to, or availability of the means for suicide such as restricting access to over the counter medicines. (Skoog I et al. 1996), Some sources (Cattell H 2000) point to the possibility of introducing opportunistic screening in the primary healthcare setting. The rationale behind this suggestion is the realisation that there is a high level of contact between the suicidal elderly person and their primary healthcare team in the week before suicide (20-50%) and in the month before suicide (40-70% make contact). This is particularly appropriate to our considerations here because of the progressively increasing significance of the role of the nurse within the primary healthcare team particularly at the first point of contact. (Hogston, R et al. 2002) The evidence base for this point of view is strengthened by reference to the landmark Gotland study (Rutz W et al. 1989) which examined the effect of specific training in suicide awareness and prevention in the primary healthcare team by providing extensive suicide awareness training and measures to increase the facilitation of opportunistic screening of the population. Prior to the intervention, the authors noted that, when compared to young adults, the elderly were only 6% as likely to be asked about suicide and 20% as likely to be asked if they felt depressed and 25% as likely to be refered to a mental health specialist. This balance was restored almost to normality after the intervention. Suicide in the elderly is a multifaceted and complex phenomenon. It appears to be the case that the elderly tend to be treated with different guidelines from the young suicidal patient insofar as the increased risk is not met with increased assistance. (Lykouras L et al. 2002). We have presented evidence that the factors included in this discrepancy may include the higher overall number of young suicides, the higher economic burden that society appears to carry for each young suicide together with ageist beliefs about the factors concerning suicide in the elderly. From the point of view of nursing intervention, both in a hospital and in a community setting, there should be greater emphasis placed on measures such as screening and prevention programmes targeted at the at risk elderly. There is equally a need for aggressive intervention if depression or suicidal feelings are overtly expressed, particularly in the relevant subgroups where additional risk factors may be active, for example those with comorbid medical conditions or social isolation or recent bereavement. (Harwood D et al. 2001), Many of the elderly spend their last years in some form of sheltered accommodation, whether this is a nursing home, a hospital, warden assisted housing or being cared for by the family. (Haupt B J et al. 1999) In the vast majority of cases this is associated with a loss of independence, increasing frailty and an increasing predisposition to illness that comes with increasing age. (Juurlink D N et al. 2004). This loss of independence and increasing predisposition to illness is also associated with depressive illnesses of varying degrees. (Bruce M L et al. 2002). These patients are arguably, by a large, more likely to come into contact with the nurses in the community. (Munson M L 1999) The comments that we have made elsewhere relating to the nurse’s role in being aware of the implications for the depressed elderly patient are particularly appropriate in this demographic subgroup. As a general rule, it may be easier to keep a watchful eye on patients who are exhibiting early sig ns of depressive illness or mood disorder in this situation by making arrangements to visit on a regular basis or on â€Å"significant anniversaries† such as the death of a spouse or a wedding anniversary. (Nagatomo I et al. 1998) when the risk factors for suicide increase dramatically (Schulberg H C et al. 1998) The literature in this area is quite extensive and covers many of the aspects of suicide in the elderly. It is noticeable however, that there is a great deal of literature on the subject of risk factors and associations of suicide together with plenty of papers which quote statistics that relate the various trends and incidences. There are, by comparison, only a few papers which emphasise and reflect on the positive aspects of nursing care. The positive steps that can be taken by the nursing profession specifically to help to minimise the burden of suicidal morbidity. There is clearly scope for studies in areas such as the impact that a dedicated community nurse might have on the levels of depression in the community if regular visits were timetabled. It is fair to observe that the community mental health nurses fulfil this role to a degree, but are severely hampered in most cases by sheer weight of numbers in the caseload. (Mason T et al. 2003) Having made these observations, we must conclude that there appears to be an overwhelming case for opportunistic screening of the at risk elderly at any point of contact with a healthcare professional. It is part of the professional remit of any nurse to disseminate their specific professional learning with others. (Yura H et al. 1998). This can either be done on an informal professional basis in terms of mentorship or, if appropriate in a lecture or seminar situation. (Hogston, R et al. 2002). There clearly is little merit in critically evalua

The Tourists Accessibility And Their Disabilities

The Tourists Accessibility And Their Disabilities Impairments are the reality of life that sooner or later each person will be experiencing this in some point of a persons life particularly during the elderly stage of an individual. Serving the disabled individuals is not something that comes naturally to most people. This chapter has been divided into three parts which are the accessible tourism, museum and disabled visitors and disabled person. To give an overview of what and who are the visually impaired individuals, a section of this report will discuss about a visual impairment. Furthermore, in this chapter, a brief overview of two museums and two galleries will be tackled in this chapter. The two museums are British Museum and National Maritime Museums while the two galleries are the National Gallery and the Tate Modern Gallery. According to Macfarlane (1996 cited in Barnes, 1991), for over a hundred years, disability has represented a culturally embedded and socially accepted form of oppression against disabled people. Furthermore, a disability may be physical, cognitive, sensory, emotional and or developmental. Also, according to the World Health Organisation (WHO, 2010), the term disability is an umbrella term, covering impairments, activity limitation is a difficulty encountered by an individual in executing a task or actions; while a participation restriction is a problem experienced by an individual in involvement in life situations. In addition, Disability Discrimination Act (DDA, 1995) defines disability as a physical or mental impairment which has a substantial and long-term adverse effect on a persons ability to carry out normal day-to-day activities. Moreover, according to Shaw and Coles (2003), disability is the loss or limitations of opportunities to take part in the normal life of the community on an equal level with others, due to physical and social barriers. On the other hand, Shaw and Coles (2003) define impairment as the functional limitation within the individual caused by mental or sensory impairment. As mentioned above, disabled individuals faces different barriers which holds them back in participating in such activities like travelling. Nevertheless, a number of disabled persons do not consider themselves as a person with disability to a certain extent. Some of disabled people prefer to be independent in nature and associate disability with passivity and dependence qualities (Barnes, 1996). In most cases, a person with disability likes better to travel with their friends and or family members. According to Yau, et al (2004: 958), the process of being a traveller with a disability can be complex, requiring personal initiative, the need to accurately evaluate ones own capabilities as well as the ability to collect reliable information, manage the trip, manage oneself and take stock to reflect experiences. Nevertheless, the experience of the traveller with disability is completely different from the experience of the other travellers without disability. Disabled travellers may have an uneven experience as the facilities being offered are not enough most especially for the other impairment such as for visually impaired individual. Even so, it is logical to note that the majority of the travellers, whether they are disabled or not, are expected to experience some form of barriers during their time of travel. A qualitative work was undertaken in Hong Kong, proposed The Model of Tourism and Disability to facilitate an understanding of the multifaceted interaction amid disability, tourism and the environmental context (Packer et al, 2007). A model of tourism and disability included three key components: The process of becoming and remaining travel active The personal and or disability context; and The environmental and or travel context (Packer et al, 2007) The model of tourism and disability tells that the relationship involving the process of becoming travel active and the environmental context are autonomous with each influencing the other (Packer et al. 2007). In travelling there is always a positive and negative outcome of travel experience. A negative travel experience could be the poor quality of service or the destination being inaccessible. Furthermore, these could result on the decrease in numbers of tourist in tourism market. Nevertheless, a positive outcome of travel experience is likely to result on a repeated visits and increasing the tourism market. 2.2.1 Visual Impairment Visual impairment is one of the types of disability. Generally, not all the individuals with visual impairment are completely blind. In 2002, the World Health Organisation (WHO) had estimated that there were more than 161 million people globally who were visually impaired. In which 37 million are blind and 124 million of whom had low in vision (WHO, 2004). At the same time, World Health Organisation (WHO) noted that the ageing of the global population and the age-related nature of visual impairment was driving global changes in the epidemiology of vision loss (WHO, 2004). In which at the present time, according to the World Health Organisation (WHO), there are about 314 Million people who are visually impaired worldwide and 45 million are blind. In addition, most of the visually impaired individuals are living in a developed city. Furthermore, according to Open University (2010), there are between one and half and two million people who are visually impaired in UK. Subsequently, most cases of visually impaired are also considered hidden disability (Open University, 2010). In tourism, disability is a neglected subject within tourism enquiry and cognate fields (Aitchison, 2009 cited in Richards et al, 2010). According to Royal National Institute of Blind People (RNIB, 2010), visual impairment may be extremely different from person to person and that there are relatively some aspects that could support and help the blind or the partially sighted individuals to enjoy and have fun on a holiday. In addition, a lot of older visually impaired individuals may as well suffer on other disabilities, for instance, mobility and or hearing difficulties. According to The Council for Museums Archives and Libraries (2001), every person with a visual impairment is different in terms of the nature of their visual limitation and their expectations and requirements. Most of the visually impaired individuals use their other sense of smell, hearing, taste and the sense of touch in order for them to feel the surroundings that they are into. On the other hand, some of the visually impaired have a difficulty in imagining an actual object. Furthermore, visually impaired people are considered as a potential market in tourism industry. In UK there are about 1.97 million adults who are visually impaired (The Council for Museums Archives and Libraries, 2001). Additionally, according to The Council for Museums Archives and Libraries (2001), 82 percent of visually impaired in UK have low visions, 90 percent are aged over sixty and approximately 75 percent of visually impaired can read large prints. In most cases, partially sighted and the blind people travel with their friends and families and there is a bigger chances that will return on the places where offers a good facilities and provides good services (RNIB, 2010). 2.3 Accessible tourism More individuals enjoy the opportunity to travel. Visiting the attractions is one of the foremost activities in tourism. On the other hand, travellers face many barriers during travelling such as getting information, accommodation and or problems in getting around at their chosen destinations. On the contrary, not most of the tourists are capable of participating in such doings that this industry could offer. Subsequently, most destinations offer a friendly environment although not to every visitors. Disabled people may be a significant market segment for the tourism industry. However, many tourism sites are not well suited to serve disabled tourist. Like, for the disabled visitors, convenience of a particular destination is essential. In almost all cases of a destination, the facilities being offered for the disabled person are limited. Accessible tourism benefits everyone. According to Darcy (2006, p: 4 cited in Darcy and Dickson, 2009), accessible tourism is defined as a process of enabling people with disabilities and seniors to function independently and with equity and dignity through the delivery of universal tourism products, services and environments. Furthermore, Tourism New South Wales (Darcy and Dickson, 2009), noted that accessible tourism is about making it easy for all people to enjoy tourism experiences. Accessibility is a necessary element for every days existence. Neither, the privilege to travel and take pleasure in all the good destinations is for every individual. Tourism desires an access to almost the whole thing that a destination has to offer. At present, the consumers demands are gradually changing. Consequently, tourism is considered as one of the fastest growing industry. Nevertheless, this industry could serve as an instrument in promoting a barrier free circumstance for the individuals with disabilities. It will be an efficient means of furthering the equality for the disabled individuals that could lead to barrier free. Each individual has the opportunity to travel and benefit from the surrounding of their chosen destinations. According to Darcy (2007, p:74), a justly accessible tourism product will lessen or eliminate physical, attitudinal, information, financial and other barriers that make the tourism experience less accessible to people with disabilities. Furthermore, an accessible tourism should be made easier for all people, irrespectively of their age, gender and or physical status, in order to enjoy their tourism experiences. According to Tourism New South Wales (2005, cited in Darcy and Dickson, 2009), Easy Access Market is define as: Any segment within the tourism market that prefers accessing tourism experiences with ease. This people with disability, including those with physical and sensory disabilities, will find it easier to access tourism facilities where there is a continuous pathway and tactile surfaces and clear signage. As accessibility plays an imperative role in tourism, not everyone could have the access to their designated destinations. Even though, still this industry attracts a numbers of tourist at all times. On the other hand, accessibility generates barriers in some particular persons such as the disabled individuals. Subsequently, people with disabilities have also the rights to partake and benefit from the community as the same quality of life of the people without disabilities. Nonetheless, people with disabilities travel less due to the lack of facilities of the tourism industry. In general, the provisions that tourism industry offers to the disabled persons are commonly for the mobility impaired individuals. Furthermore, due to the increasing facilities for the disabled most especially for the individuals who have mobility impairment, tourism has widened the amenities for these types of tourist. Due to these facilities, other disabled persons travel and participate less. In contrary to that, there are some increasing numbers of disabled individuals who set off for travel mostly for physically impaired individuals only. In addition, this industry should require having an amenities and facilities that could do well to every tourist. Given the fact that most of the facilities for the disabled are for wheel chaired person, it is more convenient for them to participate in leisure activities compared to visually impaired people. Among all the types of disabled individuals, visually impaired might not be able to be pleased about the picturesque view, on the other hand, they could still have a pleasant journey on some other way. All the same, these types of tourist could still feel, hear, smell and touch. Likewise, there are an increasing numbers of disabled people and most of them are engaging in travel. In addition, the increase in the demands of the mobility access for the disabled is in high demands at the present. In some point, the amenities that are being offered are for the mobility impaired visitors. Visually impaired travellers have a lesser numbers compared to the wheel chaired persons. Currently, the common facilities that tourism has to offer for the visually impaired tourist are the guide dogs, audio descriptions for some exhibits and Braille. Increasingly the tourism industry is able to offer improved products and services. While physical accessibility is an essential component of inclusion, it has a long been recognised that successful inclusion also requires social acceptance by others (Schwartz, 1988). According to Page and Connell (2006, p: 76), contemporary literature recognises that access is not only about buildings; a truly accessible environment is one in which a person with disability can freely express their independence, and one in which any impediment to integration is removed. Moreover, according to Page and Connell (2006), in United Kingdom, Visit Britain operates the National Accessible Scheme, which assists accommodation operators in making their products more accessible with standards for visual and physical impairments. Moreover, the Disability Discrimination Act (1995), in the UK places a responsibility on all public and private organisations to make services full accessible to disabled persons (Page a nd Connell, 2006). According to Timothy and Crispin (2006, p: 4), each year, in countries throughout the world, millions up on millions of people visits museums. Additionally, there is an increase of all kinds of museums all over the countries. In addition, the numbers of potential visitors are increasing due to the growing interest in their collections and their works. In some cases, a number of destinations such as museums have already established a friendly surrounding for their visually impaired visitors by providing an audio sound service. Moreover, in some museums, they had already provided the touching for the display objects for these types of visitors. According to Urry, (2002, p: 256), touching the objects on the display is an alternative sense, makes the objects tacky and corroded so they no longer remain visually and physically the same. Also, disabled individuals have the right to obtain the same benefits from museums as others are obtaining. Travel by people with disabilities happens regardless of the presence of numerous discouraging barriers (Darcy, 1998; Lipp 2003, cited in Packer, et.al, 2008). On the other hand, while they look for the same or similar travel experiences to other travellers, travellers with disabilities are likely to experience extremely different and uneven tourism experiences. In spite of all this, people with disabilities still retain their eagerness for travel and want to travel. A person travelling with a disability can be complex, according to Yau et al (2004) it requires a personal initiative, the need to accurately evaluate ones own capabilities, as well as the ability to collect reliable information, manage oneself and take the stock to reflect. The mentioned are considered the process of travelling with disability. It is reasonable to note that all travellers, whether they have a disability or not, are likely to experience some form of barriers to participation while travelling. Moreover, a person without disabilities thinks the barriers as just an occurrence. On the other hand, a person with disabilities dealing with the barriers during their travel is a challenging task. It is regrettable that travellers with disability may encounter or experiencing a tourism market place that does not cater and or give their needs as it does to travellers without disabilities. Imagine that this is the reason why people with disabilities participate less in travel and tourism. 2.4 Museum and disabled visitors Individuals with a sight problem can face a lot of barriers when visiting a museums and or galleries. Museum displays, whether picturesque arrangements of beautiful things or chronological narratives of a developmental process are involved in scopic forms of understanding (Hetherington, K. 2002). On the other hand, there are some displays that at times seen as discriminatory for some visitors. Furthermore, building an access in a museums or galleries for every individual is a part of the obligation to the community. In addition, a museum or gallery which are accessible to every person attracts more visitors. Most of visitors are pleased about museums and galleries as a place where they can extend their experience and also to have an enjoyment on societal circumstance. Museums have expanded in multiplicity and burst in popularity over the last few decades. Millions of people every year visit a museum. Moreover, every museum attracts a variety of visitors. According to Dr. Johnsons 1755 dictionary (cited in Yale, 1998:33) a museum was simply a repository of learned curiosities. The Museums and Galleries Commission currently defines a museum as an institution which collect, documents, preserves, exhibits and interprets material evidence and associated information for the public benefit (cited in Yale, 1998:33). Furthermore, according to the International Council of Museums (2005 cited in Sandell, 2007:2), a museum have unique potential for addressing and fostering cultural understanding in interdisciplinary ways. It is known that a museum is a collection of antiques or historical materials that has been used during a significant event during earliest times. Furthermore, a museum broadens the knowledge of its visitors. In most cases, the public is the one benefitted on what the museums could provide and do. According to Ambrose and Paine (2006), it is only when the museums public is thoroughly understood that the museum can effectively responding to the publics needs and requirements through services. It is stated in Museums Associations definition (1998 cited in Disability Directory for Museums and Galleries, 2001) that Museums enable people to explore collections for inspiration, learning and enjoyment. They are institutions that collect, safeguard and make accessible artefacts and specimens which they hold in trust for society. Museums are for everyone this includes the disabled people. A museum visitor comes in all ages of any gender, social status and with or without disability. A museums market can be thought of as the overall social and economic context within which the museum operates. All museums operate within a market and all provide a supply of services that meet a market demand. According to Ambrose and Paine (2006), internationally, there is for example a growing critical awareness of the political nature of museums and their historic role in maintaining the cultural values of elite or privileged groups ins society. A museums visitor expects more on what the museums could offer. Disabled visitors must be accommodated in the museums. On the other hand, accessibility in the museums is less for most cases of disabled groups. Furthermore, the needs of each disabled individual may vary on their types of disability and there may be an inconsistency with one another. In addition, in some cases the needs of the disabled community may alter rapidly upon their visits. According to Majewski and Bunch (1998, cited in Sandell, 2007), there are three distinct tiers of disability access that museums should address in order to meet the needs of their audiences and these are: a) Access to the exhibitions physical elements, b) Access to exhibitions content; and c) The access that describes the representation of disabled people and the inclusion of disability-related narratives and interpretation within exhibitions. (Majewski and Bunch, 1998 cited in Sandell, 2007: 146-147). Moreover, access to the museums and galleries should also take into consideration the architectural structure of the building, the parking spaces for the disabled and on how to get to the museums and galleries. Likewise, if the museum or gallery is a massive place, a map and signages will be helpful for these types of visitors. Museums facilities and services for people with mobility impairment are highly developed compared to with people with sensory difficulties such as the visually impaired visitors. Now a day, sensory approaches are common in some museums. A museum plays a major role in communal change. According to the Walters (2001), disability is viewed as being part of diversity, something that is not always the case. Furthermore, disabled people are considered a potential visitor in museums. According to Walter (2009), in order to include disabled visitors, museums should adopt and understand the social model of disability. Social model of disability does not deny impairments or any medical needs that arises from impairments (Walter, 2009). Through this social model of disability, museums will not take the disabled visitors as a problem, to a certain extent they will create a way to welcome and accommodate them in their museums. Access in the museums for disabled visitors should be considered in the broadest sense. Access is not just about providing lifts, toilets, spacious corridor and or parking spaces for the disabled. Access should also include the information and better access to the exhibits inside the museums. Furthermore, improvement of access should include sensory, physical, intellectual, cultural as well as the financial access in the museums. In addition, a disabled person prefers to be independent but most of the time needs help in some certain things most especially for visually impaired as they have low in visions and in some cases they are partially blind. According to the Disability Directory for Museums and Galleries (2001), nearly two million people have some form of visual impairment, but most blind people or 82 percent have some residual vision that they use to have good effect and many people who could register as blind do not do so. Also, visually impaired people make and appreciate art, according to Walter (2001). In addition, if a visually impaired visitor visits museums, in most cases they need a multi-sensory exploration of an object, signage printed in large image or fonts and audio format description for objects in order to enhance their visit experience. In some museums and galleries, it is allowed to have guide dog for the visitors who have vision impairment. Walter (2001) emphasise the needs of the people with visual impairments. According to Walter (2001), visually impaired individual needs accessible information in a range of alternatives formats, a tactile signs or diagrams and an audio-information. Moreover, the museums staffs needs to have training in handling a visitor with visual impairment. A museum with a well trained staff could understand more the needs of the visually impaired visitors. A visually impaired visitor is not completely blind. In most cases they could see but only blurred vision and some could only recognise large font of prints. 2.4.1 Museums and Galleries In order to establish a basic abstract structure to be use in this research project, the review will now be set out to be aware of the background of two museums and two galleries which are the British Museum, National Maritime Museum, The National Gallery and the Tate Modern as the research area for this study. a) The British Museum British Museum is one of the oldest and largest leading museums all over the world. It has a collection of more than seven million objects which originated from all continents. In addition, British Museum is a representation of almost all the culture of the world. Moreover, British Museum is known as the history of the world in a hundred objects (British Museum, 2010). The British Museum is a free entrance that attracts more or less a five thousands visitors that visits the museum during its open hours. Its visitors are ranging from children to adults, all types of gender and disabilities. Moreover, visiting this museum needs a day in order to view all the exhibits in it. b) National Maritime Museum Greenwich area is known for its unique forms of architectural design. In addition, Greenwich area has been recognized as an attraction for shopping and education which is the University of Greenwich. Furthermore, tourism in this Greenwich is developing more as the upcoming Olympics will be held in this location. Likewise, National Maritime Museum is one of the prides of this area. As a tourist destination, National Maritime Museum is composed of three main sites which are the Maritime Galleries, the Royal Observatory and the Queens House. Basically, the museum focuses on its four themes which are the sea, ships, time and the stars and the relationship with the people (National Maritime Museum, 2010). National Maritime Museum welcomes visitors in all ranges of ages and regardless of the gender with or without disability. Furthermore, it provides educational learning for the children. In addition, the visitors of this museum are usually students from different schools and or universities. Furthermore, disabled people are visiting the museum but most are mobility impaired visitors. c) National Gallery National Gallery is situated in the heart of London. Thousands of people visits National Gallery daily. It is well known for its art from the famous and renowned artist. The gallery welcomes each and every individual regardless of gender, age and disabilities. d) Tate Modern Gallery Tate Modern is a gallery of international modern art. Its collection is a British art collection from the last 1500 years till the present time (Tate Modern, 2010). 2.5 Summary This chapter bring about by discussing about the disability and the forms of disability. Moreover, it was clearly discussed in this chapter the importance of accessible tourism and which had established as the basic foundation for this study. At the latter part of this chapter, it has been discussed about the facilities being offered by the museums for the visually impaired visitors. To sum it up, the literature reviews the conditions of the accessibility of the museums for the visually impaired visitors. Consequently, it is important to recognise the particular needs of different people (age group, genders, impairment group and or disabled individuals). The following chapter will reveal the methodology of the research study along with the other relevant methodological issues.