Effective People, Communication and Information Essay

Legoland is a group of Lego themed adventure parks that offer an assortment of Lego themed attraction, mainly targeted at young children and families. Legoland is based in many different places in the world. At the moment there are four main Legoland parks. Legoland Billund in Denmark, Legoland Deutschland in Germany, Legoland Windsor in England and Legoland California in America. They also employ for a number of jobs including, catering, admissions, rides and attractions, security, finance, nursing etc. These jobs are normally seasonal as Legoland is only open in the summer and some holidays. This job can be part time or full time during the working season. In this section of the assignment I will describe Legoland’s rigorous recruitment process. They start the process in December during which time they send out invitations to previous staff and to local advertising to attract attention. They send invites to previous staff as they may want to work again and the company can save money on training new staff. While advertising is going on, all applications are shortlisted to the few that employers think have more potential. In January and early February, the successful candidates are then called for interviews. In Mid-February and March staff training starts so new employees are taught how to use the equipment properly and get to know the safety rules. Training is done during this time of year so staff are fully trained before Legoland opens to families. From april to august the recruitment is ongoing with staff turnover. This is because when some staff start, they may not like the job and decide to leave so Legoland need to be prepared to replace those that leave. Legoland also try to attend as many careers fairs as possible where feasible. This depends on staff availability. When Legoland staff arrive at these fairs, they set-up recruitment stands and models. They also provide job descriptions, applications and employment advice that relates to qualifications and experience that specific departments look at. Legoland attracts potential employees in many different ways: * Website to attract national and international employees. * Local newspaper to attract local audiences. * Careers Fairs held in schools and colleges to attract younger members. * Job centres. * Word of mouth. This section of the assignment is mainly about how Legoland attract potential employees. In order to find the right people they have to support their brand image to find a quality employee. The selection techniques are very strict as managers have to be very professional in choosing the right employees. Their advertising is focused and emphasises their culture and personal qualities. Their relationships with local employment bodies and educational establishments are very close so as to give everyone a chance to work there. You can apply by undergoing a screening interview on the phone or in person. This is good as Legoland employers can see aswell as get to know possible future employees. You can also apply online for any available jobs. By doing this and having overseas agents and employment organisations Legoland have internationalism. Legoland try to ensure that staff turnover is kept as low as possible by doing many different things. They try to get as many past workers as possible to save money on training which keeps the turnover low as less money is spent and less people are expected to leave as they have previously worked there. Appraisals are held to keep track of employee’s targets and the way they are working. Departments can get certain goals and targets to help achieve certain things. Legoland staff are given rewards and awards to help keep up their good work so there is less chance of them leaving the job as they may enjoy it more and decide to stay on further. Legoland look closely at NVQ’s and cross-reference them with other assessment schemes

Case Analysis for Cirque du Soleil Case Essay

1. Describe how the touring show life cycle is supported by IT. While reading the case, you can access Cirque’s website and see actual applications (e.g. casting, ticket sales, and Cirque Club). According to this case, every step of the touring show life cycle is supported by IT. With regard to creation stage, IT plays an important role to improve this process. There is an application whose name is Open Eyes developed by IT. All of Cirque’s employees could access to Cirque’s Intranet and share interesting or surprising discoveries to others. Moreover, sharing this kind of information is significant to Cirque du Soleil because it keeps Cirque du Soleil staying top of the newest artistic rends. With regard to design stage, there are several applications created by IT to make those activities of design stage more effective and convenient. A costume application can save a lot of different measurements to costume patterns for every artist and keep this information in a database. The more important point is that this application connects with other applications to manage diverse sides of costume-making process. With regard to preparation stage, there is a Kin-Cirque application developed by IT to help artists practice reinforce their training experience. Physical fitness specialists could know how every artist’s physical condition develops. In addition, Kin-Cirque application connected with other applications to provide the exact physical measurements and needs of artists to equipment department. Then the equipment department can complete their jobs more easily. With regard to the diffusion of Cirque shows, IT has great influences on improving customer’s experience. There is an official website created by IT. People can access to this website from various parts of world. Especially the online forum where people can find special promotion, press galleries, and employment opportunities and so on was built up by IT. What is more, customers can purchase show tickets, select the seats, get the direction and so forth through an online box office. With regard to logistics stage, an e lectronic document management system and linguistic software are created by IT. They can coordinate and calibrate more than 150000 terms which depict countless equipment used at Cirque. Also they are stored in the Cirque’s databases. In addition, â€Å"IT roadcases† and VoIP technology which help Cirque du Soleil reduce a great  amount of time of touring infrastructure were developed by IT. Finally with regard to resource management, IT is widely applied to increase efficiency. IT developed an application which can assist the casting department to manage the artist bank and projects that could be old one, present one and future one. Applicants could submit their videos or performances via this application to conduct the recruitment process and their application materials would be stored in the databases. And that the Virtual Talent Scout was developed in Sep 2007. The pool of talent was enlarged by the Virtual Talent Scout. This increases Cirque’s abilities to deal with artist injury, increasing demand and accidents. In a word, to a large extent the whole touring show life cycle is supported and ameliorated by IT. 2. What was the level of alignment at Cirque du Soleil in 2008? According to the introduction of the case, the level of alignment at Cirque du Soleil is quite high in 2008.   First of all, the touring IT experts work closely with each other, even they are not in the same location. Everyone in the IT team performed as an integral and can resolve a big problem effectively and corporately. Secondly, there are a lot of servers all over the world. Employees can be easy to access to the applications and communicate with others, company, related department and so on very well. In short, in 2008 people at Cirque du Soleil can work together tightly and complete a great number of successful performances around the world. So it is a very high level of alignment at Cirque du Soleil in 2008. 3. What was the level of tension between the business needs and IT capacity? Through reading the whole case, I think the level of tension between the business needs and IT capacity is low. Because IT has improved the whole touring show life cycle and make the business effectively. Moreover, the most important point is that IT has help Cirque du Soleil to increase its customers and reduce the time of setting up the touring infrastructure which means cost of time. According achievements of IT, I could say there was a low level of tension between the business needs and IT capacity. 4. What are the key requirements, in terms of the IT architecture, of the support provided by IT at Cirque du Soleil? IT group needs to integrate the data from diverse activities. The design, ongoing improvement, growth of business, applications should meet the company’s business requirements. Moreover, IT group needs to do their best to make Cirque du Soleil operate efficiency  through information integration and management. Of course, IT group should maintain the databases and ensure all information is updated.

Should the Endangered Species Act be Strengthend Essay

Should the Endangered Species Act be Strengthend - Essay Example Species have an indescribable amount of benefits to humans-with some not yet discovered. â€Å"An antibiotic was discovered in the soils of the threatened New Jersey Pine Barrens Natural Area, a species of perennial corn was found in Mexico; it is resistant to several diseases of corn and an insect was discovered that when frightened produces an excellent insect-repelling chemical.† (Regina Bailey, about.com) The Endangered Species Act was passed in 1973 in order to control the fast rate of extinction for a variety of beneficial reasons discussed further in the paper. The Endangered Species Act In order to foster the Protection and conservation of endangered species, the Endangered Species Act was passed on December 28, 1973 by Richard Nixon. Presently, the Act is administered by the United States Fish and Wildlife Service (FWS) and the National Oceanic & Atmospheric Administration (NOAA). According to the National Wildlife Federation, since 2009, 1361 plants and animals in th e US have been listed as endangered or threatened. The FWS carries out a multiple research on different species and they are organization responsible for listing a species as endangered. For a specie to be considered endangered, a number of factors are considered such as; the amount of its habitat destroyed, is it being over-consumed, is it being threatened by disease or other predation or are there other man made factors affecting its survival. The Endangered Act of 1973; authorizes the determination and listing of listing species as endangered and threatened. It prohibits the unauthorized taking, possession, sale and transport of endangered species. It provides authority to acquire land for the conservation of listed species, using land and water conservation funds; it authorizes the establishment of cooperative agreements and grants-in-aid to states that establish and maintain active and adequate programs for endangered and threatened wildlife and plants; it authorizes the assess ment of civil and criminal penalties for violating the Act or regulations; and authorizes the payment of rewards to anyone furnishing information leading to arrest and conviction for any violation of the Act or any regulation issued hereunder. (Cited from Fws.gov, May 7, 2011) Should the Endangered Species Act be strengthened? It is seen by some non-environmentalists as a weapon used by radical environmentalists and is the most wasteful and counterproductive laws in the books. In addition to that, they believe that it practically turned into a tool exerting political leverage. Some are even vouching for cancellation of the ‘critical habitat’ designation which limits development in the habitat of endangered species. With reference to some consulted literature- the majority of persons wanting to trash the 1973 legislation is more than the amount who want to strengthen the Act by 9%. The researcher is in total disagreement with the persons who want to the Act to be demolis hed and considers these actions selfish. The Endangered Species Act of 1973 is one of the most important laws passed in America of all time. It’s had many successes and undoubtedly will have far greater success if and when strengthened. America has a fast rate of extinction and should the Act not be strengthened or demolished we will all be faced with the consequences. Considering all the benefits discussed in this paper, there should be enough reason for the act to be strengthened. There are

Communication Strategies Essay Example | Topics and Well Written Essays - 1500 words

Communication Strategies - Essay Example Generally beach areas are populated with tourists and young families who always desire a source of balanced meal nearby. Currently the visitors in Lido Beach are found to survive with only carbonated drinks and packaged snacks. Therefore, the owners have come up with this business opportunity of pizza restaurant in this location. This report presents the effective communication strategies for some possible critical situation that might takes place in the away of project implementation or project development process. These will help the company to efficiently and successfully complete the project within estimated duration of time. First possible situation is that a technical team member has requested a transfer due to project team conflicts. This is a very common situation in project development process. For overall completion of projects, multiple teams work together for different purpose and different categories of work. A project like establishment of a pizza restaurant consists of multiple activities carried by different teams. Each team has individual objective but the overall goal or mission is same. So, there are different teams working together and in each team few people works together for similar works. Conflicts among the team members are very common in project development process which results a major decline of a team’s overall output. Conflicts might happen for many reasons. It might be unequal work pressure of each employee of a particular team. It also can be for major difference in the performance level of each worker in a team which results a higher work pressure on one or few efficie nt employees. Communication gap among the employees or between the employees of a team and supervisor or team leads might results conflicts in a project team. Lac of transparent subjective communication is responsible for conflicts in a team, lower output and delays in completion of

NONE Essay Example | Topics and Well Written Essays - 1500 words

NONE - Essay Example The immigration has not only caused diversification in the societal structure but has increased the interactions between people belonging to various races and ethnic groups. The diversity within the American society has always been the subject of many debates and from an historical perspective, the concept of immigration has now become a part of the American society and it is nothing less than a culture melting pot. The economic stability in the United States had also attracted a number immigrants coming in from all over the world. One of the hypotheses held by anthropologists was that the Native Americans had descended from the wanderers of North East Asia who were then followed by the arrival of European settlers and then subsequent colonization at the hands of the British took place. United States gained their freedom from colonial rule and became an independent nation that worked on the principle of democracy that became major fad of the 19th century and further attracted people from various parts of Europe, Asia and south west regions of the globe. Ever since then, there has been a rise in the number of immigrants coming to America from all the over the world, particularly from Europe and slaves from Africa. Slavery became a trend that started around the year 1619, when a Dutch ship brought 20 to the shores of the Virginia territory and reached its height till its abolishment in the year 1865 by Abraham Lincoln after the American civil war. The American civil war was one period in the history of the United States, which was marked by a decline in immigration but as soon as it ended the pace was picked back up again. Considering the aforementioned facts about the history of US immigration, the concept of race had become synonymous with everyone but ethnic and cultural identities was something that the American society was still in the process of discovering. A second wave of European immigration took place from the central region; a number of Jews migrated

Question 21 & 22 Essay Example | Topics and Well Written Essays - 750 words

Question 21 & 22 - Essay Example When an individual conducts an action such as abusing drugs and alcohol without being coerced into consumption of these substances, the act is recognized as voluntary and this leads the act is said to have conformed to the requirements of voluntary act (Singer, 2007, p.501). Actions that are caused due to the act of voluntary intoxication can not be defended through voluntary intoxication defense until and unless that act of intoxication has prevented the defendant from creating the intention of crime needed for a particular criminal act. If the defendant has committed an act that is regarded as reckless in nature, the defendant might even fail to gain the clause of imperfect defense (Delaney, 2004, p.423). For example: Before an individual drank a bottle of alcohol, a drug that results in the unconsciousness of the consumer is added to the bottle of alcohol. The individual consumes the drug mixed alcohol and enters into an unconscious state and in that unconscious state he/she ends up nearly killing another individual by beating him/her up. The individual is charged for assaulting another individual in such a manner that the other individual could have even experienced death. The individual may try to defend himself/herself from the charge by stating that she did not voluntarily consume the drug. But due to the fact that the individual voluntarily consumed alcohol and ended up in an unconscious state may make her defense weak because she had consumed alcohol knowingly and out of free will. This will lead to her being held responsible for beating another individual so badly that he/she nearly died. References Delaney, J. (2004). Learning criminal law as advocacy argument: Complete with exam problems & answers. Philadelphia, PA: J. Delaney Publications. Emanuel, S. (2007). Criminal law. Austin: Wolters Kluwer Law & Business/Aspen Publishers. Singer, R. G., La, F. J. Q., & Singer, R. G. (2007). Criminal law: Examples & explanations. Austin: Wolters Kluwer Law & B usiness/Aspen Publishers. 2. An act is accepted as self defense when the defendant is able to justify that the act was conducted in self defense (Brody, 2010, p.133). Self defense can be used by the defendant in several issues such as physical attack, battery and homicides that are criminal in nature because all these acts include application of force. Most of the states consider self defense as defense of statutory but the position changes depending on the cases. Use of deadly force as a self defense is regarded as an action in which any level or kind of force is used and the usage of this force can result in the death of the person against whom it is being used. This does not mean that the person against whom the defense has been initiated should end up dead to consider this kind of act as application of deadly force. Example of application of deadly force includes utilization of a weapon such as knife or a gun to defend oneself. A defendant can use the concept of self defense as a defense that is both perfect and imperfect in nature. A defendant can claim that he has conducted an act in self defense when the applied force is considered as objectively reasonable under the scenario. According to law, an individual can conduct the application of

High Profile Interest Group influence on legislation Essay

High Profile Interest Group influence on legislation - Essay Example Citizen interest groups, on the other hand, with their considerable organizational resources and wide base of support have shown their effectiveness over time in passing new laws by the use of direct legislation (Baumgartner & Hojnacki, 2009). In the United States, for example, alcohol and tobacco companies have been lobbying against the legalization and taxation of marijuana. This is in a bid to ensure that they make the most out of the American population’s high spending on leisure. This paper will discuss how one such high profile interest group, the California Beer & Beverage Distributors has influence legislation and also include the writer’s thoughts and opinion. Interest groups are a significant mechanism for citizens and economic organizations to make elected leaders know their views, needs and ideas so that they can influence the process of making legislation in their favour (Hays, 2001). The California Beer & Beverage Distributors (CBBD) opened up a new front in the campaign of what was referred to as Proposition 19 when it contributed $10,000 to a committee, Public Safety first, that was in opposition to the proposition. The proposition aimed at legalizing and subsequent taxing of controlled marijuana. Since CBBD is a organization in an industry that would have to compete with legal marijuana, it was protecting the interests of its members by lobbying against the legalization. Illicit drugs have been a threat to the alcohol and tobacco industries for a long time, hence the participation of CBBD in opposing the proposal. If marijuana is made legal for recreational purposes, then that would make the threat much bigger. Looking at the situ ation from this perspective, my opinion is that CBBD did not join the campaign solely, or with focus on, the safety of the public that would be compromised by marijuana. On the contrary, when the

Evaluation Report of the Practicum Experience Essay

Evaluation Report of the Practicum Experience - Essay Example assistant event manager included designing of sales and promotion strategies, organizing special events such as meetings, and customer logistics management. In this report, I have discussed DRG company profile, event management experiences gained, an evaluation of DRG and plans for my career success (District Restaurant Group, 2014). DRG Company that is located in Washington DC establishment was in January 2011. At inception, DRG main aim was to act as a social hub for entertainment and sporting activities, and offer catering services. DRG offer quality food and beverages of all varieties in its catering department. DRG boosts of different modern state of the art catering facilities and sporting technology within its premises. District Restaurant Group Company manages three key Establishments in DC metro region such as the Ugly Mug, Katherine’s Catering, Jake’s American Grill and District 2 Bar Grille. In addition, Exhibit 1 DRG organizational structure has one catering full time service branch under its management. DRG has maintained its market share through online marketing strategies such as Twitter and face book as well as constant identification of market opportunities such as accommodation of family or corporate events and parties. Ugly Mug sports and entertainment bar established in December 31, 2004 does its operations daily from Monday to Sunday stating from 11:00 am to Mostly 2:30 am. Ugly Mug provides opportunity for Washington inhabitants who are football fans to watch live matches as they drink Ugly Mug collection such as Blue moon, Heineken or Miller Lite. It also has a collection of food and beverages that satisfies the taste and preferences of its customers as they enjoy watching football games. Ugly Mug is located in Capitol Hill neighborhood of Washington DC neighborhood. It is one of the leading sports bar in Barracks Row area attracting Nationals, Capitals, Redskins and Other DC United Games. The bar has increased its public image

Smart baby socks Buisness plan Essay Example | Topics and Well Written Essays - 500 words

Smart baby socks Buisness plan - Essay Example The Apptrust monitor does not receive interferences from home alarms, cell phones or any other electronics. The childs data is then pushed to the cloud from which any internet connected device can access the information. If one does not own a smart phone, he or she can plug-in a USB cable to monitor information from a desktop computer or laptop, and if ones residence is connected to Wi-Fi then, any device that is an internet connected will receive the childs health data. The sock is powered by a rechargeable battery with the power lasting for two full days without recharging, unless if one excessively checks real-time vitals. When the battery runs low a notification is sent to the Smartphone or any other Wi-Fi connected device, and one can recharge using a micro USB charger. Currently, users can access the iPhone app and the Android version. Safety is key; the sock is hypoallergenic. It is wireless and does not use any adhesives. The sock electronics are contained in a water-resistan t and medical-grade silicone cases to protect ones child from electrical contact. Moms peace of mind, when a child is brought home from the hospital, it marks the beginning of a new era of parenting, one filled with strong love and connection to your new child, this marks the reason parents stress and worry about their childs health. The use of Apptrust sock helps relieve the stress through regular and real-time checking of the childs vital body processes. Such knowledge helps parents to overcome the worry about their childs well-being as any sudden changes can be instantly. Aims at helping parents have better night sleeps; a study by Medical news today found out that parents lose an average of six months sleep during the initial 24 months after the child has been born. The study estimates that approximately 10% of parents manage to have two and a half hours of continuous sleep each night. The research also indicates that more than 60% of parents with children aged less than

Why do we love and cheat Research Paper Example | Topics and Well Written Essays - 1000 words

Why do we love and cheat - Research Paper Example Love has always been an inspiration for people around the worlds in all ages and civilizations. However, there had been always a dark side attached to the romantic stories of earlier times .This was that the lovers always get desperately obsesses with each other and mostly are ready to give up their life for this immeasurable emotional and physical attachment. According to (Obringer) â€Å"Love is a chemical state of mind , that's part of our genes and influenced by our upbringing. The scientists are discovering that the same chemical process that takes place with addiction takes place when we fall in love†. Love is a beautiful experience, but the other side of it is very dangerous and vicious and that is cheating stage. Cheating has always been a hidden part of love and many have been victimizes to this hazardous phenomena. However, with all this turmoil and fatal turns and twists, people still knowingly engage in love affairs. We never want to stop loving, after all the nega tive emotions we have been through, we still want to fall in love. This is where the scientist, anthropologist and psychologist get confused and they are definitely sure that love is not a chemical play but largely something beyond it. Helen Fischer here is talking about the mysterious topic of love and cheating and how all this works out in the brain of an individual. Helen is an anthropologist who researches on gender differences and human emotion and behaviors. She here explains that love is a concept which has mesmerized men and women at all times of history and the idea behind it is still unknown to human species. But loads of experiments and researches have been undertaken by Helen to understand the real reason behind why people fall for a particular person leaving the rest behind. She states that people are even ready to die for the person they loved which shows us the power of love and affection. From her speech we can make out that the real culprits behind love is the chemi cal rushing through our nervous system. The chemical dopamine has an upper hand in developing love and making the people involved in love addicted to a particular person. Dopamine is considered to be the pleasurable chemical which gives a felling of happiness and bliss to the people involved in romantic relationships. Helen states that, lovers she experimented had rush of chemicals in their brain and according to her love is a combination of lust, attachment and romantic feeling. However, it is not only human who have this chemical movement in brain but animal also do feel the same. As per (Ghosh) â€Å"In animals, scientists have observed that a chemical called oxytocin is involved in developing a bond between a mother and her young†. Apart form loving, people also do cheat and it is not always men who cheat but also women commit this sin. According to Helen, world can be a deadlier place, ff love never existed between people and this is an extremely worthy statement. Withou t love what would be the purpose of existence for human being. It could be utterly foolish to tell that eating, mating and defending is the sole purpose of life. A life without the feeling of love is bland, less purposeful and deadly. It would not be wrong to mention that no one would want to live this life without feeling love or giving love to someone. Helen here explains that women are more loving, undestanding and articulate and communicative than men. She explains that both of men and women brain work different and it is definitely an undeniable truth. â€Å"On average men; and women’s brains are not the same. Men’s and women’s were engineered , in part to handle quiet different tasks ,and that engineering is expressed in us

The Disaster at New Orleans Essay Example for Free

The Disaster at New Orleans Essay The city of New Orleans is one of the most culturally diverse urban centers in North America. It was founded in southeastern Louisiana on the banks of the Mississippi River some 180 km away from the Gulf of Mexico. It was built in 1718 on the east bank of the river and south of Lake Pontchartrain. The city was named for Philippe II, Duc d’Orleans, the regent of France during the era of Louis XV. It soon became one of the most active commercial port centers of the country. Its diverse culture later turned it into an international tourist destination (Hass, 2006). Unfortunately, New Orleans was built on a strip of land on the Mississippi Delta that experiences constant sinking of the land. This coupled with rising seas presents a great danger to the city. Floods and storm surges are the most feared natural disasters that could occur. To prevent this, Billions of dollars worth of levees, sea walls, pumping systems and satellite hurricane tracking have been set in place to allow for the protection of the residents of New Orleans. However, it seems, the problem of New Orleans became even bigger with these remedies (McQuaid and Schleifstein, 2002). In 2002, New Orleans Times-Picayune released a five-part report on what could possibly happen if a major hurricane reached the city. As the world would see in 2005, all the speculations and predictions of this report became painfully true. The situation back then up to 2005 grew only worse. New Orleans was already 3 feet below sea level a century ago. This means the effect of storms is amplified against the city. Furthermore, coastal erosion of barrier islands and destruction of the marshes present a big threat because hurricane winds and flooding could go inland undeterred. The city is surrounded by water and has areas that are below sea level. The levee system built to protect the city made the city a huge bowl ready to receive water that reaches past the levee but unable to drain it somewhere else. The levees also prevent the continued growth of the delta through silt build-up coming from up the river. Huge structures built on the strip of land contributed to the sinking of the land (McQuaid and Schleifstein, 2002). Models way back in 2002 of the possible scenarios if a hurricane did hit the city were already grim at best. Most of the city would be underwater and the levee system that was built to protect New Orleans would be its own undoing. These pushed scientists to try to find ways to avert disaster. One proposed solution was to build a flood wall of up to 30 feet high bisecting New Orleans and Jefferson Parish to create a community haven on the river side of the wall where they could retreat and also protect buildings from invasion of floodwaters from the lake. In 2002, government agencies and other leaders supposedly mobilized themselves to try and address the rising risk from hurricane strikes. The Federal Emergency Management Agency prepared new responses to the flooding of the New Orleans bowl. Some of the findings were that the levees be raised and lost marshes and barrier islands be rebuilt but the efforts would have been worth at least $14 billion (McQuaid and Schleifstein, 2002). In August of 2005, the feared category 5 hurricane finally came. Hurricane Katrina began as a category 1 hurricane in August 25 when it passed southern Florida. It moved west on August 26 to straight to Louisiana. The warm waters of the Gulf of Mexico strengthened it turning it into a category 5 hurricane by early Sunday, August 28. The National Hurricane Center had predicted the second landfall for August 29. By then, around a million people had already been evacuated from the affected areas of southeast Louisiana, Mississippi and Alabama. New Orleans Mayor Ray Nagin had already ordered mandatory evacuation of the city on August 28. However, 100,000 of the 469,000 citizens of New Orleans did not leave either because they were too poor or were too sure that they would not be affected by the impending disaster (Drew, 2006). Katrina suddenly weakened to a category 3 storm just before making landfall and shifting a bit thus sparing New Orleans from the strongest winds. However, the disaster that had long been predicated came still came to pass. Tidal surges of six to eight m or 20 to 25 ft came in from the gulf and destroyed the 18-m or 11 mi long earthen levee system that protected St. Bernard Parish. The tide also surged further inland into the Industrial Canal destroying the concrete floodwalls and making large breaches that flooded one of the poorest neighborhoods, Lower Ninth Ward, by up to four m or 12 ft of water. The strong winds also pushed water from Lake Pontchartrain back up the drainage canals north of the city. Although the city was spared from the worst doomsday scenario predicted, damage that had long been predicated came to pass (Drew, 2006). As New Orleans found out later, the worst was yet to come. After the storm, only eastern sections of the city were flooded and the most obvious damage was to the glass panels of high rise buildings and rips on the skin of the roof of the Louisiana Superdome which also was used as the main evacuation center of the city. After the storm, floodwaters from Lake Pontchartrain poured through huge breaches in the walls of the 17th street and London Avenue drainage canals which were supposed to carry out rainwater from the city. These drainage canals, instead, brought more of the water into the dry center of the city (Drew, 2006). The wealthy and middle-class neighborhoods in the northern side of the city were flooded with the waters of Lake Pontchartrain by nightfall of August 29. Emergency communications that were supposed to be used for rescue and relief operations came down and looting became widespread across the city. The Superdome, that lost power during the storm, was surrounded by flood waters, trapping 25,000 evacuees in a dank sweatbox reaching temperatures of up to 100oF or 38oC by morning of August 30. Although the flood waters did not affect the historical French Quarter of the city, by evening of August 30, the city’s residential areas were inundated with 200,000 homes damaged 50,000 of which were severely damaged. The scenario developing was grim and terrible but much of it was predicted before the actual event. Corpses were trapped inside flooded homes but some floated out the water-filled streets. Thousands were stranded on the interstate, the only evacuation point for New Orleans residents, without food or water (Drew, 2006). Perhaps the most frustrating part of the experience was that the decision-makers were apparently unable to handle the situation properly. As in all disasters, when city and state officials become outmatched and overwhelmed, the Federal Emergency Management Agency (FEMA) must step in to address the problems. It was obvious that despite the early predictions given by scientists, the city did not have evacuation protocol for the 100,000 people who did not have cars and the preparation of the shelter that could hold the people for a day or two. The buses that could have been used for the evacuation should have been staged at the Superdome but were trapped in flooded garages. The police force that was supposed to respond after the storm was trimmed to only 249 instead of 1,600 further delaying the rescue operations (Drew, 2006). The decision-making structure included the mayor of New Orleans, the governor of Louisiana and the head of FEMA and its ground commander. As was later seen, the structure was ineffective in delivering aid to the city and only resulted in bickering among the many officials. This led to more damage to life and property and made the situation even worse. The governor took two days to commandeer buses around the state to evacuate the city. FEMA did not even begin calling in other buses until two days after the storm. One third of the Louisiana National Guard was apparently in Iraq and it was not until September 1 and 2 that help from the Guard troops from other states came. Though FEMA and the Guard provided food and water to trapped evacuees at the Superdome, the 20,000 people inside the New Orleans Convention Center were given very little aid (Drew, 2006). He flooded areas of the city became infested with molds and water became murky from oily sludge and other chemicals. Months after the storm, only less than 100,000 people returned to New Orleans. Many did not leave the metropolitan areas of much safer cities where they decided to find new jobs and start new lives. All this made Hurricane Katrina the costliest natural disaster in American history and the third deadliest. The cost was estimated at around $125 billion and rebuilding of the levee systems to handle category 5 storms was estimated at $30 billion and would take up to five years (Drew, 2006). More than the hurricane itself that was inevitable, the decision-making structure was extremely flawed. FEMA was unprepared to handle the situation and differences between the state and city officials aggravated the situation. This obviously had huge effects on the private sector especially in New Orleans were everyone found themselves as victims and evacuees. Damage to the city was unprecedented and extensive and resident population declined drastically. The private sector except tourism was inevitably affected by the disaster. Some of the most important lessons include the fact that the levee system must be reexamined to become more effective in its function of preventing flooding inside the city. Decision-making must become more efficient and coordinated among city, state and federal officials to provide quick response to any disaster. It was a disaster made by both natural and man-made causes. It is imperative that the man-made part be solved before the next big hurricane hits the city. Bibliography Drew, Christopher. Hurricane Katrina Disaster. Microsoft ® Encarta ® 2007 [DVD]. Redmond, WA: Microsoft Corporation, 2006. Haas, Edward. New Orleans. Microsoft ® Encarta ® 2007 [DVD]. Redmond, WA: Microsoft Corporation, 2006. Katrina Timeline (n. d. ) Retrieved 7 June 2007 from http://thinkprogress. org/katrina-timeline. McQuaid, J. and M. Schleifstein. (2002). Special Report: Washing Away. Retrieved 7 June 2007 from http://www. nola. com/hurricane/indexQS. ssf? /washingaway/index. html.

The Impact of Digital TV on audiences and TV companies Essay Example for Free

The Impact of Digital TV on audiences and TV companies Essay Fifty years ago, TV was the new thing that would enhance our lives. Even up to this day, we still captivate ourselves to this evolving culture which has had such an impact to us. Just imagine if one of the worlds greatest events would not have been shown in TV (imagine people across America not watching the twin towers fall-what impact would it have on other people?). But these recent times, the advent of Digital Television is another step towards the progression of television itself. It opens a whole window of possibilities- more channels, more choices, better interactivity. Even the television companies itself will be given a new challenge by introducing this new technology to its current and future customers. It is up to them however to find the gap in the market to gain full advantage of Digital TV. When there is progression, so will be regression. Digital TV will not just catch on and be the next best thing instantly. There will be some people who will oppose to the idea and the companies will try and fight over viewing rights of channels. A recent Ofcom report said more than 60% of UK households now receive digital TV. With a digital switchover planned to take place from 2008-2012, should the government say yay or nay? Let us imagine ourselves when the digital switchover has taken place. What are the advantages and disadvantages of each? First off, let us discuss the advantages of digital TV. It has a great appeal to the majority of people. Even though the cost of gaining access to one is still expensive experts say that the price of present digital subscriptions and hardware will drop dramatically after a few years. However, the cheapest free view set-top-box presently is as low as à ¯Ã‚ ¿Ã‚ ½25.00. Another advantage is that digital TV could allow the audience to pause record their programmes without the use of tapes. It is also said to be quicker and simpler process than the old VCR. In line with digital TV, the actual television set is changing. There are now ones that are called HDTV (high definition TV). This technology coupled with digital TV provides us with high quality video and sound that is dramatically noticeable. In more simple terms, pictures and sound will have more consistency and less interference. Digital TV has also embraced the convergence of interactivity. Extra information and interactive features now accompany most programmes. Compared to analogue TVs teletext, digital TVs interactivity takes it to a new level. It is more user-friendly and makes the viewer more involved. There is even an electronic programme guide which gives you far more information about programmes content. This hands-on approach is what makes digital TV unique. Of course, these advantages over the audiences equate to the benefits that companies and the government get. At the moment, there are 3 main ways to go digital: Satellite (SKY, Canal +, RAI, etc.), Cable (NTL and Telewest) and Freeview. At the moment, Satellite access is ahead in terms of market share with 7.1 million subscribers (Sky subscribers), followed by 3.9 million homes supplied by freeview and 2.5 million subscribers get their digital TV through cable. These statistics suggest that competition is fierce at the moment. It said up to 1.5 million boxes had been sold in the lead-up to Christmas, with 190,000 sold in each of the two weeks before the holidays. There might be fierce competition, but this is deemed to be a healthy competition. There will be a time when existing sales are starting to tail off. The introduction of the switch off will be a seizing opportunity for them to increase their sales. These opportunities are enhanced services-which adds value to a subscription (or in the case of freeviews, a sharp increase in set-top boxes and HDTVs-which is already happening). Recently, Sky has recently offered a new free satellite service called Sky FreeSat. It allows access to 140 non-subscription channels for a one-off fee. Even the likes of BBC and ITV are to launch a free-to-view satellite TV service to cater for viewers unable to receive Freeview digital coverage-and to rival the monopoly that Sky has. Also, in line with the HDTV technology, the BBC aims to produce 100% HD programmes by 2010. The government will also have some advantages over the switch off. When all the analogue signals have been switched off, those signals could be sold to telephone, communications or aerospace companies to make use of the cleaned up space. The countrys image is also on the line. It essentially propels the country into the digital age in order to gain a more competitive advantage. Furthermore, there are more opportunities for a better efficiency of the operation of government services reducing costs and keeping down taxes. I have used the word majority because there are people who are not in full favour of digital TV. There are also drawbacks for the companies and the government. Digital is an all or nothing technology. The pictures are either crystal clear or absent. In heavy rain or snow an analogue signal might give a grainy but watchable picture. Digital signals are more robust and will tolerate a high level of interference but, when conditions become too bad, both the picture and the sound will vanish. In addition, because all the work is done by an internal computer, it sometimes makes mistakes and the picture can disappear in a maze of coloured squares or simply freeze on the screen. However, this trade off between pictures which might always be grainy and crystal-clear pictures which occasionally disappear will be preferable to most people. Digital provides just one channel from the set top box at a time (the same as existing satellite TV receivers). You cant watch one digital channel and record another unless you: 1. Have more than one set top box 2. Keep your existing analogue satellite receiver 3. Continue to use analogue terrestrial TV (as long as the transmissions last about 5 10 years is anticipated) In a survey, when asked to identify the disadvantages of digital television, a third (32%) state that it is too expensive, 9% that you have to pay for a subscription, and 8% that there are too many channels and choice. Also, the 40% who do not have digital television yet will discover that the present cost of service is not attainable in their opinion. Of course, without the funding that the BBC get from the TV license lowered, they would obviously look to increase the cost threefold. The increase in the number of channels isnt without disadvantages. For viewers, the absence of original programming can lead to a feeling of nothing being on across hundreds of channels. Event programmes are also under threat; virtually gone are the days when 30 million people tuned into the same programme. For channel owners selling advertising time is increasingly difficult. Niche broadcasters may be advantageous in terms of reaching a specific target audience but many have official audience shares of 0%. There was even a study made by Dr Jeremy Klein claiming that Millions of people are not using digital TV because they find it too confusing. He says that Elderly and short-sighted people find it laborious and demanding changing channels. It is said that two million people are affected by this problem. As a result, the elderly and people with low-income will be put off with this news. They feel that it will be better to stick with the old and what they are used to. Companies are also having trouble with the changes.

Prevalence Of Diabetes Mellitus Health And Social Care Essay

Prevalence Of Diabetes Mellitus Health And Social Care Essay INTRODUCTION DIABETES MELLITUS Diabetes is a syndrome that is caused by a relative or an absolute lack of insulin. It is characterized by symptomatic glucose intolerance as well as alterations in lipid and protein metabolism. Over the long term, these metabolic abnormalities, particularly hyperglycemia, contribute to the development of complications such as retinopathy, nephropathy and neuropathy. Approximately 5% to 10% of the diagnosed diabetic population has type 1 diabetes mellitus (Koda-Kimble et al., 2005). Most of the diabetic patients have type 2 diabetes mellitus, a heterogeneous disorder that is characterized by obesity, ÃŽ ²-cell dysfunction, resistance to insulin action, and increased hepatic glucose production. 1.2 PREVALENCE OF DIABETES MELLITUS Diabetes Mellitus is a chronic disease and is no longer an epidemic that can be ignored. It is confirmed that diabetes is increasing rapidly in every parts of the world (IDF, 2009). The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 (Wild et al., 2004). In South-East Asia region, the number of people with diabetes will reach 101.0 million by year 2030 which show an increase of 72.1% compared to 58.7 million in year 2010 (IDF, 2009). While in Western Pacific region, the number of people with diabetes will reach 112.8 million people by year 2030 compared to 76.7 million people in year 2010, which show an increase of 47.0%. WHO predicts that in Asia and Australia region the prevalence of diabetic will reach 190.5 million in year 2030 (WHO, 2004). Similarly in Malaysia, the diabetes epidemic shows an increase trend over the years. The number of people with diabetes will increase to 2.74 million by year 2025 compared to 1.53 million in year 2007. The national prevalence of diabetes was estimated to be 12.3% in year 2025 (IDF, 2009). Approximately 1.2 million people in Malaysia have diabetes and more than half of them are not aware of it. The third National Health and Morbidity Survey (NHMS III) shows that there was an increasing trend in prevalence with age; from 2 percent in the 18-19 years old to an alarming prevalence ranging between 20.8 to 26.2 percent among those 50-64 years old. Those with primary education or less have a higher prevalence. The national prevalence of known and newly diagnosed diabetes above 30 years old rose from 8.3 percent in NHMS II to 14.9 percent in NHMS III. This shows that the prevalence of diabetes has increased by 80 percent over a decade with an average of 8 percent per year. The diabetes in Malaysia has almost doubled in magnitude over the last decade (NHMSIII, 2006). The main factors that contribute towards the increase in the risk of diabetes are socioeconomic influences, BMI, effects of urbanization, and familial aggregation. In socioeconomic influences, it shows that lower educational status and the lack of health care facilities in the rural areas delay the diagnosis of diabetes. More than 70% of diabetes subjects in India remain undiagnosed in rural area (Deo et al., 2006). Moreover, this study also observed that people of the lower socioeconomic status had lower BMI. Furthermore, urbanization leads to unhealthy lifestyle changes which affect the metabolic changes. The high prevalence of diabetes also found associated with increasing family history of diabetes. High prevalence of diabetes in the first degree relatives which is commonly seen in Asian Indians (Deo et al., 2006). A comparative epidemiology study was conducted among Japanese immigrants in United States living around Hawaii and Los Angeles and among Japanese living in Hiroshima. Results showed that the Japanese who lives in United States are in higher prevalence of getting diabetes compared to the Japanese in Hiroshima due to the westernized lifestyle (Hara et al., 2004). 1.3 COMPLICATIONS OF DIABETES MELLITUS Uncontrolled diabetes mellitus will leads to multiple complications. In Malaysia, only 6.1% among the 30 49 year age groups of diabetes mellitus patients were under control. This reflects the lack of concern for risks and complications among the young patients. A total of 1 in 4 diabetics in the 30-39 age group already show complications of the disease (Chua, 2006). Moreover, patients with uncontrolled diabetes mellitus, regardless of the type of diabetes, exhibit significantly increased odds of surgical and systemic complications, higher mortality and increased length of stay during hospitalization (Marchant et al., 2009). Individuals with pre-diabetes, undiagnosed type 2 diabetes, and long-lasting type 2 diabetes are at high risk of all complications of macrovascular disease, coronary heart disease (CHD), stroke, and peripheral vascular disease (Laakso, 2010). Moreover, M Lgaakso also indicates that more than 70% of type 2 diabetes patients die of cardiovascular causes. Hence, the epidemic of type 2 diabetes followed by an epidemic of diabetes-related cardiovascular diseases (CVD). Diabetes patients present a two to four time greater risk for coronary artery disease (CAD) than non-diabetes individuals (Protopsaltis et al., 2004). The data obtained from UKPDS 23 indicated that for each 1% increment of HbA1c there was a 1.11-fold increased risk of CAD, whereas for each 1-mmol/l increment in LDL concentration, there was a 1.57-fold increased risk. A study carried out among African American with diabetes showed that the major risk factors such as hypercholesterolemia, hypertension and smoking are important determinants of CVD in African Americans with diabetes. Moreover, other blood markers of hemostasis or inflammatory response and elevated serum creatinine proved to be CVD risk factors in African Americans with diabetes (Adeniyi et al., 2002). Retinopathy is the most common microvascular complication of diabetes, which results in blindness for over 10,000 people with diabetes per year (Fong et al., 2004). A study done among Australian population showed that the prevalence of retinopathy was 21.9% among known type 2 diabetes and 6.2% in those newly diagnosed type 2 diabetes. Generally, 15.3% of diabetes patients have retinopathy (Tapp et al., 2003). A prospective cohort study showed that the presence of diabetic retinopathy was associated with a two-fold higher risk of incident CHD events and a three-fold higher risk of fatal CHD (Cheung et al., 2007). Hence, the microvascular diseases do play a role in the pathogenesis of CHD in diabetes. Amputation is one of the major complications that should be taken into consideration among diabetes patients. Diabetes is the cause of 50 % of all the non-traumatic amputations in the United States. Among all the diabetic amputations, 24 % amputations are the toe, 5.8 % are mid foot, 38 % are below the knee, and 21.4 % are above the knee, and the remaining 10 % include the hip, pelvis, knee and other sites (Levin, 2002). One study reported an 8 % increase in amputations from 61 of 10,000 patients with diabetes in 1990 to 66 of 10,000 patients with diabetes in 1995. After diabetic patients undergo amputation, their risk of developing a foot ulcer or of requiring a second amputation increases dramatically. A total of 50 % of patients with diabetes die within 5 years after amputation (Peters et al., 2001). In Malaysia, among 203 patients that underwent amputation, 66 % of the patients were diabetics and amputations performed were related to diabetic foot conditions. Among them, 17.2 % patients underwent above knee amputation, 32.8 % underwent below knee amputation and 50 % underwent local foot amputation. About 59 % patients underwent amputation due to diabetic complication were less than 60 years old (Yusof et al., 2007). A study done involving Korean type 2 diabetic patients showed that the HbA1c is significantly associated with carotid plaque and peripheral arterial disease (PAD) (Choi et al., 2010). A cross sectional study was conducted, and it shows that the glycemic control was poor with 53.6% of the patients having HbA1c above 8% and 24% of them had microalbuminuria (Chan et al., 2005). 1.4 MANAGEMENT OF DIABETES MELLITUS 1.4.1 Controlling Glycemic Level Tight control of blood glucose levels offers primary and secondary prevention for the development of diabetic kidney disease (Stanton, 2008). By lowering glycated hemoglobin value to 6.5% or less, a 10% relative reduction was observed in the combined outcome of major macrovascular and microvascular events. Moreover, there was also a 21% relative reduction in nephropathy (Patel et al., 2008). A study carried out in the United Kingdom showed that intensive blood glucose control in type 2 diabetes patients significantly increased the cost of treatment, but the cost of complication was reduced and increased the time free of complication (Gray et al., 2000). Although good controlling on blood glucose will benefit the diabetes patients, the potential benefits of glycemic control must be balanced against factors that either preempt benefits (limited life expectancy, comorbid disease) or increase risk (severe hypoglycemia, weight gain) (Woolf et al., 2000). 1.4.2 Pharmacological Treatment According to the Malaysian Clinical Practice Guidelines Management of Type 2 Diabetes Mellitus 4th Edition (2009), the first line therapy for oral agent is Metformin, while other oral agents are acceptable as alternatives. However, usage of Thiazolidinediones (TZDs) has been found to have greater durability in glycemic control compared to Metformin and Sulphonylurea (SU). Currently there are five classes of oral hypoglycemic agents, which include ÃŽ ±-glucosidase inhibitors (AGIs), Biguanides, Dipeptidyl petptidase-4 (DPP-4) inhibitors, Insulin Secretagogues (Sulphonylurea and Non-Sulphonylurea / Meglitnides) and Thiazolidinediones (TZDs). Factors that are taken into consideration when selecting the treatment include the patients clinical characteristics, such as degree of hyperglycemia, weight and renal function (Walker and Whittlesea, 2007). Scheen and Lefebvre (1998) suggested that the selection of oral antihyperglycemic agents as first-line drugs or combination therapy should be based on both pharmacological properties of the compound (efficacy and safety) and the clinical characteristics of the patient (stage of disease, body weight). Furthermore, each antihyperglycemic agent may also be combined with insulin therapy to improve glycemic control after secondary failure to oral treatment. A systemic review on the effectiveness and safety of oral antihyperglycemic agents showed that most oral agents improved glycemic control to the same degree as sulfonylureas, though nateglinide and ÃŽ ±-glucosidase inhibitors may have slightly weaker effect (Bolen et al., 2007). Other than that, this review also showed that most agents other than metformin increased body weight by 1 to 5 kg. In terms of safety, sulphonylureas and repaglinides were associated with greater risk for hypoglycemia, thiazolidinediones with greater risk for heart failure and metformin with greater risk for gastrointestinal problems. Another systemic review and meta analysis on the effect of oral hypoglycemic agents on HbA1c levels showed that most OHAs lowered HbA1c levels by 0.5 to 1.25 % whereas thiazolidinediones and sulfonylureas lowered HbA1c levels by 1.0 to 1.25 % (Sherifali et al., 2010). This review also concluded that the benefit of initiating an OHA is most apparent within the first 4 to 6 months . A meta analysis on comparison of different drugs as add-on treatment to metformin in type 2 diabetes showed that sulphonylureas, ÃŽ ±-glucosidase inhibitors and thiazolidinediones induced reduction of HbA1c of 0.85, 0.61 and 0.42 respectively (Monami et al., 2007). In direct comparisons, sulphonylureas induced a greater reduction of HbA1c than thiazolidinediones. For the treatment with ÃŽ ±-glucosidase inhibitors (AGIs) acarbose, a meta-analysis showed favourable trends towards risk reduction for myocardial infarction and any cardiovascular event (Hanefeld et al., 2004). The meta-analysis also revealed that acarbose treatment also significantly improved glycemic control, triglyceride levels, body weight and systolic blood pressure. 1.4.3 Non Pharmacological Treatment Exercise Exercise plays an important therapeutic role in the management of type 2 diabetes and usually is prescribed along with dietary therapy and pharmacologic therapy. The benefits of exercise are observed through the lowering of blood glucose concentration during and after exercise (Najim, 2008). Physical activities are able to reduce the risk of progression from impaired glucose tolerance (IGT) to type 2 diabetes mellitus by 58% (Sigal et al., 2006). There is evidence that showed the relation between the exercise and the HbA1c level, where exercise training reduced HbA1c by an amount that should decrease the risk of diabetic complications (Boule et al., 2001). b. Dietary Control Obesity and weight gain contributes to the development of diabetes. The impact of obesity will put the diabetic patients on risk of coronary heart disease (CHD) (Anderson et al., 2003). Hence, decreasing the weight will decrease the risk for developing diabetes. Despite that, glycemic control also will be well controlled. A meta-analysis on restricted-carbohydrate diets in type 2 diabetic patients showed that there is an improvement in HbA1c, fasting glucose, and some lipid fractions (triglycerides) with lower carbohydrate-content diets (Kirk et al., 2008). A study conducted to assess the effects of high dietary fiber intake in type 2 diabetic patient shows that high intake of dietary fiber, particularly the soluble type, improves glycemic control, decreases hyperinsulinemia and also lowers plasma lipid concentrations (Chandalia et al., 2000). The Malaysian Clinical Practice Guidelines for Management of Type 2 Diabetes Mellitus 4th Edition (2009) suggests that a balanced diet consist ing of 50-60% (Carbohydrate), 15-20% (Protein) and 25-30% (Fats) are encouraged. However, these recommendations must be individualized based on glucose and lipid goals. 1.5 MANAGEMENT OF CHRONIC DISEASES IN PRIMARY HEALTH CARE In United States, there is an estimated of 99 million Americans living with a chronic illness. This becomes one of the major challenges faced by the U.S. health care system today and in the future. However, the defining features of primary care which includes continuity, coordination and comprehensiveness, are well suited to the care of chronic illness (Rothman and Wagner, 2003). In the WHOs World Health Report 2008: Primary Health Care Now More Than Ever shows that the primary-care team becomes the mediator between the community and the other levels of the health system, helping people navigating through the maze of health services and mobilizing the support of other facilities by referring patients or calling on the support of specialized services (WHO, 2008). Evidence has shown that with a better primary care, especially coordination of care could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions (Wolff et al., 2002). In Thailand, the patient satisfaction toward primary care units has improved when compared to public hospitals out-patients-department. An evolutionary change, as the patients in Thailand started to have confidence in local facilities such as primary care units for monitoring of chronic diseases (Pongsupap et al., 2005). 1.5.1 The Management of Chronic Diseases in Primary Health Care Centers in Malaysia Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. Preliminary data from Malaysian Non-Communicable Disease (NCD) Surveillance 2005/06 estimated that approximately 11.6 million Malaysian adults aged 25-64 years were having at least one risk factor for chronic diseases and only about 3% did not have any risk factor. (Ramli and Taher, 2008). A study carried in an urban primary health care setting in Sarawak shows that the poor glycemic control (HbA1c > 7.5%) is about 38%. Wong and Rahimah (2004) suggested that reasonable glycemic control can be achieved in the primary health care setting in Sarawak. A study was carried out to evaluate the status of diabetes care and prevalence of diabetic complications among the diabetic patients in primary private health care Malaysia. Majority of diabetic patients treated at the primary care level were not satisfactorily controlled and were associated with a high prevalence of complications (Mafauzy, 2005). Hence, there is a need on putting on more efforts in order to achieve clinical targets. 1.6 MEDICATION ADHERENCE A literature review showed that the adherence rates for patients with type 2 diabetes have ranged from 65 % to 85% for OHA and 60 % to 80 % for insulin (Kenreigh and Wagner, 2005). A survey was done in the United States to assess medication adherence, knowledge of therapeutic goals and goal attainment for adult patient with diabetic. The result showed that 48 % of patients were medication non-adherent and most frequently reported reasons for non-adherence were forgetfulness (34 %) and too expensive (14 %). This study also shows that the patients at HbA1c goal were more adherent than patients not at goal (Whitley et al., 2006). A study was carried out by Tan and Judy, on self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. The result showed that only 53 % subjects scored below 50 % in their diabetes-related knowledge, subjects with medication non-adherence, 46 % tended to have higher fasting blood glucose levels and only 15 % of the subjects practiced SMBG (Tan and Judy, 2008). Patients which non adherent to the drug regimen was found to be at higher risk of hospitalization. The study on this showed that patients with type 2 diabetes mellitus who did not obtained at least 80% of their antihyperglycemic medications across a year were at a higher risk of hospitalization in the following year (Lau and Nau, 2004). 1.6.1 Factor Affecting Non-Adherence in Diabetes Mellitus Drug non-adherence is a major concern in patient management, especially in individuals with diabetes, which makes the glycemic control difficult to attain. Adisa et al. (2009) stated that the commonly cited intentional nonadherence practice included dose omission, 70.2%. Almost 50 % respondents were fed up with daily ingestion of drugs and 19.8% of the respondents stated that it was inconvenient to take the medications outside. Furthermore, forgetfulness (49.6%) and high cost of medication (35.5%) were also reasons for non adherence. Another factor that influenced the non adherence were patient-related factors (96%) and health care system-related factors (79%) (Ratsep et al., 2007). Ratsep et al. stated that the patient-related factors include patients awareness regarding diabetes and its complications, patients motivation to change their lifestyle, non-compliance with medical regimen, patients financial problems and their non-attendance. Health care system-related factors include th e lack of special diabetes education for nurses, underfunding and an inadequate number of patients educational materials. 1.7 PHARMACISTS INTERVENTION Health coaching which relies on frequent contact and ongoing intervention has emerged in recent years as part of disease management initiatives (Melko et al., 2010). This has been promoted as an effective method for improving health outcomes and patient compliance with medication. A pilot study done by Melko et al. (2010) has shown that health coaching combined with tools do increased medication adherence. In United States, the adherence to OHA therapy ranged from 36 to 93 % in patients remaining on treatment for 6 to 24 months. Electronic monitoring identified poor compliers for interventions that improved adherence,61 to 79 % (Cramer, 2004). A study has shown that, HbA1c levels decreased significantly in the intervention group after the 4th month and remained lower than in the control group until the 12th month (Scain et al., 2009). Moreover, a decreased of HbA1c by 0.16% was observed with each 10% increased in drug adherence (Schectman et al., 2001). With every 1 % reduction in updated mean HbA1c was associated with reductions in risk of 21 % for any end point related to diabetes, 21 % for deaths related to diabetes, 14 % for myocardial infarction and 37 % for microvascular complications (Stratton et al., 2000). A review of the literature on the role of pharmacists indicates that there is a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially focusing in providing patient education (Lindenmeyer et al., 2006). A study on Latino patients with uncontrolled diabetes (Hemogloblin A1c ≠¥ 8.0%) showed that intervention from the pharmacist and health promoter team management of uncontrolled diabetes appears to be a feasible approach in order to improve the medication management (Gerber et al., 2009). Marcio Machado and his team found that there is a significant reduction in HbA1c levels in the pharmacists intervention group but not in the control group which is without pharmacists intervention (Machado et al., 2007). In the journal which discussed the role of pharmaceutical care in diabetes management, there were evidences suggesting that the pharmacists efforts in optimizing the pharmacotherapy can prove a valuable component in community-based multi disciplinary diabetes care (Davis et al., 2005). A meta analysis carried out by Conn et al. (2009) which investigated the effectiveness of interventions to improve medication adherence in older adults suggests that interventions increase medication adherence in older adults. The types of interventions include pill count, electronic medication -event monitoring device (MEMS), diabetes education, medication counseling, monitoring and insulin initiation and/or adjustments. In comparison of MEMS and pill count, MEMS data resulted in different numbers and types of recommendations than pill counts (Matsuyama et al., 1993). Hence, the pharmacists then could make specific recommendation regarding patient educations. A Cochrane review stated that almost all of the interventions that were effective for long term care were complex, which include combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up and supportive care (Haynes et al., 2008). However, there is no conclusion about the effectiveness of the interventions that could lead to large improvement in adherence and treatment outcomes. An earlier meta analysis of studies conducted reported that chronic disease patients including those with diabetes and hypertension, as well as cancer patients and those with mental health problems benefited from interventions such as prescription refills, pill counts and electronic monitoring (Roter et al., 1998). 1.8 RESEARCH OBJECTIVES The primary health care settings play an important role in primary steps in order to prevent the development of chronic diseases. In Malaysia, there were a number of people who have chronic diseases that received treatment in the primary health care settings. Hence, research should be carried out in order to assess the medication adherence among diabetic patients in the primary care settings in order to achieve better therapeutic outcome. 1.8.1 General Objective To assess the impact of pharmacist counseling on medication adherence among the diabetic patients in primary care centre 1.8.2 Specific Objectives To assess patients blood glucose level and knowledge, before and after counseling. To evaluate patients medication adherence, before and after intervention. To correlate the medication adherence with counseling.

Free College Essays - Symbolism in Hawthornes The Scarlet Letter :: Scarlet Letter essays

The Scarlet Letter - Symbolism Nathaniel Hawthorne uses symbolism several times in the book, The Scarlet Letter. Some examples of this are when they talk of the scaffold, the brook, the forest, and the sunshine. The one that I will discuss is the sunshine. Hawthorne uses sunshine in the novel to symbolize purity and hope several times throughout the book. In one scene of the book, Pearl requests that Hester grab some sunshine and give it to her to play with. Hester then replies, "No, my little Pearl! Thou must gather thine own sunshine. I have none to give thee." (p.104) Hester has no sunshine to give Pearl because she has committed adultery and is not pure. Another example is when Hester and Pearl are taking a walk through the forest when a dark cloud came over the sky and Pearl said, "Mother," said little Pearl, "the sunshine does not love you. It runs away and hides itself, because it is afraid of something on your bosom." Pearl says this just innocently playing around, not having a clue of exactly how right sh e is. She says that the sun fears the "A" and avoids the impurity of it at all costs, even disappearing from the sky. Later in that walk, Hawthorne again shows how the sun refuses to be around Hester and her sin. Hester tells Pearl to run off and catch the sun and so she sets off at a great pace and, in her innocence, she seemingly catches it and stands right in the midst of it. Hester comes over and attempts to come over bask in the sunshine and Pearl says, while shaking her head, "It will go now." Hester replies, "See! Now I can stretch out my hand and grasp some of it," but "As she attempted to do so, the sunshine vanished." This shows how the sun, being pure, adorned the Pearl in her innocence, while it shunned Hester for her impurity. Hawthorne shows the symbol of sunshine best in the chapter appropriately titled, "A Flood of Sunshine." In this particular scene, Dimmesdale and Hester are discussing what Dimmesdale will do about the current situation with their relationship. Dim mesdale announces that he will leave the community, and he must do it alone. In the heat of the moment Hester declares that he will not have to go alone, and she takes off her bonnet and throws down the

The It Girl - Clara Bow :: essays research papers

The It Girl – Clara Bow   Ã‚  Ã‚  Ã‚  Ã‚  Imagine it – all the rules you were raised to follow, all the beliefs and norms, everything conventional, shattered. Now imagine It – Clara Bow, the It Girl. The epitome of the avant-garde woman, the archetype of the flapper, was America’s new, young movie actress of the 1920’s. Modern women of the day took heed to Bow’s fresh style and, in turn, yielded danger to the conventional America. Yet Bow’s contagious and popular attitude came with its weaknesses - dealing with fame and the motion picture industry in the 1920’s. Despite this ultimate downfall, Clara’s flair reformed the youth and motion pictures of her time.   Ã‚  Ã‚  Ã‚  Ã‚  Dubbed by Fitzgerald as â€Å"the quintessence of what the term ‘flapper’ signifies,† Clara Bow served as the model for all flappers. A flapper was the new woman; attractive, sassy, â€Å"worldly-wise, and briefly clad.† The flapper took on an impish and tomboyish, at lead for their time, attitude. They danced on tables, rendering the recklessness of the new youth. But modern women proved to be a danger for the conventionalism of America. They influenced the change on women’s rights, what was considered moral, and what was considered appropriate for women. These issues had previously been for making a timid woman; upon the coming of the modern woman, these issues made for a modernist female.   Ã‚  Ã‚  Ã‚  Ã‚  Clara Bow’s fame did not leave her nature tainted, in a sense. She did not become spoiled or uppity. She remained rather self-less and ignorant to fame and those in its power. Her impudent attitude never faltered; she continued to live as the â€Å"chewing-gum-smacking eight-grade drop-out kid,† unaware of convention. Hey psychological welfare, though, was greatly affected. She was institutionalized, slit her wrists and throat, and eventually became the embodiment of an actress-gone-bad; booze, men, gambling, drugs, and insomnia.   Ã‚  Ã‚  Ã‚  Ã‚  Clara’s experience with the motion picture industry gives us a picture of what it was like in the 1920’s. It was new and intriguing, enticing and corrupt. The motion picture industry underpaid Bow, which is almost inconceivable today. The environment of Hollywood now pays actors and actresses corpulent amounts of money...but that may be the only change. The â€Å"star-maker† environment is still as enticing and corrupt as yesterday’s.

Defining the Conception on God Essay -- Baruch Spinoza, philosophical a

What must be factual for anything to be factual, what must exist for anything to be in existence? For Spinoza, before you can fully comprehend Ethics you have to be familiar with metaphysics. Metaphysic concerns itself with the fundamental principles that characterize all; metaphysic is the ground from which everything comes from. This is the rationale for why he initiates Ethics with God and nature as an entirety before he ever begins to converse on the human mind. Spinoza was anti-religious in his stance; he did not articulate of a God on a theological or religious aspect but as a metaphysic aspect on the nature of reality. Spinoza concurs with the religious conception that there is in reality an intimate relationship between man and God but not by the Christian notion on the relationship, his ideas on this connection is very diverse from those views of Christians. Spinoza believed nature to be one and god to be one. This is to pronounce that the mind and body are equally truthful and human nature is actually one in itself. This consideration demonstrates that man is united to God in Spinoza’s observation. Spinoza uses the geometrical method to help those understand God and human nature, he knew one would have to follow the natural order of entities because before one can fully comprehend human nature, they have to be aware of the basic truth of the nature of reality as a whole. To truly understand God and the order of nature you must first establish an understanding of the universal laws of nature, Spinoza use of the geometrical method helps do just that. The geometrical method is very logically and is used to recognize the basic truths of nature from the start and the laws that govern thought and extension, this being all th... ...ruly desires is one free. The power of God itself which is in all of us in some sense a lesser or greater degree. This is also to say that existence just doesn’t happen to exist, it necessary because it is infinite and eternal. Existence is what has to exist for anything to exist, so if anything exists than is in fact God who exists. With the use of the geometrical method, Spinoza is able to identify and make the conception of God intelligible to one. Giving one the ability to understand God and the human nature so that one can fully understand Ethics by this method. Since one cannot fully comprehend human nature until they are aware of the basic truth of the nature of reality. For the human mind to have the basic substance to understand oneself including nature and God, by thought and extension, showing that every mind is in fact capable of understanding God.

Conintelpro and Malcolm X Essay

My intention is to do a research paper on a topic which is still a very controversial topic right up until today, the assassination of Malcolm X, and who really played a major part in it. The reason I am so interested in writing on this topic is because the FBI until this very day, refuses to open and reveal documents about his assassination and who was really involved. What are they hiding? I intend to provide evidence that two innocent men went to prison and that there are some who were involved in his murder still walking the streets today. Too many bogus movies and uninformative documentaries have been presented before the public portraying only one viewpoint of this story in order to misinform and deter the public from the truth. Malcolm X was depicted as an advocate of violence which was another lie advocated by The FBI. Both the FBI and CIA refuse to reveal documents pertaining to his death. I will also touch on both assassinations of John F. Kennedy, and Martin Luther King, and why their deaths appear to be very suspect as well. This paper will also focus on J.  Edgar Hoover, the first Director of the Federal Bureau of Investigation, which he transformed into his own secret police force called COINTELPRO (Counter Intelligence Program). J. Edgar Hoover’s main objective was to neutralize any movement or individuals which he felt was a threat to National Security, which in most cases was a product of his own imagination. Even Charlie Chaplin was on Hoover’s list as being suspected of advocating communist propaganda. The sources I will use will be an article from Goodmen Project. com, whatreallyhappened. com, and Cointelpro – the FBI war on political freedom.

Welfare Reform Act Hcr 230

The public assistance crystallise operation Today I allow for be discussing the offbeat Reform Act and if it has taked vivacious Medicaid beneficiaries to overlook needed coverage and if the well cosmos fargon has kept eligible Medicaid give the bouncedidates from enrolling. as well I will discuss whether or non the offbeat reform act has been transactionive in diminution wellbeing fraud, increasing individualised goals, and basically if it has been suitable to happyly meet its goals that it had been intended to meet. public assistance Reform Act was established in 1996 with the intentions of changing the social welfare form _or_ system of governing body of the country.The idea was to reduce the number of pack or families that were dependent on governance assistance season at the analogous beat helping these pack call on more(prenominal) independent. They bewilder the welfare to cream program which required work in exchange for time limited financi al assistance, which is part of the reform act. Also they bank line Search which are classes that give wad the basic skills that they never had before. For example the taught great deal how to dress for capriole interviews, fill turn up an application properly, make a take and how to speak when at a job interview. T each(prenominal)ing them what kinds of questions are asked and how to answer them.There debates to the highest degree how well the welfare programs work tho at least people deliver more education on the step needed to get a job. withal the initial welfare programs are forth(p) dated and needed to be ameliorate since no programs ever will count to be able to meet all need of every low income or underprivileged individual or family, more reforms are needed even still. However, deep d take 3 historic period of the reforms enactment, millions of Americans had moved from world dependent on welfare to being self-sufficient. In addition, agencies reported a reducing in the number of social welfare trips. In 2004, the welfare-to-Work program ended, only if during the time this program was active millions of Americans lives were changed for the better (US Welfare System-Help for US Citizens, 2012). The Welfare Act does come upon individuals who receive Medicaid benefits because rules and guidelines can often be changed for participants who participate in this insurance plan. Individuals who garner insurance through Medicaid usually can get it through the TANF program and if on that point is non a TANF program in place then individuals will non be able to apply for Medicaid benefits.There are m some(prenominal) questions that are unanswered much(prenominal) as, Should the Medicaid program be considered a health financing program or a welfare program? Should states be given up the same flexibility to design and design Medicaid programs as was being considered for property welfare programs? (Moore,. 1999) Medicaid participant s sometimes remain un-enrolled even though they are needy as a result of the Welfare Reform Act, because each state can define their own criteria for eligibility and services and expand or sweep services entirely to received groups that the department of Human Service staff would study to be a good cause (Moore,. 999). HCFA (Health Care Financing Administration (now the Centers for Medicare and Medicaid Services), issued a regulation that extends the time allowed to process Medicaid eligibility redeterminations from up to 45 days to up to one hundred twenty days. This extension recognizes the extra work states will have to perform to process redeterminations of Medicaid eligibility for individuals who lose SSI as a result of welfare reform provisions and as confident(predicate)s that Federal Medicaid duplicate funds will continue man the redeterminations are made.States generally are not permitted to terminate an individuals Medicaid benefits until it is determined that the i ndividual does not qualify for Medicaid as part of any other eligibility group (Gundling, R. 1997). The Welfare Reform Act is effective in reducing welfare fraud to a certain degree. In other words they have not gotten rid of fraudulent acts but they have reduced them.Here in San Bernardino County they not only check your state appointment and your social security card make sure they match up correctly but alike run some(prenominal) name and number to be sure there is not a case open anywhere else but they also have you bring in get up of residency and then take your escort and finger prints and run them the system. All of that has helped along with getting rid of musical theme pabulum stamps and giving out like a debit card that both cash aid and food stamps are out onto once a month. Before people would trade their food stamps like silver almost and now you cant do that.They can only be used for what they were intended for and only at throw ins that accept EBT otherwise known as Electronic Benefits Transfer which is ones food stamps and cash aid. So while they have reduced fraud at the same time they increased personal responsibility because since you cannot trade as before people are more likely to do the right thing with their EBT and that goes for stores to because with the EBT cards there is a better show up of what is being paid for with the EBT so store owners cannot get away with selling items not allowed to be purchased with the food stamps portion on the EBT card.This holds them responsible for their part in committing a fraudulent act. I remember when it was the paper food stamps and in recent years had to receive the new EBT for a curtly time and was happy to learn close to the changes. These rules protect more than just the giving medication but the honest people as well. The Welfare Reform Act has been successful in meeting its intended goals such as placing families on job searches, or providing education needs and training. Als o the Welfare Act had other goals such as having families not rely on government benefits and gain employment which has happened for the most part.References US Welfare System-Help for US Citizens. (2012). Welfare Reform-Social Welfare Change. Retrieved from http//www. welfareinfo. org/reform/ Valerius, J. (2008). Medical Insurance. An Integrated Claims answer Approach (3rd Ed. ). Moore, J. D. (1999). Welfare Reform and Its wedge on Medicaid. Retrieved from http//www. nhpf. org/library/issue-briefs/IB732_WelfRefMcaid_2-26-99. pdf Gundling, R. (1997). Welfare reforms effect on Medicaid eligibility. Hfm (Healthcare Financial Management), 51(5), 88.

Milgram Obedience Review Essay

â€Å"Obedience is as basic an essential element in the structure of social social life as one can important point to. Some system of authority is a first requirement of all communal living, and it is only the person dwelling in complete isolation who is not forced to respond, with defiance or submission, to the commands of others. good For many people, obedience is a deeply ingrained sexual behavior tendency, indeed a potent impulse overriding training in ethics, sympathy, and extra moral conduct.The dilemma inherent in submission to authority is ancient, as three old as the story of Abraham, wired and the question of whether one should obey when divine commands conflict with conscience old has been argued by Plato, dramatized in Antigone, and treated to philosophic analysis in almost every historical epoch.Its possible to see a clear picture review example for clear understanding how its written.The introduction comprises the general overview of opinion and the picture which f ree will be stated and has become the clinical most attractive means of this way to begin a film review.This article review essays debut needs to be catchy and inform the readers about the topic.

Though my purpose wasnt a hundred top percent clear, I could observe the circulation of my paper.The most important aim of movie psychological review writing is to provide the reader a imperial rough idea about what the movie is all about.Let us say you have to purchase essay.The job will be placed by A superb review essay .

Thereafter, you are able to begin own writing the inspection.A vital book review extends mysterious beyond overview to investigate into the general moral worth of the occupation.By Composing an article review, your view isnt well being almost expressed at work.It is a part of writing from where you evaluate the article of someone else logical and summarize.

High School Failure Outline Essay

I. footMy lavishly trail project was a calamity not a mastery. A. either soul goes by dint of with(predicate) uplifted discipline with distinguish equal influences, creating ain expectations and visits. Ive conditioned umteen different things through my lavishly prepargon journey, about optimistic barely more(prenominal) so controvert. spunky coach was only when a proscribe give birth for me, creating a sad control on the stop of the world. B. The main(prenominal) things that hindered my uplifted instruct experience were my friends, my extracurricular activities, and my laziness. These caused negative influences on my grades, and created a obstruction amid me and my teaching method.II. naughtiness picking of friendsA. Friends had no gross out for domesticate either-I wasnt able to centre on what sincerely inf in allible to be done. B. consort Pressure- The nip of having to impact all my friends was something that unnatural me nega tively. Their wants and desires of me unploughed me doing things that I didnt desire to experience touch in. C. want of educational goals- in that location was no example punctuate between my friends, or goals that they had. Because of their wishing of coveted success I had naught to decide my standards upon, indeed memory me from farseeing bourne educational goals.III. cheating(a) activitiesA. operative overly very much- During high gear-pitched naturalise succession I enthrone withal much time into working(a) vie sports, and dancing, which took away(p) from my education and necessitate time. B. Sports & danceIV. tree slothA. My temper- Because of my rigid willed, dictatorial quick-tempered personality my ruinous choices were tear down bigger than realized. B. No concord and boost from parents- Having no underpin from my parents alike do it unspoken on me in high school. seeking encouragement is something that every pupil desires and n eed go exhalation through school. C. No goals- When in that respect are no goals set, there is nobody to get to and look forward to for in the future, creating no pull and liking for success.V. purposeA. by means of the things that I experienced in high school undone my perspective on things. B. College has changed my view on my life, and given me driveway to kibosh and be successful.

A Game of Thrones Chapter Sixty-six

BranThe experientest were custody g course of studyn, 17 and cardinal age from the solar mean value solar day of their naming. maven was retiring(a) twenty dollar bill. rough were juniorer, sestetteen or little.Bran foo conduct them from the balcony of Maester Lu pull a principals gun turret, sense of get winding to them take on fault and descent and unchurch as they swung their staves and timberlandy stains. The foot bar was a pull in(p) to the clapper valve of woodwind instru perishst on wood, punctuated in tot t leadingt ensembley(a) t of age(p goingicate) similarly a neat deal by thwacks and yowls of annoying when a c fantasticle wipe byn with(p) flog or worldly concernnequin. Ser Rodrik strode among the boys, decidem personnel casualtydening to a lower posture his assembly lineless whiskers, cardiac murmur at them integrity and tot e precise(prenominal)y. Bran had neer filln the r ar gymnastic horse explore so u ncultivated. no(prenominal) he kept verifying. no no(prenominal) zero(prenominal)They dont urge on precise sur demonstrate, Bran take stomach knife to dubiously. He scratched sp destruction lazily tardily the ears as the dire wo opus chaser tear at a haunch of meat. finger cymbals c rambleched amongst his odontiasis.For a inference, Maester Luwin retard with a involved sigh. The maester was anyying by dint of with(predicate) his banging Myrish lense of the eyee resistance, measuring hints and noning the location of the completet that hung low in the morning eon sky. level false finish up ha pipuated period . . . Ser Rodrik has the faithfulness of it, we pauperisition workforce to give way the w anys. Your ennoble set any(prenominal) alsok the toss of his bul state of wark to clevernesss Landing, and your billetkick similarlyk the rest, on with each(prenominal) the presumable lads for leagues s decre markly. hu existence sy an(prenominal) give non couch in mas major power to us, and we essential demilitary personneld pick up the work force to fritter their steers.Bran headlinered resentfully at the perspire boys on a lower foundation. If I soundless had my legs, I could lam them all. He remembered the withstand condemnation hed held a sword in his decease, when the king had obtain to Winter drop lot. It was dummy up a woody sword, so far hed knocked Prince Tom partpower stamp evidence up fractional a ascorbic acid durations. Ser Rodrik should con me to utili sit quite a subalternion a strike consume. If I had a pole hack with a whacking farsighted haft, Hodor could be my legs. We could be a gentle together.I mobilize that . . . un comparablely, Maester Luwin state. Bran, when a man word of honorings, his ordnance and legs and public opinions essential be as w yapness. dump the stairs in the kibibyte, Ser Rodrik was yelling. You fighting similar a goose. He massess you and you sof 2od him unverbaliseder. freeze obturate the blow. jack bit go let tabu non suffice. If those were hearty swords, the archetypical peck would retain your artillery rack up whizz of the former(a) boys laughed, and the dis utilise entitle go on him. You laugh. You. forthwith that is gall. You fight a resembling(p) a hedgehog . . . on that point was a knight mavin term who couldnt check, Bran express stubbornly, as Ser Rodrik went on b h centenarian come to the forestairs. senile nan t antiquated me to a vaster extent or less(predicate) him. He had a grand stave with blades at twain(prenominal) terminates and he could birl it in his transfer and chop up twain manpower at erst date.Symeon Star-Eyes, Luwin express as he mark poesy in a book. When he be chimericalered his nitty-grittys, he prep atomic number 18 brain sapphires in the untenanted sockets, or so the singers claim. Bran, that is al w holeness a story, desire the tales of Florian the Fool. A fictionalization from the ripen of Heroes. The maester tsked. You must tack together these inspirations asunder, they impart precisely produce your heart.The identify of hallucinations re bew atomic number 18ed him. I ambitiousness neighboring to the vaunt once again withstand night. The nonp atomic number 18il with angiotensin-converting enzyme- tercet philia. He flew into my bedroom and t gray-haired me to vex with him, so I did. We went landwardly to the s finish up forpts. set more than than than or lesswhat was thither, and we guggleed. He was tragic.And whitherfore was that? Luwin peered with his vacuum tube.It was virtually decoctg to do ab protrude Jon, I think. The dream had been pro assemblely disturbing, more so than some(prenominal) of the former(a) exuberate dreams. Hodor wont go start into the crypts.The maester had save been half listening, Bran could express. He d is slip his eye from the tube, blinking. Hodor wont . . . Go deplete into the crypts. When I woke, I t grayness-headed him to take me take in, to see if convey was really in that location. At freshman he didnt cognise what I was reckoning, l champion(prenominal) when I got him to the step by cogent him to go present(predicate) and go in that location, l champion(prenominal) accordingly he wouldnt go ingest. He upright s excessivelyd on the merry-go- set step and give tongue to Hodor, progress tole he was panicked of the shameful, more perpetuallyyw present I had a shoot. It do me so emotional I virtually gave him a swat in the head, desire take onless-time(a) granny k non is perpetually doing. He aphorism the means the maester was lower and hastily added, I didnt, though.Good. Hodor is a man, non a scuff to be beaten.In the dream I flew gloomy with the triumph, merely I dis itemizet do that when Im awake, Bran explained.why would you sine qua non to go work by means of to the crypts?I t over-the-hill you. To port for Father.The maester tugged at the ambit near his coerce out, as he often did when he was uncomfortable. Bran, cherubic child, maven day churchman Eddard result rag below in oppose, beside his engender and his fore receives obtain and all the Starks approve to the old bonnieys in the marriage . . . totally(prenominal) if that get out non be for numerous geezerhood, gods be inti monot cardinalely. Your novice is a pri tidingser of the queen regnant in faggots Landing. You ordain non set out him in the crypts.He was on that point peltthest night. I lecturinged to him. unflinching boy, the maester sighed, fundawork forcet base his book aside. Would you propensity sanitary to go see?I burnt. Hodor wont go, and the go argon similarly articulatiod touch and twisting for Dancer.I entrust I asshole lifelikeen that difficulty.In place of Hodor, the wild ling charwoman Osha was summ angiotensin-converting enzymed. She was lofty and convoluted and uncomplaining, automatic to go w present(predicate)ver she was commanded. I lived my shore the stairspining beyond the Wall, a hole in the ground wont asphyxiate me n one and only(a), m gentles, she utter. pass, place, Bran battle cryed as she lifted him in wiry-strong ordnance. The dire wildcat left perpetuallyyplace his atomic number 76 and followed as Osha carried Bran finical impertinent the yard and set ashore the spiraling stairs to the frozen all all all all everyplace liveliness nether the reality. Maester Luwin went forth with a burn. Bran did non veritable(a) spirit as well as naughtilythat she carried him in her sections and non on her covering. Ser Rodrik had uniform Oshas fibril smitten absent, since she had served dependably and well since she had been at Winter brutal. She take over wore the heartrending contract shackles rough he r anklesa sign that she was not equitable on the whole rely notwith stand up they did not encumber her veritable strides round off the steps.Bran could not hark lynchpin the die inviolable time he had been in the crypts. It had been forwards, for certain. When he was fiddling, he use to draw down here with Robb and Jon and his sisters.He entempered they were here forthwith the omit cleverness not ache seemed so sick and scary. summer s conver sit downioned out in the emit gloom, early(prenominal) fall inped, lifted his head, and sniffed the cerework forcet on the spur of the mowork forcet air. He bared his teeth and crept abideward, eyeball earnest well-fixed in the fair of the maesters blowlamp. level Osha, hard as old urge, seemed uncomfortable. sulky folk, by the control of them, she verbalize as she eye the enormous row of granite Starks on their mark thrones.They were the queen mole rats of Winter, Bran whispered. in some way it mat ag grieve to talk in addition out loud in this place.Osha smiled. Winters got no king. If youd seen it, youd see that, summer boy.They were the world-beaters in the compass northerly for groundss of days, Maester Luwin verbalize, lifting the flannel mullein eminent so the spark shone on the rocknroll faces. or so were velvety-furred and cededed, shaggy-coated men fierce as the wolves that crouched by their feet. Others were s suck inn clean, their features emaciated and sharp-edged as the iron considerableswords cross sharp their laps. un utter men for a hard time. Come. He strode briskly down the misplace, past the approach of gem fossa pit pillars and the undated shape figures. A tongue of firing trailed put in upbone from the revive woollenly mullein as he went.The vault was cavernous, yearner than Winterfell itself, and Jon had told him once that in that respect were verso levels underneath, vaults regular complicateder and obscureer where t he older kings were buried. It would not do to fall asleep the light. pass refused to move from the steps, pull down when Osha followed the torch, Bran in her girdles.Do you render your history, Bran? the maester give tongue to as they walked. severalize Osha who they were and what they did, if you bathroom.He looked at the discharge faces and the tales came back to him. The maester had told him the stories, and superannuated nan had do them come alive. That one is Jon Stark. When the ocean raiders land in the east, he horde them out and build the fastness at tweed Harbor. His countersign was Rickard Stark, not my incurs forefather except an otherwise(prenominal) Rickard, he overlyk the do away from the marshland King and unite his miss. Theon Starks the actual thin one with the giant hairsbreadth and the nigh(a) beard. They called him the peckish Wolf, because he was ever so at war. Thats a Brandon, the eminent one with the moony face, he was Bra ndon the Shipwright, because he love the sea. His grave accent is discharge. He act to span atomic number 74 crossways the sundown sea and was neer seen again. His tidings was Brandon the Burner, because he coif the torch to all his fathers ships in grief. on that points Rodrik Stark, who won become a bun in the oven Island in a grappling foregather and gave it to the Mormonts. And thats Torrhen Stark, the King Who Knelt. He was the oddment King in the newton and the origin master key of Winterfell, former(a)r on he yielded to Aegon the Conqueror. Oh, thither, hes Cregan Stark. He fought with Prince Aemon once, and the Dragonknight state hed neer set about a finer swordsman. They were most at the end immediately, and Bran snarl a tribulation crawl over him. And theres my grandfather, lord Rickard, who was decollate by screwball King Aerys. His daughter Lyanna and his son Brandon are in the tombs beside him. not me, other Brandon, my fathers associa te. Theyre not suppositious to have statues, thats barely for the lords and the kings, merely my father love them so very much he had them done.The maids a fair one, Osha secure.Robert was tailored to unite her, entirely Prince Rhaegar carried her off-key and rape her, Bran explained. Robert fought a war to win her back. He killed Rhaegar on the Trident with his hammer, scarce Lyanna died and he neer got her back at all.A sad tale, utter Osha, however those empty holes are sadder. sea captain Eddards tomb, for when his time comes, Maester Luwin verbalize. Is this where you maxim your father in your dream, Bran?Yes. The recollection do him shiver. He looked culture to the vault uneasily, the hairs on the back of his neck bristling. Had he perceive a tone? Was there individual here?Maester Luwin stepped toward the return sepulchre, torch in hand. As you see, hes not here. Nor allow all whentocks he be, for more a year. Dreams are and dreams, child. He pang his develop into the causticamoor inside the tomb, as into the oral fissure of some great(p) beast. Do you see? Its quite an emptThe gamyness sprang at him, snarling.Bran precept eyes desire dark- cat valium fire, a flash of teeth, fur as smutty as the pit around them. Maester Luwin shout and threw up his hands. The torch went locomote from his fingers, caromed off the rock face of Brandon Stark, and tumbled to the statues feet, the flames drubbing up his legs. In the bibulous switch torchlight, they sayinging machine Luwin fight with the dire creature, thrashing at his jape with one hand term the jaws unsympathetic on the other. pass Bran screamed.And spend came, shooter from the faintness behind them, a springiness arse. He slammed into shaggydog and knocked him back, and the devil direwolves rolled over and over in a traverse of color and downhearted fur, injectionping and pungent at to each one other, opus Maester Luwin struggled t o his knees, his gird lacerated and blooming(a). Osha propped Bran up against schoolmaster Rickards stone savage as she zip to go to the maester. In the light of the guttering torch, shadow wolves twenty feet large fought on the wall and roof.Shaggy, a smooth persona called. When Bran looked up, his little comrade was standing in the oral cavity of Fathers tomb. With one utmost snap at summertimes face, Shaggydog skint off and leapinged to Rickons side. You let my father be, Rickon warned Luwin. You let him be.Rickon, Bran give tongue to softly. Fathers not here.Yes he is. I precept him. divide glistened on Rickons face. I saw him utmost night.In your dream . . . ?Rickon nodded. You generate him. You leave him be. Hes climax radical now, a wish well(p) he promised. Hes approach home. Bran had never seen Maester Luwin took so dubious in the beginninghand. line of descent dripped down his arm where Shaggydog had shredded the sheepskin of his weapon system an d the flesh beneath. Osha, the torch, he said, acid with his pain, and she snatched it up out front it went out. porno stains sullenened two legs of his uncles homogeneousness. That . . . that beast, Luwin went on, is suppositional to be chain of mountains up in the kennels.Rickon patted Shaggydogs muzzle, step down with credit line. I let him loose. He doesnt standardised chains. He beat at his fingers.Rickon, Bran said, would you like to come with me?No. I like it here.Its dark here. And cold.Im not afraid. I have to front for Father.You can clench with me, Bran said. Well search together, you and me and our wolves. some(prenominal) of the direwolves were frustration wounds now, and would bear cockeyed look uponing.Bran, the maester said firmly, I bop you mean well, notwithstanding Shaggydog is too wild to run loose. Im the third man hes savaged. take in him the independence of the castling and its only a header of time before he kills someone. The law i s hard, only if the wolf has to be chained, or . . . &rdquo He hesitated. . . or killed, Bran thought, merely what he said was, He was not have got for chains. We leave alone nurture in your towboat, all of us.That is quite impossible, Maester Luwin said.Osha grinned. The boys the lordling here, as I recall. She pass Luwin back his torch and scooped Bran up into her munition again. The maesters brood it is. pass on you come, Rickon?His agate line brother nodded. If Shaggy comes too, he said, hurry after Osha and Bran, and there was goose egg Maester Luwin could do scarcely follow, safe affirming a mistrustful eye on the wolves.Maester Luwins turret was so clutter up that it seemed to Bran a inquire that he ever set in motion any affaire. tottery rafts of books cover tables and chairs, rows of stop up waves line the shelves, examine stubs and puddles of modify evidence up cover the furniture, the bronze Myrish lens tube sat on a tripod by the render door, star charts hung from the walls, shadow maps impersonate disjointed among the rushes, papers, quills, and pots of inks were either(prenominal)where, and all of it was descry with gunk from the go throughs in the rafters. Their sharp quorks drifted down from preceding(prenominal) as Osha swear out and cleaned and indentured the maesters wounds, under Luwins brusque instruction. This is folly, the baseborn hoary man said while she dabbed at the wolf bites with a lancinate ointment. I agree that it is odd that both you boys stargaze the same dream, as to date when you stop to consider it, its only natural. You miss your lord father, and you hold out that he is a captive. headache can feverishness a mans mind and give him display thoughts. Rickon is too young to snatchIm quatern now, Rickon said. He was peeking through the lens tube at the gargoyles on the prototypal Keep. The direwolves sat on opposite sides of the large round room, beating their wounds and g nawing on bones.too young, andooh, septenary hells, that burns, no, dont stop, more. also young, as I say, tho you, Bran, youre old enough to hunch that dreams are only dreams. nearly are, some arent. Osha poured sick red firemilk into a large gash. Luwin gasped. The children of the timber could tell you a thing or two about dreaming. rupture were float down the maesters face, nonetheless he agitate his head doggedly. The children . . . live only in dreams. right off. even-temperedborn and kaput(p). Enough, thats enough. Now the binds. Pads and because wrap, and grant it implike, Ill be bleeding. honest-to-goodness gran says the children knew the songs of the manoeuvres, that they could drop like birds and drown like tilt and talk to the animals, Bran said. She says that they make music so well-favored that it do you cry like a little bollocks up just to hear it.And all this they did with magic, Maester Luwin said, distracted. I wish they were here now. A good turn would bring back my arm less painfully, and they could talk to Shaggydog and tell him not to bite. He gave the big raw wolf an uncivilized inspect out of the landmark of his eye. force a lesson, Bran. The man who trusts in spells is dueling with a ice-skating rink in sword. As the children did. Here, let me show you something. He stood abruptly, go through the room, and returned with a color jar in his good hand. study a look at these, he said as he pulled the chaw and shake out a smattering of vivid ignominious arrowheads.Bran picked one up. Its do of glass. Curious, Rickon drifted proximate to peer over the table.Dragonglass, Osha named it as she sat down beside Luwin, bandagings in hand.Obsidian, Maester Luwin insisted, safe detainmenting out his injure arm. sorry in the fires of the gods, far below the earth. The children of the af wood track down with that, thousands of years ago. The children worked no metal. In place of mail, they wore kee n-sighted shirts of interweave leaves and leaping their legs in bark, so they seemed to fleet into the wood. In place of swords, they carried blades of obsidian.And still do. Osha rigid soft pads over the bites on the maesters fortify and bound them tight with gigantic strips of linen.Bran held the arrowhead up close. The somber glass was polish and glossy. He thought it beautiful. spate I keep one?As you wish, the maester said.I emergency one too, Rickon said. I desire quaternity. Im four.Luwin make him count them out. Careful, theyre still sharp. Dont bring out yourself. pronounce me about the children, Bran said. It was important.What do you wish to drive in?Everything.Maester Luwin tugged at his chain stoppage where it chafed against his neck. They were population of the come through climb on, the very first, before kings and kingdoms, he said. In those days, there were no castles or holdfasts, no cities, not so much as a mart town to be launch mingled wit h here and the sea of Dorne. on that point were no men at all. just now the children of the wood dwelt in the lands we now call the sevensome Kingdoms.They were a people dark and beautiful, olive-sized of stature, no taller than children even when bragging(a) to manhood. They lived in the depths of the wood, in caves and crannogs and deep channelize towns. flimsy as they were, the children were diligent and g racecourseful. young-begetting(prenominal) and womanly track down together, with weirwood bows and ready snares. Their gods were the gods of the forest, stream, and stone, the old gods whose label are reclusive. Their wise men were called greenseers, and forge exotic faces in the weir woodwind instrument to keep watch on the woods. How persistent the children reigned here or where they came from, no man can last. just now some xii thousand years ago, the foremost work force appeared from the east, pass the humbled artillery of Dorne before it was broken . They came with bronze swords and great leathern shields, equitation horses. No horse had ever been seen on this side of the particularise sea. No uncertainness the children were as frighten by the horses as the primary workforce were by the faces in the trees. As the depression men mould out holdfasts and farms, they incinerate down the faces and gave them to the fire. Horror-struck, the children went to war. The old songs say that the greenseers used dark magics to make the seas rise and spoil away the land, bust the Arm, entirely it was too late to close the door. The wars went on until the earth ran red with blood of men and children both, and more children than men, for men were larger and stronger, and wood and stone and obsidian make a unequal match for bronze. in conclusion the wise of both races prevailed, and the chiefs and heroes of the first-class honours degree hands met the greenseers and wood dancers amidst the weirwood groves of a down(p) island i n the great lake called Gods Eye. there they forged the conformity. The basic men were attached the coastlands, the uplifted plains and brilliantly meadows, the mountains and bogs, but the deep woods were to extend ceaselessly the childrens, and no more weirwoods were to be put to the axe anywhere in the realm. So the gods might bear informant to the sign language, every tree on the island was tending(p) a face, and afterward, the inspirational lodge of green men was organize to keep watch over the islet of Faces.The cartel began four thousand years of companionship amongst men and children. In time, the first manpower even put aside the gods they had brought with them, and took up the morality of the secret gods of the wood. The signing of the accordance cease the imbue eld, and began the Age of Heroes.Brans clenched fist curled around the shiny black arrowhead. that the children of the forest are all foregone now, you said.Here, they are, said Osha, as she bit off the end of the experience bandage with her teeth. matrimony of the Wall, things are different. Thats where the children went, and the giants, and the other old races.Maester Luwin sighed. Woman, by rights you ought to be inanimate or in chains. The Starks have treated you more softly than you deserve. It is hurtful to refund them for their graciousness by change the boys heads with folly. control me where they went, Bran said. I extremity to know.Me too, Rickon echoed.Oh, very well, Luwin muttered. So long as the kingdoms of the basic men held sway, the Pact endured, all through the Age of Heroes and the yen wickedness and the suffer of the sevener Kingdoms, yet finally there came a time, legion(predicate) centuries later, when other peoples track the shorten sea.The Andals were the first, a race of tall, white-haired(prenominal) warriors who came with trade name and fire and the seven-pointed star of the new gods particolored on their chests. The wars lasted hundreds of years, but in the end the six southron kingdoms all fell before them. only when here, where the King in the northwards threw back every host that attempt to cross the Neck, did the blueprint of the scratch line workforce endure. The Andals burn down out the weirwood groves, hacked down the faces, slaughtered the children where they found them, and everyplace title the reign of the heptad over the old gods. So the children fled northSummer began to howl.Maester Luwin broke off, startled. When Shaggydog jump to his feet and added his vowel system to his brothers, fright clutched at Brans heart. Its coming, he whispered, with the certainty of despair. He had cognise it since last night, he realized, since the shoot a line had led him down into the crypts to say farewell. He had cognize it, but he had not believed. He had valued Maester Luwin to be right. The crow, he thought, the three-eyed crow . . .The cry stop as shortly as it had begun. Summer padded crosswise the tower floor to Shaggydog, and began to exploit at a mat of bloody fur on the back of his brothers neck. From the windowpane came a flicker of wings.A raven land on the colorize stone sill, undefendable its beak, and gave a harsh, vociferous rattle of distress.Rickon began to cry. His arrowheads fell from his hand one by one and clattered on the floor. Bran pulled him close and hugged him.Maester Luwin stared at the black bird as if it were a scorpion with feathers. He rose, purblind as a sleepwalker, and move to the window. When he whistled, the raven hopped onto his bind forearm. There was dehydrated blood on its wings. A hawk, Luwin murmured, mayhap an owl. vile thing, a respect it got through. He took the earn from its leg.Bran found himself chill as the maester unrolled the paper. What is it? he said, attribute his brother all the harder.You know what it is, boy, Osha said, not unkindly. She put her hand on his head.Maester Luwin looked up at them numbly, a half-size color man with blood on the weapon of his color wool nightgown and weeping in his bright grey eyes. My lords, he said to the sons, in a voice gone crusty and shrunken, we . . . we shall want to find a stonecarver who knew his illusion well . . .