Chemical Reactions Essay -- science

Chemical Reactions Chemical reactions are the heart of chemistry. People have always known that they exist. The Ancient Greeks were the firsts to speculate on the composition of matter. They thought that it was possible that individual particles made up matter. Later, in the Seventeenth Century, a German chemist named Georg Ernst Stahl was the first to postulate on chemical reaction, specifically, combustion. He said that a substance called phlogiston escaped into the air from all substances during combustion. He explained that a burning candle would go out if a candle snuffer was put over it because the air inside the snuffer became saturated with phlogiston. According to his ideas, wood is made up of phlogiston and ash, because only ash is left after combustion. His ideas soon came upon some contradiction. When metal is burned, its ash has a greater mass than the original substance. Stahl tried to cover himself by saying that phlogiston will take away from a substance’s mass or that it had a negative mass, which contradicted his original theories. In the Eighteenth Century Antoine-Laurent Lavoisier, in France, discovered an important detail in the understanding of the chemical reaction combustion, oxigine (oxygen). He said that combustion was a chemical reaction involving oxygen and another combustible substance, such as wood. John Dalton, in the early Nineteenth Century, discovered the atom. It gave way to the idea that a chemical reaction was actually the rearrangement of groups of atoms called molecules. Dalton also said that the appearance and disappearance of properties meant that the atomic composition dictated the appearance of different properties. He also came up with idea that a molecule of one substance is exactly the same as any other molecule of the same substance. People like Joseph-Lois Gay-Lussac added to Dalton’s concepts with the postulate that the volumes of gasses that react with each other are related (14 grams of nitrogen reacted with exactly three grams of hydrogen, eight grams of oxygen reacted to exactly one gram of hydrogen, etc.) Amedeo Avogadro also added to the understanding of chemical reactions. He said that all gasses at the same pressure, volume and temperature contain the same number of particles. This idea took a long time to be accepted. His ideas lead to the subscripts used in the formulas f... ...st, stimulating a reaction between two reactants, just stimulating a reaction one molecule at a time. The molecules are stimulated in a pattern giving the wanted results. This discovery opens doors for nanoengineering and material sciences. It gives a good view of what happens, one molecule at a time. Chemical reactions are a large part of chemistry. This paper is an overveiw of that extensive subject. It gives a good idea about the history of chemical reactions as well as the future. Hopefully, there will be no end to the expansion of chemistry and our knowledge. Since Scientists are still experimenting, chemical reactions will always be a part of chemistry. Bibliography "Chemical Reactions," Encyclopedia Brittanica MACROPEDIA, 1995, Vol. 15 "Dances With molecules," Science News, Vol. 147, May 27, 1995 Eastman, Richard H., General Chemistry: Experimental and Theory, Holt, Rhinehart, and Winston Inc., 1970 "One Molecule at a Time", Discover, January 1996 Pauling, Linus and Peter, Chemistry, W. H. Freeman and Co., 1975 "Reactions, Chemical," Encyclopedia Americana, 1982, Vol. 23 "Reactions, Chemical," Academic American Encyclopedia, 1991, Vol. 16

Discuss how Ralph changes in the course of the novel

Lord of the Flies Short Essay Discuss how Ralph changes in the course of the novel and why these changes occur. Ralph is an English schoolboy who is stranded on an isolated island without adults together with the other boys after a plane crash. He tries to establish a civilized society with rules and order by blowing the conch to assemble the boys. His charismatic nature allows him to be elected the leader. Rally's changes throughout the story can also be reflected by his changing perception on Piggy. â€Å"At the beginning: bullies PiggyAs the story progresses: has become more dependent on logical thinking and Is more determined to rebuild the community with the help of Piggy and his rational mind â€Å"Rally's perception towards Piggy has changed from an inferior boy with physical illnesses to an intelligent true friend by the end of the story He has changed from a bully to a mature boy and a responsible leader who understands the need to establish a civilized society with democr acy He relies on Piggy's reminders and his intelligence to call assemblies and make himself clear->He treasures Piggy and ales his opinions Piggy's Intelligence has a great Influence on Ralph (how adults perceive the world)† Examples: â€Å"Exercised verbal violence on Piggy (sucks to your ass- mar/auntie) Insisted on calling him the name he hates-â€Å"Apply', laughed at his name â€Å"Ralph wept for the end of Innocence, the darkness of man's heart, and the fall through the air of the true, wise friend called Piggy. † â€Å"Seeing how savage the boys like Jack and Roger can be while having Piggy as his companion,By Caring As the story progresses: has become more dependent on logical thinking and is more establish a civilized society with democracy He relies on Piggy's reminders and his values his opinions Piggy's intelligence has a great influence on Ralph (how adults mar/auntie) Insisted on calling him the name he hates-â€Å"PiggY', laughed at his name Ralph wep t for the end of innocence, the darkness of man's heart, and the fall need to maintain rational thinking all the time (like Piggy) in order not to degenerate and is therefore, not lured by the temptation of food More determined to maintain Jack Piggy as â€Å"role model† as he thinks in a logical manner and has enough knowledge to comprehend how adults' may think† â€Å"†Piggy could think. He could go step by step inside that fat head of his, only Piggy was no chief. But Piggy, for all his while maintaining a rational mind thanks to the constant reminders from Piggy

Evidence-based Interventions for a Patient Suffering from Dementia

Introduction Evidence-based practice has been promoted in all healthcare levels in the NHS (Department of Health, 2012). This is done to ensure that interventions are supported by current evidence in healthcare and have been found to be effective for most patients (Pearson et al., 2009). The use of evidence-based practice is rooted in the belief that patients should only receive quality care (Pearson et al., 2009). The same approach is used when caring for patients with mental health conditions. In the policy, No Health without Mental Health (Department of Health, 2012), the NHS has emphasised that patients suffering from mental health conditions should receive quality and evidence-based care. This brief aims to critically discuss the case of an 80-year old woman who is suffering from dementia and the different forms of interventions that could be applied to the case. Consistent with the Nursing and Midwifery Council’s (NMC, 2008) code of conduct, a pseudonym will be used to hide the identity of the patient. This brief discusses the purpose of evidence-based practice in managing patients with a progressive condition such as dementia. An investigation on the different forms of evidence-based interventions and their potential impact for promoting inclusion would also be presented. A discussion on interventions as means to develop a shared understanding of the patient’s needs would also be done. Legal, ethical and socio-political factors that influence the intervention process would also be explored. Finally, the last part discusses my role as a nurse in the intervention process. Using Evidence-based Interventions for Patients with Dementia The Nursing and Midwifery Council’s (NMC, 2008) Code of Conduct has stressed the importance of delivering quality evidence-based care that is patient-centred. Fitzpatrick (2007a) emphasised that the past model of evidence-based intervention relies only on current evidence from literature to support clinical decisions. Current studies that are of high quality are often used to inform current practices. Fitzpatrick (2007b; 2007c) exmphasised that nurses and other healthcare professionals should have the skills to critically assess the quality of a study and determine whether the findings are applicable to one’s current and future practice. Evaluating the strength of the evidence presented in a research study would require understanding of the search process and whether themes or findings from the study are credible or trustworthy (Polit and Beck, 2010). In recent years, this definition has included best practices, personal experiences of healthcare professional on providi ng care, experiences of colleagues, opinions of experts and current guidelines on a health condition (Fitzpatrick, 2007a; 2007b, 2007c; Greenhalgh, 2010). This new definition embraces other sources of evidence that could be used to help healthcare practitioners and patients make decisions regarding their care. Greenhalgh (2010) specifically points out that while there is reliance on good evidence from published studies, including the experiences of nurses, expert opinion and best practices to aid decision-making would ensure that patients receive quality care. Communicating evidence from published literature is also essential in helping patients decide on the best form of intervention. Morrisey and Calighan (2011) emphasises that effective communication is needed to convey findings of a study in a manner that is understandable to the patient. Successful use of evidence depends first on the quality of relationship between the healthcare providers and the patients (Croker et al., 2013. Kizer (2002) argued that for better care, the relationship between the healthcare professionals and the patients should be strengthened first. Kizer (2002) observe that, â€Å"this intimate relationship is the medium by which information, feelings, fears, concerns, and hopes are exchanged between caregiver and patient† (p. 117). In the UK, The National Institute for Health and Clinical Excellence (NICE, 2006) and the National Collaborating Centre for Mental Health (2007) have provided evidence-based guidelines on how to care for patients with dementia. These guidelines along with current literature, my own and my colleagues’ experiences, expert opinion and the experiences of my patient and her carers will form evidence on the best form of interventions for the patient. My patient’s name is Laura (not her real name). She is 80 years old with dementia, a condition that is progressive and characterized by deterioration of mental state, aggressive behaviour and agitation (Department of Health, 2009). A psychiatric consultant oversees the management of her condition. She has been receiving medications for her dementia but her GP and psychiatrist are discussing alternative drugs to reduce her anxiety level and regulate her sleeping patterns. She is diagnosed with type 2 diabetes and is mobilised with a frame following a broken hip. While she is still lucid and can communicate clearly, it is a challenge to care for her during nighttime when she becomes more anxious and shows signs of confusion. Patients with dementia suffer from progressive cognitive impairments (Department of Health, 2009) that could have an impact on how they receive information from their healthcare professionals and carers and in their adherence to medications. In the case of my patient, she is now showing signs of advanced dementia (NICE, 2006). This could be a challenge since her ability to refuse treatment or engage in healthcare decisions is severely reduced (Department for Constitutional Affairs, 2007). In the UK, the Mental Health Act 2007 (UK Legislation, 2007) and the Mental Capacity Act (Department for Constitutional Affairs, 2007) serve as guides on how to care for patients with mental health conditions such as dementia. These acts serve to protect the rights of the patient by locating a representative of the patient who could decide on her behalf. Hence, any interventions introduced for the patient should be agreed by the patient’s immediate family members or appointed guardian (Depart ment for Constitutional Affair, 2007). Since dementia is a progressive condition that could eventually lead to palliative care, the nurses have to ensure that the patient receives appropriate support during the trajectory of the condition. In my patient’s case, she needs immediate interventions for anxiety and sleep disturbance. She is also currently taking medications for her type 2 diabetes. The NICE (2006) guideline has stated the use of psychological intervention for patients with dementia. These include cognitive behavioural therapy, which will include the patient’s carers, animal-assisted therapy, reminiscence therapy, multisensory stimulation and exercise. Evidence-based Interventions and Potential Impact for Promoting Inclusion A number of studies (Casartelli et al., 2013; Monaghan et al., 2012; Ewen et al., 2012) have shown that exercise could improve the mobility of patients following hip surgery. Most of these studies use the randomised controlled trial study design, which ranks high in the hierarchy of evidence (Greenhalgh, 2010). This type of design reduces selection bias of the participants and increases the credibility of the findings of the study (Polit and Beck, 2010). The NICE (2013) guideline for fall also supports exercise intervention for improving patient’s mobility. My patient Laura is using a frame to aid her walking following a fall and an exercise intervention would improve her mobility. Considering that Laura is also suffering from anxiety, I counseled with the carer that we might consider an exercise intervention to both manage anxiety and improve mobility of the patient. This was well-received by the carer who expressed that they could help the patient with a structured walking e xercise. Meanwhile, cognitive behavioural therapy (Kurz et al., 2012; Hopper et al., 2013) has also been shown to be effective in reducing anxiety amongst patients and in regulating sleep behaviour. This form of intervention was also introduced to Laura and her carer. A programme was created where she would receive CBT on a weekly basis. It should be noted that the psychiatrist and the GP in the healthcare team are considering on alternative pharmacologic therapy to regulate sleeping behaviour and anxiety of the patient. While this might have a positive effect on the patient, it should be noted that medications for anxiety have side effects. For instance, the acetylcholinesterase inhibitors such as rivastigmine, galantamine and donepezil are known to have side effects on the cognition of patients (Porsteinsson et al., 2013; Moncrieff and Cohen, 2009). As a nurse and part of the team, I suggested to the team to consider the effects of pharmacologic interventions on the patient. Further, the NICE (2006) guideline also states that only specialists, that include GPs specialising in elderly care or psychiatrists, should initiate pharmacologic interventions. This guideline also emphasises that the Mini Mental State Examination (MMSE) score of the patient should be between 10 to 20 points. In Laura’s case, she is pro gressing from moderately severe dementia to its severe form. Introducing pharmacologic interventions might only worsen the cognitive state of Laura. Meanwhile, there is strong evidence from a systematic review (Filan and Llewellyn-Jones, 2006) on the effectiveness of animal-assisted therapy in reducing psychological and behavioural symptoms of dementia. A systematic review also ranks as high as randomised controlled trials in the hierarchy of evidence (Greenhalgh, 2010). Findings of Filan and Llewellyn-Jones (2006) also reveal that it can promote social behaviour amongst patients. This form of therapy was initially considered in Laura’s case due to its possible effects on the sleep behaviour of the patient. However, current evidence is still unclear on whether the effects could be sustained for prolonged periods. In application to my patient’s case, the use of animal-assisted therapy might be difficult to carry out since the patient has to depend on a carer for her daily needs. However, our team decided on using music therapy for the patient. Similar to animal-assisted therapy, there is also strong evidence on the e ffectiveness of music therapy in managing anxiety, depression and aggression amongst patients with dementia (Sakamoto et al., 2013; Wall and Duffy, 2010). Importantly, cognitive behavioural and music therapies and exercise interventions all promote inclusion of the patient in the care process (Repper and Perkins, 2003). In cognitive behavioural therapy, the patient and her carer receive support on how to manage anxiety and sleeping behaviour. Since carers are highly involved during CBT, there is a higher chance that the intervention would be successful (Hopper et al., 2013). It has been shown that carers of patients with chronic conditions such as dementia are also at risk of developing depression and anxiety (Department of Health, 2009). Smith et al. (2007) explain that this might be due to the realisation that the patient would not recover from the illness. Further, these carers have to prepare themselves for the patient’s end-of-life care. All these realisations could influence the carer’s own mental health (Smith et al., 2007). Hence, it is important that interventions are not only holistic for the patient, but should also include the carers in the process. Hence, implementing CBT would promote inclusion in practice (Wright and Stickley, 2013). The patient in my care is also suffering from type 2 diabetes. Pharmacologic interventions would include metformin and insulin therapy (NICE, 2008). Non-pharmacologic interventions include exercise, behavioural modification and diet. This presents a complex problem for Laura since it has been shown that elderly patients are also at greatest risk of malnutrition due to the aging process (Department of Health, 2009). Patients with dementia could experience feeding behavioural problems. When patients are admitted in hospitals, the new environment and lack of social interaction with peers could act as triggers in behavioural problems (Department of Health, 2009). Since patients might lack the cognitive ability to express themselves, this might present as aggressive behaviour (NICE, 2006). Hence, ensuring that Laura receives appropriate nutrition during her hospital stay could be influenced by changes in her behaviour. It is important that patients with type 2 diabetes do not only receive pharmacologic interventions but should also have sufficient diet. This is seen as a challenge in Laura’s case since she could experience feeding problems due to loss in cognitive abilities. For instance, she might be reminded on how to chew food or why she needs to eat (Department of Health, 2009). In patients with severe forms, the main aim of feeding is now focused on comfort feeding rather than allowing patients to eat the proper amount of food (Department of Health, 2009). Hence, managing Laura’s type 2 diabetes through proper feeding would be an added challenge to her care. Legal, Ethical and Socio-Political Factors that Influence the Intervention Process Decisions on the care and interventions received by the patient are influenced by several factors. First, the Mental Health Act 2007 (UK Legislation, 2007) states that patients with mental health condition could seek voluntary admission to hospitals and leave whenever they want. This Act also states that patients could only be forced to receive treatment in hospital settings if they are detained under this Act. Laura and her carer could refuse treatment or interventions at any point of her care and my team and I would respect her decision. Observance of this provision under the Mental Health Act would also be consistent with patient-centred care where patients are empowered to act for own benefit and to choose appropriate interventions. Apart from the legal aspects that influence the delivery of interventions, ethical issues should also be observed. In the ethics principle of beneficence, nurses and ot her healthcare practitioners should ensure that the interventions would be beneficial to the patient (Beauchamp and Childress, 2001). In Laura’s case, all the interventions cited previously have been shown to be beneficial to the patient. Only the pharmacologic interventions are associated with adverse and side effects for the patient (Popp and Arlt, 2011). Hence, as a nurse, I lobbied for inclusion of non-pharmacologic interventions instead of reliance on anticholinergic drugs to control the patient’s behaviour. In addition to beneficence, Beauchamp and Childress (2001) also add the ethics principles of autonomy, non-maleficence and justice. In Laura’s case, her autonomy would be respected. Allowing patients to participate in the decision-making process is crucial. However, patients with dementia suffer from cognitive impairments that could influence their decision-making ability (Wright et al., 2009). In accordance with the Mental Capacity Act 2005 (Department for Constitutional Affairs, 2007), the carers of Laura could be appointed to act on her behalf. In non-maleficence, the main aim of the interventions is to promote the health of the patient. There are no known side effects of the psychosocial and exercise interventions. Justice will be observed if Laura receives tailored-interventions that would address her needs. It is important that regardless of the patient’s background, religion, race, gender, ethnicity, she should receive healthcare interventions fit for her needs. This ethics principle is observed since a healthcare team has been addressing Laura’s healthcare needs. While all interventions are patient-centred, socio-political issues that could influence the interventions include the recent changes in the NHS structure where local health boards are primarily responsible for allocating funds to healthcare services (Department for Constitutional Affairs, 2007). Hence, if dementia care is not a priority in the local health board, health programmes for dementia might not receive sufficient funding. This could pose considerable problems for the elderly who are dependent on the NHS for their care. Laura has been receiving sufficient support for her mental health condition. This demonstrates that dementia care remains a priority in my area of care. A survey of the support system in my community reveals that support groups for carers are available. This is essential since supporting carers is also a priority in the NHS (National Collaborating Centre for Mental Health, 2007). Role of the Nurse in the Intervention Process On reflection of the case, I have a role to coordinate care with other team members and to ensure that the patient receives patient-centered care. As a nurse, I have to adhere to the NMC’s (2008) code of conduct and observe patient safety. Recognising that dementia is a progressive condition, I should also focus on interventions that not only addresses the current behavioural problems of the patient but also on preparing the carer and Laura’s family members on palliative care. The NICE (2006) guideline has stated that nurses have an important role in preparing patients of dementia and their family members on end-of-life care. This could be a highly stressful stage in the patient’s disease trajectory or could be one of acceptance and peace for the family. As a nurse, I have to ensure that interventions are appropriate to the stage of dementia that the patient is experiencing. Since nursing is a continuing process, I have to inform the family members that the patie nt will increasingly lose her cognitive abilities and would have difficulty feeding in the last stages of the condition (National Collaborating Centre for Mental Health, 2007). I have to ensure that the patient receives both spiritual and physical support at this stage. Evidence-based care is crucial in ensuring that patients receive the appropriate intervention. In my role as a nurse, I have to ensure that interventions are acceptable to the patient. I should also consider the preferences of the patient, their past experiences and their own perceptions on how to best manage their condition. Since I would be caring for a patient with declining cognitive abilities, I should ensure that her dignity would be maintained (Baillie and Gallagher, 2011). As part of my future learning development, I will attend courses on how to conduct end-of-life care for patients with dementia. Through Laura, I realised that a patient’s dignity should always be observed. It is recommended that in my future and present practice, I will continue to rely on literature on the best form of interventions of my patient. I will also consult with my colleagues, seek expert opinion and the patient’s experiences on how to choose and deliver interventions. Conclusion Evidence-based practice is important in helping patients achieve quality care. In this case, Laura is an 80-year old patient with dementia. She exhibits the moderate form of the condition but is beginning to show signs of advance dementia. As her nurse, I have the duty to observe ethics in healthcare and to seek for interventions that are evidence-based. However, I also realised that other factors also influence the delivery of interventions. These include socio-political, legal and ethical factors. As a nurse, I have to protect the patient’s rights, act as her advocate and ensure her safety during the trajectory of the condition. For future practice, I will continue to practice evidence-based practice. I will also encourage others in the mental health profession to always consider the patient’s preferences when caring for patients with dementia. When patients are unable to decide for their own care, the carer of the patient could act on her behalf. Finally, as a mental health nurse, I should constantly update myself with the best form of interventions for patients with dementia. This will ensure that my patients will receive evidence-based interventions. References Baillie, L. & Gallagher, A. (2011). ‘Respecting dignity in care in diverse care settings: Strategies of UK nurses’. International Journal of Nursing Practice, 17, pp. 336-341. Beauchamp, T. & Childress, J. (2001). Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press. Casartelli, N., Item-Glatthorn, J., Bizzini, ., Leunig, M. & Maffiuletti, N. (2013). ‘Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-moth postoperative comparison’. BMC Musculoskeletal Disorder, 14:176 doi: 10.1186/1471-2474-14-176. Croker, J., Swancut, D., Roberts, M., Abel, G., Roland, M. & Campbell, J. (2013) ‘Factors affecting patients’ trust and confidence in GPs: evidence from the national GP patient survey’, BMJ Open, 3(5). Pii: e002762. Doi: 10.1136/bmjopen-2013-002762. Department of Health (2012). No Health Without Mental Health. London: Department of Health. Department of Health (2009). Living Well with dementia: A National Dementia Strategy. London: Department of Health. Department for Constitutional Affairs (2007). Mental Capacity Act 2005 Code of Practice. Norwich: The Stationery Office. Ewen, A., Stewart, S., St Clair Gibson, A., Kashyap, S. & Caplan, N. (2012). ‘Post-operative gait analysis in total hip replacement patients- a review of current literature and meta-analysis’. Gait Posture, 36(1), pp. 1-6. Filan, S. & Llewellyn-Jones, R. (2006). ‘An animal-assisted therapy for dementia: a review of the literature’. International Psychogeriatrics, 18(4), pp. 597-611. Fitzpatrick, J. (2007a). ‘Finding the research for evidence-based practice: Part one- The development of EBP’. Nursing Times, 103(17), pp. 32-33. Fitzpatrick, J. (2007b). ‘Finding the research for evidence-based practice: Part two-selecting credible evidence’. Nursing Times, 103(18), pp. 32-33. Fitzpatrick, J. (2007c). ‘How to turn research into evidence-based practice: Part three- Making a case’. Nursing Times, 103(19), pp. 32-33. Greenhalgh, T. (2010). How to read a paper: the basics of evidence-based medicine. West Sussex, UK: John Wiley and Sons. Hopper, T., bourgeois, M., Pimentel, J., Qualls, C., Hickey, E., Frymark, T. & Schooling, T. (2013). ‘An evidence-based systematic review on cognitive interventions for individuals with dementia’. American Journal of Speech and Language Pathology, 22(1), pp. 126-145. Kizer, K. (2002). ‘Patient centred care: essential but probably not sufficient’. Quality and Safety in Health Care, 11, pp. 117-118. Kurz, A., Thone-Otto, A., Cramer, B., Egert, S., Frolich, L., Gertz, H., Kehl, V., Wagenpfeil, S. & Werheid, K. (2012). ‘CORDIAL: Cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: a multicenter, randomized, controlled trial’. Alzheimer Disease and Associated Disorders, 26(3), pp. 246-253. Monaghan, B., Grant, T., Hing, W. & Cusack, T. (2012). ‘Functional exercise after total hip replacement (FEATHER): a randomised control trial’, BMC Musculoskeletal Disorder. 13:237 doi: 10.1186/1471-2474-13-237. Moncrieff, J. & Cohen, D. (2009). ‘How do psychiatric drugs work?’. British Medical Journal: 338 [Online]. Available from: http://www.bmj.com/content/338/bmj.b1963#alternate. Morrissey, J. & Callgahan, P. (2011). Communication skills for mental health nurses. Maidenhead: Open University Press. National Collaborating Centre for Mental Health (2007). Dementia: The NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. London: The British Psychological Society and Gaskell and Social Care Institute for Excellence and NICE. National Institute for Health and Clinical Excellence (NICE) (2013). Falls: assessment and prevention of falls in older people: NICE clinical guideline 161. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2008). Type 2 Diabetes: The Management of type 2 diabetes. London: NICE. National Institute for Health and Clinical Excellence (NICE) (2006). Dementia: Supporting people with dementia and their carers in health and social care. London: NICE. Nursing and Midwifery Council (NMC) (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives. London: NMC. Pearson, A., Field, J., Jordan, Z. (2009). Evidence-Based Clinical Practice in Nursing and health Care. Assimilating Research, Experience and Expertise. Oxford. Blackwell Publishing. Polit, D. & Beck, C. (2010). Essentials of nursing research: appraising evidence for nursing practice. 7th ed. London: Lippincott Williams and Wilkins. Popp, J. & Arlt, S. (2011). ‘Pharmacological treatment of dementia and mild cognitive impairment due to Alzheimer’s disease’. Current Opinion in Psychiatry, 24(6), pp. 556-561. Porsteinsson, A., Drye, L., Pollock, B., Devanand, D., Frangakis, C. Ismail, Z., Marano, C., Meinert, C., Mintzer, J., Munro, C., Pelton, G., Rabins, P., Rosenberg, P., Schneider, L., Shade, D., Weintraub, D., yesavage, J. & Lyketsos, C. (2013). ‘Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial’. JAMA, 311(7), pp. 682-691. Repper, J. & Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. London: Balliere Tindall. Sakamoto, M., Ando, H. & Tsutou, A. (2013). ‘Comparing the effects of different individualized music interventions for elderly individuals with severe dementia’, International Psychogeriatrics. 25(5), pp. 775-784. Smith, G., Greogry, K. & Higgs, A. (2007). An integrated approach to family work for psychosis. London: Jessica Kingsley Publishers. UK Legislation (2007) Mental Health Act 2007 [Online]. Available from: http://www.legislation.gov.uk/ukpga/2007/12/contents (Accessed: 13th May, 2014). Wall, M. & Duffy, A. (2010). ‘The effects of music therapy for older people with dementia’. British Journal of Nursing, 19(2), pp. 108-113. Wright, N. & Stickley, T. (2013). Concepts of social inclusion, exclusion and mental health: A review of the international literature. London: SAGE. Wright, J., Turkington, D., Kingdon, D. & Basco, M. (2009). Cognitive-behaviour therapy for severe mental illness: An illustrated guide. USA: American Psychiatric Publishing Inc.

Have vs Having in Certain Expressions

Have vs Having in Certain Expressions Have vs Having in Certain Expressions Have vs Having in Certain Expressions By Maeve Maddox Paul Russell poses an interesting question about the use of have and having. He points out the common ESL error of saying I am having a headache and asks: Why can I say Im having my lunch but not Im having a headache? Some explanations Ive read indicate its all to do with possession. Â  But every time I think I have it figured, I have to wonder why I must say I have a cold when I cant say I have a heart attack. Im sure youll be having a good explanation for me:-) Heres the usual rule given to ESL students concerning the use of have to show possession or to describe medical conditions: Have should always be in the simple present tense for the meaning to own, or to describe medical problems. For example: They have a new car. I have a bad cold. It is incorrect to say I am having a cold or I am having a new car. Im having a heart attack does seem to contradict this rule. I think that the difference between I have a headache and Im having a heart attack may have more to do with duration than with either a medical condition or possession. One can have a heart condition, but a heart attack is a singular event, usually over in a few seconds or minutes. One may say I hope I wont have a heart attack, but in the event that one has oneand is capable of telling someoneam having is the only possibility. A headache is generally of longer duration than a heart attack. It may last an hour, several hours, or days. The same applies to a cold. Both are events of indeterminate duration. You have them for a while. If youre seated at a table having your lunch, youre engaged in an activity with a predictable end. Youll stop having lunch when youve finished eating. Thats my theory, anyway. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:"Because Of" and "Due To" 36 Poetry Terms10 Terms for the Common People

Teaching English Listening Skills to ESL Classes

Teaching English Listening Skills to ESL Classes Teaching listening skills is one of the most difficult tasks for any ESL teacher. This is because successful listening skills are acquired over time and with lots of practice. Its frustrating for students because there are no rules as in grammar teaching. Speaking and writing also have very specific exercises that can lead to improved skills. This is not to say that there are not ways of improving listening skills, however, they are difficult to quantify. Student Blocking One of the largest inhibitors for students is often mental block. While listening, a student suddenly decides that he or she doesnt understand what is being said. At this point, many students just tune out or get caught up in an internal dialogue trying to translate a specific word. Some students convince themselves that they are not able to understand spoken English well and create problems for themselves. Signs that Students are Blocking Students constantly look up wordsStudents pause when speakingStudents change their eye contact away from the speaker as if they are thinking about somethingStudents write words down during conversation exercises The key to helping students improve their listening skills is to convince them that not understanding is OK. This is more of an attitude adjustment than anything else, and it is easier for some students to accept than others. Another important point that I try to teach my students (with differing amounts of success) is that they need to listen to English as often as possible, but for short periods of time. Listening Exercise Suggestion Suggest a number of shows in English on the radio, podcasts online, etc.Have students choose one of the shows based on interestAsk students to listen to the show for five minutes three times a weekKeep track of student listening to encourage them to keep up the practiceCheck with students to confirm that their listening skills are improving over time Getting in Shape I like to use this analogy: Imagine you want to get in shape. You decide to begin jogging. The very first day you go out and jog seven miles. If you are lucky, you might even be able to jog the whole seven miles. However, chances are good that you will not soon go out jogging again. Fitness trainers have taught us that we must begin with little steps. Begin jogging short distances and walk some as well, over time you can build up the distance. Using this approach, youll be much more likely to continue jogging and get fit. Students need to apply the same approach to listening skills. Encourage them to get a film, or listen to an English radio station, but not to watch an entire film or listen for two hours. Students should often listen, but they should listen for short periods - five to ten minutes. This should happen four or five times a week. Even if they dont understand anything, five to ten minutes is a minor investment. However, for this strategy to work, students must not expect improved understanding too quickly. The brain is capable of amazing things if given time, students must have the patience to wait for results. If a student continues this exercise over two to three months their listening comprehension skills will greatly improve.

Organisational Communication Essay Example | Topics and Well Written Essays - 1250 words

Organisational Communication - Essay Example Therefore during the time of participation there is a need of information flow from both the sides. However the process of communication can be in the form of interacting, talking and writing as well. The present world of business is more saturated and also the companies have global presence. Such endeavors make communication even more multifaceted. Communicating across borders requires sound communication abilities that would allow people from different areas to cooperate with each other. The communication process can be divided into 5 dimensions. The five dimensions are described below:- International or Unintentional. Verbal or Nonverbal. Internal or external. Communication which involves Humans or Machines. Communication among individuals or groups. In the context of the project, only internal and external communication within the organization will be portrayed. Internal communication refers to the way of communication that takes place within the organization. The communication b etween the employees of an organization is denoted as internal communication. It is also important to achieve organizational objectives (â€Å"Internal communications†). ... The communications are:- The internal communication Employees: - The Company mainly uses E-mail and fax to communicate within the employees. The employees have their customized programs installed on their computers, so as to receive and send E-mails. Fax is also another medium which is being highly used in the company. Management: - In order to communicate with the top management of the organization pagers are mainly used. However customized E-mail programs are also used. Also the company in order to conduct vital meetings the company uses video conferencing. The external communication In this context the communication takes place among the company and its end customers, distributors and suppliers. The company in its external communication strategy uses various techniques, but remains transparent about the offerings. In order to portray the offerings the company used the promotions from the company is mainly TV advertisements and other trade and consumer schemes. Customers: - In orde r to directly communicate with the customers the company sends direct E-mail from the customer information database. Distributors and Suppliers of Coca Cola: - In this respect the company makes use of fax and video conferencing techniques. Now in the case of Pepsi, the internal and external communication also plays an important role towards the success of the company. In respect with its internal communication, the company mainly uses E-mail and also uses verbal communication. In order to communicate with the internal employees the company mainly uses meetings to communicate information within the team members. The external communication method of Pepsi is almost similar to that of Coca cola. Pepsi also uses TV advertisements

Analyzing Understanding the War on Terror 3rd Edition Essay

Analyzing Understanding the War on Terror 3rd Edition - Essay Example It was probably then when the notion of America on war with terrorism took birth. Later on, George W. Bush, US President and other officials of USA having high ranks used this term of War on Terror extensively to show that America is against terrorism and the organisations that use weapons and keep armaments for the purpose of spreading terror. This campaign was started because these terrorist organisations were not only causing threat to USA but they are threatening to other countries as well. Such militant organisations are dangerous for humanity on the whole. The phrase of the war on terror is particularly used against militant Islamic organisations like al-Qaeda. On the other hand, the present President of USA Barack Obama does not use the terminology of war on terror officially as he makes use of the term Overseas Contingency Operation for the same idea as that of war on terror. But the term of the war on terror is still in use and is used by political persons in media and some parts of government also makes use of it e.g. Global War on Terrorism Service Medal. Some people believe that the term of the war on terror was introduced by the US President George W. Bush after the 9/11 terrorists attacks on the twin towers of USA. The term the war of terror is developed to show America’s clash with the people who have Islamic extremist thoughts. This term of the war on terror was selected by George W. Bush when the higher officials of USA wanted to introduce the term "global struggle against violent extremism† (Coaty and Babst, pp. 222–228). USA had already a strained relationship with Iraq and also with Afghanistan which was led by Taliban. This stress in relationship occurred as a result of Gulf War of 1991 but the situation worsened and the terrorists’ attacks on the Twin Towers on 9 September 2011 made the US President Bush to take some steps against terrorism. The attack on the Twin Towers is observed as the attack on humanity and not on USA alone. Terrorism is a problem which has threatened not only America but also its allies and other independent countries. Furthermore, after the 9/11 attacks on the Twin Towers the anthrax-laced letters which were sent to USA took the lives of five American people and it is thought to be the worst biological attack in the history of USA created by Islamist militant extremists, according to the Federal Bureau of Investigation (FBI). As these events occurred together so United States of America had to take an action. The union of happenings forced USA to make amendments in its foreign policy as well as domestic policy. As a consequence, American officials drafted USA Patriot Act and also developed Department of Homeland Security. These steps helped in the renovation of the security measures such as operation involving investigation and intelligence. Along with the alterations made in the domestic and foreign policy the President Bush ordered the Taliban government of Afghani stan to give Osama Bin Laden to the US government. It was suspected that Osama bin Laden was the hand behind these terrorists’ attacks and it is he who developed the whole plan of terrorism and executed it. Along with Osama bin Laden, US government wanted to capture other members of al-Qaeda which could be a threat for any further act of terrorism. But the government of Taliban did not accept the orders of President Bush which made US President to start operations of war against