Moral Law Vs Natural Law In The Scarlet Letter Essay

Moral Law Vs. Natural Law â€Å"At the dramatic center of The Scarlet Letter is the idea of the awesomeness and inescapability of the Moral Law, to which all else is finally submitted,† (Levy 384). Assuming that Hawthorne wrote The Scarlet Letter exploring the relationship between Moral law and Natural law, he chooses the moral laws to be absolute. Using definitions of nature and character provided by Seymour Katz applied to the terms natural law and moral law allow an extension of Leo Levy’s claim that Moral laws are supreme. Moral law is an internalization of normalizing aspects of society it, â€Å"is acquired in time through nurture, education, and social experience. The older the individual the more fixed and stable is his character, and the less likely he is to act outside of the principles of his society or his role,† (Katz 5). The natural law is being in a condition where society cannot impose any rules or laws, â€Å"It is undirected impulse or potential energy which the individual will expend and express in various ways in the course of his life,† (4). By applying the definitions of natural law and moral law to the way Hawthorne reveals the truth in the novel and to the development of the character Pearl, Hawthorne proves that moral law is the dominant form of law in The Scarlet Letter. In the forest natural laws should be supreme. Here, the black man or devil makes his home, Mistress Hibbons goes to perform her witchcraft, and Hester and Dimmesdale commit their adultery (Hawthorne 144-145). Moral law forbids each of these three things. Only in the forest, a place where moral law does not apply, can any of these things happen. From a very early age people are taught by the moral laws that the forest contains evil. â€Å"But she fancied me asleep when she was talking of it. She said that a thousand and a thousand people had met him here, and had written in his book, and have his mark on them. And that ugly-tempered lady, Old Mistress Hibbons, was one. And, mother, the old dame said that this scarlet letter was the Black Man’s mark on thee, and that it glows like a red flame when thou meetest him at midnight, here in the dark wood.† (126) Pearl, at the age of seven, already understands the forest contains evil. This normalizing aspect of moral law teaches the society that the representation of natural  law, the forest, is evil. Thus, the moral laws quickly gain an advantage over the natural, before an individual is old enough to form their own opinion on the matter. Another way the moral law proves to be supreme is when examining another theme in the text, hypocrisy. The hypocrisy is so wide spread, even the Reverend Dimmesdale, introduced possessing an, â€Å"eloquence and religious fervor [having] already given the earnest of high eminence in his profession,† (48). This quality combined with a, â€Å"dewy purity of thought, which, as many people said, affected them like the speech of an angel,† (48) caused Dimmesdale to be perceived as a model of purity and godliness for his congregation despite committing a sin incomprehensible to them. Even after his confession his society does not believe the truth that Dimmesdale committed adultery. This shows how strong the character of Dimmesdale is imagined to be by his people. Because the truth is often obscured by hypocrisy, where the truth is found there will be a very strong reflection on the relationship between moral law, and natural law. In the forest, when Pearl asks Hester what the scarlet letter means and why she wears it, Hester lies to her child for the first time. â€Å"What does the letter mean, mother? -and why dost thou wear it?†Ã‚ ¦.And as for the scarlet letter, I wear it for the sake of its gold thread! In all the seven bygone years, Hester Prynne had never before been false to the symbol on her bosom,† (123). Hester lies to her child for the first time while they are in the forest because she is taught to be ashamed of her sin by the moral laws. These laws have a far-reaching power; their effect is felt even in the forest, the idealization of natural law. The truth about Chillingworth’s character reveals itself at the strongpoint of moral laws, the scaffold. This device serves as the deterrent for criminals where they are displayed for the public’s entertainment. â€Å"In fact, this scaffold constituted a portion of the penal machine†Ã‚ ¦but was held, in the old time, to be as effectual an agent in the promotion of good citizenship, as ever was the guillotine among the terrorists of France†, (41). The scaffold punishes people for crimes committed violating the moral  laws by exposing the perpetrator to public ignominy. The true nature of Chillingworth’s character is revealed while Dimmesdale, Hester, and Pearl are performing a midnight vigil on the scaffold. â€Å"To his features, as to all other objects the meteoric light imparted a new expression; or it might well be that the physician was not careful then, as at all other times, to hide the malevolence with which he looked upon his victim†, (107). This revelation occurs at the pinnacle of the puritan penal system, the enforcing agent of all moral laws. Even though the â€Å"meteoric light† might be interpreted as an act of nature, this is not the case. It comes from the heavens where the puritan society acquires the religious justification to carry out their laws. Thus the moral law is responsible for providing the truth to the reader in this instance. Another symbol coming from the forest are the Indians. They live in the forest and only periodically come under the jurisdiction of moral laws by entering a city or town. Because of this their actions and ideas can be interpreted to represent the position of natural law. In the instance when they interpret the meaning of the scarlet letter during the election day sermon their interpretation that, â€Å"the wearer of this brilliantly embroidered badge must needs be a personage of high dignity among her people†, (167) is the exact opposite of what the symbol was originally intended to mean. The symbol for nature in this case considers the scarlet letter a boon. In contrast, the scarlet letter was originally intended to be a punishment having the â€Å"effect of a spell, taking her out of ordinary relations with humanity, and inclosing her in a sphere by herself†. (40) This was the original function, which the moral law dictated the letter should serve. Although the letter comes to symbolize many different things throughout the text, the only one, which is relevant to examine, is the one it was intended for. Because the moral and natural laws dictate different meaning upon the scarlet letter, one positive and one negative, which one is actually the dominant meaning? The negative meaning is the dominant one; this is because the letter serves its original purpose separating Hester from her society. She lived in a house on the outskirts of the town, not in it and whenever she was in public her fellow citizens would form circles around her. The letter is a negative symbol throughout every part of the  novel barring the conclusion, and because of this the moral laws succeeded in imposing their meaning upon the letter. Another conflict between moral and natural comes in the upbringing of Pearl, Hester’s daughter. She is similar to a wild spirit and is ostracized from society similar to Hester. â€Å"Pearl was a born outcast of the infantile world. An imp of evil, emblem and product of sin, she had no right among christened infants†, (65). She was never part of her society, failing to adhere to moral laws. As a child, she had no conception of the moral laws and acted accordingly. â€Å"‘The little baggage hath witchcraft in her, I profess’, said [Mr. Wilson] to Mr. Dimmesdale. â€Å"ËÅ"She needs no old woman’s broomstick to fly withal.'† (80). In addition to the fact that the upright citizen Mr. Wilson compares Pearl to a witch, she did not understand her religion stating, â€Å"‘He did not send me!’ cried she, positively. â€Å"I have no Heavenly Father!'† (68). By not understanding religion she was not abiding by the moral laws. While still a child Pearl is unaffected by the moral laws but as she grows older she begins to adhere to them. By the end of the novel she is entirely assimilated into the moral culture. She had taken a husband and was living a typical life in Europe (177). By taking a husband she is adhering to the moral laws. While she began her life following the natural laws they eventually were overpowered by the pervasiveness of the moral. The moral laws are so powerful she could not resist their influence. Another assertion of the power of the moral laws in relation to Pearl occurs during the forest scene spanning chapters sixteen through nineteen. Here: Hester, Dimmesdale, and Pearl meet for the first time after the scaffold scene. During these chapters Hester takes off her scarlet letter to prove to Dimmesdale that they can be free of the present situation if they go somewhere else in the world (137). Once Pearl sees her mother without the letter she immediately does not recognize her and becomes scared. â€Å"‘I see what ails the child,’ whispered Hester to the clergyman, and turning pale in spite of a strong effort to conceal her trouble and annoyance. â€Å"ËÅ"Children will not abide any, the slightest, change in the accustomed aspect of things that are daily before their eyes. Pearl misses something  which she has always seen me wear!'† (142) Even in the forest where natural laws reign, Pearl will not approach her mother without Hester wearing the scarlet letter, the symbol the moral laws imposed upon her. The moral laws extend far beyond the edges of towns and cities expanding even into the forest. Hawthorne rejects natural laws by asserting the dominant position and influence of the moral laws. By noticing when and how Hawthorne offers the truth to the reader such as when Hester lied to Pearl in the forest setting or when Chillingworth’s character is revealed under the scrutiny of heavenly light, the moral laws are dominant. Even the chief symbol of the book, the scarlet letter, has a meaning imposed solely by the moral laws. Another character originally having a natural tendency, Pearl, loses that tendency by the end of the novel. In all of these instances the moral laws prove that they are stronger and more pervasive than the natural laws. Works Cited Hawthorne, Nathaniel. The Scarlet Letter. USA: W.W. Norton & Company, Inc, 1988 Katz, Seymour. â€Å"†Ã‹Å"Character,’ â€Å"ËÅ"Nature,’ and Allegory in The Scarlet Letter† Rept. in Nineteenth Century Fiction. Ed. Blake Nevius. Vol. 23 #1. USA: University of California Press, June 1968. 3-17. Levy, Leo. â€Å"The Landscape Modes of The Scarlet Letter† Rept. in Nineteenth Century Fiction. Ed. Blake Nevius. Vol. 23 #4. USA: University of California Press, March 1969. 377-392.

Basic Cognitive Skills †A Comparison

There are three established ways to approach a task. One can either use the methods in Bloom’s Taxonomy, the Scientific Method or the Universal Troubleshooting Method. Each of these methods is systematic and hierarchical – from the least complex to the most complex, with each step as important as the next. Each method has been designed to assist individuals in undertaking tasks that are seemingly difficult.These methods have different characteristics and steps, but some of the means are parallel to the others. However, as diverse as these frameworks may seem, there are also segments connecting each method to the other.Bloom’s Taxonomy (New Version) Originally conceptualized by Benjamin Bloom, Bloom’s Taxonomy is perhaps the most popular framework describing man’s learning method. Several theorists have also discussed and provided variations of this method and recently, Lorin Anderson and David Krathwohl proposed a new version of this method. (Wilson , â€Å"Beyond Bloom – A new Version of the Cognitive Taxonomy,† par. 4) In following the template of Bloom’s Taxonomy, the first step involves the acquisition of the knowledge using the senses.It often involves identification, repetition, and memorization. The second step is comprehension. Comprehension occurs when a person can already discuss a concept or idea by explanation or illustration. When an idea can be applied to concrete situations, one has already reached the third step – application. It involves being able to use the concept in more common situations that it can be related to. The fourth step – analysis – includes the ability to scrutinize the concept. The fifth step is evaluation, in which the concept can be judged and criticized based on certain standards.By the sixth step, one shall be able to take the concept apart and use it to form a new complete entity – this is called synthesis. The Scientific Method The steps in the Scientific Method take on a slightly different angle. The first step involves asking the question where the topic to be studied is identified. Next, a background research is conducted about the concept. This is where available previous studies are referred to, so it is determined whether there have been other scientists or researchers who have undertaken the project. Formulation of the hypothesis is next in the process.A good hypothesis is measurable and coherent to the question initially proposed. Tests are to be conducted to try out the validity of the hypothesis. The results of these tests are taken down and evaluated so as to draw conclusions. The results are further evaluated and connected to the previous steps. One analyzes whether there has been positive or negative results coming from the tests that have been conducted. The initial hypothesis is brought out and scrutinized on its validity. With all of the data that have been gathered, a detailed report is constructed to illustrate the details and results of the entire task.One characteristic of the Scientific Method is that one or more of the steps can be repeated if the previous strategy does not yield results or the desirable outcome. Furthermore, there are times when a certain step like â€Å"testing the hypothesis† can be repeated several times in succession until concrete and verifiable results are accomplished. On the other hand, the new model of Bloom’s Taxonomy requires fulfillment of a certain step before moving on to the next level. In fact, one cannot move on to the next level without the completion of the previous one.For example: one cannot apply knowledge which he cannot comprehend first nor one cannot try to comprehend what he does not know of. Universal Troubleshooting Method The Universal Troubleshooting Method is characterized by a five-step program. Initially, a complete description of the problem is taken into account. To prepare for the process, all necessary too ls should be present, including the best suitable environment for the project. All of the indications of the problem should be entirely noted detail by detail to ensure that the correct steps are going to be taken in the process of solving it.To check if the problem is correctly identified, one should be able to replicate the symptoms. After this step, one is tasked to narrow down the root cause of the problem. This means that all nuances are to be tested and eliminated, if proven as a secondary cause. This can be a lengthy process and may require a lot of patience, much like testing the hypothesis in the Scientific Method. Once the root cause is identified, steps are to be taken to resolve or repair it. Using the appropriate tools, the root of the problem is eliminated and/or replaced. After the work in replacing or eliminating the problem, testing needs to be made.One checks whether the problem still exists or persists. In cases when it does, then some of the steps are to be repea ted to make sure that the problem is resolved properly. There may be instances when the problem is incorrectly identified and the step must be repeated to correctly identify the problem. But if the correct problem is resolved, it needs to be tested several times to ensure that it would not happen again. Additionally, one must check if there are any potential problems that are created while resolving the main problem – problems that may cause more difficulty in the future.The Universal Troubleshooting Method is aimed at solving or finding the solution to a particular predicament, while Bloom’s Taxonomy can be used in more levels like learning a new skill – in fact, it is often utilized in a learning environment. This method (Universal Troubleshooting Method) can be more likened to the Scientific Method since it is normally following a dilemma. The steps, although not entirely interchangeable, can be repeated as much as it calls for. These methods require careful planning and execution – each project done following the steps correctly will definitely yield productive results.These three approaches show how to manage a task. Each of these works based on a system that proves to be effective and, thus, valuable. Each system, each step, is geared towards the solution of the problem at hand. They are designed in such a way that each seems to be somewhat a reflection of the others, with variations or modifications devised based on necessity. But even with these distinctions, these approaches are, in the end, essentially similar to each other. Works Cited: Litt, Steve. â€Å"The Universal Troubleshooting Process†.2006. Troubleshooters. Com. 16 June 2009. . Wilson, Leslie Owen. â€Å"Beyond Bloom – A new Version of the Cognitive Taxonomy. † 2006. Dr. Leslie Owen Wilson’s Homepage. 16 June 2009. . â€Å"Steps of the Scientific Method†. Science Buddies. 2009. Kenneth Lafferty Hess Family Charitable Foundation. 16 June 2009. .

Follicular And Mantle Cell Lymphomas Health And Social Care Essay

follicular lymphoma 2nd most common type of lymphoma in United States ; diagnosticians able to name PL with less information and more duplicability than any other type of lymphoma ; FLs vary in character ; cutaneal ( follicle centre cell ) lymphomas normally curable with local therapy ; duodenal and paediatric -both rare indolent diseases ; make good with minimum therapy ; by and large non do of decease in affected patients Grade 3 follicular lymphoma: presently defined by figure of big ( blast ) cells per high-power field ( HPF ) ; method tolerably accurate in FL, and most consistent ; grade 1, & lt ; 5 big cells per HPF, grade 2, 5 to 15 per HPF, and grade 3, & gt ; 15 per HPF ; duplicability survey — -diagnosis of FL by diagnosticians & gt ; 90 % consistent, but well less accurate in finding class: class 3 FL farther classified as 3A ( big cleaved cells ) and 3B ( blast cells ) ; nevertheless, limited truth in finding class may bespeak limited duplicability in separating 3A from 3B ; distinctniess of class 3B ( Sloan-Kettering survey ) — -maximum standardised consumption ( [ SUV ] of fluorodeoxy glucose on antielectron emanation imaging [ PET ] ) in class 3 FL more similar to SUV in patients with diffuse similar to SUV in patients with diffuse big B cell lymphoma ( DLBCL ) than grade 1 or 2 FL ; Harris survey — per centum of Ki-67 stain-positive cells increased With increasing class of FL, with grade 3 FL staining near to degrees seen in DLBCL ; several surveies showed that some patients with FL grade 3 treated with cyclophosphamide, doxorubicin, Oncovin ( oncotic ) and Pediapred ( CHOP ) or CHOP like regimens had response to therapy similar to that of patients with DLBCL ; ability to bring around this group justifies handling all patients with grade 3 FL with regimens used to handle DLBCL.Low-grade FL: multiple effectual interventions available ( best one as yet unknown ) : ticker and wait – lupus erythematosus favored ; single-a gent Leukeran or cyclophosphamide — no longer used ( most patients treated with combination therapy ) ; local radiation therapy ( RT ) — used in patients with localised disease: total-body irradiation — out of favour ; patient Immunity and FL ( Rosenberg survey ) — showed self-generated slirinkage of FL in many patients ; multiple surveies show patients with fewer macrophages have better endurance than patients with high degrees ( may explicate shrinking without intervention ) ; vaccinum survey — -without intervention ) ; vaccinum survey — subset of patients who made antibodies had duplicating of progression-free endurance ( PFS ; suggests possibility of use of _relationship between FL and environment ) ; Gallic survey – inauspicious consequence of high macrophage degrees eliminated in patients treated with rituximab ( RTX ; suggests changing microenvironment as possible mechanism of action of interventions, including autologous root cell organ transplant [ ASCT ] ) ; ASCT non considered intervention for FL until late ( despite informations ) ASCT as salvage therapy: Chemotherapy, Unpurged and Purged ( CUP ) test – patients randomized to CHOP chemotherapy ( CTX ) entirely, or ASCT ( with or without purged marrow ) plus CHOP, in patients who had failed on Leukeran or other CTX ; patients in both organ transplant weaponries had important advantage in PFS and overall endurance ( OS ) ; survey indicates ASCT effectual therapy before RTX ; consequences decline after insistent intervention ; 3 of 4 upfront ASCT surveies in patients with FL show extremely important advantage in PFS ( no agvantage in OS ) , but upfront ASCT non done in United States ; St. Bart's/Dana Farber and UNMC informations — – of patients Farber and UNMC informations — of patients treated with ASCT ( pre-RTX, largely grades 1 and 2 ) , somewhat & lt ; 50 % had 10-yr freedom from disease patterned advance Possible functions of RTX in FL: remedy of FL ( rid ofing demand for organ transplant ) -Stanford survey update, UNMC survey, and Surveillance, Epidemiology and End Results ( SEER ) data show betterment in FL endurance over past 3 decennaries ; RTX of import subscriber to alter ( although other factors possible ) ; Cochrane meta-analysis — patients given RTX in initial therapy had extremely important survival advantage ; UNMC informations analysis suggests patients with low-grade FL and initial intervention with RTX had superior endurance, compared to patients having RTX at other times or non at all ; Primary RTX and Maintenance ( PRIMA ) survey – care RTX increased opportunity of continued remittal by 20 % ; consequence larger in patients with complete response ( CR ) than in those with partial response ( PR ) ; Swiss survey — demonstrated survival advantage with merely 4 extra doses of RTX ; analysis of PET informations from PRIMA survey — negative findings on PET seen in 92 % of patients with true CR ; one-third of patients with unsure CR PET-positive ; 20 % of patients with progressive disease 20 % of patients with progressive disease PET-negative ; PET negativeness best forecaster of result ; RTX improves endurance of FL, but unclear Whether it cures high proportion of patients with low-grade FL, ASCT after RTX therapy: Spanish survey and Collaborative Trial in Relapse Aggressive Lymphoma ( CORAL ) — — – patients with DLBCL treated with RTX before ASCT # 50 % more likely to be cured than patients with no RTX ; perchance due to bring around rate of patients after RTX therapy ( ie, patients still necessitating ASCT after RTX probably had more immune disease ) ; German surveies – patients witlt FL randomized to ASCT V care with interferon ( IFN ) af ter initiation with CHOP ; patients who got CHOP plus RTX ( R-CHOP ) and ASCT had somewhat better endurance than patients on IFN ; patients without RTX had much better endurance with ASCT than with IFN ; Cleveland study – no important difference in endurance after ASCT betweett patients with relapsed FL who had received RTX in past and those who had non In vivo purge: no direct informations available on effects on ASCT results ; UNMC informations — patients treated with monoclonal antibodies ( MAB ) and RTX earlier cell aggregation had better results after ASCT ( ill-defined how much betterment due toMAB V RTX ) ; Gallic survey – patients treated with MAB for salvage therapy had better results ; other surveies -majority of patients had no tumour cells ( per polymerase concatenation reaction [ PCR ] ) after RTX Post-transplantation care: small informations available ; several surveies showed important proportions of patients had delayed neutropenia or hypoganimma gloibulinemia if treated with RTX after ASCT ; no inerease in mortality seen with RTX, but it gives no advantage ( and increases trouble for patients ) ‘Conclusions: public-service corporation of RTX in FL remains ill-defined ; ASCT remains best tratment in younger healthier patients for relapsed FL ; best given after first intervention failure ; vivo purging perchance of import ; unproved Whether it has maior consequence on results ; value of post-transplantation RTX uncertain ; talker recommends handling rate 3 FL per protocols for DLBCL Questions and replies: consequence of length of i ¬?rst remittal on recommendations for ASCT – in other diseases ( e.g, Hodgkin lymphoma ) , patients do less good with brief initial remittal and ASCT, but likely better than with alternate likely better than with alternate therapies ; if patient immature and healthy, talker would still offer ASCT ; talker would discourse ASCT with immature healthy patients who have had really long or really brief remittals ; PET as tool to place faineant class 3 FL — unknown if patients with low SUVmaX should hold different intervention ; differences in diagnosing of class 3 FL add complexness to determination for intervention ; upfront allotransplantantation for FL — -best intervention to eliminate FL ; limited by 20 % to 30 % freshman mortality ( mortality decreases with age of patient ) Minimal Residual Disease in Follicular and Mantle Cell Lymphoma: -Foundation: CHRISTINE POTT, MD. absence of residuary lymphoma mass on imagination and bone marrow biopsy ( low sensitiveness ) referred to as clinical remittal ; analysis of minimum residuary disease ( MRD ) below clinical remittal reveals different dynamicss of lymphoma ( may specify those who will get worse, and those with remedy or who will get worse, and those with remedy or long-run remittal ) ; MRD techniques — extremely sensitive and loosely applicable ; may assist clinicians understand disease dynamicss on molecular degree ; allow polish of clinical presenting Benefits of MRD analysis: provides possible alternate parametric quantity for clinical response ; integrates biologic Features of tumour ; rei ¬Ã¢â‚¬Å¡ects pharmacogenetic traits and dose strength achieved in single patients ; identifies prognostic subgroups in B cell lymphoma ; independent predictive factor ; of import tool for indivtdualizing intervention Assessment of MRD ) : cytogenetics and fluorescent unmoved hybridisation ( FISH ) non sufficiently sensitive ( more utile for initial diagnosing and appraisal of malignant lymphoma ) ; flow cytometry and PCR chief methods ; i ¬Ã¢â‚¬Å¡ow cytometry — loosely applicable, fast, and provides quantitative consequences ; nevertheless, malignant lymphoma has partly unstable markers ( non reproducible in many patients ) ; in FL, sensitivenesss vary harmo nizing to benign hematogones ; consensus PCR — easy, rapid to perform.inexpensive, and stable, but non quantitative ; has low sensitiveness ; immunogen-based allele-specii ¬?c PCR — most advanced method ; sensitive, with- most advanced method ; sensitive, with quantitative consequences ; specific and extremely consistent ; nevertheless, labour-intensive and expenslve.PCR markers: irnntunoflobttlin cistrons — -heavy concatenation ( IgH ) an visible radiation concatenation ( IgK ) ; applicable in B cell non-Hodgkin lymphoma, chronic lymphocytic leukaemia, and acute leukaemia ; T cell receptor cistrons — – potentially available for T non-Hodgkin lymphomas and acute lymphoblastic leukaemia ; chromosomal translocations — T ( 1/14 ; 18 ) for FL ; T ( 11 ; 14 ) fer mantle cell lymphoma ( MCL ) ; translocations serve as marks in # 80 % of B cell lymphomas, in 60 % to 70 % of FL, and 30 % to 40 % af MCL ; these techniques quantify MRD in # 80 % of patients ; imrnunoglobulin heavy-chain venue – mast loosely applicable marker, rearrangement of V, D, and ] H parts in normal development of B cells ; sequence in this junctional part Acts of the Apostless as ‘DNA ‘ i ¬?ngerprint of cell ( identifiable by consensus PCR ) ; monoclonal rearrangement in lymphoma identified by gene-scan form with monoclonal extremum ; sequencing of monoclonal rearrangement allows allele-specific primer design to aim single patient ‘s sequence ; translocation marks — – T ( 14,18 ) breaktpoints in marks — T ( 14,18 ) breakpoints in different locations in cistron ; can measure # 70 % of patients with major breakpoint part ; assay developed by Biomed 2 Group usage to measure other countries ; translocations act as molecular markers ( eg, t [ 11 ; 14 ] ) Prognostic relevancy of MRD: shown in early surveies ; betterment in curative options led to increase in surveies look intoing MRD as alternate parametric quantity for forecast ; FL surveies — showed accomplishment of molecular remittal associated with improved forecast, irrespective of whether patients received ASCT, CTX, or rituximab Floridas: Lopez-Guillermo survey — – showed accomplishment of molecular remittal possible with standard-dose CTX without antibodies ; failure-free endurance significantly better in patients who achieve both clinical and molecular remittal ; Italian survey — -PCR negativeness associated with improved forecast in patients treated with CHOP entirely or R-CHOP ; Gribben survey — updated consequences show patients with sustained MRD negativeness ( by PCR ) after ASCT have continued long-run endurance ; recent Italian survey ( .2008 ) — – PCR negativeness most of import predictive factor both in patients treated with R- factor both in patients treated with R-CHOP and those who received RTX plus high-dose consecutive CTX ; outcomes improved with molecular remittal MCL: fewer surveies available ; several surveies conclude MRD has no predictive consequence in MCL ; relevancy seen after debut of RTX and ASCT ; monocentric survey — – patients consecutive monitored for MRD after R-CHOP, root cell mobilisation with dexaBEAM ( dexatnethasone_ carmustine [ BCNU ] , etoposide, cytarabine [ Ara-C ] and Alkeran ) before ASCT ; MRD ) negativeness associated with longer PFS ( 92 minute, vs 24 minute in MRD~positive patients ) and OS ; European web tests – MRD analysis done in patients under and & gt ; 65 year of age after initiation with immuno-CTX ; patients accomplishing clinical and molecular remittal have significantly longer continuance of response, irrespective of whether MRD achieved in blood or hone marrow ; molecular response after initiation superior predictive factor, compared to Mantle Cell International Prognostic Index ( MIPI ) mark and accomplishment of clinical response.Summary: PCR identifies low- and poor-risk groups in FL and MCL ; PCR holds true in multivariate analysis and is true in multivariate analysis and is independent of pretherapeutic hazard factors ; MRD negativeness achievable without ASCT Timing of MRD appraisal in FL: available surveies show relevant clip points for obtaining predictive informations ; German Lymphoma Study Group test – rating at diagnosing allowed presentation of association between low degree of go arounding lymphoma cells and molecular response ; MRRD dynamicss during initiation ( after 4 intervention rhythms ) showed that patients with rapid decrease of go arounding lymphoma cells have high chance of clinical remittal, compared to patients with slow response ; PFS with molecular remittal significantly greater than that with clinical remittal entirely ; postremission clip point of import if MRD used as foster parametric quantity ; multivariate analysis shows MRD ) better predictive factor than RTX treatnient, ASCT, or pretherapeiitic FL International Prognostic index ( FLIPI ) hazard factors ; extra informations analysis showed MRD position helps to define patients with different forecasts independent of clinical remittal position ; sustained MRD position — — forecast significantly better in patients with sustained molecular patients witch sustained molecular response in first twelvemonth after ASCT or intervention with interferon, compared to patients who developed MRD positiveness within first twelvemonth after ASCT or during care therapy.Timing of MRD appraisal in MCL: predictive relevancy shown after initiation and in postremission period ; increasing MRD ) degrees predict backsliding ; aged patients who stay in molecular remittal on care intervention have significantly longer continuance of response.Who should have MRD ) intervention: no current application of MRD ) to patients non enrolled in clinical tests Decisions: accomplishment of molecular remittal appropriate curative end for new clinical tests and interventions ; MRD appears executable for steering intervention, cut downing costs, and diminishing side effects ; identifies patient subgroups with durable remittals ; MRD allows individua lized hazard appraisal and intervention Future functions of MRD: rating of new intervention theoretical accounts and substances: designation of non respondents _for possible early intervention intensification ; way of care intervention ; usage in pre-emptive therapies ; orienting intervention to single hazard proi ¬?les.Mentions:1. Auto organ transplant for patients with Follicular Lymohoma in the epoch of rituximab: -JAMES O.ARMITAGE, MD.2. Minimal Residual Disease in Follicular and Mantle Cell Lymphoma: -Foundation: CHRISTIANE POTT, MD.Auto organ transplant for patients with Follicular Lymohoma in the epoch of rituximab: -JAMES O.ARMITAGE MD:2ND SubjectRENAL ISSUESAbstractionThe ends of this plan are to better the surgical and medical direction of locally advanced nephritic cell carcinoma and to avoid complications during public presentation of transdermal nephrolithotomy ( PNL ) . After hearing and absorbing this plan, the clinician will be better able to: 1. Surgically pull of f locally atlvancetl nephritic cell malignant neoplastic disease by separating between the demand for extremist V partial nephrectomy and acknowledging the indicants for lymphadenectomy. 2. Choose the most apprepriate drugs, based 0n their meachanisms of action, for the medical intervention of nephritic malignant neoplastic disease. 3. Sumarize the current position of neoadjuvant and accessory intervention ef nephritic malignant neoplastic disease. 4. Better his or her surgical technique for PNL. 5. Acknowledge the possible complications of PNL and their intervention, including hemorrhage, hurts to next variety meats, hypotension, infection, and delayed bleeding.Surgical direction of locally advanced nephritic cell carcinoma: – STEVEN C. CAMPBELL, MD, PhD:Background: 10 % to 20 % of all kidney malignant neoplastic disease ; strong informations run uping combination of surgery and systemic intervention best ; systemic intervention both neo adjuvant and adjuvant ; dei ¬?nitio n of locally advanced — kidney malignant neoplastic disease widening into adrenal secretory organs, venous system, regional nodes, or next variety meats ; T3a, T3b, T3c, T4, or node positive but MO ; divergent pathology — – lymphoma { see biopsy ) ; adrenocortical malignant neoplastic disease ( endocrinologist rating ) ; sarcoma ; transitional cell Carcinoma ( cystoscopy ) Preoperative steps: complete bowl readying because hemi colectomy may be required ; obtain consent for splenectomy, distal pancreaticlotomy, and partial hepatectomy ; in instance these processs necessary to obtain negative borders ; little per centum require preoperative embolization to minimise blood loss ; co-ordinate with vascular, Cardiovascular, and hepatic sawboness. Surgery: venous engagement — for degree 1 thrombi, topographic point Stansky clinch ; level 2 thrombi require consecutive clamping inferior vein cava ( lVC ) below, contralatera nephritic vena, and IVC above ; for degree 3, mobilise liver to obtain entree to retrohepatic IVC and clamp above and below tumour ; exposure — critically of import ; chevron scratch most common ; little per centum need thoracoabdominal incisien ; as necessary to let for en block deletion ( cardinal ) Lymphadenectomy: lymph node dissection controversial ; for lymphadenectomy, usage same templet as for testicle malignant neoplastic disease ; European organisation fo research and intervention of malignant neoplastic disease ( EORTC ) survey — showed no difference in complications or endurance between extremist nephrectomy with lymphadenectomy and extremist nephrectomy without lymph node dissection ; study criticized because extent 0f lymph node dissection non good defined and analyze groups may hold had low hazard for lymph node engagement ( ascertainment prejudice ) ; Mayo clinic survey — & gt ; 1600 patients ; showed 5 parametric quantities prognostic of increased likeliness of lymph node engagement, 1 ) atomic class 3 or 4, 2 ) sarcomatoid constituent, 3 ) really big 4 ) locally advanced tumour phase, and 5 ] tumour mortification ; seek to find ; parametric quantities preoperatively ( when possible ‘ ) , perform intraoperative frozen subdivision of lymph node, so make up one's mind if lymph node dissection needed ; talker ‘s attack — normally performs lymph node, dissection on younger patients but non on ; older frail patients ; forecast for node-positive malignant neoplastic disease — hapless ; 0 % to 20 % 5-yr endurance ; bulky lymph nodes may be worse prognostically than metastatic: disease ; patients with stray venous engagement have 40 % to 50 % remedy rates ; most T3a patients do good, but at higher hazard than patients with organ-confined disease ; other predictive considerations – histology ; border position ; tumour class ; algorithms availalale for anticipation of result. Medical Management of Locally advanced Renal Cell Carcinoma: -BRIAN I.RINI, MD.Mechanism of action of drugs for nephritic malignant neoplastic disease: mammalian mark of rapamycin ( mTOR ) inhibitors — these involve tract that regulates cell proliferation and metamorphosis in response to enviromental factors, associating cell growing factor receptor signaling via phosphatidylinositol-3-kinase ( Pl-3K ) to cell growing, proliferation, and an-giogenesis ; these drugs have non been studied as neoadjuvants or adjuvants ; vascular endothelial growing factor ( VEGF ) inhibitors -more relevant curative tract ; VEGF is cardinal regulator of physiologic angiogenesis ; more drugs available against VEGF, and they by and large have greater consequence ; bulk of nephritic cell carcinomas characterized laic mutant of V0n Hippel-Lindau ( VHL ) tumour suppresser cistron, ensuing it accretion of hypoxia-inducing factor ( HIF ) ; HIF is critical written text factor that leads to activation of m any mark genes.including VEGF ; VEGF is go arounding protein that binds to endotheliel cells and leads to permeableness, migration, and proliferation of tumour blood vas cells ; inhibitors of VEGF tract include little molecules that inhibitVEGF receptor and agents such as bevacizumab, sunitinib, and sorafenib. Neoadjuvant surveies: retrospective experience — 17 patients with kidney malignant neoplastic disease with primary tumour in topographic point ; intervention with sunitinib produced 30 % average volume decrease in tumour size ; growing curves show most decrease occurs in first 2 to 4 rhythms of intervention, so i ¬Ã¢â‚¬Å¡at period, so growing sketchs. Prospective test: patients with biopsy-proven kidney malignant neoplastic disease and unresectable priamary tumours ; treated with suntinib for 4 wk on drug and 2 wk off ; worsened clinically while off drug for 2 wk ; hence. intervention changed to uninterrupted dosing ; histology preponderantly clear cell carcinoma but non entirely, and most had metastatic disease ; about tierce of patients converted to resectable position ; & gt ; 70 % had somee tumour shrinking ; shrinking averaged 19 % ( # 1.5 % centimeter ) ; greatest consequence on clear cell carcinoma. Goal of neoadjuvant therapy: to bring forth cytoreduction of tumour ; avoiding high morbidity of extremist nephrectomy and leting intervention with partial nephrectomy. Safety: neoadjuvant therapy does non adversely affect surgical result ; in MD Andersen survey of # 6O patients who received targeted therapy ( largely bevacizumab ) so underwent cytoreductive neph1'ectonty, damage of superficial wotind mending 20 times more common in those who received targeted therapy than in matched controls ; so far ( & gt ; 100 patients ) , no big safety signals, eg, hemorrhage, coagulating. Accessory therapy: United States test of 1900 patients presently in advancement ; postnephrectomy patients randomized to 1 year of sunitinib, sorafenib, or placebo ; efficaciousness informations still several old ages off. Drumhead: -aggressive surgical direction basis of intervention for locally advanced kidney malignant neoplastic disease ; neoadjuvant VEGF-targeted intervention may take to enhanced feasibleness of resection in same patients ; stillinvestigational: no effectual adjuvant intervention for kidney malignant neoplastic disease at present.How to Avoid Cemplications While executing Transdermal Nephrolithotomy: — -MARSHALL L.STOLLER, MD. Background: key to success in transdermal nephrolithotomy ( PNL ) is for endourologist to derive appropriate entree ; make non trust on radiotherapist to execute ; appropriate landmarks are 2 i ¬?ngerbreadths sidelong from paraspinous.muscle and 2 finger's breadths below 12th rib ; 9 in 10 times puncture site in Petit ‘s trigon ; place patient prone with thorax blosters and articulatio genuss flexed ; utilize general. anaesthesia in instance of demand to entree airway ; extradural does non work { excessively hard to change over to general anaesthesia if desperately necessary ) ; radiologists puncture straight up and down, aiming nephritic pelvic girdle, but this does non enable urologist to make transdermal prcedure ; urine return dues non vouch entree to allow calyx. Nephrostomy tube entree: usage echography to assist direct needle ; purpose pelt posteriur calyx ; Technique for lower pole puncture: follow landmarks described above, , purpose for midaxillary line, progress acerate leaf, and draw C- arm toward you ; if needle below intended mark on x-ray, needle non steep plenty ; if needle above intended mark, travel deeper Technique for upper pole puncture: travel C- arm off from you ( indicates deepness and how far to progress acerate leaf ) coni ¬?rming entry: return of piss ; injection of retrograde methylene blue ; transition of i ¬Ã¢â‚¬Å¡oppy tip guidewire ( if needle in anterior calyx, K- wire does non progress beyond calyx into nephritic pelvic girdle ) ; ultrasonographic verification: injection of dilute contrast. Avoiding shed blooding complications: occur as consequence of progressing sheath excessively far ; distend piece of land merely to roll uping system ; go forth sheath somewhat outside roll uping system ; progressing excessively far cracks infundibulum. Other complications: pulsatile bloody outflow, rapid venous drainage into vena cava, fecal matters, air, gall ; inconsequential if recognized before dilation ; merely draw needle out and make another puncture ; make non necessitate to halt instance. Localization: text editions recommend taking for most inferior calyx ; survey of computed imaging ( CT ) from 100 patients showed 42 patients had 2 lower pole calyces and 59 had 3 lower pole calyces ; most median calyx will be anterior 93 % to 95 % of clip ; lower pole entree should be directed to most sidelong calyx ; if entree into posterior calyx non achieved, successful PNL non probably, because angle of anterior confronting calyx excessively short. Dilation: do non come in roll uping system, but attack every bit near as possible to roll uping systern ; rock should non be seeable on initial entry ( should he & gt ; 0.25 centimeter beyond ) ; guidewires – guarantee length adequate ; denominate working wires and safety wires: hydrophilic guidewires go in easy but besides fall out easy ; J & gt ; tipped guidewires do non punch roll uping system ; safety – urologist should have on lead spectacless to protect eyesfrom radiation and from sprinkling. Tips on technique: puncture easier in patients with history of PNL because kidney fixed ; in PNL-naive patients, kidney moves off from progressing tip { disconnected gesture required ) ; talker uses 18-gauge acerate leafs ( non 25~gauge ) ; uses really small fluoroscopy ; every bit long as wire moves back and Forth, exchange catheter can be advanced ; to minimise radiation, i ¬Ã¢â‚¬Å¡uoroscopy used merely when near roll uping? system ; catheter can be made less stiff by dunking it into microwaved saline or madestiffer by dunking it into ice slush. Amplatz system jobs: misidentify to progress Amplats sheath beyond cone ( likely to do hemorrhage ) ; go forth sheath outside roll uping system ( it will work its manner in during lithotripsy ) ; ldnked Dotter catheter ; fascial dilator unmatched with sheath ; inadequately advanced fascial sheath ; buried sheath in corpulent patients ( place sutura on terminal of sheath to ease retrieval ) ; balloon — – used merely in United provinces ( pneumatic lithoclast used in other states less expensive guarantee equal skin scratch ; as ballon dilates radially, it shortens lorigitudinally Complicating hurts: -bowel — set up separate drainage ( intestine separated from urinary system ) ; dual J and Foley catheters placed ; skin scratch enlarged and penrose drain placed ; patient placed on ternary antibiotics and low-roughage diet ; alert waiting ; bulk of hurts digressive ( non through-and-through ) , so colostomy non necessary ; postprocedural hemorrhagic — find whether due to hemorrhagic or infected daze ; temperature unreliiable ; organic structure temperature should be & gt ; 3S % ; temperature of 36A ° to 37A °C indicates possible sepsis ; infective complications — -appropriate antibiotic ; fulminant disease may be related to high endotoxin concentrations: low- force per unit area irrigation system ; hypothermia may confound diagnosing of urosepsis ; ticker for peripheral vasoconstriction bespeaking haemorrhagic daze V peripheral vasodilation bespeaking infected daze ; hurts to next variety meats — lung ( look into post procedural c hest X- beam ) ; incidence of pleural hurts # 12 % ( increases with supracostal puncture ) ; expression for pnettiuothorait or hydrothoralsi ( look for clear cost phrenic Angier on chest X ray ; intervention individualized ; see chest tubing ) ; liver † or spleen hurts ; vascular hurts ; delayed bleeding — in talker ‘s pattern, occurs in 1A °/o of instances ; disconnected brisk shed blooding due to pseudo aneurism ; occurs 6 wk after process ; dainty by ace selective angioembolizatien ( microcoils ) ; hazards include arterial dissection, nontarget embolization, and contrast-induced kidney disease ; highest hazard in diabetics Drain: nephrostomy tubes Council-tip: easy to rewire Endopyelotomy tubing: 14 Gallic to 8 Gallic ; can be hard to put Circle nephrostomy tubing: 2 entree piece of lands ; good for drawn-out drainage ; less likely to be dislodged.Foley balloon catheter: cut tip off ( like Councill catheter ) Pull-string: Cope-like tubings ; turn and draw out at same clip to avoid laceration of infundibulum. Malecot tubing: entrapment can happen in little nephritic pelvic girdle due to strong collagen span that forms through i ¬Ã¢â‚¬Å¡anges of tubing ; tissue must be cut in order to retreat entrapped tubing. Tract closing: tubeless — talker sees no advantage ; with or without dual J catheter ; styptic: agents and i ¬?brin sealers ( eg, FloSeal, Tisseel ) ; may restrict tract bleeding ; preplace occlusion balloon in roll uping system ; cauterant may diminish hemorrhage ; skin closing — better decorative consequence without Skin closing ; nephrostomy tubing — with or without skin suturas ; easy dislodged ; when tubing removed, do certain sutura comes with it ; place more than one nephrostomy tubing if necessary.

Decomposition Framework for Financial Analysis. Kforce Inc. and Morson Essay

Decomposition Framework for Financial Analysis. Kforce Inc. and Morson Group Plc - Essay Example Moreover, the investors needed to determine the underlying value of these investments in order to make sure that prices are rightly placed before making any decision related to purchase. These investors are generally called as rational investors who conduct analytical studies before making any decision related to investments. In this regard, the security valuation and financial statement have become very important. Financial analyses are those financial tactics and methods which help in comparing and evaluating the different investment opportunities such as projects and firms, to ensure and evaluate that the available opportunities are appropriate for making investments. Generally, the procedure of conducting financial analysis is based upon the past performance of a firm. The historical data is then used to evaluate the future performance of the company; therefore it is not at all necessary that evaluations are 100% accurate. Financial analysts usually obtain data from a variety of sources available, including income statements, balance sheets, and cash flow statements. Through these financial statements, analysts determine the ability of a firm to meet its liabilities and obligations, stability of a firm, level of profitability and liquidity and then compare them with their competitors in order to provide insights into the firm’s position as compared to the industry or its competitors. In balance sheet, the underlying financial position of of a company is present. The three main categories of which balance sheet is comprised include: assets, which demonstrate the long term and current investments of a firm through which revenues are expected to be generated; liabilities depict the long term and short term claims that stakeholders have; and equity which demonstrates the claim of the owners. This paper aims to analyze a U.K company, namely Morson Group PLC, in comparison with a U.S based firm known as Kforce Inc. The analytical methods utilized in this paper for analysis include: common-size analysis, trend analysis and profitability analysis. Understanding the Industry Companies which want to improve their performance need to provide training to their staff in recruitment centers. Leaders also get training so as to motivate their workers and working with efficient employees. A real competition among organizations has taken place nowadays. Every other company is st riving hard to develop the skills of its employees. In this regard, a lot of training and development programs are being established every other day. Subsequently, a new type of competition between employees and management has also taken place. For this reason, companies are looking for recruitment companies so as to develop the special needs of their staff. Recruitment companies play a vital role in improving the facilities and skills of employees. Moreover, they are also looking to maximize their profits. Therefore, they provide best possible offers, contracts, training and development programs through professional lecturers and trainers so as to improve their own credibility. In addition to that, they also offer some special contracts including free contract for more employees, discounts for contracts having longer tenure etc. KforceInc – U.S based firm KforceInc provides professional and technical services specially for staffing companies. This company is primarily based upon four departments which include: Government Solution (GS), Technology (Tech), Health and Life Sciences and Finance and Accounting (FA). The two activities of Tech and FA are delivered in the specific regions of North, Atlantic and Western markets. Morson Group

Discussion 1 Week 6 "Comparing First-movers in Technology" Assignment

Discussion 1 Week 6 "Comparing First-movers in Technology" - Assignment Example 244). From the videos, it was evident that Intel’s development of the first microprocessor (Intel Free Press, 2011); while Microsoft’s software design enabled them to pioneer in this endeavor and assume a proactive stance in related technological developments (Microsoft, 2012). Moreover, Intel and Microsoft capitalized and reaped the following advantages: (1) captured the opportunity to â€Å"exploit network effects and positive feedback loops, locking consumers into its technology† (Hill & Jones, 2012, p. 244); (2) enabled establishment of brand loyalty; (3) generated substantial sales volume which eventually enabled economies of scale and learning effects; (4) enabled offering pricing strategies (switching costs); and (5) gained advanced knowledge on the pioneering experience (Hill & Jones, 2012). 2. From the first and second e-Activities, compare Intel’s and Microsoft’s strategies in terms of their ability to profit from innovation. Next, analyze the manner in which shifts in new technologies revolutionized the structure of the industry, increasing profitability and growth through global expansion. Provide a rationale to support your response. Intel’s strategies, when compared to Microsoft’s strategies in terms of abilities to profit from innovation were virtually on the same field. Through pioneering efforts, both Intel and Microsoft gained substantial market shares within their respective fields of endeavors. As such, the developed core competencies established significant competitive advantage that enabled them to retain leadership in these discoveries. Moreover, the manner in which shifts in new technologies revolutionized the structure of the industry, increasing profitability and growth through global expansion – more commonly known as technological paradigm shifts, affect both Intel and Microsoft. For example, cloud computing, which

Experience of being an overseas trained health professional working in Dissertation

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Journal Essay Example | Topics and Well Written Essays - 1000 words - 1

Journal - Essay Example We also learnt about the audience of the story. The people who read stories and listen to stories are the audience. We learnt that good compositions are about things that the audience knows. Week Three During this week, I learnt about analysis. Analysis is looking for facts and issues that are presented in the composition. Analyses are important because they help us to understand the issues that the composition is writing about. This lesson was important because it helped me to get good skills of analyzing compositions and other writing in English. Week Four This week was important because I was tested on the skills of how to analyze something that I had read. It was an important week in the classroom. In this week I was able to write a paper from the article called â€Å"The Responsibility of Intellectuals, Redux.† I was interested in this article because I read it and understood what it was about. It was the first assignment of analyzing an article that was written in Englis h language. I was an important test which helped me to sharpen my analytical skills. During this week, I gained skills of analysis and summary. I was able to read articles written in English and then summarize them in my own words. It was an important task that helped my process of learning, reading, and writing. Week Five This week was important because I was taught about ethos, logos, and pathos. ... Ethos are the symbols which writers use when they want to explain something in their writing. Pathos are the things that writers use to convince the readers. Pathos use emotions to make meaning out of the various issues that writers use in their writings and articles. Many times, the use of these ethos and logos are brought about through articles and stories. I also learnt about logos. Logos are used when writers want to use facts and logic in in their articles and other writings. These week helped me to understand the way different writers use different methods for making meaning from various sources. I can also use ethos, logos and pathos to write stories and make meaning from them. Week Six During this week, I was able to learn about poetry. We learnt about poems and the way of reading and writing poems. We were taught the way the language used in poetry is different from the language that is used in other forms of writing. Usually, the writing process is important because it help s people to understand the use of language very well. I was able to write some poems and to read others. I was also able to analyze some poems that are generally brought within the element of writing. Week Seven During this week I was able to try and write about the things that I was taught in class. It was a week that helped me to practice my new skills. Week Eight This week was important because it helped me to understand poetry and the styles used in writing of poems. I was able to read about tone by looking at the words that were used in writing of the poem. I have developed the skills of writing about the things used in poems in ways that are creative and which respond to the challenges of everyday life. Week Nine During this week I was now able to practice

Is the USA PATRIOT Act an effective deterrent to terrorism Why, why Essay

Is the USA PATRIOT Act an effective deterrent to terrorism Why, why not What are your suggestions for combating terrorism - Essay Example The Patriot Act freed up international intelligence agencies so that they could share information in order to fight terrorism worldwide. Senator Kay Bailey Hutchison stated, â€Å"The Patriot Act has enabled our law enforcement much more capability to capture terrorism than we ever had before† (Ynn, 2004). The Patriot Act has helped the government track a lot of the money that was being laundered to fund terrorist organizations. A lot more has to be done in order to improve our chances in the fight against terrorism. A strategy that could be used to attack terrorism is to improve the diplomacy efforts worldwide. The UN could formulate a special terrorism task force to oversee the efforts of the different intelligence agencies across the world. The agency’s budget would be funded by all the UN allies. The develop nations would have to contribute more money than the developing nations. The Patriot Act help unite the intelligence community, but the efforts of these agencie s are still fragmented. There is a lack of a united front against terrorism. The current war on the Middle East is hurting the image of the war of terrorism because people feel that the war is driven by the desire of the US and its allies to control the petroleum in the Middle East. A new effort lead by the UN would provide legitimacy to the war on terrorism. References Ynn.com (2004). Hutchison says Patriot Act effective in fighting terrorism. YNN.

‘Mirror’ & double-layered poem Essay Example for Free

‘Mirror’ double-layered poem Essay ‘Mirror’ is a double-layered poem: The mirror, personified and equipped with senses, sees and depicts its world in the most honest terms; then we see our own world from the mirror’s perspective—how raw and tormenting it is. Why the author chooses to personify a mirror as the poem’s narrator is firstly because it is an object most closely associated with a woman who seeks to see â€Å"what she really is† (11). When she is young, the mirror cheerfully reflects and praises her youthful beauty, letting her contemplate on her own appearance. When she is old, it cruelly reminds her of time’s meddling in her fading beauty and how life has passed and left her behind. Secondly, the mirror reflects the world just as it is—it cannot lie to us—and faithfully shows us all signs of aging, sorrow, pain and sickness that appear in our face. The theme of the poem is the effects of time reflected in the mirror, how it â€Å"has drowned a young girl† and makes a woman become â€Å"an old woman†. Adverbs depicting the motion of time are employed throughout the poem: â€Å"most of the time† (6), â€Å"so long† (7), â€Å"over and over† (9), â€Å"Now† (10), â€Å"Each morning† (16), â€Å"day after day† (18). The irony is deliberated in the difference between the mirror’s reflection and cognition of changes in the outside world. The woman who looks at the mirror is sad because her beauty and youthfulness are fading while her tears and agitation are considered â€Å"rewards† by the mirror. In the first stanza, the mirror simply tries to define its existence and introduce the reader to its world using its own language register. In the opening line, the mirror describes its appearance and unique quality, â€Å"I am silver and exact. I have no preconception. †(1). The word ‘swallow’ demonstrates Plath’s sensitivities and playfulness in her personification and imagery: everything is instantly reflected inside the mirror as if the mirror has devoured them. Next, mirror immediately explains its ‘non-discriminatory’ behaviours as being truthful rather than cruel. In the last four lines of stanza 1, the mirror honestly describes its bounded world. Ironically, even though the mirror reflects everything truthfully and exactly with no preconceptions or prejudice, it seems to live in self-created illusions, that the opposite wall is â€Å"a part of my heart†. Line 8 presents the mirror with human characteristics, not â€Å"the eye of a little god, four-cornered† as it describes itself. Nevertheless, its world constantly collides with the world outside it—our world: â€Å"it flickers. //Faces and darkness separate us over and over. † In the first stanza, the use of caesura in most of the sentences interrupts the flow of the poem but gives the mirror its own tone: emphatic and meditative. The enjambment between line 2 and 3 as well as between line 7 and 8 allow the mirror to reflect on itself naturally and coherently. In stanza 2, the mirror ironically creates another illusion, â€Å"Now I am a lake† (10), which is in contrast with its claim to be â€Å"only truthful†. It proudly demonstrates its usefulness in helping a woman to see â€Å"what she really is†. The images of the â€Å"candles† and â€Å"moon† (12) may symbolize fragility, inconstancy and instability which contrast with how faithfully it serves the woman (13). The connection between the mirror and the woman strengthens by day: it is important to her and she brightens its existence. Nevertheless, its unintended cruelty is shown in its being â€Å"only truthful† (4). The simile ‘like a terrible fish’ is consistent with the mirror’s illusion that it is a lake but it shows Plath’s grotesque and tormenting view of aging—as a destructive and dehumanizing process. The poem is structured as narrative prose poetry, with the use of caesura to create an emphatic tone, to present the mirror as a misunderstood, proud and honest object. The mirror exactly and dutifully reflects what appears before it and considers the changes shown in it others’ doing and completely out of its power: â€Å"she drowned a young girl, and in me an old woman//Rises toward her day after day† (17-18).

Effectiveness Of Motivational Strategy In Habib Bank

Effectiveness Of Motivational Strategy In Habib Bank In this modernized world where globalization is fast crating an effect, the workplace realities of the ancient organizations no longer exists (Roberts, 2003). It has become past and needs to be revised very carefully before any aspect of it can be implemented nowadays. It has become increasingly important for the organizations to introduce new methods and meet the new motivational needs of the employees. The reality of workplace, the changing work environment has increased the end for the managers to reconsider the methodologies of developing durable and strong relationship between the employees and organization that ultimately leads to the achievement of the organizations goals and objectives. A thorough and complete understanding of the employees motivational need has became important for the management in order to accomplish what employees expect from the organization in order to return what organization expect from them ( Beer et al, 1984).. Therefore it becomes clear from the re searches that a motivated work-force is an instrument of success for full filling the needs of a rapidly changing work environment for both, the employees and the organization. It also becomes clear that a well- motivated workforce will eventually lead to the organization achieving its goals and objectives in a better an efficient manner. To serve this purpose ob building a strong bond between the management and workforce, the role of the top management is very crucial in this respect. According to Carnige (1985), human capital is capable of playing a pivotal role compared to financial capital, in the effectiveness of the organization. In modern times people are believed to me a source of competitive advantage and carry more importance in leading a company towards success, rather than finance. What is actually motivation and how and why does it matter? In business terms, motivation is the desire of a firm to see a job done well and quickly. The highly motivated workforce becomes an instrument for the business to achieve its goals and objectives as cost effectively as may be possible. Motivated worker also try to reach their own personal objectives. The employers should be well aware of what these are .This is because the greatest motivation will develop if workers feel that working towards the business objectives is ultimately helping them achieve their own goals. A milestone in a success of an organization is fulfilling the continually changing needs of employees and the organization. A heavy responsibility rests on the shoulder of the management to develop durable and strong relationships between them. Companies expect workers to follow the rules according to the terms and conditions set for them. Employees in return expect fir pay, good working conditions, secure career, fair treatment, involvement in decisions and power. These expectations of both groups vary from company to company. For any business to deal with these expectations successfully a complete understanding of the employee motivation becomes necessary. (Beer et al, 1984 from pdf file motivation pak bank). It is usually that it is the organization and not managers that fail to hold managers responsible for creating motivation among the people. They fail to understand the role of motivation and its connection to job performance. One of the biggest challenges for HR is to persuade line managers to develop and manage people. These line managers should be able to build string and personal relationship with the employees through effective communication. There is a need for the line mangers to understand the nature of the employee and his subordinates and should be able to deal with the problems of workers effectively. A thorough understanding of the needs of the subordinates will eventually let the managers know what the employee aims for and what are their goals and objectives. They can then decide how to develop and implement strategies that will achieve the objectives of the company while letting the employees achieve their personal goals. Staff that is unmotivated will be reluctant to do their jobs quickly and efficiently and will only provide the minimal of what is required of them from the organization. It is important to know how well motivated staff will alter the levels of productivity and performance within a company, thus affecting the competitiveness of the business. A well motivated staff is not only able to increase productivity and performance but is also prepared to accept responsibility, willingly and happily. There is low labor turnover which reduces the business cost of hiring and training new labor. With a highly motivate staff, a business also benefits from low absenteeism rate and employees participate on making suggestions for improvements. (Peter) Theories of motivation and their significance in today world: There are many theories of well known theorists that deal with the factors that affect motivation. F. W Taylor- theory of scientific management. F.W Taylor proposed a theory of scientific management that emphasized that money is the motivating factor that affects the employees to the most. Scientific management defines a method of establishing an idea after studying, analyzing and recording performance at work, then altering working conditions and recording performance. This is the approach that Taylor used to establish his idea. This method of scientific management is still used in the companies today. Taylors theory was based upon the notion of economic man and he believed that when wages are based on output, it increases workers productivity. He maintained his belief that a fair days pay for fair days work is what motivated staff to do better. But critics also say that money moves the workers to work, not motivate them. The other renowned theory of theorist is the Elton mayo Hawthorne affect. He carried out some experiments with a group of line workers. Changes in rest periods, canteen food, assembly bench lay out were made at a particular interval. Before every major change, the upcoming change was discussed with the workers. At the end of the experiment when working conditions were returned to the original, it was noticed that the output rose far above the level before the experiment. He drew some conclusions from his work that is as follows: Alterations in financial rewards or changes in working conditions have little or no effect on a workers productivity When management consult with workers before any major changes are made that affects them, motivation is improved When some control over their own working lives is given to workers, there is improved motivation Groups can establish their own targets and goals, and these can be greatly influenced by the informal leaders of the group. Taylors approach is important but not widely held today. Many workers, now a days seek for a respectable job rather than a one which is not valued but is being paid. Workers who have money as their basic need still moves towards a job offering a handsome wage/salary but they are unable to be motivated and still continue the job for money. This reduces job performance and productivity is affected. Maslow- hierarchy of needs One of another major theorist that takes a good position among the motivation theorist is Maslow. He extensively wrote on the subject concepts of the hierarchy of needs. He became a leader of the humanistic school of psychology and looked at the needs of human beings arranged like a hierarchy. The Maslow theory consists of two parts. The first one concerns the classification of the needs and the second part relates theses needs with each other. Maslow arranged the needs in a pyramid. Maslow proposed a hierarchy of needs that workers have. He suggested that these have to be fulfilled step by step. He identified and classified the basic needs that a human being has. The pyramid starts from physical needs that occupy the lowest level of hierarchy. The top level becomes the self actualization with three levels of needs in between. Maslow suggested that once a worker achieves the lower level of need, he strives for the next level. Management should be aware on what level their employees a re, and moving them trio next level, thus keeping him motivated for his job. The sequence of the Maslows pyramid is as follows: Physiological needs: these are the strongest needs. This is because if a person is deprived, the physiological needs would come first to fulfill his satisfaction. The physiological needs consist of needs like oxygen, clothing, food and shelter. These needs are the priority before any other class of need. Safety needs: this class of needs includes job security accompanied with a secured working environment. A sense of job security is essential for an employee to stay motivated towards his work with the addition of a hygiene environment with safe equipments if required. Love and belonging: the need of belonging and affection is necessary to overcome the feeling of loneliness. To overcome this, team work should be encouraged within an organization along with other social activities that instill in an employee a feeling of belonging and being a part of the organization. Esteem needs: this class of need is defined by the receipt of recognition of what the employee has achieved at work. There are chances that a worker may feel worthless and in valuable if he is not appreciated. This level of need can be achieved by the announcement of achievements publicly at events. Self actualization: this is the top level of the hierarchy. Very few workers have the potential to reach this level. This class defines need as to be given added responsibility with new challenges and promotions in his career. This theory has its own complications. Maslow did not suggest any criteria to measure which level of need has actually been satisfied. Each kevel is dependent upon the level below. The whole system might collapse if a level goes missing in between. It is also hard to say that a particular level is achieved of an employee and now the next level must be targeted. Adam- equity theory Another theory of motivation, widely recognized is the Adams equity theory of motivation. Adam proposed a very simple theory that suggested that employees balance their inputs against their out. The input is not only in the form of time that is put into work measured against the financial reward that is received as output but input also includes all the factors affecting working conditions and the worker at work. Similarly, output also includes the response, the recognition and the praise or the negative attitude experienced as a result of the job being done. The attitudes that lead to positive outcomes is repeated and attitude that lead to negative outcomes is avoided. It becomes difficult for the managers to know exactly what the employee perceives of the output against their input. Moreover inputs of the work and out puts of the work cannot be measured literally in order to calculate and balance both against each other. Herzberg- two factor theory But here our major focus would be on the Herzberg motivational theory that we desire to implement on our project. Herzberg (1923-2000) proposed a theory recognized by the world as the two factor theory. Herzberg, despite basing his research on just 200 professional workers, Herzbergs two factor theory and his conclusions has left the greatest impact on motivational practices. A survey was conducted through interviews and questionnaires that aim to know the following things: Identification of these factors that lead the workers to think very positively about their work and those factors that led them to think very negatively about their job. His conclusions reveled the following: Advancement, work itself, responsibility, achievement and the recognition for achievement were the factors relating to job satisfaction. Administration and company policy, salary, supervision, relationship with others and working conditions were these factors that lead to job dissatisfaction. These factors were termed as hygiene factors by Herzberg. Conclusions of Herzbergs work. Herzbergs two factor theory carried the hygiene factors and the motivators. Hygiene factors included working conditions, pay rates etc. these hygiene factors can eb improved in order to remove dissatisfaction from the jab but they will not help creating a motivated albor for ce. Herzberg argued that it was readily possible to move someone to do a job by paying him but it will not actually motivate him for doing the job. Similarly, he proposed that motivators, that are principles of job enrichment (encouragement, added responsibility, recognition), need to be in place to motivate the labor force to perform a task. These principles of job enrichment include Offering complete units of work: a typical mass production method only allows workers to assemble small units of a finished product. This is not motivating as the repetitive and small, invaluable task is not interesting. It also prevents workers to receive the appreciation and the importance what they are contributing to the production process. When workers are offered the complete tasks, it gives them the motivation to do a job effectively. It bears in them feeling of achievement of producing the goods themselves. Herzberg puts this idea as if u want your employees to perform a good job, offer them a good job. Feed back on performance: this communication enables workers to feel recognized and they are motivated to achieve more. A range of tasks: a range of tasks, when offered to workers is challenging and makes it interesting as their first experience if given them the first time. This provides the employees the opportunity to explore their abilities and provide incentive for the business to achieve the full potential of the workers. Analysis and evaluation of Herzberg work: As we will be implementing Herzbergs approach to her research, an analysis and evaluation of its work becomes necessary. Team working and delegation of complete tasks with much less close supervision is becoming increasingly popular in todays industrial world. Organization ensure effective communication is present between management and the workforce and this two way effective communication itself becomes a motivating factor. There is little doubt that that the increasing trend towards Herzberg approach is fast becoming popular, but many researchers who have used Herzbergs methods still argue and theory experimenting failed to arrive at such a clear cut conclusion. This wouldnt be wrong to hold Herzberg responsible for this evolution and this change would have been slower without the theories put forward by the Herzberg. Herzberg identified five main factors that resulted in job satisfaction. These factors can easily be identified in an organization and can be used for evaluation. The five main factors include achievement, recognition for achievement, responsibility, nature of work itself and advancement. These are the factors which can easily be identified if they exist in an organization. Similarly Herzberg gave five main factors that resulted in job dissatisfaction. These are termed as companys administration and policy, salary, supervision working conditions and relationships. This factor can easily be searched for in an organization to determine the effects of motivation. Service sector throughout the world is greatly dependent upon the human resource. Be it Habib bank ltd in Pakistan or RBS in Scotland, the banking sector and its success mainly depends upon the level of skilled, capable and most important motivated workforce. A motivated workforce does not only increase the performance at work but increased performance and satisfactory interaction among the clients and colleagues leads to high productivity. This in turn creates satisfied customers which forms the basis of success for any organization. Significance of motivation for commercial banks: Commercial banks are structures that are maintained and developed my human resources that ensure the delivery of a good service. The process that ensures the delivery of a good eservice is affected by the individual motivation of labor force whether skilled, unskilled, professional or unprofessional. The increased growth of service industry, commercial banks are struggling foe workers possessing the ability of providing quality service. And their labor is the best source if providing best services to their customers. Excellent services being offered and provided by the employees is able to create a positive perception among the eyes of the banking consumers. ( pdf file motivation pak bank petcharak 2004) Commercial banks play a vital role in the world wide economy. Research concludes that today it is becoming challenging for management in Pakistan to motivate their employees, especially those employed at commercial banks, to provide a quality service with increasing competitive market in the specified sector, i.e. commercial banks. The tough competition is making difficult to provide best of services to its clientele, thus satisfying their needs effectively. Theoretical frame work. Our research aims to find out the effectiveness of motivation strategies at HBL. To measure the effectiveness, the first step is to find out the variables that are creating motivation within the employees at HBL. Once the variables are identified a sample of 75 respondents will be selected from various departments of various posts, qualification and experience. These sample size is selected to determine the research question and research objective. The questionnaire will carry pout the research and will obtain the result that will identify the factors that create little or no, and high motivation among the employees. These factors when identifies will be classified under the motivators and the hygiene factors. These motivators and hygiene factors must be forming a part of the motivational strategy of the management at HBL that will effective or ineffective in creating motivation. The highly effective and the little effective will then be measured against the performance level of the workers when implemented. According to the results, those strategies will be labeled as successful or unsuccessful. For the unsuccessful strategies recommendations will be made . Research conducted through a questionnaire Identification of the factors affecting the level of motivation Identification of factors creating job satisfaction and job dissatisfaction Classifying them into hygiene factors and motivators Result on motivation result on motivation when When hygiene factors motivators implemented. implemented. Measure the effect Measure the effect on work On work performance performance. Employee motivation and work performance: Improving the work performance has always been and will continue to be the major concern of all businesses. It is the performance of work that creates satisfied managers and/or dissatisfied managers. The work performance has always been an important issue for the businesses as their success and failure depends upon the performance displays by their workforce. A manager when pays the employee, expects to return the worth of what is paid to him. In case of failure to do so, many workplace issues are created that managers then need to deal with. It is not always possible for managers to repay the accurately the input employee has put into work. This is because there exist no method to measure the input against the output wh9ich the employee receives or perceives. Failure to come up to the expectation results in demotivation. Is also seen, as described by the expectancy theory that workers expect according to what they see around. Now it becomes difficult for managers to know how they pe rceive their work output and it is compared to whose job. The performance at work is not only dependent upon the skills and abilities the worker possesses but there are many factors that exist which creates and leave an impact upon the performance of the employee. A well-motivated employee results in well performed job and an unsatisfied employee who is unmotivated towards his job naturally results in a poor job performance. But the question what motivates man to perform better has many answers. There are many motivational factors as discussed above that leaves an impact upon the motivation of the employees. When discussing and implementing the Herzberg theory, we see the hygiene factors create job satisfaction and not motivation but the motivators when placed creates motivation that results in a high performance of the job. For instance providing hygiene conditions at work place will not create motivation for the worker to perform the job but the satisfactory working conditions will make the employee continue the job a and not create a desire to do the job. Therefore a hygiene working environment will have no effect upon the performance of the job. But, if on the other hand, a worker is praised for his achievements and efforts, he will be happy and will be eager to achieve more, thus increasing his job performance. Increasing job performance includes increased productivity, putting in extra effort in the job and probably low absenteeism with happy workers who look at the golas and objectives of the company through which they can not only achieve their personal objective but companies goals become their goals and business objectives as their objectives. When performance at work is increased in any of the forms mentioned above, the company benefits from it. For a manufacturing business increased quality and quantity of it products will attract consumers which will benefit the company. In the service sector, a motivated staff will result in a cooperative and positive attitude and interactions with the customers and colleagues which will create thousands of satisfied customers. Customer service being very important in the service sector is completely dependent upon the attitude and behavior of the employees which is directly proportional to their motivation level. This motivation level is depended upon many factors like motivators described by Herzberg and others as described by many of the other renowned theorists. Linkage between objectives and questions with the theories and concept Research question/objectives Theories and concepts

Effect Of Pharmacist and Nurse on Improving Blood Pressure

Effect Of Pharmacist and Nurse on Improving Blood Pressure Afzal Hussain Problem and Purpose In this paper, I will be critically analyzing the article â€Å"A Randomized Trial of the Effect  Of Community Pharmacist and Nurse Care on Improving Blood Pressure Management  in Patients With Diabetes Mellitus- Study of Cardiovascular Risk Intervention by Pharmacists–Hypertension (SCRIP-HTN) by Donna L. Maclean ; Finlay A. McAlister; Jeffery A. Johnson, Kathryn M. King; Mark J. Makowsky ; Charlotte A. Jones and Ross T. Tsuyuki. This article outlines a quantitative experimental design involving two sample groups (experimental and Control). According to Sullivan-Bolyai, Bova, Singh (2013), experimental designs are particularly suitable for testing cause and effect relationships because they help eliminate potential alternative explanation (threats to validity) for the findings (p. 217). The authors articulate their recognition of the fact that interventions are key markers to identify and observe blood pressure (BP) control in diabetic patients. The authors also recognize the fact that there is a need for a new model of care to improve BP control, particularly with significant challenges in accessing primary care physicians attributing to labor shortages in the health scare system. In addition, the authors used manipulation by introducing the intervention, then by comparing the standard and usual care among the control group and experimental groups. This resulted in the manipulation variable being the difference of care among patients with blood pressure and diabetes. One intervention delivered to the group based on the manipulated variable of difference of care is evident through the interventions made by the pharmacist-nurse teams at various pharmacy sites, which included cardiovascular risk reduction counselling, education brochure on hypertension, lifestyle strategies, effect of diabetes on high BP, and referral to the patient’s primary care physician for further BP and cardiovascular assessment (McLean, McAlister , Johnson, King, Makowsky, Jones, and Tsuyuki, 2008, p. 2356). The control group received the standard and usual treatment compared to the experimental intervention group. Furthermore, blood pressure wallet card, educational pamphlet on diabetes and physician care were received by the control group. (McLean et al., 2008, p. 2355).The authors used randomization to categorize the research participants into two groups- experimental intervention and control which is set to receive the standard treatment of care. Mclean et al (2008) states, â€Å" Randomization was at the level of the patient ( stratified by pharmacy and using a variable block design), it was performed centrally to preserve allocation concealment using a computer generated sequence over a secure internet service at the Epidemiology Coordinating and Research (EPICORE) centre,(p. 2356). The authors propose a practical necessity for this research problem to be explored and be further researched. The purpose of the research was to explore whether pharmacist or nurses can professionally contribute to improving the BP control of patients with diabetes and implement preventative care measures due to ongoing lack of physicians, pharmacist and nurses, it is clear that the research is also significant. It is based on changing the attitude of health care professionals to meet current outcomes, outcomes which seem to be on par with those of the current health care system in Canada. Sample Size, Design and Collection Methods The sample for this study was appropriately assembled for a quantitative study. The study sample is easily identified when reading the article, included a description of the demographic characteristics and the size of the sample. Also included were any sampling bias, drop outs or loss of patients to follow up. In doing so, an adjustment of 85 to 110 per group were added. (McLean et al., 2008, p. 2357). Its purpose was to test the efficacy of community-based interventions through a pharmacist and nurse team approach on reduction of cardiovascular events in diabetes mellitus patients. This was achieved by measuring the BP which has been linked to comorbidities such as cardiovascular disease, and to BP measurement changes used as an indicator of health. This sampling was appropriate to the study as the sample were to represent diabetic patients. Mclean et al (2013) states, â€Å" All adult diabetic patients with BP higher than 130/80 mm Hg on 2 screening visits separated by 2 weeks wer e identified in participating pharmacies. Diabetes was identified by community pharmacists through the use of diabetes indicator medications in each pharmacy’s prescription database. (p. 2356). In this study, Mclean et al (2008) used a randomized controlled trial (RCT) in 14 community Pharmacies in Edmonton, Alberta as a method of data collection (McLean et al., 2008, p. 2355). Participants were identified and manipulated by pharmacists and nurses who were trained using a combination of an online learning program and a case-based learning session – both based on the Canadian Hypertension Education Program (CHEP) guidelines†. Also the use of a commercial BP monitor set at an average of 5 measurements of BP taken 1 minute was used to measure participants BP (McLean et al., 2008, p. 2356). Data analysis procedures were appropriate to the research study because â€Å"all analyses were conducted using a commercially available software program† (McLean et al., 2008, p. 2357). Threats to Internal and External Validity specifically the authors use of instrumentation and selection could possibly have introduced problems of internal validity in the research. This threat was discussed by ensuring that both groups (control and experimental) BP were measured with the same BP device, which has 6 readings, discard the first test and further takes an additional 5 measures . Mclean et al (2008) found that, â€Å"It is possible that the more frequent contact with the pharmacist –nurse team reduced the anxiety of patients and any â€Å"white coat effect† on their BP measurement†. (p.2359). Furthermore, the screening modules used by the researchers to collect the data were conducted by pharmacists and nurses well versed in their profession. Selection bias was another threat predisposing the sampling design to internal validity. The authors in their findings found that patients eligible for selection presented with lower BP, this can be caused by the researchers utilizing a convenience sample instead of a random sample. Also, selection bias may have been an essential part of the end results due to the fact that patients who are eager to monitor and control their BP are more likely to agree to participate in the trial, also that more than 80% of trial participants were aware that hypertension is a risk factor for cardiovascular disease (McLean et al., 2008, p. 2358). The external validity of the study was weakened by the sampling design. The authors failed to take into consideration non English speaking people, whose cultural differences and beliefs could influence the study, and who may lack health literacy to read and identify medical abbreviations and symbols. Maclean et al (2008) states, â€Å"pharmacists and nurses who participated may be different from those who did not participate, an investigator vol unteer bias that may limit generalizability of the program† (McLean et al., 2008, p. 2359). Limitations of the Design One major limitation of the design identified by the authors is regarding the interventions implemented in regards to the in person contact time between patients and the pharmacist-nurse team, which can be further be evaluated by future studies on whether less intensive interventions are The researchers identified a potential limitation regarding that the intervention involved substantial in-person contact time between patients and study personnel, and that future studies will need to determine whether less intensive interventions are productive in controlling BP in diabetic patients (McLean et al., 2008, p. 2359 Generalization of Findings The research findings can be generally be applied to larger populations, the authors acknowledge the fact that their research intervention was extremely efficacious, resulting in a 24.1 mm Hg greater reduction in systolic BP (McLean et al., 2008, p. 2358) They recommend a new model of care to improve BP control. In addition, by utilizing an experimental research design in which a cause and effect relationship can be analyzed and measured, the researchers were able to provide coherent evidence and correlation that community pharmacists and nurses through a collaborative effort with primary care physicians could have a huge impact on hypertension management in patients with diabetes mellitus and BP control within the community (McLean et al., 2008, p. 2360) References LoBiondo-Wood, G., Singh, M.D., (2013). Introduction to quantitative research. In C. Cameron, M. D. Singh (Eds.), Nursing research in Canada: Methods and critical appraisal for evidence-based practice (3rd ed.) (pp. 198-215). Toronto: Elsevier Canada McLean, D. L., McAlister, F. A., Johnson, J.A., King, K.M., Makowsky, M.J., Jones, C.A., Tsuyuki, R.T. (2008). A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus. Archives of Internal Medicine, 168(21), 2355-2361 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19029501 Sullivan-Bolyai, S., Bova, C., Singh, M.D. (2013). Experimental and quasiexperimental designs. In C. Cameron, M. D. Singh (Eds.), Nursing research in Canada: Methods and critical appraisal for evidence-based practice (3rd ed.) (pp. 216-233). Toronto: Elsevier Canada