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Critical regulatory issue in health care, a case of ambulatory surgical centers in America

Critical regulatory issue in health care, a case of ambulatory surgical centers in America

Critical regulatory issue in health care, a case of ambulatory surgical centers in America

According to (Lindsey Dunn, 2009) of Ambulatory Surgical Centers (ASCs), the nature of law issues facing surgical centers in America evolves around out patient and non members , doctors ownership of the centers and issues regarding the qualification of and safety of the nurses required. Robert Mosher explains this further by noting that the doctors’ ownership of the surgical centers poses a major issue in eradicating the retirees and ushering in new board members as major retirees are the owners of these centers. Associated with this is the problem of interpreting what the law requires in terms of coming with the acceptable market price in the buying and selling of the centers as away of changing ownership. Patients requiring surgical services are also hit by another problem of determining what goes to the doctors as a cover for their finances for the services offered. The rules have the advantage of stipulating the rights and the directions for the services, and the doctor’s monetary interests in the whole gamut of treatment process.

As put forward by (People to people Health Foundation, 2010) It is a requirement that should be put in writing by the surgery centers to inform the patients of any monetary interests by the doctors as a result of using the centre a few days before the patients goes in for the surgery, the contrary is that adhering to these rules has posed a problem. Amber MC and Graw Walsh, 2008 explains that among the nurse requirements on the other hand, is a prerequisite that all ASCs makes sure that all doctor ownership is a third of all the revenues generated by both surgeries done in the specified ASCs as well as those performed outside the said centers which is attributed to fair distribution of wages to both the doctors and other ASCs officers. In determining members fees the surgical centers are faced with another problem in the law about the interpretation of what is to be contained and exempted from the fees. Walsh further argues that Surgical centers from surgery procedures in most cases get so much revenue coming from people known to their previous clients and with it comes more monies from insurance firms who lack the knowledge of the best fair rates even though the patients suffer from higher monetary obligations in the long run, which in the end results to exploitation of the patient by the centers and the insurance firms. Some ASCs on the other hand ignores the collection of their fees from the client know patients as well as from the insurance firms as a result of being paid huge sums even without the said fee.

Laws on issues of surgical centers as noted by Wachler & Associates, healthcare attorneys in America for many years have not been fully dealt with, especially laws relating to out of the members fees, doctors’ ownership as well as the issue of safe nurse requirements which have not been covered well as per the expectation. This has therefore resulted into the following; ASCs in most case lack the know how to understand the agreements put forth in regard with what the fair value is in the market so as facilitate the selling and buying of the members ownership which is usually brought about by market uncertainty .As a result, it is a necessity for ASCs to agree that selling and buying of new stocks should be practiced from day to day and not wait until things are not going right in the market in order to facilitate the sales or equally not whenever the market is doing pretty well. It is also important for ASCs to have a list of all the doctors’ owners and make sure the copies of this is easily accessible to all the representatives of patients and the patients themselves as a way to promote accountability. They should also as matter of fact ensure that the list can be understood by all the stakeholders that may need to understand it. ASCs also should make sure that they adhere to all safe nurse requirements in order to avoid legal cases that could be brought forward against them and to ensure equitability and availability of funds. The idea that centers lack ways to enable them to know to what extent to waiver the doctors’ owners and what guidelines to follow in order to be consistent in their application as well as lacking the direction on what their patient clientele is billed is seen as a legal issue facing ASCs.

INCLUDEPICTURE “http://www.turnitin.com/images/spacer.gif” * MERGEFORMATINET INCLUDEPICTURE “http://www.turnitin.com/images/spacer.gif” * MERGEFORMATINET Functions of law on issues relating to surgical centers as supported by (H. J. Peter & S.M William, 2003) include the following; Firstly, it facilitates the coming up with regulations that will guide ASCs on how to come up with the best market rate INCLUDEPICTURE “http://www.turnitin.com/images/spacer.gif” * MERGEFORMATINET thus providing a mutual satisfaction to all the stakeholders in healthcare surgical centers. Secondly, the law enables the establishment of what guidelines to follow in order to be consistent in their application in terms of waiver values, come up with laws governing the adherence to safe harbor requirements therefore making centers to comply with the requirements, make sure they do not face bribery violation or anything coming with such vice. This will help surgical centers in the world and mostly in America to come up with the rules that should be followed when it comes to exemptions. It will also help in solving the problems of misunderstanding and lastly it assists ASCs to analyze state law on issues such as what the what fair competition, anti bribery, claims that should not be paid involves and ways on how to go about any of the problems arising from the issues above.

In recommending for effective functioning of the surgical centers, the law regarding all their health operations should be clearly defined and adhered to with proper mechanisms put in place by the judicial system and all stakeholders involved in provision of healthcare to ensure that they are applied effectively and to the later

References

Lindsey Dunn, 2009: ASCREVIEW: Practical Business, Legal and Clinical Guidance for Ambulatory Surgical Centers as extracted from HYPERLINK “http://www.beckersasc.com/news-analysis-asc/antikickback-legal-regulatory/top-lawyers-discuss-current-critical-legal-issues-facing-surgery-centers.html” http://www.beckersasc.com/news-analysis-asc/antikickback-legal-regulatory/top-lawyers-discuss-current-critical-legal-issues-facing-surgery-centers.html as it appeared on 7 May 2010.

Sage and Hammer, “A Copernican View of Health Care Antitrust”; and W.M.Sage, D.A. Hyman, and W. Greenberg, “Why Competition Law Matters to Health Care Quality,” HealthAffairs (Mar/Apr 2003): 31–44.

INCLUDEPICTURE “http://www.turnitin.com/images/spacer.gif” * MERGEFORMATINET

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Critical Regionalism

Critical Regionalism

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Critical Regionalism

Introduction

In an era where free movement of information, products and services has increased tremendously, the society is increasingly experiencing incidences of homogeneity. More than ever, the global population is assuming a common culture that is characterized by a high level of uniformity. Although this is in most instances considered to be western culture, it is notable that local cultural aspects are also being incorporated in the global culture. Just like other aspects of culture, it can not be disputed that architecture has equally experienced increased homogeneity. Emergent research argues that although internationalization of culture is an indication of societal advancement, it can also have detrimental effects on local culture. In this respect, it is particularly feared that internationalization undermines creativity and innovation as local efforts are integrated in to designs that are then accorded a global orientation.

The current trend has culminated in a conflict between internationalization and regional artists who argue that their efforts are increasingly undermined by the former. Increasingly, preservation of local and regional architecture and culture in general is becoming tricky. Preservation and conservation of local culture and architectural designs is requiring complex efforts in order to attain optimal results. It is against this background that this paper provides an explicit review of the concept of critical regionalism form Kenneth Frampton’s point of view. In order to enhance a harmonic consideration, the essay is classified in different phases that exhaustively review particularistic aspects of this conception, the contribution of Jorn Utzon to the subject under review, practical examples with respect to how culture has been unified in the modern cities, the response of critical universalism to future technology and several other concerns that are related in different ways to the concept of critical regionalism.

According to Butler and Spivak (2007), critical regionalism refers to the concentrated efforts or attempts that seek to synthesize or mainstream the rooted aspects of a given region such as physical attributes and cultural characteristics with the relevant technology being employed in development at that given time. The main aim of the efforts is to counter the inherent lack of identity and placelessness by putting in consideration the unique aspects that are found within the context or environment of the given building. Besides being mindful of the local environmental aspects, the ultimate architecture also incorporates the universal aspects that characterize the contemporary mobile society. In the long run, the final architecture can be considered to be sustainable and unique in different ways. This is fundamental in preserving the local culture, encouraging creativity and innovation and at he same time enhancing societal advancement. The notion of sustainability is integral to this conception as the final piece of architecture needs to be both functional and aesthetic n nature.

Critical regionalism is a concept that has been accorded increased attention since historical times. The term was initially coined by Liane Lefaivre and Alexander Tzonis. It was later analyzed and accorded new meanings by Kenneth Frampton in the preceding years. In his Towards a Critical Regionalism, Frampton provides an explicit analysis and review of different methodologies that can be employed in embracing modernity without compromising the role of the local knowledge. He also cites a host of modern construction practices that compromise the ability of the developers to incorporate important cultural aspects in constructions. His main argument revolves around the contention that as much as assuming modern values and attributes is imperative for enhancing competitiveness within the global sphere, equal attention also needs to be accorded to diverse features that are found in the environment that the building would be located.

Several authors of whom Powell (2007) is represented contend that internationalization has increasingly contributed to the erosion of critical traditional values, culture and attributes. Almost all aspects of the global population are undergoing a significant transition and more emphasis is being placed on homogenous cultures. In his review, Ricoeur (1965) contends that the current trend towards modernization can be implicated for disregarding the role of old civilizations in development. He argues that critical regionalization provides a credible alternative that can be employed in resolving the emergent challenges. The fact that the concept recognizes the importance of continuous evolution makes it instrumental in sustainable decision making as past lessons are used in determining the nature of future decisions and moves. The activities that are proposed by this conception tend to be flexible and can be employed in redefining the current decisions in order to adopt timely interventions that would reverse the current destructive trend.

In his critical review of culture and civilization, Frampton (1983) indicates that the current state of architecture and building is essentially conditioned by the building industry. This has led to the development of building restrictions and regulations that determine not only the design but also the citing of the buildings that are set up in different areas. The fact that the respective building codes and regulations are standardized and replicated in different areas undermines the ability of mainstreaming vital cultural concerns during construction of buildings. Contravention of the set restrictions and regulations often exposes the given developer to stringent measures that impact negatively on their welfare. This has led to the increase in high rise buildings that in most instances assume a similar design. At this point, it can be argued that this has played a leading role in suppressing cultural expression as well as creativity and innovation. In his research, Jameson (1983) cites that the current developments in this regard are laying undue emphasis on the concept of utility as opposed to different aspects whose interplay culminates in a sustainable construction practices.

The concept of critical regionalization according to Powell (2007) seeks to counter this trend by ensuring that as much as certain building codes are strictly adhered to, room is also provided for creativity, innovation and incorporation of critical cultural aspects. In essence, modernization is placed within the traditional concept and vice versa.

In current times, arts are increasingly employed in enhancing creativity and innovation. Artists use this medium to express their diverse cultural aspects to the entire world. It is also a viable way through which culture is preserved by the respective society and used for educational purposes in future. The fact that innovation and creativity is slowly but progressively being undermined through the gravitation of arts is also worrying. In this regard, it is argued that entertainment and manufacturing of commodities are providing avenues through which the society is increasingly developing a hybrid global culture. Specific techniques, methodologies and standards of constructing buildings provide limited room for inculcation of vital cultural aspects in the same. This is where critical regionalism comes in handy in a bit to counter the scenario. In this regard, the concept initiates and maintains an acceptable level of resistance that contravenes the set standards and procedures. This according to Frampton (1983) has been critical in putting brakes on the avant-garde pendulum. Respective efforts are geared towards a noble cause of preserving certain ideals that characterize the present day culture.

As indicated earlier, Frampton (1983) postulates that the current arrierre-garde holding position is likely to culminate in incidences of resistance and a persistent identity giving culture that is characterized by universal techniques. Seemingly, it is defined by the enlightenment progress myth that does not advocate for a return to vernacular forms. Critical regionalism at this point is defined as a bridge whose central position demands that the future architecture must pass over it in order to attain optimal results. Essentially, it is argued that position of critical regionalism demands that both universal civilization and world culture accord it utmost attention. This recognition is characterized by deconstruction of alien forms that have been forcefully or intentionally acquired by the global society and limitation of the economy that entirely depend son technological production.

A classic example of such a situation has been cited by Frampton to constitute Jorn Utzon’s Bagsvaerd Church that was built in 1976 and is located in Copenhagen. This is an exemplary illustration of the concepts of world culture and universal civilization. The construction of the exterior part was basically based on the universal technique. This is built using concrete blocks and concrete wall panels that are pre-cast. These are set up in a repetitive manner that creates an impression of a grid. Notably, this building code is found across the globe and it constitutes one of the important regulations that are set forth by the industry. Thus it can be considered a universal attribute that is in line with the global expectations with regards to building and construction.

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Interior Design of Jorn Utzon’s Bagsvaerd Church

However, the interior part can be considered to express the world culture or secular culture that is typical to Copenhagen. One dominant feature of the interior pertains to the concrete vault that is not economic in nature and is not common on a universal scale. The inherent manipulation of light is only typical to sacred places found in the region. As mentioned afore, this is not an implication of western culture; rather it can only be likened to Chinese pagoda roof that is a representation of world culture.

Also worth acknowledging with regard to the concept of critical regionalism is the mainstreaming of the regional peculiarities in the construction process. In this respect, Lovine (2004) asserts that buildings need to put in consideration the environmental features and attributes of the locales within which they are situated. Generally, modernization puts lays particular emphasis on economizing the available space and in most instances, it is forced to get rid of certain aspects such as topography. The elimination of such aspects is a clear indication that certain techniques are employed during construction. Notably, other important aspects such as climate have also been controlled by human techniques during construction. In his research, Norberg-Schulz (1980) asserts that these aspects are important as they represent certain cultural aspects of the developer. Critical regionalism counters this by assuming the principle of building the site that incorporates diverse environmental aspects that are also a reflection of the cultural aspects of the given population.

A classical illustration of the importance of preferring tectonic over scenographic features is exemplified by the Aalto’s SSynatsalo Town hall that was constructed in 1952. In this, a tactile surface is successfully employed in enhancing the legibility of the architecture. The brick steps that line the exterior and lead to the chambers of the council create a harmonic impression that arguably affirms the feet as it meets each tread. The inside of the chambers are then made up of wood that presents a different feeling and reading altogether.

Generally, Slessor (2004) contends that designers that put in consideration regional criticism need to incorporate aspects of a physical as well as localized sense of place. Respective elements that can be effectively employed in attaining this included orientation, topography, lighting characteristics, micro climatic conditions and vegetation. Further, probabilities for natural ventilation, natural lighting and shading for cooling purposes are equally important. The benefits that accrue from this are not only economic in nature but they also place the building within the physical environmental surroundings and enhance the general harmony of the two. The inherent sense of interaction with the natural surroundings is an indication of environmental sensitivity that is critical in the twenty first century. Of great importance would be the employment of local materials for construction that not only cuts down economic costs but also enhances the performance of the given building.

Also worth mentioning with regard to critical regionalism is the ability of the designer to clearly interpret the passage of time using the building. According to Foucault (1986), a building that provides clear ways of recording and understanding the passage of time is a clear expression of the period that it was constructed. This is important as it enables the society to understand it in light of historical revolution. The respective recording methods can also offer a basement upon which future construction can be devised as well as understood. In particular, attitudes regarding durability, permanence, change and decay that are related to recording are a vital expression of the sensibility of the region.

Further, Butler and Spivak (2007) indicate that emphasis on the importance of human interaction during construction is also an important aspect of regional criticism. In this regard, the given design needs to consider the organization as well as structure of the family that would reside therein. In certain communities, concerns expand beyond the domestic sphere and incorporate the dimensions of the community within which the family is situated as well as the economic and political structures that characterize the region. Issues pertaining to power, the ability of the design to either express invitation or exclusion is also accorded utmost attention during this time. Other concepts include democracy, hierarchy and bureaucracy. These need to be clearly defined as they are critical in the understanding of the places and spaces that buildings present.

Also equally important to critical regionalism is a clear understanding of human dignity and organization within the building. Emergent aspects such as leisure time need to be put in consideration during the construction process. In this regard, Jameson (1983) indicates that the twenty first century tendencies lay particular importance on the separation of spaces employed in production and consumption. These differences have been identified to have diverse impacts on the holistic functioning of the society. Relative concerns also involve the responsibility of individuals within vast business environments, the compartmentalization and separation of activities in the course of the process of production and the role of machines in the production process are important architectural concerns that need to be interpreted effectively.

Arguably, all the above concepts interlink and interrelate with each other to culminate to culminate in a suitable environment that is supportive of the activities of the post industrial society. Questions revolving around mass production and participation of individuals in the entire process need to be addressed accordingly. Human dignity needs to be upheld to attain optimal production that is fundamental for successful operation. At this juncture, it can be ascertained that critical regionalism is an all inclusive concept that generally seeks to enhance sustainable development with respect to architecture and construction.

In his research, Davey (2001) ascertains that the concept of regulation of building codes across the globe has led to unification of designs. Most cities adapt their design from the grid structure. The buildings contained therein tend to be of a similar design that is influenced by the set and standardized regulations. For instance, commercial buildings that are mostly found within the central business districts of cities such as New York and London tend to be of a similar design. This differs from those employed for constructing buildings in residential areas. Again, these tend to adopt a distinct design hat is stipulated by the technical expertise in the industry. The fact that developing economies are also increasingly adopting this trend has various implications on future construction and architecture in general.

According to Slessor (2000), the replication of these designs in developing countries can be attributed to the concept of westernization that is perceived to be more ideal than the cultural aspect. This is likely to have detrimental effects on the cultural welfare of the societies in general. In particular, this would probably be unified and would compromise the concept of diversity n the long run. Also worth mentioning are the current trends that tend to consider local and regional designs to be global in nature. Basically, this is contributed to by changes in perceptions that tend to accord certain cultural designs more importance and preference than others.

At this point, it can be contended that future architecture is compounded by various complexities that need to be effectively addressed by relevant institutions, persons and authorities. Certainly, creativity, innovation and cultural diversity are increasingly being compromised by internationalization of building codes. The loss of diversity is likely to have devastating effects on the wellbeing of the society as it would negatively impact on the ability of the given society to cushion itself against destructive environmental effects. Several factors have been put forth by relative studies in a bit to address this glaring shortcoming.

Powell (2007) maintains that the concept of sustainability needs to be revisited and made a mainstream factor during construction and architectural design. In this respect, it is suggested that practical measures need to be undertaken to significantly reduce energy consumption of buildings. Statistical evidence shows that the amount of energy consumed by the buildings is equal to those employed in the industrial sector. This can be attained if natural resources found in the given environment are employed in construction of buildings found therein. This implies that the architectural designs that are employed in such areas need to be localized.

Capitalization on the topography and other natural features found in the given environment also need to be assumed in order to reduce the resources employed in construction. Powell (2007) indicates that the current trend is leading to unification of architectural designs that undermines diversity. Environmental aesthetics is also being compromised by the internationalization of architectural designs. Techno-scientific-cum-economic agendas have inherent problems that could be difficult to resolve in future. Therefore, viable alternatives that reflect distinctive cultural aspects of a community need to be explored.

Conclusion

From the preceding analysis, it is certain that critical regionalism is an all inclusive concept that is based on the principle of sustainability. It is made up of various concepts that are imperative for sustainable development. It not only appreciates the importance of modernization in architectural design and building construction but also ensures that relative decisions are informed by important lessons learnt in the past. Traditional cultural aspects are integrated in architectural designs and construction that is driven by critical regionalism. The current trends have raised various concerns with regard to architectural designs and building codes being employed on a global scale. As it has been prescribed by this study, practical intervention measures need to be undertaken in order to counter the current scenario. The concepts of sustainability and inclusion of physical features like topography need to influence the development of modern architectural designs. This will not only save resources but will enhance diversity that is critical in cushioning the society against various threats.

ReferencesButler, J. & Spivak, G. (2007). Who Sings the Nation-State?: Language, Politics, Belonging. USA: Seagull Books.

Davey, P. (2001). Regionalism: Time to Review and renew. Architectural Review, 210, 34-5.Foucault, M. (1986). Of Other Spaces. Diacritics, 16 (1), p.23.Frampton, K. (1983). Towards a Critical Regionalism: Six Points for an Architecture of Resistance. Washington: Bay Press.Jameson, F. (1983). Postmodernism and Consumer Society: The Anti-Aesthetic. Washington: Bay Press.

Lovine, J. (2004). Building a Bad Reputation: Sloppy American Construction. New York Times, Aug. 8, pp. 4-5.

Norberg-Schulz, C. (1980) .Where is Modern Architecture Going? Tokyo: A.D.A. EDITA.

Powell, D. (2007). Critical Regionalism: Connecting Politics and Culture in the American Landscape. USA: University of North Carolina Press.Ricoeur, P. (1965). Universal Civilization and National Cultures: History and Truth. Evanston: Northwestern University Press.

Slessor, C. (2000). Concrete Regionalism. New York: Thames and Hudson.

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Critical Novel Review Hiroshima

Critical Novel Review Hiroshima

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Critical Novel Review: Hiroshima

Hiroshima by John Hersey is among he most remarkable and influential novels of its generation. Set up in the period of the Second World War, Hiroshima provides a vivid account of the events following the American atomic bombing of the city of Hiroshima. To symbolize the various effects of the atomic bomb, Hersey uses the story of six survivors with different professions. What comes out throughout the story is the immense nature of the destruction left by the bomb and the debilitating effect it had on survivors. These are observations of fact rather than fiction as all findings of studies to review the aftermath of Hiroshima have pointed debilitating radiation effects (Gordin 317).

For all its complex intrigue with details and facts, Hiroshima is surprising a simplistic piece of journalistic writing focusing on six seemingly ordinary people who had survived the atomic bomb. The narrative begins on the morning the first atomic bomb was dropped from an American plane and ends as the survivors struggle to piece together their shattered lives several months later. On this morning, approximately 245,000 residents of Hiroshima, Japan, including the six characters, were going about their normal lives (Gordin 317). When the bomb detonates, Mrs. Hatsuyo Nakamura is watching her neighbor’s house and overseeing her sleeping children; all end up covered in debris when their house is destroyed. Miss Toshiko Sasaki, an office clerk, is leaning over to speak to a fellow worker when she is blasted out of her desk and trapped under heavy bookcases. She sustains a severely broken leg. A medical doctor, Masakazu Fujii, is reading on his porch when he is catapulted into a river and squeezed between two large timbers (Ross). Still another doctor, Terufumi Sasaki, falls to the floor in the corridor of the Red Cross Hospital and gazes in wonder at the scene outside the window. Father Wilhelm Kleinsorge awakens in the vegetable garden of the Catholic mission house, injured and dazed. The Reverend Kiyoshi Tanimoto throws himself between two large rocks and is hit with debris from a nearby house (Ross). All the six survivors are to a large extent injured, but they are all alive. They try to help each other and the rest of the population that is injured the best they can. There are frantic and desperate attempts to vacate as many of the injured population as possible to higher grounds. Mr. Tanimoto in particular is immensely instrumental in vacating the injured to safer ground.

Order is later restored but the scene of misery and human suffering remains a stuck reminder of the events of the disaster that just struck the city. These scenes were also a complete contrast of what various governments and government agencies were reporting regarding the bombing. A second bomb is subsequently dropped on another Japanese city of Nagasaki and this causes the government to come out of its shell. Indeed, the Emperor of Japan gave a radio address on August 15, telling his people that Japan has surrendered (Gordin 318). The truth of the matter, pertaining to the effects that the bomb had had on the local population is further revealed by radiation illnesses that follow. For instance, Dr. Kleinsorge must go to a hospital in Tokyo. He will never again regain his energy or health. Miss Sasaki, also in a hospital, is so depressed over being crippled for the rest of her life that her doctor asks Father Kleinsorge to visit her (Ross). Dr. Sasaki spends months and years analyzing the effects of the radiation and how best to treat it; he marries and begins a medical practice. Dr. Fujii also opens a medical practice and begins socializing with the occupation officers. Mrs. Nakamura and her children lose their hair and suffer from various illnesses, but because they are so poor, they cannot afford to see a doctor. Mr. Tanimoto attempts to operate his church out of his badly destroyed home (Ross). The survivors struggle on with the effects of the radiation, and attempt to find ways to manage despite their injuries.

These events portray a tragic end to a society that had been formidable in the face of war. Although it largely shows how innocent civilians were targeted for attack in an armed war, it is vital to note the universal resolve and determination of the people of Japan; attributes that were presented to the outside world through their emperor and the relentless army. As such, most of the novel is based on facts and describe actual events that happened on that fateful morning of August 6. However, his attempt to portray all the possible outcomes of the bombing, Hersey describes scenes that are entirely contradictory to the time period of the atomic bombing. For instance, Mrs. Hatsuyo Nakamura is overseeing her children sleep when the bomb is detonated in the novel. The timing of the detonation was in the morning and it is hard to imagine anybody sleeping at that our, especially with such comfort, considering the nation knew it was at war with the British and American forces. Additionally, a female office clerk in East Asia is hard to imagine in the time that this bombing happened. According to the novel, Miss Toshiko Sasaki was an office Clerk, who was blasted out of her desk while leaning over to talk to a fellow worker. Nevertheless, it is overly convenient how Doctor Masakazu Fujii is catapulted from his porch, where he had been reading, into a river and squeezed between two large timbers, yet he survived both the impacts of shattered glass in his porch and that of a thud into the river. A glass porch in this time period is also wrongly represented.

However, these only prove to be few goofs that befall approximately all literary works. The author, as earlier mentioned, probably used them toad imagination to the story and draw empathy from his audience. They also accord a fictitious element to the story of Hiroshima bombing and save the author from any accusations of misrepresentation of facts. However, the bulk of the novel points to events that can be told and retold by immediate survivors of both Hiroshima and Nagasaki Atomic bombing; and their descendants.

To portray the continuity in the story of the atomic bombing, John Hersey transforms an originally four chapter novel into a five chapter book when he introduces ‘The Aftermath.’ This chapter was added to detail the lives of the survivors after the bombing (up to 1985). In the chapter, Mrs. Nakamura is receiving medical help for her many radiation illnesses and staying away from political rallies by the survivors, who are now called “hibakusha” (Ross). The hibakusha have become the targets of politics and the peace movement. Mrs. Nakamura’s children are grown, and she has retired from a job at a chemical company. Dr. Sasaki ran a lucrative medical practice. He lost his wife to cancer, and he is still haunted by the souls of those who died as a result of the bombing. Father Kleinsorge spent many years ill, both in and out of the hospital. In 1976, he slipped and fell on ice, resulting in fractures that left him bedridden (Ross). The following year he weakened, became comatose, and died. Miss Sasaki endured numerous surgeries on her leg. She converted to Catholicism and became a nun, helping people die in peace. Dr. Fujii died of cancer, but his life after the bombing was one of wealth and the pursuit of pleasure (Ross). The Reverend Mr. Tanimoto, after traveling to America several times to raise money to aid the hibakusha, has retired quietly, living out the rest of his life with vague memories that day forty years ago.

It is inevitable to associate yourself with the thousands of residents of Hiroshima while reading this novel. This is because, in a simple and straightforward way, Hersey has managed to re-create the events of Hiroshima bombing without having been there himself. As such, he accords insight into an event that permanently changed the history of Japan and Asia as a whole.

Works Cited:

Gordin, Michael D. “Hiroshima: The World’s Bomb (review).” The Journal of Military History 73.1 (2009): 317-318. Project MUSE

Ross, Stewart. Hiroshima. Mankato, Minn.: Arcturus Pub., 2010. Print.

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Critical Kinship Organizations

Critical Kinship Organizations

Critical Kinship Organizations

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Kinship Organizations

Kinship is that sense of being related to another person in one way or the other. Either this relationship can be brought about by a set of rules and regulations governing a society, or they can exist due to a blood relationship between the two or more individuals. It can be taken for granted as being the way it is, or natural as opposed to cultural acceptance. Kinships also include relationships due to blood or marriage between different people. Foraging and horticultural based society is the one where the community is dependent on searching for food, especially plants and fruit. Therefore, the kinship organization of foraging and horticultural based society is the study of how family relationships either by blood, marriage or by set rules affect the people, whose livelihood is preconditioned by collecting fruit, vegetables, sap and roots. (Peters, 2013).

Aborigines are one of the communities in Australia. They are one of the oldest communities believed to have a continuous culture on the planet. They are the descendants of the first immigrants from Africa for up to 75,000 years ago. This is known from a generic study and Deoxyribonucleic Acid (DNA) analysis. In Aboriginal Australia, the fact that it is one of the most complicated kinship systems; it is thus the foundation of all the interactions in society both social and cultural. Kinship encompasses every aspect of the social composition and structure of every society, because the kinship organization of a particular tribe or people dictates their links with other communities and the relationship thus solely depend on the kinship system. In this society, everyone is related to everyone else and this complicates the understanding of the kinship system of the Aboriginal people (Berndt, 1988).

The cultural practices of the Aboriginal people solely depend on their living styles that have been for long the longest in the whole world. Their culture is being influenced by their social interactions from the kinship level. The kinship system is divided into a number of units in which the community is affected. The physical or geographic grouping of communities will affect how the society does their daily activities. A language group of say 600 people is made up of a band of around 10-20 people each, these people join together for one day to another to carry out activities, such as hunting and gathering of food. The people in a band can also be referred to as a horde, and they are likely to affect the thinking of young people, who join them. In the horde you are raised to believe that what your parents and the whole village do is the right thing. Hence, young people who should apply their rational judgment to come up with solutions to get swayed by the belief of their kinsmen. The kinship also affects the way people act. The day-to-day activity of the people around is likely to shape one’s actions. The people around you that are your kinship are the shapers of your life and action. You will believe life as being complete if you attain the status of the kinsmen (Crawford, 2003).

Religious classification and its effects are also ways in which kinship is likely to affect a society. The Aboriginal people of Australia are divided on the basis of their religious affiliation and beliefs. A moiety system of classification is used to classify the Aboriginals into different groups based on their religious beliefs. This system divides them into two: the sun side and the shady side. Therefore, on this basis some people are seen as the disadvantaged, whereas the others advantaged. This consequently affects even the way people think, because of the attitude attached to him or her.

Throughout the Aboriginal culture, people had different ways to refer to each other. For example, a man could address another man with a particular kin name, which could be used to address his brother. Also a kin term used by a woman would be used to all the other sisters, and therefore kinships are likely to affect even the interpersonal relationships between people in the society. This system is formally accepted, but some instances arise, where due to attitudes and perceptions of individuals, one will feel disrespected and thus a disagreement occurs (Berndt, 1988).

Relationships are considered as another area of great interest in the Aboriginal culture and kinship organization. This therefore affects the way of life of the people as they wait for opportunities to take over their brother’s wife. The relationships among the Aboriginals from different generation levels are different because of the variance in status, age and authority. There is usually the perception of who is older in the family and who should be respected, which therefore affects the way the family duties are distributed and done. Comparing the Aboriginal kinship system with the western society, we realize that the western society is not affected by this culture because of the different ways of life of the people. The westerners are more processed food eaters and are leading an urban life, where kinship is not given a lot of emphasizes (Crawford, 2003).

References

Berndt, R. M., Tonkinson, R., & Australian Institute of Aboriginal Studies. (1988). Social

anthropology and Australian aboriginal studies: A contemporary overview. Canberra: Aboriginal Studies Press for the Australian Institute of Aboriginal Studies.

Crawford, J., & Tantiprasut, L. (2003). Australian Aboriginal culture. Western Australia: R.I.C.

Publications.

Peters, E. J., & Andersen, C. (2013). Indigenous in the city: Contemporary identities and cultural

innovation. Vancouver: UBC Press.

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Critical Issues in Higher Education

Critical Issues in Higher Education

Critical Issues in Higher Education

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Institutions of higher learning are formed for various reasons, most of the private colleges are formed as for profit organizations whose major purpose is to make profits while the not for profit colleges mainly run by governments and nongovernmental organizations have the sole aim of providing education services to the students. Due to the nature of the objectives of the institutions, there divers will also be different.

Drivers for the not for profit colleges is usually to provide quality education to the students while charging them the minimum fee possible while drivers for profit colleges is making maximum possible profits. These institutions are usually run by governments, nongovernmental organizations, faith based organizations or community based organizations because they are the institutions that are in most cases interested in the welfare of the society. The not for profit institutions are concerned with the quality of education that they offer and its accessibility to large numbers of the society, however, while they may not be driven by monetary gains, these institutions usually charge a reduced fee to meet their running expenses or part of the expenses. In very few cases will the not for profit institutions fail to charge anything from the students. On the other hand, the for profit colleges are interested in making profits for the owners. Therefore, any activity that they participate in is usually directed at achieving this goal. These colleges usually charge higher fees than their equivalent, which are not for profit depending on the courses that they offer. For instance, training school for nurses that are not for profit will aim at imparting the nursing students with knowledge and skills as their main objective while for the profit making nursing schools; they will aspire to train professional nurses as long as they are making profits. A major point to note is that irrespective of the different drivers of the two types of college, the quality of training does not necessarily have to be different as long as they meet the set standards.

In the recent past, some issues have been raised regarding higher education; these have been directed at the quality of education that institutions of higher learning provide to their students. One of the critical issues that have been identified is the quality of graduates since a large number of students have been found to be involved in plagiarism or impersonation in a bid to get good grades without toiling for them. This issue has become so rampant such that some individuals and companies have opened bureaus where students can bring their assignments and projects to be done for them. The effect of this has been that students graduate with good grades but they cannot carry out their nursing duties properly. In the recent past, institutions have been trying to cope with this problems through the use of plagiarism software such as turnitout, grammarly, plagiarism checker among others that are available online to discourage students from copying their work online. In addition, hiring institutions such as hospitals have realised good grades on paper does not always mean excellent nurses, therefore, they have adopted other hiring mechanisms that test the ability of the potential employees to perform their responsibilities according to the required standards, for instance, the use of aptitude tests. The quality of education as contributed by the educators in colleges has also been a subject of discussion; this has largely been based on the ideal of hiring part time lecturers versus full time lecturers (Virgona, 2013). While there are disagreements on the ideal method of hiring educators, a common conclusion has not been reached despite everyone agreeing that it may affect the quality of training especially in nurse training schools.

My opinion on these issues facing the educational system is that they affect the leaning and quality of education and if they are not properly addressed, they may compromise on the quality of nursing graduates that they spun.

2.

Several factors affect the cost of education in higher education models; some of these factors are common in both for profit and not for profit institutions. A major cost driver in institutions of higher learning is technology (Ja Kim,et al, 2012). The technological environment is constantly changing making the useful life of technological gadgets very short, this has forced institutions of higher learning to replace them now and then pushing up the costs. For instance, personal computers have for the last 2 decades gone through great technological advancements in terms of their processor speed and their memory capacity. In addition, data and personal security in online platforms have also pushed up the costs as leaving them like that would make the institutions vulnerable to attacks. With the increase in demand for higher education, institutions have seen most of their resources operating beyond optimal points therefore forcing them to hire or construct additional resources to cater for the increasing number of students, consequently, the costs of running these institutions have gone up. Another cost driver in the higher education is the growing diversity of student and programs that are being offered in institutions of higher learning; for instance, in united states of America, the average cost of complying with the disabilities act lei between 700, 000 dollars for public two year courses to a maximum of 13, 000, 000 dollars for research institutions. Increased competition for a relatively constant student pool has forced institutions of higher learning to invest some of their resources in marketing to attract more students; however, these costs have not reduced even with increase in student population partly because competing institutions have also continued to market. With the rising cost of living, salaries paid to staff members have been increasing, this has been especially among the teaching members of staff, institutions have tried to reduce the costs that they offer to their teaching staff by reducing the number of tenured staff member and increasing the number of part time lecturers. Increased government regulation have also pushed the costs incurred by institutions of higher learning in an attempt to meet these regulations, some studies have shown that in America, for every tuition dollar, 7.5 cent goes to help the institution meet government regulations due to the increased number of accreditation agencies.

Cost efficiency in institutions of higher learning can be achieved by ensuring that the cost drivers are maintained at their minimum possible levels. The costs associated with marketing of the institutions can be minimised by ensuring costs that are invested in other areas that improve performance of the institutions have their optimal output, this means improving the quality of education that these institutions offer (Moule, Ward & Lockyer, 2010). For institutions such as Harvard and Massachusetts institute of technology do not spend much on advertising themselves but every year they receive large volumes of application letters, which exceed their capacities, this is due to the quality of training that they have been known to offer. However, this is a long-term measure to reduce costs, as the quality of education will be manifest after the students have joined the workforce. In order to save on costs that are related to technological upgrades, collaborating with several institutions including technology firms such as Microsoft will drastically reduce the cost technological upgrades. Due to increase in demand of education especially in nursing, collaborating of institutions where the institutions, which are operating beyond their optimal capacity with those of a lower level to train nurses, would help them reduce the cost of hiring or constructing additional facilities. Instead of hiring full time lecturers, institutions should hire more part time lecturers with long class time, this will save costs since lectures will only be paid the number of hours that they are in class.

There have been discussions on the role of fulltime and part time lecturers and which is the best plan for institutions of higher learning. Full time lecturers are usually employed by the institutions, therefore their time is usually spent within the institution, proponents of this type of faculty have argues that this is the best if quality of education is to be maintained since they have ample time for research and to address students concerns. On the other hand, part time faculty is thought of as the best in terms of cost since they are only paid for the time they are in class, in addition, if the part time faculty is practising in their profession. For instance, a nursing educator who spends part of his time in the wards and part in the class is likely to produce graduates that are more qualified since he transfers his experience in nursing to the class.

3.

According to CAEL, several student services are available which are important in different aspects of a student’s life. One of the services is college credit; this service allows the students to receive college credits for the experience that they have gained from their work and from what they know from life, this will help them save on the time required to complete their education and the resources. This service also helps learning institutions to assess their students and determine how effective their teaching programs are in meeting the specific need of the students (van Riemsdijk, 2013). The second service that is available to the students is prior learning assessment, which helps students acquire college credit for college level learning that is acquired from other sources such as military training. Competence based education is the other type of service that is offered which entails giving credit to students for the skill learned rather than the time that is taken to learn that skill. This service is aimed at improving the quality of education that students receive since it based on the ability of students to demonstrate the skill learned, in addition, it allows students to progress at their own pace. Advising service helps the students and employees to make informed decision about their careers in order to for them to achieve satisfaction in them. Career service enables individual to plan their education and futures from a point of information; consulting involves enabling adults to meet their specific needs in educations. Convening services entail bringing together all stakeholders to build better solutions to tackle the challenges that face adult education while public policy involves making recommendations for legislation to remove barriers for adult education.

The faculty members role in these services include helping in assessing whether other forms of learning that do not involve conventional classrooms are at par with the skills learned in the normal classroom setting. In addition, they also play an advisory role on the various options that the adult students have in their preferred fields (Jeffries, Clochesy & Hovancsek, 2009). The impact of these services on students retention is that it is likely to retain students since they ensure that the all the needs of the students are met.

References

Ja Kim, M., Gi Park, C., Kim, M., Lee, H., Ahn, Y., Kim, E., & … Lee, K. (2012). Quality of nursing doctoral education in Korea: towards policy development. Journal Of Advanced Nursing, 68(7), 1494-1503. doi:10.1111/j.1365-2648.2011.05885.x

Jeffries, P. R., Clochesy, J. M., & Hovancsek, M. T. (2009). Designing, implementing, and evaluating simulations in nursing education. Teaching in nursing: A guide for faculty, 322-334.

Moule, P., Ward, R., & Lockyer, L. (2010). Nursing and healthcare students’ experiences and use of e-learning in higher education. Journal Of Advanced Nursing, 66(12), 2785-2795. doi:10.1111/j.1365-2648.2010.05453.x

van Riemsdijk, M. (2013). Obstacles to the Free Movement of Professionals: Mutual Recognition of Professional Qualifications in the European Union. European Journal Of Migration & Law, 15(1), 47-68. doi:10.1163/15718166-12342023

Virgona, T. J. (2013). Graduate nursing student self-assessment: Fundamental technology skills. Journal of Nursing Education & Practice, 3(3).

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Critical evaluation of the use of Cognitive Interviewing in Investigative interview of witnesses

Critical evaluation of the use of Cognitive Interviewing in Investigative interview of witnesses

Critical evaluation of the use of Cognitive Interviewing in Investigative interview of witnesses

Introduction

The process of criminal investigation heavily relies on gathering of information partly from the accounts given by eye witnesses. The interview style adapted during investigative interview of witnesses has major implications on the amount of information that is gathered from the subjects. This brings out the importance of cognitive interview. As explained in this paper, cognitive interview uses simple mnemonic techniques to get the interviewee to remember details of the scene, thereby enabling the interviewer to gather more information than would be gathered using standard methods (Orthmann & Hess, 2012, p. 190). This paper provides a critical evaluation of the usefulness of this interview style in the investigative interview of witnesses.

Discussion

As mentioned, cognitive interviewing helps forensic searchers to gather much more information from witnesses than what can be gathered using standard interview method. There are four main cognitive interview approaches used by forensic searchers. One of these is the context reinstatement technique. In this approach, an interviewer helps a witness in reconstructing internal (personal) and external (physical) contexts which existed during the time when an incident of research occurred (Milne, 1997). The interviewer asks the witness to form mental impressions of the environmental features of the original scene using objects located in the interview room or area. The witnesses may also be asked to comment on their emotional reactions to the incident and any smells, sounds or other important conditions that were present. The effectiveness of retrieval cues in this case is dependent on the extent to which the text context overlaps with the context of research. According to Tulving and Thomson (1973, p. 356) this approach is effective in retrieving much information from witnesses, provided that the information had been successfully retained in the mind of an interviewee after the incident. However, some studies have shown that this technique has transient effects that are unfavorable to the process of information gathering. The witness may not be able to effectively relate the test to the original context, hence, leaving important details (Memon & Bruce, 1985, p. 350 & Eich, 1995, p. 295). Despite this, this is one of the most accurate interview techniques, as Milne (1997) explains.

The second component of cognitive interviewing is to ask the interviewee to report all details related to an incident. The witness is encouraged to report all information, including that which may seem to be irrelevant or that which they only remember partial details (Fisher & Geiselman, 1992). According to Memon and Bull (1991, p. 298), this technique is effective in facilitating the recall of more information. Most importantly, pieces of incomplete information gathered from different witnesses regarding the same incident can be combined to form valuable information. However, this technique may sometimes lead to gathering of too much irrelevant and misleading information regarding an incident (Memon & Bruce, 1985, p. 354). Regardless of this, this is one of the most useful cognitive interview tools.

The third technique is to ask the witness to try to recall details of an incident from different perspectives (Milne, 1997). The witness is asked to place him or her self in the shoes of the witnesses or other witnesses and report information about the incident from these perspectives. This technique is based on the assumption that a change in the perspective through which a witness looks at the details of a scene leads to a change in retrieval description, hence allowing the witness to recall new information from the new perspective. The objective of this technique is to use several pathways of information retrieval and hence, increase the amount of information elicited from a witness. However, concerns have been raised regarding the effectiveness of this technique in gathering credible or valuable information. Memon and Koehnken (1992, 40) argued that the changes in perspective for reporting may confuse the witness and lead to fabricated information. According to Memon and Stevenage (1996), this technique has even been widely avoided by forensic searchers with some of them expressing concerns that the instructions may mislead witnesses. Despite this, this technique has been proven workable and useful method of soliciting additional information from witnesses. Milne (1997) explains that this technique can produce accurate information, just like the other cognitive interview techniques but it may not increase the volume of information gathered from a witness any more than the other methods.

The fourth cognitive interview component involves providing instructions to a witness to try to recall information from different starting points (Milne, 1997). Usually, witnesses feel the need to start from the beginning and are allowed to do so. However, this technique allows for a more extensive and extra-focused retrieval by encouraging the witnesses to remember information in various orders, from beginning, from the middle, from end or from the event that is most memorable. This approach has similar impact to the ‘change perspective’ instructions in that it is believed to change retrieval description, enabling a witness to recall more information. Geiselman and Callot (1990, p. 141) noted that a recall in the forward order followed by a recall in the reverse order is more effective than two attempts to recall in the forward order. However, argument provided in this technique lacks support from statistical evidence. According to Memon et al (1997) there is no evidence that a change in the order or recall can yield additional information when applied in a cognitive interview. Nevertheless, Milne (1997) noted that this instruction has some benefits when used in specific prompts.

Conclusion

Cognitive interviewing is a useful tool that helps to yield additional information during investigative interview of witnesses. There are four cognitive interview approaches used to elicit information from witnesses namely, context recreation technique, asking the witness to provide all details related to a scene, change of perspective instructions and instructing the witness to recall information from different starting points. As noted, criticisms have been raised regarding the effectiveness of these approaches on the memory of a witness. Therefore, there is need for additional research investigating the specific affects and applicability each of these cognitive interview techniques.

References

Bekerian D L & Dennett J L 1992 “The cognitive interview technique: Reviving the issues,”

Applied Cognitive Psychology, Vol. 7, Pp. 275- 297

Eich E 1995 “Mood as a mediator of place dependent memory,” Journal of Experimental

Psychology: General, Vol. 124, No. 3, Pp. 293-308.

Fisher R P & Geiselman R E 1992 Memory enhancing techniques for investigative interviewing:

The Cognitive Interview, Charles C. Thomas, Springfield III

Geiselman R E & Callot R 1990 “Reverse versus forward order recall of script based texts,”

Applied Cognitive Psychology, Vol. 4, Pp. 141-144

Memon A & Bruce V 1985 “Context effects in episodic studies of verbal and facial memory: A

review,” Current Psychological Research and Reviews, Winter 1985-86, Pp. 349-369.

Memon A & Bull R 1991 “The cognitive interview: Its origins, empirical support, evaluation and

practical implications.” Journal of Community and Applied Social Psychology, Vol. 1, Pp. 291-307.

Memon A & Koehnken G 1992 “Helping interviewees to remember more: The Cognitive

Interview,” Expert Evidence, Vol. 1, No. 2, Pp. 39-48.

Memon A & Stevenage S V (1996c) “The importance of time and training for CI interviewers.”

Psycoloquy Vo. 7, No. 18

Memon A Wark L Bull R & Koehnken G 1997 “Isolating the effects of the cognitive interview

techniques.” British Journal of Psychology

Milne R 1997 Application and analysis of the cognitive interview: Doctoral Dissertation.

University of Portsmouth

Orthmann C H & Hess K M 2012 Criminal Investigation. Cengage Learning, New York

< HYPERLINK “http://books.google.co.ke/books?id=lqBFdHTRmkwC&pg=PA190&dq=use+of+cognitive+interview+in+investigative+interview+of+witnesses&hl=en&sa=X&ei=mYkDUdGcFNS5hAf5lIAw&ved=0CD0Q6AEwAg#v=onepage&q=use%20of%20cognitive%20interview%20in%20investigative%20interview%20of%20witnesses&f=false” http://books.google.co.ke/books?id=lqBFdHTRmkwC&pg=PA190&dq=use+of+cognitive+interview+in+investigative+interview+of+witnesses&hl=en&sa=X&ei=mYkDUdGcFNS5hAf5lIAw&ved=0CD0Q6AEwAg#v=onepage&q=use%20of%20cognitive%20interview%20in%20investigative%20interview%20of%20witnesses&f=false>

Tulving E & Thomson D M 1973 “Encoding specificity and retrieval processes in episodic

memory,” Psychological Review, Vol. 80, Pp. 353- 370

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Critical Evaluation of Association between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of De

Critical Evaluation of Association between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of De

Critical Evaluation of Association between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of Developing Hypertension -Cohort study

Research questionThe primary objective of the study was to establish if consumption of high sodium diet is associated with effects on blood pressure as well as hypertension if consumed in a chronically manner. The hypothesis that the researcher employed in the study was “Chronically high intake of sodium would be associated with an increase in endothelial dysfunction especially serum acid denoted as (SUA) and urine albumin excretion (UAE) and the high intake of Na would also be related with chances of hypertension among individual with higher UAE and SUA .” The study lacked the secondary objectives however based on the results provided it was evident that secondary or sub-objectives could play a significant role in refining the results down. This could also help or encourage the use of small sample, which offer high reliability of the information as well as boost the level of accuracy. This secondary objective should have been designed to cater on specific demographic (Between people 16-50 years and those between 51 and above). The study for example could use the following secondary objectives:i. To determine how high consumption of Na diet is associated with both blood pressure and hypertension among individuals aged 16-50 of both sexesii. To evaluate how high consumption of Na diet is associated with both blood pressure and hypertension among individuals aged 51 and above of both sexesStudy design:A prospective cohort study design was used to gather or collect blood pressure and hypertension data recorded from paramedic sheets and blood pressure and hypertension logs. Complete follow-up information was available for more than ten years since the first study employed was done between 1997 and 1998 and the other between 2003 and 2006 meaning that this information was available for research (Salluh 2010). Based on the nature of the diseases being examined in the study, this research design was employed because it can assist determined the risks factors associated with chance of new diseases. This is because prospective cohort studies have longitudinal observation time as well as the collection of results and information or data is at regular intervals hence reduction of recall error.In addition, the design was used since several outcomes that the study expected could be measured for one exposure, it is possible to measure the prevalence, and an incidence arising from the study as well as the design allows exposure to be measured before the start of disease or condition (hypertension and blood pressure). However, the study failed to state in the limitation section that the research design had some weaknesses such as costly and time-consuming (the previous studies indicated took a longer period to reach to concluded outcomes 1997 to 1998 and 2003 to 2006). In addition, the design did not also offer classification of individuals based on demographics and on exposure and outcome status since this can be affected by changes in diagnostic procedures.Subjects without prior prevalent hypertension were selected for the study. Among them, those that available for measurements were considered. In addition, an exclusion criterion was used in the study; those who were taking antihypertensive medication were excluded. The study was limited to 5556 participants; 4062 were considered in SUA analysis and 4146 subjects were inclusive in the analysis of UAE. The retention rate for the study was about 97%.Explanatory variableThe main exposure variable used in the study is the intake of sodium. The study measured the effects of the consumption of Na and its relationship to both blood pressure and hypertension. There were only two levels of exposure classified in the study however the study is considered to have limited itself to the two and in such cases it leads to limited evaluation and analysis of results. Exposure of Na intake to SUA and to UAE to hypertension and blood pressure conditions. With the level of biasness is data collection, the study did not ascertain accurate results but a generalization of the exposure result and outcome were employed (Grove & Lambert 2010)Study outcomeOver time, it was noted that higher intake Na is related with an increase in UAE and SUA. Among people with higher levels of SUA and urine UAE, higher Na intake is an exposure risk factor for contracting or developing hypertension. The case that the study used in the epidemiologic investigation is “It may be of interest to determine if higher intake of Na affects patients with higher UAE and SUA levels, but these changes with age.” The case is classified as suspected for reporting purposes (Brown & Derkits 2010). The outcome of the study is considered relevant since it addressed all the pending questions and critiques of most of the past studies. In addition, based on the data from the participants, this information was worth as it was evident that most of them faced hypertension complication yet they did not know the cause. To avoid “missing events” the data from the participants were analyzed independently and not repetition was allowed.

Measures of frequency and/or association

It is evident from the cohort study that there was no evidence of prevalence and incidence used to determine the estimates of the exposure of the outcome of the study; this is because the study did have new cases with a specified period of time as excepted of an incidence study. Among all the 5558 participants, there was not any new case over the population at risk. Based on the literature available it is evident that the study did not employ both the above conditions. However, it is clear that the study should have been under incidence study. This is because, if the study could have employed more demographics in the sample, such as younger population and the elderly above 65 years, new cases could have been evident within a specified period and it could offer a more accurate outcome as the one the study has indicated. According to the exposure risks evident, the study employed direct causal association since despite the fact that the high rates of Na caused hypertension and in some cases blood pressure, other conditions could have affected the analysis of the results.

There were cases of confounding in the study since in both cases; there were high risks of conflicting effects of the exposure rates. It is clear that people could be affected by high intake hence lead to both hypertension and blood pressure. Therefore, it is clear that the study employed SPSS sorting of data skills to avoid such cases. However, I consider that this was not the best statistical technique to be used. This is because sorting of data in using SPSS sorting methods could lead to biasness of results hence compromise the findings of the study hence the outcome. The best techniques that should have been used are to avoid duplication of data from the participants as well as the use of multivariate analysis could offer the same service.

There was a true association between the exposures and the effects. The confounding factor was age produced an observed estimate of association between higher intake of sodium and hypertension. The association was very strong since the results indicated a more protective effect. The estimates could be considered as over-estimates because of the stronger association. The results could be interpreted as generally accurate since it offered a more correlated results as indicated in previous results.

Sources of error

There were two sources of random error in the study. The first is that there could be sampling errors. Having had a sample of more than 5000 participants, there was high chances of taking part in random errors (Beuther & Sutherland 2007). The second source of random error is individual biological variation. Not all the participants exposed the same results because of varied biological reactions to the tests among others hence the error. However, the extent of random error was limited. There are two potentials source of bias such as mistakes in data collection. Based on the date offered the results ought to be generalized, this was true since the study did the same.

Statistical analysis

It is evident that the results were done using SPSS data analysis package. The was not relationship between participants with SUA since the p-value was greater 0.001 but that of UAE indicated that there was a strong relations p- 0.03 for participant with hypertension exposure. The analysis was true since it was able to be in line with previous literature.

Conclusion

The study was able to meet the central objective of the study; in addition, it was also able to support the hypothesis of the study. The study was able to shows that higher intake of Na lead to blood pressure and hypertension among patients with SUA and UAE. However, future study should consider undertaking studies with different demographics such as sex, gender, and age.

References

Beuther, D. A., & Sutherland, E. R, 2007. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. American journal of respiratory and critical care medicine, 175(7), 661-666.

Brown, A. S., & Derkits, E. J., 2010. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. American Journal of Psychiatry, 167(3), 261-280.

http://journals.psychiatryonline.org/article.aspx?articleid=102128

Grove, K. A., & Lambert, J. D, 2010. Laboratory, epidemiological, and human intervention studies show that tea (Camellia sinensis) may be useful in the prevention of obesity. The Journal of nutrition, 140(3), 446-453.

http://jn.nutrition.org/content/140/3/446.short

Salluh, J. I., Soares, M., Teles, J. M., Ceraso, D., Raimondi, N., Nava, V. S., … & Rocha, M. G, 2010. Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), R210.

http://www.biomedcentral.com/content/pdf/cc9333.pdf

Diet and Carbohydrate Food Knowledge of Multi-Ethnic Women: A Comparative Analysis of Pregnant Women with and without Gestational Diabetes Mellitus

Research questionThe primary objective of the study was to establish if pregnant women and non-pregnant women with GDM could be affected with Gestational Diabetes Mellitus and how dietary therapy would reduce the rates of Gestational Diabetes Mellitus . The study did not have an hypothesis rather is used the research questions to get the results of the study right. This is not considered as the best way that the research could have employed since critics will come and state that they research was not up to standard as there was nothing being proved in the study yet it was an epidemiology research. The study lacked the secondary objectives however based on the results provided it was evident that secondary could play a significant role in refining the results down. I agree with the researcher that there was no need of a secondary variable as the paper only needed to indicate how dietary therapy was helpful to both pregnant and not pregnant women in order to avoid Gestational Diabetes Mellitus. The outcome of the study was that there is urgent need to offer nutrition =al education for all the group of women in United Arab Emirates . Study design:A cross-sectional comparative design was used to gather information about women without and those with pregnancy with GDM and possibilities of contracting Gestational Diabetes Mellitus . Complete follow-up information was not available since the study was done in a year. Based on the nature of the diseases being examined in the study, this research design was employed because it can assist determined the risks factors associated with chance of Gestational Diabetes Mellitus . This is because cross-sectional comparative design studies have vertical observation time as well as the collection of results and information or data is at regular intervals hence reduction of random and systematic error.In addition, the design was used since several outcomes that the study expected could be measured for one exposure, it is possible to measure the prevalence, and an incidence arising from the study as well as the design allows exposure to be measured before the start of disease or condition (Gestational Diabetes Mellitus) (Grove & Lambert 2010). The design did not also offer classification of individuals based on demographics and on exposure and outcome status since this can be affected by changes in diagnostic procedures. The retention rate for the study was high. There were various. In addition, the decision of the study to use the above design was that it offered a chance for the researchers to consider undertaking various follow ups to ensure the validity of information offered by the participants. The other reason why the study considered using the above design was that the study used a small sample size hence it offered a significant sample analysis. There were various strengths of using the research design. One of the strengths is that it offers an evaluation strategy for the study hence able to validate data. As far as the information was mostly quantitative, the design offered a chance to undertake critical regression analysis of the results and as well as the correlations between pregnant women and non-pregnant women and their exposure to Gestational Diabetes Mellitus. However, the study showed various weakness. The design was not able to cover the small sample a better analysis of the findings. Explanatory variableThe main exposure variable used in the study is the intake of carbohydrates. The study measured the effects of the carbohydrates and its relationship to both Gestational diabetes mellitus. There were only two levels of exposure classified in the study however the study is considered to have limited itself to the two and in such cases it leads to limited evaluation and analysis of results. With the level of biasness is data collection, the study did not ascertain accurate results but a generalization of the exposure result and outcome were employed.

Study outcomeThe study shows that that it is for women to take dietary therapy to avoid Gestational diabetes mellitus, this to both women without pregnancy and those pregnant. The case that the study used in the epidemiologic investigation is “It may be of interest to determine if how both type of women with GDM ought to take nutritional training to avoid Gestational diabetes mellitus . The case is classified as suspected for reporting purposes. The outcome of the study is considered relevant since it addressed all the pending questions and critiques of most of the past studies. In addition, based on the data from the participants, this information was worth as it was evident that most of them did not face Gestational diabetes mellitus . To avoid “missing events” the data from the participants were analyzed independently and not repetition was allowed.

Measures of frequency and/or association

It is evident from the a cross-sectional comparative study that there was evidence of incidence used to determine the estimates of the exposure of the outcome of the study; this is because the study did have new cases of women with the problem of Gestational diabetes mellitus emerged during the study. However, it is clear that the study should have not have been under incidence study since the outcome of the study was affected by the new cases. According to the exposure risks evident, the study employed direct causal association since despite the fact that the number of Gestational diabetes mellitus women patients increased other conditions could have affected the analysis of the results rather than limited carbohydrate foods.

There were no cases of confounding in the study since in both cases; there were no risks of conflicting effects of the exposure rates. It is clear that women who take less carbohydrate may lead to Gestational diabetes mellitus. Therefore, it is clear that the study employed SPSS multivariate analysis to avoid such cases. However, I consider that this was the best statistical technique to be used.

There was a true association between the exposures and the effects. The confounding factor was age of the women produced an observed estimate of association carbohydrate and Gestational diabetes mellitus multivariate. The association was very strong since the results indicated a more protective effect. The estimates could be considered as under-estimates because of the weak association.

Sources of error

There were one sources of random error in the study. There was random error cause is individual biological variation (Salluh et al., 2010). Not all the participants exposed the same results because of varied biological reactions to the tests among others hence the error. However, the extent of random error was limited. There are one possibilities source of bias such as mistakes in data collection and analysis of results hence the weak outcome. Generalized results were the best and the study offered the same.

Statistical analysis

It is evident that the results were done using SPSS data analysis package. There was relationship between women with GDM and Gestational diabetes mellitus disease since the p-value was greater 0.012.

Conclusion

The study was able to meet the central objective of the study; in addition, it was also able to support the hypothesis of the study. The study was able to shows that higher women should be advised on the dietary intake such as carbohydrate to avoid Gestational diabetes mellitus However, future study should consider undertaking studies with different demographics such women of age.

References

Grove, K. A., & Lambert, J. D, 2010. Laboratory, epidemiological, and human intervention studies show that tea (Camellia sinensis) may be useful in the prevention of obesity. The Journal of nutrition, 140(3), 446-453.

http://jn.nutrition.org/content/140/3/446.short

Salluh, J. I., Soares, M., Teles, J. M., Ceraso, D., Raimondi, N., Nava, V. S., … & Rocha, M. G, 2010. Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), R210.

http://www.biomedcentral.com/content/pdf/cc9333.pdf

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CRITICAL CARE OF A RENAL PATIENT

CRITICAL CARE OF A RENAL PATIENT

Critical Care Of A Renal Patient

Name

Institution

The article from the Nephrol Dial Transplant Journal is a representation of the works of Jeremy B. Levy, E. Joanna Chambers, and Edwina A. Brown in regards to supportive care for the renal patient. The article is keen to point out that end-stage renal disease is rampantly occurring worldwide, thus, calling out for relevant measures to curtail the problem. The article also records that patients suffering from kidney problems do undergo dialysis, which is a life prolonging process and not a life-supporting plan. Indeed, dialysis is used as a means of extending one’s life whilst suffering from kidney problems but ignores the fact that one is suffering on the side. Facing renal failure is one of the problems the article points out as a problem kidney patients are suffering from, despite their participation in dialysis (Levy, Chambers, and Brown, 2004).

Patients suffering from end-stage renal disease, otherwise referred to as ESRD, are supposed to be placed under supportive care. In addition, the article names pruritus, neuropathy, fatigue, cramps, and constipation as some of the symptoms one may possess when suffering from ESRD. Pain is a symptom that highly occurs among patients with ESRD and its cure is well elaborated in the article. Appropriate drug dosage is the most appropriate means of reducing the pain faced by renal failure patients. Administering paracetamol, adjuvants, and non-steroidal anti-inflammatory agent forms the initial step to undertake in reducing the occurrence of pain in patients suffering from ESRD. Dosing a patient with codeine and tramadol forms the second step to undertake when dealing with renal failure. Oxycodone, morphine, and buprenorphine are utilized in stage three, but this is in case the pain is too severe for the patient to persevere (Levy, Chambers, and Brown, 2004).

Interacting with patients suffering from renal failure is important as it helps them comprehend the treatment they are about to receive. Therefore, it is the senior nurses’ duty to take the initiative and make crystal explanations about the treatment following renal failure. In turn, this prepares patients psychologically.

Reference

Levy, B. J., Chambers, J. E. and Brown, E. A., (2004). Supportive care for the renal patient. Nephrol Dial Transplant, 19, 1357-1360. Retrieved from >http://ndt.oxfordjournals.org/content/19/6/1357.extract<

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Critical Book Review of Web of Smoke

Critical Book Review of Web of Smoke

Critical Book Review of Web of Smoke

This paper entails a book review of Webs of Smoke by Kathryn Meyer and Terry Parssinen. The book contains a fascinating history concerning the international drug trade during the first half of the 20th century. The history follows various stories of American gangsters and narcs, Japanese spies, warlords of China, and fortune soldiers whose livelihoods depend on opium. The books shows clearly the way the world was linked by drugs with the drug supply and markets spreading across nations both in the West and in the East. It is clear that the drug trade was centered in China.

China was the world’s largest market for narcotics before the fall of 1949. This could provide a clue on why China has been too strict whenever it comes to drug trafficking or abuse. Various personalities that are extraordinary are depicted through the authors’ stories. It is very shocking that such drug trade was facilitated by key personalities in both Chinese government and other key global figures as depicted in this review. The scandal crossed all the way from the United States, Europe, to Asian countries, especially China. Such aspects are so unique and fascinating in showing how the market for drugs had unveiled throughout East Asia with respect to the East Asian history.

This book contains over 300 pages that provides all historical information concerning drug trafficking and the drug market before the 1950s. The author states clearly that campaigns against opium were popular among many officials as well as intellectuals during the time. In contract to this popularity among officials and intellectuals, the campaign was hardly popular among the peasants. Peasants found it possible to have better lives through the cultivation of poppies. Such a case is the basis of the book but can still apply in the present world of drugs trafficking and market. Only some aspects have changed such the laws against such drugs and markets, the markets, and the motives of engaging into the business. This implies that the book is applicable in the world of drug abuse today. The authors intended to show the way different interests as well as interest groups clashed with each other in the modern drugs history. Such groups and interests are taken into consideration irrespective of races, nationalities, social interests, economic aspects, or political drives. It is evident in the book that every actor depicted in the history had some similarities in terms of programs or beliefs. Only a few people seemed to corporate with international bodies in an effort to curb or demolish the international narcotics trafficking. The book is adequately clear on the processes both the war against the drug trafficking and the barriers to the respective efforts. The book is also clear on who held the drug trafficking and kept it going. Co-operations were also involved in the smuggling. Liaisons and various associations of drug trafficking kept the trade alive.

The book is very detailed to provide the reader with everything that happened to facilitate the drug trafficking and the entire system alive for such a long time. The subject matter is however hardly human since it involves a class of various commodities. In some cases, the authors give the reader a nuance picture of the various groups that acted on the two sides of the law at the time. These contradicting cases are seen to have been happening concurrently. They authors are able to sketch out vividly the individuals or organizations that populated global drugs market. These were warlords, Nouveaux riches, Merchants, Bureaucrats, solders, and spies with Americans forming the majority of the most involved individuals. The only problem with depicting such groups or individuals is the authors’ abilities to reveal the actual identities of the key actors. Conversely, such parties or matrix provides the reader with a full sense of the way various kinds of people got involved in this type of illegal trade. Such a clue also shows how it was difficult to prevent the growth of such commerce as time went by.

A major setback in the book is the amount of repetition of various issues. The actors seem to float at some point thereby continually requiring re-introduction. To the readers, it becomes rather difficult to follow since the chapters are not historically sequential. Instead, the chapters overlap freely. The books employs complex strands, which are drawn together to show the various dimensions of this illegal trade. Individual personalities are taken to be crucial but not all cases depict individual personalities. Again, only the large companies and the key national figures could be identified. While many organizations could have participated, only large companies are depicted. One of the most prominent companies identified is the European manufacturers. The book seems to concentrate on the most important events but like any other aspects of historical information, minor participants are not vividly identified and the role each played. This is perhaps acceptable in writing since extreme details could destroy the real flow of the book. This argument could be strengthened by the sense that the historical events indicated in the book are already complex and hardly arranged in a chronological manner. Some key personalities seem to be generalized to other key individuals representing top countries and the world at large. The case of personalities like Delevinge, the English statesman shows how key individuals with the similar racial origins were highly involved in the drug trade.

The book however shows some of the most vital events that contributed to the growth of the drug trafficking business. Events like both the World War I and the World War II contributed a lot to the growth of this drug business. Many factors associated with the two great wars accelerated the growth of drugs market but the book is hardly capable of addressing all of them. Another major event contributing to the growth of the drug business and market is the 1929 Depression. The contribution of this great economic depression is also explained in the book in terms of the way it contributed or affected the drug trade around the world. The book also shows that the power of capitalism was a major aspect and contributor of the drug trade. Again, national governments had their unique roles to play to either promote the business or curb the problem. The contribution of the government could have been varied since different countries today employ different laws and policies to solve the drug trade problem. The authors try to bring out a story about the drug business that has been extended to the world of business today but their story is created during a time when there were great shifts in political climates. Such political climates also acted as a catalyst to the market growth. As far as political climates and national governments were concerned, the authors portray a mixture of opinions and intentions. While some of the national governments were working hard to stop the harmful world business, other nations were reluctant in stopping the drug trade business due to both economic and social reasons. While the book does not show these disparities clearly, the key players are adequately tackled in the book.

Generally, the book is great since it gives the reader a broad perspective of the drug business as it happened during the first half of the 20th century. Readers are able to understand about the various players and their contribution towards the growth of the global drugs business or towards the end of the business. Major events such as the World War I, World War II, and the Great Depression of 1929 are clearly explained and how they are linked to the drug trade. The only thing that seems to confuse the reader is the book title, which appear to depict a history of the global drug trade while in real sense the book concentrates mainly on the drug business in East Asia, with a few cases of links drawn to European manufacturers and the Americans. Areas like South East Asia, Latin America, and Africa among other regions are shallowly explained or are not explained at all. The real picture of the global history on drug trade is not fully brought out but the book is good enough to show the key players, who could have had great influence on the international drug trade in today’s world.

Works Cited

Meyer, Kathryn and Terry Parssinen. Webs of Smoke: Smugglers, Warlords, Spies, and the History of the International Drug Trade. Lanham: Rowman & Littlefield Publishers, 2002. Print.

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Liberal International Economic Order

Liberal International Economic Order

Name

Professor

Course

Date

Liberal International Economic Order

Most countries development is often recorded through the use of debts. With just the countries income which is collected from taxation, at times the expenditure is often too much and in order for the government to implement projects they get to borrow money from other countries or international organization such as the International Monetary fund. However, art times when the borrowing is too much the country may enter inti debt crisis. Debt crisis came in two major ways: through private sector lending as well as lending by international financial situation. This paper examines role of international institutions in helping a country recover from financial crisis specifically Liberal International Economic Order (LIEO).

In 1882, international debt crisis became apparent as Mexico announced that it was unable to pay its foreign debt. This announcement sent chills among international financial community as they thought that other countries too would do the same. The crisis was partially blamed on irresponsible practices of creditors and the debtor government as the money that was borrowed was not used on beneficial projects instead projects such as armaments, large scale projects, and projects that seemed to only benefit the government officials were implanted. During this period although even the developing countries were hurting, it was the third world countries that had suffered the most because of inflation (Pirages). After World War II, LIEO was created in order to promote monetary stability and to reduce trade barriers on the free trade among countries.

When countries become heavily indebted and they face huge amount of pressure to generate foreign exchange that may help them pay debt service as well as get to purchase imports they may need. International financial institutions often offer financial assistance to these countries. The assistance does not come without a price as most of these countries are forced into accepting stabilization as well as adjacent policies. Structural adjustment policies (SAPs) have severe economic impacts on most of these countries and these effect may be felt for a while. SAPS work by stabilizing economies and also result in economic growth by ensuring the economy is more efficient and productive. However, to achieve this certain social expenditures including education and health are cut in order to reduce fiscal debts. It may also have led to down0-sizing of employees by government and local companies may not flourish well

LIEO serves roles including creating as well as implementation of free trade agreements. These agreements may include Word Bank offering structural adjustment loans to countries especially in the Third World and the conditions may include these countries opening up their market to Western businesses. LIEO believes in liberal trade as well as free market as one key way that can be used in stabilizing of the economy (Lal, 503). When global trade is much more efficient, the people’s needs in that country are better met this results in a decline in poverty promoting stability and peace which are important factors in ensuring there is economic growth thus countries can be able to pay the debts. At times debt forgiveness occurs when countries especially developing countries are deeply plunged in debt crisis through the Multilateral Debt Relief Initiative

Works Cited

Lal, Deepak. “Threat to Economic Liberty from International Organizations.” Cato J. 25 (2005): 503.

Pirages, Dennis Clark, Christine Sylvester, and Dennis C. Piraces, eds. Transformations in the global political economy. Springer, 2016.

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