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The Importance Of A Military Sub Concentration Student

This semester, I’m enrolled in the Clinical Practice with the Military Family to increase my knowledge and understanding when working military families. As a military sub-concentration student, this course will provide the necessary skills and knowledge needed to enhance my work as an effective military social worker. I’ve been at my placement now for about nine weeks and I am getting more comfortable in interacting and using different psychotherapy techniques with my clients. The clients that I am assigned are diagnosed with anxiety, depression, bipolar and schizophrenia. Even though I’m not working with military families in my placement, I believe that the knowledge that I am gaining in class about clinical practice with military family will be helpful in my future work and it can also be helpful in my current placement. When working with service members, their families and veterans it is essential that as a social worker, I understand and respect the military culture. Cultural sensitivity is very essential when interacting with the military community. The military represents a unique cultural group with its own language, behaviors, and beliefs (Luby, 2012). The military is its own diverse community and is made up of different ethnic groups, gender, sexual orientation and spirituality. Globalization is rapidly happening in our society and this type of globalization is also visible within the military community. Being social workers, we will be working in communities thatShow MoreRelatedSystem Approach1260 Words   |  6 PagesPage 2 Introduction The systems approach developed out of the 1950s and 1960s focus on language laboratories, teaching machines, programmed instruction, multimedia presentations and the use of the computer in instruction. Rooted in the military and business world, the systems approach involved setting goals and objectives, analyzing resources, devising a plan of action and continuous evaluation/modification of the program. 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Journal The American Planning Association -Myassignmenthelp.Com

Question: Discuss About The Journal The American Planning Association? Answer: Introduction The research proposal is developed to focus on the various ways by which risks are allocated during the management of public private partnership projects within the Australian construction industry. The research is undertaken to find ways by which risks will be allocated and managed in the PPP projects during the management of construction activities between the public and private parties involved within the construction industry of Australia (Hwang, Zhao and Gay 2013). Research background The background of the research illustrates the impact of issues on the public private partnership projects and handles those with ease and effectiveness. The public private partnership is an effective procurement strategy that has influenced the construction activities within the Australian construction industry and due to this, certain risks are emerging as well including the differentiating attributes of the projects and high costs involved to resolve those issues properly. By allocating the risks in PPP projects, it has also become easy to obtain knowledge and information and create opportunities for managing the risks with ease. Inadequate information and data are also other risks that have been allocated while managing the public private partnership projects within the construction industry of Australia (Cheung, Chan and Kajewski 2012). Though the public private partnership involves a contractual agreement between the public agency and private sector entity with skills, knowledg e and assets being shared along with the facilities and services, various issues have arisen that are needed to be allocated properly for successful project functioning. Research rationale The rationale of the research demonstrates the research problems faced while managing the public private partnerships and few of these risks are higher cost of development, bidding and management of construction sites, high cost attached to debt, politically and socially challenging projects, strict rules and regulations by law and Government. There could also be complexities associated with the risk allocation during the public private partnership projects when the documents and parties were not anticipated during the contractual agreements (Osei-Kyei and Chan 2015). Gaps in knowledge and opportunities could arise due to lack of authenticated articles and documents that would be needed for extracting the best quality data and information properly. These problems should be overcome by developing new private sector technologies and enabling innovation all throughout for delivering better public services and improving the operational effectiveness too. Research aim The aim of the research is to determine the ways by which risks are allocated for the public private partnership projects within the Australian construction industry. Research objectives To conduct a critical study relating to the present situation of considering the public private partnership within the construction industry in Australia To evaluate the most relevant public private partnership procurement strategies and case studies within the Australian construction industry To conduct surveys and obtain data and information from the people about the allocation of risks in PPP within the Australia construction industry To collect relevant data and information and find out how risks are allocated between the public and private parties to manage the PPP projects within the construction industry, Australia To conduct analysis of the information and data and develop a suitable framework for allocating the risks in PPP between both public and private parties Research questions How can the critical study of the literature provide an overview of the entire situation related to the allocation of risks for the PPPs in Australian construction industry? What are the most effective public private partnership procurement strategies managed within the construction industry of Australia? How could the surveys, data and information collected could help in allocating the risks in PPP for the construction industry? How could be the analysis of data and information help in the management of a suitable framework to allocate risks in PP for both the public and private parties? Research Hypothesis H0: The allocation of risks in public private partnership projects cannot create any positive impact on the operational efficiency and promote innovation H1: Risk allocation in PPPs within the construction industry of Australia could help in implementing new technologies and deliver best quality pubic services along with betterment of operational effectiveness. Literature review The public private partnerships are important aspects considered while managing procurement of infrastructure development projects within the construction industry of Australia. PPPs deliver greater value for money projects and it has been driven with the involvement of Government of Australia too. Due to the public private partnership procurement strategy, the risk allocation of resources in public private partnership projects is minimsed. Due to the emergence of various issues and problems, the conventional delivery model has been replaced with public private partnership model, which allows the public organisation to transfer the risks and allocate those to the private party, thereby reducing the costs incurred during the construction management largely (Chou and Pramudawardhani 2015). However, the allocation of risks could be challenging and even might cost a lot of money along with issues related to transfer of risks. Other than the lowering down of costs incurred during the cons truction project management, the tax payers have also gained value for money, due to which, the risks related to the project have also been reduced. While allocating the risks, it is important not only to reduce the impact but also to manage the risks properly by assigning those between both the Government and private sectors. Allocation of risks in PPPs is quite straightforward, because of which, the party that can be able to manage the risks are handed over the risks through allocation. Between the two parties, the concerned party must be able to identify the risk in quick time, understand its likelihood as well as reduce the impact by managing the risks allocation with ease and effectiveness. The party that is responsible for managing the risks also must bear the financial costs, keep costs lower and finally deliver the greatest value for money (Porwal and Hewage 2013). There are multiple public private partnership projects undertaken in the past few years, though few of those have been successful due to the allocation of risks in an appropriate way. To manage the risks, proper approaches should be followed and this could be t he distribution of risks and allocate those to respective authorities. When multiple risks arise, few of those could be allocated to the Government while the remaining risks should be allocated to the private sector. While undertaking the public private partnership projects, investigations should be done for allocating the risks accurately between the private and public sectors and ensure that a potential gap in knowledge could be understood. By managing public private partnerships in the construction industry, it has also become easy for transferring skills and knowledge and even export the competencies through bidding procedures. This is how the long-term value of money could be derived, furthermore should assist in managing the project with ease and efficiency through risk allocation (Ismail 2013). According to various authors, it was also found that the external factors like legal, political, social and economic factors contributed to the allocation of risks between the private and public parties and ensured successful undertaking and implementation of the project. With new issues arising, new scopes and opportunities were also created, which helped in managing the public private partnership projects with much ease and effectiveness. Though there are certain benefits, there are few disadvantages associated with the management of public private partnership projects too including the increased costs of development, bidding and business functioning. This can further create issues during the allocation of risks in PPPs during the project management within the construction industry of Australia. As during the management of construction project, both public and private parties are involved to form contracts and agreements, so there can be emergence of contractual issues too (Cruz and Marques 2013). The allocation of risks is one of the major aspects of the contract negotiations where two parties are involved, both private and public. One of the parties must focus on reducing the chances of risks and maximize the value for money. The risks are allocat ed through negotiations and drafting of contractual provisions. Nearly every provision of a commercial contract could be used for allocating the risks, few of the major tools that might be used for the purpose of risk allocation had been indemnification, payment terms and conditions, warranties of products and services, contractual remedies and limitations of liabilities (Liu and Wilkinson 2014) Research plan Main activities/ stages Month January Month Feb Month April Month July Month October Month December Selecting the topic of PPPs Framing layout of the research conducting a critical study of the literature Formation of the research Plan Selection of the Appropriate Research Techniques Conducting surveys to collect data Analysis Interpretation of Data related to the construction industrys PPPs Conclusion of the Study Formation of Rough Draft Submission of Final Work Systems of inquiry The various systems required for inquiring about the project management could be the induction, deduction and abduction. The inductive system can allow for making observations and understand he occurrence and impacts of risk allocation, furthermore determine the actual pattern to achieve the goals and objectives (svoll 2014). A tentative hypothesis will be developed to create justification of theory and ensure successful project management within the construction industry. The research methods of construction also can include the deduction system for inquiring about the risk allocation in PPPs through development of theories and hypothesis, furthermore make observations and confirm the actual results or outcomes (Siemiatycki and Farooqi 2012). The abduction system could allow for understanding the proposition of value, develop an insight and propositions, and furthermore obtain critical insight of the best-fit approaches. From the research, hypothesis was developed and observations w ere made based on the literature review section and so the deduction system was the most suitable. By choosing these systems of enquiry, it can be easy to understand the benefits of public private partnership procurement strategies and how risks will be allocated within the construction industry. It will also help in analyzing the collected data and information and furthermore ensure that the risks are allocated in such a manner to prevent any issues related to the public private partnerships in construction industry in the future. Approaches to empirical work The empirical work results could be obtained by obtaining knowledge gained through various experiments and observations made. The knowledge and information gained from various observations and experiments could be the empirical work. The knowledge could be obtained based on the express and tacit knowledge (Hartmann et al. 2012). Experience is one the approaches to empirical work, which focuses on understanding the various concepts of risk allocation and its impact in public private partnerships within the construction industry. Here express knowledge will be beneficial because various documents and articles can be searched to analyse the impact of risk allocation on the PPPs within the construction industry (Liu et al. 2014). The results obtained from empirical study should depend upon the things known by the researcher after studying the literature review section. Research design The designing of research should allow for finding out the accurate answers or solutions for the various problems or questions that might arise during the research conduction. The empirical design could help in understanding the kind of data and information to be collected, ways of collecting those and evaluating the appropriateness of those. The designs should though be created based on the approaches chosen including the positivistic and phenomenological approaches during the various stages of the project management. The phenomenological approach could be to develop new ideas and concepts by considering the induction approach to gain an in-depth analysis whereas the positivism should allow to identify the issues and decrease the chances of issues for the formulation of effective strategies (Zou et al. 2014). The positivistic approach to deduction could be considered as effective because of the testing hypothesis and enhanced scopes for formulation of strategies. Empirical design The approaches for managing the empirical design are case study analysis, providing survey questionnaires, observing the behaviors of participants and conducting experiments at laboratories. Among all these, the case study analysis and large scale surveys should be done by distributing survey questionnaires because there could be considered as most effective. It could create better scopes for remaining positivistic in approaches and interpret the data and information obtained through large scale surveys accurately (Neuman 2013). Sampling methods The probability and non-probability sampling methods are effective for selecting the right samples and obtain relevant data and information all throughout. The probability sampling method could be used to select random samples from a huge population and obtain their responses in the form of data whereas the non-probability sampling method could be done by using both purposive and convenient sampling methods. The purposive sampling could be used to gather quantitative data whereas the convenient sampling method should allow for fixing the most suitable time for the managers of the organizations within the construction industry and obtain their responses (Taylor, Bogdan and DeVault 2015). Sample size As the entire Australian construction industry was chosen here, so the sampling size should be chosen as 100 employees 40 managers of the different construction management businesses. Data collection The data collected must include both primary and secondary data. The quantitative data could be collected through random sampling process and by providing survey questionnaires to the respondents to obtain their responses and feedbacks. The qualitative data should be collected by interviewing the managers of the construction businesses, which comprise the primary data. The qualitative approaches should be descriptive though, which could provide a comprehensive view of the research subject and develop theories based on the data collected (Flick 2015). The secondary data should be collected by searching relevant articles, documents and websites to obtain the best quality information and conduct the research successfully. Data analysis The analysis of data will be done by using SPSS tool and representing those on graphical formats for understanding those with ease and effectiveness. Values and ethics The values and ethics will be maintained by managing confidentiality of information and maintaining privacy of the respondents of the research. The research materials could be used for academic purposes only and not for any commercial purposes. Most of the data and information obtained during the research should be destroyed for making sure that those do not fall in wrong hands (Yanow and Schwartz-Shea 2015). The research plan for 11 weeks research project should be created to focus on the various tasks and time duration allotted to those for the proper completion. The research plan and timeline should consist of various activities including the selection of research topic in the first week. The research topic was selected as risk allocation in public private partnership projects within the construction industry of Australia. The collection of data might be a daunting task because of measuring the accuracy and authenticated results that could be obtained based on the primary and secondary data collected. By collecting relevant data and information, a research layout should be formed, which could take nearly 3 months (Flach and Hadjiantonis 2013). Based on the various research data and information collected, it could be understood that it would be important for conducting a critical study of the literature review and create assumptions for understanding the empirical study and research des igns Methodology for 1 year thesis Task Name Duration Start Finish Thesis Plan 11.88 wks Tue 1/23/18 Mon 4/16/18 Development of proposal 4 wks Tue 1/23/18 Mon 2/19/18 finding appropriate literature on the field of research-1 20 hrs Tue 1/23/18 Thu 1/25/18 identify a particular literature to find the gap-1 20 hrs Thu 1/25/18 Mon 1/29/18 framing research question/Aims/rationale and objectives-1 20 hrs Tue 1/30/18 Thu 2/1/18 Preparing the outline proposal draft and acquiring feedback from the supervisor-2 20 hrs Thu 2/1/18 Mon 2/5/18 develop research proposal -2 20 hrs Tue 2/6/18 Thu 2/8/18 submit research proposal- 2 20 hrs Thu 2/8/18 Mon 2/12/18 review feedback and complete the research proposal by refining it-3 20 hrs Tue 2/13/18 Thu 2/15/18 prepare final research question-3 20 hrs Thu 2/15/18 Mon 2/19/18 Literature review 2 wks Tue 2/20/18 Mon 3/5/18 conduct extensive literature review on risk allocation in construction industry-4 20 hrs Tue 2/20/18 Thu 2/22/18 conduct extensive literature review on Public Private Partnership -5 20 hrs Thu 2/22/18 Mon 2/26/18 Conduct extensive review to identify the methods of distribution risk allocation between public and private parties-8 20 hrs Tue 2/27/18 Thu 3/1/18 developing in depth understanding of the topic-6 20 hrs Thu 3/1/18 Mon 3/5/18 Secondary data analysis 2.38 wks Tue 3/6/18 Wed 3/21/18 Data analysis to identify the risk allocation techniques in construction industry-7 25 hrs Tue 3/6/18 Fri 3/9/18 Data analysis to identify the methods of distribution risk allocation between publci and private parties-8 35 hrs Fri 3/9/18 Thu 3/15/18 Data analysis to develop a framework for better allocation of risk in PPP in construction industry-9 35 hrs Thu 3/15/18 Wed 3/21/18 Thesis submission 3.5 wks Wed 3/21/18 Mon 4/16/18 Prepare first draft of thesis-10 40 hrs Wed 3/21/18 Wed 3/28/18 Submit draft and get feedback-10 20 hrs Wed 3/28/18 Mon 4/2/18 prepare thesis-11 60 hrs Mon 4/2/18 Wed 4/11/18 submit thesis 20 hrs Wed 4/11/18 Mon 4/16/18 The practitioners or individuals involved with the management of public private partnership during the construction project management at Australia must know about the occurrence of risk allocation along with its probable impacts created. The private sector does not create much impact on the change in laws, rules and regulations and in such cases, the public agency or party might incur the most amount of risks associated with the management of projects within the construction industry of Australia (svoll 2014). The allocation of risks should be possible through gaining ultimate control over the costs of operations and furthermore provide better incentives to the private parties. The Government of Australia is responsible for managing the risk allocation occurrence while the private party manages the impacts. Based on this literature, it could be understood that for conducting the research based on the public private partnerships within the construction industry, a proper research pla n was needed to be developed. The research timeline showed above should not only assist in determining the time frame for each of the tasks but also could allow for maintaining a proper structure and flow of information and data all throughout the research conduction (Gregor, Mller and Seidel 2013). For conducting the empirical study, the express knowledge should be useful because the researcher could use the approaches, knowledge and information that could be known to him and on the basis of his experiences. For the research design, the positivistic approach to deduction should be considered as the most effective. To manage the empirical design and ensure successful accomplishment of research goals and objectives, the case studies should be analysed along with large scale surveys done with the use of survey questionnaires distributed to the respondents involved in the research. For the collection of data, both qualitative and quantitative data were needed to be considered. The qualitative data would be collected through social construction, which could help in focusing on the languages used while the descriptive approach could provide an in-depth view of the research subject based on the materials that were researched (Creswell and Poth 2017). Hypothesis shall be developed, whi ch can strengthen the efficiency of developing project scopes and enhance the efficiency of the research conduction. References svoll, H., 2014. Abduction, deduction and induction: can these concepts be used for an understanding of methodological processes in interpretative case studies?.International Journal of Qualitative Studies in Education,27(3), pp.289-307. Cheung, E., Chan, A.P. and Kajewski, S., 2012. Factors contributing to successful public private partnership projects: Comparing Hong Kong with Australia and the United Kingdom.Journal of Facilities Management,10(1), pp.45-58. Chou, J.S. and Pramudawardhani, D., 2015. Cross-country comparisons of key drivers, critical success factors and risk allocation for public-private partnership projects.International Journal of Project Management,33(5), pp.1136-1150. Creswell, J.W. and Poth, C.N., 2017.Qualitative inquiry and research design: Choosing among five approaches. Sage publications. Cruz, C.O. and Marques, R.C., 2013. Flexible contracts to cope with uncertainty in publicprivate partnerships.International Journal of Project Management,31(3), pp.473-483. Flach, P.A. and Hadjiantonis, A. eds., 2013.Abduction and Induction: Essays on their relation and integration(Vol. 18). Springer Science Business Media. Flick, U., 2015.Introducing research methodology: A beginner's guide to doing a research project. Sage. Gregor, S., Mller, O. and Seidel, S., 2013. Reflection, Abstraction And Theorizing In Design And Development Research. InECIS(Vol. 13, p. 74). Hartmann, T., Van Meerveld, H., Vossebeld, N. and Adriaanse, A., 2012. Aligning building information model tools and construction management methods.Automation in construction,22, pp.605-613. Hwang, B.G., Zhao, X. and Gay, M.J.S., 2013. Public private partnership projects in Singapore: Factors, critical risks and preferred risk allocation from the perspective of contractors.International Journal of Project Management,31(3), pp.424-433. Ismail, S., 2013. Critical success factors of public private partnership (PPP) implementation in Malaysia.Asia-Pacific Journal of Business Administration,5(1), pp.6-19. Liu, J., Love, P.E., Smith, J., Regan, M. and Davis, P.R., 2014. Life cycle critical success factors for public-private partnership infrastructure projects.Journal of Management in Engineering,31(5), p.04014073. Liu, T. and Wilkinson, S., 2014. Large-scale public venue development and the application of PublicPrivate Partnerships (PPPs).International Journal of Project Management,32(1), pp.88-100. Neuman, W.L., 2013.Social research methods: Qualitative and quantitative approaches. Pearson education. Osei-Kyei, R. and Chan, A.P., 2015. Review of studies on the Critical Success Factors for PublicPrivate Partnership (PPP) projects from 1990 to 2013.International Journal of Project Management,33(6), pp.1335-1346. Porwal, A. and Hewage, K.N., 2013. Building Information Modeling (BIM) partnering framework for public construction projects.Automation in Construction,31, pp.204-214. Siemiatycki, M. and Farooqi, N., 2012. Value for money and risk in publicprivate partnerships: Evaluating the evidence.Journal of the American Planning Association,78(3), pp.286-299. Taylor, S.J., Bogdan, R. and DeVault, M., 2015.Introduction to qualitative research methods: A guidebook and resource. John Wiley Sons. Yanow, D. and Schwartz-Shea, P., 2015.Interpretation and method: Empirical research methods and the interpretive turn. Zou, W., Kumaraswamy, M., Chung, J. and Wong, J., 2014. Identifying the critical success factors for relationship management in PPP projects.International Journal of Project Management,32(2), pp.265-274.

The World Of Freedom Essays - Erin Hannon, , Term Papers

The World Of Freedom The World of Freedom If you have ever opened the midnight color doors, you have been in the world know as DV8. A world within a dance club, where they have forgotten labels, they have remembered images, and they have found true freedom. Welcome to the hottest dance club on Thursday nights. A placed called DV8. Where once a week some of the world's greatest D.J.'s come to spin their records on their turntables. Where some of the greatest rave dancers, come to dance. Where everyone comes together for one magical night in heaven. As you enter the doors of DV8 a bouncer will ask for you I.D. Can I see you I.D.? Oh yes. I pulled out my licence with as I trembled. 18 the bouncer says with an attitude. Everyone has an attitude in the dance clubs. They call it the survival of the fittest. To have survived and to be noticed you must carry yourself as if you were somebody important and as if you were too busy to be bothered with people. This is all part of the game. Everybody wants to be the hunter but not the prey. As I leave the front door, the bouncer started to fight with the person behind me. Sorry man, this is a fake, says the bouncer who weighs at least 200 lbs. He was a muscular man in his late twenties. Nobody would mess with him but the man behind me thought he could. They Williams 2 started to argue, but I just continued my journey into the world of fantasy. Looking around, I could not believe my eyes. There were so many beautiful men and women talking to each another. Clothes were almost too expensive to touch, yet to underground to been seen in the daylight. Realizing how beautiful these people were, I began to feel self-conscious about myself. Do I fit in? Do I belong here, I ask myself? Then, like a flash of lighting it hit me, the sounds, the beats, and the music. The sound had entered my soul like a deadly disease. I did not realize it was there, but when you did it was too late. Your body had already lost control. The music had made you feel like you were as free as the lights creeping into the smallest corners of the club and as free as the enchanting beats of the night. Nobody was safe from the music not even me. However, I decided to glance around and mingle before I entered the dance floor. Noticing a few friends of mine, I ran up to them like I had not seemed them in years. Now I began to feel a little more comfortable with myself. Erin's what is going on, I said. Nothing much. Just hanging out. Trying to get ready to show off my new dance moves., Erin said as she was standing there with a drink in her hand. Erin was a small young woman about 5' 4, but nobody could miss her. Her dark hazel eyes and light curly brown hair sparkled throughout the room. Erin introduces me to her friends, Jason and Eric. I could not believe these people were college students by day and living dancing vampires by night. They had forgotten the labels of society in this club. One could be totally free with themselves and nobody was going to judge them. I think there was also something in the atmosphere that night, a sense of freedom. Williams 3 Erin took me around and showed me all the best places to hang out. We sat on an old retro couch next to the dance floor. We watched the many nameless faces dance. Moving their bodies as if they were liquid, flowing from one end to another. All of this totally amazed me. The movements, the rhythm, and the sounds. Sounds were coming from an upstairs booth. Who was making these sounds? Were they coming from a CD?, I asked myself. Erin noticed the puzzled look on my face and asked me what was the matter. Where is all of the music coming from? She pointed her finger into the air and across the dance floor toward a booth. Lights and posters, advertising new techno sounds and

The Army is a Profession free essay sample

Is the Army a profession? Today, the Army is composed of brave men and women who have volunteered to serve our country. American citizens accept the Army’s code of ethics during their process of becoming an American soldier. The Army promotes professional development through military occupation specialties, education, and expertise. The Army develops soldiers into experts, proficient within defending our nation and the protection of human rights. Army professional development is a culture that is applied through ethics, leadership and loyalty. Throughout my experiences, service members of the Army are mostly motivated by the proficiency of craft and the outcome of self-discipline. Should the Army be considered a profession based on its code of ethics, professional development and culture? The Army’s Oath of Office, Army Values and Soldiers Creed promote the Army’s â€Å"code of ethics†. Men and women entering the Army swear to â€Å"support and defend the Constitution of the United States against all enemies, foreign and domestic†¦Ã¢â‚¬  (U. We will write a custom essay sample on The Army is a Profession or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page S Army Center of Military History, 2014). The Oath of Office is the foundation for men and women entering into the Army. The seven core Army Values are a benchmark of standards soldiers must uphold whether on or off duty. Loyalty, Duty, Respect, Selfless Service, Honor, Integrity and Personal Courage describe what it cost to be an American soldier. Service members are required to learn, recite and live the Oath of Office, Army Values and Soldiers Creed upon assuming the risk and responsibility of an American Soldier. Is the Army considered a profession to those who view it as a springboard into a civilian career? Many American’s serve our nations military for an initial enlistment. Some argue that every American should serve a minimal term. During an initial enlistment do soldiers fully indulge into the Army’s culture and professional development? How does this affect the Army as a profession? The Army White Paper specifies the Army as being a â€Å"Profession of Arms† in which the â€Å"Professional Soldier is an expert†. (Dempsey, 2010, p. 4). Is it possible for the Profession of Arms to occur without the Professional Soldier? Is it possible to become an expert within the profession of the Army without professional development? Professional development is the heartbeat of the Army. Senior leadership devote themselves to developing subordinate leaders and conveying expertise at the operational level. Published doctrines, regulations and policy letters are created from within and are used to relay knowledge of how the Army operates. Professional development is key to Army promotions. Army leaders measure the professionalism of subordinates and promote on the potential for increased responsibility. Army leaders uphold a strong code of ethics and promote its culture through professional development. Leadership is paramount to our Army profession. The Army’s greatest assets are the men and women wearing the uniform motivated by the proficiency of craft and the outcome of self-discipline. Service members accept the Army’s culture by assuming the risks and responsibilities associated with being a soldier. I believe it is virtually impossible to serve in the Army without being fully immersed. The professional soldier makes the Army a profession.

In Search of Room-Temperature Superconductors

In Search of Room-Temperature Superconductors Imagine a world in which magnetic levitation (maglev) trains are commonplace, computers are lightning-fast, power cables have little loss, and new particle detectors exist. This is the world in which room-temperature superconductors are a reality. So far, this is a dream of the future, but scientists are closer than ever to achieving room-temperature superconductivity. What Is Room-Temperature Superconductivity? A room temperature superconductor (RTS) is a type of high-temperature superconductor (high-Tc or HTS) that operates closer to room temperature than to absolute zero. However, the operating temperature above  0  °C (273.15 K)  is still well below what most of us consider normal room temperature (20  to  25  Ã‚ °C). Below the critical temperature, the superconductor has zero electrical resistance and expulsion of magnetic flux fields. While its an oversimplification, superconductivity may be thought of as a state of perfect electrical conductivity. High-temperature superconductors exhibit superconductivity above  30  K (−243.2  Ã‚ °C). While a traditional superconductor must be cooled with liquid helium to become superconductive, a high-temperature superconductor can be cooled using liquid nitrogen. A room-temperature superconductor, in contrast, could be cooled with ordinary water ice.   The Quest for a Room-Temperature Superconductor Bringing up the critical temperature for superconductivity to a practical temperature is a holy grail for physicists and electrical engineers. Some researchers believe room-temperature superconductivity is impossible, while others point to advances that have already surpassed previously-held beliefs. Superconductivity was discovered in 1911 by  Heike Kamerlingh Onnes in solid mercury cooled with liquid helium (1913 Nobel Prize in Physics). It wasnt until the 1930s that scientists proposed an explanation of how superconductivity works. In 1933, Fritz and Heinz London explained the Meissner effect, in which a superconductor expels internal magnetic fields. From Londons theory, explanations grew to include the  Ginzburg-Landau theory (1950) and microscopic BCS theory (1957, named for Bardeen, Cooper, and Schrieffer). According to the BCS theory, it seemed superconductivity was forbidden at temperatures above 30 K. Yet, in 1986,  Bednorz and Mà ¼ller discovered the first high-temperature superconductor, a lanthanum-based cuprate perovskite material with a transition temperature of 35 K. The discovery earned them the 1987 Nobel Prize in Physics and opened the door for new discoveries. The highest temperature superconductor to date, discovered in 2015  by Mikhail Eremets and his team, is sulfur hydride (H3S). Sulfur hydride has a transition temperature around 203 K (-70  °C), but only under extremely high pressure (around 150 gigapascals). Researchers predict the critical temperature might be raised above  0  Ã‚ °C  if the sulfur atoms are replaced by phosphorus, platinum, selenium, potassium, or tellurium  and still-higher pressure is applied. However, while scientists have proposed explanations for the behavior of the sulfur hydride system, they have been unable to replicate the electrical or magnetic behavior. Room-temperature superconducting behavior has been claimed for other materials besides sulfur hydride. The high-temperature superconductor yttrium barium copper oxide (YBCO) might become superconductive at 300 K using infrared laser pulses. Solid-state physicist Neil Ashcroft predicts solid metallic hydrogen should be superconducting near room temperature. The Harvard team that claimed to make metallic hydrogen reported the Meissner effect may have been observed at 250 K. Based on exciton-mediated electron pairing (not phonon-mediated pairing of BCS theory), its possible high-temperature superconductivity might be observed in organic polymers under the right conditions. The Bottom Line Numerous reports of room-temperature superconductivity appear in scientific literature, so as of 2018, the achievement seems possible. However, the effect rarely lasts long and is devilishly difficult to replicate. Another issue is that extreme pressure may be required to achieve the Meissner effect. Once a stable material is produced, the most obvious applications include the development of efficient electrical wiring and powerful electromagnets. From there, the sky is the limit, as far as electronics is concerned. A room-temperature superconductor offers the possibility of no energy loss at a practical temperature. Most of the applications of RTS have yet to be imagined. Key Points A room-temperature superconductor (RTS) is a material capable of superconductivity above a temperature of 0  °C. Its not necessarily superconductive at normal room temperature.Although many researchers claim to have observed room-temperature superconductivity, scientists have been unable to reliably replicate the results. However, high-temperature superconductors do exist, with transition temperatures between  Ã¢Ë†â€™243.2  Ã‚ °C  and  Ã¢Ë†â€™135  Ã‚ °C.Potential applications of room-temperature superconductors include faster computers, new methods of data storage, and improved energy transfer. References and Suggested Reading Bednorz, J. G.; Mà ¼ller, K. A. (1986). Possible high TC superconductivity in the Ba-La-Cu-O system. Zeitschrift fà ¼r Physik B. 64 (2): 189–193.Drozdov, A. P.; Eremets, M. I.; Troyan, I. A.; Ksenofontov, V.; Shylin, S. I. (2015). Conventional superconductivity at 203 kelvin at high pressures in the sulfur hydride system. Nature. 525: 73–6.Ge, Y. F.; Zhang, F.; Yao, Y. G. (2016). First-principles demonstration of superconductivity at 280 K in hydrogen sulfide with low phosphorus substitution. Phys. Rev. B. 93 (22): 224513.Khare, Neeraj (2003). Handbook of High-Temperature Superconductor Electronics. CRC Press.Mankowsky, R.; Subedi, A.; Fà ¶rst, M.; Mariager, S. O.; Chollet, M.; Lemke, H. T.; Robinson, J. S.; Glownia, J. M.; Minitti, M. P.; Frano, A.; Fechner, M.;  Spaldin, N. A.; Loew, T.; Keimer, B.; Georges, A.; Cavalleri, A. (2014). Nonlinear lattice dynamics as a basis for enhanced superconductivity in YBa2Cu3O6.5.  Nature.  516  (7529): 71–73.   Mourachkine, A. (2004).  Room-Temperature Superconductivity. Cambridge International Science Publishing.

Chronic fatigue syndrome, mitochondrial dysregulation and oxidative Essay

Chronic fatigue syndrome, mitochondrial dysregulation and oxidative stress - Essay Example Its treatment also is through suppression of the symptoms (Myhill 2014). The onset of symptoms of this disorder occurs at the age of early 20s to mid-40s, with a higher group reporting the onset of their symptoms at their early 30s. They can also occur in children aged between 13 and 15 years. Anyone is prone to this syndrome no matter the sex. However, it appears that females are more prone and have a greater chance of ailing this disease; 60-70% are female. The ratio of females to males suffering CFS is 3:1. In the UK, some research reports indicated that the illness was present in 0.5-2% of the population; this estimates about 250000 people in the UK with chronic fatigue syndrome (Thew & Mckenna 2009). Mitochondrial dysregulation is the impairment of the mitochondrial physiological processes (Lalsh, 1993). As we know, the role of mitochondria in the cells of the human body is to provide energy for the body that helps humans to do work. Once these regulatory processes are interfered with, the process of energy manufacturing is also affected: there may be less energy produced or more or imbalanced regarding the time that it is needed. It may be related to chronic fatigue syndrome in the sense that, it may be a causative agent. Lack of enough energy that the body needs is what makes one feel tired hence fatigued (Lalsh, 1993). Therefore, those having chronic fatigue syndrome are likely to have mitochondrial dysfunction. Oxidative stress can be described as the constant imbalance between the manufacturing of the reactive oxygen species, also known as the free radicals and their neutralisation by the antioxidants. The unstable nature of the reactive oxygen species makes them very react ive and renders them the ability to cause great cell damage through breaks and DNA mutation (Shankar & Srivastava, 2012). This phenomenon often leads to irreparable cellular damage. The mitochondrial respiratory cycle plays an

Islamic Insurance Essay Example | Topics and Well Written Essays - 2500 words

Islamic Insurance - Essay Example When the insured event doesn’t occur the insured person loses the sum invested in the policy and if the insurance claims are larger than the contributions then the insurance company is in deficit. The above three factors make conventional insurance â€Å"Haram- prohibited† in Islam. However, since safety and security is the basic human need in today’s uncertain world, therefore Muslim society needed an alternative to conventional insurance in order to secure their business transactions and personal interests. Islamic â€Å"shariah - code of conduct† is based on Muslim’s Holy book â€Å"Quran† and the sayings and traditions of the Prophet Mohammed, which preaches brotherhood and mutual interest in order to establish â€Å"just and equitable social order† in the society. Therefore, Takaful insurance was introduced to minimize the risk by mutual agreement which doesn’t exploit the interest of any party. C. TAKAFUL INSURANCE:  "Takaful is an Arabic word, which means â€Å"joint guarantee† or â€Å"mutual co-operative agreement†. Tabarru is the basic pillar of Takaful insurance which means charity or gift†, (International Co-operative and Mutual Insurance Federation, 2005). Takaful insurance is based on the principles of Islamic brotherhood that promotes common interest and solidarity. Both parties share the responsibility with a sincere intention to help the other in his/her difficult time by paying the defined loss from the defined sum. D. CHARACTERISTICS OF TAKAFUL INSURANCE: 1. Both parties trust each other and contribute their money into a common pool. 2. The losses are divided so that the element of â€Å"gharar -uncertainty† is reduced and liabilities of each party under the losses are calculated... This paper explaines why the conventional insurance in not permissible in Islam, defines takaful insurance and further explores the problem by determining the key features of takaful insurance and its differences and similarities with the conventional insurance. â€Å"Takaful is an Arabic word, which means â€Å"joint guarantee† or â€Å"mutual co-operative agreement†. Characteristics of takaful insurance are as follows: 1. Both parties trust each other and contribute their money into a common pool. 2. The losses are divided so that the element of â€Å"gharar -uncertainty† is reduced and liabilities of each party under the losses are calculated according to the Islamic pooling system. 3. The policy should not contain terms and conditions aiming towards getting the benefits at the cost of risking other party’s interest. 4. Both parties subscribe to help the other through guaranteed compensation so that uncertainty is removed. 5. The insurance funds are invested in instruments that are interest free. The study concludes that the chances for the growth of the takaful business are very promising. Takaful products are available in many countries which meet the needs of the corporations and individuals. However, the biggest challenge is to overcome the shortage of resources especially, human resources, by providing training and development to employees about Islamic financial models and retaining competent employees who can contribute to the growth of takaful industry.

Will consumers choose electric cars over traditional petrol cars in Literature review

Will consumers choose electric cars over traditional petrol cars in the future - Literature review Example The other government around the world is also concerned about the carbon dioxide emission in their country (Wells, 2010, p. 132). The biggest impact of such policies and concern will have on the transportation system which is considered the biggest emitter of carbon dioxide. This will lead to a rise in the demand for cars which are more environments friendly. The main cars available in this segment are the electric cars and the cars running on bio-fuel. The UK government proposes a subsidy of up to 5000 pounds for electric cars in 2011. Germany plans to invest 500 million Euro in 2009 to develop the infrastructure for electric cars. In this context a very important debate is that whether the petrol cars will be replaced by the electric cars. However Schroder (2009, pp. 7 -10) gives a summary of the problems faced by the electric cars. According to him the technology of the electric cars are yet to match the cost efficiency, speed and the comfort of the petrol cars. According to him t here are two alternatives for the consumer. They can either purchase a comfortable but highly expensive electric car or a less mobile and less comfortable but cheaper electric car. Therefore petrol cars still provide some advantage over the electric cars.

Information Giving and Counselling Skills Case Study

Information Giving and Counselling Skills Case Study INTRODUCTION As health professionals, every day we are invited to face patients presenting different problems and which need various solutions or therapies such as medical treatment, information giving, teaching, counseling, etc. I am a trained nurse in dialysis and renal pathologies management and I work in dialysis unit of our hospital. My main role is to receive patients with renal pathology and lead them to the Nephrologist, to plan and to execute prescribed treatment for those who are diagnosed with renal failure. That treatment concerns in general renal replacement therapies like hemodialysis or peritoneal dialysis. For the following work, I have chosen one of our patients because of the following reasons: He is a patient suffering of end stage renal disease and undergoing dialysis treatment since 2 years, he passed the first year under peritoneal dialysis but after developed chronic peritonitis and for this he has been transferred for hemodialysis. He is waiting for renal transplantation but now lacks fund needed for the process Because of peritonitis he has received painkiller drugs for a longtime to relieve pain but he finished by developing addiction to painkillers. Still now he continues to claim for painkillers while there is no valuable reason. He presents signs of anxiety and depression IDENTIFYING THE PROBLEM Identifying clients problem is the key of the success of counseling process. Problem exploration is an important step, because it permits counselor-client initial contacts and to map out the clients problem. For this, all the process has to be well prepared. The preparation concerns the client and the environment in which counseling will be given. Concerning my client preparation, to get his consent, I have before all explained him what is counseling and what its benefits are for people undergoing it. Concerning the environment, all counseling sessions have taken place in our service, in one of our offices that I have chosen because its calm, well illuminated and aerated and where distracting conditions have been eliminated. We used chairs permitting to have various positions but every time it was possible, I arranged them in manner to permit face to face interaction. This arrangement permits us to avoid distractions and to have a full opened interaction. Counseling sessions were arr anged to have place before each hemodialysis session, and I tried to avoid they went over 30 minutes. This has the purpose to permit my client to begin quietly his hemodialysis session. My client MV is a young adult presenting various problems. After a careful analysis, I found that my client has various problems which need to be resolved by himself or through assistance from other people. Here, I found that neededassistance could be categorized as following: Problem necessitating other help than counseling Treatment of End stage renal disease: the management of that condition is accomplished primarily by medication, diet therapy and renal replacement therapy. The initiators of the treatment are Physicians (Fink et al., 2001). Problems which may find solution with counseling Addiction to painkiller drugs: treatment by painkiller began while my client was treated by peritoneal dialysis. He developed chronic peritonitis with intolerable abdominal pain. For the pain he received painkiller each time he claimed it. After stopping peritoneal dialysis and starting hemodialysis, my client continues to ask painkiller although we dont see a real reason for it. We concluded that he has developed dependency to painkillers. Understanding a variety of models and theories of addiction and other problems related to substance use, describing helping strategies for reducing the negative effects of substance use, abuse, and dependency are among competencies of a counselor in addiction (U.S CSAT, 2005). Problem which may find solution in combination of medical assistance and counseling: Anxiety and depression which according to my assessment are due to: Waiting a long time the renal transplantation without hope to find financial assistance for the process. Thinking to be useless for the family Anxiety and fear of the future: before he felt sick, he was going to begin university studies and has been obliged to stop them Brusque stop of painkiller treatment Cucor D. et al, (2007)recognized that depression is one of common mental health problem for people with End-stage renal disease. According to them, depression is one of factors influencing morbidity and mortality rates among those people. Various medications are used to fight anxiety and depression but to be more effective, medication need to be combined with other therapies like behavioral therapies. When associated, both medical and behavioral therapy, patient benefits from better decrease in symptoms and a lesser risk of setback (http://helpguide.org/mental/anxiety_types_symptoms_treatment.htm). The client has developed dependency on painkillers drugs and has been obliged to stop them without any psychological assistance to help him to do gentle withdraw from drug taking. According to my assessment and a long time passed with the client, its for that problem that my client needs to be helped firstly and its about it I have chosen to work with him as also he has wished. It may be a hard task, but this will help the client and will help me to get more experienced because we are lacking experienced counselors. TRANSCRIPT OF PART OF MY COUNSELLING INTERACTION WITH MY CLIENT During counseling sessions, the counselor uses various techniques to interact with his client. Communication and interaction management skills are used during counseling interaction and their use depends on how the session is going. Here below is a short transcript of one session I had with my client. Myself: you come just to present me problems which are stressing your life, could you tell me now about the intensity of each problem? Here I have used questioning skills to help my client to express himself and explore issues concerning his problems. Client: As I told you in the last session, I have been suffering from chronic renal failure there are now more than 3 years. As you see it, I am young and I was about to begin my university studies when I felt ill. At the beginning, I was confident even though my doctor had told me that I will need long term treatment. Now when I think about my future, I feel hopeless. My studies stopped, I lost a lot of money with medical treatment, and I dont have money for renal transplantation, and for my unluckiness although he knows that I am suffering the doctor has stopped my injections of painkiller. Myself: I understand you feel overburden by all those problems; according to you which problem is mostly troubling your life? What are your main concerns? Client: actually its my continuous unrelieved pain. Myself: Can you briefly speak about that pain? Here, focusing skills to bring my client to give a clear definition of the problem for which he needs our help. Client: as you know it, I have started treatment with peritoneal dialysis. After 5 months of treatment I developed peritoneal infection which was causing me serious pain. Other patients who had the same problem in the past advised me to ask to my doctor to prescribe me Pethidine which relieves pain and permits to sleep. Here, active listening skills helped me to show to my client that I am attentive to what he is telling me. Myself: how did you appreciate the treatment with Pethidine? Here also I used questioning skills to get full information which can help me to analyze the relationship between my clients problems and his medical history. Client: at the start it was wonderful to not feel pain and I was again able to close my eyes and sleep. Myself: and after? Client: after, it became impossible for me to sleep without my injection and one injection a day was not sufficient for me. For this, all the day I was harassing my nurse to provide me Pethidine. Myself: You told me that when you begin treatment with Pethidine everything was ok, no pain and you were able to sleep. So, how did you take it when the Nephrologist decided to stop Pethidine injection for you? Here I used summarizing skills to help my client to stay fixed on our subject; pain. I asked him that question as a challenge to see if he will continue to tell me that he still needs Pethidine injection. Client: it has been a bad moment for me and up to now I dont understand him because I am still feeling pain. Myself: how do you feel when you are at your home? His family members have told me that he is quite at home and claims to feel pain only when he arrives in medical facilities. I wanted to get deep information about his pain. Client: Not very bad. I feel exaggerated pain when I come for treatment. THEORETICAL UNDERPINNINGS In this work, I have been using the client-centered approach. That approach of counseling has been conceptualized by Carl Rogers (1946). The fundamental belief turns around the idea that each individual innately strives towards self actualization, in the other words to be the best that he can. Essentially the person or child centered approach extends the central conditions of empathy, no conditional positive regard and congruence to the client, facilitating, in a reflective and non directive way the clients exploration and harmonizing of his emotional and personal issues that have been arisen from his lifes experiences. The target is, to help the client to give up the personal image which he has built around his individual experiencing (Mearns D. Thorne B, 2000 p5). This approach considers a client as an active agent, able to take responsibility for his own condition. Palmer reinforces this when he notes clients are encouraged to explore their most intimately held opinions and values, in order to discover for themselves, what it is that really matters to them, what it is worth living for or what would be worth dying for (Palmer, 1996:p31). The respect of client is essential in this approach. According to Corey (1977) the strength of this approach come from its capacity to focus on preferences and pathways headed for personal growth. Emphasis is on freedom, responsibility and the persons ability to redesign his life through attentive choice. The counselor-client relationship is also essential to good practice of client-centered approach. To participate effectively in counseling, Freshwater (2003) claims that nurses necessitate to recognize the client as an equal, though as clients often view nurses as experts it can make this relationship difficult to obtain. Through this work I have been using the theories of motivational interviewing counseling, in which the main objective of the counselor is to identify and work with the clients motivation to change. Motivational interviewing builds on Carl Rogers optimistic theories about peoples capabilities for exercising free choice and changing through a process of self-actualization (Alcohol answers, 21.8.2009). The therapeutic relationship counselor-client is a reciprocal partnership. The counselors role in motivational interviewing is directive, with a goal of eliciting self-motivational statements and behavioral change from the client in addition to creating discrepancy to enhance motivation for positive change (Miler and Rollnick, 1991). As healthcare providers, we are often asked to act as change agent for our patients, students, and colleagues. When we play that role we try to help people make necessary behavior changes by instructing them in the whys and hows of making them. We may have been trained to believe that if we simply teach our patients what they need to do to change and do it effectively enough; they will change (Ellen R. Glovsky, and Gary R., 2007). In our daily work, tendency is to think that our clients need only medical assistance, but when we try to analyze the situation, we may find that we are wrongful. All clients needs are not answered by medicines or other medical and nursing interventions. Most of the time, we ignore the socio-psychological aspect of the problem. This is remarkable with chronic renal diseases like end stage renal failure, diabetic nephropathy, cancer, etc. Sensky (1993), in his work, showed how renal failure impacts on persons life. The impact doesnt only concern the physical condition but the whole person. With renal failure, various alterations come in the life; the patient has to learn new skills and strategies which can help him to cope with his condition. The patient has to attempt to adapt to his chronic illness and the necessity to deal with dependence on dialysis machine or other elses kidney to continue to live. In their works, (Levenson, 1991; Kimmel, 1993, and Finkelstein, 2002) recognize that anxiety and depression are the most common psychological problems in dialyzed patients. The same idea can be found in the work of Chilcot and his colleagues. They found 20% to 30% of End stage renal disease patients with signs of depression at various levels (Chilcot, Al., 2008). The other problem found in patients undergoing long term dialysis is a possible addiction on pharmaceutical drugs like painkillers (Manjula, Bennett, Chertow, 2003). Addiction is defined as a state characterized by impaired controlover the use of chemical substance and/or behavior. This lead the addict to seeking and abuse of drugs, a need to continue to take drugs to which some one has become habituated following a repetitive utilization because it produces some special effects like euphoria and other types of mental status alteration. Clinical manifestations occurbeside physical, psychosocial and spiritual dimensions (College of Physicians and Surgeons of Saskatchewan, 2008). Addicted substances are like alcohol, stimulant substances like cocaine, heroine, marijuana, and medicines like tranquilizers and painkillers.Others may habitually mix prescribed drugs with alcohol to numb the mind from staying on disappointments or personal conflicts. Many people persist in taking medications to feel better physical or psychologically even when no ailments are present; and some insist that they cant function without them. Statistics indicate that, the number of visits in emergency room for prescription and illegal drugs overdoses are the same and that individual abusing medical drug like codeine can be just as addicted as the one who abuses of illegal drug like cocaine. While prescribe medicines is absolutely legal, ethical and moral laws prohibits the use of medicines for purposes other than the original aim. Addicted people need therapists specialized in chemical dependence counseling and who can help them to recover from the addiction by reviewing past medical hi story and patterns of substances abuse. Most of the time counselors discover that long term abuse has produced undesirable psychological and physical effects. The case presented above concern a patient addicted to Pethidine, a painkiller of opioids pharmacological family. Addiction to opiates like morphine can occur after chronic pain suffer is given dosages to control acute discomfort, and continues its use long after pain has collapsed (ChristiaNet, 2009). Many people with long-lasting pain receive treatment by opioids. But, there are evidence throwbacks and side effects that may follow this treatment. Developing tolerance to drugs is one major risk, sometimes at short time. The second major risk is the development of addiction. Addicted people to painkillers becomeso fixated on getting more of them that the obsession prevail over the medical target of relieving pain (Media Planet, 2009). COUNSELING IN ADDICTION The focus of individual drug counseling is on the symptoms of substances addiction. It also relates areas of weakened function and the structure and content of the clients ongoing rehabilitation program. The first target of counseling in addiction is to support the addict to achieve and maintain abstinence from addictive substances or behavior. The second target is to aidthe addict to recover from damages which have caused by addiction in his life (Delinda E. Georges W., 1999). The addicts counselor works firstly by helping the client to be aware of the reality of a problem and the connected unfounded thinking. In the next steps, client is stimulated to achieve and uphold abstinence from addicted substance or behavior. This can help to develop needed psychosocial abilitiesand spiritual growth to remain in recovery process (Delinda E. Georges W.). ADDICT INDIVIDUALIZE COUNSELING PROCESS Counseling as a helping process consists of 3 main phases. Each phase has its distinct aims although the same skills may be used in those 3 phases. Those three main phases are: Exploration, assessment and planning phase In this phase, the main objectives are to apprehend the client as a whole person, to plan counselors interventions, and to arrange an agreement between counselor and client. Rehabilitation counseling and goal achievement phase Counselors objectives in this phase are the initiation and implementation of his treatment plan in collaboration with his client. Termination and evaluation phase In the closing phase, objectives are to conclude treatment process and deliberate its outcome with the client, and to arrange agreement on upcoming actions. Rehabilitation and relapse prevention In addiction counseling, the objectives of the all process are to rehabilitate the client from the addicted substance or behavior and to prevent the relapse. Rehabilitation Rehabilitation may be defined as the process consisting in recovering the capacities that have been reduced due to injuries or illness. The recovery is sustained only when there is no relapse or return back to addicted substance or behavior. Here, the goal of counseling is to lead the client to a full reintegration into his community as dynamic and valued person. Each time its possible, detoxification comes first, and after can be started the laying of the basis of rehabilitation process. Abstinence from addicted substance or behavior is not enough in itself. The addict has to see the profits of staying abstinent; otherwise he can relapse at short or long term (United Nations International Drug Control Program, 2003). Individual addiction counseling doesnt only focus on stopping or reducing addicted substance or behavior. It will also address the other related domains of impaired functioning and those are such as social relations, illicit activities, employment status, etc. When additional helps are needed, the counselor is advised to refer the client (U.S National institute of Health, 2009). Relapse Above, I have mentioned that counseling process has to help client to maintain abstinence after the recovery period, otherwise the client can relapse and return back in addiction. What is a relapse? There is a relapse when, a client in recovering period or in post recovery, returns to the addicted substance/behavior or becomes addicted to a new substance. Prevention of relapse in counseling process Preventing relapse is a very important element of recovery. When the client becomes able to establish some constancy in abstinence, he could begin to develop skills to put off future relapse to addicted substance/behavior. To prevent relapse, the addict has to be taught how to identify in advance, when he is headed near a relapse and to modify course of events. Through counseling process, by education, the addict can identify indicators of coming up relapse. Those indicators are like negatives changes in clients behavior, feelings and attitudes. Once the client became conscious of the environment of relapse process, his next mission is to build up the skills to intervene and change any occurring negative behavior or feelings (Delinda E. Georges E.) SELF-EVALUATION I am not a professional or trained counselor. I am only a student in nursing studies who is trying to apply learnt counseling skills. I have chosen to work with my client about his addiction. I know its a very complicated subject for a beginner in counseling, more experience is needed. Difficult to handle that subject has stimulated and encouraged me to do further reading and researches concerning addiction; what is it, its causes, its management by a combination of counseling and other ways of help like pharmacotherapy. During my counseling process, in my clients needs assessment; I was more influenced by medical side of my clients problems. The social situation of the patient has not been full analyzed and I think that this can a bit weaken the problem exploring process. The second difficult is to know borderline between intervention domains of a professional counselor and a health professional who applies counseling skills to help a client. We may think that its easy but in practi ce its very complicated. You ask yourself: Does the clients problem need a professional counselor or a skilled health professional can help? This can lead us to be fluctuating in our practice. I suggest here to insist on this point during elaboration of Professional practice and counseling skills module. My strength now reside in fact that I can now lead counseling process without apprehension, methodically and without asking about the beginning or next stages. To help my client, I didnt consider medical data as enough to conclude that my client is addict. I have spoken with my client but it was necessary to know what his family thinks about him. For this, I had discussion with some members of his family about my clients problems and needs. From the family I received information reinforcing the medical diagnosis of addiction. I consider this as a positive point, because we have to check the all environment of client to get real and full information which can help us during counseling process. Not long time after the beginning of my counseling sessions, my client begins to withdraw progressively from his constant obsession to receive Pethidine injection and stop to advise other patients to ask that drug. He was suffering from end stage renal disease; a chronic condition so we had many counseling sessions to prevent relapse. We didnt continue to work together; he died before the termination of our counseling process; but all this process has been helpful for him and full of experience for me.

The Lively Earth: Important Features Make the Earth Unique

EASC 2112 Earth System The lively Earth: important features make the Earth unique Name: Leung Ho Nam, Banson UID: 2011712579 Introduction: The Earth is one of the eight planets in the solar system. The planet Earth is emphasized as â€Å"the rare Earth† in numerous literatures because of its unique physical conditions and the complicated interactions among all biotic and abiotic systems. Isotope dating indicates the earth was formed approximately from 4. 53 to 4. 568 Ga, according to isotope used (Allegre et. al. , 1995).Despite the precise formation time of the Earth, there is no exact planet formation model that is generally accepted except the minimum mass solar nebula model, MMSN (Canup, 2008). The MMSN model suggested the planetary accretion of the Earth and other terrestrial planets begins with a disc of hydrogen abundant gas and dust, circulating around the sun. Following by a series of collision, small particles combine and collapse repeatedly. The runaway growth slows down until reaching a certain mass (Canup, 2008). The formation process is crucial to the evolution of the Earth because it determines the source of materials which the Earth contains.The formation of the Earth, indeed, is not specific enough to comprise â€Å"the rare Earth† because all solar planets were grown within a circumsolar disc of gas and dust suggested by Canuo (2008). When we look at the solar system from the outer space, the Earth is probably the only shiny blue planet because of water surface reflection. 70 percent of the Earth surface is covered by the ocean. There is approximately 1. 4 billion km2 of liquid water by mass on Earth (Oak & Kanae, 2006). The existence of permanent liquid water responsible to create a mild temperature and a stable environment.Liquid water is an important element implicates the emergence and evolution of life on Earth after a few million years from the latest collision (Baross & Hoffman, 1985). The distinct blue colour of t he ocean and the green colour of the terrestrial land is obvious on the Earth surface. Nevertheless, it is hardly to observe the entire view of the surface because of the scattering effect (Adams, 1934) and screening effect of the cohesive cloud in the atmosphere. Differences between the earth’s atmosphere and other planetary atmosphere including the presence of oxygen and relatively low carbon dioxide concentration.The atmosphere is extremely important to the biosphere. Without atmosphere, organisms nowadays would probably remain in the simple form or single celled. Furthermore, the ozone layer in the atmosphere absorbs and reflects part of the solar radiation incoming from the sun. This reduction of solar radiation lowers down the atmospheric temperature dramatically which allows organisms to survive. The Earth would not be so unique among the solar system when missing either one of the systems. The Gaia hypothesis links this concept and indicates the Earth is a giant self- regulating system.The interactions of the organisms with their abiotic environments modified the condition of the Earth such as oxygen content and atmospheric temperature, making the Earth more habitable terrestrial planet (Lovelock, 1973). Evolution of the Earth: Allegre and the research team (1995) suggested that the Earth was formed 4. 53 to about 4. 7 Ga. The age range of the earth was estimated by means of a series of isotope dating so the results are relatively valid. The Earth queues the third planet from the sun and its average radius is 6371 km (Lide, 2000).Because of specific distance from the sun and the size, the Earth prevents some of the very light elements, such as hydrogen, from escaping, by gravitational force (Adams, 1934). Moreover, the Earth has a gravitational force of 10 g (Yoder, 1995). Gravitational force is an inconspicuous pull generated from the Earth core. The Earth self-spins once it is formed. The rotation period of the earth is 23 hours and 56 minutes (Gold, 1967). This spinning effect creates centrifugal force which differentiate substances by mass. Heavy metal tends to migrate toward the Earth core and leaving the light materials outside.When time passes, the surface of the earth cools and the first land formed. Although land also appears in other planets such as Mars, the crust of the Earth is different. Interestingly, unlike Mars, the Earth surface is not covered by a concrete sphere but a few tectonic plates. Since the Mars is much smaller than the Earth so the cooling effect of Mars is much faster than the Earth. By now, the crust of the Mars has not been renewed for a certain long period. The plate tectonic moves with three strategies, convergency, divergency and transformation. The movement of the plates driven by the underneath semisolid magma (Courteny, 2008).Surface morphology is determined by the way which the tectonic plates move and density of the plates. Tectonic activities, earthquake, mountain-building, volcanic eruption and subduction zone, are restricted along plate boundaries (Courtery, 2008). Volcanic activities and oceanic subduction are extremely important processes to deliver materials from the inner core and renew surface materials respectively. These recycling processes keep providing accessible resources for the living organisms. Atmosphere and ocean formation was also suggested to be related to volcanic activities (Morbidelli, 2000).Aforementioned that self-spinning of the Earth differentiate substances on Earth. Iron, as a metal that can be magnetized, and with accordingly high atomic mass, moves inward and forms the core. After 60 million years after the late Heavy Bombardment, the magnetic field was established (Staff, 2010). Studies from Karato (1993) implies the magnetic field may relate to the magnetizing properties of iron. No matter how the Earth’s magnetic field was formed, it â€Å"prevents the atmosphere being stripped away by the solar wind† (Staff, 2010 ). Atmosphere: The atmosphere is the outermost, thin layer enclosing the Earth.The composition of the atmosphere for example, oxygen, is imperative to the evolution of the Earth. The atmosphere of the Earth is comparable to the nearby terrestrial planet such as Mars and Venus. Given that the average distance and the size of Venus from the sun is 3/4 and 4/5 of the Earth, Venus has an atmosphere (Adams, 1934). Spectroscopic studies indicate that the atmosphere of Venus does not show any markings representing the presence of oxygen and water vapour, even if these elements, once, had been appearing on Venus, they were consumed by the crust.Another result in the same spectroscopic concluded that the Venus atmosphere contains a high concentration of carbon dioxide, triggering a sever greenhouse effect (Adams, 1934). In addition to Venus, the Mars with only one tenth by the mass of the Earth also has an atmosphere. Spectrograms studies raised significant markings on ? 8300 and ? 8700 reco gnizes the appearance of water and carbon dioxide respectively on the Mars atmosphere(Kaplan et. al. , 1964). The presence of water on Mars is obvious with the ice cap present in the polar region of Mars (Adams, 1934).Not surprisingly, oxygen absents in Mars atmosphere and was proofed by the light frequency relative to carbon dioxide was not absorbed by the Mars atmosphere (Kaplan et. al.. 1964). From the example of Venus and Mars, it clearly shows that containing such a high concentration of oxygen, 21%, with extraordinary low carbon dioxide concentration, 0. 03%, as the Earth’s atmosphere is uncommon in the solar system. The composition of the Earth atmosphere provides with evidences that it has been modified by some other factors. This modification, as we know, was conducted by plants.Plants inhale carbon dioxide and exhale free oxygen as a by-product through the process of photosynthesis, inorganic substances were also converted into organic substances during the process (Berkner & Marshall, 1965). Free oxygen facilitates the evolution of organisms because high oxygen concentration triggers aerobic respiration, without oxygen, organisms nowadays would probably remain simple (Fenchel & Finlay, 1994). Differences between aerobic and anaerobic respiration not only limit on the requirement of oxygen, the oxidizing power and good electron accepting properties of oxygen boosts energy metabolism (Babcock, 1999).Babcock (1999) also stated that aerobic respiration releases much more ATPs than anaerobic respiration, ATP can be treated as the energy storage unit in organisms. In other words, organisms undergo aerobic respiration can perform more vigorous activities or prolong the duration of the activities. Furthermore, the ozone layer derived from the excess free oxygen incubated a habitable environment for living organisms. The ozone layer with related to energy budget and the effect on human was well examined in Norway (Adams, 1934; Henriksen, 1990) .The ozone layer prevents living organisms burnt to death by screening out part of the UV-radiation reaching to the Earth surface. Hydrosphere: By the time when Earth was just formed, water from asteroids,  proto-planets, and  comets was locked in the core. Volcanic extrusion and outgassing brings magma along with dissolved gas and water vapour to the surface respectively. Extruded gas and water vapour suspended in the atmosphere therefore atmospheric pressure continuously increases. Water condenses when the atmospheric vapour pressure is saturated.Water droplets fall onto the ground and ocean formed (Morbidelli, 2000). Liquid water is an advance heat reservior because of having an extremely high specific heat capacity, 4200J/kg/?. This significantly high specific heat capacity, in other words, a large sum of energy can only result in a small extent of changes in temperature of water. The high energy absorption ability combined with the ocean current makes the ocean a good vecto r for transporting absorbed solar energy and regulating global climate (Michon, 2006). Apart from an excellent thermal reservoir, liquid water is also a good solvent.Gases in the atmosphere and minerals from the hydorthermal vents can easily dissolve into the water. Dissolved gas and minerals has planted a seed to the extensive evolution of life throughout the geological time (Morris, 2007). Biosphere: As we discussed the geosphere, atmosphere and the hydrosphere above, these systems have one thing in common. All the systems are linked with the biosphere. Although other planets in the solar system exhibit either physical feature, mostly not more than two, with Earth. The true uniqueness of the Earth raised from the presents of life which cannot be found on other planets recently.The origin of life is still a hot arguing topic among groups of scientists. However, the hydothermal vent is the most commonly and recently acceptable concepts of the origin of life (Baross & Hoffman, 19 85). The origin of life via submarine hydrothermal vent hypothesis has not been disproved yet since it was published because there are no other environment on Earth can provide a thermo-stable habitat with abundant minerals supply, for example, nitrogen and sulphur, for life establishment (Baross & Hoffman, 1985). Photosynthesis is considered as a key issue of the origin of life (Hartman, 1996).Bacteria record found in western Australia, dated as 3. 5 billion years ago, stated that cyanobacteria may be the first autotrophic organism and responsible for the later atmospheric modification (Awranik, 1992). This key process opens the window of free oxygen, hence considerably boosted the evolution of organisms. The GAIA Hypothesis: Every system discussed above has its own features and contributions within the system boundaries. There is no doubt that every literatures when emphasizing the planet Earth, it can hardly find any paper just put the focus on a single system.The same situat ion can also be observed in this article. For example, in the discussion part of the origin and development of the atmosphere, the tectonic activities and outgassing processes were mentioned. Moreover, a similar case was obtained when investigating biosphere. Although the whole part is bias towards living organisms, the effect of atmosphere to the biosphere can hardly be eliminated. The above situation is not due to the habit of the authors or the regulations of the publishers but it is the real case of the Earth.All systems on the Earth, including geosphere, atmosphere, hydrosphere, biosphere or even self-defined systems, are interdependent. These systems interact with each other to create a more habitable planey. This complex interaction has long been observed by James Lovelock (1973) and explained in the GAIA Hypothesis. GAIA hypothesis suggested early life form achieve some sort of ability to control the global climate and the effect is still active. Lovelock (1972) stated that once the life exist on Earth, the physical environment and the chemical states had resulted a dramatic change.For example, the solar radiation level had increased dramatically since life exists. The Earth surface temperature, nevertheless, has only changed for a few degrees, throughout billion of years, compared to the current temperature. More interestingly, the rate and the extent of temperature change during the past billion years is so slow and mild respectively that the environment always permit the persistence of living organisms or provide long enough time for organisms to adapt. Without life, the atmosphere of the Earth will be similar to that of Mars and Venus.The above example, therefore, proved that the atmosphere we are now breathing is â€Å"biological contrivance† (Lovelock, 1972). The terms â€Å"Spaceship Earth† (Lovelock, 1972) was used to represent the planet where we are living. When astronauts were sent into the space, all the requirements for survi val can only obtain from the storage in the spaceship. If either system in the spaceship fails, astronauts will probably die. Conclusion: Doubtlessly, the Earth has many physical environments that absent in other planets. For example, liquid water and living organisms.However, what really makes the Earth rare is the interaction between different functional systems with unknown complexity. These interactions connected to the terminology of the â€Å"Spaceship Earth† meaning the Earth has the ability to self-regulate to adjust its own environmental condition that result in a harmonious giant system. Reference: Awramik, S. M. (1992). The oldest records of photosynthesis. PhotosynthesisResearch 33 (2): 75-89 Claude J. Allegre,  Gerard Manhes,  Christa Gopel, (1995). The age of the Earth. David R. Lide. (2000). Various. Handbook of Chemistry and Physics  . 1 Geochimica et Cosmochimica Acta, 59 (8):1445–1456 Gerald T Babcock. (1999). How oxygen is activated and reduced in respiration. PNAS. 96(23):12971-12973 Henriksen, Thormod, Dahlback, Arne, Larsen, Soren H. H. Moan, Johan. (1990). ULTRAVIOLET-RADIATION and SKIN CANCER. EFFECT OF AN OZONE LAYERDEPLETION. Photochemistry and Photobiology. 51 (5):579-582 Hyman Hartman. (1996). Photosynthesis and the origin of life. Origins of life andevolution of the biosphere. 28:515-521 James E. Lovelock, (1972). Chapter 25: GAIA as seen through the atmosphere.Atmospheric environment. 6 (8):579-580 James E. Lovelock, (1973). Atmospheric homeostasis by and for the biosphere: thegaia hypothesis. Tellus. 26 (1-2):2-10 John A. Baross & Sarah E. Hoffman. (1985). Submarine hydrothermal vents andassociated gradient environments as sites for the origin and evolution of life. Origin of life and evolution of the biosphere. 15 (4):327-345 L. V. Berkner & L. C. Marshall. (1965). On the origin and rise of oxygen concentrationin the earth’s atmosphere. Journal of the atmospheric science. 22(3):225-261 Lewis D. Kaplan, Guido Munch, Hyron Spinrad (1964). An analysis of the spectrum ofMars. The astrophysical journal. 139 (1): 1-15 Morbidelli, A. et al. (2000). Source regions and time scales for the delivery of waterto Earth. Meteoritics & Planetary Science  35  (6): 1309–1320 Morris, Ron M. (2007). Oceanic Processes. NASA Astrobiology Magazine. P. D. Moore. (1983). Plants and the palaeoatmosphere. Journal of the GeologicalSociety of London, 140(1):13-25 Robin M. Canup, (2008). Accretion of the Earth. Philosophical Transactions:Mathematical, Physical and Engineering Sciences. 66:4061-4075 Scott, Michon (2007). Earth's Big heat Bucket. NASA Earth Observatory Seligman, Courtney (2008). The Structure of the Terrestrial Planets. OnlineAstronomy eText Table of Contents. URL: cseligman. com. Accessed: 6thNovermber,2012 Shun-ichiro Karato. (1993). Inner Core Anisotropy Due to the MagneticField—induced Preferred Orientation of Iron. Science,  262 (5140):1708-1711. Staff. (2010 ). Oldest measurement of Earth's magnetic field reveals battle betweenSun and Earth for our atmosphere. Physorgnt. news. T. Gold. (1967).Radio Method for the Precise Measurement of the Rotation Period ofthe Earth. Science. 21 (3786):302-304 Taikan Oki & Shinjiro Kanae, (2006). Global Hydrological Cycles and World WaterResources. Science 313 (1068. ) Tom Fenchel & Bland J. Finlay. (1994). The evolution of life without oxygen. Americanscientist. 82 (1):22-29 Walter S. Adams, (1934). The Planets and Their Atmospheres. The Scientific Monthly. 39 (1):5-19 Yoder, Charles F. (1995). Global Earth Physic. A Handbook of Physical Constants. Washington: American Geophysical Union. p. 12

Why Tuberculosis is a Public Health issue

This essay will undertake chiefly about the wellness topic that was assigned to the writer s group which is Tuberculosis, this so accounts for the mortality of several million people each twelvemonth chiefly, in the 3rd universe states. Health appraisal and background Introduction M. TB has been a plague for the human race for centuries. There is grounds to propose that it has perchance been endemic since at least 10, 000 BC. ( Suarez et al. , 2001 ) . At the present twenty-four hours, it is a disease which is increasing on a planetary graduated table ( WHO 2006 ) . Prevalence The WHO has been cardinal in the coordination of a figure of strategies which are targeted at guaranting that quality-assured TB programmes are rolled out in countries which are perceived to be at greatest demand ( WHO 2006 ) . These enterprises have resulted in a state of affairs globally, where 53 % of all people who are diagnosed with extremely morbific TB received intervention in conformity with the internationally recommended TB control scheme in 2004. This compares with 10 % in 1995 as an exemplifying illustration. The WHO reports that 84 % of this group were treated successfully ( WHO 2006 ) . The push of this determination is that, despite the fact that the incidence of TB in the United Kingdom is relatively low, easiness of modern travel allows exposure of the United Kingdom population to some populations where the incidence is well higher ( Scriven & A ; Garman, 2005 ) . The bulk of long term migrators, and many visitants travel from the states where there is a high incidence of active TB ( & gt ; 40 per 100,000 ) and enter states where the incidence is relatively low ( & lt ; 25 per 100,000 ) ( Joint Tuberculosis Committee of the British Thoracic Society, 2005 ) . To set this in position, the incidence of active TB in the native UK population is in the part of 4.4 per 100,000, and this contrasts with 121 210 per 100,000 in certain nonnative populations. The increased hazard of infectivity of foreign born subjects has been demonstrated to go on for up to 20 old ages after migration ( Baudette & A ; Ellis, 2004 ) . It clearly follows that, in low incidence states such as the UK, the nonnative population are responsible for the bulk of new instances of active TB. Studies put the existent incidence between 35 – 70 % of all new instances. ( Euro TB 2007 ) . Current showing and control steps In Western Europe, and North America, presently more than half of all new active TB instances diagnosed occur among nonnative recent migrators. ( Borgdorff, Nagelkerke, new wave Soolingen, de Haas, Veen & A ; van Embden 2008 ) Despite the high proportion of active instances now being found in usually low-incidence states which are attributable to nonnative occupants, the impact on the public wellness is comparatively low. A figure of recent surveies ( viz. ITA 2005 ) have demonstrated that the current thorax radiogram testing programmes in topographic point in the UK have small impact and are non cost-efficient. Screening of immigrants with sputum civilization has been demonstrated to better cost-effectiveness marginally. The intervention of latent infection which can be detected through testing with either tuberculin tegument proving or chest radiogram may necessitate the infliction of coercive steps for the mark populations to maximize impact and cost-effectiveness. ( Dahle, Sandve n, Heldal & A ; Caugant 2003 ) Some governments ( viz. Vernon 2010 ) nevertheless, suggest that, in contrast, contact tracing, peculiarly within cultural communities, appears to be more cost-effective and less intrusive. Taken in overview, in low-incidence states such as the United Kingdom, showing of immigrants at the point of entry appears to hold small overall impact and does non look to be a really cost-efficient TB control scheme. More effectual options have been suggested and these include contact following which is delivered through the primary attention substructure and, on a planetary graduated table, increased investing in planetary TB control ( Davies & A ; Macdowall 2006 ) . Rationale and mark group There are a immense figure of possible wellness promotion-related activities in this context. It is clearly beyond the range of a short reappraisal to see more than one facet in any grade of item. This reappraisal will therefore curtail its consideration to wellness publicity mechanisms which can be used to observe, hint and dainty immigrants to the United Kingdom from high TB incidence states. Evaluation of such steps can be from a figure of positions, in the current economic clime of the NHS, which is basically a rationed service, an appropriate appraising tool would be cost-effectiveness. ( Pender, Murdaugh & A ; Parsons 2002 ) . Clearly there are other positions, including acceptableness to the immigrant population ( which may be reflected in issues of conformity ) or the existent impact of a relatively little figure of instances of active TB in the community which could be dealt with by trust on the natural herd unsusceptibility of the population and contact tracing as suggested by Ewles ( Ewles 2005 ) The importance of such wellness publicity activities can be gauged from the fact that the bulk of new instances of TB amongst the immigrant population are attributed to a reactivation of a antecedently latent infection. This is most likely to happen within the 2 – 5 year following migration. ( 10 Asbroek, Borgdorff, Nagelkerke, et al. , 2006 ) . Molecular epidemiological surveies have besides shown that a little proportion of new instances can be acquired after migration, with the Chin survey proposing that this would be in the part of 20 – 30 % ( Chin, De Riemer & A ; Small 2006 ) . In the UK it has been demonstrated that the kids of nonnative occupants have higher degrees of active TB than the general population and this incidence is increased if regular visits are made to their state of beginning. ( Ormerod, Green & A ; Gray 2001 ) Policies: In the UK, specific consideration of the in-migration policy shows that the demand for testing is non cosmopolitan. Immigrants who are meaning to remain longer than 6 months either have to be screened for TB ( and some other complaints ) before come ining the UK or to be screened on reaching. Those who do non be after to remain more than 6 months or are merely tourers are non capable to showing, even those who are coming from a high hazard states. It is considered that it is impractical to test all in these classs and the primary wellness attention installations are expected to pick up sporadic instances opportunistically as they present in the population. If this is contrasted with the wellness publicity policy in the Philippines, one can observe that the scheme in the Phillipines has changed well in the last decennary. It has been noted that the incidence of drug-resistant TB is at its greatest in those with HIV, the urban hapless and the prison populations. The decrease in prevalence is greatest in these groups and the Government has reported that it has achieved a 34 % decrease in notified instances in the last decennary. The National Stop TB Partnership was introduced in 1994 and increasingly expanded. It combined with the National Interagency Coordination Strategy for TB in 2003. In bend, this was superseded with the National Strategic Plan in 2006 which has aimed to cut down the incidence of TB. It would look that the steps to test for TB in immigrants to the Philippines are limited with no demand for short term travelers to be screened. Consideration of the broad image of TB control in the Philippines suggests that the state has been fighting with the issue for many old ages. This has been hampered by considerable economic demands on authorities installations from other need-areas against an increasing incidence of HIV/AIDS, which is a major predisposing factor for the development of TB in this peculiar hazard group. Funding for TB control comes non merely from Philippine national resources but besides from international resources such as the Global Fund On a planetary graduated table the steps reported, and mostly instigated by the WHO, showed that the incidence of planetary TB peaked in 2004 and that the end of cut downing the 1990 mortality rate by half by 2015 appears to be on path, chiefly through the coordination of the DOTS programme. In specific consideration of footings of Health Promotion activity, testing for a peculiar disease is by and large considered justified if, in the frequently quoted analysis of Sackett et al. , the disease is comparatively common and treatable. The ideal screening trial should be cheap, easy to administrate, do no uncomfortableness to the patient, and offer both high sensitiveness and specificity. ( Sackett, Haynes & A ; Tugwell 1985 Pg 21 ) . Why Tuberculosis is a Public Health issue: Tuberculosis is said to be a high hazard catching type of disease that could endanger the wellness of the public one time this has non been traced, treated, and isolated. This, holding said can be fatal but most decidedly curable. It can be transmitted through a simple sneezing or cough by person who has been infected by this disease, the bacteriums can so be spread through the air and anyone nearby who can inhale it can acquire infected. The bacteriums normally dwell in the lungs, where it normally grows. It might remain and the organic structure s natural defence might discontinue the bacteriums from turning and become hibernating but one time the organic structure s immune system is at below par, this is where the danger sinks in ( WHO, 2007 ) . The manner of transmittal is undeniably effortless and giving therefore should be considered a menace to every person most particularly to the vulnerable groups ( the elderly, the babies, the pregnant adult females and those whose immune s ystem is depressed ) . Bradshaw s demands If one considers the wellness publicity issues from a theoretical point of view, one can observe that Bradshaw attempted to specify demands. Taking a social position Bradshaw categorised demands as normative ( distinguished by professionals, such as inoculation ) , felt ( wants, wants and desires ) , expressed ( vocalised demands or how people use services ) and comparative demands, which indicates that needs originating in one location may be similar for people with similar socio-demographic features populating in another location ( Bradshaw 1972 Pg 22 ) . This probe will be normative in this context as it will chiefly see the issue from the population needs as defined by health care professionals. ( Downie, Tannahill & A ; Tannahill 2002 ) . Need for testing Further accent for the demand for good wellness publicity activities comes from consideration of the economic effects of TB infection. In the USA ( where it is easier to quantify health-related disbursement ) the entire one-year outgo on TB was in surplus of $ 700 million even a few old ages ago. It is believed that a similar figure ( proportionate to the population ) is incurred in the UK. ( Brown, Miller & A ; Taylor 2005 ) Methodology The methodological analysis for this reappraisal has been to analyze and critically analyze the peer-reviewed literature on the topic and to deduce decisions from the grounds base thereby established Analysis of the activity Screening processs Screening programmes in the UK historically ( after WWII ) consisted of compulsory CXRs for all new immigrants. As the incidence of TB in the general population diminished, the cosmopolitan CXR was finally abandoned. It was besides the instance that it was discovered that the impact on the public wellness, in footings of a decrease of sputum-positive instances, overall morbidity or mortality, was negligible. ( Toman 1999 ) . The current policy in the UK is for immigrants to undergo CXR on reaching and so are later referred to the wellness authorization where they will later shack. Value of CXR The trouble here is that merely a really little proportion of immigrants who are screened with CXR are found to hold antecedently undiagnosed active pneumonic TB. Even from the high-incidence states it is & lt ; 1 % ( Blum, Polish, Tapy, Catlin & A ; Cohn 2003 ) . Paradoxically, it has been shown that the prevalence of instances of latent infection which are associated with CXR abnormalcies ( that is inactive TB and/or apical fibronodular disease ) is instead higher with Comstock et al. seting it at 3 – 5 % ( Comstock, Edwards & A ; , Livesay 2004 ) . From the public wellness point of view, one has to see that it is rather possible to hold latent TB infection with no CXR abnormalcies at all and between 35 – 42 % of instances fall into this class. ( Nolan & A ; Elarth 2005 ) Combination testing A more common and rational attack utilises a CXR to observe active tubercular disease and the tuberculin skin trial ( TST ) to observe any grade of latent infection. This method nevertheless, has non significantly reduced the incidence of TB in the community and hence one has top consider other methods of sensing such as phlegm civilizations, acid-fast staining and nucleic elaboration trials which are presently available. A figure of sero-assays and trials of cell-mediated unsusceptibility are being developed but should be considered under development at the present clip in this context. ( Wright, Walley, Philip, Petros & A ; Ford 2010 ) If one considers the wellness publicity deductions of showing of immigrants so one has to see the comparative virtues of each of these activities. It is normal pattern in the literature to compare each process to the gilded criterion of a positive phlegm civilization. As has already been outlined, the CXR has a low positive predictive value and this is found to be even lower in instances of HIV/AIDS infection. Schoch et Al. hold pointed out that the huge bulk of positive CXRs are really false positive consequences. ( Schoch, Rieder, Tueller, Altpeter, Zellweger, Rieder, Krause & A ; Turnheer 2007 ) Although sputum civilization is frequently referred to as the gilded criterion for diagnostic truth, one should observe that a individual civilization is no more sensitive than a CXR. It appears to be by and large accepted that a microbiological civilization of three to six phlegm samples is needed to be extremely sensitive for active pneumonic TB. The specificity of a TB civilization is really high and there are really few false positives and these by and large occur as a consequence of cross-contamination during research lab handling. ( Bothamley, Ditiu, Migliori & A ; Lange 2008 ) Some Centres presently use acid-fast staining as a mechanism to increase the effectual choice up rate. This proves to be more specific but less sensitive than a CXR. ( Bothamley, et Al. 2008 Smart analysis If one considers this wellness publicity attack from the position of a SMART analysis. It is surely specific as it is designed to aim TB instances from abroad. It is manageable to a grade as, within the targeted population, it is manageable by the presently bing health care mechanisms, either by direct showing of some of those persons perceived to be at hazard, or reach following if the initial showing is neither done or has a false negative result.. It is provably accomplishable as it is already in topographic point, there is a bigger inquiry as to whether cosmopolitan showing of all reachings in the UK is accomplishable and the current policy is dictated on the premise that it is non. ( Lalvani & A ; Pareek 2010 ) Relevance to the general Public Health is clear, as steps to curtail the spread of TB through the general population, peculiarly the drug immune strains, are clearly relevant. Time relation is more hard to measure as the policy is different for different immigrant groups. Those going on a short term clip graduated table ( less than six months ) are merely non screened. Some immigrants ( non all ) geting with the purpose of remaining longer than six months are screened. It would look that, in footings of clip consideration, some are screened prior to arrival and others after reaching in the UK so there is non a clearly defined reply to this inquiry. If considered from a strengths and failing point of view. The strengths are that the policy tends to aim long term immigrants, peculiarly from high hazard countries, which are the population group that are most likely to present a hazard to the general population. Clearly, holding identified those with active or latent TB, the mechanisms are available and active within the UK to adequately handle those who are identified and besides to reach hint and dainty any instances which may hold arisen through community contact with an identified septic person. The failings are that the current United kingdom policy allows in short term visitants, who may good be infected, unscreened, and relies on mechanisms of contact tracing and timeserving clinical intercession for new instances which arise periodically in the population. The short term ends for this current scheme appears to be to place those persons, chiefly from high hazard communities, who wish to shack long term in the UK and to either garbage admittance or to guarantee that they are on appropriate intervention prior to admittance to the UK. The longer term ends appear to be to cut down the exposure of the general UK population to instances of active and perchance drug-resistant TB from the immigrant population. This attack seems to be appropriate for the wellness publicity job which confronts the UK. It clearly is non perfect, as there is the possible for instances of TB to come into the state without any grade of medical showing, if they intend to be in the UK for less than six months. Although the official line is that TB requires prolonged contact in order to be a wellness hazard to another person, this is non purely true as there is no reputable grounds base to propose that contact has to be a lower limit of six months for transportation of TB between persons. ( Mack, Migliori, Sester, Reider, Ehklers & A ; Goletti et Al. 2009 ) Evaluation Cost effectivity When Dasgupta et Al. studied the comparative cost-effectiveness of these assorted mechanisms for sensing of TB they found that the costs of testing utilizing a sputum civilization method were really higher per capita, the cost per instance of active TB found would be lower when compared to CXR. This is besides reflected in the other methods which, although their costs may really be lower in footings of showing costs, because of their decreased specificity, the overall costs would be much higher. From a Health Promotion point of view nevertheless, this is non the whole narrative as the cost of testing is non overriding. This is because testing carried out with a trial with greater specificity, such as sputum civilization, would necessarily ensue in fewer false-positive trials. In bend, this would ensue in lower costs for the clinical probe of persons who had false-positive trials. The importance of this remark is that the 2nd phase of a medical probe is more expensive than all screening trials. ( Dasgupta & A ; Menzies 2005 ) Latent disease sensing Although the obvious impact of wellness publicity would be directed at the sensing and appropriate intervention of active TB. If one is sing the immigrant population of the UK, so latent signifiers of the disease processes are merely every bit of import to observe. As has already been discussed, phlegm trials are of no value and CXRs are of merely minimum value in this status. The TST is a trial which depends on the development of cell-mediated immune responses which merely occurs at some clip after exposure to the TB being. It is carried out by injection and is demonstrated to be positive with the development of skin sclerosis within 48 – 72 hours. Although this trial is considered to be the most effectual for the sensing of latent infection, in the presence of active infection between 10 47 % of patients will hold a falsely negative trial. ( Erkens, Slump, Kamphorst, Keizer, new wave Gerven, Bwire, Berkel & A ; Borgdorff 2008 ) Health publicity benefits Health publicity considerations suggest that, in the USA at least, the TST trial is given to all immigrants who have come from a state of high TB incidence. The presence of latent infection amongst immigrants to the UK is presently about 30 75 % depending on state of beginning. A positive trial is normally followed up with a class of INH which will cut down the hazard of farther spread through the population. It should be noted that false positive consequences can happen with a past history of BCG inoculation every bit good as exposure to non-tuberculous mycobacterium, both contingencies being common among appliers from developing states. In a unusually elaborate survey, once more carried out in the USA ( chiefly for grounds of finding costs ) Saraiya et Al. calculated the cost-effectiveness of a Health Promotion enterprise which offered TNT testing to all new immigrants to the state. The inside informations of the survey are highly complex but, in kernel, the writers found that, in the twelvemonth 2002, without TST showing, 13,933 instances of active TB instances could be predicted, but, if a TNT showing programme together with isoniazid intervention was instituted, so 4,342 instances would be expected. The computations suggested that the net cost to the state without TST testing would be estimated at $ 338 million, and this compares to the cost with TST testing in the part of $ 258 million. ( Saraiya, Cookson & A ; Tribble et Al. 2002 ) . These costings, although taking into history a immense figure of factors, do hold some defects such as there is no accounting of the set up costs of such a Health Promotion programme. The writers translated these figures into a net economy of $ 8,320 per instance of TB prevented. Any wellness publicity strategy has besides to take note of the fact that this is non an ideal universe which can be absolutely mathematically modelled and the Saraiya et Al. survey did non do allowances for factors such as any immigrant refusing to undergo TST proving or failure of those who did prove positive with TST to describe for subsequent medical rating. There is besides the possibility that the immigrants my garbage to get down the therapy if it is deemed to be appropriate. ( Naidoo & A ; Wills 2005 ) Conformity Unfortunately such factors are non merely theoretical, they appear to interpret into pattern with surveies such as Cain et Al. showing that jobs such as these were responsible for a really significant decrease in the overall effectivity of the Health Promotion programme, as merely between 11 30 % of immigrants who had a positive TST trial were found to hold successfully completed an appropriate class of antimycobacterial therapy. ( Cain, Haley, Armstrong, Garman, Wells, Iademarco, Castro & A ; Laserson 2007 ) . From a clinical point of view there is a farther complication nevertheless, and that appears to be that there is a sub-group of persons with latent TB who have unnatural CXRs and who are at an increased hazard of reactivation. Cain et Al. point out that hence CXR followed by TST showing may be a more effectual Health Promotion scheme and may be more cost effectual if it consequences in the eventual intervention of fewer immigrants who have latent infection, but who are at a greater hazard of reactivation. This protocol was investigated by Shwartzmann et Al. and, utilizing a Markov theoretical account, the writers attempted to work out the costings involved. Although the methodological analysis was non every bit rigorous as that employed by Saraiya et al. , they were able to reason that, in those immigrants who had latent tubercular disease with abnormalcies found on the CXR, a important figure could be targeted and prevented from reactivation. ( Schwartz adult male & A ; Menzies 2004 ) . Education and conformity In the context of patient instruction, one can observe that this survey besides found that of the 353 patients who constituted the entry cohort, merely 145 really completed the preventive therapy class. It is non clear from the survey whether this group merely was lost to follow up or the health care professionals merely did non acquire over the message of the importance of taking the medicine, which may look counterintuitive to an immigrant who really has no obvious symptoms. Hazard issues If these wellness publicity steps were translated into the likely scenario of an immigrant coming to the UK from a high TB prevalence state, so Kik et Al. suggest that if the premise is made that the prevalence of latent TB was 50 % of all TB instances, so merely supplying CXR would be probably to forestall 1.2 active instances per 1,000 immigrants screened and the usage of the TST trial would be probably to forestall 2.9 instances per 1,000 immigrants screened. ( Kik, Franken, Mensen, Coblens, Kamphorst, Arend & A ; Erkens 2010 ) . The TST government would be more expensive, non least because it would be expected to place a larger figure of low-risk persons every bit good as the group of as false-positive reactors who would all hence be considered campaigners for chemoprophylaxis. Contact following as wellness publicity activity Although this reappraisal has considered the wellness publicity effects of testing at immigrant entry to the UK, there is besides the mechanism of contact following which, a figure of surveies ( viz. Hardy, Varma, Collyns, Moffitt, Mullarkey & A ; Watson 2010 ) have concluded, is besides a cost-efficient manner of restricting TB spread. The set up of the primary wellness attention construction in the UK is suited for such steps as community based contact following squads can be geographically positioned. Some of the early surveies ( viz Omerod 1993 ) estimated that 1 % of all immigrant contacts had active TB at the clip of the initial showing process and, at least at the clip of the survey, 10 % of all active TB instances which were later treated were identified entirely through the mechanism of following the contacts of those who were found to be positive. Such a mechanism is besides cost-efficient with Grzybowski et Al. showing that, in an entry cohort of 244 immigrants, 103 contac ts were traced and 6 were found to hold active disease. ( Grzybowski, Fishaut, Rowe & A ; Brown 2001 ) . The writers besides found that, because of the personal intercession of the health care professionals, there was a high conformity and intervention completion rate amongst this group. The big Underwood et Al. survey, which was completed in the UK, in a badly economically deprived country with chiefly Bangladeshi immigrants, went farther and demonstrated that contact following really proved to be more efficient than testing of new entrants at the point of entry. Using contact following entirely, the writers found 13 instances of active TB from contacts of 322 new immigrants. ( Underwood, White, Baker, Law & A ; Moore-Gillon 2003 ) Decisions In decision, it is clear that wellness publicity requires designation of those immigrants who have active or latent TB and who arrive in the UK in appreciable Numberss. It is clear that there is no 1 showing technique which will adequately cover with all contingencies. Assessment and rating of the assorted techniques described demonstrate that each has peculiar strengths and failings. A considered combination of CXR and TST together with appropriate contact following appears to offer the most effectual mechanism for aiming intervention for those in demand and to understate the likeliness of farther disease transmittal. It is clearly problematic whether a showing programme which considers all immigrants ( peculiarly those from high hazard states ) is either executable of economically practical or whether the combination attack outlined above is a matter-of-fact via media which keeps the bulk of the active instances out of the UK with maximal cost effectivity