Absolutism in the 17th century Essay

It is said that Louis XIV proclaimed â€Å"I am the state!† Whether or not he really said it is debatable, but the meaning of such a statement is clear. Through the course of the 17th Century various regimes across Europe began to model their states of off the very theme of â€Å"I am the state,†; that is, the monarch personified and had absolute control over his nation. Prior to the 17th Century such absolute control precluded this absolutism. By the time of the 17th Century, however, the conditions were in place for monarchs to take absolute control to shape their nations. The conditions and forces that made absolutism a desirable form of government were the necessity of centralized control, the political instability of the time, and the rise of single sovereignty over a country. Before one goes into what causes states to adopt absolutism, one must understand it. Absolutism is defined as a form of government where â€Å"sovereignty is embodied in the person of the ruler.† The Monarch felt that he had a Divine Right, that is he was responsible to only God, and though he may respect the natural law of where he governed, generally the Monarch attempted to place his realm under absolute control. Measures included elimination of certain freedoms, centralization of power, and the creation of a bureaucracy loyal to the Monarch to help oversee the country. Through these measures, the Monarch was able to control the nobility that always threatened. The Monarch became more and more powerful as he or she began to assert power and institute absolutism. The first reason why absolutism seemed to be a desirable government form was the necessity of centralized power. War was a constant threat to a nation and it’s people. In a country divided into kingdoms and realms ruled by individual nobles and dukes, mobilization for war was a difficult and lengthy task. To better prepare a state for war a country needed a single ruler with the absolute power. Another cause was the need for efficiently raising revenue. A monarch needed absolute control to effectively raise revenue for the cost of maintaining the state. The nation-state became more and more expensive to run during this time due to the increasing frequency of wars, the costs of trade and exploration, and to support the burgeoning bureaucracy. A country divided and ruled by many different people would be  unable to raise sufficient revenue. On the other hand, a country ruled a by a single strong ruler could more easily control and manage finances. In addition, because of the nature of the time, warfare and politics became very personal. Monarchs considered countries an extension of themselves, as exemplified by Louis XIV’s supposed remark â€Å"I am the state!† To achieve this, Monarchs effectively eliminated all competition to their power, that is the nobles and the church. In the era of the Post-Reformation, it was all too easy for Monarchs to seize power from church and nobility, and this further contributed to their power. Another force at play that made absolutism seem desirable was the political instability of the time, both internal and external. France is a paragon example for this. There were many peasant revolts between 1624 and 1648, and â€Å"Nobles and Parlements took advantage of peasant revolts and the Regency to protest their loss of ancient privileges and levels of taxation. Barricades set up in Paris and the mob burst into the King’s bedroom.† King Louis XIII was powerless to stop these insurrections against his rule. Louis XIV soon came to power, and began to assert his royal authority. He put down these peasant revolts, reorganized government, and placed himself at its head. Loyal advisors were installed, and a deal with nobility which surrendered their authority in relation to the Crown in return for authority over their lands. In addition, the size of the military increased, and France began to engage in wars to help solve domestic problems. These wars were generally successful and contributed to an even higher growth in Royal authority. The successes of Louis XIV encouraged other European Monarchs to follow his example. The problems of instability seemed to be only able to fixed with a steady, but iron fist. Absolutism seemed to offer this, as the king would have authority to maintain control without interference from a constitution or a law making body. Finally, the political instability forced Monarchs to take measures that otherwise they would not wanted to take, i.e. levying heavy taxes. When the benefits of these measures came in, Monarchs often looked beyond their ideals to permanently install absolutism. To sum up, the basic political instability of the 17th Century, i.e. wars, peasant revolts, etc. paved the way for Monarchs seizing absolute control to stabilize their nations. The final cause for absolutism was the rise of single sovereignty over a country. In the times of feudalism, more than one person could have sovereignty over an area of a country. Dukes, Counts, and others may claim title to a land in addition to the Monarch’s. However the decline of feudalism brought an end to this. Kings began to assert that there could be only one sovereign to a land, and that was the King. Many new political and legal theories supported the Monarch’s absolute control over land. Jacques-Benigne Bossuet (1627-1704) adapted the medieval concept of kingship in his theory of the Divine Right of Kings, which argued that the king ruled absolutely by will of God, and that to oppose the king in effect constituted rebellion against God. Although people should be excluded from power, God’s purpose in instituting absolute monarchy was to protect and guide society.† Coming from a moral approach, Thomas Hobbes argued that a strong ruler could best control and protect a society. Further justifying absolutism, Monarchs pointed out that it seemed to end Europe’s religious wars and had brought social and political peace. King Louis XIV believed that such absolute rule over a people was the duty of a Monarch, and anything else was failing the people. Essentially, Monarchs based their absolute sovereignty on moral and political justifications. In conclusion, the conditions of the 17th Century made Absolutism seem to be a desirable choice for government, and rightly so. Following the example of France, many countries tried to centralize power. Yet, not all were to be as successful as France. For example, Oliver Cromwell instituted a dictatorship with many absolutist qualities, but this failed as soon as he died. But it is difficult to deny that absolutism was a powerful force in the 17th Century. Absolutism may seem harsh to people of the 21st Century, but for the many of those who experienced it, it was at least beneficial. The political instability of the time, the need to centralize, and the increasing sovereignty of Monarchs all were driving forces in making Absolutism popular and helpful. Despite its problems, absolutism eventually led Europe down the right path.

Clinical Trial On Piriformis Anaesthetic Health And Social Care Essay

The purpose of this clinical test is to compare the patients of pure piriformis syndrome treated with local anesthetic alone or a combination of local anesthetic and methylprednisolone. Thirty-one patients diagnosed with piriformis syndrome who received a fluoroscopy guided piriformis musculus injection. There were no signii ¬?cant differences in average baseline VAS scores between the two groups of the survey. There were a signii ¬?cant differences between average baseline and average VAS tonss obtained during telephone interview for both groups.Pain VAS had improved by a agencies of 5.13 and 6.06 compared to the baseline degree in the local anesthetic and steroid groups, severally. It was concluded that no extra benefit from utilizing corticoid was identified after piriformis musculus injection and both bupivacaine entirely and in combination with methylprednisolone have a important consequence in alleviating chronic hurting of pure piriformis syndrome. Piriformis syndrome is an uncommon and frequently underdiagnosed cause of hurting in the cheek part and referred hurting in the lower dorsum and leg. Intolerance to sitting, dyspareunia in females, and sciatica are some of the common symptoms attributed to this syndrome. It is the true diagnosing in 6 % to 8 % of patients with back hurting and sciatica. Mechanism normally accepted is an inflamed or spastic piriformis musculus that compresses the sciatic nervus against the bony pelvic girdle. Trauma, hypertrophy and anatomic fluctuations of musculus and sciatic nervus, infections, myositis ossificans are common cause of piriformis syndrome. Priformis syndrome may be treated by curative stretch, massage, ultrasound, use and non steroidal antiinflammatory drugs. Caudal steroid injection, injection of piriformis musculus with local anesthetics and steroids or botulinus toxins, and surgical resection of the musculus have been reported as effectual intervention options. Injections may be performed blindly, with musculus electromyography, fluoroscopy, ultrasound, or with computed tomographic or MRI counsel. Nerve stimulators may besides be used to place the sciatic nervus. Local anesthetics interrupt the pain-spasm rhythm and resounding nociceptor transmittal, whereas corticoids have anti-inflammatory belongingss related to suppression of prostaglandin synthesis, decreases in regional degrees of inflammatory go-betweens and by doing a reversible local anesthetic consequence. Eventhough their antiinflammatory belongingss corticoids have been hypothesized to be of benei ¬?t for nervus root infiltration. The emerging grounds besides implies that the durable curative consequence may be obtained with local anesthetics with or without steroids. Tachihara et Al. illustrated that no extra benefit from utilizing corticoid was identified after nervus root infiltration. Therefore, it is suggested that corticoids may be unneeded for nervus root blocks. There are besides inauspicious reactions in response to the disposal of man-made corticoids such as dermatologic conditions, osteonecrosis, peptic ulcer formation, weight addition, hyperglycaemia, Cushing ‘s syndrome and psychiatric symptoms changing from mild temper alterations to wholly developed psychosis. In the present survey, the purpose was to measure the patients of pure piriformis syndrome treated with local anesthetic alone or a combination of local anesthetic and methylprednisolone.MethodsThis survey conducted on retrospective rating of 31 patients diagnosed with piriformis syndrome, at the University of Inonu, School of Medicine, Departments of Physical Medicine and Rehabilitation and Pain Clinic, Malatya, Turkey between 2007 to 2009, who received a fluoroscopy guided piriformis musculus injection. All the patients were given elaborate information on the process and informed written consent was obtained from all of them. The present survey was approved by Local Ethics Committee. Piriformis syndrome was diagnosed from the followers: clinical history, physical scrutiny, EMG findings and by excepting other pathological conditions of the lumbar, sacral, sacroiliac and hep joint countries by physical scrutiny and magnetic resonance imagination or computed imaging if needed. Piriformis syndrome was suggested by hurting on tactual exploration of the sciatic notch and reproduction of hurting with manoeuvres that stretch or contract the piriformis musculus over the sciatic nervus such as forceful internal rotary motion of extended thigh ( Freiberg ‘s Maneuver ) and active hip flexure, abduction or adduction and internal rotary motion by the patient lying with the painful side up, the painful leg flexed and articulatio genus resting on the tabular array ( Beatty ‘s manoeuvre ) . All patients were examined by a individual hurting specializer and non referred by any other doctor. Exclusion standards included patients known allergic reactions to local anesthe tic and bleeding diathesis. Piriformis injections were carried out by a individual hurting specializer. The patients were placed prone on a fluoroscopy tabular array. In a unfertile manner, the cheek country on the affected side was widely prepped and draped. AP position of the hemi-pelvis and cotyloid part was obtained and so a metal marker is placed on 1/3 of sidelong facet of fanciful line between the greater trochanter and sacrum. Local infiltration with 0.5 % prilocaine was used for local anesthesia. Two milliliter of radiographic contrast stuff ( iohexol ) was injected to obtain a satisfactory myogram ( Figure 1 ) . A syringe was prepared with 10 milliliters of 0.5 % bupivacaine in local anesthetic group or 9 milliliter of 0.5 % bupivacaine + 40 milligram methylprednisolone ( 10 milliliters entire ) in steroid group and injected into the piriformis musculus after negative aspiration for blood. Following the process patients should observe alleviation of their usual hurting. All patients were responded good to a individual injection. The patients that were stubborn to local anesthetic and/or steroid medicine were non considered as a exclusive piriformis syndrome and non included to the survey. After the process, the patients were transferred to the recovery room for 1 hr and until any leg numbness subsides. If hurting persisted a 2nd injection was carried out with same manner. The primary result parametric quantity of the survey was hurting assessed by VAS, analgetic usage, hurting on motion and patient satisfaction. Follow-up scrutinies were conducted by telephone interview 6 months after local injection. Analysiss were performed utilizing SPSS 16.0 version ( SPSS Inc. , Chicago, IL ) . The Kolmogorov-Smirnov trial was used to find whether the informations deviated from the normal distribution. Nonparametric informations were evaluated with the Mann-Whitney U trial. Proportions were compared utilizing the Chi-square trial. P & A ; lt ; 0.05 was considered as important.ConsequencesMedical records of 68 patients with piriformis syndrome were evaluated. Thirty-one patients fuli ¬?lled the inclusion standards. The patient ‘s features including age, sex, weight, tallness, involved side and history of hurting until injection were comparable between groups ( Table 1 ) . No signii ¬?cant differences were noted sing first diagnosing before acknowledging hurting clinic, and conventional used intervention ( Table 2 ) . Three patient from local anesthetic group and two patients from steroid group needed to reiterate injection ( Table 2 ) . The injections for these 5 patients were repeated in a twosome of yearss. The other patients did non hold a repetition injection. There were no important differences between average baseline VAS scores between the two groups of the survey. There were important differences between average baseline and average VAS tonss obtained during telephone interview for both groups ( P & A ; lt ; 0.041 ) . Pain VAS had improved by a agencies of 5.1 and 6.1 compared to the baseline degree in the local anesthetic and steroid groups, severally. Adverse effects were seen by 27 % of the steroid and 6 % of the placebo patients. These included sleepiness in 2 steroid group patients, and 1 local anesthetic group patient, hypotension lasted in two yearss in 1 and temper alterations in 1 steroid group patients. There were no other inauspicious effects such as fluctuations of glucose degree, gastro-intestinal hemorrhage, osteonecrosis, infection, or demand of extra medical intervention attributed to the investigational medicines.DiscussionPiriformis syndrome is non to the full understood clinical syndrome and typically characterized by stray sciatic hurting limited to the cheek with radiation down the thigh, without centripetal shortages or neurogenic cause. Robinson described six diagnostic characteristics of piriformis syndrome which were: ( I ) a history of injury to the sacroiliac and gluteal parts ; ( II ) hurting in the part of the sacroiliac articulation, greater sciatic notch, and piriformis musculus that normally extends d own the limb and causes trouble with walking ; ( III ) acute aggravation of hurting caused by crouching or raising ; ( IV ) a tangible allantoid mass, stamp to tactual exploration, over the piriformis musculus on the affected side ; ( V ) a positive Las & A ; egrave ; gue mark ; and ( VI ) gluteal wasting, depending on the continuance of the status. There is no dependable nonsubjective trial to place the piriformis musculus syndrome and this is leads in many instances to great seeking for the beginning of the intractable sciatica among the lumbar pathologies. Many writers have considered injury in the gluteal country as the major cause of piriformis syndrome. Jawish et Al. believed that piriformis syndrome could be related to exacerbated rotators activity as it was observed in patients with difficult physical activity, Walkers, sports and football player or with insistent injury of nervus in patients with drawn-out sitting place. Regardless of the physiopathologic beginning of the c omplex upset, physical scrutiny and imaging surveies should be combined to corroborate the diagnosing. As, piriformis syndrome is a diagnosing of exclusion, although the patients had radicular symptoms were exluded from the survey, other imagination or correlativity to except were more common causes of sciatic hurting, such as lumbar phonograph record herniation, posterior aspect syndromes or spinal stricture, had been obtained from our included patients. The intervention end is directed ab initio toward diminishing ini ¬Ã¢â‚¬Å¡ammation, associated hurting, and cramp as hurting originates due to the entrapment of the nervus root or to one of its subdivisions, taking to the development of myofascial trigger point. This hurting may besides be due to energy crisis produced from a loss of O and alimentary supply in the presence of an increased metabolic demand. This leads to the release of neuroactive biochemicals that sensitize nearby nervousnesss that in bend initiate the motor and sensory of myofascial trigger point via the cardinal nervous system ensuing in mechanical hypersensitivity. Injection of the 10 milliliter local anesthetic into the abdomen of the musculus as we used in our survey may rinse up such biochemicals. This injection may ensue in musculus relaxation and release of the entrapped nervus. To our cognition, our survey is the i ¬?rst clinical test comparing the effectivity of local anesthetic and methylprednisolone added to the local anesthetic. Naja et Al. compared bupivacaine ( 9 mL 0.5 % bupivacaine in a entire volume of 10 milliliter ) and bupivacaine plus clonidine ( 9 mL 0.5 % bupivacaine and 1 milliliter 150 milligram Catapres ) in a randomised double-blind test included 80 patients with piriformis syndrome who received a nervus stimulator guided piriformis injection. The average VAS tonss obtained after 6 months follow up were 4.5, 3.5 and 3.3 on walking, sitting and lying down, severally. Better consequences with Catapres had been obtained. Benzon et Al. retrospectively reviewed the charts of 19 patients who had received piriformis musculus injections and described a technique for piriformis injection. After 80-100 milligram methyl Pediapred or Aristocort injection to the schiatic nervus and piriformis musculus, 18 of the 19 patients responded to the injectio n, with betterments runing from a few hours to 3 months. The three patients with pure piriformis syndrome had 70-90 % response to piriformis injection for 1-3 months. In Fishman et al.5 survey all participants received an injection of 1.5 milliliter of 2 % Lidocaine and 0.5 milliliter ( 20 milligram ) of Aristocort and improved an norm of 71.1 % , proposing the efi ¬?cacy of corticoid and lidocaine injection combined with physical therapy in handling piriformis syndrome. Filler et Al. reported 162 patients with pure piriformis syndrome given 10 milliliter of bupivacaine and 1 milliliter of celestone: 14.9 % had sustained hurting alleviation runing from 8 months to 6 old ages without return, 7.5 % had 2 to 4 months of alleviation but required a 2nd injection, 36.6 % had 2 to 4 months of alleviation but experienced return after a 2nd injection, 25.4 % of these patients benefited for merely 2 hebdomads, and 15.7 % received no benefit. The consequence of this retrospective survey pointed out that both bupivacaine entirely and in combination with methylprednisolone have a important consequence in alleviating chronic hurting of pure piriformis syndrome and it was concluded that no extra benefit from utilizing corticoid was identified after piriformis musculus injection. Competing involvement: No external support and no viing involvements declared

Paramedic Essay

â€Å"People don’t care how much you know, they want to know how much you care.† –John C. Maxwell I am attending Fortis College to become a paramedic. I want to become a paramedic not only to make a difference, but to help others in their time of need. I think of this degree as a passion not just a career. As a paramedic there is always room for continuing your education. You learn from your co-workers and the runs you go on. As early as 1500 B.C. there has been some kind of EMS. In those days it was a Good Samaritan act and completely voluntary. Moving up the time line in 1767, the Greeks and Romans took soldiers off of the battlefield by chariots. In the same time period a chief physician in the Napoleon’s army, Baron Dominique-Jean Larrey, started the first pre-hospital system used to triage and transport injured soldiers from the battlefield to aid station. In 1865-1869 the first ambulance service was started in the United States. Interns of the hospital used horse drawn carriages made specifically in taking the sick and injured to the hospital. And modern day today, there are many ambulance companies including fire houses and private ambulances. As knowledge of science and the anatomy of humans grows the knowledge of what paramedics can do grows. I have experience in the fire and EMS world. I was an explorer at the Fairfield Township Fire Department in Fairfield Township, Ohio. I was an explorer for four years. In that four years I did ride-a-longs, scenarios, and class room training. We also did competitions with other departments. In my last year at the department I interviewed and obtained the position of captain of the explorer program. The first year that my explorer post did competitions that I was attending, we placed 2nd overall and placed in 3 competitions; of those 3 I was involved in 2. This was a very exciting time of my life. I also attended the week long Fire/EMS academy at Hocking College as an explorer. I learned a lot from both programs. In conclusion, I can’t wait to start my career at Fortis College. I am excited to further my knowledge in the EMS field. Upon graduation at Fortis College, I plan to work as a paramedic at a private ambulance company and in the ER of a hospital, to only further on as a care flight medic in Columbus.

Discussion post Essay Example | Topics and Well Written Essays - 250 words - 4

Discussion post - Essay Example The aim of medical management is to remove H. pylori and to control gastric acidity. The methods used in the treatment include lifestyle changes, surgical intervention and medications (Walton, 2010). I agree with Theresa about Benign Prostatic Hyperplasia (BPH). BPH refers to a growth of the prostate gland that is noncancerous. The disease is common in elderly because the prostate continues to grow during a man’s lifetime. The symptoms of the disorder are different in various people. The most common symptoms are urgent or frequent urge to urinate, inability to start urinating and the sensation of incomplete bladder emptying. In addition, the signs include dribbling, weak stream of urine and pain when passing urine. A PSA level that is greater than 10ng ml-1 indicates a higher possibility of prostatic cancer. Methods available to screen prostate cancer include digital rectal examination, transrectal ultrasound, prostate-specific antigen, and a combination of tests (Kaplan & McVary, 2014). Medical treatments include alpha blockers that consist of terazosin, alfuzosin, tamsulin, and doxazosin. Other drugs consist of 5-alpha-reductase inhibitors where dutasteride and finaster ide are oral drugs to treat BPH. Likewise, combination treatment of 5-alpha-reductace inhibitors and alpha-blockers, and anticholinergics can treat BPH. Moreover, alternative and complementary drugs which are herbal treatments can be used in BPH therapy. Other techniques of treatments include transurethral microwave thermotherapy, transurethral needle ablation, surgical methods and minimal invasion treatment (Urology Care Foundation,

Nonverbal communication in romantic relationships - literature review Essay

Nonverbal communication in romantic relationships - literature review - Essay Example What individuals do is also reliable indicator of internal feelings. Four studies comprise this literature review. â€Å"Nonverbal Immediacy Behaviors and Liking in Marital Relationships† (Hinkle, 1999) measured the frequency of positive nonverbal behaviors in married couples and found a strong correlation with the subjects’ reported liking for one another. â€Å"Relational Messages Associated with Nonverbal Involvement, Pleasantness, and Expressiveness in Romantic Couples† (Le Poire, Duggan, Shepard & Burgoon, 2002) focused on vocal involvement, showing that partners perceived intimacy based on tone. The results of â€Å"Patterns of Matching and Initiation: Touch Behavior and Touch Avoidance across Romantic Relationship Stages† (Guerrero & Anderson, 1994) indicated sex differences in the initiation of touch, with men choosing the dominant role of initiation early in the relationship and women becoming the initiators after marriage. â€Å"Adult Attachment Style and Nonverbal Closeness in Dating Couples† (Tucker & An ders, 1998) reported that secure attachment style resulted in more positive touching. Although it may seem obvious that nonverbal communication—in general, a subconscious act—should correlate with relational satisfaction, researchers may take nothing for granted. Thus, the Hinkle study cited research that reported relationships have a greater success if the partners like one another. They also defined nonverbal immediacy as â€Å"behaviors such as touching, smiling, and making eye contact with another person† (Hinkle, 1999) and hypothesized that the more immediacy behaviors displayed by an individual, the more their partner liked them. The focus of their research was related to the duration of the relationship. They found that correlation remained constant, but that liking behaviors were strongest in the first year of the marriage and after the twenty-fourth year (Hinkle, 1999). Guerrero and Anderson began with a

Foundation clinical skills for community care Essay

Foundation clinical skills for community care - Essay Example Abstract conceptualization allows me to understand what I have personally experienced by going through a deeper level of thinking and reasoning. On the other hand, it is also possible for me to learn by understanding such that whatever I have learned and understand out of observation and reflection will be directly used and applied within the hospital setting (Atherton, 2005). The five skill sets include the following: (1) the importance of communication in patient assessment and clinical recording; (2) tissue viability in wound care and pain management; (3) continence assessment and management particularly when a patient on antibiotic asked me to carry out OptiFlo ® S irrigation (hospital policy strictly prohibits OptiFlo ® S irrigation among patients who are on antibiotics); (4) importance of keeping up-to-date with knowledge and skills on the proper intravenous access and management; and (5) importance of good communication in palliative care. With the use of the Gibbs model of reflection, I will reflect upon the five skill sets which I have learned through experience. The aim of this study is to enable the learner to have the opportunity to reflect upon five skill sets that was personally experienced by the student within the hospital/clinical setting. By doing so, the student will be able to learn and understanding the importance of skill sets better. I have personally experienced assessing the patients’ health condition prior to patient admission and eventually recording the assessment on the patients’ individual charts. When assessing the patient, I feel that the patient trusted me by verbally stating out her chief complaints. Upon evaluating the entire scenario, I thought that it was literally good for the patient to trust me with her physical health condition even though she knows that I am a student nurse. Basically, the trust that the patient has given me enabled us to have a two-way communication during the patient

Hakim's Preference Theory Essay Example | Topics and Well Written Essays - 3000 words

Hakim's Preference Theory - Essay Example She describes women into three groups of which only a minority is focused on having a professional career. She estimates that this minority stands somewhere between a tenth to the third of all the women in the workforce. A similar number of women are focused on their families and give preference to their children and their homes over their work (Jenkins, 2004). The remaining majority which could be anywhere from half the women in the workforce to 80% of women in the workforce try to adapt their work to their lives outside the office or they may try to work around their lives with their families. By splitting women into these three groups, Hakim also pointed out predictors for their employment patterns and they're marital as well as fertility rates. The results of the study she conducted to test her theory supported her ideas and she showed that the majority of women who focused on their work were employed on a full-time basis, had not married and had low rates in terms of fertility (Arndt, 2003). On the other hand, her research also showed that women who were focused on their homes and their families were more likely to be married with more than twice the number of children as compared to women who focused on their work. The numbers for fertility and marriage rates of women who adapted their professional careers to their family situation remained in the middle of work centered and family-centered women. With these ideas, Hakim dismisses years of feminist thought as myths (Jenkins, 2004). This has become the primary reason why Hakim’s Preference Theory has attracted so much attention because it is quite provocative.

Florence Nightingale Essay Example | Topics and Well Written Essays - 1250 words

Florence Nightingale - Essay Example Modern nursing concepts has since then developed from her time. This paper then is an exploration on how Florence Nightingale might view some of the modern nursing concepts of today based on her renowned book. According to Legal Concepts in Nursing Practice (n.d.), malpractice or professional negligence refers to the legal consequences when a professional nurse does an unreasonable act given a situation or when she fails to do the rightful act given a situation. Nightingale constantly raised the importance of vigilance while nursing patients throughout her book. She is certainly against malpractice and negligence in treating patients and sees these acts as pure carelessness. For Nightingale, nurses should do anything possible to maintain a healthy environment for the patient including unpleasant chores. "If a nurse declines to do these kinds of things for her patient, "because it is not her business," I should say that nursing was not her calling" (Nightingale, 1860, pp. 22) This statement also gives emphasis on Nightingale's belief that professionalism must be among the basic attributes of a nurse especially since they are dealing with patient's health and lives. While technical skills and knowledge are substantial in the profession, the way they are utilized are just as important. Another nursing concept is abandonment, where nurses leave their assigned patients without prior notice. Nightingale is adamant that nurses should always be focused on the patient. "A careful nurse will keep a constant watch over her sick, especially weak, protracted and collapsed cases" (Nightingale, 1860, pp.17). Moreover, Nightingale says that if a nurse has to go for health or duty requirements then she must go and tell her patient so. "If you go without his knowing it, and he finds it out, he never will feel secure again that the things which depend upon you will be done when you are away, and in nine cases out of ten he will be right" (Nightingale, 1860, p. 39). With this not only are the nurses doing their duties responsibly but also with deference to their patients. For Nightingale a nurse's deference or respect to the sick is beneficial to its recovery and it manifests in how nurses deal with their patients. "The official politeness in these things are so grateful to invalids, that many prefer, without knowing why, having none but servants about them." (Nightingale, 1860, pp. 49). According to Code of Ethics for Nurses (n.d.), the concept of beneficence is the obligation to do well and not harm other people while nonmaleficence is the principle of preventing intentional harm. This coincides with Nightingale's belief that the patient shouldn't be harmed further given his circumstances and that nurses should be careful and observant when dealing with patients to avoid distress or worse, mishaps. According to Nightingale (1860), when nurses talk to their patients, "nurses should stay within the patient's view" so that patients won't have to feel the pain when turning their heads around. It is advisable that nurses be as motionless as they can when talking to them and position themselves in a way that is not wearisome to the patient. Nightingale (1860) also adds that it is not advisable to "meet or overtake a

Country Analysis Research Paper Example | Topics and Well Written Essays - 1500 words

Country Analysis - Research Paper Example It was a collaboration of independent study and this Company's own study that we came up with some concrete decisions. Mexico is a good place of destination for tourists. Tourists can come from the USA because it shares a border with that economic power. Brazil also has a stable economic and political background. Both are stable politically and economically, so we have to give a discrete study and analysis on these two. Our study focused on the political, economic and business environments of the two countries touching on areas such as GDP and GNP, political background and stability and economic upturn or downturn during recent surveys. Primary research was provided by an independent think tank, but our very own Company did not waste time in surfing the web for possible clues and more data, from reference books, periodicals and other sources of data. This report analyses the sociopolitical and economic environments of Brazil and Mexico, and a commercial expansion potential for hotel industry. The basis for an expansion of a chain of hotels will be taken out of this study. Brazil and Mexico were chosen as expansion because the two countries showed growth in GDP in recent years. Our hotel business plans to expand by 2008 and has considered Mexico or Brazil to be the two countries where we can expand our business. ... Mexico is our next investment destination for our chain of hotels. 1.0 Introduction This report analyses the sociopolitical and economic environments of Brazil and Mexico, and a commercial expansion potential for hotel industry. The basis for an expansion of a chain of hotels will be taken out of this study. Brazil and Mexico were chosen as expansion because the two countries showed growth in GDP in recent years. 1.1. Product Profile Our hotel business plans to expand by 2008 and has considered Mexico or Brazil to be the two countries where we can expand our business. Our studies revolve around the socio-political, and economic and business environment perspectives of the two countries. We have concluded that it has to be only one country as place for expansion by the year, so that only one will be chosen as a result of this study. It will be either Brazil or Mexico. The studies focused on the cost of travel and tourism inside the country and the influx of tourists, costs of hotel accommodations and travel, international tourists who are the customers, and income expenditures. 2.0 Country Analysis on Mexico 2.1 Socio political environment of Mexico Mexico is an important tourism generator, just outside the top 20 in terms of expenditure, yet it is also a 'one destination' country. Roughly nine out of every ten outbound travelers go to the USA. A quarter of the population live in extreme poverty, while the richest 10% enjoy more than one-third of the total household income and the richest 20% earn more than half. According to the World Bank, Mexico ranks around 75th in the world in terms of GDP per capita, and a market to watch for the future. There was a catastrophe

The Lake House Story Essay Example for Free

The Lake House Story Essay The stories is about six hybrid children (bird/human) Max, Oz, Mathew, Ic, Peter and Wendy who were rescued from a place called the Hospital. The children were rescued by a vet named Frannie ONeil and a FBI agent named Kit. After being rescued by the couple the kids built a strong bond with Frannie and Kit after staying with them for sometime. The couple soon find themselves in court fighting for custody for the children from each of their biological parents. Even though the kids dearly want Kit and Frannie to be their parents the judge decides for them to be with their biological parents. All the kids hated being with their parents. Mathew was often bullied at school ,Peter and Wendy were used for commercials all the time, courtesy to their parents. On day a man named Ethan Kane, the man in charge of the Hospital tried to kidnap Max and Mathew. With their high intelligence and remarkable strength they managed to escape to safety and meet up with the rest of the flock. Collectively the children fly to Frannies house. Later that night workers from the Hospital attempt to break into Frannies house. Frannie comes up with an escape plan and sets her house on fire hoping to create a diversion from the workers while she and the other children escape from the basement of her home. After they escape the kids and Frannie meet up with Kit. Kit then takes them all to his home in Washington where the Hospital is located. While Kit and Frannie are out running errands the kids once again get a visit from the workers from the Hospital and get kidnapped. Oz is shot by a sniper trying to protect Max. Frannie and Kit try to protect the kids but are drugged and taken to the Hospital along with the children. Soon Max escapes and finds that patients are hooked up to holographic monitors, which takes the patients deep inside their dreams while their organs are being taken and used for the Resurrection of rich and famous people . Max manages to rescue Kit, Frannie and the other kids, and they all escape. Although they try to expose the Hospital, all evidence of their experiments disappear. The next appeal hearing takes place a few days shortly after the whole Hospital catastrophy.The judge decides its best the children go with Frannie and Kit. The family rejoices and moves back to the Lake House. There, Frannie notices that Max has been in her room all morning. She goes to investigate and finds out that Max has laid two eggs. One night, Kane suprisingly breaks into Maxs room to steal the eggs. Max knocks him out of the window hoping shed break his neck. Four weeks later, the eggs hatch. The winged babies are a boy and a girl, who are name Ozymandias and Frances Jane. The book ends with Max thinking that she cant wait to teach them how to fly.

Integrated Occupational Therapy Practice Case Study

Integrated Occupational Therapy Practice Case Study Introduction This report will focus on the occupational therapy (OT) process for Meera (Appendix A), a 56-year-old woman with a left cerebral vascular accident (CVA). Stroke is the death of brain cells due to the lack of oxygen (Bartels et al. 2016).It can either present as haemorrhagic or ischaemic in nature. Risk factors of CVA include hypertension and hypercholesterolemia which Meera has. Stroke may lead to neurological, psychological, speech and musculoskeletal complications. Meeras symptoms of right hemiplegia, right sided neglect and speech difficulties can be attributed to the occlusion of her left middle cerebral artery (Mtui et al. 2016). A multidisciplinary inpatient stroke rehabilitation unit was involved with Meeras post-stroke rehabilitation. Stroke patients who underwent treatment inpatient stroke care were found to have improved independence (Stroke Unit Trialists Collaboration 2013). Treatment was aimed at managing vital problems through restorative and compensatory approaches in order to prepare her for discharge (Edmans 2010). Thus, this service was most appropriate for Meera due to her recent onset of stroke. The OT process was guided by recommendations from the College of Occupational Therapist, National Institute for Health and Care Excellence (NICE)(2013) and Intercollegiate Stroke Working Party (ISWP)(2016)(Edmans 2010). Assessments and Problems Identified An initial assessment was gathered through an interview using the Kawa Model. It portrays a persons life as a river and various objects such as rocks, river banks and driftwood depict circumstances experienced by a person (Teoh and Iwama 2015). Younger stroke patients such as Meera may require services which cater particularly to their needs which most stroke units were found not to do so (ISWP 2016). As Kawa focuses on the view of the client, it allows the therapist to know what is important to Meera in order to formulate priorities for intervention. The assessment is shown below: Life flow and priorities (river) Past Medical History: Hypertension Hypercholesterolemia Roles and Occupations: Independent in self-care Proud Stay at home mother Took charge of matters at home such as: Cleaning Shopping Gardening Laundry Enjoys cooking for family Present Medical History: Stroke Roles and Occupations: Patient Needs assistance in most self-care tasks Loss of previous role and not engaging in occupations meaningful to her Future Meera felt afraid and pointless to talk about the future, worrying that she may have another stroke if she engaged in activity. Obstacle and Challenges (rocks) Occupational performance challenges: Right hemiplegia with increased spasticity in right arm and leg, causing difficulty in: Sitting Coordination of movement Tasks that require her hands due to being right handed Unable to feel sensations on right hand Feels she cannot remember things as easily and may not know the time and place she is at Right sided neglect with visual agnosia, resulting in difficulty : washing right side awareness of people approaching from affected side interacting with others Expressive dysphagia hinders communication with others. Feeling low mostly Feels useless Embarrassed that people are taking care of her Fatigues easily Concerns Family unable to function as she is unable to manage the household A burden to family, especially her husband who needs to manage the household together with the pressure at work now that she is in hospital Childrens studies and social life may be affected as they may be concerned about Meera and visiting her in hospital may affect their daily life Physical and Social Environment (river banks) Physical (Home) 3 room semi-detached Bathroom, toilet and bedroom on the upper storey Kitchen, combined living and dining room on ground floor Nearest bus stop and convenience store 10 minutes walk away Social Close knit family Meera usually supports family members as they will confide her during difficulties Looks forward to dinner every day where family will gather together Family is most vital source of support for Meera Frequent interaction with neighbours and will help each other with chores if needed Occasionally communicates with extended family overseas on phone Personal resources (driftwood) Personality Hardworking Afraid of trying new things Kind and caring Responsible With information from the initial assessment, the problem list was formulated in a client-centred manner (ISWP 2016). Stroke survivors felt more engaged in the therapeutic process when their perspectives were taken into account (Peoples et al. 2011). Interventions were based on Meeras perceived problems in order to increase her motivation in therapy which she lacked. However the Kawa model only shows the problems perceived by Meera but not the therapists views. In order to gather a clinical and therapeutic point of view, standardized assessments were conducted as well. The table below depicts the various assessment conducted, reasons for use, limitations and results. Assessment Reasons for use and limitations Results Assessment of Motor and Process Skills (AMPS) (Fisher and Jones 2010) AMPS evaluates motor and processing skills of clients through observation of appropriate tasks (Fisher and Jones 2010). Self-care, specifically showering, dressing and cooking tasks which was important to Meera, were used to assess. This allowed the OT to break the tasks down and acknowledge the challenges Meera faced in order to formulate an appropriate intervention. AMPS was found to be valid, reliable and standardized among cultures but results has to be computer generated in order to be valid which may make the process tedious (Fisher and Jones 2010). Less than 1 for both motor (Moderate increase in physical effort) and process (Moderate inefficiency and disorganization) skills. Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) (Itzkovich et al. 2000) LOTCA evaluates the orientation, visual and spatial perception, visual-motor organization and thinking operations through the use of various activities included in the kit (Itzkovich et al. 2000). This allowed the OT to assess Meeras right sided neglect and to discover any underlying cognitive deficits. The LOTCA is reliable and valid for use in people with stroke but needed to be conducted in more than one sitting as assessments were long and tedious for Meera who experience fatigue (Katz et al. 2000). Meera was able to sequence tasks but was unable to complete tasks involving her right field of vision. She needed prompts to complete orientation tasks. Activities involving memory were also a challenge for her. Rivermead Motor Assessment (RMA) (Lincoln and Leadbitter 1979) The RMA consists of tests evaluating the gross, leg, trunk and arm function of a stroke patient (Lincoln and Leadbitter 1979). This was conducted together with the physiotherapist. The RMA allowed the team to know which movements Meera had difficulties in order to formulate appropriate interventions. This assessment was found to be reliable and valid but due to being strenuous and long, it had to be conducted in a few sessions due to Meera showing signs of fatigue (Kurtais 2009) Meera was not independent in transfers and mobility, she required assistance of one for transfers and used a wheelchair for mobility. She also had minimum trunk and leg control at her affected side and require assistance for movement. However, she is able to hold objects using her affected arm but cannot reach for an object far away due to scapular instability. Â  From these assessments, 3 problems Meera faced, in order of significance was developed: 1. Loss of independence in self-care affected Meera the most. From the assessments conducted, it was found that challenges in motor, cognition and perception affected her performance in self-care. Managing self-care would focus on these domains as well (NICE 2013). It was hoped that Meera would be more engaged in therapy by focusing on an issue she perceived as critical. This was evidenced by a study where patients were more motivated and engaged more in interventions when treatment was catered to their perceived needs (Combs et al. 2010). This would also help Meera to elevate her mood as low involvement in self-care was found to be a factor for post-stroke depression (Jiang et al. 2014). The psychologist in the team would be managing Meeras low mood as well (ISWP 2016). By working with Meera on her self-care would also remove some burden from Sanjay, who was assumed to be her main carer when she is discharged from hospital. 2. Problems with visual perception, specifically right side neglect and agnosia, were targeted as it was found to have an influence on self-care (Barker-Collo et. al 2010). This would help Meera in performing self-care tasks. Her visual deficits also affected her social life and transfers. Managing her perceptual problems would allow her to interact more with other patients in the ward which could provide her with social support. 3. Meeras motor challenges, specifically right side weakness and spasticity were addressed as it was one of the major challenges faced during self-care. It was hoped that through the management of motor deficits, Meera would increase her engagement in occupations. This would also have a positive effect for Meera in future as it was shown that physical function affected quality of life in stroke patients (Ellis et al. 2013). Motor challenges faced by Meera would be managed in conjunction with the physiotherapist (ISWP 2016). Skills in managing motor challenges can also be transferred to other aspects such as cooking and reinstating her role as a homemaker. Treatment Plan Client Aims: Meera wants to be more engaged in her personal care. Therapist Aims: To increase Meeras engagement in her self-care tasks. To manage Meeras right sided neglect and agnosia. To manage Meeras weakness and spasticity in her right arm, leg and trunk. Objectives: Meera should be able take charge of her own shower and dressing every morning for an hour, with assistance of one, in 4 weeks. Meera should be able to independently identify items required on her right field of vision for washing and dressing every morning in 4 weeks. Meera should be able to go from lying to sitting, and pivot transfer from bed to wheelchair as well as from wheelchair to shower chair, every morning with assistance of one in 4 weeks. Intervention Washing and dressing assessment was conducted through the use of AMPS. This allowed the OT to formulate an appropriate wash and dress plan for multi-disciplinary use through identified difficulties in motor and processing skills (Fisher and Jones 2010). Using a meaningful occupation as a basis for intervention was beneficial for Meera. This can be supported by a study where occupation based intervention was shown to be critical in improving occupational performance (Wolf et al. 2015). The intensity of the intervention would be higher than the recommended minimum frequency of 45 minutes, 5 days a week as it was included in Meeras daily routine (NICE 2013). The washing and dressing plan was adapted from Salisbury District Hospitals (2013) assessment form. The OT conducted the first session in order to teach Meera the relevant compensatory and visual scanning skills. Other sessions could be conducted by other staff with guidance from the plan. A further review after every few days would also be required in accordance to recommendations (ISWP 2016). Washing and dressing plan for Meera Transfers Bed Mobility: Meera is able to roll to her right side independently. She requires assistance from lying to sitting. Bed to wheelchair: Require assistance of one for pivot transfer Standing: Require assistance of one and grab rail in the bathroom Wheelchair to shower chair: Require assistance of one for pivot transfer Allow Meera to navigate to bathroom Washing Notes: Require the use of a shower chair in the shower Allow Meera to initiate and sequence task independently Only give Meera assistance when she asks for it Place items necessary for shower on Meeras right side If Meera seems to be searching for something, prompt her to look for it by turning her head Encourage use of right hand to wash herself Meera may require assistance to release her grip on objects Provide assistance if Meera feel fatigue Upper body: Meera is able to wash her right side independently Meera require assistance to wash above her elbows on her left side Assistance may be needed to wash hair and back thoroughly Lower Body: Meera should be able to wash her genitals and front upper thighs independently Assist Meera in standing with the grab rail with one person supporting at all times Another person will assist Meera in cleaning her bottom and her rear upper thigh Encourage Meera to wash her lower thighs but prevent her from falling from the shower chair Assist in cleaning the rest of the lower thighs Dressing Upper Body: Encourage Meera to put on the bra independently using the one arm method. Allow Meera to use the one hand method to wear her t-shirt. Prompt her by reminding her of the steps if she is struggling Lower Body: Meera requires assistance to put on her trousers while assisted in standing. Both the restorative and adaptive approach was used to guide the intervention. Restorative approach is grounded upon neuroplasticity where relearning takes place when new neural connections form in the brain during constant exposure to various stimulus (Gillen 2016). By practising various movements of her affected side during self-care, Meera should have a reduction in her impairments. This is supported by a study where patients who went through functional motor relearning therapy were found to have improved balance and performance in self-care (Chan et al. 2006). The compensatory approach is where tasks are modified to be easier for the clients to achieve (Edmans 2010). Even though this approach has been criticized for hindering motor recovery in people with stroke, it is still appropriate for Meera (Jones 2017). The compensatory method of using the one hand dressing method served as a feedback mechanism which could improve motivation as supported by Popovic et al. (2014). This would thus encourage Meera to engage in therapy. Risk Management Plan Meera might be fatigue and may not be able to do some of the tasks required. The staff in charge will assist when required and allow Meera to rest when needed. Due to the intimate nature of a wash and dress, Meera might feel embarrassed and down during the process. In order to preserve her dignity, sensitive areas would be covered whenever necessary and observation would be subtle. Environmental hazards would be checked before commencing any transfers or wash and dress in order to prevent falls. Relapse prevention In the hospital setting, encouragement for frequent engagement in occupation and usage of relevant motor and cognitive skills would prevent Meeras occupational performance from deteriorating (Brainin et al. 2015; Ullberg et al. 2015). According to NICE (2013), long-term health and social support should include education on symptoms and dysfunction relating to stroke, services available and participation in meaningful occupation. As such, Meera and her family would be briefed on these strategies. Outcome Measures Evaluation of treatment outcomes is important to conclude if the intervention was successful and used to change the treatment plan according (Mew and Ivey 2010). The outcomes were evaluated by using goals and comparing standardized assessment at baseline and outcome. Firstly, intervention was evaluated through the achievement of goals. Goal achievement was linked to client satisfaction and a significant client-centred outcome (Custer et al. 2013). Meera was able to achieve the objectives as expected. Secondly, the AMPS was conducted again, using the task of showering and dressing (Fisher and Jones 2010). Meera scored higher in these tasks but still required some assistance in achieving them. Thirdly, Meera improved on the LOTCA tasks which involved visual scanning, little to no improvement was seen on the orientation and memory tasks (Itzkovich et al. 2000). Lastly, the RMA was conducted again (Lincoln and Leadbitter 1979). Meera improved in the trunk, leg and upper limb function but there were still signs of weakness and instability involved. Further plans Other domains of concern would be managed as according to initial assessment and outcome measures. Further interventions would include management of cognitive function such as memory and orientation through cooking. Including Meera in a social group such as breakfast club in the ward would be beneficial to her as well (Venna et al. 2014). To prepare for discharge, Meera would be referred to the Early Supported Discharge team. The team would help Meera and her family by introducing appropriate adaptations at home and relevant education on stroke (ISWP 2016). A smooth transition from hospital to home was found to improve patients function in activities of daily living and service satisfaction (Fearon et al. 2012). This would thus be beneficial for both Meera and her family. References Bartels MN, Duffy CA and Beland HE (2016) Pathophysiology, Medical Management, and Acute Rehabilitation of Stroke Survivors IN: Gillen G (ed) Stroke Rehabilitation: A Function-Based Approach (4th Edition). Missouri: Elsevier 2-45 Brainin M, Tuomilehto J, Heiss WD, Bornstein NM, Bath PMW, Teuschi Y, Richard E, Guekht A and Quinn T (2015) Post-stroke cognitive decline: an update and perspectives for clinical research. European Journal of Neurology 22(2):299-e16 Chan DYL, Chan CCH and Au DKS (2006) Motor relearning programme for stroke patients: A randomized controlled trial. Clinical Rehabilitation 30(3):191-200 Combs SA, Kelly SP, Barton R, Ivaska M and Nowak K (2010) Effects of an intensive, task-specific rehabilitation program for individuals with chronic stroke: A case series. Disability and Rehabilitation 32(8):669-678 Custer MG, Huebner RA, Freudenberger L, Nichols LR (2013) Client-chosen goals in occupational therapy: Strategy and instrument pilot. Occupational Therapy in Health Care 27(1):58-70 Edmans J (ed) (2010) Occupational Therapy and Stroke (2nd Edition). Chichester: Wiley-Blackwell Ellis C, Grubaugh AL and Egede LE (2013) Factors associated with SF-12 physical and mental health quality of life scores in adults with stroke. Journal of Stroke and Cerebrovascular Diseases 22(4):309-317 Fearon P, Langhorne P and Early Supported Discharge Trailists (2012) Services for reducing duration of hospital care for acute stroke patients. Cochrane Database of Systematic Reviews 7: CD000443 Fisher AG and Jones KB (2010) Assessment of Motor and Process Skills Vol. 1: Development, Standardization and Administration Manual (7th Edition). Fort Collins: Three Star Press Gillen G (2016) Stroke Rehabilitation: A Functional-Based Approach (4th Edition). Missouri: Elsevier Intercollegiate Stroke Working Party (2016) National Clinical Guideline for Stroke. Royal College of Physicians. Available from: https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx [Accessed 28 March 2016] Itzkovich M, Averbuch S, Elazar B and Katz N (2000) Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) Battery (2nd Edition). New Jersey: Maddak Inc. Jiang XG, Lin Y and Li YS (2014) Correlative study on risk factor of depression among acute stroke patients. European Review for Medical and Pharmacological Sciences 18(9):1315-1323 Jones TA (2017) Motor compensation and its effects on neural reorganization after stroke. Nature Reviews Neuroscience doi:10.1038. Available from: https://www.nature.com/nrn/journal/vaop/ncurrent/pdf/nrn.2017.26.pdf [Accessed 28 March 2017] Katz N, Hartman-Maeir A, Ring H and Soroker N (2000) Relationships of cognitive performance and daily function of clients following right hemisphere stroke: Predictive and ecological validity of the LOTCA battery. Occupation, Participation and Health 20(1):3-17 Kurtais Y, Kucukdeveci A, Elhan A, Yilmaz A, Kalli T, Tur BS and Tennant A (2009) Psychometric properties of the Rivermead Motor Assessment: Its utility in stroke. Journal of Rehabilitation Medicine 41(13):1055-1061 Lincoln N and Leadbitter D (1979) Assessment of motor function in stroke patients. Physiotherapy 65(2): 48-51 Mew M and Ivey J (2010) The Occupational Therapy Process IN: Edmans J (ed) Occupational Therapy and Stroke (2nd Edition). Chichester: Wiley-Blackwell 49-63 Mtui M, Gruener G and Docker P (2016) Fitzgeralds Clinical Neuroanatomy and Neuroscience (7th Edition). Philadelphia: Elsevier National Institute for Health and Care Excellence (2013) Stroke Rehabilitation in Adults. Available from: https://www.nice.org.uk/guidance/cg162/resources/stroke-rehabilitation-in-adults-35109688408261 [Accessed 28 March 2016] Peoples H, Satink T and Steultjens (2011) Stroke surviors experiences of rehabilitation: A systematic review of qualitative studies. Scandinavian Journal of Occupational Therapy 18(3):163-171 Popovic MD, Kostic MD, Rodic SZ and Konstantinovic LM (2014) Feedback-mediated upper extremities exercise: Increasing patient motivation in poststroke rehabilitation. BioMed Research International 2014(2014): Article ID 520374. Available from: https://www.hindawi.com/journals/bmri/2014/520374/ [Accessed 28 March 2017] Salisbury District Hospital (2013) Occupational Therapy Washing and Dressing Assessment. Salisbury NHS Foundation Trust. Available from: http://www.icid.salisbury.nhs.uk/ClinicalManagement/RecordsAndForms/Documents/12e3053a7be542cabff277c26634947aAcuteOTWashDressAssv1007091.doc [Accessed 28 March 2017] Stroke Unit Trialists Collaboration (2013). Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews 9:CD000197 Toeh JY and Iwama MK (2015) The Kawa Model Made Easy: A Guide to Applying the Kawa Model in Occupational Therapy Practice (2nd Edition). Available from: http://www.kawamodel.com/download/KawaMadeEasy2015.pdf [Accessed 28 March 2017] Ullberg T, Zia E, Petersson J and Norrving B (2015) Changes in functional outcome over the first year after stroke: An observational study from the Swedish Stroke Register. Stroke 46(2):389-394 Venna VR, Xu Y, Doran SJ, Patrizz A and McCullough LD (2014) Social interaction plays a critical role in neurogenesis and recovery after stroke. Translational Psychiatry 4(1):e351 Appendix A Meera CVA Meera is a 56-year-old woman who was recently admitted with a left Cerebral Vascular Accident affecting the middle cerebral artery. She has a history of hypertension and hypercholesterolemia. She was admitted via A E after being found by her husband. Her husband reports that she felt unwell and made her way upstairs to have a lie down. He went out to walk the dog and on his return found her on the floor in the bathroom. Meera presents with a right hemiplegia with increased spasticity in her right arm and leg. As a result, she has difficult with sitting balance and co-ordinating her movements in order to engage in activities such as washing and dressing. Meera also presents with right sided neglect, which results in her failing to identify objects on her right side, difficulty washing her right side and responding to others who approach her from her right. She has difficulty in articulating in a meaningful way to get her needs met and is very tearful. The Occupational Therapist under took an initial assessment with Meera, the report is detailed below. Initial assessment summary Meera appears low in mood and is reluctant to talk about the future. She is worried that she may have another stroke and consequently is reluctant to engage in activity. Meera is embarrassed that she needs help in personal activities of daily living and is reluctant to talk about activities that she finds difficult. Family Meera is married to Sanjay, a 58-year-old man who works as a plumber. They have two children, Anni aged 18 years who has just completed her A levels and will be attending a local university in one months time, and Sam aged 17 who is at secondary school. Social situation The family live in a privately owned three bedroomed semi-detached property in a small town. Sanjay describes Meera as a stay at home mum who prides herself on her family and her cookery skills. Posture Meera has a right- sided hemiplegia; her scapular is unstable and she finds it difficult to flex her arm above 90 degrees. Elbow extension is uncontrolled and there is stiffness in her forearm making supination difficult. She is able to grasp objects but finds release very difficult. Sensory assessment Meera has poor deep and light sensation in her right hand, which has a profound effect on a range of performance areas. Cognition and perception Meera has a right sided neglect which interfers with washing and dressing, and transfers. She also has difficulty socialising with other patients on the ward due to to this. Meera has some cognitive impairment which presents as poor memory and disorientation. These features are more prominent at the end of the day when Meera is tired. Mobility Meera currently uses a wheelchair but can manage a controlled transfer with one person assisting.

Charity Wards Philippine Hospitals Health And Social Care Essay

Charity Wards Philippine Hospitals Health And Social Care Essay The presence of charity wards in Philippine hospitals, whether public or private, has been a quiet issue. Those who are aware of the existence of this ward are the ones that cannot afford regular wards or those that prefer the services given in the charity wards. Most hospitals that offer their services through the means of having charity wards often have different elements to be paid for. The basic elements are the medical materials used, professional fees, and hospital fee. Often times the patients confined in these wards are the ones that provide the basic medical materials needed. There are also instances wherein professional fees of doctors are either waived or discounted for, while the hospital fee is rarely waived. One cause of conflict can be how the hospital prioritizes which patient should be attended to first; there are some hospitals that select paying patients before those who are not able to pay and sometimes they forego the triage system. The triage system is the system in which hospital personnel determine the level of priority of each patient based on the patients current physical condition. Of course, charity wards consist of only a certain number of beds and so charity patients may only be accommodated depending on availability and the hospitals capability to handle his or her case. This issue raises questions such as how do paying wards affect patient care and accommodation in charity wards? Do hospitals charge paying patients more than the actual cost of care? How are they [hospitals] able to afford for the continuous upkeep of charity wards? What is the governments involvement regarding this issue? And lastly, is the charity ward beneficial to all stakeholders? Background Information The charity system of service was first practiced in St. Lukes Medical Center and was established by American Missionaries in 1903. By 1910, St. Lukes increased bed capacity in the hospital to 52, catering dominantly to charity patients. In 1946, the University of Santo Tomas opened their pay and charity wards at the newly opened facility in Espana, Manila. More hospitals would follow suit with their own respective charity wards and as with St Lukes and UST, they funded themselves through the paying wards. It has been cited that in UST, their charity wards have solely been funded via the paying wards and never through government subsidies nor through the tuition fees of students enrolled in medical and allied medical courses. This may show that charity wards, now known in a more politically correct term of service wards, are not black holes for hospitals; they do not necessarily exhaust medical facilities of revenues, supplies and such. It also shows that hospitals charge more than t hey really should but since it is for a good cause, it may well be worth it. It has also been general knowledge that in charity wards, medical interns and students are often allowed to handle patients while they have very limited patient in pay wards. It is something that hospitals will not publish but it is a widely accepted act. Also, faster and better service can obviously be found in pay wards and not in charity wards. Despite the fact that certain hospitals can afford having a fully functional charity ward, government subsidies are always welcome things for them as, according to UST Hospital, it can cost upwards of P115 million per annum to run their charity facility, which is at a 65% occupancy rate. Of USTHs patients, only 25% have PhilHealth coverage but even then, patients still have to pay as much as 50 centavos for every peso of treatment cost. It can cost significantly more for the Philippine General Hospital which has a total of 1,500 beds for pay, charity and special patients as compared to USTHs total of 443 beds, and a 95% occupancy rate for charity ward as compared to USTHs 65%. According to the 2007 National Health Accounts, a study done by the National Statistical Coordination Board, the Department of Health along with the financial assistance of the Department of Health Office of the Secretary (DOH-OSEC), Dangerous Drugs Board (DDB), Philippine Heart Center (PHC), National Kidney Transplant Institute (NKTI), National Nutrition Council (NNC), Lung Center of the Philippines (LCP), Philippine Childrens Medical Center (PCMC), and Commission on Population (PopCom) allotted P20.3 billion for the budget of various health programs and institutions. From the P20.3 billion, only P15.4 billion goes to personal and public health care, namely government hospitals and the like. The breakdown of the budget under personal health care is P13.4 billion which is then directly transferred to government hospitals, while in public health care only P1.9 billion is allotted. The involvement of local government units (LGUs) in the financial assistance for public health care has been significant in contrast to the Department of Health; the LGUs had substantially allocated P13.7 billion according to the 2007 Philippine National Health Accounts. According to the An Analysis of the Presidents Budget for Fiscal Year 2007 conducted by the Congressional Planning and Budget Department, the total budget of the Philippines in that year was P1.126 trillion and from that P329.4 billion was allocated for social services. Of that, P14.5 billion or 1.3% of the national budget was specifically allocated for health. For 2007, hospital services get the biggest share amounting to 7.1 billion or 65% of the total budget. Public health gets only 14% of the budget, 2 percentage points lower than administration function receives. Regulation gets 5% of total budget for 2007. (Congressional Planning and Budget Department, 2007, p.103) It was also stated that in the pattern of budget distribution of the Department of Health since 2003 up to 2007, no change has been made. Hospital services continue to get the biggest chunk ranging from 65% to 71%. Budget allocation for public health and administration during the period get from 14% to 16% only. Regulation is given the least share ranging from 2% to 5%. (Congressional Planning and Budget Department, 2007, p.103) Even if there is a recognizable amount in the allocation of the national budget regarding health care, it is not sufficient in helping to defray the costs of necessary health care. Those in the marginalized sector, earning a minimum wage, often seek the services offered by the charity system available in government and public hospitals. However, there are some instances that these individuals may not be able to afford the costs that are followed in being confined in these said wards. Indeed, charity wards are supposed to be affordable, most especially to those who need it the most, but is does not necessarily mean that the services offered will be free. According to the newspaper article, title How charitable are charity hospitals?, a patient confined in the charity ward of a university-based hospital found out that their hospital bill reached P16,000 just for a weeks confinement. Now if that patient were just earning minimum wage and works for six days a week, he would just have earned P2,424 and that will not be enough to pay for his hospital bill. That only covers hospital fees and the medicines used during procedures done; it does not include post-operative or post-hospitalization care and maintenance. The implementation of the Philippine Generic Drug Act 1988 which requires the use of generic labeling and advertising of drugs have somewhat helped in making necessary drugs and such to be readily available to the public but that still adds to the expenses of the already strained household budgets of our lower class sector. According to The Prices People Have to Pay for Medicines in the Philippines by the Institute of Philippine C ulture in Ateneo de Manila University, the Philippines is one of the countries that have problems with drug accessibility for the public. According to their study, which cites the World Health Organization, less than 30% of the population has regular access to important medicines. This may be attributed to the costs of medicine taken in relation to the average income of the working classes. A 2007 statistical study titled Trends and Characteristics of the Middle-Income Class in the Philippines: Is it Expanding or Shrinking?, showed that the lower classes are in the bottom 76.7% of families living in the Philippines. This lower class group has an annual income bracket of P5,000 to P242,228 with an average annual income of P109,580. This does not include indigents and the truly poor. Sources: Ancheta, A. Q. (10 August 2010). William H. Quasha His Relevance to St. Lukes Revisited. Retrieved on November 15, 2010 from St. Lukes College of Medicine website: http://stlukesmedcollege.edu.ph/default/news-and-events/action,Display/news_id,63 Batangan M.D., M.Sc., D.B. (n.d.). The Prices People Have to Pay for Medicines in the Philippines. [PDF File]. Retrieved on November 16, 2010 from: http://www.haiweb.org/medicineprices/surveys/200502PH/sdocs/survey_report.pdf Congressional Planning and Budget Department. (2007). An Analysis of the Presidents Budget for Fiscal Year 2007. [PDF File]. Retrieved on November 16, 2010 from http://ia700104.us.archive.org/10/items/CongressBudgetPlanningDept2007NationalBudgetofPhilippines/budget07.pdf Dalangin-Fernandez, L. (22 March 2007). Arroyo signs P1.1-Tr budget for 2007. Retrieved on November 16, 2010 from Philippine Daily Inquirer website: http://newsinfo.inquirer.net/breakingnews/nation/view/20070322-56398/%28UPDATE%29_Arroyo_signs_P1.1-Tr_budget_for_2007 de la Cruz, M. (21 October 2007). How charitable are charity hospitals?. Retrieved on November 11, 2010 from Inquirer.net: http://services.inquirer.net/print/print.php?article_id=20071021-95772 Fernandez M.D., C. R. (n.d.). UP-PGH Emergency Department Triage. Retrieved on November 15, 2010 from Philippines Society of Emergency Care Physicians website: http://psecp.org/index.php?option=com_contenttask=viewid=30Itemid=48 Malaya Newspaper. (29 September 2007). Malaya Feature: Philippine General Hospital at 100, PGH: Leader in Quality Health Care. Retrieved on November 15, 2010 from Philippine Headline News Online website: http://www.newsflash.org/2004/02/si/si002422.htm National Statistical Coordination Board. (3 August 2010). 2007 Philippine National Health Accounts. Retrieved on November 16, 2010 from NSCB website: http://www.nscb.gov.ph/stats/pnha/2007/2007pnhatables.asp St. Lukes Medical Center. (n.d). St Lukes Medical Center Fast Facts. Retrieved on November 16, 2010 from St. Lukes Medical Center website: http://www.stluke.com.ph/home.php/sb/Fast_Facts Virola, R. A. (n.d.). Trends and Characteristics of the Middle-Income Class in the Philippines: Is it Expanding or Shrinking?. [PDF File]. Retrieved on November 16, 2010 from: http://www.nscb.gov.ph/ncs/10thNCS/papers/contributed%20papers/cps-12/cps12-01.pdf (n.a.). (30 September 1961). G.R. No. L-15270. Retrieved on November 16, 2010 from The LawPhil Project website: http://www.lawphil.net/judjuris/juri1961/sep1961/gr_l-15270_1961.html (n.a.). (25 June 2007). When priests quarrel. Retrieved on November 16, 2010 from Manila Standard Today website: http://www.manilastandardtoday.com/2007/june/25/felMaragay.htm

Analysis of Shakespeares The Tempest - The True Villain :: Shakespeare The Tempest

The True Villain of The Tempest On June 2, 1609, five hundred colonists set out in nine ships from Plymouth in association with the imperial Virginia Company. It was the aim of this expedition to fortify John Smith's colony in Virginia. While eight of the party's vessels securely arrived at Jamestown, the flagship, called the â€Å"Sea Adventure† , was conspicuously absent. This ship --which carried the fleet's most valuable cargo, the admiral Sir John Somers and the future governor of Virginia Sir George Somers --was separated from the other eight during a fierce storm off the coast of Bermuda, the legendary Isle of Devils, dreaded by superstitious sixteenth-century sailors. William Strachey describes the tempest which precipitated the ship's "wracke" in a letter dated July 15, 1610: "a dreadfull storme and hideous began to blow from out the North-east, which swelling, and roaring as it were by fits, some houres with more violence than others, at length did beate all light from heaven; which like an hell of darkenesse turned blacke upon us, so much the more fuller of horror." The â€Å"Sea Adventure† was rebuilt on the island, which was not as menacing as the storm itself, and nearly a year later the ship rejoined the fleet in Virginia. By many, this was deemed a miracle. Some believe it was this shipwreck that prompted Shakespeare to write this political, yet comic play which involves usurpation, mockery, love, reconciliation and forgiveness. It all starts with Prospero, the rightful Duke of Milan, being banished by his brother, Antonio, who illegally usurps the throne. Basically, the first thing Antonio does in scene I is curse the boatswain: â€Å"Hang, cur, hang, you whoreson, insolent noisemaker, we are less afraid to be drowned than thou art.† This already suggests that Antonio is not the nicest of dukes. He is a very authoritative man, he need not do anything, he lets people do it for him. As the ship splits, he still curses the boatswain and does not get involved with the desperate attempts of the mariners to steady the ship. When they find themselves stranded on the remote island, all except Antonio and Sebastian see that which is good around them, Gonzalo remarks how their clothes are surprisingly clean. Antonio and Sebastian mock Gonzalo and the others for seeing good where they only sees rottenness and corruption. Their cynicism clearly show they do not agree, they mock them with witty word-play:

The Qualities of the Houyhnhnm’s Civilization in Gullivers Travels Ess

In part 4 of Gulliver’s Travels, Gulliver is abandoned on an island by his crew. As Gulliver begins to explore his surroundings, a group of savages attack him. These savages appear to be human, however they behave like wild animals. Gulliver is rescued by a couple of horses. The horses are called â€Å"Houyhnhnms† are rational creatures which are capable of speech and thought. The horses refer to these human-like creatures as â€Å"Yahoos† and treat them as wild animals incapable of reasoning. Gulliver is very surprised how the Houyhnhnms speak to each other, while the Houyhnhnms are equally surprised at the appearance and behavior of Gulliver. The horses lead Gulliver back to their base where they proceed to find out more about him. Gulliver also describes them and how they converse with each other. Gulliver pays close attention to their language and eventually learns how to speak with them. He asks them questions about their culture and learns about their socie ty. He tells them about his society and how horses are treated and how the humans are far superior to the horses. Gulliver is treated very well by the Houyhnhnms. Gulliver spends a lot of time with one horse in particular. Gulliver refers to this horse as his master. Gulliver tells his master of his life and his native land which is England. Gulliver talks about his crew and their lives and troubles. Many of Gulliver’s crew were lost at sea and they were replaced by criminals and men who were desperate for work. In describing these men, Gulliver shows his master what human nature is like. Gulliver has a hard time explaining the crimes and motives of men and their actions because his master does not understand dishonesty and treachery. Gulliver talks about why humans wage wars aga... ... of the Houyhnhnm and their pursuit of knowledge allow them to live in perfect happiness. They are not selfish or greedy and are perfectly honest. If humanity were to strive towards gaining these qualities which the Houyhnhnm possess, humans would be more likely to create a better society. Humanity has created governments in order to promote justice, peace and prosperity. The Houyhnhnm created a similar government to help them maintain their virtuous society. Humanity must place a large importance on virtue in order to make human society better. Humanity is very different from this land of horses. The horses seem to lack any emotion and are incapable of joy and sorrow. Humans often allow emotions to guide their decision-making process. The Houyhnhnm allow only reason to guide them. Humans should try to replicate this pattern to create better effects for society.

Obamacare Essay

â€Å"Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.† Those words were famously spoken from Barack Obama during his election period. Following through with those words, he begins to make change in the country. Change isn’t easy, yet you hope it’s worth it in the end. The USA seems to be standing on both sides of the fence when it comes to the changes the President is making with healthcare. March 23, 2010 Obama signed into law Affordable Care Act, or better known as Obamacare. Together with the Health Care and Education Reconciliation Act, it represents the most significant government expansion and regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965 (www.obamacarefacts.com). Obamacare was enacted to provide affordable health insurance to 44 million uninsured Americans and to reduce the growth in health care spending. Obamacare has done some important things already, such as prohibiting insurance companies from dropping your coverage if you get sick and has been working with insurance companies who will not cover a person because of a pre-existing condition. However, as with all change there are two ways at looking at the new bill. Obamacare will drastically affect the low-income families in a positive way. In America healthcare is so difficult to afford for the average low-income family, Obama has placed the care on a sliding scale. The expansion will cover over 15 million low-income individuals and families below the 133% FLP mark. However each state has the option to opt-out of providing coverage for the poor. By not providing coverage for the poor, it will leave 2-3 million people without coverage. States that decide to opt-in employers will have to respond by laying people off and making full time employees part time to avoid Obamacare penalties and taxes by not implementing the program. Others will not expand beyond 50 employees to avoid the bill’s mandate’s (Shenk, 2013). The average consumer will see a difference because some businesses are adding surcharges to invoices in to help make up the cost of healthcare coverage for their employees. On a positive note, there would be no annual or lifetime limits, children can stay on their parent’s plans to age 26; FDA can approve more generic drugs driving prices down and breaking monopolies and protections against discrimination for gender, disabilities and domestic abuse. And there will be significant tax credits to the small businesses with less than 25 employees, to help offset the costs of providing coverage to their employees. Obamacare will certainly challenge the nation over whether it wants a national system to be dependent on Washington or rely on dual federalism that protects freedom. The bill doesn’t allow the American citizen the option, if they want to offer or accept coverage; they have to have it or they will be penalized. That doesn’t allow much freedom of choice, however at least they are being offered the opportunity to coverage. Despite the rocky road Obamacare has had to start, it has lived to see another day and each day the kinks are worked out. This bill is here to stay. So, as cchange isn’t always easy, the average American citizen can say that the law will be beneficial to them as individuals, their families, communities, and country.

Hello Inc.

Chevron Corporation United States http://database. iprofile. net/company/Chevron_Corporation/companyOverview. html 1 Contents @ 2012 iProfile. All Rights Reserved. Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps TABLE OF CONTENTS Chevron Corporation Corporate Overview Company Profile 6 Stock Performance Analysis 7 Org Charts & Contacts Executive Management 9 Senior IT Management 12 IT Management, Enterprise Architecture 14 IT Management, Strategy, Planning & Projects 16 Executive Management, Chevron Oronite Company 18 Executive Management, Chevron Venture Capital 9 Executive Management, Chevron Australia 20 Contacts Table 22 Bios, Interviews & Presentations IT & Executive Biographies 32 IT Executive Interviews 46 2 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps TABLE OF CONTENTS Chevron Corporation Patricia Yarrington 46 John Watson 47 Gary Luquette 48 IT Executive Presentations 49 J. P. Morgan Oil & Gas Conference: Global LNG 49 Australia Investor Meetings 50 UBS Global Oil & Gas Conference 2012 51 2012 UBS Thailand Natural Gas Field Trip 52 Credit Suisse Energy Summit 2012 53 Barclays Capital CEO Energy/Power Conference 4 IT Infrastructure & Applications Technology Implementations 56 QuantumRD 60 ThinManager 61 McLaren Enterprise Engineer 62 3 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps TABLE OF CONTENTS Chevron Corporation EnterpriseWizard 63 NRX Asset Information Management 64 Microsoft SQL Server 65 Wonderware IntelaTrac 66 OpenWorks R5000 67 CartoPac Field Server 68 Windows 69 IT Footprint and Budget 70 4 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps CORPORATE OVERVIEW Chevron Corporation 5 Corporate Corporate OverviewOrg Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps Chevron Corporation Headquarters Contact Information 6001 Bollinger Canyon Road San Ramon, California 94583 United States Phone: +1-925-842-1000 http://www. chevron. com Employees: 61000 D-U-N-S ® Number: 001382555 SIC: 2911 D-U-N-S is a registered trademark of the Dun & Bradstreet, Inc. and its affiliates. Financial Performance Company Profile Chevron Corporation is one of the world's leading integrated energy companies (#2 in the US behind Exxon Mobil), with proved reserves of some 11. 2 billion barrels of oil equivalent and a daily production of 2. million barrels. The company operates in the world’s most important oil and gas regions, and is a leader in refining, fuels, lubricants and additives. Chevron's interests range from chemical production and mining to energy research and nanoscience. Along with a range of power facilities, the company is also the world’s largest producer of geothermal energy. Chevron, which is restructuring its refinery and retail businesses to cut costs, owns or has stakes in some 8,200 g as stations in the US that operate under the Chevron and Texaco brands. Outside the US, the company owns or has stakes in almost 9,700 gas stations.It also owns 50% of chemicals concern Chevron Phillips Chemical. Sales by Division 6 Corporate Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps Chevron Corporation Stock Performance Analysis Compared to Index of Peers & Competitors 12 Months 5 Years 7 Corporate Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation 8 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive ManagementChief Executive Officer & Chairman Biography Paul Bennett Corp Tele: +1-925-842-1000 Corp Tele: +1-925-842-1000 James Blackwell Matthew Foehr Corp Tele: +1-925-842-1000 [email  protected] com Corp Tele: +1-925-8 42-1000 Direct Tele: +1-925-790-3434 John McDonald Joe Geagea Corp Tele: +1-925-842-1000 Corp Tele: +1-925-842-1000 Stephen Green George Kirkland Corp Tele: +1-925-842-1000 Corp Tele: +1-925-842-1000 Chief Governance Officer & Corporate Secretary Executive Vice President, Technology & Services Chief Technology Officer & Vice President Vice President & Comptroller President, Chevron Gas & Midstream & Corporate†¦ BiographyExecutive Vice President, Upstream & Gas & Vice†¦ Presentation Vice President, Policy, Government & Public Affairs Vice President & Treasurer Presentation Biography Lydia Beebe Biography Biography Corp Tele: +1-925-842-1000 Interview Biography John Watson 9 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive Management (II) Chief Executive Officer & Chairman Corp Tele: +1-925-842-1000 Roy Krzywosinski Corp Tele: +1-925-842-1000 Corp Tele: +61 -8-9216-4000 Joe Laymon Wesley Lohec Corp Tele: +1-925-842-1000Corp Tele: +1-925-842-1000 Gary Luquette Sandy Macfarlane Corp Tele: +1-925-842-1000 Corp Tele: +1-925-842-1000 Melody Meyer Hewitt Pate melody. [email  protected] com Corp Tele: +1-925-842-1000 Corp Tele: +1-925-842-1000 Interview Vice President, Human Resources, Medical & Security President, Chevron North America Exploration &†¦ President, Chevron Asia Pacific Exploration &†¦ Managing Director, Chevron Australia Pty Ltd. Vice President, Health, Environment & Safety General Tax Counsel Biography Biography Presentation Biography President, Chevron Oronite Company LLC Presentation Ronald Kiskis Interview Biography John WatsonVice President & General Counsel 10 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive Management (III) Chief Executive Officer & Chairman Corp Tele: +1-925-842-1000 Rebecc a Roberts [email  protected] com Corp Tele: +1-925-842-1000 Corp Tele: +1-713-432-6000 Chuck Taylor Trond Unneland chuck. [email  protected] com Corp Tele: +1-925-842-1000 Biography Jay Pryor Corp Tele: +1-713-954-6000 Michael Wirth Patricia Yarrington Corp Tele: +44-1224-334-000 Corp Tele: +1-925-842-1000 Vice President, Business DevelopmentVice President, Strategic Planning Vice President & Managing Executive, Chevron†¦ Chief Financial Officer & Vice President Interview Executive Vice President, Downstream & Chemicals†¦ President, Chevron Pipe Line Company Biography Biography Interview Biography John Watson Rhonda Zygocki Executive Vice President, Policy and Planning Corp Tele: +1-925-842-1000 11 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Senior IT Management Biography John McDonald Chief Technology Officer & Vice President Corp Tele: +1-925-842-1000Cor p Tele: +1-925-842-1000 Direct Tele: +1-925-842-4750 Lynn Chou Biography ahmed. [email  protected] com Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-1043 Denise Coyne General Manager, Technology Management &†¦ General Manager, Process Applications & Data Biography Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-4100 or +1-925-842-7212 Gilles Eberhard General Manager, IT Strategy, Planning & Project†¦ gilles. [email  protected] com Corp Tele: +1-925-842-1000 Louie Ehrlich President, Chevron Information Technology†¦ Corp Tele: +1-925-842-1000 Direct Tele: +1-925-790-3412 Jim Green Chief Information Officer & General Manager†¦ [email  protected] com Corp Tele: +1-925-842-1000 Biography Biography lynn. [email  protected] com Corp Tele: +1-925-842-1000 Chief Information Officer, Corporate Department†¦ Biography Peter Breunig Head, R&D, Energy Technology Biography Ahmed Badruzzaman Karen Grote Chief Information Officer, Global Marketing Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-4930 12 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Senior IT Management (II) Biography John McDonald Chief Technology Officer & Vice President Richard Jackson aul. [email  protected] com Corp Tele: +1-925-842-1000 [email  protected] com Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-9021 Ashok Krishna Celia Lin Corp Tele: +1-925-842-1000 Direct Tele: +1-925-790-3789 Corp Tele: +1-925-842-1000 Jana Multhaup Kirk Rehage Director, IT Security Chief Information Protection Officer & General†¦ Vice President, Technology Downstream Chief Information Officer, Americas Products [email  protected] com Corp Tele: +1-925-842-1000 Chief Information Officer, Chevron Global Gas Biography Paul Huttenhoff Biography Biography Corp Tele: +1-925-842-1000 General Manager, IT AuditCorp Tele: +1-925-842-1000 Direct Tele: +1-925-827-7491 13 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts IT Management, Enterprise Architecture Biography Peter Breunig General Manager, Technology Management &†¦ Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-4750 Kelly Becker Tom Bell [email  protected] com Corp Tele: +1-925-842-1000 [email  protected] com Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-1470 Dennis Bourque Wendy Brumbach [email  protected] com Corp Tele: +1-925-842-1000 [email  protected] comCorp Tele: +1-925-842-1000 Henry Cariaso Lee Conroy [email  protected] com Corp Tele: +1-925-842-1000 Direct Tele: +1-925-358-7084 lee. [email  protected] com Corp Tele: +1-925-842-1000 Joseph Fielding Sebastian Gass [email  protected] com Corp Tele: +1-925-842-1000 sebastian. [email  protected] com Corp Tele: +1-925-842-1000 Manager, Information Technology Manager, Emerging Infrastructure Techno logies Biography Senior Manager, Windows Server Security Manager, Applications Development Manager, Enterprise Architecture Manager, Organizational Capability Manager, Information Technology, MidContinent†¦ Manager, Business Analytics 14Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts IT Management, Enterprise Architecture (II) Biography Peter Breunig General Manager, Technology Management &†¦ Corp Tele: +1-925-842-1000 Direct Tele: +1-925-842-4750 Ricky Gilbert Manager, Manufacturing, IT Systems [email  protected] com Corp Tele: +1-925-842-1000 Dennis Mores Manager, Data Center Office Corp Tele: +1-925-842-1000 Direct Tele: +1-925-358-7314 Shenita Ramsey Jennifer Scriabine [email  protected] com Corp Tele: +1-925-842-1000 [email  protected] comCorp Tele: +1-925-842-1000 Direct Tele: +1-925-842-5074 Client Manager, Information Technology Audit Manager, IS Ope rations Lisa Tharaud Global Category Manager, Enterprise Software lisa. [email  protected] com Corp Tele: +1-925-842-1000 15 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts IT Management, Strategy, Planning & Projects Biography Gilles Eberhard General Manager, IT Strategy, Planning & Project†¦ gilles. [email  protected] com Corp Tele: +1-925-842-1000 Josh Burdick Paul Fontenot josh. [email  protected] comCorp Tele: +1-925-842-1000 paul. [email  protected] com Corp Tele: +1-925-842-1000 Patrick Garcia Jamie Gibbs Corp Tele: +1-925-842-1000 jamie. [email  protected] com Corp Tele: +1-925-842-1000 Gene Guidry Franz Helin [email  protected] com Corp Tele: +1-925-842-1000 franz. [email  protected] com Corp Tele: +1-925-842-1000 Darryl Martin Laura Pollock Corp Tele: +1-925-842-1000 [email  protected] com Corp Tele: +1-925-842-1000 Project Manager Manager, Gl obal Infrastructure Design, Project†¦ Project Manager, Information Technology Program Manager Project Manager, IT Project Manager Project Manager, TCO Project Manager, Information Technology 6 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts IT Management, Strategy, Planning & Projects (II) Biography Gilles Eberhard General Manager, IT Strategy, Planning & Project†¦ Denise Sexton Dipak Vekaria denise. [email  protected] com Corp Tele: +1-925-842-1000 dipak. [email  protected] com Corp Tele: +1-925-842-1000 Senior Project Manager, Information Technology Project Manager, Information Systems, Gorgon IM&T Biography Biography gilles. [email  protected] com Corp Tele: +1-925-842-1000 Tommy YanowskiProgram Manager, Global Supply & Trading Corp Tele: +1-925-842-1000 17 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive Management, Chevron Oronite Company Ronald Kiskis President, Chevron Oronite Company LLC Biography Corp Tele: +1-925-842-1000 David Seals Chief Information Officer, Chevron Oronite†¦ david. [email  protected] com Corp Tele: +1-925-842-1000 Direct Tele: +1-925-216-0026 Jirong Xiao Vice President, Products & Technology Corp Tele: +1-925-842-1000 18 Corporate Overview Org Charts & ContactsBios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive Management, Chevron Venture Capital Trond Unneland Vice President & Managing Executive, Chevron†¦ Biography Corp Tele: +1-713-954-6000 John Hanten Desmond King Corp Tele: +1-713-954-6000 Direct Tele: +1-713-954-6360 Corp Tele: +1-713-954-6000 Colleen Mazza Matthew McElhattan Corp Tele: +1-713-954-6000 Corp Tele: +1-713-954-6000 Richard Pardoe Don Riley Corp Tele: +1-713-954-6000 Corp Tele: +1-71 3-954-6000 Venture Executive President, Chevron Technology Ventures Business Support Principal PrincipalVenture Executive 19 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive Management, Chevron Australia Presentation Roy Krzywosinski Managing Director, Chevron Australia Pty Ltd. Corp Tele: +61-8-9216-4000 Colin Beckett Rick Biddle Corp Tele: +61-8-9216-4000 Corp Tele: +61-8-9216-4000 Kaye Butler Kevin Cunningham Corp Tele: +61-8-9216-4000 Corp Tele: +61-8-9216-4000 Brian Dalzell Peter Fairclough Corp Tele: +61-8-9216-4000 Corp Tele: +61-8-9216-4000 David Fielder Gerry Flaherty Corp Tele: +61-8-9216-4000Corp Tele: +61-8-9216-4000 General Manager, Greater Gorgon Area General Manager, Human Resources Manager, Finance Manager, Operational Excellence, Health†¦ General Manager, Operations General Manager, Policy, Government & Public†¦ Planning Manager General M anager, Asset Development 20 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation full org charts Executive Management, Chevron Australia (II) Presentation Roy Krzywosinski Managing Director, Chevron Australia Pty Ltd. Corp Tele: +61-8-9216-4000 David Minemier Brian SmithCorp Tele: +61-8-9216-4000 Corp Tele: +61-8-9216-4000 Neil Theobald Mike Williams Corp Tele: +61-8-9216-4000 Corp Tele: +61-8-9216-4000 Manager, Non-Operated Joint Ventures General Manager, Gas Marketing &†¦ General Manager, Wheatstone Development Managing Counsel 21 Corporate Overview Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation Contacts Company First Name Last Name Title Rank Telephone E-Mail Chevron Corporation – HRD Helen Alm HR Business Partner, AD HR Project Team Others Direct: +1-925-842-8236 [email  protected] com Chevron Corpor ation –HRD Leslie Ann Rodarte HR SAP Payroll Administrator Administrator Direct: +1-925-842-0803 [email  protected] com Chevron Corporation – HRD Jennifer Backer-Walton Manager, Global HR Reporting Manager Corp: +1-925-842-1000 jennifer. [email  protected] com Chevron Corporation Ahmed Badruzzaman Head, R&D, Energy Technology Head of Direct: +1-925-842-1043 ahmed. [email  protected] n. com Chevron Corporation Kelly Becker Manager, Information Technology Manager Corp: +1-925-842-1000 [email  protected] com Chevron Australia Pty Ltd. Colin Beckett General Manager, Greater Gorgon Area C-Level Corp: +61-8-9216-4000 Chevron CorporationLydia Beebe Chief Governance Officer & Corporate Secretary C-Level Corp: +1-925-842-1000 Chevron Corporation Tom Bell Manager, Enterprise Architecture Manager Direct: +1-925-842-1470 Chevron Corporation Paul Bennett Vice President & Treasurer Treasurer Corp: +1-925-842-1000 Chevron Corporation – HRD Norm Berkley Manager, Human R esources Manager Corp: +1-925-842-1000 Chevron Australia Pty Ltd. Rick Biddle Manager, Operational Excellence, Health, Environment & Safety C-Level Corp: +61-8-9216-4000 Chevron Corporation James Blackwell Executive Vice President, Technology & Services Vice President Corp: +1-925-842-1000Chevron Corporation Dennis Bourque Manager, Emerging Infrastructure Technologies Manager Corp: +1-925-842-1000 Chevron Corporation – HRD Susan Boyle Manager, Corporate HR Communications Manager Corp: +1-925-842-1000 Chevron Corporation Peter Breunig General Manager, Technology Management & Architecture C-Level Direct: +1-925-842-4750 Corporate Overview Org Charts & Contacts [email  protected] com [email  protected] com [email  protected] com 22 Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation Contacts Company First Name Last Name Title Rank Telephone Chevron Corporation – HRDKyle Bromley Manager, Human Resources Manager Corp: +1-925-842-1000 Chevron Corporation Wendy Brumbach Manager, Organizational Capability Manager Corp: +1-925-842-1000 Chevron Corporation – HRD Linda Buchanan Manager, Employee Development & Organization Capability Manager Corp: +1-925-842-1000 Chevron Corporation Josh Burdick Project Manager Manager Corp: +1-925-842-1000 Chevron Australia Pty Ltd. Kaye Butler General Manager, Human Resources C-Level Corp: +61-8-9216-4000 Chevron Corporation Henry Cariaso Senior Manager, Windows Server Security Manager Direct: +1-925-358-7084 [email  protected] com Chevron Corporation Lynn ChouGeneral Manager, Process Applications & Data C-Level Corp: +1-925-842-1000 lynn. [email  protected] com Chevron Corporation – HRD Sean Connors Supervisor, Staffing Supervisor Corp: +1-925-842-1000 Chevron Corporation Lee Conroy Manager, Information Technology, MidContinent & Alaska Manager Corp: +1-925-842-1000 Chevron Corporation Denise Coyne Chief Information Officer, Corporate Department & S ervices CIO Direct: +1-925-842-4100 or +1-925-842-7212 Chevron Australia Pty Ltd. Kevin Cunningham General Manager, Operations C-Level Corp: +61-8-9216-4000 Chevron Australia Pty Ltd. Brian Dalzell Manager, Finance Manager Corp: +61-8-9216-4000Chevron Corporation – HRD Janet Duncan HR Business Partner Others Direct: +1-925-842-7739 janet. [email  protected] com Chevron Corporation Gilles Eberhard General Manager, IT Strategy, Planning & Project Management C-Level Corp: +1-925-842-1000 gilles. [email  protected] com Chevron Corporation – HRD Jennifer Edris Team Leader, Human Resources Lead Corp: +1-925-842-1000 Corporate Overview E-Mail [email  protected] com josh. [email  protected] com lee. [email  protected] com 23 Org Charts & Contacts Bios, Interviews & Presentations IT Infrastructure & Apps ORG CHARTS AND CONTACTS Chevron Corporation Contacts Company First Name Last NameTitle Rank Telephone E-Mail Chevron Corporation Louie Ehrlich President, Chevron Info rmation Technology Company & Chief Information Officer, Chevron Corp CIO Direct: +1-925-790-3412 Chevron Corporation – HRD Helen Fairclough Manager, HR Strategy & Talent Management, Downstream & Chemicals Manager Corp: +1-925-842-1000 Chevron Australia Pty Ltd. Peter Fairclough General Manager, Policy, Government & Public Affairs C-Level Corp: +61-8-9216-4000 Chevron Australia Pty Ltd. David Fielder Planning Manager Manager Corp: +61-8-9216-4000 Chevron Corporation Joseph Fielding Manager, Applications Development Manager Corp: +1-925-842-1000