The Issue of Remorse on The Scarlet Letter by Nathaniel Hawthorne Research Paper

The Issue of Remorse on The Scarlet Letter by Nathaniel Hawthorne - Research Paper Example Various studies were conducted about the novel and they discuss the symbols, imageries, issues and parallelisms prevailing in The Scarlet Letter. The critical analysis of the novel would start with a brief biography of Nathaniel Hawthorne and also the significant issues faced by the United States of America in its early years would be analyzed in connection to the story. The main focus is on the issue of remorse faced by the main characters of the novel. Nathaniel Hawthorne came from a famous family living in Salem, Massachusetts. His relatives took care of him when his father died in a voyage. He studied at Bowdoin College together with some famous personalities in literature and politics like Horatio Bridge who became a writer, Jonathan Ciley who became a senator, Henry Wadsworth Longfellow who became a poet, and Franklin Pierce who became a president of the United States. The personalities mentioned helped Hawthorne to get a public sector job. Afterwards he started as a writer when his works imitate the style of Sir Walter Scott and was considered to be his early writing training. The Transcendentalist Movement of Ralph Waldo Emerson influenced Hawthorne by investing in the Utopian community. The Trancendentalist belief rejects formalism as they promote individualism because humans according to them are more than just sensory realm. Individualism and symbolism became prominent in Hawthorne’s later works especially in The S carlet Letter wherein the Transcendentalist ideals clashed against the ideals of the Puritans. The Custom House was written by Hawthorne as a prologue to The Scarlet Letter and also as an autobiographical essay. His published work became possible through the help of his friends. The Scarlet Letter became famous across time since morality, spirituality and identity of the Americans were affected by the Puritans. During the time of Hawthorne, adultery was considered as a taboo because of prevailing rigidity and formality of culture. The novel became popular to people from all ages across time (University of Wisconsin Milwaukee). The Scarlet Letter made its author a famous writer. After seeing the relevance of the novel to the life and time of Hawthorne, going deeper into the summary would link the history to the story. Spirituality, morality and Puritan influence on the early America were reflected in The Scarlet Letter. The novel went against the norms and showed how the dreaded beha vior and beliefs would be turned from weakness into strength. The story started from a prologue that could be considered as a standalone essay. The essay revealed how the novel was written as the narrator mirrored Hawthorne himself. The narrator worked as a surveyor in the customhouse and he found certain documents bundled and contained a piece of cloth shaped into an A. Since the narrator was careless and lost some important documents, he made a story out of the two-hundred-year-old manuscript made by a past surveyor. His creative thinking produced The Scarlet Letter  and the story opened in a Puritan settlement at Boston during the early years of USA. The scarlet letter â€Å"A† labeled on the chest of the protagonist named Hester Prynne symbolized her crime as viewed by the townspeople. She walked out of a prison cell together with her baby named Pearl. She arrived at Boston when her old and scholarly husband sent her there. Her husband was lost in the voyage and was ass umed to be dead. Because of loneliness, Hester engaged in an affair that led to the birth of Pearl. Afterwards the town elders put Hester Prynne to a public confession to reveal the father of Pearl. She did not reveal the name of

How Women Changed During the Civil War Essay Example for Free

How Women Changed During the Civil War Essay The Civil War was a defining moment in American history. It was the event which determined the fate of the nation as the American community was divided into two opposing sides. It was also a time of significant social change. The realm of war previously belonged to the men; it was the male soldiers who fought in the battlefields. However, the Civil War altered the situation. The status of women dramatically changed as they became active participants in the war effort. Indeed, the Civil War opened many opportunities for women and allowed them to be active members of society. This research paper aims to discuss how women changed during the American Civil War, as well as the advantages and disadvantages of the said changes. In the 19th Century America, men dominated society and women were regarded as inferior to them. Women lived under the authority of the opposite sex, either that of the father, husband or another relative (Massey, 1994). They were confined in the domestic sphere; their main concerns were their home and family. Women had no voice in the political arena because only the men had dealt with public affairs. Not only was it objectionable for women to fulfill men’s jobs, it was also disagreeable for them to wear men’s clothes (Eggleston, 2003). When the Civil War began, the social lines were blurred. Women suddenly were presented the chance to go beyond their realm and participate in the world of men. They were given roles and jobs that were not accessible to them before. Both the Union and the Confederacy allowed women to take part in the war effort. For the first time, the government allowed women to become doctors and nurses (Eggleston, 2003). Women also served as messengers and spies. Meanwhile, there are also those women whose contributions were domestic in nature; these include cooking, as well as mending and sewing uniforms for the soldiers (Eggleston, 2003; Silber, 2005). These activities may have been the same as those women were tasked to do in the past; however, there was a significant change. Before, women only did those jobs due to the necessity in the household. During the war, the women did those jobs due to the necessity of the nation. Their domestic activities were no longer performed for private purposes; they had become part of the public affairs. However, women were not merely passive participants. They were also directly involved in the war effort as soldiers. The battlefield was reserved for males, but the females eventually found themselves fighting the same war. Women became soldiers by concealing their real identities (Eggleston, 2003). There were many reasons why women opted to disguise themselves as male soldiers. There were those who fought in the war to either escape from their betrothal or to be with their loved ones. Some saw the war as an adventure and craved its excitement. There were others who saw fighting for its financial benefits and the opportunity to better provide for their families. Meanwhile, there were women who took part in the Civil War for more noble reasons; they went to war because they were compelled by duty and patriotism (Eggleston, 2003). Women had to resort to extreme measures to appear like male soldiers. There were women who were immediately discharged because the way they acted revealed their real identities (Eggleston, 2003). Meanwhile, there were women who dramatically changed their actions and behavior before enlistment to successfully disguise themselves. They modified the color of their complexion and learned how to chew tobacco. They used vests with pads to conceal their breasts; the pads also made them seem more bulky and masculine (Eggleston, 2003). Having women disguised as men in war had its share of difficulties. The problems arose from the different toilet habits as well as other personal routines (Eggleston, 2003). Nonetheless, the recruitment of young men in the army proved to be advantageous for the female soldiers. The army consisted mostly of boys, who were still shy and reserved around each other. Most of them were hesitant to relieve themselves in the company of other soldiers; to attend their toilet needs, they had to hide in the woods or others areas which offered privacy. The meek nature of young men was beneficial for the female soldiers because it allowed them to seek privacy without appearing unusual. In addition, the young men of the army have not yet started shaving, so it did not appear unusual for the females if they did not shave (Eggleston, 2003). It is remarkable that women have finally reached the public realm during the Civil War, even if they had to pretend as men to do so. However, that kind of participation had disadvantages. Women who had successfully kept their real identities hidden as part of the army suffered all the difficulties which came with war (Eggleston, 2003). Female soldiers were held captive by their opponents, brought to prison camps and killed in the battlefields. There were those who perished and buried without their real identities discovered. Because women soldiers were not supposed to be fighting in the war, their participation in the war was previously not acknowledged. There were even those who denied the direct involvement of women as soldiers (Blanton, n. d. ). The non-recognition of women fighters in the Civil War prevented the discovery of the total number of female soldiers who offered their services. The numbers available on record are merely estimates. This situation posited a real problem, as it undermined and ignored the contributions of women in the battlefield. During the American Civil War, women changed because they went beyond the roles that were initialed assigned to them. The war effort presented them to enter the public realm of men and participate in it. Women had indeed changed during that time, as they progressed from housewives to participants in war. Women even came in disguise to become soldiers. While it is a great thing that women became active members of the community, some of their contributions were not recognized or accurately recorded because of their secret identities. Nonetheless, this does not diminish that fact that women were a significant part of the American Civil War. References Blanton, D. (n. d. ). Women soldiers and nurses of the American civil war. American Civil War Website. Retrieved March 13, 2009, from http://americancivilwar. com/women/index. html Eggleston, L. G. (2003). Women in the Civil War: Extraordinary Stories of Soldiers, Spies, Nurses, Doctors, Crusaders and Others. North Carolina: McFarland. Massey, M. E. (1994). Women in the Civil War. Nebraska: University of Nebraska Press. Siber, N. (2005). Daughters of the Union: Northern Women Fight the Civil War. Cambridge, Massachusetts: Harvard University Press.

Autism Essay -- Teaching Education

Autism â€Å"We start with an image—a tiny, golden child on hands and knees, circling round and round a spot on the floor in mysterious, self-absorbed delight. She does not look up, though she is smiling and laughing; she does not call our attention to the mysterious object of her pleasure. She does not see us at all. She and the spot are all there is, and though she is eighteen months old, an age for touching, tasting, pointing, pushing, exploring, she is doing none of these. She does not walk, or crawl up stairs, or pull herself to her feet to reach for objects. She doesn’t want any objects. Instead, she circles her spot. Or she sits, a long chain in her hand, snaking it up and down, up and down, watching it coil and uncoil, for twenty minutes, half an hour--- until someone comes, moves her or feeds her or gives her another toy, or perhaps a book.† Excerpted from â€Å"The Seige† Autism—â€Å"a mysterious world where the unknowns still outnumber the knowns. A syndrome whose manifestations are many and whose etiology is suspected of being multi-causal†. â€Å"The word autism still conveys a fixed and dreadful meaning to most people—they visualize a child mute, rocking, screaming, inaccessible, cut off from human contact. And we almost always speak of autistic children, rarely of autistic adults, as if such children never grew up, or were somehow mysteriously spirited off the planet, out of society. Or else we think of an autistic â€Å"savant† a strange being with bizarre mannerisms and stereotypies, still cut off from normal life, but with uncanny powers of calculation, memory, drawing, whatever—like the savant portrayed in Rain Man. These pictures are not wholly false, but they fail to indicate that there are forms of autism which do not incapacitate in the same way, but may allow lives that are full of event and achievement, and a special sort of insight and courage too† (Grandin, 12). Autism was first identified as a disorder in 1943 by Dr. Leo Kanner. It was widely accepted that a child’s autistic condition was the result of extremely, cold distant, rejecting and overly intellectual parenting. The child’s extreme withdrawal was viewed as a refusal to engage in social or physical contact, rather than inability. The assumption therefore was that the familial environment being hostile was the cause of the child’s refusal to become enga... ...sm- perhaps even before a child is born. That day remains but doctors have recently made great strides in the field of brain research, both using psychology and through highly sophisticated technology. It’s anyone’s guess, though how long it will take them to unlock the secret of this fascinating syndrome†. â€Å"We start with an image—a tiny, golden child on hands and knees, circling round and round a spot on the floor in mysterious, self-absorbed delight. She does not look up, though she is smiling and laughing; she does not call our attention to the mysterious object of her pleasure. She does not see us at all. She and the spot are all there is, and though she is eighteen months old, an age for touching, tasting, pointing, pushing, exploring, she is doing none of these. She does not walk, or crawl up stairs, or pull herself to her feet to reach for objects. She doesn’t want any objects. Instead, she circles her spot. Or she sits, a long chain in her hand, snaking it up and down, up and down, watching it coil and uncoil, for twenty minutes, half an hour--- until someone comes, moves her or feeds her or gives her another toy, or perhaps a book.†

starbucks history :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  For one of my selections for buying stock, I invested into Starbucks, this company has attracted me with their wonders of different coffees, and I knew many others were interested in the very popular coffee company. Starbucks all started 1971 in Seattle Washington. With three men which were Jerry Baldwin, Zev Siegel and Gordon Bowker each of them put in one thousand three hundred and fifty dollars along with a barrowed five thousand from the bank to start up there small coffee shop in pick place market, witch is located in down town Seattle. The name for this company was inspired from the character Starbuck from Moby Dick; this character was a coffee lover. There close friend designed there well known logo. These men never thought of this small company to get large they just thought of it as a small coffee shop. Out of all three men Siegel was the only one that work at it full time. The men depened on a man named Alfred Peet for there coffee beans but soon then st arted there own blends of coffee beans. With in a year opening the first store they were able to open a second store. When the 1980’s rolled around, it was a thriving company, in the Seattle area. However, the co-founders began to have other interests and were involved in other careers simultaneously. Despite that, the company was about to undergo a major turning point. A man by the name of Howard Schultz started to pursue an interest in the company. He noticed that the coffee shop had a wonderful environment. He started asking a questions and becoming more and more interested by every moment. He loved how the founders had so much knowledge on the coffee and each blend. In 1982, Schultz became director of retail operation. This was just the start to a new phase with the company.   Ã‚  Ã‚  Ã‚  Ã‚  When Shultz took over, this started the beginning of a new era. He spent all his time at the stores trying to make every thing perfect in every way. He started with the employees, making the environment so friendly for every type of coffee lover. One of his biggest ideas came from visiting Italy and going to a coffee shop and seeing the idea of a espresso bar. That no longer would it be just an in and out coffee shop, but event and environment that drew many different types of people.

O-Fold Essay

1. As a part of the management team, how would you handle distribution and marketing of the O-Fold? Within the text I really liked the 2nd and 3rd option of distribution, which was going an online route or advertising I travel magazines. Although the adverting in magazines option is appealing when it comes down to it I don’t think it would reach as many people as online distribution. I would chose to create a website and distribute the O-Fold product through there. Creating a website would be extremely cost effective. I believe there are even some sites you can use for free, such as weebly.com. However, this option is risky because marketing would have to be very effective in order to generate the business he is looking for. Since the cost of a website is low, he should consider advertising in travel magazines. He probably would not need large ad space, which would help with the cost. If he could get a small section in the Sky Mall magazine on aircrafts with the link to his website, that could be a rewarding starting point. Another option is advertising on other large online retail sites, such as Amazon.com who now gives consumers an option to purchase provides from other retailers by providing a link to that product on their site. 2. At what points should Alex consider bringing on additional management? What positions should he fill and in what order? Defend your answer. I am a supporter of Alex’ crawl-walk-run strategy. I think initially he should partner with his brother and begin to make the product together and sell online through a website he creates. This way he can get an idea of how he can proceed with next steps and be able to create a business plan to present to Anger investors. Once he can seal the investment funds he should bring on a sales and marketing manager. This is one of the most important positions in a company. Alex needs to have someone with experience in sales and marketing, especially not having experience himself. He’s already contemplating different options in this area; someone who has worked in this department can give him real examples of the outcomes and weigh in on the best decision for O-Fold. Next, after he gets an investment, he should go with the outsourcing route. He already had a connection to hire a barn full of employees. He will need to hire a manager to oversee the production of these employees, and also a Human Resources Manager since he will have employees. He cannot manage everything himself so a good candidate for the productions manager would be his brother since he should have a good understanding by then of how to produce the items. 3. What are some pricing strategies you would consider utilizing in order to get the O-Fold to market? Do you agree with Alex’s pricing point? I would consider giving a special price to first time customers, or a discount when purchasing more then one O-Fold at the early stages of marketing. Alex will want to be competitive and the first thing that customers probably look for is good deals. If he creates a website and is directing people there through advertising he should try to close the sale with a discount. An option would be first time users get free shipping, or $5 off shipping. Customers buying more then one could receive $5 off their second purchase. I like the 123 percent market with the outsourcing options at $12.50 However, that would only be beneficial at wholesale, so he should price his products per item at $25, and offer the discount for the first 100 customers. He does not need to advertise the part about it only being for the first 100 customers but he should price out shipping costs for 100 people or costs of giving discounts and set a budget for it.

An Analysis of the Urban Issue of Tuberculosisin the Bourough of Newham The WritePass Journal

An Analysis of the Urban Issue of Tuberculosisin the Bourough of Newham 1.Introduction An Analysis of the Urban Issue of Tuberculosisin the Bourough of Newham ). Newham has a population of 308,000 with a population density of 85.1 per hectare as compared to 31 in central London (UK Census, 2012). These figures suggest that even in the populated city of London, Newham is an area of urbanisation, with a large number of people concentrated into a relatively small area. The increase of tuberculosis has been described as a ‘penalty for high density urban living’ (Dye 2010, p.859), likely due to the increased potential for transmission in overcrowding, and the increased rates of immigration to inner-city areas. Bhunu and Mushavabasa (2012) propose that tuberculosis thrives in conditions of overcrowding and poverty, issues that are common in urban areas. The high rates of tuberculosis in cities such as London, and areas of urbanization such as Newham, suggest that the incidence of tuberculosis is indeed an urban issue. Newham fulfills the criteria of high immigration rates and being an area of deprivation.. Newham has a diverse ethnic population, with 61% of the people being non-white (Farrar Manson 2013, p. 54). The population of ethnic minorities continues to grow along with the increasing numbers of refugees and asylum seekers in greater London. Another aspect of urbanisation illustrated in the borough of Newham is that of deprivation and overcrowding. Farrar Manson (2013, p. 16) claim that Newham ranks as the third most deprived borough in inner London. Most of the people here live in tower housing and overcrowded conditions that are the perfect condition for the spread of tuberculosis. There is a positive correlation between poor housing and poverty and the prevalence of tuberculosis, which is very clear in Newham as evidenced by the findings of 108 and 116 cases per 100,000 people (Vassal, 2009; Anderson et al., 2001). The aetiology of the issue of tuberculosis is highlighted when considering the distribution of the disease across Newham. The occurrence of disease is not evenly spread across the borough, with 70% of cases coming from Manor Park, Green Street and East Ham. These boroughs represent areas of population increase, overcrowding and higher levels of those living in poverty. Manor Park and Green Street also show differing dynamics of tuberculosis incidence, representing an overall increase of 40% since 2006 whilst all other areas of Newham either remained static or showed slight decrease (Malone et al 2009, p. 23). It can be seen that tuberculosis presents a significant urban issue, especially when comparing incidence in an urban area such as Newham to those less urbanised areas. Bromley has a population of 309,000 and a population density of 20 per hectare, in comparison to Newham’s population density of 80 per hectare (UK Census, 2012). Tuberculosis incidence in Bromley is between 0-19 per 100,000 compared to that of Newham, which is five times greater at 80-100 per 100,000 (Anderson et al., 2006). It is for this reason that necessary intervention strategies need to be formulated and implemented to help reduce the rates of tuberculosis among individuals living in Newham. 3. The Influence of Urbanisation on Tuberculosis Incidence While the global rates of tuberculosis are declining, the disease is showing steady increase in the United Kingdom. In 2012, 8751 new cases of the disease were identified in the country with 39% coming from London (Fullman and Strachan 2013, p. 43). Indeed London has the highest rates of the disease in Western Europe with Newham borough having the highest rates in the UK. Jindal (2011, p. 55) claims that the rate of tuberculosis in some London boroughs is more than twice higher than the threshold used by the world health organisation to define high rates. These higher incidences support the notion of a sick city hypothesis where there are greater levels of ill health than in rural areas, and may be due to the presence of factors in an urban environment that contribute to ill health (an urban health penalty). One factor that may contribute to the urban health penalty is that of immigration. Cities are easier to access than rural areas, provide areas of congregation and provide more facilities for immigrating families and individuals. The majority of individuals suffering from tuberculosis are people born outside the United Kingdom, with 75% of cases in 2003 being born abroad (Anderson et al., 2006). A reason for the high incidence in those born abroad but now living in the UK is exacerbated by the nature of tuberculosis. On initial infection, tuberculosis is confined by the immune system with only around 5% of cases experiencing symptoms within the first two years of infection (Narasimhan et al., 2013). The remainder of cases harbour a latent infection which may reactivate later in life, with about 10-15% of those infected going on to develop an active disease (Narasimhan et al., 2013). This insidious nature combined with the later activation of the disease explains why many people do not get the disease until later in life. It is likely that it is contracted in their country of birth, however then manifests much later once they have moved to the UK. Statistics indicate that over 90% of the residents in Newham diagnosed with the disease in 2011 were born outside the United Kingdom (Fullman and Strachan, 2013, p. 33). Among these, 50% arrived in the country in the last five years. In the same year tuberculosis diagnosis increased by 25% compared to 2010 (Fullman and Strachan, 2013), possibly as a reflection of the increased immigration. Additionally to a high immigrant population bringing significant disease burden from their countries of birth, London and Newham both represent many of the other issues of urbanisation and urban health penalty that can contribute to the high incidence of tuberculosis. Studies have shown that low vitamin D levels are associated with an increased risk of developing tuberculosis (Campbell and Spector, 2012; Chan, 1999). This is an important association in urban populations, as the living and working conditions foster less access to sunlight (the major source of vitamin D). Additionally, Asian immigrants present a problem of low vitamin D due to vegetarian diets, and a tendency to cover up their skin, not allowing to take advantage of the small amount of sunlight available (Chan, 1999). As previously mentioned, Newham is an area of both high urbanisation and with a large immigrant population, and 38.6% of the population being of Asian descent (London Borough of Newham, 2010). The immigrant population of urban areas such as Newham also present a non-vaccinated proportion of society. Whilst the BCG vaccine against tuberculosis was introduced in the UK in the 1950s and was shown to provide a reduction in risk of contracting tuberculosis (Colditz et al., 1994), those immigrating were less likely to receive this vaccination on moving to the UK. London also represents cases of tuberculosis that are socially and medically complex. As a hugely populated area, London includes those with HIV infection and presents other risk factors such as onward transmission and poor treatment. HIV is one of the most powerful risk factors for tuberculosis, with a incidence rate of 20 times higher in those that are HIV positive (Dye and Williams, 2010). People’s attitudes towards and access to healthcare also present a complex mix of factors which contribute to an increased incidence of many health problems, including that of tuberculosis. Those in impoverished areas have reduced access to healthcare, which may stem from many reasons such as complex needs, chaotic lifestyles, location of services, user ignorance, and language and literacy barriers (Szczepura, 2005). These can affect the disease process of tuberculosis from prevention, treatment of active disease, adherence to treatment and prevention of the health consequences. Especially problematic are misconceptions and a lack of understanding of the disease, leading to late presentation and delayed access to treatment (Figuera-Munoz and Ramon-Pardo, 2008) With the close living quarters in areas such as Newham, the spread of tuberculosis is facilitated. With poverty, poor housing and overcrowding, these areas concentrate several risk factors and lead to a greater spread of tuberculosis (Bates et al., 2004). These determinants therefore suggest that the incidence of tuberculosis in urban areas is a complex issue. Controlling and preventing tuberculosis in London requires effective social and economic tools that must be incorporated in the development of policies of control in treatment initiation. 4. Consequences and implications of tuberculosis on the general population Tuberculosis ranks with HIV/ AIDS and Malaria as one of the three main health challenges currently facing the world. The Commonwealth Health Ministers Update 2009 (2009, p. 41) indicates that 8 million new cases are reported globally each year. As previously mentioned, when combined with HIV, tuberculosis can prove lethal as the two diseases enhance the progress of each other. It is for this reason that tuberculosis is the major cause of death among HIV patients with the rate standing at 11% globally. The World Health Organization (2009, p. 27) indicates that tuberculosis is responsible for more deaths today than ever before, with approximately 2 million lives claimed by the disease annually. As well as the significant mortality contributed by tuberculosis, the morbidity of the disease can be extremely detrimental both socially and economically. Those with the active disease that are not receiving treatment have been shown to go on to infect 10-15 others every year (WHO, 1998). Those who do receive treatment face a long (up to six months) and complex treatment regime involving several medication side effects. This can affect adherence to the treatment regime, and lead to the disease developing a resistance to the treatment, with this drug resistant tuberculosis contributing to greater mortality and increased expense to treat (Ahlburg, 2000). As well as the significant morbidity and mortality, it is important to consider the economic impact of tuberculosis. The World Health Organisation estimated the cost to treat tuberculosis in 2000 as $250,000 US dollars ( £150,000) in developed countries (Ahlburg, 2000). This presents a significant burden to the UK NHS, not to mention the time lost through not working which can dent the economy. London is a global world trade centre whose economy is shaped by global forces, particularly in terms of trade, labour and capital. As a gateway to both the UK and other parts of Europe and the rest of the world, London records a very large number of tourists and immigrant populations. This high number of people accelerates the spread of the disease as people carry it to the country from other parts of the world is indicated by the new infection patterns and is highlighted by the prevalence in immigrant populations. 5. Strategies and intervention for addressing tuberculosis Current UK guidelines for tuberculosis intervention were made by NICE in 2006 (updated 2011). The recommendations propose strategies for identifying those with latent (non-active) tuberculosis to prevent spread or reactivation and also specify criteria for treatment (NICE, 2011). Those recommended for screening for latent tuberculosis include close contacts of infected individuals, immigrants from high incidence countries, immunocompromised individuals, and healthcare workers. Whilst this strategy targets prevention of the spread of tuberculosis, they are only targeting specific groups, and it is likely in high incidence areas such as Newham, people will slip through the net. These guidelines have only changed minimally since 2006, and since then tuberculosis incidence has been on the increase in areas such as Newham, suggesting that changes may need to be made. High incidence areas of the UK such as Newham could learn from New York experience and copy the strategy it used in dealing with the disease. With the implementation of broadened initial treatment regimes, direct observed therapy, and improved guidelines for hospital control and disease prevention, the city managed to halt the progression of an epidemic (Frieden et al., 1995). As mentioned in the previous chapter, adherence to the lengthy treatment regime as well as a lack of understanding may contribute to the spread of tuberculosis. Directly observed therapy (DOT) involves observing the patient take each dose of their medication, with outreach workers travelling to their homes. Evidence from New York showed that through DOT, only 3% of patients in therapy were infectious, compared to a proposed 20% if not receiving DOT (Frieden et al., 1995). Current UK guidelines (NICE, 2006) do not recommend DOT, although they do state that it may be used in cases of patients with previous issues with adherence or at high risk. Although an expensive and time consuming process, if DOT can reduce infectious cases, this would also work as a preventative measure. There could be one allocated outreach nurse for the borough of Newham and other high-risk areas. Another method implemented in New York was the downsizing of large shelters for the homeless. These were breeding grounds for tuberculosis, and the subsequent reduction in overcrowding led to a decrease in transmission of the disease (Frieden et al., 1995). Whilst it is not possible to split people up from living with their families in crowded homes in terms of Newham, education about keeping those with tuberculosis from interacting with too many others in crowded conditions may be of benefit. The model should also borrow from those used by other cities like Paris and the rest of Europe in controlling tuberculosis with intervention at the level of the agent, individual and community levels. In Paris, Rieder (2002) suggested that prophylactic treatment could be used to prevent the disease occurring in those at risk, for example those in the household of an identified case of tuberculosis. Additionally, Rieder (2002) proposed that early or neonate vaccination be used especially in those in areas where tuberculosis is frequent, rarely diagnosed, and adequate contact examinations rarely feasible. It may be possible that in cases where lots of people are vaccinated that they may infer herd immunity and thus protect unvaccinated individuals from the disease. Once the populations have been protected and the incidence (number of new cases) of tuberculosis has been reduced, this allows for a reduction in the prevalence of tuberculosis (number of ongoing cases at any one point in time) with preventative chemotherapy that can treat sub-clinical, latent tuberculosis in the population. This preventative chemotherapy is likely to be extremely relevant to Newham due to the large immig rant population likely harbouring latent tuberculosis. On a country- or city-wide scale, these recommendations from New York and Paris provide excellent models for preventing the increase of tuberculosis any further. It is also important, however, to consider the individual communities in Newham, and to promote health awareness and an attitude towards taking responsibility for their health. Their needs to be an encouragement at the level of primary care where immigrant populations feel that they can approach healthcare, and education to encourage tuberculosis prevention and adherence to treatment. The strategy should be all-inclusive in order to encourage people to not only go for testing but also start and finish the treatment process. 6. Recommendations and conclusion Tuberculosis presents an important urban issue in the area of Newham. Incidence is greater than other areas of the UK, and is over half that of India. There are several factors contributing to this including a large immigrant population, crowding and overpopulation, access to healthcare and comorbid health problems such as vitamin D deficiency and HIV. The disease has considerable effect on morbidity and is responsible for high levels of mortality. Further consequences of the disease manifest as economic problems such as cost of treatment and loss of work. London and the UK already have policies and structures for controlling tuberculosis in place; however the implementation process is patchy across the city, and often dependent upon budget. In high-risk areas such as Newham, there is poor access of healthcare due to inaccurate beliefs on the disease, language and cultural barriers, and complex needs of the population. In the case of tuberculosis, these contribute to poor disease prevention, delayed diagnosis and poor treatment adherence. All of which lead to an increase in transmission and health consequences. The area of Newham would benefit greatly from further education into tuberculosis, how to look for signs and how to get treatment. Encouraging good relationship with healthcare professionals and promoting access to healthcare through outreach programmes and targeting pharmacies may be helpful. Additionally, Newham should look to employ techniques used in New York and Paris, including DOT, prophylactic treatment and neonate vaccination to reduce both the prevalence and incidence of tuberculosis. References Ahlburg (2000). The economic impact of TB: ministerial conference Amsterdam, WHO Bates, I., Fenton, C., Gruber, J., Lalloo, D., Lara, A. M., Squire, S. B., and Tolhurst, R. (2004). ‘Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part II: determinants operating at environmental and institutional level’.  The Lancet Infectious Diseases,  vol. 4(6), pp. 368-375. Bhunu, C. P., and Mushayabasa, S. (2012). ‘Assessing the effects of poverty in tuberculosis transmission dynamics’.  Applied Mathematical Modelling,  vol. 36(9), pp. 4173-4185. Campbell, G. R., and Spector, S. A. (2012). ‘Vitamin D inhibits human immunodeficiency virus type 1 and Mycobacterium tuberculosis infection in macrophages through the induction of autophagy’.  PLoS pathogens, vol.  8(5). Castillo-Chavez, C., and Feng, Z. (1997). ‘To treat or not to treat: the case of tuberculosis.  Journal of mathematical biology’,   vol. 35(6), pp. 629-656. Colditz, G. A., Brewer, T. F., Berkey, C. S., Wilson, M. E., Burdick, E., Fineberg, H. V., and Mosteller, F. (1994). ‘Efficacy of BCG vaccine in the prevention of tuberculosismeta-analysis of the published literature’.  Jama, vol. 271(9), pp. 698-702. Commonwealth Health Ministers Update 2009. (2009). Commonwealth Secretarial. Dye, C., and Williams, B. G. (2010). ‘The population dynamics and control of tuberculosis’.  Science,  vol 328(5980), pp. 856-861. Dyer, C. A. (2010). Tuberculosis. Santa Barbara, California: Greenwood. Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds.  Goldmans Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011: vol332. Farrar, J., Manson, P. (2013). Mansons tropical diseases. Hoboken, NJ: Wiley. Figueroa-Munoz, J. I., Ramon-Pardo, P. (2008). Tuberculosis control in vulnerable groups.  Bulletin of the World Health Organization,  86(9), 733-735. Frieden, T. R., Fujiwara, P. I., Washko, R. M., and Hamburg, M. A. (1995). ‘Tuberculosis in New York City- turning the tide’.  New England Journal of Medicine,  vol. 333(4), pp. 229-233. Fullman, J., Strachan, D. (2013). Frommers London 2013. Hoboken, NJ: Wiley. Great Britain. (2008). Diseases know no frontiers: How effective are intergovernmental organisations in controlling their spread? ; 1st report of session, 2007-08. London: Stationery Office. Jindal, S. K. (2011). Textbook of pulmonary and critical care medicine. New Delhi: Jaypee Brothers Medical Publishers. London Borough of Newham, (2010). Community Leaders and Engagement, Manor Park Community Forum Profile [Online], Available:newham.info/research/CFProfiles/ManorPark.pdf [12 April 2014]. Malone, C., Beasley, R. P., Bressler, J., Graviss, E. A., Vernon, S. W., University of Texas Health Science Center at Houston, School of Public Health. (2009). Trends in anti-tuberculosis drug resistance from 20032007 at Pham Ngoc Thach Tuberculosis and Lung Disease Hospital, Ho Chi Minh City, Vietnam. (Masters Abstracts International, 47-5.) National Institute for Health and Care Excellence (2006) [Clinical Diagnosis and Management of Tuberculosis, and measures for its prevention and control]. [CG117]. London: National Institute for Health and Care Excellence. Ormerod, L.P. (2003) ‘Nonrespiratory tuberculosis. In Davies PDO (Ed) Clinical Tuberculosis. Third Edition. Arnold: London. pp. 125-153. Public Health England (2012), World Health Organization (WHO) estimates of tuberculosis incidence by rate, 2012 (sorted by rate). [Online] Available at: hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140584841 [12 April 2014]. Rieder, H. A. (2002).  Interventions for Tuberculosis Control, 1st edn. International Union Against Tuberculosis and Lung Disease, Paris, France. Szczepura, A. (2005). ‘Access to health care for ethnic minority populations’. Postgraduate Medical Journal,  vol. 81(953), pp. 141-147. Vassall, A., University of Amsterdam. (2009). The Costs and cost-effectiveness of tuberculosis control. Amsterdam: Amsterdam University Press. Watson, J. M., and Maguire. H.C (1997). ‘PHLS work on the surveillance and epidemiology of tuberculosis.’ Communicable disease report. CDR review 7.8, pp. R110-2. World Health Organization. (2009). Global tuberculosis control: Epidemiology, strategy, financing : WHO report 2009. Geneva: World Health Organization. World Health Organisation (2014). Tuberculosis. [Online], Available: who.int/topics/tuberculosis/en/ [12 April 2014] UK Census (2012), UK Census Data, [Online]. ukcensusdata.com/newham-e09000025#sthash.51Phmj6a.dpbs [12 April 2014]

My Public and Private School Experience Professor Ramos Blog

My Public and Private School Experience Photo by å‘ ¨ Ã¥ º · on Pexels.com When I started school I was a kindergartner at Calvary Christian School. It is a private school with about 200-300 students. I went from kindergarten until my freshman year was over. The dress code was a red, white, or blue polo shirt with a Navy Gabardine Box Pleated Jumper or Hamilton Plaid Knife Pleated Jumper for girls from kinder to eighth grade. The boys wore the same shirts with Navy Hawthorne Pleated pants from kinder to senior year. Once a girl reached 9th-12th grade they would wear skirts. The school subjects did not have a variety to choose from. Bible, Math, History, Science, P.E. and Fine Arts were the main classes provided. We all took the same classes together while not having the option of taking any ap classes. I joined the volleyball team but due to my grades my 9th grade year I could not play and I found out on the last day of school that I was going to have to take summer school or get held back. My parents didn’t take that well at all and decided to take me out. I was shocked about the news and began to worry about what is going to happen for the next school year and were I was going to attend. Luckily my mom works for the Beaumont school district and I got transfered over to Beaumont High School because at the time we were living in Banning Ca. I knew that getting adjusted to a new school and people was going to be nerve wracking but I will be gaining a new experience I never had before and I may end up liking it. Beaumont High School had around 2,000-3,000 students, no dress code limitations, counselors and a variety of classes to take. The first day of high school came around I was nervous but excited. When I got ready I remember wearing a black and white t-shirt with light blue shorts and some vans. The first day was a bit embarrassing because my fly was down the entire time and I never noticed it until I dressed out for P.E. even though we weren’t even supposed to dress out. As the weeks and months went by I felt more comfortable, I got used to it very quickly and made new friends along the way. What I learned about diversity from my point of view was the change and the adaptation I was going to have to make. I think that change is very good because it can help you grow, offer new opportunities, it can show progress and new beginnings. Others have helped me with encouragement about going to public school. My family would talk about some things they went through. My Aunt Anita in particular told me that she had to get adjusted to high school when she went while being in public all of her life. She said â€Å" Everyone goes through different stages in their life and starting of high school is one of them and you will get through it and it will be a breeze as time goes on.† I think talking to others about my situation was very beneficial because I got a look of what some of my family have went through and also one of my friends that was currently attending Calvary Christian School. Sarah Weeks and I were the only ones that stayed at that school until high school and we always thought we were going to graduate together. I attended her graduation and it was crazy seeing her up their and realizing we are finishing high school separately. We were both happy and sad that we didn’t graduate together but most importantly were still friends and still reminisce on the little things that happened throughout the years. What I learned the most from attending both of these schools is that you can succeed wherever you go and still learn new things in the process you just have to be determined wherever you go and learn from it. I believe that my experience can show others what kind of change I went through and it ended up being very positive than I thought and people should be open to it in different situations and they should step out of their comfort zone once in awhile because you can gain something out of it and can also share your own story to others whether it be good or bad because every experience is different. I have always wondered how different it would be if I went to public school first and eventually being placed in a private school because it would be a very different encounter and just adjusting to a new routine would take time for me to get used to. My sister was placed in private school for about a year and then started in public and will continue to go there. She is in the first grade right now, but its interesting to know how different both of our experiences were from each others. I would say going to public school has helped me become open to meeting new people and talking to others. I remember being very shy and to myself most of the time but eventually got the courage to be more outgoing. I think going to the private school for so long I was already used to everyone so I wasn’t as shy and to myself because I knew a lot of the people at such a young age. It was hard at first because I didn’t know anyone from bhs and I had to put myself more out there and I really didn’t want to. By opening myself to others I felt like they were really understanding who I am and what type of person I was which made made everything positive. Going to completely different schools is hard but it is doable if you put yourself out there you may have to change somethings in your daily life than you are used to but it can be beneficial to you and give you a new perspective like the school topics, dress code and the different types of people you encounter.

Certificacin laboral PERM para green card por trabajo

Certificacin laboral PERM para green card por trabajo La certificacià ³n laboral PERM  es uno de los primeros requerimientos que deben cumplir las empresas que quieren patrocinar una tarjeta de residencia (green card) a trabajadores extranjeros. El  PERM, que son las siglas que se utilizan en inglà ©s para referirse a este requisito, es un paso previo y necesario a la solicitud de la green card al Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s). En otras palabras, sin la aprobacià ³n del PERM por parte del Departamento de Trabajo (DoL, por sus siglas en inglà ©s) no es posible iniciar los trmites migratorios. En este artà ­culo se explica los pasos para obtener el PERM, para quà © categorà ­as de peticià ³n de la green card por trabajo es necesario, tiempo de demora de su tramitacià ³n, quà © sucede con la familia del trabajador para el que se solicita el PERM y otras opciones para trabajar en Estados Unidos Pasos para obtener la green card por trabajo y cunto tiene lugar el PERM El PERM  es el segundo paso en la tramitacià ³n de una green card por trabajo. El primero paso es que una empresa està © dispuesta a patrocinar a un trabajador extranjero especà ­fico. Estas son las 100 empresas que patrocinan un mayor nà ºmero de tarjetas de residencia. Esta es una informacià ³n importante porque brinda una idea clara de quà © tipo de empresas suelen patrocinar y para quà © tipo de trabajo. Sin embargo, esto no quiere decir que las empresas pequeà ±as no patrocinen o no puedan hacerlo. Todo lo contrario. Pero lo cierto es que las grandes, particularmente en algunos sectores como el tecnolà ³gico, estn ms acostumbradas a hacerlo y estn ms familiarizadas con el proceso. El segundo paso en la tramitacià ³n de la green card por patrocinio de empresa es presentar el PERM ante el Departamento de Trabajo (DoL, por sus siglas en inglà ©s). Una vez que se obtiene la aprobacià ³n del PERM tiene lugar el tercer paso, que es presentar la peticià ³n ante el Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s). Y finalmente, el à ºltimo paso se desarrolla con el Departamento de Estado si el trabajador est fuera de Estados Unidos, ya que la visa de inmigrante se obtiene en una embajada o consulado de los Estados   Unidos. Hay que destacar que los migrantes en Estados Unidos en situacià ³n de ilegalidad deben consultar con un abogado antes de iniciar cualquier tipo de trmite, porque en la mayorà ­a de los casos el tener una empresa dispuesta a patrocinar no va a servir de nada como camino hacia la regularizacià ³n. Todo lo contrario, sirve para alertar a las autoridades migratorias. Peticiones de green card cuando es necesario el PERM: EB-2 y EB-3 Para casi todos los casos en los que se patrocina una green card a travà ©s de estas categorà ­as es necesario obtener un PERM (ver ms abajo las excepciones). En primer lugar, la categorà ­a conocida como EB-2 o segunda preferencia. Pueden beneficiarse los profesionales con una maestrà ­a o estudios superiores o tambià ©n las personas con habilidades excepcionales en los Negocios, las Artes y las Ciencias. Hay 40,000 visas de inmigrante  asignadas  por aà ±o fiscal para esta categorà ­a. En segundo lugar, la categorà ­a EB-3 o Tercera preferencia y Otros trabajadores que aplica a: Profesionales con licenciatura o egresados universitarios, es decir, el equivalente a el B.A. o el B.S. de Estados Unidos. Personas sin estudios universitarios pero con una habilidad profesional especial y experiencia laboral mà ­nima de dos aà ±os. Personas sin habilidades especiales pero cuyo trabajo requiere una experiencia laboral de al menos dos aà ±os. Sin embargo, hay que tener en cuenta que la certificacià ³n laboral PERM no se requiere para los extranjeros que alegan que la tarjeta deberà ­a otorgrsele por razones de:   Interà ©s Nacional, es lo que se conoce como NIW, por sus siglas en inglà ©s dentro de la categorà ­a EB-2Habilidad extraordinaria en la categorà ­a EB-1, inversià ³n EB-5, o trabajadores especiales incluidos en la categorà ­a EB-4, tales como trabajadores religiosos, extranjeros que han prestado ms de 12 aà ±os de servicio en el Ejà ©rcito de Estados Unidos, traductores iraquà ­es y afganos que han trabajado para Estados Unidos, etc. En quà © consiste el PERM   La empresa estadounidense que desea patrocinar la green card a un trabajador extranjero debe obtener primero el PERM siguiendo 3 pasos. En primer lugar, el empleador americano debe publicitar la oferta de trabajo para asegurarse de que ningà ºn ciudadano americano, residente permanente, refugiado, asilado o persona con un permiso de trabajo est dispuesto y quiere desempeà ±ar ese empleo. Se trata de asegurar de que si hay ya en los Estados Unidos personas cualificadas que pueden trabajar, à ©stas opten al trabajo. Para ello, la empresa debe realizar labores para intentar encontrar un trabajador por un mà ­nimo de 30 dà ­as y un mximo de 180. Las condiciones son tambià ©n diferentes segà ºn se trate de una ocupacià ³n profesional o no. En segundo lugar, debe comunicarse con la NPWC –una oficina federal- para saber cul es el salario que se paga por el puesto de trabajo que se ofrece. Y es que ningà ºn extranjero puede cobrar menos y recibir beneficios laborales inferiores a los que cobran las personas nacionales en ese mismo puesto de trabajo, para evitar que las personas de otros paà ­ses presionen hacia abajo los salarios. Y en tercer lugar, el empleador debe rellenar electrà ³nicamente la planilla ETA Form 9089  en la pgina web del Departamento de Trabajo (DoL). Para ello debe crearse previamente una cuenta de usuario.  ¿Quà © examina el DoL para decidir si aprueba un PERM? El DoL bsicamente verifica  tres cosas: que la empresa està © respetando todas las regulaciones   que no hay  en Estados Unidos una persona que pueda trabajar, que està © capacitada para el trabajo que se ofrece y que està © dispuesta a hacerlo.que el empleo de una persona extrajera no afecta negativamente ni al salario ni a las condiciones laborales de trabajadores estadounidenses que se desempeà ±an en posiciones similares. El caso de empresas que quieren patrocinar a familiares El DoL pone especial atencià ³n a los casos en los que existe una relacià ³n familiar entre quien contrata y el patrocinado. En concreto la pregunta C.9 pide especà ­ficamente seà ±alar si el dueà ±o de la empresa o algà ºn socio, oficial o accionista es familiar el patrocinado. Y en este contexto el tà ©rmino de familia debe entenderse en sentido amplio e incluye a: cà ³nyuges, hijos, padres, abuelos, nietos, tà ­os y primos en cualquier grado. El và ­nculo puede ser por sangre, adopcià ³n o matrimonio. Si se puede probar que la necesidad de ese trabajador es de buena fe, el DoL aprobar el PERM, pero si el oficial a cargo del caso cree que se trata simplemente de querer contratar a un familiar pero hay ya en Estados Unidos un trabajador que puede ocupar ese trabajo, negar la peticià ³n. Tener en cuenta que contestar a esa pregunta otra cosa que no sea la verdad constituye un fraude de ley y que en el momento en que se descubre puede dar lugar bien a la negacià ³n del PERM o, si ya ha sido aprobado, a su revocacià ³n.   Tiempo de demora para la certificacià ³n laboral por el DoL Generalmente, el DoL aspira a dar una respuesta en el plazo mximo de 60 dà ­as. Sin embargo, en la actualidad se est demorando ms llegando a casi 90 dà ­as. Adems, si por cualquier razà ³n le ha tocado a la peticià ³n ser auditada, se requerir informacià ³n adicional al empleador y el trmite se demorar ms tiempo. Si la certificacià ³n de laboral PERM es aprobada, entonces el empleador debe dirigirse en un plazo mximo de 180 dà ­as al Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s). Tras rellenar la planilla I-140 se iniciar el proceso migratorio. Si el trabajador est legalmente en EEUU, por ejemplo, con una visa H1-B vlida y no hay que esperar para que la haya visas de inmigrante (tarjetas de residencia) disponibles para la categorà ­a para la que se pide al trabajador, entonces se puede solicitar al mismo tiempo un ajuste de estatus mediante la planilla I-485. Si no hay visa de inmigrante disponible, no se puede solicitar todavà ­a el ajuste y hay que esperar legalmente a tener una para poder hacerlo. Lo mismo sucede cuando el trabajador est en el extranjero, si hay visa de inmigrante disponible  se iniciar el proceso consular para concederle la visa para viajar a EEUU. La tarjeta de residencia se activar una vez que entra al paà ­s mediante un sello en el pasaporte. Pero si no hay visa disponible, tendr que esperar.  ¿Quà © es esto de si hay visa de inmigrante disponible? Puede suceder que en el caso de trmites tarjetas de residencia por empleo dentro de la categorà ­a EB-3   el nà ºmero de solicitudes sea superior al nà ºmero de visas de inmigrante que hay disponibles para esa categorà ­a. En estos casos se puede producir una demora entre la aprobacià ³n del USCIS y la fecha en la que se inician los à ºltimos trmites. Adems, esta espera puede afectar ms a los nacionales de determinados paà ­ses, ya que se establece un là ­mite por aà ±o fiscal no sà ³lo en el nà ºmero total de visas de inmigrante que se pueden dar en una determinada categorà ­a, sino tambià ©n en el porcentaje mximo que puede ir a los nacionales de un paà ­s. Para verificar cunto se puede demorar, checar la fecha de prioridad de la aplicacià ³n con la que publica cada mes el Departamento de Estado (DoS) en su Boletà ­n de Visas, dentro de la categorà ­a correspondiente. Tener en cuenta que la fecha de prioridad cuando ha sido necesario el PERM es la de presentacià ³n de papeles en el DoL mientras que si no ha sido necesaria es la fecha de presentacià ³n del formulario I-140 ante el USCIS. Familiares de trabajadores patrocinados para green card por razà ³n de trabajo El cà ³nyuge y los hijos solteros de 21 aà ±os de un trabajador para el que se patrocina una green card por estas categorà ­as tambià ©n pueden obtener sus propias residencias permanentes. A efectos migratorios, el tà ©rmino cà ³nyuge incluye tanto a los matrimonios entre un varà ³n y una mujer como a los celebrados vlidamente entre 2 personas del mismo sexo.  ¿Dà ³nde obtener ayuda para completar el PERM? Si se tiene algà ºn problema de carcter tà ©cnico como, por ejemplo, haber olvidado el PIN de usuario, se puede enviar un correo electrà ³nico a: pic.helpdol.gov Si se tiene alguna duda o inquietud sobre algà ºn aspecto del PERM, como por ejemplo, dà ³nde se debe publicitar el reclutamiento y cà ³mo, contactar por correo electrà ³nico con el Departamento de trabajo en la siguiente direccià ³n: PLC.Atlantadol.gov En todo caso, el PERM es un asunto que requiere conocimientos migratorios y   tà ©cnicos por lo que es aconsejable asesorarse con un abogado. Cuando se obtiene el PERM pero la peticià ³n de green card no es aprobada Es posible que a pesar de tener una empresa dispuesta a patrocinar y de obtener el OK del Departamento de Trabajo al PERM al final de toda la tramitacià ³n se niegue la solicitud de la tarjeta de residencia. Las razones pueden ser muy variadas pero se resumen en una sola palabra: inelegible. Y es que para obtener la green card tanto a travà ©s del procedimiento consular o por medio de un ajuste de estatus es necesario ser elegible. Si por una causa se es inelegible, la residencia no es aprobada. Dependiendo de la causa en algunos casos ser posible obtenerla ms tarde, dejando pasar un tiempo. En otros la opcià ³n puede ser solicitar un perdà ³n, tambià ©n conocido como waiver o permiso. Y, en otras situaciones no se puede hacer nada con las leyes actuales en mano y no se obtendr la green card. Otras opciones migratorias para trabajar Para trabajar legalmente en Estados Unidos se necesita un documento que explà ­citamente lo permita, como por ejemplo una visa de trabajo, una de intercambio admitiendo la visa J-1 muchas variedades  o un permiso de trabajo. En todo caso, aceptar un trabajo sin tener documentos migratorios que lo permitan es una violacià ³n migratoria. No confundir PERM con LCA La certificacià ³n laboral aplica cuando se quiere patrocinar a un trabajador extranjero en las categorà ­as  EB-2 y EB-3, es decir, esto es un proceso distinto al de Aplicacià ³n de Condicià ³n Laboral (LCA, por sus siglas en inglà ©s), que es un paso previo que se necesita realizar ante el Departamento de Trabajo pero para las  visa de trabajo temporal  H-1B. Este es un artà ­culo informativo. no es asesorà ­a legal.

Operational Warfare and the Revolutionary Nature of Interwar Period Essay

Operational Warfare and the Revolutionary Nature of Interwar Period - Essay Example It is evidently clear from the discussion that operational warfare is the term derived from Russia during 18th and 19th centuries. Operational warfare is a concept based on the military theory, which suggests a norm towards the behavior and trends in the military affairs. It was developed during the period of mechanization of armed forces. It signifies coordination of different level of command from the small level of action to a higher level. The operational level has gradually changed in case of size and objectives of armies. The operational level formation was not powerful in the post-cold war era, but during the cold war and the Second World War, the operational-level formation was highly powerful. In his seminal book, The Framework of Operational Warfare Clayton R. Newell elaborates on the three perspectives of wars- tactical, operational and strategic perspectives. The activities of war change according to how it is viewed. One can understand the war by analyzing these three pe rspectives. Among these three, operational perspective is the newest which is associated with land warfare. As Newell rightly observes, â€Å"even though the origins of the operational perspective can be traced back to the eighteenth century, it remains a new idea in warfare when compared to the hundreds of years of warfare which have been studied from only the two perspectives of strategy and tactics†. It can thus be concluded that the operational warfare was an innovative mode of waging wars and it has immensely contributed to the strategic and operational formation of future wars.

Discussion and Respond. 3 Dissertation Example | Topics and Well Written Essays - 500 words

Discussion and Respond. 3 - Dissertation Example Effective communication is required for interdependence in business. In order to understand a business or any of its operation, a manager needs to study a situation by talking to the insiders. This talking in actual means listening and extracting the domain information till complete comprehension is achieved. Only when the problem is understood can an effective and valuable solution be reached at. So the concept is basically to listen first before speaking. Managers can adopt the technique during the performance reviews of the workers. By listening to the workers problems, a better understanding of workers problems and goals can be achieved. This can be aligned with the goals of company, and practical strategies aiming at increased productivity can be reached at. 5. Give an example of how a Manager cans Model Behavior? A manager can perform a certain behavior in order to show the employees how they are expected to behave too which guides them through the imitation process of the mode led behavior. For instance, instead of telling the employees what to do, a manager can take out time to sit with them and show the proper way of doing things. By pairing them up with the experienced employees, manager motivates the inexperienced staff to ask questions and learn from the experienced resources. By communicating professionally and courteously, a manager motivates a culture where the subordinates behave in a similar manner with their lower staff.

Strategic Analysis and Choice Essay Example | Topics and Well Written Essays - 4250 words

Strategic Analysis and Choice - Essay Example The analysis includes political, economic, social and technological factors. Political factors affect the marketing and strategic growth plans of a business. Legislations and regulations of a country affect the plans of the business. This can be control of ingredients used, price changes and different views of the party in power compared to the former one. For e.g. in Pakistan, after the emergency was imposed on 3rd November 2007 the media was curbed and shut down until they signed a deal not to talk against the present government. Thus, GEO Pakistan a channel that is aired in Pakistan, Dubai, UK, USA and Canada. This organization is a multinational since it is aired in three continents around the world. The company uses all the latest technology in media like news room automation service, graphics system, automated play out system, media server systems, GEO firsts (interactive program) and training on international standards; and it is a market leader at home in Pakistan. It is huge since it employs the most people in Pakistan. The company is young. The company is family owned. The channel refused to abide by the regulations and has not been aired in Pakistan up till now. The channel was a leader in the market but now they have suffered huge losses due to the close down of the channel. Eventually, they had to abide by the regulations to avoid further losses and downsizing of employees. Now the channel will be aired soon. GEO is a good example of a company that tried to go against the industry norms and comply with the rules in order to differentiate but it all went wrong and they suffered. This was a risk and they had to pay for non compliance of industry norms. This example is a fitting example in this case because their strategic... This essay is a strategic analysis of how the companies respond to changes in their internal and external environments. Also that companies often plan to use such strategies to gain a competitive advantage over their various competitors since an edge over the others always helps them stand at the highest peak and successfully manage to balance and avoid falling disastrously. Often companies plan and forecast but the actual result is different from the forecasted one. Theories are often good to study and get a proper understanding of the situation but they do not necessarily fit in real life. Uncertainty is part of life and a proper analysis to take a decision is important for companies. Thus, businesses aim to grow and gain competitive advantages since expansion is an industry norm but then they have to face problems while operating in the internal and external environments and these businesses tend to use these strategies to their best advantage and even by manipulating these at tim es to fit their conditions and markets. This helps them grow and gain an edge over their competitors. Competitive advantages are essential to businesses for continuous growth in the existing and new markets in order to expand and turn into giants. Managers need to have a clear vision of the future of the company.

The UK No-Frills Airline Market Case Study Example | Topics and Well Written Essays - 3000 words

The UK No-Frills Airline Market - Case Study Example The entry of new companies in the market is one of the factors that greatly affect the competitiveness of companies in the sector since the new companies come with strategies to win customers into their company. Some other factors that affect the competition in the market are the bargaining power of the suppliers, the bargaining power of the consumers, the bargaining power of the competitors and the presence of substitutes in the market. This paper seeks to analyze competition in the no-frills airline market and also compare it with the condition that was there about forty or fifty years ago. The issue of price discrimination and outsourcing is also discussed in the paper. One of the factors that have brought great competition in the no-frills airline market is the entry of new competitors in the market (Krishna & Eric 2003: p.49). The moment new companies join a market; they have the intention of winning some customers so that they can have a share in the market. They also come with new capacities in the market thus challenging the companies which are already in the market. They also come with a desire to gain some substantial resources in the market. The companies are willing to do anything to meet their goals. However, these companies are likely to be affected by the barriers that are present where these barriers are usually high meaning that entry into the market would mean that the company has to sell at a higher price so as to recover its expenses. This gives the existing companies a competitive advantage over these new companies making it quite hard for these companies to survive in the environment. The reaction of the airline companies that are already in the market also matters a lot. If the present companies collude so as to eliminate a new company, it is very easy because these companies have been in the market for quite some time. Most of the companies will always be willing to eliminate these new companies and will do this by colluding with the other companies in the no-frills airline market.     

Describing myself in terms of the 5 factor model Essay

Describing myself in terms of the 5 factor model - Essay Example Each human being has different and unique personality traits. Psychologists usually take tests to find out the personality type. These tests contain a list of objective questions that find out the behavior, insight, opinion and reaction of human beings in different situations. It finds out the way human being differ with each other in their enduring emotional, interpersonal, experiential, motivational and attitudinal style. According to the answers provided in the test, a score is calculated for every personality dimension and seen in respect of general population. (McCrae & Oliver , 2006) I also took the IPIP Personality test online from http://www.personal.psu.edu/~j5j/IPIP and found out my results. Let's look at each of the five factor model according to my personality and then match my take on these with the results of the test. OPENNESS: Openness to experience relates to one's flexibility to new ideas and openness to change. It signifies that the person welcomes and accepts new ideas, experiences, people, thoughts and situations. People who are 'open to experience' usually appreciate arts, science, music, emotions, and adventure. They tend to be very imaginative, creative, and like to have a variety of different experiences. They are less conservative and stick more to traditional ways. They are usually suspicious about newer ideas and are not comfortable with abstract thoughts and ideas. I think I am slightly more 'open to experience' than general people. I love creativity and new experiences. Throughout my school life, I have been involved in various different experiences. I have participated in debates, I have studied psychology and have taken huge interest in studying business as well, I have been in sports and I am also into reading. This all combines to make me a person with diverse set of experiences. I am thrilled by newer ideas. Whenever I take up a project, I look for creative and out-of-the-box ideas. I believe that one thing can be done in seve ral ways and I always give it a try. I love to travel and go on adventures. Although I am a little afraid of heights but the idea of mountain climbing, hiking and adventurous sports thrill me. Sometimes I hold back due to fear but then I try to calm myself and give these things a go. It is because I love to have thrill and excitement in my life. My being openness to change however does not mean that I do not stay with my traditional values. I am a firm believer of my religion and I like sticking to rules. I like adventure and new ideas but only if they do not contradict with my beliefs. For example I like to have thrill in my life but I would never break rules to do so. I also enjoy the traditional events and festivals with the people around me. My Results: "My result for Openness to Experience is average, indicating that I enjoy tradition but are willing to try new things. My thinking is neither simple nor complex. To others I appear to be a well-educated person but not an intellec tual." My score is 41. The result signifies that I have an average Openness to experience or change. This is slightly different from what

The UK No-Frills Airline Market Case Study Example | Topics and Well Written Essays - 3000 words

The UK No-Frills Airline Market - Case Study Example The entry of new companies in the market is one of the factors that greatly affect the competitiveness of companies in the sector since the new companies come with strategies to win customers into their company. Some other factors that affect the competition in the market are the bargaining power of the suppliers, the bargaining power of the consumers, the bargaining power of the competitors and the presence of substitutes in the market. This paper seeks to analyze competition in the no-frills airline market and also compare it with the condition that was there about forty or fifty years ago. The issue of price discrimination and outsourcing is also discussed in the paper. One of the factors that have brought great competition in the no-frills airline market is the entry of new competitors in the market (Krishna & Eric 2003: p.49). The moment new companies join a market; they have the intention of winning some customers so that they can have a share in the market. They also come with new capacities in the market thus challenging the companies which are already in the market. They also come with a desire to gain some substantial resources in the market. The companies are willing to do anything to meet their goals. However, these companies are likely to be affected by the barriers that are present where these barriers are usually high meaning that entry into the market would mean that the company has to sell at a higher price so as to recover its expenses. This gives the existing companies a competitive advantage over these new companies making it quite hard for these companies to survive in the environment. The reaction of the airline companies that are already in the market also matters a lot. If the present companies collude so as to eliminate a new company, it is very easy because these companies have been in the market for quite some time. Most of the companies will always be willing to eliminate these new companies and will do this by colluding with the other companies in the no-frills airline market.     

Spiritual Needs Questions Essay Example | Topics and Well Written Essays - 1000 words

Spiritual Needs Questions - Essay Example With the information collected from the investigation, policies and guidelines should also be formulated to help in the implementation of care that is sensitive to these needs. From the above findings, it is clear that there are major spiritual beliefs and inclinations that patients hold that affect the health management of the patients in hospital settings. The above assessment indicates that the reasons that are given by the patients may not make medical sense but remain patients’ rights in the holistic management of the patients. The assessment tool included the religious affiliation to identify the varied nature of religious beliefs that are held owing to differences in the beliefs of Muslims, Christians, Indians and other religions. Equally, different denominations within the same religions also have different beliefs like Protestants and Catholics in Christians. The other questions in the assessment tool were aimed at assessing the knowledge and attitude of the patients to their own beliefs. From the above assessment, the patient appeared to have a good grip of the requirements that her belief system require. The attitude of the patients is that she has a predisposition and liking for these beliefs. In turn, these cause the patients attitude to be negative towards many health practices. The tool also included a question that was aimed at assessing the attitude of the health practitioner towards the spiritual dispositions of the patients. Evidently, most health practitioners are not concerned with the spiritual beliefs of the patients and how they affect their recovery. It is evident that there were no questions allowing the validation of the information given by the patient. The reason is that the tool of assessment did not have a prelude of the religion and the denomination of the patient. As such, all the information obtained is given on the assumption of truth telling on the part of the patient and that the patient adequately knows the

Museum of Art Essay Example for Free

Museum of Art Essay After visiting the Raleigh Museum of Art, I discovered two paintings that conjured up opposite feelings that I will compare and contrast. The painting I liked most was titled, Jungle Camp, 2000 an Acrylic on canvas 72 x 60 in. (182. 9 x 152. 4 cm), from one of North Carolina’s most respected artists, Maud Gatewood. Her paintings record the varied experiences of a wandering life. Writing on the back of the canvas, the artist notes the origins of this picture: Trapped in the Amazon with a bad leg. Confined to a hut, she made the most of the opportunity. The second painting titled, Venice without water, by North Carolina’s artist Donald Sultan was the painting I truly disliked because of the feelings it provoked. Sultan’s painting from 1990 was an acrylic painting and measured 96 x96 inches in dimension. Sultan used Butyl rubber, acrylic paint, and plaster on vinyl composite tiles, which were mounted on four Masonite panels. Both painting represent landscapes captured by the artists’ eyes or through a photograph. These paintings gave me two strong, but opposite, feelings: joy and sadness. I will describe the differences and contrast these two works of art. The two pieces of art works have several differences in style. First, the shape in the painting, jungle camp, is rectangular; while the second painting is square. The choice and use of color in the two paintings are completely opposite. Since color is most important to me, I chose the jungle camp painting due to the variety of bright colors that pop from canvas. The painting from Mrs. Gatewood is colorful, which gave me a feeling of joy and warmth. However, Sultan decided to use contrast instead of colors in his painting. Thus, Sultan’s painting is filled with different tones of grey, black, or white. Gatewood’s painting represents a jungle’s view from a patio or balcony. I can see tall palm trees all stuck to each other in her painting, which gives the impression of abundance and fertility. She chooses many different variations of green. For example, she utilizes certain hues of light green to create an effect of sun reflection. There are two types of curtains on the patio, hanging on a fine line. The first is really colorful, a mix of tropical color, and the second is like a white veil, which you can see trough it. The mix of materials and colors for the curtains, added to the jungle, procures me a sense of evasion, vacation, and relaxation. I was drawn to the atmosphere of serenity and tropic jumbled together, which is the reason that this painting evoked my interest. However, Sultan’s painting is the exact opposite of abundance and excursion. The whole artwork is quite dark and sad. It’s a representation of the well-known Rialto’s bridge, which is an infrastructure between to planes. The first plane is an illustration of wood’s pillars, which surround the Venetian canals; they are use by the gondoliers to park their â€Å"original dinghy†. The second plane is the bridge; it looks pretty scary and dark with no one crossing it. The final plane, which is the background, consists of some Venetian’s buildings. These buildings form a line that converges towards the bridge; which helps my eyes focus on the main subject the bridge. Sultan’s painting does not reflect the Venice that I saw five years ago. When I think about my trip to Venice, I have an enriched memory filled with bright colors from the Carnival. I remember vivid colors on all the masks, costumes, life, and crawl of people. Sultan’s artwork doesn’t have any of my souvenirs. Instead, the painting is more like a sinister version of the beautiful city, Venice. Although I do not like this particular outlook of Venice, I realized after studying his painting that the artist is expressing his environmental point of view of the city, which I completely agree with. As an admirer of this city, I feel concerned by the environmental issue depicted in the painting. The notion that the excess of tourism could be destructive to a fragile city like Venice is a valid concern. The artist conveys his dismay over â€Å"the deteriorating environment with the unused mooring posts, the dry canal bed of mud-like tar, and the melancholy mood of the painting†. I think that colors or tonalities are the essence of the painting, like the rhythm and tunes are for music. In my view colors are strongly subjective, they can have different psychologist effects and symbolist’s significations, they can differ from a culture to another; associating Black with mourning is normal, in our occidental countries, while in Asia it’s the actual opposite, White. In my case the colors are the main cause, on what I think is pretty or not.

Sepsis Systemic Immune Response Health And Social Care Essay

Sepsis Systemic Immune Response Health And Social Care Essay Sepsis is defined by the clinical signs and symptoms of a systemic immune response to infection. (1-2) Currently, sepsis on a worldwide level creates a significant level of mortality; and results in approximately one third of all Intensive Care admissions. (3-5) In Victoria alone there are approximately 8500 admissions to Emergency Departments with patients suffering from sepsis (3) and this number is increasing. Sepsis treatment can be initiated with a broad spectrum antibiotic, and then transferred onto a specific antibiotic regimen. Currently the level of pre hospital data available on the management of sepsis is very limited and the most advanced model has been initiated in the United Kingdom; including a pre hospital screening tool and then the hospital management known as the Sepsis six. (6) Pre hospital management can be utilised to the full potential of paramedics training and knowledge with the administration of pre hospital antibiotics; however this is not without risk. Per haps the resistance to hand over the authority to paramedics in the United States is the notion of creating a super bug; similar to Methicillin-resistant Staphylococcus aures. This paper proposes that the administration of antibiotics in the pre hospital field does carry some risk, but the research suggest that the benefits clearly outweigh these risks. A new pre hospital guideline must be created due to the sheer number of Emergency Department admissions. The potential to make a significant difference to a patients outcome is imperative. Epidemiology It has been highly researched and reported across the world that sepsis is a major cause of morbidity, mortality and places an enormous financial burden on the respective health system. (2, 5, 7) Statistics from Australia, United States and the United Kingdom are similar in nature and provide a wealth of information regarding the epidemiology of sepsis. Sepsis in the United States has been recognised as a public health issue, (8) with studies reporting that there are 300 reported cases per 100,000 with approximately 40% mortality. (5, 7-9) Severe sepsis in the United kingdom accounts for 27% of Intensive Care Unit admissions (4) and this is comparable with 23.8% of Intensive Care admissions in Victoria, Australia. (3) However it may be noted that this data is not very recent and that in the time of study the incidence was increasing by approximately 9% per year; whilst also reporting a decrease in the number of deaths associated with sepsis from approximately 45% to 37.7%. (5, 7, 9) Whilst many studies report the number of admissions, few report the age distribution of patients presenting with sepsis. Sundararajan et. al. highlight that the age distribution within their study was bimodal which identified that the age brackets at the extremes of the spectrum were over represented; with children less than 1 and adults in the 70-79 age bracket. (3) Upon further investigation into the types of causative pathology causing sepsis in these patients; gram positive organisms account for 28%, gram negative for 20%, fungal infections 2% and other organisms for 49%. (3) These figures are comparable with a study conducted by MacArthur et. al. of approximately 2634 patients with approximately 30% identified as gram positive and 26% gram negative bacteria. (10) Pathophysiology and clinical features What is Sepsis? Sepsis is an infection induced syndrome and the clinical appearance in nature is the consequences of cellular interactions between the host and invading pathogen. (2, 11-12) Sepsis may be initialised by prolonged local inflammation to eliminate and clear the invading pathogen. The second line of defence against invading pathogens involves the production and activation of leukocytes at the local site of infection. (13-14) Throughout this phase, immune cells identify the pathogen through pattern recognition protein receptors on the cells. (15) An example of one of these receptors are toll like receptors and these are among the recognition receptors which have the ability to activate immune cells, inducing the production of pro-inflammatory cytokines and chemokines by the stimulation with bacteria and viral proteins (depending on the infection). (15-16) The invading pathogen may initiate the complement pathway of the immune system, allowing leukocytes to phagocytose [digest] the pathoge n. If the host fails to limit the invading pathogen to a local area, the pathogen may invade the bloodstream. (16) If phagocytosis continues in the blood stream, toxic substances released by the pathogen may leak directly into the bloodstream; these include endotoxins released by gram negative bacteria (17) and lipoteichoic acid and peptidoglycan released by gram positive bacteria. (18) These by-products of phagocytosis and death of the cell may trigger a systemic activation of the complement system and stimulate the production of inflammatory cytokines. (19) Subsequently leading to an increased excessive and prolonged inflammatory response. (20) The result of this prolonged response leads to Systemic Inflammatory Response Syndrome (SIRS) which is the result of either direct or indirectly through the production and activation of nitrous oxide, oxidants and proteolytic enzymes which is known to have the potential to lead to inflammation induced organ injury. An example of this would be Acute Respiratory Distress Syndrome. (16, 20) SIRS is characterised by two or more of the following: body temperature >38Â °C or 90 beats per minute, respiratory rate >20 per minute or arterial CO2 >32mmhg or a need for artificial ventilation, and white blood count greater than 12,000/mm3 or 10% immature forms. (21) SIRS can be also initiated not only by infection, it may also develop as a result of trauma, ischemic injury or sterile inflammation. (22) What is severe sepsis? If SIRS is left untreated, this response then cascades into what is known as severe sepsis. Severe sepsis is defined as sepsis associated with organ dysfunction, hypoperfusion or hypotension responsive to fluid resuscitation. (23) This can progress to septic shock, which involves persistent hypotension unresponsive to fluid administration. (23) An example of severe sepsis is called Multiple Organ Dysfunction Syndrome (MODS). This occurs when the infection of the bloodstream leads to progressive failure of two or more organ systems which result from a prolonged and uncontrolled inflammatory response. This organ dysfunction can lead to potential organ failure and death. (19) Analyse evidence relating to the prehospital management of sepsis to identify risks and benefits of paramedic-initiated antibiotic therapy; Sibley and Sibley (23) suggest that if Emergency Medical Services (EMS) or Paramedics have a patient suffering from suspected sepsis, that they must be managed with oxygen therapy, well documented vital signs and IV access to initiate fluid resuscitation. (24) The goal for EMS is to maintain systolic blood pressure just above 90mm Hg, with a Mean arterial pressure of 65mm Hg as any higher has the potential to worsen cardiac output, with adverse reactions. (24-26) Other studies support the notion of maintaining Mean arterial pressure at 65mm Hg as there is no clinical benefit to increasing this value higher. (27-28) Sibley and Sibley (23) contradict many other studies which suggest that early empiric antibiotic treatment of patients suspected of having sepsis is a standard practice; and the earlier treatment is initiated, the more positive the outcome. (2, 6, 8, 10, 16, 25, 29-30) Empirical antibiotic treatment is the use of a broad spectrum antibiotic whilst therapeutic treatment with antibiotics is the initiation of antibiotic treatment after blood cultures are taken and the specific pathogen is identified. (31) Whilst empirical antibiotic treatment in the management of sepsis may be the initial drug of choice, it is in the patients best interest that appropriate antibiotic therapy is continued within the hospital. Appropriate antibiotic therapy is defined as the use of an antimicrobial agent that is correct on the basis of all available clinical, pharmacological and microbiological evidence. (32) With respect to the pre-hospital administration of antibiotic therapy, a recent study concluded that, if a patient is suffering septic shock, with each hour of delay in antibiotic administration after the onset of hypotension was associated with an average decrease in survival of approximately 8%. (33) However, a potential problem with empirical antibiotic treatmen t is that because sepsis is not the result of a single pathogen, the use of empirical antibiotics may not cover the pathogen causing the disease or illness. Broad spectrum antibiotics may bide time until blood cultures and appropriate testing can be done within a hospital setting. The current research suggests that the antibiotic selection used to treat conditions such as sepsis has a profound impact on patient outcomes (34) and this is also the case with inadequate antibiotic therapy, where the invading pathogen is not being effectively treated. (31) With regard to the empirical treatment, there are many different forms of pathogens that can cause sepsis, including Staphylococcus aures, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. (10) With this in mind, the aforementioned figures that roughly 28% of septic patients are caused by a gram stain positive, and 20% of patients are gram stain negative, and the rest being approximately 52% (3, 10), the notion is that broad spectrum antibiotics may not cover these specific pathogens, therefore rendering treatment useless. Potentially this could l ead to a negative or adverse outcome. An International Initiative, the Surviving Sepsis Campaign (30, 35) and the Critical Care Community in the United Kingdom (6) initially concentrated on educating emergency department staff to promote the introduction of management of sepsis known as Early Goal Directed Therapy. Upon review, poor implementation of this initiative and resuscitation lead the education staff involved to a move to target the staff working in areas outside of the emergency department, including the implementation of an operationalised resuscitation management plan referred to as the Sepsis Six. The Sepsis Six involves the administration of high flow oxygen, blood cultures, IV antibiotics, fluid resuscitation, measure serum lactate and haemoglobin and the insertion of a urinary catheter to measure urine output. The Sepsis Six can be implemented by hospital staff with different skill sets in the first hour following the diagnosis of sepsis and can make a significant contribution to decreasing mortality. (6) With respect to the rationale of the Sepsis Six Robson et. al. proposes that components of this treatment can be initiated pre hospital, and interestingly, the authors also highlight that pre hospital sepsis care is unusual, but pre hospital cardiac care is common. The question remains as to why that is. Given that all the literature available suggests that there is a significant decrease in morbidity and mortality associated with early antibiotic treatment. Within Ambulance Victoria, the current management for the treatment of severe sepsis has not been established. Only a guideline is specifically written for meningococcal septicaemia which allows paramedics to administer Ceftriaxone in the pre hospital field in the suspected case of meningococcal septicaemia. (36) Walker (37) proposes that in the year 2003, meningococcal disease affected approximately 500 Australians with approximately 100 of these cases presenting in Victoria. It would seem logical that an appropriate guideline is established for sepsis and severe sepsis based on the available data from Sundararajan et. al. (3) which suggest within a 4 year time frame, approximately 34,000 admissions to hospital were identified as suffering from sepsis. However, it must be recognised that this only accounts for 1.1% of the total number of admissions to Victorian emergency departments. (3) This is considerably more hospital admissions when compared with meningococcal septicaemia, with similar, if not more deadly consequences. Perhaps the thought of utilising empirical antibiotic therapy causing a super bug with sepsis is debateable. Whilst many studies report that Methicillin-resistant Staphylococcus aures is developed within the hospital system (38) rather than the community based setting; this attitude is changing with larger numbers of community acquired Methicillin-resistant Staphylococcus aures being reported, (39) with an estimated 50% of the population being a carrier of the bacteria. (40) The concern of doctors and other health professionals to the thought of initiating treatment with an empirical antibiotic may be a result of previous dealings with Methicillin-resistant Staphylococcus aures. Methicillin-resistant Staphylococcus aures has evolved and mutated to be come resistant over generations with different strains of antibiotic that were initially effective at eliminating the bacterial pathogen. (41) The thought that exposing such a broad spectrum antibiotic; for example ceftriaxone, (a cephal osporin antibiotic) is that the exposure of a drug like this may potentially initiate a genetic mutation in potentially a wide spread of different strains of pathogens. Many studies have investigated the use of empirical antibiotics and also the possibility of not only one pathogen causing disease, therefore developing an appropriate antibiotic regime. This makes logical sense however, with consideration to the potential to cause a genetic mutation, exposing a pathogen to several antibiotics may have the potential to produce a resistant strain to not only one antibiotic, but several. The surprising news is that these studies have proven to have little or no extra effect in reducing mortality. (42-43) Walker (37) proposes that the administration of pre hospital antibiotics by paramedics does have the potential for complications, including adverse reactions such as anaphylaxis and vasomotor collapse. However, the risk of antibiotic administration is no different to the administration of any other drug, with potential side effects and adverse reactions specific to individual patients. Synthesise recommendations for paramedic management of sepsis based on available evidence. Pre hospital data available on the treatment and management of septic patients are scarce. It is evident that more research needs to be undertaken in order to correctly identify septic patients and initiate early treatment. However the question remains as to whether data will ever be available due to the potential adverse reactions and the ethical dilemmas surrounding the prospective withholding of treatment to patients. The data that is available suggest that paramedics can make a difference in the potential outcomes of these patients. A mortality rate of close to 40% is unacceptable. It is proposed that paramedics undertake a similar model to the Sepsis Six with an available pre hospital screening tool; similar to what the United Kingdom propose. This involves the identification of systemic involvement of the immune system by utilising the classification for SIRS; whilst using this in conjunction with history of a new infection. Taking both of these into consideration, persistent h ypotension, low oxygen saturation and lack of urine output classifies pre hospital patients as suffering from severe sepsis. (6) Paramedics are an integral part of the health care team and within the United States they are being overlooked and potential skills are being disregarded and this is still not understood when the literature suggest that early treatment does make a difference in outcomes. With regard to the early administration of antibiotics, not all patients will call at the onset of symptoms. Many will wait until the condition is unbearable or they feel like they are deteriorating, therefore it is important that empirical antibiotic therapy is undertaken at the earliest opportunity. From the available literature; the United Kingdoms model is the gold standard in terms of pre hospital screening and management of sepsis. Paramedics are highly trained health professionals and are able to manage septic patients accordingly, and as previously mentioned, the sepsis six involves high flow oxygen, blood cultures, IV antibiotics, fluid resuscitation, measured serum lactate and haemoglobin and urinary catheter and measure urine output. This paper does not propose that paramedics undertake all of the treatment outlined, but instead have the ability to initiate oxygen therapy, deliver intravenous fluid and antibiotics; and potentially have the ability to take blood cultures to hand over to the hospital. However, it must be emphasised that extra on scene time to complete these assessments and treatment must be taken into consideration as well as how long till the nearest hospital. Also important to note that paramedics must notify a receiving hospital so that the hospital ca n appropriately triage (44) and utilise the pre hospital taking of blood in the commencement of faster treatment and provide the ability to initiate an appropriate antibiotic regime. Perhaps a review of the current guideline in Victoria is needed to extend the scope of paramedic practice to screen for potential septic patients, as the literature suggest that this current proportion of patients are exponentionally increasing. However; it may be easy to speculate changes that need to be made to the system, and this will take time and money. Walker (37) proposes from a management perspective there are significant costs associated with the antibiotics, training and assessment and ongoing replacement of antibiotics on all vehicles. Therefore it is imperative to continue research and therefore implement a new guideline into ambulance practice; which will benefit the health of all invested parties. The early recognition and management of sepsis has implications on potential patient outcome. Sepsis has an extremely high mortality associated with it and as mentioned previously the sooner antibiotics can be administered; the rapid decrease in patient morbidity and mortality. With respect to the high numbers of presentations to Victorian emergency departments and intensive care admissions; this is mirrored throughout the world. One of the important points to understand that the admissions to intensive care can be avoided if sepsis is recognised earlier and paramedics may have a significant impact on the recognition and administration of antibiotics, as septic patients have the potential to be very unwell. The financial burden on the health system is enormous with one study speculating that the United States approximate spend on sepsis alone to be sixteen billion dollars. (2, 7) Data is unavailable from Victoria and Australia; however the costs associated with providing antibiotics for the management of sepsis will cost less than treating in an Intensive Care Unit. Conclusion One of the main recurring themes throughout this paper is that sepsis and severe sepsis have a high association with morbidity and mortality, even though the number of presentations have increased. The point needs to be emphasised that current management is not good enough. The research within hospitals is evident, that early antibiotic treatment of patients suffering from sepsis has profound effects on survival and recovery. Paramedics are potentially the first line of health care workers exposed to patients suffering severe sepsis and have the ability to act with broad spectrum antibiotics. Within Victoria, ambulances already carry Ceftriaxone; an example of a broad spectrum antibiotic. A guideline specific to sepsis needs to be developed and implemented in the pre hospital field, potentially on the basis of the United Kingdoms model of recognising severe sepsis. The cost benefit analysis of implementing a new guideline, with the possible administration of antibiotics to more patie nts would severely outweigh the costs associated with an admission to an intensive care facility. The notion of taking pre hospital blood and notifying a receiving hospital of the potential septic patient may initiate appropriate treatment faster. Paramedics have the ability to make a difference with this time critical patient.