Americas Medicare And Medicaid Healthcare Health And Social Care Essay

Health attention costs in the United States exceed 14 per centum of the entire gross domestic merchandise, far more than in any other state. In the twelvemonth 1992 overall costs were approximately $ 838 billion or over $ 3,000 per individual. Equally good as there were about 6,066 infirmaries with 1.14 million beds in the twelvemonth 1992 in the United States. Hospital attention dominates entire wellness attention disbursement in United States.After decennaries of induction long term attention in America is undergoing enormous alteration in response to increasing Medicare and Medicaid expenditures. As the response to the lifting province and federal outgos in America community based wellness attention options are promoted for long term attention over institutional attention. Despite the fact that persons with really serious and relentless psychiatric upsets are over represented in the population of long term attention and consequences into disproportional sum of psychiatric wellness attention cost, every bit good as there is an alarming deficit of attending to the services for the aged individuals with the persistent and serious mental unwellness. About 2 per centum of individuals aged 55 or above in America are enduring from terrible and relentless psychiatric upset and it is assumed to duplicate in following three coming decennaries. Since the current strategy of long term psychiatric attention for the aged individuals with this upset is missing and service proviso is extensively driven by reimbursement policies, community based attention and managed attention is likely to hold profound consequence on this population. The grounds to twenty-four hours provinces that these proposals can cut down the demand of hospital resources but there remains concern about cost effectivity of community attention compared with infirmary attention.However the wellness policy issues of America is been debated in conformity with community based wellness attention for aged persons and the hereafter challenges of supplying psychiatric wellness services to aged population.Although, small attending has been highlighted on the plausible impact of managed attention on the concatenation of aged individuals with relentless and serious psychiatric upsets who have the most demanding long term attention demands. Service NEEDS: Aged persons with serious and relentless psychiatric upsets are denoted in this survey as individuals age 65 and over with perennial or late-onset terrible psychiatric upset with residuary damage. As by and large defined, terrible and repetitive psychiatric upsets includes diagnosings such as delusional upset, schizophrenic disorder, bipolar upset, and recurrent major depression.Elderly grownups who evolve these upsets in early maturity frequently have unequal societal support systems and lesser fiscal resources than those with late-onset unwellness, but both of them portion many similar clinical characteristics and the common demand for long-run mental wellness attention services. However, latest psychiatric wellness services for aged individuals are mostly disconnected and underutilized and do non adequately turn to their long-run mental wellness demands. Overall, deinstitutionalization has left infinite figure of aged individuals with reduced entree to mental wellness attention in both community and institutional long-run attention scenes.Larger proportion of aged grownups with terrible and relentless mental unwellness who stays in the community receive small support from the mental wellness system except for medicine despite continued demand, and those without household attention are at higher hazard of being institutionalized.These factors highlights the pressing demand to specify and advance place and community based options. LONG TERM CARE REFORM: The sudden shrinkage and closing of province infirmaries over the past few decennaries has resulted in â€Å" trans-institutionalization † into attention places of many dependent aged individuals with terrible and relentless psychiatric unwellness. Eighty-nine per centum of all institutionalized these aged individuals reside in attention places. However, assorted tendencies suggest that establishments will play a diminishing function in future systems of long-run mental wellness attention compared with community-based scenes. First, the bulk of older grownups with mental unwellness resides in the community and favour to stay at that place ( Bartels SJ, Levine KJ, Miles KM, et Al, unpublished manuscript, 1999 ) . The more recent cohort of aging individuals with terrible psychiatric unwellness had spent most of their lives in the community instead than institutional scenes. Therefore trans-institutionalization from long-run province infirmary units to care places will go a vanis hing phenomenon. Equally good as the 2nd tendency suggests the diminishing function for establishments is the execution of nursing place reforms under the federal Omnibus Budget Reconciliation Act of 1987 ( Public Law 100-203 ) , with the purpose of cut downing the use of nursing places for long-run mental wellness attention. This reform ‘s were practiced in response to increased psychiatric admittances to care places after closings of province infirmaries. Last, the lifting outgos for nursing place attention are exciting sudden reforms in policy and reimbursement. They include authorizations by provinces to curtail Medicaid outgos by forestalling the nursing place bed supply and cutting Medicaid reimbursement rates. As the wellness attention system transportations to suit the increasing figure of patients necessitating chronic attention, forthcoming anticipation suggest the greatest success in services will be in home- and community-based scenes.Sudden alterations in the funding and construction of long-run and managed attention are progressing quickly across the provinces, with a practical deficit of attending to the lifting Numberss of aged grownups with serious and relentless mental unwellness who will hold of import service demands. Financing OF MEDICARE AND MEDICAID: Soon, most of the psychiatric wellness and long-term-care services for aged individuals are financed through fee-for-service Medicare and Medicaid. Medicare is the federally financed wellness insurance plan, supplying insurance for persons age 65 and above and handicapped persons under age 65. Medicare is composed of two parts: portion 1covers inmate infirmary attention, 60 yearss of skilled nursing place attention, and place wellness and hospice attention. Separate 2 provides reimbursement for outpatient infirmary services and doctors. Among the major limitations in Medicare coverage of the psychiatric wellness services are a needed 50 per centum copayment for psychotherapeutics services, deficit of general outpatient prescription drug coverage, restricts on inpatient psychiatric yearss, and limited or no coverage of important services such as residential attention, reprieve attention and grownup twenty-four hours attention and place wellness attention. Home wellness attention is an of import permutation to institution-based attention. However, merely acute portion of unwellness instead than long-run attention is cover by Medicare. Psychiatric upsets, including dementedness, constitute merely 2.8 per centum of primary diagnosings for place wellness attention. It is likely that place wellness attention for psychiatric upsets will go barely available in future coming old ages as Medicare reform consequences in cutbacks under the Balanced Budget Act of 1997. After passage of these reforms, 14 per centum of U.S. place wellness attention bureaus, a sum of 1,355 bureaus, closed in 1998. However, less than 3 per centum of the entire budget of Medicare is spent on mental wellness, with half less than these outgos ( about 1.5 % ) – traveling to psychiatric wellness services for the aged population. Acute hospitalizations consequences to the huge bulk of these outgos. Medicaid is the main insurance company for long-run attention in nursing places and the of import beginning of reimbursement for state-funded services for handicapped persons, including persons with serious and consistent mental unwellness. Since Medicaid is a combined federal and province plan, with provinces paying up to 50 per centum of the cost, provinces have of import discretion in make up one's minding the eligibility standards and sorts of mental wellness services covered. For case, although legion provinces offer coverage of prescription drugs, most have restrictions in the sort of copayments, limited refills, or other restrictions.States may besides implement restrictions on mental wellness attention, including anterior mandate and restriction on the figure of visits to suppliers. Medicaid reimbursement rates average 20 to 30 per centum beneath bing market rates.Restricting the sum and range of services and paying for psychiatric attention at lesser rates than for medical attention create barriers to adequate psychiatric attention for aged patients. In short, the argument between the federal and province authoritiess over the costs of Medicaid, every bit good as the restrictions in Medicare coverage, leave many spreads in insurance coverage for aged grownups.These spreads result in a disintegrated intervention system and critical load in out-of-pocket costs. In add-on, briskly increasing Medicare and Medicaid outgos are ensuing in the impulse to develop schemes that contain costs. The blend of spreads in coverage and service and intensifying costs under a fee-for-service reimbursement construction has resulted in an eruption of managed attention enterprises in America. CARVED-IN AND CARVED-OUT MENTAL HEALTH SERVICES: The statement over the finest manner to pull off fiscal hazard and to transport mental wellness services in managed attention has resulted in a scope of theoretical accounts that may be loosely classified into two general classs. In some managed attention establishment, mental wellness attention is straight merged into the bundle of general wellness services that are covered and provided, or carved in. In others it is supported through a contract with a separate forte mental wellness establishment that provides services and accepts the hazard, or carved out. CARVED-IN Agreements: Patron of carved-in mental wellness services argue that this form of attention better integrates both physical and mental wellness attention, reduces barriers to mental wellness attention due to stigma, and is more apt to bring forth cost beginnings and overall nest eggs in usual wellness attention expenditures. These characteristics are specifically of import because aged individuals normally have co morbid medical conditions and take multiple medicines that may impact mental upsets ; they typically avoid forte psychiatric wellness scenes and incur important wellness attention disbursals related to psychiatric symptoms. By and large, carved-in agreements promotes communicating and coaction between medical and psychiatric suppliers suppressing arbitrary differentiations about medical versus psychiatric causes of symptoms and functional issues.Carved-in agreements may be advantageous for the many aged individuals with similar sort of upsets who receive the greater part of their mental wellness attention from primary attention suppliers. Despite the fact that, carved-in agreements are assumed to supply fiscal inducements for incorporate medical and psychiatric wellness services, functional integrating is far from guaranteed. Unfortunately, mental wellness forte services for aged persons tend to be a low precedence in managed wellness attention organisations in comparing with surgical and medical forte services. Mental wellness carve-in agreements may besides be economically hazardous. First, if mental wellness net incomes are carved in as portion of a net income bundle, grounds from private-sector wellness programs reveals that without administered para, insurance companies will offer differential coverage of mental wellness attention.In add-on, if remunerators or suppliers contest for enrollees, a healthy inducement will be to forestall those expected to hold higher costs from psychiatric jobs, such as aged persons with serious and consistent unwellness. Finally, process of seting payments to counterbalance for the increased fiscal hazard of supplying attention to more badly sick enrollees under a capitated payment, known as hazard accommodation, are rather hard to use for psychiatric wellness attention. For case, unless reliable hazard accommodation schemes are developed for complex populations such as aged person with mental unwellness, the capableness for significant losingss is likely to perpetuate the present deficiency of enthusiasm and services for this bad group among managed attention organisations. CARVED-OUT Agreements: In comparing, advocates of carved-out agreements for mental wellness services for aged persons argue that stray systems of funding and services are likely to be superior for individuals with particular mental wellness services. Specifically, they advocate that carved-out mental wellness organisations have advanced proficient cognition, a broader array of services, specialised accomplishments, greater Numberss and assortments of mental wellness suppliers with experience handling terrible mental conditions, and committedness and willingness to supply services to bad populations. In add-on, advocates argue that mental wellness carve-out organisations allows economic systems of graduated table in supplying the comprehensive array of rehabilitative and community support mental wellness services necessary to care for elderly terrible mentally sick individuals in the community. At last, an inducement exists to reinvest nest eggs from any decrease in inmate service usage into advanced outpatient options. Although appropriate surveies are missing, plans utilizing carved-out services for younger persons have by and large reported important cost nest eggs and favourable results. Unfortunately, informations are missing on results and costs for aged individuals with serious mental unwellness in mental wellness carve-outs. From a clinical mentality, the downside of a carve-out agreement is an increased hazard for unfavourable results due to atomization of medical and mental wellness attention services. The possible for these inauspicious results is significantly pronounced for aged individuals, who are frequently taking multiple medicines and who have complex medical upsets. Unsuccessful communicating or deficit of coaction between mental wellness and medical suppliers places the aged individuals at peculiar hazard of medicine, misdiagnosis, interaction, inaccurate premises about medical versus psychiatric causes of symptoms, and ambiguity about whose duty it is to vouch that appropriate community-based services are provided. From a fiscal mentality, foremost and most important, mental wellness carve-out organisations predicts the hazard of supplying services for a specific given population at a set negotiated fee. Downward pressures to incorporate or cut down costs may take into a one-sided decrease in the proportion of the overall wellness attention dollar allocated for mental wellness services. Second, a fiscal inducement exists for medical suppliers to switch and delegate duty for co-morbid conditions to mental wellness suppliers and frailty versa. For case, since the allotments for medical and psychiatric services are fixed and dispersed, it may be in the fiscal attractive force of a medical supplier organisation to inaccurately tie in the cause of a complex medical-psychiatric job to mental unwellness, which would take into unequal attention and switch the cost load to the mental wellness supplier organisation. A 3rd exposure of carve-out agreements is the hardship that they pose in finding the benefits or cost nest eggs of mental wellness services. Increased usage of mental wellness services may look to be more dearly-won in a carve-out agreement. At last, the physical and mental co-morbidity found in aged grownups with serious and relentless mental unwellness may cut down any awaited fiscal advantages of carved-out services. If the mental wellness supplier can non every bit pull off services and costs related with the combination of medical and mental wellness upsets, anticipated nest eggs may non happen. INNOVATIVE PATTERNOF MANAGED LONG TERM CARE: The demand of keeping intensifying outgos of long-run attention while supplying home- and community-based options to institutional attention has been the focal point of s experiments in long-run attention reform, including societal HMOs, the Program for All-Inclusive Care of the Elderly ( PACE ) , and state-managed long-term-care presentations. Initially initiated as a four-site long term attention presentation undertaking in the mid-1980s, societal HMOs are determined to intermix ague attention and long-run attention within a managed attention model. The implicit in plan is to supply both ague and chronic attention net income under a individual organisation at fiscal hazard, based on a postpaid capitation payment pooled from different beginnings including Medicare, Medicaid, and copayments. In comparing, PACE largely pay attending on persons who meet eligibility standards for nursing place attention and suspects high hazard under capitation for all long-term-care services, financed by monthly capitated payments from Medicare and Medicaid. Elite characteristics of the PACE plan include a multidisciplinary squad attack, service proviso in a separate grownup twenty-four hours wellness centre, chronic attention without caps on long-term-care outgos, and everyday one-year wellness showing and preventative attention. These theoretical account plans involves many elements that might be adapted to the demands of aged individuals with rigorous and grim mental unwellness to better future long-run attention for this population, including instance direction and multidisciplinary squads. Imaginative state-initiated managed long-term-care presentations include plans for people dually entitled for Medicaid and Medicare, who are among the premier users of acute and long-run wellness services. This group includes old individuals with serious and consistent mental unwellness. At present, multistate proposals are being constructed to unite Medicaid and Medicare resources under a capitated program that provides a full scope of services, including community-based and institutional ague and long-run attention. These enterprises have the possible to supply comprehensive long-run medical and mental wellness attention through public insurance to a population with high rates of chronic mental and wellness upsets. However, with few exclusions, presently planned proposals do non have mental wellness attention as a nucleus constituent or supplier of services. An alternate system of managed attention with the prospective to supply wide-ranging services is exemplified by a single-payer national wellness attention system. However, statistics from national comparings are assorted. Single-payer wellness attention systems in other states are more likely to function persons with lower incomes and more terrible mental unwellness than in the U.S. , but overall entree to specialty mental wellness services is no better and frequently involves longer waiting periods. Deduction FOR THE FUTURE: How will elder individuals necessitating long-run mental wellness attention menu in an epoch of managed attention? Existing issues reviewed here suggest that there is cause for dismay ; at the same clip, new attacks to funding services hold promise if they are suitably developed and harnessed. However, this sum-up of the literature suggests several specific instructions and steering rules for future theoretical accounts. Integration of mental wellness and medical services: Optimal services for older individuals with terrible and changeless mental unwellness require a close association of primary medical attention and mental wellness services. The high prevalence of medical and cognitive comorbidity in this group necessitates a clinical attack that recognizes the complex mixture of medical and psychiatric upsets and the value of a collaborative medical-psychiatric attack. A array of attacks to incorporating medical and mental wellness attention have been described, but run intoing the demands of persons with serious and changeless mental unwellness is particularly debatable. Promising theoretical accounts of incorporate attention consist of location of medical and mental wellness suppliers at the same site, multidisciplinary medical-psychiatric intervention squads, proviso of primary attention in mental wellness clinics, proviso of specialised mental wellness services in primary attention clinics, and cross-trained medical-psychiatric suppliers. The cardinal clinical topic here is the formation of a collaborative attention theoretical account across medical and mental wellness suppliers, of whether the services are financially incorporate ( carved in ) or separate ( carved out ) . For illustration, the literature describes booming theoretical accounts of community-based mental wellness services that include a primary wellness attention supplier as an built-in portion of a mental wellness outreach squad for senior grownups with terrible and relentless mental unwellness ( Levine KJ, Bartels SJ, unpublished manuscript, 1999 ) and the development of an associated primary attention medical clinic specifically for persons with terrible and changeless mental unwellness. Integration of specialised services and community-based attention Rising systems of community-based long-run attention across the provinces promise to supply many indispensable supports and services indispensable to keep frail aged individuals with several medical upsets in place scenes. These theoretical accounts of home- and community-based long-run attention offer advanced attacks to supplying medical and societal services to elder individuals, yet by and large do non include specialised services for long-run mental wellness attention of individuals with serious and continual mental unwellness. To undertake these demands, such plans will necessitate to spouse with specialised geropsychiatric and community support services. Although empirical informations are missing, a restricted descriptive literature suggests that theoretical account plans must hold specific clinical constituents to successfully keep senior grownups with terrible and continual mental unwellness in the community. These constituents consist of intensive instance direction, general medical attention, 24-hour crisis engagement, home-based mental wellness attention, residential and household support services, caregiver preparation, multidisciplinary squads, active instance determination and outreach, and psychosocial rehabilitation ( Levine KJ, Bartels SJ, unpublished manuscript, 1999 ) . Descriptions of results for these plans suggest that with sufficient supports, the bulk of senior individuals with terrible and continual mental unwellness can be maintained in the community at lower cost than in establishments and with equal or enhanced quality of life. Blended funding and seting for unwellness badness The greatest challenge to run intoing the long-term-care demands of the increasing Numberss of aging individuals with terrible mental unwellness will be fiscal. Predictions of the bankruptcy of the Medicare trust fund and current projections for Medicaid expenditures require advanced and resourceful usage of these and other fiscal resources. Meeting the complex long-run medical and mental wellness attention demands of senior individuals with terrible and continual mental unwellness under fee-for-service support will necessitate originative pooling of resources, including Medicare, Medicaid, and funding for aging services under federal and province block grant plans, every bit good as private insurance and limited personal financess. However, even with these steps, in the deficiency of singular reforms in the funding of wellness and long-run attention for senior individuals, financess may be deficient. Capitated attention agreements may be necessary to incorporate costs and to promote usage of the most cost-efficient services. A major aspiration of financing long-run attention will be the reallocation of outgos to back up the development of home- and community-based options. The most striving theoretical accounts of forming and funding services for open populations of senior individuals provide integrated services under a individual system responsible for both acute and long-run attention. PACE, societal HMOs, and province proposals for senior individuals who are dually suited for Medicare and Medicaid blend these beginnings of support to make systems of acute and long-run attention. All of these attacks portion the common purpose of redeploying financess from current dearly-won nursing place attention and hospital-based attention to supported community options. The end of such plans is to intermix these fiscal resources under capitation with an accent on back uping the least restrictive and least dearly-won long-term-care services. Managed attention plans functioning senior individuals with terrible and changeless mental unwellness will necessitate to integrate hazard accommodation schemes that account for the significant costs associated with combined hazards of older age, long-run mental disablement, and medical comorbidity. For case, current reforms under the 1997 Balanced Budget Act include programs to finally associate Medicare capitation rates to wellness position through risk-adjusted payments. Guaranting answerability, protagonism, and results At last, it is of import to admit that senior individuals with terrible and changeless mental unwellness typify the most complex, susceptible, resource-poor, and bad long-term-care patients. Service organisations that presume the fiscal hazard for ague and long-run psychiatric and medical attention will necessitate to be suitably reimbursed and held responsible for quality of attention. In the absence of mechanisms to finance these services, adjust for hazard, and step results, managed attention agreements will be in struggle with the ends of supplying high-quality attention for senior individuals with terrible and continual mental unwellness. Decision: We have no simple replies to the inquiry of how to outdo organize, finance, and present mental wellness and long-term-care services to elder individuals with terrible and continual mental unwellness. The integrated funding and organisation of services promised in germinating theoretical accounts of managed long-run attention offer the possible to eliminate atomization and inefficiencies and to make a much-needed continuum of medical, mental wellness, and societal support services. Yet bing theoretical accounts fail to supply the specialised mental wellness services that are critical for functioning this population in the community.REFRENCES:1 } Jonas & A ; Kovner ‘s Health Care Delivery in the United StatesA edited by Anthony Kovner, PhD, Steven Jonas, James Knickman, PhD. 2 } Hand book of Health Economics by Anthony J.Culyer and Joseph P.New house. 3 } The Economicss of Health and Health attention by Folland Goodman Stano. 4 } The Economic and Budget Outlook: Fiscal Old ages 1998-2007. Washington, DC, Congressional Budget Office, 1997. 5 } Bartels SJ, Miles KM, Levine K, et Al: Bettering psychiatric attention of the older patient, in Clinical Practice Improvement Methodology: Effective Evaluation and Management of Health Care Delivery.Edited by Horn SD. New York, Faulkner & A ; Gray, 1997. 6 } Kane RL: Managed attention as a vehicle for presenting more effectual chronic attention for olderpersons. Journal of the American Geriatric Society 46:1034-1039, 1998. 7 } Frank R, McGuire T, Newhouse J: Hazard contracts in managed mental wellness care.Health Affairs 14 ( 3 ) :50-64, 1995. 8 } Bartels SJ, Colenda CC: Mental wellness services for Alzheimer ‘s disease: current tendencies in reimbursement, public policy, and the hereafter under managed care.AmericanJournal of Geriatric Psychiatry. 9 } Jencks S, Goldman H: Deductions of research for psychiatric prospective payment.Medical Care 25:542-551, 1987. 10 } Miller R, Luft H: Does managed attention leadto better or worse quality of attention? Health Affairs 16 ( 5 ) :7-25, 1997. 11 } Wells KB: Cost containment and mental wellness results: experiences from US surveies. British Journal of Psychiatry 166 ( suppl 27 ) :43-51, 1995. 12 } Felker B, Yazel J, Short D, et Al: Mortalityand medical comorbidity among psychiatricpatients: a reappraisal. Psychiatric Services 47:1356-1362, 1996. 13 } Sturm R, Wells KB: How can care for depression become more cost-efficient? JAMA 273:51-58, 1995.

Mcbride Financial Service Essay

The purpose of this paper is to develop a marketing plan for McBride Financial Service. The paper will include what type of market research McBride should undertake. The various types of media Mcbride should use in the marketing plan. This paper will cover McBride’s target markets and explain why they are targets for McBride Financial Service. This paper will also cover what the considerations are for McBride to conduct a portion of their marketing on the Internet. Market research is a technique used to determine the acceptance of a product or service within different demographics. In the book Marketing: An Introduction market research is defined as [a systematic design, collection, analysis, and reporting of data relevant to a specific marketing situation facing an organization](Armstrong, 2011). A company can use market research to develop a target audience to help them pinpoint a specific demographic to market in. There are several forms of market research that McBride can use to help develop their marketing plan. The first would be online market research that will consist of Internet surveys and online focus groups. Online market research is easy for people in every demographic to participate in from home eliminating the need to travel to participate in focus groups. Internet surveys are taken online and the person filling out the surveys avoid the hassle of mailing the surveys back by simply clicking submit. Telephone interviewing is one of the fastest ways for a company to gather information for market research. Telephone interviewing is more personable than mail or Internet surveys and would be recommended for McBride Financial Services. An effective marketing plan should include using various types of media to advertise the goods or services a company offers. Types of media include radio, television, outdoor media, Internet, magazines, and newspapers. McBride Financial Service has many options to choose from concerning marketing media to advertise their organization. Television ads are seen by the most people, but they are also cost the most money to obtain a prime spot. Radio can target specific audiences at a lower cost but a company needs to buy time on several stations to obtain good reach. It is recommended that McBride incorporate a mixture of media in their marketing plan. These following types of media will be included television, radio, Internet and, magazines. Television as mentioned earlier in this paper is the best form of advertising so McBribe cannot hope to have a good marketing plan without it. Television ads will not be the main form of media because of the high cost. Because one of McBride’s target markets is retirees they will be buying ad space in retirement magazines like AARP. This will allow McBride to focus in on retired people or are getting close to retirement. Newspapers are a dying form of media so McBride will avoid buying ad space in any of them. This section of the paper will focus in on why Mcbride should consider conducting a major portion of their marketing via the Internet. The Internet is a major influence in society today with millions of people surfing the web every hour. This is an opportunity that McBride needs to take advantage of to capture the attention of an ever-growing population on the Internet. Buying ad space on a website is inexpensive compared to television and radio that is a major advantage for McBride. Ad space on major Internet sites is a â€Å"double edge sword† for McBride’s marketing plan. The first is that people will see the ads every time a person opens his or hers favorite website. The second would be a direct link to McBride’s website allowing even more exsposer for the company’s services. This section of the paper will cover McBride’s target market. Entrepreneur. com defines a target market as a specific group of consumers at which a company aims its products and services (â€Å"Target Market†, 2011). The site continues to write that target customers are those most likely to buy from a company. McBride has a target market shown on the home page of their website and it consists of professionals purchasing primary or secondary properties, retirees purchasing primary or secondary properties and families or individuals purchasing recreational properties. It seems like every adult in the world would fit into McBride’s target market that is not a bad target market, but it may be a wise move to narrow it down. Sticking with retired and professionals purchasing property would allow McBride to maintain a manageable target market. If the target market is too big McBride would have to cater their marketing media budget to too broad a campaign. McBride’s target market is anybody who is looking to buy property whether it be primary or secondary. In conclusion this paper has described a marketing plan that can be implemented by McBride Financial Service. The marketing plan will include market research strategies such as Internet surveys and telephone interviews aimed at collecting information. The media will play a part in McBride’s market in the form of television, radio, and Internet ads. The considerations for McBride to conduct a portion of their marketing online were covered in this paper. Finally the target markets for McBride Financial Service were discussed at the end of this paper.

Set size and search type effect on search time during visual search Essay

Set size and search type effect on search time during visual search task - Essay Example Feature Integration theory There are a number of researches with various stimuli, while most prevalent idea proposed for human visual search comes from A. Treisman (1980), who conducted a research illustrating Feature integration theory. It asserts that a visual search is faster in presence of dissimilar background and the number of distracters involved in background do not affect the time consumption in case of a feature search (a search that involves identification of a direct feature like color, shape, orientation or curvature). On the other hand, a conjunction search is affected widely with the number of distracters presented in the background. A conjunction search is defined as a search which does not involve a direct feature but a similarity of multiple features among the various objects. (For example ‘blue square’ has similarities with ‘blue triangle’ and ‘red square’.) Consequent of the propositions, feature integration theory illustrate s that those two searches consists of different methodology for human visual search. Those methods are characterized as parallel searches and serial searches for feature and conjunctive patterns. As further illustrated in Feature Integration theory, feature search and conjunction search differ widely on time consumption patterns as conjunction search follows a twofold process which requires identifying the features and categorizing the conjunctions to create a pattern of search. The distracters found in the patterns are responsible for time consumptions. The feature-integration theory of attention suggests that attention must be directed serially to each stimulus in a display whenever conjunctions of more than one separable feature are needed to characterize or distinguish the possible objects (Treisman and Gelade, 1980) There are number of arguments and theoretical results that involve some serious diversions and modification to this theory. However, most of the theories involve th e base of feature integration which asserts that there are found clear differences in the types of searches when direct features are involved or eliminated. Other theories and Guided search In contrast with feature integration theory there are some proposition which offers different arguments and researches for visual search. A major theory is in the propositions of Wolfe (1989) who offers a broad research for how visual search is not limited only to the factors if the searches are parallel or serial but it also depends largely on the motivating factors for a visual search. Wolfe presents this theory as the guided search theory. In his propositions, a number of subjects were passed through the experiments with varying number of stimuli and the data outcome was measured over the graphs to provide a serious deflection from Feature integration patterns. Subjects searched sets of items for targets defined by conjunctions of color and form, color and orientation, or color and size. Set s ize was varied and reaction times (RT) were measured. For many unpracticed subjects, the slopes of the resulting RT x Set Size functions are too shallow to be consistent with Treisman's feature integration model, which proposes serial, self-terminating search for conjunctions (Jeremy M. Wolfe, 1989). As those results offer a diversion in self-terminating s

A Critical Analysis of The Rocking Horse Winner Essay

A Critical Analysis of The Rocking Horse Winner - Essay Example The author really does a wonderfully, descriptive job in bringing the main focus of this story into reality. It shows that though you can have nice things, a comfortable home, and financial security, there is still a craving for more. Even the house, that Paul and his family live in, seems to harbor a desire for wealth, from within itself. It seems the house comes alive with the desire for money as the following literary passage shows: â€Å"There must be more money! There must be more money!† (Lawrence 288) The voice of the house is heard by everyone though no one mutters a syllable about it. The voice literally drives Paul half crazed and his only hope in shutting the house up is to win more money, or so he believes. Unfortunately, this does not work either because now the house is feeling of greed and wants more. In fact, the voice is more declarative after receiving the first sum of money and now is even louder and more demanding. â€Å"There must be more money†¦ Now www†¦ More than ever!† (296) From here on the greed and demand for money grows progressively worse. Paul had somehow hoped his mother would finally show she loved him but still she remained as she’d been when she would feel her children near, â€Å"the center of her heart would go hard† (287). She was a mother that did not know how to love her children. The only love the book shows she gave was her adoration to money. Further, in the following comment we see how much she was enthralled with it. â€Å"If you’re lucky, you will always get more money† (289). This proves she only valued the worth of the dollar and what it could bring her. If she feels there isn’t enough then she becomes resentful and preoccupied with the idea that they will never have a substantial amount. In concluding this critique of Lawrence’s short story, there is a grave lesson to be learned here. The obsession with money and

What is the role of social media in the field of journalism-LITERATURE Term Paper

What is the role of social media in the field of journalism-LITERATURE REVIEW - Term Paper Example acquire more traffic especially from the young generation, media corporations have also followed their consumers onto online space by creating social media sites. Apart from generating traffic, media corporations have also embraced social media forms of journalism in a move to be at par with competitors (Kerrigan & Graham, 2010). Apart examining values of journalism, the study will also analyze its contribution to the online community. In the current generation, it would be quite unfortunate for journalism corporations not to embrace the rapidly growing technology, especially in social media. This is due to the fact that social media is of great importance to the journalism network. Embracing social media is no longer an option since it is one of those things that are a â€Å"must have† for all journalists. Unlike previous generations, the current one is quite literate and normally spends most of the time seeking information on the internet; this is clear indication that it is rare for them to get information from hard copy materials such as books, magazines and newspapers. Because of this, journalists ought to change the ways in which they relay information to the public. Since most people depend on social media for information, journalists have no option but embrace them too. Studies so far conducted show that apart from Facebook, other common social media platforms include twitter, LinkedIn and MySpace ( Oh, Agrawal & Rao, 2013). The 21st generation is quite inquisitive to the extent that it is not possible for them to wait until the next day so that they can read about a trending story. To them this is a long time for a generation normally yearning for information. Therefore, by embracing social media, journalists are in a position to post up to date information on what is trending not only in the US but also globally. By doing so, people will become interested with journalists and media corporations that post instant news hence resulting to traffic that is

Alcohol Consumption and Smoking During Pregnancy Essay

Alcohol Consumption and Smoking During Pregnancy - Essay Example In the interview, I verified that all the three women have limited knowledge of the effects of smoking and alcohol consumption on their unborn children. They had often ignored these facts. They further explained that drinking or smoking in small amounts would have no effect on the unborn child. Furthermore, Mary also was not aware of inhaling cigarette smoke from another person. She also did not tell her health care provider of smoking during the pregnancy for fear of intimidation. Betty was a recovering alcoholic addict. She quit drinking after she realized that she was three months pregnant. She joined numerous online women groups campaigning for sobriety during pregnancy. She also joined communal activities. The most interesting observation was that the three women were unaware of the effects of smoking on the physical and psychological well-being of their children in the future. The women also did not know that smoking might trigger sudden infant death syndrome while alcohol cons umption triggers the fetal alcohol syndrome. It was interesting that the women did not have such information that we had studied in class. However, the US government has invested heavily in ensuring that health care providers educate pregnant women during prenatal care visits. The women also informed me of the role of heredity, poor parenting and lack of social support services as key driving factors for smoking and drinking. Age also plays a significant role in determining tobacco use/drinking preference and cessation of the habit.

An Occurrence at Owl Creek Essay Example | Topics and Well Written Essays - 750 words

An Occurrence at Owl Creek - Essay Example Hence, with the exemption of past time, time itself is a matter that is not real but is just perceived, with surprising and dramatic effects, to convey a conclusion. This essay will discuss the aspect of time in Ambrose Bierce’s writing, An Occurrence at Owl Creek. An Occurrence at Owl Creek refers to a short story written by Ambrose Bierce, an American author. The tale, set during the Civil war, is identified for its irregular time sequence, as well as a twisting ending (Bierce, 1948). The book is Bierce’s most anthologized writing. An Occurrence at Owl Creek, according to critics, is a richly devised explanation on the fluid of time during the civil war. The book’s structure, which shifts from the current to the past to what is portrayed to be the anticipated present, mirrors this fluidity along with the tension that which exists between competing notions of time. The second section, in the writing, interrupts what, at first, seems to be the ongoing flow of the execution happening in the present moment. Farquhar, posed on the edge of the bridge, closes his eyes as an indication of slipping into his own edition of reality (Bierce, 1948). Farquhar’s reality is one that is unburdened by numerous responsibilities to the law of time. As the minutes/ticking of Farquhar’s watch slows and more time elapses between the strokes, he moves into a timeless reality. When Farquhar pictures himself falling into the water, the author compares him to a "vast pendulum" immaterial, as well as spinning madly out of control. At this instance, Farquhar moves into a transitional space, which is neither death nor life, but a ghostly realization in a globe with its own regulations (Bierce, 1948). In the brief window of time between Farquhar’s actual death time and the officer stepping of the plank, time slows and changes in order to accommodate a comforting view of the subject’s safe return to his family. In spite of Farquhar’s m anipulation of time, he however, cannot escape realm. Whether Farquhar days are prolonged or just a few moments, death ultimately claims him (Bierce, 1948). Trying to blend time to his personal will is meaningless. One of the most remarkable elements in the book is Bierce’s sensible rendering of Farquhar’s alternating conception of time. The author’s suggestion of time is that the nature of time is, to some level, subjective (Bierce, 1948). Time, according to the author, is even more disorienting since it turns out that all of the long accounts, as well as events, which should have taken a lot of time happen within the marvel of a thought, took a short moment in time. Also, some of the themes discussed in Ambrose Bierce’s writing are as discussed earlier the fluid nature of time and the blurred line between illusion and reality. Some of the significant quotes are discussed below: 1. â€Å"As these thoughts, which have here to be set down in words, were f lashed into the doomed man’s brain rather than evolved from it the captain nodded to the sergeant. The sergeant stepped aside.† This line appears at the end of the first part of the story, right before Farquhar falls into his death and shows a significant turning point in the story (Bierce, 1948). The execution itself resumes in the third part of the story where Bierce gives details concerning Farquhar’s past. Following this flashback, in the second part, the writing comes back, not in truth, but in fantasy. 2. â€Å"

Impressionism Essay Example | Topics and Well Written Essays - 500 words

Impressionism - Essay Example It started as a movement in painting in France in the late 1860s and various artists such as Claude Monet, Camille Pissarro, Auguste Renoir, and Alfred Sisley are associated with the founding of this movement. The main features of impressionism as an art movement includes its emphasis on naturalistic landscape, subjective aspect of art, the topics of modern urban life and other commonplace subject matters, portrayal of light in its varying qualities, etc. Most essentially, this movement influenced and inspired trends in other areas such as sculpture, music, and literature. Specifically, impressionism influenced literature in various ways and helped in the growth of literature considerably. As Marlies Kronegger (1973) maintains, impressionism in literature built up its own style and techniques, although painting dominated all the other art forms during the period 1875-85. From the time it originated, it has been one of the prevailing literary styles existent in world literature today and the impressionist creations in various countries are derived from the same basic idea. (Kronegger, 33) Therefore, it is important to maintain that impressionism is one of the key literary terms today as it refers to the literary styles and techniques based on the general framework of impressionism as an art movement. This paper makes a comprehensive exploration of the term impressionism in order to define and explicate impressionism as an extremely valuable rhetorical tool in literature today.

The Body Shop Essay Example for Free

The Body Shop Essay Body Shop is a brand with a difference. Marketers consider this brand as an Icon. Body Shop has created a brand image without the aid of conventional advertising. 2006 saw this iconic brand draw up serious business plans for India. Body Shop brand was created in 1976 in Brighton United Kingdom. The brand and the brand owner share a common personality that is very much linked to each other. Anita Roddick the legendary founder of the Brand created this brand from a small shop in UK started to support her family. Body Shop in India is sold through the master franchise Planet Sports . The brand is expecting to ramp up the operations to major metros by the year 2008. Body Shop is differentiated from other conventional cosmetics by the values that the brand adheres to and the brand image created through the unique association with those values. The brand is famous for its association with ethical practices and the environment friendly world view. The products reflects these values through the use of only natural ingredients and the products are never tested on animals. The ackaging and the merchandising are carefully prepared to highlight the brand values. For example , Body Shop uses refillable packs and recycled [recyclable papers. Although the use of refillable packs were used to keep the price low, it evolved into an element that reinforced the brand positioning. The brand also was careful in the messages displayed in the shop and other POP merchandises. The messages were simple, enthusiastic and informative. These elements made Body Shop a different cosmetic brand. The brand was essentially an extension of the founder herself. Anita Roddick is an ardent environmentalist and naturalist. Her views about the nature supported with her activities and associations created a positive reinforcement for the brand. Customers were seeing a brand that does things while others Just give hope. More over Body Shop was able to communicate with the customers at a higher level rising above beauty and fairness that other cosmetics talked about. There was honesty associated with the brand. The shops also reinforced this attribute. All the shops reflected an environment of honesty, excitement and fun. It is reported that Ms Anita Roddick takes personal interview with the franchises to ensure that they share the same passion with Body Shop principle. Although Body Shop is starting serious business with Indian consumers only now, the association with India dates back to the initial years itself. India was a sourcing partner for Body Shop during the creation of the brand. The success of the brand was because of the unique business model of Body Shop. The brand relies on PR and word of mouth to make sales. The Indian launch was also

Drama assignment Essay Example for Free

Drama assignment Essay Hale is one of the most important characters in The Crucible. All of the characters contribute to the problems in Salem to some extent. But Hale is the catalyst to the hysteria beginning and it is how is awareness of this increases through the play that causes the major changes we see in his character.  Hale himself, as we are told by miller, nearing forty, a tight skinned eager eyed intellectual. He feels great pride at being asked to come and identify the signs of witchcraft and sees it as a compliment to his experience in his chosen field. Unlike the other characters his experience gives him no reason to jump to the immediate conclusion of the involvement of the devil. Because of this he is perhaps the most common sense of the officials in Salem. Hales entrance in act 1 creates a big change in the direction of the scene, but it is important to remember he is unaware of this. How miller uses Hales entrances effectively is that he calms down the situation between Giles and Putnam when they cease their argument at his arrival but eventually he will excite the scene even more with his powerful redemption of Tituba and Abigail.  After his initial entrance in act 1 Hales attitude is reasonably light hearted as he greets the other characters, he refers to the devil in an of hand way as the old boy. Yet he still treats the situation in all seriousness as he listens to the Putnams talking about their daughters ailment, picking up clues from what people say. When Hale is investigating the supernatural, leafing through his books, asking questions and listening to the other characters etc, it should be shown that he does not treat this as a chore or just his job, but that he is genuinely interested and eager, his investigations are what drives him.  His attitudes to the other characters in the early part of act 1 are interest in meeting people he has heard of, and his respect for the more distinguished company. who are there. His use of the phrase shows a wish to make a good impression with those who are higher in the village, but his interest in meeting Rebecca Nurse and talking to Giles shows that he is in no way biased to position. As we enter the increasingly hysterical ending to this act, Hales role in causing this is obvious. His quickening questioning of her is perhaps caused by his anger at her apparent lack of concern for Bettys condition and her attempts to evade answering his questions. (grasping Abigail): abigail it may be your cousin is dying. Did you call the devil last night? you cannot evade me, Abigail.  Hale is excited at the end of act 1 because he believes he has got to the root of the problem when Tituba and Abigail redeem themselves and pass the blame to Good and Osburn. Because of this both hale and Parris see the problem as ending not beginning. Hale has obviously seen the situation last a lot longer than he expected when he enters in act 2. he is different now- drawn a little, and there is a quality of deference, even of guilt, about his manner now. This shows us the beginning of his realisation of the consequences of the accusations that he has caused to be made.  This is the second time Hales entrance changes the course of events in both this act and for the rest of the play without him knowing it, his entrance has stopped John Proctor from leaving just when he had built himself up to confront Abigail to stop the accusations, so he makes things worse again, but still unintentionally. His attitudes to the Proctors in this act are mixed. He sees them as good and honest people, but knows that there is evidence that would say otherwise even if none of its serious enough to entirely incriminate them. His nervousness is also caused by him being unsure how to tell them Elizabeth has been accused, without making it sound like he is accusing them himself.  We last see Hale in the final scene of Act Four we see the total change in his opinions to the authority of the court, the guilt of those charged and in his faith. His motivation is now to try and save proctor from his fate. He is confused and wrought because of how his faith has caused so many problems. To conclude, Hale changes most of all the characters, yet like the others he changes in that his main characteristics are strengthened. His honesty and sense of public duty are there throughout the play, how they change is to which end theyre directed. He is initially convinced of the presence and existence of witchcraft, and works vigorously to combat it in the only he knows how. Yet he is the only of the prosecutors who is convinced of the innocence of the accused, he still believes his first duty is the protection of others, but loses his principles to do so at the end. He is more open minded and humane than the others, but the message of the play tells us to reject the position to which he finally comes. He doesnt reject just the religious fanaticism of the times but rejects religion itself. His attempts to save John Proctor ultimately fail, because in turning his back on the church, he has turned his back on what Elizabeth believes is right, and so his argument is worthless to her.  Perhaps Millers idea in Hale is that where the simple farmer sees the mistake in preferring life over personal integrity the learned Hale does not.

Applications Of Lanthanides For Medicine

Applications Of Lanthanides For Medicine Lanthanides have been used for medicinal applications since the 1980s but the development of technology has led to a demand for new developments.1 Lanthanides, known as rare-earth elements, have a wide range of photophysical properties that are amenable to spectroscopic and crystallographic studies.1 This, along with the absence of lanthanides in biological systems, makes them ideal for studying protein structure and interactions. The chemistry of lanthanides arises from the shielded electrons in the 4f orbitals, located within the outermost filled 5s/5p orbitals2. This shielding means the luminescent f-f transitionsehibited by lanthanides are almost ligand-dependent. Despite their chemical similarities each lanthanide gives its own distinctive colour, luminescence emission spectra and nuclear magnetic properties.2 They are electropositive, very reactive and favour the Ln3+ oxidation state. It is these properties that make them useful as medicinal agents.1 Figure The f block lanthanidesLn3+ ions have similar ionic radii, donor atom preferences and coordination numbers in binding sites as Ca2+ ions which means that to some extent Ln3+ can mimic Ca2+ behaviour.3 For drugs molecules to reach their target they first need to be absorbed across the cell membrane a calcium dependent process. Calcium concentrations of mM are needed for efficient drug uptake, but these are rarely achieved under cellular conditions and even when it is the cell is likely to become damaged.3 It has recently been found that Ln3+ can perforate the membrane at concentrations as low as 10-5 M. It is therefore no surprise that co-administration of drugs with Ln3+ has led to an increased intracellular accumulation.3 This property has allowed lanthanides to be used as a co-administer to drugs, as a drug itself and imaging agents.3 Medicinal applications Anti cancer agents Lanthanides have been known to be anti cancer agents since the early 1990s primarily through the induction of apoptosis.3 Lanthanides, particularly Tb3+, increase the infux of Ca2+ into cells thus increasing the intracellular levels. This increases the endonuclease activity, leading to DNA cleavage and therefore apoptosis.4 The same result is achieved by the inhibition of phosphodiesterase, the molecule responsible for the degradation of cyclic adenosine 3,5-monophosphate (cAMP).4,5 The molecule cAMP has an important role in DNA replication and an increase in its levels leads to a corresponding increase in the protein kinase (PKA) levels. This has two effects both of which lead to apoptosis; the increase of endonuclease activity and the expression of apoptosis genes.3,5 However, these methods were not selective and influenced healthy tissues as well as cancerous ones.4 New developments have targeted this drawback in an attempt to limit the side effects of treatment. Titania nanoparticles (NPs) have the potential to target tumours in a non-invasive manner.4 Titania, a wide band gap semiconductor, produces reactive oxygen species (ROS) following excitation of valence band electrons to the conductance band upon stimulation.4 These photoelectrochemical reactions can be promoted by x-ray irradiation which allows non-invasive penetration of the human body. Two papers, published by H.Townley et al. and A.Gnach et al., reported the discovery that the interaction of titania-NPs with x-rays can be optimised by using lanthanides as dopants.4,5 Normal cells can tolerate a certain level of exogenous ROS due to a reserve of antioxidants which counteract the ROS activity.3 Cancerous cells have metabolic abnormalities which increase the intracellular ROS levels. This makes them more dependent on the intracellular antioxidant system and vulnerable to exogenous ROS levels.4,5 Lanthanide doped NPs generate higher levels of ROS, due to the lanthanides allowing increased x-ray absorption, than general NPs thus playing on this vulnerability. The increased levels cause DNA and mitochondrial damage, causing apoptosis.4,5 NPs have the capability to accumulate in tumours as a result of the defective tumour vasculature. This gives them the potential to be selective to cancer cells thus reducing side effects. The NPs can also be coated with moieties for specific targeting and activation further limiting the damage to healthy tissues.5 These properties of the NPs are enhanced by lanthanide doping thus giving a new application for lanthanides. The best results have been seen for [emailprotected] and [emailprotected] Imaging Figure The traditional contrasting agent with Gd3+ bound to the chelate ligand and the water molecule under observation.Magnetic Resonance Imaging (MRI) has been vastly improved due to the use of contrasting agents (CA) since 1988.6 These act to improve the contrast between healthy and pathological tissue by influencing the relaxation rate of protons of bound water molecules, T2.7 The faster the relaxation rate, the higher the intensity and the sharper the image achieved. Relaxation rates are increased when the water molecule is close to a paramagnetic centre. Gd3+ has 7 unpaired electrons and is used as contrasting agents in MRI due to its highly paramagnetic centre.6 The traditional contrasting agents used Gd3+ bound to a chelate ligand through eight donor atoms (figure 2). This gives the complex the stability and strong binding needed to ensure that Gd3 is not released into the blood.6 However, Gd3+ is unselective and distributes over a wide region of extracellular space. Develop ments have been made to make the distribution more selective by linking Gd3+ chelates to moieties that cause accumulation in areas of interest.7 However, the increase of the magnetic strength from 64 MHz to the present 125 MHz has led to the decrease in the efficiency of Gd3+ based CAs. Therefore developments have had to be made to meet the technological demands. Current commercial contrasting agents are based on Gd-DPTA, Gd-DOTA and their derivatives but utilizing the magnetic and luminescent properties of other lanthanides has allowed the developments of new CA.8 A paper recently published by C.Andolinia et al. described how the near infrared (NIR) luminescence of the lanthanides Dy3+Â  and Yb3+ has been combined with the traditional MRI-CA to create new multimodal imaging agents.6 These complexes act as light harvesting antenna due to the bifunctional chelators/chromophores present. They surround the reaction centre, in this case the tissues, and funnel absorbed energy to the reaction centre.8 It is through this method that more of the incoming radiation is absorbed and the contrast is improved. Optical probes absorb photons from the excitation source within the visible region as well as absorbing the photons caused by biomolecules.6 Therefore the absorption and luminescent emission of optical probes are both in the visible region which l eads to a decrease in the limit of detection as well as the depths that the photons can reach. The NIR probes have the advantage that the depth of light penetration is increased due to their excitation wavelengths being outside of the biological window.6 Evaluation of all of the lanthanides has shown Yb3+ to be the most efficient NIR and MRI bimodal imaging agent.7 Osteoporotic treatment Bones are involved in a very precise cycle of the resorption and desorption of the bone tissue, see figure 3. Osteoporosis is a skeletal disease in which the bone density is decreased through higher levels of resorption than desorption. It is most commonly treated with biphosphonates which inhibit resorption thus preventing bone degradation.9 However, this class of drugs is poorly lipophilic and thus have a low oral bioavailability. To counteract this, the drug must be administered in high concentrations which causes GI tract problems, low patient tolerability and suspected osteoporotic issues in the jaw.9 Figure The continuous cycle of bone degradation and rebuildingIt is well known that lanthanide ions preferentially accumulate within the bone3 where they have an inhibitory effect on osteroclasts (bone degradation) and a stimulatory effect on osteoblasts (bone making). Due to the chemical similarities of Ln3+ and Ca2+ mentioned before, Ln3+ can potentially replace Ca2+ ions within the bone and affect the bone turnover cycle.3 Y.Mawani et al. discovered that heavier lanthanide ions show a 50-70% accumulation in the bones compared to lighter ions which have a >25% accumulation.9 The half life for a lanthanide ion in the bone is 2.5 years compared to an elimination time from soft tissues, such as the liver, of 15 days. These properties have led to heavier lanthanide ions being used for osteoporotic therapy.9 Furthermore, adjustment of the ligand structure has allowed the improvement of oral availability leading to an increased uptake and reduced side effects. Previous lanthanide comple xes were found to be poorly soluble in aqueous phases therefore reducing the absorption across the GI tract.9 This led to small levels of lanthanide ions accumulating in the bones therefore making the treatment inefficient. The development of an orally active drug that can pass through the GI tract has allowed efficient delivery of lanthanides to the bone. Conclusion Despite the initial disregarding of lanthanides due to suspected toxicity they have shown to have excellent properties for use as medicinal agents. The similarity of Ln3+Â  and Ca2+ has allowed lanthanides ions to be used as anti-osteoporotic agents as well as for increasing the permeability of cells to other drugs. New developments have seen lanthanide ions being used as cancer agents, by causing increased levels of ROS, as well as improving the already existing imaging techniques.

Principles of good customer service Essay -- Business and Management S

Principles of good customer service It is very important to give excellent customer service when out in resort working as a rep. customer service can be given by one person or alternatively it can be given out as a team. This is to ensure that the customers get the best from there holiday, and so that they build a rapor with you to gain trust for them to come back time and time again. Seeing the customer happy also benefits you as a rep and gives you good job satisfaction. There are many different types of giving good customer service: Body language When dealing with a customer you must always use positive body language. Giving lots of eye contact is always good because the customer feels that you are giving them you full attention and that you are developing an understanding of there needs. Also facial expressions reveal opinions, emotions and moods better than any of the other body parts. The way that your face expresses feelings i.e. smiling or frowning will always allow the customer to discover how you are feeling towards them. First Impressions First impressions count in any business, particularly overseas where dealing with people is such an important part of the work. You need to understand that the way you and your organisation present themselves to customers has a direct influence on their enjoyment, your job satisfaction and the future success of the organisation that employs you. In particular when meeting a customer for the first ...

Group Think Essay -- Argumentative Persuasive Group Thinking Essays

Group Think This type of dysfunctional operation of an organization has many ways and opportunities for failure. The basic fundamentals of this process are the beginnings of failure as groups seek conformity and unity they sacrifice everything in order to maintain peace within the group. Many times this will take the individuals creative thoughts and ability to voice the creative edge thinking away. In many organizations this is a process that is continually used. It is perceived that management wants the organizations operation or process to run without any type of question or waves. Below are listed eight of the main symptoms of group think as detailed by Janis, I. L & Manns book â€Å"Decision making† Symptoms of Groupthink are divided into three types in which they can manifest themselves: Type I: Overestimations of the group's power and morality Type II: Closed-mindedness Type III: Pressure toward uniformity When broken down the three types of groupthink can be broken farther down to eight ways groupthink causes failure. 1.  Ã‚  Ã‚  Ã‚  Ã‚  Illusion of invulnerability: Members ignore obvious danger, take extreme risks, and are overly optimistic. 2.  Ã‚  Ã‚  Ã‚  Ã‚  Collective Rationalization: Members discredit and explain away warnings contrary to group thinking. 3.  Ã‚  Ã‚  Ã‚  Ã‚  Illusions of Morality: Members believe that their decisions are morally correct ignoring the ethical consequences of their decisions. 4.  Ã‚  Ã‚  Ã‚  Ã‚  Excessive Stereotyping: The group constructs negative stereotypes of rivals outside the group. 5.  Ã‚  Ã‚  Ã‚  Ã‚  Pressure for Conformity: Members’ pressure any in a group who expresses arguments against the groups’ stereotypes, illusions, or commitment, viewing such opposition and disloyalty. 6.  Ã‚  Ã‚  Ã‚  Ã‚  Self-censorship: Members withhold their dissenting views and counter arguments. 7.  Ã‚  Ã‚  Ã‚  Ã‚  Illusion of Unanimity: Members perceive falsely that everyone agrees with the group decision silence is seen as consent. 8.  Ã‚  Ã‚  Ã‚  Ã‚  Mindguards: Some members appoint themselves to the role of protecting the group from adverse information that might threaten group compliance. Personal styles are limited by the group with GROUP THINK. Most of the time the individual will not take the chance to buck the system or willing to take the chance of being discredited by the core group if they do not agree with the process and or direction that is being lead. Decision styles are affe... ...ve that the label of Groupthink can be used too loosely. I myself have experienced situations where a Group is too quick to label themselves as sufferers of Groupthink. Although I truly think that Groupthink is a severe problem that exists today, the Challenger being one of the most disastrous of those examples. I believe that we all need to be careful not to be too swift about the use of the Groupthink label. It can be just as negative to a group to label them as wronged in their process when no such error exists as to call them victims of Groupthink. Again the dilemma is that groups need to always be alert to the existence of Groupthink, they also need to not label themselves or other victims of Groupthink unfairly. Although there are many times that Groupthink leads to failure, there are few instances when it works for the food. This is a fine line to walk, but it is most definitely a line that needs to be walked time and time again. Works Cited: Jarvis, Chris. GROUPTHINK Janis, Irving L. Victims Of Groupthink. Houghton Mifflin Company Boston, 1972 Janis, Irving L. Groupthink. Houghton Mifflin Company Boston, 1982 Griffin, Em. Groupthink. McGraw-Hill Inc., 1997

How animals save the planet Essay

Narwhals like these help scientists track global warming in the Arctic. These mythical looking tusked whales, also known as the â€Å"unicorns of the sea,† are measuring changing temperatures in Greenland’s arctic waters to track global warming. Climate scientists at the University of Washington attached thermometers and small satellite transmitters to the narwhals, who can dive far deeper than humans. As a result they found that waters in Greenland’s Baffin Bay are 0.9 degrees C warmer than formerly calculated. Dogs Working Dogs for Conservation in action. Humankind has long looked to its best friend to lend a helping nose – whether it’s a hunter tracking down prey or a police officer searching for drugs. Now groups like Working Dogs For Conservation and UK-based Conservation Dogs use dogs to sniff out endangered animals and plants – like jaguars in the Amazon or black bears in China – so researchers can track and save them. Birds Birds are natural recyclers. While our feathered friends in more urban areas have been known to utilize trash like string and paperclips in the building of their nests, male bowerbirds in Australia and New Guinea repurpose bright plastic containers and bottle caps to build their elaborate â€Å"bowers,† arched walkways carefully decorated and designed to attract female partners. Octopi A resourceful octopus searches for suitable shelter. Another animal recycler, the octopus is renowned for its intelligence and use of tools. Certain species like the veined octopus build shelters from sea shells, coconut shells, or more human debris. As this video shows, octopi enjoy hiding inside of glass jars they find on the ocean’s floor, putting what would otherwise be trash to good use. Rats An African giant pouched rat sniffs out a landmine. Like dogs, rats have a superior sense of smell. African giant pouched rats like the one pictured here sniff out land mines while being too light to  actually set them off. Anti-landmine organization APOPO dubs them â€Å"HeroRATS† for their ability to help the group find these environmentally hazardous, not to mention dangerous, weapons. Bees Bees use their keen sense of smell to detect environmental contaminants. Bees are widely talented and have a sensitivity to smells, tastes, and colors. They’re also highly communicative, using sound and dance to talk amongst themselves. It turns out that they can recognize specific types of chemicals and send off a certain buzzing sound depending on what chemical is released into the air. This is helping humans detect toxic chemicals in the environment and could be useful in detecting chemical warfare attacks. Sea Lions and Seals A sea lion measuring ocean conditions.  Like the narwhals, sea lions and seals can easily dive deep below the water’s surface to track climate change. Researchers at the University of California Santa Cruz rely on them to measure salinity, temperature, and other conditions so we can develop better models of ocean water circulation. Elephant seals in the Arctic measure temperature and have also been used to track the health of U.S. salmon populations. Mules A mule measures radiation levels.  Sarah and Little Kate are two mules that have been recruited to brave the conditions of the Santa Susana Field Laboratory outside of Los Angeles. A 1959 leak at the laboratory left radiation that may still linger in the area. Equipped with gamma radiation scanning equipment, the mules investigate the area and report back to government officials conducting this study. While it may not be ethical to subject animals to hazardous areas, the work they are doing may end up making the area safer for humans and animals alike.

The Reality of Married Life

John J. Robinson in his book â€Å"Of Suchness† gives the following advice on love, sex and married life. â€Å"Be careful and discreet; it is much easier to get married than unmarried. If you have the right mate, it's heavenly; but if not, you live in a twenty-four-hour daily hell that clings constantly to you, it can be one of the bitterest things in life. Life is indeed strange. Somehow, when you find the right one, you know it in your heart. It is not just an infatuation of the moment. But the powerful urges of sex drive a young person headlong into blind acts and one cannot trust his feelings too much. This is especially true if one drinks and get befuddled; the lousiest slut in a dark bar can look like a Venus then, and her charms become irresistible. Love is much more than sex though; it is the biological foundation between a man and a woman; love and sex get all inter-twined and mixed up†. Problems Almost everyday, we hear people complaining about their marriages. Very seldom do we hear stories about a happy marriage. Young people reading romantic novels and seeing romantic films often conclude that marriage is a bed of roses. Unfortunately, marriage is not as sweet as one thinks. Marriage and problems are interrelated and' people must remember that when they are getting married, they will have to face problems and responsibilities that they had never expected or experienced hitherto. People often think that it is a duty to get married and that marriage is a very important event in their lives. However, in order to ensure a successful marriage, a couple has to harmonize their lives by minimizing whatever differences they may have between them. Marital problems prompted a cynic to say that there can only be a peaceful married life if the marriage is between a blind wife and a deaf husband, for the blind wife cannot see the faults of the husband and a deaf husband cannot hear the nagging of his wife. Sharing and Trust One of the major causes of marital problems is suspicion and mistrust. Marriage is a blessing but many people make it a curse due to lack of understanding. Both husband and wife should show implicit trust for one another and try not to have secrets between them. Secrets create suspicion, suspicion leads to jealously, jealousy generates anger, anger causes enmity and enmity may result in separation, suicide or even murder. If a couple can share pain and pleasure in their day-to-day life, they can console each other and minimize their grievances. Thus, the wife or husband should not expect to experience only pleasure. There will be a lot of painful, miserable experiences that they will have to face. They must have the strong willpower to reduce their burdens and misunderstandings. Discussing mutual problems will give them confidence to live together with better understanding. Man and woman need the comfort of each other when facing problems and difficulties. The feelings of insecurity and unrest will disappear and life will be more meaningful, happy and interesting if there is someone who is willing to share another's burden. Blinded by Emotions When two people are in love, they tend to show only the best aspects of their nature and character to each other in order to project a good impression of themselves. Love is said to be blind and hence people in love tend to become completely oblivious of the darker side of each other's natures. In practice, each will try to highlight his or her sterling qualities to the other; and being so engrossed in love, they tend to accept each other at â€Å"face value† only. Each lover will not disclose the darker side of his or her nature for fear of losing the other. Any personal shortcomings are discreetly swept under the carpet, so to speak, so as not to jeopardize their chances of winning each other. People in love also tend to ignore their partner's faults thinking that they will be able to correct them after marriage, or that they can live with these faults, that â€Å"love will conquer all†. However, after marriage, as the initial romantic mood wears off, the true nature of each other's character will be revealed. Then, much to the disappointment of both parties, the proverbial veil that had so far been concealing the innermost feelings of each partner is removed to expose the true nature of both partners. It is then that disillusion sets in. Material Needs Love by itself does not subsist on fresh air and sunshine alone. The present world is a materialistic world and in order to meet your material needs, proper financing and budgeting is essential. Without it, no family can live comfortably. Such a situation aptly bears out the saying that â€Å"when poverty knocks at the door, love flies through the window†. This does not mean that one must be rich to make a marriage work. However, if one has the bare necessities of life provided through a secure job and careful planning, many unnecessary anxieties can be removed from a marriage. The discomfort of poverty can be averted if there is complete understanding between the couple. Both partners must understand the value of contentment. Both must treat all problems as â€Å"our problems† and share all the â€Å"ups† and â€Å"downs† in the true spirit of a long-standing life partnership.

Chronic Sorrow

Living with Chronic Sorrow The middle range theory of chronic sorrow theory was researched in the 1980’s validating parent’s feelings over the loss of not having the perfect child and having a child with a disability. Chronic sorrow provided a framework for understanding the reactions of individuals to various loss situations and offered a way to view the experience of bereavement. Involvement in an experience of a significant loss is the necessary antecedent to the development of chronic sorrow (Peterson & Bredow, 2009). The loss may affect individuals and family members at any time. Chronic sorrow may come to any of us during our lifetime. Chronic sorrow can best be described as a natural response to a tragic situation. Where life experiences cause deep distress, sadness, or regret especially for the loss of someone or something loved ( Gordon, 2009 ). Chronic sorrow is followed by a permanent loss of a personal attachment that may be ongoing with a sadness of such intensity that it recurs for the lifetime of the person. Mental pain, suffering and despair can all occur from chronic sorrow regardless if the loss is caused by injury, trauma or by death ( Alligood, & Tomey,(2010). Washington Irving says it best, â€Å"There is a sacredness in tears. They are not the mark of weakness, but of power. They speak more eloquently than ten thousand tongues. They are messengers of over whelming grief and unspeakable love. † The rational for choosing the middle range theory of chronic sorrow was because this theory was easy to identify with. From losing a home to a natural disaster, a job, and even in death of family members, friends and numerous pets this theory really hit home from personnel experiences. Possible Antecedents, Defining Attributes and Consequences Let’s start but trying to understand the antecedents of chronic sorrow and how they relate to ach other and affect each of us as individuals. This may help to understand how strongly emotions control and play an important part in our everyday lives. The antecedents that go along with chronic sorrow are loss and grief. They are experienced periodically by individuals of all ages through their life time. Whether in the death of a family member, friend or pet, losing a home and all worldly possessions or losing a functioning body part. To be able to get through these powerful feelings and emotions can be very difficult and even more difficult for others to understand (Peterson & Bredow, 2009). People all over the world are forced to deal with this daily, but until it happens to you, do you truly begin to understand the impact this has on ones’ own life. Every one of us will have to deal with loss at some time in our life. A loss can be described as â€Å"a pervasive psychic pain and sadness, stimulated by certain trigger events, which follows loss of a relationship of an attachment† (Teel,1991, pg. 1316). Losses come in many forms both large and small, such as loss of a job, a home, a way of life, a relationship, or loss of a significant other, spouse, family member or even a pet. The perception of the event, the situational supports, and the coping mechanisms all influence return of equilibrium or homeostasis. A person either advances or regresses as a result of the crisis, depending upon how the person manages the crisis (Potter & Perry, 2009). Experiencing a loss can trigger the grief process. Everyone is different and comes to terms with loss in different ways, so it is difficult to say how long a person’s process may take. Losses that are smaller and have less of an impact on peoples’ lives will take a much shorter time to resolve emotionally than more significant losses (Foust, 2006). Some people deal with the loss a day at a time, yet for some people it may be an hour at a time. As long as the person is not denying the loss, they are working through it. Action oriented is an internal management for coping with a loss. This includes continuing to be involved in interests, hobbies, activities, talking with friends, professionals and even joining a support group (Peterson and Bredow,2009). Lost your job, your home, a loved one, or a beloved pet? There are many forms of loss, and all are felt individually on a very personal level (Foust, 2006). A loss is losing or being deprived of something you once had. Any loss can have a profound effect on your life. Loss can happen at any time day or night and does not need a reason. A consequence of a loss can stop you from socializing, cause you to have lack of interests, and take you emotionally away from those who love you. A loss can impact your job, your home, your finances, and your relationships. This is a real emotion that people around the world experience daily. Coping with loss and grief can be challenging in many ways (Teel. 1991). A loss may be felt physically and emotionally, like something is missing. A feeling of worry and emptiness may be felt deep inside. Two types of losses most relevant to depressive symptoms are related to self, goal attainment, and loss of financial resources (Van Horn & Mischel, 2008). One may begin to suffer physical symptoms such as headaches, gastrointestinal upset, anxiety, sleeplessness, or anorexia. Emotionally you may feel tired, lack the ability to care about what is going on around you, sleep too much or too little, over eat or under eat, and neglect yourself and those around you. These are all feelings and emotions a person may experience in grief. Loss is an experience caused by changes and recognizing these changes are important in dentify feelings and most importantly, by allowing individuals to feel and express themselves begins the healing process (Love, 2007). Grief comes in many shapes and sizes. There is no â€Å"one size fits all† for the grieving process. Grief is the series of emotions that a person goes through after a loss. Grief may involve feelings of sadness, anger, guilt, shame, relief, jealousy, hopelessness and powerlessness ( Love, 2007). Many people allow for grief after the passing of a loved one, but many of today’s views tend to ignore the grief that can follow other kinds of losses. As a result, people find themselves unexpectedly alone dealing with the sorrow, anger and other emotions associated with grief at various times in their life. Confused and even ashamed, they may attempt to hide or avoid these emotions, pushing them inward rather than letting them out. This may cause destructive and devastating repercussions which can follow. Yet all of this can be avoided, if people recognize that there are all kinds of grief (Castledine,2002). Learning to deal with the loss and cope with ones misfortunes is where grief comes in. So, how long is the grieving process? Basically, a person grieves as long as it takes to come to terms with their loss and the impact that it has had on their life (Foust, 2006). The obvious time for grieving is after the death of a loved one. Many people experience this first with grandparents and parents, as well as aunts, uncles and family pets. Some people may suffer the difficult loss of siblings or spouses and still others may experience the tragic loss of a child. There is no way to measure grief, and no instrument or scale to measure for sorrow. Each person grieves these losses uniquely and differently. When a death of a loved one occurs those left ehind are often allowed time and space for grieving and usually supported by family and friends (Burglass, 2010). But what happens when someone loses a beloved pet? Or when a family loses a home? Or better yet the loss of a functioning body part, example hearing, seeing or loss of limb? These too are times of great loss. Unfortunately, they are seldom recognized as suc h and because of this the grieving are left alone to work through emotions that are many times misunderstood by those around them (Castledine, 2002). Coworkers, friends or even spouses can find it hard to understand ones grief and even find it difficult to handle. A person must grieve in order to heal and move forward. The suffering of dazed confusion, distress and unrelenting despair will generally ease with time (Love, 2007). At home, whenever you are alone, don’t push or force yourself to do anything. Relax and do what comes naturally. Many cultures do not encourage people to grieve openly. Crying and other ways of expressing distress can be seen as signs of weakness. Crying can actually help relieve stress, so cry, take a bath or watch television (Gipson, 2009). Do whatever makes you feel comfortable and helps you relax. Management forms of grief can be in the form of faith, istractions, like work, hobbies, and honoring your loss through ritual is important in overcoming the loss. There are many ways to go through the grieving process, regardless of how one grieves, grief is critical in the healing process (Potter & Perry, pg. 496). Any loss can warrant grief. Grief is a normal reaction to loss and is not usually associated with lon g term negative consequences. Grief is a natural psychological and sometimes physical response to loss or change. Though death is most commonly associated with grieving, many other life changes can have the same result (911, Oklahoma City bombing). Losing a job (being laid off after working several years for the same company), losing a home (natural disaster, fire, tornado or even hurricane), having children leave home ( go away to college, military service, get married), retiring, divorce, declaring bankruptcy (loss of financial resources) a breakup, even moving can all create a sense of real loss and grief (Love, 2007). Grieving is a natural and healthy reaction to all losses. The five stages of grief denial, anger, bargaining, depression and acceptance are all natural feelings when one experiences a significant loss. These can also be overlapped with shock, yearning and protest, despair, and recovery (Buglass, 2010). Grieving helps people understanding what has occurred and how to adapt to a new set of circumstances in their life. What makes the grieving process so challenging, is that many of the emotions we experience are painful and most people do not want to feel painful emotions. Another challenging piece is that many people are not prepared for the variety of emotions that occur. Most people expect to feel sad, but may not expect to feel angry, anxious, hopeless, terrified, confused, frustrated, lonely, and so on. The emotions felt do not occur in any predictable pattern and many people often tend to cycle through them throughout the grieving process (Drench, 2004). Grief is something that cannot be fixed and one cannot take a pill to make the grief go away. A person needs to experience the loss and all the negative emotions that result in order to accept the loss. Grief cannot be medicated with pills or alcohol. In fact, individuals that do attempt to take medication are using their own form of denial which usually lengthens the process and may even add a drug or alcohol addiction problem on top of their grief. The good news is that there are things that people can do to help cope and work through the grief process (Potter and Perry, pg. 496). These are a few examples people may use to help work through the grieving process. Take care of yourself by getting rest, eating regularly and maintain a regular routine. This can be challenging during the early process, but is essential with recovery (Potter & Perry, pg. 496). Support systems of family, friends and colleagues who will listen, offer advice and provide emotional support can benefit you. Talk about your loss helps get your thoughts and feelings ut. Journaling is also a helpful to get your thoughts out. In a private journal or diary people are able to express their emotions and vent their feelings honestly without hurting anyone or without concern for how they may appear to others (Potter & Perry, pg. 496). Time management techniques include developing a list of tasks that are felt to be important and need to be accomplished. Perform the tasks at the top of the list that require immediate attention, those that are not as important can be delayed (Potter & Perry, pg. 497). Guided imagery and visualization can help with relaxation. Gather pictures and other things that remind you of your loss, person, pet, house or phase of your life you have lost. Try talking with family and friends about your memories. Funniest, worst, happiest, anything you share will help with adjusting to the loss. Play music that reminds you of your loss. Music is a powerful memory that can make you feel good or is comforting to you (Potter & Perry, pg. 497). Progressive muscle relaxation may help with physiological tension. Exercise, fresh air, Sunshine, visiting with friends may all help. Deep breathing exercises may help reduce stress nd relax muscles (Potter & Perry, pg. 497). Have a friend share in an activity that may have been your activity with what or whom you lost. An example would be if you went to breakfast every morning at McDonalds, it can make you sad and upset to think about going back there. Sharing the activity with a friend will not replace your loss, but may help establish a new routine for you. That is what grieving i s about, facing and dealing with your new circumstances rather than avoiding them (Gipson, 2009). Many of these suggestions are easy things to do. What is not easy is managing negative motions. The grieving process does take time, but you can get through the loss and grief by dealing with your emotions one day at a time. None of these suggestions will take grief away, but may help to manage feelings and emotions that are experienced. Managing ones feelings can assist in feeling like the person is taking an active role again in their life. If the feelings a person experiences becomes overwhelming or significantly interferes with their life (can’t go to work, feeling suicidal, panic attacks, difficulty in carrying out every day routines, etc. ). This person ould likely benefit from seeing a therapist that can assist them with the grieving process and help them with acceptance and recovery (Buglass, 2010). Grieving can be difficult and a person does not have to go through this a lone (Gipson, 2009). Case Study Three young men, Brad, Tom and Mike return home from active military duty with the loss of a lower leg while fighting for our country. Each man experiences their loss differently and uniquely. The first, Brad, is supported by his wife, parents, two children and many other family members and friends. Brad’s leg has healed and a useful diverse type of prosthesis has been itted to his lower leg. After many months of rehabilitation Brad is able to walk again with the use of his new prosthesis. The prosthesis fits well with no skin irritations. Brad is able to enjoy many of the things he did prior to losing the leg (fishing, dancing, playing ball with his child). Brad is a very spiritual man and with the help of his wife, parents, family and friends he has been able to accept his loss and move forward. The quality of life Brad once new has slowly returned to an almost normal state. Although Brad does miss the loss of is leg he has adjusted to his ne w life and faces daily challenges as they come. The second, Tom, is also supported by his wife, parents, one child and many friends and family. The leg due to infection took longer than Tom expected to heal delaying his recovery time. Tom had a useful diverse type prosthesis fitted to his lower leg. Tom attended many more months of rehabilitation than Brad, do to skin integrity problems. Skin issues have disrupted the daily use of the prosthesis interfering with Tom’s independence and lifestyle. Tom has had difficulty at first adjusting to his new lifestyle. Everyday tasks have been very challenging for Tom at times. Toms’ wife, parents, family and friends have een very supportive to Tom every step of the way. A remote controlled wheel chair is available for Tom on the days he is unable to wear his prosthesis. Tom has learned to do many tricks with his wheel chair and has joined a wheel chair basketball team because he likes showing off. Toms’ acceptance and recovery was a lot slower, but in the end he was abl e to adjust to his new lifestyle. The third, Mike, is supported by his wife, parents, family and friends. Mike was diagnosed with Diabetes after returning home from active duty. Mikes’ leg had a hard time healing due to infection and adjustment to having Diabetes. Mike did not like having Diabetes and would refuse to eat the right foods. Mikes’ blood sugar was out of control because of his refusal to take medication prescribed and frequently drinking. These actions were responsible for causing skin integrity problems. After a long, hard, trying year, the leg finally healed. Mike was fitted with a useful diverse type prosthesis. Skin issues continued to be a problem because of Mikes Diabetes and his refusal to eat healthy and take his medication properly. The prosthesis was painful and awkward for Mike to use. Just looking at the prosthesis filled Mike with such an incredible loss. Mike was angry with everyone that tried to help him. He sat day after day in a wheelchair drinking beer. Mike refused to take a bath, shave, eat, or go anywhere he might be seen by people that knew him. Mike would stay for days at a time in bed and refuse to get up. Counseling was verbally rejected every time counseling was brought up by anyone. Mikes’ doctor placed him on depression medication which he refused to take on a regular basis. Mikes friends stopped dropping by to see him. Mikes’ wife was having difficulties dealing with Mikes’ drinking and verbal abuse. She would argue with Mike till she cried and could no onger take Mikes’ drinking and feeling sorry for himself. His parents tried being very supportive, but also found Mike really difficult to deal with. Mike continued to drink and blamed everyone for the loss of his leg. Mike refused to accept the loss or move forward. Mikes’ wife finally after two years had all the verbal abuse she coul d handle and left him. Mike ended up moving back home and living with his parents. He still is unable to wear the prosthesis and to this day rarely leaves his parents’ home. As a nurse working with individuals, families and patients we need to be able to recognize hese individuals that are suffering. By listening to what the person is saying and their body language should be triggers for nurses if this is a person wanting, needing or requiring some kid of outside assistance. Chronic sorrow is characterized as pervasive, permanent, periodic sadness or other grief- related feelings associated with ongoing disparity resulting from a loss experience (Lindgren, Burke, Hainesworth, & Eakes,1992). The concept of chronic sorrow as you have read may go hand in hand with the antecedents grief and loss. For a person to experience one, they can experience the other. Even though the loss may have been for seen or was totally unexpected, a person does not always overcome the loss or grief over night. For some people this may take days, weeks or even years. Then for others like Mike, they may be so devastated over the loss with grief that the loss is unbearable. They never overcome the loss and live with chronic sorrow. Reference Alligood, M. R. , & Tomey, A. M. (2010). Nursing Theorists and Their Work (7th ed. ). Maryland Heights, Missouri: Mosby Elsevier Inc. Bickerstaff, K. A. , Grasser, C. M. , and McCabe, B. (2007). 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