The Five Minds of a Manager Article Example | Topics and Well Written Essays - 750 words

The Five Minds of a Manager - Article Example One of the main focuses of the discussion in the article is based on the five managerial mindsets. Everything an effective manager does is sandwiched between action on the ground and reflection on the abstract. These two mindsets must be combined to in order for reflective thinking to meet practical doing. The five modules of the mindset program discussed in the article are: managing-self, managing organizations, managing context, managing relationships, and managing change. The first managerial mindset is managing self or the reflective mindset. These days managers need to desperately stop and think and to step back and reflect on their experiences. This type of mentality and thinking process can help managers gather ideas. Most people go through their lives undergoing a series of happenings which pass through their systems undigested. Happenings become experiences when they are digested and reflected upon. Synthesizing these ideas can lead to creative business solutions. Managers m ust reflect upon the actions of the company to ensure they are acting in a correct and socially responsible manner. Managers must look at this from the perspective of other stakeholder groups such as customers. Reflective managers are able to see behind in order to look ahead. Managers must pay attention to detail and to history. The problems made by the company in the past should not be repeated. The second mindset is managing organizations or the analytical mindset. Analysis breaks down complex phenomena into components or parts. Good analysis provides a language for organizing and it provides measure for performance. The key for analyzing effectively is to get beyond the conventional approaches in order to appreciate how analysis works and what effect it has on the organization. The use of analysis can enhance the problem solving abilities of the company. The third mindset is managing context or the worldly mindset. Managers have to look beyond their cubicles and appreciate the w orld around them in order to better serve the needs of the customers.

Empirical Literature on Asthma Care

Empirical Literature on Asthma Care This brief critically considers the empirical literature on asthma care. Emphasis is on UK studies although research from the USA (and other countries) is also considered. It is argued that both environmental and genetic factors are implicated in asthma onset, based on epidemiological evidence. Deficits in care provision persist: these gaps in care may be attributable to a wide range of modifiable factors, including unsatisfactory health professional (GP, nurses) input, limited use of care plans, and patient unawareness. Overall, however, conclusive inferences about asthma care provision are hampered by: A preponderance of retrospective/correlational studies, and a paucity of randomised control trials, which demonstrate causality; A paucity of research on particular gaps in asthma care; Failure to account for third-variable moderator effects. The Office for National Statistics (2004) publishes comprehensive statistics on asthma-related mortality, morbidity, treatment, and care, collapsed by demographic categories. Data is collected from the General Practice Research Database (GPRD). Issues addressed include mortality, prevalence, time trends, patients consulting general practice, incidence of acute asthma, and hospital inpatient admissions. Research suggests that health care providers often fail to agree on the precise criteria for diagnosing asthma, whether mild or severe (e.g. Buford, 2005). Severe asthma is often defined based on pulmonary function measurements, such as forced expiratory volume in 1 second, and hospitalisation. However, neither of these indicators reliably predicts asthma severity (Eisner et al, 2005). Eisner et al (2005) evaluated the efficacy of a method for identifying a cohort of adults with severe asthma based on recent admissions to an intensive care unit (ICU) for asthma. Four hundred adults with severe asthma enrolled at seventeen Northern Carolina hospitals were surveyed. A control group of patients hospitalised without ICU unit admission was also recruited. The study examined whether admission to an ICU unit is in itself a reliable indicator of asthma severity. Asthma patients with a recent ICU admission generated higher asthma scores (based on the frequency of current asthma symptoms, use of steroids and other medications, and history of hospitalisations/intubations), and poorer quality of life, were more likely to have been hospitalised, visited an asthma specialist in the previous twelve months, been in an asthma-related emergency department, and received inhaled corticosteroids in the past year. Data analysis controlled key background variables (e.g. demographic factors), increasing confidence in the reliability of the findings. However, this study was based on quasi-experimental design and hence may be confounded by sampling bias. Trends in annual rates of primary care consultations, mortality, and hospital visits/admissions were monitored for children under 5 years and 5-14 year olds. For children aged For 5-14 year olds, weekly general practice visits rose in the early 1990s (circa 70/100,000 in 1990), showed a fluctuating pattern through the mid 1990s, but has declined steadily since 1997 (about 50/100,000 by 2000). The number of patients treated annually for asthma has risen slowly but steadily, although this increase seemed to level out by the mid/late1990s. Both mortality rates have dropped steadily since the early 1990s, from about 14 million in 1990 to circa 2 million by 2000. Annual hospital admissions has also fallen steadily, from just under 30/10,000 in 1990 to about 15/10,000 by 2000. These patterns suggest an increase in self-management (e.g. action plans) that obviates the need to visit a general practice, and that asthma care overall is having the desired effect on mortality. The prevalence of wheezing and asthma in children has generally increased during the last 40 years. Although there is a paucity of reliable national statistics, data is available from specific parts of the UK, notably Leicester, Sheffield, and Aberdeen (see Figure 1). The prevalence of wheezing increased from 12% (1990) to 26% (1998) in Leicester, and from 17% (1991) to 19% (1999) in Sheffield. The prevalence of asthma showed a similar pattern in both cities, rising from 11% (1990) to 18% (1998) in Leicester, and from 18% (1991) to 30% (1999) in Sheffield. Wheezing incidence rates for Aberdeen increased from 10% (1964), to 20% (1989), 25% (1994), and 28% (1991). Data from national birth cohorts suggests a sharp increase in the average weekly GP consultations for hay fever/allergic rhinitis from 1991 to 1992. The rates rose from circa 13/100,000 (0-4 year olds) and 40/100,000 (5-14 years olds) in 1991 to about 25/100,000 (0-4 year olds) and 76/100,000 (5-14 year olds) as 1992 approached. Trends subsequently dropped off slightly but then started to show an increase again around 1998. By the year 2000 the figures were roughly 20/100,000 (0-4 year olds), and 56/100,000 (5-14 year olds). Data from a nationally representative sample of schools across the country suggests that the prevalence of asthma was fairly even across different regions. However, Data for England suggests a higher prevalence outside big cities. The greatest proportions of wheezing was found in the South West, while the highest proportion of asthma cases was found in East Anglia and Oxford (see Figure 2). In a recent Annual Report, Asthma UK (2003/2004) noted that one child in 10 has asthma and a child is admitted to hospital every 18 minutes due to an asthma attack. Over 600 copies of Asthma in the Under Fives are downloaded from the UK Asthma website monthly and on average every classroom in the UK has at least 3 children with asthma. The impact of acute asthma can be debilitating. Around 5.2 million people in Britain are presently being treated for asthma, and asthma prevention/care costs the NHS on average almost  £900 (i.e.  £889) million per year. GPs across the country treat over 14,000 new episodes of asthma each week, and UK Asthma met almost 25,000 requests for health promotion documents and other materials. About 40% of workers who have asthma find that working actually exacerbates their asthma, and 1 in 5 asthmatic people feel excluded from areas of the workplace in which people smoke. Over 12.7 million working days in the UK are lost as a result of asthma, and it is estimated that the annual cost of asthma to the economy is  £2.3 billion. Asthma UK also states that 82% of people who are asthmatic find that passive smoking triggers their asthma, and 19% of people with asthma indicate that their medical condition makes it difficult for them to play with children in their family. One in 3 children has had their routine daily activities disrupted due to asthma and 39% of asthmatic people are badly affected by traffic fumes (which stop them exercising). About 500,000 people have asthma that is very difficult to control. In 2003/2004 over 90 researchers worked on Asthma UK-funded projects and, Asthma UK spent  £2.5 million on asthma-related research. The group funded/is funding 63 research projects. These statistics paint a rather bleak picture of asthma prevalence, incidence, and the effects on people’s lives. Numerous epidemiological studies have been published that address the etiology of asthma in population groups (International Archives of Allergy Immunology, 2000; Kitch et al, 2000; Schweigert et al, 2000; Tan, 2001; Court et al, 2002; Smyth, 2002; Weissman, 2002; Tan et al, 2003; Wenzel, 2003; Gibson Powell, 2004; Barnes, 2005; Pinto Almeida, 2005). Barnes (2005) considered evidence on the role of genetic factors in resistance to atopic asthma, Studies which focus on the role of genetic factors in resistance to tropical/parasitic diseases (e.g. malaria) overlap with genetic associations found for asthma. It was concluded that genetic factors might be implicated in the development of allergic illnesses. Pregnancy is thought to increase the probability of asthma attacks in about 4% of all pregnant women. Beckmann (2006) assessed eighteen pregnant women with asthma. The study was based on a longitudinal design. Participants were recruited from local prenatal clinics and private enterprises, and enrolled during the first trimester. Patients kept a daily log recording peak expiratory flow data until delivery. Three peak-flow assessments were recorded after which the best value was entered into the log. Asthma was diagnosed by a health professional. Participants were also required to record asthma symptoms, exacerbations, medications, and cigarette use. To increase participation, subjects were reminded by telephone to complete their log. Data analysis showed that peak expiratory flow (PEF) was variable as a function of particular trimesters. Peak air flow was highest during the second trimester, with a statistically reliable difference between the second and third trimester. Unfortunately, the small sample size limits the generalisability of the findings. However, the study was based on a longitudinal design, allowing tentative causal inferences. Schweigert et al (2000) reviewed the literature on the role of industrial enzymes in occupational asthma and allergy. Enzymes used by detergent manufacturing companies (e.g. amylases, cellulases) are toxicologically benign, with mild irritation effects on the body. However, these enzymes do affected asthma and allergy. Thus, the industry is required to adhere to exposure guidelines for these enzymes. Kitch et al (2000) considered literature on the histopathology of late onset of asthma (i.e. onset in adulthood), and whether allergic exposure and sensitivity have the same impact on asthma development in adulthood as they do in children. Epidemiological studies suggest that the prevalence of asthma in older adults aged 65years or more is between 4% and 8%. The illness appears to be more common in women, especially those with a long history of smoking, and with respiratory symptoms (e.g. cough, wheeze, shortness of breath). Asthma in adulthood often developed before the age of 40, with maximum incidence occurring around early childhood. Beyond the age of 20 years the incidence of asthma tends to remain stable through young, middle-aged, and older adulthood. Death rates in adults are generally lower than figures for children; â€Å"Mortality rates attributable to asthma among those aged between 55 and 59 years of age and 60 and 64 years of age were 2.8 and 4.2 respectively, per 100,000 people, the highest rates among all age groups† (p.387). However, as adults get older asthma is less and less likely to be identified as the main cause of death due to the increased incidence of other pathology. Epidemiological research in Japan highlights a link with air pollution (International Archives of Allergy Immunology, 2000). The prevalence of asthma among kindergarten and elementary school children has increased steadily since the early 1960s, rising from 0.5-1.2% between 1960 and 1969, to 1.2-4.5% (1970-1979), 1.7%-6.8% (1980-1989), and 3.9-8.2% (1990 onwards). By contrast, data indicates little or no change in asthma prevalence amongst adults. Figures range from 1.2% in 1950-1959 to 1.2-4.0% (1960-1969), 0.9-5.0% (1970-1979), 0.5-3.1% (1980-1989) the 1960s to 1.6-2.9% (1990 onwards) (see Figure 3). Asthma in Japanese children is more common amongst boys than girls although this gender difference has diminished noticeably since the 1960s. Asthma usually appears in infancy or early in childhood but has been known to begin across all age groups. Inherited (genetic) dispositions to allergies have been implicated in the onset of asthma. There is normally a strong correlation between asthma onset and a family history of asthma. Overall, asthma-related mortality in Japan has decreased since the mid 1990s. Delays in seeking treatment and rapid exacerbation of symptoms have been strongly implicated in asthma mortality. Unfortunately, this article offers little information about the designs of studies reviewed. Inferences regarding the possible causes of asthma morbidity and mortality may be inconclusive if much of the evidence is derived from cohort studies, rather than case control studies that more effectively eliminate alternative causes. The premenstrual period in women has been implicated in asthma exacerbation. Tan (2001) reviews epidemiological literature suggesting that female sex-steroid hormones may be significant in understanding the premenstrual-asthma link, albeit the available evidence is tenuous. The luteal phase of the menstrual cycle is associated with airway inflammation and hyper-responsiveness, and hence may explain asthma exacerbation during the premenstrual phase. However, this increase in asthma severity can still be treated effectively using the normal drugs. Studies suggest that premenstrual asthma affects the rate of hospital admissions – the majority of adults admitted are women, indicating that hormonal factors play an important role. Other evidence suggested that emergency presentations increased before ovulation. It is suggested that oral contraceptive pills or gonadotrophin releasing hormone analogues may be especially effective treatments. However, premenstrual asthma was rarely associated with serious mortality. Unfortunately, most of the studies reviewed were retrospective and questionnaire based, and hence subject to response bias. There was a paucity of randomised control trials, or pseudo experiments that may permit causal inferences. Court et al (2002) considered the distinction between atopic (extrinsic) asthma, common in younger people, and non-atopic (intrinsic) asthma, found mostly in older groups. Additionally, they also considered whether identification of asthma cases in epidemiological research should be based on a doctor’s diagnosis or self-reported asthma symptoms. Nearly 25,000 people in England were surveyed. Data was collected regarding whether participants had experienced wheezing in the past 12 months and/or had been diagnosed as asthmatic by a doctor. People with atopic asthma were more likely to have experienced wheeze and been diagnosed as asthmatic in the past, compared with the non-atopic group. Logistic regression analysis showed that gender, social class, smoking status, living in an urban/rural area, and house dust mice (HDM), were all risk factors for the presence of wheeze both with (age not significant) and without (urban/rural area not significant) a diagnosis of asthma. Wheeze/asthma was more prevalent in women, younger people, lower social classes, previous/current smoking, living in an urban area, and greater HDM IgE levels. Smoking status, social class, and age were all risk factors for wheeze in both atopic and non-atopic cases. Gender was also a risk factor for atopic subjects, and urban living for non-atopics. Other research has considered the epidemiology of severe or ‘refractory’ asthma, which is rather less well understood compared with milder forms of asthma. Wenzel (2003) reviews evidence indicating that severe asthma (defined as asthmatics requiring continuous high-dose inhaled corticosteroids or oral corticosteroids for over half of the preceding year) may account for circa ≠¤ 5% of asthma cases. Data from a large Australian-based study, which has followed a large cohort of asthmatics for over three decades, implicates childhood pulmonary problems with reduced lung function in adulthood. Data suggests that over two-thirds of severe asthmatics were afflicted with asthma in childhood. Other risk factors implicated include genetic mutations (in the IL-4 gene and IL-4 receptor), and environmental factors (e.g. allergen, tobacco exposure, house dust mite, cockroach and alternaria exposures), respiratory infections (e.g. pathogens like chlamydia), obesity, gastroesophageal reflux disease, increased body mass index, lack of adherence to corticosteroid regimes, and poor physiological response to medication. Physiological factors are also implicated, notably structural changes in airway reactivity, inflammation of the peripheral regions of the lungs. Steroids are the main form of treatment. Tan et al (2003) demonstrated the role of respiratory infection in patients with severe (i.e. near fatal) asthma, acute exacerbations, or chronic obstructive pulmonary illness (COPD). Participants had all been diagnosed as asthmatic by a physician and were undergoing treatment. All showed evidence of forced expiratory volume in 1 second (FEV1) increase of 200mL. COPD patients were suffering from chronic cough and dyspnea, with a predicted FEV1% 50%, with no ÃŽ ²-agonist reversibility. Near fatal cases were patients undergoing ventilatory support in the intensive care unit of a hospital (National University Hospital and Alexandria Hospital, Singapore) as a result of a severe exacerbation. Acute asthma subjects were characterised by non-improvement following administration of ÃŽ ²-agonists, and/or severe exacerbation judging from clinical/blood data. Analysis showed that near-fatal cases were the least likely to have the influenza A + influenza B virus, but the most prone to have adenovirus and picornavirus, compared with the other two groups (see Figure 4). This suggests that viral infection may be a risk factor for severe asthma. However, due to sampling size/bias (n= 68), and failure to control for key background variables (e.g. asthma history, smoking history, prior medication use, and outpatient spirometry), the findings can be considered tentative. Smyth (2002) reviewed epidemiological studies on asthma in the UK, and worldwide. The number of new asthma cases seen by GPs has increased noticeably since the mid 1970s. Nevertheless, asthma incidence has tended to decrease since the early 1990s, consistent with data from the Office for National Statistics (2004). By the year 2000 circa 60-70, 40-50, 20-25 new cases (per 100,000 of a given age group) were reported amongst, respectively, preschool children, 5-14 year olds, and people older than 15 years. Significant ethnic differences have been reported, with high asthma prevalence in Afro-Caribbean children. Since 1962, the number of preschool children hospitalised for asthma rose steadily, then peaked in the late 80s and early 90s, and has begun to decline since. The hospitalisation rates in 1989 were 90/10,000 (preschool children), 30/10,000 (5-14 year olds), and 10/10,000 (15 years or older). By comparison the rates for 1999 were 60/10,000, 20/10,000, and 10/10,000 respectively ( see Figure 5). The British Thoracic Society identifies specific benchmarks or ‘best practice’ which health professionals are required to meet when caring for asthma patients (BTS, 2004). These recommendations are mostly based on scientific evidence from RCTs, epidemiological studies (cohort and case-control), meta-analytic reviews, and other good quality research. The recommendations related specifically to the following topics: Diagnosis and assessment in children and adults (e.g. key symptoms, recording criteria which justified diagnosis of asthma); Pharmacological management (e.g. use of drugs [inhaled steroids, ÃŽ ²2 agonist] to control symptoms, prevent exacerbation, eliminating side effects, employing a ‘stepwise’ protocol for treatment); Use of inhaler devices (technique and training for patients, agonist delivery, inhaled steroids, CFC vs. HFA propellant inhalers, suggestions on prescribing devices); Non-pharmacological management (e.g. breast feeding and modified milk formulae for primary prevention, and allergen avoidance for secondary prevention, alternative medicines); Management of acute asthma (initial assessment, clinical features, chest x-rays, oxygen, steroid treatment, referral to intensive care) Asthma in pregnancy (drug therapy, management during labour, drug treatment in breastfeeding mothers); Organisation and delivery of care (e.g. access to primary care delivered by trained clinicians, regular reviews of people with asthma, audit tools for monitoring patient care after diagnosis); Patient education (e.g. action plans, self-management, compliance with treatment regimes). Overall, despite these guidelines, recent research suggests that patients’ treatment needs are not being met. For example, Hyland and Elisabeth (2004) report data on the unmet needs of patients. Focus groups were organised between parents, patients, and clinicians. Patients and parents reported various needs that weren’t been met including frequent exacerbations, and a preference for less complex drug regimens (i.e. with fewer drugs). Many individuals had worries regarding treatment and experienced asthma symptoms 3 or more days per week. As Levy (2004) suggests, there is a need for health professionals to address these concerns, especially in relation to the BTS guidelines. Levy, a GP and Research Fellow in Community Health, identified current deficiencies in the care of asthma victims. These comprised: Higher than expected exacerbations (42/1000 patients per year); Under-diagnosis: more patients presenting for treatment with uncontrollable asthma, who had not been diagnosed previously; Deficiencies in treatment uptake: many patients fail to collect their prescriptions; Many patients with symptoms delay presenting for treatment, until their medical situation becomes critical; Health care professionals are failing to assess patients objectively (PEF, oximetry), both pre- and post-treatment; Failure to adhere to national guidelines for the care of acute asthma (e.g. not enough oral steroids and ÃŽ ²-agonists are prescribed for patients presenting with asthma attacks. Considerable variations across GPs, NHS Trusts, clinics, and other sources of care provision: patient follow-up appointments range from a few days to six months, in direct violation of standards set by the British Thoracic Society (BTS, 2004). Levy suggests various strategies for improving asthma care including diagnosis criteria (e.g. â€Å"any patient with recurring or respiratory symptoms [cough, wheeze, or shortness of breath], or who has been prescribed anti-asthma treatment should be considered to have asthma† (p.44)), use of computerised templates, having systems or triggers in place for recalling patients (e.g. patients requesting more medication, or who have been seen out of hours), introducing more effective protocols for monitoring and informing asthma patients (e.g. using a checklist to ascertain various key information on patients status, such as effects of asthma on patients life, recent exacerbations), providing written self-management plans (e.g. how to detect uncontrolled asthma, using PFM charts), and having an agreed procedure for managing acute asthma attacks (e.g. selecting a low threshold for using oral steroids). Currently there is a lack of research testing the value of these recommendations on asthma health outcomes. However various strategies are continually being implemented in various parts of the country to improve the quality of asthma care. For example, Holt (2004) describes the effects of implementing the RAISE initiative, launched by the National Respiratory Training Centre, in a primary care setting. This scheme is designed to raise awareness of existing variations in standards of care, improve standards of care through education, support, and feedback, increase awareness and understanding of respiratory disease, use asthma as platform to demonstrate the value of shared experiences across different agencies/professionals, and augment the profile of primary care settings as the main source of asthma care and innovation. The RAISE led to various improvements, such as: The use of ‘active’ and ‘inactive’ asthma registers, to distinguish patients who currently have asthma symptoms from those who don’t. Introduction of computerised templates to improve accuracy and reliability of data recording during consultations (e.g. progressing sequentially from assessment of symptoms, to peak flow, inhaler, and advice stages). Use of symptom questionnaires (e.g. handed out with repeat prescriptions) that help patients with well-managed asthma decide whether they can opt for a telephone consultation, rather than taking the trouble to visit the practice for a face-to-face consultation. Haggerty (2005) identifies several factors paramount to effective care and management of asthma in UK patients. These comprise adequate patient education about the nature of asthma (e.g. number of asthma episodes, use of quick relief medicines, long term symptoms, restrictions on daily activities, and emergency visits), use of asthma action plans, and customised treatment plans (to achieve early control), and addressing patients own concerns and perception. Treatment for asthma is usually in the form of regular inhaled corticosteroids (ICS), oral corticosteroids (OCS), and ÃŽ ² agonists. These treatments are usually administered by a health professional when symptoms manifest and/or become severe. However, since asthma can often exacerbate rapidly, before an individual can seek medical help, it is vital that asthma patients receive the necessary care from health professionals, and also self-management skills. GPs and nurses play a critical role. Griffiths et al (2004) conducted a randomised control trial to assess the effect of a specialist nurse intervention on the frequency of unscheduled asthma care in an inner city multiethnic clinic in London. The role of specialist nurses in asthma care has been uncertain. Interventions in which specialist nurses educate patients about asthma, after hospital attendance with acute asthma, were shown to have inconsistent effects on unscheduled care. However, outreach initiatives to educate medical staff had shown no effect. Thus, an intervention was designed that combined patient education with educational outreach for doctors and practice nurses. It was suspected that such an integrated approach would benefit ethnic minority groups, especially given their higher hospital admission rates and reduced access to care during asthma exacerbation. The key research question was whether specialist nurses could improve health outcomes in ethnic minority groups. Outcome variables were the percentage of patients receiving unscheduled treatment for acute asthma during a 12 month period, and time to first unscheduled attendance with acute asthma. The study was based on 44 practices in two east London boroughs. Participants comprised over 300 patients (aged 6 to 60) who were admitted to or attending the hospital, or the out of hours GP service with acute asthma. Half the sample were classified as South Asians, 34% were Caucasian, while 16% were Caucasian. The intervention was based on a liaison model. Practices were assigned to either a treatment or control condition. Practices randomised to the treatment condition ran a nurse led clinic involving liaison with GPs and practice nurses, incorporating education, raising the profile of guidelines for the management of acute asthma, and providing on-going clinical support. In practice these practices received two one-hour visits from a specialist nurse who discussed guidelines for managing patients with acute asthma. Discussions were based on relevant empirical evidence. A computer template was provided to elicit patient information on various treatment issues, such as inhaler technique and peak expiratory flow, and offer self-management advice. By contrast, control practices received a visit promoting standard asthma care guidelines. Data analysis showed that the intervention lengthened the time to first attendance (median 194 days for intervention practices, and 126 days for control practices), and also reduced the proportion of patients presenting with acute asthma (58% treatment practices versus 68% in control practices (see Figure 6). These effects were not moderated by individual differences in ethnicity, albeit Caucasians seemed to benefit more from the intervention compared with minority ethnic groups. O’Connor (2006) noted that asthma care in the UK remains below the required standards. The majority of the 69,000 hospital admissions and circa 1400 deaths annually are attributable to poor patient adherence to treatment regimens. Nurses, it is argued, play an important role in promoting adherence. Additionally, use of a new inhaled corticosteroids – circlesonide – may also help increase adherence. Circlesonide is much easier to use than more established asthma drugs (e.g. it has a once-daily dosing). Evidence is reviewed suggesting that peak expiratory flow remains stable when patients are given circlesonide compared with a placebo. Tsuyuki et al (2005) assessed the quality of asthma care delivered by community-based GPs in Alberta, Canada. They reviewed clinical charts for over 3000 patients from 45 primary care GPs. Of this number 20% had ever visited an emergency department or hospital, 25% had evidence that a spirometry had been performed, 55% showed no evidence of having received any asthma education, 68% were prescribed an inhaled corticosteroid within the past 6 months, while a very small minority (2%) had received a written action plan. Figure 6 shows percentage of participants receiving medication. Sixty-eight percent were prescribed an inhaled corticosteroid, 11% were given an oral corticosteroid, and 80% received a short acting ÃŽ ²-agonist, while 8% were prescribed a long acting ÃŽ ²-agonist. Participants with an emergency room/hospital event were (marginally) more likely to be prescribed medication (no group differences in use of short acting ÃŽ ²-agonists). Regarding pulmonary testing, 25% had evidence of a pulmonary function test (not peak flow), 46% had peak flow monitored, 34% showed no evidence of pulmonary function tests, while 26% had an x-ray. Again individuals with an emergency room/hospital event were more likely to be tested (see Figure 7). Data about education received by patients was also evaluated. Twenty-two percent received information about environmental triggers, 20% on inhaler use, 10% on how to perform a home PEF test, 2% on written action plans, while 55% received no education at all. Those with an emergency room/hospital event were more likely to receive education. Receiving asthma education, use of spirometry, and prescription of inhaled corticosteroids, were all predicted by number of asthma-related clinic visits (4 or more) and having an emergency room/hospital event. Additionally, asthma education was predicted by cormorbidities, and absence of documentation regarding asthma triggers, while use of spirometry was predicted by being a non-smoker, and symptoms or triggers. Finally, use of inhaled steroids was predicted by symptoms. Overall, this study highlights numerous gaps in the care provided by GPs, partly echoing criticisms of GPs in the UK (Levy, 2004). For example, Levy (2004) cited ‘under

The Best Years of my Life Essay example -- essays research papers

Looking back now, I can see that people were right when they said that my high school years would be the best years of my life. Most teenagers complain that their lives are unfair and that high school is the worst part. I know this to be true because I have done my share of complaining. Even though I have many responsibilities, probably more than most people my age, my teenage high school years have been very carefree and enjoyable compared to future years as an adult and I have learned many life lessons through out my years in high school that will prepare me for many of life’s challenges. I know that even though I have complained and have looked forward to graduating, I will miss being in school. So, I have to say that my high school years are the best years of my life.   Ã‚  Ã‚  Ã‚  Ã‚  If an individual really thinks about it, their high school years are some of the best years of their life. While teenagers are still in high school and living at home, they do not have to worry about having money to by lunch, clothes, gas, or anything else, unlike when one graduates and moves out on their own. As a rule, teenagers do not have to worry about whether a certain bill has to be paid on this day and another bill on that day. They do not have to worry about not getting their electric bill paid by a certain day of the month so that their lights are not turned off or they do not have house payments or medical bills or many of the responsibilities that occur later in lif...

Discussion on Organ Donation Shortage

Medicine has evolved since the days of bloodletting, but from the perspective of a waiting recipient on the organ donor list, we still live in the dark ages. With a list of 110,941 hopeful candidates for organ transplant, the status of organ donation as a taboo subject in the Intensive Care Unit (ICU) has left an average of 20 people dead each day. (1) The high demand and low supply has led to creative solutions from both medical and government sectors, but what’s the answer? Is government intervention necessary, or should the fed keep their laws off my liver? While the fourth annual National Donor Designation Report Card prepared by Donate Life America shows 94. 7 million people were enrolled in state donor registries at the end of 2010,(2) it still doesn’t address the need that exists today. The shortage of organ donors in the U. S. is a problem. There are many factors that lie behind the reasons for shortage. From socioeconomic and demographic factors to religious beliefs, candidates just aren’t surfacing like they could. (3) â€Å"All the doctors and nurses I know are donors,† says Dr. Joshua Gitter, a practicing M. D. at John Muir Medical Center in Walnut Creek, California. â€Å"We can’t be the only ones providing organs here, ya know? The general public needs to step up. † The reason organs are in chronically short supply is partly due to the U. S. policy that requires voluntary giving. Dr. Gitter says most organs for transplant come from accident victims, who become brain dead after serious head injuries. These victims are typically put on life-support, and the next of kin's consent is required to turn off the machine and donate the organs. Dr. Gitter says there are usually good chances of receiving donations from the families of accident victims, but each case changes on a family by family basis. Studies have shown the chances of donation from families who had prior knowledge of the patients’ wishes regarding donation have a higher rate of donation from the ICU,(4) but how often does mortality come up in a healthy conversation with family? Craig Gammel, a San Jose resident says he never had a conversation with his family members on the topic of organ donation, so when his father suffered a brain aneurism in the summer of 2009, Mr. Gammel possessed no pre determined ideas of donating his fathers organs during his drive to the ICU where his father waited in a coma. â€Å"You’re never ready for a call like that. † Says Mr. Gammel, reflecting on the day he got the call about his father’s aneurism. â€Å"We didn’t wait long before the doctors confirmed my father was brain dead. † Craig made the decision to take his father off life support after hearing the news, and agreed to donate his fathers hazel eyes to a waiting recipient. When the nurse initially approached Mr. Gammel with the request for eye donation, she did so in a tentative and reserved manner. Craig says he appreciated the way the topic was introduced, and grateful for the opportunity to assist another person in need. â€Å"Of course I wanted his death to at least help someone. † He said. â€Å"The old man would have wanted the same, I think. † Craig says he wouldn’t have thought about organ donation at the time if the nurse hadn’t asked him. Since organ transplant candidates cannot rely solely on these cases, the concept of mandated choice was proposed by the American Medical Association in 1994. 5) Mandated choice would make it so people are required by law to state in advance whether or not they will be an organ donor. The American Medical Association's Council on Ethical and Judicial Affairs supports mandated choice. In a 1994 report, the council said: â€Å"Requiring a decision regarding donation would overcome a major obstacle to organ donation – the reluctance of individuals to contemplate their own deaths and the disposition of their bodies. †(6) â€Å"Frankly, I’m shocked that people need the government to tell them plan for their mortality. I wouldn’t want to be brain dead and have my family refuse organ donation because I never told them I wanted to donate. It’s tantamount to being buried with your money. Donate it for Christ sakes. † Concluded Craig. However, everyone does not share this belief of Craig’s. â€Å"I would never allow my daughters body to be chopped up and shared like a joint at a doobie brothers concert. † Said Santa Barbara resident David Martin when asked if he would donate the organs of a family member in the unlikely event of their sudden or accidental death. David’s cited his strict belief in Christian Science as support. His decision to abstain from all medical practices and remedies is a cornerstone in the religion, making the concept of organ donation implausible. While David’s beliefs are of a minority opinion, it still reflects a refusal to donate healthy organs to dying people. With factors influencing donation ranging from family or patient attitudes and beliefs to deaths from trauma being the decision factors, it’s hard to come up with a method for determining the right time to approach a family. â€Å"We have been trained to approach the subject with as much care and tact as possible. † Says Hillary Gitter, a practicing nurse at John Muir Medical Center. You’d be surprised how many people are open to the request if you approach them at the right time and in the right tone. † Because Hillary interacts with patients that are waiting for organ transplants, she firmly believes the need trumps any social awkwardness that arises when asking for organ donations. â⠂¬Å"How would you look someone in the eyes and say their chance of finding a donor is slim to none? You’ve sealed their fate and dashed all hope with that fact, so you do what you can to help people get donors. I think even false hope is better than a death sentence. † Said Hilary.

Byzantine and Roman Empire Art Essay

The Byzantine Empire was the new center for the Roman Empire, but did it directly inherit the art traditions from the Roman Empire? Give examples in your response. The Byzantine people considered themselves as the heirs to the Roman Empire (Online Lecture) so this also meant that they inherited the art traditions of the Roman Empire. Their sculptures stayed with the classical style of the ancient Greek art but a new aesthetic and iconic type art began to develop. The new aesthetic art was created by the Christians to fulfill their religious needs. Byzantine art favored a more symbolic approach to religion by depicting frontal figures against a gold background and the idea the subject(s) might be floating. The subject matters in this art consisted largely of the combined religion and imperial power. This can be seen in the mosaic below (Kleiner, 137) of Justinian and the Bishop Maxinianus. The mosaic depicts Justinian, ruler of the time, in a purple rob and a halo over his head. He also holds the golden paten, helping to emphasize the balance between religion and power. He is flanked by members of the clergy on his left with the most prominent figure the Bishop Maximianus holding a golden cross. To Justinian’s right appear members of the imperial administration identified by the purple stripe, and at the very far left side of the mosaic appears a group of soldiers, one holding a shield bearing the Christogram . The presences of icons, portable paintings portraying Christ, Mary or saints, were also important during this time. They were more religious than aesthetic in nature: especially after the end of iconoclasm, they were understood to mark the unique presence of the figure depicted by means of a likeness to that figure maintained through carefully maintained canons of representation. The Virgin (Theotokos) and Child between Saints Theodore and George (Kleiner,138) is a good example of an icon. This icon is created on wood, and represents the Virgin enthroned, supporting the Child Christ in her lap and flanked by two Saints, St. Theodore on the right and St. George on the left, both standing in formal pose. Two Archangels are pictured behind the central group, their wide-open eyes staring upwards to heaven. Portrayed frontally, on a slightly larger scale than the rest of the figures composing the icon, the Virgin is seated on a throne, dressed in a dark blue. Her feet dangle of the edge of the chair. Realism is reflected in the Virgin’s white and pink face, in her accentuated features and large dissimilar. The Christ Child is pictured seated in his mother’s lap. So the inheriting of the Roman Empire traditions of art only helped in the refining of the Byzantine esthetic and iconic art forms.

The Music of Andrew Lloyd Webber

The Music of Andrew Lloyd Webber The Music of Andrew Lloyd WebberAndrew Lloyd Webber was born in London, England in 1948. He started studying music as a child, writing his first compostiton at the age of nine. Webber attended the University of Oxford and later the Royal College of Music. Some of his famous compositions include Jesus Christ Superstar, Cats, The Phantom of the Opera, Joseph and the Amazing Technicolor Dreamcoat, and Evita. One interesting fact that I discovered about Andrew Lloyd Webber was that he was officially knighted in 1997, which makes him Sir Andrew Lloyd Webber.On October 24th, The Music of Andrew Lloyd Webber was presented at the Stranahan Theater featuring many soloists and the Philharmonia Europa orchestra. The performance consisted of highlights from Webber's famous productions, including those previously mentioned as well as numbers from Starlight Express, Whistle Down the Wind, Sunset Boulevard, and Aspects of Love. The show was overall a good mix of upbeat numbers as well as some slowe r pieces, from the beginning with the fast paced theme from Jesus Christ Superstar to the final piece "Love Changes Everything", from Aspects of Love.The first act of the performance began with the orchestra performing the overture from Jesus Christ Superstar. After that, the ensemble performed the theme song. This theme was very upbeat and jazzy, and in my opinion was a great way to begin the performance. After that were highlights from Joseph and the Amazing Technicolor Dreamcoat. Then, some more pieces from Jesus Christ Superstar were performed, including the love song "I Don't Know How to Love Him", as well as two other tunes "Everything's Alright" and "Gethsemane". These songs together provided a diverse look at the music from this musical. Following this were songs from Evita, the musical that tells the story of how the wife...

Thomas Green Case Essay Example

Thomas Green Case Essay Example Thomas Green Case Essay Thomas Green Case Essay In order to determine what course of action Davis should take, the root cause of Greens struggles at Dynamic Display (ID) must be examined. Simply stated the root cause for Greens struggles stem from a lack of power and influence and a lack of credibility; however, the contributing factors for these causes require deeper examination. To fully understand the lack of power, a brief history of both Green and Frank Davis must be analyzed. According to the Beckman article, Greens short professional background included 6 years as an account manager in the banking division of a company selling Tams to regional banks in the Southeast. He was recruited to ID as an account manager in their Hospitality and Travel Division selling self-service kiosks. Due to his outstanding performance, Green was invited to a week-long training session at the corporate headquarters where he met Shannon McDonald, the Division UP. After several conversations Green discovered there was an opening for a corporate marketing role and began lobbying for the job (Beckman Gasser, 2008). Green utilized his time to persuade McDonald that he would be a good fit for this marketing role. According to Jay Conger, the four essential steps process of persuasion are establish reducibility, frame goals on common ground, vividly reinforce your position, and con neck emotionally (Conger, 1998). Greens track record of outstanding performance gave Green the credibility he needed to initiate this discussion with McDonald. He framed his goals using the fact they both attended the university of Georgia to build rapport and gain McDonalds support. Explaining his goals to McDonald and elaborating that he wanted to make a significant impact in the company vividly reinforced his position while allowing them to connect emotionally. As a result, McDonald promoted Green o Senior Marketing Specialist reporting to Frank Davis (Beckman Gasser, 2008). Green was able to quickly move in to a senior-level position in what could be perceived as a short time frame with very limited experience; a typical career path to the senior marketing specialist at ID included tenure and field experience in the marketing specialist role (Beckman Gasser, 2008). Green moved into a role where he owned no currency or credibility, and was heavily dependent on both his manager and team. It was clear that Green did not have the power to effectively manage his team or work with his anger and O be effective, managers must find ways to acquire power With those on whom they are dependent. (Hill, What It Really Means to Manage: Exercising Power and Influence, 2000). It is important to note that the power An individual accrues is context-specific and hence dynamic: if the context changes, other things being equal, the individuals power Will ch ange. (Hill, Power Dynamics in Organizations, 1995). In this case, any power Green established while he was an individual account manager was lost in his new role, and he needed to find a way to grow power quickly. Unfortunately, Green possessed neither the expertise nor the track record in marketing to garner credibility with Davis and his own team, two very important characteristics needed in establishing power. Instead, Green chose to utilize a mask in order to help cover up his lack of power in the organization, further contributing to low performance in his role. According to Peter FUD and Richard Buddha, if Green had simply asked, What imperfections might he have been concealing (FUD Buddha, 2011), he would start to understand how his actions were contributing to a poor situation with his manager. By adopting the movie point of view to reflect on the situation, Green would understand how his lack of action was perpetuating his problems with his manager and allow him to recognize what changes in his behavior needed to occur. Had Green spent time reflecting on the situation, he would realize he needed to reach out to others within the organization for coaching. For example, his peers would have offered valuable insight. From an organizational and experiential perspective they could provide Green with relevant and credible direction while relaying knowledge around Davis performance expectations. McDonald could have offered valuable insight as Greens mentor and Offer ideas to help Green develop his sales strategy. Perhaps the best resource to reach out to for coaching would be Davis; Green could have learned what made Davis successful and leveraged both Davis and McDonalds positional power with the marketing specialists who reported to Green to help build credibility and establish his own power. Conversely, Greens manager Frank Davis appeared to have sufficient power and influence at a positional and personal level. For instance, his tenure with ID was 1 7 years, during which time he held various sales and marketing positions. ROR to his promotion to Director of Marketing he spent several years as a marketing specialist and a senior marketing specialist (Beckman Gasser, 2008). His tenure allowed Davis to gain the requisite knowledge and skills to perform both marketing roles prior to his recent promotion. This allowed him to maintain positional power within the organization while allowing him to build more influence throughout the organization. Credibility is a key factor in any organization, and since Green lacked credibility in his new role he was unable to successfully have an open dialogue with Davis regarding his tasks. One example involved feedback through which Davis recommended areas of improvement to Green; specifically, he expected Green to begin developing new marketing strategies for his region (Beckman Gasser, 2008). Davis set Green up for failure by using his positional power to put pressure on Green, even though he knew Green lacked the credibility with his team to complete this task. In the workplace, credibility grows out of two sources: expertise and relationships (Conger, 1998). Since he was Newton the role, he was still developing relationships which would allow him to be successful. His lack of experience reverted him from possessing the appropriate expertise to build credibility with his team. Additionally, when Green did not agree with Davis, he openly voiced his opinions to fellow employees and mana gers, and on one occasion during a budget planning meeting, Green directly challenged Davis on some of his forecasts. His relationship with Davis eventually reached a point where he purposely avoided interactions with Davis whenever he could (Beckman Gasser, 2008). If Green had successfully gained power and credibility with those he was heavily dependent, the relationship with Davis would not have deteriorated so quickly or to the extreme it did, and would have increased Greens chances for success in his current role. Failure to complete assigned tasks also hurt Greens credibility with his manager. In his former role, Green was very effective at building credibility by performing at a high level; this is evident because of the fact that .. Enron executives Quickly took notice of Greens performance and were eager to strengthen his relationship with the company (Beckman Gasser, 2008). Only through high performance and strong credibility could Green attract that kind of attention with executives. In order to build this type of credibility, Green must have met or exceeded all of the goals and objectiv es outlined for him; had he found a way to perform at that level in his new role, Green would have succeeded in gaining credibility with Davis and avoided the poor relationship with his manager. He could also have leveraged his sales experience, along with the requested information from Davis, to further build the credibility and meet his goal of making an impact at ID. Along with a lack of power and credibility, Thomas Green lacked influence. One of the key ways he lacked influence was illustrated by is inability to effectively persuade his manager. For example, when Green challenged Davis regarding the sales figures Davis presented at a meeting, Green did not have sufficient data to help support his claims that the numbers proposed by Davis were unreasonable (Beckman Gasser, 2008). For Davis, having quantitative data was very important for any discussion and would have provided Green common ground to engage in open dialogue. This also would have allowed Green the support needed for his position, and could lead to fact-based open discussion rather than an assumption-based argument. Stilling self-awareness, Green would have recognized that rather than directly challenging his manager in an open meeting, an off-line discussion would have allowed both sides avoid the risk of letting their passion control their arguments. When combined with a data-driven discussion, Green would have been able to successfully argue his points while gaining credibility with his manager. Alternative Theory E-mails Davis sent to McDonald paint a picture of an employee who is lazy and incompetent, supported by a line from an e-mail that read Thomas wastes a great deal of time complaining about the problems of selling And Numerous incidents of poor judgment and questionable behavior concerned me (Beckman Gasser, 2008). Green ineffectively dealt with office politics while unsuccessfully managing the challenges of interdependency (depending on others to get things done while they dependent on you), diversity (the differences between managers and those whom they depend on), and power gaps (the formal authority over those whom they are dependent) (Hill, Power Dynamics in Organizations, 1995). While suggestions have been made on how to improve his work within the office and with clients, Green chooses not to follow through with them. Green openly challenging Davis in a meeting set into motion the negative aspect of the law of reciprocity (do to others what they do to you) (Hill, Power Dynamics in Organizations, 1995). By making an enemy out of Davis, Green destroyed any credibility he had. He also complained about Davis to other coworkers which can slowly poison a work environment. These statements show that Davis is appropriately considering a change with Greens position, but perhaps Davis should reconsider the consequences of terminating Green. A little bit of self- reflection would show that a percentage of the blame should be focused on IM. Davis needs to take into account that his role has changed, and that he should look to lead more strategically compared to how he did as in his previous role. He should leverage the fact that Green is a rising star in the organization and Offer as much support as possible. While he has given Green specific goals, explaining his expectations to Green and helping him gain power and influence would also reflect well on Davis as a director. Although his role as a senior marketing executive is probably coming to an end, he can seek to be placed back into his former job in the organization. From there, he an continue to be mentored by McDonald and gain the crucial managerial experience. Due to the economy, Davis could theoretically easily find another person to fill Greens role; however, terminating Green would show that he is unable to develop new talent within the organization and reflect poorly upon himself. It may also take longer than anticipated to find a viable replacement for Green. As businesses are cutting back due to the economy, Davis must consider the potential revenue loss of having Greens position sit vacant. Recommendation Our recommendation is that Green be put on a performance improvement Lana and given a short leave to reflect upon the information that has been communicated to him from Davis and McDonald. During his reflection he should take a close look at the series of events that have occurred and come back to discuss with Davis. He needs to determine if he would handle his role moving forward given the knowledge he is now equipped with. He will then need to address the issue of office politics and how he sees himself in the corporate structure at Dynamic Displays. Finally, he needs to ask himself if he feels that he is a cultural fit or does he need to part ways with the company. Implementation After the appropriate paperwork is filed with human resources, Davis should have a mediated discussion with Green prior to Greens leave of absence. Assuming Green chooses to return to Dynamic Displays, the first thing he needs to do is address his work flow issues in order to restore his rapport with Davis. He can do this by completing the tasks already requested by his manager. This will be an effective way to show initiative, be a team player, and work to repair his credibility within the organization. Finally, Green should work to be a more effective listener, taking special note of when to talk and when to listen. Green should also work on not biblically challenge his superiors, even when he does not agree with their decisions.

Thermodynamics Overview and Basic Concepts

Thermodynamics Overview and Basic Concepts Thermodynamics is the field of physics that deals with the relationship between heat and other properties (such as pressure, density, temperature, etc.) in a substance. Specifically, thermodynamics focuses largely on how a heat transfer is related to various energy changes within a physical system undergoing a thermodynamic process. Such processes usually result in work  being done by the system and are guided by the laws of thermodynamics. Basic Concepts of Heat Transfer Broadly speaking, the heat of a material is understood as a representation of the energy contained within the particles of that material. This is known as the kinetic theory of gases, though the concept applies in varying degrees to solids and liquids as well. The heat from the motion of these particles can transfer into nearby particles, and therefore into other parts of the material or other materials, through a variety of means: Thermal Contact is when two substances can affect each others temperature.Thermal Equilibrium is when two substances in thermal contact no longer transfer heat.Thermal Expansion takes place when a substance expands in volume as it gains heat. Thermal contraction also exists.Conduction is when heat flows through a heated solid.Convection is when heated particles transfer heat to another substance, such as cooking something in boiling water.Radiation is when heat is transferred through electromagnetic waves, such as from the sun.Insulation is when a low-conducting material is used to prevent heat transfer. Thermodynamic Processes A system undergoes a thermodynamic process when there is some sort of energetic change within the system, generally associated with changes in pressure, volume, internal energy (i.e. temperature), or any sort of heat transfer. There are several specific types of thermodynamic processes that have special properties: Adiabatic process - a process with no heat transfer into or out of the system.Isochoric process - a process with no change in volume, in which case the system does no work.Isobaric process - a process with no change in pressure.Isothermal process - a process with no change in temperature. States of Matter A state of matter is a description of the type of physical structure that a material substance manifests, with properties that describe how the material holds together (or doesnt). There are five states of matter, though only the first three of them are usually included in the way we think about states of matter: gasliquidsolidplasmasuperfluid (such as a Bose-Einstein Condensate) Many substances can transition between the gas, liquid, and solid phases of matter, while only a few rare substances are known to be able to enter a superfluid state. Plasma is a distinct state of matter, such as lightning   condensation - gas to liquidfreezing - liquid to solidmelting - solid to liquidsublimation - solid to gasvaporization - liquid or solid to gas Heat Capacity The heat capacity, C, of an object is the ratio of change in heat (energy change, ΔQ, where the Greek symbol Delta, Δ, denotes a change in the quantity) to change in temperature (ΔT). C Δ Q / Δ T The heat capacity of a substance indicates the ease with which a substance heats up. A good thermal conductor would have a low heat capacity, indicating that a small amount of energy causes a large temperature change. A good thermal insulator would have a large heat capacity, indicating that much energy transfer is needed for a temperature change. Ideal Gas Equations There are various ideal gas equations which relate temperature (T1), pressure (P1), and volume (V1). These values after a thermodynamic change are indicated by (T2), (P2), and (V2). For a given amount of a substance, n (measured in moles), the following relationships hold: Boyles Law ( T is constant):P 1 V 1 P 2 V 2Charles/Gay-Lussac Law (P is constant):V1/T1 V2/T2Ideal Gas Law:P1V1/T1 P2V2/T2 nR R is the ideal gas constant, R 8.3145 J/mol*K. For a given amount of matter, therefore, nR is constant, which gives the Ideal Gas Law. Laws of Thermodynamics Zeroeth Law of Thermodynamics - Two systems each in thermal equilibrium with a third system are in thermal equilibrium to each other.First Law of Thermodynamics - The change in the energy of a system is the amount of energy added to the system minus the energy spent doing work.Second Law of Thermodynamics - It is impossible for a process to have as its sole result the transfer of heat from a cooler body to a hotter one.Third Law of Thermodynamics - It is impossible to reduce any system to absolute zero in a finite series of operations. This means that a perfectly efficient heat engine cannot be created. The Second Law Entropy The Second Law of Thermodynamics can be restated to talk about entropy, which is a quantitative measurement of the disorder in a system. The change in heat divided by the absolute temperature is the entropy change of the process. Defined this way, the Second Law can be restated as: In any closed system, the entropy of the system will either remain constant or increase. By closed system it means that every part of the process is included when calculating the entropy of the system. More About Thermodynamics In some ways, treating thermodynamics as a distinct discipline of physics is misleading. Thermodynamics touches on virtually every field of physics, from astrophysics to biophysics, because they all deal in some fashion with the change of energy in a system. Without the ability of a system to use energy within the system to do work - the heart of thermodynamics - there would be nothing for physicists to study. That having been said, there are some fields use thermodynamics in passing as they go about studying other phenomena, while there are a wide range of fields which focus heavily on the thermodynamics situations involved. Here are some of the sub-fields of thermodynamics: Cryophysics / Cryogenics / Low Temperature Physics - the study of physical properties in low temperature situations, far below temperatures experienced on even the coldest regions of the Earth. An example of this is the study of superfluids.Fluid Dynamics / Fluid Mechanics - the study of the physical properties of fluids, specifically defined in this case to be liquids and gases.High Pressure Physics - the study of physics in extremely high pressure systems, generally related to fluid dynamics.Meteorology / Weather Physics - the physics of the weather, pressure systems in the atmosphere, etc.Plasma Physics - the study of matter in the plasma state.

In the context of the period 1886 to 1998, how valid is the view that Essay

In the context of the period 1886 to 1998, how valid is the view that Republican violence was the greatest barrier to achieving a solution to the Troubles of 1965 to 1998 - Essay Example The Republicans are that group of people who wanted to have a unified Ireland under the name of Republic of Ireland. But as it has been, the north six districts of the country are with the United Kingdom. The Republicans, in order to make the six districts part of the unified Ireland, time and again, took refuge under strategy of violence against the Unionist forces (the group that predominantly ruled Northern Ireland and supports Northern Ireland’s inclusion with United Kingdom) as well against the British forces. But many of the research scholars upon the history of Northern Ireland do not agree with the fact. According to them, the Republican enthusiasts only retaliated when they were suppressed or attacked by the Unionists and the British and therefore the responsibilities of the long years of trouble also bestows upon the British administration and the Unionists. In order to understand the reasons of such conflicts and the thereby impacts, the essay delves deep into the political happenings of the past century along with analysing the role of United Kingdom in the affairs of Ireland. Like many of the other Christian nations, Ireland was also affected by the differences between the two conflicting groups of Christianity i.e. the Catholics and the Protestants. Since the yearly years of 18th century, the trend suggested that majority of the Catholic population left Ireland and settled in other parts of the world rendering Protestants the majority. In between the years of 1695 to 1728, many laws were passed in the country and that were particularly motivated against the Catholics. The laws included prohibitions in the rights of education to the Catholics, ban on serving as Member of Parliament, preventing them from buying rent and property and many others. In a major happening in the history of Ireland, in the year of 1801, the two

Diversities in Health and Healing Beliefs and Its Implication to Research Paper

Diversities in Health and Healing Beliefs and Its Implication to Health Care Delivery - Research Paper Example Holistic care has been the new paradigm of healing hospitals as the world faces the challenge of diversity in each nation. This poses a challenge to institutions to render a loving service rather than mere customer service. It is utilized in understanding that patients, as human beings, are composed of mind, body, and soul and its interconnectedness must be dealt with simultaneously. The final part of this paper examines the health care provider’s attitude and management for patients with different health belief from their own. Diversities in Health and Healing Beliefs and Its Implication to Health Care Delivery Migration is a common phenomenon that transpires throughout the world in this era of globalization and capitalism. Today, each nation has diverse nationalities residing within their territories for purposes of education, business, work, or leisure. This trend posts a challenge to health care professionals, particularly nurses, in delivery of health care services and un derstanding their total well being. Through time, the hospital has shifted its paradigm from being a place where illness is treated to a place aimed to render wellness and holistic services. Practitioners now embrace this holistic approach recognizing the interconnectedness of the body, mind, and soul and treating each aspect in respect of one another rather than the traditional approach of medicine which is focused only with the bodily manifestations (Moodly and West, 2005, p.257). The concept of holistic healing transformed social institutions such as hospitals toward a more just and loving health and healing practices. As the bible says, â€Å"The Lord will strengthen him in his bed of illness, you will sustain him in his sick bed (Psalm 41:3),† Christian institutions and practitioners acknowledge the value of psycho-spiritual assistance to both the ill and well patients. The usual challenged faced by holistic hospitals is marking delineation between the Christian concept of loving service and the capitalist’s value for customer service. While most administrators aim is to increase patient satisfaction, the caregivers and patients seek for a more humanitarian and loving approach when acquiring services from institutions. Health care systems must go beyond the superficial approach of customer service and dig deeper to a more genuine loving service and care (Chapman, 2005). Holistic approach and loving service are two valuable principles that must be carried out by health caregivers. This encompasses the need for better understanding of the patient’s health beliefs, healing preferences, and religion. Respect is the key point of success in this avenue of care (Chapman, 2005), therefore, diversities among these beliefs and preferences must be fully understood by nurses and health practitioners. Christian, Native American, and Buddhist’s Healing Beliefs The Christians focus on God as the Great Physician who heals all forms of illness and this healing could be attained through prayers. They recognize Jesus as the Christ, son of God, who healed thousand of sinners and ill people though prayer and faith during his stay on earth as narrated in the New Testament of the Bible. Christians believe in the power of the Holy Spirit as a current that flows and promotes healing of the mind, body, and soul (Plante and Sherman, 2001). The bible dictated that one of the gifts of the Holy Spirit

Investment Risks Essay Example | Topics and Well Written Essays - 2500 words

Investment Risks - Essay Example This refers to the poor earning reports, legal actions against the company, management ineffectiveness, or potential bankruptcy related issues that might keep an investor from investing in the company’s securities and stocks. Credit risk refers to the possibility that the company will not be able to meet its obligations and pay off its debts as and when these become due. If this situation arises, this could have a drastically negative effect on the company’s performance and its perception into the minds of potential investors. This might also result in a decline in stock prices and may ultimately lead to solvency problems for the company.This refers to the situation where movements in exchange rates adversely affect the investments for an individual or the company. The exchange rates may move in favor of or against the investments for people. If exchange rates are decreasing, an investment in a security becomes attractive as other investment models, like foreign currenc y, becomes unattractive due to exchange rates being reduced. However, if exchange rates show an increasing trend, an investor might not be willing to invest in a company’s securities until the return from the investment in securities is more than the return from investments in foreign currency. In addition, for multinational companies or for those who try to diversify their portfolio by investing in foreign currencies, exchange risk might be a very critical element to take into account before making the investment.

Movie Provoked and Divakaruni's story The Disappearance Essay

Movie Provoked and Divakaruni's story The Disappearance - Essay Example It is about their experiences as they – especially the wives – fall down headlong the rabbit hole that is marriage. Jag Mundhra’s movie Provoked is based around similar themes, too. In The Disappearance, there is a seemingly perfectly ordinary couple whose marriage had been arranged together after the man had given his approval of the prospective bride. This is one thing that is quite common in the Indian culture; the man has the choice of choosing his wife whereas the girl is not given the same courtesy. When Kiranjit expresses doubt about her marriage stating that â€Å"(she didn’t) even know him†, an acquaintance tells her that â€Å"(she doesn’t) need to† (Austin and Gupta). The man in the book, too, has certain ideas in his minds regarding what his wife should be like, he wanted a partner who was â€Å"a quiet, pretty girl† and â€Å"not brash† (Divakaruni par. 8). Even though he lived in the United States, he still wanted someone who was the epitome of the typical Indian wife and not one who had â€Å"too many western ideas† (Divakaruni par. 8). He wanted a meek minded wife who would not interfere with his d ecisions but was smart enough as to not embarrass him in front of his friends. They get married within the week regardless of the fact that they do not know each other at all. Appearances can be misleading after all. The wife does seem like a spineless creature who follows her husband’s wishes but, in the end, it is she who manages to escape her empty life knowing that her son was safe. In Provoked, Deepak comes off as a charmingly romantic hero who loves Kiranjit but it is after their marriage when he starts showing his true colors, she is â€Å"emotionally, physically and sexually abused for ten years† (Austin and Gupta). To an outsider, the marriage written about in The Disappearance is quite good compared to the normal standards. The woman does all the housework and takes care of the son whilst the man goes out to earn money. So when she disappears, everyone thinks that she has come across an accident. For all intent and purposes, the husband does seem to have some good characteristics especially when compared to certain men who consider their wives to be their property. He lets her go out on walks daily so that she can have â€Å"time for herself† and is only â€Å"happy to watch his little boy† unlike some husbands who consider all the childrearing to be the job of their wives (Divakaruni par. 3). He is proud of himself for â€Å"being an honest man† and drills in the importance of the same moral in his son, too (Divakaruni par. 5). He lets her decide on how to furnish the kitchen and what places to visit. He is careful not to hurt her and imagines himself to be â€Å"a good husband† who indulges his wife (Divakaruni par. 10). It is not until later that the reader realizes why exactly the wife ran away from him and her child, and how the man is the same as the others but just has the ability to sugarcoat everything. Again, there are the double standards about the Indian male and female regarding the right to say no amongst other things. The husband wanted a smart wife which he got but when s he mentions going â€Å"back to school† to school, he does not allow her to (Divakaruni par. 10). Kiranjit is not allowed to continue her studies or fulfill her mother’s dream about being a lawyer. He forbids her from getting a job as well as dressing up in American clothes even though they would have helped her fit in the strange, new land. When Kiranjit dresses up in Western clothes, Deepak tells her not to â€Å"

New Venture Proposition - Individual work Essay

New Venture Proposition - Individual work - Essay Example The selected name of the restaurant will be â€Å"Rene sense Dinner theatre†. The new theatre restaurant named â€Å"Rene sense Dinner theatre† is offering the area of entertainment and fine dining concept with different, tasty and innovative food recipes. While considering the food in the restaurant, the menu includes cuisine of America, France, Germany, Italy, Japan, Mexico, Spain, and the Middle East. The wide range of cuisines is also a new and different idea in the market. Moreover, when it comes to services presenting good food in a friendly environment will be a positive and strong point for the restaurant. The representation of different cultures and music within a colourful environment, which adds an entertainment factor with dinner, will amaze the customers. Customers will be allowed to choose any theme for their table and then the service for that table will be according to that theme. It will delight the customers and the experience of extreme fun and uniqueness will attract and grab the concentration of the customers towards one restaurant that is providing all entertainment activities and food at one place (Rainsford, 2000). The restaurant industry is a diverse business the reason is that there are various cuisines and cultures that restaurants offer and follow according to the needs and demands of the customers. There are various restaurants that are offering delicious and different food items. Mostly focus on the services and food quality. People around the globe like fast food items a lot, and it is a part of their daily food intake. It is the reason due to which there is majority of fast restaurants in the industry. However, for special occasions and different taste people prefer to experience uniqueness in food items within a good environment. Although there is majority of restaurants, there is no such

Impact Of Arab Spring On The Dynamics In The Middle East And North Essay

Impact Of Arab Spring On The Dynamics In The Middle East And North Africa - Essay Example The term â€Å"Arab Spring† refers to the revolutionary wave that has hit the entire Arab world which has resulted in the â€Å"awakening† of all the Arabs in the Middle East and North Africa. This led to a series of demonstrations, strikes, and protests in the Arab region which marked the beginning of a revolution in the Middle East and North Africa. Few of the revolutions that changed the history of the Arab world are a Tunisian and Egyptian revolution, civil war in Libya that toppled the government of General Gaddafi, civil disobedience in Bahrain, Syria, and Yemen. Different protests and strikes against governments have also been observed at a large scale in Algeria, Iraq, Kuwait, and Morocco and Oman whereas, on the other hand; Saudi Arabia, Sudan, Lebanon, and Mauritania also faced the wave of revolution This Arab revolution also added fuel to the fire to the Palestinian Conflict with Israel. The â€Å"Arab Spring† involved a series of civil resistance in t erms of violent strikes, campaigns, public demonstrations and marches against the government. Media coverage and social media platforms have played a vital role in shaping the revolution and creating awareness. This civil resistance was suppressed by the government and the authorities in a violent manner which triggered the revolution more aggressively by the protestors. Arab Spring which is also known as â€Å"Arab Awakening† or â€Å"Arab Uprisings† refers to the series of protests and public demonstrations.... This civil resistance was suppressed by the government and the authorities in a violent manner which triggered the revolution more aggressively by the protestors. THE RISE OF ARAB SPRING: Arab Spring which is also known as â€Å"Arab Awakening† or â€Å"Arab Uprisings† refers to the series of protests and public demonstrations held against the government and the authorities by the Arab people. These protests and the demonstrations were observed throughout the Middle East and North Africa which changed the history of the Arab politics in the region. The incident in Tunisia on 18th December 2010 became the major reason for triggering this revolution5. The Tunisian revolution begins with the self-immolation of Mohammad Bouazizi against corruption and unjust treatment by the government authorities. This sparked the fire in other African and Middle Eastern states such as Algeria, Egypt and Yemen which was followed by a number of violent protests in other countries as well6. However, a wave of political unrest and public demonstration against governments was felt even outside the Arab region which marked the new era of revolution and rebellion against state corruption, ill treatment, unemployment and human rights violation by the official authorities. As a result of this revolution, different governments around the region as well as outside the Arab region were brought down by the protestors. These demonstrations and political unrest in the Arab states drew the global attention towards the demands of the Arab nationals. CAUSES OF THE ARAB SPRING: It is important to understand the motivating factors and causes behind the violent aggression by

New Venture Proposition - Individual work Essay

New Venture Proposition - Individual work - Essay Example The selected name of the restaurant will be â€Å"Rene sense Dinner theatre†. The new theatre restaurant named â€Å"Rene sense Dinner theatre† is offering the area of entertainment and fine dining concept with different, tasty and innovative food recipes. While considering the food in the restaurant, the menu includes cuisine of America, France, Germany, Italy, Japan, Mexico, Spain, and the Middle East. The wide range of cuisines is also a new and different idea in the market. Moreover, when it comes to services presenting good food in a friendly environment will be a positive and strong point for the restaurant. The representation of different cultures and music within a colourful environment, which adds an entertainment factor with dinner, will amaze the customers. Customers will be allowed to choose any theme for their table and then the service for that table will be according to that theme. It will delight the customers and the experience of extreme fun and uniqueness will attract and grab the concentration of the customers towards one restaurant that is providing all entertainment activities and food at one place (Rainsford, 2000). The restaurant industry is a diverse business the reason is that there are various cuisines and cultures that restaurants offer and follow according to the needs and demands of the customers. There are various restaurants that are offering delicious and different food items. Mostly focus on the services and food quality. People around the globe like fast food items a lot, and it is a part of their daily food intake. It is the reason due to which there is majority of fast restaurants in the industry. However, for special occasions and different taste people prefer to experience uniqueness in food items within a good environment. Although there is majority of restaurants, there is no such

Financial Review and Comparison Research Paper Example | Topics and Well Written Essays - 1250 words

Financial Review and Comparison - Research Paper Example For the purpose of this assignment I have chosen PepsiCo Inc and the Coca-Cola Company. Both are globally well recognized brands in beverage industry. Besides beverage brands, both the companies are offering additional products. Pepsi incorporation has established itself as a supplier of quality snacks products such as Lays and Cheetos on the other hand the Coca-Cola Company is offering brand in mineral water such as Kinley in competition to Aquafina, a mineral water product by Pepsi, fruit juices such as Pulpy Orange, coffee and other alcohol-free beverages. The performance of both competitors in the year 2012 has been analyzed with the help of the key ratios. Net profit margin is computed as net profit to sales, and sometimes also profit after tax to sales. It is always measured in terms of percentage. This ratio represents the ability of the management to provide the investors with a reasonable return on their investments (Mohapatra). A higher net profit ratio indicates the efficiency of the management to control the cost. When comparing both the companies on the basis of net profit ratio the Coca-Cola Company has generated 2.64% addition net profit than Pepsi which indicate better slightly tight control over costs. Gross profit can be defined as the profit remaining after all the directly related cost of sales or services have been deducted from the revenue. Directly attributable cost include only those cost which are necessary to produce the goods. It is also represented in terms of percentage. The higher the ratio the better is for the company (Gildersleeve). It is an important profitability ratio which indicates the margin between the revenue and the cost of the product. On the basis of gross profit margin Pepsi is much better than Coca-Cola. The GP ratio of Pepsi is 52.49% in comparison to the 44.09% in case of Coca-Cola. This reveals an important fact that the Pepsi Company is better in controlling manufacturing cost and the Coca-Cola Company

Analysis of Migration Patterns in Afghanistan

Analysis of Migration Patterns in Afghanistan Migration in Afghanistan: 1. Introduction Afghanistan is home to the largest refugee crises experienced since the inception of the UNHCR. Decades of war have led millions to flee their homes and seek refuge in the neighboring countries of Pakistan and Iran, and for those who were able, further abroad. The number of refugees spiked in 1990 at 6.2 million. They began to decrease in 1992 with the fall of the government, but began to increase again in 1996 with the rise of the Taliban. In 2002, with the fall of the Taliban and the US-led invasion, record numbers of Afghan refugees returned to Afghanistan. An international reconstruction and development initiative began to aid Afghans in rebuilding their country from decades of war. Reports indicate that change is occurring in Afghanistan, but the progress is slow. The Taliban have regained strength in the second half of this decade and insurgency and instability are rising. Afghanistan continues to be challenged by underdevelopment, lack of infrastructure, few employment opportunities, and widespread poverty. The slow pace of change has led Afghans to continue migrating in order to meet the needs of their families. Today refugee movements no longer characterize the primary source of Afghan migration. Migration in search of livelihoods is the primary reasons for migration and occurs through rural-urban migration in Afghanistan or circular migration patterns as Afghans cross into Pakistan and/or Iran. Afghans utilize their social networks to find low-skilled work in the cities or neighboring countries. The highly skilled in Afghanistan often seek to migrate to Western countries, as the opportunities in Afghanistan are limited. Afghans transnational movements have led to the development of the Afghan Diaspora, which has been essential in providing remittances to families in Afghanistan to meet their daily needs. The Afghan Diaspora has been involved in the reconstruction effort and is a key contributor to development in Afghanistan. The continued engagement of the Diaspora is important to the building of Afghanistans future. This paper seeks to provide an overview of migration and development in Afghanistan. It will begin with a country profile on Afghanistan (Chapter 2), followed by a review of historical migration patterns in Afghanistan (Chapter 3) and a synthesis of current migration patterns in Afghanistan (Chapter 4). The paper will then move to discuss migration and development in Afghanistan (Chapter 5), the Afghan Diaspora (Chapter 6), policies regarding migration in Afghanistan (Chapter 7), and the migration relationship between the Netherlands and Afghanistan (Chapter 8). The paper will conclude with an examination of future migration prospects for Afghanistan (Chapter 9) and a conclusion (Chapter 10). 2. General Country Profile Afghanistan is one of the poorest countries in the world and has been inundated by decades of war, civil strife and poverty. Today, Afghanistan is central in media attention due to the US led invasion post 9/11, however the country has been in turmoil for much longer. This section will provide a brief overview of the recent history of Afghanistan, the current economic situation, the current political situation, a cultural overview, and the current status of women in the country. Historical Overview The modern history of Afghanistan can be divided into four essential periods: pre 1978, 1978-1992, 1992-2001, and post 2001. Pre 1978 Afghanistan was founded in 1774 by Ahmad Shah Durrani who unified the Pashtun tribes in the region and created the state (CIA, 2009). The country was ruled by a monarchy and acted as a buffer between the British and Russian empires until it received independence from conjectural British control in 1919 (CIA, 2009). The last King, Zahir Shah, reigned from 1933 to 1973, when he was overthrown by a coup detat led by his cousin and ex-premier President Mohammed Daoud (Jazayery, 2002). Opposition to Daouds Government lead to a coup in 1978 by the Peoples Democratic Party of Afghanistan (PDPA) (Jazayery, 2002). 1978-1992 Soviet Invasion The PDPA was a Marxist regime and from 1989 was supported by the Soviet Union. This was the first major flow of refugees from Afghanistan. The occupation by the Soviets was viewed in the west as an escalation of the Cold War. The West began to fund millions of dollars, which became billions of dollars, to the resistance forces known as the Mujahideen (Jazayery, 2002). The resistance forces operated primarily from Pakistan. In 1986 when Mikhail Gorbachev came to power in the Soviet Union, the Soviets began the process of extraditing themselves from Afghanistan and by 1989 the Soviets had left Afghanistan. 1992-2001 Taliban Rule In 1992 the Mujahideen forces overthrew Najibullahs Government. A failure of consensus of the new Government led to a civil war from 1992-1996 (Jazayery, 2002). Afghanistan became divided into tribal fiefdoms controlled by armed commanders and warlords (Poppelwell, 2007). The country was in a state of anarchy and Afghans lived in a state of constant fear of physical and sexual assault (Poppelwell, 2007). During this time, the Taliban emerged in 1994, claiming that Afghanistan should be ruled by Sharia (Islamic law) (Jazayery, 2002). The Taliban received support and funding from Saudi Arabia and Arab individuals in the quest to establish a pure Islamic model state (Poppelwell, 2007). The Taliban swept through Afghanistan encountering no resistance by the Mujahideen and were welcomed in many areas as they established relative security in the areas they controlled (Jazayery, 2002). By 1998, The Taliban had captured the majority of the country and established the â€Å"Islamic Emirate of Afghanistan† (Jazayery, 2002). A Northern Alliance that arose in opposition to the Taliban maintained a Government of the â€Å"Islamic State of Afghanistan† with Burhanuddin Rabbini as president (Jazayery, 2002). The Taliban Government was only recognized by Pakistan, Saudi Arabia, and the United Arab Emirates, while the Government of Rabbini maintained an officially represented seat at th e UN (Jazayery, 2002). After the bombings of the US Embassys in Kenya and Tanzania the Taliban were asked to stop harboring Osama bin Laden (Poppelwell, 2007). At their refusal, the UN imposed sanctions against the Taliban and Afghanistan in 1999 (Poppelwell, 2007). By this time the Taliban were known for disregarding international law and human rights (Poppelwell, 2007). During this time, killing, pillaging, raping, and ethnic cleansing of individuals occurred across Afghanistan by the Taliban regime (Jazayery, 2002). Post 2001 The events of 9/11 2001 led the US to lead Coalition Forces to invade Afghanistan on 7 October 2007. Within months the military forces had taken control of Afghanistan and declared the fall of the Taliban. The International Security and Assistance Forces (ISAF) in Afghanistan began with 5,000 troops. In 2003, NATO took over the ISAF, which now, due to increased security concerns, is comprised of approximately 50,000 troops coming from all 28 NATO members (NATO, 2009). In December 2001 a UN led interim administration was established under the Bonn Agreement. The Bonn Agreement established a new constitution and the first democratic elections in 2004 (Poppelwell, 2007). Hamid-Karzai, became the leader of a broad based thirty-member ethnic council that aimed to be multi-ethnic and representative of Afghan society (Poppelwell, 2007). The new administration faced many challenges and in 2005 the Taliban began to regain strength in Afghanistan. The increased security challenges led to the London Conference in January 2006 to address the end of the Bonn agreement and the current challenges in Afghanistan. The result of the London Conference was the Afghanistan Compact, which identified a five-year plan for Afghanistan. The Afghanistan Compact is based on three key pillars: â€Å"security, governance, the rule of law and human rights; economic and social development; and the cross-cutting issue of counter-narcotics† (Poppelwell, 2007, p. 8). Western Governments have taken on specific areas as a country lead for areas in which they will focus. The reconstruction process in Afghanistan has been extensive. A total of $14,775,000,000 US dollars has been contributed to the reconstruction process since 2001 (Livingston, Messera, and Shapiro, 2009). Despite the development efforts, insecurity has increased since 2005 with the Taliban regaining strength. The overall situation in Afghanistan continues to be characterized by conflict and poverty. Demographics A census has not been conducted in Afghanistan since prior to the Soviet invasion in 1978. Thus, all demographic information is estimates. In 2009, the CIA World Factbook estimated the population of Afghanistan to be 28.3 million. This was a significant decrease from the previous estimate of 33.6 million. An Afghanistan census is scheduled for 2010. The population growth rate in Afghanistan was estimated by the United Nations to be 3.9 percent 2005-2010 (UN Data, 2009). Economic and Poverty Overview Economic progress in Afghanistan is occurring through the reconstruction effort, however, Afghanistan continues to be one of the least developed and poorest countries in the world. Table 1 provides an overview of key economic and poverty indicators for Afghanistan in 2007. Real GDP growth for 2008-09 decelerated to 2.3 percent from 16.2 percent in 2007-08 (World Bank, 2009). This is the lowest GDP growth has been in the post-Taliban period and was due to poor agricultural production (World Bank, 2009). In 2009, however, growth is expected to increase due to a good agricultural harvest (World Bank, 2009). Table 1: Key Indicators GDP Per Capita (PPP US $) 1,054 Life Expectancy 43.6 Adult Literacy Rate (% aged 15 and above) 28.0 Combined Gross Enrolment Ration in Education 50.1 Human Poverty Index Rank 135.0 Probability at birth of not surviving to age 40 (% of cohort) 40.7 Population not using an improved water Source (%) 78.0 Children underweight for age (% under age 5) 39.0 Overseas Development Assistance per Capita (US$) 146.0 Source: UNDP, 2009 The latest poverty assessment in Afghanistan was conducted in 2005 through the National Risk and Vulnerability Assessment (NRVA). The findings indicate that the poverty rate was 42 percent, corresponding to 12 million people living below the poverty line (Islamic Republic of Afghanistan, 2009, p. 14). In addition, 20 percent of the population was slightly above the poverty line, suggesting that a small economic shock could place them below the poverty line (Islamic Republic of Afghanistan, 2009, p. 14). It is evident that widespread poverty continues to be a challenge in Afghanistan. Political Situation In August 2009, Afghanistan held it second democratic elections (World Bank, 2009). The incumbent President Hamid Karzai, was re-elected with 50 percent of the necessary votes, however, since the election there have been over 2,000 fraud allegations lodged with the Electoral Complaints Commission (ECC). The Independent Election Commission announced in October 2009 that its final results indicated less than 50 percent of the votes for Karzai. Thus, a run-off election was scheduled for November between Karzai and the lead opponent. Before the election, however, the opponent withdrew from the race leaving Karzai as President (World Bank, 2009). The United Nations Mission to Afghanistan has continued to coordinate international assistance and support the Afghan government in developing good governance. The key aspects of the UN Mission political mandate include: â€Å"preventing and resolving conflicts; building confidence and promoting national reconciliation; monitoring and advising on the political and human rights situation; investigating and making recommendations relating to human rights violations; maintaining a dialogue with Afghan leaders, political parties, civil society groups, institutions, and representatives of central, regional and provincial authorities; recommending corrective actions; and undertaking good offices when necessary to further the peace process† (UNAMA, 2009). The political situation in Afghanistan continues to be complex. In 2009, Transparency International rated Afghanistan 1.3 on the Global Corruption Perceptions Index (Transparency International, 2009). This was the second lowest ranking with only Somalia receiving a lower score. This suggests a high lack of trust in the Government of Afghanistan. Culture/ Ethnic Groups Afghanistan is a traditional and conservative society with large ethnic divisions. Table 2 shows the percentage of the population that belongs to the different ethnic groups. Table 2: Ethnic Groups in Afghanistan 1970s 2006 Pashtun 39.4 40.9 Tajik 33.7 37.1 Uzbeck 8 9.2 Hazara 8 9.2 Turkmen 3.3 1.7 Aimak 4.1 0.1 Baloch 1.6 0.5 Other 1.9 1.4 Source: The Asia Foundation, 2006; Encycopedia Iranica, 2009 The Pashtuns have generally been the majority in Afghanistan. They occupy land in the South and the East and are divided amoung tribal lines. The Tajiks are primarily Sunni Muslims who are Persian and occupy the Northeast and West of Afghanistan. The Tajiks are often well educated and landowners. The Uzbecks are descendents from the Turks and are primarily involved in agriculture. The Hazaras are primarily Shiite Muslims who occupy the infertile highlands in central Afghanistan. The Hazaras are subsistence farms that have used migration routes for survival for centuries (Robinson and Lipson, 2002). The vast majority of the population in Afghanistan is Sunni Muslim (87.9 percent). Shiia Muslims account for 10.4 percent of the population and the remaining ethnic groups are negligible in numbers. Shiia Muslims are thus a minority and have faced persecution in Afghanistan. Status of Women Afghanistans GDI (Gender Development Index) value is 0.310, which is 88.1 percent of its Human Development Index (HDI) (UNDP, 2009). The HDI does not account for gender inequality, and the GDI adds this component to the HDI. Afghanistan ranks 155 out of 155 countries measured in the world for its GDI. Indicators, such as literacy, illustrate this; 43.1 percent of adult males are literate, compared to 12.6 percent of adult females (UNDP, 2009). The culture of Afghanistan is a based on traditional gender roles. Traditionally, women are seen as embodying the honour of the family (World Bank, 2005). As such, women are given as brides to create peace, or to honour a relationship. The role of a wife is to maintain the household and support the husband, which includes domestic and sexual services. In general, a wife meets the husbands needs and if the wife does not she has dishonoured her family and community (World Bank, 2005). The legal rights of women in Afghanistan have changed with the political structure. Prior to Taliban rule, the Constitution of Afghanistan guaranteed women equal rights under the law, although local tribes may have had different customs. Under Taliban rule womens rights were severely hindered as they were not permitted to leave their homes unless accompanied by a close male relative, receive education, and had restricted access the health care and employment. Women were frequently raped and abused during this time. With the fall of the Taliban the situation has improved for women, however there are great differences between the rural and urban situation (World Bank, 2005). The Ministry of Womens Affairs (MOWA) was established in the Bonn Agreement to promote the advancement of women in Afghanistan. MOWA works in an advocacy role to ensure that policies are implemented for both men and women. In addition, MOWA works with NGOs to ensure programs for women are implemented. Womens rights remain to be a primary concern in Afghanistan. At present, approximately 60 percent of women are married before the age of 16 (IRIN, 2005). At 44, women in Afghanistan have one of the lowest life expectancies in the world (UNDP, 2009). Women who are widowed are ostracized in rural communities, but are often able to make a living in the cities to support themselves and their families. However, female-headed households tend to be primarily represented in the poorest quintiles of Afghan society (World Bank, 2005). The situation for women in the urban centres such as Kabul is becoming more liberal. Education rates of girls in the urban centres are high than rural areas and these indicators suggest changes are occurring for women in urban areas. Womens rights are high on the international policy agenda for Afghanistan and a key goal of development aid. 3. Historic Overview of Migration Migration in Afghanistan has had a long history and has significantly shaped the countries social and cultural landscape (Monsutti, 2007). Historically, Afghanistan was a country of trade between the east and the west and a key location on the Silk Road trade route. Thus, migration is a part of the historical identity of the country. The following chapter presents an overview of the complex migration patterns, with a historical perspective. Migration Patterns from Afghanistan to Pakistan and Iran Prior to 1978 Migration between Afghanistan and Pakistan and Iran has a long history. The migration relationships are rooted in the ethnic ties that span the borders between the countries. For instance, Pashtuns make up 20 percent of the population in Pakistan and 30 percent in Afghanistan. The Pashtuns are separated by the Pakistan-Afghanistan border, which is referred to as the Durand Line. The Durand Line was established during British colonialism to demarcate British India from Afghanistan, and has been acknowledged to be an arbitrary divide of Pashtun land (Monsutti, 2005). Thus, cross-border migration of the Pashtuns between Afghanistan and Pakistan has been a way of life. Similarly, the Hazaras of Afghanistan are Shiites Muslims, which is the majority religion in Iran (Monsutti, 2005). Hazaras regularly engaged in migration to and from Iran via religious ties. These ethnic and cultural ties led to cross-border migration for decades prior to the Soviet Invasion of Afghanistan. The poor economic position of Afghanistan prior to 1978 led to further economic migration to the better off states of Pakistan and Iran. Stigter states, â€Å"The economic differences between Afghanistan and Pakistan and Iran have long led Afghans to migrate to these countries to find employment and, for Iran, enjoy the benefits of a higher income† (2006, p. 117). In the 1960s and 1970s industrialization in Afghanistan was minimal and there were limited opportunities for the newly educated and growing rural population (Stigter, 2006). A widespread drought in the 1970s led to large-scale crop failure and further migration of many Afghans from the north and north-western Afghanistan into Iran (Monsutti, 2006). In addition, the oil boom of 1973 caused further increasing numbers of Afghans to cross into Iran and other Middle Eastern countries to capitalize on the labour opportunities (Stigter, 2006). Studies have also confirmed that prior to the war migrants from Northern Afghanis tan travelled to Pakistan during the winter, illustrating that seasonal migration occurred between the two countries (Stigter, 2006 from CSSR, 2005). These pre-established migration movements reveal that social networks were established between Afghanistan and Pakistan and Iran prior to the Soviet Invasion and proceeding wars. Monsutti states that â€Å"Channels of pre-established transnational networks exist between Afghanistan, Pakistan and Iran- the movement of individuals to seek work, to escape drought or to flee war has been a common experience in Afghanistan† (Monsutti, 2006, p. 6-7). Thus, it can be deduced that migration to Pakistan and Iran was a natural option for many Afghans. International Migration Post 1978 International migration movements from Afghanistan from 1978 have primarily been comprised of refugee flows. The vast majority of refugees fled to Pakistan and Iran in the largest refugee crises of the late 20th Century. 1 shows the number of Afghan refugees in Pakistan and Iran from 1979-2001. 1 illustrates that refugee outflows from Afghanistan began in 1979 with the Soviet Invasion. The outflows continued to increase during the Soviet occupation when there was civil war between the US funded Mujahideen and the Soviet backed Najibullah. Flows during this time spanned social classes and ethnic groups as the initial reason for migration was primarily protection led. However, reasons of a lack of economic opportunities, devastation of infrastructure and trade networks, limited access to social services such as healthcare and education, and political and social reasons also contributed to migration flows (Stigter, 2006). Migration was thus not only refugee protection, but also the need to make a livelihood (Stigter, 2006). The peak of the refugee flows occurred in 1990 with 6.2 million Afghan refugees. This was after the Soviet withdrawal and when the Najibullah remained in power (Jazayery, 2002, p. 240). In the 1990s drought contributed to continuing refugee flows from Afghanistan (Stigter, 2006). The fall of the Najibullah in 1992 led to large-scale repatriation. However, with the Taliban gaining power in 1996, the number of refugees began to increase again to approximately 3.8 million refugees in 2001. During the initial refugee outflows in 1979 both Pakistan and Iran warmly welcomed the refugees under a banner Muslim solidarity (Monsutti, 2006). Iran is a signatory and Pakistan is not a signatory to the 1951 Convention of Refugees and its 1967 Protocol, however both countries welcomed the refugees. In Iran the refugees were given identification cards, allowed access to work, health care, food, free primary and secondary education, and were free to settle where they chose (Monsutti, 2006). Pakistan created an agreement with the United Nations to provide services to the Afghan refugees and received financial support from the international community (Monsutti, 2006). The era of welcoming Afghan refugees began to change in 1989. In Pakistan refugees were still welcomed from 1989-2001, but were not provided with the same level of services and facilitation (Monsutti, 2006). In Iran support also decreased and by the 1990s refugees no longer received identity cards and assistance (Monsutti, 2006). The position of the host countries became increasingly unfriendly post 2001, which will be discussed in the next chapter of this paper. Return Migration The Mujahideen took over the government in 1992 and as a result nearly 2 million refugees returned to Afghanistan. By 1997 an estimated 4 million refugees had returned from Pakistan and Iran (Stigter, 2006). Simultaneously, however, conflicts between rival Mujahideen groups dissuaded many refugees from returning, and created new refugees and IDPs. Internal Migration The primary source of internal migration in Afghanistan was Internally Displaced Persons (IDPs). Internally Displaced Persons Internal displacement flows have followed a similar trajectory as refugee flows. The exact number of IDPs is not known and 3 shows estimated number of IDPs in Afghanistan from 1985-2001. Generally those who are internally displaced do not have the means to cross an international border. IDPs in Afghanistan had access to very few services during this period. The UNHCRs capacity in Afghanistan began to increase after 1992 as is illustrated in 3 by the red line. From 1995 the two lines start to converge as the number of IDPs assisted by UNHCR increases and the total number of IDPs decreases. By 2001 the number of IDPs has significantly increased to 1.2 million. The number of IDPs in Afghanistan will be further examined in the next chapter. 4. Current Migration Patterns- 2001- Present Current migration patterns in Afghanistan are complex and multifaceted. Since 2001 Afghanistan has witnessed the largest movement of refugee return in UNHCRs history (Monsutti, 2008). These flows have been a mixture of voluntary and forced return of refugees who had been outside of Afghanistan for varying periods. The majority of returnees are from Pakistan. Afghan refugees have maintained ties with Pakistan and now cross-border labour migration between Afghanistan and Pakistan is increasing. In addition to international flows, the numbers of IDPs have decreased in Afghanistan since 2001 as IDPs return to their regions of origin. Finally, within this picture there are large flows of rural-urban migration as returnees and non-returnees find limited opportunities in rural areas and move to the cities in search of work. All of these flows are occurring simultaneously and present a complex picture of current migration patterns and flows. Each of these areas will be addressed in the follo wing section. Internal Migration Internal migration flows in Afghanistan have been increasing in the post-Taliban period. As refugees and migrants return to Afghanistan they do not necessarily end their migration cycle. Returnees may continue to migrate internally in search of livelihoods and opportunities. The internal migration flows in Afghanistan are comprised of IDPs, rural to urban migration, and trafficking. Internally Displaced Persons Internal displacement in Afghanistan has been understudied and information is limited to availability from the UNHCR. In 2004, the UNHCR conducted a data profiling of IDPs in UNHCR assisted camps and in 2008 the UNHCR created a national profile of IDPs in Afghanistan. Statistics regarding IDPs are estimates[1]. Table 3 shows the number of IDPs and IDP returnees from 2001 to 2008. At the fall of the Taliban in 2001 there were approximately 1.2 million IDPs in Afghanistan, of which many returned spontaneously in 2002 (UNHCR, 2008, p. 6). In 2008, IDP returns were negligible due to continued insecurity, inter-tribal and personal conflict, landlessness and drought, and lack of job opportunities and basic services in rural areas (UNHCR, 2008). Table 3: IDPs Total and Returns: 2001-2008 IDPs IDP Returnees Year Total Assisted Total Assisted 2001 1,200,000 2002 665,200 753,300 2003 184,300 2004 159,500 27,400 2005 143,000 17,000 8,600 2006 129,300 129,300 10,400 10,400 2007 153,700 153,700 8,000 8,000 2008 230,700 230,700 6,500 4,000 Total 2,865,700 513,700 822,600 31,000 Source: UNHCR Global Reports, 2001-2008 Of the current IDPs (235,000) the UNHCR identifies 132,000 as a protracted caseload (2008). Table 4 shows the reasons for displacement of the current IDP population. These numbers do not include those who are invisible IDPs or urban unidentified IDPs. UNHCR estimates that the actual number of IDPs in Afghanistan is substantially larger than the numbers suggest (2008, p. 18). Table 4: Reason for Displacement of Current IDPs (2008) Reason for Displacement No. of Families No. of Individuals Protracted 31,501 166,153 New Drought affected 1,083 6,598 New Conflict Affected 1,749 9,901 Returnees in Displacement 8,737 52,422 Battle-affected 127 759 Total 43,197 235,833 Source: UNHCR, 2008 Since 2007 the return of IDPs has continued to decrease due to increased instability in the country, drought, landlessness, and the spread of conflict and insurgency areas (IDMC, 2008). Disputes are arising between IDPs and locals as in Afghan culture if you are not born in the region you do not belong there (IDMC, 2008). Options for IDPs appear to be limited as they are not welcomed in the regions where they are seeking protection. Rural to Urban Migration Urbanization is rapidly occurring in Afghanistan as returnees settle in the cities and people migrate from rural communities to urban centres. Approximately 30 percent of returnees settle in Kabul (Stigter, 2006). The population of Kabul in 2001 was roughly 500,000 and it had grown to over 3 million by 2007 (IRIN, 2007). The urban centres do not have the infrastructure or resources to meet the needs of the large inflows of migrants, however, research suggest that the difficult situations in the cities are better than rural areas. In 2005 the Afghanistan Research and Evaluation Unit conducted a study on rural to urban migration (Opel, 2005). A total of 500 migrants were interviewed in the cities of Kabul, Herat, and Jalalabad. The majority of migrants were male (89 percent) and the average age of migrants was 31 years (p. 4). Males tend to migrate to support their families, and females migrate when they have lost their husbands or have been ostracized by their community and have no means of supporting themselves in rural areas. The majority did not own productive assets in their village (71.2 percent), although 43 percent owned a house in their village (p. 8). The primary reasons for migration were the lack or work in the village and better opportunities in town (42%), followed by lack of work in the village (38.2%) and insecurity (16.3%) (p. 11). The majority of migrants made the journey on their own (70.7%) and paid for the journey from their savings (p.14). Migration to urban areas is expensive and the poor est of the poor cannot afford the journey. Once in the cities, the majority were employed in low skilled day labour work and on average respondents reported working 16 out of the past 30 days (p. 20). Social networks were essential in people finding work as 89 percent of skilled workers and 60 percent of unskilled workers reported receiving assistance from a relative, friend or neighbour (p. 20). Incomes in the cities were low, but were higher than what individuals could earn in the rural areas. The majority of urban migrants remitted money to their family in rural areas, which they carried with them when they returned or sent through family or friends. None of the urban migrants use the Hawala (see Chapter 6) system, which was reported to be too expensive for them. The majority of migrants reported planning to settle in the city (55%) (p. 26). Overall, the majority did improve their economic situation through migration (61.9% for males and 80.9% for females) (p. 27). The large-scale migration to urban centers appears to be a trend that will continue. It is estimated that urban centers are now accounting for 30 percent of the population in Afghanistan (Opel, 2005). The rapid urbanization has shifted rural poverty to urban poverty (Stigter, 2006) and many challenges remain for the cities in managing the rapid growth. National Trafficking In 2003 the IOM in Afghanistan conducted a study on trafficking of Afghan women and children. Research on trafficking in Afghanistan is difficult due to the lack of data inherent in all areas of Afghanistan, but increasingly so due to the fear of reporting trafficking related crimes and the shame associated with such