Any work

I donot know how the blackboard-cleaning is related to â€Å"Rajiv Gandhi Vidyutikaran YoJana†? If automatic cleaner needs electricity,then it will be more proolematic to implement throughout India. My data related to blackboards includes all schools(private and govt. )in rural and urban India. ‘ can substantiate my conclusion with different surveys and datas prepared by govt. and non-govt. agencies that still in rural area more than half of the schools have negligible basic infrastructure.As far s Mid-day meal scheme is concerned I have worked on this in 23 blocks. ‘ know what type of food-grain comes for the food and how officials and department of education works on this? My NGO has also done survey regarding basic infrastructural facilities in government primary schools in seven districts. MOre than 40% of the schools showing different infrastructural facilities on the goverment-paper is false. Few government schools are even running on the paper only. I am not sayiing that Blackboard cleaner would not improve the situation.But,it can be used only if there will be a blackboard. If you will allow me,then I will present the datas of Planning Commission,Department of HRD(Govt. of India) and different state governments. You are lucky that you found Blackboard in the village during field- work. And,also please keep onething in mind that we were sent to those villages,where we can reach by easy transportation mode. But,there are thousands of villages in India,where even district administration and police cannot access in any extraordinary situations. hools,blackboards and other infrastuctural facilities are remote things for those villages. I appreciate your imagination for planning to adopt one BPL family by one tax-payer and Blackboard cleaner†¦ but,these poetic imagination has extreme limitations†¦.. There are other basic needs of the infrastructure which should be addressed before thinking of automatic blackboard. May be there cou ld be alternates like running the school in shifts if the class strength is large in number. People of village can be encouraged to get together and ask thePanchayat to talk at higher level to run the school in shifts in their village. As mentioned before, electricity and maintenance problem of automatic blackboard will be an issue in villages where electricity is not there. we may need automatic blackboards in schools in rural areas but before that dont you think that their are more critical and important issues like teacher students ratio,poor quality of education and reducing high dropout rates to be addressed†¦.. Anshul sood p30003 any work By dhageas

“Gender Inequality Exists to Some Extent, in Most Areas of Society, in All Countries of the World”. Geographically Examine This Statement.

â€Å"Gender inequality exists to some extent, in most areas of society, in all countries of the world†. Geographically examine this statement. Gender inequality refers to unequal treatment or perceptions of individuals based on the gender. It arises from differences in socially constructed gender roles, behaviors, and activities and attributes that a given society deems appropriate for men and women. For two years Iceland is the number one country for gender equality followed by Norway in second, Finland third and Sweden fifth – showing that the Nordic countries are the best for gender equality.The gender equality gap is measured by looking at politics, education, employment and health. According to recent studies the highest representation of women in parliament was in Europe, in which 20. 56% of parliamentary people were female, and the lowest Oceania in which 7. 5% of parliamentary people were women. Women’s political empowerment is very important, and small loans can help improve it. More power means an increase in confidence to change and challenge gender relations. Economically it will mean women have increased access to markets, and increased control over income, assests and resources within the home.Kuwait is an example of a country trying to solve gender inequality issues and increase women’s empowerment politically, socially, and economically. Women in Kuwait have been given the right to run in local and governmental elections, as well as vote in elections. Sub-Saharan Africa is another area in which women’s empowerment is being promoted. This time through giving women mobile phones to help improve their lives slightly. Statistics show that within Sub-Saharan Africa 300 million fewer men than women have mobiles. So the plan was to issue 150 million mobiles to women across the region.It is thought that mobiles can help with literacy, health programs and project awareness, developing small businesses, and gaining fina ncial independence. Education is also another area in which gender inequality is trying to be beaten. By improving women’s educations statistics show that Fertility rates and Infant and child mortality numbers will decrease, while women’s labour force and women’s children going to school will increase. Gender inequality in education correlates with ethnicity and religion, domestic responsibilities, cultural restrictions and less economic power.Examples of gender inequality within education are in Pakistan and Yemen. In Pakistan the Taliban was restricting women’s education. 125,000 girls have had to abandon their education after 180 schools were torched and 900 school closed down. Taliban are brutal, they behead, assassinate political figures and destroy homes. A recent example might be the fourteen-year-old Malala who was shot in the head by the Taliban on her way home from school because she was trying to promote women’s rights. In Yemen being th e lowest global rating of gender inequality means they’re heavily investing in this sector.The International Development Association (IDA) are working to increase access to and the quality of education, as well as promoting it to women nationally. They’re encouraging female teachers, which will increase ‘social acceptance’. 1000 new female teachers were introduced in 2008 alone, and they successfully attracted girls to schools. As well as 100- new female teachers, 4000 classrooms and 200 schools were built, and 80 of the original schools were repaired. All of these efforts have worked, as the illiteracy rate has halved from 90% in 1999 to 45% in 2009!Other areas in which gender inequality exists are within culture and government, migration, health, employment, birth ratios and legal rights and land ownership. Not all countries with gender inequality issues are third world countries. Infact, some are the most developed. Places like China, Switzerland and Th e United Kingdom all suffer from gender inequality. This might show that gender inequality does exist to some extent in all countries of the world, not just less developed countries because they don’t have the money to over come the problem. China’s a very good example of the birth ratios gender inequality issue.It is estimated there that men will outnumber women by 30 million by 2020. And in 2005, china’s birth rate was 119 males to every 100 females, in some provinces it went up to 140 males. According to feminist writers in China, it is because Chinese people would rather have a son, as they’re considered more useful, they also say that son preference is seen as blunt gender discrimination. Overall it’s common for one to think that the statement â€Å"Gender inequality exists to some extent, in most areas of society, in all countries of the world† is very much true.All the evidence points towards geographically spread gender inequality wo rldwide, not just certain countries in which one might assume to suffer from gender inequality. Yemen, Ethiopia, Kuwait and Sub-Saharan Africa are all strong examples of less economically developed countries suffering from gender inequality, and UK, Switzerland and China more economically developed countries also suffering from gender inequality – however all are affected by politics, education, employment and health.

Implications of ignored behavioral problems Assignment

Implications of ignored behavioral problems - Assignment Example Teachers get frustrated when all their teaching efforts get countered by these ignored, unsolved behavioral problems. In some extreme cases some teachers simply lose interest in making things right. This occurs as a result of lose of morale, and gets depicted by the quality of teaching services offered which is likely to be poor. They often fail to take an interest in the character details of their students. Before one knows it, the students’ unruly behavior has spiraled out of control. Problematic character is not conducive in any educational setting and hinders effective learning and teaching (Jenson, 2002). Both teachers and parents are charged with the responsibility of guiding students’ behavior. When in school, teachers get expected to outline to the students what gets viewed as appropriate and inappropriate character. However, when the students are at home, their parents get expected to maintain the same standards of behavior upheld in the schools. Persistent behavioral problems create tension between teachers, parents and the administration. The blame game that is usually involved is the manifestation of the tension. Tension between education stakeholders also affects the education environment (Jenson, 2002). Ignoring behavioral problems will more often than not lead to the progression into fully blown negative traits that inform moral decadence (Jenson, 2002). A look into the character of people who get considered as harmful to society usually reveals traces of behavioral problems in early life stages that went

Why is child obesity on the rise Research Paper

Why is child obesity on the rise - Research Paper Example BMI is a measurement that compares a person’s weight and height. Children suffering from obesity experience medical and psychological effects. Children suffering from obesity are more likely to suffer from type II diabetes, heart diseases, sleep apnea, pancreatic complications, asthma and liver problems. Obese children may suffer from depression, low self esteem and emotional eating. Medical and psychological problems may interfere with academic progress as well as successful transition of children from childhood to adulthood. Furthermore, parents or guardians of obese children spent a lot of money to treat illness associated with obesity. It is because of the above reasons that World Health Organization has declared obesity as a public health global epidemic that must be contained. The number of children suffering from obesity in Central Valley of California is increasing. According to the research conducted by The Central Valley Health Policy Institute at California State Un iversity, obesity in the valley is higher than average obesity rates in the whole of California. The prevalence rate of children suffering from obesity in Central valley has more than tripled in the recent times. According to Rivera (2005), Central Valley has the highest percentage of overweight children at 42 percent. Increased rates of obesity in the Central Valley is attributed to higher levels of poverty, limited access to healthy food and reduced opportunities for physical activities. There are various interventions that have been made by schools, department of health and community based organization to reduce the incidence of obesity in children. The interventions include increased provision of vegetables and fruits as well as increased physical activities in children among others. These interventions must be increased in scope and intensity to be more effective to reduce psychological, medical and economic challenges that will interfere with children, parents and community at large. 2.0 Historical Context World Health Organization claimed that obesity is leading cause of preventable death as well as disability globally. Obesity is also linked with increasing number of chronic diseases. Obesity was rare before twentieth century. World Health organization recognized obesity as a global epidemic in 1997. In 2005, World Health Organization estimated that about four hundred million adults were obese. This is about 9.8 percent of the global adult population. Obesity rates increases as people get older. Obesity rates are severe with people above fifty years in the United States, Canada and Australia. However, more children are diagnosed with obesity each passing day. Obesity is a medical condition where a child accumulates excess fats in the body. Obese children are overweight with body mass index above 30. According to WHO (2004), Body Mass Index (BMI) indicate weather a person is underweight, normal weight, overweight or obese. A child is underweight if BMI is less than 18.50, normal weight BMI is between 18.50 - 24.99, overweight BMI is 25.00 - 29.99 and obese children have BMI of 30.00 and above (refer to table 1). Obesity is a serious health issue because it causes untold suffering to the children and increases the cost of treatment. Ogden et al (20101) revealed that preschool children between two and five years suffering from obesity increased from 5 percent to 10.4 percent from 1980 to 2008.

Segment 10 and 11 Term Paper Example | Topics and Well Written Essays - 1000 words

Segment 10 and 11 - Term Paper Example On October 1802, Spain's King Charles IV signed a decree that transferred the Louisiana territory to France and the Spanish representative in New Orleans, following instructions Spanish court, canceled Americans' access to the port's warehouses. These moves angered the United States. Jefferson and Secretary of State James Madison worked to attain a feasible resolution through diplomacy, but other factions called for war, so that the U.S. could seize Mississippi and New Orleans. In January 1803, Jefferson recommended that James Monroe accompany Livingston in Paris as minister extraordinary. This would be called the Lewis and Clark Expedition. Jefferson wrote to Kentucky's governor, James Garrard, to notify him of Monroe's appointment. Monroe was to offer $10 million for the purchase of New Orleans and all, or part of, the Florida territories. If negotiations failed, Monroe was ordered to try buying New Orleans, or, at the very least, ensure American access to the Mississippi and the p ort. When Monroe got to Paris on April 12, 1803, Livingston informed him of different circumstances. Napoleon agreed with the recommendation of France's minister of finance, Francois de Barbe-Marbois, that it would be more strategic for France to sell Mississippi to the U.S., to avoid for it being seized by Britain, in the event of a future war. Soon, the U.S. purchased Louisiana from France for $0.03 per acre, or $15 million. This added around 252 million more acres to the American territory. The War of 1812 concerned the military conflict between the United States and Great Britain from 1812 to 1815. One of the main issues was Impressment, where the British could take away British sailors in American ships. Napoleon's statement in 1810 that revoked his decrees and British refusals to rescind their orders increased the pressures for the U.S. to go to war. On June 18, 1812, President James Madison approved a declaration of war that Congress passed at his request, although not withou t significant opposition. The Treaty of Ghent ended the War of 1812, but it did not resolve the fundamental issues that stimulated the war. The Treaty states that â€Å"all territory, places and possessions whatsoever, taken by either party from the other during the war† would be reinstated, as they were before the war. No one gained anything and Impressment was not duly addressed. Synopsis of Monroe Doctrine President James Monroe delivered a speech on December 2, 1823 that included the Monroe Doctrine. In his message to Congress, Monroe provided a set of principles of the Monroe Doctrine: 1) The Western Hemisphere can no longer be colonized; 2) The political system of the Americas differs from Europe; 3) The United States will consider all intrusions in Western hemispheric affairs as a danger to its security; and 4) The United States will cease from participating in European wars and would not agitate European colonies in the Western Hemisphere. What was Monroe trying to ac hieve with his Monroe Doctrine? Monroe wanted to deal with potential threats to the U.S., specifically that which comes from the interests of European powers in colonizing territories in the New World and to ensure that diplomacy is used first before engaging in any war against other nations. SEGMENT 11 Summary The Industrial Revolution began in Great Britain, during the 18th century. In the U.S., the industrial revolution started in the nineteenth century. During this time, the

Globalization Essay Example | Topics and Well Written Essays - 750 words - 8

Globalization - Essay Example This essay is a critique of the major driver towards globalization. It offers an explanation of how information and communication technology has contributed greatly to globalization above all the other factors, and how the contemporary society is so much focused towards moving beyond personal and national boundaries to create a link between them and other communities internationally. It mainly focuses on the technological, economic and political drivers towards globalization. The major economic factor that has contributed to globalization is technological advancement. Development in information and communication technology has to a great extent contributed to the integration of communities sharing of information as well as business world wide. For example, the use of internet enables people from all over the world to conduct business and share ideas without meeting. Social interactions through the internet have further contributed to globalization since people can share information cheaply and debate over issues regarding trade (Nye 2002). Dealing through information technology systems is one of the economic segments that have responded positively to advancement in trade. Innovation in communication technology has facilitated economic advancement especially due to the enhancement of the capability of companies to employ labor force from beyond political boundaries. It has led to division of labor globally through the establishment of multinational compan ies (Giddens 2006). They can advertise employment opportunities through the internet, and they can be able to reach people all over the world. Business is also leading people to move global in order to utilize the opportunities in the global market to sell their products. Many of the less developed nations have realized that technological advancement can not be separated from

A trend of festival-style events within hospitality industry Term Paper

A trend of festival-style events within hospitality industry - Term Paper Example Church (2013) states that any people have embraced events refreshing in order to continue appealing to the audience and adapt to the emerging festival-style events. There are four main reasons for this move, firstly, there is a shift of events from infotainment and edutainment to "idea-tainment". Its implication to the event management is overt, there should be a move from boring conference speech to the multiplicity of activities. Moreover, creation of crowd sourced ideas is instrumental in enriching events. Secondly, there is a shift from events monologue to dialogue, meaning the audience involvement is the pillar of successful events. With the need for a dialogue approach to the event succeeds, majority of hospitality-skilled event managers have opted for festival-style events (Drake 2013). Thirdly, there is a growing phenomenon in event designs that encourages the use of user-generated ideas. A new generation of people has digital access to polylogues and, as a result, the new ideas are no longer discussed top-down but rather at horizontal platform (Kim et al,. 2013). With innovative and informed audience, the place of the monologue lecture has no place. Festival-style events allow freestyle sharing of entertainment and important event activities. Lastly, there is a lot of information that can be shared in any event, and the traditional lecture approach would not allow for maximum sharing of information. With festival-style events, it allows small buzz groups that are nested within the event entertainment spree. The opportunity provided by this new strategy allows for maximum interaction during and after event. In addition, it keeps the formal event sandwiched within the long list of agenda thus allowing for change from the formal to a free-style event. Mair & Whitfold (2013) states that event management does not belong to the faint hearted; it requires resilience and

Foundations of Finance and Investment Essay Example | Topics and Well Written Essays - 1500 words

Foundations of Finance and Investment - Essay Example This paper would go to analyse the Impact on UK exchange rate against US$ over last five years due to recent MPC's 1 cut on interest rate. The pragmatic correlation among money, real output and interest rates has been attributed significantly with business cycle, monetary transmission mechanism, aggregate money demand and identification of monetary policy rules. There is no accords of interest rate to which should be included as an empirical models for exchange rate To providing the analyse the interdependency of Interest rate and Exchange rate, Fisher definition would not be relevant to economic analysis. So this paper would follow Keynes and other post-Keynesians notion of real rate and exchange rate. Smithin, J. (2003) mentioned that regulating interest rates for exchange rate cannot guard the purchasing power and it is quite unfeasible to do at the macroeconomic level. There is an empirical evidence of the break in the relationship between interest rates, exchange rate and inflation ever since 1953. The present analysis of UK interest rate cut and impact on US$ are relevant to specifying the monetary policy system pursued by the two monetary authorities. This paper assumes that the monetary authority regulates the short-term ostensible interest rate. According to classical Taylor theory the instrument is set to act in response to domestic inflation as well as output gap. On the other hand in open-economy model specificities more controversial reasoning the set of variables in the direction of which monetary policy can react is superior. The present strategy is to discover the consequences for the equilibrium allotment of simple rules, which lead to equilibrium that can be worked out analytically to understanding the transmission mechanism under open economies. The analyse go with three regimes and label as: - a) a fixed exchange rate; b) a floating exchange rate c) a managed exchange rate, Theoretical Aspect of Interest Rate First level let consider the rules that establish a fixed nominal exchange rate. Pigeon, M. A. (2004) added that it would demonstrate that in principle numerous fixed exchange rate regimes subsist on the specification of the fundamental rules. Thus a floating regime that is defined as a command in which the interest rates in both countries don't respond explicitly to the exchange rate. It would be characterised as where & is non-negative; here its combination of rules as floating command . These rules have been broadly used in the closed-economy literature. Most of the policymaker reacts to precedent movements in the interest rate, present household producer inflation rate and output gap. According to classical Taylor rules, the coefficients and are zeros.2 Benigno, G, & Benigno, P. (2006) argued within the floating-exchange regime, we consider also rules in which the reaction is toward the domestic

Experimental Study Essay Example | Topics and Well Written Essays - 500 words

Experimental Study - Essay Example Initially, participant clinics, instead of individual participants, were recruited based on the following inclusion criteria: (1) willingness to participate in the study; (2) the number of patients; and (3) similarity of clinical routines. During this stage, there were a total of 179 patients in all the clinics being considered. The following exclusion criteria were adopted in the selection of individual participants for both groups: (1) duration of diabetes of less than 6 months; (2) mental retardation; (3) lack of fluency in the Dutch language. Only eight patients were excluded, but 80 patients refused to participate. After the baseline data have been obtained, 2 clinics were allocated for monitoring intervention and 2 clinics were allocated to control group. Informed consent was administered among patients willing to participate in the research study. The initial sample size is 46 patients for the intervention group and 45 patients for the control group. Data collection at baseline was not discussed in detail in this study, but in the related study with the same set of authors (De wit, et al., 2007).   All patients and their parents were administered a booklet containing questions regarding demographic information and questions to assess their physical and psychosocial well-being which were to be answered at home and returned by mail or submitted to the clinic during one of their routine appointments. Most recent glycosylated hemoglobin (HbA1c)  and treatment regimen were recorded form the patients’ charts. Physical and psychosocial well-being  of the patients was measured using the 87-item child report version of the Child Health Questionnaire (CHQ-CF87), while their parents completed the CHQ-PF50 equivalent to the CHQ-CF87. Depression, as part of the psychosocial well-being of the patients was assessed using the 20-item Centre for Epidemiological Studies Scale for Depression (CES-D)  for both patients and their

The way Greeks and Romans understood women Essay Example for Free

The way Greeks and Romans understood women Essay In the Ancient World, women were not portrayed as they are today in modern literary works; women usually played controversial roles where their actions ranged from killing their own family to destroying their own town. Women in ancient Greek plays and Roman stories did not posses the social standing that we naturally think of today, many times their only power was to strike back when they were hurt. Medea, Phaedra, and Dido, admirable or dangerous, are among the most complex literary characters of any period. Medea, of Euripides play Medea, represents the destructive quality of possessive desire often portrayed by Greek women. Medea becomes enraged by Jason when he leaves her to be with the daughter of the King of Corinth. She reacts by destroying everything around him. She destroys his new wife, her father the King, and even goes as far as to kill her own two children she had with Jason in order to hurt him. Medea rationalizes her actions by saying if she cannot have Jason, the thing she wants the most in life, then he cannot have the things that matter the most to him in his life. Medea illustrates her nature of possessive desire for Jason with the line, At last I understand that awful deed I am to do; but passion, that cause of direst woes to mortal man, hath triumphed oer my sober thoughts (Euripides 104). From this you can see that Medea is only concerned with herself and her desires as opposed to her famil; she kills her own children to hurt her husband. Like Medea, Euripides writes another play Hippolytous, with a similar character named Phaedra. Phaedra is the wife of Theseus that has become obsessed by an incestuous passion for her stepson, Hippolytus. Phaedra attempts to win over Hippolytus in a love letter. Hippolytus, however, is a follower of Diana, the goddess of chastity and therefore refuses her. Phaedras distraught revenge includes her suicide and his succeeding, undeserved death by his father. In this case, like Medea, Phaedra could not possess her alleged good, her life and his must be sacrifice. Yet another example of this misplaced desire is in Virgils Aeneid with the character of Dido. In Aeneid, Aeneas is persuaded to leave his fate to found Rome and stay with his new found love, Queen Dido of Carthage. By the  intervention of the gods, Hermes and Jove, Aeneas is able to resist Dido and does not marry her but does in fact go on to found Rome. Once again this possessive quality is aptly shown by Hermes, Degenerate man,/Thou womans property (Virgil 166). Dido verifies this and pleas with Aeneas,  had you deferrd, at least, your hasty flight,/And left behind some pledge of our delight,/Some babe to bless the mothers mournful sight,/Some young Aeneas, to supply your place,/Whose features might express his fathers face;/I should no then complain to be left bereft/Of all my husband, or be wholly left (Virgil 168). Obviously Didos love is not actually true love since she is willing to compromise for an alternate Aeneas, whom she will be able to possess more fully be raise him to her satisfaction. Aeneas refuses Dido this as well and she, like Pheadra, burns herself. But as her sister mourns, she points out that Didos death was not a solitary destruction; At one thou hast destroyd thyself and me,/Thy town. Thy senate, and thy colony (Virgil 818)! By destroying her own town, something that she devoted a lot of her life to, she hurt many more people than just herself and Aeneas. In these three works, Medea, Hippolytus, and Aeneid, the female roles defiantly had an agenda. The women were all overwhelmed by love and were blinded by it. Medea, Phadrea, and Dido committed unthinkable crimes in an attempt to cast revenge on the object of their affection. In the end, none of them possessed the man they were longing for, they only ended up hurting themselves and those that supposedly meant the most to them.

Achieving Access to Healthcare for All Americans

Achieving Access to Healthcare for All Americans Introduction/Background Access to healthcare is one of the major issues facing Americans today. The United States is considered by many to be the greatest nation in the world with great wealth and opportunity for its citizens. However, despite many Americans having access to our advance healthcare system and technology, a significant percentage of our citizens face barriers that prevent them from obtaining basic healthcare services. The problem we face as Americans is our lack of free healthcare for all citizens, as compared to other countries such as Canada who do implement free healthcare to all of its citizens. There are many reasons people do not have access to healthcare. High healthcare costs are still a primary cause for Americans not being able to get the medical attention they need. The most common reason is because people cant afford to purchase health insurance that would allow them to get in to see a doctor. Health insurance can be hard to obtain depending where you are on the socioeconomic ladd er. The Affordable Care Act, which is sometimes referred to as Obamacare, was supposed to fix this problem by creating an insurance system that would allow everyone to afford health insurance regardless of their income. Obamacare is a United States law that reformed both the healthcare and health insurance industries in America. This did help and the latest statistics in 2016 showed that the number of uninsured has decreased from 18% to 13% (Obamacarefacts, 2016). This has not solved the problem completely and there is a lot of concern about the continued high cost of healthcare and the fact that many still dont have access. At some point in their lives, everyone will need health care or medical treatment, but the cost of this essential service threatens our countrys economy. The cost of healthcare has taken an increasing share of the United States economy, and has been rising for many years. In 2010, the US spent 17.9 percent of the nations economy on healthcare, compared to only 7 .2 percent in 1970 and to 9.5 percent on average across 34 other developed countries (Caitlin Cowan, 2015). This article shows that increased spending does not equal higher quality. In fact, many other countries healthcare systems actually provide higher quality care at a lower cost, suggesting that we dont always need to spend more to get better care and outcomes (Caitlin Cowan, 2015). This critical issue of healthcare access has caused many citizens to demand a nationalized or government sponsored healthcare system for all Americans. Nationalized Healthcare is What All Americans Deserve Proponents of nationalized healthcare believe that instituting a national health system would lower the cost of health care in the United States.In one study, under a single-payer system, in which all citizens are guaranteed access to healthcare, total public and private healthcare spending could be lowered by $592 billion in 2014 and up to $1.8 trillion over the next decade by lowering administrative and prescription drug costs (Friedman, 2013). In a study in the American Journal of Public Health, Canada, who provides universal access to healthcare, spends half as much per capita on health care as the United States (Lasser, Himmelstein Woolhandler, 2009). With nationalized healthcare, we could develop a centralized national database which makes diagnosis and treatment easier for doctors and avoids separate record-keeping systems between doctors and different hospitals. It would eliminate wasteful inefficiencies such as duplicate paper work, claim approval, insurance submission, etc . because there would not be a need for maintaining insurance information or wasting time submitting claims. The savings in the duplicate records, banking and postal areas alone would be worth significant annual savings estimated in the Billion dollar range (Backman, Hunt, Khosla, 2008). Nationalized healthcare would save lives.In a 2009 study from Harvard, lack of health insurance is associated with as many as 44,789 deaths per year, which is a 40% increased risk of death among uninsured patients (Wilper, Woolhandler, Lasser, McCormick, 2009, p. 2290). In many countries with complete access to healthcare such as Italy, Spain, France, and Norway, people live two to three years longer than people in the United States (Morgan, 2013). Access to free medical services would encourage patients to practice preventive medicine and inquire about problems early before treatment gets severe. Currently, patients often avoid physicals and other preventive measures because of the unaffordable costs. This behavior not only affects the health of the patient but the overall cost to the system, since preventive medicine costs only a fraction of a full blown illness (Lesser et al., 2006). A government-provided system would remove the deterrent patients have for visiting a medical prof essional. Proponents of nationalized healthcare are also quick to point out that good health is a right that all humans deserve. In fact, many believe that in a country as economically and culturally advanced as the United States, it is an embarrassment that we dont provide this basic service to our citizens. Many European countries with a universal right to health care have a lower Gross Domestic Product (GDP) per capita than the United States, but still provide a right to health care for all their citizens (Backman et al., 2008). Interestingly, in 2005 the United States along with other member states of the World Health Organization signed World Health Assembly Resolution 58.33, which stated that everyone should have access to health care services and should not suffer financial hardship when obtaining these services (United Nations, 2005). Nationalized Healthcare is Bad for America Opponents of nationalized healthcare believe that it would bring on economic disaster for the United States because of the increased cost of healthcare. Medicare, Medicaid, and the Childrens Health Insurance Program are government programs that provide a right to healthcare for certain segments of the population. These programs totaled less than 10% of the federal budget in 1985, but by 2012 took up 21% of the federal budget (Korobkin, 2014). Opponents are quick to point out the waste, excess expense and complexities of other government run agencies. As an example of their beliefs, when the United States Government issued a simplified tax guide several years back, it was over 1000 pages long (Kamarack, 2013). Also, the millions of dollars in waste seen in the Pentagon, Postal Service or Department of Motor Vehicles should make any American skeptical that the government could manage healthcare efficiently or effectively. Nationalized healthcare could increase the wait time and rationing for medical services. Medicaid is an example of a federally funded single-payer health care system that provides access to health care for low-income people. In a 2012 Government Accountability Office report, 9.4% of Medicaid beneficiaries had difficulty obtaining required care due to long wait times compared to only 4.2% of people with private health insurance (United States Government Accountability Office, 2012). Countries with a universal right to healthcare have longer wait times than the United States. In 2013 the average wait time to see a specialist in Canada was nearly 9 weeks but only 18.5 days in the United States (Backman et al., 2008, p. 2055). In addition to the wait to receive healthcare, the government would decide what medical care a citizen deserves. Many countries with universal health care such as Australia, Canada, New Zealand, and the United Kingdom, all ration health care using methods such as b udgeting, price setting, and service restrictions (Hoffman, 2013). In this article, the United Kingdoms National Health Service rations health care using a cost-benefit analysis. For example, in 2008 if a drug provided an extra six months of good-quality life and cost less than $15,000, it was automatically approved, while one that costs more would not (Hoffman, 2013). This takes away a persons right to choose what is best for them. Providing a right to health care could raise taxes for all Americans. In European countries with a universal right to health care, the cost of coverage is paid through higher taxes. In the United Kingdom and other European countries, payroll taxes average 37%, which is much higher than the 15.3% payroll taxes paid by an average US worker (Gregory, 2013). According to Gregory, a Research Fellow at the Hoover Institution, financing a universal right to health care in the United States would cause payroll taxes to double. There is a belief that our country has an entitlement mentality and believes that the government should pay for many services including healthcare. However, since nothing is free we would have to increase taxes to pay for this additional service. When people are provided with universal health care and are not directly responsible for the costs of medical services, they might utilize more health resources than necessary. According to a 2014 study published in Science, 10,000 uninsured Portland, Oregon residents who gained access to Medicaid had 40% more visits to emergency rooms, even though they already had guaranteed access to emergency treatment under federal law (Taubman, Allen, Wright, Baicker, Finkelstein, 2014). Since Medicaid provides access to health care for low-income individuals, expanding this to the full US population could worsen the problem of overusing health care resources. Opponents of nationalized healthcare do not believe the founding documents of the United States provide support for a right to health care. The Declaration of Independence does not guarantee a right to health care. The purpose of the US Constitution, as stated in the Preamble, is to promote the general welfare, not to provide for it. This belief is that one may have a right to life, liberty and the pursuit of happiness but not to services such as health care (Maruthappu, Ologunde. Gunarajasingam, 2013). Assessments of Different Arguments The issue of healthcare costs in a national healthcare system seem to be best supported by proponents that show reduction in overall costs when they centralize administrative overhead and duplication of paperwork that occurs now between doctors, hospitals and insurance or government payers. The argument that opponents make referencing governmental waste in other programs seems like more of a scare technique than something that would definitely happen with nationalized healthcare. In fact, providing the security of access to healthcare has been shown to increase spending on consumer goods and to promote employees upward mobility to new jobs without the fear of having to maintain health insurance coverage (Gruber, 2009). It would also expand the medical sector to meet the newly covered individuals which would create new and high quality jobs. These would drive economic growth overall. In addition, any rationing of healthcare like that seen in other countries with universal healthcare, would likely reduce costs significantly. It does make sense that increasing the number of individuals by achieving access to healthcare could increase overall costs leading to increase in taxes. However, the thought is that the overall expense reduction by avoiding duplication of services, allowing preventative healthcare to drive down cost of serious illnesses, rationing of health services and increase in economic factors by expanding the healthcare market, would still make this overall a financially positive situation. When analyzing the different opinions for a National healthcare system, there are several factors that make one more supportive of the opponents viewpoint. It is likely that there would be some component of rationing of healthcare services. In most countries with universal healthcare, there is a formula that evaluates the financial costs of a treatment vs. the likelihood of it prolonging life or quality of life. This would change current practice where patients receive less expensive end of life services and might not get surgical procedures as quickly. It would limit the ability for a patient and their Doctor to be the decision maker for all treatment options. There is also a belief by many in the medical community that it would decrease patients options for choosing a provider as less physicians would go into medicine (Fleming, 2006). Finally, there is a significant disagreement between proponents and opponents of nationalized healthcare over whether access to healthcare is a right per our founding fathers or a service that our Government has no obligation to provide. This issue really comes down to semantics and how one chooses to define promotion of general warfare as including health to its citizens. Not surprisingly, proponents or opponents choose to interpret based solely on their desire to support their own argument. Conclusion Access to healthcare can be hard to obtain depending where you are on the socioeconomic ladder. Health insurance is supposed to protect Americans from very high healthcare costs. We have just completed 8 years of President Obama attempting to increase access to healthcare. During his initial campaign promises, he vowed to bring healthcare to all Americans and seemed to be a proponent of Universal Healthcare. His trademark legislation, Obamacare, did increase the number of insured persons but it did not accomplish coverage for all. Now, with the recent Trump election, there is a yet to be understood plan that is supposed to repeal Obamacare and replace it with something that will more effectively provide healthcare coverage to all Americans. This is likely to move away from the idea of government sponsored, nationalized coverage and instead have a significant portion that utilizes private or public non-governmental companies to accomplish their goal. This is an uncertain time for many Americans regarding their access to healthcare. The idea of a nationalized healthcare system for all Americans has been a major issue for many years and continues today. Exploring the many different issues involved with nationalized healthcare provides a clearer understanding of how complicated this issue is with many different viewpoints on both sides. I believe that we cannot continue to allow healthcare costs to increase at their current rate and that as a country, we must provide healthcare to all of our citizens regardless if it is a right or a service. Despite the advantages of a national healthcare system, I do not believe most Americans are willing to limit their access to physicians or their access to the very best treatment options. Ultimately, I believe a combination of government sponsored and private healthcare will be the best option moving forward. Unlike the current situation, I do believe it will require some form of expansion of government healthcare that does have a component of treatment rationing. There will also need to be a private insurance option and for profit companies in the healthcare environment that provide for the heal thcare options that many Americans will demand. As is often the case, the approach of an all or nothing nationalized healthcare system will not work and compromise will be needed. It will require politicians and different factions to compromise on this issue and put aside bipartisan emotions to create a plan that will accomplish healthcare coverage for all Americans. References Backman G., Hunt P., Khosla R., Jaramillo-Strouss C., Fikre B.M., Rumble C. (2008). Health Systems and the Right to Health: An Assessment of 194 Countries. The Lancet, 372, 2047-85. Catlin, A.C., Cowan, C.A., (2015). History of Health Spending in the United States, 1960-2013. Retrieved January 30, 2017 from http://www.cms.gov-Statistics-Data-and- Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ HistoricalNHEPaper.pdf Dartmouthatlas.org. (2016). The Dartmouth Atlas of Health Care. Retrieved January 31, 2017 from http://www.dartmouthatlas.org/keyissues/issue.aspx? con=1338 Fleming, K.C. (2006). High-Priced Pain: What to Expect from a Single-Payer Health Care System. Retrieved January 31, 2017 from http://www.heritage.org Friedman, G. (2013). Funding HR 676: The Expanded and Improved Medicaid for All Act. Retrieved January 31, 2017 from http://www.pnhp.org Government Accountability Office (2012). Medicaid: States Made Multiple Program Changes, and Beneficiaries Generally Reported Access Comparable to Private Insurance. Retrieved January 31, 2017 from http://www.gao.gov Gregory, P. R. (2013). Obamacare a Mess? Liberals Say Go Single Payer. Retrieved January 31, 2017 from http://www.forbes.com Gruber J, (2009). Universal Health Insurance Coverage or Economic Relief A False Choice. New England Journal of Medicine, 360, 437-439. Hoffman, B. (2013). Health Care Rationing Is Nothing New. Retrieved January 31, 2017 from http://www.scientificamerican.com Kamarack, E. (2013). Lessons for the Future of Government Reform. Retrieved on January 30, 2017 from https://www.brookings.edu/lessons for the future of government reform Korobkin, R. (2014). Comparative Effectiveness Research as Choice Architecture: The Behavioral Law and Economics Solution to the Health Care Cost Crisis. Michigan Law Review, 112(4): 523-74. Lasser, K.E., Himmelstein, D., Wollhandler, S. (2006). Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Study. American Journal of Public Health, 96, 1-8. Maruthappu M., Ologunde R., Gunarajasingam A. (2013). Is Health Care a Right? Health Reforms in the USA and their Impact Upon the Concept of Care. Annals of Medicine and Surgery, 2 (1), 15-17. Morgan, K. J. (2016). Americas Misguided Approach to Social Welfare. Retrieved January 31, 2017 from http://www.foreignaffaris.com Obamacarefacts.org. (2017). Obamacare: Uninsured Rates. Retrieved January 31, 2017 from http://obamacarefacts.com/uninsured-rates ProCon.org. (2016). ProCon.org Pros and Cons of Controversial Issues. Retrieved February 1, 2017 from http://www.procon.org/ Taubman, S. L., Allen, H. L., Wright, B. J., Baicker, K., Finkelstein, A. N. (2014). Medicaid Increases Emergency-Department Use: Evidence from Oregons Health Insurance Experiment. Science, 343(6168), 263-268. United Nations.org. (2005). United Nations, The Universal Declaration of Human Rights, Retrieved February 1, 2017 from http://www.un.org Wilper, A. P. Steffie Woolhandler, S., Lasser, K.E. Danny McCormick, D. (2009). Health Insurance and Mortality in US Adults, American Journal of Public Health,99(12), 2289-95.

Earth Abides Essay -- essays research papers

Imagine waking up and looking around, only to realize that while you were asleep ninety percent of the world population had vanished. In the novel Earth Abides, George Stewart creates this scenario and makes it a reality. The novel is centered on the life of Ish, who wakes up only to find he is one of the few left on earth. Having to survive and adapt, Ish is faced with the responsibility of making contact with other survivors of the Great Disaster. In doing so, Ish meets several characters and together they form a tribe to fit the new lifestyle. Ish becomes the leader of the group and the main focus of the story; however, he is not the only important character. Some members of the community immerge and become important figures as well. In the novel Earth Abides, we see a tribe with only a few members, grow and develop into a community with over three hundred members. In a new world and with such hard conditions, The Tribe managed to survive successfully. This task was not easy, considering all the other people in the world who had failed. Many other survivors of the Great Disaster, killed themselves, drank their life away, and did not look for reason to live in a civilized manner. However, The Tribe overcame all of that and aimed itself in the right direction for yet another try at Mother Nature. Their success was mainly based on the fact that the members from the Old Times were able to adjust and adapt. They made use of the resources and in some way put the Great Disaster behind them. These members found their place in The Tribe and built a strong foundation for their children. Of such roles, one of the most important is that of a leader. The leader has to take charge of the group, make heavy decisions, and have knowledge and understanding of the world around him. It is the leaders' duty to prepare his people and make sure that they are able to survive and care for themselves. In the novel, we can see this in the character of Ish. From the moment Ish realized what had happened to the he had the desire to be a leader. When he met the black family in his cross-country trip and thought to himself, "I could be a king here if I remained." Later in the novel Ishs desires for leadership are even more noticeable when The Tribe first comes into contact with Charlie. Ish is the only one who feels hostility towards Charlie and act awkwardly around ... ...bers. Both groups often thought differently because of the different times they grew up in, and Ezra understood both cultures. Ish did not often understand what others were thinking, even the children who were his own. Ezra on the other hand could relate to everybody andcommunicate with The Tribe. The survival of The Tribe was dependent on each of the older generation members in some way. Ish had to lead, Ezra had to communicate and Em gave them all courage. There was also George; the repairman who fixed everything for everybody and made sure peoples homes did not fall apart. Molly, Jean, and Maurine, were all simple folks, but brought to The Tribe ideas. Just like in buildings, the foundation of a community or society is the most important part. All the other layers on top depend on the layer below them. The Tribe could not survive with out having a strong foundation to hold on to and build on top of. The older generation members set this foundation using themselves as examples. In the end, everything the Old generation members taught their children had paid off. The new generation were prepared for the future and were well aware of the world around them, they were survivors.

web dubois :: essays research papers

WEB DUBOIS WEB Dubois was born and raised in Barrington, Massachusetts. After high school and with the help of friends and family, and a scholarship he received to Fisk College (now University), he eagerly to Nashville, Tennessee to further his education. This was his first trip south. And during his stay there, his knowledge of the race problem became clearer. He saw discrimination in ways he never dreamed of, and developed a determination to expedite the emancipation of his people. Consequently, he became a writer, editor, and an impassioned orator. And in the process, acquired a belligerent attitude toward the color bar. While he was teaching an Atlanta University, Dubois wrote about and studied Negro morality and Negro urbanization. During this period a controversy grew between DuBois and Booker T. Washington, which later grew into a bitter personal battle. Washington argued the Black people should temporarily forego "political power, insistence on civil rights, and higher education of Negro youth. They should concentrate all their energies on industrial education." DuBois believed in the higher education of a "Talented Tenth" who through their knowledge of modern culture could guide the American Negro into a higher civilization. (DuBois’ Dusk of Dawn). When Dubois began to solicit help for â€Å"organized determination and aggressive action on the part of men who believe in Negro freedom and growth†, twenty-nine men from fourteen states answered the call in Buffalo, New York. Five months later in January of 1906 the "Niagara Movement" was formed. Its objectives were to advocate civil justice and abolish caste discrimination. Though they were criticized for their radicalism, this was the first significant black organized protest movement of the twentieth century. The downfall of the group was attributed to public accusations of fraud and deceit engineered presumably by Washington advocates. In 1909 most members of the Niagara Movement merged with some white liberals and thus the National Association for the Advancement of Colored People (NAACP) was born. DuBois was not altogether pleased with the group but agreed to stay on as Director of Publications and Research. He was also editor in chief of its publication â₠¬Å"the crisis for more than 20 years. He used his mighty pen to denounce racial injustice all over the country and grew more and more popular. This period marked the height of DuBois' popularity. The Crisis magazine subscription rate had grown from 1000 in 1909 to over 10,000 in May of 1919.

A critical analysis of The Great Gatsby Essay

It is all useless. It is like chasing the wind.† (Ecclesiastes 2:26). The â€Å"it† in this case, F Scott Fitzgerald’s groundbreaking novel The Great Gatsby, refers to the exhaustive efforts Gatsby undertakes in his quest for life: the life he wants to live, the so-called American Dream. The novel is Fitzgerald’s vessel of commentary and criticism of the American Dream. As he paints a vivid portrait of the Jazz Age, Fitzgerald defines this Dream, and through Gatsby’s downfall, expresses the futility and agony of its pursuit. Through Gatsby’s longing for it, he depicts its beauty and irresistible lure in a manner of which the Philosopher himself would be proud. The aspects of the American Dream are evident throughout Fitzgerald’s narrative. Take, for example, James Gatz’s heavenly, almost unbelievable rise from â€Å"beating his way along the south shore of Lake Superior as a clam-digger and a salmon-fisher† (Fitzgerald 95) to the great, i.e. excessive, Gatsby, housed in â€Å"a colossal affair by any standard†¦ with a tower on one side†¦ a marble swimming pool, and more than forty acres of lawn and garden† (Fitzgerald 11). The awe in which Fitzgerald presents his awakened phoenix clearly conveys the importance of improvement, or at least what one thinks is improvement, in the American Dream; it is not necessarily a life of excesses and wealth Fitzgerald defends as the Dream, for the audience sees clearly their detriments in the novel through Tom and Daisy, but rather a change in the style of life, reflecting the equally-American pioneering spirit. Nevertheless, wealth does certainly play an important role in the American Dream. With wealth, supposedly, comes comfort, as Nick mentions regarding his home: â€Å"I had a view of the water, a partial view of my neighbour’s lawn, and the consoling proximity of millionaires† (Fitzgerald 11). Wealth, states Ross Possnock in his quoting of Karl Marx, is the great equalizer of inequality: I am ugly, but I can buy the most beautiful woman for myself. Consequently, I am not ugly, for the effect of my ugliness, its power to repel, is annulled by money†¦ does not my money, therefore, transform all my incapacities into their opposites? (Possnock 204). Read Also:  Critical Response Essay Topics Gatsby’s incapacities, generally of an emotional nature, inhibitions preventing his successful capture of his long-lost love, Daisy, are washed away with the drunkenness provided by the dollar: However glorious might be his future as Jay Gatsby, he was a present a penniless young man without a past, and at any moment the invisible cloak of his uniform might slip from his shoulders†¦ He took what he could get, ravenously and unscrupulously – eventually he took Daisy one still October night (Fitzgerald 141). Once armed with the lucre, however, he is prepared to contribute equally to the relationship, making it truly an equal relation of love. Love represents the other side of the coin of wealth: as opposed to material wealth, it refers instead to emotional wealth. Whatever its plane of existence, love plays a pivotal role in the American Dream, in Gatsby’s Dream. Perhaps love is the most valuable of the aspects presented thus far of the Dream; â€Å"He hadn’t once ceased looking at Daisy, and I think he revalued everything in his house according to the measure of response it drew from her well-loved eyes† (Fitzgerald 88). Such is his love for her; the bootlegging Gatsby values this emotional wealth to the extent that he essentially abandons the material for just a moment, losing himself in the winds of passion stirred up by the swaying of Daisy’s dress as she inspects Gatsby’s lookout tower for the green light. His emotional wealth is so suddenly multiplied that â€Å"none of it [his possessions] was any longer real. Once he nearly toppled down a flight of stairs† (Fitzgerald 88). Sharing the same side of the coin is the need for social acceptance. Gatsby prides himself on his openness; his lavish parties where strangers â€Å"came and went without having met Gatsby at all, came for the party with a simplicity of heart that was its own ticket of admission† (Fitzgerald 43), proof of not only his tolerance, but also of his acceptance of those whose drinking make him grow â€Å"more correct as the fraternal hilarity increased† (Fitzgerald 51). Gatsby certainly wants the people on his side: from his house labeled a  Norman â€Å"Hotel de Ville,† or City Hall, open to the public, to Lucille’s replacement dress from Croirier’s, courtesy of Gatsby, no expense is too great in his quest to win others support. Gatsby needs as much popular support as he can get, in the face of such random acts of contempt as â€Å"he killed a man once† (Fitzgerald 45) to â€Å"he was a German spy during the war† (Fitzgerald 45). Improvement, wealth, love, popularity: all contribute to the definition of the American Dream. What is missing from the preceding list is, however, perhaps the most important quality of all: that the American Dream is exactly that, a mere dream. â€Å"Our eyes can never see enough to be satisfied; our ears can never hear enough† (Ecclesiastes 1:8). The key words here are â€Å"never† and â€Å"satisfied†; it is the essence of the American Dream, satisfaction. Unfortunately, the quest for satisfaction and happiness is unending, like eternally chasing one’s tail; hence the â€Å"never.† It is a vicious circle, one of many traps laid out by Fitzgerald for the sake of educating his audience of the perils of imagination. Indeed, given the thin line between the intrinsic desire for self-improvement and the waste and futility of pursuing mental illusions, and the consequences of the latter, the peril is quite extreme. Esteemed Gatsby inquisitor Marius Bewley succinctly defines the American Dream as â€Å"life on a level at which the material and the spiritual [i.e. imaginary] have become inextricably confused,† (Bewley 37) whose â€Å"blackest devils [are] limit and deprivation† (Bewley 38). Higher and higher the summit of its ideals climb, until surely and eventually the mountain becomes insurmountable for mortal man. â€Å"What has happened before will happen again. What has been done before will be done again† (Ecclesiastes 1:9). Such is Gatsby’s battle cry as he marches off on a mission to re-discover, or rather to re-implant, the passion he found years earlier in the person of Daisy: † ‘Can’t repeat the past?’ he cried incredulously. ‘Why of course you can!†¦ I’m going to fix everything just the way is was before,’ he said, nodding determinedly. ‘She’ll [Daisy] see’ † (Fitzgerald 106). So begins the heartbreaking circle which started on that selfish day â€Å"in the middle of spring with the arrival of Tom Buchanan†¦ The letter reached Gatsby while he was still at Oxford†Ã‚  (Fitzgerald 144). Just as Daisy re-enters Gatsby’s life and sets the circle moving, does she fulfill the reverse: she, in an equally shocking and abrupt manner, flees Gatsby, his eyes still scintillating in the reflection of the Dream, thus bringing this aspect full-circle and pounding in the first nail in the Dream’s coffin. The second nail to further seal the coffin is the revolving door quality of the rise and fall from rich to poor as the pocketbooks of the Dreamers lines with money, their moral character is chipped away. Once the conscience is destroyed, one can predict that as the money runs out, character returns. Proof of this circle is offered towards the end of the novel: heading back into East Egg from the city after a tense incident on a scorching summer’s day, Gatsby and Daisy spend their last moments together in the car; upon her return to East Egg, Daisy, Gatsby’s most valued possession, the standard against which â€Å"he revalued everything in his house† (Fitzgerald 88) leaves him and returns fully to Tom, thus leaving Gatsby â€Å"bankrupt.† As this decision transpires, Gatsby selflessly accepts the blame for the accident where Daisy, in control of the car, is at fault. Given the sheer number of its examples, the lack of morals in the materially-rich is indeed an element Fitzgerald wished to impress upon his audience. The lack of respect for life present in high society is demonstrated most strongly by Daisy’s relationship, or lack thereof, with her daughter, Pammy. Appearing only once or twice in the novel, Pammy’s non-existent role in the plot and Daisy’s life prove Daisy’s misplaced priorities as a mother and as a â€Å"successful† American Dreamer. Neglect becomes synonymous with high society in Chapter II; Myrtle’s Airedale, referred to simply as one of Mrs. Wilson’s â€Å"other purchases† (Fitzgerald 31), is last seen â€Å"sitting on the table with blind eyes through the smoke, and from time to time groaning faintly† (Fitzgerald 38) as â€Å"people disappeared, reappeared, made plans to go somewhere† (Fitzgerald 38). By the end of the book Pammy and the dog (Myrtle doesn’t even bother naming him)  are forgotten, victims of the American Dreamers’ quest for happiness. Daisy’s whims wreak havoc on other’s lives as she continues her quest for â€Å"happiness,† driving Gatsby’s car at supersonic speeds, plowing through Myrtle Wilson’s body†¦ and not even bothering to stop. Not only does she continue without batting an eye, Daisy allows Gatsby to essentially hang for her crimes without a simple â€Å"I’m sorry† or a token â€Å"I love you.† Tom, for his part, forgets the woman in favour of whom he cheats on Daisy. â€Å"There was an unmistakable air of natural intimacy about the picture, and anybody would have said that they were conspiring together† (Fitzgerald 138). Fitzgerald sums up his judgement of the financially-superior/morally-inferior: They were careless people†¦ they smashed up things and creatures and then retreated back into their money or their vast carelessness, or whatever it was that kept them together, and let other people clean up the mess they had made (Fitzgerald 170). The mess they had made; the heaps of ashes left in their wake. Unfortunately, dreams don’t come cheap. Nor do they come without work. The dreams achieved by high society, such as the creation of the enclave known as East Egg, are built, as Marx would say, on the backs of the workers; the workers who sweat and toil for the benefit of the American Dreamers (or perhaps to join their ranks) creating and living in the vast ashheaps of America, separate from their economic rulers. They do not live the Dream; they don’t have the opportunity to. This exclusionary characteristic of the American Dream appears as the distinct snobbery evident through East Egg’s assertion of â€Å"membership in a rather distinguished secret society† (Fitzgerald 22). From â€Å"I [Nick] lived at West Egg, the – well, the less-fashionable of the two† (Fitzgerald 10), to † ‘my opinion on these matters is final,’ he [Tom] seemed to say, ‘just because I’m stronger and more of a man than you are’ † (Fitzgerald 13), to â€Å"Tom†¦ deferred to the sensibilities of those East Eggers who might be on the train† (Fitzgerald 29), it certainly seems that East Egg suffers from a superiority complex: a condition due, no doubt, to their â€Å"success† in embodying the American Dream. â€Å"So I realized that all we can do is be happy, and do the best we can while we are still alive† (Ecclesiastes 3:12). The beauty of the American Dream is that, as an unattainable yet seemingly plausible goal for all intents and purposes, it continues to inspire humanity of all nationalities to stretch to a new level of existence, regardless of their current social status. The quest for happiness is perhaps the most venerable of all human institutions due to the natural human desire for a hedonistic existence: a simple pursuit, hardly; a palpable pursuit, possibly; a consuming pursuit, definitely. While the pursuit of the American Dream can easily be branded selfish and greedy, one must admire those American Dreamers with the gall to embark on its realization. The lengths to which Gatsby goes to bring his world to fruition are, to say the least, extensive. An example is his building of â€Å"gonnegtions† with less than scrupulous business partners to finance the erection of a tower from which to gaze at a green light, a task requiring years of work, as his partner Meyer Wolfshiem reminisces: † ‘My memory goes back to when I first met him [Gatsby]’, he said. ‘A young major just out of†¦ the war [1918].’†¦ ‘Did you start him in business,’ I [Nick] inquired. ‘Start him! I made him’ † (Fitzgerald 162). While one might criticize his hyperactive imagination and perhaps even his sanity, one must grant him credit for his seemingly innocent and juvenile idealism; he is a true romantic. One must also admire his tenacity and strength of will: where lesser men would have collapsed under the strain of reality, the strong Gatsby persevered against all odds and, for a moment, held â€Å"Daisy’s white face† (Fitzgerald 107) and â€Å"she blossomed for him like a flower and the incarnation was complete† (Fitzgerald 107). The facing of such a challenge is no less heroic than catching a marlin or warding off a raging bull: all three require intense mental preparation, and though each expends different physical force, all three leave the hero exhausted physically and emotionally. Where Gatsby’s inferiors depend on alcohol to wash away their inhibitions and uncertainties – â€Å"Never had a drink before, but oh how I [Daisy] enjoy it† (Fitzgerald 74) declares a drunken, uncertain,  about-to-be-married Daisy in the face of mounting stress and anxiety over her commitment; or â€Å"the bottle of whiskey – a second one – [which] was in constant demand by all present† (Fitzgerald 37) at the heated scrutinize-Tom’s-relationships meeting in Tom’s/Myrtle’s apartment – Gatsby charges headfirst, conscious without anaesthetic, straight into the source of potential joy – and potential heartbreak. â€Å"I [Nick] wondered if the fact that he [Gatsby] was not drinking helped to set him off from his guests, for it seemed to me that he grew more correct as the†¦ hilarity increased† (Fitzgerald 51). The pathetic hilarity with which the novel ends – with Gatsby dead, sincerely believing that Daisy will call back, and Tom and Daisy continuing on, living without memory of their brief affairs of the summer of 1922 – accomplishes two things: firstly, it validates Gatsby and the American Dream; Fitzgerald contrasts the unforgivable, despicable actions of Tom and Daisy with the seemingly innocent and juvenile fantasies of Gatsby. The latter earns the audience’s sympathy, while the former are condemned for their inhumanity. Secondly, it debunks the American Dream: in spite of all the efforts and labours Gatsby invests to bring his Dream to fruition, he and his bold vision are cut short, left to rot floating in a pool of blood, rejected by reality; a strong message that material existence does not take kindly to Dreamers. And the battle returns to its origin; Dreamers recommence their offensive, reality braces itself; and the story continues. â€Å"It is all useless. It is like chasing the wind† (Ecclesiastes 2:26). Or is it? Bewley, Marius. â€Å"Scott Fitzgerald’s Criticism of America.† Twentieth Century Interpretations of The Great Gatsby. Ed. Ernest Lockridge. Englewood Cliffs: Prentice-Hall, Inc., 1968. 37-53. â€Å"Book of Ecclesiastes.† Good News Bible. Manila: Philippine Bible Society, 1980. Fitzgerald, F. Scott. The Great Gatsby. London: Penguin Books, 1990. Possnock, Ross. † ‘A New World, Material Without Being Real’: Fitzgerald’s Critique of Capitalism in The Great Gatsby.† Critical Essays on Fitzgerald’s The Great Gatsby. Ed. Scott Donaldson. Boston: G.K. Hall & Co., 1984. 201-213.

Industrial Pollution

Chapter 1: I.1 Introduction: Bangladesh is an upcoming middle earning country. It has a large number of population. The working environment is good and the labor cost is less so there is an opportunity to establish industry in this country. There are many sector of industry in Bangladesh. The people of our country are very hard working.By the late 1990s, about 1.5 million people, mostly women, were employed in the garments sector as During 2001-2002, export earnings from ready-made garments reached $3,125 million, representing 52 well as Leather products specially Footwear (Shoe manufacturing unit). % of Bangladesh's total exports. Bangladesh has overtaken India in apparel exports in 2009, its exports stood at 2.66 billion US dollar, ahead of India's 2.27 billion US dollar. Other industries which have shown very strong growth include the chemical industry, steel industry, mining industry and the paper and pulp industry.Now a day’s Bangladesh is want to achieve middle class cou ntry position. So the country is going to be an industrial country. And the industry who is responsible for the pollution. Most of the industries are not follow the rules of the law.I.2 Origin of the report: To know the current situation of the industrial pollution. To know what are the reason behind this. Why the industry through their waste in to the open field? To understand the problem of the pollution.I.3 Objective of the report: To know the current situation of pollution problem. To understand the thinking of the people. To solve the problem. To work with the problem.1.4 Methodology: Primary data: field survey, Questionnaire. Secondary data: Web site, News paper.1.5 Scope of this report: In this report we want to show the over view of the total pollution of the industry in Bangladesh. There are many industries in Bangladesh. But we will cover some of the industries in Bangladesh such as: Textile industry, Chemical industry, Pharmaceutical industry, Builders industry, Tannery i ndustry,Food industry, Steel industry, Shipping industry, Electronics industry, Fabrics Industry, Plastic Industry, Paper & jut Industry, Refinnering ( Oil, Gas) Industry, Beverages Industry, Recycling Industry, Others.1.6 Limitation of the report: Limitation means something that limits a quality or achievement of any analysis. All research designs can be discussed in terms of their relative strengths and limitations. The merits of a particular design are inherently related to the rationale for selecting it as the most appropriate plan for addressing the research problem. One strength of an Selecting and starting to prepare this report it is not an easy process to complete this. To complete this report we face many problems. Those are as followsi. Information Collection1) Limited source of information 2) Limited information about the industry pollution in web sites on Bangladesh perspective. 3) Peoples are not aware about the problems by industrial pollution. 4) Business persons try to skip the questions answers.ii. Overall limitation of this report1) Limited time to prepare this report. 2) Limited information source. 3) Limited ways to analysis the quality control with founded information. 4) Limited direction from course instructor to prepare this report.Chapter 22.1 Bangladeshi Industries: A short list of Bangladeshi Industry: Name of industry Name of industry Name of industry Textile Industry Tannery Industry Paper & Jute Industry Chemical Industry Food Industry Refinnering Industry Pharmaceutical Industry Steel Industry Beverage Industry Cigarette Industry Shipping Industry Recycling Industry Builders Industry Electronics Industry Fertilizer Industry Febrics Industry Plastic Industry Other Industry2.2 Pollution in Bangladesh: Water pollution:The water pollution situation from Bangladesh could be the largest poisoning in history and the irony is that this situation could be the result of all the efforts in cleaning the water for some of the poorest nations of the world. A British study, shows that about 80 million people from Bangladesh, South Asia, are exposed to a high level of toxicity from the water contaminated with arsenic. An international team of researchers from Chicago, New York and Bangladesh has been monitoring, in the last decade, the water intake of arsenic contaminated wells and the impact of 12,000  people.The conclusions showed that the death of five people was directly linked to the elevated levels of arsenic in the bodies of the victims of the Bangladesh water. The result is not just a novelty, it is a problem known for some years now and, over time, and residents were advised to dig deeper wells to avoid the potentially contaminated surface water consumption. Now, even the deep waters appear to be problematic.The Bangladeshi people suffer most in pure drinking water by arsenic. But the people of Bangladesh also suffer by the industry pollution. The river water is not safe for the people. The industry is not use waste management system. So in future if the industry is not following the rules the waste management, the water will not look like water.Air Pollution:Air pollution contamination of the atmosphere caused by the discharge, accidental or deliberates of a wide range of toxic substances. Often the amount of the released substance is relatively high in a certain locality, so the harmful effects are more noticeable. The major sources of air pollution are transportation engines, power and heat generation, industrial processes and the burning of solid waste. A new source of air pollution is an increasing ‘hole' in the ozone layer in the atmosphere above Antarctica, coupled with growing evidence of global ozone depletion.Air pollution has also long been known to have an adverse effect on human beings, plants, livestock and aquatic ecosystem through acid rain. Recently as in other parts of the world air pollution has received priority among environmental issues in Asia. This problem is acute in dhaka, the capital of Bangladesh and also the hub of commercial activity. The other urban areas like Chittagong, Khulna and BOGRA have much lesser health problem related to air pollution. In urban areas sometimes the houses are built on rocks and soils, which radiate radioactive gas from their basement.If this gas is inhaled for a long time it may cause lung cancer. In the rural areas of Bangladesh, the air pollution problems have not yet become a point of concern. This is due to fewer motorized vehicles and industries there. Thus, it is likely that in those areas the principal air contaminants are particulate matter and volatile organic compounds (VOCs). Basically, there are two major sources of air pollution in Bangladesh industrial emissions and vehicular emissions.The industrial sources include brick kilns, fertiliser factories, sugar, paper, jute and textile mills, spinning mills, tanneries, garment, bread and biscuit factories, chemical and pharmaceutical industries, cement production and processing factories, metal workshops, and wooden dust from saw mills and dusts from ploughed land, and salt particles from ocean waves near the offshore islands and coastal lands. Noise Pollution: Man-made noise harmful to health or welfare. Transportation vehicles are the worst offenders, with aircraft, railroad stock, trucks, buses, automobiles, and motorcycles all producing excessive noise.Noise intensity is measured in decibel (dB) units. Subject to 45 dB of noise, the average person cannot sleep. At 120 dB the ear registers pain; hearing damage begins at a much lower level, about 85 dB. In Bangladesh noise pollution (also termed as sound pollution) is a major health hazard. In fact, due to noise pollution millions of people in Bangladesh are exposed to a number of health risks – from deafness to heart attack. On city streets noise pollution can be caused by hydraulic horns of vehicles, microphones and cassette players.The hydraulic horns used by b uses, trucks and scooters in the crowded city streets are dangerous for human being. This is also how noise pollution in Dhaka City is affecting the hearing power of thousands of children every day. The horns especially cause serious damage to children. Experts say, if a child below three years of age hears a horn emitting 100 dB of noise from a close range, he or she might lose his or her hearing power. A child's health may also be adversely affected by loud sounds from the radio, television, cassette players and microphones, the sound of mills and factories and loud noise.The unit of sound frequency is hertz. Human beings usually hear 15 to 20 kilohertz (KHz) frequency sound. According to the World Health Organisation (WHO), generally 60 dB sound can make a man deaf temporarily and 100 dB sound can cause complete deafness. But the noise of any busy street in Dhaka has been estimated at 60 to 80 dB, with the sound of vehicles being 95 dB, loud speakers 90 to 100 dB, mills and facto ries 80 to 90 dB, restaurants and cinema halls 75 to 90 dB, festivals 85 to 90 dB, scooter or motorbike 87 to 92 dB and trucks and buses 92 to 94 dB.But the desired sound measure is 25 dB in the bedroom, 40 dB in the dining or drawing room, 35-40 dB in the office, 30-40 dB in the class room, 35-40 dB in the library, 20-35 dB in hospital, 40-60 dB in a restaurant and 45 dB in the city at night. When the sound exceeds this limit, there is noise pollution. Noise pollution beyond the limit destroys hearing and might even lead to the losing of one's mental balance. Noise pollution also causes peevish temperament, affects lungs, hampers the intellect of the children and makes them apathetic towards their studies. 2. 3 Industries wise pollution:2. 3. 1 Textile Industry pollution: The textile industry in Bangladesh through their waste in to free area. They through their waste in to river and pond. So the water of the river is polluted. The river contains many kind of fish and other kind of animals. If the animals are go to the polluted water they will die or they have the chemical re-action in their body. And then the people eat that fish or the animals that are also suffer with chemical re-action. The textile industry also relies carbon die oxide gas which is cause for green house effect, and the global warming.It also cause for many human health problem. Some people also suffer skin problem. Textile industry makes very noise. Many people can’t suffer the noise so some time they sense less. Because the textile industry makes very much noise so we should make textile industry in nonresidential area. 2. 3. 2 Chemical industry pollution: We all know about the chemical re-action of the chemical. Many people die every year because of the poison of the drinking water. The chemical industry is also destroying our crops land, river and kills other animals. Many Bangladeshi industries don’t use waste management.They through their chemical in to the river or open area. The chemical industry polluted our water and air. Causes of chemical pollution the people suffer skin problem and other harmful Degases. 2. 3. 3 Pharmaceutical Industry pollution: The pharmaceutical industry use different types of chemical and plastic pack to keep the medicine safe. But after using the medicine there are no recycle of the plastic pack, so it make pollution. In other hand some of the company don’t follow the waste management program. They through their waste in to the sea and river.So the water is polluted by the pharmaceutical industry. 2. 3. 4 Cigarette Industry: the cigarette industry is polluted the environment very much. They produce cigarette and biri which is polluted our environment air. The people also suffer the bad effect of the smoking. The tobacco plants destroy the fertility of the land so the crop land became dry. If there are any land who grows tobacco they can’t grow any other crop. The processing of cigarette is also harmful for the environment. It pollutes air. 2. 3. 5 Builders Industry: The Bangladeshi builders industry doesn’t follow the building core.They make building of their own wish, so it is very difficult to the maintain the pollution. Because they sometime build building on the pond or near the river so in rainy season the water can’t pass to the river and it polluted our roads and houses. 2. 3. 6 Tannery Industry: The tannery industry use deadly chemical to prepare lather. Most of the tannery industry situated in highly populated area so when they through their waste in the water the water will be polluted. The bad effect of the pollution effect the human health it may cause the cancer of skin.Many labor suffer cancer because of the chemical re-action by the chemical. 2. 3. 7 Food industry: One of the largest industries in Bangladesh is food industry because of the huge rate of the population. The industry is very big. Every day the industry produce many type of the food to fulfil l the needs of the food. They use chemical fertilizer to grow mare food because of large needs. The food industry pollute our soil and water. They use high rate of chemical fertilizer so the water of river has been polluted and the water insect and the insect that help the crops die because of chemical fertilizer.Some food industry through there waste of food in to open area and water so the water is polluting. 2. 3. 8 Fertilizer Industry: There are many fertilizer industries in Bangladesh. They produce fertilizer for our farmer to grow more crops. But the process of the fertilizer is not environmental free. To produce fertilizer they need methane gas. So the air pollution is happening. They need water to cool their machine. So the water is polluting. To make chemical fertilizer they need 2. 4 An overview of tannery industry’s pollution: 2. 4. 1 Present situation of tannery industries pollution:Now days the tannery industry is playing the most important part for our economy. The products of our tannery are maintaining world class quality. So the buyers of the tannery product are more. There is a good will of Bangladesh tannery industry in the world. The tanneries are a major money-maker for Bangladesh. From June 2011 to July 2012, Bangladesh’s tanneries exported close to $663 million in leather and leather goods—like shoes and handbags—to some 70 countries worldwide, including Italy, Germany, Spain, China, and the United States. Tannery worker have been suffering from severe skin diseases, allergy and chest pain.Most of the cases, medicines do not work on them anymore. They process animal hides with toxic chemicals. Before tanning they work with chemical-mixed water, liming and de-liming, scrapping off meat and fat. They do it with bare hands chromium, sulfur, manganese, copper compound, lead and others are used to tan which are very toxic for their health. Chemical mixtures, acids and dyes used in the tanneries are very toxic for h uman health. From different sources about 20,000 tannery workers are forced to work for tanning in this hazardous situation though they are paid a little.About 90 percent tanneries of the country located at Hazaribagh of the Dhaka city. Covered by high walls which have not proper ventilation system, the air inside the factories is with fumes, heat. Very bad scent is available inside the factories. Few large factories are providing some facilities while smaller s’ are in very bad and poisonous situation. Very bad smells are also got from nearby the Hazaribagh like Rayerbazar, Jhigatola and parts of Dhanmondi. Nobody wants to go to Hazaribagh due bad effect of tanneries. Even the tanneries owner doesn’t live in those areas.Reused chemicals from the larger factories are being used by the small factories which are more dangerous and vulnerable for the workers as well as for the environment. About 40 heavy metals and acids are used for processing raw hides. Among them the m ost dangerous chemical substances are , manganese, chromium, sulfur, lead, and copper Wet blue leathers are made using these chemicals Most of the workers are directly use these chemicals each and every day because of being done the process manually. They don’t like to use hand gloves or any other safety items.About 30 export-oriented factories use these safety equipments for their workers and others don’t pay attention. It is very important to use masks, safety goggles, special suits, gloves and special shoes to save themselves from the hazardous effect of toxic chemicals. Most of the time the workers work with bear feet when thy clean dirt, bloods and chemicals which causes various diseases. Jaundice, nausea and headache are another common sickness among them. These toxic chemicals cause boils, inflammation in hands and legs, skin diseases allergy, and other infection.If it continues around more than 15 years these can even cause cancer. During working these chemical s evaporate to the air which damages lungs and causes respiratory illness such as asthma and bronchitis through inhalation of the people of Hazaribagh area. This toxic substances damages eyes and the entire nerve system . Finishing leather is processed after tanning. . These toxic chemicals cause boils, inflammation in hands and legs, skin diseases allergy, and other infection. If it continues around more than 15 years these can even cause cancer.During working these chemicals evaporate to the air which damages lungs and causes respiratory illness such as asthma and bronchitis through inhalation of the people of Hazaribagh area. This toxic substances damages eyes and the entire nerve system . Finishing leather is processed after tanning. . For probably the first time, Bangladesh’s government has leveled pollution-related fines against two leather tanneries in Hazaribagh, a Dhaka neighborhood so polluted with waste from its roughly 150 tanneries that residents and workers are plagued by serious health problems.This announcement came four months after Human Rights Watch released a report revealing the extent of workers’ and residents’ broken-down health, ranging from painful skin diseases to respiratory illnesses. Shortly before our report launch, a senior official in Bangladesh’s Environment Department told Human Rights Watch, â€Å"There is no monitoring and no enforcement in Hazaribagh. † The two tanneries were fined for not having effluent treatment plants, which would treat their chemical-laced wastewater.Each day, the area’s tanneries discharge some 21,000 cubic meters of untreated waste containing chromium, lead, and other chemicals and heavy metals into the nearby Buriganga River. The air reeks of chemicals, which have harmed the area’s water and soil and the health of people living nearby. Hazaribagh is home to between 90 and 95 percent of all Bangladesh’s tanneries, and they employ between 8,000 a nd 12,000 people. â€Å"Living beside the tanneries is difficult, all the dirty water comes here, the fumes are very bad,† said Goyenda, who is in her late teens and has lived in Hazaribagh for just over a year. â€Å"I have problems with my eyes.They water a lot and become red. The tannery gas causes this. † As follow-up to the Toxic Tanneries report, Human Rights Watch has pressed the international leather industry to identify and mitigate the human rights risks from the tanneries in Hazaribagh. Two weeks ago, Human Rights Watch called on buyers at a flagship international leather fair in Bologna to buy leather goods only from Bangladesh tanneries that respect environmental standards and comply with laws that protect the right to health and labor rights. 3. 1 Reason behind the pollution: 3. 1. 1 Corruption: Bangladesh is a corrupted country everything is possible in Bangladesh.The tannery industry is polluting the environment much. The pollution of tannery is harmful for all the human and animal. But it is a matter of sorrow that the government environment sector is silent. Because they deal with the company owner. And the government employee pays by the owner. So the environment pollution can’t be stopped. 3. 1. 2 Don’t obey the industry’s rules: Most of the tannery doesn’t show respect to the constitution rules. In Bangladesh there are no lacks of rules but in matter of worry that the industry doesn’t want to follow the rules, because of the over greedy of the of the industry owner.3. 1. 3 Lack of nation’s lover: the greedy owner and the greedy government people Politician are not love their nation. So just thought to maximize their wealth. 3. 1. 4 Lack of monitoring: The monitoring unit are not strong to control the pollution. 3. 2 effect of the pollution: Waste contains pollutants which are discarded materials, process materials or chemicals. Pollution could be caused by all sectors of a society gen erate waste: industry, agriculture, mining, energy, and these pollutants when they are released beyond the assimilation capacity of the environment.Industrial wastes are generated from different processes and the amount and toxicity of waste released varies with its own specific industrial processes. Tannery effluents are ranked as the highest pollutants among all industrial wastes. They are especially large contributors of chromium pollution . Chromium is highly toxic and carcinogenic to human beings, animals, plants and the general environment (soil and water sediment). Chrome is the primary threat when ever tanning industry comes in to practice.Though many treatment options were evaluated to prevent its consequence on the environment, neither of them could achieve to treat or recover chrome 100 %. Treatment options are either; inefficient, complicated, energy demanding, costly or applicable to a certain parts of the world due to technology or skilled man power demand. The river n ear by the tanneries can be said highly polluted rivers since they are serving as recipient of effluent from the factories. The effect of this scenario is expressed by different indicators. The Akaki -Kaliti and the tributaries of Awash River are best examples of polluted water body.The residents around the river and /or the tannery reported the death of their cattle, dried up of green plants, water born diseases and bad smell resulted due to the death of micro organisms that in turn caused by depletion of dissolved oxygen. Even though the incidences are merely the result of discharges from tanneries but it is impossible to deny the fact that the discharge from tanneries has its own contribution. (Dagnew and Daniel,2011) Global worming Destroy our safe water resource Destroy your crop land Destroying your human health Cause of chemical re-action

End of Life Care Essay

When a loved one is dying, conversations about the end of life can be uncomfortable and difficult. Still, discussing end-of-life care is important. Depending on the circumstances, you might be able to help your loved one make important end-of-life decisions — such as whether to remain at home, move to a nursing home or other facility, or seek hospice care. Also, you can work with your loved one’s health care team to make sure your loved one remains comfortable at the end of life. Pain, anxiety and other end-of-life symptoms can often be treated. Even at the end of life, you can continue to support and nurture your relationship with your loved one. Simply being there can be an important source of strength and comfort for everyone. Grief When a loved one dies, grief can feel like a dagger in your heart. Often, grief triggers raw, intense emotions. You might wonder how you’ll ever pick up the pieces and heal your wounds — yet not feel as if you’re betraying your loved one’s memory. There are no quick fixes for the grief and anguish that follow a loved one’s death. As you face your grief, acknowledge the pain and know that it’s part of the healing process. Take good care of yourself, and seek support from friends and loved ones. Although your life will never be quite the same, the searing pain of grief will eventually become less intense. Accepting your new â€Å"normal† can help you reconcile your losses and move on with your life. Hospice Care Also called: End-of-life care Hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient’s family. Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place * At home * At a hospice center * In a hospital * In a skilled nursing facility ————————————————- What is the role of the family? Family members often make sacrifices to care for relatives. Families provide care, pain management, and protect the patient. Although they may lack knowledge, caregivers gain satisfaction and pride from providing care, but are also at risk for depression and health problems related to caregiver stress (Haley & Bailey, 1999: Haley et al., 2001; Weitzner, Haley, & Chen, 2000). Some cultures may believe caring is the community’s duty and obligation. Caregivers benefit from social support, maintaining social activities and roles, and psychological interventions that teach coping skills. Most people want their family to be given choices about treatment and few wanted the physician to decide alone (Bradley, 1998). End of life: Caring for a dying loved one Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life. Caring for a dying loved one isn’t easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase your loved one’s comfort — can help. * Choosing where to die Your loved one may have various choices for end-of-life care. Options may include: * Home care. Many people choose to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care — services that help ensure the highest quality of life for whatever time remains — can be provided at home as well. * Inpatient care. Some people may prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility. Hospice and palliative care — a holistic treatment approach intended to ease symptoms, relieve pain, and address spiritual and psychological concerns — can be provided in any of these environments. When you discuss the options with your loved one, consider his or her preferences as well as special physical, emotional and psychosocial needs. Evaluate how much support can be provided by family members and friends. For help determining the best option, talk with your loved one’s health care team or a social worker. You might ask for a referral to palliative or hospice care specialists — health care providers trained in specific care for people nearing the end of life. * Spirituality at the end of life As your loved one approaches the end of life, he or she may talk about spirituality or the meaning of life. Don’t force the subject — but if it comes up, encourage your loved one to explore and address his or her feelings. You might ask your loved one open-ended questions about his or her beliefs and experiences or most meaningful moments. You may want to invite a spiritual leader to visit your loved one as well. * Saying goodbye You can help your loved one communicate his or her final wishes for family and friends. Encourage your loved one to share his or her feelings, including thanks or forgiveness, and give others a chance to say goodbye. This may stimulate discussion about important, unsaid thoughts, which can be meaningful for everyone. Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events. * Recognizing when death is near It’s difficult to predict exactly when someone will die. As death approaches, however, your loved one may show various signs and symptoms indicating that the end of life is near. Look for: * Restlessness and agitation. Your loved one may frequently change positions. * Withdrawal. Your loved one may no longer want to participate in social events or other favorite activities. * Drowsiness. Your loved one may spend most of his or her time asleep. * Loss of appetite. Your loved one may eat and drink less than usual. * Pauses or other changes in breathing. This may happen when your loved one is asleep or awake. Providing comfort The active phase of dying usually begins several days before death. Although you can’t change what’s happening to your loved one, you can help him or her feel as comfortable as possible — ideally with the support of palliative or hospice care specialists. Your loved one also may experience a brief, final surge of energy. Though it can be confusing to see your loved one with renewed vitality, remember that this is a normal part of dying. If it happens, take advantage of the opportunity to enjoy your loved one and say your final goodbyes. * Keeping vigil For many families, keeping vigil near a dying loved one’s bed is a way to show support and love. If you decide to keep vigil, continue talking to your loved one. If you think your loved one would want to share this time with others, invite family members or close friends to show their support as well. Express your love, but also let your loved one know that it’s all right to let go. What is working? Mental health providers with palliative expertise can improve communication and resources. Mental health experts help providers understand the patient’s concerns and culture. They explain confusing medical terms and clarify CPR, pain management, and other treatments and encourage collaboration. Mental health providers also help relieve the common emotional distress and grief resulting from a terminal illness or care giving. COPING WITH BEREAVEMENT â€Å"IN OUR HEARTS, WE ALL KNOW THAT DEATH IS A PART OF LIFE. IN FACT, DEATH GIVES MEANING TO OUR EXISTENCE BECAUSE IT REMINDS US HOW PRECIOUS LIFE IS.† * Coping With Loss The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. After the death of someone you love, you experience bereavement, which literally means â€Å"to be deprived by death.† Remember — It takes time to fully absorb the impact of a major loss. You never stop missing your loved one, but the pain eases after time and allows you to go on with your life. * Knowing What to Expect When a death takes place, you may experience a wide range of emotions, even when the death is expected. Many people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process. Some emotions you may experience include: * Denial * Disbelief * Confusion * Shock * Sadness * Yearning * Anger * Humiliation * Despair * Guilt These feelings are normal and common reactions to loss. You may not be prepared for the intensity and duration of your emotions or how swiftly your moods may change. You may even begin to doubt the stability of your mental health. But be assured that these feelings are healthy and appropriate and will help you come to terms with your loss. * Mourning A Loved One It is not easy to cope after a loved one dies. You will mourn and grieve. Mourning is the natural process you go through to accept a major loss. Mourning may include religious traditions honoring the dead or gathering with friends and family to share your loss. Mourning is personal and may last months or years. Grieving is the outward expression of your loss. Your grief is likely to be expressed physically, emotionally, and psychologically. For instance, crying is a physical expression, while depression is a psychological expression. It is very important to allow yourself to express these feelings. Often, death is a subject that is avoided, ignored or denied. At first it may seem helpful to separate yourself from the pain, but you cannot avoid grieving forever. Someday those feelings will need to be resolved or they may cause physical or emotional illness. Many people report physical symptoms that accompany grief. Stomach pain, loss of appetite, intestinal upsets, sleep disturbances and loss of energy are all common symptoms of acute grief. Of all life’s stresses, mourning can seriously test your natural defense systems. Existing illnesses may worsen or new conditions may develop. Profound emotional reactions may occur. These reactions include anxiety attacks, chronic fatigue, depression and thoughts of suicide. An obsession with the deceased is also a common reaction to death. * Dealing with a Major Loss The death of a loved one is always difficult. Your reactions are influenced by the circumstances of a death, particularly when it is sudden or accidental. Your reactions are also influenced by your relationship with the person who died. A child’s death arouses an overwhelming sense of injustice — for lost potential, unfulfilled dreams and senseless suffering. Parents may feel responsible for the child’s death, no matter how irrational that may seem. Parents may also feel that they have lost a vital part of their own identity. A spouse’s death is very traumatic. In addition to the severe emotional shock, the death may cause a potential financial crisis if the spouse was the family’s main income source. The death may necessitate major social adjustments requiring the surviving spouse to parent alone, adjust to single life and maybe even return to work. Elderly people may be especially vulnerable when they lose a spouse because it means losing a lifetime of shared experiences. At this time, feelings of loneliness may be compounded by the death of close friends. A loss due to suicide can be among the most difficult losses to bear. They may leave the survivors with a tremendous burden of guilt, anger and shame. Survivors may even feel responsible for the death. Seeking counseling during the first weeks after the suicide is particularly beneficial and advisable. Living with Grief Coping with death is vital to your mental health. It is only natural to experience grief when a loved one dies. The best thing you can do is allow yourself to grieve. There are many ways to cope effectively with your pain. * Seek out caring people. Find relatives and friends who can understand your feelings of loss. Join support groups with others who are experiencing similar losses. * Express your feelings. Tell others how you are feeling; it will help you to work through the grieving process. * Take care of your health. Maintain regular contact with your family physician and be sure to eat well and get plenty of rest. Be aware of the danger of developing a dependence on medication or alcohol to deal with your grief. * Accept that life is for the living. It takes effort to begin to live again in the present and not dwell on the past. * Postpone major life changes. Try to hold off on making any major changes, such as moving, remarrying, changing jobs or having another child. You should give yourself time to adjust to your loss. * Be patient. It can take months or even years to absorb a major loss and accept your changed life. * Seek outside help when necessary. If your grief seems like it is too much to bear, seek professional assistance to help work through your grief. It’s a sign of strength, not weakness, to seek help.