Excercise programs, Personal training, nutrition, Assignment

Excercise programs, Personal training, nutrition, - Assignment Example 20). As the client has expressed that they are a beginning when it comes to weight training, a series of stages have been designed as a means of aiding the client. The first stage of the exercise routine involves machine weights. Specifically, it is recommended that the client implement fully body circuit training three times per week. In terms of repetitions, implementing 10-12 repetitions on each machine at a steady rate is recognized to increase muscle capacity. The following stage of this program will then involve upper body and lower body splits of free weights. Compound exercises with 10-12 repetitions each can then be implemented 4 times per week. The compound exercise split will implement pull-ups, deadlifts, and chest presses will be implemented to target back, arm, chest and core muscles. There will be a one-day rest period and then lower body exercises will be implemented. The lower body exercises will primarily focus on squats with the barbell, but will also involve squat ting without the barbell. Both the lower body and upper body exercises will be implemented 3X each with 10-12 repetitions. The ultimate recognition is that these exercises will create the necessary muscle to reduce body fat and tone. There are a number of areas of consideration that I implement when creating an effective programme for a client. One of the prominent areas of concern is upper-body and lower body alterations. The upper body and lower body split is effective in that it is largely simplistic and does not require clients to consider complex muscle groups in implementation. Another prominent consideration involves resistance training, strength training, hypertrophy, and endurance training. The main consideration in these regards is in terms of repetitions. The implementation of lower repetitions at higher weights results generally in an increase in muscle bulk. This is contrasted with higher

Impact of Financial and Non-financial Rewards on Employee Motivation Literature review

Impact of Financial and Non-financial Rewards on Employee Motivation and Satisfaction of Saudi Nationals in Saudi Aramco - Literature review Example A predominant means for accomplishing human-resource-based competitive advantages is the use of incentives. Performance-related pay and benefits are some common incentives in the financial sector, as well as other industries. Lewis offers a process-cycle theory, where the stages of PRP must be properly managed in order to deliver optimal performance results. These stages are: 1) establishing objectives; 2) measuring performance; 3) providing performance feedback; and 4) translating performance into rewards. His study shows that incentives can greatly affect performance, when these stages are aptly managed in relation to employees’ performance levels and issues. Ferreira, Marques and Azevedo show from their study of Portuguese banks that incentive systems shape organisational competitiveness, although other factors are also important, such as management and leadership approaches. PRP per se is not the magic bullet of performance, especially when it has design and implementation flaws. (Boachie-Mensah and Dogbe, 2011). Financial incentives and performance Financial incentives alone are not enough to drive motivation and performance because employees consider other factors too (Siders, George and Dharwadkar, 2011). In the study of 139 Slovenian bank managers, Hartmann and Slapnicar (2012) explored the effect of distributive justice properties and procedural justice properties of managerial pay on manager’s intrinsic motivation. They discovered that procedural justice is a greater predictor of intrinsic motivation when low pay transparency exists, while distributive justice is a greater predictor of motivation when high pay transparency is present. Hartmann and Slapnicar (2012) concluded that pay transparency is important in analysing and designing just managerial pay

Comparison and contrast of project definitions Essay Example for Free

Comparison and contrast of project definitions Essay A project is a sequence of unique, complex, and connected activities that have one goal or purpose and that must be completed by a specific time, within budget, and according to specification. Second definition is given by Wysocki as a â€Å"Business-focused† one, and will be referred as such hereinafter. Business-focused definition of a project: A project is a sequence of finite dependent activities whose successful completion results in the delivery of the expected business value that validated doing the project. Though both definitions may seem similar in nature, there are also marked differences. First of all, both definitions outline a sequence of activities that must be completed. When common definition describes them as â€Å"unique, complex and connected†, business-focused approach is about â€Å"finite and dependent† activities, uniqueness and complexity of which are implied. Usage of â€Å"dependent† instead of â€Å"connected† is justified, since activities may be connected artificially without any technical relationship between them. On the contrary, dependent activities are indeed technically related: the output of activity A would be input for activity B, and so on. â€Å"Finite† in business-focused definition basically implies that all activities end when project is over, therefore there is a similarity with â€Å"completed by a specific time† part of a common definition. Secondly, both definitions outline some project constraints, though in different ways. â€Å"Successful completion† involves completion â€Å"by a specific time, within budget† from common definition, so there’s the second similar trait. However, here lies the most important difference. When common definition describes activities completion as goal/purpose achievement, business-focused one speaks about expected business value that a sequence of activities must deliver. Broadly speaking, business-focused definition supposes that specification, time limits and budget of a project all can be subject to change due to business world dynamics, high levels of uncertainty, or some other causes. Therefore a sequence of activities can only be defined as a project if it delivers expected business value to the customer. It’s an important issue that is omitted by common project definition.

Role of the Nurse in HIV Prevention and Care

Role of the Nurse in HIV Prevention and Care INTRODUCTION This brief considers role of the nurse in the HIV prevention and care in the black African community. The document considers empirical literature from academic, governmental, and other sources. It is argued that the available evidence is too scant to warrant conclusive inferences about the role of nurses in HIV care and management for this ethnic group. This is compounded by ambiguities about the role of nurses in promoting sexual health, and uncertainty about the appropriate criteria for evaluating their impact on the African community. Black Africans in Britain According to the Department of Health (2005b) approximately 480,000 people living in England (less than 1% of the population) have Sub-Saharan African heritage, by birth and /or descent. More than 75% live in the Greater London area, mostly in inner London Boroughs. Compared to the rest of the UK population, Africans tend to be younger, well educated (just 13% of Africans reported have no educational qualifications), more likely to be unemployed and living in rented (often overcrowded) accommodation. Asylum legislation has meant that a significant proportion of the population has questionable migration status in the UK. New arrivals in the UK, including asylum seekers, are offered a medical examination that may include a HIV test if this is requested, or the medical examiner judges that a test is necessary. The test result is not necessarily considered when an asylum application is processed. Many Africans live in isolation, separated from friends and family back in Africa, (for asylum seekers), with no access to public funds, and struggling to adapt to a new culture (Millar Murray, 1999). Many are struggling to learn English. Sexuality is heavily influenced by traditional (tribal) beliefs, taboos, customs, religion, and spirituality. HIV is virtually a taboo subject. Thus, a sero-positive status has a significant effect on various aspects of a persons life, including problems dealing with the diagnosis, ambivalence about whether or not to test, gender issues (e.g. whether or not to breastfeed), and coming to terms with the possibility of death (e.g. implications for children, family) (Miller and Murray, 1999; Doyal Anderson, 2005). The prevalence of HIV infection is high in both the immigrant and British born/resident African populations. Asylum seekers and others with unsatisfactory immigration status have limited access to public funds, live in poverty, and generally avoid utilising public health services, until illness is at an advanced stage. Black Women There is considerable research on the plight of African women as distinct from men (e.g. Withell, 2000; Tabi Frimpong, 2003). Much of this literature highlights aspects of their increased susceptibility, or predisposing factors or experiences. Motherhood is an extremely important goal for many African women, so that unprotected sex becomes a cultural necessity. Doyal and Anderson (2004) document the devastating impact of HIV on the lives of African women living in Britain. Many women harbour serious concerns about the health of their offspring. There is a distinct reluctance to give birth to a sick (HIV-positive child). Many women have a vague immigration status, whereby they may not be entitled to state benefits, have no work permit and/or rely on charities for subsistence. The immigration issue is multidimensional. Many women live with a chronic fear of deportation, perhaps remaining in doors for days at a time, and/or refusing to open the door when the bell rings. Then there is the poor housing. Some put up with unsanitary and crumbling accommodation due to lack of funds and the awareness that housing conditions back home in Africa are much worse. Furthermore, some individuals become distressed or depressed because they are isolated from friends and family back home, and for a prolonged (and perhaps indefinite) period of time. Finally, many women may be unsure of their health care entitlements in the UK, and hence be unaware off and/or fail to utilise appropriate HIV care services. Additionally, religious faith remains a stable and salient characteristic of Black African culture. In the face of adversity many women turn to religion for hope and deliverance. Doyal and Anderson (2004) quote one woman: I have turned to God. I have really got to know more about God now. I know God exists . God is in control. I know there is an afterlife here (p.1736). The danger is that some women may seek therapeutic remedy from God, as a substitute for seeking medical care. Epidemiology According to Department of Health (2005a) figures provided by the Communicable Disease Surveillance Center (CDSC), up to 12,558 black Africans living in England by 2003 were HIV-positive. This figure was based records from HIV treatment clinics and care centers in England, and accounts for 36% of the total number of people in England living with HIV. In 2003 69% of heterosexual HIV-positive people (or 2624 individuals) were probably infected in sub-Saharan Africa. The majority of cases (65%) were female. In 2002 black Africans accounted for 70% of the total number of diagnosed HIV infections. Furthermore, â€Å"of the 15,726 heterosexual men and women seen for care in England, Wales, and Northern Ireland in 2003 for whom ethnicity was reported, 70% (11068) were black African, 19% (3009) were white and 4% (657) black Caribbean. Africans feature in all the main transmission routes for HIV†¦Ã¢â‚¬  (p.12) (see Figure 1). HIV positive Africans tend to be diagnosed much later in the course of the HIV disease, and show low uptake of clinical monitoring and antiretroviral treatments. Focus: The North West of England The North West HIV/AIDS Monitoring Unit (2005a, 2005b), based at the Center for Public Health at Liverpool John Moores University, regularly and comprehensively Figure 1 Distribution of HIV infections (those seen for care) across ethnic groups in 2003 monitors HIV trends in Northwest of England. The surveys are supported by the Health Protection Agency and the Northwest Public Health Observatory, and cover three main regions: Cumbria and Lancashire, Cheshire and Merseyside, and Greater Manchester. The Units data reflects both new and total HIV cases and dates back to 1996. The total number of HIV cases virtually doubled over the nine-year period from 1996 to 2005, rising from fewer than 300 in 1996 to over 600 by mid 2005. The data suggests that black Africans living in the Northwest have an unusually highly risk of contracting HIV compared to other ethnic groups. This trend applies to both newly diagnosed HIV cases from January to December in 2004 and 2005, and total HIV cases by the end of these periods. Also, this pattern seems to echo national trends. Africans accounted for almost a quarter (23.1%) of total HIV/AIDS cases (3574), by far the highest figure of all ethnic minority groups. For comparison, black Caribbeans made up less than one percent (0.7%, or 26 cases). The vast majority of black Africans (93.1%, or 769 of 826 cases) contracted HIV through heterosexual interactions. This contrasts sharply with Caucasian cases, of whom more than three-quarters (75.2%) contracted the virus through homosexual intercourse. When the data was collapsed by gender, again, black African women accounted for the majority (63.4%) of the 857 females diagnosed with HIV. These findings may be confounded by significant variations in the distribution of ethnic groups across the UK and native (British born) versus immigrant status. For example, population census figures show a much higher population density for black Africans compared with black Caribbeans in the Northwest regions. This may partly account for the over representation of Africans in some categories. Furthermore, it is not clear whether patterns observed are statistically significant. On the other hand the proportion of Africans amongst new and total HIV cases is over represented when compared with the proportion of Africans in the overall UK population. Current Health Strategies Prior to 2001 there was no official health strategy for promoting sexual health in Britain. In July 1999 the Secretary of State for Health presented a white paper to Her Majesty, the Queen, titled Saving Lives: Our Healthier Nation (The Stationary Office, 1999). Curiously the HIV/AIDS threat received little mention in what was otherwise a comprehensive document on the Governments health policy. The lack of an elaborate national strategy for HIV/AIDS meant that the steady increases through the 1990s in HIV-related morbidity and mortality (North West HIV/AIDS Monitoring Unit, 2005a) went virtually unchecked. This all changed in 2001 when the Department of Health published the National Strategy for Sexual Health and HIV (Department of Health, 2001, 2002, 2005a, 2005b). The strategy outlines several generic aims: Reducing the transmission of HIV and other STIs (Sexually Transmitted Infections); Reducing the prevalence of undiagnosed HIV and STIs (in other words, increasing HIV testing for people at risk). Improve health and social care for HIV-infected people; Reducing the social stigma associated with sexually transmitted diseases, notably HIV. In 2005 the Department of Health published more detailed objectives for HIV prevention specifically within the African community (Department of Health, 2005b). These objectives were as follows; HIV Prevention: 1.Reducing transmission (sexual and vertical); 2.Reducing prevalence of undiagnosed HIV cases; 3.Eliminating the stigma associated with sero-positive status. Health and Social Care: 1.Ensuring that HIV-positive Africans have equal access to services; 2.Ensuring that those services are culturally sensitive; 3.Ensuring that service delivery is based on assessment of individual need; 4.Facilitating access to testing; 5.Making special provision for children and adolescents; 6.Improving adherence to anti-HIV treatment regimes; 7.Creating better access to education, employment and leisure; 8.Supporting carers and families; Eliminating social exclusion is minimized. Several strategies for prevention are outlined. The first plan is that HIV prevention must operate at both an individual and structural level. Prevention activity at the individual level must address knowledge deficiencies (e.g., awareness of available health services), tackle inappropriate attitudes, beliefs, perceptions, and intentions, and teach relevant skills (e.g., condom negotiation). These goals can be achieved through various interventions including one-to-one counseling, out-reach work, telephone help lines, the internet, provision of sperm washing services, and clinical interventions to prevent mother-to-child transmission. Structural prevention measures include reducing poverty, introducing and implementing appropriate laws and regulations, and modifying societal factors (e.g., social norms, stigma, discrimination), and organisational factors (e.g., supporting community health organisations). Structural change can be achieved through group, community, and socio-political level interventions. Strategies for social care include: making peer support available at special ‘flashpoints’ of maximum need (such as at diagnosis, or during times of emotional distress), in order to improve adherence to treatment regimes; and providing support, advice, and education to sero-positive people, to help them to return to education. Additionally, the Department of Health (2005a) has clarified how the National Strategy for Sexual Health can be implemented by primary medical services, through four contracting routes: Primary Medical Services (PMS), General Medical Services (GMS), Alternative Provider Medical Services (APMS), and PCT-led Medical Services (PCTMS). All four services rely heavily on nurses, and â€Å"provide flexibility and opportunities to tailor services around the needs of the patients† (p.17). Thus, in theory, the current sexual health strategy can be tailored to meet the needs of minority ethnic groups. RATIONALE Black Africans are the minority ethnic subgroup most at risk for contracting HIV/AIDS in the UK. It is therefore widely acknowledged that this group has special care and management requirements (Department of Health, 2005a). Gaps in Care and Practice This report reviews the literature on nursing HIV care provision specifically for the black African community. The review identifies various salient issues that need to be addressed: 1. Uncertainty about the role and effectiveness of nurses in prevention and care of this ethnic group. 2. Insufficient empirical evidence on various aspects of prevention/care including; the role of nurse in facilitating uptake of antenatal testing by African women, and HIV testing by Africans in general; the degree of involvement and effectiveness of nurses in community-based African HIV/AIDS projects; sensitivity to cultural factors in, palliative care, and self-management; Dealing with the HIV stigma and its effect on health service utilisation; and nurses roles in supporting involuntary care provision. 3. Inadequate evidence on the role that African nurses can play in reducing cultural barriers, and providing liaison and training services. LITERATURE REVIEW Literature searches were performed using several electronic data bases: PSYCHINFO (BIDS), INTERNURSE, Academic Search Premier (EBSCOhost databases), British Medical Journal On-line, HIGHWIRE Press, SOCIAL CARE Online, Department of Health database, and the Internet. Various combinations of the following key words were used: nurse, nursing, care, African, black, ethnic, minority, women, sub-Saharan Africa, community, HIV, AIDS, palliative, and antenatal[1]. Priority was given to studies published from the late 1990s, although due to the paucity of literature some earlier studies are reviewed. Furthermore, emphasis was placed on UK studies. However, limited evidence from Sub-Saharan Africa is considered to highlight certain cultural issues. Finally, the review is structured in relation to prevention (including antenatal testing and transmission through breastfeeding), and health and social care (Department of Health, 2005a). The Nurses Role The National Strategy for Sexual Health and HIV (Department of Health, 2001, 2002) illuminated the rise in HIV sero-prevalence for ethnic minority groups in Britain. Nursing care was identified as essential in managing sexually transmitted diseases and promoting sexual health in these groups. The prevention and care strategies for African communities, specified by the Department of Health (2005b), provide a framework for nurses to tailor their roles to meet the cultural needs of sero-positive Africans. Miller and Murray ((1999) provide a comprehensive account of some of these cultural characteristics, specifically regarding response to a positive diagnosis, parenting issues especially for HIV-infected mothers, problems of disclosure, attitudes towards death, immigration issues, and common health care dilemmas, and effective engagement between carer and patient. Training According to the Medical Foundation for AIDS and Sexual Health (2003) nurses do not receive any special training in HIV care and prevention. The Nursing and Midwifery Council (NMC) approves special HIV training courses for nurses but these are not offered in all universities and colleges, and may be optional at institutions that offer them. According to Campbell (2004, p.169), Pre-registration training for nurses does not include mandatory education relating to sexual health services. Nurses working in sexual health gain post-basic education in an ad-hoc manner through working in the specialty, and by undertaking specialist post-registration courses. Moreover, although the NMC regularly monitors courses, it does not scrutinise individual courses that confer no special qualification, so that they may be considerable variability in the quality of courses offered in different institutions. Thus, it is possible that a large percentage of nurses have no special knowledge or skills in HIV prevention/care for ethnic minority groups. It follows that many nurses that may be ill prepared to deal with the particular HIV needs of African communities. However, nurses who work in Greater London, and hence are regularly exposed to African patients/communities, may quickly acquire some degree of ad-hoc expertise. By contrast nurses based in other parts of the country with smaller African communities may be especially uninformed and inexperienced. Role Ambiguity In the absence of mandatory HIV training, there may be some ambiguity about the precise roles/tasks nurses are required to perform in HIV care/prevention. Campbell (2004) notes that career pathways are patchy and ill defined, and it may be necessary for nurses to undertake placements in key areas of sexual health. Certain aspects of HIV care are applicable to other diseases, and hence may form part of a nurse’s standard training and job description (e.g. antenatal testing, patient pre-admission assessments). However, certain tasks are specific to HIV and/or a particular population group. Some nurses may be uncertain whether such roles are within their jurisdiction. For example, whose job is it to reduce the powerful HIV stigma that prevents many sero-positive Africans from testing for HIV, and/or benefiting from family support? Who is responsible for addressing cultural taboos and totems? Palliative Care This refers to nursing care aimed at maximising the quality of life for terminally ill patients, for example by reducing pain and discomfort. The National Council for Hospice and Specialist Palliative Care Services (NCH-SPCS) identifies seven domains of palliative care: increasing patient/carer understanding of diagnosis/prognosis; alleviating pain/symptoms; facilitating patient independence; reducing patients/carers negative affect (e.g. anxiety, depression); soliciting support from other agencies; advising on appropriate care locations as illness progresses; supporting families/carers, before/after death. To what extent do nurses meet these requirements met in sero-positive black African patients? There is a paucity of research addressing the palliative care needs of black African patients specifically. However, some studies have examined the needs of ethnic minority groups in general (Jack et al, 2001; Diver et al, 2003). Various barriers to effective palliative care for ethnic minorities have been identified including communication difficulties and the lack of trained interpreters (Jack et al, 2001). Diver et al (2003) conducted a qualitative study to identify the specific palliative needs of ethnic minority patients attending a groups regarding palliative care. Participants comprised two Jamaicans, one Indian, and one from the Ukraine, but no black Africans, who attended the day-care center once or twice weekly, for up to a year. Several key themes emerged. One concerned the individual needs of the patients, which were not related specifically related to culture (e.g. diet, religion, day care, avoiding social isolation). Two other themes highlighted attempts to fit in with the dominant culture, for example by eating English foods and communicating with staff in English. Another theme highlighted positive perceptions of palliative care: participants expressed gratitude to staff, with one individual noting â€Å"the Macmillan nurse had been sympathetic and had not pressurised her when she decided to stop having chemotherapy† (p.395). However, participants reported that staf f had not inquired about their culture albeit they simultaneously felt their cultural needs were being addressed. Although Diver et al’s (2003) study involved a very small sample, the findings suggest that nursing staff can effectively meet the palliative needs of minority patients. Some evidence suggests that nursing care can be more effective when a liaison professional is involved. Jack et al (2001) assessed the value of a ‘liaison’ worker that mediates between ethnic minority patients, their families, and health care staff. This study focused on the role of an ethnic minorities ‘liaison’ officer, appointed in May 2000. The workers brief is to facilitate palliative care amongst the Asian community specifically. Thus, he/she helps with communication, religious, gender-specific, bereavement, and other issues. However, several case studies are presented that illustrate the difficulties inherent in using a liaison person. For example, the liaison role is emotionally demanding and health care staff sometimes assume the liaison worker has medical expertise. Nevertheless, the concept of a liaison worker may improve the job performance of nursing staff involved in palliative care. Hill and Penso (1995) make recommendations that tailor palliative care to the needs of ethnic minority groups. These include: ethnic monitoring; having an equal opportunity policy; enforcing a code of conduct; staff recruitment/training; developing a communication strategy; health promotion; facilitating culture-specific care provision; appropriate food policies; community health initiatives. Given the paucity of research evidence focusing of HIV-positive black African patients in the UK, it remains unclear the extent to which these strategies facilitate effective palliative care in this population group. Some evidence is available concerning palliative care delivery in sero-positive women living in Sub-Saharan Africa (Defilippi, 2000; Gwyther, 2005). This evidence may provide additional insights that may apply to the care of black Africans who have emigrated to the UK. Gwyther (2005) documents the nature of palliative care in South Africa. Here, hospice care is primarily performed at home, with only a few inpatient units available on a short-term basis to selected patients (e.g. those with serve symptom control problems). A comprehensive community-based home care programme has been established, in which patient care is provided by the local community (e.g. extended family, neighbours), but managed by health care (hospice) staff. Thus, there has been a shift away from the conventional hospice domiciliary nurse as the primary caregiver to community care workers, who are trained, supervised, and supported by the professional nurse (p.113). This South African model has several advantages when applied to the UK theatre: Firstly, training extended family members (and perhaps even neighbours) in palliative care, with the aim of managing AIDS, and decreasing transmission of the HIV virus, may help resolve problems of communication, diet, custom, and other culture-specific issues that the patient considers relevant. This model goes some way to address Hill and Pensos (1995) recommendations for recruitment/training, effective communication, culture-specific care, suitable food policies, and community health initiatives. The professional nurse, free from some primary responsibilities of care, may be able to commit more resources to ethnic monitoring, enforcing codes of conduct, and ensuring equal opportunities in practice. Evidence-Based Practice There is a growing requirement in nursing and (other medical specialties) for evidence-based medicine/decision making (Thompson, et al, 2004). Evidence-based practice is particularly essential in the care of minority groups due to the relatively greater level of cultural ignorance in health care about ethnic minority customs compared with the dominant culture (Serrant-Green, 2004). There is a paucity of research assessing the degree to which nurses refer to empirical evidence when making clinical decisions about black African HIV patients. Thompson et al (2004) suggest that, in reality, nurses rarely consult evidence when making clinical decisions, irrespective of the patients’ background. Instead they are much more likely to consult their colleagues for information for advice. This is worrying because clinical decisions can be made about black-African patients based on incorrect assumptions rather than fact. For example, Gibb et al (1998) highlight the possibility that nurse midwifes may fail to offer antenatal HIV-testing to black African women, for fear of appearing discriminatory. Yet, there is little or no evidence about how black women may actually perceive such offers. Overall, there is a paucity of research on the role and effectiveness of nurses in delivering health and social care to the African community. Studies that focus on â€Å"black† patients (i.e. Afro-Caribbean or African parentage) cannot be generalised to Sub-Saharan Africans as HIV/AIDS incidence and prevalence is significantly different for these groups, suggesting different health care requirements. Similarly, data collected from Asians, Bangladeshis and other UK minority groups is generally inapplicable as the cultures are vastly different. The role of African Nurses A significant number of black African nurses work for the NHS. These individuals may play an important role in facilitating HIV prevention and care in the African community (Andalo, 2004; UNISON, 2005). There are two ways this may happen. Firstly, African nurses can serve as in-house liaison workers, improving communication and eliminating cultural barriers between the health service and African communities. Secondly, African nurses can help in educating other health-professionals on fundamental cultural issues, both in relation to the African community as whole, and individual sero-positive patients. The Department of Health (2000b) acknowledges the significant contributions of African nurses to sexual (and other) health issues in the African community, in the form of the Mary Seacole Leadership Awards. A recent article published by BioMedCentral (Batata, 2005) indicates that over 3000 nurses trained in Sub-Saharan Africa were registered to work in the UK in 2002/2003. These nurses originated from eight countries (South Africa, Nigeria, Zimbabwe, Kenya, Zambia, Malawi, Botwana and Mauritius), most of which have high HIV sero-positive prevalence rates. It therefore follows that these professionals will be very familiar with HIV preventive and care measures that work effectively with African communities. Approximately a quarter of all the foreign trained nurses registered during 2002/2003 (i.e. including nurses from non-African countries) worked in or near London, with 49% based in other parts of England, suggesting that there is a significant nurse pool available to support African communities in the London area. Unfortunately, there is a lack of research evidence on the role of African nurses in facilitating HIV care and prevention in African communities. Most studies focus on immigration, recruitment, or discrimination issues, rather than job performance and impact on care provision for local communities. The World Health Organisation (2003) indicates that one of the three top non-EU source countries for international nurses working in the NHS is from a Sub-Saharan African country (South Africa). The number of nurses recruited from Zimbabwe has increased recently. Nevertheless, recruitment and retention remain a problem. Although the NHS is thought to have one of the most effective nurse recruitment schemes in the public sector, there are still problems recruiting African nurses. For example, Andalo (2004, p.17) notes that although there has a been a significant increase in the number of Africans applying for nurse diploma courses, the rejection rate was more than fifty percent higher for African compared with white applicants. However, an argument for more recruitment can be better formulated given empirical evidence on the value of African nurses in promoting HIV prevention and care in their community. Department of Health (2005b) highlights the â€Å"need for basic information regarding HIV transmission, testing, and treatment. In particular, cultural practices that place some Africans at particular risk of transmitting or acquiring HIV requires specific, culturally competent attention† (p.13). Community nurses play an important role in this regard (Hoskins, 2000). Moreover, effective dissemination of knowledge requires collaborations between health professionals and agencies, access to services, and other recommended measures (Department of Health, 2000a, 2001, 2002, 2005a, 2005b). Community Nursing Community nursing care for sero-positive Africans in Britain has expanded rapidly over the last decade, reflecting a national shift in emphasis towards community care (McGarry, 2004). The Department of Health framework for prevention and care emphasised the importance of partnerships between HIV prevention agencies, Primary Care Trusts, local African community-based organisations, and other establishments (Department of Health, 2005b). According to the Department of Health (2005b), over 75% of black Africans in Britain live within Greater London. The largest concentrations live in Inner London Boroughs, which also have high sero-prevalence rates. Thus, the role of community nursing in the Greater London area is of particular interest. There is some evidence of collaboration between different agencies. One south London HIV partnership incorporates up to fourteen HIV prevention organisations, including several African-based projects: One African project covers up to nine catchment areas (Croydon, Kingston, Lambeth, Lewisham, Merton, Richmond, Southwark, Sutton, Wandsworth), and promotes the access to and utilisation of local HIV care and support services. This project recently launched a new treatment service designed to encourage men to adhere to treatment regimens. There is a paucity of research on the efficacy of such partnerships in reducing the spread of HIV in the black African Community. More importantly, there is limited empirical evidence on the involvement and impact of community nurses in these projects. The partnership in south London offers complementary HIV care services across the local area. Some of these services are available from local HIV clinics, were nursing staff presumably play a key role. Furthermore, there appears to be specific community nursing provision for children and families. For example a childrens hospital in Croydon offers nursing care for HIV-infected children and their families. Community nursing services are also available for adults. A study was commissioned to review progress on African HIV prevention initiatives in Enfield and Haringey, from 1997 to 2002. The investigation collected data on HIV-prevention needs, and voluntary and statutory sector provision, all of which are implemented by nurses (e.g. health visitors, community nurses, nurse midwifes). It was found that a lay referral system, operated solely by friends and family, worked effectively. Medical support from nurses and other health professionals was requested when symptoms become too serious. Compared with other ethnic groups HIV-positive Africans were more reluctant to test for HIV, and those who were sero-positive showed lower uptake of anti-retroviral treatments. Furthermore, there was evidence of poor attendance at clinical monitoring sessions, and it was argued that lat

Rock :: essays research papers

Rock Later styles of heavy rock music in the 1990s, such as grunge (the typical example being Seattle's Nirvana), show influences of heavy metal but are typically not labelled sub-genres of heavy metal, as opposed to thrash metal and hair metal. The general absence of virtuosic guitar solos is perhaps one reason grunge bands haven't been considered heavy metal bands. Another key artist during this time was Megadeth, which combined the relentless, speedy thrash metal riffs with the fancy guitar soloing of speed metal ala Judas Priest. Norwegian Black Metal Since the late '80s, the Norwegian scene has been characterized by paganism, violence, and some of the best heavy metal ever recorded. The scene was largely influenced by a trio of non-Norwegian bands in the 80s - Venom, Celtic Frost, and Bathory. England's Venom is widely considered to be the first black metal band, and their campy satanic posturing was a huge influence on Europe's extreme metal scenes. Their second album, "Black Metal", gave the new genre its name. the band that had the most direct influence on Norway's extreme metal scene was a one-man studio project from Sweden called Bathory. Bathory's album "Under the Sign: The Sign of the Black Mark" pretty much defines the typical black metal sound - loud, fast, and poorly recorded. However, the Viking Trilogy, consisting of the albums "Blood, Fire, Death", "Hammerheart", and "The Twilight of the Gods", is what really kicked off the explosion of Scandinavian metal. The early 90s saw the Norwegian metal scene rise in prominence on the world stage as bands constantly tried to "out-evil" one another. Three main bands emerged - Mayhem, Burzum, and Emperor. (Especially Emperor, IMHO) Mayhem became the musical leader of the scene, while Varg Vikernes of Burzum became the centerpoint of the Black Metal "movement", for lack of a better word. Emperor, meanwhile, garnered the most critical acclaim. Varg (aka "Count Grishnakh") was responsible for starting a wave of church-burnings and grave desecrations and eventually murdered Mayhem guitarist Euronymous. Emperor has probably had the most lasting influence on the scene, as the sound that they created has been the blueprint for many bands such as Norwegian metal superstars Dimmu Borgir, as well as a large number of non-Norwegian bands. DIMMU BORGIR Dimmu Borgir is a melodic black metal band hailing from Norway. Shagrath, Silenoz and Tjodalv initiated the band in 1993. Shortly after, Brynjard Tristan joined to play bass, and Stian Aarstad joined for keyboard duties. Dimmu Borgir was born. They are a band which success is measured with such bands as Emperor, Kreator and Cradle of Filth.

Physics of How Tires Throw Rocks :: physics tire rock

Many of us have gotten rock chips, but how many of us understand how those pesky rocks hit our windshield? A common misconception is that the car in front of us throws rocks "backward" and hits the following car's windshield. A rolling tire cannot throw a rock backwards. A tire is a rolling object, thus every point along the tire is moving forwards. There is no force going in a backwards direction. Only direction part of a rolling object can go is a combination of up or down, and forward. The velocity of the rock at any given point can be determined by adding it's translational velocity at the center of mass (the orange arrow) with it's rotational velocity. Vrock= Vcenter of mass + Wrock Where V is the translational velocity, and W is the angular velocity This can be simplified to Vrock=WDR Where D is the distance from the road at the point of contact in terms of R, the Radius. That is to say, that the velocity at the top of the tire would be Vrock=W(2R) =2Vcenter That is to say, that the rock at the top of the tire may be going twice as fast as car itself. Similarly, at the point of contact of with the road, the velocity of the rock is 0. So this leaves one to ask, how do those pesky rocks get thrown at a windshield? If it is hit by the following car, then it is because the rock was thrown somewhat vertically, slowed down by air resistance and the car behind it ran into the rock. It can also be hit by a car going in the opposite direction. The magnitude of this collision will be much greater because it involves objects going in opposing directions. This is why the worse rock chips are often from cars going in the opposite direction, and why it is possible to throw rocks at yourself, which often do not do any damage. Tires are thrown from tires because the centrifugal force expels snow, rocks, and other foreign objects.

Evil: Mark Twain and Higher Animals

From The Damned Human Race by Mark Twain Mark Twain is a central figure in American literature. The Adventures of Huckleberry Finn, his finest work, is the story of a journey down the Mississippi by two memorable figures, a white boy and a black slave. Twain was born Samuel Langhorne Clemens in 1835 and was raised in Hannibal, Missouri. During his early years, he worked as a riverboat pilot, newspaper reporter, printer, and gold prospector.Although his popular image is as the author of such comic works as The Adventures of Tom Sawyer, Life on the Mississippi, and The Prince and the Pauper, Twain had a darker side that may have resulted from the bitter experiences of his life: financial failure and the deaths of his wife and daughter. His last writings are savage, satiric, and pessimistic. The following selection is taken from Letters from the Earth, one of his last works. It has been under the title The Damned Human Race and has been printed in numerous essay anthologies.Did todayâ⠂¬â„¢s newspaper feature headlines about people fighting somewhere in the world (Iraq, Afghanistan, Africa)? Most likely, it did. In the following selection, Mark Twain concludes that the combative and cruel nature of human beings makes them the lowest of creatures, not the highest. With scathing irony, he supplies a startling reason for humans’ warlike nature. The Damned Human Race Mark Twain I have been studying the traits and dispositions of the lower animals (so-called), and contrasting them with the traits and dispositions of man.I find the result humiliating to me. For it obliges me to renounce my allegiance to the Darwinian theory of the Ascent of Man from the Lower Animals; since it now seems plain to me that the theory ought to be vacated in favor of a new and truer one, this new and truer one to be named the Descent of Man from the Higher Animals. In proceeding toward this unpleasant conclusion I have not guessed or speculated or conjectured, but have used what is c ommonly called the scientific method. That is to say, I have subjected every postulate that presented itself to the crucial test of ctual experiment, and have adopted it or rejected it according to the result. Thus I verified and established each step of my course in its turn before advancing to the next. These experiments were made in the London Zoological Gardens, and covered many months of painstaking and fatiguing work. Before particularizing any of the experiments, I wish to state one or two things which seem to more properly belong in this place than further along. This, in the interest of clearness. The massed experiments established to my satisfaction certain generalizations, to wit: 1.That the human race is of one distinct species. It exhibits slight variations (in color, stature, mental caliber, and so on) due to climate, environment, and so forth; but it is a species by itself, and not to be confounded with any other. 2. That the quadrupeds are a distinct family, also. Th is family exhibits variations (in color, size, food preferences, and so on; but it is a family by itself). 3. That the other families (the birds, the fishes, the insects, the reptiles, etc. ) are more or less distinct, also. They are in the procession.They are links in the chain which stretches down from the higher animals to man at the bottom. Some of my experiments were quite curious. In the course of my reading I had come across a case where, many years ago, some hunters on our Great Plains organized a buffalo hunt for the entertainment of an English earl. They had charming sport. They killed seventy-two of those great animals; and ate part of one of them and left the seventy-one to rot. In order to determine the difference between an anaconda and an earl (if any) I caused seven young calves to be turned into the anaconda’s cage.The grateful reptile immediately crushed one of them and swallowed it, then lay back satisfied. It showed no further interest in the calves, and n o disposition to harm them. I tried this experiment with other anacondas; always with the same result. The fact stood proven that the difference between an earl and an anaconda is that the earl is cruel and the anaconda isn’t; and that the earl wantonly destroys what he has no use for, but the anaconda doesn’t. This seemed to suggest that the anaconda was not descended from the earl.It also seemed to suggest that the earl was descended from the anaconda, and had lost a good deal in the transition. I was aware that many men who have accumulated more millions of money than they can ever use have shown a rabid hunger for more, and have not scrupled to cheat the ignorant and the helpless out of their poor servings in order to partially appease that appetite. I furnished a hundred different kinds of wild and tame animals the opportunity to accumulate vast stores of food, but none of them would do it.The squirrels and bees and certain birds made accumulations, but stopped wh en they had gathered a winter s supply, and could not be persuaded to add to it either honestly or by chicane. In order to bolster up a tottering reputation the ant pretended to store up supplies, but I was not deceived. I know the ant. These experiments convinced me that there is this difference between man and the higher animals: he is avaricious and miserly; they are not.In the course of my experiments I convinced myself that among the animals man is the only one that harbors insults and injuries, broods over them, waits till a chance offers, then takes revenge. The passion of revenge is unknown to the higher animals. Roosters keep harems, but it is by consent of their concubines; therefore no wrong is done. Men keep harems but it is by brute force, privileged by atrocious laws which the other sex were allowed no hand in making. In this matter man occupies a far lower place than the rooster. Cats are loose in their morals, but not consciously so.Man, in his descent from the cat, has brought the cats looseness with him but has left the unconsciousness behind (the saving grace which excuses the cat). The cat is innocent, man is not. Indecency, vulgarity, obscenity (these are strictly confined to man); he invented them. Among the higher animals there is no trace of them. They hide nothing; they are not ashamed. Man, with his soiled mind, covers himself. He will not even enter a drawing room with his breast and back naked, so alive are he and his mates to indecent suggestion.Man is The Animal that Laughs. But so does the monkey, as Mr. Darwin pointed out; and so does the Australian bird that is called the laughing jackass. No! Man is the Animal that Blushes. He is the only one that does it or has occasion to. At the head of this article we see how three monks were burnt to death a few days ago, and a prior put to death with atrocious cruelty. Do we inquire into the details? No; or we should find out that the prior was subjected to unprintable mutilations.Man (w hen he is a North American Indian) gouges out his prisoners’ eyes; when he is King John, with a nephew to render untroublesome, he uses a red-hot iron; when he is a religious zealot dealing with heretics in the Middle Ages, he skins his captive alive and scatters salt on his back; in the first Richards time he shuts up a multitude of Jew families in a tower and sets fire to it; in Columbus’s time he captures a family of Spanish Jews and (but that is not printable; in our day in England a man is fined ten shillings for beating his mother nearly to death with a chair, and another man is fined forty shillings for having four pheasant eggs in his possession without eing able to satisfactorily explain how he got them). Of all the animals, man is the only one that is cruel. He is the only one that inflicts pain for the pleasure of doing it. It is a trait that is not known to the higher animals. The cat plays with the frightened mouse; but she has this excuse, that she does n ot know that the mouse is suffering. The cat is moderate (unhumanly moderate: she only scares the mouse, she does not hurt it; she doesnt dig out its eyes, or tear off its skin, or drive splinters under its nails) man-fashion; when she is done playing with it she makes a sudden meal of it and puts it out of its trouble. Man is the Cruel Animal. He is alone in that distinction.The higher animals engage in individual fights, but never in organized masses. Man is the only animal that deals in that atrocity of atrocities, War. He is the only one that gathers his brethren about him and goes forth in cold blood and with calm pulse to exterminate his kind. He is the only animal that for sordid wages will march out, as the Hessians did in our Revolution, and as the boyish Prince Napoleon did in the Zulu war, and help to slaughter strangers of his own species who have done him no harm and with whom he has no quarrel. Man is the only animal that robs his helpless fellow of his country takes p ossession of it and drives him out of it or destroys him. Man has done this in all the ages.There is not an acre of ground on the globe that is in possession of its rightful owner, or that has not been taken away from owner after owner, cycle after cycle, by force and bloodshed. Man is the only Slave. And he is the only animal who enslaves. He has always been a slave in one form or another, and has always held other slaves in bondage under him in one way or another. In our day he is always some mans slave for wages, and does that mans work; and this slave has other slaves under him for minor wages, and they do his work. The higher animals are the only ones who exclusively do their own work and provide their own living. Man is the only Patriot.He sets himself apart in his own country, under his own flag, and sneers at the other nations, and keeps multitudinous uniformed assassins on hand at heavy expense to grab slices of other peoples countries, and keep them from grabbing slices of his. And in the intervals between campaigns, he washes the blood off his hands and works for the universal brotherhood of man, with his mouth. Man is the Religious Animal. He is the only Religious Animal. He is the only animal that has the True Religion, several of them. He is the only animal that loves his neighbor as himself, and cuts his throat if his theology isn’t straight. He has made a graveyard of the globe in trying his honest best to smooth his brother’s path to happiness and heaven.He was at it in the time of the Caesars, he was at it in Mahomet’s time, he was at it in the time of the Inquisition, he was at it in France a couple of centuries, he was at it in England in Mary’s day, he has been at it ever since he first saw the light, he is at it today in Crete (as per the telegrams quoted above) he will be at it somewhere else tomorrow. The higher animals have no religion. And we are told that they are going to be left out, in the Hereafter. I wonder why? It seems questionable taste. Man is the Reasoning Animal. Such is the claim. I think it is open to dispute. Indeed, my experiments have proven to me that he is the Unreasoning Animal. Note his history, as sketched above. It seems plain to me that whatever he is he is not a reasoning animal. His record is the fantastic record of a maniac.I consider that the strongest count against his intelligence is the fact that with that record back of him he blandly sets himself up as the head animal of the lot: whereas by his own standards he is the bottom one. In truth, man is incurably foolish. Simple things which the other animals easily learn, he is incapable of learning. Among my experiments was this. In an hour I taught a cat and a dog to be friends. I put them in a cage. In another hour I taught them to be friends with a rabbit. In the course of two days I was able to add a fox, a goose, a squirrel and some doves. Finally a monkey. They lived together in peace; even affectiona tely. Next, in another cage I confined an Irish Catholic from Tipperary, and as soon as he seemed tame I added a Scotch Presbyterian from Aberdeen.Next a Turk from Constantinople; a Greek Christian from Crete; an Armenian; a Methodist from the wilds of Arkansas; a Buddhist from China; a Brahman from Benares. Finally, a Salvation Army Colonel from Wapping. Then I stayed away two whole days. When I came back to note results, the cage of Higher Animals was all right, but in the other there was but a chaos of gory odds and ends of turbans and fezzes and plaids and bones and flesh not a specimen left alive. These Reasoning Animals had disagreed on a theological detail and carried the matter to a Higher Court. One is obliged to concede that in true loftiness of character, Man cannot claim to approach even the meanest of the Higher Animals.It is plain that he is constitutionally incapable of approaching that altitude; that he is constitutionally afflicted with a Defect which must make such approach forever impossible, for it is manifest that this defect is permanent in him, indestructible, ineradicable. I find this Defect to be the Moral Sense. He is the only animal that has it. It is the secret of his degradation. It is the quality which enables him to do wrong. It has no other office. It is in capable of performing any other function. It could never hate been intended to perform any other. Without it, man could do no wrong. He would rise at once to the level of the Higher Animals.Since the Moral Sense has but the one office, the one capacity (to enable man to do wrong) it is plainly without value to him. It is as valueless to him as is disease. In fact, it manifestly is a disease. Rabies is bad, but it is not so bad as this disease. Rabies enables a man to do a thing, which he could not do when in a healthy state: kill his neighbor with a poisonous bite. NC) one is the better man for having rabies: The Moral Sense enables a man to do wrong. It enables him to do wro ng in a thousand ways. Rabies is an innocent disease, compared to the Moral Sense. No one, then, can be the better man for having the Moral Sense. What now, do we find the Primal Curse to have been?Plainly what it was in the beginning: the infliction upon man of the Moral Sense; the ability to distinguish good from evil; and with it, necessarily, the ability to do evil; for there can be no evil act without the presence of consciousness of it in the doer of it. And so I find that we have descended and degenerated, from some far ancestor (some microscopic atom wandering at its pleasure between the mighty horizons of a drop of water perchance) insect by insect, animal by animal, reptile by reptile, down the long highway of smirch less innocence, till we have reached the bottom stage of development (namable as the Human Being). Below us, nothing. Discussion Question: How does Twain use satire in this essay? Be specific and refer to the text along with your explanation. Summary Response Assignment: Write a summary response on Twain’s essay, The Damned Human Race. †¢ †¢In the first part of your paper, the summary, you should objectively (without bias) summarize the essay by discerning only the most significant points Twain makes. Do not include analysis, interpretation, evaluation, or opinion. Simply report the â€Å"guts† of his essay. Use academic, third person voice in this section. In the second part of your paper, the response, comment on Twain’s essay. How do you interpret it? What do you think about it? With which points do you agree or disagree? Why? Evaluate Twain’s essay. Is it effective or ineffective in making his point? Why? Use first person voice in this section because you are providing your own opinion.