Literature Changes During the Civil War Essay

When the country was still quite young and change was ever-imminent, our great America wasn’t always so great. This budding country lacked its own culture, and every single work produced by its inhabitants was rooted to an earlier version from its mother Britain. Much of our nation was devoid of literary culture and education. We were often looked down upon by other countries flourishing with their own trademark foods, goods, and customs. Very few prominent writers such as Ralph Waldo Emerson were able to create a base example of what an American literature might actually look like. Prior to the Civil War, there were almost no published American authors, as the United States was more inclined toward English texts, which were less expensive. Reading and writing had just begun to trickle down to the middle class, making literature much more popular among the common man, as rates of literacy rose tremendously. The multitude of uses for literature once the Civil War began caused an even larger development. During a time of great change and conflict, America began a period of immense literary thirst. Before the Civil War started, literature had only recently become a more regular piece of daily life. At first only the wealthiest could be expected to know how to read and write. However, as the nation approached the time of the Civil War, the lower classes were also expanding their education by becoming literate. The common man started to take more of an interest and a stand in the goings on of the country- for the most part, learning how to read allowed them to keep up with the happenings from around the nation. Literature was also serving a more entertaining purpose. Fiction grew in popularity, but infamy too. â€Å"American statesmen and leaders were fearful of fiction. They accurately understood its subversive power: fiction empowered individuals; it catered to people’s passions, fancies, and whims, which threatened republican ideas of order and rationality,† (Stauffer 237). As this quote explains, many politicians believed that fiction would lead to chaos and revolution. Literature has always had the power to plant a seed in our minds, and this was no different during the time of the Civil War. Still, these opinions did not keep novels from finding a place in most households. Mostly middle- and upper-class women were the audience for this type of reading material. Fiction, spreading rapidly, became one of the most popular types of literature in this era. Literature before the Civil War was mainly centered on functionality. Literacy had just begun to grow, so the people who learned to read had to have a reason for it. The most common reading material of the time included religious reading, instructive reading, newspapers and magazines, and â€Å"reading for escape† (Salisbury). The best method of escaping for bored housewives or even the common man was a novel. As previously stated, these fictional stories had just begun to boom in popularity. Religious reading mostly included bible study, common for the average Christian household. Newspapers and magazines were crucial for spreading news, and when the nation found an efficient way to broadcast information, people snatched them up. During a time when you couldn’t turn on your flat screen television or pull out your iPad for news updates, newspapers were essential to society. Finally, guides were another usual form of reading material. Stay-at-home wives collected cookbooks and mothering manuals by the shelf-full. All these types of reading provided some function to those who read them, which displays how the country used literature in a very confined manner. The Civil War had a big impact on literature, but literature also had a large impact on the Civil War. For example, the movement against slavery was intensified by passionate works of literature such as Uncle Tom’s Cabin by Harriet Beecher Stowe. These novels helped to spark an interest in the subject for many more people, particularly those of a higher class, who then began to encourage the movement. Literature needed to change in numerous ways. When the war began, letters would be used to keep families in touch with soldiers. News would become more biased and exaggerated depending on its origin (North vs. South). Many children created care packages and wrote letters to soldiers, which gave the men at war some hope and knowledge of the outside world. In 1864, Harper’s Weekly published a story about a young girl named Lula who wished to write a letter to a soldier. That letter wound up in the hands of Daniel P. Fleming- a man who had no family to write to. â€Å"Lula’s letter came when he felt forsaken—desperate—and saved him† (Diffley). Their correspondence created a magnificent bond that carried Fleming throughout the war, and impacted both he and Lula for the remainder of their lives. Literature served a great purpose in the Civil War, and its growth did not stop there. When literature grew in popularity, it had a plethora of effects. It both helped and hurt our country. On one hand, it led to the letters that kept the spirits of our soldiers high. On the other, it produced media that exaggerated truths and spread lies. Since the North and South had greatly varying opinions at the time, their news sources also greatly varied. Each would produce its own version of the truth, and neither would be completely honest. This sensationalism only continued to spread, which became its worst in the 20th century. Not all of the effects of literature’s changes were completely bad, though. Novels allowed people to escape the awful experiences they were going through, if only for a little while. Writers became more successful and American authors had more of a chance as American writing took over the aforementioned British literature. Essays and stories meant to rally the nation during war kept each side unified, even as the country itself split in half. Literature was, perhaps, a great factor in keeping the United States from permanently disbanding. Literature impacts a lot in our lives today: it is a tell-tale sign of the amount of education one receives, it determines a lot of our viewpoints on many issues, and it can even affect the choices you make. This was true during the Civil War era as well, but this took off mostly at the time of the Civil War itself. Before the war, literature had only just begun to spread. It was quite obviously linked to social class as well, as the upper classes were known to have a much higher percentage of literacy than the lower classes. Also, British works became less popular, while American authors prospered. With novels on the rise with the common woman, literature asserted itself as an everyday piece of life. This was reinforced by the use of newspapers, magazines, and books that provided instruction and recipes. Literature took off right before the start of the Civil War, in part causing it. Certain literary works had a strong impact on society, creating controversy and drawing the boundary between the North and the South. Literature also played a huge role in the lives of many soldiers during the war itself. It not only kept the soldiers motivated by giving them something to look forward too, but it also connected them to the outside world and reminded them of all the people they were fighting for. Literature helped to both keep this country together and tear it apart. While the printed media was not always as honest as it should’ve been, and the letters did not always keep the soldiers motivated, it is impossible to argue that literature went through an incredible change during the Civil War. Literature will always be a part of our lives, and this rang especially true during this time of struggle, which unlocked an appetite for literature that our country had never known before.

Intramuscular Injection Techniques Essay

The synthesis of art and science is lived by the nurse in the nursing act JQSEPHINE e PATERSON If you would like to contribiito to the art and science section contact: Gwcn Clarke, art and science editor, Nursing Standard, The Heights, 59-65 Lowlands Road, Harrow-on-the-Hill, Middlesex H A l 3AW. email: gwen.clarkeva rcnpublishing.co.uk Intramuscular injection techniques Hunter J (2008) Intramuscular injection techniques. Nursing Standard. 22, 24,35-40. Date of acceptance: October 29 2007 Summary The administration of intrairiLiscLitar (IM) injections is an important part of medication management and a common nursing intervention in clinical practice, A skilled injection technique can make the patient’s experience less painful and avoid unnecessary complications. Intramuscular injections AnIM injection is chosen when a reasonably rapid systemic uptake of the drug (usually within 15-20 minutes} is needed by the body and when a relatively prolonged action is required. The amounts of solution that can he given will depend on the muscle bed and range from 1 -5ml for adults. Much smaller volumes are acceptable in children (Rodger and King 2000, Corben 2005). The medication is injected into the denser part ofthe muscle fascia below the subcutaneous tissues. This is ideal because skeletal muscles have fewer pain-sensing nerves than subcutaneous tissue and can absorb larger volumes of solution because ofthe rapid uptake ofthe drug into the bloodstream via the muscle fibres. This means that IM injections are less painful when administered correctly and can be used to inject concentrated and irritant drugs that could damage subcutaneous tissue (Rodger and King 2000, Greenway 2004). Examples of drugs administered via this route are analgesics, anti-emetics, sedatives, immunisations and hormonal treatments. It is important to recognise and understand potential complications associated with IM injections and that rapid absorption of the drugs may increase these risks (Foster and Hilton 2004). The administration of any medication can present a risk and, therefore, the nurse must be able to recognise the signs of an anaphylactic (allergic) reaction, with signs of, for example, urticaria, pruritus, respiratory distress, shock or even cardiac arrest. Inappropriate selection of site and poor technique can increase the risk of patient injury and lead to pain, nerve injury, bleeding, accidental intravenous administration and sterile abscesses caused through repeated injections at one site with poor blood flow (Rodger and King2000). Author Janet Hunter is lecturer in adult nursing, City Community and Health Sciences, incorporating St Bartholomew School of Nursing and Midwifery, City University, London. Email: j.a.hunter@city.ac.uk Keywords Clinical procedures; Drug administration; Injection technique Tliese keywords are based on the subject headings from the British Nursing Index. Tliis article has been subject to double-blind review. For author and research article guidelines visit the Nursing Standard home page at www.nursing-standard.cD.uk. For related articles visit our online archive and search using the keywords. THE NURSING and Midwifery Council’s (NMC’s) (2007) Standards for Medicines Management state that administration of medicines ‘is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner (now independent/supplementary prescriber). It requires thought and the exercise of professional judgement.’ Therefore, the administration of intramuscular (IM) injections requires the healthcare practitioner to possess the knowledge and rationale of the guiding principles that underpin these clinical skills. It is essential that all aspects of these techniques -anatomy, physiology, patient assessment, preparation and nursing interventions – are evidence based so that the nurse can perform safe and accountable practice (Shepherd 2002, NMC 2007). The aim of this article is to update the nurse’s knowledge and skills on injection techniques. This article describes the practical, step-by-step approach for administering IM injections, which will assist nurses to perform this skill safely and competently. NURSING STANDARD Intramuscular injection sites There are five sites that can be considered for IM february 20 :: vol 22 no 24 :: 2008 35 art & science clinical skills: 37 injections (Figure 1). The two recommended sites for IM injections are the vastus lateralis and the ventrogluteal sites (Donaldson and Green 2005, Nisbet 2006). However, when the patient is obese, rhe vastus laterahs is a better option (Nisbet 2006). When choosing an appropriate site for administration, the nurse needs to ensure that the medication will be absorbed. The nurse needs to consider whether the patient is receiving regular ]M injections because the site will need to be rotated to avoid irritation, pain and sterile abscesses. Choice will also be influenced by the patient’s physical condition and age. Active patients are more likely to have a greater muscle FIGURE 1 Sites for intramuscular injections (IM) Mid-deltoid site The mid-deltoid site is easily accessible but due to the size of the muscle the area should not be used repetitively and only small volumes shouid be injected. Tlie maximum volume should be 1ml (Rodger and King 2000). Tlie denser part of the deitoid must be used. It is Lisef j l to visualise a triangle whereby the horizontal line is located 2.5-5cm below the acromial process and the midpoint of the lateral aspect of the arm in line with the axilla forms the apex. The injection is given about 2.5cm down from the acromiai process, avoiding the radial and brachial nerves (Workman 1999, Rodger and King 2000). Dorsogluteal site Tliis a’&3. is used for deep IM and Z-track injections. Up to 4mi can be injected into this muscle (Workman 1999, Rodger and King 2000). Commonly referred to as the outer upper quadrant, it is located by using imaginary lines to divide the buttocks into four quarters. To identify the gluteus maximtis, picture a line that extends from the iiiac spine to the greater trochanter of the femur. Draw a vertical line from the midpoint of the first line to identify the upper aspect of the upper outer quadrant This location avoids the superior gluteal artery and sciatic nerve (Workman 1999, Small 2004). Rectus femoris site This site is used for deep I M and Z-track injections. Between mass than older or emaciated patients, so individuals will need to be assessed to see if they have sufficient muscle mass. If not, the muscles may need to be ‘pinched’ up before the injection (Workman 1999, Rodger and King 2000). Any area or presence of inflammation, swelling or infection should be avoided (Workman 1999). Patient preparation It is important to explain the procedure so that the patient fully understands and is able to give his or her informed consent and co-operation. The discussion should include the choice of site for the injection and information about the medication, action and side effects. The patient can then express any concerns or anxieties relating to the procedure and the patient’s knowledge can be l-5ml can be injected, although for infants this would be 1-3 mi. The rectus femoris is a large and well-defined muscle and is the anterior muscle of the quadriceps. I t is located halfway between the superior iliac crest and the patella (Workman 1999), Vastus lateralis site The vastus lateralis site; used for deep IM and Z-track injections. Up to 5ml can be administered (Rodger and King 2000). The muscle forms part of the quadriceps femoris group of muscles and is located on the outer side of the femur. If is foLind by measuring a hand’s breafh from the greater trochanter and the knee joint, which identifies the middle third ofthe quadriceps muscle (Workman 1999). There are no major blood vessels or structures which could cause an injury in this area (Rodger and King 2000). Ventrogluteal site This site is used for deep IM and Z-track injections. This site is located by placing the palm ofthe nurse’s hand on the patient’s opposite greater trochanter (for example, the nurse’s right palm on the patient’s left hip), then extending the index finger to the anterior superior iliac spine to make a ‘V. The injection is then given into the gluteus medius muscle, which is the centre of fhe V (Workman 1999, Rodger and King 2000). Evaluated. It is important to check whether the patient has any known allergies to identify potential reactions to the medication. FVeparation ofthe equipment All the necessary equipment shouid be prepared before commencing the procedure to avoid any delays or interruptions during rhe procedure. The equipment required for administering IM injections is listed in Box I and preparation of rhe equipment is described in Box 2. The techniques used for administering IM injections are outlined in Box 3. Skin cleansing There are inconsistencies regarding skin preparation for IM injections. It is known rhar cleansing the injection site with an impregnated alcohol swab before an IM injection reduces rhe number of bacteria on the skin (Workman 1999, Lister and Sarpal 2004). However, if rhe injection is given before rhe skin is dry this procedure is ineffective and rhe patienr may experience pain and a sdnging sensation from rhe antiseptic. This may allow entry of bacteria inro rhe injection site and cause local irritation (Workman 1999, Lister and Sarpal 2004). Therefore, when using an alcohol swab ro prepare the skin it should be used for 30 seconds and then allowed to dry (Lister and Sarpal 2004). Some local policies no longer recommend skin cleansing ifthe patient’s skin is physically clean (Little 2000, Wynaden et al2005) and the nurse maintains rhe required standard of hand washing and asepsis during rhe procedure (Workman 1999). Equipment for intramuscular injections I 2. 3. 4. 5. 6. 7. 8. 9. Prescription chart. Prescribed drug to be administered. If required, diluent for reconstitution. Clean tray or receiver for equipment, Syringe of appropriate size (2-5ml), Sterile 21G (green) needle for adult patients. Alcohol-impregnated swab with isopropyi alcohol 70%. Gloves. Tissue or clinical wipe. 10. Clinical sharps container. Preparation for intramuscular (IM) Injection administration The following steps describe the procedure when preparing the equipment for an I M injection. †¢ Wash and dry hands thoroughly with bactericidal soap and wafer or use bactericidal handrub to prevent any contamination of the equipment or medication. Put on gloves. Gloves are required for all invasive procedures including IM injection (Pratt etal2Q07). Check the patient’s prescription chart and determine the: – Drug that is to be administered. – Required dose. – Route for administration. – Date and time of administration. – Prescription is legible and signed by an authorised prescriber. These actions ensure that any risk to the patient is minimised and that the patient is given the right dose of medication at the correct time by the prescribed route (Jamieson et al 2002, Lister and Sarpal 2004). If any errors are noticed withhold the medication and inform the medical team. Check the drug against the prescription chart. As all medications deteriorate over time, check the expiry date – this shows when a drug will no longer be guaranteed to be effective. To prepare the syringe for medication: (a) Check all packaging is intact to retain sterility. Check the expiry date. If any packaging is damaged or has expired, discard. (b) Open the packaging of the syringe at the plunger end and remove the syringe. Make sure that the plunger moves freely inside the barrel. Take care not to touch the nozzle end to prevent contamination. (c) Open the needle packaging at the hilt (coloured) end. Hold the syringe in one hand and then attach the needle firmly onto the nozzle of the syringe. Loosen the sheath but do not remove it. Place the syringe on the tray. This prevents contamination or any potential injuries. †¢ Examine the solution in the ampoule for cloudiness or sedimentation. This may show that the medication is contaminated or unstable. Make sure that all the contents are in the bottom o f t h e ampoule by tapping the neck gently. To prevent injury, splashing or contact with the medication use a clinical wipe or tissue to cover the neck of the ampoule and break it open. Observe the solution for any glass fragments because these pose a risk to the patient if injected. Discard the ampoule and contents if any foreign matter is visible. !f you are using a plastic ampoule, break the top off, making sure not to touch the top. †¢ Pick up the syringe and allow the sheath to fall off the needle onto the tray and insert the needle into the solution of the ampoule. Avoid scraping the needle on the bottom of the ampoule, because this wilt blunt the needle. †¢ Pull back the top of the plunger with one finger on the flange and draw up the required dose. I t may be necessary to tilt or hold the ampoule upside down to make sure the needle remains in the solution to prevent drawing in air (Figure 2). Take care not to contaminate the needle. †¢ Re-sheathe the needle carefully using the aseptic non-touch technique to to maintain sterility (Figure 3). †¢ Expel the air. Hold the syringe upright, at eye level and let any air rise to the top of the syringe To encourage air bubbles fo rise, lightly tap the barrel ofthe syringe. Slowiy, push the piunger to expel the air until the solution is seen at the top of the needle. Needles Re-sheathing a needle betore the medication is administered to a patient is safe. This method is achieved hy using the aseptic non-touch technique (Figure 3) and prevents droplets of the medication from heing sprayed onto the skin or inhaled when air is heing expelled from the syringe (Nicol etal 2004). When giving an !M injection a ‘green’ or size 21 gauge needle is used for all adult patients to ensure that rhe medication is injected into the muscle. This also applies to patients who are cachectic or thin, except that the needle is not inserted as deeply. If a smaller gauge needle is used the nurse needs to apply more pressure to inject the solution, which will increase the patient’s discomfort (King 2003). Single and multi-dose powder vials Some medications come in single or multi-dose vials and need to he reconstituted before heing drawn up and mjected. The following steps should be undertaken when administering I M injections to patients: †¢ Take the tray with the syringe, ampoule, impregnated alcohol swab, tissue, prescription and sharps container to the patient’s bedside. Re-check the prescription and medication with the patient’s name band according to local policy. Draw the curtains for privacy and assist the patient into a comfortable position to allow access to the injection siteandto make sure that the identified muscle group is flexed and relaxed. †¢ Clean the skin with an impregnated alcohol swab for 30 seconds and then allow to dry to minimise the risk of infection (Lister and Sarpal 2004), or alternatively it should be cleansed in accordance with local policy, †¢ With the non-dominant hand stretch the skin slightly over the chosen injection site to displace the underlying subcutaneous tissues and to aid the insertion of the needle. †¢ With the dominant hand hold the syringe like a dart Having informed the patient, quickly and firmly in a ‘dart-like’ motion insert the needle into the patient’s skin at a 90 ° angle until approximately 1cm of the needle is left showing (Nicol et al 2004, Corben 2005) (Figure 4). †¢ Hold the skin with the ulnar edge of the hand and with the thumb and index finger hold the coloured part of the needle to maintain stability and prevent movement. †¢ Withdraw the plunger slightly to confirm that the needle is in the correct position and has not entered a blood vessel. If blood is not present, depress the plunger and carefully inject the solution at a rate of 1ml per 10 seconds until the syringe is empty to allow the tissues to expand and absorb the solution (Workman 1999, Lister and Sarpal 2004). This rate also reduces patient discomfort. If blood is present stop the procedure and withdraw the needle and syringe. Start again with new equipment and drug and explain to the patient what has happened to reduce patient anxiety. †¢ Wait ten seconds to allow the drug to diffuse into the tissues then quickly and smoothly withdraw the needle. Use a tissue to apply pressure to the injection site or until any bleeding ceases. It is not necessary to massage the area because this may cause the drug to leak from the injection site and cause local irritation (Rodger and King 2000). †¢ Discard the needle and syringe immediately into the sharps container to prevent any injury. Do not re-sheathe the needle. Remove gloves and wash hands, †¢ Record the administration of the medication on the prescription chart to show that the drug has been given. Report any abnormalities or complications. †¢ Replace any clothing and make sure that the patient is comfortable. Return to the patient after 15-20 minutes to observe and check the effectiveness ofthe medication, especially anti-emetics and analgesics. Observe the injection site within two to four hours for signs of local irritation {Rodger and King 2000), involves some key principles to ensure safe practice. †¢ Before reconstiruting any medication, the nurse should first read rhe manufacturer’s information sheet. †¢ It is important that the powder is at the bottom of the vial so thnt all the medication is dissolved. †¢ The cap must be cleaned with an alcoholimpregnated swah and allowed to dry to prevent bacterial contamination. * It is vital that the correct volume of diluent is used according to the manufacturer’s recommendations to provide the most therapeutic concentration. †¢ The diluent should be injected slowly into the vial so that the powder Is wet before mixing. †¢ When mixing, ensure the needle remains inside the vial to maintain sterility. If there is pressure In the vial hold the plunger down while doing this to avoid the separation ofthe needle and syringe from the vial {Nicol etal 1004}. To mix the medication, agitate or roll the vial until the powder has dissolved. For some powder multi-dose vials, a needle is inserted into the cap before adding the diluent because this allows air to escape and releases the vacuum in the vial. Then with a second needle and syringe, inject the diluent into the vial. Remove the needle and syringe and place a sterile swab over the venti ng need le to prevent contamination ofthe drug and the atmosphere. Agitate or roll the ampoule until the powder has dissolved (Jamieson etal2002., Lister and Sarpal 2004). All solutions need to be inspected for precipitation and cloudiness. Continue to agitate until the powder and diluent have fully mixed to form a solution. †¢ Todrawuprhedrug, hold the ampoule upside down to avoid drawing in air, insert the needle so that it is below the level ofthe solution and pull back the plunger to withdraw the correct amount of solution. For multi-dose vials, clean the cap with an impregnated alcohol swab and allow to dry before inserting the needle and syringe to prevent bacterial contamination.

Consumer behavior about target-based internet market in China Dissertation

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The Characteristics of the Good Prince (Leader) Essay

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Finance and Market , short essay question Example | Topics and Well Written Essays - 8500 words

Finance and Market , short question - Essay Example For the purpose of this study, we dwell on the advantages and disadvantages of the diversification of REITs holdings’ activities as opposed to the focused approach. Advantages Wider Market Cover When a REIT agency registers to venture into specific areas, there is an aspect of additional market cover. REIT can thus conduct a number of projects which essentially maximize its potential. This in the broader picture implies additional return on investment and maximizes the proportions of dividends that the shareholders gain in the REIT investment. This is not usually the practical case of REITs business that is restricted to specific line of real estate development. If REITs companies have specifications to operate in restricted lines of business, they cannot later on expand to more openings and business opportunities. In a diversified perspective however, REITs have to enjoy a dynamic market characterized by a wide range of business opportunities than maintenance of an ordinary r eal estate portfolio. Dynamism and Innovations Secondly, diversification have in the past enabled RETs to introduce and practice innovative ideas in the real estate properties without the risks of exceeding the limits of operation as stated in the description of the real estate portfolio. ... This approach provides opportunities for to enable the REITs to practice real estate swap which the enables upcoming potential real estate investors to get sufficient exposure to real estate property business without necessarily fulfilling the huge amounts of capital commitment. In the swap, REITs enjoy unlimited exposure to real estate and have the ability to change their capital equity and bonds without restrictions or regulations. This means that REITs sources of revenue will then not be limited to interests, but also bonds, equity and commodities. With the inclusion of the international diversification in Real Estate, there is a low correlation with interest rates than with bonds and equities. The scale of International diversification in real estate investment securities exposes REITs to minimal risk compared to the focus on equities and bonds. Disadvantages High Taxation REITs occupy larger portfolios in real estate trading and this attracts more taxes due to the statutory cons ideration of the return on investment. The wider the portfolio a real estate maintains, the larger the taxation that is applied. This is a great and inevitable challenge which incidentally is not negotiable. Risks of Over-Commitment Secondly, REITS face high risks of over-committing capital equity into long term investments whose returns are not guaranteed. This is a high risk that either leads to the extreme results, either too high losses or extremely high returns. To realize high returns in this case requires REITs to conduct systematic studies of the contemporary market risks. Divergence of focus The third disadvantage that REITs get exposure to in the diversified

Managing Organisational Change Assessment 3 Essay

Managing Organisational Change Assessment 3 - Essay Example Still, despite the paramount importance of change and the need for continual evolution in the corporate world, there is no dearth of organizations who pathetically fail to qualify the preliminary challenge of recognizing the urgency to alter and change, what to speak of ensuing adjustments and planning. The organization under consideration that is Rondell Data Corporation is an apt example of such a dilemma where an organization fails to acknowledge the pressing need for change, despite being aware of the debilitating warning signals and unhealthy symptoms. Acceptance of change within organisations is a trait that often percolates down from top to bottom (Clement, 1994, p.1). It is the cardinal duty of the top management within an organisation, whether it is the president or the top executives, to clear the behavioural or cultural obstacles that hamper change (Beer, Eisenstat & Spector, 1990, p. 158-166). Specifically speaking, it is the prerogative of the top management to take the necessary steps to bring about the desired changes in all the three aspects of organisational culture i.e. assumptions, values and artefacts, to aid and assist the painful process of change (Schein, 1985, p.25). However, the top management at Rondell seems to be utterly confused or self complacent. The President i.e. Bill Hunt is well aware of the problems being faced by the organisation, but has still chosen to ignore the urgent need for fostering the requisite changes within the organisation. He prefers to act more of an academician, which goes well with his background and favours to delegate the onus for change to his immediate subordinates. To assess an organization's culture, it is often more relevant to consider the behaviours and performance rather then blindly appreciating the stressed upon values (Clement, 1994, p.2). His insistence on maintaining the family spirit at Rondell is not matched by the required levels of output and success.Frank Forbus, though being the incharge of one of the most crucial departments at Rondell i.e. Engineering Services Department, is caught in a precarious situation. Rather then performing the core task of extending engineering related backup and assistance to the concerned departments, most of his time and efforts seems to be engaged in soliciting the cooperation and support of other departmental heads. His commitment and credibility is being severely jeopardized by the limited job security that his position commands (Becker, 1960, p.14). Doc Reeves though enjoys a position of unique importance at Rondell, appears to be least committed to administrative procedures, schedules and deadlines. He is infact more of a visionary academician who prefers to work in isolation from the overall production and sales objectives, a flaw that is severely compromising the sustainability of Rondell (McFarlane, 1993,

Portfolios Essay Example | Topics and Well Written Essays - 1000 words

Portfolios - Essay Example There are many types of portfolios and some include the documentation portfolio, process portfolio and the show case portfolio. The documentation portfolio also known as working portfolio is an approach that entails the compilation of data that shows the growth and progression of scholars. A process portfolio is another type of portfolio that shows the general learning process of students. This means that the portfolio collects the small details of the student works and shows how a student used his/her skills to improve their grades. This type of portfolio also shows the self-reflection of the students. Showcase portfolios illustrate the cumulative assessment of the syllabus mastery by the student. It contains the best work of the student from the topics that the teachers have seen suitable for evaluation (Sharp) An electronic portfolio is a portfolio that uses technological methods to document and store the information of a student. It is better that the other types of portfolios because it uses many methods of documenting and storing data. These methods include auditory, visual and graphics. The electronic portfolios have the potential of sorting out materials so that they connect facts to suitable standards. The information can be in form of a tape or computer readable structure. Portfolios are a good way of teaching students as the students will be able to assess themselves in their learning process. When a student looks at how he is gradually becoming a poor student, he may be able to pay more attention to his weak points and work harder to perform better. Moreover, through the student portfolio, a teacher is able to make the students perform better in their studies and improve their weak points (Aurbach, 2006). Unlike a report card, which will only show a grade like C or B, a portfolio shows much more detail. It will show the weakness and struggles of a student. This is

A Reflection on Children Full of Life Movie Review

A Reflection on Children Full of Life - Movie Review Example On my part, the message of this short video virtually demolishes certain ideas regarding the aims and methods of teaching primary education level students. For a long time, I have always held on to the belief that teachers are supposed to project an impression of infallibility when it comes to teaching subjects to students. Aside from this, I have also thought that teachers should be strict disciplinarians, unwavering in their commitment to impose rules on the students and even, unbending, when it comes to meting disciplinary actions. However, I could not believe it when the teacher, Mr. Kanamori, actually allows his students to express their opposition to his views and, ultimately, changing his previous stance of punishing Yuto. There are actually two things that struck me while watching the clip; first is the students’ compassion towards their classmate, and second is the teacher’s teaching style and appreciation of the students’ independent and opposing views. I think that the two are actually related to each other. In the first place, a very rigid atmosphere in the classroom established by the teacher would make it impossible for children at such young age and to learn how to assert their ideas even if these are not in concurrence to those of the teacher.

This paper will be both an analysis of Freires educational theory as Essay - 1

This paper will be both an analysis of Freires educational theory as well as a critical - Essay Example A dialogue was a concept that remained alien to me throughout. What kept me the sane throughout that I was a part of the football team, as a left defender, I found myself becoming one with the green turf. (Freire 20) Every time I returned home, I would watch my brothers having a completely different perspective about their school. Deep inside I hated mine, I felt like a caged bird who is considered lucky because it gets fed there, the same was the case with me, I was told that I go to one of the best schools in town with the best teachers. I always wondered how they were good, when I hardly knew a thing about them except their names. Freire, in his theory involves the same idea with an example of the banking system, where the entire operating system is pre-defined, and you need to follow the sequence to get your things done or fill up your account. Alexander Cameron, My schooling was no different, a defined syllabus and handing over good notes followed by above average scores in examinations meant that you’re a good student with good personality. I missed the times of my early schooling that was just a next door daycare center in town, and I must admit that more than an apple’s spelling; I remember it by its shape. The connection between the two was made when my teacher handed over an apple to me and asked me to spell its name, I am quite sure that if she had just asked me to memorize the spellings at that time, I would not remember it so well. (Freire & Matthew 30) My brothers always had different activities on campus, like when they were taught about vegetables and plants, their teachers actually took them out for gardening. And they remembered every single name with the entire procedure in a far better way than I did. One of them would just not study harder during the exams because he remembered the day to day things so well already. I personally think that learning is a two-way process and defining one

Steel Economics Commentary Essay Example for Free

Steel Economics Commentary Essay Around the world, steel suppliers are cutting production levels as demand for the commodity is rapidly decreasing. Due to the recent global recession, people are delaying buying cars and houses, both of which are products that are predominantly made of steel. More specifically, ArcelorMittal, the worlds largest steel producer will be cutting production by more than 30% in Europe and U.S.A, resulting in an estimated $2.5 billion loss in the fourth quarter. Companies like Steel Authority of India Ltd. were forced to reduce their prices by 6000 rupees ($126) a ton in order to increase demand for the commodity, as people do not have the money to buy steel anymore. The extent of this issue has risen to the point where some steel producers are temporarily shutting down factories, and stopping the purchase of raw slabs of steel, like ThyssenKrupp AG, who is Germanys biggest producer. Thus, as a result of the leftward shift in demand for steel, due to reduced consumer incomes, supply has been forced to the right. Price Quantity Due to the decreased demand for steel, there is an excess amount of the commodity (Homogenous goods that are raw materials in critical industries)1. One solution for dealing with this excess amount of steel is by controlling supply (the quantity of goods and services that producers are willing and able to produce for a given time period, ceteris paribus)2 to fit the new level of demand (the quantity of goods and services that consumers are willing and able to buy at all prices, for a given time period, ceteris paribus)3, which some large firms, like ArcelorMittal, are already doing. Although, another solution for steel producers is to manufacture the commodity at the same level at which they were before the global recession, and store the surplus product until the demand and price of steel rise. This solution is based around a buffer stock scheme (A form of intervention to try to stabilize the price of a commodity. Stocks of the commodity are kept and sold when the price is high to try to reduce it. When the price is low further stocks of the commodity are bought)4. The marginal social benefits (incremental benefit of an activity as viewed by the society and expressed as the sum of marginal external benefit and marginal private benefit)5 of implementing a buffer stock scheme would be price stability, and economic growth. By storing the extra steel, if in the future, when the world comes out of the recession, there would ever be a shortage (which would result in high prices and lower demand), prices would stabilize as the large firms would then be able to sell the stored steel back into the market. This would not only benefit consumers, as the price of steel would lower, but also firms, as the quantity demanded for steel would go up (resulting in a rightward shift of the demand curve), due to the previous deliberate increase in quantity supplied thus creating more revenue. Price Output Also, since the demand for steel will eventually rise, and the firms will have a plentiful amount of it stored, steel producers will be able to make a greater profit off the commodity, as compared to the present situation where the steel is being sold for much less than its actual value. This will result in economic growth for steel companies, and the world, as people will start to invest in these companies again, due to the ready amount of steel on the market. These advantages, price stability and future economic growth, both contribute to a firms main goal, to maximize revenue. In conclusion, the marginal social costs (the cost incurred by both the firm and society in producing each extra unit of a good)6 of setting up a buffer stock scheme would be, the hefty amount of start-up capital, the costs of storage, and the fear of scare buyers when the recession ends. Although these MSCs are all major financial concerns, the MSBs outweigh them, as people will be eager to invest in the steel companies, buy new houses and cars, and begin new construction projects (eliminates the fear of scarce buyers). These actions all require steel, meaning thereby that the total revenue generated through this surplus of steel will be greater than the start-up capital, and the storage costs. 1 Notes: Commodity Markets 29th September, 2008 2 Notes: The law of Supply September 24th, 2008 3 Notes The Law of Demand: September 17th 2008 4http://www.bized.co.uk/cgi-bin/glossarydb/browse.pl?glostopic=0glosid=1121 5 http://www.bized.co.uk/cgi-bin/glossarydb/browse.pl?glostopic=1glosid=653 6 http://www.businessdictionary.com/definition/marginal-social-benefit.html

Effects of Heat Treatment on Seed Germination

Effects of Heat Treatment on Seed Germination Introduction Seed germination has been found to be influenced by many factors. Some of these include water availability, nutrients, light, incubation, and heat shock (Masamba, 1994). In the natural Western Australian environment, heat shock is most commonly provided by bushfires. Periodic fires result in an open environment providing enhanced moisture, light, and nutrients which are conducive to the survival of germinated seeds (Bell, Plummer, Taylor, 1993). There are many species of the Western Australian flora, especially in the Leguminosae families, that have a hardened testa in order to suppress germination until fire provides a better chance of seedling survival (Herranz, Ferrandis, Martinez-Sanchez, 1998). Heat shock is required in some plant species to fracture the hard seed coat which allows for water imbibition, gas exchange, and releases the embryo from physical restraints (Mucunguzi, Oryem-Origa, 1996). Short exposures to the high temperatures reached in soil during fires can greatly increase germination percentages of certain species (Bell et al., 1993). Under laboratory conditions, the heat shock usually provided by fire can be simulated using boiling water. Dry heat or scarification and acid treatments can also increase the percent of seeds germinated (Bell et al., 1993). The aim of the experiment was to examine the effects of different temperature heat treatments on the percent germination of four species of legumes. Materials and Methods Plant Material Four different commercially obtained plant species were used to examine the effects of different heat pre-treatments on the percent seed germination of set sample sizes. The four species used in the experiment were Kenndia coccinea, Acacia saligna, Hardenbergia, and Acacia pulchella. Experimental Treatment A total of 600 seeds were taken from each species and divided into sets of 110. Each set was pre-treated at one of five temperatures. The temperatures were: room temperature (24ËÅ ¡C), 40ËÅ ¡C, 60ËÅ ¡C, 80ËÅ ¡C, and 100ËÅ ¡C. The seeds from each treatment were divided into 50 labelled petri dishes, 11 seeds per dish. All of the seeds in a single petri dish underwent the same pre-treatment. The petri dishes were then placed into a dark cupboard for incubation at room temperature and randomized. Viability Test In order to assess the viability of the seeds collections used for the germination experiment, a tetrazolium test was carried out on 96 untreated seeds from each species. The testa of each seed was cracked before being tested. Scoring Germination The numbers of seeds germinated in each petri dish were recorded at the end of each week for four weeks, along with the species and pre-treatment the seeds underwent. A drop of fungicide was used to kill any moulds that were found growing in the petri dishes during incubation. Statistical Analysis The heat treatments of each species were compared using the chi square analysis, allowing for 5% error. The null hypothesis (Ho) for the chi square tests is that the treatments had no effect on the percent of seeds germinated. The alternate hypothesis (Ha) is that the different treatments did have an effect on the percent of seeds germinated. Results The chi square analysis compares the total number of germinated seeds between treatments for one species to determine if statistically, we should accept or reject the null hypothesis. Table 1 displays that Kenndia coccinea, Acacia saligna, and Acacia pulchella all have a chi square value greater that the 5% error value. Therefore, we can be 95 % confident that the Ho should be rejected and Ha accepted. Hardenbergia, however, has a chi square value less than the 5% error value, therefore, Ho is accepted. Table 1 Chi square values and degrees of freedom calculated from the number of germinated seeds of four different plant species after a variety of controlled heat treatments Species Chi Square value 5% error Kenndia Coccinea 52.90909 9.49 Acacia saligna 39.84615 9.49 Hardenbergia 6.15444 9.49 Acacia pulchella 38.5 9.49 Data shows that three of the four chi square values are greater than the 5% error value. This indicates that the null hypothesis should be rejected for Kenndia coccinea, Acacia saligna, and Acacia pulchella. Therefore, Ha is accepted for these species. It is obvious from the graphs in figure 1 that the different heat treatments had little effect on the percent germination of c) Hardenbergia. Significant variations can, however, be seen in the germination of the other three species. Attention should be drawn to the significant increase in germination of d) Acacia pulchella between the 80ËÅ ¡C treatment and 100ËÅ ¡C treatment. a) b) c) d) Fig. 1 Percent germination of a) Kenndia Coccinea, b) Acacia saligna, c) Hardenbergia, and d) Acacia pulchella at the end of a four week growth period. Each species had 500 seeds which were divided into five different heat pre-treatments. Discussion Heat shock treatments have two primary effects on seeds that cease dormancy. Cracking of the seed coat appears to be most common result of heat shock; however, heat can also be used to denature seed coat inhibitors (Hanley, Lamont, 2000). It is obvious from the information displayed in table 1 and figure 1 that temperature has a significant effect on the germination of Kenndia coccinea, Acacia saligna, and Acacia pulchella. In the natural environment, extreme temperatures on the soil surface can be lethal to seeds (Bell et al., 1993). Due to thermal diffusion, seeds below 6 to 8 cm may be too deep to have their seed coats cracked (Hanley, Lamont, 2000). A. pulchella has developed a relationship with ants to maximise germination. The ants bury the seeds at a depth of approximately 4cm which is the depth where heat penetration and temperature required to break dormancy appears to converge (Hanley, Lamont, 2000). A similar heat pre-treatment experiment (Table 2) to the one carried out in this report was carried out by Bell, Plummer, Taylor (1993). They examined the effects of seed scarification and boiling on the percent germination of native Western Australian legumes. The data indicates that a 300 second heat treatment tends to reduce germination percentages in most of the species listed in table 2. Acacia pulchella is one Western Australian species that shows no significant germination in the percent germination (Bell et al., 1993). This information suggests that A. pulchella evolved in an environment that experiences prolonged burning (Bell et al., 1993). The results obtained by Bell, Plummer, Taylor (1993) after examining the effects of no pre-treatments, seed scarification, and heat shock on 55 species of native Western Australian legumes. It is interesting to note that the percent germination graph of A. saligna in figure 1 shows an increase in germination as treatment temperature increased. This result is significant as A. saligna is a coastal habitat species whose seeds have the capacity to survive mild fires, but are unable to endure intense heat (Herranz et al., 1998). While high temperatures are required to crack the seed coat of many native Western Australian species, germination may also be cued by incubation temperatures that would best support the survival of the seedlings (Bell et al., 1993). It is possible that this factor may have influenced the germination results of K. coccinea, A. saligna, Hardenbergia, and A. pulchella. In Western Australia, heat is a key requirement for the successful germination of many plant species. Combinations of factors, however, are often required to maximise the chance of germination of any plant species. Due to the diversity of flora in Western Australia, more research is required to determine the optimal environment for commercial or private cultivation of many species.

Macbeth :: Shakespeare books

God and the devil have a strong presence in â€Å"Macbeth†. The characters look to heaven and hell as places they have to try and strive towards or steer away from. God and the devil seem to be the driving and obvious force behind the happenings of the tragedy. They mold the characters into what they are. Even when things do not end up in their favor. The witches have an impact on the whole theme of the play. They are the ones who start to label Macbeth with titles, which he does not yet posses. The witches predict the future, which is to Macbeth’s liking. â€Å"All hail Macbeth! Hail to thee, Thane of Glamis. All hail Macbeth! Hail to thee, Thane of Cawdor. All hail Macbeth, that’s shalt be king hereafter!†(1.3.46-48). Macbeth at this time was only the Thane of Glamis and he knew he had aspirations of becoming king, but wanted to know how these witches would know to say such things. â€Å"†¦tell me more†¦But how of Cawdor? The thane of Cawdor lives, a prosperous gentleman, and to be king stands not within the prospect of belief.† (1.3.68-73) The witches at this point fade out and leave Banquo and Macbeth to speculate. Ross and Angus enter and tell Macbeth that that the Thane of Cawdor is going to be executed and that Macbeth will take on the title. In Macbeth’s mind this means that he is going to be king. Since the witches were able to predict that he was going to be Thane of Cawdor then he believes he is definitely going to be king. â€Å"What can the devil speak true?†(1.3.107) This is Banquo’s reaction after Ross â€Å"hails† Macbeth with his new title, Thane of Cawdor. Banquo starts to wonder if what the witches proclaimed, would actually come true. If what they said did come true for him it would mean his children would be kings. This quote is sort of strange to me. I am taking it as he refers to the witches as the devil. I don’t know how he came to this conclusion; maybe it is just how he is trained to think towards anyone that can see the future. The witches planted this thought into Macbeth’s head about being king. Since the Cawdor topic came true with ease he believes that him becoming king will also be an easy transition. Macbeth :: Shakespeare books God and the devil have a strong presence in â€Å"Macbeth†. The characters look to heaven and hell as places they have to try and strive towards or steer away from. God and the devil seem to be the driving and obvious force behind the happenings of the tragedy. They mold the characters into what they are. Even when things do not end up in their favor. The witches have an impact on the whole theme of the play. They are the ones who start to label Macbeth with titles, which he does not yet posses. The witches predict the future, which is to Macbeth’s liking. â€Å"All hail Macbeth! Hail to thee, Thane of Glamis. All hail Macbeth! Hail to thee, Thane of Cawdor. All hail Macbeth, that’s shalt be king hereafter!†(1.3.46-48). Macbeth at this time was only the Thane of Glamis and he knew he had aspirations of becoming king, but wanted to know how these witches would know to say such things. â€Å"†¦tell me more†¦But how of Cawdor? The thane of Cawdor lives, a prosperous gentleman, and to be king stands not within the prospect of belief.† (1.3.68-73) The witches at this point fade out and leave Banquo and Macbeth to speculate. Ross and Angus enter and tell Macbeth that that the Thane of Cawdor is going to be executed and that Macbeth will take on the title. In Macbeth’s mind this means that he is going to be king. Since the witches were able to predict that he was going to be Thane of Cawdor then he believes he is definitely going to be king. â€Å"What can the devil speak true?†(1.3.107) This is Banquo’s reaction after Ross â€Å"hails† Macbeth with his new title, Thane of Cawdor. Banquo starts to wonder if what the witches proclaimed, would actually come true. If what they said did come true for him it would mean his children would be kings. This quote is sort of strange to me. I am taking it as he refers to the witches as the devil. I don’t know how he came to this conclusion; maybe it is just how he is trained to think towards anyone that can see the future. The witches planted this thought into Macbeth’s head about being king. Since the Cawdor topic came true with ease he believes that him becoming king will also be an easy transition.

How does Harper Lee Manage to Draw Together the Stories of Boo Radley E

How does Harper Lee Manage to Draw Together the Stories of Boo Radley and Tom Robinson? Do you find her Way of doing this Effective? There is a strong literary motif running through Harper Lee's novel 'To Kill a Mockingbird'. The stories of Boo Radley and Tom Robinson are drawn together by the way they are both mockingbirds in their own way. Both men are on the outskirts of society and are misunderstood by the predominantly white population of Maycomb. In the first part of the novel, there is a very important quote used: "Shoot all the Bluejays you want if you can hit 'em, but remember it's a sin to kill a mockingbird." 'To Kill a Mockingbird' is a novel about a young girl named Jean Louise Finch or Scout growing up in a very prejudiced American town in the 1930's. Her life is fairly normal until her father, a lawyer named Atticus, is asked to defend a black man charged with the rape of a white girl, Mayella Ewell. Atticus knows there is no chance he can win because his defendant, Tom Robinson is black and therefore guilty but as Atticus said himself: "Just because we were licked a hundred years before we started is no reason for us not to try to win." The jury persecutes Tom Robinson in his trial. It would have been impossible for him to abuse Mayella because he cannot use his left arm. Mr Heck-Tate said that she had a black right eye, suggesting her attacker was left-handed. Her father, Bob Ewell, was, suggesting that he beat her up. Because Tom couldn't punch Mayella with his left fist, it couldn't have been him. Tom Robinson is an admirable character and very brave. He showed these qualities in the trial by speaking his mind and saying the truth, but this still was not enough to sway the ju... ...or example he leaves two dolls carved out of soap in the likeness of Jem and Scout. A lot of effort and thought would have gone into those dolls, just to please the children. He has done nothing but try to make the children happy but they are still unkind towards him. Harper Lee's way of making both Boo Radley and Tom Robinson mockingbirds is very effective. It gives the reader a parallel to compare each two. Both men are on the outskirts of society and are misunderstood by the predominantly white population of Maycomb. Harper Lee draws the two stories together to give out a very powerful message: you shouldn't judge people on the colour of their skin or their lifestyle. You never know exactly how that person's feeling until you climb inside their skin and walk around in it. This is summarised in a quote made by Atticus: "Were you ever a turtle huh?"

Boston matrix analysis for BHP Billiton Group

Abstract The paper provides an analysis of BHP Billiton Group based on the Boston matrix. It is indicated that this matrix is a solid marketing tool to determine the financial performance of organisations. It focuses on companies’ market share and market growth. As a result of the implementation of the Boston matrix analysis to BHP Billiton Group, it is concluded that the company is at the position of a cash cow on the matrix. This finding has significant practical implications, and thus recommendations to use certain strategies are provided. Introduction The Boston Matrix represents a marketing tool, which is commonly used to conduct product portfolio analysis and management. This instrument was introduced by the Boston Consulting Group in the 1970s (Stern and Deimler, 2006). The Boston Matrix mainly focuses on the dimensions of market share and market growth, as these aspects are considered important to identify the areas in which companies need to utilise resources in order to optimise their profit generation capacity (Kotler, 2006). The matrix indicates a focus on a product management perspective as an integral part of the analytical process. Market share refers to the percentage of the total market, which is attained by organisations. This value can be measured by considering the percentage of revenue or unit volume. It is usually assumed that a high market share suggests significant financial benefits to a company. Market growth relates to the attractive parameters identified in a particular market (Schermerhorn, 2013). Businesses are usually grouped into four major categories: dogs, cash cows, question marks and stars. Dogs are companies that encounter the challenges of low market share and low market growth, while cash cows tend to have a high market share in low growing markets (Kotler, 2006). Question marks have a low market share in high growing markets. Stars represent the ideal situation for organisations because they tend to have a high market share in a rapidly growing industry (Stern and Deimler, 2006). These elements are reported by Stern and Deimler (2006) to generate sufficient cash and extensive opportunities for development. By applying the Boston matrix analysis to the performance of BHP Billiton Groups, it appears that specific information and trends from the company’s segments should be considered. The iron ore segment of the organisation has been following a star strategy by focusing sales in Australia due to its intention to decrease production costs, which would help the corporation obtain a bigger share of the market. This may happen even though growth in Chinese steel output significantly decreases (BHP Billiton Ltd., 2013). BHP Billiton Groups has a high market share in the Chinese location but low growth, which reflected in the price drops. This in turn decreased the revenues from the company’s associated segments. According to this dimension, the corporation has been following a cash cow strategy. The iron ore segment of the organisation is facing persistent challenges related to the decline of iron price, workers strike as well as strengthening Australian dollar (BHP Billiton Lt d., 2013). The copper segment is also affected by copper prices. As a result, the organisation has been following a question mark strategy by indicating a low market share in China due to the overall decline in copper revenues. Yet, the strategy of the company is to maintain a high market growth because of its positive production outlook in the respective segment. Similarly, the coal segment is negatively affected by low coal prices and rising cost. However, the corporation’s coals continue to be recognised as the most highly valued, supporting strong long-term margins, implying that BHP Billiton Groups has been following a star strategy in the Chinese and Australian locations (BHP Billiton Ltd., 2013). Future supply growth in the coal segment indicates that it is predominantly Australian, which directly sets the organisation at the position of a star on the Boston matrix. The fact that the outlook for the petroleum segment looks good is important to predict that the company may return to its position as a star on the Boston matrix. One of the expectations in this context is that total shale production is most likely to rise in the future (Stern and Deimler, 2006). In terms of the company’s geographical locations, it seems that geographic factors limit competition for the organisation. The company operates in more than 100 geographical locations across the world. The company’s market share is high due to its diversified portfolio of services. Moreover, its market growth is relatively high (Grant, 2013). Therefore, BHP Billion is pursuing a star marketing strategy considering the mentioned aspects. With regards to the company’s aluminium segment, it can be argued that BHP Billiton is pursuing a star marketing strategy, considering its both high market share and high market growth. For instance, the corporation’s total aluminium production for the fiscal year of 2013 is approximately 1.2 Mt (BHP Billiton Ltd., 2013). This means that the company’s market share is extremely high in this segment, which along with its high market growth in markets of Western Europe and Asia makes the corporation in a winning star position on the Boston matrix. The manganese segment of the company shows its adoption of a star strategy because approximately 80% of its production is sold directly in countries, such as China, India and South Korea (Grant, 2013). This aspect implies that BHP Billiton has both high market share in the mentioned markets and high market growth. It can be argued that BHP Billiton Group’s share prices were relatively low in 2012. This aspect prompted the company to follow a question mark strategy because despite its low market share, the provision of various natural resources took place in a high growing market (Schemerhorn, 2013). However, at the end of 2012, the corporation gradually started expanding its share prices by representing an adequate price-to-earnings (P/E) ratio. This means that the group has focused on following a star strategy in its main segments. Yet, it is challenging to estimate the market price for each product due to the extensive diversity of the company’s products (Grant, 2013). Another challenge associated with the quantification of returns is the categorisation of returns in different currencies. As previously indicated, BHP Billiton Group placed importance on location when it comes to making investments. In the United States, the corporation has been extensively concerned to adhere to a star strategy on the Boston matrix by distributing crude petroleum (BHP Billiton Ltd., 2013). It is essential to note that the company relies on its current strength of occupying a leading position in global commodities prices that are related to the health of the international economy. This suggests the potential of the corporation to predominantly follow a star strategy, which would guarantee it a better position compared to other organisations operating in the same industry sector (Grant, 2013). Nonetheless, the company is unable to predict currency assessments, which may lead to the adoption of a cash cow or a question mark strategy according to the Boston matrix. It has been indicated that certain flaws in the global economy negatively affect the performance of the corporation in the sen se of decreasing its market share in certain segments. For instance, such flaws may lead to a reduced demand for commodities, which may directly reflect in lower prices and reduced profitability of the company. The diverse portfolio of assets provided by BHP Billiton Group has assumed a solid market position of the company in its major segments. It is important to note that the corporation occupies a leading position in the trade of uranium in Australia after Olympic Dam Mine as well as of other natural assets, such as silver and copper (BHP Billiton Ltd., 2013). This places the company at a quite favourable position regarding its trade activities and thus it is more likely to adopt a star strategy in its home country. The fact that the corporation is a leading producer of nickel globally is indicative of the high market share it has in different segments and in different locations across the world (Stern and Deimler, 2006). As a result of the application of the Boston matrix analysis to the performance of BHP Billiton Group, it can be suggested that the company has the potential to make a substantial impact on the global delivery of natural assets. Its position as a star in most of its seg ments and in most locations shows solid management and leadership practices present at the organisation. It is important to note that the major purpose of the Boston matrix analysis is to help BHP Billiton Group decide which of its business units should be kept as well as in which areas it can invest further (Grant, 2013). There are different strategies to be applied considering that the organisation is in the position of a cash cow on the Boston matrix. One of these strategies is to hold in order to maintain its sales or market share (Schermerhorn, 2013). Another strategy that can be utilised is to defend its position regardless of the challenges the company faces with regards to its market share and projected market growth (Kotler, 2006). BHP Billiton Group can also implement a strategy, which is identified as ‘milk’, implying that the company is expected to use the cash it generated in the fiscal year to return to its position as a star on the matrix from the period of 2011 to 2012 (BHP Billiton Ltd., 2013). The fact that the company is at the position of a cash cow means that its profitability ratios have significantly declined. For instance, the organisation’s net profit margin, operating profit margin, ROE and ROA deteriorated in the period from 2011 to 2012 and from 2012 to 2013. It can be suggested that the company should seriously rethink its position in the market so as to try its best to restore its star position from the past (Schermerhorn, 2013). The application of the Boston matrix analysis to BHP Billiton Group’s performance yields significant conclusions about the company’s challenges and opportunities that can be addressed. Conclusion This paper has provided an analysis of BHP Billiton Group’s financial performance based on the Boston matrix. It has been indicated that the organisation is currently at the position of a cash cow on the matrix considering its high market share and low growing market (Kotler, 2006). Certain strategies have been provided so that the organisation can implement them in order to improve its position and return to the status of a star, which represents an ideal combination of a high market share and fast growing market (Grant, 2013). References BHP Billiton Ltd. (2013). Stock Analysis on Net [online]. Available at: http://www.stock-analysis-on.net/NYSE/Company/BHP-Billiton-Ltd/Financial-Statement/Income-Statement [Accessed: 14 August 2014]. Grant, R. M. (2013). Contemporary Strategy Analysis. New York: Wiley. Kotler, P. (2006). Marketing Management. New York: Pearson Education. Schermerhorn, J. R. (2013). Exploring Management. New York: Wiley. Stern, C. W. and Deimler, M. S. (2006). The Boston Consulting Group on Strategy: Classic Concepts and New Perspectives. New York: Wiley.

Principles and Policies of Health Promotion

Annex 1 â€Å"MSF & prevention†Ã‚   17 2 1. Introduction Historically, MSF is involved with IEC (Information, Education and Communication) activities or project since almost 10 years. It mainly started in 2 parallel directions: Within the HIV/AIDS vertical project developed before the introduction of ART? e used to develop prevention project to reduce the spread of infection in the general community and amongst target groups (mass communication campaign to change the behaviour of the community) Within the Water, Hygiene & Sanitation project, hygiene promotion activities were developed to promote the use of the water & sanitation facilities in the communities but also to adapt the behaviour of the pop in regards to these facilities – In April 2006, an IEC workshop was organised in the OCB in order to structure the IEC activities on the field1. From there the I. E.C activities have been redefined and a change of the terminology to Health Promotion was adopted. This change in terminology was adopted to avoid misunderstanding and confusion with the activities of communication department but also to fall within the framework of our medical activities. This policy paper is written in order to explain why MSF is involved in Health Promotion and to set a framework for the Health Promotion activities; it’s not a guide on the implementation of the activities. It will continuously evolve with the experiences gained over time. 2. Some Health Promotion definitions . 1 From WHO Health promotion is the process of enabling people to increase control over, and to improve 2 their health. Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Participation is essential to sustain health promot ion action. – The Ottawa Charter identifies three basic strategies for health promotion.These are: – advocacy for health to create the essential conditions for health indicated above; – enabling all people to achieve their full health potential; – and mediating between the different interests in society in the pursuit of health. These strategies are supported by five priority action areas: – Build healthy public policy, – Create supportive environments for health – Strengthen community action for health, – Develop personal skills – and Re-orient health services 1 2 For more information see report on the IEC workshop 2006- Genevieve Loots & Ann Wouters Reference: Ottawa Charter for Health Promotion.WHO, Geneva, 1986 3 2. 2 From John Hubley, â€Å"Communicating Health† John Hubley is presenting the HESIAD model which involves 3 different components into health promotion ? â€Å"Health promotion component is being u sed to draw attention to the need for educational & political action to improve health† 3 Health promotion Health education: Communication directed at individuals, families and communities to influence: Awareness/knowledge, decision making, beliefs/attitude/empowerment of individual and community action/behaviour change community participationService improvement : improvement: Improvement in quality & quantity of services: services Accessibility Case management Drug supply Counselling Staff attitudes Outreach Social marketing Advocacy: Agenda setting and advocay for healthy public policy Policies for health Income generation Removal of obstacles, discrimination, inequalities, gender barriers Fig. Components of health promotion (HESIAD)4 3 4 J. Hubley, Communicating health- An action guide to health education and health promotion- p. 2 J. Hubley, Communicating Health- An action guide to health education and health promotion-p. 15 4 3. 3. 1 Health Promotion within the OCB Defini tion As an emergency medical humanitarian organisation, the definition of health promotion, as state by WHO (process of enabling people to take control over their health ) is too wide for MSF actions. It involves a lot of development ideas for example poverty elimination, literacy and general education, social programs, income generating activities, etc.Therefore, within OCB, we are limiting Health Promotion as a set of activities of health education and health services improvement5 that are intending to develop better the use of health care services (patients & population). The population HP approach is focusing on communities to promote our health structures and to control the epidemics in the population. The patient HP approach is focusing on patient and on the adaptation of the health care to the cultural behaviours and practices of the population where we are working. Example of health promotion activities: 1.HP activities for population – Investigate health-seeking beha viour Promotion of available health services Create health-risk awareness about cholera, ebola for example Assure user friendliness clinic Patient education on HIV & TB to improve adherence (= treatment literacy) Providing patient-adjusted information on health-issues Stimulate self-management of chronic patients (empowerment) 2. HP activities for patients In most of the old â€Å"IEC called† project, the Health Promotion component should be re-orientated towards a support of patients (instead of community) n order to help them to reinforce or adapt a set of behaviour to get better & get more adapted care. In different organisation as well as in MSF sections you will easily hear different names for the Health Promotion activities such I. E. C (Information, education & communication), B. C. C (behaviour change communication), health communication, health education, patient education, etc. But they all aim at reinforcing knowledge and skills related to health (disease, treatmen t & prevention) in order to allow the patient to take decisions & actions towards his health.Health Promotion encourages comprehensive interventions that combine approaches such as anthropology, sociology, education, training and communication for healthy behaviour adaptation; for more information on Behaviour change model, please refer to M. Varasso â€Å"Behaviour Change towards HIV/AIDS† and the Health belief Model6. 5 Services improvement could be: – Improvement in the content of the services: e. g improvement of the patient education – Improvement in the accessibility of the service: e. g timing, location & introduction of home & community visits – Improvements in the acceptability of services: e. enforcement of confidentiality, use of women field staff, use of lay field staff, involvement of persons from the target community John Hubley – Communicating Health- An action guide to health education and health promotion- p. 15 6 Health Belief Mod el (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals 5 3. 2 Key principles for Health Promotion 1. Health Promotion activities should always be integrated and serving the medical objective of the project.It must be considered as a transversal approach integrated in the different activities of the project; it is not a project in itself. In a logical framework of a project document it should be situated at the level of activities, expected results and indicators. 2. As a particularity, Health Promotion focuses on the health communication with individuals (it's not a health problem in itself). That is why it applies to different: – diseases (HIV, TB-treatment, malaria, etc), – subgroups (children, young women, patient HIV+), – attitudes/habits that we want to influence (access to services & care, promotion of healthy behaviour, etc) 3.The MSF's understanding of the population, perception of the illness 7 and the health seeking behaviour are essential in order to offer and to improve the development of our health services. It’s an essential step to start any kind of Health Promotion activities, it's necessary to understand how the population is functioning before defining health messages adapted to the culture of the population and patients. 4. The activities of Health Promotion will vary from one project to another and will always need to be adapted to the context. 5.The Health Promotion/education activities should be done in priority within our health structures addressing patients & care takers in groups or individually 6. Health Promotion activities can also be done at the communities’ level with specific objectives: To promote our services: attract people in our structures and explain our services to communities (promotion of the services for victims of sexual violence in the community, promotion of our vaccination sites, etc) To prevent epidemics spreading: when there is an outbreak of cholera, hemorrhagic fever, malaria, measles, etc. e should inform the communities at risk how the disease is transmitted, how to prevent getting the disease and what to do in case of the contraction of the symptoms To monitor a health situation: in some context it can help the project to develop a component of community health worker or home visitor network to collect health surveillance information (mortality, morbidity, MUAC, vaccination, etc) To ensure access of the vulnerable group to our structures: when a population/village/specific group identified is not coming to our structure and they are at high risk of specific health problem 7 DISEASE is the definition of a health problem by a medical expert, ILLNESS refers to the experience of the problem by the patient; and SICKNESS is the social role attached to a health problem by the society at large. 6 3. 3 Roles and profiles: Ideally, we should send different pro files to be in charge of the HP activities; the first phase should have in priority an anthropologist or sociologist who will analyse the cultural behaviour of the population; followed by a social communicator person who will design a health communication strategy.However, this rarely happen and one person is usually in charge of the different steps of the HP activities. 3. 3. 1 Anthropologist's role in a project: To understand the risky practices of the target group linked to the transmission of a illness, for example: to collect information on the behaviour and the cultural practices of the pop. linked to the spread of HIV/AIDS; to get information on cultural burial procedure-linked to Ebola; etc To determine the health seeking behaviour of a target population ? Why are the pop not coming to our health services?Where do they go for care? Linking with Traditional healer? Sorcery, Witchcraft? To get a better analyse of cultural barriers in the population: perception of a health prob lem by the target group, organisation of the society, power, decision maker, etc. To analyse the knowledge, attitude and practices on a disease or health problem (KAP survey) To analyse and understand how MSF is perceived in the population But also at the level of the service provider, to analyse and understand the staff attitude towards patients/diseases To study the conception of illness Etc. ? He/she will then apply findings into practical recommendations for the project but also for the development of health messages. The anthropologist is NOT going to solve all your problems in the project; he needs to have a clear job description. The field needs to identify what they want to analyse and understand and how it will improve their medical activities. It’s essential to be specific. He is part of the medical team and need constant discussion with the medical team/field coordinator.It’s possible to require specifically an anthropologist for several months to undertake a qualitative survey. But often, the expatriate health promoter will also have a degree in Anthropology or Sociology (or Social Sciences); it’s more likely to have one expatriate in charge of everything. Rem: For the moment MSF is sending anthropologist too late in the stage of the project design; it would be useful to use the anthropologist’s competences at some early phase of the project (explo mission or starting of a new project).In project by choice, the sending of an anthropologist can really provide key information on the context, the population and the link with MSF (in 2008 we have send anthropologist in Niger and Lubutu). 3. 3. 2 Health Promoter's role in a project Your health promoter could have a communication or nursing or educational background depending of what is available and which profile is best suiting the project.To collect data's about the target population To set up the strategies for the HP activities according to the objectives of the project T o recruit (if not yet done) and train/coach a team of national health promoter To define the priorities of the health messages according to the risk practices and the health seeking behaviour analyse To adapt the content of the messages according to the culture & target pop (importance of pre testing the materials) To understand how MSF is perceived in the population 7 – To develop (or re-use) communication materials (educational games, pictures, osters) and to choose appropriate channels of communication To monitor the HP activities (including participation to the Annual Review Operation exercise) To evaluate the understanding of the health messages by the beneficiaries and adapt the content of information He/she is part of the medical team and need constant discussion with the medical team/field. Because the HP activities should be integrated in the project, the expatriate presence on the field should be seen as a temporary phase in order to leave the activities in the hand s of national staffs (when available) who usually know better the cultural behaviour of the target pop. nd have easily access to communities. 4. Why is MSF involved in Health Promotion? Health Promotion activities are usually linked to disease preventive 8 activities. To give information and to â€Å"coach† or educate persons on different health topic & measures is an essential element to avoid individual getting sick, to recognize earlier symptoms and come to be treated but also to ensure patients following treatment procedures. Health Promotion activities want to ensure preventive behaviour in term of health.Prevention's level and activities9 It’s important to differentiate 4 levels of prevention where MSF actions put in place will be variable but also where the Health Promotion activities will differ. Primordial prevention: level zero of prevention: Activities aiming at decreasing societal vulnerability, lowering individual risk through contextual interventions. Exa mple of activities= poverty reduction, decreasing stigma & discrimination, HIV awareness for the general public, etc.So it concerns risk reduction of a health problem at population (societal) level and MSF will never intervene at this level of prevention. Primary prevention: covers all activities designed to reduce the occurrence and the transmission of an illness (disease free). Primary prevention methods are used before the person gets the disease. ? Reduction of the incidence & prevalence of health problem Example of activities done by MSF= immunisation, improve water supply, family planning services, use of condom, prophylaxis during pregnancy, etc.Secondary prevention: activities aimed at the recognition of early signs of disease and search for treatment before it become serious. Secondary prevention avoids that infection become illness. ? Reducing the morbidity Example of activities = testing of HIV, medical consultations, treatment, vaccination 8 Disease prevention covers mea sures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established.Reference: adapted from Glossary of Terms used in Health for All series. WHO, Geneva, 1984 Primary prevention is directed towards preventing the initial occurrence of a disorder. Secondary and tertiary prevention seeks to arrest or retard existing disease and its effects through early detection and appropriate treatment; or to reduce the occurrence of relapses and the establishment of chronic conditions through, for example, effective rehabilitation. Disease prevention is sometimes used as a complementary term alongside health promotion.Although there is frequent overlap between the content and strategies, disease prevention is defined separately. Disease prevention in this context is considered to be action which usually emanates from the health sector, dealing with individuals and populations identified as exhibiting ident ifiable risk factors, often associated with different risk behaviours. 9 Disease prevention- definition of WHO For more information on â€Å"Prevention and MSF†, please refer to the doc in annex 1. 8 Tertiary prevention: Targets the person who already has symptoms of the isease and it includes behaviours that are involved in treatment & rehabilitation (person is already sick) The goals of tertiary prevention are: – prevent damage and pain from the disease – slow down the disease – prevent the disease from causing other problems – give better care to people with the disease – make people with the disease healthy again and able to do what they used to do Example of activities: treatment, patient education, emotional support etc. ? Reduction of the morbidity, suffering & mortality 9 Risk: Population: General Theoretical risk Healthy population ? ? Specific High Risk ?Healthy ind. ? Early signs ? Diseases ? Death Infected ind. ? Patients (sick) ? Death/handicap Intervention MSF Never or through partners Polio eradication, HIV awareness, etc Not systematic Prevention activities Vaccination, Vector control, HP, Family Planning, etc. Always Supportive & curative Testing, consultation, treatment, screening, health Education, etc. Always Curative & palliative care Emotional support, treatment, patient education etc. Primordial prevention Primary prevention (Incidence & prevalence) Secondary prevention (Morbidity) Tertiary prevention (Morbidity& mortality) Depending of the project’s objectives, MSF can be involved with variation at the different levels of prevention. 10 5. Health promotion as a transversal axe Health promotion was set up as a transversal axe into the Operational prospect in 2008 and in 2009 Health Promotion is integrated into the â€Å"Prevention† transversal axe. It means the HP activities should be considered into the different operational fields of intervention but also in the others transversal axes (Women health, nutrition, etc). 5. 1 Health Promotion activities to consider per health problem Some Health promotion activities to consider . Analyse & understand the risky practices increasing the transmission of HIV/AIDS amongst the population/community & patients 2. Understand the reasons of not coming for testing, for PMTCT (Health seeking behaviour, Stigma) 3. Measure the knowledge, attitude and perception of HIV/AIDS in target group 4. Promote of the services for families members, children and partners 5. Empowerment of patient (patient education on disease & preventive measure, treatment literacy, support group, PLWHA expert, etc) 6. provide support to adherence in health structure and in the community 7.Ensure HIV services adapted to your target group of patients 8. Collaborate with Traditional healer, TBA, 1. Analyse and understand the disease perception (fears and stigma) & knowledge in the pop. 2. Promotion of services for TB families & care givers 3. Provide patie nt education & treatment literacy 4. Support to adherence 5. Train health staff on infection control measure 1. Analyse and understanding the disease knowledge and preventive measure 2. Promote the use of the mosquito nets with patients & communities during the season 3. Training on recognition of symptoms 4.Promotion of the use of our services 5. Develop the component of malaria volunteers 1. Analyse and understand the disease perception and the risky behaviour in the community increasing the transmission 2. Measure the knowledge, perception & attitudes of the pop. towards the disease 3. Disseminate information on the preventive & disease control measures to the general population 4. Collaborate with key leaders of the community ? visit of the isolation unit 5. Educate of the patients and families (and neighbour) in order to decrease fears & stigma of the patients 6.Participate to burials to ensure the respect of the tradition (orientation of the body, traditional beliefs, etc). 10 Health thematic HIV/AIDS Reference documents/books 1. HIV/AIDS OCB Policy 2008 â€Å"chapter on prevention and empowerment & autonomy of PLWH† 2. Patient support in HIV/AIDS – draft MSF OCB 2008 3. DVD Health Promotion communication materials – HIV/AIDS thematic – OCB 2007 4. Patient Support for HIV Infected children- 2008 D. Goetghebuer & K. Bosteels TB 1. Adherence strategy for TB treatment- MSF OCB 2008 2. DVD Health Promotion communication materials – TB thematic – OCB 2007 1.DVD Health Promotion communication materials – malaria thematic – OCB 2007 Malaria Infectious diseases 1. FVH guideline internationalHealth Promotion & Anthropology chapter 2. Ebola, culture & politics : the Anthropology of an Emerging disease10 3. Cholera Health Promotion technical briefs 4. DVD Health Promotion communication materials – cholera, Ebola, Rift Valley fever, †¦ OCB 2007 Ebola, culture & politics: the Anthropology of an Emerg ing disease, Barry S Hewlett and BonnieL. Hewlett 11 Some Health promotion activities to consider 1.Analyze and understanding the cultural barriers of the use of the services or understanding the reasons of delivering at home or the KAP on FGM, etc. 2. Promotion of services (ANC, FP, PMTCT, delivery, abortion, sexual violence). 3. Integrated health education for mothers on different reproductive health subject 4. Home visitors to refer ANC visit, follow up of sexual violence 5. Collaboration with TBA – information on dangers of deliveries and referral of complicated cases 6. Collaboration with women groups 1. Analyse of the perception of the malnutrition in the pop 2.Understanding cultural practices or beliefs increasing malnutrition of children 3. Analyse the cultural factors in a famine context 4. Nutritional education to mothers – develop peer mothers + appetite test 5. Nutritional education to men 6. Defaulter tracing support- community support 1. Analyse of the pe rception of mental health problem in the community 2. Promotion of mental health services 3. De-stigmatization of mental health problems 1. Analyse and understand the concept of violence in the context (cultural versus contextual violence, definition of violence, cultural profile of victims, etc). . Promotion of the services 3. Working with key actors in the community 1. Understanding of the concept of vaccination, fears & taboos about vaccines. 2. Promotion of importance of the EPI 3. Promotion of day of the vaccination campaign, site of vaccination, type of vaccines, etc Health thematic Women health Reference documents 1. DVD Health Promotion communication materials – Women Health – OCB 2007 Nutrition 1. Anthropological report from Niger- Lieselotte 2008 2. DVD Health Promotion communication materials – OCB 2007 Mental Health Violence 1.Mental Health Policy OCB 2008 Link with Brazil Medical Unit Vaccination Niger 2008 Tanganika 2008 12 5. 2 Minimum package of Health Promotion activities There are minimum Health Promotion activities to be integrated in all projects: – Analysing of the disease/illness perception and knowledge of the target population – Promotion of MSF health services (usually at the beginning of the project or when new health activities is being developed) – Health education/patient education/treatment literacy in order to ensure that patients understand the symptoms, how to prevent & how to treat his disease . 3 Health Promotion within Operational Field of intervention Field of intervention I: Assistance to population in violent setting Particularities for this operational field of intervention are: The Health Promotion activities are done primary to get closer to the community, to get information on the context, the population but also on their security, on the living condition and on the access to health care. Health Promotion activities in this field are oriented towards collection of information, investigation and promotion of our services.Several experiences11 have shown good results in developing a home visitor’s network; they seem key persons to get closer to your community and gain trust. Usual HP activities done at the community level with home visitors or community health worker are collection of data (mortality, birth, morbidity, on specific thematic such violence or sexual violence) at household level, defaulter tracing activities (nutritional or others program), promotion of MSF services and health information on a specific disease (ex. malaria explanation because malaria season).In some context, there is a need to extend these communities activities further and push for a move of the civil society in the non acceptance of the problem (Similela and Seruka- sexual violence projects). HP activities in the medical infrastructure = health education on different health topic done by the medical staff or health educators Field of intervention II: Extreme health ga p Particularities for this operational field of intervention are: Health Promotion activities and anthropological components should be more often considered.In post conflict, under served general pop & exclusion there is space and time to gather key information about the population and their health seeking behaviour and it would help to develop the medical strategy of the project. Key activities to consider: -Analyse of the risky behaviour & needs of population in term of health & analyse of Health Seeking Behaviour -Look for the correlation needs of pop & offering of medical services -Promotion of MSF services -Health education in medical infrastructures -Consider the possibility to develop some HP activities in the communities to increase patient/individual’s empowerment 1 In refugee camps, we often develop network of home visitors. Since 07 In Darfur, we launched several network of HV in city the capitalisation of the network in Kebkabya will be done in 2009. 13 Field of i ntervention III: Epidemics and endemics See table with health thematic p. 11 & 12 Particularities: Health Promotion activities should be integrated in every disease Field of intervention IV: Assistance for victims of natural catastrophes Particularities are: the Health Promotion activities are usually integrated into Watsan activities (Hygiene promotion) or linked with mental health activities.The concept of home visit is very important to reinforce link with population. 14 6. Some definitions Health education12 comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health. Reference: modified definition- WHO Health education is not only concerned with the communication of information, but also with fostering the motivation, skills and confidence (self-efficacy) necessary to take action to improve he alth.Health education includes the communication of information concerning the underlying social, economic and environmental conditions impacting on health, as well as individual risk factors and risk behaviours, and use of the health care system. Thus, health education may involve the communication of information, and development of skills which demonstrates the political feasibility and organizational possibilities of various forms of action to address social, economic and environmental determinants of health.Patient education13 â€Å"The patient education is a process, integrated in the process of care, including a series of activities organized awareness, information, learning and psychological and social assistance on the disease, treatment, care, organization and hospital procedures, health behaviours and those associated with the disease, to help the patient (and his family) to understand the disease and treatment, care work, take charge of his state health and foster a retu rn to normal activities†Patient support 14 The component of Patient Support covers all the activities aiming at supporting the patient in front of his disease and his treatment, beyond the purely medical aspects of care. The patient support is a continuum of progressive, personalised or peer-supported activities addressed to the patient, and going on all along the program. Rem: for the moment within MSF, we are using the component of Patient support for HIV and TB.Main objectives for all HIV patients are: – To understand and accept his HIV status or disease 12 13 From Health Promotion glossary DECCACHE A. et LAVENDHOMME E. , Information et Education du Patient : des fondements aux methodes, De Boeck Universite, Bruxelles, 1989, p. 45 14 For more info, refer to the draft â€Å"Patient Support document for HIV/AIDSâ€Å" written by B. Laumont & G. Loots in the OCB. 15 To recognize the consequences of the disease in his everyday life – To adapt his behaviour (way of living) – To be involved in and adhere to his treatment To achieve all these objectives, the patients have to go through 3 complementary processes: 1- Educative process ? Patient Education This is about the patient understanding – the infection and the evolution of the disease – the transmission of the disease – the risky behaviours to avoid – the treatment This includes the following activities: Health Education, Health talks, Treatment Literacy 2- Process of emotional adaptation?Emotional Support This is about the patient – dealing with the loss of his self-image and the loss of the good health – dealing with the stress caused by the evolution of the disease, the perspective of death, the uncertainty of the future and the reduction of capacities – dealing with the relational changes with his close relationships and occupational environment – dealing with the improvements and the changes brought by the treatment This includes the following activities: counselling (individual & group), support groups 3- Process of adaptation to socio-economic consequences?Social Support This is about helping the patient to solve his social problems in order to improve his good adherence to treatment – risks of precariousness: financial resources, incapacity, loss of employment – risks of isolation, stigmatisation by family and community This includes the following activities: social consultation, home visits, networking, etc †¦ The Patient Support can be provided through 4 different types of activities: – Individual sessions: individual counselling (pre-test, post-test, follow-up, adherence, etc), social consultation – Group sessions: Health Talks, Educational talks, ART preparation sessions, Support Group, etc – Group activities: expression and creative activities, party, celebration, excursion, etc – Community and Family level actions: Home visits, Home Based Care , Defaulter prevention, Defaulter tracing, Community activities, etc Empowerment for health15 In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health. A distinction is made between individual and community empowerment. Individual empowerment refers primarily to the individuals’ ability to make decisions and have control over their personal life.Community empowerment involves individuals acting collectively to gain greater influence and control over the determinants of health and the quality of life in their community, and is an important goal in community action for health. 15 From Health Promotion glossary 16 7. – Bibliography  « Anthropologues et ONG: des liaisons fructueuses?  » ; Humanitaire – Hors Serie; Numero 4Automne/hiver 2007 ; editer par Medecins du Monde  « Communicating Health- an action guide to health education and health promotion  » John Hubley- 2004  "Applied Health Research, Anthropology P. Boonmongkon, P. Streefland, M. L. Tan, etc. â€Å" Health Promotion glossary† WHO CDC, Prevention â€Å"Education pour la sante, concepts, enjeux, planifications†, Jacques A. Bury  « Information et education du patient, des fondements aux methodes  », A. Deccache et E. Lavendhomme of Health and