External Factors Affecting International Operations at UPS Assignment

External Factors Affecting International Operations at UPS - Assignment Example As such there are different procedures which need to be taken into consideration to adjust the operations. The end to end process involving the capturing, processing, storages and retrieval of the package tracking within the UPS’ system is actually comprised of various points at which this is done. Firstly, the UPS drivers actually capture the customer signature and other data through handheld devices which capture other data such as delivery, destination and time card information. This information is then subsequently transferred into the vehicle adapter and from there it is uploaded to the main system of UPS. From the main system of UPS, the same data and information can be subsequently accessed worldwide through different information portals such as UPS website. The overall range of technologies used by UPS is relatively diverse in nature and comprises of the handheld devices (DIADs), barcode scanners, wireless communication networks, desktop and laptop computers as well as the storage technologies for package tracking and delivery of data. Apart from this, UPS also has pagers, cellular phone networks as well as package tracking and pricing technologies which effectively formulate the overall information technology system for UPS. The overall business strategy of the firm is based upon delivering high quality services and the technology effectively corroborate with the strategy of the firm. These technologies actually allow UPS to have smooth data flow while at the same time achieve smooth operations. There are different problems which are being solved by the information system of UPS including its supply chain as well as logistic issues.

Gambling Law - topic yet to be approved Research Paper

Gambling Law - topic yet to be approved - Research Paper Example However, there are those that are proponents of setting the minimum legal age at 18 years as is the case in the United Kingdom (UK). A number of other countries especially in Europe have also set the minimum legal age at 18 years. Therefore, which is the most appropriate minimum age? This paper details the arguments for both sides outlining the various areas that have set different restrictions and their reasons for doing this. II. BACKGROUND Gambling is the wagering of something valuable or money as a stakes on an uncertain event with the intention of winning an additional amount of money or any other valuable good. Gambling activities have been legalized in most parts of the world and are major commercial activities with $335 billion being generated from the legal gambling market in 2009. (Champion Jr and Rose, 2012) In many jurisdictions both local and international, gambling is either banned or heavily controlled through licensing. This has resulted in gambling tourism as well as illegal gambling in other parts of the world. Through regulation and taxation of gambling activities, governments and gaming organizations have had to work closely especially in countries where legal gambling is a significant source of government revenue, like in Macau or Monaco. There are many types of gambling: casino games, non-casino games like lotteries, table games, bingo among many others. (William, 1996) It is possible for any game to be played for money and by so doing this can be considered as a form of gambling. Being a popular pastime activity worldwide for thousands of years, there is overwhelming evidence that indicates that gambling existed in ancient Egypt, China, Rome, Greece and India. With the increased popularity of the Internet, this was an avenue through which entrepreneurs could further expand the gaming industry. The first Internet gambling site was hosted in August 1995. To date, there are over 2,000 Internet gambling websites that offer a variety of wageri ng options. (Champion Jr and Rose, 2012) A comparative analysis of different age restrictions in both the US and the UK gives an insight as to the reasons behind the setting of these restrictions. A brief proposal will be made as to the way forward leading to the conclusion on what restrictions are appropriate and for what reasons. III. DISCUSSION Age Restrictions in the US Gambling is legally controlled in USA and its availability as well as participation has been on the rise in recent years. According to the American Gaming Association (AGA), gambling activities generated $92.27 billion in gross revenues in the year 2007, providing 354,000 jobs in commercial casinos and $5.2 billion as state and local tax revenues. Internet gambling has significantly widened extensively as a form of gambling in the US. In the year 2006, Internet gambling in the US accounted for half of the worldwide revenue generated. (Champion Jr and Rose, 2012) However, despite being a source of regressive tax t o the government and the economy, critics claim that gambling also leads to increased compulsive gambling, political corruption and higher crime rates. The government through the AGA has legalized and authorized many forms of gambling with the aim of raising money without raising taxes. This incorporates everything from church basements with bingo games to poker tournaments with multi-million dollar winnings. The AGA, founded in 1994, promotes, educates and lobbies on behalf of the gaming

Strategy Implementation Essay Example | Topics and Well Written Essays - 1250 words

Strategy Implementation - Essay Example They need to update and improve their mission and visionary statements. A modification of their mission statement would be beneficial for them to create a new and improved business image. StilSim needs to fix its value statements and maintain them as well. Along with these, they need to create a list of stratagems to assist them in their success. To determine the risk factors that could hinder them, they should create a new organizational structure that also contains a plan of backup in the event that the new organizational structure implemented does not work. They would also benefit from a behavior controlling system, thus allowing StilSim to offer incentives and rewards to their employees, improving performance rates. Finally, StilSim needs to address the ethics problems they have and make plans for the issues that they currently have not addressed. If StilSim were to execute these changes, they would be able to be more competitive within the market and create a new period of reven ue. StilSim’s Mission and Vision Statements The name ‘StilSim’ is suggestive of the enthusiasm we have about our company. We have a large knowledge base about our people and recognitions that we have gotten from our workings in the market and in our community. In keeping with our individuality and enthusiasm, our name also implies the same. Currently, we have three operating offices in Ohio, where our staff is extensively knowledgeable of our clients’ accounts. They provide our clients with flexibility that no other company can. We have been operating for over 25 years and truly understand the trials of our chosen market, allowing us to provide the services that can exceed those tests. Value Statement Our values are simple and altruistic: Respect, integrity, honesty, quality, excellence and continued improvement are our commitments. We are committed to our clientele, which has been our primary focal point and number one priority in our service presentation . We honor our clients, partners, shareholders and employees, with a passion that provides exceptional results. To ensure quality of service and understanding, we provide all of our customers and employees with a handbook complete with all of the pertinent information about our company. Plan of Action In order for StilSim to implement the necessary changes, they must have a plan of action that is ascertainable. It will make certain that they are looking after our customers and ensuring that no one and nothing is left behind. The current plan of action is a low cost strategy that is perceived to allow them to move forward and be successful. StilSim believes that they need to update our technological base, as it is the original platform they started with. In today’s world, technological advances are in constant flux and for them to keep up with the times they must implement new technology in order to compete. To start, StilSim needs to upgrade their current database. This infor mation is imperative to be kept in a highly organized, accessible, manageable construct. An upgrade to the database will also allow the company to classify the information they have based on content. Another technological update that would be beneficial is the use of intranet. This will allow StilSim to communicate more efficiently within the company’s borders, improve communication in the sharing of data and improve employees’ knowledge of the company’s workings. StilSim would greatly benefit from voicemail, to

Capitalism Essay Example for Free

Capitalism Essay A society is capitalist if most production is carried on by employees working with means of production (equipment and materials) belonging to their employer, producing commodities which belong to the employer. (Employees: those whose services are treated as commodities. Labour is a commodity like any other, an article of trade Edmund Burke, Thoughts on Scarcity, 1795. Capitalism is an economic system in which the means of production are privately owned and operated for a private profit; decisions regarding supply, demand, price, distribution, and investments are made by private actors in the free market; profit is distributed to owners who invest in businesses, and wages are paid to workers employed by businesses and companies. This is what we mean by the system of Capitalism. Thinking about Capitalism, one directly is taken to the period of Marx and Engels where a distinction between Capitalist and Labour class was firstly and soundly made. Until then a capitalist continued to dominate the class hierarchy. Simple words suggest that a capitalist is a person in whose hands the entire power to production and the decision regarding the consumption vests. For ages capitalist class ruled the large part of the society. Even today, in several fields capitalists dominate other classes. Capitalism, as a deliberate economic system, developed incrementally from the 16th century in Europe, although proto-capitalist organizations existed in the ancient world, and early aspects of merchant capitalism flourished during the Late Middle Ages. Capitalism became dominant in the Western world following the demise of feudalism. Capitalism gradually spread throughout Europe, and in the 19th and 20th centuries, it provided the main means of industrialization throughout much of the world. Today the capitalist system is the worlds most dominant form of economic model. The term capitalist refers to an owner of capital rather than an economic system, but shows earlier recorded use than the term capitalism, dating back to the mid-seventeenth century. The Hollandische Mercurius uses it in 1633 and 1654 to refer to owners of capital. In French, Etienne Clavier referred to capitalistes in 1788, six years before its first recorded English usage by Arthur Young in his work Travels in France (1792). David Ricardo, in his Principles of Political Economy and Taxation (1817), referred to the capitalist many times. Karl Marx and Friedrich Engels, the great scholars of 18th century have continuously used the term ‘Bourgeois’ while talking about capitalist class. They raised points concerning the exploitation of Proletariats by the Bourgeois and asked the proletariats to fight for their rights. The Communist manifesto given by these scholars shows the distinction they have made between the two classes and the domination of powerful capitalist class in the society. Marx on Capitalism; How explain the possibility of Capitalism? Capital is money used to make money by buying commodities which are then to be sold to get an increased amount of money. How can money be used in this way? One answer is: by buying cheap and selling dear as prices fluctuate. This may explain how this or that individual makes money for a while, but since every gain made this way is someone elses loss, if those who gain that way now have an even chance of losing later, then it cannot explain the existence of a definite class of people who regularly make money. The explanation for the existence of such a class (capitalists) is that a limited set of people are in a position to buy a commodity which regularly yields an increase when they sell. This commodity is the service of the worker, which may produce commodities which exceed that service in exchange value (and only when when it does will the workers services be bought). The service of a worker is a commodity which has the special use of producing other commodities, which may have more exchange value than it has itself. There are other commodities (e. g. machines) which produce commodities, but (on the labour theory of value, which makes human labour the sole source of value) the exchange value contributed by a machine is simply a fraction of the cost in labour terms of making and working the machine. If over its whole working life it costs $3,000 and produces 3000 items, then it adds $1 to the value of each item. But the amount of labour a worker puts into what he produces over a lifetime may exceed the amount of labour needed to produce and maintain that worker. If some employer buys the workers services at their value i. e. for the equivalent of the labour needed to produce the worker then, since the workers product belongs to the employer, there will be an excess or surplus value, additional to the value of the wage, that the employer appropriates. Marx does not think that in the real world full value is always paid. But he conducts his argument on the hypothesis that full value is paid, for several reasons. First, he wants to make it clear that his analysis of capitalism does not rest on the assumptions that capitalists defraud the worker. Even if there were no cheating, capitalism could still exist. Second, he wants to show that even an idealized capitalism would be doomed to destruction (the argumentative strategy of proving the point for the hardest case: a fortiori it holds for other cases). Third, he wants to make it clear that it is in production itself, and not merely in the distribution of the product, that the capitalists profits originate; it is not accidental that most (though not all) capitals are used to finance production (not, e. g. , for buying non-human commodities and selling them unmodified). To argue that capitalism is a system of inequality and class conflict, Marx takes as his point of departure the idea that the dominant class, the bourgeoisie, controls capital, property, the means of production, and hence by extension all those (far more numerous than the bourgeoisie) who make up the laboring class (i. . , labor). Indeed, Marx sees an equivalence between capital, property, and the means of production, which are all concentrated in the bourgeoisie. More than this, Marx analyzes bourgeois power as aligned with fundamental forms of social organization and oppression: Hitherto, every form of society has been based . . . on the antagonism of oppressing and oppressed classes. . . . Society can no longer live under this bourgeoisie . . . its existence is no longer compatible with society (Marx, 2002, p. 209). Just as Marx links class power to political power, he links political power to industrial-economic power over the laboring classes. The bourgeoisies ability to control industry and economy had as its consequence bourgeois control of the political system. This dominance, according to Marxs logic, implies oppression of the majority of persons in society because capital will always seek to maximize its benefit. Marxs solution: revolution and dictatorship of labor, which Marx terms the proletariat. He does not deal with the result of such a dictatorship and seems to simply assume that the proletariat will exercise its own power in a just way. Capitalism and India; my viewpoint! (Socio-Economic) I am totally tuned in to the incentives, rewards, labour and profit motives of capitalism. It is not perfect. But it is historically absurd to deny that price and profit signals under capitalism have done a far better job of allocating scarce resources and sustaining long periods of economic growth than any other alternative. Communism proved itself to be a disaster wherever and in whatever name practiced. Remember the USSR? East Germany? Bulgaria? Romania? Albania? And the devastation of Cuba under Fidel Castro that his ageing brother Raul cannot fix? Socialism, too, has had its innings in the west as well as in the east, and failed. State-sponsored capitalism — once the hot East-Asian model — saw too much of the state, and relatively less of private capital, resulting in overarching ambitions, needlessly grandiose projects and poor long-term returns. Go to Dubai and see for yourself. And the mixed economy with the state occupying the ‘commanding heights’ meant one thing: too much of command with little or no height worth the name. So, if you were to closely observe the dirty, disordered canvas of economic progress during the 20th and 21st century, you should conclude that, for all its warts, capitalism has been the winner. It has sometimes caused pain; suffered from serious cycles; and often needed the clout of the state — such as we have seen from September 2008. It has also been quite resistant to sensible regulation. Even so, the basic institutions of capitalism have worked, not just in the US and the OECD (Organization for Economic Co-operation and development) nations, but also many developing countries, of which India is one. And worked better than alternative mechanisms. That brings me to India. As we move on to the second decade of the 21st century, here’s my core hypothesis: India is geared to have significantly more of capitalism than what we have had up to now. And the more the better. Let us begin with agriculture. Nowhere is there a more intensely capitalistic venture than farmers choosing the crops that they sow, water, weed, harvest and sell. Since the late 1960s, economists have run thousands of regressions called supply response functions, which quantitatively determine what best explains crop acreage and output over long periods. What are the results? From the turn of the 20th century right up to now, crops were planted according to expected prices and/or profits — surrogated by the price signals of the previous few years. Of course, other variables mattered such as rainfall, irrigation and fertiliser use. But the driving force was profits. Capitalism, therefore, defines 17 per cent of India’s GDP, namely agriculture. Now to services, which accounts for 55 per cent of GDP. If you deduct the share of government services, there is still some 40 per cent of GDP, much of it in the private sector. This is huge. And many of the activities are driven largely by profits. Whether it be mobile telephony, retail trade, restaurants, real estate, storage, hotels, road transport or finance, each service — big, medium, small or holes in the wall — rises, shrinks, falls, re-grows or disappears according to supply, demand, costs and pricing. Even earlier anti-market behemoths such as public sector banks and insurance companies have become more attuned to prices and profits than anyone could have imagined in the mid-1990s. Thus, 57 per cent of India’s GDP is tuned to capitalism. What about industry, which accounts for 28 per cent of GDP? Some two-thirds of it is purely private. That is another 18 per cent approximately. Moreover, most public sector undertakings are more price-and-profit oriented than ever before. So, hello capitalism! It accounts for at least three-quarters of our GDP. It may be higher still. But 75 per cent will do for now. Contrary to what the CPI, CPI(M) and some ‘don’t confuse me with facts’ professors tell you, India is awash with capitalism. Like China, you turn any corner, and you will meet someone who wants to start some business or the other: a photocopying shop, an STD booth, a local agency for Dabur, Godrej or Hindustan Unilever, automobile spare parts — the list is endless. The state must allow these millions of capitalists to thrive. By creating essential infrastructure such as roads and power; by fostering basic facilities for education and training; by encouraging entrepreneurship through clean governance; and by creating level playing fields. These are tough tasks, but if the state succeeds in some fair measure, you can be sure that India’s millions of capitalists will make 9 per cent GDP growth look silly. We have it in us. In spades. Conclusion Over the centuries, capitalism and capitalist class has changed with time. It is worth adding that the impact of Capitalism on Society, economy, polity is huge. This has made it a multi-disciplinary subject of discussion. Domination of other classes of a society by a particular section of the society can never be justified and hence capitalism has been largely criticized by various scholars all over the world. The work of Marx on Capitalism is praiseworthy and is still followed today when issues regarding capitalism arise.

Developing a Management Plan for Type 2 Diabetes

Developing a Management Plan for Type 2 Diabetes A long term condition (LTC) is defined as an incurable syndrome. However, some LTC can be managed through medication (Goodwin et al 2010) whereas for others, it can be managed by healthcare providers facilitating health promotional support to patients in order to self-manage their conditions effectively (examples, maintaining healthy diet and physical activities) (Hutchison Breckon 2011). Additionally, for this assignment I will use a case study to discuss my experience about caring for a patient with type 2 diabetes in the hospital. The discussion will include the identified problems to support patients’ needs, the nurses’ contributions to promote patients’ health and well-being as well as the benefits of working alongside with a multidisciplinary team. According to Goodwin et al (2010) type 2 diabetes is also known as insulin resistance. The syndrome is when an individual body lacks the ability to produce sufficient insulin or the body is incapable of controlling enough blood glucose level. It is categorised as a LTC because it is incurable. Nonetheless, it can be managed depending on the individual’s conditions needs such as healthy food and regular activities, or a combination of medications and a healthy lifestyle (Diabetes UK 2012). According to Nursing and Midwifery Council (NMC 2010) Guidance on Professional Conduct, the patient’s identity will be maintained confidential and an anonymous name (Jane) will be used. Jane 65, who has had type 2 diabetes for about two years, was suffering from kyphosis on her back. As she has not been on pharmaceutics’ therapy since her diagnosis, she was advised to maintain her weight within an ideal range. However, Jane has not been able to gain control over her weight (73 kg). She lives alone and has no close family members but she has a good relationship with her neighbours and friends. I met Jane while on placement on an aging admission ward. She was admitted via Accident and Emergency department (AE) to an elderly ward referred by her General Practice (GP) with elevated blood glucose (11.5mmol) which was making her feel weak and was also giving her severe headaches, tiredness and recent weight gain (73.6kg). While she was admitted to AE, her hyperglycaemia was s tabilised with a dosage of metformin (500mg) (8.0mmols) prior to her transfer from AE to the elderly ward. Bakris (2011) suggested that nurses should carry out a comprehensive assessment on patients with type 2 diabetes as this will support the nurse to identify and address issues that can prevent and reduce problems that may affect the patients with type 2diabetes. Diabetes UKÂ  (2012), also recommended that a patient’s risk can be recognised if healthcare professionals could aid an in-depth assessment. This includes; blood glucose level, Hba1c, blood pressure, cholesterol, Body Mass Index (BMI) and waist circumference. The rationale behind the assessment is to support healthcare professionals to make an appropriate individualised care plan considering the patient’s preference (Diabetes UK 2012). To classify any interrelated problem, the nursing assessment was to look at Jane’s medical history before the admission and to observe what her current condition looked like. The nurse along with the author admitted Jane and prior to carrying out the assessment they introduced themselves to the patient. To obtain Jane’s consent, a full detail of the information about the process was explained to her (Nursing and Midwifery Council 2010). Jane’s vital signs presented a blood pressure of 138/80 mmHg, heart rate 84, respiratory rate 16 and temperature 36 degree centigrade. While examining Jane’s nutritional assessment, her MUST stool height was (1.62cm), weight 73.6kg, and waist circumference 88cm. It was identified that she had a BMI of 27 giving her a score (0). In addition to Jane’s assessment, her fasting glucose level was stable 6-7 mmol/litre her foot showed normal to sensation, no sign of lesions on toenails and skin. From Jane’s screening, the underlying cause for Jane’s hyperglycaemia is an increased BMI 27, this indicates overweight as (British Association for Parenteral and Enteral Nutrition 2010) recognised. Overweight is when an individual has more fat than normal in their body. However, an athlete with muscle mass or someone with swollen legs (oedema) could be overweight due to an increase in BMI (Heath Sturdy 2009). According to Nazarko (2008) an individual with a BMI 25-30 is considered to be overweight. BMI is the most common evidence-based tool used to analyse normal weight, overweight or obese in hospital when patients come for admission. It is calculated by dividing an individual’s body weight kilogram by the square of body height (NICE 2006). Waist circumference is also a reliable tool used to recognise overweight and obesity as it provides information with regards to the distribution of excess body fat in a person’s abdomen (NICE 2006). Nevertheless, BMI has some weakness; it is not suitable for individuals with excess body fat or muscle mass as it does not differentiate between excess body fat and muscle mass (Heath Sturdy 2009). Diabetes UK (2012) argued that using BMI alone to calculate a patient’s height and weight would not identify overweight or obesity. However, the combination of BMI and waist circumference will help classify an overweight or obese person, and for this reason Jane’s waist circumference was measured because it is the best way to measure abdominal fat distributed around her waist as suggested by Diabetes UK (2012). Regardless BMI and waist circumference screening tool was used to classify Janes’ overweight, however, according to Ashwell et al (2012) studies have proved waist to height ratio screening tool a better way of identifying overweight or obesity in adult than BMI and waist circumference. As a result nurses should consider using waist to height ratio as a screening tool to recognize overweight or obese patients with diabetes. This is because the tool measures the ratio of an individual waist to his or her height (Ashwell et al 2012). Jane’s height and weight was measured using stadiometer and clinical scale, nevertheless, the use of stadiometer to measure Jane’s height was comparatively weak (BAPEN 2010). Jane is a 65 year old woman with a small kyphosis on her back and according to Hirani Aresu (2012) the result for an elderly with this condition may impair their actual height resulting to false reading. This is because some people grow older with distort height like kyphosis, this as such will result in the individual to losing his or her real height. Kyphosis is a deformity of an individual’s back which can lead to hunched back due to a deviation of a spinal curvature from its normal shape (Kado et al 2013). Therefore the use of demispan measure tool could be an evidence based practice to consider when a patient’s actual height is distorted. As a result this might have worked for Jane as she has a small kyphosis on her back and the NMC (2010) emphasized that nurses should use their clinical knowledge, skills and judgement to classify factors that could impair individual’s height. Consequently, Jane’s hypoglycaemia is partly dependant on her overweight; therefore the main nursing intervention that needs to be targeted is Jane’s weight loss as it will lead to long term benefit for her. This is because overweight can cause hypoglycaemia, overweight is also associated to inadequate exercise and unhealthy eating behaviours considered to be primary factors contributing in the rising prevalence of type 2 diabetes and if not well managed, it could also lead to other complications such as obesity, heart attack or stroke (Diabetes UK 2012). As a result an effective weight management can improve Jane’s wellbeing using nursing problem solving approach. According to Barrett et al (2010) nursing problem solving approach is about understanding the individual as a whole person. Therefore, using the problem solving approach means nurses have to link the individual’s illness to factors that could affect their disease. These involve psychological, emotional, social environment, spiritual and time and if there’s any of these identified then it should be addressed as they form part of the individual’s well-being (Wade 2009). Knol et al (2006) states depression is common in people suffering from type 2 diabetes. Knol et al (2006) also recognised that thirty seven percent of those people with a medical history of depression are prone to have type 2 diabetes. Evidently, Jane during her initial assessment mentioned that she had little knowledge on dietary due to lack of motivation and her dietary history reveals having unhealthy food such as ready meals and dessert while away with friends. Consequently, this has had an impact on her psychological wellbeing. She also recognised excesses carbohydrate intake and her normal dinner meals consist of pasta whereas during the day she often has rice with homemade sauce as well as walking exercise 10-15 minutes twice in a week. However, the nursing team worked with Jane to determine if Jane’s overweight was caused by her not complying with her dietary advice, as a result she agreed that a referral to a dietician and diabetes specialist nurse was her concern and this was made to deliver meal plan as well as maintain her physical activity. This is the best practice as suggested by NMC (2006) that nurses must work together with their patient to ascertain the patient’s understanding about risk associated with overweight. This is because if Jane’s food pattern is left unattended it may lead to further ill health problems such as obesity, stroke and heart disease (Thomas 2008). The United Kingdom Progressive Diabetes Study (UKPDS 1990) recognised the majority of people with type 2 diabetes have ill health complications associated with their long term condition. In addition to this, the role of the dietician is to identify problems relating to an individual’s nutritional status and once identified the dietician working in partnership with the individual will then formulate meal plan that adapt to the person’s needs and preferences (British Dietetic Association 2012). Department of Health (2005) emphasised that nurses should empower patients with long term condition so that the individual is capable to manage and live with their disease effectively. NICE (2008) also suggested this method of approach as the best practice as it helps the individuals to manage their condition. According to Thomas (2008) weight loss through dietary can be defined as a reduction of less food intake to that of the energy used by an individual. Therefore the dietician along with the nursing team main target was how Jane would lose weight through dietary behaviour change and in order to achieve this she was seen a day after her admission. The initial approach considered was the motivational interview based on providing a solution to a suitable diet. Motivational interviewing is a collaborative patient centred approach in a form of supporting a person’s motivation to encourage and empower patients’ behaviour change (Resnicow Mcmaster 2012). This is to maintain the patient’s autonomy based on his or her needs for their condition and that any decision made is eventually up to the patient (Resnicow Mcmaster 2012). Jane agreed having a motivational interview and had the opportunity to discuss her dietary plan with the main focus on the types of food she likes as mentioned above. In order for Jane to have an appropriate balance diet, the dietician and the nursing team worked with Jane by setting a realistic goal. This is because for an individual to lose weight involves time and encouragement to achieve his or her goals effectively and therefore the best practice is setting an appropriate goal that suits Jane (Thomas 2008). It was difficult to set a short term goal for Jane as she was unable to maintain weight loss due to lack of motivation and therefore a long term goal was set with smaller intake of caloric food so that Jane could gradually lose weight and also improve her glycaemic control (Diabetes UK 2012). Jane was offered the importance to a strict diet and she was provided food such as fish, vegetables, low starchy food per day; a reduction of low sugary food was put in place. She was also encouraged to drink two litres of water daily. Her daily food intake was recorded to meet her dietary care plan needs as (Lang Froelicher 2006) recommended. Moreover, Jane during her admission was subjected to weight monitoring and repeating her ‘MUST’ screening progress for any changes in her BMI (BAPEN 2010). Jane following a regular monitoring, on her fifth day on admission was still considered overweight; however, evidence shows a minimal improvement of 900gms weight loss. A risk of any physical complications of diabetes was low and no episode of hyperglycaemia. Her symptom of severe headaches and tiredness was now resolved and she was more excited to go home. Following Jane’s outcome of her dietary care plan, if Jane can be convinced to increase her physical activity her need for hypoglycaemic drug will be minimised. This is because the combination of dietary and an increase in physical activity on a regular basis is recommended to be more effective for an individual to achieve weight loss in a long term goal (NICE 2006). As such Jane’s care plan was reviewed with the nursing team prior to discharge and from her assessment it was recognised that she does not need a psychological referral but to improve her knowledge with regard to her type 2 diabetes so that she can self-manage her diabetes successfully. Even though Jane was suffering from kyphosis, physically she was fit to increase her physical activity and following the discussion how significantly an increase in exercise can have positive effect on glucose management, Jane agreed to walk each day in the mornings 20 – 25 minutes. After reviewing Jane’s dietary and physical options, a discussion about the need to continue metformin helped to improve her glycaemic control; therefore she was prescribed 500 mg twice a day. Metformin is an oral drug to lower glucose level in the blood. Jane will benefit from taking metformin as it is associated to weight loss this will prevent her from gaining more weight (NICE 2009). Other oral anti-diabetic agent such as thiazolidinedious and sulphonyureas were not recommended due to an increase of body weight caused by these agents. Prior to discharge Jane was informed about the importance of community nurse. The nursing team liaised with the community nurse for a regular monitoring of Jane’s glucose level as well as her weight. NMC (2010) highlighted that consent must be given to Jane before involving a community nurse thus it is the right of an individual to confidentiality and consequently is a must for a nurse to respect this. To sum up, Jane’s dietary plan did not make much significant changes in her weight, however, on discharge she was educated to continue recording her daily food and drinks intake, regular exercise, to closely monitor glucose level for symptoms of hyperglycaemic or hypoglycaemia. Further information about getting support from educational programme such as DESMOND was discussed with Jane. She was also given information leaflets which were easy to read as supporting interventions to help increase her knowledge about how to self-manage her diet.

The Home Changes With Time :: descriptive essay, observation essay

The Home Changes With Time Way up in the mountains, above the reaches of the hustle and bustle of the industrialized world, stands a large wooden house with loose shingles hanging off the roof, and the paint is chipping from years of wind and snow. The house was constructed on the slope of the mountain, and a long flight of stairs must be climbed to reach the first floor. The deck extends from the house on three sides, on both the first and second floors. It is a grand old house. Watching my step carefully, I climbed up the long flight of stairs to the first floor. I reached my hand out to grab the handrail, only to pull it away quickly as I received a sharp prick from the rough uncared-for wood. When I finally reach the first deck of the house, I have to stop to inflate my lungs with the barely oxygenated air of 10,000 feet. I walk across the twisted and contorted deck to the dirty-white door lined by turquoise trim. The trim color seems odd now; I don't remember it from my last visit. I stick the key into the brass handle knob and swing the door open; a rush of musty air makes my nostrils flare and twitch out of control. Looking across the neat unlived in room, memories of times when people actually lived in this house fill my mind. Spider webs tangle themselves around my head as I walk across the room towards the stairs that lead up to the second floor. I look up the dark, tight passageway of stairs, then search for the light switch that is connected to the bubble light hanging from the slanted ceiling above. After turning it to the on position, I wrap my hands around the handrails on each side and slowly pull myself up the stairs. After reaching the second floor I turned right into an open room lit brightly by the sunlight that pours in through the large windows. There are a couple of couches placed around the room. A large floral couch, backed up against the wall, is a perfect seat to relax and stare out through the treetops at the large snow capped peaks of the Rocky Mountains. Across the room sits a smaller black futon that folds down into a double bed. Next to the futon, is a tall china cabinet filled with magnificently colored wineglasses and china plates.

Journey to a New Land :: History

A Journey to a New Land My parents immigrated to Canada in 1990 to escape the tyranny of the Chinese government and to build a better life in Canada. After listening to their stories of hardships and frustrations, I realized how fortunate I was to be living in the country I now called home. When the day came to revisit my homeland, I felt uncertain and nervous. Would I fit in? Would I like it there? These were some of the concerns that were racing through my mind. But as the trip progressed, I realized how much I enjoyed staying inChina. Despite what started off as a foreboding voyage, this journey turned out to be one of the best experiences of my life. It had been a long time between my move from China to Canada and the visit to my homeland. As a baby, I had left for Canada and adopted many new traditions and learned many new things. Going back to China for the first time in eleven years would offer me incredible new experiences, but I wasn’t prepared. I wasn’t ready. Leaving my birth country at the age of one and forgetting many of the proper Chinese traditions, I felt so isolated from my culture. The only encouragement I had of taking this trip was from my parents, who reassured me that I was going to do fine. However, my doubts still remained and I knew this would be an obstacle I had to overcome. As I first stepped onto Chinese soil, I began to explore many of the different features of my culture. The benefit of the currency exchange enabled my parents and me to shop in exquisite Chinese boutiques and eat delectable Chinese foods. As I bit into a delicious deep-fried dumpling while sipping some bubble tea, my worries and anxieties drifted away like mist. Eating and drinking as if I were royalty and shopping in splendour, my life was a paradise. For the first time since I arrived in my motherland, I felt that I did fit in with my culture, for I was adopting many of the Chinese customs already. Adapting to China’s less fortunate society was the hardest challenge. One major disappointment of the Chinese living style was the unsanitary conditions. Everywhere I went, most washrooms were smelly, fly-infested places where toilets were holes dug under the ground. It was repulsive yet distressing to think that millions of people in China had to endure these conditions everyday.