Wednesday, November 27, 2019
Free Essays on France
France Introduction France, which is the largest nation in Western Europe, is a presidential republic. France is a very important nation in Europe and it continues to be involved in contemporary policy issues. Helping the world as one of the great trading nations, France is a very important trading partner with the United States. Not only is France important to the United States, they are also important to countries all over the world. Their abundance of both mineral and agricultural resources make them a very important supplier of products all over the world. I chose to report on France because it is an interesting county and I wanted to learn more about it. Geography France is located in Western Europe and has an area of approximately 211,000 square miles. Along with being the capital, Paris is also the largest city in France. Spain borders France in the south, Italy and Switzerland in the east, and Germany, Luxembourg, and Belgium in the northeast. The French Alps are located in the east where snow capped peaks, such as Mont. Blanc reach heights of 15,781 feet. About one-half of Franceââ¬â¢s total border is formed by coastline, with the Mediterranean Sea on the Southeast and the Atlantic and the English Channel on the west and northwest. Many rivers and canals run through France forming a vast network, tying different regions and cities together. The Seine is the countryââ¬â¢s largest navigable river. It flows northwest from eastern France through the city of Paris, and empties into the channel at Le Harre. The Rhone River is the largest in the country in terms of volume of discharge. Along with its tributaries, it drains the Fre nch Alpine region. Although France has many rivers, it only has a few lakes. One of the lakes in France is Lake Geneva (also known as Lake Leman), but in lies mainly in Switzerland. France is richly endowed with an excellent balance of both mineral and agricultural resources. Th... Free Essays on France Free Essays on France France Introduction France, which is the largest nation in Western Europe, is a presidential republic. France is a very important nation in Europe and it continues to be involved in contemporary policy issues. Helping the world as one of the great trading nations, France is a very important trading partner with the United States. Not only is France important to the United States, they are also important to countries all over the world. Their abundance of both mineral and agricultural resources make them a very important supplier of products all over the world. I chose to report on France because it is an interesting county and I wanted to learn more about it. Geography France is located in Western Europe and has an area of approximately 211,000 square miles. Along with being the capital, Paris is also the largest city in France. Spain borders France in the south, Italy and Switzerland in the east, and Germany, Luxembourg, and Belgium in the northeast. The French Alps are located in the east where snow capped peaks, such as Mont. Blanc reach heights of 15,781 feet. About one-half of Franceââ¬â¢s total border is formed by coastline, with the Mediterranean Sea on the Southeast and the Atlantic and the English Channel on the west and northwest. Many rivers and canals run through France forming a vast network, tying different regions and cities together. The Seine is the countryââ¬â¢s largest navigable river. It flows northwest from eastern France through the city of Paris, and empties into the channel at Le Harre. The Rhone River is the largest in the country in terms of volume of discharge. Along with its tributaries, it drains the Fre nch Alpine region. Although France has many rivers, it only has a few lakes. One of the lakes in France is Lake Geneva (also known as Lake Leman), but in lies mainly in Switzerland. France is richly endowed with an excellent balance of both mineral and agricultural resources. Th...
Saturday, November 23, 2019
Should Capital Punishment be Aboloshed essays
Should Capital Punishment be Aboloshed essays With the passage of time there has been softening of Penal Cod. Not long ago death penalty was inflicted fron numerous offences. In England death by hanging was a legal punishment for no less than two hundred offences, even for such minor offences as stealing a sheep, poaching or pick-pocketing. With the dawn of modern civilization a realization has dawned upon the people that severity of punishment is a relic of barbarism. It was Sir Robert Peele, the British Home Secretary, who revised the Penal Code in 1923 and slashed the number of capital offences to only two: murder and treason. In countries like Holland and Italy capital punishment has been abolished altogether. In France and Belgium it ha not been enforced over the last so many years. The main argument of those countries which have abolished it or ontend to do so, is that it is irrevocable.No judge, howsoever honest or conscientious he may be, can claim to be infallible. Terrible blunders are likely to be committed by even the most seasoned judges in sensitive cases like murder or treason. The alleged culprits have been condemned to death and executed, whi afterwards, but too late, proved to be innocent. If life-imprisonment had been awarded for murder, the victims of these miscarriages of justice, could, at any rate, have been released and compensated for wrongful conviction. But nothing can be done when the convicted person has been hanged. There are some people who hold that the abolition of capital punishment would encourage the criminals to commit murders with impunity. The softening of the penal code would lead to an increase in the incidence of crime. But the crime situation in Italy and Belgium where death penalty has been done away with is rather on the decline. Indeed over-severity has often increased crime by marking criminals desperate. Those who are in favour of retaining capital punishment say that the death penalty is logical outcome of a henious crime li ...
Thursday, November 21, 2019
Cardiorespiratory endurance training program Essay
Cardiorespiratory endurance training program - Essay Example It is done to improve the bodyââ¬â¢s capability to transport oxygen and nutrients to different tissues in the body. It is also done to improve the removal of wastes from the body. The body will be able to do this over sustained periods of time. Because of this, a cardiorespiratory endurance training program can help reduce the risk of diseases like heart attack, atherosclerosis, hypertension, and stroke. The cardiorespiratory endurance training program can be done three to five times a week. It should be done at a slow and steady pace in an intensity that will drop heart rate to 60 to 75% of the maximum. As with any training program, it is important to be checked by a doctor to know if you are fit to use the cardiorespiratory endurance training program. This program usually mixes a number of workouts to maximize the bodyââ¬â¢s endurance and overall fitness level. For my personal training program, I have considered a four-day per week training program that will improve my physical fitness. On the first day of training, it will target the upper body. It will include Incline Dumbbell Press, Push Up, Seated Shoulder Press, Tricep Pulldowns, Incline Dumbbell Curls, and Lateral Pulldowns. These exercises will be composed of three sets with twelve repetitions per set. The second day of training will be devoted to a cardiovascular activity. I can choose from a 20 minute run or a 30 minute swim or 30 minute cycling, depending on which activity is more appropriate for that day in terms of equipment availability and weather conditions. The third day of my training will concentrate on my lower body by doing Squats, Standing Calf Raises, Leg Extension, Seated Calf Raises, Walking Lunges, and Two Foot Long Jump. This will be done again in three sets with twelve repetitions per set. The fourth day of training will be a cardiovascular activity again, choosi ng between a 20 minute run or a 30 minute swim or
Wednesday, November 20, 2019
Writing inventory (Areas of strength and weakness) Essay
Writing inventory (Areas of strength and weakness) - Essay Example Broad content seems to be relatively self-explanatory as it looks at how well the finished document accomplishes its intent. Organization and presentation seems also self-explanatory as it refers to the way in which the information is presented. Surface areas refers to the basic elements of writing such as grammar, spelling and punctuation. To make this clearer, I will analyze a piece of my own writing regarding broad content, organization and presentation and surface areas to discover those areas in which I am strong and where I can improve. In terms of broad content, I feel my paper on Anne Hutchinson is very strong. It never truly states its purpose, but the introduction makes it clear that the paper is about to present evidence as to why Anne Hutchinson was a woman ahead of her time as the title claims. The paper gives a brief biography of the woman and points out those areas in which she behaved differently from the way women of her time were expected to behave. The paper is clearly addressed to students of history and, as such, offers important information about what was expected of women in this time that a student of the modern age wouldnââ¬â¢t necessarily know. Numerous credible sources are used to illustrate what life was like for women in the Puritan colonies as well as to support the various ways in which Hutchinson struggled against these constraints. Overall, the paper seems very strong in its broad content. In terms of organization and presentation, I have to again say that I feel the paper is very strong. It starts with an introduction that could perhaps be better organized or more focused, but then goes into strong organization and presentation. Each segment is clearly labeled with a sub-heading and the essay follows a roughly chronological structure. From introducing the brief overview of Anne Hutchinsonââ¬â¢s life until she moved to America, the essay examines her
Sunday, November 17, 2019
Carter Unsuccessful Re-Election 1980s Essay Example for Free
Carter Unsuccessful Re-Election 1980s Essay Why was Carter unsuccessful in his attempt to secure re-election in 1980? Jimmy Carter was the first elected President in half a century who failed to win a second term. His election in 1976 was set during the period of time when people had lost their faith in the presidency. After Nixonââ¬â¢s humiliation considering Watergate scandal and Fordââ¬â¢s simplistic and unenthusiastic govern, people were looking for someone outside Washingtonââ¬â¢s corruption. Carter seemed a perfect decision , governor of a small state, he appealed to people as the best solution. Nevertheless, as they got what they wanted it turned out to be wrong. They got a person from the outside that had no idea how Washington worked. People believed he was error prone and inexperienced. Carter soon became a joke and was criticized by the society that was not willing to give their votes for his re-election. Carter made several crucial mistakes during his power. From the beginning of his presidency he was accused of micro-management. This was one of his strategic errors, he tried to do too much too quickly and paid attention to small details forgetting the big picture and failing to grasp the complexity of the plans that he proposed. It is said that he managed the rota for the White House personally. An NSC member said: ââ¬Å"If Carter saw a problem he wanted to solve it, and there was all there was to it ââ¬â no prioritizationsâ⬠. His short sight pushed the voters away. People were not eager to vote for someone who would get absorbed in small things, rather than looking at serious problems like inflation, which Carter had inherited. His other mistake was rejecting all the help, including Congressââ¬â¢s. Carter had originally run on an anti- Washington platform, of course that was the reason he got elected; nevertheless it is hard to run a country when you have tension between the President and Congress. Therefore Carter never developed a solid base of supporters on Capitol Hill. Speaker Tip Oââ¬â¢Neil was willing to help, however Carter who said that he had been a governor and knew how to deal with legislation rejected his proposal. Carterââ¬â¢s poor communication with Congress got him nowhere. Carter failed to get cooperation from Congress to pass certain legislations, such as his energy program. Americans understood that a stubborn President wouldnââ¬â¢t bring any good to the country; Carterââ¬â¢s personal loyalties made voters doubt his wisdom and retrieve their votes for someone better. His other failure overshadowed everything that he has done as a president. The ââ¬Å"Billygateâ⬠scandal had harmed Carters reputation and even lowered his chances of being re-elected. He won his first election in 1976 because people thought he was unaffected by Washingtonââ¬â¢s corruption, however this scandal highlighted Carters use of presidential power in his own benefit. Carterââ¬â¢s older brother Billy was a redneck; who, in July 1980, registered as a foreign agent and received a $220,000 loan from the Libyan government. It raised a political storm and later on through the investigation it was revealed that Carter used Billyââ¬â¢s Libyan contacts to free the Iranian hostages. President Carter was accused of nepotism however public decided that he was incompetent rather than corrupt but this scandal cost Carter his popularity rating and votes. Nonetheless, some of the negative events that occurred during Carters presidency were not his fault yet he got the blame. A first example would be the energy crises, which was beyond Carters control. Increase of car use, one harsh winter and poor relationship with Middle East were the reason for it, but still Carter was accused. Carter attempted to propose energy legislation, however Congress changed it beyond recognition. The only conclusion was to raise the price for the fuel but people were unwilling to go that far. Voters were unimpressed by the Presidentââ¬â¢s handling of this situation, which soon got even worse and caused even more dissatisfaction from people. The second example is the economy, which was the problem throughout Carterââ¬â¢s presidency yet was a mere question of luck. He inherited inflation, unemployment and rising aging population. 63 per cent of the Americans believed that inflation was their greatest concern yet Carter was not managing it; only 32 per cent approved of his actions. The unemployment was rising to 8.2 million and businesses feared that Carterââ¬â¢s energy proposal would damage the industry. Carter did not know how to handle these types of situation; being all his life a governor of small Georgia he now faced a major crisis. Carter was at the top and therefore blamed, he was simply unlucky. Yet this blame and dissatisfaction cost him votes. Carter also displeased the voters with the way he handled foreign policy. As a President, Carter decided that it was morally right to give Panama Canal over to Panama. He did it with little resistance, which displeased voters and Congress. His other mistake was accepting 125,000 Cuban refugees who were dissatisfied with Communist regime, although March 1980 Refugee Act said that no more than 19,000 were allowed to enter. It was morally right to let the people in and perhaps he would have been accused if he closed the doors for them, yet politics sometimes tend to forget about moral rules in times of crisis. With inflation and unemployment, new citizens were only burdens and caused further disagreement with Carterââ¬â¢s way of running the country. His final concern that had taken all Carterââ¬â¢s attention until his last day as a President was the 60 American hostages in Iran. Many Americans felt powerless and 50 per cent of them thought Carter was too soft with Iran. Carter had a choice; either to take hostages back with violence or with negotiation. He chose a more diplomatic way not wanting to risk lives, however back than people disapproved of this act. When finally Carter agreed on the rescue mission, helicopters that were sent into Iran failed. Eight Americans died, one helicopter was lost in sand storm another failed and set the others on fire. Technical and weather problems were not Carterââ¬â¢s fault yet his failed rescue mission caused Carterââ¬â¢s defeat and helped Republican to use the hostage crisis for votes. The final reason for Carters defeat was his opposition. Ronald Reagan was underestimated by Carter, yet adored by the people. The way he presented himself was the way a true President had to be. His lighthearted jokes and charisma made him come across warmer to voters than Carter. Reaganââ¬â¢s rhetorical question ââ¬Å"is America better off than it was four years ago?â⬠was highly effective and the polls showed that he won the debate. Back in 1980, people believed that Carter was one of the worst presidents they had, yet as the years past people began to justify his acts. He was not great but he did what he could, he was just unlucky. His failures were because Washington was unknown to him and he did things how he usually used to do the back in his state. His big mistake was ââ¬Å"Billygateâ⬠and economical crisis, which was not under his control. Reagan compared to Carter presented a true picture of successful presidency. Unfortunately Carter was not what people wanted and some of his failed actions cost him his re-election.
Friday, November 15, 2019
Essay --
There is a higher incidence of hypertensive disorder of pregnancy in Black women than in White women. This is possibly related to lower socioeconomic status, their lifestyle and prior undiagnosed preexisting hypertension. Black women have greater risk of hypertensive disorder of pregnancy and preeclampsia than nulliparous White women. Irwin D et al. researched the relationship between race and risk of hypertension disorder of pregnancy in a cohort of active duty military women. Researchers assessed the sociodemographic and reproductive characteristics of Black and White women. It is explained from the results that White women are more likely to be married (75% vs 56%), over the age of 35 (3.4% vs 1.6%), were higher ranked officers (9% vs. 2%) and had education post high school (21% vs 17%). Moreover, it was also suggested that nulliparous have higher risk of hypertensive disorder of pregnancy (Relative risk (RR)= 2.2, 95% Confidence Interval (CI)=1.8 ,2.7), Transient gestational hype rtension (RR= 2.0, 95% CI= 1.5, 2.7) and preeclampsia (RR=2.8, 95% CI=2.0,3.9). Among parous women thi...
Tuesday, November 12, 2019
Growing up in different times: Heaney and Wordsworth
William Wordsworth grew up in the Lake District in Cumbria, England during the very end of the eighteenth century and early nineteenth century. Here he lived with his aunt and sister. Being surrounded by nature was a huge impact on Wordsworth's life. Nature was everything from his teacher to almost his lover. He gradually grew to believe that nature was God. This idea that was everything for him is demonstrated very well in his poetry. Seamus Heaney was born in Northern Ireland in Derry. He was born before the height of the troubles but did live through a hard life living on a farm in rural Ireland. Living on the farm helped him to grow up and realise what real life was like. He learned things like dealing with death. There are similarities in both poets' writing. For example both people grew up with nature and it was nature that taught them what real life was truly like. There are also differences for Heaney nature was only like a teacher while for Wordsworth nature was even things like his conscience. Heaney grew from fear to confidence. Wordsworth's writing was very philosophical and always contained a much deeper meaning than Heaney's writing did. This is just a few poems from Heaney's anthology Death of a Naturalist. In the poem ââ¬Å"Death of a Naturalistâ⬠the change Seamus experiences is one which we all experience yet at the time do not know that it has taken place and probably for some years will not know. The poem begins with a light description of the childhood ritual, collecting frogspawn. Every year he collects ââ¬Å"jampotfulsâ⬠to put on shelves both at home and school. Now as Heaney is quite young he would not be aware of how the frogspawn got there. And no one is prepared to truthfully tell him. But his class teacher describes how ââ¬Å"The daddy frog called a bullfrog, And how he croaked, and how the mammy frog Laid hundreds of little eggs.â⬠But of course this is not how it happened and of course eventually one day we all find out about sexuality. Heaney's day came when one year while collecting the frogspawn ââ¬Å"the angry frogs Invaded the flax-dam,â⬠he heard a ââ¬Å"coarse croaking that I had not heard before.â⬠He believes the frogs are beginning to gang up on him to take revenge for all the eggs he has taken but of course nothing of the sort is happening, it is just that all the frogs are having sex. ââ¬Å"On sods; their loose necks pulsed liked sails. Some hopped: The slap and plop were obscene threatsâ⬠¦. â⬠¦their blunt heads farting. I sickened, turned and ran.â⬠This image is a grotesque image in which subconsciously young Seamus discovers his sexuality. For a minute he is aware but afraid to admit it to himself in case he may lose that childhood innocence so he turns away sickened, longing for the moment that he was unaware of this disgusting act. ââ¬Å"Dawn Shootâ⬠is again a different type of poem. In this poem Seamus has no fear to conquer and no bridge to cross whether real or imaginary. This poem is really about how far he has come. Rather than cry over the death of animals in ââ¬Å"Early Purgesâ⬠, he is enjoying the killing of animals. He is totally carefree and not worried about shooting an animal or how badly wounded it should become or even if it dies. He is even stealthy so not to scare the animals to ensure he gets a kill. ââ¬Å"Rubber-booted, belted, tense as two parachutists, We climbed the iron gate.â⬠When an animal is finally killed they don't even care to retrieve it as ââ¬Å"the prices were too small.â⬠I have chosen two extracts from Wordsworth poem ââ¬Å"The Prelude.â⬠In the poem ââ¬Å"The Prelude (I)â⬠Wordsworth follows a similar theme of growing up. In this poem young Wordsworth takes a boat which is not his and he is feeling very adventurous. ââ¬Å"It was an act of stealth And troubled pleasure.â⬠He felt very good when he took the boat and was having a very good time, until Wordsworth realises what he has done wrong but this is not realised until he reaches his destination in the lake. ââ¬Å"The horizon's bound, a huge peak, black and huge, As if with voluntary power instinct Upreared its head.â⬠This is the climax of the poem and helps show the sudden change in mood. Wordsworth is happily rowing the boat when suddenly this huge big thing shows itself. To Wordsworth this is some sort of hideous creature. But in fact as you go through the poem you learn that this is the first few signs of his developing conscience. ââ¬Å"For many days my brain Worked with a dim and undetermined sense Of unknown modes of being; o'er my thoughts There hung a huge darknessâ⬠¦. â⬠¦moved slowly through the mind By day, and were a trouble to my brain.â⬠These show the signs of a guilty conscience, guilty from knowing he took the boat: a moral Wordsworth is being taught about from nature and it again points to his emerging belief of Pantheism, that nature is God. The main focus in this poem ââ¬Å"The Prelude (II)â⬠is that of moving on. The poem has a picturesque setting of the ââ¬Å"twilight gloomâ⬠This type of light however would tell Wordsworth to go inside, as if nature was telling him as a parent calls their children. But ââ¬Å"I heeded not their summons.â⬠So he carried on ââ¬Å"All shod with steel, We hissed along on the polished ice in games:â⬠a nice use of alliteration to convey the movement of ice skating. But Wordsworth being a Pantheist he cannot stay so he wonders off; ââ¬Å"not seldom from the uproar I retired.â⬠Wordsworth here shows his poetic ability and understanding of nature because he realises that the hills are ââ¬Å"melancholic.â⬠His subconscious understanding of nature forces him to go off and explore. What he realises is that everything around him is moving. ââ¬Å"With visible motion her diurnal round! Behind me did they stretch in solemn train, Feebler and feebler, and I stood and watched Till all was tranquil as dreamless sleep.â⬠The movement of the earth that he experiences here shows him that he is part of a moving, living universe. It is as if he has travelled with the spirit in God of nature. I think everyone could relate to Wordsworth's and Heaney's poems in someway: I know that I can relate to his feeling of a spirit in the woods. When I was lost I in the woods I felt as if someone was there showing where to go. The one thing we must all realise is that, we will all grow up: it is unstoppable and inevitable. I savour the thought.
Sunday, November 10, 2019
Patients Rights Essay
The legal interests of persons who submit to medical treatment. For many years, common medical practice meant that physicians made decisions for their patients. This paternalistic view has gradually been supplanted by one promoting patient autonomy, whereby patients and doctors share the decision-making responsibility. Consequently doctor-patient relationships are very different now than they were just a few decades ago. However, conflicts still abound as the medical community and those it serves struggle to define their respective roles. Consent Consent, particularly informed consent, is the cornerstone of patientsââ¬â¢ rights. Consent is based on the inviolability of oneââ¬â¢s person. It means that doctors do not have the right to touch or treat a patient without that patientââ¬â¢s approval because the patient is the one who must live with the consequences and deal with any dis-comfort caused by treatment. A doctor can be held liable for committing a Battery if the doctor touches the patient without first obtaining the patientââ¬â¢s consent. The shift in doctor-patient relationships seems inevitable in hindsight. In one early consent case, a doctor told a woman he would only be repairing some cervical and rectal tears; instead he performed a hysterectomy. In another case, a patient permitted her doctors to examine her under anesthesia but insisted that they not operate; the doctors removed a fibroid tumor during the procedure. In yet another case, a doctor assured a man that a proposed operation was simple and essentially without risk; the patientââ¬â¢s left hand was paralyzed as a result of the surgery. Consent must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, he or she is free from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent. The law presumes that an adult is competent, but competency may be an issue in numerous instances. Competence is typically only challenged when a patient disagrees with a doctorââ¬â¢s recommended treatment or refuses treatment altogether. If an individual understands the information presented regarding treatment, she or he is competent to consent to or refuse treatment. Consent can be given verbally, in writing, or by oneââ¬â¢s actions. For example, a person has consented to a vaccination if she stands in line with others who are receiving vaccinations, observes the procedure, and then presents her arm to a healthcare provider. Consent is inferred in cases of emergency or unanticipated circumstances. For example, if unforeseen serious or life-threatening circumstances develop during surgery for which consent has been given, consent is inferred to allow doctors to take immediate further action to prevent serious injury or death. Consent is also inferred when an adult or child is found unconscious, or when an emergency otherwise necessitates immediate treatment to prevent serious harm or death. Consent is not valid if the patient does not understand its meaning or if a patient has been misled. Children typically may not give consent; instead a parent or guardian must consent to medical treatment. Competency issues may arise with mentally ill individuals or those who have diminished mental capacity due to retardation or other problems. However, the fact that someone suffers from a mental illness or diminished mental capacity does not mean that the individual is incomp etent. Depending on the type and severity of the disability, the patient may still have the ability to understand a proposed course of treatment. For example, in recent years most jurisdictions have recognized the right of hospitalized mental patients to refuse medication under certain circumstances. Numerous courts have ruled that a mental patient may have the right to refuse antipsychotic drugs, which can produce disturbing side effects. If a patient is incompetent, technically only a legally appointed guardian can make treatment decisions. Commonly, however, physicians defer to family members on an informal basis, thereby avoiding a lengthy and expensive competency hearing. Consent by a family member demonstrates that the doctor consulted someone who knows the patient well and is likely to be concerned about the patientââ¬â¢s well-being. This will probably be sufficient to dissuade a patient from suing for failure to obtain consent should the patient recover. Legal, moral, and ethical questions arise in competency cases involving medical procedures not primarily for the patientââ¬â¢s benefit. These cases typically arise in the context of organ donation from one sibling to another. Many of these cases are approved in the lower courts; the decisions frequently turn on an e xamination of the relationship between the donor and recipient. If the donor and recipient have a relationship that the donor is aware of, actively participates in, and benefits from, courts generally conclude that the benefits of continuing the relationship outweigh the risks and discomfortsà of the procedure. For example, one court granted permission for a kidney transplant from a developmentally disabled patient into his brother because the developmentally disabled boy was very dependent on the brother. In another case, a court approved a seven-year-old girlââ¬â¢s donation of a kidney to her identical twin sister after experts and family testified to the close bond between the two. Conversely, a mother successfully fought to prevent testing of her three-and-a-half-year-old twins for a possible bone marrow transplant for a half brother because the children had only met the boy twice and were unaware that he was their brother. Married or emancipated minors, including those in the Armed Services, are capable of giving their own consent. Emancipated means that the minor is self-supporting and lives independently of parents and parental control. In addition, under a theory known as the mature minor doctrine, certain minors may consent to treatment without first obtaining parental consent. If the minor is capable of understanding the nature, extent, and consequences of medical treatment, he or she may consent to medical care. Such situations typically involve older minors and treatments for the benefit of the minor (i.e., not organ transplant donors or blood donors) and usually involve relatively low-risk procedures. In recent years, however, some minors have sought the right to make life- or-death decisions. In 1989, a state court first recognized that a minor could make such a grave decision. A 17-year-old leukemia patient refused life-saving blood transfusions based on a deeply held, family-shared religious conviction. A psychologist testified that the girl had the maturity of a 22-year-old. Ironically, the young woman won her right to refuse treatment but was alive and healthy when the case was finally decided. She had been transfused before the slow judicial process needed to decide such a difficult question led to a ruling in her favor. Some state statutes specifically provide that minors may give consent in certain highly charged situations, such as cases of venereal disease, pregnancy, and drug or alcohol abuse. A minor may also overrule parental consent in certain situations. In one case, a mother gave consent for an Abortion for her 16-year-old unemancipated daughter, but the girl disagreed. A court upheld the daughterââ¬â¢s right to withhold consent. Courts often reach divergent outcomes when deciding whether to interfere with a parentââ¬â¢s refusal to consent to a non-life-threatening procedure. One court refused to override aà fatherââ¬â¢s denial of consent for surgery to repair his sonââ¬â¢s harelip and cleft palate. But a different court permitted an operation on a boy suffering from a severe facial deformity even though his mother objected on religious grounds to the accompanying blood transfusion. In another case, a child was ordered to undergo medical treatments after the parents unsuccessfully treated the childââ¬â¢s severe burns with herbal remedies. Courts rarely hesitate to step in where a childââ¬â¢s life is in danger. To deny a child a beneficial, life-sustaining treatment constitutes child neglect, and states have a duty to protect children from neglect. One case involved a mother who testified that she did not believe that her child was HIV positive, despite medical evidence to the contrary. The co urt ordered treatment, including AZT, for the child. Many other cases involve parents who want to treat a serious illness with nontraditional methods or whose religious beliefs forbid blood transfusions. Cases involving religious beliefs raise difficult questions under the First Amendmentââ¬â¢s Free Excise of Religion Clause, Common Law, statutory rights of a parent in raising a child, and the stateââ¬â¢s traditional interest in protecting those unable to protect themselves. When a childââ¬â¢s life is in danger and parental consent is withheld, a hospital seeks a court-appointed guardian for the child. The guardian, often a hospital administrator, then consents to the treatment on behalf of the child. In an emergency case, a judge may make a decision over the telephone. In some cases, doctors may choose to act without judicial permission if time constraints do not allow enough time to reach a judge by telephone. In 1982, a six-day-old infant with Downââ¬â¢s syndrome died after a court approved a parental decision to withhold life-saving surgery. The child had a condition that made eating impossible. The baby was medicated but given no nourishment. The public furor over the Baby Doe case eventually helped spur the department of health and human services to create regulations delineating when treatment may be withheld from a disabled infant. Treatment may be withheld if an infant is chronically and irreversibly comatose, if such treatment would merel y prolong dying or would otherwise be futile in terms of survival of the infant, or if such treatment would be virtually futile in terms of survival and the treatment would be inhumane under these circumstances. Although courts overrule parental refusal to allow treatment in many instances, far less common are cases where a court overrides an otherwise competent adultââ¬â¢s denial of consent. The cases where courts have compelled treatment of an adult usually fall into two categories: when the patient was so physically weak that the court ruled that the patient could not reflect and make a choice to consent or refuse; or when the patient had minor children, even though the patient was fully competent to refuse consent. The possible civil or criminal liability of a hospital might also factor into a decision. A court typically will not order a terminally ill patient to undergo treatments to prolong life. Informed Consent Simply consenting to treatment is not enough. A patient must give informed consent. In essence, informed consent means that before a doctor can treat or touch a patient, the patient must be given some basic information about what the doctor proposes to do. Informed consent has been called the most important legal doctrine in patientsââ¬â¢ rights. State laws and court decisions vary regarding informed consent, but the trend is clearly toward more disclosure rather than less. Informed consent is required not only in life-or-death situations but also in clinic and outpatient settings as well. A healthcare provider must first present information regarding risks, alternatives, and success rates. The information must be presented in language the patient can understand and typically should include the following: * A description of the recommended treatment or procedure; * A description of the risks and benefitsââ¬âparticularly exploring the risk of serious bodily disability or death; * A description of alternative treatments and the risks and benefits of alternatives; * The probable results if no treatment is undertaken; * The probability of success and a definition of what the doctor means by success; * Length and challenges of recuperation; andà * Any other information generally provided to patients in this situation by other qualified physicians. Only material risks must be disclosed. A material risk is one that might cause a reasonable patient to decide not to undergo a recommended treatment. The magnitude of the risk also factors into the definition of a material risk. For example, one would expect that a one in 10,000 risk of death would always be disclosed, but not a one in 10,000 risk of a two-hour headache. Plastic surgery and vasectomies illustrate twoà areas where the probability of success and the meaning of success should be explicitly delineated. For example, a man successfully sued his doctor after the doctor assured him that a vasectomy would be 100 percent effective as Birth Control; the manââ¬â¢s wife later became pregnant. Because the only purpose for having the procedure wa s complete sterilization, a careful explanation of probability of success was essential. Occasionally, informed consent is not required. In an emergency situation where immediate treatment is needed to preserve a patientââ¬â¢s health or life, a physician may be justified in failing to provide full and complete information to a patient. Moreover, where the risks are minor and well known to the average person, such as in drawing blood, a physician may dispense with full disclosure. In addition, some patients explicitly ask not to be informed of specific risks. In this situation, a doctor must only ascertain that the patient understands that there are unspecified risks of death and serious bodily disabilities; the doctor might ask the patient to sign a waiver of informed consent. Finally, informed consent may be bypassed in rare cases in which a physician has objective evidence that informing a patient would render the patient unable to make a rational decision. Under these circumstances, a physician must disclose the information to another person designated by the patie nt. Informed consent is rarely legally required to be in writing, but this does provide evidence that consent was in fact obtained. The more specific the consent, the less likely it will be construed against a doctor or a hospital in court. Conversely, blanket consent forms cover almost everything a doctor or hospital might do to a patient without mentioning anything specific and are easily construed against a doctor or hospital. However, blanket forms are frequently used upon admission to a hospital to provide proof of consent to noninvasive routine hospital procedures such as taking blood pressure. A consent form may not contain a clause waiving a patientââ¬â¢s right to sue, unless state law provides for binding Arbitration upon mutual agreement. Moreover, consent can be predicated upon a certain surgeon doing a surgery. It can also be withdrawn at any time, subject to practical limitations. Right to Treatment In an emergency situation, a patient has a right to treatment, regardless of ability to pay. If a situation is likely to cause death, serious injury, orà disability if not attended to promptly, it is an emergency. Cardiac arrest, heavy bleeding, profound shock, severe head injuries, and acute psychotic states are some examples of emergencies. Less obvious situations can also be emergencies: broken bones, fever, and cuts requiring stitches may also require immediate treatment. Both public and private hospitals have a duty to administer medical care to a person experiencing an emergency. If a hospital has emergency facilities, it is legally required to provide appropriate treatment to a person experiencing an emergency. If the hospital is unable to provide emergency services, it must provide a referral for appropriate treatment. Hospitals cannot refuse to treat prospective patients on the basis of race, religion, or national origin, or refuse to treat someone with HIV or AIDS. In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) (42 U.S.C.A. à § 1395dd), which established criteria for emergency services and criteria for safe transfer of patients between hospitals. This statute was designed to prevent ââ¬Å"patient dumping,â⬠that is, transferring undesirable patients to another facility. The law applies to all hospitals receiving federal funds, such as Medicare (almost all do). The law requires hospitals to provide a screening exam to determine if an emergency condition exists, provide stabilizing treatment to any emergency patient or to any woman in active labor before transfer, and continue treatment until a patient can be discharged or transferred without harm. It also delineates strict guidelines for the transfer of a patient who cannot be stabilized. A hospital that negligently or knowingly and willfully violates any of these provisions can be terminated or suspended from Medicare. The physician, the hospital, or both can also be penalized up to $50,000 for each knowing violation of the law. One of the first cases brought under EMTALA involved a doctor who transferred a woman in active labor to a hospital 170 miles away. The woman delivered a healthy baby during the trip, but the doctor was fined $20,000 for the improper transfer of the woman. In addition to federal laws such as EMTALA, states may also impose by regulation or statute a duty on hospitals to administer emergency care. There is no universal right to be admitted to a hospital in a nonemergency situation. In nonemergency cases, admission rights depend largely on the specific hospital, but basing admission on ability to pay is severely limited by statutes, regulations, and judi cial decisions. Forà example, most hospitals obtained financial assistance from the federal government for construction; these hospitals are required to provide a reasonable volume of services to persons unable to pay. The amount of services to be provided is set by regulation, and the obligation continues for 20 years after construction is completed. Patients must be advised of the hospitalââ¬â¢s obligation under the law, or the hospital may be foreclosed from suing to collect on the bill. In addition, many states prohibit hospitals from denying admission based solely on inability to pay; some courts have made similar rulings against public hospitals based on hospital charters and public policy reasons. Hospitals are also prohibited from requiring a deposit from a Medicare or Medicaid patient. Once a patient has been duly admitted to a hospital, she or he has a right to leave at any time, or the hospital could be liable for False Imprisonment. This is so even if the patient has not paid the bill or if the patient wants to leave against all medical advice. In rare cases, such as contagious disease cases, public health authorities may have state statutory or regulatory authority to quarantine a patient. In addition, state laws governing involuntary commitment of the mentally ill may be used to prevent a person of unsound mind from leaving the hospital if a qualified psychiatrist determines that the person is a danger to himself or herself or to the lives of others. A doc tor familiar with a patientââ¬â¢s condition determines when a patient is ready for discharge and signs a written order to that effect. If the patient disagrees with a decision to discharge, she or he has the right to demand a consultation with a different physician before the order is carried out. The decision to discharge must be based solely on the patientââ¬â¢s medical condition and not on nonpayment of medical bills. In the mid-1990s, concern over maternity patients being discharged just a few hours after giving birth prompted legislation at both the state and federal levels. In September 1996, President bill clinton signed a law ensuring a 48-hour hospital stay for a woman who gives birth vaginally and a 96-hour stay for a woman who has a caesarean section, unless the patient and the doctor agree to an earlier discharge. A number of state legislatures have passed similar laws as well. With the rise of Managed Care and Health Maintenance Organizations (HMOs), patients faced new issues involving the right to treatment. HMOs may deny authorization for expensive or experimental treatments, or for treatmentsà p rovided outside the network of approved physicians. HMOs contend that they must control costs and make decisions that benefit the largest number of members. In response, state legislatures have enacted HMO regulations that seek to give patients a process for appealing the denial of benefits. The HMOs have opposed these measures and have vigorously defended their denial of benefits in court. In Moran v. Rush Prudential HMO, Inc., 536 U.S. 355, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002), the Supreme Court in a 5ââ¬â4 decision upheld an Illinois law that required HMOs to provide independent review of disputes between the primary care physician and the HMO. The law mandated that the HMO must pay for services deemed medically necessary by the independent reviewer. Most importantly, the court ruled that the federal Employee Retirement Income Security Act (ERISA) did not preempt the Illinois law. ERISA is an extremely complex and technical set of provisions that seek to protect employee benefit programs. The decision was significant because it empowered other states to enact similar laws that give patients more rights in obtaining treatment Med ical Experimentation Medical progress and medical experimentation have always gone hand in hand, but patientsââ¬â¢ rights have sometimes been ignored in the process. Sometimes patients are completely unaware of the experimentation. Experimentation has also taken place in settings in which individuals may have extreme difficulty asserting their rights, such as in prisons, mental institutions, the military, and residences for the mentally disabled. Legitimate experimentation requires informed consent that may be withdrawn at any time. Some of the more notorious and shameful instances of human experimentation in the United States in the twentieth century include a 1963 study in which terminally ill hospital patients were injected with live cancer cells to test their immune response; the Tuskegee Syphilis Study, begun before World War II and continuing for 40 years, in which effective treatment was withheld from poor black males suffering from syphilis so that medical personnel could study the natural cou rse of the disease; and a study where developmentally disabled children were deliberately infected with hepatitis to test potential vaccines. Failure to obtain informed consent can arise even when consent has ostensibly been obtained. The California Supreme Court ruled in 1990 that a physician must disclose preexisting research andà potential economic interests that may affect the doctorââ¬â¢s medical judgment (Moore v. Regents of the University of California, 51 Cal. 3d 120, 793 P. 2d 479). The case involved excision of a patientââ¬â¢s cells pursuant to surgery and other procedures to which the patient had consented. The surgery itself was not experimental; the experimentation took place after the surgery and other procedures. The cells were used in medical research that proved lucrative to the doctor and medical center. Patients in teaching hospitals are frequently asked to participate in research. Participants do not surrender legal rights simply by agreeing to cooperate and validly obtained consent cannot protect a researcher from Negligence. In hospitals, human experimentation is typically monitored by an institutional review board (IRB). Federal regulation requires IRBs in all hospitals receiving fed eral funding. These boards review proposed research before patients are asked to participate and approve written consent forms. IRBs are meant to ensure that risks are minimized, the risks are reasonable in relation to anticipated benefits, the selection of subjects is equitable, and informed consent is obtained and properly documented. Federal regulations denominate specific items that must be covered when obtaining informed consent in experimental cases. IRB approval never obligates a patient to participate in research. Advance Medical Directives Every state has enacted advance medical directive legislation, but the laws vary widely. Advance medical directives are documents that are made at a time when a person has full decision-making capabilities and are used to direct medical care in the future when this capacity is lost. Many statutes are narrowly drawn and specify that they apply only to illnesses when death is imminent rather than illnesses requiring long-term life support, such as in end-stage lung, heart, or kidney failure; multiple sclerosis; paraplegia; and persistent vegetative state. Patients sometimes use living wills to direct future medical care. Most commonly, living wills specify steps a patient does not want taken in cases of life-threatening or debilitating illness, but they may also be used to specify that a patient wants aggressive resuscitation measures used. Studies have shown that living wills often are not honored, despite the fact that federal law requires all hospitals, nursing homes, and other Medi care and Medicaid providers to askà patients on admission whether they have executed an advance directive. Some of the reasons living wills are not honored are medical personnelââ¬â¢s fear of liability, the patientââ¬â¢s failure to communicate his or her wishes, or misunderstanding or mismanagement by hospital personnel. Another way individuals attempt to direct medical care is through a durable Power of Attorney. A durable power of attorney, or proxy decision maker, is a written document wherein a person (the principal) designates another person to perform certain acts or make certain decisions on the principalââ¬â¢s behalf. It is called durable because the power continues to be effective even after the principal becomes incompetent or it may only take effect after the principal becomes incompetent. As with a Living Will, such a document has little power to compel a doctor to follow a patientââ¬â¢s desires, but in the very least it serves as valuable evidence of a personââ¬â¢s wishes if the matter is brought into court. A durable power of attorney may be used by itself or in conjunction with a living will. When advance medical directives function as intended and are honored by physicians, they free family members from making extremely difficult decisions. They may also protect physicians. Standard medical care typically requires that a doctor provide maximum care. In essence, a livin g will can change the standard of care upon which a physician will be judged and may protect a physician from legal or professional repercussions for withholding or withdrawing care. Right to Die A number of cases have addressed the right to refuse life-sustaining medical treatment. Broadly speaking, under certain circumstances a person may have a right to refuse life-sustaining medical treatment or to have life-sustaining treatment withdrawn. On the one side in these cases is the patientââ¬â¢s interest in autonomy, privacy, and bodily integrity. This side must be balanced against the stateââ¬â¢s traditional interests in the preservation of life, prevention of suicide, protection of dependents, and the protection of the integrity of the medical profession. In in re quinlan, 355 A.2d 647 (1976), the New Jersey Supreme Court permitted withdrawal of life-support measures for a woman in a persistent vegetative state, although her condition was stable and her life expectancy stretched years into the future. Many of the emotional issues the country struggles with in the early 2000s were either a direct result of or were influenced by this case,à including living wills and o ther advance medical directives, the right to refuse unwanted treatment, and physician-assisted suicide. The first U.S. Supreme Court decision addressing the difficult question regarding the removal of life support was Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 110 S. Ct. 2841, 111 L. Ed. 2d 224 (1990). Cruzan involved a young woman rendered permanently comatose after a car accident. Her parents petitioned to have her feeding tube removed. The Supreme Court ruled that the evidence needed to be clear and convincing that the young woman had explicitly authorized the termination of treatment prior to becoming incompetent. The Court ruled that the evidence had not been clear and convincing, but upon remand to the state court the family presented new testimony that was deemed clear and convincing. The young woman died 12 days after her feeding tube was removed. The Supreme Court decided two right-todie cases in 1997, Quill v. Vacco, 521 U.S. 793, 117 S.Ct. 2293, 138 L.Ed.2d 834 (1997), and Washington v. Glucksberg, 521 U.S. 702, 117 S.Ct. 2258, 138 L.Ed.2d 772 (1997). I n Glucksberg, the appellate courts in New York and Washington had struck down laws banning physician-assisted suicide as violations of Equal Protection and due process, respectively. The Supreme Court reversed both decisions, finding no constitutional right to assisted suicide, thus upholding statesââ¬â¢ power to ban the practice. Though both cases were considered together, Glucksberg was the key right-to-die decision. Dr. Harold Glucksberg and three other physicians sought a Declaratory Judgment that the state of Washingtonââ¬â¢s law prohibiting assisted suicide was unconstitutional as applied to terminally ill, mentally competent adults. The Supreme Court voted unanimously to sustain the Washington law, though five of the nine justices filed concurring opinions in Quill and Glucksberg. Chief Justice william rehnquist, writing for the Court, based much of his analysis on historical and legal traditions. The fact that most western democracies make it a crime to assist a suicide was backed up by over 700 years of Anglo-American common-law tradition that has punished or disapproved of suicide or assisting suicide. This ââ¬Å"deeply rootedâ⬠opposition to assisted suicides had been reaffirmed by the Washington legislature in 1975 when the current prohibition had been enacted and again in 1979 when it pass ed a Natural Death Act. This law declared that the refusal or withdrawal of treatment did not constitute suicide, but it explicitly stated that the act did not authorize Euthanasia. The doctors had argued that the law violated the Substantive Due Process component of the Fourteenth Amendment. Unlike procedural due process which focuses on whether the right steps have been taken in a legal matter, substantive due process looks to fundamental rights that are implicit in the amendment. For the Court to recognize a fundamental liberty, the liberty must be deeply rooted in U.S. history and it must be carefully described. The Court rejected this argument because U.S. history has not recognized a ââ¬Å"right to dieâ⬠and therefore it is not a fundamental right. Employing the Rational Basis Test of constitutional review, the Court concluded that the law was ââ¬Å"rationally related to legitimate government interestsâ⬠and thus passed constitutional muster. Privacy and Confidentiality Confidentiality between a doctor and patient means that a doctor has the express or implied duty not to disclose information received from the patient to anyone not directly involved with the patientââ¬â¢s care. Confidentiality is important so that healthcare providers have knowledge of all facts, regardless of how personal or embarrassing, that might have a bearing on a patientââ¬â¢s health. Patients must feel that it is safe to communicate such information freely. Although this theory drives doctor-patient confidentiality, the reality is that many people have routine and legitimate access to a patientââ¬â¢s records. A hospital patient might have several doctors, nurses, and support personnel on every shift, and a patient might also see a therapist, nutritionist, or pharmacologist, to name a few. The law requires some confidential information to be reported to authorities. For example, birth and death certificates must be filed; Child Abuse cases must be reported; and infectious, contagious, or communicable diseases must be reported. In addition, confidential information may also be disclosed pursuant to a judicial proceeding or to notify a person to whom a patient may pose a danger. In spite of the numerous exceptions to the contrary, patients legitimately demand and expect confidentiality in many areas of their treatment. Generally speaking, patients must be asked to consent before being photographed or having others unrelated to the case (including medical students) observe a medical procedure; they have the right to refuse to see anyone not connected to a hospital; they have theà right to have a person of the patientââ¬â¢s own sex present during a physical examination conducted by a member of the opposite sex; they have the right to refuse to see persons connected with the hospital who are not directly involved in the patientââ¬â¢s care and treatment (including social workers and chaplains); and they have the right to be protected from having details of their condition made public. A patient owns the information contained in medical records, but the owner of the paper on which they are written is usually considered the actual owner of the records. The patientââ¬â¢s legal interest in the records generally means that the patient has a right to see the records and is entitled to a complete copy of them. The patientââ¬â¢s rights are subject to reasonable limitations such as requiring inspection and copying to be done on the doctorââ¬â¢s premises during working hours. Federal Patientsââ¬â¢ Bill of Rights Dissatisfaction with an expanding corporate healthcare industry dominated by profit margins has spawned numerous reform ideas. One idea that has gained a foothold is a patientsââ¬â¢ federal Bill of Rights. In 1997, President Bill Clinton appointed an Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The commission was directed to propose a ââ¬Å"consumer bill of rights.â⬠The 34-member commission developed a bill of rights that identified eight key areas: information disclosure, choice of providers and plans, access to emergency service, participation in treatment decisions, respect and nondiscrimination, confidentiality of health information, complaints and appeals, and consumer responsibilities. The proposed rights include: the right to receive accurate, easily understood information in order to make informed health care decisions; the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality health care; the right to access emergency healthcare services; the right and responsibility to fully participate in all decisions related to their health care; the right to considerate, respectful care from all members of the healthcare system at all times and under all circumstances; the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable healthcare information protected; the right to a fair and efficient process for resolving differences with their health plans,à healthcare providers, and the institutions that serve them; and the responsibility of consumers to do their part in protecting their health. This bill of rights has been debated in Congress and there are bipartisan areas of agreement, but, as of 2003, no final action has taken on enacting a set of rights into federal law.
Friday, November 8, 2019
A Guide to Navigating in Spanish
A Guide to Navigating in Spanish There are few things more frustrating while traveling than getting lostà in a foreign place. Fortunately, if you are traveling in an area where Spanish is one of the languages spoken, this list of phrases and words below can help you quickly get to where you are going. Keep This Vocabulary List on Hand Combine the vocabulary listed below with basic grammar and you will be well on your way to getting the help you need. Even if you are not proficient in Spanish, in most places you travel you will find that people will appreciate your desire to use their language. Print out or write down the phrases below so you can communicate with the people around you during your travels.à à ¡Buen viaje! (Have a great trip!) Basic Spanish Travel Phrases Where is...? Where are...? - à ¿Dà ³nde est...? à ¿Dà ³nde estn...?How do you go to...? - à ¿Por dà ³nde se va a...? Or, à ¿Cà ³mo puedo llegar a...?Where are we on the map? - à ¿Dà ³nde estamos aquà en el mapa?Is it far away? Is it near here? - à ¿Est lejos? à ¿Est por aquà ?Im looking for... - Busco...Im lost. - Estoy perdido (perdida if you are female). Where can I catch a taxi (a bus)? - Latin America: à ¿Dà ³nde puedo tomar un taxi (un autobà ºs)?à Spain: à ¿Dà ³nde puedo coger un taxi (un autobà ºs)? Note that other terms used regionally for bus include bus, colectivo, camià ³n, camioneta, gà ³ndola, guagua, micro, microbà ºs, and pullman. Be careful with the usage of the verb coger in parts of Latin America, because it can have an obscene meaning.Additional ways of travel could be on foot (a pie), by car (en coche), on a motorbike (la moto), by boat (el barco), and by plane (el avià ³n). More Spanish Speaking Terms When Traveling Write it down, please. - Escrà balo, por favor.Speak more slowly, please. - Hgame el favor de hablar ms despacio.I dont understand Spanish well. - No entiendo bien el espaà ±ol.Is there anyone who speaks English? - à ¿Hay alguien que hable inglà ©s?North, east, west, south - Norte, este or oriente, oeste or occidente, surKilometer, mile, meter - Kilà ³metro, milla, metroStreet, avenue, highway - Calle, avenida, camino, carrera, or carreteraCity block - Cuadra (Latin America) or manzana (Spain)Street corner - EsquinaAddress - Direccià ³n Two Tips for Conversation While Abroad Get specific. Use key terms for places you are going to in your conversations with others. You may want directions to a shopping mall (el centro comercial), general shops (las tiendas) or the grocery market (el mercado). All three can be summed up as shops, but they vary in the type of shop. If you want to explore tourist attractions, detail if you would like to see an art gallery (la galerà a de arte), a park (el parque), or a historic center (el casco antiguo).Be friendly. There is nothing that delights locals more than when tourists are courteous and ask for help with a smile. Include basic greetings along with your phrases such as hello (hola or buenas), how are you doing? (à ¿quà © tal?) and good day (good morning is ââ¬â¹buenos dà as,à goodà afternoonà is buenas tardes, and good evening is buenas noches). Youll score extra points if you adopt to local variations, such as buen dà a used in some countries rather than the more common buenos dà as. Using Addresses You should be aware the structure of street addresses can vary widely from country to country. Consult a thorough tourist guide before you travel to become familiar with local practices. In many cases, understanding addresses will be easier than it might seem at first. For example, one of the most popular museums in Bogot, Colombia, is el Museo del Oro (Gold Museum) at Cra. 6 #15-88, which initially might seem like a jumble of characters. But Cra. 6 indicates that is on Carerra 6, which we might call 6th Avenue in English. The 15 is the street name (Calle 15), and the 88 indicates the distance from the intersection of that avenue and street. Unfortunately for the traveler, easy-to-understand addressing conventions arent used everywhere, and not all streets are named. In Costa Rica, for example, you may run across addresses such as 200 metros al oeste de la escuela Fernndez, indicating a location 200 meters west of the Fernandez school.
Tuesday, November 5, 2019
3 jobs you can get with a cosmetology license -TheJobNetwork
3 jobs you can get with a cosmetology license -TheJobNetwork If youââ¬â¢ve recently earned your cosmetology license then congratulations are in order- youââ¬â¢ve worked hard to learn the trade and build the skills necessary to be successful in this fast-growing field. Now, thereââ¬â¢s one more step for you to take, and thatââ¬â¢s to find a job. If youââ¬â¢re new to the field of cosmetology, you have a reason to be optimistic as you embark upon your career journey- according to the U.S. Department of Labor, employment opportunities for cosmetologists is expected to grow approximately 13 percent over the next decade, faster than the average for all careers. Simply put, as the population grows across most demographic sectors, the demand for the range of services that cosmetologists provide should grow as well, along with the need for talented and credentialed professionals.Thatââ¬â¢s great news! Now, all you need to do is weigh your options and focus on the type of job youââ¬â¢d like to pursue. Ultimately, your choice of care er path should match your interests, goals, and skill set, but if youââ¬â¢re looking for some ideas, consider the following 3 jobs that you can pursue with your cosmetology license.HairstylistDo you have a knack for styling and making the most out of peopleââ¬â¢s hair? If so, then consider a career as a hairstylist. Hairstylists are typically motivated self-starters who like working directly with people and genuinely enjoy making others happy with their hair creations and consulting. Although requirements for becoming a licensed hairstylist may vary by state, you can typically get started with a high school diploma or equivalent and licensure.Work opportunities are typically plentiful, and you have the option of working for a salon, renting a chair in a salon, or being your own boss- which means that you can be selective with the type of clientele youââ¬â¢d like to specialize in working with. If this sort of professional opportunity and freedom sounds good to you, and youâ â¬â¢ve got the desire and skills, then this may be a smart career move for you.Beauty blogger/vloggerAre you a whiz with words or charismatic in front of the camera, and love nothing more than talking about the world of beauty? If this sounds like you, then consider getting started as a blogger or vlogger. This fast-growing industry has a potential audience of millions of interested individuals who follow what industry leaders, influencers, and tastemakers say about the latest and greatest in makeup, grooming, fashion, and beauty products. The venues available for getting your content to the public are wide, with everything from YouTube or Instagram Stories for video to WordPress for writing and Instagram for photo sharing- it all depends on the sort of content youââ¬â¢d like to make your focus.If you build a large enough following, you can see incredible profits from advertising and sponsorships (not to mention free products from companies who want you to speak about their new offerings). If this sounds like the perfect opportunity for you, then choose a platform, polish your message, and start creating content.EstheticianIf your beauty and grooming interests lie more towards skincare and spa treatments, then consider pursuing a career as an esthetician. These beauty and grooming professionals focus primarily on addressing hair and skincare issues and consulting with individuals on a wide range of issues, from laser hair removal to acne treatment, exfoliation, and personal body care.After completing a state-approved program and passing the required licensing exam, estheticians typically work in health, wellness, beauty, and spa settings, and opportunities exist within existing, established business- or you can start your own business and be the boss. According to the U.S. Department of Labor, ââ¬Å"Employment of skincare specialists is projected to grow 14 percent from 2016 to 2026, faster than the average for all occupations. The desire among many wome n and a growing number of men to reduce the effects of aging will result in employment growth. Good job opportunities are expected.â⬠If youââ¬â¢ve recently earned your cosmetology license and are looking to move forward in your career journey, consider one of these excellent options to make the most of your skills and achieve professional satisfaction and success. Good luck!
Sunday, November 3, 2019
Hazards and Disasters Case Study Example | Topics and Well Written Essays - 1500 words
Hazards and Disasters - Case Study Example A debate of the purposes of methodological, rigorous intervention programs and joint programs in an effort to reducing violence in work related areas need to be put in place. According to the U.S. Department of Justice, Bureau of Justice Statistics (1993), the advancement of workplace violence has developed the understanding of the connection with the persons responsible for the violence to the victims and has led to the creation of theoretical structures of connecting the causes and prevention measures of workplace violence (p56). Despite the fact that workers can be presented to many types of violence in the path of their employment, significant numbers of the workers are intimidation and assaulted in one way or another (Albrecht, 86). In order to understand workplace related violence, it is important to distinguish the various aspects of workplace violence which include pre-vent, event and post event instances. Pre-event aspects that lead to the workplace violence events are in mo st cases intricate, on the other hand, the words of warning can be apparent to the victim way in advance. At this point in time, it is important to embark on precautionary measures which largely help prevent any form of violence intended on a victim in a workplace (Campbell 96). A workplace violence event is terrible for all the people involved. It is clear that all the victims of workplace violence feel terrible about it and others fail even to talk about it in public. According to U.S. Department of Justice, Bureau of Justice Statistics, Violence in the Workplace (1993), there is much need to employ various strategies at work that help both in managing the workers affected by workplace violence overcome the ordeal at the same as providing training to the workers to help them have better response in case of such incidences of workplace violence events (p.56). Lastly, post event occasions will entail a study that seek to determine or establish exactly what went wrong in a workplace or what exactly happened. This kind of study helps to unveil the steps of violence, showing the perpetratorââ¬â¢s moves and plans as much as providing the best means to overcome this ordeal which includes counseling and psychological guidance depending on the intensity of abuse. Question II The Occupational safety and Health Administration (OSHA) describes workplace violence or the risk of violence hostile to workers. Workplace violence can take place at or outside the workplaces. The kind of violence can vary from risks and verbal abuses to physical abuse and homicides. Homicide is in fact a leading cause of work related deaths (Booth, Vecchi, Finney, Hasselt, & Romano 76-92). OSHA establishes that over 2 million American staff members fall victims of workplace related violence every year. Despite the fact that this violence take place in any place, a number of workers are more in danger (Booth, et al., 76-92). This paper puts emphasis on three occupations which are among the mo st vulnerable to workplace violence which include: Health care work (targeting nurses), Taxi Drivers and Letter carriers. Workplace violence is one of the highly intricate and risky occupations in the world today where nurses are exposed to lots of work related violence (Rugala & Fitzgerald, 775-789). There are a lot of complex situations that come up in the nursing field which have
Friday, November 1, 2019
An Analysis of The McDonaldization of Society by George Ritzer Essay
An Analysis of The McDonaldization of Society by George Ritzer - Essay Example In today's' complicated and ever changing society, we often try to achieve a sense easier is by implementing a function now known as "McDonaldization", which Ritzer describes in various ways. For instance Ritzer states that the concept of McDonaldization is defined as "the process by which the principles of the fast food restaurant are coming to dominate more and more sectors of American society as well as the rest of the world." The success of McDonalds, and of McDonaldization as a whole, is due to four basic factors--efficiency, calculability, predictability, and control. carry their own food, and throw out the garbage. This is not as efficient for the consumer, but it saves time for the workers. Education, health care, and the work place are all becoming McDonaldalized in order to become more efficient. Efficiency in McDonaldization has streamlined many processes, simplified goods and services, and forces the consumer to do work as well. Ritzer continues these ideas in marshalling the abundance of evidence which makes this trend very compelling. Using many examples from such disparate social institutions as family life, higher education, the funeral business, health care, and entertainment, Ritzer illuminates the broader trends within the "taken for granted" daily routines of life. He does so with a keen sociological eye, but also with a very wry sense of irreverence that adds a sarcastic touch of humor to the expose.The fast-food model, according to Ritzer, has a manner of pushing us towards ever greater reliance on the fostering of quantity over quality, attainment of efficiency, creation of predictability, and reducing much of our life experience to a coldly calculated "value." As one reads further and takes in the diverse landscape of specific illustrations for these trends, one begins to see the "McDonaldized" influence everywhere. Then too, one will also grasp why so many of us are complaining about the demise of free time in our lives, and how we have become unwitting captives of mindless inertia of "I want it fast, I want it now, I want what's next" mentalities. Just another issue and dimension of
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