Discovery Of Losartan Potassium Health And Social Care Essay

Discovery Of Losartan Potassium Health And Social Care Essay Losartan is the first angiotensin II receptor antagonist drug to be marketed for use mainly to treat high blood pressure (hypertension). Losartan was first discovered in March 1986 by scientists on their first assignments at a corporate research laboratory, in Du Pont, as DuP 753(Merck 954), a highly potent and orally active non-peptide Ang II receptor antagonist. At the time, DuPont as a company was rather new to pharmaceutical business. The company had previously been dealing in chemicals, but the in the 1970s when the demand for Petroleum and its related products natural gas drove prices high, management attempted to diversify the business by seeking other business avenues to reduce their dependency on chemicals in a hope of also increasing their profit. As a result of creating new business, DuPont had ventured into pharmaceuticals and other life sciences businesses by the 1980s. Losartan work was one of the compounds DuPont research labs worked on. The company being inexperience in this area of business, hired Robert I. Taber, a scientist with two decades of research experience with Schering, to head pharmaceutical research at DuPont.It was Taber who recognized the areas of potentials and encouraged the research team to delve further. However, DuPont being a fairly young company in these areas would lead to other weighty problems, and these issues were quickly settled by a collaboration with the more experienced Merck, who also recognised the Potential of Losartan and convinced DuPont that there was more to be gained by working on Losartan. Development of Losartan was done after a series of efforts. The final market product was Co-Developed with Scientists from both Merck DuPont. [BHARDWAJ, G., 2006] Losartan was approved by the FDA in April 1995, and it was then launched that month as the first non-peptide anti-hypertensive drug in the new class of Ang II receptor antagonists. Merck started selling losartan under the trade names CozaarT and HyzaarT with annual sales in excess of $3 Billion Dollars by 2005. Chemical Structure (IUPAC) nomenclature (2-butyl-4-chloro-1-{[2-(1H-tetrazol-5-yl) biphenyl-4-yl] methyl}-1H-imidazol-5-yl) methanol Chemical data Formula C22H23ClN6O Mol. mass 422.91 Action of Losartan Losartan selectively inhibits all Ang II responses that have been studied and lowered blood pressure in several animal models of renin-dependent hypertension. In animals, the antihypertensive efficacy of losartan has been found to be similar to that of the ACE Inhibitors (Angiotensin Converting Enzyme inhibitors) but, unlike ACE inhibitors, losartan is a more selective inhibitor of the renin-angiotensin system since it does not affect the metabolism of kinins. Compared with peptide Ang II antagonists (e.g. saralasin), losartan has significant advantages, including a long duration of action, effective oral absorption and no Ang II agonist activity. [SIEGL, P.K., 1993] Indications Hypertension Losartan tablets is indicated for the treatment of hypertension. Losartan can be used alone or used in combination with other antihypertensive agents, including diuretics. [Rx LIST THE INTERNET DRUG INDEX., 2009] Hypertensive Patients with Left Ventricular Hypertrophy Losartan is also indicated in patients with hypertension and left ventricular hypertrophy to reduce the risk of stroke, but there has been a study to suggest that Losartan is not beneficial with Black patients in reducing the risk of stroke. [Rx LIST THE INTERNET DRUG INDEX.,2009] In the LIFE study, it was found out that Black patients with conditions of hypertension and left ventricular hypertrophy had a lower risk of stroke on atenolol than on Losartan. However, there was some shortcomings of the LIFE study, as it did not provide evidence that the benefits of Losartan in hypertensive patients with left ventricular hypertrophy by reducing the risk of cardiovascular events applied to Black patients. [Rx LIST THE INTERNET DRUG INDEX.,2009] Nephropathy in Type 2 Diabetic Patients Losartan is also very useful in the treatment of patients with diabetic nephropathy, where there is an elevation of serum creatinine and proteinuria (urinary albumin to creatinine ratio à ¢Ã¢â‚¬ °Ã‚ ¥ 300 mg/g) in patients that have type 2 diabetes and a history of hypertension. In this group, Losartan has been shown to reduce the rate of progression of the nephropathy. This is measured by the occurrence of doubling of serum creatinine or end stage renal disease where there is need for dialysis or renal transplantation. [Rx LIST THE INTERNET DRUG INDEX.,2009] SPECIFIC PRODUCTS ( CONTAINING THIS DRUG) AVAILABLE FOR USE IN GIVEN CONDITION Combination therapy: A combination therapy is used if losartan monotherapy alone is not sufficient to control hypertension. Hence, losartan is available in combination with hydrochlorothiazide in different strengths as follows:[BRITISH NATIONAL FORMULARY., 2009] Losartan 50mg + Hydrochlorothiazide 12.5mg Losartan 100mg + Hydrochlorothiazide 12.5mg Losartan 100mg + Hydrochlorothiazide 25mg. The above combination is used for treatment of high blood pressure and stroke in patients with heart disease. It is a prescription only medicine. [MEDICINES AND HEALTH CARE PRODUCTS REGULATORY AGENCY., 2009] EVIDENCE FOR EFFICACY FOR THIS TREATMENT. Clinical trials have shown a better efficiency of losartan as an antihypertensive by itself and a further higher efficiency in a combined state with hydrochlorothiazide. For example : a double-blind, multicenter, randomized, parallel group study performed on African Americans (who are generally less responsive to monotherapy from any hypertensive class), with severe hypertension have shown a significant reduction in sitting diastolic and systolic blood pressure with losartan monotherapy (45.8%) when compared with placebo (27.2%) . In the same study, the combination losartan/ hydrochlorothiazide regimen showed significant higher reductions (62.7%) in blood pressure compared with losartan monotherapy or placebo. More over, both the regimens i.e losartan monotherapy and the losartan/hydrochlorothiazide were as well tolerated as the placebo[FLACK, et al., 2001]. Other studies were performed on hypertensive patients who had discontinued treatment with calcium channel blockers and angiote nsin converting enzyme inhibitors due to side effects like peripheral edema or dry cough respectively. These patients when treated with losartan have shown as much reduction and control over blood pressure as they use to with previous therapies.[GIOVANNETTI, et al., 1997]. And quite interestingly it has also been observed that the clinical side effects were minimal with losartan treatment and the haematologic and biochemical profiles were also not disturbed. [GIOVANNETTI, et al., 1997] Studies performed on the pharmacokinetics and pharmacodynamic parameters of losartan on healthy male volunteers and also on special patient groups like elderly patients with renal impairment and those having liver disease, suggest that losartan is orally active and its effect lasts for over 24 hours. None of the patient groups showed any significant pharmacokinetic interactions[McINTYRE, et al., 1997]. Losartan 50mg appears to be a safe starting and maintenance dose in most patient populations. However, when an additive effect is required, it can be easily combined with thiazide diuretics to achieve the target blood pressure. Losartan has low discontinuation rate and it has also been observed that it was not associated with cough even in patients who experience this side effect with to ACE inhibitors [McINTYRE, et al., 1997]. A BRIEF COMPARISON WITH OTHER MEDICINAL PRODUCT USED TO TREAT THE SAME AILMENT Losartan potassium, is an angiotensin receptor antagonist (AT1) used in the treatment of hypertension and other cardiovascular diseases. However, a comparison with other ARB(e.g. valsartan and candesartan) shows that, these drugs have the same mechanism of action, though, their differences in pharmacokinetic profile may be responsible for their differences in efficacy in the treatment of hypertension. Losartan and valsartan when compared, exhibited a similar reduction in blood pressure at a lower concentration ,however, valsartan has a higher response rate and more effective 24hours blood pressure control rate at the dose of 160mg and 80mg respectively than losartan at 100mg and 50mg respectively.[BURNIER BRUNNER 2000]. Candesartan 8mg and 16mg has also demonstrated a more lasting antihypertensive effect than losartan 50mg and 100mg in ambulatory BP monitoring.[LACOURCIERE ASMAR 1999] A brief comparison with other medicinal products from the other class like B- adrenergic blocker(e.g. atenolol), ACEI(e.g. enerlapril), calcium channel blocker(e.g. felodipine) and diuretics were based on the efficacy, tolerability and safety in the treatment of essential hypertension. Losartan , when compared with amilodipine has been shown to exhibit a similar clinically relevant reduction in patients with systolic blood pressure, however, losartan was better tolerated as evidenced by fewer clinically adverse effect(CAE)and discontinuation compare with amlodipine [VOLPE, et al., 2003]. Meanwhile, in the contrasting effect of losartan, nifedipine GIT, and fosinopril on the ambulatory blood pressure, cardiac structure and function, and protective function of the endothelium in patients with essential hypertension, nifedipine GIT is superior to others in plate- granule membrane protein (GMP), while fosinopril and losartan had a preffered action to nifedipine GIT in reversing ventricul ar hypertrophy, however, losartan was better tolerated than the other drugs [QI XIURONG 2001]. Losartan potassium has been known to exhibit a fewer drug related adverse effect in contrast to other medicinal products in the other classes used in the treatment of hypertension. [GOLDBERG, et al., 1995] In summary, losartan potassium has an excellent tolerability profile in patient with essential hypertension and, in a demographic sub group of elderly versus young, women versus men and black versus non black; it has been shown to have an excellent safety profile. ADVANTAGES OF LOSARTAN POTASSIUM. Side effect; In the treatment of hypertension, losartan has exhibited fewer drug related side effect when it was compared with other class of antihypertensive agents .[GOLDBERG, et al., 1995] Tolerance; when compared in patients with essential hypertension, losartan was better tolerated than other agents from the other class and hence an excellent tolerability profile. Safety profile; It has a good safety profile in a demographic sub groups. It doesnt produce rebound high blood pressure when it is withdrawn. DISADVANTAGES OF LOSARTAN POTASSIUM. 1 Losartan has been associated with some damaging effect on the foetus which may include reduced body weight, death and kidney injuries hence it is contraindicated in pregnancy. [GOLDBERG, et al., 1995] Analysis of the market potential for the development of new drug candidates to treat the given condition Development of new drug products has always been a challenging task. Growth in technology resulted in an evolution in pharmaceutical world and has paved way for research and development to meet demands for more efficient products. About one billion people have been affected by hypertension world wide and reports also says that in US alone 65 millions people are affected by high blood pressure.[SMITH ASHIYA 2007]. This indicates the level of demand of antihypertensives world wide. Efforts have been made and many potential drugs have been developed till date. However the expiry of patents of angiotensin receptor blockers (ARB) opened doors for arrival of cheap generic products which resulted in a threat to the global pharmaceutical market. Data monitoring of the sales of antihypertensives in seven major global markets (i.e UK, France, US, Italy, Spain, Germany and Japan ) predicted sales of upto $ 29.5 billions by 2018, which would be a drop of $6 billion when compared to that of 2008. Considering above threats, the big pharmaceutical companies are under an impression that it is not worth to spend on research and development of novel therapies and they appear to be moving away from investing in research and development to develop more efficient antihypertensive therapies. [THE MEDICAL NEWS., 2009] Product Name Patent Number Patent Expiration Mercks COZAAR (losartan potassium) 5,138,069*PED  Ã‚   11 Feb,2010 Mercks COZAAR (losartan potassium) 5,153,197*PED   06 Apr, 2010 Mercks COZAAR (losartan potassium) 5,210,079*PED  Ã‚   11 Nov,2010 Table showing the expiry of patent of COZAAR (losartan potassium) Angiotensin receptor blocker. [DRUG PATENT WATCH., 2010] Short comings of the existing treatment to justify new drug development Though antihypertensive agents were able to achieve significant control over hypertension induced morbidity and mortality, still there is much to be done. For example: disappointments associated with coronary artery disease, risk of cardiovascular events even after treatment with antiphyertensive agents and comparatively higher possibility of cardiovascular events in hypertensive patients compared to normotensive patients. These effects are thought to be due to inability of existing antihypertensives to reverse other associated factors like left ventricular hypertrophy, negative metabolic effects and risk associated with overtreatment.[HANSSON, L., 1991]. Hence there is a need for an ideal hypertensive agent which may be able to control blood pressure to normotensive levels whilst being free of negative metabolic effects. Moreover, it should also be able to reverss cardiovascular changes like cardiac hypertrophy and control tissue damage in case of possible vascular complications. [H ANSSON, L., 1991]. Analysis of data available on search engines indicates the promising role of upcoming gene therapy and nano-technology to produce new drug candidates. For example: Exploring areas like gene transcripton, molecular genetic regulation of blood pressure ( targeting genetic risk factors as in cases of essential hypertension) appears to be a new hope for future developments of antihypertensives.[KURTZ GARDNER 1998] Possible potential for new therapy. Research is currently being carried out to explore the potential of upcoming gene therapy and nano-technology to produce new drug candidates. For example: Areas like gene transcripton, molecular genetic regulation of blood pressure ( targeting genetic risk factors as in case of essential hypertension) appears to be a new hope for future developments of antihypertensives.[KURTZ GARDNER 1998]. However alternatively, combination products containing antihypertensives and statins could be a new hope for future developments. à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦

Ethical Considerations Essay

The conduct of the members of any profession must be of very high standards in professional terms. The Australian Computer Society (ACS) requires very high standards in its Code of Conduct for members so as to be able to earn the credibility as well as the prestige IT professionals deserve. The ACS Code of Conduct does not include many detailed rules as it only focuses on the most essential matters and as such it requires a much broader interpretation. It is mandatory for all members of ACS to comply with the Code of Conduct. The code bears relevance in law in terms of legislation. Awareness of the Code’s requirements by IT professionals is crucial as non-adherence by a member in their field may lead to claims of professional negligence by clients. The regulatory regime of the Internet Censorship Body of Australia gives powers to its subsidiary, the Australian Communications and Media Authority to enforce restriction of Internet Content that is hosted within the country as well as maintaining a black-list of foreign websites by using filtering software. Foreign websites which have or are likely to be refused classification in Australia are target for mandatory filtering in Internet Censorship proposal by the Australian Labor Party-led government since 2008. The import of this proposal is that providers of internet services would be forced to ensure that they block black-listed websites from reaching its customers. Two years later, the policy still awaits enactment as a result of the inexistence of legislation to this effect (Moses 2010). As expected, the proposal for the introduction of mandatory filtering has been met with considerable opposition. Some amount of tension has been generated in Australia. Its opponents have raised various concerns but a few people who are in strong support of the policy welcomed it. In Australia, Internet content is bound by federal as well as state laws on the censorship of internet content. The ACS has an internet filtering body coupled with a taskforce for E-security. The task force provides advice on technical issues and policies concerning internet content and the material that is unsuitable for the viewing by the general society. This provides the basis for the legislation on internet content in Australia. The decision by the Australian government through information minister Senator Stephen Conroy to filter the pages viewed by internet users is consistent with the requirements of the Australian Computer Society (ACS) Code of Conduct and Ethics. The ethical code, in section 4. 1, starts by clearly stating its efforts aimed at advancing the dignity, honor a swell as the effectiveness Information Technology as a profession. It states that in observance of its ethical conduct and high competence standards, every member is supposed to be honest in addition to being forthright and impartial. Members are supposed to be loyal in their service to the community (ACS Code of Ethics 1998). It further states that every member has to put all efforts aimed at increasing the profession’s competence as well its prestige. Every member is required to use the special skill and knowledge they possess towards advancing human welfare. The code of conduct is binding in its requirements. Section NR 4. 3 and section N4. 4 categorically states that the code binds all members with regard to their professional conduct. The implication of this requirement is that once the legislation for the filtering scheme is enacted, all members will have no option other than to oblige. It will automatically take effect because it is backed by both the federal and the state government. This is good news to many parents and school teachers who have always battled delinquent behavior in learners without success. Foreign and unacceptable behaviors on some web pages have been accessed and acquired by minors who are otherwise not supposed to view them and as a result the parents and teachers have been unable to control them (Computerworld Australia 2008). Learning is seriously compromised by the content of these offending websites and filtering them is the only effective solution to ensure that it does not reach the school children. The are some specific internet contents which the government has already outlawed and indeed does filtering. These are the contents that have to do with political parties, euthanasia, video games and racism. On the ethical side of consideration on the government’s decision to filter the content that the public should be allowed to view, this is actually a move in the right direction because left uncontrolled, the public can view anything, just about everything. This automatically leads to moral rot. The advent of the internet has led to a sudden decline in morals in many societies globally and the Australian government is justified in suggesting an ambitious plan to ensure that internet content that is hosted within the country is restricted. It is upon the realization of the dangers posed by overseas websites, more than anything else, that the proposals read out by the information minister were made. It will be of no benefit for the Australian Communications and Media Authority to enforce a restriction on internet content that is hosted from within the country and leave content from outside unchecked as people can always view the pages that thrill them from the foreign websites (The Sydney Morning Herald 2009. It is not surprising that the proposal for mandatory filtering of all internet content whether local or from overseas has been met with mixed reactions (ABC News 2007). The proponents of the filtering of internet content are genuinely concerned that the benefits that these internet pages have are by far outweighed by the harm they bring upon the community, not only in Australia, but in all other countries in the world. The minister was justified in bringing the filtering proposals in his genuine concern to rid the society of the moral rot that, courtesy of unrestricted internet access, has been spreading like the country’s infamous bush fires. The opponents of the proposed legislation on mandatory filtering of both locally hosted and overseas internet pages are on their part justified to object to these requirements in such loud voices as they have. Their objection to this legislation is by a very big percentage motivated by their selfish interest to continue being in the market for all the wrong reasons. Any person or a group of people in business are motivated by the sole interest of making as much profit as they can and as such what they give to their viewers does not matter as much as the profit they stand to get out of it. It gets even worse because they are prepared to go out of their way to give their viewers anything that they view most, bad as it may be (The Digital Liberty Coalition 2008). The ACS code of conduct and ethics in 4. 3 stipulates the values and ideals expected of the members. Members are expected to be professionally responsible and display integrity in their actions. They are supposed to deal with clients and the community, students and employees in a responsible way and with integrity. This requirement is good in terms of ethics and it can minimize the number of obscene and violent web content if adhered to by all internet providers. The general society needs to be protected from some pages whose influence is negative to the society. Section 4. 3. 4 further binds the members of ACS by ensuring social responsibility in their work to the society. It states that all members should make it their duty to ensure that they uplift and improve their clients’ quality of life. This is a big calling but it must be adherered to in order to preserve and improve the lives of all the people they work for. It is unethical for any IT specialist to upload a morally corrupting page on the internet to be viewed by others who would otherwise do a lot better without it. The proposal by the information minister borrows mainly from the ACS code of conduct as it spells out clearly all the rules that IT professionals should follow so that they can preserve the prestige and dignity the profession is supposed to have. This is in section 4. 3. 5 under Information Technology Profession in which every member is expected to promote the integrity of their profession. The members must do their work in respect of the profession and for one another. Section 4. 5. 1 of the ethics code makes it mandatory for all members to preserve continuity in the services of information technology as well as to put information flow in their care. This clearly means that all members are bound by the requirement to strive to ensure that the consumers of their services get only what they are supposed to get. They must give only the useful information to the general public which constitutes their client base. Material that has been refused classification by the regulatory authority should not be uploaded because of the dangers it portents (Electronic Frontiers Australia 2008). The IT profession is a beneficiary of such a move as proposed by the information minister as it would regain its name as a respectable profession and people would have more respect for IT professionals which has of late been declining due to the actions of some unscrupulous IT specialists who have made it their habit to posting pages whose content can not do any good to the society (ABC News 2007). The general society as a whole will be the overall winners from this legislation to the detriment of those who have made it their business by sending to the innocent viewers corruptible web content. The hands of the IT professionals who may harbor ill motives are tied by clause number 4. 6. 5 which clearly states that all members of ACS must bear the responsibility of their work. If any of them posts a page that is in the opinion of the ACS disciplinary board; immoral or unsuitable for viewing by the general public, then their conduct shall be found to be unethical and the appropriate disciplinary action will be carried out on them.

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Leiningers Culture Care Theory - 699 Words

Leiningers Culture Care Theory jennifer davis PURDUE Leiningers Culture Care Theory Madeleine Leininger’s Theory of Culture Care Madeleine Leininger viewed by many as the founder of transcultural nursing. Leininger’s theory addressed the similarities and differences across human culture. She believed that transcultural nursing care could provide meaningful, therapeutic health and healing outcomes (Parker amp; Smith, 2010, 318). In her theory she hoped for the nurse to provide care within cultural measures, beliefs, and values of the patient. In the 1960’ s she devised the phased â€Å"culturally congruent care†. Leininger’s vision to provide â€Å"culturally congruent care† manifested thru the intertwinement of the nurse-patient†¦show more content†¦The radiology tech was essential during this time if not only for explanation but also comfort in regards to cultural differences and beliefs. This also made the patient very nervous, scared, and uncomfortable during a time that was most critical. Therefore, it is up to the nurses to assist the individual patient as a unique being, promoting their self-care, the improvement of their quality of life, the recovery of their health, and the integration of their family in terms of cultural care, which is what turns this theoretical practice into reality (Ruschel, Azzolin, amp; Rabelo, 2012, p. 892). Review a mid-range theory that has relevance to your own practice. Consider how it informs or is reflected in your work environment. Look at the origins of this theory and how it has been implemented in practice. Evelyn Adam describes a conceptual model in which I chose. The mid-range theory is looked as a Conceptual Model of Nursing from the work of Virginia Henderson. The theory focuses on the healthcare environment as a whole or a unit. This focus looks at the holistic process and what areas are essential in providing this level of care. This focus according to Adam’s encompasses more than just nursing. I chose this theorist’s given my current healthcare environment and how essential other disciplines are in the care of our patients. Working in the cath lab, radiology techs are just as essential as nurses and doctors. In order to provideShow MoreRelatedAnalysis Of Louise Leiningers Theory Of Transcultural Nursing1484 Words   |  6 PagesThesis statement for CLC assignment week 3 In today’s society, our culture is becoming more diverse than it had been in history. This is an important concept that is necessary for nurses to understand in order to provide the best care possible with the best out comes possible. â€Å"We embrace diversity because by doing so our understanding of our world and our emotional and intellectual horizons are expanded, making us better advocates for our clients and better members of the communities in whichRead MoreLeininger s Theory Of Culture Care Diversity1473 Words   |  6 Pages Leininger’s Theory of Culture Care Diversity and Universality in Modern Society Amy Raddatz Denver School of Nursing â€Æ' Leininger’s Theory of Culture Care Diversity and Universality in Modern Society The premise of Madeleine Leininger ‘s Theory of Culture Care Diversity and Universality is that one must regard his or her patient both holistically and with respect to the patient’s given cultural background. Leininger aims to establish a nurse-patient relationship in which communication and collaborationRead MoreCompare And Contrast Leininger And Kubler Ross1575 Words   |  7 Pages Leininger and Kà ¼bler-Ross Theories exist to guide and teach individuals about how and why certain disciplines function. One discipline that has many theories is nursing. Nursing theories help to guide patient care. For instance, Madeleine Leininger developed the theory of Culture Care Diversity and Universality also known as transcultural nursing (TCN), which helps nurses to be culturally competent. There are also non-nursing theorists which can add to a nurse’s knowledge in caring for their patientRead MoreTranscultural Caring And Human Caring1254 Words   |  6 PagesNursing Nursing Theory/ NUR 315 December 8, 2015 Transcultural Caring and Human Caring Nursing theories are ideas organized into concepts and purposes used to guide the practice of nursing. Caring has always been a concept of nursing and it’s the hallmark of the nursing profession. Two well-known nursing theories on caring are that of Madeleine Leininger’s Transcultural Care Theory, (Leininger, 2002) and Jean Watson’s Human Caring Theory (Watson, 2008)Read MoreCulture Care Theory And Application1713 Words   |  7 PagesCulture Care Theory and Application Nursing theory is foundational to nursing practice; however, there exists a reciprocal relationship between practice and theory. Through examining nursing theory, the nurse can make better-informed decisions about the patient’s care. In addition, the theory will influence the care for future patients as well. One theorist that changed the landscape of nursing is Madeleine Leininger. Her culture care theory changed the dialogue of healthcare regarding care. ThisRead MoreTranscultural Nursing : An Increasingly Important Role Of A Health Care998 Words   |  4 Pagesimportant role in health care today. The constantly growing multicultural population in the world has made it challenging for nurses to provided individualized patient care. Nurses must gain the knowledge, skills, and the ability to identify and understand the unique cultural differences and how it affects patient care. Research has shown that culturally sensitive nursing care encourages patient satisfaction and p ositive outcomes. Nurses today are using the Culture Care Theory, developed by nursingRead MoreEvaluation Of Leininger s Theory Of Culture Care Diversity And Universality1275 Words   |  6 Pages Evaluation of Leininger’s Theory of Culture Care Diversity and Universality Camille E. Dantzler Simmons College of Nursing â€Æ' Though not presently practicing, my long term goal is to provide primary care to the underserved rural population in my home state of West Virginia. Due to health disparities, this population is plagued by preventable disease. West Virginia is commonly referred to as the fattest state in the country. Along with Mississippi, it ranks number one for obesityRead MoreLeininger s Culture Care Mode857 Words   |  4 Pagess Culture Care Mode Madeleine Leininger’s cultural care theory is one of the most influential modern day theories in nursing. Leininger describes her theory as one that is cultural sensitive that is tailored to address patients of different cultures, backgrounds, or origins. Leininger develops the cultural care theory due to the fact that she believes that nurses are caring for their patients as a one hat fits all, and not taking into consideration the patient s background or their culture. ThereRead MoreCulture Care Theory And Application1675 Words   |  7 PagesCulture Care Theory and Application Nursing theory is foundational to nursing practice; however, there exists a reciprocal relationship between practice and theory. Through examining nursing theory, the nurse can make better-informed decisions about the patient’s care. In addition, the theory will influence the care of future patients as well. One theorist that changed the landscape of nursing is Madeleine Leininger. Her culture care theory changed the dialogue of healthcare regarding care. ThisRead MoreEssay about Nursing Foundations in the Healthcare Community840 Words   |  4 Pagesby Florence Nightingale and Madeline Leininger Florence Nightingale has been known to be the founder and creator of nursing. Nightingale’s innovative practice that made an impact on history and changed the outcome of patient care was one her deep concern for holistic care for her patients (Jones, Spinks, Birrell, amp; Young, 2009). From her experience she learned in Crimea in 1856, she provided her knowledge that she learned about patient ventilation, sanitation, diet, environmental and personal

Essay on Effective Communication Skills - 1315 Words

Introduction An important step to becoming an effective leader is to develop effective communication skills. Communication is the transmission of meaning from one person to another or to many people, whether verbally or non-verbally (Barrett, 2006). Effective communication enables leaders to lead. Effective communication occurs only if the receiver understands the exact information or idea that the sender intended to covey. As a leader, studying the communication process is important. Communication skills, including the ability to problem solve, work in teams, and adapt to various audiences, are critical in today’s workplace (Levy Murname, 2004). Since the most successful leaders communicate well, understanding how your†¦show more content†¦The IHC instrument consists of 27 statements. Using a 5-point scale with 1 being strongly agree and 5 being strongly disagree, I rated each of the 27 statements. A score between 109 and 135 indicates an excellent understanding of the communication process. A score between 82 and 108 means there are a few areas that need some work while a score between 54 and 81 suggests there are several areas that need attention. A score between 27and 53 implies across the board improvement is needed. This instrument heightened my underst anding of my role as a sender and a receiver. It highlighted the importance of asking questions and providing feedback in order to promote clarity. It stressed the significance of non-verbal communication so that I not only hear, but also see what is being communicated to me. Finally, I learned the impact of using the appropriate communication channels for maximum effectiveness. Next, I used an updated version of Mok’s (1975) Communication Style, to determine my communication style (see Appendix B). The Mok survey was modified by Hartman and McCambridge (2010) using insights from Alessandra and Hunsaker (1993) and Merrill and Reid (1999). I chose this survey instrument because it has been used in both academia and executive development programs over the last several years. The reason this particular tool is popular in both academia and business is because it highlights theShow MoreRelatedEffective Communication And Communication Skills Essay1146 Words   |  5 Pagestogether as a team to collaborate, delegate and consult. In order for this team effort to be effective, good communication skills must exist between medical professionals. Many times, messages can be altered and interpreted differently; if the conditions for transmission barriers develop. External barriers and internal barriers, such as confusion and mental status can hinder effective co mmunication. Communication can be both verbal and nonverbal, and it is important to understand that different culturesRead MoreCommunication Skills For Effective Communication929 Words   |  4 Pages Based on your examples from each principle of effective communication (General, Interpersonal and Written), describe the potential barriers (problems) to effective communication in the presentation, as well. Remember to state the problem and then how this can affect communication. Introduction I am going to describe how communication skills are used effectively in the presentation. General Communication Skills General communication skills are a way of expression or exchanging ideas and thoughtsRead MoreCommunication Skills : Effective Communication1656 Words   |  7 Pages Communication Skills Effective communication skills The health and social worker must be able to communicate effectively with a wide range of patients or clients. 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Specifically in the field of education, where leaders are faced daily with challenging tasks, commitments, and deadlines, having effective communication skills is detrimental in creating a positive school climate inRead MoreEffective Communication Skills Are Important905 Words   |  4 PagesEffective communication skills are important no matter who an individual is talking to, but they are vital when it comes to talking to someone who has either been a victim or a witness of a crime. A victim is at their most vulnerable state s o they need to be talked to delicately and have support. Often times, witnesses of a crime are overlooked and are not questioned and they may have valuable information that could help a victim recover from the crime and give them justice. Communication in victimologyRead MoreEffective Communication And Interpersonal Skills942 Words   |  4 Pagesleadership skills have â€Å"the ability to influence others, through effective communication and interpersonal skills† (American Sentinel University). Commonly, directors and senior nurse managers are confined to a different schedule than bedside nurses; working outside of clinical practice and patient interaction and focusing primarily on addressing organizational issues, increasing morale and productivity among staff all while increasing the quality of patient care. Effective communication and the abilityRead MoreEssay on Skills for an Effective Communication1261 Words   |  6 Pagesability to connect with others by exchanging ideas and feelings both verbally and non-verbally. Verbal communication can consist of spoken conversations (face to face or phone calls) or written messages (letters, emails newsletters). Non-verbal communication includes facial expressions, body language, eye contact, tone and pauses and is less direct but just as important. Good communication skills are essential for anyone working in the early childhood industry, because being able to communicate effectivelyRead MoreGuidelines For Effective Communication Skills1867 Words   |  8 PagesApply Effective Communication Skills in Nursing Practice ESSAY Name: Maree Bolba D R A F T COMMUNICATION Define â€Å"Communication.† Communication is an interactive process where an individual transmits a message to another individual or a group. ‘Human communication is an ongoing dynamic series of events in which meaning is generated and transmitted.’ (Potter Perry, 2000 pp 271) In saying so there are two main factors when communicating, them being the verbal or non-verbalRead MoreEffective Communication Skills Essay1144 Words   |  5 PagesListening is a vital element of communication and it is very much different from hearing sense of human. A meaningful communication requires both a good listener and a speaker. However, the effect of a listening style may vary depending on the occasions and situations a listener is in. Sometimes, speaker exhibit ineffective style such as defensiveness, ambushing, pseudo-listening, stage hogging and selective listening in their communication tracks. I am a good listener because I pay my wholeRead MoreApply Effective Communication Skills6081 Words   |  25 Pagesat least five factors that could contribute to the success of a team. - Effective communication -Constructive criticism -Focus on the issues/goals -Working within the rules/policies -Active listening 3. Suggest at least five factors that could hinder the development of an effective team. - Unclear Goals - Conflicts between personalities - Interactions between team members (lack of quality) - Poor Communication - Unclear roles within the group dynamics. Activity 2.5 You have been

A Dirty Job Chapter 19 Free Essays

19 We’re OKAY, AS LONG AS THINGS DON’T GET WEIRD ALVIN AND MOHAMMED When Charlie arrived home from his mother’s funeral, he was met at the door by two very large, very enthusiastic canines, who, undistracted by keeping watch over Sophie’s love hostage, were now able to visit the full measure of their affection and joy upon their returning master. It is generally agreed, and in fact stated in the bylaws of the American Kennel Club, that you have not been truly dog-humped until you have been double-dog-humped by a pair of four-hundred-pound hounds from hell (Section 5, paragraph 7: Standards of Humping and Ass-dragging). And despite having used an extra-strength antiperspirant that very morning before leaving Sedona, Charlie found that getting poked repeatedly in the armpits by two damp devil-dog dicks was leaving him feeling less than fresh. We will write a custom essay sample on A Dirty Job Chapter 19 or any similar topic only for you Order Now â€Å"Sophie, call them off. Call them off.† â€Å"The puppies are dancing with Daddy.† Sophie giggled. â€Å"Dance, Daddy!† Mrs. Ling covered Sophie’s eyes to shield her from the abomination of her father’s unwilling journey into bestiality. â€Å"Go wash hands, Sophie. Have lunch while you daddy make nasty with shiksas.† Mrs. Ling couldn’t help but do a quick appraisal of the monetary value of the slippery red dogwoods currently pummeling her landlord’s oxford-cloth shirt like piston-driven leviathan lipsticks. The herbalist in Chinatown would pay a fortune for a powder made from the desiccated members of Alvin and Mohammed. (The men of her homeland would go to any length to enhance their virility, including grinding up endangered species and brewing them in tea, not unlike certain American presidents, who believe there is no stiffy like the one you get from bombing a few thousand foreigners.) Yet it appeared that the desiccated-dog-dick fortune would remain unclaimed. Mrs. Ling had long ago given up on collecting hellhound bits, when after trying to dispatch Alvin with a sharp and ringing blow to the cranium from her cast-iron skillet, he bit the skillet off its handle, crunched it down in a slurry of dog drool and iron filings, and then sat up and begged for seconds. â€Å"Throw some water on them!† Charlie cried. â€Å"Down, doggies. Good doggies. Oh, yuck.† Mrs. Ling was galvanized into action by Charlie’s distress call, and timing her move with the oscillating pyramid of man and dog meat in the doorway, dashed by Charlie, into the hallway, and down the steps. LILY Lily came up the stairs and skidded to a stop on the hallway carpet when she saw the hellhounds pounding away at Charlie. â€Å"Oh, Asher, you sick bastard!† â€Å"Help,† Charlie said. Lily pulled the fire extinguisher off the wall, dragged it to the doorway, pulled the pin, and proceeded to unload on the bouncing trio. Two minutes later Charlie was collapsed in a frosty heap on the threshold and Alvin and Mohammed were locked in Charlie’s bedroom, where they were joyfully chewing away on the expended fire extinguisher. Lily had lured them in there when they had tried to bite the CO2 stream, seeming to enjoy the freezing novelty of it over the welcome-home humping they were giving Charlie. â€Å"You okay?† Lily said. She was wearing one of her chef coats over a red leather skirt and knee-high platform boots. â€Å"It’s been kind of a rough week,† Charlie said. She helped him to his feet, trying to avoid touching the damp spots on his shirt. Charlie did a controlled fall toward the couch. Lily helped him land, ending with one arm pinned awkwardly under his back. â€Å"Thanks,† Charlie said. There was still frost in his hair and eyelashes from the fire extinguisher. â€Å"Asher,† Lily said, trying not to look him in the eye. â€Å"I’m not comfortable with this, but I think, given the situation, that it’s time I said something.† â€Å"Okay, Lily. You want some coffee?† â€Å"No. Please shut up. Thank you.† She paused and took a deep breath, but did not extricate her arm from behind Charlie’s back. â€Å"You have been good to me over the years, and although I would not admit this to anyone else, I probably wouldn’t have finished school or turned out as well as I have if it hadn’t been for your influence.† Charlie was still trying to see, blinking away ice crystals on his eyelids, thinking that maybe his eyeballs were frostbitten. â€Å"It was nothing,† he said. â€Å"Please, please, shut up,† Lily said. Another deep breath. â€Å"You have always been decent to me, despite what I would call some of my bitchier moments, and in spite of the fact that you are some dark death dude, and probably had other things to worry about – sorry about your mom, by the way.† â€Å"Thanks,† Charlie said. â€Å"Well, given what I’ve heard about your night out before your mom died and whatnot, and what I’ve seen here today, I think – that it’s only right – that I do you.† â€Å"Do me?† â€Å"Yes,† she said, â€Å"for the greater good, even though you are a complete tool.† Charlie squirmed away from her on the couch. He looked at her for a second, trying to figure out if she was putting him on, then, deciding that she wasn’t, he said, â€Å"That’s very sweet of you, Lily, and – â€Å" â€Å"Nothing weird, Asher. You need to understand that I’m only doing this out of basic human decency and pity. You can just take it to the hoes on Broadway if you need to get your freak on.† â€Å"Lily, I don’t know what – â€Å" â€Å"And not in the butt,† Lily added. There was a high-pitched little-girl giggle from behind the couch. â€Å"Hi, Daddy,† Sophie said, popping up behind him. â€Å"I missed you.† Charlie swung her up over the back of the couch and gave her a big kiss. â€Å"I missed you, too, sweetie.† Sophie pushed him away. â€Å"How come you have frosting on your hair?† â€Å"Oh, that – Lily had to spray some frost on Alvin and Mohammed to settle them down and it got on me.† â€Å"They missed you, too.† â€Å"I could tell,† Charlie said. â€Å"Honey, could you go play in your room for a bit while I talk to Lily about business?† â€Å"Where are the puppies?† Sophie asked. â€Å"They’re having a T.O. in Daddy’s room. Can you go play and we’ll have some Cheese Newts in a little while?† â€Å"Okay,† Sophie said, sliding to the floor. â€Å"Bye, Lily.† She waved to Lily. â€Å"Bye, Sophie,† Lily said, looking even more pale than usual. Sophie marched away in rhythm to her new chant, â€Å"Not in the butt – not in the butt – not in the butt.† Charlie turned to face Lily. â€Å"Well, that ought to liven up Mrs. Magnussen’s first-grade class.† â€Å"Sure, it’s embarrassing now,† Lily said, without missing a beat, â€Å"but someday she’ll thank me.† Charlie tried to look at his shirt buttons as if he were deep in thought, but instead started to giggle, tried to stop, and ended up snorting a little. â€Å"Jeez, Lily, you’re like a little sister to me, I could never – â€Å" â€Å"Oh, fine. I offer you a gift, out of the goodness of my heart, and you – â€Å" â€Å"Coffee, Lily,† Charlie said with a sigh. â€Å"Could I just get you to make me a cup of coffee instead of doing me – and sit and talk to me while I drink it? You’re the only one who knows what’s going on with Sophie and me, and I need to try to sort things out.† â€Å"Well, that will probably take longer than doing you,† Lily said, looking at her watch. â€Å"Let me call down to the store and tell Ray that I’ll be a while.† â€Å"That would be great,† Charlie said. â€Å"I was only going to do you in exchange for information about your Death Merchant thing, anyway,† Lily said, picking up the phone on the breakfast bar. Charlie sighed again. â€Å"That’s what I need to sort out.† â€Å"Either way,† Lily said, â€Å"I’m unbending on the butt issue.† Charlie tried to nod gravely, but started giggling again. Lily chucked the San Francisco Yellow Pages at him. THE MORRIGAN â€Å"This soul smells like ham,† said Nemain, wrinkling her nose at a lump of meat she had impaled on one long claw. â€Å"I want some,† said Babd. â€Å"Gimme.† She slashed at the carrion with her own talons, snagging a fist-sized hunk of flesh in the process. The three were in a forgotten subbasement beneath Chinatown, lounging on timbers that had been burned black in the great fire of 1906. Macha, who was starting to manifest the pearl headdress she wore in her woman form, studied the skull of a small animal by the light of a candle she’d made from the fat of dead babies. (Macha was ever the artsy-craftsy one, and the other two were jealous of her skills.) â€Å"I don’t understand why the soul is in the meat, but not in a man.† â€Å"Tastes like ham, too, I think,† Nemain said, spitting glowing red bits of soul when she talked. â€Å"Macha, do you remember ham? Do we like it?† Babd ate her bit of meat and wiped her claws on her breast feathers. â€Å"I think ham is new,† she said, â€Å"like cell phones.† â€Å"Ham is not new,† Macha said. â€Å"It’s smoked pork.† â€Å"No,† said Babd, aghast. â€Å"Yes,† said Macha. â€Å"Not human flesh? Then how is there a soul in it?† â€Å"Thank you,† Macha said. â€Å"That’s what I’ve been trying to say.† â€Å"I’ve decided that we like ham,† said Nemain. â€Å"There’s something wrong,† Macha said. â€Å"It shouldn’t be this easy.† â€Å"Easy?† said Babd. â€Å"Easy? It’s taken hundreds – no, thousands of years to get this far. How many thousands of years, Nemain?† Babd looked to the poison sister. â€Å"Many,† said Nemain. â€Å"Many,† said Babd. â€Å"Many thousands of years. That’s not easy.† â€Å"Souls coming to us, without bodies, without the soul stealers, that seems too easy.† â€Å"I like it,† Nemain said. They were quiet for a moment, Nemain nibbled at the glowing soul, Babd preened, and Macha studied the animal skull, turning it over in her talons. â€Å"I think it’s a woodchuck,† Macha said. â€Å"Can you make ham from woodchuck?† Nemain asked. â€Å"Don’t know,† said Macha. â€Å"I don’t remember woodchuck,† Nemain said. Babd sighed heavily. â€Å"Things are going so well. Do you two ever think about when we are Above all the time, and Darkness rules all, about, you know, what then?† â€Å"What do you mean, what then?† Macha asked. â€Å"We will hold dominion over all souls, and visit death as we wish until we consume all the light of humanity.† â€Å"Yeah, I know,† Babd said, â€Å"but then what? I mean, you know, dominion and all that is nice, but will Orcus always have to be around, snorting and growling?† Macha put down her skull and sat up on a blackened beam. â€Å"What’s this about?† Nemain smiled, her teeth perfectly even, the canines just a little too long. â€Å"She’s pining about that skinny soul stealer with the sword.† â€Å"New Meat?† Macha couldn’t believe her ears, which had become visible only a few days ago when the first of the gift souls had wandered into their claws, so they hadn’t been tested in a while. â€Å"You like New Meat?† â€Å"Like is a little strong,† Babd said. â€Å"I just think he’s interesting.† â€Å"Interesting in that you’d like to arrange his entrails in interesting patterns in the dirt?† Macha said. â€Å"Well, no, I’m not talented that way like you.† Macha looked at Nemain, who grinned and shrugged. â€Å"We could probably try to kill Orcus once Darkness rises,† Nemain said. â€Å"I am a little tired of his preaching, and he’ll be impossible if the Luminatus doesn’t appear.† Macha shrugged a surrender. â€Å"Sure, why not.† THE EMPEROR The Emperor of San Francisco was troubled. He sensed that something very wrong was going on in the City, yet he was at a loss as to what to do. He didn’t want to alarm the people unduly, but he did not want them to be unprepared for whatever danger they might face. He believed that a just and benevolent ruler would not use fear to manipulate his people, and until he had some sort of proof that there was an actual threat, it would be criminal to call for any action. â€Å"Sometimes,† he said to Lazarus, the steadfast golden retriever, â€Å"a man must muster all of his courage to simply sit still. How much humanity has been spoiled for the confusion of movement with progress, my friend? How much?† Still, he’d been seeing things, strange things. One late night in Chinatown he’d seen a dragon made of fog snaking through the streets. Then, early one morning, down by the Boudin Bakery at Ghirardelli Square, he saw what looked like a nude woman covered in motor oil crawl out of a storm sewer and grab a tall, half-full latte cup out of the trash, then dive right back in the sewer as a policeman on a bicycle rounded the corner. He knew that he saw these things because he was more sensitive than other people, and because he lived on the streets and could sense the slightest nuance of change there, and largely because he was completely barking-at-the-moon batshit. But none of that relieved him of the responsibility to his people, nor did it ease his mind about the disturbing nature of what he was seeing. The squirrel in the hoop skirt was really bothering the Emperor, but he couldn’t exactly say why. He liked squirrels – often took the men to Golden Gate Park to chase them, in fact – but a squirrel walking upright and digging through the trash behind the Empanada Emporium while wearing a pink ball gown from the eighteenth century – well – it was off-putting. He was sure that Bummer, who was curled up sleeping in the oversized pocket of his coat, would agree. (Bummer, being a rat dog at heart, had a less than enlightened outlook upon coexistence with any rodent, no less one dressed for the court of Louis XVI.) â€Å"Not to be critical,† said the Emperor, â€Å"but shoes would be a welcome complement to the ensemble, don’t you think, Lazarus?† Lazarus, normally tolerant of all noncookie creatures great and small, growled at the squirrel, who appeared to have the feet of a chicken sticking out from under her skirt, which – you know – was weird. With the growl, Bummer squirmed awake and emerged from the woolen bedchamber like Grendel from his lair. He immediately erupted into an apoplectic barking fit, as if to say, You guys, in case you didn’t notice, there’s a squirrel in a ball gown going through the trash over there and you’re just sitting here like a couple of concrete library lions! The message thus barked, off he went, a furry squirrel-seeking missile, bent on single-minded annihilation of all things rodent. â€Å"Bummer,† called the Emperor. â€Å"Wait.† Too late. The squirrel had tried to take off up the side of the brick building, but snagged her skirt on a gutter and fell back to the alley, just as Bummer was hitting full stride. Then the squirrel snatched up a small board from a broken pallet and swung it at his pursuer, who leapt just in time to miss taking a nail in one of his bug eyes. Growling ensued. The Emperor noticed at that point that the squirrel’s hands were reptilian in nature, the fingernails painted a pleasant pink to match her gown. â€Å"You don’t see that every day,† the Emperor said. Lazarus barked in agreement. The squirrel dropped the board and took off toward the street, moving nicely on her chicken feet, her skirt held up in her lizard hands. Bummer had recovered from the initial shock of a weapon-wielding squirrel (something he had encountered before only in doggie nightmares brought on by the late-night gift of chorizo pizza from a charitable Domino’s guy) and took off after the squirrel, followed closely by the Emperor and Lazarus. â€Å"No, Bummer,† the Emperor called. â€Å"She’s not a normal squirrel.† Lazarus, because he did not know how to say â€Å"well, duh,† stopped in his tracks and looked at the Emperor. The squirrel rocketed out of the alley and took a quick turn down the gutter, falling now to all fours as she went. Just as he reached the corner, the Emperor saw the trail of the tiny pink dress disappear down a storm sewer, followed closely by the intrepid Bummer. The Emperor could hear the terrier’s bark echoing out of the grate, fading as Bummer pursued his prey into the darkness. RIVERA Nick Cavuto sat down across from Rivera with a plate of buffalo stew roughly the size of a garbage-can lid. They were having lunch at Tommy’s Joynt, an old-school eatery on Van Ness that served home-style food like meat loaf, roasted turkey and stuffing, and buffalo stew every day of the year, and featured San Francisco sports teams on the TV over the bar whenever anyone was playing. â€Å"What?† said the big cop, when he saw his partner roll his eyes. â€Å"Fucking what?† â€Å"Buffalo almost went extinct once,† Rivera said. â€Å"You have ancestors on the Great Plains?† â€Å"Special law enforcement portions – protecting and serving and stuff requires protein.† â€Å"A whole bison?† â€Å"Do I criticize your hobbies?† Rivera looked at his half a turkey sandwich and cup of bean soup, then at Cavuto’s stew, then at his runt of a sandwich, then at his partner’s colossus of a stew. â€Å"My lunch is embarrassed,† he said. â€Å"Serves you right. Revenge for the Italian suits. I love going to every call with people thinking I’m the victim.† â€Å"You could buy a steamer, or I could have my guy find you some nice clothes.† â€Å"Your guy the serial-killing thrift-store owner? No thanks.† â€Å"He’s not a serial killer. He’s got some weird shit going on, but he’s not a killer.† â€Å"Just what we need, more weird shit. What was he really doing when you had that shots-fired report?† â€Å"Just like it said, I was going by and a guy tried to rob him at gunpoint. I drew my weapon and told the perp to halt, he drew down on me, and I fired.† â€Å"Your ass. You never fired eleven shots in your life you didn’t hit the ten X ring with nine of them. The fuck happened?† Rivera looked down the long table, made sure the three guys sitting down at the other end were engaged in the game showing on the TV over the bar. â€Å"I hit her with every shot.† â€Å"Her? Perp was a woman?† â€Å"I didn’t say that.† Cavuto dropped his spoon. â€Å"Partner? Don’t tell me you shot the redhead? I thought that was over.† â€Å"No. This was a new thing – like – Nick, you know me, I’m not going to fire unless it’s justified.† â€Å"Just say what happened. I got your back.† â€Å"It was like this bird woman or something. All black. I mean fucking black as tar. Had claws that looked like – I don’t know, like three-inch-long silver ice picks or something. My shots took chunks out of her – feathers and black goo and shit everywhere. She took nine in the torso and flew away.† â€Å"Flew?† Rivera sipped his coffee, eyeing his partner’s reaction over the edge of the cup. They had been through some extraordinary things working together, but if the situation had been reversed, he wasn’t sure he’d believe this story either. â€Å"Yeah, flew.† Cavuto nodded. â€Å"Okay, I can see why you wouldn’t put that in the report.† â€Å"Yeah.† â€Å"So this bird woman,† Cavuto said, like that was settled, he totally believed it, now what? â€Å"She was robbing the Asher guy from the thrift shop?† â€Å"Giving him a hand job.† Cavuto nodded, picked up his spoon, and took a huge bite of stew and rice, still nodding as he chewed. He looked as if he were going to say something, then quickly took another bite, as if to stop himself. He appeared to be distracted by the game on television, and finished his lunch without another word. Rivera ate his soup and sandwich in silence as well. As they were leaving, Cavuto grabbed two toothpicks from the dispenser by the register and gave one to Rivera as they walked out into a beautiful San Francisco day. â€Å"So you were following Asher?† â€Å"I’ve been trying to keep an eye on him. Just in case.† â€Å"And you shot her nine times for giving the guy a hand job,† Cavuto finally asked. â€Å"I guess,† Rivera said. â€Å"You know, Alphonse, that right there is why I don’t hang out with you socially. Your values are fucked up.† â€Å"She wasn’t human, Nick.† â€Å"Still. A hand job? Deadly force? I don’t know – â€Å" â€Å"It wasn’t deadly force. I didn’t kill her.† â€Å"Nine to the chest?† â€Å"I saw her – it – last night. On my street. Watching me from a storm sewer.† â€Å"Ever think to ask Asher how he happened to know the flying bulletproof bird woman in the first place?† â€Å"Yeah, I did, but I can’t tell you what he said. It’s too weird.† Cavuto threw his arms in the air. â€Å"Well, sweet Tidy Bowl Jesus skipping on the blue toilet water, we wouldn’t want it to get fucking weird, would we?† LILY They were on their second cup of coffee and Charlie had told Lily about not getting the two soul vessels, about the encounter with the sewer harpy, about the shadow coming out of the mountains in Sedona and the other version of The Great Big Book of Death, and his suspicions that there was a frightening problem with his little girl, the symptoms of which were two giant dogs and an ability to kill with the word kitty. To Charlie’s thinking, Lily was reacting to the wrong story. â€Å"You hooked up with a demon from the Underworld and I’m not good enough for you?† â€Å"It’s not a competition, Lily. Can we not talk about that? I knew I shouldn’t have told you. I’m worried about other stuff.† â€Å"I want details, Asher.† â€Å"Lily, a gentleman doesn’t share the details of his amorous encounters.† Lily crossed her arms and assumed a pose of disgusted incredulity, an eloquent pose, because before she said it, Charlie knew what was coming: â€Å"Bullshit. That cop shot pieces off her, but you’re worried about protecting her honor?† Charlie smiled wistfully. â€Å"You know, we shared a moment – â€Å" â€Å"Oh my God, you complete man-whore!† â€Å"Lily, you can’t possibly be hurt by my – by my response to your generous – and let me say right here – extraordinarily tempting offer. Gee whiz.† â€Å"It’s because I’m too perky, isn’t it? Not dark enough for you? You being Mr. Death and all.† â€Å"Lily, the shadow in Sedona was coming for me. When I left town, it went away. The sewer harpy came for me. The other Death Merchant said that I was different. They never had deaths happen as a result of their presence like I have.† â€Å"Did you just say ‘gee whiz’ to me? What am I, nine? I am a woman – â€Å" â€Å"I think I might be the Luminatus, Lily.† Lily shut up. She raised her eyebrows. As if â€Å"no.† Charlie nodded. As if â€Å"yes.† â€Å"The Big Death?† â€Å"With a capital D,† Charlie said. â€Å"Well, you’re totally not qualified for that,† Lily said. â€Å"Thanks, I feel better now.† MINTY FRESH Being two hundred feet under the sea always made Minty uneasy, especially if he’d been drinking sake and listening to jazz all night, which he had. He was in the last car on the last train out of Oakland, and he had the car to himself, like his own private submarine, cruising under the Bay with the echo of a tenor sax in his ear like sonar, and a half-dozen sake-sodden spicy tuna rolls sitting in his stomach like depth charges. He’d spent his evening at Sato’s on the Embarcadero, Japanese restaurant and jazz club. Sushi and jazz, strange bedfellows, shacked up by opportunity and oppression. It began in the Fillmore district, which had been a Japanese neighborhood before World War II. When the Japanese were shipped off to internment camps, and their homes and belongings sold off, the blacks, who came to the city to work in the shipyards building battleships and destroyers, moved into the vacant buildings. Jazz came close behind. For years, the Fillmore was the center of the San Francisco jazz scene, and Bop City on Post Street the premier jazz club. When the war ended and the Japanese returned, many a late night might find Japanese kids standing under the windows of Bop City, listening to the likes of Billie Holiday, Oscar Peterson, or Charles Mingus, listening to art happen and dissipate into the San Francisco nights. Sato was one of those kids. It wasn’t just historical happenstance – Sato had explained to Minty, late one night after the music had ended and the sake was making him wax eloquent – it was philosophical alignment: jazz was a Zen art, dig? Controlled spontaneity. Like sumi-e ink painting, like haiku, like archery, like kendo fencing – jazz wasn’t something you planned, it was something you did. You practiced, you played your scales, you learned your chops, then you brought all your knowledge, your conditioning, to the moment. â€Å"And in jazz, every moment is a crisis,† Sato quoted Wynton Marsalis, â€Å"and you bring all your skill to bear on that crisis.† Like the swordsman, the archer, the poet, and the painter – it’s all right there – no future, no past, just that moment and how you deal with it. Art happens. And Minty, taken by the need to escape his life as Death, had taken the train to Oakland to find a moment he could hide in, without the regret of the past or the anxiety of the future, just a pure right now resting in the bell of a tenor sax. But the sake, too much future looming ahead, and too much water overhead had brought on the blues, the moment melted, and Minty was uneasy. Things were going badly. He’d been unable to retrieve his last two soul vessels – a first in his career – and he was starting to see, or hear, the effects. Voices out of the storm sewers – louder and more numerous than ever – taunting him. Things moving in the shadows, on the periphery of his vision, shuffling, scuffling dark things that disappeared when you looked right at them. He’d even sold three discs off the soul-vessels rack to the same person, another first. He hadn’t noticed it was the same woman right away, but when things started to go wrong, the faces played back and he realized. She’d been a monk the first time, a Buddhist monk of some kind, wearing gold-and-maroon robes, her hair very short, as if her head had been shaved and was growing out. What he remembered was that her eyes were a crystal blue, unusual in someone with such dark hair and skin. And there was a smile deep in those eyes that made him feel as if a soul had found its rightful place, a good home at a higher level. The next time he’d seen her was six months later and she was in jeans and leather jacket, her hair sort of out of control. She’d taken a CD from the â€Å"One Per Customer† rack, a Sarah McLachlan, which is what he’d have chosen for her if asked, and he barely noticed the crystal-blue eyes other than to think that heâ€⠄¢d seen that smile before. Then, last week, it was her again, with hair down around her shoulders, wearing a long skirt and a belted muslin poet’s shirt – like an escapee from a Renaissance fair, not unusual for the Haight, but not quite common in the Castro – still, he thought nothing of it, until she had paid him and glanced over the top of her sunglasses to count the cash out of her wallet. The blue eyes again, electric and not quite smiling this time. He didn’t know what to do. He had no proof she was the monk, the chick in the leather jacket, but he knew it was her. He brought all his skills to bear on the situation, and essentially, he folded. â€Å"So you like Mozart?† he asked her. â€Å"It’s for a friend† was all she said. He rationalized not confronting her by that simple statement. A soul vessel was supposed to find its rightful owner, right? It didn’t say he had to sell it directly to them. That had been a week ago, and since then the voices, the scuffling noises in the shadows, the general creepiness, had been nearly constant. Minty Fresh had spent most of his adult life alone, but never before had he felt the loneliness so profoundly. A dozen times in the last few weeks he’d been tempted to call one of the other Death Merchants under the pretense of warning them about his screwup, but mainly just to talk to someone who had a clue about what his life was like. He stretched his long legs out over three train seats and into the aisle, then closed his eyes and laid his head back against the window, feeling the rhythm of the rattling train coming through the cool glass against his shaved scalp. Oh no, that wasn’t going to work. Too much sake and something akin to bed spins. He jerked his head forward and opened his eyes, then noticed through the doors that the train had gone dark two cars up. He sat upright and watched as the lights went out in the next car – no, that’s not what happened. Darkness moved through the car like a flowing gas, taking the energy out of the lights as it went. â€Å"Oh, shit,† Minty said to the empty car. He couldn’t even stand up inside the train, but stand up he did, staying slumped a little, his head against the ceiling, but facing the flowing darkness. The door at the end of the car opened and someone stepped through. A woman. Well, not exactly a woman. What looked like the shadow of a woman. â€Å"Hey, lover,† it said. A low voice, smoky. He’d heard this voice before, or a voice like it. The darkness flowed around the two floor lights at the far end of the car, leaving the woman illuminated in outline only, a gunmetal reflection against pure blackness. Since he was first tapped as a Death Merchant, Minty had never remembered feeling afraid, but he was afraid now. â€Å"I’m not your lover,† Minty said, his voice as smooth and steady as a bass sax, not giving up a note of fear. A crisis in every moment, he thought. â€Å"Once you’ve had black, you never go back,† she said, taking a step toward him, her blue-black outline the only thing visible in any direction now. He knew there was a door a few feet behind him that was held shut with powerful hydraulics, and that led to a dark tunnel two hundred feet under the Bay, lined with a deadly electric rail – but for some reason, that sounded like a really friendly place to be right now. â€Å"I’ve had black,† said Minty. â€Å"No, you haven’t, lover. You’ve had shades of brown, dark cocoa and coffee maybe, but I promise you, you’ve never had black. Because once you do, you never ever come back.† He watched as she moved toward him – flowed toward him – and long silver claws sprouted from her fingertips, playing in the dim glow from the safety lights, dripping something that steamed when it hit the floor. There were scurrying sounds on either side of him, things moving in the darkness, low and quick. â€Å"Okay, good point,† Minty said. How to cite A Dirty Job Chapter 19, Essay examples

A Little Commonwealth Essay Example For Students

A Little Commonwealth Essay The modern image of the New England Puritans, as one perceives, is a dark one: the Puritans, religious dissenters who valued propriety and order, are seen as a witch-hunters, suspicious tribe, and their very name carries connotations of grimness and primness. Where as the book A Little Commonwealth reflects the scenario in which the Puritans lived. Most of the houses in the Puritan Colonial time were small, dark, brooding and sparsely furnished. This allowed the Puritans to use every available space in the home. For examples, most of the furnishings and utensils used by the Puritans had more than one usea trunk would be used not only for storage but also for sitting upon or maybe even a table. Moreover because of their lifestyle, they had to carry inventories, which were bulky and were stationed at the corner. In a way to demonstrate his/her standing in the community and to confirm his/her own self-image, the Puritans viewed their wealth by material and tangible acquisitions. Their modest clothing showed just what their standing was in the community. More clothes, books (even if they could not read), linens and such things were viewed as money in the bank, although jewelry, even wedding bands, were not considered tangible wealth in the Puritans. The families were very tight knit. While they lived in such cramped quarters they seemed to be able to live peaceably and by communicate with each other. Rather than squabble amongst themselves the Puritans, by way of displaced anger, would often have arguments with their neighbors instead of disrupting the harmony in their own household. Most of the families, within a given community at a given point in time, exemplified the basic model of husband, wife, and children. While the family unit was close, the Puritans would often had contract help, hopefully by formal apprenticeship, on their children due to lack of household space. Servants lived on quite intimate terms within their new family but not equally. In the case of sickness of the Master, when the Master was well and, no longer felt the need to have a servant, or passed away, the contract was deemed fulfilled. In some cases, the Master, in his will, would make a specific bequeath to the servant in of recognition of his or her friendship and affection to that servant showed, but this was rare. Though uncommon Negros and Indians servants were usually considered part of the dying mans estate and were passed on to his heirs along with others sorts of properties. Unlike todays adolescence, Puritan children knew from a very early age where they belong in the family, what was expected of them and what they would be doing probably for the rest of their lives. The elders believed the children should not know they have a will of their own. From the beginning they were dressed and treated as miniature adults and learned their stations by sharing in the activities of their parents. This helped them mature early and take their respective roles in the society. Given that the Puritans were a religious group of people, still the marriages were performed by Civil Magistrates and were viewed as a civil ceremony and not as a religious one. Being married and on their own a young married couple would still be beholden to their parents most times until middle age for fear of disinheritance of land that was given to them in marriage. On average the age of marriage was much higher than one could image. A male would marry when he would be 25- 27, where as a female would marry by 20- 22. Men needed women to take care of their homes and reproduce and women needed men for financial stability ; security. Women rarely had land of their own, the sons would be given land and the women were given utensils or livestock. The men were viewed as the head of the family. .ucb96bf40d6531301b9d46a966ad5ea7b , .ucb96bf40d6531301b9d46a966ad5ea7b .postImageUrl , .ucb96bf40d6531301b9d46a966ad5ea7b .centered-text-area { min-height: 80px; position: relative; } .ucb96bf40d6531301b9d46a966ad5ea7b , .ucb96bf40d6531301b9d46a966ad5ea7b:hover , .ucb96bf40d6531301b9d46a966ad5ea7b:visited , .ucb96bf40d6531301b9d46a966ad5ea7b:active { border:0!important; } .ucb96bf40d6531301b9d46a966ad5ea7b .clearfix:after { content: ""; display: table; clear: both; } .ucb96bf40d6531301b9d46a966ad5ea7b { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ucb96bf40d6531301b9d46a966ad5ea7b:active , .ucb96bf40d6531301b9d46a966ad5ea7b:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ucb96bf40d6531301b9d46a966ad5ea7b .centered-text-area { width: 100%; position: relative ; } .ucb96bf40d6531301b9d46a966ad5ea7b .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ucb96bf40d6531301b9d46a966ad5ea7b .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ucb96bf40d6531301b9d46a966ad5ea7b .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ucb96bf40d6531301b9d46a966ad5ea7b:hover .ctaButton { background-color: #34495E!important; } .ucb96bf40d6531301b9d46a966ad5ea7b .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ucb96bf40d6531301b9d46a966ad5ea7b .ucb96bf40d6531301b9d46a966ad5ea7b-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ucb96bf40d6531301b9d46a966ad5ea7b:after { content: ""; display: block; clear: both; } READ: Case Study: Ocean Carriers EssayIn summary, This book examines the family in the context of the colony founded by the Pilgrims who came over on the Mayflower. The author Basing his work on physical artifacts, wills, estate inventories, and a variety of legal and official enactments, portrays the family as a structure of roles and relationships, emphasizing those of husband and wife, parent and child, and master and servant. In this natural setting for both imposing discipline and encouraging and developing the character of people in the community; the family was responsible for the formal education, vocational training and while the church played a part in the community.