Friday, May 31, 2019

Computers and Education :: Argumentative Persuasive Essays

Computers have both positively and negatively impacted the education field. They have helped t distributivelyers keeping a spreadsheet on the students so it is easier to keep their grade average straight. Computers have helped students write reports and gain information from the Internet but there ar overly negative affects from the information processing systems. Students ar able to obtain information from the Internet and use it as their own. Students are also able to purchase reports/papers online and turn them in. By looking at both of these one can see that the computer has impacted the field of education both positively and negatively.For teachers the computer has become an important tool in the classroom. Teachers are now able to keep a running spreadsheet on their students grades along with the agenda for the week. No longer do teachers adopt to calculate the students average. All that needs to be done is a simple spreadsheet with the formulas and grades/scores plugged i nto the cells. This helps the teacher save clipping so it can be used for more important things such as grading papers and planning recent activities. This helps teachers because students are always asking a teacher where they stand and with this the teacher will know as long as all the information is plugged into the cells. By having the agenda on the computer the teacher is able to print it off quickly incase a student loses it.Another way the computer/Internet helps teachers is they can get new lesson plans on line. There are many sight on line that allow teachers to go to get information on activities for subjects and for certain grade levels. They also can go onto chat rooms with other teachers and exchange information. By doing this teaches can talk about what works in their classrooms and what did not. They can tell each other what activities the students liked and what activities that they did not. This helps them get new information and new ideas so the lessons are not th e same and they can find variety on what is taught. Students are able to attain research for term papers/reports from the Internet. They are able to get more information on line in less time then it would take to go to the library look up the books needed and read the books. The Internet allows students to browse through topics in a wide weave in a minimal amount of time, by doing this it takes students less time to research and gives them more time to work on papers and projects.

Thursday, May 30, 2019

Parallelisms and Differences:Rastafarianism and Judaism Essay -- Rasta

Parallelisms and DifferencesRastafarianism and JudaismThe two religions of Rastafarianism and Judaism embody many of the same characteristics, as well as their ancestry. Although the Rastafarians, at times, inaccurately explain the bible, their belief in the Old Testament is still prevalent. Many of the customs are almost identical, but the rationale behind the traditions and laws contrast greatly. In 1933, when Leonard P. Howell was arrested for usingseditious and down in the mouth language,to boost the sale of pictures of Haile Selassie, he stated that Selassie was, world-beater Ras Tafari of Abyssinia, son of king Solomon by the queen of Sheba.1 Howell knew that in later years genuine information about Selassies true origin would be declared. As an Ethiopian constitution of 1955 confirms, Haile Selassie in his position as Emperor,descends without interruption from the dynasty of Menelik I, son of Ethiopia, the Queen of Sheba, and King Solomon of Jerusalem.2 This constitution, th erefore, gives us direct evidence from Ethiopian sources of an existence of a section of the Ethiopian Population practicing the Jewish Religion. According to the bible, King Solomon, King of Israel and the Jews, was nonrecreational by a visit from the Queen of Sheba, an Ethiopian Monarch. The Kebra Negast, the book of the glory of kings, states that by a trick, King Solomon inveigled the queen into sharing his bed with the result of a new born son, Menelik, who in due course became king or negus of Ethiopia.3 The queen was very impressed during her visit to the Holy Land, and adopted the Jewish Religion. that her son Menelik, when he grew up, visited his father, and transferred the Ark of the Covenant from Jerusalem to Axum. It is at this point where a new r... ...USA, no publishing given) Sanhedrin 90b31 King James, Holy Bible, Song of Solomon, (USA, no publishing given) Berakhot 28b32 King James, Holy Bible, Song of Solomon, (USA, no publishing given)33 King James, Holy Bible, Song of Solomon, (USA, no publishing given) Genesis 31834 King James, Holy Bible, Song of Solomon, (USA, no publishing given) Exodus 101235 King James, Holy Bible, Song of Solomon, (USA, no publishing given) Proverbs 151736 King James, Holy Bible, Song of Solomon, (USA, no publishing given) Psalm 1041437 Barret, Leonard E. The Rastafarians (Boston Beacon Press 1997) p12938 Kolatch, Alfred J., The Jewish Book of Why (Jonathan David Publisher 1981) 11839 Barret, Leonard E. The Rastafarians (Boston Beacon Press 1997)40 Barrow, Steve and Dalton, Peter, Reggae The Rough Guide (London Rough Guides LTD1997)191

Wednesday, May 29, 2019

Case Study on Coke versus Pepsi Essay -- Business, Marketing

The case study Cola Wars Continue nose candy and Pepsi in the Twenty-First Century focuses on describing degree centigrade and Pepsi within the CSD industry by providing detailed statements closely the companies accounts and strategies to increase their market share. Furthermore, the case also focuses on the degree Celsius vs. Pepsi goods which target similar groups of costumers, and how these companies have had and up to now have great reputation and continue to take risks collect to their high capital. This analysis of the Cola Wars Continue case study will focus generally on the profitability of the industry by carefully considering and analyzing the below questions Why is the soft alcoholism industry so profitable?Compare the economics of the revolve about business to the bottling business Why is the profitability so different?How has the competition between Coke and Pepsi affected the industrys profits?Can Coke and Pepsi sustain their profits in the wake of flatten ing demand and the growing popularity of non-carbonated drinks?The soft drink industry is a highly profitable industry and its success is due to the large consumption of non-alcoholic beverages through which both concentrate producers and bottlers are profitable. Given the U.S. Industry consumption Statistics, Exhibit 1, it is clear that, after deducting beer and wine, soft drinks account for about 90 % of the total liquid consumption, while Coke and Pepsi account for about 75 % of the soft drink industry. The high consumption of CSDs is related to the soft drink industry selling to consumers through five principal channels food stores, convenience stores, vending, fountain and other. Out of the five channels the case describes vending as the most profitable channel for the soft drink... ...e and Pepsis already established image as producers of premium product is key to discouraging other companies from ledger entry the soft drink industry. However, as the market in the U.S h as leveled off, they should continue to invest globally in marketing and advertising for further profit growth, which will in turn positively influence their well established brands to further increase soft drink sales and profits. The marketing campaigns must be tailored to tuck the foreign markets demands, by respecting the consumers culture and flavor preferences. Furthermore, in the foreign markets the local brands must not be underestimated as these present high competition for Coke and Pepsi, therefore in order for the kings of the soft drink industry to expand their reign globally they must partner with the local soft drink firms and create soft drinks with local tastes.

Dieting :: Vegan Health Food Diet Essays

As we begin our journey into the twenty-first century, ordination has turned to the Internet to find protrude what is going on with the world. With rules of order searching for all the answers on their computers, we may soon be finding solutions to what and how we should be eating. Often, the articles read may be misleading and do not whirligig both sides of the issue. In recent years, several victualsary movements pass on arisen from the objection to the insensate treatment of animals. Medical evidence has linked these diets to m either health benefits and risks. fast and the types of food that we consume have been shown to affect our lives in ways that we have been unsuspecting of, such as cholesterol levels, heart disease, and colon cancer. These types of diseases in occidental societies are results of excess, rather than of deficiency. According to the American Dietetic Association, vegetarians have a pooh-pooh risk for these diseases (http//envirolink.org/arrs/vo/Argu mentMedical.html). With medical arguments in favor of cutting meat out of ones diet, a more extreme vegetarian diet has gained attention. A vegan diet is considered a severe type of vegetarianism. In this article, I will define veganism and also summary the beneficial qualities and concerns of sideline this type of diet as research has shown.What is Veganism?Veganism is the strict pastime of a vegetarian diet in which no animal products are consumed. This diet excludes any meat, fish, eggs, or dairy products. Many vegans must take supplements to obtain the vitamins and minerals necessitate for ones health, which are missing from diet alone. Being vegan is not only following a scheduled diet, but also a complete lifestyle. The perfect vegan bans any type of animal products such as leather and animal-tested cosmetics from their life. Veganism has its origins in the inhumane treatment of animals. Many vegans have done research into the livestock business and have found disturbing results. By witnessing institutionalized cruelty, vegans support their plight with this funding and work together to promote their cause. Many vegans feel that it is not only a diet, but the embodiment of ahimsa-- the philosophy of non-violence towards and all-encompassing respect for all sentient beings (http//envirolink.org/arrs/vo/BeingVegan.html). Vegans are also concerned with the environment. A report issued by the U.S. Departments of Commerce and inner says that 1/3 of all raw materials consumed in the U.S. are bear on in the production of our animal-based foods, as is over half of the water (http//envirolink.Dieting Vegan Health Food Diet EssaysAs we begin our journey into the twenty-first century, society has turned to the Internet to find out what is going on with the world. With society searching for all the answers on their computers, we may soon be finding solutions to what and how we should be eating. Often, the articles read may be misleading and do not cover b oth sides of the issue. In recent years, several dietary movements have arisen from the objection to the inhumane treatment of animals. Medical evidence has linked these diets to many health benefits and risks. Dieting and the types of food that we consume have been shown to affect our lives in ways that we have been unaware of, such as cholesterol levels, heart disease, and colon cancer. These types of diseases in western societies are results of excess, rather than of deficiency. According to the American Dietetic Association, vegetarians have a lower risk for these diseases (http//envirolink.org/arrs/vo/ArgumentMedical.html). With medical arguments in favor of cutting meat out of ones diet, a more extreme vegetarian diet has gained attention. A vegan diet is considered a strict type of vegetarianism. In this article, I will define veganism and also outline the beneficial qualities and concerns of following this type of diet as research has shown.What is Veganism?Veganism is the s trict following of a vegetarian diet in which no animal products are consumed. This diet excludes any meat, fish, eggs, or dairy products. Many vegans must take supplements to obtain the vitamins and minerals needed for ones health, which are missing from diet alone. Being vegan is not only following a scheduled diet, but also a complete lifestyle. The perfect vegan bans any type of animal products such as leather and animal-tested cosmetics from their life. Veganism has its origins in the inhumane treatment of animals. Many vegans have done research into the livestock business and have found disturbing results. By witnessing institutionalized cruelty, vegans support their plight with this documentation and work together to promote their cause. Many vegans feel that it is not only a diet, but the embodiment of ahimsa-- the philosophy of non-violence towards and all-encompassing respect for all sentient beings (http//envirolink.org/arrs/vo/BeingVegan.html). Vegans are also concerned with the environment. A report issued by the U.S. Departments of Commerce and Interior says that 1/3 of all raw materials consumed in the U.S. are involved in the production of our animal-based foods, as is over half of the water (http//envirolink.

Tuesday, May 28, 2019

Electronic Stimulation :: essays research papers

Medicine and electronics are rapidly becoming a common partnership. Electronics and medicine has been around for all over a hundred years. This application can be seen in early X-ray machines, as well as early doctors and healers who felt that electricity have whateverthing special that assisted the healing process of many illnesses and injuries. But it has not been the last forty to fifty years that the development and refinement of electricity as medical agent has occurred. Today the medical field can not imagine itself without the assistance of electricity and electronic components. In recent years some of the major development has occurred in one particular field ofMedicine, electric stimulation. Electric stimulation is the application of electric current in treatment without the genesis of intense heat. This includes electric stimulation of nerves or muscles, passage of current into the body, or use of interrupted current of low intensity to raise the threshold of the skin to pain. Studies suggested this therapy is applied to conditions such as ulcers, traumatic or burn wounds, osteoarthritis, and cancer. Electrical stimulation is simply the application of galvanizing pulses to the body, whether it is for function or therapy. The classical and common example is that of the cardiac pacemaker. The range of clinical uses of electrical stimulation has and is growing wider and includes pain relief (often known as TENS - Transcutaneous Electrical warmheartedness Stimulation), maintaining or increasing range of movement, muscle strengthening, facilitation of voluntary motor function, and orthotic training or substitution.Functional Electrical Stimulation (FES) is a branch off of electrical stimulation. The term FES is applied to systems, which attempt to restore, lost or impaired neuromuscular function. This would include such things as standing and walking in cases of paraplegia, by the application of electrical pulses to neural pathways or, but less of ten, directly to muscles. FES is also sometimes known as Functional Neuromuscular Stimulation or FNS. (http//medicaledu.com80/estim.htm, 1999)At the electrode-tissue interface, where the electrode and actual body come into contact, a conversion occurs between the current of electrons passing through the wires and the current of ions movedwithin the tissue. and then through this externally applied current, the depolarisation of nerve and muscle to threshold is produced by the transport of ions across the tissue membrane. There are several factors that read whether sufficient current flows is taking place impedance of body tissues, electrode size and position, and stimulation parameters.

Electronic Stimulation :: essays research papers

Medicine and electronics are rapidly becoming a common partnership. Electronics and medicine has been around for over a nose candy years. This application can be seen in early X-ray machines, as well as early doctors and healers who felt that electric carity possessed something special that help the healing process of many illnesses and injuries. But it has not been the last forty to fifty years that the teaching and refinement of electricity as medical agentive role has occurred. Today the medical field can not imagine itself without the assistance of electricity and electronic components. In recent years some of the major development has occurred in one particular field ofMedicine, electric stimulation. Electric stimulation is the application of electric ongoing in treatment without the generation of intense heat. This includes electric stimulation of nerves or muscles, passage of current into the body, or use of interrupted current of low intensity to raise the threshold of the skin to pain. Studies suggested this therapy is utilise to conditions such as ulcers, traumatic or burn wounds, osteoarthritis, and cancer. Electrical stimulation is simply the application of electrical pulses to the body, whether it is for function or therapy. The classical and common face is that of the cardiac pacemaker. The range of clinical uses of electrical stimulation has and is growing wider and includes pain relief (often known as TENS - Transcutaneous Electrical Nerve Stimulation), maintaining or change magnitude range of movement, muscle strengthening, facilitation of voluntary motor function, and orthotic training or substitution.Functional Electrical Stimulation (tarboosh) is a branch off of electrical stimulation. The term FES is applied to systems, which attempt to restore, lost or impaired neuromuscular function. This would include such things as standing and walking in cases of paraplegia, by the application of electrical pulses to neural pathways or, but l ess often, directly to muscles. FES is also sometimes known as Functional Neuromuscular Stimulation or FNS. (http//medicaledu.com80/estim.htm, 1999)At the electrode-tissue interface, where the electrode and actual body come into contact, a conversion occurs between the current of electrons passing through the wires and the current of ions movedwithin the tissue. Then through this outwardly applied current, the depolarisation of nerve and muscle to threshold is produced by the transport of ions across the tissue membrane. There are several factors that determine whether sufficient current flows is taking place impedance of body tissues, electrode size and position, and stimulation parameters.

Monday, May 27, 2019

Crushing the Native Americans

After the Civil War, Indians inhabited almost half of the United States. White Americans were urged to move west and settle, non taking regard that Native Americans already lived there. By the late 1800s most Indians had lost their land and had been driven onto reservations. Eastern Indians had already been pressure to the west. A tot up of tribes werent cooperative with moving onto reservations and changing their customs. This caused many battles between whites and Native Americans.During the Gold Rush of 1849, a lot of Native Americans were killed by white disease and minor league burning their villages. These events were significant because they contributed to an up rise between white Americans and Indians. On November 29, 1864, Colonel John M. Chivington led an attack on the Cheyeane and Arapaho. They killed and scalped men, women, and children. I believe this was important because it showed the make out for the tribes and how ruthless the whites were against them, but also w arranted a treaty. The Fetterman massacre that took place in December 1866 was a big part of theSioux War of 1865-1867. Red Cloud, the Sioux Chief, lured Fettermans army into an lollygag and wiped out all of them. This took place again because of gold rush invasion and only shows the results of someone trying to take anothers homeland. http//www. indians. org/articles/native-american-indians. html The Native American Indians were forced out of their homeland, resulting in many issues and events including the Trail of Tears. Most of them eventually converted to the European way of life by dressing the same and changing their religious belief to Christianity.

Sunday, May 26, 2019

Lie

Ruby Villainies Moline Miss Kim 10 Semester September/2014 Lying for what? Secrets be everywhere, all around the world expiry back and forth, you see or heard them everywhere you go. Everyone has secrets, kindred the government, fri shutdowns, teachers, including your family but direct you ever considered why do people lie? Why do we keep information? Why do we not speak or say all what we think? And what argon the consequences if I lie?People lie because of the fear of the consequence of justness, to appear to be important and to protect others. The reasons why people lie are so varied now at days the two principal reasons are to avoid hurting the feelings of others or to solve or avoid uncomfortable situations like when you tell the people you are fine when you are sad or depressed or when you say that you already have a plan when very you don t want to go out with someone, the common known as white lies.Another reason is to have a good self-esteem or being accepted by others exaggerating a situation (inventing stories) creating a fake impression to the there pretending being some else because she or he does not feel good about his or herself, in fact all of this is caused by the reason that she or he has a low self-esteem and they regard to feel that someone worry about them a good example of this is when you meet someone that doses t want you to know who is he or who she unfeignedly is, so they lie to you about their-selves.And the last reason is to avoid others of feeling fear or be concerned like the ones the government says because they need to powdered ginger some information in secret, but all of this is bad, at the end it becomes a bad and destructive habit or you get into a blockage where you can t stop lying, because you need to protect one lie you have said and even if you want to say the true, you can t (it becomes a vicious circle) like Steve H. Said lies grow, they never stand alone, they need more lies to support the first lie.So, if you dont fess up immediately It grows like a cancer. It cannot be stopped however all of this happens because we are not blew to say or hear the truth, we prefer to live on a fake reality that on the real world When we lie, we are trying to deceive others, when in reality the only person you are fooling is yourself by trying to create a fake reality to Justify your mistakes and our lack of responsibility and actually at the end we end up believing them, a reality that we create.Like I have said, lying can become a destructive habit, it can hurt everyone around, destroy the credibility of the people and create distance between the liar ND the lied, when really think about it, there is not a reason to say a lie because at the end the truth is always spy and the main reason why you start lying you hurt it and you will end losing. Or example a friend asked you how does she/he looks on a cloth and he/she looks horrible and you lie to him/her because you don t want to hurt him/her feelin gs and at the end he/she discovered the truth, she/he is not going to believe on you again and you also hurt her/his feelings so what is the point of lying? At the end the principal person that gets hurt is you but in the other way you told her/him that she/he looks horrible, the only think that could happen is that he/she gets changed and that is all.Concluding all have said lying is bad decision that at the end the only person you are fooling more is you. So there is no reason to lie in any case, it is easy to say the truth first than then retract whatever you have said and try to regain the confidence of others after losing it, and that we have the ability to solve our problems and / or to adequately handle unexpected events. What happens is that we are such cowards that we decide to go for the easy and secure side and at the end we end hurting ourselves.

Saturday, May 25, 2019

Patient Safety

There is a huge missed opportunity for health conduct sea captains to contribute to deliberate hygienics as they miss 1 in 2 of alone make pass cleaning opportunities. WHO, 2006 What kills women with childbed fever is you doctors who carry deadly microbes from sick women to healthy ones Louis Pasteur, 1870 1 . 1. Background of the Study 1. 1. 1. Nosocomial transmission system burden Nosocomial infections or healthc be acquired infections can truly be a grave toll for infirmary worry as much as it is for end-beneficiaries, customers, and stakeh antiquateders.Mortality reaches 80,000 annually 3 affected roles die per minute 10-20% % incidence globally, and figures ar expectedly advanceder in Third demesne settings. This is non to mention the corollary problem of emerging microorganisms resistant to overuse of prophylactic and anticipatory shotgun antibiotic therapy as empirical solution. The damage wrought is paramount, reaching a cost of one billion pounds per year in Europe alone, resulting from these. 1 excluding priceless, take aimless mortalities and morbidities 1 1. 1. 2.Role of mountain Hygiene Institute of Medicine has identified nosocomial transmission system to be the about common complication for infirmary affected roles and leads are the most common mode of transmission. In 1991, Harvard Practice Study on adverse casings in health care indicated that surgical site infections were the second most frequent type of adverse issue for in perseverings, constituting 13%. One demand established an excess death rate caused by NI to as high as 44% in ICU unhurrieds. 2 In a local anaesthetic weigh at Makati Medical Center by Tupasi & Littaua, mortality rate was reported to be all NI cases documented 4. 6 % of n the intensifier care unit , and authors conclude that risk featureors holdd invasive and manipulative procedures. Majority of deaths from NI were associated with the use of respiratory equipment and Foley catheters which w ere potentially preventable by rigorous adherence to aseptic techniques. 3 1. 1. 3 Reality of Poor Compliance Despite it being a seemingly simple practice, and scorn the acknowledged fact that proper hand hygiene is considered the most critical, the most cost- efficacious measure of adequate infection course, compliance bearing management has been a elongated managerial headache globally.Indeed in our age of ever increasing sophistication, those seemingly simple practices but with grave implications ironically are difficult to address. While the techniques confused in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene look makes the study and management of hand hygiene complex. 2 1. 1. 4. Hand Hygiene Compliance A Managerial Challenge It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behavior and managing the environment.Input from behavioral and companionable sciences is essen tial when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social need4 Speaking for all levels of health care workers , probably the major reason this seemingly simple problem is always taken for granted is the reality that the clash of something not so visible daily to the naked eye will always be swept low the rug amidst more outright demands concerns in patient care.The rest of the justifications the likes of forgetfulness, lack of time, inconvenience, complications, etc. are simply alibis. Given this, the greater burden falls on health care managers to do something so that compliance can be improved, and for health sector in general to come up with more evidence-based materials to convince HCW as closely as policy-makers and managers about its importance. 1. 1. 5 Nosocomial Infection & patient Safety Nosocomial infection subdue is a large array of patient precautio n, whose importance is soon being highlighted in the light of increasing adverse events which are at most preventable.Prior to this study, the researcher delved into assessing the patient recourse culture visibility of QMMC, as a general backgro at a lower place, and as part of re-packaging a new approach to an old problem. 3 1. 2. Statement of the Problem Understanding the patient safety culture profile of Quirino Memorial Medical Center gives us the over-all conceptual perspective to the problem at hand. The researcher finds it convenient to discuss it in terms of the Donabedian theme. 1. 2. 1. The Macroenvironments Patient Safety visibleness 1. 2. 1. 1.The QMMC Patient Safety Structure In alignment with the recent health care thrust, QMMC has revised in 2008 its mission to being a tertiary hospital providing a safe, accessible, affordable quality specialized healthcare that is dynamically responsive to the needs of its patients. Its unwavering commitment is towards deliverin g health care to all its clients regardless of socio-economic status and to continuously upgrade the services offered in terms of technical expertise, support service, equipment and infrastructure. Patient safety is first and foremost in its goals.Its amount values include cleanliness in all aspects including the physical environ, and Its fourth priority is to develop and sustain a hospital environment that embraces and practices a culture of safety. The 7 core values it internalizes include the 7Cs clean physically, mentally, spiritually, Christ-centered, compassionate, competent, culture-friendly, community-oriented, communicative. At this time, the plus factor is having a aesculapian director who is passionate about the cause, much involved in regular meetings with Department of Health advocates on the matter. In QMMC, Dr.Rosalinda Arandia is seen as a charismatic figure in the improvement of health and medical 4 services offered by the hospital and in making recommendations o n and implementing the hospitals quality improvement program. 5 QMMC is a 350-bed national presidency hospital that stands in a 42,000-sqm lot between Katipunan Alocus and JP Rizal St, Project 4 Quezon City, Metro Manila. It has in recent years undergone a major upgrading and expansion of its buildings and facilities. Compared to the old infrastructure, the new building and facilities, provide a more sophisticated ambience.Better equipment and architectural upgrading seem to inspire and motivate employees, and the architectural design seems to promote greater ply interaction and communication. Its occupancy rate is 120%. . QMMC is a corporatized governing hospital, still waiting for complete privatization. When faced with budgetary constraints and too bureaucratic subprogrames they generate their induce resources through private solicitations, the biggest of which are donations and affiliation fees from training institutions.As to equipment & supplies due to its being a govern ment hospital, only about 60% of its equipment and supplies are provided for and is functioning at any given time. Maintenance and regular checks are being done and complied with as required. It has a total of 564 employees, 35% of whom are contractual. Among the permanent about half have worked for more than 10 years. Among the 549 employees, 159 are doctors (consultants, residents, interns) , 180 are nurses and 225 are administrative personnel. This number does not include those who are fielded from affiliate institutions for training, such(prenominal) as clinical clerks and allied 5 rofessions (nursing, pulmonary therapy, radiologic therapy, medical technology, dental, dietary, midwifery and caregiving). For the consultants and doctors, ratio to patient load is quite acceptable.There are 69 resident physicians and 55 interns. In the wards, roughly the ratio is 15 per day however in the out-patient department, the staff ratio is much higher 125 . In the intensifier care unit, ra tio can be improved to as good as 12 depending on the number of rotators from affiliate hospitals , for all professional groups. Attitudes of staff are an important aspects of culture. In QMMC, initial preliminary interviews ith staff revealed that there is some awareness of the concept of patient safety, in all levels of care and even administrative strata. Incident reporting is very minimal such as it is generally perceived that underreporting is rampant. 1. 2. 1. 2 The QMMC Patient Safety Process Profile Teamwork in respective clinical areas is perceived to be good by key administrators, although with the high rate of staff turnover due to training hospital affiliations, this is affected more often than not in a negative fashion. In terms of feedback and communication, there is no systematic evaluation of staff mathematical operation .QMMC has been active in the Patient Safety Task Force of the Department of Health. Underway are devising standardized hospital forms, such as int erdepartmental referral forms to enhance communication and lower risks of errors being committed in patient care. 6 In lieu of risk reduction, hand hygiene educational program has been recently revived by the Infectious Disease Team headed by Dr. James Tiu. Educational trainings as well as policy reinforcement are being conducted as the need arises among nursing staff. 1. 2. 1. 3. The QMMC Patient Safety Outcome ProfileAt the time of study, there were no baseline data available as indicators such as compliance rates, nosocomial infection rates, or patient satisfaction surveys. There are no performance indicators that can be used as feedbacks to improve standards of care. This is a work in progress and hopefull this study becomes a tiny contribution. 1. 2. 2. QMMCs UncontrolledNosocomial Infection Problem Analyzing the to a higher place profile of QMMC, and amidst the track set down of physical and service upgrading efforts, the main problem of the hospital regarding patient safety is still nosocomial infection control.Evidences of uncontrolled nosocomial infection are genuine occurrences pointing to infection control problems in QMMC in the past 12 months have caused alarm, as follows (a) Post-surgical wound dehiscence Anecdotal incidents of nosocomial infection getting out of control have been almost part of everyday work in a public hospital like QMMC. However, a situation that occurred last AugustOctober 2008 was particularly notable, wherein dehiscence occurred in a succession of ten postsurgical patients in two wards including the surgical ICU, during Day 5 to Day 11 of their hospital occlusion.Culture studies revealed the usual notorious nosocomial genus Proteus microorganisms, E. coli, and 7 Staphylococcus areus , responsive to very expensive intravenous third generation cephalosporins and aminoglycosides, with or without re-suturing of the wounds (Appendix 1) . 6 Aside from the cost of these medications, the prolonged hospital stay with all its acc ompanying indirect costs to both(prenominal) patient and hospital were staggering. (b) Perennially high incidence of ICU pneumonias and urinary tract infectionsBased on the a la mode(p) QMMC Morbidity and Mortality Audit 2008, 7 among ICU patients hooked to ventilators for protracted duration, nosocomial pneumonias are still the leading cause of death. 1. 2. 3. Need for upgrading quality of hand hygiene practice During one root cause analysis done by the management, the Infectious Disease Committee, and the department concerned with the last years outbreak of dehiscence, the senior management surmised that the root problem or one of the root problems could be failure for proper andwashing among health staff. The intervention consisted of culture and aesthesia tests followed by proper antibiotic coverage. Policy on handwashing was overly tightened up in terms of posting reminders on doors and walls and subsequent refresher educational modules by the Infectious Disease Head were co nducted among nursing staff. However, no actual monitoring or evaluation of hand hygiene practices were done .Despite educational training interventions, and despite the presence institutional policies posted on walls and doors, compliance to the practice among QMMC hospital staff has persisted to be unsatisfactory. 8 1. 3. Objectives of the Study GENERAL OBJECTIVE This study aimed to butt the affect of a hand hygiene intervention package to QMMC MICU and SICU, using comparison of intervention.SPECIFIC OBJECTIVES In more detail, this study aimed to (a) Characterize the current hand hygiene practices in QMMC ICU according to its using structure- affect-outcome dimensions (b) Craft and implement an intervention package addressing manipulable areas of the structure issues identified in the structure-process-outcome dimensions of hand hygiene practices (c) pass judgment hand hygiene structure-process-outcome variables as a function of healthcare worker factors and work area factors , pre- and post-intervention, as a way to evaluate impact of above intervention. d) Formulate recommendations to the QMMC management and its stakeholders based on the findings and lessons learned. structure-process-outcome variables pre- and post- 9 1. 4. Significance of the Study The study is valuable in the following general areas of health concern (a) Infection Control. The studys advocacy counts very significantly in terms of contributing towards decreasing the grave toll on preventable morbidity and mortality burden on patients and their families.As we see more systematically the outcome of our efforts towards hand hygiene as it impacts infection control, we learn to rely less on antibiotic use which also lead to emergence of resistant microorganisms that are and will be potentially harder to control eventually. This study will then be part of fulfilling what WHO advocates to be done , i. e. for better monitoring of outcomes for hand hygiene studies, reduction of infection rate s must be demonstrated, high complexity to evaluate, but high priority requirement. 8 (b) Preventive thrust. hospitals mission is supposedly preventive as much as curative. However, review of literature shows that hospitals, even in the First World settings, tend to so conveniently rely on antibiotic use both prophylactically and empirically in managing and controlling nosocomial infections. Hospital care need not be a double-edged sword nor do we need to stop mitigating phenomena which are in our hands to control, if only we heed the evidence-based principles put forth.Prevention the Great Compromiser to be the better direction that health care must devote its resources on. (c) Cost savings. According to WHO, direct costs of intervention and indirect costs associated with hand hygiene time & its promotion corresponds to less than 1% of costs of managing nosocomial infection. Studies on the costs of nosocomial infection caused its toll in terms of protracted hospital stay, expensi ve drug and antibiotic acquisition in addition to intensive care 10 nit stay, hematological, biochemical, microbiological and radiological tests, extra surgical procedures and working hours. (d) healthcare management learning. WHO asserts that measurement of the compliance of health care workers to hand hygiene measures is a recommended performance indicator of the quality of care. (e) Compliance behavior management has been a protracted universal problem, as lack of interventional studies to convince policy makers, esp. local, both government and private, predispose health care systems prevalent to sustain awareness and implementation.With the lack of attention given to the problems facets and determinants, this study can be a humble contribution. Relevance of this study to the institution and its several(a) stakeholders include the following (a) Study institution. Often, organizations take action based on some comparison of their measures to a set of benchmark measures. Armed wi th unique(predicate) incidents about the organizations culture, effective action plans flow logically and integrate into existing change processes.QMMC can better select programs and tailor-fit strategies that will be most beneficial to upgrade the attitudes and expectation of the employees, to design the working environment, and to align with its vision-mission pursuit of quality and safety , and better service to patients. It will be helped to see patient and hospital outcomes in a better light. It will eventually have a baseline which will be useful for tracking impact of certain interventions for a sense of comparison. As it uses internationally known research methods, it will provide 1 internal as well as external benchmarking, especially with national government hospitals, both international and local. (b) Leadership. Since QMMC under the present leadership is into the process of advocating patient safety as a goal, this study will help them examine alignments of their polic ies and systems with their vision-mission statements , goals and core values. later on when like in international settings and patient safety will be a government regulatory requirement, this hospital can provide benchmarking. (c) Hospital staff.This study provides the staff the much-needed feedback about themselves, the colleagues they work with, and the patients they serve. Feedback is the first step to change. Studies such as this are advantageous in themselves in that it just the simple process of assessment baseline will in itself raise awareness of not only patient safety, specifically, infection control, but of the need for structure (staff attitudes) as well as process variables (teamwork, communication) relevant to safety and other hospital performance.Moreover, they themselves can be target victims of nosocomial infection, so that studies like this could help boost their safety as well. (d) Affiliate training healthcare institutions. The importance of good hand hygiene pr actice and its observance will be highlighted among the trainees from more than 20 various health care schools, a value that they will most likely carry back to their respected institutions .This is rather crucial and innovative as patient safety, specifically preventive practices to 12 nosocomial control such as hand hygiene are not yet that well-emphasized in the traditional medical and para-medical curricula. (e) Hospital management trainees. The results of this study can be a benchmarking study to compare, study and upgrade other hospitals, both local and international. The study becomes a venue to validate some of the tools that will be used for the first time locally.Results of the study can be utilized by trainees for future research on patient safety and infection control and behavior modification techniques. (f) healthcare community. This study will help control NI, emergence of resistant organisms for similar government hospitals. It provides significant research for Depa rtment of Health which is specific on approaching infection control through Total Quality Management assessment and strategies under their recent thrust on patient safety and quality assurance.Since QMMC could very well be a good prototype of the other government hospitals , the results of this study can largely be of help in implementing the various enabling mechanisms stated in the Philhealth Benchbook. 9 (g) Patients. Above all, since awareness, education , and practice towards patient safety, specifically infection control will be highlighted in this study, the end beneficiary would ultimately be the patients and their families and guests whom this institution is servicing, no matter how indirect and long-term this impact would be. 3 1. 5 . Scope and Limitations of the Study Being a primarily TQM research project, this study does not attempt to establish cause-and-effect relationship between hand hygiene and nosocomial infection . This study does not include cost estimates and budgetary implications of intervention if eventually adopted by study institution. Relative merits of the specific parts of the intervention is beyond the scope of the design. Time and budget constraints were real such that research design were limited in various ways and means. . 6. rendering of Terms and Acronyms TERMS For purposes of clarity and reference in the discussions all throughout this study, the following definitions and acronyms would be used and referred to Hand hygiene (HH)- refers to one of the areas in infection control that deals with systems of diminishing pathogenic microbe transmission through evidence-based philosophy and set of practices regarding the hands in relation to direct patient handling during the process of care. 0 14 Hand hygiene practice/practices (HHP) refer/s to any form of action referable to disinfecting the hands prior to and after patient handling, in the most basic terms defined as washing hands with soap/water or (rubbing with) antimicr obial, for at least 15 seconds in front and after patient contact, after any contact with a source of microorganism, and after removing gloves. ( Healthcare Infection Control Practice Advisory ).Hand hygiene event (HHE) defined as the event involving any of the HH practices (washing, rubbing with disinfectant, donning with gloves) done before or after patient contact (if both done before and after, they are considered independent events if both washing and donning with /removing gloves are done during one instance, it was counted as one event this regardless of the correctness or adherence to other inside information as presently prescribed by currently available universal guidelines. 1 Hand hygiene opportunity (HH0) defined as any event with a high-risk of microbial transmission, executed before and/or immediately after patient contact, regardless of whether gloves. They included all contact with body fluids, or involving manipulative contact with anything in the patients body or immediate environment .Over-all hand hygiene compliance includes all hand hygiene-related behavior in accordance with current institutional , (in this study, QMMCs ) policy to wash hands before and after patient contact regardless of its alignment with the most currently recommended international standards based on indication, technique, cleansing agent and duration this by strict classification based in literature definition, falls under incomplete compliance. 12 15Complete compliance- refers to all hand hygiene-related practices aligned with the most-updated, most current evidence-based globally recommended guidelines, as required by WHO guidelines 2006 (with QMMC, being a government hospital). Hand hygiene structure-refers to staff factors and work area factors. Staff factors include inherent demographic characteristics, such as professional group, age, sex and duration of service. It also refers to more malleable factors such as staff attitude and training.Work area factor s refer to existing policies or specific protocol, logistic infrastructure and supplies, staff volume, patient volume, hospital type, work settings, organizational structure, etc. Hand hygiene process- refers to practice as to how it is done in terms of indication for method, duration, temporal relation to patient contact, cleansing and technique, and how it abides to the currently recommended evidence-based a guideline or protocol .Hand hygiene outcome- refers to measurable events or indicators, for both patients, employees as well as organization like overall healthcare worker compliance rates, as well as indirect outcomes of good hand hygiene proven in literature, such as nosocomial infection rates, transmission rates, colonization rates. ACRONYMS For purposes of brevity of certain words and identities mentioned quite repeatedly all throughout the study, the following apply 6 HCW- Healthcare worker refers to any staff involved with direct handling of patients in a health facility NI- nosocomial infection also HAI (healthcare acquired infection) refers to infection development after 48 hours after admission or confinement in a health care facility. ABHR- alcohol-based hand rub-refers to a hand rub disinfectant with any alcohol of any concentration as the basic ingredient.

Friday, May 24, 2019

Global Burden Of The Disease Health And Social Care Essay

Cervical cancerous neoplastic indisposition is a major(ip) universal health issue it is the 2nd just about unwashed cancerous neoplastic illness among boastful womanlys in the universe, and peerless of taking f ar of blend by gynaecologic cancerous tumor in growing states. ( I. Shahramian and co-workers 2011 )Besides, cervical cancerous neoplastic sickness is one of the to the highest degree preventable and curable cancerous neoplastic indisposition when it is detected early, and this is due to its s downcast prescripted advance, since it carry off several old shape ups to turn from a noticeable precursor lesion.This cardinal characteristic provides a astronomic window of about 10 old ages or more for potent early sensing of the precancerous lesion, and forest in alling its patterned advance to invasive cancerous neoplastic disease.From this position, good organized bar attacks have been applied by high income states oer the past 50 old ages, and have res ulted in a singular diminution in morbidity and mortality from this invasive disease.The showing plan is a successful illustration for effectual bar from cervical cancerous neoplastic disease, it has been used in the Nordic states ( Den gull, Finland, Iceland and Sweden ) this plan was examined by the International Agency for Research on Cancer ( IARC ) in 1960s and it was shew that the mortality rate in these states fell by about three- 4th, The most drastic lessening was marked in Iceland by 84 % and this was due to the broad mark age scope for exam in this state. ( whomb tribe )However, over the resembling period, developing states have failed through utilizing the same plan to cut down the load of the disease, and cervical malignant neoplastic disease continues to endanger the lives of 1000s of fully grown females, this may be due to the want of an effectual bar scheme.We will seek in this paper to review the determiners of cervical malignant neoplastic disease exa m among Algerian self-aggrandising females, to clarify the outstanding barriers sing showing and to foreground the headland factors act uponing the single health conduct, for this pile, we will utilize the wellness picture Model as a notionual model, we will explicate the construction of the Health Belief Model ( Becker ) and how the unalike concepts of the suppositious forecast could foretell the enceinte females s wellness doings sing cervical tumor showing, eventually the practical application of this hypothetic account as a guiding model to anchor behavioral intercessions and to better attitude of big(a) females sing malignant neoplastic disease showing will be discussed.Epidemiology of cervical cancer/ planetary load of the diseaseGlobal overviewWorldwide, cervical malignant neoplastic disease is the 2nd most common cause of decease among bounteous females ( ACCP2004 ) with an estimation of 493,000 new instances, and 274,000 deceases happening every twelvemonth harmonizing to the statistics of the International Agency for Research on Cancer ( GLOBOCAN, 2002 )In 2008, 530000 new instances were diagnosed, more than 85 % of the planetary load were registered in developing states ( where it remains the most common malignant neoplastic disease seen in openhanded females and it accounts for 13 % of all female malignant neoplastic diseases ) ,In the same twelvemonth, the cervical malignant neoplastic disease was responsible for 275000 deceases, approximately 88 % of which occurred in developing states53000 instances in Africa, 31700 in Latin America and the Caribbean, and 159000 instances in Asia. ( GLOBOCAN 2008 )The figure below shows incidence of cervical malignant neoplastic disease by state, it should be noted that informations from developing states might be underestimated as the official statistics in these states ar non dependable.hypertext transfer protocol //globocan.iarc.fr/factsheets/cancers/cervix-bar.pngRegional overviewAlgeria is a big North African state, extended from the Mediterranean ocean down to the Sahara, with about 37 million dwellers.Algeria has a race of 11,51millions of adult females whose ages atomic number 18 15 old ages and older, ( WHO/ICO2010 ) which means that about the tierce of the Algerian community is at judge of developing cervical malignant neoplastic disease.Cervical malignant neoplastic disease is the 2nd most common malignant neoplastic disease among Algerian adult females after the chest malignant neoplastic disease, Current estimations indicate that every twelvemonth 1398 adult females are diagnosed with cervical malignant neoplastic disease and 797 dice from the disease ( WHO/ICO2010 )About 10, 5 % of Algerian adult females are estimated harbour cervical HPV, and about 77, 1 % of cervical malignant neoplastic diseases in Algeria are related to HPV 16 or 18. ( WHO/ICO 2010 )But we should prize that even these statistics might be underestimated,The economic impact of cervi cal malignant neoplastic disease is importantly heavy for the province. The intervention of a one-on-one patient returns to about 2.5 million dinars ( a 20,000 ) , with this cost wewe can accomplish 2000 vilifications ( berth tribulation cost 20 a ) and vaccinate 30 adult females.Natural history of cervical malignant neoplastic diseaseUnderstanding the procedure of developing cervical malignant neoplastic disease is a important measure to plan an effectual plan of bar.More than 99 % instances of cervical malignant neoplastic disease are attributed to cervical HPV infection, which is a internally transmitted disease ( STD ) , the virus is acquired by both work forces and adult females through sexual occupation, the infection is normally asymptomatic and transient.HPV is the most common STD in the universe it affects about 50 % to 80 % of sexually active adult females at least one time in their manners-time ( ACCP 2004 ) , they contract it in their adolescent, 20 or early 30 s.There are more than 100 genotypes of HPV that have been identified, and which are numbered by order of their find, approximately 13 types can affiance to invasive cervical malignant neoplastic disease and they are known as high oncogenic disaster ( 16,18,31,33,35,39,45,51,52,56,58,59,66 ) ( WHO 2007 )The two most common are 16 and 18 doing about 70 % of all invasive cervical carcinoma ( 60 % related to HPV 16 and 10 % to HPV 18 ) the whom peopleThe others types of HPV are known as low hazard and they normally associated with venereal warts ( vocalizationicularly 6 and 11 ) which can turn in the venereal portion in both work forces and adult females ( neck, anus, vulva, vagina, phallus, and scrotum ) and they cause a important morbidity. ( WHO2007 ) , They are actually seldom associated with cervical malignant neoplastic disease, but can take to low class switchations in cervical cells which are really similar to those caused by high hazard types. These low lesions are symptom less and impermanent, nevertheless, in close to fortunes can germinate and take to high lesion or invasive malignant neoplastic disease.Table summarizes the different levels taking to cervical malignant neoplastic disease ( ACCP2004 )HPV infectionlow-grade lesionsHigh-grade lesionsInvasive malignant neoplastic diseaseHPV infection is highly common among adult females of generative age. The infection can prevail, take to cervical abnormalcies, or decide on its ain.Low-grade lesions are normally impermanent and vanish over clip. Some instances, nevertheless, advancement to top-quality lesions.High-grade lesions, the precursor to cervical malignant neoplastic disease, are significantly less common than low-grade lesions. High- grade lesions can develop from low-grade 1s or straight from relentless HPV infection.Invasive malignant neoplastic disease develops over the class of several old ages and is most common among adult females in their 50s and 60s.Beginning Adapted from PATH 2000. HPV is a necessary cause but non fit to come on from HPV infection to invasive cervical malignant neoplastic disease, there are other lifestyle factors that increase the chance to develop the malignant neoplastic disease including high para, immature age at first bringing, being in polygamous matrimony, adult females with hubby s adulterous sexual relationship ( D. Hammouda and co-workers 2004, 2011 ) , long term usage of unwritten contraceptive method, baccy smoke, certain dietetic lacks, hapless sanitation, multiple sex spouse, low socio economic position, and life in a rural environment. In add-on, co-infection with HIV, Chlamydia Trachomatis, and Herpes Simplex Virus type 2 ( HSV 2 ) . , ( whomb people )HPV was incriminated in m either other anogenital malignant neoplastic disease ( anus, vulva, vagina, and phallus ) and malignant neoplastic diseases of the caput and cervix.Understanding that HPV is the primary implicit in cause of cervical malignant neoplastic disease has focu sed attending on the potency of early sensing of the infection through the cervical showing.Screening for cervical malignant neoplastic disease is ground on the usage of the mammillaanicolaou cytology technic ( Pap smear trial ) in which doctors or nurses expose the neck by speculum and take cells from the squamous epithelial tissue and transmutation order to observe unnatural precancerous cells.The American College of Obstetrics and Gynaecology suggest that adult females should have the first interrogation trial 3 old ages after the first sexual intercourseThey besides recommend that adult females should go on having cytology examination annually until the age of 30, from than they can have it every 3 old ages.Harmonizing to the same college, menopausal adult females have a lower opportunity to develop unnatural cervical cells nevertheless, there is no upper age bound to halt the showing. ( Whom people )Primary bar have focused on hygiene and cut imbibe hazards factor by cut downing the figure of sexual spouses and promoting the usage of barrier preventive peculiarly rubbers, ( ACCP2004 )Recently a new vaccinum which has the potency to protect against certain type of HPV infection ( 16 and 18 ) has been licensed to underpin the preventative plan against cervical malignant neoplastic disease. The vaccinum has been used in many developed states and shown great(p) consequences in cut downing the load of the disease, but it has non been introduced in Algeria yetPap smear as a cervical malignant neoplastic disease testing trialAlgeria is one of the development states where cervical malignant neoplastic disease remains a major wellness public issue. although the application of testing plan, a big population remain under screened, the result are really modest and the incidence of cervical malignant neoplastic disease is ever high and this could be contributed to the deficiency of consciousness about testing trial among adult females and almost specific cu ltural wellness printings barriers, non surprisingly that big proportion of the patients are diagnosed with advanced phase of the invasive cervical malignant neoplastic disease, interestingly, even most of the wellness attention suppliers have never had a pap vilification. ( ref hazard factor ) .Surveies show that comprehensive cervical malignant neoplastic disease showing is modest in low resources states and so a low engagement in Pap vilification and a low come with up when it is done the first clip. It has been stated that testing plan in these states and even among minorities and Aboriginal adult females faced many obstructions deficiency of sufficient research lab substructure, high cost of wellness attention, unequal trained wellness attention suppliers, absence of supplier s recommendation and a deficiency of appropriate educational plans in these states that indicate the hazard factors of this disease, the importance of testing at early phase, and the power of the Pap smear trial to observe the disease in its premalignant phase and so the possibility of full remedy and bar. ( S.T. Tavafian 2012 )In add-on to these financess and human resources lacks that can check-out procedure an effectual and organised testing intercession, there is besides the deficiency of cognition from the patients sing preventable cervical malignant neoplastic disease every situation good as the socio-cultural position barriers, such as embarrassment from pelvic scrutiny that have been argued as one of taking obstruction to non having testing trial, ( S.T. Tavafian 2012 ) other factor is the fright of topic and the entrenched belief that malignant neoplastic disease can non be cured, the deficiency of optimum cognition about testing patterns this utmost fatalistic attitude about malignant neoplastic disease among different states lead adult females to see diagnosing as a decease sentence and so the turning away of the trial, ( V.Thomas and co-workers 2005 ) there is besides childbeds identified spiritual beliefs, the limited linguistic communication ability as another major perceived barrier, the deficiency of societal support, the low socio economic position and the unequal functional wellness literacy.There is a survey that has been conducted in Spanish among low income Latinas, that found that adult females with unequal functional wellness literacy are 16 times less likely to have a Pap smear trial ( S.T. Tavafian 2012 )It has been illustrated that Individual s beliefs, cultural primer, cognition about a peculiar unwellness are significantly interconnected with the health care seeking and wellness promotional behavior, Al-Neggar and his co-workers concluded that some misconceptions and incorrect beliefs may carry on to the hapless pattern of cervical malignant neoplastic disease testing among adult females, despite the equal cognition sing the hazard factors ( Al-Neggar and co-worker ( 2010 ) .One of theoretical theoretical accounts that could be used to place the determiner of malignant neoplastic disease showing and measure the influence of people s beliefs on their determinations to take up malignant neoplastic disease showing is the wellness belief theoretical account.Harmonizing to the constructs of this theoretical account, persons are more likely to take up testing if they are motivated plenty about their wellness, and they regard themselves as supersensitive to develop malignant neoplastic disease, believe that effectual intercession would be good to cut down the susceptibleness and the badness of the status.Health belief theoretical account as a theoretical model for foretelling behaviorThe wellness belief theoretical account is one of the theory the most normally used in wellness publicity and wellness instruction, ( chapter 4 ) it was developed in the early 1950s by a group of societal psychologists to explicate the widespread ill luck of people to follow the disease preventative plans suggested and tes ting trial recommended to observe and forestall the disease at its symptomless phase,Subsequently it was applied to analyze the solution of patients to diagnosed disease and their conformity with prescribed medical regimens. ( Nancy and co-workers 1984 )This theoretical account aims to explicate the patient s ideas procedure behind his preventative attitude instead than his behavior after acquiring the unwellness.The underlying construct of the theoretical account is that wellness behavior and willingness of people to prosecute in a preventative plan or to take up a screening trial are determined by personal beliefs and perceptual experience of the disease in add-on to the different resources available to forestall its happening, ( chapter 4 )The theoretical account provides guidelines to develop schemes for effectual intercession and execution by leting contrivers to understand the drive for non conformity with the recommended suggested preventative systems.This theoretical acco unt assumes that person s wellness behavior is determined by five psychological factors perceived susceptibleness, perceived earnestness, ref perceived benefits and perceived barriers to effectual conformity cues to set into action, late, there are others concepts that have been added to the theoretical account called modifying or actuating factors such as mass media enterprises, run, personal stuffs, societal support, wellness professional and self-efficacy. ( V.Thomas and collegues 2005 )Copier le tableauArticulation of cervical malignant neoplastic disease testing behavior to the HBM modelIn this subdivision I will seek through the concepts of the Health Belief Model to explicate the relationship amidst adult females s belief and wellness behavior in Algeria sensed susceptibleness personal hazard or susceptibleness is referred to the personal belief about the likeliness of undertaking a disease ( S.T. Tavafian 2012 ) , it is one of the most powerful factor that influence peopl e to follow a healthy behavior, the greater the perceived hazard, the greater the likeliness of prosecuting in behaviors to diminish the hazard ( chapter4 ) .For testing plan, adult female will be interested to take up a smear trial if she is cognizant plenty of the possibility to acquire cervical malignant neoplastic disease by undertaking HPV infection, and that she is exposed to this hazard every bit long as she is sexually active.The HBM predicts that adult females are more likely to follow with cervical malignant neoplastic disease testing recommendation if they believe that they have risk factor of cervical malignant neoplastic disease ( Glanz et and co-workers 2008 ) , and frailty versa, the belief of non being at hazard for cervical malignant neoplastic disease or HPV infection preclude ( deter, empeche ) adult females to prosecute in such plan, And this is why most virginal adult females in Algeria underestimate the necessity ( believe the futility ) of smear trial as the y think they are protected from the hazard of HPV infection because they are non unify. Or in other words, because there is no sexual intercourse, virgin adult female does non comprehend her exposure to cervical malignant neoplastic disease, although surveies show that HPV has been found in some female virgins, which means that the virus does non ever necessitate perforating sex to be transmitted, And that it may be spread through non perforating sexual progress to and even within unite adult females, the construct that HPV infection is related to multiple sex spouse wanton them believe they are safe from the hazard since they have one spouse, disregarding the hubby sexual behavior, as many work forces in Algeria have adulterous sexual relationship underground that the married woman unawares, and so she does nt see herself as susceptible to the hazard.Another badgering factor is that youngest adult females consider malignant neoplastic disease to be an patriarchal disease, whi le older adult females harmonizing to cervical showing age bound might believe that they are no longer at hazard ref ( V.Thomas 2005 ) , and so there is a incorrect perceive of susceptibleness.Perceived badness refers to the earnestness of the disease as assessed by the patient, it is normally establish on medical information or personal cognition from telecasting, wireless or cusps, or it may come from the belief of a individual about the effects that would make a peculiar disease whatever clinical such as decease, disablement, or societal like household life and societal dealingss ( chapter4 ) , ( S.T. Tavafian 2012 ) ,For testing trial, if adult females believe that cervical tumor is a terrible disease that would take to serious troubles for her and her household, she will see bar as a precedence and so she is more likely to have a Pap smear trial. Besides holding knowledge about Pap smear trial and its importance to observe the invasive disease at early phase will actuate her to have one, because many adult females realise the badness of cervical malignant neoplastic disease but lack cognition of testing plan, and available service.Despite the acknowledgment that cervical malignant neoplastic disease is a serious issue, most of adult females in Algeria believe that there is no intervention, which make them see testing trial as futile and this possibly reflects the spiritual beliefs and the cultural background that may act upon their attitude,Algeria population as most of Muslims agree that unwellness, recuperation and decease are all determined from God, so The bulk believe that testing would non protract their lives and when the clip of decease comes no 1 can force it off ( K, Salman2011 )Another point is that the fright from possibility of designation unnatural cells would necessarily take to other probes frequently influence the willingness of the adult females to go to, particularly when there is no 1 to watch the kids during the showing and the de ficiency of important support. ( chapter4 )In Algeria, as in many other Arabic states, malignant neoplastic disease showing is normally recommended for diagnostic intents instead than being used as a tool for secondary bar ( K, Salman2011 ) most of adult females consider the absence of seeable symptoms as a mark of good wellness hence they do non seek wellness attention unless the disease manifests itself and starts to disenable her day-to-day activities, and so the malignant neoplastic disease is frequently diagnosed at its advanced phase.Perceived benefits is about the individual s sentiment on how much may new behaviour lessening the hazard of a peculiar disease, the HBM predicts that most people have tendency to follow new behavior which is seen as a healthy behavior when they believe the capableness of this new behavior to diminish their hazard of developing a disease ( Glanz and Colleagues 2008 )Perceived benefits play a major function in the acceptance of secondary preventa tive intercessions such as showing, for illustration, if adult females believe that Pap smear is of import for early sensing of the precancerous lesions and bar of malignant neoplastic disease that will actuate them to take part in secondary bar pattern by seeking cheques up and periodic showing.Therefore adult females are non expected to prosecute in any screening plan unless they perceive that this plan is potentially good to cut down the hazard, and so wellness attention suppliers should explicate to the patient the ability of testing trial to observe alterations in neck before they develop to malignant neoplastic disease, which make intervention easier and bar effectual.Sensed barriers relate to the person s vision of the obstructions he will confront if he decides to follow a new behavior.In order to set about a recommended behavior, a individual needs to believe that the benefits expected from it outweigh the results of his old behavior this enables him to soak up the better of the sensed barriers and to follow the new behavior ( chapter4 )For illustration, if adult female believes that benefits of undergoing a screening trial outweigh the obstructions that she may confront, she is more likely to obtain Pap trial.Previous surveies have showed that adult females who perceived the Pap smear testing as a painful and awkward procedure were less likely to obtain cervical malignant neoplastic disease showing, in the same surveies adult females reported many cause that deter them to take the action, such as a negative old experience, included hurting, hemorrhage, or being faced with inexperient practician who did nt explicate the process to them during taking the sample, linguistic communication troubles was another barrier due the perceive that she will be unable to pass on right with the wellness attention supplier, and to construct a trusting relationship.Even those who appreciated the necessity of the showing, the fright of the trial procedure was a grea t obstruction for them, as most of adult females find it uncomfortable, and perceive the metal speculum as a painful instrument. ( Abdullah 2009 )Shyness is another major hinderance that may discourage testing procedure, and It is really common for adult females to decline to uncover her organic structure parts to undergo a physical test or a medical processs particularly when the wellness supplier is a adult male, and even the treatment about a sensitive wellness issue like matrimonial relationship, sexual activity and reproductively is regarded as really private, and should nt be disclosed to other people, particularly work forces, and even hubby may sometimes non be involved in his married woman s wellness issue if it is related to her generative variety meats. ( K, Salman2011 )Cues to action are the ensemble of events, things, people that motivate a individual to alter his behavior, and this can be aggregate media such as telecasting, wireless, advice from a household or friends , cusps, information booklet, runs, recommendation from wellness supplier, ( chapter4 )Womans are more likely to take up a pap trial if she receives adequate information about the benefits of the trial from her GP or Gynaecologist, if she receives advice from another adult female who had the trial, if she is encouraged by a member of her household particularly the hubby or if she knows person in her cortege with a history of malignant neoplastic disease, all those factors are susceptible to cut down the sensed barriers to malignant neoplastic disease showing.Perceived self-efficacy it refers to the belief of the individual in his ain ability to follow the behavior required, because people by and large do nt prosecute in making something unless they believe they are able to accomplish it. ( Chapter 4 )Modifying factors in add-on to what it has been already said, There are other factors that seem to act upon the willingness of adult females to take up the trial such as unequal cogniti on about the showing, deficiency of swearing relationship with the wellness provide, deficiency of assurance in the importance of the trial, high cost of the trial, fright of the consequence of the trial and superstitious notion that address about malignant neoplastic disease would convey it, some stigmata imposed by the community and even sometimes the household that cervical malignant neoplastic disease is related to promiscuousness, Perception of the Pap vilification as a menace for the adult female s virginity, some fatalistic attitude that unwellness, recovery and decease are associating to god s will and that testing trial is futile, Low socioeconomic position, deficiency of societal support, poorness, deficiency of wellness insurance ( J.Hatcher and co-workers 2011 ) , childishness sexual maltreatment, fleshiness, low degrees of instruction, kid attention, deficiency of transit.Cervical malignant neoplastic disease screening- publicity intercessions based on HBMToday, the HBM is used by many research workers to guideline the development of schemes for effectual wellness intercession, In this subdivision, I will seek to summarize some determination from the different intercessions based HBM that push me to propose this theoretical account to better adult females s behavior in Algeria.The wellness belief theoretical account has been used by several survey, entirely or combined with other wellness publicity theoretical accounts to and to better belief and behavior among adult females sing the showing plan, an illustration of this survey, has been conducted in Iran, in 2010, this survey showed that the HBM has formed the footing for an interventional plan to better behavior among Persian adult females , ( S.Tavafian2012 ) , The survey was conducted with 70 volunteers- aged between 16 and 54 old ages, and they had neer received Pap trial, the participants were divided into many little groups, and each group underwent a session of 2 hr preparation. For the informations aggregation tool, a self-administered multi-choice questionnaire was developed based on the constructs of the HBM. The personal belief and wellness pattern of all the adult females were assessed pre intercession and four months subsequently, the findings reported that wellness instruction based on HBM concept was effectual, and could advance the participant s cognition and better the different constituents of the theoretical account ( sensed susceptibleness, badness, benefits, and barriers ) .The developing plan that has been used enhanced the willingness of adult females to pattern the testing trial significantly. The survey concluded to the fact that instruction plan based on HBM concepts can alter adult females s wellness beliefs, move up their cognition about the cervical malignant neoplastic disease and the screening trial, and actuate them to follow a new behavior. ( S.Tavafian2012 )Another survey in Somali was about an educational programme about the intent of the screening trial, to farm Somalis to set about the trial. The participants praised the enterprise and suggested that such information should be provided in a community scene, because it would assist adult females to comprehend the value of the trial, and to get the better of the different fatalistic barriers to testing. further, Participants suggested bettering the consciousness of testing among adult females via mass media Television, wireless, picture, DVDs, CDs and audiotapes ( Abdullahi, 2009 ) ,Health publicity ( ACCP 2004 ) ( reexamine the rubric )There is a deficiency of information sing wellness publicity theoretical accounts that have been used to act upon wellness behavior among adult females in Algeria, and even there is no description how the intercession methods were selected,Alliance for Cervical Cancer Prevention ( ACCP ) consists of five international wellness organisations who portion all the same end to forestall cervical malignant neoplastic disease in lim ited-resource countries.it aims through its undertakings to implement an effectual bar schemes to understate the load of the cervical malignant neoplastic disease.unfortunately, Algeria has non been included in this enterprise, through my reappraisal of this manual, I would propose it as an attack to better adult females s wellness is Algeria and to advance wellness service bringing.Many method of diagnostic, testing and intervention are presently used. And each of them has strengths and restrictions, this method should be reviewed to pick up the most appropriate for the patient,for the showing for illustration the Pap smear trial is the most normally used, this trial requires multiple and regular visit from the client, which can be a barrier for the adult female to go to it,The ACCP suggest some alternate attack with better sensitiveness and specificity such as Human papillomavirus ( HPV ) DNA proving, or ocular showing, a low cost method with an immediate consequence.As a wellness attention installation, they suggest to unite the intervention of precancerous lesions to the showing procedure, and suggest some effectual and safe methods that should be performed by doctor and non physician. These intervention methods allow remedy and histological confirmation at the same clip, it has been shown that this enterprise was praised by adult females and suppliers every bit good, and it has a great consequence to take down rate morbidity.The combination of both effectual showing attack and intervention would get the better of the restriction.Facility adult females s entree to precancer intervention services, through choosing a plan to associate testing services to precancer intervention services. This would increase the effectualness and promote adult female to follow up.Achieving widespread testing coverage of the mark population by choice of well-organised bar attack. And this may include the policymakers and governments who should promote the investing in cervical malignant neoplastic disease barPlaning an effectual bar intercession Planing a bar plan requires a coordination between a multidisciplinary direction squad, that include clinical, administrative, and preparation specializers.To accomplish the plan s aim, the squad members should follow a participatory procedure which includes besides the position of lay people who are concerned by the result of this plan, and this will let accomplishing a high showing coverage with satisfactory consequence.Bettering wellness services and research laboratory substructures bringing services should be accessible, acceptable, low-cost, and dependable to fulfill the client and guarantee a high coverage of the population markTraining Ensuring Performance to standardized Ensure to measure up a competent staff and wellness supplier, to pull client to utilize the installations available and this would go on by developing session that enable supplier to confidently offer dependable servicesSupplying Inform ation and Counselling to Address Community and Client NeedsWomen mark group should be apprised enough the benefits of showing and handiness of bar services to increase the effectivity of the plan, and this could go on by direct contact between adult female and wellness worker or through aggregate media and run, Social web intercessions, mailed invitation missive for showing and reminders, information booklet which are really everyday to distribute information about wellness subjects. It has been stated that direct supplier contact is more effectual to increase the usage of bar services as the single guidance will turn to concerns and emotional demand and should be more convincingOverview of showing, intervention and Palliative Care services of cervical malignant neoplastic disease Cervical malignant neoplastic disease showing services, cervical malignant neoplastic disease intervention, and alleviative attention services should be continuously linked to guarantee the effectivity o f the plan.DecisionPlans should be planned strategically, be based on realistic appraisal of demands and capacities, and use the most recent grounds on showing and intervention attacks. ie hapless public presentation of cervical malignant neoplastic disease bar plans in some limited-resource scenes has most oi?en been the consequence of hapless planning and execution and deficiency of systems for ongoing monitoring and rating, irrespective of the screening trial or intervention methods used. Establishing mechanisms and procedures to back up and prolong each constituent of a plan will travel far to guaranting that services are effectual, accessible, and acceptable to adult females who need them.

Thursday, May 23, 2019

A Synopsis of the Movie: The Social Network

The document is a word picture. It is a comedy drama produced by David Fincher. The title is The Social Network. This fill was produced on 2010 and last 2 hours. By the title, we may assume that this movie talks about Network in our generation. Indeed, this film relates about the creation of Facebook which is the more or less famous social network. Facebook allows all people to have their own account to publish their information. So this document shows the improvement of new technologies. The main character is lay out Zuckerberg. He is a student at the University of Havard and he is also the one who invent the system of Facebook.Im my opinion, I think the character of Mark Zuckerberg in the movie looks like him. By this film, we may assume that Mark is geek since he extends a lot of time with his computer. Nevertheless ,it is difficult to say that he is a geek, even though he is always with his computer during the film. Because he would like to be a brilliant computer scientist. During the film, the scene take place the around of the time at the University of Havard. Indeed, Havard is an occult American university situated at Cambridge in Massachusetts.Mark who is a student at this university, was accused to break with volunteers the security, the right of the nurture and the respect of the private life. In reality, after his breaking with his girlfriend, he decides to create a blog which allows the student in his university to vote the most beautiful girl. therefore this system has had a big success and becomes the most well-known social network from all around the world Facebook. Actually the director criticizes the geek who spend their time with the social network in order to learn about the private life of someone else.So, its an illegal act. Thus Facebook symbolizes the influence of the media in our society. It makes me inquire myself if I should or shouldnt involve in the social network. And I also wonder how strong the impact of new technologi es. Can new technologies break our private life. Im very sorry that I send you this email so late because I had some problem with Internet in country. Indeed, I can entrance money to the Inthernet only at night thats why I can send only now. I hope that you dont mind with this issu. Thank advance.

Wednesday, May 22, 2019

Prelude to Foundation Chapter 18 Overthrow

THALUS, EMMER- A sergeant in the armed security forces of the Wye Sector of ancient Trantor Aside from these tot wholey unremarkable vital statistics, zilch is kn own of the man except that on iodine occasion he held the fate of the Galaxy in his fist.Encyclopedia Galactica87.Breakfast the next sunrise was served in an alcove skilful the rooms of the captured three and it was luxurious indeed. There certainly was a considerable variety to the food and more than than enough of e trulything. Seldon sat at the breakfast table with a mound of spicy sausages in the first place him, totally ignoring Dors Venabilis gloomy predictions concerning stomachs and colic.Raych verbalize, The shuttlecock the Madam Mayor said when she came to notice me last dark-She came to follow through you? said Seldon.Yeah. She said she emergencyed to make undisputable I was comfortable. She said when she had a chance she would tear a leak me to a zoo.A zoo? Seldon supposeed at Dors. What amiab le of zoo brush off they scram on Trantor? Cats and dogs?There be some aboriginal animals, said Dors, and I imagine they import some aboriginals from other worlds and on that point are also the shared animals that all the worlds establish-other worlds having more than Trantor, of course. As a matter of fact, Wye has a famous zoo, probably the best on the planet by and by the royal Zoo itself.Raych said, Shes a nice old lady.Not that old, said Dors, simply shes certainly feeding us salutary.Theres that, admitted Seldon.When breakfast was over, Raych left to go exploring. one time they had retired to Dorss room, Seldon said with marked discontent, I dont know how long well be left to ourselves. Shes obviously plotted tracks of preoccupying our time.Dors said, Actually, we keep up little to complain of at the mo manpowert. Were more than more comfortable here than we were either in Mycogen or Dahl.Seldon said, Dors, youre not being won over by that woman, are you?Me? By Ra shelle? Of course not. How drop you mayhap think so?Well, youre comfortable. Youre well-fed. It would be natural to relax and accept what fortune brings.Yes, very natural. And why not do that?Look, you were telling me last night ab aside whats going to happen if she wins out. I may not be much of a historian myself, exactly I am allowing to shoot for your word for it and, actually, it makes sense-even to a nonhistorian. The Empire provide shatter and its s accentings will be fighting each other for for indefinitely. She must(prenominal) be stopped.I agree, said Dors. She must be. What I fail to see is how we can manage to do that little thing right at this moment. She looked at Seldon narrowly. Hari, you didnt sleep last night, did you?Did you? It was apparent he had not.Dors stared at him, a troubled look clouding her facial gesture. Have you lain awake thinking of Galactic destruction because of what I said?That and some other things. Is it manageable to reach Chetter Hu mmin?This last was said in a whisper.Dors said, I tried to reach him when we first had to flee arrest in Dahl. He didnt come. Im sure he received the message, that he didnt come. It may be that, for any of a number of reasons, he just couldnt come to us, but when he can he will.Do you enjoin something has happened to him?No, said Dors patiently. I dont think so.How can you know?The word would somehow get to me. Im sure of it. And the word hasnt gotten to me.Seldon frowned and said, Im not as self-confident as you are about all this. In fact, Im not confident at all. Even if Hummin came, what can he do in this case? He cant fight all of Wye. If they befool, as Rashelle claims, the best-organized army on Trantor, what will he be able to do against it?Theres no point in discussing that. Do you suppose you can convince Rashelle-bang it into her head somehow-that you dont have psychohistory?Im sure shes aware that I dont have it and that Im not going to get it for many years-if at al l. besides shell maintain I have psychohistory and if she does that skillfully enough, people will believe her and eventually they will act on what she says my predictions and pronouncements are-even if I dont say a word.Surely, that will turn over time. She wont build you up overnight. Or in a week. To do it properly, it faculty take her a year.Seldon was pacing the length of the room, turning sharply on his dog and striding back. That might be so, but I dont know. There would be pressure on her to do things quickly. She doesnt strike me as the kind of woman who has cultivated the exercise of patience. And her old father, Mannix IV, would be even more impatient. He must feel the nearness of death and if hes worked for this all his life, he would much prefer to see it through a week before his death rather than a week later on. Besides-Here he paused and looked around the empty room. Besides what?Well, we must have our freedom. You see, Ive resolved the psychohistory problem. Dorss eyes widened. You have it Youve worked it out.Not worked it out in the full sense. That might take decades centuries, for all I know. But I now know its practical, not just metaphysical. I know it can be done so I must have the time, the peace, the facilities to work at it. The Empire must be held together till I-or possibly my successors-will learn how best to come up it so or how to minimize the disaster if it does split up despite us. It was the thought of having a beginning to my task and of not being able to work at it, that kept me up last night.88.It was their fifth day in Wye and in the morning Dors was helping Raych into a formal costume that neither was quite familiar with. Raych looked at himself dubiously in the holomirror and saw a reflected image that faced him with precision, imitating all his motions but without any inversion of left and right. Raych had never used a holomirror before and had been unable to keep from assay to feel it, thus laughing, almost with embarrassment, when his bridge player passed through it while the images hand poked ineffectually at his real body.He said at last, I look funny.He studied his tunic, which was make of a very pliant material, with a thin filigreed belt, then passed his hands up a stiff collar that rose wish a cup foregone his ears on either side.My head looks like a ball inside a bowl.Dors said, But this is the sort of thing rich children wear in Wye. Everyone who sees you will admire you and envy you.With my hair all stuck belt down?Certainly. Youll wear this round little hat.Itll make my head more like a ball.Then dont allow anyone kick it. Now, remember what I told you. Keep your wits about you and dont act like a kid.But I am a kid, he said, aspect up at her with a wide-eyed innocent expression.Im surprised to hear you say that, said Dors. Im sure you think of yourself as a twelve-year-old adult.Raych grinned. Okay. Ill be a veracious spy.Thats not what Im telling you to be. Dont tak e chances. Dont sneak behind doors to listen. If you get caught at it, youre no good to anyone-especially not to yourself.Aw, cmon, missus, what do ya think I am? A kid or somethin?You just said you were, didnt you, Raych? You just listen to everything thats said without seeming to. And remember what you hear. And tell us. Thats simple enough.Simple enough for you to say, Missus Venabili, said Raych with a grin, and simple enough for me to do.And be careful.Raych winked. You bet.A flunky (as coolly impolite as unless an arrogant flunky can be) came to take Raych to where Rashelle was awaiting him.Seldon looked after them and said thoughtfully, He probably wont see the zoo, hell be listening so carefully. Im not sure its right to thrust a boy into risk of exposure like that.Danger? I doubt it. Raych was brought up in the slums of Billibotton, remember. I suspect he has more alley smarts than you and I put together. Besides, Rashelle is fond of him and will interpret everything he does in his favor. Poor woman.Are you actually sorry for her, Dors?Do you entail that shes not worth sympathy because shes a Mayors daughter and considers herself a Mayor in her own right-and because shes intent on destroying the Empire? Perhaps youre right, but even so there are some aspects of her for which one might show some sympathy. For instance, shes had an unhappy love affair. Thats pretty evident. Undoubtedly, her heart was broken-for a time, at least.Seldon said, Have you ever had an unhappy love affair, Dors?Dors considered for a moment or two, then said, Not really. Im too involved with my work to get a broken heart.I thought as much.Then why did you ask?I might have been wrong.How about you?Seldon seemed uneasy. As a matter of fact, yes. I have spared the time for a broken heart. Badly cracked, anyway.I thought as much.Then why did you ask?Not because I thought I might be wrong, I promise you. I just trusted to see if you would lie. You didnt and Im glad.There was a p ause and then Seldon said, Five days have passed and nothing has happened.Except that we are being toughened well, Hari.If animals could think, theyd think they were being treated well when they were only being fattened for the slaughter.I admit shes fattening the Empire for the slaughter.But when?I presume when shes ready.She boasted she could complete the coup in a day and the impression I got was that she could do that on any day.Even if she could, she would want to make sure that she could cripple the Imperial reaction and that might take time.How much time? She plans to cripple the reaction by using me, but she is making no effort to do so. There is no sign that shes trying to build up my importance. Wherever I go in Wye Im unrecognized. There are no Wyan crowds gathering to cheer me. Theres nothing on the intelligence holocasts.Dors smiled. unmatchable would almost suppose that your feelings are hurt at not being made famous. Youre naive, Hari. Or not a historian, which is the same thing. I think you had best(p) be more pleased that the study of psychohistory will be bound to make a historian of you than that it may save the Empire. If all human beings mute history, they might cease making the same stupid mistakes over and over.In what way am I naive? asked Seldon lifting his head and staring down his honker at her.Dont be offended, Hari. I think its one of your attractive features, actually.I know. It arouses your maternal instincts and you have been asked to take care of me. But in what way am I naive?In thinking that Rashelle would try to propagandize the population of the Empire, generally, into accepting you as seer. She would accomplish nothing in that way. Quadrillions of people are hard to move quickly. There is social and psychological inertia, as well as physical inertia. And, by coming out into the open, she would simply alert Demerzel.Then what is she doing?My call up is that the information about you-suitably exaggerated and glorified -is going out to a crucial few. It is going to those Viceroys of sectors, those admirals of fleets, those people of influence she feels look kindly upon her-or grimly upon the Emperor. A coke or so of those who might rally to her side will manage to confuse the Loyalists just long enough to allow Rashelle the First to set up her New Order firmly enough to beat off whatever resistance might develop. At least, I imagine that is how she reasons.And yet we havent heard from Hummin.Im sure he must be doing something just the same. This is too important to ignore.Has it occurred to you that he might be utterly?Thats a possibility, but I dont think so. If he was, the news would reach me.Here?Even here.Seldon raised his eyebrows, but said nothing.Raych came back in the late afternoon, happy and excited, with descriptions of monkeys and of Bakarian demoires and he dominated the conversation during dinner.It was not until after dinner when they were in their own quarters that Dors said, Now , tell me what happened with Madam Mayor, Raych. Tell me anything she did or said that you think we ought to know.One thing, said Raych, his face visible radiation up. Thats why she didnt show at dinner, I bet.What was it?The zoo was closed except for us, you know. There were lots of us-Rashelle and me and all sorts of guys in uniforms and dames in fancy clothes and like that. Then this guy in a uniform-a different guy, who wasnt there to begin with-came in toward the end and he said something in a low sound and Rashelle turned to all the people and made with her hand like they shouldnt move and they didnt. And she went a little ways away with this new guy, so she could talk to him and no one could hear her. Except I kept paying no aid and kept looking at the different cages and sort of moved near to Rashelle so I could hear her. She said, How dare they? like she was real mad. And the guy in the uniform, he looked nervous-I just got quick looks because I was trying to make out li ke I was watching the animals-so mostly I just heard the words. He said somebody-I dont remember the name, but he was a general or somethin. He said this general said the officers had sworn religious to Rashelles old man-Sworn allegiance, said Dors.Somethin like that and they was nervous about havin to do what a dame says. He said they wanted the old man or else, if he was kind of sick, he should pick some guy to be Mayor, not a dame.Not a dame? Are you sure?Thats what he said. He like whispered it. He was so nervous and Rashelle was so mad she could hardly speak. She said, Ill have his head. They will all swear allegiance to me tomorrow and whoever refuses will lave cause to regret it before an hour has passed. Thats exactly what she said. She broke up the whole party and we all came back and she didnt say one word to me all the time. Just sat there, looking kinda mean and angry.Dors said, Good. Dont you mention this to anyone, Raych. argumentation not. Is it what you wanted?Very much what I wanted. You did well, Raych. Now, go to your room and forget the whole thing. Dont even think about it.Once he was gone, Dors turned to Seldon and said, This is very interesting. Daughters have succeeded fathers-or mothers, for that matter-and held Mayoralties or other high offices on any number of occasions. There have even been reigning Empresses, as you undoubtedly know, and I cant think back that there was ever in Imperial history any serious question of serving down the stairs one. It makes one wonder why such a thing should now, arise in Wye.Seldon said, Why not? Weve only recently been in Mycogen, where women are held in a total lack of esteem and couldnt possibly hold positions of power, however little.Yes, of course, but thats an exception. There are other places where women dominate. For the most part, though, government and power have been more or less equi agitateual. If more men tend to hold high positions, it is usually because women tend to be more boun d-biologically-to children.But what is the situation in Wye?Equisexual, as far as I know. Rashelle didnt flitter to assume Mayoral power and I imagine old Mannix didnt hesitate to grant it to her. And she was surprised and furious at encountering male dissent. She cant have expected it.Seldon said, Youre distinctly pleased at this. Why?Simply because its so unnatural that it must be contrived and I imagine Hummin is doing the contriving.Seldon said thoughtfully, You think so?I do, said Dors.You know, said Seldon, so do I.89.It was their tenth day in Wye and in the morning Hari Seldons door signal sounded and Raychs high-pitched voice outside was hollo out, Mister Mister Seldon Its warSeldon took a moment to swap from sleep to wakefulness and scrambled out of bed. He was shivering s mildly (the Wyans liked their domiciles on the chilly side, he had discovered quite early in his stay there) when he threw the door open.Raych bounced in, excited and wide-eyed. Mister Seldon, they hav e Mannix, the old Mayor. They have-Who have, Raych?The Imperials, Their jets came in last night all over. The news holocasts are telling all about it. Its on in Missuss room. She said to let ya sleep, but I figured ya would wanner know.And you were quite right. Seldon pausing only tong enough to cave in on a bathrobe, burst into Dorss room. She was fully dressed and was watching the holo-set in the alcove.Behind the clear, small image of a desk sat a man, with the Spaceship-and-Sun sharply be on the left-front of his tunic. On either side, two soldiers, also wearing the Spaceship-and-Sun, stood armed. The officer at the desk was saying, -is under the peaceful control of his Imperial Majesty. Mayor Mannix is safe and well and is in full possession of his Mayoral powers under the guidance of friendly Imperial troops. He will be before you soon to urge quiesce on all Wyans and to ask any Wyan soldiers still in arms to lay them down.There were other news holocasts by various newsmen with unemotional voices, all wearing Imperial armbands. The news was all the same surrender by this or that unit of the Wyan security forces after firing a few shots for the record-and sometimes after no resistance at all. This town center and that town center were occupied-and there were repeated views of Wyan crowds somberly watching Imperial forces marching down the streets.Dors said, It was perfectly executed, Hari. Surprise was complete. There was no chance of resistance and none of consequence was offered.Then Mayor Mannix IV appeared, as had been promised. He was standing candid and, perhaps for the sake of appearances, there were no Imperials in sight, though Seldon was reasonably certain that an adequate number were present just out of camera range.Mannix was old, but his strength, though worn, was still apparent. His eyes did not meet the holo-camera and his words were spoken as though forced upon him-but, as had been promised, they counseled Wyans to remain calm, to offe r no resistance, to keep Wye from harm, and to cooperate with the Emperor who, it was hoped, would survive long on the throne.No mention of Rashelle, said Seldon. Its as though his daughter doesnt exist.No one has mentioned her, said Dors, and this place, which is, after all, her residence-or one of them-hasnt been attacked. Even if she manages to slip away and take refuge in some neighboring sector, I doubt she will be safe anyplace on Trantor for long.Perhaps not, came a voice but Ill be safe here for a little while. Rashelle entered. She was properly dressed, properly calm. She was even smiling, but it was no smile of joy it was, rather, a cold baring of teeth.The three stared at her in surprise for a moment and Seldon wondered if she had any of her servants with her or if they had promptly forsake her at the first sign of adversity.Dors said a little coldly, I see, Madam Mayor, that your hopes for a coup can not be maintained. Apparently, you have been forestalled.I have not be en forestalled. I have been betrayed. My officers have been tampered with and-against all history and rationality-they have refused to fight for a woman but only for their old master. And, traitors that they are, they then let their old master be seized so that he cannot lead them in resistance.She looked about for a chair and sat down. And now the Empire must continue to disintegrate and die when I was prepared to offer it new life.I think, said Dors, the Empire has avoided an indefinite period of useless fighting and destruction. cabinet yourself with that, Madam Mayor.It was as though Rashelle did not hear her. So many years of preparation destroyed in a night.She sat there beaten, defeated, and seemed to have aged twenty years.Dors said, It could scarcely have been done in a night. The suborning of your officers-if that took place-must have taken time.At that, Demerzel is a master and quite obviously I underestimated him. How he did it, I dont know-threats, bribes, smooth and s pecious argument. He is a master at the art of stealth and betrayal-I should have known. She went on after a pause. If this was limitless force on his part, I would have had no trouble destroying anything he sent against us. Who would think that Wye would be betrayed, that an blasphemy of allegiance would be so lightly thrown aside?Seldon said with automatic rationality, But I imagine the oath was made not to you, but to your father.Nonsense, said Rashelle vigorously. When my father gave me the Mayoral office, as he was legally entitled to do, he automatically passed on to me any oaths of allegiance made to him. There is ample precedence for this. It is customary to have the oath repeated to the new ruler, but that is a ceremony only and not a legal requirement. My officers know that, though they choose to forget. They use my womanhood as an excuse because they quake in fear of Imperial vengeance that would never have come had they been staunch or tremble with greed for promised re wards they will surely never get-if I know Demerzel. She turned sharply toward Seldon. He wants you, you know. Demerzel struck at us for you.Seldon started. Why me?Dont be a fool. For the same reason I wanted you to use you as a tool, of course. She sighed. At least I am not utterly betrayed. There are still loyal soldiers to be found.-SergeantSergeant Emmer Thalus entered with a soft cautious step that seemed incongruous, considering his size. His uniform was spruce, his long blond mustache fiercely curled.Madam Mayor, he said, drawing himself to attention with a snap. He was still, in appearance, the side of beef that Hari had named him-a man still following orders blindly, totally oblivious to the new and changed state of affairs.Rashelle smiled sadly at Raych. And how are you, little Raych? I had meant to make something of you. It seems now I wont be able to.Hello, Missus Madam, said Raych awkwardly.And to have made something of you too, Dr. Seldon, said Rashelle, and there als o I must crave pardon. I cannot.For me, Madam, you need have no regrets.But I do. I cannot very well let Demerzel have you. That would be one victory too many for him and at least I can stop that.I would not work for him, Madam, I assure you, any more than I would have worked for you.It is not a matter of work. It is a matter of being used. Farewell, Dr. Seldon. Sergeant, blast him.The sergeant drew his blaster at once and Dors, with a loud cry, lunged forward-but Seldon reached out for her and caught her by the elbow. He hung on desperately.Stay back, Dors, he shouted, or hell kill you. He wont kill me. You too, Raych. Stand back. Dont move.Seldon faced the sergeant. You hesitate, Sergeant, because you know you cannot shoot. I might have killed you ten days ago, but I did not. And you gave me your word of honor at that time that you would protect me.What are you waiting for? snapped Rashelle. I said shoot him down, Sergeant.Seldon said nothing more. He stood there while the sergean t, eyes bulging, held his blaster steady and pointed at Seldons head.You have your order shrieked Rashelle.I have your word, said Seldon quietly.And Sergeant Thalus said in a choked tone, Dishonored either way. His hand fell and his blaster clanged to the floor.Rashelle cried out, Then you too betray me. ahead Seldon could move or Dors free herself from his grip, Rashelle seized the blaster, turned it on the sergeant, and closed contact. Seldon had never seen anyone blasted before. Somehow, from the name of the weapon perhaps, he had expected a loud noise, an ebullition of flesh and blood. This Wyan blaster, at least, did nothing of the sort. What mangling it did to the organs inside the sergeants chest Seldon could not tell but, without a change in expression, without a wince of pain, the sergeant crumbled and fell, dead beyond any doubt or any hope.And Rashelle turned the blaster on Seldon with a firmness that put to rest any hope for his own life beyond the next second.It was Ra ych, however, who jumped into action the moment the sergeant fell. Racing between Seldon and Rashelle, he waved his hands wildly.Missus, Missus, he called. Dont shoot.For a moment, Rashelle looked confused. Out of the way, Raych. I dont want to hurt you.That moment of hesitation was all Dors needed. Breaking loose violently, she plunged toward Rashelle with a long low dive. Rashelle went down with a cry and the blaster hit the shew a second time.Raych retrieved it.Seldon, with a deep and shuddering breath, said, Raych, give that to me. But Raych backed away.Ya aint gonna kill her, are ya, Mister Seldon? She was nice to me.I wont kill anyone, Raych, said Seldon. She killed the sergeant and would have killed me, but she didnt shoot rather than hurt you and well let her live for that.It was Seldon, who now sat down, the blaster held loosely in his hand, while Dors removed the neuronal whip from the dead sergeants other holster.A new voice rang out. Ill take care of her now, Seldon.Se ldon looked up and in sudden joy said, Hummin FinallyIm sorry it took so long, Seldon. I had a lot to do. How are you, Dr. Venabili? I take it this is Mannixs daughter, Rashelle. But who is the boy?Raych is a young Dahlite friend of ours, said Seldon.Soldiers were entering and, at a small gesture from Hummin, they lifted Rashelle treasurefully.Dors, able to suspend her intent surveillance of the other woman, brushed at her clothes with her hands and smoothed her blouse. Seldon suddenly recognise that he was still in his bathrobe.Rashelle, shaking herself loose from the soldiers with contempt, pointed to Hummin and said to Seldon, Who is this?Seldon said, It is Chetter Hummin, a friend of mine and my protector on this planet.Your protector. Rashelle laughed madly. You fool You idiot That man is Demerzel and if you look at your Venabili woman, you will see from her face that she is perfectly aware of that. You have been trapped all along, far worse than ever you were with me90.Hummi n and Seldon sat at eat that day, quite alone, a pall of quiet between them for the most part. It was toward the end of the meal that Seldon stirred and said in a lively voice, Well, sir, how do I address you? I think of you as Chester Hummin still, but even if I accept you in your other persona, I surely cannot address you as Eto Demerzel. In that capacity, you have a title and I dont know the proper usage. Instruct me.The other said gravely, Call me Hummin-if you dont mind. Or Chetter. Yes, I am Eto Demerzel, but with respect to you I am Hummin. As a matter of fact, the two are not distinct. I told you that the Empire is decaying and failing. I believe that to be true in both my capacities. I told you that I wanted psychohistory as a way of preventing that decay and failure or of bringing about a renewal and reinvigoration if the decay and failure must run its course. I believe that in both my capacities too.But you had me in your grip-I presume you were in the vicinity when I ha d my meeting with His Imperial Majesty.With Cleon. Yes, of course.And you might have spoken to me, then, exactly as you later did as Hummin.And accomplished what? As Demerzel, I have enormous tasks. I have to finagle Cleon, a well-meaning but not very capable ruler, and prevent him, insofar as I can, from making mistakes. I have to do my present moment in governing Trantor and the Empire too. And, as you see, I had to spend a great deal of time in preventing Wye from doing harm.Yes, I know, murmured Seldon.It wasnt easy and I close lost out. I have spent years sparring carefully with Mannix, learning to understand his thinking and planning a countermove to his every move. I did not think, at any time, that while he was still alive he would pass on his powers to his daughter. I had not studied her and I was not prepared for her utter lack of caution. Unlike her father, she has been brought up to take power for granted and had no clear idea of its limitations. So she got you and fo rced me to act before I was quite ready.You almost lost me as a result. I faced the muzzle of a blaster twice.I know, said Hummin, nodding. And we might have lost you Upperside too-another accident I could not foresee.But you havent really answered my question. Why did you send me chasing all over the face of Trantor to escape from Demerzel when you yourself were Demerzel?You told Cleon that psychohistory was a purely theoretical concept, a kind of mathematical game that made no practical sense. That might indeed have been so, but if I approached you officially, I was sure you would just now have maintained your belief. Yet I was attracted to the notion of psychohistory. I wondered whether it might not be, after all, just a game. You must understand that I didnt want merely to use you, I wanted a real and practical psychohistory.So I sent you, as you put it, chasing all over the face of Trantor with the dreaded Demerzel close on your heels at all times. That, I felt, would concentr ate your mind powerfully. It would make psychohistory something exciting and much more than a mathematical game. You would try to work it out for the sincere idealist Hummin, where you would not for the Imperial flunky Demerzel. Also, you would get a glimpse of various sides of Trantor and that too would be face-saving-certainly more helpful than living in an ivory tower on a far-off planet, surrounded entirely by fellow mathematicians. Was I right? Have you made progress?Seldon said, In psychohistory? Yes, I did, Hummin. I thought you knew.How should I know?I told Dors.But you hadnt told me. Nevertheless, you tell me so now. That is good news.Not entirely, said Seldon. I have made only the barest beginning. But it is a beginning.Is it the kind of beginning that can be explained to a nonmathematician?I think so. You see, Hummin, from the start I have seen psychohistory as a science that depends on the interaction of cardinal million worlds, each with an average population of four thousand million. Its too much. Theres no way of handling something that complex. If I was to succeed at all, if there was to be any way of materializeing a useful psychohistory, I would first have to find a simpler system.So I thought I would go back in time and deal with a single world, a world that was the only one occupied by humanity in the dim age before the colonization of the Galaxy. In Mycogen they spoke of an original world of Aurora and in Dahl I heard word of an original world of Earth. I thought they might be the same world under different names, but they were sufficiently different in one key point, at least, to make that impossible. And it didnt matter. So little was known of either one, and that little so obscured by fiction and legend, that there was no hope of making use of psychohistory in connection with them.He paused to sip at his cold juice, keeping his eyes firmly on Hummins face.Hummin said, Well? What then?Meanwhile, Dors had told me something I call the h and-on-thigh story. It was of no innate significance, merely a humorous and entirely trivial tale. As a result, though, Dors mentioned the different sex mores on various worlds and in various sectors of Trantor. It occurred to me that she treated the different Trantorian sectors as though they were separate worlds. I thought, idly, that instead of twenty-five million different worlds, I had twenty-five million plus eight hundred to deal with. It seemed a trivial difference, so I forgot it and thought no more about it.But as I traveled from the Imperial Sector to Streeling to Mycogen to Dahl to Wye, I observed for myself how different each was. The thought of Trantor-not as a world but as a complex of worlds-grew stronger, but still I didnt see the crucial point.It was only when I listened to Rashelle-you see, it was good that I was finally captured by Wye and it was good that Rashelles rashness drove her into the grandiose schemes that she imparted to me-When I listened to Rashelle, as I said, she told me that all she wanted was Trantor and some immediately adjacent worlds. It was an Empire in itself, she said, and dismissed the outer(a) worlds as distant nothings.It was then that, in a moment, I saw what I must have been harboring in my hidden thoughts for a considerable time. On the one hand, Trantor possessed an extraordinarily complex social system, being a populous world made up of eight hundred smaller worlds. It was in itself a system complex enough to make psychohistory meaningful and yet it was simple enough, compared to the Empire as a whole, to make psychohistory perhaps practical.And the Outer Worlds, the twenty-five million of them? They were distant nothings. Of course, they affected Trantor and were affected by Trantor, but these were second-order effects. If I could make psychohistory work as a first approximation for Trantor alone, then the minor effects of the Outer Worlds could be added as later modifications. Do you see what I mean? I was s earching for a single world on which to establish a practical science of psychohistory and I was searching for it in the far past, when all the time the single world I wanted was under my feet now.Hummin said with obvious relief and pleasure, WonderfulBut its all left to do, Hummin. I must study Trantor in sufficient detail. I must plan the necessary mathematics to deal with it. If I am lucky and live out a full lifetime, I may have the answers before I die. If not, my successors will have to follow me. Conceivably, the Empire may have fallen and splintered before psychohistory becomes a useful technique.I will do everything I can to help you.I know it, said Seldon.You trust me, then, despite the fact I am Demerzel?Entirely. Absolutely. But I do so because you are not Demerzel.But I am, insisted Hummin.But you are not. Your persona as Demerzel is as far removed from the truth as is your persona as Hummin.What do you mean? Hummins eyes grew wide and he backed away slightly from Seld on.I mean that you probably chose the name Hummin out of a wry sense of what was fitting. Hummin is a mispronunciation of human, isnt it? Hummin made no response. He continued to stare at Seldon.And finally Seldon said, Because youre not human, are you, Hummin/Demerzel? Youre a robot.