Introduction. Cortisol Is A Steroid Hormone, Found In

Introduction: Cortisol is a steroid hormone, found in the glucocorticoids (GC) class of hormones. It controls many physiological processes, vital for the survival of humans. This includes â€Å"metabolism, immune response, cardiovascular activity, and brain function† (Chung et al. 2011). Over and above control functions, cortisol also helps regulate blood pressure and its use of proteins, carbohydrates, and fats. There is a strong correlation between stressful situations and circulating cortisol levels. The body response to stressful physiological or psychological situations by increasing the amount of cortisol secreted. This secretion causes the breakdown of muscle protein, which leads to the release of amino acids into the bloodstream. These†¦show more content†¦We can respond and cope with physical and emotional stresses because GC exerts effects in the body to maintain homeostasis (Chung et al. 2011) â€Å"Despite the relatively large number of studies that evalu ated stress provoked changes in cortisol secretion, the influence of a great number of variables remains to be determined† (Michaud et al. 2008). A report, written by Matheson and Cole (as cited in Michaud et al. 2008) stated that threats to an individual’s group were related to the increase in cortisol levels, particularly among individuals who had the tendency to express higher levels of anger. This experiment involved the use an of ELISA kit which stands for Enzyme- Linked- ImmunoSorbent Assay. This is based on the principle of competitive binding. A mouse monoclonal antibody coats the microplate wells directed towards an antigenic site on the cortisol molecule. Endogenous cortisol of a patient sample competes with a cortisol-horseradish peroxidase conjugate for binding to the coated antibody. I hypothesize that the amount of cortisol produced by a human, increases during the start of the day as compared to the middle and end. I also hypothesize that the amount of cortisol produced increases when he/she is placed under stressful conditions. Thus, two experiments had to be conducted. The first, to examine the circadian periodicity of circulating cortisol to determineShow MoreRelatedProtein Steroid Management Of Patients With A Normal Hypothalamic Pituitary Axis Essay1638 Words   |  7 Pages Pituitary Surgery Perioperative Steroid Management in Patients with a Normal Hypothalamic Pituitary Axis INTRODUCTION Surgery on the pituitary gland and around the sellar region is of special interest to the neurosurgeon. 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The Fundamental And Structural Principles Of The...

A constitution refers to a set of rules and guidelines intended to create both the fundamental and structural principles of the government in a state or nation. A constitution is either written or unwritten. On one hand, a written constitution is a formal document that defines the attributes or characteristics of the constitutional settlement, the rules governing the political system and the roles and responsibilities of the government and rights of citizens and inhabitants in a codified form (Shamgar 345). On the other hand, an unwritten or uncodified constitution refers to a form of the constitution where the essential rules of any nation’s government are in the form of customs, precedent, usage, and a range of statutes and legal instruments. Only three countries in the world have an unwritten constitution. They include the United Kingdom, Israel, and New Zealand. Ordinarily, a constitution is written following major political revolutions or reforms. For instance, the United States of America wrote their constitution in 1787 following the Second World War. Germany and Japan also wrote theirs at that time. Written Constitution versus Unwritten Constitution Traditionally, there were two main reasons why constitutions were essential. First, it offered an explanation on the structure of the government and its roles and responsibilities. Second, governments and citizens viewed a constitution as the pillar of liberal democracy. However, Heywood (2007) argues that the twoShow MoreRelatedGlobalization - Turkey1743 Words   |  7 Pagesoutstanding performance characterized by continuous growth. With a solid macroeconomic strategy accompanied by prudent fiscal measures and major structural reforms in place since 2002, the Turkish economy has become integrated in a global environment and transform the country into one of the most popular destinations in the region for FDI. 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Workplace Health and Safety acts in Australia

Question: Describe about the workplace health and safety acts in Australia. Answer: Introduction Establishment of the safer and secure approaches within an organisational scenario helps in achieving the success of the business. The promotion of the workplace health and safety approaches is the driving force for retaining staffs and increasing the productivity (Chan-Mok, Caponecchia and Winder 2014). The implementation of the safe and healthy practices may sometimes require the higher cost of installing the safe equipments. However, ignoring such actions would be even much severe for a workplace. The employers have to maintain their responsibilities to promote the health and safety within the workplace, which will be signifying that the employees or the customers would not face any health related hazards (Stavropoulos 2014). Each of the state and the territory has to set the principle of the health and safety acts to ensure the needs related to the workplace health and safety aspects. The study is based on the promotion of the health and safety approaches in NSW, Australia. The study will be associated with the responsibilities of both the employers and employees towards the act. This segment will be followed by the set of objectives related to the health and safety acts. The association of the human resource responsibilities in implementing the OHS and acts within a workplace will also be discussed accordingly. Workplace Health and Safety Acts in NSW, Australia The implementation of the occupational health and safety approaches in Australia is considering the development of the national policy. The Union Charter of Workplace Rights mentioned, Australian law must ensure healthy and safe workplaces and a compensation and rehabilitation system which ensures that no worker is disadvantaged should they be injured at work (Safeatwork.org.au. 2016). The implementation of such acts is helpful enough in improvising the work health and safety arrangements by providing the compensation to the workers across Australia. WHS act in NSW is mainly concentrating on both preventing and improving the safety culture within the organisations in New South Wales (Galvin 2016). The principles related to the Work Health and Safety Act 2011 is backed by the regulations related to the work place health and safety. It is to be indicated that the WHS Act 2011 has enlarged the amount of people who are associated with the duty of care (Workplaceohs.com.au 2011). Furtherm ore, it can be stated that the employers need to manage their responsibilities towards successful management of the risks involved in the workplac The WHS act in NSW is associated with a set of objectives, which are as follows: Objectives of OHS Acts The objectives set for promoting the workplace safety act (WHS) are as follows: To provide the proper advice for improvising the work health and safety and minimise the risks To offer the registration and licensing for potential risks related to the works To investigate the incidents in workplace To install the testing services and enact the laws related to WHS in NSW. Concept of Workplace Health and Safety Organisational health and safety or the workplace health and safety are considered as a disciplinary approach based on the safety and security of the stakeholders in the workplace. The enactment of the health and safety laws is concentrating on the guiding principles related to the safer approaches maintained in the workplace (Richardson 2013). The mining industry is mostly associated with the maximum risks for the employees while working with the work related instruments. Apart from the mining industry, employees of health care departments and other industries are also associated with such work place risks. However, the implementation of the workplace safety law has been improvising the productivity of workplace activities (Schofield, Reeve and McCallum 2014). The employers in NSW found out that the employees engaged with the mining industry are much involved with the risks. Hence, the act has been implemented to minimise or prevent the hazardous situations that may harm the employe es within a workplace. Responsibilities of the employers and the employees towards OHS Acts The enactment of the workplace health and safety law is mainly depending on the responsibilities maintained by the employers to facilitate the organisational based activities. The maintenance of the responsibilities has been ensuring the prevention or the minimisation of the probable risks that the employees may face while performing any organisational activity (Santos et al. 2013). The set of the responsibilities that are needed to be maintained by the employers are listed as follows: The employers need to maintain the safe plant, such as equipments and other machineries along with the safe system of work. The employers need to control the areas associated with high risks (Blewett et al. 2014). Falling from the heights may create the permanent injuries to the workers. Therefore, the system should be implemented to prevent such falls. The employers need to concentrate on the proper arrangements for the safer actions while using, handling, or transporting the chemicals including some harmful materials. The employers need to keep the fire extinguisher services and the biometric alarm system to prevent the workplace from catching fire. The workers are needed to be provided with the adequate facilities of drinking water, hygienic areas of having food, clean toilets, and so on. The proper training and development session is needed to be provided to the workers to minimise the risks related to the organisational activities. Adequate monitoring process of workers health is necessary for the employers. For example, while the employers need to provide the employees the hearing tests, it may create the high noise level (Johnstone, Bluff and Clayton 2012). Hence, it is needed to be concentrated on such parameter. The employers should implement a record system where the information about the health and safety of the workers would be recorded. It is essential to recruit the people with proper qualification or expertise that will be helpful enough in advising about the safer approaches. Even the employees need to maintain their responsibilities towards the company. While making some complaints or inquiry, the employees need to use the languages taught by the trainers (Shea et al. 2016). More specifically, the information regarding such aspects is needed to be followed. Purpose of Implementing the OHS acts It is much important to consult with the employees for the enactment of health and safety laws for managing the actions more effectively. The consultation process helps the employers to pay attention towards any work health related hazards that may cause harm to the employees. More specifically, the process is even helpful enough in promoting the positive traits of the health and safety cultures (Waldron 2013). Accordingly, the employees receive the opportunity to influence the associated procedures and policies. The bonding between the employers and the employees are also becoming much strong (Safeatwork.org.au 2016). The failure of the communication may affect the employees and the risks may increase accordingly. The health and safety representatives (HSR) have been playing much significant role in the workplaces of NSW. Schofield, Reeve and McCallum (2014) mentioned that the major responsibility of the HSR is to provide the proper means for the workers that will be helpful enough in raising the safety issues to the management. In focusing on such issues, the employer would undertake the relevant process for resolving them. The representatives are elected and they usually represent the risk management teams to discuss the issues received from the employees. While conducting the process of selecting the representatives for the work place health and safety, some of the steps are needed to be followed. As per the Work Health and Safety Act 2011, the workplace needs to include one or more work groups. The negotiation of people included in the work group can take place. Santos et al. (2013) suggested that the HSR is needed to be accessible for each of the employees. The negotiation process starts within 14 days of the request date. This negotiation process includes the composition of the work groups within the workplace. Moreover, the number of HSR and deputy HSR is also needed to be determined. All members of the group can vote for selecting the HSR. After three years the HSR needs to leave the work group by providing the resignation letter (Johnstone, Bluff and Clayton 2012). The associated training and development process is also needed to be considered. The Role of HR in maintaining the workplace health and safety The human resource management has to maintain the significant responsibilities in promoting the health and safety act within the workplace. The set of responsibilities maintained by the HR is as follows: The major duty of an HR is to explain both the employees and the authority about the necessity of the safe environment of an organisation. In some of the cases, the compliance of health and safety technicalities requires the suggestions of the supervisors or the consultants (Stavropoulos 2014). Therefore, the HR performs the role of the mediator between the consultants and the employees. The establishment of the proper communication transparency between the employees and the employer is much necessary and the HR needs to promote such practices. Simultaneously, the HR needs to represent the issues raised by the employees within the workplace (Workplaceohs.com.au 2011). Boosting the morale and motivating the employees to be more committed towards the organisation are the major concerns of an HR. Conclusion Workplace health and safety is one of the major aspects within a workplace. While recruiting the employees, the employers have to consider the workplace safety that will prevent the hazardous situation from being faced by the employees. Therefore, the Work Health and Safety Act 2011 was established in the workplaces of NSW, Australia. The principles of workplace health and safety need to concentrate on several objectives that are necessary to be followed while promoting the act of health and safety. It is to be indicated that both the employers and the employees need to maintain the set of responsibilities to promote the workplace safety and security. The consultants need to provide some advices while making any decision based on this aspect. The representatives are selected by the group members and they present the safety related concerns to the higher authority. The human resource management is also playing the vital role in promoting the practices of workplace health and safety. T he HR helps in establishing the communication transparency between the employers and the employees. Even sometimes, they work as the mediator to convey the messages of the employees to the HSR. The maintenance of these aspects has been promoting the safer approaches within the workplace. References Blewett, V., Rainbird, S., Clarkson, L., Etherton, H. and Paterson, J., 2014. Strategic engagement: including youth in the development of the Youth Work Health and Safety Strategy for South Australia. InHuman Factors in Organizational Design and Management XI: Nordic Ergonomics Society Annual Conference Proceedings(pp. 711-716). Chan-Mok, J.O., Caponecchia, C. and Winder, C., 2014. The concept of workplace bullying: Implications from Australian workplace health and safety law.Psychiatry, Psychology and Law,21(3), pp.442-456. Consultaustralia.com.au. 2016.Workplace Health Safety (OHS). Galvin, J., 2016. Director and senior management accountability for workplace health and safety.AusIMM Bulletin, (Feb 2016), p.56. Johnstone, R., Bluff, E. and Clayton, A., 2012.Work health and safety law and policy. Thomson Reuters. Richardson, K., 2013. The application of a workplace health and safety obligation to the common law duty of care.

Sexualization of Children

Introduction Bare midriffs, spaghetti strap tops, skinny jeans and short shorts all once belonged in the realm of teen/young adult clothing yet as of late there has been a growing trend wherein such clothing choices have now become common place among children aged 12 and below (Gill, 137-160).Advertising We will write a custom research paper sample on Sexualization of Children specifically for you for only $16.05 $11/page Learn More Such is the influence of modern day popular culture that sexualization and objectification has not been limited to adults and teens but has now begun to encompass children as young as 7 to 10 years of age (Bill, 1). Sexualization can be defined as process where an individual’s sense of personal â€Å"value† is actually based on sex appeal or a predefined and narrow standard of attractiveness (Goodin et al. 1). This has resulted in the proliferation of numerous clothing lines, products and even popular culture sh ows which place a certain degree of sexualization on children resulting in the creation of what is now perceived as a cultural norm when it comes to children wearing clothes or displaying behaviors with distinct sexual undertones that is many years ahead of when they should be displaying such attitudes (Bartlett, 106-11). Even parents themselves have contributed to the modern day adoption of the idea that it’s perfectly alright to employ a certain degree of sexualization on children as evidenced by their continued patronage of toys, clothing styles and TV shows for their children that have themes depicting early child sexualization (Albiniak, 1). Based on this it can clearly be seen that children have been sexualized at an earlier age as compared to their counterparts form 30 years ago yet it must be questioned whether such an early rate of sexualization actually has an adverse impact on their emotional, behavioral and social development. Several studies examining early child hood development do indicate that a child’s formative years (age 4 to 12) is a period in which they begin to develop the behavioral characteristics and ideologies that influence their subsequent adult behaviors and actions. Aspects related to religion, culture and ideologies introduced during this early stage of development reflect well into adulthood and become an integral aspect of who a person is to become. It is based on this developmental backdrop that parents and society developed the notion that early onset exposure to sexualized content will have an adverse effect on a child’s development and as such children should be inculcated early on with positive societal messages in the form of cooperation, peaceful action and other similar behavioral characteristics that espouse the creation of a socially acceptable persona (Kopkowski, 220).Advertising Looking for research paper on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More Other studies though have stated that sexualized media in modern day popular culture such as those seen in TV shows, movies and magazines and other similar forms of consumable media actually have a positive effect on children resulting in the development of independent, socially well adjusted children that from an early age are capable of utilizing what they perceive from sexualized media to become more socially well adjusted as compared to their peers that have been exposed to little if next to no sexualized content. What such studies are attempting to suggest is that the early sexualization that children are exposed to as a result of modern day pop culture and the media actually leads them to experience the full gamut of emotions denied to them by their parents and society as a direct result of the prevailing social idea that children should not exposed to sexuality at an early age (Merskin, 119-129). In the words of Melanie Moore â€Å"it enables them to explore the inescapable feelings that they’ve been taught to deny and to reintegrate those feelings into a more whole, more complete and more resilient selfhood†. While such notions are relatively alien to the current prevailing societal consensus regarding children and sexuality it does make a valid argument. Sexuality is an aspect of normal human behavior, while society disparages its utilization and expression it must be noted that it is a normal feeling that has been with humans since the beginning of evolution. Coming to a complete realization of its effective utilization while at the same time limiting its use through calm analytic thinking is actually a rite of passage for most individuals. It is based on this what this study will attempt to confirm is whether the current trend in the early sexualization of children has a purely negative effect or if there is an underlying positive effect to this level of exposure. From a certain perspective it can be stated that: it is only due to age old conservative social institutions that it is believed that children are being sexualized at an early age when it fact there is no particular limit to the age in which children should learn aspects related to being a mature individual. Negative Influence of Popular Culture on the Concept of Beauty and Sexuality The influence of popular culture on modern day society can be interpreted as a form of irrational exuberance which is defined as the act of people modeling their behavior on the actions of other people without sufficient justification for doing so. In the case of children models/child actors seen in magazines and print ads children/parents see these models, which pop culture defines as the epitome of beauty, and attempt to emulate them by buying the products that the magazines say can help you achieve the same level of flawlessness as them (Schwed, 19). Yet this beauty is nothing more than a false image made to entice the masses towards buying a particular p roduct however this doesn’t stop people from attempting to emulate them in whatever way they possibly can.Advertising We will write a custom research paper sample on Sexualization of Children specifically for you for only $16.05 $11/page Learn More What must be understood is that ours is a culture obsessed with the idea of perfect beauty; flawless skin, blemish free features, thin waistlines, striking eyes, perfect noses and not a pimple in sight yet such an obsession has been fueled by nothing more than lies and hypocrisy which has all been for the sake of making money (APA: Analysis Of Published Research Shows Sexualized Images Harmful To Girls, Women, 1). The fashion industry alones makes billions of dollars a year by presenting women with products and clothing styles that are meant to emphasize sexiness or make them look more like the â€Å"standards† of physical attractiveness that many magazines espouse. Yet this is nothing more than a farce; such beauty and elegance can be summed up in one word â€Å"Photoshop†; they aren’t real, no one has eyes that striking, no one has legs that flawless, people don’t glisten in natural light, they really aren’t that thin, and hair doesn’t normally shimmer that way as if they stepped straight out of a Palmolive commercial. It is fake, unnatural yet it has created an obsession with beauty and perfection that has dominated the fashion industry resulting in the proliferation of photoshopped imagery on almost every page of major fashion magazines around the world (Reynolds, 9). Not only that, sensuality and sexiness have now become so integrated into modern day popular culture that the sheer proliferation of ads, commercials, movies and TV shows that emphasize the necessity of women appearing in this particular fashion has begun to affect children wherein they themselves look at the sensual and the sexy and develop the notion that this is what they should be (Harris, 1). Evidence of this can easily be seen in the current proliferation of modern day media in the form of TV shows and movies which also show child stars and actors in various revealing styles of sexualized clothing, scenes or basically wearing a lot of makeup that is more suitable for adults (Odone, 18). This has furthered reinforced the message being presented by photoshopped model images in that in order to be considered beautiful you must try to emulate the model that the pictures in magazines show (International Business, 12). Media/Social Media that Causes Kids to be Sexualized at an Early Age Action figures, dolls and cartoons are an ubiquitous part of the childhood of most people within the U.S., with various individuals owning/ watching some variation of these aspects of popular culture in one form or another. Based on various studies of childhood development children actually looked up to and tried to emulate the attitudes and characteristics of the c artoons they saw on television.Advertising Looking for research paper on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More When examining past and current trends in cartoons, action figures and dolls a rather strange phenomenon was noticed wherein over the years since the 1980s action figures and cartoon heroes took on greater degrees of musculature and size resulting in almost freakishly large heroes as compared to their counterparts prior to the 1980s. Even dolls for girls took on greater degrees of overtly sexual characteristics with emphasis being placed on looks, sexuality and fashion. Behavioral Development While most individuals merely categorized this as a changing trend which was a direct result of the shifting nature of popular culture it must be noted that such changes had a distinct impact on the mannerisms, attitudes and manner in which children believed they should act and mature into. Studies examining the resulting developmental characteristics of children who grew up prior to the overly muscular and sexual trend of the 1980s showed nearly opposite developmental beliefs compared to child ren who grew up during and after the 1980s trend. It was noted that male children who grew up during and after the trend developed the notion that being overly muscular was normal and a state to develop into. It was a notion that was completely at odds with the idea of children who grew up prior to the trend who believed an average non-muscular physique was normal and what should be attained. This particular difference was also noted in female children who believed that the overtly sexual style and concentration on appearance, fashion and sexuality was what they needed to become in order to be considered normal as compared to the popular notions among children prior to the 1980s which showcased a vastly different and more conservative view on what was considered normal (Helping Kids Manage Their Media, 37). Cultural Impact What must be understood is that the resulting cultural impact of the change in the depiction of toys and cartoon heroes into either overly muscular or overly sexu al characters was noted as being one of the reasons behind the prevalence of various individual behavioral characteristics today such as the belief that looking muscular will make a person popular, that overly sexualized clothing is normal and that violence is a regular aspect of life (Helping Kids Manage Their Media, 37). While it may be true that such characteristics do not define a majority of the population it is still prevalent in large percentages with various studies confirming that one of the reasons behind their prevalence is their connection to the trend mentioned throughout this paper that began in the 1980s and continues to this day. Pop Culture and Identification One of the prevailing arguments against letting children see sexualized media is the supposed potential that exists of children imitating what they see in magazines, movies and television shows (Helping Kids To Stop Celebrating Consumption, 11) (Let’s stop teaching preschoolers to be sexy, 220). Studies examining the effect pop culture has on children reveal that on average children, especially young children, have the tendency to emulate child pop culture icons such as Hannah Montana, Spongebob Squarepants and other similar forms of identifiable imagery (Nairn, 54-60). In fact this behavioral aspect is even noted in members of the adult community and as such is the basis for many arguments stating the potentially harmful effects sexualized media could have on a child’s â€Å"proper† sexual development. What must be understood is that the arguments being presented neglect to take into account the fact that parental influences play a contributing and limiting factor to some aspects of a child’s behavior and as such should be trusted as a means of enabling children to distinguish between what is right and what is wrong (Young, 10). In fact, various studies have even shown that parental influences play a major role in personality development resulting in either pr oper growth and maturity or the instilment of negative personality traits similar to immaturity, dependence, and an overall sense of being unable to become self-reliant (Parsons, 5). The development of a child’s behavior is not dependent on consumable media alone but rather on how parent’s influence and mold a child’s behavior. As such even though sexualized media content is introduced to a child it can be stated that so long as parents are there to enable a child to distinguish right from wrong then there is little cause for concern (Egan and Hawkes, 307-322). It must be noted though that in cases where there is a distinct degree of parental absenteeism a child’s behavioral development will thus be predominantly influenced by external sources which should be a cause for concern since such instances have been shown to be influential factors in the development of abnormal personality traits which manifest in early onset sexually deviant behavior. Developme nt and Human Emotion Studies examining the prevalence of independent action and initiative in children show that on average children with the most well rounded set of emotional development often show the most drive and initiative when it comes to independent action and leadership roles. While various studies which have examined the potential effect of early child sexualization may not explicitly state it in their articles it is actually implied that children who are not exposed to certain types of â€Å"mature† media tend to not develop independent personalities but rather take on dependent behavioral characteristics (Hatch, 195-211). It must be noted that society’s adherence to the belief that exposure to sexuality is bad for children has in fact resulted in parents developing parental practices that espouse isolation from any and all forms of reference to sexual behaviors (Combe, 104). In fact such practices have grown to such an extent that the concept of social con formity and how the expression of sexuality is an adverse form of behavior is often forced upon children resulting in the suppression of the development of certain aspects of their emotional makeup. This has resulted in children developing behavioral characteristics akin to dependence, conformity and a distinct lack of initiative due to a form of trauma in which they associate aspects related to socially unacceptable conduct to the suppressive actions of their parents. This causes them to withdraw into themselves rather than become more expressive. As various studies have noted which have examined this type of phenomena children that are allowed to be exposed to â€Å"mature† media (sexualized content, violent shows etc.) tend to be more expressive, open minded and have more access to the full gamut of their emotional capacities compared to children whose emotional growth has been inadvertently suppressed by their parents. What must be understood is the fact that current day parental practices assume that exposure to sexualization is bad based on preconceived societal notions when in fact there have been few studies which have actually successfully connected early sexualization to children developing into sexually deviant adults (Fox, 77). In fact, for the most part children exposed to various forms of sexualized media and products appear, for all intents and purposes, perfectly normal and turn into well rounded individuals. It must be noted that the parental predilection to believe that sexualized media has negative implications on children is grounded in institutional theory. Institutional theory specifically states that people have the tendency to adhere to traditional institutions rather than move towards more efficient newer institutions due to their belief that older institutions are more stable due to prolonged length of time that they’ve been around. In this particular case parents adhere to a specific type of social institution that beli eves that sexualized media and advertisements will create sexually deviant children and adults. Several studies examining parental predilections towards this particular type of institution have noted that when questioned as to why they adhere to the social institution in question the essence of all answers given show that parents do so due to their belief that since the institution has been around for such a long period of time and that it is widely accepted means that it must be right. What must be understood is that just because a social institution is widely accepted and has been around for a long time doesn’t make it automatically right. For example, one of the most widely accepted social institutions in the past was the belief that men were superior to women, this resulted in women being thought of as incapable of doing certain jobs, that the place of a woman was at home and that women did not have the right to decide the future of a country. Suffice it to say, such a vi ew has been recently debunked however it must be noted that it had persisted for several hundred years with most of human culture adhering to its tenets. It is based on this that the social institution advocating that sexualized media is bad for children should not be immediately credited as being absolutely correct. Historical precedent has shown that not all widely accepted societal views are correct and thus this one should not be considered as an absolute truth. Conclusion Based on the various examples presented it can be seen that the preconceived notions attached to sexualization is in fact fallacious and heavily embedded in parental practices that originate from a social institution that may not necessarily be correct. As it was shown by the various studies cited, children that are exposed to sexualized media in the form of advertisements, movies and TV shows develop into mature and behaviorally stable adults with few problems. In fact when taking the views of articles presen ted into consideration it can even be stated that the introduction of sexualized media can in fact enable children to develop stronger and more independent personalities that will enable them to express themselves better, take the initiative more and be more likely to overcome adverse situations as compared to their peers that were not exposed to sexualized media. While it may be true that when parents prevent their children from viewing â€Å"mature† media they are under the belief that they are in effect helping their children grow into better adults but the truth is what they are doing is in effect stunting the full emotional growth of their children. As explained earlier, traits related to sexuality are inherent parts of a person’s normal emotional makeup and as such are a necessary aspect in enabling an individual to grow into an emotionally stable person. Negative emotional qualities help to balance the positive aspects of an individual’s personality so as to enable them to live a balanced life. By denying children the ability to develop the full gamut of their behaviors from an early stage parents are in effect hindering them from being able to mature at a normal pace which may actually lead to the development of abnormal personalities. This can take the form of dependence, childishness and the inability to take care of oneself without being instructed. It is based on this that in the case of the early sexualization of children this paper agrees with the assessment that it is up to the parents to properly guide children regarding aspects related to sexuality and sexualization and that it cannot really be stated that it is ever too early to start the building blocks of developing a more well rounded set of behavioral traits within a child and as such this paper suggests that while children are being sexualized at an early age as compared to their counterparts from 30 years ago this may not necessarily be an adverse situation based on the data that has been presented in this study.. Works Cited Albiniak, Paige. â€Å"Ad Market Shows Signs Of Recovery.† Daily Variety 310.50 (2011): A1.Print â€Å"APA: Analysis Of Published Research Shows Sexualized Images Harmful To Girls, Women.† Media Report To Women 35.2 (2007): 1. Print Bartlett, Myke. â€Å"Sex Sells: Child Sexualization And The Media.† Screen Education 51 (2008): 106-11. Print Bill, O’Reilly. â€Å"Unresolved Problem: The Sexualization Of American Children.† O’reilly  Factor (FOX News) (n.d.). Web Combe, Rachael. â€Å"Little Girls Gone Wild.† Redbook 216.2 (2011): 104. Print Danielle Egan, R., and Gail Hawkes. â€Å"Girls, Sexuality And The Strange Carnalities Of Advertisements: Deconstructing The Discourse Of Corpoarte Paedophilia.†Ã‚  Australian Feminist Studies 23.57 (2008): 307-322. Print Fox, Roy F. â€Å"Manipulated Kids: Teens Tell How Ads Influence Them.† Educational  Leadership 53. 1 (1995): 77. Print Gill, Rosalind. â€Å"Beyond The ‘Sexualization Of Culture’ Thesis: An Intersectional Analysis Of ‘Sixpacks’, ‘Midriffs’ And ‘Hot Lesbians’ In Advertising.† Sexualities 12.2 (2009): 137-160. Print Goodin, SamanthaDenburg, AlyssaMurnen, SarahSmolak, Linda. â€Å"‘Putting On’ Sexiness: A Content Analysis Of The Presence Of Sexualizing Characteristics In Girls’ Clothing.† Sex Roles 65.1/2 (2011): 1. Print Harris, DAN. â€Å"Little Cover Girls.† Nightline (ABC) (2011): 1. Print Hatch, Linda. â€Å"The American Psychological Association Task Force On The Sexualization Of Girls: A Review, Update And Commentary.† Sexual Addiction   Compulsivity 18.4 (2011): 195-211. Print â€Å"Helping Kids To Stop Celebrating Consumption.† Natural Life 86 (2002): 11. â€Å"Helping Kids Manage Their Media.† Natural Life 136 (2010): 37. Print International Business, Times. â€Å"‘Ashley’ Push-Up Triangle: Not the First Case of Over-Sexualization of Children.† International Business Times 12.Web Kopkowski, Cynthia. â€Å"Lolita In The Classroom.† NEA Today 26.6 (2008): 36-37. Print â€Å"Let’s stop teaching preschoolers to be sexy.† Glamour May 2007: 220.Web Merskin, Debra. â€Å"Reviving Lolita? A Media Literacy Examination Of Sexual Portrayals Of Girls In Fashion Advertising.† American Behavioral Scientist 48.1 (2004): 119-129. Print Nairn, Agnes. â€Å"Consumer Kids – The Influence Of The Commercial World On Our Children.† Education Review 22.1 (2009): 54-60. Print Odone, Cristina. â€Å"Sexy Kids.† New Statesman 131.4596 (2002): 18.Web Parsons, Russell. â€Å"NSPCC Adds Its Weight To ‘Sexualisation Of Kids’ Debate.†Ã‚  Marketing Week (01419285) 33.10 (2010): 5.Web Reynolds, Mike. â€Å"Nick Sees Kids’ Ad Sector Poised To Grow.† Multichannel News 3 2.11 (2011): 9.Web Schwed, Mark. â€Å"TV Commercials Your Kids.† TV Guide 43.7 (1995): 19.Web Young, Lesley. â€Å"A Hard Lesson.† Marketing Magazine 113.11 (2008): 10. Print This research paper on Sexualization of Children was written and submitted by user Lance V. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Word Choice Bought vs. Brought - Proofeds Writing Tips Blog

Word Choice Bought vs. Brought Word Choice: Bought vs. Brought The words â€Å"buy† and â€Å"bring† are easy to tell apart. The past tense versions of these words, however, are very similar, which can lead to confusion. That is partly because these are irregular verbs, so we can’t add an â€Å"-ed† and say â€Å"buyed† and â€Å"bringed† (even if that would be simpler). In this post, then, we’re looking at the words â€Å"bought† and â€Å"brought.† Bought (Past Tense of â€Å"Buy†) â€Å"Bought† is the simple past tense and past participle of â€Å"buy.† We use it when someone has exchanged money for something. For example: I went to the store and bought cookies. Here, for example, the speaker is describing having purchased baked goods. This is the main use of â€Å"bought,† but it is also used for other senses of â€Å"buy.† These include believing something (e.g., â€Å"I can’t believe she bought his lie†) or bribing someone (e.g., â€Å"they bought the police chief’s silence with an envelope of money†). These are less formal uses of the word, though. Brought (Past Tense of â€Å"Bring†) We use â€Å"brought† when someone or something has been taken somewhere. For instance: I brought my sister to the party with me. Another common use of this term is to mean â€Å"made to happen,† such as in: After the party ended in disaster, we brought legal action against the host. In all cases, â€Å"brought† is the simple past tense or past participle of â€Å"bring.† Bought or Brought? These words are easy to mix up if you’re not careful. This could be problematic, since only one implies spending money. One tip is to get your work proofread, which will help you avoid typos. But if you’re ever unsure which term to use, keep in mind that both â€Å"bring† and â€Å"brought† start with â€Å"br,† whereas neither â€Å"buy† nor â€Å"bought† contain an â€Å"r.† Remember: Bought = Simple past tense of buy† Brought = Simple past tense of bring†

12 Signs and Symbols You Should Know

12 Signs and Symbols You Should Know 12 Signs and Symbols You Should Know 12 Signs and Symbols You Should Know By Mark Nichol What is the origin of various symbols used in English, and when is the use of each appropriate? Here’s a guide to twelve common signs, including how they developed and in which contexts they are used or avoided. 1. (Ampersand) The ampersand was, at least until well into the nineteenth century, treated as the twenty-seventh letter of the alphabet, but its star has fallen, so that now it is used only informally except in registered names of businesses (â€Å"Ay, Bee See Inc.†), which should be written as rendered; a comma preceding it is extraneous. The symbol comes from the cursive formation of the Latin word et (â€Å"and†), and the name is a slurring contraction of â€Å"and per se and,† which used to terminate schoolroom recitals of the alphabet: The phrase means â€Å"and by itself and†; instead of reciting, â€Å". . . W, X, Y, Z, and,† children said, â€Å". . . W, X, Y, Z, and per se and† to clarify that â€Å"and† referred to a list item rather than serving as a conjunction for an item that was left unuttered. The symbol is also seen in c. (â€Å"et cetera†), an alternate form of etc. American Psychological Association (APA) style allows the ampersand to link author names in an in-text citation (â€Å"Laurel Hardy, 1921†), but other style guides call for using the word and. 2. * (Asterisk) The asterisk is used to call out a footnote or to refer to an annotation of special terms or conditions, to substitute for letters in profanity (â€Å"Oh, s***!†) or a name rendered anonymous (â€Å"the subject, M***†), to serve as a low-tech alternative to a typographical bullet, or provide emphasis in place of boldface (â€Å"Do *not* go there the food is awful.†). It also has many specialized technical usages. Its name is derived from the Greek term asteriskos, meaning â€Å"little star,† and it was originally applied to distinguish date of birth from other references to years. 3. @ (At Sign) Until the age of e-mail, the at sign was restricted mostly to commercial use, in purchase orders and the like, to mean â€Å"at the rate of† (â€Å"Order 1K widgets @ $2.50 per.†). It’s also used in displays of schedules for competitive sports to identify the event venue. Now it’s ubiquitous in email addresses and in social-networking usage, as well as computer protocols, but outside of those contexts, it is considered inappropriate for all but the most informal writing. 4.  ¢ (Cent) This symbol for cent (from the Latin word centum, meaning â€Å"hundred†), unlike its cousin the dollar sign it’s also used in many monetary systems other than that of US currency is rare except in informal usage or for price tags. When it does appear, unlike the dollar sign, it follows rather than precedes the numeral, though as in the case of the dollar sign, no space intervenes. The equivalent usage in a context where dollar signs are employed is to treat the amount as a decimal portion of a dollar (â€Å"$0.99†); for clarity, a zero should always be inserted between the dollar sign and the decimal point. The sign probably originated to distinguish an ordinary c from one denoting a monetary amount. 5.  ° (Degree Sign) The sign for degrees of arc or degrees of temperature, which started out as a superscripted zero, was chosen for consistency with use of the minute (†²) and second marks (†³) employed in geometry and geography; those symbols originally stood for the Latin numerals I and II. The degree sign appears in technical contexts, but in general-interest publications, the word degree is generally used. In references to temperature, the symbol (and the designation of the temperature scale) immediately follows the associated numerical figure (â€Å"45 °C†). This style is true of many publishing companies, though the US Government and the International Bureau of Weights and Measures prescribe a space between the number and the symbol (â€Å"45  °C†), while other publications omit the first letter space but insert another between the symbol and the abbreviation (â€Å"45 ° C†). 6. (Ditto Sign) The ditto sign, first attested three thousand years ago, signals that text shown above is to be repeated, as in a list in which the same quantity of various materials is intended to be expressed: apples 24 bananas oranges The word ditto, meaning â€Å"said,† derives from the Tuscan language, the immediate ancestor of Italian, but was borrowed into English hundreds of years ago. The word, its abbreviation (do.), and the symbol are considered inappropriate for most writing, though the term has often been used in informal spoken and written language to mean â€Å"(the same as) what he/she said.† Although the symbol has a distinct character code for online writing, straight or curly close quotation marks are usually employed to produce it. 7. $ (Dollar Sign) This symbol for the American dollar and many other currencies was first used to refer to the peso, which inspired the American currency system. Various origin stories for the symbol come in and out of fashion, but it’s most likely that it developed from an abbreviation of pesos in which the initial p preceded a superscript s; the tail of the initial was often superimposed on the s. A dollar sign with two vertical lines is a less common variant. Most books and other formal publications tend to spell out dollars in association with a (spelled-out or numerical) figure, but periodicals usually use the symbol, as do specialized books about finance or business or others with frequent references to money. In international publications, when the symbol is used, for clarity, it is combined with the abbreviation US (â€Å"US$1.5 million† or â€Å"US $1.5 million†). The dollar sign is also used as an abbreviated reference to various functions in computer programming and similar contexts. 8. # (Number or Pound Sign, or Hash) This symbol evolved from the abbreviation for pound, lb. (a literal abbreviation for the Roman word libra, meaning â€Å"balance†), in which horizontal lines were superimposed on the vertical lines of the letters, producing something like the tic-tac-toe pattern used today. One of many other names for the sign, octotherp (also spelled octothorp or otherwise), was a jocular coinage by telecommunications engineers in the mid-twentieth century. The symbol is seldom used outside informal or highly technical or otherwise specialized contexts. 9. % (Percent) The sign for indicating percentage developed in the Middle Ages over the course of hundreds of years, beginning as an abbreviation of percent (from the Latin phrase per centum, meaning â€Å"out of a hundred†). Its use is recommended only in technical contexts or in tabular material, where space it at a premium. (Some standards authorities call for a space between a number and this symbol, but most publications and publishers omit the space.) 10. ~ (Tilde) The tilde is used as a diacritical mark over various letters to indicate a variety of sounds in different languages, but it also appears midline, like a dash (and is sometimes called a swung dash), to denote â€Å"approximately (â€Å"Last night’s attendance: ~100†). It has technical connotations as well and is even used as a notation for recording sequences of action in juggling. The name, borrowed into English through Portuguese and Spanish from Latin, means â€Å"title.† 11. / (Slash, Solidus, Stroke, or Virgule) During the Middle Ages, this sign of many names, including those listed above, served as a comma; a pair denoted a dash. The double slash was eventually tipped horizontally to become an equal sign and later a dash or hyphen. (The equal sign is still used as a proofreader’s mark to indicate insertion of a hyphen.) The slash also called the forward slash to distinguish it from the backslash, which is used only in technical contexts is an informal substitute for or. 12. _ (Underscore or Understrike) This artifact from the era of the typewriter was used on such devices to underline words to indicate emphasis in lieu of italics. As a survival of that function, words are sometimes bracketed by a pair of single underscores in email and other computer contexts to mark a word for emphasis (â€Å"That band totally _rocked_ the place.†). Indeed, as I typed this post in Microsoft Word, the program automatically converted rocked to italics. The symbol also appears frequently in email and website addresses and other technical contexts. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Punctuation category, check our popular posts, or choose a related post below:Math or Maths?41 Words That Are Better Than Good55 "House" Idioms

Enviroment Assignment Example | Topics and Well Written Essays - 750 words

Enviroment - Assignment Example With that, there are a number of air pollution challenges that need to be taken into concern by all governments in the world so as to eliminate the chances of air pollution becoming tragic to life. First is the emission of smog and smoke from industries. Ozone smog is lethal when subjected to higher temperatures since it can cause severe health issues to humans. Some of the health issues include: severe asthma for individuals who already have the respiratory challenge, lung burn problems, eye irritations and throat damage. Smog has other adverse effects such as acidic rain due to the fact that it contains sulphur compounds. Acidic rain can be very dangerous to the existing water supplies. For example: If acidic rain would pour on earth; that means that the water we drink shall have higher quantities of sulphur- This is very dangerous to public health. In addition to that, acidic rain will cause damage to plant cover as well as organisms in the soil. In this case, human beings as well as animal life will be affected when they consume plant cover that has higher components of sulphur. Another effect of acidic rain is that it speeds up the decay process of objects that is comes into contact with. With those examples, it can be vividly stated that, smog and smoke air pollutions are very dangerous and both can cause a massive challenges to the existing human life, animal life and the earth. A second form of air pollution is through Green House Gases (GHG) such as: Carbon dioxide, Methane, Nitrous Oxide and Fluorinated gases. Carbon dioxide is as a result of burning fossil fuels, the use of petroleum and natural gas. Methane originates from coal burning. Nitrous Dioxide originates from the use of fertilizers that have higher contents of nitrogen and other waste products. According to a 2011 report released by the U.S Greenhouse Emissions, it was revealed that the total emissions of carbon dioxide were 84%, Methane was 9%, Nitrous Oxide was 5% and Fluorinated gases we re 2%. In addition to that, the report revealed that electricity was the highest contributor of GHG emissions by a total of 33%; the transportation sector had a total of 28%, industries had 20%; commercial and residential sector had 11%; agricultural sector had 8% (EPA, â€Å"Overview of Green House Gases†). This report clearly indicated that GHG are still a challenge due to the reason that they are still emitted from the different sources. However, according to a comparison of GHG emissions from 2010 to 2012 it is clear that GHG emissions are slowly decreasing (EPA, â€Å"Trends in Greenhouse Gas Emissions†). The most intensifying risk about GHG is that they take hundreds or even thousands of years to be completely depleted from the atmosphere. With that, they are prone to affect human life in the long term. The challenge brought about by these gases is that they prevent the release of heat from the earth into the atmosphere – ozone layer. As a result, this cau ses the earth to retain too much heat thereby leading to the global warming effect. The global warming effect causes a change in global climate. That is; it causes warmer temperatures to be experienced in different parts of the world. As a result, these higher temperatures lead to water evaporation from the existing water supplies. In areas where the global warmin

How music benefits the lives, both intellectually and socially, of Research Paper

How music benefits the lives, both intellectually and socially, of mentally retarded people - Research Paper Example Music is a medium that can meet people’ s needs for achievement, belonging, significance freedom and fun, since it allows expression of self and is a means of finding meaningful and enjoyable communication with others. The power of music has been recognized for a long time as a means of promoting health and well-being; therefore, music therapy to mentally retarded people is a means of harnessing the power of music for effective and positive change to individuals. Music actively engages people in their development and behavioural change; hence, for mentally retarded people music permits them to transmit musical and non-musical skills to other facets of life, which brings them from isolation into active participation in the world. The act of making music to mentally retarded people and reacting to musical stimuli makes these individuals able to experience immediate psychological and physiological awareness in various levels. The concrete reality of being able to sense auditorial y, tactfully, visually and emotionally brings these persons into the present, which brings immediate results. From mental retardation, these individuals experience the world around them on a subliminal or unconscious level; nevertheless, through music mentally retarded people can experience life at the conscious level, which opens lines of communication because it awakens, heighten and expand their awareness. Music has many positive changes on different levels to mentally retarded people since it has the unique properties of facilitating creative expression within individuals who have nonverbal or face difficulties in communication skills. Moreover, music provides an opportunity for experiences that open the way leading to motivation in learning in all domains of functioning; as well, music creates opportunities for positive and pleasurable social experiences, which are unavailable to mentally retarded people. In addition, music develops understanding of self, others and the surroun ding which improves the working of mentally retarded people at all levels and improves their well-being as well as fostering their independent living (Barksdale, 2003). There are various fundamental reasons to the effectiveness of using music as a curative agent, which include music being a cross-cultural mode of expression with its nonverbal nature making it a universal means of communication. Music sound stimulus is unique in its power of penetrating the mind and the body regardless of an individual’s level of intelligence or condition; therefore, music stimulates senses, evokes feelings and emotions, elicits both mental and physiological responses and energizes the mind and body. Music’s intrinsic structure and qualities has the potential for self-organization in mentally retarded individuals since it influences musical and non-musical behaviour hence it facilitates learning and acquisition of skills. Music is an extremely efficient and aesthetic modality which appl ies to all people including mentally retarded people owing to its interdisciplinary nature. Music improves motor skill, cognitive skills, affective states and adjustment as well as social skills; hence, music’s interdisciplinary aspects supplement and reinforce therapies for mentally retarded individuals (Barksdale, 2003). Music has been successful as a therapeutic intervention for individuals with mental and physical disorders; hence, music has always been recommended combined with treatment policy in order to supplement medical treatment. Music therapy theory suggest music engages the mind, bringing awareness of self and others leading to positive change and as choice theory suggest, thoughts and feelings change in accordance with actions that satisfy the individuals involved, which music invokes (Barksdale, 2003). Musial activities are useful for motion, also motivate conscious reaction, and complete the power of sensory motivation; however, music

The uses of propaganda posters in World War Essay Example for Free

The uses of propaganda posters in World War Essay On the poster you see a man and his two children. A girl is sitting on his lap with an open book, and a boy is sitting on the floor playing with soldiers. The daughter looks at him asking â€Å"Daddy, what did YOU do in the Great War? †. They designed the poster to induce a sense of patriotic guilt. They were trying to capture the British men unwilling to volunteer for the war and make them feel guilty if they didn’t join. The picture depicts a situation in the future, after the war, where the daughter asks her dad expectantly how he contributed to the war. The war on the poster is already over, the dad cant re-do it. This sends a message to the young boys, unwilling to go to war. Making them think what they would tell their children if they asked what he had done for the war. It also shows that he will come home to his family. The family in the poster are smartly dressed and look wealthy. The colours in the poster symbolise the war and army, the curtains have red roses on them and the chair has the sign of the royal coat of arms on it. This would also make the man think because these are marks of patriotism but this man has not done the patriotic thing. Everything in the poster is positive; nothing would put men off from joining the war even the boy’s toy soldiers are all standing up. â€Å"At the front† This poster would stand out to men because it is showing cavalry in battle, with horses reacting to an explosion in the foreground. This poster is trying to make boys interested in joining war to fight for their country. At the front† stands out to all readers, this would seem exciting to boys because they would be fighting at the front with their horses making them brave as the poster states. It also says â€Å"every fit briton should join† this implies that the men that fight in the war are healthy, strong and brave. It also sends out a challenge that is unspoken â€Å"ARE YOU†. This poster is very manly. The colours in this poster ties in to army colours, brown and green. This poster stands out because of the explosion. Most young boys would want be at the front with their horses working as part of a team, it is clear  these men work as comrades together to fulfill their task of bringing up the guns. Both of the posters’ primary purpose is to make men to join the army. During the World War 1, there were many of propaganda posters to persuade men in their country to enlist in the army. In addition, these two posters were one of propaganda poster to convince men to join the army with some of biased truth. Even though two of posters made same primary purpose, each of them has illustrated different intend and feeling. The poster, â€Å"Daddy, what did you do in the Great War† arouses guilt with sarcasm to those men who did not yet join the army so that it leads to men to join the army. Nonetheless, the poster, At the front! † imbue the courage and morale of the men that fight in the war. Personally I think the poster that poster â€Å"Daddy what did you do for the great war? † stands out because it is making you feel guilty with the children although the poster â€Å"At the front† would stand out more to men because it is very manly.

Response to Reading Rohinton Mistrys A Fine Balance Essay -- A Fine B

Response to Reading Rohinton Mistry's A Fine Balance I chose to read Rohinton Mistry’s A Fine Balance, a story about four very different people living in India during a period of great civil unrest known as The State of Emergency. I found this book incredibly easy to get into because of the way Mistry writes. He seems to create the story around you, placing you in the setting as a viewer, involving you in the lives of the characters. Mistry clearly outlines the political and economic situation of India at the time, further emphasizing the plight of the main characters. The first thing I noticed about Mistry’s writing style is his incredible ability to make you feel like you’ve actually shifted to another country, another continent even. His descriptive ability allowed me to imagine so many little details in the book, the smell of the street, the loud, boisterous vendors screaming their slogans as pedestrians walk by. You really get to feel as if you are witnessing the events as they unfold. The first part of the book explained the story but then it promptly switched to brief histories of each of the main characters before introducing them to the main plot. Mistry gives you the diverse backgrounds of all the main characters, using his beautifully descriptive language to make even simple things brilliant. The story takes place in an â€Å"unnamed City by the Sea† somewhere in India, exploring the lives of four very different people. Mistry creates characters that come from a very different world than I’m used to, maki ng the story all the more interesting for me. Mistry included many cultural references in the story that I looked up so that I knew a little more about the basis of the story. Before I had read this novel I had no knowledge of the State of Emergency (having been born after it took place) so I found reading about it from the perspective of a person experiencing it, very informative. This first section of the novel displays the interaction of the characters quite differently form the interaction they eventually have. All the characters are stiff and formal with each other. It is not until the next section of the book that they start to warm up to each other. Reading Response Journal #2 The beginning of this section marks a change in the book as all the main characters are now living under one roof and their attitude... ...of writing impressive and elegant without being over the top. He takes you on a roller coaster of emotions throughout the novel, leading you from happiness to depression in the blink of an eye. This book taught me something I had already vaguely known, that the world can be a very cruel place. The problem was I had never truly imagined it this cruel and abusive. It broke my heart and completely re-enforced my plans as to what I’m doing after I finish university. I plan on working for th UN in underdeveloped countries, focussing on social interactions and medical services. The way Mistry wrote this book affected me deeply. I think the theme of this book was about the power of human perseverance and the ability of the downtrodden to always look for ward to the next day with optimism. The four characters in this novel face tremendous ordeals and yet they still manage to maintain a small amount of control over their lives. Mistry writes in such a way that you can see their vul nerability, but you can also see how mentally and physically strong they are. They find comfort in the small things we take for granted, and as such they truly show their faith in a society that is failing them.

Pressure Ulcers

Feature Strategies to improve the prevention of pressure ulcers Judy Elliott describes a project that sought to improve tissue viability during the patient journey from admission to discharge Summary This article outlines the actions taken by one acute trust to implement evidence-based, best practice recommendations for pressure ulcer prevention. Initially, an exploratory study identified specific areas for practice development, particularly improving early risk assessment, intervention and focus on heel ulcers.Further actions included recruiting tissue viability support workers to promote a pressure ulcer campaign. Prevalence audit results demonstrated improved prevention and reduced prevalence of hospital-acquired pressure ulcers by 6 per cent and heel ulcers by 4. 9 per cent. Further work is required to ensure prevention strategies are consistent and documented. Keywords Best practice, evidence base, pressure ulcer prevention ( Institute for Innovation and Improvement 2009), there fore it is important to seek further initiatives to eliminate avoidable pressure ulcers from NHS care.Tissue damage A pressure ulcer is defined as (European Pressure Ulcer Advisory Panel (EPUAP) and National Pressure Ulcer Advisory Panel (NPUAP) 2009): ‘†¦ localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. ‘ Healthy individuals are continuously moving and readjusting their body posture to prevent excess pressure and shear forces. Reduced mobility or sensation interrupts this natural response, rendering an individual vulnerable to tissue damage.Eurther susceptibility is influenced by an individual's intrinsic risk factors reflected by their tissue tolerance (Bonomini 2003). Individual risk factors include immobility, malnourishment, cognitive impairment, acute and chronic ulness (National Institute for Health and CUnicad Excellence (NICE) 2005). Pressure ulcer preventio n involves the modification of an individual's risk factors by the whole multidiscipUnciry team (Gould et al 2000). Risk assessment Identification of vulnerable individuals can be challenging.Designated risk assessment tools have been found to lack reliability and validity with a tendency to overestimate risk (Pancorbo-Hidalgo et al 2006). The NICE (2005) guideline emphasises the importance of early assessment, within sbc hours, using clinical judgement. Vanderwee et al (2007a) found skin inspection more reliable compared with an assessment tool, with 50 per cent fewer patients identified as requiring intervention cuid no significant difference in patient outcomes. The skin should be assessed for early signs of tissue damage, which November 2010 | Volume 22 | Number 9PRESSURE ULCERS have potentially devastating consequences for patients, hospitals and the overaU hecdth economy. An estimated 5 to 10 per cent of patients admitted to hospital develop pressure ulcers, resulting in incre ased suffering, morbidity and mortaUty (Clark 2002, Redelings et al 2005) and depleting NHS budgets by 4 per cent, or more than ? 2 billion ? mnually (Bennett et al 2004). Prevention is a complex, multifactorial process and although it is accepted that some pressure ulcers are unavoidable, most are considered preventable.Acknowledging the difficulty in establishing national comparative prevalence data because of variances in methodology and settings (Calianno 2007), a prevalence of 21. 9 per cent of patients affected was reported in a pilot study of UK acute hospitals in 2001 (Clark et al 2004). Pressure ulcer prevention is a nursing quality indicator and high impact action for nursing and midwifery (NHS NURSING OLDER PEOPLE Feature Figure 1 I Illustrations showing a correctly fitting chair to ensure sufficient I pressure redistribution and poor sitting posture 1.The patient should be seated with hips and knees at right angles, feet flat on the floor and arms/shoulders supported. Th e patient's weight is evenly displaced through the feet, thighs and sacrum. 2. The chair is too low; the patient's upper legs are not supported, and weight is increased onto the buttocks leading to greater risk of pressure damage. include observable discolouration and palpable tissue changes such as localised bogginess, heat or cold (NICE 2005). International guidelines (EPUAP/NPUAP 2009) advise a structured approach to risk assessment using a combination of all three techniques.Ecirly intervention Once risk is identified immediate action is imperative to minimise risk of pressure ulcer development. As evidence is weak for specific interventions a number of areas should be addressed, involving ecirly initiation of preventive action, improving tissue tolerance and protecting from the adverse effects of pressure, friction and shear (Calianno 2007). Nutrition and tissue loading are two areas of nursing influence. Strategies to ensure optimal nutrition should be used and the provision o f oral nutritioneil supplements has been associated with reduced tissue breakdown (Bourdel-Marchasson et al 2000).Tissue loading may be addressed by manual and mechcinical repositioning, mobuisation and exercise. Strategies to minimise shear forces include addressing posture, moving and handling techniques and use of electric profiling beds (Keogh and Dealey 2001). Positioning and repositioning Research has not established an optimeil frequency of patient repositioning (Defloor et al 2005). Repositioning should be undertaken on an individual basis in Une with ongoing skin evaluation, avoiding bony prominences (NICE 2005).The skin shoiUd be closely monitored to ensure effectiveness of the regimen and further actions taken if ciny signs of tissue damage occur. November 2010 Volume 22 Number 9 A flatter position distributes body weight more evenly. Semi-Fowler (semi-recumbent) and prone positions yield the lowest interface pressures with sitting cind 90-degree side-lying the highest (S ewchuk et al 2006). Repositioning using the 30-degree tuted side-lying position (alternately right side, back, left side) or prone position is advised (EPUAP/NPUAP 2009).The repositioning regimen should be agreed with the patient and will require adaptation to ensure concordance with comfort, symptoms and medical condition. Prolonged chair sitting is impUcated with greater risk of pressure ulcer development (Gebhardt and BUss 1994). Chair sitting should be Umited to less than two hours at ciny one time for the acutely ul at-risk individual (Clark 2009). A correctly fitting chair is important to ensure sufflcient pressure redistribution (Figure 1).Poor sitting posture may cause posterior pelvic tilt (sacral sitting) or pelvic obUquity (side tUting onto one buttock), with the ideal chair allowing feet to sit flat on the floor, with hips and knees at 90 degrees and arm/shoulders supported (Beldon 2007). Support surfaces High specification foam mattresses have demonstrated improved perf ormance in pressure ulcer prevention (Defloor et al 2005), leading assessme Low risk †¢ Use static foam mattress. †¢ Reassess if patient's condition changes. Medium risk †¢ Use static foam mattress. †¢ Implement repositioning regimen. Check skin at least daily. †¢ If any signs of pressure damage request dynamic (air) mattress. †¢ Reassess if patient's condition changes. High risk (contraindicated if patient weighs more than 39 stone (refer to guidelines), has a spinal injury (refer to trauma and orthopaedics) or unstable fracture). †¢ Use dynamic (air) mattress. †¢ Implement repositioning regimen. †¢ Check skin at least daily. †¢ If any further signs of pressure damage increase repositioning programme. †¢ Reassess and step down onto static mattress as patient's condition improves.Remember to apply heel protector boots for patients at risk or with heel pressure ulcers. NURSING OLDER PEOPLE Feature to replacement of standard mattr esses by most hospital trusts. There has also been considerable investment in mechanical (dynamic) support surfaces, where air is pumped through the mattress via alternating pressure or low air loss. However, the benefits of these devices remain unclear in terms of clinlccd and cost effectiveness (Reddy et al 2006). Pressure ulcer incidence rates of 5 to 11 per cent have been reported in studies, with longer use associated with greater risk (Theaker et al 2005).These devices should be considered m conjunction with other support surfaces as delayed or inconsistent use may negate the benefits. Multiple strategies A number of studies have attained favourable outcomes using multiple interventions. Examples include introducing a multidisciplinary working party, improving management of pressure-relieving equipment, educational programmes and developing new guidelines (Gould et al 2000, Catania et al 2007, Dobbs et al 2007). Variations in approach suggest the commitment of practitioners is vital to success. For example, a support surface . howed improved outcomes only when used In conjunction with an educational programme for registered nurses (RNs) (Sewchuk et al 2006). Factors identified as impeding pressure ulcer prevention include lack of time, staffing levels and staff knowledge (Moore and Price 2004, Pancorbo-Hidalgo et al 2006, Robinson and Mercer 2007). Skill mix may also influence outcomes. Horn et al (2005) investigated staffing levels in a nursing home and found fewer pressure ulcers were associated with more direct RN care for each resident. heels' protocolj Apply heel protector boots to patients at high risk of heel ulcers when on bed rest.Assessment criteria include limited mobility and: †¢ †¢ †¢ †¢ I Is patient immobile, heavily sedated or unconscious? Can patient lift his or her leg up in bed? Is there any evidence of heel tissue breakdown, blistering or ulceration? Does the patient have diabetes, vascular or renal disease? experie nces highlighted the challenges in delivering timely, optimal preventive care. Opportunities to improve preventive care during the patient journey from admission to discharge were identified. These processes were influenced by the level of communication and collaborative care.Practice development recommendations included: †¢ Improve early risk assessment and intervention. †¢ Direct resources to the start of the patient journey. †¢ Prevent heel ulcers. Further actions were taken during 2009/10 to develop practice in line with these recommendations. Method Tissue viabUity support workers were recruited for each hospital site to focus on pressure ulcer prevention, in particular managing pressure-relieving equipment. They reclaimed dynamic mattresses and recurected them to admitting areas to enable immediate access ‘at the front door'.They were entrusted with keeping a ‘float' of mattresses in a clean library store and helping with maintenance, decontamination eind training. In September 2009 a trust-wide pressure ulcer campaign was launched. This focused on three Interventions: support surface, positioning and repositioning and heel offloading: 1. Risk assessment within six hours and appropriate support surface (Box 1). A simple flow chart was disseminated highlighting a structured patient pathway, based on NICF (2005) best practice recommendations.Initial risk assessment was encouraged using clinical judgement to help early assessment in the emergency admitting areas. A more detailed assessment was requested during the following 24 hours using the Waterlow assessment tool (Waterlow 1988) to provide risk status confirmation and identify individual risk factors. Patients were assessed as low risk (fuUy mobile and minimal risk factors/Waterlow score 20). All trust static mattresses consist of high specification foam offering protection to all admitted patients. The trust has purchased November 2010 Volume 22 BackgroundAn exploratory study of pressure ulcer prevention was undertaken in the project hospital trust during 2007/08. The trust includes three acute sites covering a large geographical area consisting of more than 1,200 beds and serving a predominantly ageing population. A case study meth(3dology was used to consider the topic from a range of perspectives using quantitative zind qualitative data (Yin 2003). A reduction in overall and hospital-acquired pressure ulcer prevcdence since 2001 was found. Steady reduction in sacral ulcers was observed with the heel emerging as the most common site for hospital-acquired pressure ulcers by 2008.Increased prevalence observed in 2009 reflected revised data collection methods and improved reuabuity with thorough skin inspection. Data were also generated from focus group interviews with multidisciplinary clinicians. Their NURSING OLDER PEOPLE Feature more than 350 dyncimic mattresses and local recommendations prioritise patients at high risk, unless contraindicated. 2. Im plementation of revised positioning cind repositioning documentation. Revised documentation included a visual care plan/ regimen, repositioning chart and skin evaluation for all vulnerable patients. 3. F*revention of heel ulcers.The ‘hecilthy heels' project ran concurrent to the Ccimpaign cind was undertaken from October 2009 to March 2010. Funding was procured for regular provision of heel protector boots that ‘float the heel' and offload pressure to augment the repositioning and positioning programme. A protocol was disseminated aiming to protect patients with high risk factors such as diabetes or early signs of tissue damage located at the heel (Box 2). The annual prevalence audit methodology was revised to improve reliabUity of data collection cind undertciken in Februcuy 2009 and repeated in February 2010.Data was collected by tissue viabibty nurses at the bedside including skin inspection eind related preventive interventions. Previously, ward nurses supplied the d ate using vcirious collection methods. Data analysis was undertaken by the trust's clinical audit team. ulcers as some patients hav e more than one pressure ulcer. Audit results from Februciry 2010 showed a reduction in hospital-acquired pressure ulcer prevcilence by 6 per cent and a reduction in total pressure ulcer prevalence by 4. 7 per cent (Table 1). Prevalence of patients with pressure ulcers had reduced from the previous audit by 2. per cent to 13. 4 per cent (Table 1). More than half of the total inpatient population was assessed as vulnerable to pressure dcimage. This information enables comparison with similar populations and indicates a 2 per cent increase in the population at risk from the previous year. There was also a reduction in all grades/ categories of hospiteil-acquired pressure ulcers (Table 2). The grade (category) of ulcer is used to assess depth of tissue damage, with grades 1 to 2 affecting the top skin layers and grades 3 to 4 including the deeper underlyin g tissues (EPUAP/ NPUAP 2009).The origin of some pressure ulcers was not fully established, mainly because of lack of documentation and appearance of the ulcer (Table 2). There were observable improving standards in best practice and patient comfort and care on the wards. Repositioning care plcinning documentation had improved by 7 per cent but ongoing documented repositioning had reduced by 1 per cent (Table 3). Further improvements are required to meet best practice standards in both cases. Although the heel remained the most common site for pressure dcimage, there was a reduction in hospital-acquired heel ulcers by 4. per cent. Results Benefits beccime apparent during the campaign with observable improvements in patient access to equipment cind eeirly intervention. The results were analysed in terms of patient prevalence (percentage of patients with one or more pressure ulcer) and pressure ulcer prevcilence (percentage of pressure ulcers). The prevalence of pressure ulcers is usu ally greater than the prevalence of patients with pressure Prevalence of pressure ulcers Discussion The tissue viability support workers were instrumental in raising awareness of prevention 009 Number Number of patients Population at risk Prevalence of patients with pressure ulcers Prevalence of pressure ulcers Pressure ulcers acquired in hospital Pressure ulcers present on admission Origin not known (unsure/not completed) Percentage Number 2010 Percentage Change Percentage 976 497 151 242 132 930 51 15. 5 24. 7 13. 5 492 125 186 53 13. 4 20. 0 7. 5 6. 8 5. 7 T2. 0 i 2. 1 J. 4. 7 J. 6. 0 i 0. 8 I2. 2 70 63 53 75 35 7. 6 3. 5 1 November 2010 Volume 22 Number 9 NURSING OLDER PEOPLE Feature in the admitting areas and improving early access to dynamic mattresses.Previously, dynamic systems were often a late intervention, once pressure damage was appeirent, cind competing demands from the wards impeded availability. A structured approach supported fairer allocation, prioritisation by pat ient need and improved availability. The support workers also improved processes by fostering good teamwork with support staff, hospital management teams and nursing departments. Their presence in the ward areas improved preventive care, related protocols and provided a link with the tissue viability nurses.Our experiences suggest that further education and communication are essential to reach a staff. The ‘healthy heels' campaign demonstrated the effectiveness of heel protectors in a prevention strategy. These devices were used for prevention and treatment to ‘float the heel', with resolution of superflcial tissue damage often achieved through continued use. This included the treatinent of superficial necrosis (black heels), which in many cases were kept dry cind allowed to slough off retaining viable deeper tissues, as recommended by EPUAP/NPUAP (2009).The audit results mirror previous reports of less than 10 per cent of hospiteil patients having documented adequate pr eventive care (Vanderwee ef al 2007b). Some nurses expressed concems over time constrEiints and extra paperwork, which may have contributed to a reluctance to adopt revised positioning and repositioning documentation. Communication and education Achievement of best practice standar Best practice standard quired pressujmJceyar^ajeiKe by grad Grade of pressure ulcer Grade 1 Grade 2 Grade 3 Grade 4 Total 2009 Number 59 54 7 12 2010 Number 35 24 6 5 70 Percentage Change Percentage Percentage 6,0 5. 3,7 2,5 0,6 0,5 i 2. 3 4-3. 0 0. 7 1. 2 i 0,1 1 0,7 132 Origin not known (unsure/not completed) Grade 1 Grade 2 Grade 3 Grade 4 16 15 2 2 1. 6 1. 5 0,2 0. 2 23 23 7 0 2,4 2. 4 0. 7 T0. 8 i 0,9 IO. 5 _ Total 35 † 1 issues were other possible factors. The trust operates a link nurse system for tissue viability education that may limit dissemination to all nursing staff. In an audit of 44 UK hospitals Phillips and Buttery (2009) also found a lack of documentary evidence of risk assessment on admission and C2ire planning, together with the need to improve immediate allocation of appropriate resources.Early risk assessment and immediate intervention may also be hcimpered by the focus on emergency care in admitting areas. Robinson and Mercer (2007) identified contextual barriers to pressure ulcer prevention in emergency departments as use of a stretcher and a lack of basic care provision for older Patients having a documented pressure ulcer risk assessment within six hours of admission. Patients with documented risk assessment at time of audit. Patients nursed on appropriate mattress.Patients with a high or medium risk of developing a pressure ulcer with documented evidence of a positioning and repositioning regimen. Patients with a high or medium risk of developing a pressure ulcer with documented evidence of repositioning. Use of heel protectors and offloading techniques (of total number heel ulcers). Ulcers with resolving/treated infection. Prevalence of patients wit h hospital-acquired heel ulcers. 75 79 88 13 T9 11 33 2 7,9 10 4. 1 36 0. 2 3,0 I3 Improved by 1. 8 i 4. 9 NURSING OLDER PEOPLE November 2010 Volume 22 adults.The improvement of resources and processes in admitting cireas is crucial to prevention. Technological advances may cdso have created a culture focused on dynamic systems as the primary intervention. Eurther difficulties may cuise in maintaining individual repositioning schedules in busy hospital Wcirds where competing demands often require a more immediate response. Hobbs (2004) demonstrated improved outcomes when regular repositioning schedules were re-established. Eurther work is required to place the emphasis on patient mobilisation and prevention and away from equipment and treatment.Education and leadership are peiramount to generate this culture shift and rebalance these nursing priorities. Conclusion A comprehensive review of previous and current prevention activity was invaluable in identifying appropriate areas for i mproved intervention. The recruitment of tissue viability support staff assisted with early risk assessment and intervention, particularly in terms of pressure-relieving equipment. A pressure ulcer campaign was useful in raising awareness of three interventions: early risk assessment and intervention, positioning cind repositioning regimens eind ‘healthy heels' project.Audit results from Eebruary 2010 showed a reduction in hospital-acquired pressure ulcer prevalence by 6 per cent and a reduction in total pressure ulcer prevalence by 4. 7 per cent. Heel offloading using heel protector boots was an effective strategy for prevention and treatment of heel pressure ulcers. Although the heel remained the most common site for hospital-acquired pressure ulcers, there was a reduction in prevcilence by 4. 9 per cent. Improvements are indicated in the provision of documentary evidence to support prevention, particularly in terms of risk assessment, positioning and repositioning programme s.This project has demonstrated that responding to organisational specific factors can produce encouraging results in pressure ulcer prevention and identify' areas for continued effort. Dedicated leadership, education, teamwork and commitment are fundamental to continue to improve standards and ensure best possible patient outcomes. Online archive For related information, visit our online archive of more than 6,000 articles and search using the keywords Find out more Copies of the positioning and repositioning regimen can be obtained by emailing the author at: Judy. [email  protected] nhs. ukThis article has been subject to double-blind review and checked using antiplaglarism software. For author guidelines visit the Nursing Older People home page at www. nursingolderpeople. co. uk Judy Elliott is lead tissue viability nurse. East Kent Hospitals NHS University Foundation Trust, Canterbury References Bcldon P (2007) Silting safely to prevent pressure damage. Wound Essentials. 2, 10 2-104. Bennett G, Dealey C, Posnetl J (2004) The cost oi pressure ulcers in the UK. A^e and Ageing. 33, 3, 230-235. Bonomini J (2003) Effective interventions for pressure ulcer prevention. 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November 2010 Volume 22 I Number 9 NURSING OLDER PEOPLE Copyright of Nursing Older People is the property of RCN Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.